unexplored factor in rising healthcare costs

Great article about hospitals' group purchasing organizations, or GPOs, and how they drive health care costs up in a variety of ways.

long island hospital moves towards EMRs

North Shore Long Island Jewish Health System, a network of 13 hospitals, has announced its intention to digitize its record system. The hospital hopes the new system will provide both a competitive advantage for itself and improved care for patients, mostly by better integrating records kept across the system. The estimated cost: $400 million. NYC's government has historically been a leader in encouraging the adoption of EMRs, but most of that has been in small private practices, nothing on the scale of a network like this.

EMR transition could be source of jobs

Last week, CBS News published an article about the job opportunities created in the health field by the transition from paper-based records to electronic charting.

Millions of charts will have to be transitioned from paper. Claire Dixon-Lee, of the American Health Information Management Association, points out that these charts will not only come from hospitals, but from doctor's offices, long-term care facilities, and even dentists. Her group has estimated that over 75,000 new jobs will be created in the health care industry to manage this transition. There is even a new field, "health information management", growing to accommodate the need. Typically, people going in to the field get and associate's degree and then can command salaries of $25,000-45,000.

New York City has an unusually strong health IT support. The Primary Care Information Project (PCIP) was designed and implemented by the city to encourage providers to transition to electronic charting. PCIP has targeted practices in underserved areas, and claims that 53% of the "smallest practices" work with the project, compared to a national average of 2%.

nyc singled out as having great health IT

Healthcare Information and Management Systems Society (HIMSS), a healthcare technology lobbying group, has singled out NYC's Primary Care Information Project (PCIP) as a potential model for future health IT projects across the nation.

The recent stimulus package offered a financial incentive to those providers who incorporate a "meaningful use" of health IT into their practices by 2011. To facilitate this, the government proposed establishing regional IT centers to support providers making the transition to electronic medical records (EMRs). PCIP, HIMSS argues, is a perfect model for just such a regional IT center.

PCIP was established in 2007 by the NYC Department of Health and Mental Hygiene. It currently targets providers looking to use EMRs who serve large groups of patients who rely on public insurance. PCIP helps them transition to EMRs by bulk purchasing eClinicalWorks, an EMR software, and contracting with its makers to provide two years of support to the providers who opt to use it. PCIP itself also works with these providers, developing trainings for the software, and evaluation rubrics that providers can access to assess how well they are using the software.

PCIP boasts a high level of buy in from targeted providers. The director of PCIP, Farzad Mostashari, told HIMSS, “We have been able to reach Medicaid providers in the city’s poorest neighborhoods in Harlem, the South Bronx, central Brooklyn...With the smallest practices that nationally have a 2 percent implementation rate of electronic health records, 53 percent of them are in our project.”

The practice I'm at for clinical uses eClinicalWorks, and it seems great to me. While I have never used any other EMR, and so can only compare it to paper charting, the difference between those two is huge. The program makes it incredibly easy to access notes from previous appointments, healthcare maitenance information like immunization status, and personal and familial medical histories, and to apply them immediately. Paper charts leave you fumbling for such information, and often present it in fragments so it's difficult to use in the moment.

stimulus summary

This is the best summary I've found thus far on how health-related spending is faring in the stimulus package. To be brief: not well.

must read for primary care providers

Terrific blog post on Wonk Room from Friday. Covers the evolution of the health portion of the stimulus bill, including how it will incentivize the development of IT in primary care. There's a great point at the end about how IT is in some ways uniquely relevant to PCPs (primary care providers) who "own their infrastructure" in way most specialists don't.