Health care experts warn of challenges for IT adoption March 19, 2009
Posted by gonzalezloumiet in American Enterprise Institute, EMR, HIT, nationwide health information exchange, Obama, Standards, Stimulus Plan, Trinity Health.add a comment
by Stephanie Condon
WASHINGTON–President Obama has called health information technology the “low-hanging fruit” of health care reform, but implementing the use of electronic medical records nationwide will be incredibly difficult, experts warned Wednesday, especially without larger health care reforms.
The Congressional Budget Office estimates that the use of electronic medical records could save the nation $12.5 billion over 10 years, and other analyses give more optimistic figures.
At a forum here on Wednesday, hosted by the conservative think tank the American Enterprise Institute, health care providers and buyers attested to the improved quality of care and efficiencies that can result from the use of properly implemented electronic medical records. Yet without new policies to incentivize the use of health IT systems, the stimulus funds may go to waste, they said.
“We have an incredibly complex industry that doesn’t necessarily want to change,” said Joseph Swedish, president and CEO of Trinity Health, a nonprofit health care provider that includes 44 hospitals in its network. “I think the stimulus can prime the pump, but we have to recognize the daunting task ahead of us.”
TheTrinity Healthdirects health care providers to electronically record patients’ health information for “biosurveillance and public health” and “medical and clinical research” as part of a “nationwide system for the electronic use and exchange of health information.”
However, Swedish and other health care experts said providers will be reluctant to share data–or even use health IT systems in the first place–because of the pay-for-service structure and other institutional characteristics of the health industry.
Coordinators of a federal health care IT initiative have said developing a national health IT network will be extremely difficult and slow going because of the endless number of varying standards for medical health records applied in different states and localities.
Yet Benjamin Sasse, an assistant professor at the University of Texas at Austin, said Wednesday that providers themselves–not a lack of consistent standards–are the biggest roadblock to a nationwide health information exchange.
“The standards problems are absolutely real, but if you want a sticky patient, why would you ever make a patient portable and available to your competitor?” he asked. “Most of the reasons we don’t have (health) IT have nothing to do with IT.”
“There are a lot of complexities with the sharing of data…I don’t envision in the near term being able to work with others.”
–Joseph Swedish, president and CEO of Trinity HealthTrinity Health, along with Kaiser and the U.S. Department of Veterans Affairs, has one of the nation’s largest integrated, single-platform data management systems and is using its repository of information to adopt more evidence-based treatment. However, Swedish said, Trinity is not sharing data with Kaiser or other providers.
“There are a lot of complexities with the sharing of data,” he said. “I don’t envision in the near term being able to work with others.”
Trinity rolled out its health IT network in 2000 and incurred operational costs that greatly exceeded estimates, Swedish said, but also achieved more benefits than anticipated. Its hospitals, for instance, administer emergent medications 40 percent faster, and Trinity’s nurses have increased their bedside attendance of patients by 8 percent now that they spend less time on paperwork.
“We have witnessed lowering costs and what we believe is better quality,” he said. “We believe the investment is absolutely the right thing to do in the modern world we live in today.”
Still, he said, the process took years to implement, the benefits would not have been possible with just the IT–a change in culture and staff processes was also necessary.
The economic structure of the health industry does not only deter providers from sharing information, but also from simply adopting health IT in the first place, Sasse said.
“Health IT is (part of) a much larger debate around payment reform that would provide much higher care than the fee-for-service system does today,” he said.
SOURCE: http://news.cnet.com/8301-13578_3-10199405-38.html
Bad Bet on Medical Records March 18, 2009
Posted by gonzalezloumiet in EMR, Harvard, Health Care, Obama, Stimulus Plan.add a comment
By Stephen B. Soumerai and Sumit R. Majumdar
Tuesday, March 17, 2009; A15
President Obama’s proposed health-care reforms include investing $50 billion over five years to promote health information technology. Most notably, paper medical records would be replaced with linked electronic records to try to improve quality of care and lower medical costs. The recently enacted stimulus package included $20 billion for health IT, and, indeed, the $50 billion the administration initially earmarked is almost twice the annual budget of the National Institutes of Health. Yet while this sort of reform has popular support, there is little evidence that currently available computerized systems will improve care. In short, it’s the wrong investment to make at this time.
