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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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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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So what is interoperability anyway?

So what is interoperability anyway? | Healthcare and Technology news | Scoop.it

One of my most memorable experiences as an IT leader was working with with a dissatisfied customer. I asked what requirements were unmet, what features were priorities, and what future state was desired. The answer was “I’m not sure, but I know I’m not getting what I need”.

The use of the term interoperability is being tossed around in ways that makes it seem like the test for obscenity used by Supreme Court Justice Potter Stewart in 1964 when he wrote “I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description ["hard-core pornography"], and perhaps I could never succeed in intelligibly doing so. But I know it when I see it…”

Congress is angry about the lack of interoperability. What does that mean?

House and Senate stakeholders believe that vendors enjoyed a government funded windfall yet are building proprietary networks. They have heard that vendors are blocking information sharing by charging significant interface fees and thatHITECH distributed $30 billion with minimal requirements for information sharing. Many in the House feel after all this investment, the country is not prepared for new payment models. 

Some in the House have stated that Americans can communicate because "we speak English" so interoperability is about picking a common language.

Senate HELP Committee Chairman Lamar Alexander plans to take up this issue, working closely with Ranking Member Senator Patty Murray through a bipartisan effort over the coming months. 

So what is the real issue causing providers anxiety and resulting in Congress wanting to take action?

Providers are fed up with interface fees and at how hard it is to accomplish the workflow required by Accountable Carebusiness models including care management and population health. They are unsatisfied with the kind of summaries we’re exchanging today which are often lengthy, missing clinical narrative and hard to incorporate/reconcile with existing records.

All these things are true.

So what is our next step to help providers do their job and improve satisfaction to the point that Congress no longer wants to legislate the solution to the problem?

I think we all have to step back, carefully define the requirements for care coordination and care management in an ACOworld and admit that the Meaningful Use regulations did not address those requirements. We should allow the private sector initiatives already in progress (Argonaut, Commonwell, eHealthExchange) to address these market needs in collaboration with vendors, entrepreneurs, and innovators. The economic incentives of the Affordable Care Act and the Sustainable Growth Rate fix will result in hospitals and professionals demanding different kinds of technology than was prescribed in regulation.

The role for Congress should be to hold us accountable for the outcomes we want to achieve.

At a recent AMIA presentation in Boston, Zak Kohane, Ken Mandl and I were asked to be provocative -- to go rogue.

I suggested that the Meaningful Use program should be eliminated. Yes, there should be merit-based incentives for achieving stretch goals, but those can be created in another CMS program. Meaningful Use is no longer necessary. 

ONC should focus on the 5 enablers I’ve written about:

1.  Facilitating the creation of a national provider directory for message routing

2.   Encouraging the adoption of a voluntary national identifier for healthcare

3.  Providing guidance to streamline the heterogeneous patchwork of state privacy laws that are impeding information exchange

4.  Serve as the coordinating body for aligning federal government health IT priorities

5.  Supporting private sector initiatives such as Argonaut that are simplifying the tools for health information exchange

It's not a problem of "language". We have the terminologies we need, already included in certified EHRs. We have standards for content and transport, again written into certification requirements. So what's the gap? We need to make the standards better, and build interoperability into EHR workflow. That doesn't require top-down regulation, it takes the kind of goal-oriented interaction between providers, developers, and standards bodies that characterizes efforts like the Argonaut Project.

No more regulation, no more legislation. Those will only crush innovation.

Instead of saying we need interoperability, the conversation needs to include a crisp set of requirements for care management and care coordination with defined metrics of success, supported by government enablers, and accelerated with the economic incentives provided by new reimbursement models.

To paraphrase Justice Potter, if patients and providers are happier, I’ll know it when I see it.

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Curbing medical errors with the cloud

Curbing medical errors with the cloud | Healthcare and Technology news | Scoop.it

Medical errors. The term is frightful to everyone involved in healthcare: not just the patients, but the doctors, staff, and administrators as well. A July 2014 Senate hearing on patient safety revealed that medical errors were the third most prominent cause of death in the United States, directly behind heart disease and cancer. Erin McCann of Healthcare IT News reports that these medical errors cost the nation a colossal $1 trillion each year. 400,000 Americans die annually due to these preventable mistakes.


What to make of that number, 400,000? Forbes contributor Dan Munro suggests that the same number of people would be killed if the largest commercial plane, an Airbus A-380, fell from the sky each day throughout the year. 


Deaths aren’t the only thing to be concerned about, though. Medical errors also lead to 10,000 major complications daily.  It is reported that misdiagnosis affects 12 million patients per year. Why, with all this amazing technology, are medical errors still occurring? Our amazing healthcare IT systems come along with challenges and revolutionary potential, both of which are addressed by the health data cloud.

Challenge – interoperability


Registered nurses specifically mentioned interoperability issues between different systems and devices as a major reason mistakes are made. Their perspectives were collected through a survey by the independent Gary and Mary West Health Institute.


Three in five nurses (60 percent) said that there would be fewer errors if medical equipment was completely integrated and drawing on the same information rather than relying on manual transcription. "I have seen many instances where numbers were incorrectly transcribed or put in reverse or put in the wrong column when typed manually, which can cause errors," one registered nurse commented in the survey.

Even more shocking: 50percent of RNs told the researchers that they had seen an error occur because hardware was not coordinated. Nurses must often set up digital devices and gauge the information they present; they also must regularly jot down numbers from one device and input them into others if they aren’t interoperable.


Since medical errors are not just a consumer safety issue but are also incredibly costly to healthcare companies, West Health Institute argued that the total savings to be achieved by integrated healthcare infrastructures could reach $30 billion.


How do you solve this interoperability issue? Simple, said Edmund Billings, MD: “Cloud-based interoperability, which has revolutionized travel, banking and shopping, could yield great benefits in healthcare as well.”


Revolutionary potential – EHR & big data


Mansur Hasib of Information Week believes that two basic elements – electronic health records and artificial intelligence – could help to reduce mistakes that occur in healthcare settings. EHR provides consistency to the data (assuming there aren’t interoperability issues resulting in inaccurate information). Artificial intelligence essentially gives local doctors remote access to the knowledge and skill of top-notch doctors. 


Data from electronic health records could easily fuel artificial intelligence environments – systems that are becoming smarter every day, as groups of prominent physicians work with tech companies to create AI programs that can provide a seasoned professional opinion related to any treatments or recommendations in real-time. Hasib asserts that access to that broader pool of knowledge will minimize the number of errors that are made in hospitals as the remote AI system can provide an immediately available second opinion. 


Since the basic building block of AI is big data, artificial intelligence is just one way healthcare cloud data analytics can be used to improve quality of care. Since healthcare data on a cloud can now be updated within a few minutes of changes in the source systems, it can empower doctors, payers, and national health systems to identify gaps in care, perform prescriptive analytics, provide interventional decision support, optimize treatment plans…the possibilities are limited only by one’s imagination.


Big data is not just about building AI systems but all types of applications to provide clinicians and administrators with a more robust picture of treatments and processes – in turn leading to fewer mistakes and healthier healthcare.

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Rhedyn Duncan's curator insight, March 25, 2016 3:19 AM

Over 400,000 Americans die each year due to incorrect medication administration. I found this to be a truly shocking figure. This blog calls for the urgent development of an electronic system to administer medications. I think this is vital. This topic is partially sensitive to me because I have seen the potential dangers first hand. During a recent human performance workshop, which I had to attend with Rio, medical errors were presented as an example to explain the importance of correct health and safety interventions, and the fact that it can save lives. 

 

One of the speakers used true story about how an accidental heparin overdose nearly killed the infant twins of actor Dennis Quaid. Outraged by the hospital’s mistake Dennis and his wife did some further research into how the error occurred, and found it has happened on many occasions before. This is due to the adult dose and the infant dose being packaged in nearly identical bottles. 

 

With an ageing population, I believe that current pressures on the hospital system will continue to increase, possible leading to an increase in human error with medication administration. These mistakes must stop. I definitely agree with this scoops notion of automated medical systems to all, and removing the chance of human error from the process completely.

