EMR Implementation & HITECH Act Blog

Research Shows That Electronic Medical Records Save Babies’ Lives

PC Healthstop Blogging Team — Mon, 26 Apr 2010 11:55:17 +0000

We talk a lot in this blog about the financial aspects of Electronic Medical Records (EMRs), and with good reason ñ they can entail a substantial investment in time and money.† But it’s sometimes easy to lose sight of the purpose of all that investment ñ to save lives.

There has been a great deal of research conducted into how much it will cost to implement an EMR, yet there has not been a lot of research into their impact on patient outcomes. †† A recent study shows that the adoption of Electronic Medical Records and Radiology Information Systems (RISs) in hospitals in the U.S. actually lowers infant mortality in this country.† Research conducted by Amalia Miller of the University of Virginia and Catherine Ticker of MIT’s Sloan School of Business showed that when hospitals adopt EMRs and RISs, their infant mortality rates drop.

Using data on births and infant mortality already collected by the U.S. Government, and statistics on health care information technology adoption provided by the Health Information Management Systems Society (HIMSS), the researchers compared infant mortality in selected areas of the country where data was available (privacy laws limited that data pool) with the adoption of EMRs and RISs in those same areas.

After correcting for a wide range of variables, the researchers came to the following conclusions:

The adoption of EMRs by one additional hospital in a county reduces infant mortality by 13%.
The average cost of the HIT used to save that baby is about $450,000.
The reduction of infant mortality is twice as great for African-Americans than non-African-Americans.
The median cost to implement EMR in a hospital, according to a 2007 America Hospital Association study was $5,556 in capital costs per bed and $12,060 per bed per year in maintenance costs.

The authors studied ìbare-bonesî HIT implementations of EMRs, and only looked at the impact on neonatal and infant health outcomes. †They suggest that more robust implementations of HIT, including decision-support and computerized physician order entry, as examples, will extend the beneficial effects of HIT to other classes of patients.

This research serves as a gentle reminder that the HITECH Act was intended to provide incentives for physicians and hospitals to implement and use Electronic Medical Records because EMRs will improve patient outcomes and save lives. †This research shows that they do.

Rich Silverman
PC Healthstop Blogging Team

Public Domain Image Courtesy of Wikimedia Commons

NIST Begins Rolling Out EHR Performance Testing Program

PC Healthstop Blogging Team — Mon, 19 Apr 2010 11:55:34 +0000

There are hundreds and hundreds of Electronic Health Record software packages in the marketplace that claim to be capable of allowing you to establish meaningful use, but how do you know if those claims are true?† So far there has not been an impartial, independent way to determine the truthfulness of a vendor’s claims.

Earlier this month, the National Institute for Standards and Technology (NIST) rolled out the first part of its testing infrastructure, created in conjunction with the Department of Health and Human Services (HHS), vendors, implementers, standards organizations and certification bodies.† The American Recovery and Reinvestment Act of 2009 (ARRA) designated NIST as the agency responsible for determining if EHRs meet HHS standards for functionality, interoperability and technical benchmarks.

According to Bettijoyce Lide, NIST’s senior advisor, program coordinator for Health IT, speaking to Information Week Magazine, the goal is to establish a health IT infrastructure that provides a high level of security to American’s electronic medical records.† “New test methods, along with testing infrastructure, certification, security and usability help ensure that the health information of Americans is exchanged safely, securely, reliably, and only to appropriate sources,” she said.

NIST created the test procedures and infrastructure based on the Interim Final Requirements (IFR) published by HHS on January 13th of this year. † If those requirements change, NIST says it will change its test procedures accordingly. Plans call for tests to be rolled out in four waves.

Fifteen test drafts have been rolled out so far, each keyed to a specific requirement as spelled out in the IFR.† As an example, test criteria 170.302(b) relates to maintaining an up-to-date problem list, a key meaningful use requirement. The test will determine if the program will ìenable a user to electronically record, modify, and retrieve a patientís problem list for longitudinal care in accordance with (1),the standard specified in ß170.205(a)(2)(i)(A), or, (2) at a minimum, the version of the standard specified in ß170.205(a)(2)(i)(B).î

Other tests will evaluate a product’s ability to maintain allergy and medication lists, calculate body mass index (BMI) and track among history.† Additional tests will be rolled out over the coming weeks.

