Despite health reform, age rating will still deliver stiff insurance premiums for many older Americans

Under reform legislation, insurers selling policies in the individual or small-group markets can charge older Boomers up to three times more than a younger adult would pay for an identical policy � unless the older person lives in a state that limits age-rating.

When she thinks about health insurance, 60-year old Nancy Peterson fights panic. "You think that this could never happen to you. I've always had insurance; I've always had a good job."

But not long ago, her job was eliminated. Now, she doesn't know how she is going to afford insurance when the COBRA policy that extends her former employer's group insurance expires next year.

"In 2014, health reform will help me � if I can afford the premiums," says Peterson, whose name has been changed to protect her privacy.�"But that's a big ‘if.' I'll be 62, and even with reform, insurance companies will be able to charge me a lot more than they would charge a younger person," she explains.

"We're lucky that by husband has Medicare. But I'm told that premiums just to cover me could run as high as $7,500 year."

Age rating can triple cost of premiums

Peterson is right.�The Affordable Care Act protects many groups, including women, and patients suffering from pre-existing conditions. But one group will be asked to fork over substantially higher premiums than anyone else: older Americans.

Under reform legislation, insurers selling policies in the individual or small-group markets can charge older boomers up to three times more than a younger adult would pay for an identical policy � unless the older person lives in a state that limits age rating.

Some 50-somethings and 60-somethings will be shielded: individuals who earn less than 400 percent of the federal poverty level (currently $44,680 for individuals, $60,520 for couples) will be eligible for tax credits. This will help roughly 40 percent of older Americans pay higher premiums.

Subsidies will miss many Boomers

But Peterson still works part-time, and her husband brings in a little income. Together they are earning $63,000. They're not rich; they sit squarely in the middle class. But they're too affluent to qualify for a subsidy.

The Petersons are hardly unique. As the graph below shows, under reform, 41 percent of Americans between the ages of 50 and 64 won't qualify for help, including 19 percent of the 8.9 million older Americans who are currently uninsured.

Two out of five Americans between the ages of 50 and 64 won't qualify for help from ACA subsidies. Graph: AARP Public Policy Institute

Millions feeling the pinch

Meanwhile in recent years, the number of unemployed older boomers has soared. If you count those who want full-time work but are working part-time ��as well as discouraged workers who have quit looking ��at the end of last year, over 17 percent of Americans ages 55 to 64 couldn't find a job. That's 4.3 million � up from 2.4 million in October 2006.

It's not surprising that some have given up. Among unemployed workers over 55, over half have been searching for more than two years, according to Carl Van Horn, head of the John J. Heldrich Center for Workforce Development at Rutgers University. Even when older workers land a job, nearly three-quarters of them take a pay cut, often a big one.

Still, there are legitimate reasons to ask those who are 50-64 years old to shell out more for insurance. Even if an individual does his best to take care of himself, as he ages, a combination of environmental factors, genetic predispositions, socio-economic factors and the sheer stress of daily living make him increasingly vulnerable to chronic illnesses such as heart disease and cancer. Thus, while insurers pay out only about $280 a month for American aged 25 to 34, adults in their early 60s file insurance claims that average $860.

Waiting game

They need insurance, but even under reform, many who don't work for a large employer will find age-rated premiums unaffordable. Rather than purchasing insurance, they'll pay a penalty, cross their fingers, and hope they stay relatively healthy until they qualify for Medicare at 65.

Make no mistake: Peterson realizes that, in many ways, reform will help her. "I've read that today, in some states, a 60-year-old can wind up paying seven times more than a 25-year-old for exactly the same policy. Starting in 2014, they won't be able to charge me more than three times as much. Insurance companies also will have to cover all essential benefits; they won't be able to hike my premiums because of what they call ‘preexisting conditions; and I'll be able to get preventive care without co-pays or any other cost sharing.

"For people like me, this is great news. But I worry about those premiums. Add in my co-pays and deductible, plus my husband's out-of-pocket costs under Medicare, and more than 15 percent of our after-tax income will be going out the door to pay for healthcare. It's like having another mortgage."

No bail-out needed for German health IT industry

Demand for health IT in Germany is stable, and the current financial and economic crisis is not expected to have a major impact. These were the conclusions drawn during a media briefing of the VHitG - the German Association of the Healthcare IT Industry - held in Berlin on Feb. 2.

The crisis may even provide an opportunity for "greater leaps forward" - for example for the introduction of the long-awaited Gesundheitskarte, initially planned for Jan. 1, 2006, but yet to make it beyond the testing phase.

"The Gesundheitskarte is technically mature and the industry has made enormous investments in order to proceed with a national health card. However, organizational and political management is delaying implementation," said medatiXX CEO Jens Naumann, currently holding the seat of VHitG. "Perhaps in times of crisis we will see acceptance of this technology increase," he added.

According to Bernhard Calmer, head of IT Sales Germany for SIEMENS Medical Solutions and board member of the VHitG, there are three factors which will drive IT adoption: process optimization, interoperability and medical records solutions.

The anticipated slowdown in hospital mergers and the need to reduce costs could increase the demand for IT, Calmer said, noting that "the fact that European healthcare is still organized on a national level could be beneficial for the German health IT industry," as it is hoped that the economic slowdown in Germany will have less of an impact than in other parts of the world.

 

A dash of Europe, but not too much

National responsibility for healthcare in Europe is also one of the reasons why the VHitG does not feel any urgency to internationalize its scope. "Yes, we are adding a European element to our activities, for example by providing English interpreting services at this year's conhIT," said Andreas Kassner, managing director of VHitG. conhIT is the German health-IT conference and exhibition (Berlin, 21-23 April, 2009).

 

"But at the end of the day, we must tell our customers and conference delegates how to solve their very specific problems - and these problems cannot be solved with a European solution. They require a very local, hands-on answer to regional specifics," Calmer added.

When asked about his views on a European health IT show, Calmer said that conhIT was considering "loose coorperations" with other health IT shows. "However, we will not try to force the European element on our customers," he said.

 

Industry trends

The VHitG also presented the trends from an IT survey carried out among 2,093 German hospitals. Matthias Meierhofer, CIO of the HIS-provider Meierhofer AG and member of the VHitG board, summarized the results:

 

 

Larger hospitals are more likely to implement health IT applications, with a preference for specialized solutions that support medical care rather than administrative systems.Health IT is especially appreciated when it improves workflows, optimizes usability and streamlines communications with stakeholders outside the hospital. Again, larger hospitals are more likely to value these benefits.Integration, interoperability and standardisation are key success factors and the VHitG therefore aims to develop clear recommendations for supporting these factors.

 

"There is greater potential for systems that improve data accessibility, knowledge management and transparacy, as well as technology that supports management decisions," said Meierhofer. "IT has the potential to be worth a lot more than it is today."

Related links:
www.VHitG.de (German)
www.conhit.de (German / English)

Youth diabetes, pre-diabetes rates soar

Diabetes and pre-diabetes have skyrocketed among the nation's young people, jumping from 9% of the adolescent population in 2000 to 23% in 2008, a study reports today.

The findings, reported in the journal Pediatrics, are "very concerning," says lead author Ashleigh May, an epidemiologist with the Centers for Disease Control and Prevention.

"To get ahead of this problem, we have to be incredibly aggressive and look at children and adolescents and say you have to make time for physical activity," says pediatric endocrinologist Larry Deeb, former president of medicine and science for the American Diabetes Association.

Of the two types of diabetes, type 2 accounts for more than 90% of cases. In people with diabetes, the body does not make enough of the hormone insulin or doesn't use it properly.

Insulin helps glucose (sugar) get into cells, where it is used for energy. If there's an insulin problem, sugar builds up in the blood, damaging nerves and blood vessels. Long-term complications of diabetes can include heart attacks, blindness, kidney failure, nerve damage and amputations.

May and colleagues examined health data on about 3,400 adolescents ages 12 to 19 from 1999 through 2008. They participated in the CDC's National Health and Nutrition Examination Survey, considered the gold standard for evaluating health in the USA because it includes a detailed physical examination, taking participants' blood pressure and getting fasting blood sugar levels. Their weight and height also are measured.

May notes that the diabetes findings should be interpreted with caution because the fasting blood glucose test was used and there are disadvantages associated with the test. Instead, many physicians use the A1C test, which looks at a person's average blood sugar levels for the past three months.

"I wouldn't be surprised if pre-diabetes and diabetes went up some, but how much it may have gone up is still an open question because of the way they measured it," says Stephen Daniels, chairman of the department of pediatrics at the University of Colorado School of Medicine and a spokesman for the American Heart Association.

Still, about a third of adolescents are overweight or obese, which increases their risk of high blood pressure, type 2 diabetes and other health problems.

Deeb says other research suggests there will be "a 64% increase in diabetes in the next decade," which is even higher than the predicted increase in obesity, "because stress on the pancreas and insulin resistance catches up with people. We are truly in deep trouble. Diabetes threatens to destroy the health care system."

