Archive for June, 2008

Most Doctors Aren’t Using Electronic Health Records

by Steve Lohr

A government-sponsored survey of the use of computerized patient records by doctors points to two seemingly contradictory conclusions, and a health care system at odds with itself.

The report, published online on Wednesday in The New England Journal of Medicine, found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care. Yet fewer than one in five of the nation’s doctors has started using such records.

Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care system. The slow adoption of the technology is mainly economic. Most doctors in private practice, especially those in small practices, lack the financial incentive to invest in computerized records.

The national survey found that electronic records were used in less than 9 percent of small offices with one to three doctors, where nearly half of the country’s doctors practice medicine.

Dr. Paul Feldan, one of three doctors in a primary care practice in Mount Laurel, N.J., considered investing in electronic health records, and decided against it. The initial cost of upgrading the office’s personal computers, buying new software and obtaining technical support to make the shift would be $15,000 to $20,000 a doctor, he estimated. Then, during the time-consuming conversion from paper to computer records, the practice would be able to see far fewer patients, perhaps doubling the cost.

“Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see patients, we don’t get paid. The economics of it just seem so daunting.”

Private and government insurers and hospitals can save money as a result of less paper handling, lower administration expenses and fewer unnecessary lab tests when they are connected to electronic health records in doctors’ offices. Still, it is mainly doctors who bear the burden making the initial investment.

“We have a broken market for electronic health record adoption because the people who gain financially are not the people who pay,” said Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a nonprofit medical group that includes Massachusetts General Hospital in Boston.

To fix the market, Dr. Middleton, like others, recommends that the government play a role in providing incentives or subsidies to speed the use of computerized patient records in the United States, whose adoption rate trails most developed nations.

The government took a step in that direction last week, announcing a $150 million Medicare project that will offer doctors incentives to move from paper to electronic patient records. The program is intended to help up to 1,200 small practices in 12 cities and states make the conversion.

Individual doctors will be offered up to $58,000 over the five-year span of the project, which is intended to test the impact of incentives on the spread of electronic health records. Further programs across the country are planned.

The report published in the journal also found that electronic health records were used by 51 percent of larger practices, with 50 or more doctors.

Indeed, electronic health records are pervasive in the largest integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, University of Pittsburgh Medical Center and others. These integrated groups not only have deep pockets. By combining doctors, clinics, hospitals and often some insurance they can also capture the financial savings from electronic health records.

The findings of the study, which was paid for by the Department of Health and Human Services and a grant from the Robert Wood Johnson Foundation, broadly echo previous research on the adoption of electronic health records. Large medical groups have long been the early adopters, and small practices have struggled.

But the new study is based on a large sampling — more than 2,600 doctors across the country — and a detailed survey, making it more definitive than past research, experts say. The results, they say, also show a strong endorsement of electronic health records by doctors who have them, especially for what the report termed “fully functional” records, which include reminders of care guidelines, based on a patient’s age, gender or medical history.

For example, 82 percent of those using such electronic records said they improved the quality of clinical decisions, 86 percent said they helped in avoiding medication errors and 85 percent said they improved the delivery of preventative care.

“Those numbers are huge and very encouraging,” said Dr. David J. Brailer, the former health information technology coordinator in the Bush administration.

Dr. Brailer also pointed to the 54 percent of doctors without electronic health records who said that not finding an electronic health record that met their needs was a “major barrier” to adoption. In short, they are not satisfied with the existing products, which tend to be designed for hospitals — big customers — instead of small practices.

“What we see is a deficit in innovation, and that is something innovators and the capital markets can address,” said Dr. Brailer, who leads a firm that invests in medical ventures, Health Evolution Partners.

One wave of innovation is coming from big technology companies, like Microsoft and Google, which recently have begun services that offer consumer-controlled personal health records over the Web, which are stored in the companies’ data centers. These consumer-controlled health records are intended to link up and exchange information with electronic patient records in doctors’ offices and hospitals.

Dr. Peter Masucci, a pediatrician with his own office in Everett, Mass., embraced electronic health records to “try to get our practice into the 21st century.”

