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Hospitals Reporting Quality Data FDA
Bar Codes to Reduce Errors Seniors
Confused on Medicare Law, Kaiser Survey Shows Hospitals
Struggling to Meet Leapfrog Safety Standards More
Consumers Researching Hospital Quality via Web, Survey Says Standardizing
Health IT Could Save $86 Billion Duke
University Launches Nat’l Health Information Network IBM
To Invest $250 Million In Health Care Quality Initiative Report:
Chronic Disease Registries Affordable, Practical Michigan
Hospital Seeks to Become No. 1 in Patient Safety More Hospitals Reporting Quality
Data About one out of three U.S. hospitals paid by Medicare
and Medicaid are now voluntarily reporting at least one quality measure
from a set of 10 quality measures, the Centers for Medicare and Medicaid
Services (CMS) recently announced. “The hospitals already reporting quality data deserve
credit for stepping up to the plate and joining our effort to improve
the quality of health care across the country,” Health and Human
Services Secretary Tommy G. Thompson said. “Now that Congress has
provided a financial incentive to do so as part of the new Medicare law,
we expect many more hospitals to voluntarily send in their quality data
this year.” To date, CMS reported that 1,407 hospitals are sharing
at least one of the clinical quality measures - more than three times
the number that shared the same data in October 2003, when CMS began publishing
this information. A total of 492 hospitals are sharing at least one measure
in all of the initiative’s three clinical categories - heart failure,
heart attack and pneumonia. Participation is expected to increase significantly this
year, CMS officials said, as the newly enacted Medicare Prescription Drug,
Improvement and Modernization Act of 2003 (MMA) increases payments to
hospitals that publicly report this quality information to CMS. Hospitals
that report quality data this year would receive enhanced payments in
fiscal year 2005. The new law’s requirements will effectively supersede
this phase of the voluntary reporting effort. The collaborators will now turn their attention to new
phases of the initiative, including devising a survey of public satisfaction
with hospital care and collection and reporting of additional clinical
measures. For more info, www.cms.hhs.gov/quality/hospital. FDA Bar Codes to Reduce Errors The Food and Drug Administration is issuing a final rule
requiring bar codes on the labels of thousands of human drugs and biological
products. The measure will help protect patients from preventable medication
errors and represents a major step forward in the Department’s efforts
to harness information technology to promote higher quality care. “Bar codes can help doctors, nurses and hospitals
make sure that they give their patients the right drugs at the appropriate
dosage,” said HHS Secretary Thompson. “By giving health care
providers a way to check medications and dosages quickly, we create an
opportunity to reduce the risks of medication errors that can seriously
harm patients.” “We’re encouraging widespread use of technologies
that can help health care providers avoid hundreds of thousands of medication
errors,” said FDA Commissioner Dr. Mark B. McClellan, MD, who is
also President’s Bush’s nominee to head the Centers for Medicare
and Medicaid Services at HHS. “Bar coding systems have proven their
dependability and effectiveness by ensuring the accuracy of a myriad of
actions in commerce and industry. We’re now advancing the adoption
of these systems in settings where they can help save lives.” The FDA rule calls for the inclusion of bar codes on most
prescription drugs and on certain over-the-counter drugs that are commonly
used in hospitals and dispensed pursuant to an order. This information
will be encoded within the bar code on the label of the product. Companies
also may include information about lot number and product expiration dates. In addition, the rule requires the use of machine-readable
information on container labels of blood and blood components intended
for transfusion. These labels, which are already used by most blood establishments,
contain FDA-approved, machine-readable symbols identifying the collecting
facility, the lot number relating to the donor, the product code and the
donor’s blood group and type. The bar code rule is designed to support and encourage
widespread adoption of advanced information systems that, in some hospitals,
have reduced medication error rates by as much as 85%. FDA estimates that the bar code rule, when fully implemented,
will help prevent nearly 500,000 adverse events and transfusion errors
over 20 years. The economic benefit of reducing health care costs, reducing
patient pain and suffering, and reducing lost work time due to adverse
events is estimated to be $93 billion over the same period. The final rule applies to most drug manufacturers, repackers,
relabelers, private label distributors and blood establishments. New medications
covered by the rule will have to include bar codes within 60 days of their
approval; most previously approved medicines and all blood and blood products
will have to comply with the new requirements within two years. Seniors Confused on Medicare
Law, Kaiser Survey Shows A survey released by the Kaiser Family Foundation shows
seniors are confused about the outcome of the Medicare prescription drug
debate and the prescription drug law. While about two-thirds of seniors
report following the debate closely, 15% say they understand the new prescription
drug law very well and almost seven in 10 don’t know that it passed
and was signed into law. The survey found that as of Feb. 8, 64% of seniors (49%
of the public) said they followed the Medicare prescription drug debate
“very closely” or “somewhat closely,” but most
seniors say they don’t understand the new law. According to survey
results, 15% of seniors (7% of the public overall) say they understand
the law “very well”; 24% of seniors (26% of the public) say
they understand it “somewhat well” and 60% of seniors (64%
