Mary Ellen Schneider

Diagnosing and treating patients with incomplete information is often a reality in medicine, but officials at the Department of Veterans Affairs are working to fill those gaps by exchanging information electronically with clinicians outside the VA system.

As part of a pilot program launched in 2009, physicians at the VA and Kaiser Permanente in San Diego have been exchanging data on problem lists, medications, and allergies. It usually takes weeks for patients to submit requests for paper records and to then bring them to another physician, but the test project allows electronic information to be transmitted in seconds.

“The net effect is clearly an improvement in quality, an increase in patient safety, and a tremendous improvement in the efficiency of how we share information and how we deliver the best possible care,” said Dr. John Mattison, assistant medical director and chief medical information officer for Kaiser Permanente Southern California.

The pilot involves about 450 veterans who receive their health care at both the VA and Kaiser Permanente in San Diego and who have agreed to allow their records to be shared. In the future, VA officials want to expand the pilot to include veterans around the country by partnering with other private health care institutions.

In the first quarter of this year, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This type of information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA and a neurosurgeon. About three out of four veterans receive a portion of their care in the private sector, he said, so VA physicians can't provide the best care unless they are able to see the types of treatments and medications they are getting outside of the system. The VA and DOD have been leaders in exchanging information for years, but the missing link has been information on care provided in the private sector, Dr. Ondra said.

Using standards developed as part of the Nationwide Health Information Network, clinicians can send electronic data securely and privately. In the pilot, the standards allowed the VA's VistA record system to connect with Kaiser Permanente's HealthConnect system. The Web-based exchange required patients to opt in at both sites of care. Once consent was established, clinicians at both institutions were able select patients, see their site of care, and pull up information on their problem lists, allergies, and medications.

The response from patients has been positive, Dr. Ondra said. More than 40% of patients who received invitations by mail volunteered to be part of the pilot. VA and Kaiser officials invited more than 1,100 veterans who had recently received care at both institutions to participate. Although the initial response was fairly high, officials at the two institutions plan to go back to try to get more veterans interested as the project continues in San Diego.

“While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

Diagnosing and treating patients with incomplete information is often a reality in medicine, but officials at the Department of Veterans Affairs are working to fill those gaps by exchanging information electronically with clinicians outside the VA system.

As part of a pilot program launched in 2009, physicians at the VA and Kaiser Permanente in San Diego have been exchanging data on problem lists, medications, and allergies. It usually takes weeks for patients to submit requests for paper records and to then bring them to another physician, but the test project allows electronic information to be transmitted in seconds.

“The net effect is clearly an improvement in quality, an increase in patient safety, and a tremendous improvement in the efficiency of how we share information and how we deliver the best possible care,” said Dr. John Mattison, assistant medical director and chief medical information officer for Kaiser Permanente Southern California.

The pilot involves about 450 veterans who receive their health care at both the VA and Kaiser Permanente in San Diego and who have agreed to allow their records to be shared. In the future, VA officials want to expand the pilot to include veterans around the country by partnering with other private health care institutions.

In the first quarter of this year, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This type of information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA and a neurosurgeon. About three out of four veterans receive a portion of their care in the private sector, he said, so VA physicians can't provide the best care unless they are able to see the types of treatments and medications they are getting outside of the system. The VA and DOD have been leaders in exchanging information for years, but the missing link has been information on care provided in the private sector, Dr. Ondra said.

Using standards developed as part of the Nationwide Health Information Network, clinicians can send electronic data securely and privately. In the pilot, the standards allowed the VA's VistA record system to connect with Kaiser Permanente's HealthConnect system. The Web-based exchange required patients to opt in at both sites of care. Once consent was established, clinicians at both institutions were able select patients, see their site of care, and pull up information on their problem lists, allergies, and medications.

The response from patients has been positive, Dr. Ondra said. More than 40% of patients who received invitations by mail volunteered to be part of the pilot. VA and Kaiser officials invited more than 1,100 veterans who had recently received care at both institutions to participate. Although the initial response was fairly high, officials at the two institutions plan to go back to try to get more veterans interested as the project continues in San Diego.

“While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

Diagnosing and treating patients with incomplete information is often a reality in medicine, but officials at the Department of Veterans Affairs are working to fill those gaps by exchanging information electronically with clinicians outside the VA system.

As part of a pilot program launched in 2009, physicians at the VA and Kaiser Permanente in San Diego have been exchanging data on problem lists, medications, and allergies. It usually takes weeks for patients to submit requests for paper records and to then bring them to another physician, but the test project allows electronic information to be transmitted in seconds.

“The net effect is clearly an improvement in quality, an increase in patient safety, and a tremendous improvement in the efficiency of how we share information and how we deliver the best possible care,” said Dr. John Mattison, assistant medical director and chief medical information officer for Kaiser Permanente Southern California.

The pilot involves about 450 veterans who receive their health care at both the VA and Kaiser Permanente in San Diego and who have agreed to allow their records to be shared. In the future, VA officials want to expand the pilot to include veterans around the country by partnering with other private health care institutions.

In the first quarter of this year, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This type of information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA and a neurosurgeon. About three out of four veterans receive a portion of their care in the private sector, he said, so VA physicians can't provide the best care unless they are able to see the types of treatments and medications they are getting outside of the system. The VA and DOD have been leaders in exchanging information for years, but the missing link has been information on care provided in the private sector, Dr. Ondra said.

Using standards developed as part of the Nationwide Health Information Network, clinicians can send electronic data securely and privately. In the pilot, the standards allowed the VA's VistA record system to connect with Kaiser Permanente's HealthConnect system. The Web-based exchange required patients to opt in at both sites of care. Once consent was established, clinicians at both institutions were able select patients, see their site of care, and pull up information on their problem lists, allergies, and medications.

