Electronic Medical Records (EMRs)

Medicare law offers IT incentives

Anne Zieger — Sun, 20 Jul 2008 15:30:23 -0400

Last week, physicians sighed with relief as the threatened 10.6 percent Medicare cut was put on hold for 18 months despite a presidential veto. The bill didn't just protect physician reimbursement levels, however. It also included incentives for doctors to get more wired. Critics remain skeptical that such incentives will get physicians off the fence, but this is at least a start. Until now, no one on the Hill seemed to be able to agree on an approach.

The new law offers Medicare incentives for doctors who adopt healthcare IT as well as those who use e-prescriptions--a move proponents said could ultimately help cut medication errors and healthcare costs generally. The bill also expanded the list of telehealth originating sites (sites qualified to get paid for initiating a telehealth transaction) to include hospital-based renal dialysis centers, skilled nursing facilities and community mental health centers.

To learn more about the legislation:
- read this Healthcare IT News piece

Related Article:
Bill halting MD Medicare cuts approved by Congress

Case study: Kaiser rethinks IT in building new hospital

Anne Zieger — Sun, 20 Jul 2008 15:19:35 -0400

Kaiser Permanente is well along the way on its plans to build a new, 314-bed hospital in Fontana, CA--but this time, it hopes to do something different. Not only is Kaiser focused on building a green building, it's also taking this chance to rethink how it handles its entire IT infrastructure. The new project will cost $700 million overall, including building, green modifications and new IT options. While Kaiser hasn't broken out the numbers, it's likely that this figure will include substantial money for IT investment, as Kaiser has pretty expansive plans.

The new hospital, of course, will be hooked up with Kaiser's Epic EMR installation, dubbed Health Connect. Health Connect terminals will be available at the bedside through computers with cards connected wirelessly to the network. But it plans to go well beyond that. For one thing, Fontana Medical Center will include a digital OR communication system offering real-time access to clinical data and images from varied system. Kaiser is also including digital radiology rooms, whose digital images will be available on demand to physicians, a patient monitoring system allowing for easier information sharing between teams, and many other upgrades.

To learn more about this project:
- read this Healthcare IT News article

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Study: U.S. behind other countries in EMR use

Anne Zieger — Sat, 19 Jul 2008 23:24:23 -0400

A new study suggests that the U.S. isn't just adopting EMRs slowly, but we're doing it more slowly than other countries. The study by the Commonwealth Fund concluded that at current adoption rates, it will take more than 30 years to get clinical-support tools to all U.S. doctors. While EMR use in the U.S. grew to 28 percent in 2006 vs. 17 percent in 2001, that's still well behind other countries. For example, 98 percent of practices in the Netherlands are using EMRs that are more likely to have advanced clinical functions allowing for HIE connectivity, while New Zealand has an EMR adoption rate of 92 percent.

The same study concluded that the U.S. healthcare system's problems haven't improved since 2006, when the group's first National Scorecard was released. For example, it notes that 42 percent of U.S. adults, or more than 75 million citizens, were uninsured or underinsured during 2007. That's up from 35 percent in 2003.

To learn more about the study:
- read this Modern Healthcare article
- read this Commonwealth Fund analysis

Related Articles:
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Want shared EMRs? Drop the technology debates
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SPOTLIGHT: CBO: Medicare pay, health IT use should be linked

Anne Zieger — Sat, 19 Jul 2008 01:17:58 -0400

Much of the discussion on Capitol Hill on how to foster health IT adoption has focused on using tax credits or federal subsidies to entice doctors. But according to at least one powerful Hill player, these aren't the government's best options. This week, Congressional Budget Office director Peter Orszag told members of the House that linking health IT use to Medicare reimbursements would work much better, arguing that subsidies only nudge along physicians who are already close to investing. Article

Study: Top health IT initiatives listed

Anne Zieger — Sun, 13 Jul 2008 12:15:52 -0400

According to a new study sponsored by healthcare IT company Logicalis, data storage is the top driver for many hospital and healthcare IT projects underway right now. However, when it comes to the projects themselves, predictably, EMRs are in the lead, according to the study, which names the top 10 IT initiatives being undertaken by healthcare organizations. The remainder of the list includes disaster recovery; medical archiving systems; storage consolidation/virtualization; backup; business intelligence; PACS; health IT infrastructure; compliance and the security of personal health information.

What's interesting about these conclusions is that they differ in some respects from those drawn by a status released by HIMSS in April. For one thing, HIMSS respondents said that improving safety and reducing errors were key drivers of IT investment. Also, it's worth bearing in mind that according to HIMSS results, security breaches still seem to be rather common within healthcare organizations, with 18 percent of respondents having seen a breach within the past six months. If patient safety and security are key drivers, that takes one down a different road than projects driven by storage. I'm not sure how to reconcile these results--readers, what do you think?

To learn more about the study:
- read this Healthcare IT News piece
- read the Logicalis press release

Related Articles:
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Study: Doctors fear how gov't will use EMRs

Anne Zieger — Sat, 05 Jul 2008 17:07:14 -0400

A new study has found that doctors are resistant to installing EMRs not only due to their financial and workflow impact, but also because they fear government will use the data to impose controls on their daily practice. The study, released by the Association of American Physicians and Surgeons, reached 400 doctors, and was designed to capture a portrait of their attitudes about HIT adoption.

