Mary Ellen Schneider

Hospital payment information is posted at www.cms.hhs.gov/HealthCareConInit

Patients and physicians can now find out how much Medicare pays hospitals for certain common elective procedures and for other admissions, and by fall of this year, similar information regarding outpatient and physician services will be accessible.

The hospital information, which is posted on Medicare's Web site, includes aggregated payment information by county for fiscal year 2005.

Officials at the Centers for Medicare and Medicaid Services have also released information on the volume of these procedures at each hospital.

“People need to know how much their health care costs,” Health and Human Services Secretary Mike Leavitt said during a press briefing.

“They need to know the quality of the care they receive, and they need to have a reason to care. Right now none of those things exist in our health care system,” he said.

Mr. Leavitt said this information is the first step to greater transparency of health care cost and quality information. This summer, CMS officials plan to post Medicare payment information for common elective procedures performed at ambulatory surgery centers.

Moreover, starting this fall the agency plans to post Medicare payment information for common hospital outpatient and physician services.

Ultimately, consumers will be able to use this type of information to make better decisions about their care, Mr. Leavitt said.

For example, a patient in need of knee replacement surgery today would likely choose a hospital based on its location or the recommendation of a physician. However, at some point in the future, patients will be able to assemble information on the number of knee replacement surgeries performed at a certain hospital, compare the quality of the hospital against national data, and see patient satisfaction information, he said.

The information released last month includes the range of Medicare payments and the volume of services for 30 conditions with the highest utilization rates among all Diagnosis Related Groups, including implanting cardiac defibrillators, hip and knee replacements, and gallbladder operations.

Data also are available on conditions that were not in the top 30 DRGs but which are of interest to the Medicare community.

Hospital payment information is posted at www.cms.hhs.gov/HealthCareConInit

Patients and physicians can now find out how much Medicare pays hospitals for certain common elective procedures and for other admissions, and by fall of this year, similar information regarding outpatient and physician services will be accessible.

The hospital information, which is posted on Medicare's Web site, includes aggregated payment information by county for fiscal year 2005.

Officials at the Centers for Medicare and Medicaid Services have also released information on the volume of these procedures at each hospital.

“People need to know how much their health care costs,” Health and Human Services Secretary Mike Leavitt said during a press briefing.

“They need to know the quality of the care they receive, and they need to have a reason to care. Right now none of those things exist in our health care system,” he said.

Mr. Leavitt said this information is the first step to greater transparency of health care cost and quality information. This summer, CMS officials plan to post Medicare payment information for common elective procedures performed at ambulatory surgery centers.

Moreover, starting this fall the agency plans to post Medicare payment information for common hospital outpatient and physician services.

Ultimately, consumers will be able to use this type of information to make better decisions about their care, Mr. Leavitt said.

For example, a patient in need of knee replacement surgery today would likely choose a hospital based on its location or the recommendation of a physician. However, at some point in the future, patients will be able to assemble information on the number of knee replacement surgeries performed at a certain hospital, compare the quality of the hospital against national data, and see patient satisfaction information, he said.

The information released last month includes the range of Medicare payments and the volume of services for 30 conditions with the highest utilization rates among all Diagnosis Related Groups, including implanting cardiac defibrillators, hip and knee replacements, and gallbladder operations.

Data also are available on conditions that were not in the top 30 DRGs but which are of interest to the Medicare community.

Hospital payment information is posted at www.cms.hhs.gov/HealthCareConInit

Patients and physicians can now find out how much Medicare pays hospitals for certain common elective procedures and for other admissions, and by fall of this year, similar information regarding outpatient and physician services will be accessible.

The hospital information, which is posted on Medicare's Web site, includes aggregated payment information by county for fiscal year 2005.

Officials at the Centers for Medicare and Medicaid Services have also released information on the volume of these procedures at each hospital.

“People need to know how much their health care costs,” Health and Human Services Secretary Mike Leavitt said during a press briefing.

“They need to know the quality of the care they receive, and they need to have a reason to care. Right now none of those things exist in our health care system,” he said.

Mr. Leavitt said this information is the first step to greater transparency of health care cost and quality information. This summer, CMS officials plan to post Medicare payment information for common elective procedures performed at ambulatory surgery centers.

Moreover, starting this fall the agency plans to post Medicare payment information for common hospital outpatient and physician services.

Ultimately, consumers will be able to use this type of information to make better decisions about their care, Mr. Leavitt said.

For example, a patient in need of knee replacement surgery today would likely choose a hospital based on its location or the recommendation of a physician. However, at some point in the future, patients will be able to assemble information on the number of knee replacement surgeries performed at a certain hospital, compare the quality of the hospital against national data, and see patient satisfaction information, he said.

The information released last month includes the range of Medicare payments and the volume of services for 30 conditions with the highest utilization rates among all Diagnosis Related Groups, including implanting cardiac defibrillators, hip and knee replacements, and gallbladder operations.

Data also are available on conditions that were not in the top 30 DRGs but which are of interest to the Medicare community.

The Food and Drug Administration is once again under fire for its evaluation of the proposed over-the-counter use of the emergency contraceptive Plan B, with advocates for approval accusing the agency of putting politics first.

Fueling the accusations are recently released depositions from a lawsuit filed against the FDA by the Center for Reproductive Rights along with the Association of Reproductive Health Professionals, the National Latina Institute for Reproductive Health, and individual members of the Morning-After Pill Conspiracy, an advocacy group.

The plaintiffs are asking a U.S. District Court in New York to order the FDA to make Plan B (levonorgestrel) available without a prescription to women of all ages.

In a deposition taken in April as part of the lawsuit and released in late May, Dr. Steven Galson, director of the Center for Drug Evaluation and Research, testified that he had been leaning toward approval of over-the-counter use of Plan B for older teens and women in early 2005 when Lester Crawford, Ph.D., who was then acting FDA commissioner, took over decision making on the application.

“Dr. Crawford … told me that he was concerned about where we were heading because he knew that I was heading towards this recommendation, and he told me that he was going to make the decision on what to do with the application,” Dr. Galson said in his deposition.

Dr. Galson said that this was the first time that the FDA commissioner had ever removed authority over a drug application from him, and said that he did not know of it happening to anyone else in his position.

In May 2004, the FDA rejected an application submitted by Barr Pharmaceuticals Inc. to make Plan B available without a prescription.

In August 2005, Dr. Crawford announced that the agency was issued an advance notice of proposed rule making to solicit comments about the regulatory issues involved in split approval of the drug—with over-the-counter availability for women aged 17 and older and prescription-only access for those under 17. The agency has yet to issue a decision on this dual marketing approach to Plan B.

In his deposition, Dr. Galson said that he supported the approval of Plan B for over-the-counter use among certain women based on public health considerations. However, he testified that he was not pressured into issuing the May 2004 not-approvable letter for making Plan B available over the counter for women of all ages. He also expressed concerns about the lack of data on the effect of OTC access among younger girls.

The Center for Reproductive Rights also released a deposition taken in April from Dr. Janet Woodcock, FDA Deputy Commissioner. She testified that Dr. Crawford had assumed the authority for the Plan B decision.

Dr. Crawford gave testimony in late May, but a transcript was not available at press time. Dr. Mark McClellan, former FDA commissioner and current administrator of the Centers for Medicare and Medicaid Services, is expected to give a deposition in June.

Officials with the Center for Reproductive Rights have requested that five other FDA officials give depositions as part of the lawsuit. Officials at the FDA had no comment on the lawsuit or on the recently released depositions.

Jodie Curtis, assistant director of government relations for the Planned Parenthood Federation of America, said that the information coming out of the depositions continues to raise concerns about the role politics played in FDA decision making on Plan B. She said she hopes that the lawsuit will “shine a light” on what is going on within the FDA, and that Congress will also begin to use its oversight authority to ask questions.

But despite irregularities in the way Plan B has been handled, in most instances the drug approval process works well, she said. “The system is broken in this case,” Ms. Curtis said. “I don't know that the system is broken overall.”

Susan F. Wood, Ph.D., a consultant with the Reproductive Health Technologies Project and the former head of the FDA's Office of Women's Health, said that from what she has read in media reports, the information from the depositions is “consistent” with her impressions that the FDA's professional staff was cut out of the decision making on Plan B.

Dr. Wood resigned from the FDA in 2005 in protest of the agency's delay in approving Plan B for OTC use. The handling of the Plan B application has damaged the FDA's credibility and in the long term could make it difficult to recruit and retain talented scientists, Dr. Wood said. If the FDA had relied on its normal process for evaluating Plan B, it would already have been approved, she said.

But David Christensen, director of congressional affairs for the Family Research Council, said Dr. Crawford acted properly in taking time to consider the legal and regulatory issues that go along with this type of dual marketing approval. The implications go beyond Plan B and beyond just scientific considerations, he said. “This wasn't politics,” he said. “This was just prudence.”

If the FDA had relied on its normal process for evaluating Plan B, it would already have been approved. DR. WOOD

The Food and Drug Administration is once again under fire for its evaluation of the proposed over-the-counter use of the emergency contraceptive Plan B, with advocates for approval accusing the agency of putting politics first.

Fueling the accusations are recently released depositions from a lawsuit filed against the FDA by the Center for Reproductive Rights along with the Association of Reproductive Health Professionals, the National Latina Institute for Reproductive Health, and individual members of the Morning-After Pill Conspiracy, an advocacy group.

The plaintiffs are asking a U.S. District Court in New York to order the FDA to make Plan B (levonorgestrel) available without a prescription to women of all ages.

In a deposition taken in April as part of the lawsuit and released in late May, Dr. Steven Galson, director of the Center for Drug Evaluation and Research, testified that he had been leaning toward approval of over-the-counter use of Plan B for older teens and women in early 2005 when Lester Crawford, Ph.D., who was then acting FDA commissioner, took over decision making on the application.

“Dr. Crawford … told me that he was concerned about where we were heading because he knew that I was heading towards this recommendation, and he told me that he was going to make the decision on what to do with the application,” Dr. Galson said in his deposition.

