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Widespread adoption and effective use of electronic medical record (EMR) systems and other health information technology (HIT) improvements could save the US health system as much as $162 billion annually by improving the way medical care is managed, reducing preventable medical errors, lowering death rates from chronic disease, and reducing employee sick days, says a pair of RAND Corporation studies published in the September/October 2005 issue of the bimonthly journal Health Affairs.


The studies are the first of their kind to project both the savings and health benefits that could result from nationwide adoption of HIT. Because there is limited direct evidence of the benefits at this early stage of adoption, the RAND team used computer models to show the potential benefits if EMR systems were adopted widely, interconnected, and used effectively. According to lead author Richard Hillestad, senior management scientist for the Santa Monica-based RAND, which has a team devoted to studying the role of HIT in healthcare, "The federal government will need to step into speed the diffusion of HIT and remove some major barriers if we are going to reap the tremendous benefits it could have on improving quality, managing diseases, and extending people's lives."


Barriers to wider adoption of HIT include the following:


* High initial acquisition and implementation costs


* Slow and uncertain financial payoffs for healthcare providers


* Disruptive effects on physician practices during implementation


* Payment systems that result in most HIT-enabled savings going to insurers and patients, while most adoption and care improvement costs are borne by providers



To accelerate HIT adoption, Hillestad and the RAND team say that the government will need to act more aggressively in the early stages of adoption to ensure wide spread use of EMR systems that conform to a national set of standards, information-exchange networks sharing approved data among providers and patients, and programs to measure, report, and reward the provision of high-quality, efficient care.


RAND's projections of the value of widespread adoption of EMR systems and other HIT improvements come amid a frenzy of activity at the federal level; the Department of Health and Human Services is funding numerous HIT-related projects.


Study findings reinforce the value of staying the course with these and other current federal, state, and private initiatives to promote HIT, but RAND suggests that the federal government and employer groups also consider adopting a package of policy initiatives designed to accelerate market forces and subsidize change, including laying the foundation for performance-based competition, payment differentials to providers who adopt standards based EMR systems, and targeted subsidies to help communities create regional information exchange networks. A program to measure and monitor HIT benefits during the rollout should be used to supplement the currently weak empirical base and to provide course corrections to government policy during the adoption process.



RAND's study projects sizable potential safety and cost benefits of standardized EMRs if systems were adopted widely, interconnected, and used effectively. For example, one third to one-half of the 8 million adverse drug events (ADEs) per year in ambulatory settings could be prevented. Each avoided ADE saves $1,000 to $2,000 in unnecessary healthcare costs while improving the quality of patient care.


The research team estimates that computerized physician order entry (CPOE) systems could eliminate 2 million ADEs in the ambulatory setting and 200,000 ADEs in the hospital setting. This could save up to $3.5 billion a year in the ambulatory setting and $1 billion a year in hospitals. Medicare would benefit greatly because avoiding ADEs in patients 65 and older accounts for 60% of the hospital savings and 40% of the ambulatory savings; about 37% of the potential ambulatory savings and error avoidance would come from solo practices.



Electronic medical records also can be instrumental in managing high cost chronic diseases such as asthma, congestive heart failure, chronic obstructive pulmonary disease, and diabetes. Reducing the incidence of chronic disease and hospital visits due to long-term prevention and management could save as much as $147 billion per year, but realizing the benefits requires that a substantial portion of providers and consumers participate.


Widespread use of HIT also will lead to more short-term preventive care, enabling providers to offer important screening exams or immunizations in a routine manner and remind patients to schedule medical care when they need it. RAND says that the costs of these kinds of measures "are not large compared to the benefits," projecting, for example, that 13,000 life years would be gained from more routine cervical cancer screening for a cost of $100-$400 million a year.



Despite the promise of EMRs and other HIT improvements, the United States still has far to go. Most medical records are still stored on paper, and consumers still lack the information they need about costs or quality to make informed decisions about care. The United States lags behind many other countries in its use of standardized EMRs. Only 15% to 20% of US physician offices and 20% to 25% of hospitals have adopted some version of an EMR system, and the majority of these systems cannot effectively interconnect through networks to coordinate care with other healthcare providers.


RAND estimates that the average yearly cost over a 15-year adoption period would be about $7.6 billion, much less than the $162 billion per year in possible savings. More specifically, the cost for hospitals to adopt a standardized EMR system would be $98 billion over a 15-year adoption period, or $6.5 billion per year, assuming that 20% of hospitals now have an EMR. Physician adoption adds $17.2 billion over this adoption period, for an average yearly cost of $1.1 billion, assuming that 90% of physicians buy in.


