Company hires Corrections official after winning government contract

Company hires Corrections official after winning multimillion-dollar contract
by Rhonda Cook (Available online here)

Synopsis: In Oct. 2008, the Georgia state Department of Corrections had issued a request for proposal for an EHR system. Nine companies responded. The award was given to BCA whose bid was $8.77 for each of the first 50,000 electronic records. A proposal was issued as a statewide contract to also make it available to Georgia universities, state agencies and local governments.

The total cost of the contract is not yet known, DOAS' Douglas said, because the number of records is uncertain. The first year of the contract, BCA said it would charge Corrections $8.77 for each of the first 50,000 records plus other fees. The per-record price drops as the number of files increases with the additions of more agencies.

The company that finished second, eClinicalWorks, submitted a bid of $3.50 for each of the first 50,000 records plus other fees. So in reality, eClinicalWorks who bid $3.50 for each of the first 50,000 had the top spot!


So why would a company who's bid was more than double that of the second place contender win the RFP?

Business Computer Applications was pushed into the No. 1 spot by the subjective technical scores provided by Alan Adams of the Department of Corrections and six other evaluators.

Cook explains, Adams, a retired part-time corrections official was asked to submit his resume to BCA by a BCA employee. Adams never disclosed this information to the department. The Inspector General wrote "One could infer that by requesting his resume, BCA intended to influence Adams during the course of this solicitation process. Thus, we find the communication improper."

Adams was offered a job and he accepted it less than a month after BCA's winning bid was announced, according to records obtained by the AJC. But Adams told the AJC  that he and BCA agreed to put the job offer "on hold" when the IG's review began on July 9.
Adams said it is unlikely he will ever work for BCA. He started another job on Dec. 1.

Long story short, the award will still stand.

I'm curious, what were the subjective technical scores and how were they subjectively calculated? Did each of the evaluators have their own metrics or did they all collaborate on how to calculate the technical scores? Okay, i'm not that curious... ah the drama of HIT.

"Why is Hawaiian care so efficient? No one really knows. "

Intriguing article by Gardiner Harris, "In Hawaii’s Health System, Lessons for Lawmakers", New York Times, (October 16, 2009) (available online here) What do you think? Remember this: Hawaii's top three medical providers are adopting electronic medical records — years ahead of most mainland counterparts.

But perhaps the most intriguing lesson from Hawaii has to do with costs. This is a state where regular milk sells for $8 a gallon, gasoline costs $3.60 a gallon and the median price of a home in 2008 was $624,000 — the second-highest in the nation. Despite this, Hawaii’s health insurance premiums are nearly tied with North Dakota for the lowest in the country, and Medicare costs per beneficiary are the nation’s lowest.

Hawaii residents live longer than people in the rest of the country, recent surveys have shown, and the state’s health care system may be one reason. In one example, Hawaii has the nation’s highest incidence of breast cancer but the lowest death rate from the disease. Why is Hawaiian care so efficient? No one really knows.

Would a nationwide EMR help reduce fatal drug overdoses?

Liz Szabo wrote an interesting article for USA today (scroll down for the link). The focus of her article is how prescription drugs have now become the biggest cause of fatal drug overdoses. The article explains that a patient could travel between states to obtain duplicate prescriptions. A solution for this problem could be a nationwide effort to communicate prescriptions, in other words an interoperable electronic medical records system. Here's an excerpt:

Debra Jones didn't begin taking painkillers to get high. Jones, 50, was trying to relieve chronic pain caused by rheumatoid arthritis.

Yet after taking the painkiller Percocet safely for 10 years, the stay-at-home mother of three became addicted after a friend suggested that crushing her pills could bring faster relief. It worked. The rush of medication also gave her more energy. Over time, she began to rely on that energy boost to get through the day. She began taking six or seven pills a day instead of the three to four a day as prescribed...

"The biggest and fastest-growing part of America's drug problem is prescription drug abuse," says Robert DuPont, a former White House drug czar and a former director of the National Institute on Drug Abuse. "The statistics are unmistakable." About 120,000 Americans a year go to the emergency room after overdosing on opioid painkillers, says Laxmaiah Manchikanti, chief executive officer and board chairman for the American Society of Interventional Pain Physicians...

Many doctors say that preventing abuse requires a national effort. Although 39 states have electronic databases to track narcotics prescriptions, none share that information fully with other states, Manchikanti says. So patients who get narcotics in one state may be able to cross the state line to get more.

A nationwide system of electronic medical records also would help, Zvara says, because doctors in different hospitals and clinics would easily be able to measure how many narcotics doses a patient has had.

 Source:  Liz Szabo, Prescriptions are now the biggest cause of fatal drug overdoses, USAToday, Section: Money, p. 8b (October 1, 2009) (available here)

EMR gets big push from NY hospitals

I read a great article by Mr. Steven Lohr regarding a big hospital network taking on EMR. Here's an excerpt, but read the full article here (its good!)

...an effort to be announced on Monday by a big New York regional hospital group may be the most ambitious effort of this type yet --  a sizable investment intended as a linchpin in the group's $400 million commitment to digitize patient records throughout its system, including 13 hospitals.

North Shore-Long Island Jewish Health System plans to offer its 7,000 affiliated doctors subsidies of up to $40,000 each over five years to adopt digital patient records. That would be in addition to federal support for computerizing patient records, which can total $44,000 per doctor over five years.

...Big hospitals operators like North Shore, analysts say, want to use electronic health records that share data among doctors' offices, labs and hospitals to coordinate patient care, reduce unnecessary tests and cut down on medical mistakes....The program will deploy tablet personal computers by Dell, and software by Allscripts, which can be retrieved by a doctor from devices including PCs, BlackBerrys and iPhones.

The North Shore move will be closely watched. ''This is big enough and bold enough that hospital groups across the country will take notice and rethink their own plans,'' said Glen E. Tullman, chief executive of Allscripts.

Still, to move so forcefully, analysts note, also carries risk for North Shore, if the expected payoff for physicians and the hospital group proves elusive. Mr. Dowling acknowledged that risk, but he added:  ''This was not done on  a pure dollars-and-cents, return-on-investment perspective. But better health care and better quality should be a good investment.'

Sen. Baucus Introduces Landmark Health Care Plan

Here it is hot off the press... release... website...

After more than a year of preparation, and holding more than 40 health care events in the state, Montana's senior U.S. Senator Max Baucus today introduced the America's Healthy Future Act, his landmark health care reform legislation that will lower costs and provide quality, affordable health care coverage for all Montanans and all Americans.

Baucus, chairman of the powerful U.S. Senate Finance Committee, released his plan- known as a 'Chairman's Mark'- this morning during a nationally televised news conference.

Baucus' plan will make it easier for families and small businesses to buy health care coverage while ensuring Montanans can choose to keep their current health care coverage if they like it, and slowing the growth of health care costs over time. It will block insurance companies from denying coverage because of pre-existing conditions or imposing annual caps or lifetime limits on the amount of coverage they will provide. The bill would also improve the way the health care system delivers care by improving efficiency, quality and coordination.

In addition, The Congressional Budget Office estimates the Baucus plan would make an $856 billion investment in the health care system over ten years. That investment would not add to the federal deficit. Instead, the plan would be fully paid for through increased focus on quality, efficiency, prevention and adjustments in federal health program payments.

"I've been talking with Montanans for more than a year about health care reform, and this plan is a culmination of all our efforts. This plan is balanced, based on common sense, and is right for Montanans and Americans. This is our moment to finally make quality, affordable health care available to everyone," Baucus said. "Our health care system is simply unsustainable. It is breaking the bank for everyone from families to small businesses. My plan will turn that around. It will fix the way Montanans get the care they need. I'm so proud to introduce this plan today, I'm looking forward to the finish line. It's time to get this done."

Provisions in Baucus' America's Healthy Future Act
Provisions included in the legislation to ensure Montanans have quality, affordable, health care coverage would:
• Create health care affordability tax credits to help low and middle income families purchase insurance in the private market;
• Provide tax credits for small businesses to help them offer insurance to their employees; • Allow people who like the coverage they have today the choice to keep it;
• Reform the insurance market to end discrimination based on pre-existing conditions and health status;
• Eliminate yearly and lifetime limits on the amount of coverage plans provide;
• Create web-based insurance exchanges that would standardize health plan premiums and coverage information to make purchasing insurance easier;
• Give consumers the choice of non-profit, consumer owned and oriented plans (CO-OP); and
• Standardize Medicaid coverage for everyone under 133 percent of the federal poverty level.

