Robert Finn

Major Finding: In the work-up of a patient with a recent transient ischemic attack or minor ischemic stroke, the most cost-effective strategy is duplex ultrasonography as the initial test, followed by CT angiography if the results are positive. Patients with 70%-99% stenosis should then undergo carotid endarterectomy. For the average 60-year-old man, this strategy had the lowest cost (39,826 euros) and yielded the largest number of quality-adjusted life years (14.38).

Data Sources: Meta-analysis of 41 studies, review of the literature, and a prospective diagnostic cohort study involving 351 patients.

Disclosures: The study was supported by the National Healthcare Insurance Board of the Netherlands and the Revolving Fund of Erasmus University Medical Center. The investigators stated that they had no financial relationships to disclose.

The most cost-effective strategy to diagnose carotid artery stenosis for most patients with recent transient ischemic attacks or minor strokes is duplex ultrasound, followed (if the results are positive) by CT angiography. Patients with 70%-99% stenosis should then undergo carotid endarterectomy, according to a study based on a meta-analysis, a review of the literature, and a prospective diagnostic cohort study.

This strategy yields the lowest costs and the largest number of quality-adjusted life-years (QALY) for the average patient, according to analysis by Aletta T.R. Tholen, M.Sc., and colleagues from Erasmus University Medical Center, Rotterdam, the Netherlands (Radiology 2010;256:585-97).

For the typical 60-year-old man, this strategy would cost 39,826 euros (roughly US $51,730 at current exchange rates) and would yield 14.38 QALY. For the typical 60-year-old woman, it would cost 45,911 euros (US $59,634) and would yield 16.46 QALY.

The optimum strategy would differ somewhat for patients with higher risk profiles or a high probability of carotid artery stenosis, or for those who can undergo surgery without delay. In those cases, the duplex ultrasonography can be dispensed with in favor of CT angiography and surgery for 50%-99% stenosis.

For both men and women, the least cost-effective diagnostic strategy was duplex ultrasonography performed as a solo test. Duplex ultrasonography followed by contrast-enhanced MR angiography was intermediate in cost effectiveness, but was clearly dominated by duplex ultrasound followed by CT angiography.

The investigators used a decision-tree model to assess all feasible strategies in normal practice. They based their estimates of the prior probability of carotid artery stenosis on the results of a cross-sectional prospective diagnostic cohort study of 351 patients with a transient ischemic attack or minor stroke who were admitted to Erasmus University Medical Center between November 2002 and January 2005. Of those patients, 9.8% of the males and 2.2% of the females had 70%-99% stenosis. Another 2.1% of the male patients and 1.4% of the female patients had 50%-69% stenosis.

In estimating the performances of the diagnostic tests, investigators relied on a meta-analysis that included 2,541 patients in a total of 41 studies published between January 1987 and April 2004. They based their information of the disadvantages of the various tests on their diagnostic cohort study and from a review of the literature.

“Our results suggest that if the patient cannot undergo surgery in a timely fashion, an initial duplex US examination and a 70%-99% stenosis criterion for surgery is indicated. On the other hand, if the patient can undergo surgery in a timely fashion, immediate CT-angiography and the use of a lenient criterion (50%-99% stenosis) as the surgery indication is beneficial,” the researchers concluded.

Major Finding: In the work-up of a patient with a recent transient ischemic attack or minor ischemic stroke, the most cost-effective strategy is duplex ultrasonography as the initial test, followed by CT angiography if the results are positive. Patients with 70%-99% stenosis should then undergo carotid endarterectomy. For the average 60-year-old man, this strategy had the lowest cost (39,826 euros) and yielded the largest number of quality-adjusted life years (14.38).

Data Sources: Meta-analysis of 41 studies, review of the literature, and a prospective diagnostic cohort study involving 351 patients.

Disclosures: The study was supported by the National Healthcare Insurance Board of the Netherlands and the Revolving Fund of Erasmus University Medical Center. The investigators stated that they had no financial relationships to disclose.

The most cost-effective strategy to diagnose carotid artery stenosis for most patients with recent transient ischemic attacks or minor strokes is duplex ultrasound, followed (if the results are positive) by CT angiography. Patients with 70%-99% stenosis should then undergo carotid endarterectomy, according to a study based on a meta-analysis, a review of the literature, and a prospective diagnostic cohort study.

This strategy yields the lowest costs and the largest number of quality-adjusted life-years (QALY) for the average patient, according to analysis by Aletta T.R. Tholen, M.Sc., and colleagues from Erasmus University Medical Center, Rotterdam, the Netherlands (Radiology 2010;256:585-97).

For the typical 60-year-old man, this strategy would cost 39,826 euros (roughly US $51,730 at current exchange rates) and would yield 14.38 QALY. For the typical 60-year-old woman, it would cost 45,911 euros (US $59,634) and would yield 16.46 QALY.

The optimum strategy would differ somewhat for patients with higher risk profiles or a high probability of carotid artery stenosis, or for those who can undergo surgery without delay. In those cases, the duplex ultrasonography can be dispensed with in favor of CT angiography and surgery for 50%-99% stenosis.

