Editorial: Health monitoring saves lives, money

New technologies that remotely collect and transmit health data are available; more are being developed every year. Devices can monitor vital signs and heart conditions of patients at home, for example, to alert doctors to problems and prevent or reduce costly office and hospital visits.

But while such life-enhancing, cost-efficient technology exists, too many patients can't use it. Currently, Medicare does not reimburse doctors for the time it takes to analyze and use the information. As a result, the system creates built-in incentives for costly office visits instead of less expensive remote monitoring.

It's a payment problem that should be fixed. To that end, Sen. Norm Coleman, R-Minn., introduced the Remote Monitoring Access Act. Under the proposal, a new Medicare reimbursement category would be created to reimburse physician time spent analyzing transmitted data. The benefit adjustment would cover distance management for congestive heart failure, cardiac arrhythmias, diabetes and sleep apnea -- ailments that affect millions of Americans and cost billions every year.

Closely monitoring a patient at home or at work reduces the need for face-to-face office visits. Distance monitoring minimizes unnecessary travel and missed work, and can improve quality of life for seniors. Those are big benefits for people living far from the nearest doctor or hospital. An estimated 40 percent of rural citizens live in medically underserved areas, with care an average of 30 miles or more away.

Such monitoring is not intended to completely replace office visits, but it can reduce the number to trips to the doctor and make necessary visits more productive. Closely watching a patient via technology might trigger a trip to the pharmacy rather than the hospital. And remote monitoring provides instant feedback so that interventions can happen quickly, which often saves lives.

Extending Medicare benefits to cover this part of remote monitoring won't be cheap. Senate staff estimates that the cost could run $330 million over five years. But if spending that much for monitoring can save an estimated 10 times as much in care management, office visits, hospitalizations and other related costs, then it is clearly worth the investment.

Not surprisingly, AdvaMed, a national coalition of medical technology companies (including Minnesota's Medtronic and St. Jude Medical) supports this expansion of reimbursable fees; these companies develop and manufacture much of the cutting-edge technology. But they also have an interest as employers and consumers. With over 18,000 Minnesota workers, they want the most cost-efficient care too. And if Medicare reimburses, more private insurers will as well.

Congress should approve this smart change to both improve care and make it more convenient and cost-effective.

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Medical imaging goes filmless

The days of doctors posting X-ray images on lighted white boards are over at Hilton Head Regional Medical Center.

Instead of shuffling through envelopes full of negatives and using magnifying glasses to search for problems, doctors and radiologists now can view the images on powerful computers with screen resolutions higher than the human eye can process.

With a click of the mouse, physicians can magnify images to pinpoint tiny abnormalities in image scans -- a feature not available with printouts. What's more, those physicians can do it all from their personal practices or even in their homes.

As of this week, doctors will access MRIs, X-rays, ultrasounds and CAT scans through the hospital's new $2 million picture archiving and communication systems, also known as PACS.

Photo: Dr. Robert Clodfelter demonstrates the magnification capabilities of the new PACS system Monday in an emergency room office at the Hilton Head Regional Medical Center. Kristin Goode | The Island Packet

Photo: Radiology technicians Tiffany Schweitzer, left, and Victoria Riddle ask Eric Miller, PACS administrator, a question Monday at the medical center. Kristin Goode | The Island Packet

Physicians said saving time is the most important benefit of the electronic system.

In the past, technicians would have to take the films, develop them and deliver them to the radiology department for doctors to view. That could take as long as two days.

Now, as soon as the images are shot, they're uploaded directly to a high-speed transmission line and loaded onto doctors' computers. The entire process can take less than an hour.

"Waiting," said Dr. Robert Hewes, a radiologist, "is the worst thing we go through. Patients want answers. We want to be able to provide them as fast as we can."

Dr. Robert Clodfelter, medical director of the Emergency Department, said having the images available electronically aids in diagnosis, saves valuable time in emergencies and allows doctors to consult with radiologists off site in real-time.

Through a secure, online system, images can be accessed remotely from any computer with Internet access.

A radiologist "can be at home on his personal computer and look at the exact same image I'm looking at," Clodfelter said. "There's really no comparison to the old white-board way. ... It's a good time to be practicing medicine."

It's part of Hilton Head Regional's move toward an entirely electronic patient data system, which began last year when all paper was removed from the Emergency Department.

Within the last 18 months, medical records, the pharmacy system and some patient files were moved to the electronic system. In time, charts for inpatients will be paperless as well, said hospital CEO Elizabeth Lamkin.

"This is one of a series of things we're doing to take the hospital into the Information Age," she said.

The PACS system is fairly common among South Carolina hospitals, said Patti Smoake, a spokeswoman with the state hospital association.

