By DAVE MICHAELS and JASON ROBERSON The Dallas Morning News

Dave Michaels reported from Washington, and Jason Roberson from Dallas.

An unprecedented effort to computerize the nation’s hospitals and physician offices could be the key to reducing crippling health care costs – or a giveaway to technology vendors whose sales will be subsidized by taxpayers.

Computerizing the paper-based world of medicine was a significant component of this year’s $787 billion stimulus package, which reserved $45 billion for hospitals and physicians to adopt electronic health records.

The Obama administration argues that electronic records will allow doctors to coordinate care for the sickest patients, eliminate errors such as adverse drug reactions and avoid duplicate lab and imaging tests. Medical errors alone cost the country $37.6 billion each year, according to the Institute of Medicine.

Despite years of technology development, most hospitals and physician offices, including those in North Texas, can’t electronically share information or even record patient data.

Data sharing confronts age-old assumptions that providers, not patients, own health records, which are valuable assets that can be used to obtain grants and market hospitals. It requires the government to decide what kinds of systems will improve care and how providers should use the systems to achieve that.

‘Meaningful use’

Congress dubbed that exercise “meaningful use,” and the government is taking most of this year to set the standards. The exercise is being closely watched by North Texas hospitals, vendors and consultants such as Plano-based Perot Systems and Addison-based MedHost Inc.

Some observers are concerned that the stimulus investment could be a bonanza for software vendors if the rules for “meaningful use” are too rigid and simply tied to buying software.

“Meaningful use is the whole shooting match,” said Richard Kneipper, a lawyer who co-founded Dallas health care information technology firm PHNS Inc. “The guts of the discussion will be how fast do you go?”

The first draft of “meaningful use,” produced by a federal advisory panel, resembled an approach advocated by the Healthcare Information and Management Systems Society. The government’s draft, however, was more aggressive.

Hospitals, physician groups and technology vendors have said the draft would require them to do too much too soon. Only 1.5 percent of U.S. hospitals have the comprehensive electronic records envisioned by the Obama administration, according to the New England Journal of Medicine.

The American Hospital Association, for instance, wants to put off one of the most important functions of electronic health records – having physicians enter all their orders electronically – until after 2015. “We don’t want to rush to do something just to chase money – and endanger patients’ lives,” said Rod Piechowski, senior associate director of policy for the hospital association.

The stimulus established a carrot-and-stick approach to lure providers into the electronic age. Physician practices could be paid up to $44,000 over five years, and hospitals could get a maximum of $15.9 million to install systems that comply with meaningful use rules.

The government would penalize providers that don’t participate, reducing their Medicare and Medicaid payments by 1 percent, beginning in 2015. In later years, the penalty grows to 3 percent.

“The penalties … are far more significant than the incentives,” said H. Stephen Lieber, president and CEO of the Healthcare Information and Management Systems Society.

But if hospitals think the schedule is too aggressive, they may sit out – and the government would have failed to achieve its goal, said Pamela McNutt, chief information officer for Methodist Health System in Dallas.

Dallas efforts

Many hospitals, including several in Dallas, have made big investments in electronic records, which they say can help prevent errors and reduce some costs. Methodist’s $25 million system allows physicians to order medicine from patients’ rooms. Nurses can scan a bar code to make sure patients have been given the right medication.

“Why would you want to set up a system and spend millions of dollars now, with all the questions surrounding it?” McNutt said.

Kneipper is urging a more expansive approach. He advocates not just a timeline that applies to everyone, but also extra incentives for providers that have shown they can use technology to improve care.

“The purpose isn’t just some idle technology,” he said. “It’s technology that is going to save people’s lives.”

The Obama administration is keenly aware of the high stakes of meaningful use. The goal isn’t just spreading technology – it’s using the technology to improve care and reduce costs.

“Not everyone may want to, not everyone will execute on the task,” said David Blumenthal, a Boston physician appointed by Obama as national coordinator for health information technology. “There is no guarantee in the law that people will be paid, even if they work hard.”

To qualify for incentives, providers must purchase “certified” systems.

