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Many
Large Employers Unaware Of Health Disparities, Survey Says eHealth
Report: Financial Incentives Emerging for Health IT JCAHO
Patient Safety Goal Comments Due April 30 eHealth
Initiative Launches Community Learning Network Study
Finds Wide Range of Error Interpretations in Family Practices Minnesota
Hospitals Pledge to Improve Medication Errors AHRQ
Announces Booklet To Help Older Adults Stay Healthy CPOE
Should Focus on Error Impact, Study Says New
Law Requires Hospitals, Surgery Centers to Report Errors UW
Symposium To Explore IT on Health Quality, Safety Many large
U.S. companies are not fully aware of the health care disparities affecting
their ethnic and racial minority employees, according to a survey released
by the National Business Group on Health. The survey
of more than 1,500 U.S. companies with 1,000 or more employees found 60%
or more believe that racial and ethnic minorities fare the same as their
white counterparts in terms of access to preventive and diagnostic health
care services, and screenings for cancer, heart disease and other serious
health conditions. According
to the National Healthcare Disparities Report, demographic trends indicate
that the number of Americans who are vulnerable to suffering the effects
of heath care disparities will rise over the next half century. Current
data show that some ethnic minorities, as well as low-income families,
tend to be in poorer health than other Americans. The National
Business Group on Health, formerly the Washington Business Group on Health,
has developed an employer toolkit to provide companies with culturally
competent resources, best management practices and assessment tools to
reduce and eliminate health disparities. For more
info, www.wbgh.org/programs/toolkits. eHealth
Report: Financial Incentives Emerging for Health IT A report
released jointly by the Foundation for eHealth Initiative and The Health
Strategies Consultancy indicates that financial incentives are emerging
which will help U.S. health care providers adopt innovations in information
technology that will help patients receive safer, better care. The report,
“Financial Incentives: Innovative Payment for Health Information
Technology,” identifies types of financial incentives that already
are working to promote the adoption of health information technology (HIT).
The Foundation
for eHealth Initiative’s Connecting Communities for Better Health
Program yielded in December 2003 funding applications from 134 communities
in 42 states and the District of Columbia who wanted to implement IT and
health information programs and needed funding to get this work off the
ground. While cautioning
against a “one-size-fits-all” approach toward incentive program
adoption, the report identifies the features of different programs that
show great promise in health care. It concludes that the federal government
should play a more active role in developing and promoting innovative
incentive programs and payment policies that reward HIT adoption and quality
improvements. The report
identifies four types of financial incentive models currently in place
and presents details on specific programs associated with each type: Payment
Differentials – Bonuses or add-on payments that reward clinicians
and other providers for HIT adoption. Cost Differentials
– This increasingly popular approach uses co-payment and deductible
incentives to target consumer behavior by steering them towards clinicians
and other providers that have adopted HIT. Direct Reimbursement
– This model reimburses for a new category of service – the
“online consultation.” Shared Withholds
– This model withholds a certain amount of provider reimbursement
until HIT adoption.
This is the least utilized incentive. For more
info, www.ccbh.ehealthinitiative.org. Back
to top The Joint
Commission on Accreditation of Healthcare Organizations has released its
proposed 2005 National Patient Safety Goals and Requirements, and is seeking
comments from organizations by April 30. The Joint
Commission’s Board of Commissioners is expected to adopt a subset
of these goals and their associated requirements in their present or modified
forms this summer, based in substantial measure on the results of the
field review. JCAHO is
seeking evaluation of the relevance, the relative priority, clarity, ability
to measure compliance, time needed to implement, and cost of implementation
of each new goal and requirement under consideration. Programs
include ambulatory care, assisted living, behavioral health care, critical
access hospital, disease-specific care, home care, hospital, laboratory,
long-term care, office-based surgery. . JCAHO also
has proposed revisions designed to improve the clarity of the language
of a few of the 2004 Goals and Requirements. The revisions include a requirement
for hospitals to develop a plan to implement bar code technology by 2007.
Organizations
and individuals who wish to participate in this field evaluation are asked
to complete the field review questions available online. For more
info, www.jcaho.org/accredited+organizations/05_npsg_fr.htm. eHealth
Initiative Launches Community Learning Network The Foundation
for eHealth Initiative has started the Community Learning Network—the
first-ever consolidated online resource providing on how to plan and implement
organizational, clinical, financial, legal and technical strategies to
mobilize health care information across organizations to improve the quality,
safety and efficiency of health care. The primary
vehicle for disseminating information in the Community Learning Network
is an online information sharing network and resource center for communities
(ccbh.ehealthinitiative.org) which aims to help organizations that are
moving from paper-based record-keeping to electronic health records (EHR)
and are creating an interoperable infrastructure to mobilize and share
information across institutions within their communities. A key part
of its Connecting Communities for Better Health program, the Community
Learning Network is a repository of materials on health information exchange
that reflects current research as well as practical, “on the ground”
advice and lessons learned from national health care IT experts and pioneering
implementers in communities that are engaging in electronic health information
exchange. The network
also includes a “Community Directory” section, which profiles
the work being done to mobilize health information by each of the 134
multi-stakeholder collaboratives that responded to the Connecting Communities
Program request for capabilities statement. Information
in the network is organized within seven categories: communities, financial,
clinical, patients/consumers, organizations, technology, and legal. For more
info, ccbh.ehealthinitiative.org. Study
Finds Wide Range of Error Interpretations in Family Practices A University
of Cincinnati study looking at medical errors in the family physician
setting found that family physicians identify errors and preventable adverse
events frequently during patient visits, but there is variation in how
some error categories are interpreted and how harm is defined. Led by Dr.