The assumption underlying the proposed investment in health IT is that more and better clinical information will improve care and save money. It is true that computerized records in some settings might improve care, such as by preventing duplicative prescriptions, medical errors caused by illegible handwriting and even inappropriate treatments. But the benefits of health IT have been greatly exaggerated. Large, randomized controlled studies — the “gold standard” of evidence — in this country and Britain have found that electronic records with computerized decision support did not result in a single improvement in any measure of quality of care for patients with chronic conditions including heart disease and asthma. While computerized systems seek to reduce the overapplication or misuse of care, they do little to prompt greater and more widespread health-care practices that are known to be effective. Health IT has not been proven to save money. Moreover, personal financial ties have been found between some researchers and the companies that produce these systems, and as far back as 2005 studies have shown that health IT developers are about three times more likely to report “success” than evaluators who had no part in system development.
What’s more, evidence suggests that adoption of some computerized systems has not helped but harmed patients. After the Children’s Hospital of Pittsburgh added automated prescribing recommendations to a commercial electronic records system, the institution documented a more than threefold increase in the death rate among child patients. Another leading system contributed to more than 20 different types of medical errors.
There are thousands of small groups of physicians in the United States, the majority of which are not ready for this sea change of interconnected health information. The latest national survey, published in the New England Journal of Medicine, shows that only 4 percent of doctors have fully functional electronic records that can provide any kind of clinical recommendations. Health information technology is expensive, and government subsidies may not be sufficient to persuade doctors to use them. Studies in U.S. hospitals suggest that these systems can add a half-hour or more to a day for tasks such as electronic ordering, and the false alerts that systems sometimes send can desensitize doctors to legitimate clinical recommendations. Yet, as things stand, doctors who rightly worry about these problems and delay adoption of certain types of health IT solutions beyond 2014 will be penalized through lower Medicare reimbursements. No one benefits, and reform is likely to stall, or worse, if doctors are forced to adopt flawed or unproven health IT systems.
There are, of course, places where advances in health information technology may have modestly reduced medical errors. But most such improvements came under the very large, integrated systems such as those used by Kaiser Permanente and the Veterans Administration, or the national health plans in countries such as Denmark, Britain and Israel. In those countries, physicians are required and trained to use the national systems. That isn’t standard in the United States, where such large systems cover only a small fraction of patients.
In the near term, health IT systems are an expensive and still unproven technology for most physicians in the United States. Before moving ahead, the administration should first consider conducting well-controlled research on the cost-effectiveness of health IT in office practices, which are the bulk of the U.S. medical system. It should base any investments of taxpayer funds on solid evidence of benefit and safety. Finally, it should invest in proven but underused health programs that do not bankrupt the budget, such as physician and nurse-practitioner teams that help homebound elderly people avoid hospitalization and institutionalization.
For many chronically ill and vulnerable patients, it does not matter much whether their health records are digital or their prescriptions typed. Without patient access to clinicians and adequate health insurance that includes affordable drug coverage, a $50 billion investment in health information technology won’t do much for many Americans. These funds are needed elsewhere.
Stephen B. Soumerai is a professor of ambulatory care and prevention at Harvard Medical School. Sumit R. Majumdar is an associate professor at the University of Alberta’s Department of Medicine.
Tampa Bay launches e-health ‘revolution’ March 17, 2009
Posted by gonzalezloumiet in EMR, Health Care, Obama, Stimulus Plan, Tampa.add a comment
March 15, 2009
Bernie Monegain, Editor Stephen Klasko, MD
TAMPA, FL – The people behind Paperfree Tampa Bay foresee the $18 million initiative as President Barack Obama’s vision made good. They have set their sights for the 10-county, 8,000-physician e-prescribing pilot launched Monday on no less than 100 percent adoption. They’ll achieve it, they say, by going to physicians door-to-door and providing the help they need to get on board. The backers of the project – USF Health and Allscripts – are angling for $16 million of the $2 billion in federal economic stimulus money the Office of the National Coordinator will distribute to help speed up the adoption of healthcare information technology.
