National Association for Medical Direction of Respiratory Care (NAMDRC): Annual Meeting

LAS VEGAS – The evidence supporting use of extracorporeal membrane oxygenation for treating adult patients with severe hypoxic lung failure remains uncompelling, according to Dr. Alan H. Morris.

He particularly advised against widespread use of extracorporeal membrane oxygenation (ECMO) in patients who have severe acute respiratory distress syndrome secondary to H1N1 influenza infection, as there is also no evidence that H1N1 patients treated with ECMO had better outcomes than those treated with standard ventilation support.

"We need results from a credible randomized controlled trial to define the conditions surrounding ECMO, before ECMO becomes a routine therapy option," said Dr. Morris, a pulmonologist and professor of medicine at the University of Utah and Intermountain Health Medical Center in Salt Lake City.

"There are indications and applications of extracorporeal support that are straightforward," such as when it is used intraoperatively, he said. But for patients with severe hypoxic lung failure, "I do not see compelling evidence that extracorporeal support is followed by more favorable outcomes than other approaches that are used," he said in an interview. "The evidence from the H1N1 novel influenza epidemic indicates to me that survival appears to be roughly the same with or without extracorporeal support," he added. "We do not offer ECMO as treatment for adult patients with severe hypoxic lung failure in my hospital."

The only two studies that examined the efficacy of ECMO in rigorously controlled clinical trials, published as reports in 1979 and in 1994, both failed to show that ECMO improved patient survival, he noted (JAMA 1979;242:2193-6; Am. J. Respir. Crit. Care Med. 1994;149:295-305). More recent results from a British multicenter randomized trial with 180 adults with severe respiratory failure claimed to show evidence that patient survival with ECMO surpassed survival with usual care (Lancet 2009;374:1351-63). But the newer study had the flaw of failing to define the usual care received by the control patients. In addition, the control patients were distributed to many centers, while all the ECMO patients received their treatment at one center, Dr. Morris said. The conventional ventilation that control patients received could be whatever their attending intensivist thought appropriate.

"How does a clinician know which patients will benefit [from ECMO] without knowing what was conventional treatment?" he said.

To assess the impact of ECMO in patients with acute respiratory distress secondary to H1N1 infection, Dr. Morris summarized data reported on 150 patients in a University of Michigan registry; 14 patients seen in Salt Lake County, Utah, and reported last year in a paper at the American Thoracic Society; a series of 68 patients reported from Australia and New Zealand (JAMA 2009;302:1888-95); and 896 U.S. patients entered into a registry of the National Heart, Lung, and Blood Institute during April 2009 to April 2010. These data showed a consistent pattern of no improved survival with ECMO treatment in H1N1 patients, compared with H1N1 patients who did not receive ECMO, Dr. Morris said.

He also expressed concern that a well-designed study to compare modern ECMO with other ventilation support methods would be a challenge. A major problem is that the physicians "who have ECMO skills are convinced of its efficacy. Those who do ECMO don’t believe that better testing is needed," Dr. Morris said.

He reported having no relevant financial disclosures.

LAS VEGAS – The evidence supporting use of extracorporeal membrane oxygenation for treating adult patients with severe hypoxic lung failure remains uncompelling, according to Dr. Alan H. Morris.

He particularly advised against widespread use of extracorporeal membrane oxygenation (ECMO) in patients who have severe acute respiratory distress syndrome secondary to H1N1 influenza infection, as there is also no evidence that H1N1 patients treated with ECMO had better outcomes than those treated with standard ventilation support.

"We need results from a credible randomized controlled trial to define the conditions surrounding ECMO, before ECMO becomes a routine therapy option," said Dr. Morris, a pulmonologist and professor of medicine at the University of Utah and Intermountain Health Medical Center in Salt Lake City.

"There are indications and applications of extracorporeal support that are straightforward," such as when it is used intraoperatively, he said. But for patients with severe hypoxic lung failure, "I do not see compelling evidence that extracorporeal support is followed by more favorable outcomes than other approaches that are used," he said in an interview. "The evidence from the H1N1 novel influenza epidemic indicates to me that survival appears to be roughly the same with or without extracorporeal support," he added. "We do not offer ECMO as treatment for adult patients with severe hypoxic lung failure in my hospital."

The only two studies that examined the efficacy of ECMO in rigorously controlled clinical trials, published as reports in 1979 and in 1994, both failed to show that ECMO improved patient survival, he noted (JAMA 1979;242:2193-6; Am. J. Respir. Crit. Care Med. 1994;149:295-305). More recent results from a British multicenter randomized trial with 180 adults with severe respiratory failure claimed to show evidence that patient survival with ECMO surpassed survival with usual care (Lancet 2009;374:1351-63). But the newer study had the flaw of failing to define the usual care received by the control patients. In addition, the control patients were distributed to many centers, while all the ECMO patients received their treatment at one center, Dr. Morris said. The conventional ventilation that control patients received could be whatever their attending intensivist thought appropriate.

"How does a clinician know which patients will benefit [from ECMO] without knowing what was conventional treatment?" he said.

To assess the impact of ECMO in patients with acute respiratory distress secondary to H1N1 infection, Dr. Morris summarized data reported on 150 patients in a University of Michigan registry; 14 patients seen in Salt Lake County, Utah, and reported last year in a paper at the American Thoracic Society; a series of 68 patients reported from Australia and New Zealand (JAMA 2009;302:1888-95); and 896 U.S. patients entered into a registry of the National Heart, Lung, and Blood Institute during April 2009 to April 2010. These data showed a consistent pattern of no improved survival with ECMO treatment in H1N1 patients, compared with H1N1 patients who did not receive ECMO, Dr. Morris said.

He also expressed concern that a well-designed study to compare modern ECMO with other ventilation support methods would be a challenge. A major problem is that the physicians "who have ECMO skills are convinced of its efficacy. Those who do ECMO don’t believe that better testing is needed," Dr. Morris said.

He reported having no relevant financial disclosures.

LAS VEGAS – The evidence supporting use of extracorporeal membrane oxygenation for treating adult patients with severe hypoxic lung failure remains uncompelling, according to Dr. Alan H. Morris.

