National Office for Health IT Awards State E-Health Alliance Contract

National Office for Health IT Awards State E-Health Alliance Contract

October 19, 2006

The Office of the National Coordinator for Health IT has awarded a contract to the National Governor's Association to form a State E-Health Alliance in 2007, reports.

NGA's Center for Best Practices will develop a steering panel composed of governors and state legislators working to form health information networks, according to Jodi Daniel, director of ONCHIT's Office of Policy and Research.

Daniel said that three task forces will work on issues, including:

• Health information exchanges;
  
• Licenses and other legal issues;
  
• Privacy; and
  
• Security.
  

The one-year contract, which is the third awarded by ONCHIT to promote health IT at state and regional levels, is worth nearly $2 million, according to ONCHIT spokesperson Nancy Szemraj (Ferris, Government Health IT, 10/18).

Cost called largest obstacle for EMR adoption

DENVER – The price tag remains the single most significant barrier to electronic medical record system adoption by physicians today, two leaders of prominent physician organizations said Tuesday.

William F. Jessee, MD, president and CEO of the Medical Group Management Association, and Douglas Henley, MD, executive vice president of the American Academy of Family Physicians, were part of a panel speaking to the members of the American Health Information Management Association at their annual meeting here

With doctors facing an average 5 percent cut in Medicare reimbursement in 2007, the $32,600 estimated cost per physician to adopt an EMR, plus additional annual costs for maintenance, is off-putting, said Jessee. It’s not that physicians are “technological Luddites,” he said.

Jessee noted that vendors’ quoted prices typically run 20 percent higher than estimated. A hard-to-perceive ROI - or return on investment, an almost certain change in workflow, and a still fragmented market add to the resistance, he said.

Henley’s remarks closely mirrored Jessee’s. The AAFP, which has more than 50,000 members, had a goal of having 50 percent of its members adopt electronic medical record systems by 2005. It achieved 30 percent adoption.

“We are now focused on the next 30 percent,” Henley said. “Half of them say they are ready to write the check in the next 12 months”

A recent MGMA study estimated that 75 percent of medical practices are paper-based. Fourteen percent have what Jessee called a true electronic record with a relational database. The rest employ a combination of paper and automation in their offices,

Both organizations are working to boost IT adoption rate among their members, and despite the stated roadblocks, they offered reasons for optimism.

“Forces are converging to accelerate change,” said Jessee, who pointed to federal initiatives from Congress (both parties), the Centers for Medicare and Medicaid; the Office of the National Health Information Coordinator; and the American Health Information Community.

Jessee also mentioned certification of products by the Certification Commission for Healthcare Information Technology as helping to reassure physicians regarding the functionality of products on the market today.

Among Jessee’s laundry list of pros for EMR adoption:
- Safety improves
- Workflow improves
- Productivity improves (after about six months)
- Charge capture improves
- Transcription costs go down
- Records are easily accessed (not so likely to be in the trunk of a physician’s car)
- Rx management is streamlined
- Patient satisfaction is enhanced

Jessee and Henley agreed that insurers could encourage physicians to adopt electronic medical records by creating incentives for those groups that do “take the plunge.”

“We’ve got to adopt health information technology, and get on with it,” Henley said.

Drug Reactions Send 700,000 Yearly to ER

By LINDSEY TANNER

The Associated Press
Tuesday, October 17, 2006; 7:00 PM

CHICAGO -- Harmful reactions to some of the most widely used medicines _ from insulin to a common antibiotic _ sent more than 700,000 Americans to emergency rooms each year, landmark government research shows.

Accidental overdoses and allergic reactions to prescription drugs were the most frequent cause of serious illnesses, according to the study, the first to reveal the nationwide scope of the problem. People over 65 faced the greatest risks.

"This is an important study because it reinforces the really substantial risks that there are in everyday use of drugs," said patient safety specialist Bruce Lambert, a professor at the University of Illinois at Chicago's college of pharmacy.

Even so, the study authors and other experts agreed that the 700,000 estimate was conservative because bad drug reactions are likely often misdiagnosed.

The study found that a small group of pharmaceutical warhorses were most commonly implicated, including insulin for diabetes; warfarin for clotting problems; and amoxicillin, a penicillin-like antibiotic used for all kinds of infections.

"These are old drugs which are known to be extremely effective. We could not and would not want to live without them. But you've got to get the dose exactly right. Variations, especially on the high side, are really dangerous," Lambert said. He was not involved in the research.

Those aged 65 and older faced more than double the risk of requiring emergency room treatment and were nearly seven times more likely to be admitted to the hospital than younger patients.

The results, from 2004-05, represent the first two years of data from a national surveillance project on outpatient drug safety. The project was developed by the federal Centers for Disease Control and Prevention, the Food and Drug Administration and the U.S. Consumer Product Safety Commission. The study was published in Wednesday's Journal of the American Medical Association.

The database included 63 nationally representative hospitals that reported 21,298 bad drug reactions among U.S. adults and children treated in emergency rooms during the two-year period. The tally is based on what emergency room doctors said were complications from using prescription drugs, over-the-counter medicines, dietary supplements or herbal treatments.

The researchers said it translates to 701,547 complications nationwide each year.

"Experts had thought that severe outpatient drug events were common, but no one really had good numbers" until now, said lead author Dr. Daniel Budnitz, a CDC researcher.

Complications included diabetics on insulin passing out from low-blood sugar, excessive bleeding in patients on warfarin, and severe skin rashes in patients taking amoxicillin. Drug reactions were severe enough to require hospitalization in about 17 percent of patients. The study did not include information on whether any of the reactions were fatal.

"The numbers are quite troubling," said Jim Conway, senior vice president at the Institute for Healthcare Improvement. The tally underscores that "there is a tremendous number of consumers in the United States taking medication."

The CDC has estimated that about 130 million Americans use prescribed medication every month. U.S. consumers buy far more medicine per person than anywhere else in the world.

Yet a recent study found that doctors' conversations with patients when prescribing new drugs aren't very thorough and that side effects often aren't mentioned. Many of the drugs implicated in the new study require frequent physician monitoring to make sure the dose is correct.

The new findings highlight the need for better doctor-patient communication about use of medicines, Conway said.

The number likely underestimates the number of people who have bad drug reactions outside a hospital setting because many don't get ER treatment, while others who do may have symptoms that are mistakenly attributed to something else, said patient safety expert Dr. David Bates, a professor at Harvard Medical School.

Still, Bates called the effort a significant contribution since previous reports on the problem have not been national in scope.

Developing a national HIT network

WASHINGTON – The marketplace is still defining PHRs and whether they should include claims data, National healthcare IT interim chief Robert Kolodner, MD, told an audience at the 2nd Nationwide Health Information Network Forum held earlier this week in the nation's capital. Kolodner and John Loonsk, director of the Office of Interoperability and Standards, responded Monday to several questions from some of the hundreds of stakeholders at the forum.

Patient health records
Question: Are there any plans to establish small portions of patient health records as an initial effort?
Kolodner: Yes. There are plans to develop an “e-clipboard” where patients can electronically record the basic information usually collected in the waiting room at a first visit with a doctor. A second idea is to create a way for patients to access a simple list of their prescriptions.

Volunteer burnout
Question: What does HHS plan to do about the limited pool of private entities available to build the National Health Information Network? (Glen Marshall, standards and regulations manager, Siemens Medical Solutions)
Loonsk: Volunteer burnout is a concern and one possible solution could be to bring in organizations that can participate on a smaller scale.

Property rights for PHRs and EHRs
Question: Who has property rights over PHRs and EHRs?
Loonsk: This is a complicated issue that should be addressed by states, with federal support.

PHRs vs. EHRs
Question: How do you differentiate between electronic health records and patient health records? Also, will PHRs include patient claims data, and is that needed in both PHRs and EHRs? (Ann Will, vice president, CGI Federal)
Kolodner: The marketplace is still defining PHRs and whether they should include claims data. For now, the development of EHRs–the electronic record of a patient’s healthcare to be exchanged through IT networks–takes higher priority than personal records retained by patients themselves.

International data exchange
Question: Are there plans for including international data exchange in a federal healthcare IT network? (Amy Verstappen, Adult Congenital Heart Association)
Loonsk: There have been a number of discussions over the issues, concerns and approaches for international data exchange. There is a desire to exchange data between nations.

Creating networks
Question: Standards for the financial world were not sufficient enough to create a network; how will this be addressed in developing a successful healthcare information network? (an Environmental Protection Agency representative)
Loonsk: There has been a lot of discussion about interoperability, and constraint testing will be an important part of it. There is tension between what can actually be adopted and the broader vision. “Because of the complexity, we might have to settle for less [than the broader vision].”

State AHICs
Question: What states will participate in ONC’s upcoming plans to launch several state versions of the American Health Information Community? (Donald Mon, American Health Information Management Association)
Kolodner: That information is not readily available because the project is in the initial stages.

Are We Close to Real Data Integration

Are We Close to Real Data Integration 'Redefining Healthcare'?
By Matthew Holt

Michael Porter and Elizabeth Teisberg in their book Redefining Healthcare tout the concept of hospitals competing over excellence in treating specific medical conditions nationally. The Cleveland Clinic, among others, is marketing its online second opinion service. Technology vendors such as Sun ("services-oriented architecture"), Cisco ("application-oriented networks"), and Microsoft -- which just acquired interface technology company Azyxxi -- are all narrowing in on the problem of information exchange between existing clinical and operational systems. The PACS market is growing fast, and the amount spent on medical imaging is growing faster. Meanwhile, physician shortages in rural areas mean that hospitals are outsourcing radiology to larger regional, national, and even international players.

This all sounds like the perfect environment to share information regionally. There's just one tiny problem. The average CIO is already minding more than a hundred interfaces between systems, and the concept of having to extend that management beyond the bounds of the institution is frightening -- and a major stumbling block in front of the RHIOs.

What's needed is an easy way of extracting and exchanging clinical data in its context. Companies such as TeraMedica and Philips (via its acquisition of Stentor) are all working with brand-name clients to achieve this, but some of the boldest claims being made come from a small company called CMTC. CEO Shimon Schurr says, "The concepts that RHIOs are in policy discussions about for the future, our technology can do today." For example, CMTC can take clinical data from a variety of system, allow it to be put on a secure Web site and have it uploaded into a completely different system (e.g., PACS and EMR), including keeping the surrounding workflow information and patient context. Adding videoconferencing and this creates an online workspace for consults.

Schurr says that at the core of CMTC's .NET-based technology is a concept called Semantic Interoperability, which essentially allows data to be automatically normalized and exchanged between systems. Thus far, it's been used for remote consultation between New York Presbyterian Hospital and medical centers in Turkey and Israel. In conjunction with Kodak and Accenture, University of Virginia Medical Center will soon start testing the system with community oncologists and regional hospitals.

If the Porter/Teisberg concept is to succeed, for technology to bring the expertise of centers of excellence virtually to patients in any setting requires an easy, secure method of combining patient records, workflow information, images, and conferencing technologies online. Then remote physicians or teams of clinicians can view it at one time (or asynchronously) without new interfaces or expensive infrastructure. The promise is a real "dislocation" of the workflow for how diagnoses are currently managed. Possibly using technology like CMTC's, that promise could become reality sooner rather than in some pie-in-the-sky futures.