by Richard L. Lindstrom, MD

EMR, DICOM, SNOMED, HIPAA, CCHIT — how many readers can explain in detail what each of these means to their practice? While to date only a few more than 10% of us have fully adopted electronic medical records, by 2015 we will all face significant penalties if we are not fully engaged in this next government mandate.

We at Minnesota Eye Consultants are still delaying implementation of electronic medical records (EMRs), partly because the costs are staggering, the technology available for ophthalmology is in evolution, and especially because of the horror stories we have heard from so many of our colleagues who have made the attempt to go electronic in the past. I am concerned that the penalties may be significantly greater than just the astronomical cost of implementation and the potential for reduced reimbursement for those who are noncompliant.

I am now old enough to have a few medical maladies of my own — hypertension for one, well managed on medical therapy, and a few sports injuries requiring joint surgery. Just this last week, I visited my internist who is part of a large multispecialty clinic that adopted EMRs 2 years ago. As I sat in the examination room, first the nurse and then the physician recited a long list of required questions while seated in front of a computer monitor, the whole time intent on the monitor and keyboard, without once looking up at me as they completed the history. Clearly, to me, this was a major disconnect in the way I have classically interacted with patients in our currently non-EMR clinic. Of course, there was an examination and a little laying on of hands with a few follow-up questions. Then another 5 minutes for me to look at the back of my physician as the data was entered and the treatment plan formulated.

On a positive note, a summary of the plan of therapy was immediately printed and handed to me, and the physician, one of the best internists in Minnesota, did turn and look me in the eye as he went over the plan and answered any questions. Having a good relationship with this committed physician, I asked him what he thought about EMRs. After a long sigh, which was in itself the answer to my question, he conceded that on the positive side, EMRs were a potentially powerful tool for large multi-specialty clinics such as his, where multiple providers at multiple locations participate in a single patient’s care. All caregivers at all locations have access to all the data immediately once it is entered. He admitted it was also a constructive tool for monitoring physician productivity and patterns of care, providing a powerful data set to those managing and regulating our practices.

The negatives were, however, even more important. He felt that he had lost significant rapport with his patients because he was required to enter so much data, which was an extremely time-consuming task. On many days, he felt more like a data entry clerk than a highly valued clinician. I certainly had to agree with him on this point, as two-thirds of my time with him had been devoted to data entry and only one-third to utilizing his training and skills as a physician. In addition, he said the data entry tasks had negatively affected his efficiency significantly, requiring him to reduce the number of patients he could schedule in a day.

His overall analysis: The EMR winners are management, regulators and third-party payers. The losers are patients and physicians. The bottom line: An easy-to-read computer-generated medical record does not guarantee high-quality personalized patient care.

So, at a cost of billions to physicians and surgeons already struggling to remain solvent, we enter into an era of more depersonalized care and reduced physician efficiency and productivity. Perhaps in time with dedicated physicians, increased experience, the use of scribes (which will also increase costs) and advances in voice recognition technology so that we can again look our patients in the eye when we talk with them, we will make EMRs a positive for the patients we care for every day. But for now, for most of us, it will simply be another government-mandated cost and inappropriate intrusion into the practice of medicine with no clearly demonstrated benefit to physicians or patients in regard to quality of care or patient satisfaction. No surprise, but disappointing nonetheless.

Above article published on

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CHARLOTTESVILLE, VA – Hospitals have seen a decrease in EMR adoption in states where privacy laws restrict their ability to disclose patient information, according to a study published in the journal Management Science.

The study shows that states that have enacted medical privacy laws restricting the ability of hospitals to disclose patient information have seen a reduction in EMR adoption by 11 percent over a three-year period or 24 percent overall. States with no such regulations, on the other hand, experienced a 21 percent gain in hospital EMR adoption.

According to the study, the drop is most evident in the reduced adoption of EMRs through networks of hospitals and medical providers. In states without such laws, adoption of EMRs by one hospital spurs adoption by others, with one hospital’s adoption increasing the likelihood of other hospitals in the local area adopting by 7 percent.

The study’s authors, from the Massachusetts Institute of Technology and the University of Virginia, say privacy protection may benefit the diffusion of information-sharing technologies if it reassures consumers, but may inhibit the diffusion of information-sharing technologies if it imposes costs on firms who adopt the technology.

Above article published on http://www.healthcareitnews.com/news/study-privacy-laws-deter-hospitals-emr-adoption

Ready or not, electronic medical records (EMRs) are coming. President Barack Obama has devoted $20 billion to healthcare IT in the American Recovery and Reinvestment Act, and in February 2009, he announced his aspirations to have an electronic health record for each person in the U.S. by 2014. Dr. James Pierce, chair of the Bioinformatics and Computer Science Department at University of the Sciences in Philadelphia, notes that a nation-wide implementation of EMRs comes with considerable challenges, as well as tremendous advantages.

