Health Bill Benefits for the Impatient

WASHINGTON — Some immediate benefits from the health care legislation advancing on Capitol Hill will ease the minds of parents who may have hit up against limitations of their existing health insurance.Within six months, the Senate bill approved last week would allow dependent, unmarried children to remain on their parents’ policies until their 26th birthday; the House bill would allow an additional year of dependent coverage, until the 27th birthday. Right now it varies from state to state.

The Senate bill would also bar insurers from denying coverage to children under 19 years of age based on pre-existing medical conditions. And the House bill would require insurers to cover reconstructive surgery for children born with deformities.

In many cases, the requirements, including the extended coverage for adult children, would apply only to new insurance plans, though insurers could apply the changes to existing policies.

Many major provisions in the health care legislation would not take effect for several years. New federal subsidies to help moderate-income Americans afford coverage would not begin until 2013 under the House bill, and 2014 under the Senate bill. A new requirement that nearly all Americans obtain insurance would take effect at the same time that the subsidies become available.

On the flip side, many of the new taxes and fees that will help pay for the legislation would take effect much sooner. For this reason, some Republicans have criticized the bill as akin to legislation on a layaway plan: pay now for benefits later.

The concept, however, is not unprecedented. In 1965, when Medicare was created, the payroll tax began six months before the insurance coverage began for Americans age 65 and over.

Still, the lengthy gap between the expected completion of the legislation in early 2010 and the effective date of many major provisions has left Democrats working to answer the criticism with lists of “immediate deliverables.”

Here are some of the benefits that Democrats say would be available soon after the legislation is adopted:

No annual or lifetime limits
Both the Senate and House versions of the legislation ultimately seek to prevent insurers from imposing annual or lifetime limits on coverage in new health policies. In the final package of amendments to the Senate bill, the majority leader, Harry Reid of Nevada, added new language giving the secretary of health and human services the authority to regulate annual limits from six months after the bill is enacted until the broader insurance provisions take effect in 2014. Such limits are a serious concern to people with chronic illnesses like cancer that can require expensive treatments within a relatively short period of time, and the change proposed by Mr. Reid was prompted by inquiries from the American Cancer Society.

Limits on insurance company profits
Beginning in 2011, the Senate bill would set tight restrictions to force insurance companies to spend the bulk of their revenues on providing medical care to beneficiaries. The legislation would require insurance companies in the large group market to spend at least 85 percent of their revenues on care and insurers in the individual market to spend at least 80 percent of revenues on care. Critics of the private health insurance, including Senator John D. Rockefeller IV, Democrat of West Virginia, and Senator Sherrod Brown, Democrat of Ohio, said setting such requirements on what insurers call “medical loss ratios” was needed to tamp down on profiteering.

Short-term expansion of state high risk pools
To help people who cannot obtain insurance because of pre-existing conditions, both the Senate and House bills would provide $5 billion to increase the availability of coverage through state high-risk insurance pools. This provision would take effect 90 days after enactment of the legislation, but many details remain to be worked out.

New financing for community health centers
The House bill provides $12 billion in additional financing for community health centers, which serve needy populations, particularly in rural areas. Senator Bernard Sanders, independent of Vermont, won the inclusion of $10 billion in financing for community health centers in the Senate bill. The final dollar amount will be decided in negotiations between House and Senate leaders, but the money would be available for five years beginning in the current fiscal year.

Closing the Medicare drug “doughnut hole”
The legislation would increase the amount of drug costs covered by Medicare by $500 in 2010. And beginning on July 1, 2010, the bill would provide 50 percent discounts on brand-name drugs and biologics that low- and middle-income beneficiaries have to pay for themselves once the coverage gap known as the doughnut hole begins.

Prohibition on rescinding existing coverage
Both the House and Senate bills would bar insurance companies from rescinding existing coverage other than “in cases of fraud or intentional misrepresentation of material fact.”

Small business tax credits
The Senate bill would offer tax credits to small businesses beginning in 2010 for up to 35 percent of premium costs. The full credit would be available to firms with 10 or fewer employees and average annual wages of $25,000. Reduced credits would be available to firms with up to 25 employees and with average annual wages of up to $50,000.

Patient protections
For new health plans, beginning six months after enactment of the legislation, the Senate bill would prohibit insurers from requiring prior authorization before a woman sees an obstetrician or gynecologist. The bill would also require coverage for emergency care.

Discrimination protections for lower-income workers
The Senate bill would bar group health plans from setting any eligibility rules for coverage that favor higher-wage employees. This provision would take effect six months after enactment of the legislation.

Cobra extension through 2013
Anyone currently paying for an extension of health benefits as permitted under federal law — for instance, after a loss of employment — would be permitted under the House legislation to continue Cobra coverage until the major insurance coverage provisions of the legislation take effect in 2013.

Reinsurance program for early retirees
Both the House and Senate bills would provide federal financing for a new reinsurance program to encourage employers to maintain health benefits for employees and early retirees age 55 to 64.

Consumer assistance provisions Both the House and Senate bills would begin to impose new requirements aimed at making it easier for consumers to interact with insurers, including a requirement that health plans adopt uniform descriptions of plan benefits and appeals procedures and that they begin using identical forms.

Health Care Reform

OVERVIEW
For 75 years, Democratic presidents and members of Congress have fought to create a comprehensive national system of health insurance; President Obama has made passing such a bill his central legislative priority. On Nov. 7, handing him a hard-fought victory, the House approved a sweeping overhaul of the nation's health care system by a vote of 220 to 215. The Senate passed an $871 billion bill on Dec. 24.

The bill will now go to a conference committee, where representatives of the House and Senate must combine the measures. A central difference is that the House bill contains a government-run insurance plan, the so-called public option, while the public option was dropped from the Senate bill. Other differences include provisions over abortion and taxes.

The broad outlines of both bills hew relatively closely to the plans that emerged over the summer and fall from five Congressional committees, all in the face of all but unanimous Republican opposition. The bills would expand coverage by making more lower-income people eligible for Medicaid, and by offering subsidies to help moderate-income people buy insurance. They would forbid insurance companies from denying coverage of pre-existing conditions, and would create insurance exchanges -- new government-regulated marketplaces where individuals and small businesses could come together to buy coverage. The 160 million Americans who get their coverage through their employer would stay with that insurance. Nearly everyone would be required to get insurance or face a penalty, and businesses would be required to provide coverage or contribute to its cost.

Democrats have hailed the measures as a huge leap forward in both extending coverage to the tens of millions of Americans who currently lack it and in beginning the process of reining in spiraling heath care costs. Republicans have passionately denounced them as a giant expansion of government that will prove unaffordable and undermine the coverage of those who currently have it.

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BACKGROUND
The Democrats' desire for universal access to health insurance runs deep. President Franklin D. Roosevelt hoped to include some kind of national health insurance program in Social Security in 1935. President Harry S. Truman proposed a national health care program with an insurance fund into which everyone would pay. Since then, every Democratic president and several Republican presidents have wanted to provide affordable coverage to more Americans.

President Bill Clinton offered the most ambitious proposal and suffered the most spectacular failure. Working for 10 months behind closed doors, Clinton aides wrote a 240,000-word bill. Scores of lobbyists picked it apart. Congressional Democrats took potshots at it. And Republicans used the specter of government-run health care to help them take control of Congress in the midterm elections of 1994.

One of the most significant differences between 1993-94 and 2009 is that employers and business groups, alarmed at the soaring cost of health care, are now among the advocates for change.

Insurance companies, which helped defeat the Clinton plan, began the year by saying they accept the need for change and want a seat at the table. As the bills developed, however, they became strong opponents of some Democratic proposals, especially to create a government-run insurance plan as an alternative to their offerings.

