Mary Ellen Schneider

ATLANTA – Results from new research point to a possible alternative to stimulants for the treatment of attention-deficit hyperactivity disorder in children and adolescents.

Two phase III studies presented at the annual meeting of the American Psychiatric Association show that a once-daily pediatric formulation of modafinil is well tolerated and improves attention-deficit hyperactivity disorder (ADHD) symptoms in children and adolescents.

Modafinil is currently marketed by Cephalon under the brand name Provigil in 100-mg and 200-mg strengths. Provigil is indicated for the treatment of excessive sleepiness associated with narcolepsy, obstructive sleep apnea, hypopnea syndrome, and shift work sleep disorder.

The company, which funded the phase II trials, is seeking approval from the Food and Drug Administration to market modafinil in 85-mg, 170-mg, 255-mg, 340-mg, and 425-mg strengths. If approved, the drug would be indicated for treatment of ADHD in children and adolescents aged 6–17 years.

The company is planning to launch the drug under the brand name Attenace by early 2006.

In one study, 189 patients with ADHD aged 6–17 years were randomized to a 7-week double-blind, fixed-dose treatment with either modafinil or placebo. This protocol was followed by a 2-week withdrawal period in which half of the modafinil-treated patients were placed on placebo without tapering, and half were continued on the drug, said Joseph Biederman, M.D., the lead investigator in the study and professor of psychiatry at Harvard University in Boston.

Modafinil was administered once daily, starting at 85 mg/day, and was rapidly titrated over 7–9 days to dosages of either 340 mg/day for patients who weighed less than 30 kg or 425 mg/day for patients who weighed 30 kg or more.

The results of the study were assessed using the school and home ADHD Rating Scale-IV total score change from baseline to last treatment visit.

After 1 week, the 125 modafinil-treated patients had significantly greater improvements in school scores, compared with the 64 placebo patients, and those results were maintained through week 7.

On the school scale, patients on modafinil experienced a 17.2-point drop in symptoms, compared with an 8.2-point drop for patients on placebo. Modafinil also significantly improved total scores from parents, compared with placebo.

The side effects included insomnia and appetite decrease. Overall, the side effects were generally mild and occurred at initiation of the treatment. There were two serious adverse events not associated with the trial, said Dr. Biederman, who is an advisory board member for Cephalon and receives research/grant support from the company.

The researchers also assessed ADHD symptoms and physical/emotional response after rapid discontinuation. During the 2-week withdrawal phase there were no reported symptom rebounds, no adverse events related to withdrawal, and no physical or emotional responses.

Modafinil appears to work like a gentler stimulant, Dr. Biederman said in an interview.

The findings present possible new treatment options, he said. Although stimulants are effective, they are not universally effective. About 30%–40% of patients are nonresponsive to stimulants, he said, and some patients also have tolerability problems.

Stimulants also have the potential for acute deterioration and symptom rebound if treatment is interrupted or discontinued without tapering, Dr. Biederman said.

In the second study, researchers considered the effect of a flexible dose of modafinil in children and adolescents.

The study included 198 patients aged 6–17 years who were started on a dose of 85 mg/day of modafinil, which was titrated over 22 days based on clinical effectiveness. The maximum dose was 425 mg/day with once-daily dosing, said James Swanson, Ph.D., of the University of California at Irvine Child Development Center, who was the lead investigator.

The results were assessed using the school and home ADHD Rating Scale-IV, the Clinical Global Impression of Improvement (CGI-I), and Test Variables of Attention (TOVA).

The home score showed a mean drop of 17.6 points in symptoms for the 131 patients receiving modafinil at a mean stable dose of 361 mg/day, compared with a 7.5-point drop in symptoms for the 67 patients on placebo. The improvement in the total school score was also significantly greater for modafinil patients, Dr. Swanson reported.

Modafinil was shown to significantly improve inattention and hyperactivity/impulsivity, and there was an improvement in overall clinical condition and in the TOVA measurements of ADHD.

The researchers focused not only on decreasing symptoms of ADHD, but on increasing positive interaction and social skills, and they saw an increase in positive behaviors, he said.

The side effects included insomnia, headache, and appetite problems, which are similar to the side effects for stimulants, said Dr. Swanson, who is an advisory board member with Cephalon, receives research/grant support from the company, and is a member of the company's speakers' bureau.

ATLANTA – Results from new research point to a possible alternative to stimulants for the treatment of attention-deficit hyperactivity disorder in children and adolescents.

Two phase III studies presented at the annual meeting of the American Psychiatric Association show that a once-daily pediatric formulation of modafinil is well tolerated and improves attention-deficit hyperactivity disorder (ADHD) symptoms in children and adolescents.

Modafinil is currently marketed by Cephalon under the brand name Provigil in 100-mg and 200-mg strengths. Provigil is indicated for the treatment of excessive sleepiness associated with narcolepsy, obstructive sleep apnea, hypopnea syndrome, and shift work sleep disorder.

The company, which funded the phase II trials, is seeking approval from the Food and Drug Administration to market modafinil in 85-mg, 170-mg, 255-mg, 340-mg, and 425-mg strengths. If approved, the drug would be indicated for treatment of ADHD in children and adolescents aged 6–17 years.

The company is planning to launch the drug under the brand name Attenace by early 2006.

In one study, 189 patients with ADHD aged 6–17 years were randomized to a 7-week double-blind, fixed-dose treatment with either modafinil or placebo. This protocol was followed by a 2-week withdrawal period in which half of the modafinil-treated patients were placed on placebo without tapering, and half were continued on the drug, said Joseph Biederman, M.D., the lead investigator in the study and professor of psychiatry at Harvard University in Boston.

Modafinil was administered once daily, starting at 85 mg/day, and was rapidly titrated over 7–9 days to dosages of either 340 mg/day for patients who weighed less than 30 kg or 425 mg/day for patients who weighed 30 kg or more.

The results of the study were assessed using the school and home ADHD Rating Scale-IV total score change from baseline to last treatment visit.

After 1 week, the 125 modafinil-treated patients had significantly greater improvements in school scores, compared with the 64 placebo patients, and those results were maintained through week 7.

On the school scale, patients on modafinil experienced a 17.2-point drop in symptoms, compared with an 8.2-point drop for patients on placebo. Modafinil also significantly improved total scores from parents, compared with placebo.

The side effects included insomnia and appetite decrease. Overall, the side effects were generally mild and occurred at initiation of the treatment. There were two serious adverse events not associated with the trial, said Dr. Biederman, who is an advisory board member for Cephalon and receives research/grant support from the company.

The researchers also assessed ADHD symptoms and physical/emotional response after rapid discontinuation. During the 2-week withdrawal phase there were no reported symptom rebounds, no adverse events related to withdrawal, and no physical or emotional responses.

Modafinil appears to work like a gentler stimulant, Dr. Biederman said in an interview.

The findings present possible new treatment options, he said. Although stimulants are effective, they are not universally effective. About 30%–40% of patients are nonresponsive to stimulants, he said, and some patients also have tolerability problems.

Stimulants also have the potential for acute deterioration and symptom rebound if treatment is interrupted or discontinued without tapering, Dr. Biederman said.

In the second study, researchers considered the effect of a flexible dose of modafinil in children and adolescents.

The study included 198 patients aged 6–17 years who were started on a dose of 85 mg/day of modafinil, which was titrated over 22 days based on clinical effectiveness. The maximum dose was 425 mg/day with once-daily dosing, said James Swanson, Ph.D., of the University of California at Irvine Child Development Center, who was the lead investigator.

The results were assessed using the school and home ADHD Rating Scale-IV, the Clinical Global Impression of Improvement (CGI-I), and Test Variables of Attention (TOVA).

