IDC Health Insights Community > EMR and EHR for Providers

How Many EMRs Can You Count?

Tue, 06 Jul 2010 17:13:05 +0000

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On June 9, 2010, the $1.3 billion acquisition of Eclipsys Corporation by Allscripts-Misys Healthcare Solutions, Inc. was announced. Eclipsys is a vendor of primarily inpatient, but also ambulatory EMRs, while Allscripts has focused on the ambulatory market exclusively. In thinking about the upcoming merger, the ambulatory EMR picture just sounded really confusing. While we published a Perspective report last week covering what we feel will be the implications of the merger for hospitals and practices using Eclipsys and Allscripts products, we found that listing and counting the ambulatory EMRs started to make the picture (and the potential issues for end users) a little clearer.

With the inclusion of the Misys and Eclipsys products, the combined company will have either four or five ambulatory EMR products, depending on how you count the Sunrise Ambulatory Care solution, PeakPractice and MediNotes products on the Eclipsys side. Here's our list:

Allscripts Professional (formerly HealthMatics) EMR product is aimed at the small and midsize provider market (1–25 providers) and the product was installed at 1,431 practices as of fall 2009. The Professional EMR has its origins in the acquisition of A4 Health Systems by Allscripts in 2006.
Allscripts Enterprise (formerly TouchWorks) EMR is marketed to the large provider market (25–200 providers) and is reportedly used by over 40,000 providers as of fall 2009. The TouchWorks EMR was acquired by Allscripts in 2001, as part of the acquisition of ChannelHealth from IDX.
Allscripts MyWay is a software-as-a-service-based integrated EMR/PM offering, which is marketed to small and solo practices, and is estimated to serve fewer than 300 practices. MyWay was acquired in the Msys transaction in 2008, and is derived from technology acquired by Misys from Aprima (www.aprima.com, formerly iMedica), which continues to develop and market a similar integrated EMR and practice management system.
Eclipsys PeakPractice was recently developed and marketed by Eclipsys and was its stated ambulatory strategy. PeakPractice is derived from the integration of acquired technology, including the MediNotes e EMR and Bond Technologies' practice management application. MediNotes completed its acquisition of Bond Technology in March 2008 and Eclipsys completed its acquisition of MediNotes in October 2008. Since the acquisition of MediNotes, Eclipsys has been actively integrating the two products and was focused on leveraging the acquisition to strengthen its clinic and private practice offering. The PeakPractice EMR is targeted at physician groups with 1–15 providers and as of fall 2009, the product served 110 practices, with sizes ranging from 1 to 127 providers. At the time of the MediNotes acquisition, there were 5,000 practices using the product, so while migration to PeakPractice was underway, a significant customer base likely exists still using MediNotes or with migration in progress, at the time of the Allscripts-Misys acquisition announcement.
Eclipsys also offered the Sunrise Ambulatory Care solution, sold in conjunction with the Sunrise product suite. However, Eclipsys migration to PeakPractice was in progress for practices using Sunrise Ambulatory Care at the time of the Allscripts-Eclipsys acquisition announcement.

In addition, a past partnership between Allscripts and GE Healthcare (formerly IDX) means many Allscripts EMR clients have integration in place with GE's practice management systems.

Allscripts is not the only EMR vendor to have multiple EMR applications designed for different segments of the physician practice market, GE Healthcare is another. Smaller practices, which represent the vast majority of the physician practice market, do not have the technical resources or clinical/business requirements for more robust ambulatory EMRs designed for larger multispecialty practices with a hundred or more physicians and other clinical staff, so multiple EMRs make sense. However, while the new company will clearly develop, market and sell multiple EMRs, we're not sure how many there will be in the end. From an end-user perspective this will not be desirable given the disruption to the practice EMR implementations cause, and issues surrounding migration and adoption of a new EMR while facing the upcoming ARRA deadlines to demonstrate meaningful use. Customers and prospects of both companies should expect a certain amount of disruption in service and product offerings despite the best of intentions to mitigate such risks and are advised to put into place strong service level agreements.

What's your count? Are you an Allscripts or Eclipsys user – what are your concerns about the acquisition? For more information check out the Perspective report. Use our forum to discuss or feel free to contact me directly at jhanover@idc.com.