So far, certification has been a voluntary, industry-led effort that identified the features and functions of a good system. But the stimulus law set a new standard, requiring providers to purchase certified systems to be eligible for the incentives.

Under the Bush administration, certification duties were outsourced to a commission founded by the Healthcare Information and Management Systems Society.

Kneipper and other critics argue that the commission has too many ties to industry groups to be the lone gatekeeper. The commission’s leaders contend that they are independent from the industry. But after three years of certification, most systems still don’t – and can’t – communicate easily with one another, according to health care technology experts.

“I don’t think the certification process has been particularly relevant so far,” Kneipper said. “It’s going to be very relevant for the purpose of having a toll gate for who gets into the stimulus money or not.”

The commission’s leaders acknowledge that certification has failed to achieve widespread interoperability. But they say the commission is now focused on making sure systems are compatible and is certifying systems that are homegrown, not just made by big software vendors.

“The missing piece is the government also envisioned what they called health information exchanges, which are sort of the switchboards to route data between doctors and hospitals,” said Mark Leavitt, the commission chairman. “They came up with a concept, but there wasn’t any money behind it.”

Progress in Texas

Texas has only a few small health information exchanges – in Austin, San Antonio and Fort Worth. Dallas and Houston, the two biggest health care markets in the state, don’t have exchanges up and running.

One exchange has popped up in North Texas, where Fort Worth-area doctors pay $150 to $200 per month to access SandlotMD.com, which supplies patient demographic data, lab results and patient history. Sandlot CEO Telly Shackelford says it serves 1.2 million patients.

In June, Arlington-based Texas Health Resources Inc. contracted with Epic Systems, a global supplier of electronic health records, to sync its records with those of UT Southwestern, Children’s Medical Center Dallas and Parkland Health & Hospital System. The Dallas-Fort Worth Hospital Council has begun a study of an exchange and is hoping to get stimulus funds to support it.

Shackelford expects the region will have several independent exchanges that can share data.

But in Texas, hospitals and providers have struggled to justify the money they would invest in such efforts. Competition among hospitals for patients has also stifled attempts to exchange data across numerous providers.

Two years ago, the Texas Legislature created an entity that was supposed to oversee the development of the exchanges – but lawmakers didn’t fund it. “For large institutions, many of them regard the aggregated data on their patients as a resource for grants – it’s worth something,” said Joseph M. Heyman, immediate past board chairman of the American Medical Association.

Three years ago, Kneipper, a former Parkland board member, tried to persuade three Dallas hospitals to share information about indigent patients. The homeless often bounced between emergency rooms, but each time physicians confronted their problems as if the patient were being seen for the first time.

The effort ultimately failed because the hospitals weren’t willing to devote money to it.

“If the stimulus monies were around [then], I believe that would have been the stimulus to make it happen,” he said.

Above article published on http://www.dallasnews.com/sharedcontent/dws/bus/stories/DN-healthrecords_14bus.ART0.State.Edition2.4bb476e.html

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

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

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

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

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

By Joseph Conn

Only 1.5% of nonfederal U.S. hospitals use a comprehensive electronic health record system, according to HHS-funded researchers in a report released by the New England Journal of Medicine and mirroring preliminary survey results released by the same researchers this past November.

Lead author Ashish Jha, an associate professor at the Harvard School of Public Health and a staff physician at staff physician at Veterans Affairs and Brigham and Women’s hospitals in Boston, said in a news conference that just 7.6% of hospitals had a “basic” EHR that included the capability to record and store physician and nursing notes. The survey found that 10.9% of hospitals had a basic system without those clinical note-keeping functions.

“Very few hospitals in America have a comprehensive electronic health record,” Jha said. In addition, Jha said, “We didn’t get into effective use of these technologies. And we don’t have information right now with the notion of sharing data with other providers. Just because they have these systems doesn’t mean they are sharing that information with other doctors or hospitals down the street.”

That said, not all was gloom and doom. For one thing, if data from the VA hospitals, which were gathered but excluded from the final survey totals, were added back in, the comprehensive EHR adoption numbers would nearly double to 2.9% and the national numbers for the basic adoption rates would be driven up as well.