In his 2010 budget, Mr. Obama gave an indication of the scope of his ambitions on health care reform when he asked Congress to set aside more than $600 billion as a down payment on efforts to remake the health care system over the next 10 years, partly by limiting the income tax deductions that the most affluent taxpayers claim.
But after sending Congress his budget plan, Mr. Obama's White House, displaying a surprisingly light touch, encouraged Democrats in Congress to make the hard decisions. By the end of March 2009, the chairmen of five Congressional committees had reached a consensus on the main ingredients of legislation, and insurance industry representatives had made some major concessions. The chairmen, all Democrats, agreed that everyone must carry insurance and that employers should be required to help pay for it. They also agreed that the government should offer a public health insurance plan as an alternative to private insurance.

SEPARATE PATHS
Democrats worked on three separate paths to develop legislation in the summer of 2009. On June 14, House Democratic leaders introduced their bill, which in addition to a public plan included efforts to slow the pace of Medicare spending, a tax on high-income people and penalties for businesses that do not insure their workers. After a revolt by a conservative group of "Blue Dog'' Democrats that led to more exemptions for businesses, the plan was adopted by three committees without Republican support.

In the Senate, the Health, Education, Labor and Pension committee worked on a bill with a public insurance plan, while the Senate Finance Committee, led by Senator Max Baucus, Democrat of Montana, worked on a bill that sought to avoid one, which Mr. Baucus thought was necessary to gain bipartisan support.

On July 2, the Senate health committee put forward its bill. Under the proposal, employers with 25 or more workers would have to provide coverage or pay the government an annual fee of $750 for each full-time worker and $375 for each part-timer. The government would pay the start-up costs for the public insurance option as a loan to be repaid, and premiums would be set up so that the option was ultimately self-sufficient.

The bill was passed July 15 by the health committee on a party-line vote of 13 to 10, with all Republicans opposing the package. Both Republicans and Democrats acknowledged that the health committee bill was just part of what would eventually be a single Senate measure.

THE BATTLE OVER PUBLIC OPINION
During the Congressional recess in August, the White House found itself suddenly at risk of losing control of the public debate over health care reform. As conservative protests mounted, the White House began playing defense in a way administration officials have not since the 2008 campaign.

Democratic Party officials acknowledged that the growing intensity of the opposition to the president's health care plans -- plans likened on talk radio to something out of Hitler's Germany, lampooned by protesters at Congressional town-hall-style meetings and vilified in television commercials -- had caught them off guard.

On Sept. 9, Mr. Obama confronted a critical Congress and a skeptical nation, decrying the "scare tactics" of his opponents and presenting his most forceful case yet for a sweeping health care overhaul that has eluded Washington for generations.

When Mr. Obama said it was not true that the Democrats were proposing to provide health coverage to illegal immigrants, Representative Joe Wilson of South Carolina yelled back, "You lie!" Mr. Wilson apologized but his outburst led to a six-day national debate on civility and decorum, and the House formally rebuked him on Sept. 15.
The president placed a price tag on the plan of about $900 billion over 10 years, which he said was "less than we have spent on the Iraq and Afghanistan wars." He also announced a new initiative to create pilot projects intended to curb medical malpractice lawsuits, a cause important to physicians and Republicans.

THE BAUCUS BILL
Late that month, Mr. Baucus introduced his long-awaited plan. The bill closely resembled what Mr. Obama said he wanted, except that it did not include a new government insurance plan to compete with private insurers.

Unlike the other bills, the Baucus plan would impose a new excise tax on insurance companies that sell high-end policies. The bill would not require employers to offer coverage. But employers with more than 50 workers would have to reimburse the government for some or all of the cost of subsidies provided to employees who buy insurance on their own.

The bill got a significant boost when the Congressional Budget Office announced that despite its price tag, it would reduce the federal deficit by slowing the rate of health-care spending.

On Oct. 13, the committee voted to approve the legislation. The vote was 14 to 9, with all Republicans opposed except for Senator Olympia J.  Snowe of Maine. Two weeks later, Ms. Snowe's support was lost, when Mr. Reid, the majority leader, announced he would include a public option in the legislation he took to the Senate floor.

THE HOUSE BILL PASSES
Before Speaker Pelosi put the House bill to a vote, she had to broker a series of compromises that ultimately brought along just enough support from conservative Democrats to win passage. The biggest changes concerned the public option plan, which would have to negotiate rates just as private insurers do, rather than offering a rate set slightly above what Medicare pays; the plan would also confront strict controls on abortion. After heavy lobbying by Catholic bishops, the measure was amended to tighten restrictions on abortion coverage in subsidized plans bought through the insurance exchanges, to insure that no federal money was used to pay for an abortion. Both changes angered Ms. Pelosi's base of liberal Democrats, but they chose to support the bill nonetheless.

Democrats say the House measure -- paid for through new fees and taxes, along with cuts in Medicare -- would extend coverage to 36 million people now without insurance while creating a government health insurance program. It would end insurance company practices like not covering pre-existing conditions or dropping people when they become ill. And despite its price tag, they pointed to an analysis by the Congressional Budget Office that said it would reduce the deficit over the next 10 years.

In a sign of potential difficulties ahead, some centrist Democrats said they voted for the legislation so they could seek improvements in it in a conference with the Senate.

THE SENATE'S MERGED BILL
By early November, the broad outlines of the bill Senator Reid would introduce on the Senate floor were clear -- it would include the public option that was part of the health committee's bill, but with an "opt out'' provision for states, and many of the taxes and fees written in to the Finance Committee's version.

A lull in the action ensued as the Congressional Budget Office "scored'' the bill and Mr. Reid tinkered with it to hold down its cost and to appeal to conservative Democrats.
Though broadly similar to the House bill, Mr. Reid's proposal differs in important ways. It would, for example, increase the Medicare payroll tax on high-income people and impose a new excise tax on high-cost "Cadillac health plans" offered by employers to their employees.

Mr. Reid's bill would not go as far as the House bill in limiting access to abortion. And while he would require most Americans to obtain health insurance, he would impose less stringent penalties on people who did not comply.

Both bills would create a voluntary federal program to provide long-term-care insurance and cash benefits to people with severe disabilities.

The official cost analysis released by the nonpartisan Congressional Budget Office showed that Mr. Reid's bill came in under the $900 billion goal suggested by Mr. Obama. But 24 million people would still be uninsured in 2019, the budget office said. About one-third of them would be illegal immigrants.

The Congressional Budget Office has said the House bill would reduce deficits by $109 billion over 10 years and cover 36 million people, but still leave 18 million uninsured in 2019.

DEBATE IN THE SENATE

As debate began, Mr. Reid began searching for changes that could pull together the 60 votes that would be needed to avoid a Republican filibuster. The Democratic caucus contains 60 members, including two independents, but one of those independents, Joseph I. Lieberman of Connecticut, said he would block a vote on any bill containing a public option. The support of several conservative Democrats, including Ben Nelson of Nebraska, Mary L. Landrieu of Louisiana and Blanche Lincoln of Arkansas, was also in considerable doubt.

A group of five liberal and five conservative Democratic senators, who agreed on a plan that would sidetrack, but not kill, the idea of a government-run plan. Under the agreement, people ages 55 to 64 could "buy in" to Medicare. And a federal agency, the Office of Personnel Management, would negotiate with insurance companies to offer national health benefit plans, similar to those offered to federal employees, including members of Congress. If these private plans did not meet certain goals for making affordable coverage available to all Americans, Senate Democratic aides said, then the government itself would offer a new insurance plan, somewhat like the "public option" in the bill Mr. Reid had unveiled three weeks before.

The Medicare expansion quickly died when Senator Lieberman announced his opposition, to the exasperation of liberals who pointed out that he had spoken in favor of the idea three months before.

The last  Democrat to come on board was Mr. Nelson, who won a series of changes: a provision to strip the insurance industry of its anti-trust exemption was dropped; language was added to allow states to decide to block plans covering abortion from their insurance exchanges; and the bill now provides Nebraska with additional Medicaid funds.

Republicans vowed to use every parliamentary device at their disposal to slow the measure, which they said was being rammed through the Senate in an unseemly rush. But with Mr. Nelson on board, Mr. Reid's bill survived the first serious procedural hurdle by reaching the 60 vote mark needed to fend off a filibuster.