Read the press release here

NYC Mayor and Health Commissioner Unveil 2012 Health Goals

Mayor Bloomberg and New York City Health Commissioner Thomas Farley today unveiled New York City's ambitious new health policy - Take Care New York 2012 - outlining the City's plan to improve the health of New Yorkers by targeting 10 leading causes of preventable sickness and death, including lung cancer, heart disease and HIV.

Read the press release here.

eClinicalWorks Announces P2P and Enhancements

eClinicalWorks^®, a market leader in ambulatory clinical systems, today announced eClinicalWorks P2P, a tool for improving healthcare collaboratively. eClinicalWorks P2P introduces interoperability for peer-to-peer communications not only to other eClinicalWorks users, but any provider/practice that the provider and practice interacts with for patient care.

Records are now shared electronically, so practices do not have to fax communications, including referrals and patient charts, to other providers. Practices will also be able to schedule appointments and communicate generic messages regarding patient care. P2P is an interoperable, scalable and secure way to communicate while enhancing patient care.

"Even once a practice is using an electronic medical records system, faxing is still common for communicating with other practices, which does not allow for continuity of care," said Girish Kumar Navani, CEO and co-founder of eClinicalWorks. "Our mission is to improve healthcare by providing technology and services to reduce costs, reduce errors and improve the quality of care. These goals can not be achieved without showing continuity of care. eClinicalWorks P2P, along with the enhancements to our additional solutions, allows our customers to improve healthcare collaboratively."

Enhancements to other eClinicalWorks solutions include:

•Enterprise Business Optimizer (eBO) 2.0 – eBO has been accelerated to include integration of the eClinicalWorks Registry with eBO reports, enhanced clinical metadata and reports, enhanced financial metadata data and reports, and added security integration with eClinicalWorks EMR/PM Reports exchange via eCWShare (http://ecwshare.eclinicalworks.com).•eClinicalWorks Electronic Health eXchange (eEHX) 3.0 – Some enhancements include split screen patient lookup, threshold settings for patient matching, patient reconciliation, community-wide measure reporting and population health alerts.•eClinicalMessenger 2.0 – eClinicalWorks is piloting 2.0 which includes a further refined back end infrastructure, new Web-based screens for easier navigation, additional administrative options, SMS text messaging and integration with eClinicalWorks Registry. •eClinicalMobile 2.0 – eClinicalWorks is piloting 2.0, which offers streamlined navigation on the iPhone, enhanced charge entry, lab ordering, enhanced administrative and favorite settings, creating appointments and faxing of progress notes.

Availability
eClinicalWorks P2P will be available in Q4 2009. It is included free as a module in eEHX 3.0 for community deployments. The solution is also available as a standalone product and will be offered free to clients until the end of 2010.

eClinicalWorks is a registered trademark of eClinicalWorks, LLC. All other trademarks or service marks contained herein are the property of their respective owners.

NYC's William F. Ryan Community Health Network Selects eClinicalWorks

eClinicalWorks just published a press release on their website.

eClinicalWorks^®, a market leader in ambulatory clinical systems, today announced that New York City’s William F. Ryan Community Health Network has chosen eClinicalWorks unified electronic medical records (EMR) and practice management (PM) solution along with eClinicalWorks Enterprise Business Optimizer’s (eBO) enhanced reporting capabilities for its more than 250 physicians and residents in 16 locations. These sites include three main health centers, schools, homeless shelters and mobile vans.

"Building on the belief that healthcare is a right and not a privilege, William F. Ryan searched for an electronic health records system that could help our practitioners improve care in the community," said Barbra E. Minch, president and CEO of William F. Ryan Community Health Network. "We selected eClinicalWorks because of the user-friendly nature of the product, its reporting capabilities, and its ability to coordinate care across not only multiple locations, but also various types of settings."

eClinicalWorks EMR/PM will allow William F. Ryan to streamline processes between locations and promote patient care. The community health network has also chosen to implement eBO, which uses meta-data to give the practice more flexibility through the creation of customized reports and by performing clinical and financial analysis.

 Full version available here

Healthy Dose of Digital

 I just read a NYTimes article that highlights how technology companies are pushing technology into the practice because there seems to be a bipartisan consensus that EMR is A-OK! Great article, here's a sample, scroll down for a link to the full version.

The goal of moving paper medical records into the digital age has been championed for years by health care policy makers across the political spectrum, from Hillary Rodham Clinton to Newt Gingrich. As a presidential candidate, Barack Obama, too, was an advocate, and the economic crisis opened the door for an ambitious step — $19 billion put into the recovery package to encourage doctors and hospitals to install and use electronic health records.

So even as the Obama administration and Congress struggle with broad health policy legislation, the technology industry is pursuing the opportunity in digital health records as never before. Although most of the government money will not start flowing until next year, the companies hoping to get their share include technology giants like General Electric, I.B.M. and the big telecommunications company, Verizon. Also in the hunt are smaller health technology specialists like Athenahealth, eClinicalWorks and Practice Fusion.

Source: Steve Lohr, Tech Companies Push to Digitize Patients’ Records, New York Times (September 10, 200) (available online here)

EMR Coming to NY Veterans Home

EMR is coming to a veterans home in NY. Read the article (link below in source).

The Long Island State Veterans Home will develop an electronic medical records system similar to those at U.S. Department of Veterans Affairs medical centers, using $1.13 million in federal and state grants. The grants will also allow the 350-bed nursing home on the campus of Stony Brook University to make technological improvements to the nurse training center and upgrades to resident communications systems.

Source: Martin C. Evans, Electronic records coming to state veterans home, Newsday (September 2, 2009) (available online here)

Event: eClinicalWorks 2009 User Conference

What: eClinicalWorks 2009 National Users’ Conference

Where: The Venetian, Las Vegas, NV


When: September 12 - 15, 2009

Description: eClinicalWorks is proud to announce the second annual National Users’ Conference to take place September 12-15, 2009 at the Venetian in Las Vegas. eClinicalWorks is celebrating 10 years as a company.

Register Here

eClinicalWorks Signs With Correctional Medical Services, Inc.

WESTBOROUGH, Mass.—Aug. 31, 2009—eClinicalWorks^®, a market leader in ambulatory clinical systems, today announced that the company has entered into an agreement with Correctional Medical Services, Inc. (CMS), a leading provider of health services for prisons and jails nationwide for over 30 years, to provide its electronic medical records (EMR) solution to correctional facilities affiliated with CMS.

CMS facilities using the eClinicalWorks EMR will be able to streamline processes and promote patient care. The system will also permit providers to utilize chronic and preventative care measures, including those that are unique to this setting such as suicide watch alerts and detox monitoring. eClinicalWorks will work with CMS to enhance its Electronic Medication Administration Record (EMAR) as well as intake process flows and a mental health module.

"eClinicalWorks has always strived to provide the most comprehensive EMR at an affordable price for every market segment," said Girish Kumar Navani, CEO and co-founder of eClinicalWorks. "Our commitment to customers and experience with Rikers Island makes us a logical solution for correctional facilities. We are pleased to be chosen by a national leader like CMS and look forward to working with them."

About Correctional Medical Services, Inc.
Correctional Medical Services, Inc (CMS) has been a nationwide leader for over 30 years in the provision of correctional healthcare services, offering a comprehensive suite of medical, dental, pharmacy and mental health services for the incarcerated population. CMS currently maintains a presence in 17 states and manages medical services for 10 statewide systems. More than 6,000 employees and independent contractors work with CMS nationwide. For more information, visit the CMS Web site at www.cmsstl.com.

