Healthcare and Technology news
39.4K views | +0 today
Follow
Healthcare and Technology news
Your new post is loading...
Your new post is loading...
Scoop.it!

Physician Reports Impact Of Electronic Health Record On Patient Safety

Physician Reports Impact Of Electronic Health Record On Patient Safety | Healthcare and Technology news | Scoop.it

Physicians who adopt electronic health record report EHR has improved the safety and quality of their office-based care

 

At the end of each day, every physician asks themselves two questions:

 

  • “Was there something I did today that I shouldn’t have?”

 

  • “Is there something I didn’t do that I should have?”

 

We can now see from the 2013 National Ambulatory Medical Care Physician Workflow Survey (NAMCS) that the answers to those questions weigh lighter on the minds of practicing physicians who have the help of electronic health records (EHR).

 

Through this annual survey of 11,000 physicians we get a snapshot of how EHR adoption has improved the safety and quality of their office-based care.  The details of the survey are published in an ONC data brief; and the larger contours of the perceived impact of electronic health records are clear: physicians feel that EHRs improve the quality and safety of the care they deliver.  From these data we can see that about 70 percent of physicians answering the survey felt that their EHR helped by alerting them of an important medication or a laboratory test result.

 

 

EHRs improve communications

 

As the practice of medicine becomes more complex, practice tools should help providers manage that complexity. The NAMCS survey finds that electronic health records are helping to improve communication between physicians and members of their care teams.  Nearly 60 percent of physicians using EHRs reported that their system facilitated communication among the care team and roughly one-half of them found that it improved the management of referrals.

 

Not unexpectedly, physicians in large practices (11 physicians or more) experienced slightly greater improvement in communication across the care team, compared to those in solo practices.

 

However, no practice tool is a panacea, and when looking at electronic records we also see that 40 percent of physicians felt the EHR led to a less effective communication with their patients during a visit, 15 percent felt the EHR led to an error in ordering a medication or test, and about 15 percent identified too many alerts as the reason they overlooked something important.

 

 

EHRs can improve patient safety

 

The net result of how physicians perceive the effects of electronic records on crucial processes of care within their practice is overwhelmingly positive.  This fact provides us with the support we need as we work toward the two goals of health IT safety articulated in the ONC Patient Safety Action and Surveillance Plan: to improve the safe use of health IT and to improve the overall safety and quality of care delivered through the use of health IT.

Those of us who have worked in any of the domains of safety — health care patient safety, nuclear safety, or aerospace safety — know safety is a journey and not a destination.

 

This NAMCS survey shows that electronic health records are tools that make the path toward patient safety easier for all of us who, after the day’s journey, soberly reflect on the answers to two very important questions: “Was there something I did today that I shouldn’t have?” and “Is there something I didn’t do that I should have?”

 

We all share a responsibility to try to answer these questions better today than we did yesterday.  And the good news is that we can meet that responsibility with confidence whether ordering medications and labs, communicating with our colleagues, or remembering important aspects of care, as the EHR is helping us to make that care better.

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
No comment yet.
Scoop.it!

How Physicians Must Practically Prepare for Retirement

How Physicians Must Practically Prepare for Retirement | Healthcare and Technology news | Scoop.it

In a broad survey of U.S. physicians by Merritt Hawkins in 2014, nearly 42 percent of those surveyed aged 46 and older said they plan to accelerate their retirement due to current changes in the healthcare industry. In the same survey, more than 55 percent of physicians reported their current morale as somewhat or very negative.


Numbers like those suggest some physicians could be rushing for the exits before their retirement ducks are in a row, which can lead to some regrettable outcomes, experts say. Among them: nest eggs that are too small or too heavily invested in risky assets, missed opportunities for disposing of practice assets, and depression resulting from a lack of purpose once work ends.


Ophthalmologist Arnold Pearlstone retired nearly five years ago at age 80, not because he failed to plan for retirement, but precisely because he planned so well for so long.


He and his practice partners started up a 401(k) plan decades ago when the concept was still new, and Pearlstone learned all he could about investments.


"We were all pretty conscientious about saving and we really had a pretty good amount put away, so we didn't have to worry," he says.

What did concern him was how he was going to spend his time in retirement. He loved practicing medicine and knew he wanted to do it as long as possible.


And so 23 years ago, about the time many people start retiring, Pearlstone and his wife, Marion (now deceased), established a foundation they called Eye Care for the Underprivileged. Through that foundation they received donations in addition to their own and established a clinic in Jamaica while Pearlstone was still actively practicing.


"I didn't limit the foundation's scope to Jamaica, because I thought I might one day need it for other clinics I wanted to open," he says. "I didn't know what I was going to be doing, so when I set up the fund I left it open-ended in case later on I wanted to volunteer and needed to purchase equipment."


Sure enough, as Pearlstone finally started winding down his practice, he contacted AmeriCares, a humanitarian aid organization. He began working at an AmeriCares free clinic in Bridgeport, Conn., two weeks after he retired in 2010, taking most of his office equipment with him and donating it to the clinic. Later, he used money from his foundation to add equipment to other AmeriCares clinic locations. He keeps his Connecticut medical license current with 50 hours of continuing medical education every two years.


"My advice is to not just quit when you retire," he says. "Find someplace to use those skills where they can make a difference. It's good for you to keep the brain going."


Practical Planning


As for the more practical aspects of retirement planning, getting going on those is equally important, experts say.


"Start early, because everything seems to take longer than you think it will," says Roy Bossen, a partner at Hinshaw & Culbertson LLP, with experience in medical office sales and acquisitions.


Increasingly, finding a junior partner willing to buy you out and continue the practice as it was is a rare find, Bossen says. Instead, you might have to consider a multi-year process where you join a hospital network for a few years at the end your career.


"If a hospital really wants a physician, it will often assume the lease or buy the building as part of the transaction," says Bossen. "They won't pay more than fair-market value," but having that obligation off your plate before you retire could be worth it if finding and keeping a tenant is difficult in your market, he says.


"These are issues you want to resolve going into a lease, not out, but if you're in a lease, for example, be aware that you may have to go to a condo board to get a tenant approved," he says, which can mean more delays and missed opportunities.


Near the end of his career, Pearlstone was the last of four partners in his office. He assumed the patient records of two colleagues who were retiring, closed down the office, and rented a new space from a friend who had another practice nearby for the last few years of practice. That doctor then paid Pearlstone a small fee for the patient records, which offset a portion of his rent, he says.


Preparing your nest egg to begin pumping out income at retirement is also a process that can take some time. A significant market correction in the first few years of retirement could doom an income system that relies on an initial withdrawal rate with automatic yearly increases — the oft-cited "4 percent" rule.


Be aware that because of stock market valuations and the low-yield bond market, projections for returns in coming years have market experts saying a more realistic safe withdrawal rate could be more like 2.5 percent to 3 percent.


If you're concerned you might not have saved enough to make it through retirement with just a systematic withdrawal plan, longevity insurance — or fixed deferred annuities — are beginning to be introduced for retirement accounts by insurers including The Principal and MetLife.


Recent federal regulations paved the way for these policies, called qualifying longevity annuity contracts (QLAC). Inside retirement accounts, the annuities allow owners to defer required minimum distributions on the amounts invested in the annuities.


Also, think strategically about how you want to receive Social Security income. You can now get an 8 percent bump-up in monthly benefits for every year you delay claiming benefits past full retirement age, up to 32 percent at age 70. Do this first before purchasing longevity annuities because it's the cheapest annuity available, many financial advisers say.


It's important to reconsider your risk tolerance now that retirement is looming. A decade before he retired, Pearlstone says he began shifting his savings to more fixed-income investments and away from stocks.


"Today I'm about two-thirds in income investments and one-third in equities," he says, noting that he spent considerable time throughout his career learning about financial planning and investments.

If you haven't put in that much time and don't expect to, at least thoroughly check out the financial adviser you plan to use to help tap your nest egg. Online financial management services such as Personal Capital and Betterment are beginning to offer retirement spend-down strategies.  They do so for a fraction of what traditional advisers charge — and they won't approach you with obscure land deals only available to "accredited" investors.

more...
No comment yet.
Scoop.it!

IBM Watson antes up $1B to buy Merge

IBM Watson antes up $1B to buy Merge | Healthcare and Technology news | Scoop.it

Continuing its shopping spree, IBM on Thursday announced that it will spend a cool $1 billion to acquire Merge Healthcare in a deal that will combine Merge's medical imaging technologies with IBM's Watson. 

Watson will gain the ability to "see" by bringing together Watson's advanced image analytics and cognitive capabilities with data and images obtained from Merge Healthcare's medical imaging management platform, IBM executives said in announcing the deal.


The intent, say IBM executives is to to unlock the value of medical images to help physicians make better patient care decisions.


Merge is a public company, traded on NASDAQ as MRGE.

Its technology platforms are used at more than 7,500 U.S. healthcare sites, as well as most of the world's leading clinicalresearch institutes and pharmaceutical firms to manage a growing body of medical images.


As IBM execs see it, these organizations could use the Watson Health Cloud to surface new insights from a consolidated, patient-centric view of current and historical images, electronic health records, data from wearable devices and other related medical data, in a HIPAA-enabled environment.


Under terms of the transaction, Merge shareholders would receive $7.13 per share in cash, for a total transaction value of $1 billion. The closing of the transaction is subject to regulatory review, Merge shareholder approval, and other customary closing conditions. It is expected to occur later this year.


It is IBM's third major health-related acquisition – and the largest – since launching its Watson Health unit in April, following Phytel, a population health company and Explorys, a cloud-based intelligence firm.

more...
No comment yet.
Scoop.it!

How New Prices and Payments are Changing the Way We'll Receive Healthcare under the Affordable Care Act

How New Prices and Payments are Changing the Way We'll Receive Healthcare under the Affordable Care Act | Healthcare and Technology news | Scoop.it

In the wake of the recent King v. Burwell Supreme Court decision to uphold subsidies for the 34 state health insurance exchanges under the Affordable Care Act, it's worth understanding why losing them would've made insurance for nearly 6.4 million Americans unaffordable. It boils down to two numbers: the cost of delivering care and the rate that hospitals are paid to do so.


