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Enter the Revolution

DEM blue

By David Edward Marcinko MBBS MBA CMP®

http://www.CertifiedMedicalPlanner.org

Enter the CMPs

To understand the MR revolution that has occurred the past decade , place yourself for a moment in the position of third-party payer.

You want to know if Dr. Brown actually gave the care for which he is submitting a bill.  You want to know if that care was needed.  You want to know that the care was given to benefit the patient, rather than to provide financial benefit to the provider beyond the value of the services rendered.

Can you send one of your employees to follow Dr. Brown around on his or her office hours and hospital visits?

Of course not!  You cannot see what actually happened in Dr. Brown’s office that day or why Dr. Black ordered a CAT scan on the patient at the imaging center.  What you can do is review the medical record that underlies the bill for services rendered from Dr. Blue.

Most of all, you can require the doctor to certify that the care was actually rendered and was indicated.  You can punish Dr. White severely if an element of a referral of a patient to another health care provider was to obtain a benefit in cash or in kind from the health care provider to whom the referral had been made [Stark Laws].  You can destroy Dr. Rose financially and put him in jail if his medical records do not document the bases for the bills he submitted for payment.

This nearly complete change in function of the medical record has precious little to do with the quality of patient care. To illustrate that point, consider only an office visit in which the care was exactly correct, properly indicated and flawlessly delivered, but not recorded in the office chart.  As far as the patient was concerned, everything was correct and beneficial to the patient.  As far as the third-party payer is concerned, the bill for those services is completely unsupported by required documentation and could be the basis for a False Claims Act [FCA] charge, a Medicare audit, or a criminal indictment.  We have left the realm of quality of patient care far behind.  Shall we change it back to the way it was?  That is not going to happen.

***

273_1

***

Instead, practitioners must adjust their attitudes to the present function of patient records. They must document as required under pain of punishment for failure to do so.  That reality is infuriating to many since they still cling to the ideal of providing good quality care to their patients and disdain such requirements as hindrances to reaching that goal.  They are also aware of the fact that full documentation can be provided without a reality underlying it.

“Fine, you want documentation?  I’ll give you documentation!”

Some have given in to the temptation of “cookbook” entries in their charts, or canned computer software programs, EHR [electronic medical record] templates, listing all the examinations they should have done, all the findings which should be there to justify further treatment; embedded “billing engines” not with-standing. We have personally seen records of physical examinations which record a patient’s ankle pulses as “equal and bounding bilaterally” when the patient had only one leg; hospital chart notes which describe extensive discussion with the patient of risks, alternatives and benefits in obtaining informed consent when the remainder of the record demonstrates the patient’s complaint that the surgeon has never told her what he planned to do; operative reports of procedures done and findings made in detail which, unfortunately, bear no correlation with the surgery which was actually performed.

***

EMRs

***

Whether electronic medical records (EMR) will really be helpful, in the future, is still not known.

In fact, according to Ed Pullen MD, a board certified family physician practicing in Puyallup WA, electronic health records are defined primarily as repositories of patient data [much like paper records].

But, in the era of meaningful use [MU], patient-centered medical homes, and Accountable Care Organizations [ACOs], mere patient data repositories are not sufficient to meet the complex care support needs of clinical professionals. These complaints arise because EHR systems are being used as clinical care support systems, which means they should enhance the productivity of clinical professionals and support their information needs, not hinder them [personal communication, and DrPullen.com]. 

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EHRs in the News – GAG!

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A Recent Round-Up

1-darrellpruitt[By D. Kellus Pruitt DDS]

“Feds push forward with controversial health rule – The Obama administration is moving ahead with controversial new rules that require doctors to switch to electronic health records or face fees, resisting calls from both parties to delay implementation.”

By Sarah Ferris for The Hill, October 6, 2015

http://thehill.com/policy/healthcare/256120-feds-push-forward-with-controversial-health-it-rule?utm_content=buffer9cd4b&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

“The Gag Clause is Killing Us – Doctors are barred from discussing safety glitches in software…  And what if doctors — your doctor — is unable to make problems with EHR programs public, due to a so-called ‘gag clause’ written into the contract with the software company, which forbids sharing and publishing, in any form, of potentially dangerous flaws in the IT systems? This is already happening.”

By Deirdre Reilly for HealthZette, October 6, 2015

http://www.lifezette.com/healthzette/gag-clause-is-killing-us/

 “Hackers target Australian health sector, selling records for A$1,000 – Hackers are targeting the Australian health sector, with fully populated digital health records sold on the black market for up to A$1,000 each [$720 US].”

By Beverley Head for ComputerWeekly.com, October 7, 2015

http://www.computerweekly.com/news/4500254986/Hackers-target-Australian-health-sector-selling-records-for-A1000 

 “Electronic health records software often written without doctors’ input – The reason why many doctors find electronic health records (EHR) difficult to use might be that the software wasn’t properly tested, researchers suggests.”

By Kathryn Doyle for Reuters, October 7, 2015

http://www.reuters.com/article/2015/10/07/us-health-software-ehr-idUSKCN0S11OY20151007

 “EHRs provide long-term savings, convenience.”

(no byline), American Dental Association, ADA News, December 6, 2013

http://www.ada.org/en/publications/ada-news/2013-archive/december/ehrs-provide-long-term-savings-convenience

 ***EHR

***

More:

  1. The Percentage of Office-Based Doctors with EHRs
  2. Do Nurses like EHRs?
  3. EHRs – Still Not Ready For Prime Time
  4. The “Price” of eHRs

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[Foreword Dr. Phillips MD JD MBA LLM] *** [Foreword Dr. Nash MD MBA FACP]

***

EHRs – AMA versus ADA

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Will Electronic Health Records Ever Be Usable?

[By Darrell K. Pruitt DDS]

1-darrellpruittThe American Medical Association

The AMA attempts to address the frustration EHRs create, especially for doctors and other healthcare workers. ‘It’s easy to use, once you know where everything is,’ the instructor said during an EHR training session I recently attended.

Most EHR companies seem to believe this is an acceptable way to design software. EHR usability has been greatly ignored by vendors, and last week the American Medical Association issued eight usability priorities in an attempt to address the issue.

This directive comes as a result of a joint study by the RAND Corporation and the AMA highlighting EHRs as a significant detractor from physicians’ professional satisfaction.” Commentary by Stephanie Kreml for InformationWeek, September 26, 2014.

http://www.informationweek.com/healthcare/electronic-health-records/will-electronic-health-records-ever-be-usable/a/d-id/1316071

The American Dental Association

On the other hand, “EHRs provide long-term savings and convenience,” no byline, ADA News, December 6, 2013.

http://www.ada.org/en/publications/ada-news/2013-archive/december/ehrs-provide-long-term-savings-convenience

boxing-gloves-1053702

[POW – SPLAT – BIFF – UGH]

More:

  1. The Percentage of Office-Based Doctors with EHRs
  2. Do Nurses like EHRs?
  3. EHRs – Still Not Ready For Prime Time
  4. The “Price” of eHRs
  5. Borges versus Kvedar Video eHR Debate

EHRs versus the Federal Government

Government mandated EHRs – what a waste!

“Doctors, Hospitals Went Digital, But Still Can’t Share Records – After spending billions to switch from paper to digital records — much of it taxpayer subsidized through the economic stimulus package — providers say the systems often do not share information with competitors.”

[Kaiser Health News, October 1, 2014]

http://www.kaiserhealthnews.org/Daily-Reports/2014/October/01/marketplace.aspx

Conclusion

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How EMR Vendors Mis-Lead Doctors [Part 2 of 2]

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Practical “Tips and Pearls” from the Trenches

[Part Two]

By Shahid Shah MS http://www.healthcareguy.com

Shahid N. ShahAs your practice’s CIO it’s your job to challenge the vendors’ assertions about why you need an EMR, especially during the selection and production demonstration phase.

The most important reason for the digitization of medical records is to make patient information available when the physician needs that information to either care for the patient or supply information to another caregiver.

Electronic medical records are not about the technology but about whether or not information is more readily available at the point of need. In no particular order, the major reasons given for the business case of EMRs by vendors include:

  • Increase in staff productivity
  • Increase of practice revenue and profit
  • Reduce costs outright or control cost increases
  • Improve clinical decision making
  • Enhance documentation
  • Improve patient care
  • Reduce medical errors

Let’s tackle each potential benefit and see how they can be realized or left unfulfilled based on how a practice uses the technology solutions available to it. While thinking of the benefits, keep in mind that all automation solutions have voracious appetites for data entry and information. If you do not enter the data (either manually, through scanners, or integration with external systems) the value of the solutions cannot be realized. That’s why it’s crucial to consider how much time and effort you’d like to invest in data entry and if you’re not willing or able to take the time to enter the data into the system then the system is not going to work for you.

Increase in staff productivity

The first benefit often cited by vendors is improvement of your staff’s productivity. In a well-designed and properly implemented solution, an EMR can reduce the amount of time it takes for staff to locate records and find particular information about patients as well as generally conduct their tasks in a more efficient manner. However, actually achieving productivity improvement is much more difficult than vendors often make it sound. This is because the actual improvement in productivity is directly related to the amount of detailed data that is collected for patients across the entire practice workflow. Unless your practice has identified all or at least most major workflow steps and has created appropriate automation steps is unlikely that your productivity improvement will match what the vendor promises.

Ask your vendors specifically where the staff productivity improvements come from; in a demonstration have the sales person show you how specific functions of their software can improve staff effectiveness at particular tasks. Instead of citing just studies performed in large institutions, have the vendor show you how their benefits apply to your smaller setting. Ask specifically what happens if certain data is not entered in the way the vendor requires it; does it break the software, reduce the staff productivity benefits, or something else?

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Increase of practice revenue and profit

Most physician practices make money by seeing patients and charging fees for services; but when a vendor promises an improvement in revenue or an increase in profit, you must be very reluctant to believe the claims without specific evidence. An increase in revenue can only come when the number of patients seen per day per physician can be increased. An increase in profit can only be achieved if the costs associated with seeing patients can be reduced. Unless an EMR actually reduces the number of steps involved in seeing a patient and reducing the time associated with the non-clinical aspects of patient care there is no way that the introduction of the technology itself will increase revenue. Likewise, unless an EMR is designed to significantly remove staff burden and reduce the number of people in your office that you need to perform tasks associated with patient care, realizing an increase in profits will be tough.

