Will Federal criteria for meaningful use of Electronic Health Records make doctors less likely to adopt them?

Hmmm…some pushback from the American Medical Association and other interest groups to get the the Centers for Medicare and Medicaid Services (aka Uncle Sugar) and to change the requirements for meaningful use criterion. The Centers for Medicare and Medicaid Services or CMS will have to be careful how they deal with this. Will be interesting to see how they respond. All in all this does not augur well for the speedy adoption of EHR’s.

“Last year, CMS launched an incentive program that bestows up to $44,000 under Medicare or up to $64,000 under Medicaid on clinicians who demonstrate meaningful use of EHRs, with “meaningful” defined as improving and streamlining the quality of patient care. In 2015, penalties kick in for physicians who have yet to go digital with Medicare patients.

Medical societies routinely suggest amendments to proposed federal regulations in a process that resembles negotiating the price of a car: The government comes in with high demands, the medical societies lobby for the bar to be lowered, and the final regulations usually land somewhere in between.

That kind of haggling occurred in 2010, when CMS proposed its so-called stage 1 measures for meaningful use. One measure was that physicians must electronically transmit at least 75% of their prescriptions to pharmacies. The societies said these standards were too tough, and CMS subsequently relaxed them, setting the electronic prescription threshold at just 40%, for example.

The same give-and-take is shaping up for the proposed stage 2 measurements, which will take effect in 2014, except that the changes sought by the societies are far more extensive. The medical societies recommended, for example, that CMS survey physicians on stage 1 meaningful use criteria to find out what worked and what did not, what kept participation in the incentive program at a low level in 2011, and what should be done to improve stage 2 measures. Only then should the government proceed with raising the bar, the medical societies said.

In addition, the societies want CMS to drastically alter its timetable for penalizing physicians under Medicare for failing to demonstrate EHR meaningful use. Under the proposed stage 2 criteria, CMS would dock physicians 1% of their Medicare pay in 2015 based on their performance either in 2013 or the first 9 months of 2014. “CMS is essentially pushing up deadlines for participation by up to 2 years,” the medical societies stated. It urged an end to this so-called backdating and said that CMS should allow physicians to avoid the 2015 penalty by demonstrating meaningful use in the first half of that year.”

Are adverse errors in medicine an order of magnitude more common than current estimates?

This is startling news from Healthaffairs.org ! If the methodology is sound and it pans out, I think the underwriting and risk management for hospitals will have to adjust mightily, and in short order:

The patient safety study, conducted by David Classen of the University of Utah and coauthors at the Institute for Healthcare Improvement, compared three methods for detecting adverse events in hospitalized patients, including the Institute’s own Global Trigger Tool. The study drew on comparable samples of patients from three leading hospitals that had undertaken quality and safety improvement efforts.

Among the 795 patient records reviewed, voluntary reporting detected four events, the Agency for Healthcare Research and Quality (AHRQ) Indicators detected 35, and the Global Trigger Tool detected 354 events, ten times more than the AHRQ method.  In other words, the AHRQ indicators and voluntary reporting missed more than 90 percent of adverse events identified by the Global Trigger Tool.  If anything, the researchers say, their findings are conservative, because they rely on medical record review, which would not detect as many adverse events as direct, real-time observation would.

The researchers say that reliance on voluntary hospital reporting or the AHRQ indicators could lead to seriously flawed perceptions of patient safety in the United States.  They also note that the Global Trigger Tool detected a much higher rate of adverse events for hospitalized patients than previous studies have shown.  Although the Global Trigger Tool is a somewhat more resource-intensive method because it involves medical record review, the researchers suggest that it could be incorporated into commercial electronic health record systems, thus making it easier and less costly to use.

More disturbing perspectives that should keep you eating your apple a day:

An analysis by Jill Van Den Bos and colleagues at Milliman’s Denver Health practice in Colorado, based on insurance claims, estimated the annual cost of measurable preventable medical errors that harm patients to be $17.1 billion in 2008 dollars.  Ten types of errors accounted for more than two-thirds of the total cost, with the most common ones being pressure ulcers, postoperative infections, and persistent back pain following back surgery.  The researchers recommend that these three types of errors receive top priority for intervention and improvement.

