After years of being a target of criticism, the Veterans Administration health system now stands as a model of high quality, low cost healthcare, according to the Washington Post. Reportedly, the VA's extensive use of electronic medical records contributes to its achievement.
Although information technology (IT) holds potential for transforming health care delivery in important ways, little is known about what a nationwide IT infrastructure might look like. A new issue brief from Mathematica Policy Research, Inc., summarizes recent federal policy efforts to expedite the adoption of electronic health records (EHRs), which are envisioned as the main component of a strategy for improving quality of care, reducing medical errors, and lowering administrative costs.
EHRs consist of clinical information systems that allow physicians and other health care professionals to monitor the health status of their patients with electronic medical charts; expedite referrals and other care decisions; support care decisions with evidence-based guidelines; computerize their ordering of prescription drugs, lab tests, and images; and store and retrieve medical records from different locations.
The brief is based on Mathematica's ongoing literature review of health care providers' use of EHRs, incentives to increase the number of providers that adopt them, and recent legislation aimed at expanding their use. In addition, the publication discusses the implications that use of this technology may have on the development of quality-based purchasing.
�Our review suggests that use of EHRs by physician practices is still modest among solo or small-group practices,� said Lorenzo Moreno, author of the issue brief and a senior health researcher at Mathematica. �Current policies and recent legislative initiatives are likely to expedite the adoption of this technology, however. Providing appropriate financial incentives to providers, fostering the development of standards and networks for allowing EHR systems to communicate nationwide, and addressing legal barriers to the secure exchange of data will move this process forward.�
The brief, �Electronic Health Records: Synthesizing Recent Evidence and Current Policy,� is on the web at www.mathematica-mpr.com Printed copies are available from Publications, (609) 275-2350.
Mathematica, a nonpartisan firm, conducts policy research and surveys for federal and state governments, foundations, and private-sector clients. The employee-owned company, with offices in Princeton, N.J., Washington, D.C., and Cambridge, Mass., has conducted studies of health care, disability, early childhood policies, welfare, education, employment, and nutrition programs in the U.S.
The National Quality Forum (NQF) on August 3 announced the endorsement of a
National Voluntary Consensus Standard for a patient safety taxonomy. The voluntary consensus
standard�representing the consensus of more than 260 healthcare providers, consumer groups,
professional associations, purchasers, federal agencies, and research and quality improvement
organizations�establishes the nation�s first standardized integrative classification system for
healthcare errors and other patient safety problems.
To make healthcare safer, institutions must be able to identify, catalog, and analyze errors and other patient safety concerns. This requires better data on how and when these problems occur. Many healthcare providers, professional organizations, and some states and agencies of the federal government have implemented patient safety reporting systems; unfortunately, the ability to learn from these systems is limited because they do not �talk� to each other.
The NQF project addresses this by endorsing a specific classification system (i.e., taxonomy)�the Patient Safety Event Taxonomy (PSET)�that will enable interoperability of reporting systems and comparability of information across systems and over time. The Joint Commission on Accreditation of Healthcare Organizations developed PSET with the assistance of a work group comprising representatives of provider and health professional organizations and the federal government. To add to overall clarity and to support full implementation of the taxonomy, NQF also endorses definitions of key patient safety terms, standard reporting elements for patient safety reporting systems, and additional recommendations in two areas related to the taxonomy: guiding principles to improve it and the role of the taxonomy in the healthcare information technology infrastructure.
The taxonomy can be used to classify data collected through the various reporting systems used by different healthcare providers, allowing information about patient safety events to be organized, combined, and analyzed. It is not intended to replace existing reporting systems already in use; instead, existing systems should be mapped to this taxonomy and should evolve to align with it.
NQF is a voluntary consensus standard-setting organization. Any party may request reconsideration of the recommendations, in whole or part, by notifying NQF in writing no later than September 2, 2005 (601 13th Street, NW, Suite 500 North, Washington, DC 20005; fax 202.783.3434). For an appeal to be considered, the notification letter must include information clearly demonstrating that the appellant has interests that are directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests.
