EMR Vendors

Nightingale Informatix Corporation, which is an application service provider of EMR software (Electronic Medical Records) along with related services has just disclosed that during its 3^rd quarter it will provide 190 seats of its on-demand EMR services to various healthcare facilities. In terms of definition, a “seat” is defined as an one healthcare provider that is paying for Nightingale’s EMR service. These seats will be provide to provided to facilities throughout the U.S. and Canada. For example, one facility that is being included within the 190 is a large Ontario Cardiology practice. Another is an upstate New York specialized care center.

President and CEO of Nightingale, Sam Chebib, stated that he was pleased with the current success regarding the addition of Nightingale’s new EMR customers and that the company wished to expand its presence in North America. He also stated that he believed that there was growth potential for the future for Nightingale’s EMR services. He pointed out that the company had achieved certifications throughout Canada, which have included: Ontario, Nova Scotia, Saskatchewan and others. It was also stated that Nightingale’s EMR services is expected to obtain a meaningful use certification from the U.S. Office of the National Coordinator (ONC).

Some of Nightingale’s successes with signing on new clients have come from the Ontario clinics which are supported through implementation funding from Ontario’s OntarioMD EMR program. Nightingale has experienced a growth in sales, due to a greater awareness of the available funding that is currently available to specialists in the Ontario area. These specialties are wide-ranging and include internal medicine, cardiology, orthopedic surgery, neurology, nephrology and others. The key to Nightingale’s success with obtaining their contracts is the flexibility of the “Nightingale On Demand” services when it comes to meeting the various individual needs of these differing specialties and medical care services.

The Nightingale corporation is currently one the swiftest growing services in the North American healthcare software industry. It is also recognized as a Web-based (ASP) clinician leader as well as a leader in community based EMR services that tend to the needs of smaller healthcare practices, outpatient clinics that employ multiple physicians and large scale networked and regional healthcare organizations. Nightingale offers a comprehensive set of services that also entail integrated practice management, revenue cycle managing and transcription management. These services allow their customers to enhance patient care while increasing their revenue potential and fully optimizing their operations.

Over a number of years, there have been failed attempts to bring electronic medical records (EMR) to the forefront of the medical profession. However, this may be changing in the near future. A new initiative known as “Direct Project” was just announced by David Blumenthal, who is an IT Coordinator for National Health. Blumenthal, along with Aneesh Chopra, Chief U.S. Technology Officer, and other agents for government health care are involved in the project, along with various IT health vendors.

This initiative will involve the use of a standardized protocol that will allow hospitals, physicians and other medical providers to communicate patient medical information without having to resort to proprietary communication protocols. The information that can be shared will include: laboratory results, summary documentation, medical referrals and various other related medical information. This will also allow medical professionals to upload data directly to patient health records. This data network is designed to be compatible with the data transference protocol of the National Health Information Network. However the design for the Direct Project was undertaken by a private/public collaborative effort. This design had been placed under the Office of the National Health IT Coordinator’s leadership.

The HITECH Act was also partly responsible, since it is designed to offer various initiatives to those health care providers that are able to demonstrate a “meaningful use” of their EHRs. The term “meaningful use” refers to the ability to effectively communicate between health care professionals by using their EHR systems. This definition also includes the ability to provide a patient with a health care summary, as well. The technology behind the Direct Project will make this possible by using a secure messaging system which will send a patient an attachment in much the same way as one would send an email. This will keep patients informed and up to date regarding their medical care procedures.

However, the ultimate goal that the Direct Project is focused on is the ability to exchange medical data between providers. This is especially critical in cases where providers and hospitals may be located in outlying areas or in cases of independent physician providers.

It is understood, though that the road to effective EHRs is still a long one. There need to be more technological advances in order to make the communication process a seamless one. However, the advent of the Direct Project is a major step in the right direction towards this universal health care communication.

Looking over the news regarding the medical industry, one can see a tremendous amount of hope being placed on the abilities of electronic medical records (EMR). Besides increased patient care, that hope revolves around EMR technology’s ability to bail out the U.S. in terms of its current health care woes. The improved cost effectiveness and increased efficiency, along with better patient health outcomes, form the basis of those hopes. To this end, an estimated $30 billion is being utilized, through federal funding, to make EMR a standard in the health care industry. The main issue, however, is whether or not all of the beneficial claims for EMR will translate into reality, once it’s implemented.

Recently, UK researchers concluded a review of EMR evidence that supports EMR technology along with several additional forms of electronic health technology. That review was published in PLoS Medicine, an online medical journal. The findings are based on approximately 43,000 citations that were narrowed down to 53 published reviews. The final reviews that were cited were obtained through a stringent criteria application. In addition, there were another 55 reviews that were able to provide an additional level of context that assisted with the general overall interpretation.

Among the findings of this report, it was concluded that the evidence of an overall bailout are not completely substantiated, however localized benefits are predicted. In addition, it was also stated that to understand all of the benefits of EMR, one must understand the process analysis behind it. In this case, that process analysis will involve a mathematical approach for mapping, measuring and, of course, analyzing the results. This will allow the analysis to determine any bottlenecks and to supply the true capacity of any EMR system. The problem is that health care is not always easy to quantify. Unlike manufacturing output levels, better health care can take many years to understand any overall ramifications in changes that are made. So the questions, in regard to health reform, will include just where EMR adoption fits in.

At this point, it may boil down to an analysis that includes extremely valuable data such as time stamp notations on EMR communications. This will allow the ability to truly gauge future efficiency in the real world. But this also means that the institution of EMR doesn’t mean that hospitals and other medical services can stop striving to increase the streamlining and hone the efficiency of patient care.

Northwestern Ontario is focusing on getting more of their patients connected to the region’s network of electronic medical records (EMR). Physicians point out that this will be a far more effective and efficient way of treating their patients. This view is also shared by the region’s Local Health Integration Network and the province, in general.

The advent of the Physician Office Integration program translates into over 150,000 patient records that will travel with them throughout Northwestern Ontario. These records will be directly fed from the 12 hospital in that area to over 25 local clinics. This system will be represented by 168 doctors and nurse practitioners.

The CEO and president of eHealth Ontario, Greg Reed stated that healthcare-related software integration was nearly impossible until recent times. Once this limitation was overcome, a patient could have a test performed in a hospital and get the results immediately at a doctor’s office. “It’s a huge convenience”, Reed says.

He also added that this system will cut down on the past delays that patients experienced when attempting to make appointments with specialists. Reed also pointed out that approximately one-third of specialist appointments occur prior to specialist obtaining the necessary test results to show up. In some cases, it can take up to three weeks for those results to appear.

Theresa Bruni, an Ontario pediatrician, indicated a 5,000 stack of paper items that would be needed to be addressed each year under their old system of patient record keeping. She points out that secured EMR systems are the expected evolution in patient care. This is especially true considering the vastness of Northwestern Ontario.

She states that even though many patients are from the outlying regions, their records are arriving as quickly as those generated by Thunder Bay Regional. She also notes that another advantage to treatment is the ability to quickly spot abnormal patient test results. The original problem had to do with patients who are seen in their local community hospitals with no direct communication access to the major institution. This has changed, since patient lab and blood work are able to be accessed instantaneously. This eliminates the need to having paper records sent from another hospital, reviewed and then placed in the patient’s chart.

The statistics speak for themselves. According to eHealth Ontario, each month 21,000 reports are sent through the system by the Physician Office Integration Program (which went “live” this fall). This effectively eliminated 1,100 clinical administrative work hours (scanning, filing and records distribution).

Around the state of Connecticut, 25 doctor’s offices will obtain assistance with further implementing EMR technology. The $100,000 grant for EMR deployment will help the physician’s offices qualify for national accreditation as patient-centered medical homes. This announcement was made by the Connecticut State Medical Society.

The medical society’s grant was received from The Physician’s Foundation. The Physician’s Foundation is a national organization that will also administer funds from the grant. A press release from the medical society has indicated that the 25 doctor’s offices will, by and large, be primary care givers. The medical society has also reported that the 25 doctor’s offices have yet to be chosen.

The grant is designed to help those physicians, who are currently using EMR technology, achieve recognition for the National Committee for Quality Assurance. The project, itself, is being coordinated with the Connecticut Quality Improvement Organization and the Connecticut State Medical Society Independent Practice Association.

The goal of the grant is to fund assistance for a program designed to lower costs while increasing the overall quality of health care. Others benefit expected to be derived from the program are a reduction in ethnic and racial disparities when it comes to heath care availability and overall access. This grant is also in response to a study that was released earlier by the medical society. That study illustrated the disadvantages incurred by smaller medical practices when trying to fully integrate EMR technology.

Lou Goodman, president of the Physician’s Foundation, stated that the Foundation has recognized the EMR technology is critical to the improvement of health care quality in the coming years. He also stated that the Foundation is interested in finding practical solutions that can be used repeatedly to eliminate barriers to EMR adoption. Additionally, standards need to be instituted and methods developed in order to ensure compliance.

It should be noted that the Connecticut State Medical Society is the largest physician organization in the state. Its members exceed seven thousand doctors and medical students.

Dr. David S. Katz, president of the society, has pointed out that medical care in Connecticut is predominantly given by doctors in small or solo office practices. He has also said that it is up to the Society to provide support and training that will be needed to be a part of the Connecticut’s medical model of care. If this is accomplished, it may pave the way for assisting small practices across the nation.

