Mary Ellen Schneider

A broad coalition of public and private sector groups has launched a secure Web site on which physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site—www.KatrinaHealth

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina—many with chronic health conditions.

“With access to [these records] physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association said during a telephone briefing to announce the launch of KatrinaHealth.org.

Dr. Hill, who is a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said.

And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctor, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm.

At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic prescribing service provider.

On the Web site, physicians are able to obtain information about a patient's allergies; view a patient's prescription history as well as drug interaction and therapeutic duplication reports; and query a patient's clinical pharmacology drug information.

To ensure that only authorized physicians use the site, the American Medical Association is authenticating the identity and qualifications of every physician before they are allowed to use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password.

But the sponsors of the site also caution physicians not to rely too heavily on the information. They warn that the data may have errors of duplication or omission because it has been collected from multiple sources.

For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site though the information is being added on a rolling basis.

The KatrinaHealth.org effort could also provide some lessons for the overall effort to increase the adoption of health information technology, said David J. Brailer, M.D., the National Coordinator of Health Information Technology for HHS. He added, however, that the site itself is not intended for long-term use.

With regard to patients who were relocated as a result of hurricane Rita, at press time, his office was in discussions with local officials about whether they might want to utilize the site

Dr. Brailer said that his office will perform an afteraction analysis of the site to see what had worked, what had not worked, and what could be learned from the effort.

“[Hurricane Katrina] showed us an urgent need where health information can play a role, where among all the other aspects of both the disaster and the recovery, health information has a place that can mean a real difference in people's lives,” Dr. Brailer said.

A broad coalition of public and private sector groups has launched a secure Web site on which physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site—www.KatrinaHealth

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina—many with chronic health conditions.

“With access to [these records] physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association said during a telephone briefing to announce the launch of KatrinaHealth.org.

Dr. Hill, who is a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said.

And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctor, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm.

At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic prescribing service provider.

On the Web site, physicians are able to obtain information about a patient's allergies; view a patient's prescription history as well as drug interaction and therapeutic duplication reports; and query a patient's clinical pharmacology drug information.

To ensure that only authorized physicians use the site, the American Medical Association is authenticating the identity and qualifications of every physician before they are allowed to use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password.

But the sponsors of the site also caution physicians not to rely too heavily on the information. They warn that the data may have errors of duplication or omission because it has been collected from multiple sources.

For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site though the information is being added on a rolling basis.

The KatrinaHealth.org effort could also provide some lessons for the overall effort to increase the adoption of health information technology, said David J. Brailer, M.D., the National Coordinator of Health Information Technology for HHS. He added, however, that the site itself is not intended for long-term use.

With regard to patients who were relocated as a result of hurricane Rita, at press time, his office was in discussions with local officials about whether they might want to utilize the site

Dr. Brailer said that his office will perform an afteraction analysis of the site to see what had worked, what had not worked, and what could be learned from the effort.

“[Hurricane Katrina] showed us an urgent need where health information can play a role, where among all the other aspects of both the disaster and the recovery, health information has a place that can mean a real difference in people's lives,” Dr. Brailer said.

A broad coalition of public and private sector groups has launched a secure Web site on which physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site—www.KatrinaHealth

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina—many with chronic health conditions.

“With access to [these records] physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association said during a telephone briefing to announce the launch of KatrinaHealth.org.

Dr. Hill, who is a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said.

And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctor, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm.

At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic prescribing service provider.

On the Web site, physicians are able to obtain information about a patient's allergies; view a patient's prescription history as well as drug interaction and therapeutic duplication reports; and query a patient's clinical pharmacology drug information.

To ensure that only authorized physicians use the site, the American Medical Association is authenticating the identity and qualifications of every physician before they are allowed to use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password.

But the sponsors of the site also caution physicians not to rely too heavily on the information. They warn that the data may have errors of duplication or omission because it has been collected from multiple sources.

For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site though the information is being added on a rolling basis.

The KatrinaHealth.org effort could also provide some lessons for the overall effort to increase the adoption of health information technology, said David J. Brailer, M.D., the National Coordinator of Health Information Technology for HHS. He added, however, that the site itself is not intended for long-term use.

With regard to patients who were relocated as a result of hurricane Rita, at press time, his office was in discussions with local officials about whether they might want to utilize the site

Dr. Brailer said that his office will perform an afteraction analysis of the site to see what had worked, what had not worked, and what could be learned from the effort.

“[Hurricane Katrina] showed us an urgent need where health information can play a role, where among all the other aspects of both the disaster and the recovery, health information has a place that can mean a real difference in people's lives,” Dr. Brailer said.

A broad coalition of public and private sector groups has launched a secure Web site where physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site—www.KatrinaHealth.org

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina—many with chronic health conditions.

“With access to [these records], physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association, said during a telephone briefing to announce the launch of www.KatrinaHealth.org

Dr. Hill, a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said. And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctors, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm.

At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic-prescribing service provider.

On the Web site, physicians can obtain allergy information; view prescription history as well as drug interaction and therapeutic duplication reports; and query clinical pharmacology drug information. To ensure that only authorized physicians use the site, the AMA is authenticating the identity and qualifications of every physician before they can use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password. But the sponsors of the site caution physicians not to rely too heavily on the information. The data may have errors of duplication or omission because it has been collected from multiple sources. For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site, though the information is being added on a rolling basis.

The www.KatrinaHealth.org

Dr. Brailer said his office will perform an after-action analysis of the site to see what worked, what didn't, and what can be learned from the effort.

A broad coalition of public and private sector groups has launched a secure Web site where physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site—www.KatrinaHealth.org

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina—many with chronic health conditions.

“With access to [these records], physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association, said during a telephone briefing to announce the launch of www.KatrinaHealth.org

Dr. Hill, a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said. And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctors, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm.

At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic-prescribing service provider.

On the Web site, physicians can obtain allergy information; view prescription history as well as drug interaction and therapeutic duplication reports; and query clinical pharmacology drug information. To ensure that only authorized physicians use the site, the AMA is authenticating the identity and qualifications of every physician before they can use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password. But the sponsors of the site caution physicians not to rely too heavily on the information. The data may have errors of duplication or omission because it has been collected from multiple sources. For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site, though the information is being added on a rolling basis.

The www.KatrinaHealth.org

Dr. Brailer said his office will perform an after-action analysis of the site to see what worked, what didn't, and what can be learned from the effort.

A broad coalition of public and private sector groups has launched a secure Web site where physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site—www.KatrinaHealth.org

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina—many with chronic health conditions.

“With access to [these records], physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association, said during a telephone briefing to announce the launch of www.KatrinaHealth.org

Dr. Hill, a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said. And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctors, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm.

At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic-prescribing service provider.

On the Web site, physicians can obtain allergy information; view prescription history as well as drug interaction and therapeutic duplication reports; and query clinical pharmacology drug information. To ensure that only authorized physicians use the site, the AMA is authenticating the identity and qualifications of every physician before they can use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password. But the sponsors of the site caution physicians not to rely too heavily on the information. The data may have errors of duplication or omission because it has been collected from multiple sources. For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site, though the information is being added on a rolling basis.