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Fixing health care doesn't necessarily need political reform

Fixing health care doesn't necessarily need political reform | Healthcare and Technology news | Scoop.it

It’s very hard to find a product or service that is both lousy and unaffordable. Such expensive duds are usually quickly replaced by cheaper and better competitors. Prior to the Affordable Care Act, health care was becoming more expensive every year while simultaneously becoming less convenient, less personal, and less satisfying. In 2009, I wrote a series of four posts explaining how the health care marketplace reached such a sorry state and offering a suggestion for reform.


Since then, the Affordable Care Act has passed. For many, insurance has become much more affordable, but whether this translates to better or more affordable care remains to be seen. If it results in many patients receiving affordable insurance that very few physicians accept, then the situation will be a repetition of the Massachusetts experience with universal coverage: Everyone has insurance; no one has a doctor.

At the same time, the intrusive and complex bureaucracy that physicians must navigate to collect insurance payments has vastly expanded. Physicians are now coerced into serving as the workforce for Federal plans to collect health care data, cut costs, and make their care increasingly legible to payers but increasingly opaque to patients.

Bear with me for just a few examples. In an ill-advised plan called “meaningful use,” physicians receive incentives for submitting complex reports documenting their use of electronic health records (EHRs). The time and effort required to comply with this program has earned it much scorn from physicians. And the incentives will likely distort the true value of EHRs and inflate their costs.


The International Classification of Diseases (ICD) is the coding system used by physicians and billers to report to insurance companies patients’ diagnoses. In October, the government will update ICD to its tenth version. ICD-10 will contain radically more complexity than its predecessors. It is widely ridiculed for the detail with which diseases must be reported. (Code V91.07XA is for a “burn due to water-skis on fire.”) The transition to ICD-10 was already postponed once, and I predict it will cause much disruption and grief.


My last example is the recently passed sustainable growth rate (SGR) fix which gets rid of the annual congressional scramble to increase Medicare reimbursement to physicians by increasing reimbursement in the short term, but tying reimbursement to outcomes measures in the long term. This is sure to become a data collection and reporting hassle that makes doctors long for the simpler days of meaningful use.

I honestly believe that there has been more bureaucratic complexity added to the typical physician’s life in the last few years than in the twenty years before that. None of it cares for a single patient.


Two weeks ago, my family and I spent ten days visiting New York City. We had a wonderful time. The services that completely transformed our experience were the ride sharing services of Uber and Lyft. We never used public transportation. We never hailed a taxi. For longer trips (and a family of five) this was likely cheaper than train tickets. For shorter trips, it meant not handling cash, never finding bus or subway stops, and never referring to transit schedules.


For years, passengers complained about high taxi prices and poor taxi service, and potential competitors complained about the legalized monopolies given to taxi companies by city governments. But rather than bang their heads against these barriers, companies like Uber and Lyft just started giving people rides.


This was an epiphany to me. I had always assumed that fixing the health care marketplace would mean political reform — undoing the myriad laws that substituted insurance for health care and caused prices to skyrocket, and dismantling the byzantine bureaucracy that physicians must navigate. Now, I understand that political reform is both unrealistic and unnecessary.


Doctors and patients aren’t waiting for political reform. More and more doctors are “going off the grid” to provide excellent care unencumbered by insurance regulations. Concierge primary care is just one example. The Surgery Center of Oklahoma lists on its website the prices for every surgery it offers. The prices are all-inclusive. You won’t get a separate bill from the anesthesiologist, the surgeon, and the facility. And they don’t care what insurance you have because they won’t deal with any insurance company. Other innovative companies are using video conferencing technology to connect patients to doctors thousands of miles away. LUX Healthcare Network (with which I’m proud to be associated) is building a multi-specialty concierge physician network.


I argued six years ago that using insurance for routine care is wasteful. I now realize that attempts at universal coverage and the bureaucracy that comes with it — ICD-10, meaningful use — will never be repealed. This bureaucracy will become the taxi monopolies of health care — increasingly ignored by both doctors and patients and increasingly irrelevant. The successful enterprises in health care will connect doctors and patients and then get out of the way. Like Uber and Lyft they will help patients find the service they want at a price they’re happy to pay, and they will facilitate not regulate the delivery of excellent care.


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Interoperability gets blame for serious medical errors

Interoperability gets blame for serious medical errors | Healthcare and Technology news | Scoop.it

Each year, a staggering 400,000 people are estimated to have died due to medical errors. What's more, each day there's also 10,000 serious complications resulting from medical mistakes. Part of the blame, nurses are saying, can be attributed to the lack of interoperability among medical devices.
 
That's according to new data published by the non-partisan Gary and Mary West Health Institute, which sought input from nurses nationwide. The results are telling.
 
Some 60 percent of registered nurses said medical errors could significantly decrease if hospital medical devices were coordinated and interoperable. Even more marked was that half of them said they actually witnessed a medical mistake due to the lack of interoperability of these devices, which include infusion pumps, electronic medical records and pulse oximeters.
 
When looking at the crisis from a cost perspective, West Health Institute officials estimate that a connected, fully interoperable health system could save a potential $30 billion each year by reducing transcription errors, manual data entry and redundant tests.
 
"I have seen many instances where numbers were incorrectly transcribed or put in reverse or put in the wrong column when typed manually, which can cause errors," said one participating RN in the report.
 
Indeed, some 46 percent of RN respondents said, when it comes to manual transcription from one device to another, an error is "extremely" or "very likely to occur."
 
"As many as 10 devices may monitor or treat a single patient in an intensive care unit," said Patricia H. Folcarelli, RN, senior director of Patient Safety at the Silverman Institute for Health Care Quality and Safety at Beth Israel Deaconess Medical Center, in a press statement announcing the report.

"The nurse not only has to program and monitor the machines, he or she often spends a significant amount of time transcribing data by hand because the devices are not designed to share information," she added.
 
Other key survey findings:
 

    74 percent of these nurses agreed that it is burdensome to coordinate the data collected by medical devices
    93 percent agreed that medical devices should be able to seamlessly share data with one another automatically

Just last year, healthcare clinicians and researchers convened on Capitol Hill to put their best ideas forward on how to solve the medical error crisis that reportedly claims the lives of 400,000 each year, costing the nation a colossal $1 trillion annually.
 
In terms of how to address this problem, the recommendations put forth by stakeholders were diverse – including boosting the number of registered nurses, supporting AHRQ, CDC and establishing incentives. There did, however, exist common agreement with one thing: information technology is falling short in many arenas.
 
"Medicine today invests heavily in information technology," said Peter Pronovost, MD, senior vice president for Patient Safety and Quality and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins. "Yet the promised improvement in patient safety and productivity frankly have not been realized."
 
Ashish Jha, MD, professor of health policy and management at Harvard School of Public Health, also at the hearing, agreed. The potential, he said, of electronic medical records and devices "is not going to be realized unless those tools are really focused on improving patient safety."


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Health IT Security: What Can the Association for Computing Machinery Contribute?

A dazed awareness of security risks in health IT has bubbled up from the shop floor administrators and conformance directors (who have always worried about them) to C-suite offices and the general public, thanks to a series of oversized data breaches that recentlh peaked in the Anthem Health Insurance break-in. Now the US Senate Health Committee is taking up security, explicitly referring to Anthem. The inquiry is extremely broad, though, promising to address “electronic health records, hospital networks, insurance records, and network-connected medical devices.”

The challenge of defining a strategy has now been picked up by the US branch of the Association for Computing Machinery, the world’s largest organization focused on computing. (Also probably it’s oldest, having been founded in 1947 when computers used vacuum tubes.) We’re an interesting bunch, having people who have helped health care sites secure data as well as researchers whose role is to consume data–often hard to get.

So over the next few weeks, half a dozen volunteers on the ACM US Public Policy Council will discuss what to suggest to the Senate. Some of us hope the task of producing a position statement will lead the ACM to form a more long-range commmittee to apply the considerable expertise of the ACM to health IT.

