Obama budget reflects IT promise

Obama’s $3.4 trillion federal budget, released May 8, expanded the outline he presented to Congress at the end of February. It includes $879 billion for the Department of Health and Human Services, an estimated $63 billion increase over fiscal year 2009.

The Agency for Healthcare Research and Quality (AHRQ) is expected to receive $372 million to conduct research on comparative effectiveness, prevention and care management, value research, health information technology and patient safety. In addition, the AHRQ will use the funding to support research it conducts with other agencies.
The president’s budget for AHRQ will be in addition to the $1.1 billion allotted for comparative effectiveness research under the stimulus package.

Obama’s plan calls for $635 billion over 10 years as a “down payment” toward health reform. Health and Human Services Secretary Kathleen Sebelius called it “a smart investment.”

“No one should underestimate President Obama’s commitment to getting healthcare reform this year,” she said. “This budget sends a clear message that we can’t afford to wait any longer if we want to get healthcare costs under control and improve our fiscal outlook,” she added. The president has made it clear that he considers health IT as a major aspect of containing costs into the future.

David Blumenthal, MD, National Coordinator for Health Information Technology, said his office is “totally focused” on President Obama’s initiatives to establish healthcare IT. He called health IT “a critical pillar” in the plan to build more quality into American healthcare. Obama’s goal calls for every American to have electronic health records by 2014.

Though Obama clearly has much support, some are not sold. At a Senate Finance Committee hearing May 11, Ranking Member Chuck Grassley (R-Iowa) was skeptical about spending a lot on health reform, including health IT.

“It will be some time before this fairy dust turns to gold,” he said. Grassley did say that President Obama’s leadership would be “essential” in figuring out how to pay for health reform.

Electronic Prescribing Sees Significant Growth, Surescripts' Report Finds

Adoption of electronic prescribing has increased significantly since 2006, but further action must be taken to continue its growth, according to e-prescribing network Surescripts’ annual National Progress Report on E-Prescribing, Healthcare IT News reports.

Report Details, Findings

The report details the status of e-prescribing adoption and use in the U.S. from 2006 through 2008.

According to the report, more than 100,000 prescribers now are transmitting e-prescriptions (Merrill, Healthcare IT News, 4/22).

The report found that there were 74,000 active e-prescribers by the end of 2008, compared with 36,000 at the end of 2007 and 16,000 in 2006 (Surescripts release) (.pdf).

Meanwhile, the use of three critical e-prescribing components — electronic prescription benefit, history and routing — increased by 61% in the first quarter of 2009.

The report attributes the increase in e-prescribing to three factors:

• The attention e-prescribing received at the federal and state policy level;
• National programs that spur e-prescribing and offer practical tools to help the industry in adoption; and
• The adoption of e-prescribing by important groups, such as payers, subscribers and pharmacies.

Harry Totonis, president and CEO of Surescripts, said, “In the past two years, the U.S. has gone from 19,000 to 103,000 prescribers routing prescriptions electronically — punctuated by 39% sequential growth in prescriber adoption in the first quarter of this year.” He added that “while this growth shows clear evidence that the steps taken by policymakers, prescribers, payers, pharmacies and others are having a positive impact, swift and specific action is required for the U.S. to achieve mainstream adoption and use of e-prescribing.”

Surescripts’ Recommendations

Surescripts offered five recommendations to ensure the growth of e-prescribing use continues and to further realize cost reductions and improvements in safety and efficiency:

• Continue work with the U.S. Drug Enforcement Administration to pass regulations that permit controlled substances to be electronically prescribed in a way that is workable and scalable;
• Ensure the term “meaningful use” under the economic stimulus package requires the use of e-prescribing;
• Close gaps in e-prescribing participation among payers, state Medicaid programs and independent pharmacies;
• Promote awareness across the industry and encourage the use of e-prescribing, including prescription benefit, prescription history and prescription routing; and
• Provide education, financial incentives and implementation assistance to all prescribers, specifically focusing on the needs of small- and medium-sized practices (Healthcare IT News, 4/22).

Reports: Hospital Health IT Spending, EHR Market To Grow

For the report, titled “Essentials of the U.S. Hospital Market, 4th Edition,” HIMSS Analytics surveyed 5,100 hospitals.

