CRISP health exchange goes live in Maryland

Posted on October 21, 2010 by Steve Fox and Vadim Schick

The Chesapeake Regional Information System for our Patients (CRISP) went live this month connecting three hospitals, three radiology centers and two private companies in Montgomery County, Maryland during the initial stage of this health data exchange.  According to The Washington Post, all 48 hospitals in Maryland plan to join CRISP by 2012. The exchange will allow hospitals, physician practices, hospitals, clinics, labs, radiology centers, and other health care institutions to share information electronically.

Via the Post:

The Maryland Health Care Commission designated CRISP to oversee the state's effort to create a secure exchange for electronic health information within the state. More than 300 such exchanges are in development throughout the United States as part of a larger effort to develop national exchange standards and best practices. More than 20 organizations were involved in CRISP's development, including doctors, insurance companies, hospitals and consumer advocates, who helped structure the network in a way that will protect patient privacy in accordance with applicable law.

The funding for the network came from a patchwork of state and federal grants. In 2009, Maryland allocated $10 million from a fund that insurance companies pay into to reimburse hospitals for the network's start-up costs. The state health-care commission received an additional $9.3 million in federal stimulus money that covered the cost of the exchange's rollout. In April, a division of the U.S. Department of Health and Human Services that promotes the adoption of information technology gave CRISP $5.5 million to help 1,000 primary care physicians use electronic health records more effectively.

 

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The electronic exchange is not a repository of information, but a secure method for sharing up-to-date hospital discharge summaries, radiology reports and lab results. The idea is that during medical emergencies, physicians will be able to access the health histories of those under their care. It will also help specialists and primary care providers compile complete medical histories known as continuity-of-care documents.

"Md. health information exchange begins operation," Washington Post (October 18, 2010).

"Maryland health IT exchange launches," Baltimore Business Journal (October 12, 2010).

 
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Advisory panel submits recommendations to HIT Policy Committee regarding health data exchanges

Posted on August 20, 2010 by Steve Fox and Vadim Schick

On August 19, 2010, the "tiger team" advisory panel submitted a letter to the HIT Policy Committee, established pursuant to the HITECH Act, proposing new safeguards for personally identifiable information on health information exchanges.  Via Bloomberg Business Week:

The recommendations were developed in response to a specific set of privacy-related questions raised by the Office of the National Coordinator for Health Information Technology. They touch upon and clarify topics such as patient consent and the use of third-party service providers in the exchange of personally identifiable health information.

<...> One of the bigger recommendations relates to patient consent. The direct exchange of electronic patient data between health providers for treatment purposes does not require any additional patient consent, the panel noted. The same rules that apply to paper or faxed exchanges of health information should apply in the electronic realm as well.

HIT Policy Committee will have to review and approve the proposed safeguards.  You can read more about the proposed standards after the jump, and can read the letter in full by clicking here.

 

Bloomberg Business Week described some of the proposed safeguards:

However, any data exchange that involves a third-party does require specific and "meaningful" patient consent, the letter noted. Any such consent also needs to be transparently and easily revocable by the patient at any time, the panel said.

The letter also recommended further exploration of technologies that allow individuals to exercise more granular control over the data for instance permitting the exchange of certain kinds of health data, but not all.

Third-party service organizations should also not be allowed to collect, use or share personal health data for any purposes other what's specified in their service agreements, the panel recommended.

Third parties should also be required to retain personal health data only for as long as it is reasonably needed and should then be required to destroy the data, the panel said.

All third parties having access to patient health information also need to comply with the privacy and security requirements of HIPAA.

"Panel drafts privacy recommendations for health data exchanges," Bloomberg Business Week (August 19, 2010).
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Wall Street Journal on EMRs and HIEs

Posted on April 22, 2010 by Steve Fox and Vadim Schick

On April 13, 2010, the Wall Street Journal published two fascinating articles on health information technology issues.  In "Can Technology Cure Health Health Care?" author Jacob Goldstein examined the complexities and major risks of adopting electronic medical records.  Goldstein also suggested a few high-level policies necessary to combat such risks, including designing the software with patient care in mind (rather than focusing on billing and other administrative tasks); customizing the software to fit the unique needs of one's organization; and taking the time to implement the EMR in a carefully crafted, staged manner. 

