Mary Ellen Schneider

The malpractice environment may be starting to improve for physicians in one state 2 years after a comprehensive medical liability reform bill was enacted there.

“It's probably too early to see a huge improvement,” said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians.

“But the signs are encouraging,” he said.

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness.

Within weeks of the law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians premiums.

One specialty hit hard by the medical liability crisis is emergency medicine. Since malpractice reform was enacted, there has been a slight uptick in the number of emergency physicians practicing in the state, according to figures from the West Virginia Board of Medicine. In 2003, 178 physicians licensed in the state designated their specialty as emergency medicine. By the end of last year, that figure had risen to 188 physicians.

But physicians aren't out of the woods yet, said Dr. Blum, also of West Virginia University.

The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

In addition to remaining active in state Supreme Court elections, the medical community in the state continues to push for further reforms, said Robert C. Solomon, M.D., faculty director of the emergency medicine residency at Ohio Valley Medical Center in Wheeling.

The malpractice environment may be starting to improve for physicians in one state 2 years after a comprehensive medical liability reform bill was enacted there.

“It's probably too early to see a huge improvement,” said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians.

“But the signs are encouraging,” he said.

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness.

Within weeks of the law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians premiums.

One specialty hit hard by the medical liability crisis is emergency medicine. Since malpractice reform was enacted, there has been a slight uptick in the number of emergency physicians practicing in the state, according to figures from the West Virginia Board of Medicine. In 2003, 178 physicians licensed in the state designated their specialty as emergency medicine. By the end of last year, that figure had risen to 188 physicians.

But physicians aren't out of the woods yet, said Dr. Blum, also of West Virginia University.

The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

In addition to remaining active in state Supreme Court elections, the medical community in the state continues to push for further reforms, said Robert C. Solomon, M.D., faculty director of the emergency medicine residency at Ohio Valley Medical Center in Wheeling.

The malpractice environment may be starting to improve for physicians in one state 2 years after a comprehensive medical liability reform bill was enacted there.

“It's probably too early to see a huge improvement,” said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians.

“But the signs are encouraging,” he said.

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner. The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness.

Within weeks of the law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. “Retention changed almost overnight.”

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians premiums.

One specialty hit hard by the medical liability crisis is emergency medicine. Since malpractice reform was enacted, there has been a slight uptick in the number of emergency physicians practicing in the state, according to figures from the West Virginia Board of Medicine. In 2003, 178 physicians licensed in the state designated their specialty as emergency medicine. By the end of last year, that figure had risen to 188 physicians.

But physicians aren't out of the woods yet, said Dr. Blum, also of West Virginia University.

The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

In addition to remaining active in state Supreme Court elections, the medical community in the state continues to push for further reforms, said Robert C. Solomon, M.D., faculty director of the emergency medicine residency at Ohio Valley Medical Center in Wheeling.

BOSTON — Interoperability is key to the success of electronic health records, but there are barriers to sharing data between systems, said David Brailer, M.D., national coordinator for health information technology.

The major challenges include standards harmonization, unclear data control policies, a lack of uniform security practices, the inability to ensure that products perform as advertised, and the lack of a business model around interoperability, he said.

“At the very basis of this—kind of the DNA of the interoperable electronic health record—is the emergence of harmonized standards,” Dr. Brailer said at a congress sponsored by the American Medical Informatics Association.

There are many organizations involved in developing and approving standards, but there isn't a process for harmonizing two conflicting standards.

In addition, there is no unified maintenance or release schedule for standards so that the industry can know what's coming and build investment plans around it, Dr. Brailer said.

Further, there is no means of providing input into the standards process, he said. For example, there isn't a mechanism for taking a problem in health care and distilling that into requirements that could be used by organizations that develop standards.

“Problems don't come well packaged into a standard,” Dr. Brailer said.

Harmonized standards are at the core of interoperability, but even with standards there are many other factors in achieving interoperability, he said.

One less well-known obstacle to interoperability is the lack of clear policies about data control. Health care right now lacks even a vocabulary to talk about the control of data, Dr. Brailer said. Deciding on a set of terms and their meanings will be essential to figuring out who decides if information flows from point A to point B, in what way, and who will be notified.

Security standards pose another set of problems, Dr. Brailer said. Currently, it's possible for any two health care organizations to be compliant with the Health Insurance Portability and Accountability Act of 1996 and still have security practices that render their data unable to be shared.

For example, one organization may adopt user names and passwords for authentication while another organization uses a biometric thumbprint.

Some solutions are being developed to bridge the different levels of security. For example, security brokers or other third parties could navigate between two systems. And some states have talked about creating more requirements for uniformity of security practices.

“I think this is a profound barrier to our ability to be interoperable, and standards won't address it,” Dr. Brailer said.

Physicians also need to be able to know if the system they purchase will be able to deliver on the vendor's promises of interoperability. The industry is taking a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, a group that will certify that EHRs and other products meet minimum standards.

This work is important not just so that EHRs will one day become “plug and play” technology, Dr. Brailer said, but also because it will take some of the risk out of the marketplace.

But ultimately, interoperable EHRs can't become successful without a viable business model. The industry is just starting to experiment with the value drivers in this area, such as research, clinical improvement, and transaction simplification compared with paper.

“The government's not going to tell you what the business model is,” Dr. Brailer said.

The challenge is not just what the business benefit is but who receives it, he said. And Dr. Brailer predicts that this interplay of costs and benefits will lead to new relationships between providers and payers and other entities.

BOSTON — Interoperability is key to the success of electronic health records, but there are barriers to sharing data between systems, said David Brailer, M.D., national coordinator for health information technology.

The major challenges include standards harmonization, unclear data control policies, a lack of uniform security practices, the inability to ensure that products perform as advertised, and the lack of a business model around interoperability, he said.

“At the very basis of this—kind of the DNA of the interoperable electronic health record—is the emergence of harmonized standards,” Dr. Brailer said at a congress sponsored by the American Medical Informatics Association.

There are many organizations involved in developing and approving standards, but there isn't a process for harmonizing two conflicting standards.

In addition, there is no unified maintenance or release schedule for standards so that the industry can know what's coming and build investment plans around it, Dr. Brailer said.

Further, there is no means of providing input into the standards process, he said. For example, there isn't a mechanism for taking a problem in health care and distilling that into requirements that could be used by organizations that develop standards.

“Problems don't come well packaged into a standard,” Dr. Brailer said.

Harmonized standards are at the core of interoperability, but even with standards there are many other factors in achieving interoperability, he said.

One less well-known obstacle to interoperability is the lack of clear policies about data control. Health care right now lacks even a vocabulary to talk about the control of data, Dr. Brailer said. Deciding on a set of terms and their meanings will be essential to figuring out who decides if information flows from point A to point B, in what way, and who will be notified.

Security standards pose another set of problems, Dr. Brailer said. Currently, it's possible for any two health care organizations to be compliant with the Health Insurance Portability and Accountability Act of 1996 and still have security practices that render their data unable to be shared.

For example, one organization may adopt user names and passwords for authentication while another organization uses a biometric thumbprint.

Some solutions are being developed to bridge the different levels of security. For example, security brokers or other third parties could navigate between two systems. And some states have talked about creating more requirements for uniformity of security practices.

“I think this is a profound barrier to our ability to be interoperable, and standards won't address it,” Dr. Brailer said.

Physicians also need to be able to know if the system they purchase will be able to deliver on the vendor's promises of interoperability. The industry is taking a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, a group that will certify that EHRs and other products meet minimum standards.

