Business of Medical Practice

Chapter 13: IT, eMRs & GroupWare

INTEROPERABLE e-MRs FOR THE SMALL-MEDIUM SIZED MEDICAL PRACTICE  

[You’re the CIO of your Own Office] 

By Shahid N. Shah 

These are exciting and very promising times for the widespread application of information technology to improve the quality of healthcare delivery, while also reducing costs, but there is much yet to do, and in my comments I want to note especially the importance of the resource that is most often under utilized in our information systems; our patients. 

 - Charles Safran MD [Testimony to the House Ways & Means subcommittee on health]  

Introduction 

Many large healthcare organizations have a Chief Information Officer (CIO), a Chief Technology Officer (CTO), perhaps a Chief Medical Information Officer (CMIO), or Chief Medical Officer (CMO) that is tasked to do things like figure out the information technology (IT) and computer systems that support clinical and business goals within a healthcare organization. Smaller groups and practices don’t have enough resources to have dedicated staff for such a purpose so it will fall onto the physician staff or other senior leadership at a practice. 

However, it’s still important to perform the tasks that a CIO, CTO, CMIO, or CMO performs with respect to technology strategy building:  

  • Ask lots of questions and take nothing at face value – focus on core issues of concern to your practice, why things are the way they are in your organization, why things cost what they do, and what the implications of technical changes might be. Since you’ll be your own CIO, you have to be the “grand inquisitor” when it comes to technology solutions. Technology providers try to make themselves sound smart by using heavy technical terms but the most astute are those that that can explain why things matter to you.
  • Focus on practice results, not the technology – technology supports your business and having technology is not a goal on its own. Being your own CIO means that you will have to say no to most things that vendors want you to do; you’ll have to keep telling your vendors that you’re not in the software business, that you’re in the patient care business. Many consultants have to be reminded that they need to show results for each of their suggestions and you’ll have to remember that a consultant or vendor will get paid regardless of whether or not you’re successful.
  • Understand where technology can fail you – software is complex and IT systems can become a burden when not implemented correctly. Focus on the limitations and applications of technical solutions and learn how to implement them. Try to know when vendors or consultants are giving you advice that you can’t take because it doesn’t fit your organization.
  • Make sure IT strategy decisions are made by clinical people and IT implementation decisions are made by IT people — one of the most important decisions that you can make when implementing a technology is who gets to decide what goes in versus what stays out. If you’re going to be your own CIO don’t think that somebody outside your practice will do a better job defining your needs that you can.  If you let the vendors or consultants decide, you’re relegating important responsibilities.
  • More here: BOOK ORDERS [Pre-Release]: http://www.springerpub.com/shoppingcart 

    Dictionary of Health Information Technology and Security: http://www.springerpub.com/prod.aspx?prod_id=49952

    36 Comments »

    1. My Favorite Health 2.0 I.T. Story

      ComChart EMR: An experience from the exam room

      I was in the exam room talking to a patient, who I am treating for hyperthyroidism. The patient complained of profound fatigue, of several months duration. It was unclear if the problem was being addressed by the PCP. While talking to the patient, I reviewed all his labs which were in ComChart EMR. There was nothing obviously wrong.

      From within the exam room, and while still talking to the patient, I connected to my hospital’s computer and download all his labs which were less than 1 year old. I then had ComChart file the labs into his ComChart chart. I then had ComChart EMR create a chart of all his CBCs by clicking the “Chart… CBC” button in the labs. It was obvious that his hematocrit had dropped precipitously sometime between January and March.

      The PC computer I was using had Skype installed (a free program which allows you to make free telephone calls from your computer.) I also have a headset attached to this computer, which I use with Dragon NaturalSpeech Medical. While still in the exam room, and from within ComChart EMR, I clicked the “PCP” button in the patient’s Progress Note and a dialog box popped up and asked “Do you want to go to the Dr. XXX’s Addresses file?” I selected “yes.” I then clicked on the label “private,” which is in front of the physician’s “private” phone number. ComChart opened Skype and connected the call. I spoke with the PCP and I arranged for the patient to see the PCP the following day.

      I then click the “orders” button and selected my “anemia work-up” panel. This created a lab order slip which included all the necessary blood tests. I choose the option “Send copy of results to… PCP” and then clicked the button “Fax order slip” to lab.

      Finally, in front of the patient, I dictated a Progress Note, using Dragon NaturalSpeech 8 Medical. The resultant Progress Note included the chart of the patient’s CBCs. I then selected the PCP as the recipient, and clicked the button “Create queued fax.” In my office, I have one computer which continually sends out the “queued faxes” as soon as they are created. Thus, the PCP had received a copy of the Progress Note and the lab had received the lab order slip even before the patient left my exam room. The entire process occurred within a few minutes.

