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Why Hospitals Don't Deliver Great Service

Why Hospitals Don't Deliver Great Service | EHR and Health IT Consulting |
Hospitals try to deliver the best health outcomes. But many also aim to provide high levels of customer service, and they're falling short. They need a culture change.


Hospitals try to deliver the best health outcomes. That's a given. But many also aim to deliver high levels of customer service. On that latter goal, healthcare systems are falling short. Here's why: Truly improving service demands a culture that intentionally champions a focus on the patient.

Managers must be equipped to drive employee engagement in their departments.


What healthcare systems urgently need are clear intentions and strategies at the leadership level. These will determine whether a service mindset can exist within a hospital. What's more, getting employees engaged and connected to this mission will ultimately determine whether they live out that mindset each day.


Gallup has found that a service-centered culture requires:

a committed leadership team that champions a philosophy that is aligned with serviceemployee commitment to providing outstanding service and qualitythe strategic alignment of the organization's plan, policies, and procedures with the goal of being service-focusedan established process to document and disseminate organizational knowledge and efficienciesan ongoing commitment to improving performance and using proven tactics
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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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For portals, speak patients' language | Healthcare IT News

For portals, speak patients' language | Healthcare IT News | EHR and Health IT Consulting |

Serving a multi-ethnic patient population that speaks six different languages – with five different alphabets! – is just one of the Stage 2 meaningful use challenges for New York Hospital Queens.

It's a tall order for many providers to meet MU's 5 percent threshold for patient access, even when they're located in English-speaking communities with a relatively high level of tech-savviness.

But for an urban community with many immigrants -- who also speak Spanish, Chinese, Korean, Russian and Greek -- the hurdles can be just that much higher, especially when most patient portals are accessible in English only.

Add to this the fact that most personal health record apps require an email address to create an account, and the prospective pool of people who could compose that 5 percent of patients gets winnowed down even further.

Still, the hospital is moving forward this summer with a "full court press" on patient engagement and fully expects to attain that oft-elusive access goal: ensuring that 5 percent of patients discharged between July 1 and September 30 access their medical records online.

"That 5 percent figure doesn't sound like a large number," says Camela Morrissey, vice president, public affairs and marketing, and chief marketing officer at New York Hospital Queens. "But for us, when you do the math, with our discharges in that period of time, it's probably between 450 and 500 patients."

The challenges of getting that many different people to log on to a patient portal are numerous.

Kenneth Ong, MD"It starts with patients having to give us their email so we can send a validation email and they can verify they are who they say they are," said Kenneth Ong, MD, chief medical informatics officer, New York Hospital Queens.

Given that not everyone has an email address, "We've had to engage help desk resources devoted entirely to the patient portal, in order support patients – which of course is an extra effort and extra cost on our part," says Ong.

That's not the only thing that's necessitated changes to the way the hospital does its daily work.

"The portal is in English, and our patient population speaks a number of different languages," says Morrissey. "We have to be able to deliver patient information in six languages. Being able to bridge that is a big challenge in the workflow, because we actually have to bring in some translation services."

It also, not insignificantly, "narrows the pool of patients who are most likely to find this relevant and accessible in its current form," she adds.

All that means New York Hospital Queens has had to have an all-hands-on-deck strategy to getting as many patients on board with the engagement initiative as possible.

"It's really requiring a very full-circle approach on our part," says Morrissey. "We've got everybody from Ken's group in informatics, to IT, to marketing and public affairs handling the communication, to our registration and admissions people, to our health information management people, to our volunteers and our patient advocates."

The hospital is "putting on a full court press," she says, "increasing the encouragement to provide a valid email address at registration. That's had the effect of increasing the number of email addresses that we collect."

After all, she says, "our patient population, like probably most, has concerns: 'If I give you my email address, are you going to spam me? Are you going to chase me for a bill?' Our folks who have been collecting that information up front have been educated and have a chance address those concerns."

Beyond the registration desk, another key strategy has been to take the outreach and education directly to the patients' bedsides.

"We have (staff) who are actively helping patients register and log into the patient portal using iPads," says Ong.

That's been a boon so far, says Morrissey, helping to "encourage any patients who have not provided their email at registration ... to register for a portal account and begin using it, to a) help them understand how to access and b) get them familiar with it and see the benefits of it."

To encourage patients to log on to its patient portal, New York Hospital Queens employees wear buttons like this one.Those selling points are made clear at the bedside, she says: "This is a convenient way for you to access your medical record. And you'll only be able to do that if your email address matches."

So far, the response has been gratifying.

"I would say it took a couple weeks for that to pick up some traction and streamline the way people were registered," says Morrissey. "But we've seen an increase in both the upfront collection and the frequency of the accurate match, once we're getting someone to register for a portal account."

As those numbers have gone up, the hospital is starting to think more creatively about new ways to reach out and new patient populations to target.

"As we get more facile internally with (these new workflows), we're focusing on some of our units where we have folks we think will be more eager to do it," says Morrissey. "Maybe that's our mother/baby population. We're looking at adding some features to the medical record that will make the parent want to look at it -- maybe a footprint and a photo of the baby. So we're getting a secure photo service to do that, enabling the uploading of that photo."

Still there are technical challenges inherent in the patient-facing software (a tethered portal from Allscripts), says Ong.

"It's still a relatively new technology, and even though we've had it for a while, you always find new problems when patients try to access it," he says. "Things like resetting passwords: In order for the patient to verify who they are in the registration, they have to remember what they identified as their primary email address as well as their preferred phone number that they gave the registrars.

"Speaking for myself, I can't always tell you what my preferred number is – and I have three email addresses," he adds. "If it's a challenge for me, and I work in IT, you can see what a challenge it is for many patients as well."

"We've created some very detailed but simplistic instructions for people that they get at their point of entry into the organization and we allow them to write down the email address that they use at that time," says Morrissey. "We suggest they write down their username and give them instructions on how to create a secure password.

"We made a decision here that rather than giving people 57 pieces of information or not giving them anything, we would give them one very simple thing to allow them to do this," she adds. "All of our staff, including volunteers and medical students who are part of the volunteer force going to the bedside to encourage patients to use this, everybody is using the same instructions and the same piece of paper."

Morrissey says the hospital is "absolutely" confident that a "very consistent effort," from the "moment people walk in the door," will see online patient access top 5 percent "for the full 90 days – and then after."

Even with such a challenging population to engage, she's sure that the hospital's enterprise-wide efforts will pay off: "We won't miss the mark on this, no way."

Beyond merely meeting meaningful use, after all, projects like these ultimately make for better outcomes.

"I really think that's going to make a difference and I would encourage anyone to do it," says Morrissey. "If it's a stretch for an organization to try, it's worth the stretch, because it's going to be better for patient care."

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Speech recognition proving its worth | Healthcare IT News

Speech recognition proving its worth | Healthcare IT News | EHR and Health IT Consulting |

While wary clinicians remain a big hurdle, nine out of 10 hospitals plan to expand their use of front-end speech deployment, according to a new KLAS report.

The study, "Front-End Speech 2014: Functionality Doesn't Trump Physician Resistance," found that 50 percent of providers polled cited skeptical end-users as one of the biggest barriers to more successful uptake of speech recognition.

Nonetheless, the ROI from the technology was clear for these hospitals, according to KLAS. Facilities interviewed saw a higher impact in nearly every category measured in the report: reduced transcription costs, reduced documentation time and more complete patient-narratives.

"Physicians are resistant to changes in their workflow," says report author Boyd Stewart, in a statement. "While hospital leadership sees the value of FES, many end users are frustrated that they are now being asked to do the work of transcriptionists."

Speech recognition can improve and enhance clinical documentation in many ways -- especially nowadays, as the demand for more documentation of every encounter is on the rise, and there aren't enough experienced medical transcriptionists to meet current and future demands, according to a practice brief published by AHIMA.

Front-end speech recognition refers to the process where the dictator, or end user, speaks into a microphone or headset attached to a PC, according to the brief. "The recognized words are displayed as they are recognized, and the dictator is expected to correct misrecognitions."


The upside is that "the dictator is in control of the entire process: The document is dictated, corrected and authenticated all in one sitting," the report points out. "When dictation is done, the document is ready for distribution."

Proponents say front-end speech is the most effective way to interface voice recognition with an EHR, allowing clinicians to respond to prompts from the EHR for more complete and accurate documentation.

