Electronic Medical Records: Up East & Abroad

With so much health care news these days mired in the politics of the various U.S. Presidential primaries and caucuses, I believe it's time to take a glance at some pertinent info that is getting lost in the shuffle. The topic I would like to put a spotlight on today is EMRs, Electronic Medical Records.

Let's start with this morning's Boston Globe, where Milton J. Valencia describes the creation of a new community-based network of physicians in the South Shore area of Boston, Massachusetts, who focus on sharing medical databases and records, Brockton Hospital's new Signature Healthcare:

Under the network, doctors will work off one system, making services more cost efficient, Goodman said. Standards of care will be the same within the network; all doctors will use the same prescription drug formula, for example, so that patients with the same illness aren't prescribed different drugs - saving the hospital money in buying the drugs, Goodman said.

This implementation of standards marks an important point in the evolution of health care procedures. The implementation of standards and measurements (systems thinking) is one of the big concepts in Mr. Halvorson's book, and this looks like it could be a fine step forward in that regard. The Globe's article continues:

The most evident change will be shared electronic medical record keeping, which has become the latest tool allowing doctors to share information with specialists and a key element in building a network of providers, said Rich Copp, spokesman for the Massachusetts Hospital Association.

"It's an example of hospitals around the Commonwealth doing what they can to integrate their care," Copp said. "Being able to have one system . . . is really going to be a great convenience and help improve the quality of care in Brockton."

Alan Wechsler of the Albany Times Union writes about a landmark grant program geared toward defraying the cost of implementing EMRs for small practices that would otherwise be hard pressed to afford them. The interesting part is that the grants are coming from the Capital District Physicians' Health Plan:

The Albany-based health insurer plans to award a total of $1 million, piece by piece, to small practices in the Capital Region for the purpose of investing in electronic medical records technology. [...]

The medical records system is expected to bring better health care by preventing duplication and dangerous drug interactions, as well as giving doctors access to better information about their patients. In the long term, it's expected to decrease the cost of health care -- something of great interest to insurance companies.

Lastly comes this article by Kelly Kennedy from the Air Force Times website which brings us positive tidings from overseas:

After decades of doctors treating brain injuries, heart problems and complex war wounds at Landstuhl Army Medical Center in Germany, hospital administrators there have also belatedly leaped the technological divide to create electronic records.

CliniComp International has been awarded a contract to create and track electronic medical records at the Defense Department’s largest hospital outside the continental U.S. The company provides the service for 18 other military hospitals, which together comprise 45 percent of inpatient beds in the military system.

All in all there seems to be quite a bit of good news on the topic of EMRs. Let us hope that the trend continues.

SOURCE: "Health network to keep care close to home" 01/24/08
SOURCE: " Insurer an ally in data upgrades" 01/23/08
SOURCE: "Landstuhl to use electronic medical records" 01/23/08
photo courtesy of John A. Ward, used under this Creative Commons license

ECHCI: Analyzing European Health Care Systems

Jane Sarasohn-Kahn at Health Populi once again delivers the goods as she examines the latest version of the Euro-Canadian Health Care Index (ECHCI) and its findings on the subject of consumer-centric health care systems:

The concept of consumerism in health care has migrated to Europe. The Health Consumer Powerhouse, a self-described "do-tank" (as opposed to "think-tank") based in Brussels and Stockholm, innovated and perennially updates the ECHCI. This year, the Powerhouse has added sister-nation Canada to the mix, and the results are fascinating. A key objective for the Index is to promote transparency across health systems in Europe; transparency is a major initiative in the European Union.

The Powerhouse points out that the top 5 countries all have "Bismarckian" health systems; that is, they were founded on the principles of social insurance where many health plans compete in markets and are also independent of the delivery system. This is in marked contrast to a system such as the UK's National Health Service, founded on "Beveridge" principles where financing and delivery are organized within one system (that would include Canada).

She correctly observes that a large amount of context is required to properly interpret the indexes, Still, it's useful to deconstruct them in order to gain insights into our current situation.

