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November 13, 2014  3:00 PM

Medical me: The intersection of patient privacy and health IT



Posted by: adelvecchio
Internet of Things, Patient engagement, patient privacy, Privacy and security

roberta-katzGuest post by Roberta Katz, director, healthcare solutions, EMC,  @Roberta_Katz, @EMCHealthcare

Based on the amount of data currently being produced, the digital universe is projected to double in size every two years and multiply tenfold between 2013 and 2020 — from 4.4 trillion gigabytes to 44 trillion gigabytes. A recent IDC study, “The Digital Universe of Opportunities: Rich Data and the Increasing Value of the Internet of Things,” revealed how the emergence of wireless technologies, smart products, and software-defined businesses will play a central role in expanding the volume of data.

At a 48% percent annual growth rate, the healthcare “digital galaxy” is growing even faster than the overall “digital universe.” In fact, more healthcare data is being generated than ever before, coming from cloud, big data, mobile, social media and electronic medical record sources. Healthcare providers need to be able to harness the useful, high value data produced during a patient care episode to gain insight into their patients’ conditions. This is particularly important as the population — with its higher rate of chronic diseases — continues to age, and advanced tools such as medical imaging, tracking devices, and sensors are used to remotely monitor patient physiological measures.

Because privacy and security of patient information is so critical at the point of care, trust between patients and providers is integral as it intersects across IT, patient engagement, and safer patient care delivery. Along with other industries, healthcare providers are working to balance security and privacy while they more efficiently manage, analyze, and share patient data for coordinated care.

To gain further understanding of these issues, The 2014 EMC Privacy Index surveyed 15,000 people in 15 countries to measure the relationship between online privacy and convenience. The U.S. ranks tenth among these 15 countries in its willingness to sacrifice privacy in return for greater convenience online, with 40% of Americans ready to give up some privacy for greater convenience.

The privacy irony

The Privacy Index illustrates the complexity of the privacy debate, providing three examples of how respondents are conflicted when it comes to choosing privacy or convenience.

  • We want it all paradox: Consumers say they want all conveniences and benefits of digital technology, yet say they are unwilling to sacrifice privacy to get them.
  • Take no action paradox: Although privacy risks directly impact many consumers, most say they take virtually no special action to protect their privacy — instead placing the responsibility on those handling their information such as government, healthcare organizations, and businesses
  • Social sharing paradox: Users of social media sites claim they value privacy, yet they say they freely share large quantities of personal data — despite expressing a lack of confidence and trust in those institutions to protect their information.

These same conflicts are present in healthcare.

  • We want it all paradox: A patient may like the convenience of telehealth, but may not always be open to allowing access to these services on their personal or home devices.
  • Take no action paradox: Some patients endanger the privacy of their sensitive health information by using the same password for multiple sites and accounts, and sometimes leave important medical records out in the open.
  • Social sharing paradox: How often has a patient shared a personal diagnosis or hospital experience on a social media site?

The Privacy Index dives even deeper into the healthcare privacy debate.

Medical privacy

People value easier access to their medical records, but only 47% are willing to give up confidentiality. Patients see the value and benefits of technology and may be more open in a healthcare setting, but they remain hesitant.

What’s contributing to this reluctance? A MeriTalk report, “Rx: ITaaS + Trust,” found that in the last year, 61% of global healthcare organizations experienced a security-related event in the form of a security breach, data loss, or unplanned downtime at least once. U.S. hospitals with 100 or more beds have spent more than $1.6 billion annually as a result of security incidents.

A recent hacker breach of HealthCare.gov shows that healthcare organizations can be targets for criminals. While no patient information was stolen, the incident should give consumers and the industry pause as outside threats will only make security more difficult.

Despite growing awareness of security breaches, compared to the five other personas examined in the Privacy Index (social me, financial me, citizen me, employee me, and consumer me), the medical me collectively has the highest confidence in healthcare organizations’ ethics (61%) and the second highest confidence in skills (62%). And, only 28% expressed concerns about future privacy. Part of this is explained in a recent Journal of AHIMA article, “Trusted Health IT and IT-as-a-Service: A Prescription for Change.”

As IT is a key enabler in delivering safer patient care at lower cost, many healthcare organizations are beginning to implement hybrid cloud models and IT as a Service, preparing to become the IT service provider of choice within their own networks and beyond.

For patients, this means a better sense of security knowing their healthcare provider is building a trusted hybrid cloud framework for coordinated care, which helps ensure the right data goes to the right caregiver at the right time.

About the author:

Roberta Katz is director of healthcare solutions at EMC where she focuses on helping healthcare organizations move their IT strategies forward as they invest in EMR and advanced medical imaging initiatives, cloud-based platforms, trusted IT, and big data and analytics solutions. Roberta has more than 25 years of health IT industry expertise in developing solutions to help improve patient care delivery, at the point of care, leveraging IT technologies.

October 8, 2014  11:24 AM

At-the-elbow physician support a must-have for EHR implementations



Posted by: adelvecchio
EHR, EHR implementation, EHR selection

1412785372_1412785172_Kathleen M  Myers MD low resGuest post by Kathleen Myers, M.D., FACEP, founder and chief medical officer of Essia Health

Amid the many changes to the practice of medicine over the last 10 years, the most dramatic impact at the point of care has been integrating new information technologies and systems, especially the EHR. Introducing a new or upgraded EHR system is a major undertaking for any hospital, clinic or medical practice. A successful EHR implementation goes beyond selecting the right IT vendor and system. At-the-elbow physician support has become an essential component of successful EHR go-lives, ensuring physician engagement and satisfaction, and letting them focus on patient care while meeting the new technology requirements.

