Friday, September 19, 2008

Need To fix the issue at root...

Hospitals Slow To Help Doctors Adopt EHRs, Study Finds

The federal government has eased physician self-referral and anti-kickback regulations to encourage hospitals to subsidize doctors' adoption of electronic health records, but most hospitals are not taking advantage of the temporary change in policy, according to a Center for Studying Health System Change study released Thursday, Modern Healthcare reports. 

The relaxed physician self-referral and anti-kickback regulations are set to expire Dec. 31, 2013.

Looking at 24 hospitals in 12 representative metropolitan areas, researchers found that only seven hospitals were pursuing a strategy to provide financial or other support to doctors to purchase EHR systems, with just four hospitals reporting that they had begun implementing their plans or that implementation was scheduled for the near future.

The remaining 17 hospitals were in various planning and evaluation stages and did not expect to take action this year.

The report found that the two main factors motivating hospitals to support physician EHR adoption were improving quality and efficiency and "aligning physicians more closely with the hospital."

Hospitals said they were not doing more to subsidize EHR adoption because of the burden of ongoing health IT projects, budget limitations and a lack of physician interest.

The Robert Wood Johnson Foundation funded the study (Robeznieks, Modern Healthcare, 9/18).

Wednesday, September 10, 2008

Can IT Help Hospitals Improve Their Relationships With Community Physicians?

In boardrooms across the country, health system chief executives are searching for any tactic that might better align hospital and physician interests. Downward pressure on physician incomes has placed unprecedented strain on hospital-physician relations. At a minimum, doctors are increasing their productivity by reducing the time they spend on hospital initiatives. On the other of end of the spectrum, some physicians are competing directly with local hospitals through physician-owned outpatient centers. 

From a hospital perspective, this growing disconnect could not come at a more inopportune time. From reining in supply costs by standardizing preference items to enhancing quality on reported metrics by complying with evidence-based guidelines, physicians hold the power to make or break hospitals' most critical priorities. Health system executives have responded by experimenting with a wide variety of strategies to exert greater influence over physicians. 

So what does this have to do with IT? Until the spring of 2007, not a whole lot. That's when HHS and IRS ruled that hospitals and other key stakeholders could subsidize up to 85% of the costs of electronic health records for physician offices. A new hospital-physician alignment strategy was born. Prior to the changes, the Stark Act and federal anti-kickback rules were interpreted to bar hospitals from donating technology or making other gifts to doctors or independent physician practices. 

Hospital leaders theorize that subsidizing EHRs can generate significant goodwill with physicians. They envision a world in which the seamless transfer of information between the physician office and the hospital would encourage doctors to admit patients to that hospital. In its Annual Survey of Executive Opinions on Key Information Technology Issues, 
Modern Healthcare reported that more than 70% of hospitals already extend IT benefits to physicians through the waiver program or plan to do so in the next two years.

Challenges of Physician Office EHR Implementation

While their peer executives celebrated the Stark ruling, hospital CIOs cringed. During recent Advisory Board research on physician office EHR implementation, one hospital IT executive commented, "I used to view Stark as my friend. I could tell independent physicians, 'I would love to help, but Stark won't let me.' ... Philosophically, it's not too hard to argue that the physician office [electronic health record] would be wonderful, but the fact of the matter is that I'm faced with an unlimited list of capital requests just from my own facilities, never mind trying to take on all the needs of physician offices." 

The challenges of implementing EHRs in independent community physician offices are numerous. They include: 

  • Allocating the necessary resources within an already overburdened hospital IT department;
  • Educating physicians on the hardware and infrastructure investment they must make without the hospital's support;
  • Integrating physician office data with information from inpatient systems (which might not be integrated themselves);
  • Accelerating change management within independent community physician offices where the hospital has little or no authority; and
  • Protecting physician productivity (and income) following implementation.

For hospitals subsidizing physician office EHRs, the stakes are high and failure is not uncommon. 

While serving as the National Coordinator for Health IT, David Brailer wrote, "Clinicians who purchase an EHR and who attempt to change their clinical practices and office operations face a variety of risks that make this decision unduly challenging. Implementation failure and partial use of EHRs are commonplace."

