David Blumenthal: Health IT’s billion-dollar man. October 30, 2009
Posted by gonzalezloumiet in Blumenthal, NHIN.Tags: Blumenthal, NHIN
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November/December 2009
By David Talbot
By one estimate, only 17 percent of U.S. doctors use electronic records. But the federal government has ambitious plans to create a network in which patient information is shared electronically among medical institutions. As National Coördinator for Health Information Technology, David Blumenthal is writing the rules under which the federal government will spend more than $21 billion in stimulus funds to get the job done (see "Prescription: Networking"). Blumenthal, previously a practicing physician at Massachusetts General Hospital in Boston, spoke with David Talbot, Technology Review‘s chief correspondent.
TR: How long will it take to create a national health-information network?
David Blumenthal: The president has said that everyone will have an electronic health record by 2014. That is the goal we are working toward right now. We are trying to make the network available as fast as we can.
TR: Can health IT reduce the skyrocketing U.S. health-care costs?
DB: The Congressional Budget Office projected dollar savings from the [stimulus] legislation at about $12 billion over 10 years. I expect that the actual savings will far exceed that amount.
TR: How do we get around the potential problems with electronic systems–such as overwhelming physicians with data or actually causing medical errors?
DB: Electronic health records and other forms of health IT can certainly be improved, and there are examples of bad implementation and other problems. I still think that on the whole, across the country we’d be better off with universal availability of electronic health records. We’d have fewer errors, fewer missed diagnoses, less duplication of tests, and fewer adverse drug events.
TR: If health-IT systems reduce such errors and lead to fewer needless procedures, why haven’t the insurance companies stampeded to get them installed?
DB: The insurance companies have been able to pass along the costs of waste in our health-care system to their clients.
TR: You are setting the definitions of "meaningful use"–the criteria hospitals and physicians must meet to collect their cash incentives for installing IT. What will be in these definitions?
DB: I can’t speak to the specific criteria at this point. We are in the middle of writing the regulations, and the initial release is anticipated in December.
TR: You’re giving out $564 million for states to form health-information exchanges among medical providers. Why don’t even the most electronically progressive hospitals–including your own Mass General–already share their data?
DB: There has never been a business case for health-information exchange. As a matter of fact, there has been a negative case: if you give away your information, you may lose it. You may lose the patient.
TR: You mean lose him or her to a competing hospital.
DB: That’s right.
TR: The Institute of Medicine has said that between 44,000 and 98,000 Americans die every year from medical errors of various kinds, and that IT can help. Are patients dying because of a lack of information exchange?
DB: Patients are suffering because necessary information is not available at the point of care. With robust health-information exchange, there can be improved quality of care and improved care coördination. Today, the average 65-year-old with five chronic conditions has 14 doctors and is on multiple medications.
TR: Do any technological barriers, such as conflicting standards, stand in the way of these hospital exchanges? Would we need to give everyone a national health-care ID to properly merge or reconcile their records?
DB: No. I think we have almost all the standards we need, but we have to get people to use them. And we can do this without a single health-care ID.
TR: Why not a single health-care ID? Wouldn’t that make things simpler?
DB: We have a big job ahead of us to achieve widespread adoption and meaningful use of electronic records. We can get to where we want to go without a single health-care ID.
TR: Was the changeover to electronic records difficult for you personally?
DB: At some time over the last 10 years, I was basically required to use electronic records. I learned it gradually over time. As I got more capable, I became increasingly convinced of its value in clinical care. It was making me a better physician.
TR: How, for example?
DB: A couple of years ago, I saw a patient with a urinary-tract infection. I entered the order for Bactrim [a sulfa drug] on my computerized physician-order-entry system–and a warning came up saying this patient is allergic to sulfa. I am sure in the paper record there was a record of that, but it’s often easy to overlook things in a voluminous paper record. That kind of gain, repeated hundreds of thousands of times across the country, can result in real improvements in care.
Copyright Technology Review 2009.
New Mexico Health Information Collaborative (NMHIC) Appointed as State’s Official Health Information Exchange (HIE) October 29, 2009
Posted by gonzalezloumiet in Nationwide Health Information Network.Tags: NHIN
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Tue Oct 27, 2009 9:02am EDT
New Mexico Health Information Collaborative (NMHIC) Appointed as State's
Official Health Information Exchange (HIE)
MedPlus(R) Provides Technology Solution to Enable Meaningful Data Sharing for
Improved Health Outcomes
ALBUQUERQUE, N.M., Oct. 27 /PRNewswire-FirstCall/ -- Maggie Gunter, PhD,
president of the New Mexico Health Information Collaborative (NMHIC),
announced today that the organization has been appointed as the state's
official health information exchange (HIE) by New Mexico Governor Bill
Richardson.