“All VA hospitals now have adoption of comprehensive medical records,” said Jha, who is serving as VA advisor. “There are as many VA hospitals with comprehensive medical records as there are non-VA hospitals (with those systems) if you look at it numerically.”

Also, he said, “There is no suggestion here that 90% of hospitals don’t have a computer in the hospital,” Jha said. In fact, some component parts of an EHR are in widespread use. For example, the survey found that 75% of hospitals surveyed reported having electronic lab and radiology systems.

What hospitals don’t have is “a constellation of functionalities” that help doctors and nurses provide the best care possible, Jha said, but the relatively high levels of adoption of some components “suggests we have a good place to start.”

Information about the study was under embargo until Wednesday, but its authors and other healthcare luminaries were available to reporters via a telephone conference Tuesday. One of those was David Blumenthal, the physician founder of the Institute for Health Policy, who spoke briefly about the research report and an article he had written for the New England Journal of Medicine on the federal role for health IT promotion.

Last week, Blumenthal was named as President Barack Obama’s choice to be the national coordinator for health information technology. Blumenthal said he will take over the post in mid-May.

Speaking of the impact the American Recovery and Reinvestment Act of 2009 would have on healthcare information technology, Blumenthal said that for physicians, “This whole project was conceived by the Congress as a building block as a pillar of healthcare reform.”

“One of the key elements is to support behavior change,” he said. “IT is one important and ultimately critical way to do that. I think it would be wrong to see it as a technology that can be adopted on its own, but as a technology to support that.”

The study and Blumenthal’s article are scheduled to appear Thursday in the journal’s online edition.

Above article published on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090325/REG/303259966&AssignSessionID=373357728181706

By JACOB GOLDSTEIN

Only 9% of U.S. hospitals have electronic health records, according to a new survey that reveals the gap between the present state of American health care and a high-tech future envisioned by policy makers.

“We are at a very early stage in adoption, a very low stage compared to other countries,” said David Blumenthal, a Harvard professor and an author of the survey. Last week, the Obama administration named Dr. Blumenthal National Coordinator for Health Information Technology.

The survey, sent to hospitals in March 2008 and published online Wednesday by the New England Journal of Medicine, found that most institutions have some basic electronic systems, such as those for reporting patients’ lab results.

The electronic-record systems advocated by President Barack Obama and former President George W. Bush go further, however, often replacing paper records and including doctors’ notes, treatment orders and automatic safety alerts.

Cost was the most commonly mentioned barrier to adoption of such systems, cited in the survey by 74% of hospitals without electronic records. That suggests many facilities are likely to tap into federal incentives aimed at increasing the use of electronic records.

The economic-stimulus package that Congress passed in February is likely to generate more than $20 billion in federal outlays for health-information technology, mostly between 2011 and 2015, according to the Congressional Budget Office.

Costs for installing electronic records systems vary widely, but a midsize hospital might spend about $10 million over several years, said Erica Drazen, who runs the research group for the health-care division at Computer Sciences Corp. The stimulus incentives are likely to cover much, but not all, of the cost — $6 million to $7 million for a midsize hospital, Ms. Drazen said.

Only 1.5% of hospitals have adopted what the survey’s authors define as a comprehensive, hospital-wide system. Another 7.6% of hospitals have adopted basic systems in at least one unit of the hospital, according to a less-rigorous definition that includes electronic physician notes, but not certain other features.

Proponents of electronic records say they will improve patient safety, reduce unnecessary testing and create useful data to measure quality of care. But the push is controversial, as skeptics point to the cost and complexity of installing the systems and building data networks required to share information electronically between doctors’ offices and hospitals. Some doctors argue that the systems are a distraction that takes away from patient care; more than a third of the hospitals that hadn’t adopted electronic records cited resistance from physicians as one reason.

The survey, based on responses from more than 2,900 U.S. hospitals, was funded by the federal government and the Robert Wood Johnson Foundation. The study excluded federal hospitals, such as those for veterans.

