Health IT Special Issue of The American Journal of Managed Care: Dec 2010

AJMC Publishes Health Information Technology Special Issue Online Dec 20, 2010
“Featuring scholarly articles and perspectives from policymakers, payers, providers, pharmaceutical companies, health IT vendors, health services researchers, patients, and medical educators, this [December 2010 special] issue of  The American Journal of Managed Care is a reflection” of  “the  dramatic growth of interest in the potential for HIT to improve health and healthcare delivery,” writes Sachin H. Jain, MD, MBA and David Blumenthal, MD, MPP in their introductory article titled “Health Information Technology Is Leading Multisector Health System Transformation.”  Both Jain and Blumenthal are with the Office of the National Coordinator for Health Information Technology.

Authors of 23 Articles in Special Issue
Sachin H. Jain, MD, MBA; and, David Blumenthal, MD, MPP; Cynthia L. Bero, MPH; and Thomas H. Lee, MD; Aaron McKethan, PhD; and Craig Brammer; John Glaser, PhD; Pete Stark; Newt Gingrich, PhD, MA; and Malik Hasan, MD; James N. Ciriello, MS; and Nalin Kulatilaka, PhD, MS; Seth B. Cohen, MBA, MPA; Kurt D. Grote, MD; Wayne E. Pietraszek, MBA; and Francois Laflamme, MBA; Amol S. Navathe, MD, PhD; and Patrick H. Conway, MD, MSc; Reed V. Tuckson, MD; Denenn Vojta, MD; and Andrew M. Slavitt, MBA; Marc M. Triola, MD; Erica Friedman, MD; Christopher Cimino, MD; Enid M. Geyer, MLS, MBA; Jo Wiederhorn, MSW; and Crystal Mainiero; Nancy L. Davis, PhD; Lloyd Myers, RPh; and Zachary E. Myers; Bryant A. Adibe, BS; and Sachin H. Jain, MD, MBA; Spencer S. Jones, PhD; John L. Adams, PhD; Eric C. Schneider, MD; Jeanne S. Ringel, PhD; and Elizabeth A. McGlynn, PhD; Jeffrey L. Schnipper, MD, MPH; Jeffrey A. Linder, MD, MPH; Matvey B. Palchuk, MD, MS; D. Tony Yu, MD; Kerry E. McColgan, BA; Lynn A. Volk, MHS; Ruslana Tsurikova, MA; Andrea J. Melnikas, BA; Jonathan S. Einbinder, MD, MBA; and Blackford Middleton, MD, MPH, MS;Alexander S. Misono, BA; Sarah L. Cutrona, MD, MPH; Niteesh K. Choudhry, MD, PhD; Michael A. Fischer, MD, MS; Margaret R. Stedman, PhD; Joshua N. Liberman, PhD; Troyen A. Brennan, MD, JD; Sachin H. Jain, MD, MBA; and William H. Shrank, MD, MSHS; Amir Dan Rubin, MBA, MHSA; and Virginia A. McFerran, MA; Fredric E. Blavin, MS; Melinda J. Beeuwkes Buntin, PhD; and Charles P. Friedman, PhD Robert D. Hill, PhD; Marilyn K. Luptak, PhD, MSW; Randall W. Rupper, MD, MPH; Byron Bair, MD; Cherie Peterson, RN, MS; Nancy Dailey, MSN, RN-BC; and Bret L. Hicken, PhD, MSPH; Jeffrey A. Linder, MD, MPH; Jeffrey L. Schnipper, MD, MPH; Ruslana Tsurikova, Msc, MA; D. Tony Yu, MD, MPH; Lynn A. Volk, MHS; Andrea J. Melnikas, MPH; Matvey B. Palchuk, MD, MS; Maya Olsha-Yehiav, MS; and Blackford Middleton, MD, MPH, MSc; Emily Ruth Maxson, BS; Melinda J. Beeuwkes Buntin, PhD; and Farzad Mostashari, MD, ScM; Daniel C. Armijo, MHSA; Eric J. Lammers, MPP; and Dean G. Smith, PhD; Katlyn L. Nemani, BA.

