Showing posts with label health care systems. Show all posts
Showing posts with label health care systems. Show all posts

Monday, May 18, 2015

Meaningful Use and The Exchange of Electronic Health Records


By: Joann Schulte  DO, MPH; Editorial Board Member

     Doctors and hospitals know a lot about paper pushing. Your office staff can  spend hours arranging referrals for children who each need to see a sub-specialist.   After the appointment, the same staff must feel like they’re on a treasure hunt  as they search for  the consultant’s recommendations or that delayed  lab result in the  medical record.   
     Or maybe you’re the hospitalist who needs to report a case of meningitis to the state health department. You spend fifteen minutes finding the form you need to report the case and you may spend another thirty minutes filling out the paper form if it is not online and faxing it.  Those kinds of frustrations were some of the reasons that electronic health records (EHR) were developed.  The EHR systems are supposed to end some of the paper pushing.   Information is supposed to get where it needs to go, lab results appear, and diseases are reported. That’s the concept of meaningful use (MU) of EHRs.
     At the end of last year, about 3/4 of US hospitals had adopted a basic electronic medical record that included clinician notes.  MU is another matter. The federal Centers for Medicare and Medicaid offer incentive payments to encourage implementation of EHR and meaningful use(MU) of those records.  The first phase of MU includes medication reconciliation and the exchange of health information between facilities.
      A new report by Teufel et al. (doi: 10.1542/peds.2014-2720)  published in this months' Pediatrics explores the progress of EHR adoption in children's hospitals and what barriers are reported by those institutions.  Early reports suggest that implementing pediatric EHR use was difficult because programs didn't include basics, such as weight-based dosing for medications, and pediatric normal values  for vital signs and diagnostic testing.
     The researchers surveyed the 224 members of the Children’s' Hospital Association to assess EHR adoption challenges the hospitals faced and how many got MU payments. The study period covered September 2011 to May 2012. The survey results were linked to records from the American Hospital Association to characterize the hospitals and federal records to identify the payment of MU incentives.
     Survey responses came from 133 children's hospitals (59.4%) and 35% of those hospitals (47) received some MU incentive payment.  The hospitals reported their most frequently anticipated challenges included the exchange of information with other hospitals (49%) and the generation of numerator and denominator information from the EHR to report quality information (41%).   Among the 47 hospitals that received MU payments, 58% reported that  the greatest challenge to achieving MU was the lack of meaningful criteria to pediatric care. The hospitals getting MU incentive payments reported their most challenging issues remained exchanging information with other providers (17, 44%) and generating numerator and denominator data (18, 46%).
     This report assessed only the first phase of MU; others will be implemented through 2018.  It seems that pediatric hospitals have a long EHR road ahead.

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Monday, February 16, 2015

Accountable Care Organizations: Are They Making a Difference in Reducing Cost and Improving Quality?

By: Lewis First, MD, MS; Editor-in-Chief  
 
Jay Reed @Flickr
     It seems that regardless of your personal opinions regarding how to solve the nation’s health care crisis, accountable care organizations (ACOs) are springing up more and more as a possible solution to bending the cost curve without compromising quality.  Yet are they working—and if so, are they working when it comes to caring for children? 
     Kelleher et al. (doi: 10.1542/peds.2014-2725) share with us this week 5 years of results attributable to a pediatric ACO for children on Ohio Medicaid when compared to fee-for-service or managed care cost histories also for children on Ohio Medicaid.  The results are very promising overall—but await your perusal to see if you agree.  Dr. Stephen Berman (doi: 10.1542/peds.2014-3739) an expert on health care financing and former president of the      AAP adds his input in an accompanying commentary that further helps interpret whether these findings are specific to the ACO studied or can be applied more generally to others. 
     Are you in a pediatric ACO?  Is it working to improve the value of health care delivery to children in your region?  We would love to hear your experience with this new type of health care financing model via a response to this blog, an e-letter or via your comments on our Facebook or Twitter pages.

