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=THE EMR WIKI=

**Preface:** Some of the work done on this wiki comes from collaborative papers written for the interdiscipliary project for the George Washington University Healthcare MBA program with Professor el Tarabishy. Collaborating on the project were several classmates who deserve full credit for the research they did in exploring this complex topic. There are two very informative sites worth looking at to get started, the [|HIT site] and the [|CBO repo​rt 2008] . We ask the new contributors to review our work and improve it. If you find a statement that needs to be supported by footnote documentation, please add it. We want this wiki to be a strong site for the most up to date information about this topic that is growing in importance in the American healthcare system.

**Electronic Medical Records and Electronic Health Records**

**Introduction:**  In 2006, when Nevada Representative Jon Porter introduced legislation to revamp the Federal Employees Health Benefits Program to include an electronic health information system, healthcare reform and the nation‘s economy were not at the forefront of public policy agendas. In the three years since the legislation was considered, the political and economic landscape has drastically changed. Changes at the executive branch with the election of Barack Obama, along with Democratic majorities in the House and Senate, is similar to the realignment forces that were present in the early 1990s when the Clinton administration attempted healthcare reform and in 1965 when Medicare and Medicaid were passed. In contrast, a major economic difference compared to when past measures were considered is that healthcare expenditures have increased from 5% to 17.3% of the 2009 GDP [ 1 ] , and at same time the number of uninsured has climbed to above 25%. This equals the 1965 value when Medicare and Medicaid were configured to solve the problem of the uninsured.

There are many functions associated with patient health records. Not only is the record used to document patient care, but the record is also used for financial and legal information, and research and quality improvement purposes. The electronic health record (EHR) provides the opportunity for healthcare organizations to improve quality of care and patient safety. An EHR also represents a huge potential for cost savings and decreasing workplace inefficiencies. Currently the paper record represents “massive fragmentation of clinical health information.” This not only causes the cost of information management to increase but also “fragmentation leads to even greater costs due to its adverse effects on current and future patient care” (fn) (Schloeffel, Peter, et al. “Background and Overview of the Good Electronic Health Record.” May 2001). Another benefit to an EHR is that it allows for customized views of information relevant to the needs of various specialties. The EHR is “far more flexible, allowing its users to design and utilize reporting formats tailored to their own special needs and to organize and display data in various ways” (fn)(  Dick, Richard S., Steen, Elaine B. and Detmer, Don E. __The Computer-Based Patient Record: An Essential Technology for Health Care, Revised Edition__. []). Financially, the EHR will provide more accurate billing information and will allow the providers of care to submit their claims electronically, therefore receiving payment quicker. demo <span style="color: #404040; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">It has been reported in CNNMoney that President Obama plans modernize health care as a plan to increase the provision of medical care to cover the uninsured and underinsured. Incorporating electronic medical records is a big focus of his plan. In return this will improve health care and stimulate the economy. In 2009 only about 8% of the nation’s 5000 hospitals and 17% of its 800,000 physicians utilizes some form of electronic medical records. (fn) ( <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[]<span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">) <span style="color: #404040; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">“This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests,” said Obama. “It just won’t save billions of dollars and thousands of jobs—it will save lives by reducing the deadly but preventable medical errors that pervade our health care system”, he added. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">chet

It is estimated that medical errors may cause 44,000 to 98,000 deaths per year (or the equivalent of two 737 jets crashing daily). Medication errors can be reduced, if not eliminated, by the use of EMR’s [2]. Yet, physicians and hospitals alike have been slow to adopt EMR’s due to several reasons. These include, but not limited to, technology that is not user friendly, cost of installing and training, difficulty in usage and non-communication between different systems making the information still difficult to obtain.<span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%;">[3]. <span style="color: #c0c0c0; font-family: Arial,Helvetica,sans-serif; font-size: 8pt; line-height: 150%;">deb <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">It has been estimated that the prevalence of Hospitals using EMR is 2% (fully operational) and 16% in physician offices. (fn)( Jha, AK. DesRoches, CM. Campbell, FG. et al. Use of Electronic Health Records in US Hospitals. //NEJM// 2009 April 16; 360(16):1628-38). <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">ada

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Many of the benefits of the EHR are clear and intuitive: reporting outcomes may be significantly more standardized than current systems, tracking down patient records is more streamlined ( [] ), medical errors may decrease ( [] ), data-gathering is often made easier ( [] ), and the availability at-a-click of decision aids for the physician would improve. Useful filters may help relieve part of the problem with junk data in Medicine ( [|www.connectingforhealth.org/commonframework/docs/T5_Background_Issues_ Data.pdf] ). It may help physicians with decision rules based on past experience ( [] ). kash

The Baby Boom Medicare "explosion" is quickly approaching, certain to further strain healthcare resources, and an economic recession has focused political and business leaders on cost-containment measures, including healthcare expenditures. Accordingly, these forces are poised to redirect the typical incrementalism of health policy formation to more radical reformations. <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 10pt; line-height: 150%;">This analysis was undertaken to evaluate the universal adoption of an electronic health record. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Specifically, the existing electronic health information technology is examined in the context of the meaningful use proposal in the American Recovery and Reinvestment Act of 2009 (ARRA), which provides incentives for EHR adoption. (fn) ([]). <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">gabr <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 10pt; line-height: 150%;">However, the prospects of a national electronic health record have not been uniformly received with enthusiasm. Perspectives of electronic health information systems have ranged from a bothersome burden to a healthcare panacea. While many in the insurance industry and academia have lauded its potential value, healthcare providers including physicians and hospitals have remained suspect of its cost-benefit ratio. These barriers to the implementation of an electronic health records are further considered below, along with the potential advantages and disadvantages of its global adoption. Finally, the financing of such a project, either through the private sector or government sponsorship, is evaluated. (fn) (<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[] A discussion of how doctors find EMR’s not user friendly and that they cannot share information from one system to the next.)

<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13.5pt; line-height: 150%;">**Defining an Electronic Health Record** <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> The terms EMR (electronic medical record), EHR (Electronic Health Record) and PHR (Personal Health Record) are often used interchangeably by the media and health professionals. However, there are <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">important distinctions to be made beyond mere semantics. EMR‘s are electronic databases of patient information containing many variables including demographic, medical and financial data. These systems are frequently linked to enterprise systems to coordinate billing and scheduling, in addition to non-patient care tasks such as marketing. This is in distinction to a PHR that contains individual patient information that is often entered by patients themselves. These data can be in any form. EMR‘s and PHR‘s can be merged, edited and retrieved in an electronic format and more broadly considered as an EHR,<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;"> although the Healthcare Information and Management Systems Society (HIMSS) has also includes in its EHR definition the ability to support ‘other care-related activities directly or indirectly via interface—including evidence-based decision support, quality management, and outcomes reporting’. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">(fn) ([] ). <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">gabr

The electronic health record (EHR) is traditionally a provider-controlled document. Managed care organizations and other payers can access EHR information to create standards for pay for performance programs for physicians and hospitals. Optimally, EHR data could be utilized in aggregate to develop improved standards of care, perform large epidemiological studies, and facilitate identification of patients exposed to a drug or device that has been recalled. Clinically, care provider to care provider transfer of information should be enhanced by an EHR. Improvements in documentation may optimize patient care, which arguably may reduce costs and improve collections. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Electronic communication tools, which could be included in an EHR, have been shown to be effective in facilitating communication both among providers and with patients, thus allowing for greater continuity of care and timelier interventions. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> The extent of realization of these gains is not known.

As mentioned above, the EHR may be comprised of individual PHR‘s. Traditionally, the personal health record (PHR) is patient-driven documentation. These systems are typically very user friendly, and are an important way for information to be passed between patients and providers. Many of the currently available PHRs offer additional benefits such as links to health newsletters and health encyclopedias. Most of the PHRs that were reviewed offer two to three levels of security and can include other personal information such as next of kin, insurance information, living wills, and emergency contacts. The PHRs are secure with username and password; there are restrictions regarding who can enter data, with this data being encrypted. These PHRs are made portable by using USB memory devices; some are accessed in a read-only manner for emergency services personnel. A few of the PHRs offered are free, but many are available at a very low cost. Well established internet companies such as Google and Microsoft are offering free online PHRs. As with the other PHRs, it is patient-controlled data and access -restricted, and the information is securely stored. Disadvantages to the various PHRs stem from the design of the PHRs themselves. Since the information is entered and edited by the patient, there may be inaccuracies in health assessment. A patient could omit entire sections of his health record, even if it is vital to his overall care. The elderly population, who may not be as computer literate, may not utilize a PHR at all. Another important limitation is the security of the information.

To facilitate portability, many PHRs offer ID cards for healthcare providers to obtain access to the patient‘s data. For example, the site <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">http://www.medsfile.com <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> allows printout of the record with no personal identifiers, which adds to security and assists emergency personnel. However, a lost card can <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">potentially give anyone access to the information. Also, end user failure to guard the information safely would allow unauthorized access to patient documentation, and could lead to identity theft. The numerous cases of laptops being lost containing critical personal information underscore this point. In consideration of portability, compatibility must be considered. If different databases do not afford for electronic interchange of data, the benefits of a phr are lost.

A universal patient health records system implies a single medical document accessible by all of the patient's authorized healthcare providers. Secondly, a patient health record system (whether universal or not) specifically incorporates the input of patients in addition to the input of healthcare providers. One of the major criticisms of the existing healthcare system is that the information exists in data "silos". The analogy aptly describes the situation where each patient‘s healthcare providers utilize an independent and separate health record. Within a single institution or healthcare provider group, multiple healthcare providers may be able to access the same record. When healthcare extends beyond these boundaries however, multiple duplicated health care records are created, resulting in the existence at any one time of multiple variably incomplete and semi-duplicated patient documents. The result is that healthcare, like the documentation which records it, ends up being fragmented and incomplete. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">In the U.S., electronic records across the nation may eventually communicate through the Nationwide Health Information Network (NHIN). //The NHIN is a collection of standards, protocols, legal agreements, specifications, and services that enables the secure exchange of health information over the internet//. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou The increasing use of electronic documentation requires electronic storage. Onsite servers with backup redundancy are one answer while large terabyte repositories (with backup offsite storage) are another. There remains the possibility of server failure interrupting access to the EHR. Upgrading or changing software can leave an EHR unavailable unless an expensive data conversion is done. Many EHR programs are very expensive for small private practice offices, therefore the cost impediment will slow acceptance of the project. Government financial support is being considered to advance the institution of office EHRs. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Electronically stored information should remain accurate, tamper-proof, and not at risk for spoliation. All patient care data should be discoverable. Older data in obsolete systems must be preserved and remain accessible if needed. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> When considering these factors together it becomes apparent that a universal EHR and/or universally compatible EHR project should be considered. An important consideration regarding this undertaking is that stakeholders - individuals, clinical practice groups, agencies and political parties – may have incongruent goals as they consider what technology, infrastructure and support is needed to achieve implementation of such an EHR. The current patchwork of private and public EHR’s that operate with a lack of regulation begs for federal legislation to set universal standards and coordinate ongoing efforts.


 * Individual definitions within the EMR/EHR**
 * <span style="font-family: 'Arial Black','sans-serif'; font-size: 10pt; line-height: 150%;">Electronic Medical Records (EMR) / Electronic Health Records (EHR) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. An electronic medical record (EMR) is the health-related information on an individual that can be created, gathered, managed and consulted by authorized clinicians and staff within __one__ healthcare organization. An electronic health record (EHR) is a longitudinal history of health-related information on an individual that can be created, gathered, managed and consulted by authorized clinicians and staff __across__ healthcare organizations. Although sometimes used interchangeably, an EMR is the software used at the point of care, and an EHR is the collection of health information across organizations (and potentially different EMR software). Additional confusion may be between basic EMR (e.g., patient demographics, problem list, clinical notes) and comprehensive EMR (or sometimes EHR due to integrated health information exchange) that may include E-Prescribing and Clinical Decision Support Systems functionality, as well as further integration with lab data. chof
 * <span style="font-family: 'Arial Black',Gadget,sans-serif; font-size: 10pt; line-height: 150%;">E-Prescribing <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt; line-height: 150%;">(eRx ) E-prescribing is the ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care. This is an important element in improving the quality of patient care. Plans that participate in Medicare Part D must support electronic prescribing. @http://www.cms.hhs.gov/eprescribing/ and @http://www.emrconsultant.com/education/e-prescribing . <span style="color: #444444; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> One of the greatest advantages of EMR software is that of the e-prescription feature. EMR programs can integrate with e-prescriptions. There are several vendors that have e-prescribing offerings. One vendor, Surescripts, describes their e-Rx offering as a stand-alone application or an application used as part of an EMR/EHR solution. Their application has the ability to present prescription benefit information, medication history and message routing. @http://www.surescripts.com/  chof
 * <span style="font-family: 'Arial Black',Gadget,sans-serif; font-size: 10pt;">Clinical Decision Support Systems <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">(CDSS ) [] and []. These may be stand-alone applications, but are most effective as part of an integrated EMR/EHR or eRx solution. Common features would include triggers, inputting data elements, interventions, and offered choices. <span style="color: #c0c0c0; font-family: Arial,Helvetica,sans-serif; font-size: 8pt;">chof
 * <span style="font-family: 'Arial Black',Gadget,sans-serif; font-size: 10pt; line-height: 150%;">Health Information Exchange (HIE) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt; line-height: 150%;">/ Regional Health Information Organizations (RHIO). See [], [] , [] and []. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> HIE is the electronic movement of health-related information among organizations according to nationally recognized standards, such as HL7 (i.e., clinical messaging), CDISC (i.e., medical research), LOINC (i.e., lab data), and NCDPC (e.g., ePrescribing). RHIO is a consortia of healthcare organizations and health stakeholders within a defined geographic area (typically as a separate legal entity), that governs the health information exchange for the purpose of improving health and care in that community. Some HIEs are really RHIOs, such as the Indiana Health Information Exchange (IHIE) which is a non-profit entity. <span style="color: #c0c0c0; font-family: Arial,Helvetica,sans-serif; font-size: 8pt;">chof
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">**Personal Health Records (PHR**) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] . An electronic record of health-related information on an individual that can be drawn from multiple sources while being managed, shared and controlled by the individual. <span style="color: #c0c0c0; font-family: Arial,Helvetica,sans-serif; font-size: 8pt;">chof
 * What might an EHR do? **

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The great promise of Electronic Health Records (EHRs) is to decrease healthcare cost, while improving the quality of care, and decreasing preventable medical errors. This premise however, is predicated on the widespread implementation of this information technology and the interoperability of the different systems. Widespread implementation is affected by several variables, but arguably the most important ones are: security and safety of the medical information, the legal aspects of the implementation of EHRs, the return on investment (ROI) of the systems and interoperability, especially if EHRs were to be used in the arena of clinical research. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">ziad The ultimate potential of a universal EHR is not known. Advocates contend it has the capacity to improve patient care, research, and public policy formation. However, the cost-benefit ratio and privacy concerns have yet to be resolved. Though specific goals are innumerable, the generable objectives of healthcare information systems would be to: <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 10pt; line-height: 150%;">Estimation of the benefits of an EMR system is complicated. Few comprehensive studies of overall EMR value have been performed. //A 2005 RAND review of 256 published studies… could not find any rigorous study that quantified the economic benefits of a full-functioned, vendor-supplied system.// There are several studies that assess the value of individual EMR components, but there are no widely accepted standardized methods to estimate or measure EMR benefits. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">In the short term quality improvement, monitoring and maintenance may add to costs. However, it is the response to these quality control outcomes that should decrease costs. Opponents contend that there is no definitive evidence that EHRs improve healthcare and safety or decrease costs. They point to high EMR failure rates, implementation costs and low satisfactions rates. It is important to note that these, in general, have been experiences of enterprise EMR systems, not EHRs. Also, these experiences did not include data integration and intersystem sharing. Without this, the true safety and cost saving measures of an EHR are indeterminable. Additionally, both advocates and opponents agree that privacy must be an essential component to any system, and these details have not been agreed upon. In order to be effective, an EHR must have data retrieval and manipulation characteristics over mere archival capabilities. Fortunately, the capabilities of existing EHRs‘ data mining (the process of locating and extracting information from a database; this data can be utilized in many different ways) functionality are established. The extent to which this data can or should be utilized is, however, still debated because the quality of research and public policy decisions will be proportional to the data and the manner in which they are stored. If erroneous data are input, suspect conclusions may be accepted as fact. In a universal system, this could have far reaching consequences in an environment with little checks and balances. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt;"> Computerized decision support systems, as part of an EHR, have been shown to improve clinical performance and quality of patient care. However, some studies have shown that EHRs may actually decrease efficiency and increase documentation time; factors such as the use of a bedside point of entry versus a central station played a significant role in efficiency. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> In the case of an electronic health record (EHR), these data typically pertain to protected health information, which is the focus of HIPAA regulations. When adequate safeguards are employed to protect the confidentiality of this information, it can provide researchers, policy makers and educators with extremely useful data. This information, or even access to the database, can also be misused with potentially serious adverse outcomes. Like performing a search of the internet, choosing the correct terms or measures to perform data mining are critically important. In an EHR, there are hundreds of measures that are available to include in a search. Demographic data, such as age, gender, location, health insurance, or assigned provider can generate a useful denominator. The data can be searched by diagnosis, a specific medication or laboratory result, or other similar outcomes. Time is also a variable that can be included in the data search. Including time allows the interested party to identify and track trends in the data. There are innumerable trends that data mining yields. Simple measures, such as weight or blood <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">pressure, can help identify populations at risk for other comorbid conditions. More complex studies can track the onset of a diagnosis, the subsequent treatments, as well as the degree of their success in controlling the condition. The prescribing patterns of healthcare providers, particularly when it comes to trends in utilization of generic vs. branded medications, could prove useful in analyzing the escalating costs of healthcare. Public health and consumer safety is also served by data mining. A medication recall, as discussed above, is easily facilitated by having an EHR and using common data mining techniques to identify any patient that has had that drug prescribed. A target population for a specific intervention, such as an immunization, is also readily obtainable from an EHR. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The potential of abuse in data mining is a real and significant threat to the integrity of such a program. If personal health information becomes accessible to the wrong person, confidential information might fall into the wrong hands. Like any statistical measure, an incorrect assessment might lead to a faulty conclusion and hence a misappropriation of efforts, funding, or educational intent. In this case, it is not the technology or design of the data mining system that is in question, but the integrity of the person(s) involved in the process that could generate the error. Compliance and integrity are paramount characteristics to consider in this type of program.
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">improve care
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">reduce costs

<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Offices that don't adopt technology integrating clinical practice, documentation, and billing procedures may face malpractice exposure. Insurers, including Medicare, continue to ramp up their auditing activities. When a doctor's medical record documentation doesn't match CPT codes, demands for huge repayment follow. Failure to incorporate EMR into a practice may, in the not-too-distant future, be considered a deviation from recognized standards. When an EMR could, arguably, have avoided an adverse result, trial lawyers will be arguing that physicians were obligated to use this new technology. Because EMR systems can catch medication errors and adverse drug interactions, track test results and patient follow-up, and make it far easier for a physician to access and review medical history, failure to embrace it could be problematic. As the EMR technology becomes pervasive, failure to use it to avoid medical errors may also lead to malpractice claims. It will not be too long before EMR becomes the "standard of care." demo
 * The standard of care and the EHR**


 * <span style="font-family: 'Arial','sans-serif'; font-size: 11pt; line-height: 150%;">A Microcosm of EHR’s Potential **

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">There are small examples of how EHR can improve not only quality of care, but efficiency as well. In Plainville, Kansas, a private physicians group has made the switch to EHR. The transition has gone so well that the main physician has stated that she will never go back to the old system. The quality of care has improved immensely since the conversion. One example is the ability to keep track of patients with chronic diseases, like hypertension, diabetes, or both. The EHR makes it easier to track the blood work of these patients and helps remind the doctors and patients when the labs need to be done, the patients with both have blood work done every six weeks. This ensures that the chronic condition remains manageable and does not spiral out of the patient’s control.

