A new stethoscope developed by Maplewood, MN-based 3M Co. and Stamford, CT-based Zargis Medical can wirelessly transfer sound waves from the heart and lungs directly to a computer using Bluetooth technology. The software can help physicians identify heart murmurs or other ailments.
National Coordinator for Health IT David Blumenthal sent an open e-mail urging the health IT industry to work toward an interoperable health data exchange system. In his letter, Blumenthal described how the federal economic stimulus package aims to foster a seamless information exchange network by helping the health IT industry overcome existing barriers to data exchange.
Dr. Paul Quinlan, a child psychiatrist at Michigan State University, talks to his young patients about everything from ADHD to bipolar disorder. But in a state strapped for child psychiatrists, where one in five children have behavioral or emotional issues, there's not enough time to drive to the farthest corners and innermost cities where need is greatest. So, from his office in East Lansing, he treats children through video, chatting with them and their parents as if they were sitting across from him. Videoconferencing— telepsychiatry—is an effective way to treat families where doctors may be an hour away, or as is often with Mott Children's Health Center in Flint, there's a multi-month waiting list for the one child psychiatrist on staff.
There are pieces of advice I hear repeatedly when talking with technology executives about implementing electronic health records and why some organizations are successful whereas others struggle. Phrases like "get physician buy in," "allocate more resources for training," and "spend more time planning on the frontend" come to mind. Unfortunately, the advice doesn't always come with strategies on how accomplish it.
Recently, I spoke with Chuck Podesta, senior vice president and chief information officer for Fletcher Allen Health Care, about its conversion to an EHR from Verona, WI-based Epic Systems. He shared the governance structure that the Burlington, VT-based academic medical center established to implement its EHR, which he credits as one of the key factors to their success.
The organization also spent a good deal of time determining "what that project would look like, the resources needed, and the cost associated with it," says Podesta, adding that some organizations spend a lot of time on the RFP process, but not enough time planning how they want the project to unfold.
Prior to its conversion to the EHR, the medical center had a mishmash of systems, Podesta says. Fletcher Allen was a best of breed shop with boutique systems for finance, radiology, and labs. "We had our own home grown clinical data repository--called Maple--that was viewable on the units and it had some clinical information but not a lot and everything else was paper,” he says.
The 562-licensed-bed medical center went live with the first phase of its EHR conversion this past June, which included all of its inpatient clinical applications including the emergency department. Fletcher Allen is tracking metrics linked to clinicians' adoption of the EHR system.
For its computerized physician order entry system, for example, 95% of orders are currently being placed electronically. "We were at about 90% a week out of the gate and we keep moving forward," says Podesta, noting that the system will always have some telephone orders because "it's hard for a physician who is driving a car to access a computer and enter the order."
So what went right?
Podesta says the medical center had the right number of committees and each committee knew what its role was and, just as important, what its role was not. "It was set up in a way that it wasn't too bureaucratic, but had enough meat to it that people felt if they had issues they had a place to take them and they would be worked on and decided on quickly," he says.
Fletcher Allen established three committees: a patient care operations group that was a multidisciplinary group of nurses and physicians focused on workflows at the unit level, a physician advisory council that was instrumental in keeping the physician side of the project moving forward, and a clinical transformation group.
Those three committees report back to a project executive committee that is comprised of senior leaders from across the organization including key physician leaders. The project executive committee is the deciding body. "That is where the buck stopped," says Podesta. "We knew on the PEC committee we were in power to make the decision and once we made the decision that was it."
There are leaders who are on all four committees like the senior vice president of patient care services and the senior quality officer, who were co-executive sponsors of the project, so there is continuity across the committees. In addition, each committee has no more than 12 people on it, says Podesta. The committees meet every other week, and Podesta doesn't foresee these meetings going away any time soon. "We are still dealing with decisions and changes that need to be made to current systems that we are running," he says. "But we'll probably be running these groups for a while. They could just end up becoming part of how we do business."
Podesta's advice for other systems adopting EHRs is two-fold.
Don't make it an IS project. The reporting structure for the implementation of the EHR went up through operations to the senior vice president of patient care services and the senior quality officer. Podesta had an operational responsibility as CIO, but senior leaders wanted to ensure that it was viewed as an organizational initiative not an IS project. "Clinical transformation is not about implementing an Epic EMR," he says.
