GE Healthcare announced the FDA-cleared CARESCAPE™ Monitor B850, which provides caregivers with a unique level of integration between patient monitoring data and hospital information systems. Unlike traditional patient monitors, CARESCAPE Monitor B850 directly links hospital networks, electronic medical records (EMRs), diagnostic images, lab results and third-party devices with real-time patient monitoring data, to support efficient clinical decision-making. This enables CARESCAPE Monitor B850 to integrate its continuous clinical measurements with other elements of the patient record, delivering it at the point of care.

The CARESCAPE Monitor B850 brings together the strong clinical heritage of Datex-Ohmeda’s anesthesia and Marquette Electronics’ cardiac expertise. It provides customized clinical information displays by care area and clinician preference, while also enabling hospitals to standardize on a monitoring platform throughout the organization. Developed with thousands of hours of field and in-house testing, the CARESCAPE Monitor B850 is the latest product in the GE Healthcare CARESCAPE portfolio, designed to deliver streamlined access to critical patient information for enhanced decision making.

“The CARESCAPE Monitor B850 reflects GE’s commitment to a new approach to patient monitoring-one that transforms streams of once uncoordinated patient data into meaningful, easily accessible clinical intelligence,” said David Ataide, vice president and general manager of Monitoring Solutions and Diagnostic Cardiology, GE Healthcare. “Empowering doctors and nurses with quality patient information supports fast, easy clinical decision-making, which may lead to improved patient outcomes, the foundation of GE’s Clinical Information Logistics vision. Because each hospital care area treats a unique group of patients with distinct clinical needs, the CARESCAPE Monitor B850 now enables standardization on a single monitoring platform that can be customized to meet specific care area demands.”

The CARESCAPE Monitor B850 is part of an easy to use system that can be customized to meet a variety of clinical needs. For example:

-ECG-Traditionally, when a patient experiences chest pain, a caregiver must find and move an ECG machine from a different location to the patient’s bedside. The CARESCAPE Monitor B850 not only enables ‘cart-less’ diagnostic ECGs at the bedside, but also exchanges data with the MUSE ECG repository, facilitating ECG analysis and comparisons to the patient’s prior ECG, supporting more informed clinical decisions.

-Administering Anesthetics-Anesthesia clinicians have historically administered anesthetics without real-time, integrated anesthetic management tools because anesthesia delivery and patient monitoring systems are often ineffectively integrated. GE Navigator Applications Suite combined with CARESCAPE Monitor B850 analyzes drug therapy information to model and predict the effect of anesthesia-related drugs and drug interactions. This enables clinicians to visualize modeled anesthetic drug effect predictions against live patient data, which supports patient tailored anesthesia.

-Diagnostic Images, Lab Information & more-The CARESCAPE Monitor B850 enables bedside viewing of hospital EMRs, as well as x-rays, labs and other diagnostic reports, including the associated diagnoses from the hospital’s experts. This quick, comprehensive view of the patient’s records encourages confidence as clinicians make critical decisions at the point of care.

Built upon the latest Intel® embedded processing technology, the CARESCAPE Monitor B850 performs quickly and reliably.

Protecting Existing Hospital Investments

To preserve patient monitoring investments already made by thousands of GE Healthcare customers worldwide, the CARESCAPE Monitor B850 is compatible with existing Marquette and Datex-Ohmeda products. GE’s component innovation strategy provides for an unprecedented level of backwards compatibility, allowing hospitals to leverage prior technology investments while updating monitors in the areas of strongest clinical need.

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Electronic medical record (EMR) systems, defined as “an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization,”  have the potential to provide substantial benefits to physicians, clinic practices, and health care organizations. These systems can facilitate workflow and improve the quality of patient care and patient safety. Despite these benefits, widespread adoption of EMRs in the United States is low; a recent survey indicated that only 4 percent of ambulatory physicians reported having an extensive, fully functional electronic records system and 13 percent reported having a basic system.

Among the most significant barriers to adoption are:

• High capital cost and insufficient return on investment for small practices and safety net providers.
• Underestimation of the organizational capabilities and change management required.
• Failure to redesign clinical process and workflow to incorporate the technology systems.
• Concern that systems will become obsolete.
• Lack of skilled resources for implementation and support.
• Concern that current market systems are potentially not meeting the needs of rural health centers or federally qualified health centers (FQHC).
• Concern regarding negative unintended consequences of technology.

