Search

The National Data Bank (NDB) for rheumatic diseases is a patient-based multi-disease, multi-purpose rheumatic disease registry that has been used primarily to study patients with RA, SLE, FM and OA. It enrols patients from the community, follows up with questionnaires and validates key patient data using medical records. Rheumatologist-written programs make NDB data immediately available to analysts. The NDB has been used to develop and validate diagnostic criteria, develop new questionnaires, describe illness and comorbid disease, assesses disease outcomes and the effect of therapeutic interventions, and measure costs and cost-effectiveness.

Underlying many reforms in the Patient Protection and Affordable Care Act (ACA) is the use of electronic medical records (EMRs) to help contain costs. We use MarketScan claims data and American Hospital Association information technology (IT) data to examine whether EMRs can contain costs in the ACA's reforms to reduce patient safety events. We find EMRs do not reduce the rate of patient safety events. However, once an event occurs, EMRs reduce death by 34%, readmissions by 39%, and spending by $4,850 (16%), a cost offset of $1.75 per $1 spent on IT capital. Thus, EMRs contain costs by better coordinating care to rescue patients from medical errors once they occur.

This article examines the potential role of health IT in addressing healthcare disparities among racial and ethnic minority populations. An overview of health IT utilization among healthcare providers notes certain characteristics that may disproportionately affect minority populations. Current and emerging health IT use among racial and ethnic minority populations is examined, highlighting areas in which technology use in these populations differs from that of nonminority populations and emphasizing the importance of new social media applications in healthcare education and delivery. Following a discussion of adoption and utilization barriers for providers as well as for patients and caregivers, specific opportunities to address healthcare disparities through health IT use are identified at the provider, patient/caregiver, and healthcare system levels. The article identifies several technical, practical, and human challenges to health IT adoption and stresses the need for the healthcare system to embrace the full spectrum of emerging health IT opportunities to address healthcare disparities.

In this economic climate, healthcare providers may face extraordinary challenges securing financing for health IT projects, especially ones required to capitalize on the incentives in ARRA. Vendor financing may be the best option for many such providers. While such arrangements may often seem a win-win for both parties, providers should be aware of the many potential pitfalls inherent in vendorfinanced deals, including: 1.) additional pressure from vendors to accept their standard contractual terms and conditions because vendors have much more leverage if they are also the creditor in the transaction; 2.) failing to obtain necessary warranties and representations from vendors that their systems will comply with all relevant requirements under ARRA and will permit the provider to achieve meaningful use; and 3.) dealing with problems arising if the vendors' product fails to achieve certification, or the provider fails to achieve "meaningful use" in a timely manner.

US healthcare is undergoing a transformation. The economic stimulus plan is intended to transform healthcare through health IT. The government has defined "meaningful use" of health IT. Healthcare is a team activity, and as such presents a challenge to the concept of meaningful use. While encoding clinical data into a computer is a positive step, it is not enough. A continuity-of-care record is needed to document and measure care; support clinical care; and coordinate care with public health agencies. This paper examines current research to assist decisionmakers moving forward. To realize the promise, integration across all clinical disciplines is critical. There are many challenges. These include: the threat of information overload, both at the transitions of care and between disciplines; the need to provide for data-sharing between clinical and public health agencies, an important component in both local community and national health issues; how to use health IT to improve the delivery of healthcare, especially with unintended outcomes of any change in healthcare and paper persistence; and addressing different views of "meaningful" for different uses and users of health IT. All of these challenges need to be considered for wise installation of health IT. In addition, attention must be paid to weaknesses in the current healthcare system to prevent codifying them in health IT.

The final federal rules make it easier to meet Stage 1 requirements, but are not expected to significantly change the outcomes expected by the conclusion of Stage 3 in 2015. Practices that have not already done so should begin a detailed planning process, as outlined above, so they can meet Stage 1 requirements by the deadline at the end of 2012.