The response from patients has been positive, Dr. Ondra said. More than 40% of patients who received invitations by mail volunteered to be part of the pilot. VA and Kaiser officials invited more than 1,100 veterans who had recently received care at both institutions to participate. Although the initial response was fairly high, officials at the two institutions plan to go back to try to get more veterans interested as the project continues in San Diego.

“While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

Health care spending grew less than 5% in 2008, the slowest growth rate since the federal government officially began measuring it in 1960, according to a report from the Centers for Medicare and Medicaid Services.

Although the rate of increase is slower, health care spending still outpaces the gross domestic product. In 2008, health care spending rose 4.4% to $2.3 trillion, compared with a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services, retail prescription drug spending, and nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

In a teleconference, Rick Foster, CMS chief actuary, said this trend was due mainly to the recession. As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

The federal government's share of health spending soared to nearly 36% in 2008, up from 28% in 2007, according to the CMS. The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid at the end of 2008.

Health care spending grew less than 5% in 2008, the slowest growth rate since the federal government officially began measuring it in 1960, according to a report from the Centers for Medicare and Medicaid Services.

Although the rate of increase is slower, health care spending still outpaces the gross domestic product. In 2008, health care spending rose 4.4% to $2.3 trillion, compared with a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services, retail prescription drug spending, and nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

In a teleconference, Rick Foster, CMS chief actuary, said this trend was due mainly to the recession. As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

The federal government's share of health spending soared to nearly 36% in 2008, up from 28% in 2007, according to the CMS. The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid at the end of 2008.

Health care spending grew less than 5% in 2008, the slowest growth rate since the federal government officially began measuring it in 1960, according to a report from the Centers for Medicare and Medicaid Services.

Although the rate of increase is slower, health care spending still outpaces the gross domestic product. In 2008, health care spending rose 4.4% to $2.3 trillion, compared with a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services, retail prescription drug spending, and nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

In a teleconference, Rick Foster, CMS chief actuary, said this trend was due mainly to the recession. As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

The federal government's share of health spending soared to nearly 36% in 2008, up from 28% in 2007, according to the CMS. The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP). In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP.

And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147-55). The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters on Jan. 4, Rick Foster, CMS chief actuary, speculated that this trend was mainly due to the recession. As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008. The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS. The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP). In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP.

And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147-55). The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters on Jan. 4, Rick Foster, CMS chief actuary, speculated that this trend was mainly due to the recession. As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008. The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS. The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP). In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP.

And health spending continues to consume a larger portion of the overall GDP, taking up 16.2% of GDP in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147-55). The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

During a teleconference with reporters on Jan. 4, Rick Foster, CMS chief actuary, speculated that this trend was mainly due to the recession. As people lost jobs and health insurance in 2008, they may have opted to seek health care only when their conditions became more serious, and more costly to treat, he said.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008. The share of federal dollars spent on health care rose from 28% in 2007 to nearly 36% in 2008, according to the CMS. The increase is due in part to the American Recovery and Reinvestment Act of 2009, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Officials at the Centers for Medicare and Medicaid Services recently released an initial set of pediatric quality measures that states can choose to use as part of their Medicaid and State Children's Health Insurance Programs.

The set of 24 measures focuses on prevention and health promotion, immunizations, screening, well-child visits, management of acute and chronic conditions, family experiences with care, and access to services.

The measures are likely to seem familiar to pediatricians since 14 of the 24 are current NCQA Healthcare Effectiveness Data and Information Set (HEDIS) measures reported by Medicaid managed care plans.

The measures are part of an effort by the federal government to encourage quality reporting within Medicaid and the State Children's Health Insurance Program (SCHIP), but they will be voluntary and the requirements of the program would be up to individual states to determine.

The new measures program was established as part of the Children's Health Insurance Program Reauthorization Act of 2009, which required the federal government to identify a core set of child health quality measures for voluntary use by state programs. The government's charge was to identify existing pediatric measures that are in use by public and private health plans. The initial measure set was developed in consultation with child health care providers, according to CMS.

CMS is seeking public comments on which measures should remain part of the core set, which measures need further development, and what type of technical assistance physicians and other health care providers would need to report on these measures. Comments are due by March 1. Under statute, CMS must make the final measure set available to states by Jan. 1, 2013.

Currently, there is no funding set aside by the federal government to provide financial incentives for successfully reporting on these measures, but CMS and the states are exploring ways that they could encourage voluntary reporting, such as provider incentive payments provided under the American Recovery and Reinvestment Act, according to CMS.

The move to develop pediatric-specific quality measures was praised by the American Academy of Pediatrics. The organization was involved in the creation of the initial measure set and encouraged Congress to invest in the development of measures appropriate for children.

That's definitely an area where pediatrics has fallen behind, said Dr. Stuart A. Cohen, a pediatrician in San Diego and an AAP delegate to the American Medical Association. Right now, pediatric quality measures are mostly built off measures from adult medicine, he said.

There is also a lack of research into what measures would have the greatest impact on quality. Dr. Cohen said that current measurement in pediatrics focuses on areas like immunizations and antibiotic usage, but it's unclear on whether those are the best measures of high-quality pediatric care. He speculated that future research could begin with outcomes of care and work backward to determine what kind of care was given. “We don't have those measures,” he said.

Although details about how the measurement program would be set up by the states are still a ways off, Dr. Cohen said he would like to see an appeals process put in place to ensure that physicians have the opportunity to dispute inaccurate data, a safeguard that is in place in most private pay-for-performance programs.