of the public) say they understand it “not too well” or “not
well at all. More than two-thirds of seniors, or 68%, said they did
not know the law was passed by the Congress and signed by the President;
27% think the law did not pass, and 41% say they did not know whether
or not it was passed. Some 32% of seniors correctly say the law was passed
and signed. Awareness is even lower for the general public (23% say it
was passed and signed). The drug benefit will not take effect until 2006 and clearly
confusion exists, but currently a majority of seniors have an unfavorable
impression of the law. Based on their personal knowledge about the law, 55% of
seniors (38% of the public) say their impression is unfavorable, compared
with 17% of seniors (25% of the public) who say it is favorable. Some
28% of seniors (37% of the public) say they don’t have any impression
of the new law. Findings from the survey are available on the Kaiser Family
Foundation website at: www.kff.org/kaiserpolls/omr022604pkg.cfm. Hospitals Struggling to Meet
Leapfrog Safety Standards A study released Feb. 23 by the Center for Studying Health
System Change (HSC) finds the Leapfrog Group’s three patient-safety
practices have had limited impact on hospitals. The standards call for hospitals to use computerized physician
order entry, staff intensive care units with specially trained physicians
called intensivists, and patient referral based on volume thresholds for
six high-risk procedures. The study found that while many hospitals have
not fully implemented the Leapfrog standards, many are implementing less-costly
alternatives or testing CPOE systems and ICU specialists on a smaller
scale. The study concluded that efforts to improve patient safety
are likely to be more successful if private and public purchasers collaborate
to create strong incentives—particularly financial incentives—for
hospitals to improve patient safety. The public sector also could complement Leapfrog efforts
through collaboration on research, information technology, reporting and
purchasing approaches. “Leapfrog has clearly helped put patient safety
on hospital radar screens, and many hospitals are trying to meet the spirit
if not the letter of the Leapfrog standards by substituting less expensive
alternatives,” said Paul B. Ginsburg, Ph.D., president of HSC, a
nonpartisan policy research organization funded exclusively by The Robert
Wood Johnson Foundation. “Many factors, including a lack of financial incentives,
are hindering hospitals’ adoption of the Leapfrog patient-safety
practices,” Ginsburg said. For more info, www.hschange.com. More Consumers Researching
Hospital Quality via Web, Survey Says Consumer use of the Internet to research hospital quality
is growing rapidly, according to a new survey released Feb. 23 by HealthShare
Technology, Inc. In the 18-month span between April 2002 and October 2003,
the number of people who researched hospital quality online more than
tripled from 3% to 11%. The report shows that the information these “hospital
quality seekers” receive is beginning to impact their health care
choices and behavior. According to survey results, 17% considered changing
hospitals based on the information they received when comparing hospital
quality, and 10% actually did. Eighty-eight percent of respondents were
primarily concerned with two factors: the hospital’s complication
rate and past patient satisfaction. The report, conducted by Forrester Research in Fall 2003,
was based on a survey of 5,000 online adults. Participants were selected
from an existing benchmark panel of 60,000 individuals, weighted to reflect
U.S. Census statistics. For more info, www.selectqualitycare.com. Standardizing Health IT Could
Save $86 Billion Research conducted by the Center for Information Technology
Leadership indicates that standardizing the exchange of health care information
would save about $86 billion per year in unnecessary expenses, with the
largest share benefiting health care providers. The data, presented last month at the Healthcare Information
and Management Systems Society conference in Florida, showed that the
savings would accrue following a 10-year rollout that would itself produce
$395.3 billion in positive returns and break even within five years, according
to the main findings of a study released by CITL, a Massachusetts-based
research institute connected with Boston’s Partners HealthCare System.
According to the research, full clinical and administrative
interoperability would greatly improve operational efficiency and eliminate
billions of dollars of spending on unnecessary testing and hospitalizations. Hospitals, medical offices, and other providers would
realize $33.7 billion in benefits per year at the end of the 10-year implementation
period, while payers would save $30.4 billion, CITL Chairman Blackford
Middleton, MD, said. Middleton said. Laboratories would gain $13.1 billion,
based on the assumptions in the research. For more info, www.citl.org. Duke University Launches Nat’l
Health Information Network Duke University’s Fuqua School of Business has announced
it is launching an initiative to gain widespread consumer support for
a national electronic health information network. The goal of the initiative, named the Health Data Exchange,
is to improve the quality of health care while reducing costs, said Dr.
Kevin Schulman, M.D., director of the Health Sector Management program
at Fuqua. The Duke program will involve outreach via employers and
other organizations to inform consumers of the benefits of a health information
network. Those benefits include reduced medical errors, the flexibility
of having comprehensive medical records available online and, eventually,
a reduction in the overall cost of health care through efficiencies and
other innovations made possible by the network, Duke officials said. While building consumer acceptance, the Duke initiative
will simultaneously involve technology companies, consulting firms, health
providers and insurers as well as government and other industry efforts
to address the design and implementation of the health information infrastructure.