HIE Technology Solutions - A Nascent but Volatile Market (1 Comment)

Thu, 20 May 2010 03:24:19 +0000

Entry by Lynne Dunbrack

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To demonstrate meaningful use of electronic health records and thus qualify for incentive payments under the American Recovery and Reinvestment Act of 2009 (ARRA), healthcare organizations will have to invest in health information exchange (HIE) technologies. David Blumenthal, M.D., National Coordinator for Health Information Technology, has made it very clear that information should follow the patient "across the enterprise and among competing entities." The HIE market is characterized by a number of suppliers offering a wide variety of technologies and strategies to exchange health information including integration platforms, data aggregation, physician portals, and composite applications. There is a not a one-size-fits-all solution.

To help clients chart a course through the volatile HIE market and assess the range of HIE technology solutions available on the market today, IDC Health Insights evaluated 14 vendors that supply health information exchange solutions for enterprise, regional, and statewide (or countrywide) health information organizations. The vendors we chose to cover include leaders in the industry that were chosen for their market share and penetration or their potential growth opportunities. Key findings, published in the report Vendor Assessmen: Industry Short List for Health Information Exchange Technologies, include:

There are four distinct market segments for HIE technology: enterprise (or private) HIEs that connect owned or closely affiliated entities across the integrated delivery network or health/hospital system, regional health information organizations (RHIOs) made up of competing entities, statewide and countrywide HIEs. The fastest growing segment is the enterprise HIE.
Typical of nascent markets, the HIE vendor market is volatile with new entrants and market consolidation. Mergers and acquisitions have been the dominant vendor strategy to build out the HIE technology portfolio. Most of the profiled vendors are small to medium-sized, privately held companies and could be prime acquisition targets for larger companies seeking HIE solutions.
Only a few of the profiled vendors have a large (by comparison) customer base, and these customers are primarily enterprise HIEs. More than half have 10 or fewer customers counting enterprise, regional, and statewide HIEs.

The HIE market will continue to evolve and mature over the next 12–24 months, as funding for HIE technology investments becomes more available through ARRA's incentive payments for EHRs and state grants.

I will be presenting the results of the HIE vendor assessment in a complimentary Web Conference to be broadcast on Tuesday, May 25, 2010, from 12:00 to 1:00 p.m., U.S. Eastern time titled, Vendor Assessment: Health Information Exchange Technologies. Don't miss it! Click here to register.

Progress on e-Prescribing with DEA Interim Final Rule

Mon, 19 Apr 2010 18:00:35 +0000

Entry by Judy Hanover

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On March 31, 2010, the Drug Enforcement Agency (DEA) published a rule change that will pave the way for widespread provider adoption of e-prescribing. The new Interim Final Rule removes one of the major obstacles to e-prescribing -- the need to maintain a paper process for the estimated 11-13% of prescriptions written for controlled substances. This restriction has long served as a deterrent for adopters, despite the clear advantages of e-prescribing. It has been almost two years since the DEA published the Notice of Proposed Rulemaking, and the new rule still contains a complex two-factor authentication requirement for e-prescribers, but is expected nonetheless to improve adoption of e-prescribing.

E-prescribing technology has long been hailed as a panacea for the estimated 1.5 million annual injuries that result from prescription errors each year in the US (Institute of Medicine, 2006). The benefits of using e-prescribing for eligible prescriptions are proven; it has repeatedly been shown that e-prescribing can reduce deaths and injuries related to the administration of the wrong drugs and doses, and cut administrative costs related to follow-up on illegible, incorrectly written and confusing prescriptions. In the past decade, e-prescribing usage has grown, driven by extensive documentation of the benefits and resulting subsidies from payers.

It has been clearly documented that replacing paper-based prescribing processes with e-prescribing and accompanying decision support can help to protect patient safety and lower costs, and adoption is on the rise. Surescripts (www.surescripts.com), the national network that has been instrumental in developing a standard for e-prescription authoring and exchange, helping to drive adoption, indicated in its 2009 National Report on e-Prescribing that adoption doubled in the period from 2008-2009, with 150,000 prescribers in 2009, and that 18% of eligible prescriptions were e-prescribed in 2009, up from 6.6% at the end of 2008. Two federal programs have helped to drive adoption of the technology by providers: beginning in 2009, Medicare providers were eligible for incentives as a result of using e-Prescribing, and in February 2009 the introduction of ARRA provides substantial subsidies for the acquisition of electronic health records (EHRs), while will be required to include e-prescribing among other functionality in order to qualify for meaningful use requirements and the subsidies.