Background and Purpose: There are several cost-benefit evaluations of introducing new technology for administrative purposes in the health care sector. Whereas some of these recognise the importance of adapting the working procedures to the new technology, very few look into the consequences of delays in adaptation to the new technology. In this paper, we focus on the consequences of keeping old working procedures, although new technology is implemented., Methods: Based on on-site observations we have estimated the economic gains of implementing electronic message exchange in the health care sector depending on which working procedures are applied. Then we continue by using a dynamic cost-benefit analysis (CBA) in order to take into account that conversion to new working procedures takes place over time, and we demonstrate the loss in potential gains due to such a delay., Results: Keeping working procedures fit to old technology when new technology is implemented may imply that only between 40 and 50% of the potential time savings (benefits) are realised. In a dynamic perspective, the keeping of double procedures for 10 years and more will jeopardise the economic gains for surgeries, whereas hospitals still may have an economic gain. The delay in conversion to new working procedures implies that only 50% of the dynamic net present value of the gains is realised. The longer it takes before the old procedures are abandoned the lower is the dynamic net present value of the gains. This is due to the discounting of future gains., Conclusions: These are all arguments for emphasising and putting resources into training and motivation programs for employees when new technology is being implemented., Limitations of the Study: We have only considered quantifiable effects of electronic message exchange in the health care sector, and only for hospitals and surgeries., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Objective: To estimate the effects of electronic medical records (EMR) implementation on medical-surgical acute unit costs, length of stay, nurse staffing levels, nursing skill mix, nurse cost per hour, and nurse-sensitive patient outcomes., Data Sources: Data on EMR implementation came from the 1998-2007 HIMSS Analytics Databases. Data on nurse staffing and patient outcomes came from the 1998-2007 Annual Financial Disclosure Reports and Patient Discharge Databases of the California Office of Statewide Health Planning and Development (OSHPD)., Methods: Longitudinal analysis of an unbalanced panel of 326 short-term, general acute care hospitals in California. Marginal effects estimated using fixed effects (within-hospital) OLS regression., Principal Findings: EMR implementation was associated with 6-10 percent higher cost per discharge in medical-surgical acute units. EMR stage 2 increased registered nurse hours per patient day by 15-26 percent and reduced licensed vocational nurse cost per hour by 2-4 percent. EMR stage 3 was associated with 3-4 percent lower rates of in-hospital mortality for conditions., Conclusions: Our results suggest that advanced EMR applications may increase hospital costs and nurse staffing levels, as well as increase complications and decrease mortality for some conditions. Contrary to expectation, we found no support for the proposition that EMR reduced length of stay or decreased the demand for nurses.

With the release of final rules on meaningful use, the race is on for hospitals to invest in IT systems that meet the new criteria. But some, while praising the plan, see a big flaw: Some hospitals with multiple campuses that operate under one Medicare provider number will receive less money than multiple-hospital systems with a comparable bed count. "It's about a $25 million hit to Montefiore," says Montefiore Medical Center CEO Steven Safyer.

A healthcare organization considering the roll-out of EHR technology to physicians or other referral sources should prepare a careful plan to assure that the expectations of CMS and/or the OIG are met. In particular, donation recipient selection criteria and the proper allocation of EHR technology acquisition expenses can be complex and fact-specific and prevent one size fits all approaches.

The American Recovery and Reinvestment Act and its important Health Information Technology Act provision became law on February 17, 2009. Commonly referred to as "The Stimulus Bill" or "The Recovery Act," the landmark legislation allocated $787 billion to stimulate the economy, including $147 billion to rescue and reform the nation's seriously ailing health care industry. Of these funds, $19 billion in financial incentives were earmarked for the relatively short period of 5 years to drive reform through the use of advanced health information technology (HIT) and the adoption of electronic health records (EHRs). he incentives were intended to help health care providers purchase and implement HIT and EHR systems, and the HITECH Act also stipulated clear penalties would be imposed beyond 2015 for both hospitals and physician providers who failed to adopt use of EHRs in a meaningful way. Nurses will be integral to achieving a vision that will require a nationwide effort to adopt and implement EHR systems in a meaningful way.

This study examines the impact of electronic medical records (EMRs) on cost efficiency in hospital medical-surgical units. Using panel data on California hospitals from 1998 to 2007, we employed stochastic frontier analysis (SFA) to estimate the relationships between EMR implementation and the cost inefficiency of medical-surgical units. We categorized EMR implementation into three stages based on the level of sophistication. We also examined the effects of specific EMR systems on cost inefficiency. Our SFA models addressed potential bias from unobserved heterogeneity and heteroskedasticity. EMR Stages 1 and 2, nursing documentation, electronic medication administration records, and clinical decision support were associated with significantly higher inefficiency.

"Meaningful use" of interoperable electronic health records throughout the U.S. health care delivery system--the goal set forth in the American Reinvestment and Recovery Act (ARRA) of 2009--is a critical national goal. Proposed federal regulations on data exchange standards and the definition of meaningful use are well conceived and provide a foundation for the nation to begin the journey.

