Welcome to EMR and EHR

HHS has put up an interesting new part of their website called “Health IT Journey: Stories from the road.” Here’s their description:

Have you, your practice, or your organization been through a health IT implementation? We’d like you to share your story with us. After internal review, your story may be published to inspire other providers and organizations to become meaningful users of Electronic Health Records (EHRs). Let’s learn together.

Of course, it also comes with the following disclaimer:

Disclaimer
Posting of the articles on this Web site does not necessarily constitute HHS or ONC endorsement of the procedures followed; vendors, products and services named; or overall performance of the facility’s delivery of care. We do hope you find these narratives insightful and useful in your efforts to adopt health information technology and improve patient care.

It seems like ONC is mostly looking for stories that have been published somewhere. They link to 3 articles already, but only one of those is actually available without paying for the service or signing up. This was an article about using an EHR to quantify the number of patients you’re seeing in the New England Journal of Medicine (NEJM).

Of course, you can probably imagine how high the bar is to get your story shared in the NEJM. With that said, I’m always interested in posting interesting stories on this site about people’s use of an EMR or experiences with the EMR selection and implementation processes. So, if you have a story you want to share, just send it to me on the EMR and EHR Contact form. It will be interesting to see how HHS/ONC will look at publications on blogs like this one, but they’ve been pretty open to bloggers in the past.

It will be really interesting to see what other stories are submitted, approved and published by ONC. I do applaud their efforts to try and spread the stories of EMR success. That’s a very good thing. It’s just too bad they’re promoting these stories that are stuck behind a pay wall. That’s not the way to spread good stories of HIT success.

I found this article on the WSJ Health blog titled, “Study: VA’s Computer Systems Cost Billions, but Have Big Payback” Of course, I was intrigued since I knew how much the VA had spent on their EMR and so I wanted to learn about this Big Payback that the study found.

Maybe I’m reading this wrong (in which case I’m sure you’ll correct me), but the article states that the four VA health IT systems they studied had a $3.09 billion cumulative benefit. Then, they say that just the Vista system alone cost $3.6 billion.That doesn’t seem like a good return to me. Unless, I’m misunderstanding the first number and they’re actually saying that the benefit received was a total of $3.09 billion over the $3.6 billion spent. Yes, $6.69 billion in benefit. Does either conclusion make sense to you?

Of course, the most insightful part of the article/study was the limits on the data: “the VA has a unique, integrated structure that is more likely to produce results from IT projects and is hard to match in the private sector. In short, they say your results may vary.”

Today at HIMSS, the findings of a research study by the FCC was released.  I find it pretty interesting that the FCC is looking at healthcare IT.  The research study did an analysis of the healthcare IT infrastructure and its ability to support the growth of helathcare IT. Here’s a short summary of their findings:

FCC research has found that the current broadband available to physicians is cost prohibitive and can be a barrier to important developments in health IT.

• Physician offices with less than 5 doctors can have their needs met by currently available commercial offerings, usually at a reasonable cost. Even so, roughly 3,600 small practices lack access to even the basic broadband services they require to achieve Meaningful Use.
• Practices with more than 5 practitioners face a larger challenge. They need a higher level of broadband, and tens of thousands of offices in this category face prices that differ significantly, often by $45,000 or more per year for the same level of service. The gap is substantially larger for rural providers

These disparities offset meaningful use incentives and can prove to be a barrier to health IT adoption.

