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TRANSPARENCY: Should you let patients read their notes?

Advantages and disadvantages of allowing patients to read the notes that physicians and other providers write about their office visits and hospital care are explored in this short Modern Healthcare article.  The movement towards greater transparency of care is explored further on the website OpenNotes.  Here are some of the providers that are exploring this concept.

Who is doing this?

  • Geisinger Health System (Danville, PA)
  • Beth Israel Deaconess Medical Center (Boston)
  • Sutter Medical Foundation (Sacramento, CA)
  • MUSC Health (Charleston, SC)
  • Harborview Medical Center (Seattle)
  • Mayo Clinic
  • Kaiser Permanente Northwest
  • Department of Veterans Affairs
  • UCHealth (Denver)

Sources:  Livingston, S. (2017, Jan. 2). Growing number of doctors allowing patients to read their notes. Modern Healthcare, 47(1), 14-15.  Click here for publisher’s website: http://www.modernhealthcare.com/article/20161231/MAGAZINE/312319982; and, OpenNoteswww.opennotes.org   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Largest Hospital and Ambulatory Care EHR Vendors

The Office of the National Coordinator for Healthcare Information Technology (ONC) tracks the vendors used by providers that participate in its electronic health record (EHR) incentive program. ONC has released a list of all certified health IT vendors used by providers along with how many hospitals and ambulatory care professionals are using each vendor’s technology.

There were 175 certified health IT vendors supplying technology to 4,474 non-federal acute care participating hospitals as of June 2016. These ten vendors, ranked by the number of hospitals with certified EHR technology, were the largest suppliers:

  1. Cerner Corporation (1,029 hospitals)
  2. MEDITECH (953)
  3. Epic Systems Corporation (869)
  4. Evident (636)
  5. McKesson (462)
  6. MEDHOST (359)
  7. Allscripts  (235)
  8. Sunquest Information Systems (200)
  9. FairWarning Technologies (172)
  10. Iatric Systems (161)

On the ambulatory care side, 632 vendors supplied certified health IT to 337,432 ambulatory primary care physicians, medical and surgical specialists, podiatrists, optometrists, dentists, and chiropractors also participating in the Medicare EHR Incentive Program. These were the top ambulatory care EHR vendors based on the number of participating health care professionals using each vendor’s technology:

  1. Epic Systems Corporation (83,673 professionals)
  2. Allscripts (33,127)
  3. eClinical Works LLC (25,524)
  4. Next Gen Healthcare (19,676)
  5. GE Healthcare (17,704)
  6. Cerner Corporation (15,104)
  7. athenahealth Inc (14,570)
  8. Greenway Health LLC (12,407)
  9. Practice Fusion (8,523)
  10. McKesson (7,347)

Sources:

Hospital EHR vendors: certified health IT vendors and editions reported by hospitals participating in the Medicare EHR Incentive Program. Office of the National Coordinator for Healthcare Information Technology, June 2016. http://dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Hospitals.php

Health care professional EHR vendors: certified health IT vendors and editions reported by ambulatory health care professionals participating in the Medicare EHR incentive program. Office of the National Coordinator for Healthcare Information Technology, June 2016. http://dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Professionals.php

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Update: Physician Office Adoption Rates of Certified Electronic Health Record Systems

A new data briefing from the National Center for Health Statistics reports on the progress physician offices have made in adopting EHR systems. Here are the latest key findings for 2014:

  • Nationally, nearly three-quarters of office-based physicians now have a certified electronic health record system, but adoption rates vary among states.
  • A third of physician offices with an EHR system were electronically sharing patient health information externally with other providers.

The report also provides data on adoption rates by state and by primary vs non-primary care physicians. Electronic data exchange is analyzed by type of provider the patient record is shared with externally.

Source:  Jamoom EW and others. Adoption of certified electronic health record systems and electronic information sharing in physician offices: United States, 2013 and 2014. NCHS Data Brief [National Center for Health Statistics], no. 236, Jan. 2016. http://www.cdc.gov/nchs/data/databriefs/db236.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Apple Watch and Hospitals Using It in the News

The new Apple Watch has been in the news this week, but so have several hospitals that are using it with patients. Apple’s HealthKit mobile app is available with its Watch.

Cedars-Sinai Medical Center has linked its electronic medical records system to Apple’s HealthKit software, giving patients the option for adding their data to their health records. Ochsner Health System will be using the Apple Watch to manage hypertension in patients initially, but may add other patients with chronic diseases.

Mayo Clinic, Stanford University Hospital, and Duke University Hospital are also among the first hospitals or health systems connected to HealthKit system. Reuters news service has reported that 14 of 23 major hospitals it contacted have pilot programs using Apple’s HealthKit mobile software. Competitive services from Google and Samsung have also begun reaching out to some hospitals and others in the medical field..