For both men and women, the least cost-effective diagnostic strategy was duplex ultrasonography performed as a solo test. Duplex ultrasonography followed by contrast-enhanced MR angiography was intermediate in cost effectiveness, but was clearly dominated by duplex ultrasound followed by CT angiography.

The investigators used a decision-tree model to assess all feasible strategies in normal practice. They based their estimates of the prior probability of carotid artery stenosis on the results of a cross-sectional prospective diagnostic cohort study of 351 patients with a transient ischemic attack or minor stroke who were admitted to Erasmus University Medical Center between November 2002 and January 2005. Of those patients, 9.8% of the males and 2.2% of the females had 70%-99% stenosis. Another 2.1% of the male patients and 1.4% of the female patients had 50%-69% stenosis.

In estimating the performances of the diagnostic tests, investigators relied on a meta-analysis that included 2,541 patients in a total of 41 studies published between January 1987 and April 2004. They based their information of the disadvantages of the various tests on their diagnostic cohort study and from a review of the literature.

“Our results suggest that if the patient cannot undergo surgery in a timely fashion, an initial duplex US examination and a 70%-99% stenosis criterion for surgery is indicated. On the other hand, if the patient can undergo surgery in a timely fashion, immediate CT-angiography and the use of a lenient criterion (50%-99% stenosis) as the surgery indication is beneficial,” the researchers concluded.

Major Finding: In the work-up of a patient with a recent transient ischemic attack or minor ischemic stroke, the most cost-effective strategy is duplex ultrasonography as the initial test, followed by CT angiography if the results are positive. Patients with 70%-99% stenosis should then undergo carotid endarterectomy. For the average 60-year-old man, this strategy had the lowest cost (39,826 euros) and yielded the largest number of quality-adjusted life years (14.38).

Data Sources: Meta-analysis of 41 studies, review of the literature, and a prospective diagnostic cohort study involving 351 patients.

Disclosures: The study was supported by the National Healthcare Insurance Board of the Netherlands and the Revolving Fund of Erasmus University Medical Center. The investigators stated that they had no financial relationships to disclose.

The most cost-effective strategy to diagnose carotid artery stenosis for most patients with recent transient ischemic attacks or minor strokes is duplex ultrasound, followed (if the results are positive) by CT angiography. Patients with 70%-99% stenosis should then undergo carotid endarterectomy, according to a study based on a meta-analysis, a review of the literature, and a prospective diagnostic cohort study.

This strategy yields the lowest costs and the largest number of quality-adjusted life-years (QALY) for the average patient, according to analysis by Aletta T.R. Tholen, M.Sc., and colleagues from Erasmus University Medical Center, Rotterdam, the Netherlands (Radiology 2010;256:585-97).

For the typical 60-year-old man, this strategy would cost 39,826 euros (roughly US $51,730 at current exchange rates) and would yield 14.38 QALY. For the typical 60-year-old woman, it would cost 45,911 euros (US $59,634) and would yield 16.46 QALY.

The optimum strategy would differ somewhat for patients with higher risk profiles or a high probability of carotid artery stenosis, or for those who can undergo surgery without delay. In those cases, the duplex ultrasonography can be dispensed with in favor of CT angiography and surgery for 50%-99% stenosis.

For both men and women, the least cost-effective diagnostic strategy was duplex ultrasonography performed as a solo test. Duplex ultrasonography followed by contrast-enhanced MR angiography was intermediate in cost effectiveness, but was clearly dominated by duplex ultrasound followed by CT angiography.

The investigators used a decision-tree model to assess all feasible strategies in normal practice. They based their estimates of the prior probability of carotid artery stenosis on the results of a cross-sectional prospective diagnostic cohort study of 351 patients with a transient ischemic attack or minor stroke who were admitted to Erasmus University Medical Center between November 2002 and January 2005. Of those patients, 9.8% of the males and 2.2% of the females had 70%-99% stenosis. Another 2.1% of the male patients and 1.4% of the female patients had 50%-69% stenosis.

In estimating the performances of the diagnostic tests, investigators relied on a meta-analysis that included 2,541 patients in a total of 41 studies published between January 1987 and April 2004. They based their information of the disadvantages of the various tests on their diagnostic cohort study and from a review of the literature.

“Our results suggest that if the patient cannot undergo surgery in a timely fashion, an initial duplex US examination and a 70%-99% stenosis criterion for surgery is indicated. On the other hand, if the patient can undergo surgery in a timely fashion, immediate CT-angiography and the use of a lenient criterion (50%-99% stenosis) as the surgery indication is beneficial,” the researchers concluded.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published in the Sept. 15 issue of JAMA.

For example, 53% of the students with moderate to severe depression agreed with the statement, “Telling a counselor I am depressed would be risky,” compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students enrolled at the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found between students with moderate to severe depression and those with no or minimal depression on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, “If I were depressed and asked for help, I would be admitting that my coping skills are inadequate.”

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, “Medical students with depression are dangerous to their patients,” compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was statistically significant.