The www.KatrinaHealth.org

Dr. Brailer said his office will perform an after-action analysis of the site to see what worked, what didn't, and what can be learned from the effort.

The long-awaited national pandemic influenza plan unveiled this month could also help solve chronic problems in production of seasonal flu vaccine.

“We don't need to have a disaster to get a benefit from this influenza planning,” said Andrew T. Pavia, M.D., professor and chief of the division of pediatric infectious diseases at the University of Utah, Salt Lake City.

The government's plan puts a strong emphasis on developing the capacity to produce influenza vaccine, rather than just focusing on stockpiling, said Dr. Pavia, who is also a member of the pandemic influenza task force for the Infectious Diseases Society of America.

The plan also begins to address the issue of why manufacturers have left the vaccine market, he said in an interview.

In a speech at the National Institutes of Health on Nov. 1, President George W. Bush outlined the administration's strategy for dealing with a possible influenza pandemic, and requested $7.1 billion in emergency funding from Congress to implement the plan.

The bulk of the funding—$2.9 billion—would go toward accelerating development of cell-culture technology for vaccine production. Use of such technology should allow manufacturers to produce enough vaccine for every American within 6 months of the start of a pandemic, President Bush said. He also requested $800 million for development of new treatments and vaccines for pandemic influenza.

Another $1.5 billion would be used for the Department of Health and Human Services and the Department of Defense to purchase influenza vaccines. Researchers at NIH have developed a vaccine, now in clinical trials, that is based on the current strain of the avian flu virus, President Bush said. The government plans to purchase enough doses of this vaccine from manufacturers to vaccinate about 20 million people.

Although this vaccine would not provide full coverage against a pandemic influenza strain, it would offer some protection during the early months of an outbreak, President Bush said. President Bush announced that he is also seeking about $1 billion to stockpile antiviral medications.

The administration is also requesting $251 million to detect and contain outbreaks before they spread. That money would be used to help other countries train personnel, expand surveillance and testing, and improve preparedness plans, as well as take action to contain outbreaks. At home, the president has launched the National Bio-Surveillance Initiative, aimed at rapid detection of and response to disease outbreaks. In addition, the administration is seeking $644 million to help all levels of government prepare to respond to a potential pandemic outbreak.

President Bush also urged Congress to pass liability protection for vaccine makers in an effort to improve domestic production of vaccines.

The administration was praised for addressing the issue of pandemic flu at the highest levels, but the plan also had its critics.

The proposal is too top-heavy and has a limited focus on the role of primary care physicians, said Jonathan L. Temte, M.D., associate professor of family medicine at the University of Wisconsin, Madison, and a liaison to the Advisory Committee for Immunization Practices from the American Academy of Family Physicians.

The federal strategy for dealing with pandemic flu needs to interact with state and local plans and with individual health care providers, he said. “I don't see any of that infrastructure,” Dr. Temte said in an interview.

Democrats in Congress called President Bush slow to act on this issue.

“Every public health expert I've spoken to has emphasized that when it comes to a pandemic, it's not a matter of 'if' but 'when'—yet the administration did not treat this like a national priority until very recently,” Rep. Nita Lowey (D-N.Y.), who sponsored legislation in October to address a potential influenza pandemic, said in a statement.

Sen. Edward Kennedy (D-Mass.) said in a statement that just stockpiling drugs won't be enough and that the plan needs to be stronger in terms of improving the capacity of hospitals and other health care facilities to respond to a pandemic.

Surge capacity in hospitals is a major challenge in preparing for a flu pandemic or another major event such as a bioterrorist attack, said Gregory J. Moran, M.D., a clinical professor in the department of emergency medicine and infectious disease at the University of California, Los Angeles.

Hospitals need to develop plans to create extra bed capacity in non-patient care areas of the hospital. But hospital administrators can't do this alone and need community interest and investment, Dr. Moran said in an interview.

Right now there is no financial incentive for hospitals to have extra beds that generally remain empty so that they are available in case of an emergency. “We are not well prepared for the worst-case scenario,” he said.

The national plan outlined by the president is still a work in progress, Dr. Pavia said, and more work needs to be done to spell out how to move research findings quickly into vaccine production. In addition, more must be done to plan for major public health interventions such as school closures and travel restrictions.

Information on the government's pandemic flu plan is available online at www.pandemicflu.gov

The long-awaited national pandemic influenza plan unveiled this month could also help solve chronic problems in production of seasonal flu vaccine.

“We don't need to have a disaster to get a benefit from this influenza planning,” said Andrew T. Pavia, M.D., professor and chief of the division of pediatric infectious diseases at the University of Utah, Salt Lake City.

The government's plan puts a strong emphasis on developing the capacity to produce influenza vaccine, rather than just focusing on stockpiling, said Dr. Pavia, who is also a member of the pandemic influenza task force for the Infectious Diseases Society of America.

The plan also begins to address the issue of why manufacturers have left the vaccine market, he said in an interview.

In a speech at the National Institutes of Health on Nov. 1, President George W. Bush outlined the administration's strategy for dealing with a possible influenza pandemic, and requested $7.1 billion in emergency funding from Congress to implement the plan.

The bulk of the funding—$2.9 billion—would go toward accelerating development of cell-culture technology for vaccine production. Use of such technology should allow manufacturers to produce enough vaccine for every American within 6 months of the start of a pandemic, President Bush said. He also requested $800 million for development of new treatments and vaccines for pandemic influenza.

Another $1.5 billion would be used for the Department of Health and Human Services and the Department of Defense to purchase influenza vaccines. Researchers at NIH have developed a vaccine, now in clinical trials, that is based on the current strain of the avian flu virus, President Bush said. The government plans to purchase enough doses of this vaccine from manufacturers to vaccinate about 20 million people.

Although this vaccine would not provide full coverage against a pandemic influenza strain, it would offer some protection during the early months of an outbreak, President Bush said. President Bush announced that he is also seeking about $1 billion to stockpile antiviral medications.

The administration is also requesting $251 million to detect and contain outbreaks before they spread. That money would be used to help other countries train personnel, expand surveillance and testing, and improve preparedness plans, as well as take action to contain outbreaks. At home, the president has launched the National Bio-Surveillance Initiative, aimed at rapid detection of and response to disease outbreaks. In addition, the administration is seeking $644 million to help all levels of government prepare to respond to a potential pandemic outbreak.

President Bush also urged Congress to pass liability protection for vaccine makers in an effort to improve domestic production of vaccines.

The administration was praised for addressing the issue of pandemic flu at the highest levels, but the plan also had its critics.

The proposal is too top-heavy and has a limited focus on the role of primary care physicians, said Jonathan L. Temte, M.D., associate professor of family medicine at the University of Wisconsin, Madison, and a liaison to the Advisory Committee for Immunization Practices from the American Academy of Family Physicians.

The federal strategy for dealing with pandemic flu needs to interact with state and local plans and with individual health care providers, he said. “I don't see any of that infrastructure,” Dr. Temte said in an interview.

