Amid attendance woes, TEPR names award winners, looks to the future

PALM SPRINGS, CA – Amid perfect weather but less-than-perfect attendance, the Medical records Institute's Towards the Electronic Patient Record (TEPR+) conference kicked off Monday with the announcement of two annual award winners.

Private Access, Inc., an Irvine, Calif.-based provider of Web-based solutions designed to help healthcare consumers access medical information and control who sees their records, was named the winner of TEPR's "Hot Products" competition for its PrivacyLayer, RecruitSource and TrialsFinder products. The runner-up announcement featured a tie between Doctations, a Garden City, N.Y.-based developer of online medical records, and ImageTrend, Inc. of Lakeville, Minn. for its TapChart EMS data collection tool.

The U.S. Department of Veterans Affairs was named TEPR's "Best PHRs" award winner for its MyHealtheVet product. Coming in second place was CapMed, a subsidiary of Milwaukee-based Metavante; while Doctations was named the third-place winner.

The awards were named during Monday's opening session at the Palm Springs Convention Center. Claudia Tessier, MRI's vice president, pointed out prior to the announcement that attendance at this year's 25th annual event is "well over 700," which is well under the 2,000 that MRI officials had hoped to attract.

Tessier said attendance "is not where we've been in the past," and added that the nation's troubled economy may have caused some people to curtail their travel plans. She pointed out, though, that the conference, which is scheduled to run through Wednesday, is "cost-conscious but rich in content."

MRI officials had hoped to rejuvenate the flagging show and conference by focusing on new trends in healthcare IT - namely, the patient-centered medical home, emergency services, confidentiality and privacy concerns and mobile devices. On Sunday, they announced the formation of the mHealth Initiative, a Boston-based, non-profit advocacy group designed to advance the use of health applications through mobile devices, or mDevices.

Speaking before an opening session crowd of about 200 people Monday, MRI CEO C. Peter Waegemann said mobile phones, the so-called "forbidden gadgets of the past few years," would be at the forefront of the healthcare IT movement this year, becoming "the most prized possessions of physicians." He pointed out that more than 120 companies have developed mHealth products, and that number will grow with physician acceptance of such devices.

"It's a very exciting time," he said.

Waegemann also opined that healthcare IT would venture further into the realm of financial services as the healthcare industry struggles to maintain balance in the current economy.

"We cannot focus on electronic medical records without looking at the financial system," he said, listing such uses as real-time transactions, payment incentives and charge capture without codes.

Health and Social Care Act passes in UK

The UK has recently passed the Health and Social Care Act, raising further awareness of the important of patient data security. The initiative HealthWatch will also champion patient interests at a local and national level across England.

The misuse of sensitive health information can be harmful to patients and the reputations of healthcare providers. Organizations must work to safeguard patient data to preserve individual privacy.

The NHS is under pressure to demonstrate its effectiveness at addressing public concerns, such as the confidentiality of patient records.

“The Health and Social Care Act, and the setting up of HealthWatch, means that patient privacy is becoming a more pressing concern than ever for NHS senior managers," said Kurt Long, CEO and founder of FairWarning. "Health and social care providers who act now have an excellent opportunity to strengthen their reputations with patients, clients and commissioners who will feel confident that high-quality training and safeguards are all in place. They will also be able to meet the growing demands from government, regulators, patient groups and the public to keep electronic records safe."

NHS Scotland has already made strides in protecting patient confidentiality, but much of the NHS in England is ill-equipped to prevent or detect breaches of sensitive data, officials say. But the passing of the Health and Social Care Act means that providers will have to exchange data with more external bodies. Security must remain a top priority for providers in the UK.

With new hospitals come new data centers

CHICAGO – Silver Cross Hospital’s recently opened data center puts it at the forefront of an emerging healthcare trend, according to Mortensen Construction, a company with hospital projects across the country. Combining construction of new hospitals with new data centers is becoming more common, according to company executives.

The trend is driven, they say, by the need to accommodate an explosion in applications and patient data – not only documents, but also images and videos.
 
With the February, 2012 opening of its 600,000 square foot, $370 million medical complex with outpatient center, medical service building and hospital, Silver Cross Hospital, a 289-room facility in New Lenox, Ill., needed to update and expand its aging data resources, which were already operating at capacity. So, the project also included a new 2,450 square-foot data center, 50 percent larger than its existing one.
 
Silver Cross also became one of the first hospitals to install patient tracking software so families know where a patient is at all times. New communication equipment supports wireless voice and data networks throughout the hospital, providing access to patients and their families while freeing clinicians to use phones and computers where needed instead of based on location. Also, medical telemetry enables remote monitoring of patient vital signs.

[See also: Chicago health system rolls out $3M virtual data center]

“From day one, the new capabilities have helped us improve care and have helped our medical staff to be more effective,” said Kevin Lane, Silver Cross vice president and CIO.
 
Other hospitals, including OSF HealthCare’s new Children’s Hospital of Illinois in Peoria and the soon-to-open Ann & Robert H. Lurie Children’s Hospital of Chicago, have combined new data centers with new medical facilities. As Mortenson executives see it, the hospitals are establishing a technology foundation for the emerging era in healthcare that will be dominated by electronic health records and new care delivery approaches that require real-time coordination and information exchange among multiple providers, payers, patients and locations.
 
“State-of-the-art data centers will become as essential to new healthcare construction as private patient rooms with flat-screen televisions,” said Greg Werner, Chicago office head for Mortenson Construction. Mortenson has built more than $4.5 billion in healthcare projects in the past 10 years, according to Werner, including Silver Cross and Lurie Children’s, with partner Power Construction. It has also built more than 11 million square feet of data centers – mission-critical space – nationwide, totaling more than $1.1 billion. 
 
Given the escalating IT demands, growth of bigger and better healthcare data centers is only likely to strengthen, Werner said. In a fall, 2011 survey by Mortenson of 90 data center and facilities experts at the 7x24 Exchange Conference, 92 percent of respondents ranked healthcare as the industry with the greatest need for new data centers in the next five years.

[See also: 6 keys to data storage]

Autism scientists search for help, for their own kids' sakes

Neuroscientist Kevin Pelphrey has earned a Ph.D., a long list of awards and million-dollar grants from the National Institutes of Health.

None of that impresses his 6-year-old son, Kenneth.

" 'Dad,' he says, 'why haven't you cured autism yet?' "

Young Kenneth has good reason to be impatient � and unusually curious about his father's work, says Pelphrey, one of the country's leading autism researchers. Two of Pelphrey's three children � Kenneth's big sister, Frances, and little brother, Lowell � have been diagnosed with autism-spectrum disorders.

"I'd really like to cure autism and be out of a job," says Pelphrey, an associate professor of child psychiatry at the Yale School of Medicine's Child Study Center. "I wish I had more ideas faster."

Autism Awareness

As part of autism awareness month, here is some of the latest research and findings being released throughout April.

Doctors want to redefine autism; parents worriedWith autism rising, researchers step up hunt for a causeAutism may be linked to obesity during pregnancyCDC: Autism is more common than previously thoughtMore autism coverage

Pelphrey is one of a handful of leading autism scientists who also have children with the disorder. Autism-spectrum disorders, which cause impairments in communication and socializing, as well as repetitive behaviors, now strike one in 88 children, or more than 1 million in all, according to a new report from the Centers for Disease Control and Prevention.

High-functioning autistic adults are also contributing to the study of autism. In an essay in the journal Nature, University of Montreal psychiatry professor Laurent Mottron singled out the work of a self-taught researcher with autism, Michelle Dawson, with whom he has co-written 13 papers and several book chapters.

Families, of course, have a long history of rallying to the aid of their children, using whatever talents they possess. Most of the major non-profits funding autism research � including the Simons Foundation, Autism Speaks and the Autism Science Foundation � were founded by the parents or grandparents of people with autism.

"It's definitely why I do what I do," says Edwin Cook, a professor of psychiatry at the University of Illinois-Chicago College of Medicine, whose autistic brother died in 1989 at age 28. He's now studying genes related to autism, as well as helping lead advanced clinical trials of a drug to treat social withdrawal in autism.

"I'll die not knowing what I wanted to, but hopefully I will have contributed a little bit along the way," he says.

Ricardo Dolmetsch, an associate professor of neurobiology at Stanford University, says his son's autism diagnosis has changed his personal and professional lives.

A decade ago, Dolmetsch was working in biophysics. He changed fields when his son, now 9, was diagnosed. Transforming the focus of his research, he says, was part of the "phases of grief" parents often undergo when faced with autism. After overcoming their initial denial of their son's condition, he and his wife felt compelled to "leave no stone unturned," Dolmetsch says.

"It was very traumatic," he says. "We had to change the direction of my lab. We had no funding. We had no track record. But it's motivating for me and for my lab. There is nothing like working for a cause. It's why we do what we do."

Dolmetsch's work has been singled out by Thomas Insel, director of the National Institutes of Mental Health, as a "game-changer" in autism. To help scientists study the autistic brain � a notoriously difficult task, given that doctors can't routinely biopsy the brain, as they might a colon tumor � Dolmetsch found a way to "create" brain cells in a lab dish by transforming skin cells of autistic children into stem cells, then back into neurons, or brain cells.