The last recommendation seems to be indeed crucial to a successful EMR implementation, but it will likely put many healthcare providers trying to capitalize on HITECH incentive payments in a peculiar situation.  Such providers must carefully balance their need to achieve "meaningful use" in a short time frame, while preventing as many disruptions to patient care as possible.

In "Breaking Down the Barriers," Laura Landro examined the state of regional health organizations (RHIOs) and health information exchanges (HIEs). While RHIO/HIE's are still rare, the number of such electronic patient data exchanges grows every day.  In fact, according to the Journal, the number of RHIO/HIE's increased by 57% since last year.  Such exchanges are also likely to benefit from HITECH Act funding distributed by HHS. 

There is an interesting nexus between these two articles:  interoperability and exchange.  A successful widespread adoption of EMR technology seems to depend upon different EMRs talking to each other, and different - including competing - healthcare providers exchanging patient information.  While EMRs may only marginally improve patient care in each individual hospital, they are likely to have a far greater impact as part of a nationwide health information exchange.

"Can Technology Cure Health Care?" Wall Street Journal (April 13, 2010).

"Breaking Down the Barriers," Wall Street Journal (April 13, 2010).

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Obama administration announces $975M in HIT grants

Posted on February 16, 2010 by Steve Fox and Vadim Schick

HHS Secretary Kathleen Sebelius, appearing with Labor Secretary Hilda Solis, announced the Obama administration will release almost $1 billion set aside in the stimulus bill in order to aid implementation of health information technology.

Secretary Sebelius announced $386 million in grants to advance widespread adoption of EHRs at the state level, including for health information exchanges (HIEs).  HHS also awarded $375 million to 32 nonprofits for Regional Extension Centers which assist providers in updating their medical record systems and train workers on such new technologies.

Secretary Solis announced around $225 million to support 55 job-training programs in 30 states which is expected to train around 15,000 people in the health records technology.

The Obama administration expects to help more than 100,000 health-care providers set up electronic medical records for their patients by 2014.

According to the Wall Street Journal's Washington Wire blog:

Patient privacy is the top priority,” Health and Human Services Secretary Kathleen Sebelius said. The agency is about to appoint a chief privacy officer, and the government has strengthen [sic] the penalties for negligent security breaches for companies so they reach up to $1 million.

"Electronic Medical Records get a boost," Washington Wire (February 12, 2010).

"Obama awards money for electronic medical records," Associated Press (February 13, 2010).
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Study: US lags behind other nations in HIT use

Posted on November 9, 2009 by Steve Fox and Vadim Schick

A study conducted by the Commonwealth Fund, published in this month's issue of Health Affairs, found that physicians in the United States significantly lag behind their colleagues in Western Europe, Australia and New Zealand in several categories, including rates of adoptions of electronic medical records.  This study of more than 10,000 primary care physicians in 11 countries found that only 46% of U.S. doctors use electronic medical records, compared with almost universal EMR use among doctors in Australia (95%), Italy (94%), the Netherlands (99%), New Zealand (97%), Norway (97%), Sweden (94%), and the United Kingdom (96%).  Among other HIT-related findings, the study concluded that:

<...> among the seven countries with near-universal EMRs, the majority of physicians reported electronic access to lab results, yet fewer than half of Dutch, Norwegian, and U.K. doctors can order tests electronically. Across countries, most doctors with EMRs reported electronic clinical notes, routine electronic prescribing, and computerized alerts about potential problems with drug doses or interactions (except in Norway). Answers varied for other functions.

Decision support appears generally less well developed. Computerized reminders for treatment guidelines, tracking laboratory tests, and prompts to provide patients with test results were the least frequently reported, including in countries with multifunctional capacity. Notably, the seven countries with near-universal EMRs have succeeded in spreading multifunctional capacity to smaller as well as larger practices. Their national policies and standards have supported spread of multifunctional capacity. In contrast, U.S. multifunctional capacity remains concentrated in larger practices. Half of U.S. practices with high-function capacity were associated with integrated care systems such as Kaiser.