The efficiency of the practice can also be attributed to the EHR. The practice in Plainville consists of 3 physicians. There are 2,500 people within the community. They also attend people outside of the community making their total number of patients over 8,000. The physicians do everything from delivering babies to performing checkups from colon cancer. The physicians stated that the reason for being able to do so much for so many is the EHR.

The improved quality of care has implications for arguably the biggest problem facing healthcare in the United States, its cost. The physicians described how EHR enabled them to take better care of the patients with chronic conditions and prevented them from becoming acute conditions. Preventable diseases, like diabetes and hypertension account for 8 of the 9 leading categories of death. Preventable diseases, like diabetes and hypertension, also account for 90% of healthcare costs. These physicians showed how EHR could keep preventable diseases from becoming acute conditions and therefore greatly reducing the cost.

Efficiency is another area that EHR can help in terms of a major problem within the healthcare industry. One major issue facing the industry is a shortage of primary care physicians. President Barack Obama has stated that there needs to be more doctors to attend to the aging population. While this may be needed in the long run, in the short term EHR can offer a solution. By having doctors attend more patients because their practice is more efficient, it can increase patient loads and greatly reduce the number of patients that do not have primary care physicians. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jdal

**Key Capabilities of the EHR**

<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The key capabilities of the Electronic Health Record System per the Institute of Medicine of the National Academies (and examples) include:
 * Health information and data (easy access to old records and history),
 * Results management (searching and graphing results),
 * Order management (ordering electronically),
 * Decision support (treatment algorithms),
 * Electronic communication and connectivity (anyone within the network e.g. other hospitals or clinics can access all the patients records/tests regardless of location where they were seen/performed),
 * Patient support (maintaining vaccinations, tracking risk factors),
 * Administrative processes and reporting (quality assurance, tracking workflows),
 * Reporting and population health (determining morbidity and mortality within the hospital/units/clinics and comparing to local and national benchmarks). __ jph __

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Electronic health records (E.H.R) in the medical field have been proposed as a method to go paperless and link hospitals, health medical providers’ offices and clinics via an interactive digital grid that allows clinical histories, test results and other medical data to be accessed promptly. Although there is significant consensus about its benefits, many clinicians are not keen to change their primary practice models. Few clinical studies were dedicated to showing how Electronic health records would affect physicians and healthcare in general. A few of those articles were published in major medical journals with relatively discouraging data. The New England Journal of Medicine published [|a survey in 2009](fn)( Jha,A.K, DesRoches C.M, Campbell E, Donelan K, Rao S. R, Ferris T. G, Shields A, Rosenbaum S, and Blumenthal D. Use of Electronic Health Records in U.S Hospitals (NEJM) 2009; 360:1628-1638) of //all// acute care hospitals that are members of the American Hospital Association with a conclusion that only 1.5% of the hospitals nationwide have adopted electronic record-keeping. High maintenance costs were the main barrier to E.H.R. implementation. <span style="color: #292526; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Another analysis published in Archive Internal Medicine (fn) ( <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Linder J. A, Ma J, Bates D. W, Middleton B, Stafford R. S//.// Electronic Health Record Use and the Quality of Ambulatory Care in the United States ARCH INTERN MED 2007; VOL 167 (NO.13). )found that Electronic health records were used in 18% of the estimated 1.8 billion ambulatory visits in the United States in 2003 and 2004 with **no significant difference in performance** between visits with or without EHR use. The medical community has realized that EHR is an inevitable change that will occur sooner or later. Recent reports indicate better digital switchover growth thanks to The American Recovery and Reinvestment Act of 2009, commonly known as the “**<span style="font-family: 'Arial','sans-serif'; font-weight: normal;">Stimulus Package **” with proposed incentive paid over 5 year for a physician who can show “meaningful use” of an EHR system. However, the medical community in general ranging from the medical school professor to the small town general practitioner should appreciate the benefits this change can bring for them. Only with more clinical studies directed to showing positive values of E.H.R to healthcare in general and medical practitioners in particular will we be able to steer the change toward healthcare reform goals. Then it will be seen as a cost-effective investment into the future. (fn) (<span style="color: #000081; font-family: 'Arial','sans-serif'; font-size: 10pt;">[] ) <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">veed

**<span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 200%;">Electronic Health Records and Comparative Effectiveness Research **
<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;">One of the proposed benefits of the universal adoption of EMRs and EHRs is the improvement in quality of care. While these improvements may take many forms, one important aspect is the use of electronic health data for the support of Comparative Effectiveness Research (CER). CER provides outcome-based information on the relative strengths and weakness of various medical interventions. Although this type of research has been carried out in medicine for many years to determine “best-practices” guidelines, the ability to rapidly mine and interpret data from electronic health records and networks should greatly enhance CER. In 2009, Congress enacted the American Recovery and Reinvestment Act (ARRA) which provides financial incentives to hospitals and physician practices to adopt EMR/EHR technology. ARRA also authorized the creation of the Federal Coordinating Council for Comparative Effectiveness Research. This council is a fifteen-member panel charged with conducting and supporting research that compares the effectiveness and outcomes of different medical therapies and interventions use to diagnose and treat disease. (1) ( <span style="font-family: 'Calibri','sans-serif'; font-size: 11pt; line-height: 115%;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[|Federal Coordinating Council for Comparative Effectiveness Research] ). Equally important is their role to “Encourage the development and use of clinical registries, clinical data networks, and other electronic health data that can be used to generate or obtain outcomes data. (1) While the purpose of these efforts is to use the patient data in EHRs to produce outcomes data and improve quality of care, the council will not recommend clinical guidelines for payment or coverage reasons. (1) Along with creation of this panel, ARRA allocated $1.1 billion for CER, to be administered through HHS, NIH, and the Agency for Healthcare Research and Quality. The Congressional Budget Office (CBO) described the need for this type of information in its 2008 report, The report states that there is, “evidence of deficits in the quality of healthcare in the United States and large unexplained geographic variations in the utilization and cost of care,” which should be a strong argument for the widespread adoption of health IT. Further assertions are made that health IT systems could help physicians adhere to evidence-based guidelines and avoid therapies with no proven clinical value. (2) ( <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[|Evidence on the Costs and Benefits of Health Information Technology.] ). <span style="font-family: 'Calibri','sans-serif'; font-size: 11pt; line-height: 115%;">Evidence on the Costs and Benefits of Health Information Technology. Those in the federal government who are seeking to reform our healthcare system wish to control costs as well as improve quality-of-care. They see EMR/EHR as an important aspect of quality improvement through the enhanced ability to perform CER and establish treatment guidelines. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 200%;">wsan <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The use of EHRs in clinical outcome studies has increased six fold from 2000 to 2007 (fn) ( [] ). This trend was made possible due to the EHRs flexibility to examine large cohorts of patients. Some authors have examined the characteristics of EHRs that are useful in research. They include, in summary, the richness, freshness and relevance of the data, the consistency of the medical terms and codes and the interoperability between the trial management systems and the data repositories(fn)( [] ). The later characteristic seem to be the most difficult hurdle to overcome at the present time. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">ziad **Advantages and Disadvantages of EHR** <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Major Advantages include: Merrill, Molly. Doctors with an EHR are more likely to report adverse events. Healthcare IT News. Dec. 9, 2009.<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] ) <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">tpan
 * OTHER RESEARCH POSSIBILITIES **
 * Single, sharable, up to date, accurate, rapidly retrievable source of information, potentially available anywhere at anytime
 * Potential to reduce medical errors
 * Detect and reduce possibly harmful drug interactions and allergic reactions
 * Warn of abnormal laboratory results
 * Reduce redundancy of information
 * Detect and reduce harmful adverse drug reactions (ADRs) due to easier reporting of data
 * No more errors from illegible handwriting or unapproved abbreviations that need to be deciphered (fn) (
 * Potential for automating, structuring, and streamlining clinical workflow
 * Integrated support for various activities including decision support, monitoring, electronic prescribing, electronic referrals, radiology, laboratory ordering and results display – especially beneficial in managing chronic diseases
 * Maintain a date and information trail that can be readily analyzed for medical audit, research and quality assurance, epidemiological monitoring, disease surveillance, billing, health trends
 * Support for continuing medical education
 * Reduce space and administration for medical records
 * Automatic ordering of supplies and budget generation. __ jph __
 * Test the efficacy of treatments for disease. jerd
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Enhanced Preventive Medicine. jerd
 * <span style="color: #404040; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">There are several benefits to electronic records. First of all each patients profile will include their health insurance information and explain the details of their plan. It will explain which medications are covered on formulary. Second, patient’s complete medical history will be on file. Nothing should be missing. Third, electronic records will reduce the need of specialists following patients every single time. Once a patient treatment plan is set by the specialist patients now can be followed by a non-specialist.(fn) ( <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">) <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;"> chet

<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Major disadvantages include: Although the safe bet is to say that universal adoption and use of EMR will doubtless save Billions, there needs to be a dose of reality. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 7.2pt; line-height: 150%;"> <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">As can be seen from the lists above, while EMR holds great promise for transforming the way medical care is provided, many hurdles must be overcome to realize this promise. As is the case with every new technology, advantages are offset by disadvantages, and the positives of adoption are minimized by the negatives of implementation. Such is the case for EMR. The primary disadvantages quoted by critics of EMR are security and privacy (fn) ( <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] ), both important concerns that must be addressed before healthcare providers and patients //trust// their vital medical information to these systems. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Since the advent of interconnected computers and the Internet, **security** has been a primary of every organization utilizing this technology. Whenever a computer connects to //any// network, particularly the Internet, it is taking a risk that someone who is not authorized to access and view that information will do so. (fn) ( <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] ) Issues such as penetration testing (fn)( [] ), intrusion detection, legal compliance and security auditing (fn) ( [] ) functions are important elements of any information technology (IT) system, but are //vital// to the integrity of the medical record. **Hackers** ( [] ), with financial incentives to do so, are constantly trying to gain access to IT systems for which they do not have privileges to do so. Without government-imposed EMR security standards, security will continue to be a major disadvantage for EMR. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The lack of EMR security raises concerns for the **privacy** of an individual’s medical information[|1], an issue so important that it resulted in the creation of an entire set of federal regulations called the Health Information Portability Accountability Act (HIPAA). (fn) ( <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] ) While there is considerable misunderstanding of the intent and provisions of HIPAA (fn) ( [] ), the regulations <span style="color: #262626; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">set forth policies and standards for how patient information, including doctors' notes, medical test results, lab reports, and billing information, may be shared. Included in HIPAA are policies about security and the use of electronic equipment to store and transfer records. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> The inability to guarantee the confidentiality of sensitive and potentially harmful information strikes at the core requirement of the doctor-patient relationship: //trust//. Without trust, patients do not feel that they can disclose intimate and potentially embarrassing and/or damaging details of their lives that physicians need to diagnose and treat effectively. (fn) ( [] <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> ) For many people, the ultimate worry is that an employer's or insurer’s access to information about health and treatment or even the possibility of future illness can affect employment or insurability. Additional disadvantages of EMR that are frequently cited include lack of standardization, the vulnerability of computer information to loss or deletion, the expense of the conversion of legacy paper systems to EMR, and the effect such electronic systems have on the interaction between physicians and their patients. The one disadvantage getting the most press currently is the //cost// of the widespread EMR implementation. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The lack of standardization of EMR systems makes ensuring interoperability of these systems difficult, if not impossible. While the development of standards for EMR interoperability is at the forefront of the US health care agenda (fn) ([]), progress in this area has largely been thwarted by the for-profit companies selling currently available systems that are proprietary and non-compliant with the few standards that currently exist. The biggest disadvantage, one that is recognized by the US Federal Government (fn) ( [] ), is the enormous cost associated with the widespread adoption of EMR. This includes the considerable expense of converting the legacy paper systems, systems in which most of the current medical records are stored, in the EMR format. In an effort to ‘jumpstart’ the effort of converting a nation to EMR, the Federal Government has allocated considerable resources to the effort. (fn) ([]) However, there is considerable debate about whether or not there is enough money available to fully implement EMR. Indeed, many in healthcare IT argue that the ‘investment’ in EMR made by the government will only increase the costs of implementation. (fn) ([]) <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">randy <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> The changes are inevitable, and the improvements in the system will not occur overnight, but will be long and drawn out if they occur at all. ​​ hwei
 * Erosion of doctor-patient interaction (verbal and non-verbal communication) due to physicians staring at computer screen or tablet most/the whole time while talking to the patient, especially non-verbal cues which are very important.
 * Unauthorized accessing of patients records by instutiton members may result in HIPAA violations for the institution
 * Security breach of the system: theft or loss of personal information, altered medical history, disrupted operations
 * Incorrect data entry leading to errors rather than reduce them.
 * Computer systems are subject to power surges/outages which may suspend or eliminate access to records
 * Computer viruses may attack and destroy electronic health records if insufficient firewalls and/or backup copies in place
 * Not all providers are able to work with EHR due to lack of computer skills or education
 * Need for change in procedures and education
 * Lack of standardized EHR makes learning, communicating, and integrating health records challenging
 * <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Need to convert/enter/digitize paper records of patients seen prior to implementation of EHR’s
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Need for many more Information Technology personnel to initiate and support the EHR System
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Need for expensive hardware (computer systems) and software (medical records) as an infrastructure to the EHR. __ Jph __
 * Thoughtless use of template based systems tend to generate an overabundance of meaningless documentation that may not reflect the patient encounter. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 9.5pt; line-height: 150%;">[] <span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jfg
 * <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The point and click template systems used by most primary care on EMR systems lead to documentation of exam parts not performed on a routine basis. This hides and misleads future providers needing specific information about a patient’s exam history such as the presence of a murmur. A simple search for such obvious things as amputations with a documented normal extremity exam on countless templates for the patient can demonstrate this. The ability to know if an exam is changing, such as a murmur, is an important component in decision making that cannot reliably be obtained by reading prior primary care records when electronic, which is a stark change to a succinct written or dictated note with pertinent positives of the past. More study is needed to evaluate the ramifications of this loss of clinical information. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">mibu
 * The ability to easily forward/ copy progress notes on inpatient records. [] (also known as copy and paste). beer
 * A true EMR, one that is interconnected, will need to be regulated to certain standards that equates to government intervention. Any Government-led project tends to become rather unwieldy and rapidly outdated. There are ways to keep the technology based in entrepreneurs’ hands with certain restrictions and guidelines, but then it remains expensive. There is a certain undercurrent of fear when a job of this magnitude is left up to the government.
 * I am a current user of an EMR that works quite well. Immediate lab results to my review queue are often resulted prior to the patient even returning home. All radiological tests are charted in real time. Alarms are there to be used to indicate the need for a timely test (very useful in obstetrics). Most of the benefits of EMR are certainly felt, but what of the downside. Often it can be heard in the waiting room or from a new patient that there is a reliance of other physicians to be treating the computer, as opposed to the patient. “**The Doctor never looked at me once!”**
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">A recent survey showed a fear of EMRs changing the way physicians interact with patients negatively. They no longer have the personal notes that remind them to ask how little Johnny did in the State Finals last month. Another patient writes “I notice that the physician-patient interaction is quite less. That the Doc seems quite busy with his PC gadget than examining his patient.” (fn)( <span style="font-family: 'Arial','sans-serif'; font-size: 9pt; line-height: 150%;"> Mtherald.com/how-emr-her-is-going-to-affect-medical-transcription-industry/ May 18,2009) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Another patient was quoted as saying, “Doctor, please look at me, not your EMR”
 * There are claims as to the EMR data mining and information sharing can lead to breakthroughs in universal medical care. Cross referencing a massive amount of data can lead to better quality of care, better choice of antibiotics, improved treatment. But it needs to be accessed properly, and accurately. There are tremendous implications about privacy issues. You can definitively know that the moment the first medical breakthrough is made there will be a legal breakthrough as well, indicating how simple and effective the data is for bringing malpractice cases. Lawyers seem to be one step ahead of these advances at all turns. (fn)(emrresource.com/eoo9/04/17/opinion-emr-data-and-statistics-could-help-find-cures-speed-progress April 17,2009)
 * EMR is only as good as its input. If the wrong weight is entered at the onset, it will be carried forward, and can still result in medication errors if not caught and corrected. Often there is a reliance on the written word. If someone puts in a presumptive diagnosis and knows this is a workup in progress, but leaves the care to others, it may get misrepresented as the ‘holy grail’, as a fact as opposed to something being ruled out. A misdiagnosis can get rapidly and virally propagated.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">There remains the human error, despite the most expensive and effective EMR developed, can still result in medical errors. Studies have shown a reduction in the old type of errors but the emergence of a new breed of medical errors. (fn) ( <span style="font-family: 'Arial','sans-serif'; font-size: 9pt; line-height: 150%;">Ugeskr Laeger. 2009 Aug 10;171(33):2260-4. [Does electronic medicine prescription cause new types of errors?] Flebbe E, Jensen TB, Andersen PE.)
 * The practice of medicine cannot be regimented into the black & white often associated with computer systems which are designed to be 0 or 1. There is no grey. With medicine, the grey is the reality. It is an art and a science. How a patient answers a question and gives nonverbal clues is often the most important diagnostic tool a physician has, and can be missed while he or she is busy plugging the information into the right field.
 * Technology is great when it works. Creating a new level of care will create an entire new need for a host of support people making sure the systems work. As they grow they tend to slow down. Nothing is more frustrating than being backed up for technical reasons as simple as printing a prescription or order form. Having to reboot the computer will be more painful than ever when you are running one hour behind already.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Implementation may be hard to overcome, and if done improperly, toxic to success. (fn)( <span style="font-family: 'Arial','sans-serif'; font-size: 9pt; line-height: 150%;">[]) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">It may very well become an expensive way to keep patient charts and ultimately an increased regulatory burden in the end. (fn) ( <span style="font-family: 'Arial','sans-serif'; font-size: 9pt; line-height: 150%;">Terry AL, Giles G, Brown JB, Thind A, Stewart M. Adoption of electronic medical records in family practice: the providers’ perspective. Fam Med 2009;41(7):508-12). <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 7.2pt; line-height: 150%;">hwei
 * EMRs may lead to easier upcoding and corresponding increase in healthcare costs. (fn)(Lab Soft News. Upcoding Can Result in Greater Healthcare Costs After EMR Deployment. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[] ) <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 115%;">tpan
 * <span style="color: #404040; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The adoption of electronic medical records **may** force many private practice physicians out of business. They will be forced to join larger groups due to the complexity and expense involved in incorporating this new system for maintaining patient information. (fn) ( <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">) <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">chet