“These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment,” the investigators wrote. “The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism.”

The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures. Dr. Roberts reported receiving research funding from the National Institutes of Health, the U.S. Department of Energy, and the Medical College of Wisconsin in Milwaukee, as well as being the owner of Terra Nova Learning Systems.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published in the Sept. 15 issue of JAMA.

For example, 53% of the students with moderate to severe depression agreed with the statement, “Telling a counselor I am depressed would be risky,” compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students enrolled at the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found between students with moderate to severe depression and those with no or minimal depression on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, “If I were depressed and asked for help, I would be admitting that my coping skills are inadequate.”

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, “Medical students with depression are dangerous to their patients,” compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was statistically significant.

“These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment,” the investigators wrote. “The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism.”

The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures. Dr. Roberts reported receiving research funding from the National Institutes of Health, the U.S. Department of Energy, and the Medical College of Wisconsin in Milwaukee, as well as being the owner of Terra Nova Learning Systems.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published in the Sept. 15 issue of JAMA.

For example, 53% of the students with moderate to severe depression agreed with the statement, “Telling a counselor I am depressed would be risky,” compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students enrolled at the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found between students with moderate to severe depression and those with no or minimal depression on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, “If I were depressed and asked for help, I would be admitting that my coping skills are inadequate.”

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, “Medical students with depression are dangerous to their patients,” compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was statistically significant.

“These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment,” the investigators wrote. “The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism.”

The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures. Dr. Roberts reported receiving research funding from the National Institutes of Health, the U.S. Department of Energy, and the Medical College of Wisconsin in Milwaukee, as well as being the owner of Terra Nova Learning Systems.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published in the Sept. 15 issue of JAMA.

For example, 53% of the students with moderate to severe depression agreed with the statement, "Telling a counselor I am depressed would be risky," compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students enrolled at the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found between students with moderate to severe depression and those with no or minimal depression on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, "If I were depressed and asked for help, I would be admitting that my coping skills are inadequate."

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, "Medical students with depression are dangerous to their patients," compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was statistically significant.

"These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment," the investigators wrote. "The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism."

Disclosures: The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published in the Sept. 15 issue of JAMA.

For example, 53% of the students with moderate to severe depression agreed with the statement, "Telling a counselor I am depressed would be risky," compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students enrolled at the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found between students with moderate to severe depression and those with no or minimal depression on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, "If I were depressed and asked for help, I would be admitting that my coping skills are inadequate."

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, "Medical students with depression are dangerous to their patients," compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was statistically significant.

"These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment," the investigators wrote. "The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism."

Disclosures: The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published in the Sept. 15 issue of JAMA.

For example, 53% of the students with moderate to severe depression agreed with the statement, "Telling a counselor I am depressed would be risky," compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students enrolled at the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found between students with moderate to severe depression and those with no or minimal depression on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, "If I were depressed and asked for help, I would be admitting that my coping skills are inadequate."

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, "Medical students with depression are dangerous to their patients," compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was statistically significant.

"These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment," the investigators wrote. "The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism."

Disclosures: The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published in the Sept. 15 issue of JAMA.

For example, 53% of the students with moderate to severe depression agreed with the statement, “Telling a counselor I am depressed would be risky,” compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students enrolled at the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found between students with moderate to severe depression and those with no or minimal depression on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, “If I were depressed and asked for help, I would be admitting that my coping skills are inadequate.”

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, “Medical students with depression are dangerous to their patients,” compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was statistically significant.

“These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment,” the investigators wrote. “The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism.”

The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures. Dr. Roberts reported receiving research funding from the National Institutes of Health, the U.S. Department of Energy, and the Medical College of Wisconsin in Milwaukee, as well as being the owner of Terra Nova Learning Systems.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published in the Sept. 15 issue of JAMA.

For example, 53% of the students with moderate to severe depression agreed with the statement, “Telling a counselor I am depressed would be risky,” compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students enrolled at the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found between students with moderate to severe depression and those with no or minimal depression on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, “If I were depressed and asked for help, I would be admitting that my coping skills are inadequate.”

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, “Medical students with depression are dangerous to their patients,” compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was statistically significant.

“These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment,” the investigators wrote. “The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism.”

The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures. Dr. Roberts reported receiving research funding from the National Institutes of Health, the U.S. Department of Energy, and the Medical College of Wisconsin in Milwaukee, as well as being the owner of Terra Nova Learning Systems.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published in the Sept. 15 issue of JAMA.

For example, 53% of the students with moderate to severe depression agreed with the statement, “Telling a counselor I am depressed would be risky,” compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students enrolled at the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found between students with moderate to severe depression and those with no or minimal depression on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, “If I were depressed and asked for help, I would be admitting that my coping skills are inadequate.”

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, “Medical students with depression are dangerous to their patients,” compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was statistically significant.

“These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment,” the investigators wrote. “The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism.”

