Can medicine replace motors as the economic engine in the Detroit metropolitan area? Not so fast, says the Center for Studying Health System Change, which recognizes possibilities but warns of potential dangers in high levels of health care capital investment. The Center for Studying Health System Change reports:

Despite a weak economic outlook, Detroit area hospital systems plan to spend more than $1.3 billion in the coming years on capital improvements, leading some to hope that medical care can help revitalize the area’s economy, according to a new Community Report released today by the Center for Studying Health System Change (HSC) and the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Overlooked in the enthusiasm is the possibility that significant expansion of the community’s health care infrastructure may lead to higher health care costs if the hospital systems can’t attract new patients from outside the Detroit metropolitan area, according to the report.

“If all the spending on capital improvements leads to increased use of high-tech services or additional costs from excess capacity, the end result might be higher private health insurance premiums, which could negatively impact employers and employees,” said Paul B. Ginsburg, Ph.D., HSC president and NICHR director of research.

The challenges facing the Detroit metropolitan area’s health care system are intertwined with the challenges facing the community as a whole, including a declining and aging population; major suburban/urban differences in income, employment, health insurance coverage, and health status; and a shrinking industrial base, according to the report.

I’ve written a few stories for BizVoice magazine on electronic medical records during my tenure here at the Chamber. Over the last few years, I’ve asked three different physicians (our longtime doctor moved too far away and the first choice apparently skipped the bedside manner/communicate with your patients class in medical school; thus, three family docs) about their use of EMRs.

The paraphrased responses, in no particular order: not using them and don’t ever plan to; been using for about a year but it’s been a painful transition; and they are the greatest thing in the world. The latter seemed particularly efficient as she zipped off a prescription to the pharmacy while we were wrapping up our conversation.

E-prescribing is the focus of a new national report. According to the Center for Studying Healthy System Change, few doctors were e-prescribing advocates or using the advanced features that are available. The caveat is that the survey represents 2008 use, a year before federal incentives before put into place and prior to additional government emphasis on all things electronic in health care delivery.

Here’s a portion of the study release and link to the full report.

Even when physicians have access to e-prescribing, many do not routinely use the technology, particularly the more advanced features the federal government is promoting with financial incentives, according to a new national study released today by the Center for Studying Health System Change (HSC).

Slightly more than two in five office-based physicians reported that information technology (IT) was available in their practice to write prescriptions in 2008, the year before implementation of federal incentives, according to the study funded by the Robert Wood Johnson Foundation (RWJF). And, among physicians with e-prescribing capabilities, about a quarter used the technology only occasionally or not at all.

The study also found that  fewer than 60 percent of physicians with e-prescribing capability had access to three advanced features included as part of the Medicare and Medicaid incentive programs—identifying potential drug interactions, obtaining formulary information and transmitting prescriptions to pharmacies electronically—and less than a quarter routinely used all three features.

“Adoption of e-prescribing remains low, particularly among the half of all physicians who work in solo or two- to five-physician practices, said study author Joy Grossman, Ph.D., an HSC senior researcher. “And, among physicians with e-prescribing capabilities, many do not use the technology routinely, and even fewer use advanced e-prescribing features routinely.”

In 2007, about 60 colleges and universities had enacted a smoke-free policy. That number has grown to nearly 400.

There has been some external push. Clean air laws in Illinois, New Jersey and Wisconsin require smoke-free university housing. Smoking is prohibited on all public campuses in Arkansas and at every school (public and private) in Iowa. A couple of big players soon join the list, with no smoking at the University of Florida this fall or at any of the three University of Michigan campuses starting in 2011.

For those that still allow lighting up, more have policies that restrict the number of areas and move smokers away from building entrances. What have student reactions been? According to a CongressDaily story:

A Student Tobacco-Free Task Force was created when the University of Denver went smoke-free in January. Similar associations have been created at other colleges to help enforce the policy and support the change.

However, students who oppose the ban on smoking cigarettes outdoors have not remained silent. Groups of students held daily "smoke-ins" in protest when the University of Pennsylvania attempted to ban smoking at all 14 of its campuses in 2008.

The University of Denver found that about two-thirds of the student population was in favor of banning tobacco. "Interestingly, these divisions were not necessarily based on one’s personal use of tobacco," said Katie Dunker, the assistant director of health promotions at the school. "We had students who use tobacco who were for it and students who didn’t who were against it."

A list from the American Nonsmokers’ Rights Foundation puts campuses of 15 Indiana colleges and universities in the total smoke-free category. There are another nine Hoosier campuses rated smoke-free with the exception of some remote outdoor areas.

Reforms come in various shapes and sizes. For example:

• Health care reform dominated the headlines in 2009 and early this year. No one is quite sure what we ended up with, although many in business are convinced it’s going to cost a lot of money and more and more John/Jane Q. Publics are not happy with what they’re learning about the government intrusion into their medical doings.
• Local government reform in Indiana has stalled the last few years because a:) some Hoosiers like the way the system was set up in 1851; b:) politics is taking precedence over policy (imagine that!); c:) the people who prefer the status quo have spoken louder, or at least more effectively, than the proponents for change; or d:) some combination of all of the above.

Today. however, we’re talking education reform and it’s an area in which the overall results are sometimes mixed. (But then almost any reform is an improvement over a status quo that fails far too many young people). But the focus is spending more time on task; in Massachusetts, the official name is a rather straightforward Expanded Learning Time. And ELT is working.

