FerrumIT Blog

The rush to deploy comprehensive EHR systems to meet federal deadlines could create a “perfect storm” for healthcare IT: security gaps, system integration troubles, certification issues and clinician education issues, according to a two-part Computerworld report. To get it right, hospital IT pros first have to understand the technology they already have.

Erica Drazen, a managing partner in Computer Sciences Corp.’s healthcare group, told Computerworld that her company routinely asks prospective clients if they know where they are in EHR rollouts. Most have no idea.

A CSC survey found hospitals are just halfway to meeting federal standards for EHR reimbursement. There’s both good news and bad in the CSC survey, Computerworld said. For example, about 70 percent of hospitals already can support CPOE, one of the most basic elements of an EHR, and might not need to buy new hardware or software to move ahead there. But just 8 percent have such systems throughout their facilities.

“The issue is the timelines,” Denver Health CIO Gregg Veltri said. ”I wonder if anybody understands the reality of IT systems and how complex they are, especially when they’re integrated together.”

For more:
- read part one and part two of the Computerworld report
- check out the CSC survey report

The American Medical Association is busy lining up partners for a new IT marketplace for physicians that will include EMR offerings. It announced a deal with UnitedHealth Group subsidiary Ingenix to offer the Ingenix CareTracker, a web-based EMR system, on the new online platform and a separate deal with Dell to provide consulting and support services to physician.

The yet-to-be-named AMA platform is scheduled for launch later this year. Now being beta-tested in Michigan, the platform will offer a variety of products and services to help physicians improve their practices.

According to InformationWeek, Dell initially will provide consulting and support for e-prescribing and CPOE, addressing the first wave of federal criteria for meaningful use.

For more:
- read the AMA/Ingenix news release
- check out the InformationWeek article

Just how fast EMRs might spread among U.S. physician groups, given the push of federal regulations, is mind-blowing. But at least smaller physician groups hope for, and appear to need, some major help from their hospital partners, according to a new survey.

Accenture, teaming up with Harris Interactive and the New York Academy of Medicine, surveyed 1,000 U.S. physicians in smaller group practices ( those with fewer than 10 practitioners). If the survey results bear out, within two years, almost 65 percent of those groups will have bought an EMR system. Just 15 percent of survey respondents currently have one. Of the about 850 who don’t, 58 percent said they would purchase an EMR in two years.

Current non-users hope for more help than just federal incentive payments. The majority liked the idea of buying an EMR from a local hospital or health network, but on average would expect the hospital or health network to subsidize about half the cost. And survey results hint that even more help, in terms of implementation assistance, might be a good idea. Physicians tended to underestimate the expense and time needed to implement EMRs, but also saw EMRs as more difficult to use than they generally are.

Interestingly, EMR adoption appears to be a case of the “stick” being more powerful than the “carrot.” Some 61 percent of survey respondents cited federal penalties for non-adoption as a motive for buying an EMR, compared with 51 percent who cited federal incentives.

Meaningful use of EHRs undoubtedly will require interoperability of electronic health information between care settings, as well as coordination of care. With physician practices largely “still on the fence” about investing in EHR technology, according to a new Computer Sciences Corp. report, the time seems right for hospitals and health systems to take the lead in promoting “integrated EHRs” that go beyond their own facilities to serve physician offices in their communities.

“For health organizations, the ability to help with electronic health records is becoming a competitive edge,” Dr. Todd Rothenhaus, senior VP and CIO at Caritas Christi Health Care in Boston, says in the CSC report. “The ones that look away from this miss an opportunity to align with a physician who might go to another hospital system because they are supporting an EHR.”

The Falls Church, Va.-based consulting firm recommends a three-stage process for setting up a community-wide, integrated EHR: Decide whether to extend an enterprise EHR to practices or whether to help them implement a separate ambulatory system; develop a strategy for connecting hospital and practice systems; and come up with a strategy for providing financial and technical expertise to practices. Other, “lesser,” options include provider portals, HIEs that enable partial EHR functionality, such as e-prescribing, and limited data exchange.

“The bottom line on integrated EHRs within U.S. hospital communities today is that adoption has become a widely recognized objective [from within and outside the industry] that hospitals are increasingly targeting, piloting and initiating, but also one that requires a lot more work to realize,” CSC says.

For more:
- download the CSC report (.pdf)

Another week, another study on EMR adoption.

On Wednesday–the first anniversary of the enactment of the American Recovery and Reinvestment Act–Irvine, Calif.-based research firm SK&A published a report saying that 36.1 percent of physician offices have some form of electronic medical record. That’s 3.2 percentage points greater than the 32.9 percent adoption rate reported in February 2009.

Those numbers may seem high, based on studies in esteemed academic publications such as the New England Journal of Medicine, but they are in line with the findings from a recent Centers for Disease Control and Prevention report. It’s also worth noting that SK&A had a huge sample size of 180,000 physician offices in the U.S.