This work is important not just so that EHRs will one day become “plug and play” technology, Dr. Brailer said, but also because it will take some of the risk out of the marketplace.

But ultimately, interoperable EHRs can't become successful without a viable business model. The industry is just starting to experiment with the value drivers in this area, such as research, clinical improvement, and transaction simplification compared with paper.

“The government's not going to tell you what the business model is,” Dr. Brailer said.

The challenge is not just what the business benefit is but who receives it, he said. And Dr. Brailer predicts that this interplay of costs and benefits will lead to new relationships between providers and payers and other entities.

BOSTON — Interoperability is key to the success of electronic health records, but there are barriers to sharing data between systems, said David Brailer, M.D., national coordinator for health information technology.

The major challenges include standards harmonization, unclear data control policies, a lack of uniform security practices, the inability to ensure that products perform as advertised, and the lack of a business model around interoperability, he said.

“At the very basis of this—kind of the DNA of the interoperable electronic health record—is the emergence of harmonized standards,” Dr. Brailer said at a congress sponsored by the American Medical Informatics Association.

There are many organizations involved in developing and approving standards, but there isn't a process for harmonizing two conflicting standards.

In addition, there is no unified maintenance or release schedule for standards so that the industry can know what's coming and build investment plans around it, Dr. Brailer said.

Further, there is no means of providing input into the standards process, he said. For example, there isn't a mechanism for taking a problem in health care and distilling that into requirements that could be used by organizations that develop standards.

“Problems don't come well packaged into a standard,” Dr. Brailer said.

Harmonized standards are at the core of interoperability, but even with standards there are many other factors in achieving interoperability, he said.

One less well-known obstacle to interoperability is the lack of clear policies about data control. Health care right now lacks even a vocabulary to talk about the control of data, Dr. Brailer said. Deciding on a set of terms and their meanings will be essential to figuring out who decides if information flows from point A to point B, in what way, and who will be notified.

Security standards pose another set of problems, Dr. Brailer said. Currently, it's possible for any two health care organizations to be compliant with the Health Insurance Portability and Accountability Act of 1996 and still have security practices that render their data unable to be shared.

For example, one organization may adopt user names and passwords for authentication while another organization uses a biometric thumbprint.

Some solutions are being developed to bridge the different levels of security. For example, security brokers or other third parties could navigate between two systems. And some states have talked about creating more requirements for uniformity of security practices.

“I think this is a profound barrier to our ability to be interoperable, and standards won't address it,” Dr. Brailer said.

Physicians also need to be able to know if the system they purchase will be able to deliver on the vendor's promises of interoperability. The industry is taking a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, a group that will certify that EHRs and other products meet minimum standards.

This work is important not just so that EHRs will one day become “plug and play” technology, Dr. Brailer said, but also because it will take some of the risk out of the marketplace.

But ultimately, interoperable EHRs can't become successful without a viable business model. The industry is just starting to experiment with the value drivers in this area, such as research, clinical improvement, and transaction simplification compared with paper.

“The government's not going to tell you what the business model is,” Dr. Brailer said.

The challenge is not just what the business benefit is but who receives it, he said. And Dr. Brailer predicts that this interplay of costs and benefits will lead to new relationships between providers and payers and other entities.

BOSTON — To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., said at a congress sponsored by the American Medical Informatics Association.

“You have to plan,” said Dr. Carter, chief executive officer of NT&M Informatics, Inc., Atlanta, and the editor of “Electronic Medical Records: A Guide for Clinicians and Administrators,” published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance.

“This is not the time to experiment with the latest gadgets,” he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand the current problems within the practice, to figure out how the practice should function, and identify what keeps the practice and its current system from working in an ideal way.

Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems, he said.

The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created.

During product review, it's important to have a designated project manager whose only job is to shepherd the project through each stage. In addition, senior executive support—both administrative and clinical—is key since that group will make the final decision on a system.

And staff input is essential since these are the people who really know what goes on in your practice, Dr. Carter said.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. “Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there,” he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs). Tablet computers are popular but people also tend to drop them and spill coffee on them, he said.

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

When the time comes, there are a variety of ways to roll out a system, Dr. Carter said. For example, a practice can test all the features at once through a pilot at one site in the practice. Another option is to phase in implementation of the most important features first across the entire organization.

Or a practice could opt to try a “big bang” rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with only two sites and fewer than 10 physicians, Dr. Carter said.

BOSTON — To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., said at a congress sponsored by the American Medical Informatics Association.

“You have to plan,” said Dr. Carter, chief executive officer of NT&M Informatics, Inc., Atlanta, and the editor of “Electronic Medical Records: A Guide for Clinicians and Administrators,” published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance.

“This is not the time to experiment with the latest gadgets,” he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand the current problems within the practice, to figure out how the practice should function, and identify what keeps the practice and its current system from working in an ideal way.

Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems, he said.

The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created.

During product review, it's important to have a designated project manager whose only job is to shepherd the project through each stage. In addition, senior executive support—both administrative and clinical—is key since that group will make the final decision on a system.

And staff input is essential since these are the people who really know what goes on in your practice, Dr. Carter said.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. “Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there,” he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs). Tablet computers are popular but people also tend to drop them and spill coffee on them, he said.

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

When the time comes, there are a variety of ways to roll out a system, Dr. Carter said. For example, a practice can test all the features at once through a pilot at one site in the practice. Another option is to phase in implementation of the most important features first across the entire organization.

Or a practice could opt to try a “big bang” rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with only two sites and fewer than 10 physicians, Dr. Carter said.

BOSTON — To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., said at a congress sponsored by the American Medical Informatics Association.

“You have to plan,” said Dr. Carter, chief executive officer of NT&M Informatics, Inc., Atlanta, and the editor of “Electronic Medical Records: A Guide for Clinicians and Administrators,” published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance.

“This is not the time to experiment with the latest gadgets,” he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand the current problems within the practice, to figure out how the practice should function, and identify what keeps the practice and its current system from working in an ideal way.

Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems, he said.

The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created.

During product review, it's important to have a designated project manager whose only job is to shepherd the project through each stage. In addition, senior executive support—both administrative and clinical—is key since that group will make the final decision on a system.

And staff input is essential since these are the people who really know what goes on in your practice, Dr. Carter said.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. “Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there,” he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs). Tablet computers are popular but people also tend to drop them and spill coffee on them, he said.

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

When the time comes, there are a variety of ways to roll out a system, Dr. Carter said. For example, a practice can test all the features at once through a pilot at one site in the practice. Another option is to phase in implementation of the most important features first across the entire organization.

Or a practice could opt to try a “big bang” rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with only two sites and fewer than 10 physicians, Dr. Carter said.

BOSTON — Three Massachusetts communities will soon be wired for electronic health record systems as part of a $50 million pilot project.

The idea, which is being undertaken by the Massachusetts eHealth Collaborative, is to test out the implementation of interoperable EHRs within communities before attempting to connect physicians across the entire state.

“We're completely focused on practical solutions so we can get these things into physicians' hands and health care professionals' hands and keep them there,” Micky Tripathi, CEO of the Massachusetts eHealth Collaborative said at a congress sponsored by the American Medical Informatics Association.

The collaborative is a not-for-profit group that was founded by 34 health care institutions seeking to create a health information network that would connect providers statewide.

The collaborative was launched last fall and requested applications for its pilot project last December. It received a total of 35 applications from communities located across the state and chose three communities—greater Brockton, greater Newburyport, and Northern Berkshire. The pilot project is being funded through a grant from Blue Cross Blue Shield of Massachusetts.

Each community chosen for the pilot project was a relatively self-contained medical referral market, had strong local health care professional leadership, and demonstrated an openness to information technology innovation, Mr. Tripathi said.

