Friday, November 26, 2010

Wound EMR Could Reduce Amputation Rates For Diabetics

EMR (Electronic medical records) specifically for wounds could substantially cut amputation rates for diabetes patients with foot ulcers, a study recently presented at the American College of Surgeons 96th Annual Clinical Congress determined.

Records pulled from an online wound EMR (OWEMR) system set up at by Dr. Jason Maggi at New York University Langone Medical Center’s Department of Surgery over a six-month span showed that there were up to 137 variables for each record, reports Medscape Medical News. Automated alerts sent out to all doctors involved with a particular patient’s care help doctors to sort through that information and integrate quantitative measures like healing rates in real time, according to Maggi, the study’s senior author.

“Effective management of this information and analysis of data in a timely fashion can mean the difference between limb salvage and amputation,” Maggi said, according to Medscape.

The OWEMR combined information like medications, medical history and lab results with digital photos of patient progress to help doctors “centralize information” onto a single page.

Dr. Danielle Katz, an associate professor of orthopedic surgery at SUNY Upstate Medical University who moderated Maggi’s presentation, hailed the study as potentially being “the future of medicine.”

Said Katz, “I think more and more there will be a push to have applicable practice guidelines [and] methods for tracking outcomes, and I think this really demonstrates a very potentially useful tool.”

Source : http://www.emrspecialists.com/2010/10/wound-emr-could-reduce-amputation-rates-for-diabetics/

Thursday, November 25, 2010

EMR Development Debate Focuses On Standards, Competition

Lest anyone think the issue has been settled, national health IT coordinator Dr. David Blumenthal says there is a “raging debate” in scientific and policy circles about whether standards or competition should drive EMR development, MassDevice reports.

“There is a raging debate in the computer science world, which I have only lifted the lid on because I’m not a computer scientist, but it goes basically like this: Do we want a world where somebody sets very detailed standards for what computers have to do in order to create interoperability? Or do we want a world that’s a little bit more like the Internet, where a minimal set of standards was created and an enormous, vibrant competition and spontaneous growth occurred?” Blumenthal reportedly said at a gala for the Lucian Leape Institute of the National Patient Safety Foundation.

“I hear both sides of that argument, constantly, and even those people who believe in the minimal set of standards aren’t really sure what that minimal set is, but we’re working on precisely that,” Blumenthal added.

He was responding to a question from former U.S. Treasury Secretary Paul O’Neill about EMR standardization.

“Why is it that we’re reluctant to declare that we are going to design the best prototype that we can with an idea that we will have [iterative versions] as we learn more and we identify more needs?” wondered O’Neill, himself now a patient-safety advocate. “Why is it that we can’t call to question and get on with what’s a clear and apparent need for a national standard that’s a work in progress?”

“It’s not that it has to be perfect from day one, but your office basically says, ‘We’re going to do this now’?” O’Neill asked. O’Neill noted that he had seen the “travesty” of a $500 million investment in a proprietary EMR that was not interoperable with competitive systems, something that’s “not worth a damn” when a patient travels outside the local service area, and he does not want to see others waste money like that.

Blumenthal also addressed the recent news that medical licensing boards may require health IT competency for physicians to keep up their licensure. “Information is the lifeblood of medicine, and unless physicians and other healthcare professionals are capable of using the most modern technology available for managing information, I think they will have trouble claiming, in the 21st century, the unique competence that entitles them to being licensed and board certified,” Blumenthal reportedly said at the NPSF event. “I think they’ll have trouble holding up their heads as professionals and claiming that they are at the top of their game and capable of providing the best care that technology allows.”

Source : http://www.emrspecialists.com/2010/10/emr-development-debate-focuses-on-standards-competition/

Thursday, November 11, 2010

Making Meaningful Transition To EMR

With the publication of the meaningful use guidelines on July 13, it is now clear what hospitals and doctors must demonstrate in their adoption of electronic medical records to grab a share of the billions of dollars available in federal incentives. Not as obvious, however, are the steps to take in negotiating this transition.
More than just the right technology, there must be a plan for preparing paper records and workflow processes for a “new normal,” where doctors will utilize both paper and electronic records to treat patients. The need for this “EMR enablement” work has been mostly lost amid the discussion of what technology milestones hospitals must hit and by when.

