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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.
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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.

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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.
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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.

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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.

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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.

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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.

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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.

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IT could save $100B for US healthcare

IT could save $100B for US healthcare | Healthcare and Technology news | Scoop.it

New research from Accenture projects that digital health tools will save the U.S. healthcare industry more than $100 billion over the next four years.


In 2014 alone, it calculates, technology such as Web-enabled devices, digital diagnostic tools and other FDA-approved IT help achieve some $6 billion in reduced costs – mostly thanks to things such as improved medication adherence, behavior modifications and fewer emergency room visits.


Accenture expects that number to approach $10 billion this year and $18 billion next year – increasing to $30 billion in 2017 and $50 billion in 2018 as these technologies take hold, proliferate and evolve.


It also predicts that FDA approval of digital health tools will triple by the end of 2018, to 100 (up from from just 33 this past year).

"A digital disruption is playing out in healthcare, as witnessed by the emergence of new business models and technology that will change the nature of patient interactions, alter consumer expectations and ultimately improve health outcomes," said Rick Ratliff, Accenture's managing director of digital health solutions in a press statement.

Factors, such as government health IT mandates, payment reform and other regulatory changes are accelerate the growth of FDA-approved digital solutions, the report shows.


Increasing ubiquity of health IT among physicians and patients will enable more and more devices to integrate withpatient portals and digital health records, according to Accenture, which finds that one in four U.S. physicians routinely use telemonitoring devices for some aspect of chronic disease management.


Meanwhile, as more and more patients take charge of their own care, the number of U.S. consumers who own a wearable fitness device will double in the next five years, according to Accenture, from 22 percent this year to 43 percent by 2020. More than half (57 percent) of consumers track their health online, such as medical history (37 percent), physical activity (34 percent) and symptoms (33 percent), according its poll.


Recent FDA guidelines for low-risk health products – setting a regulatory line between wellness tools and medical devices – will enable more clarity, expedite regulatory pathways and could drive 30 percent annual growth of digital tools through 2018.


The evolution toward value-based care is also creating fertile ground for clinical and business strategies that incorporate these technologies, with Accenture projecting digital health funding to reach $6.5 billion by 2018.


"The proliferation of Internet-connected solutions and evolving regulatory guidelines are blurring the lines between clinical and consumer health solutions," said Ratliff. "As consumer health platforms support more 'medical' devices, rather than just today's wellness trackers, they'll create a viable self-care model in a segment that today is occupied by chronic-disease monitoring companies."

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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.

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Opening the Door to True Health Information Sharing

Opening the Door to True Health Information Sharing | Healthcare and Technology news | Scoop.it

Many in the healthcare industry struggle over the true definition of interoperability. According to University of Texas Health School of Biomedical Informatics professor Dean F. Sittig, Ph.D., oftentimes, when people talk about interoperability, they’re talking about it from their own point of view or their own use case that they’re interested in.


As such, Sittig, who is also a member of the Houston-based UT-Memorial Hermann Center for Healthcare Quality and Safety, thought it was time to write a definition on what an open electronic health record (EHR) was. Sittig has promptly indentified five use cases for open EHR technology and health IT interoperability under the acronym of EXTREME: EXtract: extract patient records while maintaining granularity of structured data; TRansmit: authorized users transmit patient records to other clinicians without losing structured data; Exchange: exchange enables organizations to participate in health information exchanges (HIEs) regardless of which EHR they use; Move: move enables organizations to switch EHRs without incurring extraordinary data extraction and conversion costs; and Embed: embed enables organizations to develop new EHR features of functionality and incorporate it into clinicians’ workflow.


The idea of this EXTREME model is to talk about five of the key stakeholders in healthcare interoperability: patients, clinicians, researchers, developers, and administrators, and from each of their standpoints, try to understand or say what interoperability means to them, Sittig says. From there, Sitting and others wrote down different requirements that systems would have to do to meet these cases, as well as the questions that would be raised from them.