Carve out time to determine what life looks like after the go live. Organizations go from having a command center, people on the units, and fixing elements as they arise during the go live to a support role, which is a completely different discipline. "It is incredible how quickly you go from implementation to support," Podesta says. "People start using the system and they start thinking how to make it better and before you know it you have 100, 200, 300 enhancements hitting you.” Organizations should determine a way to prioritize and have resources set up for those requests while they are moving onto other phases of the project. Otherwise, it can slow projects down and tarnish what was a great go live, Podesta says. "If you have 500 enhancements, at some point you are not going to get to them in a timely fashion."
The medical center, which has about 200 employed physicians, is currently rolling out the second phase of its implementation--converting its ambulatory sites to an EHR. Its first ambulatory site, a large primary-care practice, will go live tomorrow with the rest of the practice sites coming online by September of 2010. Fletcher Allen has also upgraded its data warehouse system and is rolling out a patient portal this spring that will enable patients to schedule tests, look at a bill, track cholesterol, get lab tests, and send secure e-mails to physicians.
When the University of Colorado Hospital (UCH) moved to a new facility in July 2007, it saw an opportunity to improve nurse satisfaction by upgrading the computer process nurses used at the bedside. The Aurora-based hospital first received ANCC Magnet Recognition Program® (MRP) designation in 2002 and was resdesignated in 2006.
In the old facility, nurses in med-surg areas had their own carts assigned to them, which they had to roll from patient room to patient room as they made their rounds so they could use the computer on the cart as they administered medication and documented at the bedside.
The carts were a huge frustration for nurses, according to Kathy Smith, MS, PMC, RN, supervisor, nursing informatics—and former MRP project director—for UCH. The carts were difficult to roll on the carpet in the hallways when moving from one patient room to another, and if the cart encountered a bump, it often logged nurses off the computer, so they had to start again when they reached the patient room. The computers also had batteries—which made the carts heavy to maneuver, and needed to be recharged all the time—and nurses found the batteries were always dying at the wrong moment.
Smith relates that many times the batteries needed to be replaced, which increased workload for the IT staff. In addition, UCH realized that having one cart per nurse wouldn't work with the new bar code medication administration it system was implementing.
"We could see right away that was not going to work," says Smith. "It would require that every time a nurse wanted to administer a medication, she would have to go find her cart, unplug it, move it into the room, then plug it back in, then boot it up, then administer the meds."
Smith relates that this was a fantastic example of the CNO advocating for nursing's needs. The hospital had already budgeted and expended money on the new bar code medication administration system, and then the CNO went back to the executive level and said that the nurses needed to have a computer in every room in the hospital. Despite the significant budget, the hospital invested in its nurses.
UCH chose another cart system, rather than a wall-mounted computer, because nurses wanted flexibility with moving the cart around to different parts of the room. Also, UCH had already planned the rooms in the new building, which weren't designed for wall-mounted computers.
To choose the best system, the hospital staged a "cart fair," at which nurses could examine the different types of carts on the market and determine the ones that would best meet their needs. They eventually chose mobile computing carts from Rubbermaid Medical Solutions.
"The new carts now stay put in every patient room," says Smith. "They are plugged into the wall, so nurses don't have to worry about the battery ever being run down." But still having the computer on a cart allows nurses the freedom to move around the room as they like and use the computer where it makes most sense for them and the patients.
The carts have a computer screen, the CPU in box, a big work space, a drawer, and a light. The light enables nurses to see medications and so forth during the night shift without turning on the lights in the room and greatly disturbing patients.
The new computers were crucial to the successful adoption of the bar code medication administration system, Smith says. "I think we would have had a revolt if we hadn't done it," she adds. "They would have been very dissatisfied. And it would probably have been a failure for our bar code medication administration project."
Smith says the carts contribute to nurse satisfaction. "The nurses love them," she says. "They made a big poster with a big thank you card and gave it to the CNO. It said 'Cow-a-bunga! ["Cow" is an abbreviation for "computer on wheels."] We love the new computers in patient rooms!'"
This article also appears in the December 2009 issue of HCPro's Advisor to the ANCC Magnet Recognition Program®, an HCPro publication.
Offering a nurse residency program is an important strategy for planning for the future in nursing, but many hospitals are finding these programs costly, considering the current economic conditions affecting many healthcare organizations. Despite the financial and personnel resources it takes to support a nurse residency program, there are sound reasons to continue or begin such a program in your organization.
