EMR News

Greenway officially announces IPO

Dan Bowman — Thu, 02 Feb 2012 09:45:35 -0500

Electronic health record vendor Greenway Medical Technologies announced the pricing of its long-awaited initial public offering at $10.00 per share for close to 6.7 million shares of common stock, the Carrollton, Ga.-based company announced this morning. The company had hoped to offer the shares for between $11 and $13, Seeking Alpha reported yesterday. Greenway, which is used by 1,800 practices, boosted its revenue 55 percent in the last fiscal quarter to nearly $26 million, according to SA. Announcement

Cloud-based EHRs raise data rights questions

Marla Durben Hirsch - Contributing Editor — Thu, 02 Feb 2012 08:49:01 -0500

With cloud-based electronic health record systems becoming more popular, providers should carefully read their vendor contracts regarding their rights and use of their patients' data, according to American Medical News.

Gerard Nussbaum, director of technology services for the global management consulting firm Kurt Salmon Associates, tells amednews that since the data in the EHR is stored in the cloud, not at the host site, the vendor and others have access to the data, even if the provider owns it. That leads to issues regarding rights to the data, which the parties need to address.

One of the issues involves data mining. According to Nussbaum, some EHR vendors aggregate the data in the cloud from all of their clients' EHR systems for analytics. However, individual providers need to be able to mine their own data for purposes of attesting to Meaningful Use and to provide accounting of disclosures to patients.

Another trouble spot is data backup and recovery, especially during a natural disaster. Providers need to know that there's a back up site, that the transfer of the data to that site will be seamless, and how to access it from the second site. If the backup data is encrypted, the provider needs to know the key.

Lynette Ferrara, partners at CSC's Health Informatics Practice told amednews that providers should not only get assurances that they can get and use the data from the cloud but to have the vendor demonstrate how to do so. For instance, if a vendor can't tell the provider how to retrieve data, that should be a deal-breaker, she says.

To learn more:
- read the amednews article

GE to discontinue EHR stand-alone product

Marla Durben Hirsch - Contributing Editor — Wed, 01 Feb 2012 23:09:26 -0500

Recognizing the limits of electronic health records systems that only offer EHR services, some vendors are consolidating their offerings.

One example: GE Healthcare recently announced it will no longer support its Centricity Advance EHR product for physician practices.

The company will offer existing users the opportunity to transition to GE's Centricity Practice Solution, its "flagship" combined EHR and practice management system, according to a brief statement on the company's site. GE noted that the two systems addressed many of the same needs for small and medium sized physician practices.

GE's general manager and vice president for clinical business solutions Michael Friguletto told eWeek that "consolidating Centricity into a joint EHR/practice-management product will allow GE to update its healthcare offerings faster."

Friguletto also noted that Centricity Practice Solution offered more robust clinical workflow, as well as revenue cycle management dashboards and tools fully integrated with the EHR, "so practices will have more control."

As of June 30, users will be able to access the product in read-only format; that will end Dec. 31.

This consolidation/upgrade of an EHR product is part of a larger trend toward EHR products with added bells and whistles that, in theory, make them more appealing to providers.

Many EHR products are coupled with practice management systems. As we reported Jan. 12, more EHR vendors are also adding patient portal products to their EHR systems.

And EHR vendors aren't stopping there. For example, SOAPware, which already offers a combined EHR/practice management product, announced Jan. 25 that it has formed a joint venture with Ambir Technology to offer desktop digital scanners that allow users to input documents into its EHR software.

To learn more:

- read GE's statement
- here's the eWeek article
- read the SOAPware announcement
- check out this InformationWeek Healthcare article

Health network hires ONC's community college consortia students for EHR implementation

Marla Durben Hirsch - Contributing Editor — Wed, 01 Feb 2012 22:40:45 -0500

When Aurora Health Care, Wisconsin's largest non-profit health network, needed to add to its staff in a hurry to implement its electronic health record system, it turned to some of "ONC's kids" for help.

Aurora approached Milwaukee Area Technical College (MATC) to hire students for the project, Chitra Mohla, Director of the Office of the National Coordinator for Health IT's Community College Workforce Program, wrote in an ONC blog. MATC is one of 82 members of ONC's community college consortia that received funding to help students become HIT professionals.

