By: Grant Gross 7/06/2007 www.intergovworld.com

U.S. President George Bush’s administration gets high marks for its vision in pushing electronic health records, but the U.S. is far from implementing a national health IT system, according to an author of a government report released Thursday.

Although the U.S. could see significant benefits from more use of IT in the health-care industry, including fewer deaths from medical errors, more work needs to be done to create standards for electronic health records and other health IT initiatives, said David Powner, director of IT management issues for the U.S. Government Accountability Office (GAO).

The U.S. government still faces an “enormous challenge” in getting electronic health records to patients, Powner told the U.S. House Committee on Government Reform.

Asked to grade the Bush-created office of the National Coordinator for Health Information Technology, Powner gave the office an “A” for leadership and vision but an incomplete grade for implementation. In January 2004, Bush called for the U.S. health-care industry to embrace electronic health records, with the records available to all U.S. residents by 2014.

Powner’s report to the committee called for the Bush administration and the U.S. Department of Health and Human Services to push for health IT standards that don’t yet exist. “Otherwise, the health care industry will continue to be plagued with incompatible systems that are incapable of exchanging key data that is critical to delivering care and responding to public health emergencies,” Powner wrote.

The Bush administration is working toward setting standards, said Dr. David Brailer, the national coordinator for health IT in the U.S. Department of Health and Human Services. Next week, Brailer’s office will announce a federal government partner to harmonize health IT standards, he said.

In addition to standards, the cost of implementing electronic health records, and a lack of technical expertise, is holding up adoption at many small health-care facilities, Brailer told the committee. While existing research has sent “mixed signals” on the ability of electronic health records to cut costs, health IT can “save lives, improve care and improve efficiency in our health system,” he said.

Part of his office’s job is to convince health-care providers and patients of health IT’s benefits, Brailer added. Some health-care providers have been slow to adopt electronic health records because they’re paid per patient visit, and they aren’t paying the bills, he said. “It is against the financial interest of many providers to improve quality or to improve efficiency, because we pay by volume, and greater efficiency and quality, by definition, reduce volume,” he said.

Committee member Jon Porter, a Nevada Republican, said he plans to introduce legislation in the next couple of weeks that will require electronic health records for people using U.S. government health insurance coverage. With about 9.5 million members on the federal health plan, the requirement would push adoption to the private sector as well, Porter said.

Porter repeated concerns that the lack of electronic health records is adding to medical errors. “We are so far behind in our technology, we are costing lives of many Americans,” he said.

In 1999, the Institute of Medicine, a nonprofit health analysis organization, issued a study saying between 44,000 and 98,000 U.S. residents die each year due to medical errors.

Continue article here: http://www.intergovworld.com/

The adoption of electronic health record systems is not being driven by a return on investment in hospitals and physician practices, Pat Wise, vice president of Healthcare Information Systems at the Healthcare Information Management and Systems Society, said, Healthcare IT News reports.

Wise said that although ROI could be measured as a result of adopting EHRs, many health facilities that do not use EHRs do not seem to recognize their importance.

“There is a real business case to be made for [EHRs], but the word has not gotten out,” Wise said, adding, “More organizations need to know that [EHRs] are a better business practice.”

She cited examples, such as Evanston Northwestern Healthcare in Chicago, which had a $2.5 million increase in revenue because of improved charge capture from its EHR system. In addition, North Fulton Family Medicine in Georgia has saved $775,000 in transcription costs after adopting EHRs in 1998, and it also saves $275,000 annually because of the system.

Wise added that most health facilities have adopted EHRs to improve patient care and workflow management, and surveys indicate that “a large percentage of physician practices that don’t have [EHRs] have no intention of implementing them in the near future,” she said (Pizzi, Healthcare IT News, 6/27).

Article: http://www.ihealthbeat.org

By: Andis Robeznieks / HITS staff writer Story posted: May 21, 2007 – 10:56 am EDT

Part one of a two-part series

Like a recurring dream about having to take a test they didn’t study for, some physicians view the idea of patients with electronic personal-health records as their own personal nightmare.

