By Sheldon Alberts, Washington Correspondent, Canwest News Service

WASHINGTON — facing possible defeat on his signature domestic policy priority, President Barack Obama appealed on Wednesday for Americans to put aside fears about health care reform and back sweeping changes that include the creation of a government-run medical insurance program.

During a prime time news conference in which he linked passage of health care legislation to the nation’s overall economic stability, Mr. Obama also claimed his administration’s controversial US$787-billion stimulus package and financial industry bailouts had all but rescued the American economy from collapse.

“As a result of the action we took in those first weeks (in office), we have been able to pull our economy back from the brink,” Mr. Obama said.

The president’s declaration of victory in the fight to save the economy came amid a wave of recent criticisms that the stimulus has done little to stem the tide of job losses. It’s expected the U.S. unemployment rate could rise above 10% later this year.

“We still have a long way to go,” Mr. Obama acknowledged. “I’ll be honest with you – new hiring is always one of the last things to bounce back after a recession.”

With Congress now wavering on White House demands to pass a US$1-trillion-plus health care bill before the fall, Mr. Obama warned a failure to overhaul the system now will lead to ballooning costs and force millions of more Americans to lose their coverage over the next decade.

“If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket,” Mr. Obama said. “If we do not act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction.”

Answering Republican opponents who this week predicted the health care issue would be his “Waterloo,” Mr. Obama made a defiant prediction: “We will do it this year.”

Mr. Obama’s decision to spend precious political capital by making a personal health care plea to Americans – it was his fourth prime time press conference since taking office in January — came as the White House struggled to keep conservative Democrats from abandoning him on the issue.

The most contentious elements of the health plan include a proposal to pay for health reform by taxing the wealthiest Americans, and the politically risky idea of launching a publicly-run health insurance system that competes directly with U.S. private insurers.

Already, leaders of one key House of Representatives Committee have put off voting on a version of the legislation after admitting they lacked enough support from Republicans and Democrats to get it passed.

In the Senate, meantime, Democrats who control the committees crafting health care legislation say Mr. Obama’s August deadline for passage of a bill is too ambitious. They argue there is no need to rush, especially with Americans increasingly wary of the price tag.

“I think it’s important that there be pressure (from the president). Otherwise sometimes things tend to drift,” said Senator Kent Conrad, a North Dakota Democrat and a member of the Senate finance committee.

“But this is hard. There’s just no way around it.”

Countered Mr. Obama: “If you don’t set deadlines in this town, things don’t happen. The default position is inertia.”

The nervousness among some Democratic lawmakers has been triggered, in part, by a series of polls showing the country is not sold on Mr. Obama’s plan.

A Rasmussen survey released Wednesday showed just 44% of Americans in favour of health reform proposals – even though a detailed bill has yet to emerge from Congress – while 53% are against.

But Mr. Obama cast the U.S. health system as broken and increasingly unaffordable. Americans spend $2.5-trillion a year on health care and yet 47-million residents go without medical insurance.

Ballooning costs of existing government health programs – Medicare for Americans 65 and over, and Medicaid for the poorest U.S. citizens – are weighing down the federal balance sheet, Mr. Obama said.

“Let me be clear: if we do not control these costs, we will not be able to control our deficit,” he said.

Mr. Obama has accused Republicans of fuelling public concern with misleading claims that his reforms would set the U.S. on a path to government-run, single-payer health care — with Canadian medicare being offered as the ‘socialized’ medicine Americans must avoid at all costs.

“What the heck do we want to become England or Canada for,” Rudy Giuliani, the former New York mayor and failed Republican presidential candidate, said Wednesday in a televised interview.

Mr. Obama dismissed the idea of a government takeover of health care, saying a public insurance system would complement, not replace, private companies.

“It will keep government out of health care decisions, giving you the option to keep your (private) insurance if you’re happy with it,” he said.

Other Republicans have cast the health care battle as their best chance to deal Mr. Obama, whose personal approval ratings have slipped under 60%, a crippling political blow just six months into his presidency.

