February, 2012

Best practices for data breach prevention in health care

Guest post by: Sean Glynn, Vice President, Marketing, Credant Technologies

As the disclaimer on a non-prescription supplement or medicine tells you, it is important to consult your physician before beginning a new treatment plan, or continue an existing one that is causing an adverse reaction.  When it comes to securing Protected Health Information, and preventing data breaches, I present the same advice — start by consulting your physicians and other health care professionals.

I read a report this month, based on an analysis of data breach information on the US Department of Health and Human Services website, which found the total number of patient records compromised in the US increased by 97% in 2011 compared with 2010.  This followed a Ponemon report from December 2011 that found a 32% increase in the frequency of health care data breaches from the previous year - with 49% of respondents citing lost or stolen computing devices and 41% noting unintentional employee action. 

By any interpretation of these numbers, it is clear that when it comes to data security and data breach prevention, our patient - health care professionals - could use some expert guidance. 

Of course there are specialists in the area of data protection, (and in the spirit of full disclosure, my own company is one of those) offering technology solutions that can help you implement and manage data protection across your organization.  But even the best experts can only help after a full consultation and examination of the patient is complete, and any recommendations made are discussed with and agreed to by the patient.

The health care industry in the United States is incredibly data-rich.  As a function of delivering quality care, health care practitioners at hospitals, clinics and physician’s offices routinely access and update the sensitive Protected Health Information (PHI) of their patients - and that information in turn, be it medical, financial or administrative data — is often accessed and manipulated by any number of business associates in the course of their duties. 

This easy and immediate access to valuable health information from any device, and from any location, is very beneficial to health care professionals. It helps them deliver the highest levels of care to patients. However, if an appropriate level of protection is not in place for the data residing on those devices, the risk of that data being breached grows exponentially. 

How does a health care IT professional approach the problem of preventing data breaches? 

We could take the approach of mandating a particular treatment plan — implementing data protection processes, technologies and policies that try to force health care professionals to act and work in a different way. But in the same way flavored medicines make it easier for me to convince my daughter to take her medicines than it was for my mother to convince me to take the foul-tasting concoctions I was presented with as a child, the treatment plan will be far more successful. Furthermore, the patient is far more likely to follow the treatment plan if they have been consulted in advance, and the tools put in place to protect the sensitive data they access on a day-to-day basis are designed to meet their broader needs.

Health care professionals are resolved to avoid causing harm to their patients, including as a result of a PHI data breach. While this is important, it is only a part of their overall goal of providing the highest quality of care to patients.  If IT security professionals are to help them do so, then we must better understand their needs in delivering that care:

• Which devices do you use, or plan to use, to access the PHI data you need to provide quality care?
• o Dektops, Laptops, Tablets, Smartphones?
• When you need to share sensitive data with colleagues, how do you do so?
• o USB Thumb Drives, Cloud Storage solutions, Email, etc.?
• Do you have sensitive data stored on shared devices? (In the office / on hospital wards, etc.)
• o Should everyone with access to those devices also have access to all the data? Or if not, which users should have access and which should not?
• Who else will need to access PHI for your patients?
• o Colleagues? Outside consultants or experts? Business Associates? Etc.

Once we determine the answers to these questions, we can design and implement data protection solutions that protect data on those devices health care professionals are using;  that allow for easy sharing of data with others, while maintaining protection for data throughout its lifecycle;  that leverage existing identification and authentication tools, without having to burden users with additional steps to take in order to access relevant data and that allow health care professionals to deliver the highest quality of care, without putting sensitive patient data at risk of a breach.

By consulting early with health care professionals on the front lines we will not only be able to better understand and meet their needs for easy and immediate access to PHI, but we will also have created an environment where health care practitioners are fully trained, aware and engaged in taking advantage of the tools put in place to protect that data.

Please visit Credant Technologies for more information.

Why CIOs aren’t worried about health IT infrastructure

After attending the 23^rd Annual Leadership Survey results brunch yesterday at HIMSS 12, I had a few questions, as did many other members of the press in attendance. The survey, conducted in December of 2011, included just over 300 participating health care provider organizations and shed light on how health IT leaders are prioritizing the many enterprise-level IT issues that continue to come down the pike.