**Vendors-Oligopoly or free market access?** <span style="color: #404040; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Although the information technology (IT) industry is large only a select few expert vendors have specialized in developing electronic medical record programs. This has the effect of restricting choice and raising costs for physicians and hospitals. Most of these vendors are not recognized outside the health care industry. The reason that a limited number of vendors have entered this market is mainly due to the complexity of medical information and the regulatory/compliance requirements connected to the health care industry. The 6 largest of the top 10 vendors (which are relatively small compared to outside of the industry) install around 75% of the EMR/EHR systems in the country.(fn) ( <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">) <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">chet How will a project of this magnitude be funded? ** <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The potential value of EHR to the healthcare industry at large as well as individual‘s health care is significant only if it becomes widely adopted by both individuals and healthcare providers. Additionally, the platforms must be secure and rapidly accessible and interoperable across different locations globally. Developing and implementing this technology on a widespread basis will take significant information technology expertise, innovation, and will have substantial costs. This leads to the question: How should the development and management of EHR be funded? Should the government subsidize this endeavor with taxpayer dollars? Should EHR be a for-profit endeavor? The private sector currently provides most of the current EHR funding, although through ARRA, the government is expected to subsidize implementation of EHR systems which meet the meaningful use requirements. On February 12, 2010, the federal government’s commitment to EHR implementation was underscored by the announcement of the allocation of nearly $1 billion in health IT grants. The awards are intended to “advance the adoption and meaningful use” of EHR by 100,000 hospitals and primary care physicians, by providing them with health IT outreach and support until 2014. The grants, which will be distributed at the state and local levels, will also be used to subsidize the training of 10,000 to 15,000 workers for skilled health care occupations. (fn) ("Sebelius, Solis Announce Nearly $1 Billion Recovery Act Investment in Advancing Use of Health IT, Training Workers for Health Jobs of the Future”, February 12, 2010: [|www.hhs.gov/news/press/2010pres]) <span style="color: #c0c0c0; font-family: Arial,Helvetica,sans-serif; font-size: 8pt; line-height: 200%;">llj <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Federal electronic health promotions include bonuses for e-prescribing and filing under the auspices of pay for performance. However, the actual total amount of federal funding is unknown but it is certainly confined by existing budget deficits and competing priorities. President Obama‘s pledge to spend $10 billion per year to create and implement a universal EHR may fall short and other sources of funding are likely to be required. Additionally, government administered programs may carry the stigma of lack of efficiency and innovation, and not being as responsive to the user as those developed by the private sector. Despite the potential value to stakeholders, it is likely that additional personal and business taxes to fund this project would be met with substantial opposition. Also, the use of taxpayer dollars may not be the most efficient way to rapidly establish a widely accepted EHR system that transforms the way healthcare is practiced. As long as healthcare is part of a market driven economy, market based (as opposed to tax-based) solutions are most likely. The entrepreneurial spirit present in the private sector should be <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">leveraged to quickly innovate, develop, and institute a safe, secure, user-friendly EHR platform that can be accessed by individuals and institutions globally. These will include the networks of public, private and not-for-profit companies combining resources and expertise to gain large market shares. Competitions for prize money for developing or grants to develop the best EHR platform with regard to security (meeting government established guidelines), user friendliness, reliability, and ability to integrate with existing EMR systems may be one way to encourage innovation from IT experts. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The federal government has the option of granting tax breaks to healthcare providers who engage in implementing EMR technology in their practices. Tax breaks represent a great incentive and this may preclude physicians from holding back because of the inherent risks involved in these technologies, i.e. obsolescence, compatibility, and standardization. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">ippo <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"><span style="color: #404040; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Studies done at Harvard University and RAND showed that implementing EMR could cost anywhere from 75-100 billion dollars over 10 years. A large percentage of the total amount will go to paying and training the labor force necessary to create this program. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">chet <span style="color: #404040; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">(fn) ( <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%;"> [] )
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 13.5pt;">

Different countries are following different funding approaches. Countries with a single payor are following a top-down approach. Sweden, France and South Africa have a government funded national EHR system. England is expected to spend close to £20 billion over ten years to put in place an EHR network infrastructure and develop national applications to utilize it. Government supported non-profit organizations in Canada and Australia are leading the EHR national effort. EHRs in other countries are being developed and utilized despite the lack of significant government intervention. Germany supports the implementation of electronic records, but avoids direct interaction in its healthcare system. Japan and Israel both lack a national EHR program, yet both have fairly widespread EHR utilization. India and Singapore, like the U.S., mainly depend on funding from the private sector; in India, increased competition, in part due to medical tourism, has been an important driving force in EHR implementation. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">The potential value of EHR to the healthcare industry at large as well as individual‘s health care is significant only if it becomes widely adopted by both individuals and healthcare providers. Additionally, the platforms must be secure and rapidly accessible and interoperable across different locations globally. Developing and implementing this technology on a widespread basis will take significant information technology expertise, innovation, and will have substantial costs. This leads to the question: How should the development and management of EHR be funded? Should the government subsidize this endeavor with taxpayer dollars? Should EHR be a for-profit endeavor? The private sector presently funds the majority of EHR initiatives, but federal funding/incentives have been provided. For example, Kaiser has spent billions of dollars to develop and implement its EMR. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt;">jerd <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13.5pt; line-height: 150%;">**What is the ideal EHR?** <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The ideal EHR would meet the needs of all stakeholders. In the case of EHR‘s the sheer number of stakeholders makes the development of a universally accepted system difficult. A federal solution is unlikely in the present market base healthcare system. Market forces will likely select the "best" EHR‘s in terms of utilization, but the developers‘ interests may be divergent from other stakeholders.<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">There are several secure, affordable, compatible,and user-friendly EHRs,although transferability and universal acceptance is years away.Accessibility for the patient as well as the care provider has to be easy. Physicians can connect to their office records through their iphones and respond to patient problems much earlier. Given the mobility of many members of our society, another quality the ideal EHR should possess is global patient access. The Clinical Data Interchange Consortium (CDISC) is a nonprofit entity focusing upon establishing standard formats for global clinical data interchange. (fn) <span style="font-family: 'Times New Roman','serif'; font-size: 12pt;"><span style="font-family: Arial,Helvetica,sans-serif; font-size: 80%;">[|http://www.cdisc.org] [|/]. It does not promote any specific commercial vendor or system. Currently, this consortium is focusing efforts upon interfacing various EHR vendor groups with clinical research groups such that data can be extrapolated for research nationwide. It is also working on establishing standards for clinical content in EHR’s for common disorders, such as cardiovascular disease and the management of tuberculosis infection, so that standard therapies are disseminated, improving care and reducing costs related to critical world health issues. This group is obviously vital as a gatekeeper to file formats and data transfer as these systems globalize and require upgrading to transmit larger and more sophisticated file formats. beer However, its "season" has come, despite not knowing what the final fruits of the season will be. Hopefully, a market solution will be created before a multibillion dollar EHR tax-payer funded bailout is mandated.

Will the benefits be realized?
<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] [|Harvard Medical School study] [|In a recent study]<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">presented in 2009 <span style="color: #c0c0c0; font-family: Arial,Helvetica,sans-serif; font-size: 8pt;">__oliv__ <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">One of the big obstacles to adopting and implementation is the scale of the practice. A 2010 article in the New England Journal of Medicine, [] reveals this problem. This figure gives a good feeling for the size of the problem: lcou <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">During my research, various articles point out the barriers to adopting EMR. High cost is the most often cited factor, which has the greatest impact on solo practices and on groups with fewer than three providers. You can see it in the graph above. Another article retrieved titled: How to successfully select and implement electronic health records in small ambulatory practice settings by Nancy Lorenzi et al. discusses the benefits vs. barriers to accomplish this task. The electronic version is found at: [|http://www.biomedcentral.com], a paper version can be found at BMC Medical Informatics and Decision Making 2009, 9:15. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">[] lcou <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">(fn),( Goetz, T. Physician, Heal Thyself. //New York Times//. May 30, 2007), (fn) (Sinsky, CA. e-Nirvana: Are we there yet? //Family Practice Management//. 2008; 15:6-8) <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">ada

**Problems during the transition from paper to "paperless"**

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">I’ve had the privilege of experiencing the transition from paper charts to EMR twice in the last seven years. Challenges are great and fear is rampant among coworkers. The greatest challenge within an organization is to have a team of coworkers who are championing the change and the product to help instill a positive attitude amidst all the new challenges. A well planned transition, whether in stages or all at once, requisite knowledge for using the new system by staff and readily available technical/clinical help during transition are also vital. Decreases in patient volume by up to fifty percent is also crucial and is backed by industry evidence that total volume and billing reaches and exceeds pre-implementation levels much sooner with this initial cut back for four to six weeks. Transition is also helped by having preloaded data for 3-6 months prior to go live; this is particularly helpful if staff involved in their care participates in at least some of that preloading and schedules are monitored for patient types and preload status to prevent patient backlogs. Potential problems abound and will be different for each implementation. Technical problems, proficiency with software and hardware by users, flow of information and patients, lack of preloaded status can all lead to immediate chaos in a busy clinical setting. Careful planning and implementation carried out within an atmosphere of excitement can help catastrophes turn into gliches we’ll iron out over time. Keeping patient care at the forefront and involving patients in the process and known benefits to them is also key. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">mibu

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Like any other investments, the chances of implementation will be greater if the ROI is high. In the case of EHRs, however, the ROI may not be readily calculated or evident. There are tangible and intangible benefits that can be captured. The tangible benefits include, in essence, more productivity, better billing and reimbursement and decrease paper cost (fn) ( [] ) and (fn) ( [] ). The intangible benefits, harder to understand and quantify, include adherence to clinical practice guidelines, improved clinical reporting and patient safety. The cost of EHRs includes the hardware, software, training cost and the opportunity cost during the decrease productivity period of training. More education about the ROI of EHRs needs to be done by the federal government and the vendors. ziad
 * Return on investment (ROI)**

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;">The various reasons put forth by different experts as to the low adoption rate of EMR only partly explain the difficulties that practicing physicians face daily. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Some of the reasons that were not given or emphasized enough in my opinion are the lack of universal standards between the different systems. There is no guarantee from any entity including the vendor of the system about the longevity of the company and by extension their product. There is a very real threat of the product becoming obsolete and then the investment both in terms of capital expenditures and time being wasted. In the event a company is no longer functioning the practicing physician has no recourse to recoup his losses. In fact there is additional expenditure needed to retrieve his medical charts and then convert it to another system. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">josgab

**Design and Interface of the EHR** Should our goal be to have one national EHR system, or is it reasonable to have many systems so long as they are compatible and communicate freely with each other? I think only time will tell, however in the United States, the approach for now is multiple platforms and systems. What is important is to have the providers and key physician involved in the design and implementation of the EHR that will work best for them. There appear to be two main structural elements to medical records: core components and then specialist sub-components. Different user interfaces that can be used for the EHR (and their advantages) include:


 * Local Windows forms such as MS Access or Java forms on thin or thick client (flexible and wide range of functions);
 * Web pages on thin or thick client (flexible but limited functions)
 * Personal digital assistants or Pocket PC devices (portable and low cost)
 * Phone (widely available but limited data entry)
 * Scanned paper forms with optical character recognition (cheap but need checked and don’t handle free text well); and
 * Email (good to send warning or reminders, upload limited data, especially if user has no access to EHR) __jph__
 * Secure messaging that is HIPAA compliant. gabr

**Implementing EHR; Buy or SaaS?** Two ways to implement EHR exist, in general. One way is to buy the software from an EHR vender, and locally install the system onto your office workstation. In addition to having hardware (computers, printers, networking routers, scanners), you will need to buy EHR software and an in-house server for storing your patient’s medical records. Once installed onto your computer hardware, you are responsible for networking, IT and maintenance. Most of the time, the organization will need full time or part time IT team support to look after your system. This often involves substantial capital investment upon EHR implementation, and might work for medium to large size practices or hospitals. However, it will be difficult for a small practice or solo practice who might have limited revenue to keep up with the maintenance costs. __oba__ <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">According to a study published in the Policy Journal Health Affairs, the average cost is about $33000 per doctor, plus another $1500 a month per doctor for maintenance. For a small clinic with one or two doctors, that price is usually unaffordable. For major hospitals, installing a new system can quickly become a multimillion dollar experiment. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">ada The other way to implement EHR, without much up-front cost, is to go with a Software as a Service (SaaS) provider. SaaS is a type of software deployment where a provider licenses an application (in this case the EHR application) to customers for use as a service on demand. In short, a customer leases the EHR application (web-based EHR) through a SaaS provider. This can be done by hosting the application on a SaaS provider’s web server or upload the application to the customer’s device. We often hear of resellers of an EHR vendor, and usually they are referred to as a SaaS provider. The benefit of this is to reduce or eliminate up-front capital investment, focus on budgets rather than infrastructure, gain immediate access to the innovative technology without buying, increased accessibility remotely and locally, and finally pay as you go (predictable costs). You still need to have basic hardware, however you do not have to worry about software malfunction or database server storage trouble-shooting onsite. You can see the advantages and disadvantages at [] __ oba __ <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Non-profit organizations like Open Source Medical Software support the development of programs like OpenEMR, a free medical practice management, electronic medical records, prescription writing and medical billing application11. //Open-source software has been accepted by consumers and healthcare organizations as an equivalent and cost-effective alternative to proprietary software//12, and is being used by healthcare organizations across the world. Open source may be one of the solutions to the lack of interconnectivity between the various proprietary EMRs currently on the market. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou <span style="font-family: 'Arial','sans-serif';">In a report by John Snow, Inc. in March, 2009, the authors highlighted several implementation successes and challenges that they learned following the implementation of electronic health records at three healthcare organizations from various participating communities of the North Dakota Center for Rural Health. Factors related to success included communicating a clear process for prioritizing IT requests, conducting weekly EHR meetings, training an adequate number of super-users, transitioning to the EHR beginning with one patient a day and gradually increasing the number from there, making a strong investment in training, and supporting HIT at the highest level through organizational leadership. Implementation challenges, on the other hand, included clear and up front communication of the vision for HIT and how it fits into the organizational mission, lack comprehensive work flow and data analyses prior to EHR implementation, encouraging doctors to use the EHR, including electronic signatures, collaborating with other organizations, obtaining comprehensive training from the vendor, allowing sufficient time to select, plan, and implement the system, and preparing for a loss in productivity during implementation. <span style="color: #b2b2b2; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">arga
 * Can open source software work?**
 * A study of implementation: lessons learned**

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">I am practicing in an office that implemented EPIC about in late 2008. We are part of a 435 physician clinic system that is also tied to a hospital and insurance arm. Most of our patients are completely cared for within the system. This integration of our patients’ medical records has led to clear and immediate benefits in patient care through enhanced communication and knowledge of what various physicians taking care of a particular patient are thinking and doing. Redundancy is decreased. Patient satisfaction has actually increased. Efficiency has increased. The system is set up exactly like a paper chart for review purposes. An interactive encounter session for a visit, telephone encounter, refill, etc. allows for documentation through typing, dictation, templates (personal or system) or any combination desired. This interactive encounter also has an entry section for orders, procedures, meds, labs, etc. In addition to visit documentation, each chart has sections for past medical and surgical histories, allergies, chronic medications, social history, etc. that are easily accessible and can be reviewed and updated with each visit. After being live for a year, a new section was turned on called ‘best practice’ that also flagged any markers not at target in labs, vitals, exam, needed medications, vaccinations, parts of an exam that needed to be accomplished or worked on in a particular visit based on a patient’s diagnosis list. This will further help providers not forget the flu shot, foot exam, etc that often falls by the wayside during a visit. The system can be customized to each individual physician with regard to documentation. Functions can mostly be accomplished in many ways depending on the stream of thought in the user’s mind. Technical help has been readily available. While I know EPIC is one of the best systems available and probably also the most expensive, I have no complaints and would recommend paying the extra for a quality product. My experiences with Centricity and CPSI have not been as friendly. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">mibu
 * Evaluation in a private practice venue: EPIC **

It is important to realize that at least one bellwether exists for EMR implementation. A body of experience exists in the US government regarding EMR implementation, as the Veterans Hospitals clearly demonstrate. A review of some stakeholder experiences with the Veterans Hospital system proves very instructive regarding some of the realities of EMRs ([] ). <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">kash <span style="color: #404040; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Dr. David Brailer, former National Coordinator of Health Information Technology, mentions that “getting electronic records up and running is a very technical task”. The United States is lacking an abundance of the skilled workers necessary to build and implement the necessary technology.(fn) ([]) <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;"> chet

Several ways exist to input your daily progress notes into an EHR system. One is to type your notes directly <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">into the EHR database. If you are comfortable with typing fast, this option might work for you. A typing input prototype EHR system is VistA/CPRS from The Department of Veteran’s Affairs Medical Centers. The second way to input your daily data into an EHR system is a template based system. The template offers click and choose methods, reducing much of the typing requirement. Most of the EHR systems available from the industry offer template settings in their EHR systems. Now a new type of EHR software with voice command makes text typing not necessary for input of daily progress notes. This might work for a practitioner who is resistant to EHR systems due to typing issues. Voice recognition may be the most efficient for data entry; the software for this is improving rapidly. Some of the products are specific to the language and vocabulary of medicine. All of the different ways of entering data into an EHR are depicted pictorally below for the HemiData EHR. __sharad__ <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"><span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">For example, the Precision Voice driven ChartLogic system provides EHR software to achieve highly accurate voice recognition. One of the newer EHR systems, Medisoft Clinical, offers a choice of data entry methods including templates with click and choose, speech recognition, transcription, digital pen and dictation. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">oba __
 * Data input into EHR; Typing, Template, or Voice command?**<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

Public Awareness
<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">A Harris poll published in 2007 notes that many people know very little to nothing about the current campaign to adopt an electronic record throughout the entire U.S. healthcare system. Although 64% of those polled support the idea, 29% felt that the benefits outweigh the potential risks and 42% expressed their concern that privacy risks may outweigh expected benefits. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt;">arga

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">On the other hand, results of a survey of 2,153 adults from a Wall Street journal/Harris Interactive poll suggest three-quarters of those polled believe they would receive better care if their doctors used EHR. (fn) (Bright, B. November 29, 2007. Benefits of Electronic Health Records Seen as Outweighing Privacy Risks. Wall Street Journal. Retrieved February 14, 2010 from <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">[]) lam

<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The Heath Information Technology for Economic and Clinical Health Act (HITECH) is part of the American Recovery and Reinvestment Act signed by President Obama on February 17, 2009. The purpose of the act is summarized in this quote from the President <span style="color: #231f20; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">"To improve the quality of our health care while lowering its costs, we will make the immediate investments necessary to ensure that, within five years, all of America's medical records are computerized. This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests…But it just won't save billions of dollars and thousands of jobs; it will save lives by reducing the deadly but preventable medical errors that pervade our health-care system." <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%;">[ ] <span style="color: #231f20; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> To accomplish this goal, HITECH allocates $19.2 billion to accelerating the adoption of electronic health records (EHR), the majority of which (more than $17 billion) is in incentives to health care facilities and providers to encourage the adoption of EHR. In 2009, the Congressional Budget Office estimated 90% of physicians would adopt EHR by 2019 and the acceleration resulting from HITECH would save more than $60 billion in that time. <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%;">[5] <span style="color: #231f20; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">An additional $2 billion is allocated to the development and support of health information technology (HIT) education. This includes grants to institutions of higher education to expand medical infomatics education and integrate this with the education of healthcare professionals. HITECH specifies $598 million for the creation of the __Health Information Technology Extension Program__ wherein nonprofit organizations receive government grant money to establish and operate 70 Health Information Technology Regional Extension Centers, which will provide hospitals and clinicians with hands-on technical assistance in the selection, <span style="color: #231f20; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">acquisition, implementation, and meaningful use of certified electronic health record systems. [6] Although Medicare and Medicaid incentive payments won’t pay for the initial cost of an EHR implementation, there is funding for state loan programs, in addition to federal and state grants that are available for healthcare IT adoption. More EHR vendors are also likely to be willing to provide low-interest loans or payment plans for healthcare providers, so that their customers can use government incentives to pay them back in the future. Healthcare providers who already have an EHR system will qualify for incentives only if their system meets the requirements set by the government. Therefore, now is the time to make sure that the system purchased is or will be government-compliant. arga The act includes new security precautions “strengthening Federal privacy and security law to protect identifiable health information from misuse as the health care sector increases use of Health IT”. [7 The data mining for profit industry is forbidden from selling health information without the individual’s permission. Providers must attain authorization from the patient before utilizing health information for marketing. Patients are entitled to an audit trail showing all releases of their information, and notification of any unauthorized disclosure. HITECH includes a process for developing standards for the exchange of information and a voluntary certification process for HIT products. The implementation of HITECH is the responsibility of the Office of the National Coordinator for Health Information Technology (ONCHIT) created in 2004. ​ __Jfl__
 * HITECH Act **

The lack of strict regulatory standards of EHR development and implementation leaves a glaring need for national standards, certification, and regulation of safety issues, some of which are being developed by CCHIT ( <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|www.cchit.org] ) and HIMSS ( <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|www.himss.org] ). The proposed regulation could be modeled after adverse event reporting in aviation safety, and there should be a safety hotline that monitors for EHR adverse events <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> ( [|Sittig and Classen, 2010] ). With the pressure to implement EHR by 2014, there may be institutions and EHR developers who may not have had the time or experience with quality control and safety assurance. It is important to have a national safety monitoring presence, as well as standards, regulation, and procedures for safety assurance (fn)(<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Safe Electronic Health Record Use Requires a Comprehensive Monitoring and Evaluation Framework. JAMA, 2010; 303(5): 450-45. Retrieved February 14, 2010 from [] ). lam

This specific link, <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] is to a Perspectives article by David Blumenthal, M.D. about the launch of the HITECH Act for the implementation of EHR. ”The provisions of the HITECH Act are best understood not as investments in technology per se but as efforts to improve the health of Americans and the performance of their health care system. The installation of EHRs is an important first step. But EHRs will accomplish little unless providers use them to their full potential; unless health data can flow freely, privately, and securely to the places where they are needed; and unless HIT becomes increasingly capable and easy to use.” The implementation of EHR is not a goal, it is the means to the goal of quality improvements and efficiency. Here are the new regulations: jfl

With the Obama administration avidly promoting healthcare information technology and with tens of thousands of dollars at stake in incentives and future penalties for doctors, more physicians will be implementing EMRs in the coming years. Under the recently passed American Recovery and Reinvestment Act(fn) ( <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] ), physicians who demonstrate meaningful use of EMR by 2011 will be eligible for full federal subsidies of up to $44,000. Failure to implement EMR by 2014 may also result in increased malpractice premiums and increased exposure to malpractice claims, as well as a reduction in Medicare reimbursement, beginning in 2015 (fn) ( <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">, **Hidden Malpractice Dangers in EMRs,** 04/09/2009). <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">demo
 * Reimbursement under ARRA**

What is meant by Meaningful Use
<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The American Recovery and Reinvestment Act of 2009 (Recovery Act) was signed into law by President Obama on February 17, 2009. The law includes the Health Information Technology for Economic and Clinical Health Act, or the "HITECH Act," which established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of certified electronic health records (EHR) technology. The Centers for Medicare & Medicaid Services (CMS) has a role in three areas of the HITECH Act: <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> In general meaningful use of EHR is defined as the use of **certified EHR technology in a manner that improves quality, safety, and efficiency of health care delivery, reduces health care disparities, engages patients and families, improves care coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information.** However the lack of specific criteria remains the biggest challenge in defining meaningful use. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">garg
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Implementation of the EHR incentive programs, including defining meaningful use of certified EHR technology;
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Establishment of standards, implementation specifications, and certification criteria for EHR technology.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Privacy and Security protections under the HITECH Act.

