Safety Of Patient Data - In The Wake Of Mobile Devices In Healthcare

As more hospitals hire temporary and freelance workers who move between facilities and access sensitive patient information via mobile devices, security threats are rising. The recent infraction at Massachusetts Eye and Ear Infirmary is a cautionary tale about the consequences of violating the privacy regulations in the Health Insurance Portability and Accountability Act (HIPAA). After the loss of an unencrypted mobile device containing patient data at Mass. Eye and Ear, the facility was hit with a $1.5 million fine in a resolution agreement with the Office for Civil Rights. Healthcare facilities must provide security alongside patient access to data, as well as taking into account their employee turnover. That can be a tall order for a single security approach, unless that approach centers on protecting data itself, rather than on the traditional, network-based security model that seeks to secure the hardware on which information resides.

Mobile devices enable healthcare organizations to increase efficiency, foster collaboration and better serve patients. And yet, these devices introduce risk to patient data security. That risk goes beyond the kind of theft that occurred at Mass. Eye and Ear. Far more likely are events in which data is accidentally shared or leaked to parties that should not see it. While facilities generally have some level of security on their desktop computers, few have adopted protection for hospital- or employee-owned smartphones, laptops and tablets.

In 2011, the Ponemon Institute conducted a survey that found that 81% of healthcare organizations store sensitive information on mobile devices, some of which belong to employees. Forty-nine percent of respondents to the survey reported that their organizations don't secure the data on those devices at all.

In the meantime, healthcare professionals are increasing their use of mobile devices to share patient data. IT decision-makers in hospitals across North America are exploring text messaging as a replacement for paging. Increasingly, doctors say they expect to use text messaging to communicate with patients, even as IT personnel struggle to craft a plan for keeping texting activity in compliance with HIPAA. And the security crisis in healthcare is further heightened by the U.S. Department of Health and Human Services' Stage 2 Meaningful Use requirement for patient access to electronic health data.

In the face of HIPAA, healthcare facilities must deploy security that gives patients greater access, protects data residing on mobile devices, allows providers to electronically deliver information and accounts for a constantly shifting workforce.

Keeping Patient Data Safe & Available

Data breaches in healthcare are on the rise. In 2011, The Ponemon Institute reported a 32% increase in data leaks in the industry and said 96% of healthcare organizations suffered from data loss in the previous two years. The cost for all of those security missteps reaches $6.5 billion each year.

There are several potential approaches to solving this expensive problem. One such option is mobile device management (MDM), at least for the tablet and smartphone users. However, such tools fail to cover the true damage of potential data loss. Most MDM offerings can remotely wipe a device, but only if it is managed by the employer. That hardly answers the risks posed by the bring-your-own-device (BYOD) trend. Furthermore, MDM doesn't keep documents protected as they're shared between devices and opened in different apps.

A more effective method for safeguarding patient data without shutting down communication is to wrap every document in its own layer of security. Most clinical data takes the form of either an Adobe PDF or an image file, both document formats that can be persistently protected with the right technology. Doing so allows healthcare facilities to set the parameters for data access and sharing while controlling the sensitive documents that reside on every device, even those beyond the reach of IT. Document-based security ensures that protection travels with the data, regardless of where it goes. IT retains the ability to wipe clean selected documents in the event that a hospital-owned or personally owned device is lost or stolen.

Source: health-information.advanceweb

Consumers are now more enthusiastic about mHealth

Like a boulder — or perhaps an avalanche — splashing into a pond, mHealth has sent powerful waves spreading across the continuum of care. You can feel the impact when your cardiologist uses his smartphone to take an ECG reading in his office, or you use yours to check tests results via a secure patient portal. You feel it when the orthopedic surgeon pulls up your son’s CT scan on an iPad to show him where he fractured his bone, or your friend with diabetes wears a glucose monitor to wirelessly transmit data to his physician — and especially when the nurse in the hospital uses a barcode scanner to confirm your mother receives the right dose of the right medication.

These are just a fraction of the countless ways mobile technology is making its mark everywhere, from hospitals to long-term care facilities to patients’ homes. Increasingly, healthcare organizations and clinicians are relying on mHealth to improve patient safety, outcomes and satisfaction within hospitals.

