Mary Ellen Schneider

Federal health officials called a press conference last month to try to restore public confidence in childhood vaccines despite the charge by some parents that there is a connection between the vaccines and autism.

Several autism advocacy groups rallied on Capitol Hill last month to protest the use of mercury-containing thimerosal in vaccines.

But CDC director Julie Gerberding, M.D., said the predominance of evidence doesn't show an association between thimerosal in vaccines and autism.

Thimerosal has been used in vaccines as a preservative. However, since 2001 all vaccines recommended for children age 6 years and younger have either had no thimerosal or have contained only trace amounts.

One exception is the inactivated influenza vaccine. However, a preservative-free version, which contains trace amounts of thimerosal, is available in limited supplies. FDA officials are working with vaccine manufacturers to increase the supply of those doses, said Murray M. Lumpkin, M.D., acting deputy commissioner for international and special programs at the Food and Drug Administration.

In addition, all new vaccines licensed since 1999 are free of thimerosal as a preservative. Dr. Lumpkin said.

Dr. Gerberding said government researchers will continue to look at whether the evidence supports a link between thimerosal and autism but said it's important for researchers, policy makers, and parents not to base decisions on “unproved hypotheses.”

“Today the best available science indicates to us that vaccines save lives,” she said.

Researchers are trying to get an estimate of the prevalence of autism in children, and Dr. Gerberding said some of that data will be available next year.

In addition, researchers with the National Institutes of Health are investigating the risk factors and biological markers for autism.

“We need a war on autism, not a war on childhood vaccines,” said Peter Hotez, M.D., chair of the department of microbiology and tropical medicine at George Washington University, Washington, and the father of an autistic child.

Dr. Hotez said he is confident that vaccines have nothing to do with his daughter's autism, and if he could turn back time he would still give his daughter the full complement of vaccines. Instead, he said that parents should be reminded of the consequences of not vaccinating their children. And attention should shift from unfounded claims about vaccines to the need for respite care and other services for families with autistic children. Dr. Hotez also called for more research into the cause of autism and genetic testing for the disease.

Federal health officials called a press conference last month to try to restore public confidence in childhood vaccines despite the charge by some parents that there is a connection between the vaccines and autism.

Several autism advocacy groups rallied on Capitol Hill last month to protest the use of mercury-containing thimerosal in vaccines.

But CDC director Julie Gerberding, M.D., said the predominance of evidence doesn't show an association between thimerosal in vaccines and autism.

Thimerosal has been used in vaccines as a preservative. However, since 2001 all vaccines recommended for children age 6 years and younger have either had no thimerosal or have contained only trace amounts.

One exception is the inactivated influenza vaccine. However, a preservative-free version, which contains trace amounts of thimerosal, is available in limited supplies. FDA officials are working with vaccine manufacturers to increase the supply of those doses, said Murray M. Lumpkin, M.D., acting deputy commissioner for international and special programs at the Food and Drug Administration.

In addition, all new vaccines licensed since 1999 are free of thimerosal as a preservative. Dr. Lumpkin said.

Dr. Gerberding said government researchers will continue to look at whether the evidence supports a link between thimerosal and autism but said it's important for researchers, policy makers, and parents not to base decisions on “unproved hypotheses.”

“Today the best available science indicates to us that vaccines save lives,” she said.

Researchers are trying to get an estimate of the prevalence of autism in children, and Dr. Gerberding said some of that data will be available next year.

In addition, researchers with the National Institutes of Health are investigating the risk factors and biological markers for autism.

“We need a war on autism, not a war on childhood vaccines,” said Peter Hotez, M.D., chair of the department of microbiology and tropical medicine at George Washington University, Washington, and the father of an autistic child.

Dr. Hotez said he is confident that vaccines have nothing to do with his daughter's autism, and if he could turn back time he would still give his daughter the full complement of vaccines. Instead, he said that parents should be reminded of the consequences of not vaccinating their children. And attention should shift from unfounded claims about vaccines to the need for respite care and other services for families with autistic children. Dr. Hotez also called for more research into the cause of autism and genetic testing for the disease.

Federal health officials called a press conference last month to try to restore public confidence in childhood vaccines despite the charge by some parents that there is a connection between the vaccines and autism.

Several autism advocacy groups rallied on Capitol Hill last month to protest the use of mercury-containing thimerosal in vaccines.

But CDC director Julie Gerberding, M.D., said the predominance of evidence doesn't show an association between thimerosal in vaccines and autism.

Thimerosal has been used in vaccines as a preservative. However, since 2001 all vaccines recommended for children age 6 years and younger have either had no thimerosal or have contained only trace amounts.

One exception is the inactivated influenza vaccine. However, a preservative-free version, which contains trace amounts of thimerosal, is available in limited supplies. FDA officials are working with vaccine manufacturers to increase the supply of those doses, said Murray M. Lumpkin, M.D., acting deputy commissioner for international and special programs at the Food and Drug Administration.

In addition, all new vaccines licensed since 1999 are free of thimerosal as a preservative. Dr. Lumpkin said.

Dr. Gerberding said government researchers will continue to look at whether the evidence supports a link between thimerosal and autism but said it's important for researchers, policy makers, and parents not to base decisions on “unproved hypotheses.”

“Today the best available science indicates to us that vaccines save lives,” she said.

Researchers are trying to get an estimate of the prevalence of autism in children, and Dr. Gerberding said some of that data will be available next year.

In addition, researchers with the National Institutes of Health are investigating the risk factors and biological markers for autism.

“We need a war on autism, not a war on childhood vaccines,” said Peter Hotez, M.D., chair of the department of microbiology and tropical medicine at George Washington University, Washington, and the father of an autistic child.

Dr. Hotez said he is confident that vaccines have nothing to do with his daughter's autism, and if he could turn back time he would still give his daughter the full complement of vaccines. Instead, he said that parents should be reminded of the consequences of not vaccinating their children. And attention should shift from unfounded claims about vaccines to the need for respite care and other services for families with autistic children. Dr. Hotez also called for more research into the cause of autism and genetic testing for the disease.

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

The recommendations from the AMIA work group include:

Readiness Assessment

▸ Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

▸ Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

▸ Let everyone in the organization know this is a business transformation process, not an IT project.

▸ Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

▸ Determine the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

▸ Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

▸ Figure out the organization-wide goals and objectives to determine EHR needs.

▸ Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

▸ Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selection tool that is available at

www.ehrselector.com

Writing an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

▸ Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

▸ Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

▸ Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

▸ Involve all clinical disciplines in RFP development.

▸ Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

▸ Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list; seek out independent sources, the work group reported.

▸ Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

▸ In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around the scripted process.

▸ Make scoring simple and explicit.

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

The recommendations from the AMIA work group include:

Readiness Assessment

▸ Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

▸ Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

▸ Let everyone in the organization know this is a business transformation process, not an IT project.

▸ Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

▸ Determine the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

▸ Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

▸ Figure out the organization-wide goals and objectives to determine EHR needs.

▸ Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

▸ Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selection tool that is available at

www.ehrselector.com

Writing an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

▸ Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

▸ Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

▸ Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

▸ Involve all clinical disciplines in RFP development.

▸ Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

▸ Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list; seek out independent sources, the work group reported.

▸ Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

▸ In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around the scripted process.

▸ Make scoring simple and explicit.

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

The recommendations from the AMIA work group include:

Readiness Assessment

▸ Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

▸ Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

▸ Let everyone in the organization know this is a business transformation process, not an IT project.

▸ Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

▸ Determine the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

▸ Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

▸ Figure out the organization-wide goals and objectives to determine EHR needs.

▸ Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

▸ Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selection tool that is available at

www.ehrselector.com

Writing an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

▸ Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

▸ Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

▸ Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

▸ Involve all clinical disciplines in RFP development.

▸ Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

▸ Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list; seek out independent sources, the work group reported.

▸ Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

▸ In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around the scripted process.

▸ Make scoring simple and explicit.

The Health Information Technology Leadership Panel report is available online at www.hhs.gov/healthit/HITFinalReport.pdf

The federal government should use incentives–not unfunded mandates–to accelerate the adoption of health information technology, according to a panel of corporate executives.

And the government should coordinate the use of interoperable health information technology (IT) systems among its own agencies, the panel said.

The Health Information Technology Leadership Panel is made up of executives from companies that purchase a substantial amount of health care for their employees but have little direct involvement in the health care or IT sectors.

The panel was convened by the Department of Health and Human Services late last year to gather ideas about how IT has been successfully adopted in other sectors and how that could be applied to the health care arena.

“The leadership panel asked the federal government to approach health care in a new way–as a catalyst for change and as a collaborator,” David J. Brailer, M.D., national coordinator for health information technology said in a statement.

