Electronic Medical Records: An Obamanomic Step Toward Improved Health Care

Mary Anne Simpson

The Obama Administration’s goal to improve the entire health care system in the USA begins with an incremental first step by introducing nearly 500,000 physicians to electronic medical records via the American Recovery and Investment Act 2009. Some physicians, hospitals and clinics throughout the world all ready use some form of health care management software which includes electronic medical record programs.

The focus of the latest efforts is to digitize all existing patient medical records, store the records on a portal which is available to both patient and provider for the purpose of engaging patient participation and of equal importance cut down on medical errors. As with all seemingly benign objectives certain concerns have been expressed on the how, why and where of achieving this primary goal.

The Idea Was Born in Science:

The National Academies is comprised of the National Academy of Sciences, National Academy of Engineering, Institute of Medicine and the National Research Council. In 2007, the Rosenthal Foundation sponsored the lecture series, “Transforming Todays Health The focus of the latest efforts is to digitize all existing patient medical records, store the records on a portal which is available to both patient and provider for the purpose of engaging patient participation and of equal importance cut down on medical errors. As with all seemingly benign objectives certain concerns have been expressed on the how, why and where of achieving this primary goal.

The Idea Was Born in Science:

The National Academies is comprised of the National Academy of Sciences, National Academy of Engineering, Institute of Medicine and the National Research Council. In 2007, the Rosenthal Foundation sponsored the lecture series, “Transforming Todays Health Care Workforce to Meet Tomorrow’s Demands.” The preeminent Harvey V. Fineberg, M.D. PhD and President of the Institute of Medicine and his colleagues set forth a new attitude and direction for medical care delivery which included electronic medical records.

Citing the analogy of Bob Evans, a Canadian health care economist, “before adding more sugar to a cup of tea, make sure you stir the sugar all ready in the cup.” The problem of shortages for primary health care physicians, physician assistants and registered nurses comes down to poor utilization of their time. Dr. Kevin Brumback, M.D. Professor and Chair of the Department of Family and Community Medicine at the University of California, San Francisco says way too much time is being spent by physicians doing rudimentary tasks that someone with limited training or a computer could do.

Dr. Brumback doesn’t believe electronic medical records, (EMR) is a panacea for all that ails the health care system, but it will free up time physicians spend reviewing paper files, scheduling lab tests and notifying patients of results. The main point is to bring the patient into the health care system, by putting the health records on-line using a secure HIPAA web site wherein patients could see their medical file, schedule appointments, view lab results and form questions for their next physician visit. The active patient could order age appropriate tests like mammograms, colon cancer screenings and other annual tests

Care Workforce to Meet Tomorrow’s Demands.” The preeminent Harvey V. Fineberg, M.D. PhD and President of the Institute of Medicine and his colleagues set forth a new attitude and direction for medical care delivery which included electronic medical records.

Citing the analogy of Bob Evans, a Canadian health care economist, “before adding more sugar to a cup of tea, make sure you stir the sugar all ready in the cup.” The problem of shortages for primary health care physicians, physician assistants and registered nurses comes down to poor utilization of their time. Dr. Kevin Brumback, M.D. Professor and Chair of the Department of Family and Community Medicine at the University of California, San Francisco says way too much time is being spent by physicians doing rudimentary tasks that someone with limited training or a computer could do.

Dr. Brumback doesn’t believe electronic medical records, (EMR) is a panacea for all that ails the health care system, but it will free up time physicians spend reviewing paper files, scheduling lab tests and notifying patients of results. The main point is to bring the patient into the health care system, by putting the health records on-line using a secure HIPAA web site wherein patients could see their medical file, schedule appointments, view lab results and form questions for their next physician visit. The active patient could order age appropriate tests like mammograms, colon cancer screenings and other annual tests

Above article published on

http://www.physorg.com/news161935473.html

Maryland has approved a bill making it the first state to require commercial health plans to offer doctors incentives for adopting electronic medical records.

Starting in 2011, when physicians adopt EMRs, health plans will have to pay them higher reimbursements, pay out a lump sum incentive or offer in-kind services that have financial value. This ties in with the state’s timetable for getting physicians online; by 2015, physicians who don’t adopt EMRs will face penalties.

