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The Security Risks of Medical Devices

The Security Risks of Medical Devices | Healthcare and Technology news | Scoop.it
There are a large number of potential attack vectors on any network. Medical devices on a healthcare network is certainly one of them. While medical devices represent a potential threat, it is important to keep in mind that the threat level posed by any given medical device should be determined by a Security Risk Assessment (SRA) and dealt with appropriately.

So let’s assume the worst case and discuss the issues associated with medical devices. First off, it must be recognized that any device connected to a network represents a potential incursion point. Medical devices are regulated by the FDA, and that agency realized the security implications of medical devices as far back as November 2009, when it issued this advisory. In it, the FDA emphasized the following points:

Medical device manufacturers and user facilities should work together to ensure that cybersecurity threats are addressed in a timely manner.
The agency typically does not need to review or approve medical device software changes made for cybersecurity reasons.
All software changes that address cybersecurity threats should be validated before installation to ensure they do not affect the safety and effectiveness of the medical devices.


Software patches and updates are essential to the continued safe and effective performance of medical devices.


Many device manufacturers are way behind on cybersecurity issues. As an example, many devices are still running on Windows XP today, even though we are one year past the XP support deadline. They are often loathe to update their software for a new operating system. In other situations device manufacturers use the XP support issue as a way to force a client to purchase a new device at a very high price. All healthcare facilities would be well advised to review any purchase and support contracts for medical devices and make sure that things such as Windows upgrades do not force unwanted or unnecessary changes down the road. While there are options to remediate risks around obsolete operating systems, they are unnecessary and costly. Manufacturers should be supporting their products in a commercially reasonable manner.

Why would anyone be interested in hacking into a medical device? Of course there are those that would argue that anything that can be hacked will be hacked, “just because”. While it is possible that hacking could also occur to disrupt the operations of the device, the more likely reason is that getting onto a medical device represents a backdoor into a network with a treasure trove of PHI that can be sold for high prices on the black market. Medical devices are often accessible outside of normal network logon requirements. That is because manufacturers maintain separate, backdoor access for maintenance reasons.


Hackers armed with knowledge of default passwords and other default logon information can have great success targeting a medical device. For example, this article details examples of a blood gas analyzer, a PACS system and an X-Ray system that were hacked. Many times healthcare IT departments are unaware or unable to remediate backdoor access to these systems. These are perhaps more “valuable” as a hack because they are hard to detect and can go unnoticed for a long period of time. As a reminder, the Target data breach last year was initiated because the access that a third party had to the retailer’s network was compromised. A complete SRA should inventory all network connected medical devices and analyze the access/credentials that a device has, and any associated security threat. The best defense is a good offense – make sure that networked devices have proper security built in and implemented. Then your devices will no longer be “the weak link in the chain”.

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HHS, CVS Partner for Personalized Preventive Care

HHS, CVS Partner for Personalized Preventive Care | Healthcare and Technology news | Scoop.it

The U.S. Department of Health and Human Services (HHS) and CVS are collaborating to promote an online tool that provides recommendations for the personalized preventive services patients should receive based on their age and gender. 


Many of these preventive services are available to patients at MinuteClinic and CVS/pharmacy locations, as well as at their physician's office, and many are now covered by most insurance without additional co-pays or other cost sharing under the Affordable Care Act. The recommendations, officials say, come from government-recognized clinical experts.


Announced this week at Health Datapolooza 2015 in Washington, D.C., CVS Health says it is the first national partner to work with HHS to take advantage of the technology-based tools, developed within the Department by the Office of Disease Prevention and Health Promotion, which make it possible for the myhealthfinder tool to be available on MinuteClinic.com and at www.cvs.com/myhealthfinder.


Commonly recommended preventive services available at MinuteClinic include blood pressure checks, cholesterol screenings, wellness counseling and routine vaccinations. In a blog post accompanying the announcement, Acting Assistant Secretary for Health (ASH) and National Coordinator for Health Information Technology (ONC) Karen DeSalvo, M.D. said, “Our collaboration with CVS Health was made possible by one of our projects that has been an example of innovation in the federal government since 1997. Nearly two decades ago, healthfinder.gov was the first government website designed to share health information with consumers and improve health literacy.


Since then, the Office of Disease Prevention and Health Promotion within HHS has developed the current healthfinder.gov website into a trusted, credible source for easy-to-understand prevention and wellness information. Through myhealthfinder, an interactive tool available on the website, you can enter your age, sex, and pregnancy status to receive customized wellness and prevention information along with steps you can take with your provider and at home to prevent illnesses and improve your health.”


What’s more, DeSalvo said, “To make myhealthfinder more readily available to more people, we recently developed a free, publically available application programming interface (API) to integrate the tool into any website. The API imports up-to-date information directly from healthfinder.gov. This tool supports physicians and the care team, and is an easy way to help people understand the recommended preventive services that are often available to them at no out of pocket cost thanks to the Affordable Care Act,” DeSalvo said.

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New Medicare data available to increase transparency on hospital and physician utilization

New Medicare data available to increase transparency on hospital and physician utilization | Healthcare and Technology news | Scoop.it

As part of the Administration’s efforts to promote better care, smarter spending, and healthier people, today CMS is posting the third annual release of the Medicare hospital utilization and payment data (both inpatient andoutpatient) and the second annual release of the physician and other supplier utilization and payment data. The announcement was made at the annual Health Datapalooza conference in Washington, DC.


“These data releases will give patients, researchers, and providers continued access to information to transform the health care delivery system,” said acting CMS Administrator Andy Slavitt. “It’s important for consumers, their providers, researchers and other stakeholders to understand the delivery of care and spending under the Medicare program.”


The Medicare hospital utilization and payment data consists of information for 2013 about the average amount a hospital bills for services that may be provided in an inpatient stay or outpatient visit. The hospital data includes payment and utilization information for services that may be provided in connection with the 100 most common Medicare inpatient stays and 30 selected outpatient procedures at over 3,000 hospitals in all 50 states and the District of Columbia. The top 100 inpatient stays represented in the hospital inpatient data are associated with approximately $62 billion in Medicare payments and over 7 million hospital discharges.


