Diana Manos, Senior Editor

The Certification Commission for Health Information Technology is expected to release more details on its “modular” certification on Sept. 24, and it is also tentatively planning training sessions in Chicago on Sept. 29 and Oct. 1, to orient vendors and developers to new programs, including updated application processes, certification criteria and test scripts.

The modular approach to certification would tell providers that a healthcare IT product is capable of performing to provide meaningful use, a requirement under the federal stimulus law under which providers could receive bonus payments beginning in 2011.

The certification would be provided in advance of the definition of meaningful use, which is expected out by the end of the year.

Federal officials have said providers would have to make “a business decision” as to whether to go forward in faith with the modular certification ahead of the final rulemaking.

The Certification Commission for Health Information Technology held a “town call” Web conference Thursday to gather input from the vendor and developer communities on the commission’s planned new paths to certification for electronic health record technologies.

CCHIT Chairman Mark Leavitt, MD, said the goal is to achieve more rapid, widespread adoption and meaningful use under the American Recovery and Reinvestment Act of 2009 (ARRA).

“We are concerned that providers could not achieve meaningful EHR use in 2011 if they wait until spring 2010 - the expected date of (the Department of Health and Human Services’)’ final approval of requirements - to begin adopting this technology,” said Leavitt, “CCHIT has analyzed the recommendations of the federal HIT advisory committees and is preparing to offer new paths to certification beginning this October.”

Besides updating and enhancing its certification program for comprehensive EHRs in ambulatory, inpatient and emergency department settings, the commission plans to launch a more limited, modular inspection program for EHR technology, focusing solely on compliance with ARRA-required standards.

In an Aug. 14 meeting, the federal government’s Health IT Policy Committee adopted additional recommendations on meaningful use and proposed expansion of EHR certification to include 10 to 12 certification panels in addition to the existing Certification Commission for Health Information Technology. Physicians, activists, vendors and others warned the committee at a meeting that it was moving too fast.

Above article published on

http://www.healthcareitnews.com/news/cchit-maps-out-path-certification-meaningful-use-focus

Privacy becomes an issue with electronic health records

The Obama administration’s drive to implement electronic health records (EHRs) should have strong identity management tools to ensure privacy and security of the records, members of a panel of providers, vendors and policy experts said today.

The coming health information technology policies and standards are to include protections for patient privacy and security and safeguards against medical identity theft. Achieving those goals could be advanced by identity management tools, such as strong authentication standards and smart cards, according to panelists at an event in Washington today organized by the Smart Card Alliance and the Secure ID Coalition. Both groups represent vendors of identity management programs.

For example, patients checking in to Mount Sinai Medical Center in New York City are assigned a smart card that contains their photograph and a digital summary of recent clinical information. By delivering the information to doctors providing care, the card helps improve care and reduce medical errors. The card also has proven to be critical in reducing fraud and identity theft, which in turn decreases errors in payments and in patient care, said Paul Contino, vice president of IT at Mount Sinai.

“If you don’t catch the errors at the registration desk, you will see dramatic effects downstream,” Contino said. “If you are going to spend money on health IT, you need the right identification standards.” Without strong ID management, care records are likely to have errors because of false identities, misspelled names, duplicative names and other problems. Even a single error, such as a wrong blood type listed on a patient’s record due to a mix-up with another person’s identity, can lead to catastrophic consequences for a patient, he said.

Congress approved spending $17 billion in incentives for doctors and hospitals that install and use health IT systems as part of the economic stimulus law. The Health and Human Services Department is drawing up standards and policies to distribute payments to providers who can show meaningful use of health IT. HHS also is setting up a framework for secure exchange of the health data and the department’s national coordinator for health IT on May 15 released a road map for creating the standards and policies under the stimulus law.

One standards will involve controls on access to patient records. The leakage of private medical information can affect a patient’s employment, housing and insurance status, and because of that extreme sensitivity, medical information requires more than a password for secure handling, said Michael Magrath, director of business development for North America for Gemalto Inc.

