Massachusetts hospital to pay $750,000 to settle data breach case

WEYMOUTH, MA – South Shore Hospital has agreed to pay $750,000 to resolve allegations that it failed to protect the personal and confidential health information of more than 800,000 patients, The settlement is the result of a data breach reported to the Attorney General’s Office in July 2010.

Attorney General Martha Coakley announced the settlement May 24.

[See also: Mass. hospital investigating the potential loss of back-up data for 800,000 individuals]

The alleged breach included individual’s names, Social Security numbers, financial account numbers and medical diagnoses.

“Hospitals and other entities that handle personal and protected health information have an obligation to properly protect this sensitive data, whether it is in paper or electronic form,” Coakley said in announcing the settlement. “It is their responsibility to understand and comply with the laws of our Commonwealth and to take the necessary actions to ensure that all affected consumers are aware of a data breach.”

The consent judgment approved in Suffolk Superior Court includes a $250,000 civil penalty and a payment of $225,000 for an education fund to be used by the Massachusetts Attorney General’s Office to promote education concerning the protection of personal information and protected health information. In addition to these payments, the consent judgment credits South Shore Hospital for $275,000 to reflect security measures it has taken subsequent to the breach.

[See also: Expert weighs in on data loss at South Shore Hospital]

The lawsuit was filed under the Massachusetts Consumer Protection Act and the federal Health Insurance Portability and Accountability Act (HIPAA).

According to the AG’s findings, in February 2010, South Shore Hospital shipped three boxes containing 473 unencrypted back-up computer tapes, which contained 800,000 individuals' personal information and protected health information, off-site to be erased. The hospital contracted with Archive Data Solutions to erase the backup tapes and resell them.

The hospital did not inform Archive Data, however, that personal information and protected health information was on the backup computer tapes, nor did South Shore Hospital determine whether Archive Data had sufficient safeguards in place to protect this sensitive information. Multiple companies handled the shipping of the boxes containing the tapes.

In June 2010 South Shore Hospital learned that only one of the boxes arrived at its destination in Texas. The missing boxes have not been recovered although there have been no reports of unauthorized use of the personal information or protected health information of affected individuals to date.

The allegations against South Shore Hospital in the lawsuit are based on both federal and state law violations, including failing to implement appropriate safeguards, policies, and procedures to protect consumers’ information, failing to have a Business Associate Agreement in place with Archive Data, and failing to properly train its workforce with respect to health data privacy.

According to the consent judgment, South Shore Hospital has also agreed to take steps in order to ensure compliance with state and federal data security laws and regulations, including requirements regarding its contracts with business associates and third-party service providers engaged for data destruction purposes. The hospital also agreed to undergo a review and audit of certain security measures and to report the results and any corrective actions to the Attorney General.

South Shore, a 318-bed hospital, serves southeastern Massachusetts. The Boston Globe has reported thtat Boston-based Partners HealthCare System has been in talks to acquire the hospital.

[See also: South Shore deems missing files unrecoverable, but with little risk of misuse]

Long commute time linked with poor health, new study shows

New evidence shows that a long commute by car not only takes hours out of your day, but could take years off your life.

A study published this month in the American Journal of Preventive Medicine found that the longer people drive to work, the more likely they are to have poor cardiovascular health.

"This is the first study to show that people who commute long distances to work were less fit, weighed more, were less physically active and had higher blood pressure," said Christine M. Hoehner, a public health professor at Washington University School of Medicine in St. Louis and the study's lead author. "All those are strong predictors of heart disease, diabetes, and some cancers."

The study monitored the health of 4,297 adults from 12 counties in Texas, a metropolitan region where 90 percent of people commute to work by car, Hoehner said.

The New York area has the longest average commuting time -- almost 35 minutes -- of any metropolitan area, according to the Census Bureau in its analysis of the 2009 American Community Survey. But the other nine metro areas in the top 10 also averaged a half hour or more. And even the area with the shortest average commute, Great Falls, Mont., still clocked in at 14 minutes.

That's important because those who commuted by car 10 miles or more each way were more likely to have high blood pressure than people who drove shorter distances. And those who traveled 15 or more miles each way were more likely to have bigger waistlines and less likely to be physically active, according to Hoehner's study.

Tom Ricci, 53, drives 130 miles round trip each day from his home in Mahopac, N.Y., to his job at a music record company in Lyndhurst, N.J.

He gets up at 4:30 a.m. almost every day to hit the gym before work.

"I'd go crazy and lose my mind" without a workout routine, Ricci said. "You need a release from that grind."

Diet, exercise and sleep habits were not looked at in the study, Hoehner said. They also can also contribute to obesity and high blood pressure.

Christine Bruno of Garrison, N.Y., feels the difference. Her commute used to be 7 minutes. Now since she moved in with her fiance it take up to 90 minutes each way to make the 40-mile trek to New Rochelle, N.Y.

"By the time you finish your final meal of the day, there is no time to do much else," said Bruno, 40. "There is no time to exercise. And there is no time to go to the gym, and it's a huge issue, because I used to be a gym rat."

Danielle Mahoney, 36, lives in Patterson, N.Y., works in Suffern, N.Y., and commutes 126 miles round trip a day. Her company offers fitness classes to employees several times a week so they can exercise during the day. Without them, Mahoney said, she wouldn't have time for the gym, especially with twin toddlers at home.

The hours she spends in her car are "definitely draining," she said.

"If it's a longer day or you didn't get enough sleep, you can doze when you are driving," she said. "Numerous times I catch myself."

Dr. Franklin Zimmerman, a cardiologist and director of critical care at Phelps Memorial Hospital in Sleepy Hollow, N.Y., said what makes long commutes by car even worse is that many people are also sitting at work.

He tells patients to get 30 minutes of moderate to vigorous exercise each day. If people can't get to the gym, he suggests they park their cars farther from their offices and then walk. People can also sneak in exercise by getting off the elevator and taking the stairs.

"It's OK to split it up into increments," he said. "It's hard to find 30 minutes, but it's not hard to find five minutes, and all of that still counts."

(Contributing: Tim Henderson, The (Westchester, N.Y.) Journal News)

AlliedHIE, ICA launch behavioral health HIE

HARRISBURG, PA – Looking to remedy organizational problems that hamper health information exchange, AlliedHIE and Nashville, Tenn.-based ICA have partnered to launch an HIE that officials say will target healthcare organizations' infrastructure and communications issues.

AlliedHIE develops health information exchange technology with a focus, company officials say, on connecting vulnerable and at-risk patients to better care. ICA was founded as a way to market technology developed by Vanderbilt University Medical Center to hospitals, IDNs, communities and states.

Together, the two will launch an exchange with a secure clinical messaging DIRECT/HISP pilot project and HIE infrastructure for Lafayette Hill, Pa.-based NHS Human Services, officials say.

“Our approach to HIE is very different than other vendors,” said Kelly Lewis, president and CEO of AlliedHIE. “Most companies take a top-down approach seeking to build a technology infrastructure that will enable either a full or partial HIE capability throughout an IDN, region or state."

Instead, said Lewis, AlliedHIE seeks to identify organizations' communications and exchange needs and deliver technologies targeted to solve them, rather than selling "generic HIE solutions to customers without first diagnosing problems." That approach, he said, can result in "rapid ramp up, fast ROI and cost savings that become apparent almost immediately upon implementation."

That strategy is borne out by two recent reports from the National eHealth Collaborative and IDC Health Insights, which find that too many HIEs have relied on the "build it and they will come" strategy, said Allied HIE officials. Both reports assert that HIEs must plan for sustainability from the very beginning, and that if an HIE is not sustainable after initial funding, then careful consideration should be given to the viability of launch.

“Our partnership with AlliedHIE represents an exciting departure for ICA,” said Gary Zegiestowsky, president and CEO of ICA. “Allied’s commercial HIE approach eliminates traditional sustainability concerns of the typical 501.C3 type HIE organization by addressing specific information exchange business needs. Their strategy fits well with our new volume solution deployment methodology that offers clients specific solutions for specific needs, while also enabling a complete, robust HIE infrastructure."

He added that ICA was specifically attracted to Allied’s interest in the behavioral health market, which he said has "been underserved, from an HIE perspective.”

AlliedHIE’s first pilot project is with NHS Human Services, which develops programs that provide care to children and adults dealing with addictive diseases, autism, intellectual and developmental disabilities, mental health issues, elder care, traumatic brain injury, and foster care. NHS is a multi-state organization with a significant presence in the state of Pennsylvania.

Based in Pennsylvania, AlliedHIE is actively working with the Pennsylvania eHealth Collaborative in order to provide DIRECT and HISP (Health Information Service Provider) services across Pennsylvania's 67 counties.

Vendor Notebook: InterSystems retools HealthShare platform

InterSystems has launched the next generation of its InterSystems HealthShare, a strategic informatics platform for interoperability and active analytics. Designed originally for public HIEs, officials say the technology has been extended and rearchitected for use by integrated delivery networks (IDNs).

Philips announced the implementation of it enterprise-wide clinical informatics technology at Baptist Health South Florida (BHSF), the largest faith-based, not-for-profit health care organization in the region. Its network of services extends throughout Miami-Dade, Broward and Monroe counties with Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, Baptist Children's, South Miami Hospital, South Miami Heart Center, Homestead Hospital, Mariners Hospital, Doctors Hospital and West Kendall Baptist Hospital.