Some of the areas I have asked the USACM to look at include:

Cyber-espionage and identity theft
This issue has all the publicity at the moment–and that’s appropriate given how many people get hurt by all the data breaches, which are going way up. We haven’t even seen instances yet of malicious alteration or destruction of data, but we probably will.

Members of our committee believe there is nothing special about the security needs of the health care field or the technologies available to secure it. Like all fields, it needs fine-grained access controls, logs and audit trails, encryption, multi-factor authentication, and so forth. The field has also got to stop doing stupid stuff like using Social Security numbers as identifiers. But certain aspects of health care make it particularly hard to secure:

  • The data is a platinum mine (far more valuable than your credit card information) for data thieves.
  • The data is also intensely sensitive. You can get a new credit card but you can’t change your MS diagnosis. The data can easily feed into discrimination by employees and ensurers, or other attacks on the individual victims.
  • Too many people need the data, from clinicians and patients all the way through to public health and medical researchers. The variety of people who get access to the data also makes security more difficult. (See also anonymization below.)
  • Ease of use and timely access are urgent. When your vital signs drop and your life is at stake, you don’t want the nurse on duty to have to page somebody for access.
  • Institutions are still stuck on outmoded security systems. Internally, passwords are important, as are firewalls externally, but many breaches can bypass both.
  • The stewards/owners of health care data keep it forever, because the data is always relevant to treatment. Unlike other industries, clinicians don’t eventually aggregate and discard facts on individuals.
Anonymization
Numerous breaches of public data, such as in Washington State, raise questions about the security of data that is supposedly anonymized. The HIPAA Safe Harbor, which health care providers and their business associates can use to avoid legal liability, is far too simplistic, being too strict for some situations and too lax for others.

Clearly, many institutions sharing data don’t understand the risks and how to mitigate against them. An enduring split has emerged between the experts, each bringing considerable authority to the debate. Researchers in health care point to well-researched techniques for deidentifying data (see Anonymizing Health Data, a book I edited).

In the other corner stand many computer security experts–some of them within the ACM–who doubt that any kind of useful anonymization will stand up over the years against the increase in computer speeds and in the sophistication of data mining algorithms. That side of the debate leads nowhere, however. If the cynics were correct, even the US Census could not ethically release data.

Patient consent
Strong rules to protect patients were put in place decades ago after shocking abuses (see The Immortal Life of Henrietta Lacks). Now researchers are complaining that data on patients is too hard to get. In particular, combining data from different sites to get a decent-sized patient population is a nightmare both legally and technically.
Device security
No surprise–like every shiny new fad, the Internet of Things is highly insecure. And this extends to implanted devices, at least in theory. We need to evaluate the risks of medical devices, in the hospital or in the body, and decide what steps are reasonable to secure them.
Trusted identities in cyberspace
This federal initiative would create a system of certificates and verification so that individuals could verify who they are while participating in online activities. Health care is a key sector that could benefit from this.

Expertise exists in all these areas, and it’s time for the health care industry to take better advantage of it. I’ll be reporting progress as we go along. The Patient Privacy Rights summit next June will also cover these issues.


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ICD-10 Propels CAC Market to Reach $3.5B by 2019

ICD-10 Propels CAC Market to Reach $3.5B by 2019 | Healthcare and Technology news | Scoop.it
The computer-assisted coding (CAC) market has played a significant role in advancing the accuracy of patient data in EHRs by reducing coding errors. With the coming ICD-10 transition, CAC will continue to grow. This market has helped healthcare costs drop in recent years and stimulated greater productivity and efficiency of healthcare facilities across the world.

A press release from market research company ReportsnReports.com states that the global computer-assisted coding market is expected to grow 16 to 17 percent by 2019. Both the coming ICD-10 integration and meaningful use requirements within the healthcare sector are driving the gains in the CAC market.ICD-computer-pen

This particular sector is growing due to regulatory compliance measures set by the Centers for Medicare & Medicaid Services (CMS) and the Big Data stemming from medical facilities. There is also a growing demand for better quality of services and greater accuracy in the healthcare market.

Complex ICD-10 coding requirements as well as the move toward reducing medical spending propel the computer-assisted coding sector further. Consolidation in healthcare along with new technological innovation bring a greater need for computer-assisted coding solutions.

There are a few issues that keep the sector from advancing even more such as lack of awareness of new technologies and the hesitation of some providers from integrating innovative health IT processes.

Nonetheless, providers trust that computer-assisted coding improves accuracy and outcomes in the healthcare setting. The American Health Information Management Association (AHIMA) interviewed data management professionals to find out their take.

“The positive impact to productivity and accuracy often can be seen within days of the implementation go-live, in both the inpatient and outpatient settings,” Ann Chenoweth, MBA, RHIA, senior director of industry relations for 3M Health Information Systems, told AHIMA. “CAC solutions often incorporate workflow capabilities, which allow even greater improvements to productivity.”

North America shares the biggest segment of the growth in the computer-assisted coding division with Europe and Asia-Pacific following behind. Both ICD-10 integration, the expansion of healthcare IT tools, and other technological developments have pushed computer-assisted coding forward in North America.

Over the next four years, the Asia-Pacific region represents the largest impact on computer-assisted coding growth due to a rise in investments, a growing need for better healthcare, and the stimulus of government programs.

The increase in insurance claim reimbursement, greater affordability of medical services, and a rising number of healthcare providers in bigger cities are all driving the market growth of CAC in the Asia-Pacific region of the globe. Countries like China, India, and Brazil are especially seeing this surge.

According to a press release from the market research firm MarketsandMarkets, the global computer-assisted coding market is predicted to reach $3.5 billion by 2019. The report conducted divides the CAC market by application, solution, end user, mode of delivery, and topographical territories.

One major reason for the financial growth in this sector is the transition from ICD-9 to ICD-10 in the North American healthcare sphere set to take place by October 1, 2015. For example, computer-assisted coding is leading to the incorporation of ICD-10 diagnosis and procedure codes in payment billing and insurance reimbursements. Improved healthcare IT infrastructure is also leading to larger market share of computer-assisted coding in North America.

Over the next four years, expect to see the global CAC market reach $3.5 billion and grow at least 16 percent.
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BYOD causing IT headaches

BYOD causing IT headaches | Healthcare and Technology news | Scoop.it

"There's an app for that" may be an effective marketing phrase, but don't expect hospital security officials to appreciate it. The proliferation of personal devices and the apps that drive them is one of the biggest security concerns to hit healthcare in the digital age.

Known as BYOD – "bring your own device" – the new environment exists due to the pervasiveness of personal mobility devices among healthcare professionals in recent years. The devices have become well entrenched in a very short time, as studies show that approximately 80 percent of healthcare workers currently use a personal mobile device, whether smart phone or tablet.

The situation is a double-edged sword, with mobility giving clinicians the ability to access healthcare data at anytime from anywhere, but the flurry of unchecked apps also create an air of hospital IT vulnerability to security breaches, intrusive malware, viruses and worms.

"This issue is a huge challenge and the industry needs to get out in front of it," says Chris Bowen, chief privacy and security officer for Tempe, Ariz.-based ClearDATA. "It is a situation that needs to be controlled."

Therefore, hospitals need to implement a BYOD strategy, security specialists say, but it can be a complex process. If not implemented correctly, they contend it can potentially expose protected health information and actually create a greater risk of data breach.

"The first step is to assess risk before implementing any BYOD strategy, said Ron Sadowski, director of technology solutions for the RSA Security Management division of Hopkinton, Mass.-based EMC. Sadowski made his comment at a recent security panel discussion sponsored by Health IT Outcomes.

"Data sprawl is the biggest problem and, in terms of priority, it should rate the highest."

The next step is to focus on the data that isn't being controlled, but should be, Sadowski said.

"Figure out how it is outside the controls and prioritize accordingly," he said. "PHI (personal health information) is the most valuable information and is the most vulnerable. Use that to guide your efforts."

