How the healthcare industry can increase the number of successful EHR/EMR initiatives

Patty Enrado, Contributing Editor

Long before ARRA, more than five years ago, the University of California San Francisco (UCSF) Medical Center began a $50 million electronic medical record initiative. This past summer, UCSF reportedly wrote off a third of that cost and scrapped its contract with the EMR vendor. The EMR system reportedly had technical difficulties that never enabled it to be fully functional. Undeterred, UCSF is forging ahead with its goal of digitizing its patient records, which says a lot about its faith in EMRs.

UCSF Medical Center isn’t the first healthcare system to have a costly, disastrous experience, and it won’t be the last. Industry stakeholders, however, need to work together to ensure that the number of failures dwindle significantly.

The most important thing that the EHR/EMR market can do for itself is to be transparent. If there is no transparency, how can healthcare systems perform accurate due diligence? There’s a business reason for non-disclosure clauses in sales contracts, which prevent purchasers from reporting problems with the health IT vendor or their products, and “hold harmless” clauses, which exempt vendors from any liability. It may guarantee a risk-free business environment for the health IT vendor, but it hurts the EMR market and eventually hurts the health IT vendor’s reputation. Clinicians and healthcare organization executives may be obligated to remain silent about the product and/or the vendor’s problems, but they will talk informally to their counterparts in other healthcare organizations. You’ve heard the complaints. You know which health IT companies did what to whom.

Transparency need not be the enemy of health IT companies if they have solid products and customer support. For those that have had problems - and I’m not saying they have bad products or customer support - it’s a business imperative to fix those problems. There are less-expensive, more flexible EMR solutions that have come into the market in the last year. There will be other UCSF Medical Centers that cut off their legacy vendor and start anew.

There are some in the industry who say so long as the federal stimulus incentives help subsidize the purchase of legacy systems the problems will continue. University of Pennsylvania sociologist Ross Koppel believes the federal government should have put that money to use by developing “more usable and more responsible software.” I think that route would have been successful as a first step, though I still believe in the incentives. There are some who believe the federal government should regulate the EMR industry. If that sounds odious, then perhaps the EMR industry ought to regulate itself.

As for healthcare providers, they need to understand the enormity of the task. What I mean is that they need to not only put up the cash for the initiative but dedicate human resources to the initiative. Dedicate a team, if that is what is required.

I’d be remiss not to mention that for every UCSF there is a UPMC (University of Pittsburgh Medical Center) - large healthcare systems that have successfully implemented big-budget EMRs and are reaping administrative and clinical benefits. The problem is there aren’t enough of them. And that’s why there is hesitation among healthcare systems. As an industry, let’s try to increase those success stories.

Above article published on http://www.healthcareitnews.com/blog/how-healthcare-industry-can-increase-number-successful-ehremr-initiatives

Obama Dedicates $88M More for Health IT

As part of the new Recovery Act funding, President Obama pushes health information technology systems for community health care centers.President Obama is seeding the health care industry with another $88 million in funding for health care centers to adopt new health information technology systems to manage their administrative and financial matters and transfer old paper files to electronic medical records. The initiative is part of $600 million in stimulus money that will go toward improving community health centers across the country.

"These investments won't just increase efficiency and lower costs, they'll improve the quality of care as well –- preventing countless medical errors, and allowing providers to spend less time with paperwork and more time with patients," Obama said Dec. 9.

The new Recovery Act funds are the latest in a series of grants awarded to community health centers, which deliver preventive and primary care services at more than 7,500 service delivery sites around the country to patients regardless of their ability to pay. Health centers serve more than 17 million patients, about 40 percent of whom have no health insurance.

Both programs will be administered by the HRSA (Health Resources and Services Administration), an agency of the HHS (U.S. Department of Health and Human Services).

Obama also directed the HHS to implement a demonstration program designed to evaluate the impact of the advanced primary care practice model on access, quality and cost of care provided to Medicare beneficiaries served by community health centers.