Nurse orientations cost an estimated $20,000–$50,000 per nurse (Blanzola et al., 2004). In addition to orientation costs, turnover costs include marketing and recruitment expenses, salaries for overtime and/or external staffing resources to cover clinical staffing needs, and the potential effect on customer satisfaction scores. Nursing turnover has been estimated to cost 75%–125% of the average annual salary of an organization's nurses (Pine et al., 2007).
Organizations must weigh the cost of a nurse residency program against the cost avoidance of nurse turnover. A successful nurse residency program can lead to positive outcomes for organizations, such as lower turnover and the development of competent clinical practitioners. Anticipated future returns include improvements in staff satisfaction, clinical productivity, outcomes of care, patient safety, and, as a result, customer satisfaction (Keller et al., 2006). A successful nurse residency program helps nurses develop advanced nursing skills that contribute to these outcomes.
Challenges for new graduate nurses
Although 90% of academic nurse leaders feel new nurse graduates are fully prepared to practice, only 10% of hospital nurse leaders share this opinion (Berkow, 2009). The challenges of transitioning from nursing school to clinical practice for new nurse graduates leads to first-year turnover rates of 35%–60% (Blanzola).
New nurse graduates face a huge challenge as they transition from student to competent practitioner. New nurses must adjust to the clinical demands and environment of a new work arena, which have increasingly complex patients and specialties that are becoming more technology-focused.
In addition, new nurse graduates often work demanding alternate or rotating shifts that they were unaccustomed to as students.
For these reasons, new nurse graduates are attracted to organizations offering nurse residency programs that facilitate their transition to professional practice. Many have identified an interest in and desire to begin work in specialty areas that require strong clinical knowledge.
Cultural considerations that may lead to a new nurse graduate selecting an organization's nurse residency program include professional growth opportunities, coworker and physician relationships, nursing autonomy, scheduling, and recognition of nurses.
Orientation structure
Orientation programs are generally structured to introduce new hires to the new work environment and their new unit's scope of services. Programs typically provide information regarding the organization and the unit. Programs also assess new hires' knowledge and skill base and connect them to peer resources who can role-model expectations for nurses on that unit, as well as facilitate a sense of belonging to the team. The orientation period gives nurse leaders time to evaluate clinical competency, efficiency, communication skills, productivity, and customer service focus. Orientation programs are usually designed to guide nurses' transition to a different work arena, not a different role.
New nurse graduates have a different transition challenge—one from student to the role of a nurse—and a nurse residency program needs to be more than an extended orientation. There are a wide range of goals, program lengths, and outcomes reported for nurse resident programs (Keller et al., 2006).
New nurse graduates can become competent practitioners more quickly with the guidance of a nurse residency program. Programs should offer didactic and leadership components in addition to the standard clinical components offered in an orientation program. Incorporating didactic and leadership components supports the nurse resident's development beyond clinical skills, enhancing clinical judgment and critical thinking skills.
Residency design
Nurse residency is not a new concept—programs were first documented in 1980s literature (Altier & Krsek, 2006), and most are based on Benner's theory of novice to expert. Benner felt competence was typified by nurses who had been on the job in the same or similar situations and were consciously aware of connecting their actions to a long-range plan (Benner, 1984). Benner noted that competence was generally reached only after years of gaining experience as a practicing nurse. A nurse residency can facilitate new nurse graduates to advance more quickly from novices to competent nurses, lessening time as advanced beginners. A nurse residency, focused on developmental concepts, attracts new nurse graduates, and the organization enjoys the benefits of competent nurses and the bonus of low turnover.
Our experience at Northwest Community Hospital reflects these ideals. The initial nurse residency program was founded in 1995 and, based on Benner's theory, was originally a 24-month program. We discovered in the early nurse resident groups that through the mentorship of the residency program, nurses reached competence more quickly, and the program was reset first to 18 months and then to 12 months. These nurses come out of the program as competent practitioners. There remains some turnover among our nurse residents, but there is also longevity: 30% of the first nurse residents were still employed at our organization after 10 years. We have a culture of longevity at Northwest Community Hospital, but our nursing work force, like nursing in general, is aging. We are fortunate that our turnover rate is currently below the national and Greater Chicago–area averages. Because of our low nursing turnover, we enjoy a low nursing vacancy rate. But ours is a forward-thinking organization, so we continue to offer and support our nurse residency program. It's the smart thing to do.
References Altier, M., and Krsek, C. (2006). “Effects of a one-year residency program on job satisfaction and retention of new graduate nurses.” Journal for Nurses in Staff Development 22(2): 70–77.
Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley.