Emdat announced a partnership with Illinois Bone and Joint Institute (IBJI). A premier provider of orthopaedic, rheumatologic and podiatric services, IBJI is using a host of Emdat applications to increase productivity, accuracy and continue to provide the best care possible, including Emdat Mobile, which will allows to IBJI to bridge the gap between physicians and their EHRs.

MediRevv announced a new client-partner: Bon Secours Charity Health System, a health system that serves nearly a million people in the seven-county, tri-state area that includes Rockland, Orange and Sullivan counties in New York, Bergen, Passaic and Sussex counties in northern New Jersey and Pike County in Pennsylvania.

Anoto and NextGen Healthcare Information Systems announced that Pacific Cataract and Laser Institute is capturing new patient registration information with their joint solution, resulting in more efficient operations and the added benefit of immediate access to patient health history.

WebPT has teamed with ActiveRx to support their nationwide rollout. ActiveRx provides a proactive, wellness-oriented health care model centered on strength, time and care for the aging population. The company uses physical therapists as “gatekeepers” within their patient-centric system. They needed a software solution that would enable their PTs to spend maximum quality time with each patient during evaluations and treatment, and less time on administrative tasks outside of the clinic.

CynergisTek announced that it has expanded its solutions portfolio and partnerships. Officials say heightened regulatory requirements and enforcement, coupled with increased awareness of the company through CynergisTek's ongoing speaking and writing for industry associations and publications, have led the company to expand its portfolio of solutions to help organizations adopt best practices for managing IT privacy and security.

NextGen announced a new agreement with Norton Sound Health Corporation (NSHC) to deploy NextGen® Ambulatory EHR, NextGen Practice Management, NextGen Inpatient Solutions, and other NextGen solutions throughout the organization. Officials say the deal bolsters NextGen Healthcare’s position as a provider of IT solutions for tribal health services nationwide.

ICA announced it has contracted with Chesapeake Regional Medical Center in Chesapeake, Va. to develop interoperability and data exchange for this regional integrated delivery network (IDN) located in southeastern Virginia.

Mosaica Partners has been selected to assist the State of Arizona in updating its health information exchange (HIE) strategic and operations plans.
 
Sanofi US announced that the iBGStar Blood Glucose Monitoring System, consisting of the iBGStar blood glucose meter and iBGStar Diabetes Manager App, is commercially available in the U.S. iBGStar directly connects to the iPhone and iPod touch, offering accurate blood glucose monitoring that integrates into the lives of people with diabetes.

SRS announced that Southern Brain & Spine has selected the SRS EHR for its 10 providers and 3 locations. The physicians at Southern Brain & Spine provide high-quality, compassionate neurosurgical care to residents of the Greater New Orleans area.

TeleCommunication Systems announced the availability of its Enterprise Security & Protection (ESP) cyber security portfolio designed to meet the needs of enterprise organizations with distributed networks, including wireless operators and organizations in the energy and financial sectors.

Craneware announced the availability of new features to InSight Medical Necessity, its all-payer medical necessity verification solution. Because medical necessity is one of the greatest causes of denials, representing a threat to provider organizations' revenue integrity, Craneware has enhanced InSight Medical Necessity to help healthcare organizations save staff time in ensuring compliance with medical necessity and prior authorization requirements, officials say.

The TriZetto Group announced that CDPHP a not-for-profit health plan serving nearly 400,000 members in upstate New York, is fully live on TriZetto’s care management software solution to support its population health management and member engagement initiatives.

McKesson has released the 2012 update of its InterQual clinical criteria and software, meant to help payers and providers determine the appropriate use of healthcare resources and improve the quality of care. Enhancements this year include the extension of a “condition-specific” model to the full InterQual Acute Care suite, driving the further efficiency and effectiveness of care management processes

Philips announced the availability of CardioCare Wireless Arrhythmia Services, the latest addition to the company’s remote diagnostic arrhythmia and remote patient monitoring portfolio. Officials say the new service, available only in the U.S., is designed to streamline the complex process of remotely monitoring cardiac patients and capture critical information sooner.

Perminova has launched a strategic alliance with LifeWatch to expand interoperability between medical monitoring devices and information technology in cardiac electrophysiology. Under the arrangement, Perminova EP, the information system designed for electrophysiology, will integrate reports from LifeWatch’s cardiac monitoring and telemetry products directly into Perminova’s cloud-based system.

eClinicalWorks announced that College Park Family Care Center, the largest non-hospital owned multi-specialty group in the Kansas City-area, has chosen eClinicalWorks comprehensive electronic health records (EHR) solution for its 91 providers across 12 locations.

Flesh-eating bacteria patient sees bacteria-ravaged hands

SAVANNAH, Ga.(AP)�A Georgia graduate student fighting a rare flesh-eating infection has been looking at her ravaged hands and asking about the damage, all without tears, her father said Wednesday.

What Aimee Copeland still doesn't know is that doctors plan to amputate her all of her fingers, just as they had to remove most of her left leg in order to save her life.

"Her fingers are basically mummified. The flesh is dead," Andy Copeland said in a phone interview from Doctors Hospital in Augusta more than two weeks after a zip-lining accident left a gash in his daughter's leg that developed into the infection.

Copeland's father said she held one of her hands close to her face Wednesday and asked family members about it. He said they told her "your hands have been damaged � and we're trying to bring back as much of the life into the hands as possible."

"She was well accepting," Andy Copeland said. "No tears or anything."

The 24-year-old student from an Atlanta suburb remains in critical condition as she battles an infection called necrotizing fasciitis. Doctors initially feared they might have to remove her remaining foot and both hands. But her father said she now faces losing only her fingers after two days of treatment using a hyperbaric chamber, in which patients breathe pure oxygen to boost white blood cells and accelerate healing. Flesh on her palms that had been purple was turning pink again, he said.

Copeland's father said she was still unaware of plans to amputate her fingers, an emotional disclosure that will likely require a counselor's help.

"We don't know if she's aware of her (amputated) leg yet," he said. "We're in a don't ask, don't tell policy."

The flesh-eating bacteria, Aeromonas hydrophila, emit toxins that cut off blood flow to parts of the body. The affliction can destroy muscle, fat and skin tissue.

Copeland contracted the infection days after she suffered the deep cut May 1 when the zip line snapped over rocks in the Little Tallapoosa River near the University of West Georgia, where she studies psychology.

The bug is found in warm and brackish waters. Many people exposed to these bacteria don't get sick. When illnesses do occur, it's often diarrhea from swallowing bacteria in the water. Flesh-eating Aeromonas cases are so rare that only a handful of infections have been reported in medical journals in recent decades.

In addition to the damage to her extremities, Copeland is on a respirator and a dialysis machine as her lungs and kidneys recover. Doctors also had to remove much of the skin from her torso to keep the infection from spreading, her father said.

Though still heavily medicated, Copeland has become more alert and communicates with her parents and older sister despite the breathing tube in her throat. Her father said Wednesday doctors were removing that tube and inserting another directly into her trachea to make her more comfortable.

"If they take the tube out, I believe reading her lips is going to be a lot easier," he said. "And she might be able to actually cover the tube up and be able to talk."

Andy Copeland said his daughter has been asking for her cell phone, her laptop and a book to read, but is still in no condition to use any of those things. He said her sister, Paige, has been reading to her from a book on meditation.

Quadrant4 Systems to acquire empowHR

ROLLING MEADOWS, IL – Quadrant4 Systems Corporation, which makes enterprise resource planning and business intelligence software, will acquire Atlanta-based empowHR, a developer of SaaS platform technology for health insurance and employee benefits administration.

Officials say the deal will see Quadrant4 integrating empowHR technology into its cloud-based Health Exchange platform. Quadrant4 will also expand the empowHR platform into a full-scale portal that will include:

Integration of employer sponsored insurance and benefits, as well as work-site benefit products for enrollment, communication and administration;Agency portal for management and administration of multiple client types incorporating insurance, employee benefits and financial services into a single platform;Employer portal for managing insurance, employee benefits, human resources, financial services and integration with third-party product providers such as payroll systems, human resource systems, and others;An employee portal for managing benefit programs; andAnalytics aimed at providing insight into employee behavior and benefit expense trends.

empowHR technology has been in deployment for more than a decade and has been used by more than 2 million members for various benefits administration between licensing, OEM and recurring subscription based models. Its key user groups and customers include insurance companies, agencies, third party administrators, health plans and large employers.

Dhru Desai, Quadrant4's chairman, said the two companies together "will accelerate the development of empowHR technology beyond its current capabilities to the next generation market requirements.”

"Our ability to deliver the most complete benefits administration, communication and enrollment tool in the industry … coupled with the ability to capitalize on Quadrant4’s significant development capability, will allow us to close bigger deals, provide custom development, and deploy significant enhancements quicker," said Robert Steele, founder and CEO of empowHR.

Cleveland seen as having top HIE

Sixty-one percent of the voters selected the Cleveland Foundation as the health information exchange that would likely serve as a model for future healthcare IT developments. As one reader put it, “Cleveland rocks!”

    Most who commented, however agreed that “all of them have provided innovative ways to update their respective IT infrastructure.”

    Many others received kudos.

    “The VA continues to lead the way with an integrated health system,” one respondent said. “Same for Cleveland Clinic, North Carolina is pushing outside of the four walls and forcing data sharing.”

Breast cancer is rare in men, but they fare worse

CHICAGO�Men rarely get breast cancer, but those who do often don't survive as long as women, largely because they don't even realize they can get it and are slow to recognize the warning signs, researchers say.

