Jane Anderson

Whither Comprehensive Care?

The American Board of Internal Medicine's draft proposal on a new maintenance of certification module on comprehensive care could potentially be just another hoop to jump through, without any validated value to the internist—according to comments the American College of Physicians' Board of Regents submitted to the ABIM. The comments were not all negative, Regents chairman Joel Levine told INTERNAL MEDICINE NEWS. The Regents found much to like—for instance, the draft endorses traditional internists who coordinate and deliver care to most adults, said Dr. Levine, professor of medicine at the University of Colorado at Denver. Another point of agreement: The proposal emphasizes the importance of the medical home. But there were some concerns that such a module might not bring more recruits into internal medicine, and that it doesn't discuss how such a certification would work in a variety of different practice settings, said Dr. Levine, adding that much work still needs to be done. “I don't think this is a done deal,” he said. The ABIM board will next meet in February to discuss comments.

More Action Needed on MRSA

U.S. health care facilities are not doing enough to protect patients from methicillin-resistantStaphylococcus aureus (MRSA) infections, according to an online poll conducted by the Association for Professionals in Infection Control. A majority of infection control professionals (59%) responded that their health care facilities have stepped up efforts to curb MRSA in the past 6 months. But half said their facilities were “not doing as much as [they] could or should” to stop the transmission of MRSA. “MRSA could be beaten if the leadership at hospitals moved more aggressively to adopt strategies proven to protect patients from these virulent infections,” said Lisa McGiffert, director of Consumers Union's Stop Hospital Infections campaign. “We need to require hospitals to report their infection rates so the public can see if they are achieving results.” Consumers Union has worked to help pass laws in 20 states requiring hospitals to report their patient infection rates, and it supports a federal infection reporting law. The Centers for Disease Control and Prevention estimates that nearly 95,000 patients developed MRSA infections in 2005—most of which were acquired in health care facilities—and almost 19,000 people died.

Generics Could Save States Money

Increasing access to generic medicines would help states lower health care costs, which are putting pressure on state government budgets, according to the Generic Pharmaceutical Association (GPhA). The National Governors Association and the National Association of State Budget Officers said in December that “steadily rising health care costs” are contributing to deteriorating state fiscal conditions, and that states face many challenges in providing health care in Medicaid and other state programs. The GPhA noted in its own report that a 1% increase in the use of generics could save $4 billion annually off the total U.S. health care bill. The group advocates creating a workable pathway to approving generic biopharmaceutical medicines and preventing state governments from barring generic substitution for various therapeutic classes of medicines.

Part D Plans Not Tracking Costs

Medicare drug plans have not met all requirements for tracking out-of-pocket spending by beneficiaries in the Medicare Part D prescription drug program, according to a report from the Health and Human Services Department Office of Inspector General. Tracking out-of-pocket costs is necessary to determine when each beneficiary has reached the required spending threshold at which Medicare's catastrophic drug coverage starts. “Implementing the program has been a large undertaking for [the Centers for Medicare and Medicaid Services], its contractors, and the private Part D plans,” HHS Inspector General Daniel Levinson said in a statement. Medicare “should place more emphasis on conducting Part D oversight.” The report found that 29% of Part D plans did not submit required information to the CMS on enrollees' additional drug coverage data. And 34% of Part D plans—covering nearly half of Part D enrollees—did not submit prescription drug event data to CMS in the required time frames. In addition, the limited oversight the CMS has conducted so far on Part D plans' tracking of out-of-pocket costs relied on plans' self-reported data. And even then, about half of the plans were not in compliance with one or more of four CMS requirements in this area. The full report is available at

www.oig.hhs.gov

FDA Sets User Fees for DTC Ads

The Food and Drug Administration is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency in December. Last September, Congress authorized the FDA to create a user-fee program for the advisory review of DTC prescription-drug television advertisements. The program is voluntary; drug sponsors can choose whether to seek FDA advisory review of their ads before broadcast. However, if they seek review by the agency, they must pay the fee. The $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenues during the first year of the program.

Whither Comprehensive Care?

The American Board of Internal Medicine's draft proposal on a new maintenance of certification module on comprehensive care could potentially be just another hoop to jump through, without any validated value to the internist—according to comments the American College of Physicians' Board of Regents submitted to the ABIM. The comments were not all negative, Regents chairman Joel Levine told INTERNAL MEDICINE NEWS. The Regents found much to like—for instance, the draft endorses traditional internists who coordinate and deliver care to most adults, said Dr. Levine, professor of medicine at the University of Colorado at Denver. Another point of agreement: The proposal emphasizes the importance of the medical home. But there were some concerns that such a module might not bring more recruits into internal medicine, and that it doesn't discuss how such a certification would work in a variety of different practice settings, said Dr. Levine, adding that much work still needs to be done. “I don't think this is a done deal,” he said. The ABIM board will next meet in February to discuss comments.

More Action Needed on MRSA

U.S. health care facilities are not doing enough to protect patients from methicillin-resistantStaphylococcus aureus (MRSA) infections, according to an online poll conducted by the Association for Professionals in Infection Control. A majority of infection control professionals (59%) responded that their health care facilities have stepped up efforts to curb MRSA in the past 6 months. But half said their facilities were “not doing as much as [they] could or should” to stop the transmission of MRSA. “MRSA could be beaten if the leadership at hospitals moved more aggressively to adopt strategies proven to protect patients from these virulent infections,” said Lisa McGiffert, director of Consumers Union's Stop Hospital Infections campaign. “We need to require hospitals to report their infection rates so the public can see if they are achieving results.” Consumers Union has worked to help pass laws in 20 states requiring hospitals to report their patient infection rates, and it supports a federal infection reporting law. The Centers for Disease Control and Prevention estimates that nearly 95,000 patients developed MRSA infections in 2005—most of which were acquired in health care facilities—and almost 19,000 people died.

Generics Could Save States Money

Increasing access to generic medicines would help states lower health care costs, which are putting pressure on state government budgets, according to the Generic Pharmaceutical Association (GPhA). The National Governors Association and the National Association of State Budget Officers said in December that “steadily rising health care costs” are contributing to deteriorating state fiscal conditions, and that states face many challenges in providing health care in Medicaid and other state programs. The GPhA noted in its own report that a 1% increase in the use of generics could save $4 billion annually off the total U.S. health care bill. The group advocates creating a workable pathway to approving generic biopharmaceutical medicines and preventing state governments from barring generic substitution for various therapeutic classes of medicines.

Part D Plans Not Tracking Costs

Medicare drug plans have not met all requirements for tracking out-of-pocket spending by beneficiaries in the Medicare Part D prescription drug program, according to a report from the Health and Human Services Department Office of Inspector General. Tracking out-of-pocket costs is necessary to determine when each beneficiary has reached the required spending threshold at which Medicare's catastrophic drug coverage starts. “Implementing the program has been a large undertaking for [the Centers for Medicare and Medicaid Services], its contractors, and the private Part D plans,” HHS Inspector General Daniel Levinson said in a statement. Medicare “should place more emphasis on conducting Part D oversight.” The report found that 29% of Part D plans did not submit required information to the CMS on enrollees' additional drug coverage data. And 34% of Part D plans—covering nearly half of Part D enrollees—did not submit prescription drug event data to CMS in the required time frames. In addition, the limited oversight the CMS has conducted so far on Part D plans' tracking of out-of-pocket costs relied on plans' self-reported data. And even then, about half of the plans were not in compliance with one or more of four CMS requirements in this area. The full report is available at

www.oig.hhs.gov

FDA Sets User Fees for DTC Ads

The Food and Drug Administration is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency in December. Last September, Congress authorized the FDA to create a user-fee program for the advisory review of DTC prescription-drug television advertisements. The program is voluntary; drug sponsors can choose whether to seek FDA advisory review of their ads before broadcast. However, if they seek review by the agency, they must pay the fee. The $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenues during the first year of the program.

Whither Comprehensive Care?

The American Board of Internal Medicine's draft proposal on a new maintenance of certification module on comprehensive care could potentially be just another hoop to jump through, without any validated value to the internist—according to comments the American College of Physicians' Board of Regents submitted to the ABIM. The comments were not all negative, Regents chairman Joel Levine told INTERNAL MEDICINE NEWS. The Regents found much to like—for instance, the draft endorses traditional internists who coordinate and deliver care to most adults, said Dr. Levine, professor of medicine at the University of Colorado at Denver. Another point of agreement: The proposal emphasizes the importance of the medical home. But there were some concerns that such a module might not bring more recruits into internal medicine, and that it doesn't discuss how such a certification would work in a variety of different practice settings, said Dr. Levine, adding that much work still needs to be done. “I don't think this is a done deal,” he said. The ABIM board will next meet in February to discuss comments.

More Action Needed on MRSA

U.S. health care facilities are not doing enough to protect patients from methicillin-resistantStaphylococcus aureus (MRSA) infections, according to an online poll conducted by the Association for Professionals in Infection Control. A majority of infection control professionals (59%) responded that their health care facilities have stepped up efforts to curb MRSA in the past 6 months. But half said their facilities were “not doing as much as [they] could or should” to stop the transmission of MRSA. “MRSA could be beaten if the leadership at hospitals moved more aggressively to adopt strategies proven to protect patients from these virulent infections,” said Lisa McGiffert, director of Consumers Union's Stop Hospital Infections campaign. “We need to require hospitals to report their infection rates so the public can see if they are achieving results.” Consumers Union has worked to help pass laws in 20 states requiring hospitals to report their patient infection rates, and it supports a federal infection reporting law. The Centers for Disease Control and Prevention estimates that nearly 95,000 patients developed MRSA infections in 2005—most of which were acquired in health care facilities—and almost 19,000 people died.

Generics Could Save States Money

Increasing access to generic medicines would help states lower health care costs, which are putting pressure on state government budgets, according to the Generic Pharmaceutical Association (GPhA). The National Governors Association and the National Association of State Budget Officers said in December that “steadily rising health care costs” are contributing to deteriorating state fiscal conditions, and that states face many challenges in providing health care in Medicaid and other state programs. The GPhA noted in its own report that a 1% increase in the use of generics could save $4 billion annually off the total U.S. health care bill. The group advocates creating a workable pathway to approving generic biopharmaceutical medicines and preventing state governments from barring generic substitution for various therapeutic classes of medicines.

Part D Plans Not Tracking Costs

Medicare drug plans have not met all requirements for tracking out-of-pocket spending by beneficiaries in the Medicare Part D prescription drug program, according to a report from the Health and Human Services Department Office of Inspector General. Tracking out-of-pocket costs is necessary to determine when each beneficiary has reached the required spending threshold at which Medicare's catastrophic drug coverage starts. “Implementing the program has been a large undertaking for [the Centers for Medicare and Medicaid Services], its contractors, and the private Part D plans,” HHS Inspector General Daniel Levinson said in a statement. Medicare “should place more emphasis on conducting Part D oversight.” The report found that 29% of Part D plans did not submit required information to the CMS on enrollees' additional drug coverage data. And 34% of Part D plans—covering nearly half of Part D enrollees—did not submit prescription drug event data to CMS in the required time frames. In addition, the limited oversight the CMS has conducted so far on Part D plans' tracking of out-of-pocket costs relied on plans' self-reported data. And even then, about half of the plans were not in compliance with one or more of four CMS requirements in this area. The full report is available at

www.oig.hhs.gov

FDA Sets User Fees for DTC Ads

The Food and Drug Administration is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency in December. Last September, Congress authorized the FDA to create a user-fee program for the advisory review of DTC prescription-drug television advertisements. The program is voluntary; drug sponsors can choose whether to seek FDA advisory review of their ads before broadcast. However, if they seek review by the agency, they must pay the fee. The $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenues during the first year of the program.