Dr. Galson said that this was the first time that the FDA commissioner had ever removed authority over a drug application from him, and said that he did not know of it happening to anyone else in his position.

In May 2004, the FDA rejected an application submitted by Barr Pharmaceuticals Inc. to make Plan B available without a prescription.

In August 2005, Dr. Crawford announced that the agency was issued an advance notice of proposed rule making to solicit comments about the regulatory issues involved in split approval of the drug—with over-the-counter availability for women aged 17 and older and prescription-only access for those under 17. The agency has yet to issue a decision on this dual marketing approach to Plan B.

In his deposition, Dr. Galson said that he supported the approval of Plan B for over-the-counter use among certain women based on public health considerations. However, he testified that he was not pressured into issuing the May 2004 not-approvable letter for making Plan B available over the counter for women of all ages. He also expressed concerns about the lack of data on the effect of OTC access among younger girls.

The Center for Reproductive Rights also released a deposition taken in April from Dr. Janet Woodcock, FDA Deputy Commissioner. She testified that Dr. Crawford had assumed the authority for the Plan B decision.

Dr. Crawford gave testimony in late May, but a transcript was not available at press time. Dr. Mark McClellan, former FDA commissioner and current administrator of the Centers for Medicare and Medicaid Services, is expected to give a deposition in June.

Officials with the Center for Reproductive Rights have requested that five other FDA officials give depositions as part of the lawsuit. Officials at the FDA had no comment on the lawsuit or on the recently released depositions.

Jodie Curtis, assistant director of government relations for the Planned Parenthood Federation of America, said that the information coming out of the depositions continues to raise concerns about the role politics played in FDA decision making on Plan B. She said she hopes that the lawsuit will “shine a light” on what is going on within the FDA, and that Congress will also begin to use its oversight authority to ask questions.

But despite irregularities in the way Plan B has been handled, in most instances the drug approval process works well, she said. “The system is broken in this case,” Ms. Curtis said. “I don't know that the system is broken overall.”

Susan F. Wood, Ph.D., a consultant with the Reproductive Health Technologies Project and the former head of the FDA's Office of Women's Health, said that from what she has read in media reports, the information from the depositions is “consistent” with her impressions that the FDA's professional staff was cut out of the decision making on Plan B.

Dr. Wood resigned from the FDA in 2005 in protest of the agency's delay in approving Plan B for OTC use. The handling of the Plan B application has damaged the FDA's credibility and in the long term could make it difficult to recruit and retain talented scientists, Dr. Wood said. If the FDA had relied on its normal process for evaluating Plan B, it would already have been approved, she said.

But David Christensen, director of congressional affairs for the Family Research Council, said Dr. Crawford acted properly in taking time to consider the legal and regulatory issues that go along with this type of dual marketing approval. The implications go beyond Plan B and beyond just scientific considerations, he said. “This wasn't politics,” he said. “This was just prudence.”

If the FDA had relied on its normal process for evaluating Plan B, it would already have been approved. DR. WOOD

The Food and Drug Administration is once again under fire for its evaluation of the proposed over-the-counter use of the emergency contraceptive Plan B, with advocates for approval accusing the agency of putting politics first.

Fueling the accusations are recently released depositions from a lawsuit filed against the FDA by the Center for Reproductive Rights along with the Association of Reproductive Health Professionals, the National Latina Institute for Reproductive Health, and individual members of the Morning-After Pill Conspiracy, an advocacy group.

The plaintiffs are asking a U.S. District Court in New York to order the FDA to make Plan B (levonorgestrel) available without a prescription to women of all ages.

In a deposition taken in April as part of the lawsuit and released in late May, Dr. Steven Galson, director of the Center for Drug Evaluation and Research, testified that he had been leaning toward approval of over-the-counter use of Plan B for older teens and women in early 2005 when Lester Crawford, Ph.D., who was then acting FDA commissioner, took over decision making on the application.

“Dr. Crawford … told me that he was concerned about where we were heading because he knew that I was heading towards this recommendation, and he told me that he was going to make the decision on what to do with the application,” Dr. Galson said in his deposition.

Dr. Galson said that this was the first time that the FDA commissioner had ever removed authority over a drug application from him, and said that he did not know of it happening to anyone else in his position.

In May 2004, the FDA rejected an application submitted by Barr Pharmaceuticals Inc. to make Plan B available without a prescription.

In August 2005, Dr. Crawford announced that the agency was issued an advance notice of proposed rule making to solicit comments about the regulatory issues involved in split approval of the drug—with over-the-counter availability for women aged 17 and older and prescription-only access for those under 17. The agency has yet to issue a decision on this dual marketing approach to Plan B.

In his deposition, Dr. Galson said that he supported the approval of Plan B for over-the-counter use among certain women based on public health considerations. However, he testified that he was not pressured into issuing the May 2004 not-approvable letter for making Plan B available over the counter for women of all ages. He also expressed concerns about the lack of data on the effect of OTC access among younger girls.

The Center for Reproductive Rights also released a deposition taken in April from Dr. Janet Woodcock, FDA Deputy Commissioner. She testified that Dr. Crawford had assumed the authority for the Plan B decision.

Dr. Crawford gave testimony in late May, but a transcript was not available at press time. Dr. Mark McClellan, former FDA commissioner and current administrator of the Centers for Medicare and Medicaid Services, is expected to give a deposition in June.

Officials with the Center for Reproductive Rights have requested that five other FDA officials give depositions as part of the lawsuit. Officials at the FDA had no comment on the lawsuit or on the recently released depositions.

Jodie Curtis, assistant director of government relations for the Planned Parenthood Federation of America, said that the information coming out of the depositions continues to raise concerns about the role politics played in FDA decision making on Plan B. She said she hopes that the lawsuit will “shine a light” on what is going on within the FDA, and that Congress will also begin to use its oversight authority to ask questions.

But despite irregularities in the way Plan B has been handled, in most instances the drug approval process works well, she said. “The system is broken in this case,” Ms. Curtis said. “I don't know that the system is broken overall.”

Susan F. Wood, Ph.D., a consultant with the Reproductive Health Technologies Project and the former head of the FDA's Office of Women's Health, said that from what she has read in media reports, the information from the depositions is “consistent” with her impressions that the FDA's professional staff was cut out of the decision making on Plan B.

Dr. Wood resigned from the FDA in 2005 in protest of the agency's delay in approving Plan B for OTC use. The handling of the Plan B application has damaged the FDA's credibility and in the long term could make it difficult to recruit and retain talented scientists, Dr. Wood said. If the FDA had relied on its normal process for evaluating Plan B, it would already have been approved, she said.

But David Christensen, director of congressional affairs for the Family Research Council, said Dr. Crawford acted properly in taking time to consider the legal and regulatory issues that go along with this type of dual marketing approval. The implications go beyond Plan B and beyond just scientific considerations, he said. “This wasn't politics,” he said. “This was just prudence.”

If the FDA had relied on its normal process for evaluating Plan B, it would already have been approved. DR. WOOD

LOS ANGELES — Extended combination therapy with consensus interferon for 72 weeks appears to help improve the viral response of patients with chronic hepatitis C virus who have previously relapsed after a 48-week course of treatment, according to a study presented at the annual Digestive Disease Week.

The investigator-initiated study, conducted by researchers from the University of Tübingen in Germany, showed that at the end of 72 weeks of daily therapy, the majority of patients treated with a combination of either consensus interferon plus ribavirin or pegylated interferon alfa-2a plus ribavirin had a reduction in hepatitis RNA. However, the drop was not statistically significant, said the lead study author, Dr. Stephan Kaiser, a professor of medicine at the university.

The investigators compared the two interferon combinations in 81 patients who had experienced a previous relapse after a standard 48 weeks of pegylated interferon plus ribavirin. At the end of week 72, 89% of patients taking the consensus interferon combination were in remission, compared with 76% of the pegylated alfa-2a interferon group.

But relapse rates remained high in the study, Dr. Kaiser said. The pegylated alfa-2a interferon combination led to significantly higher rates of relapse than the consensus interferon combination. About 44% of the patients in the pegylated alfa-2a interferon combination group had a sustained viral response after completing treatment, compared with 69% of those in the consensus interferon group.

Overall, the study indicated that treatment for relapse can be successful using consensus therapy for an extended period, but more research is needed in multicenter trials, Dr. Kaiser said.

Researchers also presented new data on treatments for another difficult-to-treat population: nonresponders. Interim results from an ongoing phase II multicenter trial show that a combination of valopicitabine (NM283) at high doses plus pegylated interferon can reduce hepatitis RNA at 24 weeks of treatment, reported Dr. Paul Pockros of Scripps Clinic in California and his colleagues.

The five-arm study is comparing valopicitabine alone with three different doses of valopicitabine (400 mg/day, 800 mg/day, and dose-ramping from 400 to 800 mg/day) in combination with pegylated interferon, and with pegylated interferon plus ribavirin as a control.

Valopicitabine, manufactured by Idenix Pharmaceuticals, is the first nucleotide-type HCV polymerase inhibitor to advance to phase II trials. The study is funded by the drug maker.

The best results—about a 3-log decrease in hepatitis RNA—were achieved with the 800-mg dose of valopicitabine plus pegylated interferon. However, some patients experienced vomiting and nausea at initiation of treatment, and three patients were hospitalized with dehydration, so researchers stopped using the 800-mg dose and are continuing with 200-mg and 400-mg doses of the drug.

The results with the combination of 400 mg of valopicitabine and pegylated interferon were less promising in the nonresponder study population, with about a 2.5-log decrease, Dr. Pockros said.

Continued treatment is needed to find out if there will be a sustained response with the new drug combination, Dr. Pockros said, and to find out if the drug will be more effective for preventing relapse than are current therapies.

LOS ANGELES — Extended combination therapy with consensus interferon for 72 weeks appears to help improve the viral response of patients with chronic hepatitis C virus who have previously relapsed after a 48-week course of treatment, according to a study presented at the annual Digestive Disease Week.

