Managing the Flow in Radiology

EMRs: Putting Physicians in Power
Turning Up the HEAT
Scripps Health Seeks Standardization Through New EMR

EMRs: Putting Physicians in Power

Quantum and IBM release next-generation EMR and connectivity solution designed to be easy to implement, use, and maintain by physicians.

P.L. “Pete” Martinez, VP

The American Recovery and Reinvestment Act of 2009 allocates $19.2 billion for the implementation of health care information technology, an effort its backers hope will encourage the majority of health care providers to adopt comprehensive electronic health records (EHR) by 2014.1 The Congressional Budget Office estimates the incentives established in the bill will encourage electronic medical record (EMR) adoption by about 90% percent of physicians and 70% of hospitals by the end date.1 Without the incentives, adoption is expected to reach only 65% and 45%, respectively.1

Even aiming for the lower numbers, however, we still have a significant way to go before seeing that level of adoption. Currently, it is thought that only 17% of physicians and 8% to 10% of hospitals in the United States are using at least a basic EMR system. Those with comprehensive systems are even fewer.1

For this group, the benefits of use, which include improved care and cost savings, are enough to justify the investment. But incentives can help to expand and speed adoption beyond the early adopters. An effective system—one without significant capital, implementation, or maintenance requirements—would help too.

The Quantum Group of Wellington, Fla, and IBM, headquartered in Armonk, NY, have partnered to develop a solution to meet these requirements while also fitting within the vision of an information-based, connected health care system. Quantum’s PWeRx2122 (Personal Wellness electronic Recordx2122) is a next-generation technology platform designed to connect physicians to patients, hospitals, clinics, related professionals, and IBM’s Patient Centered Medical Home (PCMH) solution Pc3, Patient Centered Collaborative Care.

Powerful Benefits

Quantum differentiates PWeR from traditional EMRs with a patient-centric, Web-based approach. “The complexity to use an EMR today is mind blowing,” said P.L. “Pete” Martinez, Quantum’s senior vice president and chief technology and innovations officer, citing frustrations with installation, integration, and maintenance.

To reduce this complexity, PWeR relies on a “Software as a Service (SaaS) and IBM Hosted Cloud Computing” model. Patient data is centralized in one location, off-site from the physician’s office; storage and recovery are provided over the Internet. Clients do not have to manage hardware or software in-house, yet they have access to multiple functions. PWeR incorporates applications that include the EMR, but also practice management, billing, e-labs, e-prescriptions, disease management, medical home, messaging, and kiosks.

“The notion that a doctor has to integrate a different piece of software goes away,” Martinez said. With no on-site hardware or software, integration, security, staffing, and maintenance concerns are eliminated along with the associated costs.

In addition, the initial investment is reduced. “The price point for most [EMR] solutions can be $80,000 to $100,000, which becomes prohibitive for a physician to implement,” Martinez said.

The PWeR financial model charges monthly fees per doctor ($500 a month for the basics; $1,000 for inclusion of advanced analytics or home care). There are no installation, maintenance, or hosting fees. “This simplifies life for the doctor. Doctors need something that will physically provide them the speed, accuracy, and cost reductions they expect without having to learn a completely different system or having to program,” Martinez said.

Powerful Use

Simplification can help to drive adoption. “The key to any kind of stimulus is actually getting usage. You have to coordinate the financial incentive with some product that will drive use. Right now, people would be happy with pure usage, much less meaningful usage,” Martinez said.

To achieve user buy-in, PWeR is a workflow-oriented system. User access is restricted to roles (eg, physician, nurse, physician’s assistant, etc), and navigation is streamlined. “A doctor today can go through 17 steps to complete a simple procedure, getting lost in the system answering questions. With PWeR, you’re always one click away from the information,” Martinez said. This enables greater and more effective use—perhaps even “meaningful.”

“Meaningful use” has become a new buzzword since the stimulus bill included it as a criterion for reimbursement and incentives. Unfortunately, the bill did not define “meaningful use” so there is currently confusion surrounding how to meet this requirement.

“We have not seen any definitive statement from any of the agencies that will ultimately pass a decision,” Martinez said. However, there have been indications about the areas that will be included. Martinez expects detailed analysis, alert, and complementary workflow capabilities to be three of the fundamentals required of any “meaningful” system. Systems that enable meaningful use will also need to protect privacy and integrate efficiently with clinical and administrative processes.

“We anticipate that, when the final regulations are released, our system will allow the physician to qualify for the stimulus package monies,” said Ronald S. Smith, Quantum senior vice president in a release. And with easy use, implementation, and maintenance, the system will stimulate meaningful use.


  1. Steinbrook R. Health care and the American Recovery and Reinvestment Act. N Engl J Med. 2009;360(11):1057-1060.

Turning Up the HEAT

BridgeHead Software and Sun introduce a new data management solution designed to expand the storage and retention capabilities of EMR systems.

Sun servers and tape libraries support the new HEAT data management solution from BridgeHead Software.

The Stimulus Bill seeks to stimulate various industries, including health care. The American Recovery and Reinvestment Act of 2009 lists provisions—including medical incentives for both physicians and health care institutions—to push the adoption and “meaningful use” of electronic medical record systems. But what is the meaning of “meaningful”?

“That’s the question everyone is waiting to have answered. The government has yet to offer a complete definition of what is meant by ‘meaningful use’ of EHR [electronic health record] technology,” said Charles Mallio, vice president of business development and corporate marketing of UK-headquartered BridgeHead Software.

Experts and manufacturers, however, have their ideas about what meaningful use might involve. “We can speculate that it is likely to include things such as clinical decision support, e-prescribing, and the electronic exchange of health data,” Mallio said. Others suggest that point-of-care access, alert features, detailed analysis, complementary workflow capabilities, and interoperability also will come under “meaningful use” requirements.

