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."

Saturday, March 21, 2009

Report Watch – Week of 15 March, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

Americans clamor for healthcare reform now, says HHS report

March 06, 2009 | Bernie Monegain, Editor

WASHINGTON – Americans are pressing for action now on healthcare reform, according to a report released Thursday by the Department of Health and Human Services.

HHS also launched on Thursday its new healthreform.gov Web site.

The report, "Americans Speak on Health Reform: Report on Health Care Community Discussions," summarizes comments from thousands of Americans who hosted and participated in Health Care Community Discussions across the country and highlights the need for immediate action to reform healthcare.

Many of the summaries addressed the critical role healthcare information technology could play in fixing what many called a "broken" system.

The report is available on the new Web site

"This new Web site, www.healthreform.gov, and report ensure that when we discuss health reform, the American people will have an equal stake in the health reform efforts," said HHS spokeswoman Jenny Backus. "Sky-rocketing healthcare costs are creating enormous pressure on families, on businesses and our fiscal future. The Obama administration is committed to taking action this year on health reform and is calling on government, business, healthcare stakeholders and everyday Americans to come together to make it happen."

More here:


The full report is here:


A useful summary regarding how Americans view their health system. The role of the possibilities of the use of Health IT gets a good airing!

Second we have:

New Stimulus Incentives Raise Serious Health Information Technology Implementation Concerns

Contact: Lindsey Spindle, 202.207.1337, lspindle@avalerehealth.net


Washington, DC – A new Avalere review of the healthcare information technology (HIT) provisions in the recently passed stimulus bill suggests that new financial incentives will still leave many physicians in small practices facing significant up-front HIT implementation costs. Absent a leap-of-faith that new HIT will increase their efficiency, up to half of physicians (those practicing solo or in small groups) may perceive themselves better off financially by forgoing the HIT investment, and instead paying a penalty for non-compliance.

Using electronic health record (EHR) adoption costs published by the Agency for Healthcare Research and Quality (AHRQ), Avalere researchers found that a solo or small group physician practice will spend an estimated $124,000 over the five year period of 2011-2015 to adopt EHRs, and will receive up to $44,000 in federal incentive payments. The resulting financial deficit would be $70,000, or an average of $14,000 a year. This represents about 8% of this physician’s annual Medicare receipts, contrasted with the legislation’s provisions to impose an $8,500 penalty on non-adopters.

According to The New England Journal of Medicine, over 50% of physician practices consist of 1-3 doctors. In 2005, AHRQ found that the average EHR implementation cost per physician was $32,606, but noted for smaller practices that could rise to $37,204 per physician. On top of those costs, AHRQ estimates a monthly $1,500 upkeep and training cost

“These new incentives are intended to motivate doctors to adopt EHRs, yet for many physicians, the level of the incentive may not reflect current financial realities,” said Jon Glaudemans, a senior vice president at Avalere Health. “Given this gap, EHR adoption will still require a significant investment by small physician practices. In today’s economic climate, many physicians will struggle with this calculus.”

Proponents of health information technology are heralding the Obama administration’s recent $19 billion investment in this arena, noting its ability to stimulate innovation and eventually generate cost-savings through improved care coordination and reduced medical errors. Central to the stimulus bill’s HIT strategy is an incentive fund to be paid to physicians in return for the purchase and “meaningful” adoption of EHRs.

“The new Administration has critical design and definitional decisions to make over the coming months, and providers have a short window in which to engage,” said Glaudemans. “Rapid clarification of eligibility criteria relative to ‘meaningful use,’ and timely articulation of technology and interoperability standards are crucial next steps for the new administration as it seeks a way to encourage HIT adoption strategies by physicians, hospitals, technology vendors, and other HIT stakeholders. Absent this guidance, even the most enthusiastic provider may defer HIT investments indefinitely, given the cost of implementation and the relatively modest subsidy levels.”

View a snapshot of Avalere’s analysis here.

The link to the full report is in the text. The news release is here:


Third we have:


Using Technology to Skip the Doctor’s Office

By Steve Lohr

The waiting rooms in doctors’ offices rank right up there with bus stations as places to avoid. They are typically filled with cranky people, feeling lousy.

Technology, it seems, can provide at least a partial cure. A study published on Tuesday in the medical journal, Health Affairs found that visits to the doctor’s office can be significantly reduced in practices that use electronic health records and secure e-mail messages between physicians and patients. The study, focusing on the experience of Kaiser Permanente in Hawaii when it implemented electronic health records, secure e-mail and a Web portal, found that patient visits declined 26 percent from 2004 to 2007.

The technology was presented to Kaiser’s 225,000 members in Hawaii as a choice instead of a drive to limit trips to the doctor’s office — but that was certainly the effect. “The level of change exceeded our expectations,” said Dr. Louise Liang, a consultant to Kaiser and co-author of the report. “There are many more efficient ways to provide health care at the same level of quality and service.”

More here (a link to the paper abstract is in the text)


More comment is also found here:


Fourth we have:

Perot, Epic top KLAS’ ranking of IT consultants

By Joseph Conn / HITS staff writer

Posted: March 9, 2009 - 5:59 am EDT

Part one of a two-part series (Access part two):
What counts most in the world of health information technology consulting is performance, according to a new survey report by KLAS Enterprises, an Orem, Utah-based market research firm.

The massive, 500-page report, Maximizing Your Consulting Investment: A Report on Healthcare IT Consulting Services, was released today and includes the results of hundreds of interviews with provider executives. KLAS provided Health IT Strategist with an advance copy on an exclusive basis.

