By Neil Versel

Hard to believe, but 52 percent of specialists and 50 percent of primary-care physicians claim to be using EMRs, up from 42 percent and 38 percent, respectively, two years earlier, a new survey indicates. The survey does not specify what EMR usage means.

“While use of this technology will soon be mandated, these ‘early adopter’ levels suggest a desire for digital convenience at a time when patient record keeping promises to become exponentially more complex,” reports New York-based survey firm Knowledge Networks. The company conducted the study of nearly 11,000 healthcare professionals through the Physicians Consulting Network, which maintains a research panel of physicians and other caregivers.

(We quibble with whether 50 percent is “early adopter” level–or even accurate–and that technology will “soon be mandated.” CMS will penalize those that haven’t gotten to “meaningful use” by 2015, but won’t exclude non-compliant providers. For that matter, participation in Medicare and Medicaid is voluntary.)

One possible explanation for the increased EMR use is the fact that physicians continue to be crunched for time, a situation that will only get worse as 32 million newly insured patients enter the healthcare system in coming years, thanks to the Patient Protection and Affordable Care Act. Supporting this theory is the finding in the survey that 14 percent of primary-care docs and 12 percent of specialists expect to spend less time with pharmaceutical sales representatives in the next six months. Those numbers compare with 9 percent (PCP) and 8 percent (specialists) in the 2008 survey.

Meanwhile, physicians seem to be embracing smartphones to improve their efficiency. The survey found that 62 percent of specialists and 55 percent of primary-care physicians have such devices, and that at least 17 percent of these smartphone owners are using their phones for e-detailing from pharma reps.

“Healthcare professionals are embracing new technologies that promise more control and convenience; we cannot help but see a connection between the use of smartphones for e-detailing and an anticipated drop in time spent with sales reps,” Knowledge Networks Senior VP Jim Vielee tells Healthcare IT News. “These trends seem destined to magnify as healthcare reform takes effect, creating dramatic upswings in doctors’ case loads.”

Source: http://www.fierceemr.com/story/knowledge-networks-says-half-docs-now-use-emrs/2010-07-15

By Pamela Lewis Dolan,

The technology you adopt for your practice, including electronic medical record systems and smartphones, could become subject to Food and Drug Administration scrutiny. Experts are trying to discern what that level of examination might look like, and what specific technology would be affected.

So far, there’s no clear answer.

The FDA might get involved, experts say, because some kinds of health information technology could be considered medical devices — which the FDA regulates.

Sen. Charles Grassley (R, Iowa) started the high-level discussion about the FDA’s role in health IT in the context of meaningful use of EMRs and the push to get physicians to adopt technology. He sent a letter on Feb. 24 to Health and Human Services Secretary Kathleen Sebelius asking what her agency intended to do to ensure the safety of EMRs, and the role the FDA should play in monitoring them.

The next day, an FDA director stated flatly: “Under the Federal Food, Drug and Cosmetic Act, HIT software is a medical device.”

Jeffrey Shuren, MD, director of the FDA Center for Devices and Radiological Health, made that statement as he reported that his agency had received 260 reports over the past two years of health IT-related malfunctions causing 44 injuries and six deaths. Dr. Shuren’s statement was made to the Health Information Technology Policy Committee, an advisory panel under the auspices of the HHS Office of the National Coordinator, which oversees health technology.

Steve Nitenson, RN, PhD, an adjunct professor in the information technology management division at Golden Gate University in San Francisco, said the FDA has a history of stepping up scrutiny after problems occur. Many believe that the number of deaths and complications Dr. Shuren detailed in his testimony to the advisory committee was an indication that the FDA now feels it is necessary to exercise its authority.

The discussion of FDA oversight has prompted a debate over what is considered a medical device, and what should and shouldn’t fall under FDA regulation.

Experts generally divide health-related applications into three categories — those that clearly could be considered a medical device, those that clearly are not, and those that could go either way.

Nitenson said the FDA already monitors EMR functionalities that involve contact with patients, such as interpreting lab results, for example. Most experts agree that even smartphone applications that are an extension of those systems fall under the medical device category and are thus open to FDA scrutiny.

But when it comes to other uses of technology, “It’s more like the wild, wild West,” Nitenson said. This is the area that would include a combination of systems that would transmit data from one source to another, and the various devices used to store and transmit the data, including mobile devices such as smartphones.

