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

April 19, 2007 VitaBeat

The U.S. Defense Department will be partnering with the private sector hospitals in the Tampa, FL area soon, according to an Armed Forces Press Service report. The goal is “to share electronic medical record keeping expertise and technology.”

This partnership is a pilot program, which is part of President Bush’s initiative to align the U.S. medical community’s implementation of computerized record keeping within the next 10 years, according to a U.S. Health Affairs representative.

An additional goal of the Department of Defense is to have the new system initiated and actually begin running it within one year. The clinical data for inpatients needs to be added to the current outpatient medical record keeping system.

The ultimate goal is to develop and establish an inpatient system of medical records that can be accessed by the Departments of Defense and Veterans Affairs.

Passwords and encryption computer security measures will be implemented to keep the medical records safeguarded, while partnerships with the private medical sector will allow both entities to gain needed expertise and experience.

This type of partnership between the government and the private sector’s medical community is already ongoing through the government’s commercial-source provider of the TRICARE program, which is the military personnel’s HMO.

This is why the Tampa, FL area is ideal for this program, because there are currently approximately 700,000 beneficiaries who live in that area and receive care through the military facilities or through TRICARE.

The new program will bring speed, accuracy and ease with up-to-date computerized electronic filing versus paper filing of medical records for service members, their families and their beneficiaries to provide quality medical care.

Access articel here: http://www.vitabeat.com/

The Washington Post on Tuesday examined VistA, or Veterans Information Systems and Technology Architecture, the electronic health records system used by the Department of Veterans Affairs. VistA, established in 1999, allows authorized VA personnel to view EHRs for all of the 5.3 million patients treated at the 155 hospitals, 881 clinics, 135 nursing homes and 45 rehabilitation centers operated by the department. According to the Post, EHRs “make confusing and physically unwieldy masses of data instantly available, portable and searchable — altogether more useful than when the information was stored on paper” — and allow physicians to detect trends in physiological variables such as serum chemistry, cell counts, blood pressure and weight. In addition, EHRs “bridge one of the more perilous chasms in medicine” — the transfer of health care when patients leave hospitals — and help improve physician performance and prevent medication errors, the Post reports. EHRs also could reduce health care costs by as much as $162 billion annually, according to one estimate. President Bush has called for a nationwide EHR system by 2014, but VA currently is one of the few health care systems that has implemented such a system. Many health care systems have not implemented EHR systems because of the initial costs, which can range from a few million dollars to $60 million, Pat Wise, an executive with Healthcare Information and Management Systems Society, said (Brown, Washington Post, 4/10).

Article: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=44157

Read entire Article here

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