The implementation of the DEA rule change will substantially change the landscape by adding an additional 11-13% of prescriptions to those eligible for e-prescribing. Due to this omission, e-prescribers have needed to maintain an inconvenient dual process, using a combination of paper and electronic prescriptions for patients who require controlled substances. However, e-prescribing applications have long offered options and workarounds that allowed providers to see the benefits of the technology, even if they did still need to issue some paper prescriptions under the law. The rule change is expected to remove the requirement for this dual process, and boost e-prescribing rates among existing users while adding new users to its ranks, as the process is now more attractive and financially attractive to providers who take advantage of the Medicare and ARRA incentives.

Keywords

e-prescribing, e-rx, emr, ehr

Key Trends from HIMSS 2010

Mon, 08 Mar 2010 20:12:34 +0000

Entry by Judy Hanover

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Last week most of our healthcare team, including me, Lynne Dunbrack and Janice Young, headed to Atlanta for the HIMSS 2010 event. The change in energy at the event from 2009 was apparent from the moment we arrived. While the atmosphere at HIMSS 2009 was laced with cautious optimism as providers examined the HIT provisions of the recently-published American Recovery and Reinvestment Act, it was clear in the first hours of HIMSS 2010 that the pace had shifted and action and investment were underway.

The hotspots of activity at HIMSS 2010 were clearly the EHR/EMR and HIE-related topics, and the booths of vendors with EHR/EMR and HIE applications, hardware, software and services to support EHR/EMR. While there was definitely energy around EHR/EMR in 2009, the emphasis had definitely broadened to include HIEs in 2010, particularly as more of the meaningful use requirements had emerged over the course of the year to entail deeper requirements in the data exchange area that many expected at this time last year. Some of the key trends I noticed coming up again and again in our HIMSS conversations:

Actionable analytics continue to be a key focus for EHR/EMR implementers who wish to make the most of their newly-available electronic data for use in operational, clinical and quality decisions, as well as to assess performance on the meaningful use quality measures. Analytics offerings abounded at HIMSS, and those shown at HIMSS 2010 included new embedded analytics offerings from EHR/EMR vendors, offerings from HIE vendors who are aggregating data across providers such as Intersystems DeepSee, and MEDai, as well as standalone offerings from HP, Oracle, IBM and Microsoft.
Analytics are also emerging as a way to help look at provider performance with the process aspects of meaningful use. Interesting process performance tools were seen embedded in the system performance applications from Compuware, as well as many EHRs including the new service—based CareTracker from Ingenix. Eclipsys' new announcement with Microsoft's Amalga UIS is also promising for customers looking for this functionality.
Shortening and simplifying the implementation process are important for ambulatory providers, and numerous ambulatory EHR/EMR vendors mentioned new emphasis on, and programs to support the implementation and configuration process, including Allscripts and eClinicalWorks.
Connectivity and data exchange were top of mind as a critical component of meaningful use. HIE technologies abounded at HIMSS, and relationships between HIE and EHR/EMR vendors continue to flourish. Look for IDC-HI's forthcoming HIE Vendor Short List to learn more about HIE technologies.

Did you miss connecting with IDC Health Insights at HIMSS? Feel free to contact me to set up a post-HIMSS briefing … jhanover@idc.com

Keywords

HIMSS, EHR, EMR, HIE, provider, allscripts, eclinicalworks, eclipsys, intersystems, ingenix, compuware, oracle, IBM, microsoft, amalga, medai, HP, analytics

What do Dell, eClinicalWorks and WalMart Have in Common? (3 Comments)

Thu, 19 Mar 2009 14:59:41 +0000

Entry by Judy Hanover

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eClinicalWorks, Dell and Wal-Mart are all leaders on price and value, and this shared interest has led them to collaborate on a new bundled product offering that will make electronic medical records available to members of Wal-Mart's Sam's Club. The new partnership will bundle eClinicalWorks' unified application, which combines an electronic medical record (EMR) and practice management system, with Dell hardware to be marketed on Sam's Club's Web site. Sam's Club claims to have 200,000 practices among its members, amounting to access to almost 65% of the available market for ambulatory EMRs, based on an estimated 308,900 office-based practitioners in the U.S. in 2006, according to the CDC's April 2008 publication of the National Ambulatory Medical Care Survey (NAMCS).