The downside, however, is that speech recognition "may affect a dictator's billable activities," AHIMA points out. "Training the speech recognition engine is a time-consuming process that takes time away from patient care."

Indeed, assessing "the readiness of the medical staff in terms of their receptiveness to a transition of this magnitude," is essential to a successful deployment, according to the practice brief. "If they are proponents of full application of the technology, which means a commitment of learning to use the system and allocating resources to apply this in practical applications, ROI can be structured around an objective analysis of both the benefits and the risks."

As part of its study, KLAS reviewed three of the biggest vendors in the speech recognition field: Dolbey, M*Modal and Nuance. The latter, with a market capitalization of about $5.5 billion, continues to lead the sector "by an extensive margin," although M*Modal and Dolbey have gained ground in recent years.

Earlier this week, it was reported by the Wall Street Journal that Burlington, Mass.-based Nuance -- whose technology powers the Siri app on Apple's iPhone -- has "held discussions with potential suitors regarding a sale of the company."

Chief among the potential buyers were Samsung Electronics and private-equity firms, according to June 16 article, which noted that "it isn't clear where sale talks, some of which happened earlier this year, currently stand or if they will lead to a deal."

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Google Glass links to EHR | Healthcare IT News

Google Glass links to EHR | Healthcare IT News | EHR and Health IT Consulting |

Look, Ma, no hands! EHR company drchrono is incorporating Google Glass in its platform. The idea is to create the first wearable health record -- one that is always mobile. Drchrono offers its EHR free on the iPad, iPhone and cloud. Adding Google Glass to its platform would enable physicians to work hands-free, its officials say.
"The iPadwas a new consumption device that changed the world, and now we are seeing that doctors want to use more and more hands-free technology,” drchrono CEO and Co-Founder Michael Nusimow said, in a news release. "Glass is one of the first of its kind to do this. A physician wants to practice medicine and not be burdened with all of the paperwork that goes on in the practice. We knew this would be an important app to integrate into our EHR platform, and we're excited to now offer this to doctors using drchrono."

Nusimow imagines a future where the doctor has an iPad, iPhone, laptop and Glass all connected through a mobile EHR platform so they can operate efficiently and spend more one-on-one time with patients instead of processing paperwork.

Some use-case scenarios from drchrono:

  • Taking pictures in any setting by just saying, "OK, Glass, take a picture," e.g. during surgery a doctor can take a picture that will be pulled into the patient's medical record without his having to touch anything that could get his hands infected;  
  • Recording videos of patient encounters or medical surgeries to document, so that medical staff and scribes can code in asynchronous time offline, and view the video to add codes after the encounter;
  • Real-time data streaming of patient encounters so that doctors can have other physicians, patients' family members, or scribes watching anywhere in the world while the physician can focus on the patient 100 percent;
  • Flipping through patient profiles on the heads-up display -- with the tap of a finger, physicians can quickly preview a list of all of the patients they are seeing for the day;
  • Getting real-time notifications about who has come into the office with alerts about patients coming in or needing help;
  • Reviewing medical data about patients hands free.

"This is a game-changing device," Bill Metaxas, DPM, who recently started using drchrono and Glass in his San Francisco practice, said in a press statement. "I am amazed at how well drchrono and Glass help the documentation process during patient encounters. It's a big time saver. I can see Glass becoming an integral part of the norm in a physician's workflow."

Drchrono is also expanding its platform integration with Box by enabling medical data captured with Glass to be available on Box's cloud content platform. 

"Doctors want better workflow for capturing clinical documentation," Missy Krasner, managing director of healthcare and life Sciences at Box, said in a statement. "Glass provides faster alternatives to standard data collection and capture. By partnering with Box, drchrono can broaden its data-sharing options by allowing relevant medical content to be securely shared with patients, family members and other providers involved in patient care."

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Athena tops Stage 2 attestations | Healthcare IT News

Athena tops Stage 2 attestations | Healthcare IT News | EHR and Health IT Consulting |

The folks at cloud-based EHR company athenahealth found cause to celebrate earlier this week when the Centers for Medicare & Medicaid posted the list of EHR products providers used to attest to meaningful use.

The report revealed that although athenahealth's athenaClinicals EHR is used by less than 3 percent of providers, athenahealth clients account for 59.2 percent of providers across the U.S. who have successfully attested to Stage 2 of the Meaningful Use EHR Incentive Program as of May 31. Or, cut and diced in another way, of the 485 eligible providers who have attested for meaningful use Stage 2, 287 use athenaClinicals.

The announcement comes on the heels of a proposal by CMS and the Office of the National Coordinator for Health IT to ease attestation requirements and delay the program's timelines overall, athenahealth executives point out.

"The loosened requirements and delays for the meaningful use program have been too heavily influenced by the many software vendors who have not been able to upgrade their EHR products, receive certification or adequately support their healthcare provider clients," Jonathan Bush, chairman and CEO of athenahealth, said in a news release. "Providers across the country deserve full transparency around vendors' ability to perform in line with government incentive programs and in comparison to other vendors in the market. Such transparency and accountability is the only way to fully serve the provider and hospital community and to earnestly advance digitization and connectivity in healthcare."

[See also: Athenahealth quits EHR association.]
Bush pointed out that since April 22, athenahealth's clients' performance against Stage 2 measures has been publicly available on the company's online Meaningful Use Dashboard. Athenahealth is currently the only EHR vendor to publicly track its clients' meaningful use performance and offer a guarantee for successful attestations, company officials point out. 
Athenahealth also offered a testimonial in its company press release

"While we've had to work to create a behavioral shift around patient engagement, the work not only helped us receive our reimbursement, but also had the added benefits of saving time and improving care quality and patient satisfaction," Unaiza Hayat, MD, CEO and chief medical officer of Avecinia Wellness Center, said in a statement. "The bottom line is that meaningful use isn't a hardship for us at all -- it's a straightforward, seamless process built right into our workflow."

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OCR attorney predicts spike in HIPAA fines

OCR attorney predicts spike in HIPAA fines | EHR and Health IT Consulting |

The Office for Civil Rights' crackdown on HIPAA violations over the past year will "pale in comparison" to the next 12 months, a U.S. Department of Health and Human Services attorney recently told an American Bar Association conference.

Jerome B. Meites, OCR chief regional counsel for the Chicago area, said that the office wants to send a strong message through high-impact cases, according to Data Privacy Monitor.

The Office for Civil Rights has been levying fines to make healthcare entities take notice: nine settlements since June 1, 2013, have totaled more than $10 million. That includes a record $4.8 million fine announced in May against New York-Presbyterian Hospital and Columbia University.

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"Knowing what's in the pipeline, I suspect that that number will be low compared to what's coming up," Meites said in the article.

The OCR has said that when it resumes HIPAA audits this fall, the investigations will have a narrow focus and there will be fewer onsite visits. Meites told the American Bar Association that the OCR still has to decide which organizations it will select for an audit from a list of 1,200 candidates--800 healthcare providers, health plans or clearinghouses--and 400 of their business associates.

A report last December from the Office of Inspector General criticized the OCR's enforcement of the HIPAA provisions, including inadequate focus on system and data security.

Meanwhile, the number of breaches on the U.S. Department of Health and Human Services' "wall of shame" topped 1,000 this month, with at least 34 breaches so far in June. The records of nearly 31.7 million people have been exposed since federal reporting was mandated in September 2009.

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Physicians Support EHRs, but Find Implementation Daunting - iHealthBeat

Physicians Support EHRs, but Find Implementation Daunting - iHealthBeat | EHR and Health IT Consulting |

While most physicians support the switch from paper to electronic health records, many say the timeline to make the transition is happening too fast and are calling for changes, Politico reports.


Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.

Under the $30 billion program, physicians who meet certain criteria for health IT implementation can earn up to $44,000 annually in incentive payments.

Details of Concerns

Despite providers' support of the program's goal, many say that EHR systems are difficult to use and that savings and care quality improvements have not yet been widely evident, according to Politico.

HHS Director of Innovation Greg Downing said, "Government payment incentives forced people into early adoption of technology that in most of our views is not optimal for what people want to do with it."

Specifically, providers say that many EHR products:

  • Are not easy to use;
  • Are not integrated with other computer systems;
  • Require lengthy data entries;
  • Have severe design flaws; and
  • Require months of training to operate.
Call for Changes

American Medical Association President-Elect Steven Stack said he supports EHRs, but commercial EHR systems are "[i]nfuriating and cumbersome" and slow physicians down while distracting them from patient care. 

