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/

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

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

By Dennis R. Horrigan

An electronically connected health care system promises better access, improved reliability and lower costs. A portion of President Obama’s stimulus plan is aimed at having an electronic health record in every exam room. This investment in health information technology has the great potential to improve the functioning of our health care system.

Supporters and critics are facing-off on the pros and cons of this initiative. Supporters cite the potential savings that will be achieved through increased efficiency and patient self-directed care, while critics point out that cost savings is exaggerated and implementation will be slow.

Technology alone will not improve our health care system, and simply having a computer in every exam room will not be sufficient. Physicians and nurses will need continuous training on how to improve care. Equally important is engaging patients. Patients who take responsibility for their health care will have better outcomes. Make no mistake, the transition from paper to an electronic system will be disruptive, but it is important work that must be done.

The electronic health record may aid physicians in documentation, coordination of care, adherence to quality guidelines, ordering tests and prescribing medications. Electronic prompts can alert physicians to adverse drug interactions, when laboratory results are not normal and enable physicians to better monitor the care for patients with chronic health conditions to help avoid emergency room and hospital visits.

These systems are designed to be “interoperable” so that physician-to-physician and physician-to-hospital communication can be timely and reliable. The physician you see on Wednesday will have an electronic report of the services you received the day before at the specialist office.

Patients will be able to access their records, review test results, schedule appointments and request prescription refills. No more waits and delays on the phone trying to reach the office. A connected health care system will enable patients to communicate to their physician using e-mail and to have an electronic visit. Imagine e-mailing your physician for assistance with non-emergent medical issues and receiving medical advice and treatment online or accessing your physician’s Web site to gain valuable information you can use to manage your health care needs.

An electronically connected health care system has the greatest potential to reduce the duplication of services and the poorly coordinated care that is responsible for a large share of rising health costs. All physicians and hospital leaders need to embrace this formula for success by adopting technology, training staff and proactively engaging patients. Now is the perfect time for the health care system to embrace electronic health records and let the patients reap the benefit.

Dennis R. Horrigan is president and CEO of Catholic IPA Western New York, a partnership between Catholic Health and a network of associated physicians.

Above article published on www.buffalonews.com

The Healthcare Information and Management Systems Society (HIMSS), representing more than 20,000 individual members - of which 73% work in provider settings - and 350 corporate members, today announced its support for the health information technology (IT) provisions in the American Recovery and Reinvestment Plan of 2009 proposed by Congress. HIMSS believes the inclusion of funding for health IT is essential if we are to meet President Obama’s goal of computerized health records for all Americans by 2014.

HIMSS cites three reasons to support the investment in health IT:

1. The economy will benefit from an investment in health IT

According to research by IBM and the Information Technology and Innovation Foundation, investing $10 billion in Electronic Health Records (EHR) and other health-related IT projects would create 212,000 jobs.

Furthermore, multiple independent studies have shown substantial return on investment for health IT, which could help lower healthcare costs.

• Deloitte LLP reported this month that investing in e-prescribing and electronic medical records, along with better coordination of patient care through primary-care doctors, would result in 10-year savings of $530 billion.
• The RAND Corporation reported in a 2005 study that widespread health IT adoption (90 percent of hospitals and physicians) could save $77 billion annually. In testimony presented before the Senate Finance Committee on July 17, 2008, RAND forecast that during the 15-year adoption period, cumulative net savings would be about $510 billion or approximately $34 billion per year.
• The Center for Information Technology Leadership estimated in a 2005 study that full implementation of health IT could yield annual savings of $77.8 billion.

2. Patients will benefit from an investment in health IT

When used properly, EHR systems can help keep patients safe by alerting clinicians to harmful drug interactions or allergic reactions to prescribed medicines and helping clinicians manage the health of patients with complex chronic conditions.

Evidence of improvements in patient health associated with IT has been shown:

• The Jan. 26, 2009, issue of the Archives of Internal Medicine includes a study by Johns Hopkins School of Medicine that found a 15 percent reduction in patient mortality rates during hospitalization at centers that use computers instead of paper.
• A 2002 study reported in the Journal of the American Medical Informatics Association suggests that health IT could reduce the average length of a hospital by reducing delays associated with certain hospital functions and by avoiding costly errors.