THE SENATE BILL PASSES
When the roll for the final vote was called at 7:05 a.m. on Dec. 24, it was a solemn moment. Senators called out "aye" or "no." Senator Robert C. Byrd, the 92-year-old Democrat from West Virginia, deviated slightly from the protocol.

"This is for my friend Ted Kennedy," Mr. Byrd said. "Aye!"
The 60-to-39 party-line vote came on the 25th straight day of debate on the legislation.

If the bill becomes law, it would be a milestone in social policy, comparable with the creation of Social Security in 1935 and Medicare in 1965. But unlike those programs, the new initiative lacks bipartisan support. Only one Republican voted for the House bill last month, and no Republicans voted for the Senate version.

HHS Offers $60M Grants for Strategic Health IT Projects

HHS is providing $60 million in grants for researchers to develop so-called Strategic Health IT Advanced Research Projects to target "breakthrough advances" that overcome barriers to the adoption and meaningful use of health IT.

"Innovative research and approaches are required to overcome some of the foremost challenges we face in achieving our vision of a transformed healthcare system enabled through health IT," said David Blumenthal, MD, HHS' National Coordinator for Health Information Technology.

"The SHARP program will bring together some of the best and brightest minds in the nation to find breakthrough solutions and innovations that will eliminate barriers to adoption and, over time, increase the meaningful use of health IT to improve the health and care of all Americans," Blumenthal said.

Funding for the four-year research period will target:

• Security of health IT research to develop security and risk mitigation policies and the technologies to build and preserve the public trust as health IT systems become ubiquitous.

 

• Patient-centered cognitive support research to align health IT with the day-to-day practice of clinicians as they provide care.


• Healthcare application and network platform architectures research to achieve electronic exchange and use of health IT securely, privately, and accurately.


• Secondary use of electronic health record data research to improve the overall quality of healthcare, population health, and clinical research, while protecting patient privacy.

Each project will create a research agenda addressing the specific goals of the Health Information Technology for Economic and Clinical Health Act and identify the barriers to adoption and meaningful use of heath IT. HHS expects to award qualified applicants cooperative agreements to support research efforts in these four project areas.

The researchers will implement a collaborative, interdisciplinary program addressing short-term and long-term challenges in their focus area. Additionally, the projects will develop and implement a cooperative program between researchers, healthcare providers, and other health IT sector stakeholders to incorporate results into health IT practices and products.

The funding is authorized under the $787 billion American Recovery and Reinvestment Act. Applications are due January 25, with awards anticipated in March 2010. Information about the SHARP program can be found at http://HealthIT.gov/ and at www.grants.gov.

Senate OKs health care measure, reaching milestone

Play Video AP  – Raw Video: Senate passes health care bill

WASHINGTON – Senate Democrats passed a landmark health care bill in a climactic Christmas Eve vote that could define President Barack Obama's legacy and usher in near-universal medical coverage for the first time in the country's history.

"We are now finally poised to deliver on the promise of real, meaningful health insurance reform that will bring additional security and stability to the American people," Obama said shortly after the Senate acted.

"This will be the most important piece of social legislation since Social Security passed in the 1930s," said Obama, standing with Vice President Joe Biden in the State Room of the White House.

The 60-39 vote on a cold winter morning capped months of arduous negotiations and 24 days of floor debate. It also followed a succession of failures by past congresses to get to this point. Biden presided as 58 Democrats and two independents voted "yes." Republicans unanimously voted "no."

An exhausted Senate Majority Leader Harry Reid, D-Nev., initially cast a "no" vote by mistake, then quickly corrected himself as fellow senators burst out laughing.
The tally far exceeded the simple majority required for passage.

The Senate's bill must still be merged with legislation passed by the House before Obama could sign a final bill in the new year. There are significant differences between the two measures but Democrats say they've come too far now to fail.

Both bills would extend health insurance to more than 30 million more Americans. Obama said the legislation "includes the toughest measures ever taken to hold the insurance industry accountable."

Vicki Kennedy, the widow of Sen. Edward M. Kennedy, D-Mass., who made health care reform his life's work, watched the vote from the gallery. So did Rep. John Dingell, D-Mich., the longest-serving House member and a champion of universal health care his entire career.

"This morning isn't the end of the process, it's merely the beginning. We'll continue to build on this success to improve our health system even more," Reid said before the vote. "But that process cannot begin unless we start today ... there may not be a next time."

At a news conference a few moments later, Reid said the vote "brings us one step closer to making Ted Kennedy's dream a reality."

The Nevadan said that "every step of this long process has been an enormous undertaking."

Sen. Max Baucus, D-Mont., chairman of the Finance Committee, said he "very happy to see people getting health care they could not get."

It was the Senate's first Christmas Eve vote since 1895, when the matter at hand was a military affairs bill concerning employment of former Confederate officers, according to the Senate Historical Office.

After the vote Obama offered congratulations in phone calls to Vicki Kennedy and Reid, Baucus and other senators, including 92-year-old Robert Byrd, D-W.Va., who was brought to the Senate in a wheelchair.

The House passed its own measure in November. The White House and Congress have now come further toward the goal of a comprehensive overhaul of the nation's health care system than any of their predecessors.

The legislation would ban the insurance industry from denying benefits or charging higher premiums on the basis of pre-existing medical conditions. The Congressional Budget Office predicts the bill will reduce deficits by $130 billion over the next 10 years, an estimate that assumes lawmakers carry through on hundreds of billions of dollars in planned cuts to insurance companies and doctors, hospitals and others who treat Medicare patients.

For the first time, the government would require nearly every American to carry insurance, and subsidies would be provided to help low-income people to do so. Employers would be induced to cover their employees through a combination of tax credits and penalties. The legislation costs nearly $1 trillion over 10 years and is paid for by a combination of taxes, fees and cuts to Medicare.

Republicans were withering in their criticism of what they deemed a budget-busting government takeover. If the measure were worthwhile, contended Minority Leader Mitch McConnell, R-Ky., "they wouldn't be rushing it through Congress on Christmas Eve."

House Minority Leader John Boehner assailed the bill moments after passage.

"Not even Ebenezer Scrooge himself could devise a scheme as cruel and greedy as Democrats' government takeover of health care," the Ohio Republican said in a statement.

"Sen. Reid's health care bill increases premiums for families and small businesses, raises taxes during a recession, cuts seniors' Medicare benefits, adds to our skyrocketing debt, and puts bureaucrats in charge of decisions that should be made by patients and doctors," he said.

The occasion was moving for Sen. Paul Kirk, D-Mass., appointed to fill Kennedy's seat after his death in August.

"He's having a merry Christmas in heaven," Kirk told reporters after the tally. He said he was "humbled to be here with the honor of casting essentially his vote."
Said Dingell: "This is for me, this is for my dad, this is for the country."

Reid nailed the last votes down in a rush of deal making in the last week that is now coming under attack because of special provisions obtained by a number of senators. In Nebraska, home to conservative Democrat Ben Nelson, the Democrats' crucial 60th vote, the federal government will pay 100 percent of the cost of a planned Medicaid expansion in perpetuity, the only state getting that deal.

Negotiations between the House and Senate to reconcile differences between the two bills are expected to begin as soon as next week. The House bill has stricter limits on abortion than the Senate, and unlike the House, the Senate measure omits a government-run insurance option, which liberals favored to apply pressure on private insurers but Democratic moderates opposed as an unwarranted federal intrusion. Obama has signaled he will sign a bill even if it lacks that provision.

CIOs discuss what "meaningful use" means to them

Even before the government publishes its final definition of “meaningful use,” hospitals across the country are positioning themselves to prove it. It’s what they need to do to be eligible for the $5 million to $10 million in incentives available to hospitals under the American Recovery and Reinvestment Act.