To keep stakeholders informed about the full extent of NIST’s activities in the health care certification arena, NIST has set up a special website with links to all of its major activities: infrastructure creation, test methods, conformance testing, and testing and support. † The overall program can be used by vendors to determine if their products will meet standards before it submits them for certification, and will be used by approved certification bodies to test those product offerings.

This NIST program puts into place one of the final pieces of the certification puzzle.† It will enable you to determine if a product which claims to be certified will actually perform the functions it says it can perform, because it has been tested and proven to meet the standards set forth by the HITECH Act and the definition of meaningful use.

Rich Silverman
PC Healthstop Blogging Team

Public Domain Image courtesy of Wikimedia Commons

EMRs Pose New Questions About The Privacy Of And Access To Medical Records

PC Healthstop Blogging Team — Mon, 12 Apr 2010 11:55:51 +0000

You know those rows and rows of medical records sitting in your file cabinets?† Who owns them?† Do you, as the health care provider who created those records own them?† How about the health insurance company that paid you for that work?† Or the patients, whose private health information those records contain?

Attorneys Mark Hall and Kevin Schulman, writing in a commentary in the March 25th edition of the Journal of the American Medical Association (JAMA), contend that it used to be fairly clear cut ñ the health care provider and the insurance company own paper records and the patient has the right to see and correct them.

Issues of ownership of and the rights to access medical records are shaped by four separate legal realms ñ property, tort, contract and regulatory.† Depending on the lay of the legal land and the set of facts in a given case, according to Hall and Schulman, any or all of the four areas could affect ownership and access rights.

But digital records are not dependent on one physical medium ñ paper ñ for their existence, and that changes much of the law that governs their ownership and distribution.† The fact that digitizing information frees it from dependence on a particular medium (paper) leads to even greater confusion about who owns medical records and who has the right to control access to them. † ìThis impending legal issue must be addressed very soon if we are to both protect patientsí interests in their medical information and ensure that new information systems are put to their best use,î they conclude.

Let’s say you have an office in Massachusetts, and a doctor calls you from an ER in Ohio asking for one of your patient’s medical records.† What state rules should you follow in determining what you can send and to whom?† While interoperability may allow you to easily zap medical records wherever they are needed, they may also subject you to privacy and access laws at the state, federal or even international levels. † How do you know what you are allowed to do?

Other aspects of ownership and access may relate to the form of EMR you implement. † Some health care providers choose to minimize up-front costs by using an EMR provided by a third party vendor or software as a service (cloud computing).† According to OrthoSupersite, a website dedicated to orthopedic professionals, the vendor could own your data, since it would be residing on its hard drives and servers.† Yes, they would probably have to grant you access, but do you really want to get into that battle?

And, as we pointed out in a recent article about financing your EMR purchases, there may be financial circumstances that give an outside vendor control of your electronic patient data.† As more and more data is stored electronically, and can thus easily be sorted, organized and ìminedî by insurers, pharmaceutical companies and government entities, there will be increasing pressure on providers to make patient data available to them for research or more commercial purposes.

Until the questions about who owns and has the right to control access to electronic medical records are resolved, this uncertainty threatens to be both a full-employment act for privacy and rights lawyers and an 800-pound gorilla in the file room.† As new precedents are set and court decisions are made ñ and there will be courts involved at some point ñ we’ll keep you posted on what they could mean to you.

Rich Silverman
PC Healthstop Blogging Team

Public Domain Image courtesy of Wikimedia Commons

MIPPA Provides Incentives for E-Prescribing

PC Healthstop Blogging Team — Wed, 07 Apr 2010 11:55:04 +0000

American health care providers write close to 3 billion prescriptions per year, according to a number of estimates, with about 80% of them being written by hand.† A recent study conducted by the Weill Cornell Medical School in New York found that about 4 of every 10 handwritten prescriptions had an error while the rate of errors found in electronic prescriptions is around one-seventh of that, or about 6%.

