Mary Ellen Schneider

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.

While physician adoption of EHRs remains low—especially in small practices—the movement toward pay for performance could start to drive adoption, said Dr. Mureen Allen, senior associate for informatics and practice improvement at the American College of Physicians. And the certification of electronic health records 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 will gather in Washington for National Health IT Week. More than 40 groups are slated to participate in this first-ever event, including medical professional societies such the American Academy of Family Physicians, government agencies, a regional health information organization, and other public and private organizations.

The series of events follows on the heels of more than 2 years' major actions 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 only planned to stay in the job for 2 years. Dr. Brailer said there is still a lot 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 settings, and to certify the systems' networks. The announcement of the first certified products in the ambulatory setting is expected in late June or 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. While physicians still need to be educated about the value of EHRs, there are some other encouraging signs. For example, many states are becoming more interested in health IT and 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 hasn't 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 it is not acceptable to them to 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. Physicians can also 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.

While physician adoption of EHRs remains low—especially in small practices—the movement toward pay for performance could start to drive adoption, said Dr. Mureen Allen, senior associate for informatics and practice improvement at the American College of Physicians. And the certification of electronic health records 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 will gather in Washington for National Health IT Week. More than 40 groups are slated to participate in this first-ever event, including medical professional societies such the American Academy of Family Physicians, government agencies, a regional health information organization, and other public and private organizations.

The series of events follows on the heels of more than 2 years' major actions 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 only planned to stay in the job for 2 years. Dr. Brailer said there is still a lot 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 settings, and to certify the systems' networks. The announcement of the first certified products in the ambulatory setting is expected in late June or 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. While physicians still need to be educated about the value of EHRs, there are some other encouraging signs. For example, many states are becoming more interested in health IT and 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 hasn't 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 it is not acceptable to them to 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. Physicians can also 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.

While physician adoption of EHRs remains low—especially in small practices—the movement toward pay for performance could start to drive adoption, said Dr. Mureen Allen, senior associate for informatics and practice improvement at the American College of Physicians. And the certification of electronic health records 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 will gather in Washington for National Health IT Week. More than 40 groups are slated to participate in this first-ever event, including medical professional societies such the American Academy of Family Physicians, government agencies, a regional health information organization, and other public and private organizations.

The series of events follows on the heels of more than 2 years' major actions 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 only planned to stay in the job for 2 years. Dr. Brailer said there is still a lot 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 settings, and to certify the systems' networks. The announcement of the first certified products in the ambulatory setting is expected in late June or 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. While physicians still need to be educated about the value of EHRs, there are some other encouraging signs. For example, many states are becoming more interested in health IT and 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 hasn't 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 it is not acceptable to them to 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. Physicians can also purchase EHRs in a modular fashion so that they can ramp up over time, she said.

Starting next month, physicians will have an alternative to billing for Medicare Part B drugs under the average sales price system.

Officials at the Centers for Medicare and Medicaid Services are launching the Competitive Acquisition Program (CAP) for Part B drugs starting on July 1. The new voluntary program will allow physicians to obtain selected Part B drugs from vendors chosen by CMS through a competitive bidding process.

During the initial phase of the program, CMS has selected one vendor—BioScrip—to provide drugs. Physicians who participate in CAP will be paid for the administration of the Part B drug or biologic on an assignment-related basis, according to CMS, but will not have to take on the financial risk of purchasing the drugs first.

The program should help to cut down on physician paperwork, according to CMS officials, because CAP vendors are responsible for collecting coinsurance and deductibles from Medicare beneficiaries once drug administration is verified. Physicians who participate in the program will submit claims for drug administration services to their local carrier within 14 days and provide their vendor with beneficiary supplemental insurance information.

But the program may not offer the relief being advertised, some physicians said.

CAP is likely to be a plus for Medicare because it will allow the agency to reduce costs, but there are still not enough details available about the program to ensure that there won't be adverse consequences for physicians, said Dr. Richard Hellman, president-elect of American Association of Clinical Endocrinologists.

Once physicians sign up, they must obtain all drugs on the CAP drug list from their drug vendor, except in certain cases such as emergency administration, according to CMS. This year there are about 180 drugs on the CAP drug list.

Dr. Hellman said he is concerned that CAP will affect access to medications if it makes it unprofitable for physicians to deliver these services in their offices. “[CMS officials] need to be careful that they do not restrict access in their zeal to cut costs.”

Dr. Alfred Denio, a rheumatologist in Norfolk, Va., said CAP could be an alternative in areas where it has not been financially feasible for physicians to purchase infused therapies on their own. However, even going through a CAP vendor, there will be a significant administrative burden, said Dr. Denio, who serves on the American College of Rheumatology's Committee on Rheumatologic Care.

For example, physicians must submit written orders for drugs to the CAP vendor, notify the vendor when a CAP drug is not administered or the full supply was not administered, and maintain a separate electronic or paper inventory for each CAP drug. “That's added cost to the practice that you will not be reimbursed for,” he said.

This year CAP will run from July 1 to Dec. 31. Starting in 2007, the program will run year-round. Physicians can opt into the CAP program each year and will be required to stay in the program for a full calendar year.

More information on the CAP program is available online at www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp

Starting next month, physicians will have an alternative to billing for Medicare Part B drugs under the average sales price system.

Officials at the Centers for Medicare and Medicaid Services are launching the Competitive Acquisition Program (CAP) for Part B drugs starting on July 1. The new voluntary program will allow physicians to obtain selected Part B drugs from vendors chosen by CMS through a competitive bidding process.

During the initial phase of the program, CMS has selected one vendor—BioScrip—to provide drugs. Physicians who participate in CAP will be paid for the administration of the Part B drug or biologic on an assignment-related basis, according to CMS, but will not have to take on the financial risk of purchasing the drugs first.

The program should help to cut down on physician paperwork, according to CMS officials, because CAP vendors are responsible for collecting coinsurance and deductibles from Medicare beneficiaries once drug administration is verified. Physicians who participate in the program will submit claims for drug administration services to their local carrier within 14 days and provide their vendor with beneficiary supplemental insurance information.

But the program may not offer the relief being advertised, some physicians said.

CAP is likely to be a plus for Medicare because it will allow the agency to reduce costs, but there are still not enough details available about the program to ensure that there won't be adverse consequences for physicians, said Dr. Richard Hellman, president-elect of American Association of Clinical Endocrinologists.