A challenge at home, too

This work was made more difficult, Dolmetsch says, by the fact that caring for a child with a disability is a full-time job. Although his wife, neurobiologist Asha Nigh, supports his research through managing projects and writing grant proposals, she has put her own scientific career on hold so she can care for their son and his brother, age 7.

Dolmetsch says his wife has earned an honorary doctorate "in getting insurance coverage for stuff."

"The finances of autism are brutal," he says. "The amount of continuous care these kids need is a lot. � The only thing that works at all are behavioral treatments," which, depending on the state and one's health plan, may not be covered by insurance, he says. "They're very intensive � and they're horrifyingly expensive."

In some ways, knowing too much about autism can be a burden, Dolmetsch says.

"On the one hand, I get insights from him and his buddies and going to the clinic," Dolmetsch says. "The downside is that there is a certain amount of denial that is important when you are raising a child and you don't know exactly what is going to happen to them. It's harder to have that denial if you are a scientist. You've seen it in other people, and you know what can happen and you know what the statistics are."

Still, Dolmetsch feels lucky his work may help scientists better understand what's happening between brain cells in children with autism and even lead to new drug therapies. He also works hard to mentor young researchers and interest other scientists in autism.

Dolmetsch says he also tries to answer questions from other parents who write to him for advice. Because there are so few effective treatments for autism, many parents turn to alternative therapies. In many cases, however, those therapies are ineffective, a waste of money or, even worse, dangerous, Dolmetsch says.

Recently, he has gotten a lot of e-mails from parents looking to go abroad for mysterious "stem cell therapies," he says, including treatments in which practitioners offer treatments made with stem cells derived from fat, at a cost of up to $30,000.

"There are a lot of hucksters," Dolmetsch says. "They're springing up everywhere. � In the best case, it's fraud, because they will put the cells in your body and they will be attacked by the immune system and die. In the worst case, they will cause something terrible, like cancer. � This has to be fraud, because we are not about to put stem cells in anybody's brain. People are super-desperate. I'm just as desperate as they are."

Siblings change things

Pelphrey was studying a subject relevant to autism � the "social brain" � when his daughter was diagnosed at age 4. Like Dolmetsch, he shifted his research to focus exclusively on autism. Insel notes that Pelphrey has helped to change the way people think about autism by finding that the siblings of autistic children appear to share some of their brain patterns but find ways to compensate.

"You can see why they're so passionate," Insel says.

Pelphrey didn't think much of enrolling his youngest son in one of Yale's research projects, assuming that the child would serve as one in a control group of "healthy" children to their autistic siblings.

Instead, his son, Lowell, also was diagnosed with a form of autism, called pervasive development disorder-not otherwise specified, or PDD-NOS, at age 1�. In spite of Pelphrey's expertise in autism and experience as the father of an autistic daughter, he hadn't noticed his son's symptoms.

"We honestly thought he would get a clean bill of health," Pelphrey says. "Then we found out he was developing toward autism."

Thanks to that early diagnosis, Lowell began 32 hours a week of early behavioral therapy. He has made impressive progress. Today, at age 3, Lowell no longer has any autism-spectrum diagnosis, Pelphrey says.

"He's not on the spectrum anymore," Pelphrey says. "We kind of altered his developmental course. He still has subtle language and social deficits, and he's awkward and shy. But it's a matter of personality at this point.

"Frankly, he's not all that different from most of my professor colleagues. I think he will have a very different life."

Catholic Groups Sue Obama Administration Over Birth Control Rule

Enlarge iStockphoto.com

In a compromise, President Obama proposed to allow religious universities and charities offer birth control coverage through their own health insurers.

iStockphoto.com

In a compromise, President Obama proposed to allow religious universities and charities offer birth control coverage through their own health insurers.

So much for compromise.

A total of 43 Catholic educational, charitable and other entities filed a dozen lawsuits in federal court around the nation Monday, charging that the Obama Administration's rule requiring coverage of birth control in most health insurance plans violates their religious freedom.

Among the plaintiffs in the suits are the University of Notre Dame and the Catholic University of America, as well as the Archdioceses of New York, Washington, Dallas, St. Louis and Pittsburgh.

They join several other, mostly smaller entities that have sued over the requirements for no-cost coverage of regular birth control, sterilization and so-called morning after emergency contraceptives. Because one of the ways those drugs may work is by preventing the implantation of a fertilized egg into a woman's uterus, Catholics believe they can cause a very early abortion, even though they are classified by the Food and Drug Administration as contraceptives.

 

President Obama tried to defuse the controversy over the requirement back in February, after religious groups complained that the exemption from the requirement, which applied effectively only to actual houses of worship and groups that employ only members of a specific faith, was too narrow.

The president's proposal was not to expand the exemption, but to allow religious universities and charities to have their health insurers offer the coverage instead.

"The result will be that religious organizations won't have to pay for these services, and no religious institution will have to provide these services directly," Obama said. "But women who work at these institutions will have access to free contraceptive services, just like other women, and they'll no longer have to pay hundreds of dollars a year that could go towards paying the rent or buying groceries."

The president's Catholic allies were pleased, as were some of those who had been complaining. Even the president of Notre Dame, Father John Jenkins, called the announcement "a welcome step toward recognizing the freedom of religious institutions to abide by the principles that define their respective missions."

But over time, discussions over how to make it work appear to have broken down.

Even taking the actual benefits out of the hands of the religious organization "does not solve our moral dilemma," said Catholic University President John Garvey in a statement. Garvey noted that, "The only change the 'accommodation' offers is that the insurance company, rather than the University, would notify subscribers that the policy covers the mandated services." But the students and employees would still have to pay for "objectionable" prescriptions and services.

The Obama Administration declined comment on the suits, citing a policy of silence with regard to ongoing litigation.

But Cecile Richards, president of Planned Parenthood, which is among the groups most strongly backing the requirement for contraceptive coverage, said, "It is unbelievable that in the year 2012 we have to fight for access to birth control."

Judy-Care: Focusing on Fighting Cancer, Without Fear of Lifetime Insurance Caps

Judy Lamb from Colorado is an inspiration. Despite fighting breast cancer that has spread to her bones and liver and undergoing weekly chemotherapy, she has a positive outlook on life.

�I have three children, I�m married, and I cook dinner every night. It�s not really exciting, but it�s a wonderful life. I�m so glad I�m here, because without my treatments I wouldn�t be here,� she says.

She is able to maintain her positive attitude partly because the Affordable Care Act has removed a tremendous burden: the fear that her health plan would stop paying for her treatments.

YouTube embedded video: http://www.youtube-nocookie.com/embed/wHCovGi5kdA>

�Without the Affordable Care Act, I would be so worried about lifetime limits and pre-existing conditions that I wouldn�t be able to sleep,� she says. �It�s bad enough that you have cancer, but then you have to worry about the insurance companies cutting you off. I would die if I didn�t have insurance.�

In the past, Judy�s insurance company had a lifetime limit of $2 million dollars. With her care costing anywhere from $250,000 to $500,000 a year, Judy had felt like the clock was ticking on her treatments. She knew that if she hit the lifetime limit, not only would she struggle to continue to pay for her treatments, but she might have trouble finding other health care coverage because of her pre-existing condition.

But the health care law ended lifetime dollar caps on coverage, which means she can focus on staying well and living her life. And starting in 2014, insurance companies will no longer be able to discriminate against people who have pre-existing conditions, meaning that people like Judy would have more options for coverage.

"You can live your life and have cancer and you can live your life without worry because of the Affordable Care Act,� Judy says.

AxSys provides NHS with enhanced clinical IT platform

AxSys Technology has unveiled its enhanced Excelicare clinical IT platform to provide NHS Trusts and primary care providers with a cost-effective way to build patient records electronically.

Excelicare has the functionality of a portal and also works as a health information exchange. It enables multi-disciplinary care coordination, supporting disease management and delivering clinical applications through its platform. The platform also includes a patient portal complete with personal health record and an advanced clinical explorer that allows enterprise-wide viewing of integrated patient information.

The Salisbury NHS Foundation Trust is using Excelicare to replace departmental systems with custom clinical solutions created using the clinical care process modeler. This allows one clinical platform to support many different clinical specialties.

“Today’s NHS needs clinical software more than ever before," said Pradeep Ramayya, MD, CEO of AxSys. "With Excelicare you don’t need a big budget, or have to rip out and replace existing systems, as is often the case with a new electronic patient record. With the drive towards integrated and coordinated care, the new Excelicare platform allows healthcare organisations to further raise their ability to share relevant clinical information and coordinate care across boundaries."

6 things patients want from social media

NEW YORK – On the second and last day of the Connecting Healthcare + Social Media Conference in New York this past week, Jessie Gruman, president of the Center of Advancing Health, took the stage to present an honest and point-blank keynote on what she, and a majority of patients, ultimately want to see from an organization's social media efforts.

"I speak as someone who's been diagnosed four times with cancer," she said. "I'm a frequent user of healthcare, and I draw on my experiences to inform my own work … many of us personally know healthcare is a delicate balance between the cognitive and emotional, the subjective with objective and individuals with populations. Websites are an ever-changing puzzle, and as we become more familiar with looking for health things online … social media makes this puzzle less puzzling for us."