Not surprisingly, achieving meaningful use was the primary business objective, and ICD-10 implementation took the top spot as the primary financial focus for IT over the next two years. I was a bit surprised, however, to see that coming in last under the “business issue with most impact on health care” category were external threats and infrastructure, with health care reform and policy mandates taking the top spots. As a hospital’s IT infrastructure is truly the building block upon which all of its applications run and systems depend, I had a hard time wrapping my head around all 302 respondents listing it as an issue that has 0% impact on health care.

I was lucky enough to have an interview immediately following the brunch with just the guy to help clear the air and frame the results in terms of what he is seeing in his hospital. When I shared the survey data with Rick Haverty, director of IT at the University of Rochester Medical Center, he was not surprised in the least. “The infrastructure is at the bottom of the pyramid, and people expect it to work. Like dial tone in telephony. Or cleaning up the garbage. Someone has to do it, or else it starts to stink. But others don’t think about it, nor should they have to. Again, it is an expectation that it will work and it is our job to make sure it does.”

And in this light, one can see how respondents might not see health IT infrastructure considerations as impacting care as directly as the other areas of IT and informatics. Still, I had a hard time believing that 100% of those surveyed said it had no impact whatsoever.

This was especially true as I considered mobile health integration, mHealth apps and the bring your own device (BYOD) movement.  With mobile device usage by clinicians on the rise — to access protected health information (PHI) and deliver care remotely — there are many issues related to infrastructure that stand to impact care. Timely access to accurate patient data is vital for physicians on the go, and without a solid infrastructure that allows for secure connectivity, a provider’s ability to deliver the highest quality of care could be impaired. The same can be said for telehealth and remote patient monitoring systems. Without a strong foundation on which to build them, care delivery will continue to be restricted to the walls of the provider institution.

However, as Haverty noted, “the whole idea is for your infrastructure to be solid, and the people who manage it know this. No guts [in the technical sense], no glory. No one knows that we’re on conference calls into the wee hours of a Sunday morning making necessary updates at the least impactful time, nor should they. They expect it to work, and if we’re doing our jobs, it should.”

My feeling is this: If you still believe that infrastructure has no impact on health care delivery, you probably have an outstanding infrastructure director and IT staff making sure that’s the case.

HIE lessons learned: Health information exchange in action

Guest post by: Ruby Raley, Director, Healthcare Solutions, Axway

Even though the ONC started the HIE process in 2009 after the HITECH Act was enacted, it has taken time for RFPs to be answered and the implementation process to begin. Here at Axway, we were honored to be selected for several HIE initiatives, and in the hopes of offering you some insight into your own HIE plans for 2012, I’d like to reflect on key themes learned in 2011 that are important to consider, whether you plan to join a state HIE, build a private HIE or use the Direct Project approach to exchange health records. Actually, these are more than themes - they are critical success factors.

But before I jump into these themes, it might surprise you to learn that I am not going to discuss sustainability in this post. Granted, it’s an important, and global, topic. But I believe the most useful discussions about sustainability are local in nature, because the value and rationale for creating or joining an HIE can only be determined by a community member, not an outsider. Every community is at a different level of health care IT maturity and meaningful use achievement, and every community must make its own business decision about how and where to acquire health record exchange capability.

With that as preface, here are the four critical success factors gleaned as a result of real-world HIE implementations carried out by Axway, a company with a long history of building high-volume, hub-and-spoke models and facilitating internal application-to-application messaging and ad hoc file transfers:

1. Communication builds community. Trust is the foundation. You must engage your community of interest early and often in order to build awareness, coordinate strategic plans and ensure that you can deliver the right value. Trust is critical - each provider CIO must achieve meaningful use while maintaining acceptable clinical processes. CIOs are aware of and worrying about HIE sustainability, the number of HIEs and RHIOs that have closed their doors, and escalating HIPAA data breaches - so they cannot rely on an unknown HIE to move critical health records. Communicate and collaborate to build awareness and alignment.
2. Resource constraints matter. Remember: Even willing participants often have a large IT backlog and suffer from limited IT resources. Not surprisingly, vendors are equally stretched, given the double-digit growth in EMR implementations we saw in 2011. Sign up community members early, and create a schedule, so that IT leaders can integrate HIE connectivity projects with enterprise connectivity projects, and re-prioritize and/or re-plan accordingly.
3. Test data is gold. The fact is that health care standards are not standard! You should expect a number of variations in both the use of fields and the reliability of data values in those fields. Help your community by proactively developing canonical guides that describe the structure and content of the documents to be exchanged. Build conformance test tools and expose those tools to community members so that they can self-test document structures.
4. Obey the KISS principle. Complicated policy, cutting-edge concepts and early-adopter use cases can reduce interest and discourage partners. Select use cases and connection patterns that are well understood and supported by the community - simple use cases that mirror common yet valued health record exchanges are the best place to start. Avoid more challenging concepts, such as opt-in consent models and real-time response protocols that support mobile first responders.