“Health information exchanges and regional information exchanges will be targeted by hackers,” Magrath said. “I have strong concerns about the prospect of minimum standards,” such as passwords alone. Identity authentication standards for receiving medical care and handling medical data should require a password and also use of some type of identity token or certificate issued by a third party, he said.

Ideally, patients would be in charge of — and would have complete access to — all of their health records, said William Yasnoff, managing partner of the National Health Information Infrastructure Advisors consulting firm.

“Who has your complete medical records? For most people, it’s no one,” Yasnoff said.

Above article published on

http://fcw.com/articles/2009/05/19/obama-health-it-initiative-needs-strong-id-management-vendors-say.aspx

Former Gov. Mark Warner said sharing medical records among providers will improve care and reduce costs.

By Sarah Bruyn Jones
With nearly $20 billion in federal funds about to hit the world of health care information technology, Virginia’s health sector and political leadership are trying to prepare to capture their share of the money.

The money is part of the federal stimulus bill signed by President Obama in February and is intended as a financial incentive to get the health care industry to embrace using electronic medical records. Still, the timeline and details of how the money will be distributed have not been finalized.

“This represents a big leap forward for health technology, so we are excited about it,” said Virginia Secretary of Health and Human Resources Marilyn Tavenner. “We just want to be positioned to take maximum advantage of it.”

Some monies will likely go directly to the states to be distributed, while other funds will be allocated through a competitive grant process.

Tavenner said a significant amount of money coming to Virginia could boost job growth for information technology specialists as more health providers implement electronic record-keeping systems.

To help ready Virginia for coming funding, U.S. Sen. Mark Warner has arranged for a health IT summit Monday in Richmond. The national coordinator for health information technology, recently appointed by Obama, will be at the summit.

“This is going to be one of the areas that is going to drive health care reform,” Warner said.

The state will form an advisory group to help Virginia providers access the federal money and implement effective electronic medical record systems.

Between 15 and 20 people will be named to the group, including four people already named to the newly created Health Information Technology Standards Advisory Committee, which was established by the 2009 General Assembly, Tavenner said.

Warner said establishing electronic medical records in hospitals, nursing homes and physicians’ offices throughout the state will improve care and reduce costs.

“There is no reason why health care can’t get some of the efficiencies that every other field has,” he said, pointing to manufacturing and telecommunications as examples.

While the guidelines for exactly how the money will be distributed are still being worked out, Warner said he believes that cooperation between different health care providers will be the key to attracting government dollars. That includes requirements that different hospital systems and physicians’ offices be able to share information.

Warner, who has a background in telecommunications, said the system should be similar to the way cellphone companies operate: There are different providers, but a call from a Verizon phone can be received by a Sprint phone. Financial incentives will be needed to push a working system into operation, he said.

Questions remain about the security of such a system. And some medical providers don’t want to share all their data with another business due to competition in the industry.

Carilion Clinic’s chief information officer, Daniel Barchi, said it is important for system administrators to talk to each other as electronic records become the standard. Carilion began rolling out its new multi-million-dollar record system last year and has been in discussions with some other hospital systems in the state to share experiences, he said.

“The more that health IT leaders get together, the better off we are going to be,” Barchi said.

He is one of the four people already appointed to the advisory committee.

“By cooperating and choosing a common data record, there is a way we can share — with patient permission — information across all these health systems,” Barchi said. “And I think the government is doing an admirable job of putting incentives out there for the providers to make their systems more interoperable.”

The state-led efforts also focus on helping providers who don’t already have electronic medical records systems establish one. That’s because much of the federal funding will be tied to providers who already have an electronic record in use.

Above article published on

http://www.roanoke.com/business/wb/205025

Switch is four years ahead of schedule

By CAROL REITER
President Barack Obama has decreed that all medical files be electronic by the year 2013.

Mercy Medical Center Merced is ahead of the game by about four years.

By next week, the local hospital will have all its medical records on computers. Loretta Stuart-Edgerton, director of the health information department, said that with the old handwritten charts, data were input by hand and could only be looked at by one person at a time.

