As the turkey makes its way into sandwiches, casseroles and tetrazzini, and as the family slowly revives itself from food coma, it's perhaps a good time to digest and reflect upon the year.
And what a year it has been. Economic crisis. Multi-billion dollar stimulus for health IT. The contentious battle over health care reform. And the persistent rhetoric proclaiming that health IT will save the day.
Lost among the grand and hopeful visions for health care reform and health IT subsidies, however, have also been the small victories that occur daily on the ground. Accomplishments unheralded. Challenges overcome.
As we digest on a feast of grand visions, let's take a look back at a few notable milestones and data points from the year and appreciate the fact that actual progress is being made.
National Exchange Goes Live
In February of this year, MedVirginia became the first regional health information organization to go live with the Nationwide Health Information Network. Using the NHIN CONNECT Gateway, the labor-intensive process of determining Social Security disability benefits was reduced from 84 days to 25 days.
Though it's still relatively early, preliminary results suggest that a substantial percent of requests (333 of 421 cases in one sample) include clinical information used for determining eligibility. "That percentage is very high as compared to what we would expect from the general population of medical providers from whom we request medical information. It's a very good response rate," said Jim Borland, special advisor for health IT at the Social Security Administration.
Marty Prahl -- IT architect for Lockheed Martin, a partner of SSA -- added "The medical information coming back in the form of a Continuity of Care document has provided tremendous value to disability examiners who review the information for disability claims."
Though much work remains to develop a vibrant national information exchange network, RHIOs continue to gain traction locally with 57 of the 150 qualifying exchanges categorized as operational, up 40% from last year -- certainly something to be proud of.
Adherence Text Messaging
Encouraging patients to regularly take their medications for chronic illnesses is no small task. Imagine how much more difficult it is to accomplish in teenagers who may either perceive themselves as without illness or react unpredictably to authority figures.
That's why the results published in Pediatrics this November were so promising. In the small prospective study, 41 pediatric liver transplant patients with a median age of 15 were sent pre-programmed text message reminders to take their immunosuppressant medications. Over the 13 month study period, not only did patients take their medication more regularly, but only two patients experienced rejection episodes as opposed to 12 the prior year.
In the study, a text messaging adherence program from CareSpeak was used. Clinicians first enter medication and dosing schedules, and patients then modify the timing of the alerts to fit their lifestyle. As described by lead author Tamir Miloh, "Teenagers can have very busy or obscure lifestyles, so we thought it was important that they choose whatever time they wanted to get their reminders."
Importantly, after patients take the prescribed medication, they're able to respond to the message and confirm receipt and compliance -- providing a full feedback loop with data that can be readily aggregated and studied. Though we're still in the early stages of understanding how simple technologies can modify behavior, studies such as this are sure to foster further innovation and work in this important space.
E-Prescribing Adoption Curve
After many tough years of developing and promoting an electronic prescription infrastructure, it appears that the adoption of e-prescribing applications is beginning to take hold. A recent press release by SureScripts suggests that as many as 140,000 providers are now using an application with electronic prescription capabilities. That's up from about 74,000 providers last year. Part of that growth may also be reflected in the now over 200 certified systems with e-prescribing functionality.
Since 2001, Surescripts and RxHub have been working diligently to promote a secure, electronic infrastructure. By the end of 2005, the number of providers using e-prescribing was an anemic 10,000. Over the last few years, however, that number has been steadily growing -- to 35,000 at the end of 2007, 74,000 at the end of 2008 and now over 140,000. And the incentives to adopt such systems are only increasing.
Not all is roses just yet however. Missing from the press release was the actual number of electronic prescriptions being written. In 2007, the number was estimated to be about 30 million electronic prescriptions written annually, or just 0.8% of the 3.65 billion retail prescription total. How the actual transaction volume improves over the upcoming years remains to be seen.
Internet Pervasiveness
Over the last 10 years, we've seen a noticeable shift in the perceptions about the Internet. Though concerns about security and privacy remain, patients and physicians are using the Internet now for an increasingly wide range of health care functions. A couple reports from this year highlight that trend.
In a survey of 4,560 Kaiser Permanente seniors, 87% of Medicare beneficiaries who were registered for Kaiser's personal health record expressed being either satisfied or very satisfied with the application.
"The extraordinarily high satisfaction rate of the survey respondents -- all 65 and older -- reinforces what we are learning among the general population: When a PHR like My Health Manager is thoughtfully designed for an easy and convenient user experience, individuals will engage more fully in managing their own health," said Jan Oldenburg of Kaiser.
At the Connected Health Symposium, Mark Bard of Manhattan Research reported that physicians have doubled their online use over the last five years. Once a novelty, the Internet has become a necessity, according to 90% of the physician respondents, 75% of who go online daily for work-related functions. Given the growing functionality of the Web, this number is likely to go up.
A Diet for Long-Lasting Success
Though most headlines focus attention on the big dollars and launch of key initiatives, it's helpful to remember that every day, many individuals are working hard to make the system a little better. Progress, though often slow and variable, is being made. Thanks to those who continue to make those accomplishments possible and have a happy holiday season.