The Week in Review - April 16, 2009

National Association of Community Health Centers (NACHC) reports that 60 million lack access to care. NACHC links the "growth of the 'medically disenfranchised' population to a host of factors that include a worsening shortage of primary care doctors in needy communities and a growing scarcity of providers willing to treat the uninsured or publicly insured."

Blue Cross Blue Shield of Minnesota initiates a pilot virtual clinic - 10 minute consultations with a doctor over the web.

Ownership of electronic health information is not clear, as the nation gears up to put this information on-line nationally by 2014.

Using genomics to assess risk of various diseases will improve over the next several years. While it's premature to test for many diseases today, "the situation may be very different in just 2 or 3 years. Appropriate guidelines are urgently needed to help physicians advise patients who are considering this form of genetic testing as to how to interpret, and when to act on, the results as they become more stable."

Health Research Insights sends letters to a physician threatening to turn him over to the feds, if he doesn't pay $347 for up-coding on 4 occasions, the earliest dating back to 2005. American Medical News reports that companies operating under ERISA are not time limited in making such claims.

The Preident and CEO of Catholic IPA Western New York argues that the national "investment in health information technology has the great potential to improve the functioning of our health care system."

Medicare's Transitions Project aims to reduce hospital re-admissions and fragmentation of care in a pilot running in 14 communities.

Washington Hospital Center in Washington DC are piloting an ethical checklist, which includes the following items to progress notes and reports:

• "Patient's wishes unclear/refusal of treatment
• Questionable capacity to consent to, or refuse, treatment
• Disagreement involving relatives/surrogates/caregivers
• End-of-life (advance directive/power of attorney, do not resuscitate/allow natural death, withdraw/withhold Rx)
• Confidentiality/disclosure issue
• Resource or fairness issue
• Other (please note)
• No notable ethical issues"

According to the New England Journal of Medicine, "only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems."

The AMA launches an e-prescribing learning center for physicians.

The State Health Access Data Assistance Center and the Robert Wood Johnson Foundation "At the Brink" reports on the demographics of the uninsured broken down by state.