Gruman outlines six things patients want from social media.

1.To find information quickly. As a patient advocate and someone running a nonprofit, Gruman said, social media was a "bright spot," and she was "dazzled by how easy it was to find basic information about a disease." Once she started treatments, though, Gruman said her need for social media slightly shifted. "I was really weak and sick and feeling bad; it snuffed out all my curiosity in any form," she said. "I looked for specific answers to specific questions online – I wanted to spend as little time as I could getting answers. I was cautious but I wasn't curious." 

2.To have information streamlined. When turning to the Internet for information, Gruman said an organization's ability to streamline information – making it easy to find and understand for the patient – was key. "I only need to know what I need to know when I need to know it," she said. "It's representative of many people in this country." She added that organizations need to not "be seduced" into believing because there are more people online, that means a "slam dunk" for social media. Instead, she said, "the opportunities are there, but they're strategic and focused and require energy and resources to realize." Access, she concluded, is just one part of the puzzle, and having clear, concise information readily available will make all the difference. "Those of us who lack literacy skills, cognitive capacity, experience, enthusiasm, and confidence may have trouble with this and may not be adapting to it anytime soon," she said. 

[See also: 4 keys to creating a common-sense approach to social media.]

3.A clear understanding of the aging population. The assumption that older patients have adult children to interact with via social media and be on mobile phones is dangerous, said Gruman. "Be careful with this assumption. It's true for some, but not a lot…we need to reconsider that as we have this large group of people who are still kicking and using a lot of healthcare; they're struggling to get good care when it's difficult to navigate." People are going to age out, along with the doctors who won't use email and still chart notes with pens, she said. "It's the older of us using healthcare the most. What's social media going to do for us?"

4.To be engaged. Patients "live and die by HCAHPS," Gruman said. "HCAHPS scores indicate to you whether we think it's important that we engage in care, that's it's possible for us to do so, and it's safe for us to do so. Good HCAHPS scores indicate that we believe hospitals and clinicians are all of these things." Yet, only one third of patients actually consider themselves engaged, she noted. In reality, patients don't track changes in healthcare and aren't up-to-date on, for example, new drugs, procedures, etc. "One lesson I draw from listening to people talk is there's opportunity to use social media tools to target those of us who are online to help understand how to get good care," said Gruman. "And in the process of doing behavior engagement, [it's about] offering the kinds of information people need to get their care and knowing the basic barriers."

[See also: 6 reasons physicians need to be on social media.]

5.To help with the practical parts of care. "Payment and paperwork is amazing," said Gruman, and they act as perfect examples as to why patients simply aren't engaged. "They're not sexy topics, not lively, but they really are practical and they're necessary; they correspond with big gaps and the ability for many of us, who are well educated and savvy, face these gaps in understanding how to use the services of a specific hospital." Gruman added that healthcare tends to be a last resort for patients, and by the time a patient does reach out to a health professional, they're looking for specific information – not general answers. "There's urgency in our need, and we don't associate clinicians with general health information. We can get that anywhere," she said. 

6.To help with the healing process. Finally, said Gruman, being sick is "serious business for us … embedded in enthusiasm for social media, there's a sole assumption that being actively engaged with new technologies can somehow substitute for the pain and discomfort of illness." It doesn't, Gruman said, and instead, the experience and value of social media, for a sick patient, is more tactile and less transformative. "It's part of all our lives; all of us want to feel energetic and happy. We don't want to be distracted by pain, discomfort, sadness, but keeping ourselves alive is serious business. We don't want to learn new IT on the off chance it'll help us – we want IT to be efficient and useful and help us take care of ourselves and our loved ones, so we can live lives that are fun."

NextiraOne provides communications for GIE Telemedicine Group

NextiraOne, in collaboration with ISP Mobius Technology, has been selected by the GIE Télémedicine Group to provide secure communications for healthcare professionals and medical centers on the islands of Réunion and Mayotte in the Indian Ocean.

The GIE Télémedicine Group is an organization that brings together the public and private health facilities and the majority of healthcare professionals on the two islands. It manages regional projects related to health information systems, helping to improve patient care.

“Our goal is to create a secure private communications network that will improve collaboration among healthcare professionals in the Indian Ocean and will support the development of the effective solutions and services which we offer to our members,” said Antoine Lerat, director of GIE Télémedicine Group.

Réunion is currently a pilot site for the project, with the establishment of a university hospital across two main sites: Saint-Denis and Saint-Pierre.

“Thanks to NextiraOne and the GIE Télémedicine project, the La Réunion hospitals at Saint-Denis and Saint-Pierre and eventually all healthcare professionals on the island will be able to benefit from many services, including video conferencing, telephone, Internet access and remote maintenance of medical devices by external providers. There are more than 1500 users per site who will benefit from the 1Gbps high speed interconnection between the two institutions, the range of communications services and the 24-hour support,” said Dominique Talandier, deputy director at the directorate of information systems and organisation of the Réunion University Hospital.

NextiraOne has implemented a MPLS network operated by Mobius Internet Technology to facilitate seamless access to medical resources. NextiraOne has also installed a high-availability Cisco 6509 infrastructure, a security system and a Polycom RMX Bridge 150 video conferencing system. The solution is completed with a conference server and CA VBP 5300 Firewall.

Stop prostate screening with PSA test? Not all doctors agree

Doctors are unlikely to stop screening men for prostate cancer, even though about half agree they should, according to a small survey of physicians from the Johns Hopkins University School of Medicine.

Many prostate cancer patients and their doctors were outraged after a government advisory panel recommended Monday that physicians stop using the PSA blood test to screen healthy men. In its statement, the U.S. Preventive Services Task Force noted that the PSA has never been shown to reduce overall deaths, although treatments often make men impotent or incontinent.

Doctors gave conflicting and sometimes surprising responses, however, to a survey about those guidelines and whether they would follow them.

Although about half of primary care doctors agreed with the guidelines, less than 2% said they planned to actually follow them and completely stop using the PSA.

More than 60% of doctors, however, said that the guidelines would make them "much less" or "somewhat less" likely to order routine PSA tests for all men. The survey of 114 community physicians was taken in October, after the task force issued draft guidelines. The survey was published in April in Archives of Internal Medicine. The final guidelines came out Monday.

"Many of the doctors agreed we should not be ordering routine PSA screenings on everyone," says study author Craig Pollack, an assistant professor of general internal medicine at Johns Hopkins. "But there is still some degree of uncertainty."

That's partly because two large clinical trials, which followed 250,000 men for 10 to 14 years, failed to provide the definitive answer for which everyone had been waiting, Pollack says. Although each study was rigorously designed, each had real-world limitations that allow people to feel uncertain about its findings.

While one study found that the PSA reduces a man's risk of dying from prostate cancer by about 20%, the other found no benefit at all. Neither found the PSA to reduce deaths overall, partly because prostate tumors grow so slowly that older men are likely to die of something else before their cancers kill them, according to the task force.

Overall, in a best-case scenario, the PSA might prevent one death from prostate cancer in 1,000 men screened, according to task force chair Virginia Moyer, a professor of pediatrics at Baylor College of Medicine in Houston. The PSA measures a protein called prostate-specific antigen in the blood.

The new survey suggests "we're all very confused" and "nobody knows what to do," says Benjamin Davies, an assistant professor of urology at the University of Pittsburgh School of Medicine.

Davies, who has followed the PSA controversy for years, says the task force guidelines won't change his practice. Davies screens only healthy men, ages 50 to about 70, who have a life expectancy of 15 years. That's because most prostate cancers grow slowly, so the PSA may not benefit men for 10 to 15 years, about the time it would take for a cancer to become life-threatening.

Pollack says many doctors are also conflicted, because there are so many differing guidelines. While the task force has come out strongly against PSA screening, the American Urological Association endorses it. The American Cancer Society emphasizes shared decision-making, noting that men should be offered the test beginning at age 50, but should be made aware of its potential harms and limitations.

Yet Pollack's study found that many physicians aren't initiating those kinds of careful conversations.

About 17% of doctors said they had ordered PSA tests in the past year without discussing it with patients, the survey says. About 36% said they ordered the PSA after discussing the benefits and harms. And 43% said they discussed the PSA, then let the patient decide for himself.

Doctors also had trouble stopping screening as patients got older.

In 2008, the task force recommended that doctors stop giving the PSA to men at age 75, given that there is typically little chance of a test helping men this old.

Studies show that 57% of men ages 75 to 79 continue to be screened, however, along with 33% of men with low life expectancies, according to a 2012 article in Cancer.

Doctors listed a number of reasons for continuing to screen elderly men for prostate cancer:

� 75% said their patients expected them to continue.

� 66% said it was more time-consuming to explain their reasons for not screening than to just give the test.

� 54% were afraid of lawsuits.

� 26% were afraid patients would assume they were cutting costs.

� 18% were afraid patients would assume they were "giving up" on them.

Even though Davies says he believes the task force went too far, he says the controversy could benefit men by helping them understand the complexities of screening.