At-the-elbow support is in-person technical expertise provided by external EHR specialists to physicians at their place of work — be it their office, an examination room or even the operating room — before, during and after EHR go-live. EHR specialists embrace the way that physicians learn best, in real time.

There are three key reasons hospitals should consider externally sourced at-the-elbow support for EHR go-live: physician buy-in, patient satisfaction and productivity.

Physician buy-in: Training doesn’t equal support

It goes without saying that physician buy-in is crucial to successful EHR implementations and upgrades. Anecdotal information suggests go-lives that have minimal assigned provider support or support from internal staff are associated with significant provider frustration, challenges with implementation and, on rare occasion, failure.

Many health systems focus their time on selecting the right EHR software but don’t think about ensuring the effectiveness of the software by providing support to physicians — support that goes far beyond computer lab training. Most physicians don’t learn well from cookie-cutter classroom curriculum. It’s not their environment. They want to engage in conversation about the EHR when they’re in an actual patient care environment.

Without buy-in from physicians, the whole go-live — or even the profitability of the hospital or health system itself — can be affected. Surgeons, for example, are an important group from which to gain buy-in in the months leading up to a go-live, given the influence they have over where their patients have their surgeries. If orthopedic surgeons don’t feel involved in the process or adequately supported on the EHR itself, they can make every CEO’s worst nightmare come true and take their total hip, knee and other elective surgeries to another nearby hospital.

The process of gaining buy-in begins with thoughtfully looking at each subgroup of medical staff, and then helping them develop the content and tools they’ll need to care for patients. At-the-elbow support can help them develop these tools. It also includes asking them simple questions like, “What are you worried about?” and “How can we help you?”

Quality patient care: More support means less waiting

When physicians are learning to use an EHR, it means one thing for patients: waiting. Waiting to be admitted, waiting for medication and to be discharged, et cetera.

“I have not run ‘on time’ since we implemented our EHR,” is a common complaint among physicians. When physicians receive at-the-elbow support, they quickly become more comfortable and confident with the new EHR system. This means they can return to their pre-go-live baseline faster, so tasks don’t take longer than they used to before the EHR was implemented. Physicians that are not fumbling with the computer can better interact with their patients, enabling them to provide more focused care throughout the go-live and beyond.

Productivity: Keeping long term drop-off at bay

Though a short term drop-off in productivity is a natural consequence of an EHR go-live, with the right level of physician support, hospitals can make sure the drop isn’t a sustained one.
An orthopedic surgeon with a once-a-week operating room time block might have conducted five knee surgeries in eight hours before the go-live, but the hospital might suggest that the number of cases be scaled down to three to provide time to learn how to use the EHR system. With at-the-elbow support, surgeons can normally get back to their full case load in two to three weeks. Without it, they may never return to their pre-go-live baseline.

At-the-elbow support: The basics

At-the-elbow support begins after physicians complete basic computer lab or online EHR training. A key difference with at-the-elbow support versus training is that it is conducted in a patient care environment, instead of a training playground. In this environment, physicians can see how patient flow will work and what EHR tools they will need to be successful.

The process involves several one-on-one individual or small group meetings with an EHR specialist before the go-live, where workflows are reviewed and tools are developed. The orthopedic surgeon, for example, would build pre-op, intra-op, post-op and discharge note templates for every common case, as well as customize order sets, before the EHR goes live. These sessions also help them get faster on the EHR as they build their skills. When their first case is scheduled after go-live, an EHR specialist joins the surgeon in the operating room and will be there every step of the way, from the time the patient arrives for surgery until they’re in the post-anesthesia care unit recovering. The EHR specialist remains in close vicinity to the physician so assistance can be provided immediately.

Implementing an EHR is a big investment in time, money and human resources. Planning the right level of provider support is critical to realize a strong financial return on an EHR investment. Without provider support, an EHR system implementation may result in physician frustration, a long term drop-off in productivity and patient dissatisfaction. At-the-elbow support before, during and after an EHR go-live can optimize the provider and patient experience and help technology be an asset, not just a requirement.

Kathleen Myers, M.D., FACEP, is an emergency physician and founder/chief medical officer of Essia Health. She can be reached at Kathleen.myers@essiahealth.com


September 25, 2014  11:39 AM

How wearable devices are building an EHR ecosystem



Posted by: adelvecchio
Apple Health, EHR, EHR integration, EHR systems, Google Glass, Google Health, wearable devices

zach watsonGuest post by Zach Watson, content manager, TechnologyAdvice

Gathering reliable physiological data from patients has been one of the main targets of healthcare innovators for some time now. Now that EHRs are used by a majority of office-based physician practices, the foundation for such a data infrastructure is in place.

Two obstacles have historically blocked the implementation of patient-generated health data: lack of automation in processes and lack of patient adoption.

To acquire the necessary physiological data, providers need patients to adopt wearable health hardware on a widespread scale. In theory, wearable technology will record valuable health data such as blood pressure, heart rate, and glucose levels and deliver it into a patient’s record inside the EHR through a direct HIPAA-compliant protocol.

Until recently, wearable devices like Nike’s FuelBand and the Fitbit remained niche products used by fitness fanatics or early adopters — and not by the chronically ill population that providers need to collect data on. Additionally, these wearables weren’t able to directly integrate with electronic medical software systems. This meant a third-party application such as Microsoft’s Healthvault was needed in order to store and transfer the information.

If a process isn’t intuitive, users aren’t going to adopt it. This is true with wearable devices on the consumer side, and patient-generated data on the provider side. Just like a great deal of healthcare IT, the capabilities existed, but not in a scalable or connected fashion.

