Nellie Bristol

WASHINGTON — Hospitals receiving emergency transfers from other facilities are being encouraged to ensure that the move is necessary, under recommendations approved by the federal Emergency Medical Treatment and Labor Act Technical Advisory Group.

The panel approved a series of recommendations in response to concerns that hospitals are using EMTALA to justify transferring patients they should be able to treat. The technical advisory group advises the Department of Health and Human Services and the administrator of the Centers for Medicare and Medicaid Services on issues that are related to EMTALA.

The panel has collected testimony indicating that some facilities don't maintain adequate on-call coverage and thus believe that EMTALA allows them to transfer patients they can't immediately care for. Receiving hospitals are reluctant to challenge transfer requests for fear of being accused of an EMTALA violation.

The concerns were reflected in testimony received by the group. “I do think the EMTALA provisions have been an escape valve for the hospital to say, 'Well, we don't need to provide coverage because we can transfer,'” said Dr. Amos Stoll. Dr. Stoll was representing the Broward General Medical Center in Fort Lauderdale, Fla.

Dr. David Ciesla, of Washington Hospital Center, said his level I trauma center is frequently requested to accept patients who do not need the high level of care the hospital can provide. He told the panel that since 2001, the center has experienced an 80% increase in transfers to the hospital. Interfacility transfers account for one-quarter of the volume in annual trauma admissions, Dr. Ciesla explained. Half of those had only minor injuries, as defined by the National Trauma Data Bank, he added.

“In a situation where the tertiary referral centers have a finite amount of resources, these resources are increasingly used to treat patients who don't necessarily need the full spectrum of care,” he said.

The danger is that the hospital may run out of capacity needed to accommodate the severely injured patients the facility is meant for, Dr. Ciesla added. Panel members and physicians are concerned that by allowing transfers of patients, EMTALA may be worsening the situation.

“Do you think that physicians who originally were thought to be regulated by the government into taking care of patients at the site of presentation … are now gaming it? Are they using EMTALA to shift their burden, to force you docs to accept these patients?” asked panel member Dr. James Nepola, professor of orthopaedics and rehabilitation at the University of Iowa, Iowa City.

“I think that may be one of the unintended consequences,” Dr. Ciesla replied.

“There's a perceived obligation on behalf of the receiving hospital to have to take that patient,” panel member Dr. Mark Pearlmutter explained. “But there's nothing to encourage it the other way under EMTALA.” Dr. Pearlmutter is chief of emergency medicine at Caritas St. Elizabeth's Medical Center in Boston.

On-Call Recommendations

Hospitals should provide on-call coverage for services they regularly offer to the community, the EMTALA technical advisory group recommended, and such a provision should be part of the act's interpretive guidelines.

The advisory panel's recommendations also call for hospital administrators and medical staff to annually develop an on-call coverage plan that evaluates a facility's services and the number and type of emergency department visits. Hospitals also should develop plans for transferring patients whose needs cannot be met, and to provide a mechanism for evaluating a facility's provision of on-call services.

If the facility does not have the capacity to provide services at a given time, the plan must include backup provisions, the recommendations stipulate. Care could be provided through the use of telemedicine, alternative staff physicians, or transfer agreements with other facilities. Regional or community coverage arrangements also could be employed, according to the advisory group.

A hospital may satisfy its on-call coverage obligations by participating in community or regional call coverage programs approved by the CMS, the panel said. It also recommended changes to the EMTALA statute's definition governing on-call obligations for hospitals.

The current EMTALA statute says call coverage should be arranged that “best meets the needs” of the community. The advisory panel suggested replacing that definition with a provision that each hospital must maintain an on-call list of physicians who can examine and stabilize patients “in accordance with the resources available to the hospital.”

WASHINGTON — Hospitals receiving emergency transfers from other facilities are being encouraged to ensure that the move is necessary, under recommendations approved by the federal Emergency Medical Treatment and Labor Act Technical Advisory Group.

The panel approved a series of recommendations in response to concerns that hospitals are using EMTALA to justify transferring patients they should be able to treat. The technical advisory group advises the Department of Health and Human Services and the administrator of the Centers for Medicare and Medicaid Services on issues that are related to EMTALA.

The panel has collected testimony indicating that some facilities don't maintain adequate on-call coverage and thus believe that EMTALA allows them to transfer patients they can't immediately care for. Receiving hospitals are reluctant to challenge transfer requests for fear of being accused of an EMTALA violation.

The concerns were reflected in testimony received by the group. “I do think the EMTALA provisions have been an escape valve for the hospital to say, 'Well, we don't need to provide coverage because we can transfer,'” said Dr. Amos Stoll. Dr. Stoll was representing the Broward General Medical Center in Fort Lauderdale, Fla.

