Research | EMR and EHR

Geisinger Opens Doctors’ Notes To Patients

Geisinger Health System is kicking off a new program under which more than 100,000 patients will have access to their doctors’ notes. Patients will access the notes through the secure MyGeisinger online patient portal, reports Healthcare Informatics.

The initiative grows out of a pilot, funded by a $1.4 million grant from the Robert Wood Johnson Foundation. The OpenNotes project, which lasted 12 months, brought together 105 primary care doctors with more than 19,000 of their patients, in an effort to see how both patients and physicians were affected by the sharing of doctors’ notes after each encounter, according to Healthcare Informatics.

The study group included 24 Geisinger primary care docs and 8,700 patients. The rest of the patients and doctors were drawn from Harborview Medical Center, Seattle, Wash., and Beth Israel Deaconess Medical Center.

Results from the pilot, which were published in the October 2012 Annals of Internal Medicine, showed that patients strongly favored seeing their physician’s notes. Also, tellingly, no doctors asked to opt out at the study’s end.

Findings showed that patients did indeed read their notes and felt more a part of the care process when they did. Roughly 11,200 patients (or about 82 percent) opened at least one note found in their EMR.

Of patients who opened at least one note, 77 to 87 percent across the three study sites said that OpenNotes made them feel more in control of their care. Doing so also helped them adhere to their medication regimens, the magazine said. Only a few patients reported higher levels of worry, confusion or offense due to seeing the notes.

Patients liked having the notes access so much that 85 percent reported that it would influence their choice of providers in the future.

It seems that opening up a patient portal isn’t quite the pandora’s box that some thought it could be.

EMR, HIE Use Up Sharply In U.S.

A new survey by Accenture has concluded that the number of U.S. doctors using EMRs — either in their practice or at a hospital — has climbed to over 90 percent, and that almost half are using HIEs. More than half of doctors surveyed (60%) report using an EMR in their own medical practice.

The Accenture survey reached out to 3,700 doctors in eight countries, including Australia, Canada, England, France, Germany, Singapore, Spain and the U.S. Data showed a spike in healthcare IT usage across all of the countries surveyed.

In the U.S., doctors had the biggest increase in adoption demonstrated in the survey, up 32 percent in routine use of health IT capabilities, as opposed to an average increase of 15 percent among non-U.S. clinicians, reports HealthcareIT News.

Other standout activities were e-prescribing (65 percent using) and entering patient notes into EMRs (78 percent), a 34 percent annual increase between 2011 and 2012. Forty-five percent of physicians also use IT for basic clinical tasks such as getting alerts while seeing patients (45 percent), according to Healthcare IT News.

Healthcare IT News also caught an interesting detail around lab orders. The magazine notes that 57 percent of U.S. doctors said they regularly use electronic lab orders (a 21 percent annual increase) the volume of physicians doing so internationally dropped 6 percent.

Globally, the number of doctors who “routinely” access clinical data on patients seen by different health organizations has climbed by 42 percent, from 33 percent of doctors in 2011 to 47 percent in 2012. Spain was the leader by a significant margin, with 69 percent of doctors routinely accessing such data.

The study also concluded that internationally, almost 60 percent of doctors customarily enter patient notes electronically either during or after consults.

On the other hand, so-called “digital doctors” are still unlikely to connect or transact electronically with outside organizations. Accenture found that only 10 percent of physicians communicate electronically to support remote consults/diagnostics, and that roughly 20 percent e-prescribe, receive notifications of patients’ interactions with other health organizations and communicate electronically with clinicians in other organizations.

NY Hospital Links DNA Profiles With EMR

New York’s Mount Sinai Medical Center has launched a new program designed to link patient DNA to optimal treatments, in which patients consent to DNA sequencing, contact with researchers and longitudinal studies related to data within their EMR.

To date, 25,000 people have signed up to participate in the biobank program, BioMe. BioMe is designed to access a broad range of clinical and environmental information stored in the EMR and link it with genetic information provided by patients. BioMe also offers doctors the opportunity to give patients more targeted care based on their DNA profile. The program is funded by The Charles Bronfman Institute for Personalized Medicine at Mount Sinai.

As part of this effort, a team of doctors, genetic scientists and IT experts at Mount Sinai are gradually implementing a new program called CLIPMERGE (Clinical Implementation of Personalized Medicine through Electronic Health Records and Genomics). CLIPMERGE is using a new tool, developed at Mount Sinai, which gives doctors real-time therapeutic suggestions based on patient genetic profiles. The idea behind these technologies is to link CLIPMERGE and BioMe, bringing up to the moment information on genetic responses to certain medication to the patient bedside.

