TORONTO, Ontario’s doctors say a study released today by the Ontario Health Quality Council (OHQC) illustrates the need to remain vigilant in getting every Ontarian a family doctor and expanding access to Electronic Medical Records (EMRs).

“Every person in the province deserves to have access to the care and xpertise of a physician, and Ontario’s doctors will accept nothing less,” aid Dr. Suzanne Strasberg, President of the Ontario Medical Association OMA). “Since 2004, more than 630,000 people that didn’t have a doctor now do. e are very proud of what we have accomplished but we know there is more work to be done.” In the most recent agreement, Ontario’s doctors and the government committed to work together to find another 500,000 patients a physician. Dr. Strasberg suggested that one of the most effective ways to achieve this objective is through the expansion of collaborative care models. Ontario’s doctors have long advocated for collaborative health care teams where various health professionals work together under one roof to provide care to a large number of patients.

“The evidence is clear, when physicians and other health professionals work together, not only is there a more comprehensive level of care provided to patients, but it can reduce the strain on the health care system.”

The OHQC study also highlights the importance of EMRs in ensuring continuity of care to patients. EMRs are a critical component in the evolution of the province’s health care system, which is why the OMA has been pushing for the expansion of them into every doctor’s office across the province. To date, more than 3,000 family physicians in Ontario have EMRs in their offices and by the end of 2009, 4 million patients will have an EMR.

“Doctors who use Electronic Medical Records report patient safety, continuity of care and quality of care have improved,” said Dr. Strasberg. “Ensuring that EMRs are available in every doctor’s office is an important

step towards improving and strengthening Ontario’s health care system.”

Above article published on

http://www.newswire.ca/en/releases/archive/June2009/09/c4722.html

Patient privacy rights are at the heart of research by a University of Virginia professor.

The Federal Stimulus Package is pumping $20 billion into the healthcare system to move it completely to electronic records, but state privacy laws may slow that down in Virginia and across America.

Electronic Medical Records (or EMRs) have been around since the 1970’s, but today less than half of America’s hospitals have a basic EMR system.

Virginia is one of several states with strict privacy protection for hospital patients.

“There is this idea that there may be identity fraud, in particular medical identity fraud,” says University of Virginia Economics professor Amalia Miller.

While the enhanced rules should protect hospital patients in Virginia, at the same time, they could slow down vital sharing of information between hospitals.

“One of the big benefits of going electronic about sharing information could be suppressed or blocked, and this would be an unintended consequence of these strong privacy regulations,” Miller says.

Miller says the investment in a widespread switch to electronic records would not only save lives, but up to $34 billion nationwide.

“It could save money by reducing costs spent on the administration of the hospital,” she says, “reducing time that staff has to spend on paperwork.”

Miller also says there are worries that the switch could compromise privacy.

“You can imagine with certain conditions, patients or individuals wouldn’t want their insurers to know, they wouldn’t want their employers to know if they’re getting health insurance from their employer,” says Miller.

Still she believes lawmakers can find a way to computerize records and still give patients the privacy they want.

“I think it’s important for policy makers to think about the potential conflict between these goals and to navigate them together, rather than think about them in place in isolation where they might be acting against each other,” Miller says.

A standard EMR system costs a hospital more than $17,000 annually per bed.

Miller says stricter privacy rules mean the system is even more costly because of the enhanced privacy filters and other design factors that must go into the system.

Above article published on http://www.nbc29.com/Global/story.asp?S=10473911&nav=menu496_2_1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By ALAN BAVLEY

The Kansas City Star

Mark Plautz commands his patients’ care with just a few clicks of a computer mouse.

Plautz, a critical-care specialist, can pull up his patients’ complete medical files from computer terminals throughout the Kansas City VA Medical Center, where he works. He can order tests, look at X-rays, make referrals.

All without putting pen to paper. “Instead of my illegible handwriting, I can order a prescription from here,” Plautz said.

Doctors and patients of America, this is your future.

The world of health care, high-tech in so many ways, is one of the last bastions of paperwork — files and orders written by hand, stuffed into folders and stored on shelves.

That’s all about to change. Tucked into the federal stimulus package is $19 billion to computerize the nation’s health care system.

The goal: For every hospital and doctor’s office to do what the Department of Veterans Affairs has been doing successfully for years — put patients’ records into computer files and share them electronically when patients visit other doctors and hospitals.

The White House wants electronic records available for every patient by 2014.