Device 'infiltration'

Mark Roberts, manager of mobile technology at Yale New Haven (Conn.) Health, also participated in the panel discussion and summed up the challenge that healthcare organizations are facing with the app situation: "We had to conduct the risk assessment after the devices had already infiltrated the organization."

The Yale New Haven security team examined the types of devices that were out there and the type of data they were accessing, Roberts said. After making a determination, he said the team initiated a BYOD policy governing how data could be accessed, security requirements for which devices are acceptable and then published the information for everyone affected.

"Once we got our arms around it, we revisited it and tweaked it appropriately in that manner," Roberts said. "We have a lot of consolidation going on and there are different policies and security models within the organization, but we are standardizing everything."

The text threat

Siva Subramanian, senior vice president of mobile products for Los Angeles-based Zynx Health, says he doesn't see mobile apps as a true security threat.

"They are a transformation of healthcare delivery – it has become a largely mobile industry," he said. "It is an additional layer of complexity that CIOs need to manage."

Text messaging, on the other hand, presents a greater danger, Subramanian says.

"The elephant in the room is texting," he said. "CIOs may have pretended it's not happening, but it is and they can't ignore it anymore."

Texting is vulnerable on several fronts, Subramanian says – there are no log-ins or credentials required, no authorization is needed to access information and texts can easily be sent to the wrong person.

Zynx has a program called Contest Messaging, which is HIPAA compliant software designed to take guesswork out correspondence by identifying care team members and correlating health information with each patient.

Ongoing challenge

While the news is dominated by massive data breaches at major retailers, Sony Pictures and Apple's iCloud, Bowen maintains that most security missteps in healthcare are due to ordinary carelessness – lost devices and lack of sufficient encryption. And while it would be easy to blame complacency, Bowen doesn't believe that is the reason for breaches in healthcare.

"The industry is enduring a massive shift in technology, from EHRs to getting physicians up to speed on data automation," he said. "Then there is the evolution to ICD-10 and the overall squeeze on margins in healthcare, which is causing security to be overworked, under-sourced and needing help with basic elements of defense and depth. It is a swale you don't want to sail into."

Cloud safety?

Despite the headlines caused by the iCloud breach, Bowen maintains that cloud security is tight for the most part.

"You'd be surprised at how secure they are," he said. "If you really look at it, a purpose-built cloud can be more secure than an on-premises server."

Across the healthcare industry, organizations are increasingly embracing the cloud and trusting its security, confidentiality and reliability, Bowen said.

"We've had some major healthcare organizations become clients in the past year or so," he said. "We've seen a huge uptick in interest in the cloud."


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Health IT buckling under rules and regs

Health IT buckling under rules and regs | Healthcare and Technology news | Scoop.it

Nearly 95 percent of health IT professionals say complying with regulations influences is the chief driver of their decision-making, according to a new poll. Worse, a majority saying too many government mandates are having an adverse effect on their work.

The survey, from Peak 10, an IT infrastructure and cloud services provider, also finds that  with "rare exception," respondents say they lack the right expertise to "navigate the maze" of federal rules, according to Peak 10 officials.

Three out of five respondents to the poll say too many rules are having a negative effect on healthcare IT, according to the Peak 10 National IT Trends in Healthcare Study.

These mandates mean providers must make non-revenue producing investments and divert resources away from innovation and new development, according to Peak 10, which finds that cost cutting is another big concern – made worse by the fact that many IT departments are under-staffed and under-funded.

Other survey findings:

  • A 77 percent majority of hospitals and other healthcare organizations are seeking partners to help them maintain high reliability; 70 percent of respondents said they need partners to assist with security and data privacy concerns.
  • About 50 percent of healthcare IT companies say they use a third-party integrator or partner to assist them with their IT strategy.
  • Among those, 70 percent cited depth of technical knowledge as the top reason; 60 percent, meanwhile, said third-party partners alleviate the time and resource constraints on internal IT staff.

The feelings of many IT staffers might be summed up by a quote, from an anonymous director of IT at a New York medical center, included in the report: "I wake up in a cold sweat, just wondering what (regulations) I missed. It’s up to me to keep up. Things that we had a year to plan before, now we have weeks."

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Big Data in Healthcare: A Cause for Concern?

Big Data in Healthcare: A Cause for Concern? | Healthcare and Technology news | Scoop.it

A federal advisory panel has kicked off discussions about the privacy and security challenges related to the use of big data in healthcare, with a goal of making policy recommendations in the coming weeks.


During the Jan. 12 meeting of the Health IT Policy Committee's Privacy and Security Workgroup - formerly called the Tiger Team - members began sorting through a number of key big data themes that emerged from two public hearings the group hosted in December. The workgroup and the committee will make recommendations to the Office of the National Coordinator for Health IT, which could ultimately lead to new policies from the Department of Health and Human Services.


Last month's hearings included testimony from a number of stakeholders from various segments of the healthcare sector. For instance, testimony highlighted that while analyzing big data can bring big potential benefits, including better treatment outcomes and lower costs, it also can bring privacy risks to individuals, says workgroup Chair Deven McGraw, an attorney at the law firm Manatt, Phelps & Phillips, LLP.

The workgroup will now help to assess whether the nation has the right policy framework in place "in order to maximize what is good about what health data presents for us, while addressing the concerns that are raised," McGraw says.

Big Data Challenges

Big data concerns that emerged from the hearings in December included whether various "tools" that are commonly used to help protect an individual's health data privacy are sufficient, given the complexities of various big data use cases, McGraw says.

Those "tools" include data de-identification methods; patient consent; transparency to patients and consumers about how their data might be used; various practices related to data collection, use and purpose; and security measures to protect data.

Other concerns arising from the testimony that the workgroup plans to dig into relate to the legal landscape, such as whether there are regulatory gaps in HIPAA and other laws regarding keeping health data used for big data analytics private.

The workgroup, which will continue its discussion on Jan. 26, will also consider the harm that could be caused if big data is not kept private, including discrimination, medical identity theft, and mistrust of the healthcare system.

In early February, however, the workgroup will temporarily shift gears to discuss ONC's 10-year interoperability roadmap, which is expected to be released in late January. The roadmap will focus on secure health data exchange.

Nevertheless, the workgroup hopes to hammer out some preliminary findings or early recommendations about protecting big data so that it can make a presentation at the March 10 meeting of the HIT Policy Committee, McGraw says.


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Commentary: Time for innovation to alter healthcare | Healthcare IT News

Commentary: Time for innovation to alter healthcare | Healthcare IT News | Healthcare and Technology news | Scoop.it

There are few areas of modern life that technology hasn’t altered. From our smartphones to our DVRs to the GPS in our cars, technology has changed the way that we shop, read, watch movies and television, drive … the lineup goes on. What’s missing from this list? Healthcare.

While there have been pockets of innovation, the healthcare consumer has not benefitted from the rapid advancement of technology that has touched nearly every part of American life.
              
The promise of what technology innovation can bring to patient care and outcomes is high — but two major challenges stand in our way. First, we have dated government rules in place that are slowing innovation. Second, even if the pace of healthcare innovation matched that of, say, consumer electronics, it wouldn’t matter because we don’t have interoperability — that is, a system in place to safely and seamlessly share patient information between providers, payers and other healthcare stakeholders. Just imagine the public’s response if the smartest smartphone couldn’t place calls to a similar smartphone on a different wireless carrier.


What is it going to take to bring about the changes that are needed? The answer is cooperation across party and competitive lines in both the public and private sector, as well as cooperative work between industry stakeholders to develop standards and best practices for patient safety and health information technology.

We need to start by updating the current health IT regulations. Health IT operates under a regulatory framework that was crafted nearly 40 years ago. Think about it: We’re working with regulations written when people had 8-track tape players in their cars. It’s time we update the rules to create predictability for everyone involved and to support the innovation in healthcare that patients deserve.