NQF is a private, not-for-profit, public benefit corporation established in 1999 to standardize healthcare quality measurement and reporting. Established as a unique public-private partnership, NQF has broad participation from all sectors of the healthcare industry. Visit NQF on the web at www.qualityforum.org
A Blue Cross and Blue Shield of Minnesota study that shows a continued pattern of growth among Minnesota hospitals, focused in a few specialties.
�Metropolitan hospital facilities are continuing to expand and build at a fast pace, especially for specialties like cardiac care,� said Michael Morrow, senior vice president of business development and network management for Blue Cross. �More public discussion is needed by all affected parties regarding the kind and type of health care we want and need in Minnesota. We�re pleased to take this step to initiate this expanded dialogue.�
Blue Cross, the state�s largest insurer, has asked the Citizens League, a non-profit, independent public policy group, to create an expert study panel from all stakeholders, conduct independent research, involve citizens, and come up with recommendations for addressing hospital capacity issues. The intent of the study is to present information on hospital expansion and encourage broader public discussion of the issues related to expansion. �As a community, we have the opportunity to build the health care system we want, but we need broader community input to define and support that vision,� Morrow said.
�Healthcare is a critical public policy issue for Minnesotans,� said Sean Kershaw, president of the Citizens League. �Minnesota depends on high quality healthcare to sustain our high quality of life and we can�t allow rapidly increasing costs to put either of these in jeopardy. The Citizens League is excited by the opportunity to be part of the solution in looking at this issue. Blue Cross� work sets the stage for a larger effort to engage citizens and other stakeholders in this effort.
The Blue Cross study released today, called �Hospital Expansion in Minnesota: Is Growth Worth the Cost?� inventoried expansion plans since 2002 and benchmarked Minnesota hospitals against national averages.
Key findings of the report:
* One-third of Minnesota�s hospitals are growing. The report cited 56 of 148 Minnesota hospitals are planning or conducting new building or expansion projects since 2002 totaling $1.57 billion, continuing a sharp upward trend. The majority of expansion projects are in the Twin Cities metropolitan area.
* Much of the expansion occurs in a few specialties, for which Minnesota already exceeds the national average. For example, Minnesota has 28 percent more cardiac intensive care beds than the national average and yet 40 percent fewer psychiatric beds than the national average.
�We can make better informed decisions about the kind of hospital care we build so that it will result in higher quality, lower prices and better access,� Morrow said. �But it will take all of us working together for the benefit everyone.�
Disputing a report previously published by the New York Times, Health IT World reports that Medicare will charge doctors $2,700 for a version of the Department of Veterans Affairs medical records software.
Someone gained unauthorized access to a server at the University of Colorado's health center. It contained records for 42,000 university students and staff. The breach was reported on July 14, according to DenverChannel.com.
Reportedly, another server at the university's college of architecture also was violated.
According to the New York Times, Medicare will provide doctors with a free version of Vista, the record-keeping software used by the Department of Veterans Affairs.
The Times states, "There is no one in medicine who does not consider it both crucial and long overdue to have electronic records in doctor's offices and hospitals."
However, the Sydney Morning Herald has reported that there have been privacy breaches in Australia's electronic medical records system.
The U.S. health care industry has neglected engineering strategies and technologies that have revolutionized quality, productivity, and performance in many other industries, says a new report from the National Academies' National Academy of Engineering and Institute of Medicine. This "collective inattention" has contributed to serious consequences in health care -- nearly 100,000 preventable deaths per year, outdated procedures, about a half-trillion dollars wasted annually through inefficiency, costs rising at roughly three times the rate of inflation, and 43 million people uninsured. Health care professionals and engineers should work more closely together to address these challenges, said the committee that wrote the report, according to a press release.