      Needless to say, that patient was impressed that my office was able to use technology in order to efficiently advance their healthcare. And, the fact that it all happened in front of the patient, seem to reassure the patient and de-mistify the healthcare delivery process.

      True story. It occurred on 7/7/06. Score one for ComChart EMR.

      Hayward Zwerling, M.D., FACP, FACE
      20 Research Place, Suite 300
      North Chelmsford, MA 01863
      mobile: (978) 407-0101 < — best option
      fax: (978) 656-9950
      Skype: hzwerling
      HZMD@me.com

      Comment by Hayward Zwerling, MD — January 13, 2010 @ 3:49 pm

    2. Brian Ahier on Healthcare, Technology and Government 2.0
      http://www.Ahier.Blogspot.com

      Brian Ahier’s views and information on Government 2.0, Healthcare and Technology

      Randy

      Comment by Randy — February 9, 2010 @ 5:39 pm

    3. The “Real” Facts on eMRs
      [A .ppt Presentation]

      http://healthcarefinancials.wordpress.com/2009/12/03/the-real-facts-about-emrs/

      Al Borges; MD

      Comment by Al Borges MD — February 10, 2010 @ 1:56 am

    4. eMR Products

      Visit these two sites for a list of most currently available eMR systems:
      http://www.eHRscope.com and http://www.eHRwatch.com

      Bill

      Comment by Bill — February 11, 2010 @ 12:55 pm

    5. EMR success rests on culture change, MD buy-in, executive leadership

      It takes physician executive leadership, a willingness to change the organizational culture and, of course, physician buy-in to make an eMR implementation both worthwhile and successful.

      http://www.fierceemr.com/story/emr-success-rests-culture-change-md-buy-executive-leadership/2010-02-11?utm_medium=nl&utm_source=internal

      All topics covered in this book.

      Leonard

      Comment by Leonard — February 12, 2010 @ 10:59 am

    6. eMR Warnings from Industry Experts

      The New England Journal of Medicine:

      • “We have observed the electronic medical record become a powerful vehicle for perpetrating erroneous information, leading to diagnostic errors that gain momentum when passed electronically.”

      Hartzband, M.D., Pamela, and Jerome Groopman, M.D. “Off the Record-Avoiding the Pitfalls of Going Electronic.” New England Journal of Medicine. April, 2008.

      • “The humanistic depiction of the electronic medical record contrasts sharply with the experience of many patients who, during their 15 minute clinic visit, watch their doctor stare at the computer screen…This is perhaps the most disturbing effect of the technology, to divert attention from the patient.” (ibid.)

      • Only about “4% of physicians reported having an extensive, fully functional electronic medical records system…”

      DesRoches, Dr.P.H., Catherine M., et al. “Electronic Health Records in Ambulatory Care—A National Survey of Physicians.” New England Journal of Medicine. June 18, 2008; 359: 50.

      The Medical Group Managers Association:

      • “The high initial purchase amount and reduced productivity, combined with a lack of reliable financial cost/benefit studies of EHR implementation, makes it difficult to establish a business case for EHR adoption.” Gans, David N. “Off to a slow start.” MGMA Connexion, 42. Oct. 2005

      • Practices currently using an EMR have experienced a drop in physician productivity of up to 15%, usually lasting more than a year. Gans, David N. “Off to a slow start.” MGMA Connexion, 42. Oct. 2005

      The Congressional Budget Office, commissioned by the Chairman of the Senate Budget Committee

      • “…the adoption of more health IT is generally not sufficient to produce significant cost savings.” Congressional Budget Office of the Congress of the United States. 2008, May. Evidence on the Costs and Benefits of Health Information Technology [A CBO Paper],

      • “Office-based physicians in particular may see no benefit if they purchase [EMR]–and may even suffer financial harm.” Congressional Budget Office of the Congress of the United States. 2008, May.

      Evidence on the Costs and Benefits of Health Information Technology [A CBO Paper], Harvard Medical School, Stanford University, and Harvard University

      • The Chief Operating Officer at Harvard Medical School has determined that while EHRs are good for insurers and health care payers, the physician bears the financial burden of those systems.

      “Business Case Needed to Argue for EHR Adoption, Experts Say.”

      http://www.ihealthbeat.org/articles/2008/7/14/Business-Case-Needed-To-Argue-for-EHR-Adoption-Experts-Say.aspx?topicID=54. 14 July 2008.

      • After surveying 1.8 billion physician visits, researchers recently stated, “Our findings were a bit of a surprise. We did expect practices with electronic medical records would have better quality of care…” What they found was that there was no benefit to quality of care at all.