“We need to put the brakes on this president. He’s been on a spending spree since he took office,” Senator Jim DeMint, a South Carolina Republican, told NBC’s Today Show.

“It’s not personal. But we’ve got to stop his policies … They’re loading trillions of dollars of debt onto the American people.”

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The AP reports President Obama “returned to campaign-style rhetoric on Thursday,” saying at two New Jersey events that “inaction is not an option” as he urged supporters “to push for his overhaul of the nation’s health care system.” ABC World News, which opened with the story, called the President “a man on a mission. Everywhere he goes these days, he’s pushing healthcare reform.” The AP reports Vice President Biden was also touting reform, joining Health and Human Services Secretary Kathleen Sebelius at a forum in Virginia.

The Politico reports, “On the defensive over the economy and health care, the White House is shooting back with a double-barreled message for its critics and skeptics. To Republicans who say the stimulus isn’t working: Back off. To moderate Democrats wary of health care reform: We’re watching you.” Bloomberg News, however, reports Senate Finance Chairman Max Baucus “complained…Obama is ‘making it difficult’” to create a bipartisan compromise in the Senate. Baucus said Obama’s “opposition to the idea of taxing health-care benefits is ‘not helping us.’” The Hill reports Baucus and other senators emerged from “another intense day of closed-door negotiations” to “admit they had not reached the finish line.” Baucus said, “We’re very close to reaching agreement. By close, I mean it’s a matter of couple, three or four days, maybe.”

Sen. John McCain said on Fox News’ Your World, “The President has reiterated time and again his commitment to getting through before the recess. This thing is like a fish in the sun. If you leave it out there very long, it’s going to begin to smell very, very badly to the American people. That is why they are in such a rush to fundamentally affect one-sixth of our gross national product.”

USA Today reports that three tax increases “proposed by President Obama and House Democrats on the richest Americans could produce the highest tax rates in a quarter-century.” About 500,000 taxpayers earning $1 million or more would pay a full 5.4 surtax under one plan; surtaxes at lower rates would impact anyone earning more than $350,000 per year. Obama’s February budget “calls for letting tax cuts for top earners enacted at the beginning of the decade expire in 2011,” and during the presidential campaign, Obama “favored bolstering Social Security by subjecting family income above $250,000 to the 12.4% payroll tax.”

The New York Times reports Congressional Budget Office Director Douglas Elmendorf told the Senate that healthcare legislation proposed so far “would not curb the federal government’s runaway spending on medical care, and that lawmakers would need to take more forceful action to meet President Obama’s goal of controlling costs.” His testimony “drew criticism from Democratic leaders” and “provided ammunition to Republican critics.” The Wall Street Journal reports Senate Majority Leader Harry Reid “quipped that Mr. Elmendorf should consider running for Congress,” while Senate Majority Whip Richard Durbin “admitted that Senate Democrats were frustrated with the CBO’s various pronouncements over their efforts to push through health-care overhaul.”

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HDM Breaking News,

The federal government should extend the transition to a fully functional electronic health records system beyond 2015, according to the American Hospital Association.

The AHA has sent a comment letter on the initial proposal of a workgroup of the HIT Policy Committee to define meaningful use of electronic health records to David Blumenthal, national coordinator for health information technology.

“Our members believe that the functional abilities of the EHR that would result from implementation of the draft definition are correct, but that the proposed sequence for adoption is overly aggressive and unrealistic for most,” according to the AHA. “Increasing the requirements for being considered a meaningful user every two years should provide enough time for adoption, but only if the initial requirements are set at an achievable level. The AHA encourages the committee, ONC and the Centers for Medicare and Medicaid Services to develop a ‘meaningful use’ adoption timeline that begins with fewer functional requirements and extends the transition to a fully functional EHR beyond 2015.”

Computerized physician order entry, for instance, should not be required until after 2015 or beyond, the AHA contended in the comment letter. “Most hospitals are not prepared to make such significant advancements under the proposed implementation timeline, so rushing to adopt could compromise patient safety and the success of this effort,” the letter states. “Our members, including those with significant previous HIT investments and CPOE, consider a 2011 CPOE requirement to be unrealistic.”