Here is what three CIOs are doing:

Sharp HealthCare
At Sharp HealthCare in San Diego, which includes seven hospitals and two medical groups, Vice President and CIO William Spooner has a list, and he’s checking it more than twice.
“I have assigned an analyst to track the meaningful use outline for us and to prepare a high-level readiness/gap analysis for Sharp,” he said.  “I will be reviewing this with our IT steering committee. I will use this as the framework and catalyst as the final regs emerge.”
“We are plotting our interoperability strategy to both assure meeting the meaningful use requirements and to offer our providers additional connectivity that we think is important to them.  I hope to be quite self-contained for our dedicated provider network while offering the pipe to the community however HIE emerges in our region,” he added.
“We are coordinating an EHR offering by our primary EHR vendors to be made available to those docs not closely aligned through one of our formal medical groups,” Spooner concluded. “We do not plan a Stark offering but to suggest a package of pre-vetted products/services along with connectivity through our interoperability platform.”

Brigham and Women’s
At Brigham and Women’s in Boston, vice president and CIO Sue Shade says the hospital is in good shape to show meaningful use.
Brigham and Women’s is a 770-bed teaching affiliate of Harvard Medical School and a founding member of the Partners Healthcare System.
“We have a lot of the core pieces already in place,” Shade said. “We’ve had order entry for a very long time. We got electronic medication administration record in place for our core inpatients. We have an electronic medical record for ambulatory. We have a patient portal.”
“We’ve got a lot of the fundamentals already there,” she said. “One of the things that we are still working on is documentation in the inpatient setting. So that’s a pretty major undertaking for us.”
Shade said the Brigham and Women’s team is working on the gap analysis. Though it’s likely there is more work to be done to meet the criteria, she said she does not expect it to be extensive.
“As far as meaningful use not being final, in my view it’s close enough. I don’t think it’s going to change that much in the end,” she said.  “I don’t think anybody should be sitting and waiting until it’s final. If you don’t have those core systems in place, this is the time. You need to start or accelerate your evaluation process with vendors and begin moving ahead on that.”

Shriners Hospitals for Children
At Shriners Hospitals for Children, headquartered in Tampa, Fla., with 20 hospitals across the country and one in Montreal, William Bria, MD, chief medical information officer, says meaningful use has been the focus of IT for a long time.
“Our take on what is meaningful is if we lose sight of patient care, then it’s meaningless,” he said.
There are EHR systems at work in all Shriners hospitals and CPOE uptake is at 88 percent, Bria said. There is an extended informatics delivery system in place, he added, as well as a clinical analyst and a database for the entire Shriners system.
All of this means nothing, stresses Bria, if it can’t be used to help the nurse on the floor make sure she is delivering the right medication to the right patient.
“The most important thing is to have your eye on the real prize,” he said.

Data has to be analyzed, he said, and the analysis used to drive improvement to care delivery.

Source: http://www.healthcareitnews.com

Health Informatics – What is it?

• Field of information science concerned with the analysis and dissemination of medical data through the application of computers to various aspects of health care and medicine. Medical Subject Heading (MeSH) — National Library of Medicine

• 'Health informatics is the logic of healthcare.' Prof. Enrico Coiera, Guide to Health Informatics , 2nd Edition

• "The role of the information sciences in medicine continues to grow, and the past few years have seen informatics begin to move into the mainstream of clinical practice. The scope of this field is, however, enormous. Informatics finds application in the design of decision support systems for practitioners, in the development of computer tools for research, and in the study of the very essence of medicine – its corpus of knowledge. The study of informatics in the next century will probably be as fundamental to the practice of medicine as the study of anatomy has been this century." (Source: Coiera E (1995) Medical Informatics , BMJ, 1995;310:1381-7)

• The terms 'medical informatics' and 'health informatics' have been variously defined, but can be best understood as meaning the understanding, skills and tools that enable the sharing and use of information to deliver healthcare and promote health. 'Health informatics' is now tending to replace the previously commoner term 'medical informatics', reflecting a widespread concern to define an information agenda for health services which recognises the role of citizens as agents in their own care, as well as the major information-handling roles of the non-medical healthcare professions… — British Medical Informatics Society

• Health Informatics is concerned with the study of the principles of information processing and with the provision of (general) solutions for information processing problems in the field of health care; uses appropriate (formal) methods and tools, especially from informatics, to model structure and mechanism information processing systems in the field of health care in order to describe or analyze these systems or in order to provide possibilities for their construction or for their evaluation. Haux — Universiteit Maastricht

• "…Informatics is an emerging discipline that has been defined as the study, invention, and implementation of structures and algorithms to improve communication, understanding and management of medical information. The end objective of biomedical informatics is the coalescing of data, knowledge, and the tools necessary to apply that data and knowledge in the decision-making process, at the time and place that a decision needs to be made. The focus on the structures and algorithms necessary to manipulate the information separates Biomedical Informatics from other medical disciplines where information content is the focus." (Source: Aamir M. Zakaria., MD "Medical Informatics Frequently Asked Questions", Duke University)

• Informatics: "The use of information systems, computer technology and telecommunications to improve patient care, research and education." (Source: Westmead Hospital, Westmead, N. S. W. Australia

• Health Informatics examines areas such as health concepts, ontologies, classifications, terminologies, (health) knowledge managment methodologies and algorithms, electronic health record storage and delivery structures, health messaging and communication systems (including visual and auditory), decision support systems, and much more. Related topics such as the human-computer interface, ethical and legal impacts, consumer access, security and privacy as well as many ethical issues are part of the health informatics domain. Evans, D. 2003.

 

Boom Times For Health IT Sector

The healthcare IT marketplace is growing by 11% annually, which will likely continue through 2013, says a study from Scientia Advisors.

By Mitch Wagner, InformationWeek

Health information technology (HIT) is the fastest growing segment of the $1 trillion global health care marketplace, and is poised to continue its impressive growth through 2013, according to a study released Tuesday.

The health IT marketplace is showing 11% combined annual growth rate, which is likely to continue over the next four years, according to a study from Scientia Advisors, a management consulting firm.

To remain competitive, vendors must take into account government incentives, requirements for clinical decision-making and electronic health record systems, and emerging competitors in Asia and elsewhere in the developing world, the study said.

Health information technology will grow from 4% of the worldwide health care products market to 5% — a 25% increase in HIT market share, Scientia said.

HIT spending in the US will focus on inpatient and outpatient electronic health records systems, at the expense of specialty and departmental information systems and other capital investments, Scientia said.

“Leading players with large installed bases, proven products, and streamlined routes to meaningful use of EHRs are likely to gain share,” Scientia said.

Some small hospitals may choose lower risk, lower cost approaches such as remote hosting. Given the economic slowdown, vendors will lend hospitals capital to finance HIT investments.

“Clinical decision support systems (CDSS) will likely have a profound impact on clinical diagnostics and therapeutics,” Scientia said.

Also, “over the long term, disruptive innovations such as open source software and ’software as a service’ could lead to dramatically lower pricing,” the company said.

Above article published on http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml?articleID=221601057&subSection=News

EMRs, PHRs, HIE necessary to support patient-centered medical home

By Neil Versel

Without EMRs, PHRs and health information exchange, the patient-centered medical home may not be bound to fail, but it certainly is difficult to establish and maintain. “IT is really the key to supporting the doctor/patient relationship and making it more efficient, safer and more effective,” Dr. Paul Grundy, president of the Patient-Centered Primary Care Collaborative, tells Health Data Management. The Washington-based organization advocates the medical home, under which a primary-care physician manages and coordinates care on behalf of patients, with an eye toward prevention and management of chronic diseases.

It may be a challenge to implement the medical-home model under current reimbursement systems, but until payers start rewarding physicians for keeping patients healthy, IT may be the best avenue. EMRs with clinical decision support, PHRs that help patients monitor their own conditions and health information exchange to support care coordination all can help establish a team approach to care and treatment, HDM reports.

“This is simply about restructuring the way healthcare is delivered to catch the efficiency of technology,” adds Grundy, who also is director of heathcare transformation at IBM.