Recognizing the role that EMRs can play in transforming health care, in 2003, the Institute of Medicine issued a group of eight key functions for safety, quality, and care efficiency that EMRs should support.

• Physician access to patient information, such as diagnoses, allergies, lab results, and medications.
• Access to new and past test results among providers in multiple care settings.
• Computerized provider order entry.
• Computerized decision-support systems to prevent drug interactions and improve compliance with best practices.
• Secure electronic communication among providers and patients.
• Patient access to health records, disease management tools, and health information resources.
• Computerized administration processes, such as scheduling systems.
• Standards-based electronic data storage and reporting for patient safety and disease surveillance efforts.

[1] The National Alliance for Health Information Technology (NAHIT)

[2] DesRoches CM, Campbell EG, Rao SR, et al. Electronic health records in ambulatory care — a national survey of physicians. N Engl J Med  2008 Jul 3;359(1):50-60.

Areas of Current Investigation

Traditionally, the EMR vendor community has created systems that conform only to proprietary database formats, making it difficult for them to send and receive data from other, potentially competing products. The medical informatics community has realized the need for interoperability and thus has created standards for data coding and communication. The Office of the National Coordinator for Health IT (ONC) has funded several major initiatives to harmonize standards and create a certification process for EMRs so that different products can interoperate better and be easily and objectively compared. This will enable decisionmakers to adopt EMRs more easily.

In 2006, the U.S. Department of Health and Human Services (HHS) recognized initial criteria for certification of ambulatory EHR systems as recommended by the Certification Commission for Healthcare Information Technology (CCHIT). These criteria will help reduce barriers for ambulatory providers to adopt EHR systems by ensuring confidence in purchased products. CCHIT certified products also meet requirements set forth by HHS in final physician self-referral law and anti-kickback statute rules, providing access to external means of implementing EHR systems.

Federal initiatives are under way to drive adoption of interoperable EMRs, including funding of the Agency for Healthcare Research and Quality (AHRQ) Health IT portfolio.  The recent American Recovery and Reinvestment Act (ARRA) of 2009 authorizes $34 billion to be distributed starting in 2011 as adoption incentives through Medicare and Medicaid to qualified providers who adopt and use certified EMRs.  In addition, several States have recently promoted EMR adoption by mandates, initiatives, or funding programs through the disbursement of grants and loans within their States:

The State of Minnesota is perhaps the most aggressive in promoting the adoption of standards-based electronic health records to support statewide electronic health information infrastructure. Minnesota has done this through a combination of legislative mandates and grants and loans programs.

Missouri has established a fund for health IT development that is being made available to health care providers. Senate Bill 577 (2007) states, “There is hereby created in the state treasury the “Health Care Technology Fund” which shall consist of all gifts, donations, transfers, and moneys appropriated by the general assembly, and bequests to the fund.”

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The economy has been in a recessionary trend for more than a year now. Whilst the economic conditions are challenging, the insurance companies are applying a squeeze on physicians to accept lower reimbursements. Funding by way of donations from private contributions is also reducing thereby adversely impacting availability of cash to implement an EMR / EHR system.

Any investment in EMR is justified only if it can help in increasing revenues, decreasing costs or overheads, improving patient care or any combination of the above resulting in maximization of reimbursements, collections and customer goodwill.

How does EMR/EHR increase revenues?

1. Improves charge capture: When traditional paper charts are used, many services performed in a physician’s office are lost and never billed. The billing staff may either completely leave out an E&M Code or may erroneously enter fewer units, all resulting in lower billing and therefore lower reimbursements to a physician. EMR software can increase revenues by facilitating capturing of charges for all services provided by the physician thereby avoiding lost revenues. In a case study (Nick Fabrizio, July 2005, QIO Presentation quote), a family medicine physician while seeing same number of patients increased revenues by $3000 per month due to timely visit documentation and automated charge capture.

