EHR Adoption: US Hospitals, Caring for Poor; State, Federal Initiatives; Meaningful Use

EHR Adoption: US  Hospitals, Caring for Poor; Role of State, Federal Initiatives; and Meaningful Use

Robert Wood Johnson Foundation-funded Report
Health Information Technology in the United States:
On the Cusp of Change 2009
    
(See Web sites and downloads below.)

Health Information Technology in the US: On the Cusp of Change 2009, published Oct-Nov 2009, is the third report of a series produced since 2006.  The “State of the Field” report consists of five articles on EHR to “share the lessons of the ONCHIT more broadly and review what is known about the state of EHR adoptions and its implications for improving health care quality.” It was  jointly produced by Robert Wood Johnson Foundation, George Washington University Medical Center, and Institute for Health Policy at Massachusetts General Hospital and Partners Health System.

Chapter 1:  Beyond the Doctor’s Office: Adoption of Electronic Health Records in U.S. Hospitals.
Ashish K. Jha, M.D., M.P.H., Catherine M. DesRoches, Dr.P.H., Eric G. Campbell, Ph.D., Karen Donelan, Sc.D., Sowmya R. Rao, Ph.D., Timothy G. Ferris, M.D., M.P.H., Alexandra Shields, Ph.D., Sara Rosenbaum, J.D.

Chapters 1 and 2 are based on a 2008 survey conducted in conjunction with American Hospital Association to survey all acute care general medical/surgical member hospitals in US. While results show under 10% of hospitals have either comprehensive EHR (<2%) or basic (<8%), about 8 out of ten hospitals offered hospital-wide views of lab and radiology reports and radiology images. One out of five had hospital-wide computerzied order entry and clinical decision support. Earlier article based on this survey was published in New England Journal of Medicine in March 2009. Finances were cited as leading cause of non-implementation.

Chapter 2: Adoption of Electronic Health Records Among Hospitals that Care for the Poor: Early Evidence of a New Healthcare Digital Divide?
Ashish K. Jha, M.D., M.P.H., Catherine M. DesRoches, Dr.P.H., Eric G. Campbell, Ph.D.,  Alexandra Shields, Ph.D., Paola D. Miralles, B.S., Jie Zheng, Ph.D., Sowmya R. Rao, Ph.D., and Sara Rosenbaum, J.D.

This article was published online Oct 26, 2009 on HealthAffairs.org, and examines the relationship between poor hospital populations and rate and value of EHR implementation.

Chapter 3: State Roles in the Advancement of Health Information Technology.
Steffanie J. Bristol, B.S., Paola D. Miralles, B.S.

State governments adopted 168 legislative measures about HIT between 2005 and 2008 with topics including ”planning and oversight, HIE, advacning adoption and implementation, funding, and privacy protection and security.”  States have an important but fiscal-challenged role in current economic environment.

Chapter 4: Recent Federal Initiatives in Health Information Technology.

Melissa M. Goldstein, J.D., Lee Repasch, M.A., and Sara Rosenbaum, J.D.

Chapter 4 examines impact of “meaningful use,” “certified EHR,” and financial incentives on caring for vulnerable populations.

Chapter 5: Potential Implications of Widely Adopted Meaningfully Used HIT: Is Quality Measurement and Reporting About to Take Flight?
Michael W. Painter, J.D., M.D.

Chapter 5 focuses on impact of EHR adoption and public reporting of quality data. “This technology may make clinical data extraction both efficient and inexpensive, which would facilitate large-scale clinical performance measurement efforts.”

Health Information Technology in the United States:
On the Cusp of Change 2009 –
 Web Page

Executive Summary         Full Report
RWJF Release on Digital Divide

Robert Wood Johnson Foundation HIT Reports
Health IT in the US, 2008 Report Page
Health IT in the US, 2006 Report Page

This post contains summaries of and links to copyrighted content from the Robert Wood Johnson Foundation.