It's not the first time that eClinicalWorks, Dell and Wal-Mart have worked together, as this also makes public the longtime relationship by which eClinicalWorks and Dell have provided Wal-Mart with EMR applications for its in-store retail clinics since 2006, with 30 clinics now using eClinicalWorks. This relationship was the basis for the new collaboration, and according to eClinicalWorks CEO Girish Kumar Navani, as well as the spokesperson for Sam's Club, Wal-Mart's experience with the application in the clinics is what led them to want to make it available to the providers who are members of Sam's Club. The goal is to bundle the EMR software with hardware, installation and training, in an affordable and clear pricing model.

The announcement comes just weeks after the passage of the American Recovery and Reinvestment Act of 2009 (ARRA), which provides about $20 billion in funding for healthcare IT. eClinicalWorks is a CCHIT-certified product, and this will allow the member providers who purchase it at Sam's Club and demonstrate meaningful use to be eligible for incentives under ARRA. The Sam's Club offering is priced below the levels of the incentive payments that physicians who implement and use ambulatory electronic medical records under the conditions laid out in ARRA will receive.

Wal-Mart will market the EMR bundle on its Sam's Club Web site and the eClinicalWorks/Dell bundle will be delivered as software-as-a-service (SaaS), hosted in eClinicalWorks data centers. Service responsibilities are shared between Dell and eClinicalWorks, with Dell's services available for implementation and setup of the EMR hardware and infrastructure, and eClinicalWorks services provided for hosting, implementation project management, training and support for the EMRs. Providers must have broadband access to use the service, although the eClinicalWorks software can be installed on site and run on servers at the practice if this is not available. The software is pre-configured by eClinicalWorks and delivered via the SaaS model to fit the needs of the practice, with content including specialty-specific templates and databases, clinical decision support tools and order sets. The Sam's Club bundle includes eClinicalWorks standard implementation package, with five days of on-site training for small practices.

The collaboration between Wal-Mart, Dell and eClinicalWorks on this product is unprecedented, but based on a history of collaboration between the partners in Wal-Mart's retail clinics. The Sam's Club channel, with access to 200,000 U.S. practices, represents a significant opportunity for eClinicalWorks to grow its market share in the ambulatory EMR market, and for Dell to grow its hardware and service channels. It also represents an opportunity for U.S. practices to take advantage of a bundled product offering that removes some of the complexity from EMR implementation while allowing them to take advantage of the opportunities created by almost $20 billion in government incentives available for ambulatory EMRs under ARRA.

What do you think about Sam's Club facilitating EMR purchases for its members?

Keywords

walmart, eclinicalworks, dell, emr, ehr, arra

The Ambulatory EMR Short Lists

Tue, 17 Nov 2009 20:58:45 +0000

Entry by Judy Hanover

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With the passing of the HITECH Act in February of 2009, providers gained an unprecedented opportunity to receive incentive payments for implementing and using eligible electronic medical records (EMRs) under the conditions laid out in the law. In order to take advantage of the subsidies, providers must implement and demonstrate meaningful use of the EMR technology by specific deadlines, beginning in 2010. This incentive is driving interest in EMRs in all types of ambulatory practices.

In order to assist practices making EMR decisions, IDC Health Insights has updated its Ambulatory Short List reports for 2009, with two new reports covering technology providers with offerings for small and midsize practices with less than 20 providers, and technology providers for large practices with more than 20 providers.

The methodology of the ambulatory EMR shortlist reports is designed to provide an objective analysis of the ambulatory EMR space that will assist providers in determining the EHR and EMR technology and vendor best suited to their practices, existing IT environment and business needs. Key recommendations for practices selecting EMRs include:

· Practices should consider the readiness of the practice, workflow and human factors when making decisions surrounding EMR selection, implementation and ongoing use

· Practices should look for integrated solutions that incorporate clinical documentation, ordering and practice management in order to achieve the maximum benefits from EMRs

· Practices should consider the total cost of ownership for an EMR solution when budgeting for EMR projects, including not only the software license, but also the infrastructure and services that will be required to deliver the required performance from the application

· Practices should consider hosted and software-as-a-service delivery in addition to traditional installed applications, as these delivery models may offer advantages to many practices

The vendors covered in this IDC Health Insights Short List include a sample of the ambulatory EMR vendors supplying solutions to small, midsize and large practices. In our research, we found over 100 vendors of ambulatory EMR systems, and were forced to narrow down the field to create a representative sample for this report. The vendors we chose to cover include leaders in the industry who were chosen for their market share and penetration.

