Electronic health records are helping nurses provide better care, big study finds

Electronic health records are helping nurses get better health outcomes and are improving nursing care, the first big study on the subject has found.

The study conducted by the University of Pennsylvania School of Nursing involved 16,000 nurses at 316 hospitals in California, Florida, Pennsylvania and New Jersey. It found that "implementation of an EHR may result in improved and more efficient nursing care, better care coordination, and patient safety," wrote lead author Ann Kutney-Lee, a health-outcomes researcher at Penn Nursing.

The study, which was published in the Journal of Nursing Administration, also found, "having a basic EHR was associated with better outcomes independently of nurse staffing, indicating that they both play an important role in quality of care."

Nurses in hospitals that had comprehensive EHR systems were "significantly less likely to report unfavorable patient safety issues, frequent medication errors, and low quality of care," research-reporting service Newswise reports.

The most current estimates show just 12 percent of U.S. hospitals have an EHR system in place, but that will change with the Health Information Technology for Economic and Clinical Health Act. Starting in 2011, hospitals and physicians received incentive payments from Medicare and Medicaid to switch over to EHRs. The study did not measure outcomes in rural vs. urban settings "although we do know from other studies that hospitals that used electronic health records during this time period were less likely to be in rural areas," Kutney-Lee said. (Read more)

Requiring prescription for pseudoephedrine is 'silver bullet' against meth, drug officials say; some lawmakers disagree

By Tara Kaprowy
Kentucky Health News

If Kentucky wants to arm itself with a "silver bullet" against methamphetamine, it needs to make pseudoephedrine available only prescription. That was the advice of top drug officials in Mississippi and Oklahoma, who testified before lawmakers Thursday. Opponents of the idea did not testify but legislators on their side had their say.

"This is a high-stakes cat and mouse game which has damaging results if we don't win," said Darryl Weaver, director of the Oklahoma Bureau of Narcotics. "The bottom line is: Do you want to track meth labs or do you want to eliminate meth labs?"

Marshall Fisher, director of the Mississippi Bureau of Narcotics agreed: "There is a silver bullet and the silver bullet wasn't tracking it; it wasn't limiting the amount. Weaver and Fisher testified at the request of the Senate and House Judiciary Committees, whose members heard exclusively from officials who support prescription-only policy.

Several related bills are on the table this year, including measures by state Rep. Linda Belcher, D-Shepherdsville, and state Sen. Tom Jensen, R-London, that would reclassify the drug to make it prescription-only. State Rep. Brent Yonts, D-Greenville, would apply the prescription rule only to people who have been convicted of a meth-related charge. The bill sponsored by Sen. Jerry Rhoads, D-Madisonville, would prohibit such offenders from buying the drug for five years.

Mississippi passed a prescription-only law 18 months ago and has seen a 67 percent drop in the number of its meth labs, Fisher said. Weaver said he is pushing for a prescription-only law in Oklahoma since its meth problem continues to grow, despite efforts to electronically track and limit sales of the drug.

All efforts have just been temporary fixes in Oklahoma, Weaver said, since they resulted in "smurfing," in which meth cooks pay others to buy pseudoephedrine for them. The same thing happened when that state instituted a drug registry, in which people who had been convicted of a meth-related crime were prohibited from buying pseudoephedrine without a prescription. The problem, Weaver said, is the tracking and registry "formed more of a conspirator group," where cooks were approaching the homeless and the previously uninvolved African American community to buy the drug for them.

Lt. Col. Joe Williams, executive director of the Appalachia High Intensity Drug Trafficking Area, said smurfing is a big problem in Kentucky too, and MethCheck, the tracking system in place now, does little good in helping law enforcement find meth labs. Meth labs "find us for the most part, we don't find them," he said. "Once we find a meth lab, we'll use the electronic tracking system and use that to trace back."

That runs counter to what Maj. Tony King of the Jefferson County Sheriff's Office said Monday on KET's Kentucky Tonight. In order for pseudoephedrine to be made available only by prescription, it must be reclassified as a legend drug. But those drugs are not tracked by MethCheck, which instantly tracks purchases at the point of sale, but by KASPER, the state's slower system for monitoring prescription drug abuse. "We will lose the ability to track these people and we will lose the ability to track these labs," he said.