If those numbers hold true, then almost 1 billion prescriptions each year have an error in them.† Small wonder, then, that the government has enacted legislation to encourage providers to switch to electronic prescribing.

Amid the sea of health technology acronyms like HIPAA, HITECH, HIT and EMR floats one we’ve not addressed so far ñ MIPPA, the Medicare Improvement for Patients and Providers Act of 2008 (we’re really not making this one up).† The act contains provisions relating to a host of issues such as physician quality reporting, physician payments and ñ the one we’re addressing here ñ electronic prescribing.

Structured with incentives to encourage physicians to adopt electronic prescribing, MIPPA provides for payments of up to 2% of qualifying Medicare billings during 2010 by using a qualified e-prescribing or Electronic Health Record system that meets all of the following requirements:

Generates a complete active medication list
Selects medications, prints and electronically transmits prescriptions and conducts all alerts
Recommends available alternatives that are less expensive and therapeutically appropriate
Provides information on tiered formulary medications, eligibility and insurance authorization
Meets specified software technical requirements

Incentives will continue at up to 2% through 2010, drop to 1% in 2011 and 2012, and .5% in 2013.† Beginning as early as 2012, penalties for NOT using e-prescribing can and will be assessed by Medicare, rising to as high as a 2% reduction in payments.

As with all government programs, there is a host of fine print to wade through, and there are multiple ifs and ands to deal with, but the overall program does provide incentives to you to adopt electronic prescribing.† To help you navigate all that verbiage, HHS has created a comprehensive FAQ section on its website.

If you expect to qualify for incentive payments offered by the government for the adoption of an EMR/EHR system, you will need to be engaged in e-prescribing, because e-prescribing will be an integral part of the definition of meaningful use.† And grumble all you want about how that implementation of an e-Prescribing system may require work up front, but the benefits that will accrue to you down the line, such as reduced errors and far fewer phone calls using up your staff time to resolve prescribing problems, will more than make up for it.

Rich Silverman
PC Healthstop Blogging Team

Public Domain Image courtesy of WIkipedia Commons

Ten Keys To A Successful CPOE Implementation

PC Healthstop Blogging Team — Mon, 05 Apr 2010 11:55:22 +0000

One of the keys to achieving meaningful use and thus being able to qualify for federal incentive payments for the implementation of EMRs is the use of Computerized Physician Order Entry.† What exactly is CPOE and how can it be implemented successfully?

CPOE is a program that physicians use to place orders for medications, lab tests, radiology exams, admissions, referrals and other tasks.† A CPOE replaces written orders, phone calls and faxes, because it is linked to every other department in the hospital.

The Agency for Health Research and Quality (AHRQ), a unit of the federal Department of Health and Human Services (HHS) awarded ten grants to various health care providers to implement CPOE, and studied what happened.† Their results show that there are certain things that providers can do to help improve the chances of a successful implementation.

The ten contracts were spread across both urban and rural hospitals in various parts of the country, and were intended for use in implementing inpatient programs. † Some CPOE systems were implemented with EMRs, or in addition to existing EMRs, and all of them were put in place in conjunction with a decision support system.

Interviews with the grant recipients revealed that certain factors were critical to the success of a CPOE implementation.† Here is a brief summary:

Training ñ Frequent training and retraining is critical to a successful implementation.
Staffing ñ Staff who understand both IT and clinical science are important.† If you don’t have them, hire them or train existing personnel.
Workflow ñ CPOE is by nature disruptive, so plan to redesign your workflow to accommodate these changes.
Resources ñ Be sure to allocate enough resources (money, time and people) for planning, training, implementation and maintenance.
Work With Vendors ñ Have good relations with vendors, but don’t allow them to delay your implementation program.† Write penalties into contracts.
Committees ñ Create and use Clinical Steering Committees early and often.
Order Sets ñ Involve as many clinicians as possible in the creation of order sets, but strike a balance between filled-in fields and default values.
Interoperability ñ Good luck with this one. †Most of the grantees faced challenges integrating CPOE with other programs.† Vendors did not want to cooperate in connecting to other company’s products.
Support ñ Support should be available 24/7, especially at the beginning of the implementation.† Address problems quickly and completely. † Make support easy to access.
Alert Fatigue ñ Expect a lot of alerts when you go live, and expect clinicians to find it annoying. † Grantees had to develop new techniques to eliminate unnecessary alerts.

