The latest challenge: adopting electronic medical records

For those of you who do not know me personally, I am an internist and have been in private practice in central Florida for more than 30 years. Like so many of you, I have had to make changes -- expensive changes -- over the years to keep my office up to date, my practice competitive, and to provide better service to my patients.

Right now, one of the biggest challenges small offices like mine are facing is the requirement to adopt health information technology -- health car IT -- such as electronic medical records and electronic prescribing systems. Both are good ideas. Both ultimately will improve efficiency and should allow physicians to do more of what we are trained to do, and that is spend time with our patients.

Many physicians, however, are seeing a very rough passage between the here and now and full adoption of electronic medical records.

As a voice for America's physicians, the AMA is involved both in Washington and on the ground to ease the transition.

In December, the AMA was one of several dozen professional associations that co-signed a letter to Health and Human Services Secretary Kathleen Sebelius about the inconsistencies in requirements between the federal e-prescribing and EMR incentive programs. We petitioned for relief until those inconsistencies are rectified. The most troubling thing about the inconsistencies is a policy in the electronic prescribing program that will penalize physicians in 2012 if they do not e-prescribe in the first six months of 2011.

The AMA believes the penalty policy is unreasonable in that it will force physicians to purchase stand-alone e-prescribing software just to avoid penalties -- software most of them will end up discarding when they transition to a complete EMR system.

Under law, physicians cannot receive incentives from both programs simultaneously, yet they will face a penalty if they decide to participate in one over the other.

A subsequent report by the Government Accountability Office echoed the AMA's concerns about inconsistencies within the two federal health IT incentive programs.

As AMA Secretary Steven J. Stack, MD, has stated, "We continue to urge immediate action by CMS to harmonize the conflicting e-prescribing and [electronic health record] incentive programs in order to support effective health IT adoption."

Since the inception of requirements for the federal EMR incentive program, the AMA has strongly advocated for greater flexibility in adopting the meaningful use requirements for EMRs so more physicians can successfully participate.

We submitted comments to HHS during the creation of the first stage of meaningful use criteria and more recently responded to the proposed stage 2 criteria to help ensure physicians are not overly burdened with requirements that would prevent them from successful participation in the incentive program.

A survey by the Markle Foundation in February showed that nearly half of physicians indicate they are "not too" or "not at all" familiar with meaningful use requirements.

Not surprisingly, a recent Black Book Rankings user survey found that fewer than 10% of EMR purchasers are on track to meet meaningful use requirements.

More than 90% said they lack substantive support from EMR vendors, and 89% have delayed implementation because of the cost of additional support from EMR vendors and/or consultants. Significant numbers of others said they lacked trained staff (or available staff) to properly implement an EMR system or are unprepared and underfunded to rectify the difficult system interfaces.

It's a difficult situation all the way around for many physicians, made worse by the feeling by many practices that they must move quickly to adopt a complete health IT solution.

Make no mistake: The AMA is committed to widespread health IT adoption that can help streamline the clinical and business functions of a practice, but this takes time. We are working hard to help physicians understand the requirements of the federal incentive programs and how they can qualify for them. Even more important, we want to advise physicians to take the time to find the right solution for their practice.

While federal incentives for demonstrated meaningful use of electronic medical records begin this year, physicians don't have to rush into adopting a system today. If a practice reports on just the last 90 days of the year, that will qualify for meaningful use incentives, and practices even can wait to adopt a solution until 2012 and be eligible for full payment under the meaningful use program. Physicians should take the time to explore their practice needs, assess their practice's readiness to adopt health IT and select the right system for the practice -- and its patients.

Recognize that there are alternatives to implementing more complex systems, such as adopting a certified patient registry and certified e-prescribing application that also can qualify a doctor for stage 1 of meaningful use incentives and may be sufficient alone, or in conjunction with other modules, to qualify for subsequent stages as well. Such an approach can cost less, be easier to implement and be far less disruptive to work flow. But no matter the decision, it should be made with care and deliberation. In the Black Book Rankings survey, 82% of those who adopted health IT programs reported that a hurried selection of an EMR vendor produced negative consequences.

Dr. Thomas Fuller, a 17th-century British physician, noted, "All things are difficult before they are easy." That is certainly the case with EMRs.

In addition to advocating on behalf of physicians in Washington, the AMA is on the ground with support for physicians' offices that are moving forward in adopting health IT.

To this end, the AMA has many free resources available to help physicians with successful selection, purchase and implementation of health IT. We have information and tools to help physicians better understand the federal incentive program requirements and a wealth of additional health IT resources. You will find it all online (www.ama-assn.org/go/hit).

Today and always, the AMA is committed to supporting the physician community as we try to find a way through these murky waters.

This article was originally posted at http://www.ama-assn.org/amednews/2011/04/04/edca0404.htm

Obama deficit plan includes strengthened Medicare pay board

President Obama on April 13 rebutted a House Republican plan to trim $4 trillion worth of federal deficits over a decade with his own proposal that he said would protect guaranteed benefits in Medicare and Medicaid.

Obama also proposed that the Medicare Independent Payment Advisory Board be directed to enact even deeper reductions than outlined. The 15-member board was created by the health system reform law to improve Medicare quality and cut costs when the program's per capita growth rate exceeds specific targets. The IPAB, which is set to begin its work Jan. 15, 2014, could call for pay cuts to physicians and others that could be overridden only by substantial majorities in both houses.

GOP leaders have vowed to repeal the IPAB and the rest of the health reform law. A bill by Rep. Phil Roe, MD (R, Tenn.), that would accomplish the former had 83 co-sponsors, including four Democrats, at this article's deadline.

The American Medical Association also opposes the IPAB as structured, noting that physicians already are subject to deep pay cuts under Medicare's sustainable growth rate formula that lawmakers have had to override.

"We have strong concerns about the potential for automatic, across-the-board Medicare spending cuts because they are not consistent with meeting the medical needs of patients, which is our primary focus," said Ardis Dee Hoven, MD, chair of the AMA Board of Trustees.

Obama, however, proposed using the strengthened authority for the IPAB and other health care savings in his proposal to pay for a reform of the SGR formula, estimated to cost $300 billion over a decade.

The other health care proposals in the Obama deficit plan include limiting states' ability to draw higher Medicaid payments through funding loopholes and establishing tighter limits on prescription drug spending in Medicare and Medicaid. The president also proposed establishing a single rate for federal Medicaid payments that would increase automatically during recessions.

Obama said he would oppose any reform that fundamentally alters the commitments the nation has made -- in the form of Medicare and Medicaid -- to health care for seniors, the poor and the disabled. The GOP's budget plan would limit federal health spending by changing Medicare into a voucher program that would help seniors buy private coverage. It also would reduce federal Medicaid payments to states and allow states more flexibility on how they run their Medicaid programs.

Obama criticized the House Republican plan -- known as the Path to Prosperity -- for including $1 trillion in tax cuts to wealthier Americans while asking middle- and lower-income people to pay more for health care and college.

"In the last decade, the average income of the bottom 90% of all working Americans actually declined," Obama said. "Meanwhile, the top 1% saw their income rise by an average of more than a quarter of a million dollars each. That's who needs to pay less taxes?" Obama also said he would not approve further extension of the Bush tax cuts to wealthier people.