The investigator-initiated study, conducted by researchers from the University of Tübingen in Germany, showed that at the end of 72 weeks of daily therapy, the majority of patients treated with a combination of either consensus interferon plus ribavirin or pegylated interferon alfa-2a plus ribavirin had a reduction in hepatitis RNA. However, the drop was not statistically significant, said the lead study author, Dr. Stephan Kaiser, a professor of medicine at the university.

The investigators compared the two interferon combinations in 81 patients who had experienced a previous relapse after a standard 48 weeks of pegylated interferon plus ribavirin. At the end of week 72, 89% of patients taking the consensus interferon combination were in remission, compared with 76% of the pegylated alfa-2a interferon group.

But relapse rates remained high in the study, Dr. Kaiser said. The pegylated alfa-2a interferon combination led to significantly higher rates of relapse than the consensus interferon combination. About 44% of the patients in the pegylated alfa-2a interferon combination group had a sustained viral response after completing treatment, compared with 69% of those in the consensus interferon group.

Overall, the study indicated that treatment for relapse can be successful using consensus therapy for an extended period, but more research is needed in multicenter trials, Dr. Kaiser said.

Researchers also presented new data on treatments for another difficult-to-treat population: nonresponders. Interim results from an ongoing phase II multicenter trial show that a combination of valopicitabine (NM283) at high doses plus pegylated interferon can reduce hepatitis RNA at 24 weeks of treatment, reported Dr. Paul Pockros of Scripps Clinic in California and his colleagues.

The five-arm study is comparing valopicitabine alone with three different doses of valopicitabine (400 mg/day, 800 mg/day, and dose-ramping from 400 to 800 mg/day) in combination with pegylated interferon, and with pegylated interferon plus ribavirin as a control.

Valopicitabine, manufactured by Idenix Pharmaceuticals, is the first nucleotide-type HCV polymerase inhibitor to advance to phase II trials. The study is funded by the drug maker.

The best results—about a 3-log decrease in hepatitis RNA—were achieved with the 800-mg dose of valopicitabine plus pegylated interferon. However, some patients experienced vomiting and nausea at initiation of treatment, and three patients were hospitalized with dehydration, so researchers stopped using the 800-mg dose and are continuing with 200-mg and 400-mg doses of the drug.

The results with the combination of 400 mg of valopicitabine and pegylated interferon were less promising in the nonresponder study population, with about a 2.5-log decrease, Dr. Pockros said.

Continued treatment is needed to find out if there will be a sustained response with the new drug combination, Dr. Pockros said, and to find out if the drug will be more effective for preventing relapse than are current therapies.

LOS ANGELES — Extended combination therapy with consensus interferon for 72 weeks appears to help improve the viral response of patients with chronic hepatitis C virus who have previously relapsed after a 48-week course of treatment, according to a study presented at the annual Digestive Disease Week.

The investigator-initiated study, conducted by researchers from the University of Tübingen in Germany, showed that at the end of 72 weeks of daily therapy, the majority of patients treated with a combination of either consensus interferon plus ribavirin or pegylated interferon alfa-2a plus ribavirin had a reduction in hepatitis RNA. However, the drop was not statistically significant, said the lead study author, Dr. Stephan Kaiser, a professor of medicine at the university.

The investigators compared the two interferon combinations in 81 patients who had experienced a previous relapse after a standard 48 weeks of pegylated interferon plus ribavirin. At the end of week 72, 89% of patients taking the consensus interferon combination were in remission, compared with 76% of the pegylated alfa-2a interferon group.

But relapse rates remained high in the study, Dr. Kaiser said. The pegylated alfa-2a interferon combination led to significantly higher rates of relapse than the consensus interferon combination. About 44% of the patients in the pegylated alfa-2a interferon combination group had a sustained viral response after completing treatment, compared with 69% of those in the consensus interferon group.

Overall, the study indicated that treatment for relapse can be successful using consensus therapy for an extended period, but more research is needed in multicenter trials, Dr. Kaiser said.

Researchers also presented new data on treatments for another difficult-to-treat population: nonresponders. Interim results from an ongoing phase II multicenter trial show that a combination of valopicitabine (NM283) at high doses plus pegylated interferon can reduce hepatitis RNA at 24 weeks of treatment, reported Dr. Paul Pockros of Scripps Clinic in California and his colleagues.

The five-arm study is comparing valopicitabine alone with three different doses of valopicitabine (400 mg/day, 800 mg/day, and dose-ramping from 400 to 800 mg/day) in combination with pegylated interferon, and with pegylated interferon plus ribavirin as a control.

Valopicitabine, manufactured by Idenix Pharmaceuticals, is the first nucleotide-type HCV polymerase inhibitor to advance to phase II trials. The study is funded by the drug maker.

The best results—about a 3-log decrease in hepatitis RNA—were achieved with the 800-mg dose of valopicitabine plus pegylated interferon. However, some patients experienced vomiting and nausea at initiation of treatment, and three patients were hospitalized with dehydration, so researchers stopped using the 800-mg dose and are continuing with 200-mg and 400-mg doses of the drug.

The results with the combination of 400 mg of valopicitabine and pegylated interferon were less promising in the nonresponder study population, with about a 2.5-log decrease, Dr. Pockros said.

Continued treatment is needed to find out if there will be a sustained response with the new drug combination, Dr. Pockros said, and to find out if the drug will be more effective for preventing relapse than are current therapies.

LOS ANGELES — The risk of developing colorectal adenomas is increased both in women with diabetes and in individuals with coronary artery disease, according to two studies presented at the annual Digestive Disease Week.

Postmenopausal women with type 2 diabetes mellitus who are not taking hormone therapy are at increased risk for colorectal adenomas and advanced adenomas, compared with women without the disease, said Dr. Jill E. Elwing of Washington University in St. Louis. She and her colleagues selected 100 women with type 2 diabetes and 500 nondiabetic women to undergo screening colonoscopy at an outpatient endoscopy center.

A total of 37% of diabetic women had any type of adenoma, compared with 24% of nondiabetics, and 14% of diabetic women had an advanced adenoma, compared with 6% of nondiabetic women. These differences between groups were statistically significant.

Obesity compounded the risk for diabetic women, Dr. Elwing reported. A total of 42% of obese diabetic women had any adenoma, compared with 23% of the nonobese, nondiabetic women. Similarly, 19% of obese diabetic women had an advanced adenoma vs. 7% in the comparison group. In addition, diabetic women were more likely than nondiabetic women to have multiple adenomas and proximally located advanced adenomas.

The association between diabetes in women and colorectal adenomas and advanced adenomas was maintained even when researchers controlled for age, race, use of nonsteroidal anti-inflammatory drugs, and body mass index.

With confirmation of these findings, professional societies should consider incorporating diabetes as a risk factor in screening guidelines for colorectal disease, Dr. Elwing said.

A separate study looking at risk factors for developing colorectal cancer found that patients with coronary artery disease (CAD) are at greater risk for developing colorectal adenomas or colorectal cancer than are patients without CAD.

These findings suggest that patients with CAD should be screened using colonoscopy, recommended the study's lead author, Dr. Annie On On Chan of the University of Hong Kong.

The researchers recruited 307 patients who had a coronary angiogram, underwent screening colonoscopy, and completed a questionnaire on risk factors.

Interim results show that about 46% of the study subjects had CAD. The patients with CAD had a higher incidence of adenomas and cancer than did those without CAD (30% vs. 19%). Nearly 17% of the CAD population had advanced lesions, compared with less than 7% of the patients without CAD. The researchers found five cases of colorectal cancer among the CAD patients but none among those without CAD, Dr. Chan said.

LOS ANGELES — The risk of developing colorectal adenomas is increased both in women with diabetes and in individuals with coronary artery disease, according to two studies presented at the annual Digestive Disease Week.

Postmenopausal women with type 2 diabetes mellitus who are not taking hormone therapy are at increased risk for colorectal adenomas and advanced adenomas, compared with women without the disease, said Dr. Jill E. Elwing of Washington University in St. Louis. She and her colleagues selected 100 women with type 2 diabetes and 500 nondiabetic women to undergo screening colonoscopy at an outpatient endoscopy center.

A total of 37% of diabetic women had any type of adenoma, compared with 24% of nondiabetics, and 14% of diabetic women had an advanced adenoma, compared with 6% of nondiabetic women. These differences between groups were statistically significant.

Obesity compounded the risk for diabetic women, Dr. Elwing reported. A total of 42% of obese diabetic women had any adenoma, compared with 23% of the nonobese, nondiabetic women. Similarly, 19% of obese diabetic women had an advanced adenoma vs. 7% in the comparison group. In addition, diabetic women were more likely than nondiabetic women to have multiple adenomas and proximally located advanced adenomas.

The association between diabetes in women and colorectal adenomas and advanced adenomas was maintained even when researchers controlled for age, race, use of nonsteroidal anti-inflammatory drugs, and body mass index.

With confirmation of these findings, professional societies should consider incorporating diabetes as a risk factor in screening guidelines for colorectal disease, Dr. Elwing said.

A separate study looking at risk factors for developing colorectal cancer found that patients with coronary artery disease (CAD) are at greater risk for developing colorectal adenomas or colorectal cancer than are patients without CAD.

These findings suggest that patients with CAD should be screened using colonoscopy, recommended the study's lead author, Dr. Annie On On Chan of the University of Hong Kong.

The researchers recruited 307 patients who had a coronary angiogram, underwent screening colonoscopy, and completed a questionnaire on risk factors.

Interim results show that about 46% of the study subjects had CAD. The patients with CAD had a higher incidence of adenomas and cancer than did those without CAD (30% vs. 19%). Nearly 17% of the CAD population had advanced lesions, compared with less than 7% of the patients without CAD. The researchers found five cases of colorectal cancer among the CAD patients but none among those without CAD, Dr. Chan said.