About eClinicalWorks
eClinicalWorks^® is a privately held leader in the ambulatory clinical systems market. The company’s unified electronic medical record (EMR) and practice management (PM) solutions are proven for every market segment: large practice groups, including Massachusetts eHealth Collaborative (MAeHC), Electronic Health Records of Rhode Island (EHRRI) and the New York City Department of Health and Mental Hygiene, as well as medium, small and solo practices regardless of specialty. The company enjoys high profitability with a five-year compounded growth rate of more than 100 percent year-to-year. With an established customer base of more than 25,000 providers across all 50 states, eClinicalWorks has been awarded multiple top industry honors including being named to the Inc. 500 in 2008 and 2007, and a top solution by TEPR for four consecutive years. Based in Westborough, Mass., eClinicalWorks has additional offices in New York City and Alpharetta, Ga. More information on eClinicalWorks can be found at www.eclinicalworks.com or by calling 866-888-MYCW.

Nurse continuing education class to focus on electronic health records

Cloud County Community College issued the following news release:

More than ever, the healthcare industry is making significant progress in the quest for electronic health records (EHRs), in order to improve the quality and safety of patient care while achieving efficiency in the delivery of healthcare.

The purpose of this course, “Electronic Health Records: Are They Really Necessary?”, is to explore the issues related to EHRs: why change, types of EHRs, pros and cons of EHRs, what to expect in the transition process and how to prepare for the transition.

The instructor for this class will be Emilie Hagan, ANP-CNS, CDE, CCM from Valley Center, Kan.

This eight-hour continuing education class will meet from 9 a.m. – 5 p.m. September 2,  at the Country Inn & Suites, 2760 S. 9th, Salina, Kan. Registration will begin at 8:30 am.

For further information or to pre-register, please call the Community Education Department 1.800.729.5101 Ext. 370 or 243.1435, ext. 370 at Cloud County Community College.

Rule Requiring Notification of Breaches of Health Information

WASHINGTON, Aug. 19 -- The U.S. Department of Health & Human Services issued the following statement:

New regulations requiring health care providers, health plans, and other entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify individuals when their health information is breached were issued today by the U.S. Department of Health and Human Services (HHS).

These “breach notification” regulations implement provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of American Recovery and Reinvestment Act of 2009 (ARRA).

The regulations, developed by the HHS Office for Civil Rights (OCR), require health care providers and other HIPAA covered entities to promptly notify affected individuals of a breach, as well as the HHS Secretary and the media in cases where a breach affects more than 500 individuals.  Breaches affecting fewer than 500 individuals will be reported to the HHS Secretary on an annual basis. The regulations also require business associates of covered entities to notify the covered entity of breaches at or by the business associate.

“This new federal law ensures that covered entities and business associates are accountable to the Department and to individuals for proper safeguarding of the private information entrusted to their care.  These protections will be a cornerstone of maintaining consumer trust as we move forward with meaningful use of electronic health records and electronic exchange of health information,” said Robinsue Frohboese, acting director and principal deputy director of OCR.

The regulations were developed after considering public comment received in response to an April 2009 request for information and after close consultation with the Federal Trade Commission (FTC), which has issued companion breach notification regulations that apply to vendors of personal health records and certain others not covered by HIPAA.

To determine when information is “unsecured” and notification is required by the HHS and FTC rules, HHS is also issuing in the same document as the regulations an update to its guidance specifying encryption and destruction as the technologies and methodologies that render protected health information unusable, unreadable, or indecipherable to unauthorized individuals.  Entities subject to the HHS and FTC regulations that secure health information as specified by the guidance through encryption or destruction are relieved from having to notify in the event of a breach of such information.  This guidance will be updated annually.

The HHS interim final regulations are effective 30 days after publication in the Federal Register and include a 60-day public comment period.  For more information, visit the HHS Office for Civil Rights web site at http://www.hhs.gov/ocr/privacy/

To track the progress of HHS activities related to ARRA, visit www.hhs.gov/recovery. To track all federal activities related to ARRA, visit www.recovery.gov.

VP Biden Announces Availability of Nearly $1.2 Billion in Grants to Help Hospitals & Doctors Use EMR

CHICAGO, IL – Vice President Joe Biden today announced the availability of grants worth nearly $1.2 billion to help hospitals and health care providers implement and use electronic health records. The grants will be funded by the American Recovery and Reinvestment Act of 2009 (ARRA) and will help health care providers qualify for new incentives that will be made available in 2010 to doctors and hospitals that meaningfully use electronic health records.

"With electronic health records, we are making health care safer; we’re making it more efficient; we’re making you healthier; and we’re saving money along the way, "said Vice President Biden. "These are four necessities we need for healthcare in the 21st-century."

"Expanding the use of electronic health records is fundamental to reforming our health care system," said HHS Secretary Sebelius. "Electronic health records can help reduce medical errors, make health care more efficient and improve the quality of medical care for all Americans. These grants will help ensure more doctors and hospitals have the tools they need to use this critical technology."
The grants made available today include:

• Grants totaling $598 million to establish approximately 70 Health Information Technology Regional Extension Centers, which will provide hospitals and clinicians with hands-on technical assistance in the selection, acquisition, implementation, and meaningful use of certified electronic health record systems.
• Grants totaling $564 million to States and Qualified State Designated Entities (SDEs) to support the development of mechanisms for information sharing within an emerging nationwide system of networks.

The Extension Center grants will be awarded on a rolling basis, with the first awards being issued in fiscal year 2010. Grants to States will be made in fiscal year 2010. Those interested in applying for these grants may visit http://HealthIT.HHS.gov for more information.

"With these programs, we begin the process of creating a national, private and secure electronic health information system. The grants are designed to help doctors and hospitals acquire electronic health records and use them in meaningful ways to improve the health of patients and reduce waste and inefficiency," said Dr. David Blumenthal, National Coordinator for Health Information Technology. "They will also help states lead the way in creating the infrastructure for health information exchange, which enables information to follow patients within and across communities, wherever the information is needed to help doctors and patients make the best decisions about medical care."

The Department of Health and Human Services will also provide additional assistance to health care providers through the Health Information Technology Research Center (HITRC). The HITRC will gather relevant information on effective practices from a wide variety of sources across the country and help the Regional Extension Centers collaborate with one another and with relevant stakeholders to identify and share best practices in EHR adoption, effective use, and provider support.
Attached are two fact sheets on the Health Information Technology Extension Program and the State Health Information Exchange Cooperative Agreement Program.

###

The activities described in this release are being funded through the American Recovery and Reinvestment Act (ARRA). To track the progress of HHS activities funded through the ARRA, visit www.hhs.gov/recovery. To track all federal funds provided through the ARRA, visit www.recovery.gov.

South FL Leaders to Revive EMR Efforts

Health leaders in South Florida are reviving efforts to obtain widespread adoption of electronic medical records, hoping now they can land millions from the federal economic stimulus package.

Two projects in Broward and Miami-Dade counties, the other in Palm Beach County -- had ground to a halt in the past year when state seed money ran out, at a time when record-sharing systems were working in test runs but not complete.

Now, the organizers of both projects are meeting again to pursue grants from the $30 billion stimulus fund that President Obama and Congress set aside in February to create a national medical data system. Obama has called for an electronic health record for all by 2014... "It would be a natural fit for us to get the money and resume what we have started," said Dr. Bernd Wollschlaeger, a physician who is on the board of the South Florida Health Information Exchange, the group running a project in the Broward and Miami areas. "Why use the money to reinvent the wheel when that has already been done?"

Continuing reading here

Source: Bob LaMendola, South Florida leaders revive efforts to push for electronic medical records, angling for stimulus funds: New life for dormant projects aiming to reduce waste, medical errors, Sun Sentinel, Business and Financial News, (August 7, 2009)

Sens. Specter, Casey Announce Committee Approval of Northwestern PA Health and Education Projects

The office of Sen. Bob Casey, D-Pa., has issued the following news release:

   U.S. Senators Arlen Specter and Bob Casey today announced that the U.S. Senate Appropriations Committee has approved federal funding for several Northwestern Pennsylvania health and education projects. The projects are contained in the Fiscal Year 2010 Labor, Health, Human Services, Education and Related Agencies Appropriations Bill.

   "I am pleased my colleagues have approved this important funding for Northwestern Pennsylvania," Senator Specter said. "Health and education are our nation's greatest capital assets, and these projects are vital to ensuring quality health care and education for Pennsylvania."

