Public Citizen’s annual ranking of state medical boards shows that most states, including two of the largest, are not living up to their obligations to protect patients from doctors who are practicing substandard medicine, according to the recently released report.

For the first time since Public Citizen, a nonprofit consumer advocacy organization, has been publishing the rankings, California, the largest state in the country, and Florida, one of the largest, are among the 10 states with the lowest rates of serious disciplinary actions. Minnesota was the worst state when it came to disciplining doctors, and, along with Maryland, South Carolina and Wisconsin, has consistently been among the worst 10 states for each of the last six rankings.

Overall, the rate of discipline for doctors in 2008 was 21.5-percent lower than the peak year of 2004. In 2008, there were 2.92 serious disciplinary actions per 1,000 physicians, compared to 3.72 actions per 1,000 physicians in 2004. This means that if the higher 2004 rate of discipline were still occurring, 770 more doctors would have been subject to serious disciplinary actions in 2008 than actually were.

The annual rankings are based on data from the Federation of State Medical Boards, specifically on the number of disciplinary actions taken against doctors in 2008. Public Citizen calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state. The number of actions in 2008 was averaged over the past three years to establish the state’s rank.
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It looks like a few rule changes have dramatically lowered the number of malpractice suits filed in Pennsylvania. There were 1,602 filings last year, a 41% decline from the annual average between 2000 and 2002, before the changes were put in place.

One of the new rules requires a “certificate of merit” from a medical professional, establishing that “the medical procedures in a case fell below applicable standards of care,” according to a recent statement from the Administrative Office of Pennsylvania Courts. Another rule requires cases to be filed in the county where the alleged malpractice took place — an effort to discourage so-called venue shopping, where cases would be filed in counties thought to be sympathetic to plaintiffs.

The number of malpractice cases fell sharply in 2003, when the rules were in place, and have stayed down.

“The results have been extraordinarily impressive in abating the malpractice insurance crisis,” Pennsylvania’s governor said yesterday, the Philly Inquirer reports.

The president of the state’s medical society told the paper the decline in cases is encouraging, but said malpractice insurance rates in the state are among the costliest in the country. A spokesman for the society told the Health Blog that, for the most part, state doctors’ malpractice premiums have been stable or decreased slightly since 2002.

A representative of the state’s trial lawyers group told the Inquirer the group was satisfied with the rules, partly because there are no longer calls for caps on awards in the state.

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The American Medical Association (AMA) recently launched a new online learning center to provide physicians with the information and tools they need to make informed decisions about electronic prescribing (ePrescribing). The learning center can be found at www.ama-assn.org/go/eprescribing.

“The AMA’s new ePrescribing learning center takes the guess work out of the decision-making process by giving physicians all the tools they need to decide what system is best for their practice,” said Joseph M. Heyman, MD, AMA board chairman. “At the end of last year, about 13 percent of physicians were prescribing electronically, but with the incentives available through Medicare’s ePrescribing incentive program and this new AMA resource, I’m certain that percentage will increase.”

The new online learning center includes:
• Complete information on ePrescribing vendors and features;
• Calculators to estimate time savings and determine Medicare ePrescribing incentive payments;
• The latest information on federal and state programs offering ePrescribing incentives;
• Readiness and planning tools to map out an implementation plan.
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In Washington, the Obama administration is promising to spend billions to make health care more efficient, but Jennifer Brull, a family doctor in rural Kansas, is already a step or two ahead.

A year ago, she switched her 3,000 patients from paper charts to electronic health records, a core feature of most plans for healing the nation’s ailing health system. Now, working with computers and printouts, her staff of part-time nurses and shared front-office workers has more time to help her meet the needs of patients.

“I’ll never go back to the old system,” said Dr. Brull, 37, who runs a solo practice in Plainville, Kan. “I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.”

Patients are appreciative, too. Kagay Wheatley brings her 97-year-old neighbor, Charlotte Hayes, to Dr. Brull for blood tests every few weeks. “We do not have to sit and wait while the nurses search for the records,” said Ms. Wheatley, a retired school board aide who is also a patient of Dr. Brull’s. “They find the information right there on the computer, and when we leave, we get a printout of what we did and what she said.”

About 42 percent of active family doctors have installed some type of electronic health records, according to surveys and estimates by the American Academy of Family Physicians, a professional and advocacy group. One in four said they did not plan to purchase an electronic system, and many said they could not afford the $30,000 to $50,000 in start-up costs. The academy has 94,600 members, including about 60,000 in active practice.

Medical centers like the new 24-bed critical-access hospital in Plainville, connected by a walkway to Dr. Brull’s office, are also rapidly adopting electronic records.

“The use of electronic health records and being able to transmit X-rays allows us to be in contact with the whole world,” said Chuck Comeau, a hospital board member who is chief executive of Dessin Fournir, a national furniture design company that moved its head office to Plainville from Los Angeles.

Even so, 8 in 10 of all American doctors still labor in a world of paper. And some doctors said they encountered upsetting setbacks when they tried to switch to electronic records.

Michael Ferris, a 33-year-old emergency medicine physician in Parsons, Kan., said he had to give up his solo practice after he had invested $38,000 in software for systems that kept crashing and thwarting his attempts to send out electronic bills. “I was spending as much time trying to fix the computer and the billing as actually seeing patients,” he said, “and neither process was generating any revenue for me.”

Now, as director of the emergency room at the Labette County hospital in Parsons, Dr. Ferris said, “I get paid by the hour and don’t have to worry if the software is down.” But he said he expected that some day he would have to help the hospital make the transition to electronic records. “I know it is coming.”
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Results from a large-scale Johns Hopkins study of more than 40 hospitals and 160,000 patients show that when health information technologies replace paper forms and handwritten notes, both hospitals and patients benefit strongly.

“Patients appear safer and hospital bottom lines may improve when health care information is gathered and stored on computers rather than on paper,” said senior author Neil R. Powe, MD, MPH, MBA, of the Department of Medicine at Johns Hopkins University School of Medicine and director of the Welch Center for Prevention, Epidemiology and Clinical Research.

In the study, published Jan. 26 in the Archives of Internal Medicine, Powe, lead author Ruben Amarasingham, MD, MBA and colleagues rated clinical information technologies at 41 hospitals in Texas and compared those results with discharge information for 167,233 patients.

“Previous studies only told us how well one particular electronic system used by one particular hospital worked,” said Amarasingham. “This study gives us a better sense about the general success of paperless systems in a diverse set of community, academic and safety-net hospitals. We were also able to examine the many components contained in a hospital information system.”

Results showed that with computerized automation of notes and records, hospitals whose technologies ranked in the top third were associated with a 15-percent decrease in the odds that a patient would die while hospitalized.

“If these results were to hold for all hospitals in the United States, computerizing notes and records might have the potential to save 100,000 lives annually,” Powe said.
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