I felt the health care reform news out of Washington last week was decidedly mixed. For those of us who have advocated reform for many, many years, the mere fact that legislation made it past the Senate Finance Committee and one step closer to becoming reality is quite historic. A lot of folks never thought we'd even get this close, so it is indeed something that gives one great pause.

The legislation itself is another matter.

The iteration of the bill that the committee passed needs a lot of work to make it affordable before it goes up for a final vote in Congress. By now, most people are aware of the report AHIP released concluding that the current legislation would raise insurance premiums for a family of four by about $1,500. Although its authors admitted having to make simplifying assumptions that made the analysis less than comprehensive, I found it very troubling that the White House was so quick to dismiss the findings simply as insurance industry propaganda timed to derail the Finance Committee's vote. In fact, the existence of a second report that somehow flew much further under the radar not only corroborates the results of the AHIP study, it almost makes the $1,500 premium increase seem acceptable in comparison.

Oliver Wyman, Inc., the renowned actuarial consulting firm, released a more inclusive study saying that the legislation in its current form could ultimately raise rates upwards of 48 percent for approximately 94 percent of the population. Among other things, the Wyman report called for the bill to include market stabilizers to help offset such drastic cost increases. For example, it said, if the proposal calls for the elimination of pre-existing conditions, it should then also make health insurance mandatory for all. As it stands, the bill calls for the elimination of pre-existing condition rules immediately while taking a few years to implement penalties for not having coverage. And even then, the penalties are minimal. This will enable a large number of young and otherwise healthy people to wait until they're sick to buy insurance, driving up the cost of premiums for the remaining population. No proponent of the currently proposed legislation has been able to undermine the analysis, so they've chosen to simply lump it in with the AHIP report as "lies."

This is just one challenge with the legislation. There are other instances in which the bill doesn't properly address affordability, and that's why it needs to be amended significantly before making its way to Congress. It is very important that the folks on Capitol Hill recognize that affordability goes far beyond what people pay for health insurance. It extends into what we as a society can afford to pay and, if the legislation passes as-is, the price may be very steep.

Editor's note: We encourage your comments in response to this blog post; please use the electronic form provided below. You may also contact Mr. St. Clair directly at dstclair@MEDecision.com.

For example, in a report prepared for America's Health Insurance Plans (AHIP), PricewaterhouseCoopers (PwC) examined the impact of the Senate Finance Committee's health reform bill. AHIP cited the PwC analysis in voicing concerns about the bill's cost.

According to the PwC report, the cost of the average family health care policy is approximately $12,300 today and will rise to:

• $15,500 in 2013 under current law and to $17,200 if [the bill's] provisions are implemented.
• $18,400 in 2016 under current law and to $21,300 if [the bill's] provisions are implemented.
• $21,900 in 2019 under current law and to $25,900 if [the bill's] provisions are implemented.

Between 2010 and 2019 the cumulative increases in the cost of a typical family policy under this reform proposal will be approximately $20,700 more than it would be under the current system, the PwC report stated.

The Center for American Progress (CAP) responded with a statement claiming that the AHIP/PwC study is flawed and the results are not credible.

The statement -- signed by Henry J. Aaron, Brookings Institution; David Cutler, Harvard University; Judy Feder, Georgetown University (and senior fellow at CAP); Elliott S. Fisher, Dartmouth Medical School; Arnold Milstein, Institute for Health Policy Studies, University of California-San Francisco School of Medicine; Len Nichols, New America Foundation; and Meredith Rosenthal, Harvard University -- read as follows:

The AHIP study is misleading in several ways. First, it ignores critical elements of the insurance market reforms in the Senate Finance Committee bill that would protect people from many of the problems AHIP purports to analyze; it would grandfather existing coverage, provide reinsurance and risk-adjustment, and introduce special policies for young adults.

More importantly, the AHIP study ignores the many provisions in the Senate Finance Committee's reform plan that would help to streamline medical care delivery and reduce its cost, including changes in payment methods, provisions to encourage use of information technology and comparative effectiveness, and the establishment of insurance exchanges to lower the administrative costs associated with health insurance. In fact, one of the policies that AHIP criticizes, the imposition of taxes on "Cadillac health plans" would, in the view of most economists, be a powerful force to reduce the cost of health care.

Finally, it is important to note that most of the spending in the draft legislation will go for subsidies that directly lower the cost of health insurance for families and individuals with low or modest income. The report simply ignores this massive source of savings for millions of American households.

Important issues are at stake in health reform. There is ample room for legitimate debate. But responsible participants in that debate should avoid selective use of evidence and try to preserve analytic balance.

From another perspective, Joseph Antos, Health Care and Retirement Policy Scholar at The American Enterprise Institute for Public Policy Research (AEI), pointed out budget assumptions built into the Finance Committee's bill. Before joining AEI, Antos was Assistant Director for Health and Human Resources at the Congressional Budget Office (CBO).

According to Antos:

The CBO has calculated that the Finance Committee bill will reduce the federal deficit by $81 billion over the first 10 years, and even more after that. However, the favorable budget score is based on the assumption that Congress will follow through on massive cuts to Medicare providers. Even the CBO questions the reality of those proposed cuts. In particular, the [Finance Committee] bill includes automatic cuts in Medicare payments to hospitals and other health care providers worth $240 billion. Congress is sure to override the cuts in later years.

Similar cuts to physicians have been "deferred" in each of the past five years, and the [Finance Committee] bill once again provides a one-year fix. Raising payments to physicians one year at a time means $217 billion in additional spending through 2019 that is not counted in the bill.

It is likely that the [Finance Committee] bill will add as much as $376 billion to the federal deficit through 2019. A $240 billion increase will result from the proposed -- but most likely never implemented by Congress -- cuts to hospitals, home health agencies, and other Medicare providers. Also not acknowledged in the bill are the $217 billion from higher physician payments if Congress continues to provide relief one year at a time from the formula-driven pay cuts. (That is $217 billion + $240 billion = $457 billion less $81 billion in savings = $376 billion extra cost.)

Amid such divergent views being circulated in Washington, Senate Majority Leader Harry Reid will lead the effort to combine the Finance bill with the Senate Health panel measure. According to an Associated Press report, Reid wants to get health care overhaul legislation onto the Senate floor by the end of October.

Whose numbers would you trust if you were in your senator's shoes?

