Mary Ellen Schneider

NEW YORK — Asking patients to deliver therapy for sexually transmitted diseases to their sex partners is paying off, with increases in the proportion of partners who are being treated, according to study data.

The Centers for Disease Control and Prevention advises that expedited partner therapy (EPT), or treating sexual partners without requiring that they first seek a medical evaluation, is an option when other strategies are impractical or unsuccessful.

In Washington state, public health officials advise that EPT should be given when treatment cannot otherwise be ensured, according to Dr. Matthew Golden, director of the STD Control Program for Public Health in Seattle/King County.

But EPT isn't a cure-all, Dr. Golden said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV. Some people will not get their partners treated, such as those with more than one sex partner or a partner they are unikely to have sex with again, men who have sex with men, and those who say outright they won't notify their partners.

So King County health officials developed a case report form that allows the diagnosing physician to check a box indicating that the health department should assume responsibility for partner notification, such as drawing on the services of a disease intervention specialist. Through the program, patients and their partners have free access to medications through large clinics and commercial pharmacies.

Use of the form has yielded encouraging results. A random sample of patients diagnosed with gonorrhea or chlamydia shows about 39% were classified as having all partners treated before the intervention, compared with 65% in the postintervention period (Sex. Transm. Dis. 2007;34:598-603).

If the results continue, the researchers estimate there would be about a 25% reduction in chlamydial prevalence in about 2 years' time and a 50% reduction in chlamydial prevalence in 4 years' time. A community-level, randomized controlled trial is being conducted throughout the state to establish whether EPT reduces the prevalence of chlamydial infection and the incidence of gonorrhea at a population level.

NEW YORK — Asking patients to deliver therapy for sexually transmitted diseases to their sex partners is paying off, with increases in the proportion of partners who are being treated, according to study data.

The Centers for Disease Control and Prevention advises that expedited partner therapy (EPT), or treating sexual partners without requiring that they first seek a medical evaluation, is an option when other strategies are impractical or unsuccessful.

In Washington state, public health officials advise that EPT should be given when treatment cannot otherwise be ensured, according to Dr. Matthew Golden, director of the STD Control Program for Public Health in Seattle/King County.

But EPT isn't a cure-all, Dr. Golden said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV. Some people will not get their partners treated, such as those with more than one sex partner or a partner they are unikely to have sex with again, men who have sex with men, and those who say outright they won't notify their partners.

So King County health officials developed a case report form that allows the diagnosing physician to check a box indicating that the health department should assume responsibility for partner notification, such as drawing on the services of a disease intervention specialist. Through the program, patients and their partners have free access to medications through large clinics and commercial pharmacies.

Use of the form has yielded encouraging results. A random sample of patients diagnosed with gonorrhea or chlamydia shows about 39% were classified as having all partners treated before the intervention, compared with 65% in the postintervention period (Sex. Transm. Dis. 2007;34:598-603).

If the results continue, the researchers estimate there would be about a 25% reduction in chlamydial prevalence in about 2 years' time and a 50% reduction in chlamydial prevalence in 4 years' time. A community-level, randomized controlled trial is being conducted throughout the state to establish whether EPT reduces the prevalence of chlamydial infection and the incidence of gonorrhea at a population level.

NEW YORK — Asking patients to deliver therapy for sexually transmitted diseases to their sex partners is paying off, with increases in the proportion of partners who are being treated, according to study data.

The Centers for Disease Control and Prevention advises that expedited partner therapy (EPT), or treating sexual partners without requiring that they first seek a medical evaluation, is an option when other strategies are impractical or unsuccessful.

In Washington state, public health officials advise that EPT should be given when treatment cannot otherwise be ensured, according to Dr. Matthew Golden, director of the STD Control Program for Public Health in Seattle/King County.

But EPT isn't a cure-all, Dr. Golden said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV. Some people will not get their partners treated, such as those with more than one sex partner or a partner they are unikely to have sex with again, men who have sex with men, and those who say outright they won't notify their partners.

So King County health officials developed a case report form that allows the diagnosing physician to check a box indicating that the health department should assume responsibility for partner notification, such as drawing on the services of a disease intervention specialist. Through the program, patients and their partners have free access to medications through large clinics and commercial pharmacies.

Use of the form has yielded encouraging results. A random sample of patients diagnosed with gonorrhea or chlamydia shows about 39% were classified as having all partners treated before the intervention, compared with 65% in the postintervention period (Sex. Transm. Dis. 2007;34:598-603).

If the results continue, the researchers estimate there would be about a 25% reduction in chlamydial prevalence in about 2 years' time and a 50% reduction in chlamydial prevalence in 4 years' time. A community-level, randomized controlled trial is being conducted throughout the state to establish whether EPT reduces the prevalence of chlamydial infection and the incidence of gonorrhea at a population level.

NEW YORK — Many researchers and clinicians view Internet use to find sexual partners as a risk factor for sexually transmitted diseases, but it may also have some protective qualities, research indicates.

The risk of acquiring an STD may in fact be lowered in cases where someone finds a romantic partner online with whom they later have sex.

"We have to start thinking not only about how the Internet can increase risk for STDs, but also how online partnering and online behavior can reduce these risks, even among prospective sex partners," Dr. Kees Rietmeijer said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

A survey of more than 500 women who met with a person who answered their online personal ad found that they engaged in extensive e-mail correspondence to negotiate safety, boundaries, sexual preferences, and condom use and to discuss STD status before meeting face to face, said Dr. Rietmeijer, medical director of the STD clinic and control program at the Denver Public Health Department.

However, the survey also revealed that the women engaged in risky sexual behavior. For example, 30% reported that they had sex at the first encounter and 77% did not use condoms at the first encounter. The researchers concluded that the intensity of the e-mail exchange accelerated the intimacy of the relationship (Sex. Res. Soc. Policy 2007;4:27-37).

In a study looking at factors surrounding HIV serostatus discussion in men who have sex with men, Dr. Rietmeijer and associates found that those who found sex partners online were four times more likely to have a discussion of serostatus than were those who found partners in bath houses (Sex. Transm. Dis. 2007;34:215-9).

NEW YORK — Many researchers and clinicians view Internet use to find sexual partners as a risk factor for sexually transmitted diseases, but it may also have some protective qualities, research indicates.

The risk of acquiring an STD may in fact be lowered in cases where someone finds a romantic partner online with whom they later have sex.

"We have to start thinking not only about how the Internet can increase risk for STDs, but also how online partnering and online behavior can reduce these risks, even among prospective sex partners," Dr. Kees Rietmeijer said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

A survey of more than 500 women who met with a person who answered their online personal ad found that they engaged in extensive e-mail correspondence to negotiate safety, boundaries, sexual preferences, and condom use and to discuss STD status before meeting face to face, said Dr. Rietmeijer, medical director of the STD clinic and control program at the Denver Public Health Department.

However, the survey also revealed that the women engaged in risky sexual behavior. For example, 30% reported that they had sex at the first encounter and 77% did not use condoms at the first encounter. The researchers concluded that the intensity of the e-mail exchange accelerated the intimacy of the relationship (Sex. Res. Soc. Policy 2007;4:27-37).

In a study looking at factors surrounding HIV serostatus discussion in men who have sex with men, Dr. Rietmeijer and associates found that those who found sex partners online were four times more likely to have a discussion of serostatus than were those who found partners in bath houses (Sex. Transm. Dis. 2007;34:215-9).

NEW YORK — Many researchers and clinicians view Internet use to find sexual partners as a risk factor for sexually transmitted diseases, but it may also have some protective qualities, research indicates.

The risk of acquiring an STD may in fact be lowered in cases where someone finds a romantic partner online with whom they later have sex.

"We have to start thinking not only about how the Internet can increase risk for STDs, but also how online partnering and online behavior can reduce these risks, even among prospective sex partners," Dr. Kees Rietmeijer said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

A survey of more than 500 women who met with a person who answered their online personal ad found that they engaged in extensive e-mail correspondence to negotiate safety, boundaries, sexual preferences, and condom use and to discuss STD status before meeting face to face, said Dr. Rietmeijer, medical director of the STD clinic and control program at the Denver Public Health Department.

However, the survey also revealed that the women engaged in risky sexual behavior. For example, 30% reported that they had sex at the first encounter and 77% did not use condoms at the first encounter. The researchers concluded that the intensity of the e-mail exchange accelerated the intimacy of the relationship (Sex. Res. Soc. Policy 2007;4:27-37).

In a study looking at factors surrounding HIV serostatus discussion in men who have sex with men, Dr. Rietmeijer and associates found that those who found sex partners online were four times more likely to have a discussion of serostatus than were those who found partners in bath houses (Sex. Transm. Dis. 2007;34:215-9).

The Joint Commission has issued new requirements for hospitals in an effort to prevent infections from multidrug-resistant organisms, central line-associated bloodstream infections, and surgical site infections.

The requirements, which are part of the organization's 2009 National Patient Safety Goals for hospitals, include a 1-year phase-in period with full implementation by Jan. 1, 2010.

It is critical for hospitals to begin addressing the issue of health care-associated infections and to try to keep the problem from worsening, said Dr. Peter Angood, vice president and chief patient safety officer for the Joint Commission. "We're in a bit of a tight spot and we need to work our way out of it," he said.

The new infection control requirements build on an existing National Patient Safety Goal on health care-associated infections that had previously included only requirements for compliance with hand hygiene guidelines and had called on hospitals to manage serious infections as sentinel events. Those requirements will remain in place along with the new elements of the goal.

"Infection control is high on our priority list overall," Dr. Angood said.

Under the new 2009 requirements, hospitals are being asked to begin preparing to prevent infections resulting from multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus, Clostridium difficile, vancomycin-resistant enterococci, multidrug-resistant gram negative bacteria, and other epidemiologically important organisms.

