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Health Management Technology

eNews - December 2007 •

Perception versus Reality

by Mike McBride

Health Management TechnologyOn November 5, 2007, CCHIT announced it had certified 40 percent of ambulatory EMRs and 25 percent of inpatient EMRs. Around the same time I visited my doctor to receive treatment for a mild condition and was surprised when he pulled a tattered old formulary book from his pocket to look up the medication he wanted to prescribe. He's a young man and wore an electronic device on his hip, and yet he turned to a book when he needed facts on medications. I realized my perception of him was wrong. I had assumed he used a decision-support device when in reality he did not. I inquired and he explained that his brain was faster and better than the database, but that he always checked himself before prescribing medications.

Read the full editorial




Presidential Candidates’ Healthcare Plan Report
A recent study by PricewaterhouseCoopers’ Health Research Institute shows the different approaches to reformation of the U.S. healthcare system by top presidential candidates. (more)

HHS Secretary Advocates Mandatory EMR Adoption
HHS Secretary Mike Leavitt’s recent blog post advocates required physician adoption of EMRs in order to receive the full Sustainable Growth update, but physician comments are decidedly against making EMR adoption mandatory for higher payments by Medicare. (more)

Nurses and Technology Survey for 2007
CDW Healthcare recently released the Nurses Talk Tech 2007 survey on technology showing both gains and losses over last year. (more)

Celebrity Medical Records Prove Too Tempting
Unauthorized access of electronic patient medical records belonging to celebrities not limited to the Hollywood A-list. (more)

First Workforce Estimates For NHIN Implementation
The results of the first ever study to determine how many healthcare IT specialists will be needed to implement the NHIN points at a possible labor pool shortfall while the rollout moves forward. (more)

Government Healthcare IT Legislation Faces Opposition
Despite strong bipartisan support in the Senate, the Wired for Health Care Quality Act of 2007 faces an uphill battle, while dozens of medical and physicians groups join together to fight for legislation that protects patient privacy and helps offset the costs of healthcare IT adoption. (more)

Presidential Candidates’ Healthcare Plan Report

A recent study by PricewaterhouseCoopers’ Health Research Institute shows the different approaches to reformation of the U.S. healthcare system by top presidential candidates. The report, entitled, “Beyond the Sound Bite: November 2007 Review of Presidential Candidates’ Proposals for Health Reform,” is intended as an independent, nonpartisan analysis of candidates’ health proposals and how they would impact individuals, employers and the sectors within the health industries. Leading Democrats are promising broader and more immediate changes in order to lower costs and improve quality, which includes mandating coverage for the uninsured. Republican candidate goals are similar but offer less detailed proposals that rely predominantly on tax credits or incentives for individuals to purchase insurance without federal mandates, an approach that might de-emphasize the employer-sponsored insurance market. Both approaches would likely expand the existing private insurance market, which has seen minimal growth recently despite the introduction of tax-advantaged health savings accounts.

While many health industry leaders see information technology and wellness programs as the best hope for improving the efficiency of our current system, none of the candidates wants to mandate the use of information technology. Democratic candidates’ proposals to control the cost of drugs (such as direct negotiation for Medicare drugs, re-importation and bio-generics) could potentially have significant impact on the pharmaceutical industry, which currently accounts for about 10 percent of overall health care spending. The federal government already pays the biggest share of the country’s $2 trillion healthcare bill at 47 percent. The report includes analyses of candidates’ positions by a team of health industry specialists and policy analysts from PricewaterhouseCoopers, and interviews with policymakers and health industry executives. The report covers candidates who averaged at least 10 percent in national polls for their party’s nomination.

For a full copy of the report, click here.

HHS Secretary Advocates Mandatory EMR Adoption.