The Pediatrics report also found that overall, half of overweight teens and almost two-thirds of obese adolescents have one or more risk factors for heart disease, such as diabetes, high blood pressure or high levels of bad cholesterol. By comparison, about one-third of normal-weight adolescents have at least one risk factor.

When these risk factors are present in young people, the problems may persist into adulthood, May says.

Says Daniels, "The fact that we have kids who already have risk factors is disconcerting because their risk of cardiovascular disease is already starting to increase."

FCC gives green light to wireless medical devices

WASHINGTON – The Federal Communications Commission voted today to set aside protected broadband spectrum for wireless medical devices known as medical body area networks (MBANs). These sensors can monitor and read a patient’s vital signs wirelessly. By eliminating the cables that restrict a patient to their hospital bed, experts say the devices could transform the way patients' health is monitored.

The FCC's decision – taken at the suggestion of GE Healthcare and Philips Healthcare, which have been working with George Washington University Hospital on several projects related to MBANs – will set aside spectrum access that is free of transmission interference from Wi-Fi and other high-powered consumer devices.

With this ruling, the FCC has allocated 40 MHz of spectrum – 2360 to 2400 MHz – for use by MBAN devices on a shared, secondary basis. This provides a spectrum band for short-range medical technologies to facilitate reliable low-power operation. The FCC's rule aligns with its National Broadband Plan, which set the goal of advancing several specific "national purposes" including healthcare.

With most patient monitors connecting via cables, some experts say the elimination of those wires could increase a patient’s mobility, helping contribute to improved patient outcomes and enhancing overall comfort.

Small, wearable sensors could collect real-time clinical information such as temperature, blood glucose and respiratory function, and aggregate it at a nearby device for local processing and forwarding to centralized displays and electronic medical records.

GE and Philips officials applauded the FCC's ruling.

"With access to special-purpose spectrum, the healthcare industry's research and development efforts can go into overdrive," said Anthony Jones, chief marketing officer, Patient Care and Clinical Informatics, Philips Healthcare. "The expansion of wireless monitoring capabilities will help allow earlier clinical diagnoses, decisions and interventions, supporting the delivery of better patient care at lower costs."

"The FCC's ruling is the culmination of strong collaboration between the medical industry, regulatory officials and aeronautical stakeholders," added Mike Harsh, vice president and Chief Technology Officer at GE Healthcare. "This is an important inflection point, as it enables advances in miniaturized wireless sensors leveraging the latest chip design and clinical measurement technologies. MBANs could significantly enhance quality and access to patient care, while supporting reduced costs."

[See also: Philips expands clinical informatics portfolio with CDP acquisition.]

MBANs could offer further benefits in the hospital, officials noted:?

Early intervention. Clinicians can catch issues before the patient's condition becomes critical, thus improving patient outcomes while avoiding the need for acute interventional measures.Ease of patient transport. There will no longer be a need to disconnect and reconnect wires prior to transporting a patient.
Infection control. By limiting the wires, MBANs could help reduce the risk of infection and the need for cleaning procedures.
Flexibility. Caregivers will be able to quickly add or remove sensors for different physiological parameters as medical conditions warrant.?

"MBANs represent the next evolution in monitoring a patient's health status," said Richard Katz, MD, director of the Division of Cardiology at George Washington University Hospital. "These wireless innovations can enhance patient safety by giving caregivers the ability to monitor many clinical measurements, wherever the patient is located."

Stronger Benefits for Seniors, Billions in Savings This Year

Two years ago, President Obama signed the Affordable Care Act and provided important relief to seniors, including a 50% discount on brand-name prescription drugs for those in the coverage gap known as the �donut hole.�

Prior to the passage of the new health care law, people on Medicare also faced paying for preventive benefits like cancer screenings and cholesterol checks out of their own pockets. �Now, these benefits are offered free of charge to beneficiaries.

These new benefits are already making a difference in communities across the nation. �Before 2011, David Lutz, a community pharmacist from Hummelstown, PA, described customers, �splitting pills, taking doses every other day, missing doses, stretching their medications,� noting that not taking their medications as prescribed was not good for their health. �

But, according to David, this has begun to change since the passage of the Affordable Care Act. �People cannot take their medications if they can�t afford them. This [Affordable Care Act] will make them affordable and they�ll take their medications on time, the way they�re supposed to, which will improve their health,� Lutz says. �There�s no question about it.�

In 2010, for example, those who hit the donut hole received a $250 rebate � with almost 4 million seniors and people with disabilities receiving a collective $1 billion. ��In 2011, Medicare beneficiaries received more than $2.1 billion in savings � averaging $604 per person last year � from the 50% discount on brand-name drugs in the donut hole.

And today, we have more good news. Even more seniors and people with disabilities on Medicare have benefited from these important measures:

In 2010 and 2011, over 5.1 million people on Medicare saved over $3.2 billion on prescription drugs in the donut hole. �In the first four months of 2012 alone, more than 416,000 people have saved $301.5 million � an average of $724 a person so far this year.In the first four months of 2012, 12.1 million beneficiaries on traditional Medicare received at least one free preventive service. �This includes over 856,000 who have taken advantage of the Annual Wellness Visit � a new benefit that allows patients to meet with their doctors once a year to develop and update a personalized prevention plan. �In 2011, over 26 million beneficiaries in traditional Medicare � received one or more preventive benefit free of charge.

These new benefits will increase over time. �In the coming years, the automatic discount on drugs in the donut hole will expand, and by 2020 the donut hole will be closed completely. And Medicare is growing stronger in other ways as well. Doctors and hospitals are beginning to receive new incentives to provide better care to patients �improving patient safety and lowering costs. �The new law also invests more resources in fighting Medicare fraud, to protect the trust fund, and keep Medicare secure for longer.

Thanks to the Affordable Care Act, seniors and people with disabilities are enjoying a Medicare program that is stronger and working better for David�s community and others all across the country.

Computing cluster speeds targeted treatments for childhood cancer

AUSTIN – Cloud-based research technology launched by Dell last year for the Translational Genomics Research Institute (TGen) is gearing up for what's billed as the world’s first precision medicine clinical trial for pediatric cancer.

James Coffin, vice president and general manager, Dell Healthcare and Life Sciences, says the eight-teraflop supercomputer, billed as the "kids cloud," will drastically reduce the time required to identify personalized treatments for children participating in the trial program – kids who have no time to spare. In turn, that acceleration can help open the trials up to participation from more children.

The Human Genome Project "took $3 billion and 10 years" to sequence the first genome, he points out. "A year ago, it took about nine months and cost about $400,000 or $500,000 to do a full genome."

And recently, says Coffin, "we just ran a test for a full genome for a patient, and got all the the results and made a clinical decision for the patient to the tumor board in less than five days."

Dell has "done a lot of work to retune the codes and make them run really fast on this platform," he says. "Just three months ago, the analysis of 25 million bases – there's usually about 500 or 600 million bases you have to do to kind of do this whole genome sequence – and 25 million bases took about 48 hours."

Now, that time is down to six hours.

"There's an inflection point in genomic science right now, where we have these new, next generation sequencers that are coming out over the last six months from companies like Illumina and Life Technologies, and then we have very very fact computing, and new processors coming out from Intel," says Coffin.

"I've been talking about personalized medicine for 13, 14 years, since before the human genome project happened, saying that this is the future of medicine," he adds. "It's here now."

Oncologists from the Neuroblastoma and Medulloblastoma Translational Research Consortium (NMTRC) and biomedical researchers from TGen will use Dell's computing and collaboration cloud to seek out and ID treatments for pediatric cancer patients based on the specific genetic vulnerabilities of each specific tumor.
 
First announced in November 2011, Dell’s team has completed the high performance computing cluster that will serve as the cloud’s computational foundation and basis for a private cloud, officials say. When equipped with Dell’s PowerEdge M420 server technology, TGen can analyze comprehensively a patient’s tumor RNA profile seven times faster than was previously possible. Time, of course, is a precious commodity for kids with cancer.

"With this particular population of children, with pediatric neuroblastoma, you've essentially got one shot," says Coffin.

With the dedicated computing cluster in place, Dell will begin to connect the biomedical researchers sequencing and analyzing patient tumors at TGen in Arizona with oncologists providing treatment to patients participating in the trial at 11 medical centers, officials note, adding that the new cloud will eliminate the need to express mail hard drives containing tumor and diagnostic images and genomic sequencing data between locations.

[See also: Slideshow: Advances in personalized medicine.]
 
With just one new treatment for pediatric cancer approved by the FDA since the 1980s – compared with 50 treatments approved for adult cancer in the same period – pediatric oncologists have often been forced to rely on adult-sized treatments, leading to some toxic side effects that are often as harmful to children as the cancer itself. More targeted treatments can aim right for the specific vulnerabilities of each child’s tumor, leaving healthy cells untouched.

"We're really making progress and figuring out what the cocktail is for them very quickly," says Coffin. "We're able to go full genome sequence on them and really get all the information we think we need. It's a very different game."