Healthcare organizations’ security not up to HITECH standards per HIMSS Study

Healthcare organizations’ security not up to HITECH standards per HIMSS Study
Molly Merrill of Healthcare IT News reported on November 4, 2009, “Healthcare organizations aren’t prepared to meet privacy and security standards associated with the American Recovery and Reinvestment Act, according to a new survey.”
Mary Mosquera of Government HealthIT reported on November 4, 2009, “Security budgets are low and organizations lack a plan for responding to threats or a security breach, according to the findings, which were  published Nov. 3. Many healthcare organizations also have not named a chief security officer or chief information security officer.”
Lisa Gallagher, HIMSS’ senior director of privacy and security, wrote a guest column in Government HealthIT on November 4, 2009 entitled “Healthcare needs a security framework.” Gallagher noted “The advent of ARRA has brought long overdue additional statutory requirements for ‘covered entities’ as well as an extension of HIPAA to other entities. ARRA has additional requirements such as: breach notification, accounting of disclosures, new limits on the sale and marketing of personal health information, a right to restrict disclosures and increased enforcement.”

HIMSS Security Survey 2009 Document (pdf)

For another study outlining data security needs at hospitals, see previous e-Healthcare Marketing post.

Note:  Both Healthcare IT News and Government HealthcareIT are published by HIMSS, and the HIMSS survey and report were funded by Symantec.

HIT Policy Cmte Hear Specialists, Small Providers, Underserved and Medicaid Providers: Oct 27-28

HIT Policy Cmte Hear Specialists, Small Providers, Underserved, and Medicaid Providers on Meaningful Use:
Oct 27-28, 2009 
The Health Information Technology Policy Committee hears from specialists, small providers (hospitals and physician practices), underserved and medicaid providers in addition to a panel about registries and quality measures on October 27-28, 2009. This post contains most of the materials being presented. See e-Healthcare Marketing post on summary of June notes from specialists and non-physician providers. 

HIT Policy Committee Meetings Page
October 27, 2009:  9:30 a.m. to 4:00 p.m. [Eastern]
           Note: NEW START TIME
October 28, 2009:  8:30 a.m. to 12:15 p.m. [Eastern]
Excerpted from ONC site:

  • Meeting Materials (contain PDF and PPT files):
  • WashPost story slams electronic medical records; cites Grassley letter; errors and drop-off in care

    Washington Post story slams electronic medical records:
    Cites Grassley letter; errors and drop-off in care

    Alex Mostrous in Washington Post on October 25, 2009, does a roundup of critics of electronic medical records writing ”Interviews with more than two dozen doctors, academics, patients and computer programmers suggest that computer systems can increase errors, add hours to doctors’ workloads and compromise patient care.”

    Mostrous also reports on letter Senator Charles E. Grassley, ranking Republican on the Senate Finance Committee, sent 10 major manufacturers of Electronic Medical Records on October 16, 2009 requesting answers to 8 questions focusing on Health Information Technology, Computer Order Entry Systems (CPOE), “hold harmless” provisions, and procedures in place to track and report on performance of such systems. Letter example from Washington Post (pdf).

    New Study Reveals Push to Electronic Medical Records Puts Patient Privacy at Risk

    New Study: Push to EMRs Puts Patient Privacy at Risk
    70 percent of  hospital security pros say sr. mgmt. fails to prioritize privacy and data security
    Mitch Wagner’s  Information Week Healthcare story on October 20, 2009
    was sub-headlined “Healthcare IT managers say their organizations aren’t adequately protecting electronic health records, survey says.”

    Per the orginal October 20, 2009 press release from LogLogic, sponsor of  “Electronic Health Information at Risk: A Study of IT Practitioners,” produced by Ponemon Institute, a privacy and information management research firm, survey results showed:
    –”70 percent say senior management does not view privacy and data security as a priority;
    –”53 percent say their organization fails to take appropriate steps to protect the privacy rights of patients while less than half judge their existing security measures as ‘effective or very effective’; and,
    –”The average cost of a data breach, per patient record, exceeded $210 per compromised record, creating an opportunity for organized computer crime rings to traffic in stolen medical records.”

