Mary Ellen Schneider

As physicians and hospitals begin to implement electronic health record systems in the hopes of earning financial incentives from the federal government, experts are considering how to ensure patient safety when working with health information technology.

The Health IT Policy Committee, which makes recommendations to the federal National Coordinator for Health Information Technology, met this spring to discuss some of the areas where potential patient safety hazards exist. Topping the list were technology issues, such as software bugs, interoperability problems, and implementation and training deficiencies. Another major area of concern is the interaction of people and technology.

According to Paul Egerman, who co-chairs the Certification/Adoption Workgroup of the Health IT Policy Committee, straightforward problems with technology are actually the minority when it comes to safety issues. While these problems can be difficult to uncover, once they are discovered they can usually be easily and rapidly fixed.

The majority of safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because that means that even if the technology worked perfectly, there could still be problems. “There are tons of issues that are completely independent of technology,” said Mr. Egerman, who is CEO of eScription, a computer-aided medical transcription company.

Also of concern is that many of the health IT-related safety issues are local. Marc Probst, who cochairs the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and even different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” said Mr. Probst, who is the chief information officer at Intermountain Healthcare in Salt Lake City.

The Certification/Adoption workgroup previewed some of its ideas for gathering more data on the HIT-related safety issues and the need for more training. The workgroup released a set of preliminary recommendations that call for patients to play a greater role in identifying errors. In the physician office, for example, patients should ideally be able to observe as physicians enter information into an electronic record so they can call attention to mistakes. On the inpatient side, patients and family members should be encouraged to look at medication lists.

To gain more data on the scope of safety issues, the workgroup also called for establishing a national database and reporting system that would allow patients and health care providers to make confidential reports about incidents and potential hazards. This could be used for evaluation and analysis, but also for dissemination of potential problems, Mr. Egerman said.

As physicians and hospitals begin to implement electronic health record systems in the hopes of earning financial incentives from the federal government, experts are considering how to ensure patient safety when working with health information technology.

The Health IT Policy Committee, which makes recommendations to the federal National Coordinator for Health Information Technology, met this spring to discuss some of the areas where potential patient safety hazards exist. Topping the list were technology issues, such as software bugs, interoperability problems, and implementation and training deficiencies. Another major area of concern is the interaction of people and technology.

According to Paul Egerman, who co-chairs the Certification/Adoption Workgroup of the Health IT Policy Committee, straightforward problems with technology are actually the minority when it comes to safety issues. While these problems can be difficult to uncover, once they are discovered they can usually be easily and rapidly fixed.

The majority of safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because that means that even if the technology worked perfectly, there could still be problems. “There are tons of issues that are completely independent of technology,” said Mr. Egerman, who is CEO of eScription, a computer-aided medical transcription company.

Also of concern is that many of the health IT-related safety issues are local. Marc Probst, who cochairs the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and even different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” said Mr. Probst, who is the chief information officer at Intermountain Healthcare in Salt Lake City.

The Certification/Adoption workgroup previewed some of its ideas for gathering more data on the HIT-related safety issues and the need for more training. The workgroup released a set of preliminary recommendations that call for patients to play a greater role in identifying errors. In the physician office, for example, patients should ideally be able to observe as physicians enter information into an electronic record so they can call attention to mistakes. On the inpatient side, patients and family members should be encouraged to look at medication lists.

To gain more data on the scope of safety issues, the workgroup also called for establishing a national database and reporting system that would allow patients and health care providers to make confidential reports about incidents and potential hazards. This could be used for evaluation and analysis, but also for dissemination of potential problems, Mr. Egerman said.

As physicians and hospitals begin to implement electronic health record systems in the hopes of earning financial incentives from the federal government, experts are considering how to ensure patient safety when working with health information technology.

The Health IT Policy Committee, which makes recommendations to the federal National Coordinator for Health Information Technology, met this spring to discuss some of the areas where potential patient safety hazards exist. Topping the list were technology issues, such as software bugs, interoperability problems, and implementation and training deficiencies. Another major area of concern is the interaction of people and technology.

According to Paul Egerman, who co-chairs the Certification/Adoption Workgroup of the Health IT Policy Committee, straightforward problems with technology are actually the minority when it comes to safety issues. While these problems can be difficult to uncover, once they are discovered they can usually be easily and rapidly fixed.

The majority of safety issues surrounding health IT involve multiple factors. That complicates things, Mr. Egerman said, because that means that even if the technology worked perfectly, there could still be problems. “There are tons of issues that are completely independent of technology,” said Mr. Egerman, who is CEO of eScription, a computer-aided medical transcription company.