Democrats in Congress called President Bush slow to act on this issue.

“Every public health expert I've spoken to has emphasized that when it comes to a pandemic, it's not a matter of 'if' but 'when'—yet the administration did not treat this like a national priority until very recently,” Rep. Nita Lowey (D-N.Y.), who sponsored legislation in October to address a potential influenza pandemic, said in a statement.

Sen. Edward Kennedy (D-Mass.) said in a statement that just stockpiling drugs won't be enough and that the plan needs to be stronger in terms of improving the capacity of hospitals and other health care facilities to respond to a pandemic.

Surge capacity in hospitals is a major challenge in preparing for a flu pandemic or another major event such as a bioterrorist attack, said Gregory J. Moran, M.D., a clinical professor in the department of emergency medicine and infectious disease at the University of California, Los Angeles.

Hospitals need to develop plans to create extra bed capacity in non-patient care areas of the hospital. But hospital administrators can't do this alone and need community interest and investment, Dr. Moran said in an interview.

Right now there is no financial incentive for hospitals to have extra beds that generally remain empty so that they are available in case of an emergency. “We are not well prepared for the worst-case scenario,” he said.

The national plan outlined by the president is still a work in progress, Dr. Pavia said, and more work needs to be done to spell out how to move research findings quickly into vaccine production. In addition, more must be done to plan for major public health interventions such as school closures and travel restrictions.

Information on the government's pandemic flu plan is available online at www.pandemicflu.gov

The long-awaited national pandemic influenza plan unveiled this month could also help solve chronic problems in production of seasonal flu vaccine.

“We don't need to have a disaster to get a benefit from this influenza planning,” said Andrew T. Pavia, M.D., professor and chief of the division of pediatric infectious diseases at the University of Utah, Salt Lake City.

The government's plan puts a strong emphasis on developing the capacity to produce influenza vaccine, rather than just focusing on stockpiling, said Dr. Pavia, who is also a member of the pandemic influenza task force for the Infectious Diseases Society of America.

The plan also begins to address the issue of why manufacturers have left the vaccine market, he said in an interview.

In a speech at the National Institutes of Health on Nov. 1, President George W. Bush outlined the administration's strategy for dealing with a possible influenza pandemic, and requested $7.1 billion in emergency funding from Congress to implement the plan.

The bulk of the funding—$2.9 billion—would go toward accelerating development of cell-culture technology for vaccine production. Use of such technology should allow manufacturers to produce enough vaccine for every American within 6 months of the start of a pandemic, President Bush said. He also requested $800 million for development of new treatments and vaccines for pandemic influenza.

Another $1.5 billion would be used for the Department of Health and Human Services and the Department of Defense to purchase influenza vaccines. Researchers at NIH have developed a vaccine, now in clinical trials, that is based on the current strain of the avian flu virus, President Bush said. The government plans to purchase enough doses of this vaccine from manufacturers to vaccinate about 20 million people.

Although this vaccine would not provide full coverage against a pandemic influenza strain, it would offer some protection during the early months of an outbreak, President Bush said. President Bush announced that he is also seeking about $1 billion to stockpile antiviral medications.

The administration is also requesting $251 million to detect and contain outbreaks before they spread. That money would be used to help other countries train personnel, expand surveillance and testing, and improve preparedness plans, as well as take action to contain outbreaks. At home, the president has launched the National Bio-Surveillance Initiative, aimed at rapid detection of and response to disease outbreaks. In addition, the administration is seeking $644 million to help all levels of government prepare to respond to a potential pandemic outbreak.

President Bush also urged Congress to pass liability protection for vaccine makers in an effort to improve domestic production of vaccines.

The administration was praised for addressing the issue of pandemic flu at the highest levels, but the plan also had its critics.

The proposal is too top-heavy and has a limited focus on the role of primary care physicians, said Jonathan L. Temte, M.D., associate professor of family medicine at the University of Wisconsin, Madison, and a liaison to the Advisory Committee for Immunization Practices from the American Academy of Family Physicians.

The federal strategy for dealing with pandemic flu needs to interact with state and local plans and with individual health care providers, he said. “I don't see any of that infrastructure,” Dr. Temte said in an interview.

Democrats in Congress called President Bush slow to act on this issue.

“Every public health expert I've spoken to has emphasized that when it comes to a pandemic, it's not a matter of 'if' but 'when'—yet the administration did not treat this like a national priority until very recently,” Rep. Nita Lowey (D-N.Y.), who sponsored legislation in October to address a potential influenza pandemic, said in a statement.

Sen. Edward Kennedy (D-Mass.) said in a statement that just stockpiling drugs won't be enough and that the plan needs to be stronger in terms of improving the capacity of hospitals and other health care facilities to respond to a pandemic.

Surge capacity in hospitals is a major challenge in preparing for a flu pandemic or another major event such as a bioterrorist attack, said Gregory J. Moran, M.D., a clinical professor in the department of emergency medicine and infectious disease at the University of California, Los Angeles.

Hospitals need to develop plans to create extra bed capacity in non-patient care areas of the hospital. But hospital administrators can't do this alone and need community interest and investment, Dr. Moran said in an interview.

Right now there is no financial incentive for hospitals to have extra beds that generally remain empty so that they are available in case of an emergency. “We are not well prepared for the worst-case scenario,” he said.

The national plan outlined by the president is still a work in progress, Dr. Pavia said, and more work needs to be done to spell out how to move research findings quickly into vaccine production. In addition, more must be done to plan for major public health interventions such as school closures and travel restrictions.

Information on the government's pandemic flu plan is available online at www.pandemicflu.gov

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.

While 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 that you give them from the top of your 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 said. Instead, it is a secure system—similar to those used for online banking or transactions with vendors such as Amazon.com—that patients can use to send questions and information to their physician and get a response back.

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, Dr. Scherger added.

While 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 EHR systems are embedding secure messaging in the patient record now.

With messaging that's incorporated into the EHR, 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 said.

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 is private, Dr. Scherger said. But he recommends setting up a special secure system before doing so.

Dr. Scherger said he's found that patients are willing to pay for the ability to access their physician by e-mail, and 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 physicians also need to create more of a team atmosphere in the care of patients that includes 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.

While 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 that you give them from the top of your 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 said. Instead, it is a secure system—similar to those used for online banking or transactions with vendors such as Amazon.com—that patients can use to send questions and information to their physician and get a response back.

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, Dr. Scherger added.

While 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 EHR systems are embedding secure messaging in the patient record now.

With messaging that's incorporated into the EHR, 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 said.

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 is private, Dr. Scherger said. But he recommends setting up a special secure system before doing so.

Dr. Scherger said he's found that patients are willing to pay for the ability to access their physician by e-mail, and 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 physicians also need to create more of a team atmosphere in the care of patients that includes 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.

While 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 that you give them from the top of your 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 said. Instead, it is a secure system—similar to those used for online banking or transactions with vendors such as Amazon.com—that patients can use to send questions and information to their physician and get a response back.

