Quality Update for August 22, 2003

IOM Sets Core Capabilities For Electronic Health Record System Heart Attack Patients Better Off At Hospitals Doing Angioplasties AAFP To Help Develop Continuity Of Care Records URAC: Medical Necessity Reviews Can Identify Patient Safety Problems NCQA To Analyze Pay-For-Performance Data ANSI Seeks Comments On Health Care Clinical Data IT Standards Yahoo Launches Online Diabetes Management Program Grant Will Boost Medication Safety Progress New Reports on Nursing Home Infections CMS Will Pay HMOs More For Sicker Patients Beginning In 2004 AHRQ, VA Unveil Patient Safety Training Program IOM Sets Core Capabilities For Electronic Health Record System As part of a national effort to encourage the adoption of computer-based health records, an Institute of Medicine panel has identified a set of eight core functions that electronic health records should perform to promote greater safety, quality, and efficiency in health care delivery. Detailed in a new report, the list of key capabilities will be used by Health Level Seven (HL7), which is developing a common industry standard for EHRs that will guide the efforts of software developers. Having a common understanding about the key functions that EHR software should possess will allow health care organizations to more easily compare the systems currently available and help vendors build systems that meet care providers’ expectations, the report said. The specification of core functions also will help accreditation organizations and others certify EHR systems that are ready for adoption. In addition, the report said Medicare and private health care programs are considering providing financial rewards to providers for investing in EHRs with specific capabilities. The eight core functions were selected on the basis of their ability to improve patient safety, support effective care, assist in the management of chronic disease, and improve efficiency, IOM said. It said all EHRs must protect patient privacy and confidentiality, and comply with the standards for security, storage and exchange of data required by the Health Insurance Portability and Accountability Act. The committee also predicted that by 2010, comprehensive EHR systems will be available and implemented in many health systems and regions. The eight core capabilities that EHRs should possess are: Health information and data. Having immediate access to key information—such as patients’ diagnoses, allergies, lab test results, and medications. Result management. The ability for all providers participating in the care of a patient in multiple settings to quickly access new and past test results. Order management. The ability to enter and store orders for prescriptions, tests, and other services in a computer-based system. Decision support. Using reminders, prompts, and alerts, computerized decision-support systems to improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments. Electronic communication and connectivity. Efficient, secure, and readily accessible communication among providers and patients. Patient support. Tools that give patients access to their health records, provide interactive patient education, and help them carry out home-monitoring and self-testing can improve control of chronic conditions, such as diabetes. Administrative processes. Computerized administrative tools, such as scheduling systems, to improve hospital and clinic efficiency and provide more timely service to patients. Reporting. Electronic data storage that employs uniform data standards to enable health care organizations to respond more quickly to federal, state, and private reporting requirements. For more info, www.nap.edu. Back to top Heart Attack Patients Better Off At Hospitals Doing Angioplasties While most heart attack patients have been urged to seek medical treatment as soon as possible, new research has indicated it may better for those patients to go to a hospital that performs angioplasty—even if it means delaying treatment for a couple of hours. The study, published in this week’s New England Journal of Medicine, found that patients who received angioplasty were far less likely to suffer a second heart attack than patients who got a different treatment at local hospitals. The research indicated that people at risk of a heart attack should familiarize themselves about local hospitals and what kind of cardiac care they provide. About half of the 1.1 million Americans who suffer a heart attack each year can choose a hospital. Angioplasty centers are primarily located at large, urban hospitals. Most hospitals don’t offer angioplasty but instead treat heart-attack patients with a regimen of powerful clot-busting drugs, aspirin and beta blockers. The four-year study randomly assigned 1,572 Danish patients to treatment with angioplasty or drug therapy, with 1,129 going to local hospitals and 443 to angioplasty centers. The patients treated with clot-busting medication suffered second heart attacks at a rate four times that of the group that received angioplasty. The study found little difference in outcome for angioplasty patients based on whether they been taken directly to an angioplasty center or transferred there from another hospital. Of the patients treated with drugs alone, 14% either died, suffered a disabling stroke or had a second heart attack, while only 8% of the angioplasty group had a similar outcome. For more info, www.nejm.org. Back to top AAFP To Help Develop Continuity Of Care Records A team of health care IT leaders has announced that the American Academy of Family Physicians (AAFP) has joined its effort to establish a standard for the Continuity of Care Record (CCR), which will enable health care providers to base future care on relevant and timely