Implementing clinical IT systems has careermaking or career-ending potential for hospital chief information officers, and with Congress recently authorizing that $19.2 billion be spent to advance the use of health IT—including direct subsidies for the purchase of electronic health-record systems—looking for quality help could be a priority for CIOs in the near term.

Work on the report began about six months ago, but includes data gathered over 18 months, said Mike Smith, general manager of financial and services research at KLAS and the author of the survey report. It is the work of a team of eight researchers and the product of more than 800 interviews with executives and managers of provider organizations that use IT consulting services, and IT system vendors and consultants, as well as data gathered from Web sites and healthcare industry reports, according to KLAS.
Much much more here:


Not quite a report, but a report on a report with lots of useful information for those who would never buy the KLAS product!

Fifth we have:

Government turns up the heat on patient power

10 Mar 2009

The government has set out its vision for the future shape of public services, which includes giving patients greater choice and control over their care and more opportunities to input their own experiences.

In a white paper published today, Working Together- Public Services On Your Side , the prime minister Gordon Brown says he aims to put power in the hands of those who use public services, with more personalised services and greater choice, underpinned by an information revolution.

On health and health care the white paper highlights progress on a range of existing initiatives such as progress on the 18 week referral to treatment target, the setting up of 115 NHS Foundation trusts and the take-up of extended access by GPs, now offered by more than 70% of practices.

It says 25 new NHS Foundation Trusts could be set up in 2009, subject to Monitor approval, giving hospitals more control over day to day management and says the nurse-led productive ward programme, which aims to free nurses from bureaucracy, will also spread rapidly across trusts and wards in 2009.

More here (report link in text):


This sounds like a pretty good set of ideas to me!

Sixth we have:

Study Pegs Poor Communications Costs

Poor communications in U.S. hospitals costs $12 billion annually, and use of information technologies could be a big part of the solution, according to a new study.

Unnecessarily long hospital stays, which drive up time and resources used as patients wait to be discharged, account for 54% of such losses, according to the study. "To put the $12 billion amount into perspective, the loss equals approximately two percent of hospital revenue nationwide, a figure that is more than half the average hospital margin of 3.6 percent."


A typical 500-bed hospital that improves communication could save $4 million a year, researchers estimate. To access the full study, click here.

More here (the link to the report is in the text):


Seventh we have:

Can IT solve the electronic health records challenge?

Financial and technology issues make Obama's EHR push not so easy to execute

By Ephraim Schwartz

March 11, 2009

President Obama's stimulus package addresses very diverse segments of the economy, including health care, education, research, and infrastructure. However, all of these components have one thing in common: the reliance on information technology as the engine powering these stimulus initiatives.

More here.


Not quite a report – but a useful long article exploring lots of issues.

Eighth we have:

Doc use of IT up; money still key issue: ACPE survey

By Andis Robeznieks / HITS staff writer

Posted: March 13, 2009 - 5:59 am EDT

Compared with a similar survey five years ago, information technology use has almost doubled among members of the American College of Physician Executives, but money remains the primary reason why some have not implemented an IT system.

About 1,000 of the Tampa, Fla.-based organization’s 10,000 members participated in the survey that was posted online in November and December of last year, and 64.5% said that they have an electronic health-record system in place—compared with 33.1% five years ago. Almost 10% in this year’s survey said they were testing a system, compared with 14% in the 2004 survey. Only 5.9% said they haven’t started planning for EHR implementation, vs. 15.1% five years ago.

In terms of computerized physician order entry, 43.8% said they were already using it while 13.9% said they were testing a system. In 2004, 23.3% said they had implemented CPOE and 15.8% were in the testing phase. The percentage of members who had no CPOE development under way decreased to 13.7% from 22.4%.

At 32.9%, reducing liability and medical errors was the prime reason given for adopting IT. This was the No. 1 response five years ago as well, only it was much higher: 42.5%. The second most-common reason for adopting IT, accurate record-keeping, was the same in both surveys also, with 28.1% of the respondents giving that answer in the current survey, compared with 28.7% in 2004.

More here:


The report is here:


Last we have:

Diagnostic Errors—The Next Frontier for Patient Safety

by David E. Newman-Toker, MD & Peter J. Pronovost, MD

[A copy of this article can be found on our homepage:

http://www.isabelhealthcare.com/pdf/JAMA_11th_March_2009_Diagnostic_Errors_The_Next_Frontier.pdf ]

The authors report that misdiagnosis accounts for an estimated 40,000 to 80,000 hospital deaths per year and that tort claims for diagnostic errors — defined as diagnoses that are missed, wrong or delayed — are nearly twice as common as claims for medication errors. As with successful approaches to reducing treatment errors, they point out that reducing diagnostic errors will likely require a focus on larger “system” failures that affect medical practice overall.

“Moving away from a model that chastises individual physicians to one that focuses on improving the medical system as a whole could offer big payoffs for improving diagnostic accuracy as well as the cost effectiveness of care,” says Newman-Toker. Much as bloodstream infections in intensive care units have decreased through systematic solutions adopted by hospitals, such as requiring physicians to follow a procedural checklist that emphasizes sterile techniques when inserting medical catheters, the authors suggest that system-wide solutions could be the key for decreasing diagnostic errors

The authors suggests that diagnostic errors might be reduced by systematically adopting tools such as checklists that help physicians remember critical diagnoses or by making available computer programs known as “diagnostic decision-support systems”.

Report URL above. The homepage for Isabel is here:


Again, all these are well worth a download / browse.

There is way too much of all this – have fun!


No comments: