Category Archives: Electronic Health Record

Rhode Island Awards Bid To Build First-Ever Statewide EHR

July 31, 2007

The Rhode Island Department of Health has awarded a three-year, $1.7 million contract to EDS to design, implement and manage the country’s first statewide electronic health record network, Healthcare IT News reports (Pizzi, Healthcare IT News, 7/30).

The contract could last up to seven years if the state uses all four of the optional one-year extensions, Government Health IT reports.

EDS will use InterSystems’ health care software to build and integrate the system.

The network, called the Rhode Island Health Information Exchange, will consolidate state residents’ health data and provide authorized hospitals, physicians, pharmacists and other health care providers with access to the health records (Wakeman, Government Health IT, 730).

The EHR network will be “developed with strict adherence to patient-consent policies and in conjunction with industry best practices with regard to security and privacy standards,” according to a press release (Providence Business News, 7/30). In addition, residents must give permission before their records are stored on the network.

The health data exchange is expected to go live in summer 2008 (Government Health IT, 7/30).

source: http://www.ihealthbeat.org/articles/2007/7/31/Rhode-Island-Awards-Bid-To-Build-FirstEver-Statewide-EHR.aspx

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Vendors dispute EHR, ambulatory-care report

Article published Jul 18, 2007

A report detailing how the use of electronic health records does not necessarily lead to an increase in the quality of care may be misinterpreted by some as proof that EHRs aren’t useful. EHR vendors, consequently, are concerned.

“It’s caused quite a bit of discussion in our industry—to say the least,” said Hugh Zettel, director of government and industry relations for GE Healthcare. “We don’t believe the reporting on it has been accurate relative to the findings of that paper.”

The report, Electronic Health Record Use and the Quality of Ambulatory Care in the United States, appeared in the July 9 edition of the Archives of Internal Medicine, and concluded quite bluntly that: “As implemented, EHRs were not associated with better quality ambulatory care.”

Written by prominent health information technology figures from Harvard Medical School and Stanford University, the study examined records of 50,574 patient visits collected as part of the National Ambulatory Medical Care Survey in 2003 and 2004, and compared how physicians with and without EHRs did on 17 quality measures. The researchers concluded that EHR-using physicians had significantly better scores on only two quality indicators, had no significant difference on 14, and did significantly worse performance on one.

“The result was surprising,” said the study’s lead author, Jeffrey Linder, an assistant professor of medicine at Harvard Medical School and an internist at 746-bed Brigham and Women’s Hospital, Boston. “I was expecting to find that it (EHR use) was associated with better care.”

Linder said that most EHR quality studies have been done at what he described as “benchmark” institutions, and the intent of this study—which was sponsored by the Agency for Healthcare Research and Quality—was to take a more general view of how EHRs were being used across the nation. What the study shows, Linder said, is that with the way EHRs are being used they “are not much more than a replacement for the paper chart.”

“They’re not magic,” Linder said. “You just can’t plug it in, turn it on and watch quality magically improve.”

The two measures that the EHR-using physicians scored significantly better involved avoiding prescribing benzodiazepine to patients with depression and avoiding unwarranted urinalysis testing. The authors were surprised to report that EHRs were associated with worse quality when it came to prescribing statins to treat hyperlipidemia, or high cholesterol.

Linder said that he spent two days in vain trying to figure out that result. “It could be just statistical chance … it could be a statistical anomaly,” he said. “I don’t have a good explanation.”

Zettel disputed some of the findings, saying that GE Healthcare’s own research found that its customers had scores twice as high as those the researchers found on quality indicators relating to aspirin, beta blocker and statin prescribing. “We have a process that allows our customers to show these and other related metrics,” he said.

Mostly, however, Zettel said the findings may be a reflection of when half the data were collected: 2003.

“A lot has changed since then,” he said, and this includes an evolving definition of “EHR.”

According to the report, about 16% of the visits studied from 2003 involved EHRs, as did 20% of the visits in 2004.

Another of the study’s co-authors, Randall Stafford, an associate professor of medicine at Stanford University’s Prevention Research Center, acknowledged Zettel’s arguments, but said the findings point to the need for multidimensional solutions to confront the complex problems relating to healthcare quality. These include a need to look at how healthcare is organized and paid for and how continuity of care is provided for chronic conditions, he said.

“The bottom line is that people have to pay attention to more than just the EHR and to think that the electronic health record will improve quality on its own is ridiculous,” Stafford said. “The electronic health record in and of itself is not going to be adequate.”

Additionally, the report states that “it is worth noting that the performance on most indicators was suboptimal regardless of whether an EHR was used.”

Zettel somewhat agreed with Stafford’s assessment.