Starting in January 2010, hospitals will need to conduct periodic risk assessments for acquisition and transmission of multidrug-resistant organisms, and educate staff and independent providers about prevention strategies and their roles. Hospitals also will be required to provide education about infection control strategies to patients and families who are infected or colonized with multidrug-resistant organisms.

Hospitals will be required to have a surveillance program up and running by Jan. 1, 2010, that is based on the hospital's risk assessment.

When indicated by the risk assessment, hospitals will need to implement a laboratory-based alert system to identify new patients with multidrug-resistant organisms, and an alert system to identify readmitted or transferred patients who have multidrug-resistant organisms.

The Joint Commission also has put new requirements in place to prevent central line-associated bloodstream infections and surgical site infections.

As part of the requirements related to central line-associated bloodstream infections, hospitals will be expected to use a catheter checklist and a standardized protocol for central venous catheter insertion and an all-inclusive standardized supply cart or kit for insertion of central venous catheters.

The requirements also call for the use of standardized protocols for maximum sterile barrier precautions during insertion of a central venous catheter and when disinfecting catheter hubs and injection ports before accessing the ports.

As part of its effort to prevent surgical site infections, the Joint Commission is requiring hospitals to conduct periodic risk assessments, select surgical site infection measures based on evidence, and evaluate the effectiveness of their prevention efforts. Also, hospital staff will need to measure infection rates for the first 30 days following most procedures and for the first year after procedures involving implantable devices.

The surgical site infection requirements were developed to be in line with well established guidelines and should help organizations move toward compliance with those guidelines, Dr. Angood said.

All of the new requirements related to health care-associated infections include a 1-year phase-in period, with milestones for planning, development, and testing throughout 2009. Allowing organizations to phase in complex requirements over the course of a year helps them to perform better by achieving concrete goals before full compliance is expected, Dr. Angood said.

Addressing health care-associated infections is a worthy goal, said Dr. Franklin Michota, who is director of academic affairs for the department of hospital medicine at the Cleveland Clinic. There is sufficient evidence to show a clinical benefit from implementing infection control strategies. "It's not an experiment to see if these things work," he said.

Hospitals are likely to face some up-front costs when implementing the new requirements, Dr. Michota said, especially if they need to put a new educational process in place to prepare staff. For that reason, hospitals may be looking to involve hospitalists, who are already on the payroll, in a variety of activities related to preventing health care-associated infections, he said.

Hospitalists may be involved in developing process improvement plans, tracking requirements, or tracking infections. Those who are not involved on the quality side may be asked to champion changes at the floor level by modeling appropriate hand hygiene or compliance with contact precautions.

"Shining additional light on [health care-associated infections] is good," said Dr. Patrick J. Cawley, president of the Society of Hospital Medicine and executive medical director at the Medical University of South Carolina, Charleston.

The requirements for central line-associated bloodstream infections, in particular, are a significant step forward. There is clear evidence in the literature that compliance with central line placement protocols can significantly drive down infection rates, he said. "This is something we all should be doing anyway," Dr. Cawley said.

Although many hospitals have made infection control a priority, having these new requirements from the Joint Commission will help to elevate those efforts, he added.

The Joint Commission also has added new requirements to the goal for medication reconciliation. Hospitals are advised to provide a complete and reconciled list of the patient's medications directly to the patient and explain the list at the time of discharge. In those settings where medications were used minimally or for a short duration, such as the emergency department, the hospital is required to perform a modified medication reconciliation process.

For example, if a short-term course of an antibiotic is prescribed, the patient should be provided with a list containing the medications that the patient will continue using after leaving the hospital.

Also new in 2009 is a requirement to eliminate transfusion errors related to patient misidentification.

Before beginning a blood or blood component transfusion, hospital staff must match the patient to the blood during a two-person bedside verification process. In cases where two individuals are not available, a bar code or other automated technology can be used in place of one of the individuals, according to the Joint Commission.

The Joint Commission has issued new requirements for hospitals in an effort to prevent infections from multidrug-resistant organisms, central line-associated bloodstream infections, and surgical site infections.

The requirements, which are part of the organization's 2009 National Patient Safety Goals for hospitals, include a 1-year phase-in period with full implementation by Jan. 1, 2010.

It is critical for hospitals to begin addressing the issue of health care-associated infections and to try to keep the problem from worsening, said Dr. Peter Angood, vice president and chief patient safety officer for the Joint Commission. "We're in a bit of a tight spot and we need to work our way out of it," he said.

The new infection control requirements build on an existing National Patient Safety Goal on health care-associated infections that had previously included only requirements for compliance with hand hygiene guidelines and had called on hospitals to manage serious infections as sentinel events. Those requirements will remain in place along with the new elements of the goal.

"Infection control is high on our priority list overall," Dr. Angood said.

Under the new 2009 requirements, hospitals are being asked to begin preparing to prevent infections resulting from multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus, Clostridium difficile, vancomycin-resistant enterococci, multidrug-resistant gram negative bacteria, and other epidemiologically important organisms.

Starting in January 2010, hospitals will need to conduct periodic risk assessments for acquisition and transmission of multidrug-resistant organisms, and educate staff and independent providers about prevention strategies and their roles. Hospitals also will be required to provide education about infection control strategies to patients and families who are infected or colonized with multidrug-resistant organisms.

Hospitals will be required to have a surveillance program up and running by Jan. 1, 2010, that is based on the hospital's risk assessment.

When indicated by the risk assessment, hospitals will need to implement a laboratory-based alert system to identify new patients with multidrug-resistant organisms, and an alert system to identify readmitted or transferred patients who have multidrug-resistant organisms.

The Joint Commission also has put new requirements in place to prevent central line-associated bloodstream infections and surgical site infections.

As part of the requirements related to central line-associated bloodstream infections, hospitals will be expected to use a catheter checklist and a standardized protocol for central venous catheter insertion and an all-inclusive standardized supply cart or kit for insertion of central venous catheters.

The requirements also call for the use of standardized protocols for maximum sterile barrier precautions during insertion of a central venous catheter and when disinfecting catheter hubs and injection ports before accessing the ports.

As part of its effort to prevent surgical site infections, the Joint Commission is requiring hospitals to conduct periodic risk assessments, select surgical site infection measures based on evidence, and evaluate the effectiveness of their prevention efforts. Also, hospital staff will need to measure infection rates for the first 30 days following most procedures and for the first year after procedures involving implantable devices.

The surgical site infection requirements were developed to be in line with well established guidelines and should help organizations move toward compliance with those guidelines, Dr. Angood said.

All of the new requirements related to health care-associated infections include a 1-year phase-in period, with milestones for planning, development, and testing throughout 2009. Allowing organizations to phase in complex requirements over the course of a year helps them to perform better by achieving concrete goals before full compliance is expected, Dr. Angood said.

Addressing health care-associated infections is a worthy goal, said Dr. Franklin Michota, who is director of academic affairs for the department of hospital medicine at the Cleveland Clinic. There is sufficient evidence to show a clinical benefit from implementing infection control strategies. "It's not an experiment to see if these things work," he said.

Hospitals are likely to face some up-front costs when implementing the new requirements, Dr. Michota said, especially if they need to put a new educational process in place to prepare staff. For that reason, hospitals may be looking to involve hospitalists, who are already on the payroll, in a variety of activities related to preventing health care-associated infections, he said.

Hospitalists may be involved in developing process improvement plans, tracking requirements, or tracking infections. Those who are not involved on the quality side may be asked to champion changes at the floor level by modeling appropriate hand hygiene or compliance with contact precautions.

"Shining additional light on [health care-associated infections] is good," said Dr. Patrick J. Cawley, president of the Society of Hospital Medicine and executive medical director at the Medical University of South Carolina, Charleston.

The requirements for central line-associated bloodstream infections, in particular, are a significant step forward. There is clear evidence in the literature that compliance with central line placement protocols can significantly drive down infection rates, he said. "This is something we all should be doing anyway," Dr. Cawley said.

Although many hospitals have made infection control a priority, having these new requirements from the Joint Commission will help to elevate those efforts, he added.

The Joint Commission also has added new requirements to the goal for medication reconciliation. Hospitals are advised to provide a complete and reconciled list of the patient's medications directly to the patient and explain the list at the time of discharge. In those settings where medications were used minimally or for a short duration, such as the emergency department, the hospital is required to perform a modified medication reconciliation process.

For example, if a short-term course of an antibiotic is prescribed, the patient should be provided with a list containing the medications that the patient will continue using after leaving the hospital.

Also new in 2009 is a requirement to eliminate transfusion errors related to patient misidentification.

Before beginning a blood or blood component transfusion, hospital staff must match the patient to the blood during a two-person bedside verification process. In cases where two individuals are not available, a bar code or other automated technology can be used in place of one of the individuals, according to the Joint Commission.

The Joint Commission has issued new requirements for hospitals in an effort to prevent infections from multidrug-resistant organisms, central line-associated bloodstream infections, and surgical site infections.

The requirements, which are part of the organization's 2009 National Patient Safety Goals for hospitals, include a 1-year phase-in period with full implementation by Jan. 1, 2010.

It is critical for hospitals to begin addressing the issue of health care-associated infections and to try to keep the problem from worsening, said Dr. Peter Angood, vice president and chief patient safety officer for the Joint Commission. "We're in a bit of a tight spot and we need to work our way out of it," he said.

The new infection control requirements build on an existing National Patient Safety Goal on health care-associated infections that had previously included only requirements for compliance with hand hygiene guidelines and had called on hospitals to manage serious infections as sentinel events. Those requirements will remain in place along with the new elements of the goal.