He particularly advised against widespread use of extracorporeal membrane oxygenation (ECMO) in patients who have severe acute respiratory distress syndrome secondary to H1N1 influenza infection, as there is also no evidence that H1N1 patients treated with ECMO had better outcomes than those treated with standard ventilation support.

"We need results from a credible randomized controlled trial to define the conditions surrounding ECMO, before ECMO becomes a routine therapy option," said Dr. Morris, a pulmonologist and professor of medicine at the University of Utah and Intermountain Health Medical Center in Salt Lake City.

"There are indications and applications of extracorporeal support that are straightforward," such as when it is used intraoperatively, he said. But for patients with severe hypoxic lung failure, "I do not see compelling evidence that extracorporeal support is followed by more favorable outcomes than other approaches that are used," he said in an interview. "The evidence from the H1N1 novel influenza epidemic indicates to me that survival appears to be roughly the same with or without extracorporeal support," he added. "We do not offer ECMO as treatment for adult patients with severe hypoxic lung failure in my hospital."

The only two studies that examined the efficacy of ECMO in rigorously controlled clinical trials, published as reports in 1979 and in 1994, both failed to show that ECMO improved patient survival, he noted (JAMA 1979;242:2193-6; Am. J. Respir. Crit. Care Med. 1994;149:295-305). More recent results from a British multicenter randomized trial with 180 adults with severe respiratory failure claimed to show evidence that patient survival with ECMO surpassed survival with usual care (Lancet 2009;374:1351-63). But the newer study had the flaw of failing to define the usual care received by the control patients. In addition, the control patients were distributed to many centers, while all the ECMO patients received their treatment at one center, Dr. Morris said. The conventional ventilation that control patients received could be whatever their attending intensivist thought appropriate.

"How does a clinician know which patients will benefit [from ECMO] without knowing what was conventional treatment?" he said.

To assess the impact of ECMO in patients with acute respiratory distress secondary to H1N1 infection, Dr. Morris summarized data reported on 150 patients in a University of Michigan registry; 14 patients seen in Salt Lake County, Utah, and reported last year in a paper at the American Thoracic Society; a series of 68 patients reported from Australia and New Zealand (JAMA 2009;302:1888-95); and 896 U.S. patients entered into a registry of the National Heart, Lung, and Blood Institute during April 2009 to April 2010. These data showed a consistent pattern of no improved survival with ECMO treatment in H1N1 patients, compared with H1N1 patients who did not receive ECMO, Dr. Morris said.

He also expressed concern that a well-designed study to compare modern ECMO with other ventilation support methods would be a challenge. A major problem is that the physicians "who have ECMO skills are convinced of its efficacy. Those who do ECMO don’t believe that better testing is needed," Dr. Morris said.

He reported having no relevant financial disclosures.

LAS VEGAS – The evidence supporting use of extracorporeal membrane oxygenation for treating adult patients with severe hypoxic lung failure remains uncompelling, according to Dr. Alan H. Morris.

He particularly advised against widespread use of extracorporeal membrane oxygenation (ECMO) in patients who have severe acute respiratory distress syndrome secondary to H1N1 influenza infection, as there is also no evidence that H1N1 patients treated with ECMO had better outcomes than those treated with standard ventilation support.

"We need results from a credible randomized controlled trial to define the conditions surrounding ECMO, before ECMO becomes a routine therapy option," said Dr. Morris, a pulmonologist and professor of medicine at the University of Utah and Intermountain Health Medical Center in Salt Lake City.

"There are indications and applications of extracorporeal support that are straightforward," such as when it is used intraoperatively, he said. But for patients with severe hypoxic lung failure, "I do not see compelling evidence that extracorporeal support is followed by more favorable outcomes than other approaches that are used," he said in an interview. "The evidence from the H1N1 novel influenza epidemic indicates to me that survival appears to be roughly the same with or without extracorporeal support," he added. "We do not offer ECMO as treatment for adult patients with severe hypoxic lung failure in my hospital."

The only two studies that examined the efficacy of ECMO in rigorously controlled clinical trials, published as reports in 1979 and in 1994, both failed to show that ECMO improved patient survival, he noted (JAMA 1979;242:2193-6; Am. J. Respir. Crit. Care Med. 1994;149:295-305). More recent results from a British multicenter randomized trial with 180 adults with severe respiratory failure claimed to show evidence that patient survival with ECMO surpassed survival with usual care (Lancet 2009;374:1351-63). But the newer study had the flaw of failing to define the usual care received by the control patients. In addition, the control patients were distributed to many centers, while all the ECMO patients received their treatment at one center, Dr. Morris said. The conventional ventilation that control patients received could be whatever their attending intensivist thought appropriate.

"How does a clinician know which patients will benefit [from ECMO] without knowing what was conventional treatment?" he said.

To assess the impact of ECMO in patients with acute respiratory distress secondary to H1N1 infection, Dr. Morris summarized data reported on 150 patients in a University of Michigan registry; 14 patients seen in Salt Lake County, Utah, and reported last year in a paper at the American Thoracic Society; a series of 68 patients reported from Australia and New Zealand (JAMA 2009;302:1888-95); and 896 U.S. patients entered into a registry of the National Heart, Lung, and Blood Institute during April 2009 to April 2010. These data showed a consistent pattern of no improved survival with ECMO treatment in H1N1 patients, compared with H1N1 patients who did not receive ECMO, Dr. Morris said.

He also expressed concern that a well-designed study to compare modern ECMO with other ventilation support methods would be a challenge. A major problem is that the physicians "who have ECMO skills are convinced of its efficacy. Those who do ECMO don’t believe that better testing is needed," Dr. Morris said.

He reported having no relevant financial disclosures.

LAS VEGAS – The evidence supporting use of extracorporeal membrane oxygenation for treating adult patients with severe hypoxic lung failure remains uncompelling, according to Dr. Alan H. Morris.

He particularly advised against widespread use of extracorporeal membrane oxygenation (ECMO) in patients who have severe acute respiratory distress syndrome secondary to H1N1 influenza infection, as there is also no evidence that H1N1 patients treated with ECMO had better outcomes than those treated with standard ventilation support.

