On December 13, the Blue Cross and Blue Shield Association and America’s Health Insurance Plans announced a model format for a computerized personal health record. “The industry model PHR is a private, secure web-based tool maintained by an insurer that contains a consumer’s claims and administrative information. PHRs enable individual patients and their designated caregivers to view and manage health information and play a greater role in their own health care.” Full details on the format are available on the AHIP website.

HHS Secretary Leavitt announced yesterday that in 2007 HHS will support trial implementations of the National Health Information Network, which will be the backbone of the Nation’s electronic health records system.

[In 2006] NHIN activities included “prototype architectures” developed by four consortia of health care and health information technology organizations through contracts with HHS. This “prototype architecture” work included developing functional requirements, security approaches and identifying needed standards for creating secure health information exchange in different health care markets. In January 2007, the four existing consortia will present the prototype architectures at the American Health Information Community and the third NHIN forum to be held in Washington, D.C. A summary report capturing key findings from this past year will be published in early 2007.

The 109th Congress adjourned early today, ending the lame duck session, after passing a continuing resolution to fund the federal government through February 15, 2007, and tax and trade legislation which, among other things, extends otherwise expiring tax breaks, avoids the 5.0% cut in Medicare Part B payments to doctors previously scheduled for January 1, and makes several changes to the Health Savings Account (HSA) law.

The HSA law changes reportedly include setting the maximum annual contribution at the indexed amount (rather than the lesser of the annual health plan deductible or the indexed amount) and allowing a one time rollover of flexible spending account or health reimbursement account balances to fund an HSA. On a related note, the Employee Benefit Research Institute and the Commonwealth Fund released yesterday their second Annual Consumerism in Health Care Survey, 2006: Early Experience With High-Deductible and Consumer-Driven Health Plans.

The Senate also finally confirmed Dr. Andrew von Eschenbach as Food and Drug Administration Commissioner.

The National Business Group on Health recently released a “Purchaser’s Guide to Clinical Preventive Services,” which “contains the scientific evidence, recommended guidance, and detailed benefit language employers need to implement a comprehensive and structured clinical preventive services program within their medical benefit plan.” The NBGH developed the Guide with technical assistance from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC). The Guide is publicly available on the NBGH web site.

Congressional negotiators are attempting to fashion and pass before the weekend a major tax bill that will eliminate the 5.0 % reduction in Medicare Part B payments to doctors scheduled for January 1 by cutting funding for a Medicare Advantage stabilization fund that is intended to help insurers and HMOs offer Medicare Advantage plans in rural areas. The Washington Post reports that the bill also increases contribution limits for Health Savings Accounts. These measures are included in a bill that also extends popular tax cuts.

Applied Materials, BP America, Inc., Intel Corporation, Pitney Bowes, Inc. and Wal-Mart, which have 2.5 million employees combined, announced today their decision to fund “an independent nonprofit institute to develop ‘Dossia,’ a Web-based framework through which U.S. employees, dependents and retirees can maintain lifelong personal health records.” Information Week explains that

Dossia will have at its core a series of federated databases being developed by a member-company funded non-profit organization called the Omnimedix Institute. To begin with, Omnimedix will build between five and seven databases around the country. Once an employees joins the system and enters some personal information, the system will automatically supplement the data with records from outside sources like hospitals, insurance claims, and physicians, so one database would house insurance claims data, another lab results and so on. Once the databases are built, the cost of adding incremental patients is expected to be pennies.

Computerworld adds that

Dossia is based on the Connecting for Health Common Framework, a set of design and policy standards developed by consumer advocacy groups, physician groups, insurers and privacy organizations, [Omnimedix CEO J.D.] Kleinke said. Each of the founding members is contributing a “seven-figure” sum to Omnimedix to help set up the system, Barrett said. In the future, the group expects to add additional employers and government participants who would pay a per-user fee to participate in the program, he added. In February, the founding members plan to announce additional companies that have joined the effort, [Intel Corp. CEO Craig] Barrett said.

The United Health Foundation has released its America’s Health Rankings report for 2006. According to the Foundation, this report is “a yearly assessment of the relative healthiness of the nation, based upon analysis of comprehensive determining factors such as personal behaviors, the environment in which people live and work, the decisions made by public and elected officials and the quality of medical care delivered by health professionals.” The report compares relative U.S. healthiness among states (Minnesota is tops for the 17th year) and against other countries.