The conclusions reached here show that implementing the CPOE component of an EMR will pose challenges that will require creativity and tenacity while you design workarounds, but a successful implementation is possible.† It seems to be true that what works for CPOE will work for other components of an EMR implementation.

Rich Silverman
PC Healthstop Blogging Team

Image by BrokenSPhere courtesy of Wikimedia Commons under a GNU Free Documentation License

Another Country’s Experience: Health Information Technology (HIT) Can Work and Work Well

PC Healthstop Blogging Team — Wed, 31 Mar 2010 11:55:31 +0000

As the American health care system takes its first steps toward implementing a comprehensive national system of electronic medical records, can we learn anything from other countries?† Is there anywhere else in the world that’s been there and done that?

According to a new Commonwealth Fund report the answer is yes.

There is a country where 98% of all primary care physicians use EMRs with advanced clinical functionality; where they can manage medications lists, problem lists, progress notes, generate reminders, send and generate prescriptions and more ñ all electronically. †All lab results, medications and referrals are completed electronically, and physicians are automatically notified when a patient uses an ER or other after-hours provider.

Where is this utopia, you ask? †Denmark.

Yes, Denmark.

From this report, it would appear that the Danish have done in the past twenty years what we are hoping to do over the next ten †ñ implement an accurate, efficient, interoperable system of electronic medical records. †So how did they do it? †What can we learn from them?

Yes, they did it with mandates and incentives, but they also did it with something that we don’t necessarily have here in the U.S. ñ an informed, engaged patient base that pressured its physicians into adopting the technology.† According to the report: †ìPeer pressure has been competitive and supportive.† Public monitoring of participation coupled with patientsí views that physicians not using EMRs are ìsecond-rate,î compelled primary care physicians (PCPs) to install IT in their practices.† But the pressure has also been collegial and collaborative, with early adopters shar≠ing with colleagues how computer systems affected their practice.î

How did EMRs get started in Denmark? †Their roots stretch back to the 1980s, when two Danish physicians started electronically communicating on an ad hoc basis. †It worked well for them and began to spread within their hospital to other functions. †Over the next few years it grew and became more formalized, and ultimately, when the Danish government determined how beneficial it was for both physicians and patients, nationalized it.

How well does it work now, in a country with 5.5 million potential patients?† Of all the countries in the European Union, the Danish rank #1 in satisfaction with their health care delivery system.† There are ten certified suppliers supporting thirteen basic systems. †Three control 57% of the market and all but two systems are windows based.

MedCom, the national integrator which grew out of the efforts of those first two physicians, now handles all certification, training and interoperability issues with 14 people and a budget equivalent to US $2.9 million.

Rich Silverman
PCHS Blogging Team

Image by Per Palmkvist Knudsen courtesy of Wikimedia Commons under a Creative Commons Share Alike Attribution License

HIT Safety Concerns Spotlighted by FDA, HHS and Senator Grassley

PC Healthstop Blogging Team — Mon, 29 Mar 2010 11:55:51 +0000

We’re less than a year into the implementation of the HITECH Act signed into law by an administration that wants every American to have an EMR by 2014, and questions are already being raised as to the safety of Health Information Technology.† It looks more and more like error and adverse event reporting will be an integral part of implementation of EHRs.† Both Health and Human Services (HHS) and the Food and Drug Administration (FDA) plan to start tracking errors caused or created by EMRs, EHRs and other health information technologies.

According to the Huffington Post, the Food and Drug Administration plans to collect error data from 350 hospitals around the country.† Jeffrey Shuren, an associate commissioner at the FDA says that several serious safety concerns have come to light related to digital health information technologies.† Citing six deaths in the past two years that ìmay represent the tip of the iceberg,î Shuren has called for the collection of safety information about the full range of computer-assisted medical devices from pharmacy, anesthesiology, radiology and electronic health records.

