VA Takes the Lead in Paperless Care

Computerized Medical Records Promise Lower Costs and Better Treatment

By David Brown

Washington Post Staff Writer
Tuesday, April 10, 2007; Page HE01

Divya Shroff, a staff physician at the Veterans Affairs Medical Center in Northwest Washington, stops what she’s doing to answer her phone: It’s a doctor down the hall who needs help with a man struggling to breathe.

She calls up the patient’s medical record on the computer at her desk and scrolls through lab reports, doctors’ notes, X-rays and EKGs, thinking out loud with the medical resident, who is at the man’s bedside.

Strep pneumo in the blood. Chest film looks like he’s accumulating fluid. Supposed to get a chest tube. Hard to wake up. No new meds that would be sedating him. Looks like he needs the ICU.

Over the next 10 minutes, Shroff visits the patient’s room and the ICU, and in both places summons his medical record on other computers while she talks with a half-dozen people about what needs to be done. She spends no time looking for the patient’s chart, riffling through paper or decoding handwriting. Nor does she ask anyone to take her word for things. She just lets the evidence — all of it right there for everyone to see — make the case that the patient needs to be moved as soon as possible.

It turns out to be the right decision. Soon after he gets to the ICU, he stops breathing. Doctors resuscitate him and put him on a ventilator.

Did the electronic medical record save this 71-year-old man? It’s impossible to say

But this much is clear: Never again will a VA patient’s chart be an excuse for things not happening efficiently. Never again will information that is lost, hard to read or impossible to move from one place to another be a factor in the complicated calculus of what makes good medical care — and, on occasion, saves lives.

The electronic medical record is the most important single development helping to usher in the Era of No Excuses in modern medicine.

Continued at: http://www.washingtonpost.com/wp-dyn/content/article/2007/04/06/AR2007040601911.html

ANSI-Approved Health IT Standard Announced

By M.L. Baker 2/21/2007 10:18:00 AM

A health IT standards group released a new, more-comprehensive standard for electronic health records on Feb. 21. The standard, released by Health Level Seven, is the first that specifies functional requirements for electronic health-records systems to win approval from the American National Standards Institute, a key standard-setting body. Electronic health records are advocated by the federal government and many health advocacy groups as a way to make sure that doctors have more complete information when caring for patients. Besides cost, one large barrier to EHR use is that different EHR systems cannot work together to exchange information, a problem that could be greatly alleviated by industry-wide standards. But health IT is plagued by competing standards, often developed by different sets of experts for different purposes. The problem is widely recognized. Earlier this month, HL7 and ASTM International, another standards organization, announced a merged standard for describing patients’ medical histories and demographics when discharged from a health institution. The move was heralded as an important advance in creating a nationwide health-information network.

The HL7 standard released Feb. 21 describes 1,000 conformance criteria across 130 functions, including medication history, problem lists, orders, clinical decision support, plus supports for privacy and security. “This new standard is a ’superset’ of functions that enables a standardized description and common understanding of functions, which is necessary when you’re working across care settings,” said Linda Fischetti, EHR Technical Committee co-chair.

A federally supported industry collaborative that certifies electronic health-records systems praised HL7, saying the two organizations provided a good example of collaboration in the health IT field. “The HL7 standard for EHR systems has been extremely valuable to us, providing the starting framework for CCHIT’s development of certification criteria,” said Mark Leavitt, head of CCHIT (Certification Commission for Health Information Technology). The standard should also serve as the basis for additional functions of electronic health-records systems, such as the ability to serve as a legal record for business purposes. The standard is also designed to accommodate EHR systems aimed for special purposes, such as disaster preparedness, long-term care, behavioral health, children and clinical research.

Find article here: www.channelinsider.com

The EHR debate continues …

Article published Feb 16, 2007 Modern Healthcare Online

I’ve read Andis Robeznieks’ article “Using EHRs to extract data on adverse drug events.” It is all true. But why isn’t it a common practice? Why don’t we have an EHR that all healthcare providers use? Why don’t we use standards that make all this possible?