Michael Zeinfeld, founder and president of Complemedia, a Chicago-based company that builds targeted media channels for branding purposes, said one reason the FDA is taking another look at many of these devices is that their mobile counterparts are making applications easier to adopt, and thus the mobile devices are used more widely.

Kyle Heppenstall is the managing director of CompassX Group, a life sciences management consulting firm in Irvine, Calif., that helps clients get systems validated with various federal agencies. His clients include corporations, health care firms, and biotech and pharmaceutical companies that are building technology systems for the consumer market. He advises them that those systems need to be validated, even when they are mobile extensions of existing systems that already are monitored by the government.

Heppenstall said the cost of developing a regulated system could be up to three times more expensive than developing systems that are not regulated. “That is an additional burden that would have to be [paid for] by the owner of the system,” he said.

Particularly with smartphone applications — many of which are inexpensive to develop and cost nothing to download — most experts agree that the cost of developing FDA-compliant applications and software would stifle innovation.

“Finally there’s a place where doctors can go, and health care professionals can go, to get these tools and resources, and you don’t want to make it more difficult for innovation to happen,” Zeinfeld said. “And you shouldn’t have to make it more difficult. Certainly, there’s got to be some middle ground.”

On the other hand, Nitenson, who has worked clinically in emergency and intensive care departments, said, “I would never use, nor would I recommend, [that] a physician use software technology that is specifically designed around a smartphone device that is not strong enough to endure both the HHS mandates and the FDA’s mandate of data security and integrity for medical devices.”

Most experts agree that full oversight of all health information systems likely never would happen. The cost would be too high, and the scope of regulation would be too vast.

But Dr. Shuren did lay out some possible scenarios, most of which would involve tracking problems after a device or software has hit the market. For example, there could be a database of adverse effects, or a registration list of devices. Another option might be a requirement that developers adhere to the FDA’s Quality Systems Regulation, a list of specific guidelines manufacturers must follow.

Nintenson thinks there must be consequences if FDA oversight is to have an impact.

“As long as there is no consequence, people who write software don’t necessarily do things in a more secure manner,” he said.

Above article publish on

http://www.ama-assn.org/amednews/2010/05/24/bica0524.htm

By Rich Silverman

We talk a lot in this blog about the financial aspects of Electronic Medical Records (EMRs), and with good reason – they can entail a substantial investment in time and money. But it’s sometimes easy to lose sight of the purpose of all that investment – to save lives.

There has been a great deal of research conducted into how much it will cost to implement an EMR, yet there has not been a lot of research into their impact on patient outcomes. A recent study shows that the adoption of Electronic Medical Records and Radiology Information Systems (RISs) in hospitals in the U.S. actually lowers infant mortality in this country. Research conducted by Amalia Miller of the University of Virginia and Catherine Ticker of MIT’s Sloan School of Business showed that when hospitals adopt EMRs and RISs, their infant mortality rates drop.

Using data on births and infant mortality already collected by the U.S. Government, and statistics on health care information technology adoption provided by the Health Information Management Systems Society (HIMSS), the researchers compared infant mortality in selected areas of the country where data was available (privacy laws limited that data pool) with the adoption of EMRs and RISs in those same areas.

After correcting for a wide range of variables, the researchers came to the following conclusions:

The adoption of EMRs by one additional hospital in a county reduces infant mortality by 13%.

The average cost of the HIT used to save that baby is about $450,000.

The reduction of infant mortality is twice as great for African-Americans than non-African-Americans.

The median cost to implement EMR in a hospital, according to a 2007 America Hospital Association study was $5,556 in capital costs per bed and $12,060 per bed per year in maintenance costs.

The authors studied “bare-bones” HIT implementations of EMRs, and only looked at the impact on neonatal and infant health outcomes. They suggest that more robust implementations of HIT, including decision-support and computerized physician order entry, as examples, will extend the beneficial effects of HIT to other classes of patients.

This research serves as a gentle reminder that the HITECH Act was intended to provide incentives for physicians and hospitals to implement and use Electronic Medical Records because EMRs will improve patient outcomes and save lives. This research shows that they do.