Sittig says that some of these use cases are happening in patient care organizations around the nation, and others aren’t. For the ones that aren’t, people are clamoring for them to occur, he says. One such use case that’s not happening too often is that an organization should move their patient records from one EHR to another, he notes. “Say you bought a new system and you want to export all of your records from one to another, right now that’s not an easy thing to do.  That would be a huge process and cost a lot of money. But there are people who are moving from one EHR to another, especially now that small EHR vendors are not meeting advanced meaningful use criteria. Physicians are moving to more robust EHRs,” he says.

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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.

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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."

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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.

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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.

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Getting a checkup will be very different in the not-so-distant future

Getting a checkup will be very different in the not-so-distant future | Healthcare and Technology news | Scoop.it

Sometime in the not-so-distant future, getting a checkup will be very different.


When the doctor writes down your symptoms, it will be cross-checked with others in your area, making it easier to identify outbreaks and epidemics sooner. If you complain of shortness of breath, your phone’s heart rate monitor will instantly report how well your heart has functioned over the last month. Those readings then could be aggregated with others in your community, revealing hidden trends. As your doctor thinks about the best treatment for you, big-data analysis will help her assess how various options have worked for others with similar histories and body chemistry.


This is the promise of big data in healthcare. And, it’s not just while you’re at the doctor. Medical research and findings are now being combined into massive searchable databases, making it easier to assess and compare results. Databases can absorb terabytes worth of disparate data, including things like the weather. This will make it clearer whether it’s the drug — or something extraneous like humidity — that’s making people feel better.


But all this is in its infancy, with the sector moving slowly and cautiously. The Affordable Care Act now mandates that doctors switch to electronic health records when they treat Medicare patients. So far, they’re not especially sophisticated.

“Electronic health records right now are only collecting about 100 megabytes of data per patient, per year,” says Dale Sanders, senior vice president of strategy at Health Catalyst, an analytics firm. “Most patients, if they knew how poorly informed healthcare was from a data perspective, would be really disappointed.”


Health Catalyst is one of a number of companies — big and small — working to change that, seeing the immense potential to both improve care and save money. US healthcare industry expenditures are approaching $3 trillion annually. The McKinsey Global Institute estimated in 2013 that deploying big data could create $100 billion in value every year across the healthcare industry.


In Pittsburgh, a major hospital system teamed up in March with the city’s biggest universities to advance big-data analytics in healthcare. As part of a consortium, Carnegie Mellon University is working on artificial intelligence that draws on databases of studies and health records.


Andrew Moore, Dean of Carnegie Mellon’s School of Computer Science, imagines a day when his phone gives his doctor a more accurate report on his health than he can himself.

“If he or she asks me, ‘have you been getting out of breath much lately?’ and I say, ‘I don’t think so,’ at that point I would like my cell phone to chime in and say, ‘yes, you have, actually, Andrew,'” he says. “That would be awesome for me and the physician.


Moore expects the systems to be able to trace hospital-borne infections back to a specific piece of equipment or patient. Or, some might make it possible to diagnose a rash with a smartphone photo.

The Pittsburgh Health Alliance plans to spend $10-$20 million a year on its big-data collaboration. Carnegie Mellon joins with the University of Pittsburgh Medical Center and the University of Pittsburgh on the project, and UPMC already takes in info from 200 sources.


And big data has the potential to become big business. In 2013, investors put nearly $200 million into analytics and big-data startups, according to research firm Gartner. There have been similar size investments in digital medical devices and personalized medicine. The government is investing millions in analyzing medical databases, too. That’s not to mention health-tracking research and products from the likes of Apple, Google, and FitBit.


“Hospital systems realize that healthcare is becoming more and more an information technology business,” Moore says.


For all the excitement over big data’s potential for personalized medicine and better public health, it’s not without obstacles and risks. Moore worries about security, knowing that any breach of privacy will threaten public acceptance of the whole industry.


Sanders of Health Catalyst thinks the real promise of big data is improving the basics of healthcare. “We keep attaching big data to these moonshot kinds of expectations,” he says. To Sanders, big data isn’t a revolution. It’s a way to improve the fundamentals of care, like reducing hospital-borne infections.