Look for an upcoming post on e-Healthcare Marketing reviewing this special issue of AJMC.

JAMIA: Characteristics associated with RHIO viability

JAMIA: Characteristics associated with Regional Health Information Organization viability
In January 2010 issue of JAMIA,  the original research paper titled “Characteristics associated with Regional Health Information Organization viability” by Julia Adler-Milstein, John Landefeld, and Ashish K Jha concludes “Our work suggests that RHIOs find a broad group of stakeholders and begin with a narrow set of activities to help them get off the ground. Further, we believe that judicious use of grants, possibly through ‘matching’ mechanisms where stakeholders are also asked to contribute early, will help to ensure that RHIOs become viable and self-sustaining.”

As Joseph Goedert reported Dec 17, 2009 in HealthData Management article titled “What Makes HIEs Viable?” “Results from a national survey of regional health information organizations show simplicity and early funding commitments from participants improve viability of the initiatives.”

A December 2007 study in Health Affairs by two of the same Harvard authors examining “The State Of Regional Health Information Organizations: Current Activities And Financing” found “a substantial number of early failures, stalled efforts, and RHIOs that were heavily dependent on grants.”

Quality Not Top Priority For Nearly Half of Hospital Boards: New Survey

New Study Shows Quality Not Top Priority for Nearly Half of Hospital Boards
From a Health Affairs Press Release: Health Affairs  published a study on November 6, 2009 “surveying a nationally representative sample of board chairs in 1,000 U.S. hospitals. The results found that just half the boards rated quality of care as one of their two top priorities and only a minority reported receiving training in quality. This is the first national study of board chairs linked to quality performance.”

“Hospital Governance And The Quality Of Care”
By Ashish K. Jha and Arnold M. Epstein
Author affiliations:
Jha and Epstein are affiliated with the Harvard School of Public Health

“In identifying the factors that affect the quality of hospital care, leadership and governance have emerged as areas of particular interest. Since boards of directors could have an impact on quality of care, this study evaluated how hospital leadership values quality. The authors collected their data during the winter of 2007-08 by randomly selecting 1,000 institutions from a group of over 3,000 nonprofit acute care hospitals that reported quality data to the Hospital Quality Alliance (HQA) in 2007. They reached out to their board chairs, and achieved a response rate of 78.3 percent.

“Of those surveyed, a little over half identified quality as one of the two top priorities for board oversight, and only 44% reported that quality of care was important for evaluating the performance of the chief executive officer (CEO). For 63% of the institutions, quality performance was consistently an agenda item at board meetings, compared to financial performance, which was consistently on the agenda at 93% of the hospitals.

“In contrasting hospitals that had scored well in on quality measures with their lower-performing counterparts, the data revealed major differences in attitudes, priorities, and activities around quality of care. “Our data provide clear evidence of an association between an engaged board and high quality care, although we cannot yet pinpoint a causal link,” said Ashish Jha, the study’s lead author. “Most boards have primarily focused on financial issues, mistakenly assuming that their hospital’s quality of care is adequate. Major opportunities exist to shift the knowledge, training, and practices of hospital boards to promote a focus on safe, effective care.”

“This project was funded by the Hauser Center for Non-Profit Governance at Harvard Law School and the Rx Foundation.”

States Get Involved:
New Jersey Hospital Boards–Governance and Quality

In story titled ”This is a test: Exams for governance boards on quality measures could be a way to improve care, accountability in hospitals,” Modern Healthcare’s  Melanie Evans on November 16, 2009, spoke with Sally Roslow, New Jersey Hospital Association (NJHA) vice president of development and trustee relations. According to the story, NJHA ”is expected to give more weight to quality training to promote further education on the issue” in a voluntary training program for trustees on hospital governance that NJHA anticipates launching in 2010. Over 95% of New Jersey hospital boards met a new state requirement that trustees and directors attend seven hours on basic governance by August 2009.