The Medicare Part B physician, practitioner, and other supplier utilization and payment data consists of information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The data also shows payment and submitted charges, or bills, for those services and procedures by provider. It allows for comparisons by physician, specialty, location, types of medical services and procedures delivered, Medicare payment, and submitted charges. The new 2013 dataset has information for over 950,000 distinct health care providers who collectively received $90 billion in Medicare payments. Hospitals, physicians, and other health care providers determine what they will charge for services and procedures provided to patients and these “charges” are the amount the hospital or provider generally bills for the service or procedure, but the amount paid is determined by Medicare’s physician fee schedule or other payment methodologies. CMS protects beneficiaries’ personal information in all its data releases.


“Data transparency facilitates a vibrant health data ecosystem, promotes innovation, and leads to better informed and more engaged health care consumers,” said Niall Brennan, CMS chief data officer and director of the Office of Enterprise and Data Analytics. “CMS will continue to release the hospital and physician data on an annual basis so we can enable smarter decision making about care that is delivered in the health care system.”


The Administration has set measurable goals and a timeline to move Medicare toward paying providers based on the quality, rather than the quantity, of care they give patients. These data releases are part of a wide set of initiatives to achieve better care, smarter spending, and healthier people through our health care system. Open sharing of data securely, timely, and more broadly supports insight and innovation in health care delivery.


Today’s data release adds to the unprecedented information recently released on Medicare Part D prescription drugs prescribed by physicians and other health care providers.

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Is This Population Health’s Moment? Time for Data and Analytics

Is This Population Health’s Moment? Time for Data and Analytics | Healthcare and Technology news | Scoop.it

Every year, the annual HIMSS Conference, sponsored by the Chicago-based Healthcare Information and Management Systems Society, offers its attendees a kind of conference-based snapshot of where the U.S. healthcare industry is with regard to the forward evolution of healthcare information technology adoption, as well as a sense of the overall policy and operational landscape of healthcare. Attendees can get a sense of the healthcare IT Zeitgeist through attending keynote addresses, educational sessions, association meetings, and networking-focused gatherings, as well as by wandering the exhibit hall and simply by having meaningful conversations with fellow attendees.


HIMSS15, held at the vast McCormick Place Convention Center in Chicago the week of April 12, offered perhaps the clearest portrait of the current moment that has yet been offered to date. Session after session focused on the shift beginning to take place from volume-based healthcare reimbursement to value-based payment, across a very wide range of mechanisms, between providers and both the public and private purchasers and payers of healthcare, and the implications of that shift for healthcare IT leaders.


Further, as part of the keynote session on Thursday, April 16 in the Skyline Ballroom at McCormick Place, Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), made the intentions of federal authorities crystal clear, when, referencing the statement of Health and Human Services Secretary Sylvia Mathews Burwell in January that she wanted the bulk of Medicare fee-for-service payments to providers to shift as quickly as possible over to quality- and value-based payment, Slavitt said, “Our priority is simple: to drive a delivery system that provides better care, smarter spending, and keeps people healthier. The success in the first five years since the Affordable Care Act has been very encouraging… Our agenda now,” he said, “is to get busy strengthening these gains. That will mean that more providers in more communities will need to be able to transform the care they provide so that they will benefit from value-based reimbursement. And they will need technology to help them get there.”


What’s more, in his keynote address two days earlier, Humana CEO Bruce Broussard had told HIMSS attendees, “We have to change the conversation on what we are doing in healthcare from a supply-based system to a system around demand, a system where we put the customer first as opposed to the system. Over the years,” he added, “healthcare has been built by creating more and more supply. I hope I leave today by convincing you that we have to change the focus towards how we improve health for our customers, members, and patients.”


The good news on the solutions side of this landscape is that vendors are rushing forward to provide population health- and accountable care-driven analytics solutions, at a time when such solutions are most desperately needed. Certainly, the hype at HIMSS15 was all around population health, care management, and accountable care solutions. The only question now, as the U.S. healthcare industry hurtles forward into the near future, is, is this a breakthrough moment for population health efforts? And if so, are provider and health plan leaders ready to effectively leverage the tools to make pop health really happen?


The long journey ahead


Leaders from all sectors of healthcare understand that the journey to population health and value-driven care delivery and payment success is going to continue to be a long, challenging one. Donald W. Fisher, Ph.D., president and CEO of the Alexandria, Va.-based American Medical Group Association (AMGA), says he and his colleagues are putting the vast bulk of their efforts into helping prepare physician group leaders for the transition. “We’re not quite there yet, and as we change to a new reimbursement system, even the large, sophisticated medical groups are going to need a few years to make the transition,” Fisher says.  “You’ve got to put the infrastructure in place, and the large integrated health systems have been putting those elements in place—EHRs [electronic health records], alert systems, analytics systems, data warehouses—and some have teams of people mining the data to assess patient status.”

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How Virtual Reality May Change Medical Education And Save Lives

How Virtual Reality May Change Medical Education And Save Lives | Healthcare and Technology news | Scoop.it

The old adage applies to many aspects of our life in a variety of ways.

Practicing your backhand, learning a dance move, or rehearsing your speech.


But where it may matter the most is for medical professionals who perform lifesaving interventions or procedures for patients in emergency departments or in the operating room.

The reality is that there are some lifesaving procedures in emergency medicine that you rarely perform–but must always be ready to perform in a split second.


One such a procedure–known as cricothyrotomy–which involves making an incision into a specific area of patient’s neck and inserting a plastic tube through a thin membrane into the trachea—requires accuracy and speed, and can be lifesaving if performed correctly, but deadly if not completed in a timely or improper fashion. Other life-saving skills including intubation, central line and intraosseous catheter placement also require practice and repetition in order to save lives.


Over the past decade, there has been an explosion in the use of simulation medicine to help physicians gain preparation for performing lifesaving procedures as well as approaching delicate or difficult situations related to patient care.


Simulation has been embraced by residency programs as well as hospital training programs in orders to keep the skills of physicians sharp for rarely performed life saving procedures such as cricothyrotomy.


Yet one important lifesaving skill that all healthcare providers must stay current on is CPR or Cardiopulmonary Resuscitation.


CPR has generally been taught in large classes using mannequins, with instructors demonstrating technique and proper form. Students read and attempt to memorize algorithms in preparation for classes.

Newer electronic approaches involve online portals to view CPR or BLS and integrate online test taking. Whether this more modern approach is useful and sustainable is unclear at this time.


Now enter Virtual Reality or VR, which can open up an entirely new world of possibilities to experience the tense, real world clinical situations which require rapid thinking and quick analysis for management of critically ill patients undergoing CPR.

