Feds Drive for National/Regional EHR Systems
Until now, Dr. David Brailer -- National Coordinator for Healthcare Technology -- and his staff have settled for prodding and rewarding physicians and hospitals to move into the world of EHR by the target date of 2014. The results have been good, not great, and not to Dr. Brailer's liking. The Office of the National Coordinator (ONC) has added new priorities and tools that will target patients themselves to get interested and to get involved. This interlocking program is planned to be simultaneously developed and presented to the public over the next three years.
The goal is to build EHR patient demand rather than continue to face patient apathy or even interference. Proposed method is to frankly highlight some of the bioterrorist fears we all live with today and show patients how they can be much better cared for in such an emergency if caregivers have immediate access to all patients' healthcare facts; whether these facts are needed close to home or 2,000 miles away.
The initial program will be emotional. It will target "biosurveillance" and will include the launch of a national public health monitoring network able to send lab results electronically from emergency departments to public health agencies within 24 hours of a possible bioterrorist attack or the outbreak of an Asian Flu pandemic.
Supporting this is a planned "hands-on" program to target the development and availability -- within a year it is hoped -- of a software package that will enable patients and physicians to access both older and current lab results, online and/or over a secure messaging system. Supplying vital personal historic medical facts that will aid and speed on-the-spot analysis and treatment. Included will be medical registries that will in effect be "blocked out" to all but the patient and his or her team of health-care providers.
This, in turn will be supported by a Chronic Care Project designed to develop totally-secure lines for contact between patients and providers…and perhaps electronic registers that will enable patients to securely browse through their own medical records.
As a postscript to these innovative and difficult-to-achieve plans, the Office of National Coordinator (ONC) did a bit of justifiable breast-beating about overall accomplishments to date. Announcing that there are now in excess of 60 basically-statewide regional health information organizations (RHIO) in anywhere from planning stage to electronic data-sharing. Reportedly 30 states have initiated or passed legislation that strongly supports the RHIO concept.
Admittedly RHIOs are still in their earliest stages and can use all the national help -- some say "necessary national direction" -- that's available. The ONC is moving to do just that and has reportedly awarded contracts to a consortium of IT companies charged with developing a National Health Information Network that will both develop a system of data exchanges among healthcare supplies and support the various regional/statewide RHIOs.
But there are still "blips" aplenty on the road to total electronic health records. For example, responses to a recent survey of hospital executives by the Healthcare Information and Management Systems Society led to the conclusion that about a quarter of America's hospitals now have operational EHR. Best news is that last year's similar survey put that estimate at 18%. Bad news is that currently 12% of the respondees said they had no EHR plans at any level just now.
Problems Beyond Our Borders
Two recent and quite-different healthcare system dilemmas at other English-speaking countries seem to highlight that our own system -- with all its faults -- generally works a lot better than the domestic and foreign nay-sayers claim.
They are playing the IT blame game in Australia these days, as their "HealthConnect" electronic information-sharing system is having a major problem getting started. Simply speaking, their federal government laid out the ground rules, then mandated that the program would be "state-sponsored". (Yes, they call them "states" in Australia.) But the states are looking for some overall direction and a lot of funds from the Australian feds, which the states claim just isn't coming.
So the problem is literally hanging in limbo simply because everyone at every level is apparently overwhelmed by the enormity of almost-immediately starting up a cost-controlled, reasonably-accessible nationwide electronic health information system. A federal spokesperson finally conceded that it could take at least a decade to put in place all the steps that would achieve their electronic goals. But first they have to get started!
Meanwhile, north of us, a 57-year old resident of Ontario is suing the province for over $50,000 to cover the cost of cancer care. George Ruetz was thought to have an aggressive kidney cancer; wait-time for a needed CT scan was four weeks, followed by at least an eight-week wait for the surgery that seemed to be the almost-obvious next necessary step.
Mr. Ruetz opted to cross the border and "mortgage the farm" in order to get immediate care at the Cleveland Clinic. The scan showed cancer and the kidney was successfully removed at the Clinic. Patient saved.
A year ago Canadian provinces and territories agreed to publish benchmarks to determine medically-acceptable wait-time for service. Cataract surgery within 16 weeks for high-risk patients, radiation therapy within four weeks. No decision was reached on cancer-care wait times.
Mr. Ruetz felt it was logical that, after a positive CT scan, immediate cancer surgery was necessary. And therefore that he was entitled to a full refund of all the money spent at the Cleveland Clinic to literally save his life.
Ontario agreed the four-week wait for the CT scan was too long and paid him $3,833 (American) but ruled he should have returned to Canada to get on line and wait for his operation. He is appealing to the province's Health Service Review Board; feeling is his chances of getting reimbursed are not very good.
