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Technology displacing physical exams
Posted on May 23, 2014
By Kaiser Health News
By Sandra G. Boodman
This KHN story was produced in collaboration with The Washington Post.
Doctors at a Northern California hospital, concerned that a 40-year-old woman with sky-high blood pressure and confusion might have a blood clot, order a CT scan of her lungs. To their surprise, the scan reveals not a clot but large cancers in both breasts that have spread throughout her body.
Had they done a simple physical exam of the woman's chest, they would have been able to feel the tumors. So would the doctors who saw her during several hospitalizations over the previous two years, when the cancer might have been more easily treated.
A middle-aged man admitted to a Seattle emergency room for the third time in six weeks displays the classic signs of liver cirrhosis for which he has been repeatedly treated, including swollen legs and a distended abdomen.
But a veteran doctor spots a telltale indicator of a different disease: rapid inward pulsations just beneath the man's right ear. The patient's problem is not his liver but his heart: he has constrictive pericarditis, a serious condition that requires surgery.
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I.T. Behaving Badly
Elizabeth Gardner
MAY 23, 2014 9:57am ET
When Dean Sittig moved to Houston, he, like most drivers, was very comfortable merging to the left to get on the highway. But Houston's seven-lane freeways often require merging to the right. "I wasn't good at merging to the right, and I knew I had to be careful, especially if I was crossing multiple lanes," he says. Even after several years, he still exercises extra caution.
Sittig, professor of biomedical informatics at the University of Texas Health Science Center and a leading researcher on hazards in clinical information systems, says that with the rapid adoption of electronic health records, clinicians nationwide are having to learn to "merge to the right." They have to record and use information in unfamiliar ways that create new opportunities to make mistakes, and Sittig says extra training will go only so far.
"Most wrecks aren't caused by lack of driving skill," he says. "We don't re-train drivers after they have a wreck-we just tell them to be more careful." Most clinicians have the basic computing skills they need, but the "be more careful" part will take longer to internalize, and will need a team effort by vendors, provider I.T. staff and users.
Hazardous IT
While experts generally agree that electronic health records are better for patient safety than paper ones, there's growing recognition that they present their own challenges. In its annual round-up of top 10 medical technology hazards, ECRI Institute, Plymouth Meeting, Pa., ranked "data integrity failures in EHRs and other health IT systems" No. 4, with several other IT-related hazards also on the list.
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Physicians' Most-Desired mHealth Functionality
Physicians are most interested in using their mobile devices to access electronic health records, according to a survey from MedData Group.
Almost 60 percent of physicians surveyed were interested in mobile EHR access. Other areas of mobile interest include secure texting (42 percent), researching drug information (40 percent) and patient portals for scheduling communication (35 percent).
Currently, just 18 percent of physicians access EHRs on their mobile device.
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Report: Health app market has a few big winners
There are now more than 100,000 apps on the iOS and Android app stores, according to a new report by research firm Research2Guidance, double the market size of two and a half years ago. They project the mobile health app market will have produced $26 billion in revenue by the end of 2017, up from $2.4 billion so far.
Research2Guidance also found that the average app publisher has seven apps and between three and 100 employees. Thirty-six percent of publishers entered the market in the last two years.
The market has just a few winners at the top and a vast number of companies struggling on the bottom. For instance, 82 percent of publishers generated less than 50,000 downloads across all of their apps last year, but the top 5 percent reached more than 500,000 downloads. Additionally, 68 percent of publishers make less than $10,000 a year, including those that make no revenue. Seventeen percent make between $50,000 and $1 million, but the top 5 percent makes more than $1 million.
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Single Sign-On Transforms Healthcare At Michigan Hospital
5/22/2014 09:06 AM
Munson Medical Center IT department's implementation of a single sign-on system did more than increase efficiency for the hospital's healthcare workers -- it changed IT's approach to solving problems.