The same bill also mandates the creating of a health information exchange linking all of the state’s doctors, hospitals, laboratories and pharmacies. The network should be phased in gradually, with the first parts of it beginning in the fall. The seed funding for the network will come partly from stimulus funds and partly from hospital fees.

Above article published on

http://www.fiercehealthcare.com/story/
md-requiring-health-plans-offer-emr-incentives/2009-05-22

By Rosemarie Nelson

The economic stimulus bill (the American Recovery and Reinvestment Act of 2009, or ARRA) provides incentive payments up to a maximum of $44,000 per physician over five years for “meaningfully using health information technology.”

Although we don’t yet have definition of “meaningful use,” we can be pretty sure doctors will need to be e-prescribing, exchanging information electronically, and reporting clinical quality measures.

Rather than wait for that definition, start your EMR selection and implementation project now. And start it with an educational demo.

An educational demo is an opportunity for a vendor to help you understand what his EMR can do for your practice, so that as you evaluate products and services, you’ll have a better understanding of how to get a good fit.

The demo serves as an introduction to the possibilities that an EMR brings to a practice for improved operational workflow. That workflow includes both the patient flow when the patient visits the practice and the paper flow that occurs in anticipation of a visit or as the result of a visit (follow-up test results, telephone calls, correspondence, etc.).

Technology changes what is feasible and the demo will help open up ideas that you might not be able to anticipate without some background about the potential.

Pay attention to all the “set-up” and “follow-up” work the EMR can help with “around” the patient visit. In other words, do not get too hung up on the use of the EMR inside the exam room.

The chart is handled and touched and prepped and moved about three times as much outside the exam room as it is inside the exam room. This is especially important for the physicians viewing the demo to remember, because there will be a tendency to think about how it effects the doctor in the room with the patient.

You need to look at the breadth of the interaction with that chart around its entire use.

Look at two aspects of how the prescription function works. One being the first time you prescribe a medication and the second being how the reissue of a prescription will work, including the “messaging” between the nurse on the phone and the provider approving the reissue.

Also look at the messaging and communication systems in general — how will the ability to report and communicate in-office lab test results improve the workflow?

Get comfortable with the “home” page or your “desktop” (all vendors call it something different) where you will “run” your day. Look at the incoming messages and how they are highlighted or categorized.

Look at your schedule for the day with patient information, and how that is integrated/passed from the practice management system.

Get a sense of how you can navigate from a message to the patient’s last office visit documentation and then how you can generate an order (in house or outside the practice).

Know where you’ll find information about the patient’s insurer so you know which ancillary services can be provided by which testing centers, etc.

Try to learn, too, about how external documents will flow through the system — where is the point of entry in the practice and then how does the document get into the patient’s record and to the correct person for review?

Keep the 80-20 rule in mind. In other words, you will have instances that pop into mind about that one-off or atypical encounter and you’ll get caught up in the demo about how to accommodate that. Stop and ask yourself, how often is that an issue? Chances are it’s not worth spending time in the EMR demo on such problems. No EMR can accommodate every situation.

These may seem like a lot of things to consider in a 90-minute demo, but they can all be covered.

And be sure to ask questions, especially if things are not obvious or demonstrated for you.

But above all, get started! There’s economic stimulus money to be had.

Above article published on

http://www.medpagetoday.com/Columns/14250

Stimulus funds would help replace paper medical files.

By Kristi E. Swartz

The Atlanta Journal-Constitution

Hurricane Katrina illustrated what can happen when medical records are on paper instead of stored on a computer.

They washed away, rendering thousands of people unable to get prescriptions, notify doctors about allergies or receive medical help.

“We have to bring our best technology to bear in the health care system,” said Dr. David Satcher, former U.S. surgeon general and director of the Satcher Health Leadership Institute at Morehouse School of Medicine.

Federal stimulus money is available for health care providers in Georgia to convert paper medical records to electronic ones, Satcher and others said Thursday at Georgia State University. Though such technology has been available for years, fewer than 4 percent of doctors have made their medical records completely electronic, said Janet Marchibroda, chief health care officer for IBM, who said the stimulus dollars will help with some of the conversion challenges.

Stimulus money will be funneled through Medicare and Medicaid programs as well as through the National Coordinator for Health Information Technology. Marchibroda cautioned that it be spent wisely.

