GE Medical Systems Information Technologies signed an agreement with Oregon Health and Sciences University to provide its Centricity Pharmacy Information system to the 420-bed, Portland, Ore.-based academic medical center.

Futura Medical Company offers Safe-T-Lance [TM] Plus–an ergonomically designed, innovative safety lancet that will help reduce needlestick injuries. The Safe-T-Lance Plus is available in three sizes: Low Flow, Medium Flow and High Flow. It requires no preloading of the needle and has a special spring-action mechanism that provides a comfortable and quick method for blood sample retrieval.

To use, simply twist off the protective cover, place the device against the patient’s sample site and press the colored button to retrieve the blood sample. The needle remains in the cartridge before and after use. The hidden needle feature allows for one-time use to help protect both the patient and the clinician from cross-contamination.

The U.S. Department of Health and Human Services (HHS) has initiated two new steps in building an electronic health care system that will allow patients and their physicians to access their complete medical records as needed, leading to reduced medical errors, improved patient care, and reduced health care costs.

HHS Secretary Tommy Thompson said HHS has signed an agreement with the College of American Pathologists (CAP) to license the college’s standardized medical vocabulary system and make it available without charge throughout the country.

He said this action opens the door to establishing a common medical language as a key element in building a unified electronic medical records system.

HHS also has commissioned the Institute of Medicine to design a standardized model of an electronic health record. The health care standards development organization, known as HL7, has been asked to evaluate the model once it has been designed.

HHS will share the standardized model record at no cost with all components of the U.S. health care system and expects to have a model record ready in 2004. It estimates that the free system will reduce medical errors and reduce health care costs by about $100 billion per year. However, many health care institutions will need to invest in computers and train staff.

With terms for more than 340,000 medical concepts, CAP’s standardized system has been recognized as the world’s most comprehensive clinical terminology database available, the agency said.

The licensing agreement with CAP will make it possible for health care providers, hospitals, insurance companies, public health departments, medical research facilities, and others to incorporate this uniform terminology system into their information systems.

The National Library of Medicine (NLM) at the National Institutes of Health will administer the CAP agreement under a five-year, $32.4 million contract to the organization for a permanent license for their terminology, known as SNOMED (Systematized Nomenclature of Medicine) Clinical Terms.

The contract includes a one-time payment shared by the Departments of Veterans Affairs, Defense, and several HHS agencies–with annual update fees paid by the NLM.

The NLM will distribute SNOMED through its Unified Medical Language System, which incorporates, links, and distributes in a common format 100 different biomedical and health vocabularies and classifications.

In a letter to U.S. senators and representatives, the AAFP and 122 national and state medical organizations have called for adequate Medicare payment to physicians. The letter tells federal lawmakers that failure to increase Medicare payments to physicians will undermine federal policy of making health care available to America’s Congress to act on legislation that would avert a 4.4 percent cut in Medicare payments to physicians set to take effect Jan.

1, 2006. “If this cut is imposed, Medicare rates will fall 16 percent below the government’s says. “If this cut occurs, the average physician payment rate will be less in 2006 than it was in 2001.” Even if Congress were to freeze payments at 2005 levels, physicians would, in effect, experience a pay cut because inflation is projected to increase practice costs by 2.7 percent next year, according to the letter. The AAFP has urged Academy members to contact their U.S. senators and representatives about Medicare payment.

Happy New Year! As I was preparing this column, a colleague recommended including a site for those of us who are putting a positive spin on the new year by starting projects and setting other types of goals. The staff at the University of Maryland Medical Center has compiled some suggestions for a successful 2007, and we should try to apply these in our professional lives as well. A few to get you started: set realistic, attainable goals, share goals with others to keep yourself on track, use mistakes as opportunities for learning, and begin as soon as possible to get the momentum going. And reward yourself for a job well done!

I can’t help it … I’m all about the blogs. The new LISZEN–Library and Information Science Search Engine–uses Google Co-op, a create-your-own search engine, to search LIS blogs. Garrett Hungerford, the site’s creator (also a public library network manager and an LIS student), started with the blogs listed on LISWiki (also worth a click), and now there are more than 500 blogs to search. If yours isn’t listed, add your blog to the LISZEN wiki and submit your contact information. Simple. And now, simpler to find that post about [your topic here] that you know you read but can’t remember where.

What are the LIS students up to these days? At the University of Missouri-Columbia, they’re podcasting. Check out LiSRadio, where you’ll find conversations on jobs and other LIS topics, plus interviews with vendors, publishers, and professors. Download a podcast from the archives, or view the calendar for upcoming shows of interest and listen live. Lots of instructions for listeners and participants. Subscribe to feeds for individual series or all of them. Some content is directed at local students, but you’ll likely find something to listen to and even a few ideas for a podcasting in your own information center.