Right now, real-time feedback on ideal medications based on DNA profiles is available for three conditions related to cardiovascular disease, blood clots and high cholesterol. The idea is that as scientists discover other DNA-specific responses to therapeutics, CLIPMERGE and BioMe will help bring them to practicing physicians quickly.

According to Healthcare IT News, the BioMe databank will include diverse human ancestry, with self-reported 25 percent of African ancestry, 30 percent of European ancestry, 36 percent of Hispanic Latino, and 9 percent of other ancestry.

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May 6, 2013 I Written By Anne Zieger

Filed Under: EHR Electronic Health Record Electronic Medical Record EMR Healthcare Healthcare IT Hospitals Population Health Research

Tags:BioMe CLIPMERGE DNA Testing Genetic Medication Genomic EMR Genomics Mount Sinai Medical Center

Study: EMRs Have Saved Canadian Health System $1.3B Since 2006

At our current stage of EMR implementation, the evidence is sketchy at best that EMRs are draining costs from the U.S. health system. But our friends to the north seem to be capturing tangible savings, according to new research by Pricewaterhouse Coopers LLP (PwC).

The PwC study, which was backed by the Canada Health Infoway, a not-for-profit whose focus is accelerating the development of EMRs by family physicians, looked at the implementation of EMRs by family doctors across Canada. The study focused on the period between 2006 and 2012.

Adoption of EMRs by primary care doctors in Canada has more than doubled between 2006 and 2012, from 23 percent to 56 percent, Healthcare Informatics reports. These EMR investments were paid for largely through investments by the provinces and territories in EMR programs, medical practices and Infoway.

According to Healthcare Informatics, PwC found that during that period, the Canadian system saved $800 million Canadian dollars in administrative efficiencies, such as staff spending less time pulling charts and less time by doctors reading and maintaining paper files.

PwC also found savings of $584 million Canadian dollars in health system efficiencies, such a drop in duplicated diagnostic testing and adverse drug events.

In addition to concrete financial savings, EMR adoption improved chronic disease management and preventive care, such as mammogram screening rates. EMR use also improved communication between care providers, as EMRs allowed new providers to quickly and easily research histories on patients without resorting to archaic fax communications.

As part of PwC’s research, they cited examples which paint the picture of how EMRs are changing healthcare in Canada.

Since implementing EMRs, PwC notes, 67 percent of Saskatchewan’s family doctors, office managers and specialists say that their medical practices are more or significantly more productive than before. Also, 94 percent of of doctors enrolled in Alberta’s EMR program said that patients get their test results faster; in addition, 97 percent said that they’re not needlessly repeating tests and investigations.

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May 3, 2013 I Written By Anne Zieger

Filed Under: EHR Electronic Health Record Electronic Medical Record EMR Healthcare Healthcare IT International EMR Research

Tags:Canadian EMRs PricewaterhouseCoopers PwC

EMR and EHR Whitepapers

For a while I’ve been considering how the Healthcare Scene network of blogs can provide an EMR, EHR and healthcare IT whitepaper service. Over the many years I’ve been blogging about EMR and EHR, I’ve seen a lot of really valuable whitepapers created by the various EHR vendors. The time required to create a whitepaper is lengthy and for someone looking for an in depth look at a subject, a whitepaper is a nice option.

With that in mind I recently launched a new EMR, EHR and Healthcare IT whitepaper portal. We’re just getting started with the healthcare whitepaper portal, but we’ll be growing the content that’s available there over time. We’ll also be including a nice sidebar widget for those interested in the latest whitepapers we have to offer and we’ll embed a list of whitepapers in the email subscription as well.

We already have a number of great whitepapers available. For example, athenahealth created this whitepaper on Making the Switch: Replacing Your EHR for More Money and More Control. We’ve often talked about EMR switching becoming a very popular and important topic. This whitepaper helps a practice considering the EMR switch to go through an analysis of why to switch EMR or not.

Another whitepaper by NextGen is called The tips and tools to help you on the path to MU (Meaningful Use) and beyond. Considering less than 50% of providers have attested to meaningful use, this could be useful to many. It contains a lot of great resource links and some tips on how to approach meaningful use. If you’re looking at meaningful use stage 2, check out this one from AdvancedMD called Achieving Stage 2 Meaningful Use in Private Practice.

Those are just a few examples. You can find many more of them on this EMR and EHR whitepaper library page. I look forward to adding a lot more interesting whitepapers in the future. Hopefully you’ll find the content valuable.

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April 23, 2013 I Written By John Lynn

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Filed Under: ARRA EHR Electronic Health Record Electronic Medical Record EMR Healthcare IT Research

Tags:AdvancedMD athenahealth EHR Whitepapers EMR Whitepapers Meaningful Use Meaningful Use Stage 2 NextGen

Another Study Highlights Physician EMR Unhappiness

The evidence keeps coming in, over and over, like waves pounding on a beach. Many physicians aren’t happy with their EMRs, and the number of discontented doctors seems to be growing — with an undetermined but sizable number seeming likely to switch this year.