The home score showed a mean drop of 17.6 points in symptoms for the 131 patients receiving modafinil at a mean stable dose of 361 mg/day, compared with a 7.5-point drop in symptoms for the 67 patients on placebo. The improvement in the total school score was also significantly greater for modafinil patients, Dr. Swanson reported.

Modafinil was shown to significantly improve inattention and hyperactivity/impulsivity, and there was an improvement in overall clinical condition and in the TOVA measurements of ADHD.

The researchers focused not only on decreasing symptoms of ADHD, but on increasing positive interaction and social skills, and they saw an increase in positive behaviors, he said.

The side effects included insomnia, headache, and appetite problems, which are similar to the side effects for stimulants, said Dr. Swanson, who is an advisory board member with Cephalon, receives research/grant support from the company, and is a member of the company's speakers' bureau.

ATLANTA – Results from new research point to a possible alternative to stimulants for the treatment of attention-deficit hyperactivity disorder in children and adolescents.

Two phase III studies presented at the annual meeting of the American Psychiatric Association show that a once-daily pediatric formulation of modafinil is well tolerated and improves attention-deficit hyperactivity disorder (ADHD) symptoms in children and adolescents.

Modafinil is currently marketed by Cephalon under the brand name Provigil in 100-mg and 200-mg strengths. Provigil is indicated for the treatment of excessive sleepiness associated with narcolepsy, obstructive sleep apnea, hypopnea syndrome, and shift work sleep disorder.

The company, which funded the phase II trials, is seeking approval from the Food and Drug Administration to market modafinil in 85-mg, 170-mg, 255-mg, 340-mg, and 425-mg strengths. If approved, the drug would be indicated for treatment of ADHD in children and adolescents aged 6–17 years.

The company is planning to launch the drug under the brand name Attenace by early 2006.

In one study, 189 patients with ADHD aged 6–17 years were randomized to a 7-week double-blind, fixed-dose treatment with either modafinil or placebo. This protocol was followed by a 2-week withdrawal period in which half of the modafinil-treated patients were placed on placebo without tapering, and half were continued on the drug, said Joseph Biederman, M.D., the lead investigator in the study and professor of psychiatry at Harvard University in Boston.

Modafinil was administered once daily, starting at 85 mg/day, and was rapidly titrated over 7–9 days to dosages of either 340 mg/day for patients who weighed less than 30 kg or 425 mg/day for patients who weighed 30 kg or more.

The results of the study were assessed using the school and home ADHD Rating Scale-IV total score change from baseline to last treatment visit.

After 1 week, the 125 modafinil-treated patients had significantly greater improvements in school scores, compared with the 64 placebo patients, and those results were maintained through week 7.

On the school scale, patients on modafinil experienced a 17.2-point drop in symptoms, compared with an 8.2-point drop for patients on placebo. Modafinil also significantly improved total scores from parents, compared with placebo.

The side effects included insomnia and appetite decrease. Overall, the side effects were generally mild and occurred at initiation of the treatment. There were two serious adverse events not associated with the trial, said Dr. Biederman, who is an advisory board member for Cephalon and receives research/grant support from the company.

The researchers also assessed ADHD symptoms and physical/emotional response after rapid discontinuation. During the 2-week withdrawal phase there were no reported symptom rebounds, no adverse events related to withdrawal, and no physical or emotional responses.

Modafinil appears to work like a gentler stimulant, Dr. Biederman said in an interview.

The findings present possible new treatment options, he said. Although stimulants are effective, they are not universally effective. About 30%–40% of patients are nonresponsive to stimulants, he said, and some patients also have tolerability problems.

Stimulants also have the potential for acute deterioration and symptom rebound if treatment is interrupted or discontinued without tapering, Dr. Biederman said.

In the second study, researchers considered the effect of a flexible dose of modafinil in children and adolescents.

The study included 198 patients aged 6–17 years who were started on a dose of 85 mg/day of modafinil, which was titrated over 22 days based on clinical effectiveness. The maximum dose was 425 mg/day with once-daily dosing, said James Swanson, Ph.D., of the University of California at Irvine Child Development Center, who was the lead investigator.

The results were assessed using the school and home ADHD Rating Scale-IV, the Clinical Global Impression of Improvement (CGI-I), and Test Variables of Attention (TOVA).

The home score showed a mean drop of 17.6 points in symptoms for the 131 patients receiving modafinil at a mean stable dose of 361 mg/day, compared with a 7.5-point drop in symptoms for the 67 patients on placebo. The improvement in the total school score was also significantly greater for modafinil patients, Dr. Swanson reported.

Modafinil was shown to significantly improve inattention and hyperactivity/impulsivity, and there was an improvement in overall clinical condition and in the TOVA measurements of ADHD.

The researchers focused not only on decreasing symptoms of ADHD, but on increasing positive interaction and social skills, and they saw an increase in positive behaviors, he said.

The side effects included insomnia, headache, and appetite problems, which are similar to the side effects for stimulants, said Dr. Swanson, who is an advisory board member with Cephalon, receives research/grant support from the company, and is a member of the company's speakers' bureau.

BOSTON — Interoperability is key to the success of electronic health records, but there are barriers to sharing data between systems, said David Brailer, M.D., national coordinator for health information technology.

The major challenges include standards harmonization, unclear data control policies, a lack of uniform security practices, the inability to ensure that products perform as advertised, and the lack of a business model around interoperability, he said.

“At the very basis of this—kind of the DNA of the interoperable electronic health record—is the emergence of harmonized standards,” Dr. Brailer said at a congress sponsored by the American Medical Informatics Association.

Many organizations are involved in developing standards, but there isn't a process yet for harmonizing two conflicting standards. Nor is there a unified release schedule for standards so that the industry can build investment plans, he said.

Also missing is a way to provide input into the standards process. There is no mechanism for taking a problem in health care and distilling that into requirements that could be used by organizations that develop standards. “Problems don't come well packaged into a standard,” Dr. Brailer observed.

Even with standards, many other factors influence interoperability. One less well-known obstacle is that health care lacks even a vocabulary to talk about the control of data. Deciding on a set of terms and their meanings will be essential to figuring out who decides if information flows from point A to point B, in what way, and who will be notified.

Security standards pose another barrier. Currently, two health care organizations can be compliant with the Health Insurance Portability and Accountability Act of 1996, yet have security practices that prevent them from sharing data. For example, one organization may adopt user names and passwords for authentication, while another uses a biometric thumbprint.

To address this, security brokers or other third parties could navigate between two systems. Some states have talked about creating more requirements for uniformity of security practices. “This is a profound barrier to our ability to be interoperable, and standards won't address it,” Dr. Brailer said.

Physicians also need to be able to know if the system they purchase will deliver on the vendor's promises of interoperability. The industry took a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, which will certify that EHRs and other products meet minimum standards. This work will help EHRs become “plug and play” technology in the future, and will take some of the risk out of the marketplace, he said.

BOSTON — Interoperability is key to the success of electronic health records, but there are barriers to sharing data between systems, said David Brailer, M.D., national coordinator for health information technology.

The major challenges include standards harmonization, unclear data control policies, a lack of uniform security practices, the inability to ensure that products perform as advertised, and the lack of a business model around interoperability, he said.

“At the very basis of this—kind of the DNA of the interoperable electronic health record—is the emergence of harmonized standards,” Dr. Brailer said at a congress sponsored by the American Medical Informatics Association.

Many organizations are involved in developing standards, but there isn't a process yet for harmonizing two conflicting standards. Nor is there a unified release schedule for standards so that the industry can build investment plans, he said.

