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Health IT Pulse

December 18, 2014  11:16 AM

CMS seeks comments on proposed rule for ACO program

Posted by: MonicaVallejo
ACO, CMS, Medicare Shared Savings Program

Accountable care organizations are on the verge of receiving a supportive push from the Centers for Medicare and Medicaid Services (CMS) to aid them in their mission of improving the quality of care coordination while reducing expenses.

CMS recently issued a proposed rule that aims to improve policies of the Medicare Shared Savings Program (SSP). The rule would make changes to several areas of the program including:

  • Providing more flexibility for ACOs seeking to renew their participation in the program and modifications to eligibility requirements
  • Encouraging ACOs to take greater performance-based risks
  • Streamlining data sharing process to simplify administrative processes
  • Establishing, updating and resetting financial benchmarks
  • And emphasizing primary care

The rule was put together with input from program participants, experts, consumer groups and other stakeholders. Currently, the SSP includes more than 330 ACOs. There are more than 125,000 practitioners enrolled in the Medicare program and roughly 4.9 million beneficiaries assigned to ACOs.

“This proposed rule is part of our continued commitment to rewarding value and care coordination — rather than volume and care duplication. We look forward to partnering with providers and stakeholders to continuously refine and improve the Medicare Shared Savings program,” said CMS Administrator Marilyn Tavenner.

Through the SSP, established by the Affordable Care Act, ACOs that succeed in providing better, more affordable care by avoiding unnecessary duplication of services and preventing medical errors receive a percentage of the savings achieved. Among the first year SSP results announced by CMS, 58 ACOs held spending below their benchmark figures by a total of $705 million and earned shared saving payments of more than $315 million. In addition, 60 ACOs had expenses below their benchmark, but their expenses weren’t low enough to receive shared savings.

CMS is seeking comments on the proposed adjustments aiming improve ACOs through the SSP. The comment period will close on Feb. 6, 2014.

December 17, 2014  11:34 AM

Half of patients in ONC-funded trial chose to conceal sensitive personal health info

Posted by: ShaunSutner
ONC, privacy

Some 50% of the patients who participated in an ONC-funded trial withheld clinically sensitive data from some or all of their healthcare providers. The trial examined the effects of patient access to their own medical records.

The study was designed and conducted by the Regenstrief Institute at Indiana University School of Medicine and Eskenazi Health (formerly Wishard Health Services) in what Indiana University officials said is the first real-world trial intended to answer these questions:

  • Should patients control who can see specific information in their electronic medical records?
  • How much control should they have?
  • Can doctors and other clinicians provide safe, high-quality care when a patient’s preference may deny members of the medical team from seeing portions of the electronic medical record?
  • What is the appropriate balance between individual privacy concerns and healthcare providers’ need for relevant data?

The six-month trial involved 105 patients in an Eskenazi Health primary care clinic and was supported in part by a $1.6 million grant from ONC.

Patients indicated preferences for which clinicians could see sensitive personal health information in their electronic medical records, such as information on sexually transmitted diseases, substance abuse or mental health, and designated what the clinicians could see.

Regenstrief informatics developers created a system in which those preferences guided what information doctors, nurses and other clinical staff could view.

Healthcare providers were able to override patients’ preferences and see any data patients had chosen to hide, if they felt the patient’s care required it.

The trial results are presented and interpreted in five peer-reviewed research papers described in the January 2015 supplement to the “Journal of General Internal Medicine.”

In a release about the trial, Regenstrief President and CEO William Tierney, M.D., principal investigator of the project, said: “We believe it presents an opportunity to shape national policy based on evidence.”

“We learned that patients have widely different opinions of what kinds of their healthcare data they would like visible to different members of their healthcare team and others, such as health services researchers, who might have access to information in their electronic medical record,” Tierney said in the release.

Tierney added in the release that while patients are understandably concerned about privacy, doctors often need to know “everything about the patient, even sensitive issues such as recreational drug use or pregnancies or sexually transmitted infections.”

