Mary Ellen Schneider

Laws that require parental notification for teens to receive prescription contraception at family planning clinics could increase the risk of teen pregnancy, according to a study by Rachel Jones, Ph.D., and her colleagues.

“Family planning clinics need to be supported in the work that they are doing with teens,” said Dr. Jones, senior research associate at the Alan Guttmacher Institute (JAMA 2005;293:340–8).

The study found that if a law required clinics to inform parents in writing when their teenagers got prescription birth control, 18% of teens would have sex using no contraceptive method or would rely on rhythm or withdrawal.

About 1% of teens surveyed said their only reaction to such a law would be to stop having sex, the study said.

Most teens said they would continue to use the services at the clinic even if parental notification was required or would use over-the-counter contraceptives, such as condoms.

The implications are that mandated parental notification laws would discourage few teens from having sex and would likely increase rates of adolescent pregnancy and sexually transmitted diseases, the study authors concluded.

The study was based on a nationwide survey of 1,526 adolescent females under age 18 years who were seeking sexual health services, excluding abortion and prenatal and postnatal care, at publicly funded family planning clinics in 33 states.

About 60% of respondents said their parents were aware that they were using a clinic for sexual health services. In most cases, the teens had either voluntarily told their parents or they had come to the clinic at the suggestion of a parent.

About one-third of teens surveyed said that their parent or guardian was unaware that they were obtaining sexual health services at the clinic. About 4% said they were unsure if their parents knew.

Reasons respondents gave for not informing their parents included:

▸ Not wanting parents to know of the teen's sexual activity.

▸ Not wanting parents to be disappointed by the teen's sexual activity.

▸ Not feeling comfortable with discussing sex with their parents.

▸ Not wanting parents to know the reason for the teen's clinic visit.

▸ Wanting to take responsibility for their own health.

Concerned Women for America (CWA), a group that supports abstinence-only education, discounted the study. CWA said the study is biased because its authors are researchers associated with the Alan Guttmacher Institute, which is affiliated with Planned Parenthood.

CWA contends that Planned Parenthood is concerned that greater parental involvement will mean less business for them.

“Policymakers need to stop treating parents as a suspect class, presumed not to have their own kids' best interests at heart,” Wendy Wright, CWA's senior policy director, said in a statement.

“Adolescents benefit when their parents are involved in their lives, and policymakers shouldn't forbid their involvement in their daughters' and sons' most important decisions,” she said.

Texas and Utah currently require parental consent for teenage use of state-funded family planning services, and a similar restriction exists in one county in Illinois.

Last year, lawmakers in Kentucky, Minnesota, and Virginia introduced bills that were aimed at imposing parental consent requirements on teens seeking contraception.

On the federal level, lawmakers have introduced proposals in recent years to require parental involvement in teenagers seeking contraceptives at federally funded clinics; none has become law.

“All this history does not bode well for the future,” Cynthia Dailard said in a teleconference sponsored by the Alan Guttmacher Institute.

Ms. Dailard, a public policy associate at the institute, predicted that parental notification for sexual health services will be high on the federal agenda in the wake of the 2004 elections.

In addition, several newly elected senators have aggressively advocated against the use of federal dollars for family planning, she said.

Laws that require parental notification for teens to receive prescription contraception at family planning clinics could increase the risk of teen pregnancy, according to a study by Rachel Jones, Ph.D., and her colleagues.

“Family planning clinics need to be supported in the work that they are doing with teens,” said Dr. Jones, senior research associate at the Alan Guttmacher Institute (JAMA 2005;293:340–8).

The study found that if a law required clinics to inform parents in writing when their teenagers got prescription birth control, 18% of teens would have sex using no contraceptive method or would rely on rhythm or withdrawal.

About 1% of teens surveyed said their only reaction to such a law would be to stop having sex, the study said.

Most teens said they would continue to use the services at the clinic even if parental notification was required or would use over-the-counter contraceptives, such as condoms.

The implications are that mandated parental notification laws would discourage few teens from having sex and would likely increase rates of adolescent pregnancy and sexually transmitted diseases, the study authors concluded.

The study was based on a nationwide survey of 1,526 adolescent females under age 18 years who were seeking sexual health services, excluding abortion and prenatal and postnatal care, at publicly funded family planning clinics in 33 states.

About 60% of respondents said their parents were aware that they were using a clinic for sexual health services. In most cases, the teens had either voluntarily told their parents or they had come to the clinic at the suggestion of a parent.

About one-third of teens surveyed said that their parent or guardian was unaware that they were obtaining sexual health services at the clinic. About 4% said they were unsure if their parents knew.

Reasons respondents gave for not informing their parents included:

▸ Not wanting parents to know of the teen's sexual activity.

▸ Not wanting parents to be disappointed by the teen's sexual activity.

▸ Not feeling comfortable with discussing sex with their parents.

▸ Not wanting parents to know the reason for the teen's clinic visit.

▸ Wanting to take responsibility for their own health.

Concerned Women for America (CWA), a group that supports abstinence-only education, discounted the study. CWA said the study is biased because its authors are researchers associated with the Alan Guttmacher Institute, which is affiliated with Planned Parenthood.

CWA contends that Planned Parenthood is concerned that greater parental involvement will mean less business for them.

“Policymakers need to stop treating parents as a suspect class, presumed not to have their own kids' best interests at heart,” Wendy Wright, CWA's senior policy director, said in a statement.

“Adolescents benefit when their parents are involved in their lives, and policymakers shouldn't forbid their involvement in their daughters' and sons' most important decisions,” she said.

Texas and Utah currently require parental consent for teenage use of state-funded family planning services, and a similar restriction exists in one county in Illinois.

Last year, lawmakers in Kentucky, Minnesota, and Virginia introduced bills that were aimed at imposing parental consent requirements on teens seeking contraception.

On the federal level, lawmakers have introduced proposals in recent years to require parental involvement in teenagers seeking contraceptives at federally funded clinics; none has become law.

“All this history does not bode well for the future,” Cynthia Dailard said in a teleconference sponsored by the Alan Guttmacher Institute.

Ms. Dailard, a public policy associate at the institute, predicted that parental notification for sexual health services will be high on the federal agenda in the wake of the 2004 elections.

In addition, several newly elected senators have aggressively advocated against the use of federal dollars for family planning, she said.

Laws that require parental notification for teens to receive prescription contraception at family planning clinics could increase the risk of teen pregnancy, according to a study by Rachel Jones, Ph.D., and her colleagues.

“Family planning clinics need to be supported in the work that they are doing with teens,” said Dr. Jones, senior research associate at the Alan Guttmacher Institute (JAMA 2005;293:340–8).

The study found that if a law required clinics to inform parents in writing when their teenagers got prescription birth control, 18% of teens would have sex using no contraceptive method or would rely on rhythm or withdrawal.

About 1% of teens surveyed said their only reaction to such a law would be to stop having sex, the study said.

Most teens said they would continue to use the services at the clinic even if parental notification was required or would use over-the-counter contraceptives, such as condoms.

The implications are that mandated parental notification laws would discourage few teens from having sex and would likely increase rates of adolescent pregnancy and sexually transmitted diseases, the study authors concluded.

The study was based on a nationwide survey of 1,526 adolescent females under age 18 years who were seeking sexual health services, excluding abortion and prenatal and postnatal care, at publicly funded family planning clinics in 33 states.

About 60% of respondents said their parents were aware that they were using a clinic for sexual health services. In most cases, the teens had either voluntarily told their parents or they had come to the clinic at the suggestion of a parent.

About one-third of teens surveyed said that their parent or guardian was unaware that they were obtaining sexual health services at the clinic. About 4% said they were unsure if their parents knew.

Reasons respondents gave for not informing their parents included:

▸ Not wanting parents to know of the teen's sexual activity.

▸ Not wanting parents to be disappointed by the teen's sexual activity.

▸ Not feeling comfortable with discussing sex with their parents.

▸ Not wanting parents to know the reason for the teen's clinic visit.

▸ Wanting to take responsibility for their own health.

Concerned Women for America (CWA), a group that supports abstinence-only education, discounted the study. CWA said the study is biased because its authors are researchers associated with the Alan Guttmacher Institute, which is affiliated with Planned Parenthood.

CWA contends that Planned Parenthood is concerned that greater parental involvement will mean less business for them.

“Policymakers need to stop treating parents as a suspect class, presumed not to have their own kids' best interests at heart,” Wendy Wright, CWA's senior policy director, said in a statement.

“Adolescents benefit when their parents are involved in their lives, and policymakers shouldn't forbid their involvement in their daughters' and sons' most important decisions,” she said.

Texas and Utah currently require parental consent for teenage use of state-funded family planning services, and a similar restriction exists in one county in Illinois.

Last year, lawmakers in Kentucky, Minnesota, and Virginia introduced bills that were aimed at imposing parental consent requirements on teens seeking contraception.

On the federal level, lawmakers have introduced proposals in recent years to require parental involvement in teenagers seeking contraceptives at federally funded clinics; none has become law.

“All this history does not bode well for the future,” Cynthia Dailard said in a teleconference sponsored by the Alan Guttmacher Institute.

Ms. Dailard, a public policy associate at the institute, predicted that parental notification for sexual health services will be high on the federal agenda in the wake of the 2004 elections.

In addition, several newly elected senators have aggressively advocated against the use of federal dollars for family planning, she said.

With the obesity epidemic growing, physicians are facing a payment system that hasn't caught up.

Although coverage varies by payer, most Medicare carriers do not pay for office visits coded only for obesity, and the same is true for most private payers, physicians told this newspaper.

“The payment mechanism is certainly lagging behind,” said Sandra Hassink, M.D., a member of the American Academy of Pediatrics' national task force on obesity and director of the weight management program at the Alfred I. duPont Hospital for Children in Wilmington, Del.

As a result, many physicians find ways to get counseling paid for by coding for related comorbidities such as diabetes or heart disease, said Donna E. Sweet, M.D., chair of the board of regents of the American College of Physicians and professor of internal medicine at the University of Kansas in Wichita.

But that is far from a perfect solution, Dr. Sweet said. If physicians could code for obesity as the primary diagnosis, they could spend less time trying to work around the payment system. Moreover, they could perform early interventions to keep obesity and overweight from leading to diabetes and heart disease, she said.

Barriers to payment for obesity counseling and interventions reflect a larger problem with the episode-driven payment approach. “So much of this revolves around fixing our payment system,” Dr. Sweet said.

But there isn't complete agreement about whether third-party payment for obesity treatment would help patients, said G. Michael Steelman, M.D., a bariatric physician in Oklahoma City and president of the American Society of Bariatric Physicians. Many members of his group are split on this issue, he said.

One side argues that if insurers would pay for this care, patients would seek it out and stay in treatment. But others say that requiring patients to pay for these services out of pocket provides financial motivation to follow their physician's advice.

“In obesity, there's a lot of work the patients needs to do when they leave the office,” Steelman observed.

Dr. Steelman said he favors a compromise position in which reimbursement is conditional on some measure of success. For example, payers could cover visits as long as the patient is losing weight or maintaining weight below a certain point, he said.

The bottom line, Dr. Steelman said, is that insurers will generally be unwilling to invest in obesity interventions until physicians can demonstrate that they are getting results.

In the meantime, physicians should learn how to code so they have the best chance of getting paid for their time, said Jamie Calabrese, M.D., a member of the American Academy of Pediatrics' national task force on obesity and medical director of the Children's Institute in Pittsburgh, Pa.