The researchers projected that health IT would account for about 43% to 48% of total hospital capital budgets this year.

The projected figures are lower than 2007 levels, possibly as a result of the ongoing recession. However, the report predicts that health IT spending will increase over a longer time frame by a compounded annual rate of 7.5%.

The report identifies several factors that could account for the increase in health IT spending, including:

• Incentive payments for electronic health records outlined in the federal economic stimulus package;
• Increased clinical automation spending;
• New ICD-10-CM codes; and
• New 5010 standards for electronic claims.

Materials related to the report are available on HIMSS Analytics’ Web site (Anderson, Health Data Management, 6/4).

EHR Market Growth

In related news, a recent study by Kalorama Information suggests that the market for EHR applications and data transfer will increase from $575 million in 2008 to $1.6 billion by 2013, Healthcare IT Newsreports.

The report, titled “High-Tech Patient Monitoring Systems Markets,” predicts that the market will increase by 23.3% annually through 2013 as a result of increased EHR use in hospitals and physician offices.

The report also notes that EHRs are a key component of President Obama’s health care reform efforts because they have the potential to:

• Boost efficiency and accuracy;
• Cut health care costs;
• Improve patient outcomes and satisfaction;
• Provide greater physician freedom; and
• Reduce hospitalizations.

Stimulus money boosts health clinics serving poor

Homeless teenagers at a central Colorado shelter are feeling the effect of the government’s economic stimulus package. It’s the feeling of a dentist’s drill.

The 20 runaway youths living at the Urban Peak shelter had no regular dental care until this spring, when a $1.3 million stimulus grant to a community health center paid for a mobile dental and medical clinic to visit once a month. The residents now get medical and dental screenings, and cavities filled, right from their shelter’s parking lot.

“I knew my teeth needed to be fixed but I had no money,” says Michelle Daulton, 18, who has been living at the shelter for about four months and hadn’t seen a dentist since she was 13.

Now she’s had three chipped teeth repaired. “It was absolute and pure relief, I mean that,” she said.

From the Colorado homeless shelter to rural Pennsylvania clinics that can accept new patients, health centers that serve the poor are among the first places the federal stimulus package is being spent.

The stimulus law sets aside $2.5 billion for free and low-cost health clinics, and a big chunk of it – about $500 million – is already being spent. The White House has promised another burst of money this summer.

“This has really been a boost for us,” said Bob DeFelice, CEO of First Choice Community Health Care. “It’s allowed a level of stability in some very difficult times.” DeFelice’s group runs nine community health clinics around Albuquerque, N.M., and used a $703,000 grant to hire two physicians and four support staffers.

Health clinic executives say the money will allow them to keep their doors open as the rolls of uninsured patients grow. An estimated 64 million people use rural health clinics, a number that is expected to rise as people lose their jobs and health insurance.

“We’re seeing more and more people,” said Edward Michael, president of the Rural Health Corp. in Wilkes-Barre, Pa. The six-clinic group in northeastern Pennsylvania had no room for new patients until it received a $311,000 grant in April. Now, Michael says, his clinics can expand from seeing 18,000 patients last year to 19,000 this year.

“You know, we weren’t there back in the Depression, so we never experienced being back in the ’30s standing in line for food, standing in line for a doctor,” Michael said. “This money is really going to prevent a lot of long-term hardship.”

The health clinic grants are one-time boosts, not long term health care fixes. The stimulus won’t make up for a lack of doctors in poor and rural areas, a shortage the Association of American Medical Colleges says is growing and could reach 159,000 doctors by 2025.

“I look at the stimulus bill as one step to health care reform,” said Maggie Elehwany, vice president for government affairs and policy at the Washington-based National Rural Health Association. “It isn’t everything.”

While Congress considers a health care overhaul, clinic workers hope just to keep up with basic needs such as vaccinations and exams.

“I can’t imagine not having the stimulus money right now because we wouldn’t be able to do any of this,” said Nicole Noll, who drives the mobile health clinic to the teen homeless shelter and rural elementary schools.

The van was provided by Ronald McDonald House Charities. But stimulus money pays for Noll, the doctors and the dentists.

