Patient Engagement Is More of an Issue In Ambulatory Practice than In Hospitals

After having spent several days in a hospital recently caring for a loved one, I can unequivocally say that there is no comparison for patient engagement – in relation to meaningful use and in regard to health IT such as EHRs – between the hospital setting and the ambulatory practice.

Simply put, there is no comparison between the amount of attention given to the topic of patient engagement in ambulatory practice and in hospital care, at least as far as the patient experience is concerned.

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How Patients are Driving the Future of Healthcare

Girish eClinicalWorks
Girish

Guest post by Girish Kumar Navani, CEO and co-founder, eClinicalWorks.

In a world becoming more and more connected by technology, we have countless resources that fit in the palms of our hands. Thanks to smartphones, we are empowered to shop, bank and manage our social networks and more – whenever and wherever we choose. And companies are working in new ways to meet our needs by building apps and optimized websites that make our lives easier.

This notion of consumerization – the power of the consumer to drive technological innovation – is taking hold in healthcare. It means giving patients tools to track, understand and maintain their health, and meeting their demand for easy access to their doctors and personal health information. Empowering patients in this way could lead to big changes in our healthcare system.

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Are 93 Percent of Physicians Really Using EHRs?

Looks like we’re getting a lot closer to a healthcare environment where nearly every practicing physician is using electronic health records.

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Electronic Health Record Pricing Information and Guidance

Because I’m fascinated with the lack of information surrounding pricing of various electronic health records and because I admire the work of AmericanEHR Partners, I thought it relevant to shine a little light on another interesting piece of information from the organization.

As this seems to be the year of the big EHR switch, and because seemingly the folks at AmericanEHR hear as much as I do about the lack of transparency in the pricing structure of these solutions, I thought I’d publish some guidance for what to consider when making the transition to EHRs. In my research on the subject – I’m developing a piece on the subject of EHR pricing – I came across this piece, compiled by the AmericanEHR from the Maryland Health Care Commission.

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CHIME Chimes In, Says Meaningful Use Stage 2 Should Be Delayed One Year: I Agree

Breaking news hits the wires from the College of Healthcare Information Management Executives (CHIME), which has responded to a recent query by a group of six Republican senators who are hell bent on slowing down the meaningful use program to ensure its operating efficiently and not just handing out money to everyone claiming they’ve met Stage 1 (and eventually the other stages).

What’s remarkable about the news, though, is that CHIME actually issues a letter calling for a one-year extension of meaningful use Stage 2. According to CHIME’s letter, as reported by Healthcare Informatics,

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Does Using a Newer EHR System Actually Reduce the Number of Reported Errors in the Practice Setting?

When I worked with Sage Healthcare, one of the tenants of our marketing campaign was ensuring the market and those we served were well aware of the length of time our product had been used in ambulatory practice and its worth to countless physicians during that time.

Thirty years is a long time, especially for the ever changing world of software and technology; perhaps too long.

But I digress. Certainly, a product with three decades of service deserves to be recognized as one of the market’s leaders. After all, it is in the Smithsonian as the first practice management system in use commercially.

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7 Things to Consider When Choosing Clinical Decision Support Software

7 Things to Consider When Choosing CDS Software
William Daniel. M.D.

Guest post by William Daniel, M.D., medical director of Quality at Mid-America Heart Institute, Kansas City, and Chief Medical Officer for Emerge CDS.

With the new wave of healthcare reform upon us, hospitals are seeking ways to meet requirements of . With a growing number of hospitals incorporating electronic health records, health IT tools are becoming more prevalent. In fact in August 2012, a second stage of meaningful use guidelines for EHRs was set requiring physicians to use some form of clinical decision support in their practice.

The purpose of clinical decision software (CDS) software is to help the doctor?patient work process run more smoothly, however, often times, hospital staffs complain about technologies adding more time and money to the work flow. In a CompTIA’s study, 56 percent of respondents noted a need to make health IT tools easier to use, improve interoperability and increase operating speed.

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How Patient-centered, Value-based Care Will Drive Innovation in Healthcare

Fauzia Khan, MD

Guest post by Fauzia Khan, MD, FCAP, is chief medical officer and co-founder of Alere Analytics.

This has been a very interesting year for the healthcare industry, which appears to be on the brink of a real sea change. Government mandates are driving transformative discussions in the C-suite circles on topics such as meeting meaningful use Stage 2 and Stage 3 requirements, satisfying Accountable Care Organization (ACO) standards, care delivery models in the patient-centered medical home and much, much more.

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Healthcare Records: A Hacker’s Roadmap to your Life

Healthcare Records: A Hacker’s Roadmap to your Life
Alex Horan

Guest post by Alex Horan is the senior product manager at CORE Security.

In 2012 we saw an increasing number of health breaches across the country – and across continents. We saw an employee’s lost laptop turn into a healthcare records breach of more than 2,000 sensitive medical records of Boston Children’s Hospital patients. We heard how one weak password allowed a hacker to access the Utah Department of Technology Services’ server and steal approximately 780,000 patients’ health and personal information. We even read about Russian hackers encrypting thousands of patient health records and holding the information for ransom for thousands of dollars.

