The medical device industry has been quick to adopt, implement and give further definition to the Advanced Medical Technology Association (AdvaMed) Code and Ethics and its provisions, according to a survey from PricewaterhouseCoopers, in consultation with AdvaMed and its Device and Diagnostic Group (DDGC). Ninety percent of the survey's respondents, representing 32 companies, have policies in place that address all provisions of the AdvaMed Code of Ethics.

Conducted for three consecutive years, the 2008-2009 survey reports the AdvaMed Code of Ethics continues to gain notable acceptance within the medical device industry. AdvaMed developed the Code to assure a high standard of ethical conduct by the medical technology industry. A major update to the Code was unanimously approved by the AdvaMed Board of Directors in December 2008 and goes into effect on July 1, 2009.

This year's survey included an electronic survey, follow-up interviews and webcast polling on topics such as policies and procedures, auditing and monitoring, fair market value and sales compensation. The survey's findings included:

• Ninety percent of respondents have policies in place that address all provisions of the current AdvaMed Code of Ethics.
• Thirty-eight percent of respondents apply the Code globally, with revisions for legal and cultural differences based upon geography, while 43 percent apply the Code to U.S. operations only with international having its own policies.
• Ninety-four percent plan to implement new policies and procedures to reflect the changes of the new 2009 AdvaMed Code of Ethics.
• Three-fourths of respondents indicated the CEO shows support for the AdvaMed Code, or its corresponding company policies, by participating in various company activities, such as making statements to employees at live meetings, written statements in a letter to employees and periodic written e-mail statements.
• Sixty-three percent of respondents require that acquired companies comply with corporate-level compliance policies within 90 days of the acquisition, and 25 percent of those require the acquired company to comply immediately.
• Seventy-eight percent of respondents indicated that the board, or a board committee, has oversight responsibility for compliance, and 65 percent have written policies and procedures or an established practice for notifying the board of compliance-related investigations or issues.

"The medical device industry has made great strides in the past several years since the AdvaMed Code of Ethics was substantially revised in 2004," said Doug Mowen, advisory leader of the medical device industry practice at PricewaterhouseCoopers. "They have made a clear commitment to ethical business practices through adoption of the Code, putting openness and transparency on their relationships with health care providers at the forefront. Ultimately, this benefits patients by removing any perceived bias, thus increasing the quality of care."

New financial and regulatory changes have opened the door for rapid growth in the emerging infection control surveillance software market, according to a new report from KLAS Research.

The KLAS report, "Infection Control: Improving Patient Care and Reimbursements," highlights the recent growth and leading vendors in the market for infection control software, which analyzes data from various hospital departments to identify potential infections. While KLAS estimates that these systems enjoy only 10 to 15 percent market penetration today, many vendors are experiencing rapid sales growth.

While healthcare organizations have long battled the dangerous and costly effects of hospital-acquired infections, adoption of infection control surveillance software has been slow, according to KLAS.

"The decision by CMS to discontinue reimbursement for hospital-acquired infections has obviously had a direct impact on the adoption of infection control systems," said Steve VanWagenen, KLAS research director and author of the infection control report. "Couple that with initiatives in many states requiring hospitals to report infection control data to the CDC, as well as tougher standards from insurance companies, and these solutions are poised for real growth."

Not all of the benefits of automated infection control applications have been quantified, but virtually all the hospitals surveyed in the KLAS study reported significantly increased staff efficiency, better patient outcomes and improved financial reimbursement -- and that they would never return to previous manual workflows.

In terms of functionality, interfacing capabilities -- the ability to collect data from various hospital departments -- can make or break the value of infection control systems. Among the three largest infection control software vendors, provider customers reported that all three offered solid interfaces for laboratory and admissions/discharge data, but other departmental connections still need development.

Three vendor products are rated in the KLAS report: Cardinal Health MedMined, Premier SafetySurveillor and TheraDoc Infection Control Assist. Among them, Cardinal Health was the top-rated vendor, with a performance score of 93.4 out of 100. Providers cited Cardinal Health's reporting and its unique outsourced data-analysis model as key advantages.

For its part, TheraDoc has been embraced more by larger organizations and academic medical centers, while Premier offers a hosted model that is attractive to some providers, according to the report. Beyond these three largest vendors, however, the KLAS report also highlights nine other companies that are gaining traction in the IC market.

IT budgets and staffing levels are expected to remain flat over the next two years, in large part due to the global economic downturn. But demand for IT services will increase by more than 17 percent, creating a gap that companies will need to address with improved efficiencies and productivity, according to a recent study published by The Hackett Group.

Hackett's research, which looked at results from more than 80 companies, details best practices in three areas that organizations can use to close this gap: IT cost control strategies, demand management and discretionary cuts.

Demand management is a particular area of efficiency improvement the research cited as being overlooked by many companies. Only about one-third of all companies in the study use cost allocation or charge back to bill internal users based on the volume of IT services consumed, or for IT work done on their behalf. In addition, less than 30 percent have a service catalog in place that defines service offerings with an associated price per unit.

"Demand for IT services has always exceeded supply capacity," said Hackett IT Advisory Practice Leader David Ackerman. "But the global economic downturn has put more pressure than ever on IT organizations to do more with less. The growing gap between demand and budgets requires companies to broaden their mix of techniques. IT organizations that stick to traditional discretionary cuts are unlikely to truly solve the problem, and also risk significantly damaging their ability to provide strategic value to their company."

According to Hackett Senior IT Research Director Erik Dorr, "What we see is that there's significant untapped potential for companies to cut costs and manage demand. While most companies in our study have implemented basic IT cost control strategies, other areas, such as demand management, have been largely overlooked. And even in traditional areas such as discretionary cuts, which are fairly inevitable in the current environment, there's room for an increased level of sophistication to reduce the stress on the IT organization and to ensure that the cuts are sustainable."

According to Hackett's research, companies forecast that IT budgets and staffing levels will grow by only about 1.0 percent annually over the next two years, down from the annual growth rates of 5.3 percent (for budgets) and 4.3 percent (for staff) seen over the past three years. This 75 percent decline in budget growth contrasts sharply with companies' projections for IT demand, which will shrink by only 15 percent, to 8.6 percent annually for the next two years, resulting in an increase of more than 17 percent by the end of 2010.