At the same time, they’re using mHealth to monitor and connect with patients in order to keep them out of the hospital. Over the next few years, the number of patients with chronic conditions — including heart disease, diabetes, chronic obstructive pulmonary disorder and sleep apnea — who will wear wireless electronic devices is expected to climb as high as seven million. During home visits, home health nurses and therapists find mobile devices convenient and efficient for documenting and accessing patient information. And tablets are becoming popular tools for interactive “e-visits” with rural residents, seniors and people living with chronic conditions.

Meanwhile, physicians continue their love affair with tablets and smartphones, taking advantage of them to access EHRs, collaborate with peers or view test results anywhere, anytime. Nearly 70% of doctors use smartphones and 66% use tablets, according to InformationWeek’s Healthcare IT 2012 Priorities Survey. Some physicians have even started prescribing apps to their patients to encourage engagement, track medications, collect health data and help modify behavior.

This makes sense, given that consumers — already accustomed to using their mobile devices to shop, bank, book travel and more — also appear eager to access healthcare information on the go. In fact, preliminary research shows patients who are more connected are healthier and make smarter, more cost-effective choices for the services they need. Although a 2011 report from Pew Internet & American Life Project found that only 10% of smartphone users have downloaded health-related apps, Juniper Research predicts mHealth and medical app downloads will more than triple to 142 million by 2016.

A study by PwC found consumers in the U.S. and abroad highly enthusiastic about mHealth, with 59% reporting mobile health has given them solutions that have replaced some doctor visits, and nearly half saying they think it will change the way they manage their overall health, medication and chronic conditions. The catch is, many consumers still lack any electronic — let alone mobile — access to their medical records and healthcare providers. And many physicians remain reluctant to deliver care via mobile devices because payers don’t compensate them.

However, this is likely to change as value-based reimbursement models become the norm, and mHealth applications and technologies continue to demonstrate their ability to improve quality of care and reduce costs. It’s becoming increasingly clear that in addition to enabling caregivers to provide timely, cost-effective care, mHealth has the potential to fundamentally alter the way patients interact with their doctors and engage in — and take greater responsibility for — their own healthcare. And that could lead to some very positive outcomes.

Source: industryview

Heading: Healthcare IT- What are the pitfalls?

The Office of the National Coordinator for Health IT (ONC) has done an outstanding job of promoting EHR technology through Meaningful Use financial incentives, and it has fostered a spirit of cooperation among IT stakeholders. But ONC sometimes sounds more like a cheerleader than an objective observer on the extent to which modern informatics can transform healthcare.

The jury's still out. A RAND Corporation report in 2005 predicted that the efficiency and safety improvements made possible with health IT could save the U.S. healthcare system $81 billion a year. Since 2005, however, annual health spending has soared from $2 trillion to $2.8 trillion, and quality and efficiency have improved only marginally, despite an increase in health IT adoption, according to researchers Arthur L. Kellerman and Spencer S. Jones in a newly released RAND study published in Health Affairs.

Kellerman, chair of policy analysis at RAND, and Jones, a RAND information scientist and instructor at Harvard Medical School, lay it on the line: "In our view, health IT's failure to quickly deliver on its promise is not due to its lack of potential but to shortcomings in the design and implementation of health IT systems. ... As a result, we believe that the anticipated productivity gains of health IT are being hindered by the sluggish pace of adoption, the reluctance of many clinicians to invest the considerable time and effort required to master difficult-to-use technology, and the failure of many healthcare systems to implement the process changes required to fully realize health IT's potential."

ONC recently boasted about paying out $10.3 billion as of December 2012 to more than 180,000 physicians and hospitals to encourage installation of EHR technology and to bolster its meaningful use in patient care. The new RAND report suggests the program isn't exactly generating meaningful savings.

Like many other observers, the RAND scientists spotlight the lack of interoperability among electronic health record systems as a key barrier. One reason: Providers "have little incentive to acquire or develop interoperable health IT systems," the authors say.

In talking with thought leaders and clinicians, I also get the impression that many healthcare providers would rather forego the incentive checks and even cough up the eventual penalty fees than deal with the aggravation of implementing an EHR system.