The government should be looking for ways to help finance physician adoption of health IT and to allow providers to reap the benefits of the systems, the panel said.

The panel also recommended that the government be involved in promoting the development and adoption of health IT standards, as well as funding demonstrations and evaluations to learn implementation lessons and to disseminate best practices.

Private sector involvement should include the support of leading business organizations such as the National Business Group on Health and the Business Roundtable. This type of private sector involvement would result in wide public and political support for the adoption of health IT, the panel said.

Underinvesting in health IT could cause existing problems within the health care system to worsen, said Michael S. Barr, M.D., vice president for practice advocacy and improvement at the American College of Physicians.

Overall, the panel's conclusions support the message that the ACP and other groups have been trying to communicate, that the system-wide savings from implementing health IT exceed the costs. However, the report also notes that one of the challenges to adoption is that, currently, individual physicians assume the cost of IT without reaping the full savings.

“There are no surprises in the report,” said Mark Leavitt, M.D., medical director for the Healthcare Information and Management Systems Society.

However, the panel's findings help to reinforce that incentives are a big part of the effort to spur health IT adoption. And the report also points out that the health care industry is lagging behind other sectors in its adoption of IT, he said.

The report outlines an appropriate, but limited, role for the federal government, said Dr. Leavitt, who is also the chair of the Certification Commission for Healthcare Information–a voluntary, private-sector initiative to certify health information technology products.

The federal government has a role in articulating a vision for health IT adoption and using its purchasing power to accelerate that adoption, Dr. Leavitt said. But federal officials should not overregulate the area or try to dictate the specific elements of IT systems, he said.

The government should steer clear of acting too quickly in certain areas, such as mandating untested standards, said David C. Kibbe, M.D., director of the Center for Health Information Technology at the American Academy of Family Physicians.

But the government does have a role to play by finding new money to help physician practices adopt electronic health records, Dr. Kibbe said. And federal officials should consider changes to the current physician payment system to reimburse primary care physicians adequately, he said.

In the meantime, officials at the AAFP have been trying to help physicians adopt the technology by working with EHR vendors to make the hardware and software more affordable.

AAFP has also been active in encouraging IT developers to work on interoperability options for EHRs. And they have been involved in efforts to bring about a national standard for reporting lab results to EHRs.

And the attention to health IT has been paying off. Dr. Kibbe said that he has seen new products and new vendors coming to the marketplace, and the number of practices adopting EHRs continues to climb. Some estimates now put the percentage of physician practices that have adopted EHRs at 25%, and Dr. Kibbe said he estimates that an additional 30% are strongly considering it.

“The train has left the station,” Dr. Kibbe said. “It's unstoppable at this point. We're past the point where the use of EHRs in family medicine is a questionable transition.”

The Health Information Technology Leadership Panel report is available online at www.hhs.gov/healthit/HITFinalReport.pdf

The federal government should use incentives–not unfunded mandates–to accelerate the adoption of health information technology, according to a panel of corporate executives.

And the government should coordinate the use of interoperable health information technology (IT) systems among its own agencies, the panel said.

The Health Information Technology Leadership Panel is made up of executives from companies that purchase a substantial amount of health care for their employees but have little direct involvement in the health care or IT sectors.

The panel was convened by the Department of Health and Human Services late last year to gather ideas about how IT has been successfully adopted in other sectors and how that could be applied to the health care arena.

“The leadership panel asked the federal government to approach health care in a new way–as a catalyst for change and as a collaborator,” David J. Brailer, M.D., national coordinator for health information technology said in a statement.

The government should be looking for ways to help finance physician adoption of health IT and to allow providers to reap the benefits of the systems, the panel said.

The panel also recommended that the government be involved in promoting the development and adoption of health IT standards, as well as funding demonstrations and evaluations to learn implementation lessons and to disseminate best practices.

Private sector involvement should include the support of leading business organizations such as the National Business Group on Health and the Business Roundtable. This type of private sector involvement would result in wide public and political support for the adoption of health IT, the panel said.

Underinvesting in health IT could cause existing problems within the health care system to worsen, said Michael S. Barr, M.D., vice president for practice advocacy and improvement at the American College of Physicians.

Overall, the panel's conclusions support the message that the ACP and other groups have been trying to communicate, that the system-wide savings from implementing health IT exceed the costs. However, the report also notes that one of the challenges to adoption is that, currently, individual physicians assume the cost of IT without reaping the full savings.

“There are no surprises in the report,” said Mark Leavitt, M.D., medical director for the Healthcare Information and Management Systems Society.

However, the panel's findings help to reinforce that incentives are a big part of the effort to spur health IT adoption. And the report also points out that the health care industry is lagging behind other sectors in its adoption of IT, he said.

The report outlines an appropriate, but limited, role for the federal government, said Dr. Leavitt, who is also the chair of the Certification Commission for Healthcare Information–a voluntary, private-sector initiative to certify health information technology products.

The federal government has a role in articulating a vision for health IT adoption and using its purchasing power to accelerate that adoption, Dr. Leavitt said. But federal officials should not overregulate the area or try to dictate the specific elements of IT systems, he said.

The government should steer clear of acting too quickly in certain areas, such as mandating untested standards, said David C. Kibbe, M.D., director of the Center for Health Information Technology at the American Academy of Family Physicians.

But the government does have a role to play by finding new money to help physician practices adopt electronic health records, Dr. Kibbe said. And federal officials should consider changes to the current physician payment system to reimburse primary care physicians adequately, he said.

In the meantime, officials at the AAFP have been trying to help physicians adopt the technology by working with EHR vendors to make the hardware and software more affordable.

AAFP has also been active in encouraging IT developers to work on interoperability options for EHRs. And they have been involved in efforts to bring about a national standard for reporting lab results to EHRs.

And the attention to health IT has been paying off. Dr. Kibbe said that he has seen new products and new vendors coming to the marketplace, and the number of practices adopting EHRs continues to climb. Some estimates now put the percentage of physician practices that have adopted EHRs at 25%, and Dr. Kibbe said he estimates that an additional 30% are strongly considering it.

“The train has left the station,” Dr. Kibbe said. “It's unstoppable at this point. We're past the point where the use of EHRs in family medicine is a questionable transition.”

The Health Information Technology Leadership Panel report is available online at www.hhs.gov/healthit/HITFinalReport.pdf

The federal government should use incentives–not unfunded mandates–to accelerate the adoption of health information technology, according to a panel of corporate executives.

And the government should coordinate the use of interoperable health information technology (IT) systems among its own agencies, the panel said.

The Health Information Technology Leadership Panel is made up of executives from companies that purchase a substantial amount of health care for their employees but have little direct involvement in the health care or IT sectors.

The panel was convened by the Department of Health and Human Services late last year to gather ideas about how IT has been successfully adopted in other sectors and how that could be applied to the health care arena.

“The leadership panel asked the federal government to approach health care in a new way–as a catalyst for change and as a collaborator,” David J. Brailer, M.D., national coordinator for health information technology said in a statement.

The government should be looking for ways to help finance physician adoption of health IT and to allow providers to reap the benefits of the systems, the panel said.

The panel also recommended that the government be involved in promoting the development and adoption of health IT standards, as well as funding demonstrations and evaluations to learn implementation lessons and to disseminate best practices.

Private sector involvement should include the support of leading business organizations such as the National Business Group on Health and the Business Roundtable. This type of private sector involvement would result in wide public and political support for the adoption of health IT, the panel said.

Underinvesting in health IT could cause existing problems within the health care system to worsen, said Michael S. Barr, M.D., vice president for practice advocacy and improvement at the American College of Physicians.

Overall, the panel's conclusions support the message that the ACP and other groups have been trying to communicate, that the system-wide savings from implementing health IT exceed the costs. However, the report also notes that one of the challenges to adoption is that, currently, individual physicians assume the cost of IT without reaping the full savings.

“There are no surprises in the report,” said Mark Leavitt, M.D., medical director for the Healthcare Information and Management Systems Society.

However, the panel's findings help to reinforce that incentives are a big part of the effort to spur health IT adoption. And the report also points out that the health care industry is lagging behind other sectors in its adoption of IT, he said.

The report outlines an appropriate, but limited, role for the federal government, said Dr. Leavitt, who is also the chair of the Certification Commission for Healthcare Information–a voluntary, private-sector initiative to certify health information technology products.

The federal government has a role in articulating a vision for health IT adoption and using its purchasing power to accelerate that adoption, Dr. Leavitt said. But federal officials should not overregulate the area or try to dictate the specific elements of IT systems, he said.

