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Archive for April, 2010

Computed Tomography (CT) dose is on ECRI Institute’s 2010 list of top 10 technology hazards. Recommendations for regulating CT radiation dose is thus, expanded by the Institute.

High CT radiation doses are being delivered to patients on a daily basis, putting them at an increased risk of developing cancer. Hence, keeping CT radiation dose in check is a high priority safety concern for hospitals. While increased levels of radiations may put patients at risk, diminishing the same, will affect the image quality that may result in incomplete examination or rescanning of the image. The process will expose the patients to even more radiation.

Practical esteem to balance between the degree of radiation are presented in a new guidance article, “CT Radiation Dose: Understanding and Controlling the Risks,” released by ECRI Institute, an independent, nonprofit organization that researches the best modes of care. This comprehensive Health Devices article expands on the recommendations about controlling CT radiation dose published in ECRI Institute’s 2010 Top 10 Technology Hazards list.

ECRI Institute emphasizes that the responsibility also lies with the facility itself, referring physicians, medical physicists, radiation technologists, and CT device manufacturers. The article includes sixteen practical recommendations that every facility should identify with, to help control radiation dose in CT.

The recommendations are set in 5 major sections:

1. protocol optimization,
2. prioritizing dose reduction,
3. patient selection,
4. the technician’s responsibilities,
5. quality assurance.

Dr.Keller, vice president, health technology evaluation and safety, ECRI Institute, considers the latest CT models are created with dose-saving technologies, but they may not be very affordable for many organizations. “In time, these technologies will become more widely installed,” says Keller. “Until then, there are a number of effective strategies every facility can implement to reduce dosage.The article also includes a dedicated section on dose-reduction technologies and the amount of dose savings they each achieve.

Centers for Medicare and Medicaid Services ( CMS ), a division of the U.S. Department of Health and Human Services, announced on Apr-26th, 2010 that, Washington’s Medicaid program will receive federal matching funds for state planning activities required to utilize the electronic health record (EHR) incentive program formed by the American Recovery and Reinvestment Act of 2009 (Recovery Act). Washington is entitled to approximately $967,000 in federal matching funds.

EHRs are expected to serve the purpose of improving general health care for the people of Washington. These records are meant to fit in conveniently with various providers treating a Medicaid patient subject to care. Decision making comes in handy with EHRs. The Recovery Act provides a 90 percent federal match for state planning activities to administer the incentive payments to Medicaid assistants, to make sure of their payments through audits and statewide participation to promote “meaningful use” and work-structure within the block of EHR technology across Washington.

Washington intends to make full use of its federal matching funds for planning activities that include organising a detailed analysis to understand the recent situation of Health IT activities in the state. Data on issues such as existing barriers to its use of EHRs, provider eligibility for EHR incentive payments, and the creation of a State Medicaid HIT Plan, which will define the state’s vision for its long-term HIT use will taken into account.

We congratulate Washington for qualifying for these federal matching funds to assist its plan for implementing the Recovery Act’s EHR incentive program, Meaningful and interoperable use of EHRs in Medicaid will increase health care efficiency, reduce medical errors and improve quality-outcomes and patient satisfaction within and across the states.” said Cindy Mann, director of the Center for Medicaid and State Operations at CMS.

Other States who recieved similar funding include:

• New Mexico will be assigned about $405,000 for the EHR planning work.
• Missouri will receive approximately $1.53 million in federal matching funds.
• Puerto Rico will receive approximately $1.80 million in federal matching funds.
• Oregon will receive approximately $3.53 million in federal matching funds.

Associated Press reports that President Barack Obama’s healthcare reform overhaul will be more “expensive” instead of reducing cost.

According to Economists at the Health and Human Services Department, the healthcare overhaul will achieve Obama’s aim of expanding coverage but controlling costs still remains a major issue. It was also pointed out that, Medicare cuts may be impractical and unstable.