   "I am happy that funding for these vital projects has been approved by my colleagues," Senator Casey said. "These funds will ensure that Pennsylvanians have access to quality health care, job training programs and education. This is great news for Northwestern Pennsylvania."

   The bill must be approved by the full Senate, the House of Representatives and signed into law by the President before funding is final.

   Northwestern Pennsylvania projects in the bill include:

   Healthcare-related

   * $100,000 for Corry Memorial Hospital Association in Erie County for equipment. The equipment will be used in a replacement facility, which will improve access to care for residents of northwestern Pennsylvania.

   * $100,000 for Elk Regional Health Center in Elk County to purchase digital mammography equipment and to provide women with access to mammograms.

   * $100,000 for Ellwood City Hospital in Lawrence County for facilities and equipment. Funds will be used for cardiac lab construction and equipment to provide access to these services in the rural community.

   * $100,000 for Hamot Medical Center in Erie County for equipment, including ventilators and IV pumps, and will be used at various facilities in order to eliminate barriers to care and improve patient outcomes through timelier treatment.

   * $100,000 for Lake Erie College of Osteopathic Medicine in Erie County for equipment. Funds will be used for a Practice Management Information System (PMIS) to educate medical and pharmacy students on health information technology, such as electronic medical records and e-prescribing.

   * $100,000 for Meadville Medical Center in Crawford County to upgrade a CT Scanner to provide a non-invasive method of diagnosing illness and injury in an outpatient setting.

   * $100,000 for Sharon Regional Health System in Mercer County to upgrade equipment in the Cardiac Cath Lab in the Heart Center at the hospital, including IV upgrades and cardiac monitors.

   Education-related

   * $100,000 for Mercyhurst College in Erie County for education programs and support services for individuals with disabilities. The pilot program will provide students with counseling support and academic services.

Conn. Hospital Selects eClincialWorks

eClinicalWorks, a market leader in ambulatory clinical systems, announced that Stamford Hospital, serving Connecticut’s lower Fairfield County and a major teaching affiliate of the Columbia University College of Physicians and Surgeons, has selected eClinicalWorks’s unified electronic medical records (EMR) and practice management (PM) solution for its employed and affiliated physicians. In addition to the EMR/PM system, Stamford will use eClinicalWorks’s Patient Portal, Electronic Health eXchange (eEHX), Enterprise Business Optimizer (eBO) and eClinicalMobile – all designed to extend the use of electronic health records beyond the practice’s walls to improve communication and access to real-time information.

Can Patients Access EMRs From Their Home Computer?

The answer is maybe, but I do not believe the physician is obligated to make the emr electronically available. I was reading an article in the Orlando Sentinel (don't ask why, considering I'm in New Jersey), and I came across an interesting question in the paper's "ask a lawyer section". It's pretty short, scroll to the bottom for the link:

Q. My doctor has an electronic medical-records system. Does the law allow me to access my medical records, and, if so, can I access them from my home computer?~T.E. ORLANDO

A. Generally, the Health Insurance Portability and Accountability Act, a federal law commonly referred to as HIPAA, governs your right to access your medical records. Under HIPAA, upon request, your doctor must let you inspect or give you a copy of your medical records. There are some limited exceptions to this general rule, such as when a request is made for psychotherapy records. Also, your doctor is not required to release records obtained from other doctors...However, your doctor is not required to provide you an electronic version of such records or let you access such records from your home computer.

For more information about your rights under HIPAA, go to hhs.gov/ocr/.

Now I'm not the attorney who answered the question. HOWEVER, it does stand to reason that the doctor does not have to give electronic access to the record due to security reasons. Why in the world would congress go through all the trouble of requiring security in the physician's office if a doctor was to freely make his patient's medical record available without assessing the security threat?

Source: Kristy Johnson, Can Medical Records Be Accessed on Computer?, Orlando Sentinel, The Law & You Section; Florida; Ask a lawyer, pg. B1 (July 27, 2009) (available here)

The Doc is Logged In

The LA times just had a nice article on IT in the practice.

Wow. I've just taken care of three patients in 12 minutes, and I didn't do it by "churning" them through my office as if it's some sort of factory assembly line. Rather, those patients (their parents, more specifically -- I'm a pediatrician), e-mailed me over a secure network with questions and descriptions of signs and symptoms.

One mother attached a digital photo of a rash on her 3-month-old daughter's face; it turned out be nothing more serious than baby acne (it'll go away in a month or so). Another mom had noticed that her son was missing one of his pre-kindergarten immunizations (she had pulled up his shot records online) and requested that I order it. And the father of a 5-month-old boy told me that his son has been constipated off and on for the last month. I e-mailed him a questionnaire so I could determine whether the family should try something at home or bring the child to the office.

The articles goes on to list some advantages and disadvantages of healthcare IT. Read the article here .

Source: Rahul Parikh, In Practice; The doctor is in and logged on; Let's not pass notes or play phone tag anymore: E-mail and e-records do it better., Los Angeles Times, Health Section, Features Desk, Part E, pg. 1 (July 20, 2009)

Meaningful Use definition begins to firm up

The Health IT Policy Committee gave its final recommendations on "meaningful use" to the Department of Health and Human Services' Office of the National Coordinator last Thursday. The meaningful use workgroup had tweaked its original recommendations because of the 700+ comments received.

Paul Tang of the Palo Alto Medical Foundation, chairman of the meaningful use workgroup, said the revised recommendations include a faster timeline for giving patients access to information. Access to electronic health information will be counted in 2011, he said, and real-time access within personal health records was moved to 2013 from 2015. The recommendations also went to an "adoption year" approach in which 2011 is considered the first year. An organization must meet the 2011 standards for its first year of use, the 2013 standards for its third year and so on, even if it first adopts EHRs in 2012, 2013 or 2014. However, to qualify for the full five years of incentive payments, the organization would have to adopt by 2012. Penalties begin in 2015, and Tony Trenkle of the Centers for Medicare & Medicaid Services worried that an organization adopting EHRs in 2014 would have to jump a huge bar in one year to avoid the penalties.

The committee also adopted the broad outlines of the recommendations made by the certification group, which were to focus certification on meaningful use, leverage certification to improve security, privacy and interoperability, improve objectivity and transparency of the certification process, expand certification to a range of software sources, including open source and self-developed and develop a short-term transition plan. Within those high- level recommendations, the workgroup had suggested details, which it will continue to work on. Among them were that HHS should define certification criteria, rather than certification organizations, and that multiple organizations should be authorized to certify. The workgroup recognized industry concerns about opening up the process, but determined that competition would be better and would also help alleviate any bottlenecks that might ensue, co-chairmen Marc Probst of Intermountain Healthcare and Paul Egerman told the committee. They said they intended to accept public comment.

There are many suggestions out there, as the definition solidifies over the next few weeks, I'll keep you posted.

Source: Leslie Cantu, Meaningful Use Definition for Health IT Begins to Firm Up, Washington Internet Daily, Today's News Section (July 17, 2009)

Massachusetts helping to shape US efforts to digitize records

I forgot to blog about a recent article I read in the Boston Globe that emphasized why Massachusetts is in the fortunate position of being the country's electronic medical records focal point. According to Paul Egerman, Massachusetts is like the Silicone Valley of healthcare information technology.

Egerman went on to start one company, IDX Systems Corp., that was bought by General Electric for $1.2 billion, and another, eScription Inc., that was acquired by Nuance Communications Inc. last year for $363 million. He is now a volunteer adviser to David Blumenthal, the national coordinator for health information technology - and a former Harvard professor and Mass. General physician.

Synopsis of why Massachusetts is so influential in healthcare IT and the Obama Administration's goals?

- More experience than any other state

- Massachusetts doctors and hospitals do more electronic prescribing - eliminating the need for handwritten scraps of paper - than their counterparts in any other state.

According to John Halamka, chief information officer at CareGroup Healthcare System, ``The average use of EMRs in the US is between 2 and 20 percent. In Massachusetts, we're somewhere between 30 and 50 percent, so we've had a fair degree of experience with what works and what doesn't work.''

- Massachusetts won influence because Harvard economist David Cutler was the primary architect of candidate Barack Obama's healthcare plan.