Although most carriers won't pay for interventions that are associated only with obesity, most patients who are obese have other comorbidities. Dr. Calabrese recommends that physicians code the comorbid condition as the primary diagnosis and including obesity as the secondary diagnosis. With that as the starting point, there are multiple ways to code for weight management counseling, she said.

Physicians can use the basic evaluation and management CPT codes, or if the patient was referred by another professional, the doctor can use the consultation codes. When spending extra time with a patient, physicians should use the prolonged face-to-face codes. The prolonged time codes can be used when the physician goes beyond the usual time for that visit but that time doesn't need to be continuous, Dr. Calabrese said.

Typically, if physicians code accurately, they will get paid fairly, Dr. Calabrese said.

And there is some movement on this issue as some insurers begin to provide payment for the obesity code. There's a potential for a partnership between physicians and payers, who can provide physicians and patients with the tools they need to deal with obesity, she said.

Highmark Inc. of Pittsburgh is doing just that. Starting in January 2006, the health plan will include coverage for obesity interventions as part of its preventive health benefits package. That means that it will begin paying physicians who code for obesity as the primary diagnosis.

This is expected to result in two extra visits a year when coding for obesity alone, said Donald Fischer, M.D., chief medical officer for Highmark Inc. And it will allow the health plan to collect more information on obesity, he said.

Another Way to Address Obesity

Some physicians have realized that they are limited in what they can accomplish in an office visit so they have started their own weight management programs that incorporate good nutrition and physical activity.

One such physician is David Geller, M.D., a pediatrician in Bedford, Mass., who launched the Early Start program a little over a year ago. The program includes several weeks of medical sessions, nutrition counseling, and structured physical activity.

Dr. Geller said he had grown frustrated with his inability to fully address overweight and obesity issues in his practice. “I just felt there was a better way to address it,” he said.

His medical visits with patients are generally well covered by insurance, Dr. Geller said, and they have seen improved coverage since the program began for the nutrition counseling.

Families generally pay out of pocket for the remainder of the costs. “The insurance companies are realizing now that obesity is an issue,” Dr. Geller said.

With the obesity epidemic growing, physicians are facing a payment system that hasn't caught up.

Although coverage varies by payer, most Medicare carriers do not pay for office visits coded only for obesity, and the same is true for most private payers, physicians told this newspaper.

“The payment mechanism is certainly lagging behind,” said Sandra Hassink, M.D., a member of the American Academy of Pediatrics' national task force on obesity and director of the weight management program at the Alfred I. duPont Hospital for Children in Wilmington, Del.

As a result, many physicians find ways to get counseling paid for by coding for related comorbidities such as diabetes or heart disease, said Donna E. Sweet, M.D., chair of the board of regents of the American College of Physicians and professor of internal medicine at the University of Kansas in Wichita.

But that is far from a perfect solution, Dr. Sweet said. If physicians could code for obesity as the primary diagnosis, they could spend less time trying to work around the payment system. Moreover, they could perform early interventions to keep obesity and overweight from leading to diabetes and heart disease, she said.

Barriers to payment for obesity counseling and interventions reflect a larger problem with the episode-driven payment approach. “So much of this revolves around fixing our payment system,” Dr. Sweet said.

But there isn't complete agreement about whether third-party payment for obesity treatment would help patients, said G. Michael Steelman, M.D., a bariatric physician in Oklahoma City and president of the American Society of Bariatric Physicians. Many members of his group are split on this issue, he said.

One side argues that if insurers would pay for this care, patients would seek it out and stay in treatment. But others say that requiring patients to pay for these services out of pocket provides financial motivation to follow their physician's advice.

“In obesity, there's a lot of work the patients needs to do when they leave the office,” Steelman observed.

Dr. Steelman said he favors a compromise position in which reimbursement is conditional on some measure of success. For example, payers could cover visits as long as the patient is losing weight or maintaining weight below a certain point, he said.

The bottom line, Dr. Steelman said, is that insurers will generally be unwilling to invest in obesity interventions until physicians can demonstrate that they are getting results.

In the meantime, physicians should learn how to code so they have the best chance of getting paid for their time, said Jamie Calabrese, M.D., a member of the American Academy of Pediatrics' national task force on obesity and medical director of the Children's Institute in Pittsburgh, Pa.

Although most carriers won't pay for interventions that are associated only with obesity, most patients who are obese have other comorbidities. Dr. Calabrese recommends that physicians code the comorbid condition as the primary diagnosis and including obesity as the secondary diagnosis. With that as the starting point, there are multiple ways to code for weight management counseling, she said.

Physicians can use the basic evaluation and management CPT codes, or if the patient was referred by another professional, the doctor can use the consultation codes. When spending extra time with a patient, physicians should use the prolonged face-to-face codes. The prolonged time codes can be used when the physician goes beyond the usual time for that visit but that time doesn't need to be continuous, Dr. Calabrese said.

Typically, if physicians code accurately, they will get paid fairly, Dr. Calabrese said.

And there is some movement on this issue as some insurers begin to provide payment for the obesity code. There's a potential for a partnership between physicians and payers, who can provide physicians and patients with the tools they need to deal with obesity, she said.

Highmark Inc. of Pittsburgh is doing just that. Starting in January 2006, the health plan will include coverage for obesity interventions as part of its preventive health benefits package. That means that it will begin paying physicians who code for obesity as the primary diagnosis.

This is expected to result in two extra visits a year when coding for obesity alone, said Donald Fischer, M.D., chief medical officer for Highmark Inc. And it will allow the health plan to collect more information on obesity, he said.

Another Way to Address Obesity

Some physicians have realized that they are limited in what they can accomplish in an office visit so they have started their own weight management programs that incorporate good nutrition and physical activity.

One such physician is David Geller, M.D., a pediatrician in Bedford, Mass., who launched the Early Start program a little over a year ago. The program includes several weeks of medical sessions, nutrition counseling, and structured physical activity.

Dr. Geller said he had grown frustrated with his inability to fully address overweight and obesity issues in his practice. “I just felt there was a better way to address it,” he said.

His medical visits with patients are generally well covered by insurance, Dr. Geller said, and they have seen improved coverage since the program began for the nutrition counseling.

Families generally pay out of pocket for the remainder of the costs. “The insurance companies are realizing now that obesity is an issue,” Dr. Geller said.

With the obesity epidemic growing, physicians are facing a payment system that hasn't caught up.

Although coverage varies by payer, most Medicare carriers do not pay for office visits coded only for obesity, and the same is true for most private payers, physicians told this newspaper.

“The payment mechanism is certainly lagging behind,” said Sandra Hassink, M.D., a member of the American Academy of Pediatrics' national task force on obesity and director of the weight management program at the Alfred I. duPont Hospital for Children in Wilmington, Del.

As a result, many physicians find ways to get counseling paid for by coding for related comorbidities such as diabetes or heart disease, said Donna E. Sweet, M.D., chair of the board of regents of the American College of Physicians and professor of internal medicine at the University of Kansas in Wichita.

But that is far from a perfect solution, Dr. Sweet said. If physicians could code for obesity as the primary diagnosis, they could spend less time trying to work around the payment system. Moreover, they could perform early interventions to keep obesity and overweight from leading to diabetes and heart disease, she said.

Barriers to payment for obesity counseling and interventions reflect a larger problem with the episode-driven payment approach. “So much of this revolves around fixing our payment system,” Dr. Sweet said.

But there isn't complete agreement about whether third-party payment for obesity treatment would help patients, said G. Michael Steelman, M.D., a bariatric physician in Oklahoma City and president of the American Society of Bariatric Physicians. Many members of his group are split on this issue, he said.

One side argues that if insurers would pay for this care, patients would seek it out and stay in treatment. But others say that requiring patients to pay for these services out of pocket provides financial motivation to follow their physician's advice.

“In obesity, there's a lot of work the patients needs to do when they leave the office,” Steelman observed.

Dr. Steelman said he favors a compromise position in which reimbursement is conditional on some measure of success. For example, payers could cover visits as long as the patient is losing weight or maintaining weight below a certain point, he said.

The bottom line, Dr. Steelman said, is that insurers will generally be unwilling to invest in obesity interventions until physicians can demonstrate that they are getting results.

In the meantime, physicians should learn how to code so they have the best chance of getting paid for their time, said Jamie Calabrese, M.D., a member of the American Academy of Pediatrics' national task force on obesity and medical director of the Children's Institute in Pittsburgh, Pa.

Although most carriers won't pay for interventions that are associated only with obesity, most patients who are obese have other comorbidities. Dr. Calabrese recommends that physicians code the comorbid condition as the primary diagnosis and including obesity as the secondary diagnosis. With that as the starting point, there are multiple ways to code for weight management counseling, she said.

Physicians can use the basic evaluation and management CPT codes, or if the patient was referred by another professional, the doctor can use the consultation codes. When spending extra time with a patient, physicians should use the prolonged face-to-face codes. The prolonged time codes can be used when the physician goes beyond the usual time for that visit but that time doesn't need to be continuous, Dr. Calabrese said.

Typically, if physicians code accurately, they will get paid fairly, Dr. Calabrese said.

And there is some movement on this issue as some insurers begin to provide payment for the obesity code. There's a potential for a partnership between physicians and payers, who can provide physicians and patients with the tools they need to deal with obesity, she said.

Highmark Inc. of Pittsburgh is doing just that. Starting in January 2006, the health plan will include coverage for obesity interventions as part of its preventive health benefits package. That means that it will begin paying physicians who code for obesity as the primary diagnosis.

This is expected to result in two extra visits a year when coding for obesity alone, said Donald Fischer, M.D., chief medical officer for Highmark Inc. And it will allow the health plan to collect more information on obesity, he said.

Another Way to Address Obesity

Some physicians have realized that they are limited in what they can accomplish in an office visit so they have started their own weight management programs that incorporate good nutrition and physical activity.

One such physician is David Geller, M.D., a pediatrician in Bedford, Mass., who launched the Early Start program a little over a year ago. The program includes several weeks of medical sessions, nutrition counseling, and structured physical activity.

Dr. Geller said he had grown frustrated with his inability to fully address overweight and obesity issues in his practice. “I just felt there was a better way to address it,” he said.

His medical visits with patients are generally well covered by insurance, Dr. Geller said, and they have seen improved coverage since the program began for the nutrition counseling.

Families generally pay out of pocket for the remainder of the costs. “The insurance companies are realizing now that obesity is an issue,” Dr. Geller said.

SAN FRANCISCO — Finding key clinical information at the point of care has never been easier, thanks to e-mail alerts and online search tools, Scott M. Strayer, M.D., said at the annual meeting of the American Academy of Family Physicians.

A robust industry has developed to make clinical decision support available by computer or PDA, said Dr. Strayer, of the department of family medicine at the University of Virginia Health System, Charlottesville.

The new tools come in two categories: “foraging” tools allow physicians to keep up to date on the latest research and clinical guidelines, and “hunting” tools allow them to search for specific clinical information. Taken together, the tools not only provide information during a clinical encounter, but, if used widely, the tools are likely to move evidence into practice faster as well, Dr. Strayer said.

“Without both, you really don't know that new information is available, and you can't find it when you do,” he said.

Some examples of foraging tools are:

▸ InfoPoems (www.infopoems.com

▸ Journal Alerts (www.globalfamily?doctor.com/journalalerts/journalalerts.asp

Hunting tools include:

▸ InfoPoems (www.infopoems.com

▸ Up to Date (www.uptodateonline.com

▸ DynaMed (www.dynamicmedical.com

In the evaluation of clinical decision support tools, it's important to see how the information is filtered. Is the information patient oriented or disease oriented? Is it specialty specific? Is it comprehensive? Which journals does it scan? Will the information change your practice or is it simply news?

