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Tablet-Based Mobile Carts Drive EHR Engagement

Tablet-Based Mobile Carts Drive EHR Engagement | Healthcare and Technology news |
Tablet-Based Mobile Carts Drive EHR Engagement

By Matt Rossini, JACO, Inc

As health systems and eligible healthcare professionals transition from Stage 1 to Stage 2 Meaningful Use to meet the 2014 reporting deadline, they are often faced with having to find innovative solutions to satisfy the new objectives and reporting requirements.  Some of the core objectives of Stage 2 specifically address engaging patients with their medical records. For caregivers the challenge of utilizing Electronic Health Records (EHR) which is also often referred to as Electronic Medical Records (EMR) to document all of their clinical activities can be taunting enough. Adding processes that involve patient engagement to their already complex workflow activities can feel like an unattainable goal.

Stage 2 Meaningful Use Patient Access Objectives require healthcare providers to give patients the ability to view their health information online and to make records available for download and transmission to other caregivers. Today’s industry leading EHR software companies provide simple and secure patient portals to access health record information.  They will work with their clients to develop patient discharge packages with detailed instructions on how patients can access their personal information.  Now in a perfect world, every patient would return home and access their provider’s website, create a login and view their health records. As one can image, the percentage of patients taking the time to access their medical records is still very limited, yet some organizations are making some solid headway to improve results.  

Healthcare providers are always trying to discover new ways to engage patients to actively participate in their healthcare records and access the additional education resources that are made available to them. Numerous EHR providers have built in patient messaging capabilities in their software allowing a provider to send out automated phone calls, email and text alerts. Electronic messages typically provide links back to the provider’s patient portal and prompt users to create logins to access their records.  Most healthcare organizations are now directing patients to their patient portals as their sole means of accessing information such as blood work and test results.  Even with all of the automated electronic communication systems up and running, healthcare professionals are still finding patient engagement adoption results lag behind their expectations.  What healthcare professionals are find is that patients will often fall into the same old patterns of assuming that if something is wrong,  their provider will just contact them to address the situation, and therefore there is little motivation to access the information.

Some healthcare organizations are taking a more proactive approach to increase patient engagement with their EHR. By offering patients computer access during their appointments and hospital stays, caregivers have discovered a powerful tool for facilitating patient EHR access.  In environments such as a physician’s office or medical clinical providing patient computer terminals in a waiting room or during the registration process can be rather easy to implement, where as a hospital implementation can be far more complex.  For patients that are heading into the hospital to receive urgent care or to attend a stressful appointment, healthcare professionals do not necessarily have the initial time or appropriate environment to review patient EHR access until some initial care is provided.  However, depending on each patient’s unique experience during their visit to the hospital there are often numerous opportunities to engage a patient. Time should be set aside by caregivers to communicate the value of their EHR patient portal and to clearly explain to patients how they can actively participate in managing their own care.

So the question comes, how does an organization provide patient computer access when a health system has so many unique departments with complex workflows, never minded the constraints of staff resources and physical floor space?

Rather than designing fixed computer terminals to provide patient access, Healthcare IT professionals and clinician team have started to implement tablet computers into their EHR workflow. Although for most health systems tablets have their limitations for carrying out standard clinical EMR workflows, they do seem to have a place in some specific applications. Many organizations are starting to make use of tablets for activities such as patient registration, physician rounds, telemedicine programs and many more applications.  Tablet PCs offer so much flexibility for caregivers, yet they also present lots of challenges as well.  In terms of how caregivers can utilize tablet computers for patience engagement, let’s take look at how organization can address the following: tablet access,  device recharging and security.

In terms of accessibility, tablet computers are often assumed to be the ideal solution because of their compact and lightweight design. Even though a tablet is easy to handle, they can be far more challenging to manage when administering care.  Primary EHR computer devices tend to require dedicated mobile computer carts or wall mounted solutions, so that devices can be properly managed during treatment, tablets by design do not lend themselves to being secured to a device. Tablets need the flexibility to be readily accessible and at the same time detached from their docking location, regardless of whether or not they are integrated in a tablet specific mounting solution or they are located in designated storage location. 

Every healthcare organization has a unique operational environment and culture, so there is no one-size-fits-all perfect solution when deploying any new Healthcare IT solution.  Tablet mounting solutions need to compliment the original attributes that make a tablet so attractive to deploy, they are lightweight, compact and designed for mobile use.  Traditional mobile computer carts and wall cabinets are generally too excessive in size and physical weight to compliment a tablet PC.  New designs in mobile carts that cut down on both footprint and physical weight to properly manage a tablet can help address tablet access. If designed with a compact base and slim-line profile, healthcare workers are able to easily stow a dedicated tablet mobile cart at a nursing station, position them in designed-in hallways alcoves or utilize them as in-room solutions with limited intrusion to floor space.

By planning dedicated tablet mobile carts used for patient engagement, clinical workflow experts can start to implement new processes to introduce patient’s to their health record at both the appropriate time and place in the care delivery process. Tablet computer cradles that securely hold a tablet to a mobile cart can provide the fast and easy access caregivers need.  Nurses can easily remove the tablet from its dock, so they can access their medical records during their appointments or hospital stays. With some EHR patient portals available on smartphones, healthcare professionals are also able to demonstrate access on a tablet while patient use their smartphones to access their personal records and view information such as lab results, view upcoming appointments, schedule new appointments, refill prescriptions and message securely with providers.  By educating patients on all of the powerful tools that are available to them, healthcare organization will not only comply with their meaningful use objectives; it will also help rein in costs associated with managing a patient’s information and scheduling.

As a logical alternative to dedicated tablet mobile carts, healthcare IT professionals and nurses may want to deploy tablet wall mount enclosures. Given the compact profile of a tablet, wall mounted holders can fit virtually anywhere in a healthcare setting. Tablet wall mounts can be placed at nursing station, in a patient’s room or strategically placed in a hallway to improve workflow efficiency.  By making the tablets easy to access clinicians and their support staff are able to integrate the patient health record engagement into their routine patient activities.

Today’s tablets are built with long-lasting energy efficient batteries that provide great runtimes, but just like any PC device that’s not plugged in, tablets requires routine charging. By providing dedicated recharge locations for a tablet mobile cart, clinical workflow engineers are able to plan for routine device charging. In the case of a wall mount station, tablets can be returned to the secure wall mount and docked for recharging.

One of the biggest challenges with deploying tablets is addressing security concerns. Tablets are an easy target for theft.  Tablet mobile carts and wall mounts need to be designed with secure locking features that not only hold the tablet to the mounting device, yet also prevent any part of the mounting device from being tampered with. Combination locking systems and tamper proof designs are an essential part when evaluating different solutions for implementing tablets.  

Utilizing tablet computers to engage patients with managing their own care is only one way in which healthcare providers will see tremendous value in tablet EHR adoption. There is no question that tablet computers will continue to be rapidly adopted in everyday EHR workflow activities. As the industry leaders in EHR software continue to develop their platforms for tablet use, nurses and physicians will start to use tablets in specific aspects of clinical charting, monitoring patient health, sending for medication and other clinical workflow needs. For more information on how you can utilize tablet computers to improve your patient engagement objectives, please contact JACO, Inc. for more information online at or by phone at 800-649-2278. JACO is a proud partner of CDW, More Direct, PC Connection, EPlus, Flexible Business Systems, Insight, PDS, SHI and many other Healthcare IT solution providers.

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Document Management Helps Cleveland Clinic Take Epic One Step Further

Document Management Helps Cleveland Clinic Take Epic One Step Further | Healthcare and Technology news |
Document Management Helps Cleveland Clinic Take Epic One Step Further

Edited by Jennifer Dennard, Healthcare Technology Online

Systemwide integration of a document management solution helps Cleveland Clinic derive more value from its EMR.

Ninety-two-year-old Cleveland Clinic is a nonprofit, multispecialty academic medical center offering more than 4,450 beds systemwide. Its staff includes more than 3,000 physicians and scientists and 1,785 residents and fellows in training, who handle more than 5.1 million patient visits each year. Dr. Robert White, associate chief medical information officer, explains how enterprise document management has improved workflows across the organization and helped the clinic realize more value from its EMR.

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Combine Mobile Carts And Tablets For Better Communication

Combine Mobile Carts And Tablets For Better Communication | Healthcare and Technology news |
Combine Mobile Carts And Tablets For Better Communication

By Katie Wike, contributing writer

Mobile carts are now being combined with tablet technology for computer access on the go

Matt Rossini of JACO, Inc. asks, “How does an organization provide a patient computer access when a health system has so many unique departments with complex workflows, never mind the constraints of staff resources and physical floor space?” His answer: “Rather than designing fixed computer terminals to provide patient access, Healthcare IT professionals and clinician teams have started to implement tablet computers into their EHR workflow.”

Health IT Outcomes reported earlier on the same subject writing, “Tablets give everyone in the hospital the opportunity to have technology in their pocket, rather than scrambling for limited workstations that can’t support an ever-growing staff.” A HealthLeaders Media article quotes Mark Laret of UCSF Medical Center as saying his facility plans to expand the use of tablets to, “patient self-registration, MyChart sign-ups, providing educational content in waiting rooms and patient rooms, patient questionnaires, etc.”