Despite the challenges related to implementing EHRs, recent survey show that nearly all physicians have said they are willing to make the transition.

To ease the transition, AMA is requesting that the Obama administration waive meaningful use requirements for older doctors, as well as rural or small practice physicians. Stack said that EHR implementation costs and training requirements are driving older doctors out of practice.

According to Politico, health IT specialists say the only way to handle EHR implementation problems is to work through them. 

National Coordinator for Health IT Karen DeSalvo has said she recognizes that growing pains are part of health IT implementation, adding that there are still "questions about whether it's improving health care. That's an important next chapter" (Allen, Politico, 6/15).

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Coalition Calls for Action Against EHRs That Block Interoperability - iHealthBeat

Coalition Calls for Action Against EHRs That Block Interoperability - iHealthBeat | EHR and Health IT Consulting |

The Health IT Now Coalition is calling on HHS to decertify electronic health record systems that require extra modules or additional costs to share data, Politico's "Morning eHealth" reports. The group also is calling on HHS and lawmakers to investigate firms that obstruct data sharing while participating in federal incentive programs (Gold, "Morning eHealth," Politico, 6/16).


The calls come after a recent RAND Corporation report found that a lack of interoperability hinders technologies that otherwise could lower costs and improve care quality (Health IT Now Coalition release, 6/13). Specifically, the report found that Epic, an EHR vendor, was operating a "closed platform" that limited interoperability.

In response, an Epic spokesperson noted that the report was authored by two Department of Veterans Affairs researchers who suggested the VA health system's platform as an alternative to Epic's system ("Morning eHealth," Politico, 6/16).

Details of Call for Investigation

In a release, Health IT Now Executive Director Joel White said, "The RAND report reiterates what those in the health IT industry know well: Interoperability must be a priority if we truly want to improve patient outcomes, decrease costs and achieve a technology enabled system."

The coalition calls for HHS to:

  • Work with lawmakers to investigate firms that could be inhibiting data sharing while being involved in federal incentive programs; and
  • Revoke certification of EHR systems that require extra modules, expenses or other customization for data sharing.

White said that $24 billion in taxpayer money has been paid over the past three years to health IT systems that do not easily share data (Health IT Now Coalition release, 6/13).

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EHR uptake disrupts mobile growth | Healthcare IT News

EHR uptake disrupts mobile growth | Healthcare IT News | EHR and Health IT Consulting |

Athenahealth and Epocrates, an athenahealth service, released a mobile trends report that shows nurse practitioners, physician assistants and pharmacists emerging as the most engaged users of mobile technology today.

The third annual Epocrates Mobile Trends Report examines mobile technology adoption and use patterns among healthcare providers.

More than 1,200 healthcare professionals from across the Epocrates member base, including physicians, nurse practitioners, physician assistants and, for the first time, retail and hospital pharmacists, shared opinions on mobile device usage and its impact on the medical profession and clinical workflow.

[See also: athenahealth to acquire Epocrates.]

The feedback, collected in May 2014, points to the explosive adoption of mobile devices for professional use has plateaued.

As a response to healthcare reform initiatives, the majority of providers and care teams surveyed are predominantly focused on fully implementing EHRs to meet meaningful use standards.

Key trends evident from the survey include:

  • EHR adoption is disrupting mobile growth: Mobile adoption among clinicians has temporarily leveled off as tablet growth in the clinical setting slows. While there was an impressive 68 percent increase from 2012 to 2013 in "digital omnivores," those using all three devices: tablet, smartphone, and computer in their workflow showed a slight decrease. This may be the result of the push towards EHR implementation in 2013, which has fueled an upsurge in time spent on computers, the dominant platform for EHR use.
  • The lack of mobile EHRinnovation is notable: only one-third of clinicians claim their EHR is optimized for tablet or smartphone use. Most viewed traditional EHRs as time-consuming interferences and longed for more user-friendly and efficient options.
  • Nurse practitioners, physician assistants and pharmacists excel at mobile, showing themselves to be shining stars in terms of mobile engagement: PAs lead daily tablet usage among clinicians, with NPs following a close second. More than half of hospital pharmacists identified themselves as digital omnivores and point to mobile technology as having significantly improved their productivity while enhancing interactions with patients.
  • The future of mobile looks bright: Healthcare providers still consume a considerable amount of clinical content on mobile devices during the moments that matter. Smartphones remain a round-the-clock resource for quick reference.Looking to the future, 74 percent of clinicians surveyed expect to be digital omnivores by Q2 2015, suggesting the migration of tasks to mobile devices will likely continue to grow.

[See also: Epocrates seen as boon for athenahealth.]

"It's clear there is an opportunity to help healthcare providers bridge the gap between desktop and mobile while minimizing some of the more exasperating EHR pain points," said Anne Meneghetti, MD, executive director of medical information at Epocrates. "Providers expect EHRs to be mobile-optimized, allowing them flexibility to coordinate administrative tasks anytime, anywhere.

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How one ACO used mHealth to beat the odds | Government Health IT

An Indiana-based ACO is using mHealth tools to connect providers and home health patients in a new program that keeps them out of the hospital, helps them live healthier lives, and qualifies the health network for extra Medicare incentives.

The 13-hospital Franciscan Alliance Accountable Care Organization, one of the first ACOs in the country to partner with Medicare, is reportedly seeing success on several fronts using Honeywell's Genesis DM and Genesis Touch RPM devices. 

Franciscan VNS, in fact, is partnering with one of the ACO's physician groups in what is called 'The Coaching Program," according to a Honeywell HomMed whitepaper, to target patients with chronic illnesses, typically the most expensive population and one that doesn't traditionally qualify for home health services.

"The Coaching Program was designed to provide the right level of education to patients to empower them to take the management of their healthcare into their own hands and improve the overall health prognosis long-term," the whitepaper states.

Physicians, home health aides and telehealth nurses involved in this program use the Honeywell devices to keep regular tabs on enrolled patients and track long-term health progress with Honeywell's LifeStream Management Suite of analytical software. In all, 70 percent of the program's patients are monitored daily, the whitepaper states, with results compared against general population patients and those using traditional telehealth monitoring tools upon their discharge from the hospital.

According to Franciscan officials, The Coaching Program has resulted in a 5 percent readmission rate (the national average for a Medicare population is 20 percent), medication reconciliation rates above 40 percent, and a patient retention rate of 95 percent. As a result, Franciscan officials report that they've qualified for a higher bonus from the Centers for Medicare and Medicare Services.

"In order to qualify for a piece of this 'shared savings pie,' a hospital or ACO has to know every patient, what services they're getting, what it costs, and how it compared to the" contract that Franciscan has with CMS to treat Medicare patients, the whitepaper points out. "Telehealth solutions are the perfect companion to hospitals and ACOs in the new world order because they have the same overarching goal: Making healthcare delivery more efficient while simultaneously increasing quality of patient care."

The Coaching Program consists of four parts:

1. The creation of a personal health record that connects all members of the care continuum to one patient record;

2. Identifying red flags that key in telehealth nurses and other providers to points of early intervention;

3. A medication reconciliation and self-management process that ensures that the patients understand what medications are prescribed to them; and

4. Preparing patient to be involved in their own health management, including during follow-up visits.

Patients have also reported life changes due to The Coaching Program. They're exercising more often, according to the whitepaper, decreasing their caloric intake and involving themselves in more heart-healthy activities.

The key takeaway is that mHealth programs like The Coaching Program can help providers and ACOs not only reduce hospital readmissions among their most expensive populations, but they can demonstrate an improved quality of life for those patients and optimize new revenue streams.

Those benchmarks will prove vital as the nation's healthcare system transitions from a fee-for-service model to the more inclusive fee-for-value system.

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Big Data, My Data - iHealthBeat

Big Data, My Data - iHealthBeat | EHR and Health IT Consulting |

"The routine operation of modern health care systems produces an abundance of electronically stored data on an ongoing basis," Sebastian Schneeweis writes in a recent New England Journal of Medicine Perspective.

Is this abundance of data a treasure trove for improving patient care and growing knowledge about effective treatments? Is that data trove a Pandora's black box that can be mined by obscure third parties to benefit for-profit companies without rewarding those whose data are said to be the new currency of the economy? That is, patients themselves?

In this emerging world of data analytics in health care, there's Big Data and there's My Data ("small data"). Who most benefits from the use of My Data may not actually be the consumer.

