Personal Health: Music and Electronic Medical Records

Published on Monday, June 29, 2009 in THE PHILADELPHIA INQUIRER

Music therapy may help control blood pressure
When it comes to matters of the heart, music may be more than just the food of love. A small study by Italian researchers has linked swelling crescendos - volume increase - to heart rate arousal and gradual decrescendos to relaxation.

The 24 subjects, half of whom were experienced singers, were monitored using electrocardiograms while they listened to five random tracks of classical music, including Beethoven's Ninth Symphony and Verdi's La Traviata. As volume increased, so did the subject's blood pressure, heart rate, and blood flow. Long melodies led heart rhythms to synchronize with the tempo. And during a two-minute silence, breathing and blood pressure dropped.

The authors, who have done similar research before, hope their findings will show how music therapy can help in rehabilitative medicine. The paper was published in the journal Circulation.

- Heather J. Chin

Some patients are often left in dark on test results
Physician failure to notify patients or accurately record notifications about abnormal test results is common, according to a study published in the Archives of Internal Medicine. Records that were part electronic and part paper-based were more likely to be incomplete than those consisting entirely of one or the other.

The study examined 5,434 outpatient medical records from 19 community-based and four academic medical centers that offered primary care services, as well as the centers' methods of documentation - paper records, electronic medical records, or partial electronic records. Eleven blood tests and three screening tests - mammographies, Pap smears, and fecal occult blood matter - were examined in patients who were between 50 and 69 years old when treated.

Out of 1,889 abnormal test results, 135 patients were not informed of them promptly - either within 21 or 90 days, depending on the type of test. That was a failure rate of 7.1 percent. Three medical centers had a zero error rate while the rest ranged up to 26.2 percent.

The authors aim for more awareness of how often these errors occur and how managing results can reduce failure rates and successful malpractice claims from uninformed patients.

- Heather J. Chin

Philly Local: Philadelphia VA Prostate Cancer Scandal

Published on June 23, 2009 in THE PHILADELPHIA INQUIRER.
I contributed some reporting to this story.

Specter plans hearing on VA prostate cancer treatment


By Marie McCullough
Inquirer Staff Writer

Four years ago, after talking to doctors at the Philadelphia VA Medical Center, the Rev. Ricardo Flippin opted for a radiation therapy that would precisely target his prostate cancer and leave nearby organs unharmed.

Instead, his prostate cancer got too little radiation while his rectum received so much that he suffered excruciating, permanent damage.

Flippin, 68 - a minister, teacher, and Air Force veteran - is hardly unique.

The Philadelphia VA has notified 92 prostate cancer patients treated between 2002 and 2008 that their "brachytherapy" radiation doses were too high or too low. The U.S. Department of Veterans Affairs has shut down the brachytherapy program in Philadelphia and three other VA hospitals with less serious problems.

Yesterday, the unfolding scandal prompted Sen. Arlen Specter (D., Pa.) to say he would hold a hearing on the matter in Philadelphia on Monday.

Read more here...

LOCAL: UPHS Notifies Public Of Lost Payment Data

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/21/2008

The University of Pennsylvania Health System notified an undisclosed number of patients this week that an encrypted backup tape containing personal and credit information was lost in transit by an outside carrier.

Affected persons are those who made payments to UPHS between Feb. 25 and April 25.

Letters were sent to the affected people on Aug. 8 by UPHS and Bank of New York Mellon explaining the loss and detailing the information compromised, which includes names, addresses and checking account numbers. The letters also emphasized that "there is no evidence that the tape was stolen or that unauthorized persons have accessed any information on the tape."

As a precautionary measure, Mellon is offering two years of free credit monitoring and $25,000 in complementary identity theft insurance to each person affected. They assure people that these letters and offers are legitimate.


Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

MEDICAL POLICY: State, Medicaid Enact Cost-Cutting Measures

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/13/2008

The Pa. Department of Public Welfare (DPW) last week added early refills of prescription drugs to the state's list of Medicaid services and items that require prior authorization.
An "early refill" is a request for a refill when over 25 percent of the previously filled prescription would normally remain if followed properly. Requiring approval is aimed at preventing people from "stockpiling" medications.

Refilling prescriptions early resulted in Medicaid payments being paid for more than 12 months worth of prescriptions over a 12-month period, according to Stacey Witalec, a DPW spokeswoman.

The DPW's change was made on Aug. 4 and is expected to save the state more than $2.5 million on the purchase of medicines in the 2009 fiscal year. It comes after a failed bid by DPW to take over management of the state Medicaid program's prescription drug program. Matching federal Medicaid dollars would provide a total savings of $5.4 million in 2009 and $6.5 million for fiscal year 2010.

In a similar effort to both cut costs and promote more responsible health care, Philadelphia's three Medicaid HMO plans are following the DPW's lead in not paying hospitals for added costs that result from preventable medical errors.

The DPW estimates that "hundreds of millions of dollars" will be saved under this program, Ms. Witalec said.

Keystone Mercy Health Plan will implement the policy beginning on Oct. 1. The company serves over 293,000 residents, making it the region's largest Medicaid managed-care company.

After Oct. 1, all hospital claims will be required to indicate that the medical condition for which the patient received care was "present at admission" - that it existed before the patient was admitted to the hospital, said Dr. Jay Feldstein, Keystone Mercy's chief medical officer.

Dr. Feldstein said Keystone Mercy have met with its provider hospitals throughout the year to outline the new policy. Provider hospitals covered by the company will retain the right and ability to appeal what DPW has defined as a "preventable serious adverse event."

A hospital trade group, Delaware Valley Healthcare Council (DVHC), has created a team of clinicians and hospital administrators to discuss and review the policies of the Medicaid managed-care companies.

"We're looking for [the HMO's] policies to be clinically sound and financially fair," said Kenneth J. Braithwaite II, a regional executive for the DVHC.

Health Partners, the Philadelphia area's largest not-for-profit health plan serving Medicaid patients, is in the early stages of developing its policy, according to spokeswoman Felicia Phillips.

Health Partners serves over 135,000 members in southeastern Pa. and is owned by a group of seven Philadelphia hospitals, including St. Christopher's Hospital for Children and the Hospital of the University of Pa.

Similarly, AmeriChoice of Pa. has just begun work on how to implement such a policy, Steve Matthews, a spokesman for the company told a local publication. The Philadelphia-based subsidiary of United Health Group has 75,000 members in the five-county area.

DPW's original program, which began in January, was developed to identify and stop Medicaid payments to hospitals for preventable mistakes that result in a serious negative outcome. The program was created in coordination with the Hospital & Health System Association of Pa., a state trade group.

This applies to 27 types of medical errors, or "never events," such as medication mistakes, bad blood transfusions and operating on a wrong body part.

Also in October, the federal Medicare program will stop paying hospitals for procedures and treatment of hospital-acquired conditions in eight categories that cover medical errors, injuries and infections that are judged to "reasonably have been prevented."

New Jersey health officials are waiting for the national program to begin before adopting a state policy of their own.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008