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GAO Says Defense, VA Shouldn’t Have Separate EMRs

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The GAO isn’t satisfied with plans the departments of Defense and Veterans Affairs has submitted claiming that separate EMRs will be more affordable and quicker than their original joint plans.

The two agencies had claimed that implementing separate, interoperable EMR systems would be a better choice than developing a joint EMR usable by both agencies.  But the GAO says the two have not substantiated their claims that the separate EMRs would save money and time.

The GAO report comes after years of wrangling over how to create a joint, integrated EHR. The two agencies have been discussing creating the joint project, the iEHR, since 2009. The idea behind the iEHR was to allow every service member to maintain a single EHR throughout their career and lifetime.

However, the iEHR project came to a screeching halt in February 2013, when the two agencies announced plans to stop the project and focus instead on making their existing EHR systems more interoperable.

In follow-up, the House and Senate in December 2013 approved the funding bill that required to VA and DOD to create a plan for a single or interoperable electronic health record by January 31.

Since then the GAO has addressed the plans the two agencies made, and concluded that they have not:

  • Addressed management barriers to collaboration terms of enterprise architecture, IT investment management and other areas
  • Laid out what the interoperable EHR approach consists of, how much it will cost, or when and how it will be completed
  • Developed a joint healthcare architecture or investment management collaboration to guide the project
  • Updated their strategic plan to commit to an integrated approach

In the GAO’s view, the fact that the VA and DOD are taking separate approaches — the VA modernizing its system and the DOD acquiring a new commercially available system — is not going to work out well.

March 12, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Cloud Technology Can Boost Healthcare IT Market Growth

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A new study suggests that an increase in healthcare provider use of cloud technology plus a decrease in the cost of IT implementation could lead to big changes in the US healthcare IT market.

According to market research consulting firm RCNOS, between now and 2018, the health IT market will grow at a compound annual growth rate of close to 10 percent. Innovation in the market and government support for health IT tools will help the market along as well, the researchers report.

Technologies likely to have this effect include EMRs, clinical decision support systems, medical imaging information systems and lab information systems. The researchers say personal health records, telemedicine and ICD-10 systems are also growth areas.

To realize this potential, however, it will take widespread cooperation across many sectors of the healthcare industry, including providers, payers, plan sponsors, the pharmas and more, writes health blogger Jane Sarasohn-Kahn.

That being said, health IT market growth is not an absolutely sure thing. According to investor and entrepreneur Anne DeGheest, who recently spoke with the Wall Street Journal, the intense activity around health IT resembles the technology bubble of the 1990s.

Whether you share Sarasohn-Kahn’s enthusiasm or DeGheest’s caution, it’s difficult to argue that this is a golden time for health IT innovation and entrepreneurship. What makes today’s health IT activity different than bubbles of previous generations is that it solves real problems, rather than creating apps in search of a problem. I’d argue that health IT’s explosive growth will run well beyond 2018.

March 3, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

HIMSS: Insider Threats Still Biggest Health IT Security Worry

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You can do whatever you like to lock down your data, but  it if they do they do it did buy a block of members of the earth is the work doesn’t go for all it takes is one insider who knows how to unlock it to create a serious security breach.

Results from the 2013 HIMSS Security Survey suggest that despite progress towards hardening security and use of analytics, healthcare organizations must still do more to mitigate the risk of insider threat, such as the inappropriate access of data via employees.

The HIMSS survey, which was supported by The Medical Group Management Association and underwritten by Experian Data Breach Resolution, surveyed 283 information technology and security professionals employed in US hospitals and physician practices. What the researchers found was that the greatest “that motivator” was that of healthcare workers potentially snooping into EMRs to find friends, neighbors, spouses or coworkers.

Given that healthcare IT leaders are particularly concerned about inappropriate use of health data by insiders, you won’t be surprised to hear that there’s been an increase use of several technologies related to access to patient data, including user access control and audit logs in each access to patient records.

But you may be surprised to learn that of the 51 percent of respondents increase the security of the past year, 49 percent of these organizations are still spending just 3 percent  or less of their overall IT budget on securing patient data.