Far more than a brighter smile can be at stake in dentistry. In Maryland, a 12-year-old boy whose Medicaid coverage had lapsed, Deamonte Driver, died in 2007 after bacteria from the abscess of an aching tooth spread to his brain. An $80 tooth extraction might have saved his life.

“I’m so glad they did this,” Michelle Daulton said. “My parents were cheap. They never took me to the dentist. And when you don’t have any money, your teeth, you just leave ‘em alone. Not anymore.”

E-Health Records Planned Despite Stimulus Uncertainty

More than 50% of healthcare providers surveyed by IVANS do not believe the federal stimulus package will successfully encourage health IT adoption.

By Marianne Kolbasuk McGee InformationWeek

Although a majority of healthcare providers remain skeptical about how they’ll benefit by the federal government’s $20 billion stimulus program, many plan to forge ahead anyway, according to a report released this week.

About seven in 10 healthcare providers believe electronic medical records will have a positive impact on their businesses and patient care, but 80% say the lack of money is their biggest obstacle to deploying health IT systems, said the new report by IVANS, a supplier of EDI and network services to the insurance industry.

The nationwide, e-mailed survey of 508 healthcare providers — including hospitals, clinics, private medical practices, nursing homes, home healthcare organizations and medical billing companies — found that while nearly 40% plan to forge ahead with e-medical record deployments within the next 12 months, more than 50% of healthcare providers do not believe the federal stimulus package will successfully encourage health IT adoption.

Healthcare providers’ doubt appears to be rooted to several factor, most notably uncertainty about the specifics of the government’s eligibility requirements for receiving HIT-related rewards. Starting in 2011, the federal government is expected to begin awarding approximately $20 billion over the next five years, rewarding higher Medicare and Medicaid reimbursements to doctors and hospitals that demonstrate “meaningful use” of health IT.

However, the details of what will constitute “meaningful use” haven’t been worked out yet. The federal government is in the process of investigating and defining the scope of what “meaningful use” of health IT will qualify for the American Recovery and Reinvestment Act of 2009′s HITECH (Health Information Technology for Economic and Clinical Health) stimulus funding incentives. Just this week, a federal advisory panel — the HIT Policy Committee — unveiled some of its recommendations for the “meaningful use” definition.

“They’re on the right track,” said Clare DeNicola, IVANS CEO, of the HIT Policy Committee’s recommendation so far to the U.S. Dept. of Health and Human Services about the “meaningful use” definition. “It’s not about technology, it’s about the care — we can’t lose sight of that,” she said about the committee’s suggestions for how IT can be used for improving quality of patient care and public health.

Also fueling uncertainty among healthcare providers participating in the survey was this: Home healthcare providers and nursing homes were among the 508, healthcare providers polled. However, so far the HITECH federal stimulus legislations is vague on how those healthcare providers will participate in the new programs, despite the growing population of aging baby boomers who’ll likely increasingly require their services in coming years.

In fact, despite their skepticism and uncertainly about the government incentive programs, about four in 10 healthcare providers are planning to implement e-medical record systems over the next 12 months.

Many are already making investments in IT, including those that can help support e-medical record deployments, including wireless networks, business continuity technologies and connectivity to remote locations.

“Healthcare providers are wary but they are moving forward with technology innovations,” said DeNicola. “They’re not driven so much by the stimulus funds as they are in their belief that these technologies can help improve their businesses and patient care,” she said.

Governors Announce State Rankings for E-Prescribing

Massachusetts Prescribers Now Route More Than 20 Percent of Prescriptions Electronically, Followed by Rhode Island at 17 Percent

Tennessee Gov. Phil Bredesen and Vermont Gov. Jim Douglas Accept Safe-Rx™ Award, Highlighting States’ Improved Use of E-Prescribing

WASHINGTON, – At an event at the National Press Club, Surescripts announced today that Massachusetts ranks first in the nation when it comes to routing prescriptions electronically. According to the results of an annual nationwide audit of electronic prescriptions routed in 2008, it was determined that prescribers in the Bay State sent more than 6.7 million prescriptions electronically, representing 20.5 percent of all eligible prescriptions in the state – as compared to 2.3 percent in 2005. For this accomplishment, Massachusetts was recognized, along with 14 other states, at the fourth annual Safe-Rx Awards.