This paper examines Taiwan's current regulatory system for the use of healthcare information from the viewpoint of patient privacy protection. The author proposes a patient-centered, cooperative system centered on the "traffic light theory", as a solution to the potential conflict between the use of healthcare information and the protection of patient privacy. Taiwan, a country with a national healthcare insurance program and state-of-the-art electronic technology, takes a distinctive approach to the protection of patient privacy. On January 1st, 2004, the Bureau of National Health Insurance (BNHI) implemented a comprehensive embedded integrated circuit (IC) card, which puts the wide-ranging health information of its 22 million beneficiaries online to facilitate review of use and disclosure. It is well understood that healthcare information is of a personal and sensitive nature, demanding stringent privacy protection. Nevertheless, there is no denying the potential benefit of using personal health information (PHI) to achieve public good, especially in the area of cost containment. The comprehensive e-health system in Taiwan greatly facilitates copying, transmission, and use of PHI, but does the regulatory system provide enough safeguards for patient privacy? Because the law in Taiwan does not provide clear standards for the use and disclosure of healthcare information, healthcare providers are either too conservative or too aggressive. While most healthcare providers keep their oath of confidentiality, some rogue members severely abuse patient privacy. This paper proposes a "traffic-light system" to remedy this situation. Flashing yellow lights allow aggressive drivers to ignore others, while causing overly cautious drivers to be too hesitant. The author contends that clear standards should have been established for healthcare providers. Like car drivers, healthcare providers need red and green traffic signals. The law should indicate, through workable privacy regulations and guidelines, when the light is red or green-when to stop or to advance.

Unlabelled: THE LANDSCAPE: CIOs are realizing that everything they and their fellow executive and clinician leaders want to accomplish in hospital-based organizations--improving patient safety and care quality; enhancing efficiency and clinician workflow; delivering evidence-based patient care; creating outcomes transparency for purchasers, payers, and consumers; and participating in value-based purchasing initiatives, not to mention snagging federal funding under the ARRA-HITECH legislation passed last year--will require robust data infrastructures. And as pioneers are learning, creating those infrastructures is challenging and complex, but immensely critical., The Future: Experts say the need for robust data infrastructures to support performance improvement and transparency will only intensify. The time is now to put the needed technologies into place.

Background: Health information technology (HIT) has the potential to improve clinical outcomes, increase health provider productivity and reduce healthcare costs. Over half of all patient care is delivered in physician practice organisations, yet adoption and utilisation of HIT in these groups lags behind inpatient facilities., Objective: To better understand current utilisation rates along with benefits and barriers to HIT adoption in physician practice organisations., Methods: Published literature on the adoption and use of HIT in physician practice organisations within the USA between 12 January 2004 and 12 January 2009 and indexed in MEDLINE and EMBASE was included in the systematic review. Grey literature was also searched. Studies related to the adoption and use of HIT in hospitals and community health centres were excluded., Results: A total of 119 articles were eligible for inclusion in the review. Adoption rates across physician groups remain low, with between 9% and 29% of practices having implemented electronic medical records. HIT improves clinical outcomes, increases the use of vaccinations and improves medication adherence. Furthermore, HIT adoption leads to cost savings for physician groups, improves staff productivity and enriches patient-provider interactions. The largest barrier to HIT adoption in physician groups is the high initial and ongoing costs of electronic systems. Lack of sufficient training, a disorganised or non-receptive practice culture and technological problems such as inadequate connectivity appear to impede effective HIT use., Conclusions: HIT has the potential to positively impact on physician practice organisations, although significant and diverse barriers block adoption. Research into these obstacles should be coupled with efforts to understand barriers to effective implementation after HIT adoption.

Objective: Regional Health Information Organizations (RHIOs) will likely play a key role in our nation's effort to catalyze health information exchange. Yet we know little about why some efforts succeed while others fail. We sought to identify factors associated with RHIO viability., Design: Using data from a national survey of RHIOs that we conducted in mid-2008, we examined factors associated with becoming operational and factors associated with financial viability. We used multivariate logistic regression models to identify unique predictors., Measurements: We classified RHIOs actively facilitating data exchange as operational and measured financial viability as the percent of operating costs covered by revenue from participants in data exchange (0-24%, 25-74%, 75-100%). Predictors included breadth of participants, breadth of data exchanged, whether the RHIO focused on a specific population, whether RHIO participants had a history of collaborating, and sources of revenue during the planning phase., Results: Exchanging a narrow set of data and involving a broad group of stakeholders were independently associated with a higher likelihood of being operational. Involving hospitals and ambulatory physicians, and securing early funding from participants were associated with a higher likelihood of financial viability, while early grant funding seemed to diminish the likelihood., Conclusion: Finding ways to help RHIOs become operational and self-sustaining will bolster the current approach to nationwide health information exchange. Our work suggests that convening a broad coalition of stakeholders to focus on a narrow set of data is an important step in helping RHIOs become operational. Convincing stakeholders to financially commit early in the process may help RHIOs become self-sustaining.