Under the CHIP Reauthorization Act that created the quality measures program, CMS was also tasked with developing an electronic health record format specifically for children. CMS officials are working to coordinate that effort, as well as work on the meaningful-use criteria for EHRs, with the quality-measurement program.

A list of each measure and summaries of why they are being recommended are available at www.ahrq.gov/chip/corebackgrnd.htm

Officials at the Centers for Medicare and Medicaid Services recently released an initial set of pediatric quality measures that states can choose to use as part of their Medicaid and State Children's Health Insurance Programs.

The set of 24 measures focuses on prevention and health promotion, immunizations, screening, well-child visits, management of acute and chronic conditions, family experiences with care, and access to services.

The measures are likely to seem familiar to pediatricians since 14 of the 24 are current NCQA Healthcare Effectiveness Data and Information Set (HEDIS) measures reported by Medicaid managed care plans.

The measures are part of an effort by the federal government to encourage quality reporting within Medicaid and the State Children's Health Insurance Program (SCHIP), but they will be voluntary and the requirements of the program would be up to individual states to determine.

The new measures program was established as part of the Children's Health Insurance Program Reauthorization Act of 2009, which required the federal government to identify a core set of child health quality measures for voluntary use by state programs. The government's charge was to identify existing pediatric measures that are in use by public and private health plans. The initial measure set was developed in consultation with child health care providers, according to CMS.

CMS is seeking public comments on which measures should remain part of the core set, which measures need further development, and what type of technical assistance physicians and other health care providers would need to report on these measures. Comments are due by March 1. Under statute, CMS must make the final measure set available to states by Jan. 1, 2013.

Currently, there is no funding set aside by the federal government to provide financial incentives for successfully reporting on these measures, but CMS and the states are exploring ways that they could encourage voluntary reporting, such as provider incentive payments provided under the American Recovery and Reinvestment Act, according to CMS.

The move to develop pediatric-specific quality measures was praised by the American Academy of Pediatrics. The organization was involved in the creation of the initial measure set and encouraged Congress to invest in the development of measures appropriate for children.

That's definitely an area where pediatrics has fallen behind, said Dr. Stuart A. Cohen, a pediatrician in San Diego and an AAP delegate to the American Medical Association. Right now, pediatric quality measures are mostly built off measures from adult medicine, he said.

There is also a lack of research into what measures would have the greatest impact on quality. Dr. Cohen said that current measurement in pediatrics focuses on areas like immunizations and antibiotic usage, but it's unclear on whether those are the best measures of high-quality pediatric care. He speculated that future research could begin with outcomes of care and work backward to determine what kind of care was given. “We don't have those measures,” he said.

Although details about how the measurement program would be set up by the states are still a ways off, Dr. Cohen said he would like to see an appeals process put in place to ensure that physicians have the opportunity to dispute inaccurate data, a safeguard that is in place in most private pay-for-performance programs.

Under the CHIP Reauthorization Act that created the quality measures program, CMS was also tasked with developing an electronic health record format specifically for children. CMS officials are working to coordinate that effort, as well as work on the meaningful-use criteria for EHRs, with the quality-measurement program.

A list of each measure and summaries of why they are being recommended are available at www.ahrq.gov/chip/corebackgrnd.htm

Officials at the Centers for Medicare and Medicaid Services recently released an initial set of pediatric quality measures that states can choose to use as part of their Medicaid and State Children's Health Insurance Programs.

The set of 24 measures focuses on prevention and health promotion, immunizations, screening, well-child visits, management of acute and chronic conditions, family experiences with care, and access to services.

The measures are likely to seem familiar to pediatricians since 14 of the 24 are current NCQA Healthcare Effectiveness Data and Information Set (HEDIS) measures reported by Medicaid managed care plans.

The measures are part of an effort by the federal government to encourage quality reporting within Medicaid and the State Children's Health Insurance Program (SCHIP), but they will be voluntary and the requirements of the program would be up to individual states to determine.

The new measures program was established as part of the Children's Health Insurance Program Reauthorization Act of 2009, which required the federal government to identify a core set of child health quality measures for voluntary use by state programs. The government's charge was to identify existing pediatric measures that are in use by public and private health plans. The initial measure set was developed in consultation with child health care providers, according to CMS.

CMS is seeking public comments on which measures should remain part of the core set, which measures need further development, and what type of technical assistance physicians and other health care providers would need to report on these measures. Comments are due by March 1. Under statute, CMS must make the final measure set available to states by Jan. 1, 2013.

Currently, there is no funding set aside by the federal government to provide financial incentives for successfully reporting on these measures, but CMS and the states are exploring ways that they could encourage voluntary reporting, such as provider incentive payments provided under the American Recovery and Reinvestment Act, according to CMS.

The move to develop pediatric-specific quality measures was praised by the American Academy of Pediatrics. The organization was involved in the creation of the initial measure set and encouraged Congress to invest in the development of measures appropriate for children.

That's definitely an area where pediatrics has fallen behind, said Dr. Stuart A. Cohen, a pediatrician in San Diego and an AAP delegate to the American Medical Association. Right now, pediatric quality measures are mostly built off measures from adult medicine, he said.

There is also a lack of research into what measures would have the greatest impact on quality. Dr. Cohen said that current measurement in pediatrics focuses on areas like immunizations and antibiotic usage, but it's unclear on whether those are the best measures of high-quality pediatric care. He speculated that future research could begin with outcomes of care and work backward to determine what kind of care was given. “We don't have those measures,” he said.

Although details about how the measurement program would be set up by the states are still a ways off, Dr. Cohen said he would like to see an appeals process put in place to ensure that physicians have the opportunity to dispute inaccurate data, a safeguard that is in place in most private pay-for-performance programs.