“Reducing variability in care and reducing over treatment of patients is probably the most important place for any organization in healthcare to start,” he says.


And perhaps the biggest challenge for big data is culture. Doctors and hospitals tend to be understandably cautious and skeptical about adopting new technology, waiting for it to be sufficiently proven safe and effective. But as analytics improve, and the pressure to bring down the cost of healthcare builds, most agree big data will become a big deal in medicine.

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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.

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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.

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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.
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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.

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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. 

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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.

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Healthcare data security is like a box of chocolates

Healthcare data security is like a box of chocolates | Healthcare and Technology news | Scoop.it

The Fifth Annual Benchmark Study on Privacy & Security of Healthcare Data by Ponemon Institute had more surprises than Forrest Gump’s box of chocolates – surprises that were far from palatable. One key finding was that criminal attacks are up 125 percent and are now the leading cause of healthcare data breaches. Other results of the study were just as unsettling:


Surprise 1: Sixty-five percent of healthcare organizations do not offer any protection services for patients whose information has been lost or stolen. With cyber threats on healthcare data mounting, this is unacceptable. Ironically, the Ponemon study also found that 65 percent of healthcare organizations—the same percentage that don’t offer protection services—believe patients whose records have been lost or stolen are more likely to become victims of medical identity theft.


According to the Ponemon Medical Identity Fraud Alliance study, 2014 Fifth Annual Study on Medical Identity Theft, medical identity theft nearly doubled in five years, from 1.4 million adult victims to over 2.3 million in 2014. Many medical identity theft victims report they have spent an average of almost $13,500 to restore their credit, reimburse their healthcare provider for fraudulent claims and correct inaccuracies in their health records. Healthcare organizations and business associates must make available medical identity monitoring and identity restoration services to patients whose healthcare records have been exposed.


On the other hand, the majority of people still don’t understand the serious risk of medical identity theft. They pay more attention to their credit score and financial information than they do their insurance EOBs or medical records. They don’t understand that while a credit card can be quickly and easily replaced, their medical identity can take years to be restored. When their records become polluted, patients can be misdiagnosed, mistreated, denied much needed medical services, or billed for services not rendered. Medical identity theft can literally kill you, as ID Experts CEO Bob Gregg has said.


Surprise 2: The average cost of a healthcare data breach has stayed fairly consistent over the past five years – $2.1 million. This is in contrast to the average total cost of data breach in general, which has risen 23 percent over the past two years to $3.79 million, according to another recent Ponemon report, 2015 Cost of Data Breach Study: Global Analysis. Cyber liability insurance to cover notification costs, better options for identity monitoring, and more privacy attorneys offering help should reduce the cost of healthcare data breaches over time.


Healthcare organizations can take proactive steps to reduce the likelihood and impact of a data breach. This means addressing the tactical issues of protecting patient data. According to Dr. Larry Ponemon, founder and chairman of Ponemon Institute, healthcare organizations face “the dual challenge of reducing both the insider risk and the malicious outsider. Both require different approaches that can tax even the most robust IT security budget.” 


According to the Ponemon report, 96 percent of healthcare organizations had a security incident involving lost or stolen devices, and employee negligence is the greatest concern among these organizations. Dr. Ponemon says healthcare providers should create “a more aggressive training and education awareness program, as well as invest in technologies that can safeguard patient data on mobile devices and prevent the exfiltration of sensitive information.”

These training and awareness programs should center around protecting PHI, especially education on how to avoid phishing emails and what to do to ensure data is not disclosed. Healthcare organizations must also collaborate with their business associates to also ensure they have similar programs in place. 


For external risks such as the growing number of criminal attacks, Dr. Ponemon says that healthcare providers must “assess what sensitive data needs to be monitored and protected, and the location of this data.” I would add that board and executive management must recognize that professional hackers are targeting health data and records and, as mentioned earlier, that such attacks are now the leading cause of data breaches in healthcare. This awareness should spur enterprise-wide alignment in addressing cyber threats.


