U.S. Rep. Patrick Kennedy (D-RI) will reintroduce a bill that would create a trust fund to pay physicians for patients who create personal health records. The proposal would require that the Department of Health and Human Services establish regulations for Web-based PHRs, such as making possible the exchange of health data with other sources and providing de-identified data for public health analysis and research.
The Veterans Affairs Department has agreed to pay veterans $20 million as part of the settlement of a class-action lawsuit filed after a data security breach in 2006. Veterans were exposed to possible identity theft when the VA lost their personal health information. Veterans will be compensated upon proving emotional distress or expenses paid for credit monitoring.
Motion Computing and Sig-Tec have announced that they have created a partnership to deliver solutions for mobility, information security, and clinical workflow for healthcare providers. The partnership comes after several joint client initiatives at major healthcare and academic organizations where the companies implemented solutions that improve workflows, free up resources, and improve patient experiences, according to a release.
The Healthcare Information and Management Systems Society annual conference and exhibition is scheduled for April 4-8 in Chicago. The Healthcare Information and Management Systems Society is a membership organization "exclusively focused on providing global leadership for the optimal use of healthcare information technology and management systems for the betterment of healthcare," according to the HIMSS Web site.
User Centric has found that both Google Health and Microsoft HealthVault rated poorly in user experience. To fix this, experts say it will be crucial for such online services to begin coding for a personal health records operating system. It will require interfaces with hospital records and with a host of consumer devices.
Consumer Watchdog, a privacy rights group, believes that Google supports an effort allowing the sale of electronic medical records to advertisers for the new Google Health, where users can store and access those records. However, while the group has yet to provide any evidence to support this allegation, it has appealed to Congress to tighten up its ban on the sale of medical records.
As new treatment modalities become available, it has become more difficult to know the right test. Diagnostic imaging tests are ordered for more than 830 different clinical conditions. The latest developments in imaging technology have created a plethora of complexity. These advanced tests (MRs, CTs and PET-CTs) are also the hardest to match appropriately to each patient's diagnostic needs.
Imaging has expanded its role and is no longer used only for the identification or confirmation of a patient's condition. Imaging is intertwined with therapy for oncology patients and used at every stage of care: screening, diagnosis and staging, treatment, and monitoring. It is a tool for lifelong follow-up. In fact, according to an article by Christopher Farr of Sg2, the expanded utility of these applications will increase utilization by 189% by 2016.
Imaging also continues to be one of the fastest growing areas of spending for health plans, with costs expected to double over the next four years to $200 billion by 2011. As a response to this increase, many payers have contracted with radiology benefit managers (RBMs), who utilize various utilization management techniques.
The challenge for health plans, radiologists, and referring physicians is how to reduce the use of unnecessary or inappropriate imaging while ensuring access to clinically valuable imaging, especially in a period of rapid technological advancement and increased use.
History Repeats Itself
Prior to the introduction of RBMs several years ago, pharmacy benefit managers (PBM) arrived on the scene for much the same reason: help in controlling escalating costs.
In 2007, PBM spending was reduced to 6-8% of premium from a 18.2% increase in 1999. Comparatively, the radiology expenditure was 2% of benefit in 1999 and is currently 18-20% of premium today. This increase is driven by advances in imaging technology, advertising directed at patients, physician self-referrals, a wide disparity in appropriateness, and an aging population. This growing complexity has led to wide variation in the appropriateness, pricing, and quality of imaging services.
Imaging Sharpens Disease Identification and Management
Successful care management strategies offer payers many opportunities for reducing costs and improving patient outcomes. Care management tools help payers integrate data from various sources into a patient's medical record with financial and clinical data. Combining that information with laboratory, radiology, and pharmacy data provides an optimal longitudinal view of the patient's care history.