Most physicians are currently paid under a 'fee-for-service' model, a flat sum for each individual test or procedure provided to a patient. It's no surprise then that the number of prescribed tests has skyrocketed over the past two decades as hospitals attempt to increase revenue. For any given condition, the United States both orders and spends more on unnecessary screens and treatments than any other country on Earth, often with no better outcome for the patient. An MRI in the United States costs five times as much as the same MRI in France.

Most countries negotiate with healthcare providers to set rates at acceptance levels. Prices are either directly set by the government or are negotiated upon by providers and insurers prior to delivering care. In both instances, the price of healthcare is generally much lower than that of the United States, where, outside of public programs like Medicaid and Medicare, providers can usually charge whatever they can get away with to make up for the high costs of pharmaceuticals and medical devices. Furthermore, the amount paid for a given service is identical regardless of whether the outcome is good or bad. Imagine going to a restaurant and paying the same amount for a meal that left you satisfied and another--that you likely didn't order but were given anyways--that gave you food poisoning. That's how fee-for-service works.


The lack of accountability on the quality of care compounded with a healthcare financing model that rewards hospitals for increasing volume, not value, was a recipe for disaster, causing healthcare spending to jump to nearly 20% of GDP, but left the rate of increase in life expectancy in the dust compared to Europe and Japan.


The U.S. first tried to address rising healthcare costs in the 1990s through a model known as 'global capitation'. Providers were paid a single pre-defined sum to cover all treatment for each patient. If a physician or healthcare organization delivered care to a patient at a cost less than the sum it received, it turned a profit. If it overshot the sum, it lost money. While this model rewarded physicians for spending less, it did nothing to reward physicians for improving outcomes. As a result, physicians had a financial incentive to avoid expensive treatment plans and costly patients, resulting in poor quality care.


In 2012, as an extension of the Affordable Care Act, the Obama Administration launched the Pioneer Accountable Care Organization (ACO), a 'global payments' model that rewards hospitals that deliver quality care at costs lower than a pre-defined benchmark and punishes hospitals that overspend. If hospitals in the program spend below expected costs, they keep 70% of the savings; the other 30% goes to the federal government. If they spend more than expected, they pay the federal government the difference.


Some policymakers and physicians worry that the Affordable Care Act's global, or bundled, payments model is simply disguised capitation. Although bundled payments have a cost control structure similar to global capitation, they have been flexibly designed to avoid its pitfalls by rewarding value-based patient care. Physicians are paid for each patient based on how much treatment would cost for a given clinically defined episode of care. This risk adjustment allows for variability in global payments based on the illness burden of a provider's patient population. Additionally, unlike capitation, providers are directly rewarded for improving patient outcomes, incentivizing consistently-measured, high-quality care. Some global payment models do not involve any punishments for overspending, as opposed to the Pioneer ACO, but continue to reward strong physician performance.


Over the last two years, the Pioneer ACO program has saved $384 million in healthcare costs. In combination with the Medicare Shared Savings Program (MSSP), another global payments initiative, it has contracted with 154 organizations in forty states. All hospitals involved showed improved performance quality measures, readmission rates, and cholesterol level monitoring. Furthermore, patients gave similar rates of satisfaction compared to previous models of care and even reported better access to physicians. The end result is higher quality care at a lower cost for patients.


While Pioneer is illustrative of a step towards progress in managing healthcare costs, it hasn't been perfect. Most 2012 Pioneer participants were large, sophisticated hospital networks with the capability to rapidly change their method of delivering care, very different from the public hospitals that serve the populations that need health reform the most. Of the 32 hospitals that registered for Pioneer in 2012, 13 dropped out and 14 failed to produce any substantial savings. However, most dropout hospital networks still plan to pursue less-aggressive value-based payment models, such as MSSP, and found their experience with Pioneer to be an effective transition for both patients and providers to the global payments model. Additionally, the practice of measuring and collecting data on physician performance and patient outcomes will give both the federal government and providers a more transparent understanding of what treatments work, providing evidence-based information to set prices based on the value of individual treatments. If there's any one change that will reduce U.S. healthcare costs in the long term, it's lowering prices.

more...
No comment yet.
Scoop.it!

CVS Health Announces New Clinical Affiliations with Four Leading Health Care Organizations

CVS Health Announces New Clinical Affiliations with Four Leading Health Care Organizations | Healthcare and Technology news | Scoop.it

CVS Health (NYSE: CVS) announced today it has entered into new clinical affiliations with Sutter Health in California, Millennium Physician Group in Florida, Bryan Health Connect in Nebraska and Mount Kisco Medical Group, PC in New York. These affiliations will help enhance access to high-quality, affordable health care services for patients.

Through these clinical affiliations, CVS Health will provide prescription and visit information to the participating health care organizations by enabling communication between our secured electronic health record (EHR) systems, which will help enhance clinical care for patients served by the partnering organizations. In addition, patients will continue to have access to clinical support, medication counseling, chronic disease monitoring and wellness programs at CVS/pharmacy stores and MinuteClinic, the retail medical clinic of CVS Health.

"In this era of health care reform, we are pleased to work with these health care organizations to develop collaborative programs that enhance access to patient care, improve health outcomes and lower health care costs in the communities they serve," said Troyen A. Brennan, MD, Chief Medical Officer, CVS Health. "By allowing our electronic health records and information systems to communicate and share important information about the patients we collectively serve, we will have a more comprehensive view of our patients, which can aid in health care decision making and help ensure patients adhere to important medications for chronic diseases."

CVS/pharmacy currently has more than 7,800 retail pharmacy locations across the U.S. where CVS pharmacists provide counseling to patients to help them be adherent to their chronic disease medications. In addition, MinuteClinic also plays an important role by providing patients with timely, affordable and high-quality walk-in health care. There are nearly 1,000 MinuteClinic walk-in medical clinics available at CVS/pharmacy retail stores. MinuteClinic locations are open seven days a week, offering evening hours with no appointment necessary and most health insurance is accepted. The clinics are staffed by nurse practitioners and physician assistants who provide treatment for common family illnesses and administer wellness and prevention services, including health-condition monitoring for patients with chronic diseases. 

Affiliates' health care providers will receive data on interventions conducted by CVS pharmacists to improve medication adherence for their patients. The affiliation also encourages collaboration between the health care providers and MinuteClinic providers to improve coordination of care for patients seen at MinuteClinic locations.

Through this collaboration, the affiliate organizations and MinuteClinic practitioners will also work together on planning strategies around chronic care and wellness. If more comprehensive care is needed, patients can follow up with their primary care provider and have access to the services at the health care provider as appropriate. For those patients who do not have regular access to health care, MinuteClinic provides information to help patients in finding a primary care physician and a greater opportunity for continuity of health care services.

MinuteClinic, CVS/pharmacy and the participating health care organizations will begin to work toward streamlining and enhancing communication through their EHR systems. This will include the electronic sharing of messages and alerts from CVS/pharmacy to the health care organizations' physicians regarding medication non-adherence issues. In addition, MinuteClinic will electronically share patient visit summaries with the patient's primary care physician when they are part of an affiliate organization and with the patient's consent. MinuteClinic will continue its standard practice of sending patient visit summaries to primary care providers who are not affiliated with one of these participating health care organizations via fax or mail, with patient consent.

The new affiliations announced here bring the total number of clinical collaborations for CVS Health and MinuteClinic to nearly 60 major health systems and health care providers across the country.

more...
No comment yet.
Scoop.it!

Nebraska Medicine and Epic ahead of their time with a new patient engagement app for the Apple Watch

Nebraska Medicine and Epic ahead of their time with a new patient engagement app for the Apple Watch | Healthcare and Technology news | Scoop.it

Apple has always been about innovation. The same can be said for Epic, the Verona, Wisconsin-based healthcare software company whose customers manage medical records for more than half the U.S. population, including patients at Nebraska Medicine. Now, Epic and Nebraska Medicine announce one of the first efforts to improve the patient experience using Apple’s first wearable device.


“We’re always looking for ways to improve the satisfaction of our patients,” said Michael Ash, M.D., chief transformation officer at Nebraska Medicine. “We recognize that as more of our patients use devices like the Apple Watch, we not only have to be able to use that technology to initially provide convenience for them, but we also have to envision how we can also improve patient outcomes via use of the device in the future.”


Epic’s MyChart app for Apple Watch, available now on the App Store, lets patients view messages from their care providers, upcoming appointment details, and information on their active medications. They can also see notices when new test results, billing statements and health maintenance reminders are accessible on their iPhones.


“It’s great to see Nebraska Medicine help lead the way on patient engagement with the Apple Watch,” says Sumit Rana, Epic’s senior vice president for research and development. “Wearables such as the Apple Watch have great potential to empower patients as active participants in their own healthcare and wellness while improving the overall care experience.”


Epic has development in the works based on the Apple Watch’s ability to “tap” wearers on the wrist to get their attention. Diabetic patients will be able to get reminders to test their blood sugar regularly, for example. Care organizations will also be able to use the watch to help patients get quicker access to high-demand specialty visits and services. Epic’s Fast Pass On the Go feature would allow a patient with an appointment three weeks out to get an Apple Watch alert if an earlier slot opens up – when another patient cancels an appointment, for example – and accept the new appointment time from the watch.


An Apple Watch app is also available for physicians who use Epic’s Haiku mobile application for the iPhone. Doctors can view their schedule, hospitalized patients and clinical summaries. They can also use Siri’s speech-to-text functionality to record a clinical note or a MyChart message to send to a patient.

more...
No comment yet.
Scoop.it!

Health IT Certification Policies Affect Healthcare Reforms

Health IT Certification Policies Affect Healthcare Reforms | Healthcare and Technology news | Scoop.it

Over the last five years, healthcare providers have had to pay greater attention to policy changes, meaningful use requirements, and ongoing ICD-1o transition delays as the nation worked toward reforming the medical sector to greater benefit patients and everyday citizens. Specifically, EHR implementation has been a great focus of the healthcare industry. Health IT vendors as well as federal agencies have focused on developing certified EHR technology through the Health IT Certification Program.


The Department of Health and Human Services (HHS) has recently issued a document detailing the submittal of test procedures and data under the Health IT Certification Program established by the Office of the National Coordinator for Health IT (ONC).


In early 2011, HHS established a certification program for health IT systems and EHR technology. In September of 2012, the program was renamed the “ONC HIT Certification Program.” At this point in time, HHS proposes to change the name of the program once again to the “ONC Health IT Certification Program.”