"Infection control is high on our priority list overall," Dr. Angood said.

Under the new 2009 requirements, hospitals are being asked to begin preparing to prevent infections resulting from multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus, Clostridium difficile, vancomycin-resistant enterococci, multidrug-resistant gram negative bacteria, and other epidemiologically important organisms.

Starting in January 2010, hospitals will need to conduct periodic risk assessments for acquisition and transmission of multidrug-resistant organisms, and educate staff and independent providers about prevention strategies and their roles. Hospitals also will be required to provide education about infection control strategies to patients and families who are infected or colonized with multidrug-resistant organisms.

Hospitals will be required to have a surveillance program up and running by Jan. 1, 2010, that is based on the hospital's risk assessment.

When indicated by the risk assessment, hospitals will need to implement a laboratory-based alert system to identify new patients with multidrug-resistant organisms, and an alert system to identify readmitted or transferred patients who have multidrug-resistant organisms.

The Joint Commission also has put new requirements in place to prevent central line-associated bloodstream infections and surgical site infections.

As part of the requirements related to central line-associated bloodstream infections, hospitals will be expected to use a catheter checklist and a standardized protocol for central venous catheter insertion and an all-inclusive standardized supply cart or kit for insertion of central venous catheters.

The requirements also call for the use of standardized protocols for maximum sterile barrier precautions during insertion of a central venous catheter and when disinfecting catheter hubs and injection ports before accessing the ports.

As part of its effort to prevent surgical site infections, the Joint Commission is requiring hospitals to conduct periodic risk assessments, select surgical site infection measures based on evidence, and evaluate the effectiveness of their prevention efforts. Also, hospital staff will need to measure infection rates for the first 30 days following most procedures and for the first year after procedures involving implantable devices.

The surgical site infection requirements were developed to be in line with well established guidelines and should help organizations move toward compliance with those guidelines, Dr. Angood said.

All of the new requirements related to health care-associated infections include a 1-year phase-in period, with milestones for planning, development, and testing throughout 2009. Allowing organizations to phase in complex requirements over the course of a year helps them to perform better by achieving concrete goals before full compliance is expected, Dr. Angood said.

Addressing health care-associated infections is a worthy goal, said Dr. Franklin Michota, who is director of academic affairs for the department of hospital medicine at the Cleveland Clinic. There is sufficient evidence to show a clinical benefit from implementing infection control strategies. "It's not an experiment to see if these things work," he said.

Hospitals are likely to face some up-front costs when implementing the new requirements, Dr. Michota said, especially if they need to put a new educational process in place to prepare staff. For that reason, hospitals may be looking to involve hospitalists, who are already on the payroll, in a variety of activities related to preventing health care-associated infections, he said.

Hospitalists may be involved in developing process improvement plans, tracking requirements, or tracking infections. Those who are not involved on the quality side may be asked to champion changes at the floor level by modeling appropriate hand hygiene or compliance with contact precautions.

"Shining additional light on [health care-associated infections] is good," said Dr. Patrick J. Cawley, president of the Society of Hospital Medicine and executive medical director at the Medical University of South Carolina, Charleston.

The requirements for central line-associated bloodstream infections, in particular, are a significant step forward. There is clear evidence in the literature that compliance with central line placement protocols can significantly drive down infection rates, he said. "This is something we all should be doing anyway," Dr. Cawley said.

Although many hospitals have made infection control a priority, having these new requirements from the Joint Commission will help to elevate those efforts, he added.

The Joint Commission also has added new requirements to the goal for medication reconciliation. Hospitals are advised to provide a complete and reconciled list of the patient's medications directly to the patient and explain the list at the time of discharge. In those settings where medications were used minimally or for a short duration, such as the emergency department, the hospital is required to perform a modified medication reconciliation process.

For example, if a short-term course of an antibiotic is prescribed, the patient should be provided with a list containing the medications that the patient will continue using after leaving the hospital.

Also new in 2009 is a requirement to eliminate transfusion errors related to patient misidentification.

Before beginning a blood or blood component transfusion, hospital staff must match the patient to the blood during a two-person bedside verification process. In cases where two individuals are not available, a bar code or other automated technology can be used in place of one of the individuals, according to the Joint Commission.

NEW YORK — HIV infection may not be a significant risk even among adolescent populations with a high prevalence of other sexually transmitted infections, according to a study of adolescents at a juvenile detention center in Houston.

Although chlamydia and gonorrhea were relatively common among this group of incarcerated teens—28% among girls and 9% among boys—the prevalence of HIV was low among those tested, with only two cases among boys and no cases among girls.

Researchers at the University of Texas evaluated 6,805 sexually active boys and 1,425 sexually active girls who were incarcerated at the Harris County Juvenile Detention Center in 2006 and 2007. The mean age of the population was 15 years old (range 13-16 years) and all identified themselves as heterosexual, Dr. William Risser said at a joint conference sponsored by the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

All of the detainees received a physical examination and health history, and a first-catch urine screening for chlamydia and gonorrhea. They also received an HIV and rapid plasma reagin (RPR) test for syphilis if they had suspicious symptoms, had not been tested for more than 1 year, had another sexually transmitted infection, had sold sex, or requested testing.

Among the 6,805 boys evaluated, 78% were sexually active in the month before admission to the facility, 69% had used a condom at last intercourse, and 29% reported that they had a new partner in the previous month.

Nearly 8% of the boys tested positive for chlamydia, 0.68% tested positive for gonorrhea, and 1% tested positive for both organisms. Of the 2,524 boys who were tested for HIV, only 2 tested positive (0.08%). Of those who tested positive for HIV, their only admitted risk behavior was heterosexual intercourse, said Dr. Risser, director of the division of adolescent medicine at the university in Houston.

Among the 1,425 girls evaluated in the study, the rates of chlamydia and gonorrhea were higher, but there were no cases of HIV. About 74% reported that they were sexually active in the month before they were admitted to the facility, 49% said they had used a condom at last intercourse, 19% had a new partner in the previous month, and 9% said they had traded sex for drugs or money.

Overall, 17% of the girls tested positive for chlamydia, 5% tested positive for gonorrhea, and 6% were positive for both organisms. Of the 807 who underwent HIV testing, no one tested positive.

One of the factors in the low rates of HIV infection might have been the small amount of high-risk drug use. Other studies on the same population show that almost none used drugs other than marijuana. "I really believe that's true because culturally these kids don't use IV drugs," Dr. Risser said.

NEW YORK — HIV infection may not be a significant risk even among adolescent populations with a high prevalence of other sexually transmitted infections, according to a study of adolescents at a juvenile detention center in Houston.

Although chlamydia and gonorrhea were relatively common among this group of incarcerated teens—28% among girls and 9% among boys—the prevalence of HIV was low among those tested, with only two cases among boys and no cases among girls.

Researchers at the University of Texas evaluated 6,805 sexually active boys and 1,425 sexually active girls who were incarcerated at the Harris County Juvenile Detention Center in 2006 and 2007. The mean age of the population was 15 years old (range 13-16 years) and all identified themselves as heterosexual, Dr. William Risser said at a joint conference sponsored by the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

All of the detainees received a physical examination and health history, and a first-catch urine screening for chlamydia and gonorrhea. They also received an HIV and rapid plasma reagin (RPR) test for syphilis if they had suspicious symptoms, had not been tested for more than 1 year, had another sexually transmitted infection, had sold sex, or requested testing.

Among the 6,805 boys evaluated, 78% were sexually active in the month before admission to the facility, 69% had used a condom at last intercourse, and 29% reported that they had a new partner in the previous month.

Nearly 8% of the boys tested positive for chlamydia, 0.68% tested positive for gonorrhea, and 1% tested positive for both organisms. Of the 2,524 boys who were tested for HIV, only 2 tested positive (0.08%). Of those who tested positive for HIV, their only admitted risk behavior was heterosexual intercourse, said Dr. Risser, director of the division of adolescent medicine at the university in Houston.

Among the 1,425 girls evaluated in the study, the rates of chlamydia and gonorrhea were higher, but there were no cases of HIV. About 74% reported that they were sexually active in the month before they were admitted to the facility, 49% said they had used a condom at last intercourse, 19% had a new partner in the previous month, and 9% said they had traded sex for drugs or money.

Overall, 17% of the girls tested positive for chlamydia, 5% tested positive for gonorrhea, and 6% were positive for both organisms. Of the 807 who underwent HIV testing, no one tested positive.

One of the factors in the low rates of HIV infection might have been the small amount of high-risk drug use. Other studies on the same population show that almost none used drugs other than marijuana. "I really believe that's true because culturally these kids don't use IV drugs," Dr. Risser said.

NEW YORK — HIV infection may not be a significant risk even among adolescent populations with a high prevalence of other sexually transmitted infections, according to a study of adolescents at a juvenile detention center in Houston.

Although chlamydia and gonorrhea were relatively common among this group of incarcerated teens—28% among girls and 9% among boys—the prevalence of HIV was low among those tested, with only two cases among boys and no cases among girls.

Researchers at the University of Texas evaluated 6,805 sexually active boys and 1,425 sexually active girls who were incarcerated at the Harris County Juvenile Detention Center in 2006 and 2007. The mean age of the population was 15 years old (range 13-16 years) and all identified themselves as heterosexual, Dr. William Risser said at a joint conference sponsored by the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

All of the detainees received a physical examination and health history, and a first-catch urine screening for chlamydia and gonorrhea. They also received an HIV and rapid plasma reagin (RPR) test for syphilis if they had suspicious symptoms, had not been tested for more than 1 year, had another sexually transmitted infection, had sold sex, or requested testing.

Among the 6,805 boys evaluated, 78% were sexually active in the month before admission to the facility, 69% had used a condom at last intercourse, and 29% reported that they had a new partner in the previous month.

