Mitesh’s blog

EMRs might be able to give early warning about patients who are at risk for domestic abuse, new research suggests. A study published in BMJ (formerly the British Medical Journal) this week found that data from well-populated EMRs were able to predict future diagnoses of injuries and assaults that could indicate domestic abuse 10 to 30 months in advance.

Researchers from Harvard Medical School analyzed more than half a million de-identified electronic records that contained at least four years of data on adult patients and developed a scoring system based on risk factors for abuse, including alcoholism, ER visits for injuries, depression and psychosis. “Our model predicted abuse two years before it appeared on medical records,” lead author Ben Reis, an informatics specialist, told the Boston Globe.

Reis’ research team will expand their work to other health problems in hopes of creating a screening-support system that could be integrated into EMR systems in the future. “With increasing amounts of data becoming available, this work has the potential to bring closer the vision of predictive medicine, where vast quantities of information are used to predict individuals’ future medical risks in order to improve medical care and diagnosis,” he said, according to Health Imaging & IT.

A Map to Your Money

By Steven Kraus, DC, DIBCN, CCSP, FASA

Say it once, they hear you. Say it twice, they understand you. Say it three times, they take action. Maybe you’re aware of the philosophy that you have to communicate a message at least three times - and perhaps in different ways - in order to create an actionable response.

That’s precisely what the government is doing regarding meaningful use of electronic health records (EHR), and each time they communicate, they get more specific. So, although I’ve talked in broader terms about meaningful use, I’m following the government’s lead and breaking down what they’re saying (the how and the when) to create an actionable response from you - before it’s too late to cash in on $44,000. Doctors of chiropractic, start your engines.

Leader of the Pack

The Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology’s HIT Policy Committee is in charge of defining the parameters of EHRs qualifying for stimulus plan dollars - up to $44,000, depending on when you adopt the technology. The HIT organization recently sent me a communication that outlines the latest draft of requirements. I don’t have the space to inform you of every one of them, but I want to take this opportunity to drill it down. Because the regulations are well-defined, complying should not be difficult. Here’s a quick summary:

* Your EHR must be qualified through forthcoming certification by the Certification Commission for Health Information Technology (CCHIT).
* You will be required to employ “meaningful use” of your EHR.
* You must report on calculated measures as defined by the Center for Medicare & Medicaid Services, such as outcome and pain assessment for region, quality and intensity of pain.

Stipulations one and three are pretty straightforward, but truly, what the heck is meaningful use? What’s meaningful to you might not be meaningful to me and vice versa. But we don’t get to define that; the government does. The fact is, if you have the right software partner - one who is aware of the guidelines, automatically and continuously updating your software, and showing you how to use the technology - you should have little concern. Put the responsibility squarely on the shoulders of your vendor. If broad enough, they will shoulder the burden for you.

Another important announcement from the HIT Policy Committee (in August) indicated that the only current certifying body shall be the CCHIT, which will verify whether your EHR meets the standards required by the HIT Policy Committee for the $44,000 incentive payments. Additionally, they will likely blend some of the rules of meaningful use and reporting into certification approval so your EHR can properly assist you in achieving meaningful use.

The Green Flag

Here’s an eye opener: If you don’t have a meaningfully used qualified EHR in place during the next several months (by the end of first quarter of next year), you may miss up to $18,000 - the first year’s eligible payments for 2011. But that’s just the first year. Over the following four (through 2015), the HIT Policy Committee will continue to increase its requirements every two years. If you get on board in early 2010, not only will you be eligible for stimulus funds, but you also will have to meet fewer requirements than those who adopt the technology later.

For example, in 2013, the qualifying criteria will likely be doubled from what they were in 2011; by 2015, tripled. Scary? Maybe. But not really for those who are prepared. In the first two years of eligibility (2011 and 2012), a chiropractic physician can receive up to $30,000. It makes sense not only to start your engines, but also to step on the gas and go.

Three-Way Tie for First Place

Although you may not have guessed it, the HIT Policy Committee developed its guidelines for three-way benefit: payers, doctors and patients. Now ultimately, it’s the patients who will benefit most from your adopting - and meaningfully using - a qualified EHR, but the benefits for you are obvious, too. Your office will run more efficiently, records will be quicker to access, information will be easier to gather and report; and, then there’s the whole matter of the $44,000 incentive.

