Knowledge Networks says half of docs now use EMRs

By Neil Versel

Hard to believe, but 52 percent of specialists and 50 percent of primary-care physicians claim to be using EMRs, up from 42 percent and 38 percent, respectively, two years earlier, a new survey indicates. The survey does not specify what EMR usage means.

“While use of this technology will soon be mandated, these ‘early adopter’ levels suggest a desire for digital convenience at a time when patient record keeping promises to become exponentially more complex,” reports New York-based survey firm Knowledge Networks. The company conducted the study of nearly 11,000 healthcare professionals through the Physicians Consulting Network, which maintains a research panel of physicians and other caregivers.

(We quibble with whether 50 percent is “early adopter” level–or even accurate–and that technology will “soon be mandated.” CMS will penalize those that haven’t gotten to “meaningful use” by 2015, but won’t exclude non-compliant providers. For that matter, participation in Medicare and Medicaid is voluntary.)

One possible explanation for the increased EMR use is the fact that physicians continue to be crunched for time, a situation that will only get worse as 32 million newly insured patients enter the healthcare system in coming years, thanks to the Patient Protection and Affordable Care Act. Supporting this theory is the finding in the survey that 14 percent of primary-care docs and 12 percent of specialists expect to spend less time with pharmaceutical sales representatives in the next six months. Those numbers compare with 9 percent (PCP) and 8 percent (specialists) in the 2008 survey.

Meanwhile, physicians seem to be embracing smartphones to improve their efficiency. The survey found that 62 percent of specialists and 55 percent of primary-care physicians have such devices, and that at least 17 percent of these smartphone owners are using their phones for e-detailing from pharma reps.

“Healthcare professionals are embracing new technologies that promise more control and convenience; we cannot help but see a connection between the use of smartphones for e-detailing and an anticipated drop in time spent with sales reps,” Knowledge Networks Senior VP Jim Vielee tells Healthcare IT News. “These trends seem destined to magnify as healthcare reform takes effect, creating dramatic upswings in doctors’ case loads.”

Source :- http://www.emrspecialists.com/2010/07/knowledge-networks-says-half-of-docs-now-use-emrs/

Doctors Increase EMR Use

By Nicole Lewis

A growing number of primary care physicians (PCPs) and specialist doctors are using electronic medical records and other technologies as they adopt health information technology to streamline their workflow processes, a new study shows.

The survey, conducted by Knowledge Networks in conjunction with the Physicians Consulting Network (PCN) and its panel of specialists and other health care professionals, shows that 52 percent of specialists and 50 percent of PCPs said they are already keeping their patient records in an electronic format — up 10 percentage points for specialists and 12 points for PCPs since 2008.

Published last week, the study of nearly 11,000 health care professionals also shows that more than half of PCPs and specialists already have smartphones, and that many are using them for email, shopping, e-detailing and to participate in surveys.

The report reveals that smartphones, such as iPhones and BlackBerries, are quickly becoming a way of life for medical professionals. Sixty two percent of specialists and 55 percent of PCPs report having one, and roughly 85 percent to 90 percent of those who have them are using them for Internet and for email.

Other findings were that 17 percent of PCPs and 18 percent of specialists who have smartphones are using them for e-detailing, which refers to the use of technology to bypass sales calls from pharmaceutical representative. Higher proportions — 29 percent of PCPs and 24 percent of specialists — use smartphones to participate in on-line surveys.

Executives at Knowledge Networks say the research reflects the way digital technology and other factors are transforming doctors’ attitudes and habits.

“Marketers must adjust to the needs of plugged-in, increasingly busy doctors in everything they do - from the platforms they use for messaging to the time they expect to have with prescribers,” Jim Vielee, senior vice president at Knowledge Networks, said in a statement. “Health care professionals are embracing new technologies that promise more control and convenience; we cannot help but see a connection between the use of smartphones for e-detailing and an anticipated drop in time spent with sales reps. These trends seem destined to magnify as health care reform takes effect, creating dramatic upswings in doctors’ case loads.”

Knowledge Networks is a company that works closely with clients to create, effective marketing, advertising, public policies, and social science research.

Source :- http://www.emrspecialists.com/2010/07/doctors-increase-emr-use/

EMR use inches up in physician offices

By Neil Versel

The first anniversary of the enactment of the American Recovery and Reinvestment Act–Irvine, Calif.-based research firm SK&A published a report saying that 36.1 percent of physician offices have some form of electronic medical record. That’s 3.2 percentage points greater than the 32.9 percent adoption rate reported in February 2009.