During the software demonstration, ask the vendor about how the revenues increases come because of specific features. Dubious responses like studies performed in academic medical institutions or a reference to another client shouldn’t be enough – they should be able to demonstrate methodically how revenues will go up in your practice.

Reduce costs outright or control cost increases

In some fairly sophisticated implementations the reduction of costs has been proven to be possible; however outright cost reduction is still tough to gain. Controlling cost increases, however, is quite possible and is usually easier to attain because as your staff becomes familiar with their technology solutions they become more efficient over time and they are able to do more work with the same resources and staff therefore you may be able to increase the number of patients that you can see over time without increasing costs. Again, while immediate cost reductions are tough in a medical practice given that a large portion of your costs are associated with personnel, long-term cost reduction through either attrition or not having to hire new staff while still being able to increase their workload allows you to control costs better.

During the software demonstration, make sure you see how specific software features will reduce costs. You will get plenty of softballs being thrown your way about how other customers saw their costs go down or studies showing that large companies have seen the benefits. Your job as the CIO will be to force the vendor to tie cost savings specifically to use of their software, not computers in general.

Improve clinical decision making

Improving clinical decision-making is often a dubious endeavor and should not typically be the first reason you choose to implement an EMR; this is because clinical decision-making is and will remain a knowledge –based activity requiring significant training and teaching of computers before they can actually begin to improve clinical decisions. Physicians are some of the worlds’ best trained knowledge workers and they honed their clinical decision-making skills over a long period of time in very specialized training regimens that cannot easily at this time be duplicated by computers. When a vendor promises that an implementation of any EMR will improve decision-making from a clinical standpoint remain very skeptical.

Enhance documentation

Many vendors claim that their EMR’s will help improve and enhance clinical documentation. While this is very true for lead-based EMR is they are often creating much more documentation as far as quantity is concerned while likely reducing the actual quality of the information contained in the documentation. When implementing a template-based solution keep in mind that what a physician could normally easily write down in a couple of sentences will turn into many paragraphs in many pages of boilerplate text and boilerplate documentation that must then be stored red and understood by colleagues. So the promise of enhanced documentation is actually usually easy to achieve because you will get more pages of documents that are automatically generated but those pages that are generated may not necessarily be the most favorable from a clinical usefulness perspective.

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Improve patient care

Many vendors proclaim that the installation of an EMR sometimes by itself will improve patient care; if by improvement of patient care they mean actually moving patients through the different steps associated with patient care in your office in a faster and more customer friendly manner then there is some truth to that. However if by improvement of patient care the promise is to actually make people’s healthcare better or truly improve a patient’s health itself then those claims must also be seen with a skeptical eye. This is similar to the clinical decision making enhancement promises that are often made; just like clinical decisions, patient care is a very human activity and simply introducing a better record keeping system will not improve people’s health. We are an improvement in health can occur however is in the tracking of clinical goals and helping patients meet those goals by reminding patients for regular tasks.

Reduce medical errors

Reduction of medical errors is a laudable goal; and in fact many EMR’s and the use of computerized physician order entry systems can help reduce medical errors by ensuring that common clerical types of errors do not occur. When looking at medical and clinical errors those errors that can easily fit well established and known rules can be automated in a somewhat friendly and easy manner and by using such automated tools error reduction is possible.

Assessment

However, when rules become difficult to define or are not widely agreed-upon then errors associated with such rules would not be caught.

PART ONE: How to Demo and Buy an EMR Office System [Part 1 of 2]

Conclusion

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Can Politically-Correct Names Save Obamacare?

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Saving Electronic Health Record Interoperability?

1-darrellpruittBy D. Kellus Pruitt DDS

If HHS successfully persuades Americans to use happy names for its bad ideas, will the cheap trick save electronic health record interoperability which is critical to the success of Obamacare?

Healthcare Lexicon 

According to the government’s modernized healthcare lexicon, doctors have been demoted to “providers,” insurance companies, including Medicare/Medicaid, have been promoted to “payers,” and patients’ position in the hierarchy has diminished from “principals” to “stakeholders” – a rank on par with 3rd parties such as insurers, HHS and other unaccountable parasites.

Wall of Shame

Ominously, HHS recently changed the contentious name “Wall of Shame” to a more innocuous“ breach reporting tool,” to describe the public list of data breaches involving the medical records of more than 500 patients. It turns out that the growing list of major data breaches is unexpectedly shaming  far too many providers and payers – including Medicare/Medicaid. Imagine that!

In fact, since Americans’ growing disgust with privacy breaches threatens the very success of Obamacare, there is evidence that HHS has turned to betraying its lawful obligation to the nation by hiding breaches from those who are most vulnerable – Americans.

HIPAA Failure

The half-baked plan to shame providers who experience data breaches – perhaps through no fault of their own – is not working out like HHS had hoped. Due to HIPAA’s abysmal failure to halt data breaches, the Wall of Shame has become a national embarrassment and an obstacle to EHR adoption. I expect the public listing of major breaches to be quietly scrapped soon in favor of keeping patients in the dark concerning their risks of identity theft.

Dentistry 

In dentistry, on the other hand, common sense as well as market resistance evidently caused HHS and other stakeholders to give up trying to prohibit use of the 8 syllable “electronic dental records” in favor of the 14 syllable “electronic health records for dental practices.”

Nevertheless, holdouts (including Dissent Doe) still occasionally feel it is important to correct this dentists when I use “EDR” instead of “EHR.” You got to love ‘em.

Obama Care 

Assessment 

Transparent silliness suggests that HHS is failing in its duties. Due to lack of accountability, we can expect EHRs and EDRs to become even more expensive and more dangerous, possibly bringing an end to Obamacare.

Conclusion

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Do Nurses like EHRs?

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Do RNs like using electronic health records?

[A seldom considered POV]

1-darrellpruitt

BY Darrell K. Pruitt DDS

Some Facebook comments:

Big problems when you have unexpected “downtimes”.

July 15 at 3:10pm · Like · 4

It is an absolute train wreck. I haven’t seen one record of mine that is not riddled with mistakes. Especially the allergies, they show me taking meds I’m allergic to and not taking meds I’m actually on. A true mess!! And now the records are all intertwined. I don’t like it at all!!

July 15 at 3:10pm · Like · 2

It is a nightmare!

July 15 at 3:18pm · Like

I retired just in time so I don’t have to deal with this fiasco.

July 15 at 3:19pm via mobile · Like · 2

IT SUCKS

July 15 at 3:19pm · Like

I don’t like them; my doctors don’t like them; how it will affect patient care is still a ‘jury out’ matter, but we can guess it will NOT help.

July 15 at 3:30pm · Like

Our Rural Community Healthcare system is just now switching over to this .. along with our hospital switching over to a totally new computer system .. the 2 systems do not talk to each other..In my personal experience I find that the “computer” world takes us away from Direct Patient Care (to busy playing “ring around the Rosie” on the computer).

July 15 at 3:40pm · Like · 4

I like them, but it is frustrating having “downtime.”

July 15 at 3:41pm · Like

I hear patients stating things like “my doctors don’t know who I am because they don’t look at me they are glued to the computer”. It saddens me patients feel less valued. I’ve worked in places where they’ve had paper charts and places computerized. Seems the computers are redundant and I personally prefer paper charts. Chart one assessment not one assessment 4 different places.

July 15 at 3:44pm via mobile · Like · 3

It looks to me like physicians are cutting and pasting old histories and physicals, complete with the errors. Doctors in a local ER charted complete physicals on me when they did not get closer than 5 feet away. The records are difficult to read, difficult to find information; and it is not number in chronological order.

July 15 at 3:47pm · Like

I dislike it. Besides the down time, I find it very impersonal. I don’t feel as if I am giving my full attention to my pt, nor do I feel my PCP is hearing what I’m saying . They are too busy putting in info on the computer. As for the down time you then have to work late to put in the info gathered while the system is down.

July 15 at 3:47pm via mobile · Like · 2

eHRs

Assessment

https://www.facebook.com/friendanurse/posts/654085127954821

More: On DIgital Deaths

http://www.bloomberg.com/news/2013-06-25/digital-health-records-risks-emerge-as-deaths-blamed-on-systems.html

(50+ other comments)

Conclusion

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The Flaws of Electronic Records

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Reporting on an Op-Ed by Drexel University’s Scot Silverstein

By Darrell K. Pruitt DDS

pruittRecently, on Philly.com, I read the following interesting essay and counter-opinion.

“The flaws of electronic records – Drexel University’s Scot Silverstein is a leading critic of the rapid switch to computerized medical charts, saying the notion that they prevent more mistakes than they cause is not proven.”

by Jay Hancock, writing in:

KAISER HEALTH NEWS.

http://www.philly.com/philly/entertainment/20130218_The_flaws_of_electronic_records.html

Do you recall that I advised dentists to wait a year or so before purchasing electronic dental records?

Dr. Silverstein warns Hancock that we’re in the midst of “a mania” as traditional patient charts are switched to computers. “We know it causes harm, and we don’t even know the level of magnitude. That statement alone should be the basis for the greatest of caution and slowing down.”

Silverstein Speaks

Silverstein tells Hancock that he doesn’t discount the potential of digital records to eliminate duplicate scans and alert doctors to drug interactions and unsuspected dangers.

“But, the rush to implementation has produced badly designed products that may be more likely to confound doctors than enlighten them, he says. Electronic health records, Silverstein believes, should be rigorously tested under government supervision before being used in life-and-death situations, much like medical hardware or airplanes.”

Physician George Lundberg, editor at large for MedPage Today, says Silverstein “is an essential critic of the field,” and that “It’s too easy for those of us in medicine to get excessively enthusiastic about things that look like they’re going to work out really well. Sometimes we go too far and don’t see the downside of things.”