$23 billion dollars has been allocated by the President Obama’s stimulus package for the creation of a national electronic medical record for every American by the year 2014. This target date was originally set down by the previous administration. The electronic medical records (aka electronic health record) will contain a recorded history of allergies, medications, lab test findings and notes on medical procedures.

This will require a huge cooperative effort on the part of the government, privates industry and providers of health care.

Vincent Ciotti, who has worked in the healthcare information system for over 35 years stated, “While President Obama is to be applauded for his interest and attempts to move this standard along, but the difficulties will lie within determining procedures. This is not as simple as handing everyone their EMR. Case in point, this was advocated back when Bush was president.”

But providers have already figured out a way to proceed in Westchester and Rockland New York counties.

An example of this can be seen at Nyack Hospital, which is a 375-bed facility. That hospital is already poised to bring part of their EMR online in January of 2011. In addition, the Westmed Medical Group, located in White Plains, NY, has been using EMR technology for a number of years. Their medical director, Dr. Barney Newman, noted that the Group began with 20 records department employees. Currently, even with a growth of three times their original practice, they’re able to keep their record’s staff down to 6-8 people.

Dr. Newman has estimated that the practice has generated over 300,000 electronic medical records while still maintaining a high level of efficiency. The Group, as an early implementer of EMR technology, worked closely in conjunction with its vendor, GE. In this way, suggestions were made to develop improvements that fit their practice and enhanced the manufacture’s product.

At this time, there are four different types of EMRs offered: those offered by those who reimburse health care (insurance companies, etc.), those offered by providers of health care, employer sponsored and those offered by various commercial enterprises (GE, Google, Microsoft and McKesson).

John Volanto, Nyack Hospital’s chief information officer, has pointed out that McKesson’s EMR solution is designed for hospitals that have limited IT staff – such as community hospitals. Volanto has stated that he expects that the McKesson system will move medical documentation from paper to medical data sharing, documenting and managing through their comprehensive EMR solution.

A $3 million grant has been recently awarded to the Golden Valley Health Centers in order to assist the implementation of their electronic medical records system. The EMR system is expected to be in place by early next year. The results anticipated include a decrease in medical errors.
The grant was announced in June and Golden Valley was a leading agency for that grant. The EMR grant was provided by American Recovery and Reinvestment Act and included five additional health centers located in the Central Valley. The funded project is being headed by Golden Valley’s chief information officer, Ray Parris. At this juncture, various EMR software solutions are being evaluated, according to Parris.

Evaluating EMR Software

The criteria that is being used to evaluate potential software for EMR implementation is based on company track records in both the state of California and the medical field. The chosen company will also need to be well-established. This is due to the fact that, currently, there are more vendors than can be supported in the long-term. The aim of the project is to have a software vendor that will still be in business five years from now.

It’s been acknowledged that the adoption of an EMR system will not be quick or simple. However, the end results will be well worth the effort when considering the reduction in medical errors. This is because the current paper system is too slow and can be subject to medical mistakes, according to Parris.

Once the EMR provider companies are reviewed, a proposal request will be initiated. The actual EMR system should begin construction in February or March of 2011.

Potential EMR Issues

Other healthcare agencies are addressing issues with the implementation of their own systems. California Healthline, a provider of a daily opinion, policy and news digest, has reported problems with the EMR implementation at the San Francisco Dept. of Public Health. These issues may include document loss relating to millions of dollars worth of services.

Successful EMR Pilot Program

A pilot EMR program was originally started in Golden Valley over two years ago at five different clinics. Parris pointed out that the pilot program, “was successful”. “No information has been reported lost.” The same is true for Mercy Medical Center, located in Merced. The director of Health Information Management at Mercy, Loretta Stuart-Edgerton, stated that she is unaware of any negative issues related to EMR, since its implementation in May of 2009. At Mercy, 34 employees have been working on document encoding and no problems have been reported.

The AT&T corporation, the largest communications company in the U.S., recently announced that it is establishing a division that will target the health care industry. It is speculated that this recent move is designed to prepare the company for upcoming medical technology deployment. Specifically, this pertains to the nation’s adoption of the electronic medical records standard. Other upcoming medical technologies include wireless medical instruments, such as glucose monitors, and physician’s visits that are conducted through video-conferencing.

Modern technology is currently infused in a number of medical projects that include, for example, “intelligent” medicine bottle caps. These bottle caps are designed to send out an alret if the bottles have been opened. Here, the “smart caps” will send a message in the form of a text alert that goes through AT&T’s caregiver network. The information can assist the caregivers to remind a patient that they need to take their medicine.

More available opportunities

The new AT&T division, entitled “For Health” is on the lookout for more opportunities like the smart caps.

The head of AT&T Business Solutions, John Stankey, has stated that he believes that healthcare is at a crucial point in its history. He states that this influx of technological change will lead to overall better patient care and more positive health care outcomes. It is this type of change that is being spearheaded by technologies such as electronic medical records and electronic pharmacology.