This model, known as the "medical home," promotes accessible, continuous and coordinated family-centered care. Developed and administered by the CMS (Centers for Medicare and Medicaid Services), the demonstration will last three years. CMS anticipates that up to 500 health centers will participate.

According to a Dec. 8 PricewaterhouseCoopers report, the market for personalized medicine in the United States is already $232 billion, and it is projected to grow 11 percent annually.The personalized medical care portion of the market -- including telemedicine, health information technology and disease management services offered by traditional health and technology companies -- is estimated at $4 billion to $12 billion and could grow tenfold to more than $100 billion by 2015 if telemedicine takes off.

"These three initiatives –- funding for construction, technology and a medical home demonstration –- they won't just save money over the long term and create more jobs, they're also going to give more people the peace of mind of knowing that health care will be there for them and their families when they need it," Obama said. "And ultimately, that's what health insurance reform is really about."

EMR likely to boom throughout 2013

We’re in an unprecedented boom in health IT, thanks mostly to growth in the EMR/EHR sector.

A new report from Scientia Advisors says health IT is the fastest-growing segment of what the Cambridge, Mass., management advisory company calls a $1 trillion global healthcare products marketplace. Health IT currently is growing at an 11 percent annual rate, and solid growth should continue at least through 2013, which would be the third year of the federal EMR stimulus program here in the States, the Scientia report forecasts. In that time frame, health IT will increase its market share by a quarter, to 5 percent of global healthcare products sales from the current 4 percent.

In the U.S., according to Scientia, the bulk of the spending will come from inpatient and outpatient EMRs, thanks to the American Recovery and Reinvestment Act. “Clinical decision support systems (CDSS) will likely have a profound impact on clinical diagnostics and therapeutics,” the report says, according to InformationWeek. Some of the growth likely will be at the expense of specialty and departmental systems, however.

Established EMR vendors should benefit most from the increased spending. “Leading players with large installed bases, proven products, and streamlined routes to meaningful use of EHRs are likely to gain share,” Scientia says. However, the research firm says “disruptive innovations” like open-source software and new applications of software-as-a-service could drive down prices, as might new competition from emerging markets in Asia and elsewhere.

Above article published on http://www.medicexchange.com/EMR/emr-likely-to-boom-throughout-2013.html

Demystifying Electronic Health Records

Increasingly, health-care organizations are investing in clinical information systems. According Kalorama Information – the publishing division of MarketResearch.com, hospitals in the United States would be spending close to $4.8 billion on Electronic health record (EHR) or Electronic medical record systems (EMR). Despite the brouhaha, there is a lack of understanding of what an EHR can do and can not do.In this post, we will attempt to peal the layers.

What is an EHR/EMR? Simply put, the EHR is an electronic record of a patient’s medical history. This electronic record includes important information like test and imaging results, medication history, Emergency department visit summaries, doctors’ notes and general health history – from childhood allergies to surgeries.

All of this exists currently, (in most hospitals).But, in paper charts and in some cases in databases behind applications that do not talk to each other. For Instance, the Emergency department diagnosis, might reside in EMSTAT(a popular ED application), while the same patient’s Inpatient treatment notes resides in another application such as Affinity.

An EHR ultimately replaces the paper chart currently used to store the same information. The electronic version of the record can be made available to the patient’s caregivers in different locations, more quickly and efficiently. And when done well, it minimizes data redundancy (the need to enter the same information over and over) . So for instance, information captured during an emergency visit can be retrieved by an inpatient care giver, if the patient goes on to receive care as an inpatient.

How does EHR help hospitals ?
The EHR can help hospitals and health systems make improvements in three major areas.

1. Improved quality of medical decision making
It provides doctors with immediate access to a patient’s health information.Whether it is an Emergency Physician, or a nurse that needs to phone an on-call physician in the middle of the night, the patient’s chart can be accessed to support important treatment decisions. In addition, in most cases the EHR is connected to a robust library of medical information that can help physicians in making diagnoses and treatment plans based on the latest research.In some cases, it can generate automatic reminders by mail or e-mail to notify test result availability, critical values and other useful medical information.