Rossini further explains the value of combining carts and tablets, suggesting tablet cradles to hold the tablets on mobile workstations or wall mounts. “Nurses can easily remove the tablet from its dock, so they can access their medical records during their appointments or hospital stays. With some EHR patient portals available on smartphones, healthcare professionals are also able to demonstrate access on a tablet while patient use their smartphones to access their personal records and view information such as lab results, view upcoming appointments, schedule new appointments, refill prescriptions and message securely with providers.”

The always present concern is security, and providers may want to use secure locking features for tablets in wall mounted devices to avoid theft and security breaches.

It’s not surprising that adding tablets to mobile workstations is the next logical step as studies show physician adoption of tablets for professional purposes almost doubled from 2011 to 2012. This sudden increase is due in part to MU requirements for engagement. “Utilizing tablet computers to engage patients with managing their own care is only one way in which healthcare providers will see tremendous value in tablet EHR adoption,” concluded Rossini.

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Pregnant nurse: I was fired for refusing flu vaccine

Pregnant nurse: I was fired for refusing flu vaccine | Healthcare and Technology news |

(CNN) -- A pregnant nurse tells CNN she was fired from her job after she refused to get a flu shot for fear of miscarrying.

"I'm a healthy person. I take care of my body. For me, the potential risk was not worth it," Dreonna Breton told CNN Sunday. "I'm not gonna be the one percent of people that has a problem."

Breton, 29, worked as a nurse at Horizons Healthcare Services in Lancaster, Pennsylvania, when she was told that all employees were required to get a flu shot. The Centers of Disease Control and Prevention advises that all health care professionals get vaccinated annually.

She told her employers that she would not get the vaccine after she explained that there were very limited studies of the effects on pregnant women.

Breton came to the decision with her family after three miscarriages.

Photos: Flu under the microscope

CDC: More states reporting widespread flu

The mother of one submitted letters from her obstetrician and primary care doctor supporting her decision, but she was told that she would be fired on December 17 if she did not receive the vaccine before then.

Horizons Healthcare Services spokesman Alan Peterson told CNN affiliate WPVI that it's unconscionable for a health care worker not to be immunized and that pregnant women are more susceptible to the flu.

The CDC website states that getting a flu shot while pregnant is the best protection for pregnant women and their babies.

"I know that the CDC says to get it, and that's fine, but it was our choice to avoid the flu vaccine and the unknowns that come with that," Breton said.

Breton offered to wear a face mask at work, a practice that is used if employees are exempted for religious reasons. The hospital did not approve, according to Breton.

Breton has no interest in taking legal action, she said. She stated she only wants the company to reevaluate their policy on vaccines for pregnant employees and to continue working as a nurse.

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Goodbye Healthcare Technology Online Hello Health IT Outcomes

Goodbye Healthcare Technology Online Hello Health IT Outcomes | Healthcare and Technology news |
Goodbye Healthcare Technology Online, Hello Health IT Outcomes

By Ken Congdon, editor-in-chief, Healthcare Technology Online

Follow Me On Twitter @KenOnHIT

There’s a big change on the horizon for Healthcare Technology Online. So big, in fact, the Healthcare Technology Online brand will no longer be emblazoned on our website, email newsletters, print publications, or any of our other assets in just a few short weeks. Starting in January 2014, Healthcare Technology Online will change its name to Health IT Outcomes. You may have noticed our twitter handle has already been converted over to @HITOutcomes.

Our entire staff is very excited about this announcement because of what it represents for our products and the audience of healthcare providers we serve. This transition isn’t driven by a change in corporate direction or ownership. On the contrary, we’re still owned by the same parent company (Jameson Publishing), and the same staff of talented professionals (including myself) remains dedicated to producing the valuable heath IT editorial content you’ve come to expect from us. Instead, the transformation of our brand is a calculated move to address our evolution as a media outlet and illustrate our editorial mission more clearly.

A sneak peek at our new Health IT Outcomes logo.

You see, we launched our product in 2009 as an online-only health IT resource center. We aggregated valuable health IT content from a variety of sources (e.g. analysts, research organizations, blogs, consultants, vendors, health providers, etc.) and made it available (and easily searchable) to healthcare providers via a single website. Back then, the Healthcare Technology Online name fit. However, we have clearly evolved into a full-blown health IT media outlet over the past four years. We’ve become much more than just a website — we now produce a weekly email newsletter and a bimonthly print magazine. We also generate our own industry research and have an active social media following. As such, we’ve outgrown the Healthcare Technology Online moniker. (Needless to say, Healthcare Technology Online Magazine doesn’t make much sense.)


Central to our product evolution has been the increased focus we’ve placed on generating quality, original health IT editorial. When we launched in 2009, the original content we produced was limited to an opinion column that I would post once a week. Our staff now authors thousands of original health IT stories annually — and these aren’t your run-of-the-mill articles. When we decided to enter the world of health IT media, we wanted to make sure we weren’t viewed as a copycat outlet. In other words, there were already several reputable publications serving the market — we needed to bring something different (and better) to the table in order to stand out. Therefore, before we wrote a word, we spent several months interviewing technology leaders from healthcare providers to identify coverage gaps (i.e. areas where there were opportunities for us to provide value to the industry.) We wanted to find out what types of health IT content were lacking in the space. More importantly, we wanted to know what types of health IT editorial would cause a provider executive to pick up a magazine or open an email newsletter.

The feedback we gathered through this process was a defining moment in the course of our organization. From these discussions, we learned that despite there being several health IT publications to choose from, healthcare providers felt that they still lacked a voice in the media. The consensus was that most of the health IT editorial being produced was news-based or vendor focused. Moreover, much of the subject matter seemed to promote the future promise of health IT rather than document the realities. Providers were hungry for real-world accounts of health IT implementation strategies, best practices, and lessons learned from their peers. Furthermore, they wanted details about the benefits healthcare facilities were realizing as result of their IT investments today. In other words, providers wanted health IT editorial that focused on outcomes, not the hype surrounding the technology.

This became our editorial mission. Over the past two years, we have committed ourselves to interviewing technology trailblazers in the healthcare industry and chronicling their successes, failures, and the associated measurable results in the articles we write. This content has clearly resonated with our health IT audience.

When it became clear that we needed to change our name to one more fitting of the media outlet we had become, we once again polled you, our readership. You encouraged us to select a name that placed emphasis on the original editorial content that has become the life-blood of our products. This led us to the name Health IT Outcomes. It’s been an awesome journey thus far, and the days ahead only look brighter. We thank you for your continued support and loyalty, and we look forward to continuing to serve you as Health IT Outcomes.

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Study Of Impact Of IT In Nursing Homes Set To Begin

Study Of Impact Of IT In Nursing Homes Set To Begin | Healthcare and Technology news |
Study Of Impact Of IT In Nursing Homes Set To Begin

By John Oncea, editor, Healthcare Technology Online

University of Missouri three-year study is the first in 10 years to examine relationship between IT use and quality of patient care in nursing homes

A Patriot Ledger blog post asks if IT should be a decision when choosing a nursing home. The author says yes, writing, “IT sophistication should be an important factor to consider when individuals choose nursing homes for their loved ones (as it) is used  … to admit and discharge residents, monitor patients’ dietary and pharmacy needs, and complete administrative activities.”

Now, researchers at the University of Missouri will be the first to study the relationships between IT systems and specific components of nursing home care, such as resident care, clinical support and administrative activities. The study is the first of this magnitude in a decade.

Greg Alexander, associate professor in the MU Sinclair School of Nursing and lead researcher of the study said, “People may not consider IT implementation to be important when searching for a nursing home, but IT certainly impacts the communication between staff and the continuity of care for the patients. This study will show which types of IT affect the quality of nursing homes the most.”

Alexander, according to the release, “hopes to use his findings to determine which IT capabilities lead to high-quality care in order to benchmark best practices of IT implementation in nursing homes throughout the country. Also, Alexander hopes to understand how IT is being adopted in nursing homes. This information will be used to create more specific educational programs for various nursing home disciplines and fill the knowledge void regarding IT implementation in nursing homes.

“In addition, Alexander hopes the results of his study will influence the science of nursing home quality measurement by incorporating variables such as IT, which previously has not been included in these quality measurement systems. In turn, this information could help family members make better informed decisions about which nursing homes would be best for their loved ones.”

Healthcare IT News further notes, “In a previous study of IT in Missouri nursing homes, Alexander found that IT helped health professionals make clinical decisions, track patients' care, and protect residents' privacy. ‘Our research team will study 10 percent of all U.S. nursing homes' IT use for the next three years,’ Alexander said. ‘We will track survey responses each year and analyze how trends in IT adoption levels correlate with nursing home quality measures, such as the number of residents with urinary tract infections, pressure ulcers and pain.’”

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CDC back at work to track the flu

CDC back at work to track the flu | Healthcare and Technology news |
CDC back at work to track the flu

Update 10/18 3:30 p.m.: The CDC has released an abbreviated FluView report for the week ending in October 12. See it here

Published 10/17: Now that the U.S. government shutdown is over, federal workers are returning to work, including the furloughed doctors and epidemiologists who work for the Centers for Disease Control and Prevention. 