The good news is that there is bipartisan support and momentum to update health IT regulations. While the conventional wisdom these days suggests that our nation’s capital has become dysfunctional and unable to work across party lines for the greater good, we have seen real bi-partisanship at work on the issue of health IT, with key members of both parties working together to bring health IT regulation into the 21st century. These elected leaders, along with hundreds of organizations across the industry, are working to create a framework that will achieve, rather than impede, the potential that health IT has to improve patient care and enhance clinical safety.

Just as members of Congress are reaching across the aisle on the issue of health IT regulation, competitors in the private sector need to join together to achieve interoperability. Creating such a system will improve the patient experience, care delivery system efficiencies and, most importantly, the quality and safety of care.

There is also real momentum in the private sector to advance the interoperability of our healthcare system. Through the not-for-profit CommonWell Health Alliance, competitive businesses are deploying a universal system nationally to allow for the seamless access of patient-centered data across all settings of care. Through both government efforts and this Alliance and its member companies, healthcare interoperability is becoming a reality and, when realized, will significantly transform the future of the industry.


Leading industry stakeholders are working with well-respected organizations like the National Patient Safety Foundation and the ECRI Institute’s Partnership for Health IT Patient Safety to develop tools to achieve patient safety through health IT, but more must be done. Developers, implementers and end-users need to work cooperatively to ensure that patient safety is always a priority when creating and deploying any healthcare technology solution, as well as assuring usability for clinicians. By working together, we can optimize the safety benefits and mitigate any new risks that technology may bring.

We cannot deny that there is a need for increased innovation in health technology. The benefits of technological advancements are numerous, from improving patient safety to providing consumers with more tools to manage their own healthcare. At this moment in time, public and private leaders have a unique opportunity to demonstrate their ability to work cooperatively to modernize health IT regulation and achieve real interoperability — with the goal of improving patient safety and outcomes.

When that happens, we’ll begin to see exciting innovation that will fundamentally change and improve patient care.



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shelly-4's curator insight, December 4, 2014 11:59 AM

In this article, the author concludes that our modern life are surrounded by technology, what makes us abandon our helthy way of life.

The  solution: health IT regulations.

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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.


What’s more, Sittig says that with interoperability and health IT in general, there is a “socio-technical” problem, meaning there are legal, organizational, and people constraints on IT systems just as much as there are technical limitations. “A lot of people focus on the technical limitations and say we’re not achieving the interoperability we want because of those. I’d say that’s not the case at all. In a lot of cases the healthcare delivery systems don’t want to exchange data with their competitors. They blame it on a technical reason, either big or small, because they don’t want to do it anyway,” he says. Sittig gives an example of two hospitals that are currently trying to merge and they’re arguing about whether they’re going to let the nurses in the other system see the data. “It’s not a question of technical capabilities, but instead one of giving them log-ins or not,” he says.


To this end, speaking of an Office of the National Coordinator for Health IT (ONC) report released last month on health information blocking, Sittig says the blocking is coming more from the healthcare providers than from the vendors. “It’s happening and it would be better for the patients if it wasn’t happening, but there is a huge business around this. It’s not completely about patient care,” he says. “These are multi-billion dollar businesses,” he continues. “If we shared all the data that people want us to share, we would lose a significant amount of revenue, so much so that it would make us a lot smaller, maybe even put us out of business. Until that changes, and there are federal laws that people are talking about now, we won’t have interoperability,” Sittig says.


David McCallie, M.D., senior vice president of medical informatics at the Kansas City-based EHR vendor Cerner, is surprised at the degree of concern expressed by Sittig when it comes to information sharing. In addition to his Cerner job, McCallie wears several different hats when it comes to interoperability, as he was integral in the creation of Direct and the CommonWell Health Alliance. McCallie says that the first step to stopping information blocking is greater transparency. “What’s actually happening? Is data blocking occurring? We know it is, so the next questions are where and why? The government needs to ensure there’s transparency, and that will fix a bunch of problems right on the spot,” he says.


“The second biggest thing the government can do is keep up on changing the reimbursement models so that data sharing is actually a good business practice to the point where if you share and can receive data, then your ability to manage patients to high quality and low cost care goes up,” McCallie says. “Then provider organizations will demand from the vendors, local HIEs, and other service providers to make data sharing work because they can’t survive without it. In a fee-for-service world there is not much incentive to share, but in a pay-for-quality world, there is a lot of incentive to share,” he says.


As such, McCallie has fears of an ill-conceived attempt to regulate interoperability by focusing on regulatory-driven standards. “We may regret it because the technology world moves so much faster than the regulatory world, and you could end up locking into really bad standards,” he says. For example, he adds, the industry is now in a transition from document-centric sharing, which is the current ONC standard for meaningful use, to discrete data element sharing which will be enabled by FHIR (Fast Healthcare Interoperability Resources) that’s emerging from HL7 (Health Level Seven International). “FHIR is a much more powerful and flexible and a better way to do it, but it would be a shame if we locked into the document-centric model because that’s all there was available at the time rule got written. You would make a huge mistake if you did that. We’re anxious to avoid that and let market forces take care of that, and transparency is a way to make market forces work,” McCallie says.


Sittig agrees on the point of paying for quality rather than services, saying it would solve all of the problems and would make organizations want to share data since they want to make money and stay in business. Still, he says most folks would be surprised about how provider organizations view success in the market. For instance, Memorial Hermann decided to have its own HIE rather than join Greater Houston Healthconnect, a large regional HIE in Texas. “They have decided that they’re big enough all by themselves to have their own HIE, and they think they will be more successful in a value-based environment in which they control all the hospitals and physicians that their patients go to,” Sittig says. “They don’t want the patients to go outside of their network. I don’t think that’s what accountable care organization (ACO) model had in mind.”


However, McCallie says he is seeing institutions agree to work together to take on risk. “Be it an ACO or some future successor to ACOs, those organizations will put in place robust data sharing, highly coupled to the requirements of the ACO—so not only clinical data, but also appropriate financial data,” he says. At same time, he notes, those organizations need to have connectivity to the broader community, but perhaps at a lower bandwidth and with less sophistication.


Enter CommonWell, which McCallie advocates as the standard way for everyone to connect. He says the alliance is currently at the low-level document-centric data sharing phase, but inside, the network is completely neutral with no advantages or disadvantages. “A given provider might have high bandwidth connectivity in his local database behind his at-risk population, but if his patient is in a car accident in Florida and got an MRI, and he needed an EKG in his local record, he won’t get that from his high bandwidth local HIE. He’ll get it from a national connectivity through something like CommonWell, and I think those two can coexist,” he says. McCallie says he likes to call it a “virtual HMO” (health maintenance organization), though that term hasn’t caught on yet. “Not all your patients will be in that high bandwidth network, and that’s why it’s virtual. As a provider you may participate in multiple independent ACOs, and your patients are free to move around under the current rules, so you need activity to the broader world,” he says.


With regards to another barrier to true interoperability, McCallie says that that while CommonWell is predicated on the belief that you need specific services— an identity management service and record locator service—to make connectivity easy and robust, the eHealth exchange, another data sharing network, is not predicated on those same beliefs. “Some of its members, mainly the federal government partners, actively did not want a central identity management service for fear of political repercussions of having a database of all the patients. CommonWell basically looked at the eHealth model and said that’s not going to scale; we need to have identity management service and record locator service,” McCallie says.


So while conversations between the two networks are being facilitated, McCallie notes that the mismatch in capabilities is a huge roadblock. “If you have a data sharing network like CommonWell that’s predicated on strong identity management and record locator service, and you’re trying to bridge that to a data sharing service that doesn’t believe in that, that’s a challenging bridge to build. I won’t say it’s impossible though,” he says, adding that there isn’t an obvious solution to the problem. “At some point we just need to be able to go and get the record wherever it is, and not worry about which ATM machine works with which bank. We did that already and it was painful.”

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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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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.


