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%.”



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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Patients Who Email Doctors Less Likely to go for Visit, Study Finds

Jul 9, 2007

Patients with online access to an electronic health record are more likely to use secure email to contact their doctors about non-urgent matters, resulting in fewer primary care office visits and lower telephone contact rates, according to a study released yesterday by Kaiser Permanente.The study, published in the July American Journal of Managed Care, found that the use of secure email linked to an EHR decreased annual adult primary care outpatient and physician office visit rates by 7-10% and resulted in 14% fewer phone contacts. A random sample of 2,700 online users who emailed their physicians during a three-month period yielded more than 1,700 completed questionnaires; 25% of those respondents said they would have scheduled an appointment instead of electronic messaging and were “satisfied with and appreciated the alternative mode of care,” according to the study. More than 1.4 million Kaiser Permanente members are registered to use the secure online services on

Source: AHA News Press Release

Certification Group Finalizes Criteria for Inpatient EHRs

The Certification Commission for Healthcare IT on Thursday published on its Web site the final certification criteria for the first round of testing inpatient electronic health record systems, Health Data Management reports (Health Data Management, 6/28).

Vendor applications will be accepted from Aug. 1 to Aug. 14 for testing and certification of inpatient computerized physician order entry and electronic medication-administration systems. The test results are expected to be announced in late October, and certification lasts for three years.

The cost of certification testing and a first-year maintenance fee totals $34,000, and an annual maintenance fee of $5,800 will be charged for the remaining two years, Health IT Strategist reports (Conn, Health IT Strategist, 6/28).


In related news, CCHIT through July will accept applications for six positions on its 21-member board of commissioners. The positions will represent:

  • Ambulatory care providers;
  • Consumers;
  • Health information exchanges;
  • Informatics experts;
  • Public health agencies; and
  • Safety-net providers (Health Data Management, 6/28).


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).