Hospitals that correctly complete this preparatory stage will realize three benefits: a more efficient records management program that returns cost savings to apply toward EMR; a better-organized records system that makes EMR implementation easier; and improved workflows for treating patients with hardcopy and digital records. Below are key EMR-enablement steps:

Centralize paper records for better access and lower costs
Today, most hospitals have patient records and films bottled up in specific departments, with no ability to share this information across the entire organization. In many cases, this produces unnecessary duplication of records and inconsistent management processes. Consolidating hardcopy patient records and films and then re-engineering how the organization stores and uses them can save time, cut costs and improve the quality of care through faster access to patient data. These new workflows need to account for how organizations archive, use and protect patient records in paper and electronic form. 
Stop saving – and paying for – outdated and duplicate records

Going digital does not mean digitizing every patient record. A thoughtful approach – what to digitize versus what can remain paper-based or securely destroyed – is required to reduce costs and improve care. A study from the American Health Information Management Association found that more than half of U.S. hospitals keep medical records forever, a behavior driven by the twin forces of industry regulations like HIPPA and state retention laws. Hospitals should comb through their records and destroy duplicates as well as those records past state-mandated retention periods. Destroying these outdated files and redundant copies cuts storage costs and makes digitization more cost-effective.
Begin your EMR journey with the right records

Make no mistake: paper records are not going to disappear any time soon. A portion of the physical patient record will continue to exist and grow at least in the near term. Information technology will certainly change how records are accessed and stored, but paper will continue to coexist with electronic information in a so-called “hybrid” record environment for many years to come. An intelligent approach to digitizing records will control costs and change how documents are shared and protected, improving workflow-based functions like billing, coding, and chart completion. Records can be shared simultaneously by many different departments instead of being handed off piece-by-piece to complete these functions. Scanning only what is needed as it is needed – and not just scanning every record, or even the entire record – ensures that the investment in an EMR is on par with treatment requirements, using patient history and clinical needs as criteria for conversion.

The opportunities of moving to the EMR are great. By addressing the core issues of what (and how) information needs to be stored, accessed and protected, healthcare providers can develop a more efficient pathway to the EMR and, in the process, deliver the patient care and cost savings benefits promised by this transition.

Source : http://www.emrspecialists.com/2010/10/making-meaningful-transition-to-emr/

Monday, October 11, 2010

Mayo Clinic Using EMRs To Reveal Genetic Predisposition To Disease

EMRs are moving into genomics, at least at the Mayo Clinic.

In a study published in the Journal of the American Medical Informatics Association, Mayo physicians showed how EMRs were able to help them determine the genetic variants that make certain people more likely to develop peripheral artery disease.

With consent of patients, researchers tapped the Mayo database of more than 8 million Electronic Medical Records to pinpoint clinical variables that could indicate a predisposition to PAD, a task that would be difficult if not impossible with paper records, Healthcare IT News reports. The physicians were able to confirm several cases of the disease and to identify phenocopies–traits found in confirmed cases–of atherosclerotic PAD.

“Although manual abstraction of medical records can provide high-quality data, for large studies such as genetic association studies, manual review of medical records can be prohibitively expensive and time-consuming,” the study says. “Our study demonstrates … several significant advantages over traditional approaches to genomic medicine research by simplifying logistics, reducing timelines and overall costs through efficient data acquisition.”

The team, from Mayo’s Divisions of Cardiovascular Diseases and Biomedical Informatics and Statistics, said that structured EMR data from large institutions “offer great potential for diverse research studies, including those related to understanding the genetic bases of common diseases.”

Source : http://www.emrspecialists.com/2010/09/mayo-clinic-using-emrs-to-reveal-genetic-predisposition-to-disease/

Wednesday, September 15, 2010

HIMSS Analytics Europe to award wired hospitals

BRUSSELS – HIMSS Analytics Europe will introduce awards for European Hospitals that have achieved the highest scores on the EMR Adoption Model (EMRAM). They’ll be unveiled at the upcoming HIMSS Europe Health IT Leadership Summit in Rome from September 29 to October 1.