Physicians also need to consider whether the information provided is valid, Dr. Strayer said. He recommended looking for labels with the level of evidence used.

And doctors should beware of “Trojan horse” sites that look independent but are sponsored by drug companies, for example. Before committing to a product, determine how well the information is summarized, he said. The summary should be accurate, provide context, and be more comprehensive than just an abstract.

Dr. Strayer did not disclose any financial relationships with the products that he discussed.

SAN FRANCISCO — Finding key clinical information at the point of care has never been easier, thanks to e-mail alerts and online search tools, Scott M. Strayer, M.D., said at the annual meeting of the American Academy of Family Physicians.

A robust industry has developed to make clinical decision support available by computer or PDA, said Dr. Strayer, of the department of family medicine at the University of Virginia Health System, Charlottesville.

The new tools come in two categories: “foraging” tools allow physicians to keep up to date on the latest research and clinical guidelines, and “hunting” tools allow them to search for specific clinical information. Taken together, the tools not only provide information during a clinical encounter, but, if used widely, the tools are likely to move evidence into practice faster as well, Dr. Strayer said.

“Without both, you really don't know that new information is available, and you can't find it when you do,” he said.

Some examples of foraging tools are:

▸ InfoPoems (www.infopoems.com

▸ Journal Alerts (www.globalfamily?doctor.com/journalalerts/journalalerts.asp

Hunting tools include:

▸ InfoPoems (www.infopoems.com

▸ Up to Date (www.uptodateonline.com

▸ DynaMed (www.dynamicmedical.com

In the evaluation of clinical decision support tools, it's important to see how the information is filtered. Is the information patient oriented or disease oriented? Is it specialty specific? Is it comprehensive? Which journals does it scan? Will the information change your practice or is it simply news?

Physicians also need to consider whether the information provided is valid, Dr. Strayer said. He recommended looking for labels with the level of evidence used.

And doctors should beware of “Trojan horse” sites that look independent but are sponsored by drug companies, for example. Before committing to a product, determine how well the information is summarized, he said. The summary should be accurate, provide context, and be more comprehensive than just an abstract.

Dr. Strayer did not disclose any financial relationships with the products that he discussed.

SAN FRANCISCO — Finding key clinical information at the point of care has never been easier, thanks to e-mail alerts and online search tools, Scott M. Strayer, M.D., said at the annual meeting of the American Academy of Family Physicians.

A robust industry has developed to make clinical decision support available by computer or PDA, said Dr. Strayer, of the department of family medicine at the University of Virginia Health System, Charlottesville.

The new tools come in two categories: “foraging” tools allow physicians to keep up to date on the latest research and clinical guidelines, and “hunting” tools allow them to search for specific clinical information. Taken together, the tools not only provide information during a clinical encounter, but, if used widely, the tools are likely to move evidence into practice faster as well, Dr. Strayer said.

“Without both, you really don't know that new information is available, and you can't find it when you do,” he said.

Some examples of foraging tools are:

▸ InfoPoems (www.infopoems.com

▸ Journal Alerts (www.globalfamily?doctor.com/journalalerts/journalalerts.asp

Hunting tools include:

▸ InfoPoems (www.infopoems.com

▸ Up to Date (www.uptodateonline.com

▸ DynaMed (www.dynamicmedical.com

In the evaluation of clinical decision support tools, it's important to see how the information is filtered. Is the information patient oriented or disease oriented? Is it specialty specific? Is it comprehensive? Which journals does it scan? Will the information change your practice or is it simply news?

Physicians also need to consider whether the information provided is valid, Dr. Strayer said. He recommended looking for labels with the level of evidence used.

And doctors should beware of “Trojan horse” sites that look independent but are sponsored by drug companies, for example. Before committing to a product, determine how well the information is summarized, he said. The summary should be accurate, provide context, and be more comprehensive than just an abstract.

Dr. Strayer did not disclose any financial relationships with the products that he discussed.

Physicians at the Department of Veterans Affairs have been using an electronic medical record for about 20 years, so officials there are getting ready to take the next step—online patient access to their medical records.

Next May, the VA plans to provide patients with online access to their medical information through an existing patient portal called My HealtheVet—www.myhealth.va.gov

Currently, the project is in a pilot phase at nine VA medical centers around the country. As part of the pilot, patients are able to log in and see features of their medical record including hospital admissions, allergies, prescriptions, a problem list, progress notes, discharge summaries, vital signs, lab reports, radiology reports, and ECG reports.

“It really represents a fundamental advancement,” said Robert Kolodner, M.D., chief health informatics officer at the Veterans Health Administration.

VA officials are now working on the details to allow nationwide patient access to medical records. Though a few institutions and physicians offer patient portal access, it's still not the norm, Dr. Kolodner said.

But this may be about to change, according to Steven E. Waldren, M.D., assistant director of the Center for Health Information Technology at the American Academy of Family Physicians.

More widespread adoption of patient portals and personal health records may be driven by the emergence of health savings accounts, which put more decision making in the hands of patients. In addition, the development of the Continuity of Care Record—a standard that allows personal health summary information in an electronic file to be transferred in multiple formats—is likely to aid the development of these products, Dr. Waldren said.

When the VA project is expanded nationally, there will be some small changes from the pilot. For example, patients won't have access to their progress notes, at least not at first, Dr. Kolodner said. The release of progress notes will happen in a later phase of the rollout, he said. But once they are added, physicians will be able to use the notes as a tool for patient education by adding instructions that patients can later read at home.

Officials are also working out the appropriate time lag between when lab results are available to the physician and when they are released to the patient's online record. The idea is to give the clinician time to notify the patient of a lab result so patients aren't seeing that information for the first time online, he said.

The VA has yet to perform a formal evaluation of the pilot, said My HealtheVet program director Ginger Price. But questionnaires completed by patients participating in the pilot indicate that there is widespread support for expanding the program nationally. And anecdotal reports show that the online record has made it easier for patients to share information with their caregivers, she said.

But online access won't be entirely new for VA patients. For the past two years, patients across the VA system have been able to access the online patient portal My HealtheVet to self-enter both personal and medical information.

The Web site allows veterans to enter personal data such as their contact information, emergency telephone numbers, health care providers, treatment locations, and health insurance.

VA patients can also enter their prescription information and view their prescription and refill history. And they can order refills online through the site.

In addition to prescriptions, they can enter medical information such as over-the-counter drugs and herbal supplements that they take. They can also record their allergies, tests, medical events, and immunizations. For example, the medical event section allows patients to enter the type of events, the start date and stop date, and the response from their physician.

The site also includes a Health eLog feature where patients can enter their blood pressure, blood sugar level, cholesterol level, body temperature, weight, heart rate, and pain level.

For pain information, patients enter data that includes the time and their pain level from 0 to 10. And patients can enter additional comments on their pain.

VA patients can also record their military health history on the site.

The idea is that patients will use the site to help them better manage their health, get patient education information, or print out their self-entered information and bring it in to their physician, Dr. Kolodner said. But the self-entered information is entirely controlled by the patient. VA physicians do not have access to the site, and it's up to patients whether they want to share the information with health care providers or caregivers.

On Veterans Day, the portal will be expanded to include food and activity journals. In addition, patients can begin adding pulse oximetry results to the Health eLog.

When the pilot is completed this spring, patients will be able to access their medical record in the same place as their self-entered data. But the patients will retain control of the self-entered information, Dr. Kolodner said. At that point, patients can choose whether to allow their physician electronic access to the self-entered information.

In the future, patients will also have the option to integrate their self-entered information into their VA medical record. “The decision to share the information is the patient's,” Dr. Kolodner said.

VA officials are also considering secure online messaging as a possible future improvement to the patient portal. The feedback from physicians has been that they would like to have messaging so that they can communicate online with patients, Ms. Price said.

Physicians at the Department of Veterans Affairs have been using an electronic medical record for about 20 years, so officials there are getting ready to take the next step—online patient access to their medical records.

Next May, the VA plans to provide patients with online access to their medical information through an existing patient portal called My HealtheVet—www.myhealth.va.gov

Currently, the project is in a pilot phase at nine VA medical centers around the country. As part of the pilot, patients are able to log in and see features of their medical record including hospital admissions, allergies, prescriptions, a problem list, progress notes, discharge summaries, vital signs, lab reports, radiology reports, and ECG reports.

“It really represents a fundamental advancement,” said Robert Kolodner, M.D., chief health informatics officer at the Veterans Health Administration.

VA officials are now working on the details to allow nationwide patient access to medical records. Though a few institutions and physicians offer patient portal access, it's still not the norm, Dr. Kolodner said.

But this may be about to change, according to Steven E. Waldren, M.D., assistant director of the Center for Health Information Technology at the American Academy of Family Physicians.

More widespread adoption of patient portals and personal health records may be driven by the emergence of health savings accounts, which put more decision making in the hands of patients. In addition, the development of the Continuity of Care Record—a standard that allows personal health summary information in an electronic file to be transferred in multiple formats—is likely to aid the development of these products, Dr. Waldren said.

When the VA project is expanded nationally, there will be some small changes from the pilot. For example, patients won't have access to their progress notes, at least not at first, Dr. Kolodner said. The release of progress notes will happen in a later phase of the rollout, he said. But once they are added, physicians will be able to use the notes as a tool for patient education by adding instructions that patients can later read at home.

Officials are also working out the appropriate time lag between when lab results are available to the physician and when they are released to the patient's online record. The idea is to give the clinician time to notify the patient of a lab result so patients aren't seeing that information for the first time online, he said.

The VA has yet to perform a formal evaluation of the pilot, said My HealtheVet program director Ginger Price. But questionnaires completed by patients participating in the pilot indicate that there is widespread support for expanding the program nationally. And anecdotal reports show that the online record has made it easier for patients to share information with their caregivers, she said.

But online access won't be entirely new for VA patients. For the past two years, patients across the VA system have been able to access the online patient portal My HealtheVet to self-enter both personal and medical information.

The Web site allows veterans to enter personal data such as their contact information, emergency telephone numbers, health care providers, treatment locations, and health insurance.

VA patients can also enter their prescription information and view their prescription and refill history. And they can order refills online through the site.

In addition to prescriptions, they can enter medical information such as over-the-counter drugs and herbal supplements that they take. They can also record their allergies, tests, medical events, and immunizations. For example, the medical event section allows patients to enter the type of events, the start date and stop date, and the response from their physician.

The site also includes a Health eLog feature where patients can enter their blood pressure, blood sugar level, cholesterol level, body temperature, weight, heart rate, and pain level.

For pain information, patients enter data that includes the time and their pain level from 0 to 10. And patients can enter additional comments on their pain.

VA patients can also record their military health history on the site.

The idea is that patients will use the site to help them better manage their health, get patient education information, or print out their self-entered information and bring it in to their physician, Dr. Kolodner said. But the self-entered information is entirely controlled by the patient. VA physicians do not have access to the site, and it's up to patients whether they want to share the information with health care providers or caregivers.

On Veterans Day, the portal will be expanded to include food and activity journals. In addition, patients can begin adding pulse oximetry results to the Health eLog.

When the pilot is completed this spring, patients will be able to access their medical record in the same place as their self-entered data. But the patients will retain control of the self-entered information, Dr. Kolodner said. At that point, patients can choose whether to allow their physician electronic access to the self-entered information.

In the future, patients will also have the option to integrate their self-entered information into their VA medical record. “The decision to share the information is the patient's,” Dr. Kolodner said.

