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September 21-25, marked the 4th annual National Health IT Week. The nearly $20 billion set aside for health information technology stimulus in the American Recovery and Reinvestment Act (ARRA) won't be rolling out until 2011, but the Obama administration has dubbed 2009 the "Year of Healthcare Transformation." High-tech companies, hospitals and ambulatory health care centers are struggling to make the grade for future funding in order to meet the nation's health IT goals by 2014.

This year, Health IT Week was a forum for governmental, non-profit, academic and industry leaders to reach a formal partnership with the intention of improving implementation and interoperability of health IT throughout the country. The biggest push in health IT is the electronic medical record, or EMR. The technology promises a lot for health care reform -- better, more comprehensive patient care, fewer medical errors and duplicate testing, more transparency and detailed outcomes reporting, and improved accuracy in coding and reimbursement.

Congressman Patrick Kennedy (D-RI), Co-chair of the 21st Century Health Care Caucus, moderated the official news conference held Tues, Sept. 22, in Washington, D.C. He had a few things to say about the agenda behind Health IT Week.

"We need to guarantee people access to affordable health care, but we can't do that without getting a handle on costs," Kennedy said. "The choice is further rationing of care or transforming the system to get better outcomes for the money we spend. We need more research to get an evidence base about what care is most effective so we can better value the care we give. Medicare is beginning to invest in comparative effectiveness research, but we can't do that kind of research without data on clinical outcomes. We need new and innovative ways to pay for primary care so docs and patients are partners in managing chronic illnesses, not simply treating acute instances and having occasional office visits. We can't do this without the ability to coordinate care across providers and geography. For all these reasons, we need health care IT."

300 EMR Vendors

DOTmed recently spoke with Beverly Bell, partner of CSC Healthcare Group, a leading health IT consulting group. Bell informed us that there are more than 300 EMR vendors providing unique products, with some of the top players being eClinicalWorks, Epic, McKesson, Cerner, NextGen and Allscripts. For those who are still confused between the term electronic medical record and electronic health record, Bell mentioned that "EMR and EHR mean the same thing to most people in the industry and are used interchangeably. However, there are some definitions for both that are very slightly different."

For others, the EHR is the universal record that expands upon and unites electronic medical records, which document single medical events. There are currently more than 600,000 practicing physicians in the U.S. and according to a study published in the New England Journal of Medicine, about 17 percent of those physicians are using some form of electronic medical record technology.

High-tech companies that have not had a lot of penetration in the health care market are now eager to get a piece of the action and major players like Dell are coming up with innovative health IT platforms that will have them profiting from the waves of EMR adoption forecast in the not-too-distant future.

"Dell is now offering a complete EMR solution for the physician," Dell Healthcare spokesperson Cathie Hargett told DOTmed. "Ordinarily the physician or hospital would have to go to the EMR software provider and then a hardware provider, find someone to install the hardware in their practice and then someone else for ongoing support. That whole process can be very time consuming and it has prevented widespread adoption of electronic health records, even though the technology has been around for 15 to 20 years."

Dell also just announced their intent to acquire IT integration and data-hosting company Perot Systems, which has held a partnership with the acquiring company for several years. Dell is teaming up with Sam's Club to open a retail channel for their EMR product directed toward individual physician practices, which make up the bulk of the potential market for EMR. On the grand scale, one of Dell's early EMR adopters includes Houston's mammoth Memorial Hermann Healthcare System.

"One of the advantages of our system is that it ensures that physicians can share and exchange information not only with each other, physician to physician, but between the physician and the hospital. We now have a continuum from the retail level up through the largest hospitals and we are bridging the two and bringing in the interoperability and information exchange that they both need," said Hargett.

Vendors and government officials are very vocal about all that EMRs can do for American health care, but a more muted rumble of dissenting voices from clinicians tells a different story -- that while the technology may improve health care over time, it's certainly making many of their lives miserable right now.

Add-ons Proving Key

DOTmed also spoke with Keith Belton, Senior Director of Product Marketing for Nuance Healthcare, about Dragon Medical technology, a novel speech recognition software, which represents the kind of technological add-on that may be necessary to pave the way for increased EMR adoption in its early stages.

Many institutions, when faced with the cost of installing an EMR at somewhere between $20,000 and $30,000, often find that they have to eliminate other costs, including the cost of transcription. This represents a huge paradigm shift for many physicians, said Belton.

"It's turned doctors into typists," he said. "In this business, you don't get paid for what you do. You get paid for what you document."

Belton referred to the industry's "dirty little secret" -- that according to a recent study, 15 percent of doctors said EMRs slowed them down and added, on average, a half hour to an hour and a half to their workload. The study also found that 70 percent of physicians considered EMR adoption 'considerably challenging,' he said.

"EMRs allow doctors to practice better medicine, but it takes time away from focusing on the patient," Belton said.

Dr. Brian Zimmerman works in Miami Valley Hospital's Emergency and Trauma Center in Dayton, Ohio, and considers Dragon Medical one of the primary reasons why the facility has been able to go electronic.

"The ER was first in the hospital to go live with the EMR. We had CPOE [computerized physician order entry], documentation and reporting -- everything. We called it the Big Bang Go Live, but without transcription our physicians revolted," said Dr. Zimmerman. "We went live in Oct 2006 with Dragon available from day one. At first the physicians were hesitant, but then they embraced it."

Dragon Medical seems to be picking up steam, especially on the reimbursement front. "We've seen several studies in physician practice settings that showed $10-13,000 per year in increased reimbursement because of improved notes and coding," said Belton.

Nuance released version 10 of Dragon Medical last year, and now Belton estimates that 100,000 doctors -- about 1 out of 6 doctors -- are using the software, which is compatible with most of the major EMR vendors and allows doctors to speak and enter text into any free-text field in patient records, as well as populate referral forms and billing documentation.

However hospitals and physician offices end up adopting it, the EMR is sure to be on the minds and budgets of anyone hoping to cash in on the ARRA's stimulus monies. Stay tuned as the Obama administration continues to refine the criteria for meaningful use of health IT stimulus funding and as EMR product certification bodies like CCHIT begin to take on more authority by the end of the year.