Big focus on Big Data. Several reports published in the first half of 2014 talk about the promise and perils of Big Data in health care. The Federal Trade Commission's study, titled "Data Brokers: A Call for Transparency and Accountability," analyzed the business practices of nine "data brokers," companies that buy and sell consumers' personal information from a broad array of sources. Data brokers sell consumers' information to buyers looking to use those data for marketing, managing financial risk or identifying people. There are health implications in all of these activities, and the use of such data generally is not covered by HIPAA. The report discusses the example of a data segment called "Smoker in Household," which a company selling a new air filter for the home could use to target-market to an individual who might seek such a product. On the downside, without the consumers' knowledge, the information could be used by a financial services company to identify the consumer as a bad health insurance risk.

"Big Data and Privacy: A Technological Perspective," a report from the President's Office of Science and Technology Policy, considers the growth of Big Data's role in helping inform new ways to treat diseases and presents two scenarios of the "near future" of health care. The first, on personalized medicine, recognizes that not all patients are alike or respond identically to treatments. Data collected from a large number of similar patients (such as digital images, genomic information and granular responses to clinical trials) can be mined to develop a treatment with an optimal outcome for the patients. In this case, patients may have provided their data based on the promise of anonymity but would like to be informed if a useful treatment has been found. In the second scenario, detecting symptoms via mobile devices, people wishing to detect early signs of Alzheimer's Disease in themselves use a mobile device connecting to a personal couch in the Internet cloud that supports and records activities of daily living: say, gait when walking, notes on conversations and physical navigation instructions. For both of these scenarios, the authors ask, "Can the information about individuals' health be sold, without additional consent, to third parties? What if this is a stated condition of use of the app? Should information go to the individual's personal physicians with their initial consent but not a subsequent confirmation?"

The World Privacy Foundation's report, titled "The Scoring of America: How Secret Consumer Scores Threaten Your Privacy and Your Future," describes the growing market for developing indices on consumer behavior, identifying over a dozen health-related scores. Health scores include the Affordable Care Act Individual Health Risk Score, the FICO Medication Adherence Score, various frailty scores, personal health scores (from WebMD and OneHealth, whose default sharing setting is based on the user's sharing setting with the RunKeeper mobile health app), Medicaid Resource Utilization Group Scores, the SF-36 survey on physical and mental health and complexity scores (such as the Aristotle score for congenital heart surgery). WPF presents a history of consumer scoring beginning with the FICO score for personal creditworthiness and recommends regulatory scrutiny on the new consumer scores for fairness, transparency and accessibility to consumers.

At the same time these three reports went to press, scores of news stories emerged discussing the Big Opportunities Big Data present. The June issue of CFO Magazine published a piece called "Big Data: Where the Money Is." InformationWeek published "Health Care Dives Into Big Data," Motley Fool wrote about "Big Data's Big Future in Health Care" and WIRED called "Cloud Computing, Big Data and Health Care" the "trifecta."

Well-timed on June 5, the Office of the National Coordinator for Health IT's Roadmap for Interoperability was detailed in a white paper, titled "Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure." The document envisions the long view for the U.S. health IT ecosystem enabling people to share and access health information, ensuring quality and safety in care delivery, managing population health, and leveraging Big Data and analytics. Notably, "Building Block #3" in this vision is ensuring privacy and security protections for health information. ONC will "support developers creating health tools for consumers to encourage responsible privacy and security practices and greater transparency about how they use personal health information." Looking forward, ONC notes the need for "scaling trust across communities."

Consumer trust: going, going, gone? In the stakeholder community of U.S. consumers, there is declining trust between people and the companies and government agencies with whom people deal. Only 47% of U.S. adults trust companies with whom they regularly do business to keep their personal information secure, according to a June 6 Gallup poll. Furthermore, 37% of people say this trust has decreased in the past year. Who's most trusted to keep information secure? Banks and credit card companies come in first place, trusted by 39% of people, and health insurance companies come in second, trusted by 26% of people. 

Trust is a basic requirement for health engagement. Health researchers need patients to share personal data to drive insights, knowledge and treatments back to the people who need them. PatientsLikeMe, the online social network, launched the Data for Good project to inspire people to share personal health information imploring people to "Donate your data for You. For Others. For Good." For 10 years, patients have been sharing personal health information on the PatientsLikeMe site, which has developed trusted relationships with more than 250,000 community members.

On the bright side, there is tremendous potential for My Data to join other peoples' data to drive better health for "Me" and for public health. On the darker side, there is also tremendous financial gain to be made by third-party data brokers to sell people's information in an opaque marketplace of which consumers have no knowledge. Individuals have the most to gain from the successful use of Big Data in health. But people also have a great deal to lose if that personal information is used against them unwittingly.

Deven McGraw, a law partner in the health care practice of Manatt, Phelps & Phillips, recently told a bipartisan policy forum on Big Data in health care, "If institutions don't have a way to connect and trust one another with respect to the data that they each have stewardship over, we won't have the environment that we need to improve health and health care." This is also true for individual consumers when it comes to privacy rights over personal health data.

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Hospital IT execs increasingly embrace the cloud

Hospital IT execs increasingly embrace the cloud | EHR and Health IT Consulting |

Hospital IT executives increasingly turn to the cloud to lower maintenance costs while trying to meet their growing technology needs, according to a new surveypublished today by HIMSS Analytics.

Of the 150 respondents to the survey--a majority of whom were hospital CIOs--close to 83 percent indicated that they use cloud technology; half of those providers said they use the cloud to host clinical applications. The exchange of patient data and disaster recovery efforts also were among top reasons for both current and future use by providers.

Privacy and security were top of mind for providers both already using cloud technology and those considering adoption. Close to 60 percent of respondents said that physical security of a cloud service provider would factor into their cloud purchasing decisions. The same number said that a vendor's willingness to enter into a business associate agreement was also important. Provider business associates can now be held accountable for data breaches under HIPAA.

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Guest Article: Is Patient Generated Health Data (PGHD) trustworthy enough to use in health record banks?

Guest Article: Is Patient Generated Health Data (PGHD) trustworthy enough to use in health record banks? | EHR and Health IT Consulting |

The push towards shifting the patient’s role from a passive recipient of care to an active member of the care-team looks set to gain further legislative backing. Earlier this year, the Health IT Standards Committee, along with The Joint Commission and ONC, laid out recommendations for integrating patient generated health data (PGHD) into Stage 3 Meaningful Use requirements. To see what this might mean to health IT and med tech vendors, I reached out to Zach Watson of TechnologyAdvice, who covers EHR related news, along with business intelligence, and other topics. Zach mentioned that health records banks might be an interesting future direction so I asked him to share his thoughts on PGHD, how trustworthy it might be, and what the future for PGHD and health banks might be. Here’s what he said:

Greater integration of PGHD into clinical practice and research opens the door to innovative treatment standards, specifically for population health management and risk-bearing delivery models, such as accountable care organizations. Broadly, PGHD helps reduce costs by allowing providers to view a patient’s previous procedures and tests, and avoid adverse reactions through access to up to date medication information.

On a more granular level, PGHD could give providers, researchers, and device manufacturers access to real-time biometric data that infers day-to-day changes in patient health and activity. This type of data could be essential in developing care plans and technologies for patients with chronic conditions who need daily treatment to address their symptoms.

PGHD already exists in clinical practice today in the form of patient reported outcomes, but Stage 3 requirements envision a greater expansion and integration of these data, with the patient as the main comptroller.

However, questions remain around data reliability, data standards, exchange architecture, and of course privacy.

When searching for a solution to these issues, providers, legislators, patients and other stakeholders must examine the architecture of existing EHR and health information exchanges (HIE). The most common iteration of an HIE, also referred to as a decentralized or federated model, requires that a physician’s EHR showcase interoperability with every other EHR from every other provider from every previous point of care for each individual patient. The physician’s EHR must query all these previous EHRs to receive the required health information, while verifying patient consent and correcting inaccuracies in real-time.

Such decentralized architecture has led to constant citation of low interoperability rates, and scalability issues in the context of PGHD. Patients now have to contribute data to numerous EHRs, with each possibly using a different portal for access. In this federated system, EHRs must not only perform complex functions required by their end-users, but also interface with disparate systems to form an interconnected information transfer network.