VA officials are also considering secure online messaging as a possible future improvement to the patient portal. The feedback from physicians has been that they would like to have messaging so that they can communicate online with patients, Ms. Price said.

Physicians at the Department of Veterans Affairs have been using an electronic medical record for about 20 years, so officials there are getting ready to take the next step—online patient access to their medical records.

Next May, the VA plans to provide patients with online access to their medical information through an existing patient portal called My HealtheVet—www.myhealth.va.gov

Currently, the project is in a pilot phase at nine VA medical centers around the country. As part of the pilot, patients are able to log in and see features of their medical record including hospital admissions, allergies, prescriptions, a problem list, progress notes, discharge summaries, vital signs, lab reports, radiology reports, and ECG reports.

“It really represents a fundamental advancement,” said Robert Kolodner, M.D., chief health informatics officer at the Veterans Health Administration.

VA officials are now working on the details to allow nationwide patient access to medical records. Though a few institutions and physicians offer patient portal access, it's still not the norm, Dr. Kolodner said.

But this may be about to change, according to Steven E. Waldren, M.D., assistant director of the Center for Health Information Technology at the American Academy of Family Physicians.

More widespread adoption of patient portals and personal health records may be driven by the emergence of health savings accounts, which put more decision making in the hands of patients. In addition, the development of the Continuity of Care Record—a standard that allows personal health summary information in an electronic file to be transferred in multiple formats—is likely to aid the development of these products, Dr. Waldren said.

When the VA project is expanded nationally, there will be some small changes from the pilot. For example, patients won't have access to their progress notes, at least not at first, Dr. Kolodner said. The release of progress notes will happen in a later phase of the rollout, he said. But once they are added, physicians will be able to use the notes as a tool for patient education by adding instructions that patients can later read at home.

Officials are also working out the appropriate time lag between when lab results are available to the physician and when they are released to the patient's online record. The idea is to give the clinician time to notify the patient of a lab result so patients aren't seeing that information for the first time online, he said.

The VA has yet to perform a formal evaluation of the pilot, said My HealtheVet program director Ginger Price. But questionnaires completed by patients participating in the pilot indicate that there is widespread support for expanding the program nationally. And anecdotal reports show that the online record has made it easier for patients to share information with their caregivers, she said.

But online access won't be entirely new for VA patients. For the past two years, patients across the VA system have been able to access the online patient portal My HealtheVet to self-enter both personal and medical information.

The Web site allows veterans to enter personal data such as their contact information, emergency telephone numbers, health care providers, treatment locations, and health insurance.

VA patients can also enter their prescription information and view their prescription and refill history. And they can order refills online through the site.

In addition to prescriptions, they can enter medical information such as over-the-counter drugs and herbal supplements that they take. They can also record their allergies, tests, medical events, and immunizations. For example, the medical event section allows patients to enter the type of events, the start date and stop date, and the response from their physician.

The site also includes a Health eLog feature where patients can enter their blood pressure, blood sugar level, cholesterol level, body temperature, weight, heart rate, and pain level.

For pain information, patients enter data that includes the time and their pain level from 0 to 10. And patients can enter additional comments on their pain.

VA patients can also record their military health history on the site.

The idea is that patients will use the site to help them better manage their health, get patient education information, or print out their self-entered information and bring it in to their physician, Dr. Kolodner said. But the self-entered information is entirely controlled by the patient. VA physicians do not have access to the site, and it's up to patients whether they want to share the information with health care providers or caregivers.

On Veterans Day, the portal will be expanded to include food and activity journals. In addition, patients can begin adding pulse oximetry results to the Health eLog.

When the pilot is completed this spring, patients will be able to access their medical record in the same place as their self-entered data. But the patients will retain control of the self-entered information, Dr. Kolodner said. At that point, patients can choose whether to allow their physician electronic access to the self-entered information.

In the future, patients will also have the option to integrate their self-entered information into their VA medical record. “The decision to share the information is the patient's,” Dr. Kolodner said.

VA officials are also considering secure online messaging as a possible future improvement to the patient portal. The feedback from physicians has been that they would like to have messaging so that they can communicate online with patients, Ms. Price said.

Officials at the Centers for Medicare and Medicaid Services are seeking physicians to test electronic health record software originally developed by the Department of Veterans Affairs and adapted for use in physicians' offices.

CMS is releasing a test version of the software—called VistA-Office—in an effort to assess its effectiveness, usability, and potential for interoperability in small physician practices, the agency announced late last month.

"The release of an evaluation version of VistA-Office will provide a testing laboratory for interoperability and will supplement efforts by the American Health Information Community to establish a certification criteria and process," CMS Administrator Mark B. McClellan, M.D., Ph.D., said in a statement.

The goal is to refine the software based on the results of the test period and to develop a version of the VistA-Office electronic health record (EHR) that could be certified under a process that is recognized by the Department of Health and Human Services.

The VistA-Office EHR was adapted from the hospital information system of the Department of Veterans Affairs (VA). The VA system is used in 1,300 sites and has been in use for more than 20 years.

The test version of the software includes core functions such as clinical order entry, standard progress note templates, and results reporting. It also includes features designed specifically for physician offices including interfaces to existing practice management and billing systems, quality measure reporting capabilities, clinical reminders for disease management, and templates for ob.gyn. and pediatric care.

The VistA-Office test software will not be free. The first-year costs (cost of software, licensing fees, and support) are estimated to be about $2,740 for a group of 1–7 users, according to a CMS spokesman, who added that practices are likely to incur added office staff costs associated with implementing the EHR.

Health information technology experts welcomed the testing of a new office-based EHR product, but cautioned that not all physician practices are suited to becoming a beta-test site.

"It's good for physicians to have more choices," said Mark Leavitt, M.D., Ph.D., chair of the Certification Commission for Healthcare Information Technology, a voluntary, private-sector initiative to certify health information technology products.

But Dr. Leavitt warned that participating in a beta test isn't for everyone. "A beta test definitely stresses the office," he said. Generally in such a test, practices are not supposed to rely on the new software, so physicians would have to run the test software parallel with their paper systems. That extra step can cost the practice in terms of time and money, he said. The best candidates for a beta test are physicians who are technically savvy and who have the extra time and interest to devote to the project, Dr. Leavitt said.

Physicians should carefully review the VistA-Office product before volunteering to test it and not just choose it because it is less expensive than some other options on the market, said Joe Heyman, M.D., secretary of the board of trustees of the American Medical Association and a gynecologist in solo practice in Amesbury, Mass.

As with any other EHR, it's important for physicians to survey their own office and work flow, he said.

Family physicians are looking forward to evaluating and providing feedback on the ease of use and associated costs of the product, said David C. Kibbe, M.D., director of the Center for Health Information Technology at the American Academy of Family Physicians.

While the costs cited by CMS were below market costs for most EHR systems, Dr. Kibbe cautioned that charging at all for a beta test could diminish physicians' participation. "Uncertainty is a cost as well," he said.

The test software provides a reasonable cost option for physicians, said Arthur McDowell III, M.D., a cardiologist in Middletown, Conn., who has already implemented an EHR in his practice.

But what will really spur adoption of EHRs will be government-sponsored pay-for-performance programs, Dr. McDowell said.

The fear among physicians on pay for performance is that the government will choose to pay physicians less. Instead, the government needs to take the step of providing reasonably priced software and then offering payments for making the change, Dr. McDowell said.

The current discussion about incentives from the federal government is very promising, said Dr. Leavitt. Physicians want to see incentives that offer extra payment or lower the cost or administrative hassle, he said. While there are some pilot projects that offer incentives, the challenge is to make them available to the mainstream, he said.

The Certification Commission can help spur incentives, he said, because then government payers and health plans will know that they are paying for something robust.

"All the signs are pointing the right way," Dr. Leavitt said.

Physicians who are interested in being part of a beta test should contact an approved vendor who will actually run the test of the software. Vendors will select a small number of physician practices to participate. A list of approved vendors is available online at www.vista-office.orgwww.vista-office.org/software/demo

Officials at the Centers for Medicare and Medicaid Services are seeking physicians to test electronic health record software originally developed by the Department of Veterans Affairs and adapted for use in physicians' offices.

CMS is releasing a test version of the software—called VistA-Office—in an effort to assess its effectiveness, usability, and potential for interoperability in small physician practices, the agency announced late last month.

"The release of an evaluation version of VistA-Office will provide a testing laboratory for interoperability and will supplement efforts by the American Health Information Community to establish a certification criteria and process," CMS Administrator Mark B. McClellan, M.D., Ph.D., said in a statement.

The goal is to refine the software based on the results of the test period and to develop a version of the VistA-Office electronic health record (EHR) that could be certified under a process that is recognized by the Department of Health and Human Services.

The VistA-Office EHR was adapted from the hospital information system of the Department of Veterans Affairs (VA). The VA system is used in 1,300 sites and has been in use for more than 20 years.

The test version of the software includes core functions such as clinical order entry, standard progress note templates, and results reporting. It also includes features designed specifically for physician offices including interfaces to existing practice management and billing systems, quality measure reporting capabilities, clinical reminders for disease management, and templates for ob.gyn. and pediatric care.

The VistA-Office test software will not be free. The first-year costs (cost of software, licensing fees, and support) are estimated to be about $2,740 for a group of 1–7 users, according to a CMS spokesman, who added that practices are likely to incur added office staff costs associated with implementing the EHR.

Health information technology experts welcomed the testing of a new office-based EHR product, but cautioned that not all physician practices are suited to becoming a beta-test site.

"It's good for physicians to have more choices," said Mark Leavitt, M.D., Ph.D., chair of the Certification Commission for Healthcare Information Technology, a voluntary, private-sector initiative to certify health information technology products.

But Dr. Leavitt warned that participating in a beta test isn't for everyone. "A beta test definitely stresses the office," he said. Generally in such a test, practices are not supposed to rely on the new software, so physicians would have to run the test software parallel with their paper systems. That extra step can cost the practice in terms of time and money, he said. The best candidates for a beta test are physicians who are technically savvy and who have the extra time and interest to devote to the project, Dr. Leavitt said.

Physicians should carefully review the VistA-Office product before volunteering to test it and not just choose it because it is less expensive than some other options on the market, said Joe Heyman, M.D., secretary of the board of trustees of the American Medical Association and a gynecologist in solo practice in Amesbury, Mass.

As with any other EHR, it's important for physicians to survey their own office and work flow, he said.

Family physicians are looking forward to evaluating and providing feedback on the ease of use and associated costs of the product, said David C. Kibbe, M.D., director of the Center for Health Information Technology at the American Academy of Family Physicians.

While the costs cited by CMS were below market costs for most EHR systems, Dr. Kibbe cautioned that charging at all for a beta test could diminish physicians' participation. "Uncertainty is a cost as well," he said.

The test software provides a reasonable cost option for physicians, said Arthur McDowell III, M.D., a cardiologist in Middletown, Conn., who has already implemented an EHR in his practice.

But what will really spur adoption of EHRs will be government-sponsored pay-for-performance programs, Dr. McDowell said.

The fear among physicians on pay for performance is that the government will choose to pay physicians less. Instead, the government needs to take the step of providing reasonably priced software and then offering payments for making the change, Dr. McDowell said.

The current discussion about incentives from the federal government is very promising, said Dr. Leavitt. Physicians want to see incentives that offer extra payment or lower the cost or administrative hassle, he said. While there are some pilot projects that offer incentives, the challenge is to make them available to the mainstream, he said.

The Certification Commission can help spur incentives, he said, because then government payers and health plans will know that they are paying for something robust.

"All the signs are pointing the right way," Dr. Leavitt said.