patient information. The CCR is an ongoing record of a patient’s care created or updated at the end of every health care meeting between patient and provider whenever it is anticipated that a new provider or caregiver will need to be aware of changes in a patient’s diagnosis, condition, or treatment plan. The record would be available for review by the next provider, no matter what or where the setting is. The patient also may request a CCR printout to provide valid and current information for another provider. ASTM International, Healthcare Information Management Systems Society (HIMSS), and the Massachusetts Medical Society said the addition of AAFP brings the endorsement and involvement of a major medical association representing nearly 95,000 physicians nationwide. "We want to end the situation where doctors must either start from scratch or act blindly because they don’t have the patient’s relevant past history, allergies, or the details of medications," said Thomas E. Sullivan, M.D., president of the Massachusetts Medical Society, which initiated the development of CCR standards, and co-chair of the ASTM workgroup developing the standard. Dr. David Kibbe, AAFP’s director of Health Information Technology, said the CCR will bridge a variety of sources of information, and serve the interests of the clinicians who need a patient’s health information in real time. "The key here is the collaboration of patients and their family physicians and other clinicians to improve the quality and safety of care," Dr. Kibbe said. The new standard is being developed by the standards development organization ASTM. Medical and professional societies and other key stakeholders are providing input into the project through consensus meetings, workgroups, and document review. The final standard should be balloted and confirmed before the end of 2003, ASTM said. For more info, www.massmed.org/pages/081403pr_AAFP.asp. Back to top URAC: Medical Necessity Reviews Can Identify Patient Safety Problems Organizations that examine the medical necessity of medical procedures may often identify patient safety concerns, according to a report issued by the URAC accrediting body. The study, funded by the Robert Wood Johnson Foundation, looked at utilization management (UM), which insurers and managed care organizations use to determine the medical necessity and coverage of certain medical procedures, especially inpatient stays and surgical procedures. The ability to identify safety concerns in UM comes through automated processes such as flags or triggers, or through the judgments of clinical staff, URAC said. Utilization management industry leaders said the UM programs have the information technology and human resources for an effective role in patient safety, but also said that due to cost pressures in the health care industry, there is a need for additional evidence to support a direct role for UM in promoting patient safety, according to the report. While making medical necessity determinations, UM organizations collect and process clinical data that could be compared to evidence-based guidelines to identify patient safety concerns, including errors of omission or commission, the report said. The report said UM organizations, their customers, and other stakeholders should understand the contribution that UM programs can make towards promoting patient safety practices. However, the report said UM is just one area in the health care system that can promote patient safety, adding that UM has an indirect role, rather than the direct role in patient safety exercised by providers and hospitals. The study identified opportunities to establish more systematic processes for identifying, managing, and reporting safety concerns, such as use of standardized patient safety assessment protocols tailored to each stage of the review, maximizing use of available UM data fields to ease analysis and reporting of safety issues, and implementation of systematized policies and procedures to guide investigations and reporting of safety concerns. URAC collected information from 31 separate UM companies, and reviewed software demonstrations from four commercial UM software vendors for the study. For more info, www.urac.org. Back to top NCQA To Analyze Pay-For-Performance Data The Integrated Healthcare Association (IHA) has awarded the National Committee for Quality Assurance a contract to serve as the independent data aggregator for the IHA-led Pay for Performance program involving six major California health plans, about 300 physician groups, and 7 million commercial HMO enrollees. IHA said Diversified Data Design Corp will collect health care data generated from participating health plans and physician groups. Then, NCQA will analyze the data and produce reports for a public scorecard and individual health plan physician group incentive programs, as well as feedback to the participating physician groups and plans. IHA said its program is designed to create a "business case for quality" at the physician group level. Under the program, physician groups will be compared based on a common set of performance measures addressing three key domains: clinical quality, patient experience, and investment in information technology. NCQA said it adapted existing Health Plan Employer Data and Information Set (HEDIS) measures for the clinical quality domain. These measures track the quality of care for preventive health procedures, such as cancer screening, and chronic conditions, such as asthma and diabetes. For more info, www.iha.org. Back to top ANSI Seeks Comments On Health Care Clinical Data IT standards The American National Standards Institute’s (ANSI) Healthcare Informatics Standards Board is conducting its first survey of the health care community on