A separate framework for interoperability and patient participation in HIEs was proposed back in 2007. Dubbed “The Independent Health Record Trust Act,” the legislation developed an infrastructure for health record banks (HRBs). Essentially, these are untethered portals that act as repositories for patient information, designated by region. When physicians need a complete view of a patient’s record, their EHR queries the HRB for all the patients records and returns updated records to the HRB after the episode of care is completed.

In the HRB model, patients, and providers for that matter, don’t need to worry about portal redundancy, or about receiving inaccurate or incompatible records. One of the worries about utilizing patient generated health information lies in the human error associated with manually entered data. However, positioning the patient as the final quality assurance mechanism should ensure greater accuracy as the patient ultimately risks the greatest harm from health information mistakes.

Further, if physicians notice inaccuracies in the information, they can immediately make the changes if given permission by the patient, or send the patient a note about the inaccuracies. Patients can then deal with information within the HRB platform, instead of the incorrect information being transmitted back to multiple EHRs.

As an example, Geisinger piloted an ONC-funded project where patients reviewed their medication lists through patient portals and provided feedback on current and expired medications prior to an upcoming office visit. This data was reviewed by Geisinger pharmacists who followed up with the patients. Pharmacists changed the medication info as needed, notified the patient’s provider, and marked the source of the change in the EHR system.

How accurate were the patient’s changes? Pharmacists made the patient recommended changes 80 percent of the time. The providers who participated also reported that the program saved them time.

In terms of compatibility, developing one standard for HRBs will make interoperability cheaper and quicker to realize. Since the HRB would be under direct and complete control of the patient, providers could use the direct protocol to exchange information between platforms. The HRB model also offers system architects the opportunity to settle on a smaller range of standardized forms, such as CCDA.

In relation to privacy, patients can determine the level of data access they want providers to have. While this is far from a perfect solution – it’s feasible that patients may restrict information they find unflattering – it does offer a compromise for including patients, and the data they create, in health information exchanges.

Unfortunately, the aforementioned legislations for HRBs (HR 2991) died on the vine after making its way to the House Committee on Ways and Means in 2007. However, the bill’s failure didn’t signal the death of health record banks – eHealthTrust opened a health record bank in 2010 designed to scale with Arizona’s nascent HIE. Additionally, the Health Record Bank Alliance has outlined many of the ideas posited here in greater detail, along with compelling evidence of financial incentive for the HRB model.

Influential stakeholders need to incorporate PGHD to make their population health management attempts yield positive gains, both financially and clinically. The patient-facing infrastructure already largely exists, with an increasing amount of patients generating relevant data through wearable medical devices.

In lieu of a regional HRB, providers can still leverage PGHD using the following practices:

  • Begin by identifying existing information gaps in your EHR system. What data could you and your patients benefit from integrating into the decision making process?
  • Consider the mediums patients can use to record and transmit data: over 60 percent of patients want to communicate with providers electronically, while a further 30 percent are eager to utilize their smartphones and tablets. This is huge resource that potentially going untapped.
  • Implement structured and semi-structured forms that capture the data you need from patients, and can be easily accessed on a mobile device through your patient portal.
  • Consider personal health record applications such as Microsoft HealthVault. These PHR tools function much like health record banks, and provide many of the same benefits. HealthVault is even free to use.

PGHD has a great deal of potential, but still needs standards built around it. How will your organization utilize PGHD? Share your insights in the comments

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EHR incentive cash climbs to $24B | Healthcare IT News

EHR incentive cash climbs to $24B | Healthcare IT News | EHR and Health IT Consulting |

As of May, eligible hospitals and physicians have been paid out a whopping $23.7 billion in electronic health record incentive payments by the Centers for Medicare & Medicaid Services, according to Elisabeth Myers, policy and outreach lead at the CMS Office of eHealth Standards and Services at the June 10 monthly Health IT Policy committee meeting.   The announcement comes as federal officials have proposed a reboot to the Office of the National Coordinator for Health Information Technology, taking into consideration the downsizing of ONC's funding following the close-out of incentive payments.    [See also: Group wrongly claims $31M EHR payments.]   During discussions at the HIT Policy Committee meeting, differences of opinion continue to remain among EHR vendors, providers and policymakers as the difficulty in the meaningful use program has reached a head for Stage 2 and alternatives are under consideration to provide relief.   Regardless, participation in the program continues to grow, according to Jennifer King, acting director, Office of Economic Analysis, Evaluation and Modeling at ONC. King presented to the HIT Policy Committee a report on eligible providers' participation in the EHR incentive program from 2011 through 2013.   As of 2013, only 3 percent of eligible providers in the U.S. have not signed up to participate in the program, King said. Some 59 percent have received meaningful use Stage 1 incentives; 15 percent have received AIU (adopt, implement and upgrade) incentives only, while 17 percent have registered for the program and have not yet received incentives, while five percent are enrolled in a regional extension center only, without moving forward yet.   All in all, King said, participation continues to increase.   Younger physicians and non-behavioral health providers were ranked among the more likely to achieve meaningful use Stage 1 after they signed up for the program, King said.    Out of all sizes of physician practices, solo-practitioners faced the most relative risk of failing to achieve meaningful use, the analysis showed.   Physicians in rural locations or in counties with the majority of its citizen living in poverty and physicians serving mainly minority patient populations also showed the greatest risk of failing to achieve meaningful use, King said.   Physicians who participate in either or both regional extension centers and patient-centered medical homes were also more likely to achieve meaningful use, King said.  

This story first appeared in Government Health IT here
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VA reduces admissions by 35% due to telemedicine services |

VA reduces admissions by 35% due to telemedicine services | | EHR and Health IT Consulting |

The VA might be struggling to find its way out of very hot water when it comes to its scheduling services, but there’s more to the healthcare system than the mushrooming scandal. The VA has long been a leader in the telemedicine arena, and a new study published by Adam Darkins, Chief Consultant for Telehealth Services, highlights some very positive results from the suite of programs and pilots. Eleven percent of veterans received some portion of their care remotely in 2013, with the number of patients accessing telehealth through the VA growing approximately 22% annually, Darkins says. Remote programs have contributed to a 35% reduction in hospital admissions among home telehealth patients and a 59% reduction in bed days of care throughout 2013.

In the past year, the VA’s telehealth services have provided nearly 1.8 million episodes of care to over 608,000 patients. Forty-five percent of those patients lived in rural areas with limited access to physical facilities, and may not have received adequate care without clinical video services, mHealth, and home health services to support self-management for depression, PTSD, and other chronic conditions. Of the 144,520 patients enrolled in home telehealth services, 41,430 are living independently in their own homes instead of relying on long-term institutional care.

The successful home telehealth program has saved approximately $2000 per patient per annum, Darkins reports, with a patient satisfaction score of 84 percent. Clinical video telehealth services, which cover 44 specialties including dermatology, cardiology, mental health, and amputation care, has produced a 94% patient satisfaction score and a savings of $34.45 per consultation.

Remote mental health care reduced bed days of care by 38 percent, the study adds, with more than 1.1 million patient encounters delivered since 2003. In 2013 alone, there were 278,000 patient encounters dealing with mental health at more than 150 VA medical centers and 729 community-based outpatient clinics. Almost 7500 patients with chronic mental health conditions are living independently thanks to telehealth support.

“Telehealth training is not offered in medical schools, or included in health professional curricula,” Darkins writes. “With over 8,146 sites of care many in rural and remote locations, technology support is a critical success factor in developing telehealth services, and a risk that must be mitigated in their subsequent sustainment. Telehealth crosses traditional boundaries between information technology and biomedical engineering services, requiring comprehensive and dedicated support.”

“Telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the health care system will dramatically change with the full realization of the ‘connected patient,’” Darkins concludes. “The high levels of patient satisfaction with telehealth, and positive clinical outcomes, attest to this direction being the right one.”

Technical Dr. Inc.'s curator insight, June 28, 12:10 AM

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U.S. Rep: Future bright for health IT | Healthcare IT News

U.S. Rep: Future bright for health IT | Healthcare IT News | EHR and Health IT Consulting |

U.S. House Representative Michael Burgess, MD, R-Texas, vice-chair of the subcommittee on health within the House Energy and Commerce Committee, is an obstetrician and has not always been convinced of the benefits of health IT. But, Hurricane Katrina, changed his mind. And, today, Burgess is a champion.

As he told attendees at the  keynote he delivered June 18 at the Government Health IT Conference in Washington, D.C., the cost of IT infrastructure in the 1980s in the large multi-specialty practice in which he practiced was prohibitive.