Coastal Carolina Medical Center in Hardeeville has been using an older version of the computerized systems for a couple of years.

Within a year, Tenet, the parent company of Coastal Carolina and Hilton Head Regional, will upgrade that system so physicians have remote access to the images.

Source

IT Solutions Can Improve an ASC’s Bottom Line

Case Study #1:

Preventing Errors and Waste

In the operating room (OR), clear communication is supremely important. Extensive time is spent gathering patient information, and ensuring all the appropriate preparations are made. But, miscommunications and mistakes still occur resulting in potential medical mishaps and lost revenues. Within the confines of OR suites, full utilization of information technology (IT) can help prevent such errors and waste. Numerous people, operating on countless systems, are responsible for gathering all the necessary data, and a system that creates centralized storage for medical information can prevent technology gaps that plague many hospitals.

Judy Swanson, RN, joined Texas Children’s Hospital as director of perioperative services in February 2001, and discovered that the department’s existing perioperative information system was full of holes. Texas Children’s Hospital in Houston, located in the Texas Medical Center, is a 697-bed licensed, internationally recognized pediatric hospital, and is the largest children’s hospital in the U.S. The Texas Children’s surgical staff operates 24 hours a day in three different sites, treating patients ranging from newborns to adults. Managing all of the department’s vital data in order to maintain the hospital’s high-standard of safety and keep costs in check is a great challenge. Swanson, who has managed ORs like Texas Children’s for more than 19 years, led the implementation of department-wide automation technology to meet and exceed this challenge.

The Challenge

For years the department had been collecting information in several different applications that required a significant amount of manual data entry and failed to provide comprehensive reports. Surgeon preference cards were stored in Microsoft Word, and could not be tracked or organized in a significant way. Intraoperative nursing documentation and inventory control were done by hand, often with unreadable handwriting. Nurses documented surgical cases and calculated OR charges manually, resulting in numerous clerical errors. Bits and pieces of information were scattered across a group of disconnected systems, and each staff member used a personal method for documenting procedures. The lack of an agreed upon nomenclature and a central location for patient and billing information contributed to an inefficient workflow and inaccurate data. The information the system did gather could not be effectively analyzed, because the system did not generate statistical reports.

Additionally, the department’s unproductive system of data capture resulted in missing or erroneous information in approximately 40 percent of patient records. The billing department returned all errors to the OR for correction. This forced nurses to waste valuable time trying to track down correct information and caused numerous reimbursement problems. The department averaged more than $100,000 per month in late charges, and the staff time lost to manual documentation and backtracking was priceless.

The department was in desperate need of a comprehensive system that would institute an agreed upon language for all procedures being documented, and provide a single, central location for all information, from patient record details to billing codes. After initial research, it was decided that an upgrade to an all-inclusive OR management system would improve the hospital’s clinical documentation and make good sense for the hospital’s bottom line. The hospital launched a wide-ranging search for software that would document all phases of surgical care, from scheduling to preoperative care, through the OR and on to recovery, critical care and billing. Additionally, the system needed to provide a complete electronic record of the surgical event that enabled easy data access to promote patient safety, and allowed for analysis of this data to ensure the best allocation of time and resources.

A Singular Solution

In 2001, after an extensive assessment of all viable software systems on the market, the hospital team selected CareSuite OR Manager, a total perioperative automation solution from Picis, a Wakefield, Mass.-based company that specializes in high-acuity-care automation technology. The hospital chose this system because they felt it met its diverse clinical and administrative needs. OR data management and electronic record keeping from preoperative care through surgery to recovery, were all available as part of the system. Also, it easily interfaced with the hospital’s IDX admissions system and allowed for a multitude of ways for staff to capture and report statistical data without requiring manual entry.

After selecting OR Manager, Swanson and the department staff set out to fully implement the system. An implementation team was established and they examined, in detail, the functionality of the system and then streamlined organizational processes to maximize use of its capabilities. The team standardized surgeon preference cards and implemented online nursing documentation in the system to provide a complete electronic patient record of surgery, thereby erasing the need for the time consuming, often inaccurate, manual methods previously employed. Additionally, they adopted routine accounting principles in the department and focused on getting charges right before transmitting to billing. This included development of accurate and well-tested billing rules in OR Manager that automatically calculate perioperative charges based upon time, procedures, supplies and other factors. The entire staff, from clinicians to accountants, was now speaking the same language, and the focus shifted to accuracy and correctness during input, thereby greatly reducing the need for reconciliation.

