Health care may be the fastest growing industry, but it has been slow to adopt the use of technology. While orders at fast food chains are now entirely automated, most physician offices and hospitals still maintain their records on paper.

In a new position paper released today by the American College of Physicians (ACP) at www.acponline.org/advocacy, the nation's largest medical specialty organization says that collaboration among physicians, patients, technology developers, and policymakers must occur if e-health activities like electronic communication between physicians and their patients, remote monitoring of patients, personal and electronic health records, and patients seeking health information online are to transform health care in the U.S.

"E-health activities have great potential to improve the quality of patient care, reduce medical errors, increase efficiency and access to care, and achieve substantial cost savings," says David C. Dale, MD, FACP, president, ACP. "Furthermore, e-health is a critical part of the patient-centered medical home model of care, which in coordination with the other components, is the future of the U.S. health care delivery system."

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Anxious to link inpatient and outpatient data, some hospitals seize chance to help fund EHR conversion.

What used to be one hospital's pipedream -- connecting information from inpatient and outpatient settings -- is getting a trial run, thanks to new federal rules that allow hospitals, group practices and other specified health organizations to help physicians get new data-related technologies at reduced or no cost.

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Physicians find strength in numbers when negotiating with technology vendors.

Physicians in several practices in Rhode Island are about to get a new electronic health record (EHR) -- at prices up to 30% off what they might have expected to pay. They've discovered one way to overcome what can be an insurmountable cost barrier: the power of shared negotiation.

Sidebars:

• E-prescribing: New ACP guide tells you what you need to know
• Massachusetts collaborative launches EHR pilots
• RHIOs: building blocks to a national network

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Be prepared for some tense moments as you transition from paper to computer.

At Greenhouse Internists in Philadelphia, getting patients' phone messages to physicians used to be a fairly simple process. The receptionist would write the message down, pull the patient's chart, clip the message to the chart and place them both on the doctor's desk. The physician would record the conversation in the chart and then send it back to be filed.

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The CMS' offer sounds exciting -- but important service questions remain unresolved.

The headline in the July 21 issue of the New York Times announced what could be very welcomed news: "In Unexpected Medicare Benefit, U.S. Will Offer Doctors Free Electronic Records System."

Sidebars:

• Where to look for EHR resources
• Adding up the costs

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Common mistakes include converting too fast and underestimating how much time and training offices need.

Over the past year alone, physician salaries have shot up 30% at the four-physician Evans Medical Group in Evans, Ga., a suburb of Augusta. New revenue-producing strategies should boost that to an 80% increase next year--due in large part, said a physician member, to its electronic health records (EHRs) system.

Sidebars:

• Wave of the future: personal health records on the Web?
• One physician puts EHR savings to work by hiring pre-med students

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The CMS has launched a new community-based demonstration project of electronic health records (EHRs) designed to show that the adoption of interoperable EHR systems would reduce medical errors and improve the quality of care. Interoperable systems are capable of communicating with each other and sending electronic information back and forth, regardless of the particular physician's office or hospital in which they are being used.

The demonstration project will be conducted over a five-year period and will focus on small- to medium-sized primary care practices. CMS will offer financial incentives to physician practices in the chosen communities that use certified EHRs to improve quality as measured by their performance on quality measures. Bonus payments will be based on the number of EHR functionalities that the physician practices have incorporated. And, to further demonstrate the effects of financial incentives, CMS will be encouraging public and private payers to offer similar incentives.

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All sorts of unexpected things can happen in the process of going paperless, but the effort is ultimately worth it, said several physicians who participated in the ACP Center for Practice Innovation's (CPI) quality improvement project.

Potential benefits of EHRs include getting organized; improving quality indicators, patient care, and coding accuracy; and increasing reimbursements, internists said. To realize those advantages, however, physicians need to choose their EHRs wisely, set up a timeline for implementation, make workflow changes, communicate well and be prepared for the inevitable snags.

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Practicing physicians across the country have begun to purchase and install Electronic Health Record (EHR) systems for their practices. Despite the prolific number of products, adoption rates remain low, especially for physicians in solo or smaller practices (e.g., less than 10 physicians). One of the most cited barriers to adoption is the level of financial risk to the practice.

In response to member needs for guidance in the selection and implementation of practice-based Electronic Health Record (EHR) systems, ACP has developed the EHR Partners Program. The EHR Partners Program is a service offered exclusively to members and is a collaborative effort between ACP and participating certified EHR companies (the "EHR Partners"). Additional EHR Partners are expected to be added as this program matures.