One of the many things the CDC does is keep track of the flu, something that was stopped on October 1, leaving the overall flu picture in the United States a little murky.

Every Friday, the CDC is supposed to post how many cases of flu have been reported in the 50 states and U.S. territories. But during the shutdown, the CDC said on its website that it would "not be routinely analyzing surveillance data nor testing laboratory specimens submitted as part of routine surveillance."

So the most recent weekly CDC report provides data for the week of September 21. Under normal circumstances, the CDC would be posting data tomorrow from the week ending October 12 (they are always one week behind).  But since their staff is just now returning to work, it's likely the FluView reports will probably resume next Friday, a CDC spokesperson said.

Fortunately, immunization program managers and health officials in each state have been on the job for the past two weeks and have kept up with their flu surveillance. 

For many states, the 2013-2014 flu season began at the end of September or at the beginning of October, which is when they start to ramp up their surveillance. And with the help of some of these public health officials, CNN collected data from 10 states to get a snapshot of where we are when it comes to flu season. (Full disclosure: This is in no way remotely comparable to what the CDC produces each week).

For example, influenza-like illness activity has increased in recent weeks across Texas. Health officials describe the intensity of the illnesses as “low," having recorded six positive flu test results last week.

As of last week, Illinois, Rhode Island, New Hampshire, Kentucky and West Virginia were reporting no activity.

"Tennessee is not seeing signs of notable influenza activity," says the director of Tennessee's Immunization Program, Dr. Kelly Moore. What her state doesn't do is test to see if circulating strains are well matched to what's in this year's flu vaccines. That's something the CDC normally does and is now behind on.

Health officials in Wyoming tell us they are receiving "sporadic reports of influenza activity from multiple counties across the state." As of October 12, they had four cases reported.

Iowa doesn't require health care providers to report flu, so the number of cases this state reports is probably underestimated, but the state's health department describes it as "sporadic." Louisiana and Arizona are also reporting sporadic flu activity.

It's likely the CDC will soon send be spreading their annual "Get your flu shot" message again. Until then, Vermont's immunization program manager and nurse practitioner Chris Finley has this advice: "Flu activity is low, which means it's a very good time to get a flu shot because there is still time to be protected before the flu season hits."

The CDC also tests to see to see if current flu strains circulating among us are becoming resistant to existing antiviral medications like Tamiflu or amantidine. So there will be some more catching up to do by federal health researchers. 

Besides getting a flu vaccine, which the CDC and the American Academy of Pediatrics recommends for nearly everyone 6 months and older, there are a few other things you can always do to prevent getting sick:

- – Wash your hands frequently with soap and water.  If you wash them as long as it takes to sing “Happy Birthday” twice, your hands should be properly  cleaned.  Alcohol-based hand sanitizer is a good back up if you don't have soap and water.

- - Stay home when you're sick so you don't infect others.

- – Avoid people who are sick, if possible.  According to the CDC, "People with flu can spread it to others up to about 6 feet away. " People who have the flu can spread the virus when they cough, sneeze or talk.  Droplets carrying the flu virus can travel through the air and someone else could inhale the virus and get sick.

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You may not be better off after knee surgery

You may not be better off after knee surgery | Healthcare and Technology news |

(CNN) -- Patients who underwent simulated knee surgery fared just as well as those who got the real deal, according to a new study that's raising eyebrows about the most common orthopedic procedure performed in the United States.

The findings, published Thursday in the New England Journal of Medicine, add to a string of papers suggesting that arthroscopic partial meniscectomy fails to help many patients. The operation typically is performed to relieve knee pain, whether from wear or from an injury.

But other doctors say it's still too soon to draw sweeping conclusions.

The study, which was conducted in Finland, followed 146 patients between the ages of 35 and 65 with symptoms of degenerative wear and tear of the meniscus, a disk-shaped piece of cartilage that acts as a shock absorber between the shinbone and thighbone.

About half the patients underwent an arthroscopic meniscectomy, in which a surgeon inserts a blade through a tiny incision in the knee, and essentially shaves down the rough, frayed edges of the meniscus.

The other half underwent an elaborately staged "sham" surgery, in which the doctor made an incision and poked around without any actual manipulation, shaving or cutting.

A year later, there was no significant difference in the knee pain reported by patients in each group. Nearly two-thirds on each side said they were happy with the results, and most said they would do it all again.

Video: Knee pain common in women 50 and up

In patients without arthritis, the authors conclude, the procedure "provides no significant benefit over sham surgery."

As many as 700,000 arthroscopic partial meniscectomies are performed in the United States every year, at a direct cost of $4 billion, according to the study authors.

But the procedure has come under scrutiny with the publication of papers -- 2002, 2008 and earlier this year -- that found it provides little or no benefit in older patients, whose meniscus is frayed through simple wear and tear as opposed to a specific injury.

"It's pretty obvious to anyone who really has an interest in this that what we've called a meniscal tear isn't really a tear," says Dr. Teppo Jarvinen, who led the research team. "It has nothing to do with the tears we talk about in a 20-year-old athlete who twists or sprains their knee."

According to some, the new study draws a stronger conclusion because it includes patients with mechanical symptoms like popping, clicking or a sense of the knee locking up.

"When we hear a knee is locking, a bell goes off: 'this needs arthroscopy,'" says Dr. Dennis Cardone, an associate professor of orthopedic surgery at NYU Langone Medical Center in New York.

"If anything, this (study) swings it a little bit more. Even when a patient complains of locking, arthroscopy might not be necessary."

But Dr. Frederick Azar, vice-president of the American Academy of Orthopaedic Surgeons, says patients in the study are not typical.

"To have a degenerative medical meniscus tear and no evidence or arthritis is extremely unusual," says Azar. "It's well less than 1% of the patients we see."

Dr. Scott Rodeo, co-chief of the Sports Medicine and Shoulder Service at the Hospital for Special Surgery in New York, says it's likely that many of the patients in the study are in the early stages of developing arthritis, even if it's not detectable through X-rays.

He said the Finnish study reaffirms the sense that surgery is not likely to help these patients, who are suffering from chronic wear and tear.

Azar, a professor of medicine at the University of Tennessee and team physician for the Memphis Grizzlies basketball team, says he's worried about scaring away patients who might be helped.

"This is a very useful low-cost intervention, with a short recovery time and good results in most patients," he says.

Surgeon: How to give your knees some TLC

A worn meniscus can be a simple result of aging, but it's more common in people whose knees take a lot of pounding, including long-distance runners and people whose jobs have them standing for long periods on a hard floor. Obesity is an additional risk factor.

The Finnish study looks at meniscectomy, as opposed to meniscus repair, in which a surgeon actually sews together torn cartilage. According to Cardone, patients under 40 do especially well with meniscus repair, especially those whose injury stems from a single incident.

But orthopedists say many people with knee pain can be helped with physical therapy to strengthen muscles that support the knee.

Before recommending surgery, Azar also counsels patients to consider switching to low-impact activities -- for example, to mix biking or swimming into a workout routine, instead of just long-distance running. He says other patients may be helped by anti-inflammatories or injections of hyaluronic acid.

In advanced cases, when the meniscus is totally worn away, more drastic steps are an option.

"If it's bone-on-bone," says Azar, "their pain is coming from osteoarthritis and the only surgery to help is a knee replacement. But we try to exhaust all measures before doing that."

However, Jarvinen says the abundance of caution needs to start much earlier.

"All your fellow orthopedic surgeons will tell you, 'I already knew this.' But the facts are, this is still the most common orthopedic procedure," he says, and the vast majority of operations are unnecessary.

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Company needs patient OK to sell PHI | Healthcare IT News

Company needs patient OK to sell PHI | Healthcare IT News | Healthcare and Technology news |

HIPAA may have just complicated a laboratory company's bankruptcy filing after HHS lawyers argued Laboratory Partners Inc. needed to get permission from former customers before selling their protected health information as part of the bankruptcy auction deal. 


Lawyers for HHS filed a protective objection in Delaware bankruptcy court Dec. 18, and if a federal judge in Delaware agrees with the Department of Health and Human Services, HIPAA may get its way.


"HIPAA regulations provide that covered entities who seek to sell their customers' protected health information can only do so with their customers' authorization," federal lawyers wrote, asking the judge to deny the sale motion until the company proves it has former beneficiaries' approval.


Also known as MedLab, Laboratory Partners, a Cincinnati-based clinical laboratory network doing business in eight states, started voluntary chapter 11 bankruptcy proceedings in October, and as part of a restructuring plan is selling its long-term care division and, next year, one of its lab businesses in Indiana.


The long-term care division currently on the market has assets described as: "all consumer lists, machinery and equipment records, quality control records and procedures, employment and personnel records, and display materials."


It's those "customer lists" that HHS is taking issue with. "To the extent the customer lists contain any individually identifiable health information, Debtors’ have not demonstrated that each affected customer has authorized a sale of protected health information," HHS lawyers wrote. The lists “almost certainly contain protected health information whose sale is restricted under HIPAA."


If the buyer of the long-term care division is a HIPAA covered entity, the sale of the PHI in the assets would “not necessarily require the authorization of the beneficiaries as it would be considered a disclosure for the purposes of healthcare operations,” as federal lawyers told Laboratory Partners’ legal team.