HHS Secretary Mike Leavitt’s recent blog post advocates required physician adoption of EMRs in order to receive the full Sustainable Growth update. The blog post clearly outlines the problem with the current law requiring HHS to establish a Medicare Part B overall spending target rate, and the resultant “negative updates” that reduce physician reimbursement rates. Ultimately, Secretary Leavitt advocates changing the way we pay doctors to one based on results rather than volume, currently referred to as pay-for- performance. While respondents to the blog were in general agreement, things turn decidedly against the Secretary’s perspective when it endorsed mandatory EMR adoption as an eligibility requirement to receiving higher payments from Medicare. Many of the physician respondents pointed out the prohibitive cost of EMR adoption on already cash- strapped small practices, which make up the majority of primary care physicians for most Americans.

To read the HHS Secretary’s blog and associated comments, click here.

Nurses and Technology Survey for 2007

CDW Healthcare recently released “Nurses Talk Tech 2007,” the second nurses survey on technology. The survey of more than 1,000 nursing professionals from across the U.S., and from all types and sizes of healthcare organizations, shows both progress and regression in some areas. According to the findings, nurses whose organizations did not involved them in the IT selection process are twice as likely to report that IT diminishes or does not improve the quality of care than are nurses from organizations that did include them in the process. Apparently, nurse input into IT decisions is limited, with 67 percent of respondents saying nurses are not involved in IT decisions. When it comes to the ability of IT to support patient care, nurses were slightly more optimistic in 2007 than in 2006. The exception to this trend was a sharp decline in the belief that IT would reduce the rate of medical errors, down from 49 percent of respondents in 2006 to 36 percent in 2007.

While 27 percent of nurse managers are involved in the IT selection process in contrast to 17 percent of doctors, the respondents felt that nurses are still likely to be left out of these important decisions. System speed and reliability are problem areas for nurses with 43 percent of respondents saying the systems were too slow. System reliability, organizational compatibility and time spent teaching physicians are problem areas that remain at 2006 survey levels. Perception of personal health data protection by the respondents’ own healthcare organization remains high, with 41 percent seeing data security as excellent and 51 percent that see it as moderate due to some access points being unmonitored.

Healthcare organizations with informaticists in place declined among 2007 respondents in spite of the high percentages of organizations with successful and broad IT adoption for organizations with informaticists. O’Keeffe & Company conducted the current online study of nurses in July of 2007 for CDW Healthcare. A total of 1,028 nurses from large medical centers to physician offices completed the survey. The sample size equates to a +/- 2.98 percent precision at a 95 percent confidence level.

To download the study, click here.

Celebrity Medical Records Prove Too Tempting

According to a recent article in The New Zealand Herald, a staff member at the Auckland District Health Board (ADHB) was fired for inappropriately using the organization’s EMR system to access patient records, including those of several Kiwi celebrities. Twenty additional staff members, including doctors, nurses and other clinicians, were also disciplined for illicit snooping. ADHB utilizes the Concerto Physician Portal, an EMR from Auckland-based Orion Health, to supply its 3,500 clinicians with access to patient medical notes, X-rays and laboratory test results. The Auckland EMR confidentiality breach follows in the wake of a much-publicized incident that took place at the Palisades Medical Center in New Jersey involving Hollywood superstar George Clooney. The actor’s private medical information also was leaked to the media, and as a result of the access infractions and leaks, dozens of Palisades staff members received month-long suspensions without pay.

ADHB management declined to name the New Zealand celebrities involved in their case, or how often patients’ EMR privacy was compromised. But health officials there were quick to point out that, although the EMR system makes this confidential information more accessible to healthcare workers increasing the potential for misuse, it also makes a breach easy to trace. ADHB management performed electronic audits of the system’s access records to identify which of its clinicians were responsible, saying such tracking would not have been possible in the days of paper-based medical records.

Click here, to learn more about ADHB.

First Workforce Estimates For NHIN Implementation

The U.S. Department of Health and Human Services (HHS) is sponsoring a research project to determine whether the healthcare IT industry is sufficiently staffed to support the heralded implementation of the Nationwide Health Information Network (NHIN). The study is the first sobering assessment of workforce requirements for the developing electronic health records (EHR) infrastructure and includes quantifiable estimates for the numbers of trained specialists needed. The project included four focus groups, five site visits (two to regional health information organizations, one to an institutional EHR and two to physician office EHRs) and discussions with healthcare IT vendors. The data gathered supports the serious concerns about the potential shortage of trained healthcare IT personnel that was expressed in “Building the Workforce for Health Information Transformation,” the recent expert consensus report from the American Medical Informatics Association and the American Health Information Management Association.