“There’s that old axiom that a fool with a tool is still a fool,” he said. “And, if you don’t change your processes, (implementing technology) will just help you make the same mistakes faster and more efficiently.”

Continue article here: http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070718/FREE/70718003/0/FRONTPAGE 

AAFP survey: More family docs using EHRs

By Richard Pizzi, Associate Editor 07/16/07 www.healthitnews.com

A recent survey by the American Academy of Family Physicians found that the number of family physicians using electronic health records has risen consistently since the AAFP first began measuring EHR usage four years ago.

Half of the 459 respondents to the 2007 EHR survey reported that they had either fully implemented (37 percent) or were in the process of implementing (13 percent) an EHR system at their practice. The survey was mailed to a random sample of 4,000 active AAFP members in April 2007.

In the organization’s 2005 EHR survey, 30 percent of respondents reported that they were using EHRs in their practices. Only two years previously, AAFP’s survey had revealed that ten to 15 percent of AAFP members had adopted the technology.

AAFP’s current survey indicated that physicians who were most likely to have a fully implemented EHR practiced in an urban area, had practiced for seven or fewer years, did not own their practices, and worked in practices with at least two other physicians.

Steven Waldren, M.D. , director of AAFP’s Center for Health Information Technology, said that the EHR features with virtually universal appeal dealt with managing basic patient data, such as problems, medications and allergies, and with improving efficiency and documentation in the practice.

To this end, 99 percent of respondents in the process of implementing an EHR – and 99 percent of those planning to purchase one – said they were interested in using an EHR to manage patient medication lists, manage patient problem lists and display patient summaries.

Sixty percent of those respondents said they would use an e-mail or secure messaging feature in an EHR, and just 49 percent indicated an interest in using an EHR for practice-based research, according to AAFP.

AAFP also noted the following highlights from the 2007 survey:

• 26 percent of respondents said they planned to purchase an EHR in the future;
• 25 percent of respondents indicated they had no plans to implement an EHR in their practice;
• 53 percent of respondents who did not have an EHR cited cost as the reason; and
• 42 percent of respondents who had not implemented an EHR in their practices said they hadn’t done so because they were concerned about decreased productivity.

Article: http://www.healthcareitnews.com/printStory.cms?id=7461

Study: EHR System Efficiencies Can Cover the Cost of Adoption

July 13, 2007 iHeathbeat

Electronic health record systems in less than two years after adoption can create enough cost reductions to pay for the cost of the systems, according to a study published in the July issue of the Journal of the American College of Surgeons, HealthDay News/Forbes reports.

David Krusch, the author of the study, and his colleagues at the University of Rochester analyzed the return on investment of EHR systems at five ambulatory offices representing 28 health care providers. The study compared the costs of tasks — such as pulling patient charts, creating new charts, filling time, support staff salary and data transcription — in the third quarter of 2005 to costs in Q3 2003 when the EHR system was not instituted.

Using EHRs reduced costs by almost $394,000 annually, and nearly two-thirds of the savings were associated with reducing the amount of time for manually pulling charts, the study found. The EHR system in the first year cost $484,577 to install and manage, which means the hospital recouped its investment in the system within the first 16 months.

The system after the first year cost about $114,000 annually to operate, which means a yearly savings of more than $279,500, or almost $10,000 per provider using the system, the researchers found.

“Health care providers most frequently cite cost as a primary obstacle to adopting an [EHR] system. And, until this point, evidence supporting a positive return on investment for [EHR] technologies has been largely anecdotal,” Krusch said (HealthDay News/Forbes, 7/12).

Article: http://www.ihealthbeat.org

Federal IT Group To Study Secondary Uses of Health Care Data

The American Health Information Community Consumer Empowerment Workgroup on Wednesday said they would continue to study the policy issues related to secondary use of health care information, Healthcare IT News reports.

Karen Bell, director of HHS’ Office of IT Adoption, said now is the time to tackle the issue because electronic health record adoption still is low and personal health records do not yet contain much clinical information. “I think we are recognizing that we’re not even close to finding all the answers on this,” Bell said.

Charles Safran of Harvard Medical School testified before the work group on secondary uses of health data. “We believe there is tremendous value in secondary use of health information,” he said, adding, “It’s so important to national health, but we need to have better guidelines on how this information should flow.”

Guaranteeing the privacy of health data is key to winning public trust, and the technology has outpaced policies and procedures so far, Safran said. He added, “The public is woefully unaware to what is happening to their data.”

July 13, 2007 iHealthbeat

Nancy Davenport-Ennis, co-chair of the work group and executive director of the National Patient Advocate Foundation, said the group initially will focus on determining who owns the data. She added that the group should look into how to regulate a violation of stewardship over the data, how to protect consumers and how to provide incentives to consumers who make lifestyle chances based on the data collected.