Above article publish on http://blog.pchealthstop.com/?p=985

A new study reveals an exciting potential benefit of the rapidly accumulating databases of health care information, the ability to make unprecedented links between genomic data and clinical medicine. The research, published by Cell Press in the April issue of the American Journal of Human Genetics, supports the idea that large scale DNA databanks linked to electronic medical record (EMR) systems provide a valuable platform for discovering, assessing and validating associations between genes and diseases.

“The deployment of EMRs offers the hope of improving routine care, not only by enhancing individual practitioner access to patient information but also by aggregating information for clinical research,” explains senior study author Dr. Dan M. Roden from Vanderbilt University School of Medicine in Nashville Tennessee. “EMRs contain large populations with diverse diseases and have the potential to act as platforms for rapid and inexpensive creation of large inclusive patient sets.”

Dr. Roden and colleagues in informatics and in genome science were interested in examining whether large biorepositories containing DNA samples linked to EMRs might be useful for discovering and incorporating new genotype-phenotype associations. “Implementing such a vision requires that major obstacles be overcome, including technological, computational, ethical, and financial issues and determining whether genomic information will meaningfully inform clinical decision making and health care outcomes,” says Dr. Roden.

The researchers used BioVU, the Vanderbilt DNA databank, to detect known common genetic variants associated with five diseases: atrial fibrillation, Crohn’s disease, multiple sclerosis, rheumatoid arthritis and type 2 diabetes. It took only four months to generate a set of nearly 10,000 records from which the cases and controls were identified. Although the process of accessing and defining the samples was technically complex, for each of the five phenotypes, at least one previously reported genetic association was replicated.

These results support the use DNA resources coupled to EMR systems as a valuable tool for clinical research. “Our data demonstrate that phenotypes representing clinical diagnoses can be extracted from EMR systems, and support the use of DNA resources coupled to EMR systems as tools for rapid generation of large datasets required for replication of associations found in research and for discovery in genome science,” concludes Dr. Roden.

Above article publish on http://emrdailynews.com/2010/04/01/electronic-medical-records-may-accelerate-genome-driven-diagnoses-and-treatments/

By Patrick Lukacs

With the advent of the American Recovery and Reinvestment Act (ARRA)/HITECH Act and the promise of stimulus funds, physicians are mulling ways to add electronic medical records (EMRs) to their practices.

Even providers skeptical of the reimbursement process can’t afford not to consider, starting in 2011, an attempt to secure up to $44,000 per physician over five years. Some physicians even propose that those who don’t implement an EMR are diminishing the profession and may be breaking the Hippocratic Oath by not using technology to improve the care of patients, particularly those with chronic conditions.

Group practices pondering stepping up to the EMR plate know they have several routes to implementation, including working directly with EMR vendors and their resellers or leveraging hospital-owned systems. For many reasons, savvy physicians and administrators are starting to rely on third-party billing companies to provide the quickest route to success in adding and supporting an EMR.

Many physician practices and billing companies have invested time and energy in a long-term working relationship, with physicians and administrators coming to depend on the biller’s business acumen and broad technical expertise in helping run the practice. Years of working hand-in-hand with medical office staff give billing personnel a solid grasp of how the particular practice functions and how best practices can help improve effectiveness. Billing staff is attuned to how work flows most efficiently in the practice, the peculiarities of its data and patient population and the peccadilloes of particular providers.

Furthermore, billing companies understand the legislative landscape and ways to clear technical hurdles and pave the way to stimulus funds. Comprised of more than 600-member organizations, the Healthcare Billing & Management Association (HBMA) is helping physicians access necessary information from EMRs to facilitate reimbursement and meet medical and business needs. The California-based organization is dedicated to helping members monitor relevant trends and learn how best to implement EMRs into group practices through a task force, white papers, annual conferences and a series of educational summits.

In-depth knowledge of the EMR space helps third-party billing companies downsize the daunting plethora of EMR vendors in the marketplace to a short list of only those systems which best suite a practice’s financial, functional and specialty needs. Billing companies are counseling clients on whether it is best to consider an EMR with broad capabilities that can be tailored to and grow with the practice’s needs or an EMR that is designed particularly for a specialty.

The staffs at third-party billing companies are well versed in coding and compliance, including those of clinical backgrounds to ensure the best marriage of administrative and clinical functions.

