EMR Vendors

One of the major concerns in the healthcare industry concerns patients who find themselves far away from home, rendered unconscious and unable to relate any prior medical issues. These issues can be as critical as drug allergies or related medical concerns. The chances are that the attending physician would not have instant, direct access to that patient’s medical files that would contain this pertinent information. The end result could possibly lead to further medical complications and even death.

However, news of several EMR providers banding together in order to exchange data have created a solution that is designed to be a blueprint of the solution. Recently, five major electronic medical records providers have linked together in order to create a non-profit organization which directly addresses this issue. The organization is called the CommonWell Health Alliance. This new enterprise is currently engaged in creating a common software standard that would allow the different facilities to easily share medical information by moving a patient’s medical records in a manner that would allow any physician to access relevant health record information. The only requirement, with this new system in place, is that the patient has consented to sharing their health record information.

This new alliance will consist of the following EMR facilities; McKesson – which is based in San Francisco, Cerner – which is located in Kansas City, MO, Allscripts Health Solutions – based in Chicago, Athenahealth – of Watertown, Massachusetts and Greenway Medical Technologiesin Carrollton, Georgia. However, noticeably absent from the list is Epic Systems, located in Verona, Wisconsin. Epic Systems is noted for establishing EMR systems for many major academic hospitals in the US.

One thing that has been noted by John Halamka, Chief Information Officer of Beth Israel Deaconness Medical Center in Boston, is the reason for this initiative. Halamka states that this non-profit organization is not founded in the business goal of either McKesson or Cerner, for example, but as a desire to further new technology. Halamka has pointed out that the true goal has to do with “raise the tide” for all involved, thus establishing a new standard in health care.

The new CommonWell Alliance actually has roots that extend to other, similar collaborations that have moved towards creating a nation-wide industry standard for EMR. Besides facilitating the effectiveness of providing health care, there is also another reason why EMR has been given additional attention, since 2009. A government stimulus package has provided incentives for initiating EMR installations.

While hospitals and medical facilities, throughout the United States, are making the move to incorporate electronic medical records (EMR) into their procedures, the city of Austin’s Fire Department (AFD) has recently decided to join them. The City Council has reviewed and approved a “wellness tracking system” that will allow the AFD to have a system that utilizes EMR technology.

Division Chief Tom Dodds has stated that the department’s Wellness Clinic needs to be able to keep up with the times when it comes to the health concerns of its firefighters. This will enable them to perform better in their occupations. This will occur through the ability to study and accurately track those health concerns. The proposed cost of the new system is $83,000 for the first year and $53,000 for the second year.

Chief Dodds has also pointed out that the record keeping will now be automated, which will eliminate the need for additional personnel to be hired in order to perform data analysis and record keeping. It’s been noted that a Wellness Center is something that is relatively rare throughout the country’s fire departments. The Austin center allows access to medical professionals for the city’s 1,100 firefighters.

One of the primary reasons for access to doctors and other medical personnel is for the ability to undergo an annual physical. The physical is a department requirement that has, in the past, proven to be exceptionally helpful. This was the case with Battalion Chief Duke Turpin.

Chief Turpin has indicated that, initially, he felt no adverse symptoms, but was feeling a bit lethargic and sluggish. He had attributed this to the effects of becoming older, lack of exercise and work-related stress. However, physicians detected a blockage in a coronary artery. This is a key health concern that he is happy to have recorded in an EMR. This way, should an on-the-job injury occur, the EMR would be sent directly to the emergency room, where it would directly influence the type of treatment that he would receive.

The Fire Department’s Medical Director, Dr. Paul Parrish, has pointed out that data would be able to be compared across the nation and just locally. This would be done through the “International Association of Firefighters”. The collection of data will facilitate the intervention of injury and illness through the tracking of the effectiveness of the department’s medical care.

The Austin Wellness Center opened in 2006 and features injury rehabilitation care as well as a complete gym.