If you missed the webcast covering the ambulatory short list research on November 12, 2009, you can access the replay recording. Please feel free to email me at jhanover@idc.com with any questions about our findings or the reports.

Keywords

EMR, EHR, short list, meaningful use, ARRA

Meaningful Use and CPOE: The Clock is Ticking

Wed, 19 Aug 2009 04:05:55 +0000

Entry by Lynne Dunbrack

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Achieving “meaningful use” is the new holy grail in the realm of electronic medical records (EMRs) and electronic health records (EHRs). The HIT Policy Committee convened last Friday to hear from the various workgroups and receive an update from the HIT Standards Committee. The Meaningful Use Workgroup did not recommend any changes to the second draft of its Meaningful Use Matrix, which was presented at the last HIT Policy Committee meeting on July 16, 2009. The Workgroup did present a timeline for its activities over the next 12 months. Notable among the activities is that an assessment of the industry’s preparedness for meeting the 2011 objectives will not take place until Q410. It would seem, especially when one considers the low adoption rates of EMRs, EHRs, computerized physician order entry (CPOE), and health information exchange (HIE) technologies, that such an evaluation should have taken place before the Meaningful Use Matrix was developed. A case in point is the aggressive timeline for 100% use of CPOE.

The Meaningful Use Matrix describes an evolving set of criteria for capturing and sharing coded information (2011), implementing advanced processes with decision support (2013) and achieving improved outcomes (2015). Perhaps one of the most challenging of the requirements is the implementation of CPOE in the first year. It should be noted that the Workgroup recommends using adoption year timeframe (e.g., “2011 measures” applies to first adoption year (even if HIT adopted in 2013); “2013 measures” applies to 3rd adoption year.) In 2011, eligible providers must use CPOE for all orders entered by an authorized provider. However, the interfaces to receiving entities is not required in 2011. For hospitals, 10% of orders of all types must be directly entered by authorized providers. In 2013, hospitals must use CPOE for all orders types.

Achieving this objective is going to be a tall hurdle for many provider organizations given the current low rates of adoption. A recent study authored by David Blumenthal M.D., M.P.P et al and published in the New England Journal of Medicine reveals that of the 63.1% of AHA hospitals surveyed, “only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic systems (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals.” The primary barriers to implementation cited by respondents were capital acquisition and maintenance cost, but physician resistance and lack of demonstrable ROI were also a factor. While the stimulus funding addresses cost and ROI it does not address maintenance cost or physician resistance.

As hospital CIOs well know, implementing CPOE requires a significant change in clinician workflow that takes time to put into practice. It is not uncommon for hospital-based CPOE implementations, even those that are considered successful, to take several years after applications the selection is made to reach a significant level of adoption, and to make progress slowly . According to a recent CHIME study of CIOs, when asked “If you had to begin implementing CPOE today, how many years do you think it would take for you to reach 100 percent adoption?”, 34.5% reported that it would take an estimated three years, and 30.4% reported that it would take 4 or more years. The CIOs with experience implementing CPOE reported longer timeframes compared to those who had no experience.

There are other studies by the American Hospital Association and the Leapfrog Group, to name two, that also report low CPOE adoption rates. Certainly a review of the literature would show that based on current low adoption rates of underlying foundational clinical applications (e.g., lab systems, radiology and pharmacy) combined with comprehensive EHRs and CPOEs, setting a goal of 2013 for CPOE used for all order types is aggressive and may set hospitals up to fail to achieve meaningful use, at “best,” and introduce significant medical errors and adverse drug events at worst if the implementation is not successful

The Changing Landscape of Certification for Meaningful Use

Tue, 18 Aug 2009 00:47:18 +0000

Entry by Judy Hanover

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Last Friday, August 14, 2009, the HIT Policy Committee met and adopted additional recommendations for its definition of meaningful use, a key requirement U.S. providers must demonstrate to access stimulus funding for investment in electronic medical records (EMRs). Friday's HIT Policy Committee publications included an update from the Meaningful Use Workgroup, a presentation from the Health Information Exchange Workgroup and a Review of Initial Recommendations by the Certification and Adoption Workgroup. All of the proceedings can be accessed from the HIT Policy Committee's webpage.