Once physicians sign up, they must obtain all drugs on the CAP drug list from their drug vendor, except in certain cases such as emergency administration, according to CMS. This year there are about 180 drugs on the CAP drug list.

Dr. Hellman said he is concerned that CAP will affect access to medications if it makes it unprofitable for physicians to deliver these services in their offices. “[CMS officials] need to be careful that they do not restrict access in their zeal to cut costs.”

Dr. Alfred Denio, a rheumatologist in Norfolk, Va., said CAP could be an alternative in areas where it has not been financially feasible for physicians to purchase infused therapies on their own. However, even going through a CAP vendor, there will be a significant administrative burden, said Dr. Denio, who serves on the American College of Rheumatology's Committee on Rheumatologic Care.

For example, physicians must submit written orders for drugs to the CAP vendor, notify the vendor when a CAP drug is not administered or the full supply was not administered, and maintain a separate electronic or paper inventory for each CAP drug. “That's added cost to the practice that you will not be reimbursed for,” he said.

This year CAP will run from July 1 to Dec. 31. Starting in 2007, the program will run year-round. Physicians can opt into the CAP program each year and will be required to stay in the program for a full calendar year.

More information on the CAP program is available online at www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp

Starting next month, physicians will have an alternative to billing for Medicare Part B drugs under the average sales price system.

Officials at the Centers for Medicare and Medicaid Services are launching the Competitive Acquisition Program (CAP) for Part B drugs starting on July 1. The new voluntary program will allow physicians to obtain selected Part B drugs from vendors chosen by CMS through a competitive bidding process.

During the initial phase of the program, CMS has selected one vendor—BioScrip—to provide drugs. Physicians who participate in CAP will be paid for the administration of the Part B drug or biologic on an assignment-related basis, according to CMS, but will not have to take on the financial risk of purchasing the drugs first.

The program should help to cut down on physician paperwork, according to CMS officials, because CAP vendors are responsible for collecting coinsurance and deductibles from Medicare beneficiaries once drug administration is verified. Physicians who participate in the program will submit claims for drug administration services to their local carrier within 14 days and provide their vendor with beneficiary supplemental insurance information.

But the program may not offer the relief being advertised, some physicians said.

CAP is likely to be a plus for Medicare because it will allow the agency to reduce costs, but there are still not enough details available about the program to ensure that there won't be adverse consequences for physicians, said Dr. Richard Hellman, president-elect of American Association of Clinical Endocrinologists.

Once physicians sign up, they must obtain all drugs on the CAP drug list from their drug vendor, except in certain cases such as emergency administration, according to CMS. This year there are about 180 drugs on the CAP drug list.

Dr. Hellman said he is concerned that CAP will affect access to medications if it makes it unprofitable for physicians to deliver these services in their offices. “[CMS officials] need to be careful that they do not restrict access in their zeal to cut costs.”

Dr. Alfred Denio, a rheumatologist in Norfolk, Va., said CAP could be an alternative in areas where it has not been financially feasible for physicians to purchase infused therapies on their own. However, even going through a CAP vendor, there will be a significant administrative burden, said Dr. Denio, who serves on the American College of Rheumatology's Committee on Rheumatologic Care.

For example, physicians must submit written orders for drugs to the CAP vendor, notify the vendor when a CAP drug is not administered or the full supply was not administered, and maintain a separate electronic or paper inventory for each CAP drug. “That's added cost to the practice that you will not be reimbursed for,” he said.

This year CAP will run from July 1 to Dec. 31. Starting in 2007, the program will run year-round. Physicians can opt into the CAP program each year and will be required to stay in the program for a full calendar year.

More information on the CAP program is available online at www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp

Pre-15 Pregnancy More Likely

Teenage girls who have sex before the age of 15 years are more likely to become pregnant than are teens who delay sex, according to an analysis from the National Campaign to Prevent Teen Pregnancy. About 46% of girls who have had sex at least once before age 15 report having been pregnant, compared with 25% of girls who delayed sex until age 15 or older. And 22% of teenage boys who have had sex at least once before age 15 report having been involved in a pregnancy, compared with 9% who waited to have sex. While the overall teenage pregnancy rate has been decreasing since 1990, younger teens and those with multiple partners still are at high risk for pregnancy. “Much still needs to be done to convince young people of the value of delaying sexual activity and to convince those who are sexually active to use contraception consistently and carefully,” Sarah Brown, director of the National Campaign to Prevent Teen Pregnancy, said in a statement. The analysis is based on 2002 data from the National Survey of Family Growth, conducted by the Centers for Disease Control and Prevention.

Reproductive Health Disparities

From 1994 to 2001, unintended pregnancies increased 29% among women living below the poverty level and fell among higher-income women, according to an analysis from the Guttmacher Institute. Poor women, black women, and unmarried women are the groups most likely to have an abortion due to unintended pregnancy, the researchers wrote. The report also noted that certain groups of women, such as young women and low-income women, are more likely to obtain an abortion later in pregnancy. “Although abortion remains legal, a two-tiered system is already emerging in our country,” Sharon L. Camp, Ph.D., who is president and CEO of the Guttmacher Institute, said in a statement. “Wealthier women have quick, convenient access to contraceptives and safe, early abortions, while poor women are less able to prevent pregnancies through contraception and are then forced to jump over a series of obstacles in order to obtain an abortion.” The report is available online at

www.guttmacher.org/pubs/2006/05/04/AiWL.pdf

Stem Cell Committee Named

The National Academies' Institute of Medicine and National Research Council have appointed a committee to “monitor and revise” the voluntary guidelines on the conduct of human embryonic stem cell research that were issued last year by the National Academies. The panel is seeking comments on the guidelines and will hold workshops to keep informed about developments in the field. The 14-member committee will be cochaired by R. Alta Charo, professor of law and bioethics at the University of Wisconsin, and Richard O. Hynes, Ph.D., investigator at the Howard Hughes Medical Institute and professor of cancer research at the Massachusetts Institute of Technology. The Ellison Medical Foundation, the Greenwall Foundation, and the Howard Hughes Medical Institute will fund the committee.