2. Improved Patient Safety
Because doctors’ orders and prescriptions are entered into a computer rather than in handwritten orders, pharmacists and other caregivers have no trouble interpreting the information. This greatly reduces the possibility of transcription errors and other medical mistakes. Thereby reducing adverse drug events and increasing patient safety.

3. Improved efficiency
Caregivers will no longer need to search or wait for your patient chart. In addition, lab results and X-rays can be sent electronically to your doctors as soon as they are completed, for immediate analysis, diagnosis and treatment.

In addition to the major areas listed above, there are other advantages including cost savings from an EHR implementation. In a recent article that Houston Neal, (Director, Business Development, SoftwareAdvice.com) shared with us, they talk about how EMR can help reduce medical malpractice insurance premiums, reduced down-coding and even revenue gains by participating in pay for performance time programs (Medicare Care Management Performance (MCMP) ).

What are main causes of disease?

What Are the Main Causes of Disease

"Educating instead of medicating" - Disease education is about taking control of your health, helping you clearly understand what are the main causes of disease. All diseases are dysfunctions of your bodily and cellular systems. You will learn how to rebuild your immune system.

The use of supplements is expected to dramatically increase as we progress into the next century. Contemporary medicine has taught us well how to manage acute conditions that demand immediate intervention. Let us not forget that nutrition is also a vital component of health. It is important to preserve the best of what medicine has to offer and, at the same time, integrate new, and old, nutritional discoveries.

To restore optimal health you need to understand the root of what causes disease.

Disease education is your number one immune system health resource, you will learn up to date information to prevent disease and how to restore optimal health.

The fastest way to restore your health and well being is to stop doing the things that have caused the physical problem to develop in the first place and then provide your body the nutrients that you are missing so your body can restore and rebuild itself back to optimal health the way it was designed to.

This section of the site is used to bring you disease and wellness updates as soon as they occur.

Visit this section often frequently to stay up-to-date.

Let us increase our efforts to prevent disease and prolong health rather than merely to prolong life. In the following educational pages you are going to learn about many of the underlying causes of disease. Disease education will teach you what may be happening to your own body when you have specific ailments. Disease education will provide you with a clear understanding of what you need to do to enjoy a healthier lifestyle and how to rebuild your immune system.

So, any cell or microbe having a different blueprint than the body’s own code is identified as foreign to the body. Once identified, the immune system goes into action and wages a furious war to defeat the intruder. This causes a flare up which eventually makes you sick. It is thought that the infectious agents remain dormant in the body tissue and once aware of a weakness in the immune system, attack the body's cells. To be effective, the immune system must have the ability to recognize these clever, camouflaged intruders and destroy them before they do any damage to the body.

How to rebuild your immune system

Did you know that 80% of American children and 68% of American adults fail to consume the recommended amounts of fruits and vegetables each day? Pub Med Reference

Antioxidant vitamins and minerals have received immense attention because of their important role in disease protection.

The overwhelming majority (roughly 90%) of chronic diseases are not inherited, but result from environmental damage to cellular DNA or cellular processes.

Each individual's nutritional status is known to be a critical component for protection from development of some diseases, including atherosclerosis and some cancers. Decreased immune function has been shown to be counteracted with dietary antioxidant . Pub Med Reference You need to understand what your immune and cellular systems require so you can learn how to rebuild your immune system.

We are losing the health care battle everywhere else. Chronic degenerative diseases afflict over 120,000,000 Americans. Fifty plus million more suffer from one or more auto-immune diseases. Antibiotic resistant infections are now increasing at an alarming rate. We have finished mapping the human genome, but we still don't have any cures or even treatments for genetic disorders.

Approximately 90% of the medications prescribed can only help to suppress the symptoms of the disease, with no ability to actually kill or fix the disease.

Yes, we do realize that without those medications, some of you reading this web page would not have the improved quality of life, and, in some instances, wouldn't even be alive today. Though we must still recognize the limitations of symptom-suppressive medications and that the cost/ benefit ratio is getting more costly. Properly prescribed prescription drugs are now the No.4 cause of death in the U.S. Every disease category is increasing; and even worse, are now occurring at younger ages.

