Health IT News

Kinect works toward degree in early autism diagnosis

Susan D. Hall - Contributing Writer — Wed, 16 May 2012 14:37:00 -0400

Researchers at the University of Minnesota are playing around with Microsoft's Kinect sensors as part of some important work: finding ways to diagnose autism earlier.

In fact, the university was awarded two grants totaling more than $3 million from the National Science Foundation to create robotic devices and computer vision algorithms to diagnose disorders such as autism, attention deficit disorder and obsessive compulsive disorder.

At the university's Institute of Child Development in Minneapolis, five Kinect cameras capture the play of children ages 3 to 5 in groups of about 10. The cameras keeps track of children based on their shape and the color of their clothes, New Scientist reports. The information is fed to three computers, which analyze how each child moves each limb and whether he or she is hyperactive or unnaturally still--all red flags for autism. Medical staff take it from there, if the system suggests a child might need to see a specialist.

Researchers also are using Kinect in a project with infants, according to New Scientist, tracking a child's ability to track an object with his eyes, looking for behavioral markers.

A flurry of research surrounds efforts to diagnose autism earlier. Researchers at Harvard Medical School recently published online a procedure involving a seven-question test and posting of a home video to a website.

Meanwhile, research at the California Institute of Technology, the University of North Carolina and elsewhere looks at the genetic link, Scientific American reports. It involves families in which one child has autism and another is less than 6 months old. Researchers plan to look for early markers at 6 months, 12 months and 24 months. They then will look at brain development, as well as behavioral clues.

Technology Review, meanwhile, points to two other uses of Kinect in the treatment of autism: One by the Lakeside Center for Autism in Washington state, which uses it to improve children's communication skills; and another by advocacy group Autism Speaks, in which an installation meant to demonstrate the difficulty in parenting a child with autism features a girl who refuses to look people in the eye.

To learn more:
- read the New Scientist article
- read the Scientific American article
- read the Technology Review post

Mostashari: Government should play booster role in health IT innovation

Susan D. Hall - Contributing Writer — Wed, 16 May 2012 14:12:49 -0400

The government is no longer the main source of health IT innovation, Farzad Mostashari, M.D., the national coordinator for health information technology, told the Boston Globe earlier this week.

But it can--and should--play a supportive role, he told the Globe before delivering a speech at the Health 2.0 conference in Boston this week.

"The investments in research and development that are going on in the consumer technology space are now dwarfing the investment and innovation that are happening in, say, the military," he said.

In the article, he talks about five ways the government can encourage innovation in healthcare. Among them:

Lend support to old-fashioned research and development. Mostashari pointed to the Smart Project at Children's Hospital Boston, which aims to make it easier to transfer data between different medical apps and programs, as an example. Funding such research is a basic province of government, he said.
Provide data--and more data. The government's awash in data; it's just a matter of making better use of it. President Obama's $200 million Big Data initiative is just one example.
Promote competition. The Office of the National Coordinator supports developer challenges or projects, the latest of which is creating technology to integrate ophthalmologists' imaging tools and databases with an electronic health record. And the Defense Advanced Research Projects Agency just sent out a call for developers to create a portable dialysis tool to remove toxic substances from the blood of soldiers in combat, Nextgov.com reports.

Mostashari concedes that for the government to be successful, much depends on establishing workable standards and rules, which is a messy process, as FierceHealthIT has reported. "There's still a lot of work to be done," Mostashari said (in what can only be described as an understatement).

To learn more:
- read the Boston Globe article
- check out the Smart Project at Children's Hospital Boston
- read more about the Ocular Imaging Challenge
- read the Nextgov.com article.

HHS' Measurement Project presents comprehensive data on U.S. healthcare system

Ken Terry — Wed, 16 May 2012 13:57:01 -0400

The Department of Health and Human Services (HHS) has launched a web-based tool that makes it easier to find detailed U.S. healthcare industry data. The Health System Measurement Project "will allow policymakers, providers and the public to develop consistent data-driven views of changes in critical U.S. health system indicators," according to an HHS announcement.

The project combines datasets culled from a number of different federal agencies. The data spans topic areas such as access to care, cost and affordability, prevention and health information technology. It presents these indicators by population characteristics, such as age, sex, income level, insurance coverage and geography.