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, Dr. Scherger added.

While 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 EHR systems are embedding secure messaging in the patient record now.

With messaging that's incorporated into the EHR, 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 said.

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 is private, Dr. Scherger said. But he recommends setting up a special secure system before doing so.

Dr. Scherger said he's found that patients are willing to pay for the ability to access their physician by e-mail, and 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 physicians also need to create more of a team atmosphere in the care of patients that includes 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.

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 small number of institutions and physicians offer some type of 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 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 they 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 small number of institutions and physicians offer some type of 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 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 they 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 small number of institutions and physicians offer some type of 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 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 they 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.

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 FAMILY PRACTICE NEWS.

“The payment mechanism is certainly lagging behind,” said Sandra Hassink, M.D., who is 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's far from a perfect solution, she said. If physicians could code for obesity as the primary diagnosis they could spend less time trying to work around the payment system, she said. And they could perform early interventions to keep obesity and overweight from leading to diabetes and heart disease, she said.

Payment for obesity counseling and interventions is part of a larger problem with the episode-driven payment approach, she said. “So much of this revolves around fixing our payment system.”

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,” he said.

Dr. Steelman said that 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 will not pay for interventions that are associated only with obesity, most children who are obese also have other comorbidities. Dr. Calabrese therefore recommends that physicians code the comorbid condition as the primary diagnosis and include 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 (99212–99215) or, if the patient was referred by a school nurse or other professional, the physician can use the consultation codes (99241–99245). When physicians spend extra time with a patient, they should use the prolonged face-to-face codes (99354–99355). 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, she said. 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 planning to do 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 a pediatric cardiologist. 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 that 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 FAMILY PRACTICE NEWS.

“The payment mechanism is certainly lagging behind,” said Sandra Hassink, M.D., who is 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's far from a perfect solution, she said. If physicians could code for obesity as the primary diagnosis they could spend less time trying to work around the payment system, she said. And they could perform early interventions to keep obesity and overweight from leading to diabetes and heart disease, she said.

Payment for obesity counseling and interventions is part of a larger problem with the episode-driven payment approach, she said. “So much of this revolves around fixing our payment system.”

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,” he said.

Dr. Steelman said that 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 will not pay for interventions that are associated only with obesity, most children who are obese also have other comorbidities. Dr. Calabrese therefore recommends that physicians code the comorbid condition as the primary diagnosis and include 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 (99212–99215) or, if the patient was referred by a school nurse or other professional, the physician can use the consultation codes (99241–99245). When physicians spend extra time with a patient, they should use the prolonged face-to-face codes (99354–99355). 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, she said. 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 planning to do 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 a pediatric cardiologist. 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 that 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 FAMILY PRACTICE NEWS.

“The payment mechanism is certainly lagging behind,” said Sandra Hassink, M.D., who is 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's far from a perfect solution, she said. If physicians could code for obesity as the primary diagnosis they could spend less time trying to work around the payment system, she said. And they could perform early interventions to keep obesity and overweight from leading to diabetes and heart disease, she said.

Payment for obesity counseling and interventions is part of a larger problem with the episode-driven payment approach, she said. “So much of this revolves around fixing our payment system.”

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,” he said.

Dr. Steelman said that 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 will not pay for interventions that are associated only with obesity, most children who are obese also have other comorbidities. Dr. Calabrese therefore recommends that physicians code the comorbid condition as the primary diagnosis and include 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 (99212–99215) or, if the patient was referred by a school nurse or other professional, the physician can use the consultation codes (99241–99245). When physicians spend extra time with a patient, they should use the prolonged face-to-face codes (99354–99355). 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, she said. 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 planning to do 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 a pediatric cardiologist. 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 that 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 — Physicians may be failing to address abnormal blood pressure levels among adolescents, according to a study presented at the annual meeting of the American Academy of Family Physicians.

The study analyzed blood pressure levels recorded on preparticipation sports physicals for more than 1,500 adolescents. More than 13% of the adolescents had either a hypertensive systolic or hypertensive diastolic blood pressure level, but few were identified as abnormal or provided with follow-up interventions, according to Kevin E. Burroughs, M.D., of the University of North Carolina, who conducted the study.

“If anything, we should be able to use this information to help us out with trying to help decrease morbidity and mortality for these individuals,” Dr. Burroughs said.

His study looked at the preparticipation exams for 1,547 adolescents from three middle schools and three high schools in Cabarrus County, N.C., during the school years 2003–2004 and 2004–2005. He used guidelines from the National Heart Lung and Blood Institute's Working Task Force on Childhood Hypertension to classify the blood pressure by age and height.

As outlined in those guidelines, blood pressure values of greater than the 95th percentile for age, sex, and height were classified as child and adolescent hypertension. Those in the 90–95th percentile were high normal blood pressure and blood pressure values that fell below the 90th percentile were considered normal.

Overall, 7.4% (114) of the adolescents in the study had systolic blood pressure that would be considered hypertensive and 6.5% (100) of the adolescents had a hypertensive diastolic blood pressure. But only 14 of the adolescents with hypertensive values were labeled as such, Dr. Burroughs said, and only 11 were scheduled for any follow-up.

Though hypertension is not determined by a single reading, it offers physicians an opportunity to identify at-risk individuals in a population that they don't frequently see in the office, Dr. Burroughs said.

“There's an alarmingly low number of abnormal values which have been labeled as such on this examination, possibly due to a lack of awareness among practitioners about these tables and considerations,” he said.

Dr. Burroughs said he's spoken to a number of people who are unfamiliar with the guidelines for classifying blood pressure by age and height. Those familiar with the guidelines might find the process too time consuming, he said.

“We should be able to intervene for these people [by] including them in doing exercise programs, modifying their diet, before we have to get to the point of putting them on medication,” he said.

SAN FRANCISCO — Physicians may be failing to address abnormal blood pressure levels among adolescents, according to a study presented at the annual meeting of the American Academy of Family Physicians.

The study analyzed blood pressure levels recorded on preparticipation sports physicals for more than 1,500 adolescents. More than 13% of the adolescents had either a hypertensive systolic or hypertensive diastolic blood pressure level, but few were identified as abnormal or provided with follow-up interventions, according to Kevin E. Burroughs, M.D., of the University of North Carolina, who conducted the study.

“If anything, we should be able to use this information to help us out with trying to help decrease morbidity and mortality for these individuals,” Dr. Burroughs said.

His study looked at the preparticipation exams for 1,547 adolescents from three middle schools and three high schools in Cabarrus County, N.C., during the school years 2003–2004 and 2004–2005. He used guidelines from the National Heart Lung and Blood Institute's Working Task Force on Childhood Hypertension to classify the blood pressure by age and height.

As outlined in those guidelines, blood pressure values of greater than the 95th percentile for age, sex, and height were classified as child and adolescent hypertension. Those in the 90–95th percentile were high normal blood pressure and blood pressure values that fell below the 90th percentile were considered normal.