Billing companies offer fast, but carefully phased-in implementations. While EMR vendors start implementation at the absolute beginning, billing services can add an EMR to a practice in weeks rather than months because there is already a data center supporting the IT infrastructure, software configurations and policies and procedures developed to support recommended business processes, modified to client requirements.

Last, but not least, because billing companies have an ongoing relationship with medical offices, their staff can be available long after go-live to troubleshoot problems, resolve them quickly and help physicians and their staff gain confidence and wring the most out of their EMR.

Above article publish on http://www.healthcareitnews.com/blog/billing-companies-are-key-adopting-emrs

Fifty-eight percent of U.S. physicians who don’t use electronic medical records (EMRs) intend to purchase an EMR system within the next two years, according to a new report from Accenture (NYSE: ACN).

“If U.S. health care providers properly implement and use EMRs more broadly, there is no doubt that EMRs can make an important contribution to improving quality of care and controlling costs.”

Today, just six percent of U.S. office-based physicians use a fully functioning system.

Accenture’s Innovation Center for Health and Institute for Health & Public Service Value worked with Harris Interactive to survey 1,000 U.S. physicians from practices of fewer than 10 practitioners to measure their views of EMRs. Approximately 15 percent of respondents were users of EMRS and 85 percent were non-users.

The survey’s primary objective was to determine concerns and perceptions of EMRs and gauge motivating factors at a time when U.S. federal legislation includes incentives for physicians who implement and use EMRs and penalties for those who do not adopt EMRs by 2015. The New York Academy of Medicine assisted with the qualitative survey and analysis.

Among the key findings:

• 58 percent of non-users intend to purchase an EMR system within the next two years;
• About 80 percent of physicians under the age of 55 plan to implement an EMR system within the next two years;
• Three-quarters of non-users are intrigued by the idea of purchasing an EMR system from a local hospital - if the purchase is at least partially subsidized by the hospital;
• On average, non-users would expect a hospital/health network to subsidize about half the cost of an EMR system;
• The key driver of EMR adoption is federal legislation - 61 percent cited federal penalties for non-adoption and 51 percent cited federal incentives;
• Non-users underestimate the cost and time requirements to implement an EMR system, but also have an exaggerated perception of difficulties in using EMR systems, compared to the actual experiences of EMR users; and
• The vast majority of current EMR users – 90 percent – believe that their EMR system has brought value to their practice, in particular “changing the way their practice works for the better.”

The 90 percent of users who feel their EMR system has been beneficial to their practice cited the following reasons:

• Their EMR system provides an effective overview of patients’ relevant history, records and information; and,
• Their EMR system allows quick and accurate data entry.

“Our research indicates that, as intended, federal legislation is an important driver of EMR adoption among U.S. physicians,” said Dr. Kip Webb, who leads Accenture’s clinical transformation practice. “If U.S. health care providers properly implement and use EMRs more broadly, there is no doubt that EMRs can make an important contribution to improving quality of care and controlling costs.”

Above article publish on http://asociagroup.com/blog/?p=1288

In the beginning there was memory. The physician’s memory was the original repository of the patient medical record. Memory was supplemented by handwritten notes on papyri in ancient Egypt and Babylon and on paper from medieval times to the 20th century. With the advent of recording devices in the 20th century, handwritten notes gave way to the infinitely more time effective practice of dictating patient notes into a recorder which were then transcribed into a typewritten or word processed document. Of course, that practice introduced an extraneous third party into the medical record keeping process: the transcriptionist with the attendant additional expense to the physician and loss of privacy for the patient.

At the current time, 21st Century technology offers physicians and health care providers a medical record paradigm that will not only vastly upgrade the process of producing, maintaining and safeguarding medical records but will, in a direct and fundamental way, actually improve the quality of medical care. The technology is Electronic Medical Records (EMRs). EMRs produce the most accurate and complete patient health record possible to date and help physicians practice better medicine as well. EMR technology is available in a plethora of shapes and sizes with a great variety of possible features. The technology can change the way you interact with your patients, from before they make their first appointment to after they’ve left your office, and have questions about their visit in your office.