Maryland Passes Stem Cell Bill

The Maryland legislature passed a bill establishing a $15 million fund to promote stem cell research in the state. The measure, which passed by a vote of 90–48 and was signed by Republican Gov. Robert Ehrlich in April, will set procedures for reviewing research projects involving either adult or embryonic stem cells. An independent commission—including representatives from the patient advocate, biotechnology, and ethics communities—will administer grants to universities and private sector researchers. “This new law will solidify Maryland's reputation as a national leader in medical research, attract and retain biotech companies and researchers to Maryland, and offer hope to millions of American suffering from debilitating conditions,” Ehrlich said in a statement.

Teen Perceptions on Oral Sex

More than one-quarter of teenagers in a recent survey did not know that sexually transmitted diseases (STDs) can be passed through oral sex, according to a study published in the March issue of Perspectives on Sexual and Reproductive Health. In contrast, only 2% of the teens were unaware that STDs can be transmitted through “vaginal intercourse with ejaculation.” The study included a survey of more than 1,300 British teenagers and analysis of sexual event diaries of more than 100 of the teenagers. Knowledge of STD transmission improved among older girls. Only 5% of 18-year-old girls did not know that STDs could be transmitted during oral sex, compared to about 22% of 16-year-old girls. “Given the prevalence of oral sex and the lack of knowledge about its risks among young people, it is essential that those charged with teaching youth about sexual issues—whether in schools, in clinics or in homes—be encouraged to broaden the scope of their coverage,” the researchers wrote.

Pre-15 Pregnancy More Likely

Teenage girls who have sex before the age of 15 years are more likely to become pregnant than are teens who delay sex, according to an analysis from the National Campaign to Prevent Teen Pregnancy. About 46% of girls who have had sex at least once before age 15 report having been pregnant, compared with 25% of girls who delayed sex until age 15 or older. And 22% of teenage boys who have had sex at least once before age 15 report having been involved in a pregnancy, compared with 9% who waited to have sex. While the overall teenage pregnancy rate has been decreasing since 1990, younger teens and those with multiple partners still are at high risk for pregnancy. “Much still needs to be done to convince young people of the value of delaying sexual activity and to convince those who are sexually active to use contraception consistently and carefully,” Sarah Brown, director of the National Campaign to Prevent Teen Pregnancy, said in a statement. The analysis is based on 2002 data from the National Survey of Family Growth, conducted by the Centers for Disease Control and Prevention.

Reproductive Health Disparities

From 1994 to 2001, unintended pregnancies increased 29% among women living below the poverty level and fell among higher-income women, according to an analysis from the Guttmacher Institute. Poor women, black women, and unmarried women are the groups most likely to have an abortion due to unintended pregnancy, the researchers wrote. The report also noted that certain groups of women, such as young women and low-income women, are more likely to obtain an abortion later in pregnancy. “Although abortion remains legal, a two-tiered system is already emerging in our country,” Sharon L. Camp, Ph.D., who is president and CEO of the Guttmacher Institute, said in a statement. “Wealthier women have quick, convenient access to contraceptives and safe, early abortions, while poor women are less able to prevent pregnancies through contraception and are then forced to jump over a series of obstacles in order to obtain an abortion.” The report is available online at

www.guttmacher.org/pubs/2006/05/04/AiWL.pdf

Stem Cell Committee Named

The National Academies' Institute of Medicine and National Research Council have appointed a committee to “monitor and revise” the voluntary guidelines on the conduct of human embryonic stem cell research that were issued last year by the National Academies. The panel is seeking comments on the guidelines and will hold workshops to keep informed about developments in the field. The 14-member committee will be cochaired by R. Alta Charo, professor of law and bioethics at the University of Wisconsin, and Richard O. Hynes, Ph.D., investigator at the Howard Hughes Medical Institute and professor of cancer research at the Massachusetts Institute of Technology. The Ellison Medical Foundation, the Greenwall Foundation, and the Howard Hughes Medical Institute will fund the committee.

Maryland Passes Stem Cell Bill

The Maryland legislature passed a bill establishing a $15 million fund to promote stem cell research in the state. The measure, which passed by a vote of 90–48 and was signed by Republican Gov. Robert Ehrlich in April, will set procedures for reviewing research projects involving either adult or embryonic stem cells. An independent commission—including representatives from the patient advocate, biotechnology, and ethics communities—will administer grants to universities and private sector researchers. “This new law will solidify Maryland's reputation as a national leader in medical research, attract and retain biotech companies and researchers to Maryland, and offer hope to millions of American suffering from debilitating conditions,” Ehrlich said in a statement.

Teen Perceptions on Oral Sex

More than one-quarter of teenagers in a recent survey did not know that sexually transmitted diseases (STDs) can be passed through oral sex, according to a study published in the March issue of Perspectives on Sexual and Reproductive Health. In contrast, only 2% of the teens were unaware that STDs can be transmitted through “vaginal intercourse with ejaculation.” The study included a survey of more than 1,300 British teenagers and analysis of sexual event diaries of more than 100 of the teenagers. Knowledge of STD transmission improved among older girls. Only 5% of 18-year-old girls did not know that STDs could be transmitted during oral sex, compared to about 22% of 16-year-old girls. “Given the prevalence of oral sex and the lack of knowledge about its risks among young people, it is essential that those charged with teaching youth about sexual issues—whether in schools, in clinics or in homes—be encouraged to broaden the scope of their coverage,” the researchers wrote.

Pre-15 Pregnancy More Likely

Teenage girls who have sex before the age of 15 years are more likely to become pregnant than are teens who delay sex, according to an analysis from the National Campaign to Prevent Teen Pregnancy. About 46% of girls who have had sex at least once before age 15 report having been pregnant, compared with 25% of girls who delayed sex until age 15 or older. And 22% of teenage boys who have had sex at least once before age 15 report having been involved in a pregnancy, compared with 9% who waited to have sex. While the overall teenage pregnancy rate has been decreasing since 1990, younger teens and those with multiple partners still are at high risk for pregnancy. “Much still needs to be done to convince young people of the value of delaying sexual activity and to convince those who are sexually active to use contraception consistently and carefully,” Sarah Brown, director of the National Campaign to Prevent Teen Pregnancy, said in a statement. The analysis is based on 2002 data from the National Survey of Family Growth, conducted by the Centers for Disease Control and Prevention.

