The doctor who pulls out pen and carefully takes notes while patients detail their physical ailments is becoming a dinosaur. In the wake of the 2009 Health Information Technology for Economic and Clinical Health Act, which authorized incentive payments to clinicians and hospitals that use electronic health records to improve care delivery, paper is fast finding no place in the exam room.

With complex diseases and conditions in the hands of specialists and hospitals, it becomes more and more essential that all notes and test results about a particular patient be widely accessible. To support the adoption of electronic health records, the government is giving incentive payments over 10 years of up to $27 billion through Medicare and Medicaid to physicians who follow the standards for “meaningful use” of electronic health records as issued by the Department of Health and Human Services.

To be considered “meaningful users” in 2011 and 2012, physicians must, for example, enter demographics, vital signs, active medications and allergies, smoking status, and current diagnoses. They also must use clinical decision support software to enter clinical orders and prescriptions and electronically report data on quality of care. And they must meet privacy and security standards.

Once doctors and hospitals develop electronic health records, they will need to be able to share them through health information exchanges. This “mobilizes clinical health-care information electronically across organizations within a region, community, or hospital system,” says #b#Vikas Khosla#/b#, president and chief executive officer of BluePrint Healthcare IT in Cranbury.

“The government is also looking at this as a results-oriented endeavor,” says Khosla. “It is looking to track particular patient outcomes, trends, and benefits.” Public health officials, for example, may be investigating the effects of smoking or high blood pressure and cholesterol, or following the progress of pandemic. A health-information exchange would enable policymakers to capture and share this information.

Khosla will speak at the New Jersey Technology Council’s Health Information Exchange Summit on Thursday, July 22, at 8:30 a.m. at the New Jersey Hospital Association conference center, 760 Alexander Road. Cost: $110. For more information and to register, go to or call 856-787-9700.

The Office of the National Coordinator for Health Information Technology is responsible for the adoption of health information exchange technology nationwide. The challenge ahead is that while most hospitals have implemented electronic health records, less than 20 percent of physicians have done so.

Privacy. “If patients don’t feel their information is being securely stored and transmitted nationwide, they will opt out,” says Khosla. “We need the involvement of patients and physicians and their acceptance to let data freely flow over the network.”

#b#Laws about patient consent vary by state#/b#. In some states, patients may opt out of participating in health information exchange initiatives; in others they are in automatically and must deliberately opt out. Patients will need to be educated about what happens to their personal information to encourage their consent.

But security is a very real issue, says Khosla, and it is impossible to stop breaches of personal health information. The HHS website keeps a list of breaches that grows daily. But by addressing technical and physical security, Khosla adds, protection can improve. “We can’t stop breaches from happening but we can lower the risk and number of incidents by implementing a security program,” he says.

#b#Standardizing practices#/b#. Clinical information systems in hospitals and physician practices have been implemented in customized ways and must be able to speak to each other. “The challenge of creating a health information exchange is sharing information that may be stored in different forms in different places,” says Khosla. “The goal of meaningful use is to standardize all of these practices across the healthcare spectrum so there is common language for communicating health information.”

In part, says Khosla, the decision to implement electronic healthcare records (EHR) software, which can cost as much as $25,000, is generational. Whereas older physicians may feel that changes in their practices and workflow would be burdensome, younger physicians are likely to start their practices with some form of electronic health records in place.

Khosla offers an example of a doctor in Chicago with five offices who was pushed into electronic records by his office staff. “Before, they had to fax or send records by courier, with less time to see the patient,” says Khosla. “Now he can increase the volume of patients and increase revenues — not to mention have a much happier office staff.”

Because physicians do not usually have the technical staff necessary to adopt and implement electronic health records, the Office of the National Coordinator for Health Information Technology has established grants for regional extension centers that will provide physicians with technological and planning capabilities to implement fully functioning electronic medical records.

Some states are well ahead of others in moving toward health-information exchanges. The leaders, says Khosla, are New York, Massachusetts, Delaware, Indiana, and New Mexico. “The common thread in states ahead of the curve is typically funding mandates that are able to convince legislators and state government to invest in health information technology,” he says. Two years ago, for example, New York passed a law to invest $160 million statewide in health information technology.

New Jersey, he says, is probably in the middle of the pack. The Christie administration recently appointed Colleen Woods as health information technology coordinator. “She will be the one to facilitate the activities among various stakeholders in New Jersey,” says Khosla.

New Jersey has also received federal funding for four health information exchange organizations, and a New Jersey regional extension center by the Health Information Technology for Economic and Clinical Health Act.

New Jersey has put in place the framework for a health information exchange and will be submitting final plans to the federal government in the next month or so. When this is approved, funding from the federal government should follow, including approximately $12 million for the four health information exchange organizations and $23 million for the regional extension center.

Once health information exchanges are in place, another longer-term issue will come to fore — how to financially sustain the effort. Funding may come through membership fees, grants, and paired compensation models, as in California, where some of the largest payers have committed to participating, figuring that the improved patient care that results will be financially beneficial for them.

Khosla came to New Jersey from India at age 6 and grew up in Newark and Roselle. His father is a retired photographer and his mother is a retired banker; her last bank was Wachovia, before the merger. He graduated from Rutgers University in 1990 with a double major in psychology and English.

Khosla started his first business with his brother, Computer Conductors, a network services consulting company dealing with network infrastructure like routers, switches, and servers. In 2000 they sold their business to All Covered, a Silicon Valley-based company, and Khosla stayed with them until 2002, before taking time off when his first child was born.

Having begun in the late 1990s at Computer Conductors to build a customer base of hospital companies that needed help on network security and technological infrastructure, Khosla and his brother decided in 2003 to start BluePrint Healthcare IT, which now has 44 employees.

“We have a core competency in health information security, privacy, and compliance,” says Khosla. “Relative to a health information exchange, these are the foundations on which we can build a national health information exchange network.” Khosla’s brother is no longer with BluePrint, having spun off his own company providing information technology services to small businesses. Khosla lives in Old Bridge.

Although the costs are significant, the benefits of a health information exchange will be significant. Khosla suggests it will decrease healthcare costs — for doctors, hospitals, insurers, and the federal government — both by improving patient care, reducing doctors’ time with patients, and reducing the redundant costs of duplicated tests.

“Improving patient care is probably the greater cost saving,” says Khosla. “If we can reduce the amount spent on patients for healthcare, it will have an impact on the federal budget and the gross domestic product.”

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