Santa Cruz may find itself on the forefront of the health IT effort

Late last month, Santa Cruz County applied to be a Beacon Community in the federal government’s efforts to improve health internet technology. The Beacon Community program will distribute funds from the American Recovery and Reinvestment Act (the stimulus) to fifteen communities that already have invested in a high level of health IT infrastructure.Wired for Health Information Technology in Santa Cruz County

In Santa Cruz County, some 70% of physicians are already using electronic health records (EHRs), accounting for over half of the counties residents. Santa Cruz County health clinics, Sutter/Palo Alto Medical Foundation, Physicians Medical Group and Dominican Hospital make up the majority of doctors using EHRs in their practices, making care coordination between doctors within these systems more streamlined. Rama Khalsa, Santa Cruz County Health Services Director and author of the SCC grant, says the funds from the Beacon Community program would be used to make sharing across the various EHR programs being used easier and more secure.

Santa Cruz County started making the switch to EHRs early. Beginning in the mid-1990s, Dominican Hospital worked with a local software company to develop an early physician messaging system. In 2003, SCC Health Services Agency adopted EHRs in their clinics.

EHRs are essentially digital medical charts. They take the place of paper charts, but also offer added functionality. Khalsa says that the increased functionality and digitized medical records can lead to:

• Improved quality of care by allowing ambulatory, emergency and urgent care givers to make more informed decisions for patients who are unable to provide a medical history and complete list of medicines they take.
• Increased patient engagement in their own care. Because patients can see their records, they can see improvements or deterioration in health. EHR systems allow doctors to graph and track health outcomes to help patients better understand their care.
• Reduced human error by automatically checking for contra-indicated medicines and by built-in reminders for doctors to do things like checking diabetics’ feet or following up on lab results from previous visits.
• Smoother transitions between care facilities like hospitals, nursing homes and home health care organizations. These transitions represent the most risk for a patient’s health.
• Improved ability for analysis of community health. Because EHR systems also function like databases, it makes it easier to track disease vectors and analyze health outcomes for specific treatments. It also allows health agencies to contact patients at risk in the case of drug recalls.

Federal regulations mandate a high level of encryption be installed into HER systems to keep patient medical information secure. They also mandate that patient billing information be separated from health information. Khalsa says that EHRs actually makes patient information safer than paper records ever could.

While the Beacon Community program grant that Santa Cruz County’s Health Services Agency has applied for is a targeted grant that aims to improve inter-system electronic record exchanges, Rama Khalsa says that improving health IT infrastructure makes it possible to change the way that health care is done in this country.

Interviews with Sam Farr on the health care bills and their importance in the Monterey Bay area

Sam Far on hopes for a fix to low Medicare reimbursement in Monterey Bay area

Sam Farr discusses tradeoffs in the health care bills

Sam Farr reviews the State of the Union address and hopes for a health care overhaul

Elderday, adult day health care breathe easier

California is one of only a few states that covers adult day health care programs for Medicaid recipients. Adult day health care centers provide daytime supervision for people with cognitive, physical and social impairments. They also administer a variety of prescribed therapies. Since May, supporters of adult day health care have been rallying—first against a cut of all Medi-Cal funding. More recently, they rallied against a proposal to cap the number of days Medi-Cal recipients would be able to attend these programs. From Elderday, an adult day health care program in Santa Cruz, Christopher Connelly has this story.

Elderday is the only adult day health care program in Santa Cruz County. The center has about 150 regular paritipants over the age 50 with a variety of physical, cognitive and social impairments. A typical day begins at 8 or 9 in the morning, when the participants are picked up from their homes by bus and driven to the facility.

Elderday does everything that any adult daycare center does, providing seniors a chance to socialize with each other and with staff members, a variety of activities to keep them sharp and meals and supervision while their families and caretakers work during the day. But what separates adult daycare programs from adult day health care centers is the range of therapeutic and health services that are offered at programs like elderday. They provide physical and occupational therapy, case management, mental health services, excercize, transportation, podiatry and nursing.

Sheri Anselmi is the director of Elderday. She says that in California, there are over 33,000 participants at around 330 adult day health care facilities. While most participants are seniors, the facilities can serve adults of any age.

Starting last spring, anselmi and other adult day health care supporters have been fighting to keep Medi-Cal funding intact. She says that the battle began in may, when Governor Schwarzenegger proposed to cut all Medi-Cal funding of adult day health care to help balance the budget. Although a total cut didn’t gain traction, the idea was revised. In July, lawmakers and the governor passed the budget revision package that would scale back the number of days Medi-Cal would pay for—from five to three days per week.

Anselmi says although it was not a total cut, the effect of the cap on her facility would have been severe.

A law suit was filed in august on behalf of three women who attend adult day programs paid for by Medi-Cal five days a week. They argued that the cuts violated the Americans with Disabilities Act and federal Medicaid law because it failed to provide alternative care and was therefore a cut in medically necessary services. They said that the cap would lead to institutionalization in nursing homes in most cases.

The case was heard on September 9^th in federal district court in Oakland.

On September 10^th, Judge Sandra Armstrong ordered an indefinite suspension of the cap, saying that scaling back services would cause irreparable and immanent harm to the people who rely on them, and that the state was obligated to provide alternative services that would prevent insititutionalization.

The Health Effects of State Budget Cuts

September 2009 Health Dialogues

www.HealthDialogues.org

As Congress considers a major overhaul of the U.S. health care system, Health Dialogues examines how the new state budget will affect health care closer to home. Will kids in low income families be able to get basic services? What about drug treatment programs mandated by Proposition 36? And how may where you live affect the care you’ll get?

The Value of Community Health Clinics

Many unemployed Californians and the working poor often turn to the nearly 800 community health centers throughout the state when they need medical attention. Host Scott Shafer visits the Russian River Health Center in Guerneville, in rural Sonoma County, to see how the state budget cuts have affected staff and patients.

Proposition 36 Coping With Significant Cuts

California’s landmark Proposition 36 was intended to send drug users into treatment, rather than prison. The current budget slashed Prop. 36 funding almost in half. That complicates things for the Superior Court in Santa Clara County, where Judge Stephen Manley oversees Proposition 36 cases. Guest: Honorable Judge Stephen Manley, Santa Clara County Superior Court judge.

Map of Rural Health Clinics

For more information, visit www.HealthDialogues.org

Health Dialogues Looks at Food Safety

Photo by Shuka Kalantari

Recent scares over tainted peanut butter and spinach exposed holes in our system of protecting the food supply. President Obama called for tougher food safety measures, and in May of this year launched a Food Safety Working Group to update the system of food safety in America.

Health Dialogues host Scott Shafer begins by interviewing two voices familiar with food safety at the federal level: Michael Taylor, the newly appointed Senior Advisor to the Commissioner at the Food and Drug Administration, and Dr. David Acheson, who, until the end of July, worked as Associate Commissioner for Foods at the Food and Drug Administration. The program also looks urban gardening safety and lead as well as the dangers of sport fishing.

Health Dialogues also visits two grocery stores in San Francisco’s Outer Mission with food inspector Sheldon Lew to see what the food inspection process looks like.  Lew talks about what red flags he looks for during food inspections.Visit www.HealthDialogues.org to watch an audio slideshow of the inspection.

Also, check out an audio slideshow of foods imported into the United States with FDA inspectors at the Los Angeles Port of San Pedro.