The Obama administration's "new OSHA" has a simple message for U.S. industry. This message has been delivered loudly and clearly by both Secretary of Labor Hilda Solis and Acting Assistant Secretary for Occupational Safety and Health Jordan Barab. Their message: "There is a new sheriff in town." And we all know what sheriffs do. They aggressively enforce the law. That is exactly what the new Occupational Safety and Health Administration (OSHA) intends to do.

President Barack Obama was elected with the strong backing of organized labor. In return, the new president of the AFL-CIO, Richard Trumka, and other union officials have emphatically promised that organized labor will hold the Obama administration's feet to the fire to make sure that the pro-labor commitments made during his campaign are delivered. One of those commitments is a quick reversal of what the Obama campaign and its union supporters claimed was eight years of the Bush administration OSHA "selling out to big business" to the detriment of worker safety and health, allegedly accomplished through an agenda of lax enforcement, cozy partnerships and cessation of any meaningful standards-setting activities. Through its OSHA appointments, the Obama administration has established that it will, in fact, be delivering on its commitments to labor.

The new OSHA's leadership team

The tone of an agency is set at the top. The leadership team appointed to head the new OSHA leaves no doubt about what the tone of the new OSHA will be.

Labor Secretary Solis is a former member of Congress from California. Before being elected to Congress, Solis served in the California Assembly, became the first Latina elected to the California Senate and worked in the Carter administration's Office of Hispanic Affairs. Her official biography explains that her priorities in Congress included "expanding access to health care, protecting the environment and improving the lives of working families," and that she was the recipient of a John F. Kennedy Profile in Courage Award for her "pioneering work on environmental justice issues."

In a June 2009 speech at the American Society of Safety Engineers' annual conference, Solis said: "There is a new sheriff in town...Make no mistake about it, the Department of Labor is back in the enforcement business. We are serious, very serious." To demonstrate this, one of her first steps was to order an enforcement blitz by OSHA SWAT teams at construction sites across Texas to combat what she said was the state's "dubious distinction of having the most worker fatalities in the nation." Solis also announced that the Department of Labor's budget request includes funding for up to 130 new inspector positions.

The Deputy Assistant Secretary and current acting head of OSHA is Jordan Barab, who previously served as special assistant to the head of OSHA in the Clinton administration. In that position, he helped spearhead the promulgation of the controversial ergonomics workplace safety and health standard that was issued by OSHA but subsequently repealed by Congress. Prior to his appointment as Deputy Assistant Secretary of OSHA, Barab was senior labor policy advisor for health and safety for the House Education and Labor Committee, and before that he worked for the U.S. Chemical Safety and Hazard Investigation Board. Barab was a health and safety specialist for the AFL-CIO from 2001 to 2002, and directed the safety and health program for the American Federation of State, County and Municipal Employees (AFSCME) from 1982 to 1998. In a recent speech at an AFSCME convention, he remarked, "I always tell people that I still bleed AFSCME green." In another speech, he told attendees, "You are not alone. We have your back and your fight is our fight...There's a new sheriff in town."

On July 28, 2009, President Obama nominated David Michaels, PhD, MPH, to be the head of OSHA. This nomination is subject to Senate confirmation. Michaels, an epidemiologist, currently is a research professor at the Department of Environmental and Occupational Health at the George Washington University School of Public Health and Health Services. Michaels is the author of the book Doubt is Their Product: How Industry's Assault on Science Threatens Your Health. In the Clinton administration, Michaels served as Assistant Secretary of Energy for Environment, Safety and Health. In that position, he was the chief architect of an initiative to compensate nuclear weapons workers for occupational illnesses resulting from exposure to radiation, beryllium and other hazards. Key goals of Michaels would be to jump-start OSHA's standards-setting process, with a particular focus on chemical exposure issues and ergonomics. In an editorial, the Washington Times characterized Michaels as a "virulently anti-business epidemiologist." Given the new OSHA's agenda and the OSHA-head nominee's past pointed criticisms of industry, the confirmation hearings will provide early proof of the heated battles that will be fought on the OSHA front during the Obama administration.

Deborah Berkowitz has been named chief of staff at OSHA. Berkowitz is the former health and safety director at the United Food and Commercial Workers' union, and she was very active for the union during OSHA's first round of ergonomics cases in the meatpacking industry in the 1980s and during the Clinton administration's ergonomics rulemaking.

Top priorities for the new OSHA

The top priority of the new OSHA can be summarized in two words: strong enforcement. This will be accomplished in several ways:

• Implementing a "Severe Violators Inspection Program" that focuses on large employers whose histories of OSHA violations demonstrate, in OSHA's view, that they do not take their compliance obligations seriously and need to be targeted for very aggressive enforcement in order to get the message.

• Working more closely with the U.S. Department of Justice to increase the number of criminal prosecutions for workplace fatalities, injuries and illnesses.

• Supporting legislative OSHA reform efforts that include substantial increases in penalties, both criminal and civil.

• Increasing the number of inspectors; the number of inspections conducted; the number of citations issued, particularly for serious, repeat and willful violations; and the amount of penalties proposed for violations -- a more aggressive enforcement approach signaled by OSHA's June 22, 2009, proposal of $1,145, 200 in penalties against a company for combustible dust and other alleged safety violations.

• Focusing on specific enforcement issues through National Emphasis Programs (NEPs), including continuing the NEPs for process safety management compliance (PSM) at refineries and for combustible dust hazards, rolling out the NEP for PSM compliance at chemical facilities, and establishing an NEP for auditing compliance with OSHA's injury and illness recordkeeping requirements, which the new OSHA believes is a seriously flawed system as a result of what it believes is widespread "cheating."

• Decreasing what it believes was the Bush administration's over-reliance on partnerships, alliances and company participation in Voluntary Protection Programs.

What companies must do to prepare for the new OSHA

Given that the current direction of OSHA is so clear, companies have all the warning needed as well as an opportunity to ensure that their OSHA-compliance houses are in order before OSHA arrives at their doorsteps. Here is what must be done:

• Establish a Catastrophe Response and Management Plan. Workplace catastrophes present extremely large risks on a number of fronts. The way in which you manage those risks following workplace catastrophes in both the short and long terms are key to minimizing potentially substantial liabilities. You need a comprehensive, well-thought-out plan to manage the situation, including managing the multi-agency investigations that will follow, that can be triggered and effectively implemented on a moment's notice.

• Verify through compliance reviews that your OSHA-required safety and health programs are in place. Ensure that written programs, which may look good on paper and in binders, are in fact effectively implemented in your workplaces. Ensure that your OSHA-required injury and illness recordkeeping files are accurate and up-to-date. The new OSHA will be focused on looking behind the scenes and talking to employees to get the "real story" about their employers' safety and health efforts.