They figure they have a good chance of landing the money they need. The project has the right stuff, says Stephen Klasko, MD, an CEO of USF Health and dean of the USF College of Medicine. Paperfree Tampa takes bold, yet achievable steps toward the adoption of healthcare IT, he says. It creates jobs – more than 200 to help physicians and their staffs with implementation. It has the backing of the area’s Congressional delegation, it’s ready to go, and it holds the promise of a replicable model for other parts of the country. Discussions are already under way in Hartford, Conn., Pittsburgh and Iowa. “The revolution is going to start in Tampa Bay,” Klasko said. U.S. Rep. Kathy Castor (D-Tampa) says it’s fitting that the revolution would start in Tampa Bay. “We are a healthcare innovation center,” she said, noting that Tampa is home to the University of South Florida’s colleges of medicine, nursing and public health, as well as BayCare Health System and the James A. Haley Veterans Hospital. “It makes it a natural location to kick off a project like this,” she said. Castor said the initiative combines the important elements of healthcare reform and the reduction of medical errors. An Institute of Medicine report estimates 1.5 million Americans are injured each year and 7,000 die from preventable medication errors. Yet, today, less than 10 percent of U.S. physicians write prescriptions electronically. In addition, Castor noted, Paperfree Tampa Bay creates a new occupation and new jobs. “I think these jobs will multiply,” she said. U.S. Rep. C. W. Bill Young (R-Indian Shores) also champions the project. “This is an innovative private-public partnership that will help physicians across our region take a first step toward embracing electronic health records,” Young said.
SOURCE: http://www.healthcareitnews.com/news/tampa-bay-launches-e-health-revolution
GAO predicts transition to national health IT system will be challenging March 13, 2009
Posted by gonzalezloumiet in GAO, Stimulus Plan, Technology.add a comment
CCH® Healthcare Compliance — 3/13/09
The transition to a system of health information technology (IT) has the potential to improve the quality and efficiency of health care delivery but will require an important national discussion to establish standards and address existing public concerns about personal privacy, according to a Government Accountability Office (GAO) report entitled “Health Information Technology: Federal Agencies’ Experiences Demonstrate Challenges to Successful Implementation.”
The GAO explained that achieving widespread adoption and implementation of health IT will hinge on receiving input from all important stakeholders, including health care consumers, public and private health care providers, patient advocates, insurance companies, government entities, nonprofit organizations and commercial technology providers. “Developing, coordinating and agreeing on standards are crucial for allowing health IT systems to work together and to provide the right people access to the information they need,” the GAO noted.
Benefits. Government officials have long touted health IT’s potential to reduce the cost of health care by making the collection, storage, and retrieval of medical data more efficient. In 2003, a 1,900-bed teaching hospital reported that it realized about $8.6 million in annual savings by replacing outpatient paper medical charts with electronic medical records. A national, interoperable system of electronic health care records, as well as other technologies such as bar coding drug and biological product labels, also would help cut down on errors, the GAO found.
Making the transition to a national health IT system, however, will be a complicated process. “Achieving this transition and the potential efficiencies and quality improvements promised by widespread adoption of health IT will require consideration of many serious issues, including the need for a foundation of clearly defined health IT standards that are agreed upon by all important stakeholders, comprehensive planning grounded in results-oriented milestones and measures, and an approach to privacy protection that encourages acceptance and adoption of electronic health records,” according to the GAO.
CCH Chicago Bureau, Jan. 28, 2009
HIT = $ x MD^2: a New Theory on Expenditure Relativity March 12, 2009
Posted by gonzalezloumiet in EMR, HIT, Stimulus Plan, Technology.add a comment
Wednesday, March 11, 2009
by Thomas H. Lee M.D.
The much anticipated economic stimulus bill turned the final legislative corner and finally arrived. Health IT advocates eagerly wait to see how the details of the package might shake out.
The $787 billion plan allocates approximately $19 billion to “modernize health information technology systems” — mostly through Medicare Part B incentives to physicians for deploying and using certified electronic health records.
Though there has been some debate as to the efficacy of such an incentive program, most policymakers view health IT investment as an obvious short- and long-term win. Upgrading health information systems could immediately stimulate the economy and, over time, provide higher quality care at lower costs.
But will the stimulus achieve the outcomes we desire? And is $19 billion the right amount? Perhaps it’d be helpful to examine the issue from a slightly different perspective.
The Space-Time Continuum
It was more than 90 years ago when Albert Einstein was working on his breakthrough papers on special and general relativity.
Special relativity proposed that distance and time are not absolute concepts (as suggested by Isaac Newton) but rather relative — linked together by a single construct called the space-time continuum. Counterintuitively, a simple measurement by yardstick or clock is dependent on the relative motion of the observer. One hundred yards is not the same 100 yards when measured by observers moving at different rates of speed. Clocks that are moving appear to tick slower than those that are stationary.
General relatively further expanded the theory to include gravity that, like motion, would also affect the intervals of time and space. Clocks in stronger gravitational fields would appear to tick slower than those in weaker gravitational fields.
Hailed as one of the great breakthroughs in physics since Newton 250 years before, Einstein provided a new perspective on relationships that were once considered fixed and absolute. He showed that distance and time were relative — influenced by both speed of motion and strength of gravity.