Lucia Savage, ONC chief privacy officer, said in a statement:

“It is important for patients to have confidence in how clinicians and others use their sensitive health information. Patient-centered decision making in electronic health information exchange can inspire trust in health IT and the papers in the journal, along with the Regenstrief study, give us new insights on these issues.”

December 16, 2014  12:31 PM

Expansion of online appointment scheduling could lead to cost savings

Posted by: adelvecchio
health IT, health IT tools, online scheduling

Online patients will make 986 million medical appointments in the U.S. in 2019, accounting for 38% of all appointments made that year, according to projections compiled and reported by Accenture plc.

Accenture’s report also states that online appointment scheduling will generate $3.2 billion in savings or added value for U.S. health systems by 2019. That figure is largely based off the difference in time it takes to schedule an appointment online rather than over the phone. Accenture’s research shows it takes less than a minute to arrange an appointment online, whereas the average appointment made over the phone takes 8.1 minutes. Nearly two-thirds (63%) of the time, employees transfer a patient’s call. The report estimates that only 2.4% of medical appointments were self-scheduled in 2014. Accenture forecasts 64% of patients will book a doctor’s appointment online by the end of 2019.

“Evidence also shows health systems can use self-scheduling tools to boost appointment capacity, reduce costs and/or increase productivity,” Dipak Patel, managing director of Accenture’s patient access solutions, said in a release. By offering 24/7 online scheduling capabilities, Patel says healthcare employees will be able to better manage their schedules and optimize their availability to meet patient demand.

The accuracy of Accenture’s predictions will be determined by providers’ willingness to allow online appointment scheduling and their adoption of supporting technology. Self-scheduling was an option for only 11% of appointments booked in 2014. Large healthcare systems’ ample resources contribute to why they’re ahead of the curve when it comes to self-scheduling technology. Of the top 100 U.S. health systems, 40% offered some self-scheduling in 2014, a figure Accenture expects to increase to 100% in the next five years. The report forecasts that two-thirds of U.S. health systems will offer and support the use of self-scheduling tools in 2019.

December 15, 2014  9:57 AM

ONC releases federal strategic plan for health IT

Posted by: MonicaVallejo
health IT strategic plan, ONC

The passage of the Affordable Care Act and the increasing amount of professionals and hospitals receiving payments from EHR incentives had significant influence on the Federal Health IT Strategic Plan 2015-2020.  The plan — recently released by the Office of the National Coordinator for Health Information Technology (ONC) — indicates the federal government will continue to work for more widespread adoption of health IT.  It’s based on the progress health IT has made in last few years and points in the direction the industry should be heading.

“With this updated Plan, the federal government signals that, while we will continue to work towards more widespread adoption of health IT, efforts will begin to include new sources of information and ways to disseminate knowledge quickly, securely, and efficiently,” said National Coordinator for Health IT, Karen DeSalvo, M.D., in a release announcing the plan.

Recently, there have been federal efforts to increase IT adoption, stimulate the exchange of electronic data and encourage innovation in mobile health applications. Those initiatives and new technology have changed the healthcare landscape since the last strategic plan — covering the goals for 2011 through 2015 — was released.

The advances made in last five years have shaped the new goals, strategies and objectives of the 2015-2020 plan, which was put together by 35 federal departments and agencies.

The plan outlines five main goals:

  • Expand the adoption of health IT, by advancing secure national communication infrastructure
  • Promote the advancement of secure and interoperable health information by improving technical standards for secure and interoperable health information that protects patient privacy
  • Strengthen the delivery of healthcare
  • Promote better public health by aiding in the well-being of individuals and communities
  • Advance research and innovation by increasing the usability of electronic health information.

ONC is accepting public comments on the plan through Feb. 6, 2015. The final version of the plan will be released later in 2015.

December 10, 2014  3:56 PM

Projection and reality clash in PwC, Health Research Institute data

Posted by: adelvecchio
FDA, mHealth, mHealth applications

Despite PricewaterhouseCoopers predicting mobile healthcare to remain fashionable in 2015, there’s measurable hesitance on the parts of both patients and physicians to use mobile technology during the course of care, according to new research.