The FCC plans for a major expansion in its efforts to bring high-speed broadband service to healthcare providers. The program is authorized to spend up to $400 million per year, making it the largest sustainable fund for healthcare connectivity. Currently the FCC only spends approximately $70M per year of the $400M due to limitations in how it is authorized to spend the funds. Funds can currently be let through:

–   The Rural Healthcare Support Mechanism subsidizes telecommunications expenses of rural non-profit and public healthcare providers that face higher broadband prices than their urban counterparts. Also covers 25% of the internet service fees

–   Rural Healthcare Pilot Program—a one-time program with 63 projects (totaling $417M) to build dedicated healthcare broadband networks

National Broadband Plan Recommendations:

The FCC would like to substantially expand broadband subsidies to healthcare providers where service is unaffordable, including in urban areas. FCC is requesting a change to improve the health IT infrastructure, including:

• Allowing private institutions to be eligible for funding (not just non profits and public institutions)
• Supporting deployment of new broadband networks where they are insufficient by creating a permanent infrastructure program
• Linking FCC funding to outcome metrics such as “Meaningful Use” to ensure support goes to locations that use health IT in support of guidance from the Office of the National Coordinator for Health IT

It looks like Shahid gets a lot of the same emails I get. He recently posted some suggestions on how to break into the healthcare IT industry. Here’s some of his ideas:

• If you’ve got experience running or working in a medical office or you’re an experienced project manager you can apply for an implementation specialist or assistant at almost any healthcare IT firm like an EMR or EHR vendor, consulting firm, or systems integrator. The thing to keep in mind is that every customer that buys an EMR needs to have it installed and deployed and that’s done by implementation folks. There is a shortage of people that can take complex products like EHRs and EMRs live.
• If you have a little or a lot of general IT experience but no healthcare IT experience you can start by working in a technical support or training capacity. You would get the opportunity to learn new products and use your IT experience to provide customer service, support, and training talent.
• If you’re interested in the software side you can think of being a tester of software; vendors need good quality assurance and configuration management personnel and that’s a great place to begin your healthcare IT career.
• If you’re good at writing, consider joining the documentation team for creating training materials, videos, screencasts, or other related artifacts necessary to teach people how to use healthcare IT.
• If you’re a developer interested in writing software but you’re not experienced in healthcare, join one of the many open source projects that are out there building open source EMRs, EHRs, PHRs, and related tools. Open source is a great way to join a community of people willing to help you if you’re willing to give back to them, too.
• If you’re an integration specialist (you know EAI, EDI, EII, ETL, ESBs, or other integration techniques) start to learn HL7, CCR, and CCD and you can write your own ticket almost anywhere. The majority of healthcare problems in the IT arena are integration and deployment problems so if you know scripting and HL7 you’re good to go.

That’s a pretty good list for people searching for HIT jobs. I also like to point people to this list of EMR, EHR and HIT job websites. I’ve had really good reviews for that resource. I also liked Shahid’s suggestion of working on an open source EMR project in order to gain the experience in the healthcare field.

HHS Secretary Kathleen Sebelius today announced awards totaling $27.8 million to health center-controlled networks and large multi-site health centers to implement electronic health records (EHR) and other health information technology (HIT) innovations. The funds are part of the $2 billion allotted to HHS’ Health Resources and Services Administration (HRSA) under the American Recovery and Reinvestment Act of 2009 (ARRA) to expand health care services to low-income and uninsured individuals through its health center program.

“The increased use of health information technology is a key focus of our reform efforts because it will help to improve the safety and quality of health care generally while also cutting waste out of the system,” said Secretary Sebelius.

“These funds to expand and upgrade electronic health records systems will make a huge difference for health centers struggling to provide health care to the growing number of people in need,” said HRSA Administrator Mary Wakefield, Ph.D., R.N.

“Broad use of health information technology has the potential to improve health care quality, prevent medical errors, and increase the efficiency of care provision,” added David Blumenthal, National Coordinator for Health Information Technology. “This program supports the Department’s overall efforts to assist physicians and hospitals in adopting and becoming meaningful users of health information technology.”

Eighteen grants totaling more than $22.6 million will support EHR implementation. Grants totaling more than $2.6 million will help four grantees implement a variety of HIT innovations, including the creation of health information exchanges among different providers and the incorporation of HIT at dental delivery sites. Another five grants totaling over $2.5 million will help health centers devise plans to use existing EHRs to improve patient health outcomes.

Read more about the release of HIT grants and the list of grants that were given on the HHS website.