Distortions in Expenditure?
Though a far cry from relativity theory, some of the proposed health IT expenditures appear to be exhibiting similar counterintuitive distortions of reality.
Generally speaking, most lawmakers and industry experts believe that total health IT expenditures should correlate with health IT adoption and the subsequent improvement in the cost and quality of health care. Simply put, dollars put into the system should correlate to outcomes achieved. Though many including myself would take issue with that statement, let’s agree for the moment that this might be true.
Assuming a Newtonian correlation between expected outcome and proposed expenditures, what does that say about the proposed health IT expenditures? What impact should we expect from $19 billion? And is this the appropriate amount given our expectations?
In the latest version of the stimulus bill, $19 billion is proposed to help physicians adopt certified EHRs over the next several years. How does that compare with what we’re already currently spending? As context, some of today’s largest EHR mega-vendors such as Allscripts and NextGen generate annual revenues of $150 million to $300 million, or about just 1% of the proposed total. And in 2007, the size of the total EHR market was estimated to be $1.2 billion. Spent over time, $19 billion would represent about 3.5 times the total expenditures in 2007 for the entire EHR market, for each of the next five years.
In addition, the stimulus bill includes $2 billion that would be allocated to the Office of the National Coordinator for Health IT. Just a year ago, former President George W. Bush proposed a 2008 ONC budget of $117.9 million, of which only $61.3 million was approved (the same amount it received in 2007). A $2 billion budget would represent a whopping eight-fold increase in spending on an annual basis for the next five years. That would be enough to employ more than 3,200 employees at ONC.
If we’re to believe that health IT expenditures should generally correlate with improvement in outcomes, do we honestly expect adoption rates and outcomes to improve three- to eight-fold over the coming five years? If not, what could be accounting for the huge disparity in expenditures and expectations?
The Relativity of Expenditures
The reality is that the environment in which the health IT expenditures are being evaluated today is like no other in recent decades. With massive unemployment and prolonged recession looming, legislators are being forced to act broadly and swiftly with a general stimulus bill 40 times larger than the health IT portion alone. Given the context of trillion-dollar deficits, multibillion-dollar bailouts, millions of job losses, and a $787 billion stimulus package, $19 billion almost appears trivial.
It is the urgency and magnitude of the economic context today that are distorting our ability to measure the potential impact and efficacy of health IT expenditures. Just like distance and time are influenced by motion and gravity, so are the expected outcomes and metrics of expenditures distorted by the urgency and the gravity of the underlying situation.
In a normal economic environment, I think it’d be hard to find legislators who believe that $19 billion spent on health IT infrastructure alone would make for a sound investment. More individuals would question why health IT vendors haven’t created the market for themselves. And others might consider modifying the economic incentives for quality and cost-efficiency directly, rather than indirectly through health IT.
Unfortunately, given the times we’re in, it’s hard to fully criticize the intent of the health IT expenditures proposed in the stimulus bill. But over time, we may be reassessing this decision for years to come. Will it create the health IT utopia we all imagine? Or will it lead to hasty adoption of inadequate systems that only erode the crumbling infrastructure of medical practices for years to come? Perhaps the only reliable outcome we can predict from the stimulus bill is that health IT vendors should expect a financial windfall that could fully stretch across the space-time continuum.
SOURCE: http://www.ihealthbeat.org/Perspectives/2009/HIT-MD2-a-New-Theory-on-Expenditure-Relativity.aspx
Agencies move toward goal of sharing health records March 11, 2009
Posted by gonzalezloumiet in EMR, Florida Dept of Health, Stimulus Plan, Technology.add a comment
By ELISE CASTELLI
March 11, 2009
An Obama administration priority is to launch a system that allows health care providers to share records electronically. Work is already under way to begin with records federal agencies use.
Since 2004, 26 agencies with roles in citizen health care have collaborated on standards, known as the Federal Health Architecture (FHA). The goal is to allow health care providers to exchange records with the government and among themselves. The system would work somewhat like the Internet, which is built on a common set of standards, so it can be used by many.
Later this month, those agencies will release common codes that will guide creation of the network’s software. The network is called the National Health Information Network (NHIN), said Vish Sankaran, the director of the program, which is run out of the Health and Human Services Department.
“The goal is to build a network of networks,” Sankaran said.
To get the network started, these 26 agencies agreed on common mission-specific needs, Sankaran said.
“Everyone has a different mission and understanding of what needs to be done,” he said. By bringing agencies together, the FHA was able to create a comprehensive, interoperable system that still addresses unique needs, Sankaran said. This means when agencies use the network, they’ll be able to obtain the information they need, he said.