"This helps people talk about the problem," Davies says. "Maybe the recommendations will help us get away from screening people inappropriately. Maybe this will help primary care doctors feel more confident in educating people who don't need to be screened."

Coalition presses for privacy as part of stimulus package

WASHINGTON – The Coalition for Patient Privacy is urging Congress to include privacy safeguards with any funding earmarked for healthcare IT in an economic stimulus package. The package was expected to hit President Obama’s desk shortly after inauguration.

The bipartisan coalition, representing more than 30 organizations, individual experts and the Microsoft Corporation, said trust is essential to public adoption of healthcare IT.

In a letter to Congressional leaders, the coalition called for accountability for access to health records, control of personal information and transparency to protect healthcare consumers from abuse.

Michelle De Mooy, a national priorities associate from Consumer Action, said, “Privacy is not just a basic right for all Americans; it has become a basic necessity.”

Obama has called for electronic health records for every American by 2014. In the past few years, Congress has been unable to pass a healthcare IT bill, with much of that difficulty rising from inability to reconcile differences of opinion on healthcare IT privacy.

Vendor Notebook - Agfa to deliver imaging IT to Ochsner Health System

Agfa Healthcare, with American headquarters in Greenville, S.C., has announced that the Ochsner Health System of New Orleans has deployed the company's IMPAX Data Center to manage diagnostic image access and distribution.

The Informatics Corporation of America, based in Nashville, Tenn., has announced that Lourdes Hospital in Paducah, Ky., has deployed the ICA solution.

The Medsphere Systems Corporation has announced that its Bar Code Medication Administration (BCMA) system has been implemented successfully at all eight facilities of West Virginia's network of acute, psychiatric and long-term care hospitals.

Purkinje, based in St. Louis, has announced that it will offer free training and implementation services to all new EMR customers during the month of February in an effort to accelerate electronic medical records adoption and support the Obama Administration's healthcare transformation initiatives.

DocuSys, Inc., an Atlanta-based provider of anesthesia management, medication management and presurgical care management software, has announced that the VA San Diego Healthcare System has successfully upgraded its DocuSys software to version 7.0 in seven ORs and installed the company's second generation DocuJet point-of-care safety device for monitoring drug deliveries in the OR.

Pharmacy OneSource, Inc., of Bellevue, Wash., has announced that nine Pennsylvania hospitals - Pottstown Memorial Medical Center, Easton Hospital, Phoenixville Hospital, Brandywine Hospital, the Chestnut Hill Health System, Jennersville Regional Hospital, the Berwick Hospital Center, Lock Haven Hospital and Sunbury Community Hospital - have chosen to adopt the Sentri7 infection control and prevention software system.

The Eclipsys Corporation of Atlanta has announced that Madonna Rehabilitation Hospital in Lincoln, Neb., plans to adopt a wide range of the company's clinical solutions.

Unibased Systems Architecture of Chesterfield, Mo., has signed an enterprise-wide agreement with Norton healthcare for pre-visit access management, scheduling, physician portal, healthcare consumer portal and business intelligence software systems and services for Norton's five hospitals in Kentucky.

The Panasonic Computer Solutions Company of Secaucus, N.J., has launched the Toughbook H1 Healthcare Tour, hosted in partnership with Intel's Digital Healthcare Group. The multi-city tour will feature educational seminars on Panasonic's Toughbook H1.

The MedCurrent Corporation, a Los Angeles-based provider of physician practice management solutions, has announced that Pueblo Radiology Medical Group, with 22 radiologists in four centers in Santa Barbara and Ventura, Calif., is among the first imaging centers to use Verify, the company's Web-based insurance eligibility verification tool.

Epocrates, Inc., has introduced the Epocrates Essentials suite for the iPhone and iPod Touch operating systems. The expanded content features disease and diagnostic resources.

Guaranteeing Value for Your Premium Dollars

When we pay for health insurance, we want to know that most of what we are paying for is for health care, not advertising, executive bonuses or overhead. It�s pretty simple: we want to get a good value for our premium dollars.

Thanks to a new rule (the �80/20 rule�) in the Affordable Care Act, you can be sure that insurance companies are spending generally at least 80 cents of every dollar you pay in premiums on your health care or activities that improve health care quality. If the insurance company fails to meet this standard, or the �medical loss ratio�, in any year, they have to pay you a rebate.

Insurance companies that didn�t meet the standard for coverage provided in 2011 are required to provide these rebates no later than August 1st of this year, and to make sure you know what you are owed, insurance companies that owe rebates will also send a letter telling you how much you�ll receive. You can see what that letter will look like here. �According to early estimates from the Kaiser Family Foundation, insurance companies will provide 15.8 million Americans with $1.3 billion in rebates.

Today, we�re also finalizing a notice for insurance companies to send you if they meet or exceed the standard. If your insurance company is providing fair value for your premium dollars, you should know that too. You�ll be able to see your plan�s medical loss ratio on HealthCare.gov starting this summer.�

The 80/20 rule and the rate review program are two ways the Affordable Care Act is protecting you. You can find out more about how the Affordable Care Act increases transparency and protects consumers here: http://www.healthcare.gov/news/factsheets/2012/02/increasing-transparency02162012a.html.

IT pledge has market on pins and needles

WASHINGTON –  President Barack Obama’s pledge to inject $50 billion into the healthcare field over the next five years to develop and support technology has many in the industry wondering how and where that money might be spent.

On Jan. 22, 117 CEOs and business leaders sent a letter to House and Senate leaders supporting federal investment in healthcare information technology, broadband and energy smart grids, saying they “will provide our nation with a near-term stimulus and long-term comparative advantage.”

“Congress and the new Administration face a formidable task, restoring the nation’s confidence and encouraging the innovation, risk-taking and entrepreneurship needed to get our country moving again. The investments in a smarter energy grid, healthcare IT (such as electronic medical records) and accelerating broadband deployment recommended by President Obama will not only stimulate the economy, but will also accelerate long-term growth. They fund the future,” the letter read.

“I expect that the Obama Administration will strongly promote both electronic health records and electronic prescribing, and there is little doubt that this is good news for the country, for patients, for physicians and for Allscripts and other healthcare IT companies,” said Glen Tullman chief executive officer of Allscripts-Misys Healthcare Solutions. “I anticipate these new programs will include both carrots and sticks, similar to the successful CMS e-prescribing program that took effect this month. By encouraging physicians not only to buy the technology but just as importantly to provide incentives for its use, I think we’ll see a significant uptick in adoption and, as a result, better care for patients at lower cost.”

VirtualHealth Technologies, Inc., a Lexington, Ky.-based healthcare IT vendor, issued a press release the day after Obama’s entry into the White House announcing plans to develop new practice management, electronic medical records, secure messaging and patient portal technologies in the coming year.

National report shows surge in e-prescribing among health practitioners

ARLINGTON, VA – By the end of 2011, 58 percent of office-based physicians were using e-prescribing, with solo practitioners contributing the most significant growth, according to Surescripts, which released today “The National Progress Report on E-Prescribing and Interoperable Healthcare Year 2011.”

Included in the report is data analysis that documents the prevalence of e-prescribing adoption and use in the United States from 2008 through 2011.

The report is the only one of its kind in the U.S. that tracks adoption and frequency of e-prescribing nationwide. Two studies also included in the report measure both the effects of e-prescribing on medication adherence and examine e-prescribing use to determine the attainability for the e-prescribing measure in both Stage 1 and Stage 2 of meaningful use.

By the end of 2011, 58 percent of office-based physicians were using e-prescribing. Adoption rates were shown to be the highest – at 55 percent – among smaller practices with six to 10 physicians, and practices with two to five physicians totaled to 53 percent.

Solo practitioners contributed the most significant growth to physician adoption – from 31 percent in 2010 up to 46 percent in 2011.

Among specialty groups, e-prescribing adoption rates were highest among internists at 81 percent, endocrinologists at 78 percent, cardiologists at 76 percent and 75 percent for family practitioners.

Other highlights from the report include:

The number of electronic prescriptions in 2011 increased to 570 million, up from 326 million e-prescriptions in 2010. By the end of 2011, an estimated 36 percent of prescriptions dispensed were routed electronically, up from 22 percent at the end of 2010.A recently completed analysis shows that of the physicians who adopted and began using e-prescribing in 2008, up to 60 percent have successfully met the Stage 1 meaningful use e-prescribing measure and 38 percent of these early users would meet the proposed Stage 2 meaningful use e-prescribing measure if it were now in effect. Also observed in the results was the increase in e-prescriptions per active e-prescriber over time. In first quarter 2008, there was an average of 49 per month. By fourth quarter 2011, the study group averaged 213 per month.In 2011, Surescripts partnered with PBMs and retail pharmacies to compare the effectiveness of e-prescriptions and paper prescriptions on first-fill medication adherence. The data showed a consistent 10 percent increase in patient first-fill medication adherence (i.e., new prescriptions that were picked up by the patient) among physicians who adopted e-prescribing technology. The analysis suggests the increase in first-fill medication adherence combined with other e-prescribing benefits could lead to between $140 billion and $240 billion in healthcare cost savings and improved health outcomes over the next 10 years.