Physicians who are interested in being part of a beta test should contact an approved vendor who will actually run the test of the software. Vendors will select a small number of physician practices to participate. A list of approved vendors is available online at www.vista-office.orgwww.vista-office.org/software/demo

Officials at the Centers for Medicare and Medicaid Services are seeking physicians to test electronic health record software originally developed by the Department of Veterans Affairs and adapted for use in physicians' offices.

CMS is releasing a test version of the software—called VistA-Office—in an effort to assess its effectiveness, usability, and potential for interoperability in small physician practices, the agency announced late last month.

"The release of an evaluation version of VistA-Office will provide a testing laboratory for interoperability and will supplement efforts by the American Health Information Community to establish a certification criteria and process," CMS Administrator Mark B. McClellan, M.D., Ph.D., said in a statement.

The goal is to refine the software based on the results of the test period and to develop a version of the VistA-Office electronic health record (EHR) that could be certified under a process that is recognized by the Department of Health and Human Services.

The VistA-Office EHR was adapted from the hospital information system of the Department of Veterans Affairs (VA). The VA system is used in 1,300 sites and has been in use for more than 20 years.

The test version of the software includes core functions such as clinical order entry, standard progress note templates, and results reporting. It also includes features designed specifically for physician offices including interfaces to existing practice management and billing systems, quality measure reporting capabilities, clinical reminders for disease management, and templates for ob.gyn. and pediatric care.

The VistA-Office test software will not be free. The first-year costs (cost of software, licensing fees, and support) are estimated to be about $2,740 for a group of 1–7 users, according to a CMS spokesman, who added that practices are likely to incur added office staff costs associated with implementing the EHR.

Health information technology experts welcomed the testing of a new office-based EHR product, but cautioned that not all physician practices are suited to becoming a beta-test site.

"It's good for physicians to have more choices," said Mark Leavitt, M.D., Ph.D., chair of the Certification Commission for Healthcare Information Technology, a voluntary, private-sector initiative to certify health information technology products.

But Dr. Leavitt warned that participating in a beta test isn't for everyone. "A beta test definitely stresses the office," he said. Generally in such a test, practices are not supposed to rely on the new software, so physicians would have to run the test software parallel with their paper systems. That extra step can cost the practice in terms of time and money, he said. The best candidates for a beta test are physicians who are technically savvy and who have the extra time and interest to devote to the project, Dr. Leavitt said.

Physicians should carefully review the VistA-Office product before volunteering to test it and not just choose it because it is less expensive than some other options on the market, said Joe Heyman, M.D., secretary of the board of trustees of the American Medical Association and a gynecologist in solo practice in Amesbury, Mass.

As with any other EHR, it's important for physicians to survey their own office and work flow, he said.

Family physicians are looking forward to evaluating and providing feedback on the ease of use and associated costs of the product, said David C. Kibbe, M.D., director of the Center for Health Information Technology at the American Academy of Family Physicians.

While the costs cited by CMS were below market costs for most EHR systems, Dr. Kibbe cautioned that charging at all for a beta test could diminish physicians' participation. "Uncertainty is a cost as well," he said.

The test software provides a reasonable cost option for physicians, said Arthur McDowell III, M.D., a cardiologist in Middletown, Conn., who has already implemented an EHR in his practice.

But what will really spur adoption of EHRs will be government-sponsored pay-for-performance programs, Dr. McDowell said.

The fear among physicians on pay for performance is that the government will choose to pay physicians less. Instead, the government needs to take the step of providing reasonably priced software and then offering payments for making the change, Dr. McDowell said.

The current discussion about incentives from the federal government is very promising, said Dr. Leavitt. Physicians want to see incentives that offer extra payment or lower the cost or administrative hassle, he said. While there are some pilot projects that offer incentives, the challenge is to make them available to the mainstream, he said.

The Certification Commission can help spur incentives, he said, because then government payers and health plans will know that they are paying for something robust.

"All the signs are pointing the right way," Dr. Leavitt said.

Physicians who are interested in being part of a beta test should contact an approved vendor who will actually run the test of the software. Vendors will select a small number of physician practices to participate. A list of approved vendors is available online at www.vista-office.orgwww.vista-office.org/software/demo

SAN FRANCISCO — Physicians need to adopt electronic health records, clinical decision support tools, and online messaging with patients to move away from a visit-based, episodic model of care, said Joseph E. Scherger, M.D., of the department of family and preventive medicine at the University of California, San Diego.

"We need to be highly convenient to people," Dr. Scherger said at the annual meeting of the American Academy of Family Physicians.

Although all three of these tools should be adopted now, Dr. Scherger cautioned that not all electronic health records (EHRs) are the same.

Physicians should be sure to look for EHRs that are designed for interoperability with other systems, said Dr. Scherger, who was a member of the Future of Family Medicine project.

Some EHRs may have clinical decision support tools embedded in the systems. But for those that don't, Dr. Scherger said it's worthwhile to obtain the tools separately. No one is able to mentally store and retrieve all the appropriate information at the right time all the time.

While in the past, patients expected physicians to be able to recall all information important to their care, the younger generation of patients won't trust information given to them from the top of their physician's head, Dr. Scherger said.

He now uses decision support tools about 90% of the time when prescribing, and it's popular with patients, he said. It also allows him to check to see if a drug will be covered by that patient's insurance formulary.

The third important tool is online messaging with patients. "It is the new platform of communication that really revolutionizes care," Dr. Scherger said.

This is not standard e-mail, he explained. Instead, it is a secure system—similar to those used for online banking or transactions with vendors such as Amazon.com

Online messaging is the mechanism for the virtual visit, he said. But even though patients will be spending less time physically with their doctor, it's still highly personal care, he said.

Although online messaging is not yet a part of most physicians' offices, it is actually the least expensive of the three important tools to implement, he said. And many electronic health records systems are embedding secure messaging in the patient record now.

With messaging that's incorporated into the EHR systems, the information from the message can become a part of the medical record. This makes it much easier to document than advice given to patients over the phone, Dr. Scherger pointed out.

Physicians can also send regular e-mail to patients without worrying that they will be violating Health Insurance Portability and Accountability Act regulations as long as the patient consents to it and it's private, Dr. Scherger said. But he recommends that physicians set up a special secure system.

He said that he's found patients are willing to pay for the ability to access their physician by e-mail, and that the service can be made affordable. For example, one model would be to charge patients $30 a month for online messaging with the physician. A practice with 800 patients could do well under this model and drive down overhead at the same time.

In addition to new technology, Dr. Scherger said that physicians also need to create more of a team atmosphere in the care of patients, which would include the front-office staff. With EHRs and online messaging, these staff members will be even more involved in the information flow.

As physicians focus more on managing chronic conditions, they will have to find ways to connect patients to community resources, he said.

SAN FRANCISCO — Physicians need to adopt electronic health records, clinical decision support tools, and online messaging with patients to move away from a visit-based, episodic model of care, said Joseph E. Scherger, M.D., of the department of family and preventive medicine at the University of California, San Diego.

"We need to be highly convenient to people," Dr. Scherger said at the annual meeting of the American Academy of Family Physicians.

Although all three of these tools should be adopted now, Dr. Scherger cautioned that not all electronic health records (EHRs) are the same.

Physicians should be sure to look for EHRs that are designed for interoperability with other systems, said Dr. Scherger, who was a member of the Future of Family Medicine project.

Some EHRs may have clinical decision support tools embedded in the systems. But for those that don't, Dr. Scherger said it's worthwhile to obtain the tools separately. No one is able to mentally store and retrieve all the appropriate information at the right time all the time.

While in the past, patients expected physicians to be able to recall all information important to their care, the younger generation of patients won't trust information given to them from the top of their physician's head, Dr. Scherger said.

He now uses decision support tools about 90% of the time when prescribing, and it's popular with patients, he said. It also allows him to check to see if a drug will be covered by that patient's insurance formulary.

The third important tool is online messaging with patients. "It is the new platform of communication that really revolutionizes care," Dr. Scherger said.

This is not standard e-mail, he explained. Instead, it is a secure system—similar to those used for online banking or transactions with vendors such as Amazon.com

Online messaging is the mechanism for the virtual visit, he said. But even though patients will be spending less time physically with their doctor, it's still highly personal care, he said.

Although online messaging is not yet a part of most physicians' offices, it is actually the least expensive of the three important tools to implement, he said. And many electronic health records systems are embedding secure messaging in the patient record now.

With messaging that's incorporated into the EHR systems, the information from the message can become a part of the medical record. This makes it much easier to document than advice given to patients over the phone, Dr. Scherger pointed out.

Physicians can also send regular e-mail to patients without worrying that they will be violating Health Insurance Portability and Accountability Act regulations as long as the patient consents to it and it's private, Dr. Scherger said. But he recommends that physicians set up a special secure system.

He said that he's found patients are willing to pay for the ability to access their physician by e-mail, and that the service can be made affordable. For example, one model would be to charge patients $30 a month for online messaging with the physician. A practice with 800 patients could do well under this model and drive down overhead at the same time.

In addition to new technology, Dr. Scherger said that physicians also need to create more of a team atmosphere in the care of patients, which would include the front-office staff. With EHRs and online messaging, these staff members will be even more involved in the information flow.

As physicians focus more on managing chronic conditions, they will have to find ways to connect patients to community resources, he said.

SAN FRANCISCO — Physicians need to adopt electronic health records, clinical decision support tools, and online messaging with patients to move away from a visit-based, episodic model of care, said Joseph E. Scherger, M.D., of the department of family and preventive medicine at the University of California, San Diego.

"We need to be highly convenient to people," Dr. Scherger said at the annual meeting of the American Academy of Family Physicians.

Although all three of these tools should be adopted now, Dr. Scherger cautioned that not all electronic health records (EHRs) are the same.

Physicians should be sure to look for EHRs that are designed for interoperability with other systems, said Dr. Scherger, who was a member of the Future of Family Medicine project.

Some EHRs may have clinical decision support tools embedded in the systems. But for those that don't, Dr. Scherger said it's worthwhile to obtain the tools separately. No one is able to mentally store and retrieve all the appropriate information at the right time all the time.

While in the past, patients expected physicians to be able to recall all information important to their care, the younger generation of patients won't trust information given to them from the top of their physician's head, Dr. Scherger said.

He now uses decision support tools about 90% of the time when prescribing, and it's popular with patients, he said. It also allows him to check to see if a drug will be covered by that patient's insurance formulary.

The third important tool is online messaging with patients. "It is the new platform of communication that really revolutionizes care," Dr. Scherger said.

This is not standard e-mail, he explained. Instead, it is a secure system—similar to those used for online banking or transactions with vendors such as Amazon.com

Online messaging is the mechanism for the virtual visit, he said. But even though patients will be spending less time physically with their doctor, it's still highly personal care, he said.

Although online messaging is not yet a part of most physicians' offices, it is actually the least expensive of the three important tools to implement, he said. And many electronic health records systems are embedding secure messaging in the patient record now.

With messaging that's incorporated into the EHR systems, the information from the message can become a part of the medical record. This makes it much easier to document than advice given to patients over the phone, Dr. Scherger pointed out.

Physicians can also send regular e-mail to patients without worrying that they will be violating Health Insurance Portability and Accountability Act regulations as long as the patient consents to it and it's private, Dr. Scherger said. But he recommends that physicians set up a special secure system.

He said that he's found patients are willing to pay for the ability to access their physician by e-mail, and that the service can be made affordable. For example, one model would be to charge patients $30 a month for online messaging with the physician. A practice with 800 patients could do well under this model and drive down overhead at the same time.

