Category Archives: Electronic Medical Record

Analysts: Microsoft, Google Could Prompt Disruptive Change

July 11, 2007 –

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).



Electronic Health Records Didn’t Improve Quality Of Outpatient Care

Stanford University Medical Center July 11, 2007

Science Daily STANFORD, Calif. — Electronic health records have been hailed as a key element in making U.S. medical care more effective and efficient, but a new study led by a researcher at the Stanford University School of Medicine shows that electronic records were not associated with improved quality of outpatient health care in 2003 and 2004.

Of 17 quality indicators assessed by the study, electronic health records made no difference in 14 measures. In two areas, better quality was associated with electronic records, while worse quality was found in one area.

Senior author Randall Stafford, MD, PhD, associate professor of medicine at the Stanford Prevention Research Center, said that given the overall mediocre performance of physicians in the 17 quality indicator areas, he and his colleagues had expected better quality from doctors using electronic records.

Stafford said the study doesn’t discount the value of electronic health records, but points out that the entire health-care system needs to embrace the concept of improving the quality of care delivered in clinic and office visits.

“We need to be cautious about the assumption that electronic health records are going to solve problems around health-care quality by themselves,” Stafford said. “It’s not sufficient to have an electronic health record system that provides readily available patient data and decision-making guidance. Physicians have to be receptive to that input and willing to act on that input.”

The study, produced by a team of researchers from the Stanford and Harvard medical schools, will be published in the July 9 issue of the Archives of Internal Medicine.

The 14 quality indicators for which electronic records made no significant difference included such factors as prescribing recommended antibiotics; diet and exercise counseling for high-risk adults; screening tests; and avoiding potentially inappropriate prescriptions for elderly patients.

In two quality areas – not prescribing benzodiazepine tranquilizers for patients with depression, and avoiding routine urinalysis during general medical exams – doctors using electronic record systems fared better than those who didn’t. But when it came to prescribing statins for patients with high cholesterol, physicians using electronic systems did worse.

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Experts: US electronic health records still a way off

By: Grant Gross 7/06/2007

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.

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Return on Investment Does Not Drive EHR Adoption in Hospitals

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).


Proposed standards aim to add legal clout to EHRs

ANN ARBOR, MI – Healthcare IT standards organization HL7 has released a functional profile for the Legal Electronic Health Record System.

A 30-day public comment period runs from June 18 – July 18.  Balloting will occur later this year at a date to be announced.

The profile represents a significant boost for the adoption of electronic records, says Don Mon, vice president of practice leadership with the American Health Information Association and co-chair of HL7’s EHR Technical Committee.

“It goes back to the whole issue of having a legal record,” Mon said. When organizations switch to an EHR, they have to define it as a legal record for business purposes,” he said. “The benefit of this profile is that it points out within the EHR what the functionalities should be.”

The legal profile is based on HL7’s EHR System Functional Model standard adopted in February.

“An EHR system must be able to create, maintain, and manage records within a framework of ever-changing jurisdictional rules, regulations, and laws that are intended to assure electronic records are valid, accurate, and trustworthy,” HL7 officials said in a news release. “Because legal validity is at stake for all uses of electronic records as admissible business records, including admissibility as medical records, the Legal EHR is of primary importance to healthcare operations and to interoperability.”

“The Legal EHR System Functional Profile strengthens the EHR System Functional Model standard,” said Michelle Dougherty, director of practice leadership at AHIMA, and co-facilitator in the development of the legal profile. “It identifies the functionality within an EHR System that helps organizations maintain a legally sound health record.”

Mon said the legal profile will benefit both providers and vendors and will help them talk to one another about functionality.

The profile will also help healthcare organizations reduce costs associated with inefficiencies caused by redundant paper and electronic health records, he said. Without a legal definition for electronic records, organizations would be apt to rely on paper records as the legal record – prompting dual record keeping in many cases.

“The financial benefit is to the organization to the extent it will help reduce their paper,” Mon said.


IRS Memo on IT Donations to Docs Raises Patient Privacy Concerns

Reprinted from the June 2007 issue of REPORT ON PATIENT PRIVACY, the industry’s most practical source of news on HIPAA patient privacy provisions.Hospitals may donate health information technology (HIT) to physicians without fear of jeopardizing their tax-exempt status, the IRS recently announced. But the agency’s insistence that physicians grant hospitals full access to their medical records if they accept HIT assistance has privacy officials and experts scratching their heads.

Last month, the IRS released an internal memorandum in response to a November 2006 request for guidance from the American Hospital Association (AHA). AHA said hospitals were “poised to implement HIT sharing with physicians” but were worried about whether doing so would threaten their tax exemption.

Hospitals already had what they considered to be a partial go-ahead to donate HIT. To spur the adoption of HIT, including electronic health records and e-prescribing technology, Congress included a provision in the 2003 Medicare reform law requiring HHS to write rules that would provide a safe harbor under the anti-kickback statute and provide an exception under the physician self-referral statute for hospitals that wanted to share HIT.

