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/

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/

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/

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/

EMR Challenge: Tough Road To Reach Meaningful Use

Electronic medical record (EMR) systems have the true potential to transform the practice of medicine in ways that will improve patient care. But physicians must be secure in knowing that they will have the necessary support when they make the leap into the paperless world.

Congress and the White House have recognized the need for that support by getting behind Medicare and Medicaid incentives for physicians who undertake the daunting and costly process of adopting EMR systems. A final rule issued in July outlines how doctors can become “meaningful users” and receive the bonuses needed to help offset such a major investment.

Fortunately, federal officials are listening to some physician concerns about the government setting the bar too high for doctors to clear. Based in large part on advice from the American Medical Association and others in organized medicine, the final meaningful use rule has some greater flexibility for physicians. For instance, it allows them to defer some EMR requirements in the first two years and makes others easier to fulfill.

But despite the improvements, the bonus requirements are still going to make adoption a tough sell for many practices, especially the smallest ones. Obtaining a Medicare or Medicaid bonus in 2011 or 2012 still will require physicians to meet 20 EMR objectives, each with its own measure to determine whether doctors are compliant. Miss just one of them, and a physician who has spent tens of thousands of dollars on an EMR system might lose out on as much as $18,000 in a Medicare bonus for the year.

The margin of error is not wide enough for physicians. A requirement for doctors to maintain up-to-date diagnosis lists on their EMRs, for instance, mandates that such lists cover more than eight out of every 10 patients — a tall order. And if the government determines that a practice did not qualify for a bonus, no appeals process exists for those physicians to argue that they made the grade.

Physicians also are dealing with a tight deadline for EMR adoption. Because the federal government’s meaningful use rule on EMR systems is so recent, not a single vendor so far has been able to offer a product that will meet the requirements.

Officials expect such products to start reaching the market this fall, but that doesn’t leave physicians much time to research, purchase, implement and test such systems before the incentive program launches in 2011. Getting on board with a paperless system involves much more than simply plugging in the box and booting it up.

And as for those dedicated physicians who are ahead of the curve on EMRs? Some of them might not find out until fall that their costly systems are not going to be deemed government-certified for meaningful use.

The AMA is calling on the federal government both to establish a bonus appeals process and to deem early adopters’ systems as certified if they meet the meaningful use requirements. Heeding that advice would help allay some physician concerns.

But with all the uncertainty in the air, too many physicians — especially those in smaller practices — might conclude that the risks of failure are not worth the potentially outside chance of reward when it comes to EMR adoption. That would serve only to widen the gulf between those who have entered the paperless world and those who are still struggling to do so.

That gap will have consequences. The EMR incentives are voluntary — but not for long. Unless Congress changes the plans, in a few years Medicare bonuses will be replaced by penalties for vulnerable physicians who have not been able to overcome the barriers to EMR adoption. Those cuts will be on top of any deep reductions that might be required under the broken Medicare sustainable growth rate payment formula.

Physicians are ready to be teammates with the federal government in the shift to a better way of handling patient records. But federal officials must realize that if they are too strict in setting the rules of the game, they risk shutting out too many valued players.

Source : http://www.emrspecialists.com/2010/08/emr-challenge-tough-road-to-reach-meaningful-use/

EMR Purchase Poses Dilemma For Doctors Near Retirement

Investing in an electronic medical records system was not something many physicians late in their careers were probably thinking about a few years ago. But the introduction of incentive pay for adopting an EMR — and the penalties for not adopting — have older physicians wondering if such an investment is worthwhile.

Starting in 2011, physicians will have the opportunity to earn up to $44,000 over five years in Medicare incentives, or $64,000 in Medicaid incentives, for “meaningful use” of an EMR as defined by the federal government. But if a physician plans to stay in practice more than five years and does not adopt an EMR, he or she can expect Medicare reimbursement to start declining in 2015, leading to a 5% total cut by 2019.

Todd Sherman, lead partner of the Sherman Sobin Group, a Mount Laurel, N.J.-based financial consulting group that specializes in physician retirement planning, said meaningful use is a hot topic for those deciding whether to invest in technology this late in a career.

Sherman, who works mostly with physicians five to eight years away from retirement, believes the choices for physicians in one- or two-physician practices is especially hard. Not only must they consider shouldering an investment in a new system they might not use for long, they also must try to reflect on how that system might affect the sale of the practice.

Experts say many vendors would like doctors to believe an EMR would be a great selling point for potential buyers of a practice. In some cases, that’s true; in others, it could become a major expense with no return.

