Tuesday, May 1, 2007

Will Patients select their MD according to Who Has an EMR??

Although I was unable to attend the Consumer Directed Health Care Conference in Las Vegas t his past week (CDHCC) I have been able to follow some important information published on their web site.


Another Reason to Adopt Electronic Medical Recordsby Scott MacStravic
April 30, 2007 at 9:40 pm · Filed under Health IT

A recent Accenture survey found that two-thirds of consumers responding indicated that having an EMR system or not played a role in their selection of a physician. Moreover, a little over half of these consumers said that they would be willing to pay a reasonable extra amount to cover the costs of such a system. Despite this consumer preference, only about 10% of practices and 25% of doctors have EMR systems in place. The cost of implementing and maintaining the system is the overwhelming barrier, with 86% of physicians reporting that as a concern. [“Survey Finds Patients Favor Doctors Using EMRs” E-Health Trend Watch Apr 27, 2007 (www.hcpro.com)]
This consumer attitude adds to the many quality and efficiency reasons for physicians to adopt EMR systems. Fortunately, governments, employer coalitions, and hospitals are indicating a willingness to support physicians’ efforts to digitalize their records systems, and laws against hospitals helping are being relaxed. But another reason emerged in a breakout presentation at the World Healthcare Congress this week.
During the presentation of Regence BlueCross BlueShield and the software firm, Kryptiq Corporation, both in the Northwest, the preference of at least that employer for physician practices with EMR systems was made clear. This makes good business sense for Kryptiq, since it is in the software business, but also because of the advantages the EMRs offer in employee health management.
Almost all the current pressure on physicians to adopt EMR systems focuses on their importance in sickness care. They enable physicians to more quickly access information needed to diagnose and treat patients who are ill, to avoid duplication of tests in making diagnoses, and avoid contraindicated medications in treatment, for example. They also facilitate coding and billing, so help practices in managing cash flow.\
Growing importance is being given to the prospect of sharing EMR information across practices, to improve continuity of care when multiple practices are involved in an episode of care, for example. Regional Health Information Organizations are emerging as ways to enable sharing of data by practices when patients seek care away from their usual sources, perhaps in emergencies such as hurricane Katrina.
But EMRs are also excellent foundations for health management, for preventing and catching early risks and diseases that can be managed in ways that reduce direct sickness care costs, but also worker absences, impaired performance while at work (“presenteeism”), disability wage replacement costs and other labor costs to employers. And employers can influence the physician selection of hundreds, even thousands of employees.
Kryptiq considers the presence of EMRs in deciding which physician practices to include in its provider network, for example, and selected GreenField Health System in Portland, OR as a partner in its effort to manage the health of its employees, not simply deliver sickness care. The founder of GreenField Health serves on the Kryptiq board, while GreenField is also a customer for Kryptiq’s secure online communications system for communicating with patients. Such communications improve the efficiency of practices by eliminating unnecessary office visits, while providing the foundation for ongoing health improvement and maintenance efforts.
In addition to using EMRs as one factor in choosing practices for provider networks, employers can use EMR-enabled performance data on how well practices are doing in managing employee health to inform individual employee choices of personal physicians. When employee performance makes a difference to their compensation and career prospects, and health has a significant impact on their performance, this adds another reason for patients to prefer physicians with EMRs.
My comment

This is obviously a biased survey, since it was performed by businesses that stand to gain from IT adoption.

Friday, April 13, 2007

More on Scott Shreve and HIE from CALRHIO

For those of you who have already read Scott's blog you will realize here is an experienced professional who has laid "the railroad tracks" for Enterprise Health Records. I recommend the article highly to others.

CALRHIO has elaborated a comprehensive plan for the state of California to plan and implement a Health Information Exchange Backbone. This structure will be built out by Medicity and Perot Systems. It will integrate both state, county and private health care providers.

For details I have extracted the information from their posting.
It follows:



HIE Utility Service at-a-Glance

PURPOSE
To build a statewide health information exchange (HIE) utility service that will offer California health care providers and patients secure electronic access to patient medical records, where and when needed.

CalRHIO’s primary goal is to deliver critical health information services securely, reliably, and affordably to clinicians, patients, state, county, and federal health agencies, and communities throughout California.

PROFILE
The CalRHIO HIE Utility Service will provide a suite of services from which individual organizations and regional efforts can select to use some, all, or none. The financing model is designed so that participants are not paying for initial development and implementation of the utility service. Those who benefit pay only for the services they need and use.

