By ALAN BAVLEY

The Kansas City Star

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

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

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

Doctors and patients of America, this is your future.

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

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

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

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

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

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

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

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

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

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

Challenges await

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

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

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

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

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

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

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

Electronic medical records offer many opportunities to improve health care:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But locally, early adopters are pioneering electronic records.

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

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

By Tom Philpott: PNT columnist

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So it looks as if the nation’s taxpayers are going to spend about $20 billion to accelerate the use of computerized medical records. In his press conference Monday night, President Obama went out of his way to explain why that money belonged in the economic stimulus package. It is, he said, a job-creating investment in both the present and the future that will improve the quality of care and save lives.
But in a letter delivered Tuesday to the White House and Congressional offices, 50 of the nation’s leading experts in electronic health records - most of them physicians themselves - warned that “an historic opportunity to achieve quality and efficiency gains through health information technology will be lost,” unless the government channels the spending carefully.
Just throwing money at doctors, they say, is not going to work. “The challenge is going to be all about implementation,” said Dr. Blackford Middleton, chairman of the Center for Information Technology Leadership, a research arm of Partners Healthcare, a big nonprofit medical group in Boston that includes Massachusetts General Hospital. “Where is the money going to flow and what is the mechanism of implementation?”
Dr. Middleton and others who signed the document say the answer lies in replicating a few standout community projects that have had success in offering installation help, technical support, buying power and training to small physician practices. The small group practices will be where the Obama administration’s push succeeds or fails because 75 percent of the nation’s physicians work in offices of 10 doctors or fewer.
The health information technology provisions in the stimulus bill are a step toward the goal of nearly universal electronic health record adoption over the next 10 years (compared with 17 percent today). The central feature of the plan is incentive payments for using electronic records for improvements in health quality, efficiency, prevention and safety.
But the experts’ letter focuses on the importance of properly financing and assigning a significant role to the “Regional Health IT Extension Centers,” which are called for in the bill. The experts see these centers as a critical bridge to success for a nationwide rollout of electronic health records. In their document, they point to two examples of excellence, the Massachusetts eHealth Collaborative and New York City’s Primary Care Information Project.
The New York project began two years ago with $27 million in funding and a commitment to help small practices, especially in disadvantaged neighborhoods, adopt and use electronic health records. It has worked with software suppliers to tailor a health record suited for its purposes. The project’s leaders insisted that the patient information in the electronic records could be shared across a community health network, linking doctors offices, clinics and hospitals. The project provides centralized technical support, education and know-how for doctors and others. It began rolling out its records about a year ago, and they are now used in two hospital outpatient clinics, 10 community health centers, 150 small group physician practices and one women’s jail, serving a total of one million patients.
I asked Dr. Farzad Mostashari, the assistant commissioner in the New York City Department of Health in charge of the primary care information project, what he’s learned. “There is no way that small practices, especially in underserved areas, can effectively implement electronic health records on their own,” he said. “To get a public benefit, and widespread adoption, just giving cash to doctors is not going to work.”
Above Article originally published on http://bits.blogs.nytimes.com/2009/02/10/electronic-health-records-how-to-spend-the-money-wisely/