Reproductive Health Disparities

From 1994 to 2001, unintended pregnancies increased 29% among women living below the poverty level and fell among higher-income women, according to an analysis from the Guttmacher Institute. Poor women, black women, and unmarried women are the groups most likely to have an abortion due to unintended pregnancy, the researchers wrote. The report also noted that certain groups of women, such as young women and low-income women, are more likely to obtain an abortion later in pregnancy. “Although abortion remains legal, a two-tiered system is already emerging in our country,” Sharon L. Camp, Ph.D., who is president and CEO of the Guttmacher Institute, said in a statement. “Wealthier women have quick, convenient access to contraceptives and safe, early abortions, while poor women are less able to prevent pregnancies through contraception and are then forced to jump over a series of obstacles in order to obtain an abortion.” The report is available online at

www.guttmacher.org/pubs/2006/05/04/AiWL.pdf

Stem Cell Committee Named

The National Academies' Institute of Medicine and National Research Council have appointed a committee to “monitor and revise” the voluntary guidelines on the conduct of human embryonic stem cell research that were issued last year by the National Academies. The panel is seeking comments on the guidelines and will hold workshops to keep informed about developments in the field. The 14-member committee will be cochaired by R. Alta Charo, professor of law and bioethics at the University of Wisconsin, and Richard O. Hynes, Ph.D., investigator at the Howard Hughes Medical Institute and professor of cancer research at the Massachusetts Institute of Technology. The Ellison Medical Foundation, the Greenwall Foundation, and the Howard Hughes Medical Institute will fund the committee.

Maryland Passes Stem Cell Bill

The Maryland legislature passed a bill establishing a $15 million fund to promote stem cell research in the state. The measure, which passed by a vote of 90–48 and was signed by Republican Gov. Robert Ehrlich in April, will set procedures for reviewing research projects involving either adult or embryonic stem cells. An independent commission—including representatives from the patient advocate, biotechnology, and ethics communities—will administer grants to universities and private sector researchers. “This new law will solidify Maryland's reputation as a national leader in medical research, attract and retain biotech companies and researchers to Maryland, and offer hope to millions of American suffering from debilitating conditions,” Ehrlich said in a statement.

Teen Perceptions on Oral Sex

More than one-quarter of teenagers in a recent survey did not know that sexually transmitted diseases (STDs) can be passed through oral sex, according to a study published in the March issue of Perspectives on Sexual and Reproductive Health. In contrast, only 2% of the teens were unaware that STDs can be transmitted through “vaginal intercourse with ejaculation.” The study included a survey of more than 1,300 British teenagers and analysis of sexual event diaries of more than 100 of the teenagers. Knowledge of STD transmission improved among older girls. Only 5% of 18-year-old girls did not know that STDs could be transmitted during oral sex, compared to about 22% of 16-year-old girls. “Given the prevalence of oral sex and the lack of knowledge about its risks among young people, it is essential that those charged with teaching youth about sexual issues—whether in schools, in clinics or in homes—be encouraged to broaden the scope of their coverage,” the researchers wrote.

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, he 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.

This Month's Talk Back Question

If you have used patient registry software in your practice, how useful has it been in caring for patients with chronic diseases?

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, he 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.

This Month's Talk Back Question

If you have used patient registry software in your practice, how useful has it been in caring for patients with chronic diseases?

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, he 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.

This Month's Talk Back Question

If you have used patient registry software in your practice, how useful has it been in caring for patients with chronic diseases?

LOS ANGELES — There is limited risk of developing progressive multifocal leukoencephalopathy with the use of natalizumab, according to the results of a safety evaluation presented at the annual Digestive Disease Week.

Researchers from the Mayo Clinic in Rochester, Minn., and Cedars-Sinai Medical Center in Los Angeles evaluated patients who had taken the drug while participating in clinical trials of its use in treating Crohn's disease, multiple sclerosis, and rheumatoid arthritis.

Trials involving natalizumab (marketed as Tysabri) were halted in 2005 after there were two reports of patients who developed progressive multifocal leukoencephalopathy (PML) while taking combination therapy with natalizumab and interferon-β. A third report described a patient who was taking natalizumab alone and had previously taken the drug in combination with azathioprine.

Earlier this year, the FDA lifted is clinical hold on trials of the drug for multiple sclerosis. The agency has yet to announce a decision about wider marketing of the drug.

For the safety evaluation, the researchers screened participants in the two suspended studies and a completed 2004 study of multiple sclerosis. The majority of patients from the original studies participated in the safety evaluation.

No additional cases were found to have the JC virus, which has been associated with PML, according to the researchers. They found that the absolute risk of developing PML after taking natalizumab was about 0.1%.

Since only three patients developed PML, it was difficult for researchers to identify any risk factors for the rare disorder, said lead study author Dr. William Sandborn of the Mayo Clinic. Dr. Sandborn is a consultant for Elan, which jointly markets the drug with Biogen Idec. The companies funded the safety evaluation.

However, Dr. Sandborn noted that the patients who developed PML had taken natalizumab in combination with either interferon-β or azathioprine, and physicians were likely to use the drug as monotherapy until the risk factors were better understood.

It is unclear whether a screening strategy would be effective for PML, according to the researchers.

LOS ANGELES — There is limited risk of developing progressive multifocal leukoencephalopathy with the use of natalizumab, according to the results of a safety evaluation presented at the annual Digestive Disease Week.

Researchers from the Mayo Clinic in Rochester, Minn., and Cedars-Sinai Medical Center in Los Angeles evaluated patients who had taken the drug while participating in clinical trials of its use in treating Crohn's disease, multiple sclerosis, and rheumatoid arthritis.

Trials involving natalizumab (marketed as Tysabri) were halted in 2005 after there were two reports of patients who developed progressive multifocal leukoencephalopathy (PML) while taking combination therapy with natalizumab and interferon-β. A third report described a patient who was taking natalizumab alone and had previously taken the drug in combination with azathioprine.

Earlier this year, the FDA lifted is clinical hold on trials of the drug for multiple sclerosis. The agency has yet to announce a decision about wider marketing of the drug.

For the safety evaluation, the researchers screened participants in the two suspended studies and a completed 2004 study of multiple sclerosis. The majority of patients from the original studies participated in the safety evaluation.

No additional cases were found to have the JC virus, which has been associated with PML, according to the researchers. They found that the absolute risk of developing PML after taking natalizumab was about 0.1%.

Since only three patients developed PML, it was difficult for researchers to identify any risk factors for the rare disorder, said lead study author Dr. William Sandborn of the Mayo Clinic. Dr. Sandborn is a consultant for Elan, which jointly markets the drug with Biogen Idec. The companies funded the safety evaluation.