The House adopted the GOP's fiscal 2012 budget plan by a vote of 235-193 on April 15, with no Democratic support and only four Republicans voting against it. The budget resolution would set fiscal 2012 spending limits for Congress, but it faces strong opposition from Democratic leaders in the Senate.

2011 cuts affect reform

Congress and Obama avoided a partial government shutdown on April 8 by agreeing to about $38 billion in reductions over the previous year in a fiscal year 2011 spending measure that will fund the federal government until Oct. 1. In doing so, Obama and congressional Democrats agreed to cut or repeal three programs in the health reform law, including:

• Ending the Consumer Operated and Oriented Plan, created to foster the development of nonprofit health plans in individual and small group markets.


• Ending the Free Choice Voucher program to allow certain workers in 2014 to use their employers' contribution on health coverage to pay premiums for a health insurance exchange plan or a private health plan.


• Reducing the State Health Access Grants program, which awards money to states to help them expand affordable health care coverage to the uninsured.

In addition, the deal repeals $3.5 billion in performance bonus payments to states that meet certain enrollment goals in Medicaid and the Children's Health Insurance Program. The 2009 CHIP reauthorization created the program.

House Republican support for the 2011 spending bill wavered before the House adopted the package on April 14 on a 260-167 vote. In part, GOP reluctance came from the fact that the Congressional Budget Office concluded that only $352 million of the cuts actually would affect spending in fiscal 2011, which ends on Oct. 1. The CBO also said the measure would cut spending by up to only $25 billion between 2012 and 2016, with the rest of the cuts only reducing dollars Congress is authorized to spend, not dollars Congress is likely to spend.

Fifty-nine House Republicans joined the majority of Democrats to vote against the 2011 spending package on April 14, but 81 Democrats crossed the aisle to help adopt it. The Senate approved the measure 81-19, and Obama signed it into law on April 15.

The CBO did not detail which cuts it deemed part of the $25 billion of real cuts. However, a House Appropriations Committee summary of the $38 billion package outlined about $1.5 billion in cuts to health programs, including $600 million in reduced funding to community health centers.

"This cut is especially perplexing at a time when our nation and the Congress are focused on reducing health care costs," said Tom Van Coverden, president and CEO of the National Assn. of Community Health Centers.

This article was originally posted at http://www.ama-assn.org/amednews/2011/04/25/gvsa0425.htm

 

 

Homeland Security plans EHR for detainees

The Homeland Security Department plans to acquire an electronic health record system to improve the quality and efficiency of its health care for illegal aliens and other foreign fugitives detained by the Immigration and Customs Enforcement agency.

DHS clinicians and staff at 22 locations will use the electronic health record (EHR) to replace the current manual and stand-alone automated systems.

[See also: VA, citing taxpayer savings, seeks open source EHR.]

DHS is gauging vendor expertise to deploy a comprehensive system for patient operations, reporting and statistical analysis within a correctional environment, according to a request for information announcement in Federal Business Opportunities.

The agency anticipates awarding a contract in September to deploy the EHR system in fiscal 2012 as part of a five-year contract.

The potential vendor’s system must be certified by an organization authorized by the Office of the National Coordinator for Health IT as meeting the functions for meaningful use requirements. Those features include being able to exchange patient records using standard summary care and message formats when detainees move between facilities.

[Related: ONC's draft Federal Health IT Plan: Realistic in a reasonable timeframe?]

The system should also be able to perform detainee intake screening, scheduling, master medication list management and clinical decision support, according to the notice.

Last year, DHS published an announcement for such a system but ran into delays in the solicitation process, so it released another request for information, April 6 with responses due April 25.

This article was originally posted at http://ping.fm/RJLFY

 

HHS releases 2012 justification for funding requests

"OCR’s requested budget will support our ability to protect the public’s right to equal access and opportunity to participate in and receive services from all the Department of Health and Human Services’ (HHS) programs without facing unlawful discrimination, and to protect the privacy and security of individuals with respect to their personal health information.

 

OCR’s performance objectives are in line with HHS’ objectives for transforming the healthcare system, increasing access to high quality, effective healthcare; promoting the economic self-sufficiency and well-being of vulnerable families, children and individuals; and reducing disparities in ethnic and racial health outcomes.

Lastly, a 

recent program assessment demonstrated our continued commitment to use our human capital effectively and efficiently to achieve results in support of our nondiscrimination and privacy compliance mission. OCR has made progress in achieving results to support HHS-wide initiatives to improve the health and well-being of the public. To ensure continued results, individual performance plans at all levels of OCR’s leadership and staff are focused on achieving the goals and objectives set out in our organizational performance plan. In this way, all OCR staff are working together to achieve our shared objectives in protecting civil rights and the privacy and security of health information."

Read the Full Report Here.

Survey Names EHRs Most Likely to Help Physicians Earn Bonus

Clinicians with electronic health record (EHR) systems from Epic Systems and Greenway Medical Technologies may be best prepared to qualify for federal incentive payments for using the technology in a "meaningful" way, according to KLAS, a firm that researches medical software and services.

The 2 products also were customer favorites in a KLAS ranking of EHRs for medical practices published in December. Greenway's software took top honors among medical practices of 6 to 25 physicians, while the Epic program was number one among groups with more than 100 physicians.

The economic stimulus legislation of 2009 — known as the American Recovery and Reinvestment Act — authorized up to $44,000 under Medicare and almost $64,000 under Medicaid to physicians who demonstrate "meaningful use" of an EHR system as defined by the US Department of Health and Human Services. In so many words, meaningful use amounts to improving and streamlining patient care with the digital technology.

To qualify for the incentive cash, clinicians must satisfy 15 meaningful-use criteria considered "core" along with any 5 from a menu of 10 additional criteria. They can begin to report, or attest, to CMS on Monday, April 18, that they are meeting the requirements this year, the first year for the incentives to be paid out. For more information on registering for the incentive program and how to attest to meaningful use, visit the CMS Web site.

Many Providers Naively Optimistic About Receiving Bonus

KLAS surveyed 597 healthcare providers about 8 areas of EHR meaningful use, some of which include more than 1 criterion:

• Using computerized provider order entry for medication;


• Transmitting prescriptions electronically;


• Implementing drug-drug and drug-allergy alerts;


• Giving patients electronic access to their health information;


• Reporting clinical quality measures to CMS or state Medicaid programs (an example of data mining);


• Maintaining active medication, problem, and medication-allergy lists;


• Charting progress notes; and


• Implementing 1 clinical decision-support rule — in other words, a clinical alert — and tracking compliance to it (an example of a clinical alert might be a reminder to order an eye exam each year for a patient with diabetes; drug-drug and drug-allergy alerts do not count for this requirement)

According to KLAS, 80% of respondents say they are confident that they will satisfy meaningful-use requirements by year's end. However, KLAS states that this optimism is largely naive because most respondents are struggling to make the grade in 2 areas. Less than 35% are giving patients electronic access to their health information, and only about half have implemented a clinical alert. On a scale of 1 to 9, respondents scored the ability of their EHRs to provide these functions at 6.7.

