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HIT Trends Summary for August 2011

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By MICHAEL LAKE

This is a summary of the HIT Trends report for August 2011.  You can get the current issue or subscribe here.

Incentives driving the EMR market. According to a report by Sage Healthcare, most physicians (65%) buying EMRs are doing so because of federal incentives.  The biggest obstacle is still cost with 32% of non-users saying it’s the number one issue.  This is creating a mainstream market, even in solo practices, which report over 30% EMR adoption rates in a new survey by SK&A.

Incentives may also be driving hospital implementation of computerized physician order entry (CPOE).  80% of hospitals still lack CPOE capabilities as of last year.  Meaningful use requires providers to order at least one medication for 30% of unique hospital patients.  In a new KLAS report, CPOE projects have more than doubled, being led by Cerner and Epic.

It is a likely unintended consequence that the incentives are speeding the dominance of market leaders.

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HIT Trends Summary for July 2011

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By MICHAEL LAKE

This is a summary of the HIT Trends report for July 2011.  You can get the current issue or subscribe here.

Specialty EMRs. There is a market for EMRs that specialize by practice type.  This month, the ophthalmologists tell us what’s required to help them.  They have specialized vital signs, testing and measurement devices.  It is likely all specialties would benefit if EMRs get more specialty-specific.  Some specialty EMR solutions have found a successful niche markets in cardiology, oncology and other segments.  This could be another.

Medscape reports that AAFP’s smaller practice members like EMRs that focus on them.  This report is focused on user satisfaction.  The combination of easy-to-use software and physician involvement is leading to high satisfaction with products from vendors focused on small practices.  And yet, we have also heard from prior KLAS reports that many practices (30%) are abandoning current vendors for market leaders.

A national study also reports that smaller practices are interested in new care models, but may lag implementation because they tend to underutilize needed technology.  The study included 1,344 practices with fewer than 20 physicians each.  The EMR is central to success of emerging collaborative and more accountable care models.  Using registries to help manage patient populations is a core element as is medication management through e-prescribing.   This study confirms that it will take a while for smaller practices to get the utilization required to be effective in the new model.

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HIT Trends Summary for June 2011

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By MICHAEL LAKE

This is a summary of the HIT Trends report for June 2011.  You can get the current issue or subscribe here.

EMRs in the cloud. There is additional validation this month by MarketsandMarkets that the EMR market has heated with compound annual growth rates over the next couple of years pegged at nearly 20%.  Analysts report that EMRs delivered over the Internet are a fast growing segment appealing to small practices. One new example is the Allscripts’ MyWay EMR is being offered by Costco in a hosted version for as low at $499 per physician per month.  This could be an emerging market price now-a-days for a low-end hosted or web-based solution. This leaves some room for disrupters underneath to position at a lower price or premium pricing with differentiating services.  We saw a similar idea pursued by Sam’s Club and Dell last year without much success.

The AMA also clarified one of its ideas for this Internet EMR market by marrying e-prescribing and registry functions to meet stage 1 meaningful use.  DrFirst is the e-prescribing app.  DocSite and WellCentive are participating registry-oriented EMRs. It is a welcome new alternative that should get significant market attention.

EMRs and care coordination. Care plans have become the foundation for care coordination.  This is one of the lessons learned from a report by eHI.  Yet it finds that additional EMR functional support is needed.  Oncology patients report they want to collaborate with their physicians. The report tracks two detailed case studies at Taconic IPA and Community Health Center in CT.  The EMRs are useful but insufficient to support care coordination.   Workarounds are available through increased staffing.

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HIT Trends Summary for May 2011

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By MICHAEL LAKE

This is a summary of the HIT Trends report for May 2011.  You can get the current issue or subscribe here.

E-prescribing scale and innovation. Surescripts reports dramatic growth for e-prescribing with a third of office-based physicians on its network and 20% of all scripts now going electronically to pharmacies and mail order.  Yet formulary and prescription history data are underutilized by practices.  This according to a study by Center for Studying Health System Change who finds that while most physicians have access to formularies and about half to medication histories, many don’t utilize it because they don’t see the value or systems are too cumbersome.  However, there continues to be innovation in this area.  CVS Caremark is piloting electronic prior authorization and Medco released a consumer pharmacy app for Verizon phones that alerts consumers to lower cost alternatives that Medco hopes will be discussed with prescribers.  This is a terrific model for supporting the provider-patient dialog around medications.  The key is the personalization to the member’s specific benefit information and the application’s ease of use.  Perhaps these innovations can help address the utilization issues.