Nearly 8% of the boys tested positive for chlamydia, 0.68% tested positive for gonorrhea, and 1% tested positive for both organisms. Of the 2,524 boys who were tested for HIV, only 2 tested positive (0.08%). Of those who tested positive for HIV, their only admitted risk behavior was heterosexual intercourse, said Dr. Risser, director of the division of adolescent medicine at the university in Houston.

Among the 1,425 girls evaluated in the study, the rates of chlamydia and gonorrhea were higher, but there were no cases of HIV. About 74% reported that they were sexually active in the month before they were admitted to the facility, 49% said they had used a condom at last intercourse, 19% had a new partner in the previous month, and 9% said they had traded sex for drugs or money.

Overall, 17% of the girls tested positive for chlamydia, 5% tested positive for gonorrhea, and 6% were positive for both organisms. Of the 807 who underwent HIV testing, no one tested positive.

One of the factors in the low rates of HIV infection might have been the small amount of high-risk drug use. Other studies on the same population show that almost none used drugs other than marijuana. "I really believe that's true because culturally these kids don't use IV drugs," Dr. Risser said.

Breast-Feeding Support Still Lacking

Many hospitals continue to fall short in their support of breast-feeding by new mothers, according to a study published in Morbidity and Mortality Weekly Report. The findings are based on a national survey of maternity practices that scored (on a scale of 0–100) how hospitals and birth centers across the country support breast-feeding. The mean national score was 63, with hospitals and birthing centers scoring best on direct breast-feeding assistance (mean score, 80) and worst on providing support after discharge (mean score, 40). In addition, the researchers found that many hospitals and birthing centers engaged in practices that have been shown to interfere with breast-feeding. For example, 70% of facilities reported providing breast-feeding mothers with infant formula samples. More than 2,600 hospitals and birthing centers responded last year to the study, the Center for Disease Control and Prevention's first national Maternity Practices in Infant Nutrition and Care survey.

SG Releases Preterm Birth Agenda

The Surgeon General, along with a panel of experts in obstetrics, pediatrics, and public health, has released a national agenda aimed at combating the rising rate of preterm birth. Among their priorities: a national education program to engage women in preventing premature labor, and studies to identify biomarkers that would signal the beginning of preterm labor. The broad-based agenda covers biomedical research; epidemiologic research; psychosocial and behavioral considerations; professional education and training; public outreach; and quality of health care and health services. The agenda was crafted during a 2-day, Congressionally mandated conference last month.

DTC Drug Ads and Women

The Society for Women's Health Research is asking Food and Drug Administration officials to expand their study of demographic differences in the effects of direct-to-consumer drug advertising to include gender. Congress has tasked the FDA with analyzing the effect of DTC ads by age, race, and ethnicity. “It is very likely that DTC ads are and will be specifically targeted to communicate to women. Biological sex should be a vital component to any research in this area and collection of such data will be the only way to efficiently and effectively examine the impact of DTC ads on women,” Phyllis Greenberger, president and CEO of the Society for Women's Health Research, wrote in a letter to the FDA. Ms. Greenberger also noted that DTC ads should educate consumers that men and women may experience different biological responses, even when they take the same drug.

Contraceptive Research

Officials at the Contraception and Reproductive Health (CRH) Branch, part of the National Institute of Child Health and Human Development, are considering a consortium program to help develop new, nonhormonal contraceptives. The program would likely emphasize research on male contraceptives, according to a draft report from the CRH that outlines future research directions. In addition, branch officials plan to continue work on developing hormonal contraceptives for women that have better safety and side-effect profiles. For example, researchers plan to consider testing products that could be safer for obese women. The research directions are based in part on advice from a panel of 12 experts in contraception, reproductive endocrinology, drug development, clinical trials, epidemiology, and pelvic-floor disorders.

Insurers Back Medical Home

The board of directors of America's Health Insurance Plans (AHIP) has endorsed the concept of a medical home, and has sketched out what it sees as principles to guide the transformation of health care delivery into a coordinated, comprehensive approach. The board voted to approve the principles in June at the organization's Institute 2008 meeting. The board suggested that “many clinical settings can potentially constitute a patient-centered medical home,” but that all of those settings should follow the eight broad principles it outlined, including the following: Care should be comprehensive and individualized to suit each patient; coordination should include strategies to engage the patient; health information technology should be employed; clinicians should commit to being accountable for quality and to measuring and reporting on outcomes and cost-effectiveness; and payments should reflect the level of management involved and should help support the cost of developing a medical home infrastructure.

AMA Launches Report Card

The American Medical Association in June launched a campaign to cut waste from the insurance claims process with a new health-insurer report card. “To diagnose the areas of greatest concern within the claims processing system, the AMA has developed its first online rating of health insurers,” said Dr. William Dolan, an AMA board member. The report card, based on a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers, found that insurers reported to physicians the correct contracted payment rate only 62%–87% of the time. In addition, it found that there is extremely wide variation among payers as to how often they apply computer-generated edits to reduce payments (from a low of less than 0.5% to a high of more than 9%). Physicians spend as much as 14% of their total revenue to ensure accurate insurance payments for their services, according to the AMA.

—Mary Ellen Schneider

Breast-Feeding Support Still Lacking

Many hospitals continue to fall short in their support of breast-feeding by new mothers, according to a study published in Morbidity and Mortality Weekly Report. The findings are based on a national survey of maternity practices that scored (on a scale of 0–100) how hospitals and birth centers across the country support breast-feeding. The mean national score was 63, with hospitals and birthing centers scoring best on direct breast-feeding assistance (mean score, 80) and worst on providing support after discharge (mean score, 40). In addition, the researchers found that many hospitals and birthing centers engaged in practices that have been shown to interfere with breast-feeding. For example, 70% of facilities reported providing breast-feeding mothers with infant formula samples. More than 2,600 hospitals and birthing centers responded last year to the study, the Center for Disease Control and Prevention's first national Maternity Practices in Infant Nutrition and Care survey.

SG Releases Preterm Birth Agenda

The Surgeon General, along with a panel of experts in obstetrics, pediatrics, and public health, has released a national agenda aimed at combating the rising rate of preterm birth. Among their priorities: a national education program to engage women in preventing premature labor, and studies to identify biomarkers that would signal the beginning of preterm labor. The broad-based agenda covers biomedical research; epidemiologic research; psychosocial and behavioral considerations; professional education and training; public outreach; and quality of health care and health services. The agenda was crafted during a 2-day, Congressionally mandated conference last month.

DTC Drug Ads and Women

The Society for Women's Health Research is asking Food and Drug Administration officials to expand their study of demographic differences in the effects of direct-to-consumer drug advertising to include gender. Congress has tasked the FDA with analyzing the effect of DTC ads by age, race, and ethnicity. “It is very likely that DTC ads are and will be specifically targeted to communicate to women. Biological sex should be a vital component to any research in this area and collection of such data will be the only way to efficiently and effectively examine the impact of DTC ads on women,” Phyllis Greenberger, president and CEO of the Society for Women's Health Research, wrote in a letter to the FDA. Ms. Greenberger also noted that DTC ads should educate consumers that men and women may experience different biological responses, even when they take the same drug.

Contraceptive Research

Officials at the Contraception and Reproductive Health (CRH) Branch, part of the National Institute of Child Health and Human Development, are considering a consortium program to help develop new, nonhormonal contraceptives. The program would likely emphasize research on male contraceptives, according to a draft report from the CRH that outlines future research directions. In addition, branch officials plan to continue work on developing hormonal contraceptives for women that have better safety and side-effect profiles. For example, researchers plan to consider testing products that could be safer for obese women. The research directions are based in part on advice from a panel of 12 experts in contraception, reproductive endocrinology, drug development, clinical trials, epidemiology, and pelvic-floor disorders.

Insurers Back Medical Home

The board of directors of America's Health Insurance Plans (AHIP) has endorsed the concept of a medical home, and has sketched out what it sees as principles to guide the transformation of health care delivery into a coordinated, comprehensive approach. The board voted to approve the principles in June at the organization's Institute 2008 meeting. The board suggested that “many clinical settings can potentially constitute a patient-centered medical home,” but that all of those settings should follow the eight broad principles it outlined, including the following: Care should be comprehensive and individualized to suit each patient; coordination should include strategies to engage the patient; health information technology should be employed; clinicians should commit to being accountable for quality and to measuring and reporting on outcomes and cost-effectiveness; and payments should reflect the level of management involved and should help support the cost of developing a medical home infrastructure.

AMA Launches Report Card

The American Medical Association in June launched a campaign to cut waste from the insurance claims process with a new health-insurer report card. “To diagnose the areas of greatest concern within the claims processing system, the AMA has developed its first online rating of health insurers,” said Dr. William Dolan, an AMA board member. The report card, based on a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers, found that insurers reported to physicians the correct contracted payment rate only 62%–87% of the time. In addition, it found that there is extremely wide variation among payers as to how often they apply computer-generated edits to reduce payments (from a low of less than 0.5% to a high of more than 9%). Physicians spend as much as 14% of their total revenue to ensure accurate insurance payments for their services, according to the AMA.

—Mary Ellen Schneider

Breast-Feeding Support Still Lacking

Many hospitals continue to fall short in their support of breast-feeding by new mothers, according to a study published in Morbidity and Mortality Weekly Report. The findings are based on a national survey of maternity practices that scored (on a scale of 0–100) how hospitals and birth centers across the country support breast-feeding. The mean national score was 63, with hospitals and birthing centers scoring best on direct breast-feeding assistance (mean score, 80) and worst on providing support after discharge (mean score, 40). In addition, the researchers found that many hospitals and birthing centers engaged in practices that have been shown to interfere with breast-feeding. For example, 70% of facilities reported providing breast-feeding mothers with infant formula samples. More than 2,600 hospitals and birthing centers responded last year to the study, the Center for Disease Control and Prevention's first national Maternity Practices in Infant Nutrition and Care survey.

