AMS | Electronic Medical Records, Doctors Medical Software, Medical Billing, Stimulus Funding, American Medical Software

Biden Announces $220 Million in Health-Technology Grants

Posted by AMS at 11 MAY 6:30 am

May 4 (Bloomberg) — The Obama administration plans to announce today the selection of 15 communities that will share in $220 million worth of grants for pilot projects to test health-care information technology.

The money comes from the economic stimulus legislation passed last year and is intended to encourage development and use of systems to connect doctors, hospitals and patients, according to a White House official speaking on the condition of anonymity before the announcement.

Vice President Joe Biden and Health and Human Services Secretary Kathleen Sebelius will announce the locations for the grants at an event scheduled for 1 p.m. Washington time today, the official said.

The grants will create as many as 1,100 jobs, each paying an average of $70,000 per year, the official said.

The $862 billion economic stimulus measure included as much as $27 billion for doctors and hospitals to adopt electronic medical records and committed $2 billion to develop technology so every American can have electronic records by 2014.

The Obama administration announced $975 million in government grants on Feb. 12 to encourage the use of health-care technology at hospitals to help share medical information and train medical professionals to use the new systems.

By Nicholas Johnston

–Editors: Joe Sobczyk, Robin Meszoly

To contact the reporter on this story: Nicholas Johnston in Washington at njohnston3@bloomberg.net

To contact the editor responsible for this story: Jim Kirk at jkirk12@bloomberg.net

Categories: EHR Health Care News, Stimulus News

Tags: grants, human services, Stimulus

New Health-Care Law Making Doctors Responsive

Posted by AMS at 4 MAY 6:30 am

In many respects, American doctors today labor much the way their counterparts did 50 years ago.

Most are in practices with five or fewer other physicians. They keep their records on paper in longhand. When they need to consult a colleague, they reach for the telephone. They bill for each visit. They have little idea about how their skills compare to those of fellow practitioners, nor do most know what their patients really think about the care they give.

The new health-care law aims to change most of that.

Fifty years from now, it is likely that almost all doctors will be members of teams that include case managers, social workers, dietitians, telephone counselors, data crunchers, guideline instructors, performance evaluators and external reviewers. They will be parts of organizations (which either employ them or contract with them) that are responsible for patients in and out of the hospital, in sickness and in health, over decades.

The records of what they do for a patient — and what every other doctor does — will be in electronic form, accessible from any computer. Software will gently remind them what to consider as they treat, and try to prevent, diseases. How the patients fare will be measured and publicized, and used in part to judge practitioners’ performance. At the same time, the health-care organizations, aided by the government, will make an effort to let caregivers know the “best practices” they’re expected to follow.

These edifices, with primary care as the chief structural support, will go by names such as “accountable care organizations” and “patient-centered medical homes.” Versions of them already exist in health-care systems such as Kaiser Permanente, Group Health Cooperative and the Mayo Clinic.

Some physicians resent the fact that the new law promotes this evolutionary change. Others think it is liberating.

But one thing is clear: There are a lot of unhappy people practicing medicine right now.

A survey of physicians in 119 clinics in New York and the Midwest published in the Annals of Internal Medicine in 2009 found that 48 percent reported working in “chaotic” environments. Thirty percent said they needed at least half again as much time for appointments as they were given. Only a quarter said their practices strongly emphasized quality. Nearly a third said they were likely to leave their jobs in the next two years.

If the new types of practice envisioned by the Patient Protection and Affordable Care Act take hold, much of that could change for the better.

“It appears that when a doctor happens to be in a place that moves to a ‘medical home’ model, they can turn their frustration into excitement again. That is huge,” said J. Fred Ralston Jr., president of the American College of Physicians. “We are getting reports that patients are happy, physicians are happy and that, in at least some cases, [these new sorts of practices] are saving money.”

Emphasis on primary care

Key to the new law’s goals is primary care. Through many routes, the law provides a total of $26.4 billion over 10 years to support this broad field of medicine, which, dozens of studies have shown, improves health and controls costs.

States with a higher per-capita ratio of primary-care physicians have lower mortality rates from cancer, heart disease and stroke. Having one additional primary-care physician per 10,000 people was associated with a 6 percent decrease in total mortality and a 3 percent decrease in infant mortality and low-birth-weight babies. In 2000, 5 million hospital admissions, costing a total of $26.5 billion, might have been prevented with better primary care, according to one analysis.

The trouble is that there aren’t enough primary-care physicians. So the law has several provisions designed to make primary care more attractive.

