Schwartz Healthcare IT Blog

EHR Benefits: A Macro and a Micro View

2009-11-17T16:54:18Z

The New York Times ran a short piece by Steve Lohr yesterday that highlighted a new study led by two doctors from Massachusetts General Hospital.

The study compared 3,000 hospitals at various stages of implementing and using electronic health records (EHRs). For those who see EHRs as a panacea for the healthcare system, the initial findings are disappointing. To quote from Lohr’s story: “In the heart failure category, for example, the hospitals with advanced electronic records met best-practice standards 87.8 percent of the time; those with basic computer records, 86.7 percent; and those without, 85.9 percent. The differences in other categories were similarly slender.

“Reducing the length of hospital stays, according to many experts, should be a big money-saving payoff from electronic health records — as better care aided by technology translates into less time spent in hospitals. For hospitals with full-featured digital records, the average length of stay was 5.5 days; for those with basic computer records, 5.7 days; and those without, 5.7 days. The differences, Dr. Jha said, were ‘really, really marginal.’”

So, at least by these two measures the return on the use of EHRs so far is pretty meager. But, as the study authors point out, the evidence for gains from EHRs so far has come from an “elite” group of high-performing providers that have spent years adapting to the technology. No surprise, with just 20 percent of U.S. physicians now using computerized health records (and less than 5 percent in very small practice groups) there’s a long way to go to meet the federal EHR usage goals, despite the financial incentives in the HITECH portion of the 2009 ARRA stimulus package.

That’s a macro view. But if you take a micro view, there are some stunning successes in the use of EHRs to improve physicians’ practice operations and patient care. Twice this year I’ve had the pleasure of seeing a presentation by Dr. Jim Morrow, formerly of the North Fulton Family Medicine Center. Dr. Morrow presented at HIMSS 2009 in Chicago, and a few weeks ago he presented at the HIMSS and Massachusetts Health Data Consortium Healthmart 09 conference in Worcester. Massachusetts. Morrow is a compelling presenter and he tells a detailed story about his small medical practice group implementing and using EHR technology, going back almost 10 years. Here are his slides.

To summarize some of the ROI from his four-physician practice:

Transcription costs dropped from $110,000/year to zero
Chart handling dropped from $30,000/year to zero
Chart searches dropped from $16,000/year to zero
Dictation dropped from $32,000/year to zero
Reduced cost per patient visit from $112 to $79
Full time employees per provider dropped from 4.7 to 2.8

Morrow estimates that EHR technology saved the practice 11,440 billable staff hours per year, which could go into serving more patients. His presentation has some compelling images of unreadable handwritten prescriptions next to clear, legible e-prescriptions – a key part of reducing medical errors.

Now, none of this is new. EHR vendors, HHS officials, Dr. David Blumenthal and many others have been pushing for widespread EHR adoption for years. And it’s not that surprising that a study would find that so far the measureable benefits are not compelling across the entire U.S. hospital system. But EHRs will help transform healthcare and it’s only a matter of time.

This study is like taking a snapshot of internet-enabled e-commerce in 1996. What looked like hype back then is now a critical underpinning of our economy. Many people have invoked the so-called Metcalfe’s Law (ie.: the value of the network is proportional to the square of the number of users) first postulated about communications networks, as something that will come into play as EHR usage reaches critical mass. Let’s hope that’s the case, and the findings of this new Mass General study are simply a realistic progress check.

Hospital Social Media Bans: A Good Idea?

2009-10-16T16:11:22Z

A recent post in Beth Israel Deaconess Medical Center CEO Paul Levy's "Running A Hospital" blog focuses on social media policies at Boston-area hospitals.

The story follows reports that one local hospital recently instituted a six-month social media ban (Twitter, Facebook, Myspace - apparently not LinkedIn?) that will remain in effect until a policy is developed for its use and employee monitoring tools are put in place. Other area hospitals also block social media sites, citing HIPAA compliance, patient privacy fears and concerns over workplace productivity.