John Goodman of the National Center for Policy Analysis, and coauthors, found that there is a social cost to adverse events, and it is based on what people would be willing to pay to avoid the risk of death or injury caused by medical management.  That dollar figure ranges from $393 billion to $958 billion.  Yet the United States has few policies to compensate patients harmed by medical errors, other than a “very imperfect tort system,” in which fewer than 2 percent of patients harmed ever file a malpractice suit and even fewer receive any compensation, the researchers note.

 

 

Marianne McGee on what a lot of people in healthcare informatics are wondering: what are the challenges to being recognized for “Meaningful Use” of Electronic Health Records?

I suspect I am not the only one who depends on Marianne McGee to keep me in the know about the evolving knowledge about how the “meaningful use” criterion are going to be fully established, reviewed, and operationalized. I would like to know as much as she or John Halamka but I have a dissertation to finish!

from http://www.informationweek.com/blog/main/archives/2010/04/top_10_meaningf.html

Meaningful use criteria will come into effect in three incremental stages. Stage one starts in 2011, followed by stage two in 2013, and stage three in 2015. Healthcare providers have until end of 2014 to achieve any of the stages, but the more stages they achieve before 2015 the bigger the payout in meaningful use bonuses they’ll get. (By 2015, penalties will begin kicking in for non-compliance.)

Right now, it’s estimated that fewer than 6% of the nation’s healthcare providers have health IT–such as e-health records and computerized physician order entry systems–in place to meet even stage-one meaningful use requirements, said Walt Zywiak, a CSC principal researcher in an interview with InformationWeek.

1. Capture the data–that includes collecting and entering data in a structured formats so that data can be sorted and selected for reporting purposes, said Zwiak.

2. Establish effective workflows to reinforce data entry, including medication reconciliation. For instance, “often, an organization’s workflow needs to be modified to make sure data is entered,” while patients are being cared for, whether it’s vital signs like blood pressure or allergy updates, said Zywiak.

3. Drive provider involvement in adoption of the EHR. “The primary users of these systems need a say” in what’s selected, said Zwiak.

4. Computer-based provider order entry (CPOE). “In ambulatory settings, 80% of orders, including tests, referrals and medication prescriptions, will need to be entered electronically,” he said.

5. Start e-prescribing. “Do this as soon as possible,” he said.

6. Develop a process for managing clinical decision support. This could include different clinical reminders for individual doctors in the same multi-specialty practice. For instance, a primary care doctor might need different alerts than a dermatologist caring for the same diabetic patient.

7. Implement patient health information exchange workflows. As a healthcare provider, “you’ve got to provide patients access with information–but will you do this via a patient portal or through a [third party] personal-health record” site, such as Google Health, said Zwiak.

8. Formulate a provider health information exchange strategy. “How will you exchange patient summary data with hospitals, specialists?,” he said.

9. Ensure privacy and security compliance. “Most primary care organizations haven’t been on an EHR, so they think of HIPAA in terms of protecting paper-based information,” he said.

10. Initiate EHR-based quality performance measurement support. “You’ll need to report quality measures to Medicare and Medicaid,” he said.

a year later, the details of “meaningful use” are coming into focus

Almost one year ago, the President signed the HITECH Act: “Health Information Technology for Economic and Clinical Health” as part of ARRA, the “American Recovery and Reinvestment Act.” This part of the stimulus bill is intended to incentivize the migration away from legacy paper health records and non-standard health records towards electronic health records (EHRs), via incentive payments to physicians of up to $44,000, starting next year.

Since the passage of ARRA, there has been much speculation and some tentative analysis of how the criteria for “meaningful use” of EHR/EMR will play out. With the recent announcements by the Feds, the details are at last becoming more-or-less apparent. There is still the period of review and input from stakeholders and the public, so there may be some changes, but at this point the basic operational definitions can be characterized. My friends at Software Advice.com put together a very useful summary and representation of how the suits at CMS and ONC are making sense of the “meaningful use” provision:

“In the table below, we’ve combined the meaningful use objectives for both eligible professionals (physicians) and hospitals for the Stage 1 adoption year, the required EHR technology criteria to accomplish those objectives and what criteria the government will use to measure meaningful use.