NMHIC will create the health information exchange infrastructure to connect
New Mexico's health care providers through a contract with its technology
partner, MedPlus, the healthcare information technology subsidiary of Quest
Diagnostics Incorporated (NYSE: DGX). MedPlus will connect New Mexico's health
care providers to a centralized network containing critical electronic patient
information, using its Centergy(TM) suite of integrated technology solutions.
State-wide HIEs are critical for building a Nationwide Health Information
Network (NHIN). To ensure this continuity of care, NMHIC will enable health
care information to be linked electronically across organizations, both
regionally and nationally, and to move clinical information among disparate
health care information systems, including physician offices. MedPlus has
connected some of the nation's largest HIEs, including one third of the
original NHIN demonstration projects, one of which is NMHIC.
"New Mexico is a leader in the use of health information technology, and HIE
is key to our success," said Governor Bill Richardson. "The New Mexico Health
Information Collaborative has already built a solid foundation during the last
several years, thus making it an ideal choice to help move us closer to the
goal of quality health care for all at affordable prices."
NMHIC partner health care providers will have access to a centralized network
of important information such as lab results, patient record summaries,
radiology images, discharge summaries, medication history and claims data.
Several leading New Mexico health care providers are already participating in
NMHIC, including: Presbyterian Healthcare Services, TriCore Reference
Laboratory, Holy Cross Hospital and Albuquerque Ambulance.
"It is an honor that NMHIC has been selected to serve as the state's HIE and
to help drive critical data exchange," said Maggie Gunter, PhD, president of
NMHIC. "Our goal is to enable New Mexico health care organizations to deliver
more efficient and timely patient care by providing streamlined access to
vital information related to different aspects of the care process. MedPlus
has been instrumental in facilitating the seamless flow of data through all
points and has provided a comprehensive Web-based portal that is the core of
the HIE."
The MedPlus Centergy integrated solution features a combination of a Clinical
Portal, robust Data Exchange Services and a modular ambulatory EMR, Care360
EHR. The Clinical Portal aggregates patient-specific data from various
clinical systems and, in compliance with HIPAA, presents information in a
single Web-based view at multiple inpatient and remote points of care. The
Data Exchange Services form the foundation for the collection, integration,
aggregation and distribution of clinical data, while preserving it behind the
sponsoring organization's firewall. This real-time data is available to
physicians and provides them with the information needed to make more informed
decisions, ensuring high quality care for their patients.
"HIEs are an important component of driving better outcomes for patients and
more efficient health care," said Richard Mahoney, president of MedPlus and
vice president of Healthcare Information Solutions at Quest Diagnostics.
"Organizations such as NMHIC are the foundation of building a better health
care system and we are honored to be playing such an important role in helping
them to achieve their goals."
About The New Mexico Health Information Collaborative
The New Mexico Health Information Collaborative (NMHIC) is the name of New
Mexico's rapidly growing health information exchange (HIE) network, as well as
the community collaborative that has supported its development with time and
funding. The collaborative includes important New Mexico stakeholders
representing the largest health care providers, payers, employers, state
agencies and consumers. NMHIC was created in 2004, and continues to be fully
staffed and operated by the Lovelace Clinic Foundation. LCF is a non-profit
applied health research organization founded in 1990.
About MedPlus
MedPlus, based in Cincinnati, Ohio, is the healthcare information technology
subsidiary of Quest Diagnostics Incorporated. MedPlus is a leading developer
and integrator of clinical connectivity and health care information exchange
solutions designed to foster better patient care and improve business
performance for health care institutions, physicians and patients. The
company's Centergy(TM) and ChartMaxx® solutions efficiently and securely
collect, store, manage and integrate clinical information within an
organization, enterprise, practice or community. Centergy enables clinicians
to access patient data in a centralized view aggregated from multiple care
sites. ChartMaxx, the company's award-winning DMI and electronic patient
record system, has been implemented in more than 100 hospitals and integrated
health care delivery networks and has more than 300,000 users. For more
information, visit www.MedPlus.com.