"We need results from a credible randomized controlled trial to define the conditions surrounding ECMO, before ECMO becomes a routine therapy option," said Dr. Morris, a pulmonologist and professor of medicine at the University of Utah and Intermountain Health Medical Center in Salt Lake City.

"There are indications and applications of extracorporeal support that are straightforward," such as when it is used intraoperatively, he said. But for patients with severe hypoxic lung failure, "I do not see compelling evidence that extracorporeal support is followed by more favorable outcomes than other approaches that are used," he said in an interview. "The evidence from the H1N1 novel influenza epidemic indicates to me that survival appears to be roughly the same with or without extracorporeal support," he added. "We do not offer ECMO as treatment for adult patients with severe hypoxic lung failure in my hospital."

The only two studies that examined the efficacy of ECMO in rigorously controlled clinical trials, published as reports in 1979 and in 1994, both failed to show that ECMO improved patient survival, he noted (JAMA 1979;242:2193-6; Am. J. Respir. Crit. Care Med. 1994;149:295-305). More recent results from a British multicenter randomized trial with 180 adults with severe respiratory failure claimed to show evidence that patient survival with ECMO surpassed survival with usual care (Lancet 2009;374:1351-63). But the newer study had the flaw of failing to define the usual care received by the control patients. In addition, the control patients were distributed to many centers, while all the ECMO patients received their treatment at one center, Dr. Morris said. The conventional ventilation that control patients received could be whatever their attending intensivist thought appropriate.

"How does a clinician know which patients will benefit [from ECMO] without knowing what was conventional treatment?" he said.

To assess the impact of ECMO in patients with acute respiratory distress secondary to H1N1 infection, Dr. Morris summarized data reported on 150 patients in a University of Michigan registry; 14 patients seen in Salt Lake County, Utah, and reported last year in a paper at the American Thoracic Society; a series of 68 patients reported from Australia and New Zealand (JAMA 2009;302:1888-95); and 896 U.S. patients entered into a registry of the National Heart, Lung, and Blood Institute during April 2009 to April 2010. These data showed a consistent pattern of no improved survival with ECMO treatment in H1N1 patients, compared with H1N1 patients who did not receive ECMO, Dr. Morris said.

He also expressed concern that a well-designed study to compare modern ECMO with other ventilation support methods would be a challenge. A major problem is that the physicians "who have ECMO skills are convinced of its efficacy. Those who do ECMO don’t believe that better testing is needed," Dr. Morris said.

He reported having no relevant financial disclosures.

LAS VEGAS – The evidence supporting use of extracorporeal membrane oxygenation for treating adult patients with severe hypoxic lung failure remains uncompelling, according to Dr. Alan H. Morris.

He particularly advised against widespread use of extracorporeal membrane oxygenation (ECMO) in patients who have severe acute respiratory distress syndrome secondary to H1N1 influenza infection, as there is also no evidence that H1N1 patients treated with ECMO had better outcomes than those treated with standard ventilation support.

"We need results from a credible randomized controlled trial to define the conditions surrounding ECMO, before ECMO becomes a routine therapy option," said Dr. Morris, a pulmonologist and professor of medicine at the University of Utah and Intermountain Health Medical Center in Salt Lake City.

"There are indications and applications of extracorporeal support that are straightforward," such as when it is used intraoperatively, he said. But for patients with severe hypoxic lung failure, "I do not see compelling evidence that extracorporeal support is followed by more favorable outcomes than other approaches that are used," he said in an interview. "The evidence from the H1N1 novel influenza epidemic indicates to me that survival appears to be roughly the same with or without extracorporeal support," he added. "We do not offer ECMO as treatment for adult patients with severe hypoxic lung failure in my hospital."

The only two studies that examined the efficacy of ECMO in rigorously controlled clinical trials, published as reports in 1979 and in 1994, both failed to show that ECMO improved patient survival, he noted (JAMA 1979;242:2193-6; Am. J. Respir. Crit. Care Med. 1994;149:295-305). More recent results from a British multicenter randomized trial with 180 adults with severe respiratory failure claimed to show evidence that patient survival with ECMO surpassed survival with usual care (Lancet 2009;374:1351-63). But the newer study had the flaw of failing to define the usual care received by the control patients. In addition, the control patients were distributed to many centers, while all the ECMO patients received their treatment at one center, Dr. Morris said. The conventional ventilation that control patients received could be whatever their attending intensivist thought appropriate.

"How does a clinician know which patients will benefit [from ECMO] without knowing what was conventional treatment?" he said.

To assess the impact of ECMO in patients with acute respiratory distress secondary to H1N1 infection, Dr. Morris summarized data reported on 150 patients in a University of Michigan registry; 14 patients seen in Salt Lake County, Utah, and reported last year in a paper at the American Thoracic Society; a series of 68 patients reported from Australia and New Zealand (JAMA 2009;302:1888-95); and 896 U.S. patients entered into a registry of the National Heart, Lung, and Blood Institute during April 2009 to April 2010. These data showed a consistent pattern of no improved survival with ECMO treatment in H1N1 patients, compared with H1N1 patients who did not receive ECMO, Dr. Morris said.

He also expressed concern that a well-designed study to compare modern ECMO with other ventilation support methods would be a challenge. A major problem is that the physicians "who have ECMO skills are convinced of its efficacy. Those who do ECMO don’t believe that better testing is needed," Dr. Morris said.

He reported having no relevant financial disclosures.

LAS VEGAS – The evidence supporting use of extracorporeal membrane oxygenation for treating adult patients with severe hypoxic lung failure remains uncompelling, according to Dr. Alan H. Morris.

He particularly advised against widespread use of extracorporeal membrane oxygenation (ECMO) in patients who have severe acute respiratory distress syndrome secondary to H1N1 influenza infection, as there is also no evidence that H1N1 patients treated with ECMO had better outcomes than those treated with standard ventilation support.

"We need results from a credible randomized controlled trial to define the conditions surrounding ECMO, before ECMO becomes a routine therapy option," said Dr. Morris, a pulmonologist and professor of medicine at the University of Utah and Intermountain Health Medical Center in Salt Lake City.

