Posts Tagged ‘Electronic health records’

EHR Adoption Moving Forward

Wednesday, March 14th, 2012

The nation’s hospitals must demonstrate that they have collected the vital statistics of more than 80 percent of their patients in digital form if they want to continue receiving as much as $14.6 billion in federal grants for installing electronic health records (EHR) technology.  Awards as large as $11.5 million are available to hospitals that can prove “meaningful use” of the equipment, under preliminary rules issued by the Obama administration.  Physicians can apply for grants of $44,000 or $64,000, depending on whether they treat patients in Medicare or Medicaid.

The rules continue carrying out an initiative in the American Recovery and Reinvestment Act (ARRA) as a step toward overhauling the nation’s healthcare system, specifically in the Health Information Technology for Economic and Clinical Health (HITECH) Act.  Hospitals and doctors should achieve “substantial benefits” from adopting digital records, including lower record-keeping costs, fewer pointless tests, shorter hospital stays and reduced medical errors.

The percentage of U.S. hospitals that have adopted electronic records more than doubled between 2009 and 2011, to 35 percent, according to the American Hospital Association.  Approximately 85 percent of hospitals told the association that they plan to take advantage of government incentives by 2015.  The government expects that by 2019, 96 percent of hospitals will adopt electronic records and at least 36 percent of doctors’ practices.

In this second stage of adoption of EHR, the government is emphasizing making sure that electronic systems can talk to one another – or are “interoperable.”  According to Kaiser Health News, it’s “a real push ahead,” said Farzad Mostashari, the national coordinator for health information technology.  The rules require systems be able to transfer patient information across platforms.  A “summary of care” — including past diagnoses, procedures and test results – must be able to follow patients across referrals and changes in health care provider.  Additionally, the information should be available to some patients, who under Stage 2 requirements must be allowed to view their records online, as well as download and transfer information.  Finally, some patients must be able to communicate with their doctors through a secure, online system.

According to a survey of 302 hospital IT executives, more than one-quarter said they had already proven to the Centers for Medicare and Medicaid Services (CMS) that they have met the government’s standard for the first stage of meaningful use of health IT.  That means they have demonstrated that they have the baseline capabilities in their CMS-approved health IT system to collect and submit data.  Stage 2 also deals with security of exchanging patient information electronically, particularly the risk of a doctor mistakenly leaving his laptop or iPad accessible to the public.  “A huge, huge, huge portion of all breaches don’t occur because someone hacked into the system; they occur because people left their laptop on the train and they didn’t encrypt it,” Mostashari said.

Writing on the practicefusion.com website, Robert Rowley, M.D., says that “Stage 2 is about connectivity.  So let us take a step back and re-assess the larger picture.  Stage 1 Meaningful Use is about adoption of EHRs into the daily practice of clinicians and hospitals.  It is about moving the documentation of healthcare away from paper, and onto a digital platform.  The platform didn’t really have to connect with anything, though the capability to connect needs to be built for the technology to be Certified.  Stage 2 is about connectivity.  Now that EHRs are adopted, implemented and used meaningfully, the next stage is intended to be about connecting the silos together.  Stage 3, to come later, will be about inserting Decision Support between the connections, so that best practices (as well as authorizations) become part of the daily fabric of healthcare.”

A little-known fact is that EHR adoption is having a positive impact on healthcare IT job creation.  According to job resource Medzilla, an estimated 50,000 new jobs have been created in the health IT field since 2009, when the government passed the HITECH Act, which authorized funding for the EHR incentive program.  “The statistics over the past few months have been more than encouraging,” said Del Johnson, director of client relations at Medzilla.  “Here you have two, previously separate industries that are rapidly growing into one another.  Where the two meet you have an opportunity to explore a completely new labor pool.”

Senators Question CMS Rules for ACOs

Wednesday, August 24th, 2011

Some Senators want the rules for Accountable Care Organizations (ACOs) rewritten to increase their acceptance by providers. “An ACO model that can increase provider coordination and patient accountability would be a step in the right direction compared to today’s fragmented delivery system,” wrote the senators, led by Mike Enzi (R-WY) to Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Donald Berwick. “However, it is increasingly clear that this proposed rule misses the target.”

According to the Senators, the ACO rules have misaligned incentives and accountability, as well as an unclear return on investment for physicians and other providers. The Senators highlighted healthcare providers who have raised concerns about the ACO rules, including the American Hospital Association, which released a study that estimated six to 14 times higher start-up costs for the new entities than estimated by CMS.