Surescripts created the Safe-Rx Awards to raise awareness of e-prescribing as a means of enhancing patient safety by providing a more secure, accurate and informed prescribing process.

“Congratulations to all the Safe-Rx Award winners for increasing the use of e-prescribing and for the benefit it has brought to the economy, safety and quality of patient care in communities throughout their states,” said Harry Totonis, president and CEO of Surescripts. “And as much as this program is about measuring and recognizing real success, its greater purpose is to highlight the leaders who are driving that success and the stories of how they are doing it. As the numbers and rankings suggest, each year there are more and more examples of how a state and the various stakeholders within the state can work together to drive e-prescribing adoption and use. We congratulate those leaders and hope that their examples will inspire and inform many more successful efforts in many more states in the year ahead.”

“The Massachusetts model should serve as a roadmap for the rest of the nation,” said U.S. Sen. John Kerry (D-Mass.). “Electronic prescribing saves money, improves efficiency and, most importantly, reduces life or death medical errors. While we debate how to reform our healthcare system, improve quality and lower costs, one of our top priorities should include modernizing the way physicians write prescriptions.”

In its first three years, the Safe-Rx Award was given annually by Surescripts to the top 10 e-prescribing states in the nation. In an effort to measure and recognize critical progress occurring outside states that finished in the top 10, Surescripts has introduced a new category of state rankings: the Top 5 Most Improved (see both lists for 2008 below).

Top 10 E-Prescribing States Top 5 Most Improved States

1. Massachusetts 1. Vermont 2. Rhode Island 2. Tennessee 3. Michigan 3. Kansas 4. Nevada 4. Illinois 5. Delaware 5. Missouri 6. North Carolina 7. Pennsylvania* 8. Connecticut 9. Maine* 10. Arizona *New to the top 10

Today’s event featured Tennessee Gov. Phil Bredesen and Vermont Gov. Jim Douglas, co-chairs of the State Alliance for e-Health and co-hosts of the Fourth Annual Safe-Rx Awards. The State Alliance was created by the National Governors Association Center for Best Practices in January 2007 to improve the nation’s healthcare system by forming a collaborative body that enables states to increase the efficiency and effectiveness of the health information technology initiatives they develop. The State Alliance has recognized the potential for e-prescribing to improve both patient safety and the health of all Americans and has encouraged states to be proactive in creating and implementing policies that advance this and other e-health initiatives. Govs. Bredesen and Douglas were also on hand to receive Safe-Rx Awards recognizing their states’ sizable jumps in e-prescribing use.

“The State Alliance recognized early on that encouraging states to make e-prescribing a top priority would have an immense value in our electronic health efforts,” said Bredesen. “Paperless prescribing is making its way into the health care mainstream in Tennessee and across the nation. It’s our hope to see e-prescribing become a natural part of every health care provider’s workflow because of its practical benefits to patients in providing better care.”

“To the State Alliance, e-prescribing is important to building momentum toward the goals of an effective health care system and improved public health,” said Vermont Governor Jim Douglas. “And I’m proud that e-prescribing has been an integral part of Vermont’s Health Information Technology strategy from the start. That’s because e-prescribing is a fundamental system improvement for ensuring accurate, timely health care communication. Much of Vermont health care reform is about utilizing the right tools to enhance our systemic approach to health care reform and the evidence regarding the value of e-prescribing is clear.”

Surescripts Announces A Meaningful Change to Future State Rankings Historically, the Safe-Rx Awards have been based on an analysis of data from new prescriptions and refill responses electronically routed over the Surescripts network. States were ranked and recognized according to the number of prescriptions routed electronically in 2008 as a percentage of the total number of prescriptions eligible for electronic routing.

In January 2010, Surescripts will release a new state ranking. Using data from 2009, the rankings will measure use of not one, but three critical steps in electronic prescribing:

1. Prescription Benefit: Electronically accessing a patient’s prescription benefit information. 2. Prescription History: With a patient’s consent, electronically accessing that patient’s prescription history from pharmacies and payers. 3. Prescription Routing: Electronically routing the patient’s prescription to their choice of pharmacy and electronically reviewing and responding to a prescription renewal request that pharmacies send to the physicians’ practices for approval.