About Quest Diagnostics
Quest Diagnostics is the world's leading provider of diagnostic testing,
information and services that patients and doctors need to make better health
care decisions. The company offers the broadest access to diagnostic testing
services through its network of laboratories and patient service centers, and
provides interpretive consultation through its extensive medical and
scientific staff. Quest Diagnostics is a pioneer in developing innovative
diagnostic tests and advanced health care information technology solutions
that help improve patient care. Additional company information is available at
www.QuestDiagnostics.com.
Contacts:
Dave Perry (NMHIC Media): 505-938-9910
Barb Short (Quest Diagnostics Media): 973-520-2800
Kathleen Valentine (Quest Diagnostics Investors): 973-520-2900
SOURCE Quest Diagnostics Incorporated
Dave Perry (NMHIC Media): +1-505-938-9910, Barb Short (Quest Diagnostics
Media): +1-973-520-2800, Kathleen Valentine (Quest Diagnostics Investors):
+1-973-520-2900
SEC and Homeland Security need Web backup, GAO says October 28, 2009
Posted by gonzalezloumiet in DHS, H1N, H1N1, Internet.Tags: H1N1, Internet
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Mon Oct 26, 2009 6:53pm EDT
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) – Securities exchanges have a sound network back-up if a severe pandemic keeps people home and clogging the Internet, but the Homeland Security Department has done little planning, Congressional investigators said on Monday.
The department does not even have a plan to start work on the issue, the General Accountability Office said.
But the Homeland Security Department accused the GAO of having unrealistic expectations of how the Internet could be managed if millions began to telework from home at the same time as bored or sick schoolchildren were playing online, sucking up valuable bandwidth.
Experts have for years pointed to the potential problem of Internet access during a severe pandemic, which would be a unique kind of emergency. It would be global, affecting many areas at once, and would last for weeks or months, unlike a disaster such as a hurricane or earthquake.
H1N1 swine flu has been declared a pandemic but is considered a moderate one. Health experts say a worse one — or a worsening of this one — could result in 40 percent absentee rates at work and school at any given time and closed offices, transportation links and other gathering places.
Many companies and government offices hope to keep operations going as much as possible with teleworking using the Internet. Among the many problems posed by this idea, however, is the issue of bandwidth — especially the "last mile" between a user’s home and central cable systems.
"Such network congestion could prevent staff from broker-dealers and other securities market participants from teleworking during a pandemic," reads the GAO report, available here
"The Department of Homeland Security is responsible for ensuring that critical telecommunications infrastructure is protected."
BLOCKING WEBSITES
Private Internet providers might need government authorization to block popular websites, it said, or to reduce residential transmission speeds to make way for commerce.
The Financial Services Sector Coordinating Council for Critical Infrastructure Protection and Homeland Security, a group of private-sector firms and financial trade associations, has been working to ensure that trading could continue if big exchanges had to close because of the risk of disease transmission.
"Because the key securities exchanges and clearing organizations generally use proprietary networks that bypass the public Internet, their ability to execute and process trades should not be affected by any congestion," the GAO report reads.
However, not all had good plans for critical activities if many of their employees were ill, the report reads.
Homeland Security had done even less, it said.
"DHS has not developed a strategy to address potential Internet congestion," the report said.
It had also not even checked into whether the public or even other federal agencies would cooperate, GAO said.
"The report gives the impression that there is potentially a single solution to Internet congestion that DHS could achieve if it were to develop an appropriate strategy," DHS’s Jerald Levine retorted in a letter to the GAO.
"An expectation of unlimited Internet access during a pandemic is not realistic," he added.
(editing by Philip Barbara)
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CDC expands flu-tracking efforts October 26, 2009
Posted by gonzalezloumiet in Nationwide Health Information Network.Tags: CDC, NHIN
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New initiatives track and share information on the pandemic flu
- By Alice Lipowicz
- Oct 21, 2009
Also in this report
With the pandemic H1N1 flu spreading rapidly this year, officials at the Centers for Disease Control and Prevention have been aggressively expanding their information technology toolkit to provide better, faster and more in-depth data on the virus, also known as swine flu.
The virus has created an urgent need for public health authorities to track where and how quickly the illness is spreading. The Centers for Disease Control and Prevention, along with some state agencies and private entities, have responded to the challenge with new IT initiatives.
On Sept. 1, CDC began securely exchanging public health data daily via the Nationwide Health Information Network. The pilot project is gathering flu symptom data from health care providers in Indiana, New York and Washington state.
