2012 Potpourri XII

The American College of Medical Genetics and Genomics has released a policy statement regarding the use of genomic sequencing.  This issue has become more relevant as the cost of even full-genome sequencing has dropped dramatically in recent years.  The statement points out that at this point the clinical utility of much genetic information is not well-established.  It also emphasizes the importance and value of good counseling on genetic issues for patients.  When the whole genome of a patient is sequenced for a particular condition, a sensitive issue is whether and the extent to which other genetic anomalies that turn up should be disclosed to the patient.  (ACMG Guidelines)

Several recent employer surveys have purported to reflect employer attitudes toward health reform and their actions in response to it.  The most recent comes from the Midwest Business Group on Health.  Employers vary in their support for provisions of the Act.  Many favor the payment and care coordination reforms, as well as those aimed at more transparency and cost and quality data.  But most employers feel the law increases administrative and reporting burdens and over 40% hope to see the law declared unconstitutional.  Large employers report small cost impacts to date, but smaller ones have seen more significant cost rises and anticipate even greater ones.     (MBGH Survey)

Research from Ohio State University looks at the relationship between hospitals’ efforts to meet government quality regulations and improve clinical quality and patient satisfaction.  Using government reports, the researchers found that  while efforts to meet the program requirements improved clinical outcomes, patient satisfaction declined.  The research highlighted tension between checklist driven analysis of process of care, with the individualized attention that patients want.  Since value-based purchasing measures both clinical performance and patient experience, this tension may make it hard for hospitals to have high scores on both domains.   (OSU Research)

A study reported in the Archives of Internal Medicine appears to contradict another one published recently regarding the effect of health information technology on lab test ordering.  This study says that when two academic medical centers utilized a health information exchange the volume of lab test ordering dropped, theoretically because duplicate testing was avoided.  The study compared one year before the exchange with three years after and found a 50% or more drop in ordering of duplicate tests.  This study design may have issues, but it is also narrower than the earlier study, which focused on physician access to electronic test results, which seemed to promote more ordering.   (Archives Article)

Health care is so large and so acronym-happy that we often have acronym conflict, like HIE, which might be health insurance exchanges or health information exchanges!  A couple of interesting reports were released on the latter concept this week.  The first comes from the semi-official cheerleader for the concept, the National eHealth Collaborative.  It purports to be an update on where we are with health information exchanges and what needs to be done to continue to move forward.  Where we are is “not far”, a lot of talk and not that much really workable, widespread ability to access health information across providers.  One good thing the report focuses on is the need to integrate federal efforts with the private efforts that often are further along.   (HIE Report)

Another HIE related report comes from the firm IDC Health Insights, and discusses best practices to create a sustainable health information exchange.  Sustainability is code for how the heck do we find revenue to pay for the exchanges, especially when most of the affected parties don’t seem to find enough value in them to want to pay.  Based on interviews from 50 organizations, the report focuses on stakeholder engagement, gathering business requirements, meeting privacy and security concerns, ensuring interoperability and meeting the needs of evolving groups, like accountable care organizations.     (HIE Report)