Also missing is a way to provide input into the standards process. There is no mechanism for taking a problem in health care and distilling that into requirements that could be used by organizations that develop standards. “Problems don't come well packaged into a standard,” Dr. Brailer observed.

Even with standards, many other factors influence interoperability. One less well-known obstacle is that health care lacks even a vocabulary to talk about the control of data. Deciding on a set of terms and their meanings will be essential to figuring out who decides if information flows from point A to point B, in what way, and who will be notified.

Security standards pose another barrier. Currently, two health care organizations can be compliant with the Health Insurance Portability and Accountability Act of 1996, yet have security practices that prevent them from sharing data. For example, one organization may adopt user names and passwords for authentication, while another uses a biometric thumbprint.

To address this, security brokers or other third parties could navigate between two systems. Some states have talked about creating more requirements for uniformity of security practices. “This is a profound barrier to our ability to be interoperable, and standards won't address it,” Dr. Brailer said.

Physicians also need to be able to know if the system they purchase will deliver on the vendor's promises of interoperability. The industry took a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, which will certify that EHRs and other products meet minimum standards. This work will help EHRs become “plug and play” technology in the future, and will take some of the risk out of the marketplace, he said.

BOSTON — Interoperability is key to the success of electronic health records, but there are barriers to sharing data between systems, said David Brailer, M.D., national coordinator for health information technology.

The major challenges include standards harmonization, unclear data control policies, a lack of uniform security practices, the inability to ensure that products perform as advertised, and the lack of a business model around interoperability, he said.

“At the very basis of this—kind of the DNA of the interoperable electronic health record—is the emergence of harmonized standards,” Dr. Brailer said at a congress sponsored by the American Medical Informatics Association.

Many organizations are involved in developing standards, but there isn't a process yet for harmonizing two conflicting standards. Nor is there a unified release schedule for standards so that the industry can build investment plans, he said.

Also missing is a way to provide input into the standards process. There is no mechanism for taking a problem in health care and distilling that into requirements that could be used by organizations that develop standards. “Problems don't come well packaged into a standard,” Dr. Brailer observed.

Even with standards, many other factors influence interoperability. One less well-known obstacle is that health care lacks even a vocabulary to talk about the control of data. Deciding on a set of terms and their meanings will be essential to figuring out who decides if information flows from point A to point B, in what way, and who will be notified.

Security standards pose another barrier. Currently, two health care organizations can be compliant with the Health Insurance Portability and Accountability Act of 1996, yet have security practices that prevent them from sharing data. For example, one organization may adopt user names and passwords for authentication, while another uses a biometric thumbprint.

To address this, security brokers or other third parties could navigate between two systems. Some states have talked about creating more requirements for uniformity of security practices. “This is a profound barrier to our ability to be interoperable, and standards won't address it,” Dr. Brailer said.

Physicians also need to be able to know if the system they purchase will deliver on the vendor's promises of interoperability. The industry took a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, which will certify that EHRs and other products meet minimum standards. This work will help EHRs become “plug and play” technology in the future, and will take some of the risk out of the marketplace, he said.

BOSTON — To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., advised at a congress sponsored by the American Medical Informatics Association.

“You have to plan,” said Dr. Carter, chief executive officer of NT&M Informatics Inc., Atlanta, and the editor of “Electronic Medical Records: A Guide for Clinicians and Administrators,” published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance. “This is not the time to experiment with the latest gadgets,” he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand the current problems within the practice, to figure out how the practice should function, and identify what keeps the practice and its current system from working in an ideal way. Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems, he said.

The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created. When reviewing products, it's important to have a designated project manager whose only job is to shepherd the project through each stage. Senior executive support—both administrative and clinical—is key, since that group will make the final decision on a system. And staff input is essential, since these are the people who really know what goes on in your practice.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. “Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there,” he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs).

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

There are several ways to roll out a system. For example, a practice can test all the features at once through a pilot at one site in the practice. Another option is to first phase in implementation of the most important features across the entire organization. Or a practice could opt to try a “big bang” rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with only two sites and fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing staff training is critical to the success of the new system. It is not a one-time event, he emphasized.

BOSTON — To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., advised at a congress sponsored by the American Medical Informatics Association.

“You have to plan,” said Dr. Carter, chief executive officer of NT&M Informatics Inc., Atlanta, and the editor of “Electronic Medical Records: A Guide for Clinicians and Administrators,” published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance. “This is not the time to experiment with the latest gadgets,” he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand the current problems within the practice, to figure out how the practice should function, and identify what keeps the practice and its current system from working in an ideal way. Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems, he said.

The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created. When reviewing products, it's important to have a designated project manager whose only job is to shepherd the project through each stage. Senior executive support—both administrative and clinical—is key, since that group will make the final decision on a system. And staff input is essential, since these are the people who really know what goes on in your practice.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. “Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there,” he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs).

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

There are several ways to roll out a system. For example, a practice can test all the features at once through a pilot at one site in the practice. Another option is to first phase in implementation of the most important features across the entire organization. Or a practice could opt to try a “big bang” rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with only two sites and fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing staff training is critical to the success of the new system. It is not a one-time event, he emphasized.

BOSTON — To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., advised at a congress sponsored by the American Medical Informatics Association.

“You have to plan,” said Dr. Carter, chief executive officer of NT&M Informatics Inc., Atlanta, and the editor of “Electronic Medical Records: A Guide for Clinicians and Administrators,” published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance. “This is not the time to experiment with the latest gadgets,” he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand the current problems within the practice, to figure out how the practice should function, and identify what keeps the practice and its current system from working in an ideal way. Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems, he said.

The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created. When reviewing products, it's important to have a designated project manager whose only job is to shepherd the project through each stage. Senior executive support—both administrative and clinical—is key, since that group will make the final decision on a system. And staff input is essential, since these are the people who really know what goes on in your practice.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. “Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there,” he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs).

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

There are several ways to roll out a system. For example, a practice can test all the features at once through a pilot at one site in the practice. Another option is to first phase in implementation of the most important features across the entire organization. Or a practice could opt to try a “big bang” rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with only two sites and fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing staff training is critical to the success of the new system. It is not a one-time event, he emphasized.

The malpractice environment may be starting to improve for physicians in one state 2 years after a comprehensive medical liability reform bill was enacted there.

"It's probably too early to see a huge improvement," said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians. "But the signs are encouraging."

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner.

The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness.

Within a period of weeks of the law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. "Retention changed almost overnight."

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians premiums.

But physicians aren't out of the woods yet, according to Dr. Blum, also of West Virginia University.

The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

The malpractice environment may be starting to improve for physicians in one state 2 years after a comprehensive medical liability reform bill was enacted there.

"It's probably too early to see a huge improvement," said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians. "But the signs are encouraging."

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner.

The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness.

Within a period of weeks of the law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. "Retention changed almost overnight."

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians premiums.

But physicians aren't out of the woods yet, according to Dr. Blum, also of West Virginia University.

The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

The malpractice environment may be starting to improve for physicians in one state 2 years after a comprehensive medical liability reform bill was enacted there.

"It's probably too early to see a huge improvement," said Frederick C. Blum, M.D., president-elect of the American College of Emergency Physicians. "But the signs are encouraging."

The first signs are coming from the insurance industry. Loss ratios for medical liability carriers have improved since the reform legislation was passed in 2003, according to a report from the state's insurance commissioner.

The percentage of medical liability insurance premiums spent on claims and expenses in the state fell from 135% in 2002 to 107% in 2003. Ratios above 100% indicate the insurer has an underwriting loss.

The 2003 law established a $250,000 cap on noneconomic damages and set a $500,000 cap on damages for injuries sustained at trauma centers. The law also strengthened the qualifications required to be an expert witness.