Results

Texas Children’s Hospital went live with the Picis system in September 2002, and nurses began scheduling cases in OR Manager while tracking supplies and recording exceptions online. The data was then transmitted directly to the hospital’s billing system. Charge capture was improved, and lost time was decreased. Due to increased accuracy, online documentation and data analysis, Texas Children’s was then able to manage an increased number of surgical cases and meet the goal to drop the bill promptly.

Now, dependable and accurate reports allow staff members to continually see what is working and to fix what is not. With reports from OR Manager, the evaluation of staff performance, overall costs, use of supplies and other activities in the department is substantially simplified. All such reports were unavailable with the department’s old surgical information system. Reports also track staff members having clinical documentation issues, and log quality information.

Supply utilization and procedure times of individual surgeons can also be reviewed to improve the accuracy and management of schedules and supplies. By introducing a physician office link, they were able to decentralize scheduling and allow surgeons to schedule cases at their convenience into their block time. Physicians enjoy the increased flexibility, and remote scheduling has saved Texas Children’s Hospital the equivalent of two full-time positions while enabling an increase in the volume of cases. The schedule is more accurate with the offices doing their own scheduling. Additionally, the offices now can provide insurance information through the system directly to the admissions department. This has resulted in fewer delays for insurance hold.

Sweeping change across a department is never easy, and implementation of a new automation technology is no exception. But, it was worth the hard work, and hospital administrators see the effects, so they are happy. Before implementing the Picis system, it took Texas Children at least five days to process the correct patient bill. Now, the hospital captures accurate clinical, financial and statistical data during each phase of surgical care, and within 12 to 24 hours of surgical care the process is complete.

Now, less than 2 percent of OR charges contain errors. Within four months of go-live, the hospital recognized significant benefits of using the system: faster billing; an 80 percent reduction in monthly late fees; a department-wide language for documentation; and centralized data storage and reporting tools for easy access to meaningful reports. The result has been enhanced resource planning, which has physicians and staff praising the system.

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Case Study #2:

Achieving a Complete Patient Experience

In March 2007, SourceMedical, a provider of information management solutions to the ambulatory surgery center (ASC), surgical hospital, practice, rehabilitation clinic and diagnostic imaging markets, announced a strategic partnership with InstyMeds. The union establishes SourceMedical as the exclusive provider of the SourcePlus PrescriptionCenter, a fully automated, ATMstyle dispensing system for outpatient prescription medication services to ASCs and surgical hospitals. The complete outpatient prescription medication system is ideal for facilities who want to provide to patients fast, accurate dispensing every time, with the added benefit of safety and the convenience of receiving full prescription medication at the point of discharge. The system provides facilities a “complete patient experience” and differentiates them in the market and allows patients to return to the comfort of their home as quickly as possible. It will also support underserved communities that lack 24/7 pharmacy availability.

Today’s surgical facilities are always looking for distinct advantages over the competition while providing patients with compelling benefits never before seen at the point-of-care. The SourcePlus PrescriptionCenter acts as a new profit center — increasing revenue while reducing medication errors and supporting patient convenience.

Waseca Medical Center, located in Waseca, Minn. and part of Mayo Health System, has become one of the first healthcare providers in the region to offer a unique service that gives patients the option to have their prescriptions filled 24-hours a day, seven days a week. This service targets not only same-day surgery, urgent care and emergency room patients, but is available to all patients.

“Our patients have told us they want to be able to fill their new prescriptions around the clock,” says Michael Milbrath, executive vice president of Waseca Medical Center. “This new system gives our patients access to a pharmacy that never closes. They may no longer have to drive somewhere else to have their prescriptions filled, especially after hours.”

Getting a prescription through SourcePlus PrescriptionCenter works much like getting a prescription through a pharmacy. The patient’s insurance information is gathered and entered into the computer during the admission process.

The healthcare provider enters a prescription and gives the patient a prescription order number. At the SourcePlus PrescriptionCenter dispenser, located near the emergency room at Waseca Medical Center, an automated touch screen walks the user through the ordering process. The patient enters the prescription number and their birth date for verification.

The patient then enters a credit card, debit card or cash to cover the cost of the prescription or co-pay. The medication is automatically labeled and a comprehensive bar code check system ensures that the patient gets the correct medication. In most cases the medication is dispensed in less than five minutes.

“Although many of the most common prescriptions can be filed, not every medication is available from the InstyMeds (SourcePlus PrescriptionCenter) machine,” says Kim Rux, pharmacy director at Waseca Medical Center. “The machine will also carry some over-the-counter medications. InstyMeds (SourcePlus PrescriptionCenter) was added with our patients in mind. They are charged the standard retail price without any added fees or charges.”