Although Kellerman and Jones are right to point to poor design and lack of interoperability as obstacles, the other key to turning EHRs (as well as CPOE and clinical decision support systems) into cost-effective tools is to change the healthcare payment model.

Before healthcare providers small and large will see the need for this technology, they'll have to be forced into a pay-for-performance model that requires a lean, mean operational approach to patient care. Once that financial model is fully in place, clinicians will see the value of a computer-assisted system that picks up needlessly duplicative lab tests, life-threatening drug allergies buried in paper medical records, and the like. Because without such a system, all the excessive tests and adverse patient outcomes will come out of their pay checks.

Cathy Schoen of the Commonwealth Fund, a private foundation attempting to improve the U.S. healthcare system's performance, said it best: "When you pay [providers] differently -- especially emphasizing team care -- information systems become critical as they get used in an efficient and effective way, because people want to avoid duplication. ... They want real-time information on where the patient is and what's going wrong."

Health IT doesn't have to be a sinkhole in which we pour billions of dollars. And in fact many individual provider organizations have proved that it can improve quality of care and lower costs. But as a nation, we still fall woefully short of that goal.

Source: informationweek

Enabling Business Intelligence With Workflow Automation

The list of pain points for many healthcare organizations today is a long one. Lingering economic woes and uncertainty about the future has many a hospital administrator looking for new ways reduce costs, increase revenue, and improve staff efficiency, among other necessary strategies.

Utilizing best practices, lean strategies or other performance improvement tactics, hospitals have been able to achieve some success in improving patient care and processes while decreasing costs. What many don’t understand, however, is that they are sitting on a gold mine of sorts—a trove of data that can be used to promote significant operational, clinical and financial enhancements. Unfortunately, this information is locked away in databases, information systems and file cabinets. And without the proper tools to collect, extract and turn the data into knowledge, healthcare providers are left to apply the same tired solutions to new, increasingly complex problems.

Progressive healthcare organizations, on the other hand, are not simply relying on processes to improve operations. They are leveraging sophisticated business intelligence (BI) technologies to promote informed, top-down decisions that can enhance the patient experience, drive better clinical outcomes, improve staff efficiency and increase revenue.

With a BI strategy, provider organizations have a unique tool designed to extract, consolidate and standardize many different data elements from various information sources. Clinical, operational, revenue cycle and other analytics are delivered to leaders via reports and dashboards, customized to meet their personal preferences. BI software can also be configured to deliver information in near real time, ensuring that administrators can quickly change course before a little problem turns into a major disaster. And many leaders create predictive models to help identify trends that influence and direct the hospital's future course.

But these activities wouldn’t be possible without workflow automation—a set of applications designed to strip manual, paper-based administrative and clinical process from the healthcare system. Workflow automation digitizes the information necessary to effectively perform business intelligence analysis, which in turn improves staff efficiency by offloading labor-intensive, often repetitive tasks. Introducing standardized digital forms throughout the enterprise not only eliminates the need for manual data entry, it frees staff to focus on other tasks that technology is not equipped to handle.

There are a host of areas within a hospital that are ripe for automated workflows. Once implemented, automation in these segments will allow leadership to harvest previously inaccessible data.

•    Medical record review.  Compliance assurance across an entire, multidimensional healthcare organization is a daunting task. Medical record audits are designed to ensure medical necessity, correct coding and regulatory conformity. Handled manually, this can lead to confusion and produce inaccurate data.

•    Accurate coding assurance. Automated workflow solutions ensure that the hospital enters charges accurately and at the appropriately coded levels to maximize reimbursements. And with efficiency added to the charge capture process, the billing department can submit claims in a timely manner, leading to a healthier revenue cycle.

•    Audit processes management. Audits represent a significant challenge to revenues and profit margins for any healthcare provider. With an automated workflow solution, users can view timelines and share audit information with the appropriate individuals to ensure the required data is received and processed in a timely manner—all with an audit trail for accountability.

•    Risk management. Healthcare providers require the ability to record and report on events that compromise patient safety and quality care. Automated workflow solutions improve reporting efficiency by replacing paper forms with a rules-driven intelligence that allows managers to document safety incidents, analyze electronic data and send compliant documents internally as well to patient safety organizations (PSOs).

