Jim Schibanoff of the Milliman Care Guidelines, Scott Armstrong of Group Health, John Hammarlund of CMS, and Joe Scherger of Lumetra discuss physician adoption of electronic health records.
Transcript:
Q: Jim Schibanoff, we’ve talked a bit about the cost and investment requirements of adopting these systems. I’m curious also about the impact on providers of learning these new systems, learning how to use them effectively. Is this potentially a larger burden for healthcare providers?
Jim Schibanoff: Well, it’s great to hear Scott describe Group Health’s experience, the after, because most physicians are dealing with the before, which they see as great disruptions to their routines of care, more inefficiencies in their practices. They feel under financial pressure already and here it’s taking more time to use this electronic health record. So getting over that hump is a significant issue. And in systems like the VA, Kaiser, I believe Group Health, there is much more of a group culture. There’s a financial mechanism, a delivery mechanism. The physicians are more integrated into the system, as opposed to all the physicians in private practice who are in one or two physician offices and may go to one or two hospitals.
Mike Kreidler, John Hammarlund, George Scriban, Scott Armstrong, and Ron Sims discuss EHR as a catalyst for healthcare reform, responding to a question submitted by Cody Augdahl.
For submitting this question, Cody Augdahl is a finalist in our question contest. Congratulations, Cody.
Transcript:
Q: I have another question that came from someone who submitted one before the event; it was submitted via e-mail. It’s kind of an interesting question. It asks us to imagine the day when, in fact, a majority of the U.S. population has adopted personally controlled health records. What kind of impact would that have more broadly on the system potentially, do you think? I mean, it’s a little bit hard to put ourselves out there and imagine the circumstance, Mike, but could you see how that might be a catalyst for other change?
Mike Kreidler: I think you need a great deal more transparency in the system than you have right now, and that’s one of the real problems. You can’t even do any accounting in the system right now because of the variation that you have.
John Hammarlund, Regional Administrator for the Centers for Medicare & Medicaid Services, addresses this question at Healthcare Town Hall.
Transcript:
Barry: John Hammarlund, Medicaid & Medicare are kind of at Ground Zero of this demographic time bomb of potentially skyrocketing healthcare costs for the country going forward over the next 20 or 30 years. I’m wondering about your perspective on the potential for healthcare informatics and electronic health records to help us muffle that bomb.
John Hammarlund: Well, actually, I want to thank Ron for bringing up the case of his mother, because actually that’s a perfect argument for why Medicare aspires to have electronic health records for every one of our millions and millions of beneficiaries. It’s not just that it makes good clinical sense, which of course, it does.
Q: Gail Graham, in the case of the V.A., who owns the patient records in your system?
Gail Graham: Well, by statute, V.A., as the custodian of the record. But the information is actually owned by the patient, and the control and the release of that information is owned by the patient. We do have legal parameters for how we keep it and the duration for which we keep it. But disclosures of that information are established in the Privacy Act and in HIPAA. And I think for us, too, our patients have a long history of maintaining a copy of their record that dates back to their military service. So even before provisions of HIPAA allowed for amendment and getting copies of your records, it was a very commonplace thing for the veterans to keep a copy of their medical record as they moved around.
George Scriban of Microsoft, John Hammarlund of CMS, Dr. Joe Scherger of Lumetra, and Dr. Jim Schibanoff of the Milliman Care Guidelines field the question
“With so much focus being placed on hospitals and clinics implementing electronic patient information systems, what – if anything – can state and/or federal government do to help support/alleviate the sometimes significant amount of time it takes physicians and clinicians to learn and become proficient at using a clinical information system – thus amounting to less time for patient care during that learning-curve period?”
For submitting this question, Ed Boyle is a finalist in our question contest. Congratulations, Ed.
Transcript
Q: What can the state and/or federal government do to help physicians learn the clinical information systems without detracting from patient care?
Mike Kreidler: The answer is “yes, there is.” We’re working on administrative simplification so that physicians and payers can process claims in a timely fashion in a common format. The current system is antiquated. Even the rules that have been put forth for the various coding (by federal definition) have significant variations. There are format interpretation differences between one carrier or another. You’ve got to standardize that. Read more…
Will electronic health records (EHRs) minimize mistakes that may arise from sloppy handwriting and illegible files? How do we certify the accuracy of patient-provided health information?
Transcript
Q: How do you resolve issues from inaccurate information in these records?
Gail Graham: I don’t think this a different problem than we had in paper, actually—if you have patients who are not the best historians at the time, for example, or if people forget what allergies they have. You have them admitted in different states and their family providing the information. We had a lot of questions about this from our providers as we bring in other information. What we’ve decided to do is really make it clear where this information came from. Was this a physician? Was this a nurse? Was this a pharmacist? So that the clinician looking at the information can make some judgment calls on the validity of the information. Read more…
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