It increases Medicare reimbursement for “evaluation and management” services, the government’s name for examining and talking to the patient. It provides about $350 million in additional support for training programs in primary care. It provides loan-forgiveness incentives to medical school graduates who practice primary care in under-served areas. There are also incentives for the training of nurse practitioners and physician assistants, two professions likely to have growing roles in primary care.

Better coordination

The law also addresses another long-standing problem: the lack of coordination among private practitioners in the fee-for-service world (which is most of American medicine). The scope of that problem was made clear in an astonishing study published in 2009.

On average, a Medicare patient sees seven doctors, most of them specialists, in four practices each year. Researchers at the Center for Studying Health System Change looked at what that might mean to a primary-care doctor who has many Medicare patients.

They examined the experiences of 2,284 physicians, who treated an average of 264 Medicare patients each. To care for these patients each year, they determined, the typical practitioner needed to interact with 229 physicians working in 117 practices.

That nightmarish prospect may partly explain the appallingly high hospital readmission rate for Medicare patients. A study published in 2009 found that 20 percent of Medicare beneficiaries discharged from the hospital were readmitted within 30 days. Half had not visited a doctor during that period, when they were often in shaky health and taking new or higher-dose medication.

What the “right” readmission rate might be is unknown. However, it is almost certainly less than 20 percent.

A study of a large health-care organization in Colorado in which reduction of hospital use was already a main focus found it could reduce the readmission rate in elderly patients from 15 percent to 8 percent with a program that featured frequent phone calls, home visits from a “transition coach” on the lookout for a worsening condition and a medical record maintained by the patient.

Whatever the exact strategy, it seems that readmissions could be reduced if all the practitioners were in the same organization, or at least in a defined “web,” with seamless access to patient records and a shared financial interest in helping their patients recover.

The law has numerous provisions, many laid out only in general terms, for testing alternatives to the fee-for-service model that Medicare and Medicaid operate under now. They include “bundled” payments for hospital and immediate post-hospital care, which would provide an incentive to minimize readmissions, and the banding together of doctors, hospitals, clinics, imaging centers, diagnostic labs, etc., into “accountable care organizations” that would get to share in any savings accruing to the Medicare program.

To gain such savings, the organizations would have to keep patients healthy. That, in turn, would require health-care workers to perform services generally not done by doctors (or done only occasionally), such as home visits, medication monitoring, dietary counseling and intensive patient education.

The iron laws of economics suggest that only large organizations (or contractual arrangements among smaller ones) will be able to offer this kind of soup-to-nuts care. At the moment, fewer than 20 percent of clinicians are in practices with 11 or more doctors. It is clear that lots of doctors are going to have to change their work arrangements before the “accountable care” model becomes the norm — if it ever does.

Better information

Doctors already have incentives to report quality-related measures to Medicare. The new law will penalize doctors who don’t make such reports, starting in 2015. In the future, physicians participating in the Physician Quality Reporting Initiative will receive reports about how their performance compares to others’.

There is also money for the creation and dissemination of “patient decision aids” — handouts, videos, computer programs, etc. — that will help patients understand their treatment options. That is part of the law’s general intent to make medical care more patient-centered.

In one of its more controversial parts, the law establishes a Patient-Centered Outcomes Research Institute to underwrite and direct “comparative-effectiveness research” seeking to determine the best and most economical treatment for common diseases. While the law specifically says that comparative-effectiveness findings can’t become mandates that tell doctors how to practice, many champions of reform think that such research is essential to improving care.

“Three key steps — wise standardization, meaningful measurement and respectful reporting — have transformed other industries, and we believe they can help health care as well,” 12 of them wrote in the New England Journal of Medicine in January.

Get the full story: This article is adapted from Landmark: The Inside Story of America’s New Health-Care Law and What It Means for Us All by the staff of The Washington Post. Now available at bookstores and online (www.landmarkbook.com).

washingtonpost.com > Health By David Brown Tuesday, May 4, 2010

Categories: EHR Health Care News

Tags: Electronic Health Records, medicare, Primary Care

Using Personal Health Records when Doctors Reccommend

Posted by AMS at 27 APR 6:00 am

A practical look at information technology issues and usage

The number of people using personal health records has doubled in the past year. But those users still account for only 7% of the American patient population, according to one recent survey.

That survey also found that if patients are going to be pushed toward greater PHR adoption by anyone, it’s going to be by the health care system representatives they trust the most — their physicians.