MARCI STENBERG

Merced Sun-Star - Rachel Minor, a tech with the health information management team at Mercy Medical Center Merced, files a paper chart at the hospital on Tuesday afternoon. The hospital is changing over to electronic medical files within the next week.

“We had three different storage areas for the charts,” Stuart-Edgerton said. When the crossover to electronic records is complete, there will only be one offsite, long-term storage site.

Shawn Withrow, who is in Merced helping Mercy with the transition, is an employee of Catholic Healthcare West, Mercy’s parent company. He said the new way of putting records on computers will be cost effective for the hospital.

“There will be quicker retrieval and more than one person at a time can look at a medical record,” Withrow added.

For people worried about many sets of eyes looking at their medical records, Withrow said that is exceptionally hard to do. If anyone is caught, it’s a fine and jail time.

Recently, Farrah Fawcett’s medical records from UCLA were leaked to tabloids. The specialist who leaked Fawcett’s records pleaded guilty to a felony charge of violating federal medical privacy laws. The specialist, Lawanda Jackson, died of cancer in March before she could be sentenced.

“It’s a fireable offense,” said Stuart-Edgerton. “Mercy’s human resources has policies in place about what would happen if a person does look at medical records.”

Carol Caceres, a systems analyst for medical information at Mercy, said putting records on computers will make it easier for physicians. “Now multiple doctors can look at a chart at the same time, and discuss it,” Caceres said.

Although doctors notoriously oppose change, especially when it comes to computers, Caceres said local physicians have been satisfied with the change.

“A lot of our doctors also go to Emanuel Medical Center (in Turlock) and Children’s Hospital Central California,” she said. “Those hospitals already have electronic files. Plus, we are holding classes for doctors to learn the system.”

The staff in medical records has put about 90 percent of the charts online already, and everyone seems to be pleased with the new system.

“Now doctors can log on in their own office,” said Stuart-Edgerton. “Saves them a trip down here.”

Above article published on

http://www.mercedsunstar.com/167/story/842570.html

e-Patient Dave (right) while on a panel at Health 2.0

As is well known by now, part of the federal stimulus package included $19 billion for electronic medical records (EMR) implementation — and part of those billions include incentives for physicians and hospital groups that implement EMRs by various deadlines. Of course, the implementation also has to meet a criteria referred to as “meaningful use,” however, the legislation purposefully left out just what “meaningful use” meant.

In the past few weeks, health IT thought leaders have sketched out their own takes on what meaningful use should mean, but only the most recent opinion piece includes an analysis that suggests connected devices and smartphones may have a place in that definition.

Dave deBronkart, also known as ePatientDave, has written an eloquent post on the ongoing debate as to what “meaningful use” should mean for EMR implementation. One of deBronkart’s central points is: “The systems we design today will be in use a long time from now, so I suggest we look at the world as it will be in 2020, and how we’ll be using these systems then.”

deBronkart goes on to emphasize that everything and everyone will be ten years older — you, your parents, your children — and even the Internet will have ten more years of innovation behind it. Our oldest doctors today will be retired or deceased by then, and doctors like Fast Company’s “Doctor of the Future” Jay Parkinson (of Hello Health) will be middle-aged, he writes.

“Handheld computers (smartphones) will be ten years more advanced,” deBronkart writes. “(More advanced? Heck, the iPhone was only introduced 28 months ago.) Connected e-health devices will be out of their infancy: WiFi blood pressure monitors, bathroom scales, glucose monitors, you name it. It’s fairly certain that by then we’ll be able to use cheap devices that send routine data to some central storage place, where smart software (your choice of smart software) can send out alarms or reminders, your care team can view it … and you should be able to view it, too. And make notes on it.”

Predicting the future is no easy task, and deBronkart does a nice job of only hinting at the vision of a more connected health environment in 2020, but decisions makers at ARRA need to decide now whether and (then how) technologies like connected devices should be included as part of the definition for meaningful use.