“We could really mess this up by just pushing a lot of money out there but not focusing on improving health information technology,” she said.

Georgia’s Department of Community Health has received $339.6 million in the first batch of stimulus money. Rhonda Medows, the state’s health officer and commissioner of the community health department, said the agency is waiting for federal guidance on how it can use that money to reimburse health care providers who buy an electronic health record system.

Above article published on

http://www.ajc.com/services/content/printedition/2009/05/15/healthstim0515.html

Care for uninsured, electronic records receive cash

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 health care costs by funding new technologies.

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

But a portion of the federal stimulus money is targeted for cost-saving innovations. Massachusetts is getting $1.3 billion in technology and research funds, with more than $500 million going toward eHealth initiatives in the commonwealth.

The initiatives will fund the creation of electronic patient records. State officials hope the federal investment will lead to a secure statewide database of patient information, or in government parlance, an interoperable Health Information Exchange.

The program could have a long-standing impact by providing doctors quick, seamless access to patient records, offering the possibility of savings in time, money and lives. Nationwide, some $19 billion will go to e-records programs with a goal of freeing a profession from an archaic paper-based system by 2014. President Barrack Obama has touted the potential costs savings from the program.

Massachusetts, which is ahead of many states in initiating electronic medical records, stands to gain from significant federal reimbursements.

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 to e-records.

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 the Department of Health and Human Services.

Partners Healthcare could be a big winner in the stimulus sweepstakes because it has already implemented a 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 from $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 EMR 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 EMRs, 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 EMRs when it opened five years ago.

Community health centers are important centers of medical information because they serve a wide range of the 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’ national eHealth 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 IT initiative has another reward: job creation. Private sector jobs would 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.

Although federal stimulus funds end after two years, the reimbursements that follow implementation of the systems could create jobs in the long term.

“We’re looking to bring on more staff and extend our hours,” Kaminow said. “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 pie is the $764 million coming to Massachusetts for this year and next.

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 year 2009 budget holes, according to the Department of Health and Human Services.
Above article published on

http://www.thesunchronicle.com/articles/2009/05/12/news/4900258.txt

Diana Manos, Senior Editor

WASHINGTON – The economic stimulus package has allotted $17.2 billion to reward Medicare and Medicaid providers who can prove they are using certified healthcare IT “in a meaningful way.”
The incentives are scheduled to take effect starting Oct. 1, 2011. Experts say providers should not waste time getting prepared because there is a shortage of change management experts available to help.

According to Dave Garets, president and CEO HIMSS Analytics, 94 percent of hospitals currently don’t have enough healthcare IT in place to meet the stipulations required to receive bonuses. Under the new law, they must prove “meaningful use,” which will require capturing certain data.

Garets expects that healthcare organizations will adopt healthcare IT “with a vengeance” in 2009. He and other members of the Healthcare Information and Management and Systems Society are concerned there are “precious few” change management experts to help providers make the complicated transition to healthcare IT by 2011.

Garets said it’s not as simple as hiring a software technician to make the transition. There is a need for qualified people who know how to help with workflow adaptation and how to implement software packages so they work for the organization.
“These people are extremely valuable and extremely rare,” he said.

Payments under the American Reinvestment and Recovery Act are graduated in descending amounts for federal fiscal years 2011 and 2015. After 2015, there are penalties for providers that do not use healthcare IT. The sooner a provider is ready to go with healthcare IT, the more likely they are to cash in on the maximum possible, Garets said.

According to HIMSS leaders’ interpretation of the law, physicians can earn from $44,000 to more than $60,000 in extra payments over the five-year period, including $18,000 the first year. Incentives for hospitals will start at a base of $2 million annually.

To qualify for bonuses, providers must have certified electronic health record technology capable of providing clinical decision support to physician order entry and capturing query information relevant to healthcare quality. The system must also be able to exchange and integrate electronic health information with other sources.

The maximum payment for qualifying physicians under the stimulus package is $18,000 for the first year, $12,000 for the second year, $8,000 for the third year, $4,000 for the fourth year and $2,000 for the fifth year.

For those failing to use certified qualifying healthcare IT by 2014, Medicare payments will be reduced to 99 percent in 2015, 98 percent in 2016 and 97 percent thereafter.