This approach recognizes the combined role that prescription benefit, history and routing play in improving the overall safety, efficiency, cost and quality of the prescribing process. It is Surescripts’ position that measuring and reporting the actual use of all three of these services helps define ”meaningful use of electronic prescribing” under the American Recovery and Reinvestment Act of 2009.

For a full description of the change in ranking methodology, go to www.surescripts.com/Safe-Rx.

What About My State? Individuals who are interested in finding out how their state is progressing in its efforts to move to e-prescribing can go to the Safe-Rx Awards Web site at www.surescripts.com/Safe-Rx. The site shows a complete ranking of all 50 states and the District of Columbia based on prescription routing. For an in-depth statistical review of each state’s progress across a number of e-prescribing use and adoption metrics, go to the U.S. maps on either www.surescripts.com/Safe-Rx orwww.surescripts.com/stats and click on your state.

Blue Cross Blue Shield of Massachusetts Honored With Safe-Rx Evangelist Award The Safe-Rx Evangelist Award goes to a single person or organization whose leadership has made an extraordinarily positive impact on raising awareness and reducing medication errors by promoting the adoption and use of electronic prescribing. In 2008, the Safe-Rx Evangelist Award went to Health and Human Services Secretary Michael Leavitt. In 2007, the Safe-Rx Evangelist Award went to the Institute of Medicine for its breakthrough report Preventing Medication Errors.

Blue Cross Blue Shield of Massachusetts (BCBS MA) is widely known as a leader in electronic prescribing and health information technology initiatives. It was one of the very first organizations to embark on an initiative to encourage electronic prescribing with physicians because of the many patient safety, practice efficiency and cost saving benefits. BCBSMA took a very collaborative approach, bringing in multiple health plans to create the eRx Collaborative – itself a prominent advocate for e-prescribing – and ensuring that prescribers would have access to more comprehensive prescription benefit and prescription history information on their patients.

“Working together sends a message that e-prescribing is important for everyone in the community,” said Steve Fox, vice president of provider network management at BCBSMA. “As a leader in e-health initiatives and e-prescribing programs, BCBSMA will continue to focus on the delivery and promotion of technology to enable a delivery system that reliably provides safe, effective and affordable patient-centered care.”

Surescripts Salutes E-Prescribers of the Year This year, Surescripts is recognizing six prescribers for the outstanding leadership they have shown through their own use of e-prescribing. Three users of standalone e-prescribing software and three users of electronic medical record software received Safe-Rx Awards and were recognized as E-Prescribers of the Year:

Standalone E-Prescribing Users EMR Users Dr. Amando Garza (Laredo, Texas) Dr. Narinder Batra (Adrian, Mich.) Dr. Steven Green (Lancaster, Ky.) Dr. Michael Brewer (Springfield, Ill.) Dr. Abdul Kabir (Monroe, Mich.) Dr. Mark Earhart (Watkinsville, Ga.)

”More and more doctors, nurse practitioners and physician assistants are turning to e-prescribing for the safety, efficiency and quality advantages it provides them and their patients,” said Dr. Peter Basch, medical director for ambulatory clinical systems at MedStar Health. “In fact, for many clinicians, their introduction to and use of e-prescribing has helped them emerge as leaders in their communities towards the effective use of health information technology as part of everyday medical care.”

Special Health IT Report: Electronic Prescribing Increasing Despite Glitches

 Dr. Marek Durakiewicz initially welcomed the opportunity to send prescriptions to drugstores electronically, using free computer equipment provided by a state pilot program.

The chief of staff at Hickman Community Hospital in Centerville, Tenn., Durakiewicz recognized the potential benefits of “e-prescribing.” Special software allows doctors to see instantly if the drug they are ordering is covered by a patient’s health insurance plan; if there’s a less expensive, generic alternative, or if the patient is already taking medication that may interact dangerously with the new one. For patients, there’s no piece of paper to misplace.

Advocates say e-prescribing is a key advance toward health care’s digital future because of its potential to reduce medical errors, cut drug costs and save doctors and patients time and money. E-prescribing is growing – the number of doctors doing it is now more than 120,000, 20 percent of all office-based prescribers, according to an industry source. But kinks need to be worked out to spur more rapid acceptance.