The CalRHIO HIE Utility Service will provide health information exchange services that are:
available at a price that no one entity can achieve alone
flexible and adaptable to support a wide variety of legacy systems and technical environments – services adapt to existing technology
designed to permit local users to consume and pay only for those services they find valuable and are not duplicative of services provided locally
ARCHITECTURE
Service Oriented Architecture (SOA): SOA framework and Web services platform facilitates scalable, incremental growth and is capable of quickly deploying new services through the re-use of existing services. Because of the variability in IT system environments, as well as the diversity of business and clinical landscapes within health care communities, no one architectural model will suffice. Given the existing challenges, an architectural style of design for constructing HIE models must be flexible and adaptable to resolve variability and diversity issues. A Web services implementation of SOA can meet these complex, diverse business and technical requirements characteristic of HIE initiatives.

UTILITY SERVICES
Phase I: Establish a state layer or “backbone” of data and services
Phase II: Create regional overlays that leverage and expand on the state layer by adding local data sources and additional services
STATE LAYER - State Network Backbone consists of data and services
· Data: state and multi-regional clinical feeds (claims history from payers, lab/pathology reports from national labs, Meds from RxHub and SureScripts)
· Applications: Master Patient Index (MPI), Record Locator Service (RLS), e-Prescribing
· Options (for regions that are ready):
o Integration Hub: translates patient-centric health information between various Electronic Medical Record (EMR) vendor applications
o EMR Gateway: clinical feeds from lab/path reports from national labs, Meds from RxHub and SureScripts to the physician’s EMR application
REGIONAL LAYER – regional overlay of state network with local data and services
· Data: Local clinical data from hospitals, local labs and imaging facilities (data to include labs, radiology reads, transcription, etc.)
· Application Services: include a MPI; RLS; Electronic Health Record (HER) & Personal Health Record (PHR); medication management (e-Prescribing & medication reconciliation); clinical messaging (referral, lab & imaging orders and results; and data warehouse for reporting and analysis
· Integration Hub Service : translates patient-centric health information between various EMR vendor applications.
· EMR Gateway Service: clinical feeds from lab/path reports from national labs, Meds from RxHub and SureScripts to the physician’s EMR application

State Layer
State of California Clinical Data Services
MPI
RLS
EMR Gateway
Patient
Payor
Provider
Claims
History
RxHub
SureScripts
National
Labs
National Data Feeds
Statewide, Real-time
Clinical Data Access




Region A
State of California Clinical Data Services
MPI
RLS
EMR Gateway
Patient
Payor
Provider
Claims
History
RxHub
SureScripts
National
Labs
National Data Feeds
Region
B
Region
C
Regional Layer
Local Data
(From Labs, Hospitals, EMR)
EMR Gateway
Regional Reporting
BENEFITS FOR ALL USERS
· An information infrastructure that supports optimum care delivery methodologies, transparency, patient empowerment, and integrated health care records
· A utility-like infrastructure that moves health care information efficiently and at a cost that is a small fraction of the money saved for payers, patients, and providers alike
· Affordable utility services that facilitate regional health information exchanges and interconnections among them

PHASE I USERS
· EMERGENCY DEPARTMENTS
· CLINICS
· PHYSICIAN OFFICES

PRIVACY and SECURITY
Users must be authorized and authenticated and have either obtained a patient’s consent or documented an emergency. All data sharing will be carried out pursuant to state and federal laws involving patient consent, privacy, and security. Will require all appropriate parties agree on data sharing scope and methodology.

PARTICIPATION
Participation by individual organizations and communities is completely voluntary. Participation is NOT mandated by any private or public entity.

FAQ
Q: Why is CalRHIO creating a technology platform of its own instead of relying entirely on local organizations to provide a technology platform that satisfies local needs?

A: Time is of the essence. On average, every business day in California more than 50,000 patients are receiving suboptimal clinical care solely because we do not have a comprehensive method for moving patient records where and when they are needed. To rely solely on local organizations to individually engage in the expensive and time consuming effort to select vendors, develop detailed requirements, and supervise a complex HIT project will materially delay the widespread sharing of important patient medical information. CalRHIO is offering an option that organizations and communities can use to meet their individual needs and help advance HIE throughout the state.

CalRHIO and ITS STRATEGIC PARTNERS
Medicity and Perot Systems Corporation were selected to build the CalRHIO utility service through a competitive bidding process. Medicity and Perot Systems were selected because their solution offers a strong, proven, and scalable technology platform that will eliminate limitations on how individual health care organizations and local communities design and implement the health information exchange services they need.

