Telehealth Monitor

Even as the healthcare IT industry awaits the official definition of “meaningful use” from the federal government, a new report from KLAS examines which electronic medical record products should fit that description.

The report, “Meaningful Use Leading to Improved Outcomes,” assesses how well core clinical vendors are delivering solutions for CPOE, nursing automation, medication administration and other key areas.

Nine EMR vendors are profiled in the report: Cerner, CPSI, Eclipsys, Epic, GE, McKesson, Meditech, QuadraMed and Siemens.

via No vendor is perfect on ‘meaningful use,’ report concludes | Healthcare IT News.

THE only hurdle for creating a digital database of US medical records is the adoption of federal rules to guide the effort because the technology is already in place, Perot Systems Corp chief executive Peter Altabef said.

Perot Systems, founded by former presidential candidate H. Ross Perot, provides technology consulting to health care providers and other customers. The company is based in Plano, Texas.

Discussing why few hospitals and doctors had fully digital records, Mr Altabef, 49, said: “The kinks have been ironed out.

“This isnt really a technology question as much as a policy and standards question. From a technology standpoint, this is not putting a man on the moon, this is not creating a Manhattan Project. This technology in large part already exists. Its really just making sure people know what to do and have the funds to do it.”

via Policy holds up US medical records | Australian IT.

A New England Journal of Medicine article calls for the establishment of an independent institute for technology assessment and says electronic health records could “appreciatively” boost quality of care.

“The Proposed Government Health Insurance Company – No Substitute for Real Reform, “ was written by Victor R. Fuchs, professor emeritus of economics at Stanford University in Stanford, Calif.

“Cost control requires fixed budgets for basic coverage so that expenditures and revenues are in balance, as well as a payment system for providers that gives incentives for cost-effective care,” Fuchs wrote. “It also requires an independent institute for technology assessment to provide physicians with needed information and to create a value-conscious environment for future biomedical innovations. Also, the average quality of care could be raised appreciably if every patient had access to an accountable care organization that used electronic health records effectively, provided coordinated care, and monitored processes and procedures.”

via EHRs could boost quality of care, according to New England Journal of Medicine | Healthcare IT News.

The Obama administration’s ambitious plan to accelerate the adoption of electronic patient records will be a “steamroller” that drives the consolidation of the health technology industry and threatens many small physician practices, predicts Leonard M. Fuld, head of a large competitive-intelligence firm.

In an interview on Wednesday, Mr. Fuld summarized the conclusions of a “war game” his firm organized last month, “The Battle for Healthcare Information,” and added some postgame observations of his own.

The 35 participants in the business strategy-and-forecasting exercise were students from four graduate business schools — the Wharton School at the University of Pennsylvania, the Graduate School of Business at Columbia, the Sloan School of Management at the Massachusetts Institute of Technology and the Kellogg School of Management at Northwestern.

The government’s $19 billion plan to hasten the use of electronic health records in hospitals and doctors’ offices is intended to improve care and curb costs. But the government pump-priming will also set off an acquisition spree as large technology companies buy health information-technology specialists to grab market share, the war-game participants concluded. Allscripts, Epic and Cerner, they said, could well be targets for larger companies like I.B.M., Microsoft, Oracle and McKesson.

via Electronic Patient Records Will Force Consolidation in Health Care – Bits Blog – NYTimes.com.

If providers delay their acquisition of an EHR until the federal government issues a definition of “meaningful use,” they’re wasting valuable time.

That’s the consensus of healthcare IT experts who regularly take the pulse of the Washington D.C. bureaucracy.

The American Recovery and Reinvestment Act sets aside $20 billion for direct funding and incentives for providers who implement electronic health records and use them in a “meaningful” way beginning in 2010. However, the bill leaves it to the Health and Human Services Secretary to determine what kinds of actions constitute “meaningful use,” and some analysts say that ambiguity built into the law could actually delay the lengthy acquisition and implementation process.

