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cap today

April 2005

Raymond D. Aller, MD
Hal Weiner
Michael Weilert, MD

National computer network could lead to billions in savings, study says

The U.S. health care industry could provide immediate access to complete patient information and save billions of dollars every year—if only it operated via a national network of computers. That’s according to a recent study conducted by the Center for Information Technology Leadership, a Wellesley, Mass.-based research organization that studies the impact of information technology on health care.

The study, titled "The value of health care information exchange and interoperability," examined the financial value of standardized electronic health care information exchange and interoperability, or HIEI. The findings, which are posted on the online edition of Health Affairs (www.healthaffairs.org/Most_Read_1.php), showed that a nationwide system of automated health care information exchange, connecting providers with other providers, labs, radiology centers, and pharmacists, for instance, could save the industry $77.8 billion per year. The savings would result from a reduction in redundant tests, automation of administrative tasks, and improved information exchange. The study reported that hospitals and doctors’ offices could save $33.7 billion annually, while laboratories could save $13.1 billion per year. According to the CITL, 90 percent of health care data exchange is performed manually, by telephone, fax, and postal mail.

Some industry analysts, however, believe the touted savings is too optimistic, including Laurence C. Baker, PhD, associate professor and chief of health services research at the Stanford University School of Medicine, whose response also appeared on the online edition of Health Affairs. Dr. Baker commended the authors’ attempt to uncover health care savings but questioned some of the figures the authors used in their calculations.

The authors calculated the cost savings for various direct care transactions, such as test orders and results, electronic prescriptions, and billing transactions, if an automated system of data exchange were implemented, he explains. For example, the authors say the cost of an average $40 lab test could be reduced by about $19.50 through such a system. Dr. Baker’s calculations show that the overall savings could be reduced significantly, but not by half.

"One of the things that would really further discussion is a much more open debate about the numbers that went into this and getting a better understanding of them. Now that’s difficult because there are hundreds of them," says Dr. Baker, who also recognizes the space limitations in the posted version of the study.

Jan Walker, a co-author of the study and CITL executive director, also notes that the Health Affairs article offered only a brief explanation of the study’s findings. The full 165-page study, available for purchase, includes a comprehensive explanation of the figures used in the authors’ estimates. "The methodology incorporates published evidence augmented by estimates from an expert panel. We do absolutely stand behind these numbers, but that’s not to say there isn’t a lot of room for discussion and further research," says Walker, acknowledging that Dr. Baker and others who commented on the survey raised some good points.

In a separate response posted on the Health Affairs Web site, David J. Brailer, MD, PhD, national health information technology coordinator in the U.S. Department of Health and Human Services, examined the connection between automated interoperability and electronic medical records. Dr. Brailer questioned whether the standards must precede the adoption of EMRs.

While EMRs are an important part of the interoperability picture, says Walker, they represent only one part of a continuum that also includes the lab, radiology, and pharmacy systems. "And, I don’t believe we’ve come to a consensus as a nation yet on exactly what the sequence of implementation needs to be," she adds.

The study authors’ responses to Drs. Brailer and Baker and to others who commented on the study were posted on the Health Affairs Web site (www.healthaffairs.org).

The authors believe that standardized HIEI will lead to improvements in patient safety and continuity of care that will outweigh the financial gains, Walker says. "People would love to be able to point to proven clinical benefits of this as well," she adds, "and we just can’t do that yet."

New DVD media for medical market

Maxell Corporation of America has introduced a DVD media specifically for the medical market.

The medical-grade media incorporates the company’s MaxPro Hardcoat technology for the highest level of data protection for up to twice the archival shelf life. Maxell’s HIPAA- and DICOM-compliant Medical DVD-R is ideal for critical medical images, patient records, backup, and fixed-content storage.

The product will have a capacity of 700 MB and be able to store up to 700 x-rays or 550 high-resolution images.

The company claims that compared to conventional DVDs, the smudge- and fingerprint-repellent Maxell Medical DVD-R is 40-times more scratch resistant, 20-times more dust resistant, and 20 percent more light resistant.

Informatics award exposes residents to health care IT industry

The first recipient of the CAP Foundation/Association of Pathology Informatics/McKesson Informatics Award is Sourav Ray, MD. Dr. Ray has been awarded a three-month residency that will allow him to explore how future information technology developments for the clinical lab can be used to promote patient safety and support evidence-based practices. His three-month rotation will be carried out at McKesson’s Eugene, Ore., development facility and a McKesson-affiliated laboratory research facility in Vancouver, Canada. Dr. Ray will provide input on usability, workflow, and direction for McKesson’s solutions. He will also help to define future IT requirements for the laboratory. "One of the most important factors in reducing medical errors is the effective use of IT in the clinical laboratory, yet most residents don’t have the opportunity for exposure to practice-oriented informatics," says Joseph Mark Tuthill, MD, president of the API. "This collaboration allows a resident to learn directly from a national health IT provider, enabling practical, firsthand exposure to informatics. The grant will help move pathologists forward into the world of health IT, filling a critical deficit in pathology education."

Misys releases latest version of lab system

The latest version of Misys Laboratory, from Misys Healthcare Systems, offers new enhancements to the product’s blood bank and microbiology modules.

New graphical user interface-based features in this release include blood bank quality assurance checks that generate password overrides, electronic crossmatch and instrument interfacing to automate manual testing, customized specimen inventories per lab facility with security levels for viewing and accessing blood products enterprise-wide, streamlined microbiology workflow that includes results viewing from one screen, and enhanced general laboratory rules-based logic and calculations via new tools for editing and testing.

Optio Software launches electronic health record

Optio Software recently launched the Optio QuickRecord Suite integrated electronic health record. The product, which provides a subscription-based model, serves as a foundation for community-based electronic record systems. Its QuickRecord Intelligent Hub is based on a distributed model for a community-based EHR. It indexes available information rather than storing it in a central repository. The QuickRecord Suite provides forms automation and on-demand scanning, and it serves as a centralized distribution point for documents via print, fax, and secure browser access. The product also offers a browser-based dashboard, e-signature module, and e-prescribing.

PracticeXpert upgrades electronic medical record

PracticeOne, a PracticeXpert company, has released its PracticeOne Clinical 4.0 electronic medical record, a full upgrade of its EMR.

Among the new features in this release are a browser-based interface, customizable tabs, and more flexible progress notes.

Clinical 4.0 also includes a full implementation of the Microsoft .NET framework. Users can access the entire medical chart for any patient and document visits, prescribe medications, and order lab tests from any location with an Internet connection.

Dr. Aller is director of bioterrorism preparedness and response for Los Angeles County Public Health Acute Communicable Diseases. He can be reached at raller@ladhs.org. Hal Weiner is president of Weiner Consult ing Services, LLC, Florence, Ore. He can be reached at hal@weinerconsulting.com. Dr. Weilert is director of laboratories, Community Hospitals of Central California, Fresno. He can be reached at mweilertmd@communitymedical.org.