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eNews - August 2007 •

Hurry Up and Wait

by Mike McBrideHealth Management Technology

I’m not a fan of large-scale government programs, especially when applied to healthcare. For my money, the best approach will always be allowing market forces to work their magic and give us the best system we can afford. Those advocating the use of federal power to control industries often reference socialist and communist systems as proof that adopting similar policies here would improve America. However, they close their eyes to the obvious failures of those systems of government.

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Glossary

Hospital Performance Measures
The National Quality Forum (NQF) endorses the first nationally recognized hospital-based performance measures for quality of care for breast and colorectal cancer.
(more)


Electronic Diabetes Registries
Report concludes information technology data management can improve care processes, delay type-2 diabetes complications and save healthcare dollars.
 (more)


Healthcare Costs Hit Minorities Hardest
New Gallup survey demonstrates a concerning trend among Americans who report experiencing difficulty with rising healthcare costs.
(more)


Pharmacy Benefit Managers Lobby Congress
Pharmaceutical Care Management Association spurs Congress to mandate adoption of e-prescribing technology for Medicare physicians. (more)


Medication Reconciliation App. Piloted
Fauquier Health System implements Rcopia AC to automatically incorporate patient prescription information into hospital environment.   
(more)


Thanks for Nothing, EHRs?
Archives of Internal Medicine study finds EHRs fall short of expectations. 
(more)


Group Submits Plan to Encourage IT Adoption in Vermont
A non-profit group delivers a plan for the creation of a statewide health information exchange and general adoption of electronic records.
(more)

Hospital Performance Measures

According to the U.S. Bureau of Labor Statistics, the field of computer and information systems managers that includes professions in health information technology (HIT) and technology management are forecast to grow faster than the average for all occupations through the year 2014. In response to this robust growth trend in demand for HIT-professionals, American Health Information Management Association (AHIMA) launched HealthInformationCareers.com, which, according to AHIMA, is the first Web site of its kind. The site is geared toward high school students or others considering a career change, and aims to recruit talent and bring more qualified and trained people into the fields of health information management (HIM). Featuring a clean, elegant design, the easy to navigate site offers information about the HIM field, academic pathways to various careers within HIM, a useful FAQ section, advice on how to finance education opportunities and more to assist those considering a HIM career to make an informed decision.

Click here to learn more about the CoC measures.

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Electronic Diabetes Registries

A report entitled “The Value of Information Technology-Enabled Diabetes Management” (ITDM) by the Center for Information Technology Leadership (CITL) concludes that information technology data management can improve care processes, delay type-2 diabetes complications and save healthcare dollars. According to the study, electronic diabetes registries used by providers, followed by clinician decision support systems for providers, showed the greatest improvement in clinical outcomes. Of the existing technologies, diabetes registries saved $14.5 billion in expenditures during a 10-year period. The CITL report also states that while other technologies had varying degrees of savings, national adoption of them would cost more than it saves. The report went further in saying that Medicare and other payers will benefit the most from ITDM because they bear the greatest financial risk.

CITL’s research approach was to develop computer-based models that simulate type-2 diabetes patient outcomes in a diabetes management program over 10 years. CITL is a nonprofit research center based at Partners HealthCare System in Boston. The research for the report was funded through a Robert Wood Johnson Foundation grant, which was supported by the Healthcare Information and Management Systems Society.

Click here to download a copy of the report.

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Healthcare Costs Hit Minorities Hardest

New data from the Gallup Organization’s annual Minority Rights and Relations survey demonstrates a concerning trend among Americans who report experiencing difficulty with rising healthcare costs. According to results of the poll, a third of all Americans have had times during the past year when they could not afford to pay for needed healthcare. Blacks and Hispanics appear to be particularly affected by the high cost of medical care. Both of these population groups are nearly twice as likely as non-Hispanic Whites to report difficulty paying for healthcare. Forty-eight percent of Hispanics, 45 percent of Blacks, and 26 percent of non-Hispanic Whites told Gallup there were times in the past year when they couldn’t afford to pay for healthcare. Data from the CDC’s 2006 National Health Interview Survey seems to corroborate the results of the Gallup poll. According to the CDC survey, after adjusting for age and sex, the percentage without health insurance coverage at the time of the interview was 32.1 percent for Hispanics, 10.4 percent for non-Hispanic Whites and 15.9 percent for non-Hispanic Backs.

Not surprisingly, these reports indicate lower levels of education and household income are related to an increased likelihood to have trouble paying for healthcare. The June Gallup poll shows 40 percent of adults with a high school education or less say there were times in the past year when they didn’t have enough money to pay for healthcare, compared with 19 percent of adults with a Bachelor’s degree. According to the Current Population Survey, 2005 and 2006 Annual Social and Economic Supplements from the U.S. Census Bureau, 24.2 percent of households with incomes of $25,000 or less report no healthcare coverage of any specific kind. Twenty percent of households with incomes between $25,000 and $50,000 were recorded as uninsured, compared with only 7.7 percent of households earning $75,000 or more.