Major developments from Apple and Google, introduced in the last year or so, may finally make wearable devices the bridge to EHRs for which providers have been longing. Changes to payment models and a shift to quality-based reimbursement mean that device integration with EHRs is quickly becoming integral to truly preventive treatment plans.

Google Glass makes waves in the OR and exam room

Google tried and failed to create a bridge between patients and providers with Google Health. The release of Google Glass has quickly catapulted them back into the healthcare arena. While many fitness devices are strictly consumer-facing, Google Glass is gaining the most traction with providers; they that are using it everywhere from the exam room to the operating room.

Outside of the operating room, Google Glass allows physicians to record an unprecedented amount of information during a patient exam. Glass’ software connects to databases via Bluetooth, so physicians can utilize the hardware to capture photos and record videos that can be streamed directly into the patient’s record.

Further, by recording simple procedures like changing dressing on a wound, physical therapy, or proper dosing for medications, providers can easily create rich educational content that can be shared through a patient portal. Several EHR providers, such as iPatientCare, Inc. and drchrono, have already developed, or are developing, apps that integrate with Google Glass.

Google Glass is also playing a larger role in the operating room as physicians use the hardware to apply information from a patient’s health record during surgical procedures. Homero Rivas, M.D., Stanford University’s director of innovative surgery, recently used a Glass app called MedicAR to overlay the anatomy of a human model with stills from magnetic resonance imaging (MRI) to increase his precision during the operation. If the MRIs are stored in the EHR, this makes another compelling case for the integration of wearable devices.

Google has even developed contact lenses that can measure a patient’s glucose levels through the moisture in their eyes. These lenses could be especially useful for diabetic patients that have a history of poorly managing their condition. If a patient’s blood glucose level becomes dangerous, providers would receive an alert through their EHR to contact and advise the patient.

Glass has more immediate potential for providers, but the contact lenses do foreshadow what wearable devices could look like in the not-too-distant-future.

Apple Health unifies disparate data sources

While Google Glass is finding a home in the operating room, Apple’s new Health app is being positioned as a unifying health data platform for patients. Health and its companion development platform HealthKit provide patients with a hub to integrate data from all their health applications, eliminating data fragmentation.

In terms of development, a number of major healthcare players seem to be buzzing about the possibilities of Health and Healthkit. The Cleveland Clinic is reportedly testing the Health beta and giving Apple feedback, while Kaiser Permanente is said to be quietly piloting several apps developed on the HealthKit platform. Apple is also in talks with EHR market leaders, including Allscripts Healthcare Solutions, Inc. Apple’s already announced a partnership to integrate directly with Epic’s MyChart personal health record.

Of course, integrating with every EHR would be a lofty undertaking, but if Apple partners with some key players, Health could become a foundational communication element between wearable devices and EHRs. Peter McClennen, president of population health management at Allscripts is clearly on board with wearable device integration.

“That technology wave, if you look at other industries, is very clear. Every watch, every phone, everything is connected. It’s about keeping people healthy in a more productive model of health delivery,” McClennen said in a Q&A with EHRintelligence.com.

But what about Apple’s hardware? The tech giant already has deals with Nike, and other prominent devices are likely to follow, though the hope is that the iPhone’s large user base will quickly come to view their phone as a hub for everything health-related.

Other, smaller organizations are innovating around EHR integration as well. Bay Area-based startup Augmedix is reportedly working on a Glass app for transcription purposes. No doubt others will follow on both Apple and Google platforms.

Integrating wearable devices with EHR software will create more than just a bridge between devices. It could bring the EHR, and therefore the healthcare provider, into an ecosystem of technology in which the patient is a central figure and active participant. Now that some technology behemoths are in the EHR integration game, the potential for healthcare seems huge.

About the author: Zach Watson is content manager at TechnologyAdvice. He covers healthcare IT, business intelligence software, and emerging technologies. Connect with him on Google+.


September 18, 2014  10:58 AM

Secure texting in healthcare: Four emerging trends



Posted by: adelvecchio
HIPAA compliance, secure messaging, secure text messaging, texting

1411054863_bio-big-barreauGuest post by Jose Barreau, M.D., CEO and co-founder of Doc Halo

As new technology erases many of the fears that providers had about data privacy, text messaging is growing as a form of communication in healthcare.

With a secure texting system such as the Doc Halo app, physicians exchange information about their patients while staying compliant with HIPAA and other regulations. That’s good news for providers and patients alike because it improves the quality and efficiency of healthcare, but it’s really only the beginning. Much more opportunity awaits.

Text messaging has become one of the most popular ways to communicate in nearly every walk of life. Over time, the medium will become central to many of the interactions that patients have with the healthcare system.

Here are a few emerging uses of texting in healthcare:

Provider-patient communication

One key to excellent healthcare is open communication between providers, staff members, and patients. The brief moments they spend face-to-face in an exam room allow for only a snapshot of how the patient is doing and how well their treatment is working. Continuing dialogue outside of the clinic leads to more comprehensive care, but hectic schedules on both sides often make that difficult to achieve by phone call. Text messaging is a quick and convenient way for doctors and staff to answer questions, provide guidance and check patients’ progress. Recent analysis done by the University of Connecticut found that patients who texted with their providers were more apt to follow their medication routines. Current secure texting technology enables healthcare providers to take part in this type of exchange while avoiding the risk of a HIPAA violation.

Public health

Text messaging is not limited to one-on-one communication. Healthcare providers can use multi-recipient texting to help large groups of people at once. Such communication has the power to promote behavioral changes, such as guiding patients to choose healthier foods or avoid tobacco. A study published in the Journal of Adolescent Health found that texting may be a good way to reach teens with messages of violence prevention.