LOS ANGELES — The risk of developing colorectal adenomas is increased both in women with diabetes and in individuals with coronary artery disease, according to two studies presented at the annual Digestive Disease Week.

Postmenopausal women with type 2 diabetes mellitus who are not taking hormone therapy are at increased risk for colorectal adenomas and advanced adenomas, compared with women without the disease, said Dr. Jill E. Elwing of Washington University in St. Louis. She and her colleagues selected 100 women with type 2 diabetes and 500 nondiabetic women to undergo screening colonoscopy at an outpatient endoscopy center.

A total of 37% of diabetic women had any type of adenoma, compared with 24% of nondiabetics, and 14% of diabetic women had an advanced adenoma, compared with 6% of nondiabetic women. These differences between groups were statistically significant.

Obesity compounded the risk for diabetic women, Dr. Elwing reported. A total of 42% of obese diabetic women had any adenoma, compared with 23% of the nonobese, nondiabetic women. Similarly, 19% of obese diabetic women had an advanced adenoma vs. 7% in the comparison group. In addition, diabetic women were more likely than nondiabetic women to have multiple adenomas and proximally located advanced adenomas.

The association between diabetes in women and colorectal adenomas and advanced adenomas was maintained even when researchers controlled for age, race, use of nonsteroidal anti-inflammatory drugs, and body mass index.

With confirmation of these findings, professional societies should consider incorporating diabetes as a risk factor in screening guidelines for colorectal disease, Dr. Elwing said.

A separate study looking at risk factors for developing colorectal cancer found that patients with coronary artery disease (CAD) are at greater risk for developing colorectal adenomas or colorectal cancer than are patients without CAD.

These findings suggest that patients with CAD should be screened using colonoscopy, recommended the study's lead author, Dr. Annie On On Chan of the University of Hong Kong.

The researchers recruited 307 patients who had a coronary angiogram, underwent screening colonoscopy, and completed a questionnaire on risk factors.

Interim results show that about 46% of the study subjects had CAD. The patients with CAD had a higher incidence of adenomas and cancer than did those without CAD (30% vs. 19%). Nearly 17% of the CAD population had advanced lesions, compared with less than 7% of the patients without CAD. The researchers found five cases of colorectal cancer among the CAD patients but none among those without CAD, Dr. Chan said.

Public and private payers may soon be testing reimbursement strategies for secure electronic messaging between clinicians and patients, if the American Health Information Community has anything to say about it.

The group, which advises Health and Human Services Secretary Mike Leavitt on health information technology (IT) interoperability issues, voted to urge payers to pilot-test secure messaging to evaluate possible forms of reimbursement and physician work-flow and other issues.

The widespread use of secure systems that allow patients and physicians to communicate by e-mail has the potential to improve quality and lower costs, especially among patients with chronic diseases, Dr. Douglas E. Henley, executive vice president of the American Academy of Family Physicians, said at a meeting of the American Health Information Community (AHIC). Reimbursement will be essential to stimulating the widespread use of such tools, said Dr. Henley, who is a member of AHIC.

AHIC also voted to recommend that the Healthcare Information Technology Standards Panel, an independent group that facilitates harmonization of standards, work on defining standards for secure messaging that will be interoperable with electronic health records. Dr. David J. Brailer, former national coordinator for health IT and the vice chair of AHIC, said development of standards in this area should move quickly.

And in an effort to ensure that access to secure messaging is available to all patients and clinicians, AHIC is asking officials at the Health and Human Services Department to look at how to address the gaps in access to computers and the Internet for poor and underserved populations and the safety net providers that provide their care.

Public and private payers may soon be testing reimbursement strategies for secure electronic messaging between clinicians and patients, if the American Health Information Community has anything to say about it.

The group, which advises Health and Human Services Secretary Mike Leavitt on health information technology (IT) interoperability issues, voted to urge payers to pilot-test secure messaging to evaluate possible forms of reimbursement and physician work-flow and other issues.

The widespread use of secure systems that allow patients and physicians to communicate by e-mail has the potential to improve quality and lower costs, especially among patients with chronic diseases, Dr. Douglas E. Henley, executive vice president of the American Academy of Family Physicians, said at a meeting of the American Health Information Community (AHIC). Reimbursement will be essential to stimulating the widespread use of such tools, said Dr. Henley, who is a member of AHIC.

AHIC also voted to recommend that the Healthcare Information Technology Standards Panel, an independent group that facilitates harmonization of standards, work on defining standards for secure messaging that will be interoperable with electronic health records. Dr. David J. Brailer, former national coordinator for health IT and the vice chair of AHIC, said development of standards in this area should move quickly.

And in an effort to ensure that access to secure messaging is available to all patients and clinicians, AHIC is asking officials at the Health and Human Services Department to look at how to address the gaps in access to computers and the Internet for poor and underserved populations and the safety net providers that provide their care.

Public and private payers may soon be testing reimbursement strategies for secure electronic messaging between clinicians and patients, if the American Health Information Community has anything to say about it.

The group, which advises Health and Human Services Secretary Mike Leavitt on health information technology (IT) interoperability issues, voted to urge payers to pilot-test secure messaging to evaluate possible forms of reimbursement and physician work-flow and other issues.

The widespread use of secure systems that allow patients and physicians to communicate by e-mail has the potential to improve quality and lower costs, especially among patients with chronic diseases, Dr. Douglas E. Henley, executive vice president of the American Academy of Family Physicians, said at a meeting of the American Health Information Community (AHIC). Reimbursement will be essential to stimulating the widespread use of such tools, said Dr. Henley, who is a member of AHIC.

AHIC also voted to recommend that the Healthcare Information Technology Standards Panel, an independent group that facilitates harmonization of standards, work on defining standards for secure messaging that will be interoperable with electronic health records. Dr. David J. Brailer, former national coordinator for health IT and the vice chair of AHIC, said development of standards in this area should move quickly.

And in an effort to ensure that access to secure messaging is available to all patients and clinicians, AHIC is asking officials at the Health and Human Services Department to look at how to address the gaps in access to computers and the Internet for poor and underserved populations and the safety net providers that provide their care.

PHILADELPHIA — Performance measurement is one way to help eliminate racial disparities in health care, Dr. John Z. Ayanian said at the annual meeting of the American College of Physicians.

Public and private payers must also do their part by maintaining accurate and complete data on race and ethnicity to help monitor disparities, said Dr. Ayanian, associate professor of medicine and health care policy at Harvard Medical School in Boston.

There has been some success in narrowing the racial care gap in areas where measurement is widespread. For example, a study published last year found both overall quality improvement in the use of β-blockers after acute myocardial infarction among Medicare managed-care beneficiaries and a significant narrowing of the racial gap in treatment.

The treatment gap between black and white beneficiaries had been 12% in 1997 and fell to 0.4% in 2002 (N. Engl. J. Med. 2005;353:692–700).

But there is still work to do, he said. For example, the same study shows that while overall quality improved in cholesterol control for coronary artery disease, the racial disparity is actually increasing in that measure. The study showed that the gap for cholesterol control, defined as LDL cholesterol below 130 mg/dL after discharge, between black and white patients was 13% in 1999, and the gap widened to 16% in 2002.

Lack of communication and trust between minority patients and physicians also are factors in care disparities, Dr. Ayanian said. Many physicians don't recognize the legacy of discrimination in health care, such as the Tuskegee syphilis study, that still fuels mistrust of the health care system among minorities, he said.

A cooperative national study conducted by Dr. Ayanian and his colleagues looked at new patient preferences for renal transplantation among end-stage renal disease patients ages 18 to 54 in Michigan, Alabama, Southern California, and the Washington metropolitan area in 1996–1997.

The researchers found small differences in the patient preferences for the transplant but larger differences in the referral for evaluation. For example, 86% of white men favored transplantation, and 82% were referred for evaluation. However, 81% of black men favored transplantation but only 58% were referred for evaluation (N. Engl. J. Med. 1999;341:1661–9).

In addition, most patients in the study said that they agreed with and trusted their physician. But white patients were more likely to trust and agree with physicians than black patients, and black patients received less information about transplantation.

Physicians, researchers, and policy makers need to work together to help eliminate disparities, Dr. Ayanian said at the meeting.

Expanded research funding is needed to better evaluate the causes of disparities, and financial incentives from payers can be used to reward "equitable and high-quality" care, he said.

In addition, there needs to be a broader focus on Hispanic, Asian, and Native American patients, he said.

PHILADELPHIA — Performance measurement is one way to help eliminate racial disparities in health care, Dr. John Z. Ayanian said at the annual meeting of the American College of Physicians.

Public and private payers must also do their part by maintaining accurate and complete data on race and ethnicity to help monitor disparities, said Dr. Ayanian, associate professor of medicine and health care policy at Harvard Medical School in Boston.

There has been some success in narrowing the racial care gap in areas where measurement is widespread. For example, a study published last year found both overall quality improvement in the use of β-blockers after acute myocardial infarction among Medicare managed-care beneficiaries and a significant narrowing of the racial gap in treatment.

The treatment gap between black and white beneficiaries had been 12% in 1997 and fell to 0.4% in 2002 (N. Engl. J. Med. 2005;353:692–700).

But there is still work to do, he said. For example, the same study shows that while overall quality improved in cholesterol control for coronary artery disease, the racial disparity is actually increasing in that measure. The study showed that the gap for cholesterol control, defined as LDL cholesterol below 130 mg/dL after discharge, between black and white patients was 13% in 1999, and the gap widened to 16% in 2002.

Lack of communication and trust between minority patients and physicians also are factors in care disparities, Dr. Ayanian said. Many physicians don't recognize the legacy of discrimination in health care, such as the Tuskegee syphilis study, that still fuels mistrust of the health care system among minorities, he said.

A cooperative national study conducted by Dr. Ayanian and his colleagues looked at new patient preferences for renal transplantation among end-stage renal disease patients ages 18 to 54 in Michigan, Alabama, Southern California, and the Washington metropolitan area in 1996–1997.

