FerrumIT Blog

Our friends over at SoftwareAdvice.com put an interesting article up about EHR software and each vendor’s particular share of the market space.

We encourage you to take a stop by and look at what the results show from their study which is broken down as follows:

• The size of the outpatient EMR market;
• What EMR vendors have the most physicians using their system; and,
• What EMR vendors have the most practices using their system.

http://www.softwareadvice.com/articles/medical/ehr-software-market-share-analysis-1051410/

Returning to the 2004 roots of the national health IT coordinator’s role as cheerleader-in-chief for EHRs, Dr. David Blumenthal took advantage of a public speech last week to say that EHRs will indeed be in widespread use nationwide in the not-too-distant future.

“History has shown that things that improve healthcare become part of what is used. I propose to you that in a few years doctors will all support EHRs,” Blumenthal said at the 18th National HIPAA Summit in Washington, according to Healthcare IT News. “Using EHRs will become a core competency for physicians. And once we’ve established that, it will be considered an absolute requisite.”

The national coordinator then said EHR adoption will take an escalator-like trajectory once federal financial incentives kick in next year. “I think we’re going to see the upward slope of the adoption curve within a year or two, but it will be difficult to predict the slope,” Blumenthal said.

Another top HHS IT booster, Agency for Healthcare Research and Quality Director Dr. Carolyn Clancy, said that the pace of adoption will depend on how useful electronic health data is to physicians. “Information is the lifeblood of medicine,” Clancy told the gathering. “Clinicians are trained to look at patients one at a time. But, what’s missing is aggregated information.” AHRQ, of course, is in charge of comparative-effectiveness research, and thus will be providing such aggregated information to help establish standards of care.

For more on EHRs from the HIPAA Summit:
- take a look at this Healthcare IT News story

Two Ohio hospitals–Magruder Hospital in Port Clinton and Fisher-Titus Medical Center in Norwalk–soon will be among the top 5 percent of the most automated, fully digital hospitals in the United States, reports the Port Clinton News Herald. The hospitals will implement wireless, all-digital patient care systems from Cerner Corp. that will give caregivers “instant access to real-time patient information,” says Fisher-Titus President Pat Martin.

Both hospitals will go live with the new technology April 27. Magruder will spend about $10 million over the next 10 years to implement the system, while Fisher-Titus’ costs will come in at about $20 million. The price tag includes hardware, room remodeling, software, training and other costs.

Patient information will be available in each patient room via a customizable, digital television screen that uses biometric fingerprint identification. Hospital officials cite improved patient safety as the primary impetus for the move. For example, the system includes a digital medicine cabinet that tracks patient drugs and cross-checks prescriptions, as well as a wireless scanner that verifies that nurses administer the right drug to the right patient.

To learn more about the hospitals’ transition to an all-digital environment:
- read the News Herald article

A pharma-funded program in New York City will help more than 1,700 primary-care practices with EMRs coordinate preventive care for patients at high risk for serious conditions like heart attacks and strokes. The new Panel Management program, part of the citywide Primary Care Information Project, will assign outreach specialists to work with physicians to identify patients in need of screening tests and preventive treatment.

Health officials say the program will help the city achieve its goal of reducing preventable hospitalizations by 17 percent by 2012. “Panel Management moves healthcare from ‘you get it only if you come’ to a patient-centered approach that reminds people to get screenings or treatment,” New York City Assistant Health Commissioner Dr. Amanda Parsons says in a written statement.

Parsons leads New York’s Primary Care Information Project, which has helped install EMRs in hundreds of small practices. Panel Management will make use of those EMRs to find patients with chronic diseases who haven’t seen their doctors in a while. Funding for the new project comes largely from drugmaker Pfizer, city officials say.

To learn more:
- take a look at this UPI story
- read the New York City Department of Health press release

One of the side effects of greater transparency is that potentially embarrassing or alarming information could get out. This is certainly true when patients are able to view electronic medical records.

“Meaningful use” of EMRs will require providers to give patients copies of their health information on demand, but the proposal CMS released Dec. 30 does not say exactly what such reports should say, or how information should be displayed. And some patients require more context than just supposedly “normal” ranges. “You’re going to have a lot of abnormal results on paper that don’t mean anything. Some patients will be freaking out,” Dr. Steven Waldren, director of the American Academy of Family Physicians’ Center for Health IT tells a Huffington Post Investigative Fund reporter.

Kaiser Permanente has been offering a patient web portal for five years. The organization routinely used capital letters to indicate abnormal test results, and patients received an alarm in the form of an “H” to indicate a high value in their records. Kaiser, therefore, had to change how it reported lab values to compare each patient’s readings to a normal range. Intermountain Health Care in Salt Lake City took a similar tack, though Beth Israel Deaconess Medical Center in Boston still displays normal ranges and flags abnormalities and includes links to educational material to help patients understand the results.

To learn more:
- read this Huffington Post Investigative Fund article

If you’ve been following Haiti relief efforts since the Jan. 12 earthquake sent that troubled country deeper into chaos, you’ve probably seen the name “Partners In Health.” That group, a Boston-based not-for-profit with loose ties to Harvard University and Partners HealthCare System, has nine established medical clinics in Haiti, and has developed an open-source EMR called OpenMRS, now in use in nearly two dozen developing countries across the globe.