OneTouch Technologies is unveiling the OneTouch System, an electronic data-recording system for inputting resident information at bedside, improving resident care and operational efficiency. At press time OneTouch Technologies was planning to conduct pilot tests with several major long-term care chains.

The OneTouch System includes a computer microchip (iButton) embedded on both a resident’s identification wristband and on the caregiver’s name badge. In addition, the caregiver uses a customized Personal Digital Assistant (PDA) and wand to read the iButtons and record the pertinent resident information.

On the PDA, the OneTouch System provides a preformatted clinical checklist/menu of observations to be made and procedures to be performed and recorded. This enables the caregiver to simply touch an icon on the screen to record preconfigured information without computer keystrokes and in minimal time.

For years, people have been going to the doctor, paying a 810 to 830 copay and going on with their day without thinking about what it truly costs for that doctor’s visit. With the advent of consumer-directed health plans, individuals are beginning to pay closer attention to their health-care expenditures.

Until recently, it has been difficult to determine how much to set aside in dedicated accounts because the cost of doctor’s fees and other healthcare services are typically unavailable to the general public. One national health insurer, Aetna Inc. of Hartford, Conn., is looking to change that scenario.

In August, Aetna began providing members with the prices it negotiates with physicians for hundreds of medical procedures, diagnostic tests and office visits. The program, which is being piloted in Cincinnati, Davton and Springfield, Ohio, Northern Kentucky and Southeast Indiana, aims to let consumers know what they can expect to pay at the doctor’s office before going in for a visit in order to better gauge their out-of-pocket health-care expenses. Aetna members now have online access to a doctor’s discounted rates for up to 25 of the most common office-based services.

This is good news, according to Aetna executives.

“The biggest impediment to effective consumerism in health care has been the unavailability of relevant data on health-care quality and cost,” says Ronald Williams, president of Aetna. “We are taking the lead on opening what is often perceived as the ‘black box’ on physician-specific pricing. As more Americans begin managing their health-care dollars, they are increasingly interested in the ‘price tag’ for the health-care services they receive.”

Aetna is aiming to provide consumers with this information to help them make more informed decisions about their health-care services.

“We have been providing tools to help consumers make health-care related decisions for some time,” says Robin Downey, head of product development at Aetna. “Our members have had access to estimated physician cost information via Aetna Navigator, our password-protected member Web site, and are able to view in-network versus out-of-network rates for physicians in specific geographic areas, along with gauging the cost of chronic conditions, such as asthma and diabetes. With the growth in consumer-directed health plans, we felt it was time to take it to the next level–to begin offering true transparency of health-care costs.”

Aetna held focus groups with network physicians and members, in addition to representatives from local and state physician professional organizations as well as large group practices in Ohio, to guide the creation of the program.

“The physicians we spoke with agreed that patients should understand what their services cost, in addition to the need to make this information easily accessible and understandable,” says Downey. “Throughout the pilot program, we will continue to get feedback from members and physicians so that we can continue to enhance and improve these services.”

A SHROUD STILL SURROUNDS QUALITY

While many health-care consultants and medical providers applaud Aetna’s efforts because it sheds light on the real cost of health care, they agree there are still many challenges ahead, the major one being how to measure quality.

“The consumer is the force that drives cost transparency,” says Harvard Business School professor Regina Herzlinger, a long-time advocate of consumer-directed health care. “As soon as this information becomes more widely available, physicians will need to become more competitive in their pricing, in addition to focusing more attention on how they measure the quality of care provided.”

“For too long, the medical industry has shielded consumers from transparency on cost and quality,” says Stephen Neeleman, CEO of HealthEquity Inc., an administrator of health savings accounts based in American Fort, Utah. “Physicians today need to provide the highest quality for the lowest price. While we’re trying to be more transparent about price, it’s often difficult due to additional fees from treatment facilities, surgeons, anesthesiologists, hospitals, and other costs involved in treating a patient.

“The goal,” says Neeleman, “should be to provide a fair market price for our services and work with patients to determine what makes the most sense for them–such as having a procedure performed on-site at a doctor’s office or at a hospital or clinic.”

Unfortunately, says Hal Heaton, professor of finance and associate director of the Center for Entrepreneurship at Brigham Young University in Provo, Utah, “Health care does not compete like other industries. When was the last time you saw an advertisement by a health-care provider that says, ‘Come to us for the highest quality kidney stone removal at the lowest price?’ Today, health care competes by offering more expensive service because no one pays much attention to the cost. The concept of HSAs opens myriad entrepreneurial opportunities, and will ultimately lead to more specialization and competition based on both cost and quality by health-care providers.”