In the coming years, the hope it that this approach can not only be "a model for all cancer" but "a way to treat all disease," says Coffin. "Understanding the biological and genomic pathways of these things is the way you need to treat everything going forward."

He adds that "this is one of the reasons I'm so passionate about healthcare IT. This is the kind of thing health IT can do to change the world. I don't think health IT gets enough credit for what it does. This is a perfect example: you can't do this without health IT."

Health coverage for ex-prisoners: a quiet but important benefit of health reform

"If I'm trying to sell health reform, the smiling waitress with two kids, the laid-off steel worker, and the 7th grader with cancer work better on the campaign posters. Yet for many reasons � some obvious, some not � the health and well-being of ex-prisoners has a disproportionate impact on us all." - Harold Pollack

I began my public health career on a Yale postdoctoral fellowship. One of my formative experiences there was to accompany colleagues on the Community Health Care Van, a needle exchange-based mobile clinic for street drug users. I helped people complete basic paperwork.

A weathered middle-aged guy stepped onto the van. When I asked what brought him there, he pulled back his shirt to reveal a chalky-white oozing crater in his shoulder. That festering infection was my rude introduction to the life realities of injection drug users.

Most of these women and men suffered greatly. Most were uninsured. Facing complex illnesses, addiction, and severe life challenges, many nonetheless consumed enormous health system resources as they cycled through correctional facilities, became emergency department frequent-fliers, and required heavy use of other safety-net services.

We demonstrated that Community Health Care Van services reduced patients' emergency department use. We could have done more for these patients and their loved ones if we could have provided reliable primary care, appropriate drug treatment, and other services requiring insurance coverage.

This won't matter politically, but the Affordable Care Act will quietly improve public health by expanding coverage for hundreds of thousands of ex-prisoners and others under the control of the criminal justice system. Most of these men and women are on parole or probation. A nice Health Affairs paper by Alison Evans Cuellar and Jehanzeb Cheema runs the numbers. Roughly half of the 700,000 people released every year from correctional institutions will gain coverage or improved care under health reform.

Why we should care about ex-cons

Yeah I know. Ex-prisoners aren't the most cute and cuddly people who need insurance coverage. If I'm trying to sell health reform, the smiling waitress with two kids, the laid-off steel worker, and the 7th grader with cancer work better on the campaign posters. Yet for many reasons � some obvious, some not � the health and well-being of ex-prisoners has a disproportionate impact on us all.

For one thing, a large percentage of Americans with HIV/AIDS, tuberculosis, hepatitis C, and other infectious diseases pass through the gates of our jails and prisons every year. Engaging these men and women into care � and keeping them safe and healthy � yields huge public health benefits.

Many ex-prisoners suffer from severe mental illness. As states and localities implement punishing cuts to the medical safety net, frightening numbers of people have limited access to appropriate care, sometimes with tragic results.

There's suggestive evidence that ex-prisoners with health insurance may be less likely to continue prior drug use. They are also less likely to re-offend. Many ex-prisoners have serious drug problems. Absent insurance coverage, many find themselves on long waiting lists for treatment programs. Many women with drug problems require access to reproductive health services to avoid unintended pregnancies.

Nowhere to turn

Right now, many ex-offenders are ineligible for public insurance coverage. The panhandler at the train station with a heroin problem is simply poor. He isn't a vet. He isn't a mom. Addiction and substance abuse are not qualifying conditions for federal disability programs. If he has a history of violent or drug felonies, he may be barred from important aid programs. If he was enrolled in Medicaid prior to incarceration, he might well have been automatically disenrolled upon entry to jail or prison.

The Affordable Care Act improves this situation. Most important, poor people qualify for Medicaid even if they don't match the specific categories of various assistance programs. If your income falls below 133 percent of the federal poverty line, you are eligible. This is a boon for poor people. It is also a boon for mental health and drug treatment centers, and other safety-net providers. These facilities now have a reliable source of payment for their indigent patients. Many ex-prisoners will also benefit from affordability credits and protections provided under the new state health insurance exchanges.

Much practical work remains to be done. Many prisoners serve their time in relative health. They then disappear until they get rearrested or face some crisis that requires costly care. Many offenders lead chaotic lives. Some are homeless or have no fixed address. They aren't always fastidious if they are asked to return three times to the welfare office with different forms. Enrollment and retention procedures for both Medicaid and for the new exchanges must be carefully designed in light of these realities, to ensure that ex-prisoners are actually covered.

I'll bet less than one percent of the American public has thought about this difficult � often thankless � activity on behalf of an easily despised population. It's still important to protect public health and to relieve suffering. It's another reason to support health care reform.

Two new directors join Allscripts board

CHICAGO – Allscripts on Wedenesday, named two independent members to its board of directors. The board had been left decimated last month after its chairman Phil Pead was fired and three board members resigned in protest after a turbulent quarterly meeting.

Allscripts moved quickly to name a new board chairman – Dennis Chookaszian, a member of Allscripts' board since September 2010, formerly chairman and CEO of CNA Financial Corporation.

[See also: Web First: Q&A with Allscripts CEO Glen Tullman]

Now, Allscripts has named Paul M. Black, former chief operating officer of Cerner Corp., and Robert J. Cindrich, former senior vice president and chief legal officer for the University of Pittsburgh Medical Center (UPMC), as directors, effective immediately.  Black will serve on the board’s compensation committee and Cindrich will serve on the board’s audit committee. The Board is now set at seven directors.

"We are pleased to add two new independent directors of such a high caliber," said Chookaszian. "Paul and Robert bring an outstanding combination of operational, governance and healthcare industry experience, which make them excellent additions to our Board. We believe their contributions and insights will be invaluable as the Company executes on its plan to deliver value for our customers, drive long-term growth and build shareholder value."

"Allscripts has well-respected solutions, a broad and unique client base, and a compelling vision for an open, connected, community-based, individually coordinated level of care," said Black. "I’m optimistic about the market opportunity before us and looking forward to collaborating with the board and management to execute the company’s plan to enhance the client experience, improve healthcare outcomes and deliver value for customers, team members and shareholders."

[See also: Allscripts in skid mode as shares plunge, chairman ousted]

"Allscripts has an exciting opportunity to build on its leading position in the growing market for healthcare information technology," added Cindrich. "Having spent years with one of the largest and most respected integrated delivery networks in the world, I believe I can bring a unique client perspective to management and the board. I look forward to working with my fellow directors and drawing upon my experience to help the Board and management team implement the Company’s strategic plans."

Black currently serves as operating executive of Genstar Capital, LLC, a private equity firm, and as senior advisor at New Mountain Finance Corp., an investment management company. Prior to joining Genstar, Black spent more than 13 years with Cerner and retired as its chief operating officer in 2007 after helping build it into a $1.5 billion company. He also served as chief sales officer and is credited as instrumental in the company’s double-digit organic growth. Prior to Cerner, Black was with IBM from 1982 to 1994 in a number of senior sales and professional services leadership positions.

Black was most recently elected to the board of directors of Haemonetics Corporation, a global healthcare company dedicated to providing innovative blood management solutions. He also serves on the boards of Saepio, Inc., Truman Medical Centers, and Genstar portfolio company, Netsmart Technologies. He has served as a director with several New Mountain portfolio companies.

Prior to UPMC, Cindrich served as a judge of the United States District Court for the Western District of Pennsylvania for 10 years. Prior to that appointment, he was active as an attorney in both government and private practice. His government practice includes serving as chair of the Pennsylvania Legislative Reapportionment Commission, 1992-93; United States District Attorney, Western Pennsylvania District, 1978-81; and Assistant District Attorney, Allegheny County, 1970-72. While in private practice, he served as defense counsel in business and commercial litigation.

Cindrich currently serves as a director of Mylan Inc., a leading generics and specialty pharmaceutical company. 

Allscripts’ incumbent directors, including Black and Cindrich, will stand for re-election at the annual meeting of stockholders on June 15. Stockholders of record as of the close of business on April 24, 2012, will be entitled to vote. Information on all director nominees can be found in the company’s proxy statement, which has been filed with the Securities and Exchange Commission and will be mailed to all stockholders of record.

[See also: Allscripts: Debacle or silver lining?]

Abby-Care: Health Coverage for Young Adults Under 26

Born with a rare congenital disease, Abby Schanfield, a 20-year-old student at the University of Minnesota, tells us of many reasons why she cares so passionately about the Affordable Care Act, the new health care law. One particular reason she shared with us is the law�s requirement that young adults be allowed to remain on their parents� health plan until they turn 26. That one provision assures her that she�ll continue to get the care she needs, and that assurance relieves her of stress that could worsen her condition.

�That was one of the most important things in the law and one of the most powerful things for me in my life,� Abby says.

Abby was born with congenital toxoplasmosis, a parasitic disease that her mother didn�t realize she could pass to her unborn child. When she was 10 months old, Abby needed neurosurgery to install a shunt to drain spinal fluid that was collecting on her brain. She�s had to replace the shunt four times, and likely will continue to do so every couple of years. It�s a scary, expensive procedure that has a painful recovery.� When Abby was 17, she started to lose vision in her left eye, which has also required surgery and treatment to avoid losing her sight altogether in that eye.