Hackett's research found that the drivers of IT demand are also shifting, with business growth dropping as a priority while needs driven by process transformation and business reorganization increase. Two other IT demand drivers, regulatory compliance and M&A activity, are expected to remain fairly stable.

Hackett's research outlines best practices in three areas that companies can use to close the gap between flat budgets and rising demand. IT cost control includes tactics such as offshoring and outsourcing; IT reorganization; technology rationalization; productivity and process improvements; and supplier and contract management. In this area, Hackett found that offshoring and outsourcing offer the greatest opportunity for cost control -- more than three times the savings of other IT cost control strategies, primarily because they affect the largest share of the overall IT budget. But the study also found that an across-the-board goal of 10 percent cost reductions in this area is both realistic and achievable.

The study found that the second area, IT demand management, is highly underutilized by most companies. IT has traditionally been more focused on how to meet ever-growing demand than on implementing processes to curb that demand and ensure that the highest value work gets done. As a result, demand management techniques are less mature than other cost-control techniques. The study found that few companies use tactics such as charge backs, service catalogs, or IT portfolio management to reduce costs, despite the fact that these techniques can drive real savings.

The final strategy -- discretionary cuts, which generally involve mandated budget and staff reductions without underlying process improvement or rationalization, is widely used by most companies. But it is also the riskiest of the three approaches. Unless process improvements are an integrated part of any discretionary cuts, Hackett warned that they are likely to result in degraded service levels and reduced overall effectiveness. It can also be very challenging to sustain discretionary cuts on an ongoing basis, the research found, as many companies quickly find that they have very little fat left to trim.

Philadelphia-based Beyond.com, a network of niche career communities, recently released its Career Trends Analysis and Industry Outlook Reports for the first quarter of 2009, which took an in-depth look at the latest job market trends.

In a thriving economy, there is often a higher demand for management-level candidates, but in a declining economy, such as the current environment, many employers shift recruiting efforts to attract and retain less experienced professionals who will be productive and cost-effective for the organization, reported Beyond.com. While many employers, such as customer service and retail firms, typically tend to attract and foster a higher concentration of lower-level professionals, current data suggests that many industries are following suit to tap into this segment of the talent pool.  

According to Beyond.com, the top three industries for jobs in the first quarter have reported an increased demand for candidates with less than five years of experience; and with more experienced professionals out of work, many seasoned professionals will be forced to more directly compete with this less-experienced workforce. The following highlights the top three industries:

• Health care and medical. There was a 15.2 percent increase in the number of health care professionals searching for a job. While the majority of job-seekers had 1-3 years experience, most health care jobs required less than one year of experience. 
• Information technology. There was a 54.5 percent increase in the number of IT professionals searching for a job.  The majority of job-seekers have 5-10 years of experience, but candidates with 3-5 years of experience were in highest demand. 
• Sales and sales management. There was a 23.8 percent increase in the number of sales professionals searching for a job. The majority of job-seekers had more than 21 years of experience, while candidates with less than one year of experience were most in demand, representing 65.6 percent of all sales jobs posted. 

"In times of economic uncertainty, employers are mindful of expenses, especially as they relate to their recruitment program, to ensure that their business is able to continue thriving," said Rich Milgram, CEO of Beyond.com. "As a result, many companies are focused on hiring front-line workers who can make the most impact on their business with the least amount of financial risk, further widening the employment gap that exists between the type candidates in demand compared to the type of candidates currently searching for a job."

The Certification Commission for Healthcare IT (CCHIT) has announced a proposal that would allow health care providers and health IT developers to pursue three different paths for electronic health record (EHR) certification.

The three options are:

·        EHR Comprehensive. EHR-C would provide certification for comprehensive EHR systems that exceed minimum federal standards. This path is the most similar to CCHIT's current certification process.

·        EHR Module. EHR-M offers a more flexible option for vendors with specialized EHR products.

·        EHR Site. EHR-S is aimed at health providers who create their own EHR systems from a variety of non-certified components.

According to the CCHIT Web site, more than 800 people participated in two Web conferences last week; participants provided feedback on the new certification options. In real-time polls conducted during both sessions, 70 percent of respondents expressed a very favorable or favorable reaction to the plan. Development of the new certification options is scheduled to begin in July.

A new study conducted by Mathematica Policy Research concluded that while health information exchanges (HIEs) can help safety-net hospitals improve patient care, many facilities lack sufficient support for implementing the systems.

The study, funded by the Agency for Healthcare Research and Quality, began in October 2007, when Mathematica assembled a 13-member panel to examine the role of health data exchanges among safety-net facilities.

Because safety-net providers serve low-income, uninsured people who are more likely to have complex health needs, HIEs have the potential to improve care and reduce inefficiencies where the need is greatest, according to Mathematica.

In addition, uninsured patients are less likely than patients with health coverage to have a usual source of care. Engaging safety-net providers in HIEs and considering their special circumstances and needs may help disparities from growing as other providers advance, the study report said.

The study found that HIEs can help boost a facility's quality of care and lower costs by allowing emergency care providers to access an unconscious patient's medical records, improving care for patients who lack primary care physicians and reducing duplicate tests for patients who see multiple medical providers.

The report noted, however, that safety-net providers may have difficulty implementing HIEs because of lack of funding, expertise or knowledge of how to sustain their effort. At the community level, challenges include building trust so that data security and confidentiality concerns are addressed, defining initiatives so that all stakeholders' interests are represented, and dealing with technical issues that accompany HIEs.

Panel members proposed a number of ways in which federal and state governments, foundations and other organizations could support effective implementation of HIEs, such as:

·        helping safety-net providers learn from high-performing counterparts to shorten development times;

·        educating primary care associations about HIEs so they can better support primary care safety-net providers;

·        creating a mobile education team to provide training for rural health care providers;

·        identifying and supporting local physician champions to increase interest both within and outside the safety net; and

·        articulating the benefits of HIEs to physicians and patients in ways that take their perspectives into account.