CMS defines “meaningful use” as using an EHR for the objectives listed in the first column. The objectives fall under these general topics:

* Improving quality, safety, efficiency, care coordination, population and public health;
* Reducing health disparities;
* Engaging patients and their families; and,
* Ensuring adequate privacy and security protections for personal health information

For the first time, CMS has also outlined specific measurements for how the government will determine if an EHR is being used in a meaningful manner for the Stage 1 (2011) adoption year. Updated definitions of meaningful use for Stage 2 (2013) and Stage 3 (2015) EHR adoption periods will be released in the year before those periods begin.

This table outlines what Stage 1 objectives define meaningful use, what software features are necessary to accomplish those objectives and what criteria the government will use to measure meaningful use. EP refers to eligible professional.

For the full article, see http://www.softwareadvice.com/articles/medical/the-stimulus-bill-and-meaningful-use-of-qualified-emrs-1031209/

“meaningful use” criterion for EHR/EMR’s proposed

The Feds are moving forward with operationalizing “meaningful use”, as CMS and ONC have now put out an official statement proposing a definition. After many months of speculation, it appears the Healthcare IT world is much closer to knowing just what hospitals and clinical practices need to do to get their chunk of the ARRA stimulus money. It is possible that the comments from interested parties may substantially modify what is being proposed here, of course:

from http://www.hhs.gov/news/press/2009pres/12/20091230a.html

“The proposed rule would define the term “meaningful EHR user” as an eligible professional or eligible hospital that, during the specified reporting period, demonstrates meaningful use of certified EHR technology in a form and manner consistent with certain objectives and measures presented in the regulation. These objectives and measures would include use of certified EHR technology in a manner that improves quality, safety, and efficiency of health care delivery, reduces health care disparities, engages patients and families, improves care coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information.

The proposed rule would define meaningful use for the Medicare EHR incentive programs. It proposes one definition that would apply to eligible professionals participating in the Medicare fee-for-service and the Medicare Advantage EHR incentive programs as well as a proposed definition that would apply to eligible hospitals and critical access hospitals. These definitions also would serve as the minimum standard for eligible professionals and eligible hospitals participating in the Medicaid EHR incentive program. The rule proposes that states could request CMS approval to implement additional meaningful use measures, as appropriate, but could not request approval of fewer or less rigorous meaningful use measures than required by the rule.

This rule proposes a phased approach to implement the proposed requirements for demonstrating meaningful use. This approach would initially establish reasonable criteria for meaningful use based on currently available technological capabilities and providers’ practice experience. CMS will establish stricter and more extensive criteria for demonstrating meaningful use over time, as anticipated developments in technology and providers’ capabilities occur.

CMS provides a 60-day comment period on the proposed rule. “The definition and requirements for demonstrating meaningful use of EHR technology are proposals. CMS welcomes and will give serious consideration to comments that improve our proposal while achieving the goals Congress established for the EHR incentive programs,” Frizzera said.”

Cognitive load, medical error, sterilization, and “the checklist”

I was chatting with a veteran of the medical insurance business the other day and mentioned “cognitive load“, which is a common enough concept in psychology, systems usability, and human factors engineering, but otherwise sounds like arcane jargon. The demands on attention are labeled cognitive load, and job performance can suffer with too high a load. My companion gave me a look as if I had once again strayed far off into academic theory-land, but I made the point that high cognitive load is directly related to medical error and risk management. Indeed, liability management may be the next growth area for the new field of medical cognition.

Not so long ago I did research on limiting physician liability for Texas Medical Liability Trust because of the overhead associated with patients suing due to the adverse effects of “off label” medications. Doctors have a lot to worry about, their workflow involves high cognitive load, the proliferation of forms and paperwork subverts their job satisfaction, and of course my recommendation was to add yet another standard operating procedure!

