Saturday, March 27, 2010

How prescriptions are written matter to you

In India, it is common for doctors to write prescriptions for drugs based on the brand name and not the generic drug name. So a doctor will write a prescription for Metacin, Crocin etc. and not Paracetemol, Aspirin etc.

To understand why this is important for your health read on….

On the way back from work the other day I decided to stop over at a friend's place in Goregaon. She told me that she was sick and the doctor had prescribed the "Hilfas Kit" for her. She asked me if I could pick it up from a chemist near Goregaon station on my way to her home. I visited about 10 chemists and no one had even heard of the "Hilfas Kit" (I don't know why there need to be 10 different chemists near the station and that too only on the East side, but I’ll address the reasons in another blog).

I found it strange that none of the 10 chemists had even heard of the Hilfas Kit. So I asked my friend if she had her old medicines and if she could send me the drug names and their dosage. Luckily, she did. The Hilfas Kit, it turns out, consists of 2 fluconazole tablets 150mg, 1 azithromycin tablet 1g and 1 secnidazole tablet 1g. I asked a few of the chemists if they had the a similar "combo kit". They all did but yet they had not heard of Hilfas. That's because Hilfas is the name of one of over 10 companies that manufacturers the exact same kit.

Here’s the problem: suppose you have been taking the Hilfas Kit for a while now and the underlying problem is not going away, you decide to consult another doctor or a specialist. You show your prescription to the doctor and she doesn’t know what the Hilfas Kit is. How can she make the right diagnosis? How about if you wanted to get a second opinion from a doctor in another country say the USA? How will the doctor figure out what drugs you have been taking?

One way to fix this problem is for you to add the prescription to your Electronic Health Record (EHR). When you do that you will realize that the Hilfas Kit does not exist and you can call your doctor to understand what the underlying drug is. Of course, the best way would be if all doctors just entered the generic drug name and not the brand name. As EHRs gain more acceptance and are used more frequently this will become the norm.

Friday, March 19, 2010

Healthcare Initiatives Underway in the US

The American Recovery and Redistribution Act of 2009 (ARRA) allocated $19 billion towards health information (HIT)*. The $19 billion will be allocated as incentives to medical providers who implement EMR systems as well as to states to create Health Information Exchanges (HIEs).

For physicians, the full payment between 2011 and 2015 will range between $44K and $60K. For each year a physician is not in the program, the incentive payments decline by 1% each year. The ultimate calculation of payments to physicians is based on Medicare patient volume.

For hospitals, the incentive payment begins at $2 million in 2011, with additional payments based on Medicare volumes. As with physicians, the incentive stops in 2015. In 2015, there will be penalties for providers not participating in the program.

ARRA, thus is not only an economic stimulus bill, it's an HIT stimulus bill for adoption by providers.

2011 (Stage 1 of Meaningful Use)

By 2011 all medical providers need to have a certified EMR system. The Certification Commission for Health Information Technology (CCHIT, does the certification of EMR systems.

There are currently 12 doctors in the US Congress. All have indicated that the 2011 deadline is “too aggressive” so most likely the date will be extended.

2013 (Stage 2 of Meaningful Use)

All medical providers must provide each patient access to all of his/her information via a patient portal. For example, if a patient has taken a drug test the patient must be provided access to find out whether the doctor has seen the test results as yet or not. The patient should also obviously be able to see his/her test results. This has implications for Medicare/Medicaid. Doctors could be flagged if their patients have not taken particular tests. Meaningful Use also entails requiring medical providers to share information with each other.

Currently, only about 10 EMR solution providers truly have the capability of providing a patient portal. For most of the others either the EMR solution is only client/server based or they are trying to develop their solutions for certification. Microsoft is a good example with its solution being under development.

Solution providers will also need to be in a position to show “compliance”. Example, % of patients who have taken the annual exam.

2015 (Stage 3 of Meaningful Use)

By 2015 all states must have in place a Health Information Exchange (HIE). The government provides incentives to states for setting up the HIE. In addition, states can make money through advertising etc.

All medical information for a patient must be uploaded to the state HIE by all medical providers. This will ensure that a patient’s information will travel from provider to provider. This has several advantages including: eliminating the need to complete new patient documentation each time the patient sees a new medical provider, allowing a patient’s medical reports to be carried with him, thus reducing the number of “duplicate” tests the patient has to take.

Medicity is a good company providing this service.

* ARRA provisions for Health Information Technology (HIT)

Provides approximately $19 billion for Medicare and Medicaid Health IT incentives over five years.

· Officially establishes the Office of the National Coordinator for Health Information Technology (ONCHIT) within HHS to promote the development of a nationwide interoperable Health IT infrastructure; President Bush already created ONCHIT by Executive Order in 2004.

· Establishes Health IT Policy and Standards Committees that are comprised of public and private stakeholders (e.g., physicians) to provide recommendations on the Health IT policy framework, standards, implementation specifications, and certification criteria for electronic exchange and use of health information.

· HHS would adopt through the rule-making process an initial set of standards, implementation specifications, and certification criteria by December 31, 2009.

· ONCHIT would be authorized to make available a Health IT system to providers for a nominal fee.

· Provides financial incentives through the Medicare program to encourage physicians and hospitals to adopt and use certified electronic health records (EHR) in a meaningful way (as defined by the Secretary and may include reporting quality measures). Authorizes ONCHIT to provide competitive grants to states for loans to providers.

· Medicare incentive payments would be based on an amount equal to 75% of the Secretary’s estimate of allowable charges, up to $15,000 for the first payment year. Incentive payments would be reduced in subsequent years: $12,000, $8,000, $4,000, and $2000, after 2015. Physicians who report using an EHR that is also capable of e-prescribing would be eligible for EHR incentives only.

· Early adopters, whose first payment year is 2011 or 2012, would be eligible for an initial incentive payment up to $18,000. In 2014, the payment limit would equal $12,000. Adopters, whose first payment year is 2015, would receive $0 payment for 2015 and any subsequent year.

· For eligible professionals in a rural health professional shortage area, the incentive payment amounts would be increased by 10 percent.

· Incentives under the Medicaid program are also available for physicians, hospitals, federally-qualified health centers, rural health clinics, and other providers; however, physicians cannot take advantage of the incentive payment programs under both the Medicare and Medicaid programs. Eligible pediatricians (non-hospital based), with at least 20 percent Medicaid patient volume, could receive up to $42,500, and other physicians (non-hospital based), with at least 30 percent Medicaid patient volume, could receive up to $63,750, over a six-year period.

· Physicians who do not adopt/use a certified Health IT system would face reduction in their Medicare fee schedule of -1% in 2015, -2% in 2016, and -3% in 2017 and beyond. E-prescribing penalties would sunset after 2014.

· Allows HHS to increase penalties beginning in 2019, but penalties cannot exceed -5%. Exceptions would be made on a case-by-case basis for significant hardships (e.g., rural areas without sufficient Internet access).