"However," the federal lawyers wrote, Laboratory Partners "has been unable to assure the United States that the purchaser will be a 'Covered Entity.'"


Cases like this and the sale of healthcare businesses raise the issue of the live of PHI, especially in the digital age as customer lists with personal health information would be valuable in their own right to advertisers.


The chair of the Federal Trade Commission, for one, is promising robust regulation of the emerging big data field. Last year the FTC called on data brokers to give consumers access to their information through an easy-to-find, easy-to-use common portal, and is supporting legislation giving consumers the ability to access, dispute or suppress data held by brokers.


In a contentious legal case, the FTC is also seeking a consent agreement with LabMD to have the Atlanta-based diagnostics company implement a comprehensive information security program, after allegations of a data breach. LabMD contends that the FTC doesn’t have the authority to regulate digital privacy.


Technical Dr. Inc.'s insight:

Bookmark this page for daily information on HIPAA, medical IT services, and more!  Technical Doctor is the leader in medical IT support, and education is one of our specialties.  Email us at for more information on how we can help your business.

- The Technical Doctor Team

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We can trust CMS and EHR vendors but verification would be nice | Healthcare IT News

We can trust CMS and EHR vendors but verification would be nice | Healthcare IT News | Healthcare and Technology news |

This ICD-10 implementation thing might not be so bad. There are electronic health record (EHR) systems that promise to assign ICD-10 codes.

What's the problem?

John Lynn writes that there is a difference between an EHR that says it's ready for ICD-10 and one that is ready. The EHRs that figure out ICD-9 codes then suggest ICD-10 codes that could work are going to be problematic.

Which sounds like a really good reason for end-to-end testing. Find out if EHRs and practice management systems (PMS) can create medical claims with the proper ICD-10 codes.

And that's why many people think it's important that the Centers for Medicare and Medicaid Services (CMS) conduct thorough end-to-end testing with ICD-10 codes. After all, that's why failed.

And The Medical Group Management Association (MGMA) makes that case in its letter to Health and Human Services (HHS) Secretary Kathleen Sebelius that urges HHS to mandate end-to-end ICD-10 testing. What's more important is that "end-to-end testing is the only practical method practices will have to accurately predict and respond to Medicare coding edits and fully understand the impact that ICD-10 will have on reimbursement."

Of course CMS has said that it has designed the ICD-10 DRGs to be revenue neutral.

And your EHR is ICD-10 ready.

Creating an ICD-10 Action Plan: Training, Testing, and Ongoing Review

Robert Tennant, senior policy adviser in the government affairs department for the Medical Group Management Association (MGMA), shares tips for ICD-10 implementation:

Start training medical coders about six to nine months before the ICD-10 compliance deadline so they don't need retraining.

Team up with other medical practices and pool resources to train trainers.

Contact clearinghouses and ask:

What ICD-10 services will you provide?

Is my submission format appropriate?

What will be the cost of the service?

When can you accept test claims?

Are you offering any training opportunities?

Contact health plans about assistance and testing.

Monitor government sources and health plans for compliance announcements.

(Physicians Practice)

Measure Twice, Cut Once 5 Biggest Lessons in ICD-10 Documentation Success

"Look to the past to understand the future"

"Get down into the detail"

"Prioritize by risk"

"Fix what you can today"

"ICD-10 documentation isn’t a one-and-done activity"

How Prepared Are Hospitals for ICD-10?

Phoenix Health Systems surveyed 101 hospitals of various sizes and found:

Most large hospital systems — 600 to more than 2,000 beds — have little doubt that they will be ready by Oct. 1, although only a third report their ICD-10 plans are more than 50 percent complete.

58 percent of hospitals with 400 to 600 beds have initiated their ICD-10 implementation projects.

36 percent of hospitals with less than 400 beds have not begun an ICD-10 impact assessment.

60 percent of hospitals with less than 100 beds have not begun an ICD-10 impact assessment.

Three takeaways worth mentioning:

Many hospitals reported that they did not have ICD-10 compliance budgeted until 2014.

No surprise that the largest healthcare providers are the best prepared.

This means there is going t be a lot of work being done in 2014. Expect ICD-10 consultants and trainers to be booked.

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Midwestern states ink HIE deal | Healthcare IT News

Midwestern states ink HIE deal | Healthcare IT News | Healthcare and Technology news |

The Illinois Health Information Exchange and the Missouri Health Connection will be joining forces in a new data sharing agreement that will provide physicians in both states with real-time patient information to boost care quality.

 Officials say this new HIE partnership is particularly important for border states Illinois and Missouri since patients frequently cross state lines to receive care.

 "Healthcare does not neatly follow state borders, so information about patients’ needs to follow them wherever they go," said Raul Recarey, executive director of ILHIE, in a press statement announcing the agreement. "Many Illinois patients from the southern portion of our state are referred to Missouri hospitals. The ILHIE/MHC agreement will allow providers from either state to have access to critically important patient data, regardless of whether that data resides in Missouri or Illinois."

MHC and ILHIE are the state-designated entities for their respective states, tasked with creating and managing the infrastructure to connect healthcare providers with their patients via a secure health information network. As more healthcare providers move from paper-based medical records to electronic health record systems, MHC and ILHIE are teaming up to ensure they can exchange data with each other through a single, secure network – regardless of the technology platforms that they are using, officials say. 

ILHIE's network provides services to more than 2,000 providers at more than 450 healthcare organizations, including hospitals, physician practices, and community health centers.

According to officials, MHC's network provides services to more than 45 percent of the inpatient care provided in Missouri, 62 hospitals and more than 350 clinics. The network enables more than 7,000 physicians to securely access the health information of their patients to improve care quality.

"Our goal is to fulfill the vision of using technology to reduce the silos that hold back health information from being available where it is needed most — in the hands of caregivers," said Marc Andiel, MHC's president and CEO, in a news release. "Whether those silos are organizational or governmental boundaries or technological interoperability challenges, we exist to reduce those barriers, and working with Illinois on this common goal has demonstrated our shared missions of service to our communities."


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New Mobile Technology Allows Users to Track Cholesterol Levels with a Smartphone (VIDEO)

New Mobile Technology Allows Users to Track Cholesterol Levels with a Smartphone (VIDEO) | Healthcare and Technology news |
Cornell engineers have created the Smartphone Cholesterol Application for Rapid Diagnostics, or smartCARD. The smartCARD provides cholesterol-trac
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Windows XP Won’t Be HIPAA Compliant April 8, 2014 | EMR and HIPAA

Windows XP Won’t Be HIPAA Compliant April 8, 2014 | EMR and HIPAA | Healthcare and Technology news |

As was announced by Microsoft a long time ago, support for Windows XP is ending on April 8, 2014. For most of us, we don’t think this is a big deal and are asking, “Do people still use Windows XP?” However, IT support people in healthcare realize the answer to that question is yes, and far too much.

With Microsoft choosing to end its support for Windows XP, I wondered what the HIPAA implications were for those who aren’t able to move off Windows XP before April 8. Is using Windows XP when it’s no longer supported a HIPAA violation? I reached out to Mac McMillan, CEO & Co-Founder of CynergisTek for the answer:

Windows XP is definitely an issue. In fact, OCR has been very clear that unsupported systems are NOT compliant. They cited this routinely during the audits last year whenever identified.

Unsupported systems by definition are insecure and pose a risk not only to the data they hold, but the network they reside on as well.

Unfortunately, while the risk they pose is black and white, replacing them is not always that simple. For smaller organizations the cost of refreshing technology as often as it goes out of service can be a real challenge. And then there are those legacy applications that require an older version to operate properly.

Mac’s final comment is very interesting. In healthcare, there are still a number of software systems that only work on Windows XP. We’re not talking about the major enterprise systems in an organization. Those will be fine. The problem is the hundreds of other software a healthcare organization has to support. Some of those could be an issue for organizations.

Outside of these systems, it’s just a major undertaking to move from Windows XP to a new O/S. If you’ve been reading our blogs, Will Weider warned us of this issue back in July 2012. As Will said in that interview, “We will spend more time and money (about $5M) on this [updating Windows XP] than we spent working on Stage 1 of Meaningful Use.” I expect many organizations haven’t made this investment.

Did your HIPAA compliance officer already warn you of this? Do you even have a HIPAA compliance officer? There are a lot of online HIPAA Compliance training courses out there that more organizations should consider. For example, the designated compliance officer might want to consider the Certified HIPAA Security Professional (CHSP) course and the rest of the staff the HIPAA Workforce Certificate for Professionals (HWCP) course. There’s really not much excuse for an organization not to be HIPAA compliant. Plus, if they’re not HIPAA compliant it puts them at risk of not meeting the meaningful use security requirements. The meaningful use risk assessment should have caught this right?

I’m always amazed at the lack of understanding of HIPAA and HIPAA compliance I see in organizations. It’s often more lip service than actual action. I think that will come back to bite many in the coming years. One of those bites will likely be organizations with unsupported Windows XP machines.


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5 Hot Healthcare Technology Innovations To Look For In 2014

5 Hot Healthcare Technology Innovations To Look For In 2014 | Healthcare and Technology news |
5 Hot Healthcare Technology Innovations To Look For In 2014

By Jared Jacobs

Over the last year, there have been some significant developments in healthcare technology and the way in which providers are able to deliver the appropriate care to their patients. Based on these trends and developments, it is possible to determine what technologies and changes could be expected in 2014.

These innovations include everything from simple advances that improve communication between doctors and patients, to developments that could very conceivably revolutionize certain medical practices. If you’re following the industry, or are simply fascinated by the huge strides likely to happen next year, keep your eye on some of these developments.

Printing Technology
Printing technology, in this context, is not about producing more forms and documents. This is about printing biological material that allows doctors to design customized implants in the middle of a surgery. A couple years ago, some manufacturers had already used 3D printers to create bone structures. The industry has gone beyond that, this month, with the introduction of the BioPen.

This new tool, developed by researchers at the University of Wollongong in Australia, will let the doctors control exactly where they deliver live cells and growth factors – meaning they can “draw” the bone right back onto the site of an injury to help speed recovery.

Printing technology doesn’t stop there, though. Another breakthrough announced in the month of December was 3D tissue printing. Instead of printing bone materials through a special pen, researchers have used inkjet printing technology to print cells taken from the eye. This represents the first time that anyone has been able to print out central nervous system cells. Both of these advances are still in their initial stages, but expect some huge developments in 2014.

Connected Services
Big data and mobile devices are coming together to make it easier for doctors to gather and record important patient information and access it whenever necessary to make better diagnoses. The move to electronic health records has not been an easy one, but there is a huge potential there to make sweeping changes throughout the industry.

Next year there will likely be a lot more integration of tablet computers in the doctor’s office and in the hospital because they provide simple and immediate access to important information. At the rate data is produced these days, it will require a powerful and effective interface to sift through it all and find the things that are relevant. Where will it go from here? Keep your eyes on wearable technology – anything that makes access even easier.

New Uses for Old Objects
It was recently reported that the treatment costs for fungal infections was more than $3 billion USD in 2010. Projections suggest this could increase to more than $6 billion in 2014 because many common fungal strains are becoming resistant to the drugs and other therapies normally used to fight them.

Now, in Singapore’s Institute of Bioengineering and Nanotechnology (IBN), some researchers were able to take the common polyethylene terephthalate bottle (PET bottles) and use a polymer synthesis to transform it into novel small molecule compounds that self-assemble into nanofibers. They were able to use these fibers to selectively target the unwanted fungal cells without harming the mammalian cells around it. Watch for the application of this technology to spread like, well, a fungus.

Alarm Hazards
Some developments aren’t about new, groundbreaking technology. They’re about improving the current system to improve the patient experience and deliver better care. According to the ECRI Institute, one of the biggest safety goals for 2014 is improving alarm hazards. Their research showed that after 98 alarm-related events over the last three and a half years, 80 patients died while 13 others suffered permanent loss of function.

New technology, such as better mobile devices and information delivery systems, can help eliminate alarm fatigue and reduce the risk of alarms simply not alerting the right people when they should. An alarm needs to reach the right people in order to be effective, and there should be a lot more technology developed to improve the distribution of these signals.

More and Better Robotic Surgery
The use of robotic surgery has increased dramatically in recent years, but it has been a challenge to train surgeons to use them well. Over the next year, as these machines become even more prevalent, there will be a bigger push to develop new applications and train more doctors to use these machines.

One of the promised benefits of this technology, though, is the ability to have a doctor perform the surgery from across the country – or even further away. Watch for new developments that increase the remote capabilities, so that if there isn’t a doctor nearby who is ready to handle the procedure, the hospital can virtually bring in a qualified surgeon.

There were a lot of major breakthroughs in 2013, and next year looks like it will hold just as many advances, innovations, and surprises. Whether it’s about building on some previous technologies or creating something completely unique, there is some real potential for great things on the horizon.

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OCR Warns Electronic Data Most Vulnerable

OCR Warns Electronic Data Most Vulnerable | Healthcare and Technology news |
OCR Warns Electronic Data Most Vulnerable

By Katie Wike, contributing writer

Office for Civil Rights advising providers to conduct security risks protecting patients’ electronic data

Iliana Peters, a privacy specialist with the U.S. Department of Health & Human Services Office for Civil Rights, says providers hoping to meet 2014 MU standards - or even simply updating software - should be running security risk assessments to test for vulnerability. At the American Bar Association's Health Law Section's Annual Washington Health Law Summit in Washington, D.C., last week, Peters said, “Every time you change your software, do a risk analysis.”

Fierce EMR reports “Providers seem to be having a particularly difficult time complying with HIPAA's security rule, leaving patient records in electronic form the ‘most vulnerable.’ The vast majority of security breaches reported to HHS have involved the compromise of electronic protected health information in EHRs, laptops, and mobile devices, added OCR privacy specialist Anna Watterson, who also spoke at the summit. OCR's pilot HIPAA audit program found only 11 percent of audited entities in ‘good HIPAA compliance shape,’ Peters said.”

Compliance is essential since, as Peters said, the ORC has "significantly stepped up enforcement and that aggressive enforcement will continue.” Other recommendations include:

  • store electronic records on a secure network
  • train work force members on safeguarding patient data
  • encrypt all data

This comes after the OIG released a report which “concluded that the OCR had not assessed risks, established priorities, or implemented controls to provide for periodic audits of covered entities to ensure their compliance with the HIPAA Security Rule.” According to Data Guidance, this report makes it likely the OCR would begin cracking down on providers in its investigations.

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Why the MU extension is failing physicians | Medical Practice Insider

Why the MU extension is failing physicians | Medical Practice Insider | Healthcare and Technology news |

The industry seemed to sigh in relief when the Centers for Medicare & Medicaid Services (CMS), alongside the Office of the National Coordinator for Health IT (ONC), extended meaningful use Stages 2 and 3 earlier this month. But aside from a bit of breathing room, some experts are saying that the move doesn’t really offer much else.

“The extension in my opinion will not greatly impact adoption trends,” Keith Blankenship (pictured), vice president of technical solutions for Lumeris, an accountable care delivery innovation company, told Medical Practice Insider.

According to Blankenship, the extension was not designed with provider adoption in mind. It was put in place to allow CMS and ONC to hone their efforts to enhance patient engagement, interoperability and health information exchange in Stage 2. All of the 2014 deadlines for meaningful use, in fact, must still be met.

“In reality, the extension and flexibility really only applies to the transition to Stage 3 meaningful use,” he said, “and perhaps some back-end Stage 2 software deployment.”

Valuable changes will not be made by trudging forward on thinning ice, Blankenship argued, but by magnifying EMR necessity and how physicians will be paid. “In order to really impact adoption trends, we need to take a step back and focus on the extension of Year 1 meaningful use, and then help physicians see the long-term return on investment for EMR adoption by changing current reimbursement models,” he added.

The average loss for a practice five years after EMR adoption is $44,000, according to a Health Affairsstudy. This needn’t be the case, however, if the right incentives are put into play — on the proper playing field.

“In a value-based model, physicians are paid for outcomes. Technologies that integrate data and provide a more complete view of a patient’s medical history enable positive outcomes. With these technologies, physicians can close gaps in care, coordinate care throughout the continuum, note medication adherence and truly manage populations,” Blankenship explained. “However, physicians are not incentivized to achieve positive outcomes; [instead] they are incentivized to see as many patients as possible in a small amount of time.”

While CMS data shows that EMR adoption rates have nearly doubled among physicians in the past three years, meaningful use of EMR systems is still painfully low. Blankenship finds that only 12 percent of physicians have attained meaningful use, a statistic that will persist if “physicians are not paid for outcomes or value, but for the volume of patients they see.”

Thus, it’s time for regulators to get their priorities — and incentives — straight, an alignment that physicians themselves can hasten by simply being aware of their adoption reality and speaking up about it, he commented.

“Physicians are realizing that the investment in technology in fee-for-service medicine will produce no long-term return on investment,” Blankenship concluded. “Meaningful use has helped draw attention to much-needed technological advancements, but the only way we will successfully move forward to Stage 2 is to incentivize physicians to deliver positive health outcomes for patients and populations.”

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Humanizing Health IT

Humanizing Health IT | Healthcare and Technology news |
From The Editor | November 20, 2013
Humanizing Health IT

By Ken Congdon, editor-in-chief, Healthcare Technology Online

Follow Me On Twitter @KenOnHIT

In the almighty quest to secure Meaningful Use (MU) incentive dollars, it’s often easy for a healthcare provider to lose sight of the primary reason they are implementing all of these technology changes — the patient. This sentiment came through loud and clear during a recent interview I conducted with Richard Ong, CIO of St. Vincent Health System in Erie, PA (part of the Allegheny Health Network).

St. Vincent is no stranger to health IT adoption. This health system consisting of a 427-bed hospital and vast outpatient network was one of the first in Western Pennsylvania to successfully attest for Stage 1 MU (with both its McKesson inpatient and its Allscripts outpatient system). The provider has also been recognized as one of 2013’s “Most Wired” hospitals by the American Hospital Association (AHA).

Click here to view video excerpts of Ken’s interview with Richard Ong.