Most clinicians (86%) agree that mobile applications will become important for managing patients’ health within the next five years, according to survey data collected by the Health Research Institute. The number of mobile apps being created is reflective of the popularity of mHealth, which is the second entry on PwC’s 2015 issues list. The FDA, which has been regulating mobile apps for more than 10 years, is expected to review more apps in 2015 than any other year. Based on their level of risk to patient health, the FDA doesn’t regulate all of the mHealth apps available to physicians and consumers. Some clinicians (26%) said the agency’s approval would be their top criteria in determining whether they’d recommend a product to a patient.

PricewaterhouseCoopers’ (PwC) top issue for 2015, “do-it-yourself healthcare,” is also strongly tied to the advancement of health technology. In their responses to PwC, U.S. clinicians expressed their distrust for using data collected from patients’ mobile devices and apps. Nearly three-quarters (74%) said they would be uncomfortable relying on a mobile app or device that can check for an ear infection, and 53% expressed discomfort with using a mobile device or app to analyze a patient’s urine.

Clinicians’ reluctance to integrate new-age mobile technology into their care routines is surpassed by that of patients, according to PwC data. Only one-fifth of consumers said they’d be open to using a home urinalysis product. The ease of use and accessibility of mHealth data is considered one of its main draws for consumers. But patients’ responses to a Health Research Institute survey indicate they value secure data over convenience, with 71% saying the protection of their medical tests and imaging results is more important than having convenient access to that information.

December 9, 2014  1:44 PM

Presidential panel aims connected health at cancer

Posted by: ShaunSutner
Connected Health, mHealth, telehealth

Connected health is one of the fastest-growing and most fascinating of all the health IT sub-categories, particularly because it has two meanings: it deals both with electronic, usually remote, links between providers and patients, and also with connections between providers.

Connected health is also an overarching term (most people agree it was essentially coined by Joseph Kvedar, M.D., founder and director of the Center for Connected Health at Partners Healthcare in Boston) that incorporates what we know as mHealth and telehealth.

Now, federal health officials have discovered that connected health could be a serious weapon against the No. 1 killer of Americans under 65 – cancer.

The prestigious President’s Cancer Panel kicks off a series on connected health and cancer Thursday, Dec. 11 at the Royal Sonesta Boston hotel in Cambridge, MA, near the high-tech neighborhood of Kendall Square

If you can’t make it to the daylong workshop session, which is free and open to the public without registration, track the proceedings on Twitter by following #cHealth4Cancer. Check out the agenda here.

Appropriately, Kvedar, who recently presided over his center’s annual Connected Health Symposium, is participating in the Cambridge session’s first panel. He joins:

  • David Ahern, special adviser for the health communication s and informatics branch of the National Cancer Institute’s (NCI) division of cancer control and population sciences
  • Thomas Goetz, co-founder of health technology firm Iodine and entrepreneur-in-residence at the Robert Wood Johnson Foundation

Meanwhile, Bradford Hesse, chief of the NCI’s health communications and research branch and co-chairman of the Cambridge event, told SearchHealthIT that the connected health-cancer series comes at a fortuitous time: The “quantified self” movement is gathering momentum and innumerable connected health initiatives are flourishing.

A main cancer care problem that series organizers hope to address through connected health strategies is discontinuity of care, Hesse said. The commonest expression of that phenomenon today is when cancer patients in homecare fail to administer their oral chemotherapy regimens, he said.

“We’re going to have more and more of that as patients get older and are surviving longer,” he said.

One connected health approach to solving that problem is to adapt the EHR at the cancer patient’s healthcare provider, an arrangement that enables a doctor to reach out to the patient with reminders and encouragement to stay with a home-based treatment protocol.

Another path to the same goal is to use emerging Internet-of-Things (IoT) technologies, such as WI-Fi-enabled medicine bottle screw tops to monitor treatment adherence, Hesse noted.

Cancer prevention — particularly to guard against reoccurrence for people in remission and also to ward off secondary ailments — is another realm in which connected health can make an impact.