The government should steer clear of acting too quickly in certain areas, such as mandating untested standards, said David C. Kibbe, M.D., director of the Center for Health Information Technology at the American Academy of Family Physicians.

But the government does have a role to play by finding new money to help physician practices adopt electronic health records, Dr. Kibbe said. And federal officials should consider changes to the current physician payment system to reimburse primary care physicians adequately, he said.

In the meantime, officials at the AAFP have been trying to help physicians adopt the technology by working with EHR vendors to make the hardware and software more affordable.

AAFP has also been active in encouraging IT developers to work on interoperability options for EHRs. And they have been involved in efforts to bring about a national standard for reporting lab results to EHRs.

And the attention to health IT has been paying off. Dr. Kibbe said that he has seen new products and new vendors coming to the marketplace, and the number of practices adopting EHRs continues to climb. Some estimates now put the percentage of physician practices that have adopted EHRs at 25%, and Dr. Kibbe said he estimates that an additional 30% are strongly considering it.

“The train has left the station,” Dr. Kibbe said. “It's unstoppable at this point. We're past the point where the use of EHRs in family medicine is a questionable transition.”

ATLANTA – Psychiatrists treating depression associated with an acute coronary event should look to severity of a depressive episode, recurrence of major depression, and the onset of depression prior to hospitalization as predictors of drug benefit.

Most clinicians will typically consider severity in evaluating whether to treat depressed patients, but prior episodes of depression and the timing of the onset of the present episode are also important factors in assessing the possible success of drug treatment, Alexander H. Glassman, M.D., said at the annual meeting of the American Psychiatric Association.

These “two historic considerations, [which] most clinicians never use in deciding who to treat, have a very strong impact on who's going to have a drug response,” said Dr. Glassman, who is professor of clinical psychiatry at Columbia University, New York.

Even without proof of reduced mortality, depression associated with an acute coronary event can be safely and effectively treated, he said.

Dr. Glassman pointed to the results from the Sertraline Antidepressant Heart Attack Randomized Trial (SADHART), which looked at the effects of sertraline versus placebo in patients who suffered from depression that was associated with acute MI or unstable angina (JAMA 2002;288:701–9).

Dr. Glassman was a member of the steering committee for SADHART and has been a consultant for Pfizer, which markets sertraline (Zoloft).

The trial included 369 patients who were given a 2-week single-blind placebo run-in and then randomly assigned to receive sertraline or placebo for 24 weeks.

The patients selected for SADHART were not seeking psychiatric treatment and, as a result, the sample had much milder depression and depressive episodes that were shorter than would normally be expected in a typical drug trial.

The effect of the drug was modest in the overall sample, but for those patients with recurrent depression–about half of the sample–the results were dramatically different, Dr. Glassman said at the meeting.

Of those patients with no prior episodes of depression, about 59% responded to the drug, compared with 55% on placebo.

In the case of patients with any recurrent depression, however, there was a very real difference, with 72% getting better on the drug versus 51% on placebo.

The SADHART study also showed that more than half of the cases of depression began before hospitalization for the coronary event. Of those patients whose depression began before hospitalization, 93% began more than a month before and could have contributed to the heart attack, Dr. Glassman said.

Similarly, the time of onset was also a predictor of drug response. The SADHART study showed that, of those patients who had depression onset in the hospital, there was no drug-placebo difference.

In the group with earlier onset of depression, though, 63% responded to the drug, compared with 46% on placebo, he said.

When the patient had both prior history of depression and onset before hospitalization, the drug was effective in 73% of patients, compared with 43% for placebo.

Even though the evidence that depression is a risk factor for cardiovascular events is overwhelming, specialists outside of psychiatry have been slow to pick it up.

Academic institutions are just beginning to recognize it as a risk factor, and in the general community hospital setting, recognition is poor, Dr. Glassman said.

There is more to the story, however: Those in other areas of medicine may be overlooking depression, but psychiatrists generally don't ask patients about their medical risk factors, he said.

“We see patients in our office all the time who are depressed, and I'll bet that the majority of people in this room can't tell if all their patients are smokers or not,” Dr. Glassman said.

ATLANTA – Psychiatrists treating depression associated with an acute coronary event should look to severity of a depressive episode, recurrence of major depression, and the onset of depression prior to hospitalization as predictors of drug benefit.

Most clinicians will typically consider severity in evaluating whether to treat depressed patients, but prior episodes of depression and the timing of the onset of the present episode are also important factors in assessing the possible success of drug treatment, Alexander H. Glassman, M.D., said at the annual meeting of the American Psychiatric Association.

These “two historic considerations, [which] most clinicians never use in deciding who to treat, have a very strong impact on who's going to have a drug response,” said Dr. Glassman, who is professor of clinical psychiatry at Columbia University, New York.

Even without proof of reduced mortality, depression associated with an acute coronary event can be safely and effectively treated, he said.

Dr. Glassman pointed to the results from the Sertraline Antidepressant Heart Attack Randomized Trial (SADHART), which looked at the effects of sertraline versus placebo in patients who suffered from depression that was associated with acute MI or unstable angina (JAMA 2002;288:701–9).

Dr. Glassman was a member of the steering committee for SADHART and has been a consultant for Pfizer, which markets sertraline (Zoloft).

The trial included 369 patients who were given a 2-week single-blind placebo run-in and then randomly assigned to receive sertraline or placebo for 24 weeks.

The patients selected for SADHART were not seeking psychiatric treatment and, as a result, the sample had much milder depression and depressive episodes that were shorter than would normally be expected in a typical drug trial.

The effect of the drug was modest in the overall sample, but for those patients with recurrent depression–about half of the sample–the results were dramatically different, Dr. Glassman said at the meeting.

Of those patients with no prior episodes of depression, about 59% responded to the drug, compared with 55% on placebo.

In the case of patients with any recurrent depression, however, there was a very real difference, with 72% getting better on the drug versus 51% on placebo.

The SADHART study also showed that more than half of the cases of depression began before hospitalization for the coronary event. Of those patients whose depression began before hospitalization, 93% began more than a month before and could have contributed to the heart attack, Dr. Glassman said.

Similarly, the time of onset was also a predictor of drug response. The SADHART study showed that, of those patients who had depression onset in the hospital, there was no drug-placebo difference.

In the group with earlier onset of depression, though, 63% responded to the drug, compared with 46% on placebo, he said.

When the patient had both prior history of depression and onset before hospitalization, the drug was effective in 73% of patients, compared with 43% for placebo.

Even though the evidence that depression is a risk factor for cardiovascular events is overwhelming, specialists outside of psychiatry have been slow to pick it up.

Academic institutions are just beginning to recognize it as a risk factor, and in the general community hospital setting, recognition is poor, Dr. Glassman said.

There is more to the story, however: Those in other areas of medicine may be overlooking depression, but psychiatrists generally don't ask patients about their medical risk factors, he said.

“We see patients in our office all the time who are depressed, and I'll bet that the majority of people in this room can't tell if all their patients are smokers or not,” Dr. Glassman said.

ATLANTA – Psychiatrists treating depression associated with an acute coronary event should look to severity of a depressive episode, recurrence of major depression, and the onset of depression prior to hospitalization as predictors of drug benefit.

Most clinicians will typically consider severity in evaluating whether to treat depressed patients, but prior episodes of depression and the timing of the onset of the present episode are also important factors in assessing the possible success of drug treatment, Alexander H. Glassman, M.D., said at the annual meeting of the American Psychiatric Association.

These “two historic considerations, [which] most clinicians never use in deciding who to treat, have a very strong impact on who's going to have a drug response,” said Dr. Glassman, who is professor of clinical psychiatry at Columbia University, New York.

Even without proof of reduced mortality, depression associated with an acute coronary event can be safely and effectively treated, he said.

Dr. Glassman pointed to the results from the Sertraline Antidepressant Heart Attack Randomized Trial (SADHART), which looked at the effects of sertraline versus placebo in patients who suffered from depression that was associated with acute MI or unstable angina (JAMA 2002;288:701–9).

Dr. Glassman was a member of the steering committee for SADHART and has been a consultant for Pfizer, which markets sertraline (Zoloft).

The trial included 369 patients who were given a 2-week single-blind placebo run-in and then randomly assigned to receive sertraline or placebo for 24 weeks.

The patients selected for SADHART were not seeking psychiatric treatment and, as a result, the sample had much milder depression and depressive episodes that were shorter than would normally be expected in a typical drug trial.