The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures. Dr. Roberts reported receiving research funding from the National Institutes of Health, the U.S. Department of Energy, and the Medical College of Wisconsin in Milwaukee, as well as being the owner of Terra Nova Learning Systems.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online by Health Affairs, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 “core” objectives and an additional 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey’s response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote.

In addition, they noted, “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

“Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer,” they wrote.

The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online by Health Affairs, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 “core” objectives and an additional 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey’s response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote.

In addition, they noted, “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

“Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer,” they wrote.

The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online by Health Affairs, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 “core” objectives and an additional 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey’s response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote.

In addition, they noted, “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

“Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer,” they wrote.

The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online by Health Affairs, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 “core” objectives and an additional 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey’s response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote.

In addition, they noted, “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

“Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer,” they wrote.

The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online by Health Affairs, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 “core” objectives and an additional 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey’s response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote.

In addition, they noted, “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

“Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer,” they wrote.

The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online by Health Affairs, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 “core” objectives and an additional 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey’s response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote.

In addition, they noted, “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

“Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer,” they wrote.

The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

The Food and Drug Administration on Sept. 9 required manufacturers of five gadolinium contrast agents to strengthen boxed warnings on their products to minimize the risk of nephrogenic systemic fibrosis in some patients with kidney dysfunction.

Three of the agents – Magnevist (gadopentetate dimeglumine), Omniscan (gadodiamide), and Optimark (gadoversetamide) – are now contraindicated in patients with acute kidney injury (AKI) or chronic, severe kidney disease. Severe kidney disease is marked by a glomerular filtration rate of less than 30 mL/min/1.73m².

In addition, the revised labeling recommends that healthcare professionals screen all patients being considered for any gadolinium-based contrast agent (GBCA) for AKI or chronic, severe kidney disease. GBCAs also should be avoided in patients suspected or known to have impaired drug elimination unless the diagnostic information obtained is essential and cannot be acquired without the use of a contrast agent.

It’s been known since at least 2006 that patients with AKI or chronic, severe kidney disease are at increased risk of developing nephrogenic systemic fibrosis (NSF). In 2007 the FDA issued its first boxed warning about the risk of NSF associated with GBCA use. That warning stated only that healthcare professionals should be aware of the possibility that some patients might develop NSF. The new warning adds the absolute contraindication for the use of the three agents in patients with AKI and chronic, severe kidney disease.

The earlier boxed warning appears to have had the effect of reducing the incidence of NSF, according to one FDA official. Late last year, at a joint meeting of the FDA’s Cardiovascular and Renal Drugs and Drug Safety and Risk Management advisory committees, Dr. James Kaiser of the agency’s office of surveillance and epidemiology noted that in 2006 there were 194 cases of NSF associated with GBCAs. That number decreased to 128 cases in 2007, 55 in 2008, and 6 in 2009 (through September).

While three GBCAs had been associated with numerous cases of NSF, the other two – MultiHance (gadobenate dimeglumine) and ProHance (gadoteridol) ‑ have not. As of September 2009, a total of 382 reports of NSF had been associated with Omniscan (GE HealthCare), 195 with Magnevist (Bayer HealthCare), 35 with OptiMARK (Covidien), 1 with MultiHance (Bracco Diagnostics), and 0 with ProHance (Bracco Diagnostics). At last year’s meeting a majority of advisory committee members recommended that Omniscan and OptiMARK be contraindicated in patients with serious kidney dysfunction. There was less agreement on whether Magnevist should also be contraindicated.

The Food and Drug Administration on Sept. 9 required manufacturers of five gadolinium contrast agents to strengthen boxed warnings on their products to minimize the risk of nephrogenic systemic fibrosis in some patients with kidney dysfunction.

Three of the agents – Magnevist (gadopentetate dimeglumine), Omniscan (gadodiamide), and Optimark (gadoversetamide) – are now contraindicated in patients with acute kidney injury (AKI) or chronic, severe kidney disease. Severe kidney disease is marked by a glomerular filtration rate of less than 30 mL/min/1.73m².

In addition, the revised labeling recommends that healthcare professionals screen all patients being considered for any gadolinium-based contrast agent (GBCA) for AKI or chronic, severe kidney disease. GBCAs also should be avoided in patients suspected or known to have impaired drug elimination unless the diagnostic information obtained is essential and cannot be acquired without the use of a contrast agent.

It’s been known since at least 2006 that patients with AKI or chronic, severe kidney disease are at increased risk of developing nephrogenic systemic fibrosis (NSF). In 2007 the FDA issued its first boxed warning about the risk of NSF associated with GBCA use. That warning stated only that healthcare professionals should be aware of the possibility that some patients might develop NSF. The new warning adds the absolute contraindication for the use of the three agents in patients with AKI and chronic, severe kidney disease.

The earlier boxed warning appears to have had the effect of reducing the incidence of NSF, according to one FDA official. Late last year, at a joint meeting of the FDA’s Cardiovascular and Renal Drugs and Drug Safety and Risk Management advisory committees, Dr. James Kaiser of the agency’s office of surveillance and epidemiology noted that in 2006 there were 194 cases of NSF associated with GBCAs. That number decreased to 128 cases in 2007, 55 in 2008, and 6 in 2009 (through September).