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients—who now have access to literally billions of pages of medical information online—can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

“We need to get prepared for the coming consumerism in health care, because patients will have access to medical advice that no longer comes from the physician or nurse,” said Dr. Harris. He cited research that shows about one-third of medical information available online is of high quality, one-third could be useful but would require some interpretation, and the last third is “completely off the mark.”

“One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services,” Dr. Harris said during a virtual conference sponsored the Healthcare Information and Management Systems Society (HIMSS).

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, Dr. Harris said.

The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

“It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed,” Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system. “It is a single tool that goes from the initial ambulatory visit to the hospital and back again,” he said.

A total of 5,662 physicians use the electronic medical record module, including about 1,500 employed by the Cleveland Clinic and approximately 4,100 who practice in hospitals in the Cleveland Clinic system. Once other clinicians and support personnel are added, there will be about 33,000 users for the system, Dr. Harris said.

On the outpatient side, the system integrates schedules, laboratory results, other medical documentation, a computerized physician order entry system, and best practice alerts, Dr. Harris said. In one mode, physicians can communicate either informally or formally; in formal mode, comments are added to the medical record, he said.

On the inpatient side, it's exactly the same tool, although it incorporates some different elements, including a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that “almost all of our nursing documentation is online at this point.”

The system keeps track of recommended screenings and medical procedures for all patients, and provides that list to the physician electronically at the time of an office visit, allowing the physician to focus on what hasn't been done and might be needed. “That's a very powerful technique,” Dr. Harris said.

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems, Dr. Harris said. “It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient,” he said, noting that the average Cleveland Clinic patient is 65 years old and is taking at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions, Dr. Harris said. “Our goal is to get as much information in front of the patient as possible.”

In fact, the Cleveland Clinic actually is releasing certain routine test results via this online system directly to patients, Dr. Harris said. “We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours,” he said.

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said. And, the system produces a “health issues” list for patients to have and share with their physicians, he said.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process, Dr. Harris said, is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most comprehensive information to patients in a format that's easy to use and understand, Dr. Harris said. “What we know is, we're going to have to make these tools available to patients and add value.”

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients—who now have access to literally billions of pages of medical information online—can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

“We need to get prepared for the coming consumerism in health care, because patients will have access to medical advice that no longer comes from the physician or nurse,” said Dr. Harris. He cited research that shows about one-third of medical information available online is of high quality, one-third could be useful but would require some interpretation, and the last third is “completely off the mark.”

“One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services,” Dr. Harris said during a virtual conference sponsored the Healthcare Information and Management Systems Society (HIMSS).

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, Dr. Harris said.

The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

“It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed,” Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system. “It is a single tool that goes from the initial ambulatory visit to the hospital and back again,” he said.

A total of 5,662 physicians use the electronic medical record module, including about 1,500 employed by the Cleveland Clinic and approximately 4,100 who practice in hospitals in the Cleveland Clinic system. Once other clinicians and support personnel are added, there will be about 33,000 users for the system, Dr. Harris said.

On the outpatient side, the system integrates schedules, laboratory results, other medical documentation, a computerized physician order entry system, and best practice alerts, Dr. Harris said. In one mode, physicians can communicate either informally or formally; in formal mode, comments are added to the medical record, he said.

On the inpatient side, it's exactly the same tool, although it incorporates some different elements, including a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that “almost all of our nursing documentation is online at this point.”

The system keeps track of recommended screenings and medical procedures for all patients, and provides that list to the physician electronically at the time of an office visit, allowing the physician to focus on what hasn't been done and might be needed. “That's a very powerful technique,” Dr. Harris said.

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems, Dr. Harris said. “It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient,” he said, noting that the average Cleveland Clinic patient is 65 years old and is taking at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions, Dr. Harris said. “Our goal is to get as much information in front of the patient as possible.”

In fact, the Cleveland Clinic actually is releasing certain routine test results via this online system directly to patients, Dr. Harris said. “We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours,” he said.

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said. And, the system produces a “health issues” list for patients to have and share with their physicians, he said.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process, Dr. Harris said, is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most comprehensive information to patients in a format that's easy to use and understand, Dr. Harris said. “What we know is, we're going to have to make these tools available to patients and add value.”

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients—who now have access to literally billions of pages of medical information online—can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

“We need to get prepared for the coming consumerism in health care, because patients will have access to medical advice that no longer comes from the physician or nurse,” said Dr. Harris. He cited research that shows about one-third of medical information available online is of high quality, one-third could be useful but would require some interpretation, and the last third is “completely off the mark.”

“One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services,” Dr. Harris said during a virtual conference sponsored the Healthcare Information and Management Systems Society (HIMSS).

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, Dr. Harris said.

The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

“It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed,” Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system. “It is a single tool that goes from the initial ambulatory visit to the hospital and back again,” he said.

A total of 5,662 physicians use the electronic medical record module, including about 1,500 employed by the Cleveland Clinic and approximately 4,100 who practice in hospitals in the Cleveland Clinic system. Once other clinicians and support personnel are added, there will be about 33,000 users for the system, Dr. Harris said.

On the outpatient side, the system integrates schedules, laboratory results, other medical documentation, a computerized physician order entry system, and best practice alerts, Dr. Harris said. In one mode, physicians can communicate either informally or formally; in formal mode, comments are added to the medical record, he said.

On the inpatient side, it's exactly the same tool, although it incorporates some different elements, including a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that “almost all of our nursing documentation is online at this point.”

The system keeps track of recommended screenings and medical procedures for all patients, and provides that list to the physician electronically at the time of an office visit, allowing the physician to focus on what hasn't been done and might be needed. “That's a very powerful technique,” Dr. Harris said.

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems, Dr. Harris said. “It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient,” he said, noting that the average Cleveland Clinic patient is 65 years old and is taking at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions, Dr. Harris said. “Our goal is to get as much information in front of the patient as possible.”

In fact, the Cleveland Clinic actually is releasing certain routine test results via this online system directly to patients, Dr. Harris said. “We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours,” he said.

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said. And, the system produces a “health issues” list for patients to have and share with their physicians, he said.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process, Dr. Harris said, is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most comprehensive information to patients in a format that's easy to use and understand, Dr. Harris said. “What we know is, we're going to have to make these tools available to patients and add value.”

Waxman: FDA Plan Is Flawed

The Food and Drug Administration is considering new guidance that would allow drug companies to use journal articles to promote “potentially dangerous uses” of drugs and medical devices without prior FDA review and approval, according to a top lawmaker. Rep. Henry Waxman (D-Calif.), who chairs the House Committee on Oversight and Government Reform, urged the FDA in a Nov. 30 letter to reconsider its draft guidance, which the congressman said was close to being finalized. “The draft guidance that I have obtained would, in effect, allow drug and device companies to short-circuit FDA review and approval by sponsoring drug trials that are carefully constructed to deliver positive results and then using the results to influence prescribing patterns,” Rep. Waxman said. “This undercuts the prohibition on marketing of unapproved uses of drugs and devices.” He asked the FDA to provide detailed information on the development of the new policy and how it would address his concerns.

N.J. Blocks Stem Cell Measure

New Jersey Gov. Jon Corzine (D) will press ahead with efforts to promote stem cell research in the state, even after voters rejected his proposal to borrow $450 million to fund research grants. Although the measure's defeat means there will be less state funding available for research, “the governor does expect they will be able to find additional dollars in the private sector,” said spokesman Jim Gardner in an interview. State lawmakers already have authorized about $20 million in funding for a new Stem Cell Institute of New Jersey and for research grants, and that money is not affected by the bond initiative's failure, Gardner said. The $450 million bond referendum would have provided financing for stem cell research grants to eligible institutions over a 10-year period. The grants would have been awarded after review by an independent research panel and after consideration of the commercial viability of the projects. Mr. Gardner said it's too early to tell if Gov. Corzine will attempt to bring a new bond initiative before the voters this year.

Woman-Specific Drugs in Pipeline

More than 700 medicines for diseases that disproportionately or solely affect women are currently in development, according to a report from the Pharmaceutical Research and Manufacturers of America. According to the PhRMA report, drugmakers are developing new products to treat arthritis, women-specific cancers, diabetes, obstetric-gynecologic conditions, and mental illnesses, among other things. The drugs in development include 135 medicines for cancers affecting women, including 95 for breast cancer, 47 for ovarian cancer, and 17 for cervical cancer. In addition, drug manufacturers have 125 medicines in the pipeline for arthritis and musculoskeletal disorders, which disproportionately affect women, and 106 drugs in the pipeline for autoimmune disorders, which collectively afflict 23.5 million Americans, the majority of them women. Other medicines in development include treatments for diabetes, glaucoma, irritable bowel syndrome, urinary tract infections, asthma, Alzheimer's disease, migraine, depression, anxiety and sepsis, all of which PhRMA said affect women more than men.

Report: Counseling Violates Ethics

Information that doctors in 23 states are required to provide to women either verbally or in writing before an abortion falls short of fundamental ethical principles because it is inaccurate or irrelevant, a nationwide analysis of state counseling requirements from the Guttmacher Institute found. The counseling required by these 23 states “in many cases appears to be designed more to influence rather than inform a woman's decision whether to have an abortion, for instance by exaggerating the physical or mental health risks of abortion, or by including information on certain abortion procedures that is irrelevant to most women,” according to the report in the Guttmacher Policy Review. Report coauthor Rachel Benson Gold said in a statement that the widespread misinformation is “particularly troubling” in light of a recent Supreme Court decision, Gonzalez v. Carhart, that defers to legislatures, rather than the weight of the evidence, in cases where there is medical disagreement on the potential consequences of abortion. “There is ample reason to worry that some state legislatures will view the Supreme Court's ruling as a green light to set up a new array of misleading counseling requirements that in reality are attempts by politicians to muscle their way into private medical decisions that should be between a woman, her family, and her doctor,” Gold said.

Maternal 'Toolkit' Developed

The National Business Group on Health, which represents large employers, in November released a new guide designed to help employers improve the health of pregnant women, children, and adolescents, as well as potentially reduce their health care costs. “Investing in Maternal and Child Health: An Employer's Toolkit” provides a model of a medical benefits package aimed at providing guidance on benefit design, employee cost-sharing recommendations, and actuarial cost-impact data employers can use to estimate the cost of adopting the recommended benefits. The toolkit also includes data on the cost of maternal and child health care services, and the business case for investing in healthy pregnancies and primary care services, along with educational materials for employees about maternal and child health topics.

Waxman: FDA Plan Is Flawed

The Food and Drug Administration is considering new guidance that would allow drug companies to use journal articles to promote “potentially dangerous uses” of drugs and medical devices without prior FDA review and approval, according to a top lawmaker. Rep. Henry Waxman (D-Calif.), who chairs the House Committee on Oversight and Government Reform, urged the FDA in a Nov. 30 letter to reconsider its draft guidance, which the congressman said was close to being finalized. “The draft guidance that I have obtained would, in effect, allow drug and device companies to short-circuit FDA review and approval by sponsoring drug trials that are carefully constructed to deliver positive results and then using the results to influence prescribing patterns,” Rep. Waxman said. “This undercuts the prohibition on marketing of unapproved uses of drugs and devices.” He asked the FDA to provide detailed information on the development of the new policy and how it would address his concerns.

N.J. Blocks Stem Cell Measure

New Jersey Gov. Jon Corzine (D) will press ahead with efforts to promote stem cell research in the state, even after voters rejected his proposal to borrow $450 million to fund research grants. Although the measure's defeat means there will be less state funding available for research, “the governor does expect they will be able to find additional dollars in the private sector,” said spokesman Jim Gardner in an interview. State lawmakers already have authorized about $20 million in funding for a new Stem Cell Institute of New Jersey and for research grants, and that money is not affected by the bond initiative's failure, Gardner said. The $450 million bond referendum would have provided financing for stem cell research grants to eligible institutions over a 10-year period. The grants would have been awarded after review by an independent research panel and after consideration of the commercial viability of the projects. Mr. Gardner said it's too early to tell if Gov. Corzine will attempt to bring a new bond initiative before the voters this year.