Hotlines

Texting as part of public health communication does not need to consist strictly of one-way exchanges. It can be geared toward back-and-forth discussion. That concept has led to a new spin on an old concept: the text crisis hotline. As the New York Times reported earlier this year, “Texting has become such a fundamental way to communicate, particularly among people under 20, that crisis groups have begun to adopt it as an alternative way of providing emergency services and counseling.” Advantages of text hotlines over telephone versions include privacy and the ability for users to save conversations to review later. Texting is being used by groups operating hotlines for depression, suicide and other issues.

Research

One challenge of conducting clinical research trials is recruiting enough participants. Another is keeping them involved over the weeks, months or years it can take to complete the study. Text messaging can help in both cases. It’s an excellent way to reach out initially, and it allows researchers to unobtrusively keep in touch with patients and provide them reminders of what steps to take next or when to return to the clinic or lab.

Texting in healthcare is currently focused on providers communicating with each other. That’s an important use, but it represents only part of what texting will eventually mean for the industry and the people who depend on it.

The future of texting will be far broader as physicians and others use it to increase patients’ engagement with the healthcare system. Efforts now underway will unlock the medium’s potential to improve care.

About the author:

As chief executive officer of Doc Halo, Dr. Barreau leads Doc Halo’s development team and operations. He is one of the original founders of the ‘Doc Halo’ HIPAA-compliant, real-time secure text messaging communication system. The desire to exchange information quickly and securely with his healthcare colleagues led to the development of the Doc Halo app. Dr. Barreau is Board-Certified in internal medicine, hematology and medical oncology. He completed his fellowship in hematology – oncology at the University of Cincinnati in Cincinnati, Ohio and sub-specializes in breast cancer treatment. As the medical director of one of Cincinnati’s largest cancer centers, Dr. Barreau works to expand the use of multidisciplinary clinics, which will improve the quality of cancer care through better physician-to-physician communication. Among his many Awards and Recognitions include the recognition as a ‘2013 Health Care Hero’ award presented by the Cincinnati Business Courier.


August 19, 2014  12:26 PM

Healthcare, medical device security lurked beneath the surface at Black Hat



Posted by: adelvecchio
Black Hat 2014, healthcare security, Medical devices, VDI

mcmillan_macGuest post by Mac McMillan, CEO of CynergisTek, Inc.

I’ve recently read several blogs and other pieces in the press proffering the theme that the healthcare industry somehow dodged a bullet at this year’s hacker conferences. If you believe that then you don’t really understand the healthcare IT landscape.

I agree there did not seem to be much focus on medical device security compared to years past, when the hacks of implanted cardiac defibrillators and insulin pumps helped raise the visibility of patient safety. Still, there wasn’t much presented at Black Hat 2014 that won’t be an issue for healthcare. I would have liked for the folks at Black Hat to have kept pressure on medical device security because it is one issue that both providers and consumers need to be resolved.

Healthcare is an industry that is absolutely reliant on its systems and networks. Nearly all processes in hospitals today are automated or supported by some form of technology. More than 95% of patient information is digitized, and just like businesses in many other industries, healthcare providers’ operations hinge on complex interdependencies with supply chain vendors that rely on the Internet, software as a service, hosted services, cloud solutions and more. So, if you understand healthcare, you know that almost everything that went on at Black Hat applies to healthcare in some way. Let’s look at some of the highlights.

Researchers at this year’s Black Hat conference exposed weaknesses in Google Glass that could allow a hacker to capture passwords. Last time I checked we have physicians walking around some of our hospitals testing these newfangled spectacles to learn how they can be used to support care delivery. These glasses can capture patient information directly, presenting privacy and security challenges. Understanding any security issues associated with these devices is absolutely relevant to healthcare. As with any new device, we must fully explore how it can assist or improve the doctor-patient experience. We must also be sure to make any new technology safe to use by evaluating both its capabilities and associated risks.

Another session presented a new method of anonymously performing screen scraping of information with virtual desktop infrastructure (VDI) technology. Not relevant to healthcare? Think again. Many healthcare entities are turning to virtual solutions to reduce the risk of compromising patient information. Many have completed or are in the process of VDI implementations. So threats to VDI are absolutely relevant to healthcare. We are going to see more and more virtualization in the healthcare space as entities identify the risk of desktops. Again, understanding these risks is important and Black Hat provided — if nothing else — a reminder that any technology is exploitable. Presentations at the event also showed that hackers are still out there, and it’s important to be aware of their presence. VDI is no exception.

I can go on and on, and talk about the sessions that discussed compromising active directories through Kerberos, USB controller chip flaws, free cloud botnets, mobile device management solution weaknesses, or a host of other topics. But why bother, no one in healthcare uses these technologies. We’re still using cans and strings. This reminds me of a conversation I had with a CISO at a hospital this past week that highlighted how narrow some peoples’ vision is with respect to security issues. It dealt with medical device security and the fears that some healthcare professionals have — worries that most outside of the IT department totally miss.

As I said earlier, the headlines are always about devices and their potential for harming patients, because that’s what gets people’s attention. The real problem is with insecure medical devices; those running a version of Windows XP susceptible to a zero-day hack for instance, deployed by the hundreds in hospitals networks today — the same networks that also hold EHR, radiology, laboratory and financial systems, etc. All of those would be at risk if a hacker were to work their way onto their network and launch an attack. This would harm the whole network and possibly put the hospital through the embarrassment of being used to hack others. Finally, it would inadvertently affect the patients connected to or relying on the hospitals’ devices.

So were the sessions presented at Black Hat this year relevant to healthcare? You bet they were, even if not directly relevant in some cases. Indirectly, they were a reminder that diligence in maintaining awareness and keeping up with what’s going on in the security world is important to understanding risk.


August 5, 2014  11:50 AM

Will the increase in cloud EHRs lead to better interoperability?