Under the CHIP Reauthorization Act that created the quality measures program, CMS was also tasked with developing an electronic health record format specifically for children. CMS officials are working to coordinate that effort, as well as work on the meaningful-use criteria for EHRs, with the quality-measurement program.

A list of each measure and summaries of why they are being recommended are available at www.ahrq.gov/chip/corebackgrnd.htm

Public health officials in Rhode Island are using electronic pharmacy data to track the use of oseltamivir and other antiviral medications being used to treat patients infected with the 2009 H1N1 influenza virus.

As part of an ongoing partnership with SureScripts, an electronic prescribing network, all 181 pharmacies in Rhode Island now can send and receive electronic prescription information over a secure network. As a result, pharmacies are able to transmit information to the Rhode Island department of health on all antiviral prescriptions written in the state. Even if a physician uses a hand-written prescription, the information is available from the pharmacy's electronic system.

At a press conference, Dr. David Gifford, director of the Rhode Island Department of Health, said prescriptions for antiviral medications provide a good proxy measure for infection with H1N1 virus and are a complement to other surveillance systems such as school absenteeism and emergency department visits.

Real-time electronic data on antiviral prescriptions also allow health officials to match supply and demand, he said.

For example, if prescriptions are about to outpace the supply, the health department can anticipate shortages in the antiviral supply and release more medication.

If there are reports of a large volume of H1N1 illness in a community, but not a lot of prescribing of antiviral medication, that could indicate the need for more physician education, Dr. Gifford said. Conversely, if the pharmacy data show a large amount of antiviral prescribing in areas where there is not a lot of H1N1 activity, it could indicate inappropriate prescribing of oseltamivir (Tamiflu) for seasonal influenza, he said.

The statewide initiative is believed to be the first in the nation and allows pharmacies to send data that have been stripped of personal patient information to the health department on a weekly basis.

The prescription data include the patient's age and zip code as well as the prescribing physician's name, allowing health officials to track the progress of the outbreak by communities.

Public health officials in Rhode Island are using electronic pharmacy data to track the use of oseltamivir and other antiviral medications being used to treat patients infected with the 2009 H1N1 influenza virus.

As part of an ongoing partnership with SureScripts, an electronic prescribing network, all 181 pharmacies in Rhode Island now can send and receive electronic prescription information over a secure network. As a result, pharmacies are able to transmit information to the Rhode Island department of health on all antiviral prescriptions written in the state. Even if a physician uses a hand-written prescription, the information is available from the pharmacy's electronic system.

At a press conference, Dr. David Gifford, director of the Rhode Island Department of Health, said prescriptions for antiviral medications provide a good proxy measure for infection with H1N1 virus and are a complement to other surveillance systems such as school absenteeism and emergency department visits.

Real-time electronic data on antiviral prescriptions also allow health officials to match supply and demand, he said.

For example, if prescriptions are about to outpace the supply, the health department can anticipate shortages in the antiviral supply and release more medication.

If there are reports of a large volume of H1N1 illness in a community, but not a lot of prescribing of antiviral medication, that could indicate the need for more physician education, Dr. Gifford said. Conversely, if the pharmacy data show a large amount of antiviral prescribing in areas where there is not a lot of H1N1 activity, it could indicate inappropriate prescribing of oseltamivir (Tamiflu) for seasonal influenza, he said.

The statewide initiative is believed to be the first in the nation and allows pharmacies to send data that have been stripped of personal patient information to the health department on a weekly basis.

The prescription data include the patient's age and zip code as well as the prescribing physician's name, allowing health officials to track the progress of the outbreak by communities.

Public health officials in Rhode Island are using electronic pharmacy data to track the use of oseltamivir and other antiviral medications being used to treat patients infected with the 2009 H1N1 influenza virus.

As part of an ongoing partnership with SureScripts, an electronic prescribing network, all 181 pharmacies in Rhode Island now can send and receive electronic prescription information over a secure network. As a result, pharmacies are able to transmit information to the Rhode Island department of health on all antiviral prescriptions written in the state. Even if a physician uses a hand-written prescription, the information is available from the pharmacy's electronic system.

At a press conference, Dr. David Gifford, director of the Rhode Island Department of Health, said prescriptions for antiviral medications provide a good proxy measure for infection with H1N1 virus and are a complement to other surveillance systems such as school absenteeism and emergency department visits.

Real-time electronic data on antiviral prescriptions also allow health officials to match supply and demand, he said.

For example, if prescriptions are about to outpace the supply, the health department can anticipate shortages in the antiviral supply and release more medication.

If there are reports of a large volume of H1N1 illness in a community, but not a lot of prescribing of antiviral medication, that could indicate the need for more physician education, Dr. Gifford said. Conversely, if the pharmacy data show a large amount of antiviral prescribing in areas where there is not a lot of H1N1 activity, it could indicate inappropriate prescribing of oseltamivir (Tamiflu) for seasonal influenza, he said.

The statewide initiative is believed to be the first in the nation and allows pharmacies to send data that have been stripped of personal patient information to the health department on a weekly basis.

The prescription data include the patient's age and zip code as well as the prescribing physician's name, allowing health officials to track the progress of the outbreak by communities.

Diagnosing and treating patients with incomplete information is often a reality in medicine, but officials at the Department of Veterans Affairs are working to fill those gaps by exchanging information electronically with clinicians outside the VA system.

As part of a pilot program launched in 2009, physicians at the VA and Kaiser Permanente in San Diego have been exchanging data on problem lists, medications, and allergies. Although it usually takes weeks for patients to submit requests to get paper records and then bring those to another physician, the test project allows electronic information to be transmitted in seconds.