What’s more, Sittig says that with interoperability and health IT in general, there is a “socio-technical” problem, meaning there are legal, organizational, and people constraints on IT systems just as much as there are technical limitations. “A lot of people focus on the technical limitations and say we’re not achieving the interoperability we want because of those. I’d say that’s not the case at all. In a lot of cases the healthcare delivery systems don’t want to exchange data with their competitors. They blame it on a technical reason, either big or small, because they don’t want to do it anyway,” he says. Sittig gives an example of two hospitals that are currently trying to merge and they’re arguing about whether they’re going to let the nurses in the other system see the data. “It’s not a question of technical capabilities, but instead one of giving them log-ins or not,” he says.


To this end, speaking of an Office of the National Coordinator for Health IT (ONC) report released last month on health information blocking, Sittig says the blocking is coming more from the healthcare providers than from the vendors. “It’s happening and it would be better for the patients if it wasn’t happening, but there is a huge business around this. It’s not completely about patient care,” he says. “These are multi-billion dollar businesses,” he continues. “If we shared all the data that people want us to share, we would lose a significant amount of revenue, so much so that it would make us a lot smaller, maybe even put us out of business. Until that changes, and there are federal laws that people are talking about now, we won’t have interoperability,” Sittig says.


David McCallie, M.D., senior vice president of medical informatics at the Kansas City-based EHR vendor Cerner, is surprised at the degree of concern expressed by Sittig when it comes to information sharing. In addition to his Cerner job, McCallie wears several different hats when it comes to interoperability, as he was integral in the creation of Direct and the CommonWell Health Alliance. McCallie says that the first step to stopping information blocking is greater transparency. “What’s actually happening? Is data blocking occurring? We know it is, so the next questions are where and why? The government needs to ensure there’s transparency, and that will fix a bunch of problems right on the spot,” he says.


“The second biggest thing the government can do is keep up on changing the reimbursement models so that data sharing is actually a good business practice to the point where if you share and can receive data, then your ability to manage patients to high quality and low cost care goes up,” McCallie says. “Then provider organizations will demand from the vendors, local HIEs, and other service providers to make data sharing work because they can’t survive without it. In a fee-for-service world there is not much incentive to share, but in a pay-for-quality world, there is a lot of incentive to share,” he says.

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Healthcare's 'Internet of Things' should be the 'Security of Things'

Healthcare's 'Internet of Things' should be the 'Security of Things' | Healthcare and Technology news | Scoop.it

Mobile devices in healthcare institutions are giving rise to new data security and liability risks. Connected devices – another way of describing "The Internet of Things" – present many of the same security and privacy breach rises aspects, and even greater risks because the devices are designed to act automatically without active human direction.


Six fundamental questions therefore need to be asked about connected devices.

  1. Do the devices store and transmit data securely?
  2. Do they accept software security updates to address new risks?
  3. Do they provide a new avenue to unauthorized access of data?
  4. Do they provide a new way to steal data?
  5. Do they connect to the institution's existing IT infrastructure in a way that puts data stored there are greater risk?
  6. Are the APIs – through which software and devices connect – secure?


Healthcare technology officers, including Chief Information Officers (CIO), Chief Technology Officers (CTO), Chief Information Security Officers (CISO), healthcare data administrators such as the Chief Data Officer (CDO) and Chief Medical Officers (CMO) managing a medical world of connected devices should be focusing on these questions before they enter into agreements with vendors, outsourcing providers and related institutions. These executives and need to recognize that connected devices and the "Internet of Things" should be the "Security of Things."


Accordingly, existing contracts need to be reviewed and modified to provide the requisite vendor security obligations. RFPs for new contracts should require potential vendors to identify how security will be provided for the Internet of Things. New contracts should be structured to provide the security provisions that the Internet of Things requires.


Data encryption 


In setting up connected device systems, healthcare institutions' agreements with vendors (including cloud services providers) should ensure that data traffic of the device and its software application is encrypted when communicating the institution's private network and those of its outsourcing providers and any cloud systems. The contracts should allow the institution to audit, and require the vendors to periodically verify, that the data is transmitted in the appropriately strong encrypted form and the encryption works on the network.  

For example, an audit revealing that data is transmitted in "clear text" indicates that contractual encryption requirements are not being followed. Moreover, given the complexity of healthcare institutions, it is important that industry standard encryption protocols are used so that all connected devices connect securely. Encryption protocols that are proprietary to a single vendor should be avoided.  The collection and transmission of personal healthcare information, even in aggregate form, without such protections can lead to compromise of the privacy of the data and potential legal liability for the institution – especially if the information is stolen or used for unauthorized purposes by unauthorized parties. 


Authorized, secure devices


How can privacy protection be increased? In addition to the use of proper encryption, the healthcare institution should require in the contract that only a particular connected device collect only the data that is required for its intended operation, and that it enables access to data generated by the device only by authorized and authenticated individuals with a need to handle the information; the same should be true of computer systems that handle the data from the device. 

The physical security of the device itself also should not be overlooked. The device should be configured to prevent data storage media from being accessed or removed, and the device itself should not be easily disassembled. In short, building a strong security to protect data during transmission is undercut if the data can be removed from the device itself.  


Credentials and password protection


As a matter of setting up a system, connected devices are initially deployed in a form where insured or well-known default passwords and usernames are used. After setup is complete and before critical information is collected and transmitted, the vendor should change the default passwords and usernames to meet the requirements of the CIO, CISO and CDO. Most importantly, the steady-state passwords and usernames can withstand attacks by hackers and the criminal syndicates that employ them. Further, the connected device network should not be configured in a way that allows authentication credentials to be exposed in data traffic over the healthcare institution's network. This is important now that computers communicate directly with other computers and send and receive information without human intervention.  


Personnel 


Computer security consists of hardware, software and people. Disgruntled and former employees, both of the institution and the vendor and its subcontractors, can be a source of unauthorized disclosure. Good personnel practices are important, and repeated audits are necessary to enable early discovery. This factor is especially important at the computer network administrator level, as that manager provides an enhanced risk to the institution.  


Conclusion


Finally, healthcare institutions should enter into agreements with vendors that require the connected devices to be updated with improved security over time and that the updates are tested and verified before being put into use. Given the nature of healthcare data and potential legal liability for resulting data breaches, the "Internet of Things" at healthcare institutions and the contracts that cover them need to constitute a "Security of Things."


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Can interoperability go from idea to reality?

Can interoperability go from idea to reality? | Healthcare and Technology news | Scoop.it

Interoperability is one of those words you can't avoid if you work in the health IT industry, and its use is only going to grow as 2015 wears on.

It's a controversial topic, with most agreeing it is essential if healthcare technology is to move forward, but others adding that it won't be achieved in the current healthcare environment. Many are calling on industry and government to work together to create better transparency and interoperability.


To that end, interoperability is a key focus of the Office of the National Coordinator for Health IT. The government agency in January released its 10-year Interoperability Roadmap. The roadmap's goal is to provide steps to be taken in both the private and public sectors to create an interoperable health IT ecosystem over the next decade, according to ONC.


The push from the ONC to focus on interoperability comes as the agency looks to move past Meaningful Use.


As thousands gather in Chicago in April for HIMSS15, the topic of interoperability will kick off with a keynote at Sunday's preconference Health Information Exchange Symposium. ONC Interoperability Portfolio Manager Erica Galvez will address the agency's roadmap and how the government is working with the healthcare industry to make interoperability reality; there also will be a roadmap discussion run by Galvez and Steven Posnack, ONC's director of the Office of Standards and Technology, on Monday.


Additionally, on Wednesday, Massachusetts eHealth Collaborative President and CEO Micky Tripathi and Epic President Carl Dvorak will lead a session on HL7's Fast Healthcare Interoperability Resources (FHIR) standard. Another panel discussion Thursday will pinpoint how to address patient information in electronic health records pulled from different clinical systems.


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The New Next Generation ACO Model: Cause for Optimism?

The New Next Generation ACO Model: Cause for Optimism? | Healthcare and Technology news | Scoop.it

Tuesday, March 10, will inevitably looked back on as important day for CMS (the Centers for Medicare and Medicaid Services) and for the ACO (accountable care organization) concept, whether positively or (hopefully not) negatively so. That’s because now, in addition to the Medicare Shared Savings Program (MSSP) ACO model and the Pioneer ACO Program, CMS unveiled a third option, the Next Generation ACO.