Posted by: adelvecchio
Cloud, cloud ehr, data exchange, HL7, Interoperability

zach watsonGuest post by Zach Watson, content writer, TechnologyAdvice

Where providers once questioned the security of the cloud and its compliance with HIPAA standards, they’re now accepting the relief it provides by allowing vendors to handle the majority of the security infrastructure for data and applications. In 2011, around 41 % of healthcare providers were using cloud computing in their practice or facility, according to the Centers for Disease Control and Prevention. Only a year later, MarketsandMarkets predicted that cloud computing would grow at a 20% rate in healthcare until 2017.

As a result of subsiding security concerns, cloud adoption has risen among electronic health record vendors as well. Vendors who offer providers an EHR platform deployed exclusively in the cloud have realized significant growth, as evidenced by Practice Fusion’s, Inc.’s rise to the top five in market share, and athenahealth Inc. penetrating the top 10.

As cloud-based EHRs become more prominent, it behooves providers to consider whether the cloud’s improved accessibility will ease interoperability between different EHR systems. Since many providers are attesting to stage 2 of the meaningful use program, interoperability should be top of mind. In order to qualify for these federal incentives, providers have to be able to share clinical data across “geographical, organizational, or vendor boundaries.”

The vendor boundary poses the greatest challenge. Many first-generation EHRs were deployed in a client/server model, which basically works in a closed network, where a server located in a physician’s office fulfills client requests on one network. Additionally, many of these on-premise EHRs store clinical information in disparate formats, making it difficult to transport data, though not impossible.

The disparate data formats employed by these systems has made it difficult to implement a standard for data transportation. The CMS admits that stage 2 interoperability includes data in many formats and exchange standards. Data standards are fundamental to interoperability, because providers exchanging data must have an understanding about the way clinical information will be structured in order to make sending and receiving an intuitive process.

Semantic differences and proprietary data storage have led to the rise of Health Level 7 (HL7), a text-based standard that client/server systems can use to communicate. It has been around since 1987 and works well with the majority of modern information infrastructure. However, clinical data must be converted into HL7, which still needs to happen at the organizational level, undermining the simplicity of the exchange.

It shouldn’t come as a surprise that the sharing of clinical summaries, i.e., text-based data, is more common among providers than the sharing of lab results. Even at the vendor level, HL7 adoption is not ubiquitous, which affects the transfer of data and software architecture.

Until recently, the EHR market was inundated with client/server systems; will the uptick in cloud-based adoption have a positive effect on interoperability?

Ostensibly, the answer should be yes. Cloud computing came to the fore in the business world as a method to store, share, and access data — making data democratization simpler than previous client/server deployments. However, cloud-based EHRs are still subject to the same data standards as on-premise systems. Sure, access and permissions can be granted more easily, but cloud-based systems would still use HL7 and other standards to exchange data, just like client/server models.

In fact, interoperability among different cloud computing applications remains a viable concern in industries outside of healthcare, albeit in a different manner. Outside of healthcare, businesses are more worried about vendor lock-in, or not being able to transfer their data from one cloud provider to another should they choose to switch. In healthcare, data transfer holds a greater implication: improving the quality of care delivered to patients through improved coordination among providers.

Certain cloud-based applications such as patient portals can provide patients with greater access to their healthcare records, though patient portals still necessitate oversight on the part of the patient. Effective interoperability would entail the automatic transfer of necessary information to the doctor a patient is referred to.

While interoperability can be achieved, it’s still mostly occurring on same-vendor systems. Certain cloud EHRs have made great strides in improving interoperability, but that is more often the result of focused collaboration between two entities rather than widespread acceptance of particular standards.

Other industries such as telecommunications, cable, and banking agreed upon a standard method for exchanging data because they saw a competitive benefit to doing so. Meaningful use stage 2 requirements attempt to create a competitive benefit by requiring clients of EHR vendors to share data across systems. Cloud-based EHRs may have an advantage because their systems are theoretically constructed with interoperability in mind, though they are still subject to the obstacles of exchange standards.

As it stands now, interoperability is slowly becoming more common. A cloud-based system alone is not enough to facilitate intuitive data transfer, though cloud vendors may be more capable of helping providers construct a plan for reaching that goal.

About the author:

Zach Watson is a content writer at TechnologyAdvice. He covers healthcare IT, business intelligence, and gamification. Connect with him on Google+.


July 17, 2014  11:22 AM

Leverage the ICD-10 delay to address coder shortages



Posted by: adelvecchio
Coding and documentation, ICD-10, ICD-10 delay, ICD-10 migration planning, ICD-10 transition

Minnette terlep_compressedGuest post by Minnette Terlep, vice president of business development and chief compliance officer, Amphion Medical Solutions

The one-year delay in the transition to ICD-10 is considered by some healthcare professionals to be a significant setback in the progress healthcare systems had made toward implementing the expanded code set. The ICD-10 delay will likely create a financial burden for those that heeded vows from the Centers for Medicare and Medicaid Services (CMS) that there would be no further delays. Many existing preparations were rendered largely useless because of the “use or lose it” nature of the skills so carefully honed in ICD-10 training programs.

However, setting industry-wide disappointment aside, there are actually a number of ways in which healthcare organizations can use the delay to their advantage. For example, they can make use of the extra time to put together a detailed plan that will mitigate the anticipated effects on productivity and the data fog that will hover during the first few months after ICD-10 becomes the law of the land. The delay also allows providers that were behind schedule a chance to conduct critical gap analyses.

Perhaps the best way to make the most of the extra year is to conceptualize strategies to counter the delay’s effect on the coder shortage, which many industry experts place at 30% nationwide. The delay will likely worsen the problem because, in preparation for the expected 2014 transition date, most new coders were trained exclusively on ICD-10 codes — skills that don’t easily apply to ICD-9.