Also of concern is that many of the health IT-related safety issues are local. Marc Probst, who cochairs the Certification/Adoption Workgroup, said that each health care organization is unique, and relies on very different operating systems, security and privacy protocols, and even different types of monitoring. That puts the onus on individual organizations to stay on top of safety issues raised by their health IT systems, he said.

“Every organization is going to be unique, so there is a local responsibility to HIT safety that our vendors simply aren't going to be able to keep up with,” said Mr. Probst, who is the chief information officer at Intermountain Healthcare in Salt Lake City.

The Certification/Adoption workgroup previewed some of its ideas for gathering more data on the HIT-related safety issues and the need for more training. The workgroup released a set of preliminary recommendations that call for patients to play a greater role in identifying errors. In the physician office, for example, patients should ideally be able to observe as physicians enter information into an electronic record so they can call attention to mistakes. On the inpatient side, patients and family members should be encouraged to look at medication lists.

To gain more data on the scope of safety issues, the workgroup also called for establishing a national database and reporting system that would allow patients and health care providers to make confidential reports about incidents and potential hazards. This could be used for evaluation and analysis, but also for dissemination of potential problems, Mr. Egerman said.

The Health and Human Services department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible.

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers have to publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before the increases goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said during a press conference.

The Health and Human Services department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible.

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers have to publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before the increases goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said during a press conference.

The Health and Human Services department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible.

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers have to publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before the increases goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said during a press conference.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

Farzad Mostashari, a senior advisor in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Afterward, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

Farzad Mostashari, a senior advisor in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Afterward, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

Farzad Mostashari, a senior advisor in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said. For example, the practice staff and the regional extension staff may have weekly contacts as the practice works to establish a work plan for implementation, as well as during the implementation period. Afterward, the regional extension center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

The Health and Human Services Department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to the HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large-group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small-group and individual markets, the threshold is at least 80%.

The HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but the HHS has asked them to do it by June 1 so that the agency can publish the regulations soon.

The Health and Human Services Department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to the HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large-group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small-group and individual markets, the threshold is at least 80%.

The HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but the HHS has asked them to do it by June 1 so that the agency can publish the regulations soon.

The Health and Human Services Department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to the HHS on their medical-loss ratios, the percentage of premiums spent on medical care and quality improvement versus the percentage spent on administrative overhead. Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large-group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small-group and individual markets, the threshold is at least 80%.

The HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but the HHS has asked them to do it by June 1 so that the agency can publish the regulations soon.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers across the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

Range of Services Will Be Broad

To help physicians become meaningful users, the centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said.

For example, the practice staff and the center staff may have weekly contact as the practice works toward establishing a work plan for implementation, as well as during the implementation period. Following implementation, the center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Primary Care to Get Priority

Initially, the centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS.

The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS also is reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers across the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

Range of Services Will Be Broad

To help physicians become meaningful users, the centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said.

For example, the practice staff and the center staff may have weekly contact as the practice works toward establishing a work plan for implementation, as well as during the implementation period. Following implementation, the center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Primary Care to Get Priority

Initially, the centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS.

The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS also is reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers across the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information system. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

Range of Services Will Be Broad

To help physicians become meaningful users, the centers will provide a broad range of services, Dr. Blumenthal said, from helping physicians select the most appropriate equipment for their practice through the implementation of the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Physicians can expect to get a lot of assistance from the regional extension center staff, he said.

For example, the practice staff and the center staff may have weekly contact as the practice works toward establishing a work plan for implementation, as well as during the implementation period. Following implementation, the center staff may check in with the practice on a monthly basis to see how they are progressing with quality improvement and workflow design.

Primary Care to Get Priority

Initially, the centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS.

The agency defines primary care as family medicine, internal medicine, pediatrics, or obstetrics and gynecology.

In addition to small practices, HHS also is reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Dr. Lori Heim is anything but a typical hospitalist. She came to the field after working for many years as a family physician in the outpatient arena, and she now enjoys the chance to focus on quality and have time for interests outside of her own practice. And when Dr. Heim isn't in the hospital, she's likely at the airport, on her way to another meeting with lawmakers or physicians to discuss health reform, workforce issues, or the Medicare payment formula. As the current president of the American Academy of Family Physicians, Dr. Heim brings a unique perspective to her Laurinburg, N.C., hospital.

Dr. Heim is the first family physician to join the new hospital medicine program at Scotland Memorial Hospital. Currently, she practices alongside four internists and two family nurse practitioners as part of the growing program. Nationwide, family physicians are a minority in the hospitalist community. The Society of Hospital Medicine reports that fewer than 4% of hospitalists are trained in family medicine, compared with more than 80% of practicing hospitalists who were trained in general internal medicine. Similarly, only about 4% of AAFP members were working as hospitalists in 2009. Whether that indicates a lack of interest by hospitals or family physicians is unclear. But Dr. Heim said hospital medicine can be a good option for family physicians, even if it's not a career-long choice.