The Index is calculated using a "pentathalon" of five measurements: Patient rights and information, treatment waiting times, outcomes, generosity, and pharmaceuticals. These metrics lead directly to Ms. Sarasohn-Kahn's "Hot Points:"

When I ponder the five components of the ECHCI's pentathlon of consumer-friendly measures, the one that is most surprising from the US perspective is "generosity." I peeked under the hood of generosity and found the following metrics: cataract operations per 100,000 citizens; infant disease vaccination rates; kidney donations per million people; and, dental care as part of the public health offerings.

What is consumer-centrism in American health care? Is it "generosity?" To a colleague with whom I met yesterday, consumer-centrism was being seen on-time at a physician appointment. To me at my daughter's last visit to her pediatrician, it was spending sufficient time discussing the health challenges of a tween girl in 2008. When it's about you, the consumer, it's the micro-details of your experience with health providers, payors, products.

I heartily advise reading her complete post; it offers a number of useful insights into new ways of looking at health care delivery here in the U.S. In Health Care Reform Now!, George Halvorson stresses that we should look to other existing systems for ideas while crafting a health care model that is unique to our nation. Every industrialized nation has found a path to universal coverage. The U.S. must do the same, but along that path we can find elements of the systems in use elsewhere that can either be integrated into our approach or inspire new approaches.

SOURCE: " Consumers and health care through the Euro-lens" 01/23/08
photo courtesy of Albertane, used under this Creative Commons license

Wal-Mart Makes Health Care Announcement

In an announcement today Wal-Mart Stores, Inc. stated that it has experienced a drop of more than 20 percent in uninsured employees over the past year.

Businessweek gives us a breakdown:

The world's largest retailer said only 7.3 percent of its workers reported being uninsured, down from 9.6 percent the year before. Wal-Mart, which union groups have targeted over health care, said more than half of its eligible employees received coverage under its health care plans, a first in recent reporting. [...]

Linda Dillman, an executive vice president of benefits and risk management for Wal-Mart, told reporters on a conference call Tuesday that the increased enrollment likely came from the company's new health care plan. The plan, which allows employees to customize their coverage, includes premiums as low as $5 a month and access to $4 prescription drugs.

"Everybody in this company is on the same set of plans," Dillman said. Wal-Mart president and CEO "Lee Scott made the same selection the newest part-time cashier at Wal-Mart did."

According to the interview, 50.2 percent of employees made use of the company's health care plan this year, an increase from 47 percent last year (46 percent in 2006, and 43 percent in 2005). The increase is attributed to positive changes made in Wal-Mart's health plan, changes which include lowered premiums and copays for Prescription drug, coverage for the children of part time workers and a shortened eligibility period.

State lawmakers have criticized Wal-Mart for allowing its workers to take part of state-funded health care for the poor. A confidential 2006 state study in Washington state showed Wal-Mart had 3,194 workers on Medicaid and the state's Basic Health Plan, more than any other private employer.

Dillman said the retailer had seen a slight drop-off in the number of employees saying they took part in state-sponsored health care coverage, but said the percentages stayed roughly the same.

"We did get some movement off of the plan, but we didn't see much change in terms of the total percentage," Dillman said.

As of this time Meghan Scott, a spokeswoman for WakeUpWalMart.com, a union-backed website critical of the company's shortcomings on this issue declined to comment.



SOURCE: "Wal-Mart says more workers insured" 01/2/08

photo courtesy of Code Poet, used under this Creative Commons license

Health Care in Maine: Net Gains

The State of Maine is poised and ready for February 1, 2008. On that date the state's health care leaders will begin an ambitious and exciting project: the development of one of the United State's first statewide "health information exchange." Non-profit venture HealthInfoNet, the group spearheading the effort, has retained 3M and Orion Health to assist on the technology end of the equation.
Bernie Monegain, editor of Healthcare IT News, brings us a synopsis of the plan:

"This project will be big and far-reaching - touching the lives of more than half of Maine's population," said David Howes, MD, vice chairman of HealthInfoNet and president and CEO of Martin's Point Health Care.

Wendy Wolf, MD, president and CEO of the Maine Health Access Foundation, said she and her colleagues view HealthInfoNet as a key way to provide better care for both insured and uninsured patients in the state. Uninsured patients tend to receive the least coordinated care, she noted.