Colleges Discover "Health Sciences"
The fastest-growing major at colleges across the country is a subject heading that wasn't around a few years ago. It is now called by many names -- Health Sciences, Human Healthcare, Biomedical Sciences -- in a variety of institutions, but adds up to a hands-on basic-to-advanced science course drawing students in numbers that have surprised administrators.
Marquette University was among the first to offer the major in 1997; it has become the school's most-popular course-of-study. Stony Brook in nearby Long Island began the course with 35 students four years ago and now has 370. The University of Colorado started offering the course less than two years ago and now has well over a thousand students, placing it among the most-popular on campus. On a smaller level, Ohio State introduced a health sciences major four years ago, which drew 30 students; it now has 250 enrolled. Locally, Quinnipiac went from a dozen health sciences students five years ago to 100 today. That's just for starters; the number of colleges offering this type of degree seems to be expanding at a truly-surprising pace.
Apparently every school's curriculum is a bit different but their overall job is to prepare students for a broad range of careers in the various aspects of the field. Many grads go on to advanced education in such areas of physical or occupational therapy, medical technician, physician's assistant, optometrist, pharmacist, hospital administrator; some even to med school. The most-attractive point seems to be that the overall choices are broad and diversified…and that specific career choices don't have to be made until the student gets better-acclimated with the various aspects of the field.
Affairs of the Heart
Proof once again that women and men really are quite different comes in the form of the latest report of an ongoing, decade-long NIH study of 1,000 women. The study's proper name is the Women's Ischemia Syndrome Evaluation, most-often simply called WISE.
Bits of information about WISE have been released over the life of the program; this though is the first substantial and in-depth report. It is based on a variety of methods of analysis…from careful monitoring to regular angiograms. The report appeared in a recent issue of the Journal of the American College of Cardiology.
Conclusion is that many women simply do not have the same kind of heart disease that generally afflicts men. Therefore their symptoms can easily be missed in standard cardiac-related tests. No crushing chest pains, sweating, or shortness of breath during an episode; rather something as little as extreme fatigue, an upset stomach…or a pain in the jaw or shoulders.
That's because, instead of developing obvious blockages in the arteries that supply blood to the heart, these women simply accumulate plaque evenly in major arteries and in smaller blood vessels. So their arteries may look relatively clear but the danger is lurking…until their arteries fail to react to physical or emotional stress by expanding properly. Which can result in spasms that can strangle vital blood flow to the heart and trigger a totally-unexpected severe heart attack.
The study estimates that as many a three million women suffer from this condition.
Conclusion is that the way to find these problems ranges from questionnaires that target in on these "minor" problems…that are then followed up with ultrasound and other sophisticated tests which prove or disprove that a patient is at risk. Those at risk need immediate attention because they are possibly subject to a serious or fatal heart attack within five years.
A Perfectly-Patched Heart
Heart attacks and congestive heart failure leave behind areas of effectively non-functioning scar tissue that makes the duties of this essential organ more difficult almost day-by-day. Drugs can help for awhile but usually the heart has to work harder and harder, getting weaker and weaker. Last opportunity for many an individual is a difficult-to-find and often uncomfortable-to-live-with heart transplant.
New hope is still in the theoretical stage, but the theory seems to be working well in the labs. That theory is simple to state, hard to do: replace the scar tissue with what effectively is a "heart patch"…a piece of living cardiac tissue that was nurtured and grown in the laboratory and is applied in the place of the useless scar tissue. Tissue with the ability of "learning to beat" soon after it is applied; effectively making the heart "whole" and comfortably-workable again.
Basic animal studies are underway, but the march from there to humans -- if all hypotheses work out -- is obviously still far down the road. But a goal that seems attainable within a decade at least.
State-of-the-Art IT
A recent survey of 350 data center professionals reported that less than 20% of respondents said they have not integrated the much-heralded blade servers into their system. And over 30% said they had no current plans to do so.
Which seems to be sad news for both blade server producers and administrators interested in reducing backroom computer space use.
"Willing" Artificial Joints
It may seem odd, even bizarre, but a number of patients of Chicago's Rush University Hospital have agreed to have their artificial joints removed post mortem so that scientists can study and learn from an analysis of how well they have "worn". And in this way gain the knowledge that will lead to improvements in their designs. So far, the Rush lab has retrieved close to 200 joints from over a hundred deceased patients in its immediate metro area and have another 700-plus patients signed up. Their research is part of an extensive joint replacement study funded in part by NIH.
The Rush scientists admit they had emotional misgivings when the plan first surfaced in 1990, but almost immediately found willing donors.
All of these donors made it a point to say they wanted to return the favor to orthopedists who had freed them of pain and given them new mobility.