      Steenhuysen, Julie. “Electronic health records don’t lift care: study.” Reuters. July 9, 2007

      Blue Cross and Blue Shield, American Medical News

      • “For physicians I think it is more complicated, and [EMRs] are more expensive. The return on investment doesn’t materialize for practices like it does for hospitals.”

      Dolan, Pamela Lewis. “Insurer finds EMRs won’t pay off for its doctors.” American Medical News. March 10, 2008

      Shahid N. Shah
      http://www.HealthCareGuy.com
      http://www.ShahidShah.com

      Comment by Shahid Shah — February 13, 2010 @ 2:56 am

    7. About the eHealth Initiative

      The eHealth Initiative and the Foundation for eHealth Initiative are independent, non-profit affiliated organizations, whose shared mission is to improve the quality, safety, and efficiency of healthcare information technology [HIT].

      More: http://www.ehealthinitiative.org/

      Donna

      Comment by Donna — February 14, 2010 @ 3:12 am

    8. Doctors Using Mobile Applications at the Point of Care

      http://www.healthcareitnews.com/news/docs-using-mobile-apps-point-care.

      Ann Miller; RN, MHA

      Comment by Ann — February 19, 2010 @ 3:54 pm

    9. Why Most Physicians Should Not Buy a HITECT Act Certified Electronic Health Record (c-EHR)

      http://msofficeemrproject.com/MDNG92009.htm

      Al Borges; MD

      Comment by Dr. Borges — February 19, 2010 @ 9:41 pm

    10. Many More eMR Project Updates for 2010

      http://msofficeemrproject.com/Page7.htm

      Alberto A. Borges; MD

      Comment by Alberto — February 19, 2010 @ 9:46 pm

    11. Just an abbreviated list of some eMR vendors:

      7 Medical 7M PRM on demand
      AbelSoft Corp. AbelMed
      AcerMed AcerMed EMR
      Acrendo Software A.I.med
      Active MD Note Logix
      Addison Health System WritePad
      Advanced Data Systems Medics Elite
      Advanced MD Advanced EMR
      Aimset Corp. AimsetEMR
      Allmeds Inc. Allmeds EMR
      Allscripts Healthmatics/Touchworks
      Alpha It Universal e-Health MD
      AltaPoint AltaPoint EMR
      Alteer Alteer
      Altex Solutions Charting Plus
      AltosSolutions Onco EMR
      Amazing Charts Amazingcharts
      American Medical Records ImagingEMR
      American Medical Software AMS
      Amicore Amicore Clinical Management
      Amkai AmkaiCharts
      AMZ Access CureAccess EMR
      Anthesys. Inc. TranzEMR
      Assist Med MediPort
      AthenaHealth athenaClinicals
      Axolotl Elysium
      BizMatics PrognoCIS
      Blueware Wellness Connection HER
      BMD Services ePaperless Practice
      Bond Clinician Bond Clinician
      Catalis Accelorater
      Central X HiDocter
      Cerner Intuition EMR
      Chart Connect Chart ConnectEMR
      ChartCare CMRxp
      ChartLogic ChartLogic
      ChartOne eWebView
      Chartware Chartware
      Clinical NetworRx Clinical Master
      CliniComp Intl. Essentris
      ComChart ComChart
      Community HER xeniamed
      Companion Technologies Companion EMR
      Compulink MD Advantage
      Conceptual Mindworks Inc. Sevocity
      CorEMR CorEMR
      Crowell Systems Medformix
      CureMD Corporation CureMD EHR
      CyberRecords MediChart Express
      Dairyland Healthcare Solutions EMR
      digiChart digiChart OB-GYN
      DocPad DocPad
      Doctors Partners doctors partners
      DocuTap DocuTap
      Dyna Health LLC Dyna Health
      E Medical Solutions, inc. EMR2
      E-MDs E-MDs Chart/Billing
      eCast Corporation eCast
      EClinicalWorks EClinicalWorks
      Eclipsys Sunrise Clinical Manager
      edgeMED Innovation
      eHealthSolutions Sigma Point
      Electronic Healthcare Systems (EHS) CareRevolution
      Electronic Pediatrician Practical Medical Record
      EMedical, Inc. EZ Medical Office
      EmergiSoft EmergiSoftED
      EMR 4 DOCTORS EMR 4 CHARTS
      Encite Inc. Encite
      EncounterNOTES Inc. EncounterNOTES
      Epic Epic Care Ambulatory
      ePowerDoc, Inc. ePowerDoc
      Ergo Partners EMRitus
      Ethidium Health Systems Evolution EMR
      Experior Corporation Experior
      GEMMS GEMMS One