Woman-Specific Drugs in Pipeline

More than 700 medicines for diseases that disproportionately or solely affect women are currently in development, according to a report from the Pharmaceutical Research and Manufacturers of America. According to the PhRMA report, drugmakers are developing new products to treat arthritis, women-specific cancers, diabetes, obstetric-gynecologic conditions, and mental illnesses, among other things. The drugs in development include 135 medicines for cancers affecting women, including 95 for breast cancer, 47 for ovarian cancer, and 17 for cervical cancer. In addition, drug manufacturers have 125 medicines in the pipeline for arthritis and musculoskeletal disorders, which disproportionately affect women, and 106 drugs in the pipeline for autoimmune disorders, which collectively afflict 23.5 million Americans, the majority of them women. Other medicines in development include treatments for diabetes, glaucoma, irritable bowel syndrome, urinary tract infections, asthma, Alzheimer's disease, migraine, depression, anxiety and sepsis, all of which PhRMA said affect women more than men.

Report: Counseling Violates Ethics

Information that doctors in 23 states are required to provide to women either verbally or in writing before an abortion falls short of fundamental ethical principles because it is inaccurate or irrelevant, a nationwide analysis of state counseling requirements from the Guttmacher Institute found. The counseling required by these 23 states “in many cases appears to be designed more to influence rather than inform a woman's decision whether to have an abortion, for instance by exaggerating the physical or mental health risks of abortion, or by including information on certain abortion procedures that is irrelevant to most women,” according to the report in the Guttmacher Policy Review. Report coauthor Rachel Benson Gold said in a statement that the widespread misinformation is “particularly troubling” in light of a recent Supreme Court decision, Gonzalez v. Carhart, that defers to legislatures, rather than the weight of the evidence, in cases where there is medical disagreement on the potential consequences of abortion. “There is ample reason to worry that some state legislatures will view the Supreme Court's ruling as a green light to set up a new array of misleading counseling requirements that in reality are attempts by politicians to muscle their way into private medical decisions that should be between a woman, her family, and her doctor,” Gold said.

Maternal 'Toolkit' Developed

The National Business Group on Health, which represents large employers, in November released a new guide designed to help employers improve the health of pregnant women, children, and adolescents, as well as potentially reduce their health care costs. “Investing in Maternal and Child Health: An Employer's Toolkit” provides a model of a medical benefits package aimed at providing guidance on benefit design, employee cost-sharing recommendations, and actuarial cost-impact data employers can use to estimate the cost of adopting the recommended benefits. The toolkit also includes data on the cost of maternal and child health care services, and the business case for investing in healthy pregnancies and primary care services, along with educational materials for employees about maternal and child health topics.

Waxman: FDA Plan Is Flawed

The Food and Drug Administration is considering new guidance that would allow drug companies to use journal articles to promote “potentially dangerous uses” of drugs and medical devices without prior FDA review and approval, according to a top lawmaker. Rep. Henry Waxman (D-Calif.), who chairs the House Committee on Oversight and Government Reform, urged the FDA in a Nov. 30 letter to reconsider its draft guidance, which the congressman said was close to being finalized. “The draft guidance that I have obtained would, in effect, allow drug and device companies to short-circuit FDA review and approval by sponsoring drug trials that are carefully constructed to deliver positive results and then using the results to influence prescribing patterns,” Rep. Waxman said. “This undercuts the prohibition on marketing of unapproved uses of drugs and devices.” He asked the FDA to provide detailed information on the development of the new policy and how it would address his concerns.

N.J. Blocks Stem Cell Measure

New Jersey Gov. Jon Corzine (D) will press ahead with efforts to promote stem cell research in the state, even after voters rejected his proposal to borrow $450 million to fund research grants. Although the measure's defeat means there will be less state funding available for research, “the governor does expect they will be able to find additional dollars in the private sector,” said spokesman Jim Gardner in an interview. State lawmakers already have authorized about $20 million in funding for a new Stem Cell Institute of New Jersey and for research grants, and that money is not affected by the bond initiative's failure, Gardner said. The $450 million bond referendum would have provided financing for stem cell research grants to eligible institutions over a 10-year period. The grants would have been awarded after review by an independent research panel and after consideration of the commercial viability of the projects. Mr. Gardner said it's too early to tell if Gov. Corzine will attempt to bring a new bond initiative before the voters this year.

Woman-Specific Drugs in Pipeline

More than 700 medicines for diseases that disproportionately or solely affect women are currently in development, according to a report from the Pharmaceutical Research and Manufacturers of America. According to the PhRMA report, drugmakers are developing new products to treat arthritis, women-specific cancers, diabetes, obstetric-gynecologic conditions, and mental illnesses, among other things. The drugs in development include 135 medicines for cancers affecting women, including 95 for breast cancer, 47 for ovarian cancer, and 17 for cervical cancer. In addition, drug manufacturers have 125 medicines in the pipeline for arthritis and musculoskeletal disorders, which disproportionately affect women, and 106 drugs in the pipeline for autoimmune disorders, which collectively afflict 23.5 million Americans, the majority of them women. Other medicines in development include treatments for diabetes, glaucoma, irritable bowel syndrome, urinary tract infections, asthma, Alzheimer's disease, migraine, depression, anxiety and sepsis, all of which PhRMA said affect women more than men.

Report: Counseling Violates Ethics

Information that doctors in 23 states are required to provide to women either verbally or in writing before an abortion falls short of fundamental ethical principles because it is inaccurate or irrelevant, a nationwide analysis of state counseling requirements from the Guttmacher Institute found. The counseling required by these 23 states “in many cases appears to be designed more to influence rather than inform a woman's decision whether to have an abortion, for instance by exaggerating the physical or mental health risks of abortion, or by including information on certain abortion procedures that is irrelevant to most women,” according to the report in the Guttmacher Policy Review. Report coauthor Rachel Benson Gold said in a statement that the widespread misinformation is “particularly troubling” in light of a recent Supreme Court decision, Gonzalez v. Carhart, that defers to legislatures, rather than the weight of the evidence, in cases where there is medical disagreement on the potential consequences of abortion. “There is ample reason to worry that some state legislatures will view the Supreme Court's ruling as a green light to set up a new array of misleading counseling requirements that in reality are attempts by politicians to muscle their way into private medical decisions that should be between a woman, her family, and her doctor,” Gold said.

Maternal 'Toolkit' Developed

The National Business Group on Health, which represents large employers, in November released a new guide designed to help employers improve the health of pregnant women, children, and adolescents, as well as potentially reduce their health care costs. “Investing in Maternal and Child Health: An Employer's Toolkit” provides a model of a medical benefits package aimed at providing guidance on benefit design, employee cost-sharing recommendations, and actuarial cost-impact data employers can use to estimate the cost of adopting the recommended benefits. The toolkit also includes data on the cost of maternal and child health care services, and the business case for investing in healthy pregnancies and primary care services, along with educational materials for employees about maternal and child health topics.

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients—who now have access to literally billions of pages of medical information online—can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

“We need to get prepared for the coming consumerism in health care, because patients will have access to medical advice that no longer comes from the physician or nurse,” said Dr. Harris.

He cited research that shows about one-third of medical information available online is of high quality, one-third could be useful but would require some interpretation, and the last third is “completely off the mark.”

“One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services,” Dr. Harris said during a virtual conference sponsored the Healthcare Information and Management Systems Society (HIMSS).

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, according to Dr. Harris.

The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

“It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed,” Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system.

“It is a single tool that goes from the initial ambulatory visit to the hospital and back again,” Dr. Harris added.

A total of 5,662 physicians use the electronic medical record module, including about 1,500 employed by the Cleveland Clinic and approximately 4,100 who practice in hospitals in the Cleveland Clinic system. Once other clinicians and support personnel are added, there will be about 33,000 users for the system, according to Dr. Harris.

On the outpatient side, the system integrates schedules, laboratory results, other medical documentation, a computerized physician order entry system, and best practice alerts, Dr. Harris said. In one mode, physicians can communicate either informally or formally; in formal mode, comments are added to the medical record, he said.

On the inpatient side, it's exactly the same tool, although it incorporates some different elements, including a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that “almost all of our nursing documentation is online at this point.”

The system keeps track of recommended screenings and medical procedures for all patients, and provides that list to the physician electronically at the time of an office visit, allowing the physician to focus on what hasn't been done and might be needed. “That's a very powerful technique,” Dr. Harris said.

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems, Dr. Harris said.

“It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient,” he added, noting that the average Cleveland Clinic patient is 65 years old and is taking at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions, Dr. Harris said. “Our goal is to get as much information in front of the patient as possible.”

In fact, the Cleveland Clinic actually is releasing certain routine test results via this online system directly to patients, Dr. Harris said. “We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours,” he said.

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said.

And, the system produces a “health issues” list for patients to have and share with their physicians, he commented.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process, Dr. Harris said, is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most complete information to patients in a format that's easy to use and understand, Dr. Harris said.

“What we know is, we're going to have to make these tools available to patients and add value,” he said. “This provides health information so they're not generally searching on the Internet.”

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients—who now have access to literally billions of pages of medical information online—can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

“We need to get prepared for the coming consumerism in health care, because patients will have access to medical advice that no longer comes from the physician or nurse,” said Dr. Harris.

He cited research that shows about one-third of medical information available online is of high quality, one-third could be useful but would require some interpretation, and the last third is “completely off the mark.”

“One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services,” Dr. Harris said during a virtual conference sponsored the Healthcare Information and Management Systems Society (HIMSS).

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, according to Dr. Harris.

The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

“It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed,” Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system.

“It is a single tool that goes from the initial ambulatory visit to the hospital and back again,” Dr. Harris added.

A total of 5,662 physicians use the electronic medical record module, including about 1,500 employed by the Cleveland Clinic and approximately 4,100 who practice in hospitals in the Cleveland Clinic system. Once other clinicians and support personnel are added, there will be about 33,000 users for the system, according to Dr. Harris.

On the outpatient side, the system integrates schedules, laboratory results, other medical documentation, a computerized physician order entry system, and best practice alerts, Dr. Harris said. In one mode, physicians can communicate either informally or formally; in formal mode, comments are added to the medical record, he said.

On the inpatient side, it's exactly the same tool, although it incorporates some different elements, including a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that “almost all of our nursing documentation is online at this point.”

The system keeps track of recommended screenings and medical procedures for all patients, and provides that list to the physician electronically at the time of an office visit, allowing the physician to focus on what hasn't been done and might be needed. “That's a very powerful technique,” Dr. Harris said.

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems, Dr. Harris said.

“It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient,” he added, noting that the average Cleveland Clinic patient is 65 years old and is taking at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions, Dr. Harris said. “Our goal is to get as much information in front of the patient as possible.”

In fact, the Cleveland Clinic actually is releasing certain routine test results via this online system directly to patients, Dr. Harris said. “We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours,” he said.

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said.

And, the system produces a “health issues” list for patients to have and share with their physicians, he commented.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process, Dr. Harris said, is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most complete information to patients in a format that's easy to use and understand, Dr. Harris said.

“What we know is, we're going to have to make these tools available to patients and add value,” he said. “This provides health information so they're not generally searching on the Internet.”

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients—who now have access to literally billions of pages of medical information online—can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

“We need to get prepared for the coming consumerism in health care, because patients will have access to medical advice that no longer comes from the physician or nurse,” said Dr. Harris.

He cited research that shows about one-third of medical information available online is of high quality, one-third could be useful but would require some interpretation, and the last third is “completely off the mark.”

“One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services,” Dr. Harris said during a virtual conference sponsored the Healthcare Information and Management Systems Society (HIMSS).

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, according to Dr. Harris.

The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

“It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed,” Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system.

“It is a single tool that goes from the initial ambulatory visit to the hospital and back again,” Dr. Harris added.