And it will get worse before it gets better.

The aging workforce has bumped the average age of today’s coder up to 58 and the largest segment of the Baby Boomer generation is rapidly approaching retirement age. Many older coders have indicated they will retire or choose other employment rather than invest time and effort into learning the new ICD-10 code set.

Hospitals can leverage the ICD-10 delay by identifying ways to mitigate the impact the shortage has on their ability to keep up with current and future coding needs. The American Health Information Management Association recommends a multi-faceted approach that combines some or all of the following steps to create a customized program.

  • Retraining outpatient coders in ICD-9: Hiring quality inpatient coders is a far more difficult task than hiring their outpatient counterparts. Thus, hospitals have identified retraining their outpatient coders as a worthwhile investment.
  • Transitioning transcriptionists to ICD-9 coders: Transcriptionists can readily be cross-trained as coders because of their familiarity with patient records and clinical terminology. This creates a valuable resource that can be tapped to manage fluctuations in volume and planned or unplanned staff shortages — particularly as demand for transcription service declines in the wake of speech recognition technology implementations.
  • Retraining new graduates: Most new graduates are coming out of coder training programs ready to operate in an ICD-10 environment. The problem, for at least the next year, is that organizations are still coding under ICD-9. Incorporating ICD-9 training programs into recruitment efforts gives these new graduates the short-term skills they need until they can apply their ICD-10 knowledge and makes them more experienced for when ICD-10 is implemented.
  • Outsourcing: Finding qualified coders can be a daunting task. Hospitals have to use good business sense to determine if recruitment and training is where they want to put their energy and resources. For this reason, outsourcing is an appealing option for many facilities that don’t have access to a pool of qualified coders.

While each hospital has different needs, they all share a common challenge: finding enough coders to support current ICD-9 and future ICD-10 needs. Healthcare organizations that take advantage of the extra time created by the ICD-10 deferment and implement strategies to minimize the impact the ongoing coder shortage has on their facilities will benefit in the long run.

Minnette Terlep, B.S., RHIT, is vice president of business development and chief compliance officer for Amphion Medical Solutions. She can be reached at Minnette.Terlep@amphionmedical.com.


July 9, 2014  1:55 PM

Patient engagement technologies: How to stay in touch and HIPAA-compliant



Posted by: adelvecchio
Accountable Care Organizations, HIPAA, HIPAA privacy rule, mHealth

RebekahJohnson (2)Guest post by Rebekah Johnson, senior compliance manager, West Corporation

Technology has become so woven into the fabric of our society that it often overshadows face-to-face communication. It’s so prevalent in healthcare that patients have come to expect their doctors to use technology to communicate with them between office visits, hence the rise of patient engagement technologies. In 2012, a Medical Group Management Association study reported that approximately 44% of healthcare practices were using notifications technology to automate appointment reminders[1]. Today, mHealth is the fastest growing area in the health IT space. However, along with mass adoption of healthcare technology comes the necessary evil of compliance — which can be a crippling force that works against patient engagement.

When there are more pages of regulations for Medicare than in the Internal Revenue Service code, it’s no wonder healthcare professionals are struggling to keep up with regulations. Add HIPAA and its steep requirements for protecting sensitive patient data, and you’ve got a big case of compliance overload in the healthcare industry.

The compliance challenge makes it difficult for healthcare providers to maximize the technology investments they’ve made. There are thousands of healthcare providers that have automated appointment reminder systems in place. Most want to use that same technology platform to engage patients between doctor visits to drive improved health outcomes. When it comes to patient engagement, these same healthcare providers stop at simple appointment reminders because they don’t know what types of patient communications fall within the limits of HIPAA regulations.

The good news is, healthcare providers have a fairly open field when it comes to patient engagement technologies — they just need to understand the rules. For simplicity, compliance dos and don’ts should be considered in relation to messages that reach and engage patients and lead to better health outcomes.

Keep in touch with patients to reduce missed appointments

Today, it’s quite common for healthcare providers to reach out to patients with communications that remind them to make and keep appointments, or pay their bills. In fact, this strategy has resulted in a more than 30% reduction in missed appointments, industry-wide. It’s also been proven to reduce past-due accounts and increase monthly collections and by more than 25%.[2]

When this type of message is generic in content, privacy and security considerations are not a concern, and the patient communications can be delivered via interactive voice response, text, email or mobile applications.

The most common compliance culprit for these messages is including information about the purpose of the appointment, such as, “This message is to remind you of your appointment for a biopsy of your left breast on Friday, November 2, at 3:00 PM.”  These messages are fine when it comes to engaging patients. However, when patient details are included, it’s important the message be delivered using a secure mobile application with features that protect the privacy of the patient. Alternatively, the healthcare provider can simply remove the test details. Patients are open to receiving this type of communication via SMS or email — in fact, that’s often exactly the type of communication they prefer to receive from their healthcare provider. In that instance, it’s simply a matter of getting the patient’s permission and documenting her preferences so you can communicate in this fashion while remaining compliant.

Engaging patients to increase accountability

While payers and providers are usually in the spotlight when it comes to accountable care, the most successful models will be the ones that place a strong focus on patient accountability, said Kevin Pho, M.D. “All patients across the care continuum need to be participants in their own care, and providers should be implementing strategies to encourage this accountability both at the point of care and, more importantly, once the patient goes home[3],” he wrote.

To achieve success, healthcare professionals need to go beyond reminding patients to keep appointments and pay their bills. Healthcare providers must communicate with patients between visits and offer information that will help them understand the state of their health, their personal role in becoming healthier, and hope that will help patients stick with treatment plans between appointments. This is precisely the level of support Americans are asking for from their healthcare providers.