What Are the Main Causes of Disease

Taking a closer look at the causes of Disease

Why Do I Get Sick? Why Do I get disease? When you get a stuffed up nose from a cold, its not the cause of the cold it’s a symptom. Symptoms alert you that something is not right in your body. They are not the cause of illness or disease.

A heart attack is not the cause of heart disease it’s a symptom. More often then not it is the last symptom.

If you were to get or already have cancer, a tumour is not the cause it is a symptom of a very serious problem in your body.

Have you ever really thought about what causes disease and why some people get cancer while others get heart attacks or why some people have debilitating disorders such as arthritic conditions, MS, Lupus, asthma diabetes, chrones and numerous other conditions.

You know, you are probably aware that health care is dramatically shifting. But, we hear about it so much today through every conceivable media source that we are almost inoculated against it. Few of us realize how significantly things are changing and we falsely assume that it has always been this way… reality is, things are not getting better.

When you pick up the newspaper and read about the state of our health does it seem right to you? NO

Does it make sense that the disease incidence is increasing at alarming rates? NO

The number one reason people visit the emergency room today is asthma. On average one in three babies born today will develop diabetes at some point in their life.

Prior to 1990 autism affected one out of every 10,000 and today it is one out of every 150.

Something has gone wrong, in fact it is disastrous. We are living in the midst of difficult times, which brings a myriad of challenges.

Do you ever think about why disease conditions are rising at an alarming rate and why children are getting disorders like cancer, diabetes, ADD, asthma and many others at younger and younger ages?

So what is the cause, could it be that the cause for every disease is similar? Let’s take a closer look.

There are several factors and many of these factors are in your hands, you can control them.Disease - is any abnormal condition of the body or mind that causes discomfort, dysfunction, or distress to the person affected.

• Heart Disease is the leading cause of death in America
  National Center for Health Statistics


• Arthritis incidence expected to rise 40% as "Baby Boomers" age
  Centers for Disease Control


• Autoimmune Diseases affect 1 out of 5 people in U.S.A. American Autoimmune Related Disease Association


• Cancer is the second-leading cause of death in U.S.A.
  National Center for Health Statistics


• Multiple Sclerosis affects over 300,000 Americans
  National MS Society


• Pharmaceutical Drugs account for 100,000 deaths and $136 billion in medical costs each year in U.S.A.
  Time Magazine, January 15, 2001

Too many people are relying on their doctor to fix them, too many people are waiting for a symptom before they are concerned about it.

There are many people out there who do not exercise either due to motivational problems or ignorance of what is actually required in terms of time invested to achieve meaningful results. They rationalize for this by making excuses about not having enough time or not being able to afford a gym membership or exercise equipment.

This simply is not true.

The amount of training time necessary to dramatically improve ones physical condition is far less than what most people have been led to believe; at the most one hour to an hour and a half er week, and in many cases considerably less. There are few people, if any, who can not schedule 30 to 90 minutes of their time each week for something so important.

Can't afford it?

Wrong. You can't afford not to exercise. A mini trampoline is an excellent way to get your cells moving!

Who is paying the price for being sick?

You are, your family is, your friends, your co-workers, your neighbours and every other person you can think of.

Heart disease is the No.1 cause of death in the country. In 63% of the women, and 50% of the men, the first symptom will be death which doesn't give you much time to change your ways. Okay, but still an adult problem, right? Not any longer. Go to Med Line on the Internet, and type in "children in atherosclerosis" and you will pull up 4,979 medical research articles about this problem.

Even though the average life expectancy in most countries has increased dramatically during this past century. Our quality of life due to chronic degenerative disease has taken a major hit.

Did you know that 35% of people have an undiagnosed chronic disease, 50% of the time the first indication of a heart problem is FATAL heart attack!

Cancer can be present in your body 5-30 years before it is detectable and that 95% of all people will die from heart disease, cancer or diabetes.

Do you feel fine when a virus invades your body? You don’t know that you have the flu when it first enters your body. In fact, by the time you find out you have it, it’s too late to do anything about it.