Visions of patients handing over a computer disk containing years’ worth of blood-pressure readings taken every four hours along with random recollections of rashes and muscle strains that physicians are required to somehow make sense of and memorize are followed by thoughts of being sued because there was a kernel of important information missed in the deluge.

“That’s why folks like me are terrified of personal health records and what patients will bring to us,” internist Michael Zaroukian said earlier this year during a panel discussion at the Integrating the Healthcare Enterprise Connectathon, an event that brings electronic medical-record vendors together to solve interoperability problems (and sponsored by the Healthcare Information and Management Systems Society, the Radiological Society of North America and the American College of Cardiology).

While Zaroukian, who is chief medical information officer at Michigan State University, is now backing away from the word “terrified,” he still maintains “there are certainly lots of reasons to be concerned.”

The reasons for concern that Zaroukian cites include: the accuracy, completeness, usefulness and volume of the records physicians receive from patients; the hours of uncompensated work it will take to slog through them; and the potential for a misdiagnosis if something important was overlooked.

“In some ways, it’s simply an electronic extrapolation of what we’ve seen in the paper world,” Zaroukian says. “The greater the volume, the more likely it is that relevant data will be lost.”

Zaroukian certainly isn’t the only physician who feels this way.

“He has every reason to be frightened by that, and I don’t see what he is describing as an improvement over someone bringing in an entire paper chart,” says Joseph Heyman, a gynecologist and an American Medical Association trustee. “I don’t blame a physician for worrying about that. I think the beauty of a personal health record is if it’s a snapshot of a patient and their most important demographics—like their current condition, allergies and medications—that’s entirely different from their entire medical history for their entire life.”

Peter Basch, medical director for e-health at MedStar Health in Washington, says “physicians love a (hospital) discharge summary” that gives one to two pages of key points. What they may get from a PHR, however, could be something that has no resemblance to a discharge summary at all.

“Electronic records make it easier to share more information and images, so often what could be included on one page is now included on 10 and 12 pages,” says Basch, an internist who serves on the medical informatics subcommittee of the American College of Physicians.

He says, though imperfect, a quick two- to three-minute oral history taken during an office visit can be more helpful than an extensive PHR.

“It’s like saying to a patient: ‘Tell me about the rash,’ ” Basch says. “Don’t give me a seven-hour history of every rash you’ve had in your life.”

Zaroukian says that while things like patient-recorded blood-pressure readings can be useful, the value is not in each particular entry, but in the average and the range of high and low readings.

He says diabetic patients often give him diaries of insulin doses and pre-breakfast blood-sugar levels recorded in meticulously arranged rows and columns, but—despite their neat appearance—the numbers are not distilled into a useable format.

“You have to skip between rows and try to average the numbers somehow, but it’s impossible,” Zaroukian says. “The data is so poorly organized that it not only does not improve quality, it could contribute to making a bad decision.”

Nevertheless, he says that PHRs could be an important tool in developing a partnership with patients, so he “gently forces” them to use the spreadsheets—either paper or electronic—that he has developed.

“Over time, patients see how their own self-management can be improved, so over time they become more interested in doing so,” Zaroukian says. He adds that the key is to make it easy to record the information in a usable format so the patient-maintained record is not “just a few jewels of data floating in a sea of debris.”

Organization and quality of the data are paramount to making the PHRs useful, says Heyman, who has a solo practice in Amesbury, Mass.

“I think at the AMA, we believe there can be great value to PHRs and they can save physicians and patients a great deal of time, while helping to avoid medication errors and duplicate laboratory tests,” he says. “But there is a risk of ‘garbage in, garbage out,’ and if the record is populated by the patient, there are errors of understanding that can be inputted by the patient.”

Basch says it’s not the PHR alone that will create savings or improvements in care or efficiency, but it could be the tool that helps a motivated patient achieve those results. In fact, all the information included in the popular physician-provided PHR iHealthRecord from Medem, a San Francisco company founded by the AMA and several other medical societies, is entered by the patient (although if patients choose they can have data automatically flow into their PHR as it is entered in their physician’s EMR system).