The California HealthCare Foundation commissioned a study in which researchers talked to people who use PHRs as well as people who don’t. Nonusers made up 89% of the 1,864 respondents (the rest didn’t know or refused to answer). The report, “Consumers and Health Information Technology: A National Survey,” found that the biggest barrier to PHR use is privacy concerns, cited by 75% of non-PHR users. Many respondents expressed fears that their medical information could be used against them by insurers or employers, both of which are pushing for PHR adoption.

Although people may not completely understand the concept of PHRs, they generally understand that employers and insurers expect to improve their bottom lines by offering them. But nonusers said employers were not likely to interest them in PHRs. Only 25% said they might use a PHR that came from an employer. (The same percentage gave that level of interest to PHRs offered by Google and Microsoft.)

Meanwhile, 58% said they might be interested in a PHR from a hospital or physician with whom they already have a relationship. Fifty-two percent said they might be persuaded to use a PHR if a doctor said it was safe, while 50% said they would use a PHR if a friend or family member said it was safe.

Kate Christensen, MD, an internist with Kaiser Permanente and medical director for Kaiser’s patient portal and PHR system, said the survey’s findings have confirmed what Kaiser has seen in the use of its own PHR system.

“What I didn’t find surprising at all was that patients trust PHRs that come from their providers, their doctors, their health plans, because that’s what we have found,” Dr. Christensen said. Fifty percent of survey respondents expressed a relatively high level of interest in using a PHR sponsored by their health plans.
Patient portals

Although PHRs have been defined as electronic filing cabinets to store personal health information, they are evolving into larger patient portals tethered to a physician’s electronic medical record system and offering benefits beyond data storage. Integrated PHRs allow patients to look up lab and test results, communicate with physicians electronically and request prescription refills online, and offer other convenience features that patients increasingly are demanding.

Sam Karp, vice president of programs for the CHCF, said one way physicians can drive PHR use is by taking advantage of the federal incentive program for EMRs. Most newer EMR systems include a patient portal with a PHR component. These systems not only will help physicians qualify for Medicare or Medicaid incentive pay, he said, but they also can help physicians tap into a new revenue source — e-visits.

Of respondents who use PHRs, 26% said they were using one offered by a physician. Another 51% said they were using one owned by their health plan. Only 4% used an employer-issued PHR.

Colin Evans, CEO of Dossia, a PHR offered by a large employer consortium whose members include Wal-Mart Stores Inc., said he was not surprised that employer-sponsored PHRs were at the bottom of the list. “I think the question that tends to lead in people’s minds is who do they trust with their data,” he said.

Evans theorized that because hospitals and physicians have the health data anyway, patients don’t see anything negative about sharing additional data with them. But the challenge for employer-sponsored PHRs is getting people to realize that the data employers have access to already is aggregated from several different sources, and that any PHRs employers offer usually are run by independent third parties.

People also are skeptical of employers’ pushes to use PHRs. Reducing health care costs through PHR use clearly benefits employers, although employees might not see it as much of an incentive. But, Evans said, people should realize that if employers have to spend more on health care, they may not be able to afford to offer that benefit at all — or that more money will be taken out of employee paychecks.

TECHNICALLY SPEAKING – By Pamela Lewis Dolan, amednews staff. Posted April 26, 2010.

Categories: EHR Health Care News, News Blog

Tags: Medical Records

FCC’s broadband critical to health IT

Posted by AMS at 13 APR 7:37 am

WASHINGTON – Healthcare IT champions are applauding the broadband plan the government released Tuesday as a boon for health information technology.”We hope the National Broadband Plan serves as a driver for both innovation and connectivity, which are two key elements to lowering costs and improving patient care,” said Joel White, executive director of the Health IT Now! Coalition. “Millions of Americans have discovered the life-saving benefits of their doctor's use of electronic medical records. We know health information technology will not reach its true potential without full access to broadband services. This is a critical patient priority.”The Health IT Now! Coalition hosted a panel discussion with the Federal Communications Commission and a panel of experts Wednesday to discuss the FCC's National Broadband Plan and its proposals to develop affordable access to broadband and healthcare.

