Mary Ellen Schneider

New AAD Leadership

Members of the American Academy of Dermatology have elected new leaders. Stephen P. Stone, M.D., professor of clinical medicine at Southern Illinois University in Springfield, was chosen president-elect of the academy. He will assume the presidency of AAD in March 2006 and will hold the same position with the American Academy of Dermatology Association. Dr. Stone said he plans to address the fair valuation of services, the ongoing malpractice crisis, and efforts by other organizations to restrict office-based surgery. AAD members also elected William P. Coleman, III, M.D., as vice president-elect. Dr. Coleman is a clinical professor of dermatology at Tulane University in New Orleans and works in private practice in cosmetic dermatologic surgery in Metairie, La. He will also take over as vice president in March 2006.

Campaign for Psoriasis Funding

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

www.psoriasis.org

Plastic Surgery Growth

More than 9.2 million cosmetic plastic surgery procedures were performed in the United States, an increase of 5% between 2003 and 2004, according to the American Society of Plastic Surgeons (ASPS). Minimally invasive procedures rose 7% in that period. Top minimally invasive procedures were Botox injections (3 million), chemical peels (1.1 million), microdermabrasion (859,000), laser hair removal (574,000), and sclerotherapy (545,000). Conversely, surgical procedures dropped 2%, according to ASPS. "These statistics show a strong, continued, and healthy increase in cosmetic surgery that mirrors the 4.4% economic growth of the United States," ASPS President Scott Spear, M.D., said in a statement. "However, there is no evidence in the statistics to support [the hypothesis] that TV programs have led to a dramatic surge in the amount of cosmetic surgery procedures."

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-pre-scribing 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 officials at the Centers for Medicare and Medicaid Services to preempt duplicative and conflicting state laws that could increase costs.

Uninsured Projections

The plight of the uninsured isn't likely to be resolved anytime soon. More than one in four American workers under the age of 65 will be uninsured in 2013—nearly 56 million people—driven by the increasing inability to afford health insurance, reports a Health Affairs Web-exclusive article. Because growth in per capita health spending is expected to outpace median personal income by 2.4% every year, coverage will continue to decline as more Americans find it unaffordable. "It is unlikely that we will be able to solve the problem of the uninsured without some form of universal health insurance requiring contributions from some combination of employers, employees, and taxpayers," the study indicated. The researchers based the estimates on federal projections of health spending, personal income, and other population characteristics.

Unreadable Privacy Forms

Privacy forms used by major health care institutions are often lengthy and difficult to read, according to a study published in the Journal of the American Medical Association (2005;293:1593-4). The Health Insurance Portability and Accountability Act requires that health care institutions inform patients in detail about the use of information obtained during medical care, through a notice of privacy form "written in plain English." The median length of the forms was six pages. The forms were often set with inappropriately small type and written in complex language that was unlikely to be understood by a "considerable proportion" of the populations served by these institutions, the report said. Privacy practice notices from 185 institutions listed in the 2004 U.S. News & World Report "best hospitals" issue were collected for the study.

New AAD Leadership

Members of the American Academy of Dermatology have elected new leaders. Stephen P. Stone, M.D., professor of clinical medicine at Southern Illinois University in Springfield, was chosen president-elect of the academy. He will assume the presidency of AAD in March 2006 and will hold the same position with the American Academy of Dermatology Association. Dr. Stone said he plans to address the fair valuation of services, the ongoing malpractice crisis, and efforts by other organizations to restrict office-based surgery. AAD members also elected William P. Coleman, III, M.D., as vice president-elect. Dr. Coleman is a clinical professor of dermatology at Tulane University in New Orleans and works in private practice in cosmetic dermatologic surgery in Metairie, La. He will also take over as vice president in March 2006.

Campaign for Psoriasis Funding

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

www.psoriasis.org

Plastic Surgery Growth

More than 9.2 million cosmetic plastic surgery procedures were performed in the United States, an increase of 5% between 2003 and 2004, according to the American Society of Plastic Surgeons (ASPS). Minimally invasive procedures rose 7% in that period. Top minimally invasive procedures were Botox injections (3 million), chemical peels (1.1 million), microdermabrasion (859,000), laser hair removal (574,000), and sclerotherapy (545,000). Conversely, surgical procedures dropped 2%, according to ASPS. "These statistics show a strong, continued, and healthy increase in cosmetic surgery that mirrors the 4.4% economic growth of the United States," ASPS President Scott Spear, M.D., said in a statement. "However, there is no evidence in the statistics to support [the hypothesis] that TV programs have led to a dramatic surge in the amount of cosmetic surgery procedures."

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-pre-scribing 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 officials at the Centers for Medicare and Medicaid Services to preempt duplicative and conflicting state laws that could increase costs.

Uninsured Projections

The plight of the uninsured isn't likely to be resolved anytime soon. More than one in four American workers under the age of 65 will be uninsured in 2013—nearly 56 million people—driven by the increasing inability to afford health insurance, reports a Health Affairs Web-exclusive article. Because growth in per capita health spending is expected to outpace median personal income by 2.4% every year, coverage will continue to decline as more Americans find it unaffordable. "It is unlikely that we will be able to solve the problem of the uninsured without some form of universal health insurance requiring contributions from some combination of employers, employees, and taxpayers," the study indicated. The researchers based the estimates on federal projections of health spending, personal income, and other population characteristics.

Unreadable Privacy Forms

Privacy forms used by major health care institutions are often lengthy and difficult to read, according to a study published in the Journal of the American Medical Association (2005;293:1593-4). The Health Insurance Portability and Accountability Act requires that health care institutions inform patients in detail about the use of information obtained during medical care, through a notice of privacy form "written in plain English." The median length of the forms was six pages. The forms were often set with inappropriately small type and written in complex language that was unlikely to be understood by a "considerable proportion" of the populations served by these institutions, the report said. Privacy practice notices from 185 institutions listed in the 2004 U.S. News & World Report "best hospitals" issue were collected for the study.

