Articles from the news and medical publications....

S.1227
Title: A bill to improve quality in health care by providing incentives for adoption of modern information technology.

Sponsor: Sen Stabenow, Debbie [MI] (introduced 6/13/2005) Cosponsors (1)

Latest Major Action: 6/13/2005 Referred to Senate committee.

Status: Read twice and referred to the Committee on Finance.

The Patient-Computer Interview:A Neglected Tool That Can Aid the Clinician.
by John W. Bachman, M.D.
May Clinic Proceedings. 2003.78;67-78

Kids' Care Better if Doctor Uses Computer in Visit
Health - Reuters

NEW YORK (Reuters Health) - Children may get better care if their doctors use a computer to record medical information during a visit rather than taking notes the traditional way, new study findings suggest.

When using computers to log health information, doctors were more likely to discuss a variety of issues with parents, including the child's sleep patterns, exposure to smoking, possible access to guns and behavioral milestones.

While nearly all doctors offices have computerized billing systems, very few--about 5 percent to 10 percent--generate electronic medical records while seeing patients, said lead study author Dr. William G. Adams of Boston University School of Medicine in Massachusetts.

"The major findings from our study are that computers can be successfully used while seeing patients and doctors welcome them--although for some, about 40 percent--it slowed them down somewhat," Adams told Reuters Health. But all the doctors in the study said they wanted to continue to use the system, despite a few drawbacks.

According to Adams, the doctors in the study reported that that the newer method improved the quality of care overall. "For example, in a sample of paper-based records, only a few notes even mentioned the presence of smoking in the home, an important issue for passive smokers--kids--and their parents. People who need to be reminded to quit," said Adams.

The findings are published in the March issue of the journal Pediatrics. In the study, Adams and colleagues gave 10 doctors and nurse practitioners computers equipped with software, developed by the study's authors, that offered extensive electronic medical forms for gathering information.

The study included a total of 235 paper-based visits (before the system was introduced) and 986 computer-based visits for children under five. Three doctors were excluded from the study because they left the practice or did not use the system often enough.

Doctors using the electronic system were much more likely to discuss a number of issues, including exposure to domestic or community violence, guns in the home, behavioral milestones, infant sleep position, poison control, child safety and sleep in general.

Still, four of the seven doctors using computer-based systems reported that office visits were longer (about 9.3 minutes) and five of the seven said the system decreased eye-to-eye contact with patients.

"When...designed to fit into the busy workflow of a pediatric practice, the computer can help doctors be much more complete, give doctors information that would otherwise be hard to find, and give patients their own personal health information as well as information on a wide variety of topics," said Adams.

"Doctors who take care of children--all doctors actually--need to begin thinking about getting a computer system to provide at least some, if not all, the features in this (report). Doctors don't mind using it if it is well designed, quality will improve, and patients will like and benefit from it," concluded Adams.

The study was funded by the Robert Wood Johnson Foundation, David and Lucille Packard Foundation and the National Library of Medicine.

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Errors reduced in "smart" Italian hospital

2003-02-10 16:49:06 -0400 (Reuters Health)

FLORENCE, Italy (Reuters Health) - A "smart" hospital that uses bar codes to identify patients was launched in Italy on Monday, as part of a pilot scheme to curb medical errors and cut operating costs
associated with drug management.

Called DRIVE (Drug in Virtual Enterprise), the scheme was organised by the San Raffaele Institute in Milan and financed by the European Commission.

Under the scheme, all patients wear bar-code bracelets that can be read by "smart" medicine carts designed to ensure patients are only given medicines they have been prescribed.

Software applications control prescriptions, the preparation and administration of drugs, hospital logistics, and patient privacy.

"We put the patient at the centre of a technologically advanced system which provides the best safety, protection of privacy and logical efficiency. It goes from the pharmaceutical industry to the patient's bedside," Alberto Sanna, the San Raffaele engineer responsible for the project, told Reuters Health.

Preliminary results on 600 patients revealed that the bar code bracelet, along with the smart cart and other measures including more detailed drug labels, eliminated errors in patient and drug identification, while reducing errors in preparation of drugs by 71%.

"These are breakthrough results. It is also important to note that 91.3% of patients accepted the bracelet and found that it respected their dignity and their privacy," Sanna said.

The project also aims to improve the efficiency of the pharmaceutical logistic chain and reduce operating costs. In a test carried out with the Italian branches of AstraZeneca and GlaxoSmithKline, DRIVE has
shown that management costs can be reduced by 30%.

"It is particularly useful to avoid waste. I am thinking of a better organization of drugs and their expiration dates," Gampietro Leoni, the president of Farmindustria, told Reuters Health.