"There are indications and applications of extracorporeal support that are straightforward," such as when it is used intraoperatively, he said. But for patients with severe hypoxic lung failure, "I do not see compelling evidence that extracorporeal support is followed by more favorable outcomes than other approaches that are used," he said in an interview. "The evidence from the H1N1 novel influenza epidemic indicates to me that survival appears to be roughly the same with or without extracorporeal support," he added. "We do not offer ECMO as treatment for adult patients with severe hypoxic lung failure in my hospital."

The only two studies that examined the efficacy of ECMO in rigorously controlled clinical trials, published as reports in 1979 and in 1994, both failed to show that ECMO improved patient survival, he noted (JAMA 1979;242:2193-6; Am. J. Respir. Crit. Care Med. 1994;149:295-305). More recent results from a British multicenter randomized trial with 180 adults with severe respiratory failure claimed to show evidence that patient survival with ECMO surpassed survival with usual care (Lancet 2009;374:1351-63). But the newer study had the flaw of failing to define the usual care received by the control patients. In addition, the control patients were distributed to many centers, while all the ECMO patients received their treatment at one center, Dr. Morris said. The conventional ventilation that control patients received could be whatever their attending intensivist thought appropriate.

"How does a clinician know which patients will benefit [from ECMO] without knowing what was conventional treatment?" he said.

To assess the impact of ECMO in patients with acute respiratory distress secondary to H1N1 infection, Dr. Morris summarized data reported on 150 patients in a University of Michigan registry; 14 patients seen in Salt Lake County, Utah, and reported last year in a paper at the American Thoracic Society; a series of 68 patients reported from Australia and New Zealand (JAMA 2009;302:1888-95); and 896 U.S. patients entered into a registry of the National Heart, Lung, and Blood Institute during April 2009 to April 2010. These data showed a consistent pattern of no improved survival with ECMO treatment in H1N1 patients, compared with H1N1 patients who did not receive ECMO, Dr. Morris said.

He also expressed concern that a well-designed study to compare modern ECMO with other ventilation support methods would be a challenge. A major problem is that the physicians "who have ECMO skills are convinced of its efficacy. Those who do ECMO don’t believe that better testing is needed," Dr. Morris said.

He reported having no relevant financial disclosures.

LAS VEGAS – The evidence supporting use of extracorporeal membrane oxygenation for treating adult patients with severe hypoxic lung failure remains uncompelling, according to Dr. Alan H. Morris.

He particularly advised against widespread use of extracorporeal membrane oxygenation (ECMO) in patients who have severe acute respiratory distress syndrome secondary to H1N1 influenza infection, as there is also no evidence that H1N1 patients treated with ECMO had better outcomes than those treated with standard ventilation support.

"We need results from a credible randomized controlled trial to define the conditions surrounding ECMO, before ECMO becomes a routine therapy option," said Dr. Morris, a pulmonologist and professor of medicine at the University of Utah and Intermountain Health Medical Center in Salt Lake City.

"There are indications and applications of extracorporeal support that are straightforward," such as when it is used intraoperatively, he said. But for patients with severe hypoxic lung failure, "I do not see compelling evidence that extracorporeal support is followed by more favorable outcomes than other approaches that are used," he said in an interview. "The evidence from the H1N1 novel influenza epidemic indicates to me that survival appears to be roughly the same with or without extracorporeal support," he added. "We do not offer ECMO as treatment for adult patients with severe hypoxic lung failure in my hospital."

The only two studies that examined the efficacy of ECMO in rigorously controlled clinical trials, published as reports in 1979 and in 1994, both failed to show that ECMO improved patient survival, he noted (JAMA 1979;242:2193-6; Am. J. Respir. Crit. Care Med. 1994;149:295-305). More recent results from a British multicenter randomized trial with 180 adults with severe respiratory failure claimed to show evidence that patient survival with ECMO surpassed survival with usual care (Lancet 2009;374:1351-63). But the newer study had the flaw of failing to define the usual care received by the control patients. In addition, the control patients were distributed to many centers, while all the ECMO patients received their treatment at one center, Dr. Morris said. The conventional ventilation that control patients received could be whatever their attending intensivist thought appropriate.

"How does a clinician know which patients will benefit [from ECMO] without knowing what was conventional treatment?" he said.

To assess the impact of ECMO in patients with acute respiratory distress secondary to H1N1 infection, Dr. Morris summarized data reported on 150 patients in a University of Michigan registry; 14 patients seen in Salt Lake County, Utah, and reported last year in a paper at the American Thoracic Society; a series of 68 patients reported from Australia and New Zealand (JAMA 2009;302:1888-95); and 896 U.S. patients entered into a registry of the National Heart, Lung, and Blood Institute during April 2009 to April 2010. These data showed a consistent pattern of no improved survival with ECMO treatment in H1N1 patients, compared with H1N1 patients who did not receive ECMO, Dr. Morris said.

He also expressed concern that a well-designed study to compare modern ECMO with other ventilation support methods would be a challenge. A major problem is that the physicians "who have ECMO skills are convinced of its efficacy. Those who do ECMO don’t believe that better testing is needed," Dr. Morris said.

He reported having no relevant financial disclosures.

LAS VEGAS – The evidence supporting use of extracorporeal membrane oxygenation for treating adult patients with severe hypoxic lung failure remains uncompelling, according to Dr. Alan H. Morris.

He particularly advised against widespread use of extracorporeal membrane oxygenation (ECMO) in patients who have severe acute respiratory distress syndrome secondary to H1N1 influenza infection, as there is also no evidence that H1N1 patients treated with ECMO had better outcomes than those treated with standard ventilation support.

"We need results from a credible randomized controlled trial to define the conditions surrounding ECMO, before ECMO becomes a routine therapy option," said Dr. Morris, a pulmonologist and professor of medicine at the University of Utah and Intermountain Health Medical Center in Salt Lake City.

"There are indications and applications of extracorporeal support that are straightforward," such as when it is used intraoperatively, he said. But for patients with severe hypoxic lung failure, "I do not see compelling evidence that extracorporeal support is followed by more favorable outcomes than other approaches that are used," he said in an interview. "The evidence from the H1N1 novel influenza epidemic indicates to me that survival appears to be roughly the same with or without extracorporeal support," he added. "We do not offer ECMO as treatment for adult patients with severe hypoxic lung failure in my hospital."