While VR initially gained a foothold in the world of gaming, more relevant and far-reaching possibilities are now envisioned by experts in the realm of education and learning.


According to Mary Spio, CEO of Next Galaxy, a developer of innovative content solutions and consumer virtual reality technology, VR is poised to be our new medium for education and dissemination of information.

Spio, a former aerospace engineer, and patent holder of digital technology that allowed transfer of Star Wars II: Attack of the Clones to theaters, sees our global educational future based on VR.


Next Galaxy’s flagship consumer product currently in development is referred to as CEEK, “a next-generation fully immersive entertainment and educational social virtual reality platform featuring a combination of live action and 3D experiences,” according to the company’s recent press release.


Spio’s hope is that Next Galaxy’s virtual reality model will better educate and prepare health care providers–as well as consumers–for learning CPR, based on a more realistic learning environment. She advocates a paradigm shift, away from the current approach–which relies upon passively watching videos and taking written exams–to a method for learning that involves the use of gestures, voice commands and eye gaze controls, thereby transforming how medical providers and laypersons experience such situations.


As a first step towards developing this new reality, Next Galaxy Corporation recently announced an agreement with Miami Children’s Hospital to engage Next Galaxy’s VR Model and develop immersive virtual reality medical instructional content to educate medical professionals as well as patients.


Next Galaxy and Miami Children’s Hospital will be jointly developing VR didactic modules on cardiopulmonary resuscitation (CPR) as well as other lifesaving procedures that will be available on smartphones and tablets.


According to Spio, participants using VR will be required to make clinical decisions regarding proper techniques, after they make assessments using specific medical VR scenarios. Metrics and real-time feedback from the virtual CPR instructional video will also allow participants the opportunity to accurately perform CPR techniques. VR modules will highlight errors and encourage users to repeat a task when errors occur.


Next Galaxy stated that the VR models will be viewable through smartphones and desktops as 3D, 
as well as using VR devices such as Google GOOGL -1.88% Cardboard, Oculus Rift, and VRONE.

“I think that it’s going to be instrumental in the training and education of not just health care workers and medical professionals, but also patient education,” proclaimed Spio.


A lot of times, Spio explains, patients don’t understand the procedures happening or being performed on them.


“By visualizing the situation, it sinks in a more visual way when they have actually experienced the procedure beforehand,” said Spio. “They become more responsible for their own healing and treatment by having a deeper understanding.”


It also helps medical professionals even further, by reducing risk for litigation in theory, Spio also believes.


Spio also explains that her company has developed an immersive voice-activated model of CPR for choking in infants or adults—for lay providers as well as medical professionals—allowing one to virtually manipulate patients, perform CPR, and remove a potential foreign body.


Spio also describes plans to use her VR library to educate women in countries such as Jamaica and Ethiopia about birthing, where access to basic education is often lacking. Spio envisions her platform (CEEK) and her library as way for mothers to develop a basic understanding about ways to prevent and control infection or even to stop bleeding.

Appealing to consumers, Spio explains that her content library is adaptable to a Google-inspired version of a VR headset (Google Cardboard), with a price point as low as $25.00.


Teaching lactation is another potential area where Spio believes that VR may have potential application. Teaching the “normal” ins and outs and potential expectations and pitfalls would be useful for reducing anxiety for mothers.


She also believes that training the next generation of surgeons using VR technology will be commonplace, with training programs requiring content  from such a platform and library built at Next Galaxy.

“Virtual Reality represents the highest form of learning, essentially because you are immersed in the task and actually doing it,” concluded Spio.


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Health IT Holds the Promise to Help Improve Health

Health IT Holds the Promise to Help Improve Health | Healthcare and Technology news | Scoop.it

About 1 of 3 U.S. adults—67 million people—have high blood pressure, also called hypertension. High blood pressure increases the risk for a variety of diseases, including stroke, coronary artery disease, peripheral vascular disease, heart and kidney failure, and atrial fibrillation. High blood pressure is also called the “silent killer” because it often has no warning signs or symptoms, and many people do not know they have it.


The Department of Health and Human Services, through its national Million Hearts® initiative, has set a goal to prevent 1 million heart attacks and strokes by 2017. Million Hearts® is working with providers to reach clinical targets that could improve population health. For example, health care providers are encouraged to have 70 percent or more of their patients with hypertension control their blood pressure, which could be done by self-monitoring.


During National High Blood Pressure Education Month (May 2015), HHS’ Office of the National Coordinator for Health IT (ONC) and the Centers for Disease Control and Prevention (CDC) are emphasizing the important impact that electronic health records (EHRs) are having through the ability for patients and providers to interchangeably share blood pressure data.


New research about the Million Hearts® electronic clinical quality measures (eCQMs) included in the Medicare EHR Incentive Programs was published today in the Morbidity and Mortality Weekly Report (MMWR) in the article “Morbidity and Mortality Weekly Report: Using Meaningful Use Clinical Quality Measures for Million Hearts Surveillance.” The report shows that, for the first time, data reported as part of the incentive programs, or meaningful use, could improve the timeliness and possibly completeness of data used to track issues of public health concern.


Health IT is on the Quality Team


With a primary focus on the reporting of the Million Hearts® hypertension measures, the research published today shows that:


  • Among providers that started in 2011, the very first year of CMS’ EHR Incentive Program, the average proportion of patients with hypertension in control remained unchanged at 62-63 percent over 3 years.
  • About one-third (36 percent) of reporting providers met the Million Hearts® clinical target of 70 percent or more of their patients with hypertension under control.


The findings show that an EHR is a tool that should make providing better health care easier, but it cannot do so in isolation. Health IT is on the quality team, which means that patient-centered, team-based approaches to care, coupled with the use of certified health IT, can move the health system towards meeting the very important Million Hearts® targets. These strategies should also help clinicians guide patients to achieve safe blood pressures and avoid preventable death and disability.


Quality Reporting is a Powerful Tool for Population Health Surveillance

With the Health IT Dashboard: Office-based Physician Health IT Adoption, discrete blood pressure data, documented and captured electronically, are now available to help us understand hypertension trends and identify steps to accelerate progress. The first three years of the meaningful use program yielded electronic clinical quality measures data from 63,000 health care providers and about 17 million patients with hypertension, which represents large portions of health care provider and patient populations. The eCQM data reported as part of that program demonstrates that continuous quality improvement can be used to track national progress towards an important health goal – preventing 1 million heart attacks and strokes by 2017.

