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ACP
Calls for Use of Performance Measures to Improve Quality Secretary
Thompson, Names HHS IT Coordinator, Announces Milestones in Developing
Health IT NQF
Nursing Home Report on Standards Now Available Online IT
Top Priority for Hospital Execs Critical
Shortage in Geriatric Care Providers, Report Finds Allscripts,
Microsoft Sign Agreement for E-Prescribing URAC
Focus Group to Explore Quality Benchmarks for Health IT ACP
Calls for Use of Performance Measures to Improve Quality The American
College of Physicians has released two papers calling for the use of clinical
performance measures to improve physician quality, along with the development
of an interoperable, national, health information infrastructure to support
such quality improvements. The paper,
“The Use of Performance Measurements to Improve Physician Quality
of Care,” argues such measures have great potential to assess individual
physician performance, improve the quality of patient care and reward
physicians who meet or exceed high standards of health care delivery.
However,
performance measures done in a bureaucratic, arbitrary or punitive manner,
ACP warns, could hinder good patient care and cause physician frustration
and career dissatisfaction. The college
has announced its intention to take the lead in reviewing and disseminating
physician clinical performance measures and developing public policies
to support the appropriate use of performance measures. ACP outlines
other policy goals as: ACP’s
paper titled “Enhancing the Quality of Patient Care Through Interoperable
Exchange of Electronic Health Care Information” provides a comprehensive
review of efforts to date, a description of obstacles to achieving true
interoperability and recommendations for maintaining medical quality in
the process. The paper
cites numerous studies demonstrating that health care information interoperability
will bring a higher standard of quality to the U.S. health care system.
A 2003 Government Accounting Office study found interoperability benefits
included “improved quality of care, reduced costs associated with
medication errors, more accurate and complete medical documentation, more
accurate capture of codes and charges, and improved communication among
providers that enabled them to respond more quickly to patients’
needs.” The biggest
obstacles to achieving this goal include cost and the lack of common medical
terminology, coding, and communications software. This problem results
from the highly fragmented nature of the U.S. health care system. Virtually
every component of care—drugs, lab results, digital imaging, disease
classification, procedures performed, and electronic health records—uses
different terminologies. For drugs alone, at least 12 separate systems
exist for naming medications, the ingredients, dosage and route of administration.
The ACP
identifies a number of key recommendations for achieving interoperability:
The American
College of Physicians is the largest medical specialty organization and
the second-largest physician group in the United States. ACP members include
more than 115,000 internal medicine physicians, related subspecialists,
and medical students. For more
info, www.acponline.org. Secretary
Thompson, Names HHS IT Coordinator, Announces Milestones in Developing
Health IT HHS Secretary
Tommy G. Thompson announced May 6 the appointment of David J. Brailer,
M.D., Ph.D., to serve as National Health Information Technology Coordinator.
This is a new position at HHS, created by President Bush last week to
coordinate the nation’s health information technology efforts. Secretary
Thompson announced the appointment at a Secretarial Summit on health information
technology (IT) convened in Washington today. At the summit,
Secretary Thompson also announced several new accomplishments in developing
standards to help bring about electronic medical records and other health
IT benefits: Dr. Brailer,
a national leader in harnessing health IT to promote safe, quality and
efficient health care, will head a new office at HHS, created by a directive
from President Bush. The office will support efforts across government
and in the private sector to develop the standards and infrastructure
to allow more effective use of information technology to promote higher
quality care and reduce health care costs. One of the office’s first
tasks will be to study options to create incentives in Medicare and other
HHS programs to encourage the private sector to adopt interoperable electronic
health records. It is estimated that a national health information network
can save about $140 billion per year through improved care and reduced
duplication of medical tests. In addition,
the new office will work closely with the other components of HHS that
are responsible for medical privacy and security regulations to ensure
these efforts continue to secure and protect individually identifiable
health information. The office will prepare recommendations on methods
to assure that the interoperable health information technology appropriately
addresses privacy and security issues, such as appropriate authorization,
authentication and encryption of data that is being transmitted over the
Internet. Dr. Brailer
currently is a senior fellow at Health Technology Center in San Francisco,
where he has advised various regional and national efforts on IT and health
information exchange. He previously served for 10 years as chairman and
CEO of CareScience Inc., one of the nation’s leading health care
management companies. While at CareScience, Dr. Brailer designed and oversaw
the development of the health information exchange technology implemented
in Santa Barbara County, Calif. Dr. Brailer holds doctoral degrees in
both medicine and economics. For more
info, www.hhs.gov/news/press/2004pres/20040427a.html NQF
Nursing Home Report on Standards Now Available Online The National
Quality Forum (NQF) announced that its report, “National Voluntary
Consensus Standards for Nursing Home Care” is now available. The
executive summary of the report, with a list of endorsed performance measures
to improve quality of care in nursing homes, can be found on the NQF web
site, www.qualityforum.org. The report
details quality measures endorsed by the NQF’s 200-plus member organizations
through its formal Consensus Development Process. As such, the measures
have special legal standing as voluntary consensus standards. The Centers
for Medicare & Medicaid Services will use the 16 NQF-endorsed consensus
standards to collect information from all nursing homes and will provide
this information on its website. “Patients
and their families need as much objective and reliable information as
possible when they undertake the difficult process of selecting a nursing
home,” said Kenneth W. Kizer, MD, MPH, president and CEO of the
NQF. “This set of NQF-endorsed consensus standards should help consumers
at this important time. They will also help nursing homes improve their
quality.” The chronic
care consensus standards include pain, the use of restraints, depression,
weight loss, daily activities and pressure ulcers. For more
info, www.qualityforum.org. The Leapfrog
Group has released a new hospital quality survey based on the 30 patient
safety practices endorsed by the National Quality Forum. The group
will use the survey to supplement its original three patient safety measures
for hospitals: the use of computerized physician order entry, staffing
of intensive care units with specialists known as “intensivists,”
and referral of patients for certain high-risk procedures based on volume.