New AAD Leadership

Members of the American Academy of Dermatology have elected new leaders. Stephen P. Stone, M.D., professor of clinical medicine at Southern Illinois University in Springfield, was chosen president-elect of the academy. He will assume the presidency of AAD in March 2006 and will hold the same position with the American Academy of Dermatology Association. Dr. Stone said he plans to address the fair valuation of services, the ongoing malpractice crisis, and efforts by other organizations to restrict office-based surgery. AAD members also elected William P. Coleman, III, M.D., as vice president-elect. Dr. Coleman is a clinical professor of dermatology at Tulane University in New Orleans and works in private practice in cosmetic dermatologic surgery in Metairie, La. He will also take over as vice president in March 2006.

Campaign for Psoriasis Funding

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

www.psoriasis.org

Plastic Surgery Growth

More than 9.2 million cosmetic plastic surgery procedures were performed in the United States, an increase of 5% between 2003 and 2004, according to the American Society of Plastic Surgeons (ASPS). Minimally invasive procedures rose 7% in that period. Top minimally invasive procedures were Botox injections (3 million), chemical peels (1.1 million), microdermabrasion (859,000), laser hair removal (574,000), and sclerotherapy (545,000). Conversely, surgical procedures dropped 2%, according to ASPS. "These statistics show a strong, continued, and healthy increase in cosmetic surgery that mirrors the 4.4% economic growth of the United States," ASPS President Scott Spear, M.D., said in a statement. "However, there is no evidence in the statistics to support [the hypothesis] that TV programs have led to a dramatic surge in the amount of cosmetic surgery procedures."

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-pre-scribing 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 officials at the Centers for Medicare and Medicaid Services to preempt duplicative and conflicting state laws that could increase costs.

Uninsured Projections

The plight of the uninsured isn't likely to be resolved anytime soon. More than one in four American workers under the age of 65 will be uninsured in 2013—nearly 56 million people—driven by the increasing inability to afford health insurance, reports a Health Affairs Web-exclusive article. Because growth in per capita health spending is expected to outpace median personal income by 2.4% every year, coverage will continue to decline as more Americans find it unaffordable. "It is unlikely that we will be able to solve the problem of the uninsured without some form of universal health insurance requiring contributions from some combination of employers, employees, and taxpayers," the study indicated. The researchers based the estimates on federal projections of health spending, personal income, and other population characteristics.

Unreadable Privacy Forms

Privacy forms used by major health care institutions are often lengthy and difficult to read, according to a study published in the Journal of the American Medical Association (2005;293:1593-4). The Health Insurance Portability and Accountability Act requires that health care institutions inform patients in detail about the use of information obtained during medical care, through a notice of privacy form "written in plain English." The median length of the forms was six pages. The forms were often set with inappropriately small type and written in complex language that was unlikely to be understood by a "considerable proportion" of the populations served by these institutions, the report said. Privacy practice notices from 185 institutions listed in the 2004 U.S. News & World Report "best hospitals" issue were collected for the study.

NEW ORLEANS — Careers in academia can offer dermatologists financial security and a rich personal life just like jobs in private practice, academic dermatologists said at the annual meeting of the American Academy of Dermatology.

Dermatologists working at universities will still be able pay off their medical school debt, said Barbara A. Gilchrest, M.D., professor and chair of the department of dermatology at Boston University.

"You absolutely can do this and have a very good time in the process," Dr. Gilchrest told a group of residents at the meeting.

Over the years, academic careers have gotten a bad reputation, said Lynn Cornelius, M.D., associate professor of medicine and chief of the division of dermatology at Washington University, St. Louis.

There are a number of misconceptions about working in the university setting.

For starters, there are more career tracks available, she said. In the past, almost all academic dermatologists were clinician investigators who did it all—maintaining both a lab and teaching. Today, clinician investigators or scientists spend the majority of their time performing research, Dr. Cornelius said.

Dermatologists in the academic world can also become clinician educators who spend most of their time involved in teaching activities, she said.

And the difference in earning potential between private practice and academia may not be as large as some people think, Dr. Cornelius said.

Although salaries vary by region, most private practice dermatologists can earn a starting salary of about $200,000 per year, with the potential to earn more than $400,000 per year in the long term, she pointed out.

Although salaries in academia don't match up, the average academic salaries in dermatology are comparable with starting salaries in private practice, Dr. Cornelius said.

It may, however, take a year or more to get to those levels, she said, and the salary may vary depending on the level of patient care that the physician provides.

There are a lot of opportunities right now in academic dermatology, said John Olerud, M.D., president of the Association of Professors of Dermatology and professor of medicine and head of the division of dermatology at the University of Washington in Seattle.

In fact, most of the dermatology programs around the country have positions available, he said.

Calvin O. McCall, M.D., who is director of the dermatology residency program at Emory University in Atlanta, said that residents often hear about the downside of academics from the faculty in their programs, but they don't hear that some of the same problems exist in private practice.

Dr. McCall, who worked in private practice for 7 years before making the switch to the academic world, said that he didn't have the chance to talk with colleagues about interesting cases or have many opportunities for teaching.

"What hit me over and over again was that I was practicing dermatology in a near vacuum," he said.

NEW ORLEANS — Careers in academia can offer dermatologists financial security and a rich personal life just like jobs in private practice, academic dermatologists said at the annual meeting of the American Academy of Dermatology.

Dermatologists working at universities will still be able pay off their medical school debt, said Barbara A. Gilchrest, M.D., professor and chair of the department of dermatology at Boston University.

"You absolutely can do this and have a very good time in the process," Dr. Gilchrest told a group of residents at the meeting.

Over the years, academic careers have gotten a bad reputation, said Lynn Cornelius, M.D., associate professor of medicine and chief of the division of dermatology at Washington University, St. Louis.

There are a number of misconceptions about working in the university setting.

For starters, there are more career tracks available, she said. In the past, almost all academic dermatologists were clinician investigators who did it all—maintaining both a lab and teaching. Today, clinician investigators or scientists spend the majority of their time performing research, Dr. Cornelius said.

Dermatologists in the academic world can also become clinician educators who spend most of their time involved in teaching activities, she said.

And the difference in earning potential between private practice and academia may not be as large as some people think, Dr. Cornelius said.

Although salaries vary by region, most private practice dermatologists can earn a starting salary of about $200,000 per year, with the potential to earn more than $400,000 per year in the long term, she pointed out.