SG Releases Preterm Birth Agenda

The Surgeon General, along with a panel of experts in obstetrics, pediatrics, and public health, has released a national agenda aimed at combating the rising rate of preterm birth. Among their priorities: a national education program to engage women in preventing premature labor, and studies to identify biomarkers that would signal the beginning of preterm labor. The broad-based agenda covers biomedical research; epidemiologic research; psychosocial and behavioral considerations; professional education and training; public outreach; and quality of health care and health services. The agenda was crafted during a 2-day, Congressionally mandated conference last month.

DTC Drug Ads and Women

The Society for Women's Health Research is asking Food and Drug Administration officials to expand their study of demographic differences in the effects of direct-to-consumer drug advertising to include gender. Congress has tasked the FDA with analyzing the effect of DTC ads by age, race, and ethnicity. “It is very likely that DTC ads are and will be specifically targeted to communicate to women. Biological sex should be a vital component to any research in this area and collection of such data will be the only way to efficiently and effectively examine the impact of DTC ads on women,” Phyllis Greenberger, president and CEO of the Society for Women's Health Research, wrote in a letter to the FDA. Ms. Greenberger also noted that DTC ads should educate consumers that men and women may experience different biological responses, even when they take the same drug.

Contraceptive Research

Officials at the Contraception and Reproductive Health (CRH) Branch, part of the National Institute of Child Health and Human Development, are considering a consortium program to help develop new, nonhormonal contraceptives. The program would likely emphasize research on male contraceptives, according to a draft report from the CRH that outlines future research directions. In addition, branch officials plan to continue work on developing hormonal contraceptives for women that have better safety and side-effect profiles. For example, researchers plan to consider testing products that could be safer for obese women. The research directions are based in part on advice from a panel of 12 experts in contraception, reproductive endocrinology, drug development, clinical trials, epidemiology, and pelvic-floor disorders.

Insurers Back Medical Home

The board of directors of America's Health Insurance Plans (AHIP) has endorsed the concept of a medical home, and has sketched out what it sees as principles to guide the transformation of health care delivery into a coordinated, comprehensive approach. The board voted to approve the principles in June at the organization's Institute 2008 meeting. The board suggested that “many clinical settings can potentially constitute a patient-centered medical home,” but that all of those settings should follow the eight broad principles it outlined, including the following: Care should be comprehensive and individualized to suit each patient; coordination should include strategies to engage the patient; health information technology should be employed; clinicians should commit to being accountable for quality and to measuring and reporting on outcomes and cost-effectiveness; and payments should reflect the level of management involved and should help support the cost of developing a medical home infrastructure.

AMA Launches Report Card

The American Medical Association in June launched a campaign to cut waste from the insurance claims process with a new health-insurer report card. “To diagnose the areas of greatest concern within the claims processing system, the AMA has developed its first online rating of health insurers,” said Dr. William Dolan, an AMA board member. The report card, based on a random sample pulled from more than 5 million services billed electronically to Medicare and seven health insurers, found that insurers reported to physicians the correct contracted payment rate only 62%–87% of the time. In addition, it found that there is extremely wide variation among payers as to how often they apply computer-generated edits to reduce payments (from a low of less than 0.5% to a high of more than 9%). Physicians spend as much as 14% of their total revenue to ensure accurate insurance payments for their services, according to the AMA.

—Mary Ellen Schneider

NEW YORK — Many researchers and clinicians view Internet use to find sexual partners as a risk factor for sexually transmitted diseases, but it may also have some protective qualities, research indicates.

It's important to consider an individual's intent when that individual goes online to find sex partners, said Dr. Kees Rietmeijer, medical director of the STD clinic and control program at the Denver Public Health Department.

When most people think about the Internet and STDs, they think about sites such as manhunt.neteHarmony.com

“We have to start thinking not only about how the Internet can increase risk for STDs, but also how online partnering and online behavior can reduce these risks, even among prospective sex partners,” Dr. Rietmeijer said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

For example, a survey of more than 500 women who met with a person who answered their online personal ad found that they engaged in extensive e-mail correspondence before having a face-to-face meeting and that they used this exchange to negotiate safety, boundaries, sexual preferences, and condom use and to discuss STD status.

However, the survey also revealed that the women engaged in risky sexual behavior. For example, 30% reported that they had sex at the first encounter, and 77% did not use condoms at the first encounter. The researchers concluded that the intensity of the e-mail exchange accelerated the intimacy of the relationship and may have influenced the decision to engage in risky sexual behaviors (Sex. Res. Soc. Policy 2007;4:27-37).

But meeting online may be less risky than other places that individuals meet for sex, Dr. Rietmeijer said.

In a study looking at the factors surrounding HIV serostatus discussion in men who have sex with men, Dr. Rietmeijer and his colleagues found that those who found their sex partners online were four times more likely to have a discussion of serostatus than were those who found sex partners in bath houses (Sex. Transm. Dis. 2007;34:215-9).

But more research is needed to better understand online interactions between prospective partners, he said.

NEW YORK — Many researchers and clinicians view Internet use to find sexual partners as a risk factor for sexually transmitted diseases, but it may also have some protective qualities, research indicates.

It's important to consider an individual's intent when that individual goes online to find sex partners, said Dr. Kees Rietmeijer, medical director of the STD clinic and control program at the Denver Public Health Department.

When most people think about the Internet and STDs, they think about sites such as manhunt.neteHarmony.com

“We have to start thinking not only about how the Internet can increase risk for STDs, but also how online partnering and online behavior can reduce these risks, even among prospective sex partners,” Dr. Rietmeijer said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

For example, a survey of more than 500 women who met with a person who answered their online personal ad found that they engaged in extensive e-mail correspondence before having a face-to-face meeting and that they used this exchange to negotiate safety, boundaries, sexual preferences, and condom use and to discuss STD status.

However, the survey also revealed that the women engaged in risky sexual behavior. For example, 30% reported that they had sex at the first encounter, and 77% did not use condoms at the first encounter. The researchers concluded that the intensity of the e-mail exchange accelerated the intimacy of the relationship and may have influenced the decision to engage in risky sexual behaviors (Sex. Res. Soc. Policy 2007;4:27-37).

But meeting online may be less risky than other places that individuals meet for sex, Dr. Rietmeijer said.

In a study looking at the factors surrounding HIV serostatus discussion in men who have sex with men, Dr. Rietmeijer and his colleagues found that those who found their sex partners online were four times more likely to have a discussion of serostatus than were those who found sex partners in bath houses (Sex. Transm. Dis. 2007;34:215-9).

But more research is needed to better understand online interactions between prospective partners, he said.

NEW YORK — Many researchers and clinicians view Internet use to find sexual partners as a risk factor for sexually transmitted diseases, but it may also have some protective qualities, research indicates.

It's important to consider an individual's intent when that individual goes online to find sex partners, said Dr. Kees Rietmeijer, medical director of the STD clinic and control program at the Denver Public Health Department.

When most people think about the Internet and STDs, they think about sites such as manhunt.neteHarmony.com

“We have to start thinking not only about how the Internet can increase risk for STDs, but also how online partnering and online behavior can reduce these risks, even among prospective sex partners,” Dr. Rietmeijer said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.

For example, a survey of more than 500 women who met with a person who answered their online personal ad found that they engaged in extensive e-mail correspondence before having a face-to-face meeting and that they used this exchange to negotiate safety, boundaries, sexual preferences, and condom use and to discuss STD status.

However, the survey also revealed that the women engaged in risky sexual behavior. For example, 30% reported that they had sex at the first encounter, and 77% did not use condoms at the first encounter. The researchers concluded that the intensity of the e-mail exchange accelerated the intimacy of the relationship and may have influenced the decision to engage in risky sexual behaviors (Sex. Res. Soc. Policy 2007;4:27-37).

But meeting online may be less risky than other places that individuals meet for sex, Dr. Rietmeijer said.

In a study looking at the factors surrounding HIV serostatus discussion in men who have sex with men, Dr. Rietmeijer and his colleagues found that those who found their sex partners online were four times more likely to have a discussion of serostatus than were those who found sex partners in bath houses (Sex. Transm. Dis. 2007;34:215-9).

But more research is needed to better understand online interactions between prospective partners, he said.

NEW YORK — Asking patients to deliver therapy for sexually transmitted diseases to their sexual partners is paying off with increases in the proportion of partners who are being treated, according to data from researchers in Washington state.

The Centers for Disease Control and Prevention advises that expedited partner therapy (EPT), or treating sexual partners without requiring that they first seek a medical evaluation, is an option when other management strategies are impractical or unsuccessful.

In Washington state, public health officials advise that EPT should be given when treatment cannot otherwise be en-sured, according to Dr. Matthew Golden, director of the STD Control Program for Public Health in Seattle/King County.

But EPT isn't a cure-all, Dr. Golden said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV. There are also groups of people who will not get their partners treated. Risk factors include having more than one partner and/or having a partner one is unlikely to have sex with again. “They are a definable group of people who really need our assistance,” he said.

As a result, health officials in King County have developed a case report form to try to triage the more intensive partner notification services, such as the use of disease intervention specialists.

The case report form, which is completed by the diagnosing physician, allows physicians to check a box stating that the health department should assume responsibility for partner notification.

Health officials recommend this option when the patient has more than one sex partner or a partner he or she is unlikely to have sex with again, the patient is a man who has sex with men, or the patient says that he or she is not going to notify their partners.