In Haiti, OpenMRS and a web-based EMR that preceded it have been tracking HIV patients at PIH clinics since early 2003. The database now contains records for more than 14,000 patients, and includes a pharmacy management tool that serves 10 Haitian hospitals and a medication warehouse. Health workers use the system to enter medication orders, as well as track and report on stock levels. The EMR also produces reports for public-health officials and non-governmental organizations that fund health efforts in the impoverished country. Thanks to satellite links, the system has remained functional throughout the current crisis.

For more details:
- take a look at this Healthcare IT News story

Former national health IT coordinator Dr. David Brailer is “pretty impressed” with the proposed criteria for meaningful use of EMRs that HHS officials published Dec. 30.

According to Brailer, who now runs an investment fund in San Francisco, the proposal is an outgrowth of much of the work he did as the first head of the Office of the National Coordinator for Health Information Technology from 2004 to 2006. Then, ONC didn’t have much money, but it was able to convene standards-harmonization activities, fund creation of an EMR certification mechanism, test various means of health information exchange and provide some direction for health IT initiatives.

“The meaningful use criteria are highly consistent with what we did,” Brailer says in an interview with Healthcare IT News. “It feels right to me.” He says the plan is the result of the “hand of thoughtful policy” that is more substantive than symbolic.

Still, Brailer is critical of the decision by Congress to put the EMR incentive program in the broad, $787 billion American Recovery and Reinvestment Act, a bill that passed largely along party lines less than a month after President Obama took office. “It puts more risks on healthcare IT adoption than are necessary,” he says. Given its history of rolling back planned Medicare fee cuts year after year, Congress may later vote to delay or eliminate penalties for non-use of EMRs that are scheduled to take effect in 2015.

For more on Brailer’s views:
- see this Healthcare IT News story

All the pundits, vendors and interest groups have weighed in on the Dec. 30 proposal for “meaningful use” of EMRs, but what do the people who actually have to demonstrate meaningful use to earn Medicare bonus payments think?

According to a survey from Computer Sciences Corp., hospitals on average are about halfway toward meeting the proposed criteria, and only one-quarter of those queried have 70 percent of the requirements covered, suggesting that HHS and CMS may have set the bar too high. For hospitals, the program starts Oct. 1, 2010, the first year of federal fiscal year 2011. “A projection of our results to the U.S. distribution of hospitals by size indicates that our survey likely overstated readiness slightly,” CSC says in its survey report. The consulting firm interviewed executives at 58 hospitals nationwide last fall before CMS released its proposed rule, but after a federal advisory panel floated a preliminary plan.

Readiness appears high in the areas of privacy and security, according to CSC, though hospitals seem to be unclear about new, tighter HIPAA protections authorized by the American Recovery and Reinvestment Act. Respondents also seem to be lagging in their ability to report on compliance with quality measures. “Many hospitals report they have the required capabilities but they are not in active use. About two-thirds have assessed where their current systems have gaps that must be filled to achieve meaningful use,” the consulting firm reports.

To learn more:
- take a look at this NextGov story
- download the CSC report (.pdf)

With federal stimulus money–about $546 million funneled into state grants promoting health information exchange projects–illuminating the way, healthcare software vendors are evaluating their offerings to see how EMRs and health information exchanges can work together to create a true marketplace and business advantage.

Connecting EMRs through HIEs, which should help facilitate access to and retrieval of timely clinical data on patients, can cut back dramatically on expenses. A single-clinician practice, for example, could waste thousands of dollars a year dealing with referrals, consults, radiology and other orders alone. Integrating exchanges to be more than storage devices for clinical information could be a great step toward productivity and profit improvement across healthcare.

In this market, business advantage may mean acquisition. Lawson Software, for example, recently announced a $160 million deal to acquire Healthvision, a Dallas-based company providing integration and application technology and related services to hospitals and large healthcare organizations. MEDecision, a vendor of payer-centric care management technology, also plans to expand its HIE strategy this spring by unveiling new products related to its acquisition last year of HxTechnologies, a provider of HIE services.

The HIE market is heating up, according to Scott Storrer, MEDecision CEO. “We’re adding over a 100 employees to support that growth,” he says in an interview with Information Week.

To learn more:
- read this InformationWeek article

There are only three types of lies: Lies, damned lies and statistics. And in the spirit of Benjamin Disraeli (or Mark Twain or whoever actually originated that phrase) comes the annual National Ambulatory Medical Care Survey from the CDC, which estimates that 43.9 percent of office-based U.S. physicians used some form of EMR or EHR in 2009. That number, considered a preliminary estimate, is up slightly from 41.5 percent in 2008. Compare and contrast that to the less than 20 percent of physicians said to be EMR users in a highly publicized New England Journal of Medicine paper in 2008.

Breaking down the numbers leads to a little more sanity. About 20.5 percent of respondents say they had a basic system capable of recording patient demographics, problem lists, clinical notes, medication orders and of viewing test results. Just 6.3 percent had fully functional EMRs, with medical histories, electronic order entry, drug interaction checking, highlighting of abnormal readings and reminders for guideline-based interventions, the CDC says.

The CDC survey is based on self-reported data, so there is always the chance for bias. I guess we won’t know some real numbers until 2012, after a year of practices seeking Medicare and Medicaid bonuses for EMR use.

For more information:
- take a look at this Healthcare IT News story
- see this piece from CMIO
- read the CDC’s preliminary report (.pdf)