What is the only thing that will prevent the flu in your body? YOUR IMMUNE SYSTEM!

Only your immune system is going to protect you in today’s environment. If you do not take the proper steps to strengthen your immune system, folks, you are asking for trouble. Because you know what? During the black plague, it took two months to travel across Europe. Now it takes hours to travel anywhere in the world. And scientists have discovered and isolated a medication resistant form of the black plague.

People's immune system functioning has deteriorated by approximately 30 percent in the last twenty years and continues to deteriorate at a rate of approximately three percent per year. Most Americans take at least one pharmaceutical drug every day in an effort to adapt to life with chronic disease because adjusting to a decreased quality of lifestyle is all that allopathic medicine has to offer at this time.

Does a drug cure you? No it is simply designed to treat a symptom.

How about food or nutrition does that cure you? No it supplies your body with necessary nutrients to function at an optimal level.

Many people are unaware of what our bodies are designed to do. Our bodies are truly amazing, if we just understood how to treat them by eating a balanced diet, obtain all necessary nutrients, drink sufficient clean purified water, exercise, sleep well, have fun enjoy life for our short time on earth.

If we did this in the proper portions our bodies know exactly what to do, how to make healthy new cells, how to absorb essential nutrients, how to heal cuts, how to fight disease. Your amazing biological organic body is designed to defend itself, heal itself, and protect itself from all manners of threat.

The number one concern of individuals that have one or more of the known diseases is to become symptom free of the condition without any side effects from drugs or other treatments.

Let’s review some well-known diseases and what causes them.

• Scurvy - a condition caused by deficiency of ascorbic acid (vitamin C)


• Major cause of blindness – is Vitamin A deficiency


• Rickets - is characterized by insufficient amounts of vitamin D in the body.


• Vitamin E deficiency affects the central nervous system and may result in progressive neuromuscular disease


• Beriberi – vitamin B deficiency


• Osteoporosis – combined vitamin D and calcium deficiency

Information on the importance of nutrition has historically been lacking from the training of physicians, this is beginning to change. For example, a major text used in medical training (Goodman and Gilman's: The Pharmacological Basis of Therapeutics) now contains greatly expanded information on the importance of vitamins to health. In a recent review of the dangers associated with micronutrient deficiencies, Dr. Bruce Ames, Professor of Molecular and Cellular Biology at the University of California at Berkeley, concluded that "Remedying micronutrient deficiencies is likely to lead to a major improvement in health and an increase in longevity at low cost."

Digestive problems – in some cases it is an insufficient amount of fibre and enzymes.

Cancer - is partly a lack of sufficient amounts of phytochemicals (found in vine ripened fruits and vegetables). It is well known and widely accepted that lycopene a phytonutrient found in tomatoes reduces the chance of prostrate cancer in men. Ask yourself what about cancer when we see that all these other diseases have distinguished nutrient deficiencies. There have been several studies that have found that phytonutrients have a profound effect on many cancers.

The list goes on and on and on. However there still seems to something missing, as we know disease is rising at an alarming rate in spite of this information.

Understanding the Problems

Lack of proper nutrition is certainly not the only factor that causes disease, there really are many more.

Healthy functioning of the immune system is of paramount importance to everyone since it controls our ability to fend illness and disease. The basic science of staying healthy is to optimize your bodies systems. The world is filled with pathogens microbes, toxic pollutants and stress

, and so the body requires a vigorous and vigilant immune system.

Healthy functioning of the immune system is of paramount importance to everyone since it controls our ability to fend illness and disease. The basic science of staying healthy is to optimize your bodies systems. The world is filled with pathogens microbes, toxic pollutants and stress, and so the body requires a vigorous and vigilant immune system.

The main task of our immune system is to survey our bodies internally. It is like our internal security force that is constantly checking the identity of everything entering and already existing within the body. It is a personal defense system that comes charging to the rescue at the very first sign of an alien invading force. A pathogen or toxic pollutant may be recognized as 'non-self' and a potential enemy if it does not have the right biological and molecular makeup.