“Digitization of the healthcare system will be much more efficient and cost-effective, and will enable easier communication among different parts of the system, simpler manageability, and less storage compared to paper records,” explained Dr. Pierce. “EMRs allow healthcare providers to send queries electronically, which is expected to decrease the errors that are made on paper and ultimately, save lives.”

Despite the clear benefits of EMRs, there are important issues that need to be addressed before implementing the system, Dr. Pierce cautioned.

• Storage: While EMRs will likely be stored in internal hospital systems or external servers, each patient’s file could generate a colossal amount of data. “In the near future, terabytes of information may be generated during a doctor visit,” said Dr. Pierce. “It’s very difficult to transfer files of that magnitude, and the software must be able to store and send every x-ray, cat scan, genomic analysis data, MRI, prescription, and test that a patient gets.”

• Compatibility: Because most EMR programs are developed and sold by private companies, different hospital systems may not be interoperable with each other, making the transfer of electronic files complicated or impossible. Rapidly changing technology also poses a financial strain. “When a hospital or physician’s office invests millions of dollars into purchasing a system today, it may be outdated in five years, at which point, it can be very expensive to update and get a new program.”

• Privacy and Security: Given the infinite shelf-life of electronic files, EMRs incite debate about serious privacy, security, and ownership concerns, as well as the potential for past medical information to be used against a person. Dr. Pierce hypothetically notes a person who was prescribed antidepressants in college, and years later, the individual may not want this information available to potential employers. However, if the patient’s history is catalogued in an EMR, it will not only live-on forever, it is also highly accessible.

• Training: EMRs are still a relatively new system, and as such, require a form of interdisciplinary training that is not yet widely available. “Traditionally, hospitals staff an IT person who has little or no training in healthcare, and doctors and nurses who aren’t familiar with IT,” said Dr. Pierce. “A nation-wide move to EMRs prompts the need for trained individuals who are well-versed in both IT and medical technology.”

Above article published on

http://www.chiroeco.com/chiropractic/news/7885/675/Challenges-to-the-Presidents-plan-to-digitize-healthcare/

The call for widespread adoption of electronic medical records has prompted some states to pass stringent privacy laws to protect their residents against fraud or identity theft. But a new analysis finds these laws seem to significantly diminish the effectiveness of the new technology.

Many of the new technologies available to healthcare providers depend on information sharing to be effective, study authors note. If one hospital adopts the use of EMRs, they explain, that increases the likelihood of nearby hospitals adopting EMRs by 7%. Conversely, in states where EMR privacy laws restrict the sharing of patient information, record sharing has been reduced by as much as 24%. Recently, the American Association of Homes and Services for the Aging found that nursing homes lead the healthcare field in overall adoption of electronic medical records.

The Bush administration largely endorsed the idea of a national health IT infrastructure, and has set a goal of full implementation by 2014. Ideas for spurring adoption of EMRs have been present in most draft versions of new healthcare reform legislation, but no final plan has emerged. The report, “Privacy Protection and Technology Diffusion: The Case of Electronic Medical Records,” appears in the current issue of Management Science.

Above article published on

http://www.mcknights.com/State-privacy-laws-could-be-slowing-electronic-medical-record-adoption/article/139971/

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

Kyle Hardy, Community Editor

CHICAGO – The Healthcare Information and Management Systems Society’s EHR Usability Task Force has released a white paper focusing on the level of usability in electronic medical records and their implementation at healthcare organizations.

“Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating” identifies usability of software in an EMR as “one of the major factors and possibly the most important factor hindering widespread adoption of EMRs.”

“Through our research, we found that usability as a requirement in the certification process could benefit product development for more usable EMR products and give users or decision-makers more confidence in selecting clinical EMR systems,” said Jeffery L. Belden, MD, associate professor of clinical medicine at the University of Missouri Health Care’s School of Medicine and chairman of the HIMSS EHR Usability Task Force.

Principles and methods are highlighted in the study as processes that offer benefits for organizations that certify technology. These procedures allow certifications organization “to test and rate products for usability.”

The study also looks at:

• a definition of usability relating to an EMR;
• a set of principles pertaining to usability and design; and
• potential methods for assessing and rating usability of an EMR

The HIMSS task force gives suggestions for rating the usability of an EMR through a five-step process, emphasizing that organizations start small with usability ratings, devise measurements and create a five-star rating system base on a standard.

“With the American Recovery and Reinvestment Act as the catalyst for healthcare reform, this white paper provides an insightful review of usability for the EMR and its value in the certification process,” said Edna Boone, HIMSS’ senior director of healthcare information systems. “The task force will continue to study this important topic of usability and its benefits for successful EMR implementation.”