KLAS notes that although EHRs must be certified by testing organizations as capable of meeting meaningful-use requirements, "not every vendor is successful in delivering those capabilities to their customers."

Epic EHR users reported the deepest adoption of all key meaningful-use functions, and its system scored highest in giving patients digital access to their record, thanks to the success of the company's patient portal, called MyChart. Greenway customers — 96% of them — are the most confident about receiving a bonus in 2011, and they are heavily implementing most of the meaningful-use functions of their software.

KLAS calls Epic and Greenway the "safest bests" for meaningful-use success. The riskiest bets for EHRs, according to KLAS, are from 3 vendors: Praxis, SRSsoft, and simplifyMD.

The KLAS report is available for purchase on the company's Web site. The price for physicians is $980. Physicians can look up survey data on individual vendors free of charge if they first complete an online questionnaire about the medical software, equipment, or computer services used in their practices.

This article was originally posted at http://www.medscape.com/viewarticle/740769

New study estimates cost to implement EHR systems

The American Recovery and Reinvestment Act of 2009 made a significant investment to encourage the adoption of electronic health records (EHRs) by healthcare providers and the chiropractic industry.

Under the new program, due to begin in 2011, physicians — including DCs — are eligible for incentive payments totaling more than $40,000 for meeting EHR standards developed by the U.S. Department of Health and Human Services.

Conversely, healthcare providers who have not implemented EHR technology by 2014 will face Medicare fee schedule reductions.

According to a new study, total cost to purchase and implement electronic health record systems averages $46,000 for a primary care practice staffing five

physicians. Researchers in Texas studied 26 practices of various sizes that were a part of HealthTexas Provider Network.

Because of variables in practices, the average cost per physician might not convey exactly to smaller, independent practices. Researchers found that the average cost to develop an EHR infrastructure included approximately:

• $25,000 per practice for cables and wireless Internet


• $7,000 per physician for personal computers, printers and scanners


• $17,100 in maintenance costs per physician for the first year, which included software licensing fees, domain hosting, technical support and networking costs.

To read more about the study, click here.

 

 

Rural Texas Hospitals Eye EHRs

Seven rural hospitals in Texas will implement certified electronic health records software from two Texas-based vendors to go after meaningful use incentive payments.

Cameron-based Central Texas Hospital, with six facilities totaling 305 beds, will do a fast-track deployment of integrated and Web-hosted clinical/financial management software from eCareSoft, Austin. The new vendor is a subsidiary of Expert Sistemas Computacionales, which has a 40 percent market share in Mexico and now is targeting small and mid-sized hospitals in the United States.

Eastland (Texas) Memorial Hospital on March 1 started implementing the ChartAccess Comprehensive EHR from Prognosis Health Information Systems, Houston. The 52-bed hospital expects to start its 90-day attestation period on May 31.

The EHR will integrate with billing, laboratory, pharmacy, radiology and other ancillary systems, and will serve as the centralized data repository. Eastland Memorial also will join the Texas Regional Health Information Organization.

--Joseph Goedert

This article was originally posted at http://ping.fm/yhCOF

Top 10 issues for health plans in 2011

The Managed Care Executive Group, a national organization of U.S. senior health plan executives, met last week in Arizona to discuss the top issues that health plans face in 2011.

The 22nd Annual Forum, lead by industry thought leaders such as Dr. David Brailer, Thomas Main, Dr. Karen Bell, Jeff Margolis and 14 other invited healthcare experts, focused heavily on the forward progression of healthcare retail, enabling innovation and technology, payment reform, and the rising role of consumers via social media and individual markets including Medicaid and Medicare.

Each year The Managed Care Executive Group polls health plan executives and industry thought leaders across the country via surveys, webinars and other events to compile a list of issues impacting health insurance organizations. At their yearly forum the executives voted their "Top 10" issues, as represented below.

This year's list changed quite significantly from a year ago when the list was dominated by the role of government. "In such a rapidly changing environment, MCEG members and nationally recognized executives offered additional clarification and guidance on how health plan priorities continue to evolve and what they can do to address them," said Alan Abramson, the outgoing chairperson of MCEG, SVP and CIO of HealthPartners, and Emeritus MCEG board member. "The discussions were invaluable for our members to survive and thrive in 2011 and beyond."

Voted as the Top 10 issues in 2011 for health plans:

1. Administrative Mandates (Compliance HIPAA 5010, ICD-10, etc.).


2. Care Management, Data Analytics, and Informatics.


3. Health Insurance Exchanges and Individual Markets.


4. New Provider Payment & Delivery Systems (ACOs, PCMHs, etc.).


5. Bend the Cost Trend.


6. Medicare and Medicaid.


7. Health Information Exchanges and EMRs.


8. Consumer's Role in the Modernization of Healthcare.


9. Reform Uncertainties.


10. Payer/Provider Interoperability.

"These issues, and others that become critical, will continue to be the topics of additional webinars, white papers and discussions over the next year within MCEG," said Vince Ferri, VP & CIO of AvMed Health Plans, and the newly elected chairperson of MCEG. "We invite all health plan executives to join us in addressing these priority issues with a focus on enhancing collaboration and working on affordability."

Click here to read full descriptions of the top ten issues.

Bill would post every physician's Medicare billing data on Internet

A Senate bill aimed at curtailing Medicare fraud would publish physician billing data online, letting viewers determine how much individual doctors earn annually from the program.

The release of the data has been prohibited by a court ruling for more than 30 years. But some lawmakers recently stepped up their efforts to lift the ban and bring Medicare billing data to light to prevent fraud.

Sen. Charles Grassley (R, Iowa) introduced a program integrity measure before a Senate Finance Committee hearing on Medicare and Medicaid fraud on March 2. The bill in part would require the Dept. of Health and Human Services by the end of 2012 to start publishing Medicare claims and payment data on the website USAspending.gov.

In making the information public, the government could help prevent billions of dollars each year from going to those defrauding the program, Grassley said. Sen. Ron Wyden (D, Ore.) said he was drafting his own legislation that would make Medicare claims data publicly available.

"More transparency about billing and payments increases public understanding of where tax dollars go," Grassley said. "The bad actors might be dissuaded if they knew their actions were subject to the light of day."

But the American Medical Association, along with HHS, has opposed challenges to the decades-old ban on publicizing the information. Physician organizations have said allowing public access effectively could permit anyone to determine how much an individual doctor makes in a year, especially if that doctor has a patient population that is mostly Medicare. Publicizing raw claims data without any necessary context would be of dubious anti-fraud value, they said.

"Releasing Medicare claims data to the public does not further the goal of combating fraud, as those tasked with this responsibility already have access to the data," said Ardis Dee Hoven, MD, chair of the AMA Board of Trustees.

However, Grassley said the government is not the only entity trying to smoke out Medicare fraud. During the Finance hearing, he cited a recent series of Wall Street Journal articles that examined Medicare claims from 1999, 2001 and 2003-08. Under a special arrangement, the journal, working with the Center for Public Integrity in Washington, D.C., paid the Centers for Medicare & Medicaid Services $12,000 for a 5% sample of the Medicare carrier payment file for those years. The newspaper reported that it was able to identify tens of thousands of physicians and other health professionals who could be considered outliers based on the relatively large amounts they billed Medicare in those years.