A telephone located near the dispenser provides a direct line to a support center staffed by pharmacists and pharmacy technicians 24-hours a day, seven days a week. This is especially helpful for patients who may have questions about their medications, including when they should be taken, how they should be stored and possible side effects, if any.

“With the nationwide shortage of pharmacists, this is one way Waseca Medical Center can truly meet the needs of our patients,” says Milbrath. “We believe this is a good step toward reducing the amount of time patients have to wait to get their prescriptions filled, as well as reducing the number of medication errors.”

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Case Study #3:

PNDS, Electronic Medical Record Systems and Data

The Perioperative Nursing Data Set (PNDS) is an American Nurses Association (ANA)-recognized nursing vocabulary developed by the Association of periOperative Registered Nurses (AORN) to describe nursing care for patients undergoing a surgical or other invasive procedure from preadmission to discharge. As a controlled vocabulary, PNDS enables nursing care to be documented in a standardized manner. This will allow for collection of reliable and valid clinical data on perioperative nurse sensitive outcomes resulting from nursing interventions during a surgical or invasive procedure. PNDS is applicable in various perioperative practice settings including both inpatient and ambulatory surgery environments. Standardized documentation allows nurses to evaluate care across caregivers and practice settings.

While PNDS can be used in both paper and electronic documentation, the real advantage comes when it is implemented in the electronic health record (EHR). The manner in which data is documented, captured and mined is a critical factor for improving healthcare. PNDS is designed for the EHR as it contains the framework of uniquely coded clinical terms and knowledge that describe patient care provided during a surgical or invasive procedure regardless of the setting.

Using standardized nomenclature such as PNDS in electronic documentation provides the vehicle for gathering and aggregating data for analysis. The impact of using and mining the PNDS data is on several levels:

• The immediate impact is for the clinical perioperative nurse in terms of enhanced communication and the linkage to clinical support
• Healthcare organizations benefit from effective standardized outcome reporting and quality improvement activities
• PNDS provides reliable and valid clinical data that can be used by researchers to uncover new clinical relationships

Electronic Medical Record Systems

As described above, the electronic medical record is much more than just the replacement of your paper charts. Early attempts at solving the problem of storage space and access gave way to a misconception that simply scanning paper records or moving your paper forms to electronic copies of those forms was an electronic medical record. What advantage would one of those formats have over a paper record in making the use of PNDS any more practical or efficient? The answer is, none whatsoever because the image of an electronically stored document is still just an image and not useable data.

If a facility has decided to standardize the terminology and nursing diagnosis information contained in the PNDS, an EMR is the most efficient way to implement the system. Before selecting an EMR you must ensure that the required functionality is present and that the developer of the EMR has acquired the proper licensing from AORN.

Functionality is a key to the efficient use by the nursing staff. A few of the major points to look for are:

• Does the EMR contain all the required structured data elements (SDAs)?
• Can you obtain the detailed explanations of the SDAs easily?
• Can you easily access information on interventions and recommended activities?
• Does the EMR allow for recording of nursing diagnosis codes?
• Are there standard reports in the EMR for reporting on outcomes and nursing diagnosis codes?

Some of the benefits resulting from integrating PNDS with an EMR are as follows:

• Nursing as a profession benefits from documentation of outcomes and comparisons to procedures completed with a reduced amount of nurse participation.
• The integration of PNDS into an EMR will permit the measurement of nursing full-time employees (FTEs) involved in a procedure directly to a CPT code. This will further support their value in a clinical setting.
• Direct access to PNDS within the EMR (the recommended practice) will help support real-time nursing decisions.
• Facilities will be able to provide more detailed outcome studies with less cost. Comparative studies using paper charts could take as much as one, possibly two additional FTEs.
• Patient safety is a top priority among any healthcare organization. This type of solution would help determine if the correct steps were followed should a negative outcome occur. It provides risk mitigation without sacrificing productivity.
• Submission of outcomes data supported by PNDS to AORN’s national database will assist in enhancing and supporting changing or modifying practices on a national level.
• Electronic access to intervention and recommended activities improves actual utilization and reduces FTE’s when compared to information stored in paper or book format.
• Electronic maintain of nursing diagnoses and other information allows for a more current data set than a once-a-year hardcopy update.

Your unique needs may require other components and functionality to be examined in making your decision on which EMR will best suit your needs. Keep in mind that moving from paper to a true EMR will change your work flow and some duties for your staff. However, you want to look at the full scope of what changes and what you gain in making your decision.

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Shortage Closes Another Pharmacy

Oswego (WSYR-TV) - The pharmacist shortage strikes again. This time, the P&C pharmacy in Oswego shut down for three days, because there was no one around to run it.

Pockets across the country are having the same problem we are: there are more prescriptions, the population is getting older, but there aren't enough pharmacists to handle the demand.

