Since the ground breaking initial emrupdate Newsletter of 5/5/2006 much has occurred on various fronts both in the world of EMRs and at emrupdate.com. (Type-setting and jockey-asides by Nick)
This Newsletter Contents
- Bibliography - Newsletter Contents
- Certification Commission for Healthcare Information Technology (CCHIT)
- CDC: More Physicians Using Electrical Medical Records
- IBM Brings Electronic Medical Records One Step Closer Through Open Technology
- The British National Programme for IT vs EMR Adoption in the USA
- The Rand Corporation Study
- Articles Posted During the Past 3 Months at emrupdate.com
- The eCHIT Process
- Medical Voice Recognition and General IT, Hardware & (non-EMR) Software Sections
- Editorial- The State of the IT Industry 1986 vs. 2006
- Changes/Additions To emrupdate.com and Statistics
There have been numerous milestones concerning CCHIT since the initial emrupdate.com Newsletter. On 5/24/2006 Naveen had the opportunity to participate in a ‘Town Hall’ meeting with Dr. Mark Leavitt, the headman at CCHIT, at the TEPR ’06 event. He reports on the difficulties Dr. Leavitt had with the seemingly unruly, angry audience. Check out the thread located here.
The first 24 certified EMRs were published and discussed here. Every EMR that was presented passed. Many wonder what will happen when CCHIT begins to fail EMRs that apply for certification, which at some point it must do to demonstrate a meaningful process. If it doesn't, then CCHIT may turn out to be simply a buy-in clout process for the large, powerful EMR companies. As Jason (DrMurdoch) aptly stated that this list represents "a big long list of the who's who in old school of overpriced EMRs". Here's the list:
|1. Centricity® EMR 2005 Version 6.0 (GE Healthcare)
2. Companion EMR v8.5 (Companion Technologies)
3. eClinicalWorks Version 7.0 Release 2 (eClinicalWorks)
4. e-MDs Solution Series 6.1 (e-MDs)
5. EncounterPRO® EHR 5.0 (JMJ Technologies)
6. EpicCare Ambulatory EMR Spring 2006 (Epic Systems)
7. HealthMatics Electronic Health Record 2006 (Allscripts)
8. Horizon Ambulatory Care Version 9.4 (McKesson)
9. iMedica Patient Relationship Manager 2005, version 5.1 (iMedica Corporation)
10. Intergy® EHR v3.00 (Emdeon Practice Services)
11. MEDENT 16
12. (Community Computer Service)
13. Medical and Practice Management Suite Client Server Version 5.5 (Service Release 2.1)
14. (LSS Data Systems)
15. Misys EMR 8.0 (Misys Healthcare Systems)
16. mMD.Net EHR 9.0.9 (MCS-Medical Communication Systems)
17. myNightingale Physician Workstation 5.1 (Nightingale Informatix Corporation)
18. NextGen EMR 5.3 (NextGen Healthcare Information Systems)
19. Patient Records 9 (Practice Partner)
20. PowerChart 2005.02 (Cerner Corporation)
21. Praxis® Electronic Medical Records, version 3.4 (Infor-Med Corporation)
22. Record 2006 (V 3.0) (MedcomSoft)
23. TouchWorks Electronic Health Record 10.1.1 (Allscripts)
24. WebChart 4.23 (Medical Informatics Engineering)
On 8/15/2006 President Bush has put out an executive order concerning CCHIT, with the NIH Health Policy newsletter stating:
"The Bush White House is issuing an Executive Order requiring health care providers to use information technology systems certified by the Certification Commission for Healthcare Information Technology (CCHIT) and meeting federally approved efficacy and interoperability standards [if they wish to work with Medicare, Medicaid, and major insurance companies in future pay for performance schemes]."
The push is also being seen in town-hall meetings. In my neck of the woods I will be attending such a meeting in 2 weeks. Stay tuned for my thorough report on the 6 hour meeting.