Those numbers may seem high, based on studies in esteemed academic publications such as the New England Journal of Medicine, but they are in line with the findings from recent Centers for Disease Control and Prevention report. It’s also worth noting that SK&A had a huge sample size of 180,000 physician offices in the U.S.

It’s no surprise that adoption rates seem to be related to number of physicians, number of exam rooms in the office and daily patient volume, with larger practices more likely to have EMRs. Practices owned by integrated health systems tend to have greater EMR usage as well, slightly above 50 percent. Given that primary care is increasingly burdened with high patient loads and starved for cash, general practice was near the bottom in terms of EMR adoption, SK&A reports. Dialysis, critical care and radiology reported the highest EMR usage rates.

Source: http://www.emrspecialists.com/2010/07/emr-use-inches-up-in-physician-offices/

Federal panel wants national reporting on EMR software, data errors

By Neil Versel

The Adoption/Certification Workgroup of the federal Health IT Policy Committee wants to require hospitals and physicians to report “hazards and near-misses” as a result of software malfunctions, beginning in 2013. Reporting would become part of demonstrating “meaningful use” of EMRs and thus a condition for receiving Medicare and Medicaid bonus payments.

While some would like to see a database on EMR and data glitches up and running sooner than that, some patient-safety advocates believe 2013 is unrealistic. “I think it will take a while to do this right,” UCSF physician Dr. Robert M. Wachter tells the Huffington Post Investigative Fund. “The problem here is that there are potentially dangerous systems and we have no mechanism to figure out what they are or to force them to improve,” he adds.

The database could help pull together an uncoordinated group of existing public and private data repositories, such as the voluntary reporting system the FDA runs to track issues with devices it regulates. However, that system, like many others, has limited public access and redacts any fields that could identify the reporting organization.

The workgroup envisions a reporting system in which patients are encouraged to report errors and omissions in their own medical records and recommends that vendors include “feedback” buttons so they can report problems with a single click.

To learn more:
- see this Huffington Post Investigative Fund story
- check out this take from Federal Computer Week

Source:http://www.emrspecialists.com/2010/07/federal-panel-wants-national-reporting-on-emr-software-data-errors/

HHS sends final meaningful-use rules to OMB for review

By Joseph Conn

HHS has sent its final meaningful-use rules and certification criteria for electronic health-record system testing to the Office of Management and Budget—typically one of the last bureaucratic hurdles before rules are released. The criteria are called for under the EHR subsidy program established by the American Recovery and Reinvestment Act of 2009.

OMB received a copy of the final rule of the “meaningful use” criteria from the CMS Monday, according to the posting on the website of its Office of Information and Regulatory Affairs.

The White House budget authority also received a copy of the final rule on an initial set of standards, implementation specifications and certification criteria from HHS on July 2.

Under the Medicare provisions of the stimulus law, to receive an estimated $14 billion to $27 billion in federal subsidies for EHR purchases, hospitals and qualifying office-based physicians must use certified EHRs in a “meaningful manner.”

Robert Tennant, the Washington, D.C.-based senior policy adviser to the Medical Group Management Association, Englewood, Colo., said he expects a quick turnaround on both rules.

“By law, they have 90 days in which to review, but I think in all practicality, OMB has been involved in the drafting of the final rules, so it’s no surprise when they get them,” Tennant said.

OMB has had HHS’ controversial final rule on the federal requirement on public and patient notification in the event of a breach of personally identifiable health information since May 15. Tennant said he expects both recently submitted rules to be released in a week or so, possibly even later this week.

Tennant also said a proposed healthcare IT privacy rule just left the OMB review list, so “it should be published in the next couple of days.”

Source:http://www.myemrstimulus.com/hhs-sends-final-meaningful-use-rules-to-omb-for-review/

Los Angeles County approves $17M for EMR in juvenile detention facilities

By Neil Versel

Plenty has been said about the potential for EMRs and telemedicine to improve the woeful state of care in America’s prisons, but juvenile detention facilities often get left out of the discussion.

On Tuesday, Los Angeles County supervisors approved $17 million in funding for an EMR system to manage the medical records of the more than 1,500 youngsters being held in county juvenile camps and halls. The EMR is intended to improve record keeping in the county’s Probation Department, which federal authorities have cited multiple times in recent years for keeping inadequate medical records on youths in custody.

The Los Angeles Times reports that the U.S. Department of Justice has said the poor record-keeping has resulted in “inconsistent or inappropriate treatment and medication.” Los Angeles County currently faces the threat of a civil-rights lawsuit that could strip county officials of some of their control over the Probation Department, the newspaper says.