All Bill Bellow wanted to do was to get his wife's prescription filled.

“One of pharmacists had vacation and was gonna take it. This morning, I found out that vacation was schedule for many months.”

Bellow says the P&C pharmacy shut down Friday and Saturday. It’s usually closed Sundays.

“They have a responsibility to people who expect to be able to come here and get their medication.”

The National Association of Chain Drug Stores says there are 120,000 pharmacist positions at places like Kinney Drugs. 6,000 of those jobs are vacant. P&C's pharmacy isn't considered a chain drug store, but it's affected just the same.

Penn Traffic, P&C’s parent company, issued this statement: "We are striving to do everything possible to avoid any interruptions in service...however we are not immune to what is happening overall in the pharmacy industry with respect to shortages of available pharmacists. We are focused on ensuring coverage and minimizing inconvenience to our customers."

But Bellow was inconvenienced. He says if there was a simple note on the door, he would have made other arrangements.

“Mine turned out not to be life threatening, however it's just a matter of time until it is.”

Bellow says a pharmacist told him that several P&C pharmacies in the Syracuse area will be shutting down here and there, throughout this month because of vacation time. Penn Traffic didn't comment on that.

From Tuesday, July 30, 2007:

Camillus (WSYR-TV) - The Wegmans School of Pharmacy in Rochester is just about a year old.

The Albany College of Pharmacy has been growing: in enrollment, programs, and campus buildings. Both schools are working to help alleviate the shortfall of pharmacists.

We went to the Kinney Drugs in Camillus to talk with a local student about why she wants to go into the field.

Amanda Vincentini is on summer break, but she's still learning, behind the counter.

“You can fill prescriptions, fill medications, almost everything a pharmacist can do except the final check where they bag it and it's ready to go.”

Amanda has worked there on and off through college, but it isn't an official internship. But, in her 6th year, she'll work in a lot of pharmacies; she'll do six 5-week rotations.

“Some are in hospitals and some are in retail settings, and I think that's great cause you'll get so much more experience.”

It's a tough course, heavy on math and science, and six years is a long time to go to college, but what started as a suggestion from her mom, has grown into a love of the field.

“You work with patients. It’s awesome. They come in and leave, say thank you so much. That’s all it takes in your stressful day, you're like, wow, this is all worth it.”

In less than 2 years, Amanda will graduate and have her name on a plaque in record time.

“I'm going to get out of college and get a job right away, what a great thing to know.”

An average starting salary of about $100,000 doesn't hurt, either.

In addition to the Albany College of Pharmacy and the Wegmans School of Pharmacy, there's the Schwartz College of Pharmacy and Health at Long Island University, the SUNY Buffalo School of Pharmacy, and St. John's University College of Pharmacy.

From July 26, 2007:

DeWitt (WSYR-TV) - With summer vacations, you may notice your pharmacy is short-staffed.

There's a shortage of pharmacists nationwide and here in Central New York.

Earlier this month, a number of Eckerd Pharmacies closed down because too many pharmacists took vacation at the same time. (Click here to read that story)

Allen Krassenbaum could probably do his job with his eyes closed. He comes from a long line of pharmacists.

“I love pharmacy. Been doing it for 41 years, couldn't think of doing anything else. I love it.”

Allen's domain is behind a K-Mart pharmacy counter. But, he could work anywhere he wanted.

“We get calls from head hunters all the time, trying to pull us away from our stores. It’s very, very common.”

Pharmacies are busier than ever. The population is getting older. And, more than 1 billion prescriptions have been written in the past decade.

Plus, there are only five pharmacy colleges in New York State. That’s one less than when Allen was a student. And the curriculum is tougher; it's now a 6 year program.

“When I went, it was a 5 year program, then it was a 4. When my father went, a 3, my uncle, a 2 year program. My father bought a store from a man who never went to school and was a druggist.”

There isn't just the corner drug store anymore. Most grocery stores, Wal-Marts, and Targets all have pharmacies. In North Syracuse, if you go up the street from a P&C, you've got the Eckerd at Sweetheart Corners. If you go south on Route 11, there's another Eckerd.

According to the State Board of Pharmacy, there are only about 462 pharmacists to go around in Onondaga County. To fill the holes, retired pharmacists are still working part time, and floaters try to fill the gaps.

Despite the shortage, the Albany College of Pharmacy tells us they've more than doubled their graduating class in the past decade.

Some of those graduates, though, are becoming mail-order pharmacists, working through the internet.

Source

Sullivan University starting new pharmacy school

LOUISVILLE, Ky. (AP) -- A private, for-profit college in Louisville is starting a pharmacy school. When it opens next July, Sullivan University’s pharmacy school will be the second in the state. The University of Kentucky also has one.