These eight dimensions of radiology management identify shifts leading managed care organizations have made as they've adapted to industry changes and consumer expectations:
1. Wellness and prevention. includes screening and programs targeted at keeping the member population at the healthy end of the care continuum. Programs are designed to address issues before they become problematic, so patients stay well and employers and payers spend less money on treatments. One of the best-of-breed options is screenings. Screenings use a test to check people who have no symptoms of disease, to identify people who might have that disease, and allow it to be treated at an early stage when a cure is more likely.
In 2008, 182,460 new cases of breast cancer were be detected in women. Nearly 41,000 will lose their lives to breast cancer. Many of these lives can be saved by early detection. Mammograms are capable of finding breast cancer two to three years before it becomes manifest as a palpable lump. These early tumors are typically curable by local removal and radiation treatment without the need for mastectomy.
Mammography has shown that early detection of disease can improve the chances for successful treatment. In the next decade, according to Christopher Farr of Sg2, imaging's role in screening will evolve beyond mammography to include such applications as CT lung screening of high-risk patients, virtual colonoscopy, and even rapid whole-body MR studies.
2. Targeting and segmentation. stratifies a population, identifying members and matching with the right program and interventions.
Market-leading organizations link data into the member's medical record and use the information as triggers for preventive, condition, and disease management programs. For example, women can be identified who meet the American Cancer Society guidelines for a mammogram. In addition, family history can identify a member in need of a screening study for cancer.
3. Reach and engage. opens up two-way communication via multiple channels to make use of the health information that members provide. This includes personal health records (PHRs), Health Risk Appraisals and patient portals. Payers encourage behavior changes through increased connection points with members via Web-based programs and multi-channel campaigns.
Market leading organizations include diagnostic images and reports into the consumer oriented tools: PHRs and Member portals for patients with cancer, PET images can help with disease tracking and availability to the patient helps with their battle.
4. Condition management. includes the use of disease management programs, clinical pathways, biometric devices, return on investment compilation, and outcomes. The ultimate goal is to create and utilize the longitudinal member view and apply this information to the needs of the member. Market leading organizations tie the integrated member information into care managers' workstations. This includes the diagnostic images, results, and reports. Only by having the member's complete information, can an optimal care plan be created.
Market leading organizations incorporate appropriateness criteria American College of Radiology (ACR), American College of Cardiology (ACC), and National Comprehensive Cancer Network (NCCN) for high-tech radiology into the care management process. The objective is ensuring a patient receives the right test at the right time in the right facility.
This includes establishing best practices/standards of care with quarterly internal review and acquiring accreditation through ACR.
Exceed training requirements for clinical staff
Clinical equipment is current, well maintained, and regularly upgraded to remain technologically competitive
Clinical standards/guidelines are established and routinely followed
Conducts annual satisfaction surveys from referring physicians and patients to measure quality standards
Not only can the patient move on with a diagnosis, but the cost of identifying the problem is streamlined, long-term costs are lowered, and member satisfaction is increased.
5. Care coordination capability. focuses on utilization management, concurrent review, and case management. The output is included into the longitudinal view of the member. Information from every phone call, every member interaction and all other forms of communication should be included along with lab results, radiology images, and reports and pharmacy information.
With the introduction of RBM companies, the old school type of prior authorization filled with the mantra, "just say no" has unfortunately come back to care management. According to Cherrill Farnsworth, president and CEO of HealthHelp, other methods are successful such as an advocacy and continuing education/mentoring approach.
Marybeth Regan, PhD, is an expert in disease and care management. She has written numerous articles on strategies for care and disease management. She may be reached atDrmarybethregan@aol.com.
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It's time consuming, tedious, and often just plain uncomfortable for everyone involved. But, like most things in life that are unpleasant, peer review is necessary and unavoidable. So necessary that the Joint Commission has made Ongoing Professional Practice Evaluation (OPPE) part of its 2009 Standards Update. The Commission is urging hospital leaders to gather and analyze data on performance for all physicians with privileges on an ongoing basis rather than at the two year reappointment process.