These capabilities can fall within the realm of a comprehensive EMR, but some systems may lack certain features that could eventually be deemed “meaningful.” Complementary programs can help to fill these gaps. BridgeHead Software and Sun Microsystems, Santa Clara, Calif, have introduced such a program: HEAT (Healthcare Enterprise Archiving Technology), a data management solution designed to maximize EMR data storage and retention.

The Meaning of HEAT

“The EHR vendors have the primary burden of helping providers meet the meaningful use requirements, but they may or may not capture all relevant data that feeds the EHR. For example, ancillary data, such as e-mail, unstructured file data, scanned documents, and even digital medical images—PACS—may all contain relevant patient data not captured by the EHR system,” Mallio said. Items, such as living wills, consent forms, and driver’s licenses, can all be useful to have within a patient record.

Much of this data, however, normally resides outside of the EMR. HEAT makes it accessible. The system can take these documents and images; e-mail, encrypt, and compress them; and store them within a built-in repository that is indexed and searchable.

“The data can then be accessed by the existing EHR system in a number of ways, such as via BridgeHead’s open search interface, HL7 interfaces, or XDS,” Mallio said. The process maximizes efficiency and data safety while lowering costs.

Money is saved because expensive primary storage is reserved for the most current data, which needs to be more readily available; older information is retained in the less expensive, bundled Storage Server and tape archive. Additional monies are saved with size-specific product offerings and automatic protection and backup.

Hot Issue

These savings can help to justify the investment, particularly in hospitals transitioning their paper files. “We’ve come across a number of institutions that are going through the process of scanning and digitizing paper documents as part of building EHRs,” Mallio said in the release. Mallio expects the EMR incentives within the American Recovery and Reinvestment Act to inspire many more health care institutions to go through similar processes, with the resulting need to expand storage.

“Our experience of working with several of them has enabled us to estimate that just scanning relevant paper documents could generate as much as 60 gigabytes of data per bed per year,” estimates Mallio, adding that “Even for a relatively small 100-bed hospital, that would mean an additional 6 TB of new data every year.” HEAT is designed to help store, protect, and index that data so that it can be used meaningfully, whatever that may come to mean.

Scripps Health Seeks Standardization Through New EMR

Administration seeks to eliminate variability with upgrade to GE’s Centricity Enterprise version 6.1.

A nonprofit, community-based health care delivery network in San Diego, the Scripps Health organization comprises five campuses with four acute care hospitals, 19 outpatient facilities, and home health care services. Its more than 12,000 employees include approximately 2,600 affiliated physicians, who together treat roughly 500,000 patients annually.

As the health care system has grown, so has the need for standardization across the institution. “There is variability in processes and the availability of information—or rather the lack of availability of information—stored on paper,” said Joe Traube, MD, chief medical officer of Information Systems at Scripps. Variability can lead to problems that may result in patient or bottom-line harm, but how to standardize?

“We were looking at the standardization of our processes in health care delivery, and a system to assist with supporting documentation is important,” Traube said. An electronic medical record system can fill that role, eliminating variability throughout processes while improving quality, safety, and efficiency.

Although Scripps was happy with its existing EMR system, it wanted to upgrade to the next generation, the Centricity Enterprise version 6.1 from GE Healthcare, Waukesha, Wis, and it wanted to upgrade every facility (a basic requirement to achieve the goal of standardization).

One for All

“The largest challenge we faced was that we needed to bring all five campuses online at the same time,” said Patric Thomas, Scripps’ chief information officer. He contrasts the upgrade with the initial installation of an automated system and the move away from paper, when it was possible to computerize one hospital at a time. Once everyone has been integrated, however, upgrades work best when completed at once.

Preparation was intense. Departments, such as nursing, imaging, and ancillary groups, participated in workgroups where they developed the parameters that could meet their needs on a system-wide level. The preparation paid off. The installation went smoothly.

“I think it went faster and better than anticipated. It was five campuses in 6 days, and we transferred over to [Centricity] in about 18 hours,” Thomas said, noting bugs were worked out during the days following installation.

Thomas attributes the smooth transition to the preparation on the part of the entire health care team. “IS, nursing, physicians, and the administration had done a lot of preparation, and it showed during the installation,” he said. Traube concurs, adding, “I think that was what really allowed it to go forward as well as it did—because the entire organization was involved.”

All for One

The benefits are also expected to impact the entire organization. The Scripps EHR system will include more than 10,000 end users.

Clinicians will benefit from more efficient workflows that help to improve the quality of care and the efficiency of a department. “Standardizing helps us to provide continuity of care for our patients and continuity of experience for our clinicians at any of our Scripps hospitals,” Thomas said in a release.

The Centricity Enterprise 6.1 provides a comprehensive electronic health record through the digital management of clinical, financial, and administrative processes. Since its launch 25 years ago, the system objectives have remained constant: to automate the workflow of the patient care process; to provide immediate feedback; and to improve patient care quality, employee productivity, and the health of the community.

Toward this end, the system incorporates computerized physician order entry (CPOE), clinical decision support and expert rules, results display, pharmacy and care documentation, scheduling, registration and admitting, and charging and billing. These advanced clinical tools are expected to prepare the institution to take advantage of future federal stimulus incentives, which reward the meaningful use of EHRs.

But even without the financial incentives, Scripps believes the investment is worth it. Traube explains: “I think the benefit of an electronic medical record is in supporting the best patient care possible on the clinical side, and that’s ultimately our reason for existing. The implementation of the new EMR was a way to further the best care we could deliver to our patients.”