According to a recent survey of U.S. and Canadian consumers commissioned by Dayton, Ohio-based NCR Corp., patients are growing increasingly frustrated with long waits at doctors' offices and hospitals, and are looking to self-service technology as a way to help expedite those interactions.

The annual research study reveals that 74 percent of patients find waiting at a hospital or doctor's office the greatest frustration during a health care appointment. In addition, respondents indicated they are inconvenienced by the time and effort required to schedule appointments, pay medical bills and complete paper forms, and they would like to spend less time on these activities.

"Patients desire greater control over their care and that includes the way they interact with their providers," said Raj Toleti, vice president and general manager for NCR Healthcare. "In today's consumer-directed health care environment, hospitals and clinics have an opportunity to increase overall satisfaction and strengthen patient loyalty by leveraging self-service as a way to make everyday interactions faster and easier."

Among the research findings:

• Sixty-two percent of consumers are more likely to choose a health care provider that offers the flexibility to interact via online, mobile and kiosk self-service channels versus a provider that does not.
• Fifty-three percent of consumers expressed interest in booking or changing medical appointments online through a mobile device or at a kiosk and receiving text message reminders of an appointment.
• Forty-nine percent of consumers said the ability to book an appointment online would be convenient.
• Forty-nine percent of consumers said the ability to securely receive lab results online would be convenient.

"As health care providers move to implement electronic health records, self-service will become even more widespread," Toleti added. "Automating patient interactions not only addresses consumer demand, it serves as the entry point for electronic record keeping."

As the health care IT industry awaits a formal definition for the meaningful use of electronic medical records (EMRs), KLAS Research has released a report outlining which acute-care EMR products are best-positioned to achieve whatever meaningful use standard is adopted.

The report, "Meaningful Use Leading to Improved Outcomes," takes a look at the EMR market, assessing how well core clinical vendors are delivering applications for computerized physician order entry (CPOE), nursing automation, medication administration and other key areas.

The KLAS report notes that while EMR vendors Cerner, Eclipsys and Epic are the most successful with regard to physician adoption, Meditech has the largest number (327 hospitals) of clinical information system (CIS) customers with more than 200 beds, followed by Cerner (263) and McKesson (242).

According to the report, the Meditech customer base, encompassing the MAGIC and C/S product lines, has the smallest number of 200-plus bed hospitals with deep CPOE adoption -- hospitals in which more than 50 percent of all orders are entered electronically by doctors. Only 3 percent of Meditech customers have achieved this level of adoption.

Among the CIS market share leaders, McKesson exceeds Meditech in this area, with 5 percent of its customer base enjoying deep adoption. Cerner, at 23 percent, leads both McKesson and Meditech. GE, QuadraMed and Siemens also enjoy some success with CPOE adoption, the report noted.

Nine EMR vendors were specifically profiled in the new KLAS report: Cerner, CPSI, Eclipsys, Epic, GE, McKesson, Meditech, QuadraMed and Siemens. The full report can be purchased at www.KLASresearch.com.

Inadequate planning of IT projects has threatened the Department of Veterans Affairs' (VA) ability to provide health care services and benefits to veterans, according to a new report from the department's inspector general.

The report argued that the VA's office of information and technology did not adequately plan for a 2006 initiative that sought to centralize VA's IT management, leading to lax management controls and oversight.

The report noted that a $167 million project to create an automated system for scheduling appointments at VA health care facilities never developed a workable system. VA officials suspended the program earlier this year and are now studying alternatives.

The inspector general also criticized VA's management of HealtheVet, which is set to replace the department's Veterans Health Information Systems and Technology Architecture, an enterprise-wide information system built around an electronic health record, used throughout the VA medical system. According to the report, VA officials lack a comprehensive project management plan. The report notes that the target for HealtheVet's competition has been pushed back from 2012 to 2018.

The report concluded that the department "needs to develop a comprehensive written plan to achieve more robust and disciplined centralized management processes across VA."

VA officials have already implemented some of the report's recommendations, according to Stephen Warren, VA acting assistant secretary for information and technology. VA officials are close to finalizing a top-to-bottom review and will publish a report on the changes they plan to make, he added.

Warren said VA officials already have implemented a comprehensive plan for HealtheVet. However, the Obama administration's recently announced project to combine Department of Defense and VA electronic health records will change the project's planning process, he noted.

More than 50 percent of health care providers believe the billions of dollars from the American Recovery and Reinvestment Act (ARRA) earmarked for health care information technology (HIT) will have little to no success in encouraging HIT adoption, according to a recent survey sponsored by IVANS Inc.

The survey, which polled 508 U.S. health care providers this past April, found that 61 percent of respondents believe electronic health records (EHRs) could have a positive impact on their businesses. Eighty-two percent, however, cited lack of budget as their biggest challenge in implementing HIT. Only 17 percent of providers surveyed are participating or planning to participate in a health information exchange (HIE) over the next 12 months. Without the mechanism to share records among a patient's caregivers, the value of an EHR is severely restricted, and providers could face reduced payments from Medicare and other payers if a system lacks interoperability, the survey report noted.

"While there are many pieces to the health care puzzle that still need to be figured out, the use of HIEs and EHRs will create greater information transparency and will play a critical role in whether health care reform succeeds or does not," said Claire DeNicola, president and CEO of IVANS. "The government needs to get tactical about what qualifies for the funding and what doesn't, as providers are wary to start implementation without this understanding."

The market for electronic medical record (EMR) data transfer equipment and applications, currently valued at $575 million, is forecast to reach $1.6 billion in 2013, according to a new report from Kalorama Information.

Increased use of EMRs and other high-tech patient monitoring systems are a vital component of President Obama's plan to fix the looming health care crisis. EMR technology has the potential to improve patient outcomes and satisfaction, provide cost savings and more efficient use of health care resources, and reduce hospitalizations, the report said.

Patient monitoring produces a vast amount of data, but this data can be disjointed and located in different places, the report noted. EMRs are intended to give patients and physicians greater freedom and improve accuracy, and should result in better outcomes as critical records are all in one easily transportable record.

