Category Archives: EMR Success

AAFP survey: More family docs using EHRs

By Richard Pizzi, Associate Editor 07/16/07

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.



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).


Planning, Early Support Keys to EMR Success, Execs Say

Health IT veterans say result is worth the struggle

May 18, 2007 — When a major IT project is implemented at The Ohio State University Medical Center, the IT shop sends out several “Red Coats” — designated helpers for users who are struggling with the new system.

The medical center’s IT services team members, who wear coats in the university’s scarlet color to make them easily identifiable, are credited with playing a key role in the successful rollout several years ago of an electronic medical records (EMR) system.

At last week’s Healthcare Information and Management Systems Society’s Virtual Conference & Expo, IT executives who have overseen successful EMR and other health IT projects offered tips for health care firms looking to implement such systems.

“[The EMR] is a whole new application” for health care firms, said Detlev “Herb” Smaltz, CIO at the Columbus-based medical center. “They have been doing things with paper charts forever.”

Smaltz stressed the need for support teams like the medical center’s Red Coats to ease the transition. “You can do as much training as you want upfront, but invariably there will be a number of folks who will need some help,” he said. Smaltz suggested that user response to a major new applications in the three weeks after going live can “make or break” a project.

He also noted that the OSU medical center leaned heavily on its project level steering teams during the implementation phase to quickly address questions about required changes to business processes. “That is the thing that holds up projects – all the decisions about business process changes you have to make,” he added.

Smaltz said that 90% of physicians working at the center’s six hospitals use the EMR system and that it is now being rolled out to the offices of affiliated physicians.

Longtime EMR user Salvatore Volpe, a physician who practices in Staten Island, N.Y., added that detailed, upfront planning is critical to avoid the “headaches and heartaches” EMR projects can cause small and large operations alike.

For example, Volpe said, without early planning, physician practices would likely have to pay for EMR software and services long before they are ready to use them. Vendors typically begin charging users for software and services once a contract is signed — whether the customer knows how to use the product or not, he noted.

Volpe also advised potential EMR users to conduct hands-on tests of multiple EMR software offerings before selecting one. “The only way to know if these products fit into your particular workflow is by actually using them,” Volpe said.

Denni McColm, CIO of Citizens Memorial Health Care Foundation Inc. in Bolivar, Mo., credited the hospital’s success with EMRs to the support of the company’s administrators and to working closely with physicians and staff members before, during and after the move to paperless patient records.

Complete article here:

IT Executives Offer Advice for Adopting Electronic Records

May 21, 2007

Health IT executives at the Healthcare Information and Management Systems Society’s Virtual Conference and Expo last week gave recommendations on how to institute electronic health record systems most effectively, Computerworld reports.

Detley Smaltz, CIO at the Ohio State University Medical Center, said support teams and user response in the first three months after an EHR system is adopted can “make or break” a project. Project-level steering teams also can help quickly address questions about required changes to business processes, Smaltz said.

Salvatore Volpe, a physician and longtime user of EHRs in Staten Island, N.Y., recommended extensive upfront planning to avoid the “headaches and heartaches” that the projects can cause. Without early planning, physician practices have to pay for EHR software and services before they are ready to use them, Volpe said. He added that vendors typically begin charging users for software and services when a contract is signed, regardless of whether the physicians know how to use the product.

Denni McColm, CIO of Citizens Memorial Health Care Foundation in Bolivar, Mo., advised new adopters of EHR systems to completely eliminate all paper charts once the system has been instituted. “If you don’t, you can never achieve the financial benefits of implementing an EHR,” she said, adding, “Anything that is on paper won’t be available when physicians really need it to make critical decisions.”

Laura Jantos, principal with ECG Management Consultants, urged faster implementation. She said that organizations who quickly adopt EHR systems with extensive functionality will recover from startup financial and productivity losses faster than those moving slowly and trying to lessen the impact of the change (Havenstein, Computerworld, 5/18).