In addition to new technology, Dr. Scherger said that physicians also need to create more of a team atmosphere in the care of patients, which would include the front-office staff. With EHRs and online messaging, these staff members will be even more involved in the information flow.

As physicians focus more on managing chronic conditions, they will have to find ways to connect patients to community resources, he said.

Steady Surgery Growth

Nearly 5 million skin surgery procedures were performed in the United States this year, with minimally invasive procedures fueling the steady growth since 2001, according to a survey from the American Society for Dermatologic Surgery (ASDS). The 4.8 million procedures in 2005 represent a 20% increase over 2003 and a 32% increase from 2001, ASDS said. Since 2003, some of the largest increases in minimally invasive procedures have been in dermal filler injections, laser and light treatment, nonablative skin rejuvenation, resurfacing, and botulinum toxin injections. "In-office, minimally invasive treatments are driving the growth of skin surgery, primarily because the procedures are very safe and require minimal recovery time," ASDS President Rhoda Narins, M.D., said in a statement. "As a result, more and more patients are willing to undergo convenient outpatient surgery for both medically necessary and cosmetic purposes." The survey is based random sample of 1,200 ASDS members. The data were then projected to reflect the procedures done by the entire membership for a single complete year.

Alternative Medicine Centers

The National Center for Complementary and Alternative Medicine (NCCAM) is funding five new research centers to study complementary and alternative approaches to HIV/AIDS, arthritis, asthma, and pain. Three of the new centers will focus on therapies used in traditional Chinese medicine, such as acupuncture and Chinese herbal mixtures. The other centers will study millimeter wave therapy—a type of energy medicine—and botanical therapies used by traditional healers in Africa. For example, NCCAM has awarded more than $1 million in first-year funding to the Center for Mechanisms Underlying Millimeter Wave Therapy at Temple University in Philadelphia. Researchers there will examine the mechanisms of action of millimeter wave therapy for a variety of diseases and conditions, and will look at the therapy's use in animal models of pruritis and chronic neuropathic pain. NCCAM is part of the National Institutes of Health.

The Research Pipeline

Drug researchers are currently developing 446 medicines aimed at the diseases that disproportionately affect women in the United States, according to a report from the Pharmaceutical Research and Manufacturers of America (PhRMA). Forty-seven medicines are in the pipeline for autoimmune disorders, including 13 that are being developed for the treatment of psoriasis. These medicines are either in clinical trials or awaiting approval by the Food and Drug Administration. PhRMA estimates that autoimmune diseases collectively affect 23.5 million Americans, most of them women.

HHS Mulls Investigation

The Department of Health and Human Services' Office of Inspector General is looking into the circumstances surrounding the resignation of former FDA Commissioner Lester M. Crawford, D.V.M., Ph.D., to determine if an investigation should be opened, an OIG spokeswoman said. In a response to a query from Rep. Maurice Hinchey (D-N.Y.), HHS Inspector General Daniel R. Levinson said that the OIG is doing an initial review of the facts, not an investigation in any regulatory sense, according to the spokeswoman. "After reviewing the facts, the OIG will determine if an investigation is formally launched," she said. "Dr. Crawford's departure, a mere 2 months after confirmation to his position, raises significant questions," Rep. Hinchey and several fellow members of Congress wrote in their request. Dr. Crawford had resigned his position after a 30-year career with the agency.

Humana Settles Class Action Suit

Humana and representatives of more than 700,000 physicians settled a nationwide class action suit that had been pending in U.S. District Court for the Southern District of Florida for more than 6 years. The original lawsuit alleged a conspiracy between Humana and other HMOs against physicians, "to manipulate software to cheat the doctor out of getting paid money due for services rendered," Archie Lamb, lead co-counsel for the physicians, said in an interview. Pursuant to the settlement, Humana has agreed to pay $40 million to physicians, as well as modify its software system to make it more fair and efficient for physicians—changes worth more than $75 million. "Humana should be commended for joining the growing list of health insurance companies that have settled with the nation's physicians," Mr. Lamb said. Those companies include Aetna, Cigna, Prudential, and HealthNet.

Resident Work Hours

Resident work-hour restrictions have improved residents' satisfaction with their personal lives but not with their work, according to a study published online in the September issue of the Journal of Reproductive Medicine. Researchers surveyed a total of 10 current and 25 graduated ob.gyn. residents at a Cleveland medical center that implemented resident work hour changes a full year before the requirement went into effect in 2003. Current and former residents reported that their sleep while not on call did not change with the reforms, suggesting that residents were spending the extra 6 hours each week on other outside activities. In addition, residents reported sleeping an average of 1 hour less (from 3 to 2 hours) while on call. "While employers clearly have no control over employees' amount of sleep outside work, residents should be informed of the evidence of how fatigue affects performance and should be encouraged to obtain enough sleep when not on duty," the authors wrote.

Steady Surgery Growth

Nearly 5 million skin surgery procedures were performed in the United States this year, with minimally invasive procedures fueling the steady growth since 2001, according to a survey from the American Society for Dermatologic Surgery (ASDS). The 4.8 million procedures in 2005 represent a 20% increase over 2003 and a 32% increase from 2001, ASDS said. Since 2003, some of the largest increases in minimally invasive procedures have been in dermal filler injections, laser and light treatment, nonablative skin rejuvenation, resurfacing, and botulinum toxin injections. "In-office, minimally invasive treatments are driving the growth of skin surgery, primarily because the procedures are very safe and require minimal recovery time," ASDS President Rhoda Narins, M.D., said in a statement. "As a result, more and more patients are willing to undergo convenient outpatient surgery for both medically necessary and cosmetic purposes." The survey is based random sample of 1,200 ASDS members. The data were then projected to reflect the procedures done by the entire membership for a single complete year.

Alternative Medicine Centers

The National Center for Complementary and Alternative Medicine (NCCAM) is funding five new research centers to study complementary and alternative approaches to HIV/AIDS, arthritis, asthma, and pain. Three of the new centers will focus on therapies used in traditional Chinese medicine, such as acupuncture and Chinese herbal mixtures. The other centers will study millimeter wave therapy—a type of energy medicine—and botanical therapies used by traditional healers in Africa. For example, NCCAM has awarded more than $1 million in first-year funding to the Center for Mechanisms Underlying Millimeter Wave Therapy at Temple University in Philadelphia. Researchers there will examine the mechanisms of action of millimeter wave therapy for a variety of diseases and conditions, and will look at the therapy's use in animal models of pruritis and chronic neuropathic pain. NCCAM is part of the National Institutes of Health.

The Research Pipeline

Drug researchers are currently developing 446 medicines aimed at the diseases that disproportionately affect women in the United States, according to a report from the Pharmaceutical Research and Manufacturers of America (PhRMA). Forty-seven medicines are in the pipeline for autoimmune disorders, including 13 that are being developed for the treatment of psoriasis. These medicines are either in clinical trials or awaiting approval by the Food and Drug Administration. PhRMA estimates that autoimmune diseases collectively affect 23.5 million Americans, most of them women.

HHS Mulls Investigation

The Department of Health and Human Services' Office of Inspector General is looking into the circumstances surrounding the resignation of former FDA Commissioner Lester M. Crawford, D.V.M., Ph.D., to determine if an investigation should be opened, an OIG spokeswoman said. In a response to a query from Rep. Maurice Hinchey (D-N.Y.), HHS Inspector General Daniel R. Levinson said that the OIG is doing an initial review of the facts, not an investigation in any regulatory sense, according to the spokeswoman. "After reviewing the facts, the OIG will determine if an investigation is formally launched," she said. "Dr. Crawford's departure, a mere 2 months after confirmation to his position, raises significant questions," Rep. Hinchey and several fellow members of Congress wrote in their request. Dr. Crawford had resigned his position after a 30-year career with the agency.

Humana Settles Class Action Suit

Humana and representatives of more than 700,000 physicians settled a nationwide class action suit that had been pending in U.S. District Court for the Southern District of Florida for more than 6 years. The original lawsuit alleged a conspiracy between Humana and other HMOs against physicians, "to manipulate software to cheat the doctor out of getting paid money due for services rendered," Archie Lamb, lead co-counsel for the physicians, said in an interview. Pursuant to the settlement, Humana has agreed to pay $40 million to physicians, as well as modify its software system to make it more fair and efficient for physicians—changes worth more than $75 million. "Humana should be commended for joining the growing list of health insurance companies that have settled with the nation's physicians," Mr. Lamb said. Those companies include Aetna, Cigna, Prudential, and HealthNet.

Resident Work Hours

Resident work-hour restrictions have improved residents' satisfaction with their personal lives but not with their work, according to a study published online in the September issue of the Journal of Reproductive Medicine. Researchers surveyed a total of 10 current and 25 graduated ob.gyn. residents at a Cleveland medical center that implemented resident work hour changes a full year before the requirement went into effect in 2003. Current and former residents reported that their sleep while not on call did not change with the reforms, suggesting that residents were spending the extra 6 hours each week on other outside activities. In addition, residents reported sleeping an average of 1 hour less (from 3 to 2 hours) while on call. "While employers clearly have no control over employees' amount of sleep outside work, residents should be informed of the evidence of how fatigue affects performance and should be encouraged to obtain enough sleep when not on duty," the authors wrote.

Steady Surgery Growth

Nearly 5 million skin surgery procedures were performed in the United States this year, with minimally invasive procedures fueling the steady growth since 2001, according to a survey from the American Society for Dermatologic Surgery (ASDS). The 4.8 million procedures in 2005 represent a 20% increase over 2003 and a 32% increase from 2001, ASDS said. Since 2003, some of the largest increases in minimally invasive procedures have been in dermal filler injections, laser and light treatment, nonablative skin rejuvenation, resurfacing, and botulinum toxin injections. "In-office, minimally invasive treatments are driving the growth of skin surgery, primarily because the procedures are very safe and require minimal recovery time," ASDS President Rhoda Narins, M.D., said in a statement. "As a result, more and more patients are willing to undergo convenient outpatient surgery for both medically necessary and cosmetic purposes." The survey is based random sample of 1,200 ASDS members. The data were then projected to reflect the procedures done by the entire membership for a single complete year.

Alternative Medicine Centers

The National Center for Complementary and Alternative Medicine (NCCAM) is funding five new research centers to study complementary and alternative approaches to HIV/AIDS, arthritis, asthma, and pain. Three of the new centers will focus on therapies used in traditional Chinese medicine, such as acupuncture and Chinese herbal mixtures. The other centers will study millimeter wave therapy—a type of energy medicine—and botanical therapies used by traditional healers in Africa. For example, NCCAM has awarded more than $1 million in first-year funding to the Center for Mechanisms Underlying Millimeter Wave Therapy at Temple University in Philadelphia. Researchers there will examine the mechanisms of action of millimeter wave therapy for a variety of diseases and conditions, and will look at the therapy's use in animal models of pruritis and chronic neuropathic pain. NCCAM is part of the National Institutes of Health.

The Research Pipeline

Drug researchers are currently developing 446 medicines aimed at the diseases that disproportionately affect women in the United States, according to a report from the Pharmaceutical Research and Manufacturers of America (PhRMA). Forty-seven medicines are in the pipeline for autoimmune disorders, including 13 that are being developed for the treatment of psoriasis. These medicines are either in clinical trials or awaiting approval by the Food and Drug Administration. PhRMA estimates that autoimmune diseases collectively affect 23.5 million Americans, most of them women.