The idea, of course, is that compiling data on a regular basis will allow the physician to improve performance before something dire occurs. Unfortunately, the administrative burden of conducting ongoing peer reviews has kept the majority of hospitals from increasing the frequency of their evaluations. Which is completely understandable—a doctor's time is stretched thin as it is, and each physician review requires the reviewer to spend precious hours poring over boxes of medical records, which often have to be shipped at great cost to the hospital to far flung locations throughout the country.
It was that burden, combined with a desire to streamline the peer review process that led Daniel LeGrand, MD, chief medical officer at St. Vincent Hospital in Indianapolis to try out a new Web-based software system that he'd been told would simplify and modernize the procedure. Now several months later, St. Vincent is wrapping up a pilot project to review several doctors in complex sub-specialties using a software system from Silicon Valley start-up Acesis. LeGrand says the pilot was so successful at simplifying the peer review process that the hospital will begin performing peer reviews throughout each department on an ongoing basis, as recommended by the Joint Commission.
"We were in need of doing an external peer review on a group of sub-specialists. And the reason we got to that point was because these doctors were competitors and their specialty crossed over into other specialty areas. We didn't have the expertise locally to do a thorough and meaningful peer review," says LeGrand. "The traditional way to do this was to pack up a few charts and send along to a reviewer. We happen to have three in different parts of the country, which means expensive shipping and the risk of security issues."
Enter Acesis—currently the only company offering an online physician peer review product of its kind, according to company CEO Kevin Chesney. The program is an on-demand subscription service that allows hospitals to customize the review process for each medical specialty. Hospital administrators define templates using their own "triggers," such as infections, return to operating room for bleeding, mortalities, and other associated injuries. Online delivery lets physicians and peer reviewers participate anytime from anywhere, which was an especially important feature for LeGrand.
"You think about how these charts used to be transported. Hauled back and forth in the trunk of your car, which is not exactly secure. Then if you need access to the information in the hospital, well, with the hours we put in, the last thing we want to do at end of day is a peer review. Now we can access the Internet and work on what we need to do at the time that's convenient for us. We are no longer tied to a geographic location," says LeGrand.
Chesney says the software not only speeds up the review process, but it allows hospitals to meet state and federally mandated standards and establishes data-mining capabilities to chart trends and reduce medical errors. "Basically we were interested in getting greater transparency into the overall process," he says. "The key is: can you turn something contentious into something that is going to improve quality of care? We've also found that physicians are very interested data if they believe in the data that's being captured."
Acesis is an example of how health IT adoption can be accelerated in unexpected ways. LeGrand says that after using the new software, physicians who were skeptical of all things digital are expressing more interest in adopting other forms of IT. "Once you see how much something like this can ease the pain of what was a truly burdensome task, and you find out the barriers aren't as bad as you thought they were, you're definitely more willing to look at other IT possibilities," he says.
I write quite a lot about the health IT issues that get a lot of attention. The effect that electronic health records, health information exchanges, and e-prescribing will have on healthcare is being talked about and examined by every writer, politician, and pundit interested in healthcare. But sometimes, there are more nuanced changes that are being made from within hospitals that could have just as profound of an effect on the way medicine is practiced. And those that increase efficiency all the while improving the quality of care could serve as more than just tools for making doctors' lives a little easier, they could serve to speed up adoption of all forms of health IT.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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Tom Daschle withdrew his name on Tuesday as President Obama's nominee to lead the Health and Human Services Department, afer tax issues had developed into a troublesome distraction for President Obama. The president said he accepted Daschle's sudden withdrawal "with sadness and regret."
LifePoint Hospitals completed its acquisition of a hospital in Conyers, GA, while Community Health Systems announced a new deal in Arkansas. The transactions reflect how more community-owned and not-for-profit hospitals are considering options such as partnering with national hospital chains as they face a worsening national economy. Under the agreements, chains often commit money for hospital upgrades or agree to replace existing buildings.
