<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_464"
                     title="COLUMN: &apos;Meaningful Use&apos; -- You Can Do This!"
                     score="0.011"
                     href="http://www.medpagetoday.com/Columns/18394?impressionId=1265777792329"
                     
      &lt;p&gt;Certified EHR technology used in a meaningful way is one piece of a broader Health Information Technology (HIT in techie jargon) infrastructure intended to reform the healthcare system and improve healthcare quality, efficiency, and patient safety.&lt;/p&gt;
&lt;p&gt;Under the HITECH Act, the Medicare EHR incentive programs provide payments up to $44,000 over five years to eligible professionals who are &quot;meaningful&quot; users of certified electronic health records.&lt;/p&gt;
&lt;p&gt;The Medicaid EHR program provides even bigger incentives  --  up to $63,750 over five years to practices with a 30% or higher Medicaid population for efforts to adopt, implement, or upgrade certified EHR technology or for meaningful use in the first year and up to another five years. (Pediatricians need only a 20% Medicaid patient volume to qualify.)&lt;/p&gt;
&lt;p&gt;The stimulus dollars have gotten our attention, especially in light of the eventual cuts to reimbursement scheduled to take effect in 2015 and beyond for those who don&apos;t use EHR technology.&lt;/p&gt;
&lt;p&gt;On Jan. 13, 2010 two rules were published defining the certification criteria and the criteria for meaningful use of electronic health records. (The rules are available at &lt;a href=&quot;http://www.gpoaccess.gov/fr/index.html&quot; mce_href=&quot;http://www.gpoaccess.gov/fr/index.html&quot; target=&quot;_blank&quot;&gt;www.gpoaccess.gov/fr/index.html&lt;/a&gt;.) A forthcoming rule will establish an EHR certification program. With the EHR vendors offering stimulus guarantees, the EHR certification program seems less of a concern.&lt;/p&gt;
&lt;p&gt;CMS proposed three stages of &quot;meaningful use&quot; criteria over the initial years of the program given the ongoing advancement in EHR technology and standards, as well as changes in quality measurement and other healthcare-related reporting.&lt;/p&gt;
&lt;p&gt;The focus in Meaningful Use Stage 1 is on the capture of health information in coded format and: 
&lt;ul&gt; 
&lt;li&gt;The use of it to track key clinical conditions&lt;/li&gt; 
&lt;li&gt;The communication of coded health information for care coordination purposes&lt;/li&gt; 
&lt;li&gt;Initial reporting of clinical quality measures and public health information&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The good news is that all results for all measures to be reported to CMS (for Medicare) or to the states (for Medicaid) will be done through attestation for the year 2011. In 2012, we&apos;ll be running all reports through certified EHR technology.&lt;/p&gt;
&lt;p&gt;Attestation can be achieved &quot;through a secure mechanism, such as through claims-based reporting or an online portal.&quot; But providers will still be required to &quot;use certified EHR technology to capture the data elements and calculate the results for the applicable clinical quality measures,&quot; the CMS rule said.&lt;/p&gt;
&lt;p&gt;Practices that have already implemented an EHR must ensure that their software is appropriately certified and that their clinicians are fulfilling all of the meaningful-use requirements to qualify for the incentives.&lt;/p&gt;
&lt;p&gt;So, you have just about two years to implement, iterate, rehearse, pilot, and test your own implementation against the meaningful use criteria.&lt;/p&gt;
&lt;p&gt;The initial criteria are presented in health outcomes policy priorities with associated care goals. Here are just six of the 25 criteria for Stage 1 Meaningful Use:&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Improving quality, safety, efficiency, and reducing health disparities.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
&amp;bull; Provide access to comprehensive patient health data for patient&apos;s healthcare team&lt;br&gt;
&amp;bull; Use evidence-based order sets and CPOE&lt;br&gt;
&amp;bull; Apply clinical decision support at the point of care&lt;br&gt;
&amp;bull; Generate lists of patients who need care and use them to reach out to patients&lt;br&gt;
&amp;bull; Report information for quality improvement and public reporting&lt;br&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Engage patients and families in their healthcare.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Improve care coordination.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