While policies are important, outright bans send a message that the very workers selected to run the hospital are not to be trusted. They also neglect social media's community building, information sharing and brand enhancing qualities and send a negative message to employees from a newer generation of talent who embrace these tools.

Would such a ban preclude hospital administration from creating a fan page that offers compelling news that builds community, pride and results in increased loyalty and perhaps donations? Take a look at the "Healthy Living With BIDMC" fan page on Facebook, which you can also follow on Twitter.

With its more open social media policy, BI Deaconess comes off as a progressive hospital whose CEO embraces technology, is at the forefront of healthcare thought leadership and is dedicated to transparency.

Billions in Stimulus Funding for Healthcare IT - What To Do?

2009-04-02T20:17:53Z

Part of the larger, $787 billion stimulus package signed by President Obama in mid-February is $19.2 billion under a bill called the HITECH, or Health Information Technology for Economic and Clinical Health Act. Hey, no one said these things would have simple names.

That $19.2 billion directs most of the funding - $17.2 billion of it - to pay for the widespread adoption and "meaningful use" of "certified" interoperable electronic health record (EHR) technology. The other $2 billion covers a wide range of healthcare information technology projects including health records, health information exchange, computerized physician order entry, clinical decision support systems and electronic prescribing. Recently we ran a webinar about the HITECH funding - slides and an audio are available below.

The EHR funding will be administered through CMS - Medicare and Medicaid - in the form of reimbursements available to physicians and hospitals, and spread over several years. The $2 billion is allocated by the Office of the National Coordinator for Health IT to be headed by Dr. David Blumenthal, appointed to the job on March 20, 2009. A couple questions come to mind:

How do you get healthcare stimulus money? As of this week the details of the process are still being developed by several federal agencies.

So what does this mean for healthcare IT companies and how can companies get stimulus funding?

First, the stimulus funding is intended to boost rapid technology adoption in the hopes of controlling healthcare costs, making healthcare more efficient and perhaps creating jobs. Despite the fact that there are more than 200 companies offering some form of EHR technology to physicians and hospitals, adoption is still too slow - by some estimates, well below 15% market penetration with perhaps a third of those using the systems effectively. An even worse EHR market assessment was published on March 26, 2009, which said that just 1.5% of non-Federal hospitals in the U.S. are using a comprehensive EHR system. Yikes!

(An interesting recent development is the start of a backlash, often from doctors, against the orthodoxy that widespread use of HCIT technology is an unquestioned good. The latest is this opinion piece from Time, this week. Among other intriguing points, it argues that EMRs could increase healthcare costs and push providers to input inaccurate information. I’ll write more about this later.)

Second, the stimulus funding is intended to foster better integration among the various proprietary HCIT technologies, which have been notoriously complex and difficult to integrate.

Third, the EHR funding encourages adoption through a payment schedule that can subsidize the costs of purchase and implementation, but it also includes a penalty. In 2014 physicians will see reduced Medicare and Medicaid reimbursements if they have not implemented EHR technologies and are not using them effectively.

The details of accessing the ARRA and HITECH funds are not yet fully developed, but the race is on for companies to tap into these funds. Whatever the details turn out to be, HCIT companies with a strong public image and strong brand awareness will be best positioned to take advantage of this rare opportunity in which the government is essentially funding their customers to buy their products. That means HCIT companies with strong government relations, strong brands and a strong public presence must maintain and extend it. HCIT companies without those advantages had better build them, and fast.

Several of us from our Healthcare IT Practice will be at HIMSS next week. We’ll be in booth # 3145, so please stop by and let’s talk about this.

Healthcare IT Spotlight Burns Bright

2009-01-21T21:06:02Z

Last week saw a series of announcements and events that underscore the importance the Obama administration and new Congress have placed on healthcare information technology (HIT) to stimulate the economy and help solve a national crisis in healthcare access, costs and outcomes.

First up was the "Investing in Health IT: A Stimulus for a Healthier America" hearing chaired by Senator Mikulski's HELP Committee. It featured compelling testimony on the need for better applications to solve the electronic health record (EHR) problem, specifically interoperability.