This article in the New Yorker about “the checklist” for reducing the high cognitive load of medical professionals via a standard operating procedure opened up my eyes to the benefits of implementing best practices:

“On any given day in the United States, some ninety thousand people are in intensive care. Over a year, an estimated five million Americans will be, and over a normal lifetime nearly all of us will come to know the glassed bay of an I.C.U. from the inside. Wide swaths of medicine now depend on the lifesupport systems that I.C.U.s provide: care for premature infants; victims of trauma, strokes, and heart attacks; patients who have had surgery on their brain, heart, lungs, or major blood vessels. Critical care has become an increasingly large portion of what hospitals do. Fifty years ago, I.C.U.s barely existed. Today, in my hospital, a hundred and fifty-five of our almost seven hundred patients are, as I write this, in intensive care. The average stay of an I.C.U. patient is four days, and the survival rate is eighty-six per cent. Going into an I.C.U., being put on a mechanical ventilator, having tubes and wires run into and out of you, is not a sentence of death. But the days will be the most precarious of your life.

(snip)

Expertise is the mantra of modern medicine. In the early twentieth century, you needed only a high-school diploma and a one-year medical degree to practice medicine. By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. Already, though, this level of preparation has seemed inadequate to the new complexity of medicine. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology—or critical care. A young doctor is not so young nowadays; you typically don’t start in independent practice until your mid-thirties.

We now live in the era of the super-specialist—of clinicians who have taken the time to practice at one narrow thing until they can do it better than anyone who hasn’t. Super-specialists have two advantages over ordinary specialists: greater knowledge of the details that matter and an ability to handle the complexities of the job. There are degrees of complexity, though, and intensive-care medicine has grown so far beyond ordinary complexity that avoiding daily mistakes is proving impossible even for our super-specialists. The I.C.U., with its spectacular successes and frequent failures, therefore poses a distinctive challenge: what do you do when expertise is not enough?

(snip)

Yet it’s far from obvious that something as simple as a checklist could be of much help in medical care. Sick people are phenomenally more various than airplanes. A study of forty-one thousand trauma patients—just trauma patients—found that they had 1,224 different injury-related diagnoses in 32,261 unique combinations for teams to attend to. That’s like having 32,261 kinds of airplane to land. Mapping out the proper steps for each is not possible, and physicians have been skeptical that a piece of paper with a bunch of little boxes would improve matters much.

In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check. These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.

The next month, he and his team persuaded the hospital administration to authorize nurses to stop doctors if they saw them skipping a step on the checklist; nurses were also to ask them each day whether any lines ought to be removed, so as not to leave them in longer than necessary. This was revolutionary. Nurses have always had their ways of nudging a doctor into doing the right thing, ranging from the gentle reminder (“Um, did you forget to put on your mask, doctor?”) to more forceful methods (I’ve had a nurse bodycheck me when she thought I hadn’t put enough drapes on a patient). But many nurses aren’t sure whether this is their place, or whether a given step is worth a confrontation. (Does it really matter whether a patient’s legs are draped for a line going into the chest?) The new rule made it clear: if doctors didn’t follow every step on the checklist, the nurses would have backup from the administration to intervene.

Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.”

Holding individual clinicians accountable for medical mistakes?

from www.nytimes.com/2009/12/17/health/17chen.html?_r=1&hpw

“Published by the Institute of Medicine, “To Err is Human: Building a Safer Health System” estimated that as many as 98,000 people died in hospitals each year as a result of preventable mistakes. Being hospitalized, it turned out, was far riskier than riding a jumbo jet.

While the report offered comprehensive strategies to improve safety, its main conclusion was that medical errors were primarily a result of “faulty systems, processes and conditions that lead people to make mistakes or fail to prevent them.”

Spurred on by this finding, health care leaders across the country began addressing errors believed to be a result of systemic flaws. They instituted more rigorous hospital accreditation standards and procedures, increased public reporting and transparency and established systemwide safety changes like the mandatory use of checklists, the placement of hand sanitizing gel dispensers throughout hospital wards and the regulation of physician duty hours. For nearly a decade, this paradigm of systems failure defined the national movement to improve patient safety.

But more recently, some health care safety experts have begun questioning the assumption underlying the report’s conclusions: that only health care systems, and not individual clinicians, could be held accountable for medical mistakes.