As Abby tells it, she�s fortunate that her parents� plan and family assistance have made it possible for her to get excellent care. �There was a point before the Affordable Care Act was passed, I was very concerned about my future and whether I would be able to access care. � [With the health care law] I have a world available to me,� she says.

Like 2.5 million other young adults helped by the Affordable Care Act, Abby can continue to get the care she needs, including preventive services, because she can remain on her parents� health plan until she turns 26. Beginning in 2014, there will be other options as well: State-based Affordable Insurance Exchanges, new competitive marketplaces where many people will be able to purchase affordable coverage.� Additionally, the new health care law ends lifetime dollar limits on essential benefits and restricts annual dollar limits until they are phased out in 2014, which are particularly important policies to people like Abby with chronic diseases.

Families across the United States can rest easier knowing that, if necessary, their young adult children can stay on their health plans and that it will be illegal by 2014 for insurance companies to discriminate against them because of pre-existing conditions.

�You can�t guess what life will toss at you � and without health and stability, it�s so much more difficult to navigate life,� Abby says. �Even if you don�t have a health issue now like I do,� that�s uncertain. You can�t play a guessing game with life, and everybody deserves a chance at happiness and a healthy life.�

Consumer beefs with red meat put producers on defensive

ADAIR, Iowa�Veteran cattleman Dave Nichols has a recurring thought some mornings when he awakens.

"After hearing everything so bad about beef and livestock, I wonder why I'm such a bad guy," said the 72-year-old cattle producer. "Some days, I feel like a tobacco farmer."

Nichols represents the future and optimism of the cattle industry. This spring he oversaw the birth of 1,200 calves on his spread in Adair County, up about 200 from previous years, and has sold 400 bulls to other producers for seedstock.

Until a recent dip, cattle prices were at record highs. Beef exports hit record levels in 2011. Yet, cattle producers feel they're on the defensive in a public relations struggle.

The controversy over lean finely textured beef, derisively known as "pink slime," is a here-we-go-again battle in the defensive war the livestock industry has fought for four decades. The original hit to red meat began with scientific warnings about the connection between animal fats and heart disease in the 1960s, which became mainstream recommendations by cardiologists to reduce red meat consumption.

That's been followed by a barrage of blows, some more tied to personal beliefs and changing food preferences than scientific evidence. Cattle producers fear their industry could go the way of Big Tobacco, where warnings of health risk eventually shriveled sales. The average American eats 22 % less red meat (defined as beef, pork, lamb and veal) than 40 years ago.

The latest controversy was fed by social media, catching the industry by surprise. Meat packers have added the ammonia-treated beef scraps to ground beef for two decades, with few known problems.

The uproar caused the closing of Beef Products Inc. plants in Waterloo, Iowa, and two other locations in Kansas and Texas, putting 660 people out of work.

A beef processor went into bankruptcy last week, citing lost demand for beef trimmings. On the Chicago Board of Trade, cattle futures prices dropped 8 % from early March.

"And to think that a big reason the trimmings are put into the ground beef is to make it more affordable to middle- and lower-income people to feed their families," said Nichols, who has sold his cattle to 22 different nations around the world.

Factors lead to falling demand

Iowa Gov. Terry Branstad has called for Congress to investigate the "smear campaign" behind the latest controversy. Yet, the domestic decline in beef eating �and the larger consumer concerns over industrialized agriculture � has been growing for years. Were it not for the booming export markets, cattle producers would face shrinking demand.

The forces against beef have included:

� A push toward more whole-grain and vegetable diets beginning in the 1970s. Schools and consumers are embracing "Meatless Mondays" as part of a trend toward healthful eating.

� Criticism from the environmental movement unhappy about the large amounts of nitrogen and pesticides needed for production of corn livestock feed.

� A more powerful animal rights movement, which has used undercover videos to portray livestock producers as abusers of farm animals.

Reaction to 'pink slime'ALDI: No longer selling.BURGER KING: Quit using in December.COSTCO: No longer selling.DAHL�S FOODS: Say the store has never carried the product.FAREWAY: Says it has never used.HY-VEE: Announced they would cease carrying the trimmings, but then reversed itself and will carry the product, with signs labeling it �lean finely textured beef.�MCDONALD�S: Quit using in December. RED ROBIN: Says it has never used.TACO BELL: Quit using in December.TARGET: No longer selling.WAL-MART STORES INC.: The company said its Walmart and Sam�s Club stores will begin selling meat that doesn�t contain the trimmings. It did not say it would stop selling beef with the filler altogether.WENDY�S: Says it has never used.

Wayne Pacelle, president of the Humane Society of the United States, took his agency from its traditional role as protector of the nation's dogs and cats into a political activist organization that has pushed, with partial success, voter referenda against animal confinements.

Cattle producers who can live with claims that red meat is unhealthy climb the walls over the animal cruelty accusations.

"We treat our cattle better than pets," said Vince Graham, a cattle producer. "If necessary, we get up at 2 a.m. to get out and tend to cattle. During calving we hardly sleep."

Another producer, Faye Binning, asserts that cattle producers are on the right side of the conservation story. "We hear that Iowa needs more grasslands," she said. "Who plants most of the grass? It's the cattle producers, because we need it."

Yet, the health concerns over beef eating have been harder to fight. Cattle producers like Nichols remember warily how a sharp decline in cigarette smoking in the last half-century was prompted by package warnings, then a ban on television advertising.

Ulka Agarwal, chief medical officer for the Physicians Committee for Responsible Medicine, said of the red meat industry, "the evidence is stacked against them, that red and processed meat are dangerous."

The Physicians Committee in recent years has put up an in-your-face billboard in Des Moines proclaiming a link between rectal cancer and eating bacon.

All the medical, diet and cultural trends have had an effect.

Cattle producers in Iowa and the rest of the U.S. have gotten the message about reduced demand. The USDA put the total U.S. cattle inventory in January as 90.8 million head, 2 % below a year earlier and the lowest inventory of all cattle and calves since the 88.1 million on hand in 1952.

The smaller number of animals means fewer packinghouse jobs. Even before the issue exploded last month, Iowa learned of the probable closing of the original Iowa Beef Processors plant at Denison. The closing will cost 400 workers their jobs.

Changing menus, shifting tastes

However, beef is still a symbol of power and success.

"I don't hear people say they want to go out and celebrate good fortune by eating a salad," said John Lawrence, longtime head of the Iowa State University Beef Institute and now head of ISU's Extension Service.

Yet, Lawrence and Iowa Secretary of Agriculture Bill Northey acknowledge that red meat consumption is down, partly as a function of reduced production, but also in changing eating habits.

While Branstad has protested against Hollywood and the media on several occasions during the latest dispute, Northey points to a more basic reason why anti-meat sentiment seeps into popular thinking.

"We're less connected to the sources of our food today," Northey said. "Even in Iowa most people are a generation or two removed from the land. Fifty years ago everybody knew where beef and pork came from. Today they don't, and when you show a video of meat processing on network TV or on the Internet, it can disturb people."

What's ahead

The beef industry doesn't see demand rebounding. Supplies are expected to remain static in the foreseeable future, and processors continue to contract. Where a sow hog can produce up to 20 piglets a year, cattle reproduction is much slower.

A calf born this spring won't be ready to give birth until summer 2013, and the nine-month gestation period would bring the new animal into the world in 2014.

Prices will stay relatively high. U.S. cattle prices increased 25 % last year, driven primarily by a 30%increase in beef exports.

The beef industry is putting its hopes on newer and different cuts of beef that will reflect different consumer tastes.

David Dahlquist of Des Moines, a nationally recognized public artist and teacher, says the "foodie" movement among chic urbanites might bring about a new impetus for beef.

"I know a lot of foodies, and they like beef," Dahlquist said. "Most of them aren't vegetarians. They like beef. They just want it in different cuts."

Meanwhile, cattle producers plan to focus on doing what they do best.

"What a great spring we had, with the warm weather," Nichols said, exhilarated by the new births. "Best spring for calving I can remember."

International interest grows

While Americans' taste for beef has hit a plateau, foreign countries are buying more U.S. beef than ever before. In 2011 exports of red meat species hit a record $11.5 billion after increases of 30% for beef and 17% for pork.

The demand hasn't cooled. Since January 1 red meat exports are up 2% from a year ago.

"Developing countries want more protein, and they associate red meat with economic progress and higher living standards," said Iowa Secretary of Agriculture Bill Northey.

The USDA's latest weekly export report for the week ending last Thursday showed the biggest customers for American beef since Jan. 1 are Mexico (37,000 metric tons), South Korea (32,000 metric tons), Japan (27,600 metric tons), Canada (22,200 metric tons) Vietnam (21,700 metric tons) and the former Soviet Union, 11,400 metric tons).

Report: U.S., peers must cooperate on import safety

WASHINGTON�Food and drug regulators in the U.S., Europe and other developed countries should offer training, technology and expertise to developing nations in Asia, Latin America and other regions to better assure the safety of imported products, states a new report.