For some, it's simply a love of hospital medicine that drives the career choice. For others, it may represent a chance to get away from the administrative issues that plague many family physicians in private practice. And it can a pragmatic way to get a better balance in their work and family lives. “What this shows is the incredible opportunity that [physicians] have within family medicine to tailor different parts of medicine, different focuses, at different times of their career,” she said.

For their part, family physicians can bring additional skills to the hospital medicine world. For example, hospital medicine groups with family physicians can expand the care they provide to children. And Dr. Heim said that when she is called to a medicine consult with obstetric and gynecology patients, she is glad for her broad-based training. “I've dealt with a lot of the complications with regard to pregnancy and women's issues,” she said. “It's very familiar territory given our training.”

Dr. Heim said her own experience as a hospitalist over the last 18 months has really opened her eyes to systemwide issues that can result in poor outcomes for patients. Although family physicians often do a good job during the face-to-face visit, there aren't good systems to help patients outside that encounter, she said. And patients who can't get an appointment to see their regular doctor, or who don't have a regular physician, often end up hospitalized or readmitted.

But Dr. Heim is using her position as AAFP president to draw attention to some of these gaps in care. She tells lawmakers and the media about her firsthand experiences in the hospital, highlighting how conditions that can be cheaply and easily treated in the primary care setting, such as hypertension, can become expensive complications by the time they reach her in the hospital.

After her official leadership role with AAFP wraps up in a few years, Dr. Heim said she hopes to bring some of the innovative solutions she's seen while traveling around the country back to her North Carolina hospital. She looks forward to taking concrete steps on concepts like the medical home neighborhood, which envisions more coordinated patient care with roles for the hospital, the hospitalist, the primary care physician, subspecialists, and the community.

Hospital medicine can be a good option for family physicians, even if it's not a career-long choice.

Source DR. HEIM

Dr. Lori Heim is anything but a typical hospitalist. She came to the field after working for many years as a family physician in the outpatient arena, and she now enjoys the chance to focus on quality and have time for interests outside of her own practice. And when Dr. Heim isn't in the hospital, she's likely at the airport, on her way to another meeting with lawmakers or physicians to discuss health reform, workforce issues, or the Medicare payment formula. As the current president of the American Academy of Family Physicians, Dr. Heim brings a unique perspective to her Laurinburg, N.C., hospital.

Dr. Heim is the first family physician to join the new hospital medicine program at Scotland Memorial Hospital. Currently, she practices alongside four internists and two family nurse practitioners as part of the growing program. Nationwide, family physicians are a minority in the hospitalist community. The Society of Hospital Medicine reports that fewer than 4% of hospitalists are trained in family medicine, compared with more than 80% of practicing hospitalists who were trained in general internal medicine. Similarly, only about 4% of AAFP members were working as hospitalists in 2009. Whether that indicates a lack of interest by hospitals or family physicians is unclear. But Dr. Heim said hospital medicine can be a good option for family physicians, even if it's not a career-long choice.

For some, it's simply a love of hospital medicine that drives the career choice. For others, it may represent a chance to get away from the administrative issues that plague many family physicians in private practice. And it can a pragmatic way to get a better balance in their work and family lives. “What this shows is the incredible opportunity that [physicians] have within family medicine to tailor different parts of medicine, different focuses, at different times of their career,” she said.

For their part, family physicians can bring additional skills to the hospital medicine world. For example, hospital medicine groups with family physicians can expand the care they provide to children. And Dr. Heim said that when she is called to a medicine consult with obstetric and gynecology patients, she is glad for her broad-based training. “I've dealt with a lot of the complications with regard to pregnancy and women's issues,” she said. “It's very familiar territory given our training.”

Dr. Heim said her own experience as a hospitalist over the last 18 months has really opened her eyes to systemwide issues that can result in poor outcomes for patients. Although family physicians often do a good job during the face-to-face visit, there aren't good systems to help patients outside that encounter, she said. And patients who can't get an appointment to see their regular doctor, or who don't have a regular physician, often end up hospitalized or readmitted.

But Dr. Heim is using her position as AAFP president to draw attention to some of these gaps in care. She tells lawmakers and the media about her firsthand experiences in the hospital, highlighting how conditions that can be cheaply and easily treated in the primary care setting, such as hypertension, can become expensive complications by the time they reach her in the hospital.