In the early part of this month, a day-long meeting that involved over 400 employees was held at the Frontier Airlines Center in order to plan for a project that will cost over $120 million to be spent over a five year period. This project involves a conversion to an electronic medical records system, known as EMR. The Milwaukee area Children’s Hospital is slated to be the final health system to make the transition from paper records to electronic records. Needless to say, this changeover will be massive as well as complex. The entire Milwaukee health systems facilities will be spending in excess of half a billion dollars for the entire system to transition from paper to electronic records.

However, this is expected to provide an effective tool when it comes to tracking and improving the quality of health care. When used correctly, EMR assists greatly with coordination within the health care system. This allows doctors, and other health care professionals, to more easily manage chronic disease patients which include asthma and diabetes. This can also allow health care professionals to follow standardized clinical guidelines that will lessen variations in the type of medical care that the patients will receive. It is expected that the new system will be online by late 2012 or early 2013.

The Milwaukee Children’s Hospital is the fourth Milwaukee area system that has opted for Epic Systems Corp. software. Epic Systems is located in Verona, which is just outside Madison. It is one of the most successful companies in the state of Wisconsin and, as such, has become one of the dominant EMR competitors. Epic Systems recorded $825 million in revenue, which was a significant increase from $650 million recorded in 2009 and $47 million recorded in 2000. 5,100 people are employed by Epic, as opposed to 396 employed in 2000.

In this era, when most companies are located throughout the country, nearly all of Epic’s employees are located in its Verona campus, which constitutes 811 acres. The payroll for this year has been estimated at $407 million. Cerner Corp., based in N. Kansas, Mo., and Epic are the dominating companies when it comes to large, integrated systems for health care. However, Epic has emerged as the leader of the two. Epic has won 61% of new hospital contracts that comprise facilities that have over 200 beds, last year, as reported by the director of analysis at KLAS, Taylor Davis. KLAS is a research company known for customer surveys in the industry.

“Sepsis” is a medical condition that relates to a severe, and often deadly, inflammation response to microbes (such as bacteria) and, on the average, will cost the United States about $14.5 billion each year. This is according to the U.S. Centers for Disease Control and Prevention. There have been a number of initiatives that have been put into place in order to lower that figure, by the University of Kansas Hospital (KUMed). These initiatives have resulted, on the average, in a total savings of over $18 million per year, or roughly $18,000 for each patient.

However, the KUMed is working towards taking this success to the next level by using an identification tool known as “CareVeillance”. This is a tool that will reproduce the patient’s information from a EMR (electronic medical record) while monitoring that patient in a real-time environment in order to detect that particular complication.

The senior principal at the CSC Health Delivery Group, Bryan Eckert, stated in a recent interview that the CareVeillance system will include algorithms and workflows that are customized to provide alerts and overall system awareness of this condition. The system then activates an automatic risk assessment that detects early warning signs that are often contained within the electronic medical records.

Several years ago, KUMed was identified by CareVeillance as the beginning point to be used to test the system. By working together, the goal has been to successfully and aggressively work at lowering the toll of sepsis on patients and the economic strains that sepsis can cause. KUMed initially viewed patient lists that indicated those who were at-risk, towards the latter part of the second quarter of last year.

Eckert pointed out that KUMed made sure to take the time needed in order to roll out the procedures correctly and that level of care has resulted in the successful employment of CareVeillance for approximately six months. Initially, in 2005, KUMed began its initiative to reduce sepsis and witnessed a drop from 49% to 22% sepsis mortality rate within the last seven years. Now, by introducing CareVeillance, the new plan is seen as a way to further reduce the sepsis mortality as stated in an interview by the acting division chief and professor of medicine, Steve Simpson, MD.

Simpson, along with his team, are currently comparing the sepsis mortality rates before and after the implementation of CareVeillance. Overall, they are reporting at least a half-hour difference when it comes to identifying an incidence of sepsis through the use of this tool. Because of this, by giving the proper antibiotics to treat sepsis, within that half-hour, has changed the mortality rate from 80% to 20%.