“Some patients will rise to the occasion, and some won’t,” he says. “But for patients with diabetes, hypertension or congestive heart failure, daily or weekly recordings of blood pressure and weight could result in useful information that could stem chronic conditions from going bad and save a lot of ER visits.”

And, for these patients with chronic conditions, Basch cites key barriers to primary-care physician involvement in helping develop and maintain a patient’s PHR: a lack of reimbursement for coordination of care among specialists; uncertainty over the legal responsibilities of helping a patient maintain a PHR; and knowing what the record contains.

“With personal health records, one of the issues is the core problem of financing healthcare where information management and discussions with patients are poorly reimbursable in the context of an office visit,” he says. “Those are currently seen as an uncompensated burden on physicians.”

Making sense of complicated and unorganized records can require four to five hours of work—whether the records are on paper or in an electronic format—Basch says, but this is accepted in most sectors because “there’s an unwritten rule that a primary-care physician’s time is not relevant and that information management isn’t really work.”

“There’s no payer who will say: ‘Sure, I’ll pay you for your time’; they’ll say ‘Too bad, learn how to do it in 60 seconds,’ ” Basch says.

Steven Waldren, director of the American Academy of Family Physicians’ Center for Health Information Technology, says PHRs haven’t caught the attention of most doctors yet. But for the relatively small portion of physicians who have implemented electronic records, PHRs are known entities and these doctors’ main concern is on workflow.

Establishing PHR data standards—what information to include and in what format—will be important to solving workflow and data-management problems, Waldren says, adding that it’s time for physicians to get familiar with PHRs.

“PHRs are here and will continue to be,” Waldren says. “If the healthcare consumer empowerment trend continues to move in the direction it’s moving, we’ll continue to see growth in the tools available for patients.”

Waldren mentions healthcare decision-support applications as one of the tools patients are going to be using soon, and this prediction is already coming true. Earlier this month, Verizon Communications announced it was offering PHRs to 900,000 of its employees, retirees and their family members, and the system would include alerts that would inform users when their care “may not be consistent with evidence-based medicine.”

See article here: http://www.modernhealthcare.com

By: Joseph Conn / HITS staff writer Modern Healthcare Online

The American Health Information Community on Tuesday sent back for revision a list of recommendations by its work group on electronic health records aimed at boosting EHR adoption, including a controversial incentive proposal that would reward doctors who have EHRs and penalize those who do not.

David Brailer, co-chairman of the AHIC, a public-private policy healthcare information technology policy advisory panel created by HHS Secretary Mike Leavitt in 2005, asked fellow AHIC member and EHR work group co-leader Lillee Smith Gelinas to take the recommendations and tweak their language and have them checked by lawyers.

Finally, Brailer advised Gelinas, vice president of clinical performance at group purchasing organization VHA, that the EHR work group should “have some forum with an open hearing so we can have more debate” on the proposals.

The six proposals were:

• Leverage federal purchasing power by having the government, through its contracts with health plans and other payers, support widespread adoption of IT standards and “foster the use of pay-for-performance programs for physicians that include structural measures to incent the adoption and effective utilization of certified EHRs.”
• The pay-for-performance schemes should use “reliable, standardized and validated tools which are currently available to assess structural measures as defined by the Medicare Payment Advisory Commission, such as the NCQA’s Physician Practice Connections or the CMS’ publicly available Office System Survey.”
• HHS should continue to support the physician IT training programs now under way called Doctor’s Office Quality-Information Technology University, or DOQ-IT U.
• HHS should work with the federally funded Certification Commission for Healthcare Information Technology, which tests and certifies EHR systems, “to obtain medico-legal counsel to assure that its functional criteria include documentation, security and other approaches that will mitigate malpractice risk.”
• “Similarly, HHS should meet with medical malpractice insurers “to encourage premium reductions for those physicians who have adopted certified EHRs.”
• “HHS should develop a schedule for implementing differential reimbursement to Medicare physicians for use or nonuse of EHRs. While we would defer to departmental expertise, we note that this might be achieved by paying full Medicare rates and marketbasket updates (and possibly an EHR premium) to physicians using certified EHRs, while physicians using paper-based records are paid at discounted rates achieved by nonqualification for full marketbasket updates or other measures.”

