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| HHS Defines "Meaningful Use" of EHRs |
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What does it mean to make "meaningful use" of an electronic health record? The federal government began answering that question last week by unveiling specific plans for its EHR incentive program.
According to the Department of Health and Human Services' proposal, which topped 500 pages, physicians and hospitals may qualify for Medicare and Medicaid reimbursement incentives if they meet certain specific criteria for "meaningful use" of EHRs, such as:
Using computerized physician order entry for a certain percentage of medical orders - 80% for physicians, 10% for hospitals.
Providing an electronic copy of patient health information within 48 hours to at least 80% of all patients who request one.
Performing at least 1 test of an EHR technology's capacity to exchange key clinical data electronically.
Providing medication reconciliation and summary of care records for at least 80% of transitions of care and referrals.
Conducting or reviewing a security risk analysis of EHR technology and updating security as needed.
A table outlining all the criteria starts on page 103 of the official document. The public has 60 days to comment on the proposal, which will then be updated before a final rule is made, likely in spring 2010, according to HHS officials.
The Medical Group Management Association has already weighed in, calling the proposal "overly complex." "Overly burdensome requirements and needlessly complex administration will only discourage physician participation in the program and the implementation of EHR," said MGMA President and CEO William F. Jessee, MD, FACMPE, in a statement that urges HHS to simplify the criteria.
Physicians and hospitals that meet the meaningful use tests will be eligible for tens of thousands of dollars in reimbursement incentives from the Centers for Medicare and Medicaid Services beginning in 2011.
Irene Tsikitas |
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| Disinfectants Linked to Antibiotic Resistance in Pathogens |
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Bacteria that are exposed to non-lethal amounts of quaternary ammonium disinfectants (quats) can develop a resistance to the disinfectant as well as to an antibiotic, even when the bacteria have never been exposed to the antibiotic, according to a group of Irish researchers.
"Residue from incorrectly diluted disinfectants left on hospital surfaces could promote the growth of antibiotic-resistant bacteria," says Gerard Fleming, PhD, director of the marine microbiology laboratory at the National University of Ireland in Galway, in a press report. Dr. Fleming and colleagues published the results of their study in the January issue of the journal Microbiology.
The scientists studied the effect of a quat biocide on Pseudomonas aeruginosa, a frequent cause of hospital-acquired pneumonia, urinary tract infection and bacteremia in patients with weak immune systems. They found that when P. aeruginosa was exposed to increasing amounts of benzalkonium chloride, the bacteria mutated to become resistant to the biocide and the antibiotic ciprofloxacin. Besides hospital cleaning products, benzalkonium chloride is found in non-alcohol hand sanitizers, cosmetics and personal hygiene products.
Mixing up the types of disinfectants used in hospitals may be a way of deterring resistance to biocides and antibiotics, said Dr. Fleming. "We need to investigate the effects of using more than one type of disinfectant on promoting antibiotic-resistant strains."
Kent Steinriede |
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| OSA Presents No Anesthesia Risks in Endoscopy |
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Endoscopy patients who suffer from obstructive sleep apnea are not at increased risk for anesthesia-related complications while under conscious sedation, according to a study published in the December issue of the journal Gastrointestinal Endoscopy.
Researchers at Yale University's department of medicine and division of gastroenterology in New Haven, Conn., used the Berlin Questionnaire to gauge the OSA risk of 233 patients who underwent routine upper endoscopy and colonoscopy procedures. The assessment tool asks patients OSA symptom-related questions such as: Has your weight changed? Do you snore? Are you tired after sleeping? Have you ever fallen asleep while driving? Do you have high blood pressure?
The researchers, led by Vijay S. Khiani, MD, discovered that approximately one-third of the patients they studied were at high risk of OSA, but they also found that the difference in the rate of transient hypoxia (a pulse oximetry measurement less than 92%) between high- and low-risk patients was insignificant (10% versus 7%, respectively).
Based on those findings, the researchers say most endoscopy patients, even if they haven't been screened for OSA, can undergo conscious sedation for routine endoscopic procedures with standard monitoring practices.
Daniel Cook |
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| InstaPoll: Do You Buy Refurbished Equipment? |
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You can get great deals in the used equipment market, but buying demo and refurbished vital signs monitors, tables, sterilizers and microscopes isn't for everyone. Tell us how you feel about buying pre-owned capital equipment in this week's InstaPoll. We'll report the results in this space next week.
Last week we asked for your views on whether your anesthesia providers could save you money by helping to reduce supply costs and waste at your facility. Of the 50 responses we received in the holiday-shortened week, 62% said they agreed and 38% said they disagreed.
Dan O'Connor |
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| News & Notes |
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Tip of the week Getting your staff certified and re-certified in basic life support skills can burden your budget and your staffing schedule, but it won't if you bring it in house. Linda Beerman, RN, MSN, CNOR, CNIV, was 1 of 4 staff nurses at her facility who completed the American Heart Association's basic life support instructor training. This let them hold training classes twice a year for staff whose certification was expiring, at a convenient time during each shift when it wouldn't demand overtime or take them away from patient care needs.
Pulling off the bandage Australian researchers have confirmed what many have long suspected: Yanking off an adhesive bandage quickly is less painful than peeling it off slowly. For a randomized trial published among the semi-serious studies of the Medical Journal of Australia's "Christmas Offerings" in its December issue, researchers at James Cook University applied bandages to the upper arms, hands and ankles of 65 medical students, removed them using slow and fast techniques and asked them to rate their pain according to a scale. While the average pain score for slow removal was 1.58, it was only 0.92 for fast removal. In general, women reported a lower overall average pain score than men did, with scores of 0.91 versus 1.64. "This may be due to higher pain tolerance, although men did tend to have more body hair," notes one study author.
California plastic surgery law As of Jan. 1, patients undergoing elective cosmetic surgery in California are required to get a physical exam and obtain written approval from a primary care provider before the procedure can take place, according to state legislation. Dubbed the "Donda West Law" after rapper Kanye West's mother, who died of pre-existing coronary artery disease and post-operative complications the day after she underwent cosmetic procedures in 2007, the legislation aims to ensure safe practices, but critics note that reputable surgeons always review a patient's recent medical history before taking on a case.
Antibiotics, MRSA and lawyers Using census figures, statistics on doctors and lawyers and data on antibiotic administration and methicillin-resistant Staphylococcus aureus, researchers at New York Medical College have speculated that the fear of lawsuits has driven physicians to overprescribe antibiotics and, consequently, led to the increase in antibiotic-resistant bacteria. For the study, which appeared in the American Journal of Therapeutics, the researchers found a high correlation between the population density of attorneys and the prevalence of MRSA in North America and Europe, but no correlation between the population density of physicians and MRSA.
ENT use for robot The U.S. Food and Drug Administration has approved the use of the daVinci surgical robot for transoral procedures to treat tumors in adults. This new indication is based on clinical trials conducted at the University of Pennsylvania School of Medicine in Philadelphia, where more than 350 ENT patients have been treated with the robot since 2005. The robotic technique allows the removal of tumors from the head and neck while preserving a patient's ability to speak and swallow, say Penn researchers. |
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