Though juvenile detainees often get moved between facilities in Los Angeles County, paper records don’t always follow them. The EMR is intended to rectify that problem. The Probation Department’s CIO says the unspecified system should be in place in 15 to 18 months.

Source:http://www.emrspecialists.com/2010/06/los-angeles-county-approves-17m-for-emr-in-juvenile-detention-facilities/

FDA oversight may extend throughout health IT

By Pamela Lewis Dolan,

The technology you adopt for your practice, including electronic medical record systems and smartphones, could become subject to Food and Drug Administration scrutiny. Experts are trying to discern what that level of examination might look like, and what specific technology would be affected.

So far, there’s no clear answer.

The FDA might get involved, experts say, because some kinds of health information technology could be considered medical devices — which the FDA regulates.

Sen. Charles Grassley (R, Iowa) started the high-level discussion about the FDA’s role in health IT in the context of meaningful use of EMRs and the push to get physicians to adopt technology. He sent a letter on Feb. 24 to Health and Human Services Secretary Kathleen Sebelius asking what her agency intended to do to ensure the safety of EMRs, and the role the FDA should play in monitoring them.

The next day, an FDA director stated flatly: “Under the Federal Food, Drug and Cosmetic Act, HIT software is a medical device.”

Jeffrey Shuren, MD, director of the FDA Center for Devices and Radiological Health, made that statement as he reported that his agency had received 260 reports over the past two years of health IT-related malfunctions causing 44 injuries and six deaths. Dr. Shuren’s statement was made to the Health Information Technology Policy Committee, an advisory panel under the auspices of the HHS Office of the National Coordinator, which oversees health technology.

Steve Nitenson, RN, PhD, an adjunct professor in the information technology management division at Golden Gate University in San Francisco, said the FDA has a history of stepping up scrutiny after problems occur. Many believe that the number of deaths and complications Dr. Shuren detailed in his testimony to the advisory committee was an indication that the FDA now feels it is necessary to exercise its authority.

The discussion of FDA oversight has prompted a debate over what is considered a medical device, and what should and shouldn’t fall under FDA regulation.

Experts generally divide health-related applications into three categories — those that clearly could be considered a medical device, those that clearly are not, and those that could go either way.

Nitenson said the FDA already monitors EMR functionalities that involve contact with patients, such as interpreting lab results, for example. Most experts agree that even smartphone applications that are an extension of those systems fall under the medical device category and are thus open to FDA scrutiny.

But when it comes to other uses of technology, “It’s more like the wild, wild West,” Nitenson said. This is the area that would include a combination of systems that would transmit data from one source to another, and the various devices used to store and transmit the data, including mobile devices such as smartphones.

Michael Zeinfeld, founder and president of Complemedia, a Chicago-based company that builds targeted media channels for branding purposes, said one reason the FDA is taking another look at many of these devices is that their mobile counterparts are making applications easier to adopt, and thus the mobile devices are used more widely.

Kyle Heppenstall is the managing director of CompassX Group, a life sciences management consulting firm in Irvine, Calif., that helps clients get systems validated with various federal agencies. His clients include corporations, health care firms, and biotech and pharmaceutical companies that are building technology systems for the consumer market. He advises them that those systems need to be validated, even when they are mobile extensions of existing systems that already are monitored by the government.

Heppenstall said the cost of developing a regulated system could be up to three times more expensive than developing systems that are not regulated. “That is an additional burden that would have to be [paid for] by the owner of the system,” he said.

Particularly with smartphone applications — many of which are inexpensive to develop and cost nothing to download — most experts agree that the cost of developing FDA-compliant applications and software would stifle innovation.

“Finally there’s a place where doctors can go, and health care professionals can go, to get these tools and resources, and you don’t want to make it more difficult for innovation to happen,” Zeinfeld said. “And you shouldn’t have to make it more difficult. Certainly, there’s got to be some middle ground.”

On the other hand, Nitenson, who has worked clinically in emergency and intensive care departments, said, “I would never use, nor would I recommend, [that] a physician use software technology that is specifically designed around a smartphone device that is not strong enough to endure both the HHS mandates and the FDA’s mandate of data security and integrity for medical devices.”

Most experts agree that full oversight of all health information systems likely never would happen. The cost would be too high, and the scope of regulation would be too vast.