However, Dr. Sandborn noted that the patients who developed PML had taken natalizumab in combination with either interferon-β or azathioprine, and physicians were likely to use the drug as monotherapy until the risk factors were better understood.

It is unclear whether a screening strategy would be effective for PML, according to the researchers.

LOS ANGELES — There is limited risk of developing progressive multifocal leukoencephalopathy with the use of natalizumab, according to the results of a safety evaluation presented at the annual Digestive Disease Week.

Researchers from the Mayo Clinic in Rochester, Minn., and Cedars-Sinai Medical Center in Los Angeles evaluated patients who had taken the drug while participating in clinical trials of its use in treating Crohn's disease, multiple sclerosis, and rheumatoid arthritis.

Trials involving natalizumab (marketed as Tysabri) were halted in 2005 after there were two reports of patients who developed progressive multifocal leukoencephalopathy (PML) while taking combination therapy with natalizumab and interferon-β. A third report described a patient who was taking natalizumab alone and had previously taken the drug in combination with azathioprine.

Earlier this year, the FDA lifted is clinical hold on trials of the drug for multiple sclerosis. The agency has yet to announce a decision about wider marketing of the drug.

For the safety evaluation, the researchers screened participants in the two suspended studies and a completed 2004 study of multiple sclerosis. The majority of patients from the original studies participated in the safety evaluation.

No additional cases were found to have the JC virus, which has been associated with PML, according to the researchers. They found that the absolute risk of developing PML after taking natalizumab was about 0.1%.

Since only three patients developed PML, it was difficult for researchers to identify any risk factors for the rare disorder, said lead study author Dr. William Sandborn of the Mayo Clinic. Dr. Sandborn is a consultant for Elan, which jointly markets the drug with Biogen Idec. The companies funded the safety evaluation.

However, Dr. Sandborn noted that the patients who developed PML had taken natalizumab in combination with either interferon-β or azathioprine, and physicians were likely to use the drug as monotherapy until the risk factors were better understood.

It is unclear whether a screening strategy would be effective for PML, according to the researchers.

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.

While 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 electronic health records 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 will gather in Washington for National Health IT Week. More than 40 groups are slated to participate in this first-ever event, including medical professional societies such the American Academy of Family Physicians, government agencies, a regional health information organization, and other public and private organizations.

The series of events follows on the heels of more than 2 years' major actions 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 only planned to stay in the job for 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.

Since January, prescription drug plans participating in the Medicare Part D program have been 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 settings, and to certify the systems' networks. The announcement of the first certified products in the ambulatory setting is expected in late June or early July.

CCHIT Chair Dr. Mark Leavitt said that current estimates put physician adoption of EHRs at around 14%. He said that taking some of the risk out of buying an EHR product may boost use.

“I think we are on track,” said Dave Roberts, vice president of government relations at HIMSS. While physicians still need to be educated about the value of EHRs, there are some other encouraging signs. For example, many states are becoming more interested in health IT and 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.

For the majority of physicians, it just hasn't 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 new physicians are being trained on EHRs, and it is not acceptable to them to go back to a paper system once they enter practice.

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.

While 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 electronic health records 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 will gather in Washington for National Health IT Week. More than 40 groups are slated to participate in this first-ever event, including medical professional societies such the American Academy of Family Physicians, government agencies, a regional health information organization, and other public and private organizations.

The series of events follows on the heels of more than 2 years' major actions 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 only planned to stay in the job for 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.

Since January, prescription drug plans participating in the Medicare Part D program have been 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 settings, and to certify the systems' networks. The announcement of the first certified products in the ambulatory setting is expected in late June or early July.

CCHIT Chair Dr. Mark Leavitt said that current estimates put physician adoption of EHRs at around 14%. He said that taking some of the risk out of buying an EHR product may boost use.

“I think we are on track,” said Dave Roberts, vice president of government relations at HIMSS. While physicians still need to be educated about the value of EHRs, there are some other encouraging signs. For example, many states are becoming more interested in health IT and 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.

For the majority of physicians, it just hasn't 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 new physicians are being trained on EHRs, and it is not acceptable to them to go back to a paper system once they enter practice.

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.

While 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 electronic health records 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 will gather in Washington for National Health IT Week. More than 40 groups are slated to participate in this first-ever event, including medical professional societies such the American Academy of Family Physicians, government agencies, a regional health information organization, and other public and private organizations.

The series of events follows on the heels of more than 2 years' major actions 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 only planned to stay in the job for 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.

Since January, prescription drug plans participating in the Medicare Part D program have been 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 settings, and to certify the systems' networks. The announcement of the first certified products in the ambulatory setting is expected in late June or early July.

CCHIT Chair Dr. Mark Leavitt said that current estimates put physician adoption of EHRs at around 14%. He said that taking some of the risk out of buying an EHR product may boost use.

“I think we are on track,” said Dave Roberts, vice president of government relations at HIMSS. While physicians still need to be educated about the value of EHRs, there are some other encouraging signs. For example, many states are becoming more interested in health IT and 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.

For the majority of physicians, it just hasn't 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 new physicians are being trained on EHRs, and it is not acceptable to them to go back to a paper system once they enter practice.

Rheumatic Diseases Research Plan

New approaches to the treatment for rheumatoid arthritis are needed, according to a draft of the long-range plan for the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The draft outlines research needs for fiscal years 2006–2009 and calls for exploring immunosuppressive agents in inflammatory rheumatic disorders and gaining a better understanding of the epidemiology and disease manifestations of diseases such as juvenile arthritis and juvenile dermatomyositis. The draft report also notes the importance of developing new imaging technologies.

Rare Disease Studies

Officials at the National Institutes of Health have launched the first clinical studies that are part of its Rare Diseases Clinical Research Network. The network has received a total of $71 million in 5-year funding awards to study rare diseases. In the next few months, more than 20 studies are expected to open in sites around the world. For example, an investigator at the Johns Hopkins Vasculitis Center in Baltimore will conduct a study of giant cell arteritis. Other studies will focus on conditions including Angelman's syndrome, episodic ataxia, and urea cycle disorders. “By studying the genetic component of these rare diseases, we hope to be able to better predict the course of the illnesses and provide more effective, personalized treatments for those afflicted,” NIH Director Dr. Elias A. Zerhouni said in a statement. “Ultimately, this individualized approach, completely different from how we treat patients today, will allow us to prevent or to promptly treat the complications arising from these genetic disorders.”