"It has not always been a happy alliance between the physician and the information architecture," he said. "The transition of health IT for physicians has been clunky."

With the advent of the year 2000, Burgess was encouraged to purchase yet another computer system, which turned out to be unnecessary when Y2K did not wreak havoc that was expected. Yet another disappointing and costly experience in health IT, he admits.

Katrina turns the tide of health IT opinion

What turned the tables for Burgess was Hurricane Katrina. He saw first-hand the loss of vital patient information in water-logged hospitals, which later developed black mold and required biohazard gear to look at. Doctors did the best they could to fill in patient medical history with a patient's verbal memory of their medication.

"Katrina provided a first-hand look at why EHRs are important," Burgess said.

Now, his endorsement is strong. "If you want to save money in healthcare, it requires an electronic platform, for early detection and proper screening," he said.

In addition, in states like his home state of Texas, telemedicine is imperative, with so few doctors per square mile. "There's no question that the advances in telemedicine are opening up the ability to give quality care," Burgess said.

Burgess notes how far things have come from when in the 1980s doctors would never hope to receive reimbursement for a telephone conversation with patients.

The `pause' in meaningful use

Burgess said the opinion on the Meaningful Use EHR Incentive Program depends on "which side of the fence on which you sit."

Farzad Mostashari, former national coordinator for health information technology told Burgess last year, "whatever you do, don't delay meaningful use."

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Congressman offers 3-point MU fix | Healthcare IT News

Congressman offers 3-point MU fix | Healthcare IT News | EHR and Health IT Consulting |

With $23 billion already spent on incentivizing providers to adopt electronic health records, many in government and industry are wondering whether taxpayers and patients got what they paid for. The heart of the debate: The Office of the National Coordinator for Health IT, its meaningful use program, and interoperable EHRs.

"What we've done is put in place a system that is forcing people into a square hole with a round peg, or vice versa, and maybe not even doing what needs to be done as it relates to patients and physicians," said U.S. Rep Tom Price, MD, R-GA, said at the Government Health IT Conference and Exhibition. "That's certainly what I hear back home."

An orthopedic surgeon, Price added that the current "mindset of top down" is missing the customers – the patients and the doctors – and ignoring important principles of the healthcare system he thinks the US should want: affordability, accessibility, and innovation.

Price laid down three ideas for fixing the meaningful use program:

1. Keep the patient front-and-center. "Sometimes there's this notion we need to put technology first," Price said. "Let me suggest we always, always have to keep the patient first, tailor the technology, tailor the innovation, so the patient has a higher quality of care, then we'll end up at the right spot."

2. Patients own their health data. "The technology exists," Price explained, adding that among the hurdles are patient privacy and protecting personal health information. "Understanding security has to be at the top of the heap," he added. "We ought to be able to encrypt things and make them function in a way that is viable."

3. Institute and require an interoperability standard. "I believe government does more than it should. But when it comes to interoperability, let's figure out what side of the road we're going to drive on, what color the stoplights are, what the signs say," Price said. "EHRs need to be able to communicate."

[See also: AMIA: Why interoperability is 'taking so darn long'.]

Part of the problem is that the meaningful use effort that came in the HITECH Act laid down a roadmap that Price said just doesn't translate so fluidly in the real-world.

The question of whether the industry will ever get to true EHR interoperability, arose in other conference sessions, with some suggesting that open source standards might work, others recommending that the Centers for Medicare & Medicaid Services pay more to providers who adhere to standards, and ONC handing more of the development work over to the private sector. 

"We are bright enough as a society to figure out a system that helps physicians and patients at the same time … if we keep the patient at the center we will get to the right answer on this and so many things as it relates to healthcare," Price continued. "I think this will get easier over time, but I promise you if we rely on Washington, D.C. to solely set the parameters we'll be behind the curve at every turn."

This article was first published June 18, 2014, on Government Health IT, sister publication of Healthcare IT News.

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Security tips from the health IT pros | Healthcare IT News

Security tips from the health IT pros | Healthcare IT News | EHR and Health IT Consulting |

As anyone who's ever worked for IT security can attest, the job is no walk in the park. New threats, compliance mandates, vulnerabilities and updates are constant. But with strong leadership, and a culture of compliance and responsibility to match, many healthcare organizations have shown it can be done right -- and well.   Beth Israel Deaconess Medical Center's Chief Information Officer John Halamka, MD, said for this kind of career, it's a matter of first understanding that, "a CIO has limited authority but infinite accountability." You have to ask, "How do you reduce risk to the point where government regulators and, more importantly, patients will say, 'What you have done is reasonable?'" he said.   [See also: Hacker calls health security 'Wild West'.]   This involves thinking about how to encrypt every device and how to protect the data center from both internal and external attacks.

"Much of what I have to do is meet with my business owners and ask, 'What are the risks? Reputational risks? Patient privacy breach risks? Data integrity risks? We're never going to be perfect," he added. "But we can put in place, what I call a 'multilayer defense.'"   Another fundamental piece to doing privacy and security right? No surprise here: Get your risk analysis done – and done properly.

"This is the single most important document as part of the OCR investigation," said Lynn Sessions, partner at BakerHostetler, who focuses on healthcare privacy. "(OCR is) asking for the current one; they are asking for two, three, five years back. They want to see the evolution of what was going on from a risk analysis standpoint at your institution to see if you were appreciating the risk."   This includes showing the safeguards your organization has put in place from technical, physical and administrative standpoints, explained Sessions. Things such as staff training and education, penetration tests, cable locks or trackers for unencrypted devices all matter.    Time to encrypt   "Encrypt; encrypt; encrypt," said Sessions. It's a safe harbor for the HIPAA breach notification requirements, but that still fails to motivate some.    [See also: Hacker calls health security 'Wild West'.]   "(Physical theft and loss) is the biggest hands down problem in healthcare that we are seeing," said Suzanne Widup, senior analyst on the Verizon RISK team, discussing the 2014 annual Verizon breach report released in April. "It really surprises me that this is still such a big problem ... other industries seem to have gotten this fairly clearly."   According to OCR data, theft and loss of unencrypted laptops and devices account for the lion's share of HIPAA privacy and security breaches, nearing 60 percent. (Hacking accounts for some 7 percent, and unauthorized disclosure accounts for 16 percent).   "Pay attention to encryption, for any devices that can leave the office," said former OCR deputy director for health information privacy Susan McAndrew at HIMSS14 this past February.   Of course, the healthcare breach numbers are going to be slightly higher because the federal government has mandated specific HIPAA privacy and security breach notification requirements for organizations, but that has no bearing on the reality that these organizations still fail to implement basic encryption practices, Widup pointed out.    Sessions conceded that it is a pricing concern. "At a time where reimbursements are going down and technology costs are going up with the advent of the electronic health record, there are competing priorities within a healthcare organization of where they can spend their money."   A 2011 Ponemon Institute report estimated full disk encryption costs to be around $232 per user, per year, on average, a number representing the total cost of ownership. And that number could go as high as $399 per users, per year, the data suggest.    Kaiser Permanente Chief Security Officer and Technology Risk Officer Jim Doggett, however, said encryption presents a challenge not only because of costs but also because of the data itself. "The quantity of data is huge," he told Healthcare IT News.    The 38-hospital health system encrypts data on endpoint devices in addition to sensitive data in transit, said Doggett, who currently leads a 300-person technology risk management team, in charge of 273,000 desktop computers, 65,000 laptops, 21,700 smartphones and 21,000 servers. And don't forget the health data of some 9 million Kaiser members Doggett and his team are responsible for.

"This kind of scale presents unique challenges, and calls for the rigor and vigilance of not only the technology teams but of every staff member across Kaiser Permanente," he added. 

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The HHS/OCR Hit List for HIPAA Audits

The HHS/OCR Hit List for HIPAA Audits | EHR and Health IT Consulting |

As the HHS Office for Civil Rights analyzes breach reports for vulnerabilities, it has learned lessons on areas where covered entities should pay particular attention to their HIPAA compliance efforts. With OCR hoping soon to launch a permanent random HIPAA Audit program, the agency has reiterated six core ways to avoid common types of breaches, which will be among the targeted focus areas of audits.

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IT blamed in Athens EHR debacle | Healthcare IT News

IT blamed in Athens EHR debacle | Healthcare IT News | EHR and Health IT Consulting |

Who's to blame when EHR implementations go south? There's often enough fault to go around. But when the fallout is bad enough, sometimes self-interested parties are all too ready to point fingers.