Your HIE goals for 2012 may seem daunting, and rightly so. But if you keep these critical success factors in mind — and work to understand the unique and delicate balance of technology and humanity that a quality HIE initiative demands — you’ll finish the year ready to compete in 2013.

For more information on Axway, please visit www.axway.com.

Utilization management and ICD-10: 5 key benefits for payers

Guest post by: Baskar Mohan, Director, Healthcare Practice, Virtusa Corporation

The health care industry as a whole is currently focused on ICD-10 assessment and remediation strategy. Even with official word of the delay of the 2013 implementation deadline from CMS, Payers and Providers are looking at various impact areas within their organization and are seeking ways to leverage the benefits from ICD-10 implementation. In my earlier blog posts, I have talked at a high level about Utilization Management, which is part of Care Management. With the high-rising costs of health care, ICD-10 implementation could be seen as a blessing in disguise. 

Let’s look at some key areas that will benefit from the ICD-10 implementation:

1. 1. Ensure proper medical care: Utilization Management Organizations (UMO) are faced with a double-edged sword in that they need to ensure proper medical care to their members but at the same time must reduce overall health care costs associated with the suggested procedures. ICD-10 implementation will provide more granularities and help UMOs recommend the best care for their members.
2. 2. Prior authorizations: Medical reviewers are provided with additional information that they never had before. This will enable quick turnaround times for authorizations. ICD-10 implementation will also help reduce unnecessary and sometimes harmful procedures.
3. 3. Auto approvals: Business rules should be part of most ICD-10 implementations. ICD-10 implementations will provide much-needed information to automate most of the authorizations that were done manually due to the limitations of ICD-9 codes.
4. 4. Claims adjudication: Due to automated prior authorizations, information regarding claim payments is available just in time for the proper adjudication and matching of claims data. Business rules automation could also enable reduced claim denials.
5. 5. Meaningful medical policies: ICD-10 implementation provides a golden opportunity for Payers as they would have access to new Utilization data that could provide more insight into patient care and therefore enable them to create new medical policies, which will reduce abuse of medical services and focus on patient care.

Apart from the above benefits, ICD-10 implementation provides a holistic view of patient care. Payers should take advantage of this implementation and try to harvest and automate their business rules which in turn will create a more advanced Care Management System.

Please visit www.virtusa.com or email Mr. Mohan directly for more information.

Who’s the Family Medical Officer in your household?

Do you have a designated Family Medical Officer ^TM (FMO) in your household? I’m referring to the person responsible for making the majority of health care decisions for your family.  If you are like the majority of families I asked, you don’t. Or if you do, it’s simply by way of a presumption (i.e., “my wife typically deals with that type of stuff”).  According to U.S. Department of Labor statistics, women make 80 percent of the health care decisions for their families and are more likely to act as the primary caregiver when a family member becomes ill.

According to El Camino Hospital, a 542-bed, acute care facility located in Mountain View and Los Gatos, CA, it’s time for that one-sided, lackadaisical approach to family health maintenance to change. 

In December 2011, the Silicon Valley-based system released its first mobile health application created with the FMO in mind. The FMO app, which can be downloaded for free on both Android and iOS devices, provides users with instant access to health services and care information provided by the hospital and is designed to help families make informed, engagement-driven decisions.

As Barbara Dehn, R.N., M.S. and nurse practitioner at the Women’s Hospital at El Camino notes, being an “FMO is one of the most important titles you can have, as that person is responsible for making health care decisions for the family. As a result, FMOs need adequate knowledge and tools to satisfy their multiple roles as decision makers and consumers of health care.” 

