Anesthesia Billing & Management

As hospitals increasingly adopt electronic health record systems, a new study has found that inpatient physicians who receive patients from the emergency department have begun to do “chart biopsies” of electronic records in preparation. It’s helped doctors be better prepared beforehand.

The study, published in the Journal of the American Medical Informatics Association, defines a chart biopsy as “the activity of examining a patient’s health record to orient oneself to the patient and the care that the patient has received in order to inform subsequent conversations about or care of the patient.”

The researchers spent two years at the University of Michigan Health System (UMHS), studying general internal medicine physicians and surgeons who received patients from the emergency department.

During the study, doctors had access to electronic health records for inpatient and outpatient documentation, and those used in the emergency department. When doctors and nurses in the emergency department entered data into their EHR, the inpatient doctors had immediate access to the information. Eventually, doctors began to review the emergency care charts before speaking with the physician who admitted the patient from that department.

The study defined three primary roles for the chart biopsies: provide an overview of the patient, prepare for patient handoff and subsequent care, and avoiding potential biases.

“Chart biopsies appear to impact important clinical and organizational processes,” wrote researchers. “Among these are the nature and quality of handoff interactions and the quality of care.” The study authors concluded that a “chart biopsy has the potential to enrich collaboration and to enable the hospital to act safely, efficiently, and effectively.”

Last summer, we mentioned data that suggested e-prescriptions are on the rise. Surescripts, which operates the nation’s largest e-prescription network, stated that about 36 percent of physicians file prescriptions electronically. However, that number increased by about 70 percent from 2009 to 2010.

That trend appears to be continuing as Surescripts just announced that over 52 percent of office-based doctors are now use e-prescribing.

E-prescriptions are seen by many as an important step in the evolution of our healthcare system. They make for a more accurate, reliable and secure electronic prescription system and also allow prescribers to access important information regarding their patients’ medications and health plan coverage.

Here’s the latest data from Surescripts regarding the growth of e-prescribing nationwide:

• 52 percent (291,000) of all office-based physicians now actively use e-prescribing compared with fewer than 10 percent three years ago

• There are 357,000 active prescribers on the Surescripts network (including office-based physicians, nurse practitioners and physician assistants)

• 94 percent of retail pharmacies nationwide are now connected and receiving e-prescriptions

And finally, here is the list of the top 10 states with the highest rate of e-prescribing:

1.  Massachusetts                
2.  Delaware                
3.  Michigan                    
4.  Connecticut                    
5.  Rhode Island                    
6.  Pennsylvania
7.  South Dakota*
8.  Iowa*
9.  Oregon*
10. North Carolina*

(*New to the top 10)

“In the next five years, we are going to see electronic health information exchange of all types – e-prescribing, clinical summaries, population health – become commonplace and become the rule rather than the exception,” said Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center in Boston.

There is some good news for Oregon hospitals and health care providers who serve Medicaid patients: there are federal grants available to support their efforts in implementing electronic health records.

On September 26, 2011, Oregon hospitals and eligible health care providers became eligible for these new grants. Those health care providers eligible for the program can receive up to $63,750 over a period of six-years. There will be various factors that determine the value of the grants.

Oregon’s Medicaid EHR Incentive Program is administered by the Oregon Health Authority’s Office of Health Information Technology, and moving forward, is set to help with better care and lower costs on behalf of Oregonians.

The Medicaid EHR Incentive Program is a part of the federal American Recovery and Reinvestment Act of 2009, which encourages states to make the switch to electronic health records. It’s not only intended to help hospitals and healthcare providers make the switch to secure EHR systems, but empower doctors and patients to work together to manage their private and up-to-date health records, increasing efficiency, and avoid redundant procedures.

Healthcare providers can apply now. There are a number of qualifying points, but if you are a provider with less than 90 percent of your services provided in a hospital, you may qualify for the program. For more information on the criteria for qualifying, go to the Medicaid Electronic Health Records Incentive Program website.