• Focus on your "key risks," meaning the specific risks at your workplace that are actually faced by your employees on a frequent basis and which present the most exposure to a risk of serious injuries or death. Focusing on your actual key risks in a consistent, demonstrable manner will go a long way toward minimizing your overall risk of a significant OSHA enforcement action.

• Ensure that your safety and health program demonstrates a "top-down" as well as a "bottom-up" commitment to worker safety and health. Without the demonstrated interest and commitment of your company executives as well as your front-line workers, the results of your safety and health efforts will not be maximized.

• Have a plan in place to manage OSHA inspections in a careful, thought-out manner to minimize the possibility that a significant enforcement action will result, as well as a plan that ensures that every OSHA citation that is issued is properly analyzed to determine not only its validity, but also its potential effect on your company's overall OSHA violation history and its other impacts to the company. Because of the potential negative impacts of OSHA citations, decisions as to whether to appeal or accept citations will be increasingly important.

Taking the time now to determine how your company measures up in these key areas will put you in a much better position to effectively anticipate, minimize and deal with the aggressive enforcement promised by the new OSHA.

Mr. Lastowka has practiced exclusively in the field of occupational safety and health for nearly 30 years. He is a recognized authority on OSHA and MSHA law whose practice includes providing compliance counseling, conducting safety and health audits and due diligence reviews, handling the full range of OSHA and MSHA litigation. He can be reached at (202) 756-8245 or jlastowka@mwe.com.

In a recent article on the San Francisco Chronicle's Web site, Dr. Deepak Chopra speculates that a lot of what's wrong with health care today can be attributed to the false notion that more is better. As a society, Dr. Chopra suggests, we've come to believe that by undergoing more tests, receiving additional procedures, taking more drugs and seeing more doctors more often, we'll be healthier. He offers myriad statistics to highlight the inefficiencies in our health care system and underscore the need for vast improvements.

Dr. Chopra's statistics also make clear the need for the increased use of technology as part of our reform efforts. With proper evidence-based clinical support and intelligence tools, physicians would be better able to determine medical necessity, which would help to lower the number of unnecessary procedures and the growing costs associated with them. With electronic medical records providing a more complete picture of a patient's medical background, it's likely we could forego certain tests, medications and specialist visits. With a greater breadth and depth of patient information readily at hand, clinicians could more quickly and assuredly make more informed decisions. That alone would support operational efficiencies and result in considerable savings. We can also extend technology to better educate patients and enable them to make more valuable contributions to the decision-making process. With greater knowledge, they themselves can help decide whether or not a certain test or procedure is in their best interest, or if the rewards of a certain medication are worth the potential risks, and so on.

These types of technologies are readily available and, given the potential return on investment, are relatively inexpensive to implement. While the debates in Washington and around the nation continue to focus on health insurance reform, it is important for all of us to understand that there are other, far less controversial and polarizing ways to generate health care reform. Technology is quite possibly the most promising and certainly a strategy through which we can begin making inroads while we argue the details of a more comprehensive plan.

The hot topic for this summer has been health care reform. It has consumed our Congress as well as most of our national publications and TV/radio talk shows. In spite of all this attention, we still do not have a solution. In my view, we have focused too much on one possible approach -- the national health care option -- and have not focused on the basic problem that we need to address. Please consider a perspective that perhaps has not been advanced as much as it should if we are ever to address the core issue.

From my perspective, the current discussion is far too preoccupied with the question of who pays. And, for many, it is apparent that national health insurance, in some form, must be implemented to ensure that all Americans have access to high-quality, affordable health care. While probably no one quarrels with the goal, it is questionable whether the proposed remedy addresses the real problem. Let me explain.

The awkward dinner party

Picture a group of friends who meet periodically at a posh restaurant for dinner. The food and the wine are excellent and good humor prevails until after the brandy when the waiter discreetly places the check in the middle of the table. It is immediately apparent that the prices have gone up two to three times faster than the incomes of the diners since they last dined together. Uncomfortable jockeying to avoid picking up the check begins.

One diner, an automaker from Detroit, complains that health benefits for his workers now cost over $1,000 per car and are significantly higher than his Japanese and European competitors, and the gap continues to widen. The time when he could pass these increases on through higher prices has ended. Prices are no longer set in Detroit. They are set in Tokyo and Frankfurt. He is now forced to close plants; Mr. Detroit wonders if it isn't time for the small business owner sitting next to him to pick up his fair share.

After quelling the outburst of coughing this suggestion provoked, the small business owner makes his case for avoiding the check. Always hanging on by his fingernails, he is beset by increased regulation, a higher minimum wage, tougher foreign competition and limited access to capital. He reminds one and all that he alone accounts for new jobs in America. He is sorry, but if you saddle him with the bill, you will have to kiss new jobs goodbye. He looks across the table at the woman from Washington.

Ms. Washington stares at the check, slowly shaking her head. Then she explains how the government is caught squarely in the middle of the deficit and the desire to avoid new taxes to maintain any semblance of economic recovery and growth. She's also concerned about international competitiveness as well as recognizing that Medicare and Medicaid programs are running out of money.

The resulting silence is broken only when someone suggests that maybe next time they should eat at a cheaper restaurant.

Nobody notices the people outside looking through the window who apparently have nothing to eat at all.

The debate

Unfortunately, the debate over health care reform is too often limited to the question of who picks up the check. With health care consuming nearly 20 percent of our gross domestic product and continuing to increase, we must start by admitting that nobody can pick up that check. Increasingly, our choices are constrained by the world economy. If we keep arguing about how to divvy up the check, it's likely we will all end up washing dishes.

What to do? The answer seems clear: We must eat at a cheaper restaurant. Figuring out how to do this, still be adequately nourished, and be able to invite hungry people standing outside to join us is the task at hand.

A perplexing case study

Some people have suggested that management deficiencies in hospitals contribute to excessive costs. I'd like to suggest a different perspective: Imagine a manufacturing plant -- a large job shop employing perhaps 2,000 people. On any given day, 300-400 jobs are active in the plant. Any given job takes five or six days to complete. As we study the plant more closely, we discover a curious thing. Every morning, about 100 or so manufacturing planners walk into the plant, write shop orders defining the work to be done that day on their particular jobs by the 2,000 plant workers -- cutting, drilling, milling, grinding, inspecting, assembling, painting and the like -- and then walk out.

