Report Watch – Week of 2nd February, 2009

Just an occasional post when I come upon a few interesting reports that are worth a download. This week we have a few.

First we have:

"Capital crunch" forces hospitals to delay IT upgrades

January 23, 2009 | Richard Pizzi, Contributing Editor

WASHINGTON – The "capital crunch" and the recession are severely restricting U.S. hospitals in obtaining funds to upgrade their facilities and invest in new clinical and information technologies, according to the American Hospital Association.

In a conference call with reporters, AHA President and CEO Richard Umbdenstock said hospitals rely on borrowed money, philanthropy and reserves to fund capital projects, but many now find it difficult to obtain funds from these sources.

The vast majority of hospitals surveyed report that borrowing funds through tax-exempt bonds - the main source of borrowing for most hospitals - is difficult or impossible. Loans from banks or other financial institutions are similarly difficult to obtain.

Umbdenstock said hospitals' reserves have also taken a hit due to falling stock prices, while net income is down and philanthropic donations have slowed, leaving hospitals with less of their own funds to rely on to make needed improvements.

Nearly half of the hospitals surveyed by the AHA have postponed projects that were to begin within the next six months and many have stopped projects that were already in progress.

Access the full article here:

The AHA report is available online (.pdf).

This is hardly a surprise – may be the Obama Stimulus package can reverse the trend.

We also seem to have the same problem in the UK.

Credit crunch hits UK and US hospitals

26 Jan 2009

Hospitals in the US and UK are beginning to struggle to raise the funds they need for capital investment in infrastructure and Information technology projects.

In the US the result is being seen in hospitals shelving planned investments in facilities and information technology.

In the UK an internal memo from the National Health Service reveals that the private finance initiative (PFI) hospital building programme, under which banks finance the construction of health facilities and lease them back to the health service, is now seen at risk as a result of the recession and banking crisis.

According to a BBC News report a leaked NHS memo says the hospital building programme in England could be badly disrupted by the recession, and warns there is no plan B. The UK officially entered recession in January, after experiencing two quarters of contraction.

More here:

Second we have:

HIMSS Summarizes the I.T. Bills

The Healthcare Information and Management Systems Society in Chicago has published a summary of six pieces of legislation introduced in Congress in recent weeks that include health information technology provisions.

It's a tangled array. Three separate House committees -- Appropriations, Ways and Means, and Energy and Commerce -- have introduced bills that include components of the economic stimulus package, including billions of dollars for health I.T. initiatives. A full House vote on the package is expected this week.

Full article here:

For the complete HIMSS summary, click here.

It is interesting to see the various legislative proposals for Health IT that are under consideration in the US.

Third we have:

NHS IT ‘in deep trouble’ and mired in secrecy, MPs warn

Public Accounts Committee demands rapid improvement or end of national care records systems

By Leo King, Computerworld UK

The Department of Health and its key IT supplier CSC have been slammed by MPs for a confidentiality agreement surrounding the £12.7 billion National Programme for IT, the world’s largest civilian IT programme.

The powerful House of Commons Public Accounts Committee also told the NHS to “get its head out of the sand” as it flagship IT project, remain far off schedule.

The PAC hit out at civil servants and CSC for agreeing a gagging order over negotiations that took place about care records deployment in the northern, central and eastern parts of the country. CSC is the exclusive lead supplier to those regions.

Responding to the report, the Department of Health said, "New IT systems in the NHS are delivering better, safer and faster care. Current costs have declined because of the delays to implementation due mainly to adding extra functions to the system. Costs are also controlled by the contracts which only pay to providers once the service has been successfully delivered."

However, the PAC said, the care records service, which will provide digital health files for every patient in the country, remains “way off the pace”, and is due to be completed at least four years behind schedule in 2014 to 2015.

Much more here:

The full report can be found here:

This is a worry – as once politicians get involved – things can get de-railed for reasons that are not purely sensible and pragmatic!

More coverage is here:

Fourth we have:

Costs And Benefits Of Health Information Technology: New Trends From The Literature

Caroline Lubick Goldzweig 1*, Ali Towfigh 2, Margaret Maglione 3, Paul G. Shekelle 4

1 Caroline Goldzweig is associate chief of staff, Clinical Informatics, at the Veterans Affairs (VA) Greater Los Angeles Healthcare System in California.
2 Ali Towfigh is an assistant professor of medicine at the Veterans Affairs (VA) Greater Los Angeles Healthcare System in California.
3 Margaret Maglione is associate director of the Southern California Evidence-based Practice Center, at RAND in Santa Monica.
4 Paul Shekelle is director of the Southern California Evidence-based Practice Center, at RAND in Santa Monica. Shekelle also is a staff physician at the VA Greater Los Angeles Healthcare System.

*Corresponding author.


To understand what is new in health information technology (IT), we updated a systematic review of health IT with studies published during 2004-2007. From 4,683 titles, 179 met inclusion criteria. We identified a proliferation of patient-focused applications although little formal evaluation in this area; more descriptions of commercial electronic health records (EHRs) and health IT systems designed to run independently from EHRs; and proportionately fewer relevant studies from the health IT leaders. Accelerating the adoption of health IT will require greater public-private partnerships, new policies to address the misalignment of financial incentives, and a more robust evidence base regarding IT implementation. [Health Affairs 28, no. 2 (2009): w282-w293 (published online 27 January 2009; 10.1377/hlthaff.28.2.w282)]

Key Words: Consumer Issues, Health Reform, Research And Technology, Health Spending, Health Information Technology

More here:

Full free access to the article and the .pdf will be available for another week or so – along with a range of other important articles. Go and browse ASAP.

Fifth we have:

Study: Savings from Home Monitoring

Remote, home-based physiological monitoring of patients with congestive heart failure can save thousands of dollars per patient per year through fewer hospitalizations, according to a new report.

The New England Healthcare Institute, a Cambridge, Mass.-based independent research firm, has updated a report on remote physiological monitoring it published in 2004. The new data estimates an annual cost of $2,052 per patient for the monitoring technology. Add disease management software to the mix, and that price would go up to $2,802.


Consequently, the technology has the potential to save $4.7 billion to $6.4 billion a year, report authors conclude.

More here

For the full report, "Research Update: Remote Physiological Monitoring," click here.

Sixth we have a report on the good old consent issue from a US perspective

Article is here:

Go here to review the report:

Last we have:

Report: DOD, VA need better planning for e-health records interoperability

The operators of two of the largest health care systems in the world are making progress in sharing patients’ electronic health records, but they lack a clear plan for meeting a September deadline for fully interoperable systems, according to the Government Accountability Office.

The Defense and Veterans Affairs departments provide medical services to millions of Americans. All of VA’s patients come from DOD, and some are treated simultaneously in both systems. The departments have a mandate to establish an interoperable electronic system for handling patient records and exchanging information by the end of the fiscal year. The number of patients whose records the departments are sharing is growing, but it remains a small percentage of the overall patient population. Furthermore, VA and DOD have yet to establish a joint office to oversee the project.

The absence of clearly defined goals and milestones limits the departments’ ability to measure their progress and ensure success, GAO auditors wrote in a report titled “Electronic Health Records: DOD’s and VA’s Sharing of Information Could Benefit from Improved Management.”

More here:

The report is here:

GAO report

These reports and associated materials are worth a close look.



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