A total of 5,662 physicians use the electronic medical record module, including about 1,500 employed by the Cleveland Clinic and approximately 4,100 who practice in hospitals in the Cleveland Clinic system. Once other clinicians and support personnel are added, there will be about 33,000 users for the system, according to Dr. Harris.

On the outpatient side, the system integrates schedules, laboratory results, other medical documentation, a computerized physician order entry system, and best practice alerts, Dr. Harris said. In one mode, physicians can communicate either informally or formally; in formal mode, comments are added to the medical record, he said.

On the inpatient side, it's exactly the same tool, although it incorporates some different elements, including a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that “almost all of our nursing documentation is online at this point.”

The system keeps track of recommended screenings and medical procedures for all patients, and provides that list to the physician electronically at the time of an office visit, allowing the physician to focus on what hasn't been done and might be needed. “That's a very powerful technique,” Dr. Harris said.

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems, Dr. Harris said.

“It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient,” he added, noting that the average Cleveland Clinic patient is 65 years old and is taking at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions, Dr. Harris said. “Our goal is to get as much information in front of the patient as possible.”

In fact, the Cleveland Clinic actually is releasing certain routine test results via this online system directly to patients, Dr. Harris said. “We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours,” he said.

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said.

And, the system produces a “health issues” list for patients to have and share with their physicians, he commented.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process, Dr. Harris said, is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most complete information to patients in a format that's easy to use and understand, Dr. Harris said.

“What we know is, we're going to have to make these tools available to patients and add value,” he said. “This provides health information so they're not generally searching on the Internet.”

HHS Names Autism Panel

The Health and Human Services department has named a new committee, authorized under the Combating Autism Act of 2006, to facilitate the exchange of information on autism activities among federal agencies as well as coordinate autism-related programs and initiatives, according to a statement from HHS. Dr. Thomas R. Insel, director of the National Institutes of Mental Health, will chair the panel; its first task will be to develop a strategic plan for autism research to guide public and private investments.

BadgerCare Overhaul Approved

The Centers for Medicare and Medicaid Services has given Wisconsin the go-ahead to restructure its BadgerCare State Children's Health Insurance Program (SCHIP) to cover approximately 7,600 more children. BadgerCare now will enroll children in families making up to $51,625, or 250% of the federal poverty level for a family of four. Wisconsin sought to expand coverage to children in families making up to 300% of the federal poverty level but was forced to modify its request in order to stay within SCHIP guidelines designed to keep parents from voluntarily switching their children from private insurance. CMS said that Wisconsin's program change addresses this problem by requiring a period without insurance prior to a family signing up for BadgerCare. Wisconsin also has agreed to move adults from BadgerCare and into its Medicaid program.

Parents Don't See Child's Obesity

More than 40% of parents with obese children aged 6–11 years describe their child as being “about the right weight,” according to a study from the University of Michigan Health System, Ann Arbor. In fact, only 13% of parents with obese children in that age bracket rated their child as being very overweight, compared with 31% of parents with obese children aged 12–17 years. The study, which included 2,060 adults, is part of the C.S. Mott Children's Hospital National Poll on Children's Health, which is funded by the university. Pediatricians can play an important role in helping parents to recognize obesity and take steps to modify a child's diet and activity levels, the study authors noted, adding that 84% of parents said they believe it is very important for doctors to address obesity with obese adolescents during routine checkups. “Parents' willingness to discuss obesity at their children's medical appointments indicates that many parents view doctors as a welcome source of information about obesity interventions for children,” said Dr. Matthew Davis, who directs the National Poll on Children's Health.

WIC Program Adds Healthy Foods

In the first overhaul of the federal food vouchers program for women and children in nearly 3 decades, the U.S. Department of Agriculture has approved new rules that provide beneficiaries with fruits, vegetables, and whole grains. The new rules for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) also provide less support for milk, eggs, and juice, and are designed to encourage breast-feeding by giving more fruits and vegetables to women who exclusively are nursing their children. More than 8 million low-income women and children receive WIC benefits, which amount to about $39 a month.

Panel: More Smoking Prevention

Smoking rates have leveled off after nearly a decade of declines, and the nation's progress in reducing smoking is at risk unless states significantly increase funding for programs to prevent kids from smoking and to help smokers quit, warns a report from the Campaign for Tobacco-Free Kids. The annual report from the group, made up of a coalition of public health organizations, found that states have increased funding for tobacco prevention and cessation programs by 20% to $717 million, the highest level in 6 years. However, it also found that most states fail to fund these programs at minimum levels recommended by the Centers for Disease Control and Prevention. The CDC recently reported that about 21% of adults smoked in 2006, the same as in 2004 and 2005. This follows a steady yearly decline from 1997 to 2004. High school smoking rates have similarly stalled, and 23% of high school students still smoke, according to the CDC.

FDA Sets User Fees for DTC Ads

The Food and Drug Administration is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency in December. Last September, Congress authorized FDA to create a user-fee program for the advisory review of DTC prescription-drug television advertisements. The program is voluntary; the $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenues.

HHS Names Autism Panel

The Health and Human Services department has named a new committee, authorized under the Combating Autism Act of 2006, to facilitate the exchange of information on autism activities among federal agencies as well as coordinate autism-related programs and initiatives, according to a statement from HHS. Dr. Thomas R. Insel, director of the National Institutes of Mental Health, will chair the panel; its first task will be to develop a strategic plan for autism research to guide public and private investments.

BadgerCare Overhaul Approved

The Centers for Medicare and Medicaid Services has given Wisconsin the go-ahead to restructure its BadgerCare State Children's Health Insurance Program (SCHIP) to cover approximately 7,600 more children. BadgerCare now will enroll children in families making up to $51,625, or 250% of the federal poverty level for a family of four. Wisconsin sought to expand coverage to children in families making up to 300% of the federal poverty level but was forced to modify its request in order to stay within SCHIP guidelines designed to keep parents from voluntarily switching their children from private insurance. CMS said that Wisconsin's program change addresses this problem by requiring a period without insurance prior to a family signing up for BadgerCare. Wisconsin also has agreed to move adults from BadgerCare and into its Medicaid program.

Parents Don't See Child's Obesity

More than 40% of parents with obese children aged 6–11 years describe their child as being “about the right weight,” according to a study from the University of Michigan Health System, Ann Arbor. In fact, only 13% of parents with obese children in that age bracket rated their child as being very overweight, compared with 31% of parents with obese children aged 12–17 years. The study, which included 2,060 adults, is part of the C.S. Mott Children's Hospital National Poll on Children's Health, which is funded by the university. Pediatricians can play an important role in helping parents to recognize obesity and take steps to modify a child's diet and activity levels, the study authors noted, adding that 84% of parents said they believe it is very important for doctors to address obesity with obese adolescents during routine checkups. “Parents' willingness to discuss obesity at their children's medical appointments indicates that many parents view doctors as a welcome source of information about obesity interventions for children,” said Dr. Matthew Davis, who directs the National Poll on Children's Health.

WIC Program Adds Healthy Foods

In the first overhaul of the federal food vouchers program for women and children in nearly 3 decades, the U.S. Department of Agriculture has approved new rules that provide beneficiaries with fruits, vegetables, and whole grains. The new rules for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) also provide less support for milk, eggs, and juice, and are designed to encourage breast-feeding by giving more fruits and vegetables to women who exclusively are nursing their children. More than 8 million low-income women and children receive WIC benefits, which amount to about $39 a month.

Panel: More Smoking Prevention

Smoking rates have leveled off after nearly a decade of declines, and the nation's progress in reducing smoking is at risk unless states significantly increase funding for programs to prevent kids from smoking and to help smokers quit, warns a report from the Campaign for Tobacco-Free Kids. The annual report from the group, made up of a coalition of public health organizations, found that states have increased funding for tobacco prevention and cessation programs by 20% to $717 million, the highest level in 6 years. However, it also found that most states fail to fund these programs at minimum levels recommended by the Centers for Disease Control and Prevention. The CDC recently reported that about 21% of adults smoked in 2006, the same as in 2004 and 2005. This follows a steady yearly decline from 1997 to 2004. High school smoking rates have similarly stalled, and 23% of high school students still smoke, according to the CDC.

FDA Sets User Fees for DTC Ads

The Food and Drug Administration is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency in December. Last September, Congress authorized FDA to create a user-fee program for the advisory review of DTC prescription-drug television advertisements. The program is voluntary; the $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenues.

HHS Names Autism Panel

The Health and Human Services department has named a new committee, authorized under the Combating Autism Act of 2006, to facilitate the exchange of information on autism activities among federal agencies as well as coordinate autism-related programs and initiatives, according to a statement from HHS. Dr. Thomas R. Insel, director of the National Institutes of Mental Health, will chair the panel; its first task will be to develop a strategic plan for autism research to guide public and private investments.

BadgerCare Overhaul Approved

The Centers for Medicare and Medicaid Services has given Wisconsin the go-ahead to restructure its BadgerCare State Children's Health Insurance Program (SCHIP) to cover approximately 7,600 more children. BadgerCare now will enroll children in families making up to $51,625, or 250% of the federal poverty level for a family of four. Wisconsin sought to expand coverage to children in families making up to 300% of the federal poverty level but was forced to modify its request in order to stay within SCHIP guidelines designed to keep parents from voluntarily switching their children from private insurance. CMS said that Wisconsin's program change addresses this problem by requiring a period without insurance prior to a family signing up for BadgerCare. Wisconsin also has agreed to move adults from BadgerCare and into its Medicaid program.

Parents Don't See Child's Obesity

More than 40% of parents with obese children aged 6–11 years describe their child as being “about the right weight,” according to a study from the University of Michigan Health System, Ann Arbor. In fact, only 13% of parents with obese children in that age bracket rated their child as being very overweight, compared with 31% of parents with obese children aged 12–17 years. The study, which included 2,060 adults, is part of the C.S. Mott Children's Hospital National Poll on Children's Health, which is funded by the university. Pediatricians can play an important role in helping parents to recognize obesity and take steps to modify a child's diet and activity levels, the study authors noted, adding that 84% of parents said they believe it is very important for doctors to address obesity with obese adolescents during routine checkups. “Parents' willingness to discuss obesity at their children's medical appointments indicates that many parents view doctors as a welcome source of information about obesity interventions for children,” said Dr. Matthew Davis, who directs the National Poll on Children's Health.

WIC Program Adds Healthy Foods

In the first overhaul of the federal food vouchers program for women and children in nearly 3 decades, the U.S. Department of Agriculture has approved new rules that provide beneficiaries with fruits, vegetables, and whole grains. The new rules for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) also provide less support for milk, eggs, and juice, and are designed to encourage breast-feeding by giving more fruits and vegetables to women who exclusively are nursing their children. More than 8 million low-income women and children receive WIC benefits, which amount to about $39 a month.

Panel: More Smoking Prevention

Smoking rates have leveled off after nearly a decade of declines, and the nation's progress in reducing smoking is at risk unless states significantly increase funding for programs to prevent kids from smoking and to help smokers quit, warns a report from the Campaign for Tobacco-Free Kids. The annual report from the group, made up of a coalition of public health organizations, found that states have increased funding for tobacco prevention and cessation programs by 20% to $717 million, the highest level in 6 years. However, it also found that most states fail to fund these programs at minimum levels recommended by the Centers for Disease Control and Prevention. The CDC recently reported that about 21% of adults smoked in 2006, the same as in 2004 and 2005. This follows a steady yearly decline from 1997 to 2004. High school smoking rates have similarly stalled, and 23% of high school students still smoke, according to the CDC.

FDA Sets User Fees for DTC Ads

The Food and Drug Administration is charging pharmaceutical companies about $40,000 to review each of their direct-to-consumer television advertisements, according to a notice issued by the agency in December. Last September, Congress authorized FDA to create a user-fee program for the advisory review of DTC prescription-drug television advertisements. The program is voluntary; the $41,390 fee established for fiscal year 2008 is based on the number of ads slated for review and is expected to generate $6.25 million in total revenues.