      General Electric Centricity/Logician
      GeniusDoc Genius Doc
      gMed gCare
      Greeway Medical Technologies PrimeSuite
      Gscribe Gscribe
      HBOC / McKesson Pathways
      Health Highway Health Highway
      Health Vision Health Vision
      Healthcare Data Inc. Health Probe
      HealthLink Technologies CareWare
      Healthtec Software Foxmed
      Helixys ZipChart
      Hemidata Hemidata EMR
      Henry Schein Medical Systems MicroMd
      Iatroware IatroChart
      ICP MedicallySpeaking
      IDX Groupcast
      iKnowmed iKnowmed
      iMed Software Corp iMed
      iMedica iMedica PRM
      iMedx iMed
      IMPAC Medical Systems Inc. iMedx EMR
      InforMed Praxis
      Infosys Medsys
      InSite Systems MD InSite
      Integrated Healthware Entity Practice Management
      Integrated Systems Management Inc. OmniMD
      InteGreat, Inc. IC-Chart
      Integritas STIX EMR
      iSalus Office EMR
      iSprit CareTrak
      JMJ Tech. Encounter Pro
      Jonoke Software Development Inc. Medifile
      jRW Inc. ePatientChart
      Kietra Corp XPR
      Life Record Life Record EMR
      Login clinic Login EMR
      LSS Data Systems EAR
      MacPractoce MacPractice MD
      MDBase MDOffice
      MDSync MDSync EMR
      MDTablet MDTablet
      MedAffinity Corp. Medinotes
      Medamation, Inc. Medamation MD
      MedAppz MedAppz iSuite
      Medaptus Notes In Hand
      Medcere Medcere EMR
      MedcomSoft MedcomSoft Record
      Medent All-inOne
      Medepresence Medepresence
      Medical club Inc. Medical Club EMR
      Medical Office Online Medical Office Online
      MedicalNotes Medicalnote
      Medicat Medicat
      Medico System Digital clinic
      MedicWare MedicWare EMR
      Medinformatix Inc. Medinformatix
      Medinotes IMS
      Meditab Meditab
      MedLink International, Inc. MedLink HER
      Mednet System Mednet
      Mednet System emr4MD
      Medsphere VistA
      Medstar EMR Works
      Medsys Technologies Mars
      Medtec Harmony
      Medtuity Medtuity
      MercuryMD Mdata
      meridianEMR, Inc meridianEMR
      Microfour Practice Studio
      Most, LLC (iSalus Healthcare) OfficeEMR
      Mountain Medical Technologies Inc. CYRAMED
      MRO Corp Chart Online
      NCG medical d-Chart
      Next Gen Next Gen
      Nightingale My Nightingale
      Nopali Nopali EMR
      Noteworthy Medical Systems Noteworthy HER
      Nuesoft NueMD
      OCERIS Inc. FlexMedical 4
      OpenEmr OpenEmr
      PatientKeeper Inc. PatientKeeper
      PatientNow PatientNow
      Per-Se Technologies Med-Axxis
      Physician Micro Systems Inc. (Practice Partner) Practice Partner
      Phyz Biz Phyz EMR
      PluralSoft Clinicio
      Powermed Powermed
      Practice Velocity PiVot Chart
      PracticeHwy eIVF
      Practice Today Ptoday EMR
      Prime Clinical Systems OnStaff
      ProPractica Inc. StreamlineMD
      Pulse Systems PulsePro
      Purkinje Purkinje
      Quincy Systems MediTalk
      Reliance Software Systems Enterprise EMR
      RemedyMD BariEMR
      Roshtov Software Ind Clicks
      Sage Software Intergy
      Sajix Helix
      Sapphire SapphireEMR
      Scriptnetics Medscribbler
      Sequel Systems SequelMed
      SmartEMR SmartEMR
      SOAPware SOAPWare
      SoftAid Medical The Medical Office
      Solventus Aquifer.EMR
      SourceForge FreeMed
      Spring Medical Systems Spring Charts
      SRS Software SRS
      SSI Med Corp. SSIMed EMRge
      STAT! Systems Q.D. clinical EMR
      Steadfast Data Systems Inc. echarts4docs
      STI Chart Maker
      Symmetry GMS/2
      Synamed Synamed
      Synapse Direct Synapse EMR
      Systemedx, Inc. Clinical Navigator
      T System T System EV
      TetriDyn Solutions AeroMD
      Theramanager Theramanager
      Turbo Doc Turbo Doc EMR
      Ulrich TeamChartConcepts
      Unifi Technologies UnifiMedsm
      Utech EndoSoft
      Uversa Inc. ClearHealth
      VantageMed Ridgemark
      Vericle Vericle EMR
      VersaForm VersaForm
      Visionary Medical Systems Visionary Dream EMR
      WEBeDoctor WEBeDoctor EMR
      Wellogic Wellogic
      WifiMed Tablet MD
      Workflow Workflow EHR