Hospitals will have to submit data on clinical quality measures and other measures to be determined by the Department of Health and Human Services secretary.

Payment for hospitals is a complicated formula that includes the discharge amount and Medicare share a hospital receives.

The state is authorized to make bonus payments, beginning in 2011, to physicians who provide Medicaid services, are not hospital-based and have at least 30 percent Medicaid patient volume. Federally qualified health centers or rural health clinics with at least 30 percent Medicaid patient volume can receive up to $63,750 in incentives and will not face reductions in Medicaid payments if they do not adopt certified EHR technology.

The “meaningful use” of healthcare IT is yet to be determined by the HHS secretary under the new law.
On Monday, President Barack Obama nominated Kansas Gov. Kathleen Sebelius to fill this role. If Sebelius is confirmed by the Senate, she will also oversee standards development and select clinical quality measures used to determine providers’ worthiness for receiving healthcare IT incentives under the new law.

http://www.healthcareitnews.com/news/big-money-stimulus-
package-hit-users-prepare-now-experts-say

HITECH Act entices physicians into future with incentives

By Jill Coley

The federal government has put aside nearly $20 billion to convince doctors to ditch their manila files for electronic medical records. But look at any physician’s walls of patient records, and the enormousness of that task becomes apparent.

In the Lowcountry, opinions are mixed. Most agree the move would reduce unnecessary testing, administrative overhead and medical errors. Yet with so many systems to choose from, patient privacy concerns and the time it takes to learn new software, money might not be enough.

Dr. Christos Maltezos, a Mount Pleasant endodontist, is ahead of the curve and already paperless. “That’s where the future is going,” he said. Patients can fill out forms at home and enter their medical and pain histories online.

In addition to streamlining administrative work, going digital also reduces forgery since doctors can send prescriptions to pharmacies digitally, said Maltezos, who can access patients’ records on his BlackBerry no matter where he is. “I don’t think I could do it any other way now,” he said.

Starting out digital is easier than changing over. The older internist may imagine scanning in 300-page medical records. But after a few patient visits, most of the information would be contained in an electronic file.

The Health Information Technology for Economic and Clinical Health Act, or HITECH, became federal law in February and created payment incentives in Medicare and Medicaid to encourage providers to go digital. It wasn’t long before electronic medical record vendors began using the promise of stimulus money to entice physicians.

Chris Hughes, founder of Advanced TeleHealth in Mount Pleasant, consults physicians before they adopt an electronic medical records system to make sure their practice is ready for the technological leap and is compliant with the Health Insurance Portability and Accountability Act, or HIPAA.

The economics of the situation is going to drive electronic medical records forward, Hughes said.

Dr. Dave Albenberg is passionate about electronic medical records but worries the government’s lofty goal may not be feasible.

Albenberg invested about $150,000 in a digital system for his concierge practice, Access Healthcare, in Charleston and Mount Pleasant.

Every doctor thinks it needs to be done differently, and getting all of them on the same platform is impossible, Albenberg said. “This is something you can’t throw money at,” he said.

Dave Terry, former administrator of James Island Medical Care, knows firsthand the pitfalls of electronic medical records. The 6,000-patient practice tried to go electronic about six years ago, and although hardware and software has improved since, the experience is still fresh in his mind.

Doctors use so many categories of codes, Terry said, that when physicians got in a room with a patient, the program went “six ways to Sunday.”

“You feel quite often like a deer in headlights in the middle of a patient encounter,” he said. Training was a problem because doctors couldn’t stop seeing patients long enough to learn the system. And if a staff member was sick or on vacation, their replacement had to be schooled in the software.

“We yanked it out and went back to paper,” Terry said.

Above article published on http://www.postandcourier.com/news/2009/may/04/doctors_look_into_digital_age80979/

Written by Patricia King

Editor’s note: Health care attorney Pat King outlines and explains provisions of the pending economic stimulus package that deal with electronic health records (EHR/EMR 1) use by physicians.

The American Recovery and Reinvestment Act of 2009 finally passed both houses of Congress this week. As this article is written, a final vote is expected on Saturday, February 14. While there are significant differences between the House² and Senate³ version in some areas, incentives for health information technology adoption by physicians and hospitals are substantially similar in both bills. The cost of incentives is estimated to be $17 billion in increased Medicare and Medicaid payments.