Exchange meaningful clinical information among professional healthcare team.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Improve care coordination.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
Exchange meaningful clinical information among professional healthcare team.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Improve population and public health.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
Communicate with public health agencies.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Health Outcomes Policy Priority:&lt;/strong&gt;&lt;br&gt;
Ensure adequate privacy and security protections for personal health information.&lt;br&gt;
&lt;strong&gt;Care Goals:&lt;/strong&gt;&lt;br&gt;
&amp;bull; Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law&lt;br&gt;
&amp;bull; Provide transparency of data sharing to patient&lt;/p&gt;

&lt;p&gt;Each of the Care Goals has defined objectives with specific measures that must be achieved to demonstrate meaningful use.&lt;/p&gt;
&lt;p&gt;Following are examples of some of the objectives and what you&apos;ll have to do to meet each.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Maintain up-to-date problem list in ICD-9-CM or SNOMED-CT.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; 80% for unique patients.&lt;br&gt;
This objective will enable the user to manage problem lists that span multiple visits. If you&apos;ve been billing electronically, you&apos;ve already been capturing problems in ICD-9-CM format.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Generate and transmit prescriptions electronically.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; Transmit 75% of noncontrolled drug prescriptions electronically.&lt;br&gt;
Did you hop on the e-prescribing incentives? You&apos;re ahead of this one! If not, you&apos;ll need to enable e-prescribing.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Drug screening.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; Drug screening is enabled.&lt;br&gt;
Another easy objective to meet if you&apos;ve already implemented e-prescribing. If not, you&apos;ll need to be sure your system provides real-time alerts for drug-drug interactions and drug allergy contraindications, has an electronic formulary check, maintains drug-drug and drug-allergy warnings, and tracks the number of alerts that were responded to.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Maintain active medication list.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; 80% for unique patients.&lt;br&gt;
You&apos;ve been doing this too with your e-prescribing implementation. The system must be able to manage an active medication list and a medication history that spans multiple visits.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Record demographics.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; 80% for unique patients, including ALL data elements. Denominator is the number of patients seen.&lt;br&gt;
For each of your patients you should be aware of gender, race, ethnicity, date of birth, preferred language, and insurance type. You&apos;ll probably need to add fields for &quot;race&quot; and &quot;ethnicity&quot; to supplement the demographics you&apos;re already collecting.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Record vital signs.&lt;br&gt;
&lt;strong&gt;Measure:&lt;/strong&gt; 80% of patients seen age 2 and over, including ALL data elements. Denominator is total of unique patients age 2 and over seen.&lt;br&gt;
Your system must allow you to record height, weight, and blood pressure, calculate and display BMI, and plot and display growth charts for patients 2 to 20 years old, including BMI. If your system doesn&apos;t calculate BMI, ask your vendor when that will be updated in a release to your software.&lt;/p&gt;

&lt;p&gt;With the specific criteria objectives and measures such as these in hand you can implement the EHR and achieve meaningful use, improved healthcare quality and efficiency in operations.&lt;/p&gt;
&lt;p&gt;It will take work, but it can be done!&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_416"
                     title="For Diabetes, P4P Improves Patient Care, Outcomes (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/PracticeManagement/Reimbursement/tb/18328?impressionId=1265777792329"
                     
      &lt;p&gt;Measures of quality of care and clinical outcomes improved significantly when diabetic patients in a large private health plan were treated by physicians receiving pay-for-performance incentives, researchers said.&lt;/p&gt;