However, the journal could not name the physicians based on its data usage agreement with CMS. That policy stems from the federal court decision that protects the privacy of the physician data.

"I think it's time to revisit this decision and make some transparency of payment physicians receive from Medicare," said Grassley, a long-time farmer. "Pretty much like you will see Chuck Grassley's name in the newspaper sometimes that I've gotten a farm subsidy through the U.S. Dept. of Agriculture."

Reviving an old court fight

In 1978, the Florida Medical Assn. and six physicians filed a class-action lawsuit to prevent the predecessor department to HHS from disclosing a list of all medical professionals who received Medicare payments the previous year. The AMA joined the lawsuit as a plaintiff in June 1978.

In October 1979, the judge in the case ruled that individual billing data were exempt from public disclosure laws and barred the department "from disclosing any list of annual Medicare reimbursement amounts, for any years, which would personally and individually identify those providers of services under the Medicare program." The ruling protects AMA members and doctors in Florida, but HHS has applied the prohibition to all physician billing data.

Several recent challenges to the 1979 ruling have failed. In 2009, an appeals court decided that the government was not required to release claims information to the marketing firm Real Time Medical Data based in Birmingham, Ala. The same year, another appeals court denied a similar request from Consumers' Checkbook/Center for the Study of Services, a nonprofit consumer organization based in Washington, D.C. In that case, the court said release of the data was an "unwarranted invasion of personal privacy."

In the latest legal challenge, The Wall Street Journal's parent company, Dow Jones & Co., filed motions on Jan. 25 to reopen the 1979 case and intervene as a defendant. A federal judge is scheduled to hear arguments on these motions on April 14.

The paper said the original decision prevented reporters from naming physicians they believed were defrauding the Medicare program.

In a series of articles, titled "Secrets of the System," the newspaper cited doctors with questionable billing records. For instance, one New York family physician took in more than $2 million in 2008 from Medicare, the journal reported.

The AMA, meanwhile, "intends to vigorously defend the current injunction, which protects the privacy of physician data while allowing it to be seen by the agencies working to identify fraud," Dr. Hoven said.

"Medicare fraud threatens our entire health care system, and the AMA supports targeted efforts by the Dept. of Justice, [HHS] Office of Inspector General and others to identify perpetrators of fraud -- the vast majority of whom are not physicians," she said.

There's little doubt that the vast majority of physicians are billing the Medicare program appropriately, said Jason Conti, an attorney for Dow Jones in New York. However, restrictions on access to the claims data prevent further investigation of true outliers in the program.

"If the data is released, more fraud will be exposed," he said.

As it has since 1979, HHS is opposing reopening the case. The restrictions placed on the newspaper in the data usage agreement are based on a statutory exception to the Privacy Act of 1974 and not the 1979 court decision, HHS said in court papers.

This article was originally posted at http://www.ama-assn.org/amednews/2011/04/04/gvl10404.htm

AARP Under Attack In GOP Efforts Against Health Law

House Republicans issued a report Wednesday and plan to hold a hearing Friday to investigate AARP's support for the health law as well as the organization's business interests.

The Washington Post: In Campaign Against Health Care Law, Republicans Take On AARP
House Republicans, who are continuing their efforts to chip away at President Obama's health care law, have now set their sights on a powerful group that strongly supported the legislation: the AARP seniors lobby (Eggen, 3/30).

The Hill: GOP Report Questions AARP's Motivations For Supporting Health Care Reform
"Over and over during the health care debate, questions arose about why AARP was appearing to lobby in opposition to its members," said [Wally] Herger (R-Calif.), who chairs the panel's health subcommittee. "We couldn't understand why AARP would support a health care reform bill that would threaten access to doctors (and) hospitals and could force seniors out of the plan they know and like …" The report looked at AARP's public tax filings and concluded that the group stands to gain $1 billion from the health care reform law. That's because AARP makes considerably more from royalties (46 percent of revenues in 2009) than from membership dues (17 percent) (Pecquet, 3/30).

Bloomberg: AARP May Get $1 Billion on Health Law, House Republicans Say
A group of House Republicans said seniors lobby AARP will gain as much $1 billion over the next decade from the 2010 health care overhaul it supported and should have its tax-exempt status investigated. AARP represents 37 million people ages 50 and over in the U.S. Its gains will come from insurance products it endorses and that will attract customers under the health law, a group of Republicans on the House Ways and Means committee said in a report released today (Armstrong, 3/30).

The Fiscal Times: Republicans Continue Attack On AARP For Conflict of Interest
AARP's structure is not unique. Many non-profits run for-profit subsidiaries to generate revenue for their charitable and lobbying activities. The Smithsonian's or National Geographic's television deals come to mind, or every museum's gift shop. Yet the scale of AARP's insurance subsidiary's dealings (it runs its own firm as well as forms partnerships with UnitedHealth Group and other insurers) is breathtaking. The Ways and Means report, based on publicly available documents, found that insurance royalties paid to the non-profit side of the 40 milllion-member AARP nearly tripled to $657 million between 2002 and 2009, which constituted 46 percent of its $1.4 billion in revenue (Goozner, 3/30).

Modern Healthcare: GOP Lawmakers See AARP Profiting From Reform Law, Question Group's Tax Status
A new federal report concludes AARP could make $1 billion in profits (PDF) in the next 10 years as a result of the health care reform law and it questions the tax-exempt status of the organization representing America's seniors. Reps. Charles Boustany (R-La.,), Wally Herger (R-Calif.) and Dave Reichert (R-Wash.) — all members of the House Ways and Means Health Subcommittee — released the report, which cited Richard Foster, chief actuary at the CMS, as saying that about 6 million to 7 million Medicare Advantage beneficiaries will leave those plans and will want auxiliary coverage, and Medigap will be the most straightforward way to get it. A Medigap policy is private health insurance intended to supplement Medicare as it helps pay some of the health care costs that Medicare doesn't, according to HHS (Zigmond, 3/30).

The Seattle Times: Reichert Claims AARP Had Hidden Motive To Back Health Care Overhaul
Did AARP, the nation's leading advocacy group for older Americans, fight for last year's federal health care law to the detriment of its members? Guilty, according to U.S. Rep. Dave Reichert and his fellow House Republicans — and they contend AARP had a motive. On Wednesday, three members of the House Committee on Ways and Means released a report detailing what they called troubling conflicts over the nonprofit group's multimillion-dollar foray into for-profit insurance businesses. Titled "Behind the Veil: The AARP America Doesn't Know," the report takes aim at possibly stripping AARP of tax-exempt status. The organization was one of the most vocal supporters of the Affordable Care Act, which Republicans are attempting to repeal (Song, 3/30).