There are many reasons to advocate the transfer to electronic medical records. It has cost saving benefits and even can help improve the quality of care patients receive. However, if there is an improvement that needs to be addressed, it may be the privacy issues, something that opponents of electronic records often point out.

Veriphyr, a Los Altos, California-based identity and access intelligence solutions provider, conducted a survey of 90 healthcare IT managers. What they found should be a concern EHR proponent and opponents alike.

According to the survey, over 70 percent of healthcare organizations reported a breach of personal health information over the preceding 12 months. Most of these breaches were committed by nosy employees: 35 percent looked at the medical records of their co-workers and 27 percent accessed records of friends and relatives.

“While the loss of patient data on hard drives and USB sticks gets a lot of coverage, the top concern of compliance officers is the few employees who misuse the legitimate access to snoop on patient data,” says Alan Norquist, CEO of Veriphyr.

Norquist suggests that the focus on resolving the privacy problem should not be on digital security as much as tools that monitor who accesses the files. He goes on to suggest that healthcare organizations need identity and access intelligence tools that can monitor logs of employee access to patient data.

His reasoning is sound, because he points out that the main problem is not deviant outsiders hacking into the system, rather it’s employees who have access to the records.

“The problem is not authentication to keep the bad guys out, but monitoring the employees who have almost unrestricted access to patients’ data. The reason this data is greatly unrestricted is because in a life or death situation you would not want to prevent a doctor or nurse from getting the patient data they need right away,” says Norquist.

Google’s high-profile and bold mission has always been to organize the world’s information. Unfortunately (or fortunately depending upon your perspective), they haven’t been particularly successful in their health records business.

Last month, Google announced that it is folding Google Health, where consumers could organize their medical records. Starting in 2008, Google Health allowed users to manually input their health information or log in to their accounts with health services providers who partnered with Google. Some of the volunteered information included health conditions, medications, allergies, and lab results.

So what led to the demise of Google Health? For one, according to an IDC Health Insights study released last month, only seven percent of all Americans have ever used a personal health record (PHR). As more and more healthcare providers move toward electronic health records (EHRs) and health information exchanges (HIEs), the use of PHRs is expected to steadily rise. It’s just a little too late for Google Health.

“Experts say its untimely death is, in many ways, an extension of U.S. health-care providers’ failure to share data across institutions, or make it easy for patients to obtain it,” said David Talbot of MIT’s Technology Review.

Isaac Kohane, who directs the informatics program at Children’s Hospital in Boston, and co-directs Harvard Medical School’s Center for Biomedical Informatics, says that will be at least five years before data is flowing smoothly enough for something like Google Health to work. Beyond efficiency problems, some analysts feel that Google failed to create enough trust with people who may be wary about what would happen to their health records once they were loaded on Google’s servers.

Google Health will be shut down January 1, 2012, but people who currently use Google Health will be able to transfer their information to another PHR platform, such as Microsoft HealthVault, WebMD, or NoMoreClipboard, through January 1, 2013. Beyond that, they will be permanently deleted from Google Health.

An electronic prescription is any sent by computer to the pharmacy of choice. Federal programs offer incentives to physicians to file prescriptions electronically. So why is it that only 36 percent of doctors do so?

Sometimes progress can be slow, but there is and upward trend. That move upwards is being attributed to incentives offered by two federal programs that give physicians rewards for using the technology.

According to an annual report by Surescripts, which operates the nation's largest e-prescription network, about 50 percent of the physicians who take advantage of prescribing medications electronically are cardiovascular specialists, family physicians, or internists.

By the end of 2010, 190,000 physicians were e-prescribing medications. But if you include nurse practitioners and physician assistants that number jumps to 234,000, which is up from 156,000 in the previous year.

While it's estimated that only 36 percent of all doctors do electronic prescriptions it is promising to note that from 2009 to 2010 it increased by nearly 70 percent. One reason the increase isn't even higher is that controlled substances were not allowed to be transmitted electronically until the middle of 2010.