The AHA calls for the definition of meaningful use in 2011 to focus on getting the majority of hospitals running with a basic EHR. Appropriate functions for 2011 should include clinical documentation of patient demographics, problem lists, medication lists, discharge summaries, and results viewing for lab reports, radiology reports and diagnostic tests, the AHA advises.

The association, mirroring comments of the American Medical Association and some 80 other physician organizations in a separate comment letter, also noted that providers must work during the same time period to migrate to the HIPAA 5010 transaction sets and ICD-10 code sets.

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More than 50% of healthcare providers surveyed by IVANS do not believe the federal stimulus package will successfully encourage health IT adoption.

By Marianne Kolbasuk McGee InformationWeek

Although a majority of healthcare providers remain skeptical about how they’ll benefit by the federal government’s $20 billion stimulus program, many plan to forge ahead anyway, according to a report released this week.

About seven in 10 healthcare providers believe electronic medical records will have a positive impact on their businesses and patient care, but 80% say the lack of money is their biggest obstacle to deploying health IT systems, said the new report by IVANS, a supplier of EDI and network services to the insurance industry.

The nationwide, e-mailed survey of 508 healthcare providers — including hospitals, clinics, private medical practices, nursing homes, home healthcare organizations and medical billing companies — found that while nearly 40% plan to forge ahead with e-medical record deployments within the next 12 months, more than 50% of healthcare providers do not believe the federal stimulus package will successfully encourage health IT adoption.

Healthcare providers’ doubt appears to be rooted to several factor, most notably uncertainty about the specifics of the government’s eligibility requirements for receiving HIT-related rewards. Starting in 2011, the federal government is expected to begin awarding approximately $20 billion over the next five years, rewarding higher Medicare and Medicaid reimbursements to doctors and hospitals that demonstrate “meaningful use” of health IT.

However, the details of what will constitute “meaningful use” haven’t been worked out yet. The federal government is in the process of investigating and defining the scope of what “meaningful use” of health IT will qualify for the American Recovery and Reinvestment Act of 2009’s HITECH (Health Information Technology for Economic and Clinical Health) stimulus funding incentives. Just this week, a federal advisory panel — the HIT Policy Committee — unveiled some of its recommendations for the “meaningful use” definition.

“They’re on the right track,” said Clare DeNicola, IVANS CEO, of the HIT Policy Committee’s recommendation so far to the U.S. Dept. of Health and Human Services about the “meaningful use” definition. “It’s not about technology, it’s about the care — we can’t lose sight of that,” she said about the committee’s suggestions for how IT can be used for improving quality of patient care and public health.

Also fueling uncertainty among healthcare providers participating in the survey was this: Home healthcare providers and nursing homes were among the 508, healthcare providers polled. However, so far the HITECH federal stimulus legislations is vague on how those healthcare providers will participate in the new programs, despite the growing population of aging baby boomers who’ll likely increasingly require their services in coming years.

In fact, despite their skepticism and uncertainly about the government incentive programs, about four in 10 healthcare providers are planning to implement e-medical record systems over the next 12 months.

Many are already making investments in IT, including those that can help support e-medical record deployments, including wireless networks, business continuity technologies and connectivity to remote locations.

“Healthcare providers are wary but they are moving forward with technology innovations,” said DeNicola. “They’re not driven so much by the stimulus funds as they are in their belief that these technologies can help improve their businesses and patient care,” she said.

Finally, when survey participants were asked who should take the lead on driving adoption of healthcare IT to ensure its success, 47% of healthcare providers named themselves; 21% suggested the government should lead; 14% said healthcare insurers/payers should have that responsibility; and 18% were divided between industry associations and consumers leading the charge, according to the report.

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By KRISTEN WYATT
ASSOCIATED PRESS WRITER

COLORADO SPRINGS, Colo. — Homeless teenagers at a central Colorado shelter are feeling the effect of the government’s economic stimulus package. It’s the feeling of a dentist’s drill.