So, any cell or microbe having a different blueprint than the body’s own code is identified as foreign to the body. Once identified, the immune system goes into action and wages a furious war to defeat the intruder. This causes a flare up which eventually makes you sick. It is thought that the infectious agents remain dormant in the body tissue and once aware of a weakness in the immune system, attack the body's cells. To be effective, the immune system must have the ability to recognize these clever, camouflaged intruders and destroy them before they do any damage to the body.

The following are some of the common causative factors that weaken our immune system not listed in any order of importance:

1. Pathogens - Ex: Bacteria, viruses, fungi, parasites.

• Toxic pollutants - Ex: Smog, industrial smoke, cigarette smoke, harmful vapors, vehicle emissions, pesticides, herbicides and the list goes on and on.
  > Toxins in your water
  > Toxins in your working environment
  > Toxins in your home
  > Toxins in the air you breathe
  > Drugs in your drinking water – It is an unfortunate truth that we are all taking drugs. More than 100 published reports done on drinking water in cities all over the world confirm that we are getting pharmaceutical drugs in our water every day!


• Potential antigens- Ex: Medications, pollen, dander, toxins, chemicals.


• Foreign cells and tissues - Ex: Malignant cells, foreign tissue such as from transplanted organs, or transfused blood.


• Stress - Stress is a definite culprit that weakens the immune system because it affects the production of interferon and cortisol.
  > Environmental stress
  > Physical stress
  > Mental stress


• Digestive disturbances - can also result in the build-up of toxins because of inadequate elimination thus the accumulated toxins may overpower the immune system and weaken it.


• Depleted nutrients – our modern world has


• Poor food and dietary choices


• Lack of essential nutrients – 1992 USDA study concluded that only 4% of the 22,000 Americans studied were getting the minimum recommended daily allowance (DA) of essential vitamins (and who wants to settle for the minimum!)A recent US government survey found that out of the 21,000 people surveyed, NONE (0%) of them ate the RDA of all the ten basic nutrients studied
  91% of Americans do not consume the recommended amounts of fruits and vegetables
  80% do not eat any (ZERO!) carotene-containing vegetables each dayToday, foods have less nutritional value due to modern farming methods. It now takes 60 servings of spinach to get the same amount of iron as one serving in 1948
  Today, you have to eat 25 cups of spinach a day to get the RDA for vitamin E


• Lack of proper exercise – It wasn't too long ago that people with conditions such as high blood pressure, high blood sugar, arthritis, asthma and heart disease, were told by Physicians to "take it easy","stay in bed" or ingest several medications in order to stabilize these conditions. Today, there is little doubt how the impact of lifestyle changes, including exercise, can dramatically prevent, treat and even cure many of these ailments.Exercise is not merely important. It is absolutely essential. Most people, however, do not realize this, because the time factor of the cause-effect relationship between lack of exercise and the resulting decline in functional ability is so great.If nothing is done to prevent it, we gradually lose muscle tissue as we age, becoming weaker, and less flexible as a result. There are several problems associated with this, the most obvious being a decrease in metabolism resulting in increased body fat, which is a primary risk factor for heart disease and several other serious health conditions such as diabetes. Not so obvious though, are the effects of a lack of exercise on one's bones.

What is more important than your health?

Absolutely nothing!

What are the most important nutrients?

The ones that you are not getting in your current diet!

Research that has accumulated over several decades has led to the discovery and establishment of an entirely new category of essential nutrients that is radically changing the way medicine will be practiced. This new category of nutrients is already allowing the body to correct and/or prevent health challenges in ways even the most optimistic health care professional never thought possible.

Medical Billing Work – How to Approach it the Right Way?

Medical billing work is a very popular work-from-home option. Medical billing is a profitable career, but also a demanding job opportunity. However, if you approach medical billing the right way, it can bring you $30,000 – $100,000 per annum.

When it comes to medical billing work, one of the main aspects to be aware of is that there are a lot of online scams, trying to lure you into merely wasting your money. These scams can sound like they are legit. Furthermore, they may even be legit, or partly legit. Then what’s the problem with them? They will promise you more than they will actually provide you with.