Nancy Elder in the university’s Department of Family Medicine, researchers
sampled Cincinnati area family physicians representing different practice
locations and demographics. After each
clinical encounter, physicians completed a form identifying process errors
and preventable adverse events. Brief interviews were held with physicians
to ascertain their perceptions of harm or potential harm to the patient. With 15
physicians in seven practices, researchers found errors and preventable
adverse events in 24% of the 351 outpatient forms completed. Individual
physicians identifying errors ranged from 3% to 60% of visits. Office
administration errors were most frequently noted. Harm was believed to
have occurred as a result of 24% of the errors, and was a potential in
another 70%. Although most harm was believed to be minor, there was disagreement
as to whether to include emotional discomfort and wasted time as patient
harm. For more
info, www.annfammed.org/cgi/content/full/2/2/125. Minnesota
Hospitals Pledge to Improve Medication Errors Ten Minnesota
hospital systems are now pledging to cut down on medication errors by
taking aim at confusing handwritten prescriptions. According to one study
published in the Journal of the American Medical Association,
more than half of all medication errors are related to the process of
prescribing. Safest in
America (SIA), a partnership of nine metropolitan hospital systems plus
Mayo Clinic in Rochester, is implementing standardized protocols for handwritten
prescriptions. Beginning April 1, SIA member hospitals will no longer
accept medication orders containing unsafe abbreviations. Hospital pharmacies
will only process orders using accepted, safe abbreviations. Prescribers
will be required to rewrite any orders not in compliance with the policy.
Dangerous
abbreviations include orders written without a zero preceding a decimal
point. A prescription written for “.5 mg,” for instance, could
be misinterpreted as “5 mg,” thus leading to a dosage 10 times
the intended amount. Another example: The abbreviation “QD”
(once per day) can be misread as “QID” (four times per day).
A safer method is to write “Qday,” which is less likely to
be misread. This SIA
initiative complies with Joint Commission on Accreditation of Health Care
Organizations (JCAHO) goals for targeting and eliminating dangerous abbreviations.
“Each
of the SIA member hospitals has committed to educating physicians, nurses
and pharmacists on these improvements in prescribing practices. Changing
the way prescriptions are written will reduce the chances for a medication
order mix-up,” said Mark Thomas, chair of SIA’s medication
safety initiative committee and pharmacy director at Children’s
Hospitals and Clinics of Minneapolis and St. Paul. All SIA
member hospitals are embracing the initiative. Participants include Allina
Hospitals and Clinics, Children’s Hospitals and Clinics, Fairview
Health Services, Gillette Children’s Specialty Health care, HealthEast
Care System, Hennepin County Medical Center, Mayo Clinic, Methodist Hospital/Park
Nicollet Health Services, North Memorial Medical Center, and Regions Hospital/HealthPartners.
Last September,
SIA adopted a single, metro-wide standard for surgical site marking. The
goal is to further reduce the incidences of wrong-site surgeries. SIA
has also agreed to a standardized dosing concentration or protocol for
certain medications used with children. The consortium also has recommended
a standardized protocol for prescribing the blood thinner heparin. For more
info, www.mnhospitals.org/ptsafety/safest.htm. AHRQ
Announces Booklet To Help Older Adults Stay Healthy The Agency
for Health care Research and Quality released a booklet April 15 for older
adults called The Pocket Guide to Staying Healthy at 50+. This guide incorporates
new research-based recommendations from the U.S. Preventive Services Task
Force. The guide was developed in partnership with AARP and updates the
original Staying Healthy at 50+ published in 2000. “The
Pocket Guide to Staying Healthy at 50+ is an important resource for
older patients and their providers,” said AHRQ Director Carolyn
Clancy, M.D. “It provides information on which preventive services
are needed and when, and it helps open the way for better communication
between patients and providers, which leads to better health care.” The
Pocket Guide, available in English and Spanish, includes tips and
recommendations on good health habits, screening tests, and immunizations.