The researchers found small differences in the patient preferences for the transplant but larger differences in the referral for evaluation. For example, 86% of white men favored transplantation, and 82% were referred for evaluation. However, 81% of black men favored transplantation but only 58% were referred for evaluation (N. Engl. J. Med. 1999;341:1661–9).

In addition, most patients in the study said that they agreed with and trusted their physician. But white patients were more likely to trust and agree with physicians than black patients, and black patients received less information about transplantation.

Physicians, researchers, and policy makers need to work together to help eliminate disparities, Dr. Ayanian said at the meeting.

Expanded research funding is needed to better evaluate the causes of disparities, and financial incentives from payers can be used to reward "equitable and high-quality" care, he said.

In addition, there needs to be a broader focus on Hispanic, Asian, and Native American patients, he said.

PHILADELPHIA — Performance measurement is one way to help eliminate racial disparities in health care, Dr. John Z. Ayanian said at the annual meeting of the American College of Physicians.

Public and private payers must also do their part by maintaining accurate and complete data on race and ethnicity to help monitor disparities, said Dr. Ayanian, associate professor of medicine and health care policy at Harvard Medical School in Boston.

There has been some success in narrowing the racial care gap in areas where measurement is widespread. For example, a study published last year found both overall quality improvement in the use of β-blockers after acute myocardial infarction among Medicare managed-care beneficiaries and a significant narrowing of the racial gap in treatment.

The treatment gap between black and white beneficiaries had been 12% in 1997 and fell to 0.4% in 2002 (N. Engl. J. Med. 2005;353:692–700).

But there is still work to do, he said. For example, the same study shows that while overall quality improved in cholesterol control for coronary artery disease, the racial disparity is actually increasing in that measure. The study showed that the gap for cholesterol control, defined as LDL cholesterol below 130 mg/dL after discharge, between black and white patients was 13% in 1999, and the gap widened to 16% in 2002.

Lack of communication and trust between minority patients and physicians also are factors in care disparities, Dr. Ayanian said. Many physicians don't recognize the legacy of discrimination in health care, such as the Tuskegee syphilis study, that still fuels mistrust of the health care system among minorities, he said.

A cooperative national study conducted by Dr. Ayanian and his colleagues looked at new patient preferences for renal transplantation among end-stage renal disease patients ages 18 to 54 in Michigan, Alabama, Southern California, and the Washington metropolitan area in 1996–1997.

The researchers found small differences in the patient preferences for the transplant but larger differences in the referral for evaluation. For example, 86% of white men favored transplantation, and 82% were referred for evaluation. However, 81% of black men favored transplantation but only 58% were referred for evaluation (N. Engl. J. Med. 1999;341:1661–9).

In addition, most patients in the study said that they agreed with and trusted their physician. But white patients were more likely to trust and agree with physicians than black patients, and black patients received less information about transplantation.

Physicians, researchers, and policy makers need to work together to help eliminate disparities, Dr. Ayanian said at the meeting.

Expanded research funding is needed to better evaluate the causes of disparities, and financial incentives from payers can be used to reward "equitable and high-quality" care, he said.

In addition, there needs to be a broader focus on Hispanic, Asian, and Native American patients, he said.

PHILADELPHIA — A costly electronic health record system is not necessary to engage in quality improvement and participate in the growing number of pay-for-performance programs, Dr. Rodney Hornbake said at the annual meeting of the American College of Physicians.

Patient registry software is a lower-cost alternative that allows physicians to track their care of patients with chronic diseases.

"It's really an excellent starting place for quality improvement in the ambulatory setting," said Dr. Hornbake, an internist in private practice in Essex, Conn.

Patient registries are one of the best tools for physicians participating in pay-for-performance programs, Dr. Hornbake said. Many electronic health records (EHRs) may not have population-based functionality, and therefore cannot generate simple reports on the physician's performance on certain measures. Most EHR vendors can build interfaces with patient registry software, but that's generally an added cost, he said.

There are a number of patient registry programs available; a comprehensive program can be purchased for less than $1,000 per provider, Dr. Hornbake said. Some are available for free.

For example, Dr. Hornbake tested the Comorbid Disease Management Database (COMMAND) software in his practice. This registry system is available for free from the Mississippi Quality Improvement Organization. And technology-savvy physicians can use programs like Microsoft Access to design their own registries, he said.

Dr. Hornbake tried out COMMAND in his practice to help keep up with the pay-for-performance programs in his local market. One insurer—Anthem Health Plans Inc. of Connecticut—has a program that offers incentives for process and outcomes measures, as well as for the use of health-related information technology, including electronic prescribing, EHRs, and patient registries. The insurer also offers incentives to physicians for generic prescribing, he said.

Dr. Hornbake said that he exported demographic information from his billing system into COMMAND and manually entered the clinical information from patient charts himself. After using the billing system to identify all of the patients who had conditions included in his registry, he had his staff put red stickers on those patient charts.

This flagged the patients for special attention from the staff, he said. For example, patients whose charts had stickers received follow-up calls if they missed an appointment. To keep the registry up to date, every 2 months the staff pulls the charts of all registry patients and Dr. Hornbake updates the system manually. He spends about 1.5 hours entering data on 125 patients, he said.

Dr. Hornbake said that he prefers to enter the information in periodic batches because it helps him to identify any chronic disease patients who have slipped through the cracks.

Even factoring in his time, Dr. Hornbake said that he saw an immediate return on investment with the patient registry system. Unlike implementation of an EHR system, he added, patient registry software tends to fit in easily with the normal workflow of the office.

Physicians can also manage their patient care using a paper-based patient registry, he said, but once they begin to track 20 or more measures, a paper system quickly becomes unworkable.

So far, Dr. Hornbake said that he has resisted purchasing an EHR system because he still can't make a financial case for the investment.

He advised physicians to buy or upgrade an EHR system based on its ability to support pay for performance and manage a population of specific patients. Many of the other selling points for an EHR system—that it will eliminate transcription, cut down on needed staff positions, and improve coding—don't hold true for all physicians, he said.

PHILADELPHIA — A costly electronic health record system is not necessary to engage in quality improvement and participate in the growing number of pay-for-performance programs, Dr. Rodney Hornbake said at the annual meeting of the American College of Physicians.

Patient registry software is a lower-cost alternative that allows physicians to track their care of patients with chronic diseases.

"It's really an excellent starting place for quality improvement in the ambulatory setting," said Dr. Hornbake, an internist in private practice in Essex, Conn.

Patient registries are one of the best tools for physicians participating in pay-for-performance programs, Dr. Hornbake said. Many electronic health records (EHRs) may not have population-based functionality, and therefore cannot generate simple reports on the physician's performance on certain measures. Most EHR vendors can build interfaces with patient registry software, but that's generally an added cost, he said.

There are a number of patient registry programs available; a comprehensive program can be purchased for less than $1,000 per provider, Dr. Hornbake said. Some are available for free.

For example, Dr. Hornbake tested the Comorbid Disease Management Database (COMMAND) software in his practice. This registry system is available for free from the Mississippi Quality Improvement Organization. And technology-savvy physicians can use programs like Microsoft Access to design their own registries, he said.

Dr. Hornbake tried out COMMAND in his practice to help keep up with the pay-for-performance programs in his local market. One insurer—Anthem Health Plans Inc. of Connecticut—has a program that offers incentives for process and outcomes measures, as well as for the use of health-related information technology, including electronic prescribing, EHRs, and patient registries. The insurer also offers incentives to physicians for generic prescribing, he said.

Dr. Hornbake said that he exported demographic information from his billing system into COMMAND and manually entered the clinical information from patient charts himself. After using the billing system to identify all of the patients who had conditions included in his registry, he had his staff put red stickers on those patient charts.

This flagged the patients for special attention from the staff, he said. For example, patients whose charts had stickers received follow-up calls if they missed an appointment. To keep the registry up to date, every 2 months the staff pulls the charts of all registry patients and Dr. Hornbake updates the system manually. He spends about 1.5 hours entering data on 125 patients, he said.

Dr. Hornbake said that he prefers to enter the information in periodic batches because it helps him to identify any chronic disease patients who have slipped through the cracks.

Even factoring in his time, Dr. Hornbake said that he saw an immediate return on investment with the patient registry system. Unlike implementation of an EHR system, he added, patient registry software tends to fit in easily with the normal workflow of the office.

Physicians can also manage their patient care using a paper-based patient registry, he said, but once they begin to track 20 or more measures, a paper system quickly becomes unworkable.

So far, Dr. Hornbake said that he has resisted purchasing an EHR system because he still can't make a financial case for the investment.

He advised physicians to buy or upgrade an EHR system based on its ability to support pay for performance and manage a population of specific patients. Many of the other selling points for an EHR system—that it will eliminate transcription, cut down on needed staff positions, and improve coding—don't hold true for all physicians, he said.

PHILADELPHIA — A costly electronic health record system is not necessary to engage in quality improvement and participate in the growing number of pay-for-performance programs, Dr. Rodney Hornbake said at the annual meeting of the American College of Physicians.

Patient registry software is a lower-cost alternative that allows physicians to track their care of patients with chronic diseases.

"It's really an excellent starting place for quality improvement in the ambulatory setting," said Dr. Hornbake, an internist in private practice in Essex, Conn.

Patient registries are one of the best tools for physicians participating in pay-for-performance programs, Dr. Hornbake said. Many electronic health records (EHRs) may not have population-based functionality, and therefore cannot generate simple reports on the physician's performance on certain measures. Most EHR vendors can build interfaces with patient registry software, but that's generally an added cost, he said.

There are a number of patient registry programs available; a comprehensive program can be purchased for less than $1,000 per provider, Dr. Hornbake said. Some are available for free.

For example, Dr. Hornbake tested the Comorbid Disease Management Database (COMMAND) software in his practice. This registry system is available for free from the Mississippi Quality Improvement Organization. And technology-savvy physicians can use programs like Microsoft Access to design their own registries, he said.