The flu data exchange is a new use for the NHIN, itself a pilot project of the Health and Human Services Department’s Office of the National Coordinator for Health IT.
“We are supporting the use of the NHIN for biosurveillance,” said Dr. Charles Magruder, senior adviser for health information exchange activities at CDC’s for Public Health Informatics and leader of the agency’s NHIN pilot project. “It has the potential to be a broad and robust system.”
The NHIN eventually will be used for national health data exchange, but is currently a platform for several demonstration projects, including one involving the Social Security Administration and MedVirginia, a regional network of health care providers, to exchange patient medical information for determining disability benefits eligibility. It will soon be accepting data from the Veterans Affairs and Defense departments.
CDC worked with Harris and Cisco Systems to demonstrate that it could upload flu symptom data from three state health departments in a timely fashion. Researchers then aggregate and analyze the information looking for trends and make the results available to state public health officials.
The data includes clinical information on patients’ symptoms, lab results, geographic information, age and gender, Magruder said. The data has been stripped of all personally identifiable information and is put into a format that both NHIN and the CDC can work with.
One of the key advantages to using NHIN is timeliness, Magruder said. Since Sept. 1, CDC has received new H1N1 data daily.
“We are showing how the biosurveillance use case can be demonstrated in a standards-based and interoperable system,” he said. “One of the motivators for the project is to show that existing standards can facilitate the sharing of data. The NHIN is a key component of developing those capabilities.”
“I am very impressed with what the NHIN has to offer in terms of enhancing our capabilities to collect and move this type of data,” he added.
The three states’ health departments are linked to CDC through the Connect gateway software developed by HHS. The agency’s partners in the project include the New York eHealth Collaborative, Indiana’s Regenstrief Institute and Science Applications International Corp. under a contract with Washington state, Magruder said.
Once the program has been fully evaluated, CDC might expand it to include other states and diseases, he added.
CDC also partnered with the International Society for Disease Surveillance and the Public Health Informatics Institute to create a new tracking system, called Distribute, that aggregates nationwide data from state and local health departments on emergency room patients with flu symptoms.
Distribute provides the CDC with further detail on geographic and age-specific trends, officials said. For example, in the Washington, D.C., area, Distribute reports that between Sept. 13 and Oct. 11, the number of emergency room visits related to flu symptoms more than doubled — from 2.3 percent to 4.7 percent.
Other initiatives
CDC is also working with two other initiatives that began monitoring H1N1 flu activity this year: Cerner’s Flu Pandemic Initiative and the GeoSentinel global flu and disease tracking system established at the University of Alabama at Birmingham.
The initiatives complement existing CDC surveillance systems, including BioSense, the National Electronic Disease Surveillance System and the Influenza-Like Illness Surveillance Network.
CDC worked with health IT vendor Cerner to set up a national electronic swine flu tracking system. It takes advantage of Cerner’s network of lab, doctor and hospital clients, which spans as much as 30 percent of the country’s health care system. HHS Secretary Kathleen Sebelius called Cerner’s flu network a whole new model for disease monitoring when she spoke in Kansas City, Mo., Oct. 14 at a conference sponsored by Cerner.
The system, which began operating several weeks ago, is receiving data from about 1,000 hospitals, doctors and labs, said Kelli Christman, a Cerner spokeswoman.
The company set up the system voluntarily and sends results to CDC on a daily basis. The goal is to provide CDC and other clients with real-time information on hot spots of flu activity to help with preparedness efforts.
“We are providing a free service to enhance situational awareness,” Christman said. The system can be expanded to cover additional diseases or health events, such as negative reactions to vaccines, and the data can be customized to reflect activity in a specific region, she added.
The GeoSentinel network takes a global approach by connecting 48 clinics on several continents to track emerging diseases, including H1N1 flu, which first appeared in Mexico and spread worldwide within six weeks.
Unlike traditional flu surveillance systems, GeoSentinel tracks where patients got sick, not where they live.
"GeoSentinel is showing us travelers and mobile populations getting the flu," said Dr. David Freedman, co-director of GeoSentinel. "We are tracking which countries and places have intense enough transmission that they are then exporting flu and potentially seeding other countries.”
About the Author
Alice Lipowicz is a staff writer for Federal Computer Week.