Health Information to Help Coordinate Patient Care


The eCQM data can also help individual physicians target appropriate interventions that can help to manage patients’ health in an effort to better coordinate care. To do that, clinicians make it a priority to be aware of their patient’s health status, and an interoperable health care system can help make this a reality, with reporting on eCQMs being just one part of the picture. Facilitating the flow and exchange of electronic information allows for improved coordination of care across the care continuum by making sure that a patient has the health information they need, when they need it. This is a challenge because health data comes from many different sources. Consider this scenario:


Julia, diagnosed and treated initially for hypertension by her primary care clinician, has noted that her readings are still not in the optimal range. She is referred to a hypertension specialist for further evaluation and management. She is pleased to see her blood pressure reach and stay in good control. Unfortunately, though this achievement is well-documented in her personal paper health diary and in the specialist’s EHR, her primary care clinician is left out of the loop.

This situation happens frequently, but is not a model for coordinated care. Ideally, Julia’s specialist would update her primary care provider on a regular basis. However, we know that sharing, receiving, and using electronic information is not always easy. To reach a level of care coordination necessary to promote better health – and in this case to help address a patient’s high blood pressure – the entire health system must move towards an interoperable, learning health system. The exchange and use of electronic information by all health care providers on the care team is necessary to improve health and health care while decreasing costs.


The optimal use of EHRs should accommodate a provider’s workflow and take advantage of patient-generated data when available. Health information comes from a variety of sources, and eCQMs may not maximize the available data. For example, the blood pressure control measure does not capture:


  • Patient-generated data, such as measurements from a home blood pressure cuff
  • Clinical notes stored as free text in the EHR.


mproving and enhancing eCQMs, and making sure that health IT can use health data from a variety of sources, are key components of the federal health IT strategic plan, and the draft interoperability roadmap.

We still have work to do. To continue to make progress to achieve this goal for more patients, we must work together to reach an interoperable health system that facilitates information exchange across the care continuum, and that enables care transformation.


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In The Grand Canyon State, Behavioral Health Data Exchange Gets Steeper

In The Grand Canyon State, Behavioral Health Data Exchange Gets Steeper | Healthcare and Technology news | Scoop.it

Last April, two health IT vendors—the Horsham, Pa.-based NextGen Healthcare Information Systems and its sister company, Mirth, based in Costa Mesa, Calif.—announced the launch of the Behavioral Health Information Network of Arizona (BHINAZ), publicized by its officials as the first statewide behavioral health information exchange (HIE) in the nation.

BHINAZ was the brainchild of a consortium of behavioral health providers who are customers of Topaz Information Solutions, an authorized NextGen reseller and outsource partner that specializes in behavioral health and social services. Topaz, in partnership with NextGen Healthcare, built specific content within the technology platform to meet specific needs of behavioral health and social services organizations.

Leveraging NextGen’s ambulatory electronic health record (EHR) and HIE, and Mirth Connect— an open source application used for healthcare data integrations—BHINAZ created the legal and operational framework necessary to protect confidentiality while helping to facilitate data exchange and streamline the process for behavioral health providers to obtain and manage patient consent, specifically as it relates to exchanging patient information, officials say. As a result, BHINAZ will provide clinicians throughout the state with a longitudinal patient history at the point of care, making information available when and where it's needed for medical care.

Shortly after the announcement, HCI Senior Contributing Editor David Raths interviewed Laura Young, the executive director of BHINAZ, about the network’s goals and progresses for HCI’s sister publication, Behavioral Healthcare. At that time, the organization was just getting off the ground, with some of the main challenges being around legal and privacy issues with patient consent, as well as connecting to the physical health HIE in Arizona, and of course, cost.

Operating under an “opt-in” consent management model, BHINAZ said that it will ensure that data protected under Federal Law 42 CFR Part 2 is not re-disclosed without proper consent. Within the NextGen EHR, customized behavioral health consent management templates were created by working collaboratively with BHINAZ to include required content management language and capture electronic signatures at the point of care. Using these templates, information is sent to the NextGen HIE, which then dictates specifically what data a given provider can access within the EHR. Patients and clients have the option to choose if they would like their data to be shared with the rest of the closed network at each BHINAZ location. Last year, Young told Raths that, “It really is all or nothing. We are treating all of the data within our HIE as protected 42 CFR Part 2 data. If the client isn’t comfortable sharing their Part 2 data, then we aren’t going to share anything else.”

A year later, HCI Associate Editor Rajiv Leventhal checked in with Young, and the challenges for BHINAZ remain similar to what they were in 2014. Below are excerpts of that recent interview.

Tell me about the logistics behind the creation of BHINAZ?

In Arizona and in other states, we have Regional Behavioral Health Authorities (RBHAs)and in Maricopa County, where I live, the RBHA contract of $7 billion over five years—for behavioral health services passed out from federal funds to the state and then out to designated behavioral health agencies— was up for bid. In the past, the challenge has been when those agencies lose those contracts, they pack up their data with them, so there are issues with continuity of care and being able to access information about patients and clients. There was a feeling that the way to go was start working on an HIE for behavioral health.

So the HIE is stakeholder-owned, comprised of seven nonprofit organizations.  It’s very much at the community level, driven by behavioral and community health providers. Our approach comes from the bottom up rather than top down, so we are able to be at provider level and insert the HIE directly into the practice and do workflow and training right at the organizational level.

How is it being funded?

Initially, the money didn’t come from the RHBAs, but that where it’s gone towards now. We do have a subscription model, and when we connect providers, there’s a connection fee with a sliding scale for monthly subscriptions. In working with the RHBAs, and there are now three of them in Arizona, their contracts obligate them to have some sort of HIE technology, and they’re also obligated to do integrated care, for both physical and behavioral health. So it’s turned into a critical thing for them to work with us. We’re contracting with them to connect providers, and they’re covering the cost of connection in exchange. We want providers to put some sort of money into it, otherwise they don’t own the technology and are less inclined to use it to be honest. We are also working on initiatives at the state level to get allocations that would go to our HIE and the physical health HIE in the state.

To what extent has your network grown, and how many organizations are exchanging data?

We have about eight providers, not necessarily the stakeholders which is ironic since it’s around the same number. We have also partnered with Quest Diagnostics, and now we have providers ordering in results and labs through the HIE. We’re right at that threshold where we'll connect more providers. There are about 200-300 behavioral health providers statewide, and of that, 40 or 50 of them touch 90 percent of the participants, so we are working on getting those providers on board first.