Effects on the Hospital-Physician Relationship

To be sure, offering physician office EHRs to community physicians will change the hospital-physician relationship, but not necessarily for the better. Hospital IT departments will effectively become vendors for their community physicians, providing services to doctors for a fee, albeit a heavily discounted fee. 

Because most physicians expect the same level of service and flexibility offered by vendors, many hospitals have turned to a vendor-hosted application service provider model. While outsourcing affords a number of benefits, it limits the hospital's opportunity to build close relationships with physicians and potentially restricts access to patient information. Furthermore, early adopters have found that even when implementation is outsourced, many physicians still hold the hospital accountable for successful deployment.

Beyond any hoped-for improvements in physician-hospital relations, there is genuine value in collecting and communicating information between care settings. Wiring community physician offices with an interoperable office-based EHR holds the potential to elevate care quality by breaking down information silos across sites of care. 

With poor information transfer causing 20% of adverse drug events, there is a clear opportunity to reduce these events and the associated costs through office-based EHR adoption. In order to achieve these community-wide gains, however, a critical mass of physicians must adopt the office-based EHR, and the systems must be interoperable with inpatient systems. 

Unfortunately, securing interoperability is fraught with roadblocks, including the multitude of vendor products, uncertainty over data ownership and physician concerns with patient privacy. As a result, only about a third of family practice physicians with an office EHR have an interface with the hospital, according to a survey conducted by 
Family Practice Management.

Hospital executives viewing EHR subsidies as a powerful strategy for aligning interests with their community physicians should consider that the negative ramifications to hospital-physician relations of a failed implementation might very well outweigh any potential goodwill generated from a successful deployment. Hospitals and health systems hoping to strengthen their relationships with community physicians through EHR subsidies might be better off considering alternative strategies.

Source : Matt Cinque (iHealthbeat)

U.S. Lags Behind Other Countries in EHR Adoption

The U.S. trails other countries in electronic health record adoption, according to a recent Commonwealth Fund report, Modern Healthcare reports.

EHR use in the U.S. increased from 17% in 2001 to 28% in 2006, according to the report. However, if adoption continues at the current rate, it will take more than 30 years to expand clinical support tools to all U.S. physicians, the report states.

Meanwhile, 98% of physicians in the Netherlands, 92% of physicians in New Zealand and 89% of physicians in the United Kingdom have adopted EHRs. In addition, 79% of physicians in Australia and 42% of physicians in Germany have adopted EHRs. 

Canada's adoption rate is lower than the U.S., with 23% of physicians using EHRs (DerGurahian, 
Modern Healthcare, 7/18).

Source : ihealthbeat.

How Long Will It Be Until the Majority of U.S. Hospitals Use EHRs?

Forty-six percent of respondents said they believe that most U.S. hospitals will use electronic health records within 10 years, while 31% of respondents predicted that the majority of U.S. hospitals will use EHRs within five years, according to a new survey by health care technology firm Picis.

Fifteen percent of respondents said most U.S. hospitals will use EHRs within 15 years, while 8% said it will be 20 years before most hospitals use EHRs. 

The survey also found that nearly 90% of respondents said they believe that EHRs are going to "revolutionize" the health care system. 

More than 55% of respondents said patients would be more likely to want to visit a hospital that has an EHR system, while about 3% said patients would be less likely to want to visit a hospital with an EHR system, according to the survey. About 42% of respondents said an EHR system would not make a difference in whether patients wanted to visit a hospital.

Results are based on a June survey of 325 physicians, nurses, IT technicians and hospital administrators. 

Source: Picis

Telemedicine Adoption

Interesting : Online Tool Lets Seattle-Area Residents Compare Health Care Performance

The Puget Sound Health Alliance has launched an online tool that lets consumers research the performance of medical facilities in the Seattle area, the Seattle Post-Intelligencer reports.

The Community Checkup report lets users search for performance data on several health conditions, including diabetes, heart disease and depression. The site also provides information on how consistently health care facilities provide recommended care to patients. 

The Web site includes performance results for 26 hospitals, 14 medical groups and many clinics in the Seattle area. 

The information on the site was compiled using public data from HHS. Later this year, the Health Alliance will publish the second Community Checkup report and update the online information (Black, 
Seattle Post-Intelligencer, 9/9).