Dr. Robert M. Wachter, a professor of medicine at the University of California, San Francisco, and a national leader in patient safety, recently published two critiques of the safety movement, one in Health Affairs and one in The New England Journal of Medicine. Both urge physicians to begin acknowledging their individual roles in medical errors. “A blame-free culture carries its own safety risks,” he writes. “As we enter the second decade of the safety movement, while the science regarding improving systems must continue to mature, the urgency of the task also demands that we stop averting our eyes from the need to balance ‘no blame’ and accountability.”

will evidence-based medicine shift hospitals to accountable-care organizations?

from http://www.dallasnews.com/sharedcontent/dws/bus/stories/112909dnbusbaylor.3d5ccc5.html

In an accountable-care organization, doctors and hospitals share a financial incentive to control costs and improve quality by coordinating care for a defined patient group.

Today, most medical care in Dallas and across the nation is delivered piecemeal. Doctors are paid for each patient visit. Hospitals are paid for each procedure. This “fee-for-service” model rewards caregivers for how much they do rather than how well they do it.

Health economists say it does too little to ensure that the people treating a patient know what’s been done by other caregivers. Too often, the result is duplication, waste and mistakes that are both expensive and dangerous to a patient’s health.

But what sounds like a commonsense approach is full of complications. Accountable care relies on a single, bundled payment that’s spread across all caregivers dealing with a patient. In its model, Baylor, with a powerful hold on much of the North Texas hospital industry, will decide how patients should be treated and how the payment pie is sliced. Doctors, hospitals and insurers in North Texas have a hard time trusting each other. And medical professionals don’t like being told how to do their jobs.

Patients may not like it either. The last overhaul of patient care and payments on this scale took place in the 1990s, when HMOs, or health maintenance organizations, were introduced on a wide scale. Patients rebelled against insurers getting between them and their doctors on decisions about care, and they may not see much difference if it’s a hospital rather than an insurance company making the calls under accountable-care.

In 2000, 3 million Texans were enrolled in HMOs. Last year, it was 852,000.

In that decade, however, Dallas changed from an average spender for health care to one of the biggest spenders in America on a per-patient basis.

Congressional Democrats have struggled for months to write legislation that will extend coverage to more Americans, including many in Dallas who lack health insurance. Insurance might persuade some of those people to seek preventive treatments they now skip because of cost. The legislation also encourages communities to try models such as accountable-care organizations, under the theory that doing so will lead to better care at lower cost.

“I don’t think we can really afford to wait for what might happen with national health care legislation,” said health economist Mark McClellan, keynote speaker for Monday’s summit.

“It’s very clear we need to move to more preventive care, and more coordinated care. While legislation can help address that, there are certainly a lot of steps that can be taken in the meanwhile, ahead of health care reform.”

Wooing employers

Roberts said Baylor will not wait for Congress to pass a health care overhaul bill. Instead, he has been going directly to large North Texas employers with a pitch that Baylor can improve quality while lowering costs with an accountable-care model.

“I might go to a Texas Instruments and say, ‘I know you’ve been struggling with your health care costs. Can we help you bend the cost curve?’ ” Roberts said.

Early next year, Baylor will meet with the Texas Employees Retirement System and Blue Cross Blue Shield of Texas to see if it can help slow the growth of the system’s health care costs.

Those costs for the 528,000 participants are projected to be $2.1 billion by year’s end, according to the system’s records.

“We will be looking at a number of innovations in plan design and reimbursement structure, including patient-centered medical homes, clinical integration and an accountable-care organization structure,” Roberts said.

In Baylor’s accountable-care plan, Baylor would be held responsible for organizing its hospitals and physicians to lower costs. In a contract, the employer would have to agree to a number of terms, possibly changing health insurance plans, which could set up fights between Baylor and health insurers. The contract might also require the employer to hire an outside wellness program developer to get workers in shape, Roberts said.

What’s less clear, and more controversial, is whether employers would instruct workers to visit only Baylor doctors and hospitals.

Roberts said he’s unsure what employers will do. If employees are given the freedom to choose their doctors and decide not to participate in Baylor’s accountable-care system, then Baylor has limited power in controlling costs.

If workers are limited to Baylor services, the hospital system secures a steady revenue stream and leverage over regional hospital competitors.

One difficulty facing health providers that are considering accountable-care models is how to sell the idea to patients without their feeling it’s just another cost-control measure.

