States take bigger role in promoting EHR adoption

Maryland further strengthened the goals of the stimulus package or the American Reinvestment and Recovery Act (ARRA) this past week by passing legislation that required insurers to provide “monetary” incentives for physicians to adopt electronic health records (EHR).

The bill, signed by Governor Martin O’Malley, is one of the first of its kind to give sharper teeth to the EHR movement. Insurers may choose from a variety of fiscal incentives including increased reimbursement and lump-sum payments, according to Health IT News. The effort is viewed as a double incentive to providers to join the digital transition that promises to increase health care system efficiency while reducing medical errors for patients. Maryland is not alone in its effort to promote the change from paper to portal; other states are reviewing similar measures that would jumpstart implementation.

Included in the Maryland bill is a requirement for the state to bring a piloted health information exchange (HIE) live by October 1. The goal of the HIE, often comprised of business and community representatives, is to provide support to health care system stakeholders with the goal of increasing efficiency and quality.

Wait, have we heard of an HIE before? Yes. For clarification purposes, regional health information organizations (RHIO) and HIEs are terms used interchangeably; the HIE is simply a new name for a RHIO—it has yet to be determined if it is also a newer and better RHIO. Lingo aside, HIE investment is up.

Other states are looking to HIEs/RHIOs to play a prominent role in EHR adoption. New York, Texas, and Florida are all investing in these information exchanges.

In New York, the Western New York Clinical Information Exchange, known as HealthElink, signed on 6 EHR software vendors to provide community pricing to its clients.

In Texas, the legislature passed two pilot health information exchange programs that promote data transfer between local agencies.

Florida, having received a $9+ million grant from the Federal Communication Commission (FCC), is exploring how to expand broadband access across nine rural hospitals to increase the speed and efficiency of health data transfer.

Other states are vying to develop strategies for technology adoption that support EHR implementation as stimulus dollars dangle overhead. Now that EHRs are heavily banked by both federal and state government, HIEs and RHIOs may take a greater role in aiding communities in EHR adoption. These exchanges hope to serve as important providers of data warehousing as well as offering leadership for the development of criteria for data sharing and data quality. States view HIEs/RHIOs as vehicles for transporting dollars toward the development of technology infrastructure and they are moving as quickly as possible to get their take.

FISMA—a roadblock for EHRs?

The Federal Information and Security Management Act (FISMA), passed by Congress in 2002 to better protect the federal government against cyber attacks, mandates information security standards for all federal agencies. This includes the flow of data between the Centers for Medicare and Medicaid (CMS) and their contractors—over 200 hundred of them, processing billions of Medicare claims. The new worry from CMS, according to Government Health IT, is that healthcare providers sharing EHR files will be required to meet FISMA standards, which include an annual security test and FISMA certification.

A CMS spokesperson is quoted as saying that this would be more than “burdensome” for both CMS and health care providers and organizations.

The conundrum is that information will be moving between the HIPPA world (the private sector) and the FISMA world (the government)—that latter of which is much more secure, from a protocol/standards perspective. Federal agencies are held to a higher standard than the private sector with respect to information security.

For a long time, consumer groups have argued that HIPPA is a weak standard for patient information security. Yet, many worry that if FISMA is applied to the private sector, there will be a compliance crisis that will be costly to remedy. But why shouldn’t the transfer of health information be held to the highest security standards? Advocates of a middle ground argue “yes,” but not quite as stringent as FISMA. They standards should be more of a more of a “HIPPA-plus” or “FISMA-lite,” in the words of Vish Sankaran, a program director for the Federal Health Architecture project to connect health information entities.

In other words, get health care providers better engaged in securing healthcare information but do not stunt the growth of the EHR movement by placing the bar too high.

In the end, the Office of Management and Budget will dictate the debate through their determination of what falls under the FISMA umbrella. In August of 2008, OMB issued some guidance, stating that FISMA applies to groups that “possess or use Federal information—or which operate, use or have access to Federal information systems (whether automated or manual)—on behalf of a Federal agency.” OK, that could include a ton of organizations.

Outsourcing Medical Billing

In the past few years there is a dramatic change in the medical field and its treatment. Initially, while processing the insurance claims there are many administrative difficulties during the preparation of insurance policy procedures and dealing with complicated claim forms. To overcome with these obscurity doctors look out for outside help, and hire representatives to advise them, attend information about insurance company seminars, and provide them with regular clear financial reports.

This is process is called as medical billing outsourcing. Outsourcing Medical Billing acquire a profound working knowledge of the technologies and processes that are decisive to successful Business Process Outsourcing and afford a absolute scale of Back Office Outsourcing services in the areas of Medical Billing, Claim Adjudication, Call Center and Financial service. The most of the physician time is saved by means of medical billing outsourcing process. So that, physicians can much more concentrate on curing their patients. A medical billing firm will have the knowledge and experience technocrats to take care of all the medical billing issues. It makes free the other staff to concentrate on other aspects of running the practice which leads to added security to finance and transactions

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.