Mary Ellen Schneider

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 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.

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. For example, 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 only two sites and 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 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.

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. For example, 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 only two sites and 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 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.

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. For example, 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 only two sites and 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.

Taking a crucial first step in an effort to make pay for performance work for office-based physicians, a coalition of physician groups, insurers, and the federal government has endorsed a set of 26 clinical performance measures for the ambulatory care setting.

The coalition—the Ambulatory care Quality Alliance (AQA)—was formed last year by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality.

The starter set of 26 measures focuses on prevention, chronic care, and the overuse and misuse of certain treatments. The set could be implemented as early as next year

A unified set of measures will be valuable, said Paul Gluck, M.D., chair of the quality improvement and patient safety committee of the American College of Obstetricians and Gynecologists, but the key is choosing the right ones.

Quality targets should be based on whether they can be measured, whether they will improve care, and whether the physicians can influence the target, said Dr. Gluck of the University of Miami.

AQA's starter set of measures was assembled from existing measures developed by either the Physician Consortium for Performance Improvement or the National Committee for Quality Assurance. Most of the measures are now under review by the National Quality Forum.

AQA compiled the set in part to reduce the administrative burden on physicians, said John Tooker, M.D., CEO and executive vice president of the American College of Physicians. Most physicians deal with multiple health plans, and having a single set of uniform measures used across all plans would lessen the hassle factor for physicians, he said.

In addition to being less of an administrative burden, the measures are evidence based and were developed with physician input, he said.

The measures still need to be validated in the field. Dr. Tooker said he expects the measures will be adopted as they are ready to be implemented, possibly as early as next year.

AQA will also work this year on setting standards for data aggregation and reporting. And in the future, AQA plans to expand the measure set to include subspecialties outside of primary care.

The measures in the starter set were selected based on their clinical importance and scientific validity, feasibility, and their relevance to consumers, purchasers, and physician performance.

The starter set includes measures of preventive care related to breast cancer screening, colorectal cancer screening, cervical cancer screening, tobacco use and cessation, and vaccination for influenza and pneumonia. Other measures address prenatal care, diabetes, asthma, and depression.

This movement toward performance measures and pay for performance programs is already happening in many parts of the country, said Alan Nelson, M.D., a member of the Medicare Payment Advisory Commission (MedPAC) and a special advisor to the CEO of ACP.

“The pressure is coming from the purchasers of care who are insisting on buying value,” he said. “Medicare is taking the same approach.”

Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services, said his agency supports the AQA's efforts to implement valid, reliable measures. In a statement, Dr. McClellan called the initial set of measures a “milestone” in the area of ambulatory care.

But Dr. Nelson said he is concerned that most solo and small group practices are not equipped to gather and document the data needed to show compliance with the measures. As this effort moves forward, physicians will need to create patient registries and some efficient way of collecting the data needed for pay for performance.

MedPAC has acknowledged that difficulty and recommended that, under Medicare pay-for-performance initiatives, only information that can be collected through claims data should be used, he said.

Many of the performance measures that are being pushed by AQA are already in use within the Department of Veterans Affairs, said Rowen Zetterman, M.D., chief of staff at the VA Nebraska-Western Iowa Healthcare System in Omaha.

That bodes well for programs that use the measures going forward, since the VA has been able to significantly improve quality through its use of performance measures, Dr. Zetterman said.

The starter-set measures are online at www.ahrq.gov/qual/aqastart.htm

Taking a crucial first step in an effort to make pay for performance work for office-based physicians, a coalition of physician groups, insurers, and the federal government has endorsed a set of 26 clinical performance measures for the ambulatory care setting.

The coalition—the Ambulatory care Quality Alliance (AQA)—was formed last year by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality.

The starter set of 26 measures focuses on prevention, chronic care, and the overuse and misuse of certain treatments. The set could be implemented as early as next year

A unified set of measures will be valuable, said Paul Gluck, M.D., chair of the quality improvement and patient safety committee of the American College of Obstetricians and Gynecologists, but the key is choosing the right ones.

Quality targets should be based on whether they can be measured, whether they will improve care, and whether the physicians can influence the target, said Dr. Gluck of the University of Miami.

AQA's starter set of measures was assembled from existing measures developed by either the Physician Consortium for Performance Improvement or the National Committee for Quality Assurance. Most of the measures are now under review by the National Quality Forum.

AQA compiled the set in part to reduce the administrative burden on physicians, said John Tooker, M.D., CEO and executive vice president of the American College of Physicians. Most physicians deal with multiple health plans, and having a single set of uniform measures used across all plans would lessen the hassle factor for physicians, he said.

In addition to being less of an administrative burden, the measures are evidence based and were developed with physician input, he said.

The measures still need to be validated in the field. Dr. Tooker said he expects the measures will be adopted as they are ready to be implemented, possibly as early as next year.

AQA will also work this year on setting standards for data aggregation and reporting. And in the future, AQA plans to expand the measure set to include subspecialties outside of primary care.

The measures in the starter set were selected based on their clinical importance and scientific validity, feasibility, and their relevance to consumers, purchasers, and physician performance.

The starter set includes measures of preventive care related to breast cancer screening, colorectal cancer screening, cervical cancer screening, tobacco use and cessation, and vaccination for influenza and pneumonia. Other measures address prenatal care, diabetes, asthma, and depression.

This movement toward performance measures and pay for performance programs is already happening in many parts of the country, said Alan Nelson, M.D., a member of the Medicare Payment Advisory Commission (MedPAC) and a special advisor to the CEO of ACP.

“The pressure is coming from the purchasers of care who are insisting on buying value,” he said. “Medicare is taking the same approach.”

Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services, said his agency supports the AQA's efforts to implement valid, reliable measures. In a statement, Dr. McClellan called the initial set of measures a “milestone” in the area of ambulatory care.

But Dr. Nelson said he is concerned that most solo and small group practices are not equipped to gather and document the data needed to show compliance with the measures. As this effort moves forward, physicians will need to create patient registries and some efficient way of collecting the data needed for pay for performance.

MedPAC has acknowledged that difficulty and recommended that, under Medicare pay-for-performance initiatives, only information that can be collected through claims data should be used, he said.

Many of the performance measures that are being pushed by AQA are already in use within the Department of Veterans Affairs, said Rowen Zetterman, M.D., chief of staff at the VA Nebraska-Western Iowa Healthcare System in Omaha.

That bodes well for programs that use the measures going forward, since the VA has been able to significantly improve quality through its use of performance measures, Dr. Zetterman said.

The starter-set measures are online at www.ahrq.gov/qual/aqastart.htm

Taking a crucial first step in an effort to make pay for performance work for office-based physicians, a coalition of physician groups, insurers, and the federal government has endorsed a set of 26 clinical performance measures for the ambulatory care setting.

The coalition—the Ambulatory care Quality Alliance (AQA)—was formed last year by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality.

The starter set of 26 measures focuses on prevention, chronic care, and the overuse and misuse of certain treatments. The set could be implemented as early as next year

A unified set of measures will be valuable, said Paul Gluck, M.D., chair of the quality improvement and patient safety committee of the American College of Obstetricians and Gynecologists, but the key is choosing the right ones.

Quality targets should be based on whether they can be measured, whether they will improve care, and whether the physicians can influence the target, said Dr. Gluck of the University of Miami.

AQA's starter set of measures was assembled from existing measures developed by either the Physician Consortium for Performance Improvement or the National Committee for Quality Assurance. Most of the measures are now under review by the National Quality Forum.

AQA compiled the set in part to reduce the administrative burden on physicians, said John Tooker, M.D., CEO and executive vice president of the American College of Physicians. Most physicians deal with multiple health plans, and having a single set of uniform measures used across all plans would lessen the hassle factor for physicians, he said.

In addition to being less of an administrative burden, the measures are evidence based and were developed with physician input, he said.

The measures still need to be validated in the field. Dr. Tooker said he expects the measures will be adopted as they are ready to be implemented, possibly as early as next year.

AQA will also work this year on setting standards for data aggregation and reporting. And in the future, AQA plans to expand the measure set to include subspecialties outside of primary care.

The measures in the starter set were selected based on their clinical importance and scientific validity, feasibility, and their relevance to consumers, purchasers, and physician performance.

The starter set includes measures of preventive care related to breast cancer screening, colorectal cancer screening, cervical cancer screening, tobacco use and cessation, and vaccination for influenza and pneumonia. Other measures address prenatal care, diabetes, asthma, and depression.

This movement toward performance measures and pay for performance programs is already happening in many parts of the country, said Alan Nelson, M.D., a member of the Medicare Payment Advisory Commission (MedPAC) and a special advisor to the CEO of ACP.

“The pressure is coming from the purchasers of care who are insisting on buying value,” he said. “Medicare is taking the same approach.”

Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services, said his agency supports the AQA's efforts to implement valid, reliable measures. In a statement, Dr. McClellan called the initial set of measures a “milestone” in the area of ambulatory care.

But Dr. Nelson said he is concerned that most solo and small group practices are not equipped to gather and document the data needed to show compliance with the measures. As this effort moves forward, physicians will need to create patient registries and some efficient way of collecting the data needed for pay for performance.

MedPAC has acknowledged that difficulty and recommended that, under Medicare pay-for-performance initiatives, only information that can be collected through claims data should be used, he said.

Many of the performance measures that are being pushed by AQA are already in use within the Department of Veterans Affairs, said Rowen Zetterman, M.D., chief of staff at the VA Nebraska-Western Iowa Healthcare System in Omaha.

That bodes well for programs that use the measures going forward, since the VA has been able to significantly improve quality through its use of performance measures, Dr. Zetterman said.

The starter-set measures are online at www.ahrq.gov/qual/aqastart.htm

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 and approving standards, but there isn't a process for harmonizing two conflicting standards, according to Dr. Brailer.

In addition, there is no unified maintenance or release schedule for standards so that the industry can know what's coming and build investment plans around it.

Further, there is no means of providing input into the standards process, he said. For example, there isn't a mechanism for taking a problem 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 said.

Harmonized standards are at the core of interoperability, but even with standards there are many other factors in achieving interoperability, he said.

One less well-known obstacle to interoperability is the lack of clear policies about data control. Health care right now lacks even a vocabulary to talk about the control of data, Dr. Brailer said.

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 set of problems, Dr. Brailer said. Currently, it's possible for any two health care organizations to be compliant with the Health Insurance Portability and Accountability Act of 1996 and still have security practices that render their data unable to be shared.

For example, one organization may adopt user names and passwords for authentication while another organization uses a biometric thumbprint.

Some solutions are being developed to bridge the different levels of security. For example, security brokers or other third parties could navigate between two systems. And some states have talked about creating more requirements for uniformity of security practices.

“I think 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 be able to deliver on the vendor's promises of interoperability. The industry is taking a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, a group that will certify that EHRs and other products meet minimum standards.

This work is important not just so that EHRs will one day become “plug and play” technology, Dr. Brailer said, but also because it will take some of the risk out of the marketplace.

But ultimately, interoperable EHRs can't become successful without a viable business model. The industry is just starting to experiment with the value drivers in this area, such as research, clinical improvement, and transaction simplification compared with paper.

“The government's not going to tell you what the business model is,” Dr. Brailer said.

The challenge is not just what the business benefit is but who receives it, he said. And Dr. Brailer predicts that this interplay of costs and benefits will lead to new relationships between providers and payers and other entities.

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 and approving standards, but there isn't a process for harmonizing two conflicting standards, according to Dr. Brailer.

In addition, there is no unified maintenance or release schedule for standards so that the industry can know what's coming and build investment plans around it.

Further, there is no means of providing input into the standards process, he said. For example, there isn't a mechanism for taking a problem 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 said.

Harmonized standards are at the core of interoperability, but even with standards there are many other factors in achieving interoperability, he said.

One less well-known obstacle to interoperability is the lack of clear policies about data control. Health care right now lacks even a vocabulary to talk about the control of data, Dr. Brailer said.

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 set of problems, Dr. Brailer said. Currently, it's possible for any two health care organizations to be compliant with the Health Insurance Portability and Accountability Act of 1996 and still have security practices that render their data unable to be shared.

For example, one organization may adopt user names and passwords for authentication while another organization uses a biometric thumbprint.

Some solutions are being developed to bridge the different levels of security. For example, security brokers or other third parties could navigate between two systems. And some states have talked about creating more requirements for uniformity of security practices.

“I think 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 be able to deliver on the vendor's promises of interoperability. The industry is taking a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, a group that will certify that EHRs and other products meet minimum standards.

This work is important not just so that EHRs will one day become “plug and play” technology, Dr. Brailer said, but also because it will take some of the risk out of the marketplace.

But ultimately, interoperable EHRs can't become successful without a viable business model. The industry is just starting to experiment with the value drivers in this area, such as research, clinical improvement, and transaction simplification compared with paper.

“The government's not going to tell you what the business model is,” Dr. Brailer said.

The challenge is not just what the business benefit is but who receives it, he said. And Dr. Brailer predicts that this interplay of costs and benefits will lead to new relationships between providers and payers and other entities.

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 and approving standards, but there isn't a process for harmonizing two conflicting standards, according to Dr. Brailer.

In addition, there is no unified maintenance or release schedule for standards so that the industry can know what's coming and build investment plans around it.

Further, there is no means of providing input into the standards process, he said. For example, there isn't a mechanism for taking a problem 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 said.

Harmonized standards are at the core of interoperability, but even with standards there are many other factors in achieving interoperability, he said.

One less well-known obstacle to interoperability is the lack of clear policies about data control. Health care right now lacks even a vocabulary to talk about the control of data, Dr. Brailer said.

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 set of problems, Dr. Brailer said. Currently, it's possible for any two health care organizations to be compliant with the Health Insurance Portability and Accountability Act of 1996 and still have security practices that render their data unable to be shared.

For example, one organization may adopt user names and passwords for authentication while another organization uses a biometric thumbprint.

Some solutions are being developed to bridge the different levels of security. For example, security brokers or other third parties could navigate between two systems. And some states have talked about creating more requirements for uniformity of security practices.

“I think 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 be able to deliver on the vendor's promises of interoperability. The industry is taking a step in that direction with the formation last year of the Certification Commission for Healthcare Information Technology, a group that will certify that EHRs and other products meet minimum standards.

This work is important not just so that EHRs will one day become “plug and play” technology, Dr. Brailer said, but also because it will take some of the risk out of the marketplace.

But ultimately, interoperable EHRs can't become successful without a viable business model. The industry is just starting to experiment with the value drivers in this area, such as research, clinical improvement, and transaction simplification compared with paper.

“The government's not going to tell you what the business model is,” Dr. Brailer said.

The challenge is not just what the business benefit is but who receives it, he said. And Dr. Brailer predicts that this interplay of costs and benefits will lead to new relationships between providers and payers and other entities.

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 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 by clinicians and executive management. This is a chance to figure out whether an EHR will help 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 background research 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. 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. For example, 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 only two sites and fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing 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 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 by clinicians and executive management. This is a chance to figure out whether an EHR will help 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 background research 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. 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. For example, 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 only two sites and fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing 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 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 by clinicians and executive management. This is a chance to figure out whether an EHR will help 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 background research 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. 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. For example, 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 only two sites and fewer than 10 physicians, Dr. Carter said.

Regardless of the type of rollout, ongoing 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.

Stem Cell Ethics

All institutions conducting research using human embryonic stem cells should establish special oversight committees to review the research, according to a report that was issued by the National Research Council and the Institute of Medicine. But these committees should replace existing institutional review boards, the report stated. The report includes research guidelines, such as one stating that leftover blastocysts at in-vitro fertilization clinics should not be donated for research without consent and another advising researchers not to ask fertility doctors to create more embryos than necessary for reproductive treatments. “A standard set of requirements for deriving, storing, distributing, and using embryonic stem cell lines—one to which the entire U.S. community adheres—is the best way for this research to move forward,” said Richard O. Hynes, Ph.D., who is the cochair of the committee and professor of cancer research at the Massachusetts Institute of Technology. The report is available online at

http://national-academies.org

Obtaining Emergency Contraception

Emergency contraception may not be available at hospitals even in states that require emergency departments to provide it, according to a study published in the Annals of Emergency Medicine. The study, published online in May, is based on a telephone survey of 587 Catholic hospitals and 615 non-Catholic hospitals. About 42% of non-Catholic hospitals and 55% of Catholic hospitals reported that their emergency department does not dispense emergency contraception under any circumstance. About one-third of all hospitals surveyed said emergency contraception is available with some restrictions. For example, some hospitals require a woman to take a pregnancy test first, and others will only provide it to victims of sexual assault. The survey was conducted by Ibis Reproductive Health, a Cambridge, Mass.-based women's reproductive-health research and advocacy group.

Improving the WIC Program

Changes are needed to the Special Supplemental Nutrition Program for Women, Infants, and Children to promote breastfeeding and encourage participants to eat more whole grains, fruits, and vegetables, according to the Institute of Medicine. In its report, the IOM recommends that WIC revise its food packages for women who are breastfeeding. The packages should include greater amounts and a wider variety of food such as milk, eggs, cheese, and whole grains. The IOM also recommended that participants be given vouchers or coupons for fresh produce totaling $10 per month for each woman and $8 per month for each child. In fiscal year 2003, an average of 7.63 million people received WIC benefits each month. About 3.82 million were children, 1.95 million were infants, and 1.86 million were women. The report is available online at

http://national-academies.org

Teen's Abortion Allowed

A Florida judge last month cleared the way for a 13-year-old girl to have an abortion. This comes as state lawmakers consider legislation to require parental notification when minors seek abortions. The case was controversial in Florida, where the girl is a ward of the state. She had initially sought help from her caseworker to seek an abortion, but the state's Department of Children and Families had obtained a court order to block the procedure. That order was overturned after the American Civil Liberties Union fielded an appeal on the teen's behalf and Florida Gov. Jeb Bush (R) announced he would not block her efforts to obtain an abortion. The state's Supreme Court struck down a parental-notification law in 1999, but last year a ballot measure was passed to amend the constitution to allow the law to be enacted.