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Final HIPAA Rules Hit The Street

Standards require health-care organizations to develop, implement, and document the steps they take to secure health-care information.
By George V. Hulme

2003-02-19 (Information Week) - The final standards for protecting the security of health-care information within electronic transactions, adopted by the Bush administration, will be entered into the Federal Register on Thursday. While these final rules take effect on April 21, large health-care organizations have until April 2005 to comply with the regulations. Smaller ones are given an additional year to comply.

While the 289-page summary of security rules doesn't mention any specific technologies be used to secure electronic health-care information, it does require health-care companies develop, implement, and carefully document the measures they take to ensure that such information remains secure. The security standards establish baseline safeguards for health-care organizations to deploy administrative safety measures (such as security training and security assessments), physical security (such as restricting physical access to certain systems), and technological safeguards (such as electronic signatures and passwords) to ensure protected information remains confidential, isn't altered, is readily available, and isn't accessed without authorization.

While the security rules are established to protect the actual information electronically stored and transmitted, the privacy rules that go into effect in April focus on how protected health information is to be controlled through policies establishing who has access to that information and what specific rights patients have regarding their personal health-care information.

“Overall, these national standards required under HIPAA will make it easier and less costly for the health-care industry to process health claims and handle other transactions while assuring patients that their information will remain secure and confidential," Tommy Thompson, Secretary of Health and Human Services, said in a statement. "The security standards in particular will help safeguard confidential health information as the industry increasingly relies on computers for processing health-care transactions."

Pete Lindstrom, research director with Spire Security, says the final rules removed many of the technical requirements, present in earlier drafts, that may have dictated health-care organizations deploy certain types of security applications. “They removed the requirement for digital signatures and chose much less technically strict electronic signatures,” Lindstrom says. “They want health-care providers to be able to choose the types of security technologies they feel are appropriate for their own organization and systems. ... The final rules highlight that information security is an ongoing process of risk management." He notes that as a result of the final security rules, health-care organizations are going to have to carefully establish security policies and procedures and document why they chose certain tactics and technologies to secure their systems.

Security vendors hoping to find a sales boon in the final rules are going to be disappointed. “There's nothing that says you have to buy certain security technologies,” such as intrusion-detection systems, firewalls, or digital certificates, Lindstrom says.

While the lack of technological specifics about how organizations need to go about securing their information may make HIPAA compliance easier in some ways, in other ways, it will be more difficult for health-care providers to understand whether they are in compliance, Lindstrom says. “They're going to have to do their security homework, take a thoughtful approach to security, and be able to justify their polices,” he says. But without steadfast rules, “this is going to be a free-for-all for a long time.”

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Europe-wide health card slated for mid-2004

2003-02-21 14:17:51 -0400 (Reuters Health)

LONDON (Reuters Health) - A health insurance card that would cover European Union citizens throughout the region will be launched in June 2004 under European Commission recommendations released on Friday.

The personalised card would replace the forms that EU citizens currently use if they need treatment while staying temporarily in another member state. The idea is to let people who have to pay for their healthcare abroad be reimbursed more quickly by their own social security system.

"The European health insurance card will make it easier and quicker for EU citizens to obtain healthcare when staying temporarily in another Member State. The card will also have a powerful symbolic value : after the euro, the European health card is another piece of Europe in your pocket," said Anna Diamantopoulou, Commissioner for Employment and Social Affairs.

In the first phase, the new card will replace the existing 'E111' form for short stays such as holidays. In a second phase, it will take the place of all other forms used for temporary stays--including employees posted to another country (E128), international road transport (E110), study (E128) and job seekers (E119).

Eventually, the card will be replaced with an electronic 'smart' card that is readable by computer. It will also play a role as EU citizens get greater rights to non-emergency care in other EU countries, the Commission said.

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U.S. House approves medical errors bill

2003-03-12 17:48:48 -0400 (Reuters Health)

By Julie Rovner

WASHINGTON (Reuters Health) - The U.S. House of Representatives Wednesday overwhelmingly approved legislation aimed at reducing medical errors, which by some estimates are the nation's 8th leading cause of death.

"The Patient Safety and Quality Improvement Act" passed on a vote of 418-6.

The bill calls for the creation of "patient safety organizations" that would collect and analyze anonymous reports of medical mistakes, then report back on ways to prevent similar mishaps in the future. Participation by healthcare providers would be voluntary, and all information would be kept strictly confidential, with fines for disclosure up to $10,000.

