Electronic Health Record Adoption

Electronic Health Record Adoption

About the Blogger In the spirit of full disclosure, I thought I would provide some background on myself. I am the CEO of a Health Care Information company that specializes in automating the work flow of physician offices. My company has been in business for over 10 years so I am not new to the business of providing Electronic Medical Records and integration digital solutions. Our company was one of the founding members of what is now CCHIT which is the certification body that certifies Electronic Health Records (EHR), so I am quite familiar with the process of certification. Prior to this endeavor, I was an administrator of a very large specialty medicine program in the Midwest with over 70 physicians and 28 locations. The product my company sells was built originally to reduce the problems and errors we had in the large medical enterprise and to provide efficiencies so that we could meet the regulations mandated upon us while still seeing patients in an effective manner. My education includes degrees in business, a Ph.D. in psychology, and a Post Doctorate in Health Psychology. Finally, I have Dyslexia which causes me to misspell words or use the wrong tenses at times. I usually have my secretary fix those little problems, but since I am doing this on my own you may have to deal with some of these errors.

I would like to provide some definitions for terms. This way at least I know what I mean and whoever else reads this blog will have some anchors to understand my perspective.

EMR - Electronic Medical Record - This is a digital collection of information about a patient that is specific to their treatment by a single provider or a medical facility. The real issue here is that this system is for the provider of health care--not the patient. It may focus on only one aspect of the patient’s health. If you have a primary care physician that uses an electronic medical record system, the only information that is in that system is the information that he or she will put in on your behalf. If you also have a Cardiologist who you see, they also may have an electronic medical record and in all likelihood it will contain some of the information that your Primary Care Provider has as well as information that the Cardiologist decides is important. Thus, all the info in the primary care doctor’s record may not be in the Cardiologist’s record or vice verse.

EHR - Electronic Health Record - This is a digital collection of "ALL" of a patient’s medical information in one cohesive digital medical record. To my knowledge, this is a very rare animal indeed. I don't know of any that exist with the possible exception of the VA or some Managed Care systems and even then it would mean that someone has access to the entire record. Every vendor of health care information claims they have an EHR the certification committee certifies; however, in truth most of what gets sold and implemented are EMR's.

PHR - Personal Health Record - This is something that has been near and dear to my heart for a while, but I see it getting bastardized into something that will be more for the providers and less for the patient. The idea is that the patient can have a digital copy of their medical record--if not the whole historical record, the most current and relevant record. This digital record would be stored on some media (we use a wallet size CD, some others use the Internet, USB drives, Smart Cards, etc). The idea is to have some portable media that allows the patient to bring the information to other providers and give them access to them. Standards are being developed for this type of health care exchange of information. An example would be that a health care provider would send the patient to a specialist and send specific information regarding the patient that they would need to treat or assess the patient in an agreed upon format.

RHIO - Regional Health Care Information Organizations - Regional data storage centers that house PHR's or segments of the patient records (i.e., laboratory results, etc.). Not many of these really exist and they seem ill defined. Some look to be data warehouses, some want to be IT service providers, some want to be IT distribution centers.

NHIN - National Health Information Network - This would be the mother load. It has been talked about in terms of a National Data Center where all patient information for all of the United States citizenry would be housed. Google, Microsoft, etc would love to house this data. Another approach would be a Health care Exchange system that would tie all the RHIO's together and let individuals who have the proper security search patient information.

HIPAA –Health Insurance Portability Act - A collection of rules and regulations mandated by the Federal Government but with very little funding to monitor compliance. This act governs the ability to maintain health insurance as you move from one job to another. For purposes of this blog, it speaks to specific rules and regulations for submitting medical claims to third party payers as well as Medicare. It also contains standards and rules for electronic health records, including security rules, confidentiality and privacy policy and procedures.

EDI – Electronic Data interchange – This is the electronic submission of charges and remittance for clinical service rendered to patients. Again, the specific format is governed by HIPAA but the only groups that have to adhere to these standards are the physicians and health care providers who submit the charges and Medicare. Medicaid and Commercial Payers don’t have to follow the standards; they can change it to suit themselves. Thus, the standard is not so much a standard.

CCHIT - This is a certification group that was established by Health information Vendors and HIMSS, a trade association. Once established, it became an entity of its own and was given credibility and authority by the National Office of Health Technology to certify Electronic Health Records. This group is essentially deciding what features and functions will be required for EHR's to be certified. The government has already changed some legislation so that certain payments and or tax benefits can only be applied to products that are certified.

CMS - is the newer acronym for Medicare and Medicaid programs. It is the official government organizational unit responsible for Medicare and Medicaid.

Payers - This term represents all commercial insurance companies who hold health insurance policies and create the rules for what medical services are covered under their plan and what providers will be paid for their services.

eRx - This is a new acronym and it represents the new electronic prescribing programs. The government has requested that as many prescriptions as possible being written for the new part D Medicare program be delivered electronically. This is being required to cut the cost of the Part D program, and provide better quality care. I will be talking about this in the near future. This is actually, in my opinion, a prime example of why we are not getting broad adoption of the EMR's.

Private Practice - Most of the physicians that the government and payers want on EMR's do not work for hospitals or other government agencies; they work in private practice groups of between 2 and 10 physicians. There are nearly 700,000 of these physicians and less than 20% of them have full blown EMR's and digitize the medical records of a patient. The two biggest reasons for them not buying EMR's are: 1) They cost money and their fees from Medicare and Payers are continuing to be reduced over the years. 2) In most cases the EMR's provided to them are so generic (one EMR for all physicians regardless of specialty) that they do not create enough efficiencies in their practice to offset the costs. I will be discussing this as well in future blogs.

Hospital Based Practice - These are physician practices which are owned by a hospital. This is a growing trend especially as it relates to specialty medicine. The reason for this recently is economics. While provider fees continue to be reduced (doctors have no lobby group of substance), hospital fees have stayed strong and in many cases increased (they have a much better lobby group). Therefore, if a physician becomes an employee of the hospital he can do the same procedure on the same patient in the same facility as he did when he was in private practice and sometimes get 20 to 30% more cash for doing it. This is not a bad way to increase revenue, especially when you factor in that health insurance costs are drastically reduced (one of the highest expenses of employee benefits) by joining a hospital's plan with a larger employee pool and reduced overall risk.

Interoperability - This will become more and more important and I will spend considerable time on this subject in my blog over the coming weeks. This term defines the ability for health information systems to: share information between them, connect to other systems seamlessly, and to allow data from different sources, created with different applications, with different database structures, and different formats to be brought together in one location for viewing by a health care provider. Currently, this is very expensive to do and requires a level of standardization that just isn't there.

Okay, I think this is enough to digest today. I promise that I will try to keep future blogs a little shorter and to the point. Again, the purpose is to discuss the reasons why EMR adoption is slow to non existent. Using an old business psychology technique, I will first start off with how we can produce an environment that discourages adoption and then we will move to things we might be able to do to increase adoption of EMR's.