The only two studies that examined the efficacy of ECMO in rigorously controlled clinical trials, published as reports in 1979 and in 1994, both failed to show that ECMO improved patient survival, he noted (JAMA 1979;242:2193-6; Am. J. Respir. Crit. Care Med. 1994;149:295-305). More recent results from a British multicenter randomized trial with 180 adults with severe respiratory failure claimed to show evidence that patient survival with ECMO surpassed survival with usual care (Lancet 2009;374:1351-63). But the newer study had the flaw of failing to define the usual care received by the control patients. In addition, the control patients were distributed to many centers, while all the ECMO patients received their treatment at one center, Dr. Morris said. The conventional ventilation that control patients received could be whatever their attending intensivist thought appropriate.

"How does a clinician know which patients will benefit [from ECMO] without knowing what was conventional treatment?" he said.

To assess the impact of ECMO in patients with acute respiratory distress secondary to H1N1 infection, Dr. Morris summarized data reported on 150 patients in a University of Michigan registry; 14 patients seen in Salt Lake County, Utah, and reported last year in a paper at the American Thoracic Society; a series of 68 patients reported from Australia and New Zealand (JAMA 2009;302:1888-95); and 896 U.S. patients entered into a registry of the National Heart, Lung, and Blood Institute during April 2009 to April 2010. These data showed a consistent pattern of no improved survival with ECMO treatment in H1N1 patients, compared with H1N1 patients who did not receive ECMO, Dr. Morris said.

He also expressed concern that a well-designed study to compare modern ECMO with other ventilation support methods would be a challenge. A major problem is that the physicians "who have ECMO skills are convinced of its efficacy. Those who do ECMO don’t believe that better testing is needed," Dr. Morris said.

He reported having no relevant financial disclosures.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won't be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it's not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it's very complicated. We're [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It's a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It's a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won't be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it's not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it's very complicated. We're [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It's a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It's a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won't be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it's not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it's very complicated. We're [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It's a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It's a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.

The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.

In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.

"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."

As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m² or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."

The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"

Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.

"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.

"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.

"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.

The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.

Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.

LAS VEGAS – The 2005 revision of the lung allocation system for U.S. lung transplants succeeded, resulting in fewer patients dying while on the lung waiting list, Dr. Robert M. Kotloff said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

Reduced deaths in wait-listed patients "was the major goal" of the revision, "so the LAS [lung allocation system] worked," said Dr. Kotloff, professor of medicine and chief of the section of advanced lung disease and lung transplantation at the University of Pennsylvania in Philadelphia.

The new LAS also triggered other changes in the pattern of U.S. lung transplantations during the subsequent 5 years, some of which took several years to become apparent.

The revised system for allocation of donor lungs shifted the weight of the different pulmonary diseases that lead to lung transplantation, reducing the priority of chronic obstructive pulmonary disease (COPD) and boosting the importance of idiopathic pulmonary fibrosis (IPF). As recently as a decade ago, 45% of U.S. lung transplantations were done in patients with COPD and 20% in those with IPF. Although the gap between the two had narrowed considerably by 2005, that year COPD still remained the leading indication. But by 2007, IPF inched ahead of COPD, and today IPF is the leading reason why U.S. patients receive a lung transplant, Dr. Kotloff said.

"IPF is a no-brainer for listing," with a median survival of 3-4 years, and with half of IPF deaths occurring after a sudden patient decline, he said. Although some patients have an indolent form of IPF, "what’s unsettling is that half of IPF deaths are sudden and unpredictable, occurring in patients who recently had stable or mild disease. We have all had IPF patients who were told they weren’t sick enough to list and to return in 6 months – who then show up in the ICU on a ventilator, a missed opportunity" for transplantation. Because of experiences like these, IPF patients now undergo a thorough evaluation for transplantation so that if they suddenly wind up in the ICU, it’s easier to get them a transplant quickly.

Patients who receive a lung transplant have a median 5-year survival rate of 50%, which means that patients with a disease that has a similar or better prognosis are not good candidates. The poorer average survival rate of IPF patients helps explain why they are good transplant candidates.

The U.S. Department of Health and Human Services mandated a 2005 revision of the allocation systems for all organs based on medical urgency rather than time on the waiting list, a system biased against patients with more aggressive disease such as IPF. The LAS scoring formula put in place by the Organ Procurement and Transplantation Network took into account both the urgency of a patient’s need for a lung transplant and the patient’s likelihood of survival following transplantation (Chest 2007;132:1954-61). Two patient features carry the most weight in the formula: the patient’s underlying disease, and whether the patient requires mechanical ventilation and how much oxygen he or she needs. Today, about the only way for a patient to have a really high LAS score of 80 or greater is to be on a ventilator with high-flow oxygen.

The 2005 LAS revision led to a dramatic shortening of the U.S. waiting list for lungs – from more than 2,000 patients before 2005 to roughly 1,000 patients today – largely because it deemphasized time on the list and made "time banking" unnecessary. Time banking had been a practice by which potential lung transplant candidates without an immediate need got listed in case they needed a transplant in the future. If they did eventually need a transplant, they had accumulated time on the list, which boosted their chances of getting the transplant more quickly. If they eventually got a call for a transplant but still did not immediately need it, they could withdraw from accepting that organ but still retain their relatively high priority on the list, Dr. Kotloff explained.

With the new allocation formula, patients with no immediate need and an uncertain future need for a transplant, such as many COPD patients, are simply kept off the list until their transplant need becomes clear. The downside to the current system is that many patients with potentially severe and unstable lung disease, such as many IPF patients, move from referral to listing to transplantation in just a few weeks – so rapidly that they do not have time to receive adequate counseling about the consequences and possible drawbacks of lung transplantation, Dr. Kotloff said.

Dr. Kotloff said that he had no disclosures.