While three GBCAs had been associated with numerous cases of NSF, the other two – MultiHance (gadobenate dimeglumine) and ProHance (gadoteridol) ‑ have not. As of September 2009, a total of 382 reports of NSF had been associated with Omniscan (GE HealthCare), 195 with Magnevist (Bayer HealthCare), 35 with OptiMARK (Covidien), 1 with MultiHance (Bracco Diagnostics), and 0 with ProHance (Bracco Diagnostics). At last year’s meeting a majority of advisory committee members recommended that Omniscan and OptiMARK be contraindicated in patients with serious kidney dysfunction. There was less agreement on whether Magnevist should also be contraindicated.

The Food and Drug Administration on Sept. 9 required manufacturers of five gadolinium contrast agents to strengthen boxed warnings on their products to minimize the risk of nephrogenic systemic fibrosis in some patients with kidney dysfunction.

Three of the agents – Magnevist (gadopentetate dimeglumine), Omniscan (gadodiamide), and Optimark (gadoversetamide) – are now contraindicated in patients with acute kidney injury (AKI) or chronic, severe kidney disease. Severe kidney disease is marked by a glomerular filtration rate of less than 30 mL/min/1.73m².

In addition, the revised labeling recommends that healthcare professionals screen all patients being considered for any gadolinium-based contrast agent (GBCA) for AKI or chronic, severe kidney disease. GBCAs also should be avoided in patients suspected or known to have impaired drug elimination unless the diagnostic information obtained is essential and cannot be acquired without the use of a contrast agent.

It’s been known since at least 2006 that patients with AKI or chronic, severe kidney disease are at increased risk of developing nephrogenic systemic fibrosis (NSF). In 2007 the FDA issued its first boxed warning about the risk of NSF associated with GBCA use. That warning stated only that healthcare professionals should be aware of the possibility that some patients might develop NSF. The new warning adds the absolute contraindication for the use of the three agents in patients with AKI and chronic, severe kidney disease.

The earlier boxed warning appears to have had the effect of reducing the incidence of NSF, according to one FDA official. Late last year, at a joint meeting of the FDA’s Cardiovascular and Renal Drugs and Drug Safety and Risk Management advisory committees, Dr. James Kaiser of the agency’s office of surveillance and epidemiology noted that in 2006 there were 194 cases of NSF associated with GBCAs. That number decreased to 128 cases in 2007, 55 in 2008, and 6 in 2009 (through September).

While three GBCAs had been associated with numerous cases of NSF, the other two – MultiHance (gadobenate dimeglumine) and ProHance (gadoteridol) ‑ have not. As of September 2009, a total of 382 reports of NSF had been associated with Omniscan (GE HealthCare), 195 with Magnevist (Bayer HealthCare), 35 with OptiMARK (Covidien), 1 with MultiHance (Bracco Diagnostics), and 0 with ProHance (Bracco Diagnostics). At last year’s meeting a majority of advisory committee members recommended that Omniscan and OptiMARK be contraindicated in patients with serious kidney dysfunction. There was less agreement on whether Magnevist should also be contraindicated.

The Food and Drug Administration on Sept. 9 required manufacturers of five gadolinium contrast agents to strengthen boxed warnings on their products to minimize the risk of nephrogenic systemic fibrosis in some patients with kidney dysfunction.

Three of the agents – Magnevist (gadopentetate dimeglumine), Omniscan (gadodiamide), and Optimark (gadoversetamide) – are now contraindicated in patients with acute kidney injury (AKI) or chronic, severe kidney disease. Severe kidney disease is marked by a glomerular filtration rate of less than 30 mL/min/1.73m².

In addition, the revised labeling recommends that healthcare professionals screen all patients being considered for any gadolinium-based contrast agent (GBCA) for AKI or chronic, severe kidney disease. GBCAs also should be avoided in patients suspected or known to have impaired drug elimination unless the diagnostic information obtained is essential and cannot be acquired without the use of a contrast agent.

It’s been known since at least 2006 that patients with AKI or chronic, severe kidney disease are at increased risk of developing nephrogenic systemic fibrosis (NSF). In 2007 the FDA issued its first boxed warning about the risk of NSF associated with GBCA use. That warning stated only that healthcare professionals should be aware of the possibility that some patients might develop NSF. The new warning adds the absolute contraindication for the use of the three agents in patients with AKI and chronic, severe kidney disease.

The earlier boxed warning appears to have had the effect of reducing the incidence of NSF, according to one FDA official. Late last year, at a joint meeting of the FDA’s Cardiovascular and Renal Drugs and Drug Safety and Risk Management advisory committees, Dr. James Kaiser of the agency’s office of surveillance and epidemiology noted that in 2006 there were 194 cases of NSF associated with GBCAs. That number decreased to 128 cases in 2007, 55 in 2008, and 6 in 2009 (through September).