According to several estimates, the average cost for one medical doctor to introduce an electronic health record system plus hardware is $40,000 to $60,000. The cost for one doctor of chiropractic to purchase true EHR software is $12,000 (plus any hardware you may require). Take that however you’d like, but the fact of the matter is, in our profession, we are poised to not only get fully reimbursed for adopting, but also to have a little pocket change left over for all the hardware and training you would ever need.

You know there is a caveat, however. The longer you wait, the less money you’ll get, based on the incentive schedule of payments. And, if you don’t adopt at all, you’ll get financially penalized - in the form of lesser Medicare claims reimbursement. Ouch.

What’s Under the Hood?

Here’s a look at a few of the elements that make up the HIT Policy Committee’s upcoming requirements for your EHR. In order to qualify, you must do the following:

provide access to patient-specific education resources before 2011;

* provide patients with an electronic copy of their health information before 2011;
* incorporate lab-test results into your EHR before 2011;
* send preference-based reminders to patients for preventative/follow-up care before 2011;
* record clinical documentation in your EHR in 2013;
* use evidence-based order sets in 2013; and
* provide clinical decision support at point of care (reminders, alerts, etc.) in 2013.

Many of you may already be taking measures to meet these criteria. If you’re not, it’s not too late, but you’ll want to get off the starting blocks quickly.

Drive With Purpose

Let’s go back to the concept of meaningful use. When you’re looking at an EHR system, don’t buy it just to qualify for stimulus money. Make sure it’s interoperable, easy to use and allows you to report on predetermined measures as well as demonstrate meaningful use. Although meaningful use has different definitions from person to person, the HIT Policy Committee’s definition is becoming clearer. However, there is still some fine-tuning, and we should expect to see results published by December of this year.

Winning the Race

At this point, it’s a race against the clock. Although you don’t have to be the first one to reach the checkered flag (adoption, installation, implementation, understanding and meaningful use of a qualified EHR), you do have to reach it without hesitation if you want to qualify for the bigger payouts in the first two years of government incentive payments.

Should that sound overwhelming, take the pressure off. Keeping your software up-to-date in accordance with government guidelines (this includes criteria on federally defined meaningful use) means keeping reimbursements coming over the years. Otherwise, you might qualify for stimulus plan dollars now, but fail to do so through 2015. Some DCs won’t qualify at all because their EHR vendor does not have the capacity or infrastructure to meet all of the criteria for development of a true EHR. This becomes even more problematic, as other entities such as Medicare and insurers will likely require the same government certification in the coming years in order to participate in their panels of providers or to participate in reimbursement programs.

I’ve previously asked, “Why wait?” when it comes to adopting technology. Now, it’s not a question of why; that’s established - because the federal government is driving the technology (the “what”) in order to comply with changing regulations and to achieve cost savings across all avenues of health care. The “when” is also in place - by early 2010, in order to qualify for the first available annual payments totaling up to $44,000 for each doctor (the “where”) in your office. The “how” is by choosing the right EHR and support structure to assist you in being the clinic of the future rather than the clinic of the past - to call on experts and partners to help you meet the criteria smoothly, efficiently and effectively. “Who?” That’s you.

As medical practices nationwide focus on “meaningful use” of electronic health records (EHRs), the American Medical Group Association (AMGA) reports encouraging findings from a survey of AMGA member medical groups. Although few groups have yet to fully achieve all the benefits they anticipated when they began implementation, virtually all groups now have even higher expectations for the potential of health IT, as a result of their experience.

The survey was conducted in collaboration with the JHD Group, a noted healthcare management consulting and technology firm. Since more than 85 percent of AMGA member medical groups have already adopted EHRs, this survey focused on use and benefits. Exactly how are groups using EHRs, and what benefits have they achieved in patient care, practice productivity, and clinical quality? Results indicate that these groups view EHRs as essential tools and that experienced users universally expressed increased optimism regarding the value they expect to capture from their continued use of the systems. Experience with the systems has raised their expectations of the impact EHRs will have on clinical quality, patient communications, and office efficiency.

