Tag: EHR

How to Meaningfully Shop for an EHR

Feb 10, 2011• 18

By MARGALIT GUR-ARIE

So you’ve been hearing all about the recent EHR buzz and decided to give it a try. Whether you are convinced that electronic records are the way to go, or you have reached a point where you are willing to give it a try, the first thing to do is buy one of those EHRs. You may be staring at a glossy brochure or website featuring a distinguished silver-haired doctor holding a cool little tablet computer and smiling reassuringly at the little old lady sitting comfortably in front of him, with a large 1-800 number on the bottom urging you to call now. Don’t.

Shopping for an EHR may be more complicated, but is not much different in nature than shopping for a car or a new type of breakfast cereal. Of course, you have been shopping for cereal since you were a toddler and probably bought your first car as a teenager, so the entire shopping process is almost second nature. Not so with an EHR. Just like cars and cereal boxes, there are hundreds of EHR products out there, and just like cars and cereals, you need not bother with most, and after you narrow the field down to three or four, it makes little difference which one you end up taking home. The qualitative road map below will lead you to those three or four obvious choices of EHRs best suited to your particular situation. The final choice is yours to make.

Why This Primary Care Doctor Loves His EHR

Feb 7, 2011• 6

By DAVIS LIU, MD

A recent post in the Wall Street Journal Health Blog noted that a study found electronic medical records don’t improve outpatient quality. The authors of the Archives of Internal Medicine article, Electronic Health Records and Clinical Decision Support Systems, correctly points out that we should be skeptical and “doubt [the] argument that the use of EHRs is a “magic bullet” for health care quality improvement, as some advocates imply.”

This should surprise no one. Were we that naive to think that simply installing health information technology (HIT) in the medical field would generate significant improvement in outcomes? Does simply installing computers in our classrooms improve educational test scores?

Of course not.

The excellent commentary after the article makes some plausible reasons why the clinical decision support (CDS) didn’t seem to improve outcomes on 20 quality indicators. First, it isn’t clear that the CDS implemented across the various doctors’ offices and emergency rooms actually addressed the indicators studied. Second, the data studied is already dated (from the 2005 to 2007 National Ambulatory Medical Care Survey), a long time in technology terms (iPhone first debuted in 2007). The authors of the original article also point out that there is some evidence that institution specific use of CDS actually improves quality. Whether this can be scaled to the national level is the question.

The Safety of HIT-Assisted Care

Jan 31, 2011• 1

By JOHN HALAMKA, MD

I was recently asked by an Institute of Medicine committee to comment about the impact of healthcare information technologies (HIT) on patient safety and how to maximize the safety of HIT-assisted care.

“HIT-assisted care” means health care and services that incorporate and take advantage of health information technologies and health information exchange for the purpose of improving the processes and outcomes of health care services. HIT-assisted care includes care supported by and involving: EHRs, clinical decision support, computerized provider order entry, health information exchange, patient engagement technologies, and other health information technology used in clinical care.

There are two separate questions:
1. What technologies, properly used, improve safety?
2. Given that automation can introduce new types of errors, what can be done to ensure that HIT itself is safe?

To explore these topics, let’s take a look at Health Information Exchange (HIE). What HIE technologies improve safety and how can we ensure the technologies are safe to use?

Electronic Medical Records Attack Hospitals

Jan 31, 2011• 22

By MICHAEL KIRSCH, MD

Readers know of my criticisms of the electronic medical record (EMR) juggernaut that is oozing over the medical landscape. Ultimately, this technology will make medical care better and easier to practice. All systems will be integrated, so that a physician will have instant access to his patients’ medical data from other physicians’ offices, emergency rooms and hospitals. In addition, data input in the physician’s office will use reliable voice activated technology, so that some antiquated physician behaviors, such as eye contact, can still occur. Clearly, EMR is in transition. I place it on the 40 yard line, a long way from a touch down or field goal position.

A colleague related a distressing meeting he had at the community hospital he works at. This hospital, like nearly every hospital in Cleveland, is owned by one of the two towering medical behemoths. I’m not a businessman, but I have learned that when something owns you, it’s generally better for the owner than the ownee. This meeting was about the hospital’s upcoming EMR policy. Sometimes, these hospital meetings are ostensibly to seek physician input, but the true purpose is to inform the medical staff about decisions that have already been made. In the coming months, this hospital will adopt a computerized ordering system for all patients. In theory, this would be a welcome advance. It would create a digital and permanent record of all physician orders that could be accessed by all medical personnel involved in the patients’ care. It would solve the perennial problem of inscrutable physician handwriting, including mine.