“The challenge with evidence-based treatment is that sometimes we don’t like what the evidence shows,” said Eduardo Sanchez, chief medical officer of Blue Cross Blue Shield of Texas. Sanchez pointed to the uproar over a federal advisory panel’s recommendations that women younger than 50 don’t need routine annual mammograms screening for breast cancer. The panel warned that early testing causes many more false diagnoses and needless procedures than life-saving cancer detections.

“Does preventive medicine have to save money to be worthwhile?” Sanchez asked. “The response has been that, clearly, it shouldn’t be driven by the idea of saving money.”

NYTimes report: major hospital push for EMR/EHR

The September 27 New York Times is reporting an announcement that certain large hospitals are investing in EHR/EMR technology. To the extent that this adds to the evidence that the migration to the new world of electronic records is finally happening en masse, this is of course significant. But I can’t tell how this one system’s project fits into the big picture. Thousands of doctors are supposed to be offered the money, but what if word gets out that the IT is too complicated or glitchy or not user-friendly enough? The sums offered as an incentive may not be enough for cautious, busy, change-averse physicians. Usability and quality control are paramount here, and those of us in the user-centered design and quality engineering worlds should see this as an opportunity.

(It is also possible that states that pressure doctors too much to be early adopters may see some physicians leaving for less adventuresome regions. This supposedly occurred after tort reform passed in Texas)

“North Shore-Long Island Jewish Health System plans to offer its 7,000 affiliated doctors subsidies of up to $40,000 each over five years to adopt digital patient records. That would be in addition to federal support for computerizing patient records, which can total $44,000 per doctor over five years.

The federal program includes $19 billion in incentive payments to computerize patient records, as a way to improve care and curb costs. And the government initiative has been getting reinforcement from hospitals. Many are reaching out to their affiliated physicians — doctors with admitting privileges, though not employed by the hospital — offering technical help and some financial assistance to move from paper to electronic health records.

Efforts by hospital groups to assist affiliated doctors include projects at Memorial Hermann Healthcare System in Houston and Tufts Medical Center in Boston. But the size of the North Shore program appears to be in a class by itself, according to industry analysts and executives.

Big hospitals operators like North Shore, analysts say, want to use electronic health records that share data among doctors’ offices, labs and hospitals to coordinate patient care, reduce unnecessary tests and cut down on medical mistakes.

But hospitals are seeking a competitive edge, too. Digital links, analysts say, can also tighten the bonds between doctors and the hospital groups that subsidize the computerized records. In most local markets, independent physicians typically have admitting privileges at more than one nearby hospital, and so hospitals compete for doctors as well as patients.

“The North Shore-L.I.J. program is larger than other programs,” said Wes Rishel, a health technology expert at Gartner. “And it punctuates a trend of hospital groups trying to solidify and tighten relationships with physicians in their communities.”

In other words, the government-backed campaign to hasten the adoption of electronic health records has the potential not only to change how health care is delivered. It could also influence which institutions emerge as leaders in delivering care, as some local markets consolidate further.

The North Shore program is to carry strong incentives to use the electronic-record technology to try improving the health outcomes for patients — like managing diabetes, heart disease and other chronic conditions — to reduce costly hospital admissions.

The subsidy will be 50 percent of the total cost for physicians who simply install electronic health records that can communicate between the doctor’s office, labs and hospitals.

But the subsidy will rise to 85 percent of the total costs of digital records for physicians who agree to share data — stripped of personal identifiers — on patient measures that include glucose levels for people with diabetes and post-operative procedures and prescriptions for heart patients. That could help North Shore amass an ever-growing database of evidence indicating which treatments and procedures yield the best medical results”

how important is Dell’s EHR/EMR project?

I just read that Dell is offering something called the Affiliated Physicians EMR Solution

Possibly reflecting my background as much more of a software than a hardware person, I am not at all sure how much of a game changer this is. Dell is a mighty force in the IT world, no doubt about that. I think there is a pretty obvious logic that medical offices could benefit from a standardized, modularized, low-cost integrated server solution with (say) Linux as the OS and MySQL or MS SQLServer handling queries generated by interacting with an EHR/EMR user-end application.