Hancock Writes

Hancock writes. “Many say he comes on too strong.” Remind you of anyone? It’s easy to fall into a habit of “coming on too strong” once politeness proves ineffective and not nearly as much fun.

Silverstein points out that since the government doesn’t require caregivers to report problems, “many computer-induced mistakes may never surface.”

In dentistry, EHR stakeholders bury computer-induced mistakes even deeper by ignoring and even censoring dentists’ concerns about cost and safety.

Shah Opines

Furthermore, ME-P thought-leader Shahid N. Shah MS opines in Chapter 4 of the book: www.BusinessofMedicalPractice.com

Chapter 13: IT, eMRs & GroupWare

And … Pruitt Wonders?

I sincerely wonder how many dentists have been kicked off of DrBicuspid, DentalTown, Dental Economics and LinkedIn for pointing out dangerous flaws in advertisers’ dental products. I offered to start a listing of the censored, but got no response. Nevertheless, I bet I’m not the only one.

Assessment

More opinions from ME-P contributors and essayists:

Conclusion

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How I Lost my Battle Against the NPI

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Refusing a National Provider Identifier Number

By Darrell K. Pruitt DDS

pruittI can no longer refuse to apply for a National Provider Identifier (NPI). I lost that long battle. Anyone rejoicing?

I’m spent. My leverage has vanished. Telling insurers “I have no NPI” held much more inherent power than “I have an NPI but I won’t share it with you on principle.” Far too many words. My profession has become dominated by unresponsive, unaccountable 3rd parties that dental leaders in the ADA welcome as policy. Working together, they promote and commandeer the technology dentists purchase and clueless patients pay for in increased fees. I have painfully learned that principles are only for dentists who can still afford them, and it’s a bad economy for luxuries.

Non-HIPAA Entity

Since I am not a HIPAA-covered entity and therefore not required by law to adopt an NPI, my capitulation to extortion disappoints me as an American citizen. I still find it hard to believe that an anti-consumer HIPAA rule enthusiastically enforced by the dental benefits industry could force me to “volunteer” for a PERMANENT identifier. As I and 96% of dentists become jerked around by our NPIs, I hope dental historians note that I am the ONLY dentist who publicly asked “Why?” instead of “Why not?” After 6 years, I’m still awaiting an answer to that question from leaders who continue to promote the NPI to dentists while ignoring their questions.

Dental Benefits Providers

I was able to hold out up until Aetna, Delta Dental and other dental benefits providers deprived my office of access to details of patients’ dental benefits unless I have an NPI. I’m waiting for someone – anyone – to tell me how the identifier can possibly improve the dental care of those who pay Aetna and Delta Dental premiums, especially if their benefits are intentionally kept secret from their dentists. I am certain that if the nation’s employers who purchase dental benefits were aware of the transparent nonsense, they would never purchase such products. Where’s the US Chamber of Commerce? Where’s the FTC? How about the US Constitution?

This is exactly why there needs to be more openness in our profession, Doc. The cockroaches who were invited to quietly overrun dentistry cannot withstand transparency, yet I don’t know how much longer I can fight for it without further risking the health of my practice.

As anyone can understand – and as anticipated by corporate executives in the insurance industry as well as by those with vested interests in the ADA Department of Dental Informatics – to have to explain to new patients why I cannot estimate how much they will owe for treatment would destroy my practice. Outside the US, other societies deem it unethical to deny patients informed consent to treatment for any reason. The NPI is such an egregious blunder that I never expect those who promoted to accept ownership.

###

NPI

Assessment

If I lost the battle, who won? Do EDR enthusiasts in the ADA call this a glorious victory and a likely source of ADA pride for decades to come? Or is it much more shameful? Since I lost freedom, I want to know who won?

Conclusion

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Top 20 Most Popular eMRs

A Review of Some Software Solutions

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As the deadline for implementation in the US draws near, talk of electronic medical records (EMR) and electronic health records (EHR) software is a hot topic at the doctor’s office lately.

These systems assist medical practitioners in the creation, storage, and organization of electronic medical records, including patient charts, electronic prescriptions, lab orders, and evaluations (just to name a few common features).

While the terms “EMR” and “EHR” are often used interchangeably, EMR solutions allow for patient information to be shared within one health care organization, whereas EHR solutions allow for health-related records to be shared across multiple organizations.

Assessment

Above is a look at some of the most popular options in both categories, but to see a comprehensive list, visit the EMR Software Directory.

Conclusion

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The Future of eMRs

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Truth or Consequences?

Assessment

Truth or consequences; let ME-P readers and subscribers decide.

Conclusion

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Hospitals Slowly Affiliating with RBACs

The Rise of Role-Based Access Controls

By Dr. David Edward Marcinko MBA CMP

Last month I visited the University of Pennsylvania in Philadelphia. Of course, I graduated from Temple University myself and worked as an admissions clerk in the ER, back in the day.

There I learned that some local hospitals are affiliating in role-based access control (RBAC) electronic networks by controlling which patients, medical providers or health plans have access based on the needs of patients, payors, physicians, or insurers. User, doctor, and patient rights and services are then grouped by name, and access to medical resources is restricted to only those authorized.

The technology was first pioneered and used in London hospitals several years ago.

Example:

For example, when an RBAC network system is used by a hospital, each individual that is allowed access to the hospital’s network would have a pre-defined role (doctor, nurse, lab technician, administrator, patient, etc.).

If someone is defined as having the role of doctor, for example, then that user can access only resources of the healthcare network that the role of doctor has been allowed access to (electronic medical records, for example).

If another user has access as a diabetic patient, then that user cannot access unapproved health services, like OB-GYN. Each user is assigned one or more roles, and each role is assigned one or more privileges for users in that role.

Assessment

Link: http://www.computerweekly.com/Articles/2007/10/19/227566/How-to-implement-role-based-access-control.htm

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Paper Medical Records Keep Good Dentists [and Physicians] Honest

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Good Fences Keep Good Neighbors

[By D Kellus Pruitt DDS]

“Changes to an EHR (electronic health record) can go unnoticed and can be harder to trace than changes made to paper records”

Sen. Mark Leno [D-San Francisco, the author of SB 850]

Yesterday, Kendall Taggart posted “Bill would require ‘track changes’ on electronic medical records” on California Watch.com.

http://www.chron.com/disp/story.mpl/deadbymistake/ca/6555170.html

It seems there is a growing problem with providers in California who cannot be held accountable for altering patients’ digital health records to protect themselves rather than their patients. With paper records on the other hand, erasures, ink and even handwriting can be scrutinized should a court of law need reliable evidence. What’s more, Sen. Leno’s feel-good law will not make EDRs any cheaper. Meanwhile, the multifaceted safety of paper dental records is not only proven by a very long track record, but it is irrefutable and free. Hard evidence is the innocent dentist’s friend. Otherwise it’s “he said, she said” and an unpredictable jury that might not like dentists anyway.

Tagggart writes: “A bill working its way through the state Legislature would make it more difficult for health care providers [including dentists] to modify or delete electronic medical records and leave no record of the change … The bill would require providers to automatically record any change or deletion of electronically stored medical information and identify who made the change. Furthermore, the bill would make it possible for patients to see the changes if they requested their medical records.” Do Democrats from California ever consider the price tag of their ideas? Is there any wonder why healthcare costs continue to rise?

Kaiser Responds 

Teresa Stark of Kaiser Permanente responds: “Our system can’t do that, and we’re not aware of any system that can. Given the level of investment required to bring our EHR up to that level, is this really what we want to be spending our money on?”

Regulatory expenses in healthcare are like tsunamis to dentists. Big boats like Kaiser in deep water might hardly notice the swell that will overwhelm our inflatable water wings in the shallows.

And, if it is too expensive for Kaiser – one of the largest healthcare systems in the nation with thousands of staff – imagine how expensive and time-consuming the new law will make electronic dental records? Since California often leads the nation in swell regulatory ideas, will California dentists be the first to flee to paper records should the costs of digital keep rising?

Even before California’s latest regulatory patch is slapped on EDRs, they offer no return on investment. That means paperless practices are more expensive to maintain than paper practices, and ultimately, patients will pay an increased price for paperless dentistry.

Assessment 

Micromanagement of small practices is expensive even if performed using the EDRs dentists themselves purchase. Swell ideas from well-meaning lawmakers are pricing miracle discoveries from safely interconnected EDRs out of reach. Why is HIT incompatible with common sense?

Conclusion

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The “Whole Tooth” Blog Talk Radio to Interview Dr. Darrell Pruitt on eHRs

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Plugging my Interview and Otherwise Clogging Things

[By D. Kellus Pruitt DDS]

Where are the EDR cheerleaders when I need them? On Tuesday May 31st, I’ve got a show to put on!

http://www.blogtalkradio.com/thewholetooth

Where are the EDR Cheerleaders?

Every now and then I still come across EDR vendors on the internet who would mislead naïve dentists about their product to make a sale. Today, I held FirstEMR representative Robert Evans accountable for self-serving misinformation he posted on EMR and HIPAA forum. (My dad would be proud that I told him “Get that garbage out of here!”). Then, remembering my manners, I invited Mr. Evans to please call into The Whole Tooth Blogtalkradio program on May 31 to further discuss the future of EHRs in dentistry. Unfortunately, because of things like the reflexive “garbage” statement, I don’t think he’ll show.

I try my best to be “collegial,” but I simply cannot pretend unethical sales techniques are acceptable in my neighborhood, and I want to help my friends easily recognize them… so what if I have a little fun.

http://www.emrandhipaa.com/emr-and-hipaa/2010/11/18/emr-stimulus-q-and-a-emr-stimulus-money-and-dentists/comment-page-1/#comment-133132

Of Robert Evans

Thanks for your response, Robert Evans.

As I read your list of 6 rationalizations for electronic dental records here on the EMR and HIPAA forum , it occurred to me that you haven’t had a chance to read my detailed post on this thread from November 22 (Number 14) in which I de-bunked 28 similar myths – substantially including your 6. But since I never tire of doing this, let’s once again go through the details of a popular national blunder in dentistry you and other well-intentioned stakeholders in the HIT industry were sucked into.