Berkow, S., Virkstis, K., Stewart, J., and Conway, L. (2009). “Assessing new graduate nurse performance.” Nurse Educator 34(1): 17–22.
Pine, R., and Tart, K. (2007). “Return on investment: Benefits and challenges of a baccalaureate nurse residency program.” Nursing Economics 25(1): 13–18, 39.
Blanzola, C., Lindeman, R., and King, L. (2004). “Nurse internship pathway to clinical comfort, confidence, and competency.” Journal for Nurses in Staff Development 20(1): 27–37.
Keller, J., Meekins, K., and Summers, B. (2006). “Pearls and pitfalls of a new graduate academic residency program.” Journal of Nursing Administration 36(12): 589–598.
U.S. Department of Health and Human Services, Health Resources and Services Administration (2004). “What is behind HRSA's projected supply, demand, and shortage of registered nurses?”
Vicky Goeddeke, RN, MS, CEN, CPEN, is the ANCC Magnet Recognition Program® and nursing excellence manager at Northwest Community Hospital in Arlington Heights, IL.
In 1998, The University of Kansas Hospital in Kansas City, KS, was faced with a patient satisfaction rate in the fifth percentile, turnover rates that were through the roof, and the reality of an organization that was losing market share.
As part of the organization's strategy to turn the hospital around, nursing set out to change the culture of the department. A renewed commitment to quality improvement, nursing excellence, and staff engagement—along with a six-part strategic plan—effected culture change that transformed the organization. Since 1998, the hospital has seen a 60% decrease in turnover, a 65% increase in inpatient admissions, and more than 200% increase in revenue.
"We were losing volume, but even now in this economy, we've still seen an 8% increase in inpatient visits this fiscal year over last fiscal year," says Tammy Peterman, executive vice president, chief operating officer, and chief nursing officer. "We believe that one of our critical success factors in staff engagement is this strategic plan. You can get where you're going without a plan, but you don't always get where you want to be. We put very specific action items, linked to the strategies, into the plan."
The nursing department's plan focused on six key strategies:
Excellence
Caring
Professionalism
Communication
Stewardship
Quality
Peterman says the department wanted to raise the overall level of professionalism of nursing in the facility, so they examined tactical ways to raise the bar and increase quality. They did this by methods such as encouraging nurses to pursue specialty certification and initiating professional portfolios.
To incentivize nurses to obtain specialty certification, the organization compensates nurses for certifications and provides a bonus each year they maintain their certification.
Nursing portfolios are an innovative way to focus on nurse professionalism. All nurses at the hospital create their own portfolio, which is a mechanism for them to monitor and track their professional activities throughout the year, including continuing education participation, committee involvement, research activities, or presentations they have conducted. The portfolios are a part of the annual review process and are also used by nurses when they interview for other positions within the hospital.
"We all have them," says Peterman. "And it's good to do that because you find if you look back on a five-year time period you can't remember all the things you have done to help promote the profession of nursing. But this way you can."
One tactic used to engage nurses was having staff decide the department's vision statement. "We had a small team that went out and held brainstorming sessions about our vision," says Chris Ruder, vice president, patient care services. "These sessions were held during day, evening, and night shifts to really capture what the staff throughout the organization thought it should be."
The team collated all the statements, which encompassed hundreds of ideas and areas that nurses felt strongly about, and the results were voted on by the whole department. The result was a vision statement that Ruder says is truly about all of nursing at the hospital.
Once the departmentwide statement was decided upon, each unit crafted a personal vision statement that encapsulated the unit's ethos.
The sixth part of the department's strategic plan related to quality. The hospital was an early adopter of the rapid response team concept and it has tracked data for more than 3,000 rapid responses since its inception. The RRT is staffed by the medical intensive care unit, and it has played a significant role in the hospitalwide low mortality rate.
One of the most nurse-friendly initiatives the hospital undertook as part of the commitment to quality improvement was to create a nursing resource center. Now nurses have somewhere they can go when they need a quiet space to study for professional certification, a computer to research the latest evidence-based practices, or a conference table to bring people together. The nursing resource center is a room dedicated solely to nurses' use and equipped with comfortable chairs, audiovisual equipment, professional journals, and computer access.
"It is funded through an endowment that nurses and others donate to," says Peterman. "[We] have money taken out of our checks each month to support the nursing resource center. So it's really a nursing resource center supported by nurses."