&lt;p&gt;The risk that diabetic patients would be hospitalized was 25% lower (incidence rate ratio 0.75, 95% CI 0.61 to 0.93) among those seen for three consecutive years by physicians who received extra pay for meeting quality-of-care targets, compared with the risk for patients whose physicians did not receive such incentives, reported Judy Ying Chen, MD, MSHS, of IMS Health in Woodland Hills, Calif., and colleagues.&lt;/p&gt;
&lt;p&gt;High-quality care  --  defined as receiving at least two tests for glycated hemoglobin (HbA1c) and one for LDL cholesterol during a given year  --  was delivered 16% more often by physicians in the pay-for-performance system (rate ratio 1.16, 95% CI 1.11 to 1.22), the researchers also reported online in the &lt;em&gt;American Journal of Managed Care&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;This study showed a robust, consistent, significant, and positive association between increased receipt of appropriate laboratory monitoring of A1c and LDL cholesterol levels and decreased hospitalization rates,&quot; Chen and colleagues declared.&lt;/p&gt;
&lt;p&gt;On the other hand, the researchers also found that quality of care diminished when patients saw multiple primary care physicians during a given year.&lt;/p&gt;
&lt;p&gt;&quot;This finding supports the hypothesis that patients have better outcomes when they have a medical home,&quot; Chen and colleagues indicated.&lt;/p&gt;
&lt;p&gt;The researchers examined records of diabetic patients enrolled with Hawaii Medical Services Association, a large preferred provider organization, from 1999 to 2006. The plan had about 19,600 such patients in 1999 and 32,365 in 2006.&lt;/p&gt;
&lt;p&gt;The plan offered physicians in the network the opportunity to earn bonuses of 1.5% to 7.5% of their base fees for meeting care-quality targets including HbA1c and LDL cholesterol testing of diabetic patients. Bonuses ranged from $10,000 to $16,000 annually. Starting in 2001, physicians could earn an extra $6,000 if their adherence to care-quality processes improved over the previous year.&lt;/p&gt;
&lt;p&gt;Bonuses were paid each year on the basis of administrative records for the previous year.&lt;/p&gt;
&lt;p&gt;The proportion of diabetic patients seen by physicians in the pay-for-performance plan increased from 78.7% in 1999 to 94.6% in 2006.&lt;/p&gt;
&lt;p&gt;As a result of the bonus structure, Chen and colleagues observed, improvements in care quality lagged implementation of these incentives by a year or two.&lt;/p&gt;
&lt;p&gt;The most substantial improvements in quality of care and patient outcomes were seen among patients seen continuously by a physician participating in the pay-for-performance system from 2004 to 2006.&lt;/p&gt;
&lt;p&gt;Compared with patients seen by physicians who chose not to participate in the system, those whose treatment was subject to the incentives were seen by primary care physicians and endocrinologists far more often: &lt;ul&gt; &lt;li&gt;Six to 10 outpatient visits in a year: odds ratio 2.16 (95% CI 2.00 to 2.33)&lt;/li&gt; &lt;li&gt;Eleven or more outpatient visits in a year: OR 2.35 (95% CI 2.14 to 2.57)&lt;/li&gt; &lt;li&gt;Visit to an endocrinologist: OR 1.56 (95% CI 1.38 to 1.75)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Among patients receiving quality care continuously from 2004 to 2006, the chance of being hospitalized in 2006 was reduced by 33% compared with patients whose care failed to meet the quality target at some point (rate ratio 0.67, 95% CI 0.61 to 0.75).&lt;/p&gt;
&lt;p&gt;But patients who saw more than two different primary care physicians in 2006 had a dramatically increased rate of hospitalizations (RR 6.13, 95% CI 5.33 to 7.04).&lt;/p&gt;
&lt;p&gt;Chen and colleagues noted several limitations to the study, including the fact that it was conducted in a PPO setting and might not be generalizable to health maintenance organizations or other frameworks.&lt;/p&gt;
&lt;p&gt;The researchers also had no data for years before the program started, leaving open the possibility that physicians participating in the pay-for-performance program were those who were already following treatment guidelines.&lt;/p&gt;
&lt;p&gt;The study also included only one clinical outcome; effects on others such as hypoglycemic episodes, cardiovascular events, and meeting HbA1c targets were not measured and might have been different.&lt;/p&gt;