The final selection of the three communities was based in part on location, patient diversity, and information technology maturity, he said. Members of the collaborative also wanted to choose communities that were at different points of the information technology adoption curve in order to see the different types of benefits.

The three communities cover a total of nearly 600 physicians treating approximately 500,000 patients. Overall, there are 182 primary care physicians and 410 specialists. The pilots will include almost 200 office sites, most of which have between one and five physicians, Mr. Tripathi said.

The pilot projects will include the purchase and installation of EHRs at all clinical care points, as well as connecting them to other systems within the community.

Although existing studies have shown the benefits that are conferred by the use of EHRs on a small scale, Mr. Tripathi said the pilot project is a chance to see what will happen in a larger, community-wide rollout.

The pilot will be aimed at determining the barriers to adoption, identifying the costs—both direct and indirect—of adoption, and analyzing the benefits. Officials at the collaborative will also be seeking to figure out how the costs and benefits are distributed across the various stakeholders.

Finally, they will be looking for the best ways to provide incentives and how that could be replicated going forward.

“This transition can't be done to physicians,” he said. “It's got to be an idea that we sell to them.”

The Massachusetts eHealth Collaborative plans to select EHR vendors by the end of May and be under contract by the end of the summer.

The pilot timeline calls for implementing systems in a clinical care setting before the end of the year. At the beginning of 2006, the collaborative expects to implement interoperability capabilities for the systems.

The pilot projects are slated to end in mid-2008.

In addition, the collaborative plans to work with the other 32 communities that were not selected for the pilot to help them implement EHR systems by sharing the infrastructure, expertise, and arrangements created through the pilots.

BOSTON — Three Massachusetts communities will soon be wired for electronic health record systems as part of a $50 million pilot project.

The idea, which is being undertaken by the Massachusetts eHealth Collaborative, is to test out the implementation of interoperable EHRs within communities before attempting to connect physicians across the entire state.

“We're completely focused on practical solutions so we can get these things into physicians' hands and health care professionals' hands and keep them there,” Micky Tripathi, CEO of the Massachusetts eHealth Collaborative said at a congress sponsored by the American Medical Informatics Association.

The collaborative is a not-for-profit group that was founded by 34 health care institutions seeking to create a health information network that would connect providers statewide.

The collaborative was launched last fall and requested applications for its pilot project last December. It received a total of 35 applications from communities located across the state and chose three communities—greater Brockton, greater Newburyport, and Northern Berkshire. The pilot project is being funded through a grant from Blue Cross Blue Shield of Massachusetts.

Each community chosen for the pilot project was a relatively self-contained medical referral market, had strong local health care professional leadership, and demonstrated an openness to information technology innovation, Mr. Tripathi said.

The final selection of the three communities was based in part on location, patient diversity, and information technology maturity, he said. Members of the collaborative also wanted to choose communities that were at different points of the information technology adoption curve in order to see the different types of benefits.

The three communities cover a total of nearly 600 physicians treating approximately 500,000 patients. Overall, there are 182 primary care physicians and 410 specialists. The pilots will include almost 200 office sites, most of which have between one and five physicians, Mr. Tripathi said.

The pilot projects will include the purchase and installation of EHRs at all clinical care points, as well as connecting them to other systems within the community.

Although existing studies have shown the benefits that are conferred by the use of EHRs on a small scale, Mr. Tripathi said the pilot project is a chance to see what will happen in a larger, community-wide rollout.

The pilot will be aimed at determining the barriers to adoption, identifying the costs—both direct and indirect—of adoption, and analyzing the benefits. Officials at the collaborative will also be seeking to figure out how the costs and benefits are distributed across the various stakeholders.

Finally, they will be looking for the best ways to provide incentives and how that could be replicated going forward.

“This transition can't be done to physicians,” he said. “It's got to be an idea that we sell to them.”

The Massachusetts eHealth Collaborative plans to select EHR vendors by the end of May and be under contract by the end of the summer.

The pilot timeline calls for implementing systems in a clinical care setting before the end of the year. At the beginning of 2006, the collaborative expects to implement interoperability capabilities for the systems.

The pilot projects are slated to end in mid-2008.

In addition, the collaborative plans to work with the other 32 communities that were not selected for the pilot to help them implement EHR systems by sharing the infrastructure, expertise, and arrangements created through the pilots.

BOSTON — Three Massachusetts communities will soon be wired for electronic health record systems as part of a $50 million pilot project.

The idea, which is being undertaken by the Massachusetts eHealth Collaborative, is to test out the implementation of interoperable EHRs within communities before attempting to connect physicians across the entire state.

“We're completely focused on practical solutions so we can get these things into physicians' hands and health care professionals' hands and keep them there,” Micky Tripathi, CEO of the Massachusetts eHealth Collaborative said at a congress sponsored by the American Medical Informatics Association.

The collaborative is a not-for-profit group that was founded by 34 health care institutions seeking to create a health information network that would connect providers statewide.

The collaborative was launched last fall and requested applications for its pilot project last December. It received a total of 35 applications from communities located across the state and chose three communities—greater Brockton, greater Newburyport, and Northern Berkshire. The pilot project is being funded through a grant from Blue Cross Blue Shield of Massachusetts.

Each community chosen for the pilot project was a relatively self-contained medical referral market, had strong local health care professional leadership, and demonstrated an openness to information technology innovation, Mr. Tripathi said.

The final selection of the three communities was based in part on location, patient diversity, and information technology maturity, he said. Members of the collaborative also wanted to choose communities that were at different points of the information technology adoption curve in order to see the different types of benefits.

The three communities cover a total of nearly 600 physicians treating approximately 500,000 patients. Overall, there are 182 primary care physicians and 410 specialists. The pilots will include almost 200 office sites, most of which have between one and five physicians, Mr. Tripathi said.

The pilot projects will include the purchase and installation of EHRs at all clinical care points, as well as connecting them to other systems within the community.

Although existing studies have shown the benefits that are conferred by the use of EHRs on a small scale, Mr. Tripathi said the pilot project is a chance to see what will happen in a larger, community-wide rollout.

The pilot will be aimed at determining the barriers to adoption, identifying the costs—both direct and indirect—of adoption, and analyzing the benefits. Officials at the collaborative will also be seeking to figure out how the costs and benefits are distributed across the various stakeholders.

Finally, they will be looking for the best ways to provide incentives and how that could be replicated going forward.

“This transition can't be done to physicians,” he said. “It's got to be an idea that we sell to them.”

The Massachusetts eHealth Collaborative plans to select EHR vendors by the end of May and be under contract by the end of the summer.

The pilot timeline calls for implementing systems in a clinical care setting before the end of the year. At the beginning of 2006, the collaborative expects to implement interoperability capabilities for the systems.

The pilot projects are slated to end in mid-2008.

In addition, the collaborative plans to work with the other 32 communities that were not selected for the pilot to help them implement EHR systems by sharing the infrastructure, expertise, and arrangements created through the pilots.

BOSTON – To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., said at a congress sponsored by the American Medical Informatics Association.

“You have to plan,” said Dr. Carter, chief executive officer of NT&M Informatics, Inc., Atlanta, and the editor of “Electronic Medical Records: A Guide for Clinicians and Administrators,” published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance.

“This is not the time to experiment with the latest gadgets,” he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand the current problems within the practice, to figure out how the practice should function, and to identify what keeps the practice and its current system from working in an ideal way.

Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems, he said.

The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created.

When reviewing products, it's important to have a designated project manager whose only job is to shepherd the project through each stage. In addition, senior executive support–both administrative and clinical–is key since that group will make the final decision on a system.