Hesse said it is a notable coincidence that just as the president’s cancer panel zeroes in on connected health for 2015, Apple Corp. unveiled its iOS 8 suite of apps, including what could become an emergent wellness standard in the consumer tech giant’s Healthkit program. Apple has also forged a deal with EHR market leader Epic Systems Corp. to merge Healthkit with Epic’s systems.

Meanwhile, as wearable wellness and fitness bands proliferate, physicians will likely start to incorporate those devices into cancer care in another expression of connected health.

“Doctors are saying to survivors, ‘You had chemo. Now you need to get healthy again,” Hesse said.

December 4, 2014  9:43 AM

Medicare EHR incentive deadlines extended

Posted by: MonicaVallejo
CMS, EHR incentives, meaningul use hardship exceptions

Hospitals will have more time to submit meaningful use data, receive 2014 program incentive payments and avoid payment adjustments for 2016. All of that is possible because of a CMS decision that extended the deadline for meaningful use attestation measures. Among the changes  is a deadline extension for eligible hospitals and critical access hospitals  to attest to meaningful use under the Medicare EHR Incentive Program during the 2014 reporting year. CMS postponed the original Nov. 30 deadline to  Dec. 31, 2014.

The second extension announced by CMS applies to eligible hospitals and critical access hospitals working towards meeting meaningful use and hospital inpatient quality reporting programs. The new date will not affect the deadlines for Medicaid EHR Incentive Programs and will allow eligible hospitals to submit data for their electronic clinical quality care measures through Dec. 31.

These two extensions are the latest in a series of breaks CMS has given eligible professionals and hospitals. One recent deadline extension CMS granted providers was the reopening of the submission period for hardship exception applications. The submission dates were pushed back from April 1, 2014 for eligible hospitals and July 1 for eligible professionals to Nov. 30, 2014. This move gives providers more time to avoid 2015 Medicare payment adjustments for failing to demonstrate meaningful use of certified EHR technology.

December 3, 2014  5:23 PM

RSNA 2014 draws more than 55,000 to Chicago

Posted by: ShaunSutner
radiology, RSNA, RSNA 2014

CHICAGO — Welcome to RSNA 2014, the biggest, baddest granddaddy or grandmommy of all medical shows.

Actually, the Radiological Society of North America  Scientific Assembly and Annual Meeting — held in the Windy City for years — is one of the biggest trade shows of any kind in the world.

This mega-show, with its dozens of panel sessions and hundreds of peer-reviewed academic and medical papers, dwarfs the dominant show of the health IT industry — the Healthcare Information Management Systems Society (HIMSS) Annual Conference & Exhibition, although about a sixth of RSNA is devoted to health IT.

Most of the vendor exhibitors are selling the latest and greatest machines for performing radiology, offering one-stop shopping for physicians and healthcare system executives to look around the teeming exhibit floor, get hands-on demonstrations, make purchases or form valuable business relationships.

But with the rapidly increasing roles of advanced data visualization, informatics, and image sharing in radiology, health IT is a quickly growing presence within RSNA. RSNA is about four times the size of the sprawling HIMSS gathering, which will also be held in Chicago, in April 2015, in the same massive, often-confusing mini-city that is the McCormick Place convention center near the shores of Lake Michigan.

The action in some of the booths run by the big international companies that dominate the field — such as GE Healthcare, Royal Philips, Siemens AG and FujiFilm — can sometimes resemble a rock and roll performance. One exhibitor described the scene in her booth as like a frenetic mosh pit at a punk rock concert.

RSNA 2014 total attendance figures peaked at 55,555 during the middle of the show (on Dec. 4), a 5% increase over last year.

Of those, 20,782 were exhibitors; on Wednesday that number was down 2% from last year, the only attendance category to register a drop.

Guests numbered 6,288 — up 20% from 2013. And professionals, the radiologist and other physicians themselves, made up the largest segment of attendees, at 28,485, a 9% spike over 2013. The RSNA itself, though technically based in the U.S. and Canada, is actually international. It is a professional society with more than 54,000 members, mostly radiologists, medical physicists and other medical professionals, from 136 countries.