“Just buying a certified EHR is not meaningful use,” noted Mark Leavitt, MD, president and CEO of the Certification Commission for Health Information and Technology. But, he added, there’s really no mystery about what meaningful use will mean in the near future.

via ‘Meaningful use’ no mystery, experts contend | Healthcare IT News.

GE, Google, and others, in a stimulus-fueled frenzy, are piling into the business. But electronic health records have a dubious history

Neal Patterson likens the current scramble in health information technology to the 19th century land rush that opened his native Oklahoma to homesteaders. Cerner (CERN), the large medical vendor Patterson heads, is jockeying for new business spurred by a $19.6 billion federal initiative to computerize a health system buried in paper. “It’s a beautiful opportunity for us,” the CEO says.

The billions in taxpayer funds—part of the $787 billion economic stimulus—also have energized tech titans General Electric (GE), Intel (INTC), and IBM (IBM), all of which are challenging Cerner and other traditional medical suppliers. Microsoft (MSFT) and Google (GOOG) aim to put medical records in the hands of patients via the Web. Wal-Mart (WMT) is teaming with computer maker Dell (DELL) and digital vendor eClinicalWorks to sell information technology to doctors through Sam’s Club stores.

Under the federal stimulus program enacted in February, hospitals can seek several million dollars apiece for tech purchases over the next five years. Individual physicians can receive up to $44,000. These carrots should encourage the proliferation of technology that will computerize physician orders, automate dispensing of drugs, and digitally store patient records. If providers participate broadly, those files are supposed to be accessible no matter where a consumer goes for treatment. President Barack Obama says the changes will improve care, eliminate errors, and eventually save billions of dollars a year. There’s also a stick: The federal government will cut Medicare reimbursement for hospitals and medical practices that don’t go electronic by 2015.

via The Dubious Promise of Digital Medicine – BusinessWeek.

The public holds mixed views when it comes to the use of electronic medical records, with most believing it’s important to adopt EMR technology and that doing so would improve the country’s healthcare system, according to a new survey conducted by National Public Radio, Kaiser Family Foundation and Harvard School of Public Health.

“The Public and the Health Care Delivery System” reveals that Americans also question both the confidentiality of an electronic health record system a system and its potential for cost savings.

Three of every four respondents say it’s important for their healthcare providers to use electronic medical records. A large proportion of the public also sees benefits to nationwide adoption.

A majority of those surveyed also say that with greater adoption of an EMR system in the United States, their own doctors would do a better job coordinating their care (72 percent say this is at least somewhat likely), the overall quality of care in the country would be improved (67 percent) and fewer people would get unnecessary medical care (58 percent.) Just more than half (53 percent) say there would be fewer medical errors.

via Industry News | Healthcare IT News.

When physician Andrew Wiesenthal needs to work out a problem, he runs around Lake Merritt, across the street from his Oakland (Calif.) office at Kaiser Permanente. As one of the main drivers behind Kaiser’s decades-long, multibillion-dollar effort to overhaul the way patient health records are kept, Wiesenthal has had a lot of laps to run.

Doctors and other medical professionals across the country will be working through similar challenges in the coming years. President Barack Obama plans to spend $17.2 billion to induce care providers to maintain patient records electronically, scrapping the current paper-based system. The Obama Administration wants electronic health records for every American by 2014.

via How Kaiser Permanente Went Paperless – BusinessWeek.

CHICAGO – There is a great deal of resistance to healthcare reform because industry players make so much money from the current system, said George Halvorson, chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals.

Speaking Monday at HIMSS09, Halvorson said the current fee-for-service payment model generates $2.5 trillion worth of revenue, but merely sells “pieces of care” to consumers because the system is not efficient.

Healthcare is the fastest growing segment of the U.S. economy, moving toward 20 percent of the Gross Domestic Product, but Halvorson said the United States is on a dangerous path and must lower the costs of the system and improve outcomes.

“We need to fix the delivery of healthcare and move to full (health insurance) coverage,” he said.

Halvorson affirmed that only a “systematic” approach to changing U.S. healthcare would succeed. He called for an emphasis on best practices, an increase in coordination between caregivers and a more consistent follow-through on patients.