Dr. David Ciesla, of Washington Hospital Center, said his level I trauma center is frequently requested to accept patients who do not need the high level of care the hospital can provide. He told the panel that since 2001, the center has experienced an 80% increase in transfers to the hospital. Interfacility transfers account for one-quarter of the volume in annual trauma admissions, Dr. Ciesla explained. Half of those had only minor injuries, as defined by the National Trauma Data Bank, he added.

“In a situation where the tertiary referral centers have a finite amount of resources, these resources are increasingly used to treat patients who don't necessarily need the full spectrum of care,” he said.

The danger is that the hospital may run out of capacity needed to accommodate the severely injured patients the facility is meant for, Dr. Ciesla added. Panel members and physicians are concerned that by allowing transfers of patients, EMTALA may be worsening the situation.

“Do you think that physicians who originally were thought to be regulated by the government into taking care of patients at the site of presentation … are now gaming it? Are they using EMTALA to shift their burden, to force you docs to accept these patients?” asked panel member Dr. James Nepola, professor of orthopaedics and rehabilitation at the University of Iowa, Iowa City.

“I think that may be one of the unintended consequences,” Dr. Ciesla replied.

“There's a perceived obligation on behalf of the receiving hospital to have to take that patient,” panel member Dr. Mark Pearlmutter explained. “But there's nothing to encourage it the other way under EMTALA.” Dr. Pearlmutter is chief of emergency medicine at Caritas St. Elizabeth's Medical Center in Boston.

On-Call Recommendations

Hospitals should provide on-call coverage for services they regularly offer to the community, the EMTALA technical advisory group recommended, and such a provision should be part of the act's interpretive guidelines.

The advisory panel's recommendations also call for hospital administrators and medical staff to annually develop an on-call coverage plan that evaluates a facility's services and the number and type of emergency department visits. Hospitals also should develop plans for transferring patients whose needs cannot be met, and to provide a mechanism for evaluating a facility's provision of on-call services.

If the facility does not have the capacity to provide services at a given time, the plan must include backup provisions, the recommendations stipulate. Care could be provided through the use of telemedicine, alternative staff physicians, or transfer agreements with other facilities. Regional or community coverage arrangements also could be employed, according to the advisory group.

A hospital may satisfy its on-call coverage obligations by participating in community or regional call coverage programs approved by the CMS, the panel said. It also recommended changes to the EMTALA statute's definition governing on-call obligations for hospitals.

The current EMTALA statute says call coverage should be arranged that “best meets the needs” of the community. The advisory panel suggested replacing that definition with a provision that each hospital must maintain an on-call list of physicians who can examine and stabilize patients “in accordance with the resources available to the hospital.”

WASHINGTON — Hospitals receiving emergency transfers from other facilities are being encouraged to ensure that the move is necessary, under recommendations approved by the federal Emergency Medical Treatment and Labor Act Technical Advisory Group.

The panel approved a series of recommendations in response to concerns that hospitals are using EMTALA to justify transferring patients they should be able to treat. The technical advisory group advises the Department of Health and Human Services and the administrator of the Centers for Medicare and Medicaid Services on issues that are related to EMTALA.

The panel has collected testimony indicating that some facilities don't maintain adequate on-call coverage and thus believe that EMTALA allows them to transfer patients they can't immediately care for. Receiving hospitals are reluctant to challenge transfer requests for fear of being accused of an EMTALA violation.

The concerns were reflected in testimony received by the group. “I do think the EMTALA provisions have been an escape valve for the hospital to say, 'Well, we don't need to provide coverage because we can transfer,'” said Dr. Amos Stoll. Dr. Stoll was representing the Broward General Medical Center in Fort Lauderdale, Fla.

Dr. David Ciesla, of Washington Hospital Center, said his level I trauma center is frequently requested to accept patients who do not need the high level of care the hospital can provide. He told the panel that since 2001, the center has experienced an 80% increase in transfers to the hospital. Interfacility transfers account for one-quarter of the volume in annual trauma admissions, Dr. Ciesla explained. Half of those had only minor injuries, as defined by the National Trauma Data Bank, he added.

“In a situation where the tertiary referral centers have a finite amount of resources, these resources are increasingly used to treat patients who don't necessarily need the full spectrum of care,” he said.

The danger is that the hospital may run out of capacity needed to accommodate the severely injured patients the facility is meant for, Dr. Ciesla added. Panel members and physicians are concerned that by allowing transfers of patients, EMTALA may be worsening the situation.

“Do you think that physicians who originally were thought to be regulated by the government into taking care of patients at the site of presentation … are now gaming it? Are they using EMTALA to shift their burden, to force you docs to accept these patients?” asked panel member Dr. James Nepola, professor of orthopaedics and rehabilitation at the University of Iowa, Iowa City.