The 20 runaway youths living at the Urban Peak shelter had no regular dental care until this spring, when a $1.3 million stimulus grant to a community health center paid for a mobile dental and medical clinic to visit once a month. The residents now get medical and dental screenings, and cavities filled, right from their shelter’s parking lot.

“I knew my teeth needed to be fixed but I had no money,” says Michelle Daulton, 18, who has been living at the shelter for about four months and hadn’t seen a dentist since she was 13.

Now she’s had three chipped teeth repaired. “It was absolute and pure relief, I mean that,” she said.

From the Colorado homeless shelter to rural Pennsylvania clinics that can accept new patients, health centers that serve the poor are among the first places the federal stimulus package is being spent.

The stimulus law sets aside $2.5 billion for free and low-cost health clinics, and a big chunk of it - about $500 million - is already being spent. The White House has promised another burst of money this summer.

“This has really been a boost for us,” said Bob DeFelice, CEO of First Choice Community Health Care. “It’s allowed a level of stability in some very difficult times.” DeFelice’s group runs nine community health clinics around Albuquerque, N.M., and used a $703,000 grant to hire two physicians and four support staffers.

Health clinic executives say the money will allow them to keep their doors open as the rolls of uninsured patients grow. An estimated 64 million people use rural health clinics, a number that is expected to rise as people lose their jobs and health insurance.

“We’re seeing more and more people,” said Edward Michael, president of the Rural Health Corp. in Wilkes-Barre, Pa. The six-clinic group in northeastern Pennsylvania had no room for new patients until it received a $311,000 grant in April. Now, Michael says, his clinics can expand from seeing 18,000 patients last year to 19,000 this year.

“You know, we weren’t there back in the Depression, so we never experienced being back in the ’30s standing in line for food, standing in line for a doctor,” Michael said. “This money is really going to prevent a lot of long-term hardship.”

The health clinic grants are one-time boosts, not long term health care fixes. The stimulus won’t make up for a lack of doctors in poor and rural areas, a shortage the Association of American Medical Colleges says is growing and could reach 159,000 doctors by 2025.

“I look at the stimulus bill as one step to health care reform,” said Maggie Elehwany, vice president for government affairs and policy at the Washington-based National Rural Health Association. “It isn’t everything.”

While Congress considers a health care overhaul, clinic workers hope just to keep up with basic needs such as vaccinations and exams.

“I can’t imagine not having the stimulus money right now because we wouldn’t be able to do any of this,” said Nicole Noll, who drives the mobile health clinic to the teen homeless shelter and rural elementary schools.

The van was provided by Ronald McDonald House Charities. But stimulus money pays for Noll, the doctors and the dentists.

Far more than a brighter smile can be at stake in dentistry. In Maryland, a 12-year-old boy whose Medicaid coverage had lapsed, Deamonte Driver, died in 2007 after bacteria from the abscess of an aching tooth spread to his brain. An $80 tooth extraction might have saved his life.

“I’m so glad they did this,” Michelle Daulton said. “My parents were cheap. They never took me to the dentist. And when you don’t have any money, your teeth, you just leave ‘em alone. Not anymore.”

Above article published on

http://www.seattlepi.com/national/1110ap_stimulus_health_clinics.html

By Joseph Conn / HITS staff writer

Part two of a two-part series (Access part one):

The Certification Commission for Healthcare Information Technology has put on hold the rollout of its new sets of completed testing criteria for multiple health IT systems while it waits for HHS to release its plans for certifying IT under the American Recovery and Reinvestment Act of 2009, also called the stimulus law.

Earlier this month, CCHIT announced it had completed work on updated versions of test scripts and criteria for use in the 2009-10 round of testing and certification.

The commission also announced it will publish in either June or July an updated certification handbook explaining the testing and certification process. But CCHIT Chairman Mark Leavitt said that it won’t be taking applications from IT vendors for testing and certifying their electronic health record and other systems until HHS acts

Leavitt said that CCHIT will defer launch of its 2009-10 testing programs until its people have had a chance to look at the initial batch of HHS-approved criteria under the stimulus act. The law mandates the creation of an HIT Policy Committee and an HIT Standards Committee to develop and review IT certification criteria as well as health information transmission standards and implementation specifications.