3. Doctors will benefit from an investment in health IT

While many physicians realize the positive impact successful EHR implementation can have on a practice, the Congressional Budget Office reported in May, 2008, that as of 2006, only 12 percent of physicians and 11 percent of hospitals have adopted all or most recommended health IT functionalities. Survey results published in the July 3, 2008, issue of The New England Journal of Medicine found that 66 percent of doctors who have not adopted an EHR system cited cost as the biggest barrier to adoption.

In the 2008 study, the vast majority of physicians who have adopted an EHR system are satisfied with the product: 93 percent of physicians who use fully functioning EHR systems reported being generally satisfied with the systems. The same survey results showed that 82 percent of physicians who had fully functional EHR systems reported positive effects of the system on the quality of clinical decisions.

An added benefit for physicians could be lower malpractice insurance costs. The Congressional Budget Office reports that multiple physician liability insurance firms offer discounts to practices that have adopted EHR systems.

“The state of the economy and the healthcare system warrant a significant investment in health IT, especially in light of President Obama’s calls to computerize all health records within five years,” said H. Stephen Lieber, HIMSS president and CEO. “We support the health IT legislation that has been recently introduced and believe it will allow the industry to take important steps toward delivering better quality healthcare more efficiently and at a lower cost.”

In December 2008, HIMSS released A Call for Action: Enabling Healthcare Reform Using Information Technology, outlining specific priorities and recommendations for the Obama Administration and 111th Congress in regards to health IT. The recommendations were developed by more than 100 HIMSS member volunteers and represented necessary measures to develop and sustain a robust health IT infrastructure. The report is available online at www.himss.org/2009calltoaction.

For more information, visit www.himss.org.

About HIMSS

The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry’s membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. Founded in 1961 with offices in Chicago, Washington D.C., Brussels, Singapore, and other locations across the United States and the globe, HIMSS represents more than 20,000 individual members and over 350 corporate members that collectively represent organizations employing millions of people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems’ contributions to ensuring quality patient care.

Contact(s):

Joyce Lofstrom

312-915-9237

If you’re like the majority of physicians, you don’t prescribe electronically and you don’t see why you should. After all, what’s wrong with the old prescription pad that has served you well over the years? But citing safety, quality, and efficiency, the government, private insurers, and some medical societies want you to change your mind.

This month, a CMS initiative will start adding 2 percent to your Medicare payments if you prescribe electronically. The incentive drops to 1 percent in 2011 and 2012 and to 0.5 percent in 2013. Starting in 2012, CMS will pay you 1 percent less than its fee schedule if you don’t e-prescribe; that penalty will rise to 1.5 percent in 2013 and to 2 percent in 2014 and every year thereafter.

Speaking at a recent conference in Washington, D.C., CMS acting administrator Kerry Weems said he was confident that the incentive “changes the business case enough that we’ll see investments made in e-prescribing. We also think some private payers will come along with us.”

But with standalone e-prescribing systems priced at around $3,000, plus monthly maintenance fees, observers are divided on whether the CMS incentive alone will be sufficient to get doctors to adopt e-prescribing. Bruce Merlin Fried, a Washington, D.C., healthcare attorney and health IT policy expert, is one of those who think that it will: “The incentive will have an enormous impact on doctors moving toward e-prescribing.” The penalty on the back end, he adds, will convince many other physicians to do the same.

Representatives of primary-care medical societies, however, are less optimistic. Steven Waldren, director of the American Academy of Family Physicians’ Center for Health Information Technology, which has been promoting e-prescribing for years, says, “I don’t think the 2 percent incentive will be enough for most family physicians. It will accelerate the thinking of people who are close to making the decision for their practice; but for those physicians who don’t think they should be e-prescribing or aren’t ready, this 2 percent — which, for a family physician, is about $1,400 a year — is not enough to change their decision.”