It had been recently indicated the Southeast Missouri region was lagging behind the rest of the state when it came to implementing their electronic medical records (EMR). This was stated by the Missouri Hospital Association; however the hospitals, themselves, have countered that statement by saying that they are, indeed, making progress.

It was shown that hospitals in Sikeston, Perryville and Cape Girardeau averaged higher than the state and regional average when it came to compliance with 24-key electronic medical records functions, which are included in the federal government health care reform. Incentive payments are awarded by the Health Information Technology for Economic and Clinical Health Act, through Medicaid and Medicare. These incentive payments are given as a result of the adoption of specific EMR technology and its use to accomplish specific objectives.

The numbers that were pointed out indicated that 9.4 out of 24 core EMR functions are being used by the 19 hospitals surveyed in Southeast Missouri. These functions are divided into four groups that include; decision support, computerized provider order entry and electronic clinical documentation. All four of the area hospitals have recently invested their funds in new EMR software systems along with new servers, new computers and other IT equipment.

Notable achievements include Perry County Memorial Hospital, located in Perryville, Missouri, which is currently utilizing 23 out of the 24 functions. Southeast Hospital is using 20 out of the 24 functions, Saint Francis Hospital is using 16 out of the 24 and Missouri Delta Hospital in Sikeston is using 12 out of the 24. This is being compared to the average among Missouri Hospitals, which constitutes 13.4 out of the 24 functions. These numbers are reported by the Missouri Hospital Association.

The most challenging functions to implement, according to the hospitals, are computerized physician order entries (CPOE), which include; medications, nursing orders, consultation requests, radiology requests and laboratory workup requests.

The director of American Recovery and Reinvestment Act, Aaron Spratt, stated that CPOE is the most complicated function, since it involves many different people, processes and departments. Spratt’s program is being implemented at the Saint Francis Medical Center.

The spokesperson for Perry County Memorial Hospital, Jessica Kraus, stated that the same CPOE challenge existed in her facility, as well. She pointed out that her facility has responded by employing additional staff, along with investing in additional programs and equipment.  In addition, resources and time have been focused in order to get the physician offices using the function as well as training the doctors.

The State of Massachusetts has been awarded a total of $16.9M (federal funds) in order to create a system that is designed to exchange information whereby patient’s medical records can be securely shared. The announcement was made by the Patrick Administration.

This makes Massachusetts the first state in the US that will receive government funding for this type of exchange. This will be done through the Centers for Medicare and Medicaid Services. An agreement was reached in February, 2012 however the actual contract was signed in the summer of 2012.

The awarded amount of $16.9M is to go towards Phase One of that planned exchange. This will be supported by Orion Health North America, which was the winner of the bid. This project is currently expected to go live in the fall. This phase will create a management team and a operations staff and governance infrastructure. That infrastructure, operations staff and management team will be developing the exchange infrastructure. Two more phases are scheduled to follow.

This exchange will facilitate the exchange of information between patients, insurance companies and hospital facilities. This information will be transferred over a state-wide secure network – according to the Patrick administration. The healthcare cost containment bill, which was recently passed, includes the health information exchanges and is planned to be signed by Governor Deval Patrick.

Gov. Patrick has stated that the technology will support goals that are related to providing high quality healthcare while, in addition, slowing down cost growth. The governor also thanked the Obama Administration for its support, since the healthcare industry is such an important part of the state’s economy.

A combination of American Recovery and Medicaid funds were used by the federal agency – along with Reinvestment Act funding. $19 billion (HIECH money) was included in the 2009 stimulus package for backing the electronic medical records projects.

One of the primary advantages of the EMR projects is the ability to electronically transmit and store patient’s medical records. These records can be securely transmitted over a network to a physician in any part of the state of Massachusetts. This, in effect, gives a doctor access to a patient’s records, even in cases, where the doctor had never seen the patient previously.