Details of the network, including when and where people will enroll, are
expected to be finalized within the next year. Educating consumers and including them in the development
of a health information network can help overcome barriers that previously
prevented construction of such a network, Schulman said. Brian Baum, former chief marketing officer of Cap Gemini
Ernst & Young’s Health Practice, has joined Duke as senior scholar
and program director of the Health Data Exchange. “The consumer is the key to overcoming the barriers
that have impeded the health care industry from fully participating in
the information technology revolution,” Baum said. “Once consumers
understand the impact of automated information on their own health, we
anticipate a groundswell of public demand, which will quickly negate all
the previous financial, operational and political barriers and unleash
a new era of IT-enabled health care quality and cost efficiency.” Ed Hammond, Ph.D., professor emeritus of Community and
Family Medicine at Duke University Medical Center and immediate past president
of the American Medical Informatics Association, added, “The consumer
obviously has the most significant stake in health care, yet the consumer
is traditionally on the outside of health care issues. This effort offers
a unique and exciting potential to actually bring the consumer into the
center of driving the future evolution of health care.” Initially underwritten by Duke University under the auspices
of its Health Sector Management program, the Health Data Exchange will
raise additional funding through public and private grants. Ultimately,
the Health Data Exchange is expected to operate on a self-financing basis.
For more info, www.duke.edu. IBM To Invest $250 Million
In Health Care Quality Initiative IBM has announced a major health care initiative designed
to help health care providers and payers manage costs, reduce medical
errors, and deliver better patient care. The initiative will funnel an
estimated $250 million of investments into IBM’s health care business
over the next three years for new hiring of health care specialists, solutions
development, research and development projects, IBM Business Partner collaborations,
and other programs. Duke University Health System and IBM are collaborating
on an on-demand information management system. Duke On Demand will be
used to help speed critical information to researchers and clinicians
that can facilitate identification of new, more effective treatments for
diseases such as breast cancer and heart disease. The system is being designed to integrate clinical data,
such as patient records and lab tests, with research findings about genes
and proteins to help give doctors a more complete “personalized”
picture of a patient’s medical condition, while protecting patient
confidentiality. The solution also can be used to electronically locate
and initially screen potential candidates for clinical trials and for
physician training. The H. Lee Moffitt Cancer Center & Research Institute
and IBM are collaborating on a disease management system designed to help
researchers and clinicians screen patients at risk for diseases and identify
potential clinical trial participants faster. The new Clinical Research
Data Warehouse, part of Moffitt’s Total Cancer Care program, will
focus initially on lung cancer and will integrate data from more than
30 disparate databases throughout the hospital and research center. Moffitt
is located at the University of South Florida and has more than 280 physicians,
600 researchers, and a network of 13 affiliate hospitals throughout Florida.
A key focus of IBM’s health care initiative will
be the development of consulting practices, information resources, and
customized industry solutions to help transform hospitals and small and
medium health care providers, accelerate medical research, and optimize
processes to help lower health care costs. For more info, www.ibm.com/industries/healthcare.
Report: Chronic Disease Registries
Affordable, Practical A report released Feb. 19 by the California Health Care
Foundation and First Consulting Group Report concludes that computerized
disease registries are affordable and practical systems for physicians
who seek to improve chronic care. The report, Using Computerized Registries in Chronic
Disease Care, examines disease registries, systems that track and
manage disease-specific information for individual patients and populations.
Authors of the report argue that a registry is more affordable than an
electronic medical record (EMR) system and is an effective tool for improving
patient care. The report provides an overview of the function and use
of computerized disease registries and outlines issues for consideration
in obtaining registry software and integrating registry products into
the routine work of the physician practice. It is intended to help physicians,
clinics and medical groups conduct their own assessments of these tools
by offering practical information including: For more info, www.chcf.org/topics/view.cfm?itemID=21718. Michigan Hospital Seeks to
Become No. 1 in Patient Safety The University of Michigan Health System in Ann Arbor,
MI is seeking to become the safest hospital in the nation, and has undertaken
a self-described proactive approach in tackling patient safety. “We’re trying to become the safest hospital
in the United States,” Dr. Darrell Campbell Jr., chief of staff
for clinical affairs at UMHS told the Detroit Free Press in a
Feb. 24 article. A transplant doctor, Campbell said eliminating medical
errors is his top priority and told the Free Press that he spends
half his time as a transplant doctor and the rest on patient safety issues. In 2000, UMHS developed the Patient Safety Enhancement
Program to improve the quality of patient care by conducting research
that focuses on methods of avoiding or preventing adverse patient outcomes
or injuries that stem from the process of health care. UMHS patient safety researchers recently were able to
show that using antiseptic coated catheters reduced hospital acquired
infections by nearly 36 percent. Researchers at UMHS are also developing
other measures to ensure patient safety. In a state hospital report released late last month, UMHS
was the only hospital to meet or exceed all of Michigan Health and Safety
Coalition’s guidelines for quality health care. For more info, www.med.umich.edu/psep.
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