The jury is still out whether CCHIT will really help or hinder the growth of the EMR industry in the United States. Although they have decreased the cost of certification slightly, the $28000.00 per year cost for certification will increase the overall costs of CCHIT-certified EMRs taking these softwares to economically unreachable levels to providers. Fritz Switzer aptly looked at Sanvas/Doctors Partner Price Matrix using the information in the "2 Year Total Cost" column and found the following data:
- Average EMR/Product cost (all companies) = $18,776.50
- Average EMR/Product cost (CCHIT Certified) = $30,690.80
- Average EMR/Product cost (non-Certified) = $17,066.00
Nearly one in four (23.9 percent) of physicians reported using full or partial electronic medical records (EMRs) in their office-based practice in 2005 - a 31 percent increase from the 18.2 percent reported in 2001. CCHIT advocates claim that for the 2006-2007 year certification of EMRs will bring about a 30 percent increase from the current 24% level.
“Experts Predict Sharp Rise in Electronic Medical Record Adoption”,
IBM announced on 8/9/2006 a major step in the drive toward a national electronic medical records system by contributing software technology that supports the exchange of healthcare information to the open source community (“interoperability”).
The software, contributed to the Eclipse Foundation's Open Healthcare Framework (OHF) project, might allow for the creation of an EHR network similar to the Internet that would have no central depository but would allow doctors to access patient records from anywhere nationally.
Could this be a major CCHIT competitor? It’s goal seems to be focused on interoperability, which is what will eventually really drive the growth of EMRs nationwide.
Electronic Medical Records (EMRs) are now a well established part of medicine in much of Europe, with as many as 90% of practitioners using recording patient histories and care electronically. Since 2001, over half of the physicians in the United Kingdom (UK) and the Netherlands used EMRs.
The UK has a socialized medical care offered through the National Health Service (NHS). No matter which part of the United Kingdom a citizen is from, they are entitled to health care through the NHS provided by the taxes they pay. The NHS has created a plan called the National Programme for IT (NPfIT), and is currently in the process of implementation. The program is stated to “connect over 100,000 doctors, 380,000 nurses and 50,000 other health professionals and give patients access to their personal health and care information”. The program is laying the groundwork to better organize Britain’s health care system by digitizing medical records and providing doctors and patients with a way to quickly connect to the health care system to view records. In addition, the NPfIT will have a service to schedule appointments to meet with doctors, to transfer prescription information, to transfer records between practitioners, and to establish a national broadband network to support these services.
On 4/11/2006 a group of 23 computer science academics from around the UK have written an open letter calling for an “independent technical assessment” of the National Programme for IT. They asked the British House of Commons health select committee for: "Concrete, objective information about NPfIT's [National Programme for IT] progress is not available to external observers. Reliable sources within NPfIT have raised concerns about the technology itself. The report is due out by the end of the year.
In the United States, President George W. Bush has introduced a plan to have a nationwide Electronic Medical Record system in place by the year 2014. This system would be similar to the United Kingdom’s NPfIT project.
The biggest barrier to the adoption of EMRs, though, is the initial capital cost required by hospitals and medical facilities to create an EMR system. Many physicians are also worried about an increased workload associated with updating and maintaining EMRs. Doctors fear that there will be a great deal of time spent performing data entry, as well as learning how to use the new EMR systems. The final major barrier to entry is one of the most critical: security.
In conclusion, only time will tell if and when these ambitious programs will be successful. In the USA the question is whether an expensive standardization process (CCHIT) or whether a simple focus on interoperability is the way of the future.
URLs: http://www.personal.psu.edu/kjs266/IST431/Utilization.htm and http://www.ehiprimarycare.com/news/item.cfm?ID=1822
A Rand Corporation study published last fall estimated that only 15 percent of physicians and 20 percent of hospitals use computers to manage records. Key findings:
- Properly implemented and widely adopted, Health Information Technology would save money and significantly improve healthcare quality.
- Annual savings from efficiency alone could be $77 billion or more.
- Health and safety benefits could double the savings while reducing illness and prolonging life.