clinical data standards. The survey will allow the health care IT community to improve the standardization system under which it operates, ANSI officials said. The goal is to identify areas in which new or revised standards are needed, areas at risk of duplication or overlapping of standards, and new areas that may benefit from the organization’s coordination efforts, ANSI said. The survey deadline is Aug. 31. For more info, www.ansi.org. Back to top Yahoo Launches Online Diabetes Management Program Yahoo and iMetrikus have created an online system on the Yahoo Health Web site that will help people with diabetes track their blood sugar levels. Under the Medicompass system, users can enter basic health information, such as height, weight, exercise and nutrition habits and blood pressure levels on the site. The system also allows users to enter daily glucose measurements recorded by a blood sample device. The system will use color-coded charts and tables to indicate the health status of users based on the information entered. Users can allow their physicians to access to their health information on the web site and enable them to track their disease over time. For more info, http://health.yahoo.com/health/centers/diabetes/medicompass/index.html. Back to top Grant Will Boost Medication Safety Progress Thanks to a $285,000 grant from the Commonwealth Fund, the Institute for Safe Medication Practices will work with hospitals to measure their progress implementing medication safety processes and help develop educational tools and training materials to further enhance safe medication administration. The grant will fund Phase II of the ISMP Medication Safety Self Assessment. Under Phase II, the ISMP Medication Safety Self Assessment tool will be updated and distributed to hospitals in 2004. Data from a subset of these hospitals will be compared to data from the 2000 assessment to evaluate progress over the past three years. The project will seek to determine whether new, current challenges in health care have affected medication safety systems. The revised assessment also will allow hospitals to compare their current medication safety systems and practices to other demographically similar hospitals nationwide. For more info, www.ismp.org. Back to top New Reports on Nursing Home Infections In three recent studies sponsored by the Agency for Healthcare Research and Quality, researchers examined acute infections in nursing homes. In "Barriers to timely care of acute infections in nursing homes: a preliminary qualitative study," published in the Journal of the American Medical Directors Association, researchers found that communication problems between nursing staff and physicians, who typically are off site, are a major barrier to rapid identification and treatment of acute infections among nursing home residents. For more info, www.jamda.com. In "Predictors of short-term functional decline in survivors of nursing home-acquired lower respiratory infection," published in the Journal of Gerontology, researchers found that many nursing home residents who survive to 30 days following a lower respiratory infection develop new functional limitations and are more likely to decline in daily functioning within 3 months. For more info, www.geron.org. In "The cost of treating pneumonia in the nursing home setting," also published in JAMDA, the study found most of the variation in the cost of treating pneumonia in nursing home residents is not explained by the severity of the illness. For more info, www.jamda.org. Back to top CMS Will Pay HMOs More For Sicker Patients Beginning In 2004 The Centers for Medicare and Medicaid Services has unveiled plans to reimburse HMOs at higher levels for taking patients with expensive chronic conditions and less for enrollees who use fewer health care services, according to a report in American Medical News. The proposal could result in additional reporting requirements for physicians, the article said. Beginning in 2004, CMS will add physician outpatient diagnoses to the formula for adjusting payments to HMOs to create a risk score for every Medicare beneficiary. Patients who fall into one of 61 diagnostic cost groups will earn higher payments for the plan that enrolls them in the following year, AMNews said. The cost groups will identify those patients with chronic conditions, such as diabetes or congestive heart failure, that are often the most expensive for Medicare to treat. However, the plan relies on getting good data from physicians in a timely manner, which could be the biggest challenge for implementing the risk adjustment plan, the article said. CMS said the risk adjustment will be phased in over four years and will be applied to only 30% of the 2004 payment rates. By 2007, the entire capitated payment to health plans will be risk-adjusted, and the need for accurate reporting will be heightened, the article said. For more info, www.cms.gov. Back to top AHRQ, VA Unveil Patient Safety Training Program The Agency for Healthcare Research and Quality and the Veterans Administration will begin offering free patient safety training to state patient safety officers and other hospital staff next month. Through a new partnership program called the Patient Safety Improvement Corps, participants will attend three one-week sessions—in September, January, and May—with the 2003-04 program starting Sept. 15. AHRQ and VA will accept 40 participants this year, including about 10-20 state patient safety teams.There are plans to expand the program to 60 participants in coming years. Only states may submit applications, nominating up to two hospital partners selected by the state. For more info www.ahrq.gov/qual/psimpcorps.htm. Back to top

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