Although salaries in academia don't match up, the average academic salaries in dermatology are comparable with starting salaries in private practice, Dr. Cornelius said.

It may, however, take a year or more to get to those levels, she said, and the salary may vary depending on the level of patient care that the physician provides.

There are a lot of opportunities right now in academic dermatology, said John Olerud, M.D., president of the Association of Professors of Dermatology and professor of medicine and head of the division of dermatology at the University of Washington in Seattle.

In fact, most of the dermatology programs around the country have positions available, he said.

Calvin O. McCall, M.D., who is director of the dermatology residency program at Emory University in Atlanta, said that residents often hear about the downside of academics from the faculty in their programs, but they don't hear that some of the same problems exist in private practice.

Dr. McCall, who worked in private practice for 7 years before making the switch to the academic world, said that he didn't have the chance to talk with colleagues about interesting cases or have many opportunities for teaching.

"What hit me over and over again was that I was practicing dermatology in a near vacuum," he said.

NEW ORLEANS — Careers in academia can offer dermatologists financial security and a rich personal life just like jobs in private practice, academic dermatologists said at the annual meeting of the American Academy of Dermatology.

Dermatologists working at universities will still be able pay off their medical school debt, said Barbara A. Gilchrest, M.D., professor and chair of the department of dermatology at Boston University.

"You absolutely can do this and have a very good time in the process," Dr. Gilchrest told a group of residents at the meeting.

Over the years, academic careers have gotten a bad reputation, said Lynn Cornelius, M.D., associate professor of medicine and chief of the division of dermatology at Washington University, St. Louis.

There are a number of misconceptions about working in the university setting.

For starters, there are more career tracks available, she said. In the past, almost all academic dermatologists were clinician investigators who did it all—maintaining both a lab and teaching. Today, clinician investigators or scientists spend the majority of their time performing research, Dr. Cornelius said.

Dermatologists in the academic world can also become clinician educators who spend most of their time involved in teaching activities, she said.

And the difference in earning potential between private practice and academia may not be as large as some people think, Dr. Cornelius said.

Although salaries vary by region, most private practice dermatologists can earn a starting salary of about $200,000 per year, with the potential to earn more than $400,000 per year in the long term, she pointed out.

Although salaries in academia don't match up, the average academic salaries in dermatology are comparable with starting salaries in private practice, Dr. Cornelius said.

It may, however, take a year or more to get to those levels, she said, and the salary may vary depending on the level of patient care that the physician provides.

There are a lot of opportunities right now in academic dermatology, said John Olerud, M.D., president of the Association of Professors of Dermatology and professor of medicine and head of the division of dermatology at the University of Washington in Seattle.

In fact, most of the dermatology programs around the country have positions available, he said.

Calvin O. McCall, M.D., who is director of the dermatology residency program at Emory University in Atlanta, said that residents often hear about the downside of academics from the faculty in their programs, but they don't hear that some of the same problems exist in private practice.

Dr. McCall, who worked in private practice for 7 years before making the switch to the academic world, said that he didn't have the chance to talk with colleagues about interesting cases or have many opportunities for teaching.

"What hit me over and over again was that I was practicing dermatology in a near vacuum," he said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

EC Behind the Counter

Canada has approved the sale of the emergency contraceptive levonorgestrel 0.75 mg (Plan B) without a prescription. Until now, the product has been available in most provinces by prescription only, except for Quebec, British Columbia, and Saskatchewan, where women can access the product through pharmacists. The Canadian decision comes as the Food and Drug Administration is considering whether to allow the sale of Plan B without a prescription for women aged 16 years and older. “We are pleased that Canadian regulatory authorities have recognized that Plan B is safe and effective for use by women as emergency contraceptive and will make it available without a prescription,” said Bruce L. Downey, chairman and CEO of Barr Laboratories Inc., the company that markets Plan B in the United States. “Canada now becomes the 34th country that enables women to have more timely access to emergency contraception without a prescription.”

Legislating Refusal Clauses

Some federal lawmakers are taking aim at the controversy around pharmacists who refuse to fill prescriptions for birth control and emergency contraception. The Access to Legal Pharmaceuticals Act (S. 809/ H.R. 1652) would ensure that pharmacies fill all prescriptions, while protecting the right of individual pharmacists to refuse to fill a prescription. Although the controversy has revolved around the dispensing of prescription contraceptives, the legislation would apply to all drugs. “A pharmacist's personal beliefs should not come between a patient and [his or her] doctor,” said Sen. Frank R. Lautenberg, (D-N.J.), one of the sponsors of the legislation. “Tomorrow it might be painkillers for a cancer patient. Next year it could be medicine that prolongs the life of a person with AIDS or some other terminal disease.”

Cord Blood Banks

The federal government should establish a new National Cord Blood Policy Board to set rules for the donation, collection, and use of stem cells derived from umbilical cord blood, according to a report from the Institute of Medicine (IOM). The Health Resources and Services Administration should also identify an organization that could serve as a new Cord Blood Coordinating Center to manage the day-to-day operations for cord blood banking and allocation around the country, the report said. The National Marrow Donor Program and other organizations have developed several of the components needed to manage daily coordination of cord blood banking, but no single organization currently has the capability to serve as a Cord Blood Coordinating Center, the IOM said. “The lack of centralized organization, universal quality standards, and uniform matching mechanisms makes it more difficult than it has to be for physicians to provide patients with suitable cells in a timely way,” said Kristine Gebbie, chair of the IOM committee that wrote the report and director of the Center for Health Policy and Doctoral Studies at Columbia University in New York.

Understanding Vitamin D

More than half of women aged over 50 years reported that they have not discussed vitamin D with their physicians, according to a national survey released by the Society for Women's Health Research. The society also found women over 50 may lack an overall understanding of the importance of vitamin D to bone health. About 46% said they felt vitamin D was “extremely important” for bone health, compared with 72% who said they felt that way about calcium. One in six women (16%) said they thought vitamin D was “somewhat important” or “not important at all” for bone health, compared with 4% for calcium. The nationwide survey included 492 women aged 50 years and older. “These survey results should serve as a wake-up call for women over 50 to talk to their doctors about the importance of vitamin D as it relates to overall bone health due to the impact of vitamin D insufficiency on calcium absorption, bone loss, and fracture risk,” said Felicia Cosman, M.D., clinical director of the National Osteoporosis Foundation.