Driven by the growing use of EMRs in hospitals and physicians' offices, this segment of the patient monitoring market will grow 23.3 percent annually through 2013, according to the study, "High-Tech Patient Monitoring Systems Markets (Remote and Wireless Systems, Data Processing, EMR Data Transfer)."

The report covers all market aspects of the new generation of patient monitoring devices, as well as the data processing software and EMR interface software that are crucial to these systems, according to Kalorama.

How well pharmacy software vendors deliver on the integration between core clinical systems and pharmacy automation software is having a significant impact on provider adoption and satisfaction, according to a new report from vendor performance analyst KLAS Research.

The report, Pharmacy Information Systems in the Age of Integration, profiled the performance of eight pharmacy automation vendors, as reported by more than 350 health care professionals. The report looked at the level of integration each product enables with other components of the closed-look medication administration process.

In the survey, respondents noted that software vendor Epic offers a product suite that delivers full integration among a number of components, including computerized physician order entry, pharmacy and barcoding at the point-of-care. That integration, along with strong customer service and support, earned Epic EpicRx inpatient the highest overall performance score in the study.

Of the vendors highlighted in the report, Epic EpicRx inpatient was the highest-rated product by a wide margin, according to KLAS. Epic earned a performance score of 85.9 out of 100. Siemens Pharmacy (79.0) and GE Centricity Pharmacy (77.2) were the second and third highest-ranked products, respectively. Other pharmacy vendors profiled in the report were Cerner, Eclipsys, McKesson, Meditech and Mediware.

The report is available to health care providers online for a discount off the retail price. To purchase the full report, health care providers and vendors can visit www.KLASresearch.com.

WhiteHat Security, a provider of Web site risk management solutions, released its seventh "Website Security Statistics Report," providing perspective on the most prevalent Web site security issues using aggregated data from real-world production Web sites.

WhiteHat's report shows the top 10 Web site vulnerabilities, a vertical market breakout and insight into evolving threats facing organizations. WhiteHat recently reached 1,000 Web sites under management; all assessments were conducted on production sites.

The top 10 vulnerabilities remain largely unchanged from prior studies, with cross-site scripting continuing to be at the top of the list. Business logic flaws -- an often-overlooked issue -- that enable hackers to take advantage of the functionality on a site, occupied more than half of the top spots. WhiteHat's report also shows that more than 70 percent of Web sites have at least one critical vulnerability, while another 63 percent fall into the high-risk category.

In addition, the report shows Web site security issues through its vertical market breakout. Social networking sites topped the list in this survey, with 82 percent having an urgent, critical or high-severity vulnerability. Education sites slipped to the No. 2 spot with 76 percent and IT came in a close third with 75 percent.

WhiteHat's report includes data collected between Jan. 1, 2006, and March 31, 2009, finding that 82 percent of Web sites have had a high, critical or urgent issue over their lifetime. WhiteHat found that 63 percent of Web sites have a high, critical or urgent issue, indicating that consistency, thoroughness and frequency of sentinel assessments leads to a decrease in vulnerabilities and therefore a decrease in overall risk.

Of the more than 17,000 vulnerabilities identified in the study, more than 7,000 remain open.

The University of Pittsburgh Medical Center (UPMC) recently became the first non-profit health care provider to achieve an international recognition standard for effectiveness and efficiency in software development. Achievement of the Capability Maturity Model Integration (CMMI) Level 2 rating is based on a rigorous appraisal methodology from Carnegie Mellon University's Software Engineering Institute.

"This accomplishment by our technology staff underscores our commitment to continually improving the development and delivery of our technology products and services to better serve our patients," UPMC CIO Dan Drawbaugh said.

The scope of the appraisal focused on UPMC's Strategic Bio-Defense Emergency Operations and Communications System (SBEOCS) team. Developed over the past four years, the system helps emergency management officials, first responders, hospitals and others to coordinate care during a disaster, manage and share assets, and collaborate on disaster planning. SBEOCS includes a public information Web site, which provides health-related information to help the public plan for, respond to and recover from disasters. The system most recently was used during the H1N1 flu outbreak to coordinate information for UPMC, the region and the Commonwealth of Pennsylvania.

CMMI is a performance-improvement methodology established to guide users in improving quality and efficiency through repeatable processes. The primary focus of CMMI is to identify and leverage an organization's best IT practices in key disciplines to better meet its business objectives.

UPMC's Innovative Medical and Information Technologies Center provided program management for the project and sponsored the CMMI initiative. The appraisal, using Standard CMMI Appraisal Method for Process Improvement Class A methodology, was conducted by Krishnan Puthucode, an SEI-authorized lead appraiser.

Microsoft Corp. has unveiled Bing, a new decision engine and consumer brand, intended to provide customers with a first step in moving beyond search to help make faster, more informed decisions. Bing is specifically designed to build on the benefits of today's search engines, but takes a new approach to user experience and intuitive tools to help customers make better decisions, focusing initially on four vertical areas: making a purchase decision, planning a trip, researching a health condition or finding a local business.

The result of this new approach is a search service which Microsoft is calling a Decision Engine, designed to empower people to gain insight and knowledge from the Web, moving more quickly to important decisions.

Bing was developed as a tool to help people more easily navigate through the information overload that has come to characterize many of today's search experiences. Results from a custom comScore Inc. study across core search engines show that as many as 30 percent of searches are abandoned without a satisfactory result. The data also showed that approximately two-thirds of the remaining searches required a refinement or new query on the search results page.

The new brand portfolio will include the following changes to existing Microsoft programs:

·  Microsoft's mapping platform, Virtual Earth, will now be branded as Bing Maps for Enterprise.

·  Technology from Microsoft's April 2008 acquisition of Farecast is now a central part of Bing Travel. More information is coming soon.

·  Microsoft's cashback program, now dubbed Bing cashback, with more than 850 merchants and more than 17 million products available, will be fully integrated into the Bing Shopping experience.

The new service, located at http://www.Bing.com, will be fully deployed worldwide on Wednesday, June 3.

The New England Healthcare Institute (NEHI) has released a new report that calls for the expanded use of health IT to improve the quality of primary care delivery.