Girish Navani of eClinicalWorks was also quoted in that article.

EClinicalWorks software is already used by about 25,000 doctors, and the company brought in $100 million in revenue last year. The company is hiring about twice as quickly - roughly 200 people in 2009, mainly in areas like training and customer support - as it would be without the stimulus, according to Girish Navani, eClinicalWorks chief executive...``The big picture,'' says Navani, ``is truly transforming healthcare, rather than just spending a lot of money and not getting to our goal.''

I included the source of the article so that you can read it in depth. It's really a good article! (I say that about most of the articles I cite to because I only blog about the good ones!)

Source: Scott Kirsner, State helping to shape US efforts to digitize health records for all, The Boston Globe, Business Section, pg.1 (July 12, 2009 Sunday

Mayor Bloomberg's Campaign Accountability Report

Mayor Michael R. Bloomberg released his fourth Campaign Accountability Report, which shows major progress has been made in implementing the 2005 campaign promises since the last report was issued in 2007. Today, 97 percent of the 100 campaign promises the Mayor made during the 2005 campaign are either listed as done or are currently being implemented. Compared to the last report, there have been major gains on promises that are fully or substantially implemented, up to 67 percent today from 38 percent in 2007. The 2001 Campaign Accountability Report was also updated. The reports were released at the Goodhue Camp on Staten Island, and the Mayor highlighted a promise he made to expand the Out-of-School Time system and increase the number of young people served. Since the 2005-2006 school year, the Out-of-School Time budget has increased from $47 million to $110.7 million, with enrollments increasing from 59,000 to a projected 75,000 students in the 2009-2010 school year.

The Bloomberg Administration is working to complete several proposals that are already making a substantial difference in the lives of New Yorkers, such as its ambitious goal of providing electronic medical records to 3,000 doctors. So far, more than 1,100 primary care providers serving 1 million patients are already using the system – an achievement that has made New York City a national leader in the field.For the current 2005 update, no promise remains undone.

The Campaign Accountability Report can be viewed at www.nyc.gov/campaignpromises. If a New York City resident wants to receive a paper copy of the database, he or she can email campaignpromises@cityhall.nyc.gov or call 311.

Event: Briefing - The Children's Health Fund

Location: CVC-Congressional Meeting Room South, U.S. Capitol -- July 15, 2009 11:30 am

Subject: The Children's Health Fund (CHF) will hold a briefing to explore how electronic health records and health information technology are integral to enhancing the concept of a "medical home" for children and their families.

Participants: CHF Co-Founder and President Irwin Redlener; National Coordinator for Health Information Technology David Blumenthal; and CHF Chief Information Officer Jeb Weisman

Event: House Veterans Affairs Committee to Examine EMR

SECTION: U.S. HOUSE OF REPRESENTATIVES - FUTURES
TITLE: EVENT: HOUSE VETERANS AFFAIRS COMMITTEE;

LOCATION: 334 Cannon House Office Building -- July 14, 2009 10:00 am Oversight and Investigations Subcommittee hearing on "Examining the Progress of Electronic Health Record Interoperability Between Veterans Affairs and Defense Department."

CONTACT: 202-225-9756 http://veterans.house.gov

Mayo Clinic as a model for health reform?

    I read a very interesting article by Peter Benesh on Pres. Obama's health reform plan. President Obama often points to the famed Mayo Clinic in Rochester, Minn., as one model for repairing the nation's health care. He's often cited stats showing that the Mayo Clinic spends 20% to 30% less on health care than other hospitals yet produces better patient outcomes. It could be the staffing model (MC hires doctors as salaried staff rather than independent, fee-for-service contractors)

    Remember, the Mayo Clinic is a not-for-profit hospital. Benesh suggests that using a not-for-profit hospital organization as a model for health care reform will draw plenty of attention as the debate intensifies over the next few months. I believe one of the important points of this article is that researchers found patient satisfaction across the country did not increase along with higher spending on care. Nor did outcomes improve with spending.

And you know I'll always have a reference to EMR:

Mayo's cost-saving program has several components. It aggregates care under one roof, with teams of medical professionals integrating their skills for each patient. It creates a single, electronic medical record for each patient for physicians to share so that everybody knows what everyone else is doing. Surgery, if required, can be performed within 24 hours.

In addition, patients can get all their appointments and tests completed in three to five days at the Mayo Clinic, without having to see doctors and take tests in different locations and wait for results.

And because doctors are salaried employees, they don't have to spend a lot of time on paperwork, back-office staff and associated overhead.

As always, I only pick articles I think my readers would find interesting, click here for the complete article.

Source: Peter Benesh, Obama Health Plan: Reform Might Be Heavy On The Mayo Famed Clinic Seen As Model Hospital Group Scores Well On Efficieny, But Is It The Right Prototype?, Investor's Business Daily, National Edition, Front Page News, pg. A01 (July 7, 2009)

Meaningful Use Comments Set Stage for Next Health IT Policy Meeting

Health IT Policy Committee is meeting next week as they continue to discuss the definition of "meaningful use". There were over 900 comments transmitted to the Office of the National Coordinator. If you want a copy of these comments, you can physically go to the ONC starting July 13.

Some commenters have made their comments available. For example, the Computer & Communications Industry Association agreed that for meaningful use to truly be meaningful, the definition must include administration, not just actual health care. The "nightmare" of today's paper-based system of bills and claims, it said, means "that even when our citizens receive the medical care they need, they cannot understand what treatment they received, what they were billed, what was covered, and what they owe." "Meaningful use" should cover administration "down to the individual practice level," it said.

Source: Leslie Cantu, Meaningful Use Comments Set Stage for Next Health IT Policy Meeting, Washington Internet Daily, Today's News (July 7, 2009)

Rep. Andrews Announced $1.68m in aid for South Jersey health centers

On July 2nd, Congressman Andrews announced over $1.68 million in new federal funding to improve South Jersey health centers. Congressman Andrews' announcement followed last Monday's White House press conference where First Lady Michelle Obama announced the release of $851 million in grants nationwide, designed to address the immediate facility and equipment needs of America's health centers and expand service for those who cannot afford insurance. The money is appropriated under the American Recovery and Reinvestment Act (ARRA), these Capital Improvement Program (CIP) grants will support the construction, repair and renovation of over 1,500 health center sites nationwide, while more than 650 centers will use the funds to purchase new equipment or health information technology (HIT) systems, and nearly 400 health centers will adopt and expand the use of electronic health records.

Local recipients of the CIP grants include CAMcare Health Corporation and Project H.O.P.E., which received $1,375,355 and $306,385, respectively.

•  CAMCare has provided high quality, comprehensive health care to Camden's medically underserved for nearly 30 years, and they have assisted over 32,000 people in the last year alone. 
• Project H.O.P.E. sets out to improve the health and well being of Camden City's homeless by providing medical and social services as an effort to help those in need transition to self-sufficiency. 

This new boost in federal funding, hundreds of health centers will be able to adequately respond to the high demand of people who are turning to their services during these difficult economic times. Additionally, this increase in funding will also afford recipient health centers with an opportunity to retain, or even expand their staff. As Americans continue to struggle from economic recession and health care premiums spiral out of control, Congressman Andrews continues to devote his efforts to expanding patient care while striving to secure the resources needed to rebuild our workforce.

FCC Commissioner Copps tours health facilities

Source: Washington Internet Daily, Agencies (July 1, 2009 Warren Publishing, Inc.)

FCC Commissioner Michael Copps toured two D.C. health facilities Tuesday that could benefit from increased availability of broadband, beginning a national tour to look at the need for broadband in health services. At his first stop, Copps discussed the uses of technology with the staff of the Healthy Baby Project, which provides prenatal care to low-income pregnant women. Project staffers said broadband helps their work because they use Facebook and e-mail to communicate parenting class times and other information to mothers. Afterward, Copps went to Family and Medical Counseling Services, where he discussed the importance of electronic medical records, which "improves care while cutting time and costs in patient administration," he said. Copps will be in South Dakota next month, where he will discuss the role of broadband in tribal health care facilities, he said. The commission is developing a national broadband plan that is scheduled to come out next year.