Several lawmakers asked whether making pseudoephedrine available only by prescription would just result in doctor shopping and cold and allergy clinics popping up like so-called prescription pill mills. Williams said smurfers just won't take that risk. "It's very hard to fake snot in your nose," he said. "It's pretty easy to fake back pain."

Belcher's proposal would exempt pills in gel-cap format from the prescription rule, which prompted Rep. Sarah Beth Gregory, R-Monticello, to ask if that wouldn't eventually become a problem. Yonts pointed out that the U.S. Drug Enforcement Administration has said pseudoephedrine is "readily extractable" from gel caps. Weaver said he's "yet to see one lab that has been made with gel caps and liquids," he said, adding, "We have to find a balance between intrusion of government and what we need to stop the problem."

But it's that intrusion that has Yonts calling his measure the "middle ground," saying it protects "the soccer moms and Walmart moms" from having to constantly take their kids to the doctor but punishes the offenders. And while officials say only 15 cold medicines would be affected by requiring a prescription, leaving 137 other options, Yonts said medicines containing pseudoephedrine account for 63 percent of sales.

Williams said the average meth lab costs $2,100 in law enforcement, including manpower, overtime, equipment and waste disposal. With 1,146 labs found in Kentucky in 2011, that translates to $2.4 million. Sen. Robert Stivers, R-Manchester, said the problem is "a much larger cost to the taxpayers" since "the majority of these people are probably indigent care and the taxpayer is paying the bill for this."

Whatever the cost, Rep. Johnny Bell, D-Glasgow, called the issue "the most important" of the session. "I hope that we'll step forward and think about the human life and the impact it's having."

Representatives of the Consumer Healthcare Products Association said after the meeting that Pat Davis, identified as a mother of six from northern Kentucky, signed up to speak at the meeting but did not get to. She said she would have spoken about a prescription bill's "impact on consumers and parents, yet the committee was forced to watch videos of news reports and slides that have been seen several times already. It is apparent that the voices of consumers and parents aren’t important to the people running this process."

Health reform means millions more will be covered and more illness will be prevented, federal health official says at UK

By Tara Kaprowy
Kentucky Health News

What will the healthvcare system look like in 2020? Assistant Secretary of Health Dr. Howard Koh told a packed house in Lexington Monday that millions more people will have insurance, the patient will be at the center of a coordinated system, and there will be a great emphasis on prevention and public health "so the patient doesn't become the patient in the first place."

Koh talked about federal health-care reform during a panel discussion at the University of Kentucky's Albert B. Chandler Hospital. It also included Dr. Steve Hester, senior vice president of Norton Healthcare; Dr. Richard Lofgren, vice president of health care operations and chief clinical officer at UK HealthCare; and Stephen Wyatt, dean of UK's College of Public Health.

Koh said the current health-care system "is fragmented, it's episodic, it's not as coordinated as we would like, and there is still not enough attention to quality outcomes." But he said implementation of key parts of the health-care law would address those issues.

He said insurance is already more accessible, since companies can no longer refuse children with pre-existing conditions. By 2014, the same will be the case for adults. State insurance exchanges, which he called "a one-stop shop where buyers can compare plans," will inject "transparency in the whole market" and will ensure basic levels of coverage.

Insurance will also become more affordable, he said. The Medicare prescription "donut hole" is being covered; young adults can stay on their parents' plan until the age of 26; insurance companies must assure that 80 percent of their expenses go toward medical care and not overhead; and there will be a rate-review process, in which insurance companies wanting to increase their rates by 10 percent or more must formally defend their request.

Patient-centered medical homes will put the patient at the center of care and accountable care organizations, and "voluntary networks who have agreed to care for a defined Medicare population and also share in savings," will make coverage more coordinated, Koh said.

The law also puts systems in place for prevention and public health. On the individual level, new plans must cover "high-value preventive services and screenings," Koh said. Businesses are being encouraged to focus on wellness. The Centers for Disease Control and Prevention are offering community transformation grants so communities "can designs ways to make the healthy choice the easy choice," he said. And a national prevention counsel has been formed dedicated to public health.