Above article published on

http://www.healthcareitnews.com/news/himss-white-paper-usability-critical-adoption-emrs

Chip Means, Web Editor

CAMBRIDGE, MA – Economically healthy industries empower workers to make decisions, compensate based on productivity and use a lot of information technology. The healthcare industry doesn’t do any of this – yet.

Stimulus funds for IT could save the day and the economy, according to Harvard economics professor and Obama campaign advisor David Cutler, who spoke at the Tuesday afternoon session of the HIT Symposium at the Massachusetts Institute of Technology in Cambridge.

Every industry except healthcare has figured out how to become more efficient by replacing administrative work with information technology, he said. Nurses spend a third of their time documenting – a procedure Cutler said often involves printing digitized information and re-entering it into another IT system.

With the right IT systems and processes, he said, the business of healthcare could change to focus more on compensation and empowerment, making hospitals and practices more profitable.

Cutler said the promise of electronic medical records lies in three areas that can greatly improve the economic health of a hospital:

Simplified billing – The greatest potential for reducing administrative costs lies in eliminating the process of spending all day talking to insurers and drug companies. Electronic claims and e-prescribing can replace that process, he said.

Decision support – “Meaningful use has almost certainly got to mean decision support in place to avoid mistakes,” Cutler said. “Mistakes alone cost us $100 billion a year.”

Learning which treatments are effective – IT can provide organizational insight to demonstrate what is and isn’t working.

Some physicians fear that if healthcare becomes too automated, the nation will have “cookie-cutter medicine,” said Cutler.

“What we know in every industry is that computerization is good for high-skilled people – it frees them up to use their expertise to do what they should be doing.” Doctors estimate 40 percent of their time is spent doing needless administrative work, he said. “If I cut your administrative task time in half, I’ve increased the time you have to see patients by 20 percent.”

Simply putting the systems in place isn’t enough. “Electronic medical records are the beginning, not the end,” said Cutler. “What has to happen is IT has to lead to a change in healthcare as big as it led to in other businesses. If it doesn’t, everything we do now will be a big failure.”

Above article published on

http://www.healthcareitnews.com/news/saving-healthcare-industry-emrs-are-beginning-not-end

Bernie Monegain, Editor

CHICAGO – The American Medical Association has adopted new guiding principles for physicians in the event a patient’s electronic medical record is breached. AMA members approved the guidelines at the group’s annual policy-making meeting earlier this week in Chicago.

“Protecting the privacy and safety of patient information, whether in a paper record or an electronic medical record, is a top priority for physicians,” said AMA board member William A. Dolan, MD. “Physicians need a standard protocol to follow to maintain patient security in the event of a breach of personal information.”

Medical information housed in an EMR travels from patient to healthcare provider to health insurance industry with limited regulation and oversight, Dolan noted. Security breaches can happen and physicians need guidance about their responsibilities if health information has been compromised.

The new AMA guidelines ask physicians to:

• Ensure patients are properly informed of the breach,
• Follow ethically appropriate procedures for disclosure,
• Support responses to security breaches that place the interests of patients above those of physician, medical practice or institution, and
• To the extent possible, provide information to patients to enable them to diminish potential adverse consequences of the breach of personal health information.

“EMRs are the wave of the future, so it is important for both patients and physicians to feel secure” Dolan said. “These new guidelines prepare physicians to help patients in the unfortunate situation of an information breach.”

Above article published on

http://www.healthcareitnews.com/news/ama-weighs-emr-security-breaches

Readers write to say that electronic medical records cost more than you think; that companies should be required to make matching 401(k) contributions; and more.

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Although “Strong Medicine” (May) does provide some insight into why insurers want electronic medical records (EMRs), it has a lot of misconceptions and misstatements. Among them:

1. “Just as technology streamlined industries like retailing and financial services, it should create efficiencies in health care that will slow premium growth from its traditional annual rate of about 7%.” There are no citations offered to show a decent study demonstrating such “efficiencies.”

2. “Malpractice insurers have already linked electronic systems with better-quality care; some will reduce premiums by as much as 5% for doctors who have gone digital.” Very few have actually decreased their premiums. In fact, EMRs can actually result in increased errors, decreased quality, false documentation, and the loss of privacy.

3. “…only about 9% of the country’s 5,000 hospitals and just under 20% of its 800,000 physicians use computerized recordkeeping….” The only data of importance is what falls into the category of “meaningful use.” The actual numbers are 2% of hospitals and 4% of physicians.

4. “Rand…estimates that when 90% of…providers use such systems, the savings will amount to $77 billion a year.” This has never been proven.

5. “…ROI calculations of such a move showed some modest financial benefit.” Studies have shown that for every group that makes an EMR work, another 50% have a failed installation. And of those that do make their systems functional, only about 10% actually use them “significantly.” Why didn’t the author interview angry doctors who have lost thousands in the quest for the EMR ROI?