The effect of the drug was modest in the overall sample, but for those patients with recurrent depression–about half of the sample–the results were dramatically different, Dr. Glassman said at the meeting.

Of those patients with no prior episodes of depression, about 59% responded to the drug, compared with 55% on placebo.

In the case of patients with any recurrent depression, however, there was a very real difference, with 72% getting better on the drug versus 51% on placebo.

The SADHART study also showed that more than half of the cases of depression began before hospitalization for the coronary event. Of those patients whose depression began before hospitalization, 93% began more than a month before and could have contributed to the heart attack, Dr. Glassman said.

Similarly, the time of onset was also a predictor of drug response. The SADHART study showed that, of those patients who had depression onset in the hospital, there was no drug-placebo difference.

In the group with earlier onset of depression, though, 63% responded to the drug, compared with 46% on placebo, he said.

When the patient had both prior history of depression and onset before hospitalization, the drug was effective in 73% of patients, compared with 43% for placebo.

Even though the evidence that depression is a risk factor for cardiovascular events is overwhelming, specialists outside of psychiatry have been slow to pick it up.

Academic institutions are just beginning to recognize it as a risk factor, and in the general community hospital setting, recognition is poor, Dr. Glassman said.

There is more to the story, however: Those in other areas of medicine may be overlooking depression, but psychiatrists generally don't ask patients about their medical risk factors, he said.

“We see patients in our office all the time who are depressed, and I'll bet that the majority of people in this room can't tell if all their patients are smokers or not,” Dr. Glassman said.

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

Here are some of the recommendations from the AMIA work group:

Readiness Assessment

▸ Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

▸ Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

▸ Let everyone in the organization know this is a business transformation process, not an IT project.

▸ Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

▸ Assess the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

▸ Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

▸ Figure out the organization-wide goals and objectives to determine EHR needs.

▸ Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

▸ Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selector at

www.ehrselector.com

How to Write an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

▸ Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

▸ Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

▸ Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

▸ Involve all clinical disciplines in RFP development.

▸ Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

▸ Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list, seek out independent sources, the work group reported.

▸ Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

▸ In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around some the lack of transparency in a the scripted process.

▸ Make scoring simple and explicit.

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

Here are some of the recommendations from the AMIA work group:

Readiness Assessment

▸ Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

▸ Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

▸ Let everyone in the organization know this is a business transformation process, not an IT project.

▸ Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

▸ Assess the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

▸ Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

▸ Figure out the organization-wide goals and objectives to determine EHR needs.

▸ Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

▸ Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selector at

www.ehrselector.com

How to Write an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

▸ Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

▸ Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

▸ Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

▸ Involve all clinical disciplines in RFP development.

▸ Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

▸ Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list, seek out independent sources, the work group reported.

▸ Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

▸ In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around some the lack of transparency in a the scripted process.

▸ Make scoring simple and explicit.

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

Here are some of the recommendations from the AMIA work group:

Readiness Assessment

▸ Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

▸ Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

▸ Let everyone in the organization know this is a business transformation process, not an IT project.

▸ Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

▸ Assess the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

▸ Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

▸ Figure out the organization-wide goals and objectives to determine EHR needs.

▸ Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

▸ Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selector at

www.ehrselector.com

How to Write an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

▸ Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

▸ Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

▸ Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

▸ Involve all clinical disciplines in RFP development.

▸ Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

▸ Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list, seek out independent sources, the work group reported.

▸ Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

▸ In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around some the lack of transparency in a the scripted process.

▸ Make scoring simple and explicit.

Officials at the Department of Health and Human Services are trying to encourage enforcement of a 2002 law that defines any live birth as a person.

The agency issued guidance in April that withholding medical care from an infant born alive may constitute a violation of the federal Emergency Medical Treatment and Labor Act (EMTALA) and the Medicare Conditions of Participation.

Officials also notified state agencies that receive grants under the Child Abuse Prevention and Treatment Act that they must have procedures in place to respond to any reports of medical neglect of “born-alive infants.”

The Born-Alive Infants Protection Act, which was enacted in August 2002, establishes a definition of the terms “individual,” “person,” “human being,” or “child” as any infant who is born alive, at any stage of development.

The federal law (P.L. 107–207) states that “born alive,” with respect to a member of the species Homo sapiens, means the “complete expulsion or extraction from his or her mother of that member, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion.”

But the law doesn't mean much medically, according to David Grimes, M.D., an ob.gyn. in Chapel Hill, N.C., and the former chief of the abortion surveillance branch at the Centers for Disease Control and Prevention. “The medical impact is negligible,” Dr. Grimes said.

If the law is followed to the letter, he said, it will classify more miscarriages as live births and ultimately infant deaths, giving the United States a statistically worse infant mortality.

The American College of Obstetricians and Gynecologists issued an opinion at the time the law was enacted, saying that the statute did not require physicians to make changes to the standard of care.

“The act does not dictate the standard of care to be given to premature infants. It merely provides a definition and does not impose any requirements, restrictions, or penalties,” Ralph W. Hale, M.D., ACOG's executive vice president, said in a message to the membership in 2002. “Fellows should be familiar with their states' laws and should consult their local attorneys if they have any questions,” he said.

HHS decided to issued the guidance—nearly 3 years after the enactment of the law—because the department recently received several questions about whether it was planning to issue regulations to implement the law, HHS Secretary Mike Leavitt said in a statement. However, the department would not release information on whether any violations had occurred.

In its guidance, HHS said there are some circumstances where EMTALA protections can be applied to an infant who is born alive under the law.

For example, if an infant were born alive, under the definition in the law, at the hospital, and a prudent layperson could conclude that the infant was suffering from an emergency medical condition based on appearance or behavior, the hospital and medical staff would be required to perform a medical screening.

If an emergency condition existed, the staff would be obligated under EMTALA to either admit the infant or stabilize and transfer him or her. Under EMTALA, each violation can cost a physician up to $50,000.

David W. Hager, M.D., an ob.gyn. in Lexington, Ky., and a member of the Christian Medical Association, agrees that the majority of physicians have been adhering to the law. However, he said, it's important to ensure that it is being implemented across the board, even in cases where the live birth is the result of an abortion. And all physicians need to be aware of their responsibilities under the law to screen infants who are born alive, and to stabilize and transfer them when appropriate, he said.

But Vicki Saporta, president and CEO of the National Abortion Federation, said the 2002 law seems unnecessary since physicians were and are abiding by state and federal laws that protect the legal rights of infants from birth.

Officials at the Department of Health and Human Services are trying to encourage enforcement of a 2002 law that defines any live birth as a person.

The agency issued guidance in April that withholding medical care from an infant born alive may constitute a violation of the federal Emergency Medical Treatment and Labor Act (EMTALA) and the Medicare Conditions of Participation.

Officials also notified state agencies that receive grants under the Child Abuse Prevention and Treatment Act that they must have procedures in place to respond to any reports of medical neglect of “born-alive infants.”

The Born-Alive Infants Protection Act, which was enacted in August 2002, establishes a definition of the terms “individual,” “person,” “human being,” or “child” as any infant who is born alive, at any stage of development.

The federal law (P.L. 107–207) states that “born alive,” with respect to a member of the species Homo sapiens, means the “complete expulsion or extraction from his or her mother of that member, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion.”

But the law doesn't mean much medically, according to David Grimes, M.D., an ob.gyn. in Chapel Hill, N.C., and the former chief of the abortion surveillance branch at the Centers for Disease Control and Prevention. “The medical impact is negligible,” Dr. Grimes said.

If the law is followed to the letter, he said, it will classify more miscarriages as live births and ultimately infant deaths, giving the United States a statistically worse infant mortality.

The American College of Obstetricians and Gynecologists issued an opinion at the time the law was enacted, saying that the statute did not require physicians to make changes to the standard of care.

“The act does not dictate the standard of care to be given to premature infants. It merely provides a definition and does not impose any requirements, restrictions, or penalties,” Ralph W. Hale, M.D., ACOG's executive vice president, said in a message to the membership in 2002. “Fellows should be familiar with their states' laws and should consult their local attorneys if they have any questions,” he said.

HHS decided to issued the guidance—nearly 3 years after the enactment of the law—because the department recently received several questions about whether it was planning to issue regulations to implement the law, HHS Secretary Mike Leavitt said in a statement. However, the department would not release information on whether any violations had occurred.

In its guidance, HHS said there are some circumstances where EMTALA protections can be applied to an infant who is born alive under the law.

For example, if an infant were born alive, under the definition in the law, at the hospital, and a prudent layperson could conclude that the infant was suffering from an emergency medical condition based on appearance or behavior, the hospital and medical staff would be required to perform a medical screening.