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients—who now have access to literally billions of pages of medical information online—can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

"We need to get prepared for the coming consumerism in health care, because patients will have access to medical advice that no longer comes from the physician or nurse," said Dr. Harris.

He cited research that shows about one-third of medical information available online is of high quality, one-third could be useful but would require some interpretation, and the last third is "completely off the mark."

"One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services," Dr. Harris said during a virtual conference sponsored by the Healthcare Information and Management Systems Society (HIMSS).

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, Dr. Harris said. The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

"It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed," Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system. "It is a single tool that goes from the initial ambulatory visit to the hospital and back again," he said.

A total of 5,662 physicians use the electronic medical record module, including about 1,500 employed by the Cleveland Clinic and approximately 4,100 who practice in hospitals in the Cleveland Clinic system. Once other clinicians and support personnel are added, there will be a total of about 33,000 users for the system, Dr. Harris said.

On the outpatient side, the system integrates schedules, laboratory results, other medical documentation, a computerized physician order entry system, and best practice alerts, Dr. Harris said. In one mode, physicians can communicate either informally or formally; in formal mode, comments are added to the medical record, he said.

On the inpatient side, it's exactly the same tool, although it incorporates some different elements, including a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that "almost all of our nursing documentation is online at this point."

The system keeps track of recommended screenings and medical procedures for all patients, and provides that list to the physician electronically at the time of an office visit, allowing the physician to focus on what hasn't been done and might be needed.

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems, Dr. Harris said. "It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient," he said, noting that the average Cleveland Clinic patient is 65 years old and is taking at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions.

"Our goal is to get as much information in front of the patient as possible," he said.

In fact, the Cleveland Clinic actually is releasing certain routine test results via this online system directly to patients, Dr. Harris said. "We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours."

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said. And, the system produces a "health issues" list for patients to have and share with their physicians.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process, Dr. Harris said, is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most complete information to patients in a format that's easy to use and understand. "What we know is, we're going to have to make these tools available to patients and add value," he said. "This provides health information so they're not generally searching on the Internet."

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients—who now have access to literally billions of pages of medical information online—can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

"We need to get prepared for the coming consumerism in health care, because patients will have access to medical advice that no longer comes from the physician or nurse," said Dr. Harris.

He cited research that shows about one-third of medical information available online is of high quality, one-third could be useful but would require some interpretation, and the last third is "completely off the mark."

"One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services," Dr. Harris said during a virtual conference sponsored by the Healthcare Information and Management Systems Society (HIMSS).

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, Dr. Harris said. The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

"It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed," Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system. "It is a single tool that goes from the initial ambulatory visit to the hospital and back again," he said.

A total of 5,662 physicians use the electronic medical record module, including about 1,500 employed by the Cleveland Clinic and approximately 4,100 who practice in hospitals in the Cleveland Clinic system. Once other clinicians and support personnel are added, there will be a total of about 33,000 users for the system, Dr. Harris said.

On the outpatient side, the system integrates schedules, laboratory results, other medical documentation, a computerized physician order entry system, and best practice alerts, Dr. Harris said. In one mode, physicians can communicate either informally or formally; in formal mode, comments are added to the medical record, he said.

On the inpatient side, it's exactly the same tool, although it incorporates some different elements, including a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that "almost all of our nursing documentation is online at this point."

The system keeps track of recommended screenings and medical procedures for all patients, and provides that list to the physician electronically at the time of an office visit, allowing the physician to focus on what hasn't been done and might be needed.

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems, Dr. Harris said. "It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient," he said, noting that the average Cleveland Clinic patient is 65 years old and is taking at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions.

"Our goal is to get as much information in front of the patient as possible," he said.

In fact, the Cleveland Clinic actually is releasing certain routine test results via this online system directly to patients, Dr. Harris said. "We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours."

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said. And, the system produces a "health issues" list for patients to have and share with their physicians.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process, Dr. Harris said, is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most complete information to patients in a format that's easy to use and understand. "What we know is, we're going to have to make these tools available to patients and add value," he said. "This provides health information so they're not generally searching on the Internet."

The Cleveland Clinic has established a state-of-the-art electronic medical records system to provide the best information not only to clinicians, but also to patients, according to one of the system's architects.

The goal is to make sure that patients—who now have access to literally billions of pages of medical information online—can get the most relevant and accurate information as part of their electronic health record, said Dr. C. Martin Harris, chief information officer of the Cleveland Clinic Foundation.

"We need to get prepared for the coming consumerism in health care, because patients will have access to medical advice that no longer comes from the physician or nurse," said Dr. Harris.

He cited research that shows about one-third of medical information available online is of high quality, one-third could be useful but would require some interpretation, and the last third is "completely off the mark."

"One of the things we clearly have to understand is what information patients and consumers have access to and what tools they have to gain access, so that we can tailor our services," Dr. Harris said during a virtual conference sponsored by the Healthcare Information and Management Systems Society (HIMSS).

Over the past 5 years, the Cleveland Clinic has built a foundation-wide e-health program that's completely integrated with its clinical programs, Dr. Harris said. The e-health initiative features electronic medical records, test ordering and results, pharmacy records, and care reminders for physicians. But it also includes access to medical records and certain test results for patients, along with medical information that's been vetted for accuracy and appropriateness.

"It allows us to establish an ongoing relationship with patients after they leave the physician's office and after they leave the hospital bed," Dr. Harris said, adding that the Cleveland Clinic set out to develop tools for both doctors and patients when it created the system. "It is a single tool that goes from the initial ambulatory visit to the hospital and back again," he said.

A total of 5,662 physicians use the electronic medical record module, including about 1,500 employed by the Cleveland Clinic and approximately 4,100 who practice in hospitals in the Cleveland Clinic system. Once other clinicians and support personnel are added, there will be a total of about 33,000 users for the system, Dr. Harris said.

On the outpatient side, the system integrates schedules, laboratory results, other medical documentation, a computerized physician order entry system, and best practice alerts, Dr. Harris said. In one mode, physicians can communicate either informally or formally; in formal mode, comments are added to the medical record, he said.

On the inpatient side, it's exactly the same tool, although it incorporates some different elements, including a medication administration record, vital signs, and clerk order entry, Dr. Harris said, adding that "almost all of our nursing documentation is online at this point."

The system keeps track of recommended screenings and medical procedures for all patients, and provides that list to the physician electronically at the time of an office visit, allowing the physician to focus on what hasn't been done and might be needed.

The system also provides safety tools and will alert physicians to potential drug-drug interactions and other possible problems, Dr. Harris said. "It's virtually impossible for a physician to remember every drug-drug interaction they might see in a particular patient," he said, noting that the average Cleveland Clinic patient is 65 years old and is taking at least six prescription medications.

Patient services include the ability to view medical records, health reminders, and health care schedules, as well as features that allow them to request appointments and renew prescriptions.

"Our goal is to get as much information in front of the patient as possible," he said.

In fact, the Cleveland Clinic actually is releasing certain routine test results via this online system directly to patients, Dr. Harris said. "We're moving from having the physician screen it [and approve the information's release] to having it automatically released after about 24 hours."

In addition, patients are being sent a list of health maintenance activities, such as routine screenings, they should be arranging for over the course of a calendar year, Dr. Harris said. And, the system produces a "health issues" list for patients to have and share with their physicians.

The Cleveland Clinic's system also provides a streamlined process for getting a second opinion for a serious diagnosis. This process, Dr. Harris said, is available to any patient, not just those in the organization's service area, and is offered directly to patients with payment expected up front; patients are provided with instructions on how to seek reimbursement from their insurers.

The goal of all this is to provide the best, most complete information to patients in a format that's easy to use and understand. "What we know is, we're going to have to make these tools available to patients and add value," he said. "This provides health information so they're not generally searching on the Internet."

Pregnant Women Eschew Meds

A minority of women believe it is safe to take depression medication while they are pregnant, according to a new survey by the Society for Women's Health Research. The survey of 1,000 women was conducted by telephone in October; 500 family and general practitioners and internal medicine specialists also were queried. Only 11% of women said they thought it was safe to take a depression therapy during pregnancy, compared with 68% of physicians. Less educated and lower-income women and black women were more likely to believe it was unsafe to take a medication. Half of women said it was safe post partum, compared with 97% of physicians. Women falsely believed that depression was a normal part of the postpartum experience and also underestimated their risk for depression at specific life stages involving hormonal transitions, according to the society. In a statement, Sherry Marts, vice president of scientific affairs for the society, said the survey shows a disconnect between physicians' beliefs about depression and women's perceptions. “The health care community needs to do a better job communicating with women about depression,” Ms. Marts said.

Maryland Ready to Expand Medicaid

Maryland has approved legislation that, if fully implemented over its 5-year time frame, would provide Medicaid coverage to more than 100,000 state residents who currently lack health insurance. The bill, which also would subsidize up to 37,000 small businesses to help offset the cost of offering health insurance, is tied in part to slot machine gambling legislation. Part of the Medicaid expansion will occur only if voters approve slot machine gambling, which will appear as a state constitutional amendment on the November 2008 ballot. The health care legislation also will be funded in part by a separate doubling of the state tobacco tax to $2 per pack. The new law also includes language that allows the state to cap enrollment or limit benefits for childless adults if funding isn't available. About 14% of Maryland residents lack health insurance, according to the state.

Cord Blood Guidelines Adopted

The American Medical Association has approved new ethical guidelines for physicians who discuss fetal umbilical cord blood banking with their patients. According to the new guidelines, adopted at the AMA's interim House of Delegates meeting in November, physicians should encourage donation to public cord blood banks when a patient wishes to donate. They also should obtain consent before labor begins, if possible, disclose any ties they might have to a cord blood bank, and accept no fees or incentives for referral to a cord blood bank. “Umbilical cord blood stem cells are useful for some therapeutic purposes and as a potential source of stem cells, and physicians should be prepared to discuss cord blood banking options with their patients during pregnancy,” said AMA board member Dr. William Dolan in a statement. However, collection procedures must not interfere with standard delivery practices and the safety of a newborn or the mother, according to the new guidelines.

Routine HIV Testing Recommended

Also at its interim meeting, the AMA updated its policy on HIV testing to include guidelines in support of routine HIV testing. The guidelines state that physicians should continue to seek patients' informed consent prior to HIV testing but that the consent does not need to be documented in writing. Testing patients without prior consent is justified only “in limited cases” in which “the harms to individual autonomy are offset by significant benefits to known third parties,” including occupationally exposed health professionals or patients. “AMA's new policy calls on physicians to routinely test consenting adult patients for HIV and reflects the reality that, if HIV is detected early, infected patients can lead full and productive lives,” Dr. Ardis D. Hoven, an AMA board member, said in a statement. In a 2006 policy revision, the Centers for Disease Control and Prevention urged physicians to make HIV testing “a routine part of care in health care settings for all patients ages 13 through 64,” regardless of whether the patient has specific behavioral risk factors.

Preventive Coverage Widespread

Almost all health savings account/high-deductible health plans (HSA/HDHPs) offered by the employment-based insurance market provide “first-dollar” coverage for preventive care, regardless of whether the deductible has been met. In a July 2007 survey by America's Health Insurance Plans, 96% of small groups (50 or fewer employees), 99% of large groups (51 or more employees), and 99% of jumbo groups (3,000 or more employees) said they cover preventive care on a first-dollar basis. Conversely, only 59% of individually purchased HSA/HDHPs do so.