      Charlie

      Comment by Charlie — February 23, 2010 @ 12:41 am

    12. HIT Thought-Leaders

      In addition to the author of this chapter, here is a list of HIT noteables:

      Stanley Crane, CiO – AllScripts
      Dr. Patrick Soon-Shiong, Chairman – Abraxis Health
      George Lazenby, CEO – Emdeon
      Dr. John Halamka, CIO – Harvard Medical School
      Roy Schoenberg, CEO – AmericanWell
      Chaim Indig, CEO – Phreesia
      Jim Lacy, CFO and general counSel – ZirMed
      Antoine Agassi, CIO – Cogent Healthcare
      Jonathan Korngold, MD – General Atlantic
      Ryan Champlin, VP – Cook Children’s
      Susan Newbold, PhD – Professor, Vanderbilt University
      Jack Beaudoin, COO, VP CONTENT – HealthcareITNews
      Michael Hollis, VP – emids
      Shelby Solomon, EVP – Ingenix
      Tee Green, CEO – Greenway Medical
      Jana Skewes, CEO – SharedHealth
      Mike Labedz, CEO – HealthPort
      Mark Leavitt, CEO – CCHIT
      Steven Lieber, CEO – HIMSS
      Gary Seay, CiO – CHS
      Neil Hunn, CFO – MedAssets
      Mr. HISTalk, CEO – Mr.HISTalk
      Dr. Jonathan Perlin, CMO – HCA
      Richard Close, MD – Jefferies & Co.

      Hope Hetico; RN, MHA
      [Managing Editor]

      Comment by Hope — February 24, 2010 @ 12:10 pm

    13. Did you know that Federal stimulus money from President Obama doesn’t apply to electronic dental records?

      D. Kellus Pruitt; DDS

      Comment by Dr. Pruitt — February 27, 2010 @ 12:48 am

    14. Meaningful Use Will Slow Docs Down – According to MGMA Survey

      Meeting the 25 meaningful-use criteria required to receive the financial incentives contained in the federal stimulus law will result in reduced physician productivity, according to 67.9% of those who responded to a Medical Group Management Association [MGMA] member survey released March 4th. 2010

      With one being “very easy” and five being “very difficult,” the survey also asked on a one-to-five scale how easy or difficult certain proposed requirements would be to fulfill. According to the 353 respondents (out of 445) who answered the question, the most difficult requirement would be using a certified electronic health record to provide at least 10% of all patients with electronic access to their health information within 96 hours of the information being available. That requirement received a 3.72 difficulty rating with only 14 respondents saying meeting the requirement would be very easy, 90 saying it would be difficult and 99 saying it would be very difficult.

      Source: Andis Robeznieks, Health IT Strategist [3/5/10]

      Comment by Linda — March 8, 2010 @ 4:51 am

    15. What is the best eMR for your medical practice?

      As usual, the answer is, “it depends.” Choosing the right Electronic Health Record (EHR) system for your practice involves answering many questions. Here are a few:

      http://www.physiciansnews.com/2010/03/08/what%E2%80%99s-the-best-ehr-technology-for-your-practice/

      Graham

      Comment by Graham — March 8, 2010 @ 7:49 pm

    16. ONC unveils plan for health IT certification

      In a surprise announcement, here in Atlanta, at the recent Health Information and Management Systems Society [HIMSS] conference, national coordinator of health IT Dr. David Blumenthal and his staff unveiled the administration’s proposal for how electronic health record systems will be certified under the health IT incentive plan.

      http://www.govhealthit.com/newsitem.aspx?nid=73239

      Charles

      Comment by Charles — March 9, 2010 @ 1:08 pm

    17. For a buyer’s guide to eMR software systems:

      http://www.softwareadvice.com/medical/electronic-medical-record-software-comparison/

      Chris

      Comment by Chris — March 12, 2010 @ 9:51 pm

    18. Q: What is clinical groupware?

      A: According to Brian Klepper PhD, “clinical groupware” is a term that is rapidly gaining traction and that describes a new wave of inexpensive, ergonomic, useful Web-based care management tools. David Kibbe MD coined the phrase and articulated clinical groupware’s conceptual framework about a year ago in the blog-o-sphere

      He noted that:

      “… it captures the basic notion that the primary purpose for using these IT systems is to improve clinical care through communications and coordination involving a team of people, the patient included. And in a manner that fosters accountability in terms of quality and cost.”

      I trust this helps … more in the book.

      Robert

      Comment by Robert — March 15, 2010 @ 11:24 pm

    19. Costs and Health Technology

      Tom Goetz is another HIT guru who opines that in nearly every sector of the economy, technology drives costs down. Just as your digital camera gets cheaper and better every year, so technology drives down the cost of manufacturing, the cost of retailing, the cost of research. But, for some reason, in healthcare, technology has the opposite effect; it doesn’t cut costs, it raises them.