Kentucky has the second-largest pharmacists shortage in the country, said the Pharmacy Manpower Project, which tracks states’ pharmacist shortages.

The growing need for pharmacists is fueled by several factors including the aging of the baby-boom generation, more and better medications for chronic conditions, and the spread of 24-hour pharmacies.

The pharmacy school’s tuition is $32,000 a year for the three-year program. The school’s application is being reviewed by the Accreditation Council for Pharmacy Education.

Source

Sullivan Univ. to launch pharmacy school

Louisville hasn’t had a pharmacy school since 1947, when the old Louisville College of Pharmacy was moved to the University of Kentucky.

But that’s about to change. In response to a growing national demand for pharmacists, Sullivan University will break ground tomorrow for a pharmacy college in a renovated building on Gardiner Lane, across Bardstown Road from its existing campus.

It will be the first doctoral program for Sullivan, which calls itself “Kentucky’s Career University,” training students for a range of careers — from business managers to bakers, paralegals to professional nannies.

And it responds to a national demand that is acute in Kentucky, according to the Pharmacy Manpower Project, which maintains an index of states’ pharmacist shortages. Kentucky has the second-largest shortage, behind Alabama.

The growing need for pharmacists is fueled by several factors, including the aging of the baby boom-generation; more and better medications for chronic conditions; and the spread of 24-hour pharmacies, including those in food and discount stores.

“The number of prescriptions … has gone up dramatically,” said Peter Vlasses, executive director of the Accreditation Council for Pharmacy Education. “Pharmacies are opening everywhere.” The national council is currently reviewing Sullivan’s application for accreditation for its pharmacy school.

The number of pharmacy colleges nationally is also on the rise. Since 1999 their number has grown by nearly 25 percent, to 103, Vlasses said — and more are being planned.

Sullivan’s school will become Kentucky’s second when classes begin next July.

It will provide an in-state alternative to UK, whose highly rated but overcrowded pharmacy college accepts one in eight applicants.

Within a few years, Sullivan expects to turn out nearly 100 pharmacists a year — enough to fill roughly one-fourth of the current estimated shortage in Kentucky.

The college also could help business leaders recruit drug-related firms to town, and its faculty pharmacists could collaborate with medical and dental researchers at the University of Louisville, officials said.

But for Patrick Starowitz, 24, the school could provide something more basic — the chance to stay in his hometown while training for his career.

“I’ve grown up in Louisville my whole life and I love the city of Louisville.

Convenience-wise, my family’s here, my job’s here,” said Starowitz, a recent U of L graduate who is a pharmacy technician at a Kroger store in St. Matthews.

He hopes to be in Sullivan’s first pharmacy class, though he has also applied to other schools.

Source

Canadian e-health sector could use a booster shot

We don't have a trusted local brand, the size of the market is small and there's still a lot of cultural resistance. We check the vital signs of what should be a burgeoning industry

There's a host of opportunities for Canadian companies looking to serve the burgeoning electronic health record market, but insiders say serving the market is not going to be easy.

A number of hospitals have already set up electronic record systems with patient information, and a national agency, Canada Health Infoway, has a mandate to create a unified e-health record by 2009. Despite this momentum, as well as the handful of programs to help fund the automation of doctors' offices in Canada, however, resistance to the idea still runs high.

“The real challenge in health care is cultural,” said Ross Armstrong, senior research analyst at London, Ont.-based Info-Tech. Persuading doctors to invest thousands of dollars of their own money in a system that will benefit the health care system as a whole and change the way they work is a huge challenge.

To encourage doctor buy-in, vendors, he said, need to better craft their messages to show doctors how digitizing their offices will give them more time to dedicate to the most profitable parts of their practice.

Armstrong said the market for electronic health record services will take off once some hospitals start offering patients free access to their medical records online. “Once one hospital in one region offers this service for free, then all other hospitals or clinics will start doing so as well in order to maintain or gain competitive advantage,” said Armstrong. “If the health care enterprise dovetails the portal project with an existing electronic medical record or electronic health record project, then the costs of the portal could be reduced since that back end is now in place.”

Michael Martineau, director of the Branham Group, has similar predictions. Branham foresees a major increase in the automation of doctors' offices over the next 18 to 38 months. “It's the next frontier,” said Martineau. Alberta's physician office system program), for example, had 61 per cent of the province's physicians signed up as of July 2006, making it one of the leading jurisdictions in physician automation world-wide, it claims.

Martineau said to advance that uptake, companies in the electronic health record market in Canada will benefit by having their products certified by Canada Health Infoway's e-Health Collaboratory, an initiative designed to help vendors comply with CHI's e-health record standard.

