Sunday, March 15, 2009

EMR and the Stimulus Bill

There are many opinions regarding the effects of a government subsidy for EMR adoption. As I blogged earlier, my fear is this may just end up promoting older technologies and "establishment" vendors, potentially preventing smaller, innovative players from entereing the market. There also implications for open source EMR community as well.

Austin Merritt has some interesting thoughts in his article, Get Ready for EHR Failures, But Don’t Blame the Software.
He expresses concern that a free or overly subsidized EMR will not lead to meaningful use by physicians since people tend not to value somthing they did not pay for. I generally agree with this premise. However, if the "free EMR" is trully indispensible to the physician in terms of efficiency, workflow, care quaility, and is easy to use, then it will not matter if the EMR is free- it will be adopted by phyicians.

Tuesday, March 10, 2009

Addressing Long Term Healthcare worker shortage

Legislation H.R. 468 was introduced in order to expand opportunities for long term care workers to obtain additional training and education in care of our growing geriatric population. It is now well known that there will be a shortage of physicians and nurses in the near future, especially in long term care.
There's a need to widen the educational opportunities for the existing pool of long term care providers.

I'm looking for practical examples of the implications of this bill. Hopefully we will see more educational programs being offered to our nursing homes. Nurses in these facilities are over burdened by the increased complexity of today's long term care patients and often lack clinical support. Educational programs for nurses that can be offered on site at nursing homes in the practical aspects of patient care would be of great value.

Perhaps telemedicine can help fulfill this need by bringing experts remotely via video conferencing to the nursing homes and allowing all facilities equal access to quality education despite their location.

Below is an excerpt from the bill describing their findings:

Text of H.R.468 as Introduced in House

Retooling the Health Care Workforce for an Aging America Act of 2009


Congress finds the following:

(1) The United States will not be able to meet near-term demands for chronic, geriatric, and long-term care without a workforce that is prepared for the job.

(2) Between 2005 and 2030, it is estimated that the number of adults aged 65 and older will almost double from 37,000,000 to over 70,000,000, increasing from 12 percent of the population of the United States to almost 20 percent of the population.

(3) Because the overall size of the population of older adults in the United States will increase rapidly, the number of older adults in the United States who are disabled will soar in the coming decades. Between 2000 and 2040 the number of older adults who are disabled will more than double, increasing from an estimated 10,000,000 to an estimated 21,000,000.

(4) A 2008 report by the Institute of Medicine of the National Academies, entitled, ‘Retooling for an Aging America’ concludes that the health care workforce will lack the capacity, in both size and ability, to meet the needs of older patients in the future unless action is taken immediately.

(5) Inadequate training in geriatrics, gerontology, chronic care management, and long-term care is known to result in misdiagnoses, medication errors, and inadequate coordination of services and treatments that result in poor care and is costly for the health care system as a whole.

(6) Currently, only 1 percent of all physicians (approximately 7,000) in the United States are certified geriatricians, even as the population of older adults is on track to double by 2030.

(7) Inadequate amounts of time devoted to geriatric training are reported by 1/4 of graduating medical students, and close to 1/2 of graduating medical students say they are unprepared to care for residents in nursing homes.

(8) Less than 1 percent of all nurses are certified gerontological nurses. Absent any change, by the year 2020, the total supply of nurses in the United States is projected to fall 29 percent below requirements, resulting in a severe shortage of nursing expertise relative to the demand for care of medically complex, frail older adults.

(9) Estimates suggest that there are currently only 700 practicing geropsychologists in the United States, falling far short of the current need for 5,000 to 7,500 geropsychologists.

(10) The Bureau of Labor Statistics of the Department of Labor predicts that personal or home care aides and home health aides will represent the second and third fastest-growing occupations between 2006 and 2016. Yet personal or home care aides are not subject to any Federal requirements related to training or education, and States have very different requirements for personal or home care aides.

(11) Research shows that inadequate training is a major contributor to high turnover rates among direct care workers and more training is correlated with better staff recruitment and retention rates.

(12) An estimated 44,000,000 family caregivers are being asked to provide increasingly complex medical services to frail and elderly loved ones wishing to live at home. Multiple surveys have documented that basic training and access to other targeted services are necessary for family caregivers to provide

See also for more information:

Bill would expand education, training for workers in LTC

Democrats file bill addressing geriatric provider shortage

See below for Information of Geriatric Education Centers (taken from above H.R.468)


Subtitle A--Health Professions Education Related to Geriatrics


Section 753 of the Public Health Service Act (42 U.S.C. 294) is amended by adding at the end the following:

‘(d) Grants To Expand and Improve Geriatric Education Centers-

‘(1) IN GENERAL- The Secretary shall award grants or contracts under this subsection to entities that operate a geriatric education center pursuant to subsection (a)(1).