And staff input is essential since these are the people who really know what goes on in your practice, Dr. Carter said.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. “Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there,” he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs). Tablet computers are popular but people also tend to drop them and spill coffee on them, he said.

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

When the time comes, there are a variety of ways to roll out a system, Dr. Carter said. For example, a practice can test all the features at once through a pilot at one site in the practice. Another option is to phase in implementation of the most important features first across the entire organization.

Or a practice could opt to try a “big bang” rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with only two sites and fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing staff training is critical. It is not a one-time event. Staff will need training on the workflow change and planning aspects and the actual EHR system. Physicians will need additional training on physician-specific issues related to implementation, he said.

BOSTON – To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., said at a congress sponsored by the American Medical Informatics Association.

“You have to plan,” said Dr. Carter, chief executive officer of NT&M Informatics, Inc., Atlanta, and the editor of “Electronic Medical Records: A Guide for Clinicians and Administrators,” published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance.

“This is not the time to experiment with the latest gadgets,” he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand the current problems within the practice, to figure out how the practice should function, and to identify what keeps the practice and its current system from working in an ideal way.

Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems, he said.

The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created.

When reviewing products, it's important to have a designated project manager whose only job is to shepherd the project through each stage. In addition, senior executive support–both administrative and clinical–is key since that group will make the final decision on a system.

And staff input is essential since these are the people who really know what goes on in your practice, Dr. Carter said.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. “Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there,” he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs). Tablet computers are popular but people also tend to drop them and spill coffee on them, he said.

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

When the time comes, there are a variety of ways to roll out a system, Dr. Carter said. For example, a practice can test all the features at once through a pilot at one site in the practice. Another option is to phase in implementation of the most important features first across the entire organization.

Or a practice could opt to try a “big bang” rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with only two sites and fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing staff training is critical. It is not a one-time event. Staff will need training on the workflow change and planning aspects and the actual EHR system. Physicians will need additional training on physician-specific issues related to implementation, he said.

BOSTON – To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., said at a congress sponsored by the American Medical Informatics Association.

“You have to plan,” said Dr. Carter, chief executive officer of NT&M Informatics, Inc., Atlanta, and the editor of “Electronic Medical Records: A Guide for Clinicians and Administrators,” published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance.

“This is not the time to experiment with the latest gadgets,” he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand the current problems within the practice, to figure out how the practice should function, and to identify what keeps the practice and its current system from working in an ideal way.

Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems, he said.

The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created.

When reviewing products, it's important to have a designated project manager whose only job is to shepherd the project through each stage. In addition, senior executive support–both administrative and clinical–is key since that group will make the final decision on a system.

And staff input is essential since these are the people who really know what goes on in your practice, Dr. Carter said.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. “Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there,” he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs). Tablet computers are popular but people also tend to drop them and spill coffee on them, he said.

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

When the time comes, there are a variety of ways to roll out a system, Dr. Carter said. For example, a practice can test all the features at once through a pilot at one site in the practice. Another option is to phase in implementation of the most important features first across the entire organization.

Or a practice could opt to try a “big bang” rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with only two sites and fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing staff training is critical. It is not a one-time event. Staff will need training on the workflow change and planning aspects and the actual EHR system. Physicians will need additional training on physician-specific issues related to implementation, he said.

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers begin to recognize that their behaviors can lead to a health outcome that might cost them money in the long run, said Doug Kronenberg, chief strategy officer for Lumenos, an Alexandria, Va.-based company that sells health savings accounts (HSAs). And so they begin to think about changing their behavior, he said.

When an employer or insurer combines an HSA with a program that also shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg said during a teleconference sponsored by the Kaiser Family Foundation.

HSAs were authorized under the Medicare Modernization Act of 2003 and are portable accounts that consumers can use to pay for certain qualified medical expenses. The accounts are generally offered in conjunction with a high-deductible insurance plan, and both consumers and employers can contribute.

HSAs and similar accounts, such as health reimbursement accounts, can also create big savings for employers, Mr. Kronenberg said. With these types of plans, consumers tend to see the money as their own, and utilization of health care services typically drops.

But Mila Kofman, J.D., assistant research professor at the Health Policy Institute at Georgetown University, Washington, said that HSAs coupled with high deductible plans are just shifting the cost burden for health care from the insurer and the employer to the consumer.

And one of the possible pitfalls of the plans is that consumers who are facing deductibles of $1,000 or more each year will simply forego needed medical care.

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers begin to recognize that their behaviors can lead to a health outcome that might cost them money in the long run, said Doug Kronenberg, chief strategy officer for Lumenos, an Alexandria, Va.-based company that sells health savings accounts (HSAs). And so they begin to think about changing their behavior, he said.

When an employer or insurer combines an HSA with a program that also shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg said during a teleconference sponsored by the Kaiser Family Foundation.

HSAs were authorized under the Medicare Modernization Act of 2003 and are portable accounts that consumers can use to pay for certain qualified medical expenses. The accounts are generally offered in conjunction with a high-deductible insurance plan, and both consumers and employers can contribute.

HSAs and similar accounts, such as health reimbursement accounts, can also create big savings for employers, Mr. Kronenberg said. With these types of plans, consumers tend to see the money as their own, and utilization of health care services typically drops.

But Mila Kofman, J.D., assistant research professor at the Health Policy Institute at Georgetown University, Washington, said that HSAs coupled with high deductible plans are just shifting the cost burden for health care from the insurer and the employer to the consumer.

And one of the possible pitfalls of the plans is that consumers who are facing deductibles of $1,000 or more each year will simply forego needed medical care.

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers begin to recognize that their behaviors can lead to a health outcome that might cost them money in the long run, said Doug Kronenberg, chief strategy officer for Lumenos, an Alexandria, Va.-based company that sells health savings accounts (HSAs). And so they begin to think about changing their behavior, he said.

When an employer or insurer combines an HSA with a program that also shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg said during a teleconference sponsored by the Kaiser Family Foundation.

HSAs were authorized under the Medicare Modernization Act of 2003 and are portable accounts that consumers can use to pay for certain qualified medical expenses. The accounts are generally offered in conjunction with a high-deductible insurance plan, and both consumers and employers can contribute.

HSAs and similar accounts, such as health reimbursement accounts, can also create big savings for employers, Mr. Kronenberg said. With these types of plans, consumers tend to see the money as their own, and utilization of health care services typically drops.

But Mila Kofman, J.D., assistant research professor at the Health Policy Institute at Georgetown University, Washington, said that HSAs coupled with high deductible plans are just shifting the cost burden for health care from the insurer and the employer to the consumer.

And one of the possible pitfalls of the plans is that consumers who are facing deductibles of $1,000 or more each year will simply forego needed medical care.

BOSTON — Interoperability is key to the success of electronic health records, but there are barriers to sharing data between systems, said David Brailer, M.D., national coordinator for health information technology.

The major challenges include standards harmonization, unclear data control policies, a lack of uniform security practices, the inability to ensure that products perform as advertised, and the lack of a business model around interoperability, he said.

"At the very basis of this—kind of the DNA of the interoperable electronic health record—is the emergence of harmonized standards," Dr. Brailer said at a congress sponsored by the American Medical Informatics Association.

There are many organizations involved in developing and approving standards, but there isn't a process for harmonizing two conflicting standards, he commented.

In addition, there is no unified maintenance or release schedule for standards so that the industry can know what's coming and build investment plans around it, Dr. Brailer said.

Further, there is no means of providing input into the standards process. For example, there isn't a mechanism for taking a problem in health care and distilling that into requirements that could be used by organizations that develop standards.

"Problems don't come well packaged into a standard," Dr. Brailer said.

Harmonized standards are at the core of interoperability, but even with standards there are many other factors in achieving interoperability, he said.

One less well-known obstacle to interoperability is the lack of clear policies about data control. Health care right now lacks even a vocabulary to talk about the control of data, Dr. Brailer said. Deciding on a set of terms and their meanings will be essential to figuring out who decides if information flows from point A to point B, in what way, and who will be notified.

Security standards pose another set of problems, Dr. Brailer said. Currently, it's possible for any two health care organizations to be compliant with the Health Insurance Portability and Accountability Act of 1996 and still have security practices that render their data unable to be shared.

For example, one organization may adopt user names and passwords for authentication while another organization uses a biometric thumbprint.

Some solutions are being developed to bridge the different levels of security. For example, security brokers or other third parties could navigate between two systems. And some states have talked about creating more requirements for uniformity of security practices.

"I think this is a profound barrier to our ability to be interoperable, and standards won't address it," Dr. Brailer said.

Physicians also need to be able to know if the system they purchase will be able to deliver on the vendor's promises of interoperability. The industry is taking a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, a group that will certify that EHRs and other products meet minimum standards.

This work is important not just so that EHRs will one day become "plug and play" technology, Dr. Brailer said, but also because it will take some of the risk out of the marketplace.

But ultimately, interoperable EHRs can't become successful without a viable business model.

The industry is just starting to experiment with the value drivers in this area, such as research, clinical improvement, and transaction simplification compared with paper.

"The government's not going to tell you what the business model is," Dr. Brailer said.

The challenge is not just what the business benefit is but who receives it, he said. And Dr. Brailer predicts that this interplay of costs and benefits will lead to new relationships between providers and payers and other entities.

BOSTON — Interoperability is key to the success of electronic health records, but there are barriers to sharing data between systems, said David Brailer, M.D., national coordinator for health information technology.

The major challenges include standards harmonization, unclear data control policies, a lack of uniform security practices, the inability to ensure that products perform as advertised, and the lack of a business model around interoperability, he said.

"At the very basis of this—kind of the DNA of the interoperable electronic health record—is the emergence of harmonized standards," Dr. Brailer said at a congress sponsored by the American Medical Informatics Association.

There are many organizations involved in developing and approving standards, but there isn't a process for harmonizing two conflicting standards, he commented.

In addition, there is no unified maintenance or release schedule for standards so that the industry can know what's coming and build investment plans around it, Dr. Brailer said.

Further, there is no means of providing input into the standards process. For example, there isn't a mechanism for taking a problem in health care and distilling that into requirements that could be used by organizations that develop standards.

"Problems don't come well packaged into a standard," Dr. Brailer said.

Harmonized standards are at the core of interoperability, but even with standards there are many other factors in achieving interoperability, he said.

One less well-known obstacle to interoperability is the lack of clear policies about data control. Health care right now lacks even a vocabulary to talk about the control of data, Dr. Brailer said. Deciding on a set of terms and their meanings will be essential to figuring out who decides if information flows from point A to point B, in what way, and who will be notified.

Security standards pose another set of problems, Dr. Brailer said. Currently, it's possible for any two health care organizations to be compliant with the Health Insurance Portability and Accountability Act of 1996 and still have security practices that render their data unable to be shared.

For example, one organization may adopt user names and passwords for authentication while another organization uses a biometric thumbprint.

Some solutions are being developed to bridge the different levels of security. For example, security brokers or other third parties could navigate between two systems. And some states have talked about creating more requirements for uniformity of security practices.

"I think this is a profound barrier to our ability to be interoperable, and standards won't address it," Dr. Brailer said.

Physicians also need to be able to know if the system they purchase will be able to deliver on the vendor's promises of interoperability. The industry is taking a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, a group that will certify that EHRs and other products meet minimum standards.

This work is important not just so that EHRs will one day become "plug and play" technology, Dr. Brailer said, but also because it will take some of the risk out of the marketplace.

But ultimately, interoperable EHRs can't become successful without a viable business model.

The industry is just starting to experiment with the value drivers in this area, such as research, clinical improvement, and transaction simplification compared with paper.

"The government's not going to tell you what the business model is," Dr. Brailer said.

The challenge is not just what the business benefit is but who receives it, he said. And Dr. Brailer predicts that this interplay of costs and benefits will lead to new relationships between providers and payers and other entities.

BOSTON — Interoperability is key to the success of electronic health records, but there are barriers to sharing data between systems, said David Brailer, M.D., national coordinator for health information technology.

The major challenges include standards harmonization, unclear data control policies, a lack of uniform security practices, the inability to ensure that products perform as advertised, and the lack of a business model around interoperability, he said.

"At the very basis of this—kind of the DNA of the interoperable electronic health record—is the emergence of harmonized standards," Dr. Brailer said at a congress sponsored by the American Medical Informatics Association.

There are many organizations involved in developing and approving standards, but there isn't a process for harmonizing two conflicting standards, he commented.

In addition, there is no unified maintenance or release schedule for standards so that the industry can know what's coming and build investment plans around it, Dr. Brailer said.

Further, there is no means of providing input into the standards process. For example, there isn't a mechanism for taking a problem in health care and distilling that into requirements that could be used by organizations that develop standards.

"Problems don't come well packaged into a standard," Dr. Brailer said.

Harmonized standards are at the core of interoperability, but even with standards there are many other factors in achieving interoperability, he said.

One less well-known obstacle to interoperability is the lack of clear policies about data control. Health care right now lacks even a vocabulary to talk about the control of data, Dr. Brailer said. Deciding on a set of terms and their meanings will be essential to figuring out who decides if information flows from point A to point B, in what way, and who will be notified.

Security standards pose another set of problems, Dr. Brailer said. Currently, it's possible for any two health care organizations to be compliant with the Health Insurance Portability and Accountability Act of 1996 and still have security practices that render their data unable to be shared.

For example, one organization may adopt user names and passwords for authentication while another organization uses a biometric thumbprint.

Some solutions are being developed to bridge the different levels of security. For example, security brokers or other third parties could navigate between two systems. And some states have talked about creating more requirements for uniformity of security practices.

"I think this is a profound barrier to our ability to be interoperable, and standards won't address it," Dr. Brailer said.

Physicians also need to be able to know if the system they purchase will be able to deliver on the vendor's promises of interoperability. The industry is taking a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, a group that will certify that EHRs and other products meet minimum standards.

This work is important not just so that EHRs will one day become "plug and play" technology, Dr. Brailer said, but also because it will take some of the risk out of the marketplace.

But ultimately, interoperable EHRs can't become successful without a viable business model.

The industry is just starting to experiment with the value drivers in this area, such as research, clinical improvement, and transaction simplification compared with paper.

"The government's not going to tell you what the business model is," Dr. Brailer said.

The challenge is not just what the business benefit is but who receives it, he said. And Dr. Brailer predicts that this interplay of costs and benefits will lead to new relationships between providers and payers and other entities.

Medicare officials have proposed new uniform standards for electronic prescribing that will govern transactions between prescribers and dispensers of prescriptions.

Under the proposal, the standards would take effect in January, to coincide with the beginning of the new Medicare Part D prescription drug benefit.

The proposed standards would apply to transactions between prescribers and dispensers of new prescriptions, refill requests, prescription changes, and cancellation requests. In addition, the standards would govern eligibility and benefits inquiries between prescribers and drug plans and Part D sponsors.