Hips and knees make up the bulk of the donations, but they have included other areas of the body, such as artificial shoulders. Failing artificial joints that are replaced have also been added to the study, but the scientists say they are of marginal worth, since the objective is analyze both strengths and weaknesses of artificial joints that have literally outlived their recipients.
Coding Tips
CPT codes for Chemotherapy Administration 96401 - 96549 have major revisions in the notes which specify that the chemotherapy codes apply to parenteral administration of four kinds of drugs:
non-radionuclide anti-neoplastics for cancer.
anti-neoplastics for non-cancer diagnoses.
monoclonal antibodies (i.e. immunotherapy for cancer).
biologic response modifiers.
The change was made because of the inherent risk of administration, with possible toxic side effects of the drug and the need for frequent patient monitoring. Coders should obtain a list from the hospital pharmacy of the different drugs that now fall into this category. Monoclonal antibodies generic name usually ends in "mab". The following is a partial list and indications for use:
Adalimumab (Humira)-Rheumatoid arthritis and Crohn's
disease
Infliximab (Remicade)-Rheumatoid arthritis, psoriasis and
Crohn's disease
Omalizumab (Xolair)-Allergic rhinitis and asthma
Rituximab (Rituxan)-Rheumatoid arthritis
Efalizumab (Rativa)-Psoriasis
Natalizumab (Antegren)-Multiple sclerosis and Crohn's
disease
Report separate codes for each parenteral method of administration employed when chemotherapy is administered by different techniques. The administration of medications (eg, antibiotics, steroidal agents, antiemetics, narcotics, analgesics) administered independently or sequentially as supportive management of chemotherapy administration, should be separately reported using 90760, 90761, 90765, 90779 as appropriate.
Transcription Tips
Abbreviations in drug dose and dosage terminology represent Latin phrases. Abbreviations are transcribed as lower case with periods separating letters with NO comma to separate combinations. Avoid using upper case as this emphasizes the abbrevation rather than the drug. Use periods, as some lower case letters together may be misread as words. No period is placed following a number, except at the end of a sentence. No period is placed between lower case letters representing units of measure, i.e., mg, mL, mg/kg. Avoid "dangerous abbreviations" (listed from the "Institute for Safe Medication Practices").
Type: p.o. b.i.d.; NOT p.o., b.i.d.; NOT pobid
Type: q.4 h.; NOT q.4.h.; NOT q4h
DANGEROUS: DO NOT USE ug or mcg, type out "micrograms"
DO NOT USE o.d. or OD, type out "daily"
DO NOT USE TIW,tiw or t.i.w.,type out three times a week
DO NOT USE sub q or SC, type out subcutaneous
DO NOT USE cc, substitute with mL
Substitute Skin
Everyone's skin takes a lot of small and large abuse every day, some of which results in both major and minor problems. The most-major problems require the aid of the rather-basic artificial skin products now available. But artificial skin can't replace the look, feel and ability of real skin…which includes the network of blood vessels, nerves, fibrous cells, pigments and sweat glands that help keep fluids in and bacteria out. The most-serous cases -- in which burns have destroyed a good deal of the skin's protective barrier and thereby opened the body to the equally-massive infections -- cause at least 10,000 patient deaths a year. Skin grafts sometimes work fairly well in small applications, but rarely can handle a large-area wound.
So rejection -- immediately or months later -- is quite common and quite serious, even though the graft comes from the patient's own body. Researchers and doctors are now working feverishly to replicate the skin. Experimental "real" substitute skin has been used on more than three dozen massive-injury burn victims. Basically the scientist-doctors have harvested undamaged skin from the victim and then replicated it many times over in a laboratory solution for a month or more before applying it to the wound area. Researchers claim they have been able to "resurface" patients with burns over 80% of their body in little over two months.
Only time will tell whether the grafts will remain intact, in place and without the massive scarring that has destroyed the effectiveness of many efforts through the years. But it seems the pathway is open.
Healthcare Costs Race Ahead
CMS recently reported that healthcare costs are far outpacing the growth of America's economy and will account for 20% of gross domestic spending by 2015. Just two years ago it accounted for 16% of our gross domestic product...and was considered far out of line by many pundits! All this leads to a projection that America's healthcare will cost more than $4 trillion in just nine years, it is anticipated that patients will directly or indirectly bear half the cost-of-care, with the government paying the other half.
It is projected that hospital costs will rise more quickly, due to the need for added care. Overall cost of drugs, meanwhile, will be reduced somewhat, due in part to increased acceptance of generics by patients…plus the ability of the new Medicare drug benefit plans to negotiate better prices with the pharmaceuticals.