For St. Vincent, the pursuit of MU has been about much more than capitalizing on stimulus funds. The health system has worked hard to ensure its MU strategy aligns with corporate goals and patient outcomes. “When it comes to EHR MU, we’re not just in the business of electronically capturing the pieces of patient data that are required,” says Ong. “Simply, transforming a paper form into an electronic one isn’t going to revolutionize healthcare, and it isn’t going to have much of an impact on the patient. It’s what you do with that electronic data that matters. You need to rationalize and understand the real economics of this data. How can this data help us achieve our corporate objectives? How can we leverage the data in downstream hospital systems? And most importantly, how can this data ultimately benefit our patients?”

Richard Ong, CIO, St. Vincent Health System

According to Ong, taking this approach to MU is the quickest path to success and measurable outcomes. However, to Ong, EHR results are only part of the equation. You must be loud about your wins — both to your physicians and your patients — to maximize the impact your technology investments have on your ecosystem.

“A patient is never going to celebrate the fact that and EHR provides a physician with quick access to their chart or that it allows the healthcare staff to quickly generate a variety of reports,” says Ong. “However, patients will take notice if they understand how an EHR helped reduce their length of stay, allows them to get their lab results quicker, or alerts a clinician of a possible medical condition or prescription contradiction.”

According to Ong, it’s the physician’s duty to notify his or her patients about the care advantages EHR systems provide. However, in most instances, he feels the physicians need to be adequately educated on these benefits first — and that’s the responsibility of the hospital’s IT leaders.

“A lot of physicians are skeptical of EHR benefits and actually oppose the technology,” says Ong. “Our IT staff constantly demonstrates the advantages our EHR is providing using tangible metrics. Showing physicians how the EHR is helping them and their patients helps generate clinical buy in and support of the technology. It also helps to motivate the physicians to share this information with their patients. When patients can see how EHR tools impact their care, that’s when healthcare transformation will really take off.”  

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Desktop Virtualization Takes Pain Out Of EHR Install

Desktop Virtualization Takes Pain Out Of EHR Install

Edited by Jennifer Dennard, Healthcare Technology Online

By replacing 600 PCs with 1,100 cloud displays, Olympic Medical Center has created a virtualized environment that has improved clinical workflows, IT maintenance, and overall EHR utilization.

An EHR implementation is painful enough on its own. Add PC setup, troubleshooting, and upgrades to the mix, and you add untold time and frustration to the process. Olympic Medical Center (OMC), an 80-bed, acute-care community hospital in Port Angeles, WA, found that PC management was impeding its EHR progress. As a result, the provider made the decision to replace many of its clinical PCs with cloud displays that leverage desktop virtualization technology. Here, Sean Johnson, information technology manager at OMC, explains how this move has enhanced clinical workflows, improved integration with physician dictation software, and optimized EHR utilization.

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Give Patients Tablets Reduce Readmissions

Give Patients Tablets Reduce Readmissions | Healthcare and Technology news |
News Feature | December 26, 2013
Give Patients Tablets, Reduce Readmissions

By Katie Wike, contributing writer

One ACO has taken a different approach to care and provided patients with 4G tablets to manage their health

Usually, when tablets like the iPad are in the news in healthcare it’s because providers are using them for EHRs or mobility in the hospital. One ACO, however, is outfitting patients in an effort to improve care.

Hackensack (N.J.) Physician Hospital Alliance ACO “has taken care coordination to the next, high-tech level by giving patients their own 4G tablets to help manage their care,” according to Becker’s Hospital Review. “The ACO gives 4G tablets to patients with chronic heart failure, chronic obstructive pulmonary disease, and/or diabetes, since those are the three leading causes of readmissions in the HackensackAlliance ACO, according to Noreen Hartnett, BSN, RN, patient care navigator with HackensackAlliance ACO. ‘Those are disease processes that are changing for the patient day-to-day, so they need to manage their symptoms at home as well as have physicians managing in the office,’ Hartnett says.”

Nurses care navigators tell patients when to take medication, eat or measure their blood sugar via the tablets. If patients don’t check in, nurses are notified so they can contact the patient and fix the problem. "It's almost like having an electronic nurse with the patient at all times in order to maximize compliance with various recommended treatments," Morey Menacker, DO, president and CEO of Hackensack Alliance ACO says.

Patients who have dexterity and are alert qualify for a tablet and 16 patients are currently equipped with one at the cost of $150 a month, per patient, after the initial investment in tablets. This is a small price compared to readmission penalties which can cost thousands per incident.

“The tablet program is proving to help reduce readmissions in the HackensackAlliance ACO. In a pilot study of the program, a group of Medicare patients who used the tablets had a readmission rate of just 8 percent, while a control group had a 28 percent readmission rate.

“More anecdotally, Dr. Menacker brought up a patient who was hospitalized every two months for his chronic heart failure in 2012 — but hasn't been hospitalized once in 2013 after being put on the tablet program. ‘It's a dramatic change to a patient's quality of life,’ says Menacker. ‘You can't put a cost on that. The cost is miniscule compared to the benefit.’”

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What's up with Obamacare and my health care?

What's up with Obamacare and my health care? | Healthcare and Technology news |

(CNN) -- As the politicians fuss and fight over the merits of the biggest overhaul of the health insurance system in this country, you may be wondering, "What does this all mean to me?" Here's what we know so far about what's up with your health care.

1. It's all about me

The Affordable Care Act, or Obamacare, as it is now commonly known, went into effect in 2010 and was affirmed by the U.S. Supreme Court in 2012, despite the 42 times the House Republicans tried to repeal it.

It will have the most dramatic impact on the 48 million Americans who don't or haven't been able to get insurance. By 2014, everyone -- with a few exceptions -- has to have insurance or face a penalty.

2. I get insurance through work. Why should I care?

More than half of Americans get health insurance through work. For those keeping score at home, that's 55.1% of the population, or about 149 million non-elderly people, according to U.S. Census data.

If that's you, news about Obamacare marketplace computer problems and people getting letters saying they're losing their coverage -- that doesn't affect you.

Few Obamacare choices in many states
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What you do have to worry about is that e-mail reminder your company sends you this time every year telling you about open enrollment season.

You may notice that information packet is a lot easier to read and the different plans are a lot easier to compare. You've got Obamacare to thank for that, since it is now mandatory that these companies communicate clearly about what they have to offer.

5 things you need to know about picking your insurance plan

If your child is under the age of 26, under Obamacare, they can stay on your insurance. It doesn't matter if they live with you or not or whether they're married or single. As long as they don't get insurance anywhere else, you can keep them covered.

Also because of Obamacare, many health plans must offer you free preventative care services. You can get your blood pressure or cholesterol checked, get a colonoscopy or a mammogram, ask for a flu shot, seek counseling for alcohol or smoking, find out if you are depressed and seek other preventative screenings. Since studies show 70% of all health care conditions are considered preventable, in theory this should keep a lot of people healthier.

If you are a woman, you no longer need a referral to see a gynecologist. Maternity care is provided. So is birth control, which would come at no cost in most plans.

Now if you are denied a payment new rules give you a chance to appeal a decision and if that doesn't work Obamacare lets you take your appeal to an outside independent review panel. The law now says the insurance company has to let you know why your claim was denied and they have a time limit in which they have to answer your appeal.

3. Will I pay more for my insurance?

Your plan will probably take a little more out of your check next year, but really that's nothing new.

Some companies, such as UPS and Delta, did blame Obamacare for rising insurance costs, but experts say employees will pay more for their policies because the economy is improving. When people feel more secure financially, they go to the doctor more and get test and procedures they put off when they felt less secure, according to Tim Nimmer, the chief health care actuary at Aon Hewitt an employee benefits administrator.

Aon Hewitt's research on the cost of insurance predicts employees will spend just under $5,000 on premiums and out-of-pocket expenses next year. That's up 9.5% from the year before -- higher than the increases for 2013, which were more in the 5% range. Over the past 10 years, average premiums for a family have kept going up a whopping 80%, according to a Kaiser Family Foundation report.

Get ready for higher health insurance costs at work

Another reason you'll pay a little more is because employers are continuing to shift the cost of insurance to employees, studies show. There are also new fees on employers and insurers to help cover insurers with new high-risk enrollees.

"I think they key point is to recognize that victory in health care is not that the cost of your health care is going up, it is that it is going up more slowly," said Jonathan Gruber, one of the architects of both the Massachusetts and Obama health care plans and the author of a graphic novel that simply explains health care reform.

4. What happens when I use my benefits?

When you do use your benefits and go to the doctor, you may have to wait a little longer for an appointment since you'll be competing with more patients who now have insurance.

Doctor shortage could crash health care system

You may have already been waiting a bit, since there is a primary care physician shortage according to the Association of American Medical Colleges. We're down about 20,000 now, and the number is expected to get worse as physicians age. And it's not just doctors who are in short supply; we also need more nurses, according to the Institute of Medicine.

"Keep in mind, the Affordable Care Act didn't create this crisis," said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. "We've got an aging population that needs more care and a growing population."

If you do go to the hospital, in theory you should be leaving it healthier. The ACA penalizes hospitals that see patients return after treatment, and facilities have started a number of innovative programs to try and keep patients well and out of the hospital.