Above article published on http://www.fierceemr.com/story/emrs-phrs-hie-necessary-support-patient-centered-medical-home/2009-11-12

How the healthcare industry can increase the number of successful EHR/EMR initiatives

Patty Enrado, Contributing Editor

Long before ARRA, more than five years ago, the University of California San Francisco (UCSF) Medical Center began a $50 million electronic medical record initiative. This past summer, UCSF reportedly wrote off a third of that cost and scrapped its contract with the EMR vendor. The EMR system reportedly had technical difficulties that never enabled it to be fully functional. Undeterred, UCSF is forging ahead with its goal of digitizing its patient records, which says a lot about its faith in EMRs.

UCSF Medical Center isn’t the first healthcare system to have a costly, disastrous experience, and it won’t be the last. Industry stakeholders, however, need to work together to ensure that the number of failures dwindle significantly.

The most important thing that the EHR/EMR market can do for itself is to be transparent. If there is no transparency, how can healthcare systems perform accurate due diligence? There’s a business reason for non-disclosure clauses in sales contracts, which prevent purchasers from reporting problems with the health IT vendor or their products, and “hold harmless” clauses, which exempt vendors from any liability. It may guarantee a risk-free business environment for the health IT vendor, but it hurts the EMR market and eventually hurts the health IT vendor’s reputation. Clinicians and healthcare organization executives may be obligated to remain silent about the product and/or the vendor’s problems, but they will talk informally to their counterparts in other healthcare organizations. You’ve heard the complaints. You know which health IT companies did what to whom.

Transparency need not be the enemy of health IT companies if they have solid products and customer support. For those that have had problems - and I’m not saying they have bad products or customer support - it’s a business imperative to fix those problems. There are less-expensive, more flexible EMR solutions that have come into the market in the last year. There will be other UCSF Medical Centers that cut off their legacy vendor and start anew.

There are some in the industry who say so long as the federal stimulus incentives help subsidize the purchase of legacy systems the problems will continue. University of Pennsylvania sociologist Ross Koppel believes the federal government should have put that money to use by developing “more usable and more responsible software.” I think that route would have been successful as a first step, though I still believe in the incentives. There are some who believe the federal government should regulate the EMR industry. If that sounds odious, then perhaps the EMR industry ought to regulate itself.

As for healthcare providers, they need to understand the enormity of the task. What I mean is that they need to not only put up the cash for the initiative but dedicate human resources to the initiative. Dedicate a team, if that is what is required.

I’d be remiss not to mention that for every UCSF there is a UPMC (University of Pittsburgh Medical Center) - large healthcare systems that have successfully implemented big-budget EMRs and are reaping administrative and clinical benefits. The problem is there aren’t enough of them. And that’s why there is hesitation among healthcare systems. As an industry, let’s try to increase those success stories.

Above article published on http://www.healthcareitnews.com/blog/how-healthcare-industry-can-increase-number-successful-ehremr-initiatives

Obama Dedicates $88M More for Health IT

As part of the new Recovery Act funding, President Obama pushes health information technology systems for community health care centers.President Obama is seeding the health care industry with another $88 million in funding for health care centers to adopt new health information technology systems to manage their administrative and financial matters and transfer old paper files to electronic medical records. The initiative is part of $600 million in stimulus money that will go toward improving community health centers across the country.

"These investments won't just increase efficiency and lower costs, they'll improve the quality of care as well –- preventing countless medical errors, and allowing providers to spend less time with paperwork and more time with patients," Obama said Dec. 9.

The new Recovery Act funds are the latest in a series of grants awarded to community health centers, which deliver preventive and primary care services at more than 7,500 service delivery sites around the country to patients regardless of their ability to pay. Health centers serve more than 17 million patients, about 40 percent of whom have no health insurance.

Both programs will be administered by the HRSA (Health Resources and Services Administration), an agency of the HHS (U.S. Department of Health and Human Services).

Obama also directed the HHS to implement a demonstration program designed to evaluate the impact of the advanced primary care practice model on access, quality and cost of care provided to Medicare beneficiaries served by community health centers.

This model, known as the "medical home," promotes accessible, continuous and coordinated family-centered care. Developed and administered by the CMS (Centers for Medicare and Medicaid Services), the demonstration will last three years. CMS anticipates that up to 500 health centers will participate.

According to a Dec. 8 PricewaterhouseCoopers report, the market for personalized medicine in the United States is already $232 billion, and it is projected to grow 11 percent annually.The personalized medical care portion of the market -- including telemedicine, health information technology and disease management services offered by traditional health and technology companies -- is estimated at $4 billion to $12 billion and could grow tenfold to more than $100 billion by 2015 if telemedicine takes off.

"These three initiatives –- funding for construction, technology and a medical home demonstration –- they won't just save money over the long term and create more jobs, they're also going to give more people the peace of mind of knowing that health care will be there for them and their families when they need it," Obama said. "And ultimately, that's what health insurance reform is really about."

EMR likely to boom throughout 2013

We’re in an unprecedented boom in health IT, thanks mostly to growth in the EMR/EHR sector.

A new report from Scientia Advisors says health IT is the fastest-growing segment of what the Cambridge, Mass., management advisory company calls a $1 trillion global healthcare products marketplace. Health IT currently is growing at an 11 percent annual rate, and solid growth should continue at least through 2013, which would be the third year of the federal EMR stimulus program here in the States, the Scientia report forecasts. In that time frame, health IT will increase its market share by a quarter, to 5 percent of global healthcare products sales from the current 4 percent.

In the U.S., according to Scientia, the bulk of the spending will come from inpatient and outpatient EMRs, thanks to the American Recovery and Reinvestment Act. “Clinical decision support systems (CDSS) will likely have a profound impact on clinical diagnostics and therapeutics,” the report says, according to InformationWeek. Some of the growth likely will be at the expense of specialty and departmental systems, however.

Established EMR vendors should benefit most from the increased spending. “Leading players with large installed bases, proven products, and streamlined routes to meaningful use of EHRs are likely to gain share,” Scientia says. However, the research firm says “disruptive innovations” like open-source software and new applications of software-as-a-service could drive down prices, as might new competition from emerging markets in Asia and elsewhere.

Above article published on http://www.medicexchange.com/EMR/emr-likely-to-boom-throughout-2013.html

Demystifying Electronic Health Records

Increasingly, health-care organizations are investing in clinical information systems. According Kalorama Information – the publishing division of MarketResearch.com, hospitals in the United States would be spending close to $4.8 billion on Electronic health record (EHR) or Electronic medical record systems (EMR). Despite the brouhaha, there is a lack of understanding of what an EHR can do and can not do.In this post, we will attempt to peal the layers.

What is an EHR/EMR? Simply put, the EHR is an electronic record of a patient’s medical history. This electronic record includes important information like test and imaging results, medication history, Emergency department visit summaries, doctors’ notes and general health history – from childhood allergies to surgeries.

All of this exists currently, (in most hospitals).But, in paper charts and in some cases in databases behind applications that do not talk to each other. For Instance, the Emergency department diagnosis, might reside in EMSTAT(a popular ED application), while the same patient’s Inpatient treatment notes resides in another application such as Affinity.

An EHR ultimately replaces the paper chart currently used to store the same information. The electronic version of the record can be made available to the patient’s caregivers in different locations, more quickly and efficiently. And when done well, it minimizes data redundancy (the need to enter the same information over and over) . So for instance, information captured during an emergency visit can be retrieved by an inpatient care giver, if the patient goes on to receive care as an inpatient.

How does EHR help hospitals ?
The EHR can help hospitals and health systems make improvements in three major areas.

1. Improved quality of medical decision making
It provides doctors with immediate access to a patient’s health information.Whether it is an Emergency Physician, or a nurse that needs to phone an on-call physician in the middle of the night, the patient’s chart can be accessed to support important treatment decisions. In addition, in most cases the EHR is connected to a robust library of medical information that can help physicians in making diagnoses and treatment plans based on the latest research.In some cases, it can generate automatic reminders by mail or e-mail to notify test result availability, critical values and other useful medical information.

