Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Tuesday, December 16, 2008

The Evidence Mounts for the Real World Value of Health IT.

Despite the nonsense that seems to be going on in the leadership of e-Health in Australia the evidence of the real world positive impact of Health IT continues to accumulate.

First this week we have:

Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and Cost

Michael A. Fischer, MD, MS; Christine Vogeli, PhD; Margaret Stedman, MPH; Timothy Ferris, MD, MPH; M. Alan Brookhart, PhD; Joel S. Weissman, PhD

Arch Intern Med. 2008;168(22):2433-2439.

Background Electronic prescribing (e-prescribing) with formulary decision support (FDS) prompts prescribers to prescribe lower-cost medications and may help contain health care costs. In April 2004, 2 large Massachusetts insurers began providing an e-prescribing system with FDS to community-based practices.

Methods Using 18 months (October 1, 2003, to March 31, 2005) of administrative data, we conducted a pre-post study with concurrent controls. We first compared the change in the proportion of prescriptions for 3 formulary tiers before and after e-prescribing began, then developed multivariate longitudinal models to estimate the specific effect of e-prescribing when controlling for baseline differences between intervention and control prescribers. Potential savings were estimated using average medication costs by formulary tier.

Results More than 1.5 million patients filled 17.4 million prescriptions during the study period. Multivariate models controlling for baseline differences between prescribers and for changes over time estimated that e-prescribing corresponded to a 3.3% increase (95% confidence interval, 2.7%-4.0%) in tier 1 prescribing. The proportion of prescriptions for tiers 2 and 3 (brand-name medications) decreased correspondingly. e-Prescriptions accounted for 20% of filled prescriptions in the intervention group. Based on average costs for private insurers, we estimated that e-prescribing with FDS at this rate could result in savings of $845 000 per 100 000 patients. Higher levels of e-prescribing use would increase these savings.

Conclusions Clinicians using e-prescribing with FDS were significantly more likely to prescribe tier 1 medications, and the potential financial savings were substantial. Widespread use of e-prescribing systems with FDS could result in reduced spending on medications.

Author Affiliations: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital (Drs Fischer and Brookhart and Ms Stedman), and Institute for Health Policy, Massachusetts General Hospital (Drs Vogeli, Ferris, and Weissman), Harvard Medical School, Boston.

Full paper is found here if you have access.


There are articles also available with more details.

See here:

With e-prescribing, US doctors pick cheaper drugs

Mon Dec 8, 2008 4:00pm EST

By Will Dunham

WASHINGTON, Dec 8 (Reuters) - Doctors who put aside their paper pads and prescribe medicines electronically may be more likely to choose lower-cost drugs, saving money for patients and insurers, U.S. researchers said on Monday.

Only about 6 percent of U.S. doctors use "e-prescribing" even though doing so may improve efficiency and reduce errors such as a pharmacy misreading a doctor's sloppy handwriting or dispensing a different drug with a similar name.

Dr. Michael Fischer of Brigham and Women's Hospital and Harvard Medical School in Boston and colleagues detailed another e-prescribing benefit: encouraging doctors to choose cheaper drugs.

The researchers evaluated a program in Massachusetts in which two large insurers worked with a maker of e-prescribing systems, Zix Corp (ZIXI.O), to get doctors to use one that employed simple color coding to identify prescription medication, whether name-brand or generic, by price level.

Insurers use a three-tiered system regarding drug costs.

In the year after adopting this e-prescribing system, the doctors increased their use of tier 1 prescriptions -- those with the lowest cost -- by 3.3 percent, while prescriptions for the more expensive drugs declined, the researchers wrote in the Archives of Internal Medicine.

That translates to a savings for consumers and insurers of $845,000 per 100,000 patients per year. In a country of 300 million people, such savings could be substantial.

"When you use an electronic prescribing system to give physicians information on which drugs are less expensive for their patients at the point of prescribing -- right when they're making that decision -- they're going to choose medications that are more affordable for their patients," Fischer said in a telephone interview.