On December 30, 2009 CMS proposed a three staged approach for meaningful use. The proposed Stage 1 criteria for meaningful use focus on <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> For Stage 1, which begins in 2011, CMS proposes 25 objectives/measures for EPs (eligible professionals) and 23 objectives/measures for eligible hospitals that must be met to be deemed a meaningful EHR user. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">garg __<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">**Meaningful Use Criteria:** __ <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">On December 30, 2009, The Centers for Medicare and Medicaid Services (CMS) released the much-anticipated proposed rule defining “meaningful use” of electronic health records. (fn [|meaningful use]). When the 60 day comment period closes, the meaningful use criteria will define the path that hospitals (acute care, pediatric and critical access) and eligible professionals (EP’s: physicians, dentists, podiatrists, optometrists, and chiropractors) must take in order to qualify for the Medicare and Medicaid incentives to be offered as part of the American Recovery and Reinvestment Act (ARRA). lew,llj The proposed rule describes three stages for demonstrating meaningful use from 2011 to 2015. Unfortunately, only stage 1 is well defined. It describes the calculations for determining incentive payments that can begin in 2011, as well as the significant financial penalties that will be levied against hospitals and EPs failing to meaningfully use certified EHR technology by 2015. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The first stage emphasizes collecting electronic health data, implementing clinical decision support tools, reporting clinical quality measures and public health data, and tracking conditions and coordinating care. The second stage is expected to focus on structured data exchange and continuous quality improvement, while the third stage is expected to center on advanced decision support and population health. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> This rule was also accompanied by an interim final rule from the Office of the National Coordinator of Health IT (ONCHIT) that sets initial standards, implementation specifications and certification criteria for EHR technology. (fn)([])ONCHIT will also be issuing a notice of proposed rulemaking on the process for certification of EHR technology. Of note, as of February 13, 2010, no commercial EMR products are certified. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">lew <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The Office of the National Coordinator of Health IT (ONC) proposed rules for standard formats for clinical summaries and prescriptions, standard terms to describe clinical problems, tests, medication and procedures, and standards for secure transmission of online data. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou
 * 1) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Electronically capturing health information in a coded format,
 * 2) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Using that information to track key clinical conditions,
 * 3) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Communicating that information for care coordination purposes,
 * 4) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Initiating the reporting of clinical quality measures and public health information.

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The proposed Stage 1 criteria for meaningful use include capturing health information electronically, using that information to follow key clinical conditions and to use that information to coordinate care. Electronic reporting of clinical quality measures will commence with this stage. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">For Stage 1, which begins in 2011, CMS proposes 25 objectives/measures for EPs and 23 objectives/measures for eligible hospitals which must be met to be deemed a meaningful EHR use. These include measures such as provider order entry, medication order screening, recording of tobacco usage by patients and implementation of clinical decision rules. (fn) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">([] Page 1867 Table 2--Stage 1 Criteria for Meaningful Use). <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">**Stage 2** This would expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management, support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies. CMS may consider applying the criteria more broadly to both the inpatient and outpatient hospital settings. (fn) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">[|meaningful use] Stage 3,still as yet poorly defined, according to CMS, “will focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.” (fn) ( <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">[|meaningful use] ). Having stage 3 undefined at this point in time will likely place great stress on organizations still trying to design their systems. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">lew <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> It is likely that the certifying body responsible for this process will be the Certification Commission for Health Information Technology (CCHIT). (fn) []. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Incentive payments first become available in 2011 and diminish over time until 2016. After 2016, practices that do not demonstrate meaningful use will receive stepwise penalties in Medicare payments by 1-3% per year. Many EMR vendors claim to deliver platforms that meet or exceed meaningful use criteria, although no pre-certification is available to safeguard the consumer of these costly products. Many providers, especially solo practitioners and small group practices, will find the cost of purchasing and implementing an EHR system prohibitive without outside assistance. The Centers for Disease Control’s (CDC) National Center for Health Statistics reports that in 2009, an estimated 44% of office-based physicians used “full” or “partial” EMRs, up from 35% in 2007 and 41% in 2008. (fn) (Electronic medical record/electronic health record use by office-based physicians: United States, 2008 and preliminary 2009”, National Ambulatory Medical Care Survey conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention, December 2009, [|www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.htm].) The use of “fully functional” systems rose from 3.8% in 2007 to 4.4% in 2008, to 6.3% in 2009. Despite the establishment of an EHR incentive program and various other incentives by the Centers for Medicare and Medicaid (CMS)--including a maximum $44,000-per-physician tax incentive--the rate of EHR purchase and implementation is not expected to increase dramatically in the next few years. (fn) (More EMRs are in physician offices, but use still lags”, February 1, 2010, [|www.ama-assn.org/amednews].) According to Kalorama Information, a market research firm specializing in health information technology, barriers to adoption of EHR by many physician practices (such as an expected disruption of work flow and an initial loss of productivity) outweigh the prospect of receiving government incentives. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">llj beer The EHR incentive program, funded by the American Recovery and Reinvestment Act of 2009 (ARRA) will constitute a major potential funding source. Receipt of funds from the EHR incentive program will be contingent upon the provider’s ability to meet the “meaningful use” requirements, as outlined by CMS and the Office of the National Coordinator for Health Information Technology (ONC). Regardless of the cost to the provider, ARRA requires full compliance by both physicians and hospitals with the meaningful use standards by 2015, in order to avoid Medicare penalties.(fn) ( Update on Meaningful Use, Computer Services Corporation. January, 2010. [|www.csc.com] .) <span style="font-family: 'Arial','sans-serif';">Therefore, for many providers, the prospect of losing Medicare reimbursements will likely present greater motivation to meeting the meaningful use criteria than will the possibility of receiving stimulus funds. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 80%;">llj <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">__ Payments (excerpted directly from CMS Fact Sheet) __ (fn) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">( <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">) **<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Incentive Payment Calculation for Eligible Hospitals: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Incentive Payment Amount equals [Initial Amount] x [Medicare Share] x [Transition Factor]. · <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">**Initial Amount** equals $2,000,000 **+** [$200 per discharge for the 1,150th – 23,000th discharge] · <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Medicare Share equals Medicare/(Total*Charges) A **qualifying EP** can receive EHR incentive payments for up to five years with payments beginning as early as 2011. In general, the maximum amount of total incentive payments that an EP can receive under the Medicare program is $44,000, with a potential 10% bonus for EP’s practicing predominantly in a certified Health Professional Shortage Area. __<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">**Penalties** __ <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Some of the joy experienced by the healthcare IT provider community at the thought of being reimbursed for their implementation efforts was tempered by a careful reading of the HITECH act. In addition to the loss of potential incentive payments for not achieving meaningful use, there are significant penalties associated with non-compliance by 2015. [] __ lew __ The reactions to these proposals have been mixed. The Healthcare Information and Management Systems Society (HIMSS) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">[|www.himss.org], <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">[|www.himss.org/ASP/topics_ehr.asp] , supported the proposals. The American Hospital Organization expressed concerns that the rules will only reward hospitals that have already achieved advanced EHR functionality while excluding those that are making slower progress. And the Patient Privacy Rights (PPR) organization criticized them for not including sufficient patient privacy protection. jodou <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> The Advisory Board Company, a healthcare solutions firm based out of Washington, DC, [], offers 10 imperatives for hospital executives regarding implementation of meaningful use: · If you are a hospital, you must meet meaningful use eventually. · Structure of incentives requires immediate action. · Prepare for IT to consume even more of the capital budget. · Change culture before changing systems. · Change workflow in advance of system implementations. · Set a high bar for compliance from the beginning. · Overinvest in nailing CPOE implementation. · Move with urgency equal to hospital installation in employed physician practices. · Weigh the fully-loaded costs and responsibilities of subsidizing EMRs and supporting installations for affiliated independent physician practices. · <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">View future strategies and investments in light of the MU endgame. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jcol
 * __<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Staged Criteria for Meaningful Use __**
 * Stage 1**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">Stage 3 **
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Use of clinical decision support tools
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Maintenance of updated problem lists, medications, and allergies
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">>75% use of electronic prescribing
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Patient demographic information
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">>50% of laboratory results incorporated into the EHR
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The ability to exchange clinical data with other providers
 * Electronic progress notes **are not** part of the requirement at present. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">beer
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Medicare **<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> equals [number of Inpatient Bed Days for Part A Beneficiaries] plus [number of Inpatient Bed Days for Medicare Advantage Beneficiaries]
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Total **<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> equals [number of Total Inpatient Bed Days]
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Charges **<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">equals [Total Charges minus Charges for Charity Care*] divided by [Total Charges]
 * //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">EP Penalties: //**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> EP’s failing to achieve meaningful use by 2015 will face Medicare penalties in the form of reductions to their fee schedule. The reductions will set the fee schedule to 99% in 2015, 98% in 2016, and 97% in 2017. If these incentives and penalties fail to drive at least 75% adoption nationwide, the HHS Secretary has been authorized to further reduce physician fee schedules by 1% each year, not to go below 95%. (fn) ([] Page 1911)
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Hospital Penalties **

Interoperability criteria for EMR/EHR
<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[] EMR and EHR are important in improving access to patient health and medical information. However, with the numerous providers currently vying for this growing market, it is important that the data captured in one system can be transferred to other systems (for example, when one patient moves and needs to transfer her records from the old hospital to the new one). This is where HL7 plays a role. HL7 is an international standard development organization, founded 20 years ago, that creates standards for exchange, management, and integration of health care electronic information. It creates a common language that can be understood and used by the various EMR/EHR solutions that are out there now. It is important when choosing an EMR/EHR solution to make sure that they conform to the HL7 standards. Note that HL7 itself does not provide or sell software, they just define the standards that the software can use. <span style="color: #c0c0c0; font-family: 'Calibri','sans-serif'; font-size: 8.8pt; line-height: 115%;">__dja__

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;">[] On March 21, 2003 in a press release of the U.S. Department of Health and Human Services (HHS), the Federal government created the Health Information Exchange (HIE), a uniform electronic exchange of clinical health information among the three major agencies that deliver health services (HHS, Defense, Veterans affairs). The standardized health information will be coordinated among all the other federal agencies as part of the Consolidated Health Informatics initiative (CHI). The Health Information Exchange (HIE) adopted the Health Level 7 (HL7) messaging standards among others like the National Council on Prescription Drug Programs (NCDCP), the Institute of Electrical and Electronics Engineers 1073 (IEEE1073), the Digital Imaging Communication in Medicine (DICOM), the laboratory Logical Observation Identifier Name Codes (LOINC) to insure complete interoperability of the system. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 200%;">louisd

HIPAA Compliance and EMR/EHR
Considerations regarding the HIPPA privacy regulations are a major concern. An important element in developing an EMR system is to insure that there will be patient confidentiality and privacy. Some companies have already developed Privacy Compliance Audit software such that it is possible to determine who has accessed which records (1). (fn) (The Compliance Auditor interfaces with EMR to monitor who is accessing which patient records. Each provider’s implementation and interpretation of HIPAA are different. The flexibility of a Compliance Auditor appliance from Bitwork allows a practice to easily create audit reports. The government may require a privacy audit of EMR systems to determine who looked at any specific records, or whether someone is accessing records of VIPs, family members, or employees.) ippo Some surveys however have indicated that as many as 61% of IT practitioners do not have the resources available to monitor or guarantee that the HIPAA regulations will be followed (2) (fn) According to a newly released survey, 61 percent of health IT practitioners doubt that their organizations have the resources to meet privacy and security requirements, while 70 percent say senior management isn't making data protection a priority) . ippo

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] To improve the health care system’s efficiency and security, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, included Administrative Simplifications, a Privacy Rule, and a Security Rule, recognizing that advances in electronic technology may potentially erode the privacy of health information. The first had provisions for national standards in EHR transactions and code sets, the second had set standards for the protection of individually identifiable health information, and the latter set national standards for protection the confidentiality, integrity, and availability of electronic protected health information. The Office for Civil Rights both administers and enforces the Security and the Privacy Rules. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">lam

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">​**Legal Aspects of the EHR** Several legal aspects of EHRs are still unresolved and will impede the widespread implementation. These are:
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> The issue of EHRs ownership (who owns the record, the patient or the provider?) (fn) ( [] ).
 * The fact that current versions of the software do not provide legally defensible EHRs, because they do not track access and modifications to the record.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> The absence of regulation specific to EHRs (fn) ( [] ).
 * The concern about malpractice exposure (if medical information is not shared electronically and timely).
 * <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The anti-kickback and Stark laws in the case of cooperation between hospitals and providers in the implementation of EHRs. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">ziad

Safeguarding EMR Security and Privacy
<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">The safeguarding of our EMR database is perhaps a bigger problem than one might imagine. As mentioned earlier, hackers will have a heyday with this information. The conflicts of interest between patients, providers and payers will most certainly open up the doors for finding ways to beat the system. **<span style="color: #548dd4; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[1] **<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">The need to explore the avenues available to hackers should be clearly studied by IT system engineers. Only then can these doors be locked. The problem with tight security is that it limits the functionality of the format. All of the issues that affect functionality must be in place. Inability to guarantee the confidentiality of sensitive and potentially harmful information strikes at the core requirement of the doctor-patient relationship: trust. <span style="color: #548dd4; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;"> [2] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">Obviously, one of the most interesting findings as you read the mass of information already available is that primarily payers are the ones setting up the PHRs to date. <span style="color: #548dd4; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;"> [3] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;"> There are a few private for-profit groups; however, the payers do have conflicts of interest where obtaining access to the EMR is concerned. For example, in the locale where I have practiced for 20 years, a radiologist starts every chest x-ray report by stating "COPD", even on children's chest films. Once discovered by the payer, that erroneous finding will create insurance problems for the insured. The payer has a vested interest in collecting premiums while denying benefits. Any format that gives the payers access to privileged information, or information that may be subtly altered, can affect the insured's insurability. Additional problems include the myriad of hardware and software that is easily available to gain illegal entry into the EMR. For example, the "KEYLOGGER" is a small flash drive type of device that can be easily plugged into the USB end of any keyboard. The hacker, whether office employee, janitor, or other person, can retrieve every keystroke made on that computer easily. All passwords and confidential data will be available. The hacker can gain entry into any computer and access any file with the illegally gotten passwords. There are remote access software disks that can be installed to further complicate this problem. There is no point to pretend that this is not going to happen, because it already is happening. <span style="color: #548dd4; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;"> [4] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">Having spent hours discussing security and privacy issues with the top leaders at NET (SF based company that has developed the solution for the interoperability problem), it’s clear that there are no complete or clear answers for the security and privacy issues related to EMR. The cat is already out of the bag. One blogger was alarmed that medical office employees were able to “circumnavigate” the EMR security protocols and write prescriptions for their personal use, even narcotic prescriptions. [5] The AMA has adopted a protocol to be used in the event that an EMR has been breached. [6] The various issues related to security problems are making it difficult to move forward with the widespread adoption of EMR. [7] “ From the mechanical ability and methods for storage and transmission to the ways they can be accessed, new and more advanced systems are becoming available every day. However, definite limitations and issues arise from the implementation and use of EMRs and PHRs (Personal Health Records). You may have already reviewed the hurdles created by the local nature of EMRs and their lack of standardization. Additional problems exist with security and privacy of these records. Security Questions for EMRs - Security is potentially a major problem. There may be no system in the world that is <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">entirely uncrackable, including EMRs or PHRs. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">” [8] The higher the access to electronic medical information, the greater the number of issues related to patient privacy and vulnerability become. [9] Many security breaches require no access to sophisticated software or hardware or IT expertise. The individual users of computers in the medical office may create security breaches in the same manner that has jeopardized “identity” security for years. Scams to collect bits of data are plentiful. Phishing scams are bountiful. Many individual users are easily sucked into “giving away” their passwords simply because they have been asked to do so. [10] As the surge to promote EMR usage grows, each individual user must be constantly aware that computer security is easily breached. Educational programs should be instituted in the medical offices and other health service organizations in an effort to minimize the” leakage”. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 115%;">bal <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">No sophisticated hacking skills, software, or hardware are required when authorized users can be misled into revealing their user name and password via a phishing scheme. <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%;">[8] In February, 2009, the U.S. Senate approved an $838 billion “stimulus” bill by a 61-37 vote. Billions of dollars will be given to companies creating electronic health record databases and to universities to incorporate patient databases "into the initial and ongoing training of health professionals." Nowhere is this 140-page portion of the legislation does the government anticipate that some Americans may not want their medical histories electronically stored, shared, and searchable. One paragraph states that data-sharing will "be voluntary," but there's no defined way to opt out. Without an obvious system for opting out, everyone’s electronic health records could be shared without the individual’s consent. This has been a concern raised by advocates of healthcare privacy. arga <span style="color: #c0c0c0; font-family: 'Tahoma','sans-serif'; font-size: 8pt; line-height: 150%;"><span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 9.5pt;"> Considerations regarding the HIPAA privacy regulations are a major concern. Some surveys however have indicated that as many as 61% of IT practitioners do not have the resources available to monitor or guarantee that the HIPAA regulations will be followed. ippo <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> There is still a lot of dispute on how to protect electronic individual health information. The issue is subject to extensive lobbying by consumer groups and healthcare businesses (ref. 3). Proposed safeguards include strong authentication and encryption (fn) ( [] ), outlawing the sale of personal health information and allowing the patient to impose additional control on certain sensitive information like records of abortion, HIV testing or psychotherapy (fn) ( [] ). The federal stimulus package already contains some safeguards like stricter enforcement of the guidelines of HIPAA and a mandatory requirement to inform patient of any breach of their information. Several states, as well, are implementing their own privacy laws in addition to federal laws (fn) ( [] ). Too restrictive privacy laws are believed to inhibit the adoption of EHRs by hospitals and providers. ziad

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Given the challenge of physician adoption, coupled with incredibly high costs of implementation, the industry as a whole has been slow to install. As of December 2009, less than ten percent of U.S. hospitals had implemented EMRs in the most basic form and only about 1.5 percent had leveraged a comprehensive system.(fn) (Greenemeier, L, “Will Electronic Medical Records Improve Health Care?,” //Scientific American¸// December 1, 2009, //Scientific American Online//, [|www.scientificamerican.com]). <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jcol <span style="font-family: 'Arial','sans-serif';">In 2005 The George Washington University Medical Faculty Associates (MFA) published their experience in the rapid implementation of EHR in less than 30 days. What I found most fascinating in this article was the presentation on return on investment. There was an estimated first-year savings of more than $80,000 from reduced paper chart pulls. When RN time spent on chart responsibilities was included, the first-year savings on decreased chart pulls was $335,900. Over five years, savings on chart-related staffing expenses is estimated at $6.3 million. Improper coding (under-coding) errors were also corrected by the use of EHR. This is expected to generate an additional $3.5 million during the first five years. If reduction in transcription expenses and cost of developing new patient charts are factored in, the estimated overall savings over five years with the use of EHR will be upwards of $11.7 million. arga <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Current business models are already leveraging the enticements of improved coding, better reimbursement, and the above-mentioned government subsidies. Practicefusion.com (a “free” online EMR at [|www.practicefusion.com] ) directly appeals to potential users, in part, based on this anticipated reimbursement for usage. This particular model targets the segment via online banners and other advertisements. Innovative business models are already being created, and implemented, to capture the burgeoning opportunity of EMRs. kash


 * Keeping up with new information **

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Probably the three most important web sites for the most up to date health IT information is the HHS web site and two nongovernmental not-for-profit societies: the HIMSS web site and the AMIA web site. The Health Information Management Systems Society (HIMSS) has an excellent web page entitled "Topics and Tools." There are specific sections on ARRA, health care reform, EHR, clinical informatics, privacy and security issues, interoperability, standards, and ambulatory issues of information systems. The web address is []. It is an excellent starting point.