After her official leadership role with AAFP wraps up in a few years, Dr. Heim said she hopes to bring some of the innovative solutions she's seen while traveling around the country back to her North Carolina hospital. She looks forward to taking concrete steps on concepts like the medical home neighborhood, which envisions more coordinated patient care with roles for the hospital, the hospitalist, the primary care physician, subspecialists, and the community.

Hospital medicine can be a good option for family physicians, even if it's not a career-long choice.

Source DR. HEIM

Dr. Lori Heim is anything but a typical hospitalist. She came to the field after working for many years as a family physician in the outpatient arena, and she now enjoys the chance to focus on quality and have time for interests outside of her own practice. And when Dr. Heim isn't in the hospital, she's likely at the airport, on her way to another meeting with lawmakers or physicians to discuss health reform, workforce issues, or the Medicare payment formula. As the current president of the American Academy of Family Physicians, Dr. Heim brings a unique perspective to her Laurinburg, N.C., hospital.

Dr. Heim is the first family physician to join the new hospital medicine program at Scotland Memorial Hospital. Currently, she practices alongside four internists and two family nurse practitioners as part of the growing program. Nationwide, family physicians are a minority in the hospitalist community. The Society of Hospital Medicine reports that fewer than 4% of hospitalists are trained in family medicine, compared with more than 80% of practicing hospitalists who were trained in general internal medicine. Similarly, only about 4% of AAFP members were working as hospitalists in 2009. Whether that indicates a lack of interest by hospitals or family physicians is unclear. But Dr. Heim said hospital medicine can be a good option for family physicians, even if it's not a career-long choice.

For some, it's simply a love of hospital medicine that drives the career choice. For others, it may represent a chance to get away from the administrative issues that plague many family physicians in private practice. And it can a pragmatic way to get a better balance in their work and family lives. “What this shows is the incredible opportunity that [physicians] have within family medicine to tailor different parts of medicine, different focuses, at different times of their career,” she said.

For their part, family physicians can bring additional skills to the hospital medicine world. For example, hospital medicine groups with family physicians can expand the care they provide to children. And Dr. Heim said that when she is called to a medicine consult with obstetric and gynecology patients, she is glad for her broad-based training. “I've dealt with a lot of the complications with regard to pregnancy and women's issues,” she said. “It's very familiar territory given our training.”

Dr. Heim said her own experience as a hospitalist over the last 18 months has really opened her eyes to systemwide issues that can result in poor outcomes for patients. Although family physicians often do a good job during the face-to-face visit, there aren't good systems to help patients outside that encounter, she said. And patients who can't get an appointment to see their regular doctor, or who don't have a regular physician, often end up hospitalized or readmitted.

But Dr. Heim is using her position as AAFP president to draw attention to some of these gaps in care. She tells lawmakers and the media about her firsthand experiences in the hospital, highlighting how conditions that can be cheaply and easily treated in the primary care setting, such as hypertension, can become expensive complications by the time they reach her in the hospital.

After her official leadership role with AAFP wraps up in a few years, Dr. Heim said she hopes to bring some of the innovative solutions she's seen while traveling around the country back to her North Carolina hospital. She looks forward to taking concrete steps on concepts like the medical home neighborhood, which envisions more coordinated patient care with roles for the hospital, the hospitalist, the primary care physician, subspecialists, and the community.

Hospital medicine can be a good option for family physicians, even if it's not a career-long choice.

Source DR. HEIM

The Health and Human Services department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios (the percentage of premiums spent on medical care and quality improvement vs. the percentage spent on administrative overhead). Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible.

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers must publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before it goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said at a press briefing on April 12.

HHS is seeking comment from states and health plans on a number of issues, including what types of methods states use to determine whether to approve a rate increase.

The Health and Human Services department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios (the percentage of premiums spent on medical care and quality improvement vs. the percentage spent on administrative overhead). Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible.

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers must publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before it goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said at a press briefing on April 12.

HHS is seeking comment from states and health plans on a number of issues, including what types of methods states use to determine whether to approve a rate increase.

The Health and Human Services department has taken the first steps toward greater oversight of the health insurance industry called for by the new health reform laws.

On April 12, HHS officials issued requests for public comment on how to calculate medical-loss ratios for health plans as well as factors to consider in determining whether a plan's premium rate increase is “unreasonable.” The comments will be used to help HHS officials develop regulations over the next several months.

Under the Patient Protection and Affordable Care Act, signed into law on March 23, health plans must submit annual reports to HHS on their medical-loss ratios (the percentage of premiums spent on medical care and quality improvement vs. the percentage spent on administrative overhead). Beginning on Jan. 1, 2011, if the medical-loss ratio does not meet minimum federal standards, the health plans will have to provide customers with a rebate. For plans in the large group market, the amount of premium revenue spent on clinical services must be at least 85%. For those in the small group and individual markets, the threshold is at least 80%.