Donald W. Fisher, Ph.D., CAE, President and CEO of AMGA, commented, “It’s important to understand what techniques have worked for groups that have led the way in EHR adoption. Other practices can learn from their experience, and it’s gratifying to see that these pioneers are now even more optimistic about health IT than when they began their journey. Even the groups that adopted EHRs several years ago haven’t achieved everything they originally expected. But our members tend to be systems thinkers with a commitment to patient-centered care, and they now see even greater potential for health IT.

“Groups of all sizes believe that disciplined use of EHRs, including e prescribing and patient registries, not only enhances quality and promotes care coordination. They also see it as critical to improving efficiency and controlling costs.”

Hank Duffy, Founder and President of the JHD Group, added, “We are very pleased to partner with AMGA on this survey, and we are not surprised that the participation rate was extremely high. That’s because EHRs are so central to the efficient administration of health care today–and to achieving effective clinical integration. Efficient and effective delivery of health care is at the top of the nation’s strategic agenda, and there’s a focus on health IT, with significant stimulus funding available.

“The foundation of healthcare reform will be based not just on adoption, but meaningful use of EHRs in all delivery settings, including practices, clinics and hospitals. Medical groups participated because they want to know how others are faring and benefitting from their EHRs, and to understand how they can improve.”

Respondents included clinical leaders and executives from nearly half of AMGA’s 345 member organizations, plus 39 non-member medical groups. More than one-third of respondents have been utilizing their EHR for 5 years or longer, about one-fourth for less than 2 years.

Post-survey phone interviews with selected respondents provided an opportunity to glean in-depth insights regarding actual implementation experiences and organizational issues. Workflow redesign was a consistent theme. Adopting an EHR “is like moving from an ax to a chainsaw,” one medical director noted, saying that you can do a better job and be much more productive, but you need a different technique. Many groups reported that EHRs can enhance team-based care. “The EHR … allows for true collaborative care,” one practice CEO observed. A physician administrator said, “Our nurses have told me they like ‘being a nurse again.’”

Still, there are delicate balances to strike. The physician executive responsible for primary care in a large integrated system said, “The physician now orders everything through the system rather than telling the staff to make orders. It seems like clerical work for the physician, but actually it’s good, because the person making the order is also responsible.” Several respondents said the EHR was critical to growing the practice. Some focused on workflow efficiencies, others on the ability to recruit young physicians.

Patience and persistence are among the most critical success factors. The groups realizing the greatest benefits from their EHRs are those who introduced functionality in stages, allowing time for physicians and staff to develop proficiency in subsets of capabilities at a pace they were able to absorb. Groups with the longest experience reported greater overall satisfaction and greater success in capturing benefits.

The survey also obtained details on important technical issues such as orders/results interfaces for key diagnostic services and the use of templated documentation and patient problem lists. Integration of advanced functionality like e prescribing, patient registries, and patient portals, requires substantial investment and sustained effort, and ongoing attention to workflow and training is critical.

In active online conversations facilitated by AMGA, members of the group’s CMO Leadership Council are sharing experiences and advice on topics such as adjustments to productivity-based compensation formulas during EHR implementation. Many respondents have recalled aspects of the experience of implementation that were painful, but most agreed with one physician executive who said, “Our doctors would never go back. Happy or unhappy, they would never go back.”

The Centers for Medicare and Medicaid Services (CMS) plans to test its ability to accept selected clinical quality data directly from hospital electronic health record systems as early as July 2010.

CMS said it would seek volunteer hospitals to report stroke, blood clot and emergency department measures of care via EHR systems as part of the Reporting Hospital Quality Data for Annual Payment Update program, which provides higher Medicare payments to hospitals that report quality measures to the agency.

The agency detailed the plans in the Aug. 27 Federal Register in announcing changes to its rule for the Reporting Hospital Quality Data for Annual Payments Update. The program, a provision of 2003’s Medicare prescription drug legislation, required hospitals by 2010 to report on 42 quality measures to receive additional incentive payments.

Reporting to CMS is generally paper-based or through a mix of manual and automated systems.

Participating hospitals and their vendors will have to be able to transmit clinical EHR data that adhere to interoperability standards, such as cross document sharing, cross community access, clinical data architecture and Health Level 7 version 3, CMS said.