If something catastrophic happens to you and it's expensive, that's also where Obamacare will make sure your insurance continues to cover you. In the past, insurance companies could dump you if you spent too much. Those costs are capped under the ACA and there are no lifetime spending limits.

The one thing that was supposed to change under the ACA that has been delayed is a mandate that all companies with more than 50 full-time employees get benefits. Companies will eventually face fines if they don't offer insurance. That doesn't go into effect until 2015.

5. What if I own -- or work for -- a small business?

A giant part of the small business community, 96% of small businesses have fewer than 50 workers. If you own that kind of business, you don't have to worry about that employer mandate. If you work for one, you will be able to buy a policy in the new Obamacare marketplaces.

If you do employ more than 50 people, chances are you already offer insurance to your workers -- 90% do -- and business owners who are happy with their insurance plan can stick with it. In fact, many insurance companies are offering discounts to clients who renew their policies.

If you are in that 3% with more than 50 workers and you do not provide insurance, you will have to start -- or you'll have to pay a penalty starting in 2015.

The government has opened a small business marketplace, also known as the Small Business Health Options Program (SHOP). It is meant to provide an easier and cheaper venue for business owners to shop for insurance for their employees. SHOP's website lets business owners compare plans.

The government offers tax credits to these smaller business to help pay for this insurance. These are worth up to 50% of your premium costs. Small businesses can still deduct the rest of their premium cost not covered by the tax credit. It is only available for plans bought through SHOP.

6. Is anyone directly impacted by all this Obamacare talk?

If you don't have insurance or haven't qualified for insurance in the past, you'll need to have it by March 31 of next year. If you don't, you'll be fined up to 1% of your income or $95, whichever is greater.

Obamacare 101: Everything you need to know

You can buy a plan from a broker at any time. If you want to buy through the new Obamacare marketplaces, open enrollment stretches through March 31. You'll only get a tax break/subsidy if you buy a policy through the marketplaces.

If you are like Jeff Jones in Lexington, Kentucky, who wants a policy to start on January 1, you'll have to make up your mind on which plan is right for you by December 15.

Jones lost his job with the University of Kentucky and is unable to get on his partner's policy. "I've been shopping around online but haven't decided on which policy yet," he said.

Jones has been comparison shopping through Kentucky's state marketplace website. There have been some technical hiccups, but he's been able to see what he'd qualify for based on his expected income. A diabetic, he says he is grateful this is an option now. Currently, insurance companies could deny him a policy since he has this pre-existing condition. Obamacare ends that practice next year.

CNN Money: Obamacare pricier for some individual buyers

If you can get into the website, you can sign up for a policy through There's also a phone number to call: (800) 318-2596 (TTY: (855) 889-4325). The number is staffed round the clock. Information is available in more than 150 languages.

There will also be specially trained advisers in communities. These "navigators," as they are known, can help you in person. If you would like to find the closest navigator, go to Plug in your ZIP code and it will give you the closest location to get help.

7. So bottom line, what does this cost?

Costs of plans vary, depending on where you live in this country and your age; the White House says you should be able to buy a plan for less than a $100 a month. If you want to see what your bill may look like, check out the Kaiser Family Foundation's calculator. The nonpartisan foundation's tool provides an estimate of your costs, depending on where you live and the plan you pick.

For many the President's promise of health care choice doesn't ring true

The bronze level is basic, silver is midrange and gold and platinum are higher-end. There is also a catastrophic option. Catastrophic insurance covers three doctor visits per year at no cost and preventive care such as screenings and vaccines. This plan will carry a higher deductible.

8. What do I get for my money now?

All plans bought through the exchanges must offer the same coverage benefits. Mental health is covered, behavioral health is covered, maternity care, emergency care, hospitalization, newborn care, prescription drugs, rehab, lab services, and pediatric services. All offer free preventive care. Nearly all cap out-of-pocket costs to $6,350 and $12,700 per family. No one can be turned away. No one will be penalized because of their gender (women often paid more in the old insurance system). Only smokers may be penalized in some plans and some older people may pay more.

Dental is covered for kids, but it is not for adults. You'll have to buy a separate policy for that or find a policy that offers it.

Dental crisis could create 'State of Decay'

There are more limited doctor and hospital networks offered in these plans. That's how insurance companies have been able to keep costs down and offer all these benefits. Insurance brokers advise you look to see if your doctor or favorite hospital is considered in-network with whatever plan you buy. Otherwise, you will have to switch doctors or pay a higher fee for seeing him or her.

9. Didn't Obama say I can keep my policy?

Some people who do buy their own insurance have been getting letters from their insurance companies saying their plan has been canceled. That's because their old plans don't qualify under these Obamacare rules that mandate insurance cover all these benefits.

With these plans you will pay a monthly premium, and may also have a co-pay or be asked to meet a deductible when you go to the doctor or hospital.

Video: Woman scores great deal on Obamacare -- a policy for under $2

10. Is there help to pay for all this new insurance?

The good news is, if you go through the exchanges rather than buy directly from an insurance company, you will likely be eligible for tax breaks and subsidies to pay for your insurance. The assistance is available to those with incomes of up to four times the federal poverty level -- this year, that's $45,960 for an individual or $94,200 for a family of four -- and will be calculated on a sliding scale.

You can take this subsidy as a tax credit or the government will pay the insurance company directly.

You may also want to check to see if you will qualify for Medicaid. So far, 26 states are moving toward expanding who is eligible for the federal government-funded health program for lower income families and individuals.

11. I've got Medicare. Does Obamacare change that?

You are in a group that doesn't need to worry about Obamacare. Medicare doesn't change with Obamacare.

12. So then, why the fuss?

Studies show people are politically riled up about all this change in health insurance, but when it comes down to it, Gruber said the sky won't fall next year and things should get better.

"Once people experience it and go through this initial transition, which is going to be rocky, then they're going to realize the benefits of having a system like this," Gruber said.

"Yes, if you are young and healthy it will be more expensive, but right now this is an insurance market which not only is discriminatory, but the typical person who buys their own insurance has a very weak insurance plan. (Under Obamacare) everyone will have will have guaranteed, real insurance that's fairly priced."

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AMIA: 'Clinical informatics has arrived' | Healthcare IT News

AMIA: 'Clinical informatics has arrived' | Healthcare IT News | Healthcare and Technology news |

Physicians in the first subspecialty of clinical informatics spearheaded by the American Medical Informatics Association got their board certifications this month – a pivotal moment in healthcare's "systemic overhaul," according to AMIA.


The creation of this new subspecialty will help standardize clinical informatics training programs, increase the number of training opportunities available and provide an immediately recognized credential for organizations hiring informaticians, officials say.


AMIA worked for more than five years to define and create the discipline with the goal of advancing the field and the role of informaticians in improving healthcare; the new crop of doctors in the program received notice of their board certification earlier in December.


"We congratulate the newly certified leaders of the clinical informatics field, as they take their next step toward improving healthcare delivery," said AMIA Incoming Board of Directors Chair Blackford Middleton, MD, in a press statement. "These physicians have demonstrated that they understand the design and implementation of informatics systems, and are poised to integrate these solutions into their healthcare delivery organizations."


The subspecialty was approved by the American Board of Medical Specialties in 2011. The board exam was administered this past October through the American Board of Preventive Medicine, and offered to pathologists through the American Board of Pathology. The 455 new subspecialists were notified of their certification earlier this month.


"Clinical informatics has arrived, and I'm proud to be a part of the pioneer class of leaders in this field," said William Hersh, MD, professor and chair of the department of medical informatics & clinical epidemiology at Oregon Health & Science University, in a statement.


Hersh received his board certification this month and also directed AMIA's clinical informatics board review course.


"When you look at the Accreditation Council for Graduate Medical Education's definition of the informatics discipline, the operative word is 'transform,'" he said. "Every day, informaticians are working in their healthcare settings to change how we do things, to improve patient care and population health."


The board certification is open to physicians of all specialties, encouraging interdisciplinary cooperation in the clinical informatics field. Physicians can currently become eligible for the exam by demonstrating practical informatics experience. However, after five years, candidates for the subspecialty will need to complete an accredited clinical informatics fellowship with the Council on Graduate Medical Education.


"What makes this subspecialty interesting is that any primary specialty diplomat can apply to become board certified in clinical informatics," said Middleton said. "It is illustrative of the ubiquitous need across our entire healthcare delivery system to engage with professionals who understand how to improve the value of care with informatics."

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Outlook grim for docs' ICD-10 readiness | Healthcare IT News

Outlook grim for docs' ICD-10 readiness | Healthcare IT News | Healthcare and Technology news |

By the way things look now, the healthcare industry is not on track to meet the ICD-10 compliance deadline of October 2014. In fact, providers have fallen even further behind with timeline milestones than they did back in February, according to new report findings. But it's not just providers. Vendors also have a long way to go.


The Workgroup for Electronic Data Interchange survey concludes that a whopping 80 percent of healthcare providers will fail to complete their business changes and begin testing before 2014.


Moreover, 20 percent of vendors said they were halfway there or less with developing products in support of ICD-10, and 40 percent indicated they wouldn't even have a finished product available until sometime next year.