If an emergency condition existed, the staff would be obligated under EMTALA to either admit the infant or stabilize and transfer him or her. Under EMTALA, each violation can cost a physician up to $50,000.

David W. Hager, M.D., an ob.gyn. in Lexington, Ky., and a member of the Christian Medical Association, agrees that the majority of physicians have been adhering to the law. However, he said, it's important to ensure that it is being implemented across the board, even in cases where the live birth is the result of an abortion. And all physicians need to be aware of their responsibilities under the law to screen infants who are born alive, and to stabilize and transfer them when appropriate, he said.

But Vicki Saporta, president and CEO of the National Abortion Federation, said the 2002 law seems unnecessary since physicians were and are abiding by state and federal laws that protect the legal rights of infants from birth.

Officials at the Department of Health and Human Services are trying to encourage enforcement of a 2002 law that defines any live birth as a person.

The agency issued guidance in April that withholding medical care from an infant born alive may constitute a violation of the federal Emergency Medical Treatment and Labor Act (EMTALA) and the Medicare Conditions of Participation.

Officials also notified state agencies that receive grants under the Child Abuse Prevention and Treatment Act that they must have procedures in place to respond to any reports of medical neglect of “born-alive infants.”

The Born-Alive Infants Protection Act, which was enacted in August 2002, establishes a definition of the terms “individual,” “person,” “human being,” or “child” as any infant who is born alive, at any stage of development.

The federal law (P.L. 107–207) states that “born alive,” with respect to a member of the species Homo sapiens, means the “complete expulsion or extraction from his or her mother of that member, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion.”

But the law doesn't mean much medically, according to David Grimes, M.D., an ob.gyn. in Chapel Hill, N.C., and the former chief of the abortion surveillance branch at the Centers for Disease Control and Prevention. “The medical impact is negligible,” Dr. Grimes said.

If the law is followed to the letter, he said, it will classify more miscarriages as live births and ultimately infant deaths, giving the United States a statistically worse infant mortality.

The American College of Obstetricians and Gynecologists issued an opinion at the time the law was enacted, saying that the statute did not require physicians to make changes to the standard of care.

“The act does not dictate the standard of care to be given to premature infants. It merely provides a definition and does not impose any requirements, restrictions, or penalties,” Ralph W. Hale, M.D., ACOG's executive vice president, said in a message to the membership in 2002. “Fellows should be familiar with their states' laws and should consult their local attorneys if they have any questions,” he said.

HHS decided to issued the guidance—nearly 3 years after the enactment of the law—because the department recently received several questions about whether it was planning to issue regulations to implement the law, HHS Secretary Mike Leavitt said in a statement. However, the department would not release information on whether any violations had occurred.

In its guidance, HHS said there are some circumstances where EMTALA protections can be applied to an infant who is born alive under the law.

For example, if an infant were born alive, under the definition in the law, at the hospital, and a prudent layperson could conclude that the infant was suffering from an emergency medical condition based on appearance or behavior, the hospital and medical staff would be required to perform a medical screening.

If an emergency condition existed, the staff would be obligated under EMTALA to either admit the infant or stabilize and transfer him or her. Under EMTALA, each violation can cost a physician up to $50,000.

David W. Hager, M.D., an ob.gyn. in Lexington, Ky., and a member of the Christian Medical Association, agrees that the majority of physicians have been adhering to the law. However, he said, it's important to ensure that it is being implemented across the board, even in cases where the live birth is the result of an abortion. And all physicians need to be aware of their responsibilities under the law to screen infants who are born alive, and to stabilize and transfer them when appropriate, he said.

But Vicki Saporta, president and CEO of the National Abortion Federation, said the 2002 law seems unnecessary since physicians were and are abiding by state and federal laws that protect the legal rights of infants from birth.

Most hospital officials are having trouble getting specialists to take emergency department call, according to a national survey of physician executives.

About 64% of physician executives surveyed reported having a problem getting specialists to take call at their hospitals. Many of them—about 47%—report that their hospitals are coping with this problem by paying specialists to take call.

Of those whose hospitals were not offering payments, 46.4% said the idea has been considered.

The survey, conducted by the American College of Physician Executives, was sent to 3,000 physician executives in hospitals and group practices around the country. The poll had 814 responses, or a 27% response rate.

The results of the survey are consistent with previous studies over the last several years, said Alex Valadka, M.D., chairman of the Joint Section of Neurotrauma and Critical Care for the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons.

Dr. Valadka said he sees taking emergency call as part of his responsibility as a physician, but said many of his colleagues just can't afford to do it anymore.

With the high cost of professional liability insurance, physicians are stopping or cutting back on emergency call because certain insurance carriers offer discounts to physicians who cut back on these services, he said.

In the past, physicians may have had enough of a profit margin to cover the cost to them of taking emergency call, he said, but declining reimbursements have mostly eliminated that margin.

“Like any other service, nothing is for free,” said Dr. Valadka, who also is a professor of neurosurgery at Baylor College of Medicine in Houston.

But even with stipends for taking call, some physicians still won't do it, he said. “I think the money will help, but it's not going to solve all the problems,” he said.

These financial incentives need to be coupled with federal medical liability reform to ease the strain of the high cost of premiums, Dr. Valadka said.

Paying specialists to take call helps to offset their costs, but it's only a stopgap solution, said James Bean, M.D., AANS treasurer and a neurosurgeon in private practice in Lexington, Ky.

In the short term, hospitals should create more incentives for physicians to take call. “You've got to create a carrot, not a stick,” Dr. Bean said.

Over the long term, physicians and hospitals should consider the idea of a regional trauma system with a large staff of rotating specialists to handle cases.

“Clearly the community needs physicians to take call,” said Andrew Pollak, M.D., associate professor of orthopedics at the University of Maryland in Baltimore and a member of the board of directors of the American Academy of Orthopaedic Surgeons.

Hospitals and physicians need to work together to provide reasonable ways to manage call, he said.

For example, hospitals should provide stipends to help offset physician costs. In addition, hospitals need to provide physicians with the right resources to work in the emergency department, such as having an adequate level of ancillary staff to assist physicians, Dr. Pollak said.

Emergency physicians have a different take on the issue, however. It's often the hospitals with the highest number of uninsured patients that face shortages in specialist care in the emergency department, said Wesley Fields, M.D., immediate past president of the California chapter of the American College of Emergency Physicians and an emergency physician in Laguna Hills, Calif. But those are also the hospitals that are least able to provide stipends to physicians.

“This really just reflects the weakness of the hospital safety net,” Dr. Fields said. And money diverted to pay for physician stipends often means that less money is available to cover emergency department costs, he said.

Paying stipends to physicians to take emergency department call is taking away from other services and the funding for uncompensated care, said Jeff Micklos, general counsel for the Federation of American Hospitals.

The federation is concerned that more hospitals will need to offer stipends for taking call, Mr. Micklos added. Otherwise, they will be creating an incentive for physicians to invest in local specialty hospitals.

Most hospital officials are having trouble getting specialists to take emergency department call, according to a national survey of physician executives.

About 64% of physician executives surveyed reported having a problem getting specialists to take call at their hospitals. Many of them—about 47%—report that their hospitals are coping with this problem by paying specialists to take call.

Of those whose hospitals were not offering payments, 46.4% said the idea has been considered.

The survey, conducted by the American College of Physician Executives, was sent to 3,000 physician executives in hospitals and group practices around the country. The poll had 814 responses, or a 27% response rate.

The results of the survey are consistent with previous studies over the last several years, said Alex Valadka, M.D., chairman of the Joint Section of Neurotrauma and Critical Care for the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons.

Dr. Valadka said he sees taking emergency call as part of his responsibility as a physician, but said many of his colleagues just can't afford to do it anymore.

With the high cost of professional liability insurance, physicians are stopping or cutting back on emergency call because certain insurance carriers offer discounts to physicians who cut back on these services, he said.

In the past, physicians may have had enough of a profit margin to cover the cost to them of taking emergency call, he said, but declining reimbursements have mostly eliminated that margin.

“Like any other service, nothing is for free,” said Dr. Valadka, who also is a professor of neurosurgery at Baylor College of Medicine in Houston.

But even with stipends for taking call, some physicians still won't do it, he said. “I think the money will help, but it's not going to solve all the problems,” he said.

These financial incentives need to be coupled with federal medical liability reform to ease the strain of the high cost of premiums, Dr. Valadka said.

