Consumers value EHRs but still worry about breaches

As more and more consumers see their doctors using electronic health records, trust in doctors is high and patients have confidence that health information technology can improve the quality and coordination of care. Those with online access to their own medical records are especially supportive of health IT. But consumers have persistent concerns that data breaches will occur.

The federal government is providing incentives for the use of health IT right now, investing tens of billions of dollars in its adoption. Health IT is a foundation for health reform and for many of the new models of care now being developed or tested. At this key moment as health IT is being rolled out, the National Partnership for Women & Families commissioned a study to examine consumer views on health IT with research directed by Alan Westin, professor emeritus at Columbia University. It was conducted by Harris Interactive.  

Making IT Meaningful: How Consumers Value and Trust Health IT looks at consumer confidence in health IT. Survey respondents had an ongoing relationship with a care provider and knew whether that provider uses an electronic or paper record system. Among the findings:

Regardless of the type of record their physician uses, patients see value in EHRs. When asked if an EHR is or would be useful for seven key elements of care – such as making sure doctors have timely access to relevant information, and helping patients communicate directly with providers – 88 to 97 percent of those whose doctors use EHRs, and 80 to 97 percent of those whose doctors use paper medical records, said EHRs would be useful.

• Just 6 percent of respondents whose doctors use EHRs are unsatisfied with the medical record system their doctors are using.

• Three in four EHR respondents whose doctors use paper records said it would be valuable if their doctors adopted EHRs.

• The one in four respondents who have online access to their medical records (26 percent) were even more supportive of health IT than those who do not, particularly when it comes to the ways in which EHRs benefit them personally. They were also more trusting of doctors to protect their privacy.

• Overwhelming majorities of respondents, regardless of record system, trust their doctors to protect the privacy of their health information.

• Consumers rated EHRs higher than paper records when it comes to giving patients confidence their information is safe, complying with privacy laws, giving patients more control over their health information, earning their trust, and seeing a record of who has accessed their information.

• There are concerns about data breaches and current privacy laws. Three in five respondents whose doctors use EHRs (59 percent) agree that widespread adoption of EHRs will lead to even more personal information being lost or stolen, as do 66 percent of respondents whose doctors use paper records.  Similarly, more than half of those whose doctors use EHRs (51 percent) and 53 percent of those whose doctors use paper records agree that the privacy of personal medical records and personal health information is not currently well protected by federal and state laws and organizational practices.

• Those with paper records today who are most worried about their privacy in this survey were men, those with a college education, respondents ages 35 to 46, and those living in the east and west.

More information is available at www.NationalPartnership.org.

Vitamin D deficiency high among trauma patients

New research presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons found that 77 percent of trauma patients had deficient or insufficient levels of vitamin D.

Researchers have linked a lack of vitamin D with muscle weakness, bone fractures and the inability of bones to fully heal. In a new study, investigators sought to determine the prevalence of vitamin D deficiency among orthopedic trauma patients.

Investigators reviewed the medical records of 1,830 adult (ages 18 and older) patients at a university Level 1 trauma center from Jan. 1, 2009 to Sept. 30, 2010.  Participants with vitamin D levels below 20 ng/mL were categorized as "deficient," and those with levels between 20 and 32 ng/mL, "insufficient" (levels between 40 and 70 ng/mL are considered "healthy").

Thirty-nine percent of all patients were vitamin D deficient, and another 38.4 percent had insufficient levels of vitamin D. Patients ages 18 to 25 had the lowest levels of vitamin D deficiency and insufficiency of any age group, and yet 29 percent were deficient, and 54.7 percent, insufficient.

"Vitamin D deficiency affects patients of all ages and is more prevalent than we thought it was," said Brett D. Crist, MD, lead investigator and co-director of the Orthopaedic Trauma Service, Department of Orthopaedic Surgery, University of Missouri. The findings are important "as vitamin D deficiency has been linked to increased incidences of fracture nonunions (bone breaks that fail to heal)."

With the new data showing that a significant number of patients have deficient or insufficient levels of vitamin D, physicians should consider treating fracture patients with a supplement to ensure optimal outcome, said Dr. Crist, who provides vitamin D and calcium supplements to all trauma patients in his care, except to those patients for whom higher levels of calcium are not recommended.

"Although we've gone to treating most patients with weekly high dose vitamin D, in addition to daily vitamin D and calcium, continual monitoring of vitamin D levels is important," said Dr. Crist. Vitamin D deficiency is "easy to manage," and "can prevent future fractures and improve healing of current fractures."

It is extremely difficult to naturally obtain enough vitamin D. An adult needs at least 1,000 International Units (IU) of vitamin D (10 glasses of milk and one fish meal each day), and a child, 400 to 800 IUs for good health, depending on age, weight and growth.

To ensure appropriate levels of vitamin D, a daily supplement is recommended for children and adults.

For more information on bone and joint health, visit Orthoinfo.org

Vanderbilt study finds practice of defensive orthopedic medicine costs U.S. $2 billion annually

Vanderbilt University Medical Center researchers estimate that U.S. orthopedic surgeons create approximately $2 billion per year in unnecessary health care costs associated with orthopedic care due to the practice of defensive medicine.

Defensive medicine is the practice of ordering additional but unnecessary tests and diagnostic procedures that may later help exonerate physicians from accusations of malpractice. However, these additional costs result in no significant benefit to patients' care.

Published in the February issue of the American Journal of Orthopedics, the study suggests unnecessary costs associated with the practice of defensive medicine play a substantial role in the nation's rising cost of health care.

The findings are from a national survey of 2,000 orthopedic surgeons selected randomly through a list provided by the American Academy of Orthopaedic Surgeons. Respondents were located in all 50 states and practice in a variety of settings. Of respondents, 96 percent report practicing defensive medicine, which accounts for 24 percent of all imaging studies, laboratory tests, consultations and hospital admissions among the survey's cohort.

Using the American Medical Association's CPT (Current Procedural Terminology) billing codes as a reference point for costs, researchers calculated the average cost of each imaging test then tabulated an average cost per month.

On average, orthopedic surgeons spent $8,485 per month on the practice of defensive medicine, a figure which equals nearly a quarter of their total practice costs.

Per year, the cost for defensive medicine averages $101,820 per respondent. When this figure is multiplied by the 20,400 orthopedic surgeons practicing in the U.S., the average cost per year for defensive medicine procedures among this group totals $2,077,128,000.

Ordering excess tests or procedures is known as positive defensive medicine. Researchers also examined the practice of negative defensive medicine, or the practice by physicians of avoiding high-risk patients or procedures in order to limit liability.

In the past five years, 70 percent of respondents reported reducing the number of high-risk patients they treat, while 84 percent reduced or eliminated performing high-risk services and procedures.

Write-in examples of defensive medicine included closing a practice to become a consultant, no longer seeing patients in an emergency room, and not operating on patients with diabetes or heart problems.

"It becomes an access of care issue," said Alex Jahangir, M.D., assistant professor of orthopedic surgery and rehabilitation, and a study author. "Patients are now losing access to physicians if they happen to be a diabetic, obese, or a smoker with heart problems. Their care will be delayed; the costs will increase because they have to be flown to a tertiary center. Negative defensive medicine is a big part of the problem."