The incentive is prompting some physicians “to take a harder look” at e-prescribing, says Michael Barr, vice president of practice advocacy and improvement for the American College of Physicians. “It’s not something people are taking lightly. Some doctors are wondering, ‘If I’m going to invest in technology, is now the right time for me to go the EMR route, or should I go to e-prescribing?’”

Both the investment and the work flow changes are much greater with an EMR, he admits. “But if your practice has been thinking about an EMR, and hasn’t been able to create a business case for it, and if you’re on the fence, the e-prescribing incentive might push you over.”

Other help

Of course, you’d be more likely to adopt e-prescribing if all of your payers, not just Medicare, were providing incentives. Don’t hold your breath: Waldren says such a widespread move is unlikely, noting that most plans doubt that they’ll see a return on investment. But Blue Cross and Blue Shield of Massachusetts will require physicians to e-prescribe by Jan. 1, 2011 in order to participate in the plan’s incentive programs. Highmark Blue Cross Blue Shield and Blue Cross Blue Shield of Delaware are helping doctors switch to e-prescribing, and several other Blues plans have agreed to support a service offered by Prematics, a Vienna, Va.-based firm that gives e-prescribing technology to practices for free. Insurance companies also fund the PocketScript e-prescribing service of ZixCorp, based in Dallas. And the National ePrescribing Patient Safety Initiative, a coalition that includes technology companies and plans such as Anthem, Aetna, and Horizon Blue Cross Blue Shield of New Jersey, is offering physicians free e-prescribing software.

As for hospitals, most have been slow to offer a helping hand, despite a 2006 relaxation of Stark self-referral rules that was supposed to encourage them to subsidize information technology for private practices, according HIMSS Analytics, a healthcare IT research firm. They seem even less inclined to offer assistance with e-prescribing, according to Dave Garets, the firm’s president.

Online only

Further change is coming even for those physicians who have already adopted e-prescribing via their EMR’ s, most of whom are computer-faxing prescriptions to pharmacies. Starting this year, CMS prohibits computer-faxing of electronic prescriptions covered by Part D drug plans. Kevin Hutchinson, president of Prematics and former president of SureScripts, the firm that connects physician offices with pharmacies, says he thinks this will have a big impact on increasing the percentage of online scripts. All that most physicians with EMRs have to do to prescribe that way, he notes, is to get their vendors to upgrade their systems to the latest version.

According to SureScripts, the number of online prescriptions is rising fast. In 2007, 35 million online prescriptions were written, with 6 percent of office-based doctors prescribing online. In 2008, SureScripts expected 100 million prescriptions to be written and sent electronically. They projected the number of physicians e-prescribing online would jump to 85,000, or 15 percent of office-based doctors.

Many physicians will continue to hold off on e-prescribing, partly because of federal and state rules that forbid electronic prescriptions of controlled substances. Nobody wants to have a dual paper and electronic workflow in their office. This is also a problem in areas where only some local pharmacies accept electronic scripts. While nearly all chain pharmacies do, many independent drugstores continue to hold out. At the end of 2007, 70 percent of all community pharmacies accepted electronic scripts, but only 27 percent of independents did.

Still, there’s no doubt that the e-prescribing train is gathering steam. And, while it’s doubtful that there will be a federal mandate to e-prescribe, you should probably start taking a close look at the pros and cons of moving in this direction yourself. When most of your colleagues have made the leap, and your patients expect it, do you want to be the last doctor using an old-fashioned prescription pad?

Ken Terry is a New Jersey-based freelance writer and the author of the book “Rx for Health Care Reform.” He can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the January 2009 issue of Physicians Practice.

I recently read a really interesting and informative article called “Five Reasons Why EHR Implementations Fail.” My only problem with this post is that it focuses too much on the negative. Too many doctors (and all clinical staff) are looking for reasons to have their EHR fail and not enough of them are looking at the reasons why an EHR implementation will succeed.

Therefore, here’s my 5 reasons why your EHR implementation will succeed.

Amazing Trainers
There are amazing trainers out there that have gone through hundreds of successful EHR implementations. Make the time for staff to utilize one of these trainers and you’ll see amazing results in implementing an EHR. Soon after implementing your EHR you’ll wonder how you practiced medicine without an EHR.