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Tuesday, October 28, 2014

College Health Services Handling Students with Chronic Illness: Are They Ready, Willing, and Able?

By: Lewis First, MD, MS; Editor-in-Chief 

Queen's College quad.  Photo by Queen's College via Flickr.
If you are practicing in a town or city where there is a college or university, have you investigated what the college health service can provide for students with a chronic medical condition like asthma or diabetes? Do you know if these health services reach out to these students or perhaps coordinate care with your office when the care gets complex? If so, how common is it for college health services to identify, support and provide care for chronically ill students?

Lemly et al. (doi:10.1542/peds.2014-1304) tackle these questions by sharing the results of a national survey of medical directors of 200 college health services in regard to their preparedness to identify and manage care for teens and young adults with diabetes, asthma, and depression. The results will likely surprise you or perhaps even make you curious enough to visit your local college health service to get a better idea of what they do offer and whether you need to link more closely with them if services are not what you expect.

The good news is the majority of these centers are well-prepared to manage acute exacerbations although the findings for identification of students and chronic management of their underlying illnesses are not as reassuring.

And if you want some additional insight into what this study shows, don’t miss the accompanying commentary by Dr. Terry Bravender (doi:10.1542/peds.2014-2645), adolescent specialist. As you transition your patients with chronic illness off to college, investigating or alerting the college health service about your patient will ease the transition—and if you aren’t in contact with those services, this article may change that going forward.

What’s been your experience with a college health service, and if you work in a college health service, what’s been your experience with referring pediatricians sending you the information you need to optimize care? Share your thoughts by responding to this blog, via an eLetter, or on Facebook or Twitter.

Related Reading:

Tuesday, July 8, 2014

Health Reform & Its Effect on Children with Special Health Care Needs

By: Lewis First, MD, MS

Photo by familymwr via Flickr
While the Affordable Care Act (ACA) is becoming more and more of a visible force in how we provide care to all patients, the effect on children specifically is just beginning to be understood.

This week, our journal provides a venue to seeing just how the ACA is of benefit or potential risk to ensuring adequate high-quality comprehensive cost-effective care to children with special health care needs (CSHCN). Will these children get enhanced services or find new barriers to accessing the care they need?

Smith and Chien (doi: 10.1542/peds.2013-3884) opted to look into this question by comparing CSHCN in Massachusetts both before and after the institution of statewide health reform measures in 2006, similar to what the ACA is intended to do nationally. They wanted to see how these Massachusetts children compared to those in other states in terms of numbers uninsured, having access to care and adequate financial protection.

The authors discovered modest differences in CSHCN with public or private insurance post-reform in Massachusetts, with those children privately-insured having better access to specialists compared to publicly insured children in that state, as well as to all children with CSCHN nationally.

What does this mean for the ACA and its intended benefits for this population of high-risk children? Dr. Steve Berman (doi: 10.1542/peds.2014-1059) offers his opinion in an accompanying commentary.

Both the commentary and this study are two articles you cannot afford to miss, nor hopefully can our policy advocates for children at the state and national level. Read both articles and see what we mean.

Related Reading:

Thursday, September 12, 2013

Real-Time Improvement

Quality Reports Associate Editor Dr. Alex Kemper offers a preview of a Quality Report early-released this week from our upcoming October issue:

If you've not heard about SCAMPs (Standardized Clinical Assessment and Management Plans), I recommend you read the Quality Report submitted by Angoff et al. (doi:10.1542/peds.2013-0086). I like to think of SCAMPs as a component of any good learning health care system. It is an approach to guide care in a manner that is responsive to patients' clinical status and also collect the data necessary to refine algorithms. I suspect that in the near future most of us will be following SCAMPs and many of us will be developing them. This Quality Report is an excellent example of SCAMP implementation. So…scamper off and read the article (I think y'all were waiting for that).