The Act uses the same “carrot and stick” approach adopted last year to encourage electronic prescribing. The incentive portion starts in 2011: a physician who is a “meaningful user” of electronic health records (EHR) is eligible to receive additional payments under the Medicare program that can extend over five years. The penalty portion starts in 2015, when physicians who are not meaningful EHR users will begin to see declines in their Medicare payments. Neither the incentive nor the penalty applies to hospital-based physicians.

Incentives for EHR use

For the first year that a physician qualifies as a meaningful EHR user, the physician is eligible for an incentive payment of 75% of his/her Medicare charges for the year, up to a maximum of $15,000 (the Senate bill provides that the ceiling is $18,000, if the first payment year is 2011 or 2012). The ceiling declines each year: $12,000 for the second year; $8,000 in the third year; $4,000 in the fourth year; $2,000 in the fifth year; and zero for subsequent years. Late adopters are penalized through phase down of the incentives: if the physician does not qualify as a meaningful user until 2014, then the payment ceiling for that physician’s first year is $12,000, the ceiling for the second year is $8,000, and so on. Under the House bill, there are no extra payments for physicians who do not qualify before 2015.

The Secretary of the Department of Health and Human Services (HHS) has discretion to determine whether the incentive payment will be paid in a single lump sum, or in installments. If the physician provides services to Medicare beneficiaries through more than one practice, HHS will determine how to allocate the incentive payment among the practices.

Penalties for not using EHR

Under the penalty provisions, physicians who are not meaningful EHR users in 2015 will see a 1% reduction in their fee schedule amount. The reduction increases to 2% in 2016, and 3% in 2017 and each subsequent year. If HHS finds that by 2017, the proportion of physicians who are meaningful EHR users is less than 75%, HHS may continue to ratchet down payments by 1% a year (but may not reduce payments below 95%). Hardship exceptions may be issued on a case-by-case basis, such as exceptions for physicians who practice in rural areas without adequate Internet access.

How to be considered an EHR user

To be a “meaningful EHR user”, the physician must satisfy three criteria:

• The physician must use “certified EHR technology” in a meaningful manner, including electronic prescribing. The law calls for creation of a health information technology (HIT) Policy Committee, and an HIT Standards Committee. The HIT Policy Committee will focus on development of a nationwide health information infrastructure, while the HIT Standards Committee will recommend standards, implementation specifications and certification criteria. The Office of the National Coordinator for Health Information Technology (ONCHIT) is to adopt an initial set of standards, implementation specifications and certification criteria before December 31, 2009.
• The physician must demonstrate that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination.
• The physician must submit information on clinical quality measures specified by HHS.

HHS will designate the way in which a physician is recognized as a meaningful user (through attestation, submission of claims with codes indicating that a patient encounter was documented using certified EHR technology, survey responses, submission of quality reports, or other means).

The Act also authorizes state Medicaid programs to provide additional payments to physicians, at least 30% of whose patient volume is services to Medicaid beneficiaries.

In addition to the incentive program, $2 billion is available to ONCHIT for implementation of the program, including grants to states to establish loan programs for physicians seeking to acquire certified EHR systems.

Above article published on http://www.netdoc.com/Physician-Practice-Articles/General-Medical
-Practice/Stimulus-package-and-EMR-use-by-physicians/

The recently adopted package increases support for research into the best treatments for the same medical conditions or illnesses.

By Doug Trapp, AMNews staff.

Washington – A conservative backlash against comparative effectiveness research provisions in the stimulus package could be the first sign of a difficult health reform debate to come.

The stimulus act enacted Feb. 17 provides $1.1 billion to federal agencies for evaluations of the effectiveness of different drugs, devices and procedures on the same medical condition. The infusion is a huge increase over existing funding for comparative effectiveness research.

But the provision attracted unwanted attention as the stimulus bill moved forward. The House Appropriations Committee’s summary of the version it approved on Jan. 15 said the bill would help determine which drugs, procedures and medical interventions are “less effective and in some cases, more expensive.” Mentioning cost savings as a potential benefit of the research language was enough to lead conservative media outlets, from the Washington Times to radio host Rush Limbaugh, to conclude that an era of government-rationed health care was coming.