HIMSS Analytics Europe recently launched the European EMR Adoption Model and is currently surveying hospitals across 12 European countries. Initial findings will be presented at the upcoming Leadership Summit, alongside the announcement of the criteria needed to achieve the highest level of EMR adoption.

HIMSS officials explained that the European EMR Adoption Model has been adapted to meet the unique needs of European Healthcare Institutions and draws on the HIMSS Analytics US EMR Adoption Model which was developed in 2005 as a methodology for evaluating the progress and impact of electronic medical record systems for hospitals in the HIMSS Analytics Database. Tracking their progress in completing eight stages (0-7), hospitals can review the implementation and utilization of information technology applications with the intent of reaching Stage 7, which represents an advanced electronic patient record environment.

Stage 7 hospitals:

* Deliver patient care without the use of paper charts
* Are able to share patient information by sending secure standardized summary record transactions to other care providers
* Use their vast database of clinical information to drive improved care delivery performance, patient safety clinical decision support, and outcomes using business intelligence solutions
* Are best practice examples of how to implement sophisticated EMR environments that fully engage their clinicians.

The validation process that confirms a hospital has reached Stage 7 includes a site visit conducted by an executive from HIMSS Analytics Europe and two current chief information officers to ensure an unbiased evaluation of the Stage 7 environments.

“Stage 7 hospitals provide best practices that other healthcare organizations can study and emulate as they strive to use EMR applications to improve patient safety, clinical outcomes and patient care delivery efficiency,” said Uwe Buddrus, General Manager, HIMSS Analytics Europe. “The accomplishments of Stage 7 hospitals serve as important indicators of high quality patient care with the interoperable electronic medical record in place.”

Source : http://www.emrspecialists.com/2010/09/himss-analytics-europe-to-award-wired-hospitals/

Friday, September 10, 2010

Should physicians nearing retirement deploy EHRs?

One of the lesser discussed factors determining whether to adopt EHRs or not is the number of years that a physician who owns his or her practice has left before retirement.

This is a complicated issue, and the advice will vary from physician to physician, given his or her specific circumstances. There are, however, a few common facts that need to be taken into consideration.

As one healthcare consultant noted, putting in an EHR system in the office doesn’t instantly deliver value. It’s – rightly – what you do with the system. And that will require time, likely years, to reap the benefits of improved clinical outcomes of patients and perhaps derive new sources of revenues (such as charging agencies to send out data, etc.). The question is whether the physician has the time to develop value or meaningful use out of the EHRs.

There will be immediate benefits, such as data retrieval automation, which can cut down on office staff time doing low-priority tasks. Intangible benefits may surface in the form of increased patient satisfaction when appointments can be scheduled via e-mail or test results received electronically without staff intervention and time.

Another benefit is the elimination of duplicative tests, but until the fee-for-service model is replaced, this particular benefit is lost revenue for physicians. Although the industry is beginning to embrace such models as bundled payments and payments tied in with medical homes, the timeline for when we are completely rid of fee for service is fuzzy at best. Will the physician retire before that happens? If retirement is less than five years away, I’d say it’s unlikely we’ll see payment reform.

Choosing the most cost-efficient system and a vendor that guarantees achieving meaningful use criteria may remove some of the discomfort and uncertainty over the major changes. Certainly physicians should reach out to their local regional extension centers (RECs) to help with implementation and workflow and office reengineering.

The healthcare consultant made a number of good points. It’s not the end of the world if the physician’s practice does not have an EHR since many larger organizations have their own and simply have that acquired practice implement the system that they use. That’s what happened to my physician’s office, although the acquisition occurred more than five years ago, which was at a time when EHRs weren’t a hot issue, as they are now.

At any rate, David Blumenthal, MD, said that in the near future adopting health IT will be part of the cost of doing business and part of the profession. Who knows when that will be? But when that time does arrive, it may just matter who is fully using EHRs and who is not.