This time the evidence comes courtesy of the American College of Physicians and EMR selection site AmericanEHR Partners. A new study by the pair reports that physician satisfaction with EMRs dropped 12 percentage points between 2010 and 2012, and that the number who are “very dissatisfied” grew by 10 percentage points, FierceEMR reports.

These numbers, which were drawn from 4,279 responses to multiple surveys between March 2010 and December 2012, are a particularly strong reflection of the mood among smaller practices. Seventy-one percent of doctors/practices responding to the survey were in practices with 10 physicians or fewer, the ACP said.

These physicians seem downright upset with their current vendors. In fact, 39 percent of clinicians said they wouldn’t recommend their current EMR to a colleague, up sharply from the 24 percent who said the same in 2010.

According to the ACP, physicians feel their EMR is failing them in several key areas:

* Improving care: Doctors who were “very satisfied” with their EMR’s ability to improve care fell by 6 percent from 2010, while the “very dissatisfied” climbed 10 percent, with surgical specialists the least satisfied specialty.

* Decreasing workload: ACP found that 34 percent of users were “very dissatisfied” with their ability to decrease workload, up from just 19 percent in 2010.

* Return to pre-EMR productivity: The number of respondents who had not returned normal productivity after their EMR install was 32 percent in 2012, up from 20 percent in 2010.

* Ease of use: Dissatisfaction with EMR ease of use climbed to 37 percent in 2012, up from 23 percent in 2012, while satisfaction dropped from 61 to 48 percent.

That we’re seeing something of an EMR backlash seems obvious here. The question is, will unhappy physicians switch futilely and end up just as unhappy, or are they going to actually improve their experience?

Few Healthcare Pros Have Attested To Meaningful Use

Despite all of the attention given to Meaningful Use, it seems that eligible healthcare professionals have been relatively slow to achieve compliance. A new report published in the New England Journal of Medicine concludes that just over 12 percent of EPs had attested to the Medicare portion of Meaningful Use as of May 2012, well into the life of the program.

The reasons for this relatively low uptake are complex, but clearly, the EMRs physicians are buying are part of the problem. As a piece in iHealthBeat notes, the National Center for Health Statistics recently found that only 27 percent of office-based physicians had EMRs capable of supporting 13 of the Stage 1 objectives for the MU program. Since EPs have to meet 15 core objectives, plus five of 10 menu options, that leaves the remaining 73 percent of office-based physicians out in the cold.

To calculate uptake of Meaningful Use attestation for the NEJM, researchers with Brigham and Women’s Hospital looked at combined CMS data from April 2011 to May 2012, and GAO estimates of the number of eligible professionals in the U.S.

The researchers found that 12.2 percent of 509,328 eligible professionals had attested to the Medicare portion of the MU program as of May 2012, including 17.8 percent eligible PCPs and 9.8 percent of specialists. PCPs accounted for 44 percent of all Medicare Meaningful Use attestations, the researchers concluded.

Looked at state by state, the median Medicare attestation rate was 7.7 percent of eligible professionals, though rates varied from 1.9 percent in Alaska and 24.2 percent in North Dakota.

These statistics must not be very encouraging ones for CMS, particularly the leaders are ONC. And they certainly make one wonder whether the mass of doctors will end up facing penalties in 2015 rather than making sure they attest to Meaningful Use Stage 1. This should be a real eye-opener for policymakers. As for doctors whose systems simply won’t make the grade, well, this has been called the year of the big EMR switch. I guess we may see even more switching than we expected.

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February 25, 2013 I Written By Anne Zieger

Filed Under: EHR Electronic Health Record Electronic Medical Record EMR EMR Adoption Healthcare Healthcare IT Meaningful Use Research

Tags:Brigham and Women's Hospital CMS Eligible Professionals iHealth Beat Meaningful Use Attestation Meaningful Use Measures

US Lags Behind On Physician EMR Use

US doctors are far behind most of their counterparts in Europe and Australia when it comes to EMR adoption, according to a new study by The Commonwealth Fund.

To get a sense of EMR adoption internationally, the Fund surveyed almost 9,800 primary care physicians representing 11 countries. The results: the U.S. still has a ways to go to catch up with peers in other developed nations.

True, U.S. doctors’ uptake of health IT has gone up dramatically, from 46 percent using an EMR in 2009 to 69 percent in 2012, the study found.

That being said, doctors in such countries as the Netherlands, Norway, New Zealand, the U.K., Australia and Sweden all reported EMR usage rates above 88 percent in 2012. The country with the lowest adoption rate was Switzerland, which trailed all countries in the survey with a 41 percent EMR uptake rate by physicians in 2012.