HIV/AIDS Drug Waiting List

The need for HIV/AIDS drugs continues to exceed available resources, according to a report from the National AIDS Drug Assistance Programs Monitoring Project. More than 600 individuals are on waiting lists and 21 state AIDS Drug Assistance Programs report using at least one cost containment measure such as waiting lists and capped enrollment, despite increased federal and state funding. “This is an ongoing, severe crisis in which many states are desperately struggling to provide these life-saving medications to people in need,” said Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors.

EC Behind the Counter

Canada has approved the sale of the emergency contraceptive levonorgestrel 0.75 mg (Plan B) without a prescription. Until now, the product has been available in most provinces by prescription only, except for Quebec, British Columbia, and Saskatchewan, where women can access the product through pharmacists. The Canadian decision comes as the Food and Drug Administration is considering whether to allow the sale of Plan B without a prescription for women aged 16 years and older. “We are pleased that Canadian regulatory authorities have recognized that Plan B is safe and effective for use by women as emergency contraceptive and will make it available without a prescription,” said Bruce L. Downey, chairman and CEO of Barr Laboratories Inc., the company that markets Plan B in the United States. “Canada now becomes the 34th country that enables women to have more timely access to emergency contraception without a prescription.”

Legislating Refusal Clauses

Some federal lawmakers are taking aim at the controversy around pharmacists who refuse to fill prescriptions for birth control and emergency contraception. The Access to Legal Pharmaceuticals Act (S. 809/ H.R. 1652) would ensure that pharmacies fill all prescriptions, while protecting the right of individual pharmacists to refuse to fill a prescription. Although the controversy has revolved around the dispensing of prescription contraceptives, the legislation would apply to all drugs. “A pharmacist's personal beliefs should not come between a patient and [his or her] doctor,” said Sen. Frank R. Lautenberg, (D-N.J.), one of the sponsors of the legislation. “Tomorrow it might be painkillers for a cancer patient. Next year it could be medicine that prolongs the life of a person with AIDS or some other terminal disease.”

Cord Blood Banks

The federal government should establish a new National Cord Blood Policy Board to set rules for the donation, collection, and use of stem cells derived from umbilical cord blood, according to a report from the Institute of Medicine (IOM). The Health Resources and Services Administration should also identify an organization that could serve as a new Cord Blood Coordinating Center to manage the day-to-day operations for cord blood banking and allocation around the country, the report said. The National Marrow Donor Program and other organizations have developed several of the components needed to manage daily coordination of cord blood banking, but no single organization currently has the capability to serve as a Cord Blood Coordinating Center, the IOM said. “The lack of centralized organization, universal quality standards, and uniform matching mechanisms makes it more difficult than it has to be for physicians to provide patients with suitable cells in a timely way,” said Kristine Gebbie, chair of the IOM committee that wrote the report and director of the Center for Health Policy and Doctoral Studies at Columbia University in New York.

Understanding Vitamin D

More than half of women aged over 50 years reported that they have not discussed vitamin D with their physicians, according to a national survey released by the Society for Women's Health Research. The society also found women over 50 may lack an overall understanding of the importance of vitamin D to bone health. About 46% said they felt vitamin D was “extremely important” for bone health, compared with 72% who said they felt that way about calcium. One in six women (16%) said they thought vitamin D was “somewhat important” or “not important at all” for bone health, compared with 4% for calcium. The nationwide survey included 492 women aged 50 years and older. “These survey results should serve as a wake-up call for women over 50 to talk to their doctors about the importance of vitamin D as it relates to overall bone health due to the impact of vitamin D insufficiency on calcium absorption, bone loss, and fracture risk,” said Felicia Cosman, M.D., clinical director of the National Osteoporosis Foundation.

HIV/AIDS Drug Waiting List

The need for HIV/AIDS drugs continues to exceed available resources, according to a report from the National AIDS Drug Assistance Programs Monitoring Project. More than 600 individuals are on waiting lists and 21 state AIDS Drug Assistance Programs report using at least one cost containment measure such as waiting lists and capped enrollment, despite increased federal and state funding. “This is an ongoing, severe crisis in which many states are desperately struggling to provide these life-saving medications to people in need,” said Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors.

EC Behind the Counter

Canada has approved the sale of the emergency contraceptive levonorgestrel 0.75 mg (Plan B) without a prescription. Until now, the product has been available in most provinces by prescription only, except for Quebec, British Columbia, and Saskatchewan, where women can access the product through pharmacists. The Canadian decision comes as the Food and Drug Administration is considering whether to allow the sale of Plan B without a prescription for women aged 16 years and older. “We are pleased that Canadian regulatory authorities have recognized that Plan B is safe and effective for use by women as emergency contraceptive and will make it available without a prescription,” said Bruce L. Downey, chairman and CEO of Barr Laboratories Inc., the company that markets Plan B in the United States. “Canada now becomes the 34th country that enables women to have more timely access to emergency contraception without a prescription.”

Legislating Refusal Clauses

Some federal lawmakers are taking aim at the controversy around pharmacists who refuse to fill prescriptions for birth control and emergency contraception. The Access to Legal Pharmaceuticals Act (S. 809/ H.R. 1652) would ensure that pharmacies fill all prescriptions, while protecting the right of individual pharmacists to refuse to fill a prescription. Although the controversy has revolved around the dispensing of prescription contraceptives, the legislation would apply to all drugs. “A pharmacist's personal beliefs should not come between a patient and [his or her] doctor,” said Sen. Frank R. Lautenberg, (D-N.J.), one of the sponsors of the legislation. “Tomorrow it might be painkillers for a cancer patient. Next year it could be medicine that prolongs the life of a person with AIDS or some other terminal disease.”