Nancy Foster,
senior associate director of health policy at the American Hospital Association,
said that unlike the earlier measures, the new measures recognize that
quality and patient safety improvement are processes. “We
are giving hospitals credit for each of the major steps they are taking
on the way to implementation of these safe practices,” she said,
adding that not all of the measures are appropriate for all hospitals,
nor are they necessarily ones that will most benefit patients. Results
from the new Leapfrog survey will be posted in July at www.leapfroggroup.org.
IT
Top Priority for Hospital Execs In a survey
of hospital administrators in Australia, Canada, New Zealand, the U.K.
and the U.S., three of five U.S. hospital administrators ranked EMRs/IT
at the top of their priority list for a one-time capital improvement,
as did one-third to one-half of those in the other countries. Administrators
in other countries were more likely than those in the U.S. to point to
hospital facilities such as ERs as areas in need of improvement. While U.S.
hospital executives were more positive about the state of their facilities,
and were more likely to report shorter or no waiting times for elective
surgery compared with those in the other nations, they expressed more
negative views of their country’s health system in general. Half
of hospital administrators in the U.S. said they were very or somewhat
dissatisfied with their country’s health system, compared with 12%
or fewer of those in the other countries. Majorities
of hospital executives in every country favored releasing quality of care
data to the public, although U.S. and Australian hospital executives expressed
the most reluctance about doing so. Written policies to inform patients
about preventable medical errors were common in the U.S. and U.K. but
in only abut half of other countries. Majorities in every country rated
the system for finding errors at least somewhat effective but no more
than one-quarter in any country thought their system was very effective. “Confronting
Competing Demands to Improve Quality: A Five- Country Hospital Survey,”
by Robert J. Blendon, Sc.D., of the Harvard School of Public Health and
colleagues, detailed survey findings based on interviews with the CEOs
or top administrators of the larger hospitals in each the five countries.
The survey is based on a random sample drawn from a list of the largest
general or pediatric hospitals in each country, excluding specialty hospitals. Across all
five countries, hospital executives were critical of the quality of their
emergency departments. Half of Canadian respondents rated the quality
of their emergency departments as fair or poor as did 17-30% of administrators
in other countries. Long waiting times for emergency care were more common
in the U.K., Canada, and the U.S. For more
info, www.cmwf.org. Critical
Shortage in Geriatric Care Providers, Report Finds A recent
report has found a critical shortage of physicians and other health providers
trained in geriatrics. According
to “Geriatric Medicine: A Clinical Imperative for an Aging Population,”
by the Association of Directors of Geriatric Academic Programs (ADGAP)
and the American Geriatrics Society (AGS), there are about 7,500 certified
geriatricians in the nation, while estimates suggest some 14,000 are currently
required to care for today’s elderly population. By 2030, some 36,000
trained clinical geriatricians will be needed. The report cites statistics
from various sources including two ADGAP studies, “Geriatric Medicine
Training and Practice in the United States at the beginning of the 21st
Century,” which was published in July 2002, and “GME Must
Prepare All Physicians to Care for the Aged,” which was released
last February. The gap
in geriatric training is likely to have serious consequences for the treatment
of chronic diseases like hypertension, diabetes, and arthritis, diseases
particularly prevalent in older people. These are the diseases that tax
the Medicare system, which most geriatricians depend upon for payment.