Over the last several years as the program operated, health IT designers have proposed that “testing efficiencies” could be garnered if the ONC Health IT Certification Program took advantage of operational testing including e-prescribing network testing.


“The National Coordinator is open to approving test procedures, test tools, and test data that meet the outlined approval requirements above for an applicable adopted certification criterion or criteria,” the HHS document proposal stated. “By way of this document, we strongly encourage persons or entities to submit such test procedures, test tools, and test data to ONC if they believe such procedures, tools, and data could be used to meet ONC’s certification criteria and testing approval requirements. We also note that there is no programmatic prohibition on the approval of multiple test procedures, test tools, and test data for a certification criterion or criteria.”


Along with the health IT certification program, some other new proposed guidelines on healthcare reform include the modified Stage 2 Meaningful Use requirements. As providers began moving toward attesting to Stage 2 Meaningful Use regulations, federal agencies began to see certain missteps with the requirements, which led them to modify the rulings.


Currently, the Centers for Medicare & Medicaid Services (CMS) has announced that public comments to the proposed Stage 2 Meaningful Use modifications are due by June 15, 2015. The proposed ruling changes certain requirements between the years 2015 to 2017 for those eligible professionals attesting to meaningful use under the Medicare and Medicaid EHR Incentive Programs.


Public comments can be submitted to CMS electronically, by courier, and by regular or express mail. Anyone interested in more information about the proposed ruling are encouraged to read themodifications to Stage 2 Meaningful Use requirements and view a factsheet on the CMS website.


As the healthcare industry continues toward a path of reform, federal agencies will likely continue developing new regulations and policies that will aim toward improving the quality of patient care, boosting health outcomes, and reducing medical spending.

more...
No comment yet.
Scoop.it!

Even Without Meaningful Use Dollars, EMRs Still Selling

Even Without Meaningful Use Dollars, EMRs Still Selling | Healthcare and Technology news | Scoop.it

I don’t know about you, readers, but I found the following data to be rather surprising. According to a couple of new market research reports summarized by Healthcare IT News, U.S. providers continue to be eager EMR buyers, despite the decreasing flow of Meaningful Use incentive dollars.


On the surface, it looks like the U.S. EMR market is pretty saturated. In fact, a recent CMS survey found that more than 80% of U.S. doctors have used EMRs, spurred almost entirely by the carrot of incentive payments and coming penalties. CMS had made $30 billion in MU incentive payments as of March 2015. (Whether they truly got what they paid for is another story.)


But according to Kalorama Information, there’s still enough business to support more than 400 vendors. Though the research house expects to see vendor M&A shrink the list, analysts contend that there’s still room for new entrants in the EMR space. (Though they rightfully note that smaller vendors may not have the capital to clear the hurdles to certification, which could be a growth-killer.)


Kalorama found that EMR sales grew 10% between 2012 and 2014, driven by medical groups doing system upgrades and hospitals and physician groups buying new systems, and predicts that the U.S. EMR market will climb to $35.2 billion by 2019. Hospital EMR upgrades should move more quickly than physician practice EMR upgrades, Kalorama suggests.


Another research report suggests that the reason providers are still buying EMRs may be a preference for a different technical model. Eighty-three percent of 5,700 small and solo-practitioner medical practices reported that they are fond of cloud-based EMRs, according to Black Book Rankings.


In fact, practices seem to have fallen in love with Web-based EMRs, with 81% of practices telling Black Book that they were happy with implementation, updates, usability and ability to customize their system, according to the Q2 2015 survey. Only 13% of doctor felt their EMRs met or exceeded expectations in 2012, when cloud-based EMRs were less common.


Now, neither research firm seems to have spelled out how practices and hospitals are going to pay for all of this next-generation EMR hotness, so we might look back at the current wave of investment as the time providers got in over their head again. Even a well-capitalized, profitable health system can be brought to its knees by the cost of a major EMR upgrade, after all.


But particularly if you’re a hospital EMR vendor, it looks like news from the demand front is better than you might have expected.

more...
No comment yet.
Scoop.it!

Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare

Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare | Healthcare and Technology news | Scoop.it

As Healthcare Informatics reported last month, the Office of the National Coordinator for Health Information Technology (ONC) released a report in early April that highlighted what the federal healthcare IT agency referred to as “information-blocking.” As Senior Editor Gabriel Perna noted in his April 10 report immediately following the release of the ONC document, “The report’s authors and researchers detailed several examples of electronic health record (EHR) developers and health systems blocking health information sharing between each other. The act of information blocking occurs when an entity or person knowingly and unreasonably interferes with the exchange of electronic health information. Examples of this,” he noted, “are charging prices and fees for data exchange; creating terms of a contract that restrict individuals access to their health information; developing health IT in a non-standard way that dissuades information sharing; and developing health IT in a way that locks in information.”


The ONC cited examples in its report of anecdotal evidence


suggesting that “EHR application developers are breaking several of the rules in this regard,” Perna’s report noted. “Using interviews with people at regional extension centers (RECs), the authors detailed complaints from industry sources on how developers are charging fees that make it cost-prohibitive to send, receive, or export electronic health information stored in EHRs. Some EHR developers even charge a substantial transaction fee any time a user sends, receives, or queries a patient’s electronic health information, the report says. The variation in prices reported to ONC suggests that some are taking advantage of the situation.”


In announcing the availability of the report, National Coordinator for Health IT Karen DeSalvo, M.D. noted in a blog on the agency’s website that it is difficult to pinpoint concrete evidence of information-blocking. “The full extent of the information blocking problem is difficult to assess, primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details,” she noted. “Still, from the evidence available, it is readily apparent that some providers and developers are engaging in information blocking,” she said.


Given all this, I read with interest a May 20 blog in Health Affairs online by Julia Adler-Milstein on this subject, because of the clear way in which she frames the dynamic tension taking place right now in the industry between the forces that would restrict information for profit or proprietary gain, and those that would advance it for the common good. AsAdler-Milstein, who is an assistant professor of information in the School of Information and an assistant professor of health management and policy at the School of Public Health at the University of Michigan, states very bluntly in her blog, “When it comes to sharing electronic patient health information, public good should trump private gain. While it may seem like an obvious statement, it represents a tectonic shift in the narrative surrounding health information exchange,” or HIE.


As Adler-Milstein notes, “For more than a decade, our federal strategy has largely left HIE to the market under the assumption that, if there is benefit to be created (and estimates suggest that there is), we should see the emergence of ways to capture that benefit. In practice, this means that HIE efforts have sprung up in various health care markets across the country, and where public money has been spent on HIE (largely at state and community levels), it has come in the form of one-time start-up funding, not a commitment of ongoing support or regulatory mandates for HIE participation.”


Here’s where Adler-Milstein really scores a home run on this, in my view: “What has been substantially underappreciated, however,” she writes, “is the fact that, for the key actors needed to enable HIE to occur—provider organizations and vendors—there might be more benefit, or at least more certain benefit, from not doing so. And as a result, these actors may behave in ways that interfere with the free-flow of patient information that is needed to improve health and health care.”


Instead, she says, “With the release of the information blocking report, which was produced in response to a 2015 Omnibus bill request that introduced the term ‘information blocking,’ ONC makes plain that this behavior will no longer be tolerated. This enormously exciting development means we might see real progress after decades of investment that has failed to convert into sustainable approaches to robust HIE. The key to such progress, however,” she warns, “lies in how well we can identify when information blocking is occurring. This will not be easy.”


And in those short paragraphs, we can see some of the core opportunities and challenges moving forward in this critical area. In this arena as in so many others in healthcare, we see a dynamic tension based on conflicting incentives within the U.S. healthcare system. On the one hand, there is broad consensus that data- and information-sharing will be essential to accountable care organization (ACO) development, population health management, bundled payment-facilitated care delivery, patient-centered medical home work, and indeed, every iteration of the new healthcare. Yet at the same time, there are many elements embedded even in those concepts that speak to at least short-term—and certainly arguably, medium-term as well—market advantages that can be gained through data- and information-hoarding.


It is this clash of incentives that we are collectively burdened with at this early stage of the trajectory towards the new healthcare. The rhetoric around healthcare policy right now is all about sharing for common gain, and yet the incentives in the moment are far from purely conducive to—well, purity.


That’s why it’s good to be reminded at times like this by elegantly concise writings like those of Julia Adler-Milstein. Adler-Milsteiin’s blog reminds us what the ultimate prize is, on which we should at least theoretically all be setting our eyes. This is not to engage in the laying of blame on those working for specific market advantage, but rather to affirm the need to continue to push forward collectively as an industry and indeed as a society, towards a more mature healthcare system—one in which all the incentives really all will be aligned. In other words, keep watching this space.

more...
No comment yet.
Scoop.it!

A positive view of health reform, no thanks to the HITECH Act

A positive view of health reform, no thanks to the HITECH Act | Healthcare and Technology news | Scoop.it

Recently I completed the Commonwealth Fund’s 2015 International Survey of Primary Care Doctors. They wanted to know what I thought about our health system; if fundamentally it worked or needed to be better. They asked questions about my satisfaction with practicing medicine, the quality of care my patients receive, and my experiences with electronic medical records. (You can click here to read through the 2012 survey, to get an idea of what it’s all about.)


Their final question was about health care reform.

“Thinking about the health care law that was passed in 2010, also known as the Affordable Care Act (ACA) or Obamacare, would you say that you have a very favorable opinion, somewhat favorable opinion, somewhat unfavorable opinion, very unfavorable opinion, or not sure.”

And I realized, as I answered this:


That I have a somewhat favorable opinion of the Affordable Care Act. It is good for patients to have access to health insurance, even though there are ongoing and severe issues with access to care.

I have a very unfavorable opinion of the much-less-talked about HITECH Act, that rolled out about the same time as the ACA, and which has profoundly shaped physician practice and patient access. The HITECH Act pays doctors to use electronic medical records in a meaningful way in order to spur the widespread adoption of EMRs. But it didn’t provide any oversight of the EMR market to ensure that the EMRs could provide meaningful functionality in an efficient way.


When we used paper charts, I used to be able to comfortably see 24 patients and finish charting by the end of the day. Now with the suboptimal EMR adopted by our health center, I can barely see twenty, and I have to spend extra hours on evenings and weekends finishing computer charting. Sadly, the EMR hasn’t added clinical functionality beyond what paper charts did — each system is still fragmented, I can’t access records from specialists’  offices or most hospitalizations, lab results may or may not be integrated into the system, radiology reports are scanned in — only now I have to slowly click through each separate screen, rather than riffling through a chart to find what I need. A colleague described the process: “Death by a thousand clicks.”