We stop several of these shop planners in the parking lot as they are leaving, and discover a strange thing. Indeed, few of the planners are actually employed by the plant; most are paid directly or indirectly by the plant's customers. Although they have implicitly defined almost all of the plant's costs by the shop orders they have written, they bear no responsibility for them nor are they economically affected by them. Upon closer questioning, we discover that, moreover, most are ignorant of the costs incurred by the plant as a result of their shop orders. Asked to guess, their estimates are almost always grossly in error.

If we were to present this story as a case study to first-year students at Harvard Business School, not one would fail to point out the problem. Our plant has broken a cardinal rule of management: Never separate authority from accountability. The students would probably go on to add that they've never seen such an unrealistic case study. But they'd be wrong and you know why -- this is exactly the situation today with hospitals and doctors.

The solution seems clear. We must reassert the necessity to place authority and accountability in common hands. Whose hands? It must be the physicians; there is no other rational choice, because each decision made in a hospital has both clinical and economic implications. Hospitals and doctors are directly responsible for 31 percent of health care costs and indirectly affect much of the remaining costs (e.g. prescriptions for drugs and follow-on services).

The responsibility is ours

I firmly believe there are specific and immediate actions on which hospitals anddoctors can collaborate to drive the cost of healthcare down. These include:

• Making physicians more aware of the hospital costs of commonly ordered drugs and services; monitoring the resources they consume in relation to the quality of their outcomes.
• Creating standard disease management protocols for the chronic diseases (e.g., diabetes and asthma) that consume a very high percentage of health care expenses. These protocols should provide quality and effective care while reducing the wide variation in treatment expense (e.g., unnecessary laboratory tests and lower cost drugs).
• For patients in the last days of their lives, creating standard protocols that emphasize home care and minimize significantly more expensive (up to 10 times more!) hospital care that has no positive effect on quality of life.
• Understanding why many health care costs, such as laboratory costs, are growing at a significantly faster rate than inflation and taking corrective steps.
• Understanding the large variation in length-of-stay among hospitals for similar illnesses and procedures and taking corrective steps. For example, Time magazine recently reported a $40,410 difference in the cost of care for the last two weeks of a Medicare patient's life between Mayo Clinic ($53,422) and UCLA ($93,842).
• Eliminating unnecessary cesarean births.
• Eliminating unnecessary coronary bypass surgeries for patients who gain no increase in lifespan beyond what they would have achieved through medical management of their condition.
• Eliminating unnecessary pacemaker implants.
• Eliminating unnecessary upper gastrointestinal procedures that do not result in any change in treatment.
• Curtailing the ‘arms race' in construction and new services, especially for services where volume is decreasing such as CABGs.

I could go on, but it seems to me that doctors and hospitals have it within their combined scope of authority and responsibility to address the rising costs and to do so quickly. Clearly, they must work together -- either voluntarily or by government mandate. As CIO, you have the wherewithal to provide the tools to facilitate this partnership (e.g., online protocols and evidence-based medicine reports).

As a tangential comment, I do not believe that all of the recent government-provided funding for health care IT will achieve its anticipated result until it is directed toward this critical initiative.

The issue is not who pays for health care, but rather how do we drive down the costs of the (currently very inefficient and expensive) health care delivery system while improving our quality (and not quantity) of care. If we set our minds to it, I believe we can do it and without government intervention and control.

After taking Flomax, used to treat the symptoms of an enlarged prostate, instead of Volmax, used to relieve bronchospasm, a 50-year-old woman was hospitalized.

After he was given clozapine instead of olanzapine, two drugs used to treat schizophrenia, 19-year-old man showed signs of potentially fatal complications.

After receiving methadone instead of methylphenidate, a drug used to treat attention deficit disorders, an 8-year-old died, according to MedicineNet.com.

Getting patient and drug names right is crucial to the success of health care IT.

More than 4.8 million wrong drug errors occur per year in the United States, according to the Journal of the American Pharmacists Association. And as more drugs get approved, this problem can only get worse, making us even more vulnerable.

Physicians, pharmacists, nurses and patients are more likely to confuse drug names that look or sound alike (e.g., ephedrine and epinephrine, Taxol and Paxil, vinblastine and vincristine, Actos and Actonel).

We see errors happen at every stage of the medication process: prescribing, transcribing, dispensing, administration and monitoring. They can occur with handwritten and typewritten prescriptions and they can occur when prescriptions are communicated by phone, fax and computer.

The risks posed by similar drug names are well known, but until recently it has been difficult to do much about it. Historically, the problem has been approached by compiling lists of confusing names, publishing those lists, and warning practitioners (and, to a lesser extent, patients) to be extra vigilant when dealing with confusing names.

Computer systems for ordering and dispensing drugs sometimes come with built-in warnings. Sometimes pharmacists post warning signs on the shelf next to particularly confusing names, or they store such drugs in separate areas of the pharmacy.

Having objective, numerical similarity scores provided by analytics makes it possible to predict and prevent drug-name confusions in new ways such as using similarity measures as the basis for a drug-name search engine.

For example, the manufacturer of a new drug can submit the new drug name into the search engine and retrieve a list of existing drug names, with the new names on top of the resulting list and the least similar names at the bottom.

Now, new drug names can be carefully screened prior to approval, and highly similar, potentially confusing names can be kept off the market. Name similarity software also can be used to look at existing drug names -- for example, all drugs used by a given hospital -- and the most similar pairs can be identified and targeted for error prevention.

And drug name confusion is just one of the problems that threaten patient safety.

A 67-year-old woman received invasive cardiac electrophysiology. The problem was, she didn't need it.  Seventeen discrete errors resulted in a woman receiving a cardiac electrophysiology procedure intended for another patient with a similar last name, according to the Annals of Internal Medicine.

The use of fully digitized medical records has introduced greater consistency in health information systems. But the possibility for rapid propagation of errors can start during data entry of a patient's name. Effective and accurate merging of patient medical records hinges on whether we capture patient information accurately.

As new stimulus investments drive the effort to digitize medical records, we are seeing the need for better analytics to ensure consistent, accurate capture of patient name data at point of intake by flagging potential inconsistencies and miscategorized name-parts (e.g., last name in first name position) while the patient is still present to clarify or correct.

And while collecting patient name data accurately is critical for treatment, accurate data also allows analytic insights into patient demographics. We can glean a higher level of intelligence so hospitals can provide doctors and nurses up-to-date information on specific illnesses and diseases; tracking diagnostic and treatment successes enables more effective treatment of patients.