2. Improved Patient Safety
Because doctors’ orders and prescriptions are entered into a computer rather than in handwritten orders, pharmacists and other caregivers have no trouble interpreting the information. This greatly reduces the possibility of transcription errors and other medical mistakes. Thereby reducing adverse drug events and increasing patient safety.

3. Improved efficiency
Caregivers will no longer need to search or wait for your patient chart. In addition, lab results and X-rays can be sent electronically to your doctors as soon as they are completed, for immediate analysis, diagnosis and treatment.

In addition to the major areas listed above, there are other advantages including cost savings from an EHR implementation. In a recent article that Houston Neal, (Director, Business Development, SoftwareAdvice.com) shared with us, they talk about how EMR can help reduce medical malpractice insurance premiums, reduced down-coding and even revenue gains by participating in pay for performance time programs (Medicare Care Management Performance (MCMP) ).

What are main causes of disease?

What Are the Main Causes of Disease

"Educating instead of medicating" - Disease education is about taking control of your health, helping you clearly understand what are the main causes of disease. All diseases are dysfunctions of your bodily and cellular systems. You will learn how to rebuild your immune system.

The use of supplements is expected to dramatically increase as we progress into the next century. Contemporary medicine has taught us well how to manage acute conditions that demand immediate intervention. Let us not forget that nutrition is also a vital component of health. It is important to preserve the best of what medicine has to offer and, at the same time, integrate new, and old, nutritional discoveries.

To restore optimal health you need to understand the root of what causes disease.

Disease education is your number one immune system health resource, you will learn up to date information to prevent disease and how to restore optimal health.

The fastest way to restore your health and well being is to stop doing the things that have caused the physical problem to develop in the first place and then provide your body the nutrients that you are missing so your body can restore and rebuild itself back to optimal health the way it was designed to.

This section of the site is used to bring you disease and wellness updates as soon as they occur.

Visit this section often frequently to stay up-to-date.

Let us increase our efforts to prevent disease and prolong health rather than merely to prolong life. In the following educational pages you are going to learn about many of the underlying causes of disease. Disease education will teach you what may be happening to your own body when you have specific ailments. Disease education will provide you with a clear understanding of what you need to do to enjoy a healthier lifestyle and how to rebuild your immune system.

So, any cell or microbe having a different blueprint than the body’s own code is identified as foreign to the body. Once identified, the immune system goes into action and wages a furious war to defeat the intruder. This causes a flare up which eventually makes you sick. It is thought that the infectious agents remain dormant in the body tissue and once aware of a weakness in the immune system, attack the body's cells. To be effective, the immune system must have the ability to recognize these clever, camouflaged intruders and destroy them before they do any damage to the body.

How to rebuild your immune system

Did you know that 80% of American children and 68% of American adults fail to consume the recommended amounts of fruits and vegetables each day? Pub Med Reference

Antioxidant vitamins and minerals have received immense attention because of their important role in disease protection.

The overwhelming majority (roughly 90%) of chronic diseases are not inherited, but result from environmental damage to cellular DNA or cellular processes.

Each individual's nutritional status is known to be a critical component for protection from development of some diseases, including atherosclerosis and some cancers. Decreased immune function has been shown to be counteracted with dietary antioxidant . Pub Med Reference You need to understand what your immune and cellular systems require so you can learn how to rebuild your immune system.

We are losing the health care battle everywhere else. Chronic degenerative diseases afflict over 120,000,000 Americans. Fifty plus million more suffer from one or more auto-immune diseases. Antibiotic resistant infections are now increasing at an alarming rate. We have finished mapping the human genome, but we still don't have any cures or even treatments for genetic disorders.

Approximately 90% of the medications prescribed can only help to suppress the symptoms of the disease, with no ability to actually kill or fix the disease.

Yes, we do realize that without those medications, some of you reading this web page would not have the improved quality of life, and, in some instances, wouldn't even be alive today. Though we must still recognize the limitations of symptom-suppressive medications and that the cost/ benefit ratio is getting more costly. Properly prescribed prescription drugs are now the No.4 cause of death in the U.S. Every disease category is increasing; and even worse, are now occurring at younger ages.

What Are the Main Causes of Disease

Taking a closer look at the causes of Disease

Why Do I Get Sick? Why Do I get disease? When you get a stuffed up nose from a cold, its not the cause of the cold it’s a symptom. Symptoms alert you that something is not right in your body. They are not the cause of illness or disease.

A heart attack is not the cause of heart disease it’s a symptom. More often then not it is the last symptom.

If you were to get or already have cancer, a tumour is not the cause it is a symptom of a very serious problem in your body.

Have you ever really thought about what causes disease and why some people get cancer while others get heart attacks or why some people have debilitating disorders such as arthritic conditions, MS, Lupus, asthma diabetes, chrones and numerous other conditions.

You know, you are probably aware that health care is dramatically shifting. But, we hear about it so much today through every conceivable media source that we are almost inoculated against it. Few of us realize how significantly things are changing and we falsely assume that it has always been this way… reality is, things are not getting better.

When you pick up the newspaper and read about the state of our health does it seem right to you? NO

Does it make sense that the disease incidence is increasing at alarming rates? NO

The number one reason people visit the emergency room today is asthma. On average one in three babies born today will develop diabetes at some point in their life.

Prior to 1990 autism affected one out of every 10,000 and today it is one out of every 150.

Something has gone wrong, in fact it is disastrous. We are living in the midst of difficult times, which brings a myriad of challenges.

Do you ever think about why disease conditions are rising at an alarming rate and why children are getting disorders like cancer, diabetes, ADD, asthma and many others at younger and younger ages?

So what is the cause, could it be that the cause for every disease is similar? Let’s take a closer look.

There are several factors and many of these factors are in your hands, you can control them.Disease - is any abnormal condition of the body or mind that causes discomfort, dysfunction, or distress to the person affected.

• Heart Disease is the leading cause of death in America
  National Center for Health Statistics


• Arthritis incidence expected to rise 40% as "Baby Boomers" age
  Centers for Disease Control


• Autoimmune Diseases affect 1 out of 5 people in U.S.A. American Autoimmune Related Disease Association


• Cancer is the second-leading cause of death in U.S.A.
  National Center for Health Statistics


• Multiple Sclerosis affects over 300,000 Americans
  National MS Society


• Pharmaceutical Drugs account for 100,000 deaths and $136 billion in medical costs each year in U.S.A.
  Time Magazine, January 15, 2001

Too many people are relying on their doctor to fix them, too many people are waiting for a symptom before they are concerned about it.

There are many people out there who do not exercise either due to motivational problems or ignorance of what is actually required in terms of time invested to achieve meaningful results. They rationalize for this by making excuses about not having enough time or not being able to afford a gym membership or exercise equipment.

This simply is not true.

The amount of training time necessary to dramatically improve ones physical condition is far less than what most people have been led to believe; at the most one hour to an hour and a half er week, and in many cases considerably less. There are few people, if any, who can not schedule 30 to 90 minutes of their time each week for something so important.

Can't afford it?

Wrong. You can't afford not to exercise. A mini trampoline is an excellent way to get your cells moving!

Who is paying the price for being sick?

You are, your family is, your friends, your co-workers, your neighbours and every other person you can think of.

Heart disease is the No.1 cause of death in the country. In 63% of the women, and 50% of the men, the first symptom will be death which doesn't give you much time to change your ways. Okay, but still an adult problem, right? Not any longer. Go to Med Line on the Internet, and type in "children in atherosclerosis" and you will pull up 4,979 medical research articles about this problem.

Even though the average life expectancy in most countries has increased dramatically during this past century. Our quality of life due to chronic degenerative disease has taken a major hit.

Did you know that 35% of people have an undiagnosed chronic disease, 50% of the time the first indication of a heart problem is FATAL heart attack!

Cancer can be present in your body 5-30 years before it is detectable and that 95% of all people will die from heart disease, cancer or diabetes.

Do you feel fine when a virus invades your body? You don’t know that you have the flu when it first enters your body. In fact, by the time you find out you have it, it’s too late to do anything about it.