HHS is also asking the National Association of Insurance Commissioners to establish uniform definitions and standard methodologies to determine how to define clinical services and quality improvement as part of the medical-loss ratio. The health reform law had called on the organization to develop these definitions by the end of this year, but HHS has asked them to do it by June 1 so that the agency can publish regulations as soon as possible.

The health reform law also includes new oversight of insurance company rate increases. It requires HHS, in partnership with states, to establish a process for the annual review of “unreasonable” increases in premiums for health insurance coverage. As part of this process, insurers must publicly post and submit to HHS and their state the rationale for any premium increase considered “unreasonable” before it goes into effect.

“This increased accountability aims to use transparency and competition to prevent rampant premium escalations,” Jeanne Lambrew, Ph.D., director of the HHS Office of Health Reform, said at a press briefing on April 12.

HHS is seeking comment from states and health plans on a number of issues, including what types of methods states use to determine whether to approve a rate increase.

The quality of health care in the United States is improving slowly, with the slowest progress occurring in prevention and chronic disease management, according to the latest government data.

The nation also continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Services department.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

“While the Affordable Care Act isn't a cure, we think it's one of the most effective treatments we've had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports.

Specifically, the health care reform laws will expand data collection and research efforts on health care disparities, increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health.

But most important, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it's minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually. However, the speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%, according to the report.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care.

For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing. “Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time.

For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year.

Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The two reports are available online at www.ahrq.gov/qual/qrdr09.htm

The quality of health care in the United States is improving slowly, with the slowest progress occurring in prevention and chronic disease management, according to the latest government data.

The nation also continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Services department.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

“While the Affordable Care Act isn't a cure, we think it's one of the most effective treatments we've had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports.

Specifically, the health care reform laws will expand data collection and research efforts on health care disparities, increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health.

But most important, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it's minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually. However, the speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%, according to the report.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care.

For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing. “Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time.

For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year.

Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The two reports are available online at www.ahrq.gov/qual/qrdr09.htm

The quality of health care in the United States is improving slowly, with the slowest progress occurring in prevention and chronic disease management, according to the latest government data.

The nation also continues to struggle with health care disparities. Despite efforts to improve access and quality of care for minorities, new national data show that, overall, minorities and low-income individuals receive the worst health care.

The findings were detailed in two reports released by the Health and Human Services department.

The 2009 National Healthcare Quality Report provides a snapshot of how the nation is performing on 169 quality measures; the National Healthcare Disparities Report provides a summary of health care quality and access among various racial and ethnic groups and across income groups.

Although the two reports show significant gaps in care, HHS Secretary Kathleen Sebelius said that she expects to see improvement with the implementation of the new health care reform laws—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

“While the Affordable Care Act isn't a cure, we think it's one of the most effective treatments we've had for these problems in a long time,” Ms. Sebelius said during a news conference to release the reports.

Specifically, the health care reform laws will expand data collection and research efforts on health care disparities, increase the size and diversity of the health care workforce, and establish a new national institute on minority health and health disparities at the National Institutes of Health.

But most important, the laws will expand coverage for millions of Americans who are currently uninsured, Ms. Sebelius said.

“In almost every case, populations who are currently underserved get relief [under the new laws], whether it's minority Americans, women, early retirees, rural Americans, or Americans with disabilities,” she said.

The 2009 quality report showed that overall quality is improving at a rate of about 2.3% annually. However, the speed of improvement varied across settings of care: Hospitals are improving more rapidly, at a median rate of change of about 5.8%, whereas outpatient settings improved at a median rate of change about 1.4%, according to the report.

As a result, improvements in prevention and chronic disease management are lagging behind improvements in acute care.

For example, of the nine process measures tracked in the report that worsened, eight related to either preventive services or chronic disease management, including mammography, Pap testing, and fecal occult blood testing. “Although the trend is going in the right direction, which is good, the pace is unacceptably slow,” said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which produced the reports.

On the disparities side, the report showed that many disparities have not decreased over time.

For example, from 2000 to 2005, disparities in colorectal cancer screening have grown between American Indians and Alaska Natives vs. whites, increasing at a rate of 7.7% per year.

Additionally, blacks and Hispanics had worsening disparities in colorectal cancer mortality from 2000 to 2006.

The two reports are available online at www.ahrq.gov/qual/qrdr09.htm

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, including helping physicians select the most appropriate equipment for their practice and implementing the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, and obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, including helping physicians select the most appropriate equipment for their practice and implementing the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, and obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Looking to buy or implement an electronic health record in your practice? Help is on the way.