“My personal background is medical administration and operations.” That would explain your misconceptions about EHRs in the unique field of dentistry.

For your first mistake, you say “Dentists can qualify as eligible providers for ARRA incentives” You really should have gone on to explain that for a dentist to qualify for the stimulus money, 30% of his or her practice has to be from Medicare/Medicaid. Since you surely should have known that, to fail to mention it could easily be interpreted as deceptive.

This is just a guess, but I’d say less than 10% of the dentists in the nation in private practice would make it on that qualification alone even if it made business sense to accept government money and the expensive demands that come with it. Since you are in the EHR business, you may have more accurate figures on that. What’s more, our grandchildren’s money will be gone long before the stimulus makes it to dentistry. You should already know that as well.

“All of our clients, including Dentists, Endodontists, Periodontists, Implant Surgeons and more are extremely pleased that they made the transition “ All of them, Robert? Really?

The ME-P Forum 

This ME-P forum right here is full of stories about disappointed providers – perhaps other than your clients – who are finding huge problems with the transition. De-installations are far too common. It seems like a while back it was close to 30%. Then again, since you are in the business, you probably have more accurate figures for that as well.

Even the stimulus money isn’t sufficient subsidy for physicians to realize a return on investment in EMRs. And virtually nobody is interoperable as planned. That means the office tools you sell raise the cost of healthcare rather than lower it. What’s more, physicians stand to benefit from interoperability much more than dentists regardless of stimulus money. And if a dentist can’t expect ROI from an office tool, it’s called a hobby.

By the way, have you looked at the Stage 2 Meaningful Use requirements that stand between dentists and disappearing ARRA money? Well-meaning outsiders with plans for the common good just don’t realize that someone has to enter every piece of irrelevant detail about dental patients that CMS requires in order to receive full payment.

It’s a trap, Robert. And it’s not very well hidden. Dentists don’t take candy from strangers.

The Benefits

“The benefits to your office are numerous and too many to mention here; but, please take into account the following”:

1. Never having to worry about compliance issues, as we are 100% compliant with all standards and formats that CMS is mandating.

– You are 100% scary. As long as a provider stores or transmits electronic PHI he or she clearly must be concerned about HIPAA compliance issues. What’s more, as a Business Entity for the dentists you serve, if your computer system is hacked or someone on your end otherwise fumbles or steals 500 or more of a dentists’ patients’ PHI, all of the dentist’s patients must be notified of the danger of identity theft. In addition, federal law stipulates that news of the data breach must be broadcast as a press release in the dentist’s local media. This can easily bankrupt a dentist… You just had to know about this before today.

Your compliancy claim is not only wrong, but it is irresponsible and unethical advertising. You are not 100% compliant. Since the Rule is intentionally vague, nobody is. Get that garbage out of here!

2. Greatly reduce or even eliminate human error. Some offices have brought back billing into their control and terminated the outsourcing.

– Are you kidding? Eliminate human error? Someone put you up to this didn’t they. And “outsourcing”? Once again, this is misleading and irresponsible information, Robert. What about keystroke errors? Only frustrated vendors wish computers would replace human intelligence.

3. Facilitate lab and prescription orders. Offices using e-scribe services are already on board into accepting the benefits of an EMR.

– So does this mean that when the lab delivery person comes to my office to pick up plaster models of a patient’s teeth, the prescription for the restoration must be sent separately by email instead of inserting a short hand-written note in the package… with the relevant patient’s models?

– I don’t sign enough prescriptions to make e-prescribing worth it. I really, really don’t. So how expensive would you make dental care?

4. Simple and efficient scheduling. The reception and schedulers are not tied to the telephone, fax and charting tasks as well as insurance verifications.

– That’s never before been a significant problem. Dental offices were run surprisingly efficient for decades before computers were around. Since dentistry is intricate handwork, the bottleneck in dental offices isn’t the front desk. It’s the dentist.

– What’s so wrong with telephone and fax, by the way? One doesn’t have to be a HIPAA-covered entity to use those tools.

– As for insurance verification, is the EDR intended to help the patient or the insurance company?

5. No fumbling for charts, paperwork, etc. (significant cost savings)

– Prove it.

6. Gain 15+ hours per week, back!

– Where did find this chunk of information? Please don’t insult us with wild, irresponsible statements to improve sales of your product. That would be unethical.

“Again, there are too many to list here, but contact me anytime for a quick on-site or online demonstration and let us prove to you that FirstEMR is the most appropriate solution to meet your required EMR needs.”

eDR Mandate? 

Did you intentionally say my “required” EMR needs? You wouldn’t be implying that EMRs are somehow “mandated” in dentistry are you, Robert? That would be called a rookie mistake and you would be about a year behind information published in the ADA News, which was wrong to mislead members on this point in 2008.

http://www.ada.org/5348.aspx

Rather than contacting you for a quick on-site or online demonstration, I’ll do you one better. I am to be interviewed on “The Whole Tooth” blogtalkradio on May 31 concerning the future of EHRs in dentistry. It promises to be an unprecedented discussion about the obscure topic, and is certain to be educational to thousands of dentists who have been misled for years about HIPAA and EDRs.

http://www.blogtalkradio.com/thewholetooth

Assessment

When the time comes, a telephone number will be provided for live questions. I invite you to call in, Robert, and we can discuss EHRs in dentistry before an audience of around 15,000.

Conclusion

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Not so Fast – Examining eMR Options and Alternatives

Look Before you Leap

By Shahid N. Shah MS

Because of all the talk about electronic medical records [EMRs] and medical records software, doctors have many reasons to start immediately looking for an EMR vendor.

But, try to resist that urge and look at broader non-EMR solutions that can help remove some of the non-clinical burdens from your staff.

Here are some examples from Chapter 13, in our new book: www.BusinessofMedicalPractice.com

  • Using Microsoft Office Outlook® or an online calendaring system like Google to maintain patient schedules. While most vendors of clinical scheduling will tell you that medical scheduling is too complex to be handled by non-medical scheduling systems, most small and medium sized physician practices can easily get by with free or very inexpensive and non-specialized scheduling tools. By using general-purpose scheduling tools you will find that you can use less expensive consultants or IT help to manage your patient scheduling technology needs.
  • Using off-the-shelf address book software such as those built into Microsoft Office®, the Windows® and Macintosh® operating systems, or online tools such as Google apps you can maintain complete patient and contact registries for managing your patient lists. While a patient registry may not give you all of the features and functions you need immediately they can grow to a system that will meet your needs over time.
  • Using physician practice management systems you can remove much of the financial bookkeeping and insurance record-keeping burdens from your staff. Unlike calendaring or address book functionality which can be adapted from non-medical systems, insurance claims and related bookkeeping is an area where you should choose specific software based on how your practice earns its revenue. For example if a majority of your claims are Medicare related, then you should choose software that is specifically geared towards government claims management. If however your revenue comes less from insurance and more from traditional cash or related means you can easily use small business accounting software like Quicken® or Microsoft accounting.
  • Using computer telephony technology you can integrate automatic call in and call out the services that can be tied to your phone system so that you can track phone calls or send out call reminders.
  • Using integrated medical devices that can capture, collect, and transmit physiological patient data you can reduce paper capture of vital signs and other clinical data so that your staff are freed to do other work.
  • Using e-mail, instant messaging, social networking, and other online advanced tools you can reduce the number of phone calls that your practice receives and needs to return and yet continue to improve the patient physician communication process. One of the most time-consuming parts of any office is the back-and-forth phone calls so any reduction in phone calls will yield significant productivity increases.

Assessment

Any other ideas?

Link: Front Matter BoMP – 3

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com and http://www.springerpub.com/Search/marcinko

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Healthcare Organizations: www.HealthcareFinancials.com

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The Continuing Debate over Electronic Medical Records Systems

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Are We There Yet? – In Healthcare Organizations

[By Richard J. Mata MD, MS]

Dr. Mata

Paper-based medical records have been in existence for centuries and their gradual replacement by computer-based records has been slowly underway for over twenty years in western healthcare systems.

Computerized information systems have not achieved the same degree of penetration in healthcare as is seen in other sectors such as finance, transportation, and the manufacturing and retail industries.

Further, deployment has varied greatly from country to country and from specialty to specialty and in many cases has revolved around local systems designed for local use.

The DHHS

In a 2005 DHHS study, national penetration of electronic health records (EHRs) may have reached over 90% in primary care practices in Norway, Sweden, and Denmark (2003), but has been limited to 17% of physician office practices in the U.S. (2001-2003). By 2011, and the ACA, this number may now be approaching 20-25% in the US but adoption may actually be slowing.

The ISMS Vision

According to the Illinois State Medical Society there is a “Sweeping Vision for EHRs”:

  • EHRs will provide a comprehensive view of all patient information
  • Quality of care will be improved.
  • Physicians will more easily be able to review the “complete” medical record.
  • An appropriately configured EHR system will provide “alerts” and “notices” to help health care providers incorporate best practices into patient treatments. Ideally clinical decision support should be built in and be evidence-based.

Medical errors can be reduced:

  • Treatment and administrative costs will be reduced.
  • Public health will be improved.

Defining Electronic Records Systems

The 2003 Institute of Medicine (IOM) Patient Safety Report describes an EHR as encompassing:

  • a longitudinal collection of electronic health information for and about persons;
  • [immediate] electronic access to person- and population-level information by authorized users;
  • provision of knowledge and decision-support systems [that enhance the quality, safety, and efficiency of patient care] and
  • support for efficient processes for health care delivery.

IOM Report

A 1997 IOM report, The Computer-Based Patient Record: An Essential Technology for Health Care provides a more extensive definition:

A patient record system is a type of clinical information system, which is dedicated to collecting, storing, manipulating, and making available clinical information important to the delivery of patient care. The central focus of such systems is clinical data and not financial or billing information. Such systems may be limited in their scope to a single area of clinical information (e.g., dedicated to laboratory data), or they may be comprehensive and cover virtually every facet of clinical information pertinent to patient care (e.g., computer-based patient record systems).