Halvorson said there is tremendous inconsistency in the quality of healthcare in the United States, citing a study by Dartmouth professor Jack Wennberg that revealed a 40 percent variation by region in cardiac care.

via Industry News | Healthcare IT News.

When Dave deBronkart, a tech-savvy kidney cancer survivor, tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, a new free service that lets patients keep all their health records in one place and easily share them with new doctors, he was stunned at what he found.

Google said his cancer had spread to either his brain or spine – a frightening diagnosis deBronkart had never gotten from his doctors – and listed an array of other conditions that he never had, as far as he knew, like chronic lung disease and aortic aneurysm. A warning announced his blood pressure medication required “immediate attention.”

“I wondered, What are they talking about? ” said deBronkart, who is 59 and lives in Nashua.

DeBronkart eventually discovered the problem: Some of the information in his Google Health record was drawn from billing records, which sometimes reflect imprecise information plugged into codes required by insurers. Google Health and others in the fast-growing personal health record business say they are offering a revolutionary tool to help patients navigate a fragmented healthcare system, but some doctors fear that inaccurate information from billing data could lead to improper treatment.

via Electronic health records raise doubt – The Boston Globe.

THE Obama administration’s plan to spend $19 billion on electronic medical records has generated so much buzz you might think it was the biggest thing in health care since penicillin.

“We’ve got a long way to go” before digital health files are widespread, said Dr. Ashish Jha, an associate professor at Harvard who has been involved in several studies on such records.

But while policy makers, hospitals, doctors and technology companies debate the best ways to give every health care provider computer access to patient records, patients can’t help but wonder: What’s in this for me?

There is obvious appeal in the idea of an electronic file controlled by the patient but accessible with his or her permission by doctors, hospitals and insurers — a file that could be continually updated with all new medical procedures, prescriptions and tests. That kind of detailed record and seamless communication could improve the quality of health care and help reduce dangerous medical errors. And by improving the efficiency of medicine, it might also help curb the nation’s skyrocketing health care costs.

Lured by such promises, 4 of every 10 consumers are interested in creating an online personal health record that can be shared with physicians, according to a recent survey conducted by the Deloitte Center for Health Solutions.

via Patient Money – Some Caveats About Personal Digital Health Records – NYTimes.com.

FOR 20 years, I practiced pediatric medicine with a “paper chart.” I would sit with my young patients and their families, chart in my lap, making eye contact and listening to their stories. I could take patients’ histories in the order they wanted to tell them or as I wanted to ask. I could draw pictures of birthmarks, rashes or injuries. I loved how patients could participate in their own charts — illustrating their cognitive development as they went from showing me how they could draw a line at age 2 and a circle at 3 to proudly writing their names at 5.

Now that I’ve been using a computer to keep patient records — a practice that I once looked forward to — my participation with patients too often consists of keeping them away from the keyboard while I’m working, for fear they’ll push a button that implodes all that I have just documented.

We have all heard about the wonderful ways in which electronic medical records are supposed to transform our broken health care system — by eradicating illegible handwriting and enabling doctors to share patients’ records with one another more easily. The recently passed federal stimulus package provides doctors and hospitals with $17 billion worth of incentive payments to switch to electronic records. The benefits may be real, but we should not sacrifice too much for them.

The problem is not just with pediatrics. Doctors in every specialty struggle daily to figure out a way to keep the computer from interfering with what should be going on in the exam room — making that crucial connection between doctor and patient. I find myself apologizing often, as I stare at a series of questions and boxes to be clicked on the screen and try to adapt them to the patient sitting before me. I am forced to bring up questions in the order they appear, to ask the parents of a laughing 2-year-old if she is “in pain,” and to restrain my potty mouth when the computer malfunctions or the screen locks up. I advise teenagers to limit computer time as I sit before one myself for hours each day until my own eyes twitch and my neck starts to spasm.