ONC taps information exchange software for NHIN Connect October 26, 2009
Posted by gonzalezloumiet in Nationwide Health Information Network.Tags: NHIN, Vangent
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By John Moore
Friday, October 23, 2009
The Office of the National Coordinator has tapped an Arlington, Va.company’s health information exchange software as part of the federally developed Connect Gateway.
ONC selected Vangent’s Health Information Exchange Open Source (HIEOS) software as a document sharing component of Connect Gateway v. 2.2, which was released late last month. Connect lets agencies and healthcare organizations share health data, employing nationwide health information network (NHIN) protocols, agreements and services.
A document on the Connect community portal describes HIEOS as the “chosen NHIN Connect document registry and repository components for enterprise-type installations for this release.”
Kerry Weems, senior vice president for health strategy at Vangent, said HIEOS aims to let healthcare organizations use the systems they already have in place.
“Our strategy isn’t going to be rip and replace,” he said. “We are going to connect you to the NHIN and help you ensure meaningful use of the products you have.”
HIEOS can interoperate with electronic health record systems and integration engines through Web services interfaces, noted Bernie Thuman, chief technology officer for Vangent’s Health Solutions division.
Healthcare providers use integration engines to manage linkages among in-house systems, data sources and external applications.
Beyond its use in Connect, HIEOS will be offered to government agencies, hospitals, and regional health information organizations as part of Vangent’s open architecture-based health information exchange solution, according to the company.
HIEOS is written in Java and runs within the open source GlassFish application server environment. Thuman said the software can run on any server platform that supports Java.
Uber Operations’ own, profiled in the Loyola New Orleans Magazine October 19, 2009
Posted by gonzalezloumiet in Eduardo Gonzalez Loumiet.Tags: Eduardo Gonzalez Loumiet, Loyola University New Orleans
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Eduardo Gonzalez Loumiet, Managing Director of Uber Operations was profiled in the Fall 2009 edition of the Loyola University, New Orleans Magazine. Eduardo graduated from Loyola in 2003, with a degree in Finance and Computer Information Systems. Eduardo is responsible for all of the company’s worldwide sales and operations. Eduardo plays a key role in the continued development of the company’s strategic growth, including partnership and supplier relationships, ensuring flexibility in response to an increasingly demanding marketplace.
Chopra seeks outside advice on health IT standards October 14, 2009
Posted by gonzalezloumiet in Aneesh Chopra, Blumenthal, Nationwide Health Information Network.Tags: Aneesh Chopra, Blumenthal, NHIN
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By Mary Mosquera
Wednesday, October 14, 2009
The Health IT Standards Committee today said today it would bring together experts from outside the healthcare field to share ideas about best ways to apply new workflow and information sharing standards across organizations.
Aneesh Chopra, the White House’s chief technology officer and chairman of the panel’s newly formed standards implementation group, said he wants to mine the lessons of other industries in using information handling standards successfully and then apply them broadly to healthcare.
“There is an interest in how other industries have adopted standards, and I think we’re going to take that feedback to heart,” Chopra said after the meeting. The panel will host a hearing on Oct. 29 to share best practices, Chopra said.
Additionally, Chopra will open a two-week online forum to seek feedback from a wider audience on a series of structured questions and information posts on standards usage. The implementation workgroup will report on its findings at the next standards committee meeting Nov. 19
Dr. David Blumenthal, the national health IT coordinator, cautioned against confusing the adoption of standards with the adoption of electronic health record technologies.
“This is not about the adoption of technology but the adoption of standards,” he said. Health IT vendors will be able to solve most of the technology problems, he said.
Standards are at the heart of healthcare reform, Blumenthal noted, as reform will depend on standards and infrastructure being available to exchange health information anytime.
“Congress might not know it or realize it, but you are at the center of their effort to improve the healthcare system,” Blumenthal said in praising the standards committee’s work.
Blumenthal also said the Nationwide Health Information Network project, a public-private sector project that has been in progress for years, is essentially a set of standards.
“The goal has always been not to develop a thing or a network that is closed or a physical representation of a network, but to create a resource in the form of protocols, standards and specifications that are available in the public domain, he said.
“They are available to anyone who wishes to use the Internet to exchange information in a private and secure and effective way.”
Blumenthal said his office has also been considering how to accelerate the availability of the standards, protocols and specifications that comprise the NHIN as well as how to provide consumers and small practices access to the NHIN toolset.
“We think [that] is a laudatory goal just as we think that individual physicians and small physician groups should” have access. Blumenthal said. “This is a public resource whose broadest use is our goal.”