Overall, 7.4% (114) of the adolescents in the study had systolic blood pressure that would be considered hypertensive and 6.5% (100) of the adolescents had a hypertensive diastolic blood pressure. But only 14 of the adolescents with hypertensive values were labeled as such, Dr. Burroughs said, and only 11 were scheduled for any follow-up.

Though hypertension is not determined by a single reading, it offers physicians an opportunity to identify at-risk individuals in a population that they don't frequently see in the office, Dr. Burroughs said.

“There's an alarmingly low number of abnormal values which have been labeled as such on this examination, possibly due to a lack of awareness among practitioners about these tables and considerations,” he said.

Dr. Burroughs said he's spoken to a number of people who are unfamiliar with the guidelines for classifying blood pressure by age and height. Those familiar with the guidelines might find the process too time consuming, he said.

“We should be able to intervene for these people [by] including them in doing exercise programs, modifying their diet, before we have to get to the point of putting them on medication,” he said.

SAN FRANCISCO — Physicians may be failing to address abnormal blood pressure levels among adolescents, according to a study presented at the annual meeting of the American Academy of Family Physicians.

The study analyzed blood pressure levels recorded on preparticipation sports physicals for more than 1,500 adolescents. More than 13% of the adolescents had either a hypertensive systolic or hypertensive diastolic blood pressure level, but few were identified as abnormal or provided with follow-up interventions, according to Kevin E. Burroughs, M.D., of the University of North Carolina, who conducted the study.

“If anything, we should be able to use this information to help us out with trying to help decrease morbidity and mortality for these individuals,” Dr. Burroughs said.

His study looked at the preparticipation exams for 1,547 adolescents from three middle schools and three high schools in Cabarrus County, N.C., during the school years 2003–2004 and 2004–2005. He used guidelines from the National Heart Lung and Blood Institute's Working Task Force on Childhood Hypertension to classify the blood pressure by age and height.

As outlined in those guidelines, blood pressure values of greater than the 95th percentile for age, sex, and height were classified as child and adolescent hypertension. Those in the 90–95th percentile were high normal blood pressure and blood pressure values that fell below the 90th percentile were considered normal.

Overall, 7.4% (114) of the adolescents in the study had systolic blood pressure that would be considered hypertensive and 6.5% (100) of the adolescents had a hypertensive diastolic blood pressure. But only 14 of the adolescents with hypertensive values were labeled as such, Dr. Burroughs said, and only 11 were scheduled for any follow-up.

Though hypertension is not determined by a single reading, it offers physicians an opportunity to identify at-risk individuals in a population that they don't frequently see in the office, Dr. Burroughs said.

“There's an alarmingly low number of abnormal values which have been labeled as such on this examination, possibly due to a lack of awareness among practitioners about these tables and considerations,” he said.

Dr. Burroughs said he's spoken to a number of people who are unfamiliar with the guidelines for classifying blood pressure by age and height. Those familiar with the guidelines might find the process too time consuming, he said.

“We should be able to intervene for these people [by] including them in doing exercise programs, modifying their diet, before we have to get to the point of putting them on medication,” he said.

Officials at the Department of Health and Human Services have loosened restrictions on ownership of pharmaceutical and biotech company stocks for employees of the National Institutes of Health under a final rule on conflict of interest.

But the final regulation announced at a teleconference on NIH conflict of interest regulations continues to bar NIH employees from engaging in outside consulting relationships with industry.

NIH Director Elias A. Zerhouni, M.D., called the final regulation “stringent” despite the changes to stock ownership.

“We have worked hard with the Department of Health and Human Services and the Office of Government Ethics to try to come up with rules that first and foremost protect the integrity of NIH science and are balanced in terms of our ability to continue to attract and retain the best scientists and staff,” Dr. Zerhouni said.

Under the final rule, which became effective in August, about 200 NIH employees with senior decision-making authority and their families will be required to divest of all stock holdings in excess of $15,000 per company for organizations substantially affected by NIH decisions. The deadline for divestiture is Jan. 30, 2006.

About 6,000 individuals will be required to disclose more details about their financial holdings. The other approximately 12,000 employees won't be asked to specifically disclose stock holdings, according to Raynard S. Kington, M.D., NIH deputy director. Employees may have to divest stocks on a case by case basis if a potential conflict of interest is found.

This is a shift in the policy spelled out by NIH in February 2005 in the wake of a series of congressional hearings that exposed a number of potential conflicts of interest by NIH scientists.

Under the policy outlined earlier this year, about 6,000 top NIH employees would have been required to sell off all of their stock holdings in companies impacted by NIH decisions. And the remainder of NIH employees would have been subject to the $15,000 limit.

The changes are designed to target the requirements at employees who are making decisions on grants and studies, Dr. Zerhouni said, and to ease restrictions on employees who are unlikely to have conflicts. “It's impossible to have a one-size-fits-all approach,” he said.

The final regulation will also allow NIH employees more leeway to engage in outside activities with professional or scientific organizations, serve on data and safety monitoring boards, give grand rounds lectures, and perform scientific grant reviews. Under the earlier policy, these activities were prohibited, but they will now be allowed to go forward with prior approval and review by ethics officials.

The final rule continues to allow NIH scientists with prior approval to participate in compensated academic work such as teaching, writing textbooks, performing journal reviews or editing, and giving general lectures as part of continuing education programs. NIH employees can also practice medicine with prior approval.

But NIH held firm on its prohibition on relationships with pharmaceutical, biotechnology or medical device manufacturers, health care providers or insurers, and NIH grantee institutions.

Keeping in place the ban on these activities is the best way to maintain the integrity of the agency at this point in time, Dr. Zerhouni said. While some outside consulting activities hold value for NIH and the public, he said the agency currently has no way to distinguish between those positive interactions and others such as product marketing.

The changes were “right on target,” said Mary Woolley, president of Research!America. The stronger interim guidelines released in February were useful as a “cooling off period” and served as an opportunity to gather more information, she said. But the changes reflect the correct balance.

Ms. Woolley said the final regulation will serve as a benchmark for the research community.

But Sidney M. Wolfe, M.D., director of Public Citizen's Health Research Group said the changes weakened the agency's earlier attempts to get control of the problem of conflict of interest. Allowing NIH employees to participate in paid outside academic work, which frequently includes money from industry, is riddled with loopholes, he said.

The final rule does not impose restrictions on extramural scientists, but Dr. Zerhouni said it's important to have a broad dialogue about conflict of interest with the entire scientific community. “I think this is a debate that is way beyond that of NIH,” he said.

For more information on the NIHethics rules, visit ww.nih.gov/about/ethics_COI.htm

Officials at the Department of Health and Human Services have loosened restrictions on ownership of pharmaceutical and biotech company stocks for employees of the National Institutes of Health under a final rule on conflict of interest.

But the final regulation announced at a teleconference on NIH conflict of interest regulations continues to bar NIH employees from engaging in outside consulting relationships with industry.

NIH Director Elias A. Zerhouni, M.D., called the final regulation “stringent” despite the changes to stock ownership.

“We have worked hard with the Department of Health and Human Services and the Office of Government Ethics to try to come up with rules that first and foremost protect the integrity of NIH science and are balanced in terms of our ability to continue to attract and retain the best scientists and staff,” Dr. Zerhouni said.