In short, the computer depersonalizes medicine. It ignores nuances that we do not measure but clearly influence care. In the past, I could pick up a chart and flip through it easily. Looking at a note, I could picture the visit and recall the story. Now a chart is a generic outline, screens filled with clicked boxes. Room is provided for text, but in the computer’s font, important points often get lost. I have half-joked with residents that they could type “child has no head” in the middle of a computer record — and it might be missed.

via Op-Ed Contributor – The Computer Will See You Now – NYTimes.com.

President Obama, in his address to Congress this week, emphasized that he wants electronic health records (EHR) to be established for all Americans over the next five years. His recently passed American Recovery and Reinvestment Act earmarked $19 billion for health information technology spending, $17 billion of which is designated for incentive payments for EHR use beginning in 2011. To date, only about 25% of the nation’s 5,000 hospitals have rolled out EHR systems, and only a small fraction of physician practices have done the same.

The EHR funds will be controlled by the U.S. Health and Human Services (HHS), which has discretionary use over $2 billion of the funds.

The legislation also allocates, among other things, $85 million for health technology investments to the Indian Health Service, $1.5 billion for Community Health Centers and $50 million to HHS to improve its technology security.

Computerworld spoke with three health technology experts from private corporations and the IT vendor side to get their take on the new bill and whether the billions being spent will succeed in establishing EHRs.

The three experts are:

Dr. Charles Kennedy

Dr. Charles Kennedy, senior vice president for health IT at Indianapolis-based WellPoint Inc., the country’s largest health benefits provider. WellPoint provides health coverage to about 34 million members through its subsidiaries, primarily under the Blue Cross and Blue Shield name. Kennedy is a founding member of the certification commission for Healthcare Information Technology and a board member of the National eHealth Collaborative.

Frances Dare

Frances Dare, director of the health care consulting practice at the Cisco Internet Business Solutions Group. Dare recently testified on Capitol Hill and has advised the Obama administration regarding the stimulus package. She has spent more than 25 years in the health care industry as a hospital administrator for two facilities.

Phil Fasano

Phil Fasano, CIO at Oakland, Calif.-based Kaiser Permanente, a $38 billion nonprofit health care system. Kaiser Permanente offers health care services through a network of nearly 14,000 physicians at Permanente Medical Groups; 32 medical centers and more than 400 medical offices that form the Kaiser Foundation Hospitals; and the Kaiser Foundation Health Plan, which has 8.7 million members. Kaiser is finishing up a five-year EHR system implementation that cost $5 billion and created 5 petabytes of data on spinning disk serving 32 hospitals, more than 400 medical clinics and 14,000 physicians.

via Obama’s e-health plan: Three heavyweight health IT leaders weigh in.

For years, the idea of making health records electronic — for increased accessibility, reduced errors and portability — has exerted a near-gravitational pull on the government market.

So why hasn’t it happened already?

The Bush administration considered automating health records but concluded that the effort must be led by the private sector, said Dr. Michael Cowan, BearingPoint’s chief medical officer.

“Now it’s been five years, and there’s been little movement, so the next logical step is the one that President Obama is taking” with the American Recovery and Reinvestment Act, Cowan said.

“It’s been hard to build a self-sustaining financial case for electronic health records,” he said, adding that for an individual practitioner, the cost to implement the technology is about $40,000.

With government support, the effort might achieve critical mass, but health care practitioners’ reluctance is about more than money.

“As a hematologist and oncologist, anything I can do to help you can also kill you if it’s not done right,” he said. “So I take a heuristic approach to patient care. My problem with EHR is it makes me change my rhythm. It’s like changing a dance step; it can throw you off.” It’s a complaint he said he’s heard from other doctors.

It’s also where health information technology companies can help, he said. “The new wave in technology is in Web 2.0, in applications that allow social interaction. Every other market is on the Web, and that’s what health care needs to do. We need to get functions onto Web 2.0 and away from software applications.”

Web-based networking is cheaper and more efficient, and it can help solve some of the knotty privacy and security problems associated with EHRs.

“Google and Microsoft have changed the game,” Cowan said. The two companies have partnered on a pilot project to store electronic health records for as many as 10,000 patients of the Cleveland Clinic.

via E-health records need Web 2.0 cure — Washington Technology.