EHR market dynamics. There is also market growth and adoption of EMRs.  According to report by Kalorama Research it’s a $15.7B U.S. market in 2010 with predicted market growth of 18%-20% per year for the next two years.  California Health Care Foundation is reporting that over half of California’s primary care physicians using an EHR, and of the largest practices, adoption is over 80%.  EHR is increasingly a global issue with new reports on the European experience highlighting that 81% of hospitals there have electronic patient records.  This is a comprehensive European study of 909 hospitals in 30 countries.   Larger public and university hospitals are more advanced than smaller private ones.  Nordic countries are leading.  Individual spider-charts give readers a summary at-a-glance.  Still all is not rosy.  England’s National Audit Office reports its National Health Service EHR project is failing.

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HIT Trends Summary for April 2011

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By MICHAEL LAKE

This is a summary of the HIT Trends report for April 2011.  You can get the current issue or subscribe here.

Europe. European progress reports on HIT show us that it’s evolving along many similar lines to current US efforts.  One report highlights beacons of e-prescribing in Sweden and Estonia where scripts are stored centrally and available from any pharmacy.  European states are also pursuing funding national centers of excellence in HIT. They are implementing EMR-like systems mostly less comprehensive than the US (34 countries); telehealth, most notably in the UK; and ID cards (24 countries).  Governments are funding and because of that, also assessing results.

There are also success stories in cross-border health information exchange on a new website that gives us a comprehensive view into European HIE activities.  There’s a report by the European standards community exploring barriers to personal health device interoperability, an issue that is holding back the world’s telehealth market.  And CSC announced it is buying iSOFT, a subcontractor that’s been struggling, in hopes of faster progress in the UK’s National Programme for IT.

Incentives. Provider incentives have been in the news.  CMS released a report on its quality (PQRI/PQRS) and e-prescribing (MIPPA) incentive programs for 2009 with providers earning $5,000 on average.  Disincentives for the e-prescribing program begin in 2012 and the quality program in 2015.  Quality data will be available over time on the CMS Physician Compare website.Continue reading…

HIT Trends Summary for March 2011

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By MICHAEL LAKE

This is a summary of the HIT Trends Report for March 2011.  You can get the current issue or subscribe here.

Government drivers. Federal communications dominated this month’s news.  ONC defended its core EHR strategy through a report published in Health Affairs analyzing the most recent studies to prove the benefits.  It found that 92% of studies reported positive or mixed but predominately positive results.  The study updates prior research by Chaudhry (2006) and Goldzweig (2009).

It also released its 5 year HIT strategy that is more of a comprehensive tactical plan of the work over the next years.  The plan seems generally aligned with most industry expectations.  (Adopt EMRs.  Exchange patient info.  Make it secure and private.  Get patients empowered.  Measure everything.)  ONC is asking for public feedback.  Early comments wish the plan contained more on fraud prevention and innovative solutions and architectures.

There’s also some pushback on its Stage Two and Three requirements.  A CCHIT industry survey indicates some potential overreach in areas such as agency reporting, formulary checking, medication reconciliation, patient info access and other areas.  Yet CMS put out its first rules on ACOs for comments, and the HIT requirements are ginormous.  Writing in the NEJM, CMS head, Don Berwick says, “Information management — making sure patients and all health care providers have the right information at the point of care — will be a core competency of ACOs.”Continue reading…

HIT Trends Summary for August 2010

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By MICHAEL LAKE

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This is a summary of the HIT Trends Report for August 2010.

You can get the current issue or subscribe here

Large insurers make HIT commitments.  This month’s trends are dominated by national health plans revealing more about their HIT strategies.  Dr. Blumenthal called HIT a “team sport,” when asking for private industry support for meaningful use.  National insurers responded.  Humana announced that it will collaborate with athenahealth in 100 physician practices and pay for 85% of the costs of its EHR.  It will also pay a 20% bonus for hitting outcomes targets.  Ingenix, part of UnitedHealthcare Group, reported it is buying Axolotl, a leader in health information exchange.  Aetna announced a partnership between its ActiveHealth care management solution and IBM who will provide clinical decision support to providers in large groups using cloud computing.  And WellPoint told the WSJ that it is investing hundreds of millions of dollars to finance the HIT infrastructure for rural providers.  In response to a consumer advocate raising questions about an inherent conflict when payers support provider HIT efforts, health plans responded by insisting their focus is on improving patient outcomes which will lower costs.  Payer investments in provider HIT will be supported by its inclusion as a medical expense when insurers calculate medical loss ratios.  The National Association of Insurance Commissioners approved its inclusion in new MLR blanks.

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