What is the only thing that will prevent the flu in your body? YOUR IMMUNE SYSTEM!

Only your immune system is going to protect you in today’s environment. If you do not take the proper steps to strengthen your immune system, folks, you are asking for trouble. Because you know what? During the black plague, it took two months to travel across Europe. Now it takes hours to travel anywhere in the world. And scientists have discovered and isolated a medication resistant form of the black plague.

People's immune system functioning has deteriorated by approximately 30 percent in the last twenty years and continues to deteriorate at a rate of approximately three percent per year. Most Americans take at least one pharmaceutical drug every day in an effort to adapt to life with chronic disease because adjusting to a decreased quality of lifestyle is all that allopathic medicine has to offer at this time.

Does a drug cure you? No it is simply designed to treat a symptom.

How about food or nutrition does that cure you? No it supplies your body with necessary nutrients to function at an optimal level.

Many people are unaware of what our bodies are designed to do. Our bodies are truly amazing, if we just understood how to treat them by eating a balanced diet, obtain all necessary nutrients, drink sufficient clean purified water, exercise, sleep well, have fun enjoy life for our short time on earth.

If we did this in the proper portions our bodies know exactly what to do, how to make healthy new cells, how to absorb essential nutrients, how to heal cuts, how to fight disease. Your amazing biological organic body is designed to defend itself, heal itself, and protect itself from all manners of threat.

The number one concern of individuals that have one or more of the known diseases is to become symptom free of the condition without any side effects from drugs or other treatments.

Let’s review some well-known diseases and what causes them.

• Scurvy - a condition caused by deficiency of ascorbic acid (vitamin C)


• Major cause of blindness – is Vitamin A deficiency


• Rickets - is characterized by insufficient amounts of vitamin D in the body.


• Vitamin E deficiency affects the central nervous system and may result in progressive neuromuscular disease


• Beriberi – vitamin B deficiency


• Osteoporosis – combined vitamin D and calcium deficiency

Information on the importance of nutrition has historically been lacking from the training of physicians, this is beginning to change. For example, a major text used in medical training (Goodman and Gilman's: The Pharmacological Basis of Therapeutics) now contains greatly expanded information on the importance of vitamins to health. In a recent review of the dangers associated with micronutrient deficiencies, Dr. Bruce Ames, Professor of Molecular and Cellular Biology at the University of California at Berkeley, concluded that "Remedying micronutrient deficiencies is likely to lead to a major improvement in health and an increase in longevity at low cost."

Digestive problems – in some cases it is an insufficient amount of fibre and enzymes.

Cancer - is partly a lack of sufficient amounts of phytochemicals (found in vine ripened fruits and vegetables). It is well known and widely accepted that lycopene a phytonutrient found in tomatoes reduces the chance of prostrate cancer in men. Ask yourself what about cancer when we see that all these other diseases have distinguished nutrient deficiencies. There have been several studies that have found that phytonutrients have a profound effect on many cancers.

The list goes on and on and on. However there still seems to something missing, as we know disease is rising at an alarming rate in spite of this information.

Understanding the Problems

Lack of proper nutrition is certainly not the only factor that causes disease, there really are many more.

Healthy functioning of the immune system is of paramount importance to everyone since it controls our ability to fend illness and disease. The basic science of staying healthy is to optimize your bodies systems. The world is filled with pathogens microbes, toxic pollutants and stress

, and so the body requires a vigorous and vigilant immune system.

Healthy functioning of the immune system is of paramount importance to everyone since it controls our ability to fend illness and disease. The basic science of staying healthy is to optimize your bodies systems. The world is filled with pathogens microbes, toxic pollutants and stress, and so the body requires a vigorous and vigilant immune system.

The main task of our immune system is to survey our bodies internally. It is like our internal security force that is constantly checking the identity of everything entering and already existing within the body. It is a personal defense system that comes charging to the rescue at the very first sign of an alien invading force. A pathogen or toxic pollutant may be recognized as 'non-self' and a potential enemy if it does not have the right biological and molecular makeup.

So, any cell or microbe having a different blueprint than the body’s own code is identified as foreign to the body. Once identified, the immune system goes into action and wages a furious war to defeat the intruder. This causes a flare up which eventually makes you sick. It is thought that the infectious agents remain dormant in the body tissue and once aware of a weakness in the immune system, attack the body's cells. To be effective, the immune system must have the ability to recognize these clever, camouflaged intruders and destroy them before they do any damage to the body.

The following are some of the common causative factors that weaken our immune system not listed in any order of importance:

1. Pathogens - Ex: Bacteria, viruses, fungi, parasites.

• Toxic pollutants - Ex: Smog, industrial smoke, cigarette smoke, harmful vapors, vehicle emissions, pesticides, herbicides and the list goes on and on.
  > Toxins in your water
  > Toxins in your working environment
  > Toxins in your home
  > Toxins in the air you breathe
  > Drugs in your drinking water – It is an unfortunate truth that we are all taking drugs. More than 100 published reports done on drinking water in cities all over the world confirm that we are getting pharmaceutical drugs in our water every day!


• Potential antigens- Ex: Medications, pollen, dander, toxins, chemicals.


• Foreign cells and tissues - Ex: Malignant cells, foreign tissue such as from transplanted organs, or transfused blood.


• Stress - Stress is a definite culprit that weakens the immune system because it affects the production of interferon and cortisol.
  > Environmental stress
  > Physical stress
  > Mental stress


• Digestive disturbances - can also result in the build-up of toxins because of inadequate elimination thus the accumulated toxins may overpower the immune system and weaken it.


• Depleted nutrients – our modern world has


• Poor food and dietary choices


• Lack of essential nutrients – 1992 USDA study concluded that only 4% of the 22,000 Americans studied were getting the minimum recommended daily allowance (DA) of essential vitamins (and who wants to settle for the minimum!)A recent US government survey found that out of the 21,000 people surveyed, NONE (0%) of them ate the RDA of all the ten basic nutrients studied
  91% of Americans do not consume the recommended amounts of fruits and vegetables
  80% do not eat any (ZERO!) carotene-containing vegetables each dayToday, foods have less nutritional value due to modern farming methods. It now takes 60 servings of spinach to get the same amount of iron as one serving in 1948
  Today, you have to eat 25 cups of spinach a day to get the RDA for vitamin E


• Lack of proper exercise – It wasn't too long ago that people with conditions such as high blood pressure, high blood sugar, arthritis, asthma and heart disease, were told by Physicians to "take it easy","stay in bed" or ingest several medications in order to stabilize these conditions. Today, there is little doubt how the impact of lifestyle changes, including exercise, can dramatically prevent, treat and even cure many of these ailments.Exercise is not merely important. It is absolutely essential. Most people, however, do not realize this, because the time factor of the cause-effect relationship between lack of exercise and the resulting decline in functional ability is so great.If nothing is done to prevent it, we gradually lose muscle tissue as we age, becoming weaker, and less flexible as a result. There are several problems associated with this, the most obvious being a decrease in metabolism resulting in increased body fat, which is a primary risk factor for heart disease and several other serious health conditions such as diabetes. Not so obvious though, are the effects of a lack of exercise on one's bones.

What is more important than your health?

Absolutely nothing!

What are the most important nutrients?

The ones that you are not getting in your current diet!

Research that has accumulated over several decades has led to the discovery and establishment of an entirely new category of essential nutrients that is radically changing the way medicine will be practiced. This new category of nutrients is already allowing the body to correct and/or prevent health challenges in ways even the most optimistic health care professional never thought possible.

Medical Billing Work – How to Approach it the Right Way?

Medical billing work is a very popular work-from-home option. Medical billing is a profitable career, but also a demanding job opportunity. However, if you approach medical billing the right way, it can bring you $30,000 – $100,000 per annum.

When it comes to medical billing work, one of the main aspects to be aware of is that there are a lot of online scams, trying to lure you into merely wasting your money. These scams can sound like they are legit. Furthermore, they may even be legit, or partly legit. Then what’s the problem with them? They will promise you more than they will actually provide you with.