Full article here: http://www.modernhealthcare.com

Aims to reduce duplication, errors and costs while boosting quality of care

Heather Havenstein April 23, 2007 –

Blue Cross and Blue Shield insurance plans in four states are integrating the medical data of more than 11 million people into a single electronic health record (EHR) system in an effort to eliminate unnecessary treatments and to encourage preventive care.

The Health Care Service Corp., which runs Blue Cross and Blue Shield operations in Illinois, New Mexico, Oklahoma and Texas, has been working for two years to merge the plans’ various IT systems that contain data about eligibility, medication, lab visits, hospitalization and physician office visits into a single system. The Chicago-based company plans to provide its patients and doctors with free access to the integrated system.

The move by HCSC is a new twist on a national effort to shepherd the adoption of EHRs, which various government agencies are recommending in hopes of decreasing medical errors and bolstering the quality of patient care by replacing current disjointed paper records with a comprehensive electronic patient record.

To date, the effort has focused primarily on encouraging doctors and hospitals to install EHR technology. Many physicians, however, have balked at undertaking such projects because of their often hefty installation and maintenance costs. Physicians have also complained that even though they’re the ones who pay those expenses, it’s the insurance plans that receive the lion’s share of the financial rewards in the form of lower costs.

As the different insurance plans bring the service online through the rest of this year, HCSC will offer physicians and clients free access to the service, said Joe Taylor, vice president of enterprise business processes. Taylor detailed the effort Monday at the World Health Care Congress in Washington.

The HCSC system uses MeDecision Inc.’s Patient Clinical Summary software, which creates an EHR by gathering patient data from various sources, analyzing the data and applying analytics and rules to identify possible options for treating patients, Taylor said. Doctors can access the data with an Internet connection.

“We’re trying to take this data and empower it with some analytics to provide a more meaningful office visit between the member and their selected physician,” Taylor added. “Think about a health insurance company that is providing information to the physician saying, ‘We want you to do this test.’ There is a chance to do more prevention and more wellness [efforts] and to see a potential treatment opportunity and act on it.”

He noted that the system could use analytics and rules-based software to, for example, remind a patient and physician that an annual mammogram needs to be scheduled or send an alert when different physicians write a patient prescriptions for medications that can’t be used together.

The system will also provide physicians with a list of all tests done on a patient, eliminating the need for duplicate tests, Taylor said.

The system, called Blue Care Connection, went live in New Mexico and Oklahoma last year and in Illinois earlier this year. It will begin operating in Texas this summer, Taylor said.

“All of this hopefully will help to stem the high rate of [cost] increases in health care,” he added.

John Capobianco, president of Wayne, Pa.-based MeDecision, noted that doctors have been reluctant to invest in EHR tools that can cost from $35,000 to $100,000 and ultimately just feed data into a system but provide no information back to the doctor.

“He is not getting a whole lot of value out of all this big expense,” he said. “The economic benefit just isn’t there.”

The health plans, however, have multiple views of a patient’s history based on the different types of claims they pay, he added, and that information can be vital to a doctor. “[The health plans] are a wonderful source of the best set of data that is available today,” Capobianco said. “It is certainly a better record than any one individual would have.”

Article: http://www.computerworld.com/

April 23, 2007

Reps. Charles Gonzalez (D-Texas) and Phil Gingrey (R-Ga.) on Thursday introduced a bill that would give grants, loans and tax incentives to small physician-practices to help offset the costs of health IT systems, Health IT Strategist reports.

Under the bill, Medicare would provide payment incentives that could be used by physician practices with 10 or fewer full-time employees to purchase health IT infrastructure tools, such as electronic health record systems, evidence-based clinical decision support tools and secure e-mail.