2. Maximizes Billing: When using paper charts, to be on the safe side of the law, many physicians down code (use a lower billing code), rather than use an appropriate level of code. Providers who use EMR software can increase revenues by using System recommended E&M billing codes that are based on the service accurately documented within the EMR, without the fear of an audit.  Medical Economics magazine has estimated that physicians, who routinely down-code to avoid audits, lose an average of $40,000 annually.

3. Optimizes reimbursement process: EMR software allows physicians to produce adequate supporting documentation that complies with CMS guidelines and supports the appropriate level of service to be billed. Accurate coding speeds up the reimbursement process and results in fewer rejected claims from insurance companies. Even better, an EMR helps produce clean claims the first time, significantly reducing the number of rejected claims!

4. Increases Physician productivity: When physicians do not use EMR, they have to spend several minutes per encounter, first dictating and then reviewing the transcript before signing the same. With an EMR, progress notes are automatically generated which can be signed electronically from home or work, with no pulling or filing of charts. The time saved can be used to see a few more patients each day. Further, the medical records storage space released as a result of implementing an EMR System can be used to add more consultation rooms. As a result, practices are able to generate more revenue with the same fixed costs in the same amount of time.

5. Increases Services with Health Maintenance Reminders: EMR Systems provide computerized checks and reminders which enable reminders to be sent to all patients who are overdue for recommended services, or who are coming up on their annual check-ups. This helps the physician to deliver enhanced patient care, while at the same time increasing service volume and revenue.

6. Increases sources of income: Electronic Medical Records (EMR) software can allow providers to apply for enhanced sources of revenue from various payers associated with higher quality of care, such as:

(i) DOQ-IT (Doctors’ Office Quality-Information Technology is one of the Physician-focused Quality Initiatives sponsored by the Centers for Medicare & Medicaid Services (CMS).

(ii) Healthcare Pay-for-Performance (P4P) programs like Medicare Care Management Performance (MCMP), which is a 3-year, pilot P4P program that encourages physicians to follow strict quality-control guidelines for treating chronically ill patients.  During the first year of treatment, physicians receive bonuses for reporting data on quality measures and in the second and third years, participating clinics receive an extra annual performance-based bonus of $10,000 per clinician plus, an additional 25% reward for using a CCHIT Certified EMR.

To participate in a P4P program, a physician will need to track and measure care, and monitor the efficiency of delivering quality care at an optimal cost. One must also document the patients’ experiences using post-exam surveys. Most EMR systems are capable of meeting these requirements while simplifying the process.

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The healthcare industry is perhaps the most far behind in terms of adopting information technology. In addition to stimulating the economy, the American Recovery and Reinvestment Act (ARRA) allocates substantial funding to help the healthcare industry implement Electronic Medical Records (EMRs) and supporting IT infrastructure. Although the ARRA will help bring healthcare into the 21st century, it may create more problems.

The Time is Now, a recent study by Deloitte, finds the healthcare industry is not prepared to deal with security challenges that will result from the ARRA stimulus. EMRs and information technology, like computers, internet connections, and local office networks provide many benefits, and are critical for physicians that want to participate in the ARRA stimulus package. However, a computerized office introduces security risks that physicians and their staff will have to address.

Many people are familiar with stories about hospitals getting hacked, or leaking confidential patient information onto the internet. The risk of data theft or loss is real, even for small practices. Losing or having your data stolen can have terrible consequences for your practice. If a hacker or malicious software steals or destroys your data, you may not be able to see patients. As a result, you could go out of business or face prosecution for HIPAA violations.

This shouldn’t scare you away from implementing an EMR or participating in the ARRA stimulus package. Managing security risks is not difficult, but it does require some planning and foresight. HIPAA regulations require that your practice create a “security management process,” that includes a risk analysis and risk management plan.

A risk analysis will help you determine the information security risks your practice faces. The most common risks are data loss through hardware failure, malicious acts, or disasters such as fires or floods. Risk management plans typically include local and offsite backups, deploying antivirus software, keeping your computers and software up to date, as well as staff education plans.

If you currently have an EMR or think you may purchase one soon, be sure to spend some time reading up on risk management. Just like you wouldn’t drive your car without a seatbelt, you shouldn’t have a computerized office without a risk management plan. If you’re unsure about how to start, contact your local IT support professional or EMR vendor. They will be able to help you draft a risk management plan, or at least point you in the right direction.

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