Lobbying for Breast-Feeding

Mothers descended on Capitol Hill last month to support legislation that would offer incentives for women to breast-feed or pump milk while at work. The Breast-Feeding Promotion Act of 2005 (H.R. 2122) would provide tax incentives to businesses that establish private lactation areas in the workplace and would amend the Civil Rights Act of 1964 to provide protections for breast-feeding mothers at work. The bill also seeks to make the purchase of breast-feeding equipment tax deductible. “We want to make sure that any woman who decides to breast-feed will get all the support she needs,” said Rep. Carolyn Maloney (D.-N.Y.), one of the sponsors of the legislation. “The United States has one of the lowest breast-feeding rates in the industrialized world and one of the highest rates of infant mortality; we need to reverse that.” The bill had been previously introduced in the last two sessions of Congress.

Stem Cell Ethics

All institutions conducting research using human embryonic stem cells should establish special oversight committees to review the research, according to a report that was issued by the National Research Council and the Institute of Medicine. But these committees should replace existing institutional review boards, the report stated. The report includes research guidelines, such as one stating that leftover blastocysts at in-vitro fertilization clinics should not be donated for research without consent and another advising researchers not to ask fertility doctors to create more embryos than necessary for reproductive treatments. “A standard set of requirements for deriving, storing, distributing, and using embryonic stem cell lines—one to which the entire U.S. community adheres—is the best way for this research to move forward,” said Richard O. Hynes, Ph.D., who is the cochair of the committee and professor of cancer research at the Massachusetts Institute of Technology. The report is available online at

http://national-academies.org

Obtaining Emergency Contraception

Emergency contraception may not be available at hospitals even in states that require emergency departments to provide it, according to a study published in the Annals of Emergency Medicine. The study, published online in May, is based on a telephone survey of 587 Catholic hospitals and 615 non-Catholic hospitals. About 42% of non-Catholic hospitals and 55% of Catholic hospitals reported that their emergency department does not dispense emergency contraception under any circumstance. About one-third of all hospitals surveyed said emergency contraception is available with some restrictions. For example, some hospitals require a woman to take a pregnancy test first, and others will only provide it to victims of sexual assault. The survey was conducted by Ibis Reproductive Health, a Cambridge, Mass.-based women's reproductive-health research and advocacy group.

Improving the WIC Program

Changes are needed to the Special Supplemental Nutrition Program for Women, Infants, and Children to promote breastfeeding and encourage participants to eat more whole grains, fruits, and vegetables, according to the Institute of Medicine. In its report, the IOM recommends that WIC revise its food packages for women who are breastfeeding. The packages should include greater amounts and a wider variety of food such as milk, eggs, cheese, and whole grains. The IOM also recommended that participants be given vouchers or coupons for fresh produce totaling $10 per month for each woman and $8 per month for each child. In fiscal year 2003, an average of 7.63 million people received WIC benefits each month. About 3.82 million were children, 1.95 million were infants, and 1.86 million were women. The report is available online at

http://national-academies.org

Teen's Abortion Allowed

A Florida judge last month cleared the way for a 13-year-old girl to have an abortion. This comes as state lawmakers consider legislation to require parental notification when minors seek abortions. The case was controversial in Florida, where the girl is a ward of the state. She had initially sought help from her caseworker to seek an abortion, but the state's Department of Children and Families had obtained a court order to block the procedure. That order was overturned after the American Civil Liberties Union fielded an appeal on the teen's behalf and Florida Gov. Jeb Bush (R) announced he would not block her efforts to obtain an abortion. The state's Supreme Court struck down a parental-notification law in 1999, but last year a ballot measure was passed to amend the constitution to allow the law to be enacted.

Lobbying for Breast-Feeding

Mothers descended on Capitol Hill last month to support legislation that would offer incentives for women to breast-feed or pump milk while at work. The Breast-Feeding Promotion Act of 2005 (H.R. 2122) would provide tax incentives to businesses that establish private lactation areas in the workplace and would amend the Civil Rights Act of 1964 to provide protections for breast-feeding mothers at work. The bill also seeks to make the purchase of breast-feeding equipment tax deductible. “We want to make sure that any woman who decides to breast-feed will get all the support she needs,” said Rep. Carolyn Maloney (D.-N.Y.), one of the sponsors of the legislation. “The United States has one of the lowest breast-feeding rates in the industrialized world and one of the highest rates of infant mortality; we need to reverse that.” The bill had been previously introduced in the last two sessions of Congress.

Stem Cell Ethics

All institutions conducting research using human embryonic stem cells should establish special oversight committees to review the research, according to a report that was issued by the National Research Council and the Institute of Medicine. But these committees should replace existing institutional review boards, the report stated. The report includes research guidelines, such as one stating that leftover blastocysts at in-vitro fertilization clinics should not be donated for research without consent and another advising researchers not to ask fertility doctors to create more embryos than necessary for reproductive treatments. “A standard set of requirements for deriving, storing, distributing, and using embryonic stem cell lines—one to which the entire U.S. community adheres—is the best way for this research to move forward,” said Richard O. Hynes, Ph.D., who is the cochair of the committee and professor of cancer research at the Massachusetts Institute of Technology. The report is available online at

http://national-academies.org

Obtaining Emergency Contraception

Emergency contraception may not be available at hospitals even in states that require emergency departments to provide it, according to a study published in the Annals of Emergency Medicine. The study, published online in May, is based on a telephone survey of 587 Catholic hospitals and 615 non-Catholic hospitals. About 42% of non-Catholic hospitals and 55% of Catholic hospitals reported that their emergency department does not dispense emergency contraception under any circumstance. About one-third of all hospitals surveyed said emergency contraception is available with some restrictions. For example, some hospitals require a woman to take a pregnancy test first, and others will only provide it to victims of sexual assault. The survey was conducted by Ibis Reproductive Health, a Cambridge, Mass.-based women's reproductive-health research and advocacy group.

Improving the WIC Program

Changes are needed to the Special Supplemental Nutrition Program for Women, Infants, and Children to promote breastfeeding and encourage participants to eat more whole grains, fruits, and vegetables, according to the Institute of Medicine. In its report, the IOM recommends that WIC revise its food packages for women who are breastfeeding. The packages should include greater amounts and a wider variety of food such as milk, eggs, cheese, and whole grains. The IOM also recommended that participants be given vouchers or coupons for fresh produce totaling $10 per month for each woman and $8 per month for each child. In fiscal year 2003, an average of 7.63 million people received WIC benefits each month. About 3.82 million were children, 1.95 million were infants, and 1.86 million were women. The report is available online at

http://national-academies.org

Teen's Abortion Allowed

A Florida judge last month cleared the way for a 13-year-old girl to have an abortion. This comes as state lawmakers consider legislation to require parental notification when minors seek abortions. The case was controversial in Florida, where the girl is a ward of the state. She had initially sought help from her caseworker to seek an abortion, but the state's Department of Children and Families had obtained a court order to block the procedure. That order was overturned after the American Civil Liberties Union fielded an appeal on the teen's behalf and Florida Gov. Jeb Bush (R) announced he would not block her efforts to obtain an abortion. The state's Supreme Court struck down a parental-notification law in 1999, but last year a ballot measure was passed to amend the constitution to allow the law to be enacted.

Lobbying for Breast-Feeding

Mothers descended on Capitol Hill last month to support legislation that would offer incentives for women to breast-feed or pump milk while at work. The Breast-Feeding Promotion Act of 2005 (H.R. 2122) would provide tax incentives to businesses that establish private lactation areas in the workplace and would amend the Civil Rights Act of 1964 to provide protections for breast-feeding mothers at work. The bill also seeks to make the purchase of breast-feeding equipment tax deductible. “We want to make sure that any woman who decides to breast-feed will get all the support she needs,” said Rep. Carolyn Maloney (D.-N.Y.), one of the sponsors of the legislation. “The United States has one of the lowest breast-feeding rates in the industrialized world and one of the highest rates of infant mortality; we need to reverse that.” The bill had been previously introduced in the last two sessions of Congress.

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 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. 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. For example, 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 only two sites and 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.

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 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. 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. For example, 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 only two sites and 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.