“The net effect is clearly an improvement in quality, an increase in patient safety, and a tremendous improvement in the efficiency of how we share information and how we deliver the best possible care,” said Dr. John Mattison, assistant medical director and chief medical information officer for Kaiser Permanente Southern California.

Right now, the pilot involves about 450 veterans who receive their health care at both the VA and Kaiser Permanente in San Diego and who have agreed to allow their records to be shared. In the future, VA officials want to expand the pilot to include veterans around the country by partnering with other private health care institutions.

In the first quarter of this year, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This type of information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA and a neurosurgeon. About three out of four veterans receive a portion of their care in the private sector, he said, so VA physicians can't provide the best care unless they are able to see the types of treatments and medications they are getting outside of the system. Even though the VA and DOD have been leaders in exchanging information for years, the missing link has been information on care provided in the private sector, Dr. Ondra said.

The pilot relies on standards developed as part of the Nationwide Health Information Network. Using these national standards, clinicians can send electronic patient data securely and privately. In the pilot, the standards allowed the VA's VistA record system to connect with Kaiser Permanente's HealthConnect system.

The Web-based exchange required patients to opt in at both sites of care. Once consent was established, clinicians at both institutions were able select a patient, see their site of care, and pull up information on their problem list, allergies, and medications.

The response from patients has been positive, Dr. Ondra said. After an initial mailing announcing the program, more than 40% of the invited patients volunteered to be part of the pilot. VA and Kaiser officials invited more than 1,100 veterans who had recently received care at both institutions to participate. Although the initial response was fairly high, officials at the two institutions plan to go back and try to get more veterans interested as the project continues in San Diego.

“While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

Diagnosing and treating patients with incomplete information is often a reality in medicine, but officials at the Department of Veterans Affairs are working to fill those gaps by exchanging information electronically with clinicians outside the VA system.

As part of a pilot program launched in 2009, physicians at the VA and Kaiser Permanente in San Diego have been exchanging data on problem lists, medications, and allergies. Although it usually takes weeks for patients to submit requests to get paper records and then bring those to another physician, the test project allows electronic information to be transmitted in seconds.

“The net effect is clearly an improvement in quality, an increase in patient safety, and a tremendous improvement in the efficiency of how we share information and how we deliver the best possible care,” said Dr. John Mattison, assistant medical director and chief medical information officer for Kaiser Permanente Southern California.

Right now, the pilot involves about 450 veterans who receive their health care at both the VA and Kaiser Permanente in San Diego and who have agreed to allow their records to be shared. In the future, VA officials want to expand the pilot to include veterans around the country by partnering with other private health care institutions.

In the first quarter of this year, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This type of information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA and a neurosurgeon. About three out of four veterans receive a portion of their care in the private sector, he said, so VA physicians can't provide the best care unless they are able to see the types of treatments and medications they are getting outside of the system. Even though the VA and DOD have been leaders in exchanging information for years, the missing link has been information on care provided in the private sector, Dr. Ondra said.

The pilot relies on standards developed as part of the Nationwide Health Information Network. Using these national standards, clinicians can send electronic patient data securely and privately. In the pilot, the standards allowed the VA's VistA record system to connect with Kaiser Permanente's HealthConnect system.

The Web-based exchange required patients to opt in at both sites of care. Once consent was established, clinicians at both institutions were able select a patient, see their site of care, and pull up information on their problem list, allergies, and medications.

The response from patients has been positive, Dr. Ondra said. After an initial mailing announcing the program, more than 40% of the invited patients volunteered to be part of the pilot. VA and Kaiser officials invited more than 1,100 veterans who had recently received care at both institutions to participate. Although the initial response was fairly high, officials at the two institutions plan to go back and try to get more veterans interested as the project continues in San Diego.

“While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

Diagnosing and treating patients with incomplete information is often a reality in medicine, but officials at the Department of Veterans Affairs are working to fill those gaps by exchanging information electronically with clinicians outside the VA system.

As part of a pilot program launched in 2009, physicians at the VA and Kaiser Permanente in San Diego have been exchanging data on problem lists, medications, and allergies. Although it usually takes weeks for patients to submit requests to get paper records and then bring those to another physician, the test project allows electronic information to be transmitted in seconds.

“The net effect is clearly an improvement in quality, an increase in patient safety, and a tremendous improvement in the efficiency of how we share information and how we deliver the best possible care,” said Dr. John Mattison, assistant medical director and chief medical information officer for Kaiser Permanente Southern California.

Right now, the pilot involves about 450 veterans who receive their health care at both the VA and Kaiser Permanente in San Diego and who have agreed to allow their records to be shared. In the future, VA officials want to expand the pilot to include veterans around the country by partnering with other private health care institutions.

In the first quarter of this year, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.

This type of information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA and a neurosurgeon. About three out of four veterans receive a portion of their care in the private sector, he said, so VA physicians can't provide the best care unless they are able to see the types of treatments and medications they are getting outside of the system. Even though the VA and DOD have been leaders in exchanging information for years, the missing link has been information on care provided in the private sector, Dr. Ondra said.

The pilot relies on standards developed as part of the Nationwide Health Information Network. Using these national standards, clinicians can send electronic patient data securely and privately. In the pilot, the standards allowed the VA's VistA record system to connect with Kaiser Permanente's HealthConnect system.

The Web-based exchange required patients to opt in at both sites of care. Once consent was established, clinicians at both institutions were able select a patient, see their site of care, and pull up information on their problem list, allergies, and medications.

The response from patients has been positive, Dr. Ondra said. After an initial mailing announcing the program, more than 40% of the invited patients volunteered to be part of the pilot. VA and Kaiser officials invited more than 1,100 veterans who had recently received care at both institutions to participate. Although the initial response was fairly high, officials at the two institutions plan to go back and try to get more veterans interested as the project continues in San Diego.