Centers for Medicare and Medicaid Services Propose Payment Policy Changes

HEADLINE: CENTERS FOR MEDICARE AND MEDICAID SERVICES PROPOSES PAYMENT, POLICY CHANGES FOR PHYSICIANS SERVICES TO MEDICARE BENEFICIARIES IN 2010

The Centers for Medicare & Medicaid Services (CMS) announced today proposed changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS).  The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings.

CMS is making several proposals to refine Medicare payments to physicians, which are expected to increase payment rates for primary care services.  The proposals include an update to the practice expense component of physician fees.  For 2010, CMS is proposing to include data about physicians’ practice costs from a new survey, the Physician Practice Information Survey (PPIS), designed and conducted by the American Medical Association.

The Medicare law requires CMS to adjust the MPFS payment rates annually based on an update formula which includes application of the Sustainable Growth Rate or SGR that was adopted in the Balanced Budget Act of 1997.  This formula has yielded negative updates every year beginning in CY 2002, although CMS was able to take administrative steps to avert a reduction in CY 2003, and Congress has taken a series of legislative actions to prevent reductions in CYs 2004-2009.  Based on current data, CMS is projecting a rate reduction of -21.5 percent for CY 2010.

Continue reading the proposal here


For more information on the proposed rule, please see:
- www.federalregister.gov/inspection.aspx#special
- http://www.archives.gov/federal-register/public-inspection/index.html

Class Action to prevent incentive payments for EHR

A class action suit has been filed on June 25 in the U.S. District Court for Southern New York alleging that the Recovery Act's goal for every American to have an electronic health record by 2014 threatens the privacy rights of every person not already covered by Medicare or Medicaid.

Beatrice Heghmann is the lead plaintiff against Health and Human Services Secretary Kathleen Sebelius, White House Office of Health Reform Director Nancy-Ann Deparle and Acting Administrator of the Centers for Medicare and Medicaid Services Charlene Frizzera. Courthouse News Service reported that the lawsuit claims that, rather than go by HIPAA's rule for the limited amount of information doctors must give the government in special circumstances, Sebelius would now have the authority to set the minimum amount of information doctors would report.

The suit also claims the Act would allow the government to link a person's medical information to other personal information, like a Social Security number or driver's license.

Heghmann says the push for EHRs exists solely to obtain confidential health information, according to Courthouse News. She's seeking an injunction to prevent the distribution of incentive payments for purchasing EHR systems. 

I think this is the natural course of events for EHR. The EHR system is being refined, hopefully for the better.

I'm pretty sure that the court will balance public policy and private citizen's rights. I will try to find the complaint.

Arizona State offers degree in Biomedical Informatics

Arizona State University will offer the first undergraduate degree program in biomedical informatics, beginning in the 2009 fall semester. Biomedical informatics involves the integration of computer and information sciences with basic biological and medical research, clinical practice, medical imaging and public health disciplines. The American Medical Informatics Association foresees 10,000 new jobs being created in the field by 2010. Phoenix employers, including Banner Health, United Health Care and Mayo Clinic, predict a local need for at least 200 new employees in the field within 5 years.

An undergraduate degree in biomedical informatics is also a viable choice for a pre-med program because it provides students with a solid background in life sciences as well as information technology that plays an increasing important role in medical care, said Robert Greenes, chair of the Department of Biomedical Informatics.  For more information about the degree program, see the web site http://bmi.asu.edu/undergraduate/index.php

Politicians pump money into health centers

Senators Charles E. Schumer and Kirsten Gillibrand announced earlier today that they are funding healthcare projects throughout the great state of New York as part of the Capital Improvement Program (CIP). The funding will be used to build new facilities, renovate existing structures, purchase cutting-edge equipment and implement electronic health records. "This funding is just what the doctor ordered," said Schumer. The CIP grants will support the construction, repair and renovation of over 1,500 health center sites nationwide. More than 650 centers will use the funds to purchase new equipment or health information technology (HIT) systems, and nearly 400 centers will adopt or expand the use of electronic health records.

Here's a synopsis:
Western New York: $1,095,875 in American Reinvestment and Recovery Act (ARRA) funding
- $535,880 to the Community Health Center of Buffalo
- $559,995 to the Northwest Buffalo Community Health Care Center

Queens: $2,715,600 in American Reinvestment and Recovery Act (ARRA) funding
- $1,491,800 to the Floating Hospital in Long Island City
- $855,115 to the Joseph P. Addabbo Family Heath Center in Arverne
- $368,685 to the Project Samaritan Health Services, Inc. in Jamaica

Finger Lakes Region: $5,172,510 in American Reinvestment and Recovery Act (ARRA) funding
- $827,235 to Oak Orchard Community Health Center, Inc. in Brockport
- $485,690 to Finger Lakes Migrant Health Project in Penn Yan
- $1,027,840 to Westside Health Services, Inc. in Rochester
- $2,500,000 to Rochester Primary Care Network
- $331,655 to Unity Hospital of Rochester

Brooklyn: $5,530,729 in American Reinvestment and Recovery Act (ARRA) funding
- $518,695 to Brooklyn Plaza Medical Center, Inc.
- $805,374 to Brownsville Community Development Center
- $837,895 to Bedford Stuyvesant Family Health Center, Inc. will receive $837,895
- $868,765 to ODA Primary Care Health Center
- $2,500,000 to Sunset Park Health Council, Inc.

St. Lawrence County: $536,895 in American Reinvestment and Recovery Act (ARRA) funding
- $536,895 to the Cerebral Palsy Association of the North Country

Staten Island: $250,000 in American Reinvestment and Recovery Act (ARRA) funding
- $250,000 to the Beacon Christian Community Health Center

**update:
Congressman Brian Higgins (NY-27) announced that Northwest Buffalo Community Health Care Center has been awarded $559,995 in a federal grant. The funds were made available through the American Recovery and Reinvestment Act and authorized for the Department of Health and Human Services (HHS) to address health care facility and equipment needs. "Providing the best and most efficient health care starts with investing in health care facilities and equipment," said Congressman Higgins. 

That's a whole lot of money! (I'm double checking to make sure I got the figures right, but the bottom line is, a lot of money is going into this project!)

Washington Hearing on Health IT: Short Synopsis

I read a recent article in the Washington Internet Daily that provided a synopsis of a House Small Business subcommittee on regulations and health care. Witnesses asserted that the Recovery Act's provisions for adopting health IT isn't necessarily a good fit for small practices and specialists. While we disagree, I understand what the witnesses are trying to say. They are asserting that small practices and specialists need something more, but what? The witnesses (people who I don't know, or else I wouldn't keep referring to them as witnesses) urged a broad definition of meaningful use that would essential cover many providers as possible.

David Blumenthal, national health IT coordinator at the Health and Human Services Department, said his office understands "that small practices carry an extra burden." He also said HHS doesn't intend to compel other types of health care providers to adopt health IT. It isn't compelling doctors and hospitals to use health IT, just offering incentives and penalties through Medicare and Medicaid reimbursements.

But that system worries Chairwoman Kathy Dahlkemper, D- Pa. She said she fears doctors will look at the potential penalties on top of already small Medicare and Medicaid reimbursements and decide to turn away from those patients altogether. The $44.7 billion in incentive payments -- up from an original estimate of $20 billion -- should ease the way for those providers to purchase health IT systems, Blumenthal said. The regional extension centers will provide hands-on technical help in implementing the systems, he said. "It's certainly our hope those penalties will never go into effect."

To help small practices meet the start-up costs of adopting health IT, Dahlkemper introduced legislation Wednesday creating a loan program at the Small Business Administration. The SBA would back private loans of up to $350,000 for a single provider and $2 million for a group. The bill authorizes $10 billion for the program.

The committee highlighted many important points, for example, pediatrician's low adoption of EMR, 50+ definitions of "meaningful use" (state-specific), and interoperability. The article does a good job at summarizing the hearing.

Source: Leslie Cantu, Health IT Provisions Don't Address All Situations, Hearing Told, Washington Internet Daily Vol. 10 No. 121 (June 24, 2009)

Facebook's Lobbyist Once Pushed For Stricter EMR

Facebook's new lobbyist used to be one of the company's most formidable adversaries. Timothy Sparapani was the former senior legislative counsel for the American Civil Liberties Union. He used to argue that Internet companies had too much control over consumers' data! However, the self-described "privacy zealot" joined Facebook seven months ago.