Has the lack of meaningful use incentive dollars hampered things at all?

One of the barriers is definitely lack of good EHR technology. In behavioral health, there are a lot of mom-and-pop applications. The other barrier is that a lot of these vendors charge a fortune for interfaces—thy either charge per interface or charge a lot at one time to give you an HL7 channel for instance. That makes it cost prohibitive for some of these providers, especially the smaller ones. The vendor cost for their EHR is sometimes the barrier to getting connected. The EHR companies are also trying to bite a piece off the HIE business, so they compete against HIEs, which I think slows everyone down. More collaboration is needed.

How has that experience been, connecting to the physical health HIE in the state?

We’re finishing up a connection from them so we will have all the hospital admits and discharges, and we can rout those in real time to our providers. A lot of the time these behavioral health patients get admitted in hospital or go to the ER, and they stay for 72 hours which is the requirement, but they don’t necessarily get a lot of treatment during that time. They might get discharged without addressing their concerns. Sometimes there are no follow-ups, and this way with alerts, intervention and coordination becomes critical.

Working with them has been a good partnership, I’d say. Our approaches are different, they have an opt-out model, we have an opt-in one. Their main focus has been around connections, getting big hospitals and payers on board and connected. They don’t spend much time at the community level doing workflow, so we do have different approaches. But we do also need each other, and we try to work together on things as the long-term goal is bi-directional exchange so the behavioral health data is getting back to the physical health providers. That will take some work.

How does your opt-in model work specifically with behavioral health patients?

We require explicit consent. For our model, the education piece is especially important. We spend time on educating the provider on educating the patient. We have about a 78 percent opt-in rate, but it does vary by type of provider, and when that consent is presented varies too. For example, if you’re coming into a detox center you won’t be presented with the consent right away. We have had good success with it though. If we convince the patients that the HIE is good for them, that they don’t have to repeat things every time they go to another provider, it will help them understand why it’s really best to opt-in. We want to improve that rate and do more education, but we are happy with our success so far.  

Consent has also taken up a big chunk of our time. We spent 18 months doing legal and technical work on consent. In fact, we have done so much work on it that we have become the de facto expert on it. We actually get calls on how we do it. A lot of groups see things that go into consent requirements for behavioral health and want to figure it out later. I mean it took us a year and a half, that’s all our organization was doing. Imagine if you had a lot of other priorities?  

Are there other HIEs in this space who you’re competing against?

We are the only standalone behavioral health HIE in the country. Other states are doing behavioral health as a component, but some of it is just using Direct exchange point-to-point, not a full blown repository. Colorado, Kansas, Rhode Island are states that do have behavioral health in their exchanges, but it’s hard for me to say what it looks like or what’s being exchanged. So there is no competition from that perspective.

Is behavioral health data exchange any different than physical health exchange?

One of the big areas of focus for us is crisis services. In a crisis, time is of the essence, so being able to have as much data as possible available about someone is critical. The type of data isn’t your standard data set, though. Rather than radiology and labs you’re looking for documents, assessments, and treatment plans. That’s where I see a bigger difference between physical health and behavioral health data exchange. And it’s not that they don’t exchange documents, but they are looking for diagnostic types of data versus these comprehensive documents. That’s where we insert ourselves and try to get people off paper. It’s such an old process, faxing and scanning compared to embedding right into the EHR.

What are some key goals for BHINAZ in the next year or so?

A lot of what we do is dictated by our participants; the RHBAs have a priority list, so we work that direction. We are also really focused on crisis services; it’s at the top of our list. We are working on a consolidated crisis viewer, which is different than what you’d see in a standard HIE, as there are very specific data elements that you need to see for crisis. Right now folks are looking in seven different systems, and in crisis, that’s not efficient as you can imagine.

Also around crisis, we are improving our call centers. It’s a very old-fashioned process right now, so we are building a connection from the call center to the HIE that would rout a crisis call to the mobile team as a direct referral, and they would be able to pull that directly into the EHR. An added benefit of that is if there happens to be patient match, and in crisis that’s not easy because patients don’t always give their real names, we can pick up any other HIE data that we might have that they didn’t relay on the phone call. The team can then document that back in the EHR, and close that loop back to the call center. 


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Medical providers should make health data free to patients

Medical providers should make health data free to patients | Healthcare and Technology news | Scoop.it

Technology makes patient access to medical records easier than ever, but the cost of such data prevents many from doing so, according to Niam Yaraghi and Joshua Bleiberg, fellows at the Brookings Institution.

Access to health information is beneficial for patients, allowing them to take a bigger role in their care and enabling them to share the information with other providers, Yaraghi and Bleiberg write at Brookings' TechTank. The latter is especially important because of the lack of interoperability of electronic medical records, they add.

But while there are virtually no costs of reproducing digital records, "many states still use the same regulatory model--which is based on the number of copied pages--for paper and digital records," they write.

Through a Google Survey, the two Brookings fellows asked 120 patients how much they would be willing to pay for their records. Sixty-eight percent said they wouldn't pay a dime to have access to the information; 10 percent said they would pay between 1 cent and $9.99; and 6.4 percent would pay between $10 and $19.99.


This is an area that involves not only healthcare professionals, but those on Capitol Hill, as well. Putting health information in the hands of patients has been one of the goals of the 21st Century Cures initiative. During a panel discussion that included lawmakers and industry professionals last June, the importance of giving patients a voice in their care was a primary focus.


To improve patient access, Yaraghi and Bleiberg say patient advocacy groups should educate patients on the value of their data, which may make them more likely to want access to the information.

In addition, because the cost is almost zero to reproduce medical information through electronic health records, "state regulations should undergo a major revision and require the medical providers to let patients have their medical data for free," they conclude.

Patient advocate Regina Holliday has been one voice in the industry calling for such change.


"You want to have access to that information before there is a crisis. You don't want to build that system up in a moment of need. [Y]ou want to be able to see the long tail of care, to be able to look for patterns," she told FierceHealthIT in an interview in October.

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HIMSS15 Provides Both Clarity Confusion

HIMSS15 Provides Both Clarity Confusion | Healthcare and Technology news | Scoop.it

For the first time since 2009, the HIMSS Annual Conference & Exhibition was back in its hometown of Chicago this year. And, with more than 43,000 attendees and 1,200 exhibiting vendors flocking to McCormick Place Convention Center, this proved to be the largest HIMSS conference on record. Many of the same pressing topics from HIMSS14 were prevalent again at this year’s event — namely interoperability and population health management.