Cord Blood Banks

The federal government should establish a new National Cord Blood Policy Board to set rules for the donation, collection, and use of stem cells derived from umbilical cord blood, according to a report from the Institute of Medicine (IOM). The Health Resources and Services Administration should also identify an organization that could serve as a new Cord Blood Coordinating Center to manage the day-to-day operations for cord blood banking and allocation around the country, the report said. The National Marrow Donor Program and other organizations have developed several of the components needed to manage daily coordination of cord blood banking, but no single organization currently has the capability to serve as a Cord Blood Coordinating Center, the IOM said. “The lack of centralized organization, universal quality standards, and uniform matching mechanisms makes it more difficult than it has to be for physicians to provide patients with suitable cells in a timely way,” said Kristine Gebbie, chair of the IOM committee that wrote the report and director of the Center for Health Policy and Doctoral Studies at Columbia University in New York.

Understanding Vitamin D

More than half of women aged over 50 years reported that they have not discussed vitamin D with their physicians, according to a national survey released by the Society for Women's Health Research. The society also found women over 50 may lack an overall understanding of the importance of vitamin D to bone health. About 46% said they felt vitamin D was “extremely important” for bone health, compared with 72% who said they felt that way about calcium. One in six women (16%) said they thought vitamin D was “somewhat important” or “not important at all” for bone health, compared with 4% for calcium. The nationwide survey included 492 women aged 50 years and older. “These survey results should serve as a wake-up call for women over 50 to talk to their doctors about the importance of vitamin D as it relates to overall bone health due to the impact of vitamin D insufficiency on calcium absorption, bone loss, and fracture risk,” said Felicia Cosman, M.D., clinical director of the National Osteoporosis Foundation.

HIV/AIDS Drug Waiting List

The need for HIV/AIDS drugs continues to exceed available resources, according to a report from the National AIDS Drug Assistance Programs Monitoring Project. More than 600 individuals are on waiting lists and 21 state AIDS Drug Assistance Programs report using at least one cost containment measure such as waiting lists and capped enrollment, despite increased federal and state funding. “This is an ongoing, severe crisis in which many states are desperately struggling to provide these life-saving medications to people in need,” said Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors.

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers “begin to recognize that the behaviors that they have can lead to a health outcome that can actually cost them money in the long run,” said Doug Kronenberg, chief strategy officer for Lumenos, an Alexandria, Va.-based company that sells health savings accounts.

“And therefore they begin to think about changes in their behavior that can impact that health care,” he said.

When an employer or insurer combines that with a program that shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg said in a teleconference sponsored by the Kaiser Family Foundation. For example, employers can create financial incentives for consumers to complete a health risk assessment.

Health savings accounts (HSAs) were authorized under the Medicare Modernization Act of 2003 and are portable accounts consumers can use to pay certain medical expenses. The accounts generally are offered in conjunction with a high-deductible insurance plan, and consumers and employers can contribute to the accounts.

HSAs and accounts such as health reimbursement accounts can also create big savings for employers, Mr. Kronenberg said. With these types of plans, consumers tend to see the money as their own, and use health care services less.

“That's not a bad thing, when you take a look at the environment we're in today, as long as you're getting the right kind of utilization reduction,” Mr. Kronenberg said.

But Mila Kofman, J.D., assistant research professor at the Health Policy Institute at Georgetown University, Washington, said HSAs coupled with high-deductible plans just shift the cost burden from the insurer and employer to the consumer.

And one of the possible pitfalls is that consumers who are facing deductibles of $1,000 or more each year may forego needed care because they can't afford it. That could raise health care costs in general if consumers skip or delay preventive care that can identify problems early.

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers “begin to recognize that the behaviors that they have can lead to a health outcome that can actually cost them money in the long run,” said Doug Kronenberg, chief strategy officer for Lumenos, an Alexandria, Va.-based company that sells health savings accounts.

“And therefore they begin to think about changes in their behavior that can impact that health care,” he said.

When an employer or insurer combines that with a program that shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg said in a teleconference sponsored by the Kaiser Family Foundation. For example, employers can create financial incentives for consumers to complete a health risk assessment.

Health savings accounts (HSAs) were authorized under the Medicare Modernization Act of 2003 and are portable accounts consumers can use to pay certain medical expenses. The accounts generally are offered in conjunction with a high-deductible insurance plan, and consumers and employers can contribute to the accounts.

HSAs and accounts such as health reimbursement accounts can also create big savings for employers, Mr. Kronenberg said. With these types of plans, consumers tend to see the money as their own, and use health care services less.

“That's not a bad thing, when you take a look at the environment we're in today, as long as you're getting the right kind of utilization reduction,” Mr. Kronenberg said.

But Mila Kofman, J.D., assistant research professor at the Health Policy Institute at Georgetown University, Washington, said HSAs coupled with high-deductible plans just shift the cost burden from the insurer and employer to the consumer.

And one of the possible pitfalls is that consumers who are facing deductibles of $1,000 or more each year may forego needed care because they can't afford it. That could raise health care costs in general if consumers skip or delay preventive care that can identify problems early.

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers “begin to recognize that the behaviors that they have can lead to a health outcome that can actually cost them money in the long run,” said Doug Kronenberg, chief strategy officer for Lumenos, an Alexandria, Va.-based company that sells health savings accounts.

“And therefore they begin to think about changes in their behavior that can impact that health care,” he said.

When an employer or insurer combines that with a program that shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg said in a teleconference sponsored by the Kaiser Family Foundation. For example, employers can create financial incentives for consumers to complete a health risk assessment.

Health savings accounts (HSAs) were authorized under the Medicare Modernization Act of 2003 and are portable accounts consumers can use to pay certain medical expenses. The accounts generally are offered in conjunction with a high-deductible insurance plan, and consumers and employers can contribute to the accounts.

HSAs and accounts such as health reimbursement accounts can also create big savings for employers, Mr. Kronenberg said. With these types of plans, consumers tend to see the money as their own, and use health care services less.

“That's not a bad thing, when you take a look at the environment we're in today, as long as you're getting the right kind of utilization reduction,” Mr. Kronenberg said.

But Mila Kofman, J.D., assistant research professor at the Health Policy Institute at Georgetown University, Washington, said HSAs coupled with high-deductible plans just shift the cost burden from the insurer and employer to the consumer.

