Medical records Archives

Health-care providers still have a lot of work to do to meet key health IT requirements expected under the government's Stage 2 "meaningful use" standard, a new industry report finds.

CSC, an IT consulting firm based in Falls Church, Va., says the following essential areas require immediate attention:

• Electronic patient access to personal health information.


• Electronic capture of physician notes, including diagnosis and treatment, and rationale for excluding patients from treatment recommendations.


• Electronic exchange of patient information from one provider to another.

Only 12 percent of hospital chief information officers in a survey said they were prepared to allow patients to view and download their information; 24 percent said they couldn't yet transmit summary-of-care records when a patient left the hospital. And only 25 percent said they can meet proposed Stage 2 requirements for electronic physician notes.

The problem is twofold, they said: vendor products and operational readiness.

Expected Stage 2 goals for electronic medication administration (eMar) have been easier to reach, with 86 percent of the survey's respondents saying they are prepared to implement eMar in at least one hospital unit, as required.

The report combines information from early attesters to meaningful use with results of a survey of CIOs belonging to the College of Healthcare Information Management Executives.

Final rules for Stage 2 meaningful use are supposed to be published in July, but a delay is likely because the Centers for Medicare and Medicaid Services missed a December 2011 target date for releasing an early version of the rules.

While health-care professionals seem to love iPads, health IT professionals are less enamored with the consumer-friendly tablet computers, according to a new industry report.

Doctors and others are more likely to use technology they like, which could help chief information officers get everyone on board in using electronic health records and other health IT systems. But iPads in particular are challenging to integrate into existing health IT, according to the report from BizTechReports, "Diagnosis Danger: Governance and Security Issues Cause IT Concerns About iPad in Healthcare Settings."

"There is a sense of concern among healthcare IT executives that pressure to meet the demands of end-users to support consumer-grade computing and communications devices like the iPad is coming at the expense of other important priorities," the researchers reported.

Areas of concern reported by the 100 hospital and clinic CIOs and other health IT executives interviewed by BizTechReports, an independent, Washington, D.C.-based research group, include:

• Compliance with privacy governance requirements.


• The need to manage risk while sharing health information with other users.


• The ability to quickly react to and remediate data breaches.


• Integration with end-to-end productivity systems.

For example, electronic patient records are not meant to be managed on consumer-grade technology like the iPad, according to the report. It's also difficult to enter information from an iPad into an enterprise system like an EHR. Nor do iPads have mechanical keyboards or USB ports that can attach devices such as barcode scanners, severely limiting the number of applications they can support.

Panasonic Solutions Co. teamed with BizTechReports to produce the study.

The nation's health IT czar polished off his crystal ball this week and predicted five major health IT trends for the year. Dr. Farzad Mostashari, national coordinator for health IT, shared the prognostications on his office's Health IT Buzz blog:

• Meaningful use takes off. Mostashari projects that at least 100,000 providers will demonstrate that their electronic health records meet ONC standards for "meaningful use" by the end of the year, enabling them to receive Medicare or Medicaid incentive payments.


• Health information exchanges turn a corner. "ONC efforts are critical," he writes. "Robust policies that protect information and create public trust will galvanize rapid growth and innovation in health information exchange.


• The dots connect between health IT and payment reform. Pay-for-service models lead to higher costs, he argues, just as health IT helps hospitals and practices to move away from traditional pay models. "We are headed toward a virtuous cycle where payment reform improves the business case for using health IT and greater use of health IT improves the chances that new payment models will succeed."


• Consumers take advantage of eHealth resources. Mobile apps and other technological advances make it easier for patients to become more involved in improving their health, Mostashari says.


• Innovation drives improvement. Efforts in 2012 will focus on improving the usability of EHRs, he says.

Physicians who have an ownership stake in a medical practice are more likely than other doctors to rate EHR implementation as difficult.

That's the finding of a study published this month in the Journal of the American Medical Informatics Association.

"Physicians who own their practice may need more external support for EHR implementation than those who do not," the authors report in an abstract of the article. "Innovative clinical support staff may ease the EHR implementation process and contribute to its success."

In an article about the full report, ModernHealthcare.com said that about 25 percent of physicians who weren't practice owners termed EHR implementation as "very difficult." Among owners, 38 percent rated implementation as very difficult. The authors said financial risk might skew doctors' perceptions, Modern Healthcare reported.

The researchers, from Boston-based Partners HealthCare, interviewed 150 Massachusetts physicians.

The full article is available online to JAMIA subscribers or for purchase.

If you have to sit in traffic, you might as well do something to improve your health.

At the Digital Health Summit during this month's Consumer Electronics Show in Las Vegas, Ford Motor Company promoted mobile health apps enabled by its Sync computer system. Ford announced partnerships with Microsoft HealthVault, Windows Azure and Healthrageous Inc. to develop a prototype system that works with "compatible biometric measurement devices."