Roll Call: AARP Is Next On GOP Target List
House Republicans on the Ways and Means Committee on Wednesday released a report that accuses the influential senior citizens organization of having a conflict of interest because it will financially benefit from the health care overhaul that the group heavily lobbied for last year. AARP collects royalties from endorsing health insurance policies and other products (Roth, 3/31).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

This article was originally posted at http://ping.fm/QuNnWDaily-Reports/2011/March/31/aarp.aspx

Montana gets its EHR money back

[caption id="" align="alignleft" width="175" caption="Gov. Brian Schweitzer (D-Mont.)"][/caption]

HELENA, MT – The Montana Senate voted to restore the $35 million in federal incentives for electronic medical records for hospitals and community health centers across the state this week.

The Montana legislature initially denied the state's Department of Health and Humans Services (DPHHS) the authority to accept and distribute the money to hospitals four times on party-line votes – making it the only state to do so.

But, under pressure from Gov. Brian Schweitzer (D-Mont.) and healthcare providers from across the state, the Senate voted 45-5 for the motion on March 28.

Earlier this month Schweitzer warned lawmakers that they were increasing the cost and lowering the quality of healthcare in Montana by refusing funding for electronic health records technology.

The state has 47 critical access hospitals in smaller communities across the state, and almost all will likely qualify for the funding, according to the governor.

"Electronic health record systems save money and improve care through eliminating the need for duplicative testing," Schweitzer said.

Click here to see votes on the HIT funding.

This article was originally posted at http://ping.fm/xZ0vB

Apple?s iPad: Is it a perfect e-learning tool?

Apple’s iPad has been a pathbreaker of sorts in the technological field. They were many naysayers during its launch regarding its utility, but I suppose the tremendous success of the product have shut up their mouths. The craze and euphoria has not died yet, and with the launch of iPad 2, the buzz is getting stronger. And the all-important question comes to the fore: can the iPad serve as an ideal classroom teaching device?

I strongly feel that iPad will have a part to do. It is sure to displace one-to-many teaching pedagogies in favor of interactive one-to-one studying and learning and will encourage much more participation from students.

To drive home my point about the iPad will have a role in online education for children, here is some news. It has been seen by many that those children who haven’t learned to read or write or even operate a mouse are able to operate the iPad with tremendous speed. According to an article published in Ad Age in June 2010, “How the iPad Became Child’s Play – and Learning Tool,” there were many toddlers as who were as many as 18 months old only who were trying to provoke interaction from TV sets and PC monitors as if they were touch screens like that of the iPad. This indicates clearly that the next generation will find it very easy to respond well and interact with the intuitive device.

In another study related to e-book reading, a survey result released by Student Monitor revealed that out of 1200 college students who were participants in the survey and interested in e-readers, more than 46% of them opted for iPad as the preferred e-reader rather than 38% of them who favored Amazon’s Kindle. This indicates that iPad is known among the adolescents to be much more conducive and intuitive than the Kindle.

Educators today are stressing on the need for contextual learning and user participation. Digital whiteboards have failed to encourage interactivity, and is also less on computing power. The laptop is comparatively bulky too and can be problematic to handle sometimes. The iPad then serves to be the perfect device for comfortable online learning and acts as a useful tool for referencing, collaborating, and content creation. The best part is that of the choice for personalized content for students.

Some of the kinks are there: it does not support web pages which have Flash, it does not have a telephone, it does not have a camera and it also does not have USB slots or memory card slots although there is support for dongles. These limitations are somewhat deterrent for its use but once there are updates to the device, I don’t really see a problem for the iPad to be used as a e-learning device!

About emPower

emPower  is a leading provider of comprehensive Healthcare Compliance Solutions through Learning Management System (LMS). Its mission is to provide innovative security solutions to enable compliance with applicable laws and regulations and maximize business performance. empower provides range of courses to manage compliance required by regulatory bodies such as OSHA, HIPAA, Joint commission and Red Flag Rule etc. Apart from this emPower also offers custom demos and tutorials for your website, business process management and software implementation.

Its Learning Management system (LMS) allows students to retrieve all the courses 24/7/365 by accessing the portal. emPower e-learning training program is an interactive mode of learning that guides students to progress at their own pace.

For additional information, please visit http://www.empowerbpo.com .

Rent Watch: Landlord can require permission for roommate

Question: I have rented a three-bedroom unit for two years. About eight months ago, I lost my job and could no longer pay my rent. Rather than be evicted, I found a roommate who now pays half the monthly rent.
From the beginning, my roommate has written a separate check for his half of the monthly rent and I write my own check for the other half. I give both checks to the rental office, which is the place designated for payment in my rental agreement.

When I took the two checks to the office last week, the new resident manager told me she would not accept the checks. She said I was in violation of my rental agreement. She showed me a copy of the agreement, which does prohibit subletting without management's written permission. Is there anything I can do?
Answer: A landlord has the right to prohibit subletting or require advance written consent. If the management wants to enforce this clause, you could be given a three-day notice to remove your roommate or face an unlawful detainer action for eviction.

You have one potential defense to the assertion that you are in violation of the rental agreement. If you can show that the community's management allowed the roommate to occupy your unit and did not take timely action to require the roommate to vacate, you can assert that management's inaction constituted a waiver of its right to enforce the clause prohibiting sublets. Knowingly accepting a rent check from your roommate over a period of months is strong evidence of waiver.

Even if you have a strong defense, fighting an unlawful detainer can be costly in terms of time and money. If the court rejects the defense, you will have an eviction on your record, which will seriously limit your ability to rent in the future.

As an alternative, you could contact your local mediation program to see whether a resolution can be reached. For example, you and your roommate could reach an agreement to add the roommate to the rental agreement or you could negotiate an agreement allowing you or the roommate a reasonable time to vacate.
Eichner is director of Housing Counseling Programs for Project Sentinel, a Sunnyvale, Calif., mediation service. To submit a question, go to http://www.housing.org.

Bainbridge HomeShare program fills a need for affordable housing

By Tristan Baurick

Kitsap Sun
BAINBRIDGE ISLAND — A Bainbridge affordable-housing group wants homeowners to rethink a housing arrangement they likely abandoned in college.

Taking on a roommate benefits both owner and renter — especially during hard economic times, according to the Housing Resources Board (HRB), which manages the county's only roommate-matching program.
HRB program specialist Penny Lamping said a roommate can help cover a mortgage, provide companionship and chip in on house chores. In return, the homeowner provides below-market-rate housing for a person hit by hard times.

"Some people take a roommate because they have a big house to themselves and they want to share," Lamping said. "Some do it to exercise a social consciousness."

HRB's roommate-matching program, called HomeShare, was created two years ago, but it's getting renewed emphasis as the gap widens between the typical rental rate and the amount people can afford.
"We're getting phone calls all the time, but they can only afford $200 to $500 (per month)," said HRB Executive Director Ken Balizer.

Even the homes HRB manages are typically beyond that range.
HRB is also trying to boost the HomeShare program because the city greatly reduced its financial support, making it difficult for HRB to build new homes or lower the rent on existing ones.

HRB conducts background checks on rental applicants and matches them with homeowners, thereby streamlining and easing the search process for both parties.

Bainbridge homeowner Holly Hall has been renting a room to a young woman for the last 15 months.
"I lived by myself and really wasn't using half my house, so I thought it was worth a try," she said. "It's really worked out well so far."