I am not alone in taking longer with EMRs. A 2014 study in JAMA Internal Medicine showed that, nationwide, physicians average an additional 48 minutes a daycharting when using EMRs. When it take physicians longer, we take, on average 2 hours longer each day. But there are outliers — two-fifths of physicians are taking the same amount of time, or less. 2 percent even report being much more efficient! What I want to know are — what EMR products are the physicians using who find EMRs equal to or more efficient than paper charts? And can I use those too?


Not all EMRs are created equal. I have worked with three different systems since residency — one was awesome (integrating records across a county system), one was equivalent to paper (same amount of time to chart, but same challenges in accessing records from different systems adopted in the ED, inpatient, outpatient). This last EMR has been terrible. Of the hundreds of products on the market, some EMRs are more efficient than others, and deliver on the promise of improved functionality. Sadly, those are the minority. Some of the products on the market are so bad that doctors sued the companies that sold them the dysfunctional EMRs. There are health centers that have gone out of business while trying to implement inefficient EMRs. Primary care physicians have been pushed out of practice by EMRs, contributing to our primary care shortage.


So how do I feel about health care reform?


The Affordable Care Act was health insurance reform, and I like its provisions ensuring coverage.


The HITECH Act was health record reporting reform, replacing functional paper systems with what sadly, too frequently, have been dysfunctional electronic medical records.  I have a very disfavorable opinion of the impact of incentivizing the adoption of any old EMR, without requiring that EMRs meet basic functionality requirements.


Together, the ACA and HITECH Act created a destructive environment for primary care doctors, where we take longer to see fewer patients when there are more patients to be seen. The mismatch of time and need are burning us out.


But let’s not blame our health care woes on Obamacare. Let’s blame it on HITECH, and seek to improve the functionality and efficiency of our electronic health records. We don’t need to appeal the ACA. We need to improve the HITECH Act, and ensure all EMRs on the market meet minimum standards out of the package, and that all systems can talk to each other to facilitate information exchange and better clinical care. Then we’ll get a healthier America, with happier primary care doctors. And I have a very favorable opinion of that prospect.

more...
No comment yet.
Scoop.it!

EHR roadblocks holding docs back

EHR roadblocks holding docs back | Healthcare and Technology news | Scoop.it

Anna Orlova, senior director, standards at AHIMA, compares the currentinteroperability of today's electronic health record systems to treadle sewing machines of the early 20th century.

"What we give physicians is a mechanical sewing machine," she says. "You just need to move your legs to create data. It shouldn't be that way."

Steven J. Stack, MD, president-elect of the American Medical Association, says difficulties exchanging and sharing data stem in large part from "an overabundance of measures with specifications that are unaligned," creating confusion for overburdened physician practices.

"A recent study found this uncoordinated approach resulted in too much variability in the large array of measures being promoted across the healthcare system," says Stack.

The study in question – "Effects of Health Care Payment Models on Physician Practice in the United States" – finds physicians faced roadblocks to data analytics caused by missing quality performance feedback or drug prices. The joint effort with RAND Corporation recommends addressing physician concerns about operational issues to improve the effectiveness of alternative payment models.

"The underlying problem is EHRs don't talk to each other very well," says lead author Mark Friedberg, a senior natural scientist at RAND. "The analogy is to train tracks. Each EHR is different," says Friedberg who notes that interoperability "has never been incentivized by the Office of the National Coordinator for Health IT."

Orlova underscores the importance of getting interoperability standards back on track.

"In the past six years, we've seen a derailing of government as leader in the private-public partnership of developing standards needed by physicians," she says. "We're so far behind half the world. Estonia is ahead of us."

Immature standards prevent existing health IT systems from cooperating, she adds.

"The government doesn't mandate standards," says Orlova. "We need to create interface standards for semantics, technical and functional." Instead, she points out, "standards today exist only for technical" aspects of interoperability.

Stack agrees. "Many of the exchange requirements and functional objectives, identified in these programs, are based on immature standards that are untested, under-developed or lack market consensus," he says.

"The federal government could incentivize and direct healthcare interoperability through policy measures, such asmeaningful use and the standards and interoperability framework, originated by the Health Information Technology Policy Committee.

"For the most part, data is being exchanged between EHRs in the form of large, unwieldy, multi-page documents that provide little value to physicians or their patients," says Stack. "ONC's certification program currently does little to ensure the successful end-to-end exchange of data between sites and services."

Meaningful use, he says, "has hindered, rather than bolstered (interoperability) across the nation."

However, Friedberg calls EHR certification one way interoperability could be enforced.

"Using the railroad analogy, all tracks have to have the same grade," he says. "For physicians to receive a bonus through meaningful use, they have to use certified EHR. Conceivably, that could put pressure on EHR vendors to become certified and ensure physicians are meeting MU requirements."

Orlova says it's a "crime" to put interoperability requirements in place without certification. "Certification must be in place and we have a good example of this in the IRS," she says. "Every time we file our taxes, we're certifying that we did it to the best of our ability."

Stack calls medical coding diagnostic changes in October "one more burden facing physicians," noting that "every certified EHR needs to have updated software to handle ICD-10 coding. There could be a considerable number of challenges during the transition.

"If a vendor doesn't have updated software ready, installed and deployed in time, physicians will be out of compliance with HIPAA and risk significant processing and financial interruptions," he says.

Simply put, "physicians shouldn't be struggling with this stuff," says Orlova. She believes that "the current ONCadministration and Congress understand the role of government as leader and facilitator." She expects collaboration between the AHIMA and HIMSS will result in a blueprint for interoperability standards within two years.

"Five years from now, we'll see activities take off," she says. "We're working to make this easier for physicians, as well as HIMSS. We have to be patient, but we know where we're going."

"Chasing data for uncoordinated measures requires significant time and resources that could be better spent on patient care or technology that practices need to achieve desired outcomes for patients," says Stack. "Efficient data flow is key. Data must drive the rapid cycle design and implementation of quality improvement efforts."

Friedberg thinks the best use of federal energy would be "in areas where there are needs for massive coordination. If everyone's off playing their own instruments, they need a conductor. Government could be that conductor."

more...
No comment yet.
Scoop.it!

Son's ICD-10 Software Helps Save Dad's Solo Practice

Son's ICD-10 Software Helps Save Dad's Solo Practice | Healthcare and Technology news | Scoop.it

Nitin Desai has the kind of medical practice you don't see much anymore. Desai, an internist, is the only physician in the practice in Columbus, Ga. His patients are like family; they know the staff personally and even have the doctor's cell phone number. Desai's wife, Bhavna Desai, is the practice manager, and his sons, Parth and Koosh, grew up in and around the practice, cutting the grass, helping out in the office, and developing a love for the practice of medicine that would led them both to medical school.

Sadly, increasing regulations and requirements for health information technology are making it more and more difficult to keep this kind of practice afloat. "I was under a lot of pressure to sell out to a hospital or join a group of other doctors," said Desai. "It is seriously hard to maintain a solo practice these days." Coming so soon after installing an EHR, the requirement to switch to ICD-10 was the last straw for Desai. Running a medical practice as a family business just didn't seem possible any longer.


Parth Desai, a first-year student at Mercer University School of Medicine in Macon, Ga., learned early about the business side of medicine. When he was just 16, health problems forced his mother to take a break from her duties as office manager. Parth stepped in to help out. His computer skills came in very handy, since neither of his parents is very computer savvy. When Parth heard about the ICD-10 transition, he knew that he could help with that, too.


Parth and his best friend, Will Pattiz, a computer programmer with experience developing training platforms and e-learning courses, built software that creates ICD-chart templates and converts codes from ICD-9 to ICD-10. For the 70 percent of codes that have one-to-one matching, conversion requires little more than the click of a button. For the 30 percent that are more complex, "You can go through and edit, fill in the codes you use, and customize as you go," Parth explained.

The pair's "ICD-10 Charts" software is quite valuable, with many practices seeking an easy way to convert to the new coding system. But Parth isn't aiming to make money from his software; he just wants to help his dad. "Dad has always helped me," he says simply.


One lesson Parth did not miss growing up in the heart of a community-focused medical practice was the imperative to help others. Parth and Pattiz have made the software available free on the Web [at www.icd10charts.com] for anyone who can use it. In addition, the Physicians Foundation, a nonprofit organization dedicated to advancing the work of physicians practices, has stepped in to fund the project. With the foundation's support, additional free resources, including free coding training, will be available soon. "The Physicians Foundation is also helping us spread ICD-10 Charts throughout the country so that the project can benefit as many struggling practices as possible," said Parth.


Meanwhile back home, Nitin Desai says his son's software has made a noticeable difference in his practice's bottom line. "We're okay for now." And in the long run? "The chances are very high," says Desai, "that the boys will come home and join the practice."

more...
No comment yet.
Scoop.it!

Can Middleware Technology Solve Healthcare’s Interoperability Problems?

Can Middleware Technology Solve Healthcare’s Interoperability Problems? | Healthcare and Technology news | Scoop.it

In February, Black Book Research’s annual health information exchange (HIE) stakeholder survey concluded that the current state of operative HIEs in the U.S. can best be described as “persistent unpredictability,” and the industry appears a ways away from achieving meaningful interoperability.


The survey revealed that while some simple healthcare information is being exchanged among parallel electronic health record (EHR) systems in pockets of communities, 94 percent of America’s providers, healthcare agencies, patients and payers persist as meaningfully unconnected in Q1 2015. Outside of their garden walled EHR networks, providers are dropping HIE as a priority, as evidenced by a 5 percent drop in regional connectivity from last year, the data showed.


What’s more, the federal government and healthcare stakeholders seem to be at odds when it comes to addressing interoperability issues. To this end, Donald M. Voltz, M.D., department of anesthesiology and medical director of the main operating room at Aultman Hospital in Canton, Ohio, says there is an answer that solves healthcare’s interoperability problems that other vertical markets such as retail, banking, and transportation have shown to work—middleware. Middleware is software that is used to connect one or more different software applications; it has been simplified as the glue or plumbing used to pass data between applications. It is currently being used to connect completely unrelated software into a single user-friendly interface, and also to connect legacy and emerging technology that have been developed using different designs, data models, or architecture, Voltz says.