&lt;p&gt;The researchers also acknowledged that the claims data underlying the study might not have been totally accurate, and they noted that it did not include other factors known to affect hospitalizations such as cardiovascular risk factors.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the Hawaii Medical Service Association, the health plan that was the focus of the work.&lt;/p&gt;&lt;p&gt;IMS Health is a healthcare consulting firm that, among other services, advises health insurers on performance and quality programs.&lt;/p&gt;&lt;p&gt;Several co-authors were employees of the Hawaii Medical Service Association, and officials of the group reviewed the manuscript before submission. But the authors declared that the association had no influence on the study design, analysis, or results reported. No other potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_228"
                     title="Nurses Should Have a Bigger Leadership Role in Healthcare"
                     score="-0.004"
                     href="http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/tb/18080?impressionId=1265777792329"
                     
      &lt;p&gt;Opinion leaders across a wide variety of groups think nurses should have more influence in health policy, planning, and management, according to a new Gallup survey.&lt;/p&gt;
&lt;p&gt;Although nurses are viewed as being the most valued source of health information behind physicians, survey respondents rank them as the least likely of healthcare stakeholders  --  including patients  --  to have a great deal of influence in healthcare reform over the next 10 years.&lt;/p&gt;
&lt;p&gt;This despite the fact that among the 1,504 thought leaders in academia, insurance, health services, government, industry, and the corporate world polled, 51% said nurses are very important in reducing medical errors and improving patient safety, and 50% said they are very influential in improving the quality of patient care.&lt;/p&gt;
&lt;p&gt;The major barriers to increased nurse influence, nearly 70% of respondents said, are perceptions that they are lower on the totem pole than physicians when it comes to decision-making and revenue generation.&lt;/p&gt;
&lt;p&gt;When asked what could be done to ensure that nurses take on more leadership responsibility, the first priority, respondents said, was that they make their voices heard  --  56% had said that nursing lacks a single voice in speaking on national issues. More than half of respondents also noted that there was a lack of opportunities for nurses to advance into leadership positions.&lt;/p&gt;
&lt;p&gt;The survey, conducted by Gallup for the Robert Wood Johnson Foundation, examined professional views of nursing, nursing leadership, the future of the industry, and potential barriers to leadership roles for nurses among various healthcare-related groups. It included responses from opinion leaders in academia (276), health services (253), government (253), industry (253), insurance (237), and the corporate world (232).&lt;/p&gt;
&lt;p&gt;Nine out of 10 said nurses should have more influence in increasing the quality of care and reducing medical errors.&lt;/p&gt;
&lt;p&gt;About 85% said they wanted nurses to have more influence in promoting wellness and preventive care, improving efficiency and cost, coordinating care through the healthcare system, and adjusting care to meet an aging population.&lt;/p&gt;
&lt;p&gt;Additionally, 72% thought increased nurse influence would help the healthcare system adapt to the growing change in ethnic, racial, and cultural diversity in patient populations.&lt;/p&gt;
&lt;p&gt;The opinion leaders were also asked whether they feel there is a nursing shortage in the U.S. Just over 80% said Yes and of those, only 2% said it was not a serious problem.&lt;/p&gt;
&lt;p&gt;To blame for the shortage? Respondents cited a stressful/poor work environment (44% see that as a very important reason), not enough openings in nursing schools (40%), and too many nurses leaving the profession (37%). Only 22% cited low pay as very instrumental in causing the shortage.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_220"
                     title="USNS Hospital Ship Reaches Haiti"
                     score="-0.005"
                     href="http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/tb/18073?impressionId=1265777792329"
                     
      &lt;p&gt;The largest hospital in Haiti is now anchored off shore and beginning to receive patients.&lt;/p&gt;
&lt;p&gt;U.S. and international health workers greeted the arrival of the USNS Comfort  --  which has 1,000 beds and 11 operating rooms, as well as more than 600 medical personnel  --  with relief.&lt;/p&gt;