"The health care sector is deeply mired in crises related to safety, quality, cost, and access that pose serious threats to the health and welfare of many Americans," said Jerome H. Grossman, committee co-chair and senior fellow and director of the Health Care Delivery Policy Program, Harvard University, Cambridge, Mass. "Unfortunately, the health care system has been very slow to embrace engineering tools and clinical information technologies that could transform it from an underperforming conglomerate of independent entities into a high-performance system."
"Systems-engineering tools," developed for the design, analysis, and control of complex systems, have been used by many industries to improve the safety and quality of products and services and to lower production costs. These same tools, in certain circumstances, have been shown to improve the quality and efficiency of health care. If adapted and widely adopted, they could help deliver care that is safe, effective, timely, efficient, equitable, and patient-centered -- the six "quality aims" envisioned in a landmark report by the Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century -- the report says.
"While medicine has advanced rapidly in recent decades thanks to new diagnostic and therapeutic technologies developed by engineers, the health care industry has virtually ignored a broad spectrum of other technologies that could radically improve the safety and efficiency of health care," said W. Dale Compton, committee co-chair and Lillian M. Gilbreth Distinguished Professor Emeritus of Industrial Engineering, Purdue University, West Lafayette, Ind.
Cultural, organizational, and policy-related barriers have impeded the widespread use of systems-engineering tools and information technology in health care, the report says. Health care professionals often fail to recognize that they are part of a larger system and most engineering professionals have a limited understanding of the complex challenges involved in health care. To encourage health care providers to use systems-engineering tools, organizations that have already adopted or promoted the use of such tools -- such as the Veterans Health Administration, the Institute for Healthcare Improvement, and the Agency for Healthcare Research and Quality -- should increase their outreach efforts to educate the larger health care community.
The health care sector remains woefully underinvested in information and communications technologies, the committee noted. Government and private-sector organizations should accelerate implementation of the National Health Information Infrastructure, a 10-year initiative developed by the U.S. Department of Health and Human Services to improve the overall quality of health care, facilitate the exchange of data among health care organizations, public and private payers, regulatory bodies, and the research community, and enable patients to become more active partners in their own health care, the report says. The health care community should also take advantage of emerging technologies based on wireless communications and microelectronics to improve the lives and care of patients, especially the elderly and patients with chronic illnesses, who require continuous monitoring and care.
The transformation of the health care system will require dramatic changes in the education and training of health care professionals, engineers, and managers and in the way innovation in health care delivery is advanced, the committee said. To hasten this transformation, the federal government, in partnership with the private sector, universities, federal laboratories, and state governments, should establish multidisciplinary centers at institutions of higher learning to bring together researchers, practitioners, educators, and students in engineering, health sciences, management, and the social and behavioral sciences. A lead government agency should be identified to coordinate the activities of these centers and ensure that funding is stable and adequate, the report says.
"If the nation takes up the challenge to transform the health care system now, current crises can be abated -- costs can be cut, the number of uninsured can be reduced, and more Americans can have access to the quality care they deserve and that we are capable of delivering," said Grossman.
The study was sponsored by the National Science Foundation, Robert Wood Johnson Foundation, and the National Institutes of Health. The National Academy of Engineering and Institute of Medicine are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter. A committee roster follows.
Copies of Building a Better Delivery System: A New Engineering/Health Care Partnership will be available in the fall from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or order on the Internet at http://www.nap.edu
For electronic health records, healthcare providers, preferring instead commercial Microsoft and Unix vendors, have so far shunned Linux and other open source software, according to LinuxInsider.com
The Kansas Bioscience Inititative, a state project intended to boost Kansas' economy by promoting bioscience research, should have its final plan ready by this year's end, according to the Wichita Eagle.
Apparently Kansas, like Tampa Bay and Philadelphia seeks to boost its economy by promoting biological research. However, unlike the other two, its efforts appear to extend beyond cancer research to include other bioscience efforts as well.
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