A board-certified anesthesiologist, researcher, and medical educator with more than 15 years of experience in healthcare, Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices. “I wanted to try to solve these interoperability problems, but implementing processes that work both on the administrative hospital and health system side, and the clinical side, is almost impossible,” he says. “We’re constrained by whatever platform it is, be it a single EHR or multiple EHRs, based on what they bring to the table. You need to build systems that operate but also bring action to the data on the clinical side.”


Voltz says that EHRs are not smart systems, but are more about collecting data right now. They are still at the database level, he says. “We talk about putting business logic on top of them, but we’re not there yet in the sense that we haven’t addressed the needs of how we interact with the system or what kind of information can be collected from an ambient type interaction,” he says. “In anesthesia, there are issues with what am I documenting, when should I be documenting, and what’s being tracked in the EHR Open loops are putting us at risk from a medical legal standpoint but they are also blocking my ability to communicate with other providers that are taking care of the same patient.”


As such, middleware technology can connect to various pieces of information and develop on top of those connections without having to move or duplicate all of the data around it, Voltz says. Specifically, for the last several years, Voltz has been using software from the San Jose, Calif.-based Zoeticx, whose platform’s architectural design has been successfully used to link data from multiple databases, irrespective to the database platform or where the database is located, Voltz says. Essentially, it is a padding layer between EHR systems that provides interoperability, he notes. Voltz says there aren’t many “true” middleware solutions on the market today— the ones that are out there are more attempts at middleware but fall short as full platforms, and are thus more like messaging systems, he says. “They’re worried about interconnecting data but not addressing the problems in healthcare,” Voltz says. Nonetheless, earlier this year, the Plymouth Meeting, Pa.-based consulting company ECRI Institute dubbed middleware as one of 10 key technologies that healthcare CIOs need to be watching.


One of the problems that actually isn’t complained about by physicians, because they don’t know the term of it, is the concept of data provenance, Voltz continues. “I don’t know care where the data resides, but I need to know that it’s accurate or I’ll end up duplicating it,” he says.  Another problem, he adds, is not knowing who on the care team has addressed an issue—or if anyone even did. “As a surgeon for instance, I don’t even have access into the flow of an EHR system. So I don’t know who has looked at the information or what new information has bubbled to the top of an EHR system, whether that’s a consultant, a nurse putting in a concern about a patient, or a lab value that just came back.  So as an anesthesiologist, I’m sitting in the middle of this trying to orchestrate and coordinate not only the patient but how I allocate resources in the OR and how I respond to issues in the ER. There’s no way to do that well with an EHR system,” Voltz says


Middleware, on the other hand, allows Voltz to connect these systems and connect the people, and have a more efficient way to communicate with other providers or nurses that are on the care team, he says. “We can now message information even though it’s coming from disparate systems. So if I have Allscripts in one of the offices and Cerner in the hospital, I can connect those two in a secure and stable fashion, and get the data I need,” he says. For instance, currently says Voltz, he might need to get an EKG for comparison purposes at midnight in his office in order to make a decision on the fly. “Do I proceed with this patient without comparing an EKG or another lab value or do I not?  These are real issues right now and they are not solvable with our current platforms,” he says. Another example he gives is connecting an Epic platform to the McKesson drug dispensing system. “I shouldn’t have to be the connector where I have to manually re-enter all of the patient’s information and go through multiple allergy screens again on two different systems,” he says.

more...
No comment yet.
Scoop.it!

CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers

CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers | Healthcare and Technology news | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) issued final rules this week detailing how the agency will pay for services provided to beneficiaries in Medicare by physicians and other health care professionals in 2016 that reflects the administration’s commitment to quality, value, and patient-centered care. Payment rules for the 2016 calendar year for End-Stage Renal Disease Prospective Payment System, the Hospital Outpatient Prospective Payment System, Home Health Prospective Payment System, and the Physician Fee Schedule were all finalized this week.


“CMS is pleased to implement the first fee schedule since Congress acted to improve patient access by protecting physician payments from annual cuts. These rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers,” said CMS Acting Administrator Andy Slavitt. “We received a large number of comments supporting our proposal to allow physicians to bill for advanced care planning conversations and we are finalizing this rule accordingly.”

Key policies finalized in the 2016 payment rules include:

  • Finalizing the Home Health Value-Based Purchasing model. This model, authorized under the Affordable Care Act, is designed to improve health outcomes and value by tying home health payments to quality performance. All Medicare-certified home health agencies that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will participate in this model starting January 1, 2016. Compared to the proposed rule, the maximum payment adjustment in the first year of the model was reduced from 5 percent to 3 percent. This was part of the Home Health Prospective Payment System final rule.


  • Finalizing updates to the “Two-Midnight” rule. The rule clarifies when inpatient admissions are appropriate for payment under Medicare Part A. This continues CMS’ long-standing emphasis on the importance of a physician’s medical judgment in meeting the needs of Medicare beneficiaries by providing clearer guidelines and a more collaborative approach to education and enforcement. This was part of the Hospital Outpatient Prospective Payment System final rule.
  • Finalizing the End-Stage Renal Disease Quality Incentive Program. The End-Stage Renal Disease final rule will apply payment incentives to dialysis facilities to improve the quality of dialysis care. Facilities that do not achieve a minimum total performance score with respect to quality measures, such as anemia management, patient experience, infections, and safety, will receive a reduction in their payment rates. 
  • Beginning the new physician payment system post the Sustainable Growth Rate (SGR) formula and supporting patient- and family-centered care. This is the first final Physician Fee Schedule final rule since the repeal of the SGR formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Through the final rule, CMS is beginning implementation of the new payment system for physicians and other practitioners, the Merit-Based Incentive Payment System, required by the legislation.
  • Finalizing provision to empower patients and their families regarding advance care planning. Consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress, CMS is finalizing its proposal that supports patient- and family-centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers.
more...
No comment yet.
Scoop.it!

Hospitals press HHS on meaningful use

Hospitals press HHS on meaningful use | Healthcare and Technology news | Scoop.it

Their patience wearing thin, a group of leading hospital organizations have implored Health and Human Services Secretary Sylvia Mathews Burwell to publish pending meaningful use modifications sooner rather than later.

In a letter this past week that CC'd Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt, eight hospital groups urged CMS "to release, in the immediate future," final rule modifications to meaningful use for fiscal years 2015 to 2017.

"The rule is past due, given that it will affect the current program year for meaningful use," according to the letter, co-signed by America's Essential Hospitals, American Hospital Association, Association of American Medical Colleges, Catholic Health Association of the United States, Children's Hospital Association, Federation of American Hospitals,Premier healthcare alliance and VHA Inc.

"Indeed, under current rules, meaningful use applies to fiscal year performance for hospitals. FY 2015 ends on Sept. 30 – fewer than 60 days from now," they write.


CMS recently floated a proposal to shift meaningful use reporting to the calendar year. Even then, however, "the last possible reporting period would begin on Oct. 3," according to the letter.


"Even if reporting is moved to a calendar year, hospitals need the certainty of a final rule now to determine the best reporting period to choose and begin the process of reviewing performance and ensuring they have met all of the revised requirements."


While recent proposed changes to MU, such as a 90-day reporting period for FY 2015 and simplified patient electronic access requirements are appreciated, the hospitals want CMS to quickly "finalize those changes as proposed."


They object to other proposals, however – mandating the e-prescribing of discharge medications, requiring new public health reporting measures – that "would make meeting Stage 2 more difficult."


Not to mention the fact that "given the delay in the release of a final rule, they would be virtually impossible for hospitals to accommodate."

Without quick action from the feds, hospitals "simply will not have sufficient time to understand the new requirements, work with their vendors to purchase and implement new or revised technology that would accommodate them, and invest in the training and work flow changes necessary to meet the new requirements," according to the letter.

more...
No comment yet.
Scoop.it!

Epic at work on new tech to avert falls

Epic at work on new tech to avert falls | Healthcare and Technology news | Scoop.it

Healthcare IT giant Epic is working on a clinical decision tool aimed at helping healthcare providers reduce the risk of falls in unsteady patients. The technology is expected to be ready and available to Epic's EHRclients by year's end.


Longtime Epic customer Kaiser Permanente will roll out the tool at its facilities across the country and will also make its evidence-based falls prevention program widely available to other health systems and health plans.

The technology is called STEADI, an acronym for Stopping Elderly Accidents, Deaths & Injuries. The tool is being designed based on CDC's guidelines for falls assessment. The goal is to make it easier for healthcare providers to screen for falls, intervene to reduce risk and provide follow-up care.


The announcement came at the end of a White House Fact Sheet released this morning regarding The White House Conference on Aging, which President Barack Obama is hosting today.


The sweeping conference agenda focuses on issues facing Americans as they plan for retirement. Many of the measures proposed build on the Affordable Care Act and on efforts to improve Medicare and Medicaid.


"In a year that marks the 50th anniversary of Medicare, Medicaid and the Older Americans Act, as well as the 80th anniversary of Social Security, the White House Conference on Aging is an opportunity to recognize the importance of these programs, highlight new actions to support Americans as we age and focus on the powerful role that technology can play in the lives of older Americans in the decade ahead," the White House announced.

Federal data to be released

The Administration announced that by September 2015, federal data sets relevant to aging and to elderly Americans would be made easily available on Data.gov, the repository for the U.S. government's open data. This resource will continuously be updated with datasets on aging, much like it is for other important Administration priorities such as climate, public safety and education. 

