Harlan doctor tells White House summit about his changeover to electronic health records

Dr. Carl Smith Jr.

Almost a decade ago, Dr. Carl Smith Jr. did something that many health care providers across America are still struggling to do: He implemented electronic health records that can be assessed from anywhere in the United States during an emergency.

Because the process is expensive, and Smith works in rural, isolated Harlan County, he earned a trip to Washington, D.C. for this year's White House Health IT Town Hall meeting. The assembly was gathered to discuss progress and barriers on the road toward a national health IT system, reports Nola Sizemore of the Harlan Daily Enterprise.

At the meeting, senior White House officials and Department of Health and Human Services staff asked him about how he was able to accomplish the change from paper records. Smith, a pediatrician, explained how the system works: “Because of this technology, we can send the patient’s prescription electronically by secure email to pharmacies. We can check medical histories, what diseases or medical conditions are trending in the area, and I can voice activate details of the patient’s visit into their record. We can also give patients clinical summaries when they leave our office. We have proved to national governing bodies we can and are doing this.”

Smith added that with the use of electronic records, doctors will be able to access your medical history to see what medications you take, allergies and other pertinent information about your health should you be in an auto accident or suffer injury anywhere in the United States. He said this will especially be helpful if the patient were unable to provide information.(Read more)

Cardiologist: Kentucky needs better way to get heart attack patients to dedicated catheterization centers in time

Because cardiovascular disease kills more Kentuckians than anything else, and because what mostly kills them is a heart attack, and because if you can get help within 90 minutes of that heart attack your chances improve dramatically, this state needs a vastly improved way to get heart attack patients to the right hospital in a short amount of time. So explains Dr. William Dillon, an interventional cardiologist in Louisville, who writes an guest column in the In The Prime health blog of The Courier-Journal. He punctuates his point with a graph, right, that shows that Kentucky now ranks 49th of 50 states in acute myocardial infarction (AMI) deaths. AMI is doctor-speak for heart attacks. (American Heart Association graph)

Dillon's medically reasoned plea is for a more systematic regional network -- like one that have saved lives in North Carolina -- is "to transfer AMI patients to dedicated (heart catheterization lab) centers throughout the state." But Dillon also knows that many Kentuckians are not listening to their bodies as closely as they might. He writes that "another source of delay in AMI treatment is that, on average, patients wait more than 90 minutes before seeking medical attention. Furthermore, 50 percent of AMI patients drive to a hospital or clinic without calling EMS. Every year, a significant number of these patients needlessly die en route to the hospital." He adds then that health education -- in this case, early notification of needing EMS help -- is an important component in saving Kentuckians' lives. (Read more)

Statewide trauma system established; called 'most significant advancement in health of Kentuckians for the last 20 years'

Dr. Andrew Bernard, chair,
State Trauma Advisory Committee

Ten Kentucky hospitals have been recognized as part of the state's first official statewide trauma system. The announcement came during the 2012 Statewide Trauma and Emergency Medicine Symposium Friday in Lexington. Dr. Andrew Bernard, a University of Kentucky trauma surgeon and chair of the State Trauma Advisory Committee, called this "the most significant advancement in the health of Kentuckians in the last 20 years and lives will be saved because of it."

More than half of the states have such systems.  "The goal of the state trauma system is getting the right patient to the right place at the right time," said Bernard, explaining that the system provides education so that proper assessment can be made of severely injured patients, so that they are taken to the most appropriate facility as quickly as possible.

Trauma centers are graded I through IV, with Level I hospitals able to treat the most severely injured and most at risk.  Level I trauma centers are UK Chandler Hospital (Lexington), Kentucky Children's Hospital (Lexington), Kosair Children's Hospital (Louisville), and University of Louisville Hospital.  Level III  are Ephraim McDowell Regional Medical Center (Danville) and Taylor Regional Medical Center (Campbellsville). Level IV are Ephraim McDowell Fort Logan Hospital (Stanford), James B. Haggin Memorial Hospital (Harrodsburg), Livingston Hospital (Salem) and Marcum & Wallace Hospital (Irvine).

Volunteer emergency medical squads becoming less numerous

Belfry Fire and EMS responds to an accident.
(Rachel Dove-Baldwin, Williamson Daily News)

Volunteer emergency medical service squads appear to be dying out around the nation as rural populations change and EMS evolves, and Kentucky is no exception.

Volunteer squads have long been the sole emergency responders in many rural areas, reports Candi Helseth of the health-oriented Rural Assistance Center, but according to a 2010 study, "Rural Volunteer EMS: Reports from the Field," 69 percent of 49 local EMS directors in 23 states reported problems recruiting and retaining volunteers.

The North Carolina Rural Health Research and Policy Analysis Center study reported three main reasons for loss of EMS volunteers: high numbers of retirees or elderly in rural areas are unlikely to have physical strength required for EMS, many working-age individuals leave rural areas to find jobs elsewhere, and volunteers have too many obligations to cover weekends. Almost three-quarters of the all-volunteer EMS agencies hosted fundraising events to get necessary funding, requiring further time commitments. (Read more)

Volunteer fire departments have reported similar problems, but volunteer firefighters are called out less often and often receive stipends for attending meetings and training, said Michael Poynter, executive director of the Kentucky Board of Emergency Medical Services. He told Kentucky Health News that that state is part of the national trend away from volunteer EMTs, but still has 17 services that are fully volunteer and 35 that use a mixture of paid EMTs and volunteers. Kentucky has more than 250 licensed emergency medical services.

