Friday, December 03, 2010

A Very Useful Review of the Current State of Play in US EHRs.

The following appeared a week or two ago.

When and how to deploy e-health records tech

By Lucas Mearian, Computerworld
November 23, 2010 12:52 PM ET

Over the next two years, 58% of small physician practices plan to roll out electronic health records. And by 2014, the federal government wants more than half of all healthcare facilities to use EHRs.

To date, however, less than 20% of hospitals and 25% of physician practices have deployed EHR systems, and most of them would not meet the federal government's criteria for "meaningful use" of those systems, according to Karen Bell, chairwoman of the Certification Commission for Health Information Technology (CCHIT), nonprofit organization whose mission is to accelerate the adoption of healthcare IT systems.

Perhaps the biggest obstacles for physicians and hospitals are the magnitude of many healthcare IT projects and the need to meet those "meaningful use" requirements from the Office of the National Coordinator for Health Information Technology (ONC), which is part of the U.S. Department of Health and Human Services. To help providers overcome those obstacles, public and private financing is available for EHR rollouts. Moreover, there are cost-effective ways of deploying the technology, and it may not even be necessary to rebuild an existing IT infrastructure to accommodate an EHR system. One option is to share the data center of another local healthcare facility that has a large IT support staff.

Over the next two years, 58% of small physician practices plan to roll out electronic health records. And by 2014, the federal government wants more than half of all healthcare facilities to use EHRs.

To date, however, less than 20% of hospitals and 25% of physician practices have deployed EHR systems, and most of them would not meet the federal government's criteria for "meaningful use" of those systems, according to Karen Bell, chairwoman of the Certification Commission for Health Information Technology (CCHIT), nonprofit organization whose mission is to accelerate the adoption of healthcare IT systems.

Perhaps the biggest obstacles for physicians and hospitals are the magnitude of many healthcare IT projects and the need to meet those "meaningful use" requirements from the Office of the National Coordinator for Health Information Technology (ONC), which is part of the U.S. Department of Health and Human Services. To help providers overcome those obstacles, public and private financing is available for EHR rollouts. Moreover, there are cost-effective ways of deploying the technology, and it may not even be necessary to rebuild an existing IT infrastructure to accommodate an EHR system. One option is to share the data center of another local healthcare facility that has a large IT support staff.

Nonetheless, even with financing and alternative deployment strategies at their disposal, hospitals and other providers that haven't started using EHR technology might want to wait.

"I know there are incentives out there... but the $44,000 or $65,000 you can get comes over a five-year period," Bell said. "If you haven't gone through the readiness process, gotten your staff ready and gotten everyone on board with what this will entail and put a project plan in place, then you'd probably do better to wait -- maybe even until 2013, when a whole new set of criteria comes out."

By waiting, clinics or physician practices would not only be able to meet more of the criteria for meaningful use of EHR systems, but they would also be able to deploy systems that meet their own criteria for patient care and administrative automation.

The ONC uses the CCHIT to test and certify EHRs. To date, the CCHIT has certified 66 EHR products, many of which have varying levels of sophistication.

The CCHIT also has the authority to certify homegrown EHRs. If a hospital builds out its own infrastructure and pieces the software modules together, the organization can remotely access servers and work with administrators to offer a certification specifically for that system, Bell said.

There's no question that EHR technology can benefit both healthcare providers and patients, experts agree. EHRs allow physicians to share test results, radiological images and other clinical information in near real time with patients and other physicians. They can also reduce administrative tasks associated with paper-based systems, and they will eventually help ensure that caregivers adhere to so-called evidence-based medicine, or the use of best practices for treatment.

At the same time, physicians who employ EHR systems will be able to more easily use wireless devices, such as tablet PCs and smartphones, at the bedside and from remote locations.

The most basic in-house EHR systems cost about $250,000, but depending on the size of the organization and the capabilities of the technology, the price tag can quickly grow into the millions for larger hospitals, according to Judy Hanover, an analyst at research firm IDC's Health Insights unit.

Under the American Reinvestment and Recovery Act (ARRA) of 2009, physicians who implement EHR systems and demonstrate that they are engaged in meaningful use of such systems can receive reimbursements of up to $44,000 under Medicare and up to $65,000 under Medicaid.

Physicians and hospitals that don't roll out EHR technology or don't prove that they are making meaningful use of it by 2015 face penalties in the form of reduced Medicare reimbursements.

There are three stages of meaningful use, as defined by federal officials. Doctors and hospitals now implementing EHRs do so under Stage 1 guidelines released this past summer. Stage 2 and Stage 3 guidelines are set to take effect in 2013 and 2015, respectively, with the final rules coming out about a year before they go into effect.

The criteria for Stage 1 focus on improving the quality, safety, efficiency and coordination of care, and on reducing health disparities. They also call for adequate privacy and security protections for patient health information.

There are about 25 Stage 1 meaningful use objectives that must be met. Among other things, a computerized physician order entry (CPOE) system must be used for at least 80% of all physician orders and 10% of hospital orders, real-time electronic drug and allergy alerts must be enabled, and at least 75% of all prescriptions written by a clinician must be transmitted electronically to a pharmacy.

Pages more here:

http://www.networkworld.com/news/2010/112310-when-and-how-to-deploy.html

This is a really good summary of what the US is presently up to and is well worth a browse.

David.

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