Testing the system
One agency is already using the NHIN. The Social Security Administration began sharing information with a local health system, MedVirginia, on Feb. 28.
Although SSA doesn’t provide health care, it does review more than 3 million disability cases each year. In each case, medical files are required to confirm a disability, said Debbie Somers, senior adviser to SSA’s deputy commissioner for systems.
With the current, paper-based system, it could take several months to receive files. Case workers then must thumb through them looking for the appropriate diagnoses to confirm the disability, Somers said.
Electronic health records can reduce this time from months to minutes, and case workers can electronically search the documents for the pertinent information, Somers said. That was the experience in a pilot program with a Boston hospital, Beth Israel Deaconess Medical Center. But that pilot did not use the NHIN like the MedVirginia test, she said.
SSA hopes to expand the use of the NHIN to exchange information for disability cases. It is in discussions with Kaiser Permanente and the North Carolina Health Care Information and Communications Alliance to do so, she said.
The experiences exchanging information through this pilot will help other agencies launch their own connections to the network later this year.
The Veterans Affairs Department is one of the departments hoping to learn from SSA’s experience, said Linda Fischetti, VA’s chief health informatics officer.
About 40 percent of veterans receiving care through VA also use private-sector health care providers. It can be an onerous process to obtain paper medical records from those providers, she said. VA is identifying areas where levels of joint care are highest to test the electronic system starting in the fall, she said.
VA already has its own electronic records systems for more than 90 percent of medical actions, but private-sector adoption of electronic health records remains below 30 percent, making it a challenge to fully use of the network in this early stage, she said.
“We almost exist in a future state,” Fischetti said. “We’re reliant on adoption rates getting higher for the health information exchange to be transformative.”
By accelerating the exchange of medical information and automating some activities, such as flagging drug interactions, health IT can help save lives by avoiding medical errors.
The FHA is part of a larger office, the Office of the National Coordinator for Health Information Technology, which is working toward a 2014 goal of having electronic health records for all Americans. While Sankaran can’t say if that goal will be reached, “every day being wasted by not making the data available at the point of care means someone is suffering.”
Tim Young, a former deputy Office of Management and Budget administrator for IT, said agencies are leading by example.
“FHA’s collaborative interagency governance structure is enabling a more unified approach to investment alignment, data interoperability and information sharing,” said Young, now a senior consultant with Deloitte Consulting. “FHA is implementing the program with the partner agencies, not to them.”
Challenges ahead
The low adoption rate in the private sector is just one of the challenges facing the FHA and the broader health IT initiative. Security is another.
The biggest challenge, Sankaran said, is reconciling the differences in privacy and security protocols under two competing laws: the Health Insurance Portability and Accountability Act (HIPAA) and the Federal Information Security Management Act (FISMA).
For example, health data the federal government produces is governedunder FISMA privacy standards. If that information is transferred to a private-sector provider covered by HIPAA, must those private providers follow FISMA?
Answering this question is made easier because agencies have agreed to develop a single protocol to dictate which law applies, instead of each agency negotiating the point with private-sector providers, Sankaran said. By avoiding competing instructions to the private sector, government can ensure data is properly secured, he said.
Already, agencies decided that the records will not reside in a central portal and users of the network won’t be able to be call up information as they might on Google. Instead, users will follow current protocols for the release of health information: getting authorization from the patient and sending out a data call to individual service providers for the files, he said.
SOURCE: http://federaltimes.com/index.php?S=3984343
IT receives slight budget increases, some cuts in omnibus bill March 11, 2009
Posted by gonzalezloumiet in Stimulus Plan.add a comment
By Bob Brewin 03/10/2009
The $410 billion omnibus appropriations bill the Senate considered on Tuesday would provide modest boosts for key information technology programs in agencies such as the Internal Revenue Service, Food and Drug Administration, and Federal Aviation Administration.
The bill incorporates nine spending bills Congress did not pass last year and would fund most civilian agencies, including the Treasury, Transportation, and Health and Human Services departments, for fiscal 2009, which ends Sept. 30. These agencies have been operating on budgets equal to what they had in fiscal 2008 budgets for most of fiscal 2009. The House passed the bill on Feb. 25.
FDA would be one of the agencies that would receive a large boost in spending. The omnibus bill gives it a $2 billion budget, an increase of 19 percent from the fiscal 2008 budget. Nearly $256 million of the $325 million increase would fund food and medical product safety programs. Top Senate and House leaders sharply criticized FDA in January 2008 for not adequately funding programs that ensure the safety of food, drug and medical products. Part of the budget increase will pay for information systems and screening tools to test the safety of imported foods.