Above article published on

http://mobihealthnews.com/2164/should-meaningful-use-include-connected-devices/

A recent report published by San Jose, CA-based Global Industry Analysts, Inc., providing off-the-shelf market research publications, predicts the global hospital information systems (HIS) market to reach more than $35 billion by 2015.

The HIS helps manage and consolidate clinical, financial and operational data, supporting interoperability and connectivity across the continuum of care. In attempts to reduce medical errors, minimize expenditure and enhance care delivery services, the healthcare industry has witnessed a great demand for healthcare information technology, with many hospitals and healthcare organizations investing in robust HIS and other information systems like electronic health records (EHR), picture archiving and communication systems (PACS), revenue cycle management solutions, etc. With efforts to improve care delivery and patient safety HIS adoption is also being increasingly promoted by the Governments worldwide, through various initiatives and incentives as seen by the US Centers for Medicare and Medicaid Services (CMS), and the recent $787 billion American Recovery and Reinvestment Act signed into law by President Barack Obama, which earmarks $19 billion for health IT.

According to Global Industry Analysts’ current report, some of the worldwide HIS market and adoption trends include:

HIS trends in the healthcare IT global market

• From an international standpoint, the United States was found to have the biggest market for hospital information systems. The healthcare industry has witnessed a surge in the adoption of custom-made radiology information systems (RIS) and laboratory information systems (LIS), with potential market for the electronic medical record (EMR) solutions.

• Considered next in line, is Asia-Pacific, which in spite of having a smaller market with regard to revenue, holds wider opportunities for HIS. With an estimated 11.5% compounded annual rate of growth (CAGR) over the coming years, Asia-Pacific (apart from Japan) has become one of the fastest growing markets for HIS solutions, and also forebodes well for the prospective HIS market, worldwide.

• Additionally, the analysts predict increased growth in the emerging Health Informatics market in China, Australia, India, Malaysia, Thailand, and the Philippines.

Growth in various HIS segments

• Although Non-Clinical Information Systems, pertaining to the financial and administrative departments of a hospital, initially set the ball rolling for HIS adoption, according to the report, clinical information systems (CIS) have taken over in terms of adoption and revenues in the healthcare market.

• Among the various HIS offerings, clinical information systems hold the largest share in the product segment. The US represents the largest market for CIS solutions, which is estimated to increase by about 7.2% CAGR over the coming few years.

• The primary driving force for the CIS segment could be attributed to the healthcare industry’s growing demand for CIS as a decision-making tool to help reduce costs, optimize on workflow and enhance quality of care delivery.

Above article published on

http://www.healthnewsdirect.com/?p=509

By Cody Kraatz

Sunnyvale Sun

Health care is going digital in Santa Clara County, which is rolling out electronic medical records at each of its Valley Health Center sites — including the one at 660 S. Fair Oaks Ave. in Sunnyvale. The goal is to make medicine safer and more efficient.

The switch from paper to digital records — something that President Barack Obama touted since he was campaigning — will take some time, and the county expects the Sunnyvale clinic to go live in June. The clinics provide outpatient services such as internal medicine, pediatrics and obstetrics.

“Patients have had untoward consequences and even deaths related to medication problems, inaccurate diagnosing or interactions between medications, or sometimes people didn’t completely know the information about a patient,” said Dr. Robert Horowitz, associate chief of primary care at Valley Health Center Moorpark in San Jose.

He was one of the first to try the electronic medical records system, starting in April 2008, and he said that despite some challenges it stands to help with several problems.

The county has numerous clinics in addition to the Valley Medical Center hospital, and a patient could have different charts at each location. “It’s really difficult to get a sense of one record that everybody sees and contributes to,” said Horowitz.

“The practice of medicine is really a collaboration, and many people participate in that,” including physicians, managed care coordinators, chronic disease specialists, pharmacists and dietitians, he said.

Doctors can also manipulate data from many visits or the course of a disease to tease out patterns in a patient’s history. “Those of us who have been using [electronic records] the longest are seeing the benefits of having the information at your fingertips,” said Horowitz.