The EHR definitional model document developed by the Health Information and Management Systems Society (HIMSS, 2003) includes “a working definition of an EHR, attributes, key requirements to meet attributes, and measures or ‘evidence’ to assess the degree to which essential requirements have been met once EHR is implemented.”

IOM Re-Deux

In another IOM report, Key Capabilities of an Electronic Health Record System [Tang, 2003], identifies a set of eight core care delivery functions that EHR systems should be capable of performing in order to promote greater safety, quality and efficiency in health care delivery. The eight core capabilities that EHRs should possess are:

  1. Health information and data. Having immediate access to key information – such as patients’ diagnoses, allergies, lab test results, and medications – would improve caregivers’ ability to make sound clinical decisions in a timely manner.
  2. Result management. The ability for all providers participating in the care of a patient in multiple settings to quickly access new and past test results would increase patient safety and the effectiveness of care.
  3. Order management. The ability to enter and store orders for prescriptions, tests, and other services in a computer-based system should enhance legibility, reduce duplication, and improve the speed with which orders are executed.
  4. Decision support. Using reminders, prompts, and alerts, computerized decision-support systems would help improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments.
  5. Electronic communication and connectivity. Efficient, secure, and readily accessible communication among providers and patients would improve the continuity of care, increase the timeliness of diagnoses and treatments, and reduce the frequency of adverse events.
  6. Patient support. Tools that give patients access to their health records, provide interactive patient education, and help them carry out home monitoring and self-testing can improve control of chronic conditions, such as diabetes.
  7. Administrative processes. Computerized administrative tools, such as scheduling systems, would greatly improve hospitals’ and clinics’ efficiency and provide more timely service to patients.
  8. Reporting. Electronic data storage that employs uniform data standards will enable health care organizations to respond more quickly to federal, state, and private reporting requirements, including those that support patient safety and disease surveillance.”

Assessment

After reviewing the above, are we there yet in – 2011?

Conclusion

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An Argument for Wikileaks in US Healthcare

On Allscripts CEO Glen Tullman

By Darrel K. Pruitt DDS

In 2008, Allscripts CEO Glen Tullman told Alex Nussbaurm of Bloomberg.com that physicians should take out loans to invest in his EHR product “to ensure that doctors have some skin in the game.” What did you expect? How much charm does it take to sell federally subsidized products when everyone knows that they’re mandated anyway?

Life Sans Blumenthal 

Yesterday, Nicole Lewis posted “Health IT’s Future without David Blumenthal” – a glowing and arguably deserved tribute to Dr. David Blumenthal who is leaving the ONC

http://www.informationweek.com/news/healthcare/leadership/showArticle.jhtml;jsessionid=0OLOEMENGCENJQE1GHRSKH4ATMY32JVN?articleID=229201216&pgno=1&queryText=&isPrev=

From where I’m sitting, it’s clear that Tullman used Lewis and InformationWeek to score more points with Washington and Wall Street, while continuing to marginalize the interests of those who actually take out loans to purchase his product: “David shepherded ONC through a very critical time . . . the creation, definition, and implementation of meaningful use, which really is a way to ensure that physicians actually use electronic records to improve care, but also that taxpayers get good value for their investment.” What about the doctor’s investment and more importantly, if a doctor is busy clicking on links to qualify for meaningful use dollars, who is accountable to the patients?

I don’t know about you, but it’s not difficult for me to recognize that like other HIT stakeholders whose careers are propped up by easy mandates rather than finicky satisfied customers, Tullman indeed has solid free-market reasons to play to investors and politicians while fearing his customers. They’re pissed at the man.

A Nationwide Survey           

HCPlexus recently partnered with Thompson Reuters to conduct a nationwide survey of almost 3,000 physicians concerning their opinions of the quality of health care in the near future considering the Patient Protection and Affordable Care Act (PPACA), Electronic Medical Records, and their effects on physicians and their patients. (See “5-page Executive Summary”)

http://www.hcplexus.com/PDFs/Summary—2011-Thomson-Reuters-HCPlexus-National-P

“Sixty-five percent of respondents believe that the quality of health care in the country will deteriorate in the near term. Many cited political reasons, anger directed at insurance companies, and critiques of the reform act – some articulating the strong feelings they have regarding the negative effects they expect from the PPACA.”

At this crucial time when Republicans are already threatening to cut off remaining HITECH funding, whose job will it be to break the news to HHS Secretary Kathleen Sebelius that the EHR savings she was counting on to fund a major portion of healthcare reform are only as valuable as CEO Tullman’s politically-correct fantasy? Pop! From what Nicole Lewis writes, my bet is that the Secretary won’t take the news well: “[Sebelius] reiterated that the successful adoption and use of HIT is fundamental to virtually every other important goal in the reform of the nation’s health care system.” Such pressure from the top down will make it even more difficult for HIT stakeholders, including insurers and politicians, to disown the most egregious. crowd-pleasin’, bi-partisan blunder in medical history since blood-letting was declared Best Practice by popular demand.

According to the HCPlexus-Reuters survey results, one in four physicians think EHRs will actually cause more harm than help in spite of Dr. Blumenthal’s best efforts. I wonder if the escalating bad press about EHRs helped Blumenthal decide to return to his academic position at Harvard. Of course, the controversy over HITECH is nothing new. There have been signs for years that EHRs, including Allscripts products, will neither improve care nor provide taxpayers (our grandchildren) a good value for their investment.

If Tullman was unaware of the highly critical HCPlexus-Reuters study when he assured InformationWeek that his subsidized product has value in the marketplace, he must have been aware of the disappointing news concerning two other recent studies performed by Public Library of Sciences (PLoS) and Stanford which also confirm that EHRs do not improve care. So imagine what it’s like to be one of Tullman’s new, naïve and trusting customers who are expected to use the product for something it’s not designed to do.

My Opinion 

It’s my opinion that Tullman’s apparently incorrigible business ethics have no place in the land of the free, and that more transparency in healthcare would help protect the nation from such politically-connected tyrants. Tullman, a long-time Chicago friend of Barack Obama and a Wall Street sweetheart, would still be just another domesticated CEO if it weren’t for the bi-partisan mandate for electronic health records that help Allscripts, Obama and Wall Street more than clueless patients.

Assessment 

If you want to seriously cut costs in US healthcare as well as cut our grandchildren’s taxes, demand transparency from not just the doctors and patients, but from stakeholders as well. Protected communications between good ol’ boys in healthcare are hardly diplomatic cables about military secrets and always increase the cost of healthcare.

Conclusion

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Defining Electronic Medical Record Systems

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Does Linguistic Obfuscation Exacerbate our Use Ambivalence?

[By Dr. Richard J. Mata; CIS, CMP™]

[By Dr. David E. Marcinko; MBA, CMP™]

The 2003 Institute of Medicine (IOM) Patient Safety Report [1] described an EHR [2] as encompassing:

  • a longitudinal collection of electronic health information for and about persons;
  • [immediate] electronic access to person- and population-level information by authorized users;
  • provision of knowledge and decision-support systems [that enhance the quality, safety, and;
  • efficiency of patient care] with support for efficient processes for health care delivery.

The IOM Report

A 1997 IOM report, The Computer-Based Patient Record: An Essential Technology for Health Care, provides a more extensive definition:

A patient record system is a type of clinical information system, which is dedicated to collecting, storing, manipulating, and making available clinical information important to the delivery of patient care. The central focus of such systems is clinical data and not financial or billing information. Such systems may be limited in their scope to a single area of clinical information (e.g., dedicated to laboratory data), or they may be comprehensive and cover virtually every facet of clinical information pertinent to patient care (e.g., computer-based patient record systems).

The HIMSS Model

The EHR definitional model document developed by the Health Information and Management Systems Society (HIMSS, 2003) includes:

“a working definition of an EHR, attributes, key requirements to meet attributes, and measures or ‘evidence’ to assess the degree to which essential requirements have been met once EHR is implemented.”

 

The IOM Model

Another IOM report, Key Capabilities of an Electronic Health Record System [Tang, 2003], identifies a set of eight core care delivery functions that EHR systems should be capable of performing in order to promote greater safety, quality and efficiency in health care delivery:

8 Core Principles

Today, we realize that the eight core capabilities that Electronic Health [Medical] Records should possess are:

  1. — Health information and data. Having immediate access to key information – such as patients’ diagnoses, allergies, lab test results, and medications – would improve caregivers’ ability to make sound clinical decisions in a timely manner.
  2. — Result management. The ability for all providers participating in the care of a patient in multiple settings to quickly access new and past test results would increase patient safety and the effectiveness of care.
  3. — Order management. The ability to enter and store orders for prescriptions, tests, and other services in a computer-based system should enhance legibility, reduce duplication, and improve the speed with which orders are executed.
  4. — Decision support. Using reminders, prompts, and alerts, computerized decision-support systems would help improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments.
  5. — Electronic communication and connectivity. Efficient, secure, and readily accessible communication among providers and patients would improve the continuity of care, increase the timeliness of diagnoses and treatments, and reduce the frequency of adverse events.
  6. — Patient support. Tools that give patients access to their health records, provide interactive patient education, and help them carry out home monitoring and self-testing can improve control of chronic conditions, such as diabetes.
  7. — Administrative processes. Computerized administrative tools, such as scheduling systems, would greatly improve hospitals’ and clinics’ efficiency and provide more timely service to patients.
  8. — Reporting. Electronic data storage that employs uniform data standards will enable health care organizations to respond more quickly to federal, state, and private reporting requirements, including those that support patient safety and disease surveillance.” [3]

Assessment

With all the confusion surrounding terms like quality improvement and “meaningful use” which can mean major Federal dollars to the coffers of a medical practice, clinic or hospital; are we still confused about basic definitional terms?

And, does eMR linguistic obfuscation exacerbate our use ambivalence and encourage physician/dentist eMR avoidance?

Conclusion

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References:

[1]   See http://www.himss.org/content/files/PatientSafetyFinalReport8252003.pdf.

[2]   EHR (electronic health record) is often used interchangeably with EMR (electronic medical record).  In this discussion, EHR will be used consistently.