Sync "provides easy, voice-controlled access to mobile devices such as smartphones and tablets, and therefore it makes sense to research areas that are important to our customers," said Gary Strumolo, manager of infotainment, interiors, health and wellness at Ford Research and Innovation, in a news release.

Ford thinks cars could be the ultimate mobile-health platform. They're convenient and private, and they can provide "personalized access" to health information, products and services. Accessing health apps will give people something constructive to do when they're stuck in traffic, the automaker says.

BlueMetal Architects of Watertown, Mass., designed the prototype mHealth system. Boston-based Healthrageous compiles information collected from blood-pressure monitors, activity monitors and glucose meters along with "behavioral data" provided by the patient to help people end unhealthy habits, Ford says. Microsoft's programs "translate robotic sensory information" provided by the vehicle into an application with a voice and touch-screen interface.

The system will upload data from the driver to the HealthVault cloud and transfer the information to Windows Azure, which creates graphical reports that the driver can read upon reaching his or her destination.

A major U.S. Department of Health and Human Services contractor has fallen behind in its efforts to promote electronic health records, concluded the General Accountability Office in a Jan. 13 report.

The contractor, the not-for-profit National Quality Foundation, or NQF, failed to deliver five of eight projects related to electronic health records activity on time, according to the report, "Health Care Quality Measurement: HHS Should Address Contractor Performance and Plan for Needed Measures."

NQF converted existing quality measures to an electronic format compatible with EHRs -- 113 measures, according to the report. The retooling will allow data from EHRs to be exchanged and used for measuring quality of health care. The project deadline was September 2011, but the project was not completed until December, GAO said.

NQF also was required to convene an expert review panel to examine the retooled measures to ensure proper formatting and correct logic. The panel was convened in June, five months later than required.

As of August 2011, NQF had failed to meet timelines on 18 of 26 projects in nine contract categories during the first two years of the four-year HHS contract, the report said.

HHS and NQF officials listed several factors that they said contributed to the extended project timeframes. According to HHS, the first set of 44 retooled measures had errors requiring correction, including errors in electronic coding. Both organizations also said the estimated timeframes were "overly ambitious, given the scope and complexity of the work." HHS officials said "the technical complexity and labor required to complete the project were greater than anticipated."

NQF officials said HHS also modified the scope of work, requiring the company to hire extra staff to handle the work.

HHS officials told the auditors that they rely on NQF to inform them of problems in its monthly progress reports, but the GAO said the agency did not use available monitoring tools required under its contract with NQF. "These tools could have helped to provide an opportunity for HHS to make any appropriate changes to NQF's projects," the GAO said.

The GAO recommended that HHS:

• Use monitoring tools required under the NQF contract to obtain detailed and timely information on the company's performance and use that information to inform changes to timeframes, projects and cost estimates through the remainder of the contract.


• Ensure that testing of the electronic versions of the measures retooled by NQF to be used in the Medicare and Medicaid EHR incentive programs be completed in a timely manner to identify potential errors and address implementation issues.


• Develop a comprehensive plan that identifies the quality-measurement needs of HHS programs and initiatives and provides a strategy for using NQF's work product to meet those needs.

The nation's health IT czar is once again turning to the private sector to find innovative ways of spreading the word about the benefits of health technology.

This time the topic is how technology can help individuals set and meet health goals. The Office of the National Coordinator for Health IT's "Healthy New Year Video Challenge" asks people to share a resolution for improving their own or someone else's health. The challenge is to create videos that show how they will use technology to achieve and maintain their resolutions.

Entrants are encouraged to create videos that are "creative, inspiring and instructive" and relatable to others. Any health-related topic is fine, including quitting smoking or drinking, losing weight, reducing stress or managing a chronic condition.

Examples suggested by ONC include:

• I will set up an online personal health record for myself (or another family member) so I can have all of my health information conveniently stored in one place.


• I will ask my doctor for a copy of my own health records -- electronically if available -- and help him or her to identify any important information that may be missing or need to be corrected.


• I will use an electronic pedometer to help me track my physical activity and will try to take 10,000 steps per day.


• I will find an app on my smartphone to help me track my food intake so I can lose 10 pounds by my high school reunion.

The topic of health, including electronic records and health information exchanges, is among the top 12 legislative issues state lawmakers will grapple with in 2012, predicts the National Conference of State Legislatures.

States' lawmakers will focus on how to nudge health-care providers toward adopting certified EHRs, the bipartisan group said in a recent news release. Lawmakers also will seek to build health information exchanges that allow providers to access those EHRs, it noted.