Other findings from the HIMSS survey include that healthcare organizations are using multiple means of controlling employee access to patient information;  67 percent use at least two mechanisms, such as user base and role-based controls, for controlling access the data.

February 27, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Avoiding The EMR Alienation Effect

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Recently, I stumbled across a very interesting article talking about I call the “patient alienation effect” generated by EMRs.  The author, Charles Smith, who practices at the University of Arkansas, is an EMR old hand who has been using the Centricity ambulatory EMR for more than a decade.

The article, which appears in the Journal of Participatory Medicine, talks about the well-known offputting effect EMRs have on patients, and the frustration that they impose on doctors. And as readers know, we’re not talking about a minor impact here.

In the new EMR world, he notes, physicians have a list as long as your arm of EMR related tasks they must perform during the patient visit, including medication reconciliation, managing the problem list, e-prescribing, updating the patient’s history, review of systems, physical exam, entering the follow-up plan into the record, and printing “after the visit” summaries for the patient. And as he points out, this all has to happen for the patient is still sitting in the exam room.

The way he handles this problem is to treat the challenge is one for the patient and physician to solve things together:

*  At the outset, he and the patient have an open discussion of the EMR issue with new patients, discussing the advantages and challenges of the computer in the room.

*  Then, he asks the patient’s to allow him to move their chair beside him in the computer, noting that they will “all three” work together during the visit.

* He also tries to create a hybrid experience of completing some EMR tasks during the visit and others after (for example telling the patient, “hold on while I enter this order for you) before returning to face-to-face conversation.

* He finds that it works best to take notes here and there during the patient visit, then complete the past medical, surgical, family and social history and the review of systems together with the patient directly in the EMR.

Obviously, there’s no one right way to integrate patients into the process of documenting their visit in an EMR. But these ideas seem like good ones.

February 10, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

EMR Divide Remains Between Larger And Smaller Practices

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A new study finds that while physicians’ adoption of EMRs has grown substantially between 2009 and 2012, there’s still a big “digital divide” between large and small medical practices, according to a Commonwealth Fund study reported by iHealthBeat.  But it also concluded that there are ways to close the gap, largely through cash incentives and tech help.

According to the study, EMR adoption by primary care physicians increased from 46 percent in 2009 to 69 percent in 2000.  What’s more, Commonwealth Fund found that most doctors are using core health IT functions, including clinical decision support, e-prescribing and electronic ordering of lab tests.  This is clearly a sign that Meaningful Use Stage 1 has had a large impact. (We’re still waiting to see whether doctors continue to drop out and avoid Stage 2′s tougher criteria.)

The study also found that as of 2012, 33 percent of doctors could electronically exchange clinical summaries, and 35 percent could share lab or diagnostic tests with physicians outside their practices electronically.

But these results were not distributed evenly.  Specifically, researchers found that practice size substantially affected EMR adoption.

For example, the research found that 90 percent practices with 20 or more doctors had adopted EMRs, but that just 50 percent of solo physician practices were on board. That being said, the study found higher rates of EMR adoption among small practices that were sharing resources or that took advantage of Meaningful Use incentives.

All told, researchers concluded that technical assistance programs that incentives close the digital divide regarding EMRs between large and small practices.  This just makes sense. If such programs can make it easy and even lucrative to adopt EMRs, we could see the digital gap close soon.

January 31, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

ONC Offers Guidance on EHR Safety

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ONCHIT has released a new set of guidelines and tools designed to help providers make safer use of EMRs and related technology. ONCHIT calls the set of nine toolkits SAFER, or Safety Assurance Factors for EHR Resilience. (Access the toolkit here.)

According to Healthcare IT News, the SAFER tools include checklists and recommended practices designed to optimize EHR safety.  ONC officials say that this suite follows up on, and forms an important part of, the Health IT Patient Safety Action and Surveillance Plan released by HHS this past July.