The Recommendations from the Certification and Adoption Workgroup were the most surprising, although not entirely unexpected based on earlier publications from this committee. One of the stated requirements in ARRA for demonstrating meaningful use is using a certified EMR application. It was widely expected throughout the industry that the Certification Commission for Healthcare Information Technology (CCHIT), which has an established an Ambulatory EHR Certification program and has been certifying EMRs since 2006, would be the required certification. This was expected because of both the tight timelines for demonstrating meaningful use, and the fact that most of the market-leading EMR vendors had gone through the CCHIT certification process and had products available and ready to install. The timeline, reconfirmed by the committee In the same meeting, requires demonstration of meaningful use in 2010 using a certified product, to receive stimulus funds in 2011, so CCHIT seemed the obvious, easy choice for making certified applications available rapidly to providers.

However, in its presentation, the Certification and Adoption Workgroup cited several problems with the existing CCHIT certification, including its lack of alignment with meaningful use objectives in ARRA. The Workgroup recommended allowing multiple certifying organizations, including CCHIT, to certify EMRs for meaningful use. The goals of the proposed Meaningful Use Certification include:

· Focus on meaningful use objectives at a high level, with less specificity on functionality and more on interoperability

· Address privacy and security policies in ARRA and HIPAA

· Separate the criteria definition from the certification testing organization, with criteria definition to be done exclusively by ONC

· Leverage existing certification work where possible, allowing currently CCHIT certified applications to certify for meaningful use with an incremental "gap certification" process

· Increase integration between standards and certification

· Remove the barriers to certification currently faced by specialty, homegrown and open-source EMR products

· Harmonize HHS certification and Stark exception qualification

CCHIT's certification program created minimum standards for functionality, interoperability and security of an EMR that provided a starting point for evaluation of EMR products, and the committee recognized CCHIT's work in its presentation. At the same time, the committee stated that the existing CCHIT certifications are not aligned with meaningful use objectives and found the CCHIT process to be demanding and costly for vendors The new process, and new certifying organizations, if they emerge, will face the challenges that CCHIT did in its infancy, alongside the schedule demands of ARRA. Although there are certainly issues surrounding the CCHIT certification process for vendors, and the new meaningful use certification presents opportunities for growth, it may also discard progress made by the vendor community with CCHIT, even if the gap process proposed provides an interim solution.

What do you think –do we need a new certification for meaningful use? And can we do it in time for ARRA funding?

Keywords

meaningful use, emr, arra, hit policy committee, cchit, ehr, stimulus, certification

Meaningful Use On Deck!!

Wed, 17 Jun 2009 14:32:46 +0000

Entry by Judy Hanover

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On June 16, 2009, the Health IT Policy Committee published a draft description of the definition of meaningful use of EMRs by provider organizations. The published materials included a presentation, a preamble document, and a matrix summarizing the priorities, goals, objectives and measures for meaningful use. Health Industry Insights expects to provide analysis in this community forum in the upcoming days, with more to come in our reports and publications. The deadline for public comments on the definition to the Health IT Policy Committee is June 26, 2009.

The presentation represents the findings of the Meaningful Use Workgroup, and is authored by Paul Tang and Farzad Mostashari, of the Palo Alto Medical Foundation and New York City Health Department, respectively. The presentation contains much of the same content in the preamble and matrix documents. The preamble lays the context for the definition, while the matrix details the specific priorities, goals, objectives and measures of meaningful use as they stand today. The measures and objectives are stratified by year, and are progressively more ambitious going forward from 2011, to 2013 and 2015. They are categorized according to five "health outcomes policy priorities" that are identified as:

Improvement to quality, safety and efficiency while reducing health disparities. This priority ties to goals, objectives and measures including access to data across care teams, CPOE and use of evidence-based order sets, medication lists, patient lists, recording of clinical data, clinical decision support, outreach to patients who need care, and reporting to registries.
Engagement of patients and families. This includes goals, objectives and measures surrounding the provision data and tools to patients and families to allow them to manage their health. Includes patient access to copies of clinical data, care summaries and educational materials.
Improving care coordination. Goals, objectives and measures specify the exchange of clinical information amongst providers (HIE) and medication reconciliation.
Population and public health. Goals, objectives and measures surrounding electronic communication with public health agencies on immunizations, reportable surveillance data and lab results.
Privacy and security. Goals, objectives and measures that ensure the security of personal health information during data exchange and sharing with patients and other providers, including compliance with HIPAA and the Nationwide Privacy and Security Framework.