The broadband plan was released on March 16.”We believe that the National Broadband Plan will make it easier for doctors and hospitals to utilize electronic medical records, which will ultimately lead to improved care and better outcomes for patients,” said Mohit Kaushal, MD, director of connected health at the FCC. “The plan focuses on the growing need for greater connectivity and innovation.”"We need to continue momentum towards universal Health IT by ensuring doctors and hospitals have access to nationwide high-speed broadband, and the National Broadband Plan is a major step in the right direction,” said White.In addition to Kaushal, the panel included John Santelli of UnitedHealth Group; Karen S. Rheuban, MD, medical director of the Office of Telemedicine, professor of pediatrics and senior associate dean for CME and external affairs at the University of Virginia and president of the American Telemedicine Association; Hank Fanberg of CHRISTUS Health and Jim Bialick of Genetic Alliance.Continua Health Alliance, a nonprofit coalition of 230 healthcare and technology companies, commended the FCC for putting forth a plan that supports health information technologies, including: reimbursement, modernizing regulations, increasing data capture and utilization, and providing sufficient connectivity to better enable the provision of healthcare.”In the coming decades, broadband will play an increasingly important role in supporting health care delivery in America,” said Chuck Parker, executive director, Continua Health Alliance.

“The FCC plan would close the broadband connectivity gap for health care providers while aligning the commission's efforts with the emerging meaningful use criteria.”"The need for policy reform and leadership to usher in the era of connected health is clear,” said Rick Cnossen, president and board chair, Continua Health Alliance. “More than 100 million Americans lack access to basic broadband services, highlighting an urgent need for deployment of fixed and mobile broadband solutions nationwide for both patients and providers.”The plan includes 11 recommendations for using broadband networks to spur greater use of electronic health records, health data exchanges and telemedicine.

Create appropriate incentives for e-care utilization.

Congress and the Secretary of Health and Human Services (HHS) should consider developing a strategy that documents the proven value of e-care technologies, proposes reimbursement reforms that incent their meaningful use and charts a path for their widespread adoption.
Modernize regulation to enable health IT adoption.
Congress, states and the Centers for Medicare & Medicaid Services (CMS) should consider reducing regulatory barriers that inhibit adoption of health IT solutions.
The FCC and the Food and Drug Administration (FDA) should clarify regulatory requirements and the approval process for converged communications and health care devices.

Unlock the value of data.

The Office of the National Coordinator for Health Information Technology (ONC) should establish common standards and protocols for sharing administrative, research and clinical data, and provide incentives for their use.
Congress should consider providing consumers access to – and control over – all their digital health care data in machine-readable formats in a timely manner and at a reasonable cost.

Ensure sufficient connectivity for health care delivery locations.

The FCC should replace the existing Internet Access Fund with a Health Care Broadband Access Fund.
The FCC should establish a Health Care Broadband Infrastructure Fund to subsidize network deployment to health care delivery locations where existing networks are insufficient.
The FCC should authorize participation in the Health Care Broadband Funds by long-term care facilities, off-site administrative offices, data centers and other similar locations. Congress should consider providing support for for-profit institutions that serve particularly vulnerable populations.
To protect against waste, fraud and abuse in the Rural Health Care Program, the FCC should require participating institutions to meet outcomes-based performance measures to qualify for Universal Service Fund (USF) subsidies, such as HHS’s meaningful use criteria.
Congress should consider authorizing an incremental sum (up to $29 million per year) for the Indian Health Service (IHS) for the purpose of upgrading its broadband service to meet connectivity requirements.
The FCC should periodically publish a Health Care Broadband Status Report.

via FCC’s broadband plan lauded as critical to health IT | Healthcare IT News.

Categories: EHR Health Care News

Tags: Broadband, FCC, HHS, United Health Group

VA Looking To Add Social Medial Tools to EHR Portal

Posted by AMS at 11 APR 9:32 pm

The Department of Veterans Affairs is testing the use of various social media-style tools that would enhance the user experience and accessibility of VA’s electronic health record portal My HealtheVet, Federal Computer Week reports.

At the 2010 FOSE conference on Tuesday, Gail Graham, VA’s deputy chief officer of health care information management, said that younger VA members returning from deployment have been requesting more functionality and social media-like services in the EHR portal. Veterans use the portal to access their health records, maintain health diaries and order prescription refills.

She said that VA has been testing a secure message tool that would link patients to their health providers through My HealtheVet. The tool has been introduced in pilot projects at several VA hospitals, Graham said. However, she noted that HIPAA privacy rules prevent it from functioning as an instant messaging tool.

Graham said that additional features are being tested in focus groups with veterans (Beizer, Federal Computer Week, 3/23).

Categories: News Blog, Social Media & Health Care

Tags: Facebook, Social Media, Twitter, Veterans

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Biden Announces $220 Million in Health-Technology Grants

New Health-Care Law Making Doctors Responsive

Using Personal Health Records when Doctors Reccommend

FCC’s broadband critical to health IT

VA Looking To Add Social Medial Tools to EHR Portal

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