Cheryl Clark reported in HealthLeaders Media on November 9, 2009,”Carlin Lockee, managing editor of the Governance Institute, which assists hospital boards, says she was surprised at the study’s results. She says they differ from the Institute’s similar surveys of nonprofit hospital CEOs.”

Journal of AHIMA: ARRA and the HIM Workforce

ARRA and the HIM Workforce
Genna Rollins in October 2009 Journal of AHIMA reviews the workforce provisions of  both ARRA 2009′s HITECH and Department of Labor portions. HITECH workforce areas focuses on starting and expanding “medical health informatics programs, including certification, undergraduate, and master’s degree programs for both healthcare and IT students.” In addition funding is planned for projects demonstrating the integration of health IT into clinical education. 

The article highlights core competencies for an EHR workforce identified in 2008 by AHIMA and American Medical Informatics Association. Finally Department of Labor proposals due October 5, 2009 are previewed, including promoting development of technical skills which may be gained at the associate and bachelor’s level to support the more immediate needs of an expanding EHR environment.

Focus: Personal Health Records

JHiM, Summer 2009 issue, focuses on Personal Health Records
Journal of Healthcare Information Managementm (JHiM), Summer 2009 issue, carries four articles on Personal Health Records. Note: Full text available to HIMSS members or by subscription only. You can link to JHiM summaries of Summer 2009 articles here. My summaries are below generally based on article subheads.

Editor’s Report: Personal Health Records—Ready for Prime Time? (pdf) (subscription only)
by Richard D. Lang, EdD

Defines 6 types of Personal Health Records: vendor-based, provider-based, payor-based, HIE-based, portable digital file, and hybrid. Reviews value, disadvantages, challenges, and technical issues. Lang says he “believes PHRs will reach their potential value only by fully implementing the EMR.”

Assessing HIE Stakeholder Readiness for Consumer Access:
Lessons Learned from the NHIN Trial Implementation (pdf)
(subscription only) 
by Brian E. Dixon, MPA; Theda Miller, BS; and J. Marc Overhage, MD, PhD
Based on study of Indianapolis area participants in Indiana Network of Patient Care (INPC). Indiana has earned a reputation as one of the states with most advanced Health IT applications.

Personal Touch: Personal Health Records for Consumers of Healthcare (pdf) (subscription only)
by Mary N Gerard, MD; Mike Cohen; and Regina Greer-Smith FACHE
Based on review of key articles on PHRs and experiences in Chicago area. Includes case study of consumer user, examines patient control of information, patient portals in Chicago, and reviews content issues, disease management tools, exchange of information between patient and providers, and barriers and  strategies for consumer use.

Interoperability of Electronic Health Records and Personal Health Records: Key Interoperability Issues Assdociated with Information Exchange (pdf) (subscription only)
by Simone Pringle and Alex Lippitt
Based on Chicago area experiences, this article deals with data reconciliation, workflow, and implementation issues for interoperability. Summarizes roles of organizations involved in technical implementation connecting PHRs and EHRs including, HITSP, CCHIT, IHE, AHIC, The Markle Foundation Personal Health Working Group, and Health Record Banking Alliance.

BMC Medical Informatics and Decision Making
Integrated Personal Health Records:
Transformative Tools for Consumer-Centric Care

By Don Detmer, Meryl Bloomrosen, Brian Raymond and Paul Tang
Published in October 2008 by BMC Medical Informatics and Decision Making, article grew out of September 2006 roundtable convened by Kaiser Permanente Institute for Health Policy,  American Medical Informatics Association (AMIA), Robert Wood Johnson Foundation (RWJF) and the Agency for Healthcare Research and Quality (AHRQ) with three goals involving potential of integrated PHRs, barriers to realizing potential, and framework for action. The references can prove as interesting as the paper.
Link to html version:
Link to pdf version.