‘(2) APPLICATION- To be eligible for an award under paragraph (1), an entity described in such paragraph shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

‘(3) USE OF FUNDS- Amounts awarded under a grant or contract under paragraph (1) shall be used to--


    ‘(A) IN GENERAL- Pursuant to paragraph (3), a geriatric education center that receives an award under this subsection shall use such funds to offer short-term intensive courses (referred to in this subsection as a ‘fellowship’) that focus on geriatrics, chronic care management, and long-term care that provide supplemental training for faculty members in medical schools and other health professions schools with programs in psychology, pharmacy, nursing, social work, dentistry, public health, or other health disciplines, as approved by the Secretary. Such a fellowship shall be open to current faculty, and appropriately credentialed volunteer faculty and practitioners, who do not have formal training in geriatrics, to upgrade their knowledge and clinical skills for the care of older adults and adults with functional limitations and to enhance their interdisciplinary teaching skills.

    ‘(B) LOCATION- A fellowship shall be offered either at the geriatric education center that is sponsoring the course, in collaboration with other geriatric education centers, or at medical schools, schools of nursing, schools of pharmacy, schools of social work, graduate programs in psychology, or other health professions schools approved by the Secretary with which the geriatric education centers are affiliated.

    ‘(C) CME CREDIT- Participation in a fellowship under this paragraph shall be accepted with respect to complying with continuing medical education requirements. As a condition of such acceptance, the recipient shall agree to subsequently provide a minimum of 18 hours of voluntary instructional support through a geriatric education center that is providing clinical training to students or trainees in long-term care settings.

‘(5) ADDITIONAL REQUIRED ACTIVITIES DESCRIBED- Pursuant to paragraph (3), a geriatric education center that receives an award under this subsection shall use such funds to carry out 2 of the 3 activities:

    ‘(A) FAMILY CAREGIVER TRAINING- A geriatric education center that receives an award under this subsection shall offer at least 2 courses each year, at no charge or nominal cost, to family caregivers that are designed to provide practical training for supporting frail elders and individuals with disabilities. The Secretary shall require such Centers to work with appropriate community partners, including family caregivers and family caregiver organizations, to develop training program content and to publicize the availability of training courses in their service areas. All family caregiver training programs shall include instruction on the management of psychological and behavioral aspects of dementia, communication techniques for working with individuals who have dementia, and the appropriate, safe, and effective use of medications for older adults.

    ‘(B) DIRECT CARE WORKING TRAINING- A geriatric education center that receives an award under this subsection shall offer at least 2 courses each year to certified nurse aides, home health aides, personal or home care aides and other types of direct care workers on ‘best practices’ for working with frail elders and individuals with disabilities, including individuals with dementia, urinary incontinence, and problems with balance or mobility, and raising awareness of medication issues for older adults.

    ‘(C) INCORPORATION OF BEST PRACTICES- A geriatric education center that receives an award under this subsection shall develop and include material on depression and other mental disorders common among older adults, medication safety issues for older adults, and management of the psychological and behavioral aspects of dementia and communication techniques with individuals who have dementia in all training courses, where appropriate.

‘(6) TARGETS- A geriatric education center that receives an award under this subsection shall meet targets approved by the Secretary for providing geriatric training to a certain number of faculty or practitioners during the term of the grant, as well as other parameters established by the Secretary, including guidelines for the content of the fellowships.

‘(7) AMOUNT OF AWARD- An award under this subsection shall be in an amount of $150,000. Not more than 24 geriatric education centers may receive an award under this subsection.

‘(8) MAINTENANCE OF EFFORT- A geriatric education center that receives an award under this subsection shall provide assurances to the Secretary that funds provided to the geriatric education center under this subsection will be used only to supplement, not to supplant, the amount of Federal, State, and local funds otherwise expended by the geriatric education center.

‘(9) AUTHORIZATION OF APPROPRIATIONS- In addition to any other funding available to carry out this section, there is authorized to be appropriated to carry out this subsection, $10,800,000 for the period of fiscal year 2011 through 2013.’.