•    Human resources administration. Human resource departments produce an endless stream of documents such as benefits forms and performance evaluations. With staff management processes consolidated in a customizable workflow solution, not only will HR personnel be more effective, staff members that interface with the department will be better organized and informed.

With automated workflows permeating the organization, hospitals will be in a much better position to leverage their BI platform to access organized, real-time information. This, in turn, will drive a new level of intelligent decision making necessary to succeed in the increasingly complex, ever-competitive and wildly unpredictable healthcare marketplace.

Source: healthcareitnews

How To Avoid EHR Implementation Pitfalls With Strong Leadership and Training

Many physicians have chosen an electronic health record (EHR) and are now unhappy with their choice.

Multiple issues can lead to that situation. First, doctors might not have purchased the right product, for a variety of reasons. For example, they might have outside influences who tell them to use a particular product. Second, physicians might not be completely engaged in the selection of the product. And third, in some cases, doctors buy the right product but they are just not using it effectively.

To figure out which of those situations might be affecting you, go back and look at how you made the decision and how engaged you were in making that decision. In some cases, doctors literally have said to their staff, “Go find an EHR product for me and I will use it.” Or, when looking at a product, they don’t invest the time in understanding it or they don’t make site visits to see how they can use the product successfully.

The bottom line is, physicians who are making the decision about which EHR to buy have to realize how profoundly the decision will affect all aspects of the practice. Even in a multiphysician practice, you must ask: Are we going to use this system? Are we willing to put in the time and effort and adjust to adopting this tool into the style of how we practice medicine? If you can’t answer those questions in a positive way, you are putting a lot of risk on the table regarding your EHR.

When looking to adopt an EHR, you must make decisions about redesigning how your practice is going to operate.

Changing the Whole Practice Workflow

As a national EHR consultant and author, I tell people that they have to take the whole practice apart and put it back together again, no matter how big or how small the practice is, because everything they do right now is tethered to that paper record. If that tether no longer exists, they have to figure out how they will operate in their environment without this piece of paper.

For example, clinicians may be used to this type of system: if the chart is in the door this way, it means that the patient needs to see a doctor. If it’s in the door that way, a nurse is supposed to go in. If a paper record doesn’t exist, how will I know which it is? I have been flipping through this chart for years, I know all the visual cues, and now I have to sit there and flip around in this computer system.

In many cases, I have to redesign the system from a workflow perspective. I also have to consider how doctors interact with patients so that they get the information they need and put it into the EHR. That’s a lot of change that somebody has to engage in; it’s not such an easy thing.

Lack of training is another reason why physicians may dislike the EHR. The reality is that the practice must become independent from the vendor. Nobody has enough money in their pockets to pay the vendor to be there for months. The vendors come in, train everybody on the EHR, and then pull their people. You may not be willing — or have the resources — to pay for them to stay.

Even if you have those resources, you will come to a point where they will leave your practice, go back home, and you will be left to run the system yourselves.

Who Needs to Know What?

From a training perspective, you need to assign a couple of your practice employees to become in-house experts on the various aspects of using EHRs, which includes understanding the clinical content as well as the work in your environment. You have to protect that to make sure that you use the system on a consistent basis.

When doctors become disillusioned with the EHR, it could be because they don’t know how to use it correctly, or in some cases they are not maintaining it correctly. If they are not sitting down on a daily basis and saying, “Have I done all the work? Have I documented all the information I need into my EHR?” then the EHR will become problematic. They will almost be undermining the efficacy and the accuracy of the EHR records.

If that is the problem, in order to fix it, the practice has to invest the time up front for the doctors and the staff to become knowledgeable and comfortable enough with the EHR so that they can get in front of a patient and use it.

In some cases, vendors say to the doctors, “Here is your EHR, here are a few hours of training; go treat a patient.” Then we are surprised when the doctor’s focus becomes the EHR. They are not looking at the patient. Or they will turn their backs on patients so they can document something on a workstation in the corner of the room. All of these things undermine the connection with the patient.