Greg Walton, CIO for El Camino, has been involved with the app’s development from the very beginning, noting that the organization’s strategic approach to its creation was grounded in enabling connectivity and consumer engagement. While the first version was “function light and architecture heavy,” Walton assures the final release has increased capabilities designed for long term engagement. The app is able to tailor messages and provide tips and tools around specific care plans, and Walton hopes that FMOs “will begin to view the tool like a trusted friend, an extension of their decision making process.”

Some of the benefits of the FMO app are as follows:

• Site integration and system security: Can integrate with both the hospital website and additional hospital IT systems — in a secure fashion.
• ER information: Provides current wait times for El Camino’s Mountain View emergency room. Users can also view a checklist of things to bring with them to the ER and dial 911 with a single button.
• Physician finder: Users can search for an El Camino physician by name, specialty or location.
• Access to family medical history: FMOs can keep track of their families’ medical histories in this password-protected tool.
• Hospital resources: Offers access to a comprehensive health library, a drug reference and a health encyclopedia.

To learn more and read the full press release, visit www.elcaminohospital.org and follow El Camino Hospital on Twitter.

Usage-based health insurance: Coming soon to a payer near you?

Meet “Snapshot,” the newest idea to come out of the Progressive Insurance labs. The monitoring device, no bigger than a garage door opener, is part of a voluntary program from Progressive and is grounded in the usage-based insurance model, affording discounts for good driving behaviors.  

Plugging into a vehicle’s on-board diagnostics system, typically right under the steering wheel, the device takes specific readings of a driver’s habits – vehicle speed, number of sudden stops and time spent on the road, among them — and reports back. After 30 days, Progressive uses the diagnostic data to calculate an initial premium discount. The device is then reanalyzed six months later, where a final premium policy discount is calculated. 

With the growing number of health and fitness apps available to consumers, many of which include basic activity tracking and remote monitoring capabilities via a web portal component of some kind, I couldn’t help but wonder: is usage based insurance coming soon to a payer near you?  Rewarding for healthier lifestyles is not a new concept — many health insurance companies have been rewarding for wellness initiatives, such as reimbursing gym membership fees, for years. But what if this takes one, or literally many, steps further by using mHealth technology?

What if payers began gathering member activity data and offered premium discounts based on activity level?  Members could be monitored on a voluntary basis, either using a Fitbit or similar mobile health device, or else through an app that could run directly on a member’s mobile phone. Payers could use the data, such as steps walked and time spent active, and reward with lower premiums or other incentives.

Providers could also use the data to ensure that both they and their patients are taking on a more active role in a patient’s health maintenance. Similar to how many dieters and health conscious individuals tend to eat less — or are at least more aware of what they eat — when they write it down, patients might be more apt to use and manage their personal health record (PHR) if it was tied to health monitoring tools that they could easily track at home. SearchHealthIT colleague and features writer, Don Fluckinger (@DonFluckinger), would be a great guinea pig for this type of plan model, especially given the upcoming walking challenge with fellow #HITsm-er Brian Ahier (@ahier) at this year’s HIMSS 2012 conference.

However, as with any sort of monitoring and rewards-based system, especially at the insurance level, there are certainly “Big Brother” concerns to be addressed. If this type of model was to become an industry standard, a chief concern would be around patient privacy and the potentially negative ramifications from transparency into lifestyle. For many members, the data collected and patterns presented could easily be detrimental, painting the picture of a risky (aka, more expensive) patient, which could in turn drive premiums up for many patient populations.

If operating the same way as Progressive’s program though, opting to use a monitoring device tied to incentives could be completely voluntary, with rates never increasing based on activity data.  Progressive maintains that a member’s rates will never increase with the information gathered from Snapshot, and that the only cost incurred is the initial $28 fee for the device itself. As with purchasing any insurance coverage, though, caveat emptor (and do your homework!). After seeing a recent YouTube video about how the Snapshot program can actually increase rates in certain states and other asterisk type of restrictions, I’m not inclined to believe Flo anymore either. 

There would also be huge concerns around the security and intended use of the data in general — where it would live, how it would be used, who owns it and how would it be integrated into an EHR. Also, because humans do not come with an on board diagnostics systems, there would be elements of fraud and abuse to combat and safeguards that would have to be in place to be sure that the technology was being used as intended.

What do you think? If your health care insurance provider offered a program similar to Snapshot for potential premium discounts, would you volunteer, or steer clear?