- Implementation would cost around $8 billion per year, assuming adoption by 90 percent of hospitals and doctors’ offices over 15 years.
- Obstacles include market disincentives: Generally, those who pay for Health Information Technology do not receive the related savings.
- The government should act now to overcome obstacles and realize benefits.
The following articles were posted in the general EMR Forum section:
The emrupdate.com eCHIT section has been quiet for the past 2 months, but it’s far from dead. Right now everyone is frozen, trying to see how the CCHIT process will evolve and how they will adjust to the changes. The eCHIT will come in handy if and when it seems that CCHIT does somehow develop a real following outside of government and insurance company spending and incessant advertisement.
The most important discussions have been concerning the new Dragon Naturally Speaking 9 and the new Paperport 11. There has been much debate on whether or not they are worth the upgrade. Paperport 11 in particular has been found to be buggy and at times much slower than the excellent predecessor, Paperport 9. Dragon Naturally Speaking 9 continues to become more of a memory hog than prior versions, and may require major upgrades to laptops and older desktop computers. Both of the newer versions of these products include the dreaded “product activation” schemes that limit the use of the software to one installation.
Other discussions have included Windows VISTA, Office 2007, setting up a RAID solution, FAX software solutions, and backing up your data. Numerous hardware devices have been discussed, including the Origami, the Motion LE1600, some weird USB devices, and wired and wireless network devices.
For my recent trip to Vancouver/Alaska I quickly grabbed a book off my bookcase called Computers In Medicine, Applications and Possibilities by Jonathan Javitt, M.D., M.P.H.. This book was somewhat outdated, published in 1986- exactly 20 years ago. This mistake, though, was very interesting because the data reflected an era before Microsoft ruled the IT industry, before the microcomputers became the standard computer platform, and before Visual Basic and other RAD languages became the norm.
Chapter 1 begins discussing the then-current use of computers by physicians- for financial transactions, for scheduling and appointment keeping, for cognitive processes (“primitive software programs are now available…”), for medical education, and for accessing the literature. “The Future of Computers in Medicine” included uses for chief complaint and history taking, vital signs and laboratory workup, patient encounter documentation, diagnosis formulation, and plan of care. These things can be the “future” hallmarks of a general electronic record keeping process of what we now call the electronic medical record, or “EMR” (they didn’t call it that then). Futuristic statements made included:
- “Truly portable computers will allow the writing of quick notes a the time of each office visit and while making rounds in the hospital.”
- “Electronic interchanges can easily make those notes available to the hospital or to another medical office, as indicated.”
- “Hopefully, the efficiency of record keeping will be a potent factor in leading doctors to get over their antipathy to computers as an integral part of the practice of medicine.”
Chapter 2 goes into some computer hardware and software basics. Interesting statements include:
- “The best-known operating systems in the microcomputer world today are the CP/M for many eight-bit computers, Apple-DOS for Apple computers, PC-DOS and MS-DOS for IBM and IBM-compatible computers, and UNIX for newer 16- and 32-bit computers.” [Where’s MS Windows?]
- “There are many available programming languages today, such as BASIC, FORTRAN, COBOL, and APL.” [No Visual Basic Net?]
- “… the distinction between microcomputers and their larger cousins, known as mainframes, is becoming less and less distinct… The desktop IBM 370 may be able to run all the software of the room-sized [mainframe IBM 370] version.” [What- no Dell, Gateway, or HP?]
- “Currently, microcomputers that the ability to handle the requirements of a medical practice cost between $2000 and $6000 initially. Most mainframe computers, on the other hand, start with initial costs in the range of $200,000.”
- “With a microcomputer, software distribution is dominated by the commercial market. Most packages cost between $50 and $300…commercial software can be expected to be free of errors (although this is not always the case).” [Specialty “EMR” type programs had not become popular yet.]
Chapter 3 goes into the capabilities of the microcomputers versus the mainframe computers:
- “Although microcomputers today tend to be single-user-oriented, pressure is being applied from medium-sized firms and small businesses to develop limited multi-user systems on microcomputers. A connected system of microcomputers allows hardware and software resources to be shared among many users.” [The LAN was still in it's infancy- available, but expensive. The operating systems did not offer an integrated peer-to-peer setup.]