Using the tools provided by the EHR Partners Program, ACP members can review information on EHR systems that have been certified by the Certification Commission for Healthcare Information Technology (CCHIT). CCHIT certification focuses on baseline criteria for functionality, security and interoperability. The EHR Product Selector Tool, developed exclusively for ACP members, is an interactive comparison tool to assist physicians in narrowing their EHR choices. Physicians can:

• search for EHR partner systems that match a selected set of criteria
• choose among the set of EHR partners to compare across criteria

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Unlike the installation of word processing and other off-the-shelf software applications, adoption of EHR is an on-going process. Intended to transform practice operations, it requires analyzing existing processes, carefully planning operational changes, and diligent effort to bring about those changes. The process has been likened to adding a room to your house: once the construction is completed you still must decorate, furnish, and equip the room. Similarly, reaping the value of an EMR requires customizing it to your own needs, adjusting practice workflow to make effective use of this marvelous tool and continuously looking for new ways to exploit its value in the future. EMR is not itself the end objective but merely a tool for improving practice efficiency and clinical quality over time.

ACP's Practice Management Center (PMC) has assembled tools to assist College members at each stage in the adoption process. Other tools will be added over time, so please revisit the PMC periodically.

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The American Medical Informatics Association (AMIA) plays a pivotal role in the transformation of the US health system and makes measurable contributions to the improvement of health of the nation through continued development and implementation of health information technology. AMIA is an integrating force that strengthens the nation's ability to create and manage the science and knowledge base of health care. AMIA is active in the development of global health information policy and technology.

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Three leading HIT industry associations--the American Health Information Management Association (AHIMA), the Healthcare Information and Management Systems Society (HIMSS) and The National Alliance for Health Information Technology (Alliance)--joined forces in July 2004 to launch CCHIT as a voluntary, private-sector organization to certify HIT products. The three committed resources to support CCHIT during its organizational phase.

In September 2005, HHS awarded CCHIT a three-year contract to develop and evaluate certification criteria and create an inspection process for HIT in three areas:

• Ambulatory EHRs for the office-based physician or provider
• Inpatient EHRs for hospitals and health systems
• The Network components through which they interoperate and share information

The American College of Physicians (ACP) is an active participant in the CCHIT community.

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The Healthcare Information and Management Systems Society (HIMSS) is a membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (HIT) and management systems for the betterment of healthcare. Founded in 1961, HIMSS represents more than 20,000 individual members and over 300 corporate members that collectively represent organizations employing millions of people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems' contributions to ensuring quality patient care.

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From the New York Times (December 3, 2006)
Powerful forces are lobbying hard for government and private programs that could push the nation's costly and inefficient health care system into the computer age. President Bush strongly favors more use of health information technology. Health insurance and medical device companies are eager supporters, not to mention technology companies like I.B.M. and Google. Furthermore, Intel and Wal-Mart Stores have both said they intend to announce plans this week to embrace electronic health records for their employees. Others may soon follow. Bills to speed the adoption of information technology by hospitals and doctors have passed both chambers of Congress. But the legislation has bogged down, largely because of differences over how to balance the health care industry?s interest in efficiently collecting, studying and using data with privacy concerns for tens of millions of ordinary Americans -- not just celebrities and victims of crime. Advocates of such legislation, including Representative Joe L. Barton, the Texas Republican who is the chairman of the House Energy and Commerce Committee, said that concern about snooping should not freeze progress on adopting technology that could save money and improve care.

open document (pdf)

From the Journal of the American Medical Informatics Association (JAMIA)

Objective: This study evaluated a computerized method for extracting numeric clinical measurements related to diabetes care from free text in electronic patient records (EPR) of general practitioners.

Design and Measurements: Accuracy of this number-oriented approach was compared to manual chart abstraction. Audits measured performance in clinical practice for two commonly used electronic record systems.

Results: Numeric measurements embedded within free text of the EPRs constituted 80% of relevant measurements. For 11 of 13 clinical measurements, the study extraction method was 94%-100% sensitive with a positive predictive value (PPV) of 85%-100%. Post-processing increased sensitivity several points and improved PPV to 100%. Application in clinical practice involved processing times averaging 7.8 minutes per 100 patients to extract all relevant data.

Conclusion: The study method converted numeric clinical information to structured data with high accuracy, and enabled research and quality of care assessments for practices lacking structured data entry.

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A report entitled "The Value of Information Technology-Enabled Diabetes Management (ITDM)" by the Center for Information Technology Leadership (CITL) concludes that information technology data management can improve care processes, delay type-2 diabetes complications and save healthcare dollars. According to the study, electronic diabetes registries used by providers, followed by clinician decision support systems for providers, showed the greatest improvement in clinical outcomes. Of the existing technologies, diabetes registries saved $14.5 billion in expenditures during a 10-year period.

The CITL report also states that while other technologies had varying degrees of savings, national adoption of them would cost more than it saves. The report went further in saying that Medicare and other payers will benefit the most from ITDM because they bear the greatest financial risk. CITL's research approach was to develop computer-based models that simulate type-2 diabetes patient outcomes in a diabetes management program over 10 years. CITL is a nonprofit research center based at Partners HealthCare System in Boston. The research for the report was funded through a Robert Wood Johnson Foundation grant, which was supported by the Healthcare Information and Management Systems Society (HIMSS).

NOTE: This description was excerpted from an e-newsletter of Health Management Technology, August 2007.

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