The AHA study determined that the costs of elements to successfully manage the care of a defined population is considerably higher – $11.6 to $26.1 million – than the $1.8 million estimated by CMS in its proposed rule for start-up and one year of operations. “CMS’ estimate falls short of the mark,” said Rich Umbdenstock, president and CEO of the AHA. “The shared savings rate with ACOs should be adjusted to reflect these costs in order to encourage and enable participation in this important program.” Specific areas of concern include network development and management , care coordination, quality improvement and utilization management ; clinical information systems; and data analytics.

In addition to Enzi, the letter was signed by Tom Coburn (R-OK); Jon Kyl R-AZ); Mike Crapo (R-ID); John Cornyn (R-TX); Pat Roberts (R-KS); and Richard Burr (R-NC).  According to Coburn, who is also a physician, “The letter I signed today echoes the reservations of health professionals who have expressed deep concerns about the well-intended, but ultimately unworkable, ACO regulations recently proposed by the administration. It is certainly my hope that the administration will not misread this letter as partisan, but will work to address the underlying problems of misaligned incentives and regulatory uncertainty that have elicited such concern by a range of health care institutions and providers. If the administration withdraws the regulation, they will find strong bipartisan support among Congress and stakeholders to craft a proposal that encourages broad participation in innovative models to achieve lower costs and better care.”

Berwick and CMS officials believe that organizations that participated in demonstration projects will back the rules because the results showed that Medicare saved more than $38 million in the years of the pilot program; the medical groups that participated got performance payments from the feds totaling more than $31 million. Among the participants are some of the nation’s most prestigious medical systems, including The Mayo Clinic, The Cleveland Clinic and the Geisinger Health System in western Pennsylvania.

Part of the problem, according to The Hill, is that budgetary concerns were the elephant in the room when the Obama administration wrote the proposed ACO rule. This resulted in regulations requiring stringent quality improvements that offered no upfront funding for hospitals to change their procedures. According to regulators, the proposed regulation is open for public comment and can be fine-tuned. CMS recently unveiled new tools to help hospitals start care coordination efforts, for example, by giving them the money they’re supposed to save Medicare through more efficient patient care.

According to the letter, “We have been struck by the increasingly diverse chorus of concerns many of our nation’s leading health care institutions have raised in recent days. The concerns…from some of our nation’s most knowledgeable and innovative health care providers are clear. Incentives and accountability are misaligned. Detailed requirements are complex and return on investment is uncertain.”

Although the Senators complimented the work put into the ACO rules draft, the letter said that feedback received from providers around the country brought the Senators to the conclusion that the proposed ACO regulation will not fulfill its purpose.

Another perspective is offered by Robert Tennant, a managing associate with Health Directions, who says that “I’d like to offer another point of view. Certainly, for most healthcare organizations, transitioning to an ACO will create short-term expense and disruption. At Health Directions, we are finding that healthcare organizations are not dismissing ACOs outright, but they are first asking: What do we stand to gain? In some cases the answer may be either not clear or not favorable. Regardless, there is a potential upside if the focus remains on increasing quality and efficiency of care delivery. As we weigh the future of ACOs, let’s not throw the baby out with the bathwater. The point of discussion needs to shift from whether or not to become a formally organized ACO down the road toward a more focused evaluation of which ACO-type elements are worth adopting now. A commitment to achieving meaningful use with an electronic health record (EHR) is a step in that direction, as is participating in a quality-driven pay for performance program. Both have short-term, well-defined financial rewards attached to them and both will likely increase quality of care. The key is for healthcare organizations to remain focused on the underlying thought behind ACOs — improving care and reducing costs. And that really is worth getting excited about.”

Electronic Health Records Are Great, But What About Privacy?

Wednesday, June 15th, 2011

Americans will be given a tool that helps them keep their personal information private if a proposed Department of Health and Human Services (HHS) rule is adopted.  The change in federal healthcare privacy laws proposed by HHS would give patients the right to see the name of any person who accessed their electronic health records, and what he or she did with them.  The “access reports” would be available from some healthcare providers as soon as January 1, 2013.  It would be similar to a free credit report — consumers would have the ability to request one report for free every year.  The move is the latest in an effort by the Obama administration to update and streamline the nation’s medical records system.

The proposed “access report” right has its roots in a provision of the 2009 stimulus package passed by Congress to start the economy moving and which contained $30 billion to encourage development of electronic healthcare records, called the Health Information Technology for Economic and Clinical Health (HITECH).  To ease concerns about the security of online health records, Congress told the HHS’  Office of Civil Rights (OCR) to strengthen consumer disclosure rights included in the Health Information Portability and Accountability Act (HIPAA).