This kind of data could help healthcare executives benchmark their institutions' performance. For example, they could use the HHS tool to track avoidable hospitalizations for adults and children by region or ethnic group.

Population health data is also available on such conditions as smoking, obesity, HIV and low-birth-weight babies. Another excellent source of this kind of data is the Centers for Disease Control and Prevention's Data & Statistics' website. That site includes a wealth of information about the prevalence and risk factors of different diseases, but does not cover the healthcare system in the way that the Measurement Project does.

The Measurement Project also presents the latest statistics on physician and hospital EHR adoption and e-prescribing. More comprehensive data in this area is available on the new Health IT Dashboard from the Office of the National Coordinator of Health IT (ONC).

To learn more:
- read the HHS announcement
- check out the Health System Measurement Project
- visit the CDC data site

Berwick: Meaningful Use still in its adolescence

Dan Bowman — Wed, 16 May 2012 13:50:46 -0400

The use of analytics in healthcare has potential, former Centers for Medicare & Medicaid Services Administrator Donald Berwick, M.D. told HealthLeaders Media in a recent interview. According to Berwick, CMS trials with analytics adoption at Oak Ridge (Tenn.) National Laboratory showed success with regard to the use of predictive analytics for fraud prevention. Predictive analytics, he said, allows officials to "take the data and turn loose the ability to go through it looking for weird patterns." Berwick also commented on current Meaningful Use efforts, saying that the initiative is still in its adolescence. "We're just barely in phase 1," he said. "The concept of meaningful Use is going to grow. What doctor in the end would not want access, if it were technically available, to the answer to the question, 'Who does the best at this?' or 'What does Mayo think?' or 'Where's the best science?'" Interview

Barriers to mainstream genetic tests remain

Dan Bowman — Wed, 16 May 2012 12:22:29 -0400

Although genome sequencing has shown promise as a tool for the type of preventive care that will be necessary for successful accountable care, several drawbacks--such as the potential for over-treatment--remain, according to a Wall Street Journal article.

In particular, over-treatment could result from unique genetic variations in each patient that could, at first, raise concerns, but ultimately might not cause any disease, Michael Watson, executive director of the American College of Medical Genetics and Genomics, told WSJ.

Additionally, the article points out that genetics are only one of several causes of conditions such as heart disease, meaning that genome sequencing won't always be able to help with prediction and treatment plans. The article also mentions diabetes as one diseases that has causes beyond genes, although Stanford University researcher Michael Snyder was able to uncover his own genetic predisposition to type 2 diabetes, according to a study published in March in the journal Cell. Snyder ultimately developed diabetes, but changed his health habits early enough to keep it under control.

"These results have important implications and suggest new paradigm shifts," the authors wrote in Cell. "First, genome sequencing can be used to direct the monitoring of specific diseases and second, by following large numbers of molecules, a more comprehensive view of disease states can be analyzed to follow physiological states."

Still, the price of a full genetic map is expected to fall quickly, according to the article. Additionally, such tests likely will become increasingly automated, according to a blog post on Genomes Unzipped by Daniel MacArthur, a genetics researcher at Massachusetts General Hospital.

"With every genome we analyze, we get better at automating the easy steps, fix mistakes in our databases that might otherwise lead to wild goose chases and obtain more unambiguous evidence about the clinical significance of each mutation," MacArthur said. "The genome interpretation of 2017 won't be a drawn-out process involving constant back-and-forth between highly paid specialists. It will be a complex but thoroughly automated series of analysis steps, resulting in only a few potentially interesting results to be passed on to geneticists and clinicians for manual checking and signing off."

To learn more:
- read the Wall Street Journal article
- here's the Genomes Unzipped post

AMA wants two-year delay of ICD-10

Dan Bowman — Tue, 15 May 2012 14:26:03 -0400

The American Medical Association wants the Centers for Medicare & Medicaid Services to extend the deadline for ICD-10 "at a minimum" to Oct. 1, 2015, according to a letter sent to acting administrator Marilyn Tavenner last week. "A year's delay does not provide CMS with adequate time to fully examine the appropriate scope of ICD-10 and true costs to physician practices," AMA CEO James Madara, M.D. wrote. The request comes on the heels of letters from both the College of Healthcare Information Management Executives and the American Health Information Management Association to Tavenner regarding the ICD-10 delay. Letter (.pdf)

Docs should be wary of anti-kickback laws when implementing HIT

Dan Bowman — Tue, 15 May 2012 14:18:30 -0400

This week's Health 2.0 Spring Fling in Boston is, more that anything, a celebration of innovation in healthcare--as evidenced by the announcement that Health 2.0 has awarded more than $1 million in through its Developer Challenge series--but a panel session on the opening day of the conference outlined the importance of being cautious regarding technology innovation, implementation and use.