Next up, the House Appropriations committee unveiled its $825 billion "American Recovery and Reinvestment Bill of 2009," calling on significant investments to "update and computerize our healthcare system to cut red tape, prevent medical mistakes, and reduce healthcare costs." Key provisions include billions in federal HIT funding for computerize health records, with billions more targeted at disease prevention/wellness; healthcare effectiveness research; community health centers, and training primary care providers.

The new climate in Washington provides a once-in-a-decade opportunity for HIT companies to become part of a massive and coordinated effort to fix the broken healthcare system. Healthcare IT has become a bright spot in the otherwise dismal economic climate. Schwartz Communications will continue to monitor the HCIT landscape, offering insight into turning the current legislative agenda into real business opportunity through public relations. This includes hot button issues like consumer directed healthcare, transparency, interoperability and others. Stay tuned.

Coming up: Schwartz will be conducting a free Webinar titled, "The New Administration and Healthcare IT: Positioning Your Company for Success." scheduled for Thursday, February 26 at 2:00 PM Eastern. Details to follow soon.

FUD Factors

2008-10-03T15:21:02Z

An Envision Solutions/Kelton Research survey found that 85.6 million U.S. adults, or 38 percent of the population, have doubted the opinion of their doctors or other medical professionals when it conflicts with information found online. Forty three percent of consumers ages 18 to 34 reported they doubted their health provider's advice when it conflicted with online sources.

Only 3 percent of Americans seeking advice about how to manage a serious medical condition would view patient developed online health information as trustworthy. I’m sure this perspective would change if a consumer was faced with a serious disease or condition, hence the popularity of sites like PatientsLikeMe.com.

Few consumers listed the government, the media or non-profits as credible healthcare information sources. The survey shows that a majority of Americans still view health providers as their most trusted source of medical information overall.

Docs Rate Plans

2008-09-30T18:15:32Z

The AMA recently issued its first health insurance report card grading how quickly and accurately doctors get paid. Docs hope the report card will reduce the cost of claims processing and help in contract negotiations with the health plans.

According to the AMA, the report card compares Medicare and seven national commercial health insurers on the timeliness and accuracy of claims processing. UnitedHealthcare had the lowest rate – only 62 percent of medical services billed were paid by them at the agreed rate. Aetna came in higher at 71 percent, and the Medicare at an impressive 98 percent.

What you can do: If you are a healthcare IT physician practice management or EMR vendor who facilitates electronic coding and billing, use the AMA report to highlight how you can improve payment rates for you customers. It's likely your solution improves reimbursement rates and speed, translating into a more efficient and profitable practice.

Costs and Opportunities

2008-09-28T23:11:40Z

Health care costs are expected to rise more than 10 percent into next year, says an Aon Consulting survey of 70 national health insurers. This is actually good, considering it’s the smallest increase Aon has seen in six years.

Employers take measures to combat such increases through new designs, adoption of CDHP and HSA plans. Costs are still rising to keep up with growing patient demand for services, the needs of an aging population and prescription drug and technology costs, according to Aon.

What you can do: If you are a healthcare technology vendor whose solutions help lower costs for employers, leverage surveys such as this to highlight the savings you can provide customers. Highlight employer group success stories in the HR and benefits trades. Consider a round table of customers and experts to put your solution in a trend story context.

EHRachusetts

2008-09-23T21:11:14Z

Here in Massachusetts, Gov. Deval Patrick signed legislation mandating hospitals and community health centers to implement interoperable electronic health records systems by Oct. 1, 2015, as a condition of their state license. The state will develop regulations to define EHRs.

The systems must be certified by Certification Commission for Healthcare Information Technology (CCHIT.) Further, the law mandates collection and reporting of quality and cost data by providers and insurers, for dissemination to consumers via a state Web portal.

For HCIT practitioners of EHR vendors, this gives you an interesting message point to weave into pitching any Massachusetts hospital or health center customers.

PHR Thoughts

2008-09-16T15:03:18Z

While it may take a decade for widespread adoption of PHRs, it will definitely happen. It is another medium for communicating your medical condition to a doctor, which today is done verbally. Data supplied into the PHR by health plans, or the doctors via EMR interchange, will be more accurate as patients memory – selective or otherwise – isn’t often reliable.