Within a period of weeks of the law's passage, physicians stopped talking about leaving the state, said Steven Summer, president of the West Virginia Hospital Association. "Retention changed almost overnight."

And the malpractice insurance market has become more predictable, he said, adding that the next piece will be a reduction in physicians premiums.

But physicians aren't out of the woods yet, according to Dr. Blum, also of West Virginia University.

The law is already under attack by plaintiffs' lawyers trying to get the reform declared unconstitutional by the courts. But physicians got a boost last year when a state Supreme Court justice hostile to medical liability reform lost his bid for reelection.

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 health providers to reap the benefits of the systems, the panel said.

The panel of corporate executives also recommended that the federal 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 information technology 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 IT 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 such IT medical 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 adopting EHRs.

"The train has left the station," Dr. Kibbe commented. "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 health providers to reap the benefits of the systems, the panel said.

The panel of corporate executives also recommended that the federal 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 information technology 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 IT 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 such IT medical 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 adopting EHRs.

"The train has left the station," Dr. Kibbe commented. "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 health providers to reap the benefits of the systems, the panel said.

The panel of corporate executives also recommended that the federal 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 information technology 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 IT 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 such IT medical 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 adopting EHRs.

"The train has left the station," Dr. Kibbe commented. "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

BOSTON — To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., said at a congress sponsored by the American Medical Informatics Association.

"You have to plan," said Dr. Carter, chief executive officer of NT&M Informatics, Inc., Atlanta, and the editor of "Electronic Medical Records: A Guide for Clinicians and Administrators," published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance. "This is not the time to experiment with the latest gadgets," he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand current problems within the practice, to figure out how the practice should function, and identify what keeps the practice and its current system from working in an ideal way.

Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems. The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created.

During product review, it's important to have a designated project manager whose only job is to shepherd the project through each stage. In addition, senior executive support—both administrative and clinical—is key since that group will make the final decision on a system. And staff input is essential since these are the people who really know what goes on in your practice, Dr. Carter said.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. "Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there," he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs). Tablet computers are popular but people also tend to drop them and spill coffee on them, he said.

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

When the time comes, there are a variety of ways to roll out a system, Dr. Carter said. A practice can test all the features at once through a pilot at one site in the practice. Another option is to phase in implementation of the most important features first across the entire organization.

Or a practice could opt to try a "big bang" rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing staff training is critical. It is not a one-time event. Staff will need training on the workflow change and planning aspects and the actual EHR system. Physicians will need additional training on physician-specific issues related to implementation, he said.

BOSTON — To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., said at a congress sponsored by the American Medical Informatics Association.

"You have to plan," said Dr. Carter, chief executive officer of NT&M Informatics, Inc., Atlanta, and the editor of "Electronic Medical Records: A Guide for Clinicians and Administrators," published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance. "This is not the time to experiment with the latest gadgets," he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand current problems within the practice, to figure out how the practice should function, and identify what keeps the practice and its current system from working in an ideal way.

Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems. The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created.

During product review, it's important to have a designated project manager whose only job is to shepherd the project through each stage. In addition, senior executive support—both administrative and clinical—is key since that group will make the final decision on a system. And staff input is essential since these are the people who really know what goes on in your practice, Dr. Carter said.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. "Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there," he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs). Tablet computers are popular but people also tend to drop them and spill coffee on them, he said.

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

When the time comes, there are a variety of ways to roll out a system, Dr. Carter said. A practice can test all the features at once through a pilot at one site in the practice. Another option is to phase in implementation of the most important features first across the entire organization.

Or a practice could opt to try a "big bang" rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing staff training is critical. It is not a one-time event. Staff will need training on the workflow change and planning aspects and the actual EHR system. Physicians will need additional training on physician-specific issues related to implementation, he said.

BOSTON — To successfully implement an electronic health record system, set clear and specific goals and involve your clinical and administrative staff in all of the planning, Jerome H. Carter, M.D., said at a congress sponsored by the American Medical Informatics Association.

"You have to plan," said Dr. Carter, chief executive officer of NT&M Informatics, Inc., Atlanta, and the editor of "Electronic Medical Records: A Guide for Clinicians and Administrators," published by the American College of Physicians.

As many as half of complex software implementations fail, Dr. Carter said, and usually for the same reasons: vague objectives, bad planning and estimation, poor project management, insufficient involvement by senior staff, and poor vendor performance. "This is not the time to experiment with the latest gadgets," he said.

Implementation doesn't start when the organization purchases the EHR products, but, rather, as soon as the group accepts the idea of moving from paper to an electronic system, Dr. Carter said.

The first step is to understand current problems within the practice, to figure out how the practice should function, and identify what keeps the practice and its current system from working in an ideal way.

Potential EHR buyers should spend at least 3–4 weeks canvassing everyone in the practice to find out the problems and goals and to create a statement to capture those ideas, he said.

The next step is a systems and process analysis to be conducted by clinicians and executive management. This is a chance to figure out if an EHR will help to solve current problems. The executive management should also assess everyone's job functions. Adding an EHR to a practice will change job functions, and it's important to make sure that all the important duties are still covered, Dr. Carter said.

Once this backgrounding has been done, a request for proposals based on practice needs can be created.

During product review, it's important to have a designated project manager whose only job is to shepherd the project through each stage. In addition, senior executive support—both administrative and clinical—is key since that group will make the final decision on a system. And staff input is essential since these are the people who really know what goes on in your practice, Dr. Carter said.

Spend time figuring out what resources will be needed in terms of new personnel, technical support, security, and equipment. "Without that level of estimation and planning, it's very likely you'll be in a situation where you need a critical person and that person is not there," he said.

Consider hardware issues. For example, it's important to consider the types of input devices that will be used, such as tablets, desktop computers, or personal digital assistants (PDAs). Tablet computers are popular but people also tend to drop them and spill coffee on them, he said.

Don't forget to factor in security issues, Dr. Carter advised. For example, practices should be sure that any system they buy is compatible with the Health Insurance Portability and Accountability Act of 1996.

When the time comes, there are a variety of ways to roll out a system, Dr. Carter said. A practice can test all the features at once through a pilot at one site in the practice. Another option is to phase in implementation of the most important features first across the entire organization.

Or a practice could opt to try a "big bang" rollout where all features are implemented across the organization at once. This approach is generally more successful in smaller practices with fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing staff training is critical. It is not a one-time event. Staff will need training on the workflow change and planning aspects and the actual EHR system. Physicians will need additional training on physician-specific issues related to implementation, he said.

BOSTON — A coalition of private sector informatics groups plans to launch a process for certifying electronic health record products late this year.

Certification will bring some predictability into the market for physicians, vendors, and payers, Mark Leavitt, M.D., who is chair of the Certification Commission for Healthcare Information Technology, said at a congress sponsored by the American Medical Informatics Association.

The commission's initial scope is to certify electronic health record (EHR) products for physician offices and other ambulatory settings. They plan to begin beta testing products as part of a pilot project in September.

By the end of the year, the commission is slated to publish certification requirements and to outline a roadmap for vendors for requirements for the next 1–2 years, Dr. Leavitt said.

The roadmap is a key part of the commission's work because the cycle for getting new features, interfaces, and interoperability functions into a product can be 6–18 months or more. "We need to signal to the industry as to where we are going next, so it has time to respond," he said.

The certification commission was founded last year by the American Health Information Management Association, the Healthcare Information and Management Systems Society (HIMSS), and the National Alliance for Health Information Technology.

The three groups have provided seed funding and have loaned staff members to the effort. As the process moves forward, the commission will charge fees to the vendors to cover the cost of testing the products. They also plan to seek sustaining grants from other organizations to maintain their operations, said Dr. Leavitt, who is also the medical director at HIMSS.

