|
Information
Technology
Leapfrog
Group
Investments
in information technology supporting physician order entry
in hospitals are receiving strong encouragement from major
purchasers of healthcare benefits for employees and their
dependents. Major coalitions of healthcare purchasers have
tried various approaches over the past ten years in efforts
to improve the quality of care provided to their employees
and dependents. These efforts include posting quality-of-care
measures (10 or more factors with a composite ranking) on
the Internet for health plans and healthcare providers. Payments
by employees for healthcare services vary by the composite
ranking on the Internet for a given plan or facility. Some
employees are willing to pay a premium so they can continue
to be treated by a given physician associated with a low-quality
facility based on multiple measures.
A new
approach is being implemented by a major coalition of healthcare
purchasers to improve patient safety through process measures,
staffing, and volumes of selected services performed by a
given healthcare provider. This major coalition is called
the Leapfrog
Group and is sponsored by The Business Roundtable. The
executive director and staff are in Washington, DC.
The Leapfrog
Group is a coalition of Fortune 500 companies with a mission
"to trigger giant leaps forward in patient safety, as well
as the overall quality, customer service, and affordability
of health care." Seventy-eight of the corporate members in
the Leapfrog Group are listed in the May 2001 issue of Hospitals
& Health Networks with General Motors serving as
a key participant in the leadership. The corporate members
of the Leapfrog Group represent purchasers providing healthcare
benefits for 25 million American beneficiaries.
back
to top
The Leapfrog
Group's goal is to "mobilize employer purchasing power to
trigger breakthrough in the safety and the overall value of
healthcare to American consumers. Leapfrog is anchored in
supporting consumer access to safer, higher value health care
services via informed choices. It is a voluntary program aimed
at mobilizing large purchasers to alert America's health care
industry (both directly and via health plans) that big leaps
in patient safety and customer value will be better recognized
and rewarded with preferential use and other market reinforcements.
The Leapfrog Group also states as a fundamental principle
its desire to work in partnership with health care providers."
Source:
This is from "Information for Purchasers" by The Leapfrog
Group for Patient Safety Rewarding Higher Standards, a 14-page
document posted on the web.
The Leapfrog
Group is currently collecting key information about healthcare
services. Healthcare purchasers in seven regions of the country
are conducting a survey of 900 hospitals in June 2001 regarding
the three initial safety leaps:
1. Computer
physician order entry: Physician order entry in hospitals
is computerized because adverse drug events are a major area
of concern and opportunity for improvement in healthcare practice.
2. Intensive
Care Unit (ICU) Physician Staffing: Hospital ICU care
is "managed by a physician certified (or eligible for certification)
in critical care medicine, who: (1) is present during daytime
hours and provides clinical care exclusively in the ICU and,
(2) at other times, returns more than 95 percent of ICU pages
within five minutes (unless the paging system can designate
low-urgency pages), and can rely on an FCCS certified "effector"
(physician or physician extender) who is in the hospital and
able to reach ICU patients within 5 minutes in more than 95
percent of cases." Intensivists in only about 10 percent
of ICUs in the United States currently meet these standards
per Leapfrog reports.
3. Evidence-Based
Hospital Referral: Elective treatment is guided by providers
to hospitals and clinical teams with superior outcomes if
valid comparative quality measurement systems exist; if not,
such guidance is based on scientific evidence of volume-outcome
relationships.
Hospitals
that fulfill the computer physician order entry standard
will:
1. Require
physicians to enter medication orders via computer linked
to prescribing error prevention software,
2. Demonstrate
that their computer physician order entry system
can intercept at least 50 percent of common serious prescribing
errors, utilizing test cases and a testing protocol specified
by the Institute for Safe Medication Practices,
3. Require
documented acknowledgment by the prescribing physician of
the interception prior to any override, and
4. Post
the test case interception rate on a Leapfrog-designated
web site.
back
to top
Hospital
that satisfy the evidence-based hospital referral standard
will meet the favorable hospital volume characteristics as
follows:
1. Coronary
artery bypass with an annual volume of 500 or more,
2. Coronary
angioplasty with an annual volume of 400 or more,
3. Carotid
endarterectomy with an annual volume of 100 or more,
4. Abdominal
aortic aneurysm repair with an annual volume of 30 per year,
5. Esophageal
cancer surgery with an annual volume of 100 per year,
6. Delivery
with expected birth weights under 1,500 grams or gestation
age under 32 weeks for a regional neonatal intensive care
unit with average daily census of 15 or more,
7. Delivery
with prenatal diagnosis of major congenital anomalies for
a regional neonatal intensive care unit with average daily
census of 15 or more.
Leapfrog
purchasers will share results from these surveys with enrollees
and the general public as part of Leapfrog Group's goal of
initiating breakthroughs in the safety and healthcare of the
United States.
What would
be the national benefits if urban hospitals (omit rural
hospitals) were to adopt the Leapfrog Safety Standards
for Computer Physician Order Entry, Intensive Care Unit Physician
Staffing, and Evidence-Based Hospital Referral? A 37-page
monograph is posted on the web that addresses these issues
- Leapfrog Safety Standards: The Potential Benefits of Universal
Adoption by John D. Birkmeyer, Christian M. Birkmeyer, David
E. Wennberg, and Michael Young.
Their
baseline analysis of Leapfrog Safety Standards indicates:
| Safety
Initiative |
Potential
Benefit With Full Implementation |
| Computer
Physician Order Entry |
522,000
serious medication errors avoided |
| Evidence-Based
Hospital Referral - Five High Risk Procedures |
2,581
Lives Saved |
| Evidence-Based
Hospital Referral - High-Risk Deliveries |
1,863
Lives Saved |
| Intensive
Care Unit Physician Staffing |
53,850
Lives Saved |
Source: Executive
Summary (November 2000)
This monograph
and "Information For Purchasers" contain appropriate
professional references and documentation.