While three GBCAs had been associated with numerous cases of NSF, the other two – MultiHance (gadobenate dimeglumine) and ProHance (gadoteridol) ‑ have not. As of September 2009, a total of 382 reports of NSF had been associated with Omniscan (GE HealthCare), 195 with Magnevist (Bayer HealthCare), 35 with OptiMARK (Covidien), 1 with MultiHance (Bracco Diagnostics), and 0 with ProHance (Bracco Diagnostics). At last year’s meeting a majority of advisory committee members recommended that Omniscan and OptiMARK be contraindicated in patients with serious kidney dysfunction. There was less agreement on whether Magnevist should also be contraindicated.

The Food and Drug Administration on Sept. 9 required manufacturers of five gadolinium contrast agents to strengthen boxed warnings on their products to minimize the risk of nephrogenic systemic fibrosis in some patients with kidney dysfunction.

Three of the agents – Magnevist (gadopentetate dimeglumine), Omniscan (gadodiamide), and Optimark (gadoversetamide) – are now contraindicated in patients with acute kidney injury (AKI) or chronic, severe kidney disease. Severe kidney disease is marked by a glomerular filtration rate of less than 30 mL/min/1.73m².

In addition, the revised labeling recommends that healthcare professionals screen all patients being considered for any gadolinium-based contrast agent (GBCA) for AKI or chronic, severe kidney disease. GBCAs also should be avoided in patients suspected or known to have impaired drug elimination unless the diagnostic information obtained is essential and cannot be acquired without the use of a contrast agent.

It’s been known since at least 2006 that patients with AKI or chronic, severe kidney disease are at increased risk of developing nephrogenic systemic fibrosis (NSF). In 2007 the FDA issued its first boxed warning about the risk of NSF associated with GBCA use. That warning stated only that healthcare professionals should be aware of the possibility that some patients might develop NSF. The new warning adds the absolute contraindication for the use of the three agents in patients with AKI and chronic, severe kidney disease.

The earlier boxed warning appears to have had the effect of reducing the incidence of NSF, according to one FDA official. Late last year, at a joint meeting of the FDA’s Cardiovascular and Renal Drugs and Drug Safety and Risk Management advisory committees, Dr. James Kaiser of the agency’s office of surveillance and epidemiology noted that in 2006 there were 194 cases of NSF associated with GBCAs. That number decreased to 128 cases in 2007, 55 in 2008, and 6 in 2009 (through September).

While three GBCAs had been associated with numerous cases of NSF, the other two – MultiHance (gadobenate dimeglumine) and ProHance (gadoteridol) ‑ have not. As of September 2009, a total of 382 reports of NSF had been associated with Omniscan (GE HealthCare), 195 with Magnevist (Bayer HealthCare), 35 with OptiMARK (Covidien), 1 with MultiHance (Bracco Diagnostics), and 0 with ProHance (Bracco Diagnostics). At last year’s meeting a majority of advisory committee members recommended that Omniscan and OptiMARK be contraindicated in patients with serious kidney dysfunction. There was less agreement on whether Magnevist should also be contraindicated.

The Food and Drug Administration on Sept. 9 required manufacturers of five gadolinium contrast agents to strengthen boxed warnings on their products to minimize the risk of nephrogenic systemic fibrosis in some patients with kidney dysfunction.

Three of the agents – Magnevist (gadopentetate dimeglumine), Omniscan (gadodiamide), and Optimark (gadoversetamide) – are now contraindicated in patients with acute kidney injury (AKI) or chronic, severe kidney disease. Severe kidney disease is marked by a glomerular filtration rate of less than 30 mL/min/1.73m².

In addition, the revised labeling recommends that healthcare professionals screen all patients being considered for any gadolinium-based contrast agent (GBCA) for AKI or chronic, severe kidney disease. GBCAs also should be avoided in patients suspected or known to have impaired drug elimination unless the diagnostic information obtained is essential and cannot be acquired without the use of a contrast agent.

It’s been known since at least 2006 that patients with AKI or chronic, severe kidney disease are at increased risk of developing nephrogenic systemic fibrosis (NSF). In 2007 the FDA issued its first boxed warning about the risk of NSF associated with GBCA use. That warning stated only that healthcare professionals should be aware of the possibility that some patients might develop NSF. The new warning adds the absolute contraindication for the use of the three agents in patients with AKI and chronic, severe kidney disease.

The earlier boxed warning appears to have had the effect of reducing the incidence of NSF, according to one FDA official. Late last year, at a joint meeting of the FDA’s Cardiovascular and Renal Drugs and Drug Safety and Risk Management advisory committees, Dr. James Kaiser of the agency’s office of surveillance and epidemiology noted that in 2006 there were 194 cases of NSF associated with GBCAs. That number decreased to 128 cases in 2007, 55 in 2008, and 6 in 2009 (through September).

While three GBCAs had been associated with numerous cases of NSF, the other two – MultiHance (gadobenate dimeglumine) and ProHance (gadoteridol) ‑ have not. As of September 2009, a total of 382 reports of NSF had been associated with Omniscan (GE HealthCare), 195 with Magnevist (Bayer HealthCare), 35 with OptiMARK (Covidien), 1 with MultiHance (Bracco Diagnostics), and 0 with ProHance (Bracco Diagnostics). At last year’s meeting a majority of advisory committee members recommended that Omniscan and OptiMARK be contraindicated in patients with serious kidney dysfunction. There was less agreement on whether Magnevist should also be contraindicated.