Under the voluntary certification process, products will either be certified or not certified. "We are not trying to create a competitive rating system," Dr. Leavitt said.

The idea is that the commission will be setting a baseline standard, leaving space for competition and innovation above that standard. And the standard needs to be based on reality, he said, to get participation from vendors.

In the first year of certification, the members of the commission want to be sure that they don't create any requirements that will shut down the marketplace.

Dr. Leavitt, however, said he expects that, as the standards become more rigorous in the years to come, the marketplace will evolve to follow the certification process.

Currently, adoption is progressing slowly because the market lacks order and predictability.

For example, physicians won't buy electronic records systems until costs are lower, their own risk is lower, and the incentives are higher. However, it's hard for vendors to bring down prices when the sales volumes are so low and the sales cycle is so costly.

Payers have expressed interest in offering incentives for the use of EHRs, but many are concerned that if they start to offer incentives, an industry of minimal systems will spring up to capture that money, Dr. Leavitt said.

Certification is a way to take some of the risk out of the process for all the players, Dr. Leavitt said.

Another challenge is to make sure that there isn't a wave of adoption of products that aren't interoperable.

"We want to ensure that these products that get adopted will be interoperable in this emerging infrastructure," Dr. Leavitt stated at the meeting. "The challenge is the infrastructure isn't there yet, it's emerging.

For more information on the certification timeline, visit www.cchit.org

BOSTON — A coalition of private sector informatics groups plans to launch a process for certifying electronic health record products late this year.

Certification will bring some predictability into the market for physicians, vendors, and payers, Mark Leavitt, M.D., who is chair of the Certification Commission for Healthcare Information Technology, said at a congress sponsored by the American Medical Informatics Association.

The commission's initial scope is to certify electronic health record (EHR) products for physician offices and other ambulatory settings. They plan to begin beta testing products as part of a pilot project in September.

By the end of the year, the commission is slated to publish certification requirements and to outline a roadmap for vendors for requirements for the next 1–2 years, Dr. Leavitt said.

The roadmap is a key part of the commission's work because the cycle for getting new features, interfaces, and interoperability functions into a product can be 6–18 months or more. "We need to signal to the industry as to where we are going next, so it has time to respond," he said.

The certification commission was founded last year by the American Health Information Management Association, the Healthcare Information and Management Systems Society (HIMSS), and the National Alliance for Health Information Technology.

The three groups have provided seed funding and have loaned staff members to the effort. As the process moves forward, the commission will charge fees to the vendors to cover the cost of testing the products. They also plan to seek sustaining grants from other organizations to maintain their operations, said Dr. Leavitt, who is also the medical director at HIMSS.

Under the voluntary certification process, products will either be certified or not certified. "We are not trying to create a competitive rating system," Dr. Leavitt said.

The idea is that the commission will be setting a baseline standard, leaving space for competition and innovation above that standard. And the standard needs to be based on reality, he said, to get participation from vendors.

In the first year of certification, the members of the commission want to be sure that they don't create any requirements that will shut down the marketplace.

Dr. Leavitt, however, said he expects that, as the standards become more rigorous in the years to come, the marketplace will evolve to follow the certification process.

Currently, adoption is progressing slowly because the market lacks order and predictability.

For example, physicians won't buy electronic records systems until costs are lower, their own risk is lower, and the incentives are higher. However, it's hard for vendors to bring down prices when the sales volumes are so low and the sales cycle is so costly.

Payers have expressed interest in offering incentives for the use of EHRs, but many are concerned that if they start to offer incentives, an industry of minimal systems will spring up to capture that money, Dr. Leavitt said.

Certification is a way to take some of the risk out of the process for all the players, Dr. Leavitt said.

Another challenge is to make sure that there isn't a wave of adoption of products that aren't interoperable.

"We want to ensure that these products that get adopted will be interoperable in this emerging infrastructure," Dr. Leavitt stated at the meeting. "The challenge is the infrastructure isn't there yet, it's emerging.

For more information on the certification timeline, visit www.cchit.org

BOSTON — A coalition of private sector informatics groups plans to launch a process for certifying electronic health record products late this year.

Certification will bring some predictability into the market for physicians, vendors, and payers, Mark Leavitt, M.D., who is chair of the Certification Commission for Healthcare Information Technology, said at a congress sponsored by the American Medical Informatics Association.

The commission's initial scope is to certify electronic health record (EHR) products for physician offices and other ambulatory settings. They plan to begin beta testing products as part of a pilot project in September.

By the end of the year, the commission is slated to publish certification requirements and to outline a roadmap for vendors for requirements for the next 1–2 years, Dr. Leavitt said.

The roadmap is a key part of the commission's work because the cycle for getting new features, interfaces, and interoperability functions into a product can be 6–18 months or more. "We need to signal to the industry as to where we are going next, so it has time to respond," he said.

The certification commission was founded last year by the American Health Information Management Association, the Healthcare Information and Management Systems Society (HIMSS), and the National Alliance for Health Information Technology.

The three groups have provided seed funding and have loaned staff members to the effort. As the process moves forward, the commission will charge fees to the vendors to cover the cost of testing the products. They also plan to seek sustaining grants from other organizations to maintain their operations, said Dr. Leavitt, who is also the medical director at HIMSS.

Under the voluntary certification process, products will either be certified or not certified. "We are not trying to create a competitive rating system," Dr. Leavitt said.

The idea is that the commission will be setting a baseline standard, leaving space for competition and innovation above that standard. And the standard needs to be based on reality, he said, to get participation from vendors.

In the first year of certification, the members of the commission want to be sure that they don't create any requirements that will shut down the marketplace.

Dr. Leavitt, however, said he expects that, as the standards become more rigorous in the years to come, the marketplace will evolve to follow the certification process.

Currently, adoption is progressing slowly because the market lacks order and predictability.

For example, physicians won't buy electronic records systems until costs are lower, their own risk is lower, and the incentives are higher. However, it's hard for vendors to bring down prices when the sales volumes are so low and the sales cycle is so costly.

Payers have expressed interest in offering incentives for the use of EHRs, but many are concerned that if they start to offer incentives, an industry of minimal systems will spring up to capture that money, Dr. Leavitt said.

Certification is a way to take some of the risk out of the process for all the players, Dr. Leavitt said.

Another challenge is to make sure that there isn't a wave of adoption of products that aren't interoperable.

"We want to ensure that these products that get adopted will be interoperable in this emerging infrastructure," Dr. Leavitt stated at the meeting. "The challenge is the infrastructure isn't there yet, it's emerging.

For more information on the certification timeline, visit www.cchit.org

Teen Boys Ignore Sun Protection

Boys aged 15–17 years are the group least likely to protect their skin from sun exposure, according to a survey released by the American Academy of Dermatology. Only 32% of these boys said that they are "very careful" or "somewhat careful" about sun protection, compared with 58% of girls of the same age. "Our focus has primarily been on young women," Darrell S. Rigel, M.D., professor of dermatology and dermatologic surgery at New York University Medical Center, New York, said in an interview. The survey results mean that dermatologists should also be directing their sun safety messages to teen boys as well. However, he said that getting that message out can be difficult because dermatologists generally see more women, of all ages, than men in their practice. The results are based on a national telephone survey conducted among 505 adolescent boys and girls (aged 12–17 years).