&lt;p&gt;The ship brings &quot;a tremendous capability to the people of Haiti,&quot; said Capt. Andy Stevermer, of the U.S. Public Health Service&apos;s National Disaster Medical System, speaking from the Haitian capital of Port-au-Prince.&lt;/p&gt;
&lt;p&gt;It &quot;brings a welcome relief on the overburdened situation&quot; in Port-au-Prince and will also help ease the pressure on hospitals in the Dominican Republic, which have been taking some of the overflow of injured from the shattered city, said Jon Andrus, MD, deputy director of the Pan-American Health Organization (PAHO), part of the World Health Organization&lt;/p&gt;
&lt;p&gt;&quot;It provides an opportunity to have all levels of care, particularly surgical care and postoperative care,&quot; Andrus told a press briefing from Washington.&lt;/p&gt;
&lt;p&gt;U.S. personnel have set up a triage station in the city&apos;s port, Stevermer said, and patients will be shuttled to this hospital ship by helicopter. In addition to other helicopters in the country, the Comfort has two helicopters of its own.&lt;/p&gt;
&lt;p&gt;Stevermer said U.S. medical teams in the country began treating the injured Sunday and have now seen more than 5,100 patients. But, &quot;I have not seen any estimate of the number of injured,&quot; he said.&lt;/p&gt;
&lt;p&gt;The World Health Organization is now estimating 200,000 dead, but has not given any estimate of the number who need medical care.&lt;/p&gt;
&lt;p&gt;USNS Comfort has been anticipated for days. The ship, which has dual missions as a floating military combat hospital and a mobile medical center for civilian disasters, has a top speed of about 15 nautical miles an hour and it is usually not fully staffed, which created a delay in getting it ready for sea, a spokesman said.&lt;/p&gt;
&lt;p&gt;Many of the vessel&apos;s medical personnel are regularly stationed at the National Naval Medical Center in Bethesda, Md., and hundreds were flown from there and other permanent stations to join the ship in Haiti.&lt;/p&gt;
&lt;p&gt;The vessel&apos;s arrival Wednesday morning came as a powerful aftershock, reaching magnitude 5.9, hit 35 miles west-southwest of Port-au-Prince. The first earthquake struck Tuesday afternoon, with its epicenter about 10 miles southwest of the city , with a magnitude of 7.0.&lt;/p&gt;
&lt;p&gt;The new shock sent people running into the streets in panic, but both PAHO and U.S. officials said they had no reports of new injuries or death as a result.&lt;/p&gt;
&lt;p&gt;There are now 18 hospitals functioning at some level in Port-au-Prince, Andrus said, including at least five field hospitals. The facilities that appear to be more operational are generally those that are run by international nongovernmental organizations,&quot; he said.&lt;/p&gt;
&lt;p&gt;The facilities are hampered by lack of fuel and electricity, he said, but PAHO was able to deliver 1,300 gallons of fuel for generators to the state university hospital yesterday. In addition, he said, 10,000 gallons of fuel are expected to be delivered today, although he did not say how that would be used.&lt;/p&gt;
&lt;p&gt;But medical care continues to be delivered in other settings. Stevermer said one U.S. team is working in a large soccer field near the downtown area.&lt;/p&gt;
&lt;p&gt;The most common medical problems facing healthcare workers are still the direct traumatic effects of the quake, Stevermer said, but doctors are also dealing with exacerbations of chronic illnesses caused by lack of access to care.&lt;/p&gt;
&lt;p&gt;Medical supplies are still hard to come by, he said, but two planeloads landed yesterday and their contents already have been distributed.&lt;/p&gt;
&lt;p&gt;Andrus said 121 people have been rescued from the rubble so far by international search teams, and &quot;countless more&quot; were dug out by Haitians using their bare hands and simple tools. But he said the probability is shrinking that many more will be found alive.&lt;/p&gt;
&lt;p&gt;U.S. officials continue to cite a lower number of rescued, but Andrus said the discrepancy is a result of communications difficulties. &quot;The challenge is to confirm or validate the information,&quot; he said, adding: &quot;I think our information is the most up to date we have.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_10_321"
                     title="AMA Sets Rigid Principles on Pay-for-Performance"
                     score="-0.005"
                     href="