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 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. 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. For example, 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 only two sites and 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.

Legislation on Lupus

New legislation aims to strengthen federal efforts to identify the causes of and a cure for lupus. The Lupus Research, Education, Awareness, Communication, and Healthcare Amendments of 2005 (S. 756) would instruct the director of the National Institutes of Health to coordinate lupus research activities within the institutes. The bill also calls for clinical research into the development and evaluation of new treatments, research to validate lupus biomarkers, and research to develop improved diagnostic tests. The bill would also authorize a national epidemiologic study to determine the prevalence and incidence of lupus in the United States. “It has been nearly 40 years since the U.S. Food and Drug Administration approved a new medication specifically for lupus,” Sandra C. Raymond, president and CEO of the Lupus Foundation of America, said in a statement. “Ultimately, this legislation will stimulate additional investment in research that will lead to the development of safer and more effective therapies.” Sen. Robert Bennett (R.-Utah) introduced the legislation, which was referred to the Senate Health, Education, Labor, and Pensions committee.

Arthritis Patients Lack Insurance

Nearly 12% of nonelderly adults in the United States who report having arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia are uninsured, according to government statistics. And 59% of uninsured adults with arthritis-related conditions have unmet need for either medical care or prescription drugs, according to the Robert Wood Johnson Foundation, which analyzed data from the Centers for Disease Control and Prevention's National Center for Health Statistics. The analysis showed that uninsured adults with arthritis were 4.5 times as likely as insured adults with the same condition to have unmet need for medical care or prescription drugs.

Campaign For Psoriasis Funding

The National Psoriasis Foundation has launched a letter-writing campaign to lobby Congress for increased federal funding for research into psoriasis and psoriatic arthritis. The Foundation added an online advocacy tool to its Web site—

www.psoriasis.org

E-Prescribing Standards

Medicare should adopt a program-wide system of uniform national electronic prescribing standards for its new prescription drug benefit, according to the Pharmaceutical Care Management Association (PCMA). A uniform national standard is key to maximizing the participation of private plans in the Part D benefit and in helping to reduce regional variations in health care delivery and outcomes, PCMA said in comments to the Centers for Medicare and Medicaid Services on its proposed rule for Medicare e-prescribing standards. “PCMA believes that Medicare e-prescribing holds the potential to transform the health care delivery system,” PCMA President Mark Merritt said in a statement. “Regrettably, a 50-state patchwork approach would increase costs, decrease efficiency, and severely undermine the promise of e-prescribing.” The organization also urged CMS officials to preempt duplicative and conflicting state laws that could increase costs.

CMS: Pay for Performance Works

Preliminary data indicate that pay-for-performance is improving quality of care in hospitals. A 3-year demonstration project sponsored by the CMS is tracking hospital performance on a set of 34 measures of processes and outcomes of care for five common clinical conditions. Reports from more than 270 participating hospitals on their experiences during the project's first year show that median quality scores improved in all of the clinical areas. For example, scores increased from 90% to 93% for patients with acute myocardial infarction; from 64% to 76% for patients with heart failure; and from 70% to 80% for patients with pneumonia. These early returns demonstrate that using financial incentives works to deliver better patient care and to avoid costly complications for patients, said CMS Administrator Mark B. McClellan, M.D.

New Medicare Wheelchair Policy

Ability to function is the primary criterion in the CMs' new national coverage policy for power wheelchairs and scooters. The criteria look at how well the beneficiary can accomplish activities of daily living such as toileting, grooming, and eating with and without using a wheelchair or other mobility device. The criteria are “part of our efforts to ensure that seniors who need mobility help will get it promptly, and that we are paying appropriately for mobility assistive equipment,” Dr. McClellan said in a statement. The coverage policy is one element in Medicare's year-old effort to improve the coverage, payment, and quality of suppliers for wheelchairs and scooters. That effort was launched after Medicare spending on mobility equipment rose to $1.2 billion annually.

Legislation on Lupus

New legislation aims to strengthen federal efforts to identify the causes of and a cure for lupus. The Lupus Research, Education, Awareness, Communication, and Healthcare Amendments of 2005 (S. 756) would instruct the director of the National Institutes of Health to coordinate lupus research activities within the institutes. The bill also calls for clinical research into the development and evaluation of new treatments, research to validate lupus biomarkers, and research to develop improved diagnostic tests. The bill would also authorize a national epidemiologic study to determine the prevalence and incidence of lupus in the United States. “It has been nearly 40 years since the U.S. Food and Drug Administration approved a new medication specifically for lupus,” Sandra C. Raymond, president and CEO of the Lupus Foundation of America, said in a statement. “Ultimately, this legislation will stimulate additional investment in research that will lead to the development of safer and more effective therapies.” Sen. Robert Bennett (R.-Utah) introduced the legislation, which was referred to the Senate Health, Education, Labor, and Pensions committee.

Arthritis Patients Lack Insurance

Nearly 12% of nonelderly adults in the United States who report having arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia are uninsured, according to government statistics. And 59% of uninsured adults with arthritis-related conditions have unmet need for either medical care or prescription drugs, according to the Robert Wood Johnson Foundation, which analyzed data from the Centers for Disease Control and Prevention's National Center for Health Statistics. The analysis showed that uninsured adults with arthritis were 4.5 times as likely as insured adults with the same condition to have unmet need for medical care or prescription drugs.

Campaign For Psoriasis Funding

The National Psoriasis Foundation has launched a letter-writing campaign to lobby Congress for increased federal funding for research into psoriasis and psoriatic arthritis. The Foundation added an online advocacy tool to its Web site—

www.psoriasis.org

E-Prescribing Standards

Medicare should adopt a program-wide system of uniform national electronic prescribing standards for its new prescription drug benefit, according to the Pharmaceutical Care Management Association (PCMA). A uniform national standard is key to maximizing the participation of private plans in the Part D benefit and in helping to reduce regional variations in health care delivery and outcomes, PCMA said in comments to the Centers for Medicare and Medicaid Services on its proposed rule for Medicare e-prescribing standards. “PCMA believes that Medicare e-prescribing holds the potential to transform the health care delivery system,” PCMA President Mark Merritt said in a statement. “Regrettably, a 50-state patchwork approach would increase costs, decrease efficiency, and severely undermine the promise of e-prescribing.” The organization also urged CMS officials to preempt duplicative and conflicting state laws that could increase costs.

CMS: Pay for Performance Works

Preliminary data indicate that pay-for-performance is improving quality of care in hospitals. A 3-year demonstration project sponsored by the CMS is tracking hospital performance on a set of 34 measures of processes and outcomes of care for five common clinical conditions. Reports from more than 270 participating hospitals on their experiences during the project's first year show that median quality scores improved in all of the clinical areas. For example, scores increased from 90% to 93% for patients with acute myocardial infarction; from 64% to 76% for patients with heart failure; and from 70% to 80% for patients with pneumonia. These early returns demonstrate that using financial incentives works to deliver better patient care and to avoid costly complications for patients, said CMS Administrator Mark B. McClellan, M.D.

New Medicare Wheelchair Policy

Ability to function is the primary criterion in the CMs' new national coverage policy for power wheelchairs and scooters. The criteria look at how well the beneficiary can accomplish activities of daily living such as toileting, grooming, and eating with and without using a wheelchair or other mobility device. The criteria are “part of our efforts to ensure that seniors who need mobility help will get it promptly, and that we are paying appropriately for mobility assistive equipment,” Dr. McClellan said in a statement. The coverage policy is one element in Medicare's year-old effort to improve the coverage, payment, and quality of suppliers for wheelchairs and scooters. That effort was launched after Medicare spending on mobility equipment rose to $1.2 billion annually.

Legislation on Lupus

New legislation aims to strengthen federal efforts to identify the causes of and a cure for lupus. The Lupus Research, Education, Awareness, Communication, and Healthcare Amendments of 2005 (S. 756) would instruct the director of the National Institutes of Health to coordinate lupus research activities within the institutes. The bill also calls for clinical research into the development and evaluation of new treatments, research to validate lupus biomarkers, and research to develop improved diagnostic tests. The bill would also authorize a national epidemiologic study to determine the prevalence and incidence of lupus in the United States. “It has been nearly 40 years since the U.S. Food and Drug Administration approved a new medication specifically for lupus,” Sandra C. Raymond, president and CEO of the Lupus Foundation of America, said in a statement. “Ultimately, this legislation will stimulate additional investment in research that will lead to the development of safer and more effective therapies.” Sen. Robert Bennett (R.-Utah) introduced the legislation, which was referred to the Senate Health, Education, Labor, and Pensions committee.

Arthritis Patients Lack Insurance

Nearly 12% of nonelderly adults in the United States who report having arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia are uninsured, according to government statistics. And 59% of uninsured adults with arthritis-related conditions have unmet need for either medical care or prescription drugs, according to the Robert Wood Johnson Foundation, which analyzed data from the Centers for Disease Control and Prevention's National Center for Health Statistics. The analysis showed that uninsured adults with arthritis were 4.5 times as likely as insured adults with the same condition to have unmet need for medical care or prescription drugs.

Campaign For Psoriasis Funding

The National Psoriasis Foundation has launched a letter-writing campaign to lobby Congress for increased federal funding for research into psoriasis and psoriatic arthritis. The Foundation added an online advocacy tool to its Web site—

www.psoriasis.org

E-Prescribing Standards

Medicare should adopt a program-wide system of uniform national electronic prescribing standards for its new prescription drug benefit, according to the Pharmaceutical Care Management Association (PCMA). A uniform national standard is key to maximizing the participation of private plans in the Part D benefit and in helping to reduce regional variations in health care delivery and outcomes, PCMA said in comments to the Centers for Medicare and Medicaid Services on its proposed rule for Medicare e-prescribing standards. “PCMA believes that Medicare e-prescribing holds the potential to transform the health care delivery system,” PCMA President Mark Merritt said in a statement. “Regrettably, a 50-state patchwork approach would increase costs, decrease efficiency, and severely undermine the promise of e-prescribing.” The organization also urged CMS officials to preempt duplicative and conflicting state laws that could increase costs.

CMS: Pay for Performance Works

Preliminary data indicate that pay-for-performance is improving quality of care in hospitals. A 3-year demonstration project sponsored by the CMS is tracking hospital performance on a set of 34 measures of processes and outcomes of care for five common clinical conditions. Reports from more than 270 participating hospitals on their experiences during the project's first year show that median quality scores improved in all of the clinical areas. For example, scores increased from 90% to 93% for patients with acute myocardial infarction; from 64% to 76% for patients with heart failure; and from 70% to 80% for patients with pneumonia. These early returns demonstrate that using financial incentives works to deliver better patient care and to avoid costly complications for patients, said CMS Administrator Mark B. McClellan, M.D.

New Medicare Wheelchair Policy

Ability to function is the primary criterion in the CMs' new national coverage policy for power wheelchairs and scooters. The criteria look at how well the beneficiary can accomplish activities of daily living such as toileting, grooming, and eating with and without using a wheelchair or other mobility device. The criteria are “part of our efforts to ensure that seniors who need mobility help will get it promptly, and that we are paying appropriately for mobility assistive equipment,” Dr. McClellan said in a statement. The coverage policy is one element in Medicare's year-old effort to improve the coverage, payment, and quality of suppliers for wheelchairs and scooters. That effort was launched after Medicare spending on mobility equipment rose to $1.2 billion annually.

Taking a crucial first step in an effort to make pay for performance work for office-based physicians, a coalition of physician groups, insurers, and the federal government has endorsed a set of 26 clinical-performance measures for the ambulatory care setting.

The coalition—the Ambulatory Care Quality Alliance (AQA)—was formed last year by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the federal Agency for Healthcare Research and Quality.

The starter set of 26 measures focuses on prevention, chronic care, and the overuse and misuse of certain treatments. The set could be implemented as early as next year

“This is a watershed event,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

The announcement of the 26-measure starter set signals the beginning of an era in which physician performance in the aggregate will be monitored and assessed, he said.

Creating a single set of measures that can be used across health plans is key, Dr. Golden said. It means that physicians won't need to gather different types of data from each patient, he said, and it will allow for increased comparability of patient care.

“The ultimate goal is to improve the quality of care,” said John Tooker, M.D., CEO and executive vice president of the American College of Physicians.

AQA's starter set of measures was assembled from existing measures developed by either the Physician Consortium for Performance Improvement or the National Committee for Quality Assurance.

Most of the measures are now under review by the National Quality Forum.

AQA compiled the set in part to reduce the administrative burden on physicians, Dr. Tooker said.

Most physicians deal with multiple health plans and having a single set of uniform measures used across all plans would lessen the hassle factor for physicians, he said.

In addition to being less of an administrative burden, the measures are evidence-based and were developed with physician input, he said.

But this is just the beginning of the process. The measures still need to validated in the field, he said.

Dr. Tooker said he expects that the measures will be adopted as they are ready to be implemented, possibly as early as next year.

AQA will also work this year on setting standards for data aggregation and reporting. And in the future, AQA plans to expand the measure set to include subspecialties outside of primary care.

The measures in the starter set were selected based on their clinical importance and scientific validity, feasibility, and their relevance to consumers, purchasers, and physician performance.

The starter set includes measures of preventive care related to breast cancer screening, colorectal cancer screening, cervical cancer screening, tobacco use and cessation, and vaccination for influenza and pneumonia. Other measures address chronic care of coronary artery disease, heart failure, diabetes, asthma, depression, and prenatal care.

The starter set also contains measures related to appropriate treatment for children with upper respiratory infections and appropriate treatment and testing for children with pharyngitis.

This movement toward performance measures and pay-for-performance programs is already happening in many parts of the country, said Alan Nelson, M.D., a member of the Medicare Payment Advisory Commission (MedPAC) and a special advisor to Dr. Tooker.

“The pressure is coming from the purchasers of care who are insisting on buying value,” he said. “Medicare is taking the same approach.”

Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services said his agency support the AQA's efforts to implement valid, reliable measures. In a statement, Dr. McClellan called the initial set of measures a “milestone” in the area of ambulatory care.

But Dr. Nelson said he is concerned that most solo and small group practices are not equipped to gather and document the data needed to show compliance with the measures. As this effort moves forward, physicians will need to create patient registries and create some easy and efficient way of collecting the data needed for pay for performance.

MedPAC has acknowledged that difficulty and recommended that under Medicare pay for performance initiatives, only information that can be collected through claims data should be used, he said.

Many of the performance measures that are being pushed by AQA are already in use within the Department of Veterans Affairs, said Rowen Zetterman, M.D., chief of staff at the VA Nebraska-Western Iowa Healthcare System in Omaha.

That bodes well for the success of programs that use the measures going forward since the VA has been able to significantly improve quality through its use of performance measures, Dr. Zetterman said.

The starter-set measures are online at www.ahrq.gov/qual/aqastart.htm

Taking a crucial first step in an effort to make pay for performance work for office-based physicians, a coalition of physician groups, insurers, and the federal government has endorsed a set of 26 clinical-performance measures for the ambulatory care setting.

The coalition—the Ambulatory Care Quality Alliance (AQA)—was formed last year by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the federal Agency for Healthcare Research and Quality.

The starter set of 26 measures focuses on prevention, chronic care, and the overuse and misuse of certain treatments. The set could be implemented as early as next year

“This is a watershed event,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

The announcement of the 26-measure starter set signals the beginning of an era in which physician performance in the aggregate will be monitored and assessed, he said.

Creating a single set of measures that can be used across health plans is key, Dr. Golden said. It means that physicians won't need to gather different types of data from each patient, he said, and it will allow for increased comparability of patient care.

“The ultimate goal is to improve the quality of care,” said John Tooker, M.D., CEO and executive vice president of the American College of Physicians.

AQA's starter set of measures was assembled from existing measures developed by either the Physician Consortium for Performance Improvement or the National Committee for Quality Assurance.

Most of the measures are now under review by the National Quality Forum.

AQA compiled the set in part to reduce the administrative burden on physicians, Dr. Tooker said.

Most physicians deal with multiple health plans and having a single set of uniform measures used across all plans would lessen the hassle factor for physicians, he said.

In addition to being less of an administrative burden, the measures are evidence-based and were developed with physician input, he said.

But this is just the beginning of the process. The measures still need to validated in the field, he said.

Dr. Tooker said he expects that the measures will be adopted as they are ready to be implemented, possibly as early as next year.

AQA will also work this year on setting standards for data aggregation and reporting. And in the future, AQA plans to expand the measure set to include subspecialties outside of primary care.

The measures in the starter set were selected based on their clinical importance and scientific validity, feasibility, and their relevance to consumers, purchasers, and physician performance.

The starter set includes measures of preventive care related to breast cancer screening, colorectal cancer screening, cervical cancer screening, tobacco use and cessation, and vaccination for influenza and pneumonia. Other measures address chronic care of coronary artery disease, heart failure, diabetes, asthma, depression, and prenatal care.

The starter set also contains measures related to appropriate treatment for children with upper respiratory infections and appropriate treatment and testing for children with pharyngitis.

This movement toward performance measures and pay-for-performance programs is already happening in many parts of the country, said Alan Nelson, M.D., a member of the Medicare Payment Advisory Commission (MedPAC) and a special advisor to Dr. Tooker.

“The pressure is coming from the purchasers of care who are insisting on buying value,” he said. “Medicare is taking the same approach.”

Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services said his agency support the AQA's efforts to implement valid, reliable measures. In a statement, Dr. McClellan called the initial set of measures a “milestone” in the area of ambulatory care.

But Dr. Nelson said he is concerned that most solo and small group practices are not equipped to gather and document the data needed to show compliance with the measures. As this effort moves forward, physicians will need to create patient registries and create some easy and efficient way of collecting the data needed for pay for performance.

MedPAC has acknowledged that difficulty and recommended that under Medicare pay for performance initiatives, only information that can be collected through claims data should be used, he said.

Many of the performance measures that are being pushed by AQA are already in use within the Department of Veterans Affairs, said Rowen Zetterman, M.D., chief of staff at the VA Nebraska-Western Iowa Healthcare System in Omaha.

That bodes well for the success of programs that use the measures going forward since the VA has been able to significantly improve quality through its use of performance measures, Dr. Zetterman said.

The starter-set measures are online at www.ahrq.gov/qual/aqastart.htm

Taking a crucial first step in an effort to make pay for performance work for office-based physicians, a coalition of physician groups, insurers, and the federal government has endorsed a set of 26 clinical-performance measures for the ambulatory care setting.

The coalition—the Ambulatory Care Quality Alliance (AQA)—was formed last year by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the federal Agency for Healthcare Research and Quality.

The starter set of 26 measures focuses on prevention, chronic care, and the overuse and misuse of certain treatments. The set could be implemented as early as next year

“This is a watershed event,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

The announcement of the 26-measure starter set signals the beginning of an era in which physician performance in the aggregate will be monitored and assessed, he said.

Creating a single set of measures that can be used across health plans is key, Dr. Golden said. It means that physicians won't need to gather different types of data from each patient, he said, and it will allow for increased comparability of patient care.

“The ultimate goal is to improve the quality of care,” said John Tooker, M.D., CEO and executive vice president of the American College of Physicians.

AQA's starter set of measures was assembled from existing measures developed by either the Physician Consortium for Performance Improvement or the National Committee for Quality Assurance.

Most of the measures are now under review by the National Quality Forum.

AQA compiled the set in part to reduce the administrative burden on physicians, Dr. Tooker said.

Most physicians deal with multiple health plans and having a single set of uniform measures used across all plans would lessen the hassle factor for physicians, he said.

In addition to being less of an administrative burden, the measures are evidence-based and were developed with physician input, he said.

But this is just the beginning of the process. The measures still need to validated in the field, he said.

Dr. Tooker said he expects that the measures will be adopted as they are ready to be implemented, possibly as early as next year.

AQA will also work this year on setting standards for data aggregation and reporting. And in the future, AQA plans to expand the measure set to include subspecialties outside of primary care.

The measures in the starter set were selected based on their clinical importance and scientific validity, feasibility, and their relevance to consumers, purchasers, and physician performance.

The starter set includes measures of preventive care related to breast cancer screening, colorectal cancer screening, cervical cancer screening, tobacco use and cessation, and vaccination for influenza and pneumonia. Other measures address chronic care of coronary artery disease, heart failure, diabetes, asthma, depression, and prenatal care.

The starter set also contains measures related to appropriate treatment for children with upper respiratory infections and appropriate treatment and testing for children with pharyngitis.

This movement toward performance measures and pay-for-performance programs is already happening in many parts of the country, said Alan Nelson, M.D., a member of the Medicare Payment Advisory Commission (MedPAC) and a special advisor to Dr. Tooker.

“The pressure is coming from the purchasers of care who are insisting on buying value,” he said. “Medicare is taking the same approach.”

Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services said his agency support the AQA's efforts to implement valid, reliable measures. In a statement, Dr. McClellan called the initial set of measures a “milestone” in the area of ambulatory care.

But Dr. Nelson said he is concerned that most solo and small group practices are not equipped to gather and document the data needed to show compliance with the measures. As this effort moves forward, physicians will need to create patient registries and create some easy and efficient way of collecting the data needed for pay for performance.

MedPAC has acknowledged that difficulty and recommended that under Medicare pay for performance initiatives, only information that can be collected through claims data should be used, he said.

Many of the performance measures that are being pushed by AQA are already in use within the Department of Veterans Affairs, said Rowen Zetterman, M.D., chief of staff at the VA Nebraska-Western Iowa Healthcare System in Omaha.

That bodes well for the success of programs that use the measures going forward since the VA has been able to significantly improve quality through its use of performance measures, Dr. Zetterman said.

The starter-set measures are online at www.ahrq.gov/qual/aqastart.htm

Coronary Artery Stent DRGs

The Centers for Medicare and Medicaid Services is proposing to change the way it pays for the insertion of coronary stents by offering higher reimbursement for cases with secondary diagnoses. The proposed rule, published last month, would replace diagnostic related groups (DRGs) 516 and 526 with four new DRGs, defined based on the presence or absence of a secondary diagnosis from a list of comorbidities and complications. CMS will accept comments on the proposal until June 24; the final rule is expected to be published by Aug. 1.

Fighting Childhood Obesity

Former President Bill Clinton, Arkansas Governor Mike Huckabee, and the American Heart Association are teaming up to prevent childhood obesity. The newly formed alliance plans to work with the food and restaurant industry to improve the quality of food offered and to develop marketing strategies to support change within the industry. They will also focus on increasing physical activity and improving nutrition in schools. More than twice as many children and nearly three times as many teenagers are overweight today as in 1980. And overweight children and adolescents have a 70% chance of becoming overweight adults, increasing their risk of heart disease, according to the American Heart Association. “With this initiative, we can help turn young people's lives around give them hope for a healthier future,” President Clinton said in a statement.

Dual-Chamber Pacemakers

Dual-chamber pacemakers are more clinically beneficial and cost effective than are single-chamber models, according to an analysis from the health services research organization ECRI. The analysis is based on evidence from 32 trials in more than 5,500 patients. ECRI found that dual-chamber pacing reduces symptoms of the pacemaker syndrome, which causes dizziness and fatigue when the pacemaker attempts to pump against a closed valve. ECRI also found that dual-chamber pacing isn't necessarily better than single-chamber pacing when it comes to improvement in cardiovascular functional status. Some evidence indicated that dual-chamber pacemakers have more mechanical problems than single-chamber devices, but ECRI said these were generally minor.

Ads Influence Prescribing

Direct-to-consumer advertisements appear to have an impact on physician prescribing practices, a study by Richard L. Kravitz, M.D., of the University of California, Davis, found (JAMA 2005;293:1995–2002). A total of 152 family physicians and general internists were recruited from solo and group practices and health maintenance organizations for the study of advertising for prescription antidepressants. Patients were randomly assigned to make 298 unannounced visits, presenting either with major depression or adjustment disorder with depressed mood. When the patients with depression made a general request for an antidepressant, only 3% of the physicians prescribed paroxetine (Paxil). However, when they asked for the prescription by name, 27% were given a prescription for Paxil. In addition, patients with adjustment disorder symptoms were more likely to receive a prescription for an antidepressant if they made a brand-specific request (55%) versus a general request (39%).

E-Prescribing Standards

Medicare should adopt a program-wide system of uniform national electronic prescribing standards for its new prescription drug benefit, according to the Pharmaceutical Care Management Association (PCMA). Such a standard is key to maximizing the participation of private plans in the Part D benefit and in reducing regional variations in health care delivery and outcomes, PCMA said in comments to CMS on its proposed rule for Medicare e-prescribing standards. “PCMA believes that Medicare e-prescribing holds the potential to transform the health care delivery system,” PCMA President Mark Merritt said in a statement. “Regrettably, a 50-state patchwork approach would increase costs, decrease efficiency, and severely undermine the promise of e-prescribing.”

CMS: Pay for Performance Works

Preliminary data indicate that pay for performance is improving quality of care in hospitals. A 3-year demonstration project sponsored by the CMS is tracking hospital performance on a set of 34 measures and outcomes of care for five common clinical conditions. Reports from more than 270 participating hospitals on their experiences in the project's first year show that median quality scores improved in all of the clinical areas. For example, scores increased from 90% to 93% for MI patients and from 64% to 76% for heart failure patients. These early returns show that using financial incentives works to deliver better patient care and to avoid costly complications for patients, said CMS Administrator Mark B. McClellan, M.D.

Coronary Artery Stent DRGs

The Centers for Medicare and Medicaid Services is proposing to change the way it pays for the insertion of coronary stents by offering higher reimbursement for cases with secondary diagnoses. The proposed rule, published last month, would replace diagnostic related groups (DRGs) 516 and 526 with four new DRGs, defined based on the presence or absence of a secondary diagnosis from a list of comorbidities and complications. CMS will accept comments on the proposal until June 24; the final rule is expected to be published by Aug. 1.