Doctors and patients in a number of states have complaints, including Durakiewicz. Malfunctioning hardware and cumbersome security features — such as software that logged him out automatically every 30 minutes — left him frustrated. Patient prescription histories provided by the system weren’t as current as he had expected. In addition, federal restrictions prevented him from e-prescribing certain pain medications.

Now, a year later, he doesn’t use the pilot system at all. Instead, he types prescriptions into another computer and prints them out. “It’s faster,” said Durakiewicz, one of 50 doctors participating in the pilot offered by the state’s Medicaid program and the technology company Shared Health.

Emily Bagley, product development consultant with Shared Health, says electronic prescription histories should be immediately available; paper prescriptions take longer to retrieve. Log-offs, she says, result from federal regulations requiring e-prescribing software to log out doctors at regular intervals to prevent unauthorized use of systems.

There are other obstacles to e-prescribing, which helps explain why currently only about 10 percent of eligible prescriptions nationally are sent electronically. (Prescriptions for controlled substances, such as certain pain medications, aren’t eligible.) E-prescribing requires special computer equipment, which can be costly, and seamless coordination of an immense amount of data from doctors, health plans and pharmacies.

But federal money for health technology in the stimulus package and other incentives are expected to drive greater adoption of e-prescribing in coming years. Another key step occurred in 2008, when two prescription processing networks combined to form Surescripts. The e-prescribing company maintains the largest secure network through which doctors send prescriptions to patients’ pharmacies.

For the system to work, the doctor’s office must have e-prescribing software and an Internet connection; the patient’s health plan must participate, so the doctor can electronically check the patient’s drug benefit, and the patient’s pharmacy must be connected to Surescripts.

Currently, about three-quarters of U.S. retail pharmacies participate in Surescripts and support the network by paying transaction fees. Doctors generally don’t pay to send prescriptions, but they bear the costs of maintaining their computer system with periodic upgrades.

Rick Ratliff, president of the Virginia division of Surescripts, says the network, which processes 15 million prescriptions a month, is extremely reliable. However, with more than 130 different software programs certified to link with the network and many medical practices relatively new to e-prescribing, it’s inevitable that there will be problems, whether with the technology itself or with the people learning to use it, according to the company.

To encourage greater participation, Medicare, the federal health plan for the elderly, in January began giving e-prescribing doctors a bonus of 2 percent of their overall Medicare reimbursement. That incentive may be helping: Surescripts reports in the first three months of 2009 a 49 percent increase in e-prescriptions compared to the last quarter of 2008.

Tennessee — where only 3 percent of prescriptions are sent electronically – is giving grants to more than 1,800 rural doctors to help them buy or upgrade electronic prescribing and medical records systems. The state also is offering training sessions.

Other states are encouraging doctors, too, hoping to contain prescribing costs and improve care. Arkansas is one of seven states that fully link their Medicaid programs for the poor to Surescripts. After the state began heavily promoting e-prescribing in December, the number of doctors using it shot up from 225 to 665 in March.

Pilot programs in states such as Mississippi and Florida have reduced Medicaid costs, mainly by elimination of duplicate prescriptions and increased use of generic drugs.

When it works as intended, doctors and patients are enthusiastic. “I love it,” said Amber Blackwell, a working mother whose Clarksville, Tenn., pediatrician prescribes electronically. “I have an 18-month-old, so I don’t have to carry anything else to keep track of. And when I get to the pharmacy it’s ready.”

Challenges persist, especially at small practices that lack in-house technical support. Cumberland Family Care, a three-office doctor group in Sparta, Tenn., obtained a state grant for e-prescribing software. But the system hasn’t always worked well. “We send about 150 to 200 electronic prescriptions a day,” said Mischelle Ferrell, the practice manager. The failure rate is now about 20 percent.

When that happens, patients arriving at their drugstores may find no record of their prescriptions. “There’s a mother with a kid with a fever at the pharmacy who drove 15 miles and waited in line, and they have no record of the prescription,” Ferrell said. “You’ve got one mad mother on your hands.”

“There will be problems,” conceded Melissa Hargiss, director of Tennessee’s Office of E-Health Initiatives. “But I would say to doctors that this is the best time for providers to start using it, while there’s grant money available to offset the costs.”