But Dr. Shuren did lay out some possible scenarios, most of which would involve tracking problems after a device or software has hit the market. For example, there could be a database of adverse effects, or a registration list of devices. Another option might be a requirement that developers adhere to the FDA’s Quality Systems Regulation, a list of specific guidelines manufacturers must follow.

Nintenson thinks there must be consequences if FDA oversight is to have an impact.

“As long as there is no consequence, people who write software don’t necessarily do things in a more secure manner,” he said.

Above article publish on http://www.emrspecialists.com/2010/05/fda-oversight-extend-health/

EMRs Top Priority For 58% Of Hospital CIOs

By Marianne Kolbasuk McGee

CIOs rank electronic medical records projects higher than IT managers and directors, who are focused on PC refreshes.

With $20 billion-plus worth of meaningful use bonuses from the government at stake for their organizations, E-medical records and electronic ordering systems are the top IT priorities for hospital CIOs over the next two years, according to a survey.

However, among hospital IT managers and directors, EMR projects ranked further down on the IT priority list, with only 25% naming those initiatives as “most important” for their organization over the next two years.

The survey of 178 respondents, including 36 CIOs and 142 IT directors and managers at hospitals with 200 or more beds, was commissioned by HP and conducted earlier this year by research firm NewGrowth Consulting.

The survey was designed to ask about hospital IT leaders’ IT priorities and plans, especially those initiatives involving PCs.

Among CIOs surveyed, 58% named EMR systems as their most important IT project over the next 24 months, while computerized physician order entry came in at a close second, named by 56%.

Respondents could choose more than one answer.

The CIO results are in synch with the biggest theme in healthcare IT today — the federal government’s push for hospitals and doctor practices to implement EMR, CPOE, and other e-health systems over the next several years.

Under the HITECH portion of the American Recovery and Reinvestment Act signed into law in February 2009, the federal government plans to begin in 2011 rewarding healthcare providers with more than $20 billion over the next several years for their meaningful use of health IT systems such as EMR and CPOE.

Coming in third among top IT priorities of hospital CIOs was security initiatives, named by 47% of respondents, followed by database initiatives, with 42%. Other IT projects on the CIO priority list include bar-coded medication administration (36%); hospital expansion (33%); PC refresh (31%); and thin client/PC virtualization (31%).

However, further down the hospital IT leadership totem pole, IT management priorities — where PCs were involved — differed somewhat from those of CIOs.

Hospital IT managers and directors named PC refresh (51%); security initiatives (42%); and CPOE (37%) as their top IT projects for the next 24 months. That was followed by hospital expansion (34%); BCMA (33%); and database initiatives (30%).

Among hospital IT managers and directors surveyed, EMR ranked 7th, being named by 25% of the respondents. The survey also found that nearly two-thirds of hospital CIOs planned PC virtualization for some of their client hardware.

Also, nearly six in 10 hospital CIOs said their organizations did not have a telemedicine program, while 41% said their hospitals did have such initiatives underway. Most CIOs with telemedicine programs plan to expand those efforts in the next 24 months.

Above article publish on http://www.emrspecialists.com/2010/05/emrs-top-priority-58-hospital-cios/

EMR Implementation in Small and Large Clinics

I always love to hear clinics talk about the challenges they face in implementing an EMR. For the most part, they are completely predictable. Especially when it comes to the small versus large clinic challenges.

For example, small clinics will complain that they don’t have the resources that large clinics have to implement an EMR. Large clinics will complain that they have too much bureaucracy, red tape and stakeholders that they have to get on board an EMR implementation. They wish they were like smaller clinics who could quickly make decisions and had a much more focused need.

Of course, the reality is that both of these point of views are accurate. It’s not news that small clinics can make decisions easier and that larger clinics have more resources at their disposal. Certainly a generalization, but the reason it’s a generalization is because it’s generally true.

Since both small clinics and large clinics both face major challenges of resources and red tape respectively, then how does any clinic get over them and implement an EMR? Let’s be honest, it’s really more a matter of the priority EMR is given than anything else. So far many doctors offices haven’t decided to make their EMR implementation a priority. Once a clinic makes EMR a priority, it’s really quite amazing to see what happens.

The good news is that for many clinics, the EMR stimulus money has changed this fact and bumped EMR adoption up on their priority list. Plus, in the 4+ years I’ve been writing about EMR software, EMR software has come a really long way. Sure, they still have a ways to go, but the EMR software of today is much improved and can provide some real value to a clinic if implemented correctly.