LAS VEGAS – The 2005 revision of the lung allocation system for U.S. lung transplants succeeded, resulting in fewer patients dying while on the lung waiting list, Dr. Robert M. Kotloff said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

Reduced deaths in wait-listed patients "was the major goal" of the revision, "so the LAS [lung allocation system] worked," said Dr. Kotloff, professor of medicine and chief of the section of advanced lung disease and lung transplantation at the University of Pennsylvania in Philadelphia.

The new LAS also triggered other changes in the pattern of U.S. lung transplantations during the subsequent 5 years, some of which took several years to become apparent.

The revised system for allocation of donor lungs shifted the weight of the different pulmonary diseases that lead to lung transplantation, reducing the priority of chronic obstructive pulmonary disease (COPD) and boosting the importance of idiopathic pulmonary fibrosis (IPF). As recently as a decade ago, 45% of U.S. lung transplantations were done in patients with COPD and 20% in those with IPF. Although the gap between the two had narrowed considerably by 2005, that year COPD still remained the leading indication. But by 2007, IPF inched ahead of COPD, and today IPF is the leading reason why U.S. patients receive a lung transplant, Dr. Kotloff said.

"IPF is a no-brainer for listing," with a median survival of 3-4 years, and with half of IPF deaths occurring after a sudden patient decline, he said. Although some patients have an indolent form of IPF, "what’s unsettling is that half of IPF deaths are sudden and unpredictable, occurring in patients who recently had stable or mild disease. We have all had IPF patients who were told they weren’t sick enough to list and to return in 6 months – who then show up in the ICU on a ventilator, a missed opportunity" for transplantation. Because of experiences like these, IPF patients now undergo a thorough evaluation for transplantation so that if they suddenly wind up in the ICU, it’s easier to get them a transplant quickly.

Patients who receive a lung transplant have a median 5-year survival rate of 50%, which means that patients with a disease that has a similar or better prognosis are not good candidates. The poorer average survival rate of IPF patients helps explain why they are good transplant candidates.

The U.S. Department of Health and Human Services mandated a 2005 revision of the allocation systems for all organs based on medical urgency rather than time on the waiting list, a system biased against patients with more aggressive disease such as IPF. The LAS scoring formula put in place by the Organ Procurement and Transplantation Network took into account both the urgency of a patient’s need for a lung transplant and the patient’s likelihood of survival following transplantation (Chest 2007;132:1954-61). Two patient features carry the most weight in the formula: the patient’s underlying disease, and whether the patient requires mechanical ventilation and how much oxygen he or she needs. Today, about the only way for a patient to have a really high LAS score of 80 or greater is to be on a ventilator with high-flow oxygen.

The 2005 LAS revision led to a dramatic shortening of the U.S. waiting list for lungs – from more than 2,000 patients before 2005 to roughly 1,000 patients today – largely because it deemphasized time on the list and made "time banking" unnecessary. Time banking had been a practice by which potential lung transplant candidates without an immediate need got listed in case they needed a transplant in the future. If they did eventually need a transplant, they had accumulated time on the list, which boosted their chances of getting the transplant more quickly. If they eventually got a call for a transplant but still did not immediately need it, they could withdraw from accepting that organ but still retain their relatively high priority on the list, Dr. Kotloff explained.

With the new allocation formula, patients with no immediate need and an uncertain future need for a transplant, such as many COPD patients, are simply kept off the list until their transplant need becomes clear. The downside to the current system is that many patients with potentially severe and unstable lung disease, such as many IPF patients, move from referral to listing to transplantation in just a few weeks – so rapidly that they do not have time to receive adequate counseling about the consequences and possible drawbacks of lung transplantation, Dr. Kotloff said.

Dr. Kotloff said that he had no disclosures.

LAS VEGAS – The 2005 revision of the lung allocation system for U.S. lung transplants succeeded, resulting in fewer patients dying while on the lung waiting list, Dr. Robert M. Kotloff said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

Reduced deaths in wait-listed patients "was the major goal" of the revision, "so the LAS [lung allocation system] worked," said Dr. Kotloff, professor of medicine and chief of the section of advanced lung disease and lung transplantation at the University of Pennsylvania in Philadelphia.

The new LAS also triggered other changes in the pattern of U.S. lung transplantations during the subsequent 5 years, some of which took several years to become apparent.

The revised system for allocation of donor lungs shifted the weight of the different pulmonary diseases that lead to lung transplantation, reducing the priority of chronic obstructive pulmonary disease (COPD) and boosting the importance of idiopathic pulmonary fibrosis (IPF). As recently as a decade ago, 45% of U.S. lung transplantations were done in patients with COPD and 20% in those with IPF. Although the gap between the two had narrowed considerably by 2005, that year COPD still remained the leading indication. But by 2007, IPF inched ahead of COPD, and today IPF is the leading reason why U.S. patients receive a lung transplant, Dr. Kotloff said.

"IPF is a no-brainer for listing," with a median survival of 3-4 years, and with half of IPF deaths occurring after a sudden patient decline, he said. Although some patients have an indolent form of IPF, "what’s unsettling is that half of IPF deaths are sudden and unpredictable, occurring in patients who recently had stable or mild disease. We have all had IPF patients who were told they weren’t sick enough to list and to return in 6 months – who then show up in the ICU on a ventilator, a missed opportunity" for transplantation. Because of experiences like these, IPF patients now undergo a thorough evaluation for transplantation so that if they suddenly wind up in the ICU, it’s easier to get them a transplant quickly.

Patients who receive a lung transplant have a median 5-year survival rate of 50%, which means that patients with a disease that has a similar or better prognosis are not good candidates. The poorer average survival rate of IPF patients helps explain why they are good transplant candidates.

The U.S. Department of Health and Human Services mandated a 2005 revision of the allocation systems for all organs based on medical urgency rather than time on the waiting list, a system biased against patients with more aggressive disease such as IPF. The LAS scoring formula put in place by the Organ Procurement and Transplantation Network took into account both the urgency of a patient’s need for a lung transplant and the patient’s likelihood of survival following transplantation (Chest 2007;132:1954-61). Two patient features carry the most weight in the formula: the patient’s underlying disease, and whether the patient requires mechanical ventilation and how much oxygen he or she needs. Today, about the only way for a patient to have a really high LAS score of 80 or greater is to be on a ventilator with high-flow oxygen.