Healthcare attorney and blogger David Harlow, one of the panel members, said that despite the evolution of technology use in healthcare, anti-kickback laws governing arrangements of its use have remained stagnant, according to a post on EHR Intelligence. "Unfortunately, the statute hasn't kept up with the times very well," Harlow said.

What's more, he said, safe harbors--conditions under which providers can avoid anti-kickback penalties--aren't the most ideal method for circumventing those statutes because safe harbor conditions are very exact. "The arrangement that you have really has to fit within the four corners of that safe harbor in order to get protection … so it's a very tricky area," Harlow said.

A second panel member, Dan Orenstein, general counsel for electronic health record vendor athenahealth, expressed disappointment in the federal government's handling of safe harbors to date, especially considering its push for increased health IT use.

"You would think that the government would be doing more to expand … to enable all of the innovation it says it wants," he said, according to EHR Intelligence.

According to Health 2.0 News, fellow panel member Jack Eiferman, another healthcare attorney, added that the goal behind anti-kickback laws was for decision making to "remain unsullied."

"[Lawmakers] want the decision making by healthcare providers to be pristine, to be uninfluenced by any of the considerations in the commercial marketplace," Eiferman said.

To learn more:
- read this EHR Intelligence post
- here's the Health 2.0 News post

Public hospital association assails MU Stage 2 proposal

Ken Terry — Tue, 15 May 2012 10:41:24 -0400

The National Association of Public Hospitals & Health Systems (NAPH) has released an issue brief on "Health Technology and the Safety Net" that is, in effect, a commentary on the Meaningful Use Stage 2 proposal of the Centers for Medicare and Medicaid Services (CMS).

Nearly all (97 percent) of NAPH members plan to participate in both the Medicare and the Medicaid electronic health record incentive programs, the brief says. That's well above the 74 percent of all hospitals that intend to participate. But NAPH members are more likely than other hospitals to be unable to meet the Meaningful Use criteria until fiscal year 2013, according to the report.

Public hospitals have limited resources, and the government's incentive payments cover only 30 to 50 percent of the cost of EHR implementation. In addition, these hospitals find it difficult to compete financially for experienced health IT staff, the brief points out. And, because public healthcare systems are often large, with extensive outpatient clinics, it is difficult to achieve Meaningful Use within the government's time frame.

Consequently, NAPH argues, CMS should allow all hospitals three years in between the deadlines for Meaningful Use Stage 1 and Stage 2, regardless of when they begin to participate in the program. "This flexibility would help ensure safety net systems are not unfairly disadvantaged for being larger health systems with fewer resources," the report says.

NAPH's position on the time frame echoes the comments of the American Hospital Association on Meaningful Use Stage 2. And, like AHA, NAPH opposes the MU Stage 2 requirement for providers to ensure that 10 percent of their patients view, download and/or share their electronic health information.

The association notes that 58% of patients seen by NAPH members are racial or ethnic minorities, many of whom have limited access to technology. "Meaningful Use measures that hold providers accountable for patients viewing and downloading their health information could unfairly punish safety net providers for fulfilling their mission to serve the most vulnerable among us."

The issue brief also urges CMS not to raise the thresholds for core measures of Meaningful Use for Stage 2 until a "wide range of hospitals" can meet the thresholds for Stage 1. NAPH also asks the agency to retain flexibility on the menu items in Stage 2 and to exempt public hospitals from the health information exchange requirements because of the low EHR adoption rates in their communities.

To learn more:
- read the NAPH issue brief
- see the AHA's comments on Meaningful Use

Hybrid heart surgery helps patients bounce back

Susan D. Hall - Contributing Writer — Mon, 14 May 2012 14:13:30 -0400

A two-stage procedure that combines coronary stenting with robotically assisted bypass surgery can minimize complications and get patients back on their feet faster, researchers report.