Using an adverse event reporting program in place since 2002 called MedSun, the FDA will gather and publish safety issues related to digital technologies on MedSun websites.† According to the Huffington Post, an alert letter to participating MedSun clinicians mentioned an ER-based software package which took lab test orders for one patient but returned results from another.

In related events, the Department of Health and Human Services (HHS), the federal agency overseeing all the funding related to HITECH Act stimulus money, is considering setting up its own database for the reporting of adverse events related to health information technology.

According to an article in Federal Computer Week, a draft report by an HHS working group has isolated four areas where they are most concerned about errors being created:

Technology issues (hardware failures and software bugs)
Complex work flow environment with multiple interfaces
Interoperability problems (failure of systems to communicate with one another)
Deficiencies in training and implementation

Further, one functional area of EMRs the work group is concerned about is Computerized Physician Order Entry (CPOE), a key part of meaningful use.

The work group published a list of 11 areas for additional consideration, including the creation of a separate National Transportation Safety Board (NTSB)-like entity to investigate serious concerns, the creation of enhanced whistle-blower protections and the details of the relationships between incident reporting and legal liability.

Clearly, if you take Iowa Senator Grassley’s requests for information about Health IT problems to hospitals and vendors, and add these FDA and HSS efforts, a pattern emerges which suggests that the government takes the issues of health-IT safety very seriously.† We’ll keep you posted as these pending developments assume a more concrete form.

Rich Silverman
PC HealthStop Blogging Team

Public Domain Image by U.S. Government courtesy of Wikimedia Commons

Massachusetts Receives $24 Million in HIT Funding

PC Healthstop Blogging Team — Wed, 24 Mar 2010 11:55:29 +0000

Massachusetts, long a leader in the delivery of quality medical care to its citizens, has just received more than $24 million from the federal government to speed the adoption of electronic medical records (EMRs) throughout the Commonwealth.

According to a report in govmonitor .com, the Office of the National Coordinator (ONC) has authorized the release of the $24 million, the maximum that Massachusetts is entitled to under the American Recovery and Reinvestment Act (ARRA) of 2009. † According to the report, $13.4 million will go to support the adoption of EMRs throughout the Commonwealth, and another $1.6 million will go toward creating a statewide high-speed communications system for medical data and records.

According to Massachusetts Governor Deval Patrick, ìThis federal funding will help reduce health care costs and improve patient care using proven technologies, many of which are developed right here in Massachusetts.î Lieutenant Governor Timothy Murray added that in addition to streamlining health care, the money would help create jobs.

The grants, given in furtherance of the adoption of EMRs, will be administered by the Massachusetts e-Health Institute, the state agency created for that purpose.† One if its key goals, according to an article in MassHighTech.com, will be to ensure the privacy of all medical records in the state.

Couple the release of this funding with recent news that meaningful use has finally been defined and that ONC is taking definitive steps to develop a certification, and it looks like providers in Massachusetts are finally getting the tools they need to fully implement EMRs.

Rich Silverman
PC HealthStop Blogging Team

Public Domain Image courtesy of Wikimedia Commons

Financing of EMRs Carries Both Risks and Rewards

PC Healthstop Blogging Team — Mon, 22 Mar 2010 11:55:33 +0000

Physicians looking to adopt Electronic Health Records (EHRs) are facing an interesting dilemma.† Incentive money won’t be available from the government for the the implementation of EHRs until 2011, but implementation will require spending substantial amounts of money now ñ as much as $25,000 to $50,000 per provider, by some estimates ñ to get the system up and running and qualify for those incentives.

The decision many of you are doubtless facing is whether or not to take advantage of the financing programs being offered by many vendors.† To encourage you to buy their systems, many are offering low or no interest loans to bridge the gap between when you have to pay and when incentive payments become available.† They are also promising that the programs you buy will ultimately be or remain certified.