And one of the possible pitfalls is that consumers who are facing deductibles of $1,000 or more each year may forego needed care because they can't afford it. That could raise health care costs in general if consumers skip or delay preventive care that can identify problems early.

Canada has approved the sale of the emergency contraceptive levonorgestrel 0.75 mg (Plan B) without a prescription. The product will be available “behind the counter,” allowing pharmacists to provide women with the drug.

Until now, the contraceptive product has been available in most provinces by prescription only, except for Quebec, British Columbia, and Saskatchewan, where women can access the product through pharmacists.

The Canadian decision comes as the Food and Drug Administration is considering whether to allow the sale of Plan B without a prescription for women aged 16 years and older.

“We are pleased that Canadian regulatory authorities have recognized that Plan B is safe and effective for use by women as emergency contraceptive and will make it available without a prescription,” said Bruce L. Downey, chairman and CEO of Barr Laboratories Inc., the company that markets Plan B in the United States. “Canada now becomes the 34th country that enables women to have more timely access to emergency contraception without a prescription.”

Canada has approved the sale of the emergency contraceptive levonorgestrel 0.75 mg (Plan B) without a prescription. The product will be available “behind the counter,” allowing pharmacists to provide women with the drug.

Until now, the contraceptive product has been available in most provinces by prescription only, except for Quebec, British Columbia, and Saskatchewan, where women can access the product through pharmacists.

The Canadian decision comes as the Food and Drug Administration is considering whether to allow the sale of Plan B without a prescription for women aged 16 years and older.

“We are pleased that Canadian regulatory authorities have recognized that Plan B is safe and effective for use by women as emergency contraceptive and will make it available without a prescription,” said Bruce L. Downey, chairman and CEO of Barr Laboratories Inc., the company that markets Plan B in the United States. “Canada now becomes the 34th country that enables women to have more timely access to emergency contraception without a prescription.”

Canada has approved the sale of the emergency contraceptive levonorgestrel 0.75 mg (Plan B) without a prescription. The product will be available “behind the counter,” allowing pharmacists to provide women with the drug.

Until now, the contraceptive product has been available in most provinces by prescription only, except for Quebec, British Columbia, and Saskatchewan, where women can access the product through pharmacists.

The Canadian decision comes as the Food and Drug Administration is considering whether to allow the sale of Plan B without a prescription for women aged 16 years and older.

“We are pleased that Canadian regulatory authorities have recognized that Plan B is safe and effective for use by women as emergency contraceptive and will make it available without a prescription,” said Bruce L. Downey, chairman and CEO of Barr Laboratories Inc., the company that markets Plan B in the United States. “Canada now becomes the 34th country that enables women to have more timely access to emergency contraception without a prescription.”

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 conflicting standards. 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, Dr. Brailer said.

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 in health care and distilling that into requirements that could be used by organizations that develop standards.

“Problems don't come well packaged into a standard,” Dr. Brailer 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,” he 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 conflicting standards. 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, Dr. Brailer said.

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 in health care and distilling that into requirements that could be used by organizations that develop standards.

“Problems don't come well packaged into a standard,” Dr. Brailer 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,” he 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 conflicting standards. 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, Dr. Brailer said.

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 in health care and distilling that into requirements that could be used by organizations that develop standards.

“Problems don't come well packaged into a standard,” Dr. Brailer 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,” he 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.

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers “begin to recognize that the behaviors that they have can lead to a health outcome that can actually cost them money in the long run,” said Doug Kronenberg, who is chief strategy officer for Lumenos, an Alexandria, Va.-based company that sells health savings accounts.

“And therefore they begin to think about changes in their behavior that can impact that health care,” he commented.

When an employer or insurer combines that with a program that also shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg commented during a teleconference that was sponsored by the Kaiser Family Foundation.

For example, employers can create financial incentives for consumers to complete a health risk assessment.

Health savings accounts (HSAs) were authorized under the Medicare Modernization Act of 2003 and are portable accounts that consumers can use to pay for certain qualified medical expenses.

The accounts are generally offered in conjunction with a high-deductible insurance plan, and both consumers and employers can contribute to these accounts.

HSAs and similar accounts, such as health reimbursement accounts, can also create big savings for employers, Mr. Kronenberg said.

With these types of plans, consumers tend to see the money as their own, and utilization of health care services typically drops.

“That's not a bad thing, when you take a look at the environment we're in today, as long as you're getting the right kind of utilization reduction,” Mr. Kronenberg said.

However, Mila Kofman, J.D., who is an assistant research professor at the Health Policy Institute at Georgetown University, Washington, commented that HSAs coupled with high-deductible plans are just shifting the cost burden for health care from the insurer and the employer to the consumer.

And one of the possible pitfalls of the plans is that consumers who are facing deductibles of $1,000 or more each year will simply forego needed medical care because they can't afford to pay for it. This could actually raise the cost of health care in general if consumers skip or delay screenings and other preventive care that can identify problems early, Ms. Kofman said.

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers “begin to recognize that the behaviors that they have can lead to a health outcome that can actually cost them money in the long run,” said Doug Kronenberg, who is chief strategy officer for Lumenos, an Alexandria, Va.-based company that sells health savings accounts.

“And therefore they begin to think about changes in their behavior that can impact that health care,” he commented.

When an employer or insurer combines that with a program that also shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg commented during a teleconference that was sponsored by the Kaiser Family Foundation.

For example, employers can create financial incentives for consumers to complete a health risk assessment.

Health savings accounts (HSAs) were authorized under the Medicare Modernization Act of 2003 and are portable accounts that consumers can use to pay for certain qualified medical expenses.

The accounts are generally offered in conjunction with a high-deductible insurance plan, and both consumers and employers can contribute to these accounts.

HSAs and similar accounts, such as health reimbursement accounts, can also create big savings for employers, Mr. Kronenberg said.

With these types of plans, consumers tend to see the money as their own, and utilization of health care services typically drops.

“That's not a bad thing, when you take a look at the environment we're in today, as long as you're getting the right kind of utilization reduction,” Mr. Kronenberg said.