The Department of Health and Human Services has awarded more than $640 million in grants to set up regional extension centers around the country, with the goal of helping physicians and hospitals achieve “meaningful use” of electronic health record (EHR) technology. At press time, several centers were preparing to enroll physicians.

The staff at these regional extension centers will work “elbow to elbow” with physicians, Dr. David Blumenthal, national coordinator for health information technology, said during a press conference to announce the final round of regional extension center grants.

In April, HHS awarded more than $267 million in grants to 28 nonprofit organizations that will set up Health Information Technology Regional Extension Centers. This builds on more than $375 million in grants that the agency awarded for 32 regional extension centers in February. The funding is part of the 2009 American Recovery and Reinvestment Act.

The main goal of the regional extension centers is to help physicians and other health care providers to become meaningful users of EHRs, even as the standard for meaningful use is being defined through federal rule making.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the 2009 federal stimulus law, physicians who treat Medicare patients can earn up to $44,000 over 5 years for the meaningful use of a certified health information systems. Those with patient populations of at least 30% Medicaid can earn up to $64,000 in federal incentive payments.

To help physicians become meaningful users, the regional extension centers will provide a broad range of services, Dr. Blumenthal said, including helping physicians select the most appropriate equipment for their practice and implementing the products. The centers also will help practices purchase technology in groups at reduced prices, he said.

“We hope that these regional extension centers will help providers improve their workflow using electronic health records, improve the quality and efficiency of the care they can provide using electronic health records, and of course thereby increase the efficiency and quality of care available to the American people,” Dr. Blumenthal said.

Farzad Mostashari, a senior adviser in the Office of the National Coordinator for Health Information Technology, encouraged physicians to enroll with their regional extension center as soon as possible, even before they make a decision about purchasing an EHR product.

Initially, the regional extension centers will focus on aiding primary care providers in small practices. HHS estimates that the 60 regional extension centers will provide services to at least 100,000 primary care providers and hospitals within 2 years. Small, primary care practices are being targeted because this group reaches a large number of patients, Dr. Blumenthal said, but they are also the least likely to be able to afford to purchase health information technology support services in the private market.

Although the stimulus law directs the regional extension centers to give priority for direct technical assistance to primary care providers, all physicians are encouraged to participate in the outreach and educational opportunities of these centers, according to HHS. The agency defines primary care as family medicine, internal medicine, pediatrics, and obstetrics and gynecology.

In addition to small practices, HHS is also reaching out to small hospitals. HHS plans to award another $25 million to regional extension centers that work with critical access and rural hospitals with 50 beds or less. Small hospitals have an especially difficult time finding the resources and expertise to successfully adopt health information technology, Dr. Blumenthal said.

Dr. Michael McGuire, president of the American Society of Plastic Surgeons, shares his views on medical tourism, the potential risks involved in seeking surgery abroad, and the ethical obligations of physicians once patients return for care in this country.

Question: Why does medical tourism seem to be so popular right now?

Dr. McGuire: I think probably the most recent impetus has been the recession and the layoffs that have resulted in a loss of health care coverage. Obviously, if you need to have surgery and you don’t have insurance, it can be extremely expensive to pay for it on your own. But patients also need to understand that the cheapest surgery is not going to be the best surgery. If they were to seek the top surgeons around the world, they wouldn’t save much money. The savings comes in going to lesser trained surgeons, often in lesser qualified hospitals.

Question: What are the risks involved in getting surgery abroad?

Dr. McGuire: I divide the risks into three components: the preoperative phase, the interoperative phase, and the postoperative phase, each of which presents significant logistical and safety issues for patients. The major challenge in the preoperative phase is how to find a qualified surgeon. But even if you find the right surgeon, that still doesn’t mean that the rest of the surgical team will be up to the same standard. For example, in many less developed countries, nursing training is little more than a high school–level course, and the nurse may not speak English.

During the interoperative phase, patients are faced with making a long trip, which raises the risk of blood clots and pulmonary embolism. Adding to that risk, patients preparing for surgery can’t be on anticoagulants.

Then there’s the postoperative phase. The medical tourism industry often paints a picture of a patient recovering from surgery on an exotic beach. Unfortunately, that’s not the reality. Patients recovering from hip replacement, coronary bypass surgery, or cosmetic surgery have a lot of healing to do and should not be exposing themselves to possible infections and other contamination problems they could face while traveling. Perhaps even more important, once they get home, patients must face the issue of who will take care of them if they experience a complication from surgery.

Question: If a patient does return with a complication from surgery, what’s the ethical responsibility of the U.S. surgeon?

