2011 Potpourri VIII

Health Affairs published an article discussing the intersection of comparative effectiveness research and personalized medicine.  The two concepts have potential synergy, the use of personalized medicine can ensure that a treatment, particularly a drug, is in fact likely to have beneficial effects for a patient.  Comparative effectiveness research, however, is often used to draw broad population-based conclusions about more or less useful treatments, which then support guidelines that providers are expected to follow.  Those guidelines may ignore the individual biochemical differences that are the core of personalized medicine.  Therefore, it is important that comparative effectiveness research specifically incorporate a search for subpopulations that may respond uniquely to the treatments being examined.   (HA Article)

The nonprofit Institute for Clinical Systems Improvement teamed up with several outpatient diagnostic imaging centers to create a decision support tool to address inappropriate use of imaging.  The centers that used the tool lowered inappropriate scanning and saved an estimated $84 million in the state of Minnesota.  That doesn’t include the lower administrative costs probably incurred by providers.  The imaging centers would prefer use of clinical decision support to monitoring by radiology benefit managers.  If fully implemented by providers, this does appear to be a less invasive method of dealing with scanning costs.   (CMIO Article)

Guidelines aren’t much good if they don’t really reflect clear evidence-based medicine.  And apparently many don’t.  A study in the Archives of Internal Medicine looked at 41 guidelines suggested by the  Infectious Diseases Society of America, which contained over 4200 recommendations.  Most of these were based solely on expert opinion and only a small minority on the highest standard of evidence, one or more randomized trials.  The authors recommend caution by physicians before using guidelines without demonstrated validity.  Perhaps all guidelines need to contain a prominent warning notice stating the source of the evidence supporting the recommendations.   (Archives Article)

Another article in Health Affairs looks at hospitals’ progress in implementing electronic medical records.  The story was based on the American Hospital Association survey of hospitals in regard to their IT activities.  It found that the total number of hospitals using basic or comprehensive medical records had risen modestly from 8.7% in 2008 to 11.9% in 2009, with only 2% being in position to meet meaningful use requirements.  Small, rural and public hospitals lagged behind their urban, private and academic counterparts.   The survey indicates how far hospitals have to go, but we can anticipate that there was a very significant uptick in activity in 2010 due to the stimulus funding and reform.   (HA Article)

Accenture released another survey relating to hospital electronic medical record use, similarly finding that the sector was lagging in what it needed to do for regulatory purposes.  Accenture surveyed chief information officers from health systems and found less than 1% of hospitals meet the firm’s definition of mature EHR use and that 50% of hospitals are at risk of not meeting meaningful use requirements by 2015, when potential penalties of as much as 3-4 million dollars kick in.  Other findings were that the costs of implementing an EHR are usually underestimated and that the transition period can result in as much as an 80% increase in operating costs.  Guess who can help hospitals with all these problems.   (Accenture Survey)

The Journal of the American Medical Association carries a commentary outlining a “patient-centered” vision of the HIT world, in contrast to the usual focus on provider systems.  A patient-centered system, according to the author, would allow patients to collect information, including from EMR and claims systems, and would help them understand the data, provide clinical recommendations and assist in taking health related actions.  The author acknowledges that no system fully implements this vision today.  Providers might have legitimate concerns about whether such an approach would disconnect patients from professional care guidance.   (JAMA Commentary)