“It shows the health care system that you are being part of the process, so it's a good corporate citizen thing to do,” he said.

But the biggest challenge Canadian companies face in cracking the e-health market is the lack of a Canadian “brand,” said Barry Gander, executive director of The Canadian Advanced Technology Alliance (CATA).

Canadian companies, he said, toil in obscurity not only within the country but on the global stage as well.

“If people are looking for a solution or a partner Canada doesn't come to mind,” he said. “We really have to adopt a co-ordinated strategy to become better known.”

That's what CATA hopes to change with the debut of its global webinars, described as “the founding step in the creation of a new healthcare community spanning the world's biggest block: the Commonwealth.”

Gander said the idea is to use the global webinars to present profiles of Canadian companies to build awareness of the capabilities that exist within Canada in an interactive way that can lead to Canadian partnerships and dealmaking.

“We need to fuse all these public sector needs with the knowledge of our private sector capabilities, and we're just on the beginning of that road now,” said Gander. “Our aim is to create a system where everybody knows what everybody else is doing.”

Another challenge Canadian companies face is the same one any Canadian company faces: Canada represents such a small market it's often not worth pursuing.

“The market (in Canada) is one-tenth of the size so when you're dealing with an organization in the U.S. with 600,000 members, the equivalent in Canada is 60,000,” said Jay Couse, senior vice-president of business development for Toronto-based Diversinet.

Diversinet, a vendor of mobile security products, for example, recently signed a deal with Blue Cross of Northeastern Pennsylvania (BCNEPA) to provide members access to their personal medical records through mobile phones, handheld wireless devices and personal computers using Diversinet's MobiSecure Wallet and Vault soft token technology.

Its business model is to make the technology available on an OEM basis to large health insurance providers.

Diversinet has built the back end but Blue Cross is responsible for the interface consumers will use, he said, as well as for negotiating the connections to the data.

The project will roll out to 100,000 users in the first half of this year, gradually scaling up to all 600,000 members.

“MobiSecure Vault is designed to give consumers the ability to access their personal information anywhere, anytime from a mobile device,” said Couse. “It acts like a remote control in that you don't have to store everything on the phone - the phone can be used as a pointer.”

The first phase of the project will allow consumers to access all the information warehoused by Blue Cross, such as insurance claims, as well as pharmacy-related and medical record information.

Americans, said Couse, are used to the idea of paying for health care, a concept that has not yet proved popular here at home.

‘In the U.S. market even if people have insurance they are paying US$250 a month on average,” he said. “They also pay a co-pay every time they visit the doctor … so their out-of-pocket costs can be very dramatic.”

That's not to say Diversinet is not interested in the Canadian market. Couse said the company is close to announcing a Canadian customer.

“They built the system to handle all the medial records at the physician level and we will then give our technology to them and they can give it to their patients.”

Source

Clinic goes high-tech, letting patients tell doctors what's ailing them via the Internet

AMARILLO - The health clinic in Turkey looks far from modern. It sits on a dirt road in an old school building and shares a wing with the justice of the peace.

But inside the clinic sits multi-million-dollar equipment that connects these rural residents to a Plainview doctor via the Internet and a video camera.

With other programs in Hart, Earth and Quitaque, Dr. Sidney Ontai's services provide a way for rural Panhandle residents to conveniently see a doctor rather than driving as far as 45 miles.

The telemedicine program is like seeing a doctor in person - except 150 miles separate the patient and physician.

"I don't understand why more doctors aren't using it," said Don Turner, a trained emergency medical technician who helps staff the clinic.

Clinicians enter a patient's vital signs, history, lab results, even an audio recording of a person's heart and lungs, into a computer. Workers in Turkey can even scan X-rays and other pictures.

Ontai, who practices family medicine in Plainview, reviews the information, talks to the patient and treats them from miles away.

He said if he ever needs to physically examine a patient, he tells them to come see him. If the patient is in dire emergency, he tells the EMT to get the patient in an ambulance and go to the emergency room.

"Telemedicine technology is no different than a scalpel or a stethoscope or any other tool," Ontai said. "Its safety and efficacy depends on the skill of the physician using it."

The Turkey telemedicine programs sees an average of eight people a month.

"It's not a full-time job because there's not a lot of people in Turkey," Turner said.

Turkey also is home to the state's first telepharmacy program, a separate but similar program run by Texas Tech Health Sciences Center.

It's a full pharmacy staffed without a pharmacist and started in November 2002.

The same workers at the Turkey clinic can fill any prescription.