      In fact, medical technologies – from MRI, PET and CT scans – to stents to biologics – are a significant factor in the 10% annual growth rate of healthcare spending, a rate that’s nearly triple the pace of inflation. And, overall, the US is now estimated to spend a stunning $2.7 trillion on healthcare in 2010.

      I wonder why?

      Bill

      Comment by Bill — March 18, 2010 @ 9:25 pm

    20. m-Health

      Here is an interesting essay by John Moore about how Apple is targeting the mobile healthcare enterprise.

      http://www.thehealthcareblog.com/the_health_care_blog/2010/03/apple-targets-healthcare-enterprise.html#comments

      Stuart

      Comment by Stu — March 24, 2010 @ 12:06 am

    21. Here is a good post on eMRs and Microsoft:

      http://www.thehealthcareblog.com/the_health_care_blog/2010/04/microsoft-emr-its-not-just-a-matter-of-when-its-a-matter-of-who.html#comments

      Jane
      [Office Manager]

      Comment by Jane — April 17, 2010 @ 12:18 pm

    22. HOW eMR VENDORS MAY MISLEAD YOU

      As the physician executive of your medical practice, it’s your job to challenge any eMR vendors’ assertions about why you need an eMR, especially during the selection and production demonstration phase.

      The most important reason for the digitization of medical records is to make patient information available when the physician needs that information to either care for the patient or supply information to another caregiver. Electronic medical records are not about the technology but about whether or not information is more readily available at the point of need.

      In no particular order, the major reasons given for the business case of EMRs by vendors include:

      • Increase in staff productivity
      • Increase of practice revenue and profit
      • Reduce costs outright or control cost increases
      • Improve clinical decision making
      • Enhance documentation
      • Improve patient care
      • Reduce medical errors

      So, beware!
      Shahid N. Shah, MS

      http://shahid.shah.org/

      Comment by Shahid Shah — April 25, 2010 @ 8:11 pm

    23. More On eMR Adoption

      Here is an essay on the challenges of eMR adoption by doctor’s offices; written by Robert Rowley, MD.

      http://www.thehealthcareblog.com/the_health_care_blog/2010/04/challenges-in-emr-adoption-by-doctors-offices.html#comments

      Jeff

      Comment by Jeff — April 26, 2010 @ 5:44 pm

    24. The Final MU Rules?

      The government released new rules on July 13th 2010 that further define “meaningful use” of electronic medical records for physicians and hospitals.

      As our readers know, earlier this year, the Health Information Technology for Economic and Clinical Health Act (HITECH) authorized incentive payments to physicians for the use of EHRs including $44,000 through Medicare and $63,750 through Medicaid.

      But, achieving meaningful use was confusing to stakeholders until now, according to this NEJM publication by David Blumenthal MD, MPP and Marilyn Tavenner RN, MHA.

      http://healthcarereform.nejm.org/?p=3732&query=OF

      What do our readers think? Is the debate finally over?

      Dr. David Edward Marcinko; MBA
      [Editor-in-Chief]

      Comment by Dr. Marcinko — July 14, 2010 @ 9:23 pm

    25. eMR Costs

      It is a widely accepted assumption in the healthcare and information technology industries that electronic medical records in hospitals help reduce costs and enhance the quality of patient care.

      http://www.thefiscaltimes.com/Issues/Health-Care/2010/08/12/Electronic-Medical-Records-Higher-Costs-Cited-by-Study.aspx

      But, this new research on the subject contradicts that conventional IT wisdom. And, that has surprised and disappointed many in the healthcare and IT fields, including the researchers themselves.

      Richard

      Comment by Richard — August 13, 2010 @ 2:41 pm

    26. More on Meaningful Use

      For ambulatory care practices and physicians there are about 25 objectives and measures that must be met to become a “meaningful user”. Keep in mind that meaningful use is not tied to a certified EHR alone; in fact, unless you use the EHR properly and in all the ways the government wants you to, you will not be a “meaningful user”.

      Don’t be fooled by EHR vendors guaranteeing that they will make you a “meaningful user” – no vendor’s software, no matter how nice, can get your staff to use the software in the way the government wants. You, as the CIO of your practice, are the only one that can guarantee that. In fact, you don’t even need an EHR from a vendor to meet the requirements – you can even roll your own, use open source, or find any other means.

      In general, as long as you can attest and send data to the government that they require you can do it in any way that you want. Be aware that some unscrupulous vendors are scaring practices and making promises that they cannot keep.

      The final Meaningful Use (MU) Rule was published by HHS on July 13th, 2010. It defines 24 objectives for and measures eligible hospitals that could be met to become a meaningful user and qualify for incentive funding. There is a “core set” that must be met by all institutions and a “menu set” of from which organizations must implement at least 5 objectives.