It provides easy-to-use charts to help track personal health information
and includes questions to ask health care providers, as well as resources
to contact for additional information. This publication
is part of the Put Prevention Into Practice program, which is designed
to increase the appropriate use of clinical preventive services. The new
Pocket Guide to Staying Healthy at 50+ is available on the AHRQ Web site
in English at www.ahrq.gov/ppip/50plus/,
and in Spanish at www.ahrq.gov/ppip/50plussp/. CPOE
Should Focus on Error Impact, Study Says A study
released last week found that while Computerized Prescriber Order Entry
Systems systems can improve practitioner prescribing, design and implementation
of a CPOE system should focus on errors with the greatest potential for
patient harm. Researchers
also found that prescribing errors are common in the hospital setting,
and pharmacist involvement, in addition to a CPOE system with advanced
clinical decision support, is vital for achieving maximum medication safety. Researchers
at Northwestern University in Chicago sought to describe the epidemiology
of medication prescribing errors averted by pharmacists and to assess
the likelihood that these errors would be prevented by implementing computerized
prescriber order entry At a 700-bed
academic medical center in Chicago, Ill, clinical staff pharmacists saved
all orders that contained a prescribing error for a week in early 2002.
Pharmacist investigators subsequently classified drug class, error type,
proximal cause, phase of hospitalization, and potential for patient harm
and rated the likelihood that CPOE would have prevented the prescribing
error. “Medication
errors are the single most common serious adverse event that occurs in
hospitalized patients,” said Gary Noskin, M.D., medical director
of patient safety at Northwestern Memorial Hospital. “The implementation
of CPOE has the potential to prevent the majority of these errors from
reaching the patient; however, they may not actually decrease patient
harm due to medication error.” A total
of 1,111 prescribing errors were identified (62.4 errors per 1000 medication
orders), most occurring on admission (64%). Of these, 30.8% were rated
clinically significant and were most frequently related to anti-infective
medication orders, incorrect dose, and medication knowledge deficiency.
Of all verified prescribing errors, 64.4% were rated as likely to be prevented
with CPOE (including 43% of the potentially harmful errors), 13.2% unlikely
to be prevented with CPOE, and 22.4% possibly prevented with CPOE depending
on specific CPOE system characteristics. Northwestern
Memorial Hospital is currently implementing an electronic medical record
and CPOE. The study of errors within its own hospital has helped a great
deal in the design of the system. As well, the baseline data collected
in this study could be used for comparison once the system is fully implemented. New
Law Requires Hospitals, Surgery Centers to Report Errors Effective
April 4, revisions to a Texas law require all state hospitals and ambulatory
surgical centers to report medical errors and establish patient safety
programs, the Bureau of National Affairs reported. The final
rules amended Texas Administrative Code Chapters 133.48 and 135.27, implementing
requirements of a law (H.B. 1614) that Gov. Rick Perry (R) signed in June
2003. Patient
safety programs must define medical errors, adverse events, and reportable
events, and consequences for failing to report events in accordance with
hospital policy. The hospital must designate at least one individual or
group to serve as patient safety program coordinator. Hospitals
and ambulatory surgical centers must complete a root cause analysis within
45 days of a reportable event and develop an action plan identifying strategies
to reduce the risk of similar events in the future. The analyses must
be made available to TDH representatives during on-site reviews. The ruling
also requires hospitals and surgical centers to submit an annual list
of medical errors to the Texas Department of Health. For more
info, www.tdh.state.tx.us. UW
Symposium To Explore IT on Health Quality, Safety The University
of Wisconsin at Madison is holding a one-day symposium, "Leveraging
Information Technology to Improve Patient Safety and Quality Healthcare"
to explore the impact of information technology on patient safety and
quality care, the efforts necessary to build effective healthcare IT networks
at the local, state and national level and the legal obstacles to information
access. As part
of the Digital Healthcare Conference, presented by UW Health, the University
of Wisconsin - Madison Medical School, College of Engineering and School
of Nursing. Produced by the Wisconsin Technology Network, the symposium
will be hosted Wednesday, June 23 beginning at 7:30 a.m. at the Fluno
Center for Executive Education, in Madison, 601 University Avenue. "When
information technology is properly deployed following intelligent, clinically
relevant workflow, medical errors are reduced and patient safety increases.
This also creates a better and more rewarding working environment for
the clinical staff, says Dr. Barry Chaiken, Conference Chairperson and
Chief Medical Officer, for the American Board of Quality Assurance and
Utilization Review Physicians. The event
includes sessions focused on the most critical topics surrounding the
deployment of health care information systems. Featured
speakers include Dr. Jeffrey Grossman, President and CEO, UW Medical Foundation,
Dr. William A. Yasnoff, Senior Advisor, National Healthcare information
Initiative, U.S. Department of Health and Human Services, Dennis Dassenko,
CIO, UW Hospital & Clinics and Dr. Carl Weigle, Medical Director of
IS, Children's Hospital of Wisconsin. "Information
technology is already impacting the delivery of healthcare in this country,"
said Dr. Jeffrey Grossman, President and CEO University of Wisconsin Medical
Foundation, Senior Associate Dean for Clinical Affairs - UW Medical School.
"The Digital Healthcare Conference will provide healthcare executives,
clinicians, and IT professionals with a forum to discuss the challenges
and imperatives we must embrace to harness the potential of healthcare
information technology for the benefit of all patients." Founding
sponsors include Mason Wells, Wisconsin Technology Network, Network 222,
and MG&E. For more
info, Mike Klein, Wisconsin Technology Network. 608-310-6018. The agenda,
registration and sponsorship information can be found at www.wistechnology.com/dhc.htm.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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