“I think that may be one of the unintended consequences,” Dr. Ciesla replied.

“There's a perceived obligation on behalf of the receiving hospital to have to take that patient,” panel member Dr. Mark Pearlmutter explained. “But there's nothing to encourage it the other way under EMTALA.” Dr. Pearlmutter is chief of emergency medicine at Caritas St. Elizabeth's Medical Center in Boston.

On-Call Recommendations

Hospitals should provide on-call coverage for services they regularly offer to the community, the EMTALA technical advisory group recommended, and such a provision should be part of the act's interpretive guidelines.

The advisory panel's recommendations also call for hospital administrators and medical staff to annually develop an on-call coverage plan that evaluates a facility's services and the number and type of emergency department visits. Hospitals also should develop plans for transferring patients whose needs cannot be met, and to provide a mechanism for evaluating a facility's provision of on-call services.

If the facility does not have the capacity to provide services at a given time, the plan must include backup provisions, the recommendations stipulate. Care could be provided through the use of telemedicine, alternative staff physicians, or transfer agreements with other facilities. Regional or community coverage arrangements also could be employed, according to the advisory group.

A hospital may satisfy its on-call coverage obligations by participating in community or regional call coverage programs approved by the CMS, the panel said. It also recommended changes to the EMTALA statute's definition governing on-call obligations for hospitals.

The current EMTALA statute says call coverage should be arranged that “best meets the needs” of the community. The advisory panel suggested replacing that definition with a provision that each hospital must maintain an on-call list of physicians who can examine and stabilize patients “in accordance with the resources available to the hospital.”

WASHINGTON – From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.”

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

“Look at the paper system,” Ms. Wilder said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

The simplicity and efficacy of identity authentication “is going to depend upon the extent to which the vendors that are building the systems get this right,” she added.

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

“That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues,” she said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is, “I'm not jumping into bed, so to speak, with someone who has a pending malpractice and by signing onto this system thereby becoming a defendant in this case.”

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records becomes more prevalent, physicians may have a duty to be familiar with a patient's entire medical record if it is available. They also recommended that physicians spell out with hospitals via contracts which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON – From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.”

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

“Look at the paper system,” Ms. Wilder said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

The simplicity and efficacy of identity authentication “is going to depend upon the extent to which the vendors that are building the systems get this right,” she added.

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

“That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues,” she said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is, “I'm not jumping into bed, so to speak, with someone who has a pending malpractice and by signing onto this system thereby becoming a defendant in this case.”

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records becomes more prevalent, physicians may have a duty to be familiar with a patient's entire medical record if it is available. They also recommended that physicians spell out with hospitals via contracts which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON – From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.”

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

“Look at the paper system,” Ms. Wilder said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

The simplicity and efficacy of identity authentication “is going to depend upon the extent to which the vendors that are building the systems get this right,” she added.

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

“That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues,” she said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is, “I'm not jumping into bed, so to speak, with someone who has a pending malpractice and by signing onto this system thereby becoming a defendant in this case.”

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records becomes more prevalent, physicians may have a duty to be familiar with a patient's entire medical record if it is available. They also recommended that physicians spell out with hospitals via contracts which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that CDS was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool.

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to an electronic health record. “Look at the paper system. We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make, Mr. DeLoss added.

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that CDS was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool.

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to an electronic health record. “Look at the paper system. We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make, Mr. DeLoss added.

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that CDS was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool.

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to an electronic health record. “Look at the paper system. We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said.

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make, Mr. DeLoss added.

WASHINGTON—A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out, and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements. The practices are located primarily in Maryland but also in Delaware and the District of Columbia. The practices treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records, he added.

Practice improvements implemented by the groups included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material.

Certified practices receive program recognition via a National Committee for Quality Assurance "practice connections" seal they can use in advertising.

Dr. Shematek said CareFirst is now looking at proposals from academic centers to evaluate quality, utilization, and cost of the program "as well as what qualitatively changed in the practice and what motivated doctors to participate." Participating practices will be compared with a control of nonparticipating groups.

WASHINGTON—A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out, and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements. The practices are located primarily in Maryland but also in Delaware and the District of Columbia. The practices treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records, he added.

Practice improvements implemented by the groups included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material.

Certified practices receive program recognition via a National Committee for Quality Assurance "practice connections" seal they can use in advertising.

Dr. Shematek said CareFirst is now looking at proposals from academic centers to evaluate quality, utilization, and cost of the program "as well as what qualitatively changed in the practice and what motivated doctors to participate." Participating practices will be compared with a control of nonparticipating groups.