As for sophisticated usage of EMRs, defined by the Fund as using at least two electronic functions such as order entry management, generating patient information, generating panel information or clinical decision support, the U.S. didn’t make it onto the list of power users. Only the U.K., Australia and the Netherlands had more than 50 percent of doctors who did so.

Despite the gap in usage between other nations and the U.S., I thought the nearly 70 percent rate of primary care usage was a very positive sign. I don’t know if this jump is 100 percent attributable to Meaningful Use — I believe PCPs see the writing on the wall and will go with EMRs to manage medical home functions regardless — but either way, it’s a sign that changes major and permanent have happened among the primary care flock.

Still, what really matters isn’t just how many PCPs have bought an EMR. What I’d like to know is how many of those 70 percent are tackling Meaningful Use requirements effectively, and how many are still stymied. If I find that data you can be sure I’ll share it here!

Health IT Doesn’t Save As Much As Hoped Due To Interoperability Failures

Does health IT actually save money for health organizations? That’s a billion-dollar question — one which the whole Meaningful Use program rises or falls, I’d argue — but it still hasn’t been resolved. For what it’s worth, though, here’s some thoughtful input on the subject.

According to a new study appearing in the journal Health Affairs, always the class act of the health policy game, health IT isn’t generating cost savings because of slow adoption and limited interoperability, iHealthBeat reports. The research was conducted by the RAND Corporation.

Specifically, RAND researchers say, the productivity and cost benefits of health IT have been held back by:

* Slow adoption
* Reluctance of many clinicians to burn the midnight oil needed to truly master such systems
* Failure of the healthcare system as a whole to implement process changes needed to realize health IT system benefits

Another big issue is lack of interoperability between many health IT systems, the RAND researchers said. They note that previous predictions about health IT savings assumed that systems would be connected, thereby increasing efficiency.

To get savings from health IT, the U.S. healthcare industry needs to do the following, RAND says:

* Patients should be able to access their electronic health data and share those records with other health care providers
* Health care providers should be able to easily use health IT systems across different health care settings
* Health information stored in one IT system should be retrievable by health care providers that are part of other health care systems
* Health IT systems should be set up to support — rather than hinder — the work of clinicians

No one of these points should come as a surprise, but given the stakes involved, it doesn’t hurt to hammer them home again. The whole interoperability “thing” isn’t going away…

ONC Plan Focuses On Health IT Safety

The ONC has decided that it’s time to move health IT safety up to the next level, proposing a plan that would standardize the way health IT safety incidents are reported and make it easier to report straight from an EMR. And brace yourselves, vendors: this could include changing the EMR certification process to include the ability to make such reports easily.

The agency’s Health IT Patient Safety Action and Surveillance Plan is designed to strengthen patient safety efforts, including patients, providers, technology companies and healthcare safety oversight bodies in the mix. The idea, not surprisingly, is to use health IT to make care safer.

The ONC’s key objectives include the following:

* Making it easier for clinicians to report patient safety events and risks using EMRs

Right now, it’s not exactly easy for clinicians to create a safety event report when something goes wrong in their use of an EMR, and the data they do sometimes produce isn’t easy to work with or compile. ONC is proposing using certification criteria to make sure that whenever possible, EMRs make it easy to report safety events using the Agency for Healthcare Research and Quality’s standardized Common Formats.

* Getting health IT developers to support patient safety and safety reporting

Within 12 months, the ONC plans to create a code of conduct — working with professional groups and health IT developers — which will hold developers accountable for:

– Creating usable, safe designs for products and adverse event reporting
– Working with a Patient Safety Organization to report, aggregate and analyze health IT related safety events
– Scrapping practices that discourage provider reporting of safety events, such as limits in nondisclosure clauses and intellectual property protections
– Participating in efforts to compare user experiences across different EMR systems

There’s plenty more to consider in this report, but I’ll leave you with these details in the hope that you’ll read it yourself. As you’ll see in the introduction, you have until February 4th to comment on ONC’s plans. I hope plenty of readers do — this is important stuff.

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January 2, 2013 I Written By Anne Zieger

Filed Under: Certified EHR EHR Electronic Health Record Electronic Medical Record EMR EMR Technology Healthcare Healthcare IT Research

Tags:ahrq Health IT Safety ONC Patient Safety

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- What flows through you into the world? (2)
  - John Lynn: Pat, That’s really kind of you to say. I’ll keep trying to do good.
  - Pat Rioux, RHIT: John, the good you do is asking the right questions, making the right observations and always...
- Geisinger Opens Doctors’ Notes To Patients (1)
  - Jay Alicea: It will be interesting to see what happens when they open up laboratory results to patients.
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  - Ellie: Thank you for raising this issue. This should apply to nurses as well. And not just for chronic diseases. Many...
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