Healthcare IT News - June 2008 - (Page 9)

www.HealthcareITNews.com June 2008 ■ Healthcare IT News by Joan r. duke and James oakes, HIMMS Fellows o m m n t r y Look to states for HIE funding Newsmaker interview President Bush set the goal of every american having an electronic health record by 2014, there have been many federal and state initiatives to promote healthcare information technology. at the state level, the recognition of the importance of healthcare It has brought together diverse stakeholders to address challenges of healthcare information and supporting technology. Drivers for these efforts include: ■ ensuring healthcare information is secure and private; ■ making healthcare information available where it is needed; ■ Providing value to patients, providers and payers to improve healthcare; ■ ensuring equal access to healthcare; ■ Defining best practices and standards. Since early 2007, 208 bills have been introduced across all 50 states to encour- Joan R. Duke age adoption of healthcare It. nineteen of these bills have been signed into law in 16 states. Some legislation has authorized funding of state initiatives, or established exploratory task forces to facilitate progress. In addition, governors in 15 states have signed 20 executive orders, which are designed to drive improvements in healthcare through the use of It. ince 2004 when S Vermont passed legislation in both the House and Senate (4/23/08) to impose a fee on all medical claims to create a statewide heath information exchange (HIe) and to provide grants to independent physicians to encourage them to adopt electronic medical records. It is expected that a pool of $32 million dollars will be available. according to Steve Larose, public relations director for VItL, approximately one third of the funding will be used for a statewide HIe and the rest will go to independent physicians. the grant to physicians will be up to $45,000 or 75 percent of the cost of a system. It will cover hardware, software and implementation, and it will also cover costs for clinical transformation. InTervIewed by rIchard PIzzI, Associate Editor no-InteReSt LoAnS James Oakes VeRMont, MInneSotA VISIon We focus on two states, Vermont and minnesota. In July of 2005 Vermont Information technology Leaders, Inc. (VItL) began envisioning that their network would share real-time clinical information among state healthcare providers to improve patient outcomes while reducing service duplication and reducing cost. VItL completed a plan in July 2007, producing a roadmap to encourage the use of healthcare information technology and calling for a statewide network to exchange data among healthcare organizations. Grants were awarded to five Vermont primary care practices; a chronic care information system; and a project to share medication history information among hospitals for patients visiting emergency departments. minnesota recently approved a new $6.3 million electronic health record revolving account and loan program. the program provides nointerest loans of up to $1.5 million to help minnesota’s rural hospitals and small town physician, clinics, and other community healthcare providers replace paper records with eHrs as part of the state’s e-health initiative. the packages also include a $7 million interconnected electronic health records grants program. minnesota law requires all state healthcare providers to use electronic patient health records by Jan. 1, 2015, so they can exchange patient health information and deliver optimal care at all points of the healthcare system. BIg Step foRWARD the Vermont and minnesota programs to award grants and loans to physicians and hospitals to implement emrs represent a huge step forward. these programs will encourage adoption, but do not address the key reason why emrs should be used. (the emr is typically referred to as the record within a care setting whereas the eHr spans several care settings). to gain widespread adoption, there must be a value proposition understood by practitioners who are being encouraged to use electronic medical records. early adopters have shown savings in storage duke see page 10 How did you get interested in healthcare IT? I was a fellow in pulmonary medicine from 1980-1982. there was a lot of interest in the very earliest computers, and we had an opportunity to build the programming for a pulmonary function lab. that peaked my interest. my first job was at Bay State medical center (Springfield, mass.) in 1982. It was there that I met richard rydell, the new cIo at the hospital. I got involved with the It staff, telling them that their current product didn’t do much for us physicians. I thought there should be more physician involvement in the purchase of the next system. rich rydell asked me if I was serious about getting involved in It. I said yes, and then approached the hospital’s chief of medicine, who allowed me to spend 20 percent of my time working on It issues. In two years, I was up to 50 percent. currently at Shriners, I spend 90 percent of my time on It. What does a chief medical information officer do, and how is a CMIO different than a CIO? the cmIo handles all of the content in a healthcare It system, whereas the cIo understands the instrument itself. the real value of healthcare It systems is how we affect the process of patient care. We’ve confused the value of It systems in healthcare by focusing on the technology itself, rather than emphasizing content that improves the quality and safety of care. If done poorly, automation can slow down care. the value of the cmIo is as a “translator.” He or she is someone WILLIAM BRIA, MD ■ CMIO Shriners Hospitals who can navigate between the worlds of medicine and for Children ■ Pulmonary critical care technology. In some cases, physician the cmIo can be the only ■ Adjunct clinical associate guard against implementing professor, University of a wonderful piece of software Michigan in a horribly wrong way. ■ AMDIS board president brIa see page 10 leTTers Continued from page 8 a bit like judging the quality of a restaurant by the size of the grocery bill. on the pricing side, the plethora of contracts negotiated with doctors and hospitals by private sector plans means there is no information that is especially useful to consumers on this front either. even when information is presented to consumers, there is no evidence that any significant number of them use it to change decision-making. this has been documented in survey after survey - most recently by the california Health care Foundation just last week. HIt will play a prominent role in the transformation of healthcare, but it will be driven by payers and providers, not patients. HIt will be adopted when cmS, employers, and large health plans insist upon it as a condition of participation and not before. We will probably also need a full remodeling of provider payments to give the sorts of incentives needed to encourage physicians and hospitals to install the required technology. Health information exchanges will be built when the federal government realizes they are public utilities and pays to have them constructed. Kim D. Slocum President KDS Consulting, LLC it essential in Medicare billing review I by rIchard PIzzI, Associate Editor n the face of an upcoming federal crackdown on medicare billing, a significant majority of Healthcare IT News readers say their organizations will use information technology to comply with auditors’ requests for documentation. Seventy-one percent of readers who responded to the most recent news monitor poll said that It would serve a critical function in ensuring they emerge unscathed from medicare audits. twenty-nine percent of poll respondents said healthcare It would not play a major role in the upcoming medicare billing audits. one hundred and fifteen people responded to the question. the issue became urgent when the centers for medicare and medicaid Services announced plans to go nationwide to find errant medicare billing as early as this fall. cmS decided to expand the audits after the success of its pilot recovery audit contractors (rac) program, which recovered some $304 mil- lion in 2006. Under the new rac program, doctors and hospitals could be asked to provide documentation to support the bills they submitted to medicare as far back as 2007. “technology will help facilitate aggregation of data, capture data at the point of care, eliminate duplicate data entry and streamline workflow,” wrote Kate crous, corporate director of clinical information systems at Universal Health Services, Inc. reed D. Gelzer, mD, a consultant with revere, mass.-based advocates for Documentation Integrity and compliance, told Healthcare IT News that technologies such as electronic medical records could reveal billing problems. “an organization’s emr will greatly facilitate the discovery of fraud and abuse,” said Gelzer. “most physicians are not aware that the information collected in the background by the software will neWS MONitOR show fraudulent practices such as having non-credentialed staff providing services but then changing the author to a physician.” Some readers said their organizations did not have the requisite technology to aid them in preparing for a medicare audit, and others claimed the technology they did have was inferior. “the It packages we have are so vendor proprietary that it is impossible to build a cohesive and nationally uniform coding approach,” wrote one reader. many readers expressed dread at the possibility of a medicare audit without adequate It. “We are still very much a hybrid environment where the left hand doesn’t know what the right hand is doing,” wrote an anonymous reader. “Heaven help us if medicare comes in.” MorE at healthcareITnews.com e connect: NEWSMoNItor 0608 ● www.HealthcareITNews.com healthcareITnews.com

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Healthcare IT News - June 2008

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