Aurora ended up hiring 11 of MATC's students and recent graduates.

"In going through the interview and hiring process, we felt these MATC graduates had more than just the skills the job required, but also came from diverse backgrounds and had strong problem-solving faculties," said Russ Hinz, director of hospital deployments at Aurora Health Care.

The community colleges funded by ONC will help train more than 10,500 new health IT professionals by 2012.

The community college consortia initiative is just one of ONC's health IT workforce programs to help providers adopt and meaningfully use EHRs by increasing the number of HIT professionals in the country. The workforce program also has provided grants for additional college-level HIT training programs, the development of educational material, and an HIT competency exam program.

To learn more:
- read ONC's blog post
- here's information on ONC's Health IT workforce program

Study: E-prescribing improves medication adherance

Marla Durben Hirsch - Contributing Editor — Wed, 01 Feb 2012 22:23:29 -0500

Patients are more likely to pick up their prescription drugs when their physicians use e-prescribing to order them. Assuming they then take the drugs they've purchased, this trend should improve medication adherance, patient outcomes and reduce long-term healthcare costs.

That's the skinny from the latest study, conducted by Surescripts in collaboration with pharmacies and pharmacy benefit managers. Researchers analyzed data sets representing more than 40 million prescriptions. Patient first-fill medication adherence was 10 percent higher when physicians used e-prescribing.

The study suggests that e-prescribing eliminates "prescription leakage" by patients who abandon their prescriptions. Prior studies indicate that as much as 28 percent of paper prescriptions never make it the pharmacy. The study also shows that e-prescribing can help physicians choose medications that are less expensive for the patient, which is another incentive to fill them.

"E-prescribing provides physicians with the patient's insurance and medication history information during a patient visit, which can lead to more clinically appropriate prescriptions with a lower out-of-pocket cost for the patient," said Ken Majkowski, vice president of strategy and innovation at Surescripts.

"When the doctor e-prescribes, the patient is more likely to know that the prescription has a lower out of pocket cost. When you combine this with the fact that it will be electronically routed to the pharmacy--which makes it more convenient for the patient and provides more information to the pharmacist--you have a great opportunity to improve medication adherence," he adds.

The company estimates that first-fill medication adherence rates will continue to improve as e-prescribing adoption and usage increase.

To learn more:
- read Surescripts' announcement

From Meaningful Use Stage 2 to stronger HIPAA regs, HHS gets ready to juggle

Marla Durben Hirsch - Contributing Editor — Thu, 26 Jan 2012 11:10:39 -0500

We all know that 2012 will be a watershed year for electronic health records systems. The Department of Health and Human Services' fall 2011 agenda, which it presented to the Office of Management and Budget (OMB) this week, contains four rules directly impacting providers' use of EHRs. Everyone wants to know: What will the regulations require?

Good question.

It looks like the Stage 2 Meaningful Use regulations and its companion regulations (which establish the standards, implementation specifications and certification criteria to enhance EHR operability, functionality and utility under Stage 2) may receive OMB clearance first. While agencies are typically tight lipped about their rules before they're released for public view, we know from the agenda that the Stage 2 proposed rule will "expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results."

And we know that Stage 2 will include, at a minimum, more security requirements, more clinical measurements, higher thresholds, longer measurement timelines and actual reporting rather than attestation.

But the two rules to progress to Stage 2 of Meaningful Use come with the promise of incentive payments if providers comply with the rules. Moreover, they are just proposed rules. That means providers, associations, and others can give HHS their two cents (or in some cases, a piece of their minds).

Providers also can't lose sight of two more rules that should be finalized in the first half of 2012 that will have a major impact on their use of EHRs. Both will strengthen the Health Insurance Portability and Accountability Act.

The first is the accounting for disclosure rule that outlines how to tell patients who accessed their records in the EHR. The second is a "mega rule" that implements more stringent privacy, security, enforcement and breach notifications.

These rules impose burdens on providers with no corresponding promise of bonus payments for compliance. In proposed form, they're pretty tough.

For instance, the accounting for disclosure proposed rule, which expands the accounting for disclosure of protected health information (PHI) contained an EHR, created a new right for patients to obtain an "access report." The rule expands reporting requirements not only for disclosures, including those for payment treatment and operations, but also for uses, including internal uses by employees who have legitimate reasons to access the records.