Not Enjoyable for the Doctor

It’s not a pleasant experience for the doctor either, because the doctor thinks, “I’ve become a data-entry clerk.” If staff put in enough effort up front to become knowledgeable about how the EHR works so that they can integrate it into their style of interacting with patients, it’s going to be a very good experience.

If I go in and give them a very short training timeframe, they won’t be familiar or comfortable with it, and when I make them use it when they see every single patient, it’s not going to be a very pleasant experience. You have to glide into using the EHR. Make it a positive experience throughout the implementation process. Make sure that you are monitoring it so you can measure your success. You don’t want to turn around and say, “We were not successful because we made all of these mistakes.” Before setting up very specific mechanisms and asking everyone else to jump in, verify that the mechanisms will work in your practice.

Maybe the EHR Is Just Plain Wrong

The other factor that can subvert the success of the EHR is that the doctor didn’t pick the right product. Or, in some cases, over time the product or the practice has changed and the EHR is no longer a good fit.

Suppose you had bought an EHR geared toward your specialty practice, and now you want to branch out to become a multispecialty practice. Maybe the product isn’t right for that. Or perhaps the practice started out as a 2- or 3-doctor practice and now has become a 10-doctor practice. Ten-doctor practices have different EHR issues and problems than smaller practices.

Another scenario is a vendor who becomes nonresponsive. You might have started out with a vendor because it dealt with your area of medicine, but now all of its business is in primary care, which is not your area. All of the toys that are coming out in the EHR are geared toward primary care, but you are trying to deal with surgery scheduling. You can grow away from the product or the product can grow away from you. You will have to make a move to something that is more appropriate for your situation.

If you hate the EHR, even though the EHR is competent and effective but you just don’t use it correctly, consider assessing why it isn’t working for you. Do you need to go back and redesign the system? Do you need to adjust how you use it so that you can be more successful? After you go through that exercise, you might have to go through a retraining process for your staff. Once you have done that retraining, you are reimplementing the EHR.

Be forewarned that some of that reimplementation might mean going back and fixing a patient’s medical record going forward. Suppose, for example, that EHR users are entering medications as notes instead of putting them into the medications module. Everybody says, “We are doing drug utilization review; can we get our meaningful use points to collect our money?” You have to go back and say, “Wait a second — the product works; we are just not using it correctly.”

That’s very different from being in a situation in which the product itself is bad or is really inappropriate for you. At some point a doctor may cry “Uncle!” and say, “This is not the right system for us.” You have to soul-search and make sure that the product that you are buying is going to solve the problem, and make sure it’s not about your practice.

Money and Effort Will Kick In

Switching to another product requires a different effort, including cost issues. It is also extremely difficult to take information from one EHR and move it to another environment. Different systems have very different structures. Some are textual, with long text fragments that make up the medical record. Some of them have small labeled fields. If you are a cardiologist and you are taking the patient’s medical history, in some systems you will be checking off boxes, whereas in other systems you will be dictating notes through Dragon or a similar product, using voice recognition. Those are very different products, and to move from one to the other and back again is very challenging.

The features of some systems are very different. For example, consider a scanned image. If you scan in an ER report from the hospital or a patient’s previous medical record, some EHRs track whether the doctor looked at this document. Some EHRs don’t track this. When you are trying to convert from one to another, how are you going to bring that information over correctly, and where are you going to enter it? There are many examples of trying to map out where information should be entered.

Sometimes an EHR fails because the vendor is failing, and that means that the product isn’t working for you anymore. You might have lots of workarounds. In some cases, you end up with many pieces of paper that you are using to document and the system is scanning them in. Sometimes the vendor is abandoning the product and moving to a different product and therefore has stopped maintaining and fixing your system. They are no longer investing their money in it. We have vendors who have said, “We sold a product that we put in your office, and now we want to sell you a service out of the Cloud.” They make it impossible for you to continue to use that product in your office. These are things that can happen and you are subject to them.

Another situation that I have seen is when the EHR is no longer being actively sold. The manufacturer says, “No new practices are implementing this system.” That is a very serious problem strategically. Therefore, practices need to keep an eye on what’s going on with the product. Is it moving forward? Are there signs that this product is no longer a viable option to maintain your records?