Single sign-on wasn't the highest item on Munson Medical Center IT department's to-do list. Clinicians, however, were fed up with the long time it took them to log on to computers and access applications -- and these excruciatingly complex processes were having an impact on the healthcare staff's work and on patients' satisfaction.
Over the years, IT had considered various alternative approaches to its multi-faceted but very secure log-on approach, said Dale Atkins, technical architect at the Traverse City, Mich.-based hospital, in an interview. But the technologists had never found anything that met its requirements. That turned out to be the problem.
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Healthcare data goes from big to great
Posted on May 22, 2014
By Neil Versel, Contributing Writer
Not only is data getting bigger, it's getting smarter.
In this age of big data, analytics in healthcare has expanded from business intelligence and revenue-cycle management to clinical care.
For example, health insurer WellPoint is branching out from simply looking for gaps in coding, thanks to a combination of better data and more advanced algorithms. Now, the company can look for gaps in care as well, Patrick McIntyre, the company's senior vice president for healthcare economics, explained last week at SAS Institute's 11th annual executive conference on health analytics.
About 2.5 million of WellPoint's 37 million enrollees have insurance tied to some sort of value-based reimbursement model, McIntyre said, and the Indianapolis-based payer shares reports with providers whenever there is risk-sharing. "We use analytics and reporting to create economies of scale for all of the provider communities we work with," he said.
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Partners shares top 4 telehealth tips
Posted on May 22, 2014
By Eric Wicklund, Editor, mHealthNews
Making telemedicine work is often no easy process, but officials from Boston-based Partners HealthCare, a longtime leader in connected health, believe they've done it. So what's their secret?
Its Center for Connected Health is a think tank for digital and mHealth concepts, and hospitals like Massachusetts General Hospital are engaged in a number of projects that improve mobility and communications for both clinicians and consumers.
At the American Telemedicine Association conference and exhibition this week in Baltimore, Partners executives shared advice on how to link technical, clinical and business stakeholders in a new telehealth venture.
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Trusts should look to open source EPRs
21 May 2014 Sam Sachdeva
Trusts looking for electronic patient record systems should consider open source alternatives, as they offer “the biggest bang for buck”, an NHS England representative has said.
Speaking at EHI’s CCIO open source conference, held as part of the Digital Health Festival, NHS England’s head of business systems Richard Jefferson, said the organisation’s immediate focus is on encouraging a move to open source EPRs due to the greater value for money they offer trusts.
“We are prioritising the EPR space because that’s where we see [open source] as having the biggest bang for buck, but there is a wide spectrum of possibilities.”
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HANDI hints
The NHS needs to change the way it thinks about new technology – and the way it buys it, the HANDI spring symposium was told. Lis Evenstad reports.
19 May 2014
The Royal College of General Practitioners was invaded by ‘appy people’ last week as it played host to the HANDI spring symposium.
On a gorgeous spring day, while the sun was shining down on London, 100 or so app developers, NHS professionals and enthusiasts sat down inside to discuss everything app related.
Participants included chief clinical information officers, NHS IT directors, owners of small and medium sized enterprises and officials from NHS England.
As the temperature built outside, it also rose a few degrees in the air-conditioned building as they argued that the NHS is still behind the times when it comes to embracing mobile technology; and debated what can be done about that.
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Practice Fusion reveals new patient database for researchers
Practice Fusion, a San Francisco web-based electronic health record company, is opening up a huge swath of patient information to the scientific community.
The company, which more than 112,000 physicians use to store patient records, said Wednesday that it has scrubbed the identities of a subset of more than 81 million patient records. It is now allowing physicians, researchers and analysts to study that health information.
The database, called Insight, is free to access and lets users explore medical trends like diagnoses of seasonal infections like the flu, and of chronic conditions like diabetes, both in real-time and in the past. There’s information about the popularity of prescription medications. And researchers can check out which patients are being diagnosed with which diseases based on their body-mass index, age group or sex.
