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