WASHINGTON—A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out, and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements. The practices are located primarily in Maryland but also in Delaware and the District of Columbia. The practices treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records, he added.

Practice improvements implemented by the groups included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material.

Certified practices receive program recognition via a National Committee for Quality Assurance "practice connections" seal they can use in advertising.

Dr. Shematek said CareFirst is now looking at proposals from academic centers to evaluate quality, utilization, and cost of the program "as well as what qualitatively changed in the practice and what motivated doctors to participate." Participating practices will be compared with a control of nonparticipating groups.

WASHINGTON — A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out, and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements. The practices are located primarily in Maryland but also in Delaware and the District of Columbia. The practices treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management.

Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records, he added.

Practice improvements implemented by the groups included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material.

Certified practices receive program recognition via a National Committee for Quality Assurance “practice connections” seal they can use in advertising.

Dr. Shematek said CareFirst is now looking at proposals from academic centers to evaluate quality, utilization, and cost of the program “as well as what qualitatively changed in the practice and what motivated doctors to participate.” Participating practices will be compared with a control of nonparticipating groups.

WASHINGTON — A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out, and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements. The practices are located primarily in Maryland but also in Delaware and the District of Columbia. The practices treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management.

Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records, he added.

Practice improvements implemented by the groups included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material.

Certified practices receive program recognition via a National Committee for Quality Assurance “practice connections” seal they can use in advertising.

Dr. Shematek said CareFirst is now looking at proposals from academic centers to evaluate quality, utilization, and cost of the program “as well as what qualitatively changed in the practice and what motivated doctors to participate.” Participating practices will be compared with a control of nonparticipating groups.

WASHINGTON — A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out, and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements. The practices are located primarily in Maryland but also in Delaware and the District of Columbia. The practices treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management.

Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records, he added.

Practice improvements implemented by the groups included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material.

Certified practices receive program recognition via a National Committee for Quality Assurance “practice connections” seal they can use in advertising.

Dr. Shematek said CareFirst is now looking at proposals from academic centers to evaluate quality, utilization, and cost of the program “as well as what qualitatively changed in the practice and what motivated doctors to participate.” Participating practices will be compared with a control of nonparticipating groups.

WASHINGTON — The Emergency Medical Treatment and Labor Act should be waived during declared emergencies, the statute's technical advisory group recommended to federal regulators late last year.

The exemption would apply during national, state, county, city, or hospital-specific situations, the panel agreed at a meeting held in Washington. EMTALA imposes specific obligations on hospitals that participate in Medicare to treat emergency patients regardless of ability to pay.

In order to qualify for the proposed emergency-related exemption, a hospital would have to be directly experiencing the crisis, and the emergency must interfere with the hospital's ability to comply with EMTALA. In addition, a hospital would be required to take “reasonably practical steps” to secure care for patients by ensuring they are seen at another facility. Any patient care decisions must apply to all patients regardless of insurance status.

Although Centers for Medicare and Medicaid Services (CMS) representatives said they were not aware of any hospitals being cited under EMTALA for not providing care during an emergency, the panel concluded that providers should not have to worry about possible violations under extreme circumstances.

The recommended waiver would preclude patients from filing lawsuits against hospitals that could not provide care in an emergency situation, said panel member Brian Robinson, president and CEO of HCA Las Vegas. That would “allow hospitals and doctors to quite simply do the right thing for their patients at the time,” he added.

In other action, the technical advisory group approved language that would affirm the use of technology in physician communications. The provision would replace current language in EMTALA guidelines that could be construed to prohibit the use of telemedicine devices.

The recommendation affirms that the treating physician has ultimate control over how a patient is treated, but that physicians may use a variety of methods to communicate with each other about patient care. It further indicates that an EMTALA violation occurs if an on-call physician refuses to physically appear at the emergency department when the treating physician requests it of him or her.

Panel members agreed that the use of technology should be encouraged to improve care in urban and rural settings.

“As we leverage technology to make a difference in how care is provided, we've got to ensure that there are no barriers to being able to utilize technology to improve patient care,” said advisory group member Dr. Warren Jones, executive director of the Mississippi division of Medicaid.

The panel also agreed to disseminate a letter from CMS staff detailing when a hospital is responsible for a patient who arrives via emergency medical services. CMS staffer Dodjie Guioa said prior agency guidance on the issue was being used by EMS providers “as a weapon” to force hospitals to take patients as soon as they arrived, even if the facility did not immediately have enough capacity. “That was not the intent,” he added.

EMS providers should stay with patients until resources are available to care for them, Mr. Guioa said. He added that it is not the intent of CMS to take enforcement actions against hospitals that cannot immediately take patients “if the circumstances are beyond their control.”