In other areas, the Committee’s clinical quality workgroup said it would create a sub-group to focus on gaps in the transition of vocabulary standards along the health IT adoption path.
For instance, providers will have to migrate from using ICD-9 to ICD-10 to SNOMED CT by 2015 to record physician’s clinical observations in an electronic health record.
“We need to enable that conversion to the adoption process, and that’s where these gaps are,” said Jamie Ferguson, co-chairman of the work group and executive director of Kaiser Permanente’s health IT strategy and policy.
Wired Medicine’s Silent Giant October 13, 2009
Posted by gonzalezloumiet in EMR.Tags: Epic
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Special Report: Medical IT
Robert Langreth, 10.08.09, 6:00 PM ET
Big name companies like General Electric, Siemens, McKesson and Cerner are rushing to profit from the push to install electronic patient records.
But the hottest company in the electronic medical records industry is a secretive Wisconsin outfit called Epic Systems. It does little marketing or advertising, shuns acquisitions, never issues press releases and tries to stay out of the headlines. The privately owned company admits it once put up a billboard that said "Marketing Sucks … Epic Systems."
Yet with a reputation for customer service and software that is more user-friendly than most, Epic has snagged contracts with famous places like the Cleveland Clinic and University of Chicago Medical Center, the big HMO Kaiser Permanente and Group Health Cooperative in Seattle.
EPIC has recently been winning about 40% of the new contracts for electronic records systems at major hospitals–far ahead of its competitors, says health care research firm Klas Enterprises in Utah. In 2008, Epic won 24 big-hospital contracts, versus 12 for McKesson and 10 for Siemens, according to Klas. "They continue to win a lion’s share of the new business," says Klas chairman Kent Gale. A contract to install medical records software at a 400-bed hospital might be worth $20 to $30 million over several years.
Based in 500-acre campus in Verona, Wis., Epic had $600 million in revenue last year, up from $500 million in 2007. It does not disclose its profits. The company focuses exclusively on larger hospitals and health systems–it has just 180 customers–allowing it to get business by word of mouth without much marketing. Obama’s stimulus package, which provides $36 billion in incentives for doctors and hospitals to add electronic patient records, could turbocharge the entire industry.
Computer programmer Judith Faulkner founded Epic in 1979 with three part-time employees and is still chief executive. By all accounts, she remains the dominant force, but rarely does interviews. A call to the company was returned by an outside public relations agency, which said Faulkner was traveling and unavailable for interviews. It couldn’t even verify her age. But she is known for her liberal politics and buying quirky artwork for headquarters, according to local newspaper reports.
Installing a medical records system at a hospital is a bit like doing a massive house renovation while the house is still occupied. All sorts of things can go wrong. The process is so complicated that IBM is making money by advising hospitals how to combine dozens of disparate software systems, while Microsoft is selling software to rapidly extract data from multiple systems. Some installations of commercial drug ordering systems from other companies have gone awry and caused new types of prescription medication errors, according to published studies (see "The Dark Side of Wired Medicine")–or even higher death rates, according to one controversial study (see "The Devil Inside Wired Medicine").
Epic has a reputation for relatively high prices and high levels of service to ensure software is installed on time with as few snafus as possible. "They deliver what they promise," says Dr. David S. Mendelson, chief of medical informatics at Mount Sinai Medical Center in New York. Mount Sinai uses Epic in its outpatient clinics and plans to install the company’s software in its 1,200-bed hospital as well. The fact that Epic is private is also viewed as an advantage by some hospitals, says Gale. Installing medical records can take a year or more, and hospitals don’t want a vendor that will be distracted every three months with earnings reports.
Drexel University medical computing expert Scot Silverstein is a harsh critic of most medical records systems, which he says are confusing, glitch-prone and hard to use. But he gives Epic some grudging respect. "It is not terrible. Epic has the advantage of having been around for a long time, and they have been steadily improving the quality of their product. It is much simpler in its appearance to end users than some of the competing products. The user is not presented with a massively complex set of screens." However, he criticizes Epic’s reputation for hiring people fresh out of college who have no health care information technology experience.
What really put Epic on the map was when it won a massive contract in 2003 to install electronic patient records at Kaiser Permanente, the giant HMO in California and several other states. Kaiser gave Epic the job after abandoning a years-long effort to design its own electronic patient records system.