One of the provisions of the proposed mega rule allows providers to avoid telling patients of an unsecured breach if the provider determined the breach didn't meet a "harm threshold." But HHS withdrew this provision amid speculation that HHS was considering removing this threshold. That means that a should your EHR suffer a security breach of unsecured PHI, you need to notify patients, HHS and possibly the media--even if no harm occurred at all.

Whew.

HHS has a lot to juggle. It operates more than 300 programs and has an ambitious agenda for 2012, including coverage to the uninsured, implementation of the Accountable Care Act, public health programs and food safety. Can it accomplish what it has boldly set out to do?

I don't know. But hopefully HHS will realize what an awful lot it's asking of the provider community, many of whom are adopting EHRs with more than a little trepidation. - Marla

EHRs improve care given to diabetics

Marla Durben Hirsch - Contributing Editor — Thu, 26 Jan 2012 10:32:28 -0500

Type 2 diabetic patients being treated by doctors who use electronic health records are more likely to receive "optimal care" for their condition, according to a recent study published in Health Services Research. The researchers studied the care of 14,051 adult diabetic patients seen at 34 primary care practices.

Of those, 6,376 patients' physicians used an EHR. Those patients enjoyed better outcomes--including positive improvement in blood pressure, aspirin prescriptions, and smoking cessation--than patients whose doctors did not use an EHR.

Specifically, reminder features of the EHR, as well as better documentation, were key to the improved results, study co-author Jeph Herrin, Ph.D., of Yale University, noted.

Endocrinologist Spyros Mezitis of New York-based Lenox Hill Hospital, told Health Behavior News Service, however, that enthusiasm regarding the study's results should be tempered, considering two outcome measures--lipid control and a blood sugar measurement--did not show significant improvement.

"This study showed mixed results," he said. "There is much room for improvement."

To learn more:
- here's an abstract of the study
- check out this article

Use EHRs to avoid unnecessary care

Marla Durben Hirsch - Contributing Editor — Thu, 26 Jan 2012 10:03:14 -0500

Electronic health records can do more than identify which patients should be receiving preventive and other additional services. They can also help providers pinpoint who shouldn't receive care.

That's the upshot of a recent study published in the Journal of the American Medical Informatics Association. The researchers studied EHR data from clinics affiliated with Northwestern University to see if the data could flag and measure whether certain patients were receiving pap smears too frequently. Clinical guidelines recommend that women at low risk for cervical cancer be screened for the disease every three years; more frequent screening is only justified for those at high risk. The researchers used the EHR data to measure the screenings.

The study found that EHR data was sufficiently precise to better identify which women are at low risk for cervical center. The EHR data also revealed that 66 percent of women in the study at low risk for cervical cancer received a pap test sooner than the three year interval recommended by clinical guidelines. In addition to the overutilization, the false positives sometimes associated with these screenings resulted in 21 unnecessary follow-up procedures, representing inefficient care and adding to the women's financial burden and psychological stress.

The researchers suggested that this use of EHRs to decrease the overuse of low value, redundant lab tests "could improve quality and decrease costs, maximizing value with the US healthcare system."

To learn more:
- see the study abstract

Better provider support needed for EHR data capture

Marla Durben Hirsch - Contributing Editor — Wed, 25 Jan 2012 14:57:43 -0500

Electronic health records can help providers document their performance. But they're only as good as their users--and plenty of providers are abdicating their responsibility to add information to their EHRs that can't be done automatically, adversely affecting their performance measures.

That's the cautionary tale from a recent study published in the Journal of the American Medical Informatics Association, which found that workflow and documentation habits have a "profound" negative impact on quality measures. Accurately capturing quality measures not only affects the quality of patient care; it also can influence the amount of revenue the provider receives under pay for performance and other programs.

Researchers found that providers were overlooking chronic conditions/diseases located elsewhere in the patients' chart, such as obesity and smoking. They also were not bothering to add in lab data, tests, and procedure results, which often has to be done manually. The study additionally uncovered that there were design flaws in the structure of the EHRs being used, such as lack of options to document data in certain fields, which negatively impacted the quality measures.

The study focused on 82 New York physician practices, reviewing 4,081 EHR charts. The average practice missed 50 percent of the eligible patients for three out of eleven quality measures--smoking cessation intervention and cholesterol control. The practices also underreported six of the 11 measures, including breast center screening.