In addition to tracking numerous measures of health IT adoption and use, the report also discusses the future of e-prescribing, the value of prescription benefit information and how industry collaboration is driving continuous improvements in electronic prescription quality. For a downloadable copy of "The National Progress Report on E-Prescribing and Interoperable Healthcare, Year 2011" go to www.surescripts.com/report.

SLOW: Privacy issues dog progress on NHIN

WASHINGTON – Privacy issues continue to keep the country's planned nationwide health information network on the slow track, but government and community leaders say it won't be a problem going forward.

Yet things did not go exactly as the Office of the National Coordinator for Health Information Technology planned at a demonstration last month, where 19 cooperative organizations were scheduled to use real patient data to show how interoperability works. Instead, they used fictitious patient records to demonstrate greater depth in capabilities for interoperability than the initial trial run held in September.

The Office of the National, or ONC, held its second long awaited demonstration of interoperability Dec. 15 -16 at the Fifth Annual National Health Information Network Forum in the nation's capital.

Holding up the progress on building the network of networks, officials say, is the finalization of social agreements – how to protect information, and who is liable if there is a breach during the exchange of information.

However, technology experts, software providers, policymakers and regional health organization leaders participating in the December NHIN demonstration all agreed privacy concerns would not be a problem going forward. The technology is ready to go, they said.

It's all about the DURSAs

It's only a matter of time until data use and sharing agreements, or DURSAs, come through. Most regional health information organizations have their own agreements used within their exchanges, but to exchange data outside the RHIO requires a host of lawyers to resolve the untold scenarios that could evolve.

Marc Overhage MD, director of medical informatics at the Regenstrief Institute, one of the organizations participating in the NHIN demonstration, said he sees the December demonstration as a success despite the privacy hold-up.

Overhage is also president and CEO of the Indiana Health Information Exchange, an exchange with 10 million unique patients and nearly 10,000 doctors. The Indiana HIE has not completed its DURSA agreements with communities outside of its network, but Overhage is not surprised. "Everyone who has been involved in this has observed this work takes a long time," he said.

Indiana plans to have its DURSA agreement in place by the end of January.

What is holding up the works? Getting consent from the various custodians of the data, including hospitals, labs, and doctors. "Literally for us, hundreds of parties have to be comfortable with this agreement," Overhage said.

Leavitt's privacy doctrine

As if on cue, with just 36 days left in his tenure, Department of Health and Human Services Secretary Michael Leavitt released a privacy policy at the forum on Dec. 16. The policy is intended as a platform for further discussion, Leavitt said, and focuses on aspects of patient rights, safeguarding of data and HIPAA.

Though some regional health information exchange organizations have been successful in developing privacy agreements for the flow of information, others have not, Leavitt said. HHS also released a toolbox for organizations to use as a starting point for making DURSA agreements.

"Finding the balance between increased access to information and privacy is very important," Leavitt said. "If we don't have it, we won't succeed."

Banking on federal leadership

For some, privacy isn't the only problem. At Wright State University in Dayton, Ohio, Katherine Cauley, director of the Center for Healthy Communities, a participant in the NHIN cooperative, said her exchange is typical of most community RHIOs in the country. There is some local interest, but to most people on the local level health information exchange is still a far-fetched idea - especially for doctors who are wary of costs and initial disruption to workflow.

"Nobody wants to change how they do things. Everybody is worried about legal issues," Cauley said. "Everybody wants data, but nobody wants to go through the processes involved." Cauley believes federal leadership will be the key to moving things forward.

Social Security takes the lead

It looks like the federal government has the same idea. The Social Security Administration announced Dec. 16 it would be the first government agency to use the NHIN. Beginning in early 2009, SSA will receive medical records for some disability applicants electronically through the NHIN gateway.

Despite the obstacles, ONC leaders say the NHIN is making progress, and that progress will continue, they add.
Ginger Price NHIN coordinator for ONC said her office plans NHIN production, though somewhat limited, in 2009.

"The basic bottom line is we're starting simple. And we're starting with the ready, the willing, the motivated and we're starting now," Price told attendees of the forum. "As people get ready to come on board, we'll bring them on."

Standards are key

Jason Colquitt, director of research and outcomes at Greenway Medical Technologies, has been involved with the NHIN effort for years and is a member on Certification Commission for Healthcare Information Technology committees. He claims the NHIN is only as limited as its standards development.

"In my opinion it all falls to the Healthcare Information Technology Standards Panel. That's where the rubber meets the road," Colquitt said. "Many of the standards are already in place, but getting standards as robust as they need to be is the challenge."

Right now, standards have been achieved on a basic level, but to have a fully functional NHIN, they will have to be drilled down to a more refined level of detail. As the NHIN matures, it will require more and more granularity, Colquitt said.
The December demonstration is just one cog in a giant wheel that will continue turning, and already a source of excitement for many providers. "There is value in this level of exchange because we have never done it before," Colquitt said.

 

U.S. Air Force awards Noninvasive Medical Technologies $2.4M contract

LAS VEGAS – The Air Force has awarded Noninvasive Medical Technologies, Inc. a contract, valued at approximately $2.4 million, for continued development of the Multiple Casualty Assessment and Management System.

"Our company was originally challenged by the U.S. Air Force to develop a casualty assessment and management solution back in early 2006," said Ronald McCaughan, chairman and CEO of NMT. "This most recent award represents the fourth contract we've received from the Department of Defense and the third as a Department of Defense Prime Contractor with Sole Source Provider Designation."

The Multiple Casualty Assessment and Management System incorporates NMT's Etag non-contact hemodynamic monitoring device with wireless communication, display technology and advanced tactile sensors to simultaneously detect and monitor multiple casualties within 300 yards of a medic or first response team.

The system is designed to provide a real time communications link with a rear tactical command center, enhancing command's battlefield situational awareness and supplying meaningful ground intelligence for required logistical response and follow-on care.

NMT is adapting its Etag technology for commercial use. Branded as the NcIQ, market availability is pending review and clearance of a 510(k) submitted to the U.S. Federal and Drug Administration earlier this year.

Once clearance is received by the FDA, NMT intends to pursue market opportunities for the NcIQ that include applications in disaster response, underground coal mines, critical care facilities, firefighting, EMT/ambulance services and others.

"While this system is pending FDA approval, it (NcIQ) has potential applications in many different kinds of emergency response," said Frost and Sullivan Research Analyst Zachary Bujnock. "The use of complete non-contact monitoring is a perfect example of innovation, and in many ways is the future of patient monitoring, especially in remote settings."

More Reasons to Say Thanks this November

Every day we receive letters, emails, tweets and Facebook messages from people around the country that have been touched by the health care law � like a parent whose child is no longer denied coverage due to a pre-existing condition or a senior who has received a 50% discount on prescription drugs.

There are a lot of ways that the law, signed 20 months ago, has provided significant relief to families throughout the country, easing worries and ensuring that focus is on health, not on fighting with insurance companies over the phone. Chances are, someone in your family is seeing new rights and benefits.

In the spirit of Thanksgiving, during the month of November on our Twitter and Facebook pages we�ll be highlighting these benefits and sharing some of the stories we�ve heard from people around the country who have been helped by the law. We also want to hear from you, so we encourage you to tell us your story about how you�ve been helped by benefits in the law. Share on Twitter with the hashtag #ThanksHCR. You can find us on Twitter at: @HealthCareGov.

To give you an idea, here are a few new benefits we have thanks to the health care law:

Thanks to health reform, insurers cannot deny coverage to children due to pre-existing conditions.

Thanks to health reform, preventive services will be available for millions for free.

Thanks to health reform, being a woman will soon no longer be considered a pre-existing condition.

Thanks to health reform, people with Medicare get discounts on prescription drugs and a free annual wellness visit, AKA more time with their doctor.

Thanks to health reform, young adults under 26 can stay on their parents� health insurance.

Thanks to health reform, insurers can no longer raise rates with no accountability.

Thanks to health reform, insurers must spend most of your premium dollar towards your health care instead of on advertising or big CEO salaries. If they don't, they must provide refunds to you.

And the list goes on�

Many of the items in the law are common-sense provisions that end the worst insurance company abuses. From new consumer rights like appealing denied insurance claims, to new benefits like prescription drug rebates for Seniors, there are a lot of reasons to be thankful.

Join us on Twitter this November in saying thanks and share your story.

Go to @HealthCareGov, and let�s get started!

Doctors want to redefine autism; parents worried

One child doesn't talk, rocks rhythmically back and forth and stares at clothes spinning in the dryer. Another has no trouble talking but is obsessed with trains, methodically naming every station in his state.

Autistic kids like these hate change, but a big one is looming.

For the first time in nearly two decades, experts want to rewrite the definition of autism. Some parents fear that if the definition is narrowed, their children may lose out on special therapies.

For years, different autism-related labels have been used, the best known being Asperger's disorder. The doctors working on the new definition want to eliminate separate terms like that one and lump them all into an "autism spectrum disorder" category.

Some specialists contend the proposal will exclude as many as 40 percent of kids now considered autistic. Parents of mildly affected children worry their kids will be left out and lose access to academic and behavioral services � and any chance of a normal life.

But doctors on the American Psychiatric Association panel that has proposed the changes say none of that would happen.