The panel discussed a number of issues that will be decided at a later date. Those topics included improvements to the CMS EMTALA Web site and to EMTALA enforcement. Specifically, the panel is urging less variability by region in enforcement efforts, as well as improvements in surveyor training.

The issue of air ambulances also is under consideration. The group heard testimony indicating that hospitals sometimes refuse the services of specific air ambulance companies, insisting instead on the use of their own contractors.

The panel also is exploring whether psychiatric patients need a separate definition of emergency and whether there should be intermediate sanctions available for hospitals that potentially violate EMTALA.

Physician on-call issues remain a priority for the panel, including ways to encourage regionalization of services and to ensure that on-call specialists are available for needed care.

WASHINGTON — The Emergency Medical Treatment and Labor Act should be waived during declared emergencies, the statute's technical advisory group recommended to federal regulators late last year.

The exemption would apply during national, state, county, city, or hospital-specific situations, the panel agreed at a meeting held in Washington. EMTALA imposes specific obligations on hospitals that participate in Medicare to treat emergency patients regardless of ability to pay.

In order to qualify for the proposed emergency-related exemption, a hospital would have to be directly experiencing the crisis, and the emergency must interfere with the hospital's ability to comply with EMTALA. In addition, a hospital would be required to take “reasonably practical steps” to secure care for patients by ensuring they are seen at another facility. Any patient care decisions must apply to all patients regardless of insurance status.

Although Centers for Medicare and Medicaid Services (CMS) representatives said they were not aware of any hospitals being cited under EMTALA for not providing care during an emergency, the panel concluded that providers should not have to worry about possible violations under extreme circumstances.

The recommended waiver would preclude patients from filing lawsuits against hospitals that could not provide care in an emergency situation, said panel member Brian Robinson, president and CEO of HCA Las Vegas. That would “allow hospitals and doctors to quite simply do the right thing for their patients at the time,” he added.

In other action, the technical advisory group approved language that would affirm the use of technology in physician communications. The provision would replace current language in EMTALA guidelines that could be construed to prohibit the use of telemedicine devices.

The recommendation affirms that the treating physician has ultimate control over how a patient is treated, but that physicians may use a variety of methods to communicate with each other about patient care. It further indicates that an EMTALA violation occurs if an on-call physician refuses to physically appear at the emergency department when the treating physician requests it of him or her.

Panel members agreed that the use of technology should be encouraged to improve care in urban and rural settings.

“As we leverage technology to make a difference in how care is provided, we've got to ensure that there are no barriers to being able to utilize technology to improve patient care,” said advisory group member Dr. Warren Jones, executive director of the Mississippi division of Medicaid.

The panel also agreed to disseminate a letter from CMS staff detailing when a hospital is responsible for a patient who arrives via emergency medical services. CMS staffer Dodjie Guioa said prior agency guidance on the issue was being used by EMS providers “as a weapon” to force hospitals to take patients as soon as they arrived, even if the facility did not immediately have enough capacity. “That was not the intent,” he added.

EMS providers should stay with patients until resources are available to care for them, Mr. Guioa said. He added that it is not the intent of CMS to take enforcement actions against hospitals that cannot immediately take patients “if the circumstances are beyond their control.”

The panel discussed a number of issues that will be decided at a later date. Those topics included improvements to the CMS EMTALA Web site and to EMTALA enforcement. Specifically, the panel is urging less variability by region in enforcement efforts, as well as improvements in surveyor training.

The issue of air ambulances also is under consideration. The group heard testimony indicating that hospitals sometimes refuse the services of specific air ambulance companies, insisting instead on the use of their own contractors.

The panel also is exploring whether psychiatric patients need a separate definition of emergency and whether there should be intermediate sanctions available for hospitals that potentially violate EMTALA.

Physician on-call issues remain a priority for the panel, including ways to encourage regionalization of services and to ensure that on-call specialists are available for needed care.

WASHINGTON — The Emergency Medical Treatment and Labor Act should be waived during declared emergencies, the statute's technical advisory group recommended to federal regulators late last year.

The exemption would apply during national, state, county, city, or hospital-specific situations, the panel agreed at a meeting held in Washington. EMTALA imposes specific obligations on hospitals that participate in Medicare to treat emergency patients regardless of ability to pay.

In order to qualify for the proposed emergency-related exemption, a hospital would have to be directly experiencing the crisis, and the emergency must interfere with the hospital's ability to comply with EMTALA. In addition, a hospital would be required to take “reasonably practical steps” to secure care for patients by ensuring they are seen at another facility. Any patient care decisions must apply to all patients regardless of insurance status.