If all goes as planned — which some question — this digital revolution will make patients safer, help doctors practice better medicine, and save money by boosting efficiency. “It’s a historic investment,” said David Blumenthal, the newly appointed national coordinator for health information technology, who will oversee the drive to computerize. “We’re convinced that it’s possible.”

Medicare and Medicaid will use stimulus money to pay doctors and hospitals incentives to make the change.

Doctors who start by 2011 will collect $44,000, enough money to set up a system in the average office. Hospitals will get a one-time, $2 million bonus, plus higher Medicare or Medicaid payments.

By 2015, incentives will turn into penalties for those who lag behind.

Kansas City area doctors and hospitals could receive between $200 million and $300 million in stimulus money.

The federal government is still working out regulations to ensure patients’ privacy and technical standards so that different computer systems can “talk” to each other.

Challenges await

The rules are due by the end of the year. Meeting that deadline won’t be easy.

“It will be a big test of the federal government’s ability to deliver on the charge we have been given by Congress,” Blumenthal said.

Some doctors and conservative critics see electronic systems as an intrusion into medical practices that could take decisions out of doctors’ hands.

And some fret that the records will jeopardize privacy and that computer glitches could put patients at risk.

Potential risks are so great that the computer systems should get the same rigorous testing demanded of new drugs, said Sharona Hoffman, a Case Western Reserve University law professor.

Last year a glitch in the VA system affected nearly a third of its hospitals. Although no patients were harmed, the VA reported nine cases in which patients received incorrect drug doses.

But ideally, proponents of electronic medical records say, the system will work with the same seamless security as the networks of ATMs that allow customers of one bank to draw cash from machines operated by other banks.

Electronic medical records offer many opportunities to improve health care:

· Safety: No more medication mix-ups from garbled prescriptions. Alerts about drug interactions and allergies flash on the computer screen.

· Quality: As doctors examine patients, computer prompts recommend appropriate tests or treatments. When patients show up at the emergency room, their records will be available instantly online.

· Savings: No need to reorder tests or scans because the paperwork is missing.

Most researchers who have looked at whether electronic medical records can improve health care generally give automation good marks.

A recent study of urban hospitals in Texas found that the more advanced their computer systems, the lower were their death rates, complications and costs for some conditions.

For example, at hospitals where doctors had the most sophisticated software to help them make decisions about patient care, the average heart bypass cost $1,000 less.

“I can’t imagine not having electronic medical records,” said Plautz of the VA.

When Plautz sees a patient, he logs on to a computer in the exam room and calls up the record. On the screen, he gets a series of pages organized like a binder with tabs at the bottom.

The first page is a “cover sheet” with a list of the patient’s medical problems, allergies and current prescriptions. There are reminders to the doctor — if the patient needs a flu shot, for example, or should be prescribed certain drugs.

From there, Plautz can click tabs to pages for ordering tests, prescribing drugs or entering notes about the exam.

The VA’s decade-old system links all its hospitals and clinics.

Other health systems that have adopted electronic medical records also have been pleased with the results.

Group Health Cooperative, an HMO with 600,000 patients in Washington state and Idaho, maintains electronic records that patients can access from their home computers. They can review their lab results, order prescription refills and e-mail questions to their doctors.

“We’ve had huge usage,” said Gwendolyn O’Keefe, Group Health’s medical director for informatics. “It provides patient satisfaction and patients don’t abuse it. They respect physicians’ time.”

Although it is far from certain that all systems will work that way, Google and Microsoft have launched online services where people can store their medical information.

So far, only about 17 percent of doctors and 9 percent of hospitals have even basic electronic records systems.

“It’s costly, it’s complex, it’s transformational,” said Deborah Gash, chief information officer for the St. Luke’s Health System, which has been investing millions of dollars in the technology to go digital.

“Without an incentive to do it, people may be reluctant to take that step,” she said.

Many are waiting to find out which computer systems will qualify for federal incentive payments, Gash said.

But locally, early adopters are pioneering electronic records.

Two dozen Kansas City area employers and hospital systems sponsor a nonprofit network called CareEntrust that maintains electronic medical records on their employees.

Above article published on http://www.kansascity.com/105/story/1172352.html

By Tom Philpott: PNT columnist

President Obama’s ambitious plan to establish a lifetime electronic record for service members and veterans will improve delivery of benefits, speed processing of claims and, over time, open VA health care to any veteran, regardless of their medical condition or income level.

VA Secretary Eric Shinseki first raised the idea of a more sophisticated electronic record system, and linked it to automatic enrollment by all veterans in the VA health system, during a House hearing in February.