Medicare Formulary Guidance

If officials at a Medicare Part D drug plan change the preferred or nonpreferred formulary drugs, remove dosage forms, or exchange therapeutic alternatives, they must allow beneficiaries currently taking the drug to be exempt from the changes for the rest of the year, according to guidance from the Centers for Medicare and Medicaid Services. Abby L. Block, director of the CMS Center for Beneficiary Choices issued a memo to Part D sponsors in April outlining policies for formulary changes made after a beneficiary has signed onto a plan at the beginning of the plan year. In addition, Part D plans can only change therapeutic categories and classes in a formulary at the beginning of each plan year, except to account for new therapeutic uses or newly approved drugs. CMS also noted that after March 1, Part D drug plans are only allowed to make “maintenance changes” to their formulary, such as replacing a brand name drugs with a new generic drug. All proposed formulary changes, except for expansions, must be submitted to CMS for review and approval, according to the memo. “Prescription drug therapies are constantly evolving, and new drug availability, new medical knowledge, and new opportunities for improving safety and quality in prescription drug use at a low cost will inevitably occur over the course of the year,” Ms. Block said in the memo to Part D sponsors.

Stem Cell Committee Named

The Institute of Medicine and the National Research Council, two divisions of the National Academies, have appointed a committee to “monitor and revise” voluntary guidelines on the conduct of human embryonic stem cell research. The committee will provide updates to the voluntary guidelines issued last year by the National Academies; it is currently seeking comments on the guidelines. It also will have workshops to keep informed about developments in the field. The 14-member committee will be cochaired by R. Alta Charo, professor of law and bioethics at the University of Wisconsin, Madison, and Richard O. Hynes, Ph.D., investigator at the Howard Hughes Medical Institute and professor of cancer research at the Massachusetts Institute of Technology, Cambridge. The Ellison Medical Foundation, the Greenwall Foundation, and the Howard Hughes Medical Institute will provide funding for the committee.

Maryland OKs Stem Cell Research

The Maryland legislature passed a bill establishing a $15 million fund to promote stem cell research in the state. The measure, which passed by a vote of 90–48 and signed by Republican Gov. Robert Ehrlich last month, will establish procedures for reviewing research projects involving either adult or embryonic stem cells. An independent commission—including representatives from the patient advocate, biotechnology, and ethics communities—will administer grants to universities and private sector researchers. “This new law will solidify Maryland's reputation as a national leader in medical research, attract and retain biotech companies and researchers to Maryland, and offer hope to millions of American suffering from debilitating conditions,” the governor said in a statement.

Doctors Most Trusted for Advice

A new Harris poll finds that among 11 professions, physicians are the most trusted to give good advice, with dentists and nurses running a close second and third. Fifty percent of 2,302 adults polled online in late March said they “completely” trusted a physician to give advice that is best for them. Only 4% said they did not trust a physician at all. Overall, 93% of adults said they completely or somewhat trusted physicians; 92% said the same about a nurse and 91% said the same about a dentist. Mechanics, insurance agents, and real estate agents engendered the least amount of trust, with stockbrokers holding the rock-bottom position.

Rheumatic Diseases Research Plan

New approaches to the treatment for rheumatoid arthritis are needed, according to a draft of the long-range plan for the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The draft outlines research needs for fiscal years 2006–2009 and calls for exploring immunosuppressive agents in inflammatory rheumatic disorders and gaining a better understanding of the epidemiology and disease manifestations of diseases such as juvenile arthritis and juvenile dermatomyositis. The draft report also notes the importance of developing new imaging technologies.

Rare Disease Studies

Officials at the National Institutes of Health have launched the first clinical studies that are part of its Rare Diseases Clinical Research Network. The network has received a total of $71 million in 5-year funding awards to study rare diseases. In the next few months, more than 20 studies are expected to open in sites around the world. For example, an investigator at the Johns Hopkins Vasculitis Center in Baltimore will conduct a study of giant cell arteritis. Other studies will focus on conditions including Angelman's syndrome, episodic ataxia, and urea cycle disorders. “By studying the genetic component of these rare diseases, we hope to be able to better predict the course of the illnesses and provide more effective, personalized treatments for those afflicted,” NIH Director Dr. Elias A. Zerhouni said in a statement. “Ultimately, this individualized approach, completely different from how we treat patients today, will allow us to prevent or to promptly treat the complications arising from these genetic disorders.”

Medicare Formulary Guidance

If officials at a Medicare Part D drug plan change the preferred or nonpreferred formulary drugs, remove dosage forms, or exchange therapeutic alternatives, they must allow beneficiaries currently taking the drug to be exempt from the changes for the rest of the year, according to guidance from the Centers for Medicare and Medicaid Services. Abby L. Block, director of the CMS Center for Beneficiary Choices issued a memo to Part D sponsors in April outlining policies for formulary changes made after a beneficiary has signed onto a plan at the beginning of the plan year. In addition, Part D plans can only change therapeutic categories and classes in a formulary at the beginning of each plan year, except to account for new therapeutic uses or newly approved drugs. CMS also noted that after March 1, Part D drug plans are only allowed to make “maintenance changes” to their formulary, such as replacing a brand name drugs with a new generic drug. All proposed formulary changes, except for expansions, must be submitted to CMS for review and approval, according to the memo. “Prescription drug therapies are constantly evolving, and new drug availability, new medical knowledge, and new opportunities for improving safety and quality in prescription drug use at a low cost will inevitably occur over the course of the year,” Ms. Block said in the memo to Part D sponsors.

Stem Cell Committee Named

The Institute of Medicine and the National Research Council, two divisions of the National Academies, have appointed a committee to “monitor and revise” voluntary guidelines on the conduct of human embryonic stem cell research. The committee will provide updates to the voluntary guidelines issued last year by the National Academies; it is currently seeking comments on the guidelines. It also will have workshops to keep informed about developments in the field. The 14-member committee will be cochaired by R. Alta Charo, professor of law and bioethics at the University of Wisconsin, Madison, and Richard O. Hynes, Ph.D., investigator at the Howard Hughes Medical Institute and professor of cancer research at the Massachusetts Institute of Technology, Cambridge. The Ellison Medical Foundation, the Greenwall Foundation, and the Howard Hughes Medical Institute will provide funding for the committee.