Economic experts at the Health and Human Services Department concluded in a report issued Thursday that the health care overhaul will insure more Americans but costs will also rise at the same time. Obama’s aim of expanding health insurance adding 34 million to the coverage rolls will be achieved but, raising projected spending by about 1 percent over 10 years. The amount may get higher with time. In particular, concerns about Medicare could become a major political liability in the midterm elections. Some of the cost-control measures in the bill, as in, Medicare cuts, tax on high-cost insurance and a commission to seek ongoing Medicare savings could however, help reduce cost increases in the long run.

Republicans are concerned with Obama’s 10-year plan to overhaul the health care system that may cost up to or nearly $1 trillion. His healthcare reform act will increase national health care spending by $311 billion from 2010-2019, or nine-tenths of 1 percent. Approximately $35 trillion is estimated to be spent on the cause during these 10 years.

However, the overhaul is meant to improve national health care spending by $311 billion from 2010-2019. Officials in the Presidential Adminstration support the increase as a bargain price for guaranteeing coverage to 95 percent of Americans. Reductions in payments to private Medicare Advantage plans would instigate a departure from the popular alternative.

Rep. Dave Camp, R-Mich., a leading Republican on health care issues says, “A trillion dollars gets spent, and it’s no surprise. Health care costs are going to go up.”

Women with higher density on a mammogram has higher risk (four to five times) of developing breast cancer, opined the researchers who presented data regarding this during the Annual Meeting of the American Association for Cancer Research.

The presentation included data from three studies on latest research regarding mammographic density. The following two studies in the presentation indicate that mammographic breast density is an indicator of breast cancer risk.

1. Longitudinal breast density and risk of breast cancer: The study was conducted at the Mayo Clinic, Rochester,  and lead by Celine M. Vachon, Ph.D., associate professor of epidemiology in the College of Medicine and colleagues. They evaluated from data collected for Mayo Mammography Health Study, which included 19,924 women who had a mammogram at the Mayo Clinic between 2003 and 2006; the women were above 35 years and didnt have a history of breast cancer. The researchers evaluated whether change in breast density is associated with breast cancer and found that women who had an increase in breast density over six years has a higher risk (28 percent) of developing breast cancer. And it is likely that women with decreasing density has lower risk.

2. Change in mammographic density with estrogen and progestin therapy: A measure of breast cancer risk in the Women’s Health Initiative : Celia Byrne, Ph.D.and colleagues at the Lombardi Comprehensive Cancer Center at Georgetown University found that Change in mammographic density may be a useful intermediate marker to explain the increased breast cancer risk among postmenopausal women using estrogen and progestin therapy (EPT). The case-control study was conducted within the Women’s Health Initiative (WHI) randomized trial of EPT.

Mammography, which is basically an x-ray of the breast, is the gold standard for breast cancer screening and the American Cancer Society recommends yearly screening mammograms for all women aged above 40yrs of age. The new research has added a new dimension in the advantages of a mammogram, ie not just early breast cancer detection but also identification of potential risk of developing breast cancer later.

An earlier Kalorama report EMR 2010 (Market Analysis, ARRA Incentives, Key Players, and Important Trends), officially posted on April 7th-2010, states how HHS is being constantly urged by health practitioners’ organisations and Congress Members to unlax the ‘meaningful use’ criteria for active growth in the EMR industry. A $13.8 billion market is predicted in the report which can be successfully increased to almost its double earning by systematic use of incentives and urging of health systems. Kalorama identifies the standards of obtaining EMR status for a physician is the most important obstacle they are facing at the moment.

Certain criterias for medical practitioners by HSS, such as, submitting a percentage of claims electronically, implementing established diagnostic list such as ICD-9, common medications listed for every patient etc are required to be met in order to be elligible to earn the EMR incentives by 2011. Kalorama however, also believes that requiring 80% of orders via CPOE by 2011, or that half of patients get auto-reminders through an EMR system, may affect EMR systems sales.

It is also mentioned in the report, about the letter prepared by the Senate Finance Committee Chairman Max Baucus and his batch of thirty-seven U.S. Senators along with D-Montana, and American Senate Health, Education, Labor and Pensions Committee Chairman Tom Harkin, D-Iowa. It was about mprovements in an earlier proposal for distributing substantial amounts for health Information and Technology. The letter was published by the Centers for Medicare & Medicaid Services.The idea was to motivate provider participation.A total of 235 members of the United States House of Representatives insisted CMS to axpand its proposed definition and criteria for hospitals to be elligible for the ‘meaningful use’ of health IT incentives.