This center is an example of the commitment to nursing excellence that turned the culture around. The plan helped the organization achieve patient satisfaction rates in the 91st percentile, an impressive turnover rate of around 10%, and a committed and engaged staff.
"On almost all the metrics that you would consider important, we as an organization are doing well and we righted the ship in terms of where we started and where we are today," says Peterman.
As of Monday, no Congressional Budget Office (CBO) cost numbers for the Senate healthcare reform bill had been released. However, even without those CBO numbers (which could be released as early as today), activity behind the scenes on the Senate side appears to show that no one is complacently waiting for the Thanksgiving break to roll around, especially Democrats.
The goal is to have a bill passed by the Senate by Christmas.
Majority Leader Harry Reid (D-NV) has indicated that he wants the healthcare debate to formally begin this week. However, the earliest that the Senate would be likely to vote on starting the debate would be Friday; Saturday or Sunday also could be plausible. Reid had indicated he would consider a break for Thanksgiving week, but that could change as well.
If the Democrats get the needed 60 votes to move ahead and thwart a filibuster, amendments would probably be considered at the earliest on Nov. 30—the Monday after Thanksgiving. Speaking on a radio show on Monday, Sen. Thomas Harkin (D-IA), chair of the Senate Health, Education, Labor, and Pensions Committee, thought that the 60 votes were there.
Currently, the Senate has 58 Democratic senators and two independent senators, who usually vote with the Democrats. However, while it seems simple, 60 may still seem like a challenging number.
For instance, Sen. Robert Byrd (D-WV), now the longest-serving senator, has been ill in recent months and not in attendance for many votes. Also, some senators have remained noncommittal in terms of voting for a reform bill, especially one with a public insurance option, such as Senators Blanche Lincoln (R-AR), Ben Nelson (D-NE), and Mary Landrieu (D-LA).
Harkin said the Democrats are anticipating that the Republicans will try to slow down the debate by requesting that the entire bill—which likely will pass the 1,000-page mark—be read on the Senate floor. This effort is being led by Sen. Tom Coburn (R-OK). The Democrats have indicated that they would tackle this with several procedural maneuvers requiring Republicans to be in attendance during the reading.
The idea is that the Democrats plan on putting in long hours, late nights, and weekends in December to complete work on the Senate bill—and get a vote by Christmas.
Senate conferees would be selected immediately to begin work on a conference report with their House counterparts after the new year, according to Harkin. The eventual goal would be to complete a final bill that can be signed by the President Obama before his State of the Union address in January.
Aurora Health Care's new 110-bed Aurora Medical Center in the town of Summit, WI, will include coordinated care featuring an integrated electronic health record.
Opening on March 1, the medical center will offer primary care services, such as family medicine, internal medicine, OB/GYN, pediatrics, and women's health, under one roof, and in a "prime location" off Wisconsin's Interstate 94 and Highway 67, says Fran Finley, chief administrative officer for Aurora Medical Center. Specialty services will include those for oncology, cardiovascular, neurosciences, emergency, and opthalmology, to name just a few.
"Certainly, it's a convenience issue," Finley says. "You see your physician, the physician requires a diagnostic service and it's located an elevator trip down and is conveniently located in relation to your X-ray department or laboratory department."
This fully-integrated approach will also benefit the Aurora physicians who have practices in the medical clinic, Finley says.
"Say they are an obstetrician: they walk next door to the labor delivery unit for delivering the baby," Finley says. "It's ease of access and convenience for the provider or caregiver as well as the patient."
A key to the comprehensive care will be electronic health records.
"That is probably one of the best things that will be implemented here: The ability for us to track the patient across the whole continuum, from doctor office to hospital to home health to pharmacy," Finley says. "Certainly, from a patient perspective that is a huge benefit."
The opening of the medical center will integrate the Summit campus with the Aurora Wilkinson Medical Clinic, which opened in October. The new medical center's site is in a growth area of the state, says Finley. Patients in Wisconsin's Waukesha and Jefferson counties have access to Aurora's large physician practice, but there currently are no hospitals.
"With the significant number of patients that we have and the number of lives we touch here, it was a convenient location," Finley says. "There was no hospital close by, they had to go to Milwaukee."
Once the medical center is complete, the entire facility will be 800,000 square feet, 250,000 of which is the physician practice that is already up and running.
The hospital will begin to be furnished in December, when medical devices to support surgeries, diagnostics, wound care, and rehabilitation are expected to arrive at the facility. The equipment will then be installed, and each of the devices will undergo testing to obtain certification.