In addition to the HIMSS web site, the American Medical Informatics Association (AMIA) web site has an interesting initiative entitled: GotEHR? The American Medical Informatics Association (AMIA) has been exploring ways to expand understanding about, support for, and use of EHRs through its GotEHR? Initiative. According to the AMIA web site: "GotEHR? is based on two premises. First, EHR’s enable high quality, safe, and cost-effective health care services. Second, EHR’s can strengthen the relationship between patients and clinicians." The web site is located at []. While AMIA is not as well know as HIMSS, its members are deeply involved in policies that work to make medical information useful for researchers, practicing physicians, and the government. Two very good articles on basic competencies for Health Information referenced on the AMIA site are:
 * 1) Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. J Am Med Inform Assoc. 2006 Mar-Apr;13(2):121-6. Epub 2005 Dec 15.
 * 2) How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings Nancy M Lorenzi, Angelina Kouroubali, Don E Detmer and Meryl Bloomrosen BMC Medical Informatics and Decision Making 2009, Published: 23 February 2009.

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Another good site also referenced by AMIA is Emory's Blue Ridge Reports and has two very important reviews related to EHR and quality issues: > []
 * 1) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The following describes the emerging role of transformational role of informatics.
 * 1) <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> A related article to this report describes the importance of healthcare quality and safety in an academic medical center. []

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> Also listed in the Journal of AMIA is an excellent and probably one of the best reviews of issues concerning computer order entry (CPOE) and clinical decision support (CDS). [] <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt;">dew

