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Tuesday, December 16, 2008

Health Train Express--2008

The end of 2008 seems a good time to review the state of health information technology and the progress of Electronic Medical Record implementation.

Much has not occured since 2003 when GWB appointed David Brailer MD as the National Coordinator for Health Information Technology (ONCHIT). Initially, like all new things, ONCHIT attracted a great deal of publicity.  It stimulated the organization of CCHIT, a national certifying authority for producing interoperable information systems, assuring the compatibilty of different vendor offerings to move toward a goal of the National Health Information Network.

During the ensuing years, the most successful vendors became CCHIT certified, but now without annual costs paid for by the vendorss themselves to become certified each year.  These applications also are the largest companies and the most expensive software.  While bolstering interoperability, at the same time many vendors have disappeared because of  the CCHIT requirement.  The industry consolidated leaving fewer vendors.

All of the media excitement and cheerleading is now led by promises (mostly empty) of bailout funding.  Admittedly some states have ponied up to the bar with funding for EMRs. However, these 'integrated systems and EMR are limited to mostly public sector agencies. Little money has trickled over to private practice.  And this group needs it  most.

MRI (The Medical Records Institute) released it's Status Report, 2008, by it's  CEO C. Peter Waegmann.

iHealthbeat regularly charts the progress and adoption of EMRs several times each year.  It is my estimation that these figures are biased.   Many users report the use of EMRs which do not offer many functionalities which should be inherent in an EMR.

It is true that some practices have adopted electronic prescribing. and one or two other functionality.

The Chart below is taken from National Health Care Surveys done by the CDC.

infosheet_nhcs_fig1 (1)

The fact that EMR adoption has lagged does not take into  account the adoption of health information technology available via the internet and other sources.  The parallel development of Health 2.0 online services and mobile devices, such as smartphones, Personal digital assistants, and others hand held devices reflect the interest and willingness of physicians to utilize IT when cost effective. Adding to this strong trend is the deployment of high speed 3G cellular technology which empowers internet use almost anywhere.

A new survey found that 58% of U.S. physicians surveyed go online for clinical information at least two times per day. More than three out of four respondents said they go online for clinical information more often now than they did a year ago, according to the survey.

By now, most providers are familiar with software offered by third  parties as downloadable applications.

In 2008, 84% of physicians surveyed reported using the Internet and other technology to find information about pharmaceuticals, biotechnology and medical devices, up from 64% in 2004, according to a survey


Utilization of Health IT by Patients

A new survey found that 31% of non-elderly Americans with private health insurance and Internet access have used an online physician or facility finder. Meanwhile, 16% reported using an online health plan selection tool and 10% have used an online health care cost information tool.

Privacy Issues

In 2008, 62% of U.S. adults age 21 and older said they were not too or not at all confident that electronic health records would remain confidential, while 12% of survey respondents said they were extremely or very confident that EHRs would remain confidential

The area of explosive growth of health IT is in electronic prescribing. 

Fueling this growth is CMS's indication that users will receive a 2% bonus for using ePrescribing.

What does 2009 have in store?

iHealthbeat reports:

Nearly half of health IT professionals surveyed said that Democratic control of the White House and Congress will strengthen efforts to promote patient safety and the use of health IT, according to a new survey from the Healthcare Information and Management Systems Society.

Fourteen percent of respondents said that Democratic control of the White House and Congress will weaken efforts to promote patient safety and the use of health IT, while 29% said that it would have no impact and 9% said that they did not know what kind of effect it would have, according to the survey.

Meanwhile, 20% of respondents said that President-elect Barack Obama's proposal to spend $50 billion over five years on health IT is sufficient to advance health IT adoption, while 46% said that the funding would advance health IT adoption but that additional funding would be required to truly accelerate adoption. Fifteen percent of respondents said that Obama's proposed health IT funding is insufficient.

Results are based on a November survey of 622 health care IT professionals.

Source: HIMSS, "2008 Presidential Election"


This appraisal is based upon uncertain funding, intense competition for federal dollars, an exploding federal deficit, and many other unknowns. 


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