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Patient safety concerns continue to occupy a large space in national healthcare, and the American Medical Informatics Association (AMIA; Bethesda, Maryland) yesterday released a report intended to help move clinical decision support further into the future.

AMIA's report, “A Roadmap for National Action on Clinical Decision Support,” spells out the steps and timelines needed to deploy a clinical decision support (CDS) system across the U.S.

According to the report's executive summary, such systems have “been effective in improving outcomes at some healthcare institutions and practice sites,” but deployment has otherwise been “problematic, stalled in the planning stages or never even attempted.”

The report was assembled at the behest of the Office of the National Coordinator for Health Information Technology (ONCHIT) within the Department of Health & Human Services.

The three features of such systems that the report identifies as pillars of CDS's are: best knowledge when available; high adoption and effective use; and continuous improvement of knowledge and CDS methods, abetted by a steering group, the Roadmap Execution Steering Group (RESG).

RESG will “stimulate, coordinate and guide CDS efforts,” maintain a dialogue with stakeholders, promote the dissemination of best practices and develop specifications and funds for “a set of coordinated, collaborative projects aimed at demonstrating the feasibility, scalability and value of a robust approach to CDS.”

The proposed timeline for the balance of 2006 calls for publication of a roadmap for the project and the development of a funding source for the RESG in addition to funding development for demonstration projects and the establishment of working groups to provide input for those projects.

The objectives for calendar year 2007 include: development of funding and specifications for demonstration projects and clarification of any legal, financial and policy issues. In 2008, those demonstration projects would move forward and a plan to move CDS systems into “other target areas” would commence in 2009.

Karen Bell, MD, the National Health Information Technology Coordinator at ONCHIT said that CDS is not yet a mature field and will benefit greatly by the execution of the roadmap.

AMIA presented the report to HHS Secretary Michael Leavitt at the June 13 meeting of the American Health Information Community in Washington.

Healthcare IT gets index benchmarking

William Blair & Co. (Chicago), an investment banking firm with experience in venture capital and mutual fund management, reported the launch of its stock index for firms in the healthcare information technology (HIT) industry. The William Blair Health Care Information Technology (WBHCIT) Index includes the stocks of more than 30 firms in the HIT sector.

Corey Tobin, an equity research analyst with the firm, said in an accompanying report that the solid fundamentals of businesses in the HIT sector have “translated into attractive returns . . . in recent years” but that “the lack of a comprehensive index that tracks the industry” has hurt efforts to quantify the performance of these firms.

Blair has mapped out the equity increase of the companies in the index, which the press release did not name, going back to 2000 as a baseline assigned the numerical value of 1,000. The index reached nearly 3,000 late in 2005 and on Monday, June 12, stood at 2,486.32.

Blair's web site says that “from inception through May 2006, the WBHCIT has generated average returns higher than relevant benchmarks such as the Russell 2000 and the S&P Small Cap Index.” The firms in question were said to have market capitalization values ranging from $55 million to $3.4 billion with an average of $534.1 million and an aggregate capitalization of $16.6 billion. Combined sales of the firms in 2005 are estimated to have totaled $5.6 billion. The press release asserted that “a five-year trailing average annual return” came to 19.4% at the end of May.

Massachusetts votes to offer OTC needles

In legislative action outside the Beltway, the Massachusetts Senate voted 26-8 last week to pass S 1312, a bill sponsored by Democratic Sen. Robert O'Leary in January 2005 that would permit pharmacies to sell needles and syringes to anyone aged 18 or older. If the bill gets through an inter-chamber conference and Gov. Mitt Romney signs it, Massachusetts would become the 48th state to clear such legislation. However, the governor has indicated his opposition and may veto the bill because of concerns that such availability would encourage heroin abuse.

The Massachusetts House drew up and passed similar legislation in the form of H 4176 in November, a bill that would require that pharmacists give requesters a brochure discussing the use and disposal of needles and syringes as well as a toll-free number for information on HIV and hepatitis C, the two diseases of principal interest in the legislation. The Senate version calls for needle disposal sites at senior citizen centers.

Legislative procedures in Massachusetts require that either the House adopt the Senate bill or that the two groups hammer out a compromise on their respective bills. The Senate and House bills passed by two-thirds, which are margins sufficiently large to suggest that they both will override any veto, but the situation in the Senate is not clear. According to Senate Minority Leader Brian Lees, the odds of a Senate veto are nonetheless “very high.”

Lees pointed out that while only eight senators voted against S 1312, two senators who may oppose the bill were recorded as aye votes because they had paired their votes with colleagues who voted for passage. A third potential opponent, Sen. Scott Brown, missed the vote. Lees said that “this is very close” and that if the governor weighs in forcefully, he may get the required 14 votes to sustain his veto. However, Lees admitted that Romney has yet to sustain a veto.

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