Remember that the punchline to all of this is that it’s the practice that is responsible for maintaining patients’ records, not the EHR vendor, and HIPAA security is the responsibility of the practice, not the vendor.

Source: emrindustry

Patient Protection And Affordable Care Act Will Lead To Many Changes In The Way Healthcare Is Accessed And Delivered

The far-reaching Patient Protection and Affordable Care Act will mean myriad changes to the way health care is accessed and delivered in this country -- and how it affects you could depend on your age, income, health and current insurance status, among other things.

Here's a look at what changes could be most important to you:

If you don't already have health insurance: You're going to have to get coverage next year or likely face a financial penalty that starts at 1 percent of your income (or $95, whichever is more) in 2014, and rises to 2.5 percent of your income by 2016. You could be exempt if you're American Indian, if health insurance goes against your religious beliefs or if you can show financial hardship. The good news is, thanks to other provisions of the Affordable Care Act, it should be easier and more affordable for people who are uninsured now to get insurance.

If you are a senior citizen: You should already be seeing some benefits of the reform, including not having to pay for preventive services through Medicare and getting help paying for prescription drugs once you hit the "doughnut hole" in Medicare Part D coverage. By 2020, seniors should be paying only 25 percent of those drugs' costs.

On the other hand, some Medicare benefits are being cut -- things like hearing aids, glasses and memberships to fitness centers. And you may find that some illnesses and surgeries that Medicare once would have considered appropriate for an overnight hospital stay are now considered outpatient, which means you may be billed for individual costs that once were part of the hospital "package."

If you do spend time in the hospital, you may notice your providers doing more aggressive follow-up once you are released, to try to prevent you from having to go back into the hospital.

If you are a young adult: If you're younger than 27 and not offered insurance through your job, you can remain on your parents' health insurance policy until your 27th birthday. If that's not an option for you and you're young, in good health and don't expect to need much medical care, you can purchase a "catastrophic" health insurance plan with low premiums but a high deductible -- coverage doesn't kick in until you've paid for $6,000 in care yourself.

If you're wealthy: You may pay a higher Medicare tax this year. Those with an annual income of more than $200,000 for one person or $250,000 for couples will pay a 2.35 percent Medicare tax, up from 1.45 percent. In five years, the government will start taxing high-dollar, high-coverage employer-sponsored "Cadillac" health plans with a 40 percent excise tax.

If you're low income: It's possible that you'll qualify for Medicaid in the future even if your income is too high to qualify now. The ACA, in its original form, intended to make it so that all Americans who earned less than 133 percent of the federal poverty line (about $14,000 for a single person, or $29,000 for a family of four) would be eligible to enroll in Medicaid, giving the states 100 percent of the extra money needed for the first three years and gradually requiring the states to fund 10 percent of the expansion in the future.

But the U.S. Supreme Court ruled that the federal government could not force states to expand their Medicaid programs just to continue getting funds they were already receiving.

If you're middle class: If you're self-employed or work for a smaller company, you should be able to buy insurance on the health exchange. People who make four times the federal poverty level (about $44,000 for an individual or $88,000 for a family of four) or less may be eligible for subsidies from the federal government, which would be paid to the insurance companies and appear on your bill as a discount. The idea is that people would not pay more than 10 percent of their income toward health insurance (and the lower the income, the less the percentage).

If you're an undocumented immigrant: There are no provisions in the ACA for you at all. You wouldn't be eligible for Medicaid or to buy insurance on the exchange. You can still purchase a policy through a broker, if you can afford one, or pay yourself for care at clinics, hospital emergency rooms and other providers.

If you typically claim unreimbursed medical expenses on your tax return: You may not get to do so now - they must be 10 percent of your income, up from 7.5 percent in the past.

If you have a health insurance plan through your large employer: You're not likely to see many changes right now. Your premiums will likely stay flat or, if the insurance company your plan is through has been making large profits, may drop as the government now regulates what percentage of profit must be funneled back into providing quality or lowering premiums.

Right now, only small businesses and individuals who don't have insurance through their jobs can buy insurance on the exchange - but that does mean if you lose your job, you should have an easier time finding affordable health insurance coverage for you and your family.