The U.S. trails most other industrialized nations in school days. So Massachusetts has added 300 hours per year in select schools. Included among the results:

• ELT schools gaining in test results at double the state average in English language arts and math; and at five times the state average in science
• Broadened opportunities for students, including enrichment programming in a variety of subjects
• Increased student demand. One Boston middle school went from underenrolled to a waiting list in three years
• Higher teacher satisfaction
• Stronger community partnerships

No, you can’t just keep the doors open longer. No one said it is easy. But it does seem to be one of the more common sense reforms that could yield positive results for students of all abilities. Yet, in the Indiana General Assembly, time is spent each session fighting off legislation that would actually shorten the school year.

Maybe it’s no coincidence that Indiana’s local government structure and school day calendar (to meet the needs of students who had to help out on the family farm) were set up around the same time. Both are in need of a serious update. We’ve got to start somewhere — for schools, that might be with more, not less, learning opportunities.

Read Massachusetts’ More Time for Learning: Promising Practices and Lessons Learned.

The following is a guest post from Sally Stephens, president of Spectrum Health Systems in Indianapolis (an Indiana Chamber member).

Do any of us really know how health care reform will affect worksite wellness in the future? With many things still left in the air, undefined and or not clearly explained, we are left to prepare the only way we know how: continuing to focus our strategies on keeping the healthy, healthy and targeted lifestyle interventions to help the unhealthy get well. Organizations that choose to invest in similar strategies during tough economic times recognize the health of their employees is as important as having the right people.

In the book “Good to Great,” Jim Collins made an analogy of having the right people on the bus. The preface of the analogy is that by having the right people in the right seats the bus will be more operationally sound and successful. I would like to take this a step further by adding tires to the analogy. Continue to think of the bus as the organization but now the tires on the bus are those employees with the primary responsibility of moving the bus forward.  Assuming the right people are in the right seats and the tires are healthy, technically your bus should be running optimally.  Now imagine you stop providing attention and care to the tires on your bus. How do you think this affects the performance of the bus? The tires on the bus are the foundation and any unhealthy changes to the tires will ultimately affect the rest of the people on the bus as well as the bus itself. Likewise, any improvement to the health of the tires will have a positive affect. Your wellness strategies should be designed to provide the attention and care needed to improve the life and performance of your tires.

Unfortunately, the value placed on wellness is not always associated with the health of an entire organization. Whether you believe health care reform is a good thing, or a bad thing…the bottom line is good health is always a good investment and even more so during tough economic times. Behavior change is closely related to the culture and the environment we work and live in. By lowering the priority placed on health we ultimately risk the healthy becoming unhealthy, and the unhealthy becoming sick.

RJ Gerard is communications director for the Indiana Democratic Party.

Indiana went Democratic blue in 2008 for the first time in 40 years because like the rest of America, Hoosiers wanted change. The Indiana Democratic delegation has worked feverishly to bring that change to Indiana. And while the upcoming primaries should not bring any significant surprises for Democrats, the Indiana Democratic Party is poised to field a solid slate of candidates from federal to local elections this fall.

Democrats are keenly focused on holding on to all of their Congressional seats at the federal level, and feel it’s critical to maintain control of the Indiana State House of Representatives. Equally important is the Indiana U.S. Senate race, which will be in the national spotlight with former Vanderburgh County Sheriff and U.S. Congressman Brad Ellsworth working hard to replace retiring Sen. Evan Bayh.

Hoosiers saw change become reality with the passing of health care and insurance reform. Showing courage and leadership, all Hoosier Democratic members of Congress, including Sen. Bayh, voted for the measure, while the entire Republican delegation voted against it.

This one issue provides insight into this upcoming election; whether to continue on the path of hope and change, or turn back to the failed policies of the past.

Repealing health care reform would be disastrous for Hoosier families; 820,000 Indiana residents would lose health care, 76,800 small businesses would lose existing tax credits and appalling insurance practices of the past – such as denying coverage due to preexisting conditions – would be reinstated.

Let us not forget that it was the Republican Party, during eight years of GOP control, that turned record surpluses into record deficits and favored the special interests and lobbyists over the interests of ordinary Hoosiers.

Even today, Hoosier Republicans are still standing with Wall Street and opposing the reforms that would protect Americans and prevent future bailouts. To the contrary, Indiana Democrats are looking out for Hoosier families and demanding accountability from Wall Street.

In response to these failed Republican policies of the past, President Obama and Hoosier Democrats have provided tax cuts to 95 percent of working Americans through the Recovery Act, tax cuts to small businesses and instituted polices that are helping to get our deficit under control, turn our economy around and create jobs.

The Indiana GOP and its candidates represent the failed ideas of the past. The time for change has come. Hoosier Democrats are working diligently to make sure it happens.

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EDITOR’S NOTE: Out of respect for our guest bloggers, we will not be allowing anonymous comments on their blogs this week. Additionally, the Indiana Chamber does not necessarily share the opinions of our guest bloggers.

When the subject these days is health care, that dreaded six-letter "r" word that ends in "form" usually follows. Let’s skip that topic and its consequences. Instead, a few interesting insurance facts, courtesy of The Council of State Governments and its annual The Book of the States.

• Top five states for percentage of residents covered by insurance: Massachusetts (97%), Hawaii (92.5%), Wisconsin (91.8%), Minnesota (91.7%) and Maine (91.2%)
• Bottom five states for percentage of residents covered by insurance: Texas (74.8%), New Mexico (77.5%), Florida (79.8%), Mississippi (81.2%) and Louisiana (81.5%)
• On a regional basis, percent insured are 88.6% in the Midwest, 88.5% in the East, 83.9% in the South and 82.8% in the West
• Where people get their insurance: 53.7%, employer; 13.2%, Medicaid; 12.1%, Medicare; 4.9%, individual
• People under age 65: 65% have private insurance and 17% are uninsured
• Children under age 18: 58% have private insurance, 34% are on a public health plan and 8.9% are uninsured

What do all the numbers mean? Let us know your interpretation.