It’s time to address the excuses for why you can’t do an EMR and start focusing on the benefits you can receive from an EMR. Notice I didn’t say “ignore” or “hide” the excuses. We need to address the excuses people are giving and see what benefits you might be missing because you’re not using an EMR. I know very very few people who use an EMR and would ever want to go back to paper. There’s a reason for this.

Above article publish on http://www.emrspecialists.com/2010/05/emr-implementation-small-large-clinics/

Online Patient Portal – Another Innovation of Medical Technology

By Jonathan G Ponting

Latest technology has simplified our lives to a great extent. Internet is helping to simplify many complicated procedures and few examples of the same are exchanging messages, contacting people in distant places using chat and emails, online shopping, reading information of latest events and happenings across the world and collecting information required related to any topic.

One of the most benefited industries from internet is the field of medicine. The latest innovation of medical technology is online patient portals. It is designed to increase communication and relation between patient and health care providers.

Online patient portal helps in efficiently managing the available resources with the local physician or provider to reduce the cost of treatment for both patient and the provider that uses advanced technology. It also enables doctors and providers in transmission of everything that is related to treatment of the patients like medical images for diagnosis, reports, medical date related to patient etc. It is also helpful in educating local physicians online on preventing development of chronic diseases via video conferences.

Online portals are also helping physicians to easily schedule appointment with patients as there is increase in demand for health care services which helps patients in avoiding to stand in lengthy lines. Patient portal helps patients to have better understanding of the disease they are suffering from, with the help of information provided and can also request for renewal of prescriptions at these portals. Patients are also offered to join various groups where other members also suffer from similar chronic diseases which help in lifting of spirits.

Patient portals not only help patients to directly contact with physicians but also to have remote access to mobile tools. Online patient portals are helping to improve quality of health care in remote and rural areas.

Patient portals are best and easy way of contacting doctors for various ailments and getting them treated without waiting for long time. They are best sources of getting advanced treatment for patients’ condition at affordable prices. They are highly beneficial for both patient and the health care provider in offering and availing best of treatments irrespective of geographic location.

Above article publish on http://www.emrspecialists.com/2010/05/online-patient-portal-innovation-medical-technology/

Research Shows That Electronic Medical Records Save Babies’ Lives

By Rich Silverman

We talk a lot in this blog about the financial aspects of Electronic Medical Records (EMRs), and with good reason – 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 – 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 “bare-bones” 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.

Above article publish on http://www.emrspecialists.com/2010/04/research-shows-electronic-medical-records-save-babies-lives/

Health Affairs: About 80% of EMR users meet some meaningful use criteria

Filed Under (EHR, EMR, Electronic Medical Records) by admin

Between 75-85 percent of physicians with EHRs are already using functions that meet some of the proposed criteria for demonstrating meaningful use, according to analysis from Seth O. Hogan, survey director, and Stephanie M. Kissam, health services research associate, at RTI International in Chicago.

The authors of the survey, published in the April edition of Health Affairs, said their analysis contributes new information about the rates at which primary care physicians, medical specialists and surgical specialists who had a basic EHR system used specific functions before the passage of the stimulus law, compared to the level of expected meaningful use of EHRs set forth in the proposed federal regulations.

“Among physicians who had key functions available to them, 75-85 percent reported using functions in the patient record category. These functions included organizing patient information such as sex and date of birth, lists of medications taken by the patient, problem lists or the current diagnoses of patients and clinical notes,” wrote the authors.

A stratified random sample of 5,000 U.S. office-based physicians was drawn from the American Medical Association’s Physicians Masterfile where, after 516 were determined as ineligible, 2,758 of the 4,484 eligible physicians completed the surveys during a data collection period from August 2007 to February 2008, yielding a 62 percent response rate.

The authors sorted completed interviews by whether physicians reported having a basic EHR system, meaning that it offers practitioners, at minimum, the following functions: the ability to record patient demographics, including name, address and sex, inclusion of patient problem lists, clinical notes, patient medication lists, and orders for prescriptions and electronic viewing of laboratory and imaging results. “Applying these criteria resulted in a sample of 485 physicians eligible for analysis,” the authors noted.

Fewer than one in five physicians reported having at least a basic EHR system, the survey found. Of those who did, primary care physicians were the most likely to report having a basic EHR system (19.4 percent). Medical specialists were the next group most likely to have a basic EHR system (17.1 percent) followed by surgeons (16.7 percent). “Availability of additional EHR functions, beyond those defined in a basic system, varied across all physician groups,” the authors wrote.

The use of these basic functions did not differ significantly by broad medical specialty yet the authors reported these data to provide baselines for tracking changes by specialty groups over time.