The next several weeks will consist of finding the 500-700 staff members for the facility, Finley says. She estimates 20% of the positions will be filled by people who already work for Aurora and happen to live in the surrounding areas. The vast majority of the staff will come from Wisconsin, providing a boost to the local economy as well.
Finley says planning for the new medical center began 10 years ago, and its development and growth will be an ongoing process. While the medical center will only be licensed for 110 beds at first, the intent for it is to grow to become a regional center because of its location in the "growth quarter" on Interstate 94—between the cities of Milwaukee and Madison, Finley says.
"The hospital is not built for March 1, the hospital is built for five years, for 10 years, for 20 years from now and it has the capacity to expand to at least double, and a little bit more, from what we will open with in March," Finley says.
Angry radiology groups are blasting a government panel's recommendations that women ages 40 to 49 forgo annual screening mammograms and that women between age 50 and 74 should have screening mammograms only once every other year rather than annually.
The U.S. Preventive Services Task Force review of literature advises that women over age 74 should stop all breast cancer screening because the practice lacks evidence of clinical benefit, and found that breast self-examination "does not reduce breast cancer mortality." The task force also noted the increased risk of false positives and other kinds of harm that result from medical overtreatment of abnormal findings that would never have caused death.
But officials for the Access to Medical Imaging Coalition (AMIC) and the American College of Radiology immediately jumped on the task force guidelines, calling them "shocking" and an attempt to "ration care." They said that if incorporated into reimbursement policies by government insurers and payers, many avoidable breast cancer deaths will occur.
"Two decades of decline in breast cancer mortality could be reversed and countless American women may die needlessly from breast cancer each year," according to a statement from the ACR. "Mammography is not a perfect test, but it has unquestionably been shown to save lives—including in women aged 40-49," said Carol H. Lee, MD, ACR chair.
"They say it's not cost efficient. Well, we're not comfortable putting a price tag on a woman's life," added Shawn Farley, ACR spokesman. Besides, he said, the typical mammogram reimbursement from Medicare is only $89. "That's one of the reasons why this (recommendation) is so perplexing."
W. Phil Evans, MD, president of the Society of Breast Imaging, said, "These recommendations are inconsistent with current science and apparently have been developed in an attempt to reduce costs."
"To tell women they should not get regular mammograms starting at 40, when this approach has overwhelmingly been shown to save lives, is shocking," Evans said. "At least 40% of the lives saved by mammographic screening are of women aged 40-49."
If the task force's recommendations are adopted in payment policies by the Centers for Medicare and Medicaid Services and private insurers, millions of dollars in billable tests would not be performed, hitting the imaging industry at a point when it is already absorbing reimbursement cuts from CMS.
A statement from the Access to Medical Imaging Coalition (AMIC), which represents physicians, equipment manufacturers, patient groups, and those who develop imaging technology, said the guidelines seem to go against President Barack Obama's stated goals to increase efforts in early disease detection.
"Unfortunately, Medicare has already refused to cover new technologies to increase the detection of colon cancer, is cutting payments for advanced diagnostic tests such as MRI of the breast by 50%, and now the USPSTF is paving the way for insurers to deny mammography coverage," said Tim Trysla, AMIC executive director.
"This type of policy, which puts millions of women of all ages at risk, is contrary to the evidence and the President's own words, makes no sense, and should be rejected," he said.
The recommendations were issued in a paper published today in the Annals of Internal Medicine, the journal of the American College of Physicians, and was published by the Agency for Healthcare Research and Quality.
The guidance represents a significant departure from the task force's recommendations from 2002, which suggested mammography screening—with or without clinical breast examination—every one to two years for women 40 years of age or older.
They also go against recommendations from the American Cancer Society on breast cancer screening.
The task force's 16 members are appointed by the U.S. government and work with the Agency for Healthcare Research and Quality to review the evidence of effectiveness and develop recommendations for clinical preventive services.
The task force's review concluded there's inadequate evidence that more frequent mammography carries life-saving benefits. Rather, it concluded, potential harm from screening may result, including "psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results."
The task force also referred to "the harms associated with treatment of cancer that would not become clinically apparent during a woman's lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent, but would not have shortened a woman's life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration."
The task force said women who are at high risk for breast cancer and are between the ages of 40-49 should talk with their doctor about the best time to start regular, biennial screening mammography.
Among other highlights of its report, the task force said there isn't enough evidence to assess benefits or harms of digital mammography or magnetic resonance imaging instead of film mammography.