But while Dell has a proven track record in delivering low-cost solutions, I am not sure why they are an obvious fit for an EHR/EMR solution. Is it because they can sell cheap servers? But why have the server farm at the office at all? Why not run it on the “cloud” at a server farm somewhere? Is Dell wanting more of the hosted applications market? If that is the game, then the medical offices are not necessarily interacting with the hardware provider in any meaningful way, so much as outsourcing their EHR/EMR needs to a hosting company or Software as a Service company.

Of course ensuring HIPAA compliance is no trivial matter, but still…can Dell offer an on-site solution that is better than off-site hosted ones? Physicians typically have more money than time. Maybe the economies of scale involved here with Dell’s plan make it ultimately cheaper to host these mission-critical, data intensive applications yourself?

Maybe Dell is morphing from a hardware company to more of a services company? IBM has made a bundle dropping (relatively) low-margin hardware sales for higher-margin services and support. Nice work if you can get it. I suppose this is part of the strategy for righting the company after going through some difficult quarters even before the recession hit.

According to dell.com

“Together, Dell and participating hospitals are eliminating long-standing barriers to EMR adoption for small and medium medical practices: cost, complexity and interoperability. Dell’s Affiliated Physician EMR Solution lets hospitals sponsor their affiliated physicians with an EMR solution that is interoperable with the hospital’s own health information systems. The solution includes industry-leading EMR and practice management software, hardware systems, and a complete service and support portfolio. Financing options minimize physician up-front and out-of-pocket expenses until ARRA reimbursement starts.

Healthcare providers who adopt EMR and achieve “meaningful use” by 2011 are eligible to receive the maximum reimbursements of up to $44,000 in Medicare or $66,000 in Medicaid from the American Recovery and Reinvestment Act. Reimbursements decline every year thereafter until 2015. Physicians who do not achieve meaningful use by 2015 risk Medicare and Medicaid penalties.

Hospitals:
While many hospitals offer their affiliated physicians “access” to the hospitals’ health information systems, this still doesn’t manage the totality of patient care. In order for true coordinated care to exist, physicians and their patients must be connected with hospitals before admission. By sponsoring this EMR program, your hospital will be building this connection. Together with Dell, your hospital plays a pivotal role in supporting physicians with the ability to accelerate the use of health information technology, improve patient safety, and reduce healthcare costs.

Affiliated Physicians:
The question isn’t if you’re going to transition to electronic medical records (EMR). It’s when. But, faced with all of the decisions and regulations, getting from here to there can seem daunting. That’s where Dell comes in. Dell has created a comprehensive solution that simplifies EMR adoption and management, allowing you to focus on your mission of improving patient care”

The Austin American Statesmen has an article that reads like a press release:

“Health care is a valuable new target sector for Dell. The company has relied increasingly on sales to government in recent quarters to make up for big drops in computer spending by large corporations.

Dell said its early partners in the electronic records program include Tufts Medical Center in Boston and the Memorial Hermann Healthcare System in Houston.

Tufts, along with the New England Quality Care Alliance industry group, worked with Dell to design the program.

Dr. Jamie Coffin, Dell’s vice president for health care and life sciences, said Dell’s program helps attack the digital divide in the medical system where hospitals and affiliated doctors do a poor job of sharing patient records.

“Patient information that is locked away in paper records, electronic medical records solutions that are beyond the reach of most physician practices,” Coffin said. “Hospitals and physicians share patients, but not patient information. With our hospital partners, we are knocking down (electronic medical records) barriers.”

Analyst Judy Hanover with IDC said Dell has introduced one of the first comprehensive solutions for hospitals and affiliated doctors.

Elecronic medical records technology “has existed fore nearly 20 years, but cost, complexity and other barriers have kept it beyond the reach of physician practices and many hospitals, the front line of our health care system,” Hanover said.

Dell spokesman Cathy Hargett said her company believes it is important for hospitals to be the lead partner in such systems so that affiliated doctors can invest in compatible records systems.

The computer maker is plans to work with a variety of software vendors including eClinicalWorks to deliver the applications that hospitals and doctors want to use. Dell will provide a variety of services to help hospitals and doctors practices to set up such systems – including financing, needs assessment, work flow consulting, system configuration, software installation, training and support’