Full report here:


And here:

Electronic Prescribing Saves Patients Money

It steers doctors toward lower-cost drugs, study finds

Posted December 8, 2008

By Ed Edelson

HealthDay Reporter

MONDAY, Dec. 8 (HealthDay News) -- An electronic prescribing system that tells doctors which drugs are the least expensive can save millions a year, a new study finds.

"One of the challenges physicians face is that they don't know which drugs are preferred or not preferred," said Dr. Michael A. Fischer, an assistant professor of medicine at Harvard Medical School and lead author of a report in the Dec. 8/22 issue of the Archives of Internal Medicine. "The insurance companies involved in the study provided that information by a color code -- green for drugs that were preferred, red for drugs that were not preferred."

Full article here:


On a different but also important tack we have:

MDdatacor and Wellmark Release Quality Improvement Program Results

Wednesday December 10, 10:00 am ET

ATLANTA, Dec. 10 /PRNewswire/ -- MDdatacor(R), Inc. and Wellmark(R) Blue Cross and Blue Shield today released the first set of results of a quality improvement program of more than 9,000 Wellmark members living with diabetes. The dramatic results showed a significant improvement in both process and patient outcome measures.

Wellmark and MDdatacor Collaboration

The results are part of Wellmark's Collaboration on Quality(R) Incent and Reward Best Practices primary care initiative, a collaboration between Wellmark and network physicians to promote the improved quality and efficiency of health care. Wellmark contracted with MDdatacor to provide a technology platform that helps doctors identify gaps in patient care, as well as opportunities to enhance treatment for their patients, through access to clinical data.

"Providing physicians with actionable data at the point-of-care creates opportunities to enhance patient care," said Tim Roche, co-founder, president and CEO of MDdatacor. "MDdatacor has the unique ability to capture clinically-relevant information right from the physician's own patient records. Physicians find the data to be more credible because it is based on clinical data and not solely on claims data."

MDdatacor's patented and interoperable CareInformatix(TM) platform provides the most comprehensive patient information through collecting and analyzing data from all available sources in a physician practice, including electronic medical records, lab, registry and practice management systems, dictated transcriptions and claims.

Study Results Demonstrate Significant Improvement in Patient Outcomes

Using evidence-based guidelines, Wellmark's quality improvement program measured the percentage increase in diabetic patients receiving an annual HgA1C, low-density lipoprotein (LDL) and blood pressure tests, as well as improved clinical outcomes as measured by lowered test scores for each of those measures.

Prior to the implementation of Wellmark's Collaboration on Quality program, only 46 percent of the 9,012 members living with diabetes were receiving an annual HgA1C test. That number increased to 90 percent at the end of the program period. This can be attributed to the fact that physicians had access to critical data about their patients, showing that they were in need of the tests.

Patient outcomes also improved notably, with the percentage of patients with an HgA1C level less than 8 rising from 37 percent to 75 percent. Controlling blood glucose levels lowers the chance of a diabetic patient having diabetes-related health problems, such as heart attack, stroke blindness, kidney failure and life-threatening infections.

Full press release here:


Again a large real world study with a positive outcome!

It seems there a none so blind as cannot see in OZ.



Anonymous said...

Your probably being a bit unfair. Medicare Australia has been working on this very issue since 1998, and DOHA has been funding the NT Project for 4 years or so, and the Guild is funding its eRx project and then there's Hatrix, and IBA in WA picked up a $14M order for its pharmacy system for WA hospitals recently.

Dr David G More MB PhD said...

And the actual outcomes that have been achieved are? And the documented successes seen here are?

A decade on from 1998 - e-prescribing is a rarity and all that has happened in WA is that a contract has been signed.

And the Strategy to move forward with all this is unfunded. Progress is and will be glacial without major change.


Anonymous said...

What it all means is this - the states can continue as before with a foot in each bucket - the LEFT FOOT contributing to the national agenda by funding NEHTAs workplan and the RIGHT FOOT contributing to whatever local state initiatives fit with the states' ehealth strategic plans.