Health IT efforts

Like Epic's several of the planned initiatives surrounding the aging initiative have healthcare IT underpinnings. These are put forward by the private sector:


  • As part of its annual HackFest, LeadingAge, an association of 6,000 not-for-profit organizations and businesses representing a broad field of aging services, will partner with Hewlett-Packard using HP's 3D immersive computing platform and Federal open data to challenge innovators to create technology-driven tools to improve the lives of older adults and their families.
  • The employer coalition ReACT (Respect a Caregiver's Time), Care.com and the Massachusetts Institute of Technology are joining forces to generate the tools employers need to effectively support employees who are caregivers. MIT and Care.com will jointly conduct a case study based on MIT's approach to employer-supported elder care. 
  • Uber is announcing pilot programs in Florida, Texas, Ohio, Arizona and California that will partner with senior community centers and other advocates to provide free technology tutorials and free or discounted rides to older Americans to increase access to transportation options and support mobility and independence.
  • Airbnb has conducted research to support and understand the experience of older Americans in their travels and in their use of technology and is partnering with communities to enhance accessibility and the user experience for older populations. 
  • Walgreens has made advancements in its digital technologies to connect individuals with its telehealth services provider, which offers 24/7 access to U.S. board-certified doctors.  Seniors also can track their health behavior with personal wellness smartphone technologies from Walgreens and WebMD.
  • Peapod has adopted "best in class" Web accessibility standards to ensure that all individuals, including those with disabilities and those who are unable to shop at traditional stores, can use its website and mobile applications. 
  • Honor, a tech-enabled company that matches seniors with care professionals, will offer $1 million in free home care across 10 cities in the country and work with established care providing organizations in those communities to ensure this care goes to helping older Americans. 
  • The University of Washington's School of Nursing and the HEALTH-E (Home-based Environmental Assisted Living Technologies for Healthy Elders) initiative are introducing an Aging and Technology Laboratory, which includes hardware and software tools to support participatory design of technology for older adults.  The laboratory will allow scientists, engineers, and others to engage older adults and their families to accelerate the generation of new solutions to support aging.
  • The Stanford Center on Longevity will develop a State of Longevity Index to be released in early 2016 that will measure how well the U.S. is doing to improve the prospects for long-term well-being in financial security, physical health, social connectedness, educational attainment, and age-friendly communities. 
  • IDEO is announcing the launch of "The Powerful Now," a project to build a cross-sector collaboration around positive aging for all.


Among the planned government initiatives are.


  • Facilitating state efforts to provide workplace-based retirement saving opportunities: About a third of the workforce lacks access to a workplace retirement plan, the White House notes. That's why, in every budget since taking office, the President has put forth proposals to provide access for 30 million Americans to workplace-based retirement savings by requiring employers not currently offering a retirement plan to automatically enroll their workers in an IRA.  But in the absence of Congressional action, the states are leading the charge.
  • Launching Aging.gov – today: The intent is to provide older Americans, their families, friends and other caregivers, a one-stop resource for government-wide information on helping older adults live independent and fulfilling lives.
  • Modernizing federal rules that affect long-term care, healthy aging and elder justice: Steps announced today include: a new Centers for Medicare and Medicaid Services proposed rule to update, for the first time in nearly 25 years, the quality and safety requirements for more than 15,000 nursing homes and skilled nursing facilities to improve quality of life, enhance person-centered care and services for residents in nursing homes, improve resident safety, and bring these regulatory requirements into closer alignment with current professional standards.
more...
No comment yet.
Scoop.it!

CVS to connect with health systems via Epic

CVS to connect with health systems via Epic | Healthcare and Technology news | Scoop.it

CVS Health has partnered with four health systems nationwide to provide them patient prescription and visit information, securely sharing data through its Epic electronic health record system.

CVS has entered into new clinical affiliations with Sutter Health in California, Millennium Physician Group in Florida, Bryan Health Connect in Nebraska and Mount Kisco Medical Group in New York.

Through the partnerships – which bring the number of clinical collaborations for CVS Health and MinuteClinic to nearly 60 major health systems – these organizations' patients will continue to have access to clinical support, medication counseling, chronic disease monitoring and wellness programs at CVS/pharmacy stores and MinuteClinic, the retail medical clinic of CVS Health, officials say.


These providers will receive data on interventions conducted by CVS pharmacists, with the aim of improving patients' medication adherence for their patients. The affiliation encourages collaboration between the health systems and MinuteClinic providers to improve coordination of care for patients seen at MinuteClinic locations.


Affiliate organizations and MinuteClinic practitioners will also work together on planning strategies around chronic care and wellness, officials say: If more comprehensive care is needed, patients can follow up with their primary care provider and have access to the services at the health care provider as appropriate.


"In this era of health care reform, we are pleased to work with these health care organizations to develop collaborative programs that enhance access to patient care, improve health outcomes and lower healthcare costs in the communities they serve," said CVS Health Chief Medical Officer Troyen A. Brennan, MD, in a press statement.

MinuteClinic, CVS/pharmacy and participating providers will work to streamline and enhance communication through their EHRs, such as the electronic sharing of messages and alerts from CVS/pharmacy to the health care organizations' physicians regarding medication non-adherence issues. MinuteClinic will electronically share patient visit summaries with patients' primary care physician when they are part of an affiliate organization and with the patient's consent.


"By allowing our electronic health records and information systems to communicate and share important information about the patients we collectively serve, we will have a more comprehensive view of our patients, which can aid in health care decision making and help ensure patients adhere to important medications for chronic diseases," said Brennan.

more...
No comment yet.
Scoop.it!

Doctors, Not Patients, May Be Holding Back mHealth Adoption

Doctors, Not Patients, May Be Holding Back mHealth Adoption | Healthcare and Technology news | Scoop.it

Clearly, mHealth technology has achieved impressive momentum among a certain breed of health-conscious, self-monitoring consumer. Still, aside from wearable health bands, few mHealth technologies or apps have achieved a critical level of adoption.


The reason for this, according to a new survey, may lie in doctors’ attitudes toward these tools. According to the study, by market research firm MedPanel, only 15% of physicians are suggesting wearables or health apps as approaches for growing healthier.


It’s not that the tools themselves aren’t useful. According to a separate study by Research Now summarized by HealthData

Management, 86% of 500 medical professionals said mHealth apps gave them a better understanding of a patient’s medical condition, and 76% said that they felt that apps were helping patients manage chronic illnesses. Also, HDM reported that 46% believed that apps could make patient transitions from hospital to home care simpler.


While doctors could do more to promote the use of mHealth technology — and patients might benefit if they did — the onus is not completely on doctors. MedPanel president Jason LaBonte told HDM that vendors are positioning wearables and apps as “a fad” by seeing them as solely consumer-driven markets. (Not only does this turn doctors off, it also makes it less likely that consumers would think of asking their doctor about mHealth tool usage, I’d submit.)


But doctors aren’t just concerned about mHealth’s image. They also aren’t satisfied with current products, though that would change rapidly if there were a way to integrate mobile health data into EMR platforms directly. Sure, platforms like HealthKit exist, but it seems like doctors want something more immediate and simple.


Doctors also told MedPanel that mHealth devices need to be easier to use and generate data that has greater use in clinical practice.  Moreover, physicians wanted to see these products generate data that could help them meet practice manager and payer requirements, something that few if any of the current roster of mHealth tools can do (to my knowledge).


When it comes to physician awareness of specific products, only a few seem to have stood out from the crowd. MedPanel found that while 82% of doctors surveyed were aware of the Apple Watch, even more were familiar with Fitbit.


Meanwhile, the Microsoft Band scored highest of all wearables for satisfaction with ease of use and generating useful data. Given the fluid state of physicians’ loyalties in this area, Microsoft may not be able to maintain its lead, but it is interesting that it won out this time over usability champ Apple.

more...
No comment yet.
Scoop.it!

How hard is it to 'Get My Health Data'?

How hard is it to 'Get My Health Data'? | Healthcare and Technology news | Scoop.it

"We the people want easy, electronic access to our health information."

That's the seemingly simple objective for supporters of Get My Health Data, a new initiative organized by former National Coordinator for Health IT Farzad Mostashari, MD.

Folks like ePatientDave, Regina Holliday, and other patient advocates have spent years fighting for better patient access to health data, but support for the movement has reached new heights, thanks to recently proposed changes to themeaningful use program.

In April, CMS stirred up the patient data access hornets' nest by proposing a modification to the Stage 2 meaningful use requirement that 5 percent of a provider's patient population views, downloads, or transmits their online health information.

Many providers thought the bar was too high because few patients were interested in accessing their health information online. CMS responded to provider concerns by reducing the threshold from 5 percent to one single patient.

The proposal caused a bit of an uproar as patient advocates decried that one patient was not enough. Mostashari quickly called for a "day of action" to show opposition to the proposed changes.

Earlier this month Mostashari expanded on the plans for the renamed "Data Independence Day," scheduled for the fourth of July. Organizers are hoping that the one day event will actually spur a larger movement with consumers demanding access to their health data. The intent is to demonstrate to lawmakers, providers, and other decision makers that people do care about electronic access to their health information.

The Get My Health Data movement is asking consumers to sign a petition demanding convenient, secure online access to their health data. In addition, the organization is looking for patients to serve as "tracers" by requesting access to their records and reporting on the response.

I was curious how my family's doctors would comply with such a request, so I reached out to four of them. Here's how it went:

  • Primary care physician. My family practice is part of a large group that utilizes Epic's MyChart patient portal. I accessed the portal and was able to easily view and download my health summary in a format that was very user-friendly. This is how it the process should work.
  • Specialist #1. My gastroenterologist uses gMed EHR and its gPortal. I accessed the portal and easily pulled up my health summary. While it included basic details on my health history, it lacked a few critical elements, such as diagnostic test results. I had the option to email a copy of my medical summary to anyone I chose, as long as they used a secure email with a Direct protocol address. I was also able to download the summary but it came over as a .XML file that was nearly impossible to decipher. I messaged the practice about getting a more user-friendly version of my records and received a quick reply that they could either mail me a hard copy or I could pick up a copy in person. Unfortunately there was no option for a more complete electronic version. All and all this practice came close to delivering what I needed and they get bonus points for being so responsive.
  • Specialist #2. My daughter's endocrinologist uses the Medfusion portal. Actually, it's probably more accurate to say they have the portal installed but it's obviously underutilized. There is no option for accessing medical histories, though you could request lab results or medication refills, as well as pay bills online. You can send a message, so I sent a note asking for an electronic copy of my daughter's records. I wasn't optimistic I would get a response since I have sent them five messages over the last year, none of which appear to have been opened, much less replied to (I ended up calling.) It's been four days since I requested the records and so far no response. I'm calling this a failure.
  • Specialist #3.  Basically ditto to Specialist #2. Nothing is available online and no one responds to my messages.
     

My takeaways:

  • The technology exists to provide patients with easy online access to their medical data.
  • Some providers are a little behind on the technology curve but making good progress.
  • Shame on providers that implement technology to engage patients and then abandon the project. Patients like me use the online messaging option either because the office is not opened at an hour convenient to me, or because I am avoiding a confusing phone system – which never connects me to a live person.

