Telehealth: High-tech link enables pharmacies to reopen in rural communities
Medically underserved rural areas in North Dakota are seeing the return of local pharmacies, thanks to telepharmacy technology. The sites, which receive medication by courier from a central pharmacy, are staffed by a registered pharmacy technician. A registered pharmacist in another location supervises the technician and is also available for patient questions through videoconferencing technology.
North Dakota in 2001 developed the telepharmacy program in response to dozens of rural community pharmacy closures, a shortage of health care professionals and declining access to health care.
The North Dakota State Board of Telepharmacy in 2001 established pilot telepharmacy rules. In 2002, the North Dakota State University College of Pharmacy received a federal grant from the Office for the Advancement of Telehealth to implement a statewide telepharmacy program and to test the new rules. The project began with 10 volunteer sites and now has 67 locations.
Nine other states and the District of Columbia also have changed laws to allow for remote pharmacies.
Most of the telepharmacies in North Dakota are full-service sites with complete drug inventories, including over-the-counter and prescription drugs. The sites cost a pharmacist or business owner about $18,000 to set up, and the North Dakota Board of Pharmacy charges an annual licensing fee of $175. Licensed pharmacists may also be eligible for federal grant assistance through the Office for the Advancement of Telehealth.
In addition to restoring local access to health care in remote areas, the project has added approximately $12 million to rural economies through new jobs and pharmacy retail services.
For more information on the North Dakota project, visit http://telepharmacy.ndsu.nodak.edu.
IT Adoption: Docs offered $700 million to purchase EHR systems
Only 4 percent of U.S. physicians have a fully functional electronic health record system, according to a recent study in The New England Journal of Medicine. To improve ambulatory EHR adoption rates, public and private-sector programs are offering incentives and subsidies to physicians. The Certification Commission for Healthcare Information Technology identified 90 such initiatives and cataloged them in the CCHIT Incentive Index. Of the 90 programs, 50 were launched by hospital organizations responding to the 2006 federal “safe harbor” regulations.
CCHIT found that incentive programs are providing more than $700 million for the adoption of EHRs and other technology. This figure is based on 36 programs reporting current and anticipated financial investments and commitments. Initiatives distribute funds as incentive payments to physicians, for regional networks and community alliances of physician practices, and for providing EHR capabilities to rural and medically underserved areas.
Distribution amounts vary. CCHIT reports that physicians under one program can receive up to $50 per patient whose treatment meets expectations for at least one clinical improvement program, such as diabetes or heart care. Another program gives doctors up to $125 per year for each patient provided care under a medical home model.
The CCHIT Incentive Index will be updated as new programs start up or those not initially identified are uncovered.
For additional information, visit www.cchit.org/incentive-programs.
Disaster Preparedness: Hurricane Katrina has lasting impact on it, medical records
Three years after Katrina, many health care facilities remain in recovery. Physical structures have been rebuilt and staff has returned, but health information technology issues still linger, according to a report in the Journal of AHIMA.
Many hospitals lost thousands of paper medical records to flooding and subsequent mold. One of the hardest hit, Medical Center of Louisiana (now LSU Interim Hospital) in New Orleans, lost 400,000 patient records when its basement flooded, the Journal reported. Afterward, health care leaders in New Orleans saw an opportunity to build a model health care system with cutting-edge technology. In 2006, the Louisiana Health Care Redesign Collaborative was created by the Louisiana Department of Health and Hospitals. One of the collaborative’s proposals was the implementation of an interoperable electronic health record system.
Funding health IT, however, took a backseat to paying staff salaries. Many professionals required increased salaries to return to Louisiana, and hospitals struggled to bridge the gap between Medicare payments and local wages. The Journal reported that new efforts to introduce EHRs into hospitals recently began with the formation of the Coalition of Leaders for Louisiana Healthcare.
Some health care leaders are initiating their own transformations. While paper records were lost to the storm, electronic data was mostly intact after Katrina. Since then, general use of electronic systems at Tulane Medical Center has increased overall, and the hospital has seen a 50 percent increase in the number of physicians dictating information from patient visits, according to the Critical Care eNewsletter.
In some cases, the hurricane delayed needed improvements. East Jefferson General Hospital had planned to launch an enterprisewide EHR system in October 2005 but was unable to go live until July 2006, the Journal reported. The EHR ultimately contributed to the hospital’s recovery because bills were issued more quickly and coders were able to work from home, which reduced turnover.