Until recently, HRB board member Kim Hendrickson rented a room to a Peruvian woman. The arrangement took some financial pressure off Hendrickson's family and gave her kids an early introduction to Spanish, she said.
Hall said opening one's home to a renter isn't without sacrifices. Sometimes chores go undone, and a previous renter had trouble paying the rent during a family emergency.

"You have to be clear and articulate in terms of rent and house cleaning," she said.

Some renters do maintenance, pet watching or provide in-home care for elderly homeowners to supplement rent.
HRB has a list of nearly 20 people seeking homes through the HomeShare program. The list of homeowners offering a room is nearly as long, but HRB is having trouble finding homeowners who will go lower than $600.
Hall said the monthly income is nice, but she doesn't expect it to make her rich.
"It's not about the income," she said. "It's about doing something good for somebody else."

Does a New EHR Mean Switching Practice Management Systems?

Four years ago, pediatrician Jeffrey T. VanGelderen and his partner at the Children's Medical Group of Saginaw Bay in Michigan were looking for an EHR for their practice. Before shopping, they had a difficult decision to make: Find an EHR compatible with their current practice management system or buy an EHR and at the same time, buy a new management system designed to work with it.

In an effort to increase compatibility between the two systems, VanGelderen and his partner chose the latter option, going with brand new systems. They first investigated the EHR offering from their management system vendor, and found it user-friendly, but not as robust as the newer software from another company.

"In a lot of cases like ours, practices already have a management system in place and have had it there for a long time," he says. "When you make the decision to go to an EHR and fully integrate it, you usually go to another [management system]."

In 2008, Children's Medical Group debuted its new practice management system and less than nine months later, had its EHR online with the two systems working collaboratively together.
VanGelderen says the result has been great. The cost of the two new systems already has been more than made up for, he says, and in fact, the new systems have freed up staff time through better efficiencies in the software.

"We are using that time for better quality of care, like follow-ups and identifying patients who need well checks, and our nurses are doing more patient education versus paper shuffling," he says.

If you are considering implementing an EHR at your practice and want one that works with your current management system, how much of an investment should you make? Our experts weigh in with two trains of thought.

Assess your needs

You wouldn't make a big capital investment in a medical device without a little research on cost, use at your practice, and training, right? Well, our experts say when it comes to weighing a potential relationship between your practice management system and an EHR you also need to do your homework.

Fred Pennic, a healthcare IT consultant and technology blogger, says if you like your current practice management system, make a complete assessment of what it will mean to bring an EHR online also. This includes ensuring you have the proper resources to support it, in terms of IT staff or other employees, knowing what your licensing agreement will cost you, and estimating training hours required to get any new system up and running.

You also need to weigh the pros and cons for your practice, adds Don Sickle, a former EHR specialist with national consulting firm Welch Allyn. Sure your current system is all paid off and familiar to staff, but does it also have lingering problems that require tricks and shortcuts by your staff — costing time and money just to get it to work? If so, perhaps it is time for an upgrade, Sickle says.

If you are ready for an EHR, both Pennic and Sickle advise taking the same first step as Children's Medical Group — call your current practice management system vendor to inquire about its EHR offering. If you are happy with one of the vendor’s products, you may like a companion that works similarly and is more likely integrated than two systems from two different vendors.

Sickle, who was also president of advisory firm EHRInsider, says two different vendors means more "interfaces" between products so they can communicate, which isn't always a good thing.

"Interfaces are all links in a chain, and eventually, one of them will be weak somewhere at some point," he says. "The key is to have as few links in this technological chain as possible."

When calling your existing practice management system vendor to inquire about its EHR offering, Sickle advises inquiring how long the vendor has had the product in place and whether the EHR was purchased from an out-of-business company — making it less likely to work seamlessly with your practice management system. Just because it is from the same vendor doesn't mean the systems will work together in perfect harmony.

If the vendor does have a product you are happy with, schedule a Web demo, Sickle says, or even an onsite visit to your practice so you can learn more about the EHR and how it will fit into your practice's current operations.

Time for a change

But what if, during that assessment, you find that your current practice management system is not as efficient as when you bought it years ago? Then it may be time for a change.

Margret Amatayukul, president of Margret/A Consulting in Schaumburg, Ill., says when it comes to getting practice management systems and EHRs to work together, the answer is simple:

"You cannot find an EHR today worth its salt that will really integrate well with an old practice management system," she says.

So practices hoping for harmonious integration between an EHR and practice management system should at least consider buying both products new, she says.

"You should not be closed-minded about being open to looking into a new practice management component that makes sense for you," Amatayukul says. "Keep an open mind, even if you are dead set against it."

Now that you are ready to shop for some technology, try to hit as many EHR vendors as possible. Where is the best place to do that? Trade shows, says Sickle. Check for local and national trade shows where multiple vendors will talk to you and provide you with lots of literature on their products.

Take the 10 to 20 in-person visits and make a shorter list of vendors, about five or six, and set up Web-based demos for you and some of your key staff. From there, choose the two or three you want to do an in-depth demo that will include how the practice management and EHR components work together effectively.

Learn from others

More likely than not, you are not the first practice to make a big investment in a new practice management system and EHR at the same time. So to best gauge how your new products will work together, talk to those who've already done it, say our experts.

Get references directly from your potential new vendor partner, Amatayukul says, and be specific — ask for a similar-size practice making the same decisions you are.

"Don't take 'we've done a lot of these' as an answer from a vendor," she says. "They need to dig deep in terms of how many have you done on my version [of the system] and in the same size and type of practice I am. …Vendors often have references for EHRs, but don't get references for [management system] conversion. If the vendor can't come up with a reference exactly like yours, steer clear because they don't have the experience."

VanGelderen agrees, saying it is very important to see demos, but also talk to other practices.

"I have several colleagues in the medical field who opted for one system or another simply because it was more compatible with what they had," he says. "But often times, that doesn't work well if you don't have a good system. You want to be sure the system has everything to offer and the flexibility you need for your practice."

Again, just because the systems can talk to each other doesn't mean they are always the best fit, VanGelderen warns. He recalls a neighboring practice that placed compatibility over function and as a result, did not get the most from its EHR.

"You don't just want to pick something because it is an easier fit with your management system," he says. "You may lose [capabilities] on the EHR side, which is why you are making the switch in the first place."

Where do you want to go?

Marlin Moyer, program director for information technology with Pennsylvania-based Geisinger Health System, also warns small- and mid-size practices against just looking at an EHR without even considering the impact on their current practice management system.

He says going with a non-integrated system means your practice has to have the manpower in your office or the money for consultants to get those two systems talking and working together, "and that goes with significant maintenance."

At a minimum, Moyer says, get the "front end" of your management system — like scheduling, patient registration, follow-up appointments — synched to your EHR and you can live with a separate billing system.

Geisinger, which employs more than 800 physicians in 42 Pennsylvania counties, developed its own EHR in the mid-1990s to work with its in-house management system. An important part of the system's work was to adapt its operations to the EHR and not vice versa.

"Practices try to make the technology work with their current work flow versus looking at the bigger picture," Moyer says. "Look at what you want … with a combined EHR and management system. Are you looking to just get something that meets 'meaningful use' guidelines or to transform your practice, become more innovative, and take things to the next level? It's looking at where you want to be in 20 years, not 'do I want to get the incentives offered right now.'"