HHS Mulls Investigation

The Department of Health and Human Services' Office of Inspector General is looking into the circumstances surrounding the resignation of former FDA Commissioner Lester M. Crawford, D.V.M., Ph.D., to determine if an investigation should be opened, an OIG spokeswoman said. In a response to a query from Rep. Maurice Hinchey (D-N.Y.), HHS Inspector General Daniel R. Levinson said that the OIG is doing an initial review of the facts, not an investigation in any regulatory sense, according to the spokeswoman. "After reviewing the facts, the OIG will determine if an investigation is formally launched," she said. "Dr. Crawford's departure, a mere 2 months after confirmation to his position, raises significant questions," Rep. Hinchey and several fellow members of Congress wrote in their request. Dr. Crawford had resigned his position after a 30-year career with the agency.

Humana Settles Class Action Suit

Humana and representatives of more than 700,000 physicians settled a nationwide class action suit that had been pending in U.S. District Court for the Southern District of Florida for more than 6 years. The original lawsuit alleged a conspiracy between Humana and other HMOs against physicians, "to manipulate software to cheat the doctor out of getting paid money due for services rendered," Archie Lamb, lead co-counsel for the physicians, said in an interview. Pursuant to the settlement, Humana has agreed to pay $40 million to physicians, as well as modify its software system to make it more fair and efficient for physicians—changes worth more than $75 million. "Humana should be commended for joining the growing list of health insurance companies that have settled with the nation's physicians," Mr. Lamb said. Those companies include Aetna, Cigna, Prudential, and HealthNet.

Resident Work Hours

Resident work-hour restrictions have improved residents' satisfaction with their personal lives but not with their work, according to a study published online in the September issue of the Journal of Reproductive Medicine. Researchers surveyed a total of 10 current and 25 graduated ob.gyn. residents at a Cleveland medical center that implemented resident work hour changes a full year before the requirement went into effect in 2003. Current and former residents reported that their sleep while not on call did not change with the reforms, suggesting that residents were spending the extra 6 hours each week on other outside activities. In addition, residents reported sleeping an average of 1 hour less (from 3 to 2 hours) while on call. "While employers clearly have no control over employees' amount of sleep outside work, residents should be informed of the evidence of how fatigue affects performance and should be encouraged to obtain enough sleep when not on duty," the authors wrote.

Abstinence Education

The federal government is awarding $37 million to 63 abstinence education grantees, the Department of Health and Human Services' Administration for Children and Families announced. The awards, from the Community-Based Abstinence Education program, are designed to encourage youth to remain abstinent until marriage. “The only way to be 100% certain that kids avoid pregnancy and sexually transmitted diseases is to stay abstinent until marriage,” said Wade F. Horn, Ph.D., assistant secretary for Children and Families. “By focusing on this clear message, the Bush administration is ensuring youth have the information they need to make the healthiest decision.” In a policy statement issued earlier this year, the American Academy of Pediatrics didn't specifically encourage abstinence until marriage, but instead stated that physicians should encourage adolescents to postpone early sexual activity.

ART and Multiple Births

The American College of Obstetricians and Gynecologists endorsed efforts to lower the risk of multiple births with assisted reproductive technology (ART) in a new committee opinion, “Perinatal Risks Associated With Assisted Reproductive Technology.” The most important health effect of ART to the offspring is iatrogenic multiple fetal pregnancy, the committee opinion said. The opinion advises physicians to tell patients about the risks and the socioeconomic burdens of multiple births and to counsel them in advance about the option of fetal reduction to decrease perinatal risks in the case of a high-order pregnancy. The American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology have developed updated recommendations on the number of embryos per transfer to reduce the risk of multiple gestation.

Resident Work Hours

Resident work hour restrictions have improved residents' satisfaction with their personal lives but not with their work, according to a study published online in the September issue of the Journal of Reproductive Medicine. Researchers surveyed a total of 10 current and 25 graduated ob.gyn. residents at a Cleveland medical center that implemented resident work hour changes a full year before the requirement went into effect in 2003. Current and former residents reported that their sleep while not on call did not change with the reforms, suggesting that residents were spending the extra 6 hours each week on other outside activities. In addition, residents reported sleeping an average of 1 hour less (from 3 to 2 hours) while on call. “While employers clearly have no control over employees' amount of sleep outside work, residents should be informed of the evidence of how fatigue affects performance and should be encouraged to obtain enough sleep when not on duty,” the authors wrote.

The Research Pipeline

Drug researchers are currently developing 446 medicines aimed at the diseases that disproportionately affect women in the United States, according to the Pharmaceutical Research and Manufacturers of America (PhRMA). These medicines are either in clinical trails or awaiting approval by the Food and Drug Administration. The bulk of the drugs are for the treatment of cancer, including 62 for breast cancer, 38 for ovarian cancer, and 13 for cervical cancer. Fifty-eight medicines are being developed to treat obstetric and gynecologic conditions, according to PhRMA.

Stem Cell Support

There is widespread support for embryonic stem cell research across political, religious, and socioeconomic lines, according to a new survey and report from the Genetics and Public Policy Center at Johns Hopkins University. About two-thirds of respondents said they approve or strongly approve of embryonic stem cell research, according to the survey of more than 2,000 Americans. A majority of respondents across the religious spectrum said they approved of the research, except among fundamentalist and evangelical Christians, who were divided on the issue. When asked about stem cell research policy, 39.7% of respondents said the government should fund research to both create and study new embryonic stem cells, 21.6% supported the current policy, and 15.9% supported a ban on all research to create or study embryonic stem cells. “The survey revealed a subtle topography of the public's attitudes with only a small fraction (6% at each pole) of the public occupying the extreme positions that so frequently characterize the public and policy debate,” the report said. The center is funded by the Pew Charitable Trusts in partnership with Johns Hopkins University. The report is available online at

www.dnapolicy.org

Abstinence Education

The federal government is awarding $37 million to 63 abstinence education grantees, the Department of Health and Human Services' Administration for Children and Families announced. The awards, from the Community-Based Abstinence Education program, are designed to encourage youth to remain abstinent until marriage. “The only way to be 100% certain that kids avoid pregnancy and sexually transmitted diseases is to stay abstinent until marriage,” said Wade F. Horn, Ph.D., assistant secretary for Children and Families. “By focusing on this clear message, the Bush administration is ensuring youth have the information they need to make the healthiest decision.” In a policy statement issued earlier this year, the American Academy of Pediatrics didn't specifically encourage abstinence until marriage, but instead stated that physicians should encourage adolescents to postpone early sexual activity.

ART and Multiple Births

The American College of Obstetricians and Gynecologists endorsed efforts to lower the risk of multiple births with assisted reproductive technology (ART) in a new committee opinion, “Perinatal Risks Associated With Assisted Reproductive Technology.” The most important health effect of ART to the offspring is iatrogenic multiple fetal pregnancy, the committee opinion said. The opinion advises physicians to tell patients about the risks and the socioeconomic burdens of multiple births and to counsel them in advance about the option of fetal reduction to decrease perinatal risks in the case of a high-order pregnancy. The American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology have developed updated recommendations on the number of embryos per transfer to reduce the risk of multiple gestation.

Resident Work Hours

Resident work hour restrictions have improved residents' satisfaction with their personal lives but not with their work, according to a study published online in the September issue of the Journal of Reproductive Medicine. Researchers surveyed a total of 10 current and 25 graduated ob.gyn. residents at a Cleveland medical center that implemented resident work hour changes a full year before the requirement went into effect in 2003. Current and former residents reported that their sleep while not on call did not change with the reforms, suggesting that residents were spending the extra 6 hours each week on other outside activities. In addition, residents reported sleeping an average of 1 hour less (from 3 to 2 hours) while on call. “While employers clearly have no control over employees' amount of sleep outside work, residents should be informed of the evidence of how fatigue affects performance and should be encouraged to obtain enough sleep when not on duty,” the authors wrote.

The Research Pipeline

Drug researchers are currently developing 446 medicines aimed at the diseases that disproportionately affect women in the United States, according to the Pharmaceutical Research and Manufacturers of America (PhRMA). These medicines are either in clinical trails or awaiting approval by the Food and Drug Administration. The bulk of the drugs are for the treatment of cancer, including 62 for breast cancer, 38 for ovarian cancer, and 13 for cervical cancer. Fifty-eight medicines are being developed to treat obstetric and gynecologic conditions, according to PhRMA.

Stem Cell Support

There is widespread support for embryonic stem cell research across political, religious, and socioeconomic lines, according to a new survey and report from the Genetics and Public Policy Center at Johns Hopkins University. About two-thirds of respondents said they approve or strongly approve of embryonic stem cell research, according to the survey of more than 2,000 Americans. A majority of respondents across the religious spectrum said they approved of the research, except among fundamentalist and evangelical Christians, who were divided on the issue. When asked about stem cell research policy, 39.7% of respondents said the government should fund research to both create and study new embryonic stem cells, 21.6% supported the current policy, and 15.9% supported a ban on all research to create or study embryonic stem cells. “The survey revealed a subtle topography of the public's attitudes with only a small fraction (6% at each pole) of the public occupying the extreme positions that so frequently characterize the public and policy debate,” the report said. The center is funded by the Pew Charitable Trusts in partnership with Johns Hopkins University. The report is available online at

www.dnapolicy.org

Abstinence Education

The federal government is awarding $37 million to 63 abstinence education grantees, the Department of Health and Human Services' Administration for Children and Families announced. The awards, from the Community-Based Abstinence Education program, are designed to encourage youth to remain abstinent until marriage. “The only way to be 100% certain that kids avoid pregnancy and sexually transmitted diseases is to stay abstinent until marriage,” said Wade F. Horn, Ph.D., assistant secretary for Children and Families. “By focusing on this clear message, the Bush administration is ensuring youth have the information they need to make the healthiest decision.” In a policy statement issued earlier this year, the American Academy of Pediatrics didn't specifically encourage abstinence until marriage, but instead stated that physicians should encourage adolescents to postpone early sexual activity.

ART and Multiple Births

The American College of Obstetricians and Gynecologists endorsed efforts to lower the risk of multiple births with assisted reproductive technology (ART) in a new committee opinion, “Perinatal Risks Associated With Assisted Reproductive Technology.” The most important health effect of ART to the offspring is iatrogenic multiple fetal pregnancy, the committee opinion said. The opinion advises physicians to tell patients about the risks and the socioeconomic burdens of multiple births and to counsel them in advance about the option of fetal reduction to decrease perinatal risks in the case of a high-order pregnancy. The American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology have developed updated recommendations on the number of embryos per transfer to reduce the risk of multiple gestation.

Resident Work Hours

Resident work hour restrictions have improved residents' satisfaction with their personal lives but not with their work, according to a study published online in the September issue of the Journal of Reproductive Medicine. Researchers surveyed a total of 10 current and 25 graduated ob.gyn. residents at a Cleveland medical center that implemented resident work hour changes a full year before the requirement went into effect in 2003. Current and former residents reported that their sleep while not on call did not change with the reforms, suggesting that residents were spending the extra 6 hours each week on other outside activities. In addition, residents reported sleeping an average of 1 hour less (from 3 to 2 hours) while on call. “While employers clearly have no control over employees' amount of sleep outside work, residents should be informed of the evidence of how fatigue affects performance and should be encouraged to obtain enough sleep when not on duty,” the authors wrote.

The Research Pipeline

Drug researchers are currently developing 446 medicines aimed at the diseases that disproportionately affect women in the United States, according to the Pharmaceutical Research and Manufacturers of America (PhRMA). These medicines are either in clinical trails or awaiting approval by the Food and Drug Administration. The bulk of the drugs are for the treatment of cancer, including 62 for breast cancer, 38 for ovarian cancer, and 13 for cervical cancer. Fifty-eight medicines are being developed to treat obstetric and gynecologic conditions, according to PhRMA.