Pregnant Women Eschew Meds

A minority of women believe it is safe to take depression medication while they are pregnant, according to a new survey by the Society for Women's Health Research. The survey of 1,000 women was conducted by telephone in October; 500 family and general practitioners and internal medicine specialists also were queried. Only 11% of women said they thought it was safe to take a depression therapy during pregnancy, compared with 68% of physicians. Less educated and lower-income women and black women were more likely to believe it was unsafe to take a medication. Half of women said it was safe post partum, compared with 97% of physicians. Women falsely believed that depression was a normal part of the postpartum experience and also underestimated their risk for depression at specific life stages involving hormonal transitions, according to the society. In a statement, Sherry Marts, vice president of scientific affairs for the society, said the survey shows a disconnect between physicians' beliefs about depression and women's perceptions. “The health care community needs to do a better job communicating with women about depression,” Ms. Marts said.

Maryland Ready to Expand Medicaid

Maryland has approved legislation that, if fully implemented over its 5-year time frame, would provide Medicaid coverage to more than 100,000 state residents who currently lack health insurance. The bill, which also would subsidize up to 37,000 small businesses to help offset the cost of offering health insurance, is tied in part to slot machine gambling legislation. Part of the Medicaid expansion will occur only if voters approve slot machine gambling, which will appear as a state constitutional amendment on the November 2008 ballot. The health care legislation also will be funded in part by a separate doubling of the state tobacco tax to $2 per pack. The new law also includes language that allows the state to cap enrollment or limit benefits for childless adults if funding isn't available. About 14% of Maryland residents lack health insurance, according to the state.

Cord Blood Guidelines Adopted

The American Medical Association has approved new ethical guidelines for physicians who discuss fetal umbilical cord blood banking with their patients. According to the new guidelines, adopted at the AMA's interim House of Delegates meeting in November, physicians should encourage donation to public cord blood banks when a patient wishes to donate. They also should obtain consent before labor begins, if possible, disclose any ties they might have to a cord blood bank, and accept no fees or incentives for referral to a cord blood bank. “Umbilical cord blood stem cells are useful for some therapeutic purposes and as a potential source of stem cells, and physicians should be prepared to discuss cord blood banking options with their patients during pregnancy,” said AMA board member Dr. William Dolan in a statement. However, collection procedures must not interfere with standard delivery practices and the safety of a newborn or the mother, according to the new guidelines.

Routine HIV Testing Recommended

Also at its interim meeting, the AMA updated its policy on HIV testing to include guidelines in support of routine HIV testing. The guidelines state that physicians should continue to seek patients' informed consent prior to HIV testing but that the consent does not need to be documented in writing. Testing patients without prior consent is justified only “in limited cases” in which “the harms to individual autonomy are offset by significant benefits to known third parties,” including occupationally exposed health professionals or patients. “AMA's new policy calls on physicians to routinely test consenting adult patients for HIV and reflects the reality that, if HIV is detected early, infected patients can lead full and productive lives,” Dr. Ardis D. Hoven, an AMA board member, said in a statement. In a 2006 policy revision, the Centers for Disease Control and Prevention urged physicians to make HIV testing “a routine part of care in health care settings for all patients ages 13 through 64,” regardless of whether the patient has specific behavioral risk factors.

Preventive Coverage Widespread

Almost all health savings account/high-deductible health plans (HSA/HDHPs) offered by the employment-based insurance market provide “first-dollar” coverage for preventive care, regardless of whether the deductible has been met. In a July 2007 survey by America's Health Insurance Plans, 96% of small groups (50 or fewer employees), 99% of large groups (51 or more employees), and 99% of jumbo groups (3,000 or more employees) said they cover preventive care on a first-dollar basis. Conversely, only 59% of individually purchased HSA/HDHPs do so.

Pregnant Women Eschew Meds

A minority of women believe it is safe to take depression medication while they are pregnant, according to a new survey by the Society for Women's Health Research. The survey of 1,000 women was conducted by telephone in October; 500 family and general practitioners and internal medicine specialists also were queried. Only 11% of women said they thought it was safe to take a depression therapy during pregnancy, compared with 68% of physicians. Less educated and lower-income women and black women were more likely to believe it was unsafe to take a medication. Half of women said it was safe post partum, compared with 97% of physicians. Women falsely believed that depression was a normal part of the postpartum experience and also underestimated their risk for depression at specific life stages involving hormonal transitions, according to the society. In a statement, Sherry Marts, vice president of scientific affairs for the society, said the survey shows a disconnect between physicians' beliefs about depression and women's perceptions. “The health care community needs to do a better job communicating with women about depression,” Ms. Marts said.

Maryland Ready to Expand Medicaid

Maryland has approved legislation that, if fully implemented over its 5-year time frame, would provide Medicaid coverage to more than 100,000 state residents who currently lack health insurance. The bill, which also would subsidize up to 37,000 small businesses to help offset the cost of offering health insurance, is tied in part to slot machine gambling legislation. Part of the Medicaid expansion will occur only if voters approve slot machine gambling, which will appear as a state constitutional amendment on the November 2008 ballot. The health care legislation also will be funded in part by a separate doubling of the state tobacco tax to $2 per pack. The new law also includes language that allows the state to cap enrollment or limit benefits for childless adults if funding isn't available. About 14% of Maryland residents lack health insurance, according to the state.

Cord Blood Guidelines Adopted

The American Medical Association has approved new ethical guidelines for physicians who discuss fetal umbilical cord blood banking with their patients. According to the new guidelines, adopted at the AMA's interim House of Delegates meeting in November, physicians should encourage donation to public cord blood banks when a patient wishes to donate. They also should obtain consent before labor begins, if possible, disclose any ties they might have to a cord blood bank, and accept no fees or incentives for referral to a cord blood bank. “Umbilical cord blood stem cells are useful for some therapeutic purposes and as a potential source of stem cells, and physicians should be prepared to discuss cord blood banking options with their patients during pregnancy,” said AMA board member Dr. William Dolan in a statement. However, collection procedures must not interfere with standard delivery practices and the safety of a newborn or the mother, according to the new guidelines.

Routine HIV Testing Recommended

Also at its interim meeting, the AMA updated its policy on HIV testing to include guidelines in support of routine HIV testing. The guidelines state that physicians should continue to seek patients' informed consent prior to HIV testing but that the consent does not need to be documented in writing. Testing patients without prior consent is justified only “in limited cases” in which “the harms to individual autonomy are offset by significant benefits to known third parties,” including occupationally exposed health professionals or patients. “AMA's new policy calls on physicians to routinely test consenting adult patients for HIV and reflects the reality that, if HIV is detected early, infected patients can lead full and productive lives,” Dr. Ardis D. Hoven, an AMA board member, said in a statement. In a 2006 policy revision, the Centers for Disease Control and Prevention urged physicians to make HIV testing “a routine part of care in health care settings for all patients ages 13 through 64,” regardless of whether the patient has specific behavioral risk factors.

Preventive Coverage Widespread

Almost all health savings account/high-deductible health plans (HSA/HDHPs) offered by the employment-based insurance market provide “first-dollar” coverage for preventive care, regardless of whether the deductible has been met. In a July 2007 survey by America's Health Insurance Plans, 96% of small groups (50 or fewer employees), 99% of large groups (51 or more employees), and 99% of jumbo groups (3,000 or more employees) said they cover preventive care on a first-dollar basis. Conversely, only 59% of individually purchased HSA/HDHPs do so.

Medicare HPV Screening Proposed

Medicare would cover testing for the human papillomavirus (HPV) in conjunction with the standard Pap test as part of routine cervical cancer screening for older women under legislation proposed by Rep. Rosa L. DeLauro, (D-Conn.). Currently, Medicare provides coverage for a screening Pap test every 2 years for most Medicare beneficiaries, while those at high risk can receive a Pap test yearly. Rep. DeLauro noted that most private insurers and state Medicaid programs already cover HPV screening as part of routine cervical cancer screening. “Knowing if an older woman has HPV could help determine if and how often she should continue to be screened,” Rep. DeLauro said in a statement. “This can help save older women from the anguish of a cervical cancer diagnosis and can help ensure that Medicare resources are directed toward those who really need them.” Women aged 65 and older account for nearly 20% of all new cervical cancer cases and more than 35% of all deaths from the disease, according to the National Cancer Institute. The American Medical Women's Association has endorsed the bill, saying that HPV testing along with a Pap test is becoming a new standard of care in screening women age 30 and older.

States Keep Family Planning Benefit

Although federal deficit reduction legislation approved in early 2006 allows states to design their own Medicaid benefit package and potentially scale back family planning services, no state has done so thus far, according to a study from the Guttmacher Institute and the Kaiser Family Foundation. However, that legislation also included a provision that has raised the price of prescription contraceptives for some low-cost family planning providers, the study said. Historically, drugmakers have been able to offer contraceptives at low or no cost to certain entities, such as family planning clinics and college health centers, without those prices affecting the discount the drug makers must offer to Medicaid. But the 2006 legislation excluded some types of family planning providers from this formula, effectively forcing drug makers to raise their prices for prescription drugs, including contraceptives, to this group, the study said. “Family planning proponents have argued that the affected clinics cannot keep up with these sharp price increases and that access to contraceptives could be compromised for the populations they serve.”

HIV Policy Changes Urged

A small change in how the Center for Disease Control and Prevention tracks new HIV/AIDS cases could help capture data on infections in women, especially minorities, more accurately, potentially helping to get infected women into treatment much earlier, according to a coalition advocating the change. The National Women and AIDS Collective (NWAC), along with Sen. Hillary Clinton (D-N.Y.) and Sen. Edward Kennedy (D-Mass.), is asking the CDC to revise the model it uses to capture data on new cases of HIV/AIDS so it records more information on environmental and socioeconomic factors. “Research shows that women of color remain at disproportionate risk of HIV infection even when they aren't engaging in high-risk behavior such as drug use, sex with men who have sex with men, [and] sex work,” NWAC said in a statement. “As such, a data collection method that only takes into account high-risk behaviors falls far short of addressing the prevention needs of women of color and other populations whose HIV rates are influenced by a range of environmental and socioeconomic factors.” NWAC, along with the two senators, plans to set up a working group with the CDC to try to enact the changes, a NWAC spokeswoman said.

Study: Abstinence Programs Don't Work

There's no strong evidence that any abstinence program delays the initiation of sex, hastens a return to abstinence, or reduces the number of sexual partners, according to a study from the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy. “Many of the abstinence programs improved teens' values about abstinence or their intentions to abstain, but these improvements did not always endure and often did not translate into changes in behavior,” said the report, “Emerging Answers 2007.” But two-thirds of programs that support both abstinence and the use of condoms and contraceptives for sexually active teens had positive behavioral effects, according to the report. However, the report said that researchers should not conclude that all abstinence-only programs are ineffective, because fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs provided “modestly encouraging results.” More study is needed before the programs are disseminated widely, the report concluded.

Medicare HPV Screening Proposed

Medicare would cover testing for the human papillomavirus (HPV) in conjunction with the standard Pap test as part of routine cervical cancer screening for older women under legislation proposed by Rep. Rosa L. DeLauro, (D-Conn.). Currently, Medicare provides coverage for a screening Pap test every 2 years for most Medicare beneficiaries, while those at high risk can receive a Pap test yearly. Rep. DeLauro noted that most private insurers and state Medicaid programs already cover HPV screening as part of routine cervical cancer screening. “Knowing if an older woman has HPV could help determine if and how often she should continue to be screened,” Rep. DeLauro said in a statement. “This can help save older women from the anguish of a cervical cancer diagnosis and can help ensure that Medicare resources are directed toward those who really need them.” Women aged 65 and older account for nearly 20% of all new cervical cancer cases and more than 35% of all deaths from the disease, according to the National Cancer Institute. The American Medical Women's Association has endorsed the bill, saying that HPV testing along with a Pap test is becoming a new standard of care in screening women age 30 and older.