Fighting Childhood Obesity

Former President Bill Clinton, Arkansas Governor Mike Huckabee, and the American Heart Association are teaming up to prevent childhood obesity. The newly formed alliance plans to work with the food and restaurant industry to improve the quality of food offered and to develop marketing strategies to support change within the industry. They will also focus on increasing physical activity and improving nutrition in schools. More than twice as many children and nearly three times as many teenagers are overweight today as in 1980. And overweight children and adolescents have a 70% chance of becoming overweight adults, increasing their risk of heart disease, according to the American Heart Association. “With this initiative, we can help turn young people's lives around give them hope for a healthier future,” President Clinton said in a statement.

Dual-Chamber Pacemakers

Dual-chamber pacemakers are more clinically beneficial and cost effective than are single-chamber models, according to an analysis from the health services research organization ECRI. The analysis is based on evidence from 32 trials in more than 5,500 patients. ECRI found that dual-chamber pacing reduces symptoms of the pacemaker syndrome, which causes dizziness and fatigue when the pacemaker attempts to pump against a closed valve. ECRI also found that dual-chamber pacing isn't necessarily better than single-chamber pacing when it comes to improvement in cardiovascular functional status. Some evidence indicated that dual-chamber pacemakers have more mechanical problems than single-chamber devices, but ECRI said these were generally minor.

Ads Influence Prescribing

Direct-to-consumer advertisements appear to have an impact on physician prescribing practices, a study by Richard L. Kravitz, M.D., of the University of California, Davis, found (JAMA 2005;293:1995–2002). A total of 152 family physicians and general internists were recruited from solo and group practices and health maintenance organizations for the study of advertising for prescription antidepressants. Patients were randomly assigned to make 298 unannounced visits, presenting either with major depression or adjustment disorder with depressed mood. When the patients with depression made a general request for an antidepressant, only 3% of the physicians prescribed paroxetine (Paxil). However, when they asked for the prescription by name, 27% were given a prescription for Paxil. In addition, patients with adjustment disorder symptoms were more likely to receive a prescription for an antidepressant if they made a brand-specific request (55%) versus a general request (39%).

E-Prescribing Standards

Medicare should adopt a program-wide system of uniform national electronic prescribing standards for its new prescription drug benefit, according to the Pharmaceutical Care Management Association (PCMA). Such a standard is key to maximizing the participation of private plans in the Part D benefit and in reducing regional variations in health care delivery and outcomes, PCMA said in comments to CMS on its proposed rule for Medicare e-prescribing standards. “PCMA believes that Medicare e-prescribing holds the potential to transform the health care delivery system,” PCMA President Mark Merritt said in a statement. “Regrettably, a 50-state patchwork approach would increase costs, decrease efficiency, and severely undermine the promise of e-prescribing.”

CMS: Pay for Performance Works

Preliminary data indicate that pay for performance is improving quality of care in hospitals. A 3-year demonstration project sponsored by the CMS is tracking hospital performance on a set of 34 measures and outcomes of care for five common clinical conditions. Reports from more than 270 participating hospitals on their experiences in the project's first year show that median quality scores improved in all of the clinical areas. For example, scores increased from 90% to 93% for MI patients and from 64% to 76% for heart failure patients. These early returns show that using financial incentives works to deliver better patient care and to avoid costly complications for patients, said CMS Administrator Mark B. McClellan, M.D.

Coronary Artery Stent DRGs

The Centers for Medicare and Medicaid Services is proposing to change the way it pays for the insertion of coronary stents by offering higher reimbursement for cases with secondary diagnoses. The proposed rule, published last month, would replace diagnostic related groups (DRGs) 516 and 526 with four new DRGs, defined based on the presence or absence of a secondary diagnosis from a list of comorbidities and complications. CMS will accept comments on the proposal until June 24; the final rule is expected to be published by Aug. 1.

Fighting Childhood Obesity

Former President Bill Clinton, Arkansas Governor Mike Huckabee, and the American Heart Association are teaming up to prevent childhood obesity. The newly formed alliance plans to work with the food and restaurant industry to improve the quality of food offered and to develop marketing strategies to support change within the industry. They will also focus on increasing physical activity and improving nutrition in schools. More than twice as many children and nearly three times as many teenagers are overweight today as in 1980. And overweight children and adolescents have a 70% chance of becoming overweight adults, increasing their risk of heart disease, according to the American Heart Association. “With this initiative, we can help turn young people's lives around give them hope for a healthier future,” President Clinton said in a statement.

Dual-Chamber Pacemakers

Dual-chamber pacemakers are more clinically beneficial and cost effective than are single-chamber models, according to an analysis from the health services research organization ECRI. The analysis is based on evidence from 32 trials in more than 5,500 patients. ECRI found that dual-chamber pacing reduces symptoms of the pacemaker syndrome, which causes dizziness and fatigue when the pacemaker attempts to pump against a closed valve. ECRI also found that dual-chamber pacing isn't necessarily better than single-chamber pacing when it comes to improvement in cardiovascular functional status. Some evidence indicated that dual-chamber pacemakers have more mechanical problems than single-chamber devices, but ECRI said these were generally minor.

Ads Influence Prescribing

Direct-to-consumer advertisements appear to have an impact on physician prescribing practices, a study by Richard L. Kravitz, M.D., of the University of California, Davis, found (JAMA 2005;293:1995–2002). A total of 152 family physicians and general internists were recruited from solo and group practices and health maintenance organizations for the study of advertising for prescription antidepressants. Patients were randomly assigned to make 298 unannounced visits, presenting either with major depression or adjustment disorder with depressed mood. When the patients with depression made a general request for an antidepressant, only 3% of the physicians prescribed paroxetine (Paxil). However, when they asked for the prescription by name, 27% were given a prescription for Paxil. In addition, patients with adjustment disorder symptoms were more likely to receive a prescription for an antidepressant if they made a brand-specific request (55%) versus a general request (39%).

E-Prescribing Standards

Medicare should adopt a program-wide system of uniform national electronic prescribing standards for its new prescription drug benefit, according to the Pharmaceutical Care Management Association (PCMA). Such a standard is key to maximizing the participation of private plans in the Part D benefit and in reducing regional variations in health care delivery and outcomes, PCMA said in comments to CMS on its proposed rule for Medicare e-prescribing standards. “PCMA believes that Medicare e-prescribing holds the potential to transform the health care delivery system,” PCMA President Mark Merritt said in a statement. “Regrettably, a 50-state patchwork approach would increase costs, decrease efficiency, and severely undermine the promise of e-prescribing.”

CMS: Pay for Performance Works

Preliminary data indicate that pay for performance is improving quality of care in hospitals. A 3-year demonstration project sponsored by the CMS is tracking hospital performance on a set of 34 measures and outcomes of care for five common clinical conditions. Reports from more than 270 participating hospitals on their experiences in the project's first year show that median quality scores improved in all of the clinical areas. For example, scores increased from 90% to 93% for MI patients and from 64% to 76% for heart failure patients. These early returns show that using financial incentives works to deliver better patient care and to avoid costly complications for patients, said CMS Administrator Mark B. McClellan, M.D.

Taking a crucial first step in an effort to make pay for performance work for office-based physicians, a coalition of physician groups, insurers, and the federal government has endorsed a set of 26 clinical-performance measures for the ambulatory care setting.

The coalition—the Ambulatory Care Quality Alliance (AQA)—was formed last year by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the federal Agency for Healthcare Research and Quality.

The starter set of 26 measures focuses on prevention, chronic care, and the overuse and misuse of certain treatments. The set could be implemented as early as next year

“This is a watershed event,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

The announcement of the 26-measure starter set signals the beginning of an era in which physician performance in the aggregate will be monitored and assessed, he said.

Creating a single set of measures that can be used across health plans is key, Dr. Golden said. It means that physicians won't need to gather different types of data from each patient, he said, and it will allow for increase comparability of patient care.

“The ultimate goal is to improve the quality of care,” said John Tooker, M.D., CEO and executive vice president of the American College of Physicians. AQA's starter set of measures was assembled from existing measures developed by either the Physician Consortium for Performance Improvement or the National Committee for Quality Assurance. Most of the measures are now under review by the National Quality Forum.

AQA compiled the set in part to reduce the administrative burden on physicians, Dr. Tooker said. Most physicians deal with multiple health plans and having a single set of uniform measures used across all plans would lessen the hassle factor for physicians, he said.

In addition to being less of an administrative burden, the measures are evidence-based and were developed with physician input, he said.

But this is just the beginning of the process. The measures still need to be validated in the field, Dr. Tooker said. He expects that the measures will be adopted as they are ready to be implemented, possibly as early as next year.

AQA will also work this year on setting standards for data aggregation and reporting.

And in the future, AQA plans to expand the measure set to include subspecialties outside of primary care.

The measures in the starter set were selected based on their clinical importance and scientific validity, feasibility, and their relevance to consumers, purchasers, and physician performance.