"All industry segments appear to have made some progress since February 2013, but have not gained sufficient ground to remove concern over meeting the Oct. 1, 2014 compliance deadline," said Jim Daley, chairman of WEDI, in a news release announcing survey findings. "Unless all segments move quickly forward with their implementation efforts, there will be significant disruption" come October.


Becki Weber, senior vice president of information technology at the six-hospital Meridian Health in New Jersey, said she's concerned because providers haven't really gotten on board with ICD-10 like they should be.


At Meridian Health, ICD-10 has become an IT-led project where they're pushing the rest of the organization. Weber and her 211-person team have created a website for providers and office staff to train on ICD-10, but so far providers are disconnected, she said.


"The physicians are a bit disengaged," Weber said in a Healthcare IT News webinar last month. "I'm not sure they see it as a real issue, and I think that's going to be a surprise for them."


Judy Comitto, chief information officer at Trinitas Regional Medical Center in New Jersey, said what's really getting in the way of their ICD-10 progress pertains to the vendors' own meager headway.


"What's been happening is that the vendors that we need to upgrade the software and be capable of ICD-10 processing are not timely, so that is pinching our test time and the downstream functions that come after testing," said Comitto. "I'm a bit disappointed having reached out to these vendors that they are certainly not there yet."


Other survey findings include:


Some 50 percent of providers have completed their ICD-10 impact assessments.

About 50 percent of providers expect to begin external testing in the first half of 2014; only one-tenth expected to start in 2013.

The top three barriers to providers' ICD-10 delays were cited to be: staffing, competing priorities and vendor readiness.

Vendors indicated their top three barriers were: customer readiness, competing priorities and other regulatory mandates.



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Flood of health data breaches coming | Healthcare IT News

Flood of health data breaches coming | Healthcare IT News | Healthcare and Technology news |

Get ready, because data breaches are expected to rise in 2014, especially in the healthcare industry. New security threats and regulations that call for more transparency will be partly to blame.

A new report from Experian Data Breach Resolution says healthcare will face a "perfect storm” for breaches in 2014. The Affordable Care Act, with its increased activity, as well as more people signing up for health insurance will only make the target that much larger. Experian predicts the opening of a floodgate for healthcare breaches in 2014.

The time is right to beef up security precautions, warns Michael Bruemmer, vice president of Experian.

More and more organizations have learned how to identify and respond to security incidents, and this has lowered the cost per record of a data breach. This trend is expected to continue, and that’s good news, says Bruemmer. But it doesn’t mean you should let down your guard. If you’ve had one incident, don’t think you’re in the clear. Count on having another, Bruemmer says.

The use of the cloud and big data means there will be more multi-country breach events. The biggest challenge here will be awareness of each country’s regulations and complying with all of them. Privacy attorneys who work in foreign jurisdictions are best suited to help organizations understand the global notification responsibilities after a breach, Bruemmer says. Some international breach notification laws can be quite onerous. In 2014, the European Union is expected to pass privacy legislation that would require notification of breaches within five days. If you store anything in the cloud or have any international networks, and fail to comply, this could add up to significant fines that can cut into your bottom line.

Cyber insurance will continue to sell like hotcakes in 2014, just like it did in 2013. Most organizations are looking for ways to reduce risk, and that’s one good way, Bruemmer says. Because of this boon, cybersecurity insurance companies are likely to expand their offerings to include insurance geared toward particular market segments, including small businesses. Buying cyber insurance is a good idea, Bruemmer says. It’s not a sign of throwing in the white towel; it’s just good business sense. Fight the battle on all fronts. A lot of companies and organizations are already coming to that conclusion. A survey conducted by Experian and the Ponemon Institute last March showed one third of organizations are already buying cyber insurance, and one third more are planning to do so in 2014.

Breach fatigue is setting in and is expected to get worse next year. In 2012 alone, one quarter of the U.S. population received at least one letter notifying them they had been breached. As laws get more stringent and more awareness is raised, the notifications will increase. Breach fatigue is causing people to disregard these notices. The worst case scenario in the healthcare sector could find someone failing to take action when their healthcare identity has been stolen. Then, when they go in for a procedure or treatment, their medical records could contain incorrect information. All sorts of medical errors and complications could be the result.

In 2014, expect regulators to be more helpful. Regulators don’t want to be the bad guy, and Bruemmer says he’s seeing more of them reach out to organizations that have experienced a breach. Work with them, and they will work with you.

In the end, Bruemmer says, the best advice is to get a security plan in place and make sure you practice it.


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More Details From Study: Health IT Could Cut Demand For Physicians

More Details From Study: Health IT Could Cut Demand For Physicians | Healthcare and Technology news |

Earlier, we wrote up a study which strongly suggests that health IT can boost physician productivity. But we didn’t include some of the details you’ll see below — and we thought they were important enough for a follow-up.

Much of the talk about health IT in physicians’ offices addresses the struggles doctors face when adopting new technologies, and the effort it takes to get productivity back to normal levels. But this study takes things a step further, asserting that if health IT was fully and widely implemented, it could reduce demand for physicians substantially.

The study, which originally appeared in Health Affairs, concluded that if health IT were fully implemented in 30 percent of community-based physicians’ offices, efficiency improvements would cut demand for physicians by 4 percent to 9 percent. What’s more, using health IT to delegate work to midlevel practitioners and from specialists to primary care docs could reduce demand for physicians by 6 percent to 12 percent, according to a story in Information Week.

Meanwhile, growing the amount of IT-enabled remote and asynchronous care could cut the volume of overall care that physicians provide could have a big impact as well. Remote care could cut the percentage of care that physicians provide by 2 percent to 5 percent, and asynchronous care by 4 percent to 7 percent, Information Week reports.

And that isn’t all. If 70 percent of office-based docs adopted comprehensive IT support, including interoperable EMRs, clinical decision support, provider order entry and patient Web portals with secure messaging, the drop in demand for physician services would be twice as large, the Health Affairs study concluded.

That being said, the comprehensive use of health IT by even 30 percent of office-based doctors is at least five years and maybe as much as 15 years away, according to one of the study’s authors, Jonathan Weiner, professor of health policy and management at Johns Hopkins’ Bloomberg School of Public Health.


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Where Are We At With Meaningful Use? | EMR and HIPAA

Where Are We At With Meaningful Use?

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.

It seems like meaningful use is in a constant state of flux with moving deadlines and multiple stages that apply to each organization differently. With meaningful use stage 2 just around the corner for many providers it is worth taking a quick look at where we are on the journey to meaningful use.

Meaningful Use Timelines
The most important thing many organizations need to remember is the various timelines for each meaningful use stage. This can be pretty complex because it changes based on when you first attest to meaningful use. Plus, last Friday CMS announced an extension to meaningful use stage 2 and a delay of meaningful use stage 3 for one year.

Before this recent change, CMS put out the following chart which clearly illustrates how much EHR incentive money a provider will get for showing meaningful use of a certified EHR. Plus, it shows which meaningful use stages you will have to comply with based on the year you started attesting to meaningful use. After the aforementioned announcement, the only change to this chart would be that both meaningful use stage 3′s would become meaningful use stage 2.

The above chart is just for EHR incentive money under Medicare. The chart for Medicaid is much simpler and hasn’t changed much since the EHR incentives were first announced.

EHR Penalties
While the incentive money for EHR is important for many, it seems like doctors are motivated as much or more by the Medicare adjustments that will be enforced if they aren’t meaningful users of a certified EHR system. Here’s the timeline for the EHR payment adjustments:

There are a number of hardship exemptions that a provider can claim to avoid the penalties. If you plan to pursue one of these hardship exemptions, you have to apply for one by July 1, 2014. CMS has put out a nice tipsheet covering payment adjustments and hardship exemptions. As you can see, the exemptions are pretty narrow. Although, maybe they’ll create more exemptions over time like they did with the eRX penalties.

Other Notable Meaningful Use Updates
Regardless of what stage of meaningful use you are at or any prior years reporting, all eligible professionals will only have to attest to 90 days of meaningful use in 2014. This change was made to give organizations plenty of time to upgrade to the 2014 certified EHR technology. However, many EHR vendors have taken this extra time into account and are still not 2014 certified because they know eligible providers only have to attest to 90 days in 2014. Anyone attesting to meaningful use regardless of meaningful use stage will have to be on a 2014 certified EHR. The 2011 EHR certification will be expired and not accepted.

It is also worth noting that those who have not begun participation in the Medicare EHR incentive program will need to attest to meaningful use in 2014 if they want to be eligible for any EHR incentive money.

Meaningful Use Audits
If you’ve already attested to meaningful use stage 1, then you better make sure your documentation is in order. Meaningful Use audits have already begun and a number of organizations are getting caught without the proper documentation. This is worth also noting for those planning to attest to meaningful use for the first time. Make sure that you keep all your meaningful use attestation documentation in case you’re ever audited.

The most common audit issue organizations have is with core measure 15 which requires an organization to conduct a security risk analysis. Many organizations checked off this box without actually doing a security risk analysis. That’s a very risky proposition. This is one meaningful use requirement where you can’t rely on your EHR vendor to do it for you. This is not a hard task and many organizations will be happy to come and do one for you. Just make sure you’ve actually done it before you attest.

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