The publications on meaningful use can be found on the Health IT Policy committee's website at: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1269&parentname=CommunityPage&parentid=1&mode=2&in_hi_userid=10741&cached=true.

We were surprised by a few things in the definition of meaningful use and look forward to delving deeper into it in coming days. What do you think of the definition of meaningful use? How will it change your organization's approach to EMR implementation? Or will it?

Keywords

arra, meaningful use, emr, ehr, electronic medical record, electronic health record, HIT policy committee

Will Hospitals be Ready in Time to Capitalize on ARRA Incentive Payments?

Mon, 15 Jun 2009 21:02:42 +0000

Entry by Lynne Dunbrack

Entry

For hospitals to maximize their incentives payments, especially those that have not begun to invest in the requisite healthcare information technology (HIT), they must act swiftly. After all they can begin qualifying as soon as October 1, 2010. But there are so many looming issues – "What does meaningful use mean?", "Who will be the certifying body?" – not the least of which is the economic crisis thwarting HIT investment in advance of the incentive payments to come in the new few years.

Recent news reports suggest that the economy is having a dire affect on hospitals and their ability to invest in and implement EMRs, EHRs and health information exchange technologies that would enable them to qualify for incentive payments and avoid later penalties. A stunning statistic is that approximately half of the U.S. hospitals were in the red in the third quarter of 2008 according to a Thompson Reuter analysis. A number of factors are impacting hospitals' bottom line:

Shrinking endowments. Hospital endowments are facing a double whammy. They've been battered by the stock market and philanthropy is down as patrons tighten their purse strings. Some hospitals were caught up in the Madoff scandal or their donors were.
Declining elective surgeries and preventive care. Patients, even those with insurance, are putting off seeking care in an effort to reduce their out of pocket expenses. A Massachusetts Hospital Association survey reported that 59% of Massachusetts hospitals surveyed saw "a drop in elective surgeries in 2008 and into the beginning of fiscal 2009."
Increasing charity and uncompensated care. As the number of uninsured or underinsured patients increases due to increasing unemployment, employers dropping health benefits for their employees or shifting to high deductible health plans, consumers will seek care where they know it must be provided - in the emergency department (of a non-profit hospital).

To cope with these massive losses and increased expenses, hospitals are freezing or cutting salaries, laying off staff, and deferring IT and other capital projects. A report by the American Hospital Association, The Economic Crisis: The Toll on the Patients and Communities Hospitals Serve, makes clear the grim reality facing hospitals in light of harsh economic conditions. The report concludes the impact of the economy on clinical and information technology projects. When asked about changes in capital plans since the capital crisis began in early 2008:

6 % of respondents reported that they stopped clinical technology projects already in process
32% reported scaling back projects already in process, and
34% decided not to move forward with projects planned

Many hospitals will find that they will have to wait for state matching loans and grants made possible through the $2 billion allocated to ONCHIT and available next year before resuming IT projects. Or look for financing arrangements with their IT vendors which are making loans available to their customers, such as GE Healthcare and IBM. The low rates of HIT adoption combined with the impact of the economy causing hospitals to layoff staff and defer IT projects does not bode well for Obama's vision of electronic health records for all Americans by 2014.

Keywords

EMRs ARRA Obama Economy GE Healthcare IBM

IDC Health Insights Community > EMR and EHR for Providers

How Many EMRs Can You Count?

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HIE Technology Solutions - A Nascent but Volatile Market (1 Comment)

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Progress on e-Prescribing with DEA Interim Final Rule

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Key Trends from HIMSS 2010

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What do Dell, eClinicalWorks and WalMart Have in Common? (3 Comments)

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The Ambulatory EMR Short Lists

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Meaningful Use and CPOE: The Clock is Ticking

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The Changing Landscape of Certification for Meaningful Use

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Meaningful Use On Deck!!

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Will Hospitals be Ready in Time to Capitalize on ARRA Incentive Payments?

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