CMS has encouraged hospitals to adopt EHRs that can report quality data directly to a CMS data repository. Ideally, the use of EHR systems would improve the quality of care by providing physicians with pertinent clinical data as they were treating patients.

“The testing of EHR submission is an important and necessary step to establish the ability of EHRs to report clinical quality measures and the capacity of CMS to receive such data,” the agency said in the published interim rule.

The reporting of selected quality measures is also a key provision of the stimulus law. The Health IT Policy Committee, led by Dr. David Blumenthal, the national coordinator for health IT, has recommended that quality reporting be a part of the criteria providers must meet to demonstrate meaningful use of electronic health record systems, CMS said.

The stimulus law authorized Medicare and Medicaid incentive payments to providers who prove they are meaningful users of health IT starting in 2011.

Healthcare providers will have the option to use electronic health record systems to report Medicare quality and electronic prescribing measures to CMS in some of its pay-for-performance programs next year, according to an announcement by the Centers for Medicare and Medicaid Services.

The revisions are designed “to promote adoption and use of electronic health records and to provide both eligible professionals and CMS with experience on EHR-based reporting,” CMS said in the Oct. 30 announcement.

They run parallel to efforts by the Office of the National Coordinator for Health IT to set up additional incentives for providers to measure and submit data measuring the quality of their treatments.

According to CMS, providers could use EHRs to submit information for the CMS’s Physician Quality Reporting Initiative (PQRI) program, which pays an incentive to eligible physicians and other healthcare professionals who report on specific quality measures for care for Medicare patients.

Providers also will be able to report e-prescribing usage through qualified EHR systems or registries, according to CMS. Currently, providers’ reports about e-prescribing are based on patient medical claims.

Under the fee schedule rule, providers for the first time will be able to count quality data submitted through electronic health record systems toward their eligibility for a PQRI incentive payment, CMS said.

Next year, those payments will be equal to 2 percent of their total estimated allowed charges for the reporting periods, CMS said. The final rule will appear in the Nov. 25 Federal Register.

The rule also streamlines reporting of e-prescribing and focuses on the actual use of e-prescribing by the provider. In 2010, providers will use one code for e-prescribing, but they “need to report this code at least 25 times during the reporting period to be considered a successful electronic prescriber,” CMS said.

The Medicare fee schedule puts into practice provisions of the Medicare Improvement for Patients and Providers Act of 2008, which established a program for incentive payments for e-prescribing over five years. In 2012, CMS will impose penalties on providers who are not “successful e-prescribers.”

Once CMS publishes the rule, it said it will accept comments on designated provisions of the final rule until Dec. 29. The policies become effective Jan. 1, 2010.

The health care industry is trying to catch up when it comes to technology.

“Other businesses have been able to figure out how to make it work, such as the finance business. You can get money wherever you go. Health care is really behind,” said Helen Connors, executive director for Kansas University Center for Health Informatics.

Connors said it is unreasonable to ask patients to recall their medications and past history every time they see a doctor.

“Why are we asking the patient for that information? We can’t rely on the patients or providers to remember everything, so it’s got to change,” she said. “I think eventually consumers are going to drive it because they are not going to put up with it.”

The federal government has earmarked $34 billion in stimulus funds to address the issue.

“That’s a lot of money,” said Dave Garets, CEO and president of HIMSS Analytics, which collects and analyzes health care data related to information technology. “The federal government has never allocated much of any money to provide incentives to hospitals and doctors to get in gear. But boy, they did this time.”

The goal is to offer incentives for health care providers to move from paper charts to computers during the next five years, and after 2015 penalize those who don’t by, for example, providing lower reimbursements for Medicare patients.

Congress is working on the details with some preliminary regulations expected by year’s end, Garets said.

High-tech advantages

The ultimate goal is for doctors, hospitals and pharmacies to be able to access any patient’s information in a more efficient and timely manner by using electronic medical records, commonly called EMRs.

For example, if an out-of-town patient is taken to an emergency room and has allergies, an EMR would immediately alert the physician. EMRs also allow doctors to order and see lab results at the click of a button. Research has shown that EMRs significantly reduce medical errors.

