Electronic Health Records Emerging as Important Care, Research Tool

With the American Recovery and Reinvestment Act set to spur their development and implementation, electronic health records (EHRs) are getting a lot of attention.

The widespread adoption of EHRs, however, involves “huge challenges,” acknowledged Dr. David Blumenthal, the National Coordinator for Health Information Technology. As a recent study he led documented, less than 2 percent of U.S. hospitals have a comprehensive EHR system in place. Cost, the study found, was the biggest obstacle to adoption.

Despite some of the problems reported to date with EHRs, evidence is emerging that they can improve the quality and efficiency of medical care. For example, the relatively new EHR system at the University of Arkansas for Medical Sciences (UAMS) has made many aspects of delivering care “so much better,” said Dr. Laura Hutchins, director of Hematology/Oncology at the UAMS Winthrop P. Rockefeller Cancer Institute. While the system is not perfect, she continued, “I don’t know of anybody here who wants to go back to a paper record. In addition to saving money, she explained, the system has generally made patient visits more efficient—for example, streamlining the search for information that can influence diagnosis or treatment.

Whereas the UAMS system is still in its early days, the EHR system at the University of Pittsburgh Medical Center (UPMC) dates back to 1991. The center recently completed the first phase of an “interoperability initiative” intended to eventually provide staff at 20 hospitals and more than 400 physician offices and outpatient sites access to what Dr. Daniel Martich, UPMC’s chief medical information officer, calls a “full-fidelity” EHR system, an integrated network of patient records with data on everything from admissions to allergies to recent imaging studies. While access to a number of EHR-related tools, such as electronic prescribing, still varies, he explained, the goal is a widely accessible EHR system that “provides a unified view of what’s going on with the patient.”

Importantly, EHR systems are beginning to demonstrate their utility in research. At UPMC, for example, they have conducted studies showing that, with the addition of clinical prompts, the EHR system reduced the risk of patients receiving an overdose of acetaminophen and improved by fivefold the number of patients notified by their primary care physicians that they may be candidates for clinical trials. Dr. Hutchins and colleagues at UAMS, meanwhile, used their EHR system to evaluate vitamin D levels in women with metastatic breast cancer who received bisphosphonates to treat bone pain and osteoporosis, finding that vitamin D supplements were being underprescribed, which can affect patient outcomes.

The success of EHRs, Dr. Martich believes, will be measured by the extent to which they can be effectively integrated into clinical care and research systems. “The real issue [with EHRs] isn’t a technological one,” he said. “The question is: How do they function within the workflow of a health care system?”

Above article published on http://www.cancer.gov/ncicancerbulletin/050509/page6

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.

Out of seventeen companies, OmniMD( A Division of Integrated Systems Inc.) received the highest overall 5-Star rating. The GE Centricity new integrated product is expected to also become a 5-star rated product. Five important caveats to keep in mind as you review the results:

• Literally hundreds of products are identified as EMRs, and while a good faith effort was made to contact as many vendors as possible, many chose not to respond.
• The survey findings are self-reported, that is, they are based on what vendors said about their own products.
• Fourteen vendors were required to participate in face-to-face demonstrations of their product’s functionality in order to receive “validation”. The validation process tested more than 200 scenarios. A number of the vendors have not been tested as of this report and therefore have an (*) next to their company name.
• A few of the highly visible EMR vendors elected NOT to participate in the survey. Many of these vendors are not willing to document their functionality in writing, while others state that either they do not participate in surveys or they were too busy to participate.
• Starting in May of 2005, AC Group added a “confidence factor” which indicates AC Group’s confidence in the vendor’s reported rakings. A vendor with a 5-Star confidence level indicates that their product has been tested and we believe that more than 90% of their answers are validated. A vendor with a 3-Star confidence level indicates that the product has been tested at least once and we are confident that over 70% of the responses are validated. A vendor with a 1-Star confidence level indicates that AC Group has NOT been able to evaluate the vendor’s claims as of this report.