As the American Recovery and Restoration Act of 2009 allocates $19 billion to health information technology, it will be useful for health care managers to project the true cost of implementing an electronic health record (EHR). This study presents a step-by-step guide for using activity-based costing (ABC) to estimate the cost of an EHR. ABC is a cost accounting method with a "top-down" approach for estimating the cost of a project or service within an organization. The total cost to implement an EHR includes obvious costs, such as licensing fees, and hidden costs, such as impact on productivity. Unlike other methods, ABC includes all of the organization's expenditures and is less likely to miss hidden costs. Although ABC is used considerably in manufacturing and other industries, it is a relatively new phenomenon in health care. ABC is a comprehensive approach that the health care field can use to analyze the cost-effectiveness of implementing EHRs. In this article, ABC is applied to a health clinic that recently implemented an EHR, and the clinic is found to be more productive after EHR implementation. This methodology can help health care administrators assess the impact of a stimulus investment on organizational performance.

Unlabelled: The analysis of the Management Unit of the National TB Programme (NTP) database, together with the reports of the TB county managers, allowed to the authors to identify some weaknesses of TB control in Romania in the recent years and to propose the appropriate measures., Problems: The marked decrease in the reduction of TB cases reported annually from 2,761 in 2005-2006, to 145 in 2007-2008 and the stagnation of mortality rate: 7.5 per ten thousand in 2007 and 7.6 per ten thousand in 2008. Deficiencies in data recording and reporting through informatic system of the NTP. Lack of financial resources for system maintenance and upgrade. Deficiencies in monitoring and control of mycobacterium resistance to antituberculous drugs phenomenon at national level. Sensitivity testing only for a small percentage of culture confirmed new TB cases (21%). Higher percentage of MDR in new TB cases compared to the results of national survey of mycobacterium drug resistance 2003-2004. Lack of personnel: 16 TB dispensaries without any pulmonologist, vacancies for 259 doctors, 436 nurses and 433 auxiliary personnel. Important deficiencies in the NTP network's infrastructure and logistics countrywide. Discontinuities in the supply with first and second line antituberculous drugs resulting in interruption of treatments. Lack of an officially endorsed protocol for the diagnosis, treatment and monitoring of cases with TB/HIV co-infection. Solutions: Revitalization of monitoring-supervision activities of the NTP running countrywide, provision with necessary financial resources to perform the scheduled visits in counties. Providing maintenance and upgrade of the informatic system for data collection. Implementation of the necessary measures in order to attract and maintain the personnel in the NTP network. Conduct the national survey of mycobacterium susceptibility to first and second line antituberculous drugs and drug susceptibility testing of the most culture confirmed TB cases. Restore the centralized procurement of TB drugs. Finalization and official endorsement of the protocol for TB/HIV co-infection initiated in 2004.

Background: Many believe that computerization will improve health care quality, reduce costs, and increase administrative efficiency. However, no previous studies have examined computerization's cost and quality impacts at a diverse national sample of hospitals., Methods: We linked data from an annual survey of computerization at approximately 4000 hospitals for the period from 2003 to 2007 with administrative cost data from Medicare Cost Reports and cost and quality data from the 2008 Dartmouth Health Atlas. We calculated an overall computerization score and 3 subscores based on 24 individual computer applications, including the use of computerized practitioner order entry and electronic medical records. We analyzed whether more computerized hospitals had lower costs of care or administration, or better quality. We also compared hospitals included on a list of the "100 Most Wired" with others., Results: More computerized hospitals had higher total costs in bivariate analyses (r=0.06, P=.001) but not multivariate analyses (P=.69). Neither overall computerization scores nor subscores were consistently related to administrative costs, but hospitals that increased computerization faster had more rapid administrative cost increases (P=.0001). Higher overall computerization scores correlated weakly with better quality scores for acute myocardial infarction (r=0.07, P=.003), but not for heart failure, pneumonia, or the 3 conditions combined. In multivariate analyses, more computerized hospitals had slightly better quality. Hospitals on the "Most Wired" list performed no better than others on quality, costs, or administrative costs., Conclusion: As currently implemented, hospital computing might modestly improve process measures of quality but does not reduce administrative or overall costs., (Copyright 2010 Elsevier Inc. All rights reserved.)