An expert panel assembled by the Institute of Medicine recommends the U.S. Food and Drug Administration work with counterparts throughout the world to assure supply chains for imported food and drugs, which increasingly cross borders. More than 80 percent of pharmaceutical ingredients are imported from abroad, as well as 85 percent of the seafood consumed in the U.S., according to federal figures.

"The integrated global economy demands cooperation across borders � to thwart terrorists, reduce environmental hazards, and ensure that our food and medical products are safe and effective," states the 300-page report released Wednesday.

The report comes amid an ongoing FDA investigation into counterfeit vials of a popular cancer drug sold to U.S. doctors in California and other states. European regulators have traced the counterfeit product through distributors in Denmark, Switzerland and the Middle East. Previous import safety scares have involved contaminated seafood, pet food and blood thinning drugs from China.

The 12-member panel of experts recommends the U.S. and its "technologically advanced counterparts" in Europe, Canada and Japan share inspection duties for facilities in developing countries.

"There is no need for American and European inspectors to examine the same facilities, especially when a vast number of facilities go uninspected," the committee said.

The FDA has taken steps to boost inspections of foreign facilities in recent years, while acknowledging it will be impossible to visit every source of imported goods. The agency is responsible for imports from more than 300,000 foreign facilities in 150 different countries. A 2010 report by the Government Accountability Office reported that FDA inspected fewer than 11 percent of the plants on its own list of high-priority sites.

The Institute of Medicine is a nonpolitical group of experts that advises the federal government on medical issues. Its recommendations often make their way into laws drafted by Congress and policies implemented by federal agencies. The new report was requested by the Food and Drug Administration.

Doctors Group Tells Patients To Go For Cheaper, High-Value Treatments

Enlarge iStockphoto.com

Got a backache? You can probably skip that pricey scan.

iStockphoto.com

Got a backache? You can probably skip that pricey scan.

The American College of Physicians is urging patients with newly diagnosed diabetes and back pain not to opt for the latest-and-supposedly-greatest.

It's part of a new campaign to steer patients (and their doctors) to what the College of Physicians calls "high value care," and away from expensive tests and treatments that aren't any better � and often are worse.

That may seem like common sense. But it's a departure, and maybe a surprise, to hear a mainline physician group name names when it comes to drugs that shouldn't be first choices � and even steer patients to non-physician competitors.

Instead of highly touted diabetes brands such as Actos, Januvia and Avandia, the physicians' group says, patients with type 2 diabetes should start out on a tried-and-true generic.

"The best first choice usually isn't one of the newer, heavily advertised" drugs, says a new brochure put out by the College in cooperation with Consumer Reports magazine. "It's metformin, a drug that has been around for nearly two decades."

 

"A month's supply of generic metformin typically costs only about $14 compared with about $230 to $370 for Actos and about $265 for Januvia," the brochure points out.

Metformin "lowers blood sugar levels more than newer drugs do," the brochure says. It also reduces "bad cholesterol," while newer drugs don't, and sometimes even raise it.

When it comes to back pain, it's usually not a good idea to get an x-ray, CT scan or MRI, says another new pamphlet that carries the College of Physicians brand.

"If you don't feel better after four weeks or so, it might be worth talking to your doctor about other options," back pain sufferers are advised. Maybe they should see a chiropractor or an acupuncturist, the brochure says.

Steven Weinberger, CEO of the American College of Physicians, says many patients come into doctors' offices with the expectation they're going to get a high-tech imaging study to diagnose their back pain.

"Their neighbor might say, 'When I had back pain I had an MRI, so maybe you didn't get the best care,' " Weinberger told Shots. "We're saying the reflex reaction doesn't represent the best care."

The group plans to put out a series of other pull-no-punches pieces of advice on common conditions.

"In these days of crisis in health care costs," he says, "the medical profession should take its ethical and professional responsibility to do what we can to reduce costs while not compromising care."

Weinberger says that doing the right thing make take courage, "because physicians have financial incentives" to prescribe less cost-effective care, and so do hospitals. So, of course, do pharmaceutical companies.

But Sethu Reddy, the U.S. medical director of Merck, maker of the diabetes drug Januvia, idn't sound too threatened.

"Cost is one factor," Reddy told Shots. "But there are four or five other factors that the doctor has to weigh in. He can't just automatically say that this is the automatic option for every new patient."

Reddy pointed out that, on the very day the physicians' group urged newly diagnosed type 2 diabetics who need drugs to start with metformin, US and European diabetes specialists issued new guidelinesthat are less prescriptive.

"More than any other previously reported guidelines," notes diabetes expert William Cefalu, the new position statement "emphasizes that one size clearly does not fit all."

7 types of security features for your tablet

With the release of the "new" iPad, an increased focus has been placed on how to protect sensitive information. And although there are a myriad of basic ways to safeguard your device, certain security features have become necessary to take tablet protection one step further.

"Clearly, healthcare is a vertical that is more concerned, or needs to be more concerned, about security, more so than any other vertical because of the personal info they're dealing with," said John Bischof, executive director of sales operations for Lenovo Americas. 

And with tablets in particular, Bischof continued, there's a number of added security concerns users need to be aware of. "When you look at PCs, they've had years and years to see and react to security issues – mainly hackers and people who try to break into the operating systems. When you look at tablets, because of their mobility, the bigger concern isn't just that, but also the loss of the lack of control of data that the IT center has … as tablets explode across the world in terms of the volume, that's becoming a big place for hackers to break into." 

Bischof outlines seven types of security features all tablet owners should consider employing. 

1.Encryption. Consider encrypting the data stored on USB devices, Bischof suggested, and also the data found on SD cards. "Being able to encrypt those things is critical, because if someone were to steal or plug their own SD card into a device they come across, by encrypting the data, you prevent them from getting anything useable." This can also come in handy for an employee using an SD card for his/her own convenience. "If someone comes across it and the data is encrypted, it's not usable by anyone outside of the company."

2.Remote wipes. Using specific types of software, the IT department can have the power to remote wipe a lost device. "So if someone comes in and they say, 'Oh I was at the airport and someone stole by device,' the IT center can go in remotely and activate the wipe," said Bischof. "Then the data is destroyed."

[See also: Tablet PC's fate?.]

3.Data leakage protection. This includes disabling USB ports, SD card slots, device cameras and the microphone, if you choose to do so. It's a critical function, Bischof said, and isn't something the IT department has to do on their own. By employing a partner, devices can arrive at an organization and be given to employees with limited functionality. "You don’t have to make the IT department go in and configure each device," he said. "But sometimes, [an organization] doesn't want [tablets] to have that capability." You will lose a bit of your tablet's efficiency, Bischof said, yet, more and more organizations are opting for this feature. "The beauty of it is, they have options available. There are many different paths they can take to protect themselves, and that's one some do take."

4.Storing data on a desktop. If an organization does chose to disable USB ports and SD card slots, Bischof recommended considering apps that allow you to store data remotely on a desktop. "You don't have to hardwire it; you can store the data on a desktop by using [the app's] functionality." And as a result, you don't lose functionality because of disabled ports. "You don't lose the ability to have the efficiency of that mobility and data exchange," he said. "The data is now on a desktop in the office."

5.Customizable app stores. "That's a big thing," said Bischof. "One of the big problems of the Andriod operating system is anyone can go in and take an app and put it out there, and it can be a malware app." By making a customizable app store, he said, you can limit what people come across in terms of apps. "They're limited in what they can download and it's not wide open," he said. "You bring the control back to the IT center." He added if you're comfortable with one app store, like Amazon, you could limit users to that one store as well. 

[See also: iPad 2 looks even better for doctors.]

6.Perimeter settings. Through specific programs, organizations have the ability to disable ports once a tablet leaves a set perimeter. "So that's something that's pretty nifty," Bischof said. "Again, it's giving the IT center that control. People can't walk out the door and who whatever they want to do. It's key."

7.Auto-lock and auto-erase functions. Bischof went "back to the basics," and suggested all users take advantage of the auto-lock and auto-erase functions. "Those all have to be utilized within the framework of the function," he said. It's possible, he added, to give the IT department the power to manage the passwords, "so employees have to utilize the IT center password and not their own to configure the device. ... That's one more everyone should be aware of. It's basic, but it's critical."

Follow Michelle McNickle on Twitter, @Michelle_writes

Helping More Medical Students Repay their Loans

Thousands of primary care providers have a passion for helping those in need, and the National Health Service Corps Loan Repayment Program, strengthened by the Affordable Care Act, helps doctors, nurses, dentists and other health care providers do just that.

Today marks the opening of the 2012 application cycle for the National Health Service Corps Loan Repayment Program. Primary care medical, dental, and mental/behavioral health clinicians are able to pay down their educational debt, and earn a competitive salary, while providing comprehensive care in underserved communities.

Access to primary care services remains a major challenge in the United States.� About one in five people (21 percent) live in a primary care shortage area. This often means that entire families � from infants to grandparents � must travel far distances to receive care, can�t find a provider, or they simply go without.