Paying specialists to take call helps to offset their costs, but it's only a stopgap solution, said James Bean, M.D., AANS treasurer and a neurosurgeon in private practice in Lexington, Ky.

In the short term, hospitals should create more incentives for physicians to take call. “You've got to create a carrot, not a stick,” Dr. Bean said.

Over the long term, physicians and hospitals should consider the idea of a regional trauma system with a large staff of rotating specialists to handle cases.

“Clearly the community needs physicians to take call,” said Andrew Pollak, M.D., associate professor of orthopedics at the University of Maryland in Baltimore and a member of the board of directors of the American Academy of Orthopaedic Surgeons.

Hospitals and physicians need to work together to provide reasonable ways to manage call, he said.

For example, hospitals should provide stipends to help offset physician costs. In addition, hospitals need to provide physicians with the right resources to work in the emergency department, such as having an adequate level of ancillary staff to assist physicians, Dr. Pollak said.

Emergency physicians have a different take on the issue, however. It's often the hospitals with the highest number of uninsured patients that face shortages in specialist care in the emergency department, said Wesley Fields, M.D., immediate past president of the California chapter of the American College of Emergency Physicians and an emergency physician in Laguna Hills, Calif. But those are also the hospitals that are least able to provide stipends to physicians.

“This really just reflects the weakness of the hospital safety net,” Dr. Fields said. And money diverted to pay for physician stipends often means that less money is available to cover emergency department costs, he said.

Paying stipends to physicians to take emergency department call is taking away from other services and the funding for uncompensated care, said Jeff Micklos, general counsel for the Federation of American Hospitals.

The federation is concerned that more hospitals will need to offer stipends for taking call, Mr. Micklos added. Otherwise, they will be creating an incentive for physicians to invest in local specialty hospitals.

Most hospital officials are having trouble getting specialists to take emergency department call, according to a national survey of physician executives.

About 64% of physician executives surveyed reported having a problem getting specialists to take call at their hospitals. Many of them—about 47%—report that their hospitals are coping with this problem by paying specialists to take call.

Of those whose hospitals were not offering payments, 46.4% said the idea has been considered.

The survey, conducted by the American College of Physician Executives, was sent to 3,000 physician executives in hospitals and group practices around the country. The poll had 814 responses, or a 27% response rate.

The results of the survey are consistent with previous studies over the last several years, said Alex Valadka, M.D., chairman of the Joint Section of Neurotrauma and Critical Care for the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons.

Dr. Valadka said he sees taking emergency call as part of his responsibility as a physician, but said many of his colleagues just can't afford to do it anymore.

With the high cost of professional liability insurance, physicians are stopping or cutting back on emergency call because certain insurance carriers offer discounts to physicians who cut back on these services, he said.

In the past, physicians may have had enough of a profit margin to cover the cost to them of taking emergency call, he said, but declining reimbursements have mostly eliminated that margin.

“Like any other service, nothing is for free,” said Dr. Valadka, who also is a professor of neurosurgery at Baylor College of Medicine in Houston.

But even with stipends for taking call, some physicians still won't do it, he said. “I think the money will help, but it's not going to solve all the problems,” he said.

These financial incentives need to be coupled with federal medical liability reform to ease the strain of the high cost of premiums, Dr. Valadka said.

Paying specialists to take call helps to offset their costs, but it's only a stopgap solution, said James Bean, M.D., AANS treasurer and a neurosurgeon in private practice in Lexington, Ky.

In the short term, hospitals should create more incentives for physicians to take call. “You've got to create a carrot, not a stick,” Dr. Bean said.

Over the long term, physicians and hospitals should consider the idea of a regional trauma system with a large staff of rotating specialists to handle cases.

“Clearly the community needs physicians to take call,” said Andrew Pollak, M.D., associate professor of orthopedics at the University of Maryland in Baltimore and a member of the board of directors of the American Academy of Orthopaedic Surgeons.

Hospitals and physicians need to work together to provide reasonable ways to manage call, he said.

For example, hospitals should provide stipends to help offset physician costs. In addition, hospitals need to provide physicians with the right resources to work in the emergency department, such as having an adequate level of ancillary staff to assist physicians, Dr. Pollak said.

Emergency physicians have a different take on the issue, however. It's often the hospitals with the highest number of uninsured patients that face shortages in specialist care in the emergency department, said Wesley Fields, M.D., immediate past president of the California chapter of the American College of Emergency Physicians and an emergency physician in Laguna Hills, Calif. But those are also the hospitals that are least able to provide stipends to physicians.

“This really just reflects the weakness of the hospital safety net,” Dr. Fields said. And money diverted to pay for physician stipends often means that less money is available to cover emergency department costs, he said.

Paying stipends to physicians to take emergency department call is taking away from other services and the funding for uncompensated care, said Jeff Micklos, general counsel for the Federation of American Hospitals.

The federation is concerned that more hospitals will need to offer stipends for taking call, Mr. Micklos added. Otherwise, they will be creating an incentive for physicians to invest in local specialty hospitals.

Physicians should screen all pregnant women for HIV infection, according to updated recommendations from the U.S. Preventive Services Task Force.

The task force—an independent panel of experts in prevention and primary care—recommended in 1996 that physicians routinely screen and counsel pregnant women at high risk for HIV and those living in communities with high numbers of HIV-infected newborns.

At that time, the task force did not find sufficient evidence to recommend for or against routine screening for pregnant women without identified risk factors for HIV.

The updated recommendation is based on “good evidence” that both standard and rapid screening tests can accurately detect HIV infection in pregnant women and “fair evidence” that the universal prenatal counseling and voluntary testing increases the proportion of HIV-infected women who are diagnosed and treated before delivery (Ann. Intern. Med. 2005;143:32–7).

The task force also determined that there is “good evidence” that treatments such as highly active antiretroviral therapy (HAART) can lead to significantly reduced rates of HIV transmission from mother to child.

“Early identification of maternal HIV seropositivity allows early antiretroviral treatment to prevent mother-to-child transmission, allows providers to avoid obstetric practices that may increase the risk for transmission, and allows an opportunity to counsel the mother against breast-feeding,” the task force said.

About 40,000 people are infected with HIV each year in the United States; this number includes about 300 cases of mother-to-child transmission, the task force reported.

The recommendation for universal screening of pregnant women is “sensible,” said Doug Campos-Outcalt, M.D., chair of the American Academy of Family Physicians Commission on Clinical Policies and Research.

Many physicians are already following this recommendation, he said, and for those who are screening high-risk patients only, the switch to routine screening should be an easy one. “It is becoming more of a common practice,” said Dr. Campos-Outcalt, who is also associate chair of the department of family medicine at the University of Arizona, Phoenix.

The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention all recommend that HIV testing be part of a routine battery of prenatal blood tests unless declined by the patient.

The CDC and ACOG also recommend that women in their third trimester be retested if they are known to be at high risk for acquiring HIV and that rapid HIV testing be done during labor in women whose HIV status is undocumented.

A system in which women are informed of the screening and given the chance to opt out has been shown to produce higher screening rates than opt-in approaches for which specific informed consent is required, according to ACOG.

“Given the enormous advances in HIV prophylaxis for pregnant women and newborns, it is clear that early identification and treatment of all pregnant women with HIV is the best way to prevent neonatal disease,” ACOG's Committee on Obstetric Practice wrote in a November 2004 committee opinion.

The USPSTF also recommended that physicians screen all adolescents and adults at increased risk for HIV infection. Patients are considered to be at increased risk for HIV if they have one or more individual risk factors or receive health care in a high-prevalence or high-risk clinical setting such as an STD clinic or correctional facility.

The task force did not make a recommendation for routine screening for HIV among adolescents and adults who are not at increased risk.

The task force recommendations are available online at www.ahrq.gov/clinic/uspstf/uspshivi.htm

Physicians should screen all pregnant women for HIV infection, according to updated recommendations from the U.S. Preventive Services Task Force.

The task force—an independent panel of experts in prevention and primary care—recommended in 1996 that physicians routinely screen and counsel pregnant women at high risk for HIV and those living in communities with high numbers of HIV-infected newborns.

At that time, the task force did not find sufficient evidence to recommend for or against routine screening for pregnant women without identified risk factors for HIV.

The updated recommendation is based on “good evidence” that both standard and rapid screening tests can accurately detect HIV infection in pregnant women and “fair evidence” that the universal prenatal counseling and voluntary testing increases the proportion of HIV-infected women who are diagnosed and treated before delivery (Ann. Intern. Med. 2005;143:32–7).