On average, women with breast cancer lived two years longer than men in the biggest study yet of the disease in males.

The study found that men's breast tumors were larger at diagnosis, more advanced and more likely to have spread to other parts of the body. Men were also diagnosed later in life; in the study, they were 63 on average, versus 59 for women.

Many men have no idea that they can get breast cancer, and some doctors are in the dark, too, dismissing symptoms that would be an automatic red flag in women, said study leader Dr. Jon Greif, a breast cancer surgeon in Oakland, Calif.

The American Cancer Society estimates 1 in 1,000 men will get breast cancer, versus 1 in 8 women. By comparison, 1 in 6 men will get prostate cancer, the most common cancer in men.

"It's not really been on the radar screen to think about breast cancer in men," said Dr. David Winchester, a breast cancer surgeon in NorthShore University HealthSystem in suburban Chicago who was not involved in the study. Winchester treats only a few men with breast cancer each year, compared with at least 100 women.

The researchers analyzed 10 years of national data on breast cancer cases, from 1998 to 2007. A total of 13,457 male patients diagnosed during those years were included, versus 1.4 million women. The database contains about 75 percent of all U.S. breast cancer cases.

The men who were studied lived an average of about eight years after being diagnosed, compared with more than 10 years for women. The study doesn't indicate whether patients died of breast cancer or something else.

Greif prepared a summary of his study for presentation Friday at a meeting of American Society of Breast Surgeons in Phoenix.

Dr. Akkamma Ravi, a breast cancer specialist at Weill Cornell Medical College in New York, said the research bolsters results in smaller studies and may help raise awareness. Because the disease is so rare in men, research is pretty scant, and doctors are left to treat it the same way they manage the disease in women, she said.

Some doctors said one finding in the study suggests men's breast tumors might be biologically different from women's: Men with early-stage disease had worse survival rates than women with early-stage cancer. But men's older age at diagnosis also might explain that result, Greif said.

The causes of breast cancer in men are not well-studied, but some of the same things that increase women's chances for developing it also affect men, including older age, cancer-linked gene mutations, a family history of the disease, and heavy drinking.

There are no formal guidelines for detecting breast cancer in men. The American Cancer Society says routine, across-the-board screening of men is unlikely to be beneficial because the disease is so rare.

For men at high risk because of a strong family history or genetic mutations, mammograms and breast exams may be helpful, but men should discuss this with their doctors, the group says.

Men's breast cancer usually shows up as a lump under or near a nipple. Nipple discharge and breasts that are misshapen or don't match are also possible signs that should be checked out.

Tom More, 67, of Custer, Wash., was showering when he felt a pea-size lump last year near his right nipple. Because a golfing buddy had breast cancer, More didn't put off seeing his doctor. The doctor told More that he was his first male breast cancer patient.

Robert Kaitz, a computer business owner in Severna Park, Md., thought the small growth under his left nipple was just a harmless cyst, like ones that had been removed from his back. By the time he had it checked out in 2006, almost two years later, the lump had started to hurt.

The diagnosis was a shock.

"I had no idea in the world that men could even get breast cancer," Kaitz said. He had a mastectomy, and 25 nearby lymph nodes were removed, some with cancer. Chemotherapy and radiation followed.

Tests showed Kaitz, 52, had a BRCA genetic mutation that has been linked to breast and ovarian cancer in women. He may have gotten the mutation from his mother, who is also a breast cancer survivor. It has also been linked to prostate cancer, which Kaitz was treated for in 2009.

A powerboater and motorcycle buff, Kaitz jokes about being a man with a woman's disease but said he is not embarrassed and doesn't mind showing his breast surgery scar.

The one thing he couldn't tolerate was tamoxifen, a hormone treatment commonly used to help prevent breast cancer from returning in women. It can cause menopausal symptoms, so he stopped taking it.

"It killed me. I tell you what � night sweats, hot flashes, mood swings, depression. I'd be sitting in front of the TV watching a drama and the tears wouldn't stop pouring," he said.

Doctors sometimes prescribe antidepressants or other medication to control those symptoms.

Now Kaitz gets mammograms every year. Men need to know that "we're not immune," he said. "We have the same plumbing."

���

Online:

Male breast cancer: http://bit.ly/ayq2S6

Support group: http://www.malebreastcancer.org

A Bright New Day for Families and Small Employers

For more than a decade, the cost of health insurance has risen rapidly, straining the pocketbooks of families and business. In fact, since 1999, the cost of coverage for a family of four has climbed 131 percent. These extreme increases have forced too many Americans to spend more money, and often for less coverage.

Prior to the Affordable Care Act, insurance companies in too many states were able to raise their rates without explaining their actions. Consumers often received little or no information about their premium increases and weren�t told why their health insurance company was raising their rates. And insurance company profits continued to soar. But thanks to the Affordable Care Act, things are changing. Starting today.

In the 18 months since President Obama signed the health care law, we have worked with state leaders and others to shine a spotlight on how insurers do business. When a California insurer tried to raise premiums by as much as 87 percent, federal and state officials asked them to justify these increases. �After additional scrutiny, the insurer withdrew its request, saving California families and businesses millions.

Over the last year, 42 States, the District of Columbia and the five U.S. Territories have used funds from the Affordable Care Act to help them stiffen their oversight of proposed health insurance rate increases. So far:

9 States have passed legislation to further enhance rate review25 States have hired new staff to review rates33 States have enhanced their IT capacity to review rates more efficiently31 States have improved rate filing requirements to improve transparency

The Affordable Care Act gives States the support they need to review increases and take action to reduce unreasonable rates. As a former Governor and State Insurance Commissioner I know that effective rate review helps to slow premium growth and results in real savings. In the past year alone:

Maryland was able to reduce premium increases in 10 of the 22 rate filings approved during the 3rd quarter of 2010.�In August of 2011, Rhode Island cut a 20% rate increase request in half, to 10%.�Oregon chopped the rate increase by one of its largest insurers almost in half, saving money for 60,000 people.�

These success stories are only the beginning of a nationwide effort to curb insurance company behavior. Starting today, insurers who want to hike their rates by 10 percent or more have to explain and justify those increases in writing.� Experts will scrutinize those explanations and, in many cases, can tell the insurer to reduce their price.� In other cases, insurers who insist on a double-digit increase will have to post their explanations on the web.� And we will post it on Healthcare.gov, too.� Families and small business owners will be able to compare prices and choose the plan that best suits their needs and their budgets.� That�s the kind of good news we can all use.

To view a mock-up of what the rate review website will look like on Healthcare.gov, click here.� And to view the fact sheet, visit this page.

Correction: The third paragraph in this blog has been revised.

Making Progress to Close the Gaps in AAPI Health Care

Each May during Asian American and Pacific Islander (AAPI) Heritage Month, we celebrate the remarkable contributions and accomplishments of the AAPI community to the fabric of our nation. As a Korean American son of immigrants, I am all too familiar with the barriers AAPIs face in accessing health care for reasons such as poverty, lack of insurance, language barriers and other challenges.�

But, as the Assistant Secretary for Health, I am particularly pleased to see the progress we have made in closing the gaps in AAPI health care, and am honored to oversee efforts that can address the ongoing health disparities that continue to exist within our vibrant community.�

The good news is that the President�s health care law -- the Affordable Care Act � provides us with the opportunity to increase access to care, and vastly improve health outcomes for AAPIs. According to an HHS Research Brief released today, an estimated two million AAPIs will be eligible for insurance coverage by 2016 under the new health care law. �

Already, the Affordable Care Act has expanded access to free preventive services. The law requires insurers to cover preventive care so families do not have to pay out-of-pocket costs for services such as well-child visits, flu shots or blood pressure screenings. In 2011, private insurers improved coverage for mammograms, other cancer screenings, and other preventive services to 2.7 million AAPIs.� And, to date, 867,000 elderly and disabled AAPIs with Medicare have used free preventive services, including an annual wellness visit with their doctor.

As the law continues to be implemented, uninsured AAPIs will gain access to affordable health care insurance through new Affordable Insurance Exchanges or expanded Medicaid coverage. And AAPIs suffering from chronic diseases, including an estimated 891,000 with diabetes, will have access to promising new health care innovations to improve the management of these conditions. �

Today, as we kick off Asian American and Pacific Islander Heritage Month, let us celebrate the critical progress we are making toward achieving our collective goal of reducing � and eventually eliminating � health care disparities. We are all committed to improving the health and well-being of all Americans, including our family and friends in the AAPI community.

To learn more about the impact of the Affordable Care Act on the health of Asian Americans and Pacific Islanders read the issue brief and fact sheet .

FDA's Stance On Online Pharmacies May Go Too Far, Study Says

Maya Kovacheva Photography/iStockphoto.com

Each year, millions of Americans don't fill their prescriptions because they can't afford to.

The Food and Drug Administration has warned people about the many dangers of buying medications from foreign pharmacies over the Internet. While some sites might offer high-quality medicines, there are plenty that sell bogus and potentially dangerous products.

But a recent economic analysis suggests that while there's good reason for the safety warnings, the FDA's stance on the matter might go too far. Many Americans don't fill their prescriptions because they can't afford to, the study says, and some legitimate foreign pharmacies may offer medicines at prices lower than those of verified U.S. suppliers.

"A blanket warning against any foreign website may deny consumers substantial price savings," states the report from the National Bureau of Economic Research.