As our news story on Tuesday afternoon reported, “The U.S. Department of Health and Human Services announced on March 10 that the Centers for Medicare & Medicaid Services (CMS) had launched a new accountable care organization (ACO) initiative, creating a new vehicle called the Next Generation ACO Model. The announcement came via The CMS Blog, and was authored by Patrick Conway, M.D., Deputy Administrator for Innovation and Quality and Chief Medical Officer for CMS.”

We reported the text of the announcement, in which Dr. Conway noted in The CMS Blog that “This model builds on the successes of earlier ACO models, such as the Pioneer ACO Model, and further enables innovation by providers to improve care for patients. Made possible by the Affordable Care Act,” Dr. Conway continued, ”ACOs encourage quality improvement and care coordination to help improve our health care system. ACOs are a critical part of achieving the Department’s goals of delivery system reform nationally – aimed at better care, smarter spending and healthier people.”

And on the Next Generation ACO web page, CMS explained that “The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP). The goal of the Model,” according to its website, “is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.”

The description from the website went on to say that “Included in the Next Generation ACO Model are strong patient protections to ensure that patients have access to and receive high-quality care. Like other Medicare ACO initiatives, this Model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures. This is in accordance with the Department of Health and Human Services’ “Better, Smarter, Healthier” approach to improving our nation’s health care and setting clear, measurable goals and a timeline to move the Medicare program -- and the health care system at large -- toward paying providers based on the quality rather than the quantity of care they provide to patients. In addition, CMS will publicly report the performance of the Next Generation Pioneer ACOs on quality metrics, including patient experience ratings, on its website.”

We’re still just beginning to learn the first details about this model, but already, provider associations are applauding CMS’s move. Shortly after the announcement, the Charlotte-based Premier healthcare alliance released a statement, attributed to Blair Childs, senior vice president of public affairs at Premier, stating that “Members of the Premier healthcare alliance strongly support well-designed alternative payment models.  We are eager to begin working with our members to assess the Next Generation ACO Model. Today’s announcement,” the statement said, “gives healthcare providers another Medicare payment option with substantially greater flexibility to provide innovative, high quality care to a defined group of beneficiaries.”

Premier leaders particularly liked the fact that CMS seemed to signal a shift towards more flexibility in terms of delivery and payment models. “With this announcement, providers have even more choices, which will enable the market to both mature and evolve,” Premier’s statement said.

Only time—and the revelation of all the details of beneficiary attribution, risk adjustment, outcomes measures, and payment nuances—will tell how this all turns out. But I think it can be fairly said that senior officials at CMS are doing active thinking these days around how to keep the ACO concept alive, and hopefully, thriving—because their flexibility, their agility, and their collaborativeness with providers, will be essential to the nurturance of the ACO concept, in the public payment sphere, going forward.


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The Consumerization of Healthcare: Can Providers Keep Pace?

The Consumerization of Healthcare: Can Providers Keep Pace? | Healthcare and Technology news | Scoop.it

Healthcare is undergoing a wave of consumerization. Changing regulations are requiring patients to contribute more financially toward their own care, turning them into true healthcare consumers and motivating them to make more careful and informed decisions. At the same time, the consumerization of healthcare is driving more players into the healthcare space – from tech giants like Google and Apple, to convenience-focused retailers like Walmart and CVS. These new entrants are not only creating savvier, more informed patients, but are opening up more choices for where and how consumers direct their healthcare dollars.

I see three key changes that providers will need to make in order to compete with new entrants and adapt to this new era of healthcare consumerization:

  • Making patient information a shared responsibility. The days of keeping each consumer’s information locked up in a filing cabinet and available only through a paper document request process are long over. Many providers have already started making progress by using patient portals to share information. Today’s patient portals are only a beginning. Instead of information flowing from provider to patient, consumers will increasingly want and need to contribute more of their own information, such as daily readings from weight scales, wearables or in-home test results.
  • Allowing more variety in care settings. Patients are increasingly looking for care to come to them instead of traveling to a hospital or doctor’s office. Healthcare providers are shifting care to the home and to other outpatient settings in an effort to respond to these new demands for convenience, and new connected technologies and mobile devices are making it easier to deliver quality care in new settings.
  • Delivering more personal healthcare. In an era of healthcare consumerization, healthcare providers need to think more like other industries. This is challenging because of the perverse incentives associated with fee for service. For many patients, interacting with the healthcare system is like dealing with the DMV. Interactions can be lengthy, complicated and frustrating. However, healthcare organizations that put the patient at the center of their care delivery processes can improve the health and wellness of their communities; drive patient satisfaction and engagement, which are critical to controlling costs; and increase quality and profitability. This can start with simple measures, like providing a multi-lingual staff, addressing people by a preferred name, knowing personal histories and providing more convenient after-hours access that other industries have mastered.


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Accountable Care, Quality Metrics Must Combine for Improvement

Accountable Care, Quality Metrics Must Combine for Improvement | Healthcare and Technology news | Scoop.it

The healthcare industry has taken many positive steps towards improving the measurement of quality and patient outcomes, says Margaret E. O’Kane, MHA, President of the National Committee for Quality Assurance (NCQA), but true improvement comes from the marriage of metrics with innovative reform of payment and care delivery systems.  In a commentary for the American Journal of Managed Care, O’Kane states that providers, payers, and regulators must continue to promote the business case for providing the highest possible quality of care for patients.

“The accomplishments of the last quarter-century are real and significant,” O’Kane says. NCQA is celebrating its 25 year anniversary in 2015, and the healthcare quality measurement landscape looks significantly different today.  “In 1990, measuring quality was just an idea—today it is an everyday reality. Most Americans—more than 171 million—are enrolled in health plans that report NCQA’s HEDIS (Healthcare Effectiveness Data and Information Set) clinical quality measures.”

HEDIS scores are now used by Medicare, the majority of state Medicaid plans, and numerous private insurers to benchmark performance, reward improvement, and pinpoint opportunities for change.  HEDIS, along with similar patient satisfaction and outcomes measures designed to drive quality improvement, will become increasingly important as more and more industry stakeholders adopt the principles and strategies of accountable care. As HHS and private industry set ambitious goals for cost and risk sharing, benefit structures for patients and provider networks should respond appropriately.

While high-deductible plans have become the norm for patients, who are now expected to shoulder a larger proportion of costs, patients do not always invest in necessary care when they feel unable to afford the large out-of-pocket bills that will result.

“Rather than the blunt instrument of the high deductible, a better approach is Value-Based Insurance Design (VBID)—low co-pays for high value services and medications, higher for those that don’t improve heath,” O’Kane suggests. “An interesting twist is to give a financial incentive to members with chronic conditions to choose a PCMH or accountable care organization with active care management.”

Quality measurement should also be used to distinguish high-quality, high-value providers from those with poorer outcomes in order to make it easier for patients to make better choices for their health and their wallets.  In order to ensure that providers deliver high-quality care, payers should create clear financial incentives.

“This is no small set of tasks,” O’Kane acknowledges. “Over the past 25 years, consumers have become accustomed to the paradigm of choice. Providers have been rewarded for doing more and for giving more complex care. These are deeply embedded cultural norms that need to change. Now, as payers look at what is being purchased, they can act as market makers who drive volume and rewards to the delivery systems that have accepted the challenge of delivering quality, patient-centered care that is affordable.”


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Cerner big data platform gets new client

Cerner big data platform gets new client | Healthcare and Technology news | Scoop.it

Truman Medical Centers and the University of Missouri-Kansas City's Center for Health Insights have teamed up on a new initiative that will harness data from electronic medical records, de-identifying it and digesting it into a database that can help inform better care decisions.