As part of the initiative, patients and their partners have free access to medications through large clinics and commercial pharmacies.

Use of the case report form has yielded encouraging results. A random sample of individuals diagnosed with gonorrhea or chlamydia showed that about 39% were classified as having all partners treated before the intervention, compared with 65% in the postintervention period (Sex. Transm. Dis. 2007;34:598-603).

And the initiative also seems to have an impact on morbidity, based on preliminary data from a simulation model, said Dr. Golden.

He and his colleagues used the model and estimated that if the trends continue, there would be about a 25% reduction in chlamydial prevalence in about 2 years' time and a 50% reduction in chlamydial prevalence in 4 years' time.

On the basis of the King County data, Dr. Golden and his colleagues are now conducting a community-level, randomized controlled trial throughout the state of Washington. They hope that this larger study will establish whether EPT reduces the prevalence of chlamydial infection and the incidence of gonorrhea at a population level, Dr. Golden said.

NEW YORK — Asking patients to deliver therapy for sexually transmitted diseases to their sexual partners is paying off with increases in the proportion of partners who are being treated, according to data from researchers in Washington state.

The Centers for Disease Control and Prevention advises that expedited partner therapy (EPT), or treating sexual partners without requiring that they first seek a medical evaluation, is an option when other management strategies are impractical or unsuccessful.

In Washington state, public health officials advise that EPT should be given when treatment cannot otherwise be en-sured, according to Dr. Matthew Golden, director of the STD Control Program for Public Health in Seattle/King County.

But EPT isn't a cure-all, Dr. Golden said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV. There are also groups of people who will not get their partners treated. Risk factors include having more than one partner and/or having a partner one is unlikely to have sex with again. “They are a definable group of people who really need our assistance,” he said.

As a result, health officials in King County have developed a case report form to try to triage the more intensive partner notification services, such as the use of disease intervention specialists.

The case report form, which is completed by the diagnosing physician, allows physicians to check a box stating that the health department should assume responsibility for partner notification.

Health officials recommend this option when the patient has more than one sex partner or a partner he or she is unlikely to have sex with again, the patient is a man who has sex with men, or the patient says that he or she is not going to notify their partners.

As part of the initiative, patients and their partners have free access to medications through large clinics and commercial pharmacies.

Use of the case report form has yielded encouraging results. A random sample of individuals diagnosed with gonorrhea or chlamydia showed that about 39% were classified as having all partners treated before the intervention, compared with 65% in the postintervention period (Sex. Transm. Dis. 2007;34:598-603).

And the initiative also seems to have an impact on morbidity, based on preliminary data from a simulation model, said Dr. Golden.

He and his colleagues used the model and estimated that if the trends continue, there would be about a 25% reduction in chlamydial prevalence in about 2 years' time and a 50% reduction in chlamydial prevalence in 4 years' time.

On the basis of the King County data, Dr. Golden and his colleagues are now conducting a community-level, randomized controlled trial throughout the state of Washington. They hope that this larger study will establish whether EPT reduces the prevalence of chlamydial infection and the incidence of gonorrhea at a population level, Dr. Golden said.

NEW YORK — Asking patients to deliver therapy for sexually transmitted diseases to their sexual partners is paying off with increases in the proportion of partners who are being treated, according to data from researchers in Washington state.

The Centers for Disease Control and Prevention advises that expedited partner therapy (EPT), or treating sexual partners without requiring that they first seek a medical evaluation, is an option when other management strategies are impractical or unsuccessful.

In Washington state, public health officials advise that EPT should be given when treatment cannot otherwise be en-sured, according to Dr. Matthew Golden, director of the STD Control Program for Public Health in Seattle/King County.

But EPT isn't a cure-all, Dr. Golden said at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV. There are also groups of people who will not get their partners treated. Risk factors include having more than one partner and/or having a partner one is unlikely to have sex with again. “They are a definable group of people who really need our assistance,” he said.

As a result, health officials in King County have developed a case report form to try to triage the more intensive partner notification services, such as the use of disease intervention specialists.

The case report form, which is completed by the diagnosing physician, allows physicians to check a box stating that the health department should assume responsibility for partner notification.

Health officials recommend this option when the patient has more than one sex partner or a partner he or she is unlikely to have sex with again, the patient is a man who has sex with men, or the patient says that he or she is not going to notify their partners.

As part of the initiative, patients and their partners have free access to medications through large clinics and commercial pharmacies.

Use of the case report form has yielded encouraging results. A random sample of individuals diagnosed with gonorrhea or chlamydia showed that about 39% were classified as having all partners treated before the intervention, compared with 65% in the postintervention period (Sex. Transm. Dis. 2007;34:598-603).

And the initiative also seems to have an impact on morbidity, based on preliminary data from a simulation model, said Dr. Golden.

He and his colleagues used the model and estimated that if the trends continue, there would be about a 25% reduction in chlamydial prevalence in about 2 years' time and a 50% reduction in chlamydial prevalence in 4 years' time.

On the basis of the King County data, Dr. Golden and his colleagues are now conducting a community-level, randomized controlled trial throughout the state of Washington. They hope that this larger study will establish whether EPT reduces the prevalence of chlamydial infection and the incidence of gonorrhea at a population level, Dr. Golden said.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee this month, health care experts are once again scrutinizing his plans to reform the health care system.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress. For individuals and families who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program.

Under the proposal, the government would offer subsidies to individuals who do not quality for Medicaid or SCHIP but still needed financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they are proposing would save the average family about $2,500 a year in medical expenses.

“I want to wake up and know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child,” Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.).

Sen. Obama's approach is really a “backdoor” to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far, short.” Dr. McCanne said he objects to the plan because it continues to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program for health care.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have some method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for the higher risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. One of the drawbacks of Sen. McCain's plan is that it has the potential to destabilize the existing employer-based coverage system, he said. While in the long-term it might be a good idea to move away from that system, that should be a gradual process, he said.

“Employer coverage isn't really broken,” Dr. Lewin said. “But we can improve upon it.” Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said. For example, Sen. Obama's plan commits to improving quality and efficiency in the system but doesn't define how it would be done.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute. Still, Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground. … There's a different environment,” Mr. Nichols said.

Sen. Obama is proposing to create a National Health Insurance Exchange.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee this month, health care experts are once again scrutinizing his plans to reform the health care system.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress. For individuals and families who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program.

Under the proposal, the government would offer subsidies to individuals who do not quality for Medicaid or SCHIP but still needed financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they are proposing would save the average family about $2,500 a year in medical expenses.

“I want to wake up and know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child,” Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.).

Sen. Obama's approach is really a “backdoor” to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far, short.” Dr. McCanne said he objects to the plan because it continues to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program for health care.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have some method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for the higher risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. One of the drawbacks of Sen. McCain's plan is that it has the potential to destabilize the existing employer-based coverage system, he said. While in the long-term it might be a good idea to move away from that system, that should be a gradual process, he said.

“Employer coverage isn't really broken,” Dr. Lewin said. “But we can improve upon it.” Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said. For example, Sen. Obama's plan commits to improving quality and efficiency in the system but doesn't define how it would be done.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute. Still, Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground. … There's a different environment,” Mr. Nichols said.

Sen. Obama is proposing to create a National Health Insurance Exchange.

With Sen. Barack Obama (D-Ill.) set to become the Democratic Party's presidential nominee this month, health care experts are once again scrutinizing his plans to reform the health care system.

The centerpiece of Sen. Obama's plan is a public-private system that would allow people to remain in their employer-sponsored health plans while offering the uninsured the chance to purchase either a private or government-sponsored plan.

For the government-sponsored plan, the proposal uses as a model the Federal Employees Health Benefits Program—the system available to federal employees and members of Congress. For individuals and families who want to purchase insurance on the private market, Sen. Obama is proposing to create a National Health Insurance Exchange through which they could enroll in either the new government-sponsored plan or purchase a private plan.

All plans offered through the exchange would be required to offer at least the same coverage as the government-sponsored plan and adhere to the same standards for quality and efficiency.

Employers also would have a role to play under the Obama plan. Those employers that do not offer or contribute to employee health coverage would be required to pay a percentage of their payroll toward the cost of the government health plan. There would be an exemption for some small employers under the proposal.

The Obama proposal also calls for expanding eligibility for Medicaid and the State Children's Health Insurance Program.

Under the proposal, the government would offer subsidies to individuals who do not quality for Medicaid or SCHIP but still needed financial assistance to purchase health insurance.

Sen. Obama also would guarantee that no American could be turned down for health insurance because of illness or a preexisting condition. However, his proposal stops short of requiring all Americans to purchase coverage. Instead, the plan mandates coverage for children only.

The other half of Sen. Obama's plan is aimed at reducing premiums and decreasing overall health system costs. For example, he would target the catastrophic health expenses that account for a significant portion of the costs incurred by private payers. Under his plan, the federal government would reimburse employer-sponsored health plans for a portion of the cost of catastrophic health events above a certain threshold. In exchange, the plans would have to use the savings to reduce the cost of premiums.

Cost control also is addressed in the Obama plan, with electronic health records playing a big role. The candidate proposes to spend $10 billion a year for the next 5 years in an effort to encourage widespread adoption of EHRs. The idea is that the investment would reap savings through increased efficiencies since paper records are more costly to store and process than are electronic ones, according to the Obama campaign. The plan also seeks to control costs through greater regulation of insurance companies and by allowing the federal government to negotiate drug prices.

The Obama campaign estimates that, if implemented, the reforms they are proposing would save the average family about $2,500 a year in medical expenses.

“I want to wake up and know that every single American has health care when they need it, that every senior has prescription drugs they can afford, and that no parents are going to bed at night worrying about how they'll afford medicine for a sick child,” Sen. Obama said in June during a health care town hall meeting in Bristol, Va.