[...]

Beginning this winter, more than 2,000 healthcare providers, including 15 rural and urban hospitals across Maine and one-third of practicing physicians in Maine, will join with the Maine Center for Disease Control and Prevention (part of the Department of Health and Human Services) in a 24-month pilot of the new network.

Monegain says that once the network is launched across the state, network officials project an approximate $50 million reduction in healthcare costs due to the reduction in unneeded and duplicate testing, procedures, and hospital admissions.

HealthInfoNet makes possible a consolidated electronic health record that combines data usually kept in separate physical locations such as labs, private health care providers, hospitals, etc. As the program develops it should also provide individuals with a much greater level of access to their own personal health records.

SOURCE: "Maine begins to build statewide HIE" 01/16/08
photo courtesy of tanakawho, used under this Creative Commons license

Alegent, MEDSEEK Team Up to Empower The Patient

On January 15-16 decision makers from nine U.S. health care systems met with analysts, technology experts and policy makers in Omaha, Nebraska for Alegent Health's "Power to the Patient," forum. This event is geared toward the development of policies and systems that provide tools and information to consumers in the interest of allowing them to make more informed decisions on health care issues.

The Alegent Health Online Press Room lists the confirmed participants as:

• Aurora Health Care, Milwaukee, WI


• Elliot Health System, Manchester, NH


• Martin Memorial Health Systems, Stuart, FL


• Mercy Medical Center, Cedar Rapids, IA


• North Shore LIJ Health System, New York, NY


• Provena Health System, Joliet, IL


• Sisters of Mercy Health System, St. Louis, MO


• St. John’s Health System, Springfield, IL


• Via Christi Health System, Wichita, KS

According to the press release from MEDSEEK, who are supporting the forum, Alegent will share its proprietary technology and methodology with any health system that sent a representative to the forum. According to Alegent CEO Wayne Sensor, this could be a large step forward in data transparency, electronic medical records, and the application of systems thinking to health care:

"Information technology is at the core of our ability to better serve consumers," noted Sensor. "Whether it’s providing patients accurate pricing and quality information through the Internet, or implementing greater use of it in our practice settings, our experiences in putting information technology to work for the benefit of consumers is something we are eager to share openly. That is what the 'Power to the Patient' forum is about -- helping other health care providers to learn from our mistakes and benefit from our experiences."

The website for "Power to the Patient" lists the objectives of the forum as follows:

• To foster acceptance of transparency among health care providers, resulting in an environment that empowers consumers to make quality health care decisions by the use of meaningful tools and information.
• To help providers begin or progress along their journey to cost and quality transparency by sharing experiences about innovative new access points and the implementation of consumer-driven health plans within the workforce.
• To create an environment where the lessons and ideas of providers in this arena can be shared and discussed.

Alegent is a faith-based health care system with nine hospitals in Nebraska and Iowa. MEDSEEK is an Enterprise eHealth solutions provider focused on connecting information and people in order to provide better care and promote community advocacy.

SOURCE: "Press Release: National Policy Makers and Health Care Executives Come Together to Discuss the Future of Health Care" 01/15/08
SOURCE: "Alegent: Power to the Patient"
SOURCE: "Press Release: Alegent Health Establishes "Power to the Patient" Forum to Focus on Increasing Consumers’ Engagement in Health Care"
photo courtesy of neovain, used under this Creative Commons license

Hurry Up and Wait: Emergency Care in The US

"I mean, people have access to health care in America. After all, you just go to an emergency room. "
- President George W. Bush Cleveland, OH July 7, 2007

This morning a Harvard study was released that is causing ripples across the media and Internet. Let us begin with the The Boston Globe's medical column:

Between 1997 and 2004, wait times went up an average of 4.1 percent per year for all patients, but for heart attack patients, the waits stretched 11.2 percent per year, researchers from Cambridge Health Alliance report in today’s issue of Health Affairs. Blacks, Hispanics, women, and patients in urban hospitals waited longer than other patients.

"The striking finding is that waits are increasing for all Americans, for people who are insured and for people who are uninsured," lead author Dr. Andrew Wilper, also a fellow in internal medicine at Harvard Medical School, said in an interview. “For patients with severe illnesses, it is troublesome.”