[3]   See http://www.iom.edu/.

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How eMR Vendors May Mislead You

Challenging Assertions

By Shahid N. Shah MS

As the physician executive of your medical practice, it’s your job to challenge any eMR vendors’ assertions about why you need an eMR, especially during the selection and production demonstration phase.

Information Availability [Anytime – Anywhere]

The most important reason for the digitization of medical records is to make patient information available when the physician needs that information to either care for the patient or supply information to another caregiver.

Electronic medical records are not about the technology but about whether or not information is more readily available at the point of need.

Reasons to Purchase?

In no particular order, the major reasons given for the business case of eMRs by vendors include:

• Increase in staff productivity
• Increase of practice revenue and profit
• Reduce costs outright or control cost increases
• Improve clinical decision making
• Enhance documentation
• Improve patient care
• Reduce medical errors

Assessment

So, doctors beware! Challenge vendor “authority.”

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Editor’s Note

Shahid N. Shah is an ME-P thought leader who is writing Chapter 13: “Interoperable e-MRs for the Small-Medium Sized Medical Practice” [On Being the CIO of your Own Office] for the third edition of the best selling book: Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] to be released this fall by Springer Publishers, NY. He is also the CEO of Netspective Communications, LLC.

www.BusinessofMedicalPractice.com

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PR Firm Behind Propaganda Videos Wins HIT Stimulus Contract

Ketchum Deep in Controversy

By Sebastian Jones and Michael Grabell

ProPublica – March 30, 2010 12:26 pm EDT

President Obama’s push for electronic medical records [1] has faced resistance from those who question whether health information technology systems can protect patient privacy. So last week, the U.S Department of Health and Human Services hired a public relations firm to try to win consumer trust.

The irony?

The firm chosen for the job — Ketchum Inc. [2] — was hip-deep in controversy a few years ago for producing a series of fake TV news stories that violated a federal ban on propaganda. The company also drew fire for channeling taxpayer funds to a conservative pundit to promote the Bush administration’s education policies.

About Ketchum

Ketchum, based in New York, is one of the world’s largest public relations firms, with a host of large corporate clients and a history of winning government contracts. Company spokeswoman Alicia Stetzer declined to answer questions about the $25.8 million contract, funded by the federal stimulus package. Nancy Szemraj, a spokeswoman for the government’s health IT initiative, said the PR firm won the contract over four other companies because of its ability to attract public acceptance. “Ketchum has a long rich history of doing outstanding communication outreach work for large social marketing endeavors,” Szemraj said. “They are very capable of moving the needle, with has to happen here.”

She noted that Ketchum’s work helped HHS enroll 35 million people in the Medicare prescription drug program. And she said all of the firm’s marketing ideas would be reviewed by senior managers at HHS.

Consumer advocates warned that the PR contract will only heighten skepticism about the security of online health records. A poll [3] conducted last year by NPR, the Kaiser Family Foundation and the Harvard School of Public Health found that roughly six in 10 Americans lack confidence in the privacy of online health records.

Public Suspicions

“The public has always been very suspicious over whether electronic health information will be safe,” said Dr. Deborah C. Peel, a physician and founder of the Coalition for Patient Privacy, which includes consumer, privacy and health groups. Peel called Ketchum a “very, very troubling choice because the last thing the public needs are more tricks being pulled on them.”

During the Bush administration, Ketchum and its former lobbying arm, the Washington Group, had several prominent Republicans on the payroll, including former New York Rep. Susan Molinari. In the last year, it has beefed up its Democratic credentials, hiring Jonathan Kopp, a member of the Obama campaign’s national media team, and Donald J. Foley, a longtime Democratic strategist.

Ketchum has continued to draw government work – particularly from HHS – despite a series of reports in 2004 [4] and 2005 [5], in which Government Accountability Office investigators found it had produced a series of video news releases that constituted “covert propaganda” because they did not disclose they were paid for by the federal government.

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The segments aired during local television broadcasts on at least 40 stations across the country. Designed to look like news reports, each concluded with a paid actor posing as a journalist reporting from Washington.

One series was produced for HHS in an effort to promote the Medicare prescription drug program to seniors. The others were paid for by the Department of Education. Overall, video news releases have become increasingly common, used by large public relations firms and companies to repackage advertisements as news. [6]

Prior Controversy

Ketchum was involved in a separate controversy in 2005, when reports surfaced that it had used taxpayer funds to pay syndicated columnist Armstrong Williams $240,000 to promote the No Child Left Behind [7] education bill during radio broadcasts as part of outreach to the African-American community.

In both instances, Ketchum defended its tactics. Stetzer referred reporters to a 2005 PR Week article, in which CEO Ray Kotcher said, “There is no indication that it was ever the intent of Ketchum or any of our people to mislead anyone.”

This time around, HHS has hired Ketchum to provide a “comprehensive campaign for communications and education,” to encourage doctors and hospitals to adopt health IT and to assure the public that their information will be safe.

Assessment

The campaign is part of the administration’s $26 billion health IT program, also backed by the stimulus package, which aims to spearhead the transition to online medical records through grants, bonuses to doctors and hospitals, and the development of national standards.

Link: http://www.propublica.org/ion/stimulus/item/pr-firm-behind-propaganda-videos-wins-stimulus-contract

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Electronic Medical Records and Dentistry

A Note to Diane Rehm

[By Darrell K. Pruitt; DDS]

Dear Diane Rehm,

I always enjoy your show.

You add value to my drive to work.

As a dentist, I was especially interested in your March 10 show “Electronic Medical Records.”

http://wamu.org/programs/dr/10/03/10.php?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+WAMU885DianeRehm+%28WAMU%3A+The+Diane+Rehm+Show%29&utm_content=FaceBook#30598

In all the excitement that surrounds the 19 billion dollars our grandchildren have unwittingly granted to physicians and hospitals for “meaningful” adoption of certified eMRs, you probably haven’t noticed that nobody is talking about including dentistry in the conversion from paper to digital. Do you find that odd?

Small and Mid Sized Practices

Like small and mid sized physicians’ practices, small dental practices are intended to be part of the federal mandate for interoperable eMR adoption – even without the help from stimulus money that physicians receive. You probably weren’t aware that the stimulus money will run out before HHS gets around to defining “meaningful use” of eMRs in dental office. That would be impossible, but nevertheless, I anticipate that the attempts will be entertaining. Physicians in small practices typically have tens of thousands of paper charts as thick as phone books. On the other hand, a busy solo dental practice, like the majority of practices in the US, might have 5,000 files that are very thin in comparison to files that involve the whole body instead of just the bottom third of the face. That makes sense, doesn’t it?

Marginal Benefits May Not Exceed Marginal Costs 

I listened to your guest Dr. Carol Horn, who practices internal medicine in private practice, as well as others involved in the actual delivery of healthcare. They list not only the benefits of eMR adoption, but in fairness, they also described the expense and liability of digital records that continue long after the tedious and dangerous conversion from paper to digital. In other words, it appears that the benefits for physicians barely make the effort worth the price, even with 19 billion dollars in help.

Editor’s Note: In economics, we say that the marginal benefits may not exceed the marginal costs; all things being equal.

Assessment 

And so, it occurs to me that if dentists are to be included in the plans for digital interoperability, we will be very, very slow adopters for natural reasons: like eMRs in physicians’ offices, eMRs in dentists’ offices are more expense and trouble than they are worth – even before considering the bankruptcy-level liability of a data breach.

Most of those who champion eMRs for the entire healthcare system in the nation don’t realize that the bottleneck in dental offices isn’t the front desk. It’s the dentist who is hopefully taking his or her time providing care with those hands instead of working a keyboard.

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Why eMRs Won’t Improve Patient Care or Reduce Costs

Deus Ex Machina – NOT

By Staff Reporters

Question

Have electronic medical records made a difference in patient care?

Answer

According to a new study looking at the digital medical record adoption of 3,000 hospitals, electronic records have made little difference in healthcare costs or the quality of medical care.

Assessment

That’s discouraging, considering that the government is investing billions of dollars into the technology.  

Related posts from Kevin Pho MD:

Conclusion

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Protected Health Information Data Breaches

Affecting 500 or More Individuals

[By Staff Reporters]

As required by section 13402(e)(4) of the HITECH Act, the Secretary must post a list of breaches of unsecured protected health information affecting 500 or more individuals.

The following breaches have been reported to the Secretary of the US Department of Health and Human Services [DHHS].

Full Report

This link was sent in by our own investigative reporter Darrell K. Pruitt, DDS.

Link: http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/postedbreaches.html

Assessment

Shall we await a response from Kathleen Sebelius, who was sworn in as the 21st Secretary of the Department of Health and Human Services (HHS) on April 28, 2009?

Currently, she leads the principal agency charged with keeping Americans healthy, ensuring they get the health care they need, and providing children, families, and seniors with the essential human services they depend on. She also oversees one of the largest civilian departments in the federal government, with nearly 80,000 employees.

Conclusion

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Criticizing Electronic Medical Records?

By Brent A. Metfessel; MD, MS

By Staff Writers

www.HealthcareFinancials.comHOFMS

Despite ARRA and the HITECH initiatives, eMRs are not without drawbacks. And, with apologies to USCTO Aneesh Chopra, we list the following.   

