EMISSARY - HEALTHCARE CONSULTING

Medication error rates fell substantially in two Australian hospitals after they introduced commercial electronic prescribing systems, according to a study published in PLoS Medicine. Although the use of these systems introduced new errors--as some U.S. studies have also shown--those additional mistakes were far outweighed by the increase in safety when the e-prescribing applications were used.

At one hospital, clinicians used the Cerner Millennium e-prescribing system in a geriatric ward. Three other wards served as controls. In the second hospital, the iSoft Medchart system was implemented in a psychiatric ward and a cardiology ward. The researchers compared the error rates before and after the introduction.

The use of the e-prescribing systems resulted in error reductions of 66.1 percent, 57.5 percent, and 60.5 percent in the three intervention wards. The control wards in the first hospital did not experience a significant decline in errors.

The researchers attributed the decrease in errors in the wards that used e-prescribing to "a large reduction in unclear, illegal and incomplete orders." Fewer mistakes in prescribing were responsible for a far smaller portion of the decline.

However, e-prescribing did lead to a significant drop in serious errors that could have resulted in death. Rates of serious errors were cut nearly in half, while serious errors in control wards fell only 17 percent.

System-related mistakes, such as picking the wrong medication from a drop-down box, accounted for more than a third of the errors in the intervention wards. But these were considered relatively minor in light of the overall error reduction.

It's hard to compare this study with similar U.S. trials, because hospitals in the U.S. use computerized physician order entry (CPOE), a system that includes both medication and test orders. But several studies of CPOE have shown that they can cause medical errors, while other studies have indicated that they can prevent mistakes from occurring.

Last November, the Institute of Medicine proposed that the federal government establish a panel to investigate patient deaths and serious injuries associated with health IT.

To learn more:
- read the PLoS study
- see a Medscape article on the study
- check out an InformationWeek Healthcare article on e-prescribing errors in hospitals

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The GOP primary candidates head to Nevada on Saturday, a state with poor healthcare and few healthcare resources -- also one that has plunged in and begun implementing what it can of the Affordable Care Act, even though many in the state doesn't agree with the politics of it.

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Recently, the Huron Consulting Group released its report, “Leading Through Transformation:  Top Healthcare CEO’s Perspectives on the Future of Healthcare.” The report included insights from the Huron Healthcare CEO Forum and took a hard look at some of the top industry issues that will be plaguing CEOs in the year to come. 

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Despite rising investments by venture capital firms, the health IT field as a whole is poised for no more than 5 to 10 percent growth this year, financial analysts who attended a panel discussion hosted by the Nashville Health Care Council this week predicted.

Factors conducive to continued growth include the impending conversion to ICD-10, the analysts said in remarks reported by Healthcare IT News. "I foresee a slightly better 2012, with the emphasis on slightly," said Darren Lehrich, managing director of Deutsche Bank Securities.

John Moore, founder of Chilmark Research, made a similar prediction in a blog post last month. "There will be plenty more [electronic health record] sales in the year to come, but over 2012 we will also see EHR sales growth begin to plateau and level off by end of Q4 '12," he wrote.

The main reason for these forecasts is that EHR sales have been driven by the government's financial incentives. To get that money, physicians and hospitals have to show Meaningful Use; and if they have not already implemented clinical systems, they're unlikely to meet the criteria in time to get the full amount of federal largesse.

However, there are other issues that could affect sales growth of individual companies in the next year or two. One is how much effect the Stage 2 Meaningful Use criteria will have on EHR vendors. If it is difficult to meet the certification requirements in Stage 2, some firms undoubtedly will drop out. That leads to the other question: Will the disappearance many of the current vendors boost sales of the surviving companies?

Even Stage 1 Meaningful Use undoubtedly has increased the big vendors' sales as physicians with minimal EHRs converted to more capable systems. But the market has already consolidated to some extent. Five vendors accounted for more than half of the Meaningful Use attestations last year, and some observers think that fewer than 10 companies own most of the market. If that's the case, the disappearance of many smaller firms won't have much impact on the survivors.

Nevertheless, venture capital firms see gold in health IT. They poured $633 million into the field last year, InformationWeek Healthcare reported. That was the highest amount since 2001, when they invested $759 million.