The unusual aspect of AT&T’s approach to marketing their healthcare endeavors has to do with the way they are approaching the situation. All of the major telecom groups have incorporated various sales teams that are designed to individually target the big industry sectors. This, of course, includes healthcare. But it’s a different story when one of them decides to devote a large group that will actually integrate more than one product category. With AT&T, we’re looking at network, wireless, “cloud computing” and video-conferencing services. These services are run by AT&T under their computer and client applications, over the Internet.

Revenue opportunity and healthcare for its employees

Based in Dallas, Texas, AT&T has reported that their 2009 revenue was in excess of $4 billion just from healthcare sources. This includes hospital facilities, insurance providers, drug manufacturing and retail along with physicians. The analyst firm, IDC, has reported that the entire healthcare market for information technology is $34 billion for 2010.

But there is more to this picture than just additional revenue for AT&T. AT&T provides healthcare for approximately 12 million employees and their dependents. Cutting healthcare costs is also a major motivator.

A far-reaching management program for maintaining health-related information in conjunction with the latest technology can reduce health risks, according to a new study. This study has shed more light on the current progression of electronic medical record (EMR) technology that is fast becoming the standard in the health care industry.

This latest study was conducted by Kaiser Permanente Colorado and involved 628 individuals who were enrolled in their proposed disease management program. An additional group of 628 individuals acted as the control group while receiving standard medical care.

The study outcome

The outcome that was reported by Kaiser stated that the group that received the benefits of the intensive management program has an 88% overall reduction in mortality related to cardiac issues. The overall mortality reduction rate was 89% when compared to the group that was receiving standard medical care. This was stated in a new release published by Kaiser, earlier this week.

This program seeks to deliver treatment over a 3-6 month program that supports data that is in accordance with treatment results that are supported by EMR-based treatment factors. With this type of intensive care, patients are assigned to a personal nurse who is tasked with assisting the patient with making healthy lifestyle choices. Additionally, a personal clinical pharmacy professional is also assigned to the patient. This is required to manage the necessary medications that can assist in decreasing the risk of heart disease and its effects.

According to Kaiser:

Computer disease registry databases and electronic medical records are invaluable when coordinating medical care. These electronic tools, for example, can notify a pharmacist when a patient neglects to pick up their prescription. It can also indicate when a prescription change is needed – possibly due to a change in the patient’s cholesterol level. This form of data transmission will allow medical professionals to be more proactive in patient care as opposed to merely being reactive. In this manner, a clinical pharmacist can reach out and provide patient support.

The bottom line

With this new and more intensive approach to patient care, the majority of the care is provided by pharmacists and nurses who are working under the supervision and direction of a physician. Because of this, the average healthcare costs for a patient, who was receiving care under this program, averaged $60 a day less than for patients who received standard care. This adds up to about $21,000 a year in savings.

However, the biggest savings were in hospitalization costs. For the group receiving the intensive medical program, the average cost was $19 per day. For the standard care control group, it was $69 per day.

The U.S. Department of Health and Human Services has granted South Carolina $9.6 million in funding pertaining to the Health Information Technology (HIT). This was announced this past March and funding is geared towards technology such as electronic health records and E-prescribing.

To put it succinctly, the federal government want to digitize various aspects of the health care industry. One of the primary areas on the list has to do with Electronic Medical Records (EMR). The target date for this renovation has been set at 2014.

HHS Secretary Kathleen Sebelius stated that these investments in the health care industry will ultimately result in lower health care costs. This will be achieved through far less paperwork while assisting physicians in providing a higher standard of patient care through effective coordination. He pointed out that this course of action is not some far-flung futuristic concept, but rather a viable solution whose time has come. This can be seen in the fact that EMR is quickly becoming the national standard.

For many, the belief is that the old image of medical files sitting in cabinets and sporting different colored tabs will no longer exist. For the patient, as well as the physician, this will be a welcome evolution. In this way, managing patients with chronic illnesses will be far more reliable and cost-effective. In addition, patients who are not meeting the goals of their treatment can be more easily identified.

The bottom line is that health care will be more effective through our use of modern technology. Some of the advantages that will be seen are:

• Technologies that allow physicians to keep track of those patients who are high-risk.
• Flagging patients who are smokers and the initiating of a dialog to quit smoking.
• Prescription refills and appointment confirmation will be facilitated.
• Prescription changes can be expedited.

The primary concern is that HIT will continue to focus its attention on the quality of patient care while providing the necessary access to medical service that the patients need. This will require the cooperation, assistance and communication with medical insurance companies. Insurance companies and partner organizations must make the effort no to manipulate HIT processes in order to limit access to treatments and medications that doctors see fit to prescribe.

HIT systems have been designed to allow doctors to make scientifically sound decisions based on current medical data. At this moment in time, we find ourselves at the brink of a revolution in health care.