The researchers recommended that providers need "regular prompts, training and feedback to alter their documentation habits." They also suggested that providers use claims data to populate their EHRs and clinical decision support.

To learn more:
- read the study abstract

Meaningful Use Stage 2 a high priority on HHS regulatory agenda

Marla Durben Hirsch - Contributing Editor — Wed, 25 Jan 2012 14:42:27 -0500

The next few months are going to be chock-full of new regulations affecting electronic health records systems. That's the scoop from U.S. Department of Health & Human Services' latest regulatory agenda, submitted to the Office of Management and Budget (OMB) and published Jan. 20. According to the agenda, EHRs are one of the agency's top priorities for the first half of 2012. HHS has accordingly sent to OMB proposed rules both on Stage 2 of Meaningful Use and on new standards, implementation specifications and certification criteria that EHRs would need to support Meaningful Use.

"The Department continues to encourage healthcare providers to become meaningful users of health information technology by accelerating health IT adoption and promoting electronic health records to help improve the quality of healthcare, reduce costs and ultimately improve health outcomes," HHS noted in the agenda.

OMB has up to 90 days to review rules submitted by agencies, although that deadline can be extended.

The stage 2 proposed regulations could be approved by OMB and published in the Federal Register within weeks, predicted Robert Jarrin, senior director, government affairs for Qualcomm. Beth Israel Deaconess Medical Center CIO John Halamka said that process could take as long as 90 days. Both presented on a webinar held Jan. 23.

Other regulations slated for OMB clearance within the next six months include an advance notice of proposed rulemaking on governance for a national health information network and final rules implementing the Health Information Technology for Economic and Clinical Health Act's changes to the HIPAA privacy, security and breach notification rules, including the new accounting for disclosures provisions for users of EHRs.

To learn more:
- read the 2012 HHS agenda

VA ready to consolidate EHR data centers

Marla Durben Hirsch - Contributing Editor — Wed, 25 Jan 2012 12:43:24 -0500

The move to consolidate the electronic health records systems for the military just took another step forward, with the announcement that the Department of Veterans Affairs will begin transitioning the data centers that support its Veterans Health Information Systems and Technology Articulation (VistA) EHR into data centers run by the Defense Information Systems Agency (DISA) beginning in March.

VA CIO Roger Baker told Nextgov that the move helps support the development of a joint EHR system, making it the largest in the world, covering 15.7 million people. The move is expected to take a year to complete.

Baker also noted that each of the VA's 152 hospitals will have one to six servers to host VistA in the DISA data centers and that the data centers will have backup systems.

This consolidation is within the timelines projected by the VA. In its September 2011 Data Center Consolidation Plan and Progress Report, the VA acknowledged that VistA's current operations were non-standardized and disconnected, and that its goals was to eventually consolidate operations into four Department of Defense data centers. The consolidation is meant to reduce costs, improve efficiencies and maximize sustainability.

The report also stated that VA expected the transition of VistA to DISA data centers in 2012 will free up space in at least 80 VA medical centers computer rooms for repurposing, resulting in a "greatly reduced" operational IT footprint.

To learn more:
- read the Nextgov article
- here's the progress report

Related Articles:
DoD, VA making steps towards joint EHRs--for now
DoD, VA will use service-oriented architecture in joint EHR
DoD, VA closing ground on joint EHRs

EHR implementation more difficult for physician owners

Debra Beaulieu — Thu, 19 Jan 2012 11:05:08 -0500

Physician owners report more difficulty in implementing electronic health records at their practices than other users, likely because they have more financial and personal responsibility in the process, according to a study of surveyed physicians about pre- and post-implementation, published in the Journal of the American Medical Informatics Association. Specifically, 38 percent of survey respondents with ownership stakes in their practices reported that the implementation was very difficult, compared to 26 percent of non-owners. FiercePracticeManagement

Patient-specific, eye catching alerts less likely to be ignored

Marla Durben Hirsch - Contributing Editor — Thu, 19 Jan 2012 09:29:14 -0500

Want doctors to read the alerts they receive in their electronic health records systems? Then make them more patient-specific and interesting to read.