Bill to Thwart Medicare Cuts

A bipartisan bill (H.R. 2356) introduced by Rep. Clay Shaw (R-Fla.) and Rep. Ben Cardin (D-Md.) seeks to halt impending cuts to Medicare physician payments and replace the flawed formula that determines those payments. Following up on a recommendation of the Medicare Payment Advisory Commission, the bill would increase payments by no less than 2.7% in 2006. It would also repeal the sustainable growth rate adjustment, replacing it "with a methodology that ensures adequate and appropriate payments as well as stable updates for Medicare providers," Rep. Cardin said in a statement. Physicians face a 4.3% cut in Medicare payments in 2006 and subsequent cuts totaling 30% from 2007 and 2012, if the formula isn't fixed. The bill was referred to the House Ways and Means and Energy and Commerce committees. A similar Senate bill (S. 1081) would provide a positive update for 2 years.

Sunscreen Use Falls

More and more Americans are going outside without their sunscreen, according to the results of a survey released by the Sun Safety Alliance. About 60% of American adults reported using sunscreen when outdoors this year, a drop from the 72% who reported using sunscreen in a 2004 survey. When asked why they aren't using sunscreen, about 35% of survey respondents said they forgot. Respondents reported other reasons for not applying sunscreen, including that they liked the feel of the sun on their skin and the way they looked with a tan, or they did not have sunscreen handy. However, more respondents reported having encouraged others to practice sun safety behaviors; in 2004, 79% of respondents said they encouraged sun safety in others, compared with 82% this year. The survey respondents also favored public policy to address sunscreen use among children. About 51% of those surveyed said that one state's recent legislation requiring sunscreen education for all children in kindergarten through grade 8 should be passed in all states. The national telephone survey, which was conducted by Harris Interactive in May, polled 1,000 adults.

Few Seeking Quality Improvement

A majority of physicians are not actively engaged in quality improvement practices and are reluctant to share information about the quality of care they provide with the general public, a survey of more than 1,800 physicians revealed. Only one-fourth of respondents said they were using an electronic medical record routinely or occasionally, and one-third said they were redesigning their systems to improve care. In addition, just one-third said they had access to any data about the quality of their own clinical performance. Although 7 out of 10 thought physicians' clinical information should be shared with leaders of the health care systems at which they work, fewer respondents (55%) thought patients should have access to quality data about their own doctors. The survey was conducted by the Commonwealth Fund between March and May 2003 and published in the journal Health Affairs.

Medicaid Patients and Drug Access

Medicaid patients are finding it just as difficult as the uninsured to get access to prescription drugs. Researchers from the Center for Studying Health System Change found that 22% of Medicaid beneficiaries aged 18 and older could not afford to get at least one prescription filled in the previous year. Although access problems experienced by Medicaid beneficiaries were comparable with those experienced by the uninsured, only 9% of adults with employer-sponsored health coverage said they could not afford a prescribed drug in the previous year. The findings were drawn from HSC's Community Tracking Study Household Survey, a national survey involving 46,600 people in 2003 and 60,000 people in 2001.

GAO Weighs In on Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office (GAO). The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism efforts. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was "historically far in excess" of the budgeted amount. The GAO recommended that the FBI improve its monitoring capability and establish better reporting procedures. The bureau said it already has taken steps in that direction.

Teen Boys Ignore Sun Protection

Boys aged 15–17 years are the group least likely to protect their skin from sun exposure, according to a survey released by the American Academy of Dermatology. Only 32% of these boys said that they are "very careful" or "somewhat careful" about sun protection, compared with 58% of girls of the same age. "Our focus has primarily been on young women," Darrell S. Rigel, M.D., professor of dermatology and dermatologic surgery at New York University Medical Center, New York, said in an interview. The survey results mean that dermatologists should also be directing their sun safety messages to teen boys as well. However, he said that getting that message out can be difficult because dermatologists generally see more women, of all ages, than men in their practice. The results are based on a national telephone survey conducted among 505 adolescent boys and girls (aged 12–17 years).

Bill to Thwart Medicare Cuts

A bipartisan bill (H.R. 2356) introduced by Rep. Clay Shaw (R-Fla.) and Rep. Ben Cardin (D-Md.) seeks to halt impending cuts to Medicare physician payments and replace the flawed formula that determines those payments. Following up on a recommendation of the Medicare Payment Advisory Commission, the bill would increase payments by no less than 2.7% in 2006. It would also repeal the sustainable growth rate adjustment, replacing it "with a methodology that ensures adequate and appropriate payments as well as stable updates for Medicare providers," Rep. Cardin said in a statement. Physicians face a 4.3% cut in Medicare payments in 2006 and subsequent cuts totaling 30% from 2007 and 2012, if the formula isn't fixed. The bill was referred to the House Ways and Means and Energy and Commerce committees. A similar Senate bill (S. 1081) would provide a positive update for 2 years.

Sunscreen Use Falls

More and more Americans are going outside without their sunscreen, according to the results of a survey released by the Sun Safety Alliance. About 60% of American adults reported using sunscreen when outdoors this year, a drop from the 72% who reported using sunscreen in a 2004 survey. When asked why they aren't using sunscreen, about 35% of survey respondents said they forgot. Respondents reported other reasons for not applying sunscreen, including that they liked the feel of the sun on their skin and the way they looked with a tan, or they did not have sunscreen handy. However, more respondents reported having encouraged others to practice sun safety behaviors; in 2004, 79% of respondents said they encouraged sun safety in others, compared with 82% this year. The survey respondents also favored public policy to address sunscreen use among children. About 51% of those surveyed said that one state's recent legislation requiring sunscreen education for all children in kindergarten through grade 8 should be passed in all states. The national telephone survey, which was conducted by Harris Interactive in May, polled 1,000 adults.

Few Seeking Quality Improvement

A majority of physicians are not actively engaged in quality improvement practices and are reluctant to share information about the quality of care they provide with the general public, a survey of more than 1,800 physicians revealed. Only one-fourth of respondents said they were using an electronic medical record routinely or occasionally, and one-third said they were redesigning their systems to improve care. In addition, just one-third said they had access to any data about the quality of their own clinical performance. Although 7 out of 10 thought physicians' clinical information should be shared with leaders of the health care systems at which they work, fewer respondents (55%) thought patients should have access to quality data about their own doctors. The survey was conducted by the Commonwealth Fund between March and May 2003 and published in the journal Health Affairs.

Medicaid Patients and Drug Access

Medicaid patients are finding it just as difficult as the uninsured to get access to prescription drugs. Researchers from the Center for Studying Health System Change found that 22% of Medicaid beneficiaries aged 18 and older could not afford to get at least one prescription filled in the previous year. Although access problems experienced by Medicaid beneficiaries were comparable with those experienced by the uninsured, only 9% of adults with employer-sponsored health coverage said they could not afford a prescribed drug in the previous year. The findings were drawn from HSC's Community Tracking Study Household Survey, a national survey involving 46,600 people in 2003 and 60,000 people in 2001.

GAO Weighs In on Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office (GAO). The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism efforts. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was "historically far in excess" of the budgeted amount. The GAO recommended that the FBI improve its monitoring capability and establish better reporting procedures. The bureau said it already has taken steps in that direction.

Teen Boys Ignore Sun Protection

Boys aged 15–17 years are the group least likely to protect their skin from sun exposure, according to a survey released by the American Academy of Dermatology. Only 32% of these boys said that they are "very careful" or "somewhat careful" about sun protection, compared with 58% of girls of the same age. "Our focus has primarily been on young women," Darrell S. Rigel, M.D., professor of dermatology and dermatologic surgery at New York University Medical Center, New York, said in an interview. The survey results mean that dermatologists should also be directing their sun safety messages to teen boys as well. However, he said that getting that message out can be difficult because dermatologists generally see more women, of all ages, than men in their practice. The results are based on a national telephone survey conducted among 505 adolescent boys and girls (aged 12–17 years).