    “Electronic Health Information at Risk: A Study of IT Practitioners”
    Press release
    Study Download (registration required)

    NY Times/CBS Interviews David Blumenthal, Nat’l Coordinator for Health IT

    David Pogue of NYTimes and CBS shares interview with
    David Blumenthal, Nat’l Coordinator for Health IT

    In September 2009 reporter David Pogue did a piece on CBS News Sunday Morning program on Electronic Health Records. On October 15, 2009, on the New York Times, Pogue shares the  interview he conducted with National Coordinator of Health IT David Blumenthal in preparation for that CBS News segement. Blumenthal spoke about the usage of electronic health records in other countries: Danes–virtually 100% of physicians use EHRS; Britain–100%; Australia–100%; Sweden–100%; Norway–100%.  “In many, many other Western countries, the electronic record is virtually ubiquitous.” A study Blumenthal did last year “found (in the US) that about 17 percent of physicians in 2008 had adopted an electronic health record, and about ten percent of hospitals.”

    CBS News Sunday Morning Video Segment (Sept 13, 2009)
                        Transcript of Video Segment
    New York Times Pogue Interviews Blumenthal

    ‘Meaningful Use’ for Hospitals: The Top Ten Challenges + HIMSS Hospital Study

    CSC Report: Top Ten Challenges for Hospitals on Implementing ‘Meaningful Use’
    According to CSC, “Much is at stake for U.S. hospitals as they advance the implementation of the inpatient EHR, not just the financial incentives of HITECH, but also the urgent need for the EHR as an enabler of the efficient, reliable, high-quality care that positions the organization to thrive in the future, regardless of the approach to health care reform.” Report offers a concise outline of “meaningful use” requirements for hospitals in addition to the ten ways to benefit from experience of other hospitals, and then restated as ten principles to guide the effort.

    Challenges of achieving ‘meaningful use’ daunting, yet plausible
    Jeff Byers of HealthImaging.com on October 7, 2009 with later updates provides complete feature on this CSC nine-page report written by Jane Metzger, Erica Drazen, and Beverly Bell.

    Joseph Goedert of HealthData Management reported October 8, 2009 “Report Covers ‘Meaningful Use’ Challenges,” bringing this to my attention. Thank you Joseph Goedert.

    CSC Report Page: Top Ten Challenges for Hospitals on Implementing Meaningful Use
    CSC Report PDF:  Top Ten Challenges for Hospitals on Implementing Meaningful Use (pdf)

    HIMSS: Hospitals lagging in IT to meet ‘meaningful use’
    Brian Robinson of Government HealthIT reported October 8, 2009  
    “The study from HIMSS Analytics maps the requirements of the stimulus law to the organization’s own seven-stage EMR Adoption Model (EMRAM). The results identify implementation gaps that need to be bridged if the health care industry is to meet the 2015 targets for meaningful use.” Article in Government HealthIT, which is published by HIMSS, gives a good overview of study.

    HIMSS Analytics Study (pdf)
    The State of  U.S. Hospitals Relative to
    Achieving Meaningful Use Measurements
    (pdf)
    by Michael W. Davis, Executive Vice President, HIMSS Analytics

    North Shore-LIJ (NY) Health System Investing $400M to Connect Up to 7,000 Physicians, 13 Hospitals with Electronic Health Records System

    North Shore-LIJ (NY) Health System Investing $400M to Connect
    Up to 7,000 Physicians, 13 Hospitals with Electronic Health Records System
    Per North Shore-LIG and Allscripts September 28, 2009 Press Release: “The North Shore-LIJ Health System announced today it is subsidizing up to 85 percent of the cost of implementing and operating an Electronic Health Records (EHR) system in the offices of its more than 7,000 affiliated physicians in New York City and Long Island — part of a $400 million investment to strengthen the quality of care throughout the region by automating inpatient and outpatient records in all medical settings, including 13 hospitals. In implementing the largest EHR program in the New York metropolitan area and one of the largest in the nation, North Shore-LIJ will provide physicians with individual subsidies of up to $40,000 over five years.”

    Michael J. Dowling, president and chief executive officer (CEO) of the North Shore-LIJ Health System said “We’re not going to measure our return-on-investment (ROI) in terms of dollars and cents; our ROI will be based on our ability to improve patient outcomes.”

    “Glen Tullman, CEO of Allscripts, noted that providing physicians with real-time care guidelines via the EHR increases the probability of achieving fundamental improvements in the quality of patient care.”