Improved name-processing techniques for health care also can provide important analytical insights into ethnicity, national origin, native language, and even unanticipated relationships or connections in the entire patient demographic, such as locating an organ donor or rare blood type.

For example, if a hospital sees from patient records that 30 percent of its demographic is Korean, then it can ensure it has staff who can speak the language, a critical factor when working in an emergency room where seconds can mean the difference between life and death.

For larger health care providers, effective strategic use of name analytics can yield valuable insights to detect demographic trends in the surrounding community and to predict where there will be a need for improved customer-care and communications. Outreach, education and prevention programs can be kept fresh and effective by staying in touch with the changing blend of cultures and languages that are being served.

Many medical errors associated with name confusion can be prevented. For instance, alerts can be sent to caregivers when a name has been incorrectly captured into the master patient index (MPI) system, or when there is significant potential for errors due to names shared by two or more patients currently under care within that system.

We need to do a better job of providing the right training to caregivers, and medical intake and record-keeping personnel, with special attention paid to capturing data of patients from unfamiliar cultural/ethnic backgrounds whose names may fit poorly or not at all into the typical First-Middle-Last pattern used in many Western countries.

In addition, extra quality-control must be placed on patient names as they are converted from spoken/recorded to handwritten forms, then converted from handwritten to electronic form. These multiple steps are fertile ground for potentially harmful transcription errors. 

At the same time, key health care information technology (HIT) assets such as master patient index (MPI) systems need to provide state-of-the-art support for searching and analysis of names across all segments in patient demographics.

Sustainable progress in U.S. health policies and medical practices should include a renewed emphasis on getting names right. Driving out unnecessary medical risks and treatment costs associated with drug-name and patient-name errors can have a pervasively life-saving impact; using patient-name analytics can be a key preventive step for both patients and health care organizations. 

There's no denying the importance of health care reform within President Barack Obama's agenda. In a July 28 interview with Time magazine's Karen Tumulty, the president said that in the last two to three weeks, he's been spending at least a third of his time focused on health care.

He explained the detailed level of his policy push:

"Certainly we spend a lot of time with our health-care team talking both policy and politics. I'm reaching out to members of Congress, meeting with them or talking to them on the phone to get their perspectives. Speaking to the public is absolutely critical, and so today, for example, I was over at AARP trying to answer questions of the public. So whenever we're in the middle of a big legislative effort like this, it's going to attract a lot of my attention, as well as my team's attention."

The full transcript of the interview will appear on Time.com on July 30.

In the halls of Congress, in the media, in the coffee shops and restaurants of Washington, D.C. -- health care reform is dominating the conversation, and for good reason. We have an enormous opportunity, and a small window of time, to make the transformational changes to our health system that we urgently need. 

As the health care reform debate unfolds, the National Partnership for Women & Families is working tirelessly to remind Congress of the challenges women face in obtaining high-quality, affordable health care for ourselves and our families. It's our job to remind lawmakers what's at stake for women in health care reform. To that end, we've outlined those challenges along with our recommended policy solutions in a new Issue Brief titled Health Care Reform: What Women Need. 

Unfortunately, when you look at the reality of women's lives, it's clear that our system is in many -- and perhaps most -- ways, failing us. More than many other populations, we experience high costs, inadequate coverage and poor quality care at the same time that we're required to regularly intersect with a broken system. Consider that women are often the primary health care decision-makers for their families -- choosing the providers for family members; making and sharing in treatment decisions; and coordinating and providing much of the care ourselves. Many young women lack access to the primary, preventive, and reproductive health care they need. Women in their middle years who are caring for aging parents are simultaneously developing their own chronic conditions, compounding the already overwhelming job of being a caregiver themselves. 

In our Issue Brief, we provide in-depth analysis of the state of health care for women along with solutions we believe will bring meaningful change to women's lives. These solutions include:

• Affordability. Making care and health coverage more affordable in a number of ways including capping out-of-pocket costs and premiums so that no family pays more than 10 percent of their income on health coverage and allowing more families access to basic and primary health services through Medicaid. 
• Quality. Reforming our delivery and payment systems so that high-quality patient- and family-centered care is rewarded and value of care is compensated over volume of services.
• Choice of plan. Creating a health insurance exchange that allows individuals and families to compare plans, just as they would with any major family purchase, so they know they are choosing the best insurance plan for their needs. 
• Market protections. Applying federal rating rules across the board and preventing insurance companies from denying coverage to someone based on their age, gender, or a pre-existing condition.
• Adequate coverage. Guaranteeing that insurance coverage be comprehensive and at a minimum cover preventive and primary care, emergency services, hospitalization, outpatient services, maternity and newborn care, medical and surgical care, prescription drugs, mental health and substance abuse services, and comprehensive reproductive care, without lifetime or annual limits on any benefits.
• Reliability. Eliminating barriers to enrollment in public programs and offering a public health insurance option so consumers have a high-quality, affordable choice for health coverage.   

Real reform must address the realities of women's lives and the hardships we face in getting quality, affordable care. The health of our families, and our strength and vitality as a nation, depends on health care reform succeeding. 

For more in-depth analysis on each of these areas of reform, please see Health Care Reform: What Women Need.

Medical billing is about to get a lot more complicated. If your medical practice hasn't kept pace with new billing requirements, or if you're bogged down by receivables, it may be time to take action.

As part of its health care reform plan, the Obama administration is calling for a standards- based electronic health information system and the widespread adoption of electronic medical records. The administration says that the expanded use of electronic medical records could save over $77 billion each year in improved efficiencies.

The call for a more robust health information system aligns with the government's plan to overhaul the aging coding system used by medical practitioners to bill insurers. The new coding system, ICD-10, expands on an older version developed in 1977 by the World Health Organization. ICD-10 increases the number of codes by almost ten-fold, from 17,000 to 155,000. The new system includes 68,000 diagnostic codes, up from 13,000, and 87,000 codes for medical procedures, up from 3,000. Practitioners are expected to switch over to the new system by 2013. (Source: Zhang, Jane, "Why We Need 1,170 Codes for Angioplasty" Wall Street Journal, Nov, 11, 2008)

Hospitals and medical practitioners have hailed the new coding system because it will allow them to more accurately describe -- and bill for -- diagnoses and complex medical procedures. But the new system is also expected to create havoc in their billing offices. According to the Centers for Medicare and Medicaid Services (CMS), it's expected that the new system will increase the number of claims returned because of coding errors by 10 percent. And, at least in the short term, health care providers can anticipate greater delays in getting paid.