The Houston Chronicle converts those percentages into minutes and also provides this telling quote from Charles Begley, a professor at the University of Texas School of Public Health:

"Because the emergency room has become a source of primary care for a lot of people, it is distracting the emergency room from being able to provide the emergency trauma care that the community needs," Begley said.

For patients across the country identified as needing "emergent" care, wait times increased to 14 minutes in 2004, up from 10 minutes in 1997, study authors reported. And the subset of patients who were diagnosed as suffering from heart attacks saw a significant increase, from eight minutes in 1997 to 20 minutes in 2004.

A twenty minute wait time for a heart attack victim? Think about that for a moment. Think about how long a minute is when suffering chest pains.

The Washington Post also has a piece online today which tells us a bit more about how the data was compiled :

The researchers analyzed data on patient visits and wait times collected between 1997 and 2000, and from 2003 and 2004, by the National Hospital Ambulatory Medical Care Survey, a nationally representative database. Among other findings, they learned that wait times tended to be longer for African Americans and Hispanics, perhaps because those patients are often treated in urban emergency departments, which are more likely to be overcrowded than their rural counterparts.

In recent years, several expert reports have detailed the strains on emergency room care in the United States. Three reports issued in 2006 by the Institute of Medicine, a branch of the National Academies, concluded that the nation's emergency medical system is "overburdened, underfunded and highly fragmented."

It is well documented (in Health Care Reform Now! of course) that for chronic conditions such as asthma, a few hundred dollars a year are required to manage the condition, while a single emergency room visit could skyrocket to over $20,000. This cost factor combined with the wait times present a disturbing portrait of a broken system.


SOURCE: "Emergency room wait times getting longer" 01/15/08
SOURCE: "Wait times at the ER are ticking upward: Researchers say patient care is at risk as crowding causes many to just leave" 01/15/08
SOURCE: "Emergency Care Waits Found to Be on Rise" 01/15/08
photo courtesy of macoggins, used under this Creative Commons license

California Nurses Use Obama's Words Against Schwarzenegger Plan

This morning The Nation brings us some interesting news (via Yahoo). Evidently while U.S. Senator Barack Obama is focusing his attentions on other states, his voice is ringing out across California thanks to an ad campaign run by the California Nurses Association (CNA). The ads attack the health care reform plan backed by California Governor Arnold Schwarzenegger, Democratic Assembly Speaker Fabian Nunez, and a group of major insurance corporations.

The radio ads being aired by CNA announce that, "The nurses of California agree with Senator Barack Obama: the government shouldn't punish people who can't afford health insurance."

Then an audio clip from Obama is heard. "I know that there have been some folks who said that it's not possible to provide universal health care coverage unless there's a mandate," says the senator. "Their essential argument is the only way to get everybody covered is if the government forces you to buy health insurance. If you don't buy it, then you'll be penalized in some way. And the reason people don't have health insurance is because they can't afford it."

You may read a transcript of the ad or listen to/download it in MP3 format from the CNA Online Press Release.

The CNA has not gone easy on Senator Obama's plan in the past. Last year the organization's then president, Deborah Berger, RN, criticized it for failing to address pricing practices in the health care industry. She said that those practices, "put so many American families at financial and health risk."

Then there is Iowa. During the recent caucuses the CNA ran an ad aimed at Senator Obama which said: "It's not good enough just to be better than the Republicans on this."

The current ad campaign has potential to be a very powerful one. Senator Obama's voice and face have become ubiquitous, especially after his victory in the Iowa caucuses. The CNA, as we wrote about here, was the group behind the last month's powerful "if he were anyone else, he'd be dead by now," ad campaign that used U.S. Vice-President Dick Cheney's recent medical history as it's basis.

It will be interesting to see what direction things take in response, especially between now and the California presidential primary on February 5.

SOURCE: " Putting Obama to Work for Health-Care Reform" 01/11/08
SOURCE: "Nurses Unveil New Advertising Campaign Against Schwarzenegger-Nunez “Individual Mandate” Plan" 01/10/08
photo courtesy of Transplanted Mountaineer, used under this Creative Commons license