Source : http://www.ehrexperts.us/should-physicians-nearing-retirement-deploy-ehrs/

Wednesday, September 8, 2010

Detroit Medical Center pegs EMR savings at $5M a year

DETROIT – Detroit Medical Center executives say they have achieved improved patient safety and saved $5 million to boot, thanks to DMC’s system-wide electronic medical system.

It is the second year in a row in which computer-based healthcare information processing created major improvements in quality of care and cost-savings for DMC’s eight hospitals, officials said.

The windfall in savings - triggered by highly effective electronic monitoring of critical tasks such as treating pressure ulcers and preventing medication errors - resulted in a healthy return on investment, they said.

The $50 million system powered by Kansas City, Mo-based Cerner Corp, has gone online throughout the DMC in gradual stages over a 12-year period, starting in 1998.

“The latest numbers are in, and we continue to see great strides in improving quality, treating patients more quickly and preventing error, which translates to dollar savings as well,” said Chief Nursing Officer Patricia Natale. “This work with these results is very exciting.”

“The savings are only part of the story,” she added, “because EMR is also a major step forward on the road to better quality of patient care. Thanks to EMR, we’re now seeing a dramatic reduction in the length of hospital stays due to pressure sores, along with a dramatic reduction of drug errors through EMR-enabled medication scanning.”

“The latest surveys show that EMR has helped to reduce medication errors by up to 75 percent,” said DMC Chief Medical Information Officer Leland Babitch, MD. “Obviously, that’s a major gain for patients - especially given the fact that medication errors account for the majority of accidental deaths and injuries at U.S. hospitals.”

The U.S. Institute of Medicine has estimated that up to 100,000 patients die as a result of hospital errors annually.

Treating pressure ulcers

The impact of the electronic medical record system on the treatment of pressure ulcers was especially noticeable, said DMC quality-of-care administrators.

They noted that the chronic sores often require extended hospital stays and thus drive up costs. But the most recent DMC Patient Care Services study of severe pressure ulcer cases showed that close EMR monitoring of bedsores reduced the average length of stay required to treat them by nearly three full days last year, compared with the average length of ulcer-triggered stays before EMR monitoring began in 2008.

The DMC study concluded that the reduction in the length of pressure ulcer-related hospital stays - in a system that admits more than 75,000 patients each year - was now helping to generate more than $4.5 million in yearly cost savings.

“The data on electronic medical records and patient safety and quality of care are clear and convincing by now,” said DMC Vice President for Quality and Safety Michelle Schreiber, MD. “Those data demonstrate beyond a reasonable doubt that EMR is an extremely powerful tool when it comes to protecting patients from hospital errors.

“But EMR is also proving to be an effective method for promoting quality of care - and the new numbers on bedsores and length of stays show how computer-based recordkeeping helps caregivers to take better care of patients day in and day out.”

In spite of the savings to be had from hospital-based EMR, however, recent studies show that the majority of U.S. hospitals have either failed to implement top-to-bottom EMR systems - or are cutting back on information technology (IT) programs already in place.

As of August 2010, fewer than 4 percent of U.S. hospitals had implemented the level of system-wide electronic patient recordkeeping that is now in place at the DMC. In addition, a recent study at the University of Michigan School of Medicine showed that more than one-fourth of the nation’s recession-affected hospitals have been cutting back on their already existing IT programs.

The cash-strapped hospitals were slashing IT budgets, reported the study in the Journal of Hospital Medicine, in spite of the fact that the Obama administration has recently made available more than $2.73 billion in Medicare/Medicaid bonuses for clinicians and hospitals that spend to improve their electronic medical records systems.

“The DMC has spent $50 million on building a powerful EMR system over the past five or six years, said Michael Duggan, president and CEO of the Detroit Medical Center, “and we did it because we like to think of ourselves as the ‘hospital of the future’ - as a state-of-the-art healing center where patients know they can get the best healthcare available anywhere today. ”

“At the same time, the ability to greatly reduce healthcare costs via electronic medical records is an added bonus - which makes implementing EMR a win-win situation for everyone involved.”

Source : http://www.emrspecialists.com/2010/09/detroit-medical-center-pegs-emr-savings-at-5m-a-year/