The foreword to the report warns

To our dismay, this year’s report once again documents the lack of significant progress in improving health status, a trend we first noticed in 2000. And, alarmingly, overall health in the United States continues to suffer in comparison to that of many other nations. For example, a baby girl born today in the United States has a healthy life expectancy of 71 years compared to 78 years for a baby girl born today in Japan! Our country can do better, and our children deserve better. It is our collective hope that this report will continue to stimulate action by people, communities, health professionals, policy leaders, politicians and others as we intelligently dedicate our rich national resources toward the goal of optimal health and survival for all Americans.

I scratched my head when I read that U.S. life expectancy was 71 years at birth for girls. According to the National Center on Health Statistics, the average life expectancy of a newborn girl in the U.S. was 80.1 years in 2003, which reflects quite a public health accomplishment. (It was 71.1 years in 1950.) A Japanese Aging Center website reports that the average life expectancy of 85.2 years in 2002.

I then recognized that the United Health Foundation is using a different statistic “healthy life expectancy“. According to the World Health Organization, this statistic “is based on life expectancy (LEX), but includes an adjustment for time spent in poor health. This indicator measures the equivalent number of years in full health that a newborn child can expect to live based on the current mortality rates and prevalence distribution of health states in the population.” I’m not sure if I buy this statistic, but you do learn something new everyday.

Here is a link to the World Health Organization’s World Health Statistics 2006′ and ‘The World Health Report, 2006 Edition’

A new Wall Street Journal Online / Harris Interactive poll projects that employer sponsored health plan participants will stay put during the current open season. (The FEHB Program historically has offered an Open Season during November and December and private sector employers who have introduced cafeteria plans now offer them as well. This poll was not directed at FEHB Program participants.) “About 86% of insured Americans expect to keep their current coverage next year, while 6% plan to switch or drop their plan.” Another interesting tidbit from the poll of 2,673 adults with health-care coverage is that

About 17% of those polled said they are enrolled or will enroll in flexible spending accounts, compared with 69% who said they won’t. Six percent or fewer said they will enroll in medical saving accounts, health reimbursement accounts or health savings accounts, compared with about 79% who said they will not.

Today’s New York Times offers an lengthy article on the outlook for increased regulation of health care privacy in the new Congress and the privacy issue’s relationship to the Administration’s push for widespread use of health information technology. In that regard, it should be noted that the U.S. Office of Personnel Management now features its own health information technology transparency web page.

• The Kaiser Family Foundation released a survey of participants in consumer driven health plans. Consumer driven plans have high deductibles and usually are associated with health savings accounts or health reimbursement arrangements. According to a Washington Post article, the surveyed participants are more health care cost conscious than traditional plan participants. However, many of them wish to switch back to a traditional plan. Definity Health, a unit of United Healthcare, that administers consumer driven plans offered a rebuttal.
• The New York Times offered its perspective on the first two months of Walmart’s $4 generic drug program. The article notes that
  

  Wal-Mart, declining to cite overall sales figures for the program, said that in the first seven weeks it had filled 2.1 million more prescriptions of all types — generic and name-brand — compared with prescriptions in the same stores a year ago. Those numbers would indicate that in the early going at least, Wal-Mart’s $4 prescriptions are not having a huge impact on overall sales of generic drugs in this country. Nationwide, many of the most popular generic drugs are each prescribed more than a million times in a single week, according to Wolters Kluwer Health, a drug data company. In the Tampa area, some independent druggists and a big drug wholesaler say that they have not noticed much effect on their businesses since the September rollout.

• Laura Landro of the Wall Street Journal wrote a fascinating article on steps that the medical profession is taking to prevent the “tragedy of misdiagnosis.”
  

  With growing concern about costly malpractice claims from missed, delayed or wrong diagnoses, two of nation’s largest health-care providers, the Veterans Administration and managed-care giant Kaiser Permanente, are leading new efforts to improve diagnostic accuracy. They are embarking on system-wide initiatives aimed at the most common lapses in the diagnostic process, including failure to order the right tests, create proper follow-up plans, obtain complete medical histories or perform adequate physical exams. To address such glitches, Kaiser and the VA are turning to a variety of new tools, including Web-based “decision support” programs [such as Isabel] to help doctors by offering an array of possible diagnoses they might not have considered or prompting them to perform appropriate tests on patients with certain symptoms.