Pharmacists at Texas Tech in Lubbock verify through a bar-code system that Turkey workers are dispensing the correct pills to patients. A pharmacist in Lubbock talks to the patient over the phone about safety and proper instructions.

Lawmakers changed state law in September 2001 to allow telepharmacies. Turkey was an immediate candidate for telepharmacy because it had health care with its telemedicine but no pharmacy.

"To my knowledge, there's probably been less than 10 telepharmacies set up in Texas," said Don McBeth, director of special projects at TTHSC.

Rush Pierce, interim regional dean of the Texas Tech School of Medicine in Amarillo, said the university should work harder to have more telemedicine programs in Panhandle cities. Most programs are in the South Plains, closer to Lubbock.

Texas Tech did 636 telepharmacy and telemedicine rural consultations in 2006.

Ontai said money is the main reason why telemedicine hasn't spread in popularity.

"Most doctors do things that make them money," Ontai said. "Telemedicine doesn't make money, so it is usually only done with grant support."

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McKesson aims to spread healthcare efficiency

McKesson, the largest US pharmaceuticals distributor and healthcare information technology provider, will probably ring up more than $100bn in sales this fiscal year.

The eye-popping figure puts the group in elite company, but it is McKesson's expertise in squeezing out efficiencies that allows it to make profits from the razor-thin margins of drug distribution, reflected in last year's net income of $913m out of $93bn of sales.

McKesson is one of the large cogs in the immense machinery of private market healthcare in the US, where annual health spending exceeds $1,000bn and continues to rise. It is one of the three dominant pharmaceutical distributors, along with Cardinal Health and AmerisourceBergen, acting as middlemen and service providers for thousands of pharmacies, doctors, clinics, hospitals, health insurers and sometimes patients.

One of the US's oldest healthcare companies, McKesson started in 1833 in New York importing and distributing therapeutic products and chemicals. Using covered wagons, it laid the groundwork for the country's first national drug distribution network.

Less well-known than the pharmaceutical groups it serves, McKesson seeks to move beyond being a middleman to using its central position to help connect the fragmented US healthcare system and make it more efficient.

It also is looking for more business overseas, where it is a contractor for work on the UK National Health Service's ambitious project to build a national electronic medical records system. It also has IT business in France, and disease management operations in Australia and New Zealand.

Marc Owen, head of McKesson corporate strategy, said: "What we're trying to do in effect is be the back office and help to industrialise healthcare . . . Part of our role being at the centre of all this, being in the middle, is to see the opportunities to bring it all together and help broker it and make the system work better."

But what McKesson does most is sell drugs, and lots of them. It is the largest North American drug distributor, with a big presence in Canada, and owns a stake in Nadro, a distributor in Mexico. In the fiscal year ended March 31, the pharmaceutical business generated 95 per cent of McKesson's sales and 85 per cent of its operating profits.

The drug distribution industry has recently undergone a transition in its business model following a drug manufacturers' inventory and accounting scandal. In the past, distributors would arbitrage pricing changes by drugmakers by buying large quantities prior to price increases and making money from the difference. McKesson and its rivals have now moved to a service-oriented model, charging drugmakers a fee to help manage wholesale drug inventory.

Changing to a service model has made the distribution business more predictable, which allows McKesson to focus harder on squeezing more efficiency and profits out of it. Last year, it improved its margin 8 basis points to 1.53 per cent.

Robert Willoughby, analyst at Bank of America, rates McKesson stock as a "buy" and says the group is growing, cash-rich, and pushing to improve efficiency and market share.

The other side of McKesson is its healthcare IT and software business. Although much smaller than drug distribution, McKesson's healthcare IT business is the largest in the world.

It ranges from patient records, hospital systems - including automated processes for drug dispensing - and pharmacy systems to back-office and claims processing for payers, and internet portals and remote monitoring for patients.

IT sales increased 24 per cent last year to $1.9bn, with profits up 11 per cent to $159m, representing 10 per cent of McKesson's total operating profits.

Improving US healthcare computer network systems has increasing, broad political and business support.

However, the immense and fragmented US healthcare business poses challenges. Lack of funds and interoperability between healthcare IT systems are significant obstacles.

But the hope remains that eventually a more widespread, if not national, electronic medical records system could bring more efficiency to US healthcare.

McKesson sees itself at the nexus of several key pushes in healthcare: IT infrastructure, disease management services for patients, and improving the efficiency and costs of its distribution.

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United Kingdom: Ripe For The Picking? Technology Futures In Local Government

Excerpt from this article:

The Ohio Board of Pharmacy uses fingerprinting for authorising prescription orders. It has installed 800 workstations that can check that the prescriber is allowed to issue an order for a prescription. Biometric technology is used in the UK‘s asylum system.