Electronic patient records may not save money, study finds; critics question methodology

Though officials tout otherwise, a study has found electronic health records do not cut costs "and may actually encourage doctors to order expensive tests more often," reports Steve Lohr for The New York Times. (Photo by Keith Srakocic for The Associated Press)

The study, published in the journal Health Affairs, found doctors using EHRs to track tests, such as X-rays and MRIs, ordered 40 percent more tests than those using paper-based records. Doctors with access to a patient's previous image via a computer "ordered tests on 18 percent of the visits, while those without the tracking technology ordered tests on 12.9 percent of visits," Lohr reports. And when it came to more expensive and advanced tests, like MRI and CT scans, doctors using EHRs ordered more tests 70 percent of the time.

The study was based on a survey conducted by the National Center for Health Statistics, and included data from 28,000 patient visits to more than 1,100 doctors in 2008. It contradicted a 2005 study from RAND Corp., which estimated that EHRs could save as much as $80 billion a year. The Obama administration used that study as justification for $19 billion in federal spending to help providers switch to digital technology.

EHR supporters were critical of the latest study for using the NCHS data, which they say is used to assess how medical care is practiced, not how well computerized patient records work. It also "included any kind of computer access to tracking images, no matter how old or isolated the function," Lohr reports. Modern EHRs are more integrated in their function and must meet federal standards for "meaningful use" — guidelines that were not in place in 2008.

Dr. David Blumenthal, professor at Harvard Medical School and former national coordinator for health information technology for the Obama administration, found 92 percent of articles published in professional journals on EHRs were "positive over all" regarding whether the technology would improve efficiency and quality of care. Dr. Danny McCormick, lead author of the new study and assistant professor at the same school, argued his analysis "looked at not just a few cutting-edge institutions, but a nationally representative sample." (Read more)

Read More

Medical records of 1,018 patients stolen at Lexington Clinic, but no apparent identity theft

One of the fears of electronic health records is that personal information can be stolen en masse, a possibility that became a reality when a laptop computer was stolen at the Lexington Clinic.

The machine was taken Dec. 7 from the clinic's neurology department at the St. Joseph Office Park. Letters were sent to the 1,018 affected patients last week about the theft, Mary Meehan of the Lexington Herald-Leader reports.

The laptop contained the names, contact information and diagnoses from patients from as long as five years go. Not among the data were Social Security numbers, credit card or bank account numbers. So far, there is no sign of identify theft. 

The clinic said it took six weeks to informing patients because it took time to "pinpoint exactly what information was on the laptop, which was used in conjunction with the clinic's electromyography machine," Meehan reports.

Another theft happened at UK HealthCare in June, when the medical records of 3,000 patients were taken from the Department of Pediatrics' newborn screening program. Patients were not informed of that breach until two months later. (Read more)

Read More

Kentucky center helps more than 1,000 providers get electronic health records

The Kentucky Regional Extension Center has helped more than 1,000 health care providers transition to electronic health records, with specialists advising providers so they can meet the federal standards of "Meaningful Use."

"Quick access to electronic health records can make the difference in a provider's ability to treat the patient, whether it means checking a patient's cholesterol during a routine examination or identifying a medication allergy during an emergency," said Dr. Carol Steltenkamp, who directs the KY-REC and is the chief medical officer and pediatrician at UK HealthCare.

The adoption of EHRs by providers doubled from 17 percent in 2008 to 34 percent in 2011, the National Center for Health Statistics reports. As of Nov. 30, 2011, the Centers for Medicare and Medicaid Services had paid out more than $920 million in Medicare EHR incentives and $916 in Medicaid incentives, UKNow reports. The use of electronic prescribing, which allows physicians to generate, transmit and file patient prescriptions, has increased from 0.8 percent in December 2006 to 40.2 percent in September 2011, the nation's largest e-prescribing network Surescripts reports. (Read more)

Read More

Electronic health records are helping nurses provide better care, big study finds

Electronic health records are helping nurses get better health outcomes and are improving nursing care, the first big study on the subject has found.