The task force also determined that there is “good evidence” that treatments such as highly active antiretroviral therapy (HAART) can lead to significantly reduced rates of HIV transmission from mother to child.

“Early identification of maternal HIV seropositivity allows early antiretroviral treatment to prevent mother-to-child transmission, allows providers to avoid obstetric practices that may increase the risk for transmission, and allows an opportunity to counsel the mother against breast-feeding,” the task force said.

About 40,000 people are infected with HIV each year in the United States; this number includes about 300 cases of mother-to-child transmission, the task force reported.

The recommendation for universal screening of pregnant women is “sensible,” said Doug Campos-Outcalt, M.D., chair of the American Academy of Family Physicians Commission on Clinical Policies and Research.

Many physicians are already following this recommendation, he said, and for those who are screening high-risk patients only, the switch to routine screening should be an easy one. “It is becoming more of a common practice,” said Dr. Campos-Outcalt, who is also associate chair of the department of family medicine at the University of Arizona, Phoenix.

The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention all recommend that HIV testing be part of a routine battery of prenatal blood tests unless declined by the patient.

The CDC and ACOG also recommend that women in their third trimester be retested if they are known to be at high risk for acquiring HIV and that rapid HIV testing be done during labor in women whose HIV status is undocumented.

A system in which women are informed of the screening and given the chance to opt out has been shown to produce higher screening rates than opt-in approaches for which specific informed consent is required, according to ACOG.

“Given the enormous advances in HIV prophylaxis for pregnant women and newborns, it is clear that early identification and treatment of all pregnant women with HIV is the best way to prevent neonatal disease,” ACOG's Committee on Obstetric Practice wrote in a November 2004 committee opinion.

The USPSTF also recommended that physicians screen all adolescents and adults at increased risk for HIV infection. Patients are considered to be at increased risk for HIV if they have one or more individual risk factors or receive health care in a high-prevalence or high-risk clinical setting such as an STD clinic or correctional facility.

The task force did not make a recommendation for routine screening for HIV among adolescents and adults who are not at increased risk.

The task force recommendations are available online at www.ahrq.gov/clinic/uspstf/uspshivi.htm

Physicians should screen all pregnant women for HIV infection, according to updated recommendations from the U.S. Preventive Services Task Force.

The task force—an independent panel of experts in prevention and primary care—recommended in 1996 that physicians routinely screen and counsel pregnant women at high risk for HIV and those living in communities with high numbers of HIV-infected newborns.

At that time, the task force did not find sufficient evidence to recommend for or against routine screening for pregnant women without identified risk factors for HIV.

The updated recommendation is based on “good evidence” that both standard and rapid screening tests can accurately detect HIV infection in pregnant women and “fair evidence” that the universal prenatal counseling and voluntary testing increases the proportion of HIV-infected women who are diagnosed and treated before delivery (Ann. Intern. Med. 2005;143:32–7).

The task force also determined that there is “good evidence” that treatments such as highly active antiretroviral therapy (HAART) can lead to significantly reduced rates of HIV transmission from mother to child.

“Early identification of maternal HIV seropositivity allows early antiretroviral treatment to prevent mother-to-child transmission, allows providers to avoid obstetric practices that may increase the risk for transmission, and allows an opportunity to counsel the mother against breast-feeding,” the task force said.

About 40,000 people are infected with HIV each year in the United States; this number includes about 300 cases of mother-to-child transmission, the task force reported.

The recommendation for universal screening of pregnant women is “sensible,” said Doug Campos-Outcalt, M.D., chair of the American Academy of Family Physicians Commission on Clinical Policies and Research.

Many physicians are already following this recommendation, he said, and for those who are screening high-risk patients only, the switch to routine screening should be an easy one. “It is becoming more of a common practice,” said Dr. Campos-Outcalt, who is also associate chair of the department of family medicine at the University of Arizona, Phoenix.

The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention all recommend that HIV testing be part of a routine battery of prenatal blood tests unless declined by the patient.

The CDC and ACOG also recommend that women in their third trimester be retested if they are known to be at high risk for acquiring HIV and that rapid HIV testing be done during labor in women whose HIV status is undocumented.

A system in which women are informed of the screening and given the chance to opt out has been shown to produce higher screening rates than opt-in approaches for which specific informed consent is required, according to ACOG.

“Given the enormous advances in HIV prophylaxis for pregnant women and newborns, it is clear that early identification and treatment of all pregnant women with HIV is the best way to prevent neonatal disease,” ACOG's Committee on Obstetric Practice wrote in a November 2004 committee opinion.

The USPSTF also recommended that physicians screen all adolescents and adults at increased risk for HIV infection. Patients are considered to be at increased risk for HIV if they have one or more individual risk factors or receive health care in a high-prevalence or high-risk clinical setting such as an STD clinic or correctional facility.

The task force did not make a recommendation for routine screening for HIV among adolescents and adults who are not at increased risk.

The task force recommendations are available online at www.ahrq.gov/clinic/uspstf/uspshivi.htm

Doctors and Politics Do Mix?

The American Academy of Dermatology Association is advocating for physicians serving in the U.S. Senate to be allowed to continue to practice medicine.

Senate Rule 37 prohibits senators from affiliating with "a firm, partnership, association, or corporation for the purpose of providing professional services for compensation." Although the rule addresses professional services for compensation, it would prohibit physicians in the Senate from maintaining not-for-profit medical practices, according to the AADA.

The AADA, a sister organization to the American Academy of Dermatology, along with 11 other medical associations, wrote to the U.S. Senate Rules and Administration Committee urging it to change the policy. "Unlike many other professions, physicians require continuing, hands-on experience to maintain their skills," the groups wrote. "This is essential, since a lawmaker returning to the private sector cannot simply 'pick up where he left off.'"

Psoriasis Research Support Urged

Support for federal research on psoriasis seems to be growing. Twenty-five members of Congress recently circulated a letter to their colleagues urging increased psoriasis funding in next year's National Institutes of Health budget. And last month, the House approved language as part of the report that accompanies its NIH appropriations bill calling on the agency to support research on psoriasis.

The language supported increased research within the National Institute of Allergy and Infectious Diseases, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Center for Complementary and Alternative Medicine, and other NIH institutes. At press time, the bill was still being considered in the Senate.

NIH Extends Disclosure Deadline

Officials at the U.S. Department of Health and Human Services are giving NIH employees more time to report prohibited financial interests and to divest stock. In announcing the extension, HHS wrote it is considering issuing revisions to its current ethics regulations.

In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding stocks in these affected organizations. NIH employees now have until Oct. 3 to file financial disclosure reports and until Jan. 2, 2006, to divest of prohibited financial interests. This is the second extension offered to NIH employees.

Sleep Deprivation Dogs Doctors

Residents and medical students are still suffering from fatigue, despite the shorter work hours established in 2003 by the Accreditation Council for Graduate Medical Education. In a survey of 1,126 medical students and 1,010 residents, the American Medical Association found that 44% of residents and 39% of medical students said they've experienced sleep deprivation about once a week or more often during their most recently completed rotation.

The ACGME work limit is 80 hours per week, but 11%–12% of the respondents said their workweek exceeded those hours on their most recent rotation. Nearly half of the respondents thought that sleep deprivation or fatigue may have had a negative impact on the quality of patient care they delivered.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all drugs in six categories on their formularies starting in 2006, when the Part D drug benefit begins. The agency noted that in earlier guidance on the Medicare drug plan, it stated that "a majority" of drugs in these categories—antidepressants, antipsychotics, anticonvulsants, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in those classes.

But in training sessions and in answering user calls, "CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies," the agency said. "This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short time frame."

DEA Battles OxyContin Abuse

The Drug Enforcement Administration's efforts to stop illegal use of the prescription painkiller OxyContin have "cast a chill over the doctor-patient candor necessary for successful treatment," Ronald T. Libby, Ph.D., a political science professor at the University of North Florida in Jacksonville, wrote in a policy analysis for the Cato Institute, a libertarian think tank.

The DEA's campaign includes elevating OxyContin to the status of other schedule II substances and using "aggressive undercover investigation, asset forfeiture, and informers," he noted. "The federal government has made physicians scapegoats for the failed drug war," he wrote. When asked for comment, a DEA spokeswoman referred to a recent statement by DEA Administrator Karen Tandy. "We employ a balanced approach that recognizes both the unquestioned need for responsible pain medication and the possibility … of criminal drug trafficking," Ms. Tandy said, noting that physicians "are an extremely small part of the problem."