The law also provides millions for health-care technology, which Hester said will revolutionize the health-care landscape and "the way we respond to patients." Koh agreed, saying a paper-based system "was another example of fragmentation. . . . prevSometimes you could find the chart, sometimes you couldn't. The electronic-based system will coordinate."

Hester said patients have recently become more equipped to accept the technology of electronic health records because they've become used to devices like smart phones. Logren said that, traditionally, patient records have been "proprietary." Electronic records will get information moving from place to place and will no longer be "owned."

Koh acknowledged one of the greatest challenges of the health-reform law is sustainability, but by 2020, he said "We will see stable funding and stable results" in public health and prevention. While the law has created divisiveness in the political arena, Koh said strong opinions about health care are a good thing because they generate discussion and passion. "We can debate many parts of the health reform law," he said, "but in the meantime, we are making progress."

In front-page editorial, rural weekly in Adair County demands that board members of county-owned hospital resign

In our experience, most weekly newspapers don't have editorial pages, much less editorials, so when one puts an editorial on the front page and also runs an editorial about the decision, and the work is well-written and well-argued, it's worth noting.

The Adair County Community Voice in Columbia, Ky., noted county government's bailout of the "collapsing" county-owned hospital; elected officials' request that they have "a say in any final decision to sell the hospital" and that "the hospital administration will try just as hard to keep the hospital independent as they will to sell it;" and some appointed board members' dislike of the requests.

"It seems like little to ask of someone who is $13 million in debt and asking you for $1.7 million," the editorial said, noting that one member said the board had been "a rubber stamp" for agents who secured the bonded debt. That admission "saves us the trouble of trying to prove that board members acted irresponsibly in overseeing the hospital’s business," the editorial said. "Now the question has to be, 'Why are they still on the board?'" It said the board not only "ran the hospital into the ground" but is "in control of a document that will show if any criminal activity took place," a forensic audit that gives board members "a personal stake in any damaging evidence that may come out."

In her explanatory editorial, Editor-Publisher Sharon Burton said she put the editorial out front because "We believe this is a critical time for our community, and we believe bad decisions will continue if the board is left as it is. We believe it’s our job to bring the issue to the forefront, and there is no better place to do that than on the front page of the Community Voice." The explanatory editorial also included useful background and perspective, including: "At small newspapers we don’t have the luxury of separating the people who cover the news from the people who write opinion pieces. Instead, we work hard to provide fair and unbiased coverage of local news. Then, we look at how that news impacts the people in our community and take a stand as needed on our editorial page."

Burton told us in an email that the editorial generated responses by phone, emails, Facebook messages "and of course being stopped at church and the grocery store," all of them positive except a letter from the daughter of a board member, which is running this week. The Community Voice doesn't put editorials or most news online, but PDFs of the pages with the editorials are available on the Institute for Rural Journalism and Community Issues website. The front page, with color, is 3.5 MB; the inside page is 682 KB.

Hopkinsville newspaper endorses smoking ban

The Kentucky New Era newspaper in Hopkinsville said in a recent editorial that if the state legislature doesn't enact a smoking ban, the city should.

The General Assembly "should not squander the opportunity or delay action on a law that could protect everyone against the health risks associated with exposure to secondhand smoke," the editorial said. "Legislators should not disregard the overwhelming scientific evidence of the effects of secondhand smoke. . . . Opponents of a smoking ban argue that they want to protect the rights of smokers. We believe those rights to not extend to smoking in places where non-smokers work, shop and eat." (Read more)

UK professor named chair of new national board that will grant accreditation to local, state and other health departments

Dr. F. Douglas Scutchfield, director of the National Coordinating Center for Public Health Services and Systems Research and the Peter P. Bosomworth Professor of Health Services Research and Policy at the University of Kentucky College of Public Health, has been named chair of the first Accreditation Committee of the Public Health Accreditation Board.