Bill to Thwart Medicare Cuts

A bipartisan bill (H.R. 2356) introduced by Rep. Clay Shaw (R-Fla.) and Rep. Ben Cardin (D-Md.) seeks to halt impending cuts to Medicare physician payments and replace the flawed formula that determines those payments. Following up on a recommendation of the Medicare Payment Advisory Commission, the bill would increase payments by no less than 2.7% in 2006. It would also repeal the sustainable growth rate adjustment, replacing it "with a methodology that ensures adequate and appropriate payments as well as stable updates for Medicare providers," Rep. Cardin said in a statement. Physicians face a 4.3% cut in Medicare payments in 2006 and subsequent cuts totaling 30% from 2007 and 2012, if the formula isn't fixed. The bill was referred to the House Ways and Means and Energy and Commerce committees. A similar Senate bill (S. 1081) would provide a positive update for 2 years.

Sunscreen Use Falls

More and more Americans are going outside without their sunscreen, according to the results of a survey released by the Sun Safety Alliance. About 60% of American adults reported using sunscreen when outdoors this year, a drop from the 72% who reported using sunscreen in a 2004 survey. When asked why they aren't using sunscreen, about 35% of survey respondents said they forgot. Respondents reported other reasons for not applying sunscreen, including that they liked the feel of the sun on their skin and the way they looked with a tan, or they did not have sunscreen handy. However, more respondents reported having encouraged others to practice sun safety behaviors; in 2004, 79% of respondents said they encouraged sun safety in others, compared with 82% this year. The survey respondents also favored public policy to address sunscreen use among children. About 51% of those surveyed said that one state's recent legislation requiring sunscreen education for all children in kindergarten through grade 8 should be passed in all states. The national telephone survey, which was conducted by Harris Interactive in May, polled 1,000 adults.

Few Seeking Quality Improvement

A majority of physicians are not actively engaged in quality improvement practices and are reluctant to share information about the quality of care they provide with the general public, a survey of more than 1,800 physicians revealed. Only one-fourth of respondents said they were using an electronic medical record routinely or occasionally, and one-third said they were redesigning their systems to improve care. In addition, just one-third said they had access to any data about the quality of their own clinical performance. Although 7 out of 10 thought physicians' clinical information should be shared with leaders of the health care systems at which they work, fewer respondents (55%) thought patients should have access to quality data about their own doctors. The survey was conducted by the Commonwealth Fund between March and May 2003 and published in the journal Health Affairs.

Medicaid Patients and Drug Access

Medicaid patients are finding it just as difficult as the uninsured to get access to prescription drugs. Researchers from the Center for Studying Health System Change found that 22% of Medicaid beneficiaries aged 18 and older could not afford to get at least one prescription filled in the previous year. Although access problems experienced by Medicaid beneficiaries were comparable with those experienced by the uninsured, only 9% of adults with employer-sponsored health coverage said they could not afford a prescribed drug in the previous year. The findings were drawn from HSC's Community Tracking Study Household Survey, a national survey involving 46,600 people in 2003 and 60,000 people in 2001.

GAO Weighs In on Health Fraud

The Federal Bureau of Investigation is not monitoring its spending on health care fraud investigations as carefully as it should, according to a report from the Government Accountability Office (GAO). The report, requested by the chairman of the Senate Finance Committee, Chuck Grassley (R-Iowa), found that some agents who previously were assigned to work on health care fraud had been shifted to counterterrorism efforts. The GAO said it had been told by the FBI that the bureau wasn't too concerned about not spending enough because most of the time such spending was "historically far in excess" of the budgeted amount. The GAO recommended that the FBI improve its monitoring capability and establish better reporting procedures. The bureau said it already has taken steps in that direction.

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.

Obstetricians are among the specialists who are reluctant to take call because of the liability risks involved, said Damian Alagia, M.D., vice chair of the department of ob.gyn. at the Virginia Hospital Center, Arl- ington, and president-elect of the Medical Society of the District of Columbia.

“It's a horrible situation because we're talking about the life of a baby,” he said.

While physicians recognize their obligation to take call in the emergency department, Dr. Alagia said the economic realities are different.

Obstetricians are walking into a situation where they haven't managed the pregnancy and they have no relationship with the patient. And many of the women who present in the emergency department have had little or no prenatal care, which obviously increases their risk of complications, he said.

“We're talking about the poorly insured or uninsured,” he said.

Even if physicians are compensated for taking call, it's not enough to cover the related malpractice insurance costs. The risks incurred far exceed any payment provided, Dr. Alagia said.

The answer is to provide some type of legal protection for physicians, he said. Obstetricians need to know that if they provide their best care to patients in the emergency department, they will be protected from being sued, Dr. Alagia said.

The high cost of professional liability insurance also is forcing some neurosurgeons to stop or cut back on emergency call, 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. Some 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 neurosurgeons 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 is 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., who is the 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. This worsens the burden on emergency medical groups, Dr. Fields 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 to doctors for taking call, Mr. Micklos added. Otherwise, they will be creating an incentive for physicians to begin 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.

Obstetricians are among the specialists who are reluctant to take call because of the liability risks involved, said Damian Alagia, M.D., vice chair of the department of ob.gyn. at the Virginia Hospital Center, Arl- ington, and president-elect of the Medical Society of the District of Columbia.

“It's a horrible situation because we're talking about the life of a baby,” he said.

While physicians recognize their obligation to take call in the emergency department, Dr. Alagia said the economic realities are different.

Obstetricians are walking into a situation where they haven't managed the pregnancy and they have no relationship with the patient. And many of the women who present in the emergency department have had little or no prenatal care, which obviously increases their risk of complications, he said.

“We're talking about the poorly insured or uninsured,” he said.

Even if physicians are compensated for taking call, it's not enough to cover the related malpractice insurance costs. The risks incurred far exceed any payment provided, Dr. Alagia said.

The answer is to provide some type of legal protection for physicians, he said. Obstetricians need to know that if they provide their best care to patients in the emergency department, they will be protected from being sued, Dr. Alagia said.

The high cost of professional liability insurance also is forcing some neurosurgeons to stop or cut back on emergency call, 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. Some 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 neurosurgeons 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 is 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., who is the 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. This worsens the burden on emergency medical groups, Dr. Fields 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 to doctors for taking call, Mr. Micklos added. Otherwise, they will be creating an incentive for physicians to begin 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.

Obstetricians are among the specialists who are reluctant to take call because of the liability risks involved, said Damian Alagia, M.D., vice chair of the department of ob.gyn. at the Virginia Hospital Center, Arl- ington, and president-elect of the Medical Society of the District of Columbia.

“It's a horrible situation because we're talking about the life of a baby,” he said.

While physicians recognize their obligation to take call in the emergency department, Dr. Alagia said the economic realities are different.

Obstetricians are walking into a situation where they haven't managed the pregnancy and they have no relationship with the patient. And many of the women who present in the emergency department have had little or no prenatal care, which obviously increases their risk of complications, he said.

“We're talking about the poorly insured or uninsured,” he said.

Even if physicians are compensated for taking call, it's not enough to cover the related malpractice insurance costs. The risks incurred far exceed any payment provided, Dr. Alagia said.

The answer is to provide some type of legal protection for physicians, he said. Obstetricians need to know that if they provide their best care to patients in the emergency department, they will be protected from being sued, Dr. Alagia said.

The high cost of professional liability insurance also is forcing some neurosurgeons to stop or cut back on emergency call, 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. Some 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 neurosurgeons 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 is 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., who is the 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. This worsens the burden on emergency medical groups, Dr. Fields 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 to doctors for taking call, Mr. Micklos added. Otherwise, they will be creating an incentive for physicians to begin to invest in local specialty hospitals.

BOSTON — A coalition of private sector informatics groups plans to launch a process for certifying electronic health record products late this year.