The Health and Human Services Department was accepting comments on the proposal through April 5. Additional electronic prescribing standards will be developed by 2008. Electronic prescribing is voluntary for physicians, but the aim is to make it easier and more attractive for physicians to use the technology.

"These proposed e-prescription rules would set standards to help Medicare, physicians, and pharmacies take advantage of new technology that can improve the health care of seniors and persons with disabilities," HHS Secretary Mike Leavitt said in a statement.

One of the most successful strategies for getting physicians to adopt electronic prescribing systems in their offices is to provide ongoing reimbursement, said Jonathan Teich, M.D., chief medical officer at Healthvision, an Internet health care company, who chaired the Electronic Prescribing Project of the eHealth Initiative.

Over the last few years, there's been a lot of work in both the public and private sectors examining what drives adoption of e-prescribing. What they have found is that there is money to be saved through the use of the technology, but it's usually saved by the payer, not by the physician, he said.

But payers and others can provide incentives to physicians by supplying the technology up front, giving increased reimbursement per visit for the use of electronic prescribing, or incorporating electronic prescribing into a pay for performance program, Dr. Teich said.

A group of health plans in Massachusetts has joined forces to cover the costs of electronic prescribing for physicians interested in integrating the technology into their practices. Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, and the Neighborhood Health Plan have partnered with the technology vendor ZixCorp to provide physicians in Massachusetts with the hardware and software needed for electronic prescribing.

The project is called the eRx Collaborative, and from October 2003 through the end of 2004, nearly 2,700 physicians and their clinical staff members signed up to participate in the project.

At the end of last year, more than 1,500 doctors had incorporated the technology into their practices. The collaborative plans to cover the costs of the e-prescribing technology through the end of this year. The project uses ZixCorp's PocketScript e-prescribing system, which allows physicians to create new and refill prescriptions electronically and allows for real-time access to a patient's prescription history.

This year, physicians will also be able to choose to use DrFirst Inc.'s Rcopia electronic prescription management program.

Facilitating the adoption of electronic prescribing is a way to try to curb both high pharmacy costs and medication errors, said Robert Mandel, M.D., vice president of eHealth for Blue Cross Blue Shield of Massachusetts.

And electronic prescribing seems like a good solution because it would easier to incorporate into the physician's workflow than an electronic health record, Dr. Mandel said. But he said he hopes that physicians will choose to move to a fully functional electronic health record in the future. "We do believe that this is a transitional technology," he said.

James Whitman, M.D., who is a pediatrician in Framingham, Mass., and was one of the physicians who received the electronic prescribing technology through the eRx Collaborative, said that it has shown him how easy it can be to use.

He and his colleagues plan to make the jump to full electronic health records when they replace their practice management system. "Our experience with this system makes it a little less scary," Dr. Whitman said.

Medicare officials have proposed new uniform standards for electronic prescribing that will govern transactions between prescribers and dispensers of prescriptions.

Under the proposal, the standards would take effect in January, to coincide with the beginning of the new Medicare Part D prescription drug benefit.

The proposed standards would apply to transactions between prescribers and dispensers of new prescriptions, refill requests, prescription changes, and cancellation requests. In addition, the standards would govern eligibility and benefits inquiries between prescribers and drug plans and Part D sponsors.

The Health and Human Services Department was accepting comments on the proposal through April 5. Additional electronic prescribing standards will be developed by 2008. Electronic prescribing is voluntary for physicians, but the aim is to make it easier and more attractive for physicians to use the technology.

"These proposed e-prescription rules would set standards to help Medicare, physicians, and pharmacies take advantage of new technology that can improve the health care of seniors and persons with disabilities," HHS Secretary Mike Leavitt said in a statement.

One of the most successful strategies for getting physicians to adopt electronic prescribing systems in their offices is to provide ongoing reimbursement, said Jonathan Teich, M.D., chief medical officer at Healthvision, an Internet health care company, who chaired the Electronic Prescribing Project of the eHealth Initiative.

Over the last few years, there's been a lot of work in both the public and private sectors examining what drives adoption of e-prescribing. What they have found is that there is money to be saved through the use of the technology, but it's usually saved by the payer, not by the physician, he said.

But payers and others can provide incentives to physicians by supplying the technology up front, giving increased reimbursement per visit for the use of electronic prescribing, or incorporating electronic prescribing into a pay for performance program, Dr. Teich said.

A group of health plans in Massachusetts has joined forces to cover the costs of electronic prescribing for physicians interested in integrating the technology into their practices. Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, and the Neighborhood Health Plan have partnered with the technology vendor ZixCorp to provide physicians in Massachusetts with the hardware and software needed for electronic prescribing.

The project is called the eRx Collaborative, and from October 2003 through the end of 2004, nearly 2,700 physicians and their clinical staff members signed up to participate in the project.

At the end of last year, more than 1,500 doctors had incorporated the technology into their practices. The collaborative plans to cover the costs of the e-prescribing technology through the end of this year. The project uses ZixCorp's PocketScript e-prescribing system, which allows physicians to create new and refill prescriptions electronically and allows for real-time access to a patient's prescription history.

This year, physicians will also be able to choose to use DrFirst Inc.'s Rcopia electronic prescription management program.

Facilitating the adoption of electronic prescribing is a way to try to curb both high pharmacy costs and medication errors, said Robert Mandel, M.D., vice president of eHealth for Blue Cross Blue Shield of Massachusetts.

And electronic prescribing seems like a good solution because it would easier to incorporate into the physician's workflow than an electronic health record, Dr. Mandel said. But he said he hopes that physicians will choose to move to a fully functional electronic health record in the future. "We do believe that this is a transitional technology," he said.

James Whitman, M.D., who is a pediatrician in Framingham, Mass., and was one of the physicians who received the electronic prescribing technology through the eRx Collaborative, said that it has shown him how easy it can be to use.

He and his colleagues plan to make the jump to full electronic health records when they replace their practice management system. "Our experience with this system makes it a little less scary," Dr. Whitman said.

Medicare officials have proposed new uniform standards for electronic prescribing that will govern transactions between prescribers and dispensers of prescriptions.

Under the proposal, the standards would take effect in January, to coincide with the beginning of the new Medicare Part D prescription drug benefit.

The proposed standards would apply to transactions between prescribers and dispensers of new prescriptions, refill requests, prescription changes, and cancellation requests. In addition, the standards would govern eligibility and benefits inquiries between prescribers and drug plans and Part D sponsors.

The Health and Human Services Department was accepting comments on the proposal through April 5. Additional electronic prescribing standards will be developed by 2008. Electronic prescribing is voluntary for physicians, but the aim is to make it easier and more attractive for physicians to use the technology.

"These proposed e-prescription rules would set standards to help Medicare, physicians, and pharmacies take advantage of new technology that can improve the health care of seniors and persons with disabilities," HHS Secretary Mike Leavitt said in a statement.

One of the most successful strategies for getting physicians to adopt electronic prescribing systems in their offices is to provide ongoing reimbursement, said Jonathan Teich, M.D., chief medical officer at Healthvision, an Internet health care company, who chaired the Electronic Prescribing Project of the eHealth Initiative.

Over the last few years, there's been a lot of work in both the public and private sectors examining what drives adoption of e-prescribing. What they have found is that there is money to be saved through the use of the technology, but it's usually saved by the payer, not by the physician, he said.

But payers and others can provide incentives to physicians by supplying the technology up front, giving increased reimbursement per visit for the use of electronic prescribing, or incorporating electronic prescribing into a pay for performance program, Dr. Teich said.

A group of health plans in Massachusetts has joined forces to cover the costs of electronic prescribing for physicians interested in integrating the technology into their practices. Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, and the Neighborhood Health Plan have partnered with the technology vendor ZixCorp to provide physicians in Massachusetts with the hardware and software needed for electronic prescribing.

