March 2005
Mission: to transform the health care system through information and technology to improve patient safety and health care quality, lower costs, and coordinate care .
IN THIS ISSUE:
1. FY06 Budget Resolution Update
2. CDC Reports on EHR Adoption
3 . Kennedy Discusses HIT
4. Reports Show Promise, Challenges of Health IT
5. AHRQ Reports on Healthcare Quality
6. Governors Call on Congress to Create National Health Innovations Program
7. MedPAC Encourages Pay-for-Performance
8. AHRQ to Hold Patient Safety and Health IT Conference
9. Senate HELP Committee Passes Patient Safety Bill
10. Study Finds Hospital Leaders Have Reservations about Mandatory Error Reporting
11. Pennsylvania Launches Health Network Initiative
12. HIMSS to Host Technology Solutions Showcase on Capitol Hill
13. IHI's Promising Practice of the Month : Putting Safety on the (Central) Line
FY06 Budget Resolution Update
As the U.S. Congress left for a two week recess, both houses of Congress completed the first step on the long path to pass a FY06 budget for the federal government. A budget resolution is a plan that consists of spending and revenue targets which are implemented through subsequent legislation, including appropriation acts and changes in laws that affect revenues and direct spending. The House passed a Budget Resolution (218-214) that mirrored the President's Budget Request. The Caucus sent a letter to the House Budget Committee signed by 28 Members of Congress of both parties in support of health information technology funding.
The Senate passed a Budget Resolution (52-48) that restored $14B in proposed Medicaid reductions. The Senate also proposed establishing a reserve fund to accommodate future legislation that would provide incentives for adoption of modern information technology and for performance-based payments that are based on accepted clinical performance measures. The reserve fund requires that such legislation be budget neutral over five years. Following the Easter recess, both houses will have to come back and resolve their differences in conference.
CDC reports on EHR adoption
Less than 20 percent of doctor's offices have electronic medical records according to the Centers for Disease Control and Prevention (CDC). The report, Use of Computerized Clinical Support Systems in Medical Settings: United States, 2001-2003 , shows what many have known for years, that healthcare lags behind other industries in the adoption of information technology. The study included many interesting findings including:
Kennedy Discusses HIT
Sen. Edward Kennedy (D-MA) cited the Department of Veterans Affairs as an example of the savings information technology can provide in the delivery of healthcare in a recent Face the Nation program . "We have seen the decline of the costs per bed in the Veterans Administration by 7% over the last five years," Kennedy stated. "It's gone up 62% in the rest of the healthcare system because we don't use information technology. Preventive healthcare, best practices healthcare, information technology on this and then we're going to expand the Medicare to cover all Americans." According to Kennedy, 33 cents out of every health dollar is used non-clinically.
Reports Show Promise, Challenges of Health IT
Several recently published reports show that information technology can improve the effectiveness and efficiency of medical care, but that it is not a silver bullet. A study by Wellpoint of Maine physicians using e-prescribing found that those using the system prescribed generic drugs 3.7% more often than those in the control group, saving an average of $562 per patient in the first year.
Another study of a computerized physician order entry (CPOE) system at the Hospital of the University of Pennsylvania, however, found a number of persistent errors resulting from use of the system. The problems were primarily traced to the design of the system. For example, users would forget to sign out of a patient's record, and a drug intended for another patient would be inadvertently ordered to the first patient. Researchers found that in some cases, physicians needed to look at 20 different screens to see all of the medications a patient was taking. Dr. David Brailer, the National Coordinator for Health Information Technology said that the study provided a valuable wake-up call. "The way health information technology is developed, the way it is implemented and the way it is used are what matter," Dr. Brailer said.
AHRQ reports on healthcare quality
The Agency for Healthcare Research and Quality (AHRQ) has released its second annual reports on quality of and disparities in healthcare in America. The 2004 National Healthcare Quality Report measured quality in effectiveness, patient safety, timeliness, and patient centeredness. It found that while quality is improving in many areas, quality varies significantly across the country and that the gap between the best possible care and the care that is actually provided is wide. The report is intended to provide a benchmark on the quality of care in America. While modest improvement in the quality of care across the country was shown the report breaks down some of the information by state showing dramatic improvements in some areas.
It also states that improved data availability and improving health care quality is one of several potential results of an improved health information technology infrastructure and that future quality reports will benefit from accelerated development of the Nation's health information infrastructure.
Governors call on Congress to create National Health Innovations program
The National Governors Association has called on Congress to establish a National Health Care Innovations program to support the implementation of ten to fifteen state-led demonstrations in healthcare reform over a three to five year period. Some of the demonstration programs would focus on deploying information and communications technology to improve services and improving quality of care. The whitepaper describing the initiative states that by failing to effectively use information technology, the U.S. health care industry has created a system that encourages inefficiency.
MedPAC Encourages Pay-for-Performance
MedPAC, the Medicare Payment Advisory Commission, issued its March report to Congress. The report looks at the Medicare payment policy and recommends that Medicare adopt cost-neutral pay-for-performance incentives throughout the program amounting to 1 to 2 percent of reimbursements. The report suggested that such incentives should reward both the best performance on outcomes measures and the largest improvements. Last year's report recommended pay-for-performance for Medicare Advantage managed care contractors; this year's extends that recommendation to hospitals, physicians, and home health agencies.
