Ebola: New Health Care Worker Guidance on Equipment, Testing, and Personal Protection

Posted in Department of Public Health, Ebola, preparedness on October 21st, 2014 by Erica Noonan – Be the first to comment

MMS has updated its website with new guidance for health care workers related to Ebola Virus Disease from the Massachusetts Department of Public Health and the Centers for Disease Control and Prevention.

Ebola Virus

New guidance from the CDC for Personal Protective Equipment  for health care workers treating Ebola patients:

Both the CDC and MDPH guidance reflect one change to the clinical criteria for a patient under investigation for Ebola Virus Disease having a fever of >100.4 °F. Previous guidance for fever was 101.5°F. (Guidance regarding additional symptoms remains: the patient must also exhibit additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage, AND within the 3 weeks prior to the onset of symptoms, either having contact with the bodily fluids of a patient suspected to have EVD, or having traveled from an EVD-endemic region.)

Links to these resources are available at www.massmed.org/ebola, which is updated as new information and guidance is released.

– Robyn Alie

New Ebola Advice for Massachusetts Health Providers 

Posted in Ebola, Public Health on October 15th, 2014 by Erica Noonan – 1 Comment

Ebola virusCDC officials reiterated this week that chances are quite slim that a patient infected with the Ebola virus will appear at a U.S. health facility in need of care during a conference call to offer preparedness guidance to hospitals, physicians, and other caregivers.

Although patients who have recently returned from Ebola-stricken areas of west Africa with complaints of fever are more likely to be suffering from malaria or some other illness, “every emergency department should be prepared for this,” said Alexander P. Isakov, MD, MPH, Director, Prehospital and Disaster Medicine at Emory Healthcare.

There have been no diagnosed cases of Ebola in Massachusetts, said DPH Commissioner Cheryl Bartlett in a separate call for Massachusetts hospitals on Wednesday, but the reported infections of two Dallas health care workers who cared for an Ebola patient “makes us all anxious,” she said.

The state’s hospitals have been doing well in running drills and implementing proper procedures, she said. “The most important thing we can do is communicate, coordinate our efforts and learn from each other,” Bartlett said.

DPH Medical Director Al DeMaria, MD, said the responsibility for diagnosing and treating Ebola cannot be placed only on large medical centers.  “We have to take care of these patients where they turn up,” he said. The Massachusetts state laboratory is one of 16 labs nationwide equipped to test for Ebola, and results can be obtained in 4-6 hours.

Comprehensive Initial Patient Screening – State and federal officials recommend health providers ask patients who present with possible symptoms of Ebola the following: “In the past three weeks, have you traveled outside the U.S. If so, where?”

If the patient has traveled to a location with an Ebola outbreak, he/she should be moved to a private room, and contact with other patients and staffers limited. Asking about travel history is a useful healthcare routine in general, said Dr. DeMaria “There are lots of diseases where travel can be a component.”

Prepare Your Staff – CDC officials recommend all health care staffers be briefed on proper infection-control procedures, and all facilities designate point persons to handle patients who could be at risk of Ebola. This limits possible protocol breaches, and unnecessary exposure to other staffers and patients.

Obtain Proper Equipment – The CDC recommends all facilities obtain an adequate amount of personal protective gear for staff, and all staff receive training on proper donning and doffing procedures. See CDC links to information on hospital preparedness.

Contact Public Health Officials ­– The DPH said providers with concerns or questions should consult local health authorities, or the DPH directly at its 24/7 Epidemiology Hotline at (617) 983-6800. More DPH Ebola online resources.

Communicate Ahead of Time with Your Vendors – Consider how you would transfer a possibly infectious patient, if needed. Officials recommend providers consider the following questions: Is your ambulance/transport company prepared to handle a patient possibly infected with Ebola?  Are you able to conduct needed procedures safely and do you have a testing company with proper protocols in place?

Is your waste disposal company prepared to dispose of any medical waste related to the patient’s visit? These are questions that should be answered “before the first patient comes through the door” said Bruce S. Ribner, MD, MPH, Director, Emory’s Serious Communicable Disease Unit.

 — Erica Noonan


The ACA Really Does Matter This Election Season: Blendon

Posted in Affordable Care Act, Health Policy, Health Reform, State of the State: 2014 on October 8th, 2014 by MMS – Be the first to comment


The Affordable Care Act is still a major election issue this year, particularly in states whose voters will ultimately decide who controls the next U.S. Senate, according to a leading health policy analyst from the Harvard School of Public Health.