It’s no surprise that adoption rates seem to be related to number of physicians, number of exam rooms in the office and daily patient volume, with larger practices more likely to have EMRs. Practices owned by integrated health systems tend to have greater EMR usage as well, slightly above 50 percent. Given that primary care is increasingly burdened with high patient loads and starved for cash, general practice was near the bottom in terms of EMR adoption, SK&A reports. Dialysis, critical care and radiology reported the highest EMR usage rates.

For further details:
- take a look this Medicine and Technology post
- see this SK&A press release
- read the full report, embedded in the Healthcare IT Guy blog

The proposed rules for meaningful use of EHRs include a series of standards related to certification of EHR systems, seemingly opening up the certification process to more than just the long-established Certification Commission for Healthcare Information Technology. “There’s a one-to-one relationship between the meaningful use objectives and the certification criteria,” CCHIT Chairman Dr. Mark Leavitt says in an audio podcast with Hospitals & Health Networks magazine.

It’s still unclear, however, both how and when HHS will accredit certifying bodies, so CCHIT is having to be flexible and responsive as conditions develop. “We are operating our certification programs in just as close a correlation as we can to the federal requirements. We are in fact updating them right now so they will correspond precisely with the meaningful use and certification criteria documents that were just released,” says Leavitt, who has announced that he will step down as chairman on March 31.

Just because the government is still working through the details doesn’t mean hospitals and physician practices should delay their EHR programs, though. “We believe that it’s risky for providers to wait until all the federal rules are final,” Leavitt says. “If you wait to purchase an EHR until the rules are final and the accreditation process for certifying bodies is complete, I will put my reputation on the line and say that you will not achieve meaningful use in 2011.”

For more from Leavitt:
- download this HHN podcast

We know, we know, you’ve heard this before: It takes executive leadership, a willingness to change the organizational culture and, of course, physician buy-in to make an EMR implementation both worthwhile and successful.

At the Institute for Health Technology Transformation’s Winter Health IT Summit in Chandler, Ariz., this week, Banner Health’s senior director for clinical informatics, Judy Van Norman, explained how she had to spend about 80 percent of her time on cultural change–not the nuts and bolts of technology–to help the Phoenix-based organization implement its vision of EMR-enabled care transformation. “This project is not an IT project,” Van Norman said. “The bigger part of the work is the people piece.”

That’s pretty much what has gone on at Lehigh Valley Health Network in Allentown, Pa., too, which installed EMRs in more 25 ambulatory medical practices and will reach 40 more by the end of 2012. “In some cases, our EMR teams have spent as much as 80 percent of their time working with the practice on office workflow,” Information Services Clinical Applications Director Lori Yackanicz writes in Hospitals & Health Networks.

Cultural issues have been a big part of that. “With our initial implementations, we tailored the clinical templates to the demands of our different physician groups,” Yackanicz writes. “But it soon became apparent that over-customization was imposing a greater workload on the EMR teams trying to support and maintain the systems. It also was having a negative effect on the overall system response time and making it very difficult to pull clinical data.”

So the IS department brought in physicians to help standardize clinical templates for each division and specialty, then enlisted physician champions to help sell other doctors on the idea of cultural change and the EMR as a vehicle for quality improvement.

For more information about the Lehigh Valley strategy:
- read Yackanicz’s commentary in Hospitals & Health Networks

The conventional wisdom is that younger doctors are more likely to use EMRs than their more senior counterparts–at least when the relative newcomers have a say in the buying decision. But does patient age matter when it comes to EMR adoption? A new survey seems to suggest just that.

In a survey of 1,000 U.S. adults conducted by GfK Roper Public Affairs & Media on behalf of EMR vendor Practice Fusion, nearly 53 percent of those over the age of 65 reported that their primary-care physicians kept records electronically of their last visit, compared to just 40 percent in the 24 to 34 age group. Overall, 48 percent of respondents said their primary-care physicians had EMRs, seemingly backing up estimates by the American Academy of Family Physicians, which has said for several years that perhaps half of all family practitioners were using EMRs.

Affluence also seems to play a role in adoption. For patients with annual incomes above $50,000, physician EMR use was 53 percent. Only 45 percent of those who make less than $20,000 a year reported that their doctors had EMRs, according to the survey.

Among those whose physicians had EMRs, about 45 percent report that the switch from paper happened in the last two years.

The Practice Fusion report also suggests that the health IT industry has undergone rapid growth in the past year, adding 100,000 new jobs since the Feb. 17, 2009, signing of the American Recovery and Reinvestment Act. “I see the change in the exponential growth of our company. Doctors see it through the availability of innovative new technology. Educators see it through grants and the creation of new health IT courses. Patients see it in their doctor’s office,” Practice Fusion CEO Ryan Howard says in a company statement.

For more information:
- have a look at this Practice Fusion press release
- download this Practice Fusion white paper
- read health economist Jane Sarasohn-Kahn’s take at the Health Populi blog

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)