For almost eight years I was chairman of CEN/tc251/wg1. CEN is the European standardization organization. While I was chairman, CEN/tc251 worked on three European standards—one is becoming an Australian standard; two are on their way to becoming International Organization for Standardization standards.

One standard defines the concepts and terms clinicians need to cooperate. The second standard makes possible plug-and-play exchange of documented information gathered while providing care to the patient and while collaborating with colleagues. Plug-and-play is defined as systems capable of recieving, storing, retrieving, presenting and exchanging information without any programming. This is based on a new exciting paradigm—a paradigm that is used for messaging. It is called the archetype paradigm or two-model-level paradigm. The third one makes it possible that EHR systems are capable of cooperation.

This set of three standards makes it possible for EHR systems to provide the things discussed in the article, and it can provide much more.

The question is, “Why are we not using these standards?” My answer is:

• The “not invented here” syndrome.
• The belief by many that Health Level 7 and its message paradigm will solve the problems, while it never can because all messages take a lot of resources to produce them and even more to implement them in all systems in a patient-safe way.
• The fact that information technology vendors and consultants make a lot of money out of the mess the message paradigm is associated with.
• HL7—the industry and consultants do a good job promoting the message paradigm as the only solution.

For more information I refer to openehr.org, an open-source community that provides a lot of background technical information and implementable specifications, plus some software.

Gerard Freriks, MD
member of EuroRec
European Institute for Health Records
the Netherlands

Article Here: www.modernhealthcare.com

Standards rivals’ collaboration could have major impact

By: Joseph Conn / HITS staff writer
Story posted: February 13, 2007 - 10:56 am EDT

The compromise reached between two sometimes rival standards development organizations could have far-reaching implications for the development of a national healthcare information network, experts close to the effort say.

The collaboration, called the Continuity of Care Document, or CCD, is the handiwork of Health Level 7, Ann Arbor, Mich., and ASTM International, Conshohocken, Pa., which jointly announced its release Monday after required formal balloting was completed. Initial development efforts by both organizations was aimed at developing patient care summaries but has since broadened in scope.

The CCD is a melding of HL7’s broader Clinical Document Architecture, or CDA, and the Continuity of Care Record, or CCR, developed by ASTM in collaboration with the Massachusetts Medical Society. Balloting on the much-anticipated CCD began on Dec. 6, 2006, and concluded Jan. 7. It took two ballots to pass muster among HL7 members and other interested parties who reviewed the development, according to Robert Dolin, an Orange County, Calif.-based physician lead for national terminology services for the Kaiser Permanente Medical Group, a member of the HL7 board of directors and the editor-in-chief of CCD for the standards development organization.

Richard Peters, also a physician, is chairman of the ASTM International Committee on Healthcare Informatics and serves as ASTM’s lead in the collaboration on the CCD.

Peters could not be reached for comment by deadline.

“I am the primary editor, and I voted no on it on the first ballot,” Dolin said. “We had enough time so we tightened up all the constraints and the language to use to express the constraints that were a little ambiguous. We went through each section of the CCR and went through it line by line,” he said, making sure it dovetailed with the CCD.

In October 2006, the federally funded Healthcare Information Technology Standards Panel recommended to HHS Secretary Mike Leavitt its first batch of “harmonized” IT standards aimed at facilitating specific healthcare data transmission tasks chosen by HHS. Among those was a recommendation by HITSP that the then-unfinished CCD be adopted for the exchange of certain clinical information, including patient demographics, medications and allergies.

HITSP Chairman John Halamka, the physician chief information officer of Harvard Medical School, in an e-mail called the successful CCD ballot “a very significant development for healthcare IT” and “a milestone in the standards world.”

“HL7 and ASTM worked together seamlessly to incorporate the best of their standards into a work product that will now form the basis of many HITSP Interoperability Specifications,” Halamka said. “CCD was included in the HITSP interoperability specifications submitted to Secretary Leavitt last October. We’ll ensure any updates to CCD are included in our next release of interoperability specifications which will be voted on in May.