Both organizations will partner with EMR giant Cerner to leverage its Health Facts data warehouse platform to drive the analytics initiative. Health Facts extracts data from both clinical and financial IT systems, de-identifies the data, standardizes terms through mapping to common nomenclature and has the ability to create adverse drug events and outcomes reports.

The platform, as Cerner officials described, will allow the two-hospital TMC to use its current clinical and financial data and transform it into a usable form that can be leveraged to improve patient safety and care outcomes. What's more, TMC officials anticipate the data analysis can also be used to reduce specific health disparities and reduce costs for certain procedures.

Specifically, with the platform TMC officials will be able to use the generated reports and compare one's organization's performance with other clients who use the warehouse. The warehouse already includes millions of EMR records from inpatient, ED and outpatient visits from patients nationwide.

"The centerpiece of this partnership provides tools to accelerate clinical and translational research and ultimately provide better health outcomes," said Lawrence Dreyfus, UMKC vice chancellor for Research and Economic Development, in a Feb. 18 press statement. "We couldn't be more excited about the prospects that this partnership holds for healthcare decisions that ultimately improve care and reduce costs."

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Future Of TeleMedicine: Will Robot Chips Live In Our Bodies

Future Of TeleMedicine: Will Robot Chips Live In Our Bodies | Healthcare and Technology news | Scoop.it

These were two predictions made by MYOB’s chief technology officer, Simon Raik-Allen, as part of the software outfit’s Future of Business Australia 2040 report, which looks at the impact of technology in the workplace and in our daily lives.

Raik-Allen claimed that we won’t just be wearing technology, we’ll have chips embedded inside us that will interface with various parts of our body. This will help us manage our food or vitamin intake, or send signals to various organs to help regulate our bodies.

“Extremely tiny robots known as nanobots will crawl through your veins performing maintenance,” he claimed.

“Your brain will also start to be integrated and there will be many things you can control just by thinking about them. You might even be able to purchase brain add-ons, just like you buy apps today for your phone,” he predicted.

Technology will transform the way we work, but those changes will be driven by the rising cost of energy and transport and the need to manage impacts on the environment, he said.

The biggest invention to change the workforce since email will be the holographic representation of people, he said.

“We will work in a shared workplace that will be set up so that you can interact with holographic people from all around the world. You may never meet the people you work for in person, because you will be pitching your ideas to a global workforce,” he predicted.

He also said the people will transact and be paid by internet-based crypto currencies, governed by independent bodies such as associations and corporations, rather than governments.

Any business will be able to make its own currency – to buy and sell at values regulated by the market and at the perceived value of the company, he said.

The focus of 2040 will be a suburban village with everyone living within walking distance of their homes, said Raik-Allen.

He believes autonomous vehicles such as drones and self-driving cars will deliver packages between communities or even a coffee and a bagel to your current location.


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Future of interoperability is here | Healthcare IT News

Future of interoperability is here | Healthcare IT News | Healthcare and Technology news | Scoop.it
Hard to believe, but it has been a decade since the George W. Bush administration created the Office of the National Coordinator for Health Information Technology and issued a challenge to the healthcare industry that it should be seamlessly interoperable by the year 2014.

The initiative outlined some bold ideas and served as motivation for an industry that lagged behind in information technology development. And while the initial vision of a completely interoperable healthcare system may have had an off-the-mark time frame, experts agree that it got the machinations spinning in the right direction.

“To me, interoperability should be about that seamless flow of information,” says Joy Huntington, RN, clinical specialist at Roper St. Francis Healthcare in Charleston, S.C. “In reality, we’re not experiencing it at this particular point – we’re still in siloes electronically and gaps still exist. We’re not where the pundits thought we should be, but we can see now that they weren’t realistic in their expectations. That doesn’t mean we haven’t made substantial progress – we have in many ways.”

Currently Roper St. Francis has “a higher degree of interoperability than most,” Huntington says, as the inpatient and outpatient sectors “have some degree of interoperability.” The ER has its own system apart from the enterprise because it operates in its own self-contained environment, she says.

“We needed documentation that was easier to use, more specific and customizable,” Huntington says. “What we managed to do is let clinicians in the enterprise see and share the patient’s information, which they can view and validate.”

Looking back 10 years, Kirk Larson, regional CIO of Healthcare for Sunnyvale, Calif.-based NetApp, says the 2004 initiative helped to push healthcare out of its IT lethargy.

“Before that, organizations were content not to be interoperable,” he says. “That was OK because it was the norm and there was no pressure to change. Now as meaningful use is well into Stage 2, progress is not only encouraged, but mandated.”

If there is one place where interoperability has taken hold, it’s with health information exchanges, Larson says.

“They may not be eloquent, but they achieve the spirit of interoperability,” he says. “They can access data at the point of care and that makes a difference.”

More than EHRs

The impetus for the ONC’s creation and subsequent 10-year interoperability assignment focused on electronic health records and the seamless exchange of patient information among healthcare entities. And though that remains the chief concern, interoperability has various dimensions of functionality, says Zane Schott, vice president of business development for Salt Lake City-based BlueStep.

“You don’t need an EHR to be integrated,” he says. “There are so many organizations in post-acute and long-term care that are still running paper. Even so, they have the ability to be interoperable because with the MDS (Minimum Data Set) they have to produce files that can be sent to CMS electronically. We can lift that piece of information and submit it to an HIE or hospital based off the MDS so that even without an EHR they can be interoperable.”

A key reason why providers in the post-acute sector are still dealing with paper is that they were not included as eligible for ARRA funds and therefore are not involved in the meaningful use push.

“What this means is that, ironically, seniors are being left behind in the interoperability initiative,” he says, “and that is tragically unfair.”

‘Cross pollination’

Connectivity with payers is another important aspect of interoperability, which is the bailiwick of Cambridge, Mass.-based Pegasystems. While the company serves most of the major health plans, it also focuses on government agencies, health systems and life sciences.

“It’s a great pollination of ideas from retail verticals to financial services,” says Elizabeth Hart, industry principal for healthcare. “We target the different pain points and verticalize them for the customers we sell to, but also extend from those so that you can start a CRM system and call center and build an enrollment system out of that.”

Hart concedes that despite gains, healthcare is still reliant on 30-year-old legacy systems that don’t have the functionality needed to make interoperability a reality.

“Traction is being made, but it is still not moving at the pace we need,” she says. “A lot of it has to do with the fact that there is more data coming out with in-home monitoring and mobile devices that weren't envisioned from the old systems and existing EHRs. We end up wrapping around those systems to give them the capabilities and capacity they need.”

A new ‘connection’

The hallmark event for interoperability is the IHE North American Connectathon, which will be held Jan. 26-30 at the Cleveland Convention Center and HIMSS Innovation Center in Cleveland. The sponsors are enthused with the new venue after 15 years in Chicago.

“Cleveland’s state-of-the-art Convention Center and Global Center for Health Innovation – called ‘The Globe’ by the locals – has provided Cleveland with the opportunity to become an epicenter for healthcare and innovation,” said Celina Roth, HIMSS manager of informatics and staff liaison to the IHE. “Together these two venues are creating a new renaissance in downtown and revitalizing the city.”

The IHE Connectathon is a cross-vendor, live, supervised, and structured testing event with more than 100 participating vendors and 600-plus engineers and IT architects. All these organizations and IT experts converge on-site for one week of interoperability testing and problem resolution. Participants test their products against multiple vendors using real-world clinical scenarios contained in IHE's Integration Profiles.

With implementation of IHE Profiles growing, IHE USA has introduced new programs, such as a new one-day technical program called Connectathon 101. It will be offered on Tuesday, Jan. 27, to help engineers gain a full understanding of the Connectathon testing process, experiment with the testing tools, and work one-on-one with industry experts. Engineers who complete the session leave prepared to participate in next year’s IHE North American Connectathon 2016.

“While EHR usage has increased significantly, the interoperability necessary to achieve continuity of care, population health, patient management and clinical quality improvement is not yet realized,” Roth says. “Interoperable health IT has made strides in many areas like ePrescribing, but widespread progress remains slow.”
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