He could not afford conventional software, and chose a Web-based service from Athenahealth, a company supplying online financial and electronic health record services to doctors’ offices.

Dr. Masucci was already using Athenahealth’s outsourced financial service, and less than two years ago adopted the online medical record.

Today, Dr. Masucci is an enthusiast, talking about the wealth of patient information, drug interaction warnings and guidelines for care, all in the Web-based records.

“Do I see more patients because of this technology? Probably no,” Dr. Masucci said. “But I am doing a better job with the patients I am seeing. It almost forces you to be a better doctor.”

Labor unions ready to start operating (their cranes)

By Albert Amateau

Labor union representatives and community leaders from Chelsea and Chinatown spoke out in support of the revised St. Vincent’s/Rudin redevelopment plan at a June 10 Community Board 2 forum. But preservation advocates and close neighbors remained adamantly against the project.

The C.B. 2 forum followed a previous Landmarks Preservation Commission hearing on the scaled-down plan for a new 299-foot-tall hospital on the St. Vincent’s O’Toole Building site on the west side of Seventh Ave. and a residential project that would adapt four of the eight existing hospital buildings and add a 235-foot-tall residential tower on the avenue’s east side.

“Nine times out of 10, I’m against development, but this is a unique situation,” said Miguel Acevedo, a member of Community Board 4, speaking only for residents of the Robert Fulton Houses in Chelsea. “This hospital has done so much for underprivileged kids in Chelsea,” Acevedo told the Community Board 2 Omnibus St. Vincent’s Committee forum.

Jimmy Pelsey, another C.B. 4 member, submitted a letter as president of the Robert Fulton Tenants Association saying he was happy to support the revised redevelopment plan because St. Vincent’s is the nearest facility for thousands of city housing project tenants in Chelsea.

Al Lau, speaking for the Chinatown Rotary Club, and Joseph Wong, representing the Chinese Consolidated Benevolent Association, said St. Vincent’s was important to their neighborhood because it is far superior to the smaller Downtown Hospital on Gold and Beekman Sts.

Ed Ott, president of the New York City Central Labor Council, sent a statement to the forum noting the plan calls for demolishing the O’Toole Building, originally built on the west side of Seventh Ave. for the National Maritime Union.

“While some have made the argument for O’Toole to be saved because of its significance as a former labor headquarters, I can assure you, as leader of the umbrella organization for New York City labor, we have absolutely no objection to losing this building, especially for it to serve a greater purpose as a technologically advanced hospital for the West Side and Downtown, including our many members in the area. We strongly believe that the building should not stand in the way of St. Vincent’s being able to carry out its significant mission,” Ott’s statement said.

Eleni Delimpaltadaki spoke for Communications Workers of America Local 1180 in support of the revised plan.

Jack Kittle, of Painters and Allied Trades District Council 9, said members of his union need the Level 1 trauma center — the highest level of emergency room care — that the new hospital would provide.

“But basically we support it because of the jobs it will create,” he added.

Gil Horowitz, president of the Washington Square-Lower Fifth Ave. Block Association, which was strongly opposed to the previous plan, said the association now supports the project.

“We’re sure the Landmarks Preservation Commission will require refinements, but we now support the proposal,” Horowitz said.

The original plan was for the hospital tower on the west side of the avenue to be 329 feet tall and 40 feet wider than the revised plan. Originally, the residential tower on the east side of the avenue was to be 265 feet tall and 60 feet wider than the revised design.

Speaking in support of the new plan, Norman Rosenfeld, an architect specializing in healthcare projects and a Village resident for 14 years, found what he said were misconceptions in recent criticism of the plan.

Neighbors who say St. Vincent’s should reconstruct its existing facilities, like Lenox Hill Hospital did a few years ago, rather than build anew, forget that the eight old St. Vincent’s buildings on the east side of the avenue have floor plates at different levels, as opposed to Lenox Hill, where floor plates of the various buildings matched, Rosenfeld said.

Moreover, if St. Vincent’s built its new hospital outside the Greenwich Village Historic District at the staff residence the hospital owns at 555 Sixth Ave., between 15th and 16th Sts., the emergency room would have to be on two floors, said Rosenfeld, noting that no hospital he knows has a two-level emergency room.