HHS also could include additional incentives for evaluation and care management services, payments for structured e-mail consultations and any other necessary communication methods, Health IT Strategist reports.

The amount of reimbursement would be based on certain factors, including the type and price of equipment and how it will be used, according to the bill. Grants and loans also would be subject to the discretion of the HHS secretary.

The bill also would change the tax code to increase deductions for purchasing qualified health IT tools for physician practices qualifying under the IRS’ broad definition of a small business. Physicians also could use the deduction for equipment that they started using at the beginning of 2007, Health IT Strategist reports (DoBias, Health IT Strategist, 4/20).

Source: http://www.ihealthbeat.org/

The Centers for Medicare & Medicaid Services (CMS) today announced the national launch of DOQ-IT(Doctor’s Office Quality Information Technology) University, or DOQ-IT U, to support health information technology (HIT) in physicians’ offices.

DOQ-IT U is an interactive, Web-based tool designed to provide solo and small-to-medium sized physician practices with the education for successful HIT adoption, including lessons on culture change, vendor selection and operational redesign, along with clinical processes.  The nationally available e-learning system is available at no charge.

“CMS is pleased to launch DOQ-IT University, the first of its kind e-learning platform, to provide assistance to physicians across the United States in the adoption and implementation of electronic health records and care management practices,” said CMS Acting Administrator Leslie V. Norwalk, Esq.  “DOQ-IT U’s interactive platform, self-paced curriculum, and associated tools provide physicians with easy access to the resources they need to help ensure that patients receive the highest quality of care at all times.”

DOQ-IT U will provide lessons in assessment, planning and implementation methodologies that will be disease and population specific, incorporating clinical decision support and evidence-based medicine guidelines.  This e-learning platform will be utilized to provide physicians with a self-paced curriculum and associated tools, based on adult learning principles, available at their convenience.  Additional features, such as surveys, utilization tracking, and Continuing Medical Education/Continuing Education Unit (CME/CEU) offering/issuing capabilities will also be included in the near future.

The first learning sessions (modules), available now, focus on physician office workflow redesign, culture change, and communication necessary for successful Electronic Health Record (EHR) adoption, implementation of care management, and the incorporation of a strong patient self-management component to clinical care. Disease specific modules, starting with diabetes, will include a patient self-management component, which is critical to successfully managing patients with chronic disease.

DOQ-IT U is being developed and managed by the Quality Improvement Organization (QIO) program, under contract to CMS.  A QIO is present in each U.S. state, territory, and the District of Columbia.

A technical advisory panel (TAP) composed of leading medical experts from the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), the American Board of Internal Medicine (ABIM), Healthcare Information and Management Systems Society (HIMSS), Private Payers, American Health Information Management Association (AHIMA), and Patient Self Management experts, has been convened and will provide content, consultation and evaluation of the care management/DOQ-IT U modules.

For more information, please see CMS’ DOQ-IT U Web site at: http://elearning.qualitynet.org.

Cultural and cost issues continue to impede adoption of electronic medical records systems, but new approaches may provide relief.

Thomas Hoffman March 26, 2007 (Computerworld) — The new electronic medical records system at Harbin Clinic has the strong support of its CEO, board of directors and chief medical officer. Its technology can improve patient outcomes while saving physicians money. But cultural issues, including resistance from some of Harbin’s physicians, have stretched the implementation from two and a half years to four.

Welcome to the world of EMR, where the best technology and the best intentions come smack up against the inertia of human nature.

Advocates of EMR contend that melding these systems with the work processes of physicians, nurses and administrators can dramatically improve the quality of patient care and cut waste out of health care costs. For instance, by using an EMR system, a doctor can view a patient’s entire medical history, use a rules-based engine to pinpoint potentially harmful drug interactions and receive suggestions for new tests and medications.

Studies have shown that the use of EMR systems can help reduce medical errors, including misdiagnoses and unintentionally harmful prescriptions, leading to fewer accidental patient deaths.