If elected, Sen. Obama has pledged to implement his health care proposal by the end of his first term as president.

But the plan continues to face critics on the left and the right. Grace-Marie Turner, president of the Galen Institute, an organization that favors free-market approaches to health care, said she is concerned that the government-sponsored program would be underpriced and crowd out the private insurance options the same way that Medicare has crowded out private insurance in the over-65 market.

“That is not a level playing field,” said Ms. Turner, who also is an adviser to the presidential campaign of Sen. John McCain (R-Ariz.).

Sen. Obama's approach is really a “backdoor” to getting everyone on a government-funded health plan, she said.

Ms. Turner also criticized Sen. Obama's plan to have the federal government take on a portion of the costs of catastrophic health costs in employer-sponsored health plans. This type of approach would require the government to be heavily involved in auditing health care expenditures, she said.

Sen. Obama's plan also faced criticism from the left. Dr. Don McCanne, a senior health policy fellow with Physicians for a National Health Program, said the plan “falls far, far, short.” Dr. McCanne said he objects to the plan because it continues to use the private health insurance industry as part of the structure. His organization favors the elimination of private plans and the creation of a single public program for health care.

The concern with providing a government-sponsored plan in competition with private plans is that it would be subjected to adverse selection and the premiums would become unaffordable, Dr. McCanne said. The only way around that would be to provide additional funding through taxes or to have some method of risk pool transfer, in which the private plans with healthier beneficiaries would shift funds to pay for the higher risk individuals, he said.

But Dr. Jack Lewin, CEO of the American College of Cardiology, said that maintaining the private system is politically smart. One of the drawbacks of Sen. McCain's plan is that it has the potential to destabilize the existing employer-based coverage system, he said. While in the long-term it might be a good idea to move away from that system, that should be a gradual process, he said.

“Employer coverage isn't really broken,” Dr. Lewin said. “But we can improve upon it.” Dr. Lewin also praised the Obama plan for starting with coverage for children. However, after the mandate for universal coverage of children, the plan's details are somewhat murky, he said. For example, Sen. Obama's plan commits to improving quality and efficiency in the system but doesn't define how it would be done.

Sen. Obama also has been vague about subsidies, requirements on businesses, and the interaction of the public and private plans, said Len Nichols, director of the health policy program at the New America Foundation, a nonpartisan public policy institute. Still, Sen. Obama's plan is likely to get a warm reception in Congress next year, Mr. Nichols predicted. Unlike in 1992, there has been far more “plowing of the ground. … There's a different environment,” Mr. Nichols said.

Sen. Obama is proposing to create a National Health Insurance Exchange.

If the feds have it their way, 40% of physician offices will use certified electronic health records by 2012 as part of a strategic plan for coordinating the federal government's health IT efforts over the next 4 years.

About 14% of physicians had adopted some form of health information technology (IT) by 2007, according to the Office of the National Coordinator for Health Information Technology, which released the strategic plan. Specifically, the plan calls for removing business barriers and disincentives for adoption of electronic health records (EHRs) and providing training and technical assistance.

For example, the plan says that by next year information on low-cost and effective provider support on EHR adoption should be available online.

The plan also calls for increasing the health IT workforce by training more standards developers, ensuring vendors are trained in the implementation of health IT tools, and training physicians and other health care providers in informatics.

It also highlights the need to address physician concerns about liability risks related to the exchange of electronic health information.

In addition to issues related to adoption, the plan lays out goals for achieving patient-focused health care through electronic health record access, and enabling the use of electronic health data to benefit public health, research, and emergency preparedness.

“[The plan] establishes the next generation of health IT milestones to harness the power of information technology to help transform health and care in this country,” Dr. Robert Kolodner, national coordinator for health information technology, said in a statement.

The goals are all positive, said Dr. Steven Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians, but the plan does not place enough emphasis on the need to provide financial incentives to physicians for purchasing and using electronic health record systems, he said.

“The real bottom line is getting the payment reform that is needed in health care today,” Dr. Waldren said.

The strategic plan represents a “reasonable approach” going forward and gives a sense of how to achieve the president's objective of greater access to EHRs, commented Dan Rode, vice president of policy and government relations at the American Health Information Management Association.

However, many of the items don't have specific timetables for completion but will instead be reassessed in 2010, he said, leaving a lot to be accomplished before 2014.

And while the plan outlines the objectives envisioned by the current administration, the goals and strategies could change with a new president who may be proposing changes to the way health care is delivered, Mr. Rode said.

The plan was developed by the Office of the National Coordinator for Health IT in collaboration with 12 agencies within the Department of Health and Human Services, along with the departments of Commerce, Defense, and Veterans Affairs, and the Federal Communications Commission. The National Committee on Vital Statistics and the American Health Information Community also contributed to the plan.

The strategic plan is available at www.hhs.gov/healthit

If the feds have it their way, 40% of physician offices will use certified electronic health records by 2012 as part of a strategic plan for coordinating the federal government's health IT efforts over the next 4 years.

About 14% of physicians had adopted some form of health information technology (IT) by 2007, according to the Office of the National Coordinator for Health Information Technology, which released the strategic plan. Specifically, the plan calls for removing business barriers and disincentives for adoption of electronic health records (EHRs) and providing training and technical assistance.

For example, the plan says that by next year information on low-cost and effective provider support on EHR adoption should be available online.

The plan also calls for increasing the health IT workforce by training more standards developers, ensuring vendors are trained in the implementation of health IT tools, and training physicians and other health care providers in informatics.

It also highlights the need to address physician concerns about liability risks related to the exchange of electronic health information.

In addition to issues related to adoption, the plan lays out goals for achieving patient-focused health care through electronic health record access, and enabling the use of electronic health data to benefit public health, research, and emergency preparedness.

“[The plan] establishes the next generation of health IT milestones to harness the power of information technology to help transform health and care in this country,” Dr. Robert Kolodner, national coordinator for health information technology, said in a statement.

The goals are all positive, said Dr. Steven Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians, but the plan does not place enough emphasis on the need to provide financial incentives to physicians for purchasing and using electronic health record systems, he said.

“The real bottom line is getting the payment reform that is needed in health care today,” Dr. Waldren said.

The strategic plan represents a “reasonable approach” going forward and gives a sense of how to achieve the president's objective of greater access to EHRs, commented Dan Rode, vice president of policy and government relations at the American Health Information Management Association.

However, many of the items don't have specific timetables for completion but will instead be reassessed in 2010, he said, leaving a lot to be accomplished before 2014.

And while the plan outlines the objectives envisioned by the current administration, the goals and strategies could change with a new president who may be proposing changes to the way health care is delivered, Mr. Rode said.

The plan was developed by the Office of the National Coordinator for Health IT in collaboration with 12 agencies within the Department of Health and Human Services, along with the departments of Commerce, Defense, and Veterans Affairs, and the Federal Communications Commission. The National Committee on Vital Statistics and the American Health Information Community also contributed to the plan.

The strategic plan is available at www.hhs.gov/healthit

If the feds have it their way, 40% of physician offices will use certified electronic health records by 2012 as part of a strategic plan for coordinating the federal government's health IT efforts over the next 4 years.

About 14% of physicians had adopted some form of health information technology (IT) by 2007, according to the Office of the National Coordinator for Health Information Technology, which released the strategic plan. Specifically, the plan calls for removing business barriers and disincentives for adoption of electronic health records (EHRs) and providing training and technical assistance.

For example, the plan says that by next year information on low-cost and effective provider support on EHR adoption should be available online.

The plan also calls for increasing the health IT workforce by training more standards developers, ensuring vendors are trained in the implementation of health IT tools, and training physicians and other health care providers in informatics.

It also highlights the need to address physician concerns about liability risks related to the exchange of electronic health information.

In addition to issues related to adoption, the plan lays out goals for achieving patient-focused health care through electronic health record access, and enabling the use of electronic health data to benefit public health, research, and emergency preparedness.

“[The plan] establishes the next generation of health IT milestones to harness the power of information technology to help transform health and care in this country,” Dr. Robert Kolodner, national coordinator for health information technology, said in a statement.

The goals are all positive, said Dr. Steven Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians, but the plan does not place enough emphasis on the need to provide financial incentives to physicians for purchasing and using electronic health record systems, he said.

“The real bottom line is getting the payment reform that is needed in health care today,” Dr. Waldren said.

The strategic plan represents a “reasonable approach” going forward and gives a sense of how to achieve the president's objective of greater access to EHRs, commented Dan Rode, vice president of policy and government relations at the American Health Information Management Association.

However, many of the items don't have specific timetables for completion but will instead be reassessed in 2010, he said, leaving a lot to be accomplished before 2014.

And while the plan outlines the objectives envisioned by the current administration, the goals and strategies could change with a new president who may be proposing changes to the way health care is delivered, Mr. Rode said.

The plan was developed by the Office of the National Coordinator for Health IT in collaboration with 12 agencies within the Department of Health and Human Services, along with the departments of Commerce, Defense, and Veterans Affairs, and the Federal Communications Commission. The National Committee on Vital Statistics and the American Health Information Community also contributed to the plan.

The strategic plan is available at www.hhs.gov/healthit

The Food and Drug Administration has developed a new national electronic surveillance system that will allow it to search and analyze claims data and other clinical databases for possible postmarket adverse events for drugs and medical devices.

The Sentinel Initiative is designed to bring safety concerns from approved drugs and other medical products to the FDA's attention faster than the traditional MedWatch adverse event reporting system alone.

“We are moving from a reactive dependence on voluntary reporting of product safety concerns to a proactive surveillance of medical products that are currently on the market,” Health and Human Services Secretary Mike Leavitt said during a press conference to announce the initiative.

