The Preventive Care Solution

Preventive care is far more efficient than curative care. It is also a lot cheaper. With the US economy under crisis and healthcare expenditure on the rise, a change is required now more than ever. After all, information technology has influenced several industries and while healthcare anticipates similar benefits, the progress has been relatively slow. However, as a result of the governments backing towards health IT and EMR adoption, almost 55% of physicians in the US have either adopted or are in the process of implementing an EMR. There have also been multiple developments on the health IT front, with mobile healthcare poised to make big waves, especially in consumer markets.

Consumer health IT products will definitely help in increasing patient awareness. There is an increased level of expectancy from interactive mobile applications that will help patients manage health, interact with physicians and maintain their own personal health records. Farzad Mostashari the National Coordinator for Health Information Technology said, “We all know that most of the health does not happen in the doctor’s office; it happens with the patient”. Mostashari believes that electronic reminders through patient portals and electronic medical records will influence patients to pursue recommended prevention and recovery plans, while allowing physicians to play a more prominent role in care delivery.

Dr. Ned Claxton, medical director and president of medical staff at the Central Maine Healthcare’s new Accountable Care Organization (ACO) believes that there is an increased need for the health community to shift from reactive care to proactive and health focused care. A healthy patient is a happy patient and preventative care costs less. ACOs promote a similar concept with ‘quality and affordable care’. Many medical professionals would agree that ACOs are in fact the future of care. “ACOs are outlining a roadmap for health organizations. The Accountable Care principle is not just about health IT and use of EMRs; it’s about a change in health perspective. By incentivizing quality care and collaboration, ACOs are transforming care.” Cutting costs and reducing budgets may only produce short term results, while compromising on the quality of care. This is why ACOs and preventive care are the way forward.


Will ACOs pop the EMR bubble?

Ever since the government announced its plan for changing healthcare through Accountable Care Organizations (ACOs), healthcare professionals all over the nation have been anxiously trying to assess the implications of such a theory being put into practice. The government realizes that the fee for service method is the root cause for care disparity and an inefficient healthcare system. However, implementing a performance based compensation system poses a whole new set of questions, amongst which of course is the issue of existing EMRs, which are designed to complement the current system through linear documentation.

Most vendors are expected to survive the onslaught of the meaningful use stage 2 requirements despite the initial interoperability scare which surfaced with the publication of the proposed rules. Physicians believe that most EHR systems lack the capability to interface and share information with other systems and care organizations. However, it is also true that most EHR vendors have already invested much time and effort to simply back down now, while others have enough funds from adoption to enter the next phase.

“EMRs have changed haven’t they? I don’t see many doctors manually typing notes anymore.” says a healthcare IT executive. Yes, EMRs have come a long way, as most advanced EMRs offer high levels of portability and interoperability. Physicians can document notes on tablets, navigate the system through voice commands and even accomplish clinical and administrative tasks while using a smart phone. Considering these recent developments in the health IT industry, it is not hard to believe that EMR vendors would find a way to re-configure their applications to provide the required level of interoperability, because vendors who fail to facilitate providers in regards to attesting for meaningful use will simply become irrelevant.

Coming back to the implications of ACOs, many medical professionals believe that they are indeed the way forward. ACOs will transform the care community within the US and while EHRs may not be designed to deal with the complexities of a performance based compensation model yet, they would have to in the near future.

EMR – Changing Medical Norms



What Does Meaningful Use Pay for?

Who would have thought for the CMS meaningful use incentive program to become one of the most polarizing topics in healthcare industry? Today, physicians stand divided. While some seek to benefit from the direction of use it provides, others blame meaningful use for stifling innovation in EMRs and health IT. Many medical professionals argue that use of medical technology should not be capped by regulations, “It is like a limiter. I should be able to decide how an EHR benefits my patient. Care should not be standardized. We deal with individuals as individuals. Not machines.”, says an annoyed physician.

However, the issue with meaningful use is not limited to standardization. Physicians attesting have to deal with several unique issues while reporting for meaningful use. The most significant concern has been the loss of productivity and the increase in overtime. When shifting from a paper based system, physicians want more control over documentation procedures and while few electronic medical records fulfill that need through customization, the meaningful use criteria still dictates clinical documentation for most physicians.

Some providers feel that restriction and control over their work causes an unnecessary delay that leads to loss of business and frustration among staff members. “The meaningful use incentive program is strategically designed to push physicians into adoption. Nobody incorporates overtime fees that one has to pay or the visitation slots that get freed up for meaningful documentation to be complete, particularly during the implementation and early adoption phase.”, says one provider.