However, Mila Kofman, J.D., who is an assistant research professor at the Health Policy Institute at Georgetown University, Washington, commented that HSAs coupled with high-deductible plans are just shifting the cost burden for health care from the insurer and the employer to the consumer.

And one of the possible pitfalls of the plans is that consumers who are facing deductibles of $1,000 or more each year will simply forego needed medical care because they can't afford to pay for it. This could actually raise the cost of health care in general if consumers skip or delay screenings and other preventive care that can identify problems early, Ms. Kofman said.

Health savings accounts and other consumer-directed insurance products can help lower health care utilization and encourage better health behaviors, according to an industry expert.

Consumers “begin to recognize that the behaviors that they have can lead to a health outcome that can actually cost them money in the long run,” said Doug Kronenberg, who is chief strategy officer for Lumenos, an Alexandria, Va.-based company that sells health savings accounts.

“And therefore they begin to think about changes in their behavior that can impact that health care,” he commented.

When an employer or insurer combines that with a program that also shows consumers the financial benefits of changing their behavior and offers support tools, consumers really become engaged in their health care, Mr. Kronenberg commented during a teleconference that was sponsored by the Kaiser Family Foundation.

For example, employers can create financial incentives for consumers to complete a health risk assessment.

Health savings accounts (HSAs) were authorized under the Medicare Modernization Act of 2003 and are portable accounts that consumers can use to pay for certain qualified medical expenses.

The accounts are generally offered in conjunction with a high-deductible insurance plan, and both consumers and employers can contribute to these accounts.

HSAs and similar accounts, such as health reimbursement accounts, can also create big savings for employers, Mr. Kronenberg said.

With these types of plans, consumers tend to see the money as their own, and utilization of health care services typically drops.

“That's not a bad thing, when you take a look at the environment we're in today, as long as you're getting the right kind of utilization reduction,” Mr. Kronenberg said.

However, Mila Kofman, J.D., who is an assistant research professor at the Health Policy Institute at Georgetown University, Washington, commented that HSAs coupled with high-deductible plans are just shifting the cost burden for health care from the insurer and the employer to the consumer.

And one of the possible pitfalls of the plans is that consumers who are facing deductibles of $1,000 or more each year will simply forego needed medical care because they can't afford to pay for it. This could actually raise the cost of health care in general if consumers skip or delay screenings and other preventive care that can identify problems early, Ms. Kofman said.

Controversial Abstinence Site

A new government Web site aimed at helping parents talk to their teens about sex and abstinence is drawing fire from reproductive-rights advocates. The Web site, www.4parents.gov

EC Legislation Fails

Colorado Governor Bill Owens (R) vetoed legislation last month that would have required all hospitals in his state to provide rape victims with information about the availability of emergency contraception. Gov. Owens said he objected to the legislation because it would not have provided victims with the “full, balanced and detailed array of information” needed to make a decision about emergency contraception. In addition, he said the bill did not include provisions to protect the right of hospitals with religious affiliation or moral objections to emergency contraception to opt out of the requirement. While the bill offered health care professionals the right to decline to offer emergency contraception, it did not provide that option to institutions, Gov. Owens said. “This bill would violate fundamental constitutional principles by forcing an institution to say things to patients that it explicitly does not believe to be morally or ethically valid,” Gov. Owens said in his veto message.

Contraceptive Access

Elsewhere in the states, Illinois Governor Rod Blagojevich (D) filed an emergency rule last month clarifying that state pharmacies that sell contraceptives must accept and fill such prescriptions without delay. The action comes after complaints filed against a licensed Illinois pharmacy that refused to dispense prescription contraceptives. “Our regulation says that if a woman goes to a pharmacy with a prescription for birth control, the pharmacy is not allowed to discriminate who they sell it to and who they don't. The pharmacy will be expected to accept that prescription and fill it in the same way, and in the same period of time they would fill any other prescription,” Gov. Blagojevich said. “No delays. No hassles. No lecture. Just fill the prescription.”

STDs Among Lesbians

Lesbians and bisexual women who participated in a focus group reported that the need to protect against sexually transmitted diseases (STDs) is primarily a concern for heterosexual women, according to a study published in the March issue of Perspectives on Sexual and Reproductive Health (Perspect. Sex. Reprod. Health 2005;37:6-12). The focus group included 23 lesbian and bisexual women between the ages of 18 and 29. Focus group participants also had limited knowledge of bacterial vaginosis and the potential for commons STDs, such as genital herpes, to be transmitted between women. These findings point to the need to design interventions that explain the risk of STD transmission between women, the study authors said. The authors also advises that interventions are most likely to be successful when they are framed in terms of sexual enjoyment and healthy sexuality instead of disease.

Prenatal Testing Legislation

New federal legislation aims to improve the information that expectant parents receive when a prenatal test is positive for conditions such as Down syndrome and spina bifida. The Prenatally Diagnosed Condition Awareness Act (S. 609/H.R. 1353) is sponsored by Sen. Sam Brownback (R-Kan.) and Sen. Edward Kennedy (D-Mass.). “We have been able to screen for certain conditions in the womb for quite some time now, but I'm concerned that we don't have a great track record for handling that information very well,” Sen. Brownback said. The legislation is aimed at improving epidemiologic understanding of prenatally diagnosed conditions, ensuring confidentiality, and supporting health care providers who perform prenatal tests and deliver results. The bill would also authorize a study of the effectiveness of existing health care and family support services for children with disabilities and their families.

Controversial Abstinence Site

A new government Web site aimed at helping parents talk to their teens about sex and abstinence is drawing fire from reproductive-rights advocates. The Web site, www.4parents.gov

EC Legislation Fails

Colorado Governor Bill Owens (R) vetoed legislation last month that would have required all hospitals in his state to provide rape victims with information about the availability of emergency contraception. Gov. Owens said he objected to the legislation because it would not have provided victims with the “full, balanced and detailed array of information” needed to make a decision about emergency contraception. In addition, he said the bill did not include provisions to protect the right of hospitals with religious affiliation or moral objections to emergency contraception to opt out of the requirement. While the bill offered health care professionals the right to decline to offer emergency contraception, it did not provide that option to institutions, Gov. Owens said. “This bill would violate fundamental constitutional principles by forcing an institution to say things to patients that it explicitly does not believe to be morally or ethically valid,” Gov. Owens said in his veto message.