The report, Remaking Primary Care: From Crisis to Opportunity, suggests that properly implemented technologies such as electronic medical records and computerized prescription ordering will free up physician time during visits, provide timely access to information and aid in the overall coordination of care.

The report also recommends primary team training; centralized care at single clinical settings; offering primary care services at retail clinics, worksites and in the home; and improved pay-for performance as new approaches that could enhance care quality and outcome.

According to NEHI's research, the primary care crisis is the confluence of a rising demand for primary care and a decreasing supply of professionals providing these services. On the demand side, challenges to primary care are fueled by a demographic shift -- the percentage of Americans aged 65 and older is expected to rise to more than 20 percent by 2050 -- and a rising incidence of chronic disease. Currently, 67 percent of Americans aged 65 to 79 live with at least one chronic condition, and much of their care has shifted from hospitals to ambulatory care settings.

On the supply side, NEHI identified the relative lower pay of primary care doctors and dissatisfaction over high workloads, long hours and a sense of being undervalued as driving existing providers out of the profession while deterring new physicians from pursuing primary care.

The Markle Foundation recently hosted a forum to discuss the $19 billion allocation to investments in health information technology (IT) under the American Recovery and Reinvestment Act (ARRA). Health care and IT leaders met with government and policy experts to discuss how health IT investments can be directed toward improving health outcomes, protecting patient privacy and reducing rising health care costs, laying the groundwork for health reform.

Markle Connecting for Health released principles, supported by a group of health and IT leaders, outlining an initial approach to "get health IT right" under ARRA.

"The leaders will be instrumental in achieving the goals of ARRA and in making sure that these investments support broader health reform efforts," said Zoë Baird, president of the Markle Foundation.

Forum participants released a new document entitled "Achieving the Health Objectives under ARRA: A Framework for Meaningful Use and Certified or Qualified EHR." The definition of meaningful use will determine how clinicians and hospitals qualify for the health IT incentives included in the economic stimulus law. The document is available for download at www.connectingforhealth.org.

The document was developed in collaboration with consumer, business and health organizations. Individuals supporting the document included:

AARP, Allscripts, America's Health Insurance Plans, American Academy of Family Physicians, American College of Cardiology, Association of Online Cancer Resources, the Blue Cross and Blue Shield Association, Center for Democracy and Technology, Center for Information Therapy, the Childbirth Connection, Chilmark Research, Consumers Union, DocSite, Dossia, DrFirst, Google, Health Care For All, Intel, The Joint Commission, Keas, Inc., McKesson Provider Technologies, the Medical Group Management Association, Mental Health America, Microsoft, National Coalition for Cancer Survivorship, National Committee for Quality Assurance, National Consumers League, National Partnership for Women & Families, NewYork-Presbyterian Hospital and the New York-Presbyterian Healthcare System, Prematics, ReachMyDoctor, Surescripts, WebMD, Zix Corp. and The Markle Foundation.

"The consensus that we've been able to build -- and continue to build -- around the principles in this paper is truly remarkable," said Baird. "There is enormous potential to improve our health care system through modern information tools. To do that, we need to set clear goals, define meaningful use as the use of information to improve health, and adopt an approach to technology and standards that fosters market innovation."

The group suggests a practical starting point for using information to achieve the goals of ARRA. It says a basic set of open standards are necessary, along with assurances that systems bought with federal support are being used to achieve health improvement goals. The group recommends an approach to technology that encourages innovation of tools and services particularly for clinicians in small office practices.

IT budgets and staffing levels are expected to remain flat over the next two years, in large part due to the global economic downturn. But demand for IT services will increase by more than 17 percent, creating a significant gap that companies will need to address with improved efficiency and productivity, according to a new study published by The Hackett Group, Inc.

Hackett's research, which looked at results from more than 80 global companies, details best practices in three areas that companies can use to close this gap: IT cost control strategies, demand management and discretionary cuts.

Demand management for efficiency improvements is being neglected by many companies, the research firm said. Only about a third of all companies in the study use cost allocation or charge-backs to bill internal users based on the volume of IT services consumed, or for IT work done on their behalf. In addition, less than 30 percent of organizations have a service catalog that defines a set of discrete IT service offerings with an associated price per unit.

"Demand for IT services has always exceeded supply capacity," said Hackett IT Advisory Practice Leader David Ackerman. "But the global economic downturn has put more pressure than ever on IT organizations to do more with less. The growing gap between demand and budgets requires companies to broaden their mix of techniques. IT organizations that stick to traditional discretionary cuts are unlikely to truly solve the problem, and also risk significantly damaging their ability to provide strategic value to their company."

According to Hackett Senior IT Research Director Erik Dorr, "What we see is that there's significant untapped potential for companies to cut costs and manage demand. While most companies in our study have implemented basic IT cost-control strategies, other areas, such as demand management, have largely been ignored. And even in traditional areas like discretionary cuts, which are fairly inevitable in the current environment, there's room for an increased level of sophistication to reduce the stress on the IT organization and to ensure that the cuts are sustainable."

Hackett's research found that companies forecast that IT budgets and staffing levels will each grow by only about 1 percent annually over the next two years, down from the annual growth rates of 5.3 percent (for budgets) and 4.3 percent (for staff) seen over the past three years. This 75 percent decline in budget growth contrasts sharply with companies' projections for IT demand, which will shrink by only 15 percent, to 8.6 percent annually for the next two years, resulting in an increase of more than 17 percent by the end of 2010, the research firm stated.

Republicans in the House and Senate have proposed health care reform legislation (H.R. 2520, S 1099) that would create health record banks to collect and maintain patients' health records, according to a recent published report.

Under a health record bank model, a trusted entity collects patients' paper and electronic health records from physicians, laboratories, pharmacies and other sources.

Each bank account contains an electronic copy of a patient's health record, and patients control who can access their data and what information to make available, Health Data Management reported.

Typically, a health record bank is financed through account fees charged to individuals or sponsors, such as health care provider organizations or health plans.

The legislation, called the Patients' Choice Act of 2009, states, "This act proposes adopting the same model used by the financial services industry in promoting the use of automated teller machines.