Some EHR Vendors Losing Out as Market Evolves

Jan 30, 2011• 13

By DON FORNES

Electronic health record (EHR) software vendors aren’t churning out profits like you might expect. You’d think that the Federal subsidies for EHR implementation would create a rising tide that lifted all boats in the EHR software industry. In reality, some vendors are about to capsize.

Based on data points I’ve observed in the market over the past few months, I think some vendors are facing a cash flow crunch. They’re thrilled to have the wind at their backs for once, but the pace is proving hard to maintain as market evolution has accelerated under the unnatural effect of government subsidies.

Here’s the problem.

EHR Vendors Are Spending Money Like Crazy

Most software markets evolve over a twenty or thirty-year period. Consider the enterprise resource planning (ERP) market: the first ERP vendors were founded in the early 1970s, but rapid growth and innovation continued until about the year 2000. The EHR market, however, will mature in the next five years. This is because healthcare providers are buying EHR systems sooner than they otherwise would, to make the most of massive federal subsidies and avoid penalties. Consequently, EHR vendors are in a mad rush to gain market share.

Those that win will own a massive customer base paying recurring support fees. Those that lose will become irrelevant from a market share standpoint and will be ingested into a larger vendor (if they’re lucky; some will just go broke). As a result, EHR vendors are increasing their R&D budgets to develop new features and meet meaningful use criteria. Their marketing colleagues are spending heavily on demand generation and brand building. These vendors have no choice but to win today’s market share battle.Continue reading…

EHR Product Management

Jan 24, 2011• 17

By MARGALIT GUR-ARIE

It has become politically incorrect to refer to EHRs as products. Instead, EHRs are now “technologies” as evident in all ONC and CMS published rules and regulations. This subtle change in terminology was intended to encourage, yes you guessed it, Innovation. It was supposed to signal an open market for alternatives to existing EHR products in the form of modular approaches, open platforms, mobile applications and web-based software-as-a-service. Naturally, the industry is obliging and all efforts now are geared towards creating stuff that runs on iPads, preferably “cloud” based and with minimal utility. The new stuff looks very cool and promises to become even cooler, so what’s the problem?

The problem is that these new things do not solve any problems. Traditional product innovation concentrated on identifying problems, designing solutions and then selecting technologies that were capable of enabling those solutions. New technologies were usually born out of the necessity to solve a burning problem and those with enough applicability to larger markets became blockbusters. Every frying-pan today sports technology first invented in the process of creating refrigerants and later used for nuclear destruction (Teflon). Every large enterprise embarking on cost cutting, new markets acquisition, or general improvements, should know all too well that selecting a “cool” technology first, and then attempting to find a good use for it, is recipe for failure.

EMR and the Falling Patient

Jan 20, 2011• 8

By STEVE SANDERS, DO

Is Mom at risk of falling?

Electronic medical records (EMR) efficiently capture physician’s keystrokes—yes or no—to this question and tuck it along side other data about our so–called medical lives.The physician’s judgment has to take into account many factors: is the patient elderly and ‘frail,’ do they have an orthopedic or neurological problem causing them to lose their balance, can they get up from a chair without having to use their arms to push-off, importantly do they live alone. Most of the answers to these questions come quickly through discussions with the patient or their family, or by simply observation. Nine times out of ten physicians can predict that a patient will fall before it happens.

Now, the EMR owns this critical piece of information. But the next most obvious question, as many of you can guess, seems clear: now what?

Ideally by clicking yes, a sequence of events occurs; (a) Home health receives an electronic message requesting a patient safety visit. Specially trained home health nurses look for loose rugs that may slip out from under the patient, extension cords waiting to snag an unsuspecting foot, toilets without support for getting up and down, or the need for an electronic alert system bringing help quickly (b) An alert goes to the patient’s pharmacy requesting a drug–drug interaction report, detailing which drugs interfere with each other causing precarious side effects. Alerts also goes to the primary physician highlighting which of the patient’s medication tend to cause problems in the elderly (c) Schedules an appointment with physical therapy for balance and strengthening exercises (d) Arranges for a visual examination and hearing test, after checking on previous tests. These steps become placed into motion within a nanosecond after clicking ‘yes.’