In addition to a suite of solutions that are already integrated and interoperable, Medicity and Perot Systems brought an innovative financial model to the table that will enable CalRHIO to sustain the project long term. Creating a sustainable business model is one of the biggest challenges for health information exchange efforts nationally.

COST AND FINANCING
· The financing model eliminates the front-loaded expenses that penalize the early adopters.
· Cost to the Point of Sustainability: Capital required to finance an implementation that is thereafter sustainable without further capital infusion will require up to $300M with financing coming in two stages: 1) initial private equity funding covering the phase one build of the state HIE backbone and 2) after backbone delivery of basic information and proof of concept, final funding with more traditional debt financing replacing private equity capital. A connected California could save $9B annually.

Stakeholder
HIE Benefits
Physicians
· More “real time” information from outside clinical setting
· Rapid access to test results and ability to track medication history
· Changes the point of clinical aggregation from physician’s desk to having aggregated clinical data accessible electronically – reportable and available anywhere, anytime
· Improves referred patient flow, eligibility determination
· Improve patient experience
· Improves administrative efficiencies and offers administrative savings
· Improves the consistency and completeness of documentation
Health Plans
· Potential to drive down administrative costs
· No capital required; only an expense-related payment, and then only after patient HIE services actually rendered
· Potential to significantly reduce expenditures for unnecessary, redundant, or ineffective services
· Pathway to improved care, quality
· Support for value driven health care and pay-for-performance by helping health care organizations track and document the efficiency and appropriateness of care patients received
· Potential to perform widespread data capture for analysis of utilization rates and quality and performance measurements, which has the potential to reduce costs and improve quality of care
Hospitals
· Reductions in administrative times: (Experience of Indiana HIE is 12 min. reduction in nurse and pharmacist time for each admission as a result of “delivering synthesized useful medication histories to hospitals”)
· Improves care delivery and efficiency through immediate access to information that assists clinicians in diagnosis and treatment
· Support for medication reconciliation in accordance with JCAHO requirements
· Source for patient coverage eligibility for both private and public health plans/insurance
Patients
· Improve care at the point of delivery (including reduced medical errors)
· Improve overall coordination of care
· Improve application of evidence-based medicine
· Facilitate greater patient engagement in their health care through networked personal health records
Employer
· Improve transparency on cost and quality
· Help educate consumers about value and ultimately reduce cost through increased preventive care and lower hospital admissions
· Improve quality of care and reduce preventable admissions
Public Health
· Move toward ability to aggregate surveillance data of disease and critical patient information during disasters or bioterrorist threats

Monday, April 2, 2007

Sunday, March 25, 2007

NATIONAL HEALTH INFORMATION NEWS-WATCH

Timely and current information regarding RHIOs in the United States is available at NHIN Watch, http://nhinwatch.com/performSearch.cms?channelId=1

The Office of the National Coordinator for Health Information Technology (ONCHIT) offers a listserv mail list which announces what ONCHIT is doing to advance RHIO development.
It can be found at: https://list.nih.gov/archives/health-it.html

Sunday, March 18, 2007

Google announces collaboration with Practice Fusion

Practice Fusion and Google, the internet search engine have announced a collaboration whereby the EMR and RHIO solution will be offered to providers free of charge. Income will be derived from advertising banners supplied and linked by Google, which will be accessible from the EMR pages used by the provider online. Privacy issues are one of the main concerns for this business model, which however can be addressed since the advertising would not be linked to particular patient's records.