The Kaiser project was bigger and more complex than anything Epic had done. (Kaiser has more than 8 million members.) "Most competitors thought it would bring Epic to its knees," says Gale. But today, despite some controversy along the way, all 435 of Kaiser’s outpatient clinics and 30 of its 36 hospitals are fully wired. One study of Kaiser clinics in Hawaii found that patient office visits dropped 26.2% after the electronic system was installed, as many simpler problems were now able to be resolved by telephone appointments or secure e-mail.
The Kaiser project will cost $4.2 billion by the time the final updates are completed in 2013. Two billion dollars of this is going to hardware and software, and much of the rest is for training, but exactly how much of this Epic gets is unclear. "They excel at helping clients deploy the software," says Kaiser pediatric infectious disease specialist Andrew Wiesenthal, who is associate executive director at the Permanente Federation, Kaiser’s doctor group. "Their service level has been at the top," agrees Cleveland Clinic Chief Information Officer Martin Harris. Compared to other vendors, he says, he rarely has had to call Epic to replace a software consultant that isn’t working out.
Not everyone picks Epic. Intermountain Healthcare in Utah, known for its medical computing expertise and cited for its top-quality care by President Obama, decided a few years ago that none of the existing medical records systems had the advanced capabilities it wanted. So it is collaborating with General Electric to design a new system from scratch. Epic, of course, was unavailable for comment.
Meaningful" Progress Toward Electronic Health Information Exchange A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology October 2, 2009
Posted by gonzalezloumiet in Blumenthal.Tags: Blumenthal, HITECH
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I recently reported on our announcement of State Health Information Technology Grants and grants to establish Health Information Technology Regional Extension Centers, as authorized under the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the American Recovery and Reinvestment Act of 2009 (the Recovery Act).
Today I want to discuss the important term “meaningful use” of electronic health records (EHRs) – both as a concept that underlies the movement toward an electronic health care environment and as a practical set of standards that will be issued as a proposed regulation by the end of 2009.
The HITECH Act provisions of the Recovery Act create a truly historic opportunity to transform our health system through unprecedented investments in the development of a nationwide electronic health information system. This system will ultimately help facilitate, inform, measure, and sustain improvements in the quality, efficiency, and safety of health care available to every American. Simply put, health professionals will be able to give better care, and their patients’ experience of care will improve, leading to better health outcomes overall.
As many of you are aware, the HITECH Act provides incentive payments to doctors and hospitals that adopt and meaningfully use health information technology. Eligible physicians, including those in solo or small practices, can receive up to $44,000 over five years under Medicare or $63,750 over six years under Medicaid for being meaningful users of certified electronic health records. Hospitals that become meaningful EHR users could receive up to four years of financial incentive payments under Medicare beginning in 2011, and up to six years of incentive payments under Medicaid beginning in October 2010.
The HITECH Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help those who want to improve their care delivery, and will serve as a catalyst to accelerate and smooth the path to HIT adoption by more individual providers and organizations. The dollars are tangible evidence of a national determination to bring health care into the 21st century.
The Office of the National Coordinator for Health Information Technology (ONC) is charged with coordinating nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. ONC is working with the Centers for Medicare & Medicaid Services (CMS), through an open and transparent process, on efforts to officially designate what constitutes “meaningful use.”
ONC has already engaged in a broad range of efforts to support the development of a formal definition of meaningful use. The HITECH Act designated a federal advisory committee, the HIT Policy Committee, with broad representation from major health care constituencies, to provide recommendations to ONC on meaningful use. The HIT Policy Committee has provided two sets of recommendations, informed by input from a variety of stakeholders. ONC and CMS have also conducted a series of listening sessions to solicit feedback from more than 200 representatives of various constituent groups and an open comment period where over 800 public comments were submitted and reviewed. The second set of recommendations on meaningful use was issued at a July 16 HIT Policy Committee meeting and details can be found at healthit.hhs.gov/policycommittee.
CMS is expected to publish a formal definition of meaningful use, for the purposes of receiving the Medicare and Medicaid incentive payments, by December 31, 2009. At that time, the public will be able to comment on the definition, and such comments will be considered in reaching any final definition of the term.
By focusing on “meaningful use,” we recognize that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care. Meaningful use of EHRs, we anticipate, will also enable providers to reduce the amount of time spent on duplicative paperwork and gain more time to spend with their patients throughout the day. It will lead us toward improvements and sustainability of our health care system that can only be attained with the help of a reliable and secure nationwide electronic health information system.