When evaluating functionality by different methods of input, the AC Group team determined that today’s technology allows end-users the same functionality no matter where they are located. In 95% of the cases, the vendor’s application functioned the same on the desktop, from remote locations, and from a wireless tablet. Therefore, the EMR evaluation team was able to consolidate Desktop, Remote and Wireless functionality into one rating. The only major difference was the functionality on a PDA device – given that the screen size is limited. Therefore the EMR team created a separate rating for PDA devices. Simply stated, a number of the vendors that were highly ranked for the triad of desktop, remote and wireless, either did not offer a portable device or had one with limited functionality. When their overall performance ranking included low or nil scores for PDA their ranking dropped, precipitously.

OmniMD™ , a developer of HIPAA compliant Internet-based enterprise healthcare , Electronic Medical Records (EMR) and Practice Management solutions, is pleased to announce its certification by SureScripts®, operator of the Pharmacy Health Information Exchange™. SureScripts ® ’s certification allows for interoperability with the nation’s community pharmacies , which improves the safety and efficiency of the prescribing process and the quality of patient care. Physicians using Omni MD ’s EMR application can now connect directly with local pharmacies connected to the Pharmacy Health Information Exchange, operated by SureScripts ® .

Starting 2009, providers will be able to earn additional money from Medicare if they use electronic prescribing systems, U.S. health officials said Monday.

The bonus program, which will continue for four years, is designed to streamline the prescription process and cut down on errors. In 2009 and 2010, Medicare will give doctors an additional 2 percent bonus on top of their fee for “e-prescribing.” In 2011 and 2012, the bonus will drop to 1 percent, and in 2013, the bonus will drop again to 0.5 percent, officials said.

“There are terrific human and financial costs to illegible prescriptions,” Mike Leavitt, secretary of the U.S. Department of Health and Human Services, said during a Monday afternoon teleconference.

According to the Institute of Medicine , 1.5 million Americans are injured every year by drug errors, Leavitt said. Another study found that each year pharmacists make more than 150 million phone calls to doctors to clarify what was written on the prescription, he added.

“We are dedicated to providing solutions that improve the efficiency of medical practices and the quality of patient care. Omni MD ’s Prescription Writer already has a functionality to check for drug interactions, print patient medication sheets, create favorite prescriptions and check prescription coverage at the point of care. Surescripts ® electronic prescribing will certainly improve the efficiency, safety and overall quality of the prescribing process for our customers. “ said Divan Dave, CEO , Omni MD ™ .

This certification will allow providers to establish a two-way computer-to-computer connection with the majority of pharmacies in their area. Using this connection, providers can send prescriptions electronically to the patient’s pharmacy of choice before the patient leaves the provider’s office. Patients will no longer need to worry about losing paper prescriptions or pharmacies having to call offices to verify illegible prescriptions. When a patient needs a prescription refilled, a pharmacy will be able to send the request to the provider’s office electronically, eliminating the need for time consuming phone calls and faxes. This will also reduce potential errors with prescriptions due to misread handwriting.

About SureScripts®

Founded by the pharmacy industry in 2001, SureScripts® operates the Pharmacy Health Information Exchange™, which facilitates the secure electronic transmission of prescription information between physicians and pharmacists . This also provides access to lifesaving information about patients during emergencies or routine care. Working collaboratively with health plans, health systems, technology vendors and health policy leaders, SureScripts ® is committed to improving the safety, efficiency, and quality of the prescribing process.

More information about SureScripts ® is available at www.surescripts.com .

about Omni MD ™

Omni MD ™ is a developer of HIPAA compliant Internet-based enterprise healthcare practice solutions, designed to fully automate the work-flow of contemporary healthcare organizations. The company is a division of Integrated Systems Management, Inc. – ISM- ( www.ismnet.com ) a leader in Internet consulting and e-business development since 1989 .

Omni MD ™ ’s suite of products and services empowers hundreds of clinics with the ability to efficiently automate and manage clinical processes and patient information electronically. With its comprehensive and flexible product modules, the suite allows you to choose a customized solution that grows with your practice needs and electronic readiness over a period of time. For additional information, please visit www.omnimd.com