“While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.

The U.S. government has released its plan to deal with the health consequences associated with major national emergencies such as disease outbreaks, natural disasters, and terrorist attacks.

The National Health Security Strategy, available at www.hhs.gov/disasters

The plan outlines several objectives including fostering integrated, scalable health care delivery systems; incorporating postincident health recovery into planning and response; maintaining a workforce necessary to respond to health emergencies; and preventing or minimizing emerging threats to health. HHS will update the plan every 2 years to reflect advances in medicine and public health.

Although the National Health Security Strategy was prepared by the federal government, HHS Secretary Kathleen Sebelius said that for the plan to be effective, it requires participation from everyone in the nation.

“As we've learned in the response to the 2009 H1N1 pandemic, responsibility for improving our nation's ability to address existing and emergency health threats must be broadly shared by everyone—governments, communities, families, and individuals,” Ms. Sebelius said in a statement. “The National Health Security Strategy is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency.”

The new national plan provides a framework for physicians, in particular, to begin planning for their response to an emergency, Dr. Georges C. Benjamin, executive director of the American Public Health Association, said in an interview. Looking back at the challenges that physicians faced during the aftermath of Hurricane Katrina, Dr. Benjamin said that many of those obstacles could have been addressed in a systemic way if a strategy like this one had existed at the time.

This year, HHS officials, with the help of government and external partners, plan to analyze health care workforce levels, seeking to identify any areas where there is a shortage when it come to health security readiness. For example, shortages have already been identified in the number of public health nurses, epidemiologists, and laboratory personnel, according to HHS.

Dr. Benjamin said that workforce is a major issue. While part of the solution will likely involve recruiting more people to the health care field, it will also involve asking clinicians to expand their traditional scope of practice. For example, there is a range of emergency skills that practicing internists are trained in, but don't use in daily practice. As part of emergency planning, they may need to refresh those skills, he said.

Emergency skills also must be taught so that health care providers are ready for the long term, Dr. Benjamin said. That means reexamining graduate medical education to ensure that the full range of practitioners—physicians, nurses, physician assistants, and nurse practitioners—are able, he said. “We've never done that in a comprehensive way in our country.”

“Good planning for those kinds of emergencies, for your own needs as well as your family's and your patients' needs, is probably a good thing to do,” Dr. Benjamin said.

The U.S. government has released its plan to deal with the health consequences associated with major national emergencies such as disease outbreaks, natural disasters, and terrorist attacks.

The National Health Security Strategy, available at www.hhs.gov/disasters

The plan outlines several objectives including fostering integrated, scalable health care delivery systems; incorporating postincident health recovery into planning and response; maintaining a workforce necessary to respond to health emergencies; and preventing or minimizing emerging threats to health. HHS will update the plan every 2 years to reflect advances in medicine and public health.

Although the National Health Security Strategy was prepared by the federal government, HHS Secretary Kathleen Sebelius said that for the plan to be effective, it requires participation from everyone in the nation.

“As we've learned in the response to the 2009 H1N1 pandemic, responsibility for improving our nation's ability to address existing and emergency health threats must be broadly shared by everyone—governments, communities, families, and individuals,” Ms. Sebelius said in a statement. “The National Health Security Strategy is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency.”

The new national plan provides a framework for physicians, in particular, to begin planning for their response to an emergency, Dr. Georges C. Benjamin, executive director of the American Public Health Association, said in an interview. Looking back at the challenges that physicians faced during the aftermath of Hurricane Katrina, Dr. Benjamin said that many of those obstacles could have been addressed in a systemic way if a strategy like this one had existed at the time.

This year, HHS officials, with the help of government and external partners, plan to analyze health care workforce levels, seeking to identify any areas where there is a shortage when it come to health security readiness. For example, shortages have already been identified in the number of public health nurses, epidemiologists, and laboratory personnel, according to HHS.

Dr. Benjamin said that workforce is a major issue. While part of the solution will likely involve recruiting more people to the health care field, it will also involve asking clinicians to expand their traditional scope of practice. For example, there is a range of emergency skills that practicing internists are trained in, but don't use in daily practice. As part of emergency planning, they may need to refresh those skills, he said.

Emergency skills also must be taught so that health care providers are ready for the long term, Dr. Benjamin said. That means reexamining graduate medical education to ensure that the full range of practitioners—physicians, nurses, physician assistants, and nurse practitioners—are able, he said. “We've never done that in a comprehensive way in our country.”

“Good planning for those kinds of emergencies, for your own needs as well as your family's and your patients' needs, is probably a good thing to do,” Dr. Benjamin said.

The U.S. government has released its plan to deal with the health consequences associated with major national emergencies such as disease outbreaks, natural disasters, and terrorist attacks.

The National Health Security Strategy, available at www.hhs.gov/disasters

The plan outlines several objectives including fostering integrated, scalable health care delivery systems; incorporating postincident health recovery into planning and response; maintaining a workforce necessary to respond to health emergencies; and preventing or minimizing emerging threats to health. HHS will update the plan every 2 years to reflect advances in medicine and public health.

Although the National Health Security Strategy was prepared by the federal government, HHS Secretary Kathleen Sebelius said that for the plan to be effective, it requires participation from everyone in the nation.

“As we've learned in the response to the 2009 H1N1 pandemic, responsibility for improving our nation's ability to address existing and emergency health threats must be broadly shared by everyone—governments, communities, families, and individuals,” Ms. Sebelius said in a statement. “The National Health Security Strategy is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency.”