Then there's the change from Unique Provider Identification Number (UPIN) to National Provider Identifier (NPI), the new numbering system used by CMS to identify providers of Medicare services. All individual HIPAA-covered health care providers (physicians, physician assistants, nurse practitioners, dentists, chiropractors, physical therapists, etc.) or organizations (hospitals, home health care agencies, nursing homes, residential treatment centers, group practices, laboratories, pharmacies, medical equipment companies, etc.) must obtain an NPI for use in all HIPAA standard transactions. Commercial insurance carriers will use NPIs, too. Some practitioners will be required to have two NPI numbers, (one for the individual practitioner and one for the group practice) and many private insurers will still require their own identification number. (Source: www.cms.hhs.gov)

Sound complicated? It is. Medical billing is considered one of the most complicated of all business revenue cycles, with an average of 14 steps compared to the six or eight that are common in other types of businesses. Pre registration, health insurer verification, documentation of services provided, assignment of codes, code verification and review, pre authorization, claim generation, claim review, claims processing, adjudication and payment, collection/claim follow-up and, when necessary, claims appeal are all part of the process.

To manage the complexities of medical billing -- and the sheer volume of claims filed -- many practitioners have moved away from paper claims to an automated system. Of the more than 6 billion insurance claims filed each year, about 60 percent are now filed electronically. Automated claims have helped reduce error rates, but even with an automated system, there's a lot for practitioners and their billing staffs to keep track of.

Billing codes change regularly. Insurers can implement new regulations or change their reimbursement payment policies, often without warning. Staffing and computer problems occur. Small mistakes, such as keying errors, can go unnoticed. The sheer volume of claims makes it hard to catch up, and huge workloads make it difficult to evaluate office procedures. It's hard enough keeping track of medical advances; the huge demands of health care reform and regular changes in claims adjudication can severely tax the resources of many health care providers. To stay in business, it's imperative that health care practitioners adopt more efficient business practices. Outstanding receivables and bad-debt write-offs should not be tolerated in today's modern medical office. Yet even with electronic billing, mistakes still occur that can cost the practitioner or group time, money or both. (Source: Reinke, Thomas W.; Hilbert, Timothy C, "Improving Physician Billing Departments" www.physiciannews.com)

It's understandable, then, that many doctors and other health care providers have outsourced their billing departments.

Outsourcing can help streamline the billing and collections process as most reputable billing companies have experience working with multiple carriers and providers. (In addition to Medicare and Medicaid, there are over 3,000 private insurers, each with its own policies and procedures.) Because billing companies handle more claims than most medical offices, they must stay current on federal and state CMS updates, as well as changes in payment policies for major payers. This expertise can increase revenue by reducing the number of delinquent and denied claims.

Outsourcing can also reduce overhead. Fewer personnel mean less cost in salaries, benefits and turnover. Outsourcing can also reduce the expense of hardware, software and training typically required by in-house billing departments. Billing companies can provide medical practices with a variety of standard and custom reports to make their operations run more smoothly. But above all, outsourcing makes it possible for medical practitioners to spend less time on office operations and more time on the health and well-being of their patients.

How to choose a billing company

 Billing companies range in size from small, independent practitioners to larger firms, and can offer a variety of services. Choose wisely. Not all firms have the expertise to meet the needs of a modern, busy medical practice, or the skills and resources to provide secure, uninterrupted service. Your billing service should have the experience to handle a broad set of requirements, and be able to address the needs of solo practitioners, and small and large group practices. The more experience the company has, the more responsive the company can be to the needs of your practice.

What specifically should you look for when retaining the services of a billing company? Here are some practical considerations:

• Electronic claims submission and payment programs with all major carriers;
• Timely implementation of federal and state updates and changes;
• Denial follow-up and resolution;
• Patient statement preparation and the ability to respond to patient inquiries;
• Access to and experience in using of state-of-the-art billing software;
• Assigned staff and back-up for full-cycle claims submission through collection;
• Electronic claim status inquiries and eligibility capabilities;
• Compliance with HIPAA portability and privacy standards;
• Expertise in managed care rules, regulations and restrictions;
• Longstanding and established contacts in the insurance industry;
• State-of-the-art billing software;
• Standard and custom management reports, prepared in a timely manner;
• Clinical expertise and diversity of practice in a number of specialties;
• Education and training on documentation and billing compliance;
• Periodic internal audit and self-reviews;
• The ability to offer education and training on documentation and billing compliance;
• Banking services and an experienced and recognized management team; and
• Excellent collection rates and competitive pricing.

Ms. Nager is a health care expert with over 35 years of experience in inpatient and outpatient management, strategic planning, marketing, operations, budgeting, fiscal responsibility, medical and behavioral care, regulatory requirements and business development.

Guest commentary from Lee Barrett, executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC), a non-profit standards-development and accreditation organization.

Information technology has been mature enough to transform health care for years. The HITECH Act has now cemented the business case. The biggest remaining obstacle to achieving the benefits of interoperability -- everything from e-prescribing to truly accessible medical records -- is building trust and confidence among data-sharing partners.

The chief privacy and security threats are already familiar to most: constant breaches, internal snooping and even piratical extortion more creative than what we've seen from Somalia. Clearly, organizations must get their houses in order. But the actions or inactions of their data-sharing partners can also put them at risk with regulators and the marketplace. They need a dose of confidence in the abilities of their application vendors, service providers and peer organizations. Also along those lines, as health care management grows in complexity, organizations are looking for ways to gain assurance regarding technical performance, customer service levels and resource capacity for all business partners.

Health care organizations need a model for controlling risk and vetting data-sharing partners at three levels. The first is the application level. As software moves to the application service provider (ASP) model, by which applications are hosted off-site via Internet, verifying these systems becomes as important as demonstrating reliable technical performance and scalability. The second group is transaction-based service providers, such as claims clearinghouses, e-prescribing services or financial services firms. Beyond assurance that they are HIPAA-compliant and HITECH-ready, provider organizations spend much energy assessing prospective partners' customer support and business processes. Lastly, at the community level, there is a tremendous need for confidence among peers across technical, operational, administrative and all other areas. Regional health information organizations (RHIOs) have an accountability dilemma: No data sharing due to fears about data integrity and no confidence because few have a history of sharing data.