Sources:

Stempniak M. New Orleans Health System harnesses Apple Watch to manage chronic disease. H&HN Daily, April 27, 2015. http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Daily/2015/April/Oschsner-Health-Apple-Watch-chronic-disease-blog-stempniak

Bowman D. Cedars-Sinai goes all-in on Apple HealthKit. FierceHealthIT.com, April 27, 2015. http://www.fiercehealthit.com/story/cedars-sinai-goes-all-apple-healthkit/2015-04-27

Comstock J. Apple Watch already has 264 health apps, unused pulse ox functionality, and a hospital pilot. MobiHealthNews.com, April 27, 2015. http://mobihealthnews.com/42900/apple-watch-already-has-264-apps-unused-pulse-ox-functionality-and-a-hospital-pilot/

Higgins T. Apple’s HealthKit linked to patients at big Los Angeles hospital. BloombergBusiness, April 26, 2015. http://www.bloomberg.com/news/articles/2015-04-26/apple-s-healthkit-linked-to-patients-at-big-los-angeles-hospital

Diamond D. A hospital is already giving Apple Watch to its patients. Forbes.com, April 24, 2015. http://www.forbes.com/sites/dandiamond/2015/04/24/can-apple-watch-make-patients-healthier-how-one-hospital-is-trying-to-find-out/

Farr C. Exclusive: Apple’s health tech takes early lead among top hospitals. Reuters, Feb. 5, 2015. http://www.reuters.com/article/2015/02/05/us-apple-hospitals-exclusive-idUSKBN0L90G920150205

Dvorak K. mHealth Summit 2014: HealthKit, EHR pilot programs show great promise, execs say. FierceMobileHealthcare.com, Dec. 20, 2014. http://www.fiercemobilehealthcare.com/story/mhealth-summit-2014-healthkit-ehr-pilot-programs-show-great-promise-execs-s/2014-12-10

Goldstein P. Apple moves into mobile healthcare with HealthKit software. FierceWireless.com, June 2, 2014. http://www.fiercewireless.com/story/apple-moves-mobile-healthcare-healthkit-software/2014-06-02

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Update: EHR Adoption by U.S. Community Hospitals, 2008-2014

How have hospitals progressed in adopting electronic health records? New data from a survey conducted by the American Hospital Association for the Office of the National Coordinator of Health Information Technology points to significant progress:

  • Three-quarters of hospitals had adopted at least a basic EHR system in 2014, up 27% from 2013.
  • Almost all hospitals [97%] had a certified EHR technology, up 35% over the previous year.
  • Over a third of hospitals had adopted a comprehensive EHR system by 2014.

Hospitals have made major inroads towards interoperable exchange of health information.

 

Source: Dustin C. and others. Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008-2014. ONC Data Brief [Office of the National Coordinator for Health Information Technology], no. 23, April 2015. http://www.healthit.gov/sites/default/files/data-brief/2014HospitalAdoptionDataBrief.pdf 

Related: AHA Annual Survey IT Database is available for purchase, and the 2015 release with 2014 data should be available soon. For further background on the survey, see http://www.ahadataviewer.com/about/it-database/  Call (866) 375-3633 or email ahadatainfo@healthforum.com for more information.

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

2014: Health Care Year in Review

The Commonwealth Fund has posted an online overview of the past year in health care. The following health care highlights from 2014 are identified and briefly discussed:

  • Uninsured rate drops
  • Spending slowdown continues
  • Republicans gain control of Congress and more
  • Supreme Court takes up an ACA challenge
  • Sovaldi draws attention to specialty drug prices
  • Ebola is a wake-up call on global health security
  • Delivery system reform gathers steam
  • Wiring of the health system continues

Source: Blumenthal D and Squires D. 2014: the health care year in review. Commonwealth Fund Blog, Dec. 23, 2014. http://www.commonwealthfund.org/publications/blog/2014/dec/2014-health-care-year

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

What is a medical scribe? How many are there?

Medical scribes are unlicensed employees of physician practices or hospitals who have been hired to key-in information into patients’ electronic health records.  This is a new and growing job category – there are at least 22 companies who provide scribe service.  In this short opinion piece, the authors argue that the use of medical scribes is a workaround for physicians frustrated with the limitations of today’s EHR systems.  But, because the workaround works, there is less market pressure on EHR vendors to improve their products.  The author also argues that the possibility of “use creep” is high, that is, that medical scribes may be asked to do order entry, which is a patient safety concern.

How many medical scribes are there?

  • “The chief executive officer of ScribeAmerica, the largest US scribe company, estimates that 10,000 scribes are working in hospitals and medical practices across the country.”