The surgery does not require splitting the chest. Instead "keyhole" surgery is performed through small incisions between the ribs, speeding recovery. The da Vinci surgical robot assists the cardiac surgeon in re-routing blood around the most critical blockages, while other blockages are treated with percutaneous coronary intervention (PCI), which typically involves both angioplasty and stenting, according to the Society for Cardiovascular Angiography and Interventions. The study's findings were presented at the SCAI 2012 Scientific Sessions in Las Vegas last week.

"The traditional paradigm is you either stent or you perform surgery, but not both. Now there is a third option where you can do both," senior author Robert Poston, M.D., chief of cardiothoracic surgery at the University of Arizona in Tucson, told MedPage Today.

The technique allows cardiologists and surgeons to work on the same patient in one day, although the article notes that requires a facility with a hybrid cath lab designed for both surgery and catheter-based interventions. Although it plans to install a hybrid lab next year, Poston's team for now does the two procedures on consecutive days.

The 32 patients studied averaged 4.3 days in the hospital. After one year they were 16 percent less likely to die or experience major complications than patients treated with conventional bypass surgery, and after one month, 85 percent were able to perform yard work or run a short distance.

Poston told MedPage Today that two of the biggest major complications--sternal infections and stroke--are avoided "almost by definition" of the minimally invasive procedure.

He pointed out, though, that it will require a culture change in which cardiothoracic surgeons and interventional cardiologists work together. Indeed, in agreeing to reimburse for a device called transcatheter aortic valve implantation (TAVI), the Centers for Medicare and Medicaid Services emphasized a multidisciplinary heart team, ThirdAge.com notes.

The hybrid procedure is more expensive, but a faster recovery is appealing to patients.

Sugam Bhatnagar, associate research scientist in cardiothoracic surgery, says the cost is "marginally higher," according to the society announcement.

"We can never look at costs without linking them with benefits. The hybrid program clearly offers benefits in terms of better quality of life and quicker recovery."

To learn more:
- here's the study's announcement
- read the MedPage Today article

VA outlines protection of VLER data

Dan Bowman — Mon, 14 May 2012 13:58:42 -0400

The use of firewalls and increased encryption to protect data transmissions between various operational systems and warehouses are among several steps the Department of Veterans Affairs plans to take to safeguard patient data used in the Virtual Lifetime Electronic Record (VLER) program, according to a recent notice posted in the Federal Register.

The VA will limit access to databases with such information only to individuals whose job requires that access, and will enforce that access using information security officers, in addition to security software, according to the notice. What’s more, the VA plans train all staff on information security, emphasizing that it’s not just the job of the IT department to keep such information safe.

Other steps outlined by the VA in its notice include providing physical security for buildings and rooms housing veterans’ data and housing copies of back-up computer files at off-site locations.

The notice also proposes a number of “routine use disclosures” for the data. For example, the VA says that such data can be disclosed to federal, state, local, tribal or foreign agencies pertaining to criminal and civil violations of law.

The VLER program--which shares veterans’ health information electronically between the VA, the Department of Defense and select private healthcare facilities partnering with those entities--initially was launched in April 2009 to create a unified lifetime electronic health record for members of the armed forces. Last fall, it was expanded to seven sites: Grand Junction, Colo; rural Utah; Asheville and Western North Carolina; Buffalo; Charleston, S.C.; Minneapolis; and Puget Sound Wash.

The VA’s proposed 2013 budget requests $52.9 million for the VLER program.

To learn more:
- here’s the notice in the Federal Register

Flu vaccination rates up with use of online health management tool

Dan Bowman — Mon, 14 May 2012 11:51:21 -0400

Use of a web-based health management system helped to boost preventive health measures by patients, such as getting flu vaccinations, a new study published in the Journal of the American Medical Informatics Association finds. The study examined use of a personally controlled health management system (PCHMS) known as Healthy.me by roughly 370 students and staff at the University of New South Wales in Australia. Those using the system were 6.7 percent more likely to have received a flu vaccination and 11.6 percent more likely to have visited a health service provider than those that did not use the system, according to the researchers. Abstract

Telemedicine, mHealth will connect with EHRs when providers are motivated

Ken Terry — Mon, 14 May 2012 06:34:35 -0400

In a discussion at the recent American Telemedicine Association (ATA) conference, panelists bewailed the absence of electronic health record vendors from the meeting, according to a post in NHIN Watch.