 

Researchers Roger Bate, Ginger Zhe Jin and Aparna Mathur looked at how different online pharmacies compared in terms of drug safety and cost savings. They went to dozens of websites and ordered medications widely used by Americans: Viagra, Celebrex, Lipitor, Nexium and Zoloft.

They obtained 328 drug samples from 41 online pharmacies based in the U.S., Canada, Australia, Europe or Asia. They found the foreign suppliers the same way many consumers do: by doing a search on Google and Yahoo.

Eight of the websites were U.S.-based providers verified by the National Association of Boards of Pharmacy, Legitscript.com, PharmacyChecker.com or the Canadian International Pharmacy Association. Those websites were classified as Tier 1 and sold high-quality, authentic drugs. (The researchers established the drugs' authenticity through detailed, chemical analyses.) Another group � classified as Tier 3 � was made up of unverified, mostly foreign providers that sometimes shipped fake versions of one of the drugs, Viagra.

But there was a middle group of mostly foreign suppliers that had been verified by two agencies � dubbed Tier 2 � that sent drugs that were authentic and cost much less than at Tier 1 pharmacies.

In fact, the Tier 2 drugs were, on average, 52.5 percent cheaper (including shipping and handling) than the Tier 1 medicines. The only exception was Viagra, which was the same in drug safety and price for both groups.

"In the U.S., tens of millions of Americans go without prescribed medication due to cost each year," the study says. "For most uninsured Americans, lower priced drugs from foreign online pharmacies are an attractive option and for many a necessary one."

"In light of this," the researchers asked, "we wonder whether a blanket warning against foreign websites has limited price competition between U.S. and foreign websites, and whether a more open and educational policy could make better use of the existing verification services for consumer savings in authentic drugs."

Still, people shouldn't rush online and buy from a pharmacy that hasn't been checked out. The FDA strongly recommends verification from the National Association of Boards of Pharmacy.

Plus, as Nancy Shute has reported in Shots, people searching for prescription drugs even on legitimate websites can sometimes fall victim to hackers and scams.

Sidney Wolfe, director of Public Citizen's Health Research Group, tells Shots that despite the study's findings, he has concerns about the safety of the products from foreign pharmacies. When drugmakers develop and sell generic copies of existing brand-name drugs, he says, regulators require them to prove the copies are not only chemically identical but work the same way inside the body � a concept known as bio-equivalence.

If the drugs from foreign websites could be shown to be the same in terms of bio-equivalence as drugs from verified suppliers, he says, "we would strongly support it."

Helping Parents Quit Smoking

As a pediatrician, I�ve seen too many children whose health problems could have been avoided if they hadn�t been exposed to cigarette smoke. And when parents smoke, it�s especially dangerous to their children.

Exposed to smoke, children are at greater risk of serious lower respiratory infections such as bronchitis and pneumonia.� They are more prone to ear infections.�� If they have asthma, they have more frequent and severe attacks.��

In pregnant women, smoking can cause serious complications.� Babies born to mothers who smoke are more likely to be lower birth weight, have lung problems, and other health problems.� They�re more likely to die from sudden infant death syndrome.�

But it�s not easy for a person with a tobacco addiction to quit.� That�s why it�s so important to reach pregnant smokers, with services like face-to-face counseling, telephone quit-lines staffed by specially-trained coaches, and�in very limited cases�medication, if a woman and her doctor determine that it�s necessary.�

It�s why the Centers for Medicare & Medicaid Services (CMS) sent a letter to all state Medicaid directors today, reminding them that state Medicaid programs now must fully cover tobacco cessation services for pregnant women, as a result of the Affordable Care Act.� In addition, CMS is making it easier for states to fund tobacco use treatment for all Medicaid beneficiaries by making funding available for quit-lines.

And smoking adults model unhealthy behavior for children. Every day, an estimated 4,000 children try their first cigarette; 1,000 of those kids become daily smokers. Helping the adults in their lives to quit is a powerful message to them not to start.

The State Medicaid Director letter was issued in conjunction with National Prevention and Wellness Month, to bring attention to the power of prevention to improve health and quality of life for millions of Americans.� It�s just one way we�re making access to preventive services easier.�

The Affordable Care Act also eliminated the Medicare Part B deductible and copayments for a host of preventive tests and screenings for seniors.� We�re working on closing the Medicare Part D donut hole, since we know that making prescription drugs more affordable increases the chance they�ll be taken as needed to stay well.
If we�re successful at preventing disease and promoting health we might also bring down the high cost of health care.� According to the Congressional Budget Office, the reduction in preventable health problems resulting from an investment in tobacco cessation services would create savings for states and the federal government.� According to the American Legacy Foundation, we could save $9.7 billion over five years if every Medicaid beneficiary stopped smoking.

If you add in the intangible costs of pain and suffering, the costs of chronic illness are simply unacceptable.�� Everyone in the community�including parents and children�benefits when essential services that people need to stay healthy are within their reach.

Panasonic launches Panasonic Healthcare Company of North America

SECAUCUS, N.J. – Panasonic has announced the formation of Panasonic Healthcare Company of North America, consolidating the business operations of the former Panasonic Healthcare Group and the former Sanyo Biomedical Solutions Division.

Panasonic officials said the newly-formed company will be based in Secaucus, N.J., and will also have operations in Houston and Wood Dale, Ill.

Yoshi Yuasa, who was formerly (and concurrently) senior vice president of Panasonic Corporation of North America's Corporate Planning and Strategic Initiatives Department, head of Panasonic Healthcare Group and vice president of corporate planning at Panasonic Canada, will lead Panasonic Healthcare Company of North America as president.
 
The company's health IT and life science tools will include the Panasonic digital hearing instruments and CardioHealth Station of the former Panasonic Healthcare Group, pharmacy automation technology and biomedical and other life science support products of Sanyo Biomedical Solutions Division.

Officials noted that the new firm will support Panasonic's goals for green innovation by emphasizing energy savings and improved efficiency of healthcare operations through the use of Panasonic life science and healthcare products.

"We have formed Panasonic Healthcare Company of North America with the aim of anticipating society's changing demands in the healthcare market," said Joe Taylor, chairman and CEO, Panasonic Corporation of North America. "Panasonic will continue to service the needs of life science customers with innovative products and solutions.  As a leader in the technology field, Panasonic has much to offer both the medical devices and life sciences research communities and we believe that we can make a significant contribution in helping to meet their evolving needs."

New Online Tool Gives You More Information about Premium Increases

For too long, when it came to health insurance, consumers were left in the dark. In the past, insurance companies could often raise your rates without any transparency or accountability. Many insurers were under no obligation to give you any explanation as to why they felt an increase was necessary. Thanks to the Affordable Care Act, this is changing.

Starting today, you will begin to have more information about your health insurance premiums. This year, in every State and for the first time ever, the Affordable Care Act requires insurance companies to publicly justify their actions if they want to raise rates by 10% or more.

Today, we posted the first set of explanations from insurance companies. Right here on HealthCare.gov.

We�ll update the site with more information from other insurers as it comes in so you can see why insurance companies think they should raise your rates. On our website, you will also have the opportunity to submit comments and share your views on the proposed rate increase.�Please send your comments to ratereview@hhs.gov.

At the same time, independent experts will determine whether or not the increase is reasonable.

This process is known as �rate review.� �It makes the health insurance marketplace more transparent and holds insurance companies accountable. It promotes competition that can drive down costs. And we know rate review works:

Oregon forced an insurer, Regence, to lower its request for a rate hike by nearly 10% for 60,000 enrollees after public hearings and scrutiny.Connecticut�s Insurance Department rejected a 20% rate hike by Anthem.North Carolina saved beneficiaries $14.5 million by reducing a rate increase request from the State�s Blue Cross Blue Shield plan.And, Aetna scrapped a proposed 19% rate increase in California after a close review found math errors that undermined the need for the hike.�

Insurers are also now required to spend most (80% or 85%) of the dollars you put toward insurance on your care � instead of on advertising or big CEO salaries � so you can get more value for your money. This is known as �medical loss ratio.� If they don't spend at least 80 cents of every premium dollar you pay on your health care, they must refund the difference to you. Consumers will start receiving these rebates next year.

We, in partnership with States, are taking a good, hard look at why insurance companies are seeking to raise your rates, why your premiums might be going up, and making sure these decisions are public and justified.

This is just a start, and over time we will be posting these requests as they come in.� Be sure to check back, though, as we�ll be updating the website regularly.

And if you see your insurance company�s rate and don�t like its reason for raising it, you may be able to take your business elsewhere.� Check out your options on HealthCare.gov.

The Affordable Care Act: Helping You Spend More Time With Your Doctor, Reducing Costs

This week, you can expect to hear more from us about one of the most important goals of the health care law, the Affordable Care Act: taking down barriers so you can spend more time with your doctor, reducing costs and ensuring you get the best care. When you get the time you need to talk with your doctor and ask questions, you can work with your doctor and be as healthy as possible.�

The Affordable Care Act also encourages doctors and nurses to talk to each other more about your care.� Giving doctors and other health care professionals tools � like electronic health records � to help them coordinate your care will make sure you are getting the best care possible, and help spend our health care dollars more wisely.�

We�ve already made tremendous progress toward achieving those goals � lowering Medicare costs, improving benefits, and cracking down on fraud � and we�re doing even more. Starting today, CMS is accepting applications for a new Innovation Advisors program made possible by the Affordable Care Act.�� The new program will identify and support up to 200 leaders with the knowledge and the vision to make lasting improvements in patient care and wise use of our health care dollars.