For example, they can alert a doctor if he or she prescribes a medication that would not interact well with a current medication. EMR prescriptions also are more legible than their hand-written counterparts. Dr. Jon White, health information technology director of the Agency for Healthcare Research and Quality, said EMRs can help doctors manage more information better and more quickly. An EMR can contain patients’ medical information, lab work, the latest research in health, insurance information, pharmaceutical data and messages from other office workers, to name a few applications. “You can still practice without those tools, and in fact, people do every day. It just becomes more challenging to do it as time goes by,” he said.

High-cost process

White said doctors and hospitals have been dragging their heels on changing over to EMRs primarily because of costs. “They are expensive. But, we think that they will get back the money that they put into it,” he said. “Ultimately, everyone who successfully implements electronic medical records say they would never go back, but that’s a big hurdle to get over.”

The agency estimates that it costs about $30,000 for a provider that isn’t in a hospital setting.

Lawrence Memorial Hospital and Kansas University both started moving to an electronic system several years ago. LMH has spent more than $12 million just for software. KU Hospital has budgeted $52 million for the entire process.

“It’s probably one of the largest single activities that any hospital will pursue,” said Chris Hansen, chief information officer at KU Hospital. “It’s monumental, which is why there haven’t been a lot of hospitals that have gotten there.”

According to a 2008 survey in the New England Journal of Medicine, only 4 percent of physicians reported having an extensive, fully functional electronic records system and 13 percent had a basic system.

Hospitals are doing better.

Garets, of HIMSS Analytics, said 83 percent of hospitals nationwide have a basic system, but in Kansas, only 62 percent of the 132 hospitals do. More startling, he said, is that 29 percent — or 38 — of the state’s hospitals have no basic system and have no plans to purchase one, compared with 12 percent nationally.

“That is craziness,” Garets said, laughing. “It’s like what, ‘Are you living under a rock?’”

Connors, of KU’s Center for Health Informatics, is chairwoman of the state’s new e-Health Advisory Council, which is working to recommend a health information exchange plan for the state. She said some states already have a plan and are applying for federal money to begin implementing those plans. However, Kansas is applying for funding to develop a plan.

“Right now, we are fact-finding, looking at what other states have done, what do we need and what is going to be best for Kansas,” she said.

The first mission is to help health professionals get electronic systems and then figure out how they can exchange that information. Ultimately, the state’s systems will plug into a national one.

Learning curve

But, change isn’t easy.

“Almost every single one of us that is out there now grew up writing words on charts, writing notes on charts and using a pen,” White said. “Until not too long ago, we were taught that the pen was the mightiest instrument available to a doctor.”

Dr. Sabrina Prewett, 54, medical director in the LMH Emergency Department, would agree. In January, the emergency room will be one of few nationwide that is paperless.

“It was very challenging,” Prewett said of the five-year process. She worked alongside IT personnel to implement the software and then helped train staff.

“That’s why I became the one that helped develop it because if I can do it — anybody can do it,” she said, laughing.

But, Prewett said it has been worthwhile. It is safer, quicker and the information is legible.

“The impetus is for patient safety,” she said.

With billions of dollars for electronic health record (EHR) technology purchases hanging in the balance, psychiatrists need to be paying attention to the Department of Health and Human Services (HHS) deliberations on the definition of “meaningful use.” HHS Secretary Kathleen Sebelius is supposed to set an interim definition in a few months. This is important to all office-based physicians because it will set the requirements they will have to meet for proving they are making meaningful use of EHR software and hardware they previously purchased. If they can make the case, starting in 2011, they would qualify for federal grants to partially compensate them for those previous software and hardware purchases.

Those grants are available for 5 years, and if obtained starting in 2011, they could amount to as much as $64,000 per practice for psychiatrists whose patient mix is at least 30% Medicaid recipients. That figure falls to $44,000 for physicians who cannot meet the Medicaid percentage and who see Medicare patients, with no specific percentage of the latter being designated.

There is also a penalty for physicians who do not meet the meaningful use definition. It comes into play after 2016; the Medicare fee schedule for professional services is reduced by 1% in 2015, by 2% in 2016, by 3% for 2017, and by between 3% to 5% in subsequent years.