“The policy and standards committees have some very tight deadlines,” Leavitt said.

“HHS has to take it through a public rulemaking and then it goes to OMB,” Leavitt said, referring to the White House’s Office of Management and Budget.

To keep the whole process on schedule, the policy and standards committees have to be done with their work by Aug 21, Leavitt said. “Since we want to conform our process to what those committees’ recommendations are, we want to hold our process,” until the committees’ work is completed. “They may want to add or subtract something. This will give us a chance to adapt the 2009-2010 process” to the stimulus act.

Initially, CCHIT certification lasted for three years, but testing was updated annually. Going forward, Leavitt said, he’s guessing certification will be on a two-year cycle.

CCHIT has been criticized in some quarters for certifying systems only on functionality, but not ease of use. Leavitt said that CCHIT is “beginning to investigate how to test usability.”

“There are a number of ways to do it, but we have to look for ways that are objective, that we can repeat,” Leavitt said.

One way, Leavitt said, would be to “look for the most common tasks and then count the number of clicks to do those tasks.” Those would include what Leavitt, himself a physician, calls “the speed-dial tasks in a physician’s office,” including refilling a prescription or taking a history on a new patient.

“You test that part of the product and you literally time it,” Leavitt said. Vendors could be asked to bring in their systems and their best user and test them on these common tasks. “If it takes 150 clicks and 10 minutes, you have a big problem.

“The other end of the spectrum is you survey users,” Leavitt said. “We ask the vendors for 10 sites. We want to see at least one that’s measuring quality, or using (the system) to manage chronic disease. Or even do a survey as part of the reimbursement payment process.”

The survey results could provide data on how many customers of a given system have applied for reimbursement under the “meaningful use” standard in the stimulus act vs. how many have qualified under that standard.

Leavitt said that the new certification criteria for 2009-10 have “a big focus on interoperability, including a requirement that EHRs be able to input and store data using the Continuity of Care Document format developed by standards development organizations Health Level 7 in collaboration with ASTM International.

Another test area—an option, not a requirement this year—will be whether the systems incorporate the interoperability specification approved by the federally supported Healthcare Information Technology Standards Panel that deals with querying another data source, such as a health information exchange, for the existence of patient records.

“If they do it, we give them a gold star and everyone will know it, but if they don’t, they’ll still get certified,” Leavitt said.

Another testing requirement that was on the CCHIT road map for inclusion in future certification criteria was that all EHRs be able to link the diagnosis code with an electronic prescription and be able to communicate the diagnosis code and prescription information together in a single electronic prescription sent to a drugstore or pharmacy benefit manager outside the physician’s practice.

The American Medical Association has a long-standing and oft-reaffirmed policy against any requirement to include diagnosis codes on prescriptions “to protect patient confidentiality and to minimize administrative burdens.”

According to a grid of CCHIT testing criteria posted on the organization’s Web site, the specific listing of this testing requirement “will be removed in 2009 when the corresponding Foundation criterion is tested.” The requirement itself isn’t being eliminated, however.

Leavitt said that by requiring EHRs be able to combine prescription data with a patient’s diagnosis doesn’t mean physicians will be forced to do so.

“The AMA doesn’t want you to provide it. Fine. Don’t provide it,” Leavitt said. “That’s a policy decision, so go ahead and fight that one out.”

But there are safety benefits, Leavitt said, allowing a second set of eyes to review the applicability of the prescription for the specified diagnosis. “It’s a potential way to reduce errors.” And there are financial considerations. “For some medications, in some prescribing situations, you’re required to do it. I believe it has to do with health plans qualifying patients to be on a medication.”

Another controversial requirement that was originally proposed as a separate line item in the 2009 criteria would require building into EHRs a back door to allow access by insurance companies for fraud control. The requirement would make EHRs conform to a recommendations in the 2007, HHS-funded report by RTI International “Recommended Requirements for Enhancing Data Quality in Electronic Health Records Systems,” which, despite the title, primarily dealt with the issue of medical billing and payment fraud control.