The 2005 LAS revision led to a dramatic shortening of the U.S. waiting list for lungs – from more than 2,000 patients before 2005 to roughly 1,000 patients today – largely because it deemphasized time on the list and made "time banking" unnecessary. Time banking had been a practice by which potential lung transplant candidates without an immediate need got listed in case they needed a transplant in the future. If they did eventually need a transplant, they had accumulated time on the list, which boosted their chances of getting the transplant more quickly. If they eventually got a call for a transplant but still did not immediately need it, they could withdraw from accepting that organ but still retain their relatively high priority on the list, Dr. Kotloff explained.

With the new allocation formula, patients with no immediate need and an uncertain future need for a transplant, such as many COPD patients, are simply kept off the list until their transplant need becomes clear. The downside to the current system is that many patients with potentially severe and unstable lung disease, such as many IPF patients, move from referral to listing to transplantation in just a few weeks – so rapidly that they do not have time to receive adequate counseling about the consequences and possible drawbacks of lung transplantation, Dr. Kotloff said.

Dr. Kotloff said that he had no disclosures.

LAS VEGAS – The 2005 revision of the lung allocation system for U.S. lung transplants succeeded, resulting in fewer patients dying while on the lung waiting list, Dr. Robert M. Kotloff said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

Reduced deaths in wait-listed patients "was the major goal" of the revision, "so the LAS [lung allocation system] worked," said Dr. Kotloff, professor of medicine and chief of the section of advanced lung disease and lung transplantation at the University of Pennsylvania in Philadelphia.

The new LAS also triggered other changes in the pattern of U.S. lung transplantations during the subsequent 5 years, some of which took several years to become apparent.

The revised system for allocation of donor lungs shifted the weight of the different pulmonary diseases that lead to lung transplantation, reducing the priority of chronic obstructive pulmonary disease (COPD) and boosting the importance of idiopathic pulmonary fibrosis (IPF). As recently as a decade ago, 45% of U.S. lung transplantations were done in patients with COPD and 20% in those with IPF. Although the gap between the two had narrowed considerably by 2005, that year COPD still remained the leading indication. But by 2007, IPF inched ahead of COPD, and today IPF is the leading reason why U.S. patients receive a lung transplant, Dr. Kotloff said.

"IPF is a no-brainer for listing," with a median survival of 3-4 years, and with half of IPF deaths occurring after a sudden patient decline, he said. Although some patients have an indolent form of IPF, "what’s unsettling is that half of IPF deaths are sudden and unpredictable, occurring in patients who recently had stable or mild disease. We have all had IPF patients who were told they weren’t sick enough to list and to return in 6 months – who then show up in the ICU on a ventilator, a missed opportunity" for transplantation. Because of experiences like these, IPF patients now undergo a thorough evaluation for transplantation so that if they suddenly wind up in the ICU, it’s easier to get them a transplant quickly.

Patients who receive a lung transplant have a median 5-year survival rate of 50%, which means that patients with a disease that has a similar or better prognosis are not good candidates. The poorer average survival rate of IPF patients helps explain why they are good transplant candidates.

The U.S. Department of Health and Human Services mandated a 2005 revision of the allocation systems for all organs based on medical urgency rather than time on the waiting list, a system biased against patients with more aggressive disease such as IPF. The LAS scoring formula put in place by the Organ Procurement and Transplantation Network took into account both the urgency of a patient’s need for a lung transplant and the patient’s likelihood of survival following transplantation (Chest 2007;132:1954-61). Two patient features carry the most weight in the formula: the patient’s underlying disease, and whether the patient requires mechanical ventilation and how much oxygen he or she needs. Today, about the only way for a patient to have a really high LAS score of 80 or greater is to be on a ventilator with high-flow oxygen.

The 2005 LAS revision led to a dramatic shortening of the U.S. waiting list for lungs – from more than 2,000 patients before 2005 to roughly 1,000 patients today – largely because it deemphasized time on the list and made "time banking" unnecessary. Time banking had been a practice by which potential lung transplant candidates without an immediate need got listed in case they needed a transplant in the future. If they did eventually need a transplant, they had accumulated time on the list, which boosted their chances of getting the transplant more quickly. If they eventually got a call for a transplant but still did not immediately need it, they could withdraw from accepting that organ but still retain their relatively high priority on the list, Dr. Kotloff explained.

With the new allocation formula, patients with no immediate need and an uncertain future need for a transplant, such as many COPD patients, are simply kept off the list until their transplant need becomes clear. The downside to the current system is that many patients with potentially severe and unstable lung disease, such as many IPF patients, move from referral to listing to transplantation in just a few weeks – so rapidly that they do not have time to receive adequate counseling about the consequences and possible drawbacks of lung transplantation, Dr. Kotloff said.

Dr. Kotloff said that he had no disclosures.

LAS VEGAS – The 2005 revision of the lung allocation system for U.S. lung transplants succeeded, resulting in fewer patients dying while on the lung waiting list, Dr. Robert M. Kotloff said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

Reduced deaths in wait-listed patients "was the major goal" of the revision, "so the LAS [lung allocation system] worked," said Dr. Kotloff, professor of medicine and chief of the section of advanced lung disease and lung transplantation at the University of Pennsylvania in Philadelphia.

The new LAS also triggered other changes in the pattern of U.S. lung transplantations during the subsequent 5 years, some of which took several years to become apparent.

The revised system for allocation of donor lungs shifted the weight of the different pulmonary diseases that lead to lung transplantation, reducing the priority of chronic obstructive pulmonary disease (COPD) and boosting the importance of idiopathic pulmonary fibrosis (IPF). As recently as a decade ago, 45% of U.S. lung transplantations were done in patients with COPD and 20% in those with IPF. Although the gap between the two had narrowed considerably by 2005, that year COPD still remained the leading indication. But by 2007, IPF inched ahead of COPD, and today IPF is the leading reason why U.S. patients receive a lung transplant, Dr. Kotloff said.