Some healthcare
providers and health association leaders are upset because
a computer physician order entry system may cost $5
million, and many hospitals are financially distressed. Appropriate
staffing of intensivists is also expensive. Some recognized
medical centers might not qualify by the volume measures that
may be used by some corporate purchasing groups. For more
information on the criticism, see Ed Lovern, "Minding Hospitals'
Business; Purchasing Coalition Pushes Hospitals To Improve
Patient Safety Through Process measures, But Industry Says
Standards are Too Expensive," Modern Healthcare 31(no. 22)
(May 28, 2001): 30-33.
back
to top
The
Washington Business Group on Health
The Washington
Business Group on Health was founded in 1974 as the voice
of larger employers on their most important health issues. The
Fortune 500 companies and larger public sector employers who
belong to the Washington Business Group on Health provide
health coverage for more than 39 million U. S. workers, retirees,
and their families. Currently, there are 160 members in the
Washington Business Group on Health.
Helen
Darling is the new president of the Washington Business Group
on Health. Ms. Darling chaired the (National Committee for
Quality Assurance) NCQA's Health Plan Employer Data
and Information Set (HEDIS) Committee during the mid
1990s when the foundation for healthcare profile analysis
was established. She is recognized in corporate circles as
a leader in healthcare cost management.
The Washington
Business Group on Health launched in February 2002 the Institute
of Health Care Costs and Solutions to address corporate America's
most urgent health benefit problem - the rapid rise of health
care costs. This Institute will send a clear message that
affordability and cost-effectiveness must be major considerations
in the health system by undertaking programs to identify the
most promising practices, developing guiding principles, and
elevating the dialogue on cost containment measures in healthcare.
back
to top
Coalition
for Affordable Quality Healthcare (CAQH)
Chief executive officers of 25 of America's largest
health plans, along with two principal health plan associations,
have been working on a cooperative effort to improve healthcare
coverage, service and quality for American consumers and their
doctors. These 25 health plans serve a combined total of more
than 100 million Americans. This cooperative effort is known
as the Coalition
for Affordable Quality Healthcare (CAQH).
The July
12, 2000 Progress Report indicated that the participating
companies were focused on:
1. Enabling
consumers to have access to quality coverage and information,
2.
Making administration easier for doctors and consumers,
and
3. Working
with doctors to help them improve overall healthcare quality.
The February
7, 2001 Progress Report disclosed substantial accomplishments
for the first year of work. The implementation of the first
phase of these action steps include:
1. Improving
access to quality healthcare coverage,
2. Working
with doctors and other health advocates to help them improve
healthcare quality, and
3. Making
administration and information easier for doctors and consumers.
These
administrative simplification efforts encompass easier credentialing
and standard information. A common database of formularies
listing all prescription drugs that CAQH plans cover is being
developed.
All participating
CAQH plans meet service and care pledges for:
1. Assuring
direct access to obstetrical/gynecological (OB/GYNs) services
for women and pediatricians as primary providers for children,
2. Assuring
coverage for a condition that a reasonable person would
consider as an emergency,
3. Facilitating
a timely independent external review when there is a question
about the necessity of tests or treatment,
4. Encouraging
doctors participating in CAQH plans to discuss all appropriate
treatment options, their costs and expected outcomes with
their patients, and
5. Supporting
a competitive marketplace by assuring that all plans provide
a full range of choices for customers.
The CAQH
web site provides more detail on the first year of progress
and the next steps.
back
to top
MedAvant
Healthcare Solutions
MedAvant
Healthcare Solutions is an Internet-based healthcare information
services company committed to lowering costs and developing
an integrated, more accurate and timely exchange of healthcare
business information for two primary customers: physicians
and health plans. MedAvant Healthcare Solutions is located
in San Diego, California, and was founded by seven leading
health plans: Aetna Inc., Anthem Blue Cross and Blue Shield,
CIGNA Corporation, Health Net, Inc., Oxford Health Plans,
PacifiCare Health Systems Inc., and WellPoint Health Networks
Inc. These seven founding investors represent health insurance
coverage for over 60 million Americans. For more information
on commitment, vision, mission, experience, leadership, and
business model, see the MedAvant Healthcare Solutions Web
site.
back
to top
The MedBiquitous Consortium
Johns
Hopkins has joined with many of the leading professional medical
societies to create the MedBiquitous
Consortium, a group dedicated to creating technology standards
and software for education and collaboration in online medical
communities. Fifteen organizations representing over 400,000
physicians have already joined the Consortium, including the
Council of Medical Specialty Societies, the American Academy
of Family Physicians, the American Academy of Ophthalmology,
the American Academy of Otolaryngology-Head and Neck Surgery,
the American Academy of Pediatrics, the American College of
Gastroenterology, the American College of Radiology, the American
Heart Association, the American Society of Clinical Oncology,
CTSNet (Cardiothoracic Surgery Network), the European Association
for Cardio-Thoracic Surgery, the International Council of
Ophthalmology, and the Society for Vascular Surgery. Katholieke
Universiteit Leuven in Belgium and UNITAR, a virtual university
in Malaysia, have joined the Consortium as university members.
IBM, Sun Microsystems, and Rational Software will be taking
a lead role in designing the Consortium's technical architecture.
The
MedBiquitous Consortium is a non-profit international
organization dedicated to creating a comprehensive XML (Extensible
Markup Language) framework for professional medical societies.
For more information on the combined efforts to build on this
framework to create thriving online communities and Web-based
services for physicians, see the MedBiquitous Consortium on
the web.
back
to top
|