According to CCHIT spokeswoman Sue Reber, that specific testing criterion also was de-listed—but not eliminated—sometime before the first draft of the 2009 criteria was published “because it is redundant with existing security criteria in the area of ‘access control.’ ”

Above article published on

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Saying it’s not logical to complain that the government ‘can’t run anything’ but will put them out of business, he also leaves room for compromise on a public plan as Congress tackles the issue.

By Noam N. Levey and Peter Nicholas

Reporting from Washington — In an effort to maintain control of the healthcare debate, President Obama on Tuesday ridiculed critics of his government-run insurance proposal, saying private insurers have nothing to fear if they are efficient and consumer-friendly.

“If private insurers say that the marketplace provides the best-quality healthcare — if they tell us that they’re offering a good deal — then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business?” Obama asked. “That’s not logical.”

t the same time, the president left the door open to compromise with the private insurance industry as Congress begins the process of tackling one of the most complex and politically sensitive issues on the national agenda.

In a news conference Tuesday, Obama framed his proposal as the only way to break the cycle of ever-higher medical costs that has sapped the financial stability of families and the government.

At the same time, however, he refused to rule out the possibility that he might sign a healthcare bill that did not include a public-plan option.

“We are still early in this process,” he told reporters at the White House. “We have not drawn lines in the sand.”

The president, who last week both challenged and sought to appease doctors in a speech to the American Medical Assn., will host a healthcare town hall at the White House tonight, the second such event in the last two weeks.

And with help from the Democratic National Committee, Obama supporters plan to hold events around the country Saturday aimed at promoting his healthcare overhaul — including blood drives, medical fairs and sessions on nutrition.

Fifteen years ago, the insurance industry was able to defeat President Clinton’s healthcare proposal by playing on the public’s fears with its “Harry and Louise” ad campaign, which featured a couple fretting about the government making their healthcare choices for them.

Now, Obama’s campaign website is urging people to share stories about their own battles with the healthcare system and to send letters to members of Congress.

“We think there are powerful stories to be told that argue for healthcare reform,” said Hari Sevugan, national press spokesman for the DNC. “Once you hear those stories, it demands reform this year.”

The administration’s push comes amid signs of division over Obama’s plan among some Democrats on Capitol Hill.

In recent days, the legislation being shaped by party leaders has drawn fire not only from Republicans and industry critics, but also from some moderate Democrats concerned about the cost of the overhaul and its potential to disrupt the current healthcare system. Obama’s plan is expected to cost at least $1 trillion over the next decade.

Several centrists, including Sen. Kent Conrad (D-N.D.), have indicated interest in pursuing alternatives to a government plan.

“You can have the greatest plan in the world on paper. If it does not pass, nothing changes,” said Conrad, who is working closely with senior Senate Democrats and Republicans on healthcare legislation and has championed the creation of health insurance cooperatives to compete with private insurers, rather than a government plan.

Illinois Sen. Richard J. Durbin, the No. 2 Democrat in the Senate, acknowledged Tuesday that preliminary work on the legislation would probably not be completed before Congress leaves town this week for its 10-day July 4 recess.

Senate Finance Committee Chairman Max Baucus of Montana, who is leading one of the two Democratic healthcare efforts in the Senate, sounded a sanguine note Tuesday. “I feel much more hopeful and encouraged,” he said. And Conrad noted that lawmakers were making progress in containing costs by reducing the size of the subsidy that the government would give people to help them buy insurance.

But neither would say when the negotiating might yield a bill.

noam.levey@latimes.com, peter.nicholas@latimes.com

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-healthcare24-2009jun24,0,3575870.story

The Healthcare Information and Management Systems Society predicts that hospitals will spend $14.4 billion on IT systems through 2014 but that capital spending will remain relatively flat until funding from the federal stimulus package kicks in, Government Health IT reports.

On Tuesday, HIMSS officials discussed their hospital health IT spending projections, which are based on the group’s tracking of more than 5,000 U.S. hospitals.