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Health Information Governance Lags Behind Other Industries
Greg Slabodkin
MAY 20, 2014 8:30am ET
Information governance programs are not as prevalent or mature in healthcare compared to other industries, according to preliminary results of a benchmarking survey by the American Health Information Management Association.
In the survey, only 11 percent of respondents characterized their information governance as "mature" programs. Also, a mere 17 percent of healthcare organizations had mature policy and procedure practices in place. In addition, 35 percent of survey respondents either didn't know whether their healthcare organizations had information governance efforts underway or indicated that their organization did not recognize the need for information governance, while 22 percent acknowledged the need but didn't yet initiate a program.
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Elderly may have trouble accessing online health records
Wed, May 21 2014
By Andrew M. Seaman
NEW YORK (Reuters Health) - Electronic medical records will let patients access their health information over the Internet, but a new study suggests some of the most vulnerable older Americans may be left behind.
While Internet use doubled among seniors in general over the past decade, researchers found, there was little growth among people with physical impairments - suggesting a new digital divide could be forming.
Functional impairments, including physical disabilities such as the loss of a sense or the ability to walk, make it difficult for people to live in their community, take care of personal finances and coordinate transportation.
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Barcoding still a key tool for safety
Posted on May 21, 2014
By Anthony Vecchione, Contributing Writer
There is ample evidence that barcode technology for medication has had a significant impact on patient safety. But while most U.S. hospitals have adopted barcode medication administration, experts say there's big room for improvement.
According to a recent study conducted at Boston's Brigham and Women's Hospital and published in the New England Journal of Medicine, the use of the bar-code electronic medication administration significantly reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events.
The study, "Effect of Bar-Code Technology on the Safety of Medication Administration," concluded that while barcoding did not eliminate errors altogether, it remains "an important intervention to improve medication safety."
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E-prescribing continues to grow
May 21, 2014 | By Susan D. Hall
More than 1 billion prescriptions were routed electronically in 2013, up from 788 million the previous year, according to Surescripts' annual National Progress Report and Safe-Rx Rankings, published this week.
The nationwide health information network routed 58 percent of the eligible prescriptions, including 73 percent of those written by office-based physicians, according to an announcement.
In addition, last year Surescripts delivered nearly 700 million electronic medication history records, covering two-thirds of the U.S. population, a 19 percent increase over the 2012 total.
Doctors' Use of E-Records More Than Doubles
HealthDay May 20, 2014
TUESDAY, May 20, 2014 (HealthDay News) -- Almost 80 percent of doctors in the United States have switched from paper to electronic health records, new government statistics show.
By 2012, almost 72 percent of physicians had made the change, compared to just under 35 percent in 2007, according to the report from the U.S. Centers for Disease Control and Prevention. Since then, the number of doctors using electronic health records has increased even more, added lead researcher Esther Hing, a statistician at CDC's U.S. National Center for Health Statistics.
"In 2013, 78 percent of physicians were using electronic health record systems," Hing said. "We are reaching nearly all the doctors."
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Update: CMS, ONC ease EHR certification requirements for MU
By Tom Sullivan, Editor
Healthcare providers and the IT vendors who serve them just got a dose of welcome relief from the increasingly controversial certification pieces of meaningful use.
That came in the form of a proposed rule the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT jointly circulated on Tuesday to “change the meaningful use timeline and the definition of certified electronic health record technology (CEHRT),” the agencies wrote in the rule. “It would also change the requirements for reporting clinical quality measures for 2014.”
And it appears to be arriving none too soon.
“Vendors aren’t ready, no subject matter experts are available to implement upgrades,” said Mandi Bishop, president of FloriDATA Foundation, and a self-described hardcore data geek and patient engagement advocate. “Products aren't fully-baked. Providers are frustrated.”
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Online Health Pricing Tools Growing, but Usefulness, Patient Engagement Still Low
Wednesday, May 21, 2014
Historically, health care prices negotiated between providers and insurers have lived in a black box, making it nearly impossible for consumers to figure out how much a particular service or procedure will cost. There are two primary reasons for this, according Suzanne Delbanco, executive director of Catalyst for Payment Reform.