However, the study also found a high rate of increase of EMR use among U.S. doctors, rising from 28% to 46% from 2006 to 2009.  At the same time, only 26% of U.S. physicians were reported to have "advance electronic information capacity" (i.e., reporting use of more 9 - out of 14 - clinical IT functions such as e-prescribing and ordering tests, Rx alerts, clinical notes, and others).

The situation seems even more dire in Canada, where only 37% of physicians use EMRs, and only 14% have "advance electronic information capacity."

On the access, cost and quality of care issues, the Commonwealth Fund study found that:

More than half (58%) of U.S. physicians—by far the most of any country surveyed—said their patients often have difficulty paying for medications and care. Half of U.S. doctors spend substantial time dealing with the restrictions insurance companies place on patients’ care.

Only 29 percent of U.S. physicians said their practice had arrangements for getting patients after-hours care—so they could avoid visiting a hospital emergency room. Nearly all Dutch, New Zealand, and U.K. doctors said their practices had arrangements for after-hours care.

Twenty-eight percent of U.S. physicians reported their patients often face long waits to see a specialist, one of the lowest rates in the survey. Three-quarters of Canadian and Italian physicians reported long waits.

While all the countries surveyed use financial incentives to improve the quality of care, primary care physicians in the U.S. are among the least likely to be offered such rewards; only one-third reported receiving financial incentives. Rates were also low in Sweden (10%) and Norway (35%), compared with large majorities of doctors in the U.K. (89%), the Netherlands (81%), New Zealand (80%), Italy (70%), and Australia (65%).

Patients with chronic illness require substantial time with physicians, education about their illness, and coaching about treatment, diet, and medication regimens. Care teams composed of clinicians and nurses have been shown to be effective in providing care to people with chronic conditions and in improving outcomes. The use of such teams is widespread in Sweden (98%), the U.K. (98%), the Netherlands (91%), Australia (88%), New Zealand (88%), Germany (73%), and Norway (73%). It is less prevalent in the U.S. (59%) and Canada (52%), with France (11%) standing out on the low end.

You can find the Commonwealth Fund study here, and please be sure to take a look at the accompanying graphs here.

"A Survey Of Primary Care Physicians In Eleven Countries, 2009: Perspectives On Care, Costs, And Experiences," Health Affairs (November 5, 2009).
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In the news: Blumenthal on "meaningful use," new health information management jobs, etc.

Posted on October 12, 2009 by Steve Fox and Vadim Schick

Dr. David Blumenthal, the National Coordinator for Health IT, gave an update on the Obama Administration's efforts to define "meaningful use" and to further adoption of EHRs nationwide.  Blumenthal did not reveal any new details regarding the upcoming regulations on meaningful use, reminding his audience of the upcoming "notice of proposed rulemaking in late 2009 with a public comment period in early 2010."

Meanwhile, according to Government HealthIT, the next meeting of the HIT Policy Committee, which will meet on October 27 and 28, will focus on how to map meaningful use objectives to medical specialties as well as small practices and hospitals.

Speaking at the 81st annual American Health Information Management Association convention in Grapevine, Texas, Dr. Blumenthal stated that he expects 50,000 health information management (HIM) jobs to be created as the U.S. moves from the paper-based to the digital system of healthcare.  AHIMA's CEO, Linda Kloss, noted that the interest in HIM careers has "exploded" during the last year.

Much more news after the jump.
  

 

  • American Medical News reported on the staffing changes for healthcare organizations necessitated by the nationwide switch to electronic health records. According to the article:

There are some assumptions about staff changes that are easy to make, experts say. Any job that was strictly paper-based prior to implementation, for example, will need to be overhauled or eliminated.

Other changes are not so easy to predict, and could depend on how willing your employees are to adapt and learn new skills.

  • According to Crain's Detroit Business, urban hospitals lag behind rural hospitals and physicians' practices in joining health information exchanges (HIE's) because such HIE's pose a combination of monetary, strategic, and technological challenges.
     