Robert Blendon, ScD., speaking at the MMS” annual State of the State of State’s Healthcare conference, said anti-ACA messaging and advertising is very heavy in the 14 competitive state races, and most of those states tend to be conservative, Republican, or both.

After the ACA: Some Successes, and Lots More Work to Do

Posted in Accountable Care Organizations, Affordable Care Act, Health Policy, Health Reform, State of the State: 2014 on October 8th, 2014 by MMS – Be the first to comment


David Blumenthal, MD, president of The Commonwealth Fund, told attendees of the MMS State of the State conference yesterday that while federal health reform has fostered many important improvements in our health care system, there are still big gaps in access to care, affordability, and health status.

Dr. Blumenthal said the U.S. is still “Two Americas,” where on the most metrics, the northern half of the country is generally much better off than the southern half. For example, he asserted that middle income people in the South are in no better a situation than low-income people in the Northeast.

However, the Affordable Care Act has been the primary reason for “historic” improvements on several fronts. In the attached video clip, he outlines some of those changes. Then he reviews the experience so far in Massachusetts.

Transforming Health: The Need for an Innovation Ecosystem

Posted in Accountable Care Organizations, Health Policy, Health Reform, State of the State: 2014 on October 7th, 2014 by MMS – Be the first to comment


How do you transform the health care system in mid-flight?

Victor J. Dzau, MD, recently named president of the Institute of Medicine, argues that health care organizations have the ability to create an ecosystem that encourages the creation of ideas, nurtures them through experimentation, and then disseminates them to the rest of the health care system – up to and include commercialization.

His video clip begins with the wry observation that “innovation was not invented in the United States,” and can arise from anywhere.

His comments today were part of the 15th annual MMS  State of the State of Healthcare Leadership Forum.

Cleveland Clinic’s Lessons for Health Care Transformation

Posted in Accountable Care Organizations, Affordable Care Act, Health Policy, Health Reform, State of the State: 2014 on October 7th, 2014 by MMS – Be the first to comment


The CEO of the Cleveland Clinic provided a persuasive and moving case study today of how a health care organization can tackle the transformation of health care.

Delos M. Cosgrove, MD, said the Cleveland Clinic has made significant improvements in the areas of affordability, access and quality.

But he noted that none of these are important if a fourth critical item is missing: empathy.

Dr. Cosgrove’s presentation was part of the MMS’ 15th annual State of the State’s Healthcare Leadership Forum.

View video clips from the conference’s other presentations.

Mass. Health Care Costs: Evidence, Testimony, and Scrutiny

Posted in Global Payments, Health Policy, Health Reform, Payment Reform, Payment Reform Commission on October 6th, 2014 by MMS Communications – 1 Comment

“We’re not interested in just saving money, we’re also concerned aboutMassachusetts State House quality and access, but we need to do it in a way that we have the capacity to afford it,” said Stuart Altman, chairman of the Massachusetts Health Policy Commission, as he opened two days of hearings on health care cost trends in Massachusetts at Suffolk University Law School this morning.

Billed as an “opportunity to present evidence and testimony to hold the entire health care system accountable,” the Annual Health Care Cost Trends Hearing represents the first review of the state’s performance under the health care costs growth benchmark established in Chapter 224 in 2012. Over two days, the Commission is examining cost trends for public and commercial payers as well as hospitals and other providers.

Along with health care policy experts making detailed presentations, nearly 30 individuals – a list that reads like a “Who’s Who” of Massachusetts health care – are providing testimony on such topics as meeting the health care cost benchmark, transforming the payment system, coordinating behavioral health and post-acute care, and insurance market trends and provider market trends in promoting value-based health care.

The mood among the HPC commissioners and morning’s presenters as the session began was generally upbeat, as the Center for Health Information and Analysis (CHIA) last month released the first report on the Commonwealth’s performance. With the health care cost growth benchmark set at 3.6 percent, CHIA found that total health care expenditures increased by 2.3 percent , 1.3 percent below the benchmark. Total expenditures reach $50 billion statewide.

Governor Deval Patrick, one of the first to speak and declaring that “health is a public good,” said that “by any measure, Massachusetts health care reform is a success,” at the same time cautioning that even after eight years of health reform “there’s plenty of room to innovate” and “constant refinement” will be needed. Patrick added that challenges remain, chief among them the delivery of primary care.