Jointly funded by the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, the board was created to  administer the new accreditation process for state, local, tribal, and territorial health departments. The program was launched in September 2011, and health departments are already beginning to apply. The 11-member Accreditation Committee will make accreditation decisions on behalf of the PHAB board of directors, a UK press release said.

Require all to have a prescription for pseudoephedrine, or just meth criminals? Officials debate the issue on KET

By Tara Kaprowy
Kentucky Health News

If something isn't done now about the prevalence of methamphetamine in Kentucky, "We're going to lose a generation." That was one of the jarring comments from one of the public officials who discussed ways to limit access to pseudoephedrine, the key ingredient in meth, Monday evening on KET's Kentucky Tonight.

The issue is one of the most contentious in the legislative session that began last week. There are two bills on the table aimed at quashing the problem, both sponsored by House Democrats.

Rep. Linda Belcher of Shepherdsville would make pseudoephedrine available only by prescription, but exempt the gel-cap version of the decongestant. Her bill would expire in three years, to give legislators an opportunity to assess its effectiveness.

Rep. Brent Yonts of Greenville would merely require the 5,500 Kentuckians who have already been convicted on a meth-related charge to have a prescription for the drug.

Belcher argued on the program that Yonts' bill "doesn't go far enough, it doesn't do the job," because meth cooks can pay others to buy the drug over the counter, while Yonts said his bill is a "middle ground" compromise. He asked, "Do we punish the whole population of Kentucky or do we punish those who have violated the law?"

Clay County Sheriff Kevin Johnson called into the program and sided with Belcher, saying "As far as putting the crooks on a banned list, that's not going to help the problem." Chris Cohron, Warren County commonwealth's attorney, said officers with the Kentucky Narcotics Officers Association "overwhelmingly support" Belcher's effort.

Maj. Tony King of the Jefferson County Sheriff's Office took an opposing view In order for pseudoephedrine to be made available only by prescription, it must be reclassified as a legend drug, he said, but those drugs are not tracked by MethCheck — the system that instantly tracks pseudoephedrine purchases at the point of sale — but by KASPER, the state's slower system for monitoring prescription drug abuse. "We will lose the ability to track these people and we will lose the ability track these labs," he said.

Meth-lab numbers continue to go up in Kentucky, reaching nearly 1,100 in 2010. Cohron said that is not the case in Oregon, one of two states that has passed a prescription law. He noted that in 2004, there were 472 labs in Oregon and 571 in Kentucky. In 2010, there were 13 in Oregon, and nearly 1,100 in Kentucky. Still, Yonts said Belcher's bill would punish people in all Kentucky counties for the problems of a relatively few counties.

Yonts argued MethCheck is working now, and his bill would merely strengthen what's in place. He said MethCheck stopped more than 14,000 attempts to buy pseudoephedrine last year. "All our surrounding states will very quickly have our system," he said. "CVS and Walgreens will inter-connect. It's a system that instantly verifies. It works." Cohron countered that 100,000 attempts were blocked in Oklahoma, which has a similar system, "but meth labs are still going up by 10 percent a year there. "Being reactive instead of blocking it is not going to solve the problem," he said.

Some callers to the show said Belcher's bill should not exempt gel caps, from which pseudoephedrine is more difficult to produce. Belcher acknowledged her bill is also a compromise and that 97 percent of meth labs use the pill version. Yonts said exempting the gel caps "just opens the door to another problem."

Panelists also discussed the issue of cost. Yonts said the state stands to lose up to $1 million in tax revenue if pseudoephedrine is reclassified as a legend drug, because prescription medication is not subject to sales tax. Belcher said the cost will be far greater, $1 million in manpower alone. "If we're looking at a tight budget, I'd certainly like to take that $1 million and use it for something that is more productive," she said.

Both Yonts and Belcher said they expect their bills to be heard in committee soon. In the meantime, Cohron, who said a generation is at stake if nothing is done, underscored the importance of dealing with the issue without being romanced by drug companies and lobbyists. "We're talking about a billion-dollar industry," he said. "They will spare no expense and they will stop at nothing to defeat it because it a billion dollars on the line."

To watch the show via KET videostreaming, click here.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.