Although Centers for Medicare and Medicaid Services (CMS) representatives said they were not aware of any hospitals being cited under EMTALA for not providing care during an emergency, the panel concluded that providers should not have to worry about possible violations under extreme circumstances.

The recommended waiver would preclude patients from filing lawsuits against hospitals that could not provide care in an emergency situation, said panel member Brian Robinson, president and CEO of HCA Las Vegas. That would “allow hospitals and doctors to quite simply do the right thing for their patients at the time,” he added.

In other action, the technical advisory group approved language that would affirm the use of technology in physician communications. The provision would replace current language in EMTALA guidelines that could be construed to prohibit the use of telemedicine devices.

The recommendation affirms that the treating physician has ultimate control over how a patient is treated, but that physicians may use a variety of methods to communicate with each other about patient care. It further indicates that an EMTALA violation occurs if an on-call physician refuses to physically appear at the emergency department when the treating physician requests it of him or her.

Panel members agreed that the use of technology should be encouraged to improve care in urban and rural settings.

“As we leverage technology to make a difference in how care is provided, we've got to ensure that there are no barriers to being able to utilize technology to improve patient care,” said advisory group member Dr. Warren Jones, executive director of the Mississippi division of Medicaid.

The panel also agreed to disseminate a letter from CMS staff detailing when a hospital is responsible for a patient who arrives via emergency medical services. CMS staffer Dodjie Guioa said prior agency guidance on the issue was being used by EMS providers “as a weapon” to force hospitals to take patients as soon as they arrived, even if the facility did not immediately have enough capacity. “That was not the intent,” he added.

EMS providers should stay with patients until resources are available to care for them, Mr. Guioa said. He added that it is not the intent of CMS to take enforcement actions against hospitals that cannot immediately take patients “if the circumstances are beyond their control.”

The panel discussed a number of issues that will be decided at a later date. Those topics included improvements to the CMS EMTALA Web site and to EMTALA enforcement. Specifically, the panel is urging less variability by region in enforcement efforts, as well as improvements in surveyor training.

The issue of air ambulances also is under consideration. The group heard testimony indicating that hospitals sometimes refuse the services of specific air ambulance companies, insisting instead on the use of their own contractors.

The panel also is exploring whether psychiatric patients need a separate definition of emergency and whether there should be intermediate sanctions available for hospitals that potentially violate EMTALA.

Physician on-call issues remain a priority for the panel, including ways to encourage regionalization of services and to ensure that on-call specialists are available for needed care.

WASHINGTON — A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements. The practices are located primarily in Maryland but also in Delaware and the District of Columbia. The practices treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records.

Practice improvements included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material. Certified practices receive program recognition via a National Committee for Quality Assurance “practice connections” seal.

Dr. Shematek said CareFirst is now looking to evaluate quality, utilization, and cost “as well as what qualitatively changed in the practice and what motivated doctors to participate.”

WASHINGTON — A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements. The practices are located primarily in Maryland but also in Delaware and the District of Columbia. The practices treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records.

Practice improvements included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material. Certified practices receive program recognition via a National Committee for Quality Assurance “practice connections” seal.

Dr. Shematek said CareFirst is now looking to evaluate quality, utilization, and cost “as well as what qualitatively changed in the practice and what motivated doctors to participate.”

WASHINGTON — A total of $1.4 million in pay-for-performance rewards was distributed to physicians in 20 group practices that participated in a pilot project sponsored by CareFirst BlueCross BlueShield, Dr. Jon Shematek said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Thirty practices initially were selected for participation in the first year of a $4.5 million, 3-year project, said Dr. Shematek, vice president for quality and medical policy at CareFirst. Eight dropped out and rewards were given to the remaining practices that met National Committee for Quality Assurance certification requirements. The practices are located primarily in Maryland but also in Delaware and the District of Columbia. The practices treat a combined total of 50,000 patients.

CareFirst used the Bridges to Excellence model program developed by a group of employers, insurers, and physicians. Standards met by physicians addressed clinical information systems, use of evidence-based medicine, patient education and support, and care management. Seventeen groups passed at a basic level, and three passed at an intermediate level, Dr. Shematek said. No groups passed at an advanced level.

Of the pilot practices, 14 had paper medical records, while 6 had partial electronic records.

Practice improvements included chronic disease registries and follow-up, electronic prescribing, follow-up of emergency department visits and inpatient admissions, improved rates of colonoscopy screening and diabetes eye exams, and enhanced patient education material. Certified practices receive program recognition via a National Committee for Quality Assurance “practice connections” seal.

Dr. Shematek said CareFirst is now looking to evaluate quality, utilization, and cost “as well as what qualitatively changed in the practice and what motivated doctors to participate.”

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting on sponsored by eHealth Initiative and Bridges to Excellence.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said.

Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.”

Attorney Marcy Wilder, a partner with Hogan & Hartson, Washington, pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

“Look at the paper system,” Ms. Wilder said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

The simplicity and efficacy of identity authentication “is going to depend upon the extent to which the vendors that are building the systems get this right,” according to Ms. Wilder.

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses—such as a regional health information organization—are incorporated into an electronic medical record, Ms. Wilder said.

“That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues,” she said.

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records grows, physicians may have a duty to be familiar with a patient's entire medical record if it is available.

In their contracts with hospitals, physicians spell which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting on sponsored by eHealth Initiative and Bridges to Excellence.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said.

Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.”

Attorney Marcy Wilder, a partner with Hogan & Hartson, Washington, pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

“Look at the paper system,” Ms. Wilder said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

The simplicity and efficacy of identity authentication “is going to depend upon the extent to which the vendors that are building the systems get this right,” according to Ms. Wilder.

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses—such as a regional health information organization—are incorporated into an electronic medical record, Ms. Wilder said.

“That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues,” she said.

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records grows, physicians may have a duty to be familiar with a patient's entire medical record if it is available.

In their contracts with hospitals, physicians spell which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts said at a meeting on sponsored by eHealth Initiative and Bridges to Excellence.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said.

Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.”

Attorney Marcy Wilder, a partner with Hogan & Hartson, Washington, pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record.

“Look at the paper system,” Ms. Wilder said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the medication change. It is both easier and more difficult to do that with electronic health records.”

The simplicity and efficacy of identity authentication “is going to depend upon the extent to which the vendors that are building the systems get this right,” according to Ms. Wilder.

Although systems are in place to address identity authentication in health care institutions, problems may arise when data from shared information warehouses—such as a regional health information organization—are incorporated into an electronic medical record, Ms. Wilder said.

“That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues,” she said.

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records grows, physicians may have a duty to be familiar with a patient's entire medical record if it is available.

In their contracts with hospitals, physicians spell which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts maintained at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record. “Look at the paper system,” she said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the change in medication. It is both easier and more difficult to do that with electronic health records.”

The simplicity and efficacy of identity authentication “is going to depend upon the extent to which the vendors that are building the systems get this right,” she added.

Although systems are in place to address identity authentication in health care facilities, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said. “That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues.”

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is that physicians might inadvertently end up becoming part of a malpractice suit by signing off on their portion of a medical record that also includes an entry by a physician who has a pending malpractice case.

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records becomes more prevalent, physicians may have a duty to be familiar with a patient's entire medical record if it is available. They also recommended that physicians spell out with hospitals via contracts which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts maintained at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record. “Look at the paper system,” she said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the change in medication. It is both easier and more difficult to do that with electronic health records.”

The simplicity and efficacy of identity authentication “is going to depend upon the extent to which the vendors that are building the systems get this right,” she added.

Although systems are in place to address identity authentication in health care facilities, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said. “That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues.”

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is that physicians might inadvertently end up becoming part of a malpractice suit by signing off on their portion of a medical record that also includes an entry by a physician who has a pending malpractice case.

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records becomes more prevalent, physicians may have a duty to be familiar with a patient's entire medical record if it is available. They also recommended that physicians spell out with hospitals via contracts which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON — From a liability perspective, health information technology remains a double-edged sword whose parameters still need to be spelled out, experts maintained at a meeting sponsored by eHealth Initiative and Bridges to Excellence.

“It's going to provide protection in some places and increase liability in others,” said attorney Marcy Wilder, a partner with Hogan & Hartson.

When it comes to electronic clinical decision support (CDS) tools, Jud DeLoss, vice chair of the HIT Practice Group at the American Health Lawyers Association, recommended that physicians document their reasoning when they disregard the tool's suggestion.

Although it would be “difficult to pull off,” attorneys could create a class of victims for whom they argue that clinical decision support was not followed, leading to detrimental results, he said. Conversely, attorneys could charge that a physician overly relied on the tool “and did not actually engage in the care they said they did.

Ms. Wilder pointed out another gray area created by HIT: delineating who contributed what sections to a patient's electronic health record. “Look at the paper system,” she said. “We have handwriting and signatures, which are simple tools to identify who's responsible for which clinical applications, which provider made the diagnosis, who authorized the change in medication. It is both easier and more difficult to do that with electronic health records.”

The simplicity and efficacy of identity authentication “is going to depend upon the extent to which the vendors that are building the systems get this right,” she added.

Although systems are in place to address identity authentication in health care facilities, problems may arise when data from shared information warehouses such as a regional health information organization are incorporated into an electronic medical record, Ms. Wilder said. “That's where it's going to be very messy, and I think it will be a long time before we are going to be using shared data warehouses in part because of those kinds of liability issues.”