With more than 10,000 clinicians working at one of 17,000 National Health Service Corps-approved health care sites in urban and rural communities, the program helps train Americans who work in organizations that provide primary care services to approximately 10 million people � regardless of where they live or their ability to pay. From Oakland, California to Altamont, Tennessee to Glassboro, New Jersey, Corps members make an impact in their communities for the long-term.

Dr. Katherine Culp says the National Health Service Corps provided her exactly what she was looking for � an opportunity to be debt free, stay in her state and be close to family. Dr. Culp is a dentist who has remained at her NHSC site for the past 8 years and has risen to the position of Dental Director. �I got here and saw how we provide access to so many people, especially children and that it is a perfect match for me.�

Since 1972, the National Health Service Corps has supported some 40,000 primary care providers as they�ve worked in communities with limited access to care.� Many changes have happened over the years, but the central goal of the Corps has remained the same: to connect dedicated primary care providers with the communities that need them most.

For more information about the NHSC and the Loan Repayment Program, please visit NHSC.hrsa.gov.

Wyoming hospital takes leap to the cloud for email

CASPER, WY – Wyoming Medical Center (WMC), a 100-year-old hospital in Casper, Wyo., has dumped its frustratingly limited in-house legacy email system for Google’s cloud-based system. WMC officials say the new Google system has saved the hospital money and trouble, and they don’t have concerns about privacy.

Last August, the 207-bed WMC completed the transition of its entire organization from Novell Groupwise to Google Apps – Google’s email system for businesses and organizations, says Tom Schoenig, the CIO at WMC. The hospital was one of the first three healthcare systems and the first hospital in the country to adopt Google Apps for its email. The decision came after a number of years with constant server breakdowns during the middle of the night and too little email capacity for providers, he says. In addition, Web access to the in-house server was touchy.

[See also: Google Health shutdown spurs debate over PHR viability.]

“With the Novell system, even with upgrades, our Web piece was unstable at best,” says Rob Pettigrew, WMC’s network manager. “It was the thorn in our side.  We couldn’t figure out why it kept crashing.”

Pettigrew said it was a running joke in the hospital’s tech department: “Why don’t we just get Google to handle this email?” So one day, out of sheer frustration, they called Google. And it turns out, Google could do just that.

“Once we made the decision it would be best to switch to Google Apps, all of us had to convince our administration, he says. "It wasn’t a straight apples to apples comparison on cost, because the Novell system and Google Apps can’t compare. The real savings came in the enormity of the email space Google could give us. Groupwise gave us 200 MB of space per user. Users at the hospital were constantly complaining that their mailboxes were full.

Google gave us 25 GB per user. “We couldn’t give that to our users with hundreds of thousands of in-house servers,” says Pettigrew.

Of course, the hospital administration was concerned with security on the Google cloud system, Pettigrew says, but "we explained to them. A four-man hospital IT team can’t beat what an entire company like Google can do on security. Google handles safety and is always concerned and always upgrading its safety measures. This all happens in the background."

The hospital hired an Atlanta-based company called Cloud Sherpas to help transition to Google email, making it seamless and painless, according to Pettigrew. Cloud Sherpas is Google’s top implementation partner.

“One of our biggest fears was of migrating the system from Novell to Google,” Pettigrew said. “Clinicians don’t like a lot of change. It’s intimidating to them and intimidating to us. The best thing Google did for us was introduce us to Cloud Sherpas. Their plan was rock solid, if we deviated we would have run into trouble, but we had a very successful conversion. We did a lot of training and had a fairly large beta group. We went overboard on the training. But, we were paid off with a surprisingly quiet day of conversion. It was  smooth and we haven’t looked back since."

Google Apps allowed the hospital to keep its own domain name and run its own system, but Google provides all the service on the backside, Pettigrew explains. “All we worry about now is training users on the new system.”

Pettigrew says the IT team at WMC is fielding calls from other hospitals, wanting to know what they think about the Google Apps program.

Schoenig said Google security policies and procedures keep the email safe. “At the end of the day, the email resides with Google, under Google’s infrastructure, protocol and within the safety of its data centers.”

Follow Diana Manos on Twitter @DManos_IT_News.

5 keys to IT and the physician-patient relationship

As the concept of patient-centered care continues to evolve, a key to its success is the relationship between physician and patient. But factor in all the technologies springing up left and right, and finding the perfect balance between patient engagement and new IT initiatives can be tricky.

"Focusing specifically on the physician-patient relationship – it's behind the rest of the world," said Steve Wigginton, CEO of Medley Health, a medical practice marketing and communication services company. "But there are a lot of benefits to be had. More information is readily available to physicians as a result of IT, and therefore, it's easier for them to keep track of what's going on with their patients."

"IT has, in some ways, made it possible for patients to be more self-serviced around transactional types of interchanges with their doctor," Wigginton continued. This includes "scheduling appointments, reviewing bills, etc. Those are just some of the main ways we're seeing IT have an impact so far."

Wigginton breaks down five keys to understanding IT and the patient-physician relationship.

1. Patient-centered IT initiatives hold multiple benefits for the physician. Small physician practices in particular, Wigginton said, need to adopt the same features as their competitors. And, it's important to note their competitors are no longer just their fellow physician practices down the street. "As Walmart and Walgreens and CVS expand into transactional, low-cost primary care, there's a competitive pressure to be able to add these features," Wigginton said.  And although a competitive edge is important, he said maintaining closer and more convenient relationships with patients has incredible value. "Your inability to communicate with them in modern terms is a big hindrance," he said. "My financial planner, my physician trainer – all the people in my life who are important to me, I can communicate with through email and other channels. It makes it easier to achieve the best health outcomes when a physician practice adopts this."

2. Challenges exist when it comes to reimbursement models. The disconnect between physician practices and IT initiatives almost always involves the business model, Wigginton said, and the value of the technology. "There are some challenges that aren't widely addressed but are brought to light by both physicians and patients with the advances in IT," he said. The biggest of which is the advancements in IT – emailing, texting and video conferencing – coming without payment. "There's no good reimbursement model, and most of those reimbursement models are rooted in the traditional office visit," Wigginton said. "So it puts pressure on the physician to do more for less – not the same, but less. It's a double whammy because there's a higher service load on the physician and higher expectations from the patients, given these tools. There are only a few instances where the business models align."

[See also: New report addresses HIE sustainability.]

3. Patient-centered IT practices continue to vary.  While larger-volume practices are using email and patient portals to optimize patient input, lower-volume, more patient-centric practices are using email, text, video and mobile apps, said Wigginton. "They're doing it to create more of an impact across a broader spectrum of their patients' health; they're helping them manage it not only when they're sick, but also interactive wellness programs." The most important part of employing these technologies, he continued, is to find what works best for the patient. "If I'm a texter, I'll text, if email is my thing, I'll do that, and if I want to come to your office, I can," said Wigginton. "I want my physician to be highly knowledgeable about me and communicate with me and have a relationship with me." 

Continued on the next page.

Korean hospital system builds country's first integrated hospital infrastructure

IBM announced that the Soon Chun Hyang University Hospital will use the company’s hardware and software solution to build South Korea’s first integrated hospital infrastructure.

The solution is designed to enable the hospital to gain insight from increasing volumes of patient data and easily provide it to doctors, nurses, laboratories and payers, officials say. The hospital expects to improve patient care by determining and administering the most appropriate treatments quickly and efficiently.

Soon Chun Hyang University Hospital operates 2,890 beds in four locations, including Seoul, Bucheon, ChunAn and Kumi.

Two years ago, the hospital launched an EMR project aimed at enhancing the use of patient data and reducing fragmentation of medical information.

IBM Korea was chosen to implement the project, which created a workload-optimized system that supports doctors in the hospital’s four locations, enabling them to work collaboratively to improve patient care and accountability.

“We wanted to provide a powerful platform that made it easier to develop and integrate tools supporting physicians’ decision-making processes,” said Yoon Soo Keun, managing director at Donegun Information Technology (IT subsidiary of Soon Chun Hyang University Hospital).

IBM is delivering a full range of technologies for processing, storage and virtualization. Officials say the new infrastructure will be capable of handling more than 100 TB of data – the approximate equivalent of more than 650 billion photos on Facebook. The hospital will use the new infrastructure to host an integrated medical information system that establishes a single EMR system with a single database.

The technology will also enable a platform that can facilitate data-sharing between the hospital’s locations.

“Going forward with Korea’s first integrated hospital infrastructure system, Soon Chun Hyang University Hospital will pave the way towards smarter healthcare, elevating patient convenience and satisfaction, while delivering better economics,” said Lee Jang Suk, director of IBM Korea.

Melanoma cases rising; young women at greatest risk

Planning to head to a tanning salon to beef up your bronze looks for prom and graduation or to get a head start on beach season? Young people might want to reconsider.

A dramatic rise in skin cancer rates among young adults is leading health officials to shed light on the risk factors, specifically tanning salons, which women are more likely to use.