Last week, through a press spokeswoman, Shinseki confirmed universal access to VA health care is integral to the administration’s plan to develop as quickly as possible a 21st Century electronic record system.

“Secretary Shinseki and the whole (VA) team believe that ‘uniform registration’ ” in the VA health system “is an essential part of the lifetime virtual record,” said Katie Roberts, his press secretary, in an e-mail.

Shinseki and Defense Secretary Robert Gates were with the president April 9 in the Old Executive Office Building when Obama announced to an audience of veterans a “huge step toward modernizing the way VA health care is delivered and (VA) benefits are administered.”

Obama described a comprehensive electronic record system, to be developed and used jointly by the Department of Defense and VA, which would hold all service-related documents, administrative and medical, on individuals from the time they enter service until “they are laid to rest.”

Members leaving service no longer would have to “hand carry” medical records to VA health facilities. And VA health providers, like military counterparts, would have full electronic medical files on any member or veteran. VA claim processes likewise would have access to military administrative files, thereby reducing delays and mistakes for applicants.

“And it would do all this,” the president said, “with the strictest and most rigorous standards of privacy and security so our veterans can have confidence that their medical records can only be shared at their direction.”

Shinseki, a retired four-star general and former Army chief of staff, told the House Veterans Affairs Committee on Feb. 4 that he already was discussing with Gates a joint electronic record system.

“An individual enters the ranks as a youngster and stays for several years, or stays for 20, and comes to us as a veteran. Those records ought to be transferable … accurate and complete. Not just medical records but personal records as well, because the personnel records are also part of the disability adjudication process. If we can get to this agreement on what an electronic medical record looks like, we will solve the challenges we’re wrestling with today where we have two different records,” Shinseki said.

With regard to medical records, Shinseki said features of the VA Vista system were preferred, even by military doctors, to the more cumbersome AHLTA system used by the Defense Department.

At the same hearing, Shinseki said mandatory enrollment in the VA health care system should be part of any move to a joint electronic record.

Above article published on http://www.pntonline.com/opinion/veterans_17270___article.html/care_obama.html

To help transform health care, the state should invest more in electronic infrastructure that supports the automated exchange of electronic medical information, writes Russell Sarbora of Community Health Network of Washington. Increased efficiencies, lower costs and less waste of resources will help improve the health-care system.

By Russell Sarbora Special to The Times

IN Washington, state spending on health care ranks second only to education. The state has consistently asked how we can improve efficiency, reduce costs and focus scarce resources on insuring and caring for more Washingtonians.

The rapid exchange of accurate and timely information is going to transform the delivery of medical care. Infrastructure that supports the automated exchange of electronic medical information is and will continue to be a primary driver for efficient health-care delivery. We need to encourage and realize an efficient infrastructure for interoperability between electronic medical-record systems.

Washington state has at least two key assets already in place that have the potential to support creation of this infrastructure. These are the Washington State Health Care Authority-sponsored Health Information Infrastructure Advisory Board (HIIAB), and the Community Health Network of Washington (CHNW), the nation’s largest system of community health centers.

The 19 community health centers that make up the network are the primary health-care home for more than 600,000 low-income people in Washington state, including one-third of the state’s uninsured adults and one-half of the state’s uninsured children.

At CHNW we are working with HIIAB to achieve its objectives and have already implemented electronic medical-record systems that cover more than 70 percent of our member clinics and more than 85 percent of our patient population.

Business pressures will eventually produce efficient health-data-exchange services for patients served by commercial insurers and providers who rely primarily on commercially insured patients. But who will ensure that similar services are provided to vulnerable populations?

Through continued support for the HIIAB and by strengthening efforts to encourage the interoperability of electronic medical records, Washington state can improve patient health and safety while simultaneously controlling state-funded health-care costs.

Electronic medical records are used in the vast majority of acute-care facilities in Washington state; by all laboratory-service organizations operating in the state; by almost 25 percent of Washington’s primary-care physicians, and by more than 70 percent of CHNW’s member physicians. Yet, there is no statewide or national infrastructure today that supports sharing this information.

This infrastructure needs to be created, and the states that do so will lead the nation in delivery of efficient health care during the next decade. Washington state can and should be a leader in realizing this goal.

To achieve this leadership position, our state must adopt existing data-exchange policies and standards for health-information exchanges between organizations receiving state funding, provide incentives for technology investments required to support health-information exchanges, and financially support pilot programs that enable health-information exchanges.