The new national plan provides a framework for physicians, in particular, to begin planning for their response to an emergency, Dr. Georges C. Benjamin, executive director of the American Public Health Association, said in an interview. Looking back at the challenges that physicians faced during the aftermath of Hurricane Katrina, Dr. Benjamin said that many of those obstacles could have been addressed in a systemic way if a strategy like this one had existed at the time.

This year, HHS officials, with the help of government and external partners, plan to analyze health care workforce levels, seeking to identify any areas where there is a shortage when it come to health security readiness. For example, shortages have already been identified in the number of public health nurses, epidemiologists, and laboratory personnel, according to HHS.

Dr. Benjamin said that workforce is a major issue. While part of the solution will likely involve recruiting more people to the health care field, it will also involve asking clinicians to expand their traditional scope of practice. For example, there is a range of emergency skills that practicing internists are trained in, but don't use in daily practice. As part of emergency planning, they may need to refresh those skills, he said.

Emergency skills also must be taught so that health care providers are ready for the long term, Dr. Benjamin said. That means reexamining graduate medical education to ensure that the full range of practitioners—physicians, nurses, physician assistants, and nurse practitioners—are able, he said. “We've never done that in a comprehensive way in our country.”

“Good planning for those kinds of emergencies, for your own needs as well as your family's and your patients' needs, is probably a good thing to do,” Dr. Benjamin said.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP). In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP: 16.2% in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008, rising from 28% in 2007 to nearly 36%, according to CMS. The increase is due in part to the Recovery Act, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP). In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP: 16.2% in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008, rising from 28% in 2007 to nearly 36%, according to CMS. The increase is due in part to the Recovery Act, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest rate of growth since the federal government officially began measuring it in 1960, according to a new report from the Centers for Medicare and Medicaid Services.

But the figures show that even though the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP). In 2008, health care spending rose 4.4% to $2.3 trillion, compared with only a 2.8% increase in the GDP. And health spending continues to consume a larger portion of the overall GDP: 16.2% in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services.

For example, spending on physician and clinical services increased 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008, rising from 28% in 2007 to nearly 36%, according to CMS. The increase is due in part to the Recovery Act, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest growth rate since the federal government officially began measuring it in 1960, according to a report from the Centers for Medicare and Medicaid Services.

But the figures show that although the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP). In 2008, health care spending rose 4.4% to $2.3 trillion, compared with a 2.8% rise in the GDP. And health spending continues to consume a larger portion of the overall GDP: 16.2% in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services. For example, spending on physician and clinical services rose 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008, rising from 28% in 2007 to nearly 36%, according to CMS. The increase is due in part to the Recovery Act, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest growth rate since the federal government officially began measuring it in 1960, according to a report from the Centers for Medicare and Medicaid Services.

But the figures show that although the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP). In 2008, health care spending rose 4.4% to $2.3 trillion, compared with a 2.8% rise in the GDP. And health spending continues to consume a larger portion of the overall GDP: 16.2% in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services. For example, spending on physician and clinical services rose 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008, rising from 28% in 2007 to nearly 36%, according to CMS. The increase is due in part to the Recovery Act, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

Health care spending in the United States grew less than 5% in 2008, the slowest growth rate since the federal government officially began measuring it in 1960, according to a report from the Centers for Medicare and Medicaid Services.

But the figures show that although the rate of increase is slower than in previous years, health care spending is still outpacing the gross domestic product (GDP). In 2008, health care spending rose 4.4% to $2.3 trillion, compared with a 2.8% rise in the GDP. And health spending continues to consume a larger portion of the overall GDP: 16.2% in 2008, compared with 15.9% in 2007 (Health Affairs 2010;29:147–55).

The overall slowdown in health spending growth is reflected in slower rates of increase in hospital spending, physician services spending, retail prescription drug spending, and spending for nursing home and home health services. For example, spending on physician and clinical services rose 5% in 2008, down from 5.8% in 2007. The deceleration in physician services was driven by a decrease in patient volume, even as the intensity of services picked up in 2008.

While spending rates slowed in many areas, the federal government's share of health spending soared in 2008, rising from 28% in 2007 to nearly 36%, according to CMS. The increase is due in part to the Recovery Act, which retroactively shifted $7 billion in federal funds to Medicaid to assist budget-challenged states at the end of 2008.

The U.S. government has released its plan to deal with the health consequences associated with major national emergencies such as disease outbreaks, natural disasters, and terrorist attacks.

The National Health Security Strategy, available at www.hhs.gov/disasters

The plan outlines several objectives including fostering integrated, scalable health care delivery systems; incorporating postincident health recovery into planning and response; maintaining a workforce necessary to respond to health emergencies; and preventing or minimizing emerging threats to health. HHS will update the plan every 2 years to reflect advances in medicine and public health.

Although the National Health Security Strategy was prepared by the federal government, HHS Secretary Kathleen Sebelius said that for the plan to be effective, it requires participation from everyone in the nation.

“Responsibility for improving our nation's ability to address existing and emergency health threats must be broadly shared by everyone–governments, communities, families, and individuals,” she said in a statement. “The [strategy] is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency.”

The new national plan provides a framework for physicians, in particular, to begin planning for their response to an emergency, Dr. Georges C. Benjamin, executive director of the American Public Health Association, said in an interview. Many of the obstacles faced in the aftermath of Hurricane Katrina could have been addressed in a systemic way if a strategy like this one had existed at the time, he said.

This year, HHS officials, with the help of government and external partners, plan to analyze health care workforce levels, seeking to identify any areas where there is a shortage when it comes to health security readiness. For example, shortages have already been identified in the number of public health nurses, epidemiologists, and laboratory personnel, according to HHS.