Ready, Set…ACO?

Jan 14, 2011• 19

By JONATHAN BUSH

Happy New Year, everyone! 2010 was certainly action-packed, and 2011 promises the same.

I hear a lot of thunder about getting ready for ACOs.

This isn’t a crystal ball forecast, but I see hospitals spending tons of capex on new HIT from old-fashioned “software-based” companies, and it seems like the EMR is the new “pavilion.” I see hospitals buying medical practices using arrangements that are certain to require the hospital to subsidize doctor income. [For another take: Paul Levy on ACO.]

These two major waves are explained by clients and prospects alike as “readiness for ACO.”

I have three thoughts:

Don’t worry. We at athenahealth will do our part. If and when ACO payment models emerge, you won’t need to buy a new “module” from us in order to get payment. We will go get you that money the same way we are getting you the “Meaningful Use” stimulus payments, the P4P money, and the plain old health care reimbursements that we have always delivered. The changes to our technology and service needed to accomplish all that will be on us.
Don’t turn blue holding your breath waiting for the big bonus opportunity. The fundamental underlying principle of an ACO is that you will get a bonus in exchange for lower utilization. If that bonus is bigger than what you’d get from the utilization, then why would Medicare pay it? If that bonus is LESS than what you are getting now, why would you do it?
I have met newly elected Republican lawmakers of late and few of them are thinking that money will be saved with this approach. As with other aspects of health reform law, they appear to be eager to… well, let’s just say…scrutinize the mechanics closely.

None of this is certain and there will be exceptions to all the rules anyone tries to write.

This leaves one thing certain.

Do NOT make multi-year investments that depend upon ACO actually happening.

So as far as ACO goes, pay as you go.

With me?

Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997. He blogs regularly at THCB and at the athena blog where this post first appeared. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School. He blogs regulary at the athena blog, where this post first appeared.

Early Experiences with Hospital Certification

Jan 10, 2011

By JOHN HALAMKA, MD

As one of the pilot sites for CCHIT’s EHR Alternative Certification for Hospitals (EACH), I promised the industry an overview of my experience.

It’s going very well. Here’s what has happened thus far.

1. Recognizing that security and interoperability are some of the more challenging aspects of certification, we started with the CCHIT ONC-ATCB Certified Security Self Attestation Form to document all the details of the hashing and encryption we use to protect data in transit via the New England Healthcare Exchange Network.

Next, I had my staff prepare samples of all the interoperability messages we send to patients, providers, public health, and CMS. Specifically, we created

CCD v.2.5 used to fulfill the Discharge summary criterion
HL7 2.51 Reportable lab
HL7 2.51 Syndromic surveillance
HL7 2.51 Immunizations
PQRI XML 2009 for hospital quality measures

We validated them with the HL7 NIST test site

and the HITSP C32 version 2.5 NIST test site.

CCHIT validated the PQRI XML as conforming.Continue reading…

That Which We Call a Rose

Jan 8, 2011• 6

By MARGALIT GUR-ARIE

What’s in a name? Sometimes nothing much.

Sometimes a shift in paradigm. The Medical Record in its current format was created over a century ago by Dr. Henry Stanley Plummer at the Mayo Clinic. When in the course of human events the Medical Record began migrating from paper folders to computer files, the Institute Of Medicine naturally named the new invention Computer-based Patient Record System (CPRS)

The Medical Records Institute chose the term Electronic Patient Record (EPR). Somewhere along the line the “patient” got dropped from the concept and the software used to compose and store medical records became known as Electronic Medical Record and the name EMR stuck.

As EMR software evolved and started exhibiting rudimentary information exchange abilities and some semblance of “intelligence”, it was felt that a name change was in order. To differentiate the newer and smarter software from the original EMR, the term Electronic Health Record (EHR) was introduced and is now enthusiastically supported by the Federal Government. The term EHR is used in acts of Congress, rule makings from CMS and ONC and Presidential speeches. Since EMR has been around for quite some time, most industry veterans, as well as most doctors, are a bit confused about the new terminology.