On the other hand, there are a number of physicians that advocate for the CMS program. Some medical professionals believe that the meaningful use program is actually transforming healthcare, using a step by step approach. “We know that EMRs have been around for a while and some hospitals have been using these systems for nearly a decade. However, when you talk about solo practitioners without IT personnel, you can’t just expect them to start utilizing these systems in an efficient way. They would need a plan or a beginner’s guide to introduce them to the potential benefits of their EMRs.”, says Keith Smith, a health IT consultant.

Apart from the incentives, the improvement in care quality is what should ideally be the strongest proponent of Meaningful Use. It may add to the responsibility of providers to collect, analyze and share medical information, but it is through these changes that the healthcare system can truly transform. Farzad Mostashari the National Coordinator for Health Information Technology explains, “MU is a step by step road map of how our healthcare system can transform itself to provide higher quality of care, safer patients and patient coordinated care,” adding, “That means not only MU is the blue print of how to deliver better care, it is also the blue print of how healthcare providers can thrive in the healthcare markets.”

Read more: Everything You Need to Know about Meaningful Use Hardship Exemptions in 2016

EMR Adoption and Health Information Exchange

The last few years have been monumental for health. Electronic medical records have flooded into the mainstream with a recent report from Center for Disease Control (CDC) suggesting that nearly 55% of physicians in the US are at some stage of adoption. The survey also indicated that most respondents felt that EMRs had improved the overall quality of care. Industry analysts view this as a huge achievement for the healthcare industry and a giant leap towards the reformation process. One industry expert says, “The EMR has the numbers now. With more than half of the physician populous already using electronic medical records, physicians still using paper will have to join in or risk becoming obsolete.”

The U.S has been quick to utilize emerging technology in healthcare and with EMR adoption on the rise, physicians are likely to respond positively to innovation. “Our objective is connecting care and to reach this goal, we require an electronic health information exchange platform. EMRs provide just that”, says a hospital administrator.

John Lynn from shared a similar opinion in his blog. He believes that most of the healthcare community is aware of the benefits of Health Information Exchange (HIE). John argues that while standardization and development costs are two main barriers, the scale of EMR adoption in the country may be the biggest impediment to growth in the sector, he writes, “We want HIE’s to be successful, but can an HIE be really successful for doctors and hospitals that don’t have an EHR? The lack of EHR adoption might be the biggest impediment to HIE.”

The transformation of the healthcare system hinges on the success of electronic medical records. Having realized the importance of EMR adoption, the government extended its support through Regional Extension Centers and other educational communities in various states. The ONC highlighted the need for outreach programs targeting the rural and underdeveloped areas. While cost is a major deterrent here, education and exposure are the other key constraints.

The CDC survey also listed solo providers as the laggards in the adoption cycle, with only 30% reporting for adoption. However, the outlook is not so bleak. An industry expert highlighted that it’s common for independent businesses to lag behind in industrial changes, saying, “The adoption may be slower for independent doctor offices but it would change in the long run. Physicians are likely to follow large health corporations and hospitals in adoption. In fact there is an increasing trend of independent doctors adopting EMR systems with an HIE interface with their local hospital.”

HIEs are a step in the right direction and should help reduce cost in the long run. The communication process will simplify and health organizations will be able improve the patient care process through coordination. EMR adoption will continue to be the top priority and the government remains optimistic as it aims to shift America to electronic medical records by the end of 2014.

Read more: Data migration: Why is it important in Healthcare?


Another Year for the EMR

While the clichéd “year of the EMR” statement may have run its due course, adoption continues to rise at an exponential rate. The results for a recent survey by the Center for Disease Control and Prevention’s National Center for Health Statistics indicate that approximately 55% of doctors in the US are at some stage of EMR implementation. Health IT experts have been lauding the role played by the Office of the National Coordinator for Health Information Technology (ONC) in promoting EMR adoption. “The ONC deserves a lot of credit for making this happen. Their work with the Regional Extension Centers (RECs) and beacon communities has really helped in increasing awareness.”, says Frank Quinn, a health IT analyst.

The survey also suggests that nearly 75% of all the physicians that have implemented an EMR solution report to have an EMR system capable of meeting the meaningful use criteria. “This indicates that the EMR technology is becoming more sustainable.”, Frank added. The CMS stimulus has been a major driver for EMR adoption. The meaningful use (MU) program has helped vendors by identifying a framework of operations. “They have not mandated a design. They have just specified the minimum requirements. I don’t see how this stifles innovation.”, says a physician attesting for Meaningful Use.

However, Bob Keaveney editorial director of Physicians Practice believes that there is nonetheless some resentment regarding standardization in healthcare. Keaveney points out that the general perception about incentive programs is that they are designed to make doctors behave in a certain way. He explains that this negativity is likely to stem from the physician’s fear of being controlled and manipulated by the government. Frank Quinn argues that while opinions vary, numbers portray a clear pattern saying, “Nearly 250,000 physicians will have attested for meaningful use by the end of this year.”