RSNA publishes two respected peer-reviewed journals: Radiology and RadioGraphics. And via its Research and Education Foundation, it funnels millions of dollars to up-and-coming researchers.

This is the historic RSNA show’s 100th year, believe it or not. RSNA celebrated its centennial with a special website, centennial showcase on the exhibition floor featuring a timeline of historical markers in the evolution of the group, and, of course, an array of parties and receptions.

If you’re in health IT, you owe it to yourself to experience the RSNA phenomenon.

December 2, 2014  3:39 PM

CIOs, ECRI Institute set their sights on health data security for 2015

Posted by: adelvecchio
CIOs, data breach, health data security

Healthcare CIOs and hospital IT departments setting goals for next year are staring down a familiar task: maintaining healthcare data security on limited budget resources.

A group of CIOs representing eight healthcare organizations met at the Scottsdale Institute 2014 Fall CIO Summit to discuss how providers can stay competitive in today’s healthcare market. Participants noted a breach perpetrated by a hacker group from China that exposed the data of 4.5 million Community Health Systems, Inc. patients in April and June of this year. The healthcare CIOs at the summit agreed data security is one of their primary concerns. They also concurred that regardless of the preventive measures taken, their organization remains likely to endure a data breach at some point.

Providers’ worst data breach fears are confirmed when they learn of incidents such as one that put the information of patients at Boston-based Brigham and Women’s Hospital (BWH) at risk. An armed robbery of a BWH physician resulted in the theft of their laptop and cellphone and the forced disclosure of the passcodes to those devices, which could be used to access the information of neurology and neurosurgery patients treated between October 2011 and September 2014.

Cybersecurity checked in at ninth in the ECRI Institute’s 2015 Top 10 Health Technology Hazards list. The list coincidentally is headed by alarm fatigue for the fourth consecutive year. Robotic surgery complications and inadequate reprocessing of medical equipment after use are two other concerns included as concerns to monitor next year.

The ECRI Institute’s downloadable report goes into greater detail about the various security weaknesses of which providers should be aware. Protecting electronic and medical devices used in their facilities requires keeping those technologies updated with the latest security patches, something that’s not always possible. Providers sometimes skip security updates out of fear that it could interfere with the device’s performance. Some legacy devices are simply no longer supported by the manufacturer, and their continued use is fraught with data security risks.

November 26, 2014  10:51 AM

Laptop theft exposes protected health information, brings six-figure fine

Posted by: adelvecchio
data breach, HIPAA, HIPAA data breach

Beth Israel Deaconess Medical Center in Boston must pay the state of Massachusetts a $100,000 fine due the theft of an employee’s laptop in May 2012. The laptop — which was not issued by BIDMC — contained the unencrypted protected health information of 3,796 patients and employees. Beyond medical information, patient names and social security numbers were potentially exposed when the device was taken from a physician’s office.

In a release announcing that a consent judgment had been reached, Massachusetts Attorney General Martha Coakley said, “The healthcare industry’s increased reliance on technology makes it more important than ever that providers ensure patients’ personal information and protected health information is secure.” The lawsuit filed against Beth Israel Deaconess Medical Center (BIDMC) was based on violations of federal HIPAA and two state privacy laws. BIDMC failed to notify patients of the security breach within 60 days of discovering it, which was required by those laws.

The release from the attorney general’s office said the owner of the stolen device failed to follow hospital security protocol. The hospital’s policy required employees to physically secure and encrypt all devices that contained sensitive patient information. The majority, $70,000, of the amount to be paid by BIDMC is a civil penalty and $15,000 will go to a fund for educational programs supporting the security of personal and protected health information. The hospital also agreed to review their security policies to find and correct any weaknesses.

Shortly after sharing news of the breach, BIDMC announced its intention for employees to play a larger part in data protection. John Halamka, M.D., CIO at BIDMC, stated his hope that this initiative would strengthen and build upon the hospital’s existing security policies. Halamka also made it clear that the risk of security breaches will always hover over hospital operations as long as employees are accessing patient data on different devices from scattered locations.

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