Dr. Benjamin said that workforce is a major issue. Whereas part of the solution will likely involve recruiting more people to the health care field, it will also involve asking clinicians to expand their traditional scope of practice. For example, there are a range of emergency skills that practicing internists are trained in, but don't use in daily practice. As part of emergency planning, they may need to refresh those skills, he said.

Emergency skills also must be taught so that health care providers are ready for the long term, Dr. Benjamin said. That means reexamining graduate medical education to ensure that the full range of practitioners–physicians, nurses, physician assistants, and nurse practitioners–are able, he said.

In addition to staying current on emergency skills, physicians also need to consider how a major crisis would affect their practice, Dr. Benjamin advised, adding they should identify the most likely emergency scenarios in their area and think through their role in an emergency. That should include examining employment policies and ensuring safe storage of medical records. Physicians should also plan for the recovery from an emergenc, such as having a plan for how to get rapidly re-credentialed in another hospital or state if necessary, he said.

The U.S. government has released its plan to deal with the health consequences associated with major national emergencies such as disease outbreaks, natural disasters, and terrorist attacks.

The National Health Security Strategy, available at www.hhs.gov/disasters

The plan outlines several objectives including fostering integrated, scalable health care delivery systems; incorporating postincident health recovery into planning and response; maintaining a workforce necessary to respond to health emergencies; and preventing or minimizing emerging threats to health. HHS will update the plan every 2 years to reflect advances in medicine and public health.

Although the National Health Security Strategy was prepared by the federal government, HHS Secretary Kathleen Sebelius said that for the plan to be effective, it requires participation from everyone in the nation.

“Responsibility for improving our nation's ability to address existing and emergency health threats must be broadly shared by everyone–governments, communities, families, and individuals,” she said in a statement. “The [strategy] is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency.”

The new national plan provides a framework for physicians, in particular, to begin planning for their response to an emergency, Dr. Georges C. Benjamin, executive director of the American Public Health Association, said in an interview. Many of the obstacles faced in the aftermath of Hurricane Katrina could have been addressed in a systemic way if a strategy like this one had existed at the time, he said.

This year, HHS officials, with the help of government and external partners, plan to analyze health care workforce levels, seeking to identify any areas where there is a shortage when it comes to health security readiness. For example, shortages have already been identified in the number of public health nurses, epidemiologists, and laboratory personnel, according to HHS.

Dr. Benjamin said that workforce is a major issue. Whereas part of the solution will likely involve recruiting more people to the health care field, it will also involve asking clinicians to expand their traditional scope of practice. For example, there are a range of emergency skills that practicing internists are trained in, but don't use in daily practice. As part of emergency planning, they may need to refresh those skills, he said.

Emergency skills also must be taught so that health care providers are ready for the long term, Dr. Benjamin said. That means reexamining graduate medical education to ensure that the full range of practitioners–physicians, nurses, physician assistants, and nurse practitioners–are able, he said.

In addition to staying current on emergency skills, physicians also need to consider how a major crisis would affect their practice, Dr. Benjamin advised, adding they should identify the most likely emergency scenarios in their area and think through their role in an emergency. That should include examining employment policies and ensuring safe storage of medical records. Physicians should also plan for the recovery from an emergenc, such as having a plan for how to get rapidly re-credentialed in another hospital or state if necessary, he said.

The U.S. government has released its plan to deal with the health consequences associated with major national emergencies such as disease outbreaks, natural disasters, and terrorist attacks.

The National Health Security Strategy, available at www.hhs.gov/disasters

The plan outlines several objectives including fostering integrated, scalable health care delivery systems; incorporating postincident health recovery into planning and response; maintaining a workforce necessary to respond to health emergencies; and preventing or minimizing emerging threats to health. HHS will update the plan every 2 years to reflect advances in medicine and public health.

Although the National Health Security Strategy was prepared by the federal government, HHS Secretary Kathleen Sebelius said that for the plan to be effective, it requires participation from everyone in the nation.

“Responsibility for improving our nation's ability to address existing and emergency health threats must be broadly shared by everyone–governments, communities, families, and individuals,” she said in a statement. “The [strategy] is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency.”

The new national plan provides a framework for physicians, in particular, to begin planning for their response to an emergency, Dr. Georges C. Benjamin, executive director of the American Public Health Association, said in an interview. Many of the obstacles faced in the aftermath of Hurricane Katrina could have been addressed in a systemic way if a strategy like this one had existed at the time, he said.

This year, HHS officials, with the help of government and external partners, plan to analyze health care workforce levels, seeking to identify any areas where there is a shortage when it comes to health security readiness. For example, shortages have already been identified in the number of public health nurses, epidemiologists, and laboratory personnel, according to HHS.

Dr. Benjamin said that workforce is a major issue. Whereas part of the solution will likely involve recruiting more people to the health care field, it will also involve asking clinicians to expand their traditional scope of practice. For example, there are a range of emergency skills that practicing internists are trained in, but don't use in daily practice. As part of emergency planning, they may need to refresh those skills, he said.

Emergency skills also must be taught so that health care providers are ready for the long term, Dr. Benjamin said. That means reexamining graduate medical education to ensure that the full range of practitioners–physicians, nurses, physician assistants, and nurse practitioners–are able, he said.

In addition to staying current on emergency skills, physicians also need to consider how a major crisis would affect their practice, Dr. Benjamin advised, adding they should identify the most likely emergency scenarios in their area and think through their role in an emergency. That should include examining employment policies and ensuring safe storage of medical records. Physicians should also plan for the recovery from an emergenc, such as having a plan for how to get rapidly re-credentialed in another hospital or state if necessary, he said.