Work by ASTM on the electronic CCR flowed out of an initial effort by physicians in Massachusetts to develop a standard, paper-based discharge summary for patients leaving the hospital bound for nursing homes.

Dolin said a similar interest by HL7 members to develop a standard for patient summaries led HL7 to come up with on its own Care Record Summary, or CRS. But the parallel development work of ASTM on the CCR and HL7 on its CRS led to strained relations between adherents of the two standards—what Dolin diplomatically described as “all this politics going on between HL7 and ASTM.” Cooler heads apparently have prevailed and with the collaboration leading to the successful balloting, “CRS is now sunseted by CCD,” Dolin said.

A major event at the IT trade show, Toward the Electronic Patient Record, last May in Dallas, was a demonstration of the CCR by more than a dozen vendors of electronic medical-records systems. At the time, most of the participating vendors could export documents in the CCR format and at least one vendor could import a CCR document and seamlessly place discrete data elements from the record in the fields of the receiving vendor’s EMR.

The demonstration showed the potential of peer-to-peer communication between physicians with different EMR systems.

Peter Waegemann, chief executive officer of the Medical Records Institute, sponsor of the show, said development of the compromise CCD “is really a win-win situation.”

Vendors and users of large IT “legacy” systems that are backers of HL7’s Clinical Document Architecture will gain the most benefit from the CCD because they will be able to use the CCR format in their systems, Waegemann said. But the collaboration with HL7 on the CCD further establishes the CCR, he said.

“Both have a community and both are good for the doctors and everyone else,” Waegemann said.

The American Academy of Family Physician’s Center for Health Information Technology operates an online list of EMR and personal health record system vendors that have committed to using ASTM’s CCR. The list, currently with 31 vendors, also includes the status of their CCR incorporation efforts.

Going Paperless Without EHR?

In a June 2006 interview with Mark Leavitt, Chair, Certification Commission for Healthcare Technology, Leavitt commented that “a practice that waits to adopt EHR [electronic health record] must consider an important ‘downside’: They need at least three months for EHR implementation, one year to collect data, and at least another year to put quality improvement mechanisms in place. The bottom line is that it will take them up to three years from the time they purchase [an EHR system] until they are ready to take full advantage of pay-for-performance reimbursement, and waiting until the last minute to go electronic could end up costing them money.”

“Electronic document management tools for office practices are available now without implementing a full EHR system,” states Evan Steele, CEO, SRS Software, Inc. “We have the capability today to eliminate patient charts, and improve productivity and efficiency without the multi-year timeframe or high cost of a comprehensive EHR system.” The key for SRS Software has been using readily-available technology to create a simplified approach to going paperless.

Are Practices Converting to EHR?

Research findings from the 2005 Medical Group Management Association (MGMA) survey of more than 3,300 medical group practices shed light on challenges of adopting EHR technologies. Proponents claim that paperless records shared across health care settings could: shrink US medical costs by hundreds of billions of dollars annually, reduce medical errors, and improve the overall quality of patient care. “Despite these stated benefits,” Steele remarks, “physicians face significant burdens—especially time for data entry and costs—that impede uptake of comprehensive EHR systems.”

“Time needed for data entry by physicians during clinical encounters is a significant factor. Imagine the president of UPS inputting data about package deliveries—the productivity loss would be enormous,” Steele remarks, pointing to evidence from the MGMA survey that manual entry of patient exam information using an EHR reduces physician productivity by up to 15%.

What About Costs?

“Small- and mid-sized practices could afford EHR if the return on investment [ROI] were there,” says Steele. “However, without reliable ROI, the initial investment is often lost, making EHR ‘unaffordable’ for many practices.”

According to the same MGMA survey, just 14% of all medical group practices had invested in an EHR, identifying an average purchase and implementation cost of $32,606 per full-time physician. Maintenance costs were an additional $1,200 per physician per month. Smaller practices had the highest per-physician implementation cost at $37,204, and the average cost for EHR implementation was about 25% more than initial vendor estimates. Lack of capital resources to invest in EHR was cited as the top barrier to adoption. Also, practices are not convinced EHRs will improve their performance or justify return on investment in terms of cost and quality.