A Lifeline for Primary Care

NEJM Perspective Calls for More Technical Assistance to Reorganize Primary Care Practices
NEJM notes that HIT Regional Extension Centers called for in ARRA to assist practices and hospitals in implementing HIT are based on Department of Agriculture’s Cooperative Extension Service which combines federal, state, state university experts, and farmers. In June 25, 2009 issue of New England Journal of Medicine, Thomas Bodenheimer, MD, and Kevin Grumbach, MD, from University of California, San Francisco, School of Medicine; and Robert A. Berenson, MD, Urban Institute; present three areas of focus needed to revitalize primary care with the goal of transforming primary care practices into “modernized medical homes.” Authors state that national policies are required to rescue primary care from its inability to attract enough primary care practitioners due to lower pay, stress of “more work at less pay,” and “medical education favors training in non-primary care fields.”

Primary-Care Doctor Shortage May Undermine Reform Efforts
Washington Post’s Ashley Halsey III reported on June 20, 2009, that “Fixing the problem (of a shortage of primary care physicians) will require fundamental changes in medical education and compensation to lure more doctors into primary-care offices, which already receive 215 million visits each year.”

Blumenthal Pledges EHR Support for Small Physician Practices
“National Coordinator for Health IT David Blumenthal said the federal government would pay special attention to individual physicians and small group practices as it works to implement the health IT provisions of the federal economic stimulus package,” based on reporting from CongressDaily that iHealthBeat summarized on June 25, 2009. Blumenthal also discussed regional extension programs to support implementation of EHRs and said he would set up listening sessions nationwide.
Here’s the the orginal reporting from Andrew Noyes, CongressDaily on, a National Journal Group site.  Hearing by “the House Small Business Regulations and Healthcare Subcommittee, which heard from pediatricians, optometrists and others who fear they could be disadvantaged when the government doles out about $17 billion in Medicare and Medicaid bonuses, grants and technical assistance.”

Do Small Practices Lack Resources for Quality Upgrades?
also pointed out reporting from John Commins for HealthLeaders Media on June 24, 2009: “Small medical practices provide nearly 75% all ambulatory care in the United States, yet many lack the resources to improve the quality of care delivered or install electronic health records to serve an increasingly diverse patient mix, according to a report released today by the National Committee for Quality Assurance.”

National Committee for Quality Assurance (NCQA) Report on Small Physician Practices
Recommends HITECH Act Regional Centers should give priority to “certain types of providers including individual or small group practices focused on primary care and providers that serve uninsured, undreinsured and medically underserved individuals.”
Supporting Small Practices: Lessons for Health Reform Topic Page
Press Release
Presentation Slides pdf

Physicians: Prepare to meet “meaningful use”

Advice to Physicians: Prepare to meet “meaningful use” EMR requirement
Pamela Lewis Dolan, of
American Medical News, reporting June 15, 2009 on the experts’ answer to whether physicians should wait until all the rules have been clarified. The experts told her “Don’t wait to buy or upgrade just for want of a definition. There are enough clues in the legislation to estimate the definition of ‘meaningful use.’”

Scenario: How do you keep the patient at the center of the medical interview?
On the American Medical News site on June 8, 2009, Frederic W. Platt, MD, answered the question: “Given the high-tech trend in patient encounters, how do you conduct the medical interview in a way that does not interfere with the patient relationship?” Dr. Platt is clinical professor of medicine, University of Colorado, Denver, School of Medicine, and regional consultant for the Institute for Healthcare Communication. The post is part of’s Ethics Forum.
Dr. Platt’s quide to the essence of physician-patient communications:
Field Guide to the Difficult Patient Interview, 2nd Edition. Co-authored with Geoffrey H. Gordon.’s Current and Archived Articles on EMRs
Ready source of articles written for physicians about Electronic Medical Records

Primary References

Health Affairs
March-April 2009 issue
Themed “Stimulating Health IT”

And here’s the link to key briefing materials and slides from
Health Affairs Issue Briefing on
Stimulating Health Information Technology
Tuesday, March 10, 2009 – Washington, D.C.

New England Journal of Medicine
Volume 360–March 26, 2009–Number 13
No Small Change for the Health Information Economy

Your Doctor’s Office or the Internet? Two Paths to Personal Health Records