State of Indiana Holds Leadership Position in Electronic Health Record Growth

Few would question that dramatic change in the U.S. health care arena is well on the way. With billions of dollars on the table to fund systemic change in critical records management and other aspects of service delivery, what will American health care services look like a few years from now?

Health care reform champions have long complained that secure IT systems exist where consumers can pull out cash from an ATM anywhere in the world. That said, patients today often can’t so much as transfer from one clinical floor to the other without filling out multiple duplicate forms about their medical histories. In the past, some medical records have been lost, misplaced or misfiled too often sometimes with devastating results.

Health care reform is expected to speedily address this unfortunate information transfer gap. With large and small hospitals alike embracing high-speed fiber-based broadband, the capacity increasingly exists for instantaneous access to digital X-ray and MRI images, patient histories and even direct physician-to-patient consults.

Such is the basis for emerging telehealth applications where physicians, specialists and other medical professionals can leverage high-speed and secure data platforms to deliver health care services in a more efficient and cost-effective manner. Unfortunately, even in a lightning-fast Internet-fueled world, much of the present state of medical record keeping still represents an anachronistic throwback to a pre-digital age.

While the technology has existed for health care institutions to develop full-spectrum electronic medical records (EMR) and electronic health record (EHR) systems for more than three decades, as of 2006 less than 10 percent of American hospitals had a fully integrated system. This statistic makes many medical experts cry foul as integrated EHR systems can improve patient safety, reduce errors and promote efficient standards of care.

If that’s not enough, a 2005 RAND Corporation study estimated that efficient exchange of medical records among doctors and hospitals in the U.S. (also known as a health information exchange or HIE) would save $81 billion annually. Other estimates have put that figure as high as $450 billion per year. Throw in better outcomes and a potential higher quality of life and one can only wonder why this hasn’t happened earlier.

Here enters the Obama administration’s American Recovery & Reinvestment Act (ARRA), which includes unprecedented billions of dollars for EHR conversion and development. This access to massive funding has resulted in many hospitals scrambling to update their systems. The ARRA includes both funds for planning and execution as well as cash for physicians to convert their outmoded legacy systems into a 21st century model.

With so few hospitals presently deploying fully integrated systems, where could American hospitals and health care organizations find proven models for EHR and EMR implementation? How about Indiana?

Led by the Indiana Health Information Exchange (IHIE), the Hoosier state is home to not one but four operating health information exchange organizations. This represents a remarkable development as many states in the U.S. today don’t even have a single health information exchange that’s nearing implementation much less operational.

How does it work in the Hoosier state? Created by the Indiana-based Regenstrief Institute, the IHIE securely connects 39 hospitals, 10,000 physicians and more than 6 million patients. It delivers real-time lab results, reports, medication histories and treatment histories that are sent instantly to where they’re needed regardless of the hospital system or location, according to IHIE officials.

Indiana health care leaders haven’t been bashful about touting their early success, openly profiling the IHIE as a proven working model that should be closely reviewed and copied across the United States.

“Indiana has seen how health information exchange drives better health care for our patients, increases efficiencies for our health care professionals and saves health care dollars. Replicating this kind of platform throughout the U.S. would have incredible positive implications on our health care outcomes and cost savings,” IHIE Chairman Vincent C. Caponi (also the CEO of St. Vincent Health said.

The benefits of participating in an HIE or adopting best practices within an EHR system are by no means limited to large hospitals in urban areas as Major Hospital in Shelbyville, Ind. (population 18,000) has eloquently demonstrated.

This 86-bed community hospital was recently named one of America’s top 100 hospitals by Thompson Reuters and its early adoption of state-of-the-art technology is one of the reasons why. Only the St. Vincent Health and St. Francis Hospital systems (which are much larger than Major Hospital) were also included as central Indiana health institutions named in the 2009 benchmark study.

How did this happen? Working in the shadow of much larger hospital systems in nearby Indianapolis, Major Hospital trumped its hefty competitors by instituting the beginnings of a full-scale EMR back in the mid-1990s.

The result, according to Major Hospital CEO Jack Horner, is reflected in both the growth of the hospital and its more than 25 vertical medical practices. They are all linked together by fiber-based broadband connectivity. That coupled with aggressive recruitment and retention of top physicians and hospital staff has led to substantial growth and a high degree of patient satisfaction.