A Step Forward For Interoperability


Interoperability continues to be one of the biggest challenges facing the health IT industry. And, thankfully, HIMSS15 actually seemed to provide some much needed direction in this area as opposed to just rhetoric.


For example, HIMSS15 provided one of the biggest venues for health IT industry leaders to sit down with members of the ONC to discuss the nationwide Interoperability Roadmap that was drafted earlier this year. This roadmap charts a path for the health IT industry to achieve interoperability progress in 3, 6, and 10 years using core critical building blocks identified by the ONC.


The ONC even organized several listening sessions dedicated to fostering industry collaboration on the Roadmap. One, titled Advancing Interoperability and Standards, was open to all HIMSS attendees and aimed to answer questions, provide clarity, and set realistic expectations surrounding the Roadmap. Another, titled ONC Interoperability Listening Session With Health IT Developers, was specifically designed for the software developer community to discuss the unique challenges and opportunities associated with developing an interoperable infrastructure for health IT. Yet another ONC interoperability listening session targeted clinicians in an effort to gain a better understanding of their interoperability demands.


The ONC’s take on interoperability was summed up well by the organization’s National Coordinator Karen DeSalvo, MD during her keynote on Thursday morning.  During her speech, DeSalvo referenced that she participated in dozens of similar interoperability listening sessions throughout the year and she believes the path to health IT interoperability hinges on three primary objectives:


  1. Creating standardized standards, including APIs;
  2. Improving clarity regarding the trust environment, particularly data security and privacy; and
  3. Establishing sustainable and durable incentives that promote interoperability and appropriate use of health information between systems.


Finally, HIMSS15 once again featured an Interoperability Showcase, where more than 50 sponsoring vendors offered first-hand demonstrations as to how their technologies could be leveraged to deliver health IT interoperability in a variety of care settings. This year’s Interoperability Showcase was the largest landmark on the exhibit floor and provided visitors with real-world insight into how interoperability can be achieved.


A Muddled Population Health Management Message


While HIMSS15 did an admirable job of attempting to clarify the interoperability dilemma facing health IT and the go-forward strategy, I believe it had the opposite effect in regards to Population Health Management (PHM). PHM was one of the biggest buzzwords at HIMSS15. Just about every other vendor on the exhibit floor promoted how its product or service was instrumental in the PHM equation. I can’t help but think that all of this noise was confusing to the providers in attendance searching for an effective PHM solution.


From my perspective, HIMSS15 clearly illustrated the clear need for a universally accepted definition for PHM in the health IT industry. I must have spoken to executives from more than a dozen self-proclaimed PHM vendors at HIMSS, and I never heard the term defined the same way twice.


Rather than simply complain about the lack of an agreed upon PHM definition, I thought I might take a crack at getting the ball rolling toward this end. Based on my conversations at HIMSS and my editorial coverage on PHM to date, a true PHM initiative must include the following key elements:


  1. It must incorporate data aggregation from multiple sources;
  2. It must include the analytics technology necessary to turn that aggregated data into actionable intelligence;
  3. It must provide workflow tools to facilitate/automate case management and care coordination; and
  4. It must deliver mechanisms for patient engagement and feedback.


In my opinion, if a vendor product or service doesn’t address all four of these areas, then it only solves part of the equation, and isn’t a true PHM solution. While I doubt the list of criteria outlined above is the universal PHM definition the industry needs, I believe these elements provide the building blocks upon which that definition can be based. What factors am I missing? How can we round out this rough skeleton to create an accurate PHM definition that clarifies the concept as opposed to leaving it up to multiple interpretations? I’d be interested in your thoughts and feedback.  

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More Patients, Not Fewer, Turn To Health Clinics After Obamacare

More Patients, Not Fewer, Turn To Health Clinics After Obamacare | Healthcare and Technology news | Scoop.it

Nurse practitioner Martha Brinsko helps a lot of patients manage their diabetes at the Charlotte Community Health Clinic in North Carolina.

“Most mornings when you check your sugar, what would you say kind of the average is?” Brinsko asked patient Diana Coble.


Coble hesitated before explaining she ran out of the supplies she needs to check her blood sugar levels, and she didn’t have the gas money to get back to the clinic sooner. Brinsko helped Coble stock up again.


“If you need to get more than one box, get more than one box,” Brinsko said. “But you need to check them every morning so that we can adjust things.”


Coble, who is unemployed, lives with her sister and can’t afford insurance even now that the health law is in place, relies on the clinic for health care.


“They do a great job with everything,” Coble said. “I couldn’t do without them.”


Nancy Hudson was the clinic’s director as Obamacare rolled out and now consults for the clinic. She expected the insurance exchange, or marketplace, established under the Affordable Care Act would reduce the number of uninsured patients the clinic sees. The opposite happened, she says.


“What we found within our patient population and within the community is that a lot of the advertisement and information about the marketplace brought people [in who] didn’t know anything about free clinics and did not qualify for any of the programs within the ACA marketplace,” Hudson says.


And now they get free or low-cost care at the clinic, which is designated by the government at an FQHC, or federally qualified health center.


The health law was designed to cover the poorest people by expanding Medicaid, the federal-state program for low-income people. But the Supreme Court made that optional. The result in states that didn’t expand Medicaid is a gap, where some people make too much money to qualify for Medicaid but not enough to qualify for insurance subsidies. In North Carolina, about 319,000 people, like Coble, fall into the Medicaid gap.


“Over half of the people that we see would’ve been eligible for Medicaid expansion had the state elected to exercise that option,” says Ben Money is president of the association that represents North Carolina’s community health centers.


North Carolina is among the 21 states, including many in the South, that are currently saying no to Medicaid expansion. Louisiana is another.


Dr. Gary Wiltz, the CEO of 10 community health centers in the southwestern part of Louisiana, says demand has surged. “We’ve gone from 10,000 patients to 20,000 in the last six or seven years, so we’ve doubled,” he says.


Wiltz says other things are at play, too. The economic recovery hasn’t reached many of the poorest people, and some who do qualify for Obamacare subsidies say their options are still too expensive.

“The need keeps increasing, and I think that’s reflected throughout all the states,” he says.


Wiltz, who also heads the board of directors for the National Association of Community Health Centers, says clinics are packed even in states that expanded Medicaid. After all, most of the clinics treat Medicaid patients too.