The Secretary of Health and Human Services, Judy Ann Bigby, said, in a statement, that the exchange will create a “backbone” that will connect every healthcare payer, patient and provider throughout the state by utilizing a single technology.

It’s been said that portable electronic medical records (EMR) reduce errors in medical recording – which serves to improve patient safety. The new EMR system at Catskill Regional Medical Center in Harris has recently gone live. After preparation and training for a year, the launch of the system commenced on Saturday, June 30^th, 2012. At the Harris campus and Grover M. Hermann Hospital in Callicoon, physicians and nurses will begin the input of patient’s information into portable EMR workstations. The expectation, from hospital officials, is that the new system will reduce operating costs while cutting down on medication and medical errors, which increases patient safety levels.

CEO for the Catskill Medical Center, Fred Huriger, has stated that the new system represents a “great technological advancement” for both the medical center and for the general community. He also stated that the new system will provide a seamless and safe environment for the entire medical care system. This will ensure the best outcomes possible. This switch to EMR by Catskill Medical comes approximately 15 months after Orange Regional Medical Center began using its own EMR system. The changeover is costing the hospital $12 million with some of the cost covered by federal government stimulus funds.

The backbone of the new EMR system consists of portable wheeled workstations. The workstations will be used by the medical staff to create electronic medical charts for their patients. Then the records can be accessed at any time and at any location all throughout the hospital. Doctors will also be able electronically transmit patients’ prescriptions to their pharmacies. The chief information officer for the Greater Hudson Valley Health system, John Lynch, has stated that electronic health records will allow access to the correct information for the right patient, in the correct format in real time, all of the time. This will lead to more efficient patient care from medical providers.

On Saturday, June 30^th, the command center will be operative in order to respond to any questions regarding the new EMR system and also to address any glitches that may arise. According to Catskill Regional’s director of marketing and public relations, J.P. McGuirk, the command center will be open for at least a week, around the clock. He cautioned that during that time, the staff may take a bit longer than what is expected in order to input information, as they become used to the new system. At the same time, however, the new system has been greeted with positive reviews and high expectations.

University of Notre Dame’s assistant professor of management at the Mendoza College of Business, Corey Angst, is an expert on Health IT. He has pointed out that the “policy makers” are doing more than just “insisting on EMR”. They are actually listening and making sure that the technology is being used in a meaningful way. This means that the technology is being adapted to report and measure the specific pieces of information that doctors and hospitals will need in order to qualify for government incentives. Angst specializes in conducting research on IT technology usage, its value and its transformational effect.

He has also stated his belief that a standardized set of processes for EMR will not only increase its efficiency, but will also diminish the potential for errors in the medical industry. He says that there are still barriers to overcome, however. In his opinion, the biggest obstacle is convincing physicians that EMR is a worthwhile pursuit. It’s been observed that some doctors have embraced the new technology, but others have resisted. The primary complaint stems from the perception that EMRs are less than intuitive. In addition, they have complained that the EMR technology doesn’t blend well with the workflow that they prefer and, in general, is “slow and difficult to use”.

Another concern has to do with privacy. Some individuals and small, but vocal, anti-EMR groups have expressed concern that the EMR system’s security could be compromised. Their argument is that by digitizing patient records, it becomes easier for others to access that information. Angst has pointed out that while these are valid concerns, the ultimate benefits far outweigh the potential negatives. Angst states that he believes that it’s “fantastic” that the U.S. Olympic Committee has decided to finally go digital. He stated that it would be unimaginable how much effort it would take to maintain paper records for those athletes. He believes that EMR is extremely important to the network of physicians who treat the athletes as well as providing medical record information to the athletes, themselves.

This type of recording is also important when it comes to claims of “doping” in the sports world. With EMR, unlike paper records, there is a record of who accessed an athlete’s medical records and when. This type of blood test and prescription data tracking is nearly impossible with standard paper records, today. This is just one more reason why EMR can be very valuable to the world of sports as well as to the general medical community.