List of Drawbacks

The following are some of the more notable negatives:

  • Operator dependenceThe term “garbage in, garbage out” applies to eMRs as well. The computer only works as well as the data it receives. If one is resistant to computing and works begrudgingly, is not well-trained, or is rushed for time, the potential exists for significantly incomplete or error-prone documentation.
  • Variable flexibility for unique needs — When one sees a single hospital, one sees just that — a single hospital, with unique needs unlike any other facility. A “one size fits all” approach misses the target. Even within a hospital, needs may change rapidly over time given the continued onslaught of external initiatives and measurement demands. Systems vary in flexibility and the ease with which they can customize options. More flexible systems exist but cost much more.
  • Data entry errors — Although data items normally only have to be entered once, data entry errors may still occur and be propagated throughout the system. Most notably, patient data can more easily be entered into the wrong chart when there is an error in chart selection. In general, simple double-checking and “sanity checks” in the system usually catch these errors, but if the error goes through the system the impact can be significant.
  • Lack of system integration — Interconnectivity of systems becomes more important with eMRs than with any other system. Personnel use the data in many different areas. If there are isolated departmental systems without connectivity, redundant data entry occur leading to confusion in the different departments. Appropriate and intelligent clinical decision support systems can make the job of the physician easier through education, real-time feedback, and through the presentation of choices that allow for clinical judgment.
  • Costs of implementation — Intelligently applied eMR implementations may also be cost saving; long term. For example, one large east coast hospital found that eMRs saved $9,000 to $19,000 annually per physician FTE. This savings was achieved through a decrease in costs for record retrieval, transcription, non-formulary drug ordering, and improvements in billing accuracy. And, in radiology, storage of digital pictures and the use of a picture archival and communication system significantly [PACS] decreased the turnaround time for radiology image interpretation — from 72 hours to only 1 hour. However, there is significant front-loading of costs prior to achieving such costs savings. 

Link: WSJ_Letter_3M_Company_2009-10-16

Assessment

At the American Health Information Management Association [AHIMA] October 2006 conference,  panelists suggested that developing, purchasing, and implementing an EMR would cost over $32,000 per physician, with an outlay of $1,200 per physician per month for maintenance.  This is larger in economic scope, today. Also, there exists no national standard that would require compatibility between the numerous competing eMR vendor systems that may need to communicate with each other, which can escalate costs and frustration in systems that attempt to integrate the features of multiple vendors.

Some recent HIT fiascos:

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=3090

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=1905

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=5286

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=3891

 http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2009/10/12/newscolumn3.html#

Conclusion

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Championing Electronic Medical Records?

By Brent A. Metfessel; MD, MS

By Staff Writers

www.HealthcareFinancials.comHOFMS

eMRs involve accessibility at the bedside either through bedside terminals, portable workstations, laptops, wireless tablets, and hand-held computers and personal digital assistants (PDAs), (e.g., 3ComtmPalm Pilot®). The inputs can either be uploaded into the main computer system after rounds or transmitted immediately to the system in the case of wireless technology. Bedside technology obviates the need to re-enter data from notes after rounds are complete. This improves recall and avoids redundancy in the work process, saving time that can instead be devoted to patient care. 

Usual eMR Features

Common features of an eMR include the following:

  • history and physical exam documentation, progress notes, and patient demographics;
  • medication and medication allergy information;
  • CPOEs and laboratory results;
  • graphical displays of medical imaging studies including X-rays, CT, and MRI;
  • ordering of drugs, diagnostic tests, and treatments, including decision support and drug interaction alerts;
  • clinical practice guidelines (evidence-based) to aid diagnostic and treatment decisions;
  • alerts that can be sent to patients reminding them of appointments and necessary preventive care;
  • scheduling of appointments;
  • processing of claims for payment; and
  • a GUI, which may include secure Web-based and wireless technologies that allows providers or other authorized healthcare personnel access to health information from remote sites, including outside offices and home.

Assessment

There are also other benefits, as well. For example, instead of calculating fluid balance off-line, the computer can perform calculations immediately, once again saving time and ensuring accurate values. Medication orders can also be entered in real-time, giving the provider the option to react to alerts at the bedside rather than waiting to load the orders into the system in “batch” mode.

Conclusion

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A Personal Health Records [PHRs] Video

Where We’ve Been … Where We’re Going!

By John Moore

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Encrypt or De-identify PHI

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Which One Just Might Work?

[By Darrell K. Pruitt; DDS]pruitt

The United States’ advancement in Healthcare Information Technology, which has the potential to lead to wonderful money-saving cures through research using trustworthy interoperable health records, is currently stopped cold by patient security problems that are only getting worse. Our lawmakers cannot get around the security obstacle without resorting to authoritarian means using CMS’s power to withhold providers’ discounted payments and threats of obscene fines from the HHS and the FTC. History shows that tyranny is not tolerated well in this part of the world. Lawmakers can get their butts voted smooth out of office in my neighborhood.

HITECH  

Here is something nobody mentions: Despite the current hope in a thick, political fantasy called HITECH, encryption of patients’ Protected Health Information [PHI] is a non-starter in the land of the free. Everyone knows that resourceful, cynical Americans will simply never trust encryption to protect their secrets, and will reliably withhold important information from their eMRs – one way or another. Doctors as well as patients can be expected to go out of their way to sabotage technology they fear. We all intuitively know this is true, don’t we? We aren’t so naïve to think all the players will happily play by the rules, are we? And I think we can all agree that an untrustworthy digital health record in an emergency room is worse than no patient information at all. Security is a grand problem with eMRs that started with HIPAA changes in 2003 that made eHRs so slippery. And the problem is clearly not being resolved. Not yet.

Public Lacks Trust 

Regardless of the campaign donations which follow him, there is nothing Newt Gingrich and his entrepreneurial friends in high places can do about the public’s lack of trust in encryption. It gets worse: Encryption hasn’t a chance of isolating PHI from dishonest employees in doctors’ offices, and slippery digital patient data can be moved soo easily. Everyone knows that as well, don’t they? It is estimated that two-thirds of the identities stolen in the nation are lifted from doctors’ offices. That’s us, Doc. HIPAA is not only irrelevant, it is an expensive distraction – it gives future ID theft victims a false sense of security.

HIPAA Approved 

De-identifying digital records is not mentioned in HITECH as a HIPAA-approved method of security. Yet it is the ONLY solution that promises to be even more secure than paper records. Because of heavy stakeholder stakes in hospital care, it will take longer for CEO-types to embrace patient-friendly de-identification. Other than identifiers such as names, social security numbers, birthdates, addresses and other items that have street value, NOBODY cares what is in a dental record. I actually think this opens a tremendous opportunity for someone courageous in the Texas Dental Association to discuss the feasibility of de-identification of dental records. Otherwise, instead of leading the nation in solving security problems, the TDA will look just as stupid as the ADA.

Encryption would also provide a dangerous false sense of security in eMRs – that is if it had a chance in the marketplace. But encryption will never go far because consumers simply won’t buy it. That is a marketplace fact that stoically optimistic HIT stakeholders are trying hard to avoid. They also know they are running out of time. Deadlines are quickly approaching for both HIPAA and the Red Flags Rule that providers are far from prepared for.

Former Attorney Speaks 

Bill Lappen, a former attorney and author of the ad I copied below, as well as a partner with his brother David in the de-identified health record venture says: “Since no identifying information is ever entered, a hacker can’t determine whose information is shown.”

So in addition to protecting one’s practice against dishonest or vindictive employees, de-identification of dental records would make hacking a dentist’s computer a complete waste of time, and hackers wouldn’t endanger dental patients and bankrupt dentists.

My Confidence 

I confidently tell you that soon, someone smart will come upon the unprecedented idea that the ultimate answer to our security problem in healthcare will be de-identification of medical records, not encryption. De-identification allows a compromise of privacy for only a miniscule percentage of physicians’ patients. We cannot allow that to stand in the way of better health for everyone else. Those special cases are so few that I am confident that they can be dealt with individually. We simply must move forward. I’ll have to retire some day. I may need help from Medicare.

Encryption gives us only danger and protects nobody but a thief with a key.

Assessment 

We’ve wasted enough time on HITECH and HIPAA, as well as CCHIT. It’s time to say no to stakeholders and pay attention to patients’ needs instead of those who would needlessly increase the cost of their care. Stimulus money attracts cockroaches.

In the name of Hippocrates, disregard the tainted HIPAA mandate. It is dangerous, and especially absurd in dentistry.

Link: http://www.theopenpress.com/index.php?a=press&id=58568

Life-Saving Patient Information can be Online, Anonymous and Usable

Published on: September 26th, 2009 12:19am

By: blappen

Los Angeles, CA (OPENPRESS) September 26, 2009 — Hospital Emergency Rooms need instant access to patient medical information. Allergic reactions and dangerous drug interactions can be deadly. Time is critical. Until now, privacy was a large concern. Two brothers, who have developed medical software over the past 15 years, think they have a simple first step towards moving patient information on to the internet.

“The ER doesn’t need to look up the information by patient name” said Bill Lappen, a former attorney. “We have implemented secure systems in the past, but no matter how secure we make the site, we have to assume that it will be hacked” added David Lappen, a computer design engineer from Stanford. “But providing instant access to life-saving information is too important to ignore”, he added. To protect patient privacy, their system does not know to whom the medical information belongs. Since the person’s identifying information is never on the system, it can’t be stolen. “By enabling anonymous entry, we have protected people’s privacy while allowing them to put their life-saving information in a place where it can be instantly accessed when needed”, added Bill Lappen.

www.AMCC.me is the public service website they created. It allows anyone to enter medical information anonymously. The site provides a random ID which the user carries in his/her wallet. For someone to see that user’s medical information, they merely enter the ID into the site. Unless the user has given them their ID, the information shown is meaningless. That same information, when associated with a patient, can save their life.

Since no identifying information is ever entered, a hacker can’t determine whose information is shown. “Secure patient-controlled Electronic Medical Records are now available on the internet” said David Lappen. A sample ID has been set up on the site to allow users to evaluate the concept before setting up their own free ID.

Contact:

Bill Lappen

Bill@AMCC.me

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Improving Patient Control of eHRs

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Traditional Command-Control Option Dying Out … Slowly!

[By Staff Reporters]Hospital Access Management

NewYork-Presbyterian Hospital recently introduced a new personal electronic health record [eHR] enabling patients to access medical information wherever and whenever they need it. Called myNYP.org, the system uses Microsoft’s HealthVault and Amalga technologies to offer patients the ability to select and store personal medical information generated during visits to NewYork-Presbyterian.

About NewYork-Presbyterian

NewYork-Presbyterian Hospital is one of the most comprehensive university hospitals in the world, with leading specialists in every field of medicine. The hospital is composed of two renowned medical centers, NewYork-Presbyterian Hospital/Columbia University Medical Center and NewYork-Presbyterian Hospital/Weill Cornell Medical Center, It is affiliated with two Ivy League medical institutions, Columbia University College of Physicians and Surgeons and Weill Cornell Medical College.