The Charlotte clinic’s Nancy Hudson says there’s another part of the health law helping fuel the growth: additional funding for community health centers.


Hudson found out last week her clinic is getting about $700,000 to expand in partnership with Goodwill.


“Many of their clients did not have any access to health care,” she says. “They can’t train and sustain a job if they don’t have the basic needs taken care of, and health care is one of them.”

Nationwide, the federal government estimates its latest round of funding will lead to about 650,000 people getting better access to health care.


This story is part of a reporting partnership with NPR, WFAE and Kaiser Health News.


Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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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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Is This Population Health’s Moment? Time for Data and Analytics

Is This Population Health’s Moment? Time for Data and Analytics | Healthcare and Technology news | Scoop.it

Every year, the annual HIMSS Conference, sponsored by the Chicago-based Healthcare Information and Management Systems Society, offers its attendees a kind of conference-based snapshot of where the U.S. healthcare industry is with regard to the forward evolution of healthcare information technology adoption, as well as a sense of the overall policy and operational landscape of healthcare. Attendees can get a sense of the healthcare IT Zeitgeist through attending keynote addresses, educational sessions, association meetings, and networking-focused gatherings, as well as by wandering the exhibit hall and simply by having meaningful conversations with fellow attendees.


HIMSS15, held at the vast McCormick Place Convention Center in Chicago the week of April 12, offered perhaps the clearest portrait of the current moment that has yet been offered to date. Session after session focused on the shift beginning to take place from volume-based healthcare reimbursement to value-based payment, across a very wide range of mechanisms, between providers and both the public and private purchasers and payers of healthcare, and the implications of that shift for healthcare IT leaders.


Further, as part of the keynote session on Thursday, April 16 in the Skyline Ballroom at McCormick Place, Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), made the intentions of federal authorities crystal clear, when, referencing the statement of Health and Human Services Secretary Sylvia Mathews Burwell in January that she wanted the bulk of Medicare fee-for-service payments to providers to shift as quickly as possible over to quality- and value-based payment, Slavitt said, “Our priority is simple: to drive a delivery system that provides better care, smarter spending, and keeps people healthier. The success in the first five years since the Affordable Care Act has been very encouraging… Our agenda now,” he said, “is to get busy strengthening these gains. That will mean that more providers in more communities will need to be able to transform the care they provide so that they will benefit from value-based reimbursement. And they will need technology to help them get there.”


What’s more, in his keynote address two days earlier, Humana CEO Bruce Broussard had told HIMSS attendees, “We have to change the conversation on what we are doing in healthcare from a supply-based system to a system around demand, a system where we put the customer first as opposed to the system. Over the years,” he added, “healthcare has been built by creating more and more supply. I hope I leave today by convincing you that we have to change the focus towards how we improve health for our customers, members, and patients.”


The good news on the solutions side of this landscape is that vendors are rushing forward to provide population health- and accountable care-driven analytics solutions, at a time when such solutions are most desperately needed. Certainly, the hype at HIMSS15 was all around population health, care management, and accountable care solutions. The only question now, as the U.S. healthcare industry hurtles forward into the near future, is, is this a breakthrough moment for population health efforts? And if so, are provider and health plan leaders ready to effectively leverage the tools to make pop health really happen?


The long journey ahead


Leaders from all sectors of healthcare understand that the journey to population health and value-driven care delivery and payment success is going to continue to be a long, challenging one. Donald W. Fisher, Ph.D., president and CEO of the Alexandria, Va.-based American Medical Group Association (AMGA), says he and his colleagues are putting the vast bulk of their efforts into helping prepare physician group leaders for the transition. “We’re not quite there yet, and as we change to a new reimbursement system, even the large, sophisticated medical groups are going to need a few years to make the transition,” Fisher says.  “You’ve got to put the infrastructure in place, and the large integrated health systems have been putting those elements in place—EHRs [electronic health records], alert systems, analytics systems, data warehouses—and some have teams of people mining the data to assess patient status.”

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Apple Watch Changes the Health Wearables Game

Apple Watch Changes the Health Wearables Game | Healthcare and Technology news | Scoop.it

After months of speculation and hype, the Apple Watch has finally arrived. 


What are some first impressions? How does it compare with other watches, bands and wearables? How will it impact the digital health landscape? (By the way, if you are reading this review for information on how to deliver your one-way banner ads brand messages via Apple Watch, you're already missing the point.)

I have been an avid user of wearable fitness and health trackers for a few years. After losing several Nike FuelBands on the soccer field, I recently switched to the Microsoft Band. Although it's slightly bulky, I truly enjoy the simple interface for tracking my activities, instantly measuring my heart rate and even paying for my Starbucks coffee.

Then along comes the Apple Watch. Of course it's got a great design, but it's not going to be for everyone initially. The learning curve is steep, especially if you're like me and don't take advantage of the online or in-store training. It does have a limited battery life and seems to be missing some core health functions. It might not be ideal for people with poor vision, and it doesn't currently have independent GPS capability. I was particularly worried about whether I could wear it while playing soccer, but I simply placed a wristband over it. Voila! I didn't find a default sleep-measurement function, but I assume that there will be apps to do that. Maybe Apple would rather I charge my watch while I sleep.

It's been only a few days, but I can already say that the Apple Watch experience is a great improvement over my other fitness bands. In addition to tracking my heart rate and how much I'm moving or sitting, the Apple Watch lets me do everyday things like receive texts and email, take phone calls and use Apple Pay. But I'm most excited about how it and other wearables will help me modify my behavior for better health. There's something very motivating about receiving visual and sensory cues from a device attached to your body. For instance, the Apple Watch gives you a nudge every hour to get up and move for a minute. It's very subtle and it may be a minuscule benefit, but it can be a great tool to combat the 21st century “disease of sitting” that so many of us are facing. 

We have been talking about big data, value beyond the pill and behavioral economics for some time. 

These wearable devices provide a great opportunity to do more than simply be shiny objects for early adopters. Wearables aren't just for fitness—they can make a big impact on adherence, compliance and cessation of unhealthy behaviors. 


Two hospital systems are currently conducting digital medicine trials using the Apple Watch to help manage hypertension and to determine how nurses and physicians can benefit from incorporating the Apple Watch into a medical home program. There are already a number of industry-related apps available for Apple Watch, including those from Drchrono, Lark, Doximity, WebMD, HealthTap and others.