RAND's review of the impact of information technology in other industries suggests that the savings could even be larger. "If health care in the U.S. was transformed sufficiently to generate the 1.5 percent annual productivity gains from information technology-enabledefficiencies in the retail and whole sale industries, the annual cost of healthcare could be reduced by $346 billion or more. But the dramatic transformations and productivity gains seen in other industries resulted from both large investments in information technology and other factors such as deregulation, value-based competition, and system integration," says RAND, adding that "almost none of these factors are at work in healthcare."





The Joint Commission on Accreditation of Healthcare Organizations has announced the establishment of a Healthcare Information Technology Advisory Panel to focus attention on the improvement of patient safety and clinical processes as new healthcare information systems are implemented.


William Jessee, MD, president and chief executive officer, Medical Group Management Association, chaired the Healthcare Information Technology Advisory Panel when it convened for its inaugural meeting in October 2005.


The 39-member panel, of whom 19 are physicians and four are nurses, includes Don Detmer, President of the American Medical Informatics Association; Gail Graham, Director of Health Data and Informatics for the Veterans Health Administration; Scott Young, Director for Health Information and Technology for the Agency for Healthcare Research and Quality; H. Stephen Lieber, President of the Healthcare Information and Management Systems Society; and Stephen Rosenfeld, Chief Information Officer for the National Institutes of Health Clinical Center. Other members include representatives of institutions such as the Cleveland Clinic Foundation and Kaiser Permanente, as well as the Center for Health Transformation, founded by former Speaker of the House Newt Gingrich.


Joint Commission Board members LaMar McGinnis, MD, and Joseph Heyman, MD, will lead a strategic issues work group that will consider the panel's recommendations and spearhead the Joint Commission's future directions relative to healthcare information technology.


Members will be asked to recommend ways the Joint Commission's accreditation process and the wide spread use of technology can be used to help reengineer the delivery of patient care that result in major improvements in safety, quality, and efficiency. In addition to safety and quality issues, panel members will exchange lessons learned and examine topics such as the impact of electronic health records on performance benchmarking and public reporting capabilities.





According to a study by researchers at Japan's National Institute of Advanced Industrial Science and Technology in Tokyo, travel itself may be the reason why talking on cellphones is more distracting for drivers than talking to a passenger. A moving car may cause the driver's cellphone to switch from base station to base station searching for the call signal, and the slight loss of sound quality may force the driver's brain to concentrate harder to capture what the speaker on the other end is saying.


Takashi Hamada and colleagues measured the sound quality of mobile phone calls in both parked cars and vehicles traveling at 65 kilometers per hour. Comparing the signals revealed silent periods of up to 300 milliseconds that interrupted the signal about 6 times per minute. In addition, a 300-millisecond time lag between speech and reception, and frequency range distortions occurring up to 5% of the time, contributed to poor quality in cellphone calls that required more concentration on the phone than on the task of driving.


When audio recordings with similar interruptions and distortions were played for test subjects, electronic signals revealed higher activation of the right parietal cortex, the portion of the brain that perceives sound. Previously, it had been assumed that drivers were less distracted by speaking to passengers because conversation stops when a driver needs to concentrate.


Results of the study are published in Transportation Research Part F: Psychology and Behaviour, available on the Web at





Springer Publishing has re-released four books in the popular "Cherry Ames" nursing series. Originated by Helen Wells, a social worker turned full-time writer, Cherry Ames' adventures in nursing and mystery-solving continued through 27 titles, a second author, Julie Tatham, and publication around the world in countries such as Great Britain, Norway, Sweden, Denmark, Finland, Iceland, Japan, France, Italy, Holland, and Bolivia.


Originally published by Grosset & Dunlap from 1943 to 1968, Springer's four-volume set includes the first four titles in the series: Student Nurse, Senior Nurse, Army Nurse, and Chief Nurse. The books feature the original cover art by Ralph Crosby Smith in a soft-finished hardcover format, and introduce Cherry as an idealistic 18-year old who yearns to make a difference. Cherry leaves home for 3 years of nursing school, then into the armed services, where she eventually becomes Chief Nurse even as she pushes the limits of authority and solves mysteries. Series editor Harriet Schulman Forman, EdD, RN, remains a devoted fan of Cherry Ames, who inspired her to become a nurse. "Nothing else would do," she says.


The books are available from Springer individually for $14.95 or as a boxed set for $39.95. For more information, visit Springer on the Web at