Healthcare fraud or medical identity theft put both individuals and healthcare organizations at huge and severe risk. Since 2010, Ponemon Institute has annually benchmarked the progressing and evolving issues of patient privacy and security. The third annual study, released in December 2012, found that healthcare organizations still face an uphill battle in their efforts to stop and reduce the loss or theft of protected health information (PHI) and patient records. What’s more, data breaches can have severe economic consequences – and the repercussion costs are only climbing. The study estimates the average price tag for dealing with breaches has increased from $2.1 million in 2010 to $2.4 million in 2012. The report projects that the economic impact of continuous breaches and medical identity theft could be as high as $7 billion annually, for the healthcare industry alone.

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Electronic Health Records: Money Pit or Bang for the Buck? The Economics of EHR

Electronic Health Records: Money Pit or Bang for the Buck? The Economics of EHR
Farrell

Guest post by David Farrell, PA Consulting Group.

In the past decade, academics and industry experts have published conflicting reports on whether electronic health records (EHRs) actually save money. Recent studies based on large, historical data from diverse providers suggest that EHRs haven[i]’t decreased costs[ii] [iii]  – contrast this with cost benefit analyses published back in 2003 that predicted EHRs would save around $15,000 to $20,000 per primary care physician per year[iv][v]. In addition, multiple vendors, academics and industry experts have published positive case studies on how EHR provides a positive return on investment or saves money in areas such as billing and staffing costs.

So why the divergence? Are providers simply not achieving what we expected in 2003? Are the positive case studies overly selective? Is it a case of what’s true for some is not true for all?

EHRs actually enable more productivity and satisfy more demand, and this is what drives cost. For providers, this also means driving up revenues.

Supply and Demand

One reason healthcare costs have not uniformly decreased is that more (efficient) supply from EHRs leads to more demand.

Firstly, consider the Jevons Paradox: energy efficiency leads to greater consumption (e.g. as air conditioning becomes more efficient and affordable, more air conditioners are purchased.) Taking a healthcare analogy, data center capacity has grown exponentially and EHR functionality has improved in recent years. In response, providers are storing larger amounts of detailed patient data and accessing greater capabilities. For example, providers are integrating IT and medical devices for real time patient data monitoring, storage and beyond. Additionally, a 2012 study supports this theory in that physicians ordered 40 percent to 70 percent more radiology exams with EHRs than with paper records. The efficiency and capability of EHRs (supply) have driven up the demand.

Secondly, I’ll paraphrase Parkinson’s Law: work expands to fill the time available. Demand for services in (public) healthcare will always outstrip the supply. This is because there is a backlog of patients waiting for currently available services and once this backlog is cleared, expectations of what should be provided will increase. It is therefore important to recognize that current health care reforms may not automatically decrease costs with EMRs in place, as demand will then increase too.

Increased demand means increased cost.

Productivity

So if cost doesn’t uniformly decrease with EHRs, does anything improve? Productivity does. A 2009 Wisconsin Medical Journal Study[vi] found that physician productivity increased about 20 percent and remained at that sustained level of productivity following EHR implementation. This means that more patients were seen on a given day. Not bad, considering the average wait time to see a physician in the U.S. is 20 days.

Increased productivity, however, leads to increased costs.

Payers vs. Providers

Another way to explain the divergence may lie in who we’re actually talking about. Do we mean payers like Medicaid/Medicare or providers like primary care physicians or hospitals? Studies often reference cost but fail to discuss revenue increases that an EHR system delivers to providers. Seeing more patients means more revenue to providers. In addition, providers with integrated EHR and billing benefit by eliminating billing errors and enabling better revenue protection. Payers, however, don’t share these financial benefits as more procedures means their costs are rising.  Indeed, payers may not realize the full cost savings of EHR until providers move away from pay-per-procedure to quality based payments.  Quality based payments of course, are next to impossible without the enabling reporting capabilities of EHR systems.

So when we talk about the cost of EHR systems, it’s important to distinguish who we’re talking about. In addition, when comparing pre- and post-EHR situations, instead of simply asking: “What’s the cost?” we should also be asking “What do we get for this cost?”

David Farrell is an IT strategy specialist at PA Consulting Group, focusing on project management and strategy for healthcare providers. He has worked with accountable care organizations and county-run hospitals on both U.S. coasts, assisting clients in building business cases, managing project benefits and forecasting the long term infrastructure impact of EHR. 

 

[i] Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests , Journal Of Health Affairs, 2012, http://content.healthaffairs.org/content/31/3/488.abstract

[ii] Hospital Computing and the Costs and Quality of Care: A National Study, American Journal of Medicine,2010 http://www.pnhp.org/sites/default/files/docs/AJM-Himmelstein-Hospital-Computing.pdf

[iii] Electronic Medical Records: Lessons from Small Physician’s Practices, iHealth Reports, 2003  http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/E/PDF%20EMRLessonsSmallPhyscianPractices.pdf

[iv] A Cost Benefit Analysis of Electronic Medical Records in Primary Care, American Journal of Medicine, 2003, http://www.amjmed.com/article/PIIS0002934303000573/fulltext

[v] Implementing an Electronic Medical Record at a Residency Site: Physicians’ Perceived Effects on Quality of Care, Documentation, and Productivity, Wisconsin Medical Journal, 2009, http://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/108/2/99.pdf