Annotated Bibliography
<span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> is an engineering standands website. This 2006 article talks about a novel **.pdf/h** platform for electronic health records. The .pdf format will accept all types of medical information including images, text and graphics. The working group included the AAFP as well as Intel and Adobe and several others to create a ―est practices‖guide to facilitate the capture of data and make it secure. Its portability can be done with USB memory sticks. It will give patients more control over their health information. There is a list of associated ehr standards accompanying the article covering formatting, nomenclature, and other necessary standards. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.healthvault.com] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> is a personal health record created by Microsoft no longer in beta testing. It offers https encryption as well as SSL secure transmission of information. The healthvault can be used to set up single or family accounts, using the Windows Live username and password. Sharing the information with others is by invitation only except for healthcare professionals or for legal purposes. The program allows links to other programs that can be used for personal health programs. Control of the data is personal but at different levels. Anyone with custodian level access is able to alter and/or delete all information. That person can also exclude the original custodian from access, a dangerous situation. Microsoft adequately warns in its privacy statement about this possibility. Many of the linked programs are phrs, and others are information sites such as the Mayo Clinic Health Manager. The entering and editing of data is tedious in HealthVault due to the manual nature of entry. This could be a negative factor for the elderly. The HealthVault website will lock you out if there is no activity for twenty minutes, and unsaved data is lost when you reenter the site. The Mayo Clinic Health Manager is one of the linked programs and is a better interface. It works in conjunction with Healthvault very well and has several trackers to follow weight, BMI, Cholesterol levels, etc. Its editing function is better than that of HealthVault. Overall, HealthVault is a good phr site, and its partnering links are very useful. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.pdhi.com] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">, the website for ConXus Health Improvement platform, under the name of PDHI, //protocol driven healthcare, Inc//. ConXus has several tools to be used for health risk assessments that its clients can access. A phr is part of the module but the product is aimed toward employers, health plans and hospitals for their members. While it can interface with a member‘s emr, it does not seem to be either a true phr or emr/ehr. The data storage site is very tightly protected with guards, alarm doors, and other protections for the data storage. This option is central web based data management. A key feature is third party data importation/exportation. Its stated market is health plans, hospitals, brokers and health improvement companies. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> is a service of Google health. It is similar to the Healthvault service with several linked associated services and an ability for the user to control the <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">health information. The site allows the user to build a health profile and track changes. Google offers links to online health-related educational material. The service does allow HIPAA partner linking to other holders of the user‘s health information, such as a personal physician or pharmacy. That data can be linked to the Googlehealth account. Access is through a Google username and password, offering security. The privacy policy does not allow sharing of personal health information. Google does collect aggregate data for some purposes but it is never personally identifiable. A partial ―ealth history‖can be viewed by physicians. Google allows the user full control of the information including deleting all information found in the account. The service is free. To evaluate the site, a health profile was created. A component of this site is a shell repository for basic, personal medical information. There are links to find a doctor and import medical records. This appears to be an electronic phr (personal health record) site. However, its partners include notable hospitals, clinics, pharmacies and healthcare provider rating services. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.ihealthrecord.org] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> is now part of Medem. The backbone of the site is a series of checkoff options that are then added to a phr that can be placed on a wallet card. Access to the information can be granted to others, including personal physicians. While the site is easy to access and the entry of personal information is easy, the checkbox system is limiting in the options to check. I found the immunization module to be outdated. Some procedures, such as MRIs are found in the surgery module, which might confuse older patients. The site does allow printing of the full phr or just the wallet card. There is a patient library that can be accessed as well as a message center that will deliver information on programs that interest the patient. The ihealth record is secure and email addresses are not divulged to anyone. The privacy policy protects personal information. Linked sites are not protected by the Medem privacy policy, a standard disclaimer. The privacy policy is written in an easy to read font and is only one short page long. I found no statement regarding security of the personal information, such as encryption of the data. As a phr and to create a wallet card it looks very adequate. As a full phr it needs improvement. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> is ER-id, portable phr, editable only by the owner, but with a name and member number, can be accessed by a professional. It appears that the information is kept at er-id and communicated to a provider over the Net. It gives a good measure of portability to the health record, but editing is up to the patient who is the only one who can open the file to write to. Membership is $30/yr single, max $84/yr for very large families. Good security and portability. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.onlinehealthrecords.com] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> myphr.ca is a Canadian site. It proudly proclaims privacy as No.1 priority. The website itself is not well created and the links alluded to are nonexistent. It has a lot in common with er-id cards. It too is self edited by the patient or his representative. What about the internet illiterate? This personal hr does two good things: it logs anyone who accesses the information and which information was examined. It claims to organize everything in one site. Membership is free. I asked the company a few questions about myphr.ca. After contacting the company here are some of the responses: 1. //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 9pt; line-height: 150%;">MyPHR.ca is not just for Canadians. In fact, because our company and servers are situated in Canada our customers’ information is not subject to the US patriot act. 2. Yes, health professionals can have their own emergency login to see members’ profiles without the member's username and password. All the health professional and emergency responders have to do is create an account and request a health professional login (and once verified as such) they can login and then enter a member's 12 digit number to see a "read-only" profile of a member's health information. You can have all of your patients create an account for free (and have them enter their information online) and then you can see their information online at **www.myPHR.ca** or mobile device (such as a Blackberry/Palm) at **www.myPHR.ca/mobile** 24/7 where ever you are //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.aetna.co​m/news/2006/pr_20061003.htm] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">is a phr developed by Aetna. Most of the information is filled in automatically by Care Engine, which is actually a relational database that searches claims records and pharmacy fills. There is an area where the patient can enter and update other items. Its portability is that it can be printed out to give to physicians. Physicians also have access to the data. Its strength is in its database capabilities to automatically access information and update the phr. Aetna will send alerts to the patient and physician regarding cross reactions, medications to refill, and tests/exams that need to be done. These are some very nice features. Security features are password encoded. It is web based for access. Its weakness is that it is linked to the insurance company. If your employer changes policies, can you still access the data and give it to your physician. If not, at that point the information becomes static and out of date and it decreases in value unless Aetna sets it up independently of its insurance function and allows anyone to purchase and use it. But then how does Care Engine access the claims data. STD, HIV, and family planning information are not automatically entered and must be entered by the patient. There are more questions from my initial review than answers. Question on alternate (non primary) provider access to the information—the ER or out of town visit (snowbird phenomenon). Their data will enter the system via claims, but how do these providers access the information in emergency situations. How do you correct a misdiagnosis? <span style="color: blue; font-family: 'Calibri','sans-serif'; font-size: 10pt; line-height: 150%;">[|Soarian Integrated Care] <span style="color: black; font-family: 'Calibri','sans-serif'; font-size: 11pt; line-height: 150%;"> by Siemens <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">is more than just an ehr product but rather a complete practice management and computer aided diagnosis‖package. It has several modules that you can add for more complete management but our quest is to identify how to make ehr and the phi portable and private. The setup looks very expensive, a barrier for small practices and individuals. The Soarian portal allows for online access by providers. There is little information about the personal health record, but the EMR, called the online medical record, appears to be very strong. We are looking for nationwide access to phr that can help in patient care. The website only indicates that Siemens will assist you in building a phr. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Allscripts had partnered with Microsoft in 2006 to develop EHRs. It has since branched out forming other IT and content provider partnerships. To date it has 150,000 physician participants. Its focus includes business and office management as opposed PHRs, alone. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. is a case management site and can‘t be accessed unless you have a member id. From the webpage it looks like they do case management for employers, etc. and offer to customers a personal health record. I could not look at the form of the record itself or how it keeps things secure. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> This site, Canadian based, offers secure servers to store one‘s medical information. All data is sent encrypted, and there is a three-step security system to ensure no one can have access to your records except you. Access is via the internet. It appears that the patient adds/updates the information, so it could be biased or susceptible to errors. There is a section for physician notes to be added, but the patient has the ability to delete entries at his or her discretion. It costs $44 per year (Canadian dollars) for this service. I think it would be great to have if one does a lot of travel, but would not be optimal from a physician‘s perspective to replace the patient‘s original chart, whether paper or electronic. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Times New Roman','serif'; font-size: 10pt; line-height: 150%;">. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Another site where personal health information, entered by the patient, is stored and that is accessed via the web. The patient carries a card with his ID number on it and this will allow anyone to access the record; there is encryption but no super-secret password. The <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">data can also be accessed on a cell phone, if that is the only system available to the emergency responder. It is $30 annually, $50 for a couple and only $20 per child. Very affordable, and would appeal to travelers, but access is possible by anyone who obtains your ID card, so is less secure. The entry of data is 100% controlled by the patient as well; there is no option for a physician to add entries unless the patient scans records into his or her MyAccess chart. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Times New Roman','serif'; font-size: 10pt; line-height: 150%;">. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">This site is an online service to request copies of medical records, and then view/retrieve them via the internet. They make a big push about customer service, promptness and accessibility in particular, towards the requesting entity. Their primary service is attending physician statements for the insurance industry. The request is made on-line, and frequent status reports of the request are available. Fees are not disclosed for this service. One advantage is that the entire process, including viewing the records, can be handled in a paperless method and is very customizable. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Another provider of records retrieval services, like chart access. The site is as much an advertisement about the company, with press releases and financial reports, as a portal to obtain medical records in a completely electronic format. They do have a global network with several more specialized subsidiaries, which include research and digital radiographic images. The company appears well organized and has a whole section where all the various stakeholders in Health Information Management are able to see where ehealth will interact and likely benefit them. The website is exhaustive; they seem to have thought of everything. Despite this impression, one cannot find out the fees for this service unless you make direct contact with a customer service representative. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.medfusion.net] <span style="color: black; font-family: 'Times New Roman','serif'; font-size: 10pt; line-height: 150%;">. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">This company develops secure patient-physician communication systems which provide many levels of service. From requesting appointments to facilitating doctor-patient communication, mass e-mailings to patients, as well as individualized messages. The service includes training of client office staff and broad technical support. Patients can use this product to complete forms and pay bills online, request prescription refills, and communicate with the office staff directly. There is also a medical record that is partially controlled by the patient, but the specifics are omitted. It is difficult to determine the cost of the product without making contact with a sales representative, but like many of these EMR-related sites, there is a ROI calculator which likely can demonstrate a positive yield using medfusion‘s numbers. They offer many other services not at all related to an EMR, such as helping develop an intranet or webpage for the healthcare provide. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. This physician developed EHR has been implemented into 2000 offices. Its benefits include chart and schedule integration with low licensing fees ($995). I was able to download a trial version of the program. It is quite easy to use, but its lack of sophistication would make add-ons (X-rays, EKG‘s, Labs, etc) difficult. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.cchit.org] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Certification Commission for Healthcare Information Technology. This nonprofit organization has the goal to ―accelerate the adoption of health information technology by creating an efficient, credible and sustainable certification program.‖ Site includes a list of CCHIT certified ambulatory, inpatient, emergency and information transfer EHR providers and information of certification requirements. The mere existence of this site points to some of the challenges facing EMRs developed in the private sector. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. GE Centricity GE offers personal use and enterprise software. Potential advantages include data integration (GE media platforms are available) and web/network based portals. Operational benefits include data mining <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">programs for business units which are optional. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.nextgen.com] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. This product appears to be very similar to the Centricity system, but more end user focused. I tried out the online Demo and previewed the version for our institution. It will likely require the use of a scribe to allow efficient use that does not interrupt the typical human interface between patient and physician. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.practicepartner.com] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. McKesson Practice Partner. McKesson recently acquired Practice Partner which was originally founded in 1983 as Physician Micro Systems. Its focus is integration of appointments, scheduling and patient information with billing features. McKesson is already a major force in healthcare operations and has partnered with Oracle, Citrix and Microsoft (SQL Server). <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.webmd.com]. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">is the WebMD site. To better evaluate this feature I completed the two minute registration. It is a basic PHR platform with health assessment and information sharing options. A weakness ​includes the lack of data importation. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.iom.edu]. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Institute of Medicine. This influential health policy institute‘s website contains a number of reports advocating the use of electronic medical records to improve patient quality. Specifically addressed are the potential uses of data mining to monitor diseases, treatments and trends. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> A site within the main IOM that outlines the key Capabilities of the EHR system. The report was sponsored by the U.S. Department of Health and Human Services and is one part of a public and private collaborative effort to advance the adoption of EHR systems. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jph5 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.kaiseredu.org] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. The Henry J. Kaiser Foundation. The Kaiser foundation has summaries of health information technologies and links to related sites. Particularly useful is its breakdown of electronic health records and associated costs. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|htt​ps://www.kaiserpermanente.org] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. Kaiser Permanente, the nation‘s largest HMO/insurer offers on its site ―y Health Manager‖and ―y Medical Record‖features that are extensions of its ambitious EMR project. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.he​althcareitnews.com] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. Healthcare IT News. This site covers the expanse of healthcare information technology. In particular news and evaluations of EMRs and PHRs are presented. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.revolutionhealth.com] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. Revolution Health, like Google, Microsoft and WebMD, this software offers a PHR option at no charge. It is similar in content and format to WebMD, but it offers less personal diagnostic and self help options. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> NeHII, Inc. is a health information organization, providing services that securely exchange important clinical information among physicians and other health care providers, real time and at the point of care.Created through collaboration among a group of Nebraska health leaders, NeHII serves more than half of Nebraska's population and continues to grow.Through its secure electronic exchange of patient medical information, NeHII is hoping to contribute to the quality of health care while helping to control the escalating cost of health care in Nebraska and the U.S.The initiative began early in 2005 when several individuals representing health organizations gathered to discuss the need to create a statewide health information exchange (HIE) for the betterment of patient care in the state. The exchange would enable physicians statewide to view consolidated patient medical history at the point of care, improving safety and care delivery while reducing duplicate or redundant procedures. This organization is an interesting concept as a clearing house for electronic medical data. However, the <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">success in Nebraska will depend on 100% participation. The goal is to ultimately engage other states in a similar concept in order to share information and data. This site tends to be self-promoting. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">willisc1 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> This is the website for //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Health Affairs, a //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> journal of health policy thought and research. The peer-reviewed journal was founded in 1981 under the aegis of Project HOPE, a nonprofit international health education organization. //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Health Affairs //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> explores health policy issues of current concern in both domestic and international spheres. Every article //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Health Affairs //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> has ever published is available online at <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|www.healthaffairs.org] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. All readers have free access to selected //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Health Affairs //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> journal articles at time of posting ( <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|Web Exclusive] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> for two weeks, Editor’s Choice articles for two months); all journal articles three years old or older; and all <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|//Health Affairs// Blog] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> content. The full twenty-six-year <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|article archive] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> is online. The site also provides search capability within //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Health Affairs //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">’ full archive. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|E-mail alerts] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> and <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|RSS feeds] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> are available. This site is all encompassing with currently 121 articles on health information technology (HIT) and 571 articles that discuss health information exchanges. The abstracts are free but do require a subscription to download the full-text PDF for articles that are within the last three years (except as described above). __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">willisc2 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> This is an article entitled //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The Value of Electronic Health Records in Solo or Small Group Practices //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. It is linked to the main healthaffairs website (see above) that looks at the value of EHR in solo and small medical practices. Even though this was written in 2005, many of the priciples and conclusions about the financial viability of such endeavors still hold. It is a well-organized study that compares two EHR systems in eleven different practice settings. The format of their study is a valuable format that could be used for evaluating EHR systems in larger practice settings and hospitals, as well. Conclusions about cost benefit analysis of EHR systems in these small practices can help policy makers formulate better financial and nonfinancial incentives for EHR use. The authors address the cost to providers, the time to recoup those costs, risk, and time benefits and quality of life associated with implementing EHR. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">willisc3 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> eClinicalWorks is a privately-held, profitable company formed in 2000. It does not have outside investors. eClinicalWorks employs more than 800 people across its Westborough, Mass., headquarters and New York and Georgia offices.It offers EMR/PM solutions in all 50 states, with more than 30,000 providers using eClinicalWorks. eClinicalWorks is utilized in large hospital systems and affiliated physicians; large and small health systems; large and medium medical group practices, including FQHCs and community health centers; and small and solo provider practices. The company offers EMR solutions, a health exchange, patient portal and practice management solutions. It was chosen by the New York City Department of Health and Mental Hygiene as its EMR/PM solution in 2007. There is an online demo of their services or you can schedule a demo. The company has a 98.9% renewal rate based on figures from maintenance contracts and Software-as-a-Service (SaaS) renewal agreements. The company reported $85 billion in revenues in 2008. The company’s success spurred a Harvard Business School case study, titled “eClinicalWorks: The Paths to Growth,” by Professor Robert F. Higgins that is available at <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">www.harvardbusinessonline.com <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">willisc4 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 9pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 9.5pt; line-height: 150%;">KLAS Enterprises is an independently owned LLC and monitors vendor performance through the active participation of thousands of healthcare organizations. KLAS helps healthcare providers make informed technology decisions by offering accurate, honest, and impartial vendor performance information. KLAS focuses solely on healthcare technology. Their main areas of research involve software, service firms, and medical equipment. They have an extensive vendor directory. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">willisc5 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> OpenClinical is a not-for-profit organization created and maintained <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">as a public service with support from Cancer Research UK under the overall supervision of an international technical advisory board. The OpenClinical Web site is aimed in particular at healthcare professionals and managers, medical informaticians and computer scientists and industry. It is designed to be a "one-stop shop" for anyone interested in learning about and tracking developments on advanced knowledge management technologies for healthcare such as point-of-care decision support systems, "intelligent" guidelines and clinical workflow. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jph1 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Quan, SF. The Electronic Health Record: The Train is Coming. J Clin Sleep Med. 2009 April 15; 5(2): 101. A nice brief editorial about the pros and cons of the EHR written by a physician from Harvard Medical School on the front line and who has been working with various EHR’s for some time. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jph2 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Pallav Sharda P, et al. Specifying Design Criteria for Electronic Medical Record Interface Using Cognitive Framework. AMIA Annu Symp Proc. 2003; 2003: 594–598. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jph3 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Fraser HSF et al. Implementing electronic medical systems in developing countries. Informatics in Primary Care 2005;13:83–95. A nice review on the EHR in general as well as its design and possible application in developing countries by authors from Harvard Medical School. <span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;"> __jph4__ <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 9.5pt; line-height: 150%;"><span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> As a not-for-profit organization funded by the federal government, //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Infoway //<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> works with the provinces and territories to foster and accelerate the development and adoption of pan-Canadian electronic health <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">information systems. Once these technology systems are up and running, health care professionals will have ready access to accurate and complete patient information. Also, Canadians will be able to access and manage their own health information electronically. What this means is better communication between health care professionals and a clearer understanding of what patients need. Thanks to the growing implementation of EHR technology, many Canadians are already realizing some significant benefits such as faster, more accurate diagnosis, and shorter wait times for treatment, safer prescriptions and better access to chronic disease management. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">glj1 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> This website, CMPA (Canadian Medical Protective Association) speaks of implementing and using electronic medical records and electronic health records. More specifically, it describes the regulation of electronic records, patient consent and rights to access, security and privacy issues, maintaining data integrity, sending / transferring records, destroying / disposing of records, data sharing and inter-physician arrangements, and emerging issues (PHR – Patient health Record). __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">glj2 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> This website describes how one province in Canada, Alberta is at the leading edge in developing its electronic health record (EHR). The site describes the provincial initiative to provide healthcare providers with immediate access to a patient's medication history and laboratory test results, regardless of where they are in the province, or where the patient's drugs or other treatments were ordered. The Alberta EHR was launched in October 2003. So far 6,000 healthcare providers have voluntarily signed on to use it, and benefits to patient safety have been reported. The EHR is an important part of healthcare renewal that is required to improve patient safety; however, it must not be viewed as a stand alone cure-all solution to Canada's patient safety challenge. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">glj3 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> This is a paper by Miller A., and Tucker C. titled “Privacy Protection and Technology Diffusion: The Case of Electronic Medical Records" (February 2009). The authors examined the impact of privacy laws on EMR adoption. They found that state privacy protection of hospital medical information inhibited EMR adoption by approximately 11% per three-year period, or 24% overall in states with such laws. The laws appear to reduce the network effects of EMR. In states without hospital privacy protection, if one hospital in an area adopts EMR, the propensity of other hospitals in the area to adopt EMR is increased by 7%. In states that have privacy laws, this propensity increase is not observed. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">bunmi1 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|CSC Accomplishing EHR/HIE (eHealth): Lessons from Europe] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Authors: Dr. Harald //Deutsch//, Fran Turisco. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">This article takes a critical look at implementation of EHR in several European countries and addresses many of the issues faced by the United States as it strives for full implementation of EHR by the year 2014. The discussion points on lesson learned from the European experience are organized into five major topics: 1) Planning and sustaining initiative, 2) Major issue management, 3) Governance and communication 4) Technology and interoperability, and 5) Implementation. Each major topic discusses decision points, as well as best practices and lesson learned. Privacy, security and patient identification were identified as the decision point for “major issue management. An approach that facilitated acceptance of EHR in Europe included early communication with the citizens regarding options for security of their data. Based on the experience in Europe, the best practices for authorizing access to shared-patient information includes role-based and legitimate relationship-based authentication. In the United Kingdom and Netherlands, end uses must have a smart card, which identifies their roles. In Denmark, end users access EHR using a sign-on and password. Access restrictions vary amongst the countries. For example, in Denmark, only physicians can see all patient data. Nurses can only see current encounter data for the patients on their wards and there are restrictions on selected diseases. Additionally, patients have the right to restrict access by role, facility and type of data. There is a full audit trail for access and updates and patients are entitled to know what information is recorded about them. Several regions have the Opt In/Opt Out policy for data sharing. Interestingly, in Denmark, patients do not own their data. They can only opt in / opt out with restrictions. In the Netherlands, the have the options to opt in, opt in with restrictions or opt out. Patient had to sign an informed consent prior to data capture and collection. There were <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">differences in approach to patient identifier. In Denmark, patient identifier is equivalent to the social security number utilized in the United States. As stated by the authors of this article, the best practice with respect to patient identifies is to cleanse the patient identification data and consolidate records within a healthcare provider facility or region first, institute policies to prevent duplicates before implementation of EHR and maintain this practice once EHR is implemented so that duplicates are not introduced. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt;">__bumi2__ <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Lipowicz, A. Progress still slow on electronic health record adoption. Federal Computer Week. September 29, 2009. __ [] __ <span style="color: #c0c0c0; font-family: Arial,Helvetica,sans-serif; font-size: 8pt;">__​bunmi3__ =<span style="color: windowtext; font-family: 'Arial','sans-serif'; font-size: 10pt; font-weight: normal; line-height: 150%;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] Address by Patricia Kosseim, General Counsel, Office of the Privacy Commissioner of Canada. Here, Now & Beyond: Protecting Privacy in an Electronic Health Record World. = ==<span style="color: windowtext; font-family: 'Arial','sans-serif'; font-size: 10pt; font-weight: normal; line-height: 150%;">Third Annual Conference on Electronic Health Records and Information Systems == <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">November 28, 2006, Toronto, Ontario <span style="color: #c0c0c0; font-family: Arial,Helvetica,sans-serif; font-size: 80%;">__​bunmi4__ <span style="font-family: 'Cambria','serif'; font-size: 12pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">[] Glendinning D., “Teamwork called necessary for EMR clinical research success”; <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 10pt;">As highlighted in this article, the potential contribution of EMR to clinical research can only be realized once private stakeholders and government have ironed out the logistics of data sharing. According to Lynn Etheredge who was quoted in this article “Until the educational potential of millions of EMRs can be harnessed, patients will continue to suffer from major gaps in clinical knowledge”. __bunmi5__ <span style="color: blue; font-family: Arial,Helvetica,sans-serif; font-size: 8pt; line-height: 150%;">[] <span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">__jfl1__ <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 9.5pt; line-height: 150%;">Jerome Groopman, Pamela Hartzband The two clinical faculty members of Harvard Medical School who authored this opinion were responding to statements President Obama made after his healthcare summit in early March. Dr. Hartzband is an endocrinologist at Beth Israel Deaconess Medical Center and an assistant professor of medicine at Harvard Medical School, and Dr. Groopman is a hematologist–oncologist at Beth Israel Deaconess Medical Center and a professor of medicine at Harvard Medical School — both in Boston. They believe touting EHR as a cornerstone of healthcare reform is overly simplistic and unsubstantiated. The article was enlightening regarding the basis for support of EMR is a __theoretical__ study in 2005 by the RAND Corporation which is funded by corporations likely to benefit. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 7.5pt; line-height: 150%;">jfl2 __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> VirMedice is a reseller company for the web-based NextGen EHR/ EPM system. VirMedice, as a SaaS provider, provides full service electronic health records by offering remote access to the NextGen system using internet connections. Instead of buying the complete software and server, and then hiring IT service to start the electronic health record system, VirMedice provides them for you. This is a convenient, low initial capital outlay way to implement an electronic record system for a small group and single practitioner, however an ongoing monthly leasing fee is required. It eliminates some of the headaches of a medical business, such as initial high cost purchase, ongoing IT maintenance and loss of patients’ records due to power outage and computer dysfunction. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">oba1 __ [|capzule image] seen above. <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|http://www.chartlogic.com] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> A significant difference in this EHR system, compared to any other EHR systems is the Precision Voice driven ChartLogic EMR, which integrates proprietary software with voice driven commands, dictation, specialty specific vocabulary, microphones, and hardware. This system is designed to achieve highly accurate voice recognition and provides time-saving shortcuts in addition to electronic medical records. This company combines Electronic Medical Record (EMR), Practice Management (PM), and Document Management (DM), and offers three different EMR solutions. ChartLogic claims that by implementing Precision Voice command, it makes doctors lives easier and saves time for busy medical practitioners. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">oba2 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> and <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> The Department of Veteran’s Affairs Medical Centers use their award winning electronic health record, CPRS (Computerized Patient Record System). CPRS is networked across the VA patient care centers in the U.S., including VA medical centers, clinics, and care facilities. The purpose of this is to be able to access Veterans patients’ medical records including labs, patient’s information, medications, diagnostics and progress notes so Veterans can have their medical care anywhere in the U.S. without disruption. CPRS is a comprehensive Veterans Health Information Systems and Technology Architecture (VistA) program, where VistA became part of the public domain. Therefore VistA can legally be the basis of proprietary software and free and open source software in community. The adoptation of VistA by EHR industry is discussed at <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">oba3 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> A number of companies already have taken the source code for VistA and commercialized it as a lower-cost alternative to the many proprietary, enterprise EHRs on the market. Medsphere Corporation, a founder of Open Vista which is the most fully commercialized VistA offspring, emphasizes the affordability being a huge issue to implement EHR system in many communities. The company claims that they can do everything the other systems do without upfront capital costs or back-end balloon payments. Medsphere is based in Carlsbad, California, and was founded in 2002. <span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;"> __oba4__ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|**http://www.centerforhit.org/online/chit/home/ehr-adoption.html**] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> This site by the American Association of Family Practice has a large web of education on what the MD needs to know about EMR. Tutorials are given on the teminology, on evaluating programs, on the implementation, etc. Also has product reviews by members. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jfl3 __ <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> The American Medical News site is a huge resource on many topics and is rich in articles on EMR. The navigation bar in lavender down the left side of the screen makes content easy to access. This article from January 2010, discusses a different issue of EMR security: one does not need to be a talented hacker if one can merely obtain a user name and password from an authorized user. Sophisticated phishing schemes are targeting physicians in large EMR networks to steal the identity not only of the physician but also of the unsuspecting patients in the database. __ jfl4 __ [] - " <span style="font-family: Arial,Helvetica,sans-serif;">KLAS questions vendor claims on HIEs". This report published 2/9/10 examines a report by KLAS, an Orem, Utah-based research firm. KLAS found that only a few vendors can claim that they have created a proven and reputable model for HIE. They validated 89 separate organizations that use live HIE technology to share patient information that is viewed by physicians. Acute-to- acute sites as well as acute-to-ambulatory sites were evaluated. Medicity's Novo Grid was the leader with 22 live sites in the acute-to-ambulatory HIE's. More than 70% of the validated sites were funded through state or federal grants. Many challenges were reported on establishing a HIE including security and privacy concerns as well as governance and patient consent.. __jfg1__ [|Hemidata] __sharad2__ __**Meaningful Use**__ <span style="font-family: 'Arial','sans-serif';">On January 13, 2010, the Department of Health and Human Services issued an initial set of standards, implementation specifications and certification criteria for “meaningful use”. When finalized, these standards will be used by the Centers for Medicare and Medicaid (CMS) to determine “eligible professionals” and “eligible hospitals”, i.e., those institutions and clinicians which have met CMS’ requirements for EHR Incentive Program funds. The document comprehensively tabulates Stage 1 health outcome policy goals (i.e., “improving quality, safety and efficiency, and reducing health disparities), clinical objectives (“maintain active medication allergy list”) and implementation benchmarks (“__>__ 75% of all permissible prescriptions…are transmitted electronically using certified EHR technology”). The current proposal contains more loosely summarized guidelines for stages 2 and 3, as these stages are not scheduled to be implemented until 2013 and 2015, respectively. ( Proposed rules: Medicare and Medicaid Programs, Electronic Health Record Incentive Program: 42 CFR Parts 412, 413, 422, 495). <span style="color: black; font-family: 'Arial','sans-serif';">[]. Comments on the proposal are being accepted by the Health and Human Services Department until March 15, 2010 and they are expecting finalizing the plan in late spring. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 80%;">__laj2__ [] This congressional hearing addresses the strides made in sharing information between the VA Medical System and the Department of Defense. However, when reading through the testimony from BG Robb, it becomes clear that there is still a great deal of fragmentation within the Department of Defense Electronic Medical Records Systems. For example, in a deployment scenario, there are two standard systems for tracking wounded soldiers, JPTA and TC2 (both discussed by BG Robb). The EMR system used by the DoD within the United States (AHLTA) does not "talk" to the VA Medical Center's System (VistA). The testimony from this hearing points out that making the connection between these two systems is key to the success of patient care within both organizations. nol2 [] __jfg2__ <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Many providers, especially solo practitioners and small group practices, will find the cost of purchasing and implementing an EHR system prohibitive without outside assistance. The Centers for Disease Control’s (CDC) National Center for Health Statistics reports that in 2009, an estimated 44% of office-based physicians used “full” or “partial” EMRs, up from 35% in 2007 and 41% in 2008. [i] The use of “fully functional” systems rose from 3.8% in 2007 to 4.4% in 2008, to 6.3% in 2009. Despite the establishment of an EHR incentive program and various other incentives by the Centers for Medicare and Medicaid (CMS)--including a maximum $44,000-per-physician tax incentive--the rate of EHR purchase and implementation is not expected to increase dramatically in the next few years. [ii] According to Kalorama Information, a market research firm specializing in health information technology, barriers to adoption of EHR by many physician practices (such as an expected disruption of work flow and an initial loss of productivity) may outweigh the prospect of receiving government incentives. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;">The EHR incentive program, funded by the American Recovery and Reinvestment Act of 2009 (ARRA) will constitute a major potential funding source. Receipt of funds from the EHR incentive program will be contingent upon the provider’s ability to meet the “meaningful use” requirements, as outlined by CMS and the Office of the National Coordinator for Health Information Technology (ONC). Regardless of the cost to the provider, ARRA requires full compliance by both physicians and hospitals with the meaningful use standards by 2015, in order to avoid Medicare penalties. [iii] Therefore, for many providers, the prospect of losing Medicare reimbursements will likely present greater motivation for meeting the meaningful use criteria than will the possibility of receiving stimulus funds. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 200%;">__laj1__ <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: Arial,Helvetica,sans-serif;">For over a decade, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) have been working on initiatives to share electronic health information. To expedite their efforts, Congress mandated in the National Defense Authorization Act for Fiscal Year 2008 that VA and DoD establish a joint interagency program office to orchestrate the development of electronic health records systems or capabilities that allow for full interoperability by September 30, 2009. In this statement, the Government Accountability Office (GAO) summarizes findings from its upcoming report, focusing on progress in setting up the interagency program office and the departments' actions to achieve fully interoperable capabilities by September 30, 2009. To do so, GAO analyzed agency documentation on project status and conducted interviews with agency officials. GAO's draft report recommends that the Secretaries of Defense and Veterans Affairs emphasize the interagency program office's establishment of a project plan and integrated master schedule to guide their interoperability activities <span style="color: #c0c0c0; font-family: Arial,Helvetica,sans-serif; font-size: 80%;">__nol1__
 * <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 9.5pt; line-height: 150%;">Obama’s $80 Billion Exaggeration. **<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 9.5pt; line-height: 150%;"> The Wall Street Journal, Opinion, March 11, 2009
 * __Health Data Exchange__**

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 10pt;"> [i] “Electronic medical record/electronic health record use by office-based physicians: United States, 2008 and preliminary 2009”, National Ambulatory Medical Care Survey conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention, December 2009, www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.htm. [ii] “More EMRs are in physician offices, but use still lags”, February 1, 2010, www.ama-assn.org/amednews [iii] Update on Meaningful Use, Computer Services Corporation. January, 2010. www.csc.com. [|Capzule] sharad1 //Electronic Medical Records, Electronic Health Records.//@http://www.openclinical.org/emr.html craig1 //Use of Electronic Health Records in U.S. Hospitals.//@http://content.nejm.org/cgi/content/full/360/16/1628 craig2 //IBM Smarter Planet: Electronic Health Records for Evolving Healthcare.//@http://www.youtube.com/watch?v=OeaksbGMp8y craig3 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] chof1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> [] This site discusses the benefits of an EMR in being able to measure quality across different regions and areas of the country. In 2008, the then <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Health and Human Services Secretary Michael Leavitt stated standards for EMR adoption and quality reporting must be developed nationally and executed locally. In addition to financial incentives, HHS will provide local exchanges with Medicare data to populate their research according to this 2008 article. Leavitt said the nation is broken down into hundreds of healthcare markets “doing their own thing to measure quality.” If chartered value exchanges are established and they use the same standards, he predicted the emergence of a capacity to measure quality. <span style="color: #c0c0c0; font-family: Arial,Helvetica,sans-serif; font-size: 8pt;">chof2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> [] <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 10pt; line-height: 150%;">This site discusses the positive aspects of an EMR from a physician viewpoint. EMR increases productivity as a result of automated processes. An EMR can increase revenue by providing the ability to offer new services to patients. An EMR can reduce the expenses associated with paper charts, poor documentation and transcription costs. An EMR can improve clinical decision making and potentially increase profits. Overall, EMR helps deliver quality patient care <span style="color: #c0c0c0; font-family: Arial,Helvetica,sans-serif; font-size: 8pt; line-height: 150%;">. chof3 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] This article presents a skeptical view on EMRs. It questions why the benefits of health IT and electronic health records, and the fixability of their flaws are taken for granted. More specifically, it asks if it is worth $30 billion, as the Obama administration proposes, to digitize everybody's individual medical histories, test results, medications, scans, clinical notes from physicians and nurses, and other healthcare detritus and convert them into electronic health records, accessible from anywhere. This articles cites a NEJM study that found that //<span style="font-family: 'Arial','sans-serif'; font-style: normal;">1.5 percent // of hospitals have equipped all of their major medical services with comprehensive electronic health records. The main reasons identified by the thousands of hospitals that responded to a massive survey was not enough money to buy the systems ($20 million to $100 million), not enough money to maintain them, physician resistance, and unclear return on their investment. Skepticism about the ability of such systems to fulfill their promise (while not creating risks of their own) was not among the list of reasons that hospitals surveyed were offered but is a real question. chof4 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> [] This discusses the impact of medical group size, time and money on EMRs. Medical experts agree that electronic patient records, when used wisely, can help curb costs and improve care. Large medical groups have seen success with the implementation of EMRs. These larger groups have the scale to invest in information technology, and they are often insurers as well as providers, so they benefit directly from the cost savings. Yet these large groups are the exceptions in American health care. Three-fourths of the nation’s doctors practice in small offices, with 10 doctors or fewer. For most of them, an investment in digital health records looks like a cost for which they are not reimbursed. “This is really not a technology problem,” observed Erik Brynjolfsson, an economist at the Sloan School of Management at the Massachusetts Institute of Technology. “It’s a matter of incentives and market failure.” In this article a New York office discusses their implementation and stated “There’s no way small practices can effectively implement electronic health records on their own”. “This is not the iPhone.” The expense in both time and money can’t be underestimated when implementing an EMR. chof5