      Core Set Objectives

      These are the “core set” of 14 objectives that must be met by all institutions and a “menu set” of 10 from which organizations must implement at least 5 objectives (at least 1 public health objective must be chosen from that set).

      1. Use Computer Provider Order Entry (CPOE).
      2. Implement drug-drug, drug-allergy, and drug-formulary checks.
      3. Record demographics.
      4. Implement one clinical decision support rule.
      5. Maintain a problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT.
      6. Maintain active medication list.
      7. Maintain active medication allergy list.
      8. Record and chart changes in vital signs.
      9. Record smoking status for patients 13 years or older.
      10. Report hospital clinical quality measures to CMS or States.
      11. Provide patients with an electronic copy of their health information, upon request.
      12. Provide patients with an e-copy of their discharge instructions at time of discharge, upon request.
      13. Capability to exchange key clinical e-information among providers and patient-authorized entities.
      14. Protect electronic health information.

      Menu Set Objectives

      These are the “menu set” of 10 objectives from which organizations must implement at least 5. At least one public health objective must be chosen from this set as well (numbers 8, 9, or 10).

      1. Drug-formulary checks.
      2. Record advanced directives for patients 65 years or older.
      3. Incorporate clinical lab test results as structured data.
      4. Generate lists of patients by specific conditions.
      5. Use certified eHR technology to identify patient-specific education resources and provide to patient, if appropriate.
      6. Medication reconciliation.
      7. Summary of care record for each transition of care/referrals.
      8. Capability to submit electronic data to immunization registries/systems.
      9. Capability to provide electronic submission of reportable lab results to public health agencies.
      10. Capability to provide electronic syndromic surveillance data to public health agencies.

      The Office of the National Coordinator for Healthcare IT (ONCHIT) is a component of the Department of Health and Human Services (HHS). ONCHIT, usually abbreviated just ONC, is the principal policy group of the Federal Government that defines and manages NHIN.

      • ONC is responsible for coordinating with the Department of Commerce’s National Institute of Standards and Technology (NIST) the specifications for NHIN standards.
      • The HIT Policy and HIT Standards Committees are the working groups that advise ONC on what to put in the standards.
      • NIST is responsible for coming up with the test materials (assertions, procedures, methods, tools, data, and so on) that will be used to certify working systems.

      Shahid N. Shah

      http://shahid.shah.org/

      Comment by Shahid N. Shah — August 29, 2010 @ 3:08 pm

    27. More on the Final meaningful use rule announced July 13, 2010

      As noted above, Federal officials released the final rule on meaningful use on Tuesday, July 13th, which allows physicians and hospitals to qualify for thousands of dollars in stimulus funding incentives for the adoption of electronic health records.

      http://www.healthcareitnews.com/news/flexibility-built-final-rule-meaningful-use

      Craig

      Comment by Editors — September 4, 2010 @ 3:00 pm

    28. MU Revisions [Oh No!]

      The Centers for Medicare and Medicaid Services [CMS] plans to correct a few inconsistencies in the meaningful use final rule it published in July and that I noted above. It will post on its Web site more detailed guidance for providers on how to meet quality measures required by the health IT incentive program.

      The minor revisions will include more detailed descriptions of each of the meaningful use objectives and measures. The panel met to propose preliminary requirements for the second stage of meaningful use in 2013, such as raising the level of performance required for computerized physician orders, electronic prescribing and other measures that were begun in the first stage.

      So, be informed.

      http://www.govhealthit.com/newsitem.aspx?nid=74711

      Craig

      Comment by Craig — September 27, 2010 @ 5:09 pm

      • HAPPY BIRTHDAY DR.PULLEN.COM! and congratulations on your first’ year of povdiring your many followers of reliable and relevant medical and non-medical topics! This is a great blog and I enjoy it a lot!

        Comment by Hakan — November 26, 2012 @ 11:44 pm

    29. Seeking Your Favorite Health 2.0 Patient Story

      Please send in your favorite story [serious, humorous, poignant, personal, etc] or anecdote on participatory medicine and electronic patient connectivity. If selected, it may be posted on the ME-P or used in our new book in a blinded or named fashion; or on an individual or aggregated basis.

      ME-P Support

      Editorial support is available, as your input would not only assist your colleagues, but be illustrative in an erudite and credible fashion. Your synergy in this space also seems ideal. Length is up to you in a prose writing style. And, be sure to address health 2.0 modernity.

      Definition: http://healthcarefinancials.wordpress.com/2008/09/12/emerging-healthcare-20-initiatives
      Please contact me for more details, if interested. Regardless, we remain apostles promoting your core vision whenever possible.