Analytics alone cannot improve health care: Integrating with quality improvement initiatives

Guest post by: Trevor Strome MSc, PMP, Informatics Lead, Winnipeg Regional Health Authority; Assistant Professor, Department of Emergency Medicine, Faculty of Medicine, University of Manitoba

Analytics are not a magic bullet

A sales representative from a major Business Intelligence (BI) software vendor recently tried to convince me that with their product, we would “just have to make the information available to everyone via dashboards and reports, and change will happen by itself.” I am a firm believer in promoting transparency in health care by ensuring people have access to whatever data they need to make decisions. I definitely know from experience, however, that analytics alone can’t (and won’t ever) cause meaningful change in health care.

Too much data to take meaningful action

Health care analytics tools (into which I group business intelligence applications, dashboards, simulation, predictive algorithms and intelligent reporting) now provide amazing insight into the operations of a health care organization (HCO). This is especially true now that electronic medical records (EMRs) are becoming more commonplace and are providing a wealth of data for analysis.

With literally hundreds of data elements being generated on some modern EMR systems, it is important to differentiate which of this data is important to analyze and report on for purposes of improving health care, and which should be set aside until needed at a different time. It is likely that only some of the data available is relevant to the current quality and improvement performance goals of a HCO, and even less are directly actionable.  

Yet, with so much data becoming available, the temptation is to create numerous indicators and to build a myriad of dashboards to display them all. In a recent post on my blog, I note that the proliferation of dashboards (and other information tools) risks are causing an increase in information overload, which can be counterproductive to the goals of improving the health care system.

Choose metrics that are relevant and actionable

To prevent information overload (especially in health care situations), all information available via dashboards, reports or other analytics tools must be both relevant and actionable. In other words, the information must be useful for understanding the most pressing quality and performance issues facing a HCO, and should also identify what needs to be done to mitigate those quality and process issues.

The question is, though, how do health care executives, unit managers, QI professionals and analytics developers know what information, of all that is available, is important and necessary for making the right decisions?

When choosing indicators, one factor is alignment with organizational strategy. Such alignment is important so that the goals and objectives of a HCO are communicated (and being adhered to) throughout the organization. Most decision-making that impacts process changes and quality, however, occurs at a more “tactical” level.

When working on or close to the front-lines, integration with a methodology for quality and process improvement is essential to ensure indicators and other information is relevant and actionable. In a previous SearchHealthIT article, I stated that, “insight is best gained when analytic and BI tools (such as dashboards, scorecards other information applications) are applied in a strategic combination with quality improvement initiatives via approaches such as Lean and Six Sigma.”

Focusing on the critical few

Lean and Six Sigma are two of the more common quality improvement approaches in health care, and are often used in concert with each other. Lean is a systematic approach to improving quality and value to the patient by eliminating the waste that is present in almost every health care process. Six Sigma goes a step further, and is a rigorous data-driven approach to reduce process variation and eliminate defects in the delivery of health care.

A quality improvement methodology or framework helps provide the necessary context for analytics to help drive appropriate decision making. Practitioners of Lean and Six Sigma strive to identify the most pressing quality issues based on inputs such as patient safety and quality needs (which are the most important factors), the overall goals of the HCO, national standards and legislative requirements. The methodologies then follow structured approaches for addressing and solving the identified quality issues  The results of this process naturally helps to filter all the possible metrics and indicators (based on hundreds of available data points) down to the critical few indicators required for true quality and performance improvement success.

An example of what works, and what doesn’t

As an example, a HCO may set a goal of an average Emergency Department (ED) Length of Stay (LOS) of four hours. This metric, while certainly relevant to the ED and HCO as a whole, fails the actionable test. If the ED is not meeting the target (with an average LOS of six hours, for example), LOS as a metric provides little information about how to address the problem, as a plethora of factors actually contribute to LOS.

Process improvement projects using Lean and Six Sigma will break down ED visits into their component parts to identify the root causes of long LOS. Depending on what the root causes are, metrics of interest to the quality teams might include average time to bed availability, consultant wait times and other measures. Indicators identified by process and quality improvement teams — following rigorous methodologies — will help guide process improvement activities and, therefore, should be the focus of dashboards and other analytic tools. Close monitoring of these metrics will provide much more clarity when determining if implemented changes are effective, or if further changes are necessary. Once a change has been implemented and successfully sustained, teams can then move onto other quality issues (likely requiring their own metrics for analysis).