The project is called the eRx Collaborative, and from October 2003 through the end of 2004, nearly 2,700 physicians and their clinical staff members signed up to participate in the project.

At the end of last year, more than 1,500 doctors had incorporated the technology into their practices. The collaborative plans to cover the costs of the e-prescribing technology through the end of this year. The project uses ZixCorp's PocketScript e-prescribing system, which allows physicians to create new and refill prescriptions electronically and allows for real-time access to a patient's prescription history.

This year, physicians will also be able to choose to use DrFirst Inc.'s Rcopia electronic prescription management program.

Facilitating the adoption of electronic prescribing is a way to try to curb both high pharmacy costs and medication errors, said Robert Mandel, M.D., vice president of eHealth for Blue Cross Blue Shield of Massachusetts.

And electronic prescribing seems like a good solution because it would easier to incorporate into the physician's workflow than an electronic health record, Dr. Mandel said. But he said he hopes that physicians will choose to move to a fully functional electronic health record in the future. "We do believe that this is a transitional technology," he said.

James Whitman, M.D., who is a pediatrician in Framingham, Mass., and was one of the physicians who received the electronic prescribing technology through the eRx Collaborative, said that it has shown him how easy it can be to use.

He and his colleagues plan to make the jump to full electronic health records when they replace their practice management system. "Our experience with this system makes it a little less scary," Dr. Whitman said.

WASHINGTON — Complementary and alternative therapies should be held to the same standards as conventional treatments, according to a new report from the Institute of Medicine.

"Complementary and alternative medicine [CAM] use is widespread and here to stay," Stuart Bondurant, M.D., said at the institute's press briefing. "The same rules should apply for testing of effectiveness and safety regardless of the origin."

Already, the use of CAM therapies in the United States is widespread and amounts to $27 billion a year in out-of-pocket costs by consumers, a figure that is comparable with the projected out-of-pocket expenditures for all U.S. physician services, the report said. In 1997, the total number of visits to CAM providers (629 million) outpaced the total number of visits to all primary care physicians (386 million), according to a survey from that year.

But despite the increases in the use of CAM services, few patients disclose their use of CAM therapies to their physicians. Less than 40% of CAMusers told their physicians about their use of alternative therapies, according to surveys in 1990 and 1997.

The IOM committee defined CAM broadly as encompassing "health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period." The committee's definition also states that CAM includes resources that patients perceive as being associated with positive health outcomes.

While the same principles should be used in evaluating conventional and alternative treatments, some new methods may have to be devised for CAM therapies, said Dr. Bondurant, interim executive vice president and executive dean of Georgetown University Medical Center in Washington. Randomized controlled trials may not be appropriate for all CAM treatments. However, other designs include preference trials that include randomized and nonrandomized arms, observational and cohort studies, case-control studies, and studies of bundles of therapies.

Licensing boards and accrediting and certifying organizations should set competency standards for the use of conventional medicine and CAM, the committee said.

CAM practitioners also have a role to play by being trained as researchers. This would help ensure that research reflects the ways CAM therapies are used, the report said. CAM practitioners should also work to develop practice guidelines for CAM therapies, the report said.

"The intent of the report is not to medicalize or co-opt CAM but to sustain the existing forms of validated CAM therapies whether integrated into conventional practices or continuing as freestanding approaches," Dr. Bondurant said. "The committee urged that great care be taken to test CAM therapies in the ways that they are actually used."

The IOM report is available online at http://national-academies.org

WASHINGTON — Complementary and alternative therapies should be held to the same standards as conventional treatments, according to a new report from the Institute of Medicine.

"Complementary and alternative medicine [CAM] use is widespread and here to stay," Stuart Bondurant, M.D., said at the institute's press briefing. "The same rules should apply for testing of effectiveness and safety regardless of the origin."

Already, the use of CAM therapies in the United States is widespread and amounts to $27 billion a year in out-of-pocket costs by consumers, a figure that is comparable with the projected out-of-pocket expenditures for all U.S. physician services, the report said. In 1997, the total number of visits to CAM providers (629 million) outpaced the total number of visits to all primary care physicians (386 million), according to a survey from that year.

But despite the increases in the use of CAM services, few patients disclose their use of CAM therapies to their physicians. Less than 40% of CAMusers told their physicians about their use of alternative therapies, according to surveys in 1990 and 1997.

The IOM committee defined CAM broadly as encompassing "health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period." The committee's definition also states that CAM includes resources that patients perceive as being associated with positive health outcomes.

While the same principles should be used in evaluating conventional and alternative treatments, some new methods may have to be devised for CAM therapies, said Dr. Bondurant, interim executive vice president and executive dean of Georgetown University Medical Center in Washington. Randomized controlled trials may not be appropriate for all CAM treatments. However, other designs include preference trials that include randomized and nonrandomized arms, observational and cohort studies, case-control studies, and studies of bundles of therapies.

Licensing boards and accrediting and certifying organizations should set competency standards for the use of conventional medicine and CAM, the committee said.

CAM practitioners also have a role to play by being trained as researchers. This would help ensure that research reflects the ways CAM therapies are used, the report said. CAM practitioners should also work to develop practice guidelines for CAM therapies, the report said.

"The intent of the report is not to medicalize or co-opt CAM but to sustain the existing forms of validated CAM therapies whether integrated into conventional practices or continuing as freestanding approaches," Dr. Bondurant said. "The committee urged that great care be taken to test CAM therapies in the ways that they are actually used."

The IOM report is available online at http://national-academies.org

WASHINGTON — Complementary and alternative therapies should be held to the same standards as conventional treatments, according to a new report from the Institute of Medicine.

"Complementary and alternative medicine [CAM] use is widespread and here to stay," Stuart Bondurant, M.D., said at the institute's press briefing. "The same rules should apply for testing of effectiveness and safety regardless of the origin."

Already, the use of CAM therapies in the United States is widespread and amounts to $27 billion a year in out-of-pocket costs by consumers, a figure that is comparable with the projected out-of-pocket expenditures for all U.S. physician services, the report said. In 1997, the total number of visits to CAM providers (629 million) outpaced the total number of visits to all primary care physicians (386 million), according to a survey from that year.

But despite the increases in the use of CAM services, few patients disclose their use of CAM therapies to their physicians. Less than 40% of CAMusers told their physicians about their use of alternative therapies, according to surveys in 1990 and 1997.

The IOM committee defined CAM broadly as encompassing "health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period." The committee's definition also states that CAM includes resources that patients perceive as being associated with positive health outcomes.

While the same principles should be used in evaluating conventional and alternative treatments, some new methods may have to be devised for CAM therapies, said Dr. Bondurant, interim executive vice president and executive dean of Georgetown University Medical Center in Washington. Randomized controlled trials may not be appropriate for all CAM treatments. However, other designs include preference trials that include randomized and nonrandomized arms, observational and cohort studies, case-control studies, and studies of bundles of therapies.

Licensing boards and accrediting and certifying organizations should set competency standards for the use of conventional medicine and CAM, the committee said.

CAM practitioners also have a role to play by being trained as researchers. This would help ensure that research reflects the ways CAM therapies are used, the report said. CAM practitioners should also work to develop practice guidelines for CAM therapies, the report said.

"The intent of the report is not to medicalize or co-opt CAM but to sustain the existing forms of validated CAM therapies whether integrated into conventional practices or continuing as freestanding approaches," Dr. Bondurant said. "The committee urged that great care be taken to test CAM therapies in the ways that they are actually used."