They maintain the revision is needed to dump confusing labels and clarify that autism can involve a range of symptoms from mild to severe. They say it will be easier to diagnose kids and ensure that those with true autism receive the same diagnosis.

With new government data last week suggesting more kids than ever in the U.S. � 1 in 88 � have autism, the new definition may help clarify whether the rising numbers reflect a true increase in autism or overdiagnosis by doctors.

There is no definitive test for autism. The diagnosis that has been used for at least 18 years covers children who once were called mentally retarded, as well as some who might have merely been considered quirky or odd. Today, some children diagnosed with autism may no longer fit the definition when they mature.

"We're wanting to use this opportunity to get this diagnosis right," said Dr. Bryan King, a member of the revision panel and director of the autism center at Seattle Children's Hospital.

The revision is among dozens of changes proposed for an update of the psychiatric association's reference manual, widely used for diagnosing mental illnesses. The more than 10,000 comments the group has received for the update mostly involve the autism proposal, with concerns voiced by doctors, researchers, families and advocacy groups. A spokeswoman declined to say whether most support or oppose the autism revision.

The group's board of trustees is expected to vote on the proposals in December, and the updated manual is to be published next year.

Among the proposed changes:

� A new "autism spectrum disorder" category would be created, describing symptoms that generally appear before age 3. It would encompass children with "autistic disorder," now used for severe cases, plus those with two high-functioning variations.

A diagnosis would require three types of communication problems, including limited or no conversation and poor social skills; and at least two repetitive behaviors or unusual, limited interests, including arm-flapping, tiptoe-walking and obsession with quirky topics.

� Autistic disorder and high-functioning variations � Asperger's disorder and PDD-NOS, or "pervasive developmental disorder not otherwise specified" � would be eliminated, but their symptoms would be covered under the new category.

Asperger's kids often have vast knowledge about a quirky subject but poor social skills; PDD-NOS is notoriously ill-defined and sometimes given to kids considered mildly autistic.

� Another new category, "social communication disorder," would include children who relate poorly to others and have trouble reading facial expressions and body language. A small percentage of children now labeled with PDD-NOS would fit more accurately into this diagnosis, autism panel members say.

They say the changes make scientific sense and are based on recent research.

Opponents include older kids and adults with Asperger's who embrace their quirkiness and don't want to be lumped in with more severe autism, and parents like Kelly Andrus of Lewisville, Texas. Her son, Bradley, was diagnosed with mild autism a year ago, at age 2.

"I'm really afraid we'd be pushed out of the services we get," she said. That includes a free preschool program for autistic kids and speech and occupational therapy, which cost her $50 a week. The family has no medical insurance.

Opponents also include a well-known Yale University autism researcher, Dr. Fred Volkmar, who was on the revision panel but says he was unhappy with the process and quit. "I want to be sure we're not going to leave some kids out in the cold," he said.

Volkmar is senior author of a study suggesting that the revision would exclude nearly 40 percent of children with true autism. But members of the revision panel have challenged Volkmar's methods, saying he relied on outdated data from two decades ago.

One major advocacy group in the field, Autism Speaks, said it is awaiting further research on the effects of the revisions before deciding whether to endorse them.

Dr. James Harris, a panel member and founding director of the developmental neuropsychiatry program at Johns Hopkins University, said the proposal will provide a better label for children who really only have communication problems.

"I don't want a child labeled as autistic, which suggests a chronic, lifelong problem, when he has a social communication problem that may get better if he has proper services and his brain matures," Harris said.

Harris said these kids don't need intensive autism therapy but should be eligible for other types of special education typically offered in public schools.

Dr. Daniel Coury, chief of developmental and behavioral pediatrics at Nationwide Children's Hospital in Columbus, Ohio, said parents have valid concerns because insurance companies and schools may not immediately recognize that children receiving the new diagnosis may need special services.

"So there may potentially be a lag time where services would not be available," he said.

He noted it is already difficult for many families to get costly autism therapy. Some insurers don't cover it, and many financially strapped school districts have cut special education.

Arizona hospital hopes to boost diagnosing with new imaging system

GILBERT, AZ – Gilbert Hospital, a full-service, acute care general hospital in Gilbert, Ariz., has installed a 64-slice CT imaging system from GE Healthcare.

Hospital executives say physicians are using the new equipment to improve the way they obtain information to diagnose diseases and life-threatening illnesses, including cardiovascular disease, stroke and chest pain.

According to GE officials the LightSpeed VCT is the world's first Volume Computed Tomography (VCT) system. They say it's nearly twice as fast as conventional multi-slice CT scanners, captures images in as little as one second and can perform whole body trauma scans in as little as 10 seconds.

"Our new Volume CT system will now allow our physicians to perform new and enhanced procedures and obtain information they need to diagnose patients who are suffering from chest pain or stroke much quicker and much more effectively," said Tim A. Johns, Gilbert Hospital's founder and medical director. "This new Volume CT is extremely patient-friendly. The fast scans can help reduce patient stress and anxiety, and some of the volume CT procedures can be done in only one simple exam."

The LightSpeed VCT creates 64 high-resolution anatomical images as thin as a credit card that are combined to form a three-dimensional view of the patient's anatomy. From these images, physicians can view such things as blockages in the coronary arteries, as well as the motion and pumping action of a patient's heart.

"We're breaking barriers in speed and accuracy of patient exams and are now able to offer new and enhanced diagnostic procedures thanks to our new CT," said David Wanger, chief executive officer of Gilbert Hospital. "The technology is greatly benefiting both the physicians and the patients of the southeast valley. We're excited to be one of the first to offer this medical technology in the area."

Idaho case shows midwife tension with hospitals

MERIDIAN, Idaho�Midwives and doctors are longtime rivals in the politics governing where women should give birth: Home or hospital.

But that tension, typically played out privately between pregnant women and their health care providers, was laid bare this month in the case of two Idaho midwives suspended by the state after three babies died during a 14-month period between 2010 and 2011.

The Baby Place in Meridian remains open, but its midwife owner, Coleen Goodwin, and her daughter, Jerusha Goodwin, are barred for now from practicing, in part over decisions allegedly influenced by their distrust and frayed relationships with doctors in hospitals where they felt mistreated or disrespected.

A former employee who trained at The Baby Place said hostility the Goodwins developed for doctors ultimately led to delays in emergency transports to hospitals.

Dani Kennedy told The Associated Press this antagonism caused them to make decisions against the best interests of mothers and babies, broadening the historic midwife-doctor divide to a wide gulf � with tragic consequences.

Coleen Goodwin "did hesitate to transport, and that was really upsetting to me," said Kennedy, who trained at The Baby Place between 2007 and 2010. She left to open a practice in Hawaii, in part over these concerns.

"I wanted to work in an environment where I was able to make my own decisions about the care of my clients," she said.

Kennedy was interviewed by Idaho investigators who began scrutinizing the Goodwins after one of the three mothers who lost babies lodged a complaint with the state.

The Goodwins, whose website indicates they've helped 1,400 women give birth, declined interviews, including on Monday. A receptionist who answered the phone declined to say who is providing services to women following the Goodwins' March 23 suspensions.

St. Luke's Health System spokesman Ken Dey in Boise declined to comment specifically about the Goodwins' interactions with doctors at the hospital's facilities in Meridian or Boise.

"The message we want to get across is, we're not anti-midwife," Dey said. "Women have the option to choose where they have their babies. But we want to make sure all the safety regulations are in place."

OB/GYN Associates, the Idaho business that provides doctors to St. Luke's, didn't return phone calls seeking comment.

Though more than 99 percent of U.S. women give birth in hospitals, home births are increasing, accounting for 0.72 percent of deliveries in 2009, up from 0.56 percent in 2004, according to the National Center for Health Statistics. Significantly more Idaho women have a midwife-assisted birth or home birth than the national average. About 3.2 percent of the 92,000 total births between 2008 and 2011 were midwife-assisted, either at birthing centers or home birth.

Given that, remedying feuds like the one Kennedy said influenced the Goodwins' decision-making is growing more important, said Oregon State University professor Melissa Cheyney, a medical anthropologist and certified midwife.

Midwives often feel disrespected by the medical establishment, Cheyney said, while doctors' objections to out-of-hospital births may harden with every traumatic transport.

This comes on top of the already-existing divide between the two views of childbirth, with midwives emphasizing the safety of natural births in a familiar, comfortable setting, while the American Medical Association contends women are best off in a hospital, where life-saving technology is nearby if something goes awry.

"You're having this compulsory interaction between two value systems," Cheyney said. "A transport means these two systems have to come together � and work together."

The Idaho Board of Midwifery probe that preceded the Goodwins' suspensions highlights numerous instances where investigators said that didn't happen.

In August 2011, Jerusha Goodwin waited 11 minutes to call paramedics after a baby was born "limp, unresponsive and pale," investigators wrote. The mother labored for more than 48 hours, prompting the Meridian Police Department to launch an ongoing criminal negligence investigation after the baby died.

"There were some questions about the length of labor," Deputy Chief Tracy Basterrechea told the AP.