States Keep Family Planning Benefit

Although federal deficit reduction legislation approved in early 2006 allows states to design their own Medicaid benefit package and potentially scale back family planning services, no state has done so thus far, according to a study from the Guttmacher Institute and the Kaiser Family Foundation. However, that legislation also included a provision that has raised the price of prescription contraceptives for some low-cost family planning providers, the study said. Historically, drugmakers have been able to offer contraceptives at low or no cost to certain entities, such as family planning clinics and college health centers, without those prices affecting the discount the drug makers must offer to Medicaid. But the 2006 legislation excluded some types of family planning providers from this formula, effectively forcing drug makers to raise their prices for prescription drugs, including contraceptives, to this group, the study said. “Family planning proponents have argued that the affected clinics cannot keep up with these sharp price increases and that access to contraceptives could be compromised for the populations they serve.”

HIV Policy Changes Urged

A small change in how the Center for Disease Control and Prevention tracks new HIV/AIDS cases could help capture data on infections in women, especially minorities, more accurately, potentially helping to get infected women into treatment much earlier, according to a coalition advocating the change. The National Women and AIDS Collective (NWAC), along with Sen. Hillary Clinton (D-N.Y.) and Sen. Edward Kennedy (D-Mass.), is asking the CDC to revise the model it uses to capture data on new cases of HIV/AIDS so it records more information on environmental and socioeconomic factors. “Research shows that women of color remain at disproportionate risk of HIV infection even when they aren't engaging in high-risk behavior such as drug use, sex with men who have sex with men, [and] sex work,” NWAC said in a statement. “As such, a data collection method that only takes into account high-risk behaviors falls far short of addressing the prevention needs of women of color and other populations whose HIV rates are influenced by a range of environmental and socioeconomic factors.” NWAC, along with the two senators, plans to set up a working group with the CDC to try to enact the changes, a NWAC spokeswoman said.

Study: Abstinence Programs Don't Work

There's no strong evidence that any abstinence program delays the initiation of sex, hastens a return to abstinence, or reduces the number of sexual partners, according to a study from the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy. “Many of the abstinence programs improved teens' values about abstinence or their intentions to abstain, but these improvements did not always endure and often did not translate into changes in behavior,” said the report, “Emerging Answers 2007.” But two-thirds of programs that support both abstinence and the use of condoms and contraceptives for sexually active teens had positive behavioral effects, according to the report. However, the report said that researchers should not conclude that all abstinence-only programs are ineffective, because fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs provided “modestly encouraging results.” More study is needed before the programs are disseminated widely, the report concluded.

Medicare HPV Screening Proposed

Medicare would cover testing for the human papillomavirus (HPV) in conjunction with the standard Pap test as part of routine cervical cancer screening for older women under legislation proposed by Rep. Rosa L. DeLauro, (D-Conn.). Currently, Medicare provides coverage for a screening Pap test every 2 years for most Medicare beneficiaries, while those at high risk can receive a Pap test yearly. Rep. DeLauro noted that most private insurers and state Medicaid programs already cover HPV screening as part of routine cervical cancer screening. “Knowing if an older woman has HPV could help determine if and how often she should continue to be screened,” Rep. DeLauro said in a statement. “This can help save older women from the anguish of a cervical cancer diagnosis and can help ensure that Medicare resources are directed toward those who really need them.” Women aged 65 and older account for nearly 20% of all new cervical cancer cases and more than 35% of all deaths from the disease, according to the National Cancer Institute. The American Medical Women's Association has endorsed the bill, saying that HPV testing along with a Pap test is becoming a new standard of care in screening women age 30 and older.

States Keep Family Planning Benefit

Although federal deficit reduction legislation approved in early 2006 allows states to design their own Medicaid benefit package and potentially scale back family planning services, no state has done so thus far, according to a study from the Guttmacher Institute and the Kaiser Family Foundation. However, that legislation also included a provision that has raised the price of prescription contraceptives for some low-cost family planning providers, the study said. Historically, drugmakers have been able to offer contraceptives at low or no cost to certain entities, such as family planning clinics and college health centers, without those prices affecting the discount the drug makers must offer to Medicaid. But the 2006 legislation excluded some types of family planning providers from this formula, effectively forcing drug makers to raise their prices for prescription drugs, including contraceptives, to this group, the study said. “Family planning proponents have argued that the affected clinics cannot keep up with these sharp price increases and that access to contraceptives could be compromised for the populations they serve.”

HIV Policy Changes Urged

A small change in how the Center for Disease Control and Prevention tracks new HIV/AIDS cases could help capture data on infections in women, especially minorities, more accurately, potentially helping to get infected women into treatment much earlier, according to a coalition advocating the change. The National Women and AIDS Collective (NWAC), along with Sen. Hillary Clinton (D-N.Y.) and Sen. Edward Kennedy (D-Mass.), is asking the CDC to revise the model it uses to capture data on new cases of HIV/AIDS so it records more information on environmental and socioeconomic factors. “Research shows that women of color remain at disproportionate risk of HIV infection even when they aren't engaging in high-risk behavior such as drug use, sex with men who have sex with men, [and] sex work,” NWAC said in a statement. “As such, a data collection method that only takes into account high-risk behaviors falls far short of addressing the prevention needs of women of color and other populations whose HIV rates are influenced by a range of environmental and socioeconomic factors.” NWAC, along with the two senators, plans to set up a working group with the CDC to try to enact the changes, a NWAC spokeswoman said.

Study: Abstinence Programs Don't Work

There's no strong evidence that any abstinence program delays the initiation of sex, hastens a return to abstinence, or reduces the number of sexual partners, according to a study from the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy. “Many of the abstinence programs improved teens' values about abstinence or their intentions to abstain, but these improvements did not always endure and often did not translate into changes in behavior,” said the report, “Emerging Answers 2007.” But two-thirds of programs that support both abstinence and the use of condoms and contraceptives for sexually active teens had positive behavioral effects, according to the report. However, the report said that researchers should not conclude that all abstinence-only programs are ineffective, because fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs provided “modestly encouraging results.” More study is needed before the programs are disseminated widely, the report concluded.

Primary care doctors welcomed news of a federal project aimed at extending the use of electronic health records in small- to medium-size practices, but “The devil is in the details,” said Dr. Steven E. Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians, in an interview. “What are going to be the real requirements for physician practices to participate and submit data?”

The demonstration project, sponsored by the Centers for Medicare and Medicaid Services, would be open to participation by up to 1,200 physician practices beginning next spring. Over a 5-year period, the project will provide financial incentives to physician groups using certified electronic health records (EHRs) to meet certain clinical quality measures.

Bonuses will be provided each year, based on a physician group's score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care.

All participating practices would be required to use a certified EHR system to perform specific functions, such as clinical documentation and writing prescriptions. The system, which must be in place by the end of the second year of the 5-year demonstration, must also be approved by a certification body recognized by the Department of Health and Human Services.

The core incentive payment will be based on performance on the quality measures, with an enhanced bonus based on how well the EHRis integrated.

“This project will appropriately align incentives to reward doctors in small physician practices who use certified EHRs as tools to deliver higher-quality care,” CMS's acting administrator Kerry Weems said in a statement.

Over the course of the demonstration project, CMS estimated that 3.6 million consumers will be affected directly as their primary care physicians adopt certified EHRs. CMS also is encouraging private insurers to offer similar incentives for adopting EHRs.

Dr. David Dale, president of the American College of Physicians, praised the demonstration project as “an encouraging step in the right direction,” and said it was acknowledging that market forces alone will not be enough for physicians to afford new market systems.

“For physicians in small and medium-sized practices, the cost of an EHR system—not just the dollars spent on the hardware and software, but the time lost on training and conversion to a new system—makes implementing these systems a financial impossibility,” Dr. Dale said in a statement.

AAFP's Dr. Waldren agreed that the biggest barriers to EHR implementation are the cost and the design of the physician payment system.

He added that CMS has not yet divulged the details of the project, including which EHR systems will be certified and whether physician practices must provide up-front funding for the EHR systems in order to join the demonstration.

“There's some great potential here to really move this forward—1,200 practices [are] a lot,” Dr. Waldren said. “But we need to know what are going to be the requirements to participate.”

Primary care doctors welcomed news of a federal project aimed at extending the use of electronic health records in small- to medium-size practices, but “The devil is in the details,” said Dr. Steven E. Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians, in an interview. “What are going to be the real requirements for physician practices to participate and submit data?”

The demonstration project, sponsored by the Centers for Medicare and Medicaid Services, would be open to participation by up to 1,200 physician practices beginning next spring. Over a 5-year period, the project will provide financial incentives to physician groups using certified electronic health records (EHRs) to meet certain clinical quality measures.

Bonuses will be provided each year, based on a physician group's score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care.

All participating practices would be required to use a certified EHR system to perform specific functions, such as clinical documentation and writing prescriptions. The system, which must be in place by the end of the second year of the 5-year demonstration, must also be approved by a certification body recognized by the Department of Health and Human Services.

The core incentive payment will be based on performance on the quality measures, with an enhanced bonus based on how well the EHRis integrated.

“This project will appropriately align incentives to reward doctors in small physician practices who use certified EHRs as tools to deliver higher-quality care,” CMS's acting administrator Kerry Weems said in a statement.

Over the course of the demonstration project, CMS estimated that 3.6 million consumers will be affected directly as their primary care physicians adopt certified EHRs. CMS also is encouraging private insurers to offer similar incentives for adopting EHRs.

Dr. David Dale, president of the American College of Physicians, praised the demonstration project as “an encouraging step in the right direction,” and said it was acknowledging that market forces alone will not be enough for physicians to afford new market systems.

“For physicians in small and medium-sized practices, the cost of an EHR system—not just the dollars spent on the hardware and software, but the time lost on training and conversion to a new system—makes implementing these systems a financial impossibility,” Dr. Dale said in a statement.

AAFP's Dr. Waldren agreed that the biggest barriers to EHR implementation are the cost and the design of the physician payment system.

He added that CMS has not yet divulged the details of the project, including which EHR systems will be certified and whether physician practices must provide up-front funding for the EHR systems in order to join the demonstration.

“There's some great potential here to really move this forward—1,200 practices [are] a lot,” Dr. Waldren said. “But we need to know what are going to be the requirements to participate.”

Primary care doctors welcomed news of a federal project aimed at extending the use of electronic health records in small- to medium-size practices, but “The devil is in the details,” said Dr. Steven E. Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians, in an interview. “What are going to be the real requirements for physician practices to participate and submit data?”

The demonstration project, sponsored by the Centers for Medicare and Medicaid Services, would be open to participation by up to 1,200 physician practices beginning next spring. Over a 5-year period, the project will provide financial incentives to physician groups using certified electronic health records (EHRs) to meet certain clinical quality measures.

Bonuses will be provided each year, based on a physician group's score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care.

All participating practices would be required to use a certified EHR system to perform specific functions, such as clinical documentation and writing prescriptions. The system, which must be in place by the end of the second year of the 5-year demonstration, must also be approved by a certification body recognized by the Department of Health and Human Services.

The core incentive payment will be based on performance on the quality measures, with an enhanced bonus based on how well the EHRis integrated.

“This project will appropriately align incentives to reward doctors in small physician practices who use certified EHRs as tools to deliver higher-quality care,” CMS's acting administrator Kerry Weems said in a statement.

Over the course of the demonstration project, CMS estimated that 3.6 million consumers will be affected directly as their primary care physicians adopt certified EHRs. CMS also is encouraging private insurers to offer similar incentives for adopting EHRs.

Dr. David Dale, president of the American College of Physicians, praised the demonstration project as “an encouraging step in the right direction,” and said it was acknowledging that market forces alone will not be enough for physicians to afford new market systems.

“For physicians in small and medium-sized practices, the cost of an EHR system—not just the dollars spent on the hardware and software, but the time lost on training and conversion to a new system—makes implementing these systems a financial impossibility,” Dr. Dale said in a statement.

AAFP's Dr. Waldren agreed that the biggest barriers to EHR implementation are the cost and the design of the physician payment system.

He added that CMS has not yet divulged the details of the project, including which EHR systems will be certified and whether physician practices must provide up-front funding for the EHR systems in order to join the demonstration.