The speculation also was fueled by bill language creating a panel of federal government leaders to recommend federal priorities for comparative effectiveness research. A November 2008 white paper by Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee, cited a Congressional Budget Office estimate that $700 billion of the nation’s annual $2.3 trillion health spending is ineffective, said Dennis Smith, former director of the Centers for Medicare & Medicaid Services’ Center for Medicaid and State Operations and a senior fellow at the Heritage Foundation.

Some GOP members of Congress, including Sen. Mike Enzi (R, Wyo.), spoke out against what was seen as a potential for additional government power over health spending. “The bureaucracy, not doctors and patients, will have the power to make decisions about which treatments folks can and can’t have,” Enzi said Feb. 13.

Robert Doherty, the American College of Physicians’ senior vice president for governmental affairs and public policy, said some conservatives were looking far into the future when they objected to the act’s research provisions. “This was viewed by some as the opening skirmish in a broader battle over the role of government in health care,” Doherty said. The ACP and the American Medical Association supported the comparative effectiveness provisions and funding in the stimulus package, called the American Recovery and Reinvestment Act of 2009.

The final version of the bill did not specifically include cost as part of comparative effectiveness research. The House Appropriations panel’s report summarizing the House-Senate negotiations that produced the final version said the research funding “is not to be used to mandate coverage, reimbursement or other policies for any public or private payer.”

“There are a lot of dots [conservatives] are connecting. And the dots are certainly not connected in the bill,” Doherty said.

Adding “clinical” to “comparative effectiveness” in the bill’s language would have clarified that the research won’t include costs as a factor, but the stimulus act didn’t do that, said Gail Wilensky, PhD, a former Medicare administrator and senior fellow at Project Hope, an international health advocacy organization. “That is, in my mind, a permissive difference,” she said.

Smith agreed on the need to compare treatments, but he worries about any payer, especially Medicare and Medicaid, having too much influence in the medical payment system.

Doherty said the concerns about government intrusion are overblown. “All it really does is provide additional funding to the National Institutes of Health and the Agency for Healthcare Research and Quality to build upon their existing work they are doing in comparative effectiveness.”

Doctors and patients need more rigorous evidence about treatments’ effectiveness, Doherty said. Informed patients might be more likely to choose a less-invasive treatment if its outcome is similar to surgery or another more invasive option.

Government funding of research isn’t a perfect solution, said Roy Poses, MD, a clinical associate professor of internal medicine at Brown University in Rhode Island who has researched clinical epidemiology and evidence-based medicine. “But in the absence of research, the government might use something else to make coverage decisions that might be even less valid,” he said.

Doherty said several ACP members contacted him after the association said it supported the stimulus bill, which was controversial among conservatives for a variety of reasons. “So it was hard to separate the health care provisions from one’s overall views of the stimulus bill. For more conservative physicians … a lot of them didn’t like the idea of the stimulus bill, period.”

The print version of this content appeared in the March 16, 2009 issue of American Medical News.

Above article published on http://www.ama-assn.org/amednews/2009/03/09/gvsb0309.htm

By Ken Alltucker

The Arizona Republic

Federal money could accelerate Arizona’s push toward digital health records, making staples such as paper charts, written prescriptions and doctor’s-office clipboards a thing of the past.

As part of its stimulus package, the government will pump more than $19 billion into computers and software systems that promise to connect hospitals, doctors, pharmacies and other health-care players.

Widespread use of electronic health records would save lives and money and eliminate waste in the complex world of health care, medical experts agree.

Arizona doctors appear to be adapting to electronic records faster than the national rate, but getting there can be costly and frustrating.

At Central Phoenix OB/GYN, the three doctors and a nurse practitioner started using a digital system in January. The doctors are still learning the system, and the office staff is on the final leg of scanning 20 years’ worth of patient records into computer records. “We are still in the ‘Oh, my God, what have I done’ (phase),” office manager Tracey Vega said.

Arizona’s medical community is poised to collect as much as $500 million in stimulus funds beginning in 2011, local officials estimate, provided health-care organizations adopt “meaningful use” of such digital systems.