Dr. Hornbake tried out COMMAND in his practice to help keep up with the pay-for-performance programs in his local market. One insurer—Anthem Health Plans Inc. of Connecticut—has a program that offers incentives for process and outcomes measures, as well as for the use of health-related information technology, including electronic prescribing, EHRs, and patient registries. The insurer also offers incentives to physicians for generic prescribing, he said.

Dr. Hornbake said that he exported demographic information from his billing system into COMMAND and manually entered the clinical information from patient charts himself. After using the billing system to identify all of the patients who had conditions included in his registry, he had his staff put red stickers on those patient charts.

This flagged the patients for special attention from the staff, he said. For example, patients whose charts had stickers received follow-up calls if they missed an appointment. To keep the registry up to date, every 2 months the staff pulls the charts of all registry patients and Dr. Hornbake updates the system manually. He spends about 1.5 hours entering data on 125 patients, he said.

Dr. Hornbake said that he prefers to enter the information in periodic batches because it helps him to identify any chronic disease patients who have slipped through the cracks.

Even factoring in his time, Dr. Hornbake said that he saw an immediate return on investment with the patient registry system. Unlike implementation of an EHR system, he added, patient registry software tends to fit in easily with the normal workflow of the office.

Physicians can also manage their patient care using a paper-based patient registry, he said, but once they begin to track 20 or more measures, a paper system quickly becomes unworkable.

So far, Dr. Hornbake said that he has resisted purchasing an EHR system because he still can't make a financial case for the investment.

He advised physicians to buy or upgrade an EHR system based on its ability to support pay for performance and manage a population of specific patients. Many of the other selling points for an EHR system—that it will eliminate transcription, cut down on needed staff positions, and improve coding—don't hold true for all physicians, he said.

Two Democratic senators are aiming to move patient safety to the center of the medical liability debate.

Sen. Hillary Rodham Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.) have introduced legislation that would provide grant funding for physicians, hospitals, and health systems to routinely report medical errors to a national database. In cases in which patients were harmed, the hospitals and physicians involved would disclose the error and offer to enter into confidential negotiations on compensation. Any disclosures and apologies from physicians would be considered confidential under the bill.

"For too long, our health care system has discouraged the kind of communication needed to find and correct the conditions that lead to medical errors," Sen. Clinton said in a statement. "Our bill puts patient safety first and creates an avenue for doctors and patients to find solutions outside of the courtroom."

The two senators recently touted the benefits of the bill, the National Medical Error Disclosure and Compensation Act (S. 1784), in a perspective published in the New England Journal of Medicine (2006;354:2205–8).

In addition, medical liability insurers who participate in the program would be required to put a portion of any savings realized toward reducing physician premiums. For health care providers who participate, a portion of the savings must be used for activities that result in reduced medical errors and improved patient safety.

Some physician leaders, however, are skeptical that the bill will gain any traction in an election year. The legislation was introduced last September and was referred to the Senate Committee on Health, Education, Labor, and Pensions.

Two Democratic senators are aiming to move patient safety to the center of the medical liability debate.

Sen. Hillary Rodham Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.) have introduced legislation that would provide grant funding for physicians, hospitals, and health systems to routinely report medical errors to a national database. In cases in which patients were harmed, the hospitals and physicians involved would disclose the error and offer to enter into confidential negotiations on compensation. Any disclosures and apologies from physicians would be considered confidential under the bill.

"For too long, our health care system has discouraged the kind of communication needed to find and correct the conditions that lead to medical errors," Sen. Clinton said in a statement. "Our bill puts patient safety first and creates an avenue for doctors and patients to find solutions outside of the courtroom."

The two senators recently touted the benefits of the bill, the National Medical Error Disclosure and Compensation Act (S. 1784), in a perspective published in the New England Journal of Medicine (2006;354:2205–8).

In addition, medical liability insurers who participate in the program would be required to put a portion of any savings realized toward reducing physician premiums. For health care providers who participate, a portion of the savings must be used for activities that result in reduced medical errors and improved patient safety.

Some physician leaders, however, are skeptical that the bill will gain any traction in an election year. The legislation was introduced last September and was referred to the Senate Committee on Health, Education, Labor, and Pensions.

Two Democratic senators are aiming to move patient safety to the center of the medical liability debate.

Sen. Hillary Rodham Clinton (D-N.Y.) and Sen. Barack Obama (D-Ill.) have introduced legislation that would provide grant funding for physicians, hospitals, and health systems to routinely report medical errors to a national database. In cases in which patients were harmed, the hospitals and physicians involved would disclose the error and offer to enter into confidential negotiations on compensation. Any disclosures and apologies from physicians would be considered confidential under the bill.

"For too long, our health care system has discouraged the kind of communication needed to find and correct the conditions that lead to medical errors," Sen. Clinton said in a statement. "Our bill puts patient safety first and creates an avenue for doctors and patients to find solutions outside of the courtroom."

The two senators recently touted the benefits of the bill, the National Medical Error Disclosure and Compensation Act (S. 1784), in a perspective published in the New England Journal of Medicine (2006;354:2205–8).

In addition, medical liability insurers who participate in the program would be required to put a portion of any savings realized toward reducing physician premiums. For health care providers who participate, a portion of the savings must be used for activities that result in reduced medical errors and improved patient safety.

Some physician leaders, however, are skeptical that the bill will gain any traction in an election year. The legislation was introduced last September and was referred to the Senate Committee on Health, Education, Labor, and Pensions.

Views on Stem Cells

Support for human embryonic stem cell research appears to be growing, with more than three-quarters of Americans who participated in a recent survey saying that they favor some form of the research. The survey, commissioned by the Coalition for the Advancement of Medical Research, found that 72% of Americans favor embryonic stem cell research, up from 68% in 2005. Most Americans also would favor an up or down vote in the Senate on H.R. 810, a bill that would ease restrictions on the use of federal funding for embryonic stem cell research. The legislation was passed in the U.S. House last year and advocates for stem cell research have been calling on Senate Majority Leader Bill Frist (R-Tenn.) to bring the legislation to the Senate floor. About 70% of survey respondents said the Senate should allow a vote on the bill or probably should allow a vote on the bill. In comparison, 18% of respondents said the Senate should not allow a vote on the bill or probably should not allow a vote. About 6% of respondents said they did not know. The poll was conducted by the Opinion Research Corp. and included a sample of 1,000 individuals taken in early May.

Supporting HIV/AIDS Fight

More than half (56%) of respondents to a recent poll said they believe the U.S. government isn't spending enough money to help combat HIV/AIDS in developing countries, up from 31% in 2002, according to poll sponsor the Kaiser Family Foundation. However, even more Americans said the government isn't doing enough at home. About 63% said the federal government is spending too little to address the HIV/AIDS epidemic in the United States. This figure is up from 52% in 2004. “Perhaps surprisingly, it appears that the American public does not suffer from AIDS fatigue,” Drew E. Altman, president and CEO of the Kaiser Family Foundation said in a statement. “They want more done and believe it will pay off.” The survey included a random, nationally representative sample of more than 2,500 adults. Detailed results are available online at

www.kff.org/kaiserpolls/7513.cfm

Abortion Training Gaps

Nurse practitioners, physician assistants, and certified nurse midwives lack clinical training in first trimester abortion procedures, according to a study that was published in the April issue of Contraception. Of the 202 accredited advanced practice clinician training programs that responded to a survey, 53% reported that they offer didactic instruction in at least one abortion procedure—surgical abortion, manual vacuum aspiration, or medical abortion. In addition, 21% provide clinical training in at least one of these abortion procedures. However, 96% provide didactic coverage on family planning and contraception, and 89% offer clinical training in these areas. Programs that did not offer didactic instruction in abortion procedures cited a number of reasons including that it was not a curriculum priority, clinical sites were not available for education, and the practitioner scope of practice does not include abortion. In addition, 19% of nurse practitioner programs and 33% of physician assistant programs cited the issue as too politically charged. The study was conducted by Ibis Reproductive Health, the National Abortion Federation, and the Abortion Access Project.

Military Abortions Defeated

Congress once again defeated an attempt to allow overseas U.S. military hospitals to perform privately funded abortions. Last month, Rep. Susan Davis (D-Calif.) and Rep. Jane Harman (D-Calif.) sponsored an amendment that would have allowed servicewomen to seek abortions at a U.S. military health facility. The amendment, which was offered to the Department of Defense Authorization bill (H.R. 5122), was defeated by a vote of 237–191 in the House. The current law forbids U.S. military hospitals to provide abortion services except in cases of rape, incest, or life endangerment. Under the law, federal funds can be used for an abortion to save the life of the mother but private funds are required for abortions in cases of rape and incest. The existing ban forces U.S. servicewomen stationed overseas to travel long distances to find an American provider, seek services at an unfamiliar local facility, or have an “unsafe back-alley abortion,” according to a statement from Vicki Saporta, the president and CEO of the National Abortion Federation. Defeat of the amendment was praised by anti-abortion advocates. “Pro-abortion advocates have been trying to sneak this bill in for almost a decade, but each year, the House strikes it down,” Lanier Swann, director of government relations for the Concerned Women for America, said in a statement.

Abuse and Depression Linked

Women who have been victims of intimate partner violence have higher rates of severe depression than women who have not been abused, according to a study published in the June issue of the American Journal of Preventive Medicine. Recent victims of intimate partner violence were 2.3 times as likely to report any depressive symptoms and 2.6 times as likely to report severe depressive symptoms as women who had never been victims of intimate partner violence. Women who had experienced physical and/or sexual violence and long durations of abuse also had higher rates of depression, the researchers found. The researchers analyzed data from 3,429 women who were members of an HMO serving the Pacific Northwest and completed a telephone survey.