Given the urgent need, what are the industry's options for establishing this accountability? These are discussed in an excellent research paper, New York's Health IT Strategy: RHIO Governance & Accountability. Expanding on that discussion, these are the three main options:

• The laissez-faire or "hands off" approach requires contracts between and among organizations. It's buyer beware. It's also "buyer manage a large number of complex agreements with no practical enforcement mechanism." This model has potential for much litigation.

• The Soviet approach would use central planning and call for hands-on oversight and management by a representative entity (that is, a government agency). To put it mildly, this approach is typically unpopular in the U.S.

• The accreditation approach requires that industry stakeholders work together, through an independent organization using transparent process, to develop standards. This group then confers accreditation on willing organizations. Those who demonstrate excellence use the distinction to their advantage in the marketplace. Accreditation models can be devised that allow flexibility for the candidate in terms of specific tools and methods yet evaluate it against performance standards and criteria that are more results-oriented.

EHNAC -- which gathers consumer groups, payers, hospitals, physicians, security organizations, electronic health network vendors and others to develop standards criteria -- has successfully accredited one type of service provider for years: electronic health networks or, more specifically, claims clearinghouse services. More recently, we have expanded to cover e-prescribing and financial services providers. At the application level, we apply the accreditation approach to ASP-based electronic health records; our beta testing begins in the summer of 2009. At the community level, we're developing an accreditation framework for health information exchange that can be used by RHIOs. That beta program begins in the fall.

We're making great progress, but awareness about accreditation is going to be critical. Provider organizations need to know what accreditation means. They simply need to know to ask the question "are you accredited?" and understand the due diligence that accreditation represents.

As long as provider organizations don't find a satisfactory solution, progress toward interoperability will be delayed. In addition to missing out on productivity, efficiency and quality benefits, health care will continue to rely on paper. And as any quick Internet news search will reveal, paper-based medical records do not necessarily solve accountability problems.

Surescripts made the announcement in conjunction with the release of the company's "National Progress Report on E-prescribing." The report, based on the operations of the Surescripts network, details the status of e-prescribing adoption and use in the U.S. from 2006 through 2008.

Among the report's key findings:

• By the end of 2008, there were 74,000 active prescribers -- vs. 36,000 at the end of 2007 and 16,000 in 2006.
• Prescriber use of benefit information and prescription history grew from 37 million in 2007 to 78 million in 2008, and from 6 million in 2007 to 16 million in 2008, respectively.
• Prescriptions routed electronically more than doubled from 29 million in 2007 to 68 million in 2008.
• By the end of 2008, increased participation by payers in e-prescribing enabled access to prescription benefit and history information for 65 percent of patients in the U.S.
• Seven states are connected to the Surescripts network through their pharmacy benefit managers to deliver prescription information for fee-for-service Medicaid patients.
• At the end of 2008, approximately 76 percent of community pharmacies and six of the largest mail-order pharmacies in the U.S. were connected for prescription routing.

Harry Totonis, president and CEO of Surescripts, commented, "[W]hile this growth shows clear evidence that the steps taken by policymakers, prescribers, payers, pharmacies and others are having a positive impact, swift and specific action is required for the U.S. to achieve mainstream adoption and use of e-prescribing."

Surescripts acknowledged that only about 10 percent of eligible prescriptions are currently routed electronically. The company recommends that five actions be taken at the earliest opportunity to continue the growth of e-prescribing use and adoption and to further secure reductions in cost as well as improvements in safety and efficiency:

1) Continue to work with the U.S. Drug Enforcement Administration to pass regulations that allow controlled substances to be electronically prescribed in a way that is workable and scalable.

2) Work to ensure that "meaningful use" under the American Recovery and Reinvestment Act of 2009 requires the actual use of e-prescribing.

3) Fill gaps in e-prescribing participation among payers, state Medicaid programs and independent pharmacies.

4) Raise awareness across the industry and encourage deployment and use of e-prescribing -- encompassing prescription benefit, prescription history and prescription routing.

5) Provide education, financial incentives and implementation assistance for all prescribers, with a particular focus on addressing the needs of small and medium-size practices.

 You can access a downloadable version of the report by visiting www.surescripts.com/e-prescribing-statistics.html.

For example, Absolute Software, a provider of firmware-based computer-theft recovery, data protection and IT asset management solutions, points out that ARRA's incentives will revolutionize record-keeping, making medical records available throughout hospitals on mobile computers, tablet PCs and shared terminals.

"With this accessibility and increased efficiency," the company warns, "health care providers need to be aware of and address the vulnerabilities of such systems to data breaches and theft."

The company's Web site lists five best practices for keeping data secure in the age of ARRA:

1) Know the consequences of a data breach. According to a recent study from the Ponemon Institute, organizations that experienced a data breach in 2008 paid an average of $6.6 million to rebuild their brand image and retain their customers. The study also found that health care companies lost the most business resulting from data breaches compared to any other industry.

2) Assess your organization's situation. Health care managers should properly assess all areas of the facility where confidential data may be stored, then determine who has access to them and how they are being protected. Before an organization can begin to streamline its IT security, it must have a firm understanding of what it needs to protect.

3) Implement a comprehensive data security plan. Even with encryption in place, 56 percent of employees disable their company-issued encryption solution. Security and asset management solutions should be part of a multilayered approach in protecting organizational computers. Absolute Software noted that its Computrace product has the ability to track and recover missing laptops as well as to remotely delete sensitive files. (The software is embedded in the firmware of computers from ASUS, Dell, Fujitsu, General Dynamics Itronix, HP, Lenovo, Motion, Panasonic and Toshiba.) The company also has a product that allows IT managers to monitor and protect smart phones in a similar fashion.

4) Secure data on mobile computers. The more hospitals use mobile computers and PDAs, the higher the risk of theft and data ending up in the wrong hands. A multi-layered approach to data security and theft is necessary to protect these assets.

5) Create a data breach policy. In the event of a data breach, a standard procedure should be in place to minimize damage and provide timely notification of supervisors, law enforcement, patients and the media, as necessary.

Pulling together as a nation to overhaul an aging, often paper-based medical records system is long overdue. We can all agree it will create jobs, pump money into various industries and make managing a fast-growing patient base much easier. With great potential comes great risk -- in this case, risk of stretching an ailing health care IT industry to the breaking point. Legacy systems abound, support for decade's-old central infrastructure no longer exists, and facilities must consider increased privacy and regulatory measures.