Now Sparapani is responsible for shaping Washington's view of Facebook, the world's third-most-viewed website and the privacy policies that will define its business.

Sparapani has earned a reputation as a tenacious champion of consumers' privacy rights. At the ACLU, he fought against racial profiling in airport security lines and pushed for stricter rules for how patient information should be used in electronic medical records.

Let's see how this shapes social media networks!

Rising Medical Costs Are Driving Patients Overseas

*Update: I changed the title because I decided it's not really a "failure" of the medical industry, more an implication of rising costs.

I just read a great article in the Pittsburgh Post-Gazette written by Dr. Josef E. Fischer, entitled "Outsourcing Patients: the Failures of Our Health System Are Driving More and More Americans To Look For Treatment Overseas". Dr. Josef E. Fischer is the William V. McDermott Professor of Surgery at Harvard Medical School and a past chairman of the Board of Regents of the American College of Surgeons. (He knows what he's talking about)

The article emphasizes that there is one particular threat to our medical sector that demands particular attention: Medical tourism.

Mainly, [medical tourism] means surgical tourism -- patients going abroad for surgical care. Our initial response to this phenomenon, which began in earnest in 1998, was reminiscent of our response to competition in our manufacturing industries: We denigrated the upstarts. Their products were poor, outcomes unsatisfactory; there were many complications, surgeons were poorly trained, facilities were inadequate -- with dated imaging equipment and the like.

Dr. Fischer has visited overseas facilities and asserts that the clinics are first-class, and various levels of accommodation are available, from moderate to luxurious. Staffs are caring, schedules are tight, and a variety of tests can be accomplished within 24 hours, not spread over weeks as they are in the U.S. Bottom line: most foreign medical centers rival those in the United States.

What's driving thousands and thousands of people overseas?

Dr. Fischer asserts that this phenomenon may be attributable to the "inexorable increases" in U.S. health-care costs at a rate far exceeding inflation, with health insurance companies paying a smaller percentage of the medical bills and patients paying more.

Why would someone travel 10,000 miles to get medical treatment from a doctor they don't know at a hospital whose name they can't pronounce?

Dr. Fischer asserts that its all about "One-stop shopping. Fully integrated hospital medical staff. Immediate access. No technology or quality gap. Competitive prices. A focus on service."

This article is excellent. It notes the scary price gaps that exist between countries. I really never understood the gravity of the price disparity until my family-member had a dental bridge done in India. The price in India: $2,000. What was the price stateside? $15,000 - $20,000! Dr. Fischer notes the price discrepancy:

...the cost of a heart-valve replacement in the United States: $230,000. In India, the same procedure, all costs included, runs $9,500; in Thailand, $10,500; in Singapore, $13,000.

A knee replacement in the United States costs up to $58,000. In India, it's about $8,500; in Thailand, $10,000; in Singapore, $13,000.

Dr. Fischer noted that we can reduce costs of U.S health care. Of the few ways, one was tort reform. If malpractice costs were lesser, the savings would trickle down to the patient. Oh yea, and Electronic medical records! According to Dr. Fischer, EMR may help, but there has to be an emphasis on interoperability. Find the article, read the article!

Source: Dr. Josef E. Fischer, Pittsburgh Post-Gazette (Pennsylvania), Outsourcing Patients: The Failures of Our Health System Are Driving More and More Americans To Look For Treatment Overseas, Pg. B-4 (June 21, 2009 Sunday) (Available in the Two Star Edition, Editorial Section):

ONCHIT Requests Comments on "Meaningful Use"

The Office of the National Coordinator for Health Information Technology (ONC) is asking for comments on the preliminary definition of “Meaningful Use,” as presented to the HIT Policy Committee on June 16, 2009. Comments on the draft description of Meaningful Use are due by 5 pm est June 26, 2009, and should be no more than 2,000 words in length.

Electronic responses to the draft description of Meaningful Use are preferred and should be addressed to:
MeaningfulUse@hhs.gov
With the subject line “Meaningful Use”

Written comments may also be submitted to:
Office of the National Coordinator for Health Information Technology
200 Independence Ave, SW
Suite 729D
Washington, DC 20201
Attention: HIT Policy Committee Meaningful Use Comments

Public comment on the definition of "Meaningful Use"

The Office of the National Coordinator is accepting public comments until June 26 on the initial definition of "meaningful use" proposed by the HIT Policy Committee's meaningful-use work group. Remember, the definition will determine whether doctors and hospitals will be reimbursed for their use of electronic health records with regard to the stimulus package.

The goal for 2011 is to electronically capture information in coded format, report health information and use that information to track key clinical conditions. Some of the objectives are implementing drug-drug and drug-allergy checks, recording vital signs, providing patients with an electronic copy of the record, providing electronic submissions of reportable lab results to public health agencies, and complying with fair data practices, HIPAA and state laws.

Source: Agencies, Washington Internet Daily, Vol. 10 No. 116, (June 18, 2009)

Blackberry Tour 9630, It's (more) official!

I apologize for the non-healthcare IT tangent, but this is great news for Blackberry users! I follow crackberry.com, so just thought I would share the news. Also, because I'm trying to find a replacement for my Motorola Razr (which replaced my LG EnV)

Research in Motion has officially announced the BlackBerry Tour 9630. This is RIM's latest next-generation phone. The Tour is a non-touchscreen, full physical qwerty smartphone for CDMA carriers. This phone acts as a replacement for the BlackBerry 8830 World Edition, which users can agree was a hit.

Carriers: Slowly but surely to: Verizon, Sprint, Alltel, Bell, Telus and probably whoever else had the 8830.

Crackberry did a wonderful two-part review of the Tour
Part 1
Part 2

Obama to Observe Green Bay's Healthcare Model

According to a recent Washington Post article, Green Bay, Wis. is one of the best cities in the country according to numerous measures. The city has "managed to control medical spending while steadily improving health outcomes."

Peter Orszag, the Obama administration's budget chief, said, "If we could make the rest of the nation practice medicine the way that Green Bay does, we would have higher quality and significantly lower costs."

In his drive to rein in skyrocketing health-care costs, Obama is increasingly focused on wasteful medical care that does not extend life and may actually be harmful. Today's town-hall-style meeting, his first as president to promote health reform, is intended to spotlight one city's strategy for squeezing out waste without hurting quality.

What Obama is likely to hear in Green Bay is testimony to the value of digital records, physician collaboration, preventive care and transparency, say those most involved in Wisconsin's innovative approach.

"There's been a fairly steady progression of quality" in areas such as diabetes care and cancer screening, said Chris Queram, executive director of the Wisconsin Collaborative for Healthcare Quality, which publishes statewide performance measures....The federal Agency for Healthcare Research and Quality gives Wisconsin high scores on 100 measures, ranging from the treatment of heart disease to childhood asthma.

However, what's exciting the Obama administration the most? The Dartmouth Institute for Health Policy and Clinical Practice have some very interesting findings.

The New Hampshire researchers have documented and mapped wide variations in the cost and types of care given to American seniors through the Medicare program, concluding that spending more on health care has not resulted in better health.

For example, the researchers found that In the final two years of a patient's life, Medicare spent an average of $46,412 per beneficiary nationwide, with the typical patient spending 19.6 days in the hospital, including 5.1 in the intensive-care unit. Green Bay patients cost $33,334 with 14.1 days in the hospital and just 2.1 days in the ICU, while in Miami and Los Angeles, the average cost of care exceeded $71,000, and total hospitalization was about 28 days with 12 in the ICU.

Are these differences attributed by big-city prices? According to the article, maybe. WP interviewed a Elliott Fisher, principal investigator for the Dartmouth Atlas Project, who said "but the differences that are really important are due to the differences in utilization rates." That is key, the "utilization rate". This is why the Obama administration is so interested in the study. If we are utilizing our resources at an optimal level, we are operating at an optimal level.

Click here to read the full article

Maryland Gov. O'Malley (D) Develops Health Goals

Maryland Gov. Martin O'Malley (D) has developed the following goals for his administration, which are being monitored by the newly created Governor's Delivery Unit (modeled on a concept developed by former British prime minister Tony Blair).