On Oct. 11, 2010, a student midwife improperly cut an infant's umbilical cord, resulting in significant blood loss before the baby died. Jerusha Goodwin failed to provide medical personnel at St. Luke's Meridian Medical Center with relevant records, investigators wrote.

And on June 30, 2010, Coleen Goodwin delayed paramedics from entering The Baby Place for four minutes. When they were finally allowed in, Coleen Goodwin instructed them to drive past two nearby hospitals to St. Luke's in Boise, adding precious minutes to a journey that ended in the infant boy's death.

The mother, Rachel Rabey, said in an interview Coleen Goodwin whispered to her, "If we go to Meridian, they won't let me stay with you." Rabey said she was perplexed.

"I didn't care where I went, or if Coleen could stay with me," remembers Rabey, who recently had her third child, a girl, at St. Luke's in Boise. "All I cared about was getting to a hospital."

The Baby Place's web site does indicate negative feelings toward hospitals, with one employee writing in a testimonial to prospective clients that she began her midwife studies after a hospital birth where she felt "cheated out of the birth experience."

The Goodwins do have troubled relationships with doctors, said Alison Hunter Stucki, who planned her eighth child's delivery at The Baby Place in 2007 but was forced by complications to transfer to nearby St. Luke's Meridian Medical Center.

Stucki said her family witnessed hostile doctors force Coleen Goodwin from the delivery room.

Still, Stucki, an ardent Baby Place supporter, doesn't believe those experiences led Goodwin to endanger women or their babies.

"What I've experienced is nothing but professionalism," said Stucki, who gave birth to her ninth baby at The Baby Place in 2009. "I do believe the doctors are upset with her. Every baby she delivers in her birthing center is one baby they don't get."

In addition to the three babies that died, the Goodwins were hit by a separate 2010 lawsuit, filed by the parents of a baby that suffered permanent brain damage. Last week, the midwives agreed to pay $5 million to Adam and Victoria Nielson, the couple that sued.

The Nielson's attorney, Eric Rossman in Boise, said he pursued the case pro bono because he couldn't "in good conscience dismiss the case as long as they continue to practice in this facility."

Objective measures of Idaho's midwife-doctor relationships � and their impacts on babies � are difficult to come by, because the state doesn't keep comprehensive records of the outcomes of midwife-assisted births requiring hospital transports.

A private effort, the Idaho Perinatal Project run by St. Luke's, documented 138 instances between 2005 and 2011 where mothers who planned a home birth were transported to a hospital.

Though its records are also incomplete � reporting is voluntary; there are no reports for 2012 � they do point to the trauma that accompanies a planned out-of-hospital birth where something goes wrong. There were at least nine cases where infants died at or before arriving at the hospital and several instances of birth asphyxia, fractures, post-partum hemorrhage and unexpected twins.

For many doctors who don't see the cases of successful home births, these tense interactions add to already deep misgivings about midwifery.

"There were also 34 cases which had no infant outcome listed," said Dr. Scott Snyder, medical director of St. Luke's Newborn Intensive Care Units. "The data is not an overestimation of what we're seeing. It's an underestimation."

Snyder does believe standards set by Idaho's midwife licensing that took effect in 2010 have fostered communication between most midwives and doctors, despite problems investigators found at The Baby Place. Midwives now visit St. Luke's, attending some staff meetings. Doctors' appreciation for midwives' services has grown, he said.

Snyder is also hopeful when the Idaho Legislature reviews the state's midwife rules in 2014, when the existing licensing law expires, they'll make it mandatory for midwives and doctors to track outcomes of transfers.

Breaking It Down: The Health Care Law & Cost Control

For too long, too many hard working Americans paid the price for policies that handed free rein to insurance companies and put barriers between patients and their doctors. The Affordable Care Act gives families the security they deserve. The new health care law forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition.�

The new law also includes a number of key provisions designed to help make health care more affordable � and help address the drivers of health care costs.� The new health care law is already making a difference.� Many Americans are seeing lower costs, and health care spending growth in 2009 and 2010 decreased to record lows.

Here are more ways the law helps control costs for families and small businesses:

The law�s small business tax credit has lowered health insurance costs for small business owners. On average, small businesses have paid about 18 percent more than large firms for the same health insurance policy.� If you have up to 25 employees, pay average annual wages below $50,000, and provide health insurance, you may qualify for a small business tax credit of up to 35 percent (up to 25 percent for non-profits) to offset the cost of your insurance. This will bring down the cost of providing insurance.Holding insurance companies accountable for how they spend your premium dollars.� In 2011, if health insurers don�t spend at least 80 percent of your premium dollar on medical care and quality improvements rather than advertising, overhead and bonuses for executives, they will have to provide you a rebate for that excessive overhead.� The first rebates will be made in the summer of 2012.�Preventing insurance companies from raising rates with no accountability or transparency.� In every State and for the first time ever, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. These efforts are paying off.� In the last quarter of 2011 alone, States reported that premium increases dropped by 4.5 percent. And, in States like Nevada, premiums actually declined.�Recommended preventive benefits without deductibles or copayments. Millions of Americans with Medicare and private insurance have seen their out-pocket costs go down to zero for recommended preventive care like flu shots or cancer screenings now covered with no cost sharing under the law. This puts more money back into people�s pockets, while making sure they get the preventive care they need.

Bacteria contaminated cheese results in four indictments

CHICAGO(AP)�Prosecutors have announced the indictment of four people who are accused of ignoring Food and Drug Administration orders and distributing more than 110,000 pounds of Mexican cheese. Some of it contained salmonella, e. coli and other potentially harmful bacteria.

The U.S. Attorney's office in Chicago says the suspects even scraped mold and fungus off 35- and 40-pound wheels of cheese that unhappy customers had returned so they could be resold.

Prosecutors say there's no evidence anyone became ill eating the cheese.

A Wisconsin company distributing the cheese under the brand Queso Cincho De Guerrero to Illinois, Indiana, Michigan, Georgia, and Texas, issued a recall in 2007.

To cover up the distribution, the defendants allegedly sent false documentation to the FDA. They're charged with violating various federal food safety laws.

'Obamacare' Sounds Different When Supporters Say It

Until recently, "Obamacare" was a word mostly used by opponents of President Obama's health care law. Now, supporters of the law are attempting to claim it as their own.

During the three days of health care hearings, protesters outside of the Supreme Court in favor of the law returned to one chant more than any other: "We love Obamacare."

The phrase was not somebody's impromptu brainstorm on the steps of the Supreme Court. People carried mass-printed black-and-yellow signs that said it in big, bold letters.

"My daughter was a 24-year-old who was without health care, was put back on my plan, and luckily she did because she tore her ACL playing soccer and needed surgery, so she was covered for her insurance," says Alan Perigoy, who was handing out granola bars. "So I'm happy to have the Obamacare. That's why I'm here supporting it."

He says his use of the word "Obamacare" is "very appropriate."

"Well, Obama does care, as he said recently," he says. "It's not pejorative at all. It's a wonderful thing."

A GOP Tag Line

It sure was pejorative for a while. During the 2009 health care debate in Congress, the word was almost exclusively used by Republicans. Obamacare became shorthand for big, bad government. By 2010, the word was all over Republican TV ads.

This year on the Republican presidential campaign, Mitt Romney and the other candidates have learned that one of the biggest applause lines in any stump speech is: "If I'm president, I'm going to get rid of Obamacare on Day 1."

Series: Judging The Health Care Law Shots - Health Blog Justices Tackle The Big Question: Can Congress Force You To Buy Insurance? More In The Series Reading Between The Lines Of Monday's Supreme Court Arguments Justices Seem Intent To Get To The Heart Of The Health Care Law

The term echoes "Hillarycare," the word Republicans used to describe the Clinton health care plan in the early '90s.

It doesn't help Democrats that this law's real name is a mouthful. "The Patient Protection and Affordable Care Act" doesn't exactly roll off the tongue.

Early on, the White House didn't want to adopt the word Obamacare. It was trying to win over Republicans. The message was that universal health care is bigger than one man.

But over time it became clear: The word was not going away. At a speech in Atlanta earlier this month, Obama embraced it.

"You want to call it Obamacare? That's OK, because I do care," he said. "That's why we passed it."

He made a similar point all the way back in August: "If the other side wants to be the folks who don't care, that's fine with me," he said.

On the second anniversary of the law last week, the Obama re-election campaign set up a webpage that says, "I Like Obamacare." It is selling buttons, T-shirts and bumper stickers with that message.

Turning Terms Around

Linguist Ben Zimmer, executive producer of Visual Thesaurus and Vocabulary.com, says there's a long history of groups trying to reclaim negative words.

"So for instance, the term 'queer,' which is a very pejorative term, in fact was reclaimed by members of the gay community as a neutral or positive term," he says, "to the extent that now you have queer studies at universities, for instance."

In politics, he says, whether a term is positive or negative often hinges on outside events.

"During Ronald Reagan's first term, 'Reaganomics' was generally a negative epithet," he says, "but by 1984, the economy had turned around, and Ronald Reagan in fact embraced the term 'Reaganomics.' "

So whether "Obamacare" has a bright future or not may depend less on the people shouting the word on the Supreme Court steps and more on the folks deliberating inside that white marble building.