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Sitting DF, Singh H. Eight rights of safe electronic health record use. JAMA. 2009;302(10):1111-1113 **<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. The eight rights include: right hardware and software, right content, right user interface, right personnel, right workflow and communication, right organizational characteristics, right state and federal rules and regulations, right monitoring. chof6 <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">**Smelcer JB, Miller-Jacobs H, Kantrovich Lyle. Usability of electronic medical records. Journal of Usability Studies. Vol 4, Issue2, February 2009, 70-84** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Excellent review on how to make EMRs more usable focusing on the physician’s task flow. It is helpful to understand different work styles, variation in work pace, the use of nurses, the mode and timing of data entry and the variations in needed functionality. Solutions are proposed to address flexible navigation, personalization and customization, accessing multiple patients, delegation of responsibility among medical personnel and enabling data variations and visualizations. chof7
 * <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Other resources: **

<span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 10pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[] This paper discusses adding spatial interoperability (data from geographical information systems, GIS) to the HL7 Standards. This could be an efficient tool for public health agencies, allowing them to monitor quickly the geographical spread of disease (for example, swine flu) for decision making purposes. Local hospital, in return can receive this information back and adjust their preparation according to their geographical risks. __dja1__ <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[] The website of Certification Commission for Health Information Technology. As EMR/EHR gains adoption and becomes more mainstream there will be a need for health information professionals to install and maintain this system. This commission provides certification for these professionals. The ARRA requires certain rules to be satisfied before implementation of a certain EHR can qualify for incentive payment. CCHIT maintains a list of EHR products that satisfy these requirements. __dja2__ <span style="color: #0000ff; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] Medical records online are to become available in Dubai soon. This article reveals that Dubai Health Authority’s Electronic Medical Records system will go live in 2012 in Dubai. The system, launched by the authority at the Arab Health Conference and Exhibition on Monday, will store detailed patient data for both private and government hospitals in future. The electronic system will be able to compile complete patient information such as history, allergies, prescriptions and diagnostic test results. The system will provide one clinical data depository where all patient information is stored. The eventual aim is use this system across Dubai, in both private and public hospitals. It is not clear how this information will be managed or if the patient will be able to control or edit the information. __oliv1__ <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">In this article, the author discusses the current available free VistA software (VA emr software). It argues that “free software” may not be free at all since it does not account for implementation costs, training and maintenance costs. The current VistA software is plagued with compatibility issues and its platform is quite antiquated and complex with little expertise on the software complexities. It argues that Medicare should invest more of its resources in the development of system integration of existing software and allowing the patients to control access to their EHRs. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">oliv2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">[] Surgical Information Systems is a specialty specific electronic user interface that targets the traditional cash cow for health care institutions, surgical procedures. This system carries the distinct advantage as being a leader in cross user compatibility among clinical, management, billing, and scheduling staff. It has fairly advanced data mining capabilities. Disadvantages include the fact that it is at present specialty specific and implementation to a health care wide platform would be challenging for its developers. beer1 [] This vendor site produces an EHR that specifically satisfies all government imposed requirements for meaningful use and produces reports based upon clinical data that is primed for submission for CMS’s Pay for Performance outcome measures incentives. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt;">beer2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] This website, presented by the National Quality Forum, is dedicated to presenting a series of cases that demonstrate the successful implementation of HIT to reduce costs and to improve the quality of care. These cases are broad based and show the use of many platforms. Cases are reported in standardized formats according to national quality metrics for ease of comparison. Reasonable economic arguments are presented in most cases demonstrating cost savings. beer3 [] This site points out some of the shortcomings of modern EHR’s particularly with regard to the ability to easily forward copy progress notes on inpatient records. This practice, the authors contend, is in widespread use and compromises the patient’s health status and is a source of billing fraud as well. Widespread use of this will violate the purported real advantages of EHR’s with data mining and population based best therapeutic practices. Another disadvantage pointed out is the ease in this format by which one health care provider may be misrepresented, either intentionally or unintentionally, by another EHR person. The current systems available for electronic signature do not adequately protect against this violation. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">beer4 Institute of Medicine of the National Academies (2003). ” Key capabilities of an Electronic Health Record System”. Retrieved from <span style="font-family: 'Times New Roman','serif'; font-size: 12pt;"><span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">[] This paper discusses how a better Information Technology (IT) infrastructure is required to improve healthcare quality and reduce costs. It examines healthcare delivery functions and focuses on EHR implementation, core functionalities, primary and secondary uses, and the benefits of such a system. jodou1 Carter, J.H. (2007). The legal health record in the age of E-Discovery. Retrieved from <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">[] This presentation discusses the legal health record in the context of an EMR. It discusses security requirements, software, administrative and technical features of valid legal electronic records. It briefly discusses how electronic records should be managed under HIPAA and electronic discovery. jodou2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Health Information Technology for the Future of Health and Care (January 29, 2010). Nationwide Health Information Network (NHIN) architecture overview. Retrieved from <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">[] The Health Information Technology website is managed by the U.S. Department of Health and Human Services and is a resource for Health Information Technology. This paper focuses on the Nationwide Health Information Network (NHIN). It provides an overview for the NHIN and describes the proposed architectural concepts and framework for the network. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou3 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Thompson, D., Osheroff, J., Classen, D., & Sittig, F. (2007). “A review of methods to estimate the benefits of electronic medical records in hospitals and the need for a national benefits database”. Journal of Healthcare Information Management, Vol. 21 (1), pp. 62-68. Retrieved from [] Electronic Medical Records are reported to have numerous benefits; however it is difficult for healthcare organizations to assess these benefits and whether they will apply to their organization once the system is applied. This paper describes the different approaches organizations can utilize to estimate the potential benefits of an EMR system. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt;">jodou4 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Poissant, L., Pereira, J., Tamblyn, R., Kawasumi, Y. (May 19, 2005). The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. Journal of American Medical Informatics Association, vol. 12 (5), pp. 505-516. Retrieved from [] The authors of this article performed a systematic review of the literature to assess the impact of electronic health records on the efficiency of physicians and nurses. A total of 23 papers were reviewed. The authors found a difference in results depending on the place of documentation (point of care vs. central station) and the length of time the EHR has been in place. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou5 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Healthcare Information and Management Systems Society (HIMSS) Enterprise Systems Steering Committee and the Global Enterprise Task Force (August 2008). Electronic Health Records: A global perspective. Retrieved from [] This paper focuses on the implementation efforts of Electronic Health Records in various countries around the world. The authors discuss the four main issues (funding, governance, standardization and interoperability, and communication) that affect the success or failure of implementation, and what the United States can learn in implementing a standardized and interoperable EHR. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou6 iHealthBeat (January 4, 2010). Officials announce ‘Meaningful Use’, EHR certification criteria. Retrieved from <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">[] This article discusses the proposed regulations defining “meaningful use” of electronic health records (EHR) and the interim final rules for the required certification standards for EHR technology. <span style="color: windowtext; font-family: 'Arial','sans-serif'; font-size: 10pt; text-decoration: none; textunderline: none;">[|Centers for Medicare & Medicaid Services (//CMS//] ) proposed phasing in meaningful use requirements over three stages. The stages of implementation, certification criteria, budget for incentive payments, and the reaction to the regulations are elaborated on further in the article. jodou7 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">OpenEMR. Retrieved from [] OpenEMR is one of the most popular, free medical practice management, electronic medical records, prescription writing, and medical billing applications. It is a free open source replacement for medical applications and is an alternative to proprietary EHR software. OpenEMR’s community members are comprised of software developers and physicians. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou8 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Bowen, S., Valdes, I., Hoyt, R., Glenn, L., McCormick, D., Gonzales, X. (November 21, 2009). Open-source Electronic Health Records: policy implications. Open Source Medical Software. Retrieved from [] This paper focuses on open-source electronic health records (EHRs), and their utilization by consumers and healthcare organizations as an alternative to proprietary software. The authors report on the costs, benefits, and limitations of an open-source EHRs and practice management systems implemented in the US and abroad. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jodou9 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] **<span style="color: #595959; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">HIPAA Basics **<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">: Medical Privacy in the Electronic Age. This site is an all inclusive collection of the reasons why privacy and security is important in the age of EMR. It is filled with information and links to much of the important work that has been accumulated on this subject. __<span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">bal1 __ <span style="color: #365f91; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Privacy Rights Clearing House. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] **<span style="color: #4a442a; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Security: **<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Begins with a case study commentary begins by stating the central ethical dilemma: this being whether or not a physician should actually record information in the patient chart that could be harmful or embarrassing to the patient, or could be used in any way against Him/Her. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">bal2 __ <span style="color: #548dd4; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[]- 30.9KB **<span style="color: #595959; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> PHR IMPLEMENTATION – SPEARHEADED BY PAYERS: **<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> The system, called My Florida Health eBook. Three payers have banded together to build an EHR for consumers in Florida. This is a PayerBased system. I have personal concerns about this kind of activity done by parties whose interests are conflicted.__ bal3 __ [|Florida first to offer Medicaid claims data online :: Dec. 21, 2009] <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: #4a442a; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">- <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Home <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> > EMR > **<span style="color: #4a442a; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">EMR and HIPPA **<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">: - November 11, 2009 This is a blog by a consumer who was surprised to discover that it is possible to access the EHR for the purposes of self-prescribing medications. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> bal5 __ []**Keystroke logging is the practice of tracking** bal4 <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: #4a442a; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">- <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Home <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> > EMR > **<span style="color: #4a442a; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">EMR and HIPPA **<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">: - November 11, 2009 This is a blog by a consumer who was surprised to discover that it is possible to access the EHR for the purposes of self-prescribing medications. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> bal5 __ The American Medical Association (AMA) adopted a lengthy report and related protocol for physicians to follow in the event a patient's electronic medical record were to be breached. __<span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">b ____<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">al6 __<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. <span style="color: #595959; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[|Patient privacy rules] hamper adoption of electronic medical records. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;"> bal7 __ <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|**http://patients.about.com/od/electronicpatientrecords/a/privacysecurity.htm**] **<span style="color: #595959; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">When it comes to EHRs/EMRs - the digital technology has a few limitations: **<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> There are many problems and hurdles related to privacy and security with the EHR. This site describes the varied details of these problems. This is a great resource. __<span style="color: silver; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">bal8 __ <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] **// An INVERSE relationship between Higher electronic access to records and Privacy/Security: //** //<span style="color: #4a442a; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">This site discusses the issues related to the legal system //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. The findings are very relevant and insightful. This site should be on all security conscious person’s list of sources. __ bal9 __ <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] and [|Business Identity Theft Prevention www.IDTheftSecurity.com] **<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">No sophisticated hacking skills, software, or hardware are required **<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> when authorized users can be mislead into revealing their user name and password via a phishing scheme. There are many ways that computer users can be tricked into revealing important personal information.__ bal10 __ [] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Indivo is an open source personally controlled health record (PCHR) developed jointly by Harvard Medical School and MIT at the Children’s Hospital of Boston. The technology concept is that with open source code, for which programmers may write applications labeled Indivo compatible similar to iPhone apps. The EMR is approached differently with patient control. The site lists publications by the developers. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">Jfl5 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> [|http://www.physicianspractice.com] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">This journal is distributed complimentary to physicians and is full of useful, practical information regarding the business of medicine. The usual topics include billing, coding, collections, legal issues, and technology. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">Jfl6 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[] Singing From the Same Hymnal. The article bemoans the lack of inactivity in current electronic data silos and is in favor of government supported standardization. jfl7 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] An in-depth consideration of the issue of de-identifying private medical data for research and evidence based medicine. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">Jfl8 <span style="font-family: 'Arial','sans-serif';">[] Harris Interactive (the 12th largest and fastest-growing market research company in the world), responsible for the so-called Harris Poll, posts its results of three surveys on EMR and EHR. The polls note that many people know very little to nothing about the current campaign to adopt EMR throughout the entire U.S. healthcare system. Although 64% of those polled support the idea of an EMR, 29% felt that the benefits outweigh the potential risks and 42% expressed their concern that privacy risks may outweigh expected benefits. arga1 [] Sue Hildreth writes an update on the current status on funding for healthcare IT. She also addresses issues related to cost and how the stimulus package could help cover some of these expenses. However, she cautions the reader about making sure that their EHR system is compliant with government requirements. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 80%;">arga2 <span style="font-family: 'Arial','sans-serif';">[] This article from February 10, 2009 brings up the issue of informed consent before any individual’s health record is entered into an electronic database. It makes a strong argument for people who do not want their health information included. However, it makes no mention about the possibility of a mandate should government funds, including Medicare and Medicaid, be used to implement such a system. <span style="color: #b2b2b2; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">arga3 <span style="font-family: 'Arial','sans-serif';"> [] This website is a link to the article entitled “Lessons Learned from Electronic Health Record Implementation at Three North Dakota Critical Access Hospitals” from March of 2009. It discusses their experiences as it relates to successes and challenges. Factors related to success included clear communication, training an adequate number of super-users, strong commitment to training, and taking the transition slowly. Factors mentioned in challenges are communication, lack of comprehensive work flow, encouraging providers to use the electronic record, loss in productivity, and obtaining adequate comprehensive training from the vendor. <span style="color: #b2b2b2; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">arga4 <span style="font-family: 'Arial','sans-serif';"> [] This article, entitled “Rapid Implementation of an Electronic Health Record in an Academic Setting” by Badger, Bosch, and Toteja (published in the Journal of Health Information Management in 2005) chronicles the experience at George Washington University’s Medical Faculty Associates. It brought 99 physicians and 130 residents and interns live on EHR in less than 30 days. It discusses the obstacles and challenges and how they were dealt with. It talks about early implementation strategies and encountering physician resistance. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 80%;">arga5 <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">@http://www.idtheftdailynews.com/articles/44266/four-out-of-five-healthcare-it-pros-had-at-least-o/ According to a newly released survey, 61 percent of health IT practitioners doubt that their organizations have the resources to meet privacy and security requirements, while 70 percent say senior management isn't making data protection a priority. ippo1 <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">http://www.law.uh.edu/healthlaw/perspectives/2006%5C%28JM%29E-RecordsFinal.pdf <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Although there is great potential in the EMR technology, it is still unaffordable for most hospitals, group practices, and definitely for solo-practitioners. Furthermore, every healthcare institution and physician is aware that, after taking on the sunk costs of acquiring EMR technology, there is no guarantee that it will not become the next laser disc or that a newer version will not eclipse the previous model every three months. Additionally, there are the opportunity costs: The amount of money a healthcare institution spends on EMR technology in order to improve healthcare is money that the institution will not have to acquire other resources to provide healthcare. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">ippo2 <span style="color: blue; font-family: 'Arial','sans-serif'; font-size: 9.5pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 9.5pt; line-height: 150%;">The Compliance Auditor interfaces with EMR to monitor who is accessing which patient records. Each provider’s implementation and interpretation of HIPAA are different. The flexibility of a Compliance Auditor appliance from Bitwork allows a practice to easily create audit reports. The government may require a privacy audit of EMR systems to <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 9.5pt; line-height: 150%;">determine who looked at any specific records, or whether someone is accessing records of VIPs, family members, or employees. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 7.6pt; line-height: 150%;">ippo3 [|Reimbursements through ARRA] The American recovery and Reinvestment Act of 2009 authorizes the Centers for Medicare and Medicaid Services to provide reimbursement incentives for eligible professionals and hospitals who are successful in becoming “meaningful users: of certified health record technology. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 115%;">lcou1 [|mgma blog] The current definition of “meaningful use” <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;"> 1. The EHR software must be certified 2. It must exchange certain clinical data 3. It must report quality measures 4. The clinician must prescribe electronically Stage 1 of the “meaningful use” criteria which begins in 2011 list 25 objectives/measures for eligible professionals and 23 objectives/measures for eligible hospitals; to be considered a meaningful user, you must meet all of the criteria set forth. The Federal Register carries a complete list. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 115%;">lcou2 [|healthimaging.com] The Office of the National Coordinator for Health IT (ONC) sets forth the standards and specification that will enhance the interoperability, functionality, utility and security for HIT. **Current EMR systems made by different manufacturers cannot interface with each other.** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">ONC describes standards that will need to be met by “certified HER technology to exchange health care information among providers and between providers and patients. The interim final regulation issued by the ONC describes standard formats for clinical summaries and prescriptions, standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; standards for the secure transportation of this information using the internet. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 115%;">lcou3 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;"> [|http://arstechnica.com] One of the problems is that systems that are being put in place are largely focused in **recreating the current paper-based system in a new medium**. ( [|http://arstechnica.com] ). <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 115%;">lcou4 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;"> The interim final regulations call on the industry to standardize the way in which EHR information is exchanged between organizations, and sets forth criteria required for an E.H.R. technology to be certified. Linking the electronic records of doctors, hospitals and clinics remain an elusive goal. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 115%;">lcou5 [] an article from Health Affairs that discusses ideas on financing prototypes in IT. lcou6 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Kern, S. Hidden Malpractice Dangers in EMRs. [|http://www.medscape.com]. This article discusses the many hidden risks of malpractice suits from using EMRs such as containing too much information, making it easy to overlook important information, use of wrong templates, and decreased attention to patients in untrained physicians. <span style="color: #d9d9d9; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">ada1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Swartz, N. Electronic Medical Records' Risks Feared; //Information Management Journal//, May/June 2005. This article discusses the challenges of implementing a nationwide EMR system, public concern of privacy risks and the fact that some states such as Kentucky have passed measures to create a statewide electronic health network. <span style="color: #d9d9d9; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">ada2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Sinsky CA. e-Nirvana: Are We There Yet? //Family Practice Management//. 2008; 15:6-8. This article written by a physician narrates her experience with EHR, the good, bad and challenging. The writer gives her perspective on how innovators can create a streamlined, user-friendly EHR. <span style="color: #d9d9d9; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">ada3 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Koppel R. Case Commentary, EMR Entry Error: Not So Benign. //Agency for Healthcare// //Research and Quality; web Morbidity and Mortality// April 2009. This article begins with a case that exposes the weaknesses of EMR, better yet the mistakes that can occur with inputting patients’ information and the need for linking computer systems, implementing safeguards against patient identification and avoiding data fragmentation. <span style="color: #d9d9d9; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;"> ada4 <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Terry, N. The Government Push for Electronic Medical Records <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">; [|http://www.medscape.com] //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> February 24, 2009. This article offers frank opinions about the utility of EMRs in clinical practice -- opinions that are decidedly mixed. Physicians who are dissatisfied with EMR systems cite loss of productivity, the negative impact on patient care, and high maintenance requirements. Physicians who have embraced EMRs cite the increased efficiency the systems have brought to their practices. EMRs tend to get high marks from subspecialists and low marks from primary care physicians. Solutions offered include use of templates by specialists and programs that uses pattern recognition of similar cases as well as rare cases for primary care physicians which decreases the workload immensely. <span style="color: #d9d9d9; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;"> ada5 [|**http://www.hhs.gov/Recovery**]<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;"> is the government’s site to describe the provisions of ARRA. This includes a description of the [|Federal Coordinating Council for Comparative Effectiveness Research] and its responsibilities. It also describes the funding provided for CER under ARRA and which agencies would oversee those funds and what types of studies would be eligible. Here is a <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;">[|webcast] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;"> from 2009 describing the Council (requires Windows Media Player). <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 200%;">wsan1 [|**http://www.cbo.gov**] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%; text-decoration: none; textunderline: none;">is the CBO’s official website. Specifically reference here is their 2008 report, <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;">[|Evidence on the Costs and Benefits of Health Information Technology.] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%; text-decoration: none; textunderline: none;">This report describes the benefits of cost reduction, improved efficiency, and improved quality of care provided by health IT adoption, as well as the costs to physician practices and hospitals. It also includes a section on possible reasons for low adoption rates and the federal government’s possible role in health IT implementation. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 200%; text-decoration: none; textunderline: none;">wsan2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[] This website gives an overview of a surgically implantable identification chip is unique to an individual. It can contain information such as identification but also is currently applicable to healthcare records. There is significant debate on this product. Those who oppose it are concerned mainly about privacy issues. Other arguments against its use are the security of the information, religious opposition, and risks of cancer. Those who support it can clearly point to the ease of use. timh1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[|ARRA incentive plan] This website is from the Department of Health and Human Services. It describes an incentive plan for electronic health records brought about through the Recovery Act of 2009. It is dedicated to describing eligible individual health care providers as well as hospitals. Furthermore it gives specific information in regards to time frame of the program. It also explains the monetary incentive amounts for the individual providers. Along the same line, it describes the mathematical formulas that are used in determining the incentive dollars for health care institutions. timh2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] This is the official website of Certification Commission of Health Information Technology. It describes the commission’s goals in regards to developing and implementing electronic health information technology. It describes the standards used in determining eligibility for the incentives advanced through the Recovery Act of 2009. It also provides links to products that have met the criteria for certification. This site would be invaluable to anyone interested in purchasing electronic health records systems and software while remaining eligible for the federal incentives. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">timh3 [] was a town hall published on 03/01/2010 and gives a roadmap for EHR certification and Meaningful Use. timh4 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">[] Healthcare Information Management Systems Society (HIMSS) site dedicated to leadership in optimization of information technology for the betterment of healthcare. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] Wikipedia page dedicated to reference materials and a summary concerning EHRs. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] American Academy of Family Physicians site (uses EMR and EHR interchangeably) that describes how use of EHR alone does not improve quality of healthcare delivery. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;"> kash3 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] Health and Human Services (US government) website that describes the 2009 Recovery Act as it relates to EHRs. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash4 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] Medical news website with an article that describes difficulties in creating a platform for multiple corporate users. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash5 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] Archives of the Massachusetts medical society with flash presentation (“EHR 101”) concerning EHR usage in the physician’s office. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash6 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] Expresses EHR as an opportunity for expanding data collection and for leveraging this function in the practice of evidence based medicine. k <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">ash7 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] Subsection focuses on utilizing EHRs to avoid medical errors. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash8 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] PDF that describes the problems associated with junk data in Medicine. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash9 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] This site describes EHRs as an opportunity for pharmaceutical companies to improve research and development efforts. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash10 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] Identifies those parties likely to use aggregated health data from EHRs, and addresses data security concerns. kash11 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">[] National Committee on Vital and Health Statistics (public advisory body to Secretary of Health and Human Services) website that describes meaningful use of EHR, and sets broad national goals to accomplish this use. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash12 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] The Department of Health and Human Service’s summary of important press releases concerning EHRs. This site also summarizes “meaningful use” criteria and incentives for staff to utilize an EHR. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash13 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] Regulations regarding payments for EHR usage explained in detail. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash14 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] This site describes important components of EHR standardization on the national level. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash15 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> [] trend regarding total number of smartphone users. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash16 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> []. Blog concerning virtues of Veterans Hospitals’ EMRs. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt;">kash17 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] HIMSS (Healthcare Information Management and Systems Society) has a quick two-page guide on how to select a vendor for EMR at the following link: jcol1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] HIMSS has great material on both soft- and hard- ROI. Profiling specific users and documented ROI in their //2009 Call to Action//, HIMSS identifies patient safety, process improvement, communication, and regulatory compliance as indicators of proven soft-ROI. They have also identified specific cases where increased patient flow, materials and staff reductions, and billing improvements were directly correlated to EMR implementation. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jcol2
 * <span style="color: #595959; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Protocol to follow when EMR has been breached ****<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">: **<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;">[] In the first study of its kind, Richard Tannen, M.D., Professor of Medicine at the University of Pennsylvania School of Medicine, led a team of researchers to find out if patient data, as captured by EMR databases, could be used to obtain vital information as effectively as randomized clinical trials, when evaluating drug therapies. The study appeared online 2/2009 in the British Medical Journal. After examining six previously performed randomized trials with 17 measured outcomes and comparing them to study data from an electronic database, Tannen found that there were no differences in the database outcomes compared to randomized clinical trials in nine out of 17 outcomes. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 200%;"> jerd1