For instance, some scammers will promise you a list of doctors who are interested in acquiring medical billing online services. The fact is that these lists are either fake, or have for the most part any doctor out there, who may not even be looking for any medical billing online service provider whatsoever.

Medical billing work has some requirements, including: a personal computer, special medical billing software and sound understanding of medical billing. In order to locate the most efficient medical billing course, find out the individual prices for the software and the training.

The codes in medical billing are the most important knowledge asset required. The codes are assigned to practically everything in medical billing, such as diagnoses, procedures, health professions etc. Apart from the codes, other important medical billing work details include what to do if the accounts collectible are not paid by the patients or by their insurance company etc.

Medical billing work is a good opportunity for someone who is willing to undergo special training and who can cover the costs of the courses and the software.
While working, you will mostly be constrained by time. In fact, it is common that medical billing service providers work 10 or 10+ hours per day. Don’t be too aggressive in taking work, as too much work may turn into a problem in itself.

However, medical billing work has the appeal of freeing you from having to report to a boss. You will stay at home, close to your family, while still making money. Depending upon the amount of work you can carry out, you will be able to earn more than with a 9-to-5 job. If you are self-motivated, medical billing work will fit you well.

How much work can you expect? Well this varies between companies. Some companies require 30-50 medically coded invoices per week, others require more or less. Basically, if medical billing work is your sole income, you can decide to take as much work as you wish.

Medical billing work is a nice opportunity for working at home. If it is approached the right way, medical billing work may become a great work-at-home opportunity. However, just like any other work, it can be tedious and involved.

ELECTRONIC MEDICAL RECORDS

Paper-based records have been in existence for centuries* and their gradual replacement by computer-based records has been slowly underway for over twenty years in western healthcare systems. Computerised information systems have not achieved the same degree of penetration in healthcare as that seen in other sectors such as finance, transport and the manufacturing and retail industries. Further, deployment has varied greatly from country to country and from speciality to specialty and in may cases has revolved around local systems designed for local use. National penetration of EMRs may have reached over 90% in primary care practices in Norway, Sweden and Denmark (2003), but has been limited to 17% of physician office practices in the USA (2001-2003) [HHS, 2005]. Those EMR systems that have been implemented however have been used mainly for administrative rather than clinical purposes. Electronic medical record systems lie at the center of any computerised health information system. Without them other modern technologies such as decision support systems cannot be effectively integrated into routine clinical workflow. The paperless, interoperable, multi-provider, multi-specialty, multi-discipline computerised medical record, which has been a goal for many researchers, healthcare professionals, administrators and politicians for the past 20+ years, is however about to become reality in many western countries. Over the past decade, the political impetus for change in almost all western countries has become stronger and stronger. Incontrovertible evidence has increasingly shown that current systems are not delivering sufficiently safe, high quality, efficient and cost effective healthcare (see Public Reports section on OpenClinical), and that computerisation, with the EMR at the centre, is effectively the only way forward. As Tony Abott (Australian Minister for Heath and Ageing) said in August 2005: "Better use of IT is no panacea, but there's scarcely a problem in the health system it can't improve". For the first time, the responses have been national and co-ordinated. Governments in Australia, Canada, Denmark, Finland, France, New Zealand, the UK, the USA and other countries have announced - and are implementing - plans to build integrated computer-based national healthcare infrastructures based around the deployment of interoperable electronic medical record systems. And many of these countries aim to have EMR systems deployed for their populations within the next 10 years.

TERMS

Terms used in the field include electronic medical record (EMR), electronic patient record (EPR), electronic health record (EHR), computer-based patient record (CPR) etc. These terms can be used interchangeably or generically but some specific differences have been identified. For example, an Electronic Patient Record has been defined as encapsulating a record of care provided by a single site, in contrast to an Electronic Health Record which provides a longitudinal record of a patient�s care carried out across different institutions and sectors. But such differentiations are not consistently observed.