Under the final rule, which became effective in August, about 200 NIH employees with senior decision-making authority and their families will be required to divest of all stock holdings in excess of $15,000 per company for organizations substantially affected by NIH decisions. The deadline for divestiture is Jan. 30, 2006.

About 6,000 individuals will be required to disclose more details about their financial holdings. The other approximately 12,000 employees won't be asked to specifically disclose stock holdings, according to Raynard S. Kington, M.D., NIH deputy director. Employees may have to divest stocks on a case by case basis if a potential conflict of interest is found.

This is a shift in the policy spelled out by NIH in February 2005 in the wake of a series of congressional hearings that exposed a number of potential conflicts of interest by NIH scientists.

Under the policy outlined earlier this year, about 6,000 top NIH employees would have been required to sell off all of their stock holdings in companies impacted by NIH decisions. And the remainder of NIH employees would have been subject to the $15,000 limit.

The changes are designed to target the requirements at employees who are making decisions on grants and studies, Dr. Zerhouni said, and to ease restrictions on employees who are unlikely to have conflicts. “It's impossible to have a one-size-fits-all approach,” he said.

The final regulation will also allow NIH employees more leeway to engage in outside activities with professional or scientific organizations, serve on data and safety monitoring boards, give grand rounds lectures, and perform scientific grant reviews. Under the earlier policy, these activities were prohibited, but they will now be allowed to go forward with prior approval and review by ethics officials.

The final rule continues to allow NIH scientists with prior approval to participate in compensated academic work such as teaching, writing textbooks, performing journal reviews or editing, and giving general lectures as part of continuing education programs. NIH employees can also practice medicine with prior approval.

But NIH held firm on its prohibition on relationships with pharmaceutical, biotechnology or medical device manufacturers, health care providers or insurers, and NIH grantee institutions.

Keeping in place the ban on these activities is the best way to maintain the integrity of the agency at this point in time, Dr. Zerhouni said. While some outside consulting activities hold value for NIH and the public, he said the agency currently has no way to distinguish between those positive interactions and others such as product marketing.

The changes were “right on target,” said Mary Woolley, president of Research!America. The stronger interim guidelines released in February were useful as a “cooling off period” and served as an opportunity to gather more information, she said. But the changes reflect the correct balance.

Ms. Woolley said the final regulation will serve as a benchmark for the research community.

But Sidney M. Wolfe, M.D., director of Public Citizen's Health Research Group said the changes weakened the agency's earlier attempts to get control of the problem of conflict of interest. Allowing NIH employees to participate in paid outside academic work, which frequently includes money from industry, is riddled with loopholes, he said.

The final rule does not impose restrictions on extramural scientists, but Dr. Zerhouni said it's important to have a broad dialogue about conflict of interest with the entire scientific community. “I think this is a debate that is way beyond that of NIH,” he said.

For more information on the NIHethics rules, visit ww.nih.gov/about/ethics_COI.htm

Officials at the Department of Health and Human Services have loosened restrictions on ownership of pharmaceutical and biotech company stocks for employees of the National Institutes of Health under a final rule on conflict of interest.

But the final regulation announced at a teleconference on NIH conflict of interest regulations continues to bar NIH employees from engaging in outside consulting relationships with industry.

NIH Director Elias A. Zerhouni, M.D., called the final regulation “stringent” despite the changes to stock ownership.

“We have worked hard with the Department of Health and Human Services and the Office of Government Ethics to try to come up with rules that first and foremost protect the integrity of NIH science and are balanced in terms of our ability to continue to attract and retain the best scientists and staff,” Dr. Zerhouni said.

Under the final rule, which became effective in August, about 200 NIH employees with senior decision-making authority and their families will be required to divest of all stock holdings in excess of $15,000 per company for organizations substantially affected by NIH decisions. The deadline for divestiture is Jan. 30, 2006.

About 6,000 individuals will be required to disclose more details about their financial holdings. The other approximately 12,000 employees won't be asked to specifically disclose stock holdings, according to Raynard S. Kington, M.D., NIH deputy director. Employees may have to divest stocks on a case by case basis if a potential conflict of interest is found.

This is a shift in the policy spelled out by NIH in February 2005 in the wake of a series of congressional hearings that exposed a number of potential conflicts of interest by NIH scientists.

Under the policy outlined earlier this year, about 6,000 top NIH employees would have been required to sell off all of their stock holdings in companies impacted by NIH decisions. And the remainder of NIH employees would have been subject to the $15,000 limit.

The changes are designed to target the requirements at employees who are making decisions on grants and studies, Dr. Zerhouni said, and to ease restrictions on employees who are unlikely to have conflicts. “It's impossible to have a one-size-fits-all approach,” he said.

The final regulation will also allow NIH employees more leeway to engage in outside activities with professional or scientific organizations, serve on data and safety monitoring boards, give grand rounds lectures, and perform scientific grant reviews. Under the earlier policy, these activities were prohibited, but they will now be allowed to go forward with prior approval and review by ethics officials.

The final rule continues to allow NIH scientists with prior approval to participate in compensated academic work such as teaching, writing textbooks, performing journal reviews or editing, and giving general lectures as part of continuing education programs. NIH employees can also practice medicine with prior approval.

But NIH held firm on its prohibition on relationships with pharmaceutical, biotechnology or medical device manufacturers, health care providers or insurers, and NIH grantee institutions.

Keeping in place the ban on these activities is the best way to maintain the integrity of the agency at this point in time, Dr. Zerhouni said. While some outside consulting activities hold value for NIH and the public, he said the agency currently has no way to distinguish between those positive interactions and others such as product marketing.

The changes were “right on target,” said Mary Woolley, president of Research!America. The stronger interim guidelines released in February were useful as a “cooling off period” and served as an opportunity to gather more information, she said. But the changes reflect the correct balance.

Ms. Woolley said the final regulation will serve as a benchmark for the research community.

But Sidney M. Wolfe, M.D., director of Public Citizen's Health Research Group said the changes weakened the agency's earlier attempts to get control of the problem of conflict of interest. Allowing NIH employees to participate in paid outside academic work, which frequently includes money from industry, is riddled with loopholes, he said.

The final rule does not impose restrictions on extramural scientists, but Dr. Zerhouni said it's important to have a broad dialogue about conflict of interest with the entire scientific community. “I think this is a debate that is way beyond that of NIH,” he said.

For more information on the NIHethics rules, visit ww.nih.gov/about/ethics_COI.htm

NASHVILLE, TENN. – The governor of Massachusetts is proposing to cover the uninsured in his state by creating lower-cost health insurance options and requiring individuals to obtain coverage.

This effort is aimed at providing affordable coverage for the 7% of Massachusetts residents–approximately 460,000 people–without health insurance, Amy Lischko, assistant commissioner of the Massachusetts Division of Health Care Finance and Policy, said at the annual conference of the National Academy for State Health Policy.

“We really feel like this is the year to get something done, and we're hopeful that parts at least of the governor's proposal will be moved on,” Ms. Lischko said.