Louisiana health information management departments are also looking to enhance their disaster preparedness plans by using technology, but many backup plans remain rooted in paper processes. LSU Interim Hospital has moved its paper records to the second floor and, as part of the strategic plan at Touro Infirmary in New Orleans, each patient’s medical record will be sent with the patient during an evacuation.
For the full report, visit www.ahima.org/journal.
Quality: NQF tech standards to help providers assess current systems, identify gaps
The National Quality Forum has endorsed nine structural standards for health information technology. While these measures are voluntary, NQF intends for them to help providers assess efficiency and standardization of current systems and identify areas where additional IT tools can be used.
The nine measures fall into five categories:
- E-prescribing: Adoption of e-prescribing; use of an EHR with electronic data interchange for a prescribing event
- Interoperable EHR: Adoption of health information technology; ability for providers with health IT to electronically receive laboratory data directly into their qualified/certified EHR systems as discrete searchable data elements
- Care management: Ability to use health IT to perform care management at the point of care; provider tracking of clinical results between patient visits
- Quality registry: Physician or other clinician participation in a practice-based or individual quality database registry with a standard measure set; physician or other clinician participation in systematic clinical database registry that includes consensus-endorsed quality measures
- Medical home: Meet Medical Home System Survey standards
The standards come from mea-sures developed by the Centers for Medicare & Medicaid Services, Quality Insights of Pennsylvania, the New York Department of Health and Mental Hygiene, and the National Committee for Quality Assurance.
For more information on NQF’s health IT standards, visit www.qualityforum.org.
Infrastructure: Information exchanges deliver benefits, save money, survey confirms
Most fully operational health information exchanges reported reductions in health care costs in a recent survey conducted by the eHealth Initiative. The survey found that savings came from the elimination of redundant tests; reduced number of admissions due to medication errors, allergies or interactions; decreased cost of caring for chronically ill patients; and reduced staff time spent on administration. The benefits of health information exchanges included improved access to test results, improved guideline compliance and increased recognition of disease outbreaks, respondents reported.
The survey received responses from 130 community-based initiatives, of which 42 are operational. This is an increase from the 32 operational initiatives that responded in 2007. Major findings include:
- 18 new exchange initiatives were reported for 2008.
- All 32 operational initiatives in place in 2007 were still functional in 2008.
- Respondents reported active participation in health information exchange initiatives by providers, payers, patients and public health agencies.
Financing continues to be a struggle for health exchange initiatives. Eighty-two percent of respondents cited development of a sustainable business model as a very difficult or moderately difficult challenge, and 79 percent cited securing up-front funding as a very difficult or moderately difficult challenge. Respondents noted that hospitals are the primary source of funding, with 62 percent of active health information exchanges receiving funds from hospitals to support ongoing operations.
For additional information, visit www.ehealthinitiative.org/HIESurvey.
Data: Key patient sample analysis methods prove worthless
Researchers at Uppsala University, Sweden, concluded that two computer-based methods for classifying patient samples may be worthless when applied to practical problems, according to MTBEurope. A practical application of such classification methods might be choosing a form of cancer therapy.
The methods reviewed in the study, cross-validation and bootstrapping, have been used to determine performance estimates for decision support systems by researchers around the world. Cross-validation is the statistical practice of partitioning a sample of data into subsets and analyzing one subset at a time, while the other subsets are retained for use in confirming and validating the initial analysis. Bootstrapping, also known as resampling, involves generating subsets of the data on the basis of random sampling with replacements as the data are sampled. Because biomedical research is often expensive and patient samples difficult to collect, these methods have been relied upon heavily since the 1980s.
Computer-based methods for measuring patient samples have received significant interest in recent years because they provide a foundation for technical applications such as recognition of voices, images and fingerprints, and are attracting more health-care-related applications.
MTBEurope reports that the Uppsala researchers used both theory and computer simulations to demonstrate that the methods do not work when the total number of samples is small in relation to natural variation existing among different observations. The researchers determined that what is considered a small number depends on the problem being studied and that it is impossible to conclude whether the number of samples is sufficient.
“Our main conclusion is that this methodology cannot be depended on at all,” Mats Gustafsson, co-author of the study, told EurkAlert. The study was published in Pattern Recognition Letters.
For more information on this study, visit www.uu.se/en.
This article first appeared in the Fall issue of HHN's Most Wired Magazine.
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