What will help doctors is a high degree of interoperability between the PHR and the EMR, otherwise it’s still easier to take down a patient’s information verbally. When the Certification Commission for Healthcare Information Technology (CCHIT) starts certifying PHRs this will hopefully be addressed.

Other obstacles that will be overcome with time is general technology acceptance by doctors. The old guard's resistence will be replaced by younger doctors who are more comfortable and trusting of technology. Ubiquity of PHRs via Microsoft, Google, health plans and hospitals will move PHRs from “nice to have” to “must have."

This presents PHR vendor PR folks with opportunities to highlight how their solutions are making adoption easier, helping facilitate the vision of universal PHRs.

Who Watches the Watchmen?

2008-09-09T10:54:28Z

University of Missouri researchers conducted a national survey and found that the majority of health journalists have not had specialized training in health reporting and face challenges in communicating new medical science developments.

Health literacy, as defined by the American Medical Association, is ‘the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment.’

According to the UM press release, of the journalists surveyed, only 18 percent had specialized training in health reporting and only 6.4 percent reported that a majority of their readers change health behaviors based on the information they provide. The journalists had an average of 18 years of journalism experience and seven years experience as health journalists.

Journalists reported quoting medical experts, avoiding technical terms, and providing data and statistics, as the three most important elements to making health information understandable.

According to the survey, a majority of journalists reported believing that their readers understand information from medical professionals, but are not proficient with scientific information and more prone to believe health myths. The results suggest that newspaper journalists view their roles as information providers, while magazine journalists perceive themselves more as advocates for behavioral change.

PHR Factoids

2008-09-02T22:39:52Z

A recent Markle Foundation survey found that regardless of their interest in using an online PHR service, 79 percent or more of the public believe using an online PHR would provide benefits to individuals in managing their health. Fifty six percent cited worries about privacy and confidentiality as a reason for their reluctance.

Only 2.7 percent of adults have an electronic PHR today (representing about 6.1 million persons). Most (57.3 percent) do not keep any form of personal health records, and 40 percent keep some paper health records.

What you can do: If you're a PHR vendor PR person, utilize the survey findings to support your solution. Use the statistics in press releases or collateral to help make your case. Highlight the privacy and security safeguards that your product takes, given that privacy is a major obstacle to PHR acceptance.

Most Powerful?

2008-08-26T16:07:23Z

Modern Healthcare's annual "100 Most Powerful People in Healthcare" list for 2008 has been published and includes healthcare IT vendors in the top three spots.

1) Steve Case, CEO/founder of Revolution Health

2) Eric Schmidt, Chairman/CEO of Google

3) Bill Gates

4) Hillary Clinton

5) Barack Obama

6) Ted Kennedy

7) Arnold Schwarzenegger

8) George W. Bush

9) John McCain

10) Newt Gingrich

These popularity/political contests are amusing. As a healthcare IT PR practitioner it’s good to see the vendors in the top spots, as it indirectly helps all our causes. Personally I think none of them deserve to be there. Revolution, Google and Microsoft’s consumer health efforts are so early stage with virtually no users that they really should be in the low ‘teens.

No one seems to like Bush, but you can bet that doctors have privately thanked and rooted for him in not cutting Medicare reimbursement rates. That would put Bush from #8 to #1 no question. And Newt’s quasi-political think tank which charges vendors $50,000+ for representation is in many circles (as discussed by the Associated Press on occasion) a questionable operation. I could go on. But most people will agree that in our own real world, the most powerful person in healthcare is your or your child’s very own doctor.

Cloudy Outlook for PHRs?

2008-08-20T18:31:40Z

According to market research firm Gartner, government ITexecutives should investigate the impact of personal health records (PHRs) and health information exchange programs.

PHRs, such as Google Health, Microsoft HealthVault and ActivePHR from ActiveHealth Management, are free and controlled by the consumer and could achieve a high degree of interoperability with clinical systems operated by healthcare providers and other third parties, says Gartner. Microsoft recently announced a pilot project with Kaiser Permanente to enable data transfers between consumers' medical records and Microsoft's HealthVault online health site.