In comparison, SRS Software and other groups dedicated to simplifying practice administration and progressing towards paperless health care can cost practices up to 75% less per physician, depending on the size of the practice, according to Steele.

Keep It Simple!

“To help counter rising costs, shrinking reimbursement, and heavy patient volume, physician practices need a practical approach to organizing and retrieving patient information,” says Steele. Existing technologies offer today’s busy medical practices common-sense solutions to document management. In fact, according to Steele, “physician groups that implement a document management solution not only do well—but also thrive—without an EHR!”

One such solution is SRS Chart Manager™, available from SRS Software. Medical practices of all sizes, from primary care to subspecialties, use SRS Chart Manager to eliminate paper charts, streamline operations, improve information flow, enhance patient care, and reduce costs. The software, according to Steele, is “easy to use, easy to learn, and easy to afford.”

Key features of the SRS Chart Manager include:

• A paperless system—The software program scans paper documents into a database that allows practices 24/7/365 access to patients’ charts from any remote location through a high-speed Internet connection. The product is designed to work with any type of computer or electronic tablet.
• Physician workflow improvements—Doctors can review all patient information electronically rather than pulling paper charts. The system allows physicians to do electronic prescriptions, flow sheeting, and order entry; attach lab or imaging reports; and digitally sign reports.
• Office staff workflow improvements—Nurses can handle 35 to 40 phone messages each day with quick access to test results and prescription information. Messages for physicians at different office sites can be placed, accessed, and acted-upon quickly.
• Barcode technology—Filing of paper documents is automatically digitized and filed in patient charts.
• Ease of use—The system’s components are extremely user-friendly.
• Lab interface—Immediate access to patient test result data is available electronically, routed from the lab directly into patient charts and physician inboxes for review and digital approval.
• Digital imaging interface—Digital images (x-rays, ultrasound, CT scans, etc) are downloaded and placed directly into the patient’s electronic chart for viewing on the computer.
• Savings on forms, paper, printing, and faxing costs—All forms are produced electronically from within SRS and are printed when needed by physicians and staff.

The number of records lost has been zero for practices using the SRS system. Another impressive statistic is the time it takes to train your practice’s physicians—approximately 20 minutes per doctor. Such factors contributed to SRS Software receiving “First Honors” for Best Document Imaging Solution at the May 2006 TEPR (Towards the Electronic Patient Record) annual meeting. This award recognizes SRS as an industry leader in health care document management.

“No one can predict the outcome of the federal eHealth initiative, but SRS can help practices become more efficient, effective, and organized starting today,” Steele says.

To learn more about EHR implementation, services, and the first steps towards paperless, check out these past articles from For the Business of Medicine:

• Moving Towards a Paperless Office?
• Evaluating & Adopting HIT
• Solid Advice for Selecting, Implementing, & Ongoing Management of EHR
• Can Good Health Information Improve Your Practice?

To read more about the national eHealth initiative, see www.hhs.gov/healthit/ahiccharter.pdf.

U.S. Electronic Medical Records Market Primed to Jump by 400%!

NEW YORK, Jan. 24 /PRNewswire/ — With the ability to make healthcare workflows more efficient, reduce costs, and improve the quality of patient care, the advent of Electronic Medical Records (EMR) is swiftly taking this technological wonder from a $1 billion market in 2005 to more than $4 billion by 2015, according to EMR Technologies in Healthcare, a new study from market research firm Kalorama Information.Nearly a 400% increase over an eight year period, the report reveals double-digit growth projections which begin to escalate significantly as electronic healthcare modalities enter the next decade. With hospitals, physician’s offices, and other healthcare entities increasing their IT budgets to include wireless technology applications — with many focusing on EMR adoption — the stage is set for a market surge.