Smoking rates, which declined precipitously in the United States from 1964 to 2004, have remained virtually unchanged since then, according to data from the 2009 National Health Interview Survey. In 2009, 20.6% of adult Americans smoked cigarettes, compared with 20.9% of Americans in 2005, a difference that was not statistically significant.

© PhotoDisc

On the other hand, data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) demonstrated a significant drop in the proportion of nonsmoking Americans aged 3 years and above with detectable levels of serum cotinine, an indication of exposure to secondhand smoke. That rate fell from 52.5% in the 1999-2000 survey to 40.1% in the 2007-2008 survey.

Both studies appeared in the Sept. 7 issue of the Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention (MMWR 2010;59:1-6 and 7-12).

In announcing the results at a press briefing today, Dr. Thomas R. Frieden, director of the CDC, said that both the tobacco industry and federal, state, and local governments bear the blame for the failure of smoking rates to decline. “The industry has gotten even better at sidestepping laws designed to get people to stop smoking,” he said. “They ensure that every cigarette they sell delivers nicotine quickly and efficiently to keep people addicted.”

In addition, the industry has found ways to sidestep regulations banning the sale of flavored cigarettes, which can encourage children to start smoking, Dr. Frieden said. And while tobacco companies are not permitted to market their products as having lower levels of tar and nicotine, “they continue to deceive smokers with color coding and other subtle and not-so-subtle ways of sending the message that some cigarettes are less deadly than others, when in fact all cigarettes kill equally,” he said.

Furthermore, “government is also not doing what it needs to reduce smoking,” he charged. “Comprehensive, evidence-based programs are not being widely implemented. Last year, states took in about $25 billion from tobacco taxes and the [Tobacco] Master Settlement Agreement but spent only about $700 million – about 3 cents on every dollar [on tobacco control]. By 2015, if all states funded tobacco control at the CDC recommended level – 15 cents on the dollar of tobacco revenue – there would be an estimated 5 million fewer smokers in this country and that would prevent at least 1 million deaths in the future.”

While the NHANES study did find significant overall declines in the proportion of nonsmokers with detectable levels of serum cotinine, that decline did not extend to children who live with a smoker. Virtually all such children – 98.3% – had detectable cotinine levels, compared with 39.9% of children not living with someone who smoked inside the home. For nonsmoking adults, the corresponding figures were 93.4% and 33.4%.

The first study used data collected in 2009 by the National Health Interview Survey, which involved telephone interviews with 27,603 Americans aged 18 years and older. The second study used NHANES data collected from a nationally representative sample of 30,451 nonsmoking Americans aged 3 years and older.

In answer to a reporter’s question, Dr. Frieden said, “There’s a lot that doctors can do. Doctors can ask every patient if they smoke, and they can advise every patient who does to quit and quit today, and, if not today, then to set a date when they can quit. [Physicians] should also know what services are available in their community to help smokers quit and refer people to quit [telephone] lines. With the Affordable Care Act, tobacco cessation medication will be free of charge, so it should be easier for people to quit smoking in the future.”

No disclosures were reported.

Smoking rates, which declined precipitously in the United States from 1964 to 2004, have remained virtually unchanged since then, according to data from the 2009 National Health Interview Survey. In 2009, 20.6% of adult Americans smoked cigarettes, compared with 20.9% of Americans in 2005, a difference that was not statistically significant.

© PhotoDisc

On the other hand, data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) demonstrated a significant drop in the proportion of nonsmoking Americans aged 3 years and above with detectable levels of serum cotinine, an indication of exposure to secondhand smoke. That rate fell from 52.5% in the 1999-2000 survey to 40.1% in the 2007-2008 survey.

Both studies appeared in the Sept. 7 issue of the Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention (MMWR 2010;59:1-6 and 7-12).

In announcing the results at a press briefing today, Dr. Thomas R. Frieden, director of the CDC, said that both the tobacco industry and federal, state, and local governments bear the blame for the failure of smoking rates to decline. “The industry has gotten even better at sidestepping laws designed to get people to stop smoking,” he said. “They ensure that every cigarette they sell delivers nicotine quickly and efficiently to keep people addicted.”

In addition, the industry has found ways to sidestep regulations banning the sale of flavored cigarettes, which can encourage children to start smoking, Dr. Frieden said. And while tobacco companies are not permitted to market their products as having lower levels of tar and nicotine, “they continue to deceive smokers with color coding and other subtle and not-so-subtle ways of sending the message that some cigarettes are less deadly than others, when in fact all cigarettes kill equally,” he said.

Furthermore, “government is also not doing what it needs to reduce smoking,” he charged. “Comprehensive, evidence-based programs are not being widely implemented. Last year, states took in about $25 billion from tobacco taxes and the [Tobacco] Master Settlement Agreement but spent only about $700 million – about 3 cents on every dollar [on tobacco control]. By 2015, if all states funded tobacco control at the CDC recommended level – 15 cents on the dollar of tobacco revenue – there would be an estimated 5 million fewer smokers in this country and that would prevent at least 1 million deaths in the future.”