The grants were authorized by the American Recovery and Reinvestment Act (ARRA)—which is the stimulus bill Congress passed last winter. Sebelius will set interim requirements based on recommendations from 2 new advisory committees that were established by the ARRA: a health information technology policy and a standards committee. The meaningful use requirements will be different, in part, for office-based physicians and hospitals, but they will have escalating requirements in 2011, 2013, and 2015.

The ARRA gave HHS some guidelines as to what the meaningful use definition should include. The overriding requirement is that a physician be able to exchange certain categories of patient data electronically with other providers and to report quality measures to the HHS and Centers for Medicare and Medicaid Services (CMS).

Complying with a meaningful use definition may have some general and specific challenges for psychiatrists. To begin with, it looks likely that all physicians would have to use computer physician order entry (CPOE) for all patients. In 2011, CPOE would have to perform certain basic tasks. For example, it would need to be able to implement drug-drug, drug-allergy, drug-formulary checks; maintain an up-to-date problem list of current and active diagnoses; and generate and transmit permissible prescriptions electronically. In addition, certain quality measures would have to be reported to the CMS. Those would include, on the basis of the policy committee’s final recommendations, percentages of:

* Diabetic patients whose glycosylated hemoglobin levels are under control

* Hypertensive patients whose blood pressure is under control

* Patients with dyslipidemia whose LDL levels are under control

* Smokers to whom smoking cessation counseling and other measures are offered

At meetings with HHS officials this summer, and in comments, the American Psychiatric Association (APA) pointed out that the elements of the meaningful use definition were shaped for generalists—not specialists such as psychiatrists, for whom some of the requirements might pose serious adherence problems. For example, about the reporting of quality measures, none of those endorsed by the policy committee included mental illnesses. “Additionally, there are some quality measures which could be incorporated into primary care and some specialty settings which were not included on the committee’s proposal, such as those pertaining to major depressive disorder,” said James Scully Jr, MD, medical director and chief executive officer of the APA in a letter to HHS this summer.

It is not that quality measures for psychiatrists do not exist. They do. The New York State Office of Mental Health has developed a decision support and quality improvement system for what in that state are called “Article 31” hospitals, which are for psychiatric patients. The Psychiatric Services and Clinical Knowledge Enhancement System affects only psychiatrists at those hospitals.

According to Hao Wang, PhD, deputy commissioner, chief information officer, office of mental health, state of New York, the state weeds through Medicaid data for indications that psychiatrists at Article 31 hospitals may be outside the boundaries of good practice in 2 areas in which the state has developed quality indicators: polypharmacy and cardiometabolic syndrome indicators. Psychiatrists who appear to need some help in those 2 areas are required to report to the state office of mental health to ensure they are improving their stats. Wang suggests that those 2 quality indicators have utility beyond psychiatrists and could be used by HHS if it wanted to make its quality measures reporting definition more relevant to psychiatric practice.

Wang stated what everyone already knows: that psychiatrists—and physicians more broadly—have not exactly flocked to EHRs. But psychiatrists may have a particular disincentive, Wang explained, “because they can’t find a good behavioral health care product.” He added that hospitals are more concerned about patients with physical conditions, because they generate more revenue. And EHR vendors have responded to that by producing systems that have little utility for physicians who see high percentages of patients with mental health conditions.

When Dr. Henry Plummer developed the concept of the “unit record” nearly 100 years ago, his idea was to place all of a patient’s records in a single file that traveled with the patient and could be stored in a central repository. His concept of medical care continuity quickly became the standard for medical record keeping worldwide.

I wonder what Dr. Plummer would make of today’s adoption of electronic medical records (EMR) by U.S. health care providers? After all, the concept is basically the same, just expanded to take advantage of today’s capacious electronic storage and retrieval methods.

Even the federal government has gotten into the act, defining a complete EMR system as containing four basic functions: computerized orders for prescriptions, computerized orders for tests, reporting of test results and physician notes.

In a perfect world, an EMR system tracks a patient’s entire health and medical history in a computerized, electronic format that is accessible wherever the patient is. These records are more easily retrievable than manual systems, and can make a patient’s navigation through the health care system much safer and more efficient.