  • Washington Post reported on a pilot project in Ohio aimed at streamlining the cost of healthcare administration.  The state's eight major health insurers - representing 91% of the patients - have signed on to participate in this initiative.  The Post described the program as:

a single Web portal [that the participants] believe will reduce duplication, miscommunication, and confusion between doctors and insurance companies. That will mean quicker office and hospital service, more time for patient care, and, ultimately, cost savings, participants said.

  • Healthcare IT News reported that -- according to e-prescribing company Surescripts -- "the number of physicians using electronic prescribing will have more than doubled in 2009 and that "more than 140,000 – 23 percent of all office-based physicians, nurse practitioners and physician assistants in the United States – are e-prescribing today."
     
  • USA Today reported on the various hardships and setbacks to widespread implementation of EHRs.  The article ended on a somewhat hopeful note, with a great quote by Stephanie Reel, the CIO of Johns Hopkins University:

We've been saying that we're five years away from electronic medical records for the past 40 years ... Now maybe we really are only five years away.

"Meaningful" Progress Toward Electronic Health Information Exchange, David Blumenthal, MD (October 1, 2009).

"Specialists, primary care providers differ in meaningful use," Government HealthIT (October 6, 2009).

"Health IT effort to create thousands of new jobs, says Blumenthal," Healthcare IT News (October 6, 2009).

"How electronic medical records affect staffing," Amednews.com (October 5, 2009).

"Slow with the flow: Hospitals lag in joining health info exchanges," Crain's Detroit Business (October 4, 2009).

"Paperwork angst drives Ohio doctor, insurer effort," The Washington Post (October 5, 2009).

"More than 140,000 physicians on growing list of e-prescribers," Healthcare IT News (October 5, 2009).

"High-tech 'scribes' help transfer medical records into electronic form, " USA Today (October 7, 2009).
 


 

 
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Maryland awards $10M for CRISP, a health IT exchange

Posted on August 13, 2009 by Steve Fox and Vadim Schick

The State of Maryland awarded $10 million to support the Chesapeake Regional Information System for our Patients (CRISP), a newly created health information technology exchange organization.  Some of  the biggest players in Maryland's health care industry, including Johns Hopkins, MedStar and the University of Maryland Medical System are going to participate in CRISP. 

According to the Baltimore Business Journal:

Funding will come from the hospitals that will receive a slight increase in the prices they can charge patients and federal stimulus money.

The news comes as health care officials and lawmakers champion electronic medical records as a way of reducing health care costs. They argue that electronic medical records will reduce costs by hopefully eliminating unnecessary tests and reducing errors by allowing doctors to quickly access patients’ medical records.

State health insurers plan to provide incentives to hospitals, which include a lump sum payment or increased reimbursement, to adopt electronic health records.

"Maryland awards $10M for health IT exchange," Baltimore Business Journal (August 5, 2009).

 

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Study finds dramatic increase in operational HIEs

Posted on July 22, 2009 by Steve Fox and Vadim Schick

eHealth Initiative, an affiliation of organizations devoted to improving the quality, safety and efficiency of healthcare through information technology, released its 2009 survey on Health Information Exchange (HIE), titled "Migrating Toward Meaningful Use: The State of Health Information Exchange."

The survey found many positive trends in the expansion of HIE's in the United States, including:

  • the number of operational HIE initiatives (e.g., exchanges transmitting live data among stakeholders) has increased by nearly 40% since 2008;
  • positive impact on physician practices by improving efficiency without disrupting care (e.g., quicker access to test results, reduced staff time spent searching for results and performing other administrative functions);
  • reduction in costs associated with, inter alia, reduced staff time spent on searching for test results and performing other clerical functions, as well as reduction in duplicate tests and medical errors; and
  • steadily growing number of initiatives are exchanging data, with almost universal increases in the type of data exchanged.

The survey also found that "initiatives identified 'addressing privacy and confidentiality issues' as the most pressing challenge they face, surpassing 'developing a sustainable business model'."

eHealth Initiative's press release, which includes a more detailed summary of the survey, can be found here.

"Migrating Toward Meaningful Use: The State of Health Information Exchange," eHealth Initiative Study (July 22, 2009).

 

 

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