The CDC poll goes on to report that a majority (85%) of doctors were ‘somewhat’ or ‘very satisfied’ with the day to day operations of their EMRs while every 3 out of 4 physicians believed that patient care had been improved with the introduction of electronic medical records. Almost half of the physicians who had not adopted an EMR system affirmed that they were planning to adopt one in the upcoming year. Frank explains that these all are positive indications, “This should illustrate how EMRs are becoming embedded within the culture of care.”

The other report findings citied single providers to be lagging behind in adoption, with only 30% reported to be using an EMR system. The report also indentified physician age as a factor in adoption. Physicians over the age of 50 were less likely to adopt an EMR in comparison to a younger medical compatriot with respective percentages being 49 and 64.



EMR Data Mining Reports – Turning Data into Insight

The most productive benefits of utilizing an electronic medical records (EMR) system are practice efficiency, cost reduction and quality of care delivery. While these benefits might persuade physicians to adapt EMRs, the true potential of an EMR lies in information management.

By centralizing the patient demographics, complaints, diagnosis and medical history, an EMR effectively creates a data bank which can be accessed to aid medical research, manage health risks, and improve patient care.

In 2009 researchers at Children’s Hospital Boston conducted a study by mining more than 500,000 de-identified health records from Massachusetts in order to capture and analyze any specific pattern that would enable them to determine future diagnoses of domestic abuse. Later that year, the researchers published their results citing 88% accuracy of the diagnoses derived from their data mining reports.

Most advanced EMRs allow for sophisticated reporting using complex queries and data collaboration. Physicians can utilize the information collected to better deliver personalized care, accommodate exceptions and improve practice outlook.

EMRs offer a more cost effective way of conducting research on a larger scale instead of using conventional methods. Last year, a group of researchers identified a potentially harmful drug to drug interaction that could adversely affect glucose levels and put patients at risk of developing diabetes. The researchers then validated the information utilizing electronic records of patients from three different medical institutions. “EMRs were really critical in our study because they allowed us to validate our FDA-derived predictions at minimal cost,” quoted the corresponding author and professor, Dr. Ross Altman.

This is one of the foremost reasons the federal government backs EHR adoption. EHR not only ensures consistent, quality information capture but allows users to further utilize the information collected by identifying data patterns and exceptions through its data mining capabilities. It not only helps physicians by aiding medical learning but also the patients, as they are the key beneficiaries for any breakthrough in the medical science and technology.



The Healthcare Reform – Are We There Yet?

The progression in health IT is introducing a new culture of care across the US. Developments in the world of technology have paved the way for a fluid and pro-active healthcare system.  “The pace of technological advancement in health IT has been incredible. We have witnessed a significant change over the course of a few years.”, says Josh Andrews a health IT analyst. Josh elaborates that the transformation of the healthcare industry within the US has come about rapidly saying, “While the health IT phenomena is worldwide, the growth rate across the US has been unprecedented. Our EMR adoption rate is extraordinary, having doubled from 2009 to 2011 and this is likely to increase in the coming months.”

However, this exponential growth presents new challenges for providers and regulatory bodies alike. Mark Kadrich, a security expert and the author of Endpoint Security explains that, the shortening of the testing phase to push technology is likely to give rise to multiple threats in the long run. 2011 was a huge year for mobile health with a lot of tablets and alternative devices being launched one after the other leaving the EMR industry to follow suit. Majority of the EMR vendors created non-native, remote desktop interfaces to grab a quick market share. However, in most cases these solutions were not practical and lacked maturity as Kadrich explains, “Mobile applications linking medical workflow between clinician and patient aren’t quite there, yet. There are some, but they’re rife with flaws.”

The healthcare system requires sustainable technology to grow and poorly developed systems will only hamper progression while compromising patient safety. There is a clear gap between the actual and expected capabilities of EMRs, in terms of interoperability. This is the reason that most medical professional were aghast upon learning the proposed requirements of the meaningful stage 2. “Our systems are incapable of connecting with hospitals and we still have issues with lab integration and e-prescribing.”, says a new EMR user.

The Health Information Exchange initiative (HIE) has shown remarkable growth and potential but the HIE industry itself is still in its adolescent stage. Only a handful of HIEs have been able to resolve technical issues. Exchange of medical information will pose significant risks that need to be addressed before commercial use. However, there is much optimism surrounding the development of HIEs.

Security is a huge concern for the health IT industry. With countless mobile and connected medical devices coming out, developers cannot ignore the need for improved security measures and better system design. The reason we are seeing an increased activity on the part of the federal government for system abuse is because our current healthcare system is arguably immature. Fraud and abuse are huge concerns for CMS as bugs in the systems are likely to be exploited. According to Kadrich, traditional methods will no longer be adequate, “We need to get beyond the traditional throw it behind the firewall’ mentality and take a good hard look at some new and innovative ways to fix things.”