That's the skinny from a recent study published in the Journal of the American Medical Informatics Association. The study focused on the use of computerized drug alerts for psychotropic drugs prescribed to 5,628 senior citizens by 81 physicians. The researchers expected computerized alerts to reduce the number of falls by these seniors, which is a leading cause of injuries. However, physicians overrode most drug alerts because they believed that the benefit of the drugs outweigh the risks involved. Physicians also expressed a concern that too many drug alerts were "nuisance alerts" of little clinical value.

The researchers created more patient-specific alerts for seniors on these drugs, estimating the risk of injury from falling using factors such as the patient's injury history, type and dose of psychotropic drug, presence of cognitive impairment, gait and balance. The improved alert showed both numerically and graphically on a "risk thermometer" how much risk the patient may be of falling; changes in the patient's risk from therapy changes--say, from a reduction in dosage--was reflected on the thermometer.

The "new generation" of drug alert worked: the physicians opened more than 83 percent of the alerts and the physicians modified the therapy in nearly one-fourth of them, reducing the risk of injury by 1.7 injuries per 1,000 patients.

"Individual risk estimates displayed graphically and numerically are a more effective method of eliciting response to drug alerts and reducing the risk of medicine-related injuries in higher-risk seniors," the authors noted.

To learn more:
- here's the abstract of the JAMIA study

Electronic alerting system improves documentation of patient problems

Marla Durben Hirsch - Contributing Editor — Thu, 19 Jan 2012 09:23:13 -0500

Using an automatic alert system in providers' EHR systems "significantly" increases the documentation of previously unknown patient problems, which could potentially facilitate quality improvement.

That's the conclusion of a recent study published by the Journal of the American Medical Informatics Association. According to the study, which involved 28 clinics affiliated with a large academic medical center, patient problems were about three times more likely to be documented when providers received an alert. "This increase is clinically important, since many of these problems are used for quality improvement and clinical decision support," the study's authors reported.

Patient clinical problem lists are often inaccurate, incomplete or out of date, making it harder to treat the patient, especially when the provider is unfamiliar with the patient or the patient is in an inpatient setting.

Accurate problem lists are also an essential component of meeting Meaningful Use. To qualify for meaningful use under the EHR incentive programs, providers must maintain up-to-date problem lists of current and active diagnoses with 80 percent of patients having at least one problem recorded or an indication of no known problems.

The study's authors recommended that the industry find new tools to improve patient problem list documentation.

The researchers used data mining techniques to identify potential patient problems, reviewing billing diagnosis codes, lab results, medications and vital signs, and developed an electronic alert in the providers' EHR system when there appeared to be an undocumented problem for 17 conditions, including stroke, glaucoma, attention deficit hyperactivity disorder and breast cancer. The study generated more than 17,000 alerts, of which more than 41 percent were accepted by the provider.

The authors did note that the EHR system used in the study was conducted within one system, which developed the EMR. So results might not be generalizable and commercial products might not be as flexible when it comes to adding clinical alerts, the authors said.

To learn more:
- read the study

CCHIT chair: Tips to use EHRs to improve safety

Marla Durben Hirsch - Contributing Editor — Wed, 18 Jan 2012 21:37:13 -0500

How well can your EHR system protect patients from substandard patient care? Evidently quite a bit, according to Karen Bell, chair of the Certification Commission for Health Information Technology (CCHIT).

Bell, citing a recent report from the Institute of Medicine (IOM) calling for better patient safety in HIT, notes that providers should consider patient safety when evaluating and using EHR systems. While there is no one assessment tool that providers can use to test EHRs regarding safe care, providers can take practical steps to see if their EHRs include the most up-to-date functions and features to improve patient safety--and to check whether the providers are using them.

Bell's checklist is an excellent resource for providers shopping for and implementing EHR systems. Just a few features she recommends include:

Communication

Secure messaging between provider and patients
Patient-specific instructions and education materials
Documentation of verbal, phone and electronic messages

Documentation

Efficient and reliable documentation of findings and results
Templates that default to normal findings only when the patient has been examined and the provider has reported positive findings
Ability to document why the provider chose to act or not act on an alert

Diagnosis/treatment issues

Alerts that are meaningful to providers
Closed loop ordering, including notifications when a test result has not been returned or when a patient doesn't fill a prescription

To learn more:
- here's Bell's full list of suggestions
- read the IOM report (.pdf)