In addition, the Agency for Healthcare Research and Quality recently requested information on the idea of national stewardship over the secondary use of data (Manos, Healthcare IT News, 7/12).

Article: http://www.ihealthbeat.org/

AMA delegates discuss best ways to go paperless

By: Andis Robeznieks / HITS staff writer Story posted: June 29, 2007 – 10:18 am EDT

Experts speaking at the American Medical Association’s annual House of Delegates meeting agreed that widespread adoption of electronic medical records is inevitable, but—during a symposium entitled Health Information Technology: Is It Help or Hype?—there was disagreement on the best way to wean a medical practice off its paper record system.

In her PowerPoint presentation, Barbara McAneny, an oncologist and chief executive officer of the New Mexico Cancer Center, Albuquerque, showed the 200 or so physicians in the audience a slide reading “Scan everything!!!” and then she recalled how her organization “hired every college kid in Albuquerque” to scan old paper charts into the new electronic system.

“It is expensive and it is necessary,” she said. “And all this has to occur before you let the physicians get near the system.”

A few weeks after everything is scanned and the EMR system is up and running, McAneny recommends shredding the paper records. “There is no going back,” she warned, adding that the old file space at her organization is now being used as clinical space.

McAneny said that, as long as the paper-based system exists, there will be people on staff tempted to use it.

“The temptation is to run two systems and my advice is: Don’t do it,” she said. “You won’t get the implementation you want.”

But Philip Tally, a Bradenton, Fla., neurosurgeon who has been using health IT and developing software for 15 years, said that his organization took about three years to transition over to an entirely electronic system. He said it wasn’t necessary to scan everything because, what they found they really needed were the most recent hospital discharge summaries and prescription records.

“We’d pull out practical things we needed to know and scanned those,” he said.

McAneny, however, said that she still found 20-year-old pathology reports useful in her oncology practice and she was convinced that scanning everything was the way to proceed.

Another speaker, family physician Bernd Wollschlaeger showed a picture of his North Miami Beach, Fla., office which was devoid of filing cabinets.

“I have no paper records in my office,” Wollschlaeger said, noting that scheduling for his cash-only practice is all done online.

He also said that, while he was waiting for his turn to speak, he used his personal computer to refill prescriptions and process appointment requests, and he explained that EMRs help physicians know what they’re doing with their practice.

“This is not just a platitude,” he said. “This gives me tremendous professional satisfaction—and it makes me money.”

When speaking to IT vendors, Wollschlaeger recommended that physicians describe their typical patient and then ask the vendor how its product will help with that patient.

“If they say ‘I’ll get back to you,’ they’re gone,” he said. “They need to be able to answer your basic questions.”

All three speakers agreed that electronic records would become the norm, and Tally cited a study on consumer preferences for maintaining personal health records. According to Tally, 28% of those surveyed would prefer to store the records on a smart card, 27% prefer online storage, 21% wanted to use a flash drive, and 24% still preferred to keep records on paper.

“If you’re one of those who still believe in paper,” Tally said, “you better seek out that 24%.”

Article: http://www.modernhealthcare.com/

Analysts: Microsoft, Google Could Prompt Disruptive Change

July 11, 2007 – http://www.ihealthbeat.org

Analysts-Microsoft-Google-Could-Prompt-Disruptive-Change.aspxRecognizing that many Internet searches are related to health care, Google and Microsoft are working to build a presence in the health care industry, Government Technology reports. The move could significantly impact health care professionals and medical device manufacturers, according the Wireless Healthcare, an analyst group in the United Kingdom.

Google’s recent investment in the genetic profiling company 23andMe and Microsoft’s purchase of the medical search company Medstory could result in new services that are disruptive to the industry, according to Wireless Healthcare.

“We are seeing the emergence of a new e-health model that challenges some the assumptions made by existing online health care providers and medical device manufacturers,” Peter Kruger, an analyst with Wireless Healthcare, said. He added, “This new model impacts not only on how diseases are diagnosed but also the way health care is delivered and e-health services are funded.”

Kruger noted that Internet search engines currently profit mostly from advertising, which is unlikely to be the funding model used for online health. “Advertising and health care do not mix well and this issue is already proving to be controversial,” he said, adding, “I am sure that regulators would be unhappy if banner advertisements started to appear on a patient’s online medical record or diagnosis.”

Wireless Healthcare in a report details a number of funding models already used by companies marketing health care devices and services to the growing demographic of consumers ages 40 to 59 years old. Kruger in September will present research on new models for online health care at a conference in San Francisco (Government Technology, 7/10).

Article: http://www.ihealthbeat.org/