As a practicing physician you are aware of the repetitive nature of some aspects of your practice, specifically with regard to patient diagnosis. It is very likely that you and/or your staff have asked the same or at least very similar questions to each of the thousands of patients you have treated. Unless you are practicing in a tertiary referral center, and never see the same condition twice, the patient answers likewise tend to be repetitive. Similarly, physical examination findings fit into certain categories that are seen over and over again. For this reason, most of the current high-end Electronic Medical Record products very capably utilize ‘pick lists’ or ‘click and point’ methodology to complete large portions of the patient medical record.

These point and click systems are particularly adept at documenting, for instance, allergies to medications, medications that are currently being taken, past medical history, family history, social history, and major portions of the physical exam. This is the case because of the narrow range of options which are available as patient responses. For instance, your patient either smokes or doesn’t smoke. And if he/she smokes, it is probably 1 ppd, or 2 ppd, or some other value that can reasonably easily be foreseen by the experts who have designed the point and click system for your office.

However, the historical portion of the patient medical record typically has a great deal of information that cannot be easily foreseen by the developers of the point and click templates. For instance, as an Orthopedic Surgeon, my patients frequently find themselves in automobile accidents. It is not likely that the author of whichever EMR may find its way into my office has contemplated the various street names and intersections in my community. Therefore, in a typical point and click system, there will be a scarcity of relevant information concerning the specifics of the accident. And I find that these specifics are important for a wide variety of reasons, not least of which is that they remind me of the particulars regarding this patient when they return to the office. Utilizing templates for the historical portion of the report, while feasible, tends to produce extraordinarily repetitive reports, each of which sounds not only vaguely similar to the previous patients, but in many cases essentially identical to other patients. This certainly makes it difficult to recall the characteristics of this particular patient.

One of the advantages of an EMR is that it allows physicians, hospitals, insurance companies, pharmaceutical companies, medical societies, and other parties entitled to view the patient data for legitimate, permissible purposes, to do so. Legitimate, permissible purposes include coordinating patient treatment, accessing diagnostic procedures and results, preventing adverse drug reactions, and ensuring medical practice within clinical practice guidelines. One particularly high priority purpose from the physician’s standpoint is that the data be accessed by third party payors to streamline reimbursement for services.

Above article publish on http://www.emrconsultant.com/education/voicerecog

By: Michael Young

The medical industry has changed significantly over the past decade. One of the major changes is that many medical offices are moving from paper to electronic medical records. There are also a number of practice management software packages available to medical practitioners. This makes their lives easier, but what does it mean for patients? To understand the answer to that question, it is first important to understand what an electronic medical records system is.

Generally EMRs, electronic medical records, and EHRs, electronic health records, are synonymous. These systems keep track of medical information. These systems keep medical records stored in a central location so that they can be made available to pharmacies, specialists and other providers. What this means for the patient is that medical care is becoming more portable.

President Bush created the Office of the National Coordinator for Health Information Technology (ONC) in 2004. This office was headed by David Brailer in the beginning. Brailer addressed interoperability issues and established a National Health Information Network (NHIN). Regional Health Information Organizations (RHIOs) have been established under the ONC in many states for the purpose of promoting the sharing of health information. Currently, Congress continues to create legislation to increase funding for these programs and programs like them.

Moving from paper systems to EMRs is a process that is still in the beginning stages within the medical community. It is a work in progress. Many concerns exist, and privacy is one of those concerns. While a moving to an EMR would potentially give many providers, pharmacists and other medical professionals access to a patient’s records, these records are kept very secure. The adoption of electronic medical records systems is clearly what the future holds, from a technology as well as legislative standpoint. In the end, the patient benefits because it is easier to fill prescriptions, transfer records and receive consistent care than with paper systems.

As medical records systems continue to move from paper to electronic, look for the ability of systems to communicate with each other to also become important. As the patient, you will benefit because of the portability of electronic health records and you will no doubt benefit from the increased continuity-of-care that they can offer.

Above article publish on http://www.sooperarticles.com/health-fitness-articles/general-health-articles/electronic-medical-records-more-prevalent-now-2926.html

By Brian Smith / Register News Writer

The days of a white-coated doctor taking a pen from his pocket and making notations in a file are long gone.

With computers becoming smaller, cheaper and more portable, health care professionals are replacing paper records with electronic records that can be instantly accessed.