Study: Long use of any hormones poses breast cancer risk

CHICAGO(AP)�New research suggests that long-term use of any type of hormones to ease menopause symptoms can raise a woman's risk of breast cancer.

It is already known that taking pills that combine estrogen and progestin � the most common type of hormone therapy � can increase breast cancer risk. But women who no longer have a uterus can take estrogen alone, which was thought to be safe and possibly even slightly beneficial in terms of cancer risk.

The new study suggests otherwise, if the pills are used for many years. It tracked the health of about 60,000 nurses and found that use of any kind of hormones for 10 years or more slightly raised the chances of developing breast cancer.

"There's a continued increase in risk with longer durations of use and there does not appear to be a plateau," said study leader Dr. Wendy Chen of Brigham and Women's Hospital in Boston.

The hormone picture has been confusing, and the absolute risk of breast cancer for any woman taking hormone pills remains small. Doctors say women should use the lowest dose needed for the shortest time possible.

"It's hard to be surprised that if you keep taking it, sooner or later it's going to raise risk," said Dr. Robert Clarke of Georgetown University's Lombardi Comprehensive Cancer Center.

The study was discussed Sunday at a cancer conference in Chicago.

Top NewsMakers: Making good on an IT vision today and tomorrow

They dominated the headlines, both in the mainstream and in the healthcare IT-focused media. We asked Healthcare IT News readers to pick the people they believed had and would continue to have the biggest impact on healthcare IT on the policy front, as a healthcare provider and as a vendor. The choices – from more than 1,100 respondents – were clear.
POLICYMAKERS

More than 33 percent of the votes for most influential policymaker were cast for then Presidential candidate now President-elect Barack Obama. Obama has pledged $10 billion a year over the next five years to help boost the adoption of healthcare IT.

Department of Health and Human Services Secretary Michael Leavitt, the winner in the policy category for 2007, garnered the second most number of votes, with more than 18 percent. The rest of the candidates in this category, including Republican presidential candidate John McCain, Sen. Edward M. Kennedy (D-Mass.) and New York City Mayor Michael Bloomberg, each landed about 6 percent of the votes. But each had ardent champions.

Narayanachar S. Murali, MD, of Orangeburg, S.C., cast his vote for Obama. “When the mess cannot get any worse,” he said, “we need direction from the very top. If Barack Obama falls prey to the lobbyists and decides to ignore healthcare reform it will haunt the Democratic Party for the foreseeable future.”

“What is the strongest ally for healthcare IT other than the president-elect?” asked Maria Filamor-Robinson, a nurse at Woodland Heights Medical Center in Lufkin, Texas. “Healthcare IT needs a very strong supporter from administration for its realization. I think with Obama’s support, more people if nothing else are more open to its concept and possible implementation.”

“Michael Leavitt is the captain of the ship that is driving the mechanism that enables caregivers at the local level to facilitate change,” one respondent said. “His vision to deliver appropriate care at lower cost is being implemented by individuals and institutions nationwide.”

PROVIDERS

C. Martin Harris, MD, CIO of the Cleveland Clinic, won the provider category of newsmakers with 31 percent of the vote. The Cleveland Clinic is partnering with Google to launch a pilot program that will use Google’s new services to provide patients with greater control and access to medical records.

“Innovation is having vision to do what others have not, being the first entry into a market or task or solution to a problem,” said one respondent. “Clevland Clinic has done this with the huge piggyback onto the Google ehealth solution offered to their patient data base and millions of people across the globe.”

“Cleveland Clinic has been a pioneer in electronic patient records and sharing patient information across the continuum of care from hospital, physician and post acute, home care and hospice,” said Joyce McFadden.

PPS adds instant insurance verification tool for continuing care providers

ATLANTA – Long-term healthcare providers face a myriad of issues with prospective patients, often pushing insurance verification down to the bottom of the list. A new software solution aims to make that process a lot easier for everyone involved.

Patient Placement Systems, an Atlanta-based provider of software and services for continuing care providers, has added instant insurance verification to its PatientPlacement.com Referral Management System, a Web-based software suite designed to automate each step of the admissions and intake process for continuing care providers, including skilled nursing facilities, home health agencies and hospices. The new tool allows administrators to instantly confirm a prospective patient's eligibility for Medicare, Medicaid or commercial insurance coverage.

"We heard a recurring request from our continuing care customers to help simplify and speed up insurance verification," said Eric Christ, PPS' president, in a press release. "By integrating an instant insurance check with the workflow, document management, communications and tracking tools already in the Referral Management System, we give providers the most streamlined, efficient way possible to confirm coverage and expedite referral approval."

PPS leverages McKesson's RelayHealth network to connect with more than 430 payers, including Medicare, Medicaid, Aetna, Blue Cross and Blue Shield, CIGNA, Humana, TRICARE and United Healthcare. In about 3-5 seconds, and using patient information already contained in the system, the PatientPlacement.com solution determines insurance eligibility and files it with the patient's records.

"The insurance verification feature is so valuable for us that, by itself, it is worth the monthly subscription fee for the entire system," said Marilyn Guitreau, executive assistant for the Belle Maison Nursing Home in Hammond, La., which has been using PPS software for years. "The service is fast, simple and saves us a tremendous amount of time and effort on tasks that used to slow down our admissions process and responsiveness."

Florida hospital becomes 100th to install CyberKnife

BRANDON, FL – Brandon Regional Hospital, a 367-bed acute care facility in Brandon,Fla., has implemented a robotic radiosurgery system to improve care forcancer patients.

The hospital installed the CyberKnife System, which is developed by Sunnyvale, Calif.-based Accuray, Inc.

The installation at Brandon Regional Hospital is the 100th CyberKnife robotic radiosurgery system installation in the country.

"Our installation ... shows the progress we're making in expanding patient access to the benefits of radiosurgery," said Euan S. Thomson, PhD, president and CEO of Accuray. "It is our continued goal to make radiosurgery an option that is available and accessible to cancer patients around the world, and achievement of this national milestone means we're one step closer to that goal."

The technology is designed to treat tumors anywhere in the body non-invasively. It uses continual image guidance technology and computer controlled robotic mobility to automatically track, detect and correct for tumor and patient movement in real-time throughout the treatment, which enables the system to deliver high-dose radiation with pinpoint precision.

Earlier this month Accuray officials announced they had installed 150 CyberKnife robotic radiosurgery systems worldwide.

Pricewaterhouse Coopers looks into healthcare crystal ball for 2009

NEW YORK – The Internet and social networking, pay-for-performance, the economic crisis and conversion from ICD-9 to ICD-10 disease code sets are among the top issues facing healthcare in 2009, according to PricewaterhouseCoopers Health Industries Group.

In its annual review of the top concerns for health executives and policymakers released earlier this month, global research and consulting firm PwC says the healthcare industry will face many challenges in the year ahead, including how to deal with more underinsured and fund new cures in a capital-starved market.

The adoption and use of healthcare IT is implicit in several categories, including pay-for-performance and the conversion to a new coding system.

"The coming year will be a watershed for healthcare in the United States," said David Chin, MD, PricewaterhouseCoopers' Health Research Institute Leader. "Severe economic conditions are placing pressure on hospitals, insurers, employers and patients alike. President-elect Obama has called for significant reform for healthcare and will have a Democratic Congress supporting him. The convergence of market and political forces will drive the greatest change in healthcare in a generation, changes that could benefit patients and make the health system stronger."

The report is an annual review of the most pressing issues for health executives and policy makers. PwC identified nine top issues for 2009:

1. The Economic Downturn Will Hit Healthcare

Although the health industry historically has been less vulnerable to economic downturns than other industries, the disrupted economy will hit healthcare in 2009. Hospitals and other providers, from family physicians to dentists, will experience an increase in bad debt and a drop in elective procedures. Investment portfolios for all health organizations have been affected. The payer mix is shifting away from relatively lucrative commercial insurers and seeing a drop in enrollment and premium revenue - a trend that will likely continue if employment drops further. Charitable donations and investment income are down, and improvement projects involving capital outlays for IT, facilities and equipment, have been put on hold. Pharmaceutical and biotech companies have seen their valuations drop, which could further affect access to additional capital. Health organizations that need to find new sources of capital will have to demonstrate that they're improving their core businesses, improving efficiencies and delivering value.

2. The Underinsured Will Surpass the Uninsured as Healthcare's Biggest Headache

The uninsured draw most of the attention, but the number of underinsured is growing even faster - an estimated 25 million adults qualify as underinsured, an increase of 60 percent since 2003. With some but not enough health insurance, the underinsured often can't or won't pay the high deductibles and co-pays for the services they need. In 2009, the nation could see more bad debts for hospitals, more cost-shifting to commercial plans and more patients delaying or foregoing care.

With growing unemployment, self-pay is becoming a major part of providers' revenue cycle processes. Many hospitals have begun to pre-qualify patients. Some are using credit card-like swipe machines to verify eligibility and estimate insurance coverage. Others are using credit cards and extending their own lines of credit. Not-for-profit hospitals must tread carefully, as they don't want to further complicate the credit for uninsured and low-income patients. Business operations will likely look to technology and processes from the retail, banking and credit industries to manage self-pay patients and the underinsured.