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Final Rule for Meaningful Use Issued; Critics Point to Problems
Last month, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology issued the final rule outlining what constitutes "meaningful use" of electronic health records. According to the rule, physician practices and hospitals that show they make meaningful use of electronic health records will qualify for incentive payments from Medicare and Medicaid beginning in 2011; by 2015, providers who do not demonstrate such meaningful use will be subject to reduced payments under Medicare.

The American Medical Association (AMA) issued a statement July 21 saying that, while the final rule is an improvement from the proposed rule issued during the comment period, several problems remain. According to the AMA, these problems include:

  • too little time for providers to comply with the requirements before the program's launch in January 2011;
  • too many measures—20—of meaningful use; and
  • a dearth of available electronic health record systems that meet all of the requirements.

While the AMA and other provider groups have argued that meaningful use regulations move too quickly or ask too much of providers, the Leapfrog Group released an August 4 statement saying that the rule did not go far enough.

Citing safety concerns, Leapfrog Group CEO Leah Binder argues that the government should require providers to demonstrate that their information technology, including computerized physician order entry (CPOE) systems, functions as intended. A recent report from the organization found that in simulation tests of the CPOE systems in 214 hospitals, only half of potential medication errors were detected by the technology. Repeated tests six months later found improved performance, showing that ongoing monitoring and adjustment are critical to improving the reliability and effectiveness of health information technology.

Survey: Hospital Infections Caused by Lack of Resources, Ignorance
Catheter-related bloodstream infections remain one of the most serious and deadly complications of care because hospitals fail to commit sufficient resources and attention to eradicating them, according to the Association for Professionals in Infection Control and Epidemiology. Released last month, a survey by the association sought to uncover the reasons hospitals fail to adopt proven practices for preventing infections; responses were collected from 2,075 health care professionals, most of whom were infection control nurses employed by hospitals. Half of respondents said that bloodstream infections were a persistent problem in their hospitals and identified lack of time and resources, as well as lack of commitment by hospital leaders, as barriers to infection prevention.

More than half of respondents said that time spent on tracking and reporting infection rates—often through cumbersome paper-based systems—meant that they had little time to devote to prevention. And seven of 10 said they did not have enough time to train other hospital workers on ways to avoid infections. One of five said their hospital administrators were not willing to spend the money needed to aggressively fight infections.

Experts argue that the most powerful method for reducing preventable injuries has been to require physicians to provide data on their own performance and then provide them with their risk-adjusted complication rates and those of their peers. To further such efforts, data on the incidence of central line–associated bloodstream infections at some 900 hospitals across the country are now available on The Commonwealth Fund's performance benchmarking Web site,

Study: What Happens When Doctors Share Their Notes with Patients?
The Wall Street Journal, New York Times, Associated Press, and other news sources reported recently on a growing movement to give patients access to their physicians' notes. While patients have a legal right to read their doctors' notes, few do so because they are unaware of their right to see them or find it difficult to obtain the records.

An ongoing study described in the current issue of the Annals of Internal Medicine finds that inviting patients to review the notes—typically on electronic medical records—improves patients' understanding of their health and results in greater compliance with care regimens. Researchers caution that sharing the notes raises the potential that patients will misunderstand medical terminology or misinterpret medial information.

The OpenNotes study, funded by the Robert Wood Johnson Foundation, involves 25,000 patients and their primary care physicians at Beth Israel Deaconess Medical Center of Boston, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle.

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