In the days ahead, we�ll have more important announcements about our effort to save money for hospitals, promote new efforts that make it easier for doctors and specialists to coordinate their care, and our work to strengthen community health centers.

All of these announcements build on our previous efforts. Here are a few examples of what we�ve been working on:

Primary Care � Some of the best health care systems in the world, like the Mayo Clinic, Geisinger, and the Cleveland Clinic make primary care doctors the center of their care.� One of the many ways we are doubling down on primary care is through an initiative called the Comprehensive Primary Care Initiative.� The new health care law provides significant and flexible support � financial and otherwise � to the primary care doctors we need to be the quarterbacks of the 21st century health care system we want.

Coordination � Another way we help you spend more time with your doctor is by helping doctors set up networks with each other.� These networks ensure your doctor knows and talks to your other doctors about your care.� Through the Accountable Care Organization programs, we are starting to set up these networks so that hospitals, nursing homes, and other health care providers are working with your doctor to focus on your needs.� This is another area where we are taking cues from practices in some of the best health care systems in the country, where we�ve learned that these networks lead to better care and lower costs.

Paying for Quality � We are also changing the way we reimburse doctors for care, so they are able to spend more time talking to and caring for their patients.� Before the new health care law, doctors were paid for every scan, test, procedure and patient visit.� And, doctors, hospitals, nursing homes and other providers were paid separately for treating the same patient.� That meant they didn�t have any reason to coordinate with each other about that patient�s care. �The health reform law includes new pilot programs that change the way health care professionals are paid and rewards them for working together.

Partnerships � HHS has come together with private health care providers to partner in an effort to improve the quality, safety, and affordability of health care for all Americans.� This effort, called the Partnership for Patients, brings together over 5,000 leaders of major hospitals, employers, physicians, nurses, and patient advocates along with state and federal governments in a shared effort to make hospital care safer, more reliable, and less costly.�The Partnership is focused on keeping you from being harmed in the hospital and making sure patients that are discharged aren�t readmitted for preventable conditions.� We project it will save up to $50 billion for Medicare alone over 10 years.

Prevention � We are trying to prevent people from getting sick in the first place, and focus on wellness and prevention. Under the Affordable Care Act, many insurers are required to cover certain preventive services, including mammograms, vaccines, well child visits, and more at no cost to you. Medicare now pays the full price of an annual Wellness Visit.� And, the Affordable Care Act�s Prevention and Public Health Fund expands the infrastructure necessary to prevent disease, detect it early, and manage conditions before they become severe.� It addresses factors that influence our health � housing, education, transportation, quality of food, and workplace and environment.

Reduced Paperwork � We have also started work to help your doctors begin using Electronic Health Records that help doctors, nurses, and hospitals communicate with each other about your care. Electronic Health Records make it easier for physicians, hospitals, and others to assess your medical status and make sure that care is appropriate.� They can help your doctor avoid redundant paperwork and make sure you get only the right tests and medications so you can get healthy sooner. We also issued rules to simplify the mounds of paperwork that doctors, nurses, and other caregivers have to complete in order to get paid for treating you. We estimate that these changes will save our health care system $12 billion over the next 10 years.�

Stay tuned for more in the days and weeks ahead.

Even A Small Slowdown In Obesity's Rise Would Save Big Money

Enlarge iStockphoto.com

iStockphoto.com

Slowing the rising rates of obesity in this country by just 1 percent a year over the next two decades would slice the costs of health care by $85 billion.

Keep obesity rates where they are now � well below a 33 percent increase that's been expected by some � and the savings would hit nearly $550 billion over the same 20 years.

Those are two attention-grabbing conclusions from an analysis released this morning at the Weight of the Nation conference in Washington, D.C., sponsored by the Centers for Disease Control and Prevention. Researchers from Duke University, RTI International and CDC prepared the analysis, published in the American Journal of Preventive Medicine.

 

It's the latest work that shows the health care costs associated with obesity, and the stark financial consequence of the epidemic.

In the new study, researchers estimate that obesity will continue to rise and will affect 42 percent of adults by 2030. (Obesity represents a body mass index score, a ratio of weight to height, of 30 or higher. Separate estimates for children aren't calculated.)

That projection reflects recent evidence that obesity has leveled off in some groups. So it's lower than an earlier estimate that just over half of the nation's adults would be obese by 2030. It also factors in conditions in the states that can affect the prevalence of obesity, such as unemployment, the availability of fast food, and price differences between healthful and less healthful food items.

While increases in obesity may have slowed some, the health trends still bode poorly � especially for people who are roughly 100 pounds overweight, with body mass index scores of 40 or higher.

That rapidly growing group of severely obese people, who have the most medical problems and incur the highest health care costs, will rise from about 5 percent of the population now to 11 percent by 2030, researchers suggest.

The findings are meant to be a call to action, as experts gathered at the CDC conference consider how best to to combat obesity, a public health problem that affects about 78 million adults and 12.5 million children and adolescents.

Proven interventions are now available. "We know more than ever about the most successful strategies that will help Americans live healthier, more active lives and reduce obesity rates and medical costs," said Dr. William H. Dietz, director of the CDC's division of nutrition, physical activity and obesity, in a prepared statement.

The fight won't be cheap. Still, the new study from Duke, RTI and CDC researchers shows that even a small dent in obesity rates could pay off.

New Health Care Law Helps Expand Primary Care Physician Workforce

We wanted to make sure you didn�t miss the good news. On Monday at the Eisner Pediatric and Family Medical Center in Los Angeles, Secretary Sebelius announced that the National Health Service Corps (NHSC) awarded $9.1 million in funding to medical students at schools in 30 States and the District of Columbia who will serve as primary care doctors and help strengthen the health care workforce.

The National Health Service Corps� Students to Service Loan Repayment Program, made possible by the new health care law, the Affordable Care Act, provides financial support to fourth year medical students who are committed to a career in primary care in exchange for their service in communities with limited access to care. This program provides loan repayment assistance of up to $120,000 to medical students (MDs and DOs) in their last year of education. In return, they commit to serve in a health professional shortage area upon completion of a primary care residency program.

Secretary Sebelius visited the Eisner Pediatric and Family Medical Center, which serves more than 26,000 patients each year. During a tour followed by a panel discussion about community health centers, doctors at the center said that the National Health Service Corps has helped them remain at the clinic. They have been able to continue serving their community without worrying about being able to make their monthly loan payments.

One of the Students to Service awardees this year is Eric Schluederberg, a 4th year medical student at Western University of Health Sciences in Pomona, California, who appeared at the Eisner Pediatric and Family Medical Center with Secretary Sebelius. Eric has a very compelling story inspired by his fianc�e who has Spina Bifida.

�I always knew my calling was primary care, � Eric said. �I�m not a social researcher, and I�m not an economist. But it seems that there are a lot of underserved people in this nation, and that providing sound primary care is a good economic investment. For example, ensuring that pregnant women know to take folic acid supplements is one way to prevent the cost of the numerous surgeries required to help someone with Spina Bifida become an independent member of society.�

And medical students all across the country will go in to communities that need help the most thanks to this funding.

Anna Gladston, a student at Michigan State University � College of Osteopathic Medicine has seen firsthand the need for expanding the primary care work force.

�As a resident of the city of Detroit I see how poor access to care can really ruin an individuals' health and life,� Anna� said.� �Throughout my training I have met individuals who have not seen a doctor for over half their life and have let a problem that could've been treatable reach a level that is beyond repair because they didn't have a doctor to go to or they didn't have insurance.� So much of the world health problems could be prevented and that is why I love primary care.� So that we can cut disease off at the pass, preventing it before it starts.�

Monica Mitcham, a student at the University of Texas � Medical Branch at Galveston is also a recipient of the NHSC award and speaks passionately about the importance of primary care in underserved communities.

�Having grown up in a resource-limited, poverty-stricken east Texas town and experienced first-hand the toll that access barriers can take on entire families, a seed of determination to bridge the socioeconomic health care divide was planted within me from an early age,� Monica said. �Several years later, as a young lady facing the challenges of becoming a first generation college student, I reflected once again on the importance of primary care in underserved communities. These humble beginnings taught me an important lesson and cultivated within me a strong desire to dedicate myself to community building and strengthening through reaching out to all age groups as a family physician.�

Thanks to the Affordable Care Act, this new program is allowing medical students to pursue their passion for primary care and serve some of the country�s most underserved rural and urban communities, by relieving a tremendous debt burden.

For more information, about the National Health Service Corps, check out this page.

TeleHealth Services, Medcalm join forces to create Blue Monkey Planet

CHAPPAQUA, NY – Healthcare providers would be the first to admit that when it comes to calming worried children and their parents, a well-used book and a Muzak version of Led Zeppelin's "Stairway to Heaven" just won't do the trick.

TeleHealth Services, a Chappaqua, N.Y.-based provider of on-demand patient and staff education services for healthcare providers, is targeting that problem in a new partnership with Medcalm, a Raleigh, N.C.-based developer of audio-visual wellness products. The two are combining to create Blue Monkey Planet, a pediatric channel pairing wellness education content with family-friendly video programs designed to take the tension out of a hospital visit.

In developing Blue Monkey Planet, Medcalm executives worked with authors, pediatric psychologists and sound-healing musicians to create programs designed to educate and ease the fears of children and parents both before and after the hospital visit.

"Each video incorporates a variety of messaging and education catering to the pediatric wards," said Amy Gordon-Fisher, Medcalm's founder and chief executive. "The goal of the content was to provide family-centric education across a broad foundation of techniques, allowing facilities to meet their educational needs and, thus, provide optimal healthcare for children."