New law will allow officers to make arrests in emergency-room assaults that they do not witness

Emergency-room workers who treat individuals under the influence of drugs or alcohol will have greater legal protection, and those who misbehave in ERs will have less protection, under a law that will take effect next month.

The measure, sponsored by Sen. John Schickel, R-Union, will allow peace officers to make an arrest or issue a citation for a fourth-degree assault that occurs in a hospital emergency room, even if the officer didn’t witness the crime, as long as the officer has probable cause to believe the offense occurred.

“Hospital emergency personnel treat individuals in the worst of conditions – and sometimes that means putting themselves at risk, if a patient comes in intoxicated or high,” Gov. Steve Beshear said at a ceremonial signing of the bill today.  “This law gives medical staff the security of knowing that an offender will be held accountable for an assault that takes place when they’re brought in for care.”

Under current law, a hospital worker has to swear out a warrant alleging assault. Fourth-degree assault is a Class A misdemeanor, punishable by up to a year in jail.

Medicaid recipients displaced by tornadoes can get emergency 30-day refills of prescriptions

Kentuckians on Medicaid who were displaced by last week's storms can get a 30-day supply of needed medicine from their pharmacy, the Department of Medicaid Services announced yesterday.

The right to receive an emergency refill applies to residents living in Ballard, Bath, Carroll, Campbell, Grant, Grayson, Hardin, Johnson, Kenton, Laurel, Lawrence, McCracken, Magoffin, Martin, Menifee, Montgomery, Morgan, Muhlenberg, Ohio, Owsley, Pendleton, Rowan, Russell and Trimble counties. Those counties have declared a state of emergency.

The state's four managed-care organizations are informing pharmacies of the policy, which was part of an executive order signed by Gov. Steve Beshear last weekend. Medicaid recipients who are not enrolled with an MCO can also receive replacement medications at their pharmacy. Co-payments will be waived.

"Many Kentuckians depend on regular maintenance medications, like blood pressure pills, and skipping a few days could cause unnecessary hardship or possible poor health outcomes for some citizens," Beshear said. "This order will allow people to contact a pharmacist to restore their regular medications." (Read more)

Rural emergency rooms frequented by the poor and uninsured

A new report from the federal Agency for Healthcare Research and Quality shows that low-income adults accounted for 56 percent of the 8 million rural emergency room visits in 2008. In nonrural hospitals, low-income adults accounted for only 30 percent of emergency room visits. According to the report, 44 percent of adult visits to rural emergency departments were paid for by Medicaid, were uncompensated, or billed to uninsured patients. Only 31 percent were paid for by private health plans. In nonrural hospitals, 37 percent of adult visits were paid for by private health plans, and 42 percent were paid for by Medicaid, uncompensated or billed to uninsured patients.

Emergency business is mainly just that for rural hospitals. Only 8.3 percent of rural emergency department visits resulted in a hospital admission, compared to 16 percent of non-rural emergency department visits.

The report also noted the lack of rural hospitals with trauma-level emergency departments. Nationally, only 2.4 of rural emergency departments held any level of trauma designation. Among non-rural emergency departments, 35.5 percent had a trauma designation. Read more here.

In Kentucky, approximately 75 of the state's 130 hospitals are in rural areas, according to the Kentucky Hospital Association. The state has been working to improve its trauma system and will soon begin designating level IV trauma centers in some of the state's smallest hospitals, said Dick Bartlett, emergency preparedness and trauma coordinator for the Kentucky Hospital Association. Already, Marcum & Wallace in Irvine and Livingston Hospital in have met requirements for the designation and will be certified, once the state approves the new level IV designation. (The national report focused on levels I-III; in Kentucky, level I-III are certified by the American College of Surgeons.)

The new designation is part of an effort by Kentucky to improve trauma care statewide. Having a level IV trauma center means better trauma care for Kentuckians injured in rural areas, Bartlett said. "It improves your potential for survival," he said. These hospitals have committed to providing certain levels of staffing, including a board-certified emergency room physician, and to following protocols to quickly decide whether a patient can be treated at their facility or if a patient should be transported to another, higher-level facility.

A map showing Kentucky's current trauma hospitals and those hospitals seeking trauma certification is available here.

Ambulance providers raising fees to deal with rising costs

Ambulance services are being forced to raise their fees in order to pay the bills, USA Today's Greg Latshaw reports. "Ambulance providers nationwide are coping with rising costs, decreased support from local government, low Medicare reimbursement rates and a jump in the number of uninsured Americans," Stephen Williamson, president of the American Ambulance Association, told Latshaw.

Medicare reimbursement rates were between 6 and 17 percent below cost, a 2007 report by the Government Accountability Office showed. Since, that gap has grown even wider. Moreover, in the past 18 to 24 months, far more people are using ambulance services who don't have health insurance. "We're having to raise the rate on everyone else because of the people who don't have insurance," said Steve Weigland, director of servicing for the International Association of EMTs and Paramedics. (Read more)