Views on Stem Cells

Support for human embryonic stem cell research appears to be growing, with more than three-quarters of Americans who participated in a recent survey saying that they favor some form of the research. The survey, commissioned by the Coalition for the Advancement of Medical Research, found that 72% of Americans favor embryonic stem cell research, up from 68% in 2005. Most Americans also would favor an up or down vote in the Senate on H.R. 810, a bill that would ease restrictions on the use of federal funding for embryonic stem cell research. The legislation was passed in the U.S. House last year and advocates for stem cell research have been calling on Senate Majority Leader Bill Frist (R-Tenn.) to bring the legislation to the Senate floor. About 70% of survey respondents said the Senate should allow a vote on the bill or probably should allow a vote on the bill. In comparison, 18% of respondents said the Senate should not allow a vote on the bill or probably should not allow a vote. About 6% of respondents said they did not know. The poll was conducted by the Opinion Research Corp. and included a sample of 1,000 individuals taken in early May.

Supporting HIV/AIDS Fight

More than half (56%) of respondents to a recent poll said they believe the U.S. government isn't spending enough money to help combat HIV/AIDS in developing countries, up from 31% in 2002, according to poll sponsor the Kaiser Family Foundation. However, even more Americans said the government isn't doing enough at home. About 63% said the federal government is spending too little to address the HIV/AIDS epidemic in the United States. This figure is up from 52% in 2004. “Perhaps surprisingly, it appears that the American public does not suffer from AIDS fatigue,” Drew E. Altman, president and CEO of the Kaiser Family Foundation said in a statement. “They want more done and believe it will pay off.” The survey included a random, nationally representative sample of more than 2,500 adults. Detailed results are available online at

www.kff.org/kaiserpolls/7513.cfm

Abortion Training Gaps

Nurse practitioners, physician assistants, and certified nurse midwives lack clinical training in first trimester abortion procedures, according to a study that was published in the April issue of Contraception. Of the 202 accredited advanced practice clinician training programs that responded to a survey, 53% reported that they offer didactic instruction in at least one abortion procedure—surgical abortion, manual vacuum aspiration, or medical abortion. In addition, 21% provide clinical training in at least one of these abortion procedures. However, 96% provide didactic coverage on family planning and contraception, and 89% offer clinical training in these areas. Programs that did not offer didactic instruction in abortion procedures cited a number of reasons including that it was not a curriculum priority, clinical sites were not available for education, and the practitioner scope of practice does not include abortion. In addition, 19% of nurse practitioner programs and 33% of physician assistant programs cited the issue as too politically charged. The study was conducted by Ibis Reproductive Health, the National Abortion Federation, and the Abortion Access Project.

Military Abortions Defeated

Congress once again defeated an attempt to allow overseas U.S. military hospitals to perform privately funded abortions. Last month, Rep. Susan Davis (D-Calif.) and Rep. Jane Harman (D-Calif.) sponsored an amendment that would have allowed servicewomen to seek abortions at a U.S. military health facility. The amendment, which was offered to the Department of Defense Authorization bill (H.R. 5122), was defeated by a vote of 237–191 in the House. The current law forbids U.S. military hospitals to provide abortion services except in cases of rape, incest, or life endangerment. Under the law, federal funds can be used for an abortion to save the life of the mother but private funds are required for abortions in cases of rape and incest. The existing ban forces U.S. servicewomen stationed overseas to travel long distances to find an American provider, seek services at an unfamiliar local facility, or have an “unsafe back-alley abortion,” according to a statement from Vicki Saporta, the president and CEO of the National Abortion Federation. Defeat of the amendment was praised by anti-abortion advocates. “Pro-abortion advocates have been trying to sneak this bill in for almost a decade, but each year, the House strikes it down,” Lanier Swann, director of government relations for the Concerned Women for America, said in a statement.

Abuse and Depression Linked

Women who have been victims of intimate partner violence have higher rates of severe depression than women who have not been abused, according to a study published in the June issue of the American Journal of Preventive Medicine. Recent victims of intimate partner violence were 2.3 times as likely to report any depressive symptoms and 2.6 times as likely to report severe depressive symptoms as women who had never been victims of intimate partner violence. Women who had experienced physical and/or sexual violence and long durations of abuse also had higher rates of depression, the researchers found. The researchers analyzed data from 3,429 women who were members of an HMO serving the Pacific Northwest and completed a telephone survey.

Views on Stem Cells

Support for human embryonic stem cell research appears to be growing, with more than three-quarters of Americans who participated in a recent survey saying that they favor some form of the research. The survey, commissioned by the Coalition for the Advancement of Medical Research, found that 72% of Americans favor embryonic stem cell research, up from 68% in 2005. Most Americans also would favor an up or down vote in the Senate on H.R. 810, a bill that would ease restrictions on the use of federal funding for embryonic stem cell research. The legislation was passed in the U.S. House last year and advocates for stem cell research have been calling on Senate Majority Leader Bill Frist (R-Tenn.) to bring the legislation to the Senate floor. About 70% of survey respondents said the Senate should allow a vote on the bill or probably should allow a vote on the bill. In comparison, 18% of respondents said the Senate should not allow a vote on the bill or probably should not allow a vote. About 6% of respondents said they did not know. The poll was conducted by the Opinion Research Corp. and included a sample of 1,000 individuals taken in early May.

Supporting HIV/AIDS Fight

More than half (56%) of respondents to a recent poll said they believe the U.S. government isn't spending enough money to help combat HIV/AIDS in developing countries, up from 31% in 2002, according to poll sponsor the Kaiser Family Foundation. However, even more Americans said the government isn't doing enough at home. About 63% said the federal government is spending too little to address the HIV/AIDS epidemic in the United States. This figure is up from 52% in 2004. “Perhaps surprisingly, it appears that the American public does not suffer from AIDS fatigue,” Drew E. Altman, president and CEO of the Kaiser Family Foundation said in a statement. “They want more done and believe it will pay off.” The survey included a random, nationally representative sample of more than 2,500 adults. Detailed results are available online at

www.kff.org/kaiserpolls/7513.cfm

Abortion Training Gaps

Nurse practitioners, physician assistants, and certified nurse midwives lack clinical training in first trimester abortion procedures, according to a study that was published in the April issue of Contraception. Of the 202 accredited advanced practice clinician training programs that responded to a survey, 53% reported that they offer didactic instruction in at least one abortion procedure—surgical abortion, manual vacuum aspiration, or medical abortion. In addition, 21% provide clinical training in at least one of these abortion procedures. However, 96% provide didactic coverage on family planning and contraception, and 89% offer clinical training in these areas. Programs that did not offer didactic instruction in abortion procedures cited a number of reasons including that it was not a curriculum priority, clinical sites were not available for education, and the practitioner scope of practice does not include abortion. In addition, 19% of nurse practitioner programs and 33% of physician assistant programs cited the issue as too politically charged. The study was conducted by Ibis Reproductive Health, the National Abortion Federation, and the Abortion Access Project.

Military Abortions Defeated

Congress once again defeated an attempt to allow overseas U.S. military hospitals to perform privately funded abortions. Last month, Rep. Susan Davis (D-Calif.) and Rep. Jane Harman (D-Calif.) sponsored an amendment that would have allowed servicewomen to seek abortions at a U.S. military health facility. The amendment, which was offered to the Department of Defense Authorization bill (H.R. 5122), was defeated by a vote of 237–191 in the House. The current law forbids U.S. military hospitals to provide abortion services except in cases of rape, incest, or life endangerment. Under the law, federal funds can be used for an abortion to save the life of the mother but private funds are required for abortions in cases of rape and incest. The existing ban forces U.S. servicewomen stationed overseas to travel long distances to find an American provider, seek services at an unfamiliar local facility, or have an “unsafe back-alley abortion,” according to a statement from Vicki Saporta, the president and CEO of the National Abortion Federation. Defeat of the amendment was praised by anti-abortion advocates. “Pro-abortion advocates have been trying to sneak this bill in for almost a decade, but each year, the House strikes it down,” Lanier Swann, director of government relations for the Concerned Women for America, said in a statement.

Abuse and Depression Linked

Women who have been victims of intimate partner violence have higher rates of severe depression than women who have not been abused, according to a study published in the June issue of the American Journal of Preventive Medicine. Recent victims of intimate partner violence were 2.3 times as likely to report any depressive symptoms and 2.6 times as likely to report severe depressive symptoms as women who had never been victims of intimate partner violence. Women who had experienced physical and/or sexual violence and long durations of abuse also had higher rates of depression, the researchers found. The researchers analyzed data from 3,429 women who were members of an HMO serving the Pacific Northwest and completed a telephone survey.

More than 2 years after President Bush issued his call to action on the adoption of electronic health records, experts say there is growing pressure on physicians to heed that call.

Although physician adoption of EHRs remains low—especially in small practices—the movement toward pay for performance could start to drive adoption, said Mureen Allen, senior associate for informatics and practice improvement at the American College of Physicians. And the certification of EHRs by an independent body, which is slated to begin this summer, should help too. “The paradigm to some extent is changing.”

This month, many of the biggest players in health information technology gathered in Washington for National Health IT Week.

The series of events follows on the heels of more than 2 years' major action in the health IT landscape starting with President Bush's State of the Union address in January 2004 in which he called for the widespread adoption of interoperable EHRs within the decade.

A few months later, the Health and Human Services secretary appointed Dr. David J. Brailer as the first National Health Information Technology Coordinator. Dr. Brailer resigned from the post last month saying that he planned to stay in the job for only 2 years. Dr. Brailer said there is still a lot of work to be done in closing the adoption gap between large and small physician practices. His office has been focused on three strategies to close the gap—lowering costs, raising the benefits, and lowering the risks involved in purchasing an EHR system, he said during a teleconference announcing his resignation. Last fall, HHS Secretary Mike Leavitt established the American Health Information Community, a federally chartered commission to advise the secretary on interoperability issues. HHS proposed allowing hospitals and other entities to give physicians health IT hardware, software, and training.

HHS also awarded three contracts to public and private groups to create processes for harmonizing information standards, certifying health IT products, and addressing variations in state laws on privacy and security practices. And starting in January, prescription drug plans participating in the Medicare Part D program were required to begin supporting electronic prescribing. The regulation is optional for physicians and pharmacies.