"Politically, commercially--it's an issue," said Hon Park, M.D., CEO of Diversinet, which provides secure two-way connectivity for mHealth applications. Pak said that mHealth apps, EHRs, and health information exchanges must be integrated for effective care coordination, according to the post.

Michael Lemnitzer, an executive with Philips Home Healthcare Solutions, said his company is "working aggressively" with EHR vendors to develop interfaces, because 90 percent of Philips' contracts with healthcare providers require connectivity with EHRs. Lemnitzer predicted that by 2015, the majority of EHR companies would have interfaces for telemedicine applications. For that to happen, he said, more interoperability standards would be necessary, according to the post.

This technical approach to the issue, however, leaves out economic and workflow factors that must be addressed before telemedicine and mHealth data can travel "the last mile" to the point of care, to use Pak's metaphor.

In a recent iHealthBeat commentary, Health IT executive and former Accenture consultant David Chase described the problem this way: Current EHRs were designed for a "do more, bill more" system that's on its way out, and they're not nimble enough to cope with the pace of healthcare transformation. In other words, EHRs were not designed for quality improvement or population health management, but for helping practices do things a little faster while enabling them to increase their charges through better documentation.

Even more troubling, the Consumer Partnership for eHealth accuses some EHR vendors of purposely blocking providers' ability to connect with other systems. In comments to the Centers for Medicare and Medicaid Services (CMS) about CMS' proposed Meaningful Use Stage 2 regulations, the Partnership, which represents 23 consumer groups, said CMS should bar such EHRs from getting certification for the purpose of showing Meaningful Use.

To be sure, EHR vendors aren't as bad as these observers make them sound. For one thing, the leading EHRs are all capable of generating and transmitting standardized clinical summaries known as Continuity of Care Documents (CCDs). CCDs convey only key data, but in theory, it should be able to flow into the discrete fields of disparate EHRs. So the vendors won't be able to "block" interoperability.

To Chase's point, the vendors did what he said because that's what the market demanded. Until very recently, physicians purchased EHRs because they believed it would make them more efficient and help them code patient visits higher. Only with the advent of Meaningful Use and the healthcare industry's first tentative steps toward accountable care are we seeing any real interest among providers in using EHRs to improve quality or manage population health. So, while EHR vendors are beginning to offer registries, health information exchanges, and the like, their applications in these areas remain inferior to those offered by third party vendors.

What does this all mean for telemedicine and mHealth? Remember that we're only in the foothills of the major transformation that Chase sees coming. Most providers still derive most of their income from fee for service, so they're still in a "do more, bill more" mindset. Until the reimbursement system changes completely, the percentage of customers who demand that EHRs provide capabilities to thrive under that new payment system will remain small.

As a result, telemedicine and mHealth vendors will have to spend a lot to create interfaces to the leading EHRs, and a minority of the providers who use those systems will be interested in their products. But in the long run--assuming that the industry continues along its current trajectory--the new technologies will play a key role in coordinating care and in engaging patients in self-management. - Ken

ONC issues RFI on NwHIN governance, lays framework for nonprofit entity

Ken Terry — Mon, 14 May 2012 05:49:44 -0400

The Office of the National Coordinator for Health IT (ONC) has issued a request for information (RFI) on the mechanisms required for governance of the Nationwide Health Information Network (NwHIN), which ONC plans to spin off as a private, nonprofit entity next fall.

In a May 11 webinar of the National eHealth Collaborative (NeHC) University, Steven Posnack, director of ONC's federal policy division, outlined the RFI. The objectives of creating a NwHIN governance structure, he said, include:

Making it more efficient for entities to exchange health information
Avoiding potential conflicts between the disparate governance structures of state health information exchanges (HIEs)
Laying the foundation for future stages of Meaningful Use
Guiding the evolution of interoperability standards in the HIE marketplace

The RFI seeks comments in the following areas:

Establishing a set of conditions of trusted exchange (CTEs), or rules of the road
Setting up a validation process for entities that want to show conformance with CTEs
Establishing a process to measure the readiness of evolving standards of interoperability
Updating and retiring CTEs
Approaches for monitoring and oversight

The three classes of CTEs in the ONC schema address the security of personal health information (PHI), technical standards for information exchange, and required business practices such as providing open access to directory services.

The RFI specifies preconditions for allowing organizations to become NwHIN-validated entities (NVEs). Among the entities that ONC anticipates will attain that status are electronic health record developers, integrated delivery networks, regional, state and local HIEs, health information service providers, and state and federal agencies.