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Pharmacy Benefit Managers Lobby Congress

The Pharmaceutical Care Management Association (PCMA), representing pharmacy benefit managers, has launched an effort to spur Congress to mandate adoption of e-prescribing technology for Medicare physicians that includes a print advertising campaign and the findings of a research study. Gorman Health Group LLC, which conducted the study, was commissioned by PCMA to estimate the savings and safety potential associated with government policies that could increase the use of e-prescribing. Among the findings of the study: Government options to increase e-prescribing could reduce federal health expenditures by up to $29 billion over the next decade and help physicians to prevent nearly 1.9 million adverse drug events over the same time period. Additionally, government action could potentially expand e-prescribing to encompass nearly 80 percent of prescriptions by 2017. The PCMA is attempting to ignite wider and more rapid adoption of the technology through Medicare because the program is so large it practically dictates national standards.

The push is aptly timed. Congress is currently considering a $30 billion update of the Medicare physician payment formula, one of the largest new healthcare expenditures facing Congress this year, and which many consider only a temporary fix. The Gorman study proposed three models to increase e-prescribing for Medicare. PCMA’s preferred approach would call on Congress to require Medicare physicians to use e-prescribing for all Part D prescriptions by 2010 and provide annual incentive payments that would offset their costs for equipment, training and support. The Gorman study estimates federal healthcare costs could be reduced by $26 billion over the next 10 years under this approach. The second option is an e-prescription requirement only, without incentives, reducing federal healthcare costs by $29 billion over a decade, and the third suggests implementing only the incentives—reducing costs by a comparatively small $2 billion over the next 10 years.

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Medication Reconciliation App. Piloted

Fauquier Health System of Warrenton, Va., is implementing Rcopia AC (Acute Care) to improve patient safety by automatically incorporating a patient’s current prescription information into the hospital environment. In doing so, Fauquier Health becomes the first in the nation to pilot an electronic medication reconciliation system that incorporates outpatient medication information into the patient setting and tracks external records as well. The medication reconciliation application, developed by DrFirst Inc., will compile a Fauquier patient’s current prescriptions from various prescription history databases so that any potential new medications can be compared to limit drug interaction. Upon discharge, this list will be reviewed to ensure that any prescriptions made at the time of discharge are also without complications, such as duplicative therapy and unnoticed contraindications. The prescription information is also provided to the patient and can be electronically accessed by the patient’s regular physician to ensure a continuum of care.

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Thanks for Nothing, EHRs?

A new study published July 9 in the Archives of Internal Medicine found that electronic health records (EHR) are falling short of the lofty expectations given them by healthcare policy makers. The retrospective, cross-sectional study conducted by researchers from Harvard and Stanford Universities was based on 1.8 million outpatient healthcare visits in 2003 and 2004. Assessing 17 quality indicators, the study reveals that EHRs had no impact on the quality of care among 14 of the quality indicators analyzed. The study shows improvements with use of EHRs in two of the measures— not prescribing benzodiazepine tranquilizers for patients with depression (91 percent versus 84 percent) and avoiding routine urinalysis during general medical exams (94 percent versus 91 percent)— and a marked downturn in one: statin therapy (33 percent versus 47 percent). Factors such as prescribing recommended antibiotics; diet and exercise counseling for high-risk adults; screening tests; and, avoiding potentially inappropriate prescriptions for elderly patients were among the remaining 14 quality indicators for which use of EHRs made no significant difference.

Performance on the quality indicators was defined as the proportion of visits in which patients received recommended care. The study also determined that use of EHRs was not influenced by age, sex, race, ethnicity, or insurance status, or by physician specialty or office type. Solo practitioners were less likely to use EHR systems compared with other types of practices (13 percent versus 21 percent) and EHR use was less in physician-owned practices versus those in which physicians were employees, contractors, or otherwise employed (16 percent versus 25 percent). Use of EHRs was significantly more common in practices owned by HMOs (60 percent) or other healthcare corporations (36 percent) compared with physician ownership (17 percent) or some other type of ownership (19 percent). The study author, Jeffrey A. Linder, M.D., M.P.H., of Harvard, acknowledged several limitations to the study which included: small sample size for some of the quality indicators; self-reporting of data in the survey; although pre-tested, a problem defining EHR, because not all products bearing that name allow for clinical decision support, a necessary feature for optimal quality improvement; and, because the survey is cross-sectional, causality cannot be assumed. The study findings came from an analysis of ambulatory care data from the National Center for Health Statistics (NCHS) for 2003 and 2004. The study was funded by the Agency on Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

Click here to access the study abstract.

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Group Submits Plan to Encourage IT Adoption in Vermont

In a 140-page document submitted to Vermont’s state legislature and several state agencies, Vermont Technology Leaders Inc. (VITL), a non-profit public/private partnership, laid out a roadmap for a 50 percent clinical adoption of electronic medical records, as well as, a statewide health information exchange (HIE) in Vermont by 2011. The document, entitled “The Vermont Health Information Technology Plan,” was developed by a group of more than 30 representatives that included providers, payers, employers and patients, at the request of Vermont’s General Assembly seven months earlier. It contains core objectives for a 5-year planning cycle that includes encouraging the use of existing electronic health records, constructing a secure infrastructure for the health information exchange, empowering the state’s healthcare consumers and enabling public agencies to leverage investments in health IT to monitor the public’s health.

To accomplish these goals, the group, among other things, identified select interoperability standards, established 40 guiding principles, developed a hybrid technology architecture, made HIE security recommendations, developed plans to educate providers and consumers, and identified EMR deployment costs.

Click here to download a copy of the VITL document.

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