"IPF is a no-brainer for listing," with a median survival of 3-4 years, and with half of IPF deaths occurring after a sudden patient decline, he said. Although some patients have an indolent form of IPF, "what’s unsettling is that half of IPF deaths are sudden and unpredictable, occurring in patients who recently had stable or mild disease. We have all had IPF patients who were told they weren’t sick enough to list and to return in 6 months – who then show up in the ICU on a ventilator, a missed opportunity" for transplantation. Because of experiences like these, IPF patients now undergo a thorough evaluation for transplantation so that if they suddenly wind up in the ICU, it’s easier to get them a transplant quickly.

Patients who receive a lung transplant have a median 5-year survival rate of 50%, which means that patients with a disease that has a similar or better prognosis are not good candidates. The poorer average survival rate of IPF patients helps explain why they are good transplant candidates.

The U.S. Department of Health and Human Services mandated a 2005 revision of the allocation systems for all organs based on medical urgency rather than time on the waiting list, a system biased against patients with more aggressive disease such as IPF. The LAS scoring formula put in place by the Organ Procurement and Transplantation Network took into account both the urgency of a patient’s need for a lung transplant and the patient’s likelihood of survival following transplantation (Chest 2007;132:1954-61). Two patient features carry the most weight in the formula: the patient’s underlying disease, and whether the patient requires mechanical ventilation and how much oxygen he or she needs. Today, about the only way for a patient to have a really high LAS score of 80 or greater is to be on a ventilator with high-flow oxygen.

The 2005 LAS revision led to a dramatic shortening of the U.S. waiting list for lungs – from more than 2,000 patients before 2005 to roughly 1,000 patients today – largely because it deemphasized time on the list and made "time banking" unnecessary. Time banking had been a practice by which potential lung transplant candidates without an immediate need got listed in case they needed a transplant in the future. If they did eventually need a transplant, they had accumulated time on the list, which boosted their chances of getting the transplant more quickly. If they eventually got a call for a transplant but still did not immediately need it, they could withdraw from accepting that organ but still retain their relatively high priority on the list, Dr. Kotloff explained.

With the new allocation formula, patients with no immediate need and an uncertain future need for a transplant, such as many COPD patients, are simply kept off the list until their transplant need becomes clear. The downside to the current system is that many patients with potentially severe and unstable lung disease, such as many IPF patients, move from referral to listing to transplantation in just a few weeks – so rapidly that they do not have time to receive adequate counseling about the consequences and possible drawbacks of lung transplantation, Dr. Kotloff said.

Dr. Kotloff said that he had no disclosures.

LAS VEGAS – The 2005 revision of the lung allocation system for U.S. lung transplants succeeded, resulting in fewer patients dying while on the lung waiting list, Dr. Robert M. Kotloff said at the annual meeting of the National Association for Medical Direction of Respiratory Care.

Reduced deaths in wait-listed patients "was the major goal" of the revision, "so the LAS [lung allocation system] worked," said Dr. Kotloff, professor of medicine and chief of the section of advanced lung disease and lung transplantation at the University of Pennsylvania in Philadelphia.

The new LAS also triggered other changes in the pattern of U.S. lung transplantations during the subsequent 5 years, some of which took several years to become apparent.

The revised system for allocation of donor lungs shifted the weight of the different pulmonary diseases that lead to lung transplantation, reducing the priority of chronic obstructive pulmonary disease (COPD) and boosting the importance of idiopathic pulmonary fibrosis (IPF). As recently as a decade ago, 45% of U.S. lung transplantations were done in patients with COPD and 20% in those with IPF. Although the gap between the two had narrowed considerably by 2005, that year COPD still remained the leading indication. But by 2007, IPF inched ahead of COPD, and today IPF is the leading reason why U.S. patients receive a lung transplant, Dr. Kotloff said.

"IPF is a no-brainer for listing," with a median survival of 3-4 years, and with half of IPF deaths occurring after a sudden patient decline, he said. Although some patients have an indolent form of IPF, "what’s unsettling is that half of IPF deaths are sudden and unpredictable, occurring in patients who recently had stable or mild disease. We have all had IPF patients who were told they weren’t sick enough to list and to return in 6 months – who then show up in the ICU on a ventilator, a missed opportunity" for transplantation. Because of experiences like these, IPF patients now undergo a thorough evaluation for transplantation so that if they suddenly wind up in the ICU, it’s easier to get them a transplant quickly.

Patients who receive a lung transplant have a median 5-year survival rate of 50%, which means that patients with a disease that has a similar or better prognosis are not good candidates. The poorer average survival rate of IPF patients helps explain why they are good transplant candidates.

The U.S. Department of Health and Human Services mandated a 2005 revision of the allocation systems for all organs based on medical urgency rather than time on the waiting list, a system biased against patients with more aggressive disease such as IPF. The LAS scoring formula put in place by the Organ Procurement and Transplantation Network took into account both the urgency of a patient’s need for a lung transplant and the patient’s likelihood of survival following transplantation (Chest 2007;132:1954-61). Two patient features carry the most weight in the formula: the patient’s underlying disease, and whether the patient requires mechanical ventilation and how much oxygen he or she needs. Today, about the only way for a patient to have a really high LAS score of 80 or greater is to be on a ventilator with high-flow oxygen.

The 2005 LAS revision led to a dramatic shortening of the U.S. waiting list for lungs – from more than 2,000 patients before 2005 to roughly 1,000 patients today – largely because it deemphasized time on the list and made "time banking" unnecessary. Time banking had been a practice by which potential lung transplant candidates without an immediate need got listed in case they needed a transplant in the future. If they did eventually need a transplant, they had accumulated time on the list, which boosted their chances of getting the transplant more quickly. If they eventually got a call for a transplant but still did not immediately need it, they could withdraw from accepting that organ but still retain their relatively high priority on the list, Dr. Kotloff explained.

With the new allocation formula, patients with no immediate need and an uncertain future need for a transplant, such as many COPD patients, are simply kept off the list until their transplant need becomes clear. The downside to the current system is that many patients with potentially severe and unstable lung disease, such as many IPF patients, move from referral to listing to transplantation in just a few weeks – so rapidly that they do not have time to receive adequate counseling about the consequences and possible drawbacks of lung transplantation, Dr. Kotloff said.

Dr. Kotloff said that he had no disclosures.