The Madison County Health Department’s home health division, MEPCO Home Health, is in the process of implementing an electronic medical records (EMR) system, department spokesperson Christie Green said, and will begin using the system on Sept. 1.

“EMRs will make things faster, more efficient and will provide a huge space savings,” Green said. “For example, MEPCO will be moving from nearly 200 square feet of filing space to electronic records housed in a server room of less than 40 feet.”

Federal health care reform efforts have focused on transitioning health care providers to EMR systems to increase efficiency and reduce spending.

Local public health director Jim Rousey said that an EMR system frees personnel to spend more time treating patients instead of making records.

“Every year, our home health nurses were spending more and more time fulfilling documentation requirements for patient care,” Rousey said.

“This interfered with what nurses really wanted to be doing, which was taking care of patients.

“Employing an electronic medical record system should reduce the amount of time it takes to document the care and ultimately provide more time with the patients,” he said.

Rousey said that using an EMR can take some adjustment for practitioners experienced in maintaining paper records.

“At the beginning, there is a steep learning curve for everyone. Sometimes it actually takes longer to use the EMR in the beginning, but the efficiency becomes apparent as everyone gets accustomed to the system,” Rousey said.

At Pattie A. Clay Regional Medical Center, which switched to an EMR system in 2004, the system has paid large benefits, said Joy Barnes, information technology director.

“The nurse at the bedside may need to spend more time to initially gather and document patient information, but the administration and reporting side of nursing has seen efficiency improvements in both time and accuracy of the patient chart,” Barnes said.

Cost is still a concern when transitioning to an EMR system, Green said, despite the decrease in equipment costs over the past few years.

“Less than a tenth of our total outlay for an electronic medical records system in MEPCO was for the hardware,” Green said. “The cost of installing, licensing, and maintaining a quality system is still extremely high — in the 100s of thousands of dollars, even for a small family practice.”

Security can be another concern, said Martin Hensley, information technology specialist for the health department.

“Controlling access and ensuring security is a problem that exists on a bigger scale than it did in the past,” Hensley said. “In the past, we could just lock a file room and the charts would be secure. Now, everyone in the agency must be more conscious of security. Each computer terminal or laptop can be a doorway to confidential medical information.”

Barnes and Green also both pointed to making wise choices about the systems that are implemented as a key component of implementing an EMR system.

“In the past, we used carts with laptop computers that were wheeled into each patient room,” Barnes said. “The carts were cumbersome and not the best option, especially in a semi-private room with two patients.

“With the new renovations in place, the nursing staff are testing hand-held computers developed specifically for the health care environment,” Barnes said.

“We have to be aware of the potential for the computer to come between the provider and the patient,” Green said. “For example, large screens may block a patient’s view, or a computer’s location in the room may cause the provider to turn her back to the patient.”

Despite the costs and concerns, Green said EMRs and other health technology have a benefit to patients.

“In the long run, electronic records will increase the speed and accuracy of the flow of information between providers,” Green said.

“This translates into improved quality of care for patients, as various providers can communicate about an individual’s health needs.”

Above article published on

http://www.richmondregister.com/localnews/local_story_236085613.html?keyword=secondarystory

By Neil Versel

After months of being the target of critics both legitimate and questionable, the Certification Commission for Healthcare Information Technology is reasserting itself in the EMR marketplace. Last week, the federal Health IT Policy Committee signed off on recommendations from its Workgroup on Certification and Adoption that there should be multiple bodies to certify EMRs for participation in the multibillion-dollar Medicare and Medicaid EMR subsidy program authorized by the economic stimulus legislation. However, given the time it would take to start up a competing certification mechanism, the committee recommended that CCHIT take the lead for now in adapting certification to the “meaningful use” matrix that will determine whether a provider qualifies for stimulus money.

Meanwhile, CCHIT says it will update its certification criteria in October to meet the stimulus requirements for 2011, the first year of the subsidy program. The commission plans to respond to earlier criticism by adding certification options for some individual EMR components such as e-prescribing and clinical decision support. It also asked HHS to determine whether CCHIT’s existing criteria satisfy the 2011 requirements for meaningful use.

Above article published on

http://www.fierceemr.com/story/cchit-advances-plans-2011-emr-certification/2009-08-20