“The result will be much-improved safety and protections for the American people,” he said.

During the first phase of the surveillance project, the FDA will rely on Medicare data. As part of a pilot collaboration with the Centers for Medicare and Medicaid Services, FDA officials will use the Sentinel system to query Medicare Part D prescription drug claims data, which will be linked to Medicare inpatient and outpatient claims data.

The Part D database currently holds information on medications used by more than 25 million beneficiaries, according to HHS.

The FDA will begin to look into the data in 30 days, following the publication of a final regulation that will allow federal agencies, states, and academic researchers to use claims data from the Medicare Part D program for safety research and quality initiatives.

Starting with the Medicare population will provide valuable data on the elderly and disabled population, said Kerry N. Weems, acting CMS administrator. Drug safety and efficacy data is usually limited in this group because the elderly and disabled often are excluded from clinical trials. This population also is at greater risk for medication side effects because of polypharmacy and many chronic diseases, according to CMS.

In the future, FDA officials hope to be able to query data from other government agencies, such as the Department of Defense and the Department of Veterans Affairs, as well as from large private health plans, said Dr. Andrew C. von Eschenbach, FDA commissioner.

He added that the Sentinel Initiative includes patient privacy protections. The system queries existing databases without actually acquiring the data. Essentially, the system asks questions and gets answers without identifying patient information, Dr. von Eschenbach said.

The Sentinel system will work in conjunction with the existing FDA surveillance systems. For example, if the FDA receives a report of an adverse event following the use of a drug, officials will be able to query data on a large number of subjects who have taken the drug. And, in the future, agency officials may even be able to compare data from patients taking the drug with a control group of similar patients who have not taken the drug. This will allow FDA officials to give physicians better information about what particular groups of patients may be at higher risk for a specific adverse event, said Dr. Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research.

“Although it won't answer all the questions, it will provide us with a tremendous new source of information,” Dr. Woodcock said.

The Institute of Medicine called on the FDA in a 2006 report to create an active surveillance system as a way to improve the safety of drugs. In addition, the Food and Drug Administration Amendments Act of 2007 (FDAAA) directs the FDA to develop a proactive surveillance system.

The Sentinel Initiative has garnered the support of the Pharmaceutical Research and Manufacturers of America. The group issued a statement praising the movement from voluntary reporting alone to a system that incorporates proactive monitoring of drugs and other medical products.

“Clearly, this program should improve the efficiency of postmarket surveillance of medicines and, in the end, the beneficiaries will be the many patients using these products,” said Ken Johnson, senior vice president of PhRMA.

We are moving from a reactive dependence on voluntary reporting to a proactive surveillance of current products. MR. LEAVITT

Consumer Guide to Complaint Reporting

A Web site with detailed instructions on how to use the Food and Drug Administration's consumer complaint system and Medwatch is available at

www.fda.gov/consumer/updates/reporting061008.html

www.fda.gov/consumer/updates/reporting061008.pdf

The Food and Drug Administration has developed a new national electronic surveillance system that will allow it to search and analyze claims data and other clinical databases for possible postmarket adverse events for drugs and medical devices.

The Sentinel Initiative is designed to bring safety concerns from approved drugs and other medical products to the FDA's attention faster than the traditional MedWatch adverse event reporting system alone.

“We are moving from a reactive dependence on voluntary reporting of product safety concerns to a proactive surveillance of medical products that are currently on the market,” Health and Human Services Secretary Mike Leavitt said during a press conference to announce the initiative.

“The result will be much-improved safety and protections for the American people,” he said.

During the first phase of the surveillance project, the FDA will rely on Medicare data. As part of a pilot collaboration with the Centers for Medicare and Medicaid Services, FDA officials will use the Sentinel system to query Medicare Part D prescription drug claims data, which will be linked to Medicare inpatient and outpatient claims data.

The Part D database currently holds information on medications used by more than 25 million beneficiaries, according to HHS.

The FDA will begin to look into the data in 30 days, following the publication of a final regulation that will allow federal agencies, states, and academic researchers to use claims data from the Medicare Part D program for safety research and quality initiatives.

Starting with the Medicare population will provide valuable data on the elderly and disabled population, said Kerry N. Weems, acting CMS administrator. Drug safety and efficacy data is usually limited in this group because the elderly and disabled often are excluded from clinical trials. This population also is at greater risk for medication side effects because of polypharmacy and many chronic diseases, according to CMS.

In the future, FDA officials hope to be able to query data from other government agencies, such as the Department of Defense and the Department of Veterans Affairs, as well as from large private health plans, said Dr. Andrew C. von Eschenbach, FDA commissioner.

He added that the Sentinel Initiative includes patient privacy protections. The system queries existing databases without actually acquiring the data. Essentially, the system asks questions and gets answers without identifying patient information, Dr. von Eschenbach said.

The Sentinel system will work in conjunction with the existing FDA surveillance systems. For example, if the FDA receives a report of an adverse event following the use of a drug, officials will be able to query data on a large number of subjects who have taken the drug. And, in the future, agency officials may even be able to compare data from patients taking the drug with a control group of similar patients who have not taken the drug. This will allow FDA officials to give physicians better information about what particular groups of patients may be at higher risk for a specific adverse event, said Dr. Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research.

“Although it won't answer all the questions, it will provide us with a tremendous new source of information,” Dr. Woodcock said.

The Institute of Medicine called on the FDA in a 2006 report to create an active surveillance system as a way to improve the safety of drugs. In addition, the Food and Drug Administration Amendments Act of 2007 (FDAAA) directs the FDA to develop a proactive surveillance system.

The Sentinel Initiative has garnered the support of the Pharmaceutical Research and Manufacturers of America. The group issued a statement praising the movement from voluntary reporting alone to a system that incorporates proactive monitoring of drugs and other medical products.

“Clearly, this program should improve the efficiency of postmarket surveillance of medicines and, in the end, the beneficiaries will be the many patients using these products,” said Ken Johnson, senior vice president of PhRMA.

We are moving from a reactive dependence on voluntary reporting to a proactive surveillance of current products. MR. LEAVITT

Consumer Guide to Complaint Reporting

A Web site with detailed instructions on how to use the Food and Drug Administration's consumer complaint system and Medwatch is available at

www.fda.gov/consumer/updates/reporting061008.html

www.fda.gov/consumer/updates/reporting061008.pdf

The Food and Drug Administration has developed a new national electronic surveillance system that will allow it to search and analyze claims data and other clinical databases for possible postmarket adverse events for drugs and medical devices.

The Sentinel Initiative is designed to bring safety concerns from approved drugs and other medical products to the FDA's attention faster than the traditional MedWatch adverse event reporting system alone.

“We are moving from a reactive dependence on voluntary reporting of product safety concerns to a proactive surveillance of medical products that are currently on the market,” Health and Human Services Secretary Mike Leavitt said during a press conference to announce the initiative.

“The result will be much-improved safety and protections for the American people,” he said.

During the first phase of the surveillance project, the FDA will rely on Medicare data. As part of a pilot collaboration with the Centers for Medicare and Medicaid Services, FDA officials will use the Sentinel system to query Medicare Part D prescription drug claims data, which will be linked to Medicare inpatient and outpatient claims data.

The Part D database currently holds information on medications used by more than 25 million beneficiaries, according to HHS.

The FDA will begin to look into the data in 30 days, following the publication of a final regulation that will allow federal agencies, states, and academic researchers to use claims data from the Medicare Part D program for safety research and quality initiatives.

Starting with the Medicare population will provide valuable data on the elderly and disabled population, said Kerry N. Weems, acting CMS administrator. Drug safety and efficacy data is usually limited in this group because the elderly and disabled often are excluded from clinical trials. This population also is at greater risk for medication side effects because of polypharmacy and many chronic diseases, according to CMS.

In the future, FDA officials hope to be able to query data from other government agencies, such as the Department of Defense and the Department of Veterans Affairs, as well as from large private health plans, said Dr. Andrew C. von Eschenbach, FDA commissioner.

He added that the Sentinel Initiative includes patient privacy protections. The system queries existing databases without actually acquiring the data. Essentially, the system asks questions and gets answers without identifying patient information, Dr. von Eschenbach said.

The Sentinel system will work in conjunction with the existing FDA surveillance systems. For example, if the FDA receives a report of an adverse event following the use of a drug, officials will be able to query data on a large number of subjects who have taken the drug. And, in the future, agency officials may even be able to compare data from patients taking the drug with a control group of similar patients who have not taken the drug. This will allow FDA officials to give physicians better information about what particular groups of patients may be at higher risk for a specific adverse event, said Dr. Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research.

“Although it won't answer all the questions, it will provide us with a tremendous new source of information,” Dr. Woodcock said.

The Institute of Medicine called on the FDA in a 2006 report to create an active surveillance system as a way to improve the safety of drugs. In addition, the Food and Drug Administration Amendments Act of 2007 (FDAAA) directs the FDA to develop a proactive surveillance system.

The Sentinel Initiative has garnered the support of the Pharmaceutical Research and Manufacturers of America. The group issued a statement praising the movement from voluntary reporting alone to a system that incorporates proactive monitoring of drugs and other medical products.

“Clearly, this program should improve the efficiency of postmarket surveillance of medicines and, in the end, the beneficiaries will be the many patients using these products,” said Ken Johnson, senior vice president of PhRMA.

We are moving from a reactive dependence on voluntary reporting to a proactive surveillance of current products. MR. LEAVITT

Consumer Guide to Complaint Reporting

A Web site with detailed instructions on how to use the Food and Drug Administration's consumer complaint system and Medwatch is available at

www.fda.gov/consumer/updates/reporting061008.html

www.fda.gov/consumer/updates/reporting061008.pdf