While many other hospitals (large or small) across the nation are just now ditching their legacy systems and working to implement full-scale EHR platforms, Major Hospital is already well into direct physician order and advanced applications all to the benefit of the hospital’s patients.

Major Hospital was one of the first health care institutions outside of Indianapolis to join the Indiana Health Information Exchange. Its success demonstrates that EHR systems can work well in either large or small health care organizations.

Medical industry pins hopes on IT funds

By Sarah Bruyn Jones
With nearly $20 billion in federal funds about to hit the world of health care information technology, Virginia’s health sector and political leadership are trying to prepare to capture their share of the money.

The money is part of the federal stimulus bill signed by President Obama in February and is intended as a financial incentive to get the health care industry to embrace using electronic medical records. Still, the timeline and details of how the money will be distributed have not been finalized.

“This represents a big leap forward for health technology, so we are excited about it,” said Virginia Secretary of Health and Human Resources Marilyn Tavenner. “We just want to be positioned to take maximum advantage of it.”

Some monies will likely go directly to the states to be distributed, while other funds will be allocated through a competitive grant process.

Tavenner said a significant amount of money coming to Virginia could boost job growth for information technology specialists as more health providers implement electronic record-keeping systems.

To help ready Virginia for coming funding, U.S. Sen. Mark Warner has arranged for a health IT summit Monday in Richmond. The national coordinator for health information technology, recently appointed by Obama, will be at the summit.

“This is going to be one of the areas that is going to drive health care reform,” Warner said.

The state will form an advisory group to help Virginia providers access the federal money and implement effective electronic medical record systems.

Between 15 and 20 people will be named to the group, including four people already named to the newly created Health Information Technology Standards Advisory Committee, which was established by the 2009 General Assembly, Tavenner said.

Warner said establishing electronic medical records in hospitals, nursing homes and physicians’ offices throughout the state will improve care and reduce costs.

“There is no reason why health care can’t get some of the efficiencies that every other field has,” he said, pointing to manufacturing and telecommunications as examples.

While the guidelines for exactly how the money will be distributed are still being worked out, Warner said he believes that cooperation between different health care providers will be the key to attracting government dollars. That includes requirements that different hospital systems and physicians’ offices be able to share information.

Warner, who has a background in telecommunications, said the system should be similar to the way cellphone companies operate: There are different providers, but a call from a Verizon phone can be received by a Sprint phone. Financial incentives will be needed to push a working system into operation, he said.

Questions remain about the security of such a system. And some medical providers don’t want to share all their data with another business due to competition in the industry.

Carilion Clinic’s chief information officer, Daniel Barchi, said it is important for system administrators to talk to each other as electronic records become the standard. Carilion began rolling out its new multi-million-dollar record system last year and has been in discussions with some other hospital systems in the state to share experiences, he said.

“The more that health IT leaders get together, the better off we are going to be,” Barchi said.

He is one of the four people already appointed to the advisory committee.

Bill Supports Grants For Digital Medical Records

The use of electronic medical records could become more widespread in Pennsylvania if new legislation passes.

Rep. Bryan Cutler, R-100th district, is introducing a bill that would create a grant program for health care providers to implement the health information technology.

The systems used in parts of Lancaster General Hospital and some of its doctors offices put a patient’s medical records in one electronic chart.

Cutler wants to use $25 million in stimulus money to fund the program.

“This technology needs to be adopted for patient safety and for decreasing costs,” said Cutler.

Sixty percent of the doctors in its health system will have computerized medical records by July and all of them will have the system by 2010, Lancaster General officials said.

The medical record system will be shared with physicians outside its health system, Lancaster General officials said.

Maryland requiring health plans to offer EMR incentives

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.

The New Medical Transcription Scenario

The challenge for any medical transcription company is to enable a seamless coordination of medical care. This coordination can be provided by electronic system of medical records. This system enables seamless transmission of medical data from one doctor to another. If incorporated this system helps to provide coordinated, safe and cost effective care.

An estimated 1% to 7% of the patients have a medication error during their stay at the hospital. The medical records provide a foundation for a support system that enables a check on these kinds of errors.
The need of the hour for the transcription companies is to evolve around the electronic medical record system. Also, the companies need to understand their position in the current day scenario and also learn where they are moving to in the future.

A safe and effective medical care can not be provided without a seamless movement to medical data. This is the most exciting change that is happening all around us and the next three to four years will be the most important in the process to ensure that the timely and accurate medical data is always available to the doctor on the web with the oversight of a transcriptionist to ensure its accuracy.