HHS Promulgates New Regulations to Facilitate Adoption of Health Information Technology

On August 1, 2006, the U.S. Department of Health & Human Services (“HHS”) promulgated final rules (“Final Rules”) that will permit hospitals, physician practices and certain other organizations to donate electronic prescribing (“e-prescribing”) and electronic health records (“EHR”) technology and supporting services to physicians without violating either the federal physician self-referral (“Stark”) law or the federal health care program anti-kickback law (“AKL”). Both Final Rules are a result of the Congressional mandate in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (“MMA”) for the creation of a Stark law exception and an AKL safe harbor that would enable entities (such as hospitals) to encourage and assist physicians to embrace the use of e-prescribing technology. In promulgating the Final Rules,

HHS elected to go beyond e-prescribing, providing immunity for the donation of EHR technology and services under certain circumstances, as well.

I. The Final Rules

The Stark law exceptions and AKL safe harbors established by the Final Rules

are considerably more protective than was originally contemplated in the

October 11, 2005 proposed rules (the “Proposed Rules”). Among other things, the Final Rules allow for a broader range of qualifying donors and recipients; cover a more extensive range of technology; and replace a possible cap on the value of the donated e-prescribing or EHR technology with a recipient cost sharing provision for EHR.

A. E-prescribing

The e-prescribing exception and safe harbor are nearly identical, protecting donations by a hospital, physician group practice, Medicare Part D Prescription Drug Plan (“PDP”) sponsor, or Medicare Advantage (“MA”) organization of hardware, software, information technology (including internet connectivity), and training and support services that are necessary and used solely to receive and transmit electronic prescription information, provided that several conditions are met. For example: (1) the donor may not limit or restrict the use or compatibility of the donated technology or services with other e-prescribing or electronic health information systems; (2) the technology and services must be capable of being used for any patient regardless of payor status; (3) the donation of the items and services cannot be conditioned on an agreement by the recipient to do business with the donor; and (4) the decision to make the donation – including the amount and nature of the items and services – must not be determined in a manner that takes into account the volume or value of referrals or other business generated between the parties. Significantly, HHS did not impose a limit on the value of e-prescribing technology that may be donated to an eligible recipient.



The Final Rules also establish a new regulatory Stark law exception and AKL safe harbor for the donation of EHR technology and services. The most significant aspects of this exception and safe harbor are discussed below.

1. Donors

In comparison to the Proposed Rules, the Final Rules expand the types of entities that may donate EHR items and services. Under the Stark law exception, donations may be made by any entity that furnishes “designated health services.” Under the AKL safe harbor, the donor may be (1) any individual or entity that provides covered items and services and seeks reimbursement, either directly or through reassignment, from any federal health care program, or (2) any health plan. This generous definition encompasses hospitals, group practices, physicians, nursing and other facilities, pharmacies, laboratories, oncology centers, community health centers, and dialysis facilities, among others.

2. Recipients

The Stark law exception protects items and services donated to any physician. The AKL safe harbor protects donations to any individual or entity engaged in the delivery of health care, such as physicians, group practices, physician assistants, nurse practitioners, nurses, therapists, audiologists, pharmacists, nursing and other facilities, community health centers, and laboratories.

3. Protected Items and Services

The Final Rules protect “information technology” (e.g., internet connectivity and maintenance) in addition to the software and training services (e.g., help desk) covered under the Proposed Rules. Software must contain, or link to, an e-prescribing component. (Protection is not afforded to the donation of hardware, however.) Unlike the e-prescribing Final Rule, EHR items and services must be necessary and used predominantly (rather than solely) to create, maintain, transmit or receive the EHR of the donor’s or physician’s patients in order to be protected. Although it is not clear what regulators will consider to be “necessary and predominant,” Preamble commentary indicates that software packages may include, depending on the circumstances, functions related to the care and treatment of individual patients, such as patient administration, scheduling functions, billing, and clinical support. Expressly excluded, however, is any technology used primarily for personal business or business unrelated to the recipient’s clinical practice or operations.