Physicians also are concerned about the validity of the portion of an electronic medical record that they did not make. Mr. DeLoss said the concern is that physicians might inadvertently end up becoming part of a malpractice suit by signing off on their portion of a medical record that also includes an entry by a physician who has a pending malpractice case.

Mr. DeLoss and Ms. Wilder added that as use of electronic medical records becomes more prevalent, physicians may have a duty to be familiar with a patient's entire medical record if it is available. They also recommended that physicians spell out with hospitals via contracts which party is liable for problems that arise from software donated to them by hospitals.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance.

According to AQA, the programs “will not only measure quality, but will identify those high-quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how we can report publicly on performance and, at least as important although probably not as rapidly, how we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

Although measurement will be conducted locally, Dr. Clancy said, it is important to have one set of measures used nationally.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care.

Part of the effort is to define “episodes of care” for frequent procedures that can be used as units by which to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison,” Mr. Leavitt commented. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

“During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America,” Dr. Clancy said.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance.

According to AQA, the programs “will not only measure quality, but will identify those high-quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how we can report publicly on performance and, at least as important although probably not as rapidly, how we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

Although measurement will be conducted locally, Dr. Clancy said, it is important to have one set of measures used nationally.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care.

Part of the effort is to define “episodes of care” for frequent procedures that can be used as units by which to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison,” Mr. Leavitt commented. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

“During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America,” Dr. Clancy said.

WASHINGTON — Schemes measuring the quality of health care services against price will emerge in some local markets for several procedures in the next 2 years, Secretary of Health and Human Services Mike Leavitt said at a meeting on health information technology sponsored by eHealth Initiative and Bridges to Excellence.

Within 5 years, Mr. Leavitt said, the term “value” will become part of the health care lexicon. “Within 10 years, value-based competition will have truly emerged.”

Working toward that goal are six pilot projects being conducted by the Ambulatory Care Quality Alliance (AQA), Mr. Leavitt said. Supported by the Centers for Medicare and Medicaid Services and the Agency for Health Care Research and Quality (AHRQ), the pilot projects are testing approaches to aggregating and reporting both public and private data on physician performance.

According to AQA, the programs “will not only measure quality, but will identify those high-quality providers who are able to deliver efficient care to patients, avoiding unnecessary complications and cost.”

Dr. Carolyn Clancy, AHRQ director, expanded on the purpose of the projects. “These pilots will begin to pave the way for showing how we can use the same set of measures … to try to figure out how we can report publicly on performance and, at least as important although probably not as rapidly, how we get that information back to providers so they can improve.” She added that other sites would be added to the project shortly.

“We expect that when completed, the knowledge we develop through the AQA pilots will provide a comprehensive national framework for performance measurement and public reporting,” she said.

Although measurement will be conducted locally, Dr. Clancy said, it is important to have one set of measures used nationally.

AQA is a national coalition of 125 physician, consumer, business, insurer, and government organizations that are working to develop strategies for measuring, reporting, and improving performance at the physician level. The group developed a “starter set” of 26 standard performance measures last year that AQA says is “now being incorporated in physician contracts and implemented around the country.” Measurements for hospital care are being developed by the Hospital Quality Alliance.

Mr. Leavitt said that, in addition to those two national alliances, he knows of 29 community-based quality measurement efforts, driven not only by businesses but also by physicians.

“The force that I believe must drive quality will be those who provide it, and the force that I have seen learning to measure quality [is] the physicians,” he said. “This cannot simply be the MBAs ganging up on the MDs. This has got to be a collaborative effort.”

Measuring quality is a key component of the Bush administration's policy to increase transparency and value in health care purchasing and delivery. The policy requires federal health care purchasers, including Medicare, Medicaid, and the Department of Veterans Affairs, to encourage the use of health information technology, share information about procedure prices, develop quality of care measures, and develop and identify approaches that facilitate high quality and efficient care.

Part of the effort is to define “episodes of care” for frequent procedures that can be used as units by which to compare costs among providers.

“The important thing is that insurance companies and larger payers like the government are able to present their information in a form that the data can, in a privacy-protected way, be assembled into episodes of care for comparison,” Mr. Leavitt commented. “What is a hip replacement? What expense ought to be put into that bucket so we can compare one hospital or one physician to another?”

Mr. Leavitt and Dr. Clancy said the Bush administration's goal is to merge the insurance market power of the federal government with that of the private sector to move value-based competition along.

“During the next several months, we're going to see a tremendous push to combine the purchasing clout of the federal government with the health care buying power of the top 100 private employers in America,” Dr. Clancy said.