Among segments within the healthcare industry, the physicians market for EMR is expected to witness the maximum growth as the vast customer base of this segment presents a huge potential market. While cost is currently a key deciding factor for most healthcare sectors — a typical EMR infrastructure requires workstations, servers, PDAs, tablet PCs, computer on wheels, and other networking hardware as well as software — the eventual reduction in costs is expected to expedite the adoption of EMR systems in the next several years.

“The potential not only in the U.S., but globally as well, is enormous, making EMR an exceptional opportunity not only for the current market players but for new entrants into the market,” notes Steven Heffner, the publisher at Kalorama Information. “This is one area of healthcare where regulations such as HIPPA and various other government initiatives will actually help drive adoption of this advanced technology.”

Including extensive hospital IT budget data and over 100 figures and tables, EMR Technologies in Healthcare provides the most comprehensive EMR market analysis available. It profiles key market players and technology innovators, looks at current products and new products on the horizon, and provides extensive insights into the business and regulatory issues catapulting this market from pipedream to reality. It can be purchased directly from Kalorama Information by visiting www.kaloramainformation.com or it is also available at MarketResearch.com.

Open Source Software: A Primer for Health Care Leaders

Forrester Research

As information technology in the health care industry evolves from an administrative tool for billing and bookkeeping to a clinical tool for improving the quality and efficiency of health care, the scope of information sharing is expanding beyond the walls of individual institutions. Achieving this level of integration will require that software models overcome a host of technical obstacles, and that they are accessible, affordable, and widely supported.

This report examines the development and distribution of open source software, a well-established software development model—and a potential solution to the looming challenges of integration—characterized by collaboration among individuals and organizations with common interests, sharing intellectual property, and a commitment to standards.

It explores open source basics, including the advantages open source presents, and how it works. The report also offers industry perspectives, explores the potential impact on EMR systems and regional health information networks, and compares open source to traditional, proprietary software.

While not heralding the end of commercial software vendors, the report concludes that conditions are ripe for open source solutions to take root in health care, and that it will likely become the standard for capturing, sharing, and managing patient information to support quality care. It also notes that health care businesses have the opportunity to take the lead and drive the shift to this new model.

PDF Download:

Open Source Software: A Primer for Health Care Leaders (325K)

Visit the author here: www.chcf.org

VistA: A look back and a look forward

By: Joseph Conn / HITS staff writer of Modern Healthcare Online

Members of the not-for-profit organization WorldVistA gathered for three days last week at the 14th VistA community meeting near Washington.

Rolling through the 578-acre campus past the many buildings of the National Institute of Standards and Technology in Gaithersburg, Md., one wonders, given all the resources devoted to standardization, how any problems with standardization of healthcare information technology could remain unsolved.

Yet in fairness to the institute, which is home to two Nobel Laureates, there is a lot on its test bench, even though healthcare IT has long been a big part of the NIST portfolio.

And as such, it was something of a homecoming for WorldVistA, whose members promote use of the Veterans Health Information Systems and Technology Architecture, or VistA, clinical record system for use in physician offices and hospitals outside the Veterans Health Administration.

Organizational roots

The precursor to NIST, the National Bureau of Standards was founded in 1901. Three years later, the bureau faced an early challenge when a two-day fire destroyed an estimated 2,500 buildings in Baltimore.

Firefighters from New York City, Philadelphia and Washington called in for backup watched in frustration as 80 square blocks of the city burned because their hose connections didn’t match up with Baltimore hydrants. Afterward, the bureau examined 600 couplings from fire departments across the country to come up with standards for threading and a universal connector. The federal agency has been dealing with all manner of manufacturing standards and quality improvement programs ever since.

The bureau would play a significant role in laying the foundation for today’s healthcare IT infrastructure, since many of the major healthcare IT systems are based on the Massachusetts General Hospital Utility Multi-Programming System, or MUMPS, database and programming language.

