Wednesday, July 16, 2008

Part II RHIOs Progress and Evolution


Quote of the day:
The nice thing about standards is that there are so many of them to choose from. - Andrew S. Tanenbaum

Opinion: Physicians' Resistance to EHRs Could Be Changing

Health care has lagged behind nearly every other industry in transitioning to computer record keeping, St Louis Post-Dispatch columnist Mary Jo Feldstein writes.
Physicians have been reluctant to invest in electronic health record systems because of the cost, integration challenges and concerns about the technology becoming obsolete, according to Feldstein. However, "waves of successful early adopters" could be "changing [the] tide," she writes.
A recent New England Journal of Medicine survey found that of the 83% of physician respondents without an EHR system, 16% said they had purchased a system but had yet to implement it and 26% said they planned to purchase an EHR system in the next two years.
Scott Anderson -- president of KIG Healthcare Solutions, an EHR vendor -- said he believes that most physicians are "over the hump" and know they need to invest in EHRs (Feldstein, St. Louis Post

E-Prescribing Provisions

The new law will provide Medicare physician incentive payments of 2% for e-prescribing in fiscal years 2009 and 2010, 1% in FY 2001 and 2012, and 0.5% in FY 2013. In addition, Medicare payments to physicians who do not e-prescribe will be reduced by 1% in 2012, 1.5% in 2013 and 2% in subsequent years.
The new law also requires the reporting of e-prescribing quality measures established under Medicare's physician reporting system.
The e-prescribing provisions only apply to physicians participating in Medicare, but other health plans often follow Medicare's lead and implement similar policies, according to Health Data Management.  At the same time there was a 'veiled threat", that those providers who did not adopt e-prescribing would be penalized.  The AMA cautioned that standards for e-prescribing were not yet solidified, which would delay implementation of e-prescribing.

FINANCIAL DISINCENTIVES IN PLAY

In most cases, the U.S. health care system does not provide incentives for physicians or hospitals to share clinical data with other health care providers, raising barriers to widespread adoption of the technology, Computerworld reports.

Charles Jaffe -- CEO of Health Level 7, which develops data standards for health care organizations -- said, "The problem we have in this country is a lack of business reasons for integrating." He added, "What is the business case for two competing hospitals to share data? None."
For example, five major hospitals in San Diego held a series of meetings about three years ago to consider sharing information stored in their respective EHR systems.
However, the hospitals decided not to pursue the plan because economic benefits were inadequate.
Joshua Lee, medical director of information services at the University of California-San Diego Medical Center, said, "The financial and oversight responsibility would fall on the medical centers, even though it's a very intangible benefit to the medical centers."
Although studies show that EHRs, computer physician order entry and other technology applications can improve the quality of health care, health care providers generally are not compensated for improvements to care, according to John Quinn, chief technology officer for HL7.

John Halamka, CIO at Harvard Medical School and Beth Israel Deaconess Medical Center, said, "The provider bears the cost, but most of the benefits accrue to other parties," particularly insurers and other health care payers.  Shaun Grannis, a medical informatics researcher at the Regenstrief Institute in Indianapolis, said that Regenstrief is working to develop an economic model for health information exchanges that would be sustainable over the long term, but he said that such projects continue to rely on "a patchwork of funding" (Mitchell

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