Kalorama quoted Mr.Bruce Carlson, the publisher of Kalorama Information saying, “Requiring physicians to undergo 25 mandates by next year may not be effective given the kind of real-world usage among physicians we see today.Getting physicians used to these systems is the challenge to a totally paperless healthcare system in the United States and we think gradual, achievable goals would be preferable.

The report can be purchased from Kalorama Information at: http://www.kaloramainformation.com/redirect.asp?progid=78541&productid=2503320.

President Obama signed a bill to law on 16th April 2010, to stretch the eligibility criteria of the EHR incentive program for physicians in hospital outpatient departments or in hospital-affiliated clinics, who would not have been otherwise eligible for the above mentioned incentives under the Centers for Medicare and Medic-aid Services’(CMS).

HANYS and HANYS’ HIT Strategy Group insisted on expansion of the EHR plan for the out-patient medical practitioners along with CMS, important members from the Congress board, committees of jurisdicition in partnership with AHA and President Obama’s Adminstration.

The bill is meant to expand unpaid or lapsed unemployment insurance benefits and higher subsidies for individuals buying health insurance through the Consolidated Omnibus Budget Reconciliation Act (COBRA). Provisions to delay a Medicare physician fee schedule until the end of May is also proposed in this bill.

According to HANYS, “all-or-nothing” requirements must be flexed out for hospitals and physicians to fit the EHR incentive bill criteria. Failure to meet the requirements by 2015 may affect Medicare payment penalties. They further pressed on EHR incentive base payment should be made to all Hospitals, with or without a Medicare provider number with other institutions.

The President of Stackpole & Associates, Irving Stackpole will talk about the effects of American health care reforms on medical tourism marketing on Monday, April 26th, ’10 at San Jose, Costa Rica at the First Latin American Global Medicine and Wellness Congress.

Global Medicine and Wellness Congress is the first Congress in Latin American Medical Tourism and it  aims to attract the attention and participation of major players in this industry.  Stackpole and Associates is actively involved in Client Market research and is successfully headed by Mr. Irving Stackpole with over 30 years of experience in the service industry.

The Medical Tourism is one of the most flourishing industries in the world and many people travel to United States each year with hope of finding expert treatments for their illness and now more insurance companies are coming forward to cover treatment abroad.

The healthcare reform bill being introduced by the Obama administration in the US is likely to have its effects on health tourism particularly regarding the uninsured Americans and self- insured American health plan providers.

Mr. Irving Stackpole’s presentation titled  “The Impact of US Health Care Reform on Medical Tourism Marketing” is going to focus on these issues and how far the new healthcare reform legislation can influence the booming medical tourism market. He is the featured speaker of the event.

Mr Irving stated in a press release that,  “The insurance industry will be in flux for at least the next two years as it responds to the changes in the marketplace as a result of health care reform. Until issues are ironed out over time, traditional medical tourism markets such as uninsured individuals and self-insured providers may not be the best targets for medical tourism marketing. A preliminary assessment of the law does identify some opportunities for international health travel organizations”.

Other dignitaries attending the event include Costa Rica’s Minister of Competitiveness, Jorge Woodbridge, who has contributed in making Costa Rica, an international health turf.

The presentation will be available on the company’s web site in the beginning of May 2010.

In the current scenario, when many doctors and patient advocacy groups are advocating low-dose computed tomography (CT) as a standard screening tool for the diagnosis of lung cancer, researchers have found out that these screening tests lead to higher false positive rates and thereby unnecessary anxiety and follow-up interventions.

Additionally, these tests can lead to potential hazards of radiation exposure and unnecessary health expenditure from the screening tests as well as from unnecessary interventions. Also an indolent lung cancer might not lead to the person’s death.

The ongoing National Lung Screening Trial aims to find out the actual effectiveness of lung cancer screening in saving patient’s lives when there is widespread promotion of lung cancer screening tests especially CT and x-rays among the public by doctors as well as companies.