Clearly, outsourcing is the most attractive solution within an economy of reduced IT budgets -- a solution that can be greatly improved for the betterment of all involved with the planning and building of EMRs. As a theme, "risk" often starts with traditional outsourcing arrangements emphasizing getting to the lowest bid...as opposed to getting to the best business value. The health care IT industry needs this to change. In my opinion, this change should follow a few basic guidelines.

1) Outsourcing should generate a favorable return. The goal of an outsourcing investment should be achieving a specific business result -- not simply buying cheaper labor. Project risks and execution should be shared responsibilities between you and your outsourcing partner. If you structure the outsourcing partnership correctly, risk reduction happens automatically -- thereby reducing your costs.

2) Methodology matters. Demand that the specific methodology of outsourcing and project execution is an explicit part of your vendor's business proposition. Project governance should be the responsibility of the vendor. Make sure that methodology and governance address the risks of project execution, as well as unique risks of distributed development.

3) Success is a joint responsibility. Success is a function of the time and effort invested into the project by the stakeholders (engineering, IT and business users). The absolute key to success is frequent and timely feedback by the all the stakeholders, particularly on the business side. Whenever possible, clearly identify the decision-making criteria in advance so that the team can work most effectively to meet your business goals.

4) Things will change. Within any project, change is inevitable. Make sure the business model and the methodology are nimble enough to absorb business change, and that the sign-off approving project change is held in the relevant hands. To ensure maximum project return, reassess and reconfirm priorities periodically during the project as part of the project execution methodology.

5) Align end to end. Because outsourced projects rely on resources who are working for a different company, there is the potential for staff changes to affect your intellectual property and project control. The best way to minimize this risk is to make sure your outsourcing business model aligns you and your outsourcing vendor all the way from overall business goals down to the staff level. Specifically, verify that the HR and compensation strategy of the vendor aligns with your project goals.

The health care technology industry has already asked IT departments to do more with less, reduce staff and stretch existing legacy systems far beyond their original life expectancy. Under the normal circumstances of a down economy this is a risk organizations are forced to take. The mandated EMR system implementation compounds this situation and will push outsourcing practices to change.

President Obama's economic recovery package allows for billions of dollars for health care IT investment. As the recovery package begins to be distributed, hospitals and health care providers have significant monetary incentives to demonstrate "meaningful use of certified electronic health record (EHR) technology."

The benefits of EHR systems are numerous. However, for those organizations that want to maximize the amount of stimulus funds received, the time to begin the transition is now, as EHR implementation is a long and challenging road.

In order to encourage hospitals to make an early switch to EHRs, the millions offered in incentive payments will incrementally decrease the longer a hospital waits to adopt the electronic system. Hospitals that implement the EHR system within the first three payout years (2011 - 2013) will receive the maximum funds, each year thereafter decreasing by 25 percent until eventually funding disappears.

Hospitals will also be penalized for not making the switch to EHRs with decreased Medicare and Medicaid reimbursement. For example, if an organization is not EHR-equipped, it may only receive 95 percent reimbursement, versus the 100 percent reimbursement that an EHR-equipped hospital might receive.

While there's certainly some resistance among the health care community in implementing EHRs, we must realize that electronic record keeping is certain to become standard given the administration's focus and the direct involvement of heavyweight corporations such as Wal-Mart.

As hospitals and health care providers grapple with rapid advancements in technology, the new breed of doctors that grew up in the Internet age choose to work for institutions that employ the most modern and up-to-date communications and EHR systems. So, another major benefit of EHR technology is its influence on attracting and retaining the best talent.

Beyond all the benefits for hospitals, an EHR system has a real life-saving potential. EHRs allow for not only the rapid transfer of information from physician to pharmacy but also the ability for medical professionals to access records simultaneously, reduce errors and cross check prescriptions for contraindications. Especially during emergency situations, easy access to records can make the difference in life-threatening situations. Soon, EHRs will enable paramedics to access patient records, on-site, in real time, identifying any pre-existing conditions or allergies to medications.

Finally, by avoiding multiple entries, EHRs can increase efficiencies and streamline operations, allowing hospitals to shift focus from heavy clerical tasks to more mission-critical tasks.

EHR implementation, depending on where a specific organization is in the transition process, can take 2-3 years. Therefore, it is critical to take the right steps toward implementation now in order to receive maximum stimulus funds and ensure a smooth and timely transition.

In essence, EHR implementation is a six-step process. The first step is an initial assessment of a hospital's existing infrastructure and data to determine its quantity, quality and age. Patient records must be up-to-date and consistent throughout the hospital prior to the transition to ensure a flawless switch. 

Once the infrastructure has been assessed, the future state of the hospital must be defined to answer the question: Which best practices need to be implemented for this particular hospital system?

A gap analysis will then define what will need to be upgraded or reformatted to interface each system into the future state, followed by the development of an overarching strategy to close the gap.

Once a strategic plan is in place, the next step is to build a business case that includes the cost of the implementation, time needed for completion, long-term payback and any other advantages or disadvantages to be realized through the implementation.

Lastly, the longest and most challenging step is the implementation, which will involve implementing both the technical specifications of the envisioned system as well as the business process to enable the desired shift. This stage includes vendor analysis, hardware and software implementation, and building custom software for the institution. All the appropriate business processes need to be in place in order to convert to a new EHR system.

Normally, hospital IT departments are not staffed to implement new, large initiatives such as EHR systems. They are staffed to address the critical day-to-day issues necessary to keep the hospital running, so a smart way to expedite the implementation is to use an outside party to oversee and manage the process. This will allow for an uninterrupted process of assessment and plan development for the hospital, without any internal distractions. This is a relatively small expense for a dedicated team that is unbiased and unburdened by constituencies or existing projects, either of which can delay getting an EHR system up and running.

With the first stimulus payouts beginning in 2011, putting EHR implementation on the back burner will only hurt an institution. Delaying lets the competition race ahead and diminishes the financial incentive. Start today. It makes financial sense, and more importantly, helps patients.

A large majority of readers -- 65 percent -- who answered ADVANCE's online opinion poll during the past month said they need to rework their existing EHR plans in light of the HIT provisions of the recently enacted American Recovery and Reinvestment Act.

Twenty-two (22) percent of respondents said they need to expedite their current EHR plans.

Six (6) percent said they are already making meaningful use of a certified EHR.

Four (4) percent said they need to study the legislation in more detail.

Four (4) percent said they are starting from scratch with their EHR plans.

A total of 79 readers participated in the poll.

Click here to participate in this month's poll, which asks you to estimate the probability that the Obama administration will be able to achieve universal health care coverage as part of its health care reform plan.