Projections forecast that overall Medicare spending will double, rising to $792 billion, by 2015. Spending on nursing home care will almost double, to $216 billion, in the same years…while home health care will more than double to $103 billion in this period. Beyond the figures, it is important to realize that few of these costs are wasteful; the majority are the result of the medical field's increasing ability to devise treatments and medical-care tools that enable people to live better, live longer and recover failing health more often.
Much of the above forecasts were recently published in Health Affairs magazine.
Medical Minutia
Pity poor French fries, an icon of American fast food. First its name was attacked in a patriotic fervor when the French failed to support us in Iraq. Some people started to ask for "American fries", but that didn't last.
Then McDonald's, its chief purveyor-to-the-public, was attacked for not fully disclosing that its fries contain more highly-undesirable trans fat than first admitted. Now McDonald's has also admitted that wheat and dairy ingredients are used as flavoring in its fries, substances which can cause allergic and even more-serious reactions to people on gluten-free diets.
Since 2002, McDonald's has paid a total of $18.5 million to settle suits brought by advocacy groups concerned with the cooking oil ingredients used in their fries.
Auditing the News
The Department of Defense has announced that by year's end the Armed Forces Health and Longitudinal Technology Application (AHLTA) will be up and running; providing complete EMR for every member of the service. It will supply specific facts that will help treat individual military causalities on the battlefield…and go on to immediately supply this often-vital information for those treating current military personnel in later life.
When needed, these easily-retrievable records will be accessible anywhere in the world.
>>>>>>>>>>>>>>
New Jersey is just one of fifteen states reporting increased deaths from an intestinal bacteria infection (C-diff) that most-often strikes elderly hospital patients who apparently have previously taken too many antibiotics for often-trivial illnesses.
According to the CDC, the infection has been reported in fifteen other states including neighboring Connecticut, Pennsylvania, New York and Maryland.
>>>>>>>>>>>>>>
Kidneys from over-60 potential donors have usually been refused because their "life expectancy" was considered too short. Now Italian scientists have apparently developed a test for older kidneys -- taken from cadavers -- that are able to differentiate between ones that will perform well in transplant and those that can't be used.
They've even tested marginal kidneys they feel could be transplanted in pairs and would then offer the recipient a good chance of a successful transplant.
>>>>>>>>>>>>>>
A recent EHR-knowledge survey of 1,095 Americans by Health Industry Insights came up with sad and surprising responses. (1) That most people -- almost 70% -- apparently are not aware of the fed's prodding, direction and overall efforts to get electronic medical records up and running across the country. And (2) that most of those interviewed that did have some knowledge of these efforts were not aware of the fed's target date to put a nationwide EHR network in operation, for at least the vast majority of Americans, has been set at 2014. Over 85% of those interviewed said they were most-worried about the ability to protect their private information in an EHR era. And only a third said they thought EHR could reduce healthcare costs.
>>>>>>>>>>>>>>
Working together, Cisco, Intel and Oracle are offering "rewards" to major medical groups in Northern California that use IT to share data that can improve patient care. First eligibles are member of the "Silicon Valley Pay for Performance Consortium" lead by Kaiser Permanente. Members of the consortium all treat employees of the three suppliers. Reportedly the plan is to expand the idea to physicians' groups.
Program managers say they will be guided by standards approved by the National Committee for Quality Assurance.
>>>>>>>>>>>>>>
Sometimes doctors just don't have the vital minutes to thumb through reams of reports before making a decision on how to treat children in the neonatal units. The Scots are experimenting with a way…."Baby Talk", offering in a time of stress, a current and concise computer-generated summary of the young patient's medical history.
The reports, which are being produced and updated automatically from infant's medical records, hopefully will supply doctors with better vital information when instant and perhaps life-saving patient-care decisions have to be made. Britain's NHS says the program's goal is to eventually adapt this to the needs of intensive-care adult patients.
>>>>>>>>>>>>>>
EHR achievement news…a doctor at Wasusau, Wisconsin's Marschfield Clinic recently wrote the clinic's one millionth electronic prescription on the hospital's "Medications Manager" They claim the system took a while to master but it is worth the effort many times over.
Balancing this is a recent report from highly-regarded Solucient Corp. that overall hospital margins had dropped from 5.05% in 2003 to 4.04% in 2004 and did not show signs of improving. Reported AHA figures were a little higher, Moody's Investment Services a little lower.
All agree that small margins just don't leave room for adequate investment in high-initial-cost IT installations.
>>>>>>>>>>>>>>
A coalition of the Connecticut's political and healthcare leaders have joined in an effort to store and share medical records over an electronic network throughout the state.
Spokespeople say the "eHealth Connecticut" program is designed to completely eliminate paper-based systems ASAP.
>>>>>>>>>>>>>>
|