The study conducted by the University of Pennsylvania School of Nursing involved 16,000 nurses at 316 hospitals in California, Florida, Pennsylvania and New Jersey. It found that "implementation of an EHR may result in improved and more efficient nursing care, better care coordination, and patient safety," wrote lead author Ann Kutney-Lee, a health-outcomes researcher at Penn Nursing.

The study, which was published in the Journal of Nursing Administration, also found, "having a basic EHR was associated with better outcomes independently of nurse staffing, indicating that they both play an important role in quality of care."

Nurses in hospitals that had comprehensive EHR systems were "significantly less likely to report unfavorable patient safety issues, frequent medication errors, and low quality of care," research-reporting service Newswise reports.

The most current estimates show just 12 percent of U.S. hospitals have an EHR system in place, but that will change with the Health Information Technology for Economic and Clinical Health Act. Starting in 2011, hospitals and physicians received incentive payments from Medicare and Medicaid to switch over to EHRs. The study did not measure outcomes in rural vs. urban settings "although we do know from other studies that hospitals that used electronic health records during this time period were less likely to be in rural areas," Kutney-Lee said. (Read more)

Read More

Health reform means millions more will be covered and more illness will be prevented, federal health official says at UK

By Tara Kaprowy
Kentucky Health News

What will the healthvcare system look like in 2020? Assistant Secretary of Health Dr. Howard Koh told a packed house in Lexington Monday that millions more people will have insurance, the patient will be at the center of a coordinated system, and there will be a great emphasis on prevention and public health "so the patient doesn't become the patient in the first place."

Koh talked about federal health-care reform during a panel discussion at the University of Kentucky's Albert B. Chandler Hospital. It also included Dr. Steve Hester, senior vice president of Norton Healthcare; Dr. Richard Lofgren, vice president of health care operations and chief clinical officer at UK HealthCare; and Stephen Wyatt, dean of UK's College of Public Health.

Koh said the current health-care system "is fragmented, it's episodic, it's not as coordinated as we would like, and there is still not enough attention to quality outcomes." But he said implementation of key parts of the health-care law would address those issues.

He said insurance is already more accessible, since companies can no longer refuse children with pre-existing conditions. By 2014, the same will be the case for adults. State insurance exchanges, which he called "a one-stop shop where buyers can compare plans," will inject "transparency in the whole market" and will ensure basic levels of coverage.

Insurance will also become more affordable, he said. The Medicare prescription "donut hole" is being covered; young adults can stay on their parents' plan until the age of 26; insurance companies must assure that 80 percent of their expenses go toward medical care and not overhead; and there will be a rate-review process, in which insurance companies wanting to increase their rates by 10 percent or more must formally defend their request.

Patient-centered medical homes will put the patient at the center of care and accountable care organizations, and "voluntary networks who have agreed to care for a defined Medicare population and also share in savings," will make coverage more coordinated, Koh said.

The law also puts systems in place for prevention and public health. On the individual level, new plans must cover "high-value preventive services and screenings," Koh said. Businesses are being encouraged to focus on wellness. The Centers for Disease Control and Prevention are offering community transformation grants so communities "can designs ways to make the healthy choice the easy choice," he said. And a national prevention counsel has been formed dedicated to public health.

The law also provides millions for health-care technology, which Hester said will revolutionize the health-care landscape and "the way we respond to patients." Koh agreed, saying a paper-based system "was another example of fragmentation. . . . prevSometimes you could find the chart, sometimes you couldn't. The electronic-based system will coordinate."

Hester said patients have recently become more equipped to accept the technology of electronic health records because they've become used to devices like smart phones. Logren said that, traditionally, patient records have been "proprietary." Electronic records will get information moving from place to place and will no longer be "owned."

