Prevention Matters

In 2009, the Obama administration and Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH) to increase the use of Electronic Health Records (EHR’s). The law authorizes incentive payments through Medicare and Medicaid to clinicians and hospitals when they use EHR’s to achieve improvements in care delivery. On July 13, 2010 Secretary Sebelius announced the final rules to support meaningful use of EHR’s, officially launching a concentrated five-year national initiative to improve the health of Americans and reduce health care costs through their adoption and use.

Earlier this year Partnership for Prevention joined with its colleagues at Trust for America’s Health in submitting public comments on the HITECH rules, requesting that the clinical quality measures have a focus on preventive care, specifically those clinical preventive services that provide the highest value as recommended by the National Commission on Prevention Priorities (NCPP). These include influenza immunization rates, smoking cessation counseling, BMI screening and follow-up, cervical cancer and chlamydia screening, and aspirin therapy. We applauded the Department of Health and Human Services for including public health among its goals for implementation.

While the final rules do not include all the measures recommended, smoking status for patients 13 years old or older was included as a measured functionality. This is a victory for tobacco control advocates because recording smoking status may lead to an increase in the number of patients who receive smoking cessation treatment. The age threshold is important as counseling for adolescent smokers has been shown to be effective, approximately doubling long-term abstinence rates in the multiple studies. Additionally, this measure will be in accord with the 2008 Update to the Public Health Service Clinical Practice Guideline on Treating Tobacco Use and Dependence.

This is an exciting time in healthcare in America. Paper-based treatment, surveillance, and recordkeeping is yielding to same-time health communication. The 2009 law and the July 13 announcement of its rules will go a long way toward operationalizing these advances.

For more information:

http://www.hhs.gov/news/press/2010pres/07/20100713a.html

http://healthcarereform.nejm.org/?p=3732


David Zauche
Senior Program Officer
Partnership for Prevention

The use of electronic records significantly increasing how fast patients with Chlamydia are treated was named the “Best Prevention Idea of the Week,” while children on Medicaid not receiving all required preventive screening services was named the “Worst Prevention Idea of the Week."

BEST

Chlamydia Treated Sooner When Docs Use E-Records

Switching to electronic medical records can significantly boost how quickly patients with the sexually transmitted disease chlamydia are treated, a new study shows.

Researchers found that an electronic medical record system more than doubled the percentage of patients treated within two weeks of diagnosis. The longer a sexually transmitted infection goes untreated, "the more risk there is of onward transmission and of clinical complications," the authors wrote. "Appropriate use of technology greatly improves our ability to treat patients rapidly, and we should strive to use all available methods for the good of our patients and the betterment of public health."

WORST

Medicaid Children Are Not Receiving All Required Preventive Screening Services

The Department of Health and Human Services’ Office of Inspector General (IG) has just released a new report (OEI-05-08-00520) concluding that “Most children in nine selected States are not fully benefiting from Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) comprehensive screening services.”

For anyone concerned about the importance of expanding coverage for clinical preventive services under health reform, this report is a reminder that coverage alone isn’t enough to assure access.

Google Health is trying to apply lessons learned from one of its users to improve the accuracy of medical records. An item on the Google blog tells how the user, whom they call "e-patient Dave," found that data was imported into his Google Health Account from his hospital in Boston that included "diagnoses that were both alarming and wrong."

The data came from the billing codes and associated descriptions used by the hopsital to fillout Dave's insurance forms.

"These descriptions, from the International Classification of Diseases (ICD-9), often do not accurately describe a patient because the right ICD-9 code may not exist," says Roni Zeiger, M.D., Product Manager of Google Health. "So the doctor or hospital administrator chooses something that is 'close enough' for billing purposes. In other cases, the assigned code is precisely what the doctor is trying to rule out, and if the patient turns out not to have that often scary diagnosis, it is still associated with their record."

Google Health and Dave met with hospital officials, and they worked out a plan to address the situation. The hospital agreed to stop sending ICD-9 billing codes and will instead only send to Google Health the free text descriptions entered by doctors. The hospital is also working with the National Library of Medicine (NLM) to associate those free text descriptions with a more clinically useful coding system called SNOMED-CT.

"The result will be more accurate and useful information in patients' Google Health profiles," Zeiger says.

Wal-Mart continues to show how it can be a change-maker in the health world by virtue of its ability to distribute products at a high-volume for low prices. The New York Times says the world's largest retailer, which already has introduced $4 generic prescriptions and over-the-counter tobacco cessation kits priced below $10, is now working to provide electronic health records technology that will be affordable for physicians working in small offices.

"The company plans to team its Sam’s Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software," writes the Times' Steve Lohr. "...The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates."

The Obama administration's plan provides financial incentives of more than $40,000 per physician over a few years, to install and use electronic health records. Only about 17 percent of the nation’s physicians currently use computerized patient records. About 200,000 health care providers, mostly doctors, are among Sam Club’s 47 million members.