A hospital at 555 Sixth Ave. would also have to be 379 feet tall, according to the St. Vincent’s application for a hardship to allow the demolition of the O’Toole Building. Rosenfeld also figured that the hospital needs a larger emergency room.

“The emergency room was built to handle about 35,000 visits per year; it’s currently handling about 36,000 per year,” he said.

But most neighbors appeared as opposed to the revised plan as they had been to the original. Despite the reduction in the proposed size of the new hospital and the adaptive reuses of St. Vincent’s existing Nurses Residence, Smith, Raskob and Spellman buildings, along with a lower residential tower, neighbors said the development was too big for the Greenwich Village Historic District.

“It should be in Dubai, not in the Village,” said Raven Petreth, a resident at 101 W. 12th St.

Although the project was downsized and four buildings were preserved for residential use, the revised plan’s total square footage remains about the same as in the original. St. Vincent’s and the Rudin Organization presented the revised plan two weeks after the Landmarks Preservation Commission told them both to rethink the project and make it more appropriate for the Greenwich Village Historic District.

The new plan also includes a hardship application to allow demolition of the O’Toole Building.

Tom Molner, a resident of 217 W. 13th St. and a founding member of Protect the Village Historic District, attacked the hardship application to demolish O’Toole on the grounds that preserving the building would prevent St. Vincent’s from fulfilling its charitable mission of providing hospital care to the community.

“It can clearly be used for hospital purposes, as it has been for the past 25 years,” Molner said. “St. Vincent’s real claim is that O’Toole cannot be used for the high-rise hospital tower that it wants to build.” He said St. Vincent’s acquired O’Toole knowing it was in a protected historic district. “If St. Vincent’s is successful here, any charitable organization could acquire a landmark property and then claim hardship because the building was not suited to its charitable mission,” Molner said.

Andrew Berman, director of the Greenwich Village Society for Historic Preservation, said the precedent of allowing the project would be disastrous for the Village because the neighborhood “is chock full of not-for-profit organizations.”

Other neighbors said that, in addition to the four buildings on the avenue’s east side preserved in the revised plan, Rudin should also include the hospital’s Reiss Building.

Several neighbors referred to the July issue of Vanity Fair in which writer Christopher Hitchens says the large buildings in the St. Vincent’s and Rudin designs are “like two huge toads, these ugly and tedious and uninspired structures would impede the view and block the light of one of New York’s historic neighborhoods, a district that in a previous generation survived even Robert Moses and his plan to slam a neo-Brutalist urban highway through bohemia.”

Layoffs Show on New York Unemployment Rolls

by Patrick McGeehan

Week after week, Wall Street banks and other big employers have announced layoffs by the thousands, but month after month, the official gauges of the job market in the New York metropolitan area registered few signs of a downturn.

Until now.

Smith Slapped Over Tax Cap

The Working Families Party is not reserving its criticism over the proposed property tax cap solely to Gov. David Paterson.

The labor-backed party is also upset with another of its Democratic allies, Senate Minority Leader Malcolm Smith, for his recent announcement that he not only supports the cap, but wants it to be lower than even Paterson has proposed (2 percent rather than 4).

The minority leader’s move also shocked members of his Democratic conference who were angry Smith got out in front of them on a subject on which they have yet to take a formal position.

The WFP took Smith to task in a June 17 e-mail that also mentions the party’s displeasure with his failure to join Assembly Speaker Sheldon Silver in supporting the so-called “millionaire’s tax.”

The WFP has proposed a property tax plan that would provide relief to low and moderate-income families through a circuit breaker funded by increasing the personal income tax for wealthy New Yorkers.

Eyes Bloodshot, Doctors Vent Their Discontent

By Sandeep Jauhar, M.D.

“I love being a doctor but I hate practicing medicine,” a friend, Saeed Siddiqui, told me recently. We were sitting in his office amid his many framed medical certificates and a poster of an illuminated lighthouse that read: “Success doesn’t come to you. You go to it.”