This plan is one of a few proposals being considered by the state's legislature. Under the governor's plan, individuals would be required to have a minimum level of insurance or proof of their ability to pay for care on their tax return.

Those who do not comply could see a loss of their personal tax exemption and withholding of a portion or all of their income tax refund for deposit in a state personal health care expenditure account.

Individuals without coverage who use medical services would be required to pay, and there would be more up-front billing by providers. If patients are unable to pay, the provider may request payment from the state personal health care expenditure account. But policy makers are flexible on the details of how such an individual mandate would be enforced.

“This is the hard stuff,” Ms. Lischko said. “There's not going to be insurance police on the streets throwing people in jail that don't have health insurance.”

Coupled with the proposed individual insurance mandate, Gov. Mitt Romney (R) is also proposing to create two new low-cost health insurance options designed to appeal to the 7% of uninsured residents in the state.

But John McDonough, executive director of the advocacy group Health Care for All, noted there are a lot of unanswered questions about Gov. Romney's plan.

For example, there is no guarantee that private insurers will step up to offer the new insurance plans envisioned by the governor, Mr. McDonough said in an interview. Also unstated is whether there are sufficient existing funds in the health care safety net to pay for the subsidies required for low-income residents.

Mr. McDonough's group instead favors an approach that would require employers to offer health insurance or pay a fee to the state, as well as expanding Medicaid eligibility and offering subsidies to moderate-income workers.

One program–called Commonwealth Care–will be aimed at the approximately 204,000 uninsured residents who have incomes of more than 300% of the federal poverty level. The other coverage option–called Safety Net Care–is aimed at the 150,000 residents whose salaries are between 100% and 300% of the federal poverty level but who do not qualify for Medicaid.

The Commonwealth Care program tries to ease the burden of rising health care premiums that has hit some individuals and small businesses, Ms. Lischko said. The proposal would allow private insurers to offer new, more affordable health plans.

The proposal would reduce costs for individuals through pre-tax treatment of premiums and make it easier for businesses to offer insurance to their contractors and part-time workers by allowing employers to pay a smaller portion of the health insurance.

And Ms. Lischko said that state policymakers expect private insurers to sign on because it creates a new market for younger, healthier people.

The Commonwealth Care plan would include coverage for primary care, hospitalization, mental health, and prescription drugs. But the provider network would be limited and insurers would be able to apply for exemptions from the state's 27 mandated benefits.

“It's not a bare-bones package,” Ms. Lischko said. “But it does have a more defined provider network. We're asking the insurers to really tighten up these networks.”

The annual deductible for the plan would be between $250 and $1,000, and copayments would be moderate but somewhat higher than what is seen in the marketplace right now, Ms. Lischko said. And the monthly premium would be less than $200, compared with more than $350 a month in a standard small group.

It's been a balancing act, Ms. Lischko said, in figuring out how to make the plans attractive without incentivizing employers to drop coverage.

NASHVILLE, TENN. – The governor of Massachusetts is proposing to cover the uninsured in his state by creating lower-cost health insurance options and requiring individuals to obtain coverage.

This effort is aimed at providing affordable coverage for the 7% of Massachusetts residents–approximately 460,000 people–without health insurance, Amy Lischko, assistant commissioner of the Massachusetts Division of Health Care Finance and Policy, said at the annual conference of the National Academy for State Health Policy.

“We really feel like this is the year to get something done, and we're hopeful that parts at least of the governor's proposal will be moved on,” Ms. Lischko said.

This plan is one of a few proposals being considered by the state's legislature. Under the governor's plan, individuals would be required to have a minimum level of insurance or proof of their ability to pay for care on their tax return.

Those who do not comply could see a loss of their personal tax exemption and withholding of a portion or all of their income tax refund for deposit in a state personal health care expenditure account.

Individuals without coverage who use medical services would be required to pay, and there would be more up-front billing by providers. If patients are unable to pay, the provider may request payment from the state personal health care expenditure account. But policy makers are flexible on the details of how such an individual mandate would be enforced.

“This is the hard stuff,” Ms. Lischko said. “There's not going to be insurance police on the streets throwing people in jail that don't have health insurance.”

Coupled with the proposed individual insurance mandate, Gov. Mitt Romney (R) is also proposing to create two new low-cost health insurance options designed to appeal to the 7% of uninsured residents in the state.

But John McDonough, executive director of the advocacy group Health Care for All, noted there are a lot of unanswered questions about Gov. Romney's plan.

For example, there is no guarantee that private insurers will step up to offer the new insurance plans envisioned by the governor, Mr. McDonough said in an interview. Also unstated is whether there are sufficient existing funds in the health care safety net to pay for the subsidies required for low-income residents.

Mr. McDonough's group instead favors an approach that would require employers to offer health insurance or pay a fee to the state, as well as expanding Medicaid eligibility and offering subsidies to moderate-income workers.

One program–called Commonwealth Care–will be aimed at the approximately 204,000 uninsured residents who have incomes of more than 300% of the federal poverty level. The other coverage option–called Safety Net Care–is aimed at the 150,000 residents whose salaries are between 100% and 300% of the federal poverty level but who do not qualify for Medicaid.

The Commonwealth Care program tries to ease the burden of rising health care premiums that has hit some individuals and small businesses, Ms. Lischko said. The proposal would allow private insurers to offer new, more affordable health plans.

The proposal would reduce costs for individuals through pre-tax treatment of premiums and make it easier for businesses to offer insurance to their contractors and part-time workers by allowing employers to pay a smaller portion of the health insurance.

And Ms. Lischko said that state policymakers expect private insurers to sign on because it creates a new market for younger, healthier people.

The Commonwealth Care plan would include coverage for primary care, hospitalization, mental health, and prescription drugs. But the provider network would be limited and insurers would be able to apply for exemptions from the state's 27 mandated benefits.

“It's not a bare-bones package,” Ms. Lischko said. “But it does have a more defined provider network. We're asking the insurers to really tighten up these networks.”

The annual deductible for the plan would be between $250 and $1,000, and copayments would be moderate but somewhat higher than what is seen in the marketplace right now, Ms. Lischko said. And the monthly premium would be less than $200, compared with more than $350 a month in a standard small group.

It's been a balancing act, Ms. Lischko said, in figuring out how to make the plans attractive without incentivizing employers to drop coverage.

NASHVILLE, TENN. – The governor of Massachusetts is proposing to cover the uninsured in his state by creating lower-cost health insurance options and requiring individuals to obtain coverage.

This effort is aimed at providing affordable coverage for the 7% of Massachusetts residents–approximately 460,000 people–without health insurance, Amy Lischko, assistant commissioner of the Massachusetts Division of Health Care Finance and Policy, said at the annual conference of the National Academy for State Health Policy.

“We really feel like this is the year to get something done, and we're hopeful that parts at least of the governor's proposal will be moved on,” Ms. Lischko said.

This plan is one of a few proposals being considered by the state's legislature. Under the governor's plan, individuals would be required to have a minimum level of insurance or proof of their ability to pay for care on their tax return.