Assessment

MyNYP.org uses a “pull model” in which patients proactively opt to copy their medical data into their own personal health record and access that information using a secure username and password with any Web-enabled device. And yes, online bill pay features are available.

Conclusion

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About HealthDataRights.org

Mitigating the Unintended Consequences of HIPAA

By Staff ReportersWaiting for Medical Records

Many patients and pundits opine how today’s HIPAA regulations [written in the relative paper based stone age] say that while doctors must provide a copy of your records, they can take a month to do so. And, if they want, they can say that’s not enough and take another month. However, when a patient needs medical care; that time-line is not acceptable.

Enter a Website and Start a Movement

According to the website www.HealthDataRights.org, in an era when technology allows personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. We the people:

  • Have the right to our own health data.
  • Have the right to know the source of each health data element.
  • Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost; if data exist in computable form, they must be made available in that form.
  • Have the right to share our health data with others as we see fit.

Assessment

These principles express basic human rights as well as essential elements of health care that is participatory, Health 2.0 appropriate and in the interests of each patient. No law or policy should abridge these rights.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Visit the site, join the movement by signing their petition, and tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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About Practice Fusion and Free eHRs

A Web Based Concept in the Clouds

By Staff ReportersOpen

Practice Fusion is a firm that reports to address the complexities and critical needs of today’s healthcare environment by providing a free, web-based electronic Health Record (eHR) application to physicians.

America’s Fastest Growing EHR community

Practice Fusion is also a fast growing electronic Health Record community. Founded in 2005, they are rapidly expanding and adding new users regularly. Over 18,000 physicians and practice managers in 50 states currently use Practice Fusion’s electronic Health Record.

Online and Free

Practice Fusion stands out in a marketplace dominated by complicated, expensive and often inefficient eHR services. Their user-friendly eHR is reported to be activated in less than five minutes, with no downtime or extensive training; eliminating the difficult conversion process that has become an industry-standard.

Secure and Reliable

The firm understands the mission-critical nature of their application. Practice Fusion’s electronic Health Record is developed for the highest levels of security and performance with world-class data centers equipped with best-in-class technology to securely house sensitive data.

Assessment

Although Practice Fusion is a young company, they are led by a well-established team of healthcare and technology veterans. Practice Fusion is directed by a group of investors and medical practitioners who believe in the power of electronic Health Records. Investors include Band of Angels, Salesforce.com and Felicis Ventures. So, give the site a click, and tell us what you think! www.PracticeFusion.com

Conclusion

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Borges versus Kvedar Video eHR Debate

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The Great HIT Debate

[By Staff Reporters]Boxing Gloves

All ME-P subscribers and readers are invited to watch a debate between Dr. Alberto Borges and Dr. Joseph Kvedar. In the original broadcast, by HCPLive, both participants were asked some very interesting questions about health information technology [HIT] when posed to them. And so, if you were unable to attend the live event, it is now re-broadcasted in podcast form for your review.

About Alberto A. Borges; MD

Al Borges is Founder and CEO of the MS Office eMR Project http://www.msofficeemrproject.com He is the project author, visionary and main content developer for the independent website. As a board certified physician, he practices oncology, hematology, and internal medicine in Arlington, Virginia. He is also a clinical professor at the George Washington University Medical School. Dr. Borges is a colleague and thought-leader for the ME-P

About Joseph C. Kvedar; MD

Joe Kvedar is the Founder and Director of the Center for Connected Health http://www.connected-health.org The Center is known for applying communications technology and online resources to increase access and improve the delivery of quality medical services and patient care outside of the traditional medical setting.  A division of Partners HealthCare; the Center for Connected Health works with Harvard Medical School-affiliated teaching hospitals, including Massachusetts General and Brigham and Women’s Hospitals. Dr. Kvedar is also a board-certified dermatologist and Associate Professor of Dermatology at Harvard Medical School

Podcast Link: http://www.hcplive.com/hcplive/great_debate

Assessment

Feel free to email questions, or to post follow-up comments, for all our viewers to consider and respond. The principals are asked to weigh-in, as well.

And the Winner is … ?

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About EHRWatch.com

A New Online Virtual Collaborative 

By Staff ReportersNurse Paper MRs

www.EHRWatch.com is a new online community dedicated to developments in electronic health records [eHRs], including practice, funding, product integration, standards developments and trends in implementation. The new site features blog posts, polling, commenting and a weekly e-newsletter.

A Collaborative

www.EHRWatch.com is designed to encourage community participation, interaction, collaboration and reaction. Whether you need to select and implement an EHR solution or make sure your current system meets the requirements and timeline necessary to receive the Obama Administration’s ARRA, and HITECCH,  stimulus incentives, the site may offer the products, information, services and expertise to help.

Assessment

Visit www.EHRWatch.com to read the latest posts and join the virtual community. Just give em’ a click, today!

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Interview with Jack Levy of Securebill, Inc

President – Securebill, IncMeeting

What: An Interview and Special Report Exclusively Prepared for the ME-P
Who: Mr. Jack Levy, CISSP [President – Securebill, Inc]
Topic: Physician Selection of eHRs
Reporter: Amaury Cifuentes; CFP®
Where: Internet Ether

Although skeptics of eHRs abound, President Barack H. Obama’s signing of the American Recovery and Reinvestment Act [ARRA] of 2009 has created a massive push for their implementation. The Act provides $19.2 billion, including $17.2 billion for financial incentives to be administered by Medicare and Medicaid. This assistance of up to $40 to $65 thousand per eligible physician, and up to $11 million per hospital, begins in 2011.

Link: https://healthcarefinancials.files.wordpress.com/2009/05/jack-levy-interview.pdf

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Feds Propose Educational Website on ePHRs

Site Aimed at Consumers

[By Staff Reporters]

Conference RoomAs reported by Mary Mosquera on May 22 2009, the Office of the National Coordinator for Health Information Technology (ONCHIT) just proposed developing a Web site for consumers. The site is to contain facts about electronic-personal health record systems and their privacy policies. It aims to help consumers and patients make informed decisions.

http://govhealthit.com/articles/2009/05/22/feds-propose-phr-website.aspx?s=GHIT_260509

Assessment

The Department of Health and Human Services [DHHS] Agency information collection request, for a 30-days public comment period, is also located here.

http://edocket.access.gpo.gov/2009/E9-12023.htm

Conclusion

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Military Health System Records

Expanding PHR Pilot Testing

By Staff Reporterscomputer-hardware2

According to Paul McCloskey, on April 08, 2009, the Military Health System [MHS] will extend its test of personal health records at Madigan Army Medical Center in Tacoma, Wash., to two additional health care venues in an attempt to test the technology in larger populations and more diverse care settings.

MiCare PHR Focus

The new projects will focus on using the MiCare Personal Health Record [PHR] as a tool for care coordination and a mechanism for patients to share health records across a mix of military and commercial providers and payer organizations, according to Col. Keith Salzman, chief of informatics at Madigan, which is hosting a pilot test of MHS’ MiCare PHR.

Assessment

Link: http://govhealthit.com/articles/2009/04/08/phr-pilot-testing.aspx?s=GHIT_140409

Conclusion

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Wal-Mart’s Health Information Technolgy Game Plan

CCHIT Meet Sam Walton

By Darrell K. Pruitt; DDSpruitt3

Dana Blankenhorn posted an article recently on zdnet titled “Wal-Mart Selling Windows Health Records.”

Link: http://healthcare.zdnet.com/?p=1966

After reading it, I opened a good, cost-effective fortified breakfast wine and began hammering out my comment that I copied below, long before the sun came up.  Hope you enjoy it.  I’m going to get some sleep. 

Looks Like Rein

Coach Glen Tullman’s traditionally favored and tough Allscripts-Misys team originating in CCHIT meets Walton’s consumer-supported, nimble team from Arkansas in front of Sam’s home town crowd. As a sports fan and occasional off-color commentator standing on the sidelines, Dana, I think this ball game could get exciting. The weather is perfect for sloppy, poor conditions and heaven knows that these two ideologies share history.

Wal-Mart HIT 

Some odds-makers say Wal-mart’s success in selling healthcare IT at Sam’s Club prices and quality is likely to take off in their patented free-market style in the next few months. 

The big question is; could this threaten federally-favored Allscripts’ early advantage? 

For example; if things get competitive, and the value of MDRX starts to falter under natural pressure, will Trustee Tullman call on the reserve strength of his exclusive Club CCHIT to out-flank the quick and slippery Sam’s Club wide-ended attorneys?  Some say that if CCHIT suddenly selects surprising, deceptive and occasionally lame applications for certification requirements – that happen to already reflect Allscripts pre-determined game plan – it is a cinch to give Tullman’s team a head start around their strong side with a pulling guard or three from the right (weak side) to lead interference.

Assessment 

Will Sam protest such a rule? You bet. It could get messy. Snot could fly. 

Here is the question on this reporter’s mind. If close calls are occasionally ruled in the home team’s favor, will Tullman move on down the road? I like to watch the cheerleaders.

Conclusion

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Office Based EMR Cost Report

A Preliminary BC/BS Cost-Benefit Analysis

By Staff Reporters  Stethoscope

BlueCross-BlueShield of Massachusetts recently announced that it will not require physicians to install or use electronic medical records [EMRs] to participate in its new bonus program. The health plan came to the conclusion that the financial benefits of office-based electronic medical records systems are just not worth the cost to doctors.  

Little Office-Based Value 

Relying on information from past studies, the American Medical Association [AMA] estimated that office-based doctors see only 11 cents of every dollar saved through the use of information technology, according to AMNews reports. 

More Hospital Value 

But, the Massachusetts Blues did find value in health information technology [HIT] that physicians would need to use, as its own cost-benefit analysis concluded that computerized physician order entry makes financial sense in the hospital and enterprise-wide healthcare setting. 

Assessment 

The MA-Blues will require hospitals and health systems to install computerized physician order entry systems [CPOEs] by 2012, in order to participate in the bonus program.

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