More isn’t always better

In times when health care is feeling the pressure, it is important to provide management and quality improvement teams with the key pieces of information they need to focus on the most important problems, and to make appropriate, timely decisions. In the same manner that a pilot will focus on about six key instruments throughout most of a flight (with supplemental information being provided by other instruments), the critical indicators derived from approaches such as Lean and Six Sigma can guide decision making on the part of the HCO and result in real health care improvement.

About the author:
Trevor Strome MSc, PMP, is the Informatics Lead for the Winnipeg Regional Health Authority, and is Assistant Professor at the Department of Emergency Medicine, Faculty of Medicine, University of Manitoba. You can visit Trevor’s blog at http://healthcareanalytics.info or contact him via email.

Batteries included: Robots aiding in virtual care, expand telehealth continuum

“It’s like Skype on wheels!” was how Dr. Brian Rosman described the no longer space-age robots currently in pilot at Children’s Hospital Boston (CHB) during the Massachusetts Health Data Consortium’s HIT’12: Future of Health IT conference on Feb. 3, 2012.  Rosman, who was part of a panel of experts at the event, discussed “Cutting Edge Technologies in Genomics, Robotics and Medical Care,” and shared some truly innovative ways that CHB is breaking from the brick and mortar model to increase patient satisfaction and expand the care continuum through telehealth technologies.

Rosman’s enthusiasm about CHB’s telepresence robot pilot was contagious as he highlighted the many benefits that these R2D2-esque devices provide. The robots, physician-controlled machines that stand at approximately 4 and a half feet tall and look similar to a miniature Segway, offer monitoring tools and two-way video communication unlike anything CHB has used before. The benefits of the robots, manufactured by VGo Communications, are only further solidified by the overwhelmingly positive response from clinicians and patients alike — and in CHB’s case, the latter refers to the parents as well. 

Using the robots means that physicians are able to employ remote patient monitoring and conduct virtual visits, which can be a huge benefit to many patient populations, including seniors and chronically ill individuals. It can also mean the difference between going home and staying in a hotel for weeks at a time to patients and families living in rural areas.

Given that each robot is also completely reusable and customizable, it is easy to tailor and update each machine to manage each patient’s condition. This type of standardization is key to ensuring that the standards of care are not sacrificed and each patient is treated with the same degree of quality as they would in an office setting. And because all of the machines are running on Verizon’s 4G LTE network and only require an electrical outlet to work, they are truly turnkey in nature and automated enough for people to feel comfortable using in their own homes.

One of the most important benefits of the robots’ telepresence is improved communication between physicians and patients.  Since the physician maintains control of the robot, they are able to manually point the camera where it needs to be, instead of a parent trying to dangle a child in front of a webcam. Rosman also noted the benefits of non-verbal communication. Parents felt that their care providers were truly listening because they could see their faces and maintain eye contact, a luxury that is lost when communicating via phone or email. Most importantly, it allowed a way for parents to easily ask questions during post-operative care, a time where having direct connection to a physician becomes an invaluable resource to a concerned parent.

Whether you are comfortable with the idea of telehealth technologies taking a primary role in your care delivery or not, the benefits are becoming harder to ignore, especially when looking at remote monitoring capabilities and the limitations of certain patient populations. With the silver tsunami of baby boomers approaching the shore at full speed, there is no better time than now to embrace these technologies and push the care continuum to the virtual space.

The ACO / HIE dichotomy: Perspectives from MHDC’s HIT’12

BURLINGTON, MA - I have to say, Dr. Schnieder, Mr. Campbell and the team at the Massachusetts Health Data Consortium did it again. One of the perks of living in Boston is the ability to easily attend the MHDC events that are held throughout the year, and the HIT’12: Future of Health IT conference I attended today was no different.

Harvard School of Public Health associate professor Ashish Jha, M.D., did an amazing job telling the story of how health care IT has evolved, from the passing of ARRA - which he thankfully didn’t waste a slide explaining - through the $2.5 billion in EHR incentives paid out in CY 2011, as well as what to expect from meaningful use stage 2, the criteria of which hopefully being announced this month.

The most thought-provoking perspective he shared, however, was on health information exchange (HIE).  Jha explained the fundamentals of the HIE /ACO dichotomy and the inherent competition built in to each model so well, I’m considering lobbying for him to become Mostashari’s successor as ONC national coordinator. 