The financing may be through their own finance operations, or through third party vendors.† General Electric, for example, offers the Stimulus Simplicity financing program, which offers zero-interest payments until stimulus incentive moneys become available.

Be careful before entering into any kind of financing program, not just because it is always prudent to do so, but because once installed, the system you finance will hold the lifeblood of your practice ñ your records.† What happens in the event of a dispute or disagreement with your vendor?† Since with most financing agreements, the vendor owns or has a significant financial interest in the equipment until you have paid it off, are you effectively giving them control over the data that exists on your system?

Once your EMR is up and running, you still have to demonstrate meaningful use on a certified Electronic Medical Record system before the government will write that incentive check.† So what happens if after three or six months or a year you are unhappy with the system you implement?† Will financing limit your options if the software fails to meet your expectations for usability or suitability to your practice, or if the vendor fails to achieve certification?

In some cases, according to a recent article in ModernHealthcare.com you may find your options limited by your financing agreement.† In most cases, the financing company has an interest in leased equipment, so, for example, if you were to stop payments until a dispute is resolved, the finance company may be able to come in and haul your equipment away ñ with all your data.

According to the article, dispute resolution should be agreed upon by all parties as part of the financing agreement.† There have been cases where a finance company has literally held data hostage until their requirements were met.† And if you opt for EMR software as a hosted service, you are just as vulnerable ñ they can simply lock you out of your own system until you pay.

The finance companies, while saying that they try to work things out first, don’t deny that they can repossess an EMR system.† ìWe have that right, ultimately, if they didn’t pay and there was no resolution to the dispute,î said Jim Ambrose, president of health care financial services, equipment and finance for GE Capital, the division of General Electric Co. that offers the financing for GE Healthcare systems. † Several other vendors interviewed in that story confirmed they have a legal right to repossession in cases of nonpayment.

Try to keep your financing linked to your equipment or software supplier, suggests Steven Waldren, director of the American Academy of Family Physicians’ Center for Health Information Technology.† ìOnce the vendor got paid, the incentive to find a solution was less.† They had no obligation to make sure the software really worked.î

The industry consensus is that financing health care IT is a lot liking financing a car, in that they won’t change the rules for you just because you aren’t happy with what you bought. † Do everything you possibly can before you finance an EMR system to protect yourself down the road.

Rich Silverman
PCHS Blogging Team

Public Domain Image by U.S. Treasury Department courtesy of Wikimedia Commons

Certification of EMRs Takes a Big Step Forward

PC Healthstop Blogging Team — Wed, 17 Mar 2010 11:55:42 +0000

The two most important aspects of any electronic medical records system have been meaningful use and certification.† Meaningful use, as we discussed in an earlier post, has finally been defined.† Now the certification process is being clarified.

The Office of the National Coordinator (ONC) has announced the release of the National Proposed Rulemaking (NPRM) related to how certification will work.† The NPRM,† published in the Federal Register on March 9th, came through at a mind-boggling 186 pages.

When you read between the lines, what seems to be happening is this: The Office of the National Coordinator is setting up a temporary certification process.† This will enable providers to finally be sure they are getting certified systems, and begin establishing meaningful use so they can qualify for the incentive payments.† The ONC is also asking for organizations that want to be approved to perform the certifying and testing of EMR products to send in applications.

Once the temporary system is up and running, ONC will work to create a second, separate and permanent certification system for use moving forward.† While the processes of certification and testing will require separate approvals from ONC, it looks as though an organization can be authorized by ONC to do both.

The rulemaking sets forth 30- and 60-day periods for public comment, after which ONC will make decisions as to the final form the testing and certifying bodies will ultimately take.† The Certification Commission for Health Information Technology (CCHIT), which has been certifying EHRs since 2004, has already announced that it is ready to apply.

There is currently no guarantee that if you invest today in an electronic medical record system, it will eventually wind up being certified and enable collection of the incentives available from the government for its meaningful use.† This rulemaking is intended to eliminate that admittedly major reason that many physicians are not ready to commit to using any EMR.

Rich Silverman
PC Healthstop Blogging Team

Image by The National Guard – Flickr