"HIEs function like an online file cabinet where your medical record is securely stored, and can be accessed by any doctor or health care professional you visit," the legislative group said. "By mid-year 2012, every state should have Medicaid EHR Incentive programs in place and will be working toward building an HIE by late 2014 or early 2015 as required by deadlines attached to federal cooperative agreements."

The group also noted that the U.S. Supreme Court would hear arguments this spring on the federal health reform law, formally known as the Patient Protection and Affordable Care Act. A ruling is not expected until the summer, so states will have to move forward with health information exchanges and other requirements of the law, the organization said.

Here are the top 10 developments in health IT for 2011, straight from the national coordinator for health IT. Dr. Farzad Mostashari released the month-by-month list Jan. 6 on his Health IT Buzz blog:

• January: Medicare and Medicaid electronic health record incentive programs launched. Since then, "the marketplace of certified products has grown quickly, interest in meaningful use among providers and hospitals is sky-high, and the pace of incentive payments has continued to accelerate," Mostashari said. More than $1.8 billion in incentives had been paid to more than 20,000 health-care providers and 1,200 hospitals as of Nov. 30.


• February: ONC launched Direct Project, providing "a simple, secure, standards-based way for providers and other participants to send encrypted health information directly to trusted recipients over the Internet - a kind of 'health email,'" Mostashari said. Multiple vendors and states are implementing the system.


• March: The Health and Human Services Department, ONC's parent agency, released its National Quality Strategy, a framework to guide efforts to improve health-care, with health IT as a critical component.


• April: The "Summer of Standards" kicked off, a series of standards and interoperability forums to support Stage 2 standards and certification requirements for EHR incentive programs, resulting in consensus being reached on the Consolidated Clinical Document Architecture. Mostashari described the architecture as a "single, broadly supported electronic data standard for patient care transitions."


• June: The Investing in Innovations (i2) program used challenges and prizes to promote innovations in health IT. Several i2 challenges have been launched since, including a call to create applications "activating and empowering patients to improve their heart health."


• July: Health IT training curriculum was released on the open market in July. Employment continued growing in the health IT workforce, which added more than 50,000 jobs between 2008 and 2010, according to the Bureau of Labor Statistics.


• September: HHS' Office for Civil Rights issued its first report to Congress on breaches of protected health information. Breaches now must be reported to HHS, those affected, and in some cases the news media.


• September: ONC formally launched its Consumer e-Health Program, with the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention proposing regulations making it easier for patients to access lab data. More than 250 organizations covering more than 100 million people, including Aetna, the Mayo Clinic and AARP, have "agreed to make health information easily available to consumers," Mostashari said.


• October: ONC's 62 Regional Extension Centers passed their goals to enroll 100,000 "priority" primary-care providers nationwide, and by mid-December had enrolled 116,000 providers requesting help with EHR implementation, including 70 percent of rural primary-care providers.


• November: A CDC survey of office-based physicians showed the percentage of nonhospital-based physicians with a basic EHR doubled from 17 percent in 2008 to 34 percent in 2011, with nearly 40 percent of primary-care physicians adopting an EHR. The proportion of hospitals operating EHRs with the functionality required in the Medicare and Medicaid incentive programs rose from 2 percent to 41 percent, among hospitals eligible for the incentives.

Two teams using health IT tools to help prevent and treat cancer have been named winners in an Investing in Innovation (i2) challenge sponsored by the Office of the National Coordinator for Health IT.

Winners of the "Using Public Data for Cancer Prevention and Control: From Innovation to Impact" competition are:

• Ask Dory!, which helps patients learn about clinical trials for cancer and other diseases, using data from www.ClinicalTrials.gov and an algorithm to aid decision-making. The application was submitted by Chintan Patel, Dr. Sharib Khan, and Aamir Hussain of Applied Informatics LLC.


• My Cancer Genome provides options for therapy based on gene mutations in the patient's tumor. It uses clinical trial data from the National Cancer Institute and gene information under evaluation in therapeutic clinical trials. It was submitted by Dr. Mia Levy of the Vanderbilt University Medical Center.

"What makes these health IT challenges so powerful is their ability to catalyze the expertise and creativity of innovators both in and out of health care," says Wil Yu, ONC's special assistant for innovations. "We seek breakthrough solutions to nuanced issues. Some are ready for the marketplace and some are prototypes, but all will have a great potential to benefit Americans."

The other two finalists were Health Owl, which makes tailored recommendations on cancer-screening and decision-making based on family history and demographic variables, submitted by Michael Diefenbach and Kevin Durr; and Cancer App, by mHealth solutions, which provides personalized strategies for reducing cancer risk, submitted by Ralph Passarella.

The i2 cancer challenge was supported by the National Cancer Institute, part of the National Institutes of Health.