Most recently, the Food and Drug Administration adopted the Systematized Nomenclature of Medicine (SNOMED) standard as the format for the highlights section of prescription drug labeling. The format will be required starting on June 30 for all new drugs and drugs approved within the last 5 years. The use of the SNOMED standards will make it easier for electronic systems to exchange FDA-approved labeling information, according to the agency.

One of the most significant developments has been the establishment of the Certification Commission on Health Information Technology (CCHIT). This group was formed in 2004 by the American Health Information Management Association, the Healthcare Information and Management Systems Society (HIMSS), and the National Alliance for Health Information Technology to develop criteria for the certification of EHRs.

CCHIT received a 3-year grant from HHS last fall to certify products in the ambulatory and inpatient setting as well as the systems' networks. Announcement of the first certified products in the ambulatory setting is expected by early July.

The means for objectively comparing EHR systems is “about to become a reality,” said CCHIT Chair Dr. Mark Leavitt. Current estimates put physician adoption of EHRs at around 14%. Dr. Leavitt said he hopes that by taking some of the risk out of buying an EHR product it will boost those adoption figures.

“I think we are on track,” said Dave Roberts, vice president of government relations at HIMSS. Although physicians still need to be educated about the value of EHRs, there are some other encouraging signs. For example, many states are helping to form regional health information organizations, he said.

These groups, called RHIOs, help to standardize the various regulations and business policies surrounding health information exchange. The federal government has funded more than 100 of these regional projects, and more efforts, supported by private industry or state governments, are underway, according to HHS. “The states are really buying into this whole initiative,” Mr. Roberts said.

For the majority of physicians, it just has not made financial sense to purchase an EHR system, Dr. Allen said. However, some physicians are beginning to see a strategic advantage in the adoption of technology. One advantage stems from regulations that encourage electronic prescribing.

EHR adoption is inevitable, Dr. Allen said, if only because so many younger physicians were trained on EHRs and won't go back to a paper system once they enter practice. And older physicians recognize that the change is coming, she said.

But Dr. Allen advised physicians that they don't need to jump into a full-blown EHR system. Electronic prescribing systems and electronic patient registries may be easier to adopt than a full EHR system, she said. Physicians can purchase EHRs in a modular fashion so that they can ramp up over time, she said.

More than 2 years after President Bush issued his call to action on the adoption of electronic health records, experts say there is growing pressure on physicians to heed that call.

Although physician adoption of EHRs remains low—especially in small practices—the movement toward pay for performance could start to drive adoption, said Mureen Allen, senior associate for informatics and practice improvement at the American College of Physicians. And the certification of EHRs by an independent body, which is slated to begin this summer, should help too. “The paradigm to some extent is changing.”

This month, many of the biggest players in health information technology gathered in Washington for National Health IT Week.

The series of events follows on the heels of more than 2 years' major action in the health IT landscape starting with President Bush's State of the Union address in January 2004 in which he called for the widespread adoption of interoperable EHRs within the decade.

A few months later, the Health and Human Services secretary appointed Dr. David J. Brailer as the first National Health Information Technology Coordinator. Dr. Brailer resigned from the post last month saying that he planned to stay in the job for only 2 years. Dr. Brailer said there is still a lot of work to be done in closing the adoption gap between large and small physician practices. His office has been focused on three strategies to close the gap—lowering costs, raising the benefits, and lowering the risks involved in purchasing an EHR system, he said during a teleconference announcing his resignation. Last fall, HHS Secretary Mike Leavitt established the American Health Information Community, a federally chartered commission to advise the secretary on interoperability issues. HHS proposed allowing hospitals and other entities to give physicians health IT hardware, software, and training.

HHS also awarded three contracts to public and private groups to create processes for harmonizing information standards, certifying health IT products, and addressing variations in state laws on privacy and security practices. And starting in January, prescription drug plans participating in the Medicare Part D program were required to begin supporting electronic prescribing. The regulation is optional for physicians and pharmacies.

Most recently, the Food and Drug Administration adopted the Systematized Nomenclature of Medicine (SNOMED) standard as the format for the highlights section of prescription drug labeling. The format will be required starting on June 30 for all new drugs and drugs approved within the last 5 years. The use of the SNOMED standards will make it easier for electronic systems to exchange FDA-approved labeling information, according to the agency.

One of the most significant developments has been the establishment of the Certification Commission on Health Information Technology (CCHIT). This group was formed in 2004 by the American Health Information Management Association, the Healthcare Information and Management Systems Society (HIMSS), and the National Alliance for Health Information Technology to develop criteria for the certification of EHRs.

CCHIT received a 3-year grant from HHS last fall to certify products in the ambulatory and inpatient setting as well as the systems' networks. Announcement of the first certified products in the ambulatory setting is expected by early July.

The means for objectively comparing EHR systems is “about to become a reality,” said CCHIT Chair Dr. Mark Leavitt. Current estimates put physician adoption of EHRs at around 14%. Dr. Leavitt said he hopes that by taking some of the risk out of buying an EHR product it will boost those adoption figures.

“I think we are on track,” said Dave Roberts, vice president of government relations at HIMSS. Although physicians still need to be educated about the value of EHRs, there are some other encouraging signs. For example, many states are helping to form regional health information organizations, he said.

These groups, called RHIOs, help to standardize the various regulations and business policies surrounding health information exchange. The federal government has funded more than 100 of these regional projects, and more efforts, supported by private industry or state governments, are underway, according to HHS. “The states are really buying into this whole initiative,” Mr. Roberts said.

For the majority of physicians, it just has not made financial sense to purchase an EHR system, Dr. Allen said. However, some physicians are beginning to see a strategic advantage in the adoption of technology. One advantage stems from regulations that encourage electronic prescribing.

EHR adoption is inevitable, Dr. Allen said, if only because so many younger physicians were trained on EHRs and won't go back to a paper system once they enter practice. And older physicians recognize that the change is coming, she said.

But Dr. Allen advised physicians that they don't need to jump into a full-blown EHR system. Electronic prescribing systems and electronic patient registries may be easier to adopt than a full EHR system, she said. Physicians can purchase EHRs in a modular fashion so that they can ramp up over time, she said.

More than 2 years after President Bush issued his call to action on the adoption of electronic health records, experts say there is growing pressure on physicians to heed that call.

Although physician adoption of EHRs remains low—especially in small practices—the movement toward pay for performance could start to drive adoption, said Mureen Allen, senior associate for informatics and practice improvement at the American College of Physicians. And the certification of EHRs by an independent body, which is slated to begin this summer, should help too. “The paradigm to some extent is changing.”

This month, many of the biggest players in health information technology gathered in Washington for National Health IT Week.

The series of events follows on the heels of more than 2 years' major action in the health IT landscape starting with President Bush's State of the Union address in January 2004 in which he called for the widespread adoption of interoperable EHRs within the decade.

A few months later, the Health and Human Services secretary appointed Dr. David J. Brailer as the first National Health Information Technology Coordinator. Dr. Brailer resigned from the post last month saying that he planned to stay in the job for only 2 years. Dr. Brailer said there is still a lot of work to be done in closing the adoption gap between large and small physician practices. His office has been focused on three strategies to close the gap—lowering costs, raising the benefits, and lowering the risks involved in purchasing an EHR system, he said during a teleconference announcing his resignation. Last fall, HHS Secretary Mike Leavitt established the American Health Information Community, a federally chartered commission to advise the secretary on interoperability issues. HHS proposed allowing hospitals and other entities to give physicians health IT hardware, software, and training.

HHS also awarded three contracts to public and private groups to create processes for harmonizing information standards, certifying health IT products, and addressing variations in state laws on privacy and security practices. And starting in January, prescription drug plans participating in the Medicare Part D program were required to begin supporting electronic prescribing. The regulation is optional for physicians and pharmacies.

Most recently, the Food and Drug Administration adopted the Systematized Nomenclature of Medicine (SNOMED) standard as the format for the highlights section of prescription drug labeling. The format will be required starting on June 30 for all new drugs and drugs approved within the last 5 years. The use of the SNOMED standards will make it easier for electronic systems to exchange FDA-approved labeling information, according to the agency.

One of the most significant developments has been the establishment of the Certification Commission on Health Information Technology (CCHIT). This group was formed in 2004 by the American Health Information Management Association, the Healthcare Information and Management Systems Society (HIMSS), and the National Alliance for Health Information Technology to develop criteria for the certification of EHRs.

CCHIT received a 3-year grant from HHS last fall to certify products in the ambulatory and inpatient setting as well as the systems' networks. Announcement of the first certified products in the ambulatory setting is expected by early July.

The means for objectively comparing EHR systems is “about to become a reality,” said CCHIT Chair Dr. Mark Leavitt. Current estimates put physician adoption of EHRs at around 14%. Dr. Leavitt said he hopes that by taking some of the risk out of buying an EHR product it will boost those adoption figures.

“I think we are on track,” said Dave Roberts, vice president of government relations at HIMSS. Although physicians still need to be educated about the value of EHRs, there are some other encouraging signs. For example, many states are helping to form regional health information organizations, he said.

These groups, called RHIOs, help to standardize the various regulations and business policies surrounding health information exchange. The federal government has funded more than 100 of these regional projects, and more efforts, supported by private industry or state governments, are underway, according to HHS. “The states are really buying into this whole initiative,” Mr. Roberts said.

For the majority of physicians, it just has not made financial sense to purchase an EHR system, Dr. Allen said. However, some physicians are beginning to see a strategic advantage in the adoption of technology. One advantage stems from regulations that encourage electronic prescribing.

EHR adoption is inevitable, Dr. Allen said, if only because so many younger physicians were trained on EHRs and won't go back to a paper system once they enter practice. And older physicians recognize that the change is coming, she said.

But Dr. Allen advised physicians that they don't need to jump into a full-blown EHR system. Electronic prescribing systems and electronic patient registries may be easier to adopt than a full EHR system, she said. Physicians can purchase EHRs in a modular fashion so that they can ramp up over time, she said.