To learn more:
- read the Healthcare IT News story
- watch this video recap of the event 
- see the Chilmark Research blog post
- check out an InformationWeek article on venture capital investment
- see an article on Meaningful Use attestation

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Health information exchange will ramp up significantly in 2012 because the necessary elements of interoperability will be in place, ONC chief Farzad Mostashari, told the Health IT Policy Committee at a meeting Feb. 1.

The health information exchange strategy means finally bringing together the standards, identity authentication certificates, governance for rules of the road, and the availability of directories or digital provider phone books.

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Fortune magazine recently released its annual 100 Best Companies to Work For list. Healthcare companies nabbed 17 slots. What is their secret to creating a workplace that makes employees want to stay and makes their companies the ones for which job seekers aim? Healthcare Finance News reached out to those companies to find out.

Of those responding, one thing stood out: The importance of listening to their employees and responding to them.

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Some hospitals pay thousands of dollars more than others for big-ticket medical devices, according to Government Accountability Office (GAO) investigators, The Wall Street Journal reported.  From defibrillators to hip replacements to drug-eluting stents, a portion of those higher costs are coming out of Medicare's pockets.

The report released today surveyed 31 hospitals and found, for example, that one hospital paid $8,723 more than another for an identical implantable cardioverter defibrillator, which typically costs between $16,445 and $19,007. The cost of stents varied by as much as $828 from the typical cost of $1,700 to $1,800 each.

The report "raises serious concerns over the prices hospitals and Medicare are forced to pay for implantable medical devices," said Montana Democrat Max Baucus, chairman of the Senate Finance Committee, who requested the GAO study.

The GAO report says lack of price transparency hampers hospitals' ability to be "prudent purchasers" of medical devices.

Device makers say their products represent only a small portion of the $2.8 trillion in annual health spending and that greater savings could be found elsewhere, according to WSJ. Although confidential price agreements are in part to blame, price transparency could increase costs by discouraging sellers from offering discounts, David Nexon, an executive vice president of the Advanced Medical Technology Association, a device trade group, told WSJ.

Drivers of medical device costs includes healthcare organizations' desire to look better than competing hospitals, as well as doctors who demand hospitals provide them with specific devices, even if identical but less-expensive models are available. The GAO report highlights that latter problem and said contracts between manufacturers and hospitals often forbid price disclosures even to doctors, making it harder to steer doctors to less-expensive options, according to WSJ.

In some cases, hospitals bound by such contracts resorted to using color-coded stickers to help doctors distinguish between cheaper or more expensive devices on stock shelves, the report said.

To learn more:
- read the WSJ article (subscription required)
- see the GAO report (.pdf)

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While the American Medical Association (AMA) is calling for a halt to ICD-10, the American Health Information Management Association (AHIMA) is countering by urging all to stay the course toward the Oct. 1, 2013 deadline.

In the letter sent Thursday to Department of Health and Humans Services Secretary Kathleen Sebelius., AMA CEO James Madara, MD urged HHS “to make good on its commitment to improve the regulatory climate for physicians.”

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HealthGrades, a provider of consumer healthcare information, today released a list of America’s top cities for hospital care.

In its study, “HealthGrades Hospital Quality and Clinical Excellence,” HealthGrades identified those hospitals performing in the top five percent nationwide across 26 different medical procedures and diagnoses, then ranked cities by highest percentage of Distinguished Hospitals for Clinical Excellence. 

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Computerized tests used to determine whether football players and other athletes can return to competition following a concussion aren't always reliable and arguably are relied upon too much, a study published this week in the Journal of Clinical and Experimental Neuropsychology concludes. The study's authors, according to an announcement, find that some tests don't measure functional and metabolic impairments of the brain. What's more, cognitive performance measured by the most scientifically-validated of the tests currently being used--Immediate Post-concussion Assessment and Cognitive Testing (ImPACT)--usually normalizes within three weeks of a concussion, according to the authors, but that doesn't necessarily mean the injured athlete being tested is fully healed. Additionally, they say, such tests can actually harm recovery. Announcement

Minnesota is home to the Mayo Clinic – a world-renowned institution for medical care, research and education, employing more than 3,700 of the smartest physicians and scientists and scientists in the world and caring for patients from across the globe.

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Despite efforts by some religious organizations to be exempt from its provisions, the Obama Administration announced Friday that employers must offer health benefits that provide coverage for contraceptive services without charging a co-pay, co-insurance or a deductible.

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