The spending bill also increased funding for the IRS’ Business Systems Modernization program by $7.3 million, a 3 percent increase above the agency’s requested $222.7 million budget.
But the Senate is concerned with the program, which has experienced cost overruns and long delays. Language in the bill stated the program, started in 1999 to replace aging computer systems, “will continue to require vigilant management attention for several years.”
The bill would cut some IT projects, such as the Justice Department’s fiscal 2009 budget for its IT program, a central account that the department’s chief information officer manages to fund departmentwide IT projects. The Senate would trim the IT program’s budget to $80 million, a decrease of about $14 million, because of delays and other issues with the deployment of the Unified Financial Management System at the Drug Enforcement Administration, according to the bill.
Congress is “concerned about the department’s ability to meet appropriate standards of success for this project,” which has been under development since 2006 when Justice awarded IBM a $150 million contract to build the system.
Jolenen Lauria Sullens, deputy assistant attorney general and controller at Justice, said the report language does not reflect the current status of the financial management system project, which is based on Momentum Enterprise Resource Planning software developed by CGI.
Sullens said she delayed the live deployment at DEA for three months, from October 2008 until January 2009, because of its complexity. She said the Momentum software is designed to manage financial systems and workflow processes across the department. Sullens said the financial management system is “on schedule and healthy” and intends to ask Congress to reprogram funds to fund the project through fiscal 2009.
IBM and Justice have started to deploy the financial management system at the Bureau of Alcohol, Tobacco and Firearms and the Federal Bureau of Prisons, said Lia Davis, an IBM spokeswoman.
Congress also zeroed out a $10.7 million funding line requested by the FBI for a planned National Security Analysis Center, which would use predictive data modeling technology that could “violate the privacy and civil liberties of law abiding America citizens,” the bill said. The FBI originally requested funding for the center in 2007, and at the time said it eventually would store 6 billion records, or about 20 files for every person in the country.
Although the stimulus bill passed by Congress last month provided $19 billion for health information technology, the omnibus bill would cut spending for the Office of the National Coordinator for Health Information Technology. The Senate would cut the fiscal 2009 budget for the office, which is part of HHS, to $61.2 billion, $4.9 billion below what the Bush administration requested and only $670,000 above the office’s fiscal 2008 budget.
Dave Roberts, vice president of government relations for the Healthcare Information and Management Systems Society, said the Office of the National Coordinator for Health Information Technology has started to develop the infrastructure to establish, for example, policy and standards committees to “make [health IT] happen.” But he cautioned that Kansas Gov. Kathleen Sebelius, whom President Obama nominated as secretary of Health and Human Services, must define the future of the program.
Dennis Williams, selected on March 3 as deputy assistant secretary for recovery act coordination at HHS, will play a key role in determining how HHS manages the health IT portion of the stimulus bill, Roberts added. Williams previously served as deputy administrator of the Health Resources and Services Administration.
The bill would give FAA the $300 million budget it requested for its program to develop an advanced satellite-based air traffic control system. The Automatic Dependent Surveillance-Broadcast system is the core component of its Next-Generation Air Transportation System. Doug Church, a spokesman for the National Air Traffic Controllers Association, said Congress is likely to provide additional funds for the surveillance system, which uses Global Positioning System technology to locate and track aircraft, in the 2009 FAA Reauthorization Act, which the House Transportation and Infrastructure Committee passed on March 5.
The Transportation Department’s Office of the Chief Information Officer received its requested budget of $12.9 million, but the Agriculture department’s Office of the Chief Information Officer had its budget request cut $800,000 to $17.5 million.
SOURCE: http://www.nextgov.com/nextgov/ng_20090310_9489.php
New York State health IT strategy may be model for the nation March 11, 2009
Posted by gonzalezloumiet in EMR, Health Care, Interoperability, New York, Stimulus Plan, Technology.add a comment
100 percent of HEAL NY programs still exist, Weill Cornell Medical College study finds
NEW YORK (March 10, 2009) — Health information technology programs implemented in New York state are active and functioning a full two years after being established, and could serve as models for new federal initiatives, according to a study by investigators at Weill Cornell Medical College.
“Programs such as these could transform the way health care is delivered nationally and locally,” says senior author Dr. Rainu Kaushal, chief of the Division of Quality and Clinical Informatics and associate professor of pediatrics, public health and medicine at Weill Cornell Medical College.