Koh acknowledged one of the greatest challenges of the health-reform law is sustainability, but by 2020, he said "We will see stable funding and stable results" in public health and prevention. While the law has created divisiveness in the political arena, Koh said strong opinions about health care are a good thing because they generate discussion and passion. "We can debate many parts of the health reform law," he said, "but in the meantime, we are making progress."

Read More

Several pieces of federal health reform law taking effect in 2012

At the beginning of the new year, family doctors started facing a 1 percent cut in Medicare reimbursement if they hadn't nixed their paper-based prescription pads in favor of an electronic version. The change is part of another piece of the federal health-care reform law taking effect, USA Today reports.

"There will be a significant number of folks that will incur the penalty," said Robert Tennant, senior policy adviser with the Medical Group Management Association.

E-prescribing, which allows physicians to generate, transmit and file patient prescriptions, is part of the federal government's effort to get doctors to use electronic health records. Last year, doctors received bonuses from Medicare and Medicaid to set up EHRs, but this year they will start being penalized if they haven't already done so — 1 percent this year, 1.5 percent in 2013 and 2 percent in 2014.

Another piece of the federal health care reform law that will begin falling into place in 2012 involves Medicare's Shared Savings Program, "under which groups that qualify as accountable care organizations will be eligible for shared savings in 2013," USA Today reports. "Under the program, savings from participants in an ACO — including hospitals and doctors working together to improve patient care and reduce costs — would be shared between Medicare and the providers."

One study showed Kentucky already has three ACOs established, though several Kentucky experts have said no ACOs have been formed in the state yet.

Jan. 1 also marked the beginning of consumers being eligible for rebates if their insurer spent less than it should have on medical care. As per the new law, insurers have to spend 85 percent for large group plans and 80 percent for small groups and individuals on medical care as opposed to administrative and other costs. Kentuckians will not be privy to these rebates this year, however. Kentucky got a one-year break from the rule after applying for an exemption. (Read more)

Read More

Data leaks are a risk with electronic health records; state says it has safeguards to protect privacy

As hospitals and other health-care providers in Kentucky and across the country are adopting electronic health records to save money and improve care, they do so at some risk. The medical files containing insurance forms, Social Security numbers and doctors' notes of about 300,000 Californians were posted recently on the Internet, available to anyone who might stumble across them or know how to search for them. "At a time of mounting computer hacking threats, the incident offers an alarming glimpse at privacy risks as the nation moves steadily into an era in which every American's sensitive medical information will be digitized," The Associated Press reports.

"When things go wrong, they can really go wrong," said Beth Givens, director of Privacy Rights Clearinghouse, a nonprofit that tracks data breaches. "Even the most well-designed systems are not safe ... This case is a good example of how the human element is the weakest link."

Generally, data breaches are the result of hackers who break into computers or thieves who steal the actual equipment. Sometimes they can just be be caused by human error. Leaks can also happen as data passes through health industry networks. "Dozens of companies can be authorized to handle a single person's medical records," the AP reports. "The further away from the health care provider the records get, the flimsier the enforcement mechanisms for ensuring the data are protected."

One of the biggest breaches was in 2006 when a laptop containing data for 26.5 million veterans was stolen from the home of a government employee. The computer was recovered. This year, hard drives containing personal information of 1.9 million Health Net insurance customers were taken. They contained health histories, financial information and Social Security numbers. The matter is still under investigation.

In the wrong hands, "health records can be used for blackmail and public humiliation," AP notes. "The information can also be used by insurance companies to inflate rates, or by employers to deny job applicants."

Preventing data leaks is on the minds of Kentucky officials setting up the Kentucky Health Information Exchange, the state clearinghouse for EHRs. Participating providers have to sign several agreements in which they attest the information they obtain will be used responsibly. "The golden rule is this data will only be viewed by a provider who is providing care to a patient," said Jeff Brady, executive director of the Governor's Office of Electronic Health Information. To make sure that is happening, Brady said the software has an audit function, in which administrators are able to see who looks at a patient's data, when they did, from what computer and what piece of data was examined. (Read more)

Read More