CHNW is already working with HIIAB to create a Health Record Banking system that supports sharing of health information between patients and their health-care providers. We need to upgrade this existing business process to use current generation technology and thereby overcome existing shortcomings in reliability, efficiency and accuracy.

Interoperability between electronic medical-record systems is the key to achieving widespread sharing of clinical data. Today, these proprietary systems are incented to constrict access to the data they contain and there are numerous unresolved issues regarding access to the data and under what conditions data are shared.

Fortunately, the HIIAB is well-versed in these issues and well-positioned to support their resolution. The HIIAB is already proceeding with the creation of mechanisms to support patient access and control of their health data. However, the single greatest shortfall in the proposed Health Record Bank system is the absence of mechanisms to automatically include physician-created health data in these patient-controlled record systems. Lacking this critical body of data, the value of Health Record Banks will be substantially diminished.

We need to extend the HIIAB charter and role to encourage interoperability between electronic medical-record systems employed in Washington State and to achieve automated exchange of clinical data. The technology to do so already exists. Policy and will are the only hurdles to be overcome.

Russell Sarbora is the chief information officer for Community Health Network of Washington.

Copyright © 2009 The Seattle Times Company

Above article published on http://seattletimes.nwsource.com

Even in advance of the stimulus package, adoption of electronic records is increasing.

By Pamela Lewis Dolan, AMNews staff. Posted March 16, 2009.

An analysis of hospital health IT systems found that not only are more hospitals implementing electronic medical record systems, compared with a year ago, but the systems are becoming more sophisticated.

HIMSS Analytics, which rates hospital EMR systems on an eight-stage scale, announced in February that 42 hospitals are in the top two tiers of implementation, with 15 hospitals reaching the highest stage for the first time since the group started conducting the quarterly surveys in 2005. Those hospitals will be announced at an April 6 awards ceremony by HIMSS Analytics, a subsidiary of the Healthcare Information and Management Systems Society.

However, those hospitals represented fewer than 1% of the 5,166 hospitals that responded to the survey. More hospitals are somewhere in the middle to lower stages, with functions in place such as clinical documentation, error-detecting clinical decision support and photographic archiving systems outside of radiology.

Michael W. Davis, executive vice president of HIMSS Analytics said he was encouraged by the findings.

“As I look at where the market is moving I think the U.S. has done a pretty good job overall because, remember, all of the stuff they [hospitals] have been doing, they have been funding on their own. There has been no help from the government,” Davis said. “I’m just hoping that when we get the funding, we don’t mess that up.”

42 hospitals are in the top two tiers of EMR implementation.

The society in 2005 began rating hospitals quarterly with an eight-stage rating system called the EMR Adoption Model. Stage 0 represents no or very little installation, while Stage 7 represents hospitals that are fully electronic with medical records.

The data are self-reported by participating hospitals, with validation by HIMSS for Stage 6 or Stage 7.

Since the survey was published in February, Davis said, more hospitals have entered Stage 6, bringing that total number to 32, with 15 hospitals still in Stage 7.

Recent entries into Stage 6 range from the 4,049-bed UPMC system in Pittsburgh to the 55-bed Parkview Adventist Medical Center in Brunswick, Maine.

The stage that saw the largest increase (from 25.1% to 35.7%) since 2007 was Stage 3, which includes clinical documentation systems that mostly affect the nursing environment.

Hospitals with EMRs in the higher stages are the ones impacting physicians who would be expected to do clinical documentation, create continuity of care records within the EMR, and use clinical support tools for everything from error detection to clinical protocols.

Rod Piechowski, senior associate director of policy for the American Hospital Assn., said he found the survey’s findings encouraging, especially when coupled with the AHA’s finding that 68% of hospitals are on the road to full EMR adoption.

Don E. Detmer, MD, president and CEO of the American Medical Informatics Assn., said the findings were a “really clear indication of the work that lies ahead.” Dr. Detmer said he hoped that forthcoming stimulus package money dedicated to advancing health information technology will help further the efforts.

Davis and Piechowski both said they, too, were encouraged at the potential the stimulus money will bring in advancing EMR use. Davis said while government reporting guidelines, which would qualify hospitals for incentive money, would likely be met with a Stage 4 or 5 system, “those with Stage 6 and Stage 7 should be rewarded too. Just because they did this on their own doesn’t mean they shouldn’t be rewarded.”

Dr. Detmer said he hopes the stimulus money will help pay not only for the hardware and software, but also for the “clinical champions,” personnel with the expertise to implement the systems and help train people to use them.

Above article published online on www.ama-assn.org