If implemented correctly, information technology (IT) systems — including electronic health records — have the potential to improve quality of care, increase efficiency and cost savings, reduce medical errors, and enhance continuity of care.
“Ideally, a doctor treating a patient will have access to the patient’s entire medical history at the point of care,” says lead researcher Dr. Lisa Kern, assistant professor of public health and medicine and the Nanette Laitman Clinical Scholar in Public Health–Clinical Evaluation at Weill Cornell Medical College. “For example, I’m better able to avoid an adverse drug event if I know what the patient’s cardiologist prescribed the patient yesterday.”
The findings were published in the March 10 issue of Health Affairs, a special themed issue on health information technology. Dr. Kaushal and Dr. Kern represented New York state at a briefing in Washington, D.C., held the same day to coincide with the release of the journal issue.
The federal government is poised to pour $19 billion into health information technology as part of the new economic stimulus package.
At present, New York state is substantially ahead of the game, with approximately $250 million allocated for health information technology and, specifically, electronic health records that can connect to other health IT systems through the statewide health information exchange network, or “interoperable” health IT. The Healthcare Efficiency and Affordability Law for New Yorkers Capital Grant Program (HEAL NY) is the largest state-based investment of its kind, surpassing the next largest state program by a factor of eight. Currently $160 million in HEAL NY funds have been granted and $230 million in private sector dollars committed to health IT infrastructure, bringing New York’s current investment to $390 million.
Dr. Kaushal and Dr. Kern direct HITEC (Health Information Technology Evaluation Collaborative), a multi-institutional academic collaboration formed to evaluate New York state health IT initiatives.
The authors conducted a longitudinal survey of the 26 grantees that were funded under the first phase of HEAL NY, starting in 2005. Each grantee consisted of a consortium of health care institutions in a given community. The grantees had received a total of $53 million for this phase of the project. The authors also assessed the implications of New York’s health IT strategy on the grantees approach and progress.
“Over the past two years, the grantees have been involved in developing and implementing statewide policy solutions, technological building blocks, and clinical capacity as part of New York’s health IT infrastructure,” says Lori M. Evans, Deputy Commissioner, New York State Department of Health, Office of Health Information Technology Transformation, who is responsible for leading New York’s health IT strategy. “I think this has made a big difference in the progress and success of our grantees — innovating from the bottom up and following statewide policies, standards and technical specifications from the top down.”
“Two years into the program, 100 percent of grantees were still in existence and functioning and all were still implementing interoperable health IT systems,” says Dr. Kern. This is in contrast to national trends, where 25 percent of regional health information organizations (RHIOs) nationwide do not survive their first year.
Eighty-five percent of the communities studied were still actively pursuing health information exchange, and more than one-third met the formal criteria for a regional health information organization, an information-technology model that connects hospitals, doctors’ offices, pharmacies and laboratories.
One-third of grantees had actual users for their systems.
“New York state is leading the nation in health IT,” Dr. Kaushal says. “These successes could help shape the federal government’s approach to health IT.”
“The Department of Health applauds the authors and the Health Information Technology Evaluation Collaborative (HITEC) on their article in Health Affairs,” says Ms. Evans. “HITEC is responsible for evaluating New York’s health IT agenda and providing short-cycle feedback every step of the way as well as longer-term contributions to the literature. This piece in particular provides positive evidence that health information exchange and electronic health record adoption, as a means to an end, can progress statewide through a balance of common policies and technical approaches and local innovation and market variation.”
###
Funding for the study was provided by the Commonwealth Fund.
Co-authors included Yolanda Barron, M.S., Dr. Erika L. Abramson and Dr. Vaishali Patel, all of Weill Cornell Medical College.
In Ailing Economy, Health Careers Are In March 9, 2009
Posted by gonzalezloumiet in EMR, Health Care, Obama, Stimulus Plan.add a comment
By LINDSAY PETERSON
lpeterson@tampatrib.com
Feeling sick about the job market?
Go to a hospital. That’s where the jobs are.
Health care is the only major industry showing solid growth in our shrinking economy, state economist Rebecca Rust said.
Manufacturing, retail and other major sectors shed 2 million jobs across the country last year, but the health care sector added 372,000. In the next seven years, it’s expected to add 3 million more, according to the U.S. Labor Department.
Thank the increasing number of older people in the population who tend to use more health care services, particularly after they hit 65 and qualify for Medicare.
This is good news for Florida, where nearly 20 percent of the population is 65 and older.