Women under 40 are hit hardest by the escalating incidence of melanoma, according to a Mayo Clinic study published in the April issue of Mayo Clinic Proceedings, out today.

Researchers examined records from a decades-long database of all patient care in Olmsted County, Minn., and looked for first-time diagnoses of melanoma in patients 18-39 from 1970 to 2009. Melanoma cases increased eightfold among women in that time and fourfold for men, the authors say.

"We need to get away from the idea that skin cancer is an older person's disease,'' says report co-author Jerry Brewer, a dermatologist at the Mayo Clinic in Rochester, Minn.

The findings might be explained by gender-specific behaviors addressed in other studies, the authors wrote. "Young women are more likely than young men to participate in activities that increase risk for melanoma, including voluntary exposure to artificial sunlamps."

The study is the latest evidence of a steady rise in skin cancer. A major government study published Wednesday reported that while new cases of many of the most common cancers are declining, melanoma cases are increasing.

"We're very concerned about the melanoma rates and the damage done by early exposure to sun, but also the increasing use of tanning beds," says physician Marcus Plescia, director of the division of cancer prevention for the Centers for Disease Control and Prevention.

Tanning industry disagrees

The Indoor Tanning Association defends tanning lamps. "There is no consensus among researchers regarding the relationship between melanoma skin cancer and UV exposure either from the sun or a sunbed," says executive director John Overstreet. "I expect more from the Mayo Clinic. There is no direct link from their report to tanning beds."

Yet, according to the National Institutes of Health, excess exposure to ultraviolet light increases risk for all skin cancers. UV light is invisible radiation that can damage DNA in the skin and can be generated by the sun, sunlamps and tanning beds.

Skin cancer most often occurs in people 50 and older. Melanoma is the most serious type and is potentially deadly. Symptoms include changes in an existing mole or development of an unusual growth on your skin, according to the Mayo Clinic. People with fair skin are at higher risk. The authors noted that the population of Olmsted County is mostly white.

The 'Jersey Shore' effect

Fair skin has less pigment to protect the body from UV radiation. Other risk factors: one or more severe sunburns as a child, an unusual number of moles, a family history of melanoma � and exposure to UV light.

The possibility of skin cancer might seem remote to young people. "I think (TV) shows like Jersey Shore portray healthy people as someone who has a great tan,'' says Laura Hopwood, 22, who was diagnosed with melanoma a year ago. "Somehow you're not attractive unless you're deeply tanned. Before I developed melanoma, a friend scolded me about not using sunscreen."

Hopwood, who works at Barnard College in New York, says she did not do enough to protect herself from sun damage but has never used a tanning bed. Her parents have not had melanoma. A surgeon made an incision from below her left eye to nearly her chin to remove damaged skin. Now she gets routine skin checkups every six months.

"The people most affected are not just Baby Boomers but actually young adults," says Hopwood's dermatologist, Kavita Mariwalla, director of dermatological surgery at Beth Israel Medical Center in New York. "Tanning before prom or big events has become a 'norm' for many teenagers. What they don't know is that each time they visit a tanning booth, their risk of skin cancer rises."

Providing a platform for learning

With physician adoption of electronic medical records still woefully low, some healthcare technology vendors are looking to the next generation of doctors.

Practice Fusion, a San Francisco-based provider of free EMR technology for physicians, has launched the Academic Program, a modified version of its EMR software designed for universities, students and residents.

“I don’t think those guys are coming out of the gate with any software experience right now,” says Ryan Howard, Practice Fusion’s chairman and CEO, whose software is now being used by the University of West Florida. “This gives us the ability to get in on the ground floor.”

Spring Medical Systems, a Houston-based developer of SpringCharts EHR and SpringCharts Essentials, is working with McGraw Hill to have its technology included in educational textbooks. According to CEO Jack Smyth, medical schools that purchase these textbooks also gain the right to download training versions of SpringCharts for educational use.

“We’re finding that doctors are still leery of EMRs,” says Smyth, pointing out that the typical journey for a physician these days is to come out of school and join a hospital or large physician organization that still depends on paper-based solutions. “A lot of them coming out of school now at least have e-mail addresses and are computer-literate, but (EMR adoption) is not going to be as fast as people think it should be.”

Employees give thumbs up to on-screen info

WASHINGTON - A recent internal survey conducted by George Washington University Hospital shows employee satisfaction with hospital communication is up by 33 percent, thanks in part to new methods of communicating.Those new methods are based on Netpresenter software and include a mix of interactive PC screensavers, digital signage and emergency alerts.The technology makes it possible for the hospital to inform and motivate staff, update visitors and patients and warn everyone of emergencies with a single system.Messages are now targeted to the audience or monitor location. The latest hospital and healthcare news is broadcast on all 1,200 personal computer workstations and on large monitors in the staff elevator bays. Targeted messages are also published on big screens in the visitor elevator bays, main lobby and physician lounges.

Girl with deformed face learns to navigate the world

WINNETKA, Ill.�What if you knew, even before your child was born, that she wouldn't look like everyone else?

Clara Beatty's parents knew.

They were living in Belgium at the time, a decade ago. Prenatal screening was extensive, probably more than would have been done in the United States.

Those tests determined that baby Clara, their third child, was likely to be a perfectly normal kid inside. But even in the womb, doctors could see severe facial deformities � droopy eyes, under-developed cheekbones and a tiny jaw. It meant she'd need a tube in her neck to help her breathe after birth. The lack of an outer ear and restricted ear canals also would mean she'd have hearing aids by the time she was 6 months old.

In Belgium, it was unusual for babies to be born with Treacher Collins syndrome, caused by a genetic mutation. Parents almost always opted to abort, doctors said.

But the Beattys wouldn't hear of it. It wasn't any big moral statement, they say.

"There was just no question," Janet Beatty says. No wavering, despite the looks of disapproval from the medical staff before she was born and even after, in the intensive care unit.

"It was kind of strange sometimes . with the doctors, some of whom I think really, really questioned why we had this baby," says Eric Beatty, Clara's dad.

The next few years would be so challenging that the family moved back to the United States, both for family support and to seek medical care at Chicago's Children's Memorial Hospital and other institutions. There were breathing and feeding issues. The family had 24-hour nursing care for the first three years of Clara's life because she vomited so frequently.

They were lucky, they realized, to have that kind of help.

Still, it took a toll on Clara's parents, especially her mom. Janet Beatty just wanted her daughter to be OK physically, to not be constantly worried that she might stop breathing, or choke. She wanted her daughter to have the happy childhood that her other two children had had � free from the physical challenges and, yes, free from the constant stares of strangers when they were out in public.

"Make her normal," her mother, Janet Beatty, thought privately. "I want that normal kid. I didn't want people to stare, and I didn't want people running away from her."

Cosmetic surgery was an option. But on a child so young, it would have to be redone, over and over. It was better, doctors said, to wait until her teen years.

And as her parents discovered, Clara was quite able to cope, sometimes better than they. Even today, Janet Beatty is astounded at how well her youngest daughter navigates the world.

"Even when she was little, you could look at her and people would say there's an old soul in there," she says. "She just had these big eyes and you could see her taking everything in."

Certainly, there are times when Clara gets frustrated.

Now 9 years old and finishing the fourth grade, she looks forward to the day a few years from now when her skull will have grown enough for cosmetic surgery. It won't "fix" things, but likely will help her blend more � and possibly help her get rid of the breathing tube.

"I want to try to make myself as much like the other kids, so that I can stop having everyone asking me questions," Clara says, "because it gets so annoying."

She says it matter-of-factly � not like she's hurt or damaged by the questions and comments.

When people stare, she says, she just "smiles and says 'hi,'" because that's what her parents have taught her to do.

It's easiest, of course, when she's in her "protective bubble," as her mom calls it � at home or school or church. There, people know her. To them, she is just Clara � the funny, kind girl who wants to be a doctor when she grows up, who's quick to help classmates with homework when she finishes her own.

She also volunteers as a mentor at the Special Gifts Theatre, an acting troupe for children with special needs. One cognitively impaired girl needed help with her lines.

"It's fun," Clara says, "to help someone and give them a better chance at life."

People often assume that Clara can't speak or understand them. Her classmates at school, however, are perplexed that a reporter would be doing a story about her.

"Why?" one asks.

"Because Clara is awesome!" another quickly replies.

The support is heartening, her parents say. This is what they hoped for their daughter, that she would be accepted, well-adjusted and confident � though they also know that she has many challenges.

When she goes to middle school next year, there will be new people to meet, new adjustments. Same with high school, college, dating.

Doctors have told her parents that Clara is more likely to worry about her appearance when she reaches adolescence. "Those are hard things to think about in a world where your physical presence, the way you look, is so much a part of society and how people react," says Eric Beatty, vice president of a manufacturing company.

"But as any parent will know, you just get on with life."

Clara � the girl with big, brown eyes and an easy smile � has helped them truly learn how to do that.

"We're all learning that we're just going to do what we're going to do, and we're not going to pay attention to what other people think," Janet Beatty says.

Still, the urge to protect will always be there.