But to date, EMR adoption has been a big challenge in the health care industry. Rome, Ga.-based Harbin Clinic is a case in point. Georgia’s largest privately owned, multispecialty medical clinic has 135 physicians spread out across 20 locations in northwest Georgia and northeast Alabama. With 33 different medical specialties under its roof, ranging from endocrinology to ophthalmology, Harbin has had a tough time getting various specialists to adapt their work processes to accommodate the EMR system from Chicago-based Allscripts LLC that it’s installing. Indeed, the cultural and work process differences among these specialists has made the EMR implementation “more difficult than I would have imagined,” says Harbin CIO Tom Fricks.

However, primary care physicians at the clinic immediately embraced the EMR system, since they found it easier and cheaper to key in patient information than to pay a third party to transcribe dictation, says Fricks. But high-end specialists, such as cardiologists, have been considerably more resistant to learning and using the Allscripts TouchWorks EMR system, says Fricks. Cardiologists “don’t want aggravation in their lives,” he explains.

Despite strong support of the EMR system from Harbin’s CEO, the board of directors and its chief medical officer (who happens to be a cardiologist), the project has dragged on.

Read full article here: www.computerworld.com

By Diana Manos, Senior Editor Healthcare IT NEws 03/09/07

WASHINGTON – The Certification Commission for Healthcare Information Technology is developing a concept that will allow certification across settings, populations and specialties over and above basic EHR certification. CCHIT Chair Mark Leavitt, MD, made the announcement at a session of the Healthcare Information and Management Systems Society annual conference in New Orleans last week.

Leavitt said the reason the Commission is considering such a plan is that most physicians provide care across more than one setting and to more than one population. “Most documents work across many settings. It’s like soup,” Leavitt said. “That’s why CCHIT began to ask whether one set of certification criteria can cover everything–and the answer was, no, not for long.”

Populations, such as varying ages of patients, are a big concern, Leavitt noted. Documents need to cover certain things such as growth charts for children, but not for adults.

CCHIT plans to introduce its proposed dimensions of certification within two years, beginning with products that can serve behavioral healthcare, long-term care, home care, emergency care, and cardiology. The Commission is discussing adding allergy, dermatology, neurology and ophthalmology in years to follow and welcomes input from various other specialties interested in access to products certified for their use. Based on a recent survey conducted by CCHIT, cardiologists were chosen first because they were the most prevalent in their responses, Leavitt said.

CCHIT is also currently working on developing inpatient EHR test criteria and is accepting comments on its second draft criteria until March 16 with a certification launch date of August. “In-patient EHR certification is ten times more complex than ambulatory,” Leavitt said.

In 2008, CCHIT plans to develop, pilot test and launch certification of health information networks, according to Leavitt.

“The future is interoperability,” Leavitt said. “I see health information exchange networks as a first demo with potential for sharing, but what we’ll need is to test interoperability. We will need a test network to simulate a network. We all need this, but there are no contracts to build it so far.”

According to Alisa Ray, executive director of CCHIT, within the last 10 months, the Commission has certified 57 ambulatory health record products. On March 19, CCHIT will publish the final criteria for the 2007 ambulatory EHR certification and will begin accepting applications for certification on May 1, Ray said.

CCHIT, an independent, nonprofit organization, has received a number of endorsements from trade associations and the federal government, including the Department of Health and Human Services, American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, Medical Group Management Association and the Physician’s Foundations for Health Systems Excellence, Leavitt said.

 Access article here: www.healthcareitnews.com

Relaxed regulations may spark largesse, but when it comes to I.T. donations, nothing is really free. By Beckie Kelly Schuerenberg, Senior Editor Health Data Management 02/01/2007

There’s usually a huge disparity between the use of I.T. in hospitals and physician practices. But the Bush administration is betting that recent revisions to federal law will help change that.Last August, the Department of Health and Human Services published two final rules designed to ease restrictions on hospitals and other entities donating information technology to physicians and group practices.