Dr. McGuire: It is a real challenge. I think if it’s a true emergency, you must take care of the patient without question. But if it’s something more elective, you have to be very cautious. I think it has to be done on a case-by-case basis, evaluating the patient and trying to minimize your exposure to liability.

There are obviously agreements that you can make, such as developing a “hold harmless” contract so that the patient understands that you cannot assume liability for all that’s happened before. That can minimize the exposure risk. But again, it depends on whether this is a patient whom you know and one who will have realistic expectations. In that case, I think it’s certainly possible to work something out, but you have to be careful.

Question: What about insurance? Is that becoming a driver at all? Are insurers creating packages where people can go abroad for surgery?

Dr. McGuire: Insurance companies were beginning to get involved in medical tourism, but that has really declined recently. In speaking to some insurers, I have pointed out that once they encourage or incentivize people to have surgery abroad, they are no longer functioning as an insurance company. And as a result, they assume liability if the patient does not have a good outcome. Needless to say, the malpractice attorneys are very anxious to have a deep pocket like an insurance company that they can sue. So that has put a significant damper on the insurance industry’s enthusiasm for promoting this.

Question: Do you think medical tourism will continue to grow?

Dr. McGuire: In terms of aesthetic surgery, I see it as plateauing. I don’t see it as dramatically increasing, because the real costs involved are so significant that it’s not going to be enough of a savings for most people. And most people who are interested in aesthetic surgery are not looking for bargains.

In terms of insurance-covered procedures, I think it depends entirely on how much health care reform minimizes the number of people without insurance. As the economy improves and more people gain insurance, I think that’s going to be the major driver in terms of the growth of insurance-covered medical tourism. Right now, I think we’re seeing a bit of a spike simply because there are more and more people without insurance. Once that trend changes, I think the number of people going abroad will significantly decline. Virtually nobody is going abroad if they have insurance coverage.

Dr. Michael McGuire, president of the American Society of Plastic Surgeons, shares his views on medical tourism, the potential risks involved in seeking surgery abroad, and the ethical obligations of physicians once patients return for care in this country.

Question: Why does medical tourism seem to be so popular right now?

Dr. McGuire: I think probably the most recent impetus has been the recession and the layoffs that have resulted in a loss of health care coverage. Obviously, if you need to have surgery and you don’t have insurance, it can be extremely expensive to pay for it on your own. But patients also need to understand that the cheapest surgery is not going to be the best surgery. If they were to seek the top surgeons around the world, they wouldn’t save much money. The savings comes in going to lesser trained surgeons, often in lesser qualified hospitals.

Question: What are the risks involved in getting surgery abroad?

Dr. McGuire: I divide the risks into three components: the preoperative phase, the interoperative phase, and the postoperative phase, each of which presents significant logistical and safety issues for patients. The major challenge in the preoperative phase is how to find a qualified surgeon. But even if you find the right surgeon, that still doesn’t mean that the rest of the surgical team will be up to the same standard. For example, in many less developed countries, nursing training is little more than a high school–level course, and the nurse may not speak English.

During the interoperative phase, patients are faced with making a long trip, which raises the risk of blood clots and pulmonary embolism. Adding to that risk, patients preparing for surgery can’t be on anticoagulants.

Then there’s the postoperative phase. The medical tourism industry often paints a picture of a patient recovering from surgery on an exotic beach. Unfortunately, that’s not the reality. Patients recovering from hip replacement, coronary bypass surgery, or cosmetic surgery have a lot of healing to do and should not be exposing themselves to possible infections and other contamination problems they could face while traveling. Perhaps even more important, once they get home, patients must face the issue of who will take care of them if they experience a complication from surgery.

Question: If a patient does return with a complication from surgery, what’s the ethical responsibility of the U.S. surgeon?

Dr. McGuire: It is a real challenge. I think if it’s a true emergency, you must take care of the patient without question. But if it’s something more elective, you have to be very cautious. I think it has to be done on a case-by-case basis, evaluating the patient and trying to minimize your exposure to liability.

There are obviously agreements that you can make, such as developing a “hold harmless” contract so that the patient understands that you cannot assume liability for all that’s happened before. That can minimize the exposure risk. But again, it depends on whether this is a patient whom you know and one who will have realistic expectations. In that case, I think it’s certainly possible to work something out, but you have to be careful.

Question: What about insurance? Is that becoming a driver at all? Are insurers creating packages where people can go abroad for surgery?

Dr. McGuire: Insurance companies were beginning to get involved in medical tourism, but that has really declined recently. In speaking to some insurers, I have pointed out that once they encourage or incentivize people to have surgery abroad, they are no longer functioning as an insurance company. And as a result, they assume liability if the patient does not have a good outcome. Needless to say, the malpractice attorneys are very anxious to have a deep pocket like an insurance company that they can sue. So that has put a significant damper on the insurance industry’s enthusiasm for promoting this.

