News Briefs
News Briefs
Six groups agree to HIPAA standard-setting protocol
Six standard-setting organizations signed a memorandum of understanding (MOU) on March 31, agreeing to cooperate and communicate on implementation of electronic transactions standards adopted by the Department of Health and Human Services (HHS).
The 1996 Health Insurance Portability and Accountability Act (HIPAA) mandates HHS to adopt standards that will help reduce the costs of administrative and financial transactions in the health care industry. The development of maintenance and updating protocols for these standards has been one factor delaying publication of a final rule, now expected out this month.
The standards groups currently include the Alexandria, VA-based Accredited Standards Committee X12; the Dental Content Committee in Chicago; Health Level Seven in Ann Arbor, MI; the National Council for Prescription Drug Programs in Phoenix; the National Uniform Billing Committee in Chicago; and the National Uniform Claim Committee in Chicago. Other organizations may be added in the future.
The MOU establishes a process that will allow "a single entry point" for requesting changes to HIPAA standards, for the request’s evaluation, and for a response to the request to be sent to the National Committee on Vital and Heath Statistics in Washington, DC, for review and HHS for adoption, according to the Medical Group Management Association in Englewood, CO.
Several issues, such as providing for ongoing funding for Web site maintenance and the timing of changes, must still be ironed out. Each of the standards groups, though, now has in place an important vehicle for modifying or adding to HIPAA-mandated standards.
Multidisciplinary system improves drug error reports
When Methodist Medical Center (MMC) in Dallas addressed medication errors, the seemingly obvious objective of error reduction proved unrealistic. The QI team realized that first it had to get a better handle on the extent of the problem. MMC was no different from most institutions in that drug errors were severely under-reported. The quality of data from the existing report process was inadequate to prevent repeat events.
The revised goals aimed at the more basic solutions of higher report rates and more useful error data. The team also determined that MMC needed a standard definition of "medication error" and wider availability of the database housing report results. An additional goal — and perhaps the most challenging one — was to remove the perceived and actual punitive aspects of error reporting.
The team membership included representatives from pharmacy, quality assurance, and nursing staffs. The medical and legal staffs provided consultation. With interdisciplinary representation came access to a richer knowledge base. In fact, the team found the nursing literature to be the most helpful in designing the new occurrence report.
Features of the report include:
• Incident description detailing where and why the mistake happened.
• Point of origin in the drug administration system.
• Error details that describe the incident and tell where and why it happened.
• Data elements laid out by field for easy input to the database.
The fear factor was the target of all-out staff education efforts. Nurses learned, for example, that reports bearing their names do not end up in their employee files.
The result of the initiative is the availability of good data for use in targeted drug error prevention processes. Within the first year, occurrence reports increased 60%. Incomplete reports decreased 60%. The data are now available to multiple departments from the centralized database. For details, see: DeJong D, Brookins LH, Odgers L. Multidisciplinary redesign of a medication error reporting system. Hosp Pharm 1998; 33:1,372-1,377.
NSAIDs in elderly patients increase their risk of CHF
A study published in the March 27, 2000, issue of Archives of Internal Medicine shows that use of nonsteroidal anti-inflammatory drugs (NSAIDs) can exacerbate development of congestive heart failure (CHF).1 The authors performed a matched case-control study of the relationship between NSAID use and hospitalization with CHF. Cases (those admitted to hospitals with a primary diagnosis of CHF) and controls (those admitted to the same hospitals but without CHF) were interviewed for a thorough history of recent use of aspirin and other NSAIDs.
Results of the study show that recent use of NSAIDs in elderly cases (mean age 76.6 years, n=365) doubled the odds of hospital admission for CHF over that of controls (mean age 75 years, n=658). Both high dose and long plasma half-life of NSAIDs appear to increase the risk of CHF occurrence. In addition, the tendency of NSAIDs to antagonize the actions of diuretics and angiotensin-converting enzyme inhibitors may factor into the increased risk of CHF in elderly NSAID users. Also, there appears to be an increased risk in patients with a history of heart disease, even if that history did not include CHF.
Reference
1. Page J, Henry D. Consumption of NSAIDs and the development of congestive heart failure in elderly patients. Arch Intern Med 2000; 160:777-784.
Tool checks background, sanction reports on doctors
An on-line company now offers consumers a means to order a license/sanction report on physicians nationwide.
DoctorDirectory.com, based in Asheville, NC, has joined with SearchPointe in Atlanta to offer this service. Users can learn about a physician’s credentials and educational background and, for less than $10, find out about disciplinary actions and sanctions taken against any medical doctor with an active license. The information offered through SearchPointe’s database of more than 650,000 physicians has been collected from private, professional, and federal agencies, as well as from the medical boards from all 50 states.
Also available to consumers is a convenient alert service that will provide notification via e-mail of any change in the license and/or sanction data on specific doctors when users purchase a sanction report.
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