In its 1999 report estimating that medical mistakes kill between 44,000 and 98,000 Americans each year, the federally chartered Institute of Medicine called for both a voluntary reporting system for minor mistakes and "near misses," and a mandatory reporting system for more serious errors.

Congress, however, has been unable to agree on mandatory reporting provisions, which are opposed by most healthcare provider groups. The less controversial voluntary system has also been delayed for several months, while two House committees argued over which of their bills should reach the floor.

The winner was the Energy and Commerce Committee, whose Health Subcommittee Chairman, Michael Bilirakis, R-Fla., said the bill "would help us move from a culture of blame to a culture of safety."

The system created under the bill, said Chris John, D-La., "will enable healthcare providers to learn from past mistakes."

House Republicans were eager to get the medical errors bill to the floor before they took up a more controversial medical malpractice bill scheduled for Thursday that would limit damages for injured patients.

Some Democrats, including Rep. Pete Stark, D-Calif., took them to task for that schedule. "Reducing medical errors is an important goal, and this legislation takes a small step in that direction," he said. "Unfortunately, the timing of the consideration of this bill is driven by crass political motives to provide cover for the anti-patient legislation that will be considered tomorrow."

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Tenet to sell hospitals, cut costs

Last Updated: 2003-03-18 12:32:17 -0400 (Reuters Health)

NEW YORK (Reuters) - Tenet Healthcare Corp., the nation's No. 2 hospital chain, said on Tuesday it plans to sell or consolidate 14 hospitals, cutting costs by at least $100 million in a bid to increase profit margins and accelerate its share repurchase program.

Tenet, which is being investigated for alleged improper billing of Medicare, plans to sell all four of its hospitals in Arkansas; its only hospital in rural northern Florida; its one hospital in Nevada; and one of its 14 hospitals in Texas.

It will also sell two hospitals in Tennessee, two in Missouri, and it will sell, convert or consolidate two acute-care hospitals in Pennsylvania.

Tenet also plans to transfer acute-care services at its Santa Ana, California hospital to nearby hospitals in Orange County.

The company, which is based in Santa Barbara, California and runs 114 hospitals, also said it would also begin treating stock options as expenses as part of an effort to increase its financial transparency.

The impact of expensing options will lower net earnings in the year ended Dec. 2003 by about 18 cents a share.

The company said it has changed its non-standard fiscal year ending May 31 to a calendar year ending Dec. 31. The change will align Tenet's financial reporting with its new Medicare billing policy, which took effect Jan. 1.

As part of the transition, the company will report results for the quarter ended Feb. 28, 2003, the third fiscal quarter under the old reporting schedule, on April 10.

Tenet shares were up 69 cents at $17.89 in midday trade on the New York Stock Exchange.

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Electronic medical records save money

Last Updated: 2003-04-21 11:20:38 -0400 (Reuters Health)

NEW YORK (Reuters Health) - It pays to use electronic medical records,
according to a cost-benefit analysis by a team of Boston researchers.

Primary care providers can save an estimated $86,400 over five years
versus the traditional paper-based method of maintaining patient records,
with a third of that savings coming from reduced drug expenditures, the
study found.

U.S. physicians have been slow to adopt electronic medical records, even
though the Institute of Medicine sees information technology as one of the
principal ways to improve healthcare quality.

The findings reported in the April issue of The American Journal of
Medicine help make the "business case" for moving to a paperless system by
demonstrating the financial benefit.

Dr. Samuel J. Wang and colleagues at Partners HealthCare System in Boston
weighed the costs and benefits of investing in an electronic medical
record system using data from Partners, published studies and expert
opinion.

The cost side of the equation included the cost of hardware and software,
training, implementation, and ongoing maintenance and support. It also
included the cost of transitioning from a paper to an electronic system,
such as a temporary loss in physician productivity.

Financial benefits included averted costs and increased revenues. The move
to an electronic system, for instance, avoids the time and cost of
retrieving and re-filing a paper chart. At Partners, that's roughly $5 for
each chart that is pulled.

An electronic system also can cut costs by reducing adverse drug events an
estimated 34%.

After the initial cost of implementing an electronic medical records
system, benefits started to accrue in years two through five of the
five-year model. Reduced spending on drugs accounted for 33 percent of
total savings over the five years.

Other major benefits included decreased use of radiology (17 percent),
decreased billing errors (15 percent) and better capture of charges for
procedures performed but not documented (15 percent).

Researchers said the savings held up across a wide range of assumptions.

"Because of their quality and cost benefits, electronic medical records
should be used in primary care, and incentives to accelerate their
adoption should be considered at the national level," the team concluded.

Source: The American Journal of Medicine 2002;114:397-403.

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