Stem Cell Support

There is widespread support for embryonic stem cell research across political, religious, and socioeconomic lines, according to a new survey and report from the Genetics and Public Policy Center at Johns Hopkins University. About two-thirds of respondents said they approve or strongly approve of embryonic stem cell research, according to the survey of more than 2,000 Americans. A majority of respondents across the religious spectrum said they approved of the research, except among fundamentalist and evangelical Christians, who were divided on the issue. When asked about stem cell research policy, 39.7% of respondents said the government should fund research to both create and study new embryonic stem cells, 21.6% supported the current policy, and 15.9% supported a ban on all research to create or study embryonic stem cells. “The survey revealed a subtle topography of the public's attitudes with only a small fraction (6% at each pole) of the public occupying the extreme positions that so frequently characterize the public and policy debate,” the report said. The center is funded by the Pew Charitable Trusts in partnership with Johns Hopkins University. The report is available online at

www.dnapolicy.org

SAN FRANCISCO — Finding key clinical information at the point of care has never been easier thanks to e-mail alerts and online search tools, Scott M. Strayer, M.D., said at the annual meeting of the American Academy of Family Physicians.

A robust industry has developed to make clinical decision support available by computer or PDA, said Dr. Strayer, of the department of family medicine at the University of Virginia Health System, Charlottesville.

The new tools come in two categories—“foraging” tools allow physicians to keep up to date on the latest research and clinical guidelines and “hunting” tools allow them to search for specific clinical information.

Taken together, the tools not only provide physicians with information during a clinical encounter, but, if used widely, are likely to move evidence into practice faster as well, he said.

“Without both, you really don't know that new information is available, and you can't find it when you do,” Dr. Strayer said.

Some examples of available foraging tools include:

▸ InfoPoems (www.infopoems.com

▸ Journal Alerts (www.globalfamilydoctor.com/journalalerts/journalalerts.asp

Hunting tools include:

▸ InfoPoems (www.infopoems.com

▸ Up to Date (www.uptodateonline.com

▸ DynaMed (www.dynamicmedical.com

Dr. Strayer, who did not disclose any financial relationships with the products discussed, said physicians should be aware that not all of these tools are created equal.

When evaluating clinical decision support tools, it's important to see how the information is filtered. Is the information patient oriented or disease oriented? Is it specialty specific? Is it comprehensive? Which journals does it scan? Will the information change your practice or is it simply news?

Physicians also need to consider whether the information provided is valid, he said.

Dr. Strayer recommended looking for labels with the level of evidence used.

And physicians should beware of “Trojan horse” sites that look independent but are sponsored by drug companies, for example. When using these tools, physicians should be aware if there is any bias to the information, he said.

Before committing to a product, physicians should also determine how well the information is summarized, Dr. Strayer said. The summary should be accurate, provide context, and be more comprehensive than just an abstract.

SAN FRANCISCO — Finding key clinical information at the point of care has never been easier thanks to e-mail alerts and online search tools, Scott M. Strayer, M.D., said at the annual meeting of the American Academy of Family Physicians.

A robust industry has developed to make clinical decision support available by computer or PDA, said Dr. Strayer, of the department of family medicine at the University of Virginia Health System, Charlottesville.

The new tools come in two categories—“foraging” tools allow physicians to keep up to date on the latest research and clinical guidelines and “hunting” tools allow them to search for specific clinical information.

Taken together, the tools not only provide physicians with information during a clinical encounter, but, if used widely, are likely to move evidence into practice faster as well, he said.

“Without both, you really don't know that new information is available, and you can't find it when you do,” Dr. Strayer said.

Some examples of available foraging tools include:

▸ InfoPoems (www.infopoems.com

▸ Journal Alerts (www.globalfamilydoctor.com/journalalerts/journalalerts.asp

Hunting tools include:

▸ InfoPoems (www.infopoems.com

▸ Up to Date (www.uptodateonline.com

▸ DynaMed (www.dynamicmedical.com

Dr. Strayer, who did not disclose any financial relationships with the products discussed, said physicians should be aware that not all of these tools are created equal.

When evaluating clinical decision support tools, it's important to see how the information is filtered. Is the information patient oriented or disease oriented? Is it specialty specific? Is it comprehensive? Which journals does it scan? Will the information change your practice or is it simply news?

Physicians also need to consider whether the information provided is valid, he said.

Dr. Strayer recommended looking for labels with the level of evidence used.

And physicians should beware of “Trojan horse” sites that look independent but are sponsored by drug companies, for example. When using these tools, physicians should be aware if there is any bias to the information, he said.

Before committing to a product, physicians should also determine how well the information is summarized, Dr. Strayer said. The summary should be accurate, provide context, and be more comprehensive than just an abstract.

SAN FRANCISCO — Finding key clinical information at the point of care has never been easier thanks to e-mail alerts and online search tools, Scott M. Strayer, M.D., said at the annual meeting of the American Academy of Family Physicians.

A robust industry has developed to make clinical decision support available by computer or PDA, said Dr. Strayer, of the department of family medicine at the University of Virginia Health System, Charlottesville.

The new tools come in two categories—“foraging” tools allow physicians to keep up to date on the latest research and clinical guidelines and “hunting” tools allow them to search for specific clinical information.

Taken together, the tools not only provide physicians with information during a clinical encounter, but, if used widely, are likely to move evidence into practice faster as well, he said.

“Without both, you really don't know that new information is available, and you can't find it when you do,” Dr. Strayer said.

Some examples of available foraging tools include:

▸ InfoPoems (www.infopoems.com

▸ Journal Alerts (www.globalfamilydoctor.com/journalalerts/journalalerts.asp

Hunting tools include:

▸ InfoPoems (www.infopoems.com

▸ Up to Date (www.uptodateonline.com

▸ DynaMed (www.dynamicmedical.com

Dr. Strayer, who did not disclose any financial relationships with the products discussed, said physicians should be aware that not all of these tools are created equal.

When evaluating clinical decision support tools, it's important to see how the information is filtered. Is the information patient oriented or disease oriented? Is it specialty specific? Is it comprehensive? Which journals does it scan? Will the information change your practice or is it simply news?

Physicians also need to consider whether the information provided is valid, he said.

Dr. Strayer recommended looking for labels with the level of evidence used.

And physicians should beware of “Trojan horse” sites that look independent but are sponsored by drug companies, for example. When using these tools, physicians should be aware if there is any bias to the information, he said.

Before committing to a product, physicians should also determine how well the information is summarized, Dr. Strayer said. The summary should be accurate, provide context, and be more comprehensive than just an abstract.

ATLANTA — The use of oral contraceptives appears to decrease the premenstrual worsening of depressive symptoms, Hadine Joffe, M.D., said at the annual meeting of the American Psychiatric Association.

In preliminary research, the use of augmentation with oral contraceptive pills was evaluated in women who already take antidepressants but experience worsening symptoms during the luteal phase of the menstrual cycle, said Dr. Joffe, a psychiatrist at Massachusetts General Hospital, Boston.

The 17 women who completed the study reduced their depression scores during the premenstrual phase on the Daily Record of Severity of Problems Scale from a median score of 58 to a median score of 35.3. In addition, their Montgomery-Asberg Depression Rating Scale scores improved from a median of 20 to a median of 4.

A total of 26 women, aged 18–45 years, were randomized to a double-blind treatment with an oral contraceptive that contained drospirenone and ethinyl estradiol (Yasmin). One group received additional ethinyl estradiol on days 22–28, which is the typical placebo week of the oral contraceptive pills.

To be eligible for the 2-month study, women had to have regular 25- to 35-day menstrual cycles, a depressive disorder, and stable use of an antidepressant for 2 months or more. In addition, all participants completed a run-in tracking month before starting the oral contraceptive pill. Depressive symptoms were found to be present only during the premenstrual phase. Of the women included in the study, 82% had major depression, 12% had minor depression, and 6% had dysthymia.

The oral contraceptive pills were well tolerated. There seemed to be no difference between women who received the additional ethinyl estradiol during days 22–28 of their cycles and those who received placebo during that time. The study was sponsored by the National Alliance for Research on Schizophrenia and Depression. Berlex, which manufactures Yasmin, provided product support.

ATLANTA — The use of oral contraceptives appears to decrease the premenstrual worsening of depressive symptoms, Hadine Joffe, M.D., said at the annual meeting of the American Psychiatric Association.

In preliminary research, the use of augmentation with oral contraceptive pills was evaluated in women who already take antidepressants but experience worsening symptoms during the luteal phase of the menstrual cycle, said Dr. Joffe, a psychiatrist at Massachusetts General Hospital, Boston.

The 17 women who completed the study reduced their depression scores during the premenstrual phase on the Daily Record of Severity of Problems Scale from a median score of 58 to a median score of 35.3. In addition, their Montgomery-Asberg Depression Rating Scale scores improved from a median of 20 to a median of 4.

A total of 26 women, aged 18–45 years, were randomized to a double-blind treatment with an oral contraceptive that contained drospirenone and ethinyl estradiol (Yasmin). One group received additional ethinyl estradiol on days 22–28, which is the typical placebo week of the oral contraceptive pills.

To be eligible for the 2-month study, women had to have regular 25- to 35-day menstrual cycles, a depressive disorder, and stable use of an antidepressant for 2 months or more. In addition, all participants completed a run-in tracking month before starting the oral contraceptive pill. Depressive symptoms were found to be present only during the premenstrual phase. Of the women included in the study, 82% had major depression, 12% had minor depression, and 6% had dysthymia.

The oral contraceptive pills were well tolerated. There seemed to be no difference between women who received the additional ethinyl estradiol during days 22–28 of their cycles and those who received placebo during that time. The study was sponsored by the National Alliance for Research on Schizophrenia and Depression. Berlex, which manufactures Yasmin, provided product support.

ATLANTA — The use of oral contraceptives appears to decrease the premenstrual worsening of depressive symptoms, Hadine Joffe, M.D., said at the annual meeting of the American Psychiatric Association.

In preliminary research, the use of augmentation with oral contraceptive pills was evaluated in women who already take antidepressants but experience worsening symptoms during the luteal phase of the menstrual cycle, said Dr. Joffe, a psychiatrist at Massachusetts General Hospital, Boston.

The 17 women who completed the study reduced their depression scores during the premenstrual phase on the Daily Record of Severity of Problems Scale from a median score of 58 to a median score of 35.3. In addition, their Montgomery-Asberg Depression Rating Scale scores improved from a median of 20 to a median of 4.

A total of 26 women, aged 18–45 years, were randomized to a double-blind treatment with an oral contraceptive that contained drospirenone and ethinyl estradiol (Yasmin). One group received additional ethinyl estradiol on days 22–28, which is the typical placebo week of the oral contraceptive pills.

To be eligible for the 2-month study, women had to have regular 25- to 35-day menstrual cycles, a depressive disorder, and stable use of an antidepressant for 2 months or more. In addition, all participants completed a run-in tracking month before starting the oral contraceptive pill. Depressive symptoms were found to be present only during the premenstrual phase. Of the women included in the study, 82% had major depression, 12% had minor depression, and 6% had dysthymia.

The oral contraceptive pills were well tolerated. There seemed to be no difference between women who received the additional ethinyl estradiol during days 22–28 of their cycles and those who received placebo during that time. The study was sponsored by the National Alliance for Research on Schizophrenia and Depression. Berlex, which manufactures Yasmin, provided product support.