According to the AAPS, 81 percent of respondents said their practice didn't use EMRs, and many respondents said that they'd rather retire in their 50s than adopt EMRs. When asked why they were not adopting EMR technology, fear of interference from government was one of the top reasons they gave, along with privacy concerns, worries about return on investment, lack of capital to acquire HIT and preference for using hand-written notes.

To learn more about the study:
- read this Healthcare IT News piece

Related Articles:
California MDs lead in EMR adoption
NY gives no-cost EMRs to some physicians
CMS to offer EMR adoption incentives
Congress holds key to EMR adoption

Physician group helps doctors buy, install EMRs

Anne Zieger — Sat, 14 Jun 2008 22:46:36 -0400

The American College of Physicians has started a program to help members buy and install electronic medical records meeting Certification Commission for Healthcare Information Technology (CCHIT) functionality, security and interoperability standards. ACP members get not only the vendors' own pricing and product information, but also an "EHR Product Selector Tool" that helps to search out systems meeting specific criteria. ACP members also get EMR evaluations based on a combination of vendor responses to requests for information, a demonstration patterned on a standard patient visit, a site visit to a physician practice using a participating vendor's product and survey responses from ACP members.

To learn more about the program:
- read this Modern Healthcare article (reg. req.)

Related Article:
Mass. MD group strikes EMR deals

Is the VA killing VistA? Say it ain't so

Mon, 09 Jun 2008 06:59:59 -0400

As longer-term readers know, this newsletter has praised the VA's efforts with open-source EMR VistA since we first got started.

VistA is, in short, a remarkable accomplishment that performs better than virtually every commercial installation available. Every office visit, prescription, and medical procedure is recorded in VistA's database, allowing doctors and nurses to update themselves on a patient's status with just a few keystrokes. In 1995, patient records at VA hospitals were available at the time of a clinical encounter only 60 percent of the time. Today it is 100 percent. Some 96 percent of all prescriptions and medical orders, such as lab tests, are now entered electronically. The national comparison is more like 8 percent.

Despite all this, however, VistA's future may be less promising. While I have heard this second hand, the anecdotal evidence sounds pretty convincing that the VA's world-class VistA EMR system may be dying a slow death.

According to various sources, including ZDNet Healthcare and Phillip Longman of the New America Foundation, political forces within the VA are causing it to starve Vista:

* The DoD wants centralized systems to meet its security goals
* DoD execs are giving favor to AHLTA, the agency's own medical computing system
* Philosophically, the DoD wants to privatize all government functions

This is leading to some real losses in care coordination, Longman says. While institutions can hook up two hospitals using Vista "in an afternoon," he says, AHLTA and VistA don't interoperate. That's true even though building a Vista/AHLTA interface wouldn't be a big technical deal. According to Longman, however, it wouldn't make a lot of sense to some career DoD people, who have staked their careers to AHLTA.

Now, I don't know about you, but I'm of the "if it ain't broke don't fix it" school. But when it comes to the DoD, that kind of logic may not matter. Sure, why not sacrifice one of the best-performing EMRs anywhere just for the purposes of having centralized control? To a bureaucrat, that's probably a stroke of genius.

Many thanks to ZD's Dana Blankenhorn for the tip on this story. Meanwhile, readers, I encourage you to weigh in--not just with me, but also the VA itself--if there's a chance it will do any good. VistA deserves a better fate than this. - Anne

Federal HIT coordination office releases five-year plan

Mon, 09 Jun 2008 06:59:57 -0400

HHS's Office of the National Coordinator for Health IT (ONCHIT) has released its five-year strategic plan, designed to help federal agencies synch up their health IT efforts. While the plan is broad, it does dig into two key goals: fostering patient-focused healthcare and population health.

To meet the "patient focused healthcare" goal, ONCHIT would like to see a transition to using electronic health records. Specifically, the agency wants to see private, secure, interoperable data sharing systems adopted, with a collective governance system in place to help guide the emergence of a shared health IT infrastructure. The population health goal, meanwhile, is to provide appropriate access to, and use of electronic health information to boost public health, biomedical research, quality improvement and emergency preparedness.

In addition to describing its broad goals, the ONCHIT report establishes timelines for achieving more than 40 milestones, in areas including adoption, interoperability, privacy and security. The report also provides a useful summary of electronic health information projects underway at agencies across the entire range of the federal government, from AHRQ to the Veterans' Administration.

To learn more about the plan:
- read ONCHIT's report (.pdf)
- read this iHealthBeat item

NAHIT name game gives some vendors a headache

Mon, 09 Jun 2008 06:59:55 -0400

In theory, it doesn't make sense to move ahead with major IT initiatives until the industry has at least some clue as to how to define key terms. However, a recent effort by the National Alliance for Health Information Technology (NAHIT)--particularly in defining the difference between EMRs and EHRs--seems to be creating as many problems as it solves. Over several months, NAHIT came up with definitions for key terms in HIT, including EHR, EMR, personal health record, health information exchange and regional health information organization. Most notably, as NAHIT defines things, an EMR is a record used internally in a medical practice that can't share information with other practices, while EHRs can do so.

The problem with this is that NAHIT seems to have defined some vendors right out of their marketing position. There are several companies that use the term "EMR" to define themselves, such as NextGen Healthcare Information, and have gotten their interoperability certification from the CCHIT. If they have to go back and rebrand themselves as an "EHR" they'll be a bit annoyed, to say the least, officials note.

To learn more about the terminology dispute:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
CCHIT makes EMR certification simpler
CCHIT gets official, approves new vendors