Employers outside of health care also have openings, in engineering and information technology, for instance. But many are looking for people to fill niches that require years of training and experience. The health care jobs cover a spectrum, from entry-level records clerks to pharmacists.
Six of the 20 jobs ranked as the hottest in Florida through 2016 are in health care, according to the state Agency for Workforce Innovation. The hottest job is medical assisting, with about 1,300 openings a year.
A medical assistant’s annual pay is not high, about $22,000 to $31,000. But many of these jobs require only vocational training, the state work force agency said, so they’re useful for people who need to change careers fast.
The state also projects short- and long-term demand for pharmacy technicians, physician assistants, medical and public health social workers, dental hygienists and post-secondary health care educators.
“What’s good about these medical occupations is that they are strong everywhere, in every city, in and out of Florida,” Rust said. “Health care workers can be very mobile.”
TGH Employment Rising
The demand is high, and growing, at Tampa General Hospital, said Chris Roederer, senior vice president of human resources. “People are still getting sick,” he said. “They still need access to quality health care.” Insurance reimbursement is steady, even though tens of thousands in the Bay area have lost their jobs.
Last year at this time the hospital employed 5,300 people. Today, that number is 5,832.
Registered nurses “are still our No. 1 need” among licensed workers, he said. Demand also is strong for physical therapists. But the hospital needs dozens of other people, from office workers to nursing assistants, Roederer said.
St. Joseph’s Hospital plans to start hiring about 300 people this summer for a 76-bed hospital to be built in Lutz early next year.
Although hospitals are still hiring, overall, they’re not hiring as many people as in the past, said Rebecca DeBoer of Tampa, who has been a hospital recruiter for 17 years.
“Last year at this time I would have had 20 openings for every qualified candidate. This year, I probably have two.”
And demand in certain areas has dropped. Last year, jobs for radiology, CT scan and ultrasound technicians were hot, she said. Not this year.
Roederer confirmed that TGH didn’t have a lot of these openings. “The volume is still there, but the turnover rate is lower than with other positions.”
One trend DeBoer is seeing is an increasing demand for nursing assistants instead of licensed practical nurses, who have more training. “It’s a way to cut costs,” she said.
Likewise, demand is high for nurse practitioners and physician assistants who can fill in for doctors but don’t cost as much. Both careers require at least a four-year degree, DeBoer said, but they can make $60,000 to $80,000 a year.
Seeing an unmet need for nursing education three years ago, for-profit South University opened a campus in Tampa, and enrollment has nearly doubled to about 450 students.
“We see a lot of people who have had this dream for a while, but this economy has spurred them to make the change,” said President Dan Coble, former nursing director at TGH.
“If I were young and just going into school, I’d go into medicine,” DeBoer said. “With almost all of these jobs, unless you get into management, you can almost name your hours. You could have a family and work on call as needed and still make a dandy salary but be home with your kids.”
Edward Peachy, executive director of WorkNet Pinellas, said he would recommend engineering.
Although he’s seeing the strong demand in health care, employers also are looking for engineers. The problem is, the openings require years of education and experience.
“But if you’re just starting out, I would suggest you go to school to be an engineer,” he said. “The demand is pretty stable.”
Information technology is also steady.
“People who know IT are always going to have value and will land on their feet,” he said. “They’ll have to upgrade their skills, but people who are willing to do that will always be in good shape.”
No. 2 on the state hot-jobs list behind medical assisting is computer network and data communications analyst, with a projected annual growth rate of more than 5 percent. Software engineers are also high on the list.
These jobs don’t require four-year degrees, but they do call for several years of experience, the state work force agency said.
A Guide To Job Growth
Locally, the job picture is more limited. Hillsborough County needs nurses like everyone else, according to the Tampa Bay Workforce Alliance. Beyond that, the fastest-growing jobs are in the service sector, where pay tends to be lower.
The highest demand is for customer service representatives and retail salespeople. Also high on the agency’s list: restaurant servers, janitors and office clerks.
There is one problem with the state and the local lists. They don’t take into account the drastic changes in the economy in the past few months, Rust said. Health care is still strong, but many of the other industries represented, retail sales, for instance, have pulled back faster than economists expected.
The lists are meant to be a guide to job growth over the next several years. And they assume an economic recovery, Rust said.
There’s one job not on the list that’s also in demand: economist. Events of the past several months have kept Rust hopping, she said. “It’s a good job, but I don’t recommend it for one’s health. There’s a lot of stress.”
SOURCE: http://www2.tbo.com/content/2009/mar/08/na-in-ailing-economy-health-is-in/