“This proposed rule represents an important step in our continued efforts to promote accountability across the healthcare system, ensuring that providers properly safeguard private health information,” OCR Director Georgina Verdugo said.  “We need to protect peoples’ rights so that they know how their health information has been used or disclosed.”

In the proposed rule, HHS said the majority of providers oppose the change, because they believe it would be costly to implement and provide minimal consumer benefit.  Tena Friery, a HIPAA expert with the Privacy Rights Clearinghouse advocacy organization, disagrees, noting that the potential to identify who accessed a health record would be a significant disincentive to potential snoops.

Disclosure reports would summarize medical information transfers to entities such as law enforcement, judicial hearing or public health investigations, but would not explain the reason for the transaction.  Under the proposed rule, exchanges of medical information made via an electronic health records systems would not be included in a disclosure report.  “After careful consideration of this option, we concluded that accounting for such disclosures at this time would be overly burdensome when compared to the potential benefit to individuals,” the proposed rule states.

So just how prevalent are unauthorized views of Americans’ healthcare records?  The New York Times reports that the personal medical records of at least 7.8 million people have been improperly accessed in the past two years.  The Office of Civil Rights has a website dubbed the “wall of shame which lists 300 hospitals, doctors and insurance companies who have reported significant breaches of medical privacy.  The list reveals that major HMOs such as Kaiser Permanente Medical Care Program, New York Presbyterian Hospital and Columbia University Medical Center have experienced medical records security breaches.  These can occur when a laptop or other portable electronic device is lost or stolen.  An employee of Massachusetts General Hospital left the paper records of 192 patients on a Boston subway train.  Other reasons may be improper record disposal; hacking; and the unauthorized accessing of computer records.

Cleveland Clinic Moves Towards More Personalized Healthcare

Thursday, January 27th, 2011

The renowned Cleveland Clinic has launched a Center for Personal Healthcare “for the identification, analysis, adoption and integration of select new services and technologies that will allow for personalized care of patients,” according to the clinic.   One goal of the program is moving information on the patient’s family medical history – which is currently available via the Clinic’s electronic health-record system – and developing clinical decision support tools to transmit pertinent information to physicians as quickly as possible.

Kathryn Teng, M.D., a primary-care physician at the Cleveland Clinic, is heading the new center.  She said “In the first year, we plan to create awareness of, and supply physicians with, additional resources that allow collection and analysis of family medical history.  Ultimately, our goal is to help clinicians offer a wider range of considerations and options for patients, while also providing patients with resources that encourage proactive behavior and empower them to be active partners in their health plan.  This new center will build on our efforts to create evidence-based personalized health plans for our patients by incorporating new technologies and innovations which will allow us to truly focus upon each individual,” said Dr. Teng.  “There will be a greater emphasis on the physician-patient relationship as we team together to develop more accurate and personalized care plans.  Our ultimate goal is to empower our patients and our community towards greater health.”

Teng is an assistant professor at the Cleveland Clinic Lerner College of Medicine and Case Western Reserve University.  Additionally, she has been the Clinic’s director of general medicine since 2007 and the patient experience officer since 2008.  Additionally, she founded the Voice of the Patient Advisory Council for the Medicine Institute.

HHS Designates $8 Million to Advance Community Health Centers

Monday, December 13th, 2010

The Department of Health and Human Services (HHS) has announced that approximately $8 million in federal funding will be made available to community health centers that have cooperative agreements to provide training and technical assistance to local organizations. The agency’s Health Resources and Services Administration (HRSA) noted that the funding is courtesy of the Patient Protection and Affordable Care Act.  The health centers will use the funding to promote community development, plan expansions, create patient-centered medical homes and support the adoption of electronic health records.  Additionally, the Affordable Care Act will invest $11 billion to fund the operation, expansion and construction of community health centers across the country.  Of that, $9.5 billion will be used to construct community health centers in regions that are medically underserved.

“These Health Center Cooperative Agreements help build on the Affordable Care Act’s investments in community health centers,” said HHS Secretary Kathleen Sebelius.  http://www.hhs.gov/news/press/2010pres/11/20101119b.html “These funds will provide assistance to community health centers to help them improve access to healthcare services, especially for those who are uninsured, isolated or medically vulnerable.”

Community health centers serve nearly 19 million patients, approximately 40 percent of whom lack health insurance.  These centers deliver preventive and primary care services at more than 7,900 service delivery sites around the country to, regardless of patients’ ability to pay.  Charges for services are set according to income.

“The funding the Secretary announced will ensure that health centers who need it have the ability to plan for their futures,” said HRSA Administrator Mary K. Wakefield, Ph.D., R.N.  “Community health centers provide high quality health care to anyone who needs it, these funds make continuing that care possible.”