The answer depends on the true value of the EMR, said Joseph Mack, a health care consultant from Dana Point, Calif. Several factors play into that equation, including the cost of the investment, its financial return and the time it takes to arrive at that return. But don’t think the system alone will add value to your practice, Mack warned. The value comes from what is accomplished with the EMR.

An EMR can help reduce costs and improve care in many ways, including better documentation, improved efficiency and better care coordination. But a physician generally must invest money and time to reach a break-even point.

The system’s price is usually the biggest factor. However, some systems can be implemented with little capital investment, especially Web-based models that are hosted remotely and do not need a big infrastructure investment.

For most practices, there will probably still be periods of several-months of reduced patient volume while the practice adjusts to new workflows, which means practices also should plan on reduced revenue as staff members get up to speed with the new procedures, experts say.

“There’s a lot of manpower costs that are not articulated in vendor information, because they [the vendors] don’t have to deal with it,” Mack said.

It could take 18 months to several years before practices reach the break-even point. For a physician on a tight time schedule, underestimating break-even by as little as six months could throw a wrench in long-held retirement plans. Therefore, practices need to quantify benefits so they can be weighed against the costs, and a realistic time frame can be predicted, Mack said.

Exactly when break-even occurs could depend on the technical savvy of the practice staff, who will need to know how to operate the EMR, Mack said. It also could depend on choosing the right system.

Sherman said once a realistic expectation of break-even is set, physicians can determine their succession plans. Those less than three years away from retirement may have a hard time justifying the investment, Mack said. But those eight to 10 years away probably should find a way to make the investment, Sherman said. Not only could they earn incentive pay and avoid penalties, they also could provide a higher level of service in those last years of practice.

That higher level of service also can help build the practice’s profitability, which is especially important if the physician plans to sell, Mack said. Data collected from an EMR could help physicians earn other pay-for-performance bonuses in addition to those from meaningful use. If the EMR helps improve efficiencies, it could lead to a larger patient load and, at the very least, cleaner claims for better billing.

Everything that adds to the cash flow in a practice matters to a potential buyer, not how much was spent on technology, Mack said. But if you buy an ineffective EMR, it actually could increase your costs, thus reducing the value of your practice, he said.

If it doesn’t make financial sense to make the purchase, the lack of technology won’t necessarily hinder selling, Sherman said. Many small practices are being bought by larger groups that already have an EMR. They will want that same EMR installed at any practice they buy.

“I am a big proponent of an EMR, but doctors have to examine the cost benefit of it,” Mack said. “Unless the EMR helps increase their profitability … then it can’t really be said the EMR will increase the value of the practice when you sell it in one, two or three years.”

Source : http://www.emrspecialists.com/2010/08/emr-purchase-poses-dilemma-for-doctors-near-retirement/

EMR retrieval tool full of potential

BOSTON – Radiologists’ use of an advanced search tool that aims at improving the way they retrieve and sort data from an electronic medical record has the potential to benefit many other departments, according to one of the authors of a new study.

The Queriable Patient Inference Dossier (QPID) search engine was initially developed in 2005 in response to the need for radiologists at Massachusetts General Hospital in Boston to quickly have access to information about their patients.

Michael Zalis, MD, lead author of the study, which was published in the August issue of the Journal of the American College of Radiology, says the system serves as an adjunct to the hospital’s EMR system.

“Even in its simplest implementation, the presence of an EMR system presents considerable challenges to the radiologist,” he explains. “For example, radiologists commonly encounter each patient with little prior familiarity with the patient’s clinical situation. As a result, the time and effort required to retrieve, review, and assimilate EMR data relevant for the case at hand becomes an important consideration for use of EMR in busy clinical practice.”

The QPID system currently serves 500 registered users at Massachusetts General Hospital and posts 7,000 to 10,000 thousand pages of medical record data daily, according to hospital officials.

“[QPID] It was developed separately from the EMR and operates in a read-only fashion in relation to it,” Zalis says. “Thus QPID is not a source of new EMR data, but serves as a method to extract useful patterns of EMR data from the separately curated clinical data repositories at our institution,”

He says this tool has the ability to extend the radiologist’s awareness of a patient’s clinical history and care record, which he says can lead to better value, quality, and safety of practice.

“The potential impact of advanced EMR search tools is by no means limited to radiology and in fact many departments in the hospital and outpatient clinic may benefit from these capabilities,” Zalis says. “In our own institution, with the QPID search system, we have catalyzed a growing base of enthusiastic users, many of whom have contributed their own insights and content to the system’s catalogue of search modules, each of which is potentially applicable at more than one site. The future for advanced search of the EMR looks to be exciting and full of potential.”

Source : http://www.emrspecialists.com/2010/08/emr-retrieval-tool-full-of-potential/