The first and primary reason has been political, she said. "Providers and plans don't want us to have it. Plans feel just as proprietary about what they're paying to providers as providers feel about what they're getting paid."
Second, our health care benefit designs historically have not supported the need for price transparency. Employers have shouldered a large portion of health care costs for the majority of Americans, creating little incentive for consumers/patients to question the cost of their care.
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Better Healthcare Through Analytics
Analytics can help healthcare providers reduce costs and save lives, say attendees of Crimson Clinical Advantage Summit 2014 -- but they must be implemented thoughtfully.
When healthcare organizations provide clinicians with data previously hidden within disparate databases and paper files, they can improve treatment and reduce costs, according to a recent gathering of high-level medical professionals.
More than 600 CEOs, CIOS, health system executives, chief medical officers, physicians, and informatics professionals attended The Advisory Board Company's Crimson Clinical Advantage Summit 2014 in Orlando last week, where they shared best-practices, case studies, and partnerships surrounding their use of Crimson Continuum of Care, Crimson Population Risk Management, and Crimson Care Management and related services.
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Millennials, Boomers Want Different Healthcare Conveniences
5/20/2014 11:30 AM
As systematic changes in US healthcare convert patients into consumers, hospitals must meet each generation's measures of quality.
The Hospital Consumer Assessment of Healthcare Providers and Systems, better known as HCAHPS (pronounced H-caps), is the national, standardized, publicly reported survey of patients' perspectives of hospital care -- an increasingly important metric as hospitals learn to treat patients more like consumers and pay more attention to consumer choice.
The HCAHPS survey, its methodology, and its results were first publicly reported in March 2008. This reporting creates incentives for hospitals to improve healthcare quality and also increases accountability by increasing transparency into hospitals' quality of care.
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Feds push for health IT safety center
Posted on May 20, 2014
By Diana Manos, Senior Editor
What the U.S. government really needs now is a federal safety center for health IT.
That was the consistent drumbeat during a three-day workshop, May 13-15, on the FDA’s Safety and Innovation Act efforts. The workshow drew a wide variety of industry stakeholders and the involvement of other agencies that work with the FDA, among those the Federal Communications Commission and Office of the National Coordinator for Health IT.
“This safety center needs to be in place as soon as possible,” said Michael Hodgkins, MD, chief medical information officer at the American Medical Association, adding that it will be “where the rubber meets the road.”
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MPs look abroad for records inspiration
15 May 2014 Sam Sachdeva
Patients should be allowed to “own” and interact with their medical records if they are to be fully involved in their own care, a new parliamentary report argues.
The report on patient empowerment, released today by a coalition of six health-based All-Party Parliamentary Groups, says NHS England should be aiming further than its goal of providing online access to GP records by 2015.
Successive UK governments have promised patients greater access to their healthcare records, with Labour promising to give patients 'records on a stick' a decade ago.
The present government promised that patients would have access to all their records as it came into power, but the pledge has steadily been scaled back, to cover GP records and then the information in the Summary Care Record.
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What are the four dimensions critical to effective mHealth?
May 18, 2014 | By Judy Mottl
People, places, payment and purpose are the four critical dimensions necessary for mobile healthcare to attain its full potential, according to a new Deloitte report.
"The key to the four dimensions is to be sure all are considered, which is associated with greater success and return on investment," Henry Greenspun (pictured), senior advisor for Deloitte, told FierceMobileHealthcare. "Typically, when mHealth programs fail, it is often the result of one of the dimensions being overlooked."
Greenspun also recently discussed mHealth strategies in a radio broadcast and the challenges ahead, including the need for more investment in data security and new privacy regulations. A recent Compass study revealed regulatory and privacy issues are also looming hurdles.
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CDC: Lab staff essential to accurate EHR data
Beth Walsh
May 19, 2014
Well-designed and rigorously tested EHR systems can improve care by making it easier to collect, share and interpret patient data, according to a paper from the Centers for Disease Control and Prevention (CDC). Laboratory data-related interoperability and usability issues, however, can result in preventable patient safety risks.