According to HIMSS, spending on systems — such as electronic health records, computerized physician order entry and clinical decision support — is expected to reach $1.7 billion this year. Hospitals’ IT spending later will increase because of the effect of the federal stimulus package, HIMSS predicts.

Funding Constraints

Mike Davis, executive vice president of HIMSS Analytics, said that hospitals face funding challenges in the near term.

He said that banks are not lending to the hospitals he has talked to, including those that have submitted business plans based on the federal stimulus package. He added that hospital endowment funds have lost 20% to 30% of their value in some cases.

Davis said he hopes to see signs of improvement by the end of the year.

Davis also noted that some IT vendors have begun to offer financial assistance to hospitals. For example, GE announced earlier this week that it plans to offer interest-free loans to hospitals and health care providers, he said.

Conflicting Priorities

Davis said that as funding becomes more available, hospitals will face conflicting investment priorities.

He said that as hospitals continue to pursue EHR projects, they face a January 2012 compliance deadline for HIPAA 5101 transactions and an October 2013 deadline for ICD-10 coding compliance (Moore, Government Health IT, 6/17).

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-Health-IT-Through-2014-HIMSS-Says.aspx

President Obama believes one of the most effective ways to reduce health care costs is to go paperless. Children’s Mercy Hospital is one of a growing number of hospitals relying on electronic records, but recent studies found only nine percent of US hospitals and about 25 percent of doctor offices have gone to electronic records.

Everyone agrees that’s the trend but not everyone agrees it’ll save money and improve patient care.

Kansas City’s Internal Medicine Clinic moved to electronic medical records four years ago.

“We have everything, if we want to look at a lab, we push a button,” Dr. Marianne Hudgins said.

The administrative staff has shrunk by 5 and the clinic is adding a new doctor, but it’s patient quality that really impresses Dr. Hudgins.

“I think one of the beauties of this is that if it’s 2:00 in the morning and I get that call, I jump on my computer and I know everything about that patient,” Dr. Hudgins said.

Another obvious advantage of going paperless is more space, that become exam rooms.

“There are some benefits to the old paper way of doing it such as you can go through a 200 page chart in a matter of a minute,” Dr. Scott Kuennen with the Clay Platte Family Medicine Clinic said.

Dr. Kuennen’s clinic has plans to go electronic, but not until it absolutely has too.

“You’ll save money, in the sense that you’ll have less staff, you’ll be more efficient, not the case with anybody I’ve ever talked to,” Dr. Kuennen said.

He said the upfront costs are huge and adds too often doctors and hospitals aren’t on the same computer system until they are, he prefers paper.

The Obama administration is offering stimulus money to partially reimburse doctors who go electronic. One of the biggest benefactors could be Kansas City-based Cerner.

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-paperless-records,0,7058639.story

By Rosemary D’Amour/Daily News correspondent

GHS

The $4 billion in federal stimulus health care money headed to the Bay State over the next three years will help provide care for those who can’t afford it and it is hoped help stem hemorrhaging costs by funding new technologies.

The bulk of the health care stimulus funding - some $3.5 billion - will keep mostly safety-net programs afloat with Medicaid/Federal Medical Assistance Percentage funds.

But a portion of federal stimulus money is targeted for cost-saving innovation. Massachusetts is expected to receive $1.3 billion in technology and research funds, with more than $500 million slated for initiatives to help create electronic patient records in the commonwealth.

State officials hope the federal investment will lead to a secure statewide database of patient information.

Nationwide, some $19 billion will go to electronic records programs with a goal of freeing health workers from an paper-based system by 2014. President Barack Obama has touted the potential costs-savings from the program.

Stimulus funds will be used to reward those who have already installed the record system and provide money to hospitals and physicians who implement it. The state would also penalize those who fail to upgrade.

Physicians who meet the state criteria for electronic files could receive reimbursements of up to $44,000 each over four years directly from the federal government. There are about 20,000 physicians in the state, according to Health and Human Services.