4. Interoperability

Under the Final Rules, which abandon the pre- and post-interoperability distinction

contained in the Proposed Rules, donated EHR technology must be interoperable with other e-health systems at the time of its donation in order to be protected.

“Interoperable” is defined as software able to (1) communicate and exchange data accurately, effectively, securely, and consistently with different information technology systems, software applications, and networks, in various settings, and (2) exchange

data such that the clinical or operational purpose and meaning of the data are preserved without alteration. Software is “deemed” interoperable if a certifying body recognized by HHS has certified the software no more than 12 months prior to the date

of donation. In notices published in the August 4, 2006 edition of the Federal Register,

HHS (1) recognized certain ambulatory EHR criteria developed by the Certification

Commission for Healthcare Information Technology that may be used by certifying

bodies to deem technologies interoperable and (2) promulgated interim guidance for entities that want to become recognized EHR certifying bodies.

5. Cost Sharing

The Final Rules require the recipient physician to pre-pay a minimum of 15 percent of the donor’s costs. Neither the donor nor a related party may finance the physician’s payment.

6. Selection of Recipients

EHR donors may not directly take into account the volume or value of referrals or other business generated between the parties when determining whether, and the extent to which, a particular recipient is provided EHR. The Final Rules, however, list various selection criteria that donors may use without triggering the volume or value or other business generated standards. For example, donors may consider such practice specific criteria as the total number of prescriptions written, practice size, number of hours worked by the physician, and the physician’s overall use of automated technology.

II. Conclusion

The Final Rules reflect an unprecedented degree of coordination between CMS and OIG, resulting in consistent treatment of health information technology donations under the Stark law and AKL. This coordination reflects the government’s desire to remove impediments to the adoption of important, but expensive, software and related information technology that will enhance patient care and safety and reduce medical errors while simultaneously protecting federal health care programs from fraud, waste and abuse.

The Final Rules are scheduled to be published in the Federal Register on August 8, 2006, and will become effective 60 days thereafter. Although the exception and safe harbor for EHR donations will sunset on December 31, 2013, the e-prescribing provisions are indefinite.

IRS gives physician EMR donations the OK for Non-profits

By Nancy Ferris Published on May 14, 2007 Government Health IT

A long-awaited Internal Revenue Service memo has made it clear that nonprofit hospitals can give e-health records software and support services to their staff doctors without jeopardizing their tax-exempt status.

The May 11 memo was welcomed by health IT advocates, who had expressed concern that uncertainty about how the IRS might rule was inhibiting hospitals from including the doctors’ offices in their medical records networks.

The IRS memo cites Department of Health and Human Services regulations that created exemptions from anti-kickback and physician self-referral laws. Those regulations, which became final in August 2006, were intended to encourage hospitals to share their systems with doctors who practice at the hospitals.

The alignment between the IRS and HHS actions prompted Scott Wallace, president and chief information officer of the National Alliance for Health IT, to call the memo “absolutely as good as anyone could have hoped for.” He predicted it would encourage more doctors to use EHR systems. Once hospitals install such system for their internal operations, “the incremental cost of adding a physician is fairly low,” Wallace said.

“The AHA is pleased that the IRS moved quickly in responding to hospitals’ request for guidance on this important issue,” said Lawrence Hughes, regulatory counsel of the American Hospital Association.

According to the AHA, nearly 3,000 of the nation’s 4,936 community hospitals are nonprofit organizations.

The memo from Lois Lerner, the IRS’ director of exempt organizations, notes that some hospitals believe their medical staff physicians need financial incentives to use EHR software that would exchange information with hospital systems.

Wallace said such arrangements are likely to help especially with small medical practices, which have a much lower rate of EHR usage than larger practices.

Article:, also see the HHS EHR Regulation here

To learn more about the ruling:

– read this Health Data Management item
– read the IRS ruling (.pdf)

AHIC reviews, sends back EHR recommendations

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: