U.S. Doctors Embracing Electronic Health Records: Survey

TUESDAY, July 17 (HealthDay News) -- A majority of U.S. physicians have now adopted an electronic health record system as part of their routine practice, a new national survey reveals.

The finding is based on responses provided by nearly 3,200 doctors across the country who completed a mail-in survey in 2011. The survey was conducted by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics as part of an ongoing three-year effort (continuing through 2013) designed to assess perceptions and practices regarding electronic health record systems.

Specifically, the poll found that 55 percent of U.S. doctors have embraced some type of electronic health record system. And roughly 75 percent of those who have done so reported that the type of system they took on meets the criteria of playing a "meaningful" role in their practice, according to the terms of 2009 federal legislation (entitled the Health Information Technology for Economic and Clinical Health Act) designed to promote the use of electronic health records.

What's more, 85 percent of those doctors who now have an electronic health record system in place said they are either "somewhat" or "very" satisfied with its day-to-day operations (47 percent and 38 percent, respectively). And three in four said patient care has improved as a result of electronic health record adoption.

The poll also indicated that among those who have yet to embrace an electronic health record system, almost half said they plan to do so in the coming year.

Physician age seems to have played a role in how likely a doctor was to have already brought an electronic health record system into their practice, the findings showed. While 64 percent of those under the age of 50 have done so, the poll revealed that the same was true of only 49 percent among those aged 50 and older.

Office size also seems to matter, with larger physician practices being more likely to have incorporated an electronic health record system into their administrative infrastructure. Specifically, 86 percent of offices with 11 or more physicians on site had taken on such a system, compared with roughly 60 percent to 62 percent of those with two to 10 physicians and just under 30 percent of single-doctor practices.

But although some kinds of specialists (such as surgeons) were somewhat less likely to have implemented an electronic health record system, race, gender and physician location did not seem to play a role in the likelihood that a doctor's office would or would not bring the technology into their workplace.

Eric Jamoom, of the health care statistics division of the U.S. National Center for Health Statistics, and colleagues published their findings July 17 in the NCHS Data Brief.

More information

For more on electronic health records, visit the U.S. National Library of Medicine.

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Can Health Care Orgs Maintain Trust With Electronic Records?

Guest post written by S. Joe Bhatia and Rick Kam

S. Joe Bhatia is CEO of the American National Standards Institute, ANSI. Rick Kam is president and co-founder of ID Experts.

You don’t want your personal health information to spread virally around the Internet. Save that for the talking baby videos on YouTube.

The truth is, the electronic health information of millions of patients can be breached in a matter of seconds. As the industry moves from paper records to electronic health records (EHR), protected health information (PHI) is now more susceptible to exposure than ever.

The White House just published the Consumer Privacy Bill of Rights, stating that “trust is essential to maintaining the social and economic benefits that networked technologies bring to the United States and the rest of the world.”

Trust is a precious thing. Trust is the cornerstone of solid doctor-patient relationships. We also trust that our health-care providers will protect our confidential patient information. That trust is at the core of the viability of our health care delivery system. Without it, the entire industry will crumble and put patients at risk. Yet as the industry moves toward EHR adoption, that trust is being seriously tested.

In February 2009, the U.S. Senate passed an $838 billion stimulus bill, in part to enable the digitization of every American’s medical record – a move that President Obama said would improve the quality and lower the cost of health care. To ensure a paperless health care system, the federal government set up financial incentives and a five-year deadline.

With the 2014 deadline approaching, health care industry leaders are at a crossroads. Investment in adopting policies and procedures to better protect patients’ information must increase, yet the boardroom appears to be at odds with the staff responsible for corporate security and privacy.

The stakes are high and the challenge is growing. There are 5,754 registered hospitals in the U.S. with nearly 37 million patients admitted, according to the American Hospital Association. And the number of medical records compromised in the United States nearly doubled from 2010 to 2011, according to Redspin, a consulting firm.

The adoption of electronic health care records magnifies the risks of a data breach in ways that paper records never did. Hacking, theft, or loss of computing devices containing sensitive health information, and the use of unsecured mobile devices all increase the likelihood that a patient’s medical records will be exposed, endangering their physical and financial health.

A group of 100 industry leaders spent the last year examining the huge ramifications that a personal health information breach can have on health care organizations. They came together to offer suggestions for action, and to create a new model that will drive a more meaningful dialogue between those who are protecting vulnerable personal health information and corporate leadership. The report The Financial Impact of Breached Protected Health Information: A Business Case for Enhanced PHI Security enables health care organizations to make a business case for appropriate investments to better protect PHI. It is available for free download at webstore.ansi.org/phi.

The entire health care ecosystem – health care organizations, health plans, providers, payers, and support services – must take action to evaluate the “at risk” value of the protected health information with which they are entrusted, in order to determine the proper level of investment in their security initiatives. And they must do it before the trust erodes.

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Electronic Health Records Could Improve Care for Type 2 Diabetics

KEY POINTS

* Switching from paper records to electronic records does not adversely affect the care of patients with type 2 diabetes older than 40, according to a new study in Health Services Research.

* Patients older than 40 with type 2 diabetes at a clinic that uses electronic records are more likely to meet blood pressure target levels, refrain from smoking and take aspirin daily than patients at clinics that continue to use paper records.

* Switching to electronic records might not help patients older than 40 with type 2 diabetes to control their cholesterol levels or improve their HbA1c levels.

Newswise — Use of electronic health records shows promise for improving care and outcomes in patients with type 2 diabetes, but still has considerable room for improvement, according to a new study in the journal Health Services Research.

With the U.S Department of Health and Human Services currently offering incentives for medical practices to move their records to electronic systems—and Medicare payment penalties to those who don’t convert by 2015—doctors and hospitals are increasingly incorporating these tools into their practices. However, the notion that electronic health records can improve care measurably has been under significant debate, said study co-leader Jeph Herrin, Ph.D., of Yale University.

“What’s unknown is whether moving to an electronic health records system would actually improve health outcomes,” he said. “So far, different studies have shown different results.”

Seeking more evidence, Herrin, co-author David Ballard, M.D., Ph.D., and their colleagues took advantage of two concurrent initiatives at the HealthTexas Provider Network, a northern Texas primary care medical group subsidiary of Baylor Health Care System. The first is a long-term effort made by the group to collect health data on their diabetes patients. The second is the roll out, started in 2006, of an electronic health record system to the Network’s nearly 100 clinics.

Herrin and his colleagues followed 14,051 diabetes patients from 34 group clinics over a four-year period. They looked at optimal diabetes care as a whole as well as individually examining each of five measures of diabetes management: HbA1c (a measurement that indicates average blood sugar control over time), LDL cholesterol, diastolic blood pressure, systolic blood pressure, aspirin prescription and non-smoking status.

They report that over the rollout period, the 29 practices that had the electronic health record system saw 6,376 diabetic patients. Comparing those exposed to the system to those that were not, the researchers found a significant improvement in all of the variables except for HbA1c and LDL cholesterol in the electronic health records group.

Herrin explained that certain features of the electronic health record system might be responsible for the better health measures among patients whose doctors used it. For example, even if patients visited their physician for something unrelated to diabetes—such as a flu shot—the system reminded their doctor to ask questions related to diabetes care. The researchers also noted that part of the increase might be due to better documentation in electronic health records than in paper records.

“This study offers evidence and reassurance that switching to electronic medical records isn’t going to hurt patients and may in fact help them,” Herrin said.

However, despite the significant increase in the number of patients who met some optimal care and outcome standards, Spyros Mezitis, M.D., an endocrinologist at Lenox Hill Hospital in New York City, noted that doctors and electronic health records still have a long way to go.

“This study showed mixed results,” he said. “There’s much room for improvement here.”

Mezitis points out measures for HbA1c and LDL cholesterol, two very important elements in diabetes care, did not improve in this study in the electronic health records group. With the extra initial expense, time and effort it takes to set up electronic health records, he added, more research is needed to develop systems that improve all measures of diabetes care.

TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required. While the information provided in this news story is from the latest peer-reviewed research, it is not intended to provide medical advice or treatment recommendations. For medical questions or concerns, please consult a health care provider.

# # #

Health Services Research is the official journal of the Academy Health and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust. For information, contact Jennifer Shaw, HSR Business Manager at (312) 422-2646 or jshaw@aha.org. HSR is available online at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1475-6773/

Herrin, J. et al. (2012). The effectiveness of implementing an electronic health record on diabetes care and outcomes. Health Services Research, DOI: 10.1111/j.1475-6773.2011.01370.x

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Report: Electronic health records still need work

WASHINGTON (AP) — America may be a technology-driven nation, but the health care system's conversion from paper to computerized records needs lots of work to get the bugs out, according to experts who spent months studying the issue.

Hospitals and doctors' offices increasingly are going digital, the Bipartisan Policy Center says in a report released Friday. But there's been little progress getting the computer systems to talk to one another, exchanging data the way financial companies do.

"The level of health information exchange in the U.S. is extremely low," the report says.

At the consumer level, few people maintain a personal health record on their laptop or electronic tablet, partly due to concerns about privacy, security and accuracy that the government hasn't resolved.

"How will sensitive health data be kept confidential and secure in digital data-sharing environments?" the report asks. "Many consumers ... are waiting for a reassuring answer to this question."

The report offers a window on progress toward a goal set by President Barack Obama, and President George W. Bush before him, that everyone in the United States should have an electronic medical record by 2014.

While making no predictions, the report offers a collection of details indicating that the goal is a long shot at best.

"Will 100 percent of our nation have electronic health records by 2014?" asked Janet Marchibroda, who directs the center's health technology initiative. "I would say getting to that last mile is difficult." She expects the majority of hospitals and doctors to meet the goal, but it's another matter when it comes to consumers.

In politically polarized Washington, the center tries to tackle national problems from a pragmatic perspective. The report, more than six months in the making, was produced by a panel representing hospitals, doctors, insurers, consumers and technology companies. The review was led by two former senators with ties to the health care industry, Democrat Tom Daschle of South Dakota and Republican Bill Frist of Tennessee.

Electronic medical records are seen as a crucial component in creating a system that's more efficient and less prone to error. The government has committed up to $30 billion to encourage this shift, mostly through incentive payments to hospitals and doctors that were authorized in 2009 under Obama's economic stimulus law. Payments started flowing last year.

The report found that 5 percent of eligible doctors received payments last year, while about 33 percent had registered with the government that they intend to qualify.

Overall, about one-third of doctors' offices had some form of electronic records last year, compared with one-fourth in 2010.

Among hospitals, 32 percent received the incentive payments last year, the report said, while 61 percent notified the government they intend to qualify.

Those are signs of momentum, but the report found little progress in devising ways for the different computer systems to communicate with each other.

Part of the problem is that there isn't much financial incentive for competing health care providers to share information.

If an emergency room orders a test on a patient that a family doctor had run a week ago, the hospital gets paid for it. If the emergency room doctor relies on the test results from the family doctor, that's less revenue for the hospital.

"Health information exchange will not occur at optimal levels ... without a viable, sustainable business model," the report said.

Only from 7 percent to 11 percent of individuals have a personal electronic medical record. Some early adopters still run into problems with basic tasks such as downloading test results, renewing prescriptions online or scheduling appointments.

The report also says the government must address gaps in privacy protections. For example, a federal health privacy law that applies to hospitals, doctors, insurers and data transmission companies doesn't apply to companies that market electronic medical records directly to the public.

"This uneven coverage of federal health privacy law can be confusing for consumers and contributes to reluctance," the report said.

____

Online:

Bipartisan Policy Center report: http://tinyurl.com/86vgum3

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Epic Systems, Digitizing Health Records Before It Was Cool

THE push to move the nation from paper to electronic health records is serious business. That’s why a first look at the campus of Epic Systems comes as something of a jolt.

A treehouse for meetings? A two-story spiral slide just for fun? What’s that big statue of the Cat in the Hat doing here?

Don’t let these elements of whimsy fool you. Operating on 800 acres of former farmland near Madison, Wis., Epic Systems supplies electronic records for large health care providers like the Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, and Johns Hopkins Medicine in Baltimore, as well as health plans like Kaiser Permanente and medical groups like the Weill Cornell Physicians Organization in New York. In fact, Epic’s reputation as a fun-filled, creative place to work helps draw programmers who might otherwise take jobs at Google, Microsoft or Facebook.

Epic supplies software, systems, training and support so its customers can manage their data. As far as the general public is concerned, it operates far under the radar. Yet it helps keep track of 40 million patients, alongside a handful of large software companies and hundreds of smaller firms that have emerged to digitize health records.

Unlike some of those firms, Epic is no newcomer. Judith Faulkner, the chief executive, started the company more than 30 years ago, when, in all but a very few places, patient records were kept on paper. As such, she has a long-term view of the nation’s struggle to digitize medical records.

Ms. Faulkner understands why it’s taken much longer for the health care industry than, say, banks and airlines to move to electronic data. In banking, the types of data are much more limited and known, she says. In health care, by contrast, data is constantly changing based on information from doctors, nurses, patients and others. New discoveries, protocols and government requirements add even more complexity.

The way this data is stored and used can literally be a matter of life and death — which is why the transition to electronic health records is so sensitive. And why it’s so important, Ms. Faulkner says. Computerized record systems can actively search for and analyze information in ways that paper files never can, thereby improving patients’ health, she says.

Digital records are an invaluable tool for doing research and improving care, says Philip Fasano, executive vice president and chief information officer of Kaiser Permanente. “For example, we are able to follow decades of data on diabetes patients,” he says. “We can see which medicines are absolutely the best and personalize the doses. We can truly change the medical outcomes.”

Ms. Faulkner started digitizing patient records when she was just out of graduate school in computer science at the University of Wisconsin. That’s when a research group in the psychiatry department asked her to create a system to help keep track of patient data over time.

Her program, built on ideas from a few other pioneers, was a success. Other medical researchers began requesting their own versions, and eventually a business was born.

At first, Epic consisted of three part-time employees working at $10 used desks in the basement of an apartment house near the university. They bought a bulky computer from a company called Data General; it had two 50-megabyte disk drives that sounded like a noisy washing machine, Ms. Faulkner recalls. “You couldn’t touch it, or the data got messed up,” she says.

There may have been a learning curve, but “to the best of our knowledge, in the 32 years we’ve been in business, there has never been a breach of Epic’s data by a hacker,” Ms. Faulkner says — speaking to a concern that has some people nervous about the conversion to electronic health records.

Concerns about security are hardly groundless. A government Web site known as the “Wall of Shame” has documented hundreds of breaches that threatened patients’ privacy.

At Epic, “We have all sorts of firewalls and security systems in effect to prevent data breaches,” Ms. Faulkner says. On laptops used by doctors, files can be viewed but not stored. The same is true for smartphones and tablets. “We do not store patient data on them,” she says, so it cannot be misused if these devices are stolen.

Ms. Faulkner is an industry representative on a government panel charged with examining privacy and security issues regarding health data. She says she wants to strike a balance between ensuring privacy and making sure that information can be shared for better patient care.

“I’m worried if we put up too many barriers in order to make things private, and if that makes the flow of information slow and hard to share, in effect more people will be harmed,” she says. So far the committee has maintained that balance well, she says.

View the original article here

Epic Systems, Digitizing Health Records Before It Was Cool

THE push to move the nation from paper to electronic health records is serious business. That’s why a first look at the campus of Epic Systems comes as something of a jolt.

A treehouse for meetings? A two-story spiral slide just for fun? What’s that big statue of the Cat in the Hat doing here?

Don’t let these elements of whimsy fool you. Operating on 800 acres of former farmland near Madison, Wis., Epic Systems supplies electronic records for large health care providers like the Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, and Johns Hopkins Medicine in Baltimore, as well as health plans like Kaiser Permanente and medical groups like the Weill Cornell Physicians Organization in New York. In fact, Epic’s reputation as a fun-filled, creative place to work helps draw programmers who might otherwise take jobs at Google, Microsoft or Facebook.

Epic supplies software, systems, training and support so its customers can manage their data. As far as the general public is concerned, it operates far under the radar. Yet it helps keep track of 40 million patients, alongside a handful of large software companies and hundreds of smaller firms that have emerged to digitize health records.

Unlike some of those firms, Epic is no newcomer. Judith Faulkner, the chief executive, started the company more than 30 years ago, when, in all but a very few places, patient records were kept on paper. As such, she has a long-term view of the nation’s struggle to digitize medical records.

Ms. Faulkner understands why it’s taken much longer for the health care industry than, say, banks and airlines to move to electronic data. In banking, the types of data are much more limited and known, she says. In health care, by contrast, data is constantly changing based on information from doctors, nurses, patients and others. New discoveries, protocols and government requirements add even more complexity.

The way this data is stored and used can literally be a matter of life and death — which is why the transition to electronic health records is so sensitive. And why it’s so important, Ms. Faulkner says. Computerized record systems can actively search for and analyze information in ways that paper files never can, thereby improving patients’ health, she says.

Digital records are an invaluable tool for doing research and improving care, says Philip Fasano, executive vice president and chief information officer of Kaiser Permanente. “For example, we are able to follow decades of data on diabetes patients,” he says. “We can see which medicines are absolutely the best and personalize the doses. We can truly change the medical outcomes.”

Ms. Faulkner started digitizing patient records when she was just out of graduate school in computer science at the University of Wisconsin. That’s when a research group in the psychiatry department asked her to create a system to help keep track of patient data over time.

Her program, built on ideas from a few other pioneers, was a success. Other medical researchers began requesting their own versions, and eventually a business was born.

At first, Epic consisted of three part-time employees working at $10 used desks in the basement of an apartment house near the university. They bought a bulky computer from a company called Data General; it had two 50-megabyte disk drives that sounded like a noisy washing machine, Ms. Faulkner recalls. “You couldn’t touch it, or the data got messed up,” she says.

There may have been a learning curve, but “to the best of our knowledge, in the 32 years we’ve been in business, there has never been a breach of Epic’s data by a hacker,” Ms. Faulkner says — speaking to a concern that has some people nervous about the conversion to electronic health records.

Concerns about security are hardly groundless. A government Web site known as the “Wall of Shame” has documented hundreds of breaches that threatened patients’ privacy.

At Epic, “We have all sorts of firewalls and security systems in effect to prevent data breaches,” Ms. Faulkner says. On laptops used by doctors, files can be viewed but not stored. The same is true for smartphones and tablets. “We do not store patient data on them,” she says, so it cannot be misused if these devices are stolen.

Ms. Faulkner is an industry representative on a government panel charged with examining privacy and security issues regarding health data. She says she wants to strike a balance between ensuring privacy and making sure that information can be shared for better patient care.

“I’m worried if we put up too many barriers in order to make things private, and if that makes the flow of information slow and hard to share, in effect more people will be harmed,” she says. So far the committee has maintained that balance well, she says.

View the original article here