Following the same arms-length process used in approving the entities that certify EHRs for Meaningful Use, ONC would select an "accreditation body" to appoint "validation bodies" that would validate the NVEs.

Besides ONC and its affiliated bodies, NwHIN governance would be subject to oversight by the Federal Trade Commission and the U.S. Department of Health & Human Services' Office of Civil Rights, which also enforces HIPAA regulations. So, despite ONC's stated intention to make NwHIN a nongovernmental organization, it appears that it will be closely supervised by the government.

NwHIN already includes more than 500 hospitals and 4,000 practices, but most of those providers are participating in a pilot of the Virtual Electronic Lifetime Record (VLER) of the Department of Defense and the Department of Veterans Affairs, according to a recent article in InformationWeek Healthcare.

To learn more:
- see the NeHC PowerPoint presentation
- read the ONC RFI
- check out the InformationWeek article
- read a Health Data Management article about the NwHIN spin-off

Public vs. private HIEs: Room for both?

Dan Bowman — Fri, 11 May 2012 13:25:10 -0400

While private health information exchanges are non-reliant on government handouts and thus, slightly more self-sustaining, according to an article published in this month's Journal of AHIMA, they also, according to some, undermine efforts of public HIEs, which aim to connect providers for the greater good, rather than for greater profits. So the question remains: Is there room for both?

Steven Roth, chief medical information officer with Harrisburg, Pa.-based PinncaleHealth, believes there is. While Pinnacle created its own HIE in 2009--which has been operating with a profit for most of that time--it also has committed to join the Pennsylvania eHealth Collaborative's HIE, currently in progress.

"It makes sense to me that some public entity brings all of those [private] entities together, where there really isn't a motivation," Roth told the journal. State HIEs, he said, can help to fill the gaps left by private HIEs.

Others, including University of Utah School of Medicine professor Leslie Lenert disagree. The article points to a paper Lenert wrote at the beginning of the year that concluded that private HIEs and efforts like the Direct Project have undermined regional health information organizations and state-based HIEs.

What's more, a report released this week by Chilmark Research found that while the HIE market grew more than 40 percent in 2011, only a small portion of that growth resulted from the HITECH Act and statewide HIE efforts; rather, most of that growth was due to vendors targeting the private enterprise market.

A recent survey of hospital CIOs found that nearly 60 percent are currently involved in either a regional or system-to-system HIE effort, though roughly 21 percent said they were "skeptical" of HIE sustainability.

To learn more:
- read the Journal of AHIMA article
- here's Lenert's paper in JAMIA

HHS finalizes new standards for Part D e-prescribing

Ken Terry — Fri, 11 May 2012 12:06:07 -0400

The Department of Health and Human Services (HHS) has finalized two changes in its e-prescribing rules for Medicare Part D, regulations that govern the standards for communications between dispensers and drug plans and for insurance eligibility inquiries and responses.

For the latter, HHS will adopt the ASC X12 standards for electronic data interchange, technical report type 3-health care eligibility benefit inquiry and response. The department will also adopt updated standards of the National Council for Prescription Drug Programs (NPCDP) for transmitting eligibility inquiries and responses between pharmacies and Part D plans.

In commenting on the proposal for these changes, one observer noted that HHS has not yet adopted standards for a clinical drug terminology, electronic prior authorization, or a structured and codified SIG format (i.e., instructions on the prescription label). HHS responded that "several of the necessary standards are still under development," including the prior authorization and SIG standards. "Thus, it would be premature for us to propose the adoption of standards that have been not fully developed and tested."

HHS announced the e-prescribing changes as part of a package of new rules that are supposed to cut red tape and save the healthcare industry more than $5 billion over 5 years.

The department has not responded to complaints from the American Medical Association that physicians have not been given enough time to avoid penalties for non-compliance with e-prescribing regulations. The AMA recently reminded doctors they have only until June 30 to send at least 10 prescriptions electronically so they can avoid having their Medicare payments reduced in 2013.

According to Surescripts, 58 percent of office based physicians, or 317,000 providers, prescribed electronically last year, compared to 10 percent in 2009, reports Drug Store News.

To learn more:
- read the HHS final rule on e-prescribing
- see the HHS announcement
- see the AMA letter
- see the Drug Store News article