Thirty years ago, Joseph “Ted” O’Neill and Martin Johnson were with the bureau, working as part of a public-private effort to get a MUMPS programming language standard approved by the American National Standards Institute. Later in 1977, O’Neill and Johnson came to work as part of the computer-assisted system sttaff within the VA’s Department of Medicine and Surgery.

“There, they had the vision that MUMPS could be brought into the VA hospitals nationwide,” wrote George Timson, a pioneering former VA programmer and a historian of the VA’s clinical IT effort.

Settling on MUMPS as a common language and database opened the door for Timson and a group of fellow insurgent programmers to incorporate MUMPS in the decentralized development of a clinical computing system across the VA.

In 1978, Timson began work on FileMan, a package of MUMPS programming utilities which, though much expanded, is still in use today within VistA. Timson is still writing code, including a significant May 2006 update of FileMan released as open source by Medsphere Systems Corp., which sells a modified version of VistA to private- and public-sector hospitals and nursing homes.

Members of the loosely knit VistA community include programmers, IT consultants, pharmacists and more than a few geek docs who combine their clinical knowledge with programming expertise. In 2002, they incorporated WorldVistA as an only slightly more structured not-for-profit to provide a legal entity for their future work.

Pursuing certification

Next month, WorldVistA plans to submit to the federally funded Certification Commission for Healthcare Information Technology its VistA Office Electronic Health Record for testing and, if all goes well, certification. The submission will be a milestone in the life of the project begun in 2004 by the VA and the CMS. The goal of the project is to make EHRs more affordable to physicians in solo practice and small groups, where EHR adoption remains persistently low and where the real-dollar incomes of many primary-care physicians has shrunk during the decade.

VistA was a natural choice by the CMS for two reasons. It is in use at more than 800 outpatient facilities across the VA, and the VistA software is in the public domain, thus it is available from the VA without charge under the Freedom of Information Act. The CMS hired the Iowa Foundation for Medical Care, the state quality-improvement organization, to oversee the project, and the foundation eventually hired WorldVistA to help.

WorldVistA members, with funding from the Honolulu-based Pacific Telehealth and Technology Hui, a partnership between the VA and the Defense Department, had developed a branch of VistA that runs on open-source versions of MUMPS and the Linux operating system. VistA Office EHR, or VOE, is based on this open-source VistA software. According to Mark Leavitt, chairman of the certification commission, none of the 37 EHR systems that have received CCHIT certification thus far is open-source.

A turning point

With all this history and success behind them, WorldVistA members face a crucial turning point in addition to certification testing.

On Jan. 31, the $4 million CMS contract with Iowa Foundation for Medical Care, and thus the foundation’s contract with WorldVistA, runs out. The biggest challenge, according to WorldVistA member Cameron Schlehuber, will be to keep up with the VA “patch stream,” an electronic outpouring of upgrades and bug fixes to VistA that VA programmers produce at the rate of 500 to 600 a year.

“One of the discussions that is under way as part of the CMS contract is we have to be able to stay ahead of that VistA tsunami,” said Schlehuber, who holds a doctorate in neuroscience and helped develop the VA’s computer system from 1978 until he retired last September. “We’re hoping that the VA recognizes their obligation when they partnered with CMS, that they’re responsible for maintaining it.”

“It should not be a high-cost process,” Schlehuber said, noting that it should take 15 to 20 hours of programming time a month to keep up with the stream. The risk is if VOE falls behind the patch stream, the two programs will “fork,” or go on separate development paths, a potentially costly problem that VistA developers already know all too well.

Like VOE, the clinical IT systems in use today at the Indian Health Service and the Defense Department were based on copies of the VA’s clinical IT system. But the IHS system and the $1 billion development at Defense were allowed to fork so badly that records could not be readily transmitted between them and the VA. Since then, taxpayers have paid many millions of dollars to try to make the VA and Defense systems interoperable. Thus, the forking of the Defense system ranks as one of the bigger mistakes in healthcare IT history.