Above article published on

http://online.wsj.com/article/SB123802378615142099.html?mod=dist_smartbrief

By Jacob Goldstein

Remember that survey last year that found only 17% percent of U.S. doctors have electronic health records? Turns out, the figure’s even lower for hospitals.

In all, about 9% of hospitals have EHRs, according to a survey published in the New England Journal of Medicine. Only 1.5% of U.S. hospitals have adopted “comprehensive” EHRs — those with a complete set of bells and whistles, installed throughout the hospital. Another 7.6% have basic systems installed in at least part of the hospital.

For both docs and hospitals, the main barrier to adoption was the same: Cost. That augurs well for the great big pile of cash the feds will be handing out in a few years to encourage everybody to get with the EHR program.

The federal money should be worth about $6 million over several years for a midsized hospital, according to an expert cited by the WSJ. That will cover a decent chunk of the cost of getting an electronic records system, which runs about $10 million, the WSJ says. But the stimulus incentives should

The survey, funded by the feds and the Robert Wood Johnson Foundation, is brought to you by the same researchers who did the EHR docs survey. One of the authors — Harvard Prof. David Blumenthal — was recently named as the feds’ health IT chief.

Above article published on http://blogs.wsj.com/health/2009/03/26/docs-hospitals-skip-electronic-records-for-the-same-reason/

CHICAGO (Reuters) - Less than 2 percent of U.S. hospitals have adopted fully functional electronic medical records, with most citing cost as the biggest barrier, U.S. researchers said on Wednesday.

“The data collectively show we are at a very early stage in adoption, a very low stage compared to other countries,” said Harvard’s Dr. David Blumenthal, who last week was tapped to lead President Barack Obama’s $19 billion push to increase the use of information technology in healthcare.

Obama has made electronic medical records a central piece of his plan to cut costs out of a U.S. healthcare system that consistently ranks lower in quality measures than other rich countries.

Blumenthal said the study, published in the New England Journal of Medicine, clearly shows the United States has room to improve. He said financial incentives in the economic stimulus bill should help, given that most hospitals reporting that cost as their biggest stumbling block.

The study by Blumenthal, Dr. Ashish Jha of the Harvard School of Public Health, and others, is based on data collected in 2008 from nearly 3,000 hospitals.

It was designed to get a baseline reading on how widely U.S. hospitals have adopted electronic medical records, which promise to reduce medical errors and improve health quality.

“Right now, very few hospitals in America have a comprehensive electronic health record,” Jha told the briefing. “Only about 1 in 10 meet the definition of a basic electronic health record.”

A study by the same group last year found just 17 percent of American doctors have switched from conventional paper records to electronic health records, and only 4 percent had fully-functional systems that help them make decisions about patient care or order tests.

COMPREHENSIVE SYSTEM

The group defined a comprehensive system as one that collects doctor and nurse notes, orders tests, helps doctors make decisions about care and is available in every unit of the hospital. They considered a basic system as one that included doctor or nurse notes and was used in at least one care unit, such as radiology.

They found that larger, urban teaching hospitals are more likely to have electronic health records than other hospitals, in part because they are better funded.

Health information systems cost between $20 million to $100 million, depending on hospital size and complexity of the system. And many hospitals in the survey said they had no way of recouping that investment.

Blumenthal said funding purchases is a barrier the stimulus money can address. “For physicians, the cost of adoption could be more or less completely covered. For hospitals, perhaps they would be covered for modest-sized institutions,” he said.

He said the bill would also offer funding for training and technical support, which many smaller institutions lack.

Interoperability — systems that can easily share information between departments — was another big hurdle, the study found. Many hospitals have a hodgepodge of systems for different departments, but none of the pieces fit together.

“That is one of the reasons hospitals have been slower” to adopt such systems, Blumenthal said, adding that standards requiring electronic medical records to be interoperable was “a widely held core goal.”

He said the push for electronic health records needs to be part of an overall transformation of healthcare in the United States, including how doctors and hospitals are paid.

“It would be wrong to see this as a technology that can be adopted solely on its own. It needs to be adopted in an environment that supports it,” he said.

Above article originally published on www.reuters.com