Hospitals and EMRs: Stimulating a connection

Availability of government stimulus money, combined with hospitals being allowed to finance portions of physicians’ electronic medical record systems, could make EMR adoption a veritable bargain. Or the stimulus money could make hospital systems less eager to help pay for your EMR, figuring that government funds will instead.

Either way, the possibility of combining two avenues of EMR funding has added a twist to the economic picture for physicians deciding what, when and whether to buy.

Doctors can get a maximum of $44,000 in funds from the federal economic stimulus package for adopting a certified EMR system that meets the government’s “meaningful use” standards. How much physicians get in stimulus funds will be based on the percentage of their practice that is made up of Medicare or Medicaid patients. Hospitals can get their own share of stimulus funds, but the amount depends on how they’re connected with physicians.

Blumenthal: Meaningful use must result in quality improvement, more time at bedside, less duplication

HHS’ definition of meaningful use will include an organization’s ability to use health IT to improve quality and “inform clinical decisions at the point of care,” David Blumenthal, national coordinator for health information technology, wrote in an Oct. 1 letter to the industry.

CMS is expected to publish its formal definition of meaningful use by the end of the year. Expect it to require providers to use HIT to “reduce the amount of time spent on duplicative paperwork” so they can spend more time with patients, Blumenthal wrote.

“The concept of meaningful use is simple and inspiring, but we recognize that it becomes significantly more complex at a policy and regulatory level,” he added. “As a result, we expect that any formal definition of ‘meaningful use’ must include specific activities healthcare providers need to undertake to qualify for incentives from the federal government.”

HITECH ‘Meaningful Use’ More About Improving Patient Care Than Tech Itself

Dr. David Blumenthal, the national health IT coordinator, is responsible for doling out government grants to reimburse health care organizations that implement electronic records technology. According to the HITECH section of the American Recovery and Reinvestment Act, nearly $22 billion in federal fundshas been set aside to “advance the use of health information technology.” A significant portion of that amount will take the form of grants to those health care organizations that can demonstrate “meaningful use” of such IT.

However, what exactly “meaningful use” will entail has been unclear. HHS is expected to release a definition in December, InformationWeek blogger Mitch Wagner says. But those who attended the Medical Informatics Association’s symposium got a “heads up” from Blumenthal on what that definition will focus on.

FierceEMR’s Neil Versel quotes Blumenthal this way:

The meaningful use framework will be about the goals of care, not the technology.

It’s a matter of using technology to improve patient care, not just installing the technology to say you have it. Versel speculates that the goal is to make electronic recordkeeping a best practice, the EMR system a standard medical tool, just as stethoscopes and examination tables are standard now.

Take, for instance, my own experience. I visited the local immediate care center over the weekend when I got tired of a wrenched neck muscle making my life miserable.I filled out the initial paperwork, listed my maintenance prescriptions, gave them the name of my primary care physician, the date of my last visit to her office, insurance information and all the rest. When they called me back, I gave my primary doctor’s name and listed all my meds and my medication allergies (again) for the nurse who took my temperature and blood pressure.

Then, guess what? The doctor came in, looked at my chart, asked again who my primary care physician was and what kinds of anti-inflammatory and muscle spasm medications had worked for me in the past, which ones irritated my stomach and which ones didn’t. After a little over an hour, I was out of there, prescriptions in hand, confident that the pain in my neck was about to go away.

All in all, it was a good experience — especially considering I would have waited at least twice that long if I had gone to the emergency room. But, I was reminded how helpful health IT will be. If the immediate care center and my primary care office had EMR systems that allowed easy sharing of patient information — with my consent, of course — then my visit would have been even quicker. I wouldn’t have had to go through the litany of information three times, and the doctor who treated me would have had my medication history at her fingertips, allowing her to make better informed decisions.

EMRs, PHRs, HIE necessary to support

Without EMRs, PHRs and health information exchange, the patient-centered medical home may not be bound to fail, but it certainly is difficult to establish and maintain. “IT is really the key to supporting the doctor/patient relationship and making it more efficient, safer and more effective,” Dr. Paul Grundy, president of the Patient-Centered Primary Care Collaborative, tells Health Data Management. The Washington-based organization advocates the medical home, under which a primary-care physician manages and coordinates care on behalf of patients, with an eye toward prevention and management of chronic diseases.

It may be a challenge to implement the medical-home model under current reimbursement systems, but until payers start rewarding physicians for keeping patients healthy, IT may be the best avenue. EMRs with clinical decision support, PHRs that help patients monitor their own conditions and health information exchange to support care coordination all can help establish a team approach to care and treatment, HDM reports.

“This is simply about restructuring the way healthcare is delivered to catch the efficiency of technology,” adds Grundy, who also is director of heathcare transformation at IBM.

EMR likely to boom throughout 2013

A new report from Scientia Advisors says health IT is the fastest-growing segment of what the Cambridge, Mass., management advisory company calls a $1 trillion global healthcare products marketplace. Health IT currently is growing at an 11 percent annual rate, and solid growth should continue at least through 2013, which would be the third year of the federal EMR stimulus program here in the States, the Scientia report forecasts. In that time frame, health IT will increase its market share by a quarter, to 5 percent of global healthcare products sales from the current 4 percent.