Source: kypost

Use Of Computerized Physician Order Entry (CPOE) Systems In Hospitals Likely To Accelerate EHR Utilization

The advanced use of electronic health records is starting to accelerate in hospitals, mainly because of the government's EHR incentive program, concludes a new analysis of HIMSS Analytics' Electronic Medical Record Adoption Model (EMRAM) scale. The EMRAM scale is an eight-stage model that indicates where hospitals stand on the EHR adoption curve.

A survey by HIMSS Analytics, the research arm of the Health Information Management and Systems Society, indicates that during the five quarters ended in September 2012, the number of U.S. acute care hospitals achieving EMRAM stage 5 or 6 increased by more than 80%; the number of facilities in stage 7 rose 63%.

Nevertheless, the percentages of hospitals that are actually in these stages show that the majority of facilities have a long way to go before they realize the full potential of their EHRs. In the fourth quarter of 2012, HIMSS Analytics figures show, just 1.9% of hospitals had reached stage 7; 8.2%, stage 6, and 14%, stage 5. Three-quarters of the hospitals were not yet in stage 5.

Although the EMRAM stages have no direct relationship to the stages of Meaningful Use in the federal incentive program, the current distribution of hospitals' IT capabilities raises questions about their ability to meet the requirements of Meaningful Use stage 2.

On the plus side, a hospital in EMRAM stage 4 has computerized physician order entry (CPOE) and clinical decision support, both of which are required in Meaningful Use stages 1 and 2. Facilities in stage 4 have nursing documentation, error checking, and other capabilities. But they are missing closed-loop medication administration (stage 5), physician documentation and full clinical decision support (stage 6), and the ability to exchange standardized summary documents with other providers (stage 7). All of these are required in Meaningful Use stage 2 except for physician documentation, which is an optional menu item for eligible professionals.

Health information exchange capabilities are moving slowly in the right direction as well, according to John Hoyt, executive VP of HIMSS Analytics. "Facilities moving to the upper stages of EMRAM are laying the groundwork for interoperability to occur," he said in a press release. "Stage 6 and Stage 7 hospitals are fully prepared for provider-to-provider or facility-to-facility interoperability, as well as increasing the provider or facility's ability to provide electronic health data reporting to public health and immunization registries to support population health review and syndromic surveillance."

In an interview with InformationWeek Healthcare, Hoyt said, "We still have an accelerating rate of growth in stages 5, 6 and 7. The biggest hurdle is getting physicians to enter data on their keyboards. Of course, that's required for stage 1 of Meaningful Use."

That comment referred to the Meaningful Use stage 1 requirement that clinicians enter pharmacy orders for 30% of patients with at least one pharmacy order through CPOE. Noting that HIMSS Analytics has always required medication, lab, imaging and other orders to be done electronically in stage 4, he observed that some hospitals might not achieve that level in EMRAM, yet still be able to attest to stage 1 Meaningful Use.

Providers who achieve stage 5 in EMRAM could probably meet the Meaningful Use stage 2 requirements, Hoyt said, partly because they already have full CPOE. In addition, EMRAM stage 5 requires closed-loop medication administration that matches patient IDs with bar codes on drug packages. Although the Meaningful Use regs aren't so specific, he said, they "imply" that kind of medication administration.

Asked why it takes most hospitals so long to get to advanced stages of EHR implementation, Hoyt pointed out, "It's really difficult to implement these systems with voluntary medical staffs." In a highly competitive environment, he noted, hospitals want to make private practice physicians happy, so they don't want to lean on them too heavily to enter orders through CPOE or do electronic documentation. But Meaningful Use has leveled the playing field, he said, making it easier for hospitals to seek physician participation because their competitors are doing the same thing.

In addition, he said, it's expensive and time consuming to fully implement clinical systems. "It's not just a matter of buying software, it's about process redesign. It takes leadership and access to capital. That's clearly a problem, especially for small hospitals -- not leadership, but access to capital," he said.

Many hospitals are doubtful about their ability to achieve Meaningful Use stage 2. In a recent KPMG survey, 47% of healthcare executives said they were only "somewhat confident" about their ability to satisfy these requirements. The biggest challenge, the respondents said, would be training and change management.

Source: informationweek