Maryland OKs Stem Cell Research

The Maryland legislature passed a bill establishing a $15 million fund to promote stem cell research in the state. The measure, which passed by a vote of 90–48 and signed by Republican Gov. Robert Ehrlich last month, will establish procedures for reviewing research projects involving either adult or embryonic stem cells. An independent commission—including representatives from the patient advocate, biotechnology, and ethics communities—will administer grants to universities and private sector researchers. “This new law will solidify Maryland's reputation as a national leader in medical research, attract and retain biotech companies and researchers to Maryland, and offer hope to millions of American suffering from debilitating conditions,” the governor said in a statement.

Doctors Most Trusted for Advice

A new Harris poll finds that among 11 professions, physicians are the most trusted to give good advice, with dentists and nurses running a close second and third. Fifty percent of 2,302 adults polled online in late March said they “completely” trusted a physician to give advice that is best for them. Only 4% said they did not trust a physician at all. Overall, 93% of adults said they completely or somewhat trusted physicians; 92% said the same about a nurse and 91% said the same about a dentist. Mechanics, insurance agents, and real estate agents engendered the least amount of trust, with stockbrokers holding the rock-bottom position.

Rheumatic Diseases Research Plan

New approaches to the treatment for rheumatoid arthritis are needed, according to a draft of the long-range plan for the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The draft outlines research needs for fiscal years 2006–2009 and calls for exploring immunosuppressive agents in inflammatory rheumatic disorders and gaining a better understanding of the epidemiology and disease manifestations of diseases such as juvenile arthritis and juvenile dermatomyositis. The draft report also notes the importance of developing new imaging technologies.

Rare Disease Studies

Officials at the National Institutes of Health have launched the first clinical studies that are part of its Rare Diseases Clinical Research Network. The network has received a total of $71 million in 5-year funding awards to study rare diseases. In the next few months, more than 20 studies are expected to open in sites around the world. For example, an investigator at the Johns Hopkins Vasculitis Center in Baltimore will conduct a study of giant cell arteritis. Other studies will focus on conditions including Angelman's syndrome, episodic ataxia, and urea cycle disorders. “By studying the genetic component of these rare diseases, we hope to be able to better predict the course of the illnesses and provide more effective, personalized treatments for those afflicted,” NIH Director Dr. Elias A. Zerhouni said in a statement. “Ultimately, this individualized approach, completely different from how we treat patients today, will allow us to prevent or to promptly treat the complications arising from these genetic disorders.”

Medicare Formulary Guidance

If officials at a Medicare Part D drug plan change the preferred or nonpreferred formulary drugs, remove dosage forms, or exchange therapeutic alternatives, they must allow beneficiaries currently taking the drug to be exempt from the changes for the rest of the year, according to guidance from the Centers for Medicare and Medicaid Services. Abby L. Block, director of the CMS Center for Beneficiary Choices issued a memo to Part D sponsors in April outlining policies for formulary changes made after a beneficiary has signed onto a plan at the beginning of the plan year. In addition, Part D plans can only change therapeutic categories and classes in a formulary at the beginning of each plan year, except to account for new therapeutic uses or newly approved drugs. CMS also noted that after March 1, Part D drug plans are only allowed to make “maintenance changes” to their formulary, such as replacing a brand name drugs with a new generic drug. All proposed formulary changes, except for expansions, must be submitted to CMS for review and approval, according to the memo. “Prescription drug therapies are constantly evolving, and new drug availability, new medical knowledge, and new opportunities for improving safety and quality in prescription drug use at a low cost will inevitably occur over the course of the year,” Ms. Block said in the memo to Part D sponsors.

Stem Cell Committee Named

The Institute of Medicine and the National Research Council, two divisions of the National Academies, have appointed a committee to “monitor and revise” voluntary guidelines on the conduct of human embryonic stem cell research. The committee will provide updates to the voluntary guidelines issued last year by the National Academies; it is currently seeking comments on the guidelines. It also will have workshops to keep informed about developments in the field. The 14-member committee will be cochaired by R. Alta Charo, professor of law and bioethics at the University of Wisconsin, Madison, and Richard O. Hynes, Ph.D., investigator at the Howard Hughes Medical Institute and professor of cancer research at the Massachusetts Institute of Technology, Cambridge. The Ellison Medical Foundation, the Greenwall Foundation, and the Howard Hughes Medical Institute will provide funding for the committee.

Maryland OKs Stem Cell Research

The Maryland legislature passed a bill establishing a $15 million fund to promote stem cell research in the state. The measure, which passed by a vote of 90–48 and signed by Republican Gov. Robert Ehrlich last month, will establish procedures for reviewing research projects involving either adult or embryonic stem cells. An independent commission—including representatives from the patient advocate, biotechnology, and ethics communities—will administer grants to universities and private sector researchers. “This new law will solidify Maryland's reputation as a national leader in medical research, attract and retain biotech companies and researchers to Maryland, and offer hope to millions of American suffering from debilitating conditions,” the governor said in a statement.

Doctors Most Trusted for Advice

A new Harris poll finds that among 11 professions, physicians are the most trusted to give good advice, with dentists and nurses running a close second and third. Fifty percent of 2,302 adults polled online in late March said they “completely” trusted a physician to give advice that is best for them. Only 4% said they did not trust a physician at all. Overall, 93% of adults said they completely or somewhat trusted physicians; 92% said the same about a nurse and 91% said the same about a dentist. Mechanics, insurance agents, and real estate agents engendered the least amount of trust, with stockbrokers holding the rock-bottom position.

The OIG advisory opinion is available online at oig.hhs.gov/fraud/advisoryopinions.html

The Health and Human Services Office of Inspector General recently gave the green light to a redesigned patient assistance program from the drug maker Schering-Plough Corp.

Late last year, the Inspector General issued a special advisory bulletin cautioning drug makers that continuing their patient assistance programs for people enrolled in the Medicare Part D prescription drug benefit could put them at risk for violating the federal antikickback statute. But the bulletin outlined some designs that would allow Medicare beneficiaries to continue to receive drug assistance from the companies outside of the Part D benefit.