The TeleVox Healthy World report titled, “Technology Beyond the Exam Room,” found that 85% of United States healthcare consumers feel that high-tech engagement, from sources such as email, text messages and voicemails, is as helpful, if not more helpful, than in-person or phone conversations with their healthcare provider. More than 35% of patients who don’t follow exact treatment plans say that they would be more likely to follow directions if they received reminders from their doctors via email, voicemail or text[4].

Moving from simple appointment reminders to engaging patients at this level is where healthcare providers begin to feel crippled by compliance. Fortunately, when taking patient engagement up a notch, a little knowledge goes a long way toward remaining compliant. In the case of HIPAA regulations, the most important thing for healthcare providers to remember is that the same rules apply regardless of whether the communication is a text message reminding the patient of an upcoming appointment or an email intended to educate the patient about his health and encourage him to follow his treatment plan.

Healthcare providers don’t need to worry about non-compliance of HIPAA privacy and security when communications contain generic information. However, messages that reveal past or present health conditions can cause compliance concerns. The workaround is being diligent about capturing, documenting and using patient engagement preferences and permissions. With diligence comes a policy that enables compliance officers, in many cases nurses, to quickly and easily approve and deliver patient engagement communications based on the patient’s unique preferences and permissions. A policy should provide communications guidelines that include clear examples of messages or pre-approved scripts by the healthcare professional. It also should include examples of messages that may require a closer compliance review prior to delivery.

It’s also a good idea to have a formal procedure for capturing and documenting patient engagement preferences. It could be as simple as having the patient complete an electronic questionnaire on a tablet while waiting to be greeted by the doctor. This intake form should ask patients to share their preferences for receiving various types of communications. The way patients prefer to receive communications from their provider will likely change based on the information being delivered. For example, patients often want their doctors to email educational tips or information that will help them live a more healthy life, but they may prefer to receive a phone call to remind them about an upcoming appointment.

1404931729_Rebekah Johnson blog graphic

[Activating positive patient behaviors requires providers not only understand what information their patients require to stay on track, but how their patients want that communication to be delivered --- via voice, automated messages, text or email.]

Activating improved health outcomes

With the industry’s movement toward accountable care, it’s no longer enough to prescribe a treatment plan. It’s increasingly important for healthcare providers to focus on encouraging patients to follow treatment plans. This requires ongoing reminders and alerts to take medication, check blood sugars, eat right, and exercise. In fact, research shows patients welcome activation emails, text messages and voicemails from their healthcare providers that tell them to do something specific, such as take medication, schedule a routine medical screening, or get a flu shot. Almost half of American adults are currently treating a disease or chronic illness, such as a heart problem, diabetes or cancer[5]. That’s more than 100 million opportunities for healthcare providers to deliver communications that drive patients to follow their treatment plans.

In the near future, two-way communication between patients and providers will be the norm. So, overcome the compliance challenge today by putting the power of preference in the hands of the patient.

This article is intended to provide general information about the subject matter covered. It is not intended to provide legal advice, opinions, or serve as a substitute for counsel by licensed legal professionals.

About the author: Rebekah Johnson, CIPP/US, is a senior compliance manager for West Corporation. In this role, she develops and maintains compliance operations concerning the privacy and security of client information, including personally identifiable information, PHI, sensitive and financial data. Rebekah’s experience also includes managing West Notification, Inc.’s U.S.-European Union Safe Harbor certification.


[1] “2012 Performances and Practices of Successful Medical Groups,” Medical Group Management Association, 2012.

[2] TeleVox Software

[3] “Implementing Strategies to Encourage Patient Accountability”, www.kevinmd.com/blog, January 2012.

[4] “Technology Beyond the Exam Room: How Digital Media is Helping Doctors Deliver the Highest Level of Care, TeleVox Software, December 2012.

[5] “Chronic Diseases: The Leading Causes of Death and Disability in the United States,” Centers for Disease Control and Prevention, 2012.


June 18, 2014  1:53 PM

When it comes to healthcare data, is more always better?



Posted by: adelvecchio
Data security, Data storage, Health care analytics, PHI

roberta-katzGuest post by Roberta Katz, director, healthcare solutions, EMC Corporation, @Roberta_Katz, @EMCHealthcare

The online data we produce will grow 40% per year into the next decade, according to IDC’s new report, “The Digital Universe of Opportunities: Rich Data and the Increasing Value of the Internet of Things.” For healthcare organizations, this data will expand the number of opportunities to include smarter medical devices and innovative sensors to track and manage critical health indicators in real time. Caregivers can employ advanced analytics on the data coming from these devices to help reduce inpatient complications and avoidable readmissions, deliver personalized medicine, identify genetic markers, improve clinical trial safety, and more.

This increase in data places more responsibility on organizations to strengthen their IT department by leveraging the latest technologies and advancements for the security, privacy, and continuous availability of protected health information, (PHI) with a particular focus on patient identification and the reliability of information being collected.

The digital universe — what’s to come

Imagine for a minute the sheer volume of the world’s digital data in 2014, cited in the Digital Universe report — which could fill a stack of iPad Air tablets extending two-thirds of the distance to the moon. By 2020, this stack would extend from the earth to the moon 6.6 times, meaning that the digital universe is doubling every two years. In 2013, the digital universe contained 4.4 trillion gigabytes, and by 2020, that figure will grow to 10 times that number — to 44 trillion gigabytes. For healthcare organizations, the real question is not what to do with this data, but how to make use of it to accelerate clinical effectiveness and time to treatment.