Gartner says these publicly available applications are built on important characteristics of cloud computing - they are enormously scalable resources that offer services directly to end users and to other IT products through an application program interface (API). Gartner reports they have the potential to achieve several important benefits:

]]> -They could provide a lifetime consumer health record that is free to consumers and healthcare payers because the vendors have very low costs through their cloud-computing facilities and the ability to monetize their PHRs by drawing consumers to their other online products.

- They have the potential to scale up to cover the dramatic expansion in healthcare data driven by increased use of diagnostic imaging, genomics and proteomics.

- They offer Internet-savvy approaches to the two most vexing issues in sharing electronic information in many jurisdictions: consumer authorization and consumer identification.

- Their cloud-computing approach, offering data access as a software service, can help to create a new market of consumer-oriented healthcare applications, enabling better consumer lifestyle choices and more active consumer participation in choosing a course of treatment for serious health problems.

- The cloud-computing approach is synergistic with the underlying philosophy of these products, which is to engage consumers in managing their own data. This consumer engagement is another reason that better consumer choices could stem from their use.

"It is very early in the life of these products and there are numerous obstacles that the vendors will have to overcome to achieve the benefits," said Gartner’s Wes Rishel in a press release. "The availability of these cloud-based approaches can disrupt health information-sharing initiatives and policies that some jurisdictions have in place by providing PHRs that better leverage vendor and global healthcare provider partnerships."

Gartner defines cloud computing as a style of computing where massively scalable IT-related capabilities are provided "as a service" using Internet technologies to multiple external customers.

Gartner recommends that policymakers prepare now to deal with issues pertaining to consumer confidentiality, competition with government programs, disenfranchisement of disadvantaged populations and policies on the secondary use of consumer health data.

"PHRs can impact government IT organizations and executives by creating the need for informed participation in policy initiatives and by impacting beliefs about whether some initiatives should be governmentally operated," said Rishel. "For almost all jurisdictions, preventing the entry of PHRs is not a viable approach. Delay is not a long-term strategy, but a limited amount of delay may provide time to ensure good confidentiality and craft an approach that is synergistic with government programs."

Additional information on personal health records is available in the report "The Cloud-Based Personal Health Record." The report is available on Gartner's Web site.

The Cost of National EHR

2008-08-15T16:30:31Z

Government Health IT reported that full implementation of networked e-health records in U.S. doctors’ offices and hospitals could cost around $150 billion over eight years.

According to Robert Miller, a professor of health economics at the University of California, San Francisco, this $150 billion estimate is actually “manageable” because it amounts to less than a 1 percent increase per year in the nation’s total health care spending.

Miller said hospitals are further along the path toward implementing clinical information systems, partly because they get some boosts in revenues when they install EHRs. With hospital profit margins around 5 percent, most hospitals can afford it.

Miller’s projections call for hospitals to spend $35 billion to acquire and expand EHR systems and $55 billion in new operating costs over eight years. Financial incentives and reporting requirements are going to be key to getting useful data from EHR users, Miller said.

The Rand Corp. reported in 2005 that the total cost over 15 years would be $114 billion, an amount Rand said would be completely offset by cost efficiencies and other financial benefits of EHR use.

What you can do: HCIT PR practitioners may want to consider highlighting the ROI of their EHR solutions in contrast to all this talk about costs. For those vendors with low cost hosted solutions, take full advantage of this feature in comparison to the bigger and more expensive licensed solution vendors.

Finally a Fine

2008-08-09T16:46:58Z

Some past posts of mine have talked about the lack of HIPAA enforcement fines. Finally a nursing home company in Seattle got fined. The A.P. reported that Providence Health & Services was socked with a $100,000 fine and mandate to fix it’s security in light of past privacy complaints.

Providence failed to properly secure backup tapes, disks and laptops with electronic patient information, even after thefts of the tapes and laptops.

Providence agreed to revise its policy on transporting patient records improve training.