[See also: CEO resigns amid troubled EHR rollout]

In late May, we covered the story of a $31 million Cerner rollout at Athens Regional Health System in Georgia that didn't go as planned.

Thanks to what was described by clinicians as a rushed process, doctors nurses and staff were up in arms about a series of medication mistakes, scheduling snafus and other communication glitches.

[See also: IT and informatics play well together]

"The last three weeks have been very challenging for our physicians, nurses and staff," wrote Athens Regional Foundation Vice President Tammy Gilland, Athens Regional Foundation vice president, in a letter to donors explaining the situation. "Parts of the system are working well while others are not."

The complaints lodged by clinicians were soon followed by the resignation of President and CEO James Thaw and, less than a week later, Senior Vice President and CIO Gretchen Tegethoff.

This past weekend, on June 15, the Athens Banner Herald reported that Athens Regional's chief medical officer – as well as executives from Cerner – were pointing fingers at the health system's IT team, complaining that they made strategic decisions that should have been the bailiwick of clinicians.

"Could there have been more information shared at the administrative level? I suppose you could make that argument," Senior Vice President and CMO James L. Moore told the paper. "The implementation was through the CIO, and so that's where the information was held."

The Banner Herald's Kelsey Cochran also quotes a Cerner vice president, Michael Robin, who noted that while some end-users were involved in the rollout, it seemed primarily to be led by Athens Regional's IT team, which he said was "atypical" of Cerner sites.

Another Cerner VP, Ben Hilmes, told the paper that successful EHR implementations are "clinically driven, not IT-driven." At Athens Regional, he added, "it came out of balance toward the IT side of things."

Moore has since taken the lead on the project. Cerner has pledged to do "whatever we need to do" to help the process get back on track, Hilmes told Cochran.

Whether or not this is a matter of three different parties – IT, clinicians, vendors – circling the wagons around their own and casting blame on others, one thing is certainly true: On big projects like these, the technology side and the clinical side need to be committed and communicative partners from the get-go

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Will true EHR interoperability ever really happen? | Government Health IT

Will true EHR interoperability ever really happen? | Government Health IT | EHR and Health IT Consulting |

Allison Viola pointed to a photograph of a bridge. Actually, it was two bridges being built to meet in the middle and only when they were close enough to join did the architects realize the designs were too different to form a smooth road.

Depending on one’s purview, that picture may represent the current state of interoperability between electronic health records systems — or it may be inadequate. 

“Interoperability will be able to transform our healthcare system,” Viola, vice president of policy and government affairs at eHealth Initiative, said on Tuesday at the Government Health IT Conference and Exhibition. “If we work to be interoperable, patients will have less tests, we’ll save, we’ll standardize; research can be run on the data. I think the business case is there.”

Not that it will be easy. Before the idea of interoperability moves beyond its current hype phase, however, the industry must overcome a number of substantive obstacles: semantic interoperability, provider workflow to capture and enter data, privacy and security, patient identity and safety, just to name a few.

And some of those are more complex than others, but true interoperability will require them nonetheless.

Privacy, security, patient matching, consent, data provenance “all of these touch the national strategy and are key concerns to ONC,” said Debbie Bucci of ONC’s office of standards and interoperability on Tuesday.

ONC, in fact, is working with the National Strategy for Trusted Identities in Cyberspace, otherwise known as NSTIC on the Identity Ecosystems Steering Group, a group comprising more than 200 public and private organizations and more than 60 individuals, of which NSTIC senior advisor James Sheire said “healthcare is a key sector engaged and has its own group.”

NSTIC aligns with the 10-year plan for interoperability that ONC laid out, Bucci said.

In a wide-ranging discussion, presenters and attendees alike proposed and debated ideas including ONC handing over more of the standards development work to the private sector, turning to open source software standards, CMS paying providers a higher rate for using certain standards or technologies.  

While each idea has merits and deficits, the looming question was whether true interoperability — wherein payers, providers and EHRs easily share patient information — will ever really happen?

“Technically, it is possible but I don't think it will ever be interoperable. There will always be an EHR or another system that crops that, for better or good, won't be interoperable,” eHealth Initiative’s Viola said. “You can use interfaces to connect but I don’t think every EHR system will interoperate with every other EHR out there.”

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Will Apple's Swift Make mHealth App Development Easier than Ever? | MDDI Medical Device and Diagnostic Industry News Products and Suppliers

Will Apple's Swift Make mHealth App Development Easier than Ever? | MDDI Medical Device and Diagnostic Industry News Products and Suppliers | EHR and Health IT Consulting |

Swift, Apple's new programming lanugage, wants to make coding mobile apps easier for everyone-including digital health developers.


Swift is designed to lower the barrier to ent anyone looking to creates apps for iOS or Mac OS X [image copyright Apple Inc.]

It's “Objective-C without the baggage of C” according to Apple's senior VP of software engineering Craig Federighi. Apple promises its new programming language, Swift, will make developing apps for OS X and iOS of all kinds, from games to health and fitness, easier and faster than ever. But will Swift live up to its name?

“We don't see a strategic downside from Swift, although as a youthful language, it maintains the risk of global adoption,” says Dr. Chuck Thornbury, CEO and founder of meVisit, an iPhone- and Android-based app that remotely connects patients to their doctors. “Swift is relatively new and maturity is something that has to be considered; it is especially true for those features like mix-and-match and interoperability with old (legacy) code.”
The first thing you have to understand is why this is such a big deal from a developer's perspective. Mac and iPhone-based apps are typically created using an older, legacy programming language called Objective-C that first appeared back in 1983 and has carried over through Apple products since the early days. Being an older language however, Objective-C is arguably not best suited for most modern computing applications. After all, it was created in a time when all the computing power of a smartphone would take up an entire desk.
“Swift has many excellent features that have been learned from other programming languages. It offers a more similar syntax than other leading languages–especially, those that are script-like, dynamic languages,” Thornbury says. “The mix-and-match between Objective-C and Swift may be expected to attract developers to begin engineering in Swift quickly, as they wouldn't be expected to have concerns regarding the legacy code in Objective-C."
Ned Fox, a software engineer with AliveCor, makers of the mobile ECG and accompanying app of the same name, agrees with this assessment. Fox believes that it will be most advantageous for developers to use Objective-C in conjunction with Swift. “In terms of syntax, [Swift has] some pretty big differences that people are using....I'll probably stick with [Objective-C] for a while and use features of Swift,” Fox says. “I don't think it's quite as short a line from Objective-C to Swift.” However he adds that there are new features in Swift that could speed up app development significantly. One such feature is Playground, which allows programmers to test individual snippets of code without having to test the entire app at once.
Swift vs. Android
However there are conflicting reports on the efficacy of Swift. According to an article from InfoWorld [] Swift performed markedly slower in benchmarks compared to other programming languages, Objective-C included. However Swift has only been released in beta so it is unclear how valuable such benchmarks are at this point, particularly since Swift and Objective-C will have to co-exist for the time being.
“We do not believe that Objective-C will diminish from the landscape in the immediate future, as there remain many committed developers that many not see an immediate value in amending their preferred engineering language unless it is absolutely necessary,” Thornbury says. “For new projects, developers may have a passion for using a new language (Swift). Based on the feedback that we've received, engineers may be expected to gradually migrate from Objective-C to Swift as we revisit the old code...The learning curve should be shorter for those with no prior experience in iOS development.”
The idea of an easier programming language for Apple platforms has to have raised eyebrows with Android developers. It doesn't take a mastermind to see how clearly advantageous it would be for Apple to lock developers into an exclusive programming language for its platforms. A recent article in Fast Company [] argues that Swift's low barrier to entry and simpler syntax could easily win developers over to Apple's side and keep the ones already there from drifting over into Android-infested waters.
However Android is not likely to easily give up its market share and developers who want to reach the broadest audience would still be best served to develop for both platforms. “Swift appears to be most promising; however, the majority market that Android and other platforms command may act as a firm headwind, against which, it would have to pilot,” Thornbury says. “
“The iPhone has always been a little bit easier to code for,” Fox says. “But Android has been gaining market share in an important population that I don't believe third-party developers will want to ignore. If Google doesn't come out with something similar to Swift I think someone else will.” The AliveCor ECG is compatible with iPhone and Android phones, though the Android version was released much later.
Taking the Next Steps
Fox's theory bares some fruit given how widely competitive the digital health app space has gotten this year. Later this month, Google is expected to announce Google Fit [], its own digital health platform similar to Apple's HealthKit []. For hardware companies like AliveCor platforms like these can be key ingredients to allow companies to move into the market quickly. “HealthKit is a really great step,” Fox says. “It makes it really easy to collect health data and take data out. If a company is focusing on hardware they can focus on hardware and you can import all of this data.”
Apple has already released a free instructional eBook [] that gives programmers a tour of Swift and its functionality. While the company has certainly taken a step in the right direction in encouraging future app development it will be the developers themselves that ultimately decide where the market goes. Ultimately, coders want the largest audience possible and will use any tool at their disposal to get it. “Large markets, by their very nature, offer incentives for app developers to provide content. Platform-independent development tools might be expected to attract continued innovation and motivate developers,” Thornbury says.
Apple demonstrates Swift at the 2014 Apple WWDC.