Delivered via TeleHealth Services' TIGR family of on-demand patient education systems, Blue Monkey Planet features art, music and other visual relaxation programs, including "Feel Happy by Dr. Roxanne Daleo," "Healing Music for Children by Steven Halpern," "Tickle Monsters Are Robots and Other Stories by the Story Pirates" and "Visions of Africa by Earth VideoWorks."

EHR Association weighs in on Stage 2

CHICAGO – The HIMSS Electronic Health Records Association logged its comments on Stage 2 meaningful use with CMS and ONC this past Friday. Members of the vendor group praised the decision to delay Stage 2 by a year, allowing more time for development and testing.

The association responded to notices of proposed rulemaking (NPRMs) from both the Centers for Medicare and Medicaid Services, related to meaningful use objectives and measures for providers' use of certified EHRs, and the Office of the National Coordinator for Health IT, regarding EHR certification criteria and standards related to Stage 2.

The group offered recommendations on proposed certification criteria and standards, as well as on Stage 2 meaningful use requirements for providers. It praised CMS’ confirmation of a one-year delay in the start of Stage 2 in order to allow more time for testing and implementation of EHRs updated for Stage 2 – something that had been requested by a wide variety of stakeholder organizations.

"This was truly a collaborative effort that engaged more of our members than any of the previous public comment opportunities," said Leigh Burchell, vice president of government affairs for Allscripts and chair of the association’s Public Policy Leadership Workgroup. “Seven of our eight standing workgroups focused on specific sections of the NPRMs, ultimately collecting feedback from 138 individuals representing 25 member companies. We’re delighted with the level of participation, which represents the majority of operational EHRs in the U.S. and, most importantly, their users, lending credibility and weight to these comments.”

The EHR Association represents a community of software developers with many decades of experience creating successful electronic health records and related modules. Members noted that comments and suggestions sent to ONC and CMS represent companies ranging from developers of small ambulatory systems to large enterprise systems, software-as-a service models to traditional software, and software module suppliers.

“Through our comments, we try to highlight many of the initiatives from ONC and CMS that we agree with and offer our comments on how to fine-tune other areas for best adoption by our users,” said Carl Dvorak, vice president at Epic and chair of the EHR Association.

“We are honored to carry the message from our customers to ONC and CMS in support of appropriate timelines for not only software development and deployment, but most importantly for safe adoption by clinicians," he added. "In this regard, we strongly support and appreciate CMS’ proposed one-year extension of Stage 1 of meaningful use. We also recommend that CMS and ONC consider the additional ideas shared previously by the EHR Association and again in our comments this week that would build upon the one-year extension and assist in holistically resolving the challenge of appropriately timing Stage 2 for all stakeholders.”

Association members also noted that many elements of both the CMS and ONC proposed rules are aimed at substantially increasing the use and benefit of standards-based interoperability and exchange, which has been one of the EHR Association’s areas of advocacy and support since its inception in 2004.

“Overall, we congratulate ONC and CMS on the tremendous effort that went into the development of the proposed rules, as well as the progress we’ve made as an industry in accelerating the adoption of EHRs and other health IT," said Burchell. "We are ready to work with ONC and CMS to add clarification to the final rules as quickly as possible after they are published to ensure that our companies are ready to support the work our customers will need to do to upgrade their systems and implement many new features prior to the rapidly approaching start of Stage 2.”

Read the EHR Association's letters to National Coordinator for Health IT Farzad Mostashari, MD, and Centers for Medicare and Medicaid Services Acting Administrator Marilyn Tavenner, with their respective comments on the Stage 2 NPRMs, here and here.

EHR Association weighs in on Stage 2

CHICAGO – The HIMSS Electronic Health Records Association logged its comments on Stage 2 meaningful use with CMS and ONC this past Friday. Members of the vendor group praised the decision to delay Stage 2 by a year, allowing more time for development and testing.

The association responded to notices of proposed rulemaking (NPRMs) from both the Centers for Medicare and Medicaid Services, related to meaningful use objectives and measures for providers' use of certified EHRs, and the Office of the National Coordinator for Health IT, regarding EHR certification criteria and standards related to Stage 2.

The group offered recommendations on proposed certification criteria and standards, as well as on Stage 2 meaningful use requirements for providers. It praised CMS’ confirmation of a one-year delay in the start of Stage 2 in order to allow more time for testing and implementation of EHRs updated for Stage 2 – something that had been requested by a wide variety of stakeholder organizations.

"This was truly a collaborative effort that engaged more of our members than any of the previous public comment opportunities," said Leigh Burchell, vice president of government affairs for Allscripts and chair of the association’s Public Policy Leadership Workgroup. “Seven of our eight standing workgroups focused on specific sections of the NPRMs, ultimately collecting feedback from 138 individuals representing 25 member companies. We’re delighted with the level of participation, which represents the majority of operational EHRs in the U.S. and, most importantly, their users, lending credibility and weight to these comments.”

The EHR Association represents a community of software developers with many decades of experience creating successful electronic health records and related modules. Members noted that comments and suggestions sent to ONC and CMS represent companies ranging from developers of small ambulatory systems to large enterprise systems, software-as-a service models to traditional software, and software module suppliers.

“Through our comments, we try to highlight many of the initiatives from ONC and CMS that we agree with and offer our comments on how to fine-tune other areas for best adoption by our users,” said Carl Dvorak, vice president at Epic and chair of the EHR Association.

“We are honored to carry the message from our customers to ONC and CMS in support of appropriate timelines for not only software development and deployment, but most importantly for safe adoption by clinicians," he added. "In this regard, we strongly support and appreciate CMS’ proposed one-year extension of Stage 1 of meaningful use. We also recommend that CMS and ONC consider the additional ideas shared previously by the EHR Association and again in our comments this week that would build upon the one-year extension and assist in holistically resolving the challenge of appropriately timing Stage 2 for all stakeholders.”

Association members also noted that many elements of both the CMS and ONC proposed rules are aimed at substantially increasing the use and benefit of standards-based interoperability and exchange, which has been one of the EHR Association’s areas of advocacy and support since its inception in 2004.

“Overall, we congratulate ONC and CMS on the tremendous effort that went into the development of the proposed rules, as well as the progress we’ve made as an industry in accelerating the adoption of EHRs and other health IT," said Burchell. "We are ready to work with ONC and CMS to add clarification to the final rules as quickly as possible after they are published to ensure that our companies are ready to support the work our customers will need to do to upgrade their systems and implement many new features prior to the rapidly approaching start of Stage 2.”

Read the EHR Association's letters to National Coordinator for Health IT Farzad Mostashari, MD, and Centers for Medicare and Medicaid Services Acting Administrator Marilyn Tavenner, with their respective comments on the Stage 2 NPRMs, here and here.

Ill. hospital uses InfoLogix to keep employees up to date on technology

NAPERVILLE, IL – Administrators, clinicians and other staff at Edward Hospital don't have much time to learn the latest software applications and hospital procedures. When the choice comes down to taking a training course or doing your job in an ever-busy healthcare environment, healthcare wins out.

The hospital had offered four-hour training sessions at least 10 times a month, but those were hard to fit into a tight schedule, and often clinicians had to postpone or cancel sessions if a medical emergency arose. As a result, the traditional, classroom-based approach was proving unwieldy and expensive.

To keep its employees up to date on the latest tools and procedures, the 300-bed, full-service hospital in Naperville, Ill., turned to InfoLogix to implement an online training system.

InfoLogix, based in Hatboro, Pa., offers enterprise mobility and wireless asset tracking solutions to a number of healthcare providers, including Kaiser Permanente, the MultiCare Health System and the Stanford School of Medicine. The company created a customized version of its OnTrack Learning Management System for Edward Hospital, developing an online curriculum for more than 150 supervisors and department managers.

The system allowed hospital employees to develop their own individual training schedules. The Web-based program is accessible from any computer and at any time.

"Training administrators and clinicians in a busy healthcare organization involves significant logistical challenges, but InfoLogix studied our requirements and built a Learning Management System that's custom-tailored to how we work, right down to the smallest detail," said Teresa Oliszewicz, the hospital's manager of organization development and learning. "Now we have a fully-automated training system that allows us to train employees quickly and efficiently so they can devote time to what matters most - our patients."  

"Based on our experience working with more than 1,400 hospitals nationwide, we know organizational development and training are ongoing challenges to healthcare organizations," said David Gulian, InfoLogix's president and CEO. "We're excited about the customized Learning Management System we created for Edward Hospital, as we believe that new technology solutions play a vital role in increasing efficiencies, reducing costs and providing better patient care."
 

CDC Says Helmets Are No Match For Tornadoes, But They Might Not Hurt

Enlarge Courtesy of the Stewart family

Noah Stewart shelters in the closet just 15 minutes before an April 2011 tornado demolished his house. Wearing the helmet may have saved his life, one doctor says.

Courtesy of the Stewart family

Noah Stewart shelters in the closet just 15 minutes before an April 2011 tornado demolished his house. Wearing the helmet may have saved his life, one doctor says.

Can a helmet protect you in a tornado?

The Centers for Disease Control and Prevention says there's no research on how effective helmets are in preventing head injuries during tornadoes.

But, in what looks like a first, the agency says, in effect, that it's not out of the question that they might help.

Last year, tornadoes claimed the lives of more than 500 people in the U.S. Some safety advocates say protecting your head with a sturdy helmet could help reduce injuries and deaths.