According to the survey, 79 percent of 306 responding physicians whose EHR systems had warnings for drug-to-drug interactions used this function. For information exchange functions, the authors also reported on the use of sending prescriptions electronically (79 percent of 265 respondents whose records had this function) and submitting laboratory orders electronically (used by 64 percent of 256 respondents whose records had this function).

“Public health reporting functions were less commonly used among the small number of physicians who had those functions available to them,” the authors wrote. In addition, only 27.6 percent of the 128 responding physicians said they could provide at least 10 percent of unique patients with timely electronic access to their health information, the authors found.

“To qualify for new federal funds intended to promote the widespread adoption and use of EHRs, U.S. physician practices must meet the government’s meaningful use benchmarks,” concluded the authors. “Tracking the use of EHRs across different types of providers will be a critical component in evaluating how their use affects healthcare costs, quality and safety and overall population health measures.”

Above article publish on http://www.emrspecialists.com/2010/04/health-affairs-80-emr-users-meet-meaningful-criteria/

Relaxing Meaningful Use Key to EMR Industry Growth, Kalorama Notes

By Chip Means

Relaxing the meaningful use standards, as some physician organizations and members of Congress are urging HHS to do, would be a boon to the EMR industry, according to market research firm Kalorama Information, which completed its market research report “EMR 2010 (Market Analysis, ARRA Incentives, Key Players, and Important Trends)” earlier this year. The report predicts a $13.8 billion market that if properly driven by incentives and encouragement of health systems, could grow in double digits.

“Requiring physicians to undergo 25 mandates by next year may not be effective given the kind of real-world usage among physicians we see today,” said Bruce Carlson, publisher of Kalorama Information. “Getting physicians used to these systems is the challenge to a totally paperless healthcare system in the United States and we think gradual, achievable goals would be preferable.”

Kalorama notes that the objectives of the HSS meaningful use requirements, in order for physicians to receive incentives in 2011, include some that would be expected, such as a requirement that physicians must submit a percentage of claims electronically, use an established diagnostic list such as ICD-9, and have common medications entered for each patient. The firm notes that some sort of requirement for computerized physician order entry (CPOE) on a percentage of orders should also be expected to increase EMR use. But Kalorama believes that requiring 80% of orders via CPOE by 2011, or that half of patients get auto-reminders through an EMR system, is a possible limiter to sales of EMR systems.

Thirty-seven U.S. Senators, led by Senate Finance Committee Chairman Max Baucus, D-Montana, and Senate Health, Education, Labor and Pensions Committee Chairman Tom Harkin, D-Iowa, wrote a letter requesting improvements in a proposed rule for distributing stimulus funds for health IT that was published by the Centers for Medicare & Medicaid Services which would increase flexibility and encourage participation among providers. 235 members of the U.S. House of Representatives urged CMS to modify its proposed definition and requirements for hospitals to qualify for the meaningful use of health IT incentive payments.

Kalorama’s market research study was conducted before the release of ‘meaningful use’ standards by HHS, but it did note that the largest barrier to EMR use in the United States is physician compliance. Kalorama has also noted that for EMR to grow in the way the federal government envisions, healthcare systems will have to develop incentives of their own, something that might be in jeopardy if standards are not easier to follow.

“It’s not just about encouraging physicians directly, though that’s part of it,” notes Carlson. “It’s about encouraging healthcare systems to develop ‘matching’ programs to encourage EMR among their affiliated physicians. Unless there’s a clear road to incentive money they won’t do that.”

Above article publish on http://www.emrspecialists.com/2010/04/relaxing-meaningful-key-emr-industry-growth-kalorama-notes/

Dermatologist’s Guide To Electronic Medical Records Systems

The medical community has had quite a challenge to convert to entirely medical records and, in many ways, is still in transition. Dermatologists frequently enjoy straightforward practice settings that integrate patient data on surgical procedures, patients’ historical data, and newer technologies that continue to emerge. Any more, the accuracy and reliability of these data systems are improving and high quality dermatology care is being increasingly streamlined. The sophisticated technology is undermined, however, if each piece of the dermatologist’s arsenal isn’t integrated into a comprehensive Electronic Medical Records (EMR) system.