The new advisory opinion (no. 06–03) states that the OIG will not impose administrative sanctions on Schering-Plough based on the specific design of the program's two patient assistance plans, which offer free drugs to financially needy patients taking hepatitis or cancer drugs, and to such patients taking other outpatient prescription drugs. The advisory opinion does not apply to any other arrangements.

Under Schering-Plough's design, Medicare Part D beneficiaries are still eligible for free drugs if they meet the income eligibility requirements for the patient assistance plans and have already spent at least 3% of their household income on outpatient prescription drugs that coverage year. The free drugs do not count toward the beneficiary's true out-of-pocket costs and will not be billed to either the Part D plan or Medicare.

Schering-Plough is working with officials at the Centers for Medicare and Medicaid Services on a data-sharing agreement to notify Part D plans about beneficiary participation in the program.

“Having reviewed the arrangement, we conclude that the arrangement contains safeguards sufficient to ensure that the [patient assistance plans] operate entirely outside the Part D benefit, and, therefore, there is minimal risk of fraud and abuse under the Part D program,” Lewis Morris, chief counsel to the Inspector General, wrote in the advisory opinion.

The OIG advisory opinion is available online at oig.hhs.gov/fraud/advisoryopinions.html

The Health and Human Services Office of Inspector General recently gave the green light to a redesigned patient assistance program from the drug maker Schering-Plough Corp.

Late last year, the Inspector General issued a special advisory bulletin cautioning drug makers that continuing their patient assistance programs for people enrolled in the Medicare Part D prescription drug benefit could put them at risk for violating the federal antikickback statute. But the bulletin outlined some designs that would allow Medicare beneficiaries to continue to receive drug assistance from the companies outside of the Part D benefit.

The new advisory opinion (no. 06–03) states that the OIG will not impose administrative sanctions on Schering-Plough based on the specific design of the program's two patient assistance plans, which offer free drugs to financially needy patients taking hepatitis or cancer drugs, and to such patients taking other outpatient prescription drugs. The advisory opinion does not apply to any other arrangements.

Under Schering-Plough's design, Medicare Part D beneficiaries are still eligible for free drugs if they meet the income eligibility requirements for the patient assistance plans and have already spent at least 3% of their household income on outpatient prescription drugs that coverage year. The free drugs do not count toward the beneficiary's true out-of-pocket costs and will not be billed to either the Part D plan or Medicare.

Schering-Plough is working with officials at the Centers for Medicare and Medicaid Services on a data-sharing agreement to notify Part D plans about beneficiary participation in the program.

“Having reviewed the arrangement, we conclude that the arrangement contains safeguards sufficient to ensure that the [patient assistance plans] operate entirely outside the Part D benefit, and, therefore, there is minimal risk of fraud and abuse under the Part D program,” Lewis Morris, chief counsel to the Inspector General, wrote in the advisory opinion.

The OIG advisory opinion is available online at oig.hhs.gov/fraud/advisoryopinions.html

The Health and Human Services Office of Inspector General recently gave the green light to a redesigned patient assistance program from the drug maker Schering-Plough Corp.

Late last year, the Inspector General issued a special advisory bulletin cautioning drug makers that continuing their patient assistance programs for people enrolled in the Medicare Part D prescription drug benefit could put them at risk for violating the federal antikickback statute. But the bulletin outlined some designs that would allow Medicare beneficiaries to continue to receive drug assistance from the companies outside of the Part D benefit.

The new advisory opinion (no. 06–03) states that the OIG will not impose administrative sanctions on Schering-Plough based on the specific design of the program's two patient assistance plans, which offer free drugs to financially needy patients taking hepatitis or cancer drugs, and to such patients taking other outpatient prescription drugs. The advisory opinion does not apply to any other arrangements.

Under Schering-Plough's design, Medicare Part D beneficiaries are still eligible for free drugs if they meet the income eligibility requirements for the patient assistance plans and have already spent at least 3% of their household income on outpatient prescription drugs that coverage year. The free drugs do not count toward the beneficiary's true out-of-pocket costs and will not be billed to either the Part D plan or Medicare.

Schering-Plough is working with officials at the Centers for Medicare and Medicaid Services on a data-sharing agreement to notify Part D plans about beneficiary participation in the program.

“Having reviewed the arrangement, we conclude that the arrangement contains safeguards sufficient to ensure that the [patient assistance plans] operate entirely outside the Part D benefit, and, therefore, there is minimal risk of fraud and abuse under the Part D program,” Lewis Morris, chief counsel to the Inspector General, wrote in the advisory opinion.

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, noted Dr. Hornbake.

He said that he exported demographic information from his billing system into COMMAND and then 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 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, noted Dr. Hornbake.

He said that he exported demographic information from his billing system into COMMAND and then 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 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, noted Dr. Hornbake.

He said that he exported demographic information from his billing system into COMMAND and then 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 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 — 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 although overall quality improved in cholesterol control for coronary artery disease, the racial disparity is increasing in that measure. It 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 by Dr. Ayanian and his colleagues looked at new patient preferences for renal transplantation in end-stage renal disease patients ages 18 to 54 in Michigan, Alabama, Southern California, and the Washington metropolitan area in 1996–1997. They 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).

Most patients in the study said they agreed with and trusted their physician. But white patients were more likely to trust and agree with physicians than were 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. 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, adding that there needs to be a broader focus on Hispanic, Asian, and Native American patients.

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 although overall quality improved in cholesterol control for coronary artery disease, the racial disparity is increasing in that measure. It 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 by Dr. Ayanian and his colleagues looked at new patient preferences for renal transplantation in end-stage renal disease patients ages 18 to 54 in Michigan, Alabama, Southern California, and the Washington metropolitan area in 1996–1997. They 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).

Most patients in the study said they agreed with and trusted their physician. But white patients were more likely to trust and agree with physicians than were 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. 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, adding that there needs to be a broader focus on Hispanic, Asian, and Native American patients.

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 although overall quality improved in cholesterol control for coronary artery disease, the racial disparity is increasing in that measure. It 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 by Dr. Ayanian and his colleagues looked at new patient preferences for renal transplantation in end-stage renal disease patients ages 18 to 54 in Michigan, Alabama, Southern California, and the Washington metropolitan area in 1996–1997. They 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).

Most patients in the study said they agreed with and trusted their physician. But white patients were more likely to trust and agree with physicians than were 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. 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, adding that there needs to be a broader focus on Hispanic, Asian, and Native American patients.