Contraceptive Access

Elsewhere in the states, Illinois Governor Rod Blagojevich (D) filed an emergency rule last month clarifying that state pharmacies that sell contraceptives must accept and fill such prescriptions without delay. The action comes after complaints filed against a licensed Illinois pharmacy that refused to dispense prescription contraceptives. “Our regulation says that if a woman goes to a pharmacy with a prescription for birth control, the pharmacy is not allowed to discriminate who they sell it to and who they don't. The pharmacy will be expected to accept that prescription and fill it in the same way, and in the same period of time they would fill any other prescription,” Gov. Blagojevich said. “No delays. No hassles. No lecture. Just fill the prescription.”

STDs Among Lesbians

Lesbians and bisexual women who participated in a focus group reported that the need to protect against sexually transmitted diseases (STDs) is primarily a concern for heterosexual women, according to a study published in the March issue of Perspectives on Sexual and Reproductive Health (Perspect. Sex. Reprod. Health 2005;37:6-12). The focus group included 23 lesbian and bisexual women between the ages of 18 and 29. Focus group participants also had limited knowledge of bacterial vaginosis and the potential for commons STDs, such as genital herpes, to be transmitted between women. These findings point to the need to design interventions that explain the risk of STD transmission between women, the study authors said. The authors also advises that interventions are most likely to be successful when they are framed in terms of sexual enjoyment and healthy sexuality instead of disease.

Prenatal Testing Legislation

New federal legislation aims to improve the information that expectant parents receive when a prenatal test is positive for conditions such as Down syndrome and spina bifida. The Prenatally Diagnosed Condition Awareness Act (S. 609/H.R. 1353) is sponsored by Sen. Sam Brownback (R-Kan.) and Sen. Edward Kennedy (D-Mass.). “We have been able to screen for certain conditions in the womb for quite some time now, but I'm concerned that we don't have a great track record for handling that information very well,” Sen. Brownback said. The legislation is aimed at improving epidemiologic understanding of prenatally diagnosed conditions, ensuring confidentiality, and supporting health care providers who perform prenatal tests and deliver results. The bill would also authorize a study of the effectiveness of existing health care and family support services for children with disabilities and their families.

Controversial Abstinence Site

A new government Web site aimed at helping parents talk to their teens about sex and abstinence is drawing fire from reproductive-rights advocates. The Web site, www.4parents.gov

EC Legislation Fails

Colorado Governor Bill Owens (R) vetoed legislation last month that would have required all hospitals in his state to provide rape victims with information about the availability of emergency contraception. Gov. Owens said he objected to the legislation because it would not have provided victims with the “full, balanced and detailed array of information” needed to make a decision about emergency contraception. In addition, he said the bill did not include provisions to protect the right of hospitals with religious affiliation or moral objections to emergency contraception to opt out of the requirement. While the bill offered health care professionals the right to decline to offer emergency contraception, it did not provide that option to institutions, Gov. Owens said. “This bill would violate fundamental constitutional principles by forcing an institution to say things to patients that it explicitly does not believe to be morally or ethically valid,” Gov. Owens said in his veto message.

Contraceptive Access

Elsewhere in the states, Illinois Governor Rod Blagojevich (D) filed an emergency rule last month clarifying that state pharmacies that sell contraceptives must accept and fill such prescriptions without delay. The action comes after complaints filed against a licensed Illinois pharmacy that refused to dispense prescription contraceptives. “Our regulation says that if a woman goes to a pharmacy with a prescription for birth control, the pharmacy is not allowed to discriminate who they sell it to and who they don't. The pharmacy will be expected to accept that prescription and fill it in the same way, and in the same period of time they would fill any other prescription,” Gov. Blagojevich said. “No delays. No hassles. No lecture. Just fill the prescription.”

STDs Among Lesbians

Lesbians and bisexual women who participated in a focus group reported that the need to protect against sexually transmitted diseases (STDs) is primarily a concern for heterosexual women, according to a study published in the March issue of Perspectives on Sexual and Reproductive Health (Perspect. Sex. Reprod. Health 2005;37:6-12). The focus group included 23 lesbian and bisexual women between the ages of 18 and 29. Focus group participants also had limited knowledge of bacterial vaginosis and the potential for commons STDs, such as genital herpes, to be transmitted between women. These findings point to the need to design interventions that explain the risk of STD transmission between women, the study authors said. The authors also advises that interventions are most likely to be successful when they are framed in terms of sexual enjoyment and healthy sexuality instead of disease.

Prenatal Testing Legislation

New federal legislation aims to improve the information that expectant parents receive when a prenatal test is positive for conditions such as Down syndrome and spina bifida. The Prenatally Diagnosed Condition Awareness Act (S. 609/H.R. 1353) is sponsored by Sen. Sam Brownback (R-Kan.) and Sen. Edward Kennedy (D-Mass.). “We have been able to screen for certain conditions in the womb for quite some time now, but I'm concerned that we don't have a great track record for handling that information very well,” Sen. Brownback said. The legislation is aimed at improving epidemiologic understanding of prenatally diagnosed conditions, ensuring confidentiality, and supporting health care providers who perform prenatal tests and deliver results. The bill would also authorize a study of the effectiveness of existing health care and family support services for children with disabilities and their families.

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.

There are many organizations involved in developing and approving standards, but there isn't a process for harmonizing two conflicting standards.

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, Dr. Brailer said.

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 in health care and distilling that into requirements that could be used by organizations that develop standards. “Problems don't come well packaged into a standard,” he 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,” he 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.

There are many organizations involved in developing and approving standards, but there isn't a process for harmonizing two conflicting standards.

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, Dr. Brailer said.

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 in health care and distilling that into requirements that could be used by organizations that develop standards. “Problems don't come well packaged into a standard,” he 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,” he 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.

There are many organizations involved in developing and approving standards, but there isn't a process for harmonizing two conflicting standards.

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, Dr. Brailer said.

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 in health care and distilling that into requirements that could be used by organizations that develop standards. “Problems don't come well packaged into a standard,” he 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,” he 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.