6. “For small practices…the price of implementing an EMR system could reach nearly $40,000 per physician.” That’s only the initial cost, which ignores the average $1,500 per month ongoing fees and the cost of “significant use.” Overall, the average five-year cost is estimated to be about $300,000 per physician.

7. “CFOs…may soon develop an affection for EMRs, especially if the technology proves to be an antidote to soaring health-care premiums.” Again, these systems are expensive, rarely show an ROI, and have never been shown to decrease health-care costs.

Alberto Borges, M.D.
Arlington, Virginia

The Author Responds: In most cases, Dr. Borges is referring to projections, estimates, and tangential issues beyond the scope of the article. Previous studies haven’t tested EMRs under the same kind of conditions that will exist should substantial adoption come to pass; that is, with certification, standardization, training — and motivation.

The story did refer to doctors who have had EMRs for many years; they aren’t unhappy, but the systems they use are more like electronic order-entry than EMR. Their views may change, however, if they find out there is no cheap way for them to plug their systems in to the government-sanctioned network. They seem to expect that one of the existing companies (or an up-and-comer) will target them as a desirable market and come up with a solution.

Above article published on

http://www.cfo.com/article.cfm/13687654/1/c_13720245

True or false? The American Recovery and Reinvestment Act will provide physician practices incentives for the purchase of an electronic medical record system.

False. The ARRA is, indeed, meant to foster health IT adoption. But the incentive money will directly address the use of EMRs, not the purchase of the systems.

Secretary of the U.S. Dept. of Health and Human Services, Kathleen Sebelius, has until the end of the year to define “meaningful use,” which physicians will have to meet by 2011, when the incentives kick in.

Without a definition, those in the market for an EMR are left wondering if waiting might be the best option, while early adopters wonder if their systems can meet future standards.

So what’s a practice to do?

The experts’ answer: Don’t wait to buy or upgrade just for want of a definition. There are enough clues in the legislation to estimate the definition of “meaningful use.”

Experts say it will be easier on you, and your practice, to buy now and tweak later. “Time is your enemy,” said Mark Garsombke, an attorney with the Milwaukee law firm Whyte Hirschboeck Dudek. Waiting to buy could mean a delay in qualifying for incentives, he said.

Details included in the Health Information Technology for Economic and Clinical Health Act, or HITECH Act, the provision of the ARRA that created the incentives, have hinted at what physicians can expect in the meaningful use definition:

• Qualifying EMR systems must be certified. Pat Wise, RN, vice president of health information services for the Healthcare Information and Management Systems Society, said because the Certification Commission for Health Information Technology is currently the only certifying body up and running, she expects early meaningful use requirements will include CCHIT certification.
• Systems must include electronic prescribing. According to Wise, the administration has made clear that e-prescribing will be one of the key components of meaningful use. The Centers for Medicare & Medicaid Services is already offering incentives to physicians who e-prescribe.
• Systems must be used for quality reporting. Incentive programs already exist under CMS’s Physician Quality Reporting Initiative. The meaningful use guidelines are expected to include and build on those performance measures.
• Systems must be capable of exchanging information with other systems. The HITECH Act makes it clear the administration is still working toward a national health data exchange whose foundation will be EMRs.

And experts say there are steps practices can take to help them ensure their system is compatible with the future meaningful use definition:

• Talk to vendors. Grill them on what steps they are willing to take to ensure their clients will meet meaningful use. Ask them to put any promises in writing. Practices using small vendors should get contingency plans in writing in the event the vendor goes out of business or is bought out by another company.
• Focus attention on the practice holdouts if you’re already using EMRs. Many practices that don’t require EMR use have doctors still using paper. Now is a good time to get to the core of their concerns with using health IT, Quirk said. Incentives will be available on a per-physician basis, so physicians not using the systems will be leaving money — up to $44,000 per doctor — on the table, he said.
• Start e-prescribing. Incentive money is already available to physicians who prescribe electronically. This is sure to be part of the meaningful use requirements. The sooner you start, the quicker you’ll be up and running by 2011, experts say.
• Begin participation in the Physician Quality Reporting Initiative. This is also something that is sure to be a requirement and something physicians can get paid to do now.
• Explore additional functionalities, such as clinical decision support tools. Wise said it’s likely there will be some level of clinical decision support use required. Many systems don’t have these functions. Computerized physician order entry is also likely to be required.

Wise said even if you want to wait until the definitions for meaningful use are released to make the purchase, doing your homework now can save time later. There are many systems out there as well as functions existing EMR users could add. It’s always a good idea to compare prices and research vendors.

“That kind of preparatory work can be absolutely invaluable,” Wise said. “And that kind of preparatory work can also make the difference between making a good, wise selection when you do decide to make the purchase as opposed to a selection that might come back and not give you the functionality that you desire.”

Above article published on

http://www.ama-assn.org/amednews/2009/06/15/bica0615.htm