The county is also hoping to secure funding from the American Recover and Reinvestment Act, or stimulus, for inpatient electronic medical records at the county hospital. But the county won’t decide how much stimulus money to seek until after May, when it expects the federal government to release criteria for how applicants must show a “meaningful” usage for the funds.

Besides the Moorpark clinic, the outpatient system was rolled out at the Valley Health Center Silver Creek in January and at the Valley Health Center East Valley in early April.

The county hopes that the cost of the system — which was one of eight elements of a $43.6 million information technology contract signed in 2006 — will be recouped through the efficiency that the system allows.

Take prescriptions, for example. The system allows a doctor to write a prescription directly into the computer and send it to the pharmacy electronically, saving the patient time.

Also, “you no longer have the doctor’s traditionally terrible handwriting to sort out,” Horowitz said. Moreover, because the patient’s existing prescriptions are in the electronic record, the system can highlight potentially dangerous drug interactions or allergies.

With paper records, that process would likely be slower. Refills — of which some doctors fill 25 to 100 per day — become more rapid through electronic requests, too.

All this could, in the end, save the county money. But many, including those who are not as technology-savvy, are finding that electronic medical records slow them down.

“That is definitely an issue that we will need to grapple with. I think it does make me a little bit slower,” said Horowitz.

It takes about six months to get comfortable with the program, which includes a mind-boggling number of pages, templates and data entry fields. There have also been technical glitches that the county hopes will be ironed out by the time clinics such as Sunnyvale’s go online.

Meanwhile, doctors who are accustomed to taking notes about patient visits by hand may feel that the many entry fields of the software disrupt their flow.

“It’s a significant learning curve both to learn the product but also to learn to use the [electronic record] and be with a patient at the same time,” Horowitz said. “You’re almost speaking a different language.” There is, however, a space for free text and he makes use of that.

There are also opportunities to make treatment more collaborative and transparent for patients, he said, by showing them what he is entering on the screen and asking them to review their medications with him.

Patients have been mostly enthusiastic about the electronic records, in Horowitz’s experience. “It’s sort of a`What took you so long?’ kind of feeling. This is a modern way to do medicine, and this is the way people expect medicine to be done,” he said.

However, he does know of one patient who refused to have information entered into an electronic record, fearing that it would be insecure. Ultimately, there will be no opting out.

Likening electronic records to e-mail, Horowitz said that within a year he expects doctors to feel the way he does. “I don’t know how I could have lived without it. I couldn’t see going back to the other way.”

http://www.mercurynews.com/valley/ci_12203584

WPI team launches international study to glean insights and best practices for realizing the benefits of electronic medical records and health care IT systems

WORCESTER, Mass. – The push is on to bring the U. S. health care system into the digital age by replacing paper-based systems now used at many medical facilities with electronic medical records systems and other information technology (IT) tools. To understand how best to realize the benefits these systems can provide, a team of experts at Worcester Polytechnic Institute (WPI) has launched a three-year study of health information technology (HIT) systems now in various stages of implementation at four medical organizations—two in the United States and one each in Canada and Israel.

Funded by a $750,000 grant from the National Science Foundation, the study will focus on the primary care setting to examine and analyze how implementing HIT systems impacts medical providers, their patients, and the operations of the health care delivery system. The goal of the study is to develop new insights and best practices to help guide future HIT implementations at other medical facilities. “Adapting to computer systems will be a learning process for primary care organizations, for physicians, and even for patients,” said Diane Strong, Ph.D., professor of management at WPI. “From what we observe, we will develop new ideas and new concepts for health care delivery, such as better ways of organizing work flow and decision making to take advantage of the new opportunities enabled by these IT systems.”

Strong and colleagues Sharon Johnson, Ph.D., associate professor of industrial engineering, and Isa Bar-On, Ph.D., professor of mechanical engineering, are the principal investigators leading the study. The team has extensive experience analyzing the impact of IT systems in other large organizations, such as global manufacturing companies, which have been using enterprise-wide computer systems for decades, with varying degrees of success. “As we’ve seen in many other complex organizations, just installing an IT system alone typically doesn’t achieve efficiencies,” Johnson said. “What has to happen is that an organization and its processes need to adapt to realize the efficiencies and quality improvements that are enabled by IT—and that’s tough to do. If processes don’t adapt, then just imposing at IT system alone can be counter-productive.”