Display discrepancies in EHR systems, such as variations in EHR system design, functionality and ability to exchange data accurately, serve as challenges but lab professionals are critical to ensuring the safety and effectiveness of laboratory data in EHR systems, according to the paper.
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Doctors Check Online Ratings From Patients and Make Change
Many physicians are wary of bad reviews from disgruntled patients
By Sumathi Reddy
May 19, 2014 7:13 p.m. ET
It's one of the most important services we pick, yet more people are turning to online reviews to pick doctors. Sumathi Reddy reports on Lunch Break with Tanya Rivero. Photo: Getty.
To find a good restaurant, we can check any number of online reviews.
To select a doctor, however, many of us rely on a single recommendation, or even a random search through the Yellow Pages. A growing number of doctor-review websites are aiming to change that by allowing people to rate physicians in much the same way they would a sushi dinner or haircut.
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Healthcare IT Priorities: No Breathing Room
5/19/2014 09:06 AM
Regulatory requirements have gone from high priority to the only priority for healthcare IT.
Healthcare has always been a highly regulated industry, but in the last few years requirements for implementing and documenting digital healthcare systems have been piling up so fast that IT organizations have little time for anything else -- including making sure the systems they already have in place are being used effectively. The InformationWeek Healthcare IT Priorities Survey of 322 technology pros at healthcare providers shows "meeting regulatory requirements" is the No. 1 initiative on participants' minds. Most of the other items at the top of the list, such as implementing or upgrading electronic health records (EHR) systems, are also largely driven by federal government requirements.
"The priorities we're trying to deal with right now are those being mandated," says Randy McCleese, CIO of St. Claire Regional Medical Center. "We can't do anything else. We have put everything else on the back burner except for those things that absolutely have to be done."
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The Difficulty of Technology Disruption in Healthcare
Scott Mace, for HealthLeaders Media , May 20, 2014
The new book by athenahealth's Jonathan Bush offers few ways out of the current healthcare mess, despite the importance of technological fixes. But liberated data is a bright spot.
"My fondest wish, my highest hope, is to inspire a small clan of crazy ones in every substrata of the healthcare system. A small strata of crazy medical school deans, a small strata of crazy health system CEOs, a small strata of community hospital CEOs, a small strata of crazy primary care docs. Each one of them says, I am going to be the guy who marches the wrong way. I am going to be the guy who stops protecting my flank and starts attacking her flank. And the great news is, I don't need many of them, because the point is, we've got about 50% excess capacity in our system, so frankly, if everyone did it, it wouldn't work."
So says Jonathan Bush, CEO and co-founder of the prominent ambulatory EHR software maker athenahealth. In my Q&A with him last week, Bush took aim at complacent large healthcare organizations who expose their flank to disruptors, but fail to use technology effectively to expose others' flanks, instead relying on an older generation of technology to lock in physicians and patients.
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Hospitals Lead in Quality Improvement Gains
Greg Goth
MAY 16, 2014 12:45pm ET
Hospitals are leading the movement to improve the quality of care delivered to U.S. patients, outpacing improvements in other settings, according to two national reports issued by the Agency for Healthcare Research and Quality (AHRQ). Three-quarters of hospital quality measures showed significant improvement, compared with 60 percent for home health and nursing home care, and about half for ambulatory settings.
The 2013 National Healthcare Quality Report and National Healthcare Disparities Report shows that Americans are receiving recommended medical services 70 percent of the time. The reports include data based on hundreds of healthcare measures categorized in several areas of quality. These are effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure and access. This marks the 11th year AHRQ has reported on the state of national healthcare quality and disparities.
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Faster isn't always better: Recognizing EHR fraud risks
May 19, 2014 | By Jane Antonio
While the country moves toward fully automated healthcare documentation, electronic healthcare technology may make fraud and abuse schemes easier through cut and paste shortcuts, according to an Office of Inspector General report.