- “LANs usually employ a single coaxial cable that connects each User in the entire network.” [Think daisy-chain, 11 mbps LANs vs. the gigabyte LANs available today.]
- “With the evolution of “windows,” software engineers have allowed more than one program to be run at the same time (a process called multi-tasking) and information from each program to be presented on the screen at the same time. [Nowadays we take this for granted!]
Chapter 4 goes into “basic tools”:
- “In 1984, an integrated software package called Symphony (developed for the IBM PC) was released by the Lotus Development Corporation. Symphony is a fully integrated package that includes and improves upon the Lotus 1 2 3 spreadsheet, graphics, and data base capabilities while adding new word processing and data communications environments.”
- “In late 1984, another competitive integrated package for the IBM PC and il5 compatibilities called Framework was released by Ashton Tate. Much like Symphony, Framework contains word processing, spreadsheet, data base, graphics and communications capabilities. Likewise, Framework also allows windowing and multi-tasking.”
- “Also, in 1984, Apple released its version of the integrated persona1 computer with the introduction of the Macintosh computer. The Macintosh is a portable, user-friendly, personal computer based on a new generation of current microprocessors.”
[Note: MS Office would not be available for another 8 years.]
- This chapter also went into word processing software. What was available was not much more powerful than a fancy WordPad type software. All were text based; WordPerfect and Word wouldn’t come up with graphic-centric software versions for another 7-8 years.
Chapter 5 goes into the “Use of the Electronic Network”:
- The internet was not yet available; an electronic network meant dialing up a far away computer using primitive modems with speeds of up to 2400 baud.
- Available communication software at the time included PC Talk III, KERMIT, Crosstalk, and Smartcom II.
- There was available between major cities a set of data forwarding services, the prototype called ARPANET, a network developed to handle communications for the Department of Defense research projects in universities in many cities. Three major data forwarding networks in the United States provide service to the data base services of most interest to physicians. These networks are Tymnet, Telenet, and Uninet. In Canada, Datapac provides a similar service. The charges are quite reasonable, about $4 to $6 per hour, which at the time was much cheaper than the typical long distance lines.
- There were several medical data base services, all of which were quite expensive, although could be used freely through libraries. Of the 14 services listed, I only recognized MEDLINE.
Skipping to Chapter 9 (“Computerized History Taking”) and Chapter 10 (“Software for Patient Management”) one can see the discussion of what is needed for a good EMR. All of it was text based to be run on DOS operating systems.
Chapter 11 discussed “Computer-Aided Diagnosis and Decision Making”. Systems available at the time included Consult-I, Mycin, Expert, and Caduceus. It’s actually well written going into the intricacies of these systems and how they can potentially help the physician in his decision making. This chapter is very thorough and well written, even though none of these software titles have survived the years.
Chapter 12 discussed “Computerized Medical Records”, how these systems can improve on medical care. Questions at the time included:
- Should you supplement or replar.e the manual chart?
- Should word processing data storage be used, or should the data be encoded?
The chapter went into the components of a good EMR, what should go into the EMR, and how data is entered into the EMR (at that time usually it involved typing in the data- hand scanners weren’t available, and touchscreens were to come out 6-7 years later.
Chapter 13 discussed “Data Management Systems in Research”. I won’t get into this section at all. Generally the book was a great read and I felt lucky to have both the modern day hardware and software that I currently work with. The EMR still has to progress a lot, but it’s well on its way to becoming mainstream worldwide. I would love to see where we’ll be in 20 years (year 2026). I’ll make another report then. Stay tuned!
Nick has been hard at work changing the look and feel of the website. Noticable changes include:
- The new blog sections on the right side column of the website window. Notice blogs that include-
- EMR Interviews with Robert Gleeman talking to Doctors who have implemented their own EMR. So far he has performed 7 interviews, all of which make excellent reads.