DERMATOLOGY-SPECIFIC WORKFLOW

The term “workflow” refers here to an EMR that adapts to the way you conduct your office activities. Instead of being a cumbersome addition to your workload, the right EMR System for you can and should easily integrate into your unique office setting. For example, if you do physical exams, laser treatments and phlebotomy all in different rooms, you need your EMR to be able to automatically migrate all of the patient’s data so that it is accessible from any computer throughout your office. The days of manually scanning, uploading, and transferring patient data are over. Therefore, we will begin here with the assumption that all patient records will be easily accessible from one user interface, not multiple software programs for different types of records. This includes drawings you use to identify the locations of lesions with respect to anatomy. As you will read in a moment, all of this information can be housed within one EMR System.

VERIFY EQUIPMENT AND SOFTWARE COMPATIBILITY

Many dermatologists acquire new patients from a host of community referral locations, with physicians that use different machines and software than they own in their office. You need to be able to verify their previous imaging for the best possible patient care and to avoid repeating any tests, particularly for staging various cancers. The problem is that trying to choose an EMR based on the myriad of consultant’s equipment is difficult at best. For example, if you use the DicomWorks viewer for viewing radiographic images, but a patient brings you a CD-ROM from a consultant that used CT Scanner from Toshiba, the Aquilion 16-Slice, you need to make sure that the EMR you choose to grow your practice will be compatible.

If you consult on patients in the hospital or another setting separate from your primary office, the right EMR can really help increase your efficiency. First, being able to view the patient’s record remotely while your taking the consulting physician’s phone call can be extremely helpful. Second, you can synchronize the data on your laptop or handheld device directly into your EMR. Taking your laptop of portable digital assistant with you on your visit to the away patient can save you time by not having to type notes a second time after the consult is finished.

DRAWING DERMATOLOGIC IMAGES IN YOUR EMR

A growing trend is for physicians to use tablet PC’s at bedside. This lends itself very easily to using EMR’s that allow you to draw on anatomical diagrams directly in the patient’s record. Traditional desktop computers also allow this feature. For example, you can outline a nevus and the EMR software will convert that to an image file that is saved with the patient record. This can be particularly useful when tracking growth. You will need to put specific notes in the text areas of the EMR for it to be searchable later.

BUILDING TRUST IN YOUR EMR SYSTEM

Dermatologists are known to conduct rather extensive excisions of carcinomas in the clinic setting. Your EMR should record vital signs in real time and trigger audible and visual notifications in the event of abnormal readings. You shouldn’t have to watch the monitor continually; rather you can control all the parameters and alarms exactly how you want them to behave.

EASILY TRACK STAFF AND PATIENTS’ ACTIVITIES

Appointment reminders and recurring laboratory studies frequently require valuable time from your staff. An EMR System that could integrate automatic emails or phone calls one week prior to an appointment would improve efficiency.

In addition, your EMR should timestamp and track every authorized user’s activities. From ordering special materials prior to nuclear studies, to tracking who logs into the EMR, a lot of repetitive tasks can be integrated into an office system that curbs human error and improves your practice’s measurable outcomes.

Above article publish on http://www.emrspecialists.com/2010/03/dermatologists-guide-electronic-medical-records-systems/

The Importance of Voice Recognition in an EMR

In the beginning there was memory. The physician’s memory was the original repository of the patient medical record. Memory was supplemented by handwritten notes on papyri in ancient Egypt and Babylon and on paper from medieval times to the 20th century. With the advent of recording devices in the 20th century, handwritten notes gave way to the infinitely more time effective practice of dictating patient notes into a recorder which were then transcribed into a typewritten or word processed document. Of course, that practice introduced an extraneous third party into the medical record keeping process: the transcriptionist with the attendant additional expense to the physician and loss of privacy for the patient.

At the current time, 21st Century technology offers physicians and health care providers a medical record paradigm that will not only vastly upgrade the process of producing, maintaining and safeguarding medical records but will, in a direct and fundamental way, actually improve the quality of medical care. The technology is Electronic Medical Records (EMRs). EMRs produce the most accurate and complete patient health record possible to date and help physicians practice better medicine as well. EMR technology is available in a plethora of shapes and sizes with a great variety of possible features. The technology can change the way you interact with your patients, from before they make their first appointment to after they’ve left your office, and have questions about their visit in your office.

As a practicing physician you are aware of the repetitive nature of some aspects of your practice, specifically with regard to patient diagnosis. It is very likely that you and/or your staff have asked the same or at least very similar questions to each of the thousands of patients you have treated. Unless you are practicing in a tertiary referral center, and never see the same condition twice, the patient answers likewise tend to be repetitive. Similarly, physical examination findings fit into certain categories that are seen over and over again. For this reason, most of the current high-end Electronic Medical Record products very capably utilize ‘pick lists’ or ‘click and point’ methodology to complete large portions of the patient medical record.