But it’s hardly a perfect world. Even though the American Recovery and Reinvestment Act of 2009 has made the promotion of a national, interoperable health information system a priority, EMRs have not been adopted nearly as quickly in the U.S. as one might expect. Issues, including the high cost, lack of standardization, security and privacy have stood in the way of implementation.

A recent study from the New England Journal of Medicine points out that hospital EMR adoption rates are still abysmal, concluding that only about 8 percent of the 3,000 hospitals studied by researchers used even a basic EMR in a single unit, which included nurse or physician notes. And only 1.5 percent of non-federal U.S. facilities use a comprehensive EMR.

This seems counter-intuitive, especially when one considers the numerous advantages of EMRs, starting with efficiency. Information stored in an electronic format can be retrieved easily at the touch of a button or the click of a mouse. Search and retrieval times are a fraction of what they would be in manual systems. At the very least, this saves time by eliminating the need to complete the old manual medical history forms at a new physician’s office. This also reduces the chance for error when a patient forgets to list certain prescribed medications or supplements. It’s all there in one easily accessible record.

But efficiency isn’t the only benefit. For patients, access to good care becomes easier and safer when records can easily be shared. Important information — such as blood type, prescribed drugs, medical conditions and other medical history aspects — can be accounted for much more quickly. Doctors and other medical personnel can retrieve these medical records from anywhere using handheld devices like an iPhone, which allows them to continue treatment no matter where they are. And, in case of emergency, information can be shared with emergency room physicians who can then order diagnostic tests and share results online.

Another benefit is safety. It’s estimated that nearly 98,000 patients die annually by preventable medical errors of some type. It’s entirely possible that these numbers could be greatly reduced by a comprehensive medical history information generated through an EMR system.

The Mayo Clinic is setting the standard for EMR implementation. With one of the largest such systems in the world, all medical documentation relating to a patient’s care – physician notes, laboratory reports, surgical dictations, copies of correspondence, appointment schedules, X-rays, ultrasounds, CT and MRI scans, echocardiograms – is instantly available to caregivers via more than 16,000 computer terminals on Mayo’s three campuses. The efficiencies created by simply typing a few identifying keystrokes to retrieve a patient’s record saves a doctor’s practice or a hospital many thousands of dollars. That’s even taking the cost of the electronic system into account.

Even the federal government thinks electronic record keeping is important. Veterans’ hospitals across the country share an electronic system called VistA, which shares records of veterans in its health system. Should a patient find him or herself in a VA hospital, even away from home, the hospital will have the same access to his or her records that the hometown hospital does.

It’s interesting to note that a recent report from PricewaterhouseCoopers’ Health Research Institute contends that Medicaid penalties might do more to boost EMR adoption than incentives, like available funding to physicians to purchase and implement EMRs. According to the report, “Provisions in the stimulus law that call for cuts in Medicare reimbursements, rather than a multibillion-dollar incentive program, will do more to push the adoption of electronic medical records among hospitals and doctor practices by 2015.”

However EMR adoption happens, it’s critical that it happen sooner rather than later. The health care industry’s ability to provide efficient, coordinated, safe and high-quality care is only enhanced by the rapid availability of accurate data. And with the availability of solid data, researchers can also use the EMR to analyze large amounts of patient information more efficiently, speeding the application of new research findings and vastly improving patient care in the future.

Just as Dr. Plummer saw beyond the information exchange limitations of his era, we can see the benefits of using the latest technologies for the practice of continuity in 21st century medicine. But the goal, just as it was in Dr. Plummer’s time, or even going as far back as Hippocrates and his famous oath, is still nobly laudable: “First, do no harm.”

Dr. Scott Ransom is president and professor in obstetrics, gynecology, health management and policy at the University of North Texas Health Science Center at Fort Worth.

Special to the Mercury News

Patients in the Kaiser Permanente San Jose Hospital are seeing something new when a physician or nurse visits their rooms. The doctors and nurses themselves aren’t different; they continue to provide their patients with superior care and service.

But a piece of equipment they bring with them — a wheeled cart with a computer screen on top — is a significant difference, and it’s an example of what will help dramatically improve health care in America.