For instance, some scammers will promise you a list of doctors who are interested in acquiring medical billing online services. The fact is that these lists are either fake, or have for the most part any doctor out there, who may not even be looking for any medical billing online service provider whatsoever.

Medical billing work has some requirements, including: a personal computer, special medical billing software and sound understanding of medical billing. In order to locate the most efficient medical billing course, find out the individual prices for the software and the training.

The codes in medical billing are the most important knowledge asset required. The codes are assigned to practically everything in medical billing, such as diagnoses, procedures, health professions etc. Apart from the codes, other important medical billing work details include what to do if the accounts collectible are not paid by the patients or by their insurance company etc.

Medical billing work is a good opportunity for someone who is willing to undergo special training and who can cover the costs of the courses and the software.
While working, you will mostly be constrained by time. In fact, it is common that medical billing service providers work 10 or 10+ hours per day. Don’t be too aggressive in taking work, as too much work may turn into a problem in itself.

However, medical billing work has the appeal of freeing you from having to report to a boss. You will stay at home, close to your family, while still making money. Depending upon the amount of work you can carry out, you will be able to earn more than with a 9-to-5 job. If you are self-motivated, medical billing work will fit you well.

How much work can you expect? Well this varies between companies. Some companies require 30-50 medically coded invoices per week, others require more or less. Basically, if medical billing work is your sole income, you can decide to take as much work as you wish.

Medical billing work is a nice opportunity for working at home. If it is approached the right way, medical billing work may become a great work-at-home opportunity. However, just like any other work, it can be tedious and involved.

ELECTRONIC MEDICAL RECORDS

Paper-based records have been in existence for centuries* and their gradual replacement by computer-based records has been slowly underway for over twenty years in western healthcare systems. Computerised information systems have not achieved the same degree of penetration in healthcare as that seen in other sectors such as finance, transport and the manufacturing and retail industries. Further, deployment has varied greatly from country to country and from speciality to specialty and in may cases has revolved around local systems designed for local use. National penetration of EMRs may have reached over 90% in primary care practices in Norway, Sweden and Denmark (2003), but has been limited to 17% of physician office practices in the USA (2001-2003) [HHS, 2005]. Those EMR systems that have been implemented however have been used mainly for administrative rather than clinical purposes. Electronic medical record systems lie at the center of any computerised health information system. Without them other modern technologies such as decision support systems cannot be effectively integrated into routine clinical workflow. The paperless, interoperable, multi-provider, multi-specialty, multi-discipline computerised medical record, which has been a goal for many researchers, healthcare professionals, administrators and politicians for the past 20+ years, is however about to become reality in many western countries. Over the past decade, the political impetus for change in almost all western countries has become stronger and stronger. Incontrovertible evidence has increasingly shown that current systems are not delivering sufficiently safe, high quality, efficient and cost effective healthcare (see Public Reports section on OpenClinical), and that computerisation, with the EMR at the centre, is effectively the only way forward. As Tony Abott (Australian Minister for Heath and Ageing) said in August 2005: "Better use of IT is no panacea, but there's scarcely a problem in the health system it can't improve". For the first time, the responses have been national and co-ordinated. Governments in Australia, Canada, Denmark, Finland, France, New Zealand, the UK, the USA and other countries have announced - and are implementing - plans to build integrated computer-based national healthcare infrastructures based around the deployment of interoperable electronic medical record systems. And many of these countries aim to have EMR systems deployed for their populations within the next 10 years.

TERMS

Terms used in the field include electronic medical record (EMR), electronic patient record (EPR), electronic health record (EHR), computer-based patient record (CPR) etc. These terms can be used interchangeably or generically but some specific differences have been identified. For example, an Electronic Patient Record has been defined as encapsulating a record of care provided by a single site, in contrast to an Electronic Health Record which provides a longitudinal record of a patient�s care carried out across different institutions and sectors. But such differentiations are not consistently observed.

C. Peter Waegemann in his Medical Record Institute EHR Status Report provides, within a historical context, a summary of the different functions and visions implied by the various terms used to refer to EMRs.

What Is Healthcare Informatics?

Health care informatics combines the fields of information technology and health to develop the systems required to administer the expansion of information, advance clinical work flow, and improve the security of the health care system. It involves the integration of information science, computer technology, and medicine to collect, organize, and secure information systems and health–related data. The extraordinary explosion of medical knowledge, technologies, and ground-breaking drugs may vastly improve health care delivery to consumers, and keeping the information related to these advancements organized and accessible is key.

Health care informatics utilizes computer hardware, specialized software, and communication devices to form complex computer networks to collect, analyze, and transmit medical processes. The tools for creating health information systems are not limited just to information technology. These systems should also allow for the assimilation of clinical directives, understanding of formal medical jargon, storage of data, and transmission of clear communication. Medical informatics can be applied in all types of health environments, including primary care, general practice, hospital care, and rehabilitation. It is also inclusive of many of the specialties within the health care field.

Information systems may used to create greater operating efficiencies in three basic functions of health care: clinical, administrative, and financial. For example, health care informatics is pivotal in the movement to cut costs and enhance patient care by implementing a standardized system for electronic medical records. It is also a key to expanding the development health information systems for billing, clinical research, client scheduling, and the exchange of medical information.

Physicians can avail themselves of the growing knowledge base and make better decisions bolstered by computer software called clinical decision support systems (CDSS). Other computer systems, called electronic prescribing systems, eliminate the need for hand-written prescriptions and minimize errors. Informatics also allow for data mining to determine the effectiveness of drugs. This may reduce the cost of treatments, lessen mistakes, and help further advancements in the quality of care.

One of the major objectives of health care informatics is to formulate a standard approach for health care internationally. The idea is for researchers, providers, and patients to benefit from the informatics tools, techniques, concepts, and protocols that transform health care delivery, and to promote best practices in the health care field. As a result of evolving and complex legal issues related to information technology and health-related fields, health care informatics is also important in health law as it relates to ethical, operational, and privacy concerns.

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Medicare to Cover HIV Screening Tests

The Centers for Medicare & Medicaid Services (CMS) announced its final decision to cover human immunodeficiency virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service. The decision is effective immediately.

Under the recently passed Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS now has the flexibility of adding to Medicare’s list of covered preventive services, if certain requirements are met. Prior to this law, Medicare could only cover additional preventive screening tests when Congress authorized it to do so.

“Today’s decision marks an important milestone in the history of the Medicare program,” said HHS Secretary Kathleen Sebelius. “Beginning with expanding coverage for HIV screening, we can now work proactively as a program to help keep Medicare beneficiaries healthy and take a more active role in evaluating the evidence for preventive services.”

Under MIPPA, CMS can consider whether Medicare should cover preventive services that Congress has not already deemed as covered or noncovered by law. Among other requirements, the new services must have been “strongly recommended” or “recommended” by the U.S. Preventive Services Task Force. For instance, the Task Force graded HIV screening as “strongly recommended” for certain groups.

New Limits Set on RAC Medical Record Requests

The Centers for Medicare & Medicaid Services (CMS) has modified the additional documentation request limits for the RAC (Recovery Audit Contractor) program in FY10. These limits will be set by each RAC on an annual basis to establish a cap per campus on the maximum number of medical records that may be requested per 45-day period. A campus unit may consist of one or more separate facilities/practices under a single organizational umbrella; each limit will be based on that unit’s prior calendar year Medicare claims volume.Limits will be based on the servicing provider/supplier’s Tax Identification Number (TIN) and the first three positions of the zip code where they are physically located. Using TINs will reduce the total number of limits that would have been imposed per organization under the previous draft policy, which was based on National Provider Identifiers, while zip codes are factored in to promote equitability for regional or national organizations.
Limits will be set at 1 percent of all claims submitted for the previous calendar year (2008), divided into eight periods (45 days). Although the RACs may go more than 45 days between record requests, in no case shall they make requests more frequently than every 45 days
Read the CMS notice.