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;">[] This article from the Journal of the American Board of Family Medicine is a retrospective analysis to identify children and adolescents in the Primary Care Education and Research Learning practice-based research network (PBRN) who were at risk for dyslipidemia. Using technology within electronic medical records allowed for the identification of children at risk for dyslipidemia and to create clinical reminders that will allow the practice to improve the efficiency of screening efforts. <span style="color: #c0c0c0; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 200%;">jerd2

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;">[] This article addresses the very real issue of EMR security and privacy in our digital age. Starting with a birth date, sex, and ZIP code, computer privacy expert Latanya Sweeney, PhD, retrieved health data of William Weld, former governor of Massachusetts, from an allegedly anonymous database of state employee health insurance claims. Knowing Weld lived in Cambridge, Mass, she cross-linked her data with that community's publicly available voter registration records. Only six people shared Weld's birth date. Only three were men. Of these, Weld was the only man in his five-digit ZIP code. Sensitive information can be obtained with standard office computer software, without resorting to hacking, said Sweeney, founder and director of the Laboratory for International Data Privacy at Carnegie Mellon University, Pittsburgh. Removing names and social security numbers doesn't ensure privacy, she said. Birth date, sex, and ZIP code alone uniquely identify 87% of the US population. The conclusion of this article stresses the absolute necessity of EMR software to be encrypted and stored in such a manner so as to be non-identifiable to a particular patient when accessed outside of the system itself. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 200%;">jerd3 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 200%;">

[] This November 2009 article from AMA News details the very lucrative benefits of being the nation's largest civilian health record database. The National Institutes of Health awarded Kaiser Permanente 22 grants worth more than $54 million for EMR research that will be paid out over two years. The money was made available as part of the American Recovery and Reinvestment Act. The largest grant, worth $25 million, will be used to conduct genotype testing on 100,000 Kaiser members participating in the Research Program on Genes, Environment and Health, which Kaiser says is the largest population-based bio-bank in the United States. The grant will be shared with the University of California, San Francisco's Institute for Human Genetics, which will perform the actual genotyping. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 200%;">jerd4

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Milt Freudenheim. (2009). As Medical Charts Go Electronic, Rural Doctors See Healthy Change. //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The New York Times //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">. [] This article outlines the benefit that EMR has been to rural and smaller communities. It showed how a relatively younger physician switched and now will never switch back. She states how it makes it easier to keep track of her patients, especially those with diabetes, hypertension, or both. It also makes things easier on her patients. The three physicians have a total of 8,000 patients. The EMR can send electronic prescriptions to pharmacies, which is makes filling faster and easier for patients. The article cautions against being to optimistic about EMR. It tells how physicians have problems using the software and have gone bankrupt getting the software to convert. The overall article does show how small communities can be taken care of with fewer physicians because EMR makes treating and keeping track of patients easier and more efficiently. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jdal1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

Health Care Statistics. (2009). //PreventDisease.com// [] This article provided statistics about a number of healthcare topics. It focuses on focuses on the costs of healthcare in the United States and where the majority of those costs go. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jdal2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

Robert Pear. (2009). Shortage of Doctors and Obstacle to Obama Goals. //The New York Times//. [] This article outlines how the shortage of primary care physicians is creating a major problem for an aging population. The high cost of medical education, the low payouts from being a primary care physician and the high salaries of specialists all combine to lead to the current shortage. The article outlines various ways to increase the payments made to primary care physicians because it is evident that there needs to be more. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jdal3 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

[] Eighty six primary care clinicians participated in surveys between 2006 and 2008 in order to measure changes in their attitudes towards an EHR after the first year following EHR implementation. Overall, they agreed that the EHR improved quality of care, reduced medication errors, and improved follow-up of test results. They also felt that it improved communications between clinicians and over time the negative perceptions, like increased duration of patient visit and increased time spent on documentation faded. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">gabr1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

[] This is an excellent overview of EHR by the National Institutes of Health National Center for Research Resources. Defines EHR, discusses key components of an EHR system, reviews standards and trends, provides a good overview of workflow implications, and reviews cost and return on investment with a final section on implications for clinical research. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">gabr2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

[] presents an excellent summary of the literature regarding EHRs and the quality of ambulatory care along with the economic value of a HIT and EHR system. The main quantifiable benefits were saving from data capture and access, decision support efficiency, quality, and safety of care. There are few quantitative studies however that compared the implementation costs compared to benefits. All cost-benefit analyses predicted that the financial benefits would outweigh the costs in a timeframe that varied from three to thirteen years. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">gabr3

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Sittig, D. and Classen, D. Safe Electronic Health Record Use Requires a Comprehensive Monitoring and Evaluation Framework. JAMA, 2010; 303(5): 450-45. [] The authors put forth a strong argument for and proposal for implementing comprehensive EHR monitoring and evaluation for safety and quality assurance. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">lam1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Sittig, D. and Singh H. Eight rights of safe electronic health record use. JAMA, 2009; 302(10):1111-1113. [] The authors propose eight dimensions or “rights” of EHR safety that address social, technical, and personal issues that arise or are associated with electronic health record use. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">lam2

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] This paper describes not only the advantages of EMR over paper health records directly related to medical services, but also advantages in risk management and billing. These advantages include: providing information to improve risk management and assessment outcomes; allowing the providers of care to submit their claims electronically and receiving payment quicker, increasing storage capabilities for longer periods of time; accessible from remote sites to many people at the same time; allowing for customized views of information relevant to the needs of various specialties… In terms of disadvantages, the author discussed: the startup costs; a substantial learning curve of the users; the portability of the equipment; legal concerns…These factors must be considered before EMR can be implemented. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">fchen1

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] This site provides you a document developed by netForensics entitled "HIPAA in 2010: A Renewed Focus on HIPAA and the Role Security Information Management in Healthcare Organizations". This document covers the following issues: 1. How changes in the HHS guidelines will affect your security management program; 2. Keys to proving diligence in managing information security. 3. How you can best leverage existing technology and tools to address new HIPAA security standards by identifying and reporting on security related issues. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">fchen2

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] This paper discussed three major emerging trends in the healthcare information systems in 2010, including: Electronic Medical and Health Records (EMR/EHR) and two related and complex regulatory and legal requirements: ICD-10 and HIPPA 5010. The last 2 will change/influence how healthcare organizations use technology/EMR to manage data and other patient’s information. The deadline for HIPPA 5010 is January 1, 2012 and the mandated date for fully implementing ICD-10 is Oct. 1, 2013. When planning EMR, the future influence to ICD-10 and HIPPA 5010 needs to be considered. fchen3

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">[] This site contains many documents from the “HL7 International” workgroup that is a collaborative technology to support the HL7 organization. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 115%;">louisd1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">

The documents in the wiki [] are not permanent but serves as resource for the persistent documents found in the official HL7 website. louisd2

Electronic Medical Records vs. Electronic Health Records: Yes, There is a Difference. January 26, 2006. HIMSS Analytics. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">This is a white paper written by two authors from HIMSS Analytics. Makes a clear distinction between EMR and EHR, and argues that one cannot truly exist without the other. Presents an algorithm describing where in its implementation of EMR do various hospitals in its database fall. Needless to say, the majority of hospitals are in the early stages. An effective EMR system must be in place before EHR can truly be considered. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess1

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Electronic Medical Records: The Benefits Significantly Outweigh the Costs. March 7, 2008. The American Consumer Institute. [|http://www.theamericanconsumer.org/2008/03/07/electronic-medical-records-the-benefits-significantly-outweigh-the-costs/] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The article states that comprehensive EMR would be beneficial and the benefits would outweigh the costs. Highlights the fact that the healthcare industry itself a roadblock to implementation since it benefits somewhat from the inefficiency of the system. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess2 Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. September 2005. Health Affairs. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">This article discusses the potential benefits of initiating EMR as it relates to efficiency, cost savings, reduction in medical errors, and improved treatment of chronic diseases. The cost of implementation could be recouped in a short span. Potential benefit is the operative word as the assumption is made that the EMR system would be widely used and interconnected. It goes on to state other barriers to implementation, such as disruptive effects on practices. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess3 Electronic medical records not seen as a cure-all. October 25, 2009. The Washington Post <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">This article essentially states that all that glitters is not gold. Outlines some of the drawbacks of EMR including, decreased physician productivity, decreased efficiency, and the fact that hospitals are not required to report problems since EMR is not a medical device. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess4

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">Proposed rules set stage for e-health records incentives. January 4, 2010. Federal Computer Week. [] This small article touches briefly on what the Health and Human Services Department defines as “meaningful use” to qualify for incentive payments. For physicians this most centers on electronic order writing and for hospitals, it center mostly on the collection of patient data. This is initial criteria as it is expected to become more stringent in 2011, 2013, and 2015. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess5 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Can Electronic Medical Records be Secured? December 5, 2009. Information Week. [] This article brings to light some of the security issues presented by EMR. Making sure that EMR’s are secure is a challenging task. Also brings to light the concept of medical identity theft where a criminal will steal an identity in order to get medical treatments. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess6 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

State privacy laws may undercut electronic medical records. April 14, 2009. Ars Technica. [] This article discusses how state privacy laws may be impeding the implementation of EMR. The two goals of privacy and security of records are at times at odds with free interchange of data among providers. The public remains with significant concerns about EMR and its ability to keep patient information private. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess7 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> A Buyer’s Guide to Medical Software: Electronic Medical Records Software Systems. Nd. Software Advice. [] Interesting website that unintentionally highlights the problem with EMR, there are too many of them. Gives several examples of EMR systems and offers price quotes. The site highlights various EMR systems that are tailored to specific specialties. What is lost is whether any of these systems can communicate with each other, which is the point of going “paperless.” <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess8 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> An Affordable Fix for Modernizing Medical Records. April 30, 2009. The Wall Street Journal. [] makes the case for using an open-source, free software system for EMR that already exist: the VA system. This could serve as a cheap way to establish EMR and eventually EHR. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess9

Electronic medical records: Extra payments designed to get more doctors on board. January 7, 2010. Chicagotribune.com. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] h <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">ighlights the fact that physicians can receive more than $40,000 in Medicare payments over five years beginning in 2011 to implement an electronic health record system. Also shows that some companies are offering interest free loans if their EMR product is chosen. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess10

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> 6 Ways Electronic Medical Records Could Make Your Life Safer and Easier. March 10, 2009. US News and World Reports. [] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">The article outlines 6 ways electronic medical records improve a person’s life, written for the lay person. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess11 Online Health Data in Remission. February 16, 2009. The Washington Post. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">This article discusses some of the various reasons impeding the implementation of EMR. Congress has prescribed $19 billion in its current economic stimulus with the goal of creating an EHR for every American by 2014. However, the cost will be much more, and without any standard for data collection and management, those in healthcare are reluctant to purchase available systems out of fear they may not meet the yet to be announced standards. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess12 How to Make Electronic Medical Records a Reality. March 1, 2009. The New York Times. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">This article’s title is a misnomer as it does not discuss how to make EMR a reality. It simple states that money is line to help in its implementation but it will be a difficult process. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess13 Obama’s big idea: Digital health records. January 12, 2009. CNNMoney.com. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> This article looks beyond the concerns of the money it will take to implement the system. States that electronic medical records could work, but the country suffers from a lack of skilled workers need to build an implement the technology. Also, there exists a lack of IT professionals trained in EMR. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">jess14

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">For the most current information on governmental initiatives is the HHS site on Health IT. This web site is Health and Human Services governmental web address on health information technology and the future of healthcare as defined by the government. [] <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">dew1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

The Health and Human Services governmental web site on meaningful use as defined in the American Recovery and Reinvestment Act of 2009 is located at: [] <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">dew2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

For the Health and Human Services governmental web site on HITECH, the Health Information Technology for Economic and Clinical Health (HITECH) Act, this information is located at: [] <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">dew3 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

The Health and Human Services governmental web site on standards and certification issued what is currently known as the Interim Final Rule (IFR) on the initial set of standards, implementation specifications, and certification criteria on December 30, 2009. This information can be found at: [] The HHS site will be important to visit in the future as any of the rules for meaningful use and criteria are refined or changed both for ambulatory and hospital based EMR systems. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">dew4 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

[] This site and this specific article provides an overview of “financial rewards of implementing an EMR”. It makes the case for capturing potential missed revenue by under coding by physicians. josgab1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> [] This is a vendor site providing “solutions” to physicians once again touting the benefits of EMR where costs are saved by eliminating the unprofitable space used to keep charts, which is eliminated by going completely paperless. josgab2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> [] This is a comprehensive site dealing with the two interconnected issues at hand, the Electronic Medical Record and the laws dealing with patient confidentiality as well as privacy issues in this digital age. There are other articles dealing with other issues. josgab3 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> [] This article deals with the dangers of EMR when a not carefully thought out implementation is done. It provides a case study where there was a failure in the design of the EMR, which did not lead to meaningful information exchange between the physicians. josgab4 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> [] This article in the NY Times provides a summary of the potential benefits of using an EMR and the possible reasons for the slow adoption and implementation. josgab5

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] : this site is for Standard Register, a document management company, that has been involved from many angles in transitioning to electronic records. The scenarios of historical norms particularly with regards to large investments that are then abandoned with potential benefits never being realized are important lessons to learn. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">mibu1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

[] : a great medscape article on transition, need for uniformity within a group or system and legal pitfalls to implementation of emr. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">mibu2

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">[] <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> A story that's not going to sell EMRs. ACP Internist, Jan. 15, 2009. This article points out some recently discovered problems in the VistA system. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">tpan1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> Key Flaws with CCHIT Criteria. Industry News. Oct. 22, 2009 [] <span style="color: #000000; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> This article highlights the concerns of the American Academy of Professional Coders regarding CCHIT credentialing. Although this gets into the level of the world of coding, it does highlight several potential problems which may be encountered concerning the interface of EMRs and procedural coding. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">tpan2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

[] The link provide the news release from CMS and ONC issuing regulations proposing a definition of “meaningful use” and setting standards for electronic health record (EHR) incentive program. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">garg1 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;">

[] This fact sheet provides the proposed definition of “meaningful use” of EHR by CMS. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">garg2 <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 150%;"> [] This detailed document list the 3 stages of meaningful use and also enumerate the criteria for all the stages that need to be meet by EPs and eligible hospitals. <span style="color: #bfbfbf; font-family: 'Arial','sans-serif'; font-size: 8pt; line-height: 150%;">garg3