In the United States, the study will focus on two organizations in Massachusetts: Fallon Clinic, a large group medical practice located throughout Central Massachusetts, and UMass Memorial Heath Care, an integrated medical system with 700 primary care physicians, several community hospitals, and an academic medical center serving Central New England. In Canada, which has universal coverage and a single-payer funding system, the study will include primary care offices of the Vancouver Coastal Health District. In Israel, which has a hybrid health care delivery model with four health funds that provide medical care to the entire population, the study will examine primary care practices in two of the health funds.

These four sites were chosen because of their diversity of operating models, management structures, financial systems and cultural differences. The sites are all at different points on the continuum of migrating from paper-based systems to fully digital systems, giving the researchers a broader range of perspectives and data for analysis. Israel, for example, has the most extensive experience with HIT, with more than 90-percent of physicians there already using the technology. “Looking at the experience in Israel will give us a reality check,” Professor Bar-On said. “We’ll see what works, and what doesn’t, and learn from people who have been using these systems for more than 10 years. And we will examine how the organization changes in response to the implementation of these systems. We want to see how people live with the systems.”

Over the course of the three-year study, the research team, working closely with the leadership at each of the primary care sites, will conduct an extended series of interviews and observational sessions with physicians, management and support staff. The researchers will observe the planning for HIT implementations and the roll-out of the systems in various locations, and examine how management and staff adapt to the new systems and tools.

“We are fortunate to have outstanding partners at the four clinical sites to work with on this project,” Professor Strong said. “We are not evaluating any particular software package or software vendor. Our focus is on how organizations must adapt to realize the potentially transformative benefits that can be achieved by the use of these new systems and the data they will collect.”

About Worcester Polytechnic Institute

Founded in 1865 in Worcester, Mass., WPI was one of the nation’s first engineering and technology universities. WPI’s 14 academic departments offer more than 50 undergraduate and graduate degree programs in science, engineering, technology, management, the social sciences, and the humanities and arts, leading to bachelor’s, master’s and PhD degrees. WPI’s world-class faculty work with students in a number of cutting-edge research areas, leading to breakthroughs and innovations in such fields as biotechnology, fuel cells, information security, materials processing, and nanotechnology. Students also have the opportunity to make a difference to communities and organizations around the world through the university’s innovative Global Perspective Program. There are more than 20 WPI project centers throughout North America and Central America, Africa, Australia, Asia, and Europe.

Above article published on http://www.eurekalert.org/pub_releases/2009-03/wpi-mti030509.php

I have been learning about the Web 2.0 for more than a year. Since February I have been writing about it in this blog. The purpose is to share with others what I know, to get more and more people involved with it. Not all my colleagues I have talked to about it really understand the concept or why it is so important to learn about it though.

That is why I have been thinking how to teach my colleagues in the health care community about the importance of Web 2.0 and Medicine . But without complicated terms or definitions. Why is important to learn about it? For me it is really clear that these concepts and technologies of the web 2.0 applied to medicine are going to change how the flow of medical information is created. With the use of these “new” tools we are going to go back to basics, and we will have the chance to learn medicine in a Socratic way again. We will have more time to spend with our peers to talk about the humanistic side of medicine. Learning about Web 2.0 and Medicine is as important as to learn about writing . All of us recognize the importance of knowing how to write. I think all of us can recognize the importance of writing in the mankind history.

I going to quote The British Library Board . Why to write: “For thousands of years human beings have used marks, symbols, drawings and signs to communicate with one another. In order to share knowledge, we need to be able to store information and pass it on to future generations. Memory is our first resource, but, over the centuries, we have developed many other ways to store and transmit information.”

You know how to write in paper format and you know all the advantages it has. But do you know how to write on internet ? How much do you know ? Can you imagine all the opportunities the learning of these technologies can generate? That is why to learn about Web 2.0 and Medicine is important.