With HIE focusing on increasing access to quality care by enabling data sharing across borders, and ACOs trying to keep patients within a medical home for better coordination of care and increased quality, it’s easy to see the double edge sword. Add to that the number of “competing” stakeholder groups participating — from payers, providers and technology experts to regulatory bodies at both the state and federal  levels — and I also question what it will all be for if we don’t have the exchange of and access to clinical data along with its digitization.

While Jha did not pretend to have all the answers, he encouraged attendees to keep HIE at the top of their “to do” lists, reiterating that there is no way that EHR adoption will have the impact on quality of care and patient safety as was intended without the exchange of data to go along with it.

Clinical Document Architecture and meaningful use stage II: If you do nothing else, do this now

Guest post by: Peter Bedell, Business Development Manager, Fujitsu

With the ever-changing requirements for meaningful use stage II lingering just out of reach, it can be hard to determine which step to take first.  Investment in technology is a major commitment, and the wrong choices can be a costly mistake.  In fact, with the official announcement from the ONC still in the offing, some might think it is best to not take any action at all.  However, while time continues to tick, there is one critical decision that can be made today with confidence and meaning that extends beyond the terms of meaningful use: creating a strategy to preserve the full patient narrative.

Even though it is easy to capture most health care information in an electronic medical record (age, height, weight, temperature and even diagnostic and treatment codes), there is an enormous amount of information that lives in a narrative that can be challenging to fit into the fields of a database.  It is within these “outliers” that vital medical data is contained - information that is crucial to providing a comprehensive and holistic approach to medicine.

Meaningful for ‘’meaningful use” sake

What is meaningful use anyway?  There are two definitions: one created by administrators and legislators, and the other by practitioners in the trenches of health care. Regardless of the source, most would agree that the incentives for reimbursement provisioned under the HITECH Act are merely nice- to-have and not the primary driver behind technology adoption. Instead, they are designed to motivate action from laggards and, perhaps secondarily, reward early adopters for being pioneers. Yet anyone who has ever had first-hand experience with technology knows no amount of compensation can offset a solution that is complicated or disruptive, nor replace a solution that makes providing quality care easier and more affordable… and that is the real litmus test of meaningful use. 

Enter the Clinical Document Architecture (CDA).  On its surface, CDA is just another industry standard that the Government will (soon) require needs to be met.  Go a layer deeper and you can see how defining a process for preserving the patient narrative is at the core of health care, both here in the U.S. and everywhere throughout the world.

Think back to a bygone era when physicians still made house calls.  Beyond the convenience of coming into your home (where care can be provided with the greatest comfort), these visits represented more than clinical examinations; they fostered trust and bred loyalty that can be hard to replace.  And with the nature of health care becoming increasingly transactional these days, that sense of relationship has been jeopardized.

Fast-forward to today: modern technology has made it plausible to once again offer personalized care, and it has done so by reintroducing the full patient narrative as a permanent part of the Continuity of Care Documentation (CCD).  Now every care provider can quickly and easily add or exchange patient information in a medical record, across broad geographies and between provider networks, regardless of whether it originates electronically or on paper, with the complete confidence of knowing that it will interoperate with every other system downstream, no matter what.

How does it work?  EMR software allows for hospitals and physicians to aggregate discrete data about their patients with ease.  These systems can provide treatment and diagnostic codes to help with the process of both treatment and billing and house them in a database designed to produce quality outcomes.  But when it comes to including information that may fall outside of vital signs and diagnostics - for instance, how a patient’s home or work life is impacting his or her health - it becomes necessary to have the means to capture these outlying data elements with similar ease, even though the information may often exist in unstructured form.

CDA provides a framework for structuring the unstructured.  Created under the guidelines of HL7 by a consortium of health care professionals, CDA was designed to provide a means for capturing data and exchanging information in a manner that is both internationally accepted and universally interoperable across all health care systems.  Accomplishing such a feat can only be made possible by defining industry standards, which is why CDA (and other standards like it) are so fundamental to accomplishing the goals of technology adoption, including meeting meaningful use requirements. 

If you do nothing else, do this now: develop a strategy for preserving the full patient narrative today by adopting technology built on CDA standards. There is no more meaningful step you can take no matter how you define the term meaningful use.

For more information, please visit us.fujitsu.com/ehrsolutions.