The other challenge, Schlehuber said, is for the VA to create an orderly process for incorporating improvements to VistA developed outside the VA. Several modifications to VistA done in the development of VOE have been presented to the VA, but have yet to be incorporated and distributed via the patch stream throughout the system. The Instituto Mexicano del Seguro Social, one of Mexico’s national health services, has installed a Spanish language version of VistA at 56 of its hospitals and has built what programmers there think are improved versions of several VistA software modules. Medsphere has several hospital installations under way in the U.S. using its version of VistA, yet Timson’s upgrades to FileMan, created when he was employed by Medsphere, were not readily accepted by the VA. Other VistA vendors, aiming to leverage open-source VOE and target the 200,000-physician small-office market, could boost development of the software dramatically and produce a stream of improvements to the software just as steady as that now emanating from the VA.

“There are going to be a number of users of VOE that far exceeds the number of users at VA,” Schlehuber said. “At some point I can see that is going to develop stresses in VA.”

WorldVistA member Brian Lord is a former VA programmer who has worked on the development of VOE. Lord is president of Sequence Managers Software, which is selling a subscription EMR service based on VistA that is distributed to clients using the application service provider, or ASP, model.

WorldVistA plans to release VOE under the Free Software Foundation’s General Public License, and that’s as it should be, according to Lord.

“We are dedicated to open source because we believe there is a business model there,” he said. “We’ve got a PACS (picture archiving and communication system) attached to our VistA, a practice-management system that’s attached, and it’s all open-source.

“This product must be released under GPL,” Lord said. “It has to be community property. They want to ensure that anybody that wants to start working with VistA has to contribute to the community. Unless they are invested in the community, they are not going to be able to make all of this work. The fact is, the intellectual capital that is required to make VistA work and make it grow, no company can match that.

“The underlying goal for all of this is to change the way healthcare is practiced and that is to create a system where records can be exchanged, and VistA is a foundation that can make that happen,” he said.

Find the full article here

Industry leaders identify movers and shakers to watch in 2007

Read Article: Healthcare IT News

By  Bernie Monegain, Editor 01/03/07

Since President Bush mentioned the electronic medical record in his 2004 State of the Union Address, the concept of automating healthcare has become part of everyday talk. A concept that may have seemed abstract to many just three years ago seems complex, but doable today.

It won’t be that simple or quick, of course, to transform a behemoth into a smart, new machine, industry insiders say. But, there are plenty of movers and shakers doing their part.

Healthcare IT News asked a few of these leaders to identify who – besides themselves – would likely influence healthcare IT initiatives in 2007. Who is worth watching?

Some familiar names – and initiatives – emerged.

William F. Jessee, MD, president and CEO of the Medical Group Management Association, predicts there will be a flock of players in the personal health records space. He mentioned the recent launch of Dossia by a coalition of employers led by Intel, followed by a similar announcement from America’s Health Insurance Plans and the Blue Cross Blue Shield Association. Jessee expects ICW, a German company, to make a splash in the U.S. market in 2007 with its LifeSensor PHR, a product he says is already well proven in Europe.

“What is new in all this,” said Jessee, “is the idea of encouraging consumers to create their own PHR as a ‘pull-through’ strategy to get more physicians to use EHRs that can interface with those PHRs. Unfortunately, Dossia is more of a concept than a product at this point, but it demonstrates the kind of large corporate investments that I think we are likely to see more of in 2007.”

Concept or product, the prospect of Dossia was enough to put Intel Chairman Craig Barrett on Jeffrey Hill’s list of potentially top influencers for 2007. Hill is CEO of Anceta, a subsidiary of the American Medical Group Association. Hill admires Barrett for taking the lead on personal health records.

“He’s not going to sit and wait until it all gets fixed,” he said.

The AMGA itself is not sitting still, having charged Anceta with gathering data from its membership of more than 300 large multi-specialty groups for comparison and analysis.

Hill credits Donald W. Fisher, AMGA president and CEO, with the vision to get the comparative data project launched and for creating a direction for other critical initiatives, such as CAPP, the Council of Accountable Physician Practices, which promotes a model of care focused on performance, efficiency, use of electronic clinical systems and results-based reimbursement.