"I just don't want her spirit to ever be crushed so much that she can't recover," she adds. "That's why it's good that she has the thick skin. I just want to keep it thick.

"She needs it."

���

Online:

More on Treacher Collins syndrome: http://ghr.nlm.nih.gov/condition/treacher-collins-syndrome

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Martha Irvine is an AP national writer. She can be reached at mirvine(at)ap.org or at http://twitter.com/irvineap

Making Progress to Close the Gaps in AAPI Health Care

Each May during Asian American and Pacific Islander (AAPI) Heritage Month, we celebrate the remarkable contributions and accomplishments of the AAPI community to the fabric of our nation. As a Korean American son of immigrants, I am all too familiar with the barriers AAPIs face in accessing health care for reasons such as poverty, lack of insurance, language barriers and other challenges.�

But, as the Assistant Secretary for Health, I am particularly pleased to see the progress we have made in closing the gaps in AAPI health care, and am honored to oversee efforts that can address the ongoing health disparities that continue to exist within our vibrant community.�

The good news is that the President�s health care law -- the Affordable Care Act � provides us with the opportunity to increase access to care, and vastly improve health outcomes for AAPIs. According to an HHS Research Brief released today, an estimated two million AAPIs will be eligible for insurance coverage by 2016 under the new health care law. �

Already, the Affordable Care Act has expanded access to free preventive services. The law requires insurers to cover preventive care so families do not have to pay out-of-pocket costs for services such as well-child visits, flu shots or blood pressure screenings. In 2011, private insurers improved coverage for mammograms, other cancer screenings, and other preventive services to 2.7 million AAPIs.� And, to date, 867,000 elderly and disabled AAPIs with Medicare have used free preventive services, including an annual wellness visit with their doctor.

As the law continues to be implemented, uninsured AAPIs will gain access to affordable health care insurance through new Affordable Insurance Exchanges or expanded Medicaid coverage. And AAPIs suffering from chronic diseases, including an estimated 891,000 with diabetes, will have access to promising new health care innovations to improve the management of these conditions. �

Today, as we kick off Asian American and Pacific Islander Heritage Month, let us celebrate the critical progress we are making toward achieving our collective goal of reducing � and eventually eliminating � health care disparities. We are all committed to improving the health and well-being of all Americans, including our family and friends in the AAPI community.

To learn more about the impact of the Affordable Care Act on the health of Asian Americans and Pacific Islanders read the issue brief and fact sheet .

UK trust kicks off largest hospital-based e-prescribing project

Birmingham's Heart of England NHS Foundation Trust has launched a full implementation of e-prescribing and drug administration across three acute care sites. JAC's E-Prescribing and Medicines Administration (EPMA) system has been selected for the project, expected to be the largest of its kind in the UK.

The roll-out of hospital EPMA will provide advanced functionality and reporting tools for managing inpatient and TTO (to-take-out) medicines to several thousand front-line clinicians and cover over 1,800 beds across all the wards and theatres at Heartlands, Solihull and Good Hope Hospitals, a press release stated.

The implementation is being given a high priority and is due to be completely rolled out by July 2009 - 14 months after the implementation team was expanded in preparation for the full roll-out. A dedicated team of pharmacy and nursing staff is in place to manage the process across the trust.

The EPMA system is also fully integrated with the trust's Pharmacy Management system.?Niall Poole, electronic prescribing project manager at the trust, said, "Integrating the EPMA system provides a comprehensive medicines management solution that connects clinical and pharmacy staff across the trust."

Officials said the system further supports patient safety by incorporating the Multilex Drug Data File, from First DataBank Europe. Multilex DDF provides the system's clinical users with patient-specific clinical decision support to actively check for drug-drug interactions, duplicate therapies and drug allergies.

"E-prescribing minimises the risk of medication errors in many ways: from the very basic, such as producing legible prescriptions which are not subject to the difficulties and potential dangers of reading and interpreting handwriting, to the very advanced such as drug interaction information at the point of prescribing," said Poole.

Robert Tysall-Blay, JAC's chief executive, said, "Today, the large majority of hospitals are still using a paper-based prescribing system so it is encouraging to see that trusts are realising the benefits that e-prescribing can offer, notably improved patient safety and overall medicines management."

The trust plans to implement e-prescribing in its outpatient processes in the future.

Americans' Cholesterol Levels Shrink, Even As Waistlines Expand

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Americans are heavier than ever, yet the amount of cholesterol in our blood is on the decline.

A curious � and good � thing has happened on the road to Obesity Nation: the share of the U.S. adult population with high cholesterol has dropped.

Data just out from the Centers for Disease Control and Prevention show that only 13.4 percent of adults in this country have high cholesterol, according to data collected in 2009 and 2010.

A decade earlier, 18.3 percent of adults in the U.S. had high cholesterol.

High cholesterol starts at 240 milligrams of cholesterol per deciliter of blood. Having high cholesterol more than doubles the risk of a heart attack compared with desirable total cholesterol, which is less than 200 milligrams per deciliter.

 

The government had set a public health goal of getting the proportion of adults with high cholesterol down to 17 percent or less by 2010.

Lately, the obesity wave appears to have leveled off, but at a pretty high mark. Some two-thirds of American adults are obese or overweight.

Being overweight can raise your cholesterol. So what gives?

"Experts believe it's largely because so many Americans take cholesterol-lowering drugs, but dropping smoking rates and other factors also contributed," the Associated Press reports.

Drugs called statins, such as Lipitor and Zocor, lower cholesterol and are enormously popular. Last year, 264 million prescriptions were dispensed for drugs to reduce cholesterol, according to data from IMS Health.

But some are asking whether it's such a good idea to prescribe statins to people who haven't had a heart attack already. The Food and Drug Administration said in February that the drugs' instructions should note reports of memory loss and diabetes among people taking them.

The agency said, however, that the new information shouldn't scare people away from taking statins. The drugs's value in preventing heart disease is clear, FDA said.

Unusual Alliances Form In Nebraska's Prenatal Care Debate

Enlarge Nati Harnik/AP

Nebraska Gov. Dave Heineman vetoed a bill that would spend government funds on prenatal care to illegal immigrants. He has that service for illegal immigrants should be provided by churches and private organizations, not with taxpayer money.

Nati Harnik/AP

Nebraska Gov. Dave Heineman vetoed a bill that would spend government funds on prenatal care to illegal immigrants. He has that service for illegal immigrants should be provided by churches and private organizations, not with taxpayer money.

In Republican-dominated Nebraska, government leaders often line up together, but lately a political tornado has ripped through this orderly scene.

A political showdown over taxpayer funding of prenatal care for illegal immigrants has produced some unusual political splits and alliances in the statehouse of the Cornhusker State.

"I am extraordinarily disappointed in your support of taxpayer-funded benefits for illegal aliens," said Republican Gov. Dave Heineman as he read a letter he wrote to fellow Republican Mike Flood, speaker of Nebraska's officially nonpartisan Legislature.

Heineman was referring to a bill he subsequently vetoed that would restore publicly funded prenatal care for women in the country illegally. Until two years ago, Nebraska was one of about 15 states providing that benefit.

 

Nebraska dropped the coverage when the federal government said the state couldn't use Medicaid funds, though it offered to continue funding under another program. Heineman frames the issue as one of the benefits to illegal immigrants.

Flood, a leading abortion opponent, says pregnant illegal immigrants will ultimately give birth to babies who will be U.S. citizens. He says providing them with prenatal care is consistent with his opposition to abortion.

"If I'm going to stand up in the Legislature and protect babies at 20 weeks from abortion, and hordes of senators and citizens are going to stand behind me, and that's pro-life, then I'm going to be pro-life when it's tough, too," Flood said.

The issue has exposed a fault line between anti-illegal-immigrant sentiment and anti-abortion groups, but it's also brought together an unusual coalition. Among those supporting the bill is the politically influential Nebraska Right to Life organization.

"We don't want to distinguish that because ... of a baby's circumstances or in whose womb that baby resides that dictates whether that baby receives care or not," said Julie Schmit-Albin, the group's executive director.

Another supporter is the Nebraska Appleseed Center for Law in the Public Interest, which advocates for immigration reform and access to universal health care. Jennifer Carter, the center's public policy director, says the immigrants are our "neighbors" and should be helped.

"They're in our communities and they're helping contribute to our communities," Carter said. "So we believe providing this kind of prenatal care coverage to their children is appropriate."

Still, Heineman, backed by what Republican Party polls say is a clear majority of voters, remains adamant in his opposition, though he calls himself strongly anti-abortion.

"Most Nebraskans and I agree, we support prenatal care, but in the case of illegal immigrants, it should be done by churches, private organizations, charities, private individuals � not the use of taxpayer funds," he said.

Supporters of the bill, on both sides of the abortion debate, cite their own polls in support and say the savings from avoiding intensive care for babies born without prenatal care would outweigh the costs of the program.

With the governor turning up the political heat, the question now is whether enough legislators will vote to override the veto. That vote is scheduled for Wednesday.