Doctors and Politics Do Mix?

The American Academy of Dermatology Association is advocating for physicians serving in the U.S. Senate to be allowed to continue to practice medicine.

Senate Rule 37 prohibits senators from affiliating with "a firm, partnership, association, or corporation for the purpose of providing professional services for compensation." Although the rule addresses professional services for compensation, it would prohibit physicians in the Senate from maintaining not-for-profit medical practices, according to the AADA.

The AADA, a sister organization to the American Academy of Dermatology, along with 11 other medical associations, wrote to the U.S. Senate Rules and Administration Committee urging it to change the policy. "Unlike many other professions, physicians require continuing, hands-on experience to maintain their skills," the groups wrote. "This is essential, since a lawmaker returning to the private sector cannot simply 'pick up where he left off.'"

Psoriasis Research Support Urged

Support for federal research on psoriasis seems to be growing. Twenty-five members of Congress recently circulated a letter to their colleagues urging increased psoriasis funding in next year's National Institutes of Health budget. And last month, the House approved language as part of the report that accompanies its NIH appropriations bill calling on the agency to support research on psoriasis.

The language supported increased research within the National Institute of Allergy and Infectious Diseases, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Center for Complementary and Alternative Medicine, and other NIH institutes. At press time, the bill was still being considered in the Senate.

NIH Extends Disclosure Deadline

Officials at the U.S. Department of Health and Human Services are giving NIH employees more time to report prohibited financial interests and to divest stock. In announcing the extension, HHS wrote it is considering issuing revisions to its current ethics regulations.

In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding stocks in these affected organizations. NIH employees now have until Oct. 3 to file financial disclosure reports and until Jan. 2, 2006, to divest of prohibited financial interests. This is the second extension offered to NIH employees.

Sleep Deprivation Dogs Doctors

Residents and medical students are still suffering from fatigue, despite the shorter work hours established in 2003 by the Accreditation Council for Graduate Medical Education. In a survey of 1,126 medical students and 1,010 residents, the American Medical Association found that 44% of residents and 39% of medical students said they've experienced sleep deprivation about once a week or more often during their most recently completed rotation.

The ACGME work limit is 80 hours per week, but 11%–12% of the respondents said their workweek exceeded those hours on their most recent rotation. Nearly half of the respondents thought that sleep deprivation or fatigue may have had a negative impact on the quality of patient care they delivered.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all drugs in six categories on their formularies starting in 2006, when the Part D drug benefit begins. The agency noted that in earlier guidance on the Medicare drug plan, it stated that "a majority" of drugs in these categories—antidepressants, antipsychotics, anticonvulsants, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in those classes.

But in training sessions and in answering user calls, "CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies," the agency said. "This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short time frame."

DEA Battles OxyContin Abuse

The Drug Enforcement Administration's efforts to stop illegal use of the prescription painkiller OxyContin have "cast a chill over the doctor-patient candor necessary for successful treatment," Ronald T. Libby, Ph.D., a political science professor at the University of North Florida in Jacksonville, wrote in a policy analysis for the Cato Institute, a libertarian think tank.

The DEA's campaign includes elevating OxyContin to the status of other schedule II substances and using "aggressive undercover investigation, asset forfeiture, and informers," he noted. "The federal government has made physicians scapegoats for the failed drug war," he wrote. When asked for comment, a DEA spokeswoman referred to a recent statement by DEA Administrator Karen Tandy. "We employ a balanced approach that recognizes both the unquestioned need for responsible pain medication and the possibility … of criminal drug trafficking," Ms. Tandy said, noting that physicians "are an extremely small part of the problem."

Doctors and Politics Do Mix?

The American Academy of Dermatology Association is advocating for physicians serving in the U.S. Senate to be allowed to continue to practice medicine.

Senate Rule 37 prohibits senators from affiliating with "a firm, partnership, association, or corporation for the purpose of providing professional services for compensation." Although the rule addresses professional services for compensation, it would prohibit physicians in the Senate from maintaining not-for-profit medical practices, according to the AADA.

The AADA, a sister organization to the American Academy of Dermatology, along with 11 other medical associations, wrote to the U.S. Senate Rules and Administration Committee urging it to change the policy. "Unlike many other professions, physicians require continuing, hands-on experience to maintain their skills," the groups wrote. "This is essential, since a lawmaker returning to the private sector cannot simply 'pick up where he left off.'"

Psoriasis Research Support Urged

Support for federal research on psoriasis seems to be growing. Twenty-five members of Congress recently circulated a letter to their colleagues urging increased psoriasis funding in next year's National Institutes of Health budget. And last month, the House approved language as part of the report that accompanies its NIH appropriations bill calling on the agency to support research on psoriasis.

The language supported increased research within the National Institute of Allergy and Infectious Diseases, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Center for Complementary and Alternative Medicine, and other NIH institutes. At press time, the bill was still being considered in the Senate.

NIH Extends Disclosure Deadline

Officials at the U.S. Department of Health and Human Services are giving NIH employees more time to report prohibited financial interests and to divest stock. In announcing the extension, HHS wrote it is considering issuing revisions to its current ethics regulations.

In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding stocks in these affected organizations. NIH employees now have until Oct. 3 to file financial disclosure reports and until Jan. 2, 2006, to divest of prohibited financial interests. This is the second extension offered to NIH employees.

Sleep Deprivation Dogs Doctors

Residents and medical students are still suffering from fatigue, despite the shorter work hours established in 2003 by the Accreditation Council for Graduate Medical Education. In a survey of 1,126 medical students and 1,010 residents, the American Medical Association found that 44% of residents and 39% of medical students said they've experienced sleep deprivation about once a week or more often during their most recently completed rotation.

The ACGME work limit is 80 hours per week, but 11%–12% of the respondents said their workweek exceeded those hours on their most recent rotation. Nearly half of the respondents thought that sleep deprivation or fatigue may have had a negative impact on the quality of patient care they delivered.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all drugs in six categories on their formularies starting in 2006, when the Part D drug benefit begins. The agency noted that in earlier guidance on the Medicare drug plan, it stated that "a majority" of drugs in these categories—antidepressants, antipsychotics, anticonvulsants, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in those classes.

But in training sessions and in answering user calls, "CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies," the agency said. "This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short time frame."

DEA Battles OxyContin Abuse

The Drug Enforcement Administration's efforts to stop illegal use of the prescription painkiller OxyContin have "cast a chill over the doctor-patient candor necessary for successful treatment," Ronald T. Libby, Ph.D., a political science professor at the University of North Florida in Jacksonville, wrote in a policy analysis for the Cato Institute, a libertarian think tank.

The DEA's campaign includes elevating OxyContin to the status of other schedule II substances and using "aggressive undercover investigation, asset forfeiture, and informers," he noted. "The federal government has made physicians scapegoats for the failed drug war," he wrote. When asked for comment, a DEA spokeswoman referred to a recent statement by DEA Administrator Karen Tandy. "We employ a balanced approach that recognizes both the unquestioned need for responsible pain medication and the possibility … of criminal drug trafficking," Ms. Tandy said, noting that physicians "are an extremely small part of the problem."

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

Here are some of the recommendations from the AMIA work group:

Readiness Assessment

Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

Let everyone in the organization know this is a business transformation process, not an IT project.

Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

Determine the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

Figure out the organization-wide goals and objectives to determine EHR needs.

Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selector at

www.ehrselector.com

How to Write an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

Involve all clinical disciplines in RFP development.

Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list, seek out independent sources, the work group reported.

Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around some the lack of transparency in a the scripted process.

Make scoring simple and explicit.

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

Here are some of the recommendations from the AMIA work group:

Readiness Assessment

Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

Let everyone in the organization know this is a business transformation process, not an IT project.

Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

Determine the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

Figure out the organization-wide goals and objectives to determine EHR needs.

Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selector at

www.ehrselector.com

How to Write an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

Involve all clinical disciplines in RFP development.

Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list, seek out independent sources, the work group reported.

Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around some the lack of transparency in a the scripted process.

Make scoring simple and explicit.

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

Here are some of the recommendations from the AMIA work group:

Readiness Assessment

Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

Let everyone in the organization know this is a business transformation process, not an IT project.

Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

Determine the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

Figure out the organization-wide goals and objectives to determine EHR needs.

Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selector at

www.ehrselector.com

How to Write an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

Involve all clinical disciplines in RFP development.

Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list, seek out independent sources, the work group reported.

Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around some the lack of transparency in a the scripted process.

Make scoring simple and explicit.