“He’s the one who is tying all these things together,” Hill said,

Hill expects continued accomplishments on the healthcare IT front from Janet Marchibroda, CEO of eHealth Initiative. Marchibroda has been brilliant at pulling together all the different factions that – together – can transform healthcare, he said.

Francois de Brantes, from GE who, as head of Bridges to Excellence, has dedicated himself to effecting change, is on Hill’s movers and shakers list, too. de Brantes is developing a model of pay for performance and “trying to get his hands on data in the real world,” Hill said.

Donald Mon, vice president of practice leadership at the American Health Information Management Association will be watching who fills top positions at JCAHO (the Joint Commission on Accreditation of Healthcare Organizations) and Health Level 7, a standards development organization.

Mon is also keeping his eye on Robert Kolodner, MD, the nation’s interim healthcare IT chief. If he stays in the position, he could have broad influence.

Carolyn Clancy is director of the government’s American Healthcare Research and Quality. It will be interesting to see how she leads the AHIC (American Health Information Community) quality work group, Mon said, and what AHRQ does to advance quality reporting across the country.

Mark Leavitt, MD, chairman of the Certification Commission on Healthcare Information Technology, is another leader expected to accomplish great things, Mon indicated. He noted that Leavitt has deftly handled the process of certifying ambulatory EHRs. Now Leavitt faces new challenges as the commission begins certifying network components and specialty areas.

On the project front, Jessee of the MGMA predicts that hospitals are finally about to turn the corner on their IT investments. “Many of them have been in the selection/development mode, and more are going to transition into an operational mode in 2007,” he said. “So the stars will be those organizations and vendors that have done a good job of preparing to throw the switch – and the horror stories will be those that haven’t.

“The number of stories – both successes and failures – will really take an upswing in 2007 as more and more systems come online.”

 

Ahead for 2007: Open-source software for RHIOs?

BY Nancy Ferris
Published on Nov. 13, 2006

The California HealthCare Foundation is considering turning the software developed for the Santa Barbara County Care Data Exchange into an open-source software product that other regional health information organizations (RHIOs) could use.

Foundation officials revealed their tentative plan at a Washington, D.C., forum where people from many organizations discussed the potential of open-source software for health information exchanges. A Forrester Research executive said at the forum that the use of open-source software could result in a 20 percent increase in nationwide RHIO expansion by 2014.

Forrester Vice President Eric Brown said open-source software would not solve all the problems that RHIOs are encountering as they try to establish information exchanges. But he said a survey Forrester undertook for the foundation suggested that if open-source systems were available, 60 percent of the country might have access to a RHIO by 2014, compared with 48 percent without open-source software.

President Bush set 2014 as a target for all Americans to have e-health records. Health care providers could share those records via RHIOs.

In Santa Barbara, the foundation and other organizations spent nearly $20 million on the software that underlies one of the country’s first RHIOs. To increase the return on that investment, the foundation might submit the software to a consortium or other nonprofit that could license it to other users, said Sam Karp, the foundation’s vice president of programs. As a result, RHIOs could acquire less expensive software and easily modify or enhance the system to meet their needs, forum speakers said.

The Forrester study suggested that the software from Santa Barbara could be converted to an open-source product for about $695,000. Even if less than 10 percent of RHIOs used it, Brown said, its existence in the marketplace would influence other software vendors, holding prices down and tending to make products more open and standards-compliant, he said.

Lori Hack, director of government relations and policy at California RHIO, endorsed open-source software for health information exchanges.

“We have to find a sustainable model,” she said, “and what’s out there today just isn’t working.”

With open-source software, users can see the source code and modify it to meet their needs. They are expected to share enhancements with other users. As is the case with the open-source Linux operating system, for-profit companies can make money on open-source software by providing custom implementations and support.

About 75 people attended the forum, and many expressed interest in joining an open-source community for clinical systems. The foundation will hold a similar meeting in California this week.

Article: Government Health IT - http://www.govhealthit.com/article96800-11-13-06-Web