The Lung Cancer Mortality Reduction Act of 2009 Senate bill states that “significant and rapid improvements in lung cancer mortality can be expected through greater use and access to lung cancer screening tests”.

The details of the research findings titled ‘Cumulative Incidence of False-Positive Test Results in Lung Cancer Screening’ are published in the April issue of the ‘Annals of Internal Medicine’. The lead author of the study is Jennifer Croswell, MD, MPH from the National Institutes of Health.

The researchers state in the journal that there is no ‘solid evidence’ yet about the advantages or disadvantages of screening but the knowledge is important as the people involved are healthy adults.

The study followed up 3318 persons, aged 55 to 74 years, from September 2000 to January 2001 who were randomly assigned to undergo CT or chest x-ray. They had a history of cigarette smoking 30 pack-years or more, and were current smokers or had quit in the past 10 years.

The screening tests were repeated after one year if the baseline examination was negative for lung cancer.

Patients who received one CT scan had a 21 percent risk of a false-positive result, compared with a 9 percent risk for those who had a chest X-ray. The risk was 33 percent for those who underwent two annual CT scans compared with a 15 percent in those who had two chest X-rays.

Seven percent of participants with a false-positive low-dose CT examination and 4% with a false-positive chest x-ray underwent an invasive follow-up procedure.

“The most important thing right now is to try to figure out if this lowers death rates,” Dr. Jennifer M. Croswell told Reuters Health. “Most professional medical societies do not recommend this (lung cancer screening) right now,” she said, “and the reason is because we don’t know if it works.”

biospace med has announced that the company’s lead product, EOS ultra-low-dose 2D|3D imager, has been proven to reduce patient’s radiation exposure by upto 89 percent when compared to conventional computed radiography systems.

The findings of the study are published in the latest issue of the ‘Spine’ journal. The principal investigator of the 50 patient clinical study was Dr. Stefan Parent, M.D., Ph.D. from the Centre Hospitalier Universitaire Sainte-Justine, Montreal.

The study enrolled 9 girls and 11 boys with an average age of 14 and 8 years who were being followed up for spinal abnormalities. All patients recieved a CR (Computed Radiography) x-ray exam and an EOS exam for which skin dose was measured at skin level by dosimeters in 13 anatomical areas.

The study found that the quality of an EOS image is equal to or better than conventional or a CR x-ray system and exposes patient to upto 9 times lesser radiation.

EOS ultra-low-dose 2D|3D imager, developed by biospace med, is a new technology in orthopedic x-ray imaging and is used in the diagnosis and follow-up of bone and joint disorders, particularly spinal deformities. It can take local as well as whole body images; can also generate two dimensional or three dimensional images of the skeleton. The system allows full-body imaging of patients in sitting as well as in weight-bearing position that enables global assessment of balance and posture.

EOS has recieved approval from the FDA for use in adults and children and is now available in Europe and the USA.

A new study published online in March, in the American Journal of Gastroenterology, have found that the hazard of colo-rectal cancer death decreased by 3 percent with every one percent increase in complete colonoscopy rate.

The study included 2,412,077 persons who were men and women aged 50-90 years of age living in Ontario on January. The mean age was 64 years with 53.7 percent of the people included were women, and all the individuals involved in the study had been exposed to different intensities of colonoscopy.

They were followed up for 14 years from January 1st 1993 to December 2006.  Age- and sex-standardized colo-rectal-cancer (CRC) incidence rates were calculated and all CRC deaths were identified. Multivariable cox proportional hazards models were used to evaluate the association between colonoscopy rate and death from CRC, adjusting for age, sex, comorbidity, income, and location of residence (urban/rural).

Colonoscopy, which is the endoscopic examination for the visualization of the colon and distal part of the small intestine and is the gold standard screening test for colorectal cancer and precancerous conditions. It has the advantage that it can also be used in the detection and removal of adenomas and polyps during the same procedure.

With this study, the researchers have attempted to prove that colonoscopy rates is inversely proportional to CRC death rates, that is, as the rate of colonoscopy increases in the population, the CRC death rates decreases.