The IOM report is available online at http://national-academies.org

BOSTON — Three Massachusetts communities will soon be wired for electronic health record systems as part of a $50 million pilot project.

The idea, being undertaken by the Massachusetts eHealth Collaborative, is to test out the implementation of interoperable EHRs within communities before attempting to connect physicians across the entire state.

"We're completely focused on practical solutions so we can get these things into physicians' hands and health care professionals' hands and keep them there," Micky Tripathi, CEO of the Massachusetts eHealth Collaborative said at a congress sponsored by the American Medical Informatics Association.

The collaborative is a not-for-profit group founded by 34 health care institutions seeking to create a statewide health information network.

The collaborative was launched last fall and requested applications for its pilot project last December. They received 35 applications from communities across the state and chose three—greater Brockton, greater Newburyport, and Northern Berkshire.

The pilot is being funded through a grant from Blue Cross Blue Shield of Massachusetts. Each community chosen was a relatively self-contained medical referral market, had strong local health care professional leadership, and demonstrated an openness to information technology innovation, Mr. Tripathi said.

The final selections were based in part on location, patient diversity, and information technology maturity, he said.

Members of the collaborative also wanted to choose communities at different points of the information technology adoption curve in order to see the different types of benefits.

The three communities cover nearly 600 physicians treating roughly 500,000 patients. Overall, there are 182 primary care physicians and 410 specialists. The pilots will include almost 200 offices sites, most of which have one to five physicians, Mr.Tripathi said.

The pilot projects will include the purchase and installation of EHRs at all clinical care points, as well as connecting them to other systems within the community. Although existing studies have shown the benefit of EHRs on a small scale, Mr. Tripathi said this pilot is a chance to see what will happen in a larger, community-wide rollout.

The pilot will be aimed at determining the barriers to adoption, identifying the costs—both direct and indirect—of adoption, and analyzing the benefits.

Officials at the collaborative will also be seeking to figure out how the costs and benefits are distributed across stakeholders. Finally, they will be looking for the best ways to provide incentives and how that could be replicated going forward.

"This transition can't be done to physicians," he said. "It's got to be an idea that we sell to them."

The collaborative plans to select EHR vendors by the end of May and be under contract by the end of the summer. The pilot timeline calls for implementing systems in a clinical care setting before the end of the year. At the beginning of 2006, the collaborative expects to implement interoperability capabilities for the systems. The pilot projects are slated to end in mid-2008.

In addition, the collaborative plans to work with the other 32 communities that were not selected for the pilot to help them implement EHR systems by sharing the infrastructure, expertise, and arrangements created through the pilots.

BOSTON — Three Massachusetts communities will soon be wired for electronic health record systems as part of a $50 million pilot project.

The idea, being undertaken by the Massachusetts eHealth Collaborative, is to test out the implementation of interoperable EHRs within communities before attempting to connect physicians across the entire state.

"We're completely focused on practical solutions so we can get these things into physicians' hands and health care professionals' hands and keep them there," Micky Tripathi, CEO of the Massachusetts eHealth Collaborative said at a congress sponsored by the American Medical Informatics Association.

The collaborative is a not-for-profit group founded by 34 health care institutions seeking to create a statewide health information network.

The collaborative was launched last fall and requested applications for its pilot project last December. They received 35 applications from communities across the state and chose three—greater Brockton, greater Newburyport, and Northern Berkshire.

The pilot is being funded through a grant from Blue Cross Blue Shield of Massachusetts. Each community chosen was a relatively self-contained medical referral market, had strong local health care professional leadership, and demonstrated an openness to information technology innovation, Mr. Tripathi said.

The final selections were based in part on location, patient diversity, and information technology maturity, he said.

Members of the collaborative also wanted to choose communities at different points of the information technology adoption curve in order to see the different types of benefits.

The three communities cover nearly 600 physicians treating roughly 500,000 patients. Overall, there are 182 primary care physicians and 410 specialists. The pilots will include almost 200 offices sites, most of which have one to five physicians, Mr.Tripathi said.

The pilot projects will include the purchase and installation of EHRs at all clinical care points, as well as connecting them to other systems within the community. Although existing studies have shown the benefit of EHRs on a small scale, Mr. Tripathi said this pilot is a chance to see what will happen in a larger, community-wide rollout.

The pilot will be aimed at determining the barriers to adoption, identifying the costs—both direct and indirect—of adoption, and analyzing the benefits.

Officials at the collaborative will also be seeking to figure out how the costs and benefits are distributed across stakeholders. Finally, they will be looking for the best ways to provide incentives and how that could be replicated going forward.

"This transition can't be done to physicians," he said. "It's got to be an idea that we sell to them."

The collaborative plans to select EHR vendors by the end of May and be under contract by the end of the summer. The pilot timeline calls for implementing systems in a clinical care setting before the end of the year. At the beginning of 2006, the collaborative expects to implement interoperability capabilities for the systems. The pilot projects are slated to end in mid-2008.

In addition, the collaborative plans to work with the other 32 communities that were not selected for the pilot to help them implement EHR systems by sharing the infrastructure, expertise, and arrangements created through the pilots.

BOSTON — Three Massachusetts communities will soon be wired for electronic health record systems as part of a $50 million pilot project.

The idea, being undertaken by the Massachusetts eHealth Collaborative, is to test out the implementation of interoperable EHRs within communities before attempting to connect physicians across the entire state.

"We're completely focused on practical solutions so we can get these things into physicians' hands and health care professionals' hands and keep them there," Micky Tripathi, CEO of the Massachusetts eHealth Collaborative said at a congress sponsored by the American Medical Informatics Association.

The collaborative is a not-for-profit group founded by 34 health care institutions seeking to create a statewide health information network.

The collaborative was launched last fall and requested applications for its pilot project last December. They received 35 applications from communities across the state and chose three—greater Brockton, greater Newburyport, and Northern Berkshire.

The pilot is being funded through a grant from Blue Cross Blue Shield of Massachusetts. Each community chosen was a relatively self-contained medical referral market, had strong local health care professional leadership, and demonstrated an openness to information technology innovation, Mr. Tripathi said.

The final selections were based in part on location, patient diversity, and information technology maturity, he said.

Members of the collaborative also wanted to choose communities at different points of the information technology adoption curve in order to see the different types of benefits.

The three communities cover nearly 600 physicians treating roughly 500,000 patients. Overall, there are 182 primary care physicians and 410 specialists. The pilots will include almost 200 offices sites, most of which have one to five physicians, Mr.Tripathi said.

The pilot projects will include the purchase and installation of EHRs at all clinical care points, as well as connecting them to other systems within the community. Although existing studies have shown the benefit of EHRs on a small scale, Mr. Tripathi said this pilot is a chance to see what will happen in a larger, community-wide rollout.

The pilot will be aimed at determining the barriers to adoption, identifying the costs—both direct and indirect—of adoption, and analyzing the benefits.

Officials at the collaborative will also be seeking to figure out how the costs and benefits are distributed across stakeholders. Finally, they will be looking for the best ways to provide incentives and how that could be replicated going forward.

"This transition can't be done to physicians," he said. "It's got to be an idea that we sell to them."

The collaborative plans to select EHR vendors by the end of May and be under contract by the end of the summer. The pilot timeline calls for implementing systems in a clinical care setting before the end of the year. At the beginning of 2006, the collaborative expects to implement interoperability capabilities for the systems. The pilot projects are slated to end in mid-2008.

In addition, the collaborative plans to work with the other 32 communities that were not selected for the pilot to help them implement EHR systems by sharing the infrastructure, expertise, and arrangements created through the pilots.