The toolkits, which include self-assessment checklists, practice worksheets and recommended practices, include the following topics:

  • High-priority practices
  • Organizational responsibilities
  • Patient identification
  • CPOE and decision support
  • Test results review and follow-up
  • Clinician communication
  • Contingency planning
  • System interfaces
  • System configuration

According to officials, the SAFER guides complement existing health IT safety tools already developed by ONC and the Agency for Healthcare Research and Quality.

The idea behind these guides, it seems, is to bring evidence-based practices to an area which is still evolving rapidly. As things stand, EHR use and workflow development is subject to a lot of guessing, especially as to what pathways work best in getting providers to use EHRs most effectively and safely.

All that being said, hospital executives are eyebrow deep in operational and IT issues related to their EHR, and may be simply too overwhelmed to shift their work processes to adopt these evidence-based tools.  It will be interesting to see, in other words, whether the industry considers these guidelines to be “nice to have” or necessary.

January 17, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Connecting Smart Mobile Devices to the EHR

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My colleague, John Lynn, posted a hilarious CES marketing video advertising a new product it calls the iOximeter.  The iOximeter, which operates on both the iOS and Android platforms, is an independent device which attaches to smart phones, turning the phone into a pulse oximeter.

I strongly suspect that an i-glucose meter, i-scale and i-blood pressure cuff designed for the mass consumer market are starting to make major headway.

Not to be Scrooge at the Christmas party — I think such devices are a very positive development — but I’m left wondering what the purpose of getting the data onto the phone really is.  After all, unless the data gets to a physician conveniently, and ideally comes to live in their EMR, just how much good does it do?

On the consumer side, it does little but add bells and whistles to products consumers are increasingly used to using anyway, given that the price point for these devices is low enough that they’re sold in consumer pharmacies.

On the provider side meanwhile, you’re left with data that, while it might be arranged in pretty charts, doesn’t integrate itself easily into clinicians’ work flow.  And with EMRs already dumping huge volumes of data into their laps, some physicians are actively resisting integrating such data into the records.

No, the existing arrangement simply doesn’t do anything for clinicians, it seems.  Yes, consumers who are into the whole Quantified Self movement might find collecting such data to be satisfying, but the truth is that at this point many doctors just don’t want a ton of consumer-driven data added to the mix.

To make such phone-based devices useful to clinicians, someone will probably have to create a form of middleware, more or less, which accepts, parses, and organizes the data coming in from mobile health app/device combos like these.  When such a middleware layer goes into wide use, then you’ll see hospitals and doctors actively promote the use of these apps and devices.  Until then, devices like the iOximeter aren’t exactly toys, but they’re not going to change healthcare either.

January 9, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Vendors Way (Seriously, Way) Behind In ICD-10 Readiness

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While providers are well aware that the consequences of failing to be ready for ICD-10 in time can be dire, that hasn’t kept them on track. In fact, according to a new report, providers have fallen further behind with ICD-10 milestones that they did back in February, reports Healthcare IT News.

But as you will see, it’s not necessarily the providers’ fault. In fact, if I were a provider, and my vendor was as behind as some apparently are right now, I would be beside myself.

Research from the Workgroup for Electronic Data Interchange found that some 50 percent of providers have completed the ICD-10 impact assessments. And about 50 percent of providers expect to begin external testing in the first half of 2014, Healthcare IT News notes.

But the study concludes that about 80 percent of healthcare providers will fail to complete their business changes and testing ICD-10 before 2014.

This may not be their fault. According to WEDI, 20 percent of vendors surveyed said they were halfway there or less developing products to support ICD-10. Even worse, 40 percent indicated they wouldn’t even have a finished product available until sometime in mid-2014, a situation which could create enormous problems for providers. (Wondering vendors are addressing the changeover? Here’s how one vendor has been handling the  problem.)

According to WEDI, the top three barriers to vendors completing their ICD-10 upgrades were customer readiness, competing priorities and other regulatory mandates. Personally, I’d argue that vendors have had plenty of time to get the ICD-10 act together. And I wouldn’t find any of those excuses compelling given the impact these delays are likely to have on my operations – - specifically, that special part of operations known as getting paid.  (But hey, maybe you’re a more forgiving type than me.)