While the NHANES study did find significant overall declines in the proportion of nonsmokers with detectable levels of serum cotinine, that decline did not extend to children who live with a smoker. Virtually all such children – 98.3% – had detectable cotinine levels, compared with 39.9% of children not living with someone who smoked inside the home. For nonsmoking adults, the corresponding figures were 93.4% and 33.4%.

The first study used data collected in 2009 by the National Health Interview Survey, which involved telephone interviews with 27,603 Americans aged 18 years and older. The second study used NHANES data collected from a nationally representative sample of 30,451 nonsmoking Americans aged 3 years and older.

In answer to a reporter’s question, Dr. Frieden said, “There’s a lot that doctors can do. Doctors can ask every patient if they smoke, and they can advise every patient who does to quit and quit today, and, if not today, then to set a date when they can quit. [Physicians] should also know what services are available in their community to help smokers quit and refer people to quit [telephone] lines. With the Affordable Care Act, tobacco cessation medication will be free of charge, so it should be easier for people to quit smoking in the future.”

No disclosures were reported.

Smoking rates, which declined precipitously in the United States from 1964 to 2004, have remained virtually unchanged since then, according to data from the 2009 National Health Interview Survey. In 2009, 20.6% of adult Americans smoked cigarettes, compared with 20.9% of Americans in 2005, a difference that was not statistically significant.

© PhotoDisc

On the other hand, data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) demonstrated a significant drop in the proportion of nonsmoking Americans aged 3 years and above with detectable levels of serum cotinine, an indication of exposure to secondhand smoke. That rate fell from 52.5% in the 1999-2000 survey to 40.1% in the 2007-2008 survey.

Both studies appeared in the Sept. 7 issue of the Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention (MMWR 2010;59:1-6 and 7-12).

In announcing the results at a press briefing today, Dr. Thomas R. Frieden, director of the CDC, said that both the tobacco industry and federal, state, and local governments bear the blame for the failure of smoking rates to decline. “The industry has gotten even better at sidestepping laws designed to get people to stop smoking,” he said. “They ensure that every cigarette they sell delivers nicotine quickly and efficiently to keep people addicted.”

In addition, the industry has found ways to sidestep regulations banning the sale of flavored cigarettes, which can encourage children to start smoking, Dr. Frieden said. And while tobacco companies are not permitted to market their products as having lower levels of tar and nicotine, “they continue to deceive smokers with color coding and other subtle and not-so-subtle ways of sending the message that some cigarettes are less deadly than others, when in fact all cigarettes kill equally,” he said.

Furthermore, “government is also not doing what it needs to reduce smoking,” he charged. “Comprehensive, evidence-based programs are not being widely implemented. Last year, states took in about $25 billion from tobacco taxes and the [Tobacco] Master Settlement Agreement but spent only about $700 million – about 3 cents on every dollar [on tobacco control]. By 2015, if all states funded tobacco control at the CDC recommended level – 15 cents on the dollar of tobacco revenue – there would be an estimated 5 million fewer smokers in this country and that would prevent at least 1 million deaths in the future.”

While the NHANES study did find significant overall declines in the proportion of nonsmokers with detectable levels of serum cotinine, that decline did not extend to children who live with a smoker. Virtually all such children – 98.3% – had detectable cotinine levels, compared with 39.9% of children not living with someone who smoked inside the home. For nonsmoking adults, the corresponding figures were 93.4% and 33.4%.

The first study used data collected in 2009 by the National Health Interview Survey, which involved telephone interviews with 27,603 Americans aged 18 years and older. The second study used NHANES data collected from a nationally representative sample of 30,451 nonsmoking Americans aged 3 years and older.

In answer to a reporter’s question, Dr. Frieden said, “There’s a lot that doctors can do. Doctors can ask every patient if they smoke, and they can advise every patient who does to quit and quit today, and, if not today, then to set a date when they can quit. [Physicians] should also know what services are available in their community to help smokers quit and refer people to quit [telephone] lines. With the Affordable Care Act, tobacco cessation medication will be free of charge, so it should be easier for people to quit smoking in the future.”

No disclosures were reported.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their "meaningful use." The survey, whose results were published online by Health affairs, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 "core" objectives and an additional 10 "menu" criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey's response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. "Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection," they wrote.

In addition, they noted, "If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion."

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

"Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer," they wrote.

The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their "meaningful use." The survey, whose results were published online by Health affairs, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 "core" objectives and an additional 10 "menu" criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey's response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. "Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection," they wrote.

In addition, they noted, "If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion."

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

"Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer," they wrote.

The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their "meaningful use." The survey, whose results were published online by Health affairs, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 "core" objectives and an additional 10 "menu" criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey's response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. "Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection," they wrote.

In addition, they noted, "If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion."

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

"Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer," they wrote.

The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.