The medical transcriptionist is the first line of defense in providing the accurate and the timely care that he needs by providing the necessary documentation. Though a transcriptionist works at the background but plays an important and integral part in providing safe and effective care to the patients.

Health IT program needs ID management

Privacy becomes an issue with electronic health records

The Obama administration’s drive to implement electronic health records (EHRs) should have strong identity management tools to ensure privacy and security of the records, members of a panel of providers, vendors and policy experts said today.

The coming health information technology policies and standards are to include protections for patient privacy and security and safeguards against medical identity theft. Achieving those goals could be advanced by identity management tools, such as strong authentication standards and smart cards, according to panelists at an event in Washington today organized by the Smart Card Alliance and the Secure ID Coalition. Both groups represent vendors of identity management programs.

For example, patients checking in to Mount Sinai Medical Center in New York City are assigned a smart card that contains their photograph and a digital summary of recent clinical information. By delivering the information to doctors providing care, the card helps improve care and reduce medical errors. The card also has proven to be critical in reducing fraud and identity theft, which in turn decreases errors in payments and in patient care, said Paul Contino, vice president of IT at Mount Sinai.

“If you don’t catch the errors at the registration desk, you will see dramatic effects downstream,” Contino said. “If you are going to spend money on health IT, you need the right identification standards.” Without strong ID management, care records are likely to have errors because of false identities, misspelled names, duplicative names and other problems. Even a single error, such as a wrong blood type listed on a patient’s record due to a mix-up with another person’s identity, can lead to catastrophic consequences for a patient, he said.

Congress approved spending $17 billion in incentives for doctors and hospitals that install and use health IT systems as part of the economic stimulus law. The Health and Human Services Department is drawing up standards and policies to distribute payments to providers who can show meaningful use of health IT. HHS also is setting up a framework for secure exchange of the health data and the department’s national coordinator for health IT on May 15 released a road map for creating the standards and policies under the stimulus law.

One standards will involve controls on access to patient records. The leakage of private medical information can affect a patient’s employment, housing and insurance status, and because of that extreme sensitivity, medical information requires more than a password for secure handling, said Michael Magrath, director of business development for North America for Gemalto Inc.

“Health information exchanges and regional information exchanges will be targeted by hackers,” Magrath said. “I have strong concerns about the prospect of minimum standards,” such as passwords alone. Identity authentication standards for receiving medical care and handling medical data should require a password and also use of some type of identity token or certificate issued by a third party, he said.

Ideally, patients would be in charge of — and would have complete access to — all of their health records, said William Yasnoff, managing partner of the National Health Information Infrastructure Advisors consulting firm.

E-prescription boost for 1,800 hospital beds

The ePrescribing and Medicines Administration (EPMA) system will manage medicines for the more than 1,800 hospital beds at Heartlands, Solihull and Good Hope hospitals, as well as their take-out prescriptions.

The system includes access to the Multilex Drug Data File database, which allows clinicians to check how drugs will interact with each other, potential duplicate therapies and allergies that can be triggered by certain medications.

Niall Poole, electronic prescribing project manager at Birmingham’s Heart of England NHS Foundation Trust, said in a statement: “E-prescribing minimizes the risk of medication errors in many ways: from the very basic, such as producing legible prescriptions which are not subject to the difficulties and potential dangers of reading and interpreting handwriting, to the very advanced such as drug-interaction information at the point of prescribing.”

Plan Outlines Medicare/Medicaid Incentives

The Department of Health and Human Services has released the outlines of the program to offer Medicare and Medicaid incentive payments for meaningful use of electronic health records systems.

The payments are authorized under the economic stimulus law. Medicare incentives to eligible hospitals will start in October 2010, HHS has clarified. Medicare incentives to physicians, as well as Medicaid incentives to physicians and hospitals, will start in January 2011.

By the end of 2009, HHS expects to:

1. coordinate with the Office of the National Coordinator for Health Information Technology to develop related policies for the incentive programs, such as the definition of meaningful use;
2. develop proposed rules to allow public input to the incentive program policies;
3. plan systems and other requirements to support the incentive programs; and
4. plan a national outreach program.
5. By the end of 2010, HHS expects to:
6. conduct outreach to eligible professionals and providers and to state Medicaid agencies;
7. develop systems to support the payment of incentives;
8. develop final rules to establish policies to pay incentives; and
9. develop systems to monitor and evaluate incentive payments.