These point and click systems are particularly adept at documenting, for instance, allergies to medications, medications that are currently being taken, past medical history, family history, social history, and major portions of the physical exam. This is the case because of the narrow range of options which are available as patient responses. For instance, your patient either smokes or doesn’t smoke. And if he/she smokes, it is probably 1 ppd, or 2 ppd, or some other value that can reasonably easily be foreseen by the experts who have designed the point and click system for your office.

However, the historical portion of the patient medical record typically has a great deal of information that cannot be easily foreseen by the developers of the point and click templates. For instance, as an Orthopedic Surgeon, my patients frequently find themselves in automobile accidents. It is not likely that the author of whichever EMR may find its way into my office has contemplated the various street names and intersections in my community. Therefore, in a typical point and click system, there will be a scarcity of relevant information concerning the specifics of the accident. And I find that these specifics are important for a wide variety of reasons, not least of which is that they remind me of the particulars regarding this patient when they return to the office. Utilizing templates for the historical portion of the report, while feasible, tends to produce extraordinarily repetitive reports, each of which sounds not only vaguely similar to the previous patients, but in many cases essentially identical to other patients. This certainly makes it difficult to recall the characteristics of this particular patient.

One of the advantages of an EMR is that it allows physicians, hospitals, insurance companies, pharmaceutical companies, medical societies, and other parties entitled to view the patient data for legitimate, permissible purposes, to do so. Legitimate, permissible purposes include coordinating patient treatment, accessing diagnostic procedures and results, preventing adverse drug reactions, and ensuring medical practice within clinical practice guidelines. One particularly high priority purpose from the physician’s standpoint is that the data be accessed by third party payors to streamline reimbursement for services.

Above article publish on http://www.emrspecialists.com/2010/03/importance-voice-recognition-emr/

Single Specialty vs. Multi-Specialty EMR

By Eric Fishman, MD

There is a lot of discussion concerning which is the “best” Electronic Health Record for any individual entity. There are a variety of parameters which should be considered prior to embarking upon what will undoubtedly be one of the most important decisions in the life of a healthcare organization.

One of the most important issues is “Should I purchase an EMR designed for my specific specialty?” We will attempt to address some of the pros and cons of each option.

If you are involved in a multi-specialty clinic I would strongly advise against purchasing multiple different EMRs, one for each specialty. One of the major difficulties with this plan, and it may be all but insurmountable, is the interconnectivity between the various programs. Yes, they may all be HL7 compatible, but you will find yourself in an almost endless quagmire of interfaces.

The question is a bit more difficult to answer if you practice in a single specialty environment. There are a large number of specialty specific EMRs for a variety of specialists, including Oncology, Ophthalmology, Orthopedics, Cardiology, etc. In this instance, if you have a very sophisticated workflow, often seen in larger single specialty medical groups, then a specialty specific EMR may be most appropriate. I find that Oncologists, in particular, do well with EMRs designed specifically for their specialty. This is, in part, because many of their workflow issues are entirely foreign to almost all other specialties. This would include, of course, dosing issues concerning their cancer curing pharmaceuticals.

At the other end of the spectrum would be Internal Medicine and/or Family Practice. Most “general” EMRs are fully capable of handling most of the workflow and reporting issues found in those practices, and therefore a more general EMR would be most appropriate.

Cardiology, Ophthalmology and Orthopedics, and many others, fall somewhere in the middle. If you find yourself using a substantial number of activities that are not performed by any other specialists, such as in office arthroscopy for Orthopedists, you’ll likely find generic EMRs to be lacking in functionality. If, however, your office based practice is more standardized, by which I mean closer to the activities performed by other specialists, then the problems which may be associated with single specialty EMRs may not be worth encountering.

What are some of these problems? First of all, many single specialty EMRs are provided by companies which are both small and unlikely to grow much larger because of their limited potential user base. Certainly this is not the case of all single specialty EMRs, and there are some multi-billion dollar companies producing fine software in this arena. However, many of them are products which were started by a physician in that specialty. Their longevity in the marketplace must be considered when acquiring software of that nature.

So, in short summary, I would encourage you to take a careful look at the workflow in your office and consider how similar or different it is to other physicians of different specialties. If it is not extraordinarily different, I would go with a more general EMR. For your specific installation, that of a multi-specialty clinic, I would strongly recommend purchasing a general EMR from a company which is large enough to have developed the different workflows for each relevant specialty.

Above article publish on http://www.emrspecialists.com/2010/03/single-specialty-multispecialty-emr/