      Ann Miller: MarcinkoAdvisors@msn.com
      http://www.BusinessofMedicalPractice.com

      Comment by Ann Miller RN MHA — October 3, 2010 @ 2:08 pm

    30. Hi Dr. Marcinko,

      I just wanted to send over a quick update about our poll on RECs. I tallied up the results today and published a summary on my blog at:

      http://www.softwareadvice.com/articles/medical/five-reasons-we-think-recs-are-reckless-1092310/.

      We received a total of 87 responses in our poll asking “Will Regional Extension Centers Deliver on their Mission?” 62 respondents answered no and another 25 answered yes.

      While not a huge turn out, we did receive a lot of great comments. I listed all 52 comments in a Google Doc that you can access from my blog post.

      Check out the summary post if you get a chance, and feel free to use any of our findings on this blog.

      Thanks,
      Houston
      ____________________________
      Houston Neal
      EHR Market Analyst
      Software Advice

      (512) 364-0117 (office)
      (800) 918-2764 (toll free)
      houston@softwareadvice.com

      Comment by Houston Neal — October 15, 2010 @ 10:33 pm

    31. About the 5010 Standards

      Shahid – I just received my book; excellent chapter. And, in addition, medical practices face two significant deadlines that require planning and testing in 2011.

      The first deadline of January 1, 2012, is for the adoption of a new standard — the 5010 standard —for electronic claims transactions.

      The second deadline is the long-awaited (or long-dreaded) deadline for moving from the ICD-9 to the ICD-10 code set. This deadline is slated for October 1, 2013

      http://www.physicianspractice.com/pearls/content/article/1462168/1720195?GUID=E5D1C438-A423-4146-A0D3-9E314F5871B2&rememberme=1

      http://www.physicianspractice.com/tools/content/article/1462168/1720165?GUID=E5D1C438-A423-4146-A0D3-9E314F5871B2&rememberme=1

      Hope R. Hetico RN MHA

      Comment by Hope — December 18, 2010 @ 12:53 pm

    32. Top eMRs for 2010

      Medscape reports that electronic health record (EHR) systems for medical practices from Greenway Medical Technologies, Epic Systems, and eClinicalWorks continue to be customer favorites, according to an annual ranking of such software, recently released by the research firm KLAS.

      http://www.medscape.com/viewarticle/734392


      Ann Miller RN MHA

      Comment by Ann Miller RN MHA — December 18, 2010 @ 2:15 pm

    33. On Paper Medical Records

      Some doctors believe that the idiosyncrasies of hand-written or paper notes do more to convince a courtroom [jury and patient] of their level of involvement than a computerized, cookie cutter, mind-numbingly cloned note or a prompt driven fill-in-the-blank template. Me too!

      http://www.jblearning.com/catalog/9780763733421/
      http://www.jblearning.com/catalog/9780763745790/

      Why? It is easier to conclude that the doctor was really there; involved, listening and thinking; etc.

      IOW: Caring

      Dr. David Edward Marcinko MBA CMP™
      http://www.CertifiedMedicalPlanner.com
      [Publisher-in-Chief]

      Comment by Dr. David Edward Marcinko MBA CMP™ — January 25, 2011 @ 10:38 pm

    34. Current Approaches to Patient Self Management – Do They Improve Quality or Lower Costs? [A Video Debate]

      Moderator: Cynthia Bouthot: MA, President, Collaborative Innovation Group.

      Dis-Agree: Shahid Shah MS: CEO Netspective; blogger http://www.HealthCareITGuy.com, and HIT “Thought-Leader” for the ME-P.

      Agree: Joseph Kvedar MD: Director, PartnersCenter for Connected Health.

      Get Ready to Rumble!

      http://healthcare.partners.org/streaming/CCH/symposium2011/Plaza/PlazaThursday01.html

      Assessment
      Mr. Shah is the author of Ch 13 [Interoperable eMRs for the Small to Medium-Sized Medical Office] in the book: Business of Medical Practice [3rd edition], edited by Dr. David Edward Marcinko MBA CMP™ http://www.BusinessofMedicalPractice.com

      Prof. Hope R. Hetico RN MHA CMP™
      [Co-Editor]

      Comment by Hope R. Hetico RN MHA — December 14, 2011 @ 4:12 pm

    35. Early EMR Adopters Get a Break – Tougher Criteria Delayed to 2014

      Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will have more time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses.

      The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. Doctors and hospitals who currently meet stage 1 meaningful use criteria would be able to vie for bonuses for an extra year under the same requirements, HHS Secretary Kathleen Sebelius announced on Nov. 30. These bonus recipients would not need to upgrade their EMR systems to comply with stage 2 standards until 2014, instead of 2013 under the initial plan.

      Source: Charles Fiegl, AM News (12/12/11]

      Comment by Andy — December 26, 2011 @ 1:27 pm


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