Jeffery Sanchez, Chair of the legislature’s Joint Committee on Public Health, the second public official to speak, was also upbeat but cautious as well. “Let us continue to show the nation we continue to be a leader,” he said, at the same time expressing concern about behavioral health, alternative payment systems, and reaching underserved populations. He noted that minorities have difficulty navigating the health care system, and that it is imperative to “make sure the health care system is accessible and effective for all.”

Morning presentations included those from David Seltz, executive director of the Health Policy Commission; Aron Boros, executive director of CHIA, and Michael E. Chernew, Ph.D., Professor in the Department of Health Care Policy at Harvard Medical School. Other expert speakers scheduled include Alan Weil, J.D., Editor-in-Chief, Health Affairs, and Thomas Lee, M.D., Chief Medical Officer of Press Ganey Associates.

The hearing concluded at the end of the day on Tuesday. Written testimony, agency reports, and expert presentations are available on the HPC’s website at www.mass.gov/hpc. Live streaming of the hearing is also available from the website.

News coverage of hearings:

Health care stakeholders size up cost-control bid
State House News Service via Worcester Business Journal, October 7, 2014



October Physician Focus: HPV

Posted in Physician Focus, Public Health on October 1st, 2014 by MMS Communications – Be the first to comment

Human Papillomavirus is the most common, sexually-transmitted infection, and the Centers for Disease Control (CDC) estimates that some 79 million Americans are currently infected with HPV, with about 14 million people become newly infected each year. HPV is so common that most sexually-active men and women will get at least one type of the virus at some point in their lives.

While a vaccine for adolescents is available for this human carcinogen, to prevent the cervical and anal cancers, head-and-neck cancers, and genital warts that the infection can cause, too many adolescents are putting their health at risk by not getting vaccinated. In July, CDC reported that only 38 percent of girls and 14 percent of boys had completed the full regimen of three shots.

To raise awareness of human papillomavirus and encourage vaccination, the October edition of Physician Focus features Rebecca Perkins, M.D. (photo, right), a board-certified obstetrician/gynecologist at Boston Medical Center who has completed research on HPV vaccination projects sponsored by the American College of Obstetrician-Gynecologists, the CDC, and the American Cancer Society. Hosting the program is Mavis Jaworski, M.D. (photo, left), a family medicine physician.

Among the topics of discussion by the physicians are the prevalence of HPV, the risks associated with the virus, the importance of vaccination, and the safety and effectiveness of the vaccine.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org, and on YouTube .

The President’s Podium: Common Sense on EHRs

Posted in Board of Medicine, Electronic health records, Electronic Medical Records, Health IT, meaningful use on September 26th, 2014 by MMS Communications – 1 Comment

By Richard Pieters, M.D., President, Massachusetts Medical Society

In its landmark 2001 report,  Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine recognized the “enormous potential” of technology to improve health care.  Indeed, of all the changes sweeping throughout healthcare in recent years, perhaps the most revolutionary has been health information technology (HIT).

One area of explosive growth within HIT has been electronic health records (EHRs). The U.S. Department of Health and Human Services noted in May of 2013 that the use of EHRs by doctors and hospitals more than doubled from the previous year, with Massachusetts one of the heaviest adopters.  Statistics from the Office of the National Coordinator for Health IT show that 71 percent of physicians and 80 percent of hospitals in the Commonwealth have adopted EHRs.

Yet, 14 years after the IOM’s report, after billions of dollars spent in federal incentives, and despite skyrocketing adoption, physician acceptance of EHRs appears at best, a mixed bag, at worst, a struggle. Recent efforts are instructive.

In its 2014 Survey of America’s Physicians released this month, The Physicians Foundation found that nearly half of respondents (45.8%) felt that EHRs “detracted from efficiency” and slightly more (47.1%) thought it “detracted from patient interaction.”  More than half (50.5%) believe EHRs “pose a risk to patient privacy.”

Separately, on September 16, the American Medical Association called for an overhaul of EHR systems. “Today’s current EHR products,” said AMA President-Elect Steven J. Sack, M.D., “are immature, costly, and are not well designed to improve clinical care…. The usability of EHRs is a significant driver of physician professional dissatisfaction and a challenge to practice sustainability.” AMA then outlined eight priorities for improving EHR usability to benefit caregivers and patients.