  • Everyone should take 30 seconds and sign the Get My Health Data petition. We all deserve easier and less frustrating access to our health information.
more...
No comment yet.
Scoop.it!

Preventing Physician Burnout

Preventing Physician Burnout | Healthcare and Technology news | Scoop.it

In a cross-sectional survey ("Predictors of physician career satisfaction, work-life balance, and burnout," Obstetrics & Gynecology) of randomly selected physicians from across the country just under half of all respondents indicated that they were satisfied with their work-life balance, and half of respondents indicated that they felt some level of emotional "resilience." It turns out that the lack of these two factors plays a significant role in the development of physician burnout; a syndrome that occurs when a person is under constant pressure, and is marked by emotional exhaustion, cynicism, feeling ineffective in one's work, and experiencing interpersonal difficulties. Burnout in physicians, which has been on the rise, has been linked to impaired job performance, poor health, marital difficulties, and alcohol or substance abuse.

The good news is that there are strategies that can be taken to significantly reduce the incidence and negative effects of burnout. Factors that are critical to combating burnout are having control over one's schedulethe number of hours worked, and emotional resilience. Unfortunately, in this current era of healthcare reform, controlling the first two factors can be quite challenging, but not impossible, if one takes a conscious and deliberate approach to managing priorities and time. Many physicians find that they spend a significant amount of time on activities that do not provide enough value — one way to think about this is to determine your "time ROI" (return on investment).


Follow these five steps to significantly improve your work-life imbalance:


1. Identify the five to eight most important aspects of your life (what you value most).

2. Now determine how much time you devote to those areas (and how much time is spent in areas not on your list).

3. If there is a disconnect between what you value and how you spend your time, this is a signal to you to make changes in your life.

4. Plan your time so that you are focused on what you value most.

5. Determine what can be delegated to others.


Preventing burnout also involves developing emotional resilience — the ability to manage stressful situations effectively and prevent stress from building up. For this we turn to some interesting research from the field of neuroscience that explores the link between stress, sleep, and positivity. These three factors have an interdependent relationship with one another — cause a change in one, and the other two are impacted.


So for example, the more stress in your life, the worse your sleep and mood. If you get too little sleep, then you will experience more stress and a lowered mood. In general, it can be difficult to derive meaningful change in the first two factors, sleep and stress, but much easier to have an impact on the latter one — positivity. If you are able to increase positivity, you will experience a significant improvement in sleep and a significant reduction in stress (negative emotional state).


Follow these simple brain-training steps to increase your positivity:


1. Practice positive "self-talk" by cultivating self-encouragement optimism, recognizing accomplishments, and appreciating good fortune.

2. Challenge your negative (typically distorted) thinking, the most common of which are:


• Catastrophic thinking. Identify a more realistic assessment of the situation. Usually, things are not as bad as we think they are. And often, our greatest learning comes from adversity.

• Black and white thinking. Challenge all-or-nothing thinking. Usually there is some gray area to work with. It is very seldom absolute.

• Jumping to conclusions. Avoid leaping to a foregone conclusion, such as thinking you know what others must be thinking. Learn to get curious, ask questions, and look for alternative explanations.

• Over generalizing. Look for a more accurate appraisal of the situation. When we look more closely at situations, we often find that negative or stressful outcomes are limited to that event, not generalizable across all situations.

• Excessive criticism. Whenever you hear yourself thinking, "should," substitute "it would be nice." This allows you to avoid excessive self-criticism or the belief that there is only one solution.

Changing thinking leads to changes in behaviors which leads to changes in results. So the easiest and most efficient method to change the results you are getting is to engage in positive and constructive thought patterns. As you transform your thoughts, you actually create an alteration in the neural connections in your brain. This in turn, leads to the development of new habits, ensuring that the changes you create are lasting ones.

more...
Dan Diamond, MD's curator insight, June 12, 2015 2:16 PM

I also suggest that people have a team of at least 10 people that will encourage and challenge them. If you team is too small, it is easy to burn them out. Write the name of your ten on paper and post it on the back of your medicine cabinet. Reconnect, stay connected. 

Scoop.it!

Health IT Certification Policies Affect Healthcare Reforms

Health IT Certification Policies Affect Healthcare Reforms | Healthcare and Technology news | Scoop.it

Over the last five years, healthcare providers have had to pay greater attention to policy changes,meaningful use requirements, and ongoing ICD-1o transition delays as the nation worked toward reforming the medical sector to greater benefit patients and everyday citizens. Specifically, EHR implementation has been a great focus of the healthcare industry. Health IT vendors as well as federal agencies have focused on developing certified EHR technology through the Health IT Certification Program.


The Department of Health and Human Services (HHS) has recently issued a document detailing the submittal of test procedures and data under the Health IT Certification Program established by the Office of the National Coordinator for Health IT (ONC).


In early 2011, HHS established a certification program for health IT systems and EHR technology. In September of 2012, the program was renamed the “ONC HIT Certification Program.” At this point in time, HHS proposes to change the name of the program once again to the “ONC Health IT Certification Program.”


Over the last several years as the program operated, health IT designers have proposed that “testing efficiencies” could be garnered if the ONC Health IT Certification Program took advantage of operational testing including e-prescribing network testing.


“The National Coordinator is open to approving test procedures, test tools, and test data that meet the outlined approval requirements above for an applicable adopted certification criterion or criteria,” the HHS document proposal stated. “By way of this document, we strongly encourage persons or entities to submit such test procedures, test tools, and test data to ONC if they believe such procedures, tools, and data could be used to meet ONC’s certification criteria and testing approval requirements. We also note that there is no programmatic prohibition on the approval of multiple test procedures, test tools, and test data for a certification criterion or criteria.”


Along with the health IT certification program, some other new proposed guidelines on healthcare reform include the modified Stage 2 Meaningful Use requirements. As providers began moving toward attesting to Stage 2 Meaningful Use regulations, federal agencies began to see certain missteps with the requirements, which led them to modify the rulings.


Currently, the Centers for Medicare & Medicaid Services (CMS) has announced that public comments to the proposed Stage 2 Meaningful Use modifications are due by June 15, 2015. The proposed ruling changes certain requirements between the years 2015 to 2017 for those eligible professionals attesting to meaningful use under the Medicare and Medicaid EHR Incentive Programs.


Public comments can be submitted to CMS electronically, by courier, and by regular or express mail. Anyone interested in more information about the proposed ruling are encouraged to read themodifications to Stage 2 Meaningful Use requirements and view a factsheet on the CMS website.


As the healthcare industry continues toward a path of reform, federal agencies will likely continue developing new regulations and policies that will aim toward improving the quality of patient care, boosting health outcomes, and reducing medical spending.

more...
No comment yet.
Scoop.it!

Health apps fall short in telling us how they use our data

Health apps fall short in telling us how they use our data | Healthcare and Technology news | Scoop.it

Health apps are capturing increasing amounts of information about us. And it’s a lot more than medical history. We’re often asked to enter our names, address, real-time location, height, weight, date of birth, and other demographic information into the app.


A recent study raises some serious concerns about how all of that information is being used.


The way that a developer will use the information collected by the app is usually spelled out in a Privacy Policy. To get a better sense of how information use is being disclosed, researchers from the University of Cologne in Germany and Boston Childrens Hospital looked at the 300 most popular apps in iTunes and Google Play (600 apps total).


An impressive 70% of apps lacked a privacy policy; slightly more iOS apps had privacy apps than Android apps (38% vs. 23%, p<0.001). And of the apps that did have a privacy policy, nearly two thirds described the developer or topics unrelated to the app itself. For the privacy policies that were found, most were written at a very high reading level.


A limitation here is that the researchers didn’t look specifically at what types of information these apps are collecting. That said, most apps can collect at least some information about us – even if we don’t specifically enter more information. And we should be able to quickly assess how that information could be used.


The study indexed apps for evaluation in May 2013 so hopefully things have changed for the better since then. However, it’s an important reminder that a privacy policy – particularly for apps that we enter personal information into – is something that we should all be looking for.

more...
No comment yet.
Scoop.it!

Partners Goes With $1.2B Epic Installation

Partners Goes With $1.2B Epic Installation | Healthcare and Technology news | Scoop.it

After living with varied EMRs across its network for some time, Boston-based Partners HealthCare has decided to take the massive Epic plunge, with plans to spend an estimated $1.2 billion on the new platform. That cost estimate is up from the initial quite conservative spending estimate from 3 years ago of $600M, according to the Boston Globe.


As is always the case with an EMR install of this size, Partners has invested heavily in staff to bring the Epic platform online, hiring 600 new employees and hundreds of consultants to collaborate with Epic on building this install. The new hires and consultants are also tasked with training thousands of clinicians to navigate the opaque Epic UI and use it to manage care.


The move comes at the tail end of about a decade of M&A spending by Partners, whose member hospitals now include Brigham & Women’s Hospital, Massachusetts General Hospital, the Dana-Farber Cancer Institute, McLean Hospital, Spaulding Rehabilitation Hospital and the North Shore Hospital.


The idea, of course, is to create a single bullet-proof record for patients that retains information no matter where the patient travels within the sprawling Partners network. Partners can hardly manage the value-based compensation it can expect to work with in the future if it doesn’t have a clear patient-level and population level data on the lives it manages.


Even under ideal circumstances, however, such a large and complex project is likely to create tremendous headaches for both clinical and IT staffers. (One might say that it’s the computing equivalent of Boston’s fabled “Big Dig,” a gigantic 15-year highway project smack in the middle of the city’s commuting corridor which created legendary traffic snarls and cost over $14.6 billion.)


According to a report in Fortune, the Epic integration and rollout project began over the weekend for three of its properties, Brigham & Women’s, Faulkner Hospital and Dana Farber. Partners expects to see more of its hospitals and affiliated physician practices jump on board every few months through 2017 — an extremely rapid pace to keep if other Epic installs are any indication. Ultimately, the Epic install will extend across 10 hospitals and 6,000 doctors, according to the Globe.


Of course, the new efforts aren’t entirely inward-facing. Partners will also leverage Epic to build a new patient portal allowing them to review their own medical information, schedule appointments and more. But with any luck, patients will hear little about the new system going forward, for if they do, it probably means trouble.

more...
No comment yet.
Scoop.it!