But when NPR's Russell Lewis asked the health gurus at the CDC about the merits of the approach, he didn't get much of an answer.

 

As he reported last week:

"The CDC website tells motorcyclists to wear helmets because they save lives; ditto for bicyclists.

But if a tornado is bearing down? The CDC recommends people use their hands to protect their heads. It makes no mention of a helmet.

For three months we tried to interview someone from the CDC, but the agency would only email a statement, which said: 'The scientific evidence from helmet use during tornadoes is inadequate to make a recommendation.' "

Today, the CDC issued a statement that affirms the importance of getting yourself to a safe place, such as a basement, or deep in a ditch or gully if you're outside. That's nothing new.

Can Helmets Cut Tornado Risks? heard on Morning Edition

April 27, 2012

Can Helmets Cut Tornado Deaths? CDC Isn't So Sure [4 min 32 sec] Add to Playlist Download  

But the agency says it recognizes that people facing down a tornado want to protect themselves however they can. "Individuals may decide to use helmets to protect their heads," the agency says. And it's not telling people to refrain from doing so.

Since time is likely to be short in a heavy-weather emergency, the agency recommends that you have a helmet ready to go in your emergency kit, if you think you'll want to use one. You don't want to be fumbling around for one as a funnel cloud draws near.

Of course, a helmet alone is no match for a tornado. "For those who choose to use helmets, these helmets should not be considered an alternative to seeking appropriate shelter," the CDC says. "Rather, helmets should be considered just one part of their overall home tornado preparedness kit to avoid any delay."

For more information on how to prepare for a tornado, the CDC has some advice here.

Manila hospital implements cloud-based EHR

OffSiteCare Resources (OSCR) recently implemented HarmoniMD, its cloud-based EHR, in Mary Johnston Hospital in Manila, Philippines. The implementation follows installations in Haiti and the Congo, where OSCR helped open a four-bed ICU in Kolweizi, central Congo.

“Our implementation in Mary Johnston Hospital demonstrates that HarmoniMD can be readily implemented in hospitals with limited IT support and proves the value of a cloud-based system that is intuitive and easy to use,” said Nick Smith, CTO of OSCR.

“Unlike almost every other EHR system, we built HarmoniMD from the ground up with the latest cloud technologies so we are able to leapfrog over legacy server-based applications," he added. "This makes it ideal for hospitals like Mary Johnston, which is in one of the poor parts of Manila.”

Under the leadership of James Gude, MD, OSCR provides telemedicine services to seven hospitals locally. OSCR has also provided medical consultations to the Congo using the iPad for telemedicine consults.

Health insurance exchanges mired in political battle

WASHINGTON – While President Barack Obama and the all-but-official Republican contender Mitt Romney gear up to debate how each would fashion future healthcare, the battle over a critical underpinning of the law is being fought not in the nation’s capital, but in the states.

That would be individual state’s health insurance exchange (HIX). This contentious segment of the Patient Protection and Affordable Care Act (ACA) is caught in a firestorm of political crosscurrents. Some states, such as Wisconsin, actually started work to ultimately stand up an HIX – only to abandon that effort and return the federal funding. Maryland and others are moving forward. And others still are trying, in the governor’s mansion, but meeting formidable resistance in the legislature.

[See also: HHS issues final rule on insurance exchanges]

What with Republican presidential hopeful Mitt Romney frequently reasserting his plans that day one in office, if elected, would entail signing an Executive Order to grant all 50 states waivers that essentially serve as get-out-of-health-insurance-exchange-free cards, the future of HIX appears troubled.

And if President Obama is reelected? Well, as the federal overreach part of the Republican’s argument against the ACA, and something states have the right to decline funding for, HIX might not fare much better under a Democrat than a Republican.

Health insurance exchanges, meanwhile, are the prime example of how partisan politics can effectively inhibit health reform and the information technology underpinning it – something that started almost immediately after President Obama signed PPACA in March 2010.

[See also: Cost, confusion hindering HIX development]

[See also: How bipartisan is health IT?.]

Yet the success of health reform is dependent on health insurance exchanges.

Tracing it back to the mid-terms
While the road to this year’s presidential election grabs the headlines, it is the effect of the 2010 mid-term elections for state legislatures and governors that has shaped how states are driving forward or sliding behind in applying the health reform law, most notably the establishment of health insurance exchanges.

The dizzying swing to the right in 2010 led some states to balk at an insurance exchange. Some, such as Iowa and Wisconsin, set work aside until the Supreme Court rules in June on the constitutionality of the Patient Protection and Affordable Care Act – an approach that will leave little time to accomplish what is needed to be operational by 2014.

Other states have plowed ahead. Arizona, Maryland and California, among those, are taking on the policy, political, and economic work to establish their exchanges.

The project is “not for sissies,” said California Health Benefits Exchange Board member Kimberly Belshe, adding that tasks tend to be even more enormous in practice than on paper. “The implementation of health insurance exchanges and other parts of federal health reform is an undertaking that is not for the faint of heart,” said Belshe, who is also senior policy advisor at the Public Policy Institute of California. Belshe spoke at a recent conference roundtable with other state exchange officials. She was also secretary of the state’s Health and Human Services Agency under former Gov. Arnold Schwarzenegger.

California and Maryland have each received about $40 million in federal grants to plan, establish and innovate IT systems to get their exchanges off the ground.

States like California and Maryland have assembled stakeholders representing providers, payers, consumers, vendors and public policy groups to outline what an exchange should do and develop the rules of the road, sought legislative approval where needed and collaborated with Medicaid and other state health agencies on eligibility and enrollment systems.

[Political Malpractice: How politics distort Americans' perception of health reform.]

Iowa and Kansas joined the Florida-led lawsuit challenging the constitutionality of the PPACA when newly-elected Republican governors took office in January 2011.

Mired in legislation
Kansas dug in its heels around all things health reform, according to Robert St. Peter, MD, president and CEO of the Kansas Health Institute, an independent researcher for state policymakers (pictured at left).

Kansas Gov. Sam Brownback returned to the government $31 million for an early innovator grant to work on insurance exchanges. The legislature passed a bill opposing the requirement of any Kansan to purchase insurance or be in the state healthcare system. And Kansas did not apply for pockets of grant money available through the Affordable Care Act, such as community transformation grants, St. Peter said.

[See also: HIX deadline �less than 600 days�]

Family’s trip down health insurance ‘rabbit hole’ puts human face on desperately needed reform provisions

"A crippling accident could befall any one of us if we happen to travel on the wrong road, at the wrong time, in the wrong situation. Such a calamity would crush any one of us, too, were we left to face it alone. In such cases, our families ... would become dependent on relatives, friends, and neighbors collecting money in decorated coffee cans from strangers to help meet our basic needs." - Harold Pollack

Today's Times includes a jaw-dropping op-ed, "Down the insurance rabbit hole," by MIT political scientist Andrea Louise Campbell. Reflecting on Justice Scalia's recent professed skepticism about forcing young people to buy insurance that largely subsidizes others, Campbell writes:

May the justices please meet my sister-in-law. On Feb. 8, she was a healthy 32-year-old, who was seven and a half months pregnant with her first baby. On Feb. 9, she was a quadriplegic, paralyzed from the chest down by a car accident that damaged her spine. Miraculously, the baby, born by emergency C-section, is healthy.

Were the Obama health care reforms already in place, my brother and sister-in-law's situation � insurance-wise and financially��� would be far less dire. My brother's small employer � he is the manager of a metal-fabrication shop��� does not offer health insurance, which was too expensive for them to buy on their own.

Campbell's sister-in-law will eventually be covered by Medi-Cal (California's version of Medicaid), and will thus become subject to that program's rather punishing financial constraints. There is a $3,000 asset limit. Campbell's family can own a house and a vehicle, but no retirement or college savings. Relatives are not allowed to provide financial help. And so on.

Campbell's essay suggests the human impact of otherwise arcane aspects of the 2010 Affordable Care Act, otherwise known as health reform. One issue concerns personal responsibility and the individual mandate. This young couple took their chances going without coverage. Of course, they didn't take that chance in a vacuum. They, like millions of others, faced a tough, confusing, and troubled market for individual coverage. Under such circumstances, it's not surprising that many people decide they can't afford reasonable coverage.

Two years from now, when the main pillars of health reform become operative, young families will be able to buy decent coverage through an insurance exchange. Families will receive financial help if they can't afford to buy such coverage. It should therefore become less common to see uninsured victims of tragic accidents struggling to find help. Two years from now, Campbell's brother will be able to find a job and get health insurance under terms that do not discriminate against people with pre-existing conditions. Their family may qualify right now for the new high-risk insurance pools known as Pre-Existing Condition Insurance Plans.

Health reform matters in other ways, too. Because quadriplegics require such intensive treatments and nursing care for so long, many eventually hit annual or lifetime limits of their health insurance and are financially wiped out. (See, e.g., this sad story of�Chicago-area athlete Rocky Clark, rendered quadriplegic by a football mishap, who outlived his insurance coverage.)

The Affordable Care Act addressed such tragedies by eliminating lifetime insurance dollar caps for appropriate care. It phases out annual dollar limits on what insurers must cover in the event of catastrophic illness or injury. It established regulations to ensure that insurance provides essential benefits with limits on out-of-pocket expenses when catastrophe strikes.