Those who do not comply could see a loss of their personal tax exemption and withholding of a portion or all of their income tax refund for deposit in a state personal health care expenditure account.

Individuals without coverage who use medical services would be required to pay, and there would be more up-front billing by providers. If patients are unable to pay, the provider may request payment from the state personal health care expenditure account. But policy makers are flexible on the details of how such an individual mandate would be enforced.

“This is the hard stuff,” Ms. Lischko said. “There's not going to be insurance police on the streets throwing people in jail that don't have health insurance.”

Coupled with the proposed individual insurance mandate, Gov. Mitt Romney (R) is also proposing to create two new low-cost health insurance options designed to appeal to the 7% of uninsured residents in the state.

But John McDonough, executive director of the advocacy group Health Care for All, noted there are a lot of unanswered questions about Gov. Romney's plan.

For example, there is no guarantee that private insurers will step up to offer the new insurance plans envisioned by the governor, Mr. McDonough said in an interview. Also unstated is whether there are sufficient existing funds in the health care safety net to pay for the subsidies required for low-income residents.

Mr. McDonough's group instead favors an approach that would require employers to offer health insurance or pay a fee to the state, as well as expanding Medicaid eligibility and offering subsidies to moderate-income workers.

One program–called Commonwealth Care–will be aimed at the approximately 204,000 uninsured residents who have incomes of more than 300% of the federal poverty level. The other coverage option–called Safety Net Care–is aimed at the 150,000 residents whose salaries are between 100% and 300% of the federal poverty level but who do not qualify for Medicaid.

The Commonwealth Care program tries to ease the burden of rising health care premiums that has hit some individuals and small businesses, Ms. Lischko said. The proposal would allow private insurers to offer new, more affordable health plans.

The proposal would reduce costs for individuals through pre-tax treatment of premiums and make it easier for businesses to offer insurance to their contractors and part-time workers by allowing employers to pay a smaller portion of the health insurance.

And Ms. Lischko said that state policymakers expect private insurers to sign on because it creates a new market for younger, healthier people.

The Commonwealth Care plan would include coverage for primary care, hospitalization, mental health, and prescription drugs. But the provider network would be limited and insurers would be able to apply for exemptions from the state's 27 mandated benefits.

“It's not a bare-bones package,” Ms. Lischko said. “But it does have a more defined provider network. We're asking the insurers to really tighten up these networks.”

The annual deductible for the plan would be between $250 and $1,000, and copayments would be moderate but somewhat higher than what is seen in the marketplace right now, Ms. Lischko said. And the monthly premium would be less than $200, compared with more than $350 a month in a standard small group.

It's been a balancing act, Ms. Lischko said, in figuring out how to make the plans attractive without incentivizing employers to drop coverage.

A broad coalition of public and private sector groups has launched a secure Web site where physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site, www.KatrinaHealth.org

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina–many with chronic health conditions.

“With access to [these records] physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association said during a telephone briefing to announce the launch of KatrinaHealth.org

Dr. Hill, a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said.

And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctor, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm.

At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic prescribing service provider.

On the Web site, physicians can obtain allergy information, view prescription history as well as drug interaction and therapeutic duplication reports, and query clinical pharmacology drug information. To ensure that only authorized physicians use the site, the American Medical Association is authenticating the identity and qualifications of every physician before they can use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password.

However, the sponsors of the site caution physicians not to rely too heavily on the information. The data may have errors of duplication or omission because it has been collected from multiple sources. For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site, although the information is being added on a rolling basis.

The KatrinaHealth.org

Regarding patients relocated as a result of the more recent Hurricane Rita, at press time Dr. Brailer's office was in discussions with local officials about whether they might want to use the site.

A broad coalition of public and private sector groups has launched a secure Web site where physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site, www.KatrinaHealth.org

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina–many with chronic health conditions.

“With access to [these records] physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association said during a telephone briefing to announce the launch of KatrinaHealth.org

Dr. Hill, a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said.

And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctor, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm.

At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic prescribing service provider.

On the Web site, physicians can obtain allergy information, view prescription history as well as drug interaction and therapeutic duplication reports, and query clinical pharmacology drug information. To ensure that only authorized physicians use the site, the American Medical Association is authenticating the identity and qualifications of every physician before they can use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password.

However, the sponsors of the site caution physicians not to rely too heavily on the information. The data may have errors of duplication or omission because it has been collected from multiple sources. For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site, although the information is being added on a rolling basis.

The KatrinaHealth.org

Regarding patients relocated as a result of the more recent Hurricane Rita, at press time Dr. Brailer's office was in discussions with local officials about whether they might want to use the site.

A broad coalition of public and private sector groups has launched a secure Web site where physicians and pharmacists can access medication histories for patients who were evacuated from their homes in the aftermath of Hurricane Katrina.

The Web site, www.KatrinaHealth.org

The effort is aimed at providing timely information to help physicians renew prescriptions, prescribe new medications, and coordinate care for the hundreds of thousands of people who have been displaced by Hurricane Katrina–many with chronic health conditions.

“With access to [these records] physicians I think can begin to piece together medical histories and avoid drug interactions and renew prescriptions that are vital to these patients' health,” J. Edward Hill, M.D., president of the American Medical Association said during a telephone briefing to announce the launch of KatrinaHealth.org

Dr. Hill, a family physician in Tupelo, Miss., had been working on the front lines of this disaster in a makeshift clinic in the days following the hurricane. That work made him aware of just how much health care information was missing on these patients, he said.

And the information only becomes more critical as patients are scattered across the country, far from their homes and regular doctor, he said.

The network of prescription data was initially tested at seven shelters in the Gulf Coast region. In late September, the information was made available nationwide.

The effort, which has been facilitated by the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology, also includes more than 150 organizations that helped to plan, test, and launch the site.

The information in the network comes from electronic databases from commercial pharmacies, government health insurance programs, private insurers, and pharmacy benefits managers in states affected by the storm.

At press time, the network contained more than 1 million patient records representing more than 7 million prescriptions, according to Kevin Hutchinson, president and CEO of SureScripts, an electronic prescribing service provider.

On the Web site, physicians can obtain allergy information, view prescription history as well as drug interaction and therapeutic duplication reports, and query clinical pharmacology drug information. To ensure that only authorized physicians use the site, the American Medical Association is authenticating the identity and qualifications of every physician before they can use the site.

Physicians who want access to the site can contact AMA's 24-hour Unified Service Center at 800-262-3211 to obtain a username and password.

However, the sponsors of the site caution physicians not to rely too heavily on the information. The data may have errors of duplication or omission because it has been collected from multiple sources. For privacy and security reasons, the site does not include information relating to some classes of drugs approved or commonly used to treat mental illness, chemical dependency, or HIV/AIDS.

And not all evacuees' information is available on the site, although the information is being added on a rolling basis.

The KatrinaHealth.org

Regarding patients relocated as a result of the more recent Hurricane Rita, at press time Dr. Brailer's office was in discussions with local officials about whether they might want to use the site.