According to the Institute of Medicine (IOM) in its 2000 report “To Err Is Human: Building a Safer Health System,” at least 44,000 and as many as 98,000 deaths due to “preventable adverse events” occur in hospitals each year. That exceeds automobile accidents, breast cancer and AIDS as a leading cause of death in the United States. The report further states that medication errors account for one in 131 outpatient and one in 854 inpatient deaths, and cites another study that found 2 percent of admissions experience a preventable adverse drug event (ADE). Not all ADEs result in death. However, when it comes to our health or the health of our loved ones, what percentage is acceptable?

Michelle Geurink is an IT analyst at Methodist Medical Center in Peoria, Ill. She also is a trained pharmacist. When she arrived at Methodist in 1999, the organization was implementing a new hospital information system (HIS) for pharmacy, lab, nursing documentation, radiology and order management. As a part of the client services department, Geurink was to make sure the new systems flowed well with IT and the pharmacy. Another Methodist IT analyst, Jennifer Nelson, R.N., was charged with the same task on the nursing side. As a team, they set out to ensure a smooth HIS installation and staff training.

The HIS software included several modules that Client Services intended to roll out one at a time, starting with Nursing Documentation. But when the IOM report came out, Methodist’s executive IT steering committee chose the Meds module because it contained bar coding technology and would address the need to reduce the risk of medication errors and ADEs. Even though studies showed Methodist experienced a statistically tiny number of ADEs compared to the national average (only five in 10,000), they knew they could improve. Instead of lowering their standards, they raised the bar.

By 2001, Geurink and Nelson were attending classes to learn how to build and implement the modules with Methodist’s policies and procedures. They chose the oncology floor as the pilot unit and held a vendor fair so staff could evaluate the new HIS hardware’s placement, and decide whether to go with permanent fixtures or mobile carts. The nurses were given evaluation sheets and asked to state their likes and dislikes. They chose permanent-mounted, all-in-one units that would be installed at the bedside and include a flat-screen monitor/CPU combo, mouse, keyboard and bar code scanner.

While the nurses evaluated the hardware, Geurink and the Methodist pharmacy buyer evaluated their meds. If they weren’t already packaged with unit-dose bar codes, pharmacy would find a company that sold them that way, or purchase them in bulk bottles, print their own unit-dose bar codes and repackage the meds. Today, Methodist always tries to buy meds unit-dose bar coded. Says Geurink, “Every time someone touches them there’s the possibility for human error. And then there’s the cost.” Although Methodist could print their own unit-dose bar codes, it was determined to be more cost-effective to purchase the meds already bar-coded. “I don’t know if we save any money, because, as opposed to a bottle, the unit-dose meds are more expensive, but then you save the labor cost,” says Geurink.

The Little Bang Approach

“When the nurses came in, the first thing we told them was that this was not about saving them time, it was about patient safety,” says Geurink. According to Nelson, the average age of nurses today is 45. That meant some of them needed to learn how to use a mouse and turn on a computer before being taught how to use the bar code system. She says the initial acceptance of the new system by the nurses was not good. “They were so used to having paper, we kind of rocked their world with introducing the equipment in the room–by logging in and scanning–we changed their whole process of delivery of medication.”

Geurink and Nelson trained the first set of nurses to work with the new system and then established a program where each floor’s nurses would train on the system, practice until proficient and then train the next floor in line. They called it the “little bang” approach to training, versus a big bang, where all floors are rolled out simultaneously. The method fostered camaraderie by providing support from within and also gave a sense of ownership to the nurses.

Today, Nelson says the nurses have totally accepted the bar code scanning system, though there are still issues to overcome. Methodist is not yet a paperless hospital, so the nurses are managing two systems, which has its challenges. “It’s hard when some of the physicians still write their notes and orders on paper,” she says. The nurses can, however, do their assessments and chart all their medications online, which is a good thing, because the nurses want more–more technology, more information on the computer and more things done on the computer. “We can’t roll it out fast enough.”

Reiboldy, a medical practice consultant, overviews the changing landscape of health care delivery and shows what doctors can do to cope with the reality of managed care, detailing integration strategies for hospitals, physicians, ancillary services, managed care, and technology. He explains how to identify the operational strengths and weaknesses of a practice, calculate its worth, and how to select a partner. There is information on allowing physician input in hospital-affiliated groups, hospital and physician relations programs, and the prospect of a single-payer system. Sample job descriptions, checklists, and surveys are included.

Gone are the days when physicians could hang their shingles just once and expect to practice in one geographical location their entire careers. Most physicians in the US now expect to relocate for professional reasons, to transfer from place to place within corporation-run health care, or to have other reasons for seeking licenses in more than one state, such as participating in tele- medicine and e-medicine. This guide, which covers osteopathic as well as allopathic physicians, gives states’ licensing requirements, including relevant examinations and fees, requirements for re- registration and CME requirements, endorsement policies for physicians holding an initial license, information on foreign medical graduates, continuing education, national boards, and licensing in the US Air Force, Army and Navy. It includes a list of references and useful web sites.