Contrary to the opinions of some Supreme Court Justices, this case even brings out the connections between health insurance and interstate commerce. I suggested to Andrea that her brother's family move to Massachusetts, which operates a much better, much more humane health care system for the disabled and for those with pre-existing conditions.

The new law isn't perfect. Campbell's sister-in-law will qualify for Medicare because she is disabled. Yet she faces a 24-month waiting period which should have been eliminated long ago. The failure to fix this problem was a political and policy error in health reform. Even after she qualifies for Medicare, Campbell's sister-in-law will remain dependent on Medi-Cal to pay for essential disability services that Medicare does not cover. So her family will still face Medicaid's punishing requirements.

A crippling accident could befall any one of us if we happen to travel on the wrong road, at the wrong time, in the wrong situation. Such a calamity would crush any one of us, too, were we left to face it alone. In such cases, our families, like Andrea Campbell's, would become dependent on relatives, friends, and neighbors collecting money in decorated coffee cans from strangers to help meet our basic needs.

America spends almost $3 trillion on health care. We can do better than that. We should take care of each other. That, too, is a fundamental principle of health reform.

Wash. woman accused of putting bleach in daughter's eyes

TACOMA, Wash.(AP)�Prosecutors have accused a Washington state woman of repeatedly putting bleach into her daughter's eyes, causing permanent vision loss in the toddler's right eye.

Jennifer Mothershead was arrested Friday and was charged with assault after a lengthy investigation.

Authorities say her daughter was airlifted to Harborview Medical Center in Seattle in May 2011 after sustaining a serious head injury. The girl, who was 14 months old at the time, also had an eye infection. Doctors called the Pierce County Sheriff's Department because they suspected the head injury was a result of abuse.

Mothershead told a detective her daughter started to have an eye issue in March 2011 after playing in a barn. She said the girl received antibiotics and eye drops, but Mothershead didn't provide an explanation for the head injury and, according to the detective, didn't show any emotion about her daughter's injuries.

The detectives placed the girl in state protective custody.

Mothershead had brought the eye drops to the hospital, and a staff member later opened the drops and noticed a foul odor. Investigators sent the drops to the Food and Drug Administration's Forensic Chemistry Lab for analysis. The lab determined the drops contained bleach.

"The staff at Harborview determined that the damage to the child's eyes was consistent with repeated exposure to bleach, and ruled out any possibility that the eye dropper had been merely cleaned with bleach," prosecutors said in a statement.

The girl's condition improved in the hospital, but doctors noted she'd lost vision in her right eye. The girl now lives with her father.

Mothershead, 29, of Buckley pleaded not guilty to first-degree assault of a child Monday. Mothershead was ordered held in lieu of $150,000 bail.

���

Information from The News Tribune: http://www.thenewstribune.com/

New Facebook feature encourages organ donation

The organ donation community is applauding Facebook's announcement Tuesday that it will allow its 900 million members to share their donor status with friends and family, and to link to state databases where people in the USA can register online to officially become donors.

"This is great news. It has the potential to be one of the biggest campaigns to increase donor designation that we've ever seen," said John Green, community relations director for the Gift of Life Donor Program, based in Philadelphia.

"It's absolutely critical at this time when online communication and social media are really the way people are communicating," said Julia Rivera, director of communications for the New York Organ Donor Network.

In an interview on Good Morning America Tuesday, Facebook founder Mark Zuckerberg said the organ donation initiative was inspired by disasters such as last year's earthquake and tsunami in Japan and the social network's role in keeping people connected.

Zuckerberg also cited his girlfriend, Priscilla Chan, who is studying to become a pediatrician. "Our dinner conversations are often about Facebook and kids, and the kids that she's meeting," he said. "She'll see them getting sicker, then, all of a sudden, an organ becomes available, and she comes home and her face is all lit up because someone's life is going to be better because of this."

Facebook is partnering with Donate Life America, a national umbrella organization for local groups working to increase the number of registered organ, eye and tissue donors.

Nearly 114,000 men, women and children are currently waiting for a lifesaving transplant, said the organization's Aisha Huertas Michel. Thousands more are in need of tissue or corneal transplants to resume normal lives or restore sight, she said.

"We're hoping people will be excited about the initiative and it will prompt them to take the next step and register to be a donor," Michel said.

Only about 43%, of U.S. adults have signed up to be an organ donor through a state registry � often accessed through their state Department of Motor Vehicles and listed on their driver's licenses.

Facebook's initiative will "help bring out the conversation about organ donation," said Jeffrey Punch, chief of transplantation surgery at the University of Michigan in Ann Arbor.

"The vast majority of people understand that it's a good thing and want to donate," he said, but for various reasons have never officially registered.

When that happens, "it puts families in a tough situation when a tragic loss occurs and they're faced with having to make a decision while grieving," Punch said.

"There's no downside to spreading this awareness and encouraging people to make a commitment" to be an organ donor, he adds, "so their family won't be placed in this situation."

Cancer Doc Brawley Says The U.S. Health Care System Is Sick

Journalists make for a pretty tough crowd.

But Dr. Otis Brawley, chief medical officer for the American Cancer Society, fired up hundreds of them at the annual meeting of Association of Health Care Journalists over the weekend with a no-holds-barred critique of the U.S. health system.

Brawley has a book out, How We Do Harm: A Doctor Breaks Ranks About Being Sick in America, that makes his case in full. But in a sometimes dizzying speech in Atlanta, Brawley ripped the health establishment from top to bottom. It was bracing stuff.

The group just posted a video about the event.

AHCJ/YouTube

Here are some of the highlights, as tweeted by journalists at the meeting, if you prefer.

 

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[View the story "Otis Brawley Lays Down Health Care Challenge" on Storify]

Wanted: Mavericks And Missionaries To Solve Mississippi's M.D. Shortage

When Janie Guice looks at the Mississippi Delta she sees a vast, flat flood plain home to cotton fields and catfish farms. She also sees desperate rural health problems and a deep shortage of doctors to offer care. Her job: to find doctors to fill that void.

"Who is the one that is going to go back and live in a community that maybe doesn't even have a Wal-Mart? And yes, there are a lot of communities in Mississippi that don't have a Wal-Mart yet!" Guice laments.

Enlarge Jeffrey Hess for NPR

Janie Guice is the recruiter for the Mississippi Rural Physician Scholarship Program.

Jeffrey Hess for NPR

Janie Guice is the recruiter for the Mississippi Rural Physician Scholarship Program.

In rural or poor places like Mississippi the number of doctors per person is among the lowest in the country. Five years ago, the state Legislature established the Mississippi Rural Physician Scholarship Program to provide a full ride to medical students who agree to begin their practice in a rural area. There are two conditions: Students must originally come from a small Mississippi town far from health care, and they must agree to go back into practice in a rural area for four years after they graduate.

Guice is the recruiter for the program. She is fervent in her commitment to finding the perfect candidates.

"Basically I am looking for one of two personalities," she explains. "Either the maverick who is going to go to med school and go back home and fix what is wrong with the health care system. Or the missionary. The student who says to me, 'I thought about going to seminary but now I want to be a doctor,' to which I say 'Have I got a mission for you � it's called Mississippi!' "

 

Guice believes students from small towns will put down roots and stay after their mandatory four years are up.

The success � or failure � of the program depends largely on her ability pick the right students.

Students like 26-year old John Russell McPherson, who'd already been admitted to med school when one day he got an email. "It said, 'Do you want to work in a primary care setting?' I said yes and kept scrolling. It said, 'Do you want to work in rural Mississippi?' Yes. 'Do you want $30,000 a year?' It had Janie's email on it, so I signed up!"

McPherson is from the Delta town of Inverness � population 1,000 � and he outlines why he plans to return to the area he loves.

"Dirt roads. No traffic. Hunting. Outdoor stuff. That is what I am about and that is what I want to get back to," McPherson says. "Work is going to be work and you are going to make a good living doing this, but it is really about being close to the family and hobbies that you enjoy."

Drive an hour and a half from the medical school and you'll find yourself in the Delta county of Humphreys. There are four doctors in Humphreys County for its 10,000 residents

Colorfully painted stone catfish statues line the streets of the town Belzoni, which is the Humphreys County seat and self-described "catfish capital of the world."

In the Belzoni town square is a squat, white concrete building that houses the Gorton Rural Health Clinic. It happens to have a perfect example of what Guice wants to replicate: a father-son team of doctors Mack and Carlton Gorton.

The older doctor just turned 70 and has been running the clinic for 40 years. His roots go way back. His father had a drugstore in Belzoni, and when the town needed a doctor, Mack Gorton set up his practice. Eight years ago, Gorton's son Carlton joined him. Carlton explains that he can't imagine being anywhere else.

"It is a challenge to get people to come to the Delta to practice. So I think it is usually somebody who has to be here who has a love for people and love for what you are going to be treating here," he says.

In rural areas of Mississippi, obesity and diabetes are the norm and life expectancy is far lower than the national average. At least one Delta county has no doctor at all.

Guice says the doctors who leave her program for these areas will help provide better treatment. They'll also play another role: generating as much as $2 million a year in economic impact in a town.

The first of Guice's rural scholars will be leaving residency to begin practice later this year, with more than 40 aspiring doctors currently in the pipeline.

Editor's note: Another source of physicians for Mississippi is in the works. A new school of osteopathic medicine in the state expects to graduate its first Doctors of Osteopathy in 2015. The William Carey University College of Osteopathic Medicine was started in 2008 and received provisional accreditation in 2009.

This report is part of a partnership with NPR, Mississippi Public Broadcasting and Kaiser Health News.