“There's some great potential here to really move this forward—1,200 practices [are] a lot,” Dr. Waldren said. “But we need to know what are going to be the requirements to participate.”

Congress Eyes CPSC Overhaul

Safety concerns about imported Chinese toys have prompted the House and a Senate committee to approve legislation to overhaul the nation's consumer product safety system. The House-passed bill would increase annual funding for the Consumer Product Safety Commission (CPSC) over 4 years from $63 million to $100 million, and would quintuple—to $10 million—the penalties for companies that don't report safety problems. The Senate legislation, which has cleared the Senate Commerce Committee, would increase the agency's funding even more, and would raise penalties to $100 million. Both bills would require independent laboratory testing of toys; the CPSC employs just one full-time toy tester. While the commission supports parts of the Senate bill, other parts would strain the agency's resources, Acting CPSC Chairman Nancy Nord wrote in a letter to the Senate committee.

'Healthy Steps' Benefits Said to Last

Healthy Steps for Young Children, a practice-based intervention that aims to enhance relationships among parents, children, and pediatric practices, showed sustained benefits for children more than 2 years after participation in the program ended, according to a study published online by Pediatrics. The program placed trained developmental specialists in pediatric practices to provide enhanced behaviorial and developmental services during the first 3 years of a child's life. Several benefits were sustained more than 2 years after program involvement, including greater satisfaction among parents with their child's health care, greater likelihood that children were reading, and greater odds that parents report serious behavioral issues to pediatricians.

More Katrina Mental Health Sequelae

Schools in Alabama, Louisiana, Mississippi, and Texas that received an estimated 196,000 students displaced by Katrina have not been able to meet students' ongoing mental health needs, according to a RAND Corp. survey. The researchers interviewed mental health professionals from 19 public and 11 private schools and school systems in 2006 (Psych. Services 2007;58:1339–43). The targeted schools had student population increases of more than 10%. Though they mobilized large and effective assistance efforts early on, most of the schools could not or did not continue services, according to the study. The schools cited pressure by administrators to focus again on academics, trouble reaching parents living in trailers or without reliable phone service or transportation, not enough resources, and staff burnout.

Dental Health in Hispanic Youth

Hispanic youth report better dental health habits than their non-Hispanic peers, according to a new study of low-income New York City adolescents. The study, which appeared in the November Journal of Health Care for the Poor and Underserved, relied on questionnaires filled out by the adolescents and clinical exams performed during each child's visit to a school-based dental clinic. Researchers found cavities in 52% of the Hispanic participants and 54% of the black participants. But overall, the dental health and health-promoting habits of the Hispanic children were better than those of the other study participants: Many more Hispanic youths said they had had a dental visit sometime in their lifetime, and 94% reported that they brushed daily, compared with 83% of black adolescents and 85% of other children in the study.

Hopkins Posts Autism-Genetics Data

Researchers at Johns Hopkins University's McKusick-Nathans Institute of Genetic Medicine have released genetic data they hope will help speed autism research. The data, coordinated with a similar data release from the Autism Consortium, aims to help uncover the underlying hereditary factors and speed the understanding of autism by encouraging scientific collaboration, the researchers said. These data provide the most detailed look to date at the genetic variation patterns in families with autism, they said. The Hopkins research team analyzed whole genomes from 1,250 autistic individuals, along with their siblings and parents. “Autism is a difficult enough genetic mystery for which we need all of the best minds and approaches to help unravel the role of genes in this neuropsychiatric illness,” said Aravinda Chakravarti, Ph.D., director of the Center for Complex Disease Genomics at Johns Hopkins, in a statement.

Lawsuit Filed on Medicaid Drugs

The National Association of Chain Drug Stores and the National Community Pharmacists Association filed a federal lawsuit last month seeking to block Medicaid pharmacy reimbursement reductions scheduled to be implemented in January 2008. The two groups said the cuts, which result from a rule dealing with average manufacturer prices, violate the Social Security Act and will drastically cut payments to community pharmacies that serve Medicaid beneficiaries to levels well below the prices that retail pharmacies pay for drugs. Many pharmacies will be forced to stop serving Medicaid patients as a result, the groups said.

Congress Eyes CPSC Overhaul

Safety concerns about imported Chinese toys have prompted the House and a Senate committee to approve legislation to overhaul the nation's consumer product safety system. The House-passed bill would increase annual funding for the Consumer Product Safety Commission (CPSC) over 4 years from $63 million to $100 million, and would quintuple—to $10 million—the penalties for companies that don't report safety problems. The Senate legislation, which has cleared the Senate Commerce Committee, would increase the agency's funding even more, and would raise penalties to $100 million. Both bills would require independent laboratory testing of toys; the CPSC employs just one full-time toy tester. While the commission supports parts of the Senate bill, other parts would strain the agency's resources, Acting CPSC Chairman Nancy Nord wrote in a letter to the Senate committee.

'Healthy Steps' Benefits Said to Last

Healthy Steps for Young Children, a practice-based intervention that aims to enhance relationships among parents, children, and pediatric practices, showed sustained benefits for children more than 2 years after participation in the program ended, according to a study published online by Pediatrics. The program placed trained developmental specialists in pediatric practices to provide enhanced behaviorial and developmental services during the first 3 years of a child's life. Several benefits were sustained more than 2 years after program involvement, including greater satisfaction among parents with their child's health care, greater likelihood that children were reading, and greater odds that parents report serious behavioral issues to pediatricians.

More Katrina Mental Health Sequelae

Schools in Alabama, Louisiana, Mississippi, and Texas that received an estimated 196,000 students displaced by Katrina have not been able to meet students' ongoing mental health needs, according to a RAND Corp. survey. The researchers interviewed mental health professionals from 19 public and 11 private schools and school systems in 2006 (Psych. Services 2007;58:1339–43). The targeted schools had student population increases of more than 10%. Though they mobilized large and effective assistance efforts early on, most of the schools could not or did not continue services, according to the study. The schools cited pressure by administrators to focus again on academics, trouble reaching parents living in trailers or without reliable phone service or transportation, not enough resources, and staff burnout.

Dental Health in Hispanic Youth

Hispanic youth report better dental health habits than their non-Hispanic peers, according to a new study of low-income New York City adolescents. The study, which appeared in the November Journal of Health Care for the Poor and Underserved, relied on questionnaires filled out by the adolescents and clinical exams performed during each child's visit to a school-based dental clinic. Researchers found cavities in 52% of the Hispanic participants and 54% of the black participants. But overall, the dental health and health-promoting habits of the Hispanic children were better than those of the other study participants: Many more Hispanic youths said they had had a dental visit sometime in their lifetime, and 94% reported that they brushed daily, compared with 83% of black adolescents and 85% of other children in the study.

Hopkins Posts Autism-Genetics Data

Researchers at Johns Hopkins University's McKusick-Nathans Institute of Genetic Medicine have released genetic data they hope will help speed autism research. The data, coordinated with a similar data release from the Autism Consortium, aims to help uncover the underlying hereditary factors and speed the understanding of autism by encouraging scientific collaboration, the researchers said. These data provide the most detailed look to date at the genetic variation patterns in families with autism, they said. The Hopkins research team analyzed whole genomes from 1,250 autistic individuals, along with their siblings and parents. “Autism is a difficult enough genetic mystery for which we need all of the best minds and approaches to help unravel the role of genes in this neuropsychiatric illness,” said Aravinda Chakravarti, Ph.D., director of the Center for Complex Disease Genomics at Johns Hopkins, in a statement.

Lawsuit Filed on Medicaid Drugs

The National Association of Chain Drug Stores and the National Community Pharmacists Association filed a federal lawsuit last month seeking to block Medicaid pharmacy reimbursement reductions scheduled to be implemented in January 2008. The two groups said the cuts, which result from a rule dealing with average manufacturer prices, violate the Social Security Act and will drastically cut payments to community pharmacies that serve Medicaid beneficiaries to levels well below the prices that retail pharmacies pay for drugs. Many pharmacies will be forced to stop serving Medicaid patients as a result, the groups said.

Congress Eyes CPSC Overhaul

Safety concerns about imported Chinese toys have prompted the House and a Senate committee to approve legislation to overhaul the nation's consumer product safety system. The House-passed bill would increase annual funding for the Consumer Product Safety Commission (CPSC) over 4 years from $63 million to $100 million, and would quintuple—to $10 million—the penalties for companies that don't report safety problems. The Senate legislation, which has cleared the Senate Commerce Committee, would increase the agency's funding even more, and would raise penalties to $100 million. Both bills would require independent laboratory testing of toys; the CPSC employs just one full-time toy tester. While the commission supports parts of the Senate bill, other parts would strain the agency's resources, Acting CPSC Chairman Nancy Nord wrote in a letter to the Senate committee.

'Healthy Steps' Benefits Said to Last

Healthy Steps for Young Children, a practice-based intervention that aims to enhance relationships among parents, children, and pediatric practices, showed sustained benefits for children more than 2 years after participation in the program ended, according to a study published online by Pediatrics. The program placed trained developmental specialists in pediatric practices to provide enhanced behaviorial and developmental services during the first 3 years of a child's life. Several benefits were sustained more than 2 years after program involvement, including greater satisfaction among parents with their child's health care, greater likelihood that children were reading, and greater odds that parents report serious behavioral issues to pediatricians.

More Katrina Mental Health Sequelae

Schools in Alabama, Louisiana, Mississippi, and Texas that received an estimated 196,000 students displaced by Katrina have not been able to meet students' ongoing mental health needs, according to a RAND Corp. survey. The researchers interviewed mental health professionals from 19 public and 11 private schools and school systems in 2006 (Psych. Services 2007;58:1339–43). The targeted schools had student population increases of more than 10%. Though they mobilized large and effective assistance efforts early on, most of the schools could not or did not continue services, according to the study. The schools cited pressure by administrators to focus again on academics, trouble reaching parents living in trailers or without reliable phone service or transportation, not enough resources, and staff burnout.

Dental Health in Hispanic Youth

Hispanic youth report better dental health habits than their non-Hispanic peers, according to a new study of low-income New York City adolescents. The study, which appeared in the November Journal of Health Care for the Poor and Underserved, relied on questionnaires filled out by the adolescents and clinical exams performed during each child's visit to a school-based dental clinic. Researchers found cavities in 52% of the Hispanic participants and 54% of the black participants. But overall, the dental health and health-promoting habits of the Hispanic children were better than those of the other study participants: Many more Hispanic youths said they had had a dental visit sometime in their lifetime, and 94% reported that they brushed daily, compared with 83% of black adolescents and 85% of other children in the study.

Hopkins Posts Autism-Genetics Data

Researchers at Johns Hopkins University's McKusick-Nathans Institute of Genetic Medicine have released genetic data they hope will help speed autism research. The data, coordinated with a similar data release from the Autism Consortium, aims to help uncover the underlying hereditary factors and speed the understanding of autism by encouraging scientific collaboration, the researchers said. These data provide the most detailed look to date at the genetic variation patterns in families with autism, they said. The Hopkins research team analyzed whole genomes from 1,250 autistic individuals, along with their siblings and parents. “Autism is a difficult enough genetic mystery for which we need all of the best minds and approaches to help unravel the role of genes in this neuropsychiatric illness,” said Aravinda Chakravarti, Ph.D., director of the Center for Complex Disease Genomics at Johns Hopkins, in a statement.

Lawsuit Filed on Medicaid Drugs

The National Association of Chain Drug Stores and the National Community Pharmacists Association filed a federal lawsuit last month seeking to block Medicaid pharmacy reimbursement reductions scheduled to be implemented in January 2008. The two groups said the cuts, which result from a rule dealing with average manufacturer prices, violate the Social Security Act and will drastically cut payments to community pharmacies that serve Medicaid beneficiaries to levels well below the prices that retail pharmacies pay for drugs. Many pharmacies will be forced to stop serving Medicaid patients as a result, the groups said.