This article was originally posted at http://ping.fm/7lTJf

Which OSHA Regulations Require Written Plans?

If OSHA Compliance came to your door, what’s one of the first things the inspector might ask to see? The answer is . . . your Hazard Communication Plan. Is your written plan up for that kind of scrutiny? How about your other safety and health plans? Are you sure you have all the required written plans you need in place?

Not all OSHA regulations require written plans, but many do. The question is which ones? Take a look at the bulleted list of general industry regulations requiring written plans. For your convenience, we’ve put them in order from most-violated down to least-violated plans, according to the latest OSHA statistics:


*  Hazard communication – 1910.1200(e)
*  Lockout/tagout (energy control procedures)- 1910.147(c)(4)
*  Respiratory protection – 1910.134(c)(1)
*  Process safety management – 1910.119(d),(e)(1),(f)(1),(j)(1),(l)(1),(m)(4),(o)(3)
*  Personal protective equipment (hazard assessment) – 1910.132(d)
*  Bloodborne pathogens – 1910.1030(c)
*  Emergency action plans – 1910.38(b)
*  Permit-required confined spaces – 1910.146(c)(4)
*  Hazardous waste operations and emergency response – 1910.120(b)(1),(l)(1),(p)(1),(q)(1)
*  Electrical safety (assured equipment grounding conductor program and lockout/tagout procedures for work with energized parts) – 1910.304(b)(3)(ii) and 1910.333(b)(2)(i)
*  Fire prevention plans – 1910.39(b)
*  Laboratory standard (chemical hygiene plan) – 1910.1450(e)
*  Commercial diving operations (safe practices manual) – 1910.420
*  Powered platforms for building maintenance (emergency action plan) – 1910.66(e)(9)

When OSHA considers a safety or health hazard to be serious, the agency usually requires written documentation of the steps an employer takes to counteract the hazard. You can see that the above list covers some of the most serious hazards faced by workers today, including, but not limited to, chemical exposures, process explosions, fire, electrocution, and bloodborne pathogens.

As an employer, not all of these plans will necessarily be applicable to your workplace, so you’ll want to review the scope and applicability of these regulations to see if your company falls under any of them. For the applicable ones, make sure your written plans meet all the OSHA-required elements specified in the regulations.

This article was originally posted at http://ping.fm/TtYUH

Hospital chief pleads guilty in case over firing of Texas nurses

Stan Wiley, former hospital administrator of Winkler County Memorial Hospital, Kermit Texas, pleaded guilty to abuse of official capacity for his role in the firing of two nurses who had complained about a doctor to the Texas Medical Board, according to the Texas attorney general's office.

Wiley was sentenced to 30 days in the Winkler County Jail by visiting Judge Robert H. Moore III as part of a plea deal in which he has agreed to cooperate in the prosecution of three other defendants, according to a news release from the attorney general’s office, which is prosecuting the case because the Winkler County District Attorney recused himself from the proceedings.

Also being prosecuted are former Winkler County Memorial Hospital physician Dr. Rolando Arafiles, Winkler County Sheriff Robert Roberts and Winkler County Attorney Scott Tidwell. Arafiles recently was fined $5,000, publicly reprimanded and required to undergo training and oversight by the state medical board .

Wiley, Arafiles, Roberts and Tidwell were indicted in January for allegedly retaliating against two nurses who had reported Arafiles to the state medical board in 2009 for actions they believed were endangering hospital patients.

The two nurses, Anne Mitchell and Vickilyn Galle, settled with Winkler County for $750,000 in August, according to their attorneys.

This article was originally posted at http://ping.fm/xdFhr

Study: Many Physicians Eligible for Incentives but Lack EHRs

Many physicians are eligible for federal incentive payments for the meaningful use of electronic health records but lack a basic EHR system, according to a study published in the journal Health Affairs, Healthcare IT News reports.

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for incentive payments through Medicare and Medicaid. Eligibility for the incentive payment programs is based on the number of Medicare and Medicaid patients seen.

For the study, researchers used data from the 2007 and 2008 National Ambulatory Medical Care Survey to gauge EHR use by nonfederal, office-based physicians (Merrill, Healthcare IT News, 3/8).

Key Findings

Overall, researchers found that nearly 83% of office-based physicians are eligible for either the Medicare or Medicaid incentive program. They noted that:

• About 76% of physicians could qualify for the Medicare incentive program; and
• About 15% could qualify for the Medicaid incentive program.

Physicians must choose to participate in either the Medicare or the Medicaid incentive program. Because the Medicaid program likely would offer higher incentive payments, researchers assumed that most physicians eligible for the Medicaid program would pursue it (Conn, Modern Healthcare, 3/8).

The study also found that:

• 70.5% of physicians are eligible for either the Medicare or Medicaid incentives, but do not have a basic EHR system;
• 14.6% of physicians are not eligible for incentives and do not have a basic EHR;
• 12.1% of physicians are eligible for incentives and have a basic EHR; and
• 2.8% of physicians are not eligible for incentives and have a basic EHR system (Healthcare IT News, 3/8).

In addition, researchers found that eligibility for the EHR incentive programs varied by medical specialty. For example, 91% of general practice, internal medicine and family practice specialists are eligible for incentives, compared with 53% of pediatricians.

Recommendations

Researchers recommended that policymakers broaden eligibility requirements for the incentive payments to help more specialists qualify for the programs (Modern Healthcare, 3/8).

The study authors wrote that "if after the HITECH incentives have been implemented, research reveals that physicians still are not generally using EHRs and that further incentives would lead to commensurate gains in the quality and efficiency of care, there would be stronger basis for recommending changes in the incentive structure" (Healthcare IT News, 3/8).

This article was originally posted athttp://www.ihealthbeat.org/articles/2011/3/8/study-many-physicians-eligible-for-incentives-but-lack-ehrs.aspx#ixzz1G713uzI0

Accelerating the Use of Electronic Health Records in Physician Practices

North Shore Hospital System on Long Island in New York recently announced that it will pay an incentive of up to $40,000 to each physician in its network who adopts its electronic health record (EHR) — paying 50% of the cost to physicians who install an EHR that communicates with the hospital and 85% of the cost if the physician also shares de-identified data on the quality of care.1 This payment would apparently come on top of the $44,000 incentive that the American Recovery and Reinvestment Act of 2009 (ARRA) has authorized Medicare to pay each eligible health care professional who uses certified EHRs in a meaningful manner. “Meaningful use” is still being defined, but the overarching goal is to improve the population’s health through a transformed health care delivery system with the use of EHRs to improve local processes, foster quality measurement, and increase communication. North Shore’s announcement is a sign of the continuing acceleration of EHR adoption by physicians’ offices2 and hospitals.3 Support for information systems is exempted from the Stark amendment to the Omnibus Budget Reconciliation Act of 1989, which prohibits hospitals from offering physicians incentives for providing referrals or admissions. The exemption for information technology acknowledges that the likelihood of additional referrals may be part of the motivation for hospitals to form closer links with community physicians through EHRs. Another benefit to hospitals from supporting the use of EHRs by physicians who are linked to them by geography, academic appointment, or practice pattern is the enhanced ability to manage the quality and outcomes of care. For example, if financial penalties and incentives are to be imposed on the basis of rates of readmission, then the more closely aligned a hospital is with the physicians who provide its patients’ postdischarge care, the greater the benefits it will reap.