    John Bosco, North Shore-LIJ’s chief information officer said “the Allscripts’ EHR will connect to a separate inpatient clinical information system from Eclipsys Corporation that North Shore-LIJ is deploying at its hospitals and other facilities.”

    Several accounts following this story in conjunction with Press Release:
    Steve Lohr of New York Times broke the story previous day on September 27, 2009 reporting ”The nation’s drive toward computerized medical records is getting a push from big hospitals, which hope not only to improve patient care but to gain an edge on competitors.”
    Ridgley Ochs of Newsday reported on September 28, 2009 “Dr. Paul Moulinie, a cardiologist in Huntington and Syosset, said he is excited – and nervous – that his practice will be one of the first to get rid of paper charts and go completely electronic.” Moulinie said that physicians could do a better job of patient care with immediate access to complete patient histories.
    Claude Solnik of Long Island Business News reported September 28, 2009 that Dr. Robert Williams, director of Deloitte Healthcare Consulting said “No comparably-sized hospital system in the country is providing this level of financial assistance to so many physicians to integrate an electronic health record.”  Solnick also quoted Stanley Bergman, CEO of Melville, Long Island-based Henry Schein, one of several independent distributors of Allscripts’ system to physicians, but it appears that the North Shore deal is directly with Allscripts.

    See previous e-Healthcare Marketing post on “Connecting All Your Docs at ‘Most Wired’ Hospitals.”

    Digital Dilemma for Hospital Medicine

    Digital Dilemma for Hospital Medicine Physicians
    The September 2009 issue of The Hospitalist does an overview of the HITECH Stimulus act and what Hospitalists face in terms of implementing EHRs, not getting left behind, and facing privacy and communication obstacles.

    Added note: What’s the dilemma? The boxed sidebar entitled “DON’T GET LEFT BEHIND” describes the dilemma, though the article and my brief summary above should have pointed this out. According to the Society of Hospital Medicine  ”The term ‘hospitalist’ refers to physicians whose practice emphasizes providing care for hospitalized patients.” Yet, as the sidebar points out that the hospitalist must get involved from the earliest stages, taking time away from their immediate focus of caring directly for patients, to work through what may seem tedious discussions and activities to make EHR adoption successful: attend meetings with hospital leaders and IT about adoption; speak up with your concerns; participate in design forums, testing, and feedback sessions; and plan ahead.

    Hospital Medicine and Hospitalists
    Web site for Society of Hospital Medicine:
    http://www.hospitalmedicine.org
    The Society for Hospital Medicine estimates that there are about 20,000 hospitalists in the country, with 30,000 expected by the end of the decade. In June 2009, the American Medical Association approved recommendations for 15 Prinicipals for Developing Sustainable and Successful Hospitalist Programs. While the AMA does not represent the majority of physicians, it does maintain a generally accepted database of all US physicians and its official specialty count for US Hospitalists was about 110 at the end of 2008. This specialty was added relatively recently to the AMA’s physician database.

    Thanks to a LinkedIn member for noting that the original brief summary needed more value, and not just another click before the full text.

    Connecting All Your Docs at ‘Most Wired’ Hospitals

    Connecting All Your Docs at ‘Most Wired Hospitals’
    Alden Solovoy reports in the September 2009 issue of American Hospitals Association’s
    H&HN–Hospitals & Health Networks  The majority of the Most Wired (hospitals and hospital systems) do not distinguish between employed and independent physicians in their integration efforts, with 57 percent subsidizing both types of physician practices.” 93% of the 2009 Most Wired provide some EHR support to at least one category of practices. Story includes useful charts plus quotes from John Halamka, Beth Israel Deaconess Medical Center, #1 Most Wired; Daniel Barchi,  Carilion Clinic, Roanoke, VA, #7 of 100 Most Wired;  John Schrenker, Lakeside Health System, Brockport, NY, one of the 2009 Most Improved; and Jerry Peter, Lakeside Hospital System, Painesville, Ohio, one of the 2009 Most Improved.

    H&HN Lists of Most Wired, Most Improved, Most Wired–Small and Rural, and Most Wireless. Published in July 2009.

    See Sept 29 post on e-Healthcare Marketing about North Shore-LIJ subsidizing up to 7,000 physicians.