- The Doctors Lounge is where Naveen Venkatachalam and volunteers blog useful EMR information. There are now 5 major topics, including handling faxes, starting a new office with an EMR, making backups of your important data, and web surfing and reading your emails safely.
- Medical Picks with Dr. Al Borges provides a useful place to catch up on Medical issues, diseases, latest treatments and hand-picked medical photos. There are 19 separate topics/case presentations so far.
- Free Software with Nick Harrington, Ducknet and Techguy provides a showcase for useful Free Software to help run your practice office. There are simply too many neat software to list here.
• Nick has added a Google Search option onto the Advanced Search page.
Other neat information and statistics include:
Two welcome new sponsors have been added:
Terry Ellis at DescriptMED has finally caved into pressure from Nick and parted with some hard-earned sponsorship money.
MedInformatix have also generously offered to sponsor emrupate and are using a sponsor page, dynamically updated from their own web-site. I don't know how Nick does it.
Without our sponsors we couldn't afford to keep this site running. We encourage you to check out our sponsors links in our footer. As another reminder and a thank you, this is the complete list of our sponsors:-
|A4 Health Systems
There are now 14 “President” class posters-
|Jason Murdoch MD (DrMurdoch), Canada (4,989)
Lowell Kleinman MD (DrQuit), USA (3,144)
Chris Wilkerson DCM (digital-doc), USA (2,134)
Kirk Voelker, MD (DrVoelker) USA (1,845)
Al Borges MD (alborg), USA (1,758)
Layne Hermansen, MD (FPdoctor), USA (1,337)
Graham Chiu (gchiu), New Zealand (1,335)
MrLynn, USA (1,304)
Robert Gleeman, USA (1,238)
Nick Harrington, United Kingdom (1,190)
Brendon, USA (1,099)
cyath, USA (1,097)
DrWinn, USA (1,083)
Matt Chase MD (mchasemd), USA (1,013)
These are the general emrupdate.com statistics-
- There are now 4,727 members.
- There have been started (approx) 11,966 threads and there have been 52,919 total posts.
- There have been over 2 million visits.
In July 2006 we received:
- A total of 62,257 distinct visits were made to the site.
- The average visit lasted 13 Minutes and 3 Seconds (Statistically longer than, you-know-what)
- 47,657 distinct web pages were viewed a total of 757,421 times.
- The average visit contained 12.17 page views.
- People spent an average of 1 Minute and 4 Seconds viewing a page.
- Downloadable files were requested 137 times.
- 18.46 GigaBytes of Bandwidth
- 24.97% of all visits were by people using a version of Microsoft Internet Explorer (how quaint) to view the site, 6.44% used Netscape (anti-establishment), 9.65% used FireFox (way to go), and 7.98% used the AOL browser (oh, pity them).
- 44.85% of all visits were by people using a version of Microsoft Windows, 1.57% used MacOS (probably Cyath), and 0.43% used a version of Unix/Linux (Nick)
Really odd stuff:
- The 12th most popular Search Phrase (that visitors came here from) was secret italian training video, the 13th was ass, 19th was uglywoman, 21st was misys buyout. What an odd bunch!
- Microsoft , WA, USA visited us 1,033 times
- We have only one visit from the following countries
- Ivory Coast (or Cote d'Ivoire to be accurate)
- Sri Lanka
- Myanmar (formerly Burma)
- Luxembourg (not that many folks in Luxembourg anyway)
Well, that’s it! Many thanks to Nick for his efforts on making this site run smoothly. If any readers have any interesting comments, suggestions, or news stories, send a private email anyone or to Nick Harrington or Al Borges. I plan to make these newsletters updated either periodically throughout the year, or at least on a monthly basis.
If you read a thread which you think needs the spotlight of our front-page, please let us know.
Lastly, don’t forget that it not only takes volunteer time and effort to run emrupdate.com, but it also takes money to achieve the web presence. If you can, consider donating what you can afford. The donation link can be found here.
Al Borges MD
Aug 19 2006, 09:10 AM