MedPAC also discussed the potential for information technology to improve quality of care and considered actions to further its use. The Commission recommended that functions of IT systems that are linked to quality improvements be included as measures in pay-for-performance initiatives in all sectors beginning with physician offices. The report also mentions the important role that certification can play in assisting provider navigate the information technology market. Due to the financial realities of the healthcare sector and the cost associated with the adoption of healthcare information technology the Commission favors the use of pay-for-performance as a financial incentive to the adoption of healthcare IT rather than direct loans or grants. It also looks at the need to stimulate community efforts to exchange health information and the impact this could have on public health.
AHRQ to hold Patient Safety and Health IT Conference
The Agency for Healthcare Research and Quality (AHRQ) will be holding a conference from June 6 through June 10 in Washington, DC that will provide AHRQ grantees and other stakeholders the opportunity to present finding from their patient safety and health IT-related projects. The week-long conference will also offer the opportunity to hear from providers, researchers and practitioners about their work in patient safety and health IT, including a day devoted to presentations from innovative leaders who understand the importance of health IT as a critical element of improving the safety and quality of the health care system.
Senate HELP Committee Passes Patient Safety Bill
On March 8, the Senate Committee on Health, Education, Labor and Pensions passed the Patient Safety and Quality Improvement Act (S. 544). The bill, identical to legislation passed by the Senate last year, provides for reporting systems for medical errors and near-misses, shielding the information from litigation. The legislation is intended to strike a balance between creating opportunities for hospitals and physicians and other medical staff to learn from mistakes without fear of liability and protecting injured patients' rights. The House passed similar legislation last year, but the two houses never reconciled their bills. The Senate bill, introduced by Senator Jeffords (I-VT), passed the committee unanimously by voice vote.
Study finds hospital leaders have serious reservations about mandatory error reporting
A survey of hospital leaders found that nearly 70 percent believed that a non-confidential, mandatory system would discourage staff from reporting patient safety incidents to their hospital's own internal reporting system, and almost 80 percent thought it would encourage lawsuits. The AHRQ-funded study , led by Joel S. Weissman, Ph.D., of Massachusetts General Hospital in Boston, was published in the March 16 issue of JAMA. The researchers also found that more than 80 percent felt the names of both the hospital and involved staff members should be kept confidential, although respondents from states with mandatory, non-confidential systems already in place were more willing to have hospital names released. Over 90 percent said their hospital would report serious injuries to their state hospital licensing agencies, but far fewer would report moderate or minor injuries. However, the hospital leaders surveyed generally did favor disclosing patient safety incidents to patients who were involved.
Pennsylvania Launches Health Network Initiative
Twenty-eight health care organizations in Pennsylvania have announced the creation of the Pennsylvania e-Health Technology Consortium, a group endeavoring to build a health information network for the state. Led by members such as the University of Pittsburgh Medical Center and the Hospital and Health System Association of Pennsylvania, the consortium plans to tackle difficult questions about how to make existing systems interoperate, what data should be shared, and how to pay for the network.
HIMSS to Host Technology Solutions Showcase on Capitol Hill
The Healthcare Information and Management Systems Society (HIMSS) and 13 other non-profit associations will host a technology demonstration and congressional reception saluting the 21 st Century Health Care Caucus in the Foyer of the Rayburn House Office Building on Thursday, April 7, from 4:30 - 6:30 p.m. The event is open to the public and will include HIT displays from vendors, initiatives, universities and associations from around the nation. Membership plaques will be presented to all 34 members of the Caucus. For details, contact advocacy@himss.org .
IHI's Promising Practice of the Month : Putting Safety on the (Central) Line
If you're a patient in an intensive care unit, you're likely to need a catheter inserted in order to receive life-saving medicines and fluids. Unfortunately, that same catheter, or central line, can also become the source of a deadly bacterial infection. Central line infections are estimated to kill 28,000 people each year. Several hospitals have proven that these infections are nearly entirely preventable, and the 100,000 Lives Campaign seeks to bring prevention strategies to over 1,000 hospitals nationwide. Hospitals need no longer accept central line infections as inevitable. Read more: http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/Literature/PuttingSafetyontheCentralLine.htm
The House 21 st Century Health Care Caucus thanks the following organizations for their contributions to this newsletter:
HIMSS (Healthcare Information and Management Systems Society) is the healthcare industry's membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology and management systems for the betterment of human health. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems' contributions to ensuring quality patient care. On the web at www.himss.org . (Items 1-3, 5, 6, 8, 10, 12)
The Institute for Healthcare Improvement (IHI) is a not-for-profit organization leading the improvement of health care throughout the world. Founded in 1991 and based in Boston, MA, IHI is a catalyst for change, cultivating innovative concepts for improving patient care and implementing programs for putting those ideas into action. Thousands of health care providers participate in IHI's groundbreaking work. To find out more, go to www.ihi.org . (Item 13)