"Individuals could get a card -- just like their ATM card -- that would maintain their insurance and medical history information from an independent health record bank. Every time you visit your doctor, you would swipe the card for instant access to your medical history and insurance payment information."

Sponsors of the legislation include Sen. Richard Burr (R-N.C.); Sen. Tom Coburn (R-Okla.); Rep. Devin Nunes (R-Calif.); and Rep. Paul Ryan (R-Wis.).

The U.S. Department of Veteran Affairs (VA) has begun a national initiative using data from its electronic medical record (EMR) system to study how well various treatments work for post-traumatic stress disorder and methicillin-resistant Staphylococcus aureus infections.

The $10 million project, called the Consortium for Healthcare Informatics Research, will last four years. The project will be led and coordinated by physicians at the VA hospital in Salt Lake City, but investigators from California, Connecticut, Florida, Indiana, Massachusetts, Oregon, Pennsylvania and Tennessee will also be involved.

Matthew Samore, chief of the division of internal medicine at the University of Utah and head of the University's part in the project, noted that throughout the past 20 years, the VA has developed a clinical data warehouse that can be used for advanced research.

The new VA project will advance data warehousing functions by collecting detailed patient data such as clinical notes by providers; discharge information; family history; lab reports; pharmacy records; physician orders; radiology reports and images; and vital statistics.

The initiative will allow researchers to use advanced language processing techniques to extract previously unsearchable EMR data. Researchers hope that the compiled data will allow them to identify novel associations for conditions and treatments that might not have been apparent under the previous system.

While major health care companies have long been at work on proprietary medical informatics software, the VA initiative has "adopted principles that favor, where possible, using open source software," said Samore, in a recent Salt Lake City Deseret News article. "That means these different components are organized in such a way that they are modular and can be shared."

The Association of Medical Directors of Information Systems (AMDIS) has partnered with Compuware, a software firm that develops hospital applications, to launch a Web site that provides a forum for health care professionals to discuss the definition of "meaningful use." The American Recovery and Reinvestment Act (ARRA) includes incentive payments for health care providers who demonstrate meaningful use of health IT, such as electronic health records (EHR).

The Web site, www.meaningfuluse.org, includes a discussion forum; a listing of relevant news articles; links to government and other sites related to meaningful use; and news feeds on discussion boards. Compuware funded the site's development and hosting, while AMDIS owns and manages its content, according to a recent Modern Healthcare report.

William Bria, president of the AMDIS board, said the association will communicate the consensus of experts' comments to President Obama's administration. The administration is expected to have a draft of the meaningful use provisions by this summer, and must complete the specific requirements by the end of the year under the stimulus law.

Bria emphasized that people who understand both medicine and technology should be involved in designing health IT systems for different health care settings.

"It's our fervent belief that the men and women who have implemented this technology in hospitals and clinics should be listened to and their advice incorporated in the national plan," he said.

Bria also suggested that qualifications for meaningful use could change in graduated steps over a multi-year span. For example, early standards could require providers to use EHRs to report vaccinations, detect medicine interactions and track patient compliance with tests and treatments, he said.

Boston-based Beth Israel Deaconess Medical Center's CIO said it was "a mistake" to send insurance claims data to Google Health as a way of summarizing patients' medical histories and discontinued the practice, The Boston Globe reported.

The newspaper reported that Beth Israel is one of many hospitals and insurers that send claims data to Google Health's "personal health records," which lets people keep their medical records in a single file that is accessible over the Internet.

But as The Globe reported recently, claims data is prone to inaccuracies, particularly for those patients with complex health problems. When Dave deBronkart, a kidney cancer survivor from Nashua, N.H., tried to move his Beth Israel records into his Google Health file recently, the list of conditions in his new Google record included diagnoses he had never received from his doctors, such as the spread of his cancer to his brain or spine and an aortic aneurysm. Dates were missing or wrong.

Such inaccuracies could lead to medical errors if doctors make decisions based on bad information, medical technology specialists say.

Beth Israel will now send Google lists of patients' medical problems from clinical records, said John Halamka, MD, Beth Israel's CIO, who spoke with deBronkart, his doctor, Daniel Z. Sands, MD, and Google officials about deBronkart's case.

Google Health said Roni Zeiger, MD, a product manager for the company, who wrote in an e-mail to the newspaper that Google would continue to let each of its partners determine the best way to send patient records to Google.

Google Health prefers its clinical partners to send lists of each patient's problems in a coded format so the Web site can refer patients to additional information about their conditions using links to other medical Web sites, the newspaper said.

Dr. Halamka told The Globe that Google will immediately be able to provide links to Web sites with additional disease information for about 70 percent of the medical terms in the hospital's clinical records, which are written in a mix of free text and the hospital's own diagnostic coding language. He said the hospital is working with the National Library of Medicine on devising a way to codify the free-text terms.

An executive at Disney's Florida Hospital for Children in Orlando, Fla., who was also New York's former Health Commissioner, was charged with theft and fraud last week by the Albany County District Attorney's office in Albany, N.Y.

Antonia C. Novello, MD, who is listed as vice president of women and children's health and policy affairs at the Florida Children's Hospital, is also the former New York Health Commissioner. She was charged last week in a 20-count indictment accusing her of abusing her power during her tenure as Commissioner of Health for the State of New York.

The Albany Times-Union reported that Novello was accused of exploiting her staff to meet her personal needs; the one-time U.S. surgeon general was arraigned on felony and misdemeanor charges in Albany after a grand jury accused her of abusing her powers while in office.

Novello is a physician and public health administrator. She was vice admiral in the Public Health Service Commissioned Corps., and served as the 14th Surgeon General from 1990 to 1993, during former President George H.W. Bush and former President Bill Clinton's administrations. Novello served as Commissioner of Health for the State of New York from 1999 to 2006.

In the indictment, Novello is accused of theft of government services, defrauding the government and filing a false instrument, the newspaper said. Novello had been under investigation for several months.

Novello pleaded not guilty to the charges in Albany District Court. The charges carry a maximum 12-year sentence in prison, the newspaper reported. The case is being prosecuted by the Albany County District Attorney's office.