Electronic Health Records: Their Time Has Come

Electronic Health Records: Their Time Has Come | Healthcare and Technology news | Scoop.it

In 1991, when portable computers were the size of sewing machines and the World Wide Web was aborning, the Institute of Medicine proposed a plan for how emerging technologies could be used to improve medical recordkeeping. The plan highlighted the potential of health information systems in general, and computer-based patient records specifically, to support health care professionals as they make decisions at the point of care. It also called for developing a national health information infrastructure. The goal was to achieve ubiquitous use of such patient records by all U.S. health care delivery organizations by 2001.


The goal was overly ambitious. But the proposed plan proved to be an important milestone in the evolution of thinking about patient data and the health information infrastructure needed within organizations and the nation. And such thought is now turning into action. In early 2009, with passage of the American Recovery and Reinvestment Act, the government committed its first serious investment in electronic health records (EHRs) and in developing a national health information infrastructure. The act calls for achieving widespread use of EHRs by 2014, and it provides $36 billion to support the use of EHRs in clinical settings and another $2 billion to coordinate their implementation.


EHRs are much more than computer-based versions of paper medical records or stand-alone data repositories, and their successful implementation is not without challenges. Indeed, the federal government’s newly appointed national coordinator for health information technology, David Blumenthal, said in his first public statement that technical assistance is a “critical factor” in advancing EHRs to reduce health risks.


As an illustration of how EHRs and EHR systems may bring about multiple benefits in medicine, consider how two other industries have used similar technologies to provide convenient, efficient, and customer-centered services. In the banking industry, automatic teller machines and online Web sites provide customers with ways to conduct their banking when and where they choose and with confidence that their personal information is protected. Banks also provide alerts to customers about sensitive activity in their accounts and reminders about payment deadlines. These easy-to-use tools depend on a secure, seamless information infrastructure that enables data to cross organizational and national lines. In the online retail industry, companies such as Amazon.com not only offer convenience in shopping but also provide personalized shopping recommendations based on past purchases or selections made by other customers who have shown similar interests. This feature depends on the ability to capture and analyze data on individual and population levels. Amazon also provides a mechanism for used-book sellers to offer their products via its Web site—a process that is possible, in part, because there is a shared format (technically, interoperability standards) for the information presented to customers.


Now consider how data, information, and knowledge could securely and seamlessly flow through health care organizations. As a case in point, begin with a patient who has a chronic condition and is tracked by an electronic record of her health history, including any unusual symptoms, an accurate list of numerous medications, and reminders of when lab work is needed to ensure that the medications are not causing kidney damage. Lab results are forwarded directly to her electronic health record, which is maintained by her primary care clinician. If lab results are outside of the normal range, the physician receives an alert and, in turn, sends the patient an e-mail requesting that she repeat the lab work and schedule an appointment.


During the appointment, the physician has a comprehensive view of the patient’s health history and receives a reminder that the recommended protocol for treating her condition has been changed. After reviewing options with the patient, the physician prescribes a new medication, and the prescription is sent directly to the patient’s preferred pharmacy and to the patient’s EHR. The physician also recommends increased physical activity, and so the patient elects to receive weekly exercise programs and commits to recording her daily exercise in her health record.


After the visit, selected data elements without personal identifiers are automatically forwarded to a larger population data set maintained by the health organization in which the physician works. The organization can use the data to compare outcomes for its patients to regional or national benchmarks. For example, a hospital may learn that its post-surgery infection rate is higher than the national trend and then compare its practices to those used by other organizations with lower infection rates. Or a physician practice group may learn that its outcomes for a particular diagnosis meet national norms, but that there are less expensive alternatives that yield comparable results.


On a broader scale, outside authorized users—say, university researchers—can access the population data in conducting clinical research. Pooling data from an entire region or state, or even nationwide, will enable more comprehensive and efficient research on the effectiveness of treatments and clinical processes. For example, bioinformaticians might benefit from using large data sets as they seek to advance the intellectual foundation of medicine from its current focus on organs and systems to one based on molecules. Public health professionals can use the data to monitor health trends across various populations. Further, selected EHR data elements may flow into biosurveillance systems so that analysts can detect new outbreaks of disease, whether due to natural infections or bioterrorism.


For the full impact of EHRs and EHR systems to be realized, the results from these studies, when fully verified, must flow back to clinical professionals and patients so that they can base their decisions on the most current knowledge available. This cycle of using knowledge to support decisions, capturing data on the outcomes of those decisions, analyzing the data, and using insights gained to refine the knowledge base is the essence of how to develop a “learning” health care system that is safe, timely, efficient, effective, equitable, and patient-centered. EHRs are the beginning and end of that cycle. Each time that an EHR is used, there is an opportunity to enhance current and future decisions. But EHRs are only a part of the complex infrastructure that is needed to enable learning cycles within health care organizations across the country.

more...
No comment yet.
Scoop.it!

The Mobile Patient: How mHealth Tools are Paving the Way for Better Care Management

The Mobile Patient: How mHealth Tools are Paving the Way for Better Care Management | Healthcare and Technology news | Scoop.it

In the new healthcare, one which emphasizes comprehensive, team-based and accessible care, provider organizations will need to make concerted efforts to become more patient-centered.  For many providers, patient engagement is no easy task, but it’s certainly at the top of mind for healthcare CIOs.


Indeed, according to findings of the 26th Annual HIMSS Leadership Survey, sponsored by the Chicago-based Healthcare Information and Management Systems Society (HIMSS) and released at the annual HIMSS conference this past April, patient satisfaction, patient engagement, and quality of care improvement have raced to the top of healthcare CIOs’ and senior IT executives’ agendas in the past year, a stark change from previous years which found that health IT leaders were more focused on business and financial goals. Nonetheless, it’s been a struggle for physicians to truly engage their patients, especially the 45 percent of U.S. adults with at least one chronic condition.


Enter the world of mobile health (mHealth) to help with care management and patient engagement, a growing trend in healthcare. In fact, another recent survey from HIMSS found that more than 90 percent of survey respondents are utilizing mobile devices within their organizations to engage patients in their care. The fourth annual HIMSS mobile survey, which included more than 200 healthcare provider employees, revealed that 73 percent of respondents believe the use of app-enabled patient portals has been the most effective tool in patient engagement to date.


Further, when asked about patient-generated health data (PGHD), 14 percent reported that all or most data generated by mobile devices is integrated into the electronic health record (EHR), while 52 percent reported that some data has been integrated into the medical record. “mHealth continues to evolve as a tool to drive healthcare efficiencies. The proposed meaningful use Stage 3 rule realizes this with the concept of application program interfaces (APIs) and patient-generated health data, and this year’s survey showed that the wide spread availability of mobile technology has had a positive impact on the coordination of patient care,” said David Collins, senior director of the HIMSS mHealth community.


Analysts do predict that the wearables market will grow tenfold to $50 billion over the next three to five years. So undoubtedly, putting personal devices in the hands of patients has begun to change the way patients and physicians communicate with each other. And for each of the major smartphone operating systems, there is now an app for almost every conceivable healthcare need.


What’s more, there are policy implications to consider as well. As HIMSS’ Collins mentioned, the recent meaningful use Stage 3 proposal that calls for more that 15 percent of patients to contribute PGHD or data from a non-clinical setting into the certified EHR technology during the EHR reporting period, will put the onus on providers to collect information from patients, often captured from exercise or fitness devices or recorded on mobile apps.


What does all this mean? For forward-thinking providers, it’s about getting patients to use mHealth tools for more effective care management. Mobile health tools have the potential to create a low-cost stream of highly actionable clinical data, using readily available cloud-connected sensors, ranging from glucose meters to heart monitors to asthma tools. To this end, all sorts of vendors in the market place are working on using mobile devices to get first get patients to track their own data, with the eventual goal to get said data into the EHR. For most vendors and provider organizations though, as noted in the HIMSS mHealth survey, this concept is a novel one.


USING THE DATA


According to Ken Kleinberg, director of health IT membership service at the Washington, D.C.-based The Advisory Board Company, mHealth vendors are now making it easier on patients to track and share their data than ever before. “These apps are now designed for a small device. You’re no longer trying to open a browser on a tiny screen, but instead you’re looking at an app designed just for that platform, so the data entry and reminders are pretty straight forward,” Kleinberg says. “You may get text message reminders, for example, and these are simple mechanisms that don’t require complex hardware,” he says. Kleinberg adds that there is also a trend involving smartphones with medical devices, where asthma patients, for instance, can have their inhaler with an attachment to it that keeps track of every time the inhaler is used. “This way you can sit down with your provider or look at the data yourself, and sit down and figure out trends,” he says.


To this end, at this year’s HIMSS conference, the Durham, N.C.-based Duke Medicine shared the experience it has had thus far with Apple’s HealthKit, a framework designed to house healthcare and fitness apps, allowing them to work together and gather their data under the Health app. Since HealthKit’s launch, many notable healthcare organizations, including Stanford Medicine, Cleveland Clinic, and EHR vendors like Epic, have all partnered with Apple to work in their own patient-generated data applications.


At Duke, Ricky Bloomfield, M.D., director, mobile technology strategy, has led the effort to integrate Apple’s HealthKit. For providers at Duke, the first step to getting the data integrated with their medical records involved asking patients if they want to share their information, says Bloomfield. Such data, which goes into the EHR via the patient portal, can be from activity trackers, blood pressure devices, glucose monitoring, and many other devices. But then there are limits, he adds. “Patients cannot unilaterally enter their data into the EHR, and that’s by design. There simply is no way for providers to handle that mass intake of data right now,” he says. As such, the provider enables Apple’s HealthKit for patients right now, and the provider has a flow sheet that keeps the patient-generated data separate from other data in the system, Bloomfield says. This way, you can still do analytics on it, but it’s separate from other clinical data, he says.


Across the country, providers are handling patient-generated data in the same manner. In Palo Alto Calif., Stanford Health Care recently released its MyHealth mobile app that will allow patients to review test results and medical bills, manage prescriptions, schedule appointments, and conduct video visits with a Stanford physician.  The app also connects directly with Epic’s EHR system and with Apple’s HealthKit. The idea behind this integration, according to Aditya Bhasin, executive director of software at Stanford Health Care and part of the team that built the app, was to get both doctors patients to be looking at exactly the same sources of truth.

more...
No comment yet.