Realistic Implementation Schedule
Create a realistic implementation schedule and stick to it. Be open to modifying the schedule as needed, but don’t let excuses get in the way of your plans. Everyone is always busy. Staying on schedule is more about making the EHR implementation a priority. Make it a priority and you’ll have no problem staying on schedule. Also, remember that you don’t have to bite everything off at once. Take it in stages and celebrate the milestones you achieve.

Succeed Despite Challenges
Tons of unrealistic expectations exist around the benefits of EHR implementations. One clear expectation is that every EHR implementation has unique challenges. However, thousands of doctors have faced these challenges and successfully implemented an EHR despite the challenges. There’s no reason you can’t overcome your own unique challenges as well.

Forget About Timing
Certainly there are some times that are better than others for implementing an EHR. You know your practice and should schedule your EHR implementation during a slower time for the practice. However, once you’ve made the decision to implement don’t dwell on the timing, but instead focus on ways you’ll overcome whatever challenges happen because of timing. Reminds me of a common phrase said about marriage, “Before marriage keep both eyes open. After marriage keep both eyes closed.” Apply the same conviction to implementing an EHR and you’ll be amazed by the results.

Create Clinical Buy-In
Each situation is unique, but don’t be surprised if some of your most ardent opponents turn out to be some of your most powerful users. The person complaining about an EHR implementation are probably the same people that are complaining about finding paper charts and illegible charting. An EHR does amazing things to solve these problems. Focus on these types of benefits and it’s very likely that you’ll have more clinical buy-in than you’d have every expected.

Summary
We too often focus on the challenges of an EHR implementation that people easily ignore some of the many reasons why your EHR implementation will succeed. I guess my point is that the glass is half full if you want it to be.

Source from emrandhipaa.com

Researchers at the University of Pennsylvania School of Medicine have discovered that electronic medical records can be used to test drug efficacy.

Richard Tannen, MD, a professor of medicine at the university, was the lead researcher in the study to find out if patient data, as captured by EMR databases, could be used to obtain vital information as effectively as randomized clinical trials when evaluating drug therapies.

“Our findings show that if you do studies using EMR databases and you conduct analyses using new biostatistical methods we developed, we get results that are valid,” Tannen said. “That’s the real message of our paper - this can work.”

Tannen said his group recognized that large EMR databases could potentially give researchers the ability to study groups reflective of the total population, not just those who participate in clinical trials, and circumvent studies too costly or unethical for clinical trials.

“Our study cautiously, yet strongly, suggests that enormous amounts of information within electronic medical records can be used to expand evidence of how we should or shouldn’t manage healthcare,” he said.

Some critics have argued that these databases contain observational information, which does not offer the same level of control as random trials. To address this criticism, Tannen’s group had to determine a way to use EMR databases for insights on therapy efficacy and then prove the results they found were valid.

Tannen’s team selected six previously performed random trials with 17 measured outcomes and compared them to study data from an electronic database - the UK general practice research database (GPRD), which included the medical records of roughly 8 million patients. Treatment efficacy was determined by the prevalence of cardiovascular outcomes, such as stroke, heart attack and death.

Researchers used standard biostatistical methods to adjust for differences in the treated and untreated groups in the analysis of the database information and found there were no differences in the database outcomes compared to random clinical trials in nine out of 17 outcomes.

In the other eight outcomes, Tannen’s group used an additional new biostatistical approach that controlled for differences between the treated and untreated groups prior to the time the study began. By using the new method instead of the standard approach, the researchers showed there were no differences between the outcomes in the EMR database study compared to the random clinical trials.

Tannen said the ability to use EMR databases from the United States to measure the efficacy of therapies will take more than 10 years of national data, and the results of this study should serve as a catalyst for more researchers to explore the accuracy of the information that can be obtained using EMR database studies.

“An appropriately configured EMR database could offer an invaluable tool, but we need to get to work now on how to configure it properly,” Tannen said. “If we don’t worry about this issue right now and promote a higher investment in the area of EMR research, we’ll lose … an enormous health opportunity.”

Source from HealthcareITNews

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.