Novello's attorney, E. Stewart Jones, called her prosecution a "selective process" that should have been handled in civil court, the newspaper said. "Why is she here? She's here because she has a bulls-eye on her back, because politics is a contact sport, because there are people who are vindictive and who have wanted to get her ever since she left the state," Jones told the newspaper.

Albany County District Attorney David Soares said Novello's official status was not a factor in his decision to prosecute the case, the newspaper reported. The allegations in the indictment are similar to accusations detailed in a January New York Inspector General's Office report about of her conduct as commissioner, the newspaper reported.

In that report, State Inspector General Joseph Fisch said Novello allegedly exploited and abused her staff by requiring guards to chauffeur her to retail malls and stores, and required staff members to allegedly accrue 2,540 hours of overtime at a cost of $50,000 to taxpayers, the newspaper said.

Novello served the state health department under New York Gov. George Pataki following her service as surgeon general. 

Johns Hopkins Hospital is warning more than 10,000 patients about data theft after linking a woman working in the hospital's patient registration area to a fraud that victimized a handful of the Baltimore-based facility's patients. 

However, most of the 10,200 patients and former patients being notified are thought to be at "extremely low risk" of fraud, according to hospital spokesman Gary Stephenson. "We just contacted them to do due diligence," he said in a statement.

After the U.S. Secret Service and U.S. Postal Service got involved, investigators began suspecting that the Johns Hopkins employee was linked to a fraud that involved fake Virginia drivers' licenses, although officials declined to provide more information regarding that alleged scheme.

Law enforcement has identified 46 victims of the scam, 31 of whom were linked to Johns Hopkins. The hospital is offering them credit protection services, and it is also offering similar services to another 526 Virginia patients who may have been targeted by the fraud.

"Beginning around January 2009, Johns Hopkins received reports, some from individuals themselves, and some through various local law enforcement agencies, that some individuals had determined that they were victims of identify theft and that the theft activities focused in the Baltimore area," the hospital said in an April 2, 2009 letter sent to patients whose data was accessed.

The employee had access to the Social Security numbers, names, addresses, dates of birth, telephone numbers, parents' names and medical insurance information of current and former patients. The employee was not able to acquire information about the patients' medical conditions, however.

News of the incident was first reported May 11 on www.databreaches.net, which noted that a former Johns Hopkins employee had been indicted in January on fraud charges for allegedly using patient data to open fraudulent credit card accounts.

Stephenson said that the case that spurred the January indictment was separate from this latest incident, but he declined to comment further on the matter, citing an ongoing investigation.

In its notification letter, Johns Hopkins said it has fired a female employee it suspects of this latest fraud and expects that she will be indicted. However, "there is no absolute certainty, at this time, that she was the source of the information," the letter warned.

April 29, 2009 - HIMSS Defines 'Meaningful Use'

HIMSS published its definitions of meaningful use of certified electronic health record (EHR) technologies this week, as outlined in the American Recovery and Reinvestment Act of 2009 (ARRA). HIMSS sent a letter, plus two definitions -- meaningful users of certified EHR technologies and meaningful use for hospitals -- to the National Coordinator of Health IT and the Acting CMS Commissioner, within the Department of Health and Human Services (HHS)

ARRA calls for multiple years of Medicare incentive payments to hospitals and physicians who meet the requirements of "meaningful use of certified EHR technology." To be eligible for the incentive payments, hospitals and physicians must use the technology in a meaningful manner; to exchange electronic health information to improve the quality of care; and, submit clinical quality measures -- and other measures -- as selected by the Secretary of HHS. Hospitals and physicians must meet the definition within a specific time frame, which as described in ARRA, will be made increasingly stringent over time by the Secretary.

Approved by the HIMSS board of directors, the definitions resulted from a consensus-building effort with input from HIMSS members (73 percent who work in end-user settings) and the public at-large. HIMSS represents more than 20,000 individual members and 350 corporate members.

HIMSS recommends the following:

1)      To ensure continuity, recognize CCHIT as the certifying body for EHRs.

2)      To achieve incremental maturation of "meaningful use," adopt metrics that can be reasonably captured and reported beginning in the federal government's fiscal year 2011, and then made increasingly stringent using intervals of not less than two years. HIMSS' definitions include metrics to enact, in phases, over a multi-year period.

3)      To bridge existing gaps in interoperability of health information, coordinate with HITSP and IHE to create new harmonized standards and implementation guides.

4)      Reconcile the gap between certified EHR technologies, best-of-breed and open-source technologies.

As noted in HIMSS' letter, the organization believes that ARRA has the potential to improve the quality, safety and cost-effectiveness of patient care.

April 29, 2009 -- Virtualization Drives Management Software Requirements
As virtualization moves beyond early test implementations to taking a more active role across corporate IT environments, IT organizations with the most mature and complex virtualization implementations (more than 50 virtual machines in operation) are demanding sophisticated tools to help manage these environments.

According to research from IDC, the experience of organizations with larger scale virtualization implementations indicates how important state-of-the-art management software tools and best practices are to ensuring effective operation of these increasingly mission-critical environments.

A recent IDC survey of 100 North American IT decision-makers -- responsible for virtualization infrastructure -- showed that 56 percent of the more complex/mature organizations believe that management of their organization's virtual environment is critical to reaching the organization's business goals, compared to just 24 percent of the decision-makers responsible for less complex environments.

'"To be successful, organizations expecting to grow their virtualization environments need to simultaneously invest in appropriate management tools, best practices and automation," said Mary Johnston Turner, research director, System Management Software.

Other findings from the IDC survey include the following:

·                     79 percent of organizations with more than 50 virtual machines report they currently apply or plan to apply ITIL or other best-practice process models to managing their virtual infrastructure. This compares to 48 percent of the less complex organizations.

·                     70 percent of larger implementations currently use or plan to deploy common management tools across physical and virtual environments, compared to 53 percent of the less complex organizations.

·                     70 percent of decision-makers responsible for larger implementations expect automation to play a very important role in their virtualization management environment going forward. This compares to 37 percent of the less complex organizations.