Health
-- End childhood hunger in Maryland by 2015.
-- Establish a first-in-the-nation comprehensive statewide private-public secure health information exchange and electronic health records by 2012.
-- Reduce infant mortality in Maryland by 10 percent by 2012.
-- Expand access to substance abuse treatment in Maryland by 25 percent by 2012

Security
-- Reduce violent crime in Maryland by 10 percent a year.
-- Reduce violent crime against women and children by 25 percent by 2012.
-- Make Maryland the leader in homeland security preparation by 2012.

Skills
-- Create or save 250,000 growth-sector jobs in Maryland by 2012.
-- Improve student achievement and skill levels in Maryland by 25 percent by 2012.
-- Improve marketable skills of Maryland's workforce by 20 percent by 2012.

Sustainability
-- Accelerate Chesapeake Bay restoration efforts, reaching "Healthy Bay Tipping Point" by 2020.
-- Increase transit ridership in Maryland by 10 percent annually.
-- Reduce per capita electricity consumption in Maryland by 15 percent by 2015.
-- Increase Maryland's renewable energy portfolio by 20 percent by 2022.
-- Reduce Maryland's greenhouse gas emissions by 25 percent by 2020.


Having goals is the only way things get done, so we applaud the Governor's ambition to improve his state. We need to find some more of these ambitious plans!

SOURCE: Gov. Martin O'Malley's office

Why should your IT company know about Security?

Why should your IT company know about Security? Because lawmakers (politicians, judges, etc.) are soon going to require some pretty strict rules about EMR and IT in the clinic.

The stimulus bill included $20 billion to promote adoption of EMR. Adopting EMR promises increased efficiency, lower costs and a reduction of preventable errors. This summer, the Secretary of Health and Human Services will define standards for EMR. Among these standards, I'm pretty sure we're going to see some strong authentication and encryption requirements. (We've been doing this for years, so we're prepared!) The question is, will tougher privacy and security records stunt the efficiency and adoption of EMR?

According to new research co-authored by Amalia Miller, University of Virginia economics assistant professor, Yes.

Ratcheting up the privacy and security of medical records means slower adoption of electronic medical records. "Reducing adoption by more than 24 percent - that's a pretty big effect," Miller said. "It's important to know those costs and have that be part of the policy decision-making process. To decide how much privacy is optimal, we need to quantify the costs and benefits, and those haven't been well quantified.

I personally think its wonderful to have more stringent requirements when it comes to privacy. However, Professor Miller is absolutely correct, we must quantify the costs and benefits of any new requirements.

The issue is, what's more important, speeding up EMR adoption or protecting the actual records? Slowing EMR has substantial costs to our healthcare institution. "How long can we wait?" is the question everyone is probably asking. We have just as much of a public policy concern with slow EMR adoption (since our healthcare insurance costs are so high) as we have with protecting those EMR records.

As long as policy makers are being reasonable in their policy making, I don't see why anyone would really complain about stringent requirements! Why? Because if the requirement is practical, competent IT companies will be able to implement the proper solution. In fact, I highly believe IT companies should ALREADY be taking safety precautions when designing an IT infrastructure. I'm waiting for the first string of these requirements to come forth. I'll keep you posted.

(I won't brag about our credentials in this blog post... maybe next time!)

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eClinicalWorks Ranks 39 in the HIC 100!

Over the years I've known Girish Navani, Mahesh Navani, and Dr. Rajesh Dharampuriya, I've learned they're a pretty smart trio. They've done a terrific job at expanding eClinicalWorks, while maintaining an excellent product with quality support. Let me be one of the first to congratulate eClinicalWorks on being ranked #39 on Healthcare Informatics annual HCI 100 list of companies by HIT revenue. eClinicalWorks ranked #39 this year, moving up from #51 in 2008.

Here is the listing:

eClinicalWorks | Westborough, MA | 508-836-2700 | http://www.eclinicalworks.com

HIT Revenue: $ 86,360,323 ('08) $ 63,900,619 ('07) $ 38,214,865 ('06)
Major Revenue: Physician practice systems

Employees: 750 Market: Private Founded: 1999

eClinicalWorks' unified EMR/PM system manages patient flow and streamlines processes regardless of practice size, specialty and number of locations. Its solutions can create community-wide records.

Company Executives: Girish Kumar Navani, CEO and Co-Founder; Mahesh Navani, Chief Operating Officer and Co-Founder

President Obama & EMR

According to a White House bulletin, President Obama laid out an outline of five "key areas" that his administration will pay particular attention to, one of which is EMR.

"...we will continue to invest in the cutting-edge research and development necessary for the innovation and discovery we need to meet the digital challenges of our time. And that's why my administration is making major investments in our information infrastructure: laying broadband lines to every corner of America; building a smart electric grid to deliver energy more efficiently; pursuing a next generation of air traffic control systems; and moving to electronic health records, with privacy protections, to reduce costs and save lives."

Using the EMR model from Veterans Affairs

Policy discussion: I recently read an article in the Washington Post which states that the Veterans Health Administration operates the largest health-care system in our country and utilizes state-of-the-art records systems. Here's the excerpt:

There was no mention of the Department of Veterans Affairs' successful use of electronic medical records in the May 16 front-page story "The Machinery Behind Health-Care Reform."

The Veterans Health Administration operates the largest health-care system in the country and treats millions of veterans every year, all of whom benefit from the VA's state-of-the-art records system.

The VA's electronic medical records should be a model for care, yet they are rarely mentioned.

Citation: A Medical Records Model From Veterans Affairs, The Washington Post, p. A18 (May 23, 2009) (available in the Regional Edition)

HEALTHeLINK Signs with EMR Vendors (Interoperability)

Buffalo, NY - HEALTHeLINK, the Western New York Clinical Information Exchange, announced that it has reached formal agreements with Allscripts, eClinicalWorks, McKesson Corp., MedAppz LLC, NextGen and Pulse Systems, Inc. for the use of their technologies in local physician offices and other health care practices. The vendors have agreed to extend preferred community-based pricing to improve adoption rates.

HEALTHeLINK is a collaborative community-based approach to interoperability. Interoperability basically means the ability to move health care information safely and securely between a patient’s health care providers. Interoperability promotes collaboration and can help control healthcare costs (not to mention improving patient care!) HEALTHeLINK's vision is for Western New York to have an electronic system for real-time sharing of clinical information among health care professionals.

Study Reveals Patient's Positive Attitude Towards EMR

A new study, conducted by a research team at Beth Israel Deaconess Medical Center in Boston, MA determined how patients feel about converting their records to EMR.

In this new technological era where Facebook and Twitter are dominant, physicians should rest assured that their patients will be (according to the study) very receptive to EMR technology. The study's lead author, Jan Walker, said patients not only want computers to bring them customized medical information, but fully expect to be able to rely on electronic technology in the future for many routine medical issues. The study found that patients want full access to all of their EMR, are willing to make some privacy concessions in the interest of making them transparent and fully expect that computers will play a major role in their medical care.

To read more on this study, click here

Using EMR to conduct Clinical Research

N.Y - Clinical Research used to take months. The process would require putting together a committee of physicians and data experts to begin an elaborate research review process. Fortunately, Montefiore Medical Center used electronic health records and some new analytic software to conduct the clinical research; many of these studies are now done by a single clinician in a matter of minutes. The software is called Clinical Looking Glass (according to the cited article below, the D.O.H is also using this software). The software taps into the pool of existing electronic medical records data. While I do not know the details with which the research is done, the lesson is, EMR data can also be utilized in research (another way to improve patient care!)

The article has case studies on how the analytics software was utilized, here are some examples:
-Quantifying The Reduction of Radiation Exposure for Patients in the ED
-Publishing Professional Articles on Topics From Embolisms to Hospitalists
-Measuring Impact of a Medicare Rule: A Policy Case Study

Citation: Clinical Research; Physicians Conduct Research Studies in Minutes, Not Months, at Montefiore Medical Center, Aging & Elder Health Week via NewsRx.com, p. 41 (May 24, 2009) (available in the Expanded Reporting Section)