The cart-borne computer is wirelessly connected to a huge database containing the medical history of our members, as well as the latest recommended treatments for a wide range of medical conditions. The database contains all outpatient and inpatient visit information, diagnostic images such as X-rays and mammograms, allergies, specialists’ notes, lab tests and prescriptions. And it is all part of KP HealthConnect, the largest nongovernmental electronic medical record (EMR) system in the United States.

Electronic medical records are a cornerstone of President Barack Obama’s health reform effort, and as part of his effort to stimulate the economy, he has dedicated some $19 billion to make EMRs a national reality.

Why? Electronic medical records improve the quality of care. A fully functional EMR system gives physicians, nurses and technicians a patient’s comprehensive medical history at the point of care, whether it’s in the doctor’s office, the emergency room or in a skilled nursing facility. It is also remotely accessible for specialists and others who are on call, allowing them to make informed decisions that expedite patient care.

EMRs have the potential to increase efficiency and contain costs by reducing duplication and improving patient safety, and they do this by harnessing the incredible power of computers — their ability to calculate, to network, to automatically check facts and to provide targeted research results — and applying that power to medical care.

In health care systems with fully implemented electronic medical records, physicians and nurses no longer need to spend valuable time looking through several files for paper records that are often incomplete.

Now, for example, emergency department physicians with a fully functional EMR system can see a patient’s previous hospitalizations, medications and diagnoses when that patient shows up complaining of chest pains. That means treatment can begin more quickly and success is more likely.

Medication is safer, too: Prescriptions written by physicians using the EMR system are spell-checked and legible, and the computer automatically combs the patient’s history for potentially dangerous drug interactions and alerts the doctor.

In the hospital, medications are bar-coded and scanned at bedside to help ensure the right patient is getting the right drug in the right dose at the right time.

Of course, EMRs should not be a one-way street. In integrated health care systems, patients can use their home computers to increase convenience by making appointments online, ordering prescription refills that are delivered to their home, viewing their lab results through secure Web pages, and e-mailing their physicians — all at no additional cost.

Last year, thanks to these online tools tied to EMRs, Kaiser Permanente members had 6 million e-visits without using a gallon of gas.

Notes jotted on paper and placed in multiple files where doctors rarely see them are a remnant of a fragmented, inefficient model of medical care. In the 21st century, Americans expect — and deserve — more.

Dr. Raj Bhandari is physician-in-chief and Terry L. Austen is senior vice president and area manager for Kaiser Permanente San Jose Medical Center. They wrote this article for the Mercury News

Medical treatment of Business has changed significantly in recent years. It presents many administrative difficulties during the preparation of the insurance policy and procedures dealing with complicated claim forms. To avoid these complications, doctors seek help from outside. Hire and advise their representatives, attend seminars insurance company and provide them with periodic financial reports this process is known as medical billing outsourcing.

An efficient and precise medical billing service is of prime importance for the smooth functioning of any medical service provider. A comprehensive medical billing service will in turn secure speedy reimbursements for clients. Medical billing is the process of submitting and following up on claims to insurance companies in order to receive payment. It is useful for medical healthcare providers. Medical billing services also supports on-demand invoicing, batch claims processing and interactive electronic claims Submission and remission.

Medical professionals and medical companies, whether they are Small companies or big organizations, are benefited from medical billing services. This billing can be considered as a communication between Medicare providers and insurance companies.

One can get following benefits by using medical billing services:

Medical Data Entry – patient demographics, details like place date type of service, and referring physician, CPT and ICD Codes, and Modifiers are keyed into the billing system

Medical Claims Billing – electronic and paper

Appeals – make appeals for denials and incorrect payments

Payment Posting and Reconciliation Medical Claims Management Collections Management

Accessibility – 24 hours a day, 7 days a week

Medical billing business involves many other important services such as handling all patient billing inquiries, submitting reports to the doctor, posting payments, mailing patient’s statements and following-up all unpaid insurance claims.

Medical billing services assist physicians in saving money through payroll Generation, equipment reduction, eliminating shipping costs, and support software. Outsourcing to a Professional medical billing company is free from management problems. A number of leading outsourcing medical billing services companies offer medical billing assistance for medical billing needs. The company uses the database free of compensation, and established practice, and other Online.