Partners Healthcare could be a big winner in the stimulus sweepstakes because it has already implemented an electronic records system. With individual reimbursements for its 3,000 members, including teaching hospitals Brigham and Women’s and Massachusetts General Hospital, the health care consortium could receive $10 million to $50 million.

The state’s Health Care Quality and Cost Council estimates that it takes a small medical practice an average of four months to adopt an electronic system at an up-front cost of up to $40,000 per physician.

Up-front costs have been one of the biggest obstacles in creating an electronic system. But Massachusetts, which has nearly twice the national average of doctors using these systems, could face an easier transition with quicker federal reimbursements.

“The adaptation in Framingham was smoother because there wasn’t an existing paper record, so our advisors picked it up very quickly,” said Paula Kaminow, executive director of the Framingham Community Health Center, which began using electronic records when it opened five years ago.

Community health centers are important sources of medical information, Kaminow said, because they serve a wide population that doesn’t have personal physicians. Installation of electronic records in 12 centers could increase staff productivity, allow for expansion in the number of patients and ensure easier and faster sharing of patient information with hospitals.

“From a risk-management standpoint it’s much easier for providers to find the information they need,” Kaminow said. “The handwriting is clean, you can find different chart notes very quickly, and can integrate information from different sources.”

The electronic system could save the nation $530 billion over 10 years, according to the Health Care Quality and Cost Council, which estimates that the stimulus’ initiative could reduce the nation’s health care spending by up to 30 percent.

Kaminow said the most important characteristic for an electronic record is the ability to interface with other types of records.

“The challenge is to make sure that all the different pieces can speak to each other, such as a management system that can speak to an electronic health record, or a lab report,” she said.

The central project for the state is the Health Information Exchange, which is not funded by federal dollars. The state’s newly-established Health Information Technology Council will provide $15 million in initial funding to help install the exchange by 2014.

The exchange would combine electronic record projects for individual practices, hospitals, and community health centers, sharing patient information in a secure statewide database. Anyone in the system treating a patient could quickly learn about the patient’s allergy data, medication and test results.

The initiative has another reward: Job creation.

Private-sector jobs could grow among vendors installing database systems, with positions ranging from entry-level programmers to high-level project managers.

Massachusetts has a leg up in this respect with an already developed system of software and hardware vendors.

“We’re looking to bring on more staff and extend our hours,” said Kaminow. “After a start-up period, our costs are covered through billing, so in that way we’d be able to sustain increased employment.”

The other big slice of the health care stimulus package is the $764 million coming to Massachusetts for over the next two years.

Funds will be used primarily to maintain services-securing jobs, meeting health care standards and safety net services, with $190 million going to offset fiscal 2009 budget holes, according to Health and Human Services.

Stimulus money provide a nationwide increase in federal matching dollars to Medicaid/Federal Medical Assistance Percentage funds of 6 percent, with potential increases depending on the state’s unemployment rate during the stimulus period.

Massachusetts receives an increase from 50 percent in federal matching dollars to 56.2 percent. Given the state’s shaky unemployment rate, which rose to 7.4 percent in March - a full point since December - the commonwealth could see an increase as high as 11.6 percent in the medical assistance dollars.

In fiscal 2010, $255 million would go to securing jobs and health care services provided by the state. The breakdown for this portion of funds is as follows:

• $160 million for hospitals
• $10 million to community health centers
• $45 million to nursing homes
• $15 million to community mental health $20 million to the “Community First” initiative, which transitions those with mental and intellectual disabilities from institutional care to community-based care $5 million to other health care providers $222 million toward maintaining coverage and eligibility for members of the state’s MassHealth and Commonwealth care health insurance programs.
• Finally, $97 million would help protect safety-net services by maintaining or restoring portions of funds to the Departments of Mental Health, Developmental Services, Commissions and Veterans, Children and Families, Youth Services, Public Health and MassHealth.

The Executive Office of Administration and Finance will be in charge of overseeing and coordinating spending for Medicaid/Federal Medical Assistance Percentage funding.

Rosemary D’Amour is a reporter in the Boston University State House Program.

Above article published on

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Stimulus-cash-gives-health-care-records-technology-a-boost