Rewards and Penalties

The federal government is offering incentives for doctors to switch over to the e-prescription model because it has cost-saving benefits similar to any electronic health records. They are more efficient, reduce healthcare costs, and increase patient safety through more accurate transcriptions and communications.

These incentives appear to be working and are in part responsible for the significant increase in e-prescriptions. Under the Medicare Improvements for Patients and Providers Act, a law passed in 2009, doctors can receive a two percent Medicare bonus in 2010 if they e-prescribed using approved software. That bonus decreases by one percent in the next two years (2011 and 2012) then drops to 0.5 percent in 2013 and then no longer exists by 2014.

There are potential penalties as well. For 2012, doctors who do not report at least 10 electronic prescriptions in the first six months of 2011 on their Medicare claims, will receive a one percent pay cut.

Another significant incentive was introduced in the 2009 the legislation entitled the American Recovery and Reinvestment Act. It authorizes up to $44,000 under Medicare over five years and nearly $64,000 under Medicare over six years for physicians who show “meaningful use” of an electronic health record system, which includes using e-prescriptions.

According to a 2009 survey, just 33 percent of medical practices more than three physicians currently use electronic medical records software. If your practice is considering a shift to electronic medical records from your current paper system, it’s good to know some of the benefits you can expect.

Increased Revenues

When a medical practice Uses paper charts, many of their services are lost and never get billed. Using an Electronic Medical Records (EMR) software program, you can increase your practice’s revenues by ensuring you receive money on charges for all services you perform.

Lower Expenses

Electronic Medical Records can reduce the labor costs related to appointment scheduling, billing, filing, medical chart transcriptions, and more. Plus, once a doctor’s office goes to electronic medical records, the costs associated with buying, storing, and destroying paper charts can be eliminated.

Reduce Costs Related to Malpractice

Malpractice insurance costs are always increasing. When you use an Electronic Medical Records (EMR) software, some insurance companies may reduce malpractice premiums by as much as 10 percent. This is due to the fact that a doctor’s office reduces their chances of medical errors. EMR software can reduce medical errors in many areas, including misdiagnosis, conflict in medications, reading errors due to bad handwriting, just to name a few.

Versatile Access to Records

Electronic Medical Records can be accessed practically anywhere. This not only saves time for one person, but multiple people in the office, since files can be accessed by multiple people at the same time. Not to mention, you no longer have to worry about files being lost or misplaced.

Better Security

Not only can files have restricted access, medical practices can have more restrictions on certain files, which gives you more flexibility with how you want certain information accessed.

Allscripts MyWay EHR version 9.0 recently received Complete EHR Ambulatory certification. This means that the software, an integrated electronic health records and practice management solution, now enables providers to meet the Stage One meaningful use measures that are required to qualify for funding under the American Recovery and Reinvestment Act (ARRA).

“The certification of our MyWay EHR provides physicians in independent practice and small groups an electronic health record that is simple, easy to use and that works the way their practice works, while positioning them to qualify for federal incentives under ARRA,” said Glen Tullman, Chief Executive Officer of Allscripts.

The software was tested and certified under the Drummond Group’s Electronic Health Records Office of the National Coordinator Authorized Testing and Certification Body (ONC-ATCB) program. Their certification program tests and certifies EHRs to make sure that they fit the criteria adopted by the Secretary of Health and Human Services, currently Kathleen Sebelius.

Healthcare providers who use the Allscripts EHR system are qualified to receive federal stimulus money once they demonstrate “meaningful use” of the technology.

Allscripts MyWay version 9.0 is currently available in two forms: an on-premise software solution or as a SaaS (Software as a Service), which is software deployed over the Internet.

MBA Medical uses the Allscripts MyWay, and has seen firsthand how this intuitive easy-to-use software can make managing medical records a much more efficient process. For more information, including a video presentation on the software, go to our AllScripts EMR Software page.