With vendors falling behind on ICD-10 software updates and patches, providers are left having to wait — way too long — to begin tests of the downstream functions to come after testing, Judy Comitto, CIO at Trinitas Regional Medical Center in New Jersey, told Healthcare IT News: “I’m a bit disappointed, having reached out to these vendors that they are certainly not there yet.”  Sadly, I think more disappointment is yet to come.

December 23, 2013 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

EMR Can Improve Diabetes Care

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EMRs can help improve diabetes care by making care coordination of such patients more efficient, according to a study reported in iHealthBeat.

The federally-funded study, which was done by the Western New York Beacon Community, went to one of 17 Beacon Communities funded by ONCHIT, which has handed out $250.3 million in total grants.

In this case, the Beacon Community is a partnership between HealtheLink, Catholic Medical Partners and P2 Collaborative of Western New York. The partnership’s $16.1 million is the largest grant received by any of the 17 Beacon Communities.

To study the impact of EMRs on diabetes care, the partners looked at about 40,000 patients, and 344 primary care physicians working in 98 practices.

To implement the study, participants created diabetes registries that tracked lab tests and results, created personalized reminders and guidance for patients, and generated quarterly reports for physicians underscoring areas where they could cut costs and improve diabetic care, iHealthBeat said.

But the diabetic registry was just the beginning. The Beacon project also implemented preventive telemonitoring to avoid excess emergency department visits and hospital readmissions; medication therapy tools to alert doctors — in real time — of changes ED doctors make medication regiments, and patient portals giving patients access to prescription refills, appointment requests and lab results.

At the end of the study, researchers polled the 57 practices that consistently used the registries, and found that the number of diabetics with uncontrolled sugars levels fell 4 percent, with some practices seeing as much as a 10 percent improvement. Researchers calculated that if project guidelines were followed by 20 percent of patients with diabetes and their doctors in Western New York, savings could be $18 million.

This result echoes results of other studies. For example, last year researchers at Weill Cornell Medical College concluded that when a group of community-based doctors moved to EMRs , they provided better care, particularly in managing chlamydia, diabetes, colorectal cancer and breast cancer.

December 16, 2013 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

EHR Helps Researchers Find Genetic Connections To Disease

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A group of researchers have completed a study which found new links between patients’ genetic profile and specific diseases by mining EMR data, reports a story in iHealthBeat.

The research, which was conducted by the Electronic Medical Records and Genomics Network, a consortium of medical research institutions including the Mayo Clinic and Vanderbilt University School of Medicine, analyzed data from about 13,000 of EMRs.

The participants then grouped about 15,000 billing codes contained in the EMRs into 1,600 disease categories. Next, they looked for links to diseases in EMRs which contained DNA data.

The researchers, whose study was published in the journal Nature Biotechnology, found  63 new genetic links to diseases, ranging from skin cancer to anemia, iHealthBeat said.

The EMR study method, which is known as a phenome-wide association study, is a departure from the 13-year old genome-wide association model, which has been used to search for common mutations in the DNA of patients of people with the same diseases.

Co-author Joshua Denny, a biomedical informatics researcher at Vanderbilt, says that the newer method can help link seemingly unrelated symptoms, detect potentially harmful side effects of a drug, and help find new uses for drugs.

This is just the tip of the iceberg where translation medicine and EMRs are concerned. Using EMRs to conduct genomic research is becoming an increasingly popular exercise, cutting across a wide range of clinical disciplines.

And it’s not just institutional academic research houses getting into the act. For example, this summer a large northern Virginia hospital announced that it had struck a deal with a Massachusetts analytics firm to see if data mined from EMRs can better predict the risk of preterm live birth.

Now, genomics research is not for just any hospital — it’s obviously a major undertaking — but I think it’s likely more hospitals will get into the game. By this time next year I think there will be a crop of interesting new genomics projects mining EMRs. Although, it will be interesting to see how the 23andMe FDA battle impacts this as well.

December 5, 2013 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.