The starter set includes measures of preventive care related to breast cancer screening, colorectal cancer screening, cervical cancer screening, tobacco use and cessation, and vaccination for influenza and pneumonia. Other measures address chronic care of coronary artery disease, heart failure, diabetes, asthma, depression, and prenatal care.

The starter set also contains measures related to appropriate treatment for children with upper respiratory infections and appropriate treatment and testing for children with pharyngitis.

This movement toward performance measures and pay for performance programs is already happening in many parts of the country, said Alan Nelson, M.D., a member of the Medicare Payment Advisory Commission (MedPAC) and a special advisor to Dr. Tooker.

“The pressure is coming from the purchasers of care who are insisting on buying value,” he said. “Medicare is taking the same approach.”

Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services said his agency support the AQA's efforts to implement valid, reliable measures.

In a statement, Dr. McClellan called the initial set of measures a “milestone” in the area of ambulatory care. But Dr. Nelson said he is concerned that most solo and small group practices are not equipped to gather and document the data needed to show compliance with the measures. As this effort moves forward, physicians will need to create patient registries and create some easy and efficient way of collecting the data needed for pay for performance.

MedPAC has acknowledged that difficulty and recommended that under Medicare pay for performance initiatives, only information that can be collected through claims data should be used, he said.

Many of the performance measures that are being pushed by AQA are already in use within the Department of Veterans Affairs, said Rowen Zetterman, M.D., chief of staff at the VA Nebraska-Western Iowa Healthcare System in Omaha.

That bodes well for the success of programs that use the measures going forward since the VA has been able to significantly improve quality through its use of performance measures, Dr. Zetterman said.

The starter-set measures are online at www.ahrq.gov/qual/aqastart.htm

Taking a crucial first step in an effort to make pay for performance work for office-based physicians, a coalition of physician groups, insurers, and the federal government has endorsed a set of 26 clinical-performance measures for the ambulatory care setting.

The coalition—the Ambulatory Care Quality Alliance (AQA)—was formed last year by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the federal Agency for Healthcare Research and Quality.

The starter set of 26 measures focuses on prevention, chronic care, and the overuse and misuse of certain treatments. The set could be implemented as early as next year

“This is a watershed event,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

The announcement of the 26-measure starter set signals the beginning of an era in which physician performance in the aggregate will be monitored and assessed, he said.

Creating a single set of measures that can be used across health plans is key, Dr. Golden said. It means that physicians won't need to gather different types of data from each patient, he said, and it will allow for increase comparability of patient care.

“The ultimate goal is to improve the quality of care,” said John Tooker, M.D., CEO and executive vice president of the American College of Physicians. AQA's starter set of measures was assembled from existing measures developed by either the Physician Consortium for Performance Improvement or the National Committee for Quality Assurance. Most of the measures are now under review by the National Quality Forum.

AQA compiled the set in part to reduce the administrative burden on physicians, Dr. Tooker said. Most physicians deal with multiple health plans and having a single set of uniform measures used across all plans would lessen the hassle factor for physicians, he said.

In addition to being less of an administrative burden, the measures are evidence-based and were developed with physician input, he said.

But this is just the beginning of the process. The measures still need to be validated in the field, Dr. Tooker said. He expects that the measures will be adopted as they are ready to be implemented, possibly as early as next year.

AQA will also work this year on setting standards for data aggregation and reporting.

And in the future, AQA plans to expand the measure set to include subspecialties outside of primary care.

The measures in the starter set were selected based on their clinical importance and scientific validity, feasibility, and their relevance to consumers, purchasers, and physician performance.

The starter set includes measures of preventive care related to breast cancer screening, colorectal cancer screening, cervical cancer screening, tobacco use and cessation, and vaccination for influenza and pneumonia. Other measures address chronic care of coronary artery disease, heart failure, diabetes, asthma, depression, and prenatal care.

The starter set also contains measures related to appropriate treatment for children with upper respiratory infections and appropriate treatment and testing for children with pharyngitis.

This movement toward performance measures and pay for performance programs is already happening in many parts of the country, said Alan Nelson, M.D., a member of the Medicare Payment Advisory Commission (MedPAC) and a special advisor to Dr. Tooker.

“The pressure is coming from the purchasers of care who are insisting on buying value,” he said. “Medicare is taking the same approach.”

Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services said his agency support the AQA's efforts to implement valid, reliable measures.

In a statement, Dr. McClellan called the initial set of measures a “milestone” in the area of ambulatory care. But Dr. Nelson said he is concerned that most solo and small group practices are not equipped to gather and document the data needed to show compliance with the measures. As this effort moves forward, physicians will need to create patient registries and create some easy and efficient way of collecting the data needed for pay for performance.

MedPAC has acknowledged that difficulty and recommended that under Medicare pay for performance initiatives, only information that can be collected through claims data should be used, he said.

Many of the performance measures that are being pushed by AQA are already in use within the Department of Veterans Affairs, said Rowen Zetterman, M.D., chief of staff at the VA Nebraska-Western Iowa Healthcare System in Omaha.

That bodes well for the success of programs that use the measures going forward since the VA has been able to significantly improve quality through its use of performance measures, Dr. Zetterman said.

The starter-set measures are online at www.ahrq.gov/qual/aqastart.htm

Taking a crucial first step in an effort to make pay for performance work for office-based physicians, a coalition of physician groups, insurers, and the federal government has endorsed a set of 26 clinical-performance measures for the ambulatory care setting.

The coalition—the Ambulatory Care Quality Alliance (AQA)—was formed last year by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the federal Agency for Healthcare Research and Quality.

The starter set of 26 measures focuses on prevention, chronic care, and the overuse and misuse of certain treatments. The set could be implemented as early as next year

“This is a watershed event,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

The announcement of the 26-measure starter set signals the beginning of an era in which physician performance in the aggregate will be monitored and assessed, he said.

Creating a single set of measures that can be used across health plans is key, Dr. Golden said. It means that physicians won't need to gather different types of data from each patient, he said, and it will allow for increase comparability of patient care.

“The ultimate goal is to improve the quality of care,” said John Tooker, M.D., CEO and executive vice president of the American College of Physicians. AQA's starter set of measures was assembled from existing measures developed by either the Physician Consortium for Performance Improvement or the National Committee for Quality Assurance. Most of the measures are now under review by the National Quality Forum.

AQA compiled the set in part to reduce the administrative burden on physicians, Dr. Tooker said. Most physicians deal with multiple health plans and having a single set of uniform measures used across all plans would lessen the hassle factor for physicians, he said.

In addition to being less of an administrative burden, the measures are evidence-based and were developed with physician input, he said.

But this is just the beginning of the process. The measures still need to be validated in the field, Dr. Tooker said. He expects that the measures will be adopted as they are ready to be implemented, possibly as early as next year.

AQA will also work this year on setting standards for data aggregation and reporting.

And in the future, AQA plans to expand the measure set to include subspecialties outside of primary care.

The measures in the starter set were selected based on their clinical importance and scientific validity, feasibility, and their relevance to consumers, purchasers, and physician performance.

The starter set includes measures of preventive care related to breast cancer screening, colorectal cancer screening, cervical cancer screening, tobacco use and cessation, and vaccination for influenza and pneumonia. Other measures address chronic care of coronary artery disease, heart failure, diabetes, asthma, depression, and prenatal care.

The starter set also contains measures related to appropriate treatment for children with upper respiratory infections and appropriate treatment and testing for children with pharyngitis.

This movement toward performance measures and pay for performance programs is already happening in many parts of the country, said Alan Nelson, M.D., a member of the Medicare Payment Advisory Commission (MedPAC) and a special advisor to Dr. Tooker.

“The pressure is coming from the purchasers of care who are insisting on buying value,” he said. “Medicare is taking the same approach.”

Mark McClellan, M.D., administrator for the Centers for Medicare and Medicaid Services said his agency support the AQA's efforts to implement valid, reliable measures.

In a statement, Dr. McClellan called the initial set of measures a “milestone” in the area of ambulatory care. But Dr. Nelson said he is concerned that most solo and small group practices are not equipped to gather and document the data needed to show compliance with the measures. As this effort moves forward, physicians will need to create patient registries and create some easy and efficient way of collecting the data needed for pay for performance.

MedPAC has acknowledged that difficulty and recommended that under Medicare pay for performance initiatives, only information that can be collected through claims data should be used, he said.

Many of the performance measures that are being pushed by AQA are already in use within the Department of Veterans Affairs, said Rowen Zetterman, M.D., chief of staff at the VA Nebraska-Western Iowa Healthcare System in Omaha.

That bodes well for the success of programs that use the measures going forward since the VA has been able to significantly improve quality through its use of performance measures, Dr. Zetterman said.

The starter-set measures are online at www.ahrq.gov/qual/aqastart.htm