The research project targeted three distinct categories of EHR activities in order to estimate workforce requirements: EHRs in physician offices; EHRs in hospitals and other healthcare institutions; and, the health information infrastructure required in communities to link the various sources of records. Assuming a 5-year rollout for the NHIN, the study concludes approximately 7,600 specialists will be needed to install EHRs for the 400,000 practicing physicians who do not currently have EHRs. For the 4,000 hospitals that need to install an EHR, an estimated 28,600 specialists will be needed. The research project also estimated an additional 420 personnel are required to build the health information infrastructure systems within communities throughout the nation to interconnect these disparate EHR systems. The HHS Office of the Assistant Secretary for Planning and Evaluation presented a summary of the research project results to the American Health Information Community EHR Workgroup in late September.

To learn more about the NHIN Workforce Study, the final report is available here along with the executive summary.

Government Healthcare IT Legislation Faces Opposition

The Wired for Health Care Quality Act (S. 1693), a bill that has been battling its way onto the law books since 2005, has come under siege in the Senate by the American Medical Association (AMA) and 35 other physician organizations banded together against it. The Wired for Health Care Quality Act originally came to life as S. 1418 in 2005, a bipartisan effort introduced by Sen. Mike Enzi, (R-Wyo.), chairman of the Senate Health, Education, Labor and Pensions Committee and cosponsored by 38 additional Senators. Among its many supporters, were prominent Democratic presidential candidates, Senators Hillary Rodham Clinton (N.Y.) and Barack Obama (Ill.).

After unanimously passing in the Senate, the bill lost momentum in the House and never became law. Now, reborn last June in the 110th Congress and sponsored this time around by Sen. Edward Kennedy (D-Mass.), the bill’s prospects seemed to be looking good. However, despite two unsuccessful “hotlining” attempts, (a congressional tactic for swift passage of a bill that requires no debate in the Senate), the bill is once again losing traction. The issues of contention, which are central to the bill’s opposition, concern its provisions for quality measurement, patient privacy and funding. A budget report for the bill from the Congressional Budget Office estimates the cost for implementing S. 1693 at $47 million in 2008 and $317 million through the next four years. This amount includes approximately $278 million budgeted for grants to assist physicians with purchasing new healthcare IT systems, such as an EHR.

However, the AMA, the Patient Privacy Rights Foundation, as well as numerous additional opponents of the bill, say its financial support fails to go far enough. The AMA and its medical organization coalition sent a letter in November to the legislation’s principle champions, Senators Clinton, Kennedy, Mike Enzi (R-Wyo.) and Judd Gregg (R-N.H.), expressing the organizations’ concerns with the bill. Among the issues of protest, the letter states that the grants for purchasing new healthcare IT fail to support the healthcare providers that require it the most—“solo or small physician practices, and those who practice in rural, inner-city and medically underserved areas.”

Other disputes detailed in the letter revolve around the bill’s establishment of a healthcare IT interoperability standards board that would require federal agencies to adopt its approved standards. The HHS Secretary would be given the authority to create quality measures and doctor-specific reports on performance on the measures. Opponents argue quality measures should be developed in a process that is transparent and that involves physicians and other stakeholders. Another barrier preventing lawmakers and healthcare policy groups from seeing eye-to-eye, and perhaps the most contentious issue with the legislation, is patient privacy rights and who retains control of access to personal health information. As of late November, negotiators from the Senate Health, Education, Labor and Pensions Committee were still working with the AMA and other physician groups to reach an accord.

Click here, to learn more about the Wired for Health Care Quality Act of 2007 on the U.S. Committee on Health, Education, Labor and Pensions Web site.

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