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Be Futuristic – Use Forecasting and Predictive Analytics to improve Quality | View from the Vertex

Be Futuristic – Use Forecasting and Predictive Analytics to improve Quality | View from the Vertex | EHR and Health IT Consulting |

As we gear up for the overhaul it is not just the compliances that Providers need to secure their processes for, you also need to tap large amount of data for data forensics. The EMR and data warehouse systems will become rich sources of information, making it important to build a holistic framework to manage clinical and financial information for effective and efficient reporting. Similarly, it is important to design processes to achieve high levels of data quality and standardization and appropriately interpret and implement evidence-based clinical guidelines.   You can leverage this rich source of data to improve quality of care rendered to patients by drawing insights to support important decisions. At this juncture, the healthcare industry can benefit immensely by using this vast data for Patient Focused Analytics. One aspect is to use predictive/forecasting models, in order to build these algorithms it is important to:

  • Analyze structured data from EMR – demographic data (age, race, and gender), vitals (blood pressure, temperature), clinical diagnosis, present on admission indicators, lab results, medication, etc.
  • Domesticate and analyze unstructured data – physician notes, discharge summaries, images (ECG, x-ray, ultrasound), etc.
  • Arrive at a patient risk score for each patient
  • Predict possibility of readmissions and length of stay of patients

This will aid Providers to improve disease management programs and predict patient health, based on their current lifestyle. Predictive analytics is also expected to bring down costs, by assisting preventive care and employing methods to improve AR, thereby reducing the cost burdens   Data analytics will rejuvenate the entire healthcare system, allowing doctors to deliver high quality, personalized patient care, efficiently and cost effectively, anytime, anywhere. The next step going forward should be to enable real-time analytics and mobile health for easier, faster, and cheaper access, allowing more people to receive good care.  

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BI gains might on patient side | Healthcare IT News

BI gains might on patient side | Healthcare IT News | EHR and Health IT Consulting |

A new survey from the American Health Information Management Association finds that 95 percent of the more than a thousand healthcare industry professionals queried believe that "high-value information" is essential for improving patient safety and care quality.

"I'm reassured," says Deborah Green, AHIMA's executive VP of operations and COO, and a contributor to the study. "That's what it is about."

This bit of news comes as analytics is slowly making its way from business intelligence – revenue-cycle management and financial performance – to the clinical side of healthcare. "Predictive analytics can help with readmissions prevention," notes Charles Christian, CIO at St. Francis Hospital in Columbus, Ga.

His and other community hospitals are just starting to make small strides in this direction, but larger organizations are seeing results. As the Wall Street Journal reported this month, the University of Pittsburgh Medical Center has put $105 million toward a massive data analytics program, which is employed to analyze the success of a patient-centered medical home pilot. UPMC found that those with medical homes had substantially better health outcomes after six months in the program, and the medical home reduced health expenditures by $15 million in the first year.

[See also: Clinical data analytics next big thing.]

In a pilot at the Ohio State University's Wexner Medical Center, analytics have deployed cardiologists and oncologists to an ambulatory clinic in a part of Columbus, Ohio, with high rates of heart disease and cancer. With data algorithms, the university has been able to identify patients in need of intervention and personalize care for those individuals in order to reduce initial hospitalizations as well as readmissions, according to Burroughs Healthcare Consulting Network.

Jim Adams, executive director for research and insights at The Advisory Board Company, a Washington, D.C.-based consultancy and research firm, notes that analytics can help health systems add psychosocial factors to their decision-making. For example, if a hospital knows that a patient lives alone, the discharge plan can include arranging transportation for follow-up care.

Adams says that it's possible to do "simple analytics" just by getting people together in teams and brainstorming, which may be the best some can do at the moment, though he has seen many organizations applying business intelligence to stratify clinical risk and prioritize patient interventions. "Ideally they're doing it at admission time, not just at discharge," he says.

[See also: Mayo Clinic launches bedside analytics.]

As the AHIMA survey suggests, healthcare organizations may get the importance of having good data, but many apparently still have a long way to go in building a foundation for high-functioning analytics programs.

The Advisory Board has developed a four-phase maturity model for business intelligence, starting at "fragmented," then progressing to analytics from an enterprise perspective, "advanced" analytics and, ultimately, big data.

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Healthcare Disrupt: Who Will Be The Winners In This Multi-Trillion Dollar Industry?

Healthcare Disrupt: Who Will Be The Winners In This Multi-Trillion Dollar Industry? | EHR and Health IT Consulting |

In continuation of my last blog, Healthcare Beware! New Intruders are Coming – Introducing the New Gold Rush, it is becoming crystal clear that big pharma and med tech companies need to start re-establishing their pride of place in the new ecosystem.  Over a dozen new industries are already swarming into this marketplace, and Frost & Sullivan’s assessment of the total size of some of these disruptions could amount to trillions of dollars over the next five to seven years.

Who are these invaders? Check out the infographic below that provides ideas of the new disruptions and new markets being created as a result.

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Health IT doc to head the AMA | Healthcare IT News

Health IT doc to head the AMA | Healthcare IT News | EHR and Health IT Consulting |

The American Medical Association on Monday named its new president-elect, who has been recognized for his involvement with health information technology. The to-be president has been critical of several aspects of the EHR Incentive Program.     Steven J. Stack, MD, an emergency physician currently practicing in Lexington, Ky., will assume the role of AMA president starting June 2015 after serving a one-year term as president-elect. At 43, he is poised to be the youngest AMA president in the past century, according to officials.    "It is a deep honor and privilege to be named president-elect of an organization that is committed to serving as a strong physician voice and a dedicated patient advocate on the pressing healthcare issues confronting our nation," said Stack, in a June 9 press release. "With vision and perseverance, I look forward to creating a brighter future for patients and the medical profession."   Stack has served as chair of the AMA's Health Information Technology Advisory Group from 2007 to 2013. He also held roles on several federal advisory groups for the Office of the National Coordinator for Health Information Technology, including the Information Exchange, PCAST Report and Strategic Plan workgroups. Stack also served as secretary of the eHealth Initiative.    He has been critical of aspects of the Electronic Health Record Incentive Programs, which he has described as creating a "Catch-22" for physicians, mandating they implement EHRs, while under the threat of a monetary fine.    "Documenting a full clinical encounter in an EHR is pure torment," said Stack last May during the CMS Listening Session: Billing and Coding with Electronic Health Records, where he called on CMS and ONC to make Stage 2 requirements more flexible for physicians who are already struggling with myriad mandates and deadlines.    [See also: AMA has a wish list of MU improvements.]  Stack, who clarified that he thinks ONC and CMS are honestly attempting to improve healthcare, added: "My purpose is not to denigrate EHRs."   Back in 2006, Stack was elected to the AMA board of trustees, making him the first board-certified emergency doc to serve in the role of AMA board member, officials note. During the past eight years, Stack has held several leadership positions, including AMA board chair and AMA secretary. Prior to his service on the AMA board, he held a record as an elected leader within numerous state, national and specialty medical associations.   Stack's previous roles also include medical director of the emergency departments at St. Joseph East in Lexington, Ky., and St. Joseph Mt. Sterling in eastern Kentucky. He also served as medical director of the emergency department at Baptist Memorial Hospital in Memphis, Tenn.  

Born and raised in Cleveland, Stack graduated from the College of the Holy Cross in Worcester, Mass. He then returned to Ohio and completed his medical school education and emergency medicine training at the Ohio State University before relocating to Memphis to begin his clinical practice. In 2006, he and his family moved to Lexington.
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