AHA Fears Policy May Be Altered

HHS released such rules in August 2006, but AHA said nonprofit hospitals needed the IRS to weigh in on the issue before they felt comfortable going ahead with HIT sharing. A survey of chief information officers conducted this spring revealed that a majority did not plan to make such donations, out of fear that the rules, issued when Republicans controlled Congress, could be altered now that Democrats are the majority. Rep. Pete Stark (D-Calif.), in particular, has stated his opposition to the HHS rules.

AHA’s letter seeking clarification was sent to Lois Lerner, the IRS’s director of exempt organizations. AHA says non-profit should be allowed to make IT donations without tax consequences. “The HHS regulations permit hospital and health care systems to provide software and other health IT and support services (but not hardware) to physicians for the purpose of promoting health by improving patient safety, and the efficiency and effectiveness of care,” the letter states.

The memo that the IRS released on May 11 was written by Lerner, addressed to her staff and posted on the IRS’s Web site under the topic “Electronic Health Records Directive.” The IRS described the memo as a “directive for cases on hospitals that help physicians acquire electronic health records.”

“We will not treat the benefits a hospital provides to its medical staff physicians as impermissible private benefit or inurement in violation of section 501(c)(3) of the Code if the benefits fall within the range of Health IT Items and Services that are permissible under the HHS EHR Regulation and the hospital operates in the manner described below,” Lerner writes in the memo.

The rub for privacy experts comes from the phrase “the manner described below.” The memo goes on to state that following the HHS rules is not enough. Hospitals that want to share HIT will enter into “Health IT Subsidy Arrangements” or agreements, Lerner writes.

“The Health IT Subsidy Arrangements provide that, to the extent permitted by law, the hospital may access all of the electronic medical records created by a physician using the Health IT Items and Services subsidized by the hospital,” the memo states.

In addition, the hospital must:

  • Ensure that the Health IT Items and Services are available to all of its medical staff physicians; and
  • Provide the same level of subsidy to all of its medical staff physicians or vary the level of subsidy by applying criteria related to meeting the health care needs of the community.

These requirements do not apply to for-profit hospitals.

Ambiguity on Access Issue: Continue article here:

Not everyone benefits from IRS ruling, analysts say

6/11/07 Richard Pizzi

Not all electronic medical records vendors will benefit equally from the recent Internal Revenue Service ruling allowing not-for-profit hospitals to provide healthcare information technology to physicians, according to a recent report by analysts at Leerink Swann & Company.

George Hill and Bret Jones of Leerink Swann’s Health Care Equity Research team wrote the report for investors in the wake of the May 11 IRS memorandum. They believe that vendors that currently have a high profile position in the national EMR market are best positioned to capitalize on the “potential influx of spending from not-for-profit hospitals,” but that the ruling could actually harm smaller, regional vendors.

The recent IRS ruling was important because it declared that a not-for-profit hospital’s purchase of an EMR system for a physician would not be considered an “impermissible private benefit,” according to the terms of the exemption to the Stark Anti-trust laws provided by CMS, and would not put a hospital’s tax-exempt status at risk.

In their report, Hill and Jones anticipate that the number of hospitals planning to assist physicians with the purchase of an EMR system may be greater than previously thought.

The Leerink Swann analysts contend that some regions, particularly urban areas, could see a “heightening competitive environment” as hospitals offer financial assistance to physicians for EMR purchases in order to attract more referrals for surgeries and other hospital-based procedures.

While hospital spending on EMRs for physicians is likely to increase, Hill and Jones suggest that contract signings with vendors may not spike in the immediate future. Hospital systems are generally conservative, they say, and their longer cycle capital budgeting process probably means that contract awards are several quarters away.

The analysts point out that the relaxation of the Stark Law may have some negative effects on ambulatory EMR vendors. In the near term, physician practices might choose to delay the purchase of EMR systems, “in the hopes that some local hospital will pick up a large portion of the tab for the costs” of a new EMR.

Hill and Jones also claim that competition for the large hospital-physician contracts that the Stark relaxation allows could lead to increased price competition and discounting among EMR vendors. If so, this could result in “lower net pricing and potentially lower levels of profitability for EMR software vendors.”

While the analysts suggest that many companies that offer an ambulatory EMR package will benefit from the IRS ruling, not all vendors will realize financial rewards.

The Leerink Swann report predicts that hospitals may be willing to be interoperable with a few outpatient EMR systems, but by no means all. If this proves to be true, it could act as a barrier to entry for smaller vendors in the ambulatory market.

“A hospital could choose to work with its inpatient vendor, another 3-4 outpatient [EMR] systems vendors, and then all other smaller vendors could essentially be locked out of that regional market as RHIOs are developed,” Hill and Jones warn in the report.

This possibility unnerves many smaller EMR vendors, says Don Schoen, CEO of Des Moines, Iowa-based MediNotes.

“Hospitals need to allow physician practices – particularly smaller practices – to make choices about which product they want to use in the office,” Schoen said. “This ruling can be a good thing, but it’s very dangerous for a hospital to push for only one specific product in every physician office in a community.”