The cost–benefit calculus behind physicians’ adoption of EHRs is also changing. Financial incentives are one element. The prices of EHRs have come down as the volume of software licenses being sold has increased. A second factor is that the time investment associated with data entry, which has long represented a major obstacle to adoption, has been reduced as systems have improved in performance and become more flexible with regard to individual preferences for data entry, including free text, templated data entry, dictation, speech recognition, and freehand graphic input. System usability has also improved, thanks to competition and customers’ resistance to cumbersome products. Third, the addition to EHR systems of capabilities beyond documentation, including coding functions, the ability to create and export bills, the automated creation of consultation and patient letters, electronic prescribing, and task tracking, now translates into greater time savings for users. And a fourth factor is the increasing emphasis on quality of care, since payment for quality requires documentation of quality.

Other trends favoring EHR adoption include the emerging consensus that alignment of hospitals and physicians is necessary to provide higher-quality care and service for patients as they move among providers and traverse levels of care, as well as the recognition that information transfer is an important component of care given by multiple providers. Younger physicians — and some older ones — are more comfortable and function more efficiently and effectively in an electronic-information environment than in a world of paper records.

Some obstacles persist, of course. EHR products remain expensive to install and maintain — cost issues that should not be underestimated. The decision by North Shore to provide a financial incentive as well as the software license suggests that many physicians still do not believe that current-generation EHRs will offer a return on investment directly to physicians.

Wide dissemination of EHRs requires public trust. The sharing of patients’ information — which has been common practice for decades for the purposes of billing, treatment, and public health — has come into the public eye because of the risks associated with vastly expanded sharing and the newfound ability to easily and quickly transfer many patient records simultaneously. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) created a framework for defining privacy, breaches of privacy, and penalties. The ARRA further defined privacy breaches and increased the penalties for them. One of the challenges to setting policy in this area is that electronic privacy and its relative importance are still being defined. The capability of providing a secure electronic environment for patient data — like the capability of providing reliable data storage — is beyond the reach of most individual physician practices. Truly secure and reliable EHRs are currently feasible only for larger organizations with centrally supported technological capabilities. This may be one reason why the rate of adoption has been much higher among large practices (see graph).

Shea_F1

Rates of Adoption of Electronic Health Records According to Practice Size.

The percentage shown above each bar is the proportion of physicians who work in a practice of the given size. The green portion of each bar represents the percentage of physicians in a practice of a given size who have adopted at least basic electronic health records (EHRs), and the yellow portion represents the percentage of physicians who have not adopted EHRs.2 For each practice size, the percentage of physicians who have not adopted EHRs relative to the total number of physicians in practice is shown at the bottom. Physicians in the smallest practices account for more than 50% of those who have not yet adopted EHRs, whereas physicians in the largest practices account for only about 3%.

Exchanging information requires that EHRs share common standards. Work is ongoing at organizations for standards development and facilitation such as Health Level Seven (HL7), which have been providing practical standards for decades. The ultimate in interoperability would be a single EHR for all health care providers, but the disadvantage of this model would be a loss of competition among vendors — a factor that has presumably contributed to increased usability and lower cost. Moreover, interoperability among disparate EHRs may actually increase competition and innovation if it makes it easier for health care providers to change vendors by populating a new system with an old system’s data. Innovation is not predicated on competition alone, however. Increasing funding for EHR research and development — as opposed to implementation and evaluation — may produce evolutionary and revolutionary improvements in EHRs.

The next major step in EHR deployment is a concrete definition of the requirements — in terms of meaningful use, information sharing, and reporting of quality measures — for physicians to receive ARRA incentives. The federal Health Information Technology Policy Committee has submitted recommendations4 to the National Coordinator of Health Information Technology; the Centers for Medicare and Medicaid Services published draft rules on December 30, 2009, and this publication will be followed by a period for public comment before a final set of rules is issued. Clarity on federal incentives for physicians to adopt EHRs will allow these incentives to be aligned with those offered by state governments, provider organizations, and commercial payers. Poorly aligned incentives may have unintended consequences, such as increases in health disparities or incentives for specialty-specific silo systems.

Electronic interaction between hospitals and physicians is just the beginning. Patients are also interacting electronically with the health care system, exchanging information with providers through secure patient portals and patient-based health records. More active transactions, such as remote case management by nurses for patients with chronic diseases,5 may occur through telemedicine. Some possibilities that will be advanced by phys icians’ adoption of EHRs include the use of cell-phone technology for messaging, the capability of moving data from home monitoring devices to cell phones and upstream to EHRs, yet-to-be developed software capabilities that will allow EHRs to manage these uploaded data streams within clinical workflows, and the effective provision of out-of-office care.

Medical Transcription Software Means Greater Efficiency

For a long time medical transcription has been a growing field. It allows medical professionals to leverage their time by dictating the information that needs to be included in a patient file into some type of audio format. It is then taken by a transcriptionist for conversion to a text format. These software is making the job easier for transcriptionists and in the end it provides a service not only to medical professionals but to patients as well.

The most current medical transcription software utilizes speech recognition technology. This software can automatically take something that has been delivered in an audio file format and convert it to text. The transcriptionist will then review the text and generally also the audio file to ensure accuracy and the ability of someone to comprehend the data that has been delivered.

The improvements in the software have not only included the ability to recognize speech and convert it to text but also the methods that are used for the gathering of information. Audio files are currently being reduced in size and improved in quality so that the software can be even more effective, and the file size can be even smaller. This translates into faster download times and quicker turnaround.

Some people may believe that the advancements in medical transcription software will spell the end of the transcription field. This is simply not the case, as there will always be in need to have somebody who is versed in medical terminology to ensure that the text sent back to the patient file can be understood by anybody who reads it. Someone using this software will continue to need to make the end product something usable.

Part of the reason that there will always be a need for medical transcriptionists is that no matter how good the transcription software might be there may be errors or omissions on the part of the medical professional that is providing the information in the first place. The fact that these software can increase the output of the transcriptionist only means that the information will get back into the patient’s file quickly, that the transcriptionists will have the luxury of taking more time to ensure that quality text is sent back.

Medical transcription software will continue to allow physicians to leverage their time and provide them with more accurate and accessible patient files. The fact that the increased productivity of the transcriptionists will result in more current patient files will mean that patients receive better quality medical care. Transcription companies will be able to streamline their processes and handle greater volume for increased profitability.

For the work of a transcriptionist, these software can be a powerful aid. It is not, and may never be a replacement for the medical transcriptionist but instead a tool that allows them to be more efficient. There will always be discrepancies in the spoken word of a medical professional and the fact that many medical terms sounds so much alike will always have a need for somebody to review the final product.

Medical transcription software is changing the transcription industry, and medical transcription software that can increase productivity is a must. Keep pace by learning what a good medical transcription software program can do for your company.