The uptake has been rapid: Consider the fact more Apple Watches were sold in one day than Android Wear devices in an entire year. As a digital marketer, don't expect every demographic to immediately adopt the Apple Watch or other wearables. But ignore the Apple Watch effect at your own risk. The impact of this new technology and interface will manifest over time, just like our mobile phones did. 

Remember when they said social media was only a fad?


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The Pain (and Gain) of Building a Private HIE in NYC

The Pain (and Gain) of Building a Private HIE in NYC | Healthcare and Technology news | Scoop.it
Frat Iqbal, senior manager of information management at New York University’s Langone Medical Center, led off his presentation at HIMSS15 in Chicago with two photos that provided a stark reminder of what happens when information doesn’t flow properly through the healthcare system. They were two pictures of his brother two years apart, one in full health and the other wheelchair-bound and permanently disabled by multiple sclerosis.
 
“It took two years to diagnose MS as he went from doctor to doctor, lab to lab,” he said. “His life was ruined by inefficiencies in the healthcare system.”
Iqbal said it is a reminder of the importance of improving patient care at the community level, of connecting all the small practices in New York so that data can flow from their offices to specialists, labs and hospitals. 
 
NYU Langone has been working to build a private health information exchange to link 200 practices and 1,900 clinicians using 26 different EHRs as the state and country work toward building larger exchanges.
 
The HIE was established in mid-2011 and privately funded by NYU Langone Medical Center. The goal was to become a central repository of clinical information for community providers to review, reference and share data and to provide 360-degree care to patients, Iqbal said.
 
Anthony Antinori, senior director of clinical affairs IT at NYU Langone, said a private HIE has advantages over a public one. “We can make decisions quickly. We have a small ecosystem of private practices and one governing body. We are local and funded by a private organization, with no federal or state funding required,” he said. The HIE is able to rapidly align itself with the strategic goals of the organizations it is serving, he added.
 
Instead of dictating which EHRs it would support, NYU Langone decided to work with whatever the providers had. “We left it open. If the EHR has the capability, we will integrate with it. It’s more headaches for us, but we did that for the community,” he said. 
 
They knew it was going to be challenging, and it has been, Iqbal said. “It is one of the most complicated projects I have ever embarked on,” he said. Interfacing with all those EHRs has been a “project management nightmare,” he added. Project prioritization has been tough, in terms of deciding which data is most valuable to the HIE. A whole team has been focused on privacy and security of the 4 million patient records in the HIE.
 
There are technical challenges, but more difficult have been cultural changes and setting the right expectations, he said. Many physicians are not inclined to share data and don’t want to change. Most EHRs are designed to retain, not share, information. 
 
Some providers are resistant to change. They don’t care if more information is available and they don’t want to share information. With these providers, you really have to make them realize the benefit the HIE brings to the table, he said. (Members of the NYU Provider Network are mandated to connect to the HIE.)
 
Legal and policy issues were a challenge. Getting data sharing agreements vetted by the practices, vendors and NYU Langone’s legal teams took longer than the integration itself. Consent policies are also difficult to work through, he said.
 
Despite the huge challenges in getting it set up, the HIE offers an array of benefits. Here are a few listed in the NYU presentation:
• Providers gain immediate access to valuable clinical data that provides a more holistic view of patient health when using the HIE;
• Providers will be able to reduce unneeded patient visits and lower the cost of care;
• Providers can begin to embrace the powerful benefits of trend and pattern analysis toward new decision-making frontiers;
• HIE facilitates evidence-based medicine and creates a potential positive feedback loop between health-related research and actual practice.
• Patients can expect improved payment coordination and smoother care transitions
• Duplicative procedures or tests will be reduced and visit satisfaction will be improved when patients opt to participate in the HIE;
• The collection and linking of data across the HIE facilitates extensive and robust community health records that can foster the ability to quickly detect, respond and efficiently prevent threats to public health;
• The HIE will also enhance public health practices at all levels of government through infectious disease case investigation and health surveillance.
 
The next step, he said, is analytical innovation that will pull together payer data, HIE data and Epic data from the hospital system to get more proactive at recognizing issues and monitoring patients and populations.
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Report: ACOs Continue to Grow, Now Serve 16 Percent of U.S. Population

Report: ACOs Continue to Grow, Now Serve 16 Percent of U.S. Population | Healthcare and Technology news | Scoop.it

The number of accountable care organizations (ACOs) continued to rise in the past year, though at a slower pace than in 2013, according to new research from consulting firm Oliver Wyman.


Almost 70 percent of the U.S. population now lives in localities served by ACOs, and 44 percent live in areas served by two or more. The total number of ACOs participating in Medicare programs has increased to 426, up from 368 in January 2014 and 134 in January 2013. Oliver Wyman has identified an additional 159 ACOs, bringing the estimated total to 585, up from 520 in January 2014, and 260 in January 2013.

The figures from the firm are based on the Department of Health and Human Services’ (HHS) announcement of the latest class of ACOs approved to participate in Medicare’s ACO programs. The firm further found that about 5.6 million Medicare beneficiaries, or about 11 percent of total Medicare beneficiaries, now receive their healthcare from ACOs participating in Medicare’s ACO programs. These organizations also provide care to 35 million non-Medicare patients, about 6 percent more than last year. And ACOs collectively serve between 49 and 59 million U.S. residents, or between 15 and 17 percent of the population, according to the research.


“The slowdown we’re seeing in the growth of ACOs was almost inevitable, given the pace of change of the past two years,” said Niyum Gandhi, a partner in Oliver Wyman’s Health & Life Sciences practice. “The next big spurt will be more in effectiveness and sophistication than it will be in growth in numbers of ACOs.” Gandhi also cites that the changes to the rules that the Centers for Medicare & Medicaid Services (CMS) proposed this past winter, especially the Next Generation ACO model, could give ACOs the boost they need to compete more aggressively. “ACOs have reached an important point in their evolution. The best deliver care at 10 or more percent below average with excellent quality and patient satisfaction. But most have not progressed nearly that far,” Gandhi added.


These results come in spite of the well-publicized departures from Medicare’s Pioneer ACO Program. A recent study from Harvard Medical School on Medicare Pioneer ACOs found that while the program achieved a savings of $118 million in its first year, the program needs tweaking, citing the 13 ACOs that dropped out of the program after 2012, despite achieving savings that were similar to those that stayed in the program.


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