“Automation is eventually going to be everywhere,” said David Landrith, the Arizona Medical Association’s vice president of policy and political affairs. Proponents say electronic health records are superior in many ways. A physician can verify a patient’s prescription-drug regimen, helping to avoid harmful drug combinations. Nurses can use a hand-held scanner to zap a patient’s medication to ensure they are giving the right drug to the right person.

Multiple caregivers can simultaneously view a patient’s medical charts, making care more efficient. Still, there are challenges. Some worry that a wide range of computer systems and standards may block effective communication. Systems that cost $100,000 or more are too expensive for smaller doctor’s offices. Comprehensive hospital systems can range from $20 million to $100 million.

Also, worries about patients’ privacy persist.

Arizona’s progress

Studies show varying degrees of adoption rates for computerized records. A New England Journal of Medicine survey indicated that 17 percent of doctors have some type of electronic health-records system, while another survey indicated hospitals’ use of electronic health records vary widely.

Arizona health-care providers have turned to computerized systems at a faster clip, with at least 30 percent of physicians employing some type of digital system, according to Brad Tritle, executive director of the Arizona Health-e Connection, a non-profit group established to orchestrate Arizona’s digital health initiative. Tritle said that figure comes from an ongoing survey of licensed doctors performed by Arizona State University and funded by the state’s Medicaid program.

Arizona’s digital health push isn’t new. While governor, Janet Napolitano signed an executive order calling for statewide adoption of digital-records systems for prescribing drugs. Arizona Health-e Connection has spearheaded the effort to research and develop model policies in the state.

With federal stimulus dollars providing a tailwind, Tritle said he expects the use of digital health records to accelerate.

Digital doctors

Even the biggest backers of a health-information revolution acknowledge that questions remain about cost, training and standards.

Dr. Bradford Croft, a family practitioner in Flagstaff, is one of Arizona’s digital pioneers, having tossed out paper records a decade ago.

Each room is outfitted with a computer. He chats with nurses or assistants via instant messaging. The conversion has made Croft’s practice more efficient, allowing him to see more patients each day. One reason: He doesn’t waste time writing notes only to have others duplicate note-taking several times.

“We’ve been more productive, without a doubt,” said Croft, who also holds an MBA and completed his master’s thesis on the efficiency of his practice.

Yet even Croft said his current system is less than ideal. He has cobbled together eight software programs to get everything he wants. He plans to spend up to $50,000 on a new system. Regardless, he said he cannot imagine going back to paper records. “Does it make us better doctors? Not necessarily,” Croft said. “But I think it makes us more organized, and it makes us more observant to detail.”

Dr. Lesley Johnstone at Central Phoenix OB/GYN said the conversion will make her office more efficient.

One example: A doctor could access a patient’s records and authorize a prescription refill with a few keystrokes rather than searching the office for a paper file.

Plus, the 24/7 availability of patients’ records will allow the doctors to more easily take care of the other doctors’ patients. When a doctor delivers the baby of a patient he or she is less familiar with, it is essential the doctor has access to the patient’s records.

That typically meant a late-night or early-morning call to locate paper records. Now, the on-duty doctor needs only to access a computer. Despite the knowledge that digital records will help make things easier, Johnstone said the transition has not been simple. “It was always really easy on paper, but for some reason, it is harder with the computer,” she said.

Leaders and laggards

Tritle said other areas of Arizona’s health care are considered leaders in digital health, too.

Banner Estrella Medical Center was among the nation’s first hospitals to go all digital when it opened in January 2005. Other hospitals that have established digital records include Banner Gateway Medical Center, Mayo Clinic, Cancer Treatment Centers of America and University Medical Center in Tucson.

One of Banner Estrella’s most recent initiatives is called “positive patient ID,” which aims to eliminate a common medical mistake: giving the wrong patient the wrong medication.

The system works by requiring nurses to use a hand-held device to scan medications to ensure they match a patient’s records. If the nurse has the incorrect room, they will get an alert from the scanner.

The program has cut down on medication errors, said Richard Schmidt, a registered nurse who serves as the hospital’s interim deployment manager. Banner Health plans to roll out such digital-records systems for all its hospitals over the next 18 to 24 months, spokesman Bill Byron said. Banner Health and other Arizona hospitals likely will seek federal stimulus dollars to help fund the transition. “We view this as an affirmation of what we’ve been doing,” Byron said of the stimulus plan.

Above article published on www.azcentral.com.