A doctor in his late 30s, he has been in practice for six years, mostly as a solo practitioner. But he told me he recently had decided to go into partnership with another cardiologist; his days, he said, will be “totally busy.”

2008 YouthSafe Poster Contest Winner

Gov. Paterson proclamation of June as “Teen Worker Safety Month”

Bethanie Lethbridge (second from left), 17, a student at T-S-T BOCES in Ithaca, is shown with her winning poster in the 2008 YouthSafe Poster Contest, jointly sponsored by the New York Committee on Occupational Health and Safety (NYCOSH) and the New York State United Teachers (NYSUT). The contest is held annually to promote workplace safety and education for young workers. Bethanie received a $400 award in Albany following Governor David Paterson’s proclamation of June as Teen Worker Safety Month.

Also shown in photo are NYCOSH Executive Director Joel Shufro (left), M. Patricia Smith (right), New York State Commissioner of the Department of Labor (DOL), and Assemblymember Susan John (second right), Chairperson of the New York State Assembly Committee on Labor. Commissioner Smith has announced new initiatives on youth worker safety as part of Teen Worker Safety Month.

Governor’s plan to cap school taxes won’t get through Legislature

By Tom Precious

ALBANY — A dispute over how to control rising school taxes came out into the open Thursday, as Gov. David A. Paterson and legislative leaders squared off over whose idea is best to get a grip on a problem worsening the exodus of New Yorkers to states with lower taxes.

After nearly a half-hour of rhetoric, the sides were no closer, leaving it all but certain that property taxpayers will not be seeing a relief plan from Albany before lawmakers end their 2008 session on June 23.

State Seeks Way to Save Benefits for Workers

by Steven Greenhouse

State officials say they may have to create a $200 million emergency fund to finance workers’ compensation benefits for thousands of injured New Yorkers because 12 trusts that provided insurance to their employers have failed financially.

The self-insured trusts provide workers’ compensation insurance to groups of small- to medium-size employers in the same industry, and the failure of so many of them in recent months has sparked fears of a cutoff in benefits to thousands of injured workers. It has also generated criticism that the State Workers’ Compensation Board was lax in regulating the trusts. There are 50 group trusts remaining in the state that provide insurance to more than 20,000 businesses with a total of about 500,000 employees.

The Plight of the Underinsured

It is well known, by now, that almost 50 million Americans lacked health insurance for all or part of last year. What is less well known is that 25 million Americans who did have health insurance often found it pitifully inadequate when a medical crisis hit. They were only marginally better off than those who had no coverage at all.

That is the disturbing finding of a survey by the Commonwealth Fund, a private foundation specializing in health policy research, that was published by the journal Health Affairs. The survey found that some 22 million adults with health coverage all year still spent a large chunk of their incomes — at least 10 percent for middle-class families — for out-of-pocket medical expenses. Another 3.4 million were saddled with high deductibles that would cause financial problems if they became ill.

Burying the tax cap

by Rick Karlin

Burying the concept of a school tax cap was pretty much what these leaders of the state’s education lobby were doing just now during a press conference.

Among the arguments against Gov. Paterson’s 4 percent tax cap idea: there’s no accompanying “floor,” or guarantee of minimum state funding for the schools; it would disproportionately hurt poor schools and could force cutbacks in all sorts of school programs and activities.

“It’s like replacing half your roof or buying one shoe to save money,” said Maria DeWald, pictured above, from the state PTA.

“What is the rush?” DeWald added.

Actually, the prospect of a tax cap being passed, at least this year, is pretty much non-existent with neither the Republican Senate or Democratic Assembly showing no indication that they plan to take up the idea.

But nonetheless, said NYSUT spokesman Carl Korn, the press conference was a way to get the messsage out to lawmakers about how deep the opposition to a property tax cap is in the education community.

Among those joining the coalition against the tax cap are New Yorkers for Fiscal Fairness, the New York State PTA; Working Families Party; Fiscal Policy Institute; New York State Council of School Superintendents; New York State United Teachers; Citizens Action of NY; TREND; Center on Budget and Policy Priorities; Campaign for Fiscal Equity; Alliance for Quality Education; and the Civil Service Employees Association.