Featured in RHIO Monitor CALRHIO selects Vendors

Featured in: CalRHIO Selects Medicity and Perot Systems Corporation to Build Statewide Health Information Exchange for California
CalRHIO Selects Medicity and Perot Systems Corporation to BuildStatewide Health Information Exchange for California
SAN FRANCISCO, Calif., March13, 2007 – CalRHIO announced today that it has selected Medicity, Inc.,teamed with Perot Systems Corporation (NYSE:PER), to build a statewidehealth information exchange utility service that will offer Californiahealth care providers secure electronic access to patient medicalrecords, where and when they are needed.
“CalRHIO’s primary goal is to deliver critical health informationservices reliably and affordably to clinicians, patients, state,county, and federal health agencies, and local exchange effortsthroughout California,” said CalRHIO CEO and President DonaldHolmquest, MD, JD. “Medicity and Perot Systems were selected becausetheir solution offers a strong, proven, and scalable technologyplatform that will eliminate limitations on how individual health careorganizations and local communities design and implement the healthinformation exchange services they need.”
“In addition to a suite of solutions that are already integrated andinteroperable, Medicity and Perot Systems brought an innovativefinancial model to the table that will enable us to sustain the projectlong term,” said Molly Coye, MD, MPH, one of the founding directors ofCalRHIO’s board and CEO and president of the Health Technology Center.“Creating a sustainable business model is one of the biggest challengesfor health information exchange efforts nationally,” Coye noted, citingfindings of a federal study she chaired last year that assessed ninestatewide HIE initiatives.
Medicity and Perot Systems’ first step will be to assist in theprocurement of private seed money to fund start-up costs for theCalRHIO HIE utility service, including building the statewide backboneinfrastructure and integration, marketing and communication, andCalRHIO’s operating budget. Financing requirements for this phase areestimated at $300 million.
The health information exchange platform will make it possible forphysician offices, hospitals, and health plans that have invested inhealth information technology to use their current technology to accessdata outside their walls. While details of charges are yet to bedetermined, the savings expected as a result of having betterinformation will be many times greater than the cost, according toHolmquest.
Through its partnership with Medicity and Perot Systems, CalRHIOwill offer a suite of secure, privacy-protected services from whichorganizations can select to use all, some, or none. For example, forcommunities that want to enable all their health care providers toexchange information, CalRHIO’s HIE utility service will offer anoptional alternative to building and financing their owninfrastructure. For communities that have already initiated localhealth information exchange efforts, the services offered will becompatible and complementary.
“It is imperative that we get a technology solution up and runningas soon as possible to accommodate the needs of California doctors,hospitals, and patients,” Holmquest said. “Every day in California,50,000 or more patients are experiencing suboptimal care solely becauseimportant medical information is missing from their records. Payers andpatients are paying huge additional costs because of the fragmentedcare that result from lack of timely information.”
-

Tuesday, March 6, 2007

Cerner Statement

I missed last week’s deadline for RHIO MONITOR and Health Train Express due to some interviews and other related projects on EMR. I myself am in the midst of examining and implementing an EMR for my practice. In the process I have had the advantage of my research and study of RHIO as coordinator of a RHIO. In my evaluation it has become apparent that having an EMR which is certified by CCHIT is the ticket of admission, for any serious vendor. All that hard work of the past two years is paying off and demonstrates the process will take time and much patience. Of course I am speaking to the choir, but it emphasizes that we need to do a lot more educating of our fellow physicians. The scope and depth of understanding varies tremendously amongst physicians about EMRs, and RHIOs. There continues to be a divide between vendors and providers. According to my sources they have a difficult time and spend much of it explaining IT to providers. Providers’ eyes glaze over when given a new set of vocabulary and how these systems operate. The differences are also generational. Younger MDs have a set of material from their education which now exposes almost all school children to the basics and more of computers. Microsoft Windows is now the W of the three Rs.
One publication I have access to is a resource is “Functional Matrix” of a number of EMR solutions as prepared by the American Academy of Ophthalmology. While focused on ophthalmology it organizes in a readable manner the items all provider should look at when examining EMRs.
This resource can be found at: http://www.aao.org/aaoesite/promo/business/EMR3.cfm
A profound statement by the CEO of Cerner was quoted in iHealthbeat, published by the California Health Foundation.

Cerner CEO: Revamp Health Care Reimbursement SystemMarch 01, 2007
The U.S. health care reimbursement system is "grossly inefficient" and "needs to be changed," Cerner Chair and CEO Neal Patterson said Tuesday at the Healthcare Information and Management Systems Society conference in New Orleans, the Kansas City Star reports.Patterson cited the Healthe Mid-America program, run by Cerner, as an example of how the system could be improved. The independent, not-for-profit program manages the employee health records of Cerner and about 20 other Kansas City-area businesses. Program participants can use an electronic debit and information card to pay for a physician visit and to access computerized personal health records with a PIN, the Star reports. Patterson cited a study that found that 31% of U.S. health care spending is on administrative costs and said that one of Cerner's "goals is to eliminate insurance companies as they exist today." The Healthe Mid-America program is being tested in the Kansas City area, and Cerner hopes eventually to expand the program nationwide, the Star reports (Karash, Kansas City Star, 2/28).

End quote: The Kansas City Star link expands on this brief .

 
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