Surprise 3: Too many healthcare organizations take an ad-hoc approach to incident risk assessment. Only 50 percent of healthcare organizations in the study performed the four-factor risk assessment following each security incident, as required by the HIPAA Final RuleOf that 50 percent, 34 percent used an ad hoc risk assessment process, and 27 percent used a manual process or tool that was developed internally.


This practice is not acceptable. Healthcare organizations now have software tools available to help automate and streamline processes such as risk assessment and data breach response. By supporting consistent and objective analysis of security incidents, providing a central repository for all incident information, and streamlining the documentation and reporting process, these tools can improve outcomes and free an organization’s privacy and security staff to spend more time on prevention.


So far, 2015 has been a bad year for protecting patients and their data. Increasing cyber attacks mean that even more patients and their data will be put in harm’s way. While nobody can escape the inevitable security incidents, it is my hope that we can all learn lessons from the Ponemon study and each other, and work more collectively so that next year will bring fewer unpleasant surprises and many more happy ones.

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Advocacy Groups Question Logic of Stage 3 Proposals to CMS

Advocacy Groups Question Logic of Stage 3 Proposals to CMS | Healthcare and Technology news | Scoop.it

Healthcare advocacy groups and other stakeholders are turning a critical eye towards the proposed rule for Stage 3 of meaningful use.

Comments for the Stage 3 proposed rule, released in March, are due at the end of the week. Major groups, such as the American Hospital Association (AHA) and the College for Healthcare Information Management Executives (CHIME), have begun to release their overall thoughts. The early consensus is a negative outlook on the Stage 3 proposals.


CHIME called the sum of all Stage 3 proposals by the Centers for Medicare and Medicaid Services (CMS) “unworkable.” Specifically, CHIME mentioned the requirement that would establish a single set of objectives and measure, tailored to eligible providers (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs), by 2018. They said that most providers wouldn’t be able to participate by 2018.

“And with so few providers having demonstrated Stage 2 capabilities, we question the underlying feasibility of many requirements and question the logic of building on deficient measures,” CHIME wrote in its letter to Andy Slavitt, Acting Administrator for CMS.


CHIME offered specific suggestions including a 90-day reporting period for the first year of Stage 3, the elimination of patient action thresholds for the care coordination objectives, reduce the view, download or transmit requirement from 25 percent to five percent, reduce the number of measures in multi-measure objectives, and allowing paper-based means to achieve measure thresholds. They specifically targeted the patient action requirements to care coordination, saying it was “unrealistic.”


"We question the value of setting thresholds for technology and process not yet invented, let alone widely deployed in healthcare," CHIME Board Chair Charles E. Christian, Vice President of Technology and Engagement with the Indiana Health Information Exchange, said in a statement. "From the heavy reliance on APIs to an assumption that patient-generated health data will flow in standardized ways, our industry has a long way to go if it is going to catch-up with this rule by 2018."


The AHA had an even more critical tone with the patient-generated data element. They called it “premature” in their comments. They said the readiness of standards to support the validation of the data and the ability to match the data to the correct patient are record are “unknown at this time.” They also say that the concept of using APIs to share data also lacks maturity and the security risks are too significant to be a requirement. Like CHIME, they said the lack of a patient matching solution is a huge issue to accelerating health information exchange.

Both the AHA and CHIME were not certain over the health information exchange objectives outlined in the proposed rule. CHIME said the thresholds for the three HIE measures were unrealistic while AHA said that the standards and exchange infrastructure were not mature.


Moreover, the AHA said that CMS should avoid doing anything at all with Stage 3 until Stage 2 is all settled.  “While the Stage 3 proposals offer promising ideas that could further health information exchange and support greater patient engagement, we do not yet have sufficient experience at Stage 2 to be confident that the proposals for Stage 3 are feasible and appropriate,” AHA Executive Vice President Rick Pollack wrote.


Healthcare Informatics will add more to this story as published comments from stakeholders roll in. Once the commenting period ends, CMS will use that feedback to create the Stage 3 final rule. Potentially adding to the confusion is a requirement in newly minted legislation repealing the Sustainable Growth Rate that sunsets penalties for meaningul use by 2019.

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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.

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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.

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