April 20, 2009 -- Microsoft, MS-HUG Announces Winners of Innovation Awards

The Microsoft Healthcare Users Group (Microsoft HUG) and Microsoft announced the winners of the 12th annual Microsoft Health Users Group 2009 Innovation Awards at the HIMSS09 conference.

For more than a decade, the honors have been awarded to health care organizations, software vendors and system integrators who have demonstrated advancements, innovation and success using Microsoft technology in the health care industry -- ultimately helping to improve health care around the world.

Each year, Microsoft HUG and Microsoft collaborate to produce the Microsoft Health Users Group awards, which recognize health care organizations and individuals who exhibit the best use of Microsoft-based products, as well as independent software vendors and systems integrators that develop solutions on Microsoft technology for the health care industry.

Award contestants were judged by a panel of industry experts and luminaries, and were evaluated on the extent to which they provide significant business benefits to healthcare organizations and improve patient care. Winners and finalists were recognized at the HIMSS09 conference at the Microsoft booth. The following are the 2009 winners for the Microsoft Health Users Group 2009 Innovation Awards:

Winner for Best Use of Clinical Records - Inpatient

·                    Heritage Valley Health System with Healthcare Software Collaborative, LLC developed Mobile Clinical Access Portal (MCAP). MCAP is a mobile clinical portal with seamless collaboration and clinical desktop applications.

Winner for Best Use of Clinical Records - Ambulatory

·                    Elmhurst Memorial Healthcare with NextGen Healthcare Information Systems implemented NextGen EHR. NextGen EHR allows providers to securely access comprehensive and up-to-date charts from any location, ensuring that current patient data is available to them, resulting in informed decision-making, and additional time to see more patients each day.

Winner for Best Use of Information Exchange (HIE) and Interoperability

·                    Northeast Physician Hospital Organization (NEPHO) with MedVentive developed MedVentive Analytic Platform and Quality Intervention Module (QIM), a collaborative care platform that resulted in quality above the 90th percentile nationally across diabetic care, adult and pediatric preventive care, women's health and cardiovascular disease, while being efficient with the utilization and cost of care.

Winner for Best Use of HealthVault Applications

·                    American Heart Association with Get Real Consulting launched Heart360, an online health management tool that sets personal goals for blood pressure, cholesterol and weight, and tracks for other heart disease risk factors. All this data is then stored online in the patient's HealthVault account.

The 2009 Microsoft HUG judges were Josh Fisher, founder and managing partner, PresPoint Capital; Ahmad Hashem, MD, PhD, chairman and CEO, Rawasi Investing Group; Matthew Holt, founder and author, The Healthcare Blog; Scott Lundstrom, research vice president, Health Industry Insights; Charlene Marietti, director, corporate editorial initiatives, The Vendome Group; Bob Mitchell, managing editor, ADVANCE for Health Information Executives; Doris Nessim, BScPhm, RPh, MA, healthcare informatics consultant and director of pharmacy services, New York General Hospital; Charles Potter, CPHMIS, president, Seapotter Corp.; Benjamin Rooks, director, William Blair & Company; Jay Srini, chief innovation officer, UPMC Health Plan; Andrew Ury, MD, chief medical officer, McKesson Provider Technologies; and Ferdinand Velasco, MD, chief medical information officer at Texas Health Resources.

 April 20, 2009 -- PAeHI Releases Privacy and Security White Paper

The Pennsylvania eHealth Initiative (PAeHI) published its third white paper to date, "Ensuring Privacy and Security of Health Information Exchange in Pennsylvania," which follows the publication last year of "Building a Sustainable Model for Health Information Exchange in Pennsylvania" and "Establishing Widespread Adoption of Electronic Health Records and Electronic Prescribing in Pennsylvania," which were prepared at the request of Gov. Ed Rendell's office. An abridged version of the paper was also published last month in the Journal of Health Information Management, the official journal for HIMSS.

"These comprehensive white papers represent the collective efforts and expertise of dozens of health care IT leaders from across the state," said Martin Ciccocioppo, PAeHI board chair and vice president for research with The Hospital & HealthSystem Association of Pennsylvania. 

To quote the paper's introduction: "PAeHI recommends the patient privacy and security protections outlined in this paper, with priority given to the adoption of a common consent form governing patient data disclosure statewide. Collectively, these protections will build and sustain the desired level of trust among patients, providers, health plans and other stakeholders, while balancing the protections with the necessity for adequate, accurate and timely patient data-sharing at the point of care."

The paper's Executive Summary concludes, "We further recommend that the state's approach to these and other areas of policy be consistent with the guiding principles laid out in the organization's strategic plan, Connecting Pennsylvanians for Better Health (April 25,2007), namely that:

• patients come first;

• Consumer privacy, security and confidentiality are paramount; and

• multi-stakeholder collaboration is essential."

The full white paper is available at www.PAeHI.org.

The third white paper comes at a busy time for PAeHI, as the organization continues its research and preparation following the passage of the American Recovery and Reinvestment Act, including its $20 billion in health information technology incentives and support. 

"To say we are excited about the possibilities for Pennsylvania would be an understatement," said Mark Stevens, PAeHI executive director.  "We are in the process of consulting with our membership, state government and other organizations across the Commonwealth on how Pennsylvania can best take advantage these unprecedented resources."

PAeHI also is pleased to announce that, after a two-year wait, the Internal Revenue Service has approved the organization's request for 501(c)(3) not-for-profit status, a designation that will improve PAeHI's ability to raise grant funding from corporations, foundations and other entities.

Finally, PAeHI will co-host a series of events at the Crowne Plaza hotel and State Capital in Harrisburg on May 4 and 5 with the Pennsylvania chapters of HIMSS. PAeHI's second statewide health IT Summit will be held on May 4, and will be followed by a reception and Solutions Showcase, an interactive demonstration of HIT at work in hospitals in Pennsylvania. These events will be followed on May 5 by the second Pennsylvania HIMSS HIT Advocacy Day, which provides a full day of education and networking, pairing Pennsylvania health IT leaders with their legislators to promote better health care through increased technology awareness and adoption. For more information, visit www.dvhimss.org.