As many as 90 percent of doctors copy and paste electronic health record (EHR) encounter data, a Health IT Exchange blog post noted. And up to 78 percent of physicians' notes are copied text, according to a Sedgwick Connection blog post.
This raises the question of whether providers hear the concerns of each patient and record them in unique notes, or if providers try to save time by using copy and paste commands to document typical complaints and treatment plans. "Risk managers shudder when they think about the potential fallout from this practice," Sedgwick Connection noted.
Another program integrity hazard, physicians can make macros that autopopulate certain parts of the chart and document all aspects of a physical exam whether doctors performed them or not. Concerns such as this led one hospital executive to conclude that too many EHR features are tied to billing as opposed to patient care.
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Med School Promises Full Google Glass Integration
While there are plenty of settings where wearable tech like Google Glass is rather inappropriate and can make you, well, look like a tool, it’s becoming more clear that one place it could find a home is in the medical community. Doctors with Glass? Makes sense. Last June, Google Glass was used during surgery for the first time ever, and since then more and more hospitals and medical schools and hospitals have been experimenting with the technology.
Now, one school is looking to make Google Glass an integral part of its curriculum.
UC Irvine School of Medicine has announced intentions to become the first med school in the country to fully integrate Google Glass into its four-year program–from anatomy course to rotations, UC Irvine wants to equip its students with the wearable tech.
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Proposed 2015 CQM Reporting Options for Hospitals Participating in Meaningful Use
Monday, May 19, 2014
Through the newly released 2015 Inpatient Prospective Payment System Proposed Rule, CMS lays out the clinical quality measure (CQM) reporting options that Medicare hospitals may use to submit CQM data to meet the meaningful use requirements. The proposed options are similar to those available in 2014; hospitals may select to submit CQM data via attestation or electronically.
The attestation option may relieve some resource needs for now, but the electronic submission option would help hospitals validate the accuracy of their electronic health record-collected CQM data and prepare for the alignment advantage between the Medicare Electronic Health Record Incentive Program and the Hospital Inpatient Quality Reporting Program in the near future. CMS has reiterated its intent to align clinical quality reporting across various programs, so it is only a matter of time before electronic CQM reporting becomes mandatory.
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EHR Adoption A Success, Says ONC Leader
5/16/2014 12:50 PM
Karen DeSalvo, new National Coordinator for Health IT, says improving interoperability standards is the next big challenge.
The US Department of Health and Human Services will work with the public and private sectors to improve interoperability standards in healthcare, said Dr. Karen DeSalvo, National Coordinator for Health Information Technology, during a keynote question-and-answer session at the Crimson Clinical Advantage Summit 2014 in Orlando, Fla., on Thursday.
The Office of the National Coordinator for Health Information Technology (ONC) "has authority for governance of an interoperable exchange," said DeSalvo, who is four months into her new role at ONC. "It matters so much to me that systems have a way to speak to each other. Incentive or no, this is one of these situations where everyone's asking for it."
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EHR Use Surges at Health Centers
John Commins, for HealthLeaders Media , May 19, 2014
More than nine out of 10 federally qualified health centers reported having electronic health records systems in 2013 compared with 30% in 2009.
The adoption and use of electronic health records in federally qualified health centers has grown by 133% in the past five years, thanks in large part to targeted federal funding and incentives, a survey from The Commonwealth Fund shows.
The survey of 679 senior executives and clinicians at FQHCs found that 85% reported advanced HIT capabilities in 2013, which meant that they could perform at least nine of 13 functions, such as ordering pharmacy prescriptions electronically. The rate was 30% in 2009, when The Commonwealth Fund conducted its last survey.
The pace of HIT implementation at many FQHCs has accelerated to the point where it is outstripping that of many larger physicians groups or integrated health systems. In 2013, 78% percent of office-based physicians used electronic health records, up from 48% in 2009.
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Enjoy!
David.