Currently in Toronto, Canada the supporting clinicians are integrating electronic medical records technology into their patient care. This is the objective of a relatively new initiative by “Registered Nurses’ Association of Ontario” (OntarioMD). For this initiative, it has been recorded that approximately 5,000 providers of healthcare have requested to make this move in just the last two years. The president and CEO of Health Infoway, Richard Alvarez, has pointed out that the electronic medical records systems (EMR) has attracted large numbers of providers. They are also using peers, that have already made the transition, as resources in order to answer questions and give practical advice while providing support and leadership.

Infoway has adopted, as part of their strategy, a way to connect pharmacists, doctors and nurses. Their “Peer Leader Support Network” has enabled peer leaders, with experience in EMR, to work more closely with their fellow health care providers when achieving better clinical value through process changes and practice both during and after they have adopted EMR technology. Their project encourages mentorship and support for about 21,000 family doctors, nurse practitioners, clinical managers and other specialists when it comes to learning how to use EMR technology in Ontario. Alvarez also applauded Canada Health Infoway for their support in this important collaboration.

Canada Health Infoway is a non-profit, independent organization that is sponsored monetarily by Canada’s federal government. Infoway has jointly invested with each Canadian territory and province when it comes to accelerating the adoption and subsequent development of projects that deal with communication technology. They are also adamant about protecting the privacy of patients by ensuring that the systems are secure while providing doctors, as well as patients, with the information that is needed to enhance healthcare. This is accomplished by assisting with proper care decisions and the management of the patient’s own health.

OntarioMD is part of the Ontario Medical Association and serves as a wholly owned subsidiary. It is funded by eHealth Ontario and its purpose is to provide the leverage needed, in the healthcare industry’s information technology, when it comes to meeting the ever-growing needs of doctors and patients. They also manage the EMR Adoption Program of Ontario which supports doctors while they are in the process of transitioning from their paper records to EMR. Doctors will apply for consideration for funding while selecting an EMR in order to optimize patient care. Once funded and set up with EMR, they can then manage the benefits that EMR technology provides.

Having the correct information, when it comes to a patient’s health care can actually be the difference between life and death. This is especially true in an emergency situation since this is a time when physicians and nursing personnel have to make quick decisions regarding the way to immediately deal with a crisis situation. A quick evaluation of the patient’s symptoms in conjunction with a past medical history is crucial. However, there has been a steady increase in the use of Electronic Medical Records (EMRs) when it comes to retrieving a patient’s medical history. This allows health care providers to interact with one another and with the patient’s themselves when the crisis has passed.

Ryan Howard, the CEO and founder of a major EMR technology company, Practice Fusion, is adamant about discussing the way that EMR technology is making changes to the healthcare industry. He points out that his company currently has 150,000 providers with an estimated 34 million patients benefiting from their technology. This equates to about ten percent of the entire population of the United States. This averages out to about 70,000 patients each day. The company’s free solution is web-based and is designed to assist physicians to run their offices. This includes writing prescriptions and scheduling appointments.

According to Howard, this reduces the potential for human mistakes. He pointed out that, over the course of a lifetime, a patient will see 18 doctors, on the average. This means that a lot of time is spent on explaining and re-explaining medical conditions and past medical issues. This is highly inefficient and can leave a lot of room for omissions and an incorrect diagnosis. This also means that you may not get the required healthcare or the wrong prescription may be given. It all boils down to the doctor not having the right information or having information in a timely manner. This is especially true in cases where a patient has relocated to another area. If the patient doesn’t hand carry their health records, they have to be sent for.

When asked what’s next for Power Fusion, Howard stated that once a robust platform has been built, a “walled garden” environment will be constructed that will be private and secure. This will allow patients to interact and connect around specific conditions that they share. An example of this would be diabetic patients interacting with each other, specialists and physicians in a secure environment designed to treat and manage their symptoms.