The low Medicare reimbursement levels and high patient caseload are a
major disincentive to enroll in geriatric training programs and at the
same time are driving many practicing physicians into early retirement. The situation
is complicated by a lack of academic geriatricians teaching in medical
schools. Only 900 academic geriatricians are employed today (full time
equivalents) and it is estimated that 2,400 academic geriatricians are
actually needed. A 1987 Institute
of Medicine advisory panel recommended that at least nine faculty- trained
in geriatrics be part of each medical school. But only 30% of medical
schools have reached this target, according to the ADGAP survey. The report
notes that most American medical schools still concentrate on training
for critical care, but most people in the aging population are likely
to require care for chronic diseases that need treatment over the long
term. They are also the patients likely to receive multiple prescriptions
for medications, seek alternative medicine treatments, and spend many
more years in the workforce than previous generations. As a result, they
are most likely to suffer complications from side effects of medication
interactions. These are symptoms that trained geriatric health care providers
are taught to recognize. Among its
recommendations, the report asks Congress to make changes to the Medicare
reimbursement system that would reimburse physicians for geriatric assessment
and care coordination services. Medicare should also develop a risk adjuster
to account for the time and complexity involved in treating frail elderly
patients. The report
also calls for loan forgiveness and other incentives to encourage training
in geriatrics including adequate funding Title VII geriatrics program
training under the Public Health Service Act. For more
info, www.americangeriatrics.org. Allscripts,
Microsoft Sign Agreement for E-Prescribing Allscripts
Healthcare Solutions, a provider of clinical software, connectivity and
information solutions for physicians, announced April 29 that it has signed
an agreement with Microsoft Corp. for the electronic prescribing initiative
sponsored by WellPoint Health Networks Inc. TouchScript(TM),
the e-prescribing application from Allscripts, will be available at no
charge for 12 months to nearly 19,000 physicians in WellPoint’s
physician networks in California, Georgia, Missouri and Wisconsin. WellPoint
officials also said they are offering a substantial discount to the remainder
of its network physicians. Additionally, Allscripts signed an agreement
with WellPoint to integrate WellPoint’s formulary, eligibility,
and medication history information directly into the Allscripts e-prescribing
solution. The TouchScript
e-prescribing solution will be used by physicians on Pocket PCs, and physicians
and their staff will be able to access the TouchScript solution via a
browser from any PC in their practice and remotely from their home. “In
the seven years that I’ve used TouchScript, the e-prescribing software
has had a very positive impact on the safety and satisfaction of my patients,”
commented Azar Korby, MD, a family practice physician in Salem, New Hampshire,
and current user of the TouchScript e-prescribing solution. “This
technology instills confidence in my patients and helps me make the best
decisions for their care.” For more
info, www.allscripts.com. The Agency
for Healthcare Research and Quality has announced a second clinical decision-support
tool for personal digital assistants (PDAs) designed to help clinicians
deliver evidence-based medicine when they are with a patient. AHRQ’s
new Interactive Tool, the Preventive Services Selector, an application
for Palm Pilots and other PDAs, is designed to help clinicians quickly
and easily search for which preventive services to provide—or not
provide—to patients based on their age and gender. The tool is available
for download from the AHRQ Web site at pda.ahrq.gov/index.html. The interactive
preventive services tool is based on the latest recommendations from the
U.S. Preventive Services Task Force. The tool will be automatically updated
with new Task Force recommendations each time the PDA is synchronized.
The Task Force, sponsored by AHRQ, is the leading independent panel of
experts in prevention and primary care. The Task Force conducts rigorous,
impartial assessments of all of the scientific evidence for a broad range
of preventive services, and its recommendations are considered the gold
standard for clinical prevention. The AHRQ
Preventive Services Selector is available in Palm OS, Pocket PC and HTML
formats. AHRQ said additional PDA applications are under development. For more
info www.ahrq.gov/clinic/gcpspu.htm. URAC
Focus Group to Explore Quality Benchmarks for Health IT The health
care accreditation agency URAC announced May 4 that it will be convening
a research and focus group to explore new quality benchmarks for health
information technology, including the possibility of developing standards
addressing electronic health records (EHRs) and possibly the infrastructure
of health IT systems. The potential
of health IT systems to improve quality and safety in the health care
system has been highlighted in recent announcements by President George
W. Bush regarding creation of an office in the Department of Health and
Human Services to oversee federal efforts to develop health IT. The Healthcare
Information and Management Systems Society (HIMSS) will be providing URAC
with strategic and technical insight for the health IT research and focus
group. “HIMSS
recognizes the importance of and need for consistent implementation standards
for the effective use of electronic health records,” said H. Stephen
Lieber, president and CEO of HIMSS. “We look forward to working
with URAC in its efforts to establish an accreditation benchmark for information
technology in health care.” The first
topic the health IT research and focus group is likely to address is the
possible development of EHR standards to achieve the following goals:
The health
IT research and focus group is expected to convene for the first time
next month in Washington, D.C. Parties interested in participating can
contact Liza Greenberg, RN, MPH, URAC’s vice president of research
and standards at research@urac.org. In addition
to its many clinically focused accreditation programs, URAC offers three
health IT focused accreditation programs for HIPAA Privacy, HIPAA Security
and health websites, along with a number of other health IT products and
services to promote quality and regulatory compliance. For more
info, www.urac.org.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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