The concept of meaningful use is simple and inspiring, but we recognize that it becomes significantly more complex at a policy and regulatory level. As a result, we expect that any formal definition of “meaningful use” must include specific activities health care providers need to undertake to qualify for incentives from the federal government.
Ultimately, we believe “meaningful use” should embody the goals of a transformed health system. Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality.
What’s next?
As stated above, the next step in our process is a notice of proposed rulemaking in late 2009 with a public comment period in early 2010. As this process unfolds, we will continue to talk and share experiences about transitioning to EHRs, and to help deepen understanding among physicians and hospitals about the use of EHRs. We will also present programs designed to help smooth the transition process, and identify activities physicians and hospitals can engage in now to promote adoption of EHRs. As efforts advance, we will turn our attention to other necessary supporting programs, some of which you will hear more about in the coming weeks, including defining what constitutes a “certified” EHR, which is one of the requirements to qualify for Medicare and Medicaid incentives.
In the meantime, what can providers do to move toward becoming “meaningful users” – even in the absence of a formal definition? Naturally, while understanding that the final definition will be adopted through a formal rulemaking process, it will be helpful to be as familiar as possible with the discussion of meaningful use criteria to date. (You will find that information posted at healthit.hhs.gov/meaningfuluse.)
Armed with an understanding of the discussion of meaningful use as it unfolds, providers can begin to consider how their own practices or organizations might be reshaped to enhance the efficiency and quality of care through the use of an electronic health record system. Be assured you will not be alone as you seek to adopt an EHR system. Through our recently announced collaborative HITECH grants programs and others to be initiated later this year, we will continue to support providers in moving forward. Additional details about the grants are also available in my previous update and at healthit.hhs.gov/HITECHgrants.
To some providers, particularly small or already stretched physician practices or small, rural hospitals, the path toward meaningful use may still seem arduous. To others, who would just prefer to stick with the “status quo,” it may seem like an unwanted intrusion. We believe that the time has come for coordinated action. The price of inaction – in adverse events, lost patient lives, delayed or improper treatments, unnecessary procedures, excessive costs, and so on – is just too high, and will only get worse.
There is much at stake and much to do. We must relieve the crushing burden of health care costs in this country by improving efficiency, and assuring the highest level of patient care and safety regardless of geography or demographics. By using current technologies in a meaningful way, as well as technology to be developed in the future, we will take great strides toward solving some of the most vexing problems facing our health care system and creating a new platform for innovative solutions to health care.
Sincerely,
David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services
This letter is part of a series of ongoing updates from the National Coordinator for Health Information Technology. The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.
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Halamka: How to build a long distance service for healthcare October 1, 2009
Posted by gonzalezloumiet in NHIN.Tags: Halamka, NHIN, Office of the National Coordinator for Health IT
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By Mary Mosquera
Tuesday, September 29, 2009
To Dr. John Halamka, co-chairman of the Health IT Standards Committee, the nationwide health information network (NHIN) is a kind of long distance carrier, with health information exchanges in the role of connecting people via local phone exchanges.
“Generally healthcare information exchange is local,” he wrote recently in his blog, “Life as a Healthcare CIO.”
“Hospitals, labs, pharmacies, clinician offices, and public health in a region exchange data for a specific purpose. Privacy and data use concerns are resolved locally.”
“I do not believe that an architecture that requires a monolithic central database in the basement of the Whitehouse is going to be acceptable to stakeholders.”
Halamka listed several success factors for the NHIN, including governance via a NHIN framework for policy and technology, mostly likely orchestrated by the HIT Standards Committee could serve this purpose.
NHIN development would also require education and promotion. The Office of the National Coordinator for Health IT could do this or partner with health IT organizations, such as the National eHealth Collaborative or the e-Health Initiative, he said.
Incentives related to meaningful use would encourage health information exchange, as well as a desire to access federal stakeholders, including, CDC, SSA, and FDA, and CMS via electronic health record systems.
Ideally, EHRs, HIEs, and the NHIN should use the same standards for data transport, content and vocabularies to assure that they can easily integrate regional and national information efforts, he wrote.
And, to gain the trust of consumers, healthcare organizations should agree upon “a set of security and privacy rules, including data use and reciprocal support agreements to which everyone who links to the NHIN must conform,” Halamka said.
His blog is at http://geekdoctor.blogspot.com/.