In the U.S., according to Scientia, the bulk of the spending will come from inpatient and outpatient EMRs, thanks to the American Recovery and Reinvestment Act. “Clinical decision support systems (CDSS) will likely have a profound impact on clinical diagnostics and therapeutics,” the report says, according to InformationWeek. Some of the growth likely will be at the expense of specialty and departmental systems, however.

Established EMR vendors should benefit most from the increased spending. “Leading players with large installed bases, proven products, and streamlined routes to meaningful use of EHRs are likely to gain share,” Scientia says. However, the research firm says “disruptive innovations” like open-source software and new applications of software-as-a-service could drive down prices, as might new competition from emerging markets in Asia and elsewhere.

Blumenthal: Patient Care, Not Tech, Will Drive Meaningful Use

National health IT coordinator Dr. David Blumenthal dropped a big hint about upcoming criteria for giving out e-health records grants. He advised healthcare IT managers to focus on “goals of care” rather than technology.

Blumenthal works for the U.S. Department of Health and Human Services, which is responsible for giving out grant money to reimburse healthcare providers for implementing electronic medical records. The U.S. American Recovery and Reinvestment Act of 2009 (ARRA), which set aside the money, specified that the funding will go to “meaningful use” of EMRs, but did not specify a definition for the phrase. HHS plans to release a preliminary definition of meaningful use next month. But Blumenthal dropped a hint at an address at the Medical Informatics Association’s annual symposium. He “gave attendees what they wanted to hear by reiterating his philosophy that technology simply is an enabler of quality improvement, not a panacea for healthcare,” according to FierceEMR.

“The meaningful use framework will be about the goals of care, not the technology,” Blumenthal said. While he didn’t elaborate on that statement, he did state the position of the Obama administration–one largely held by the informatics community, if not the broader healthcare industry–that the billions of dollars in federal subsidies aren’t simply meant to buy EMRs for providers. “It’s not the money that will turn out to be the most important,” Blumenthal said.

Instead, the net $19 billion investment is a way to demonstrate that EMRs should and will be accepted in the fairly near future as “symbolic of professionalism in medicine,” just as much as the stethoscope or examination table are today. “The idea that government should subsidize health IT will be as foreign an idea that the government should buy stethoscopes or exam tables for doctors,” Blumenthal explained.

“Information is really the lifeblood of medicine,” Blumenthal added. “Health information technology is its circulatory system.”

Final standards for meaningful use will be released in the spring, after a period of public comment on the first effort to be released by the end of the year, according to a ModernHealthcare.com write-up of Blumenthal’s address.

Blumenthal stressed that health IT must be focused on the goal of making the healthcare system work better for patients and providers.

“It’s not the technology that’s important, but its effect,” Blumenthal said. “That’s the purpose of the stimulus bill.”….

While Blumenthal declined to give a specific definition of meaningful use, he offered some hints. People working in health IT should think about EHRs “not as a technology project, but as a change-management project,” he said. Components of meaningful use include sociology, psychology, behavior change and the “mobilization of levers to change complex systems and improve their performance,” he added.

Through the stimulus law, Congress mandated that meaningful use become more focused over time, with yearly benchmarks. There has been a “lively discussion” in the Obama administration of that timetable in the proposed rulemaking of meaningful use, Blumenthal said.

Privacy and security will be essential, he said.

HHS plans to announce the first round of recipients of two major rounds of grants soon, Blumenthal said. The first, for $700 million, will establish up to 70 health IT regional extension centers nationwide to help healthcare providers become meaningful users of EHRs. The second program offers $560 million in grants to states to develop health information exchanges linking providers.

HHS also plans programs to increase the supply of trained health IT workers.

“The skills needed are not necessarily what our teenage children have,” Blumenthal said, which brought laughter from the crowd.

Specifically, the nation needs professionals who understand meaningful use and improved processes of care, the ability to redesign workplaces to integrate the new technology and to help providers use the technology to its full potential, he said.

“The training needed is well beyond the installation of information technology,” he said.

Blumenthal expressed great confidence that health IT can be a foundation for fundamental change in the healthcare system.

“I believe it will be a short time before EHRs are as common in medicine as the stethoscope, the cardiogram, the MRI and other core tools,” he said. “I think we’re already moving in that direction.”

Iowa gets $1.6 in ARRA funds for EHR planning

Iowa’s Medicaid program is the first to receive matching federal funds to plan for the implementation of an EHRs incentive program as established by the American Recovery and Reinvestment Act of 2009 (ARRA).

According to the Centers for Medicare & Medicaid Services (CMS), Iowa will receive $1.6 million in matching funds.

“While Iowa is the first state to receive approval of its plan for implementing the Recovery Act’s EHR incentive program, a number of other states have submitted plans as well,” said Cindy Mann, director of the Center for Medicaid and State Operations at CMS.

Iowa will, according to CMS, use the funds for planning activities such as conducting an analysis to determine the status of health IT in the state, including barriers to EHR implementation, eligibility for EHR incentive payments and the creation of a state Medicaid health information technology plan.