Question: Do you think medical tourism will continue to grow?

Dr. McGuire: In terms of aesthetic surgery, I see it as plateauing. I don’t see it as dramatically increasing, because the real costs involved are so significant that it’s not going to be enough of a savings for most people. And most people who are interested in aesthetic surgery are not looking for bargains.

In terms of insurance-covered procedures, I think it depends entirely on how much health care reform minimizes the number of people without insurance. As the economy improves and more people gain insurance, I think that’s going to be the major driver in terms of the growth of insurance-covered medical tourism. Right now, I think we’re seeing a bit of a spike simply because there are more and more people without insurance. Once that trend changes, I think the number of people going abroad will significantly decline. Virtually nobody is going abroad if they have insurance coverage.

Dr. Michael McGuire, president of the American Society of Plastic Surgeons, shares his views on medical tourism, the potential risks involved in seeking surgery abroad, and the ethical obligations of physicians once patients return for care in this country.

Question: Why does medical tourism seem to be so popular right now?

Dr. McGuire: I think probably the most recent impetus has been the recession and the layoffs that have resulted in a loss of health care coverage. Obviously, if you need to have surgery and you don’t have insurance, it can be extremely expensive to pay for it on your own. But patients also need to understand that the cheapest surgery is not going to be the best surgery. If they were to seek the top surgeons around the world, they wouldn’t save much money. The savings comes in going to lesser trained surgeons, often in lesser qualified hospitals.

Question: What are the risks involved in getting surgery abroad?

Dr. McGuire: I divide the risks into three components: the preoperative phase, the interoperative phase, and the postoperative phase, each of which presents significant logistical and safety issues for patients. The major challenge in the preoperative phase is how to find a qualified surgeon. But even if you find the right surgeon, that still doesn’t mean that the rest of the surgical team will be up to the same standard. For example, in many less developed countries, nursing training is little more than a high school–level course, and the nurse may not speak English.

During the interoperative phase, patients are faced with making a long trip, which raises the risk of blood clots and pulmonary embolism. Adding to that risk, patients preparing for surgery can’t be on anticoagulants.

Then there’s the postoperative phase. The medical tourism industry often paints a picture of a patient recovering from surgery on an exotic beach. Unfortunately, that’s not the reality. Patients recovering from hip replacement, coronary bypass surgery, or cosmetic surgery have a lot of healing to do and should not be exposing themselves to possible infections and other contamination problems they could face while traveling. Perhaps even more important, once they get home, patients must face the issue of who will take care of them if they experience a complication from surgery.

Question: If a patient does return with a complication from surgery, what’s the ethical responsibility of the U.S. surgeon?

Dr. McGuire: It is a real challenge. I think if it’s a true emergency, you must take care of the patient without question. But if it’s something more elective, you have to be very cautious. I think it has to be done on a case-by-case basis, evaluating the patient and trying to minimize your exposure to liability.

There are obviously agreements that you can make, such as developing a “hold harmless” contract so that the patient understands that you cannot assume liability for all that’s happened before. That can minimize the exposure risk. But again, it depends on whether this is a patient whom you know and one who will have realistic expectations. In that case, I think it’s certainly possible to work something out, but you have to be careful.

Question: What about insurance? Is that becoming a driver at all? Are insurers creating packages where people can go abroad for surgery?

Dr. McGuire: Insurance companies were beginning to get involved in medical tourism, but that has really declined recently. In speaking to some insurers, I have pointed out that once they encourage or incentivize people to have surgery abroad, they are no longer functioning as an insurance company. And as a result, they assume liability if the patient does not have a good outcome. Needless to say, the malpractice attorneys are very anxious to have a deep pocket like an insurance company that they can sue. So that has put a significant damper on the insurance industry’s enthusiasm for promoting this.

Question: Do you think medical tourism will continue to grow?

Dr. McGuire: In terms of aesthetic surgery, I see it as plateauing. I don’t see it as dramatically increasing, because the real costs involved are so significant that it’s not going to be enough of a savings for most people. And most people who are interested in aesthetic surgery are not looking for bargains.

In terms of insurance-covered procedures, I think it depends entirely on how much health care reform minimizes the number of people without insurance. As the economy improves and more people gain insurance, I think that’s going to be the major driver in terms of the growth of insurance-covered medical tourism. Right now, I think we’re seeing a bit of a spike simply because there are more and more people without insurance. Once that trend changes, I think the number of people going abroad will significantly decline. Virtually nobody is going abroad if they have insurance coverage.