Frustration and dissatisfaction with electronic health records among physicians had surfaced well before the AMA pronouncement, and complaints about EHRs have been increasing as well. The inability of different systems to communicate easily with one another – the “interoperability” issue – remains a drawback.  Perhaps most unsettling, however, is the reality that hazards and risks remain, as the promise of widespread and reproducible gains in patient safety has yet to be fulfilled.

Here in Massachusetts, electronic health records have captured physicians’ attention for quite another reason.  Chapter 224, a law passed in August 2012 that outlined phase two of health care reform for the Commonwealth, included a provision that required physicians to demonstrate “meaningful use” proficiency (which only applies to Medicare and Medicaid) with EHRs as a condition of licensure.  That mandate is to become effective on January 1 of next year.  Without proper interpretation, the law as written could have had severe unintended consequences by disenfranchising over half of the state’s licensed physicians.

Now here’s the good news: The Board of Registration in Medicine has proposed regulations that include a broad set of exemptions for certain license categories.  The Board’s proposal also establishes multiple ways in which physicians could comply with the requirement.

The Board has posted its draft regulations and is accepting comments on them through Friday, October 3 at 5 p.m. MMS offered testimony in strong support of the proposals at the public hearing on Monday, September 29, and I encourage members to add their comments as well. Comments may be submitted via email to Eileen.Prebensen@state.ma.us All comments become public records and will be posted to the state’s website.

MMS has advocated on this issue since the law was passed two years ago, raising the specter of severe disruptions in physician practice and patient access to care.  We are now near a resolution that is advantageous to both physicians and patients.

The Board’s proposal, which addresses all of our major concerns, represents a reasonable, prudent approach to complying with the law, easing physician concerns, and maintaining access to care for patients.

While physician frustration with EHRs is high, it is important to distinguish between problems of technology and problems of policy.  Technological issues are likely to be worked out over time, if only by continued physician persistence and outcry for solutions, as demonstrated by the AMA.

Policy issues, as shown by the Board of Registration in Medicine’s common sense approach to fulfilling the requirements of Chapter 224, are more readily capable of resolution.

MMS, like the IOM, believes that electronic health records do indeed have “enormous potential” for patient care. Our extensive policy on EHRs declares support for them and a desire to work toward improving them, to capture “an opportunity for dramatic benefits to patients in clinical care, research, and the delivery of health care.”

Reaching that potential, however, will require the strong voice of physicians. Whether the issue is one of technology or policy, our local experience has shown how important it is that physicians participate in the conversation.  I urge you once again to review the draft regulations and send in your comments.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine. 

September Physician Focus: Is Marijuana Medicine?

Posted in Medical Marijuana, Medicine, Physician Focus on August 28th, 2014 by MMS Communications – Comments Off

Despite a ban by the Federal government, little clinical research into its effectiveness as a medicine, and lack of approval by the Food and Drug Administration, the use of marijuana for medical purposes has been approved by 23 states and the District of Columbia as of August.

In Massachusetts, voters in 2012 overwhelmingly approved a ballot question allowing the use of marijuana by patients with “debilitating medical conditions.” The vote represented a declaration of medicine by plebiscite, a major departure from the nation’s structured way of creating, testing, and approving medications through well-controlled, sanctioned clinical trials and review and approval by the U.S. Food and Drug Administration.

As the regulatory process of overseeing the marijuana program proceeds and marijuana dispensaries prepare to open in the Commonwealth, the September episode of Physician Focus examines a basic question: Is marijuana medicine?

Guests for the show are two physicians who presented at the MMS’s recent CME course on medical marijuana in June: Alan Ehrlich, M.D. (photo, center), Senior Deputy Editor of DynaMed, a clinical reference tool created by physicians that examines medical articles for clinical relevance and scientific validity, and Kevin Hill, M.D., M.H.S., (right), Director of the Substance Abuse Consultation Service in the Division of Alcohol and Drug Abuse at McLean Hospital in Belmont. Hosting the program is John Fromson, M.D., (left) Chief of Psychiatry at Brigham and Women’s Faulkner Hospital in Boston.

The three physicians examine the current evidence surrounding marijuana, the risks of using the drug, what conditions marijuana may help, and what patients should know about the drug if they are considering using it for medicinal purposes.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org,  and on YouTube.