Source: Gellert, G.A., Ramirea, R., and Webster, S.L. (2014, Dec. 15). The rise of the medical scribe industry: implications for the advancement of electronic health records. JAMA.  Click here for access to the publisher’s website: http://jama.jamanetwork.com/journal.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

2014 Survey of America’s Physicians: Practice Patterns and Perspectives

The Physicians Foundation is out with its latest biennial survey of physicians in the country, looking at work satisfaction, practice patterns, and other attitudes of over 20,000 survey participants. Key questions addressed in the survey include these:

  • Are they seeing more or fewer patients?
  • Do they continue to accept Medicare and Medicaid as a form of payment?
  • How do they grade the Affordable Care Act?
  • How many are part of an ACO?
  • What effect have electronic medical records had on their practice?
  • Are they independent practice owners or employees?
  • Do they plan to retire, work part-time, practice concierge medicine, seek hospital employment, or pursue some other option?

And here are some of the answers from physicians:

  • 38% do not see Medicaid patients or limit the number of Medicaid patients seen.
  • 46%  give the Affordable Care Act a failing grade.
  • 26% participate in an ACO, but only 13% think ACOs will improve quality or lower costs.
  • 85% have adopted electronic medical record,s but 46% say they detract from their efficiency.
  • 53% describe themselves as employees, up from 44% in 2012.
  • 44% plan to take steps that could impact the physician supply and patient access, such as retiring, closing their practices to new patients, cutting back on the number of patients seen, or seeking a non-clinical job.

Source: Merritt Hawkins. 2014 survey of America’s physicians: practice patterns & perspectives. Physicians Foundation, Sept. 2014. http://www.physiciansfoundation.org/uploads/default/2014_Physicians_Foundation_Biennial_Physician_Survey_Report.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Accountable Care Organizations: Findings from an AHA Survey

How many hospitals are part of an accountable care organization? How are their ACOs structured, and what types of contracts and risk models are being used? What are the challenges? How are patient engagement, care management, and performance management being handled? Are the ACOs part of an information exchange?

To find answers to these and other questions, the American Hospital Association sent a survey in 2013 to all 4999 community hospitals in the US, and of the 1517 responses received [a representative sample], 309 hospitals [20%] reported they were part of an accountable care organization.

Here are some of the other findings:

  • ACO STRUCTURE:  Two-thirds reported a new legal entity was formed for the ACO, such as an LLC. Governance was most often characterized as either a physician/hospital-led joint venture or as a physician-led ACO. Most [72%] ACOs will centralize their purchasing function.
  • CONTRACTS/RISK MODELS: A commercial payer partnership or a Medicare Shared Savings Program were the most frequently cited shared savings programs pursued. Under Medicare, nearly two-thirds preferred the one-sided risk model, and 89% anticipated engaging in an upside or simple shared savings model.
  • CHALLENGES: The biggest ACO challenges were developing clinical and management information systems and aligning incentives to promote provider productivity.
  • PATIENT ENGAGEMENT/CARE MANAGEMENT: Nearly two-thirds will notify patients that they are attributed to an ACO, and about half of those will allow patients to opt out. Nearly all the ACOs had a systematic process for identifying eligible patients.
  • PERFORMANCE MANAGEMENT: Most ACOs will track multiple types of measures, including quality, utilization, financial, and patient satisfaction. Just over half can track and routinely share these measure with all ACO members.
  • INFORMATION EXCHANGE: Less than half of ACOs are participating in a health information exchange.

The AHA Survey of Care Systems is an ongoing survey to be updated regularly.

Sources:

Accountable care organizations: findings from the Survey of Care Systems and Payment. American Hospital Association, Aug. 2014. http://www.aha.org/content/14/14aug-acocharts.pdf

AHA survey of care systems and payment [database for sale]. Health Forum, an American Hospital Association affiliate, 2014. Description at http://www.ahadataviewer.com/about/AHA-Survey-of-Care-Systems-and-Payment/; Download available for purchase at http://www.ahadataviewer.com/quickreport/

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Trends in EHR System Use among Office-Based Physicians, 2007-2012

In 2012 nearly 72% of office-based physicians reported they were using electronic health records, up from 35% in 2007. However, only 40% were using an EHR system that met criteria for a basic EHR system, while 24% were using a fully functional system for EHRs. This progress in the adoption and use of EHR systems by office-based physicians is being tracked by the National Center for Health Statistics as part of its annual National Ambulatory Medical Care Survey.

The EHR usage data is further analyzed by physician age, specialty type, gender, practice size, practice ownership, geographic region, metropolitan status, and percent of practice revenue from Medicaid.

Source: Hsiao CJ and others. Trends in electronic health record system use among office-based physicians: United States, 2007-2012. National Health Statistics Reports, no. 75, May 20, 2014. http://www.cdc.gov/nchs/data/nhsr/nhsr075.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org