C. Peter Waegemann in his Medical Record Institute EHR Status Report provides, within a historical context, a summary of the different functions and visions implied by the various terms used to refer to EMRs.

What Is Healthcare Informatics?

Health care informatics combines the fields of information technology and health to develop the systems required to administer the expansion of information, advance clinical work flow, and improve the security of the health care system. It involves the integration of information science, computer technology, and medicine to collect, organize, and secure information systems and health–related data. The extraordinary explosion of medical knowledge, technologies, and ground-breaking drugs may vastly improve health care delivery to consumers, and keeping the information related to these advancements organized and accessible is key.

Health care informatics utilizes computer hardware, specialized software, and communication devices to form complex computer networks to collect, analyze, and transmit medical processes. The tools for creating health information systems are not limited just to information technology. These systems should also allow for the assimilation of clinical directives, understanding of formal medical jargon, storage of data, and transmission of clear communication. Medical informatics can be applied in all types of health environments, including primary care, general practice, hospital care, and rehabilitation. It is also inclusive of many of the specialties within the health care field.

Information systems may used to create greater operating efficiencies in three basic functions of health care: clinical, administrative, and financial. For example, health care informatics is pivotal in the movement to cut costs and enhance patient care by implementing a standardized system for electronic medical records. It is also a key to expanding the development health information systems for billing, clinical research, client scheduling, and the exchange of medical information.

Physicians can avail themselves of the growing knowledge base and make better decisions bolstered by computer software called clinical decision support systems (CDSS). Other computer systems, called electronic prescribing systems, eliminate the need for hand-written prescriptions and minimize errors. Informatics also allow for data mining to determine the effectiveness of drugs. This may reduce the cost of treatments, lessen mistakes, and help further advancements in the quality of care.

One of the major objectives of health care informatics is to formulate a standard approach for health care internationally. The idea is for researchers, providers, and patients to benefit from the informatics tools, techniques, concepts, and protocols that transform health care delivery, and to promote best practices in the health care field. As a result of evolving and complex legal issues related to information technology and health-related fields, health care informatics is also important in health law as it relates to ethical, operational, and privacy concerns.

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Medicare to Cover HIV Screening Tests

The Centers for Medicare & Medicaid Services (CMS) announced its final decision to cover human immunodeficiency virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service. The decision is effective immediately.

Under the recently passed Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS now has the flexibility of adding to Medicare’s list of covered preventive services, if certain requirements are met. Prior to this law, Medicare could only cover additional preventive screening tests when Congress authorized it to do so.

“Today’s decision marks an important milestone in the history of the Medicare program,” said HHS Secretary Kathleen Sebelius. “Beginning with expanding coverage for HIV screening, we can now work proactively as a program to help keep Medicare beneficiaries healthy and take a more active role in evaluating the evidence for preventive services.”

Under MIPPA, CMS can consider whether Medicare should cover preventive services that Congress has not already deemed as covered or noncovered by law. Among other requirements, the new services must have been “strongly recommended” or “recommended” by the U.S. Preventive Services Task Force. For instance, the Task Force graded HIV screening as “strongly recommended” for certain groups.

New Limits Set on RAC Medical Record Requests

The Centers for Medicare & Medicaid Services (CMS) has modified the additional documentation request limits for the RAC (Recovery Audit Contractor) program in FY10. These limits will be set by each RAC on an annual basis to establish a cap per campus on the maximum number of medical records that may be requested per 45-day period. A campus unit may consist of one or more separate facilities/practices under a single organizational umbrella; each limit will be based on that unit’s prior calendar year Medicare claims volume.Limits will be based on the servicing provider/supplier’s Tax Identification Number (TIN) and the first three positions of the zip code where they are physically located. Using TINs will reduce the total number of limits that would have been imposed per organization under the previous draft policy, which was based on National Provider Identifiers, while zip codes are factored in to promote equitability for regional or national organizations.
Limits will be set at 1 percent of all claims submitted for the previous calendar year (2008), divided into eight periods (45 days). Although the RACs may go more than 45 days between record requests, in no case shall they make requests more frequently than every 45 days
Read the CMS notice.