Certification will bring some predictability into the market for physicians, vendors, and payers, Mark Leavitt, M.D., chair of the Certification Commission for Healthcare Information Technology, said at a congress sponsored by the American Medical Informatics Association.

The commission's initial scope is to certify electronic health record (EHR) products for physician offices and other ambulatory settings. They plan to begin beta testing products as part of a pilot project in September.

By the end of the year, the commission is slated to publish certification requirements and to outline a roadmap for vendors for requirements for the next 1–2 years, Dr. Leavitt said.

The roadmap is a key part of the commission's work because the cycle for getting new features, interfaces, and interoperability functions into a product can be 6–18 months or more. “We need to signal to the industry as to where we are going next, so it has time to respond,” he said.

The commission was founded last year by the American Health Information Management Association, the Healthcare Information and Management Systems Society (HIMSS), and the National Alliance for Health Information Technology.

The three groups have provided seed funding and have loaned staff members to the effort. As the process moves forward, the commission will charge fees to the vendors to cover the cost of testing the products. They also plan to seek sustaining grants from other organizations to maintain their operations, said Dr. Leavitt, who is also the medical director at HIMSS.

Under the voluntary certification process, products will either be certified or not certified. “We are not trying to create a competitive rating system,” Dr. Leavitt said.

The idea is that the commission will be setting a baseline standard, leaving space for competition and innovation above that standard. And the standard needs to be based on reality, he said, to get participation from vendors.

In the first year of certification, the members of the commission want to be sure that they don't create requirements that will shut down the marketplace. However, Dr. Leavitt said he expects that as the standards become more rigorous in the years to come, the marketplace will evolve to follow the certification process.

Currently, adoption is progressing slowly because the market lacks order and predictability. For example, physicians won't buy EHR systems until costs are lower, their own risk is lower, and the incentives are higher. However, it's hard for vendors to bring down prices when the sales volumes are so low and the sales cycle is so costly.

Payers have expressed interest in offering incentives for the use of EHRs, but many are concerned that if they start to offer incentives, an industry of minimal systems will spring up to capture that money, Dr. Leavitt said.

Certification is a way to take some of the risk out of the process for all the players, Dr. Leavitt said.

Another challenge is to make sure that there isn't a wave of adoption of products that aren't interoperable.

“We want to ensure that these products that get adopted will be interoperable in this emerging infrastructure,” according to Dr. Leavitt. “The challenge is the infrastructure isn't there yet, it's emerging.”

For more information on the certification timeline, visit www.cchit.org

BOSTON — A coalition of private sector informatics groups plans to launch a process for certifying electronic health record products late this year.

Certification will bring some predictability into the market for physicians, vendors, and payers, Mark Leavitt, M.D., chair of the Certification Commission for Healthcare Information Technology, said at a congress sponsored by the American Medical Informatics Association.

The commission's initial scope is to certify electronic health record (EHR) products for physician offices and other ambulatory settings. They plan to begin beta testing products as part of a pilot project in September.

By the end of the year, the commission is slated to publish certification requirements and to outline a roadmap for vendors for requirements for the next 1–2 years, Dr. Leavitt said.

The roadmap is a key part of the commission's work because the cycle for getting new features, interfaces, and interoperability functions into a product can be 6–18 months or more. “We need to signal to the industry as to where we are going next, so it has time to respond,” he said.

The commission was founded last year by the American Health Information Management Association, the Healthcare Information and Management Systems Society (HIMSS), and the National Alliance for Health Information Technology.

The three groups have provided seed funding and have loaned staff members to the effort. As the process moves forward, the commission will charge fees to the vendors to cover the cost of testing the products. They also plan to seek sustaining grants from other organizations to maintain their operations, said Dr. Leavitt, who is also the medical director at HIMSS.

Under the voluntary certification process, products will either be certified or not certified. “We are not trying to create a competitive rating system,” Dr. Leavitt said.

The idea is that the commission will be setting a baseline standard, leaving space for competition and innovation above that standard. And the standard needs to be based on reality, he said, to get participation from vendors.

In the first year of certification, the members of the commission want to be sure that they don't create requirements that will shut down the marketplace. However, Dr. Leavitt said he expects that as the standards become more rigorous in the years to come, the marketplace will evolve to follow the certification process.

Currently, adoption is progressing slowly because the market lacks order and predictability. For example, physicians won't buy EHR systems until costs are lower, their own risk is lower, and the incentives are higher. However, it's hard for vendors to bring down prices when the sales volumes are so low and the sales cycle is so costly.

Payers have expressed interest in offering incentives for the use of EHRs, but many are concerned that if they start to offer incentives, an industry of minimal systems will spring up to capture that money, Dr. Leavitt said.

Certification is a way to take some of the risk out of the process for all the players, Dr. Leavitt said.

Another challenge is to make sure that there isn't a wave of adoption of products that aren't interoperable.

“We want to ensure that these products that get adopted will be interoperable in this emerging infrastructure,” according to Dr. Leavitt. “The challenge is the infrastructure isn't there yet, it's emerging.”

For more information on the certification timeline, visit www.cchit.org

BOSTON — A coalition of private sector informatics groups plans to launch a process for certifying electronic health record products late this year.

Certification will bring some predictability into the market for physicians, vendors, and payers, Mark Leavitt, M.D., chair of the Certification Commission for Healthcare Information Technology, said at a congress sponsored by the American Medical Informatics Association.

The commission's initial scope is to certify electronic health record (EHR) products for physician offices and other ambulatory settings. They plan to begin beta testing products as part of a pilot project in September.

By the end of the year, the commission is slated to publish certification requirements and to outline a roadmap for vendors for requirements for the next 1–2 years, Dr. Leavitt said.

The roadmap is a key part of the commission's work because the cycle for getting new features, interfaces, and interoperability functions into a product can be 6–18 months or more. “We need to signal to the industry as to where we are going next, so it has time to respond,” he said.

The commission was founded last year by the American Health Information Management Association, the Healthcare Information and Management Systems Society (HIMSS), and the National Alliance for Health Information Technology.

The three groups have provided seed funding and have loaned staff members to the effort. As the process moves forward, the commission will charge fees to the vendors to cover the cost of testing the products. They also plan to seek sustaining grants from other organizations to maintain their operations, said Dr. Leavitt, who is also the medical director at HIMSS.

Under the voluntary certification process, products will either be certified or not certified. “We are not trying to create a competitive rating system,” Dr. Leavitt said.

The idea is that the commission will be setting a baseline standard, leaving space for competition and innovation above that standard. And the standard needs to be based on reality, he said, to get participation from vendors.

In the first year of certification, the members of the commission want to be sure that they don't create requirements that will shut down the marketplace. However, Dr. Leavitt said he expects that as the standards become more rigorous in the years to come, the marketplace will evolve to follow the certification process.

Currently, adoption is progressing slowly because the market lacks order and predictability. For example, physicians won't buy EHR systems until costs are lower, their own risk is lower, and the incentives are higher. However, it's hard for vendors to bring down prices when the sales volumes are so low and the sales cycle is so costly.

Payers have expressed interest in offering incentives for the use of EHRs, but many are concerned that if they start to offer incentives, an industry of minimal systems will spring up to capture that money, Dr. Leavitt said.

Certification is a way to take some of the risk out of the process for all the players, Dr. Leavitt said.

Another challenge is to make sure that there isn't a wave of adoption of products that aren't interoperable.

“We want to ensure that these products that get adopted will be interoperable in this emerging infrastructure,” according to Dr. Leavitt. “The challenge is the infrastructure isn't there yet, it's emerging.”

For more information on the certification timeline, visit www.cchit.org