Study highlights:

  • Data growth is largely due to the explosion of the Internet of Things, thanks to wearable technology and machine to machine applications that may help improve clinical workflows and outcomes. The use of health tracking devices for disease prevention and management is an emerging trend. There are new tools that remotely monitor patient physiological measures, aging in place, and smart pills that report proper adherence with medications. Analyst firm IDC estimates that the number of computerized things is approaching a staggering 200 billion, with 7% of all computerized objects wired and communicating on the Internet.
  • To leap ahead, organizations are adopting cloud, IT as a Service, and software defined technologies. These next generation IT models offer new ways to improve caregiver collaboration and interactions with patients.
  • The percentage of “target rich” data is expected to more than double by 2020, compared to the 5% available in 2013, as organizations take advantage of new big data analytics technologies. IDC defines target rich data as data that is accessible, available in real time, and can be properly analyzed and acted upon.
  • For healthcare organizations, this means leveraging automated tools to aggregate, manage, and analyze useful data from across the healthcare ecosystem to gain patient care insights.

Is big data the cure?

A recent MeriTalk study, “The Big Data Cure,” reveals the impact of growing data sets on the healthcare industry and its ability to improve drug trial safety, disease surveillance, prescribed treatments, and overall patient outcomes. Emerging technologies including mHealth and machine to machine will be driving forces behind this change. However, to reap these benefits, healthcare organizations must take the first steps now, so the technology can deliver real returns later.

To ensure preparedness, healthcare organizations should:

Plan: Embrace an enterprise-wide trusted IT approach that integrates security, backup and recovery, and availability solutions for improved efficiency and stronger protection.

Automate: With ever-growing volumes of PHI, security, data protection, and disaster recovery procedures should be automated to meet 24/7 patient care requirements.

Manage compliance: Verify and test trusted IT environments often to ensure compliance with HIPAA and HITECH rules and to meet recovery time objective and recovery point objective goals.

What’s next?

For healthcare organizations, success in this digital universe will depend on taking the right steps today to build an IT infrastructure that can manage and take advantage of the data deluge. As uncovered in The Big Data Cure, 59% of Federal executives working in agencies with a healthcare-related mission say that in five years, fulfilling their agency’s mission objectives will depend on successfully leveraging big data. But, the report also highlights that fewer than one out of five respondents say their agency is very prepared to work with big data today. So, what’s the takeaway? Consider the healthcare data that is coming as well as the target-rich data in hand. Act now to benefit long-term patient care down the road.


June 11, 2014  11:06 AM

BYOD policies, secure texting should simplify healthcare



Posted by: adelvecchio
BYOD, byod security, HIPAA

th_1382638398_jon2Guest post by Jon Jansen, CTO, Doc Halo

Though the question whether or not healthcare organizations should adopt bring your own device (BYOD) policies for physicians and staff members still crops up, there’s probably not much choice at this point.

Two years ago, 85% of hospitals were already allowing BYOD. In organizations that prohibit the practice, chances are it’s happening anyway, given the popularity of smartphones and tablets among doctors.

It’s a subject that makes healthcare executives nervous. BYOD can feel like too much of an IT security risk in an industry where data breaches hurt both the bottom line and your reputation. With the right tools, BYOD can boost healthcare efficiency without sacrificing patient privacy. Technology such as secure texting apps — including the one developed by Doc Halo — control BYOD by combining security with ease of use.

The advantages of BYOD start with physicians and other staff members, who are likely already carrying their preferred devices, with no desire to add a hospital-assigned smartphone to the mix. Healthcare organizations also stand to gain in terms of improved workflows and cost savings on devices. For health IT departments, the instinct is often to lock things down in hopes of avoiding HIPAA violations and other issues.

A key way to protect patients’ health information has been to limit which devices can access it. That approach made sense when computers stayed on desks. But now that we carry one or more of them with us everywhere we go in the form of mobile devices, it’s not as practical.

Much of the advice on BYOD in healthcare deals with rules and boundaries. The idea is to reduce the chance of problems by building layers of security, limiting what users can do from their devices and monitoring usage and access. Of course, it pays to have reasonable security. Federal rules that took effect last year mean it’s more important than ever to keep protected health information safe — or face fines of $50,000 or more per violation.

But if protocols get in the way of clinicians doing their jobs, then BYOD doesn’t accomplish anything. Users either won’t take advantage of what mobility can bring to healthcare, or they’ll find workarounds, putting your organization at even greater risk.

Healthcare needs tools, such as secure texting, that let physicians and other providers work without thinking much about security. The tools, not complicated processes or lists of dos and don’ts, should prevent protected health information (PHI) exposure. From the user’s point of view, secure texting doesn’t feel much different from regular texting, which most people do every day. However, a variety of features work together to make sure conversations stay private.

For example, a good secure texting solution encrypts PHI at all levels — database, transmission and on the app — according to federally validated standards. It also deletes messages from your app and the receiver’s app based on the time period of your choosing and has a remote wipe option in case the phone is lost. None of these security measures require time or effort from healthcare providers. The only difference that physicians are likely to notice when they start using the app is that communication is more efficient. HIPAA is here to stay, but so is BYOD. The most successful healthcare organizations are adopting tools that meet the requirements of both.

Jon Jansen is CTO and partner in Doc Halo which specializes in secure text messaging. He brings an extensive knowledge of programming secure interfaces between hospitals, EMRs and physicians’ data. He has been through the entire life-cycle of HIPAA and secure texting from its beginnings and brings the needed experience to navigate this complex topic. He formerly owned a software company which specializes in business and medical communication as well as Web-based portals for remote data access.

Jon’s role on the Doc Halo team is to coordinate all of the behind-the-scenes programming and database creation and optimization using his more than two decades of experience in this area.


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