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Health IT Pulse


March 31, 2015  1:26 PM

Patients favor physicians over technology and online medical resources



Posted by: adelvecchio
patient engagement, telemedicine

Many patients acknowledge there is a place for technology in their healthcare, but the majority of them still value face-to-face interaction with their physicians above all else.

A 3,000-person survey given to residents of the U.S., U.K. and Germany by Nuance Communications, Inc. provided more evidence for patients’ acceptance of healthcare technology. Nearly 40% of respondents have referred to online medical resources — such as WebMD — prior to making a doctor’s visit. A greater percentage of patients displayed a tendency to go straight the professionals with their medical concerns, as more than two-third of respondents said they have brought a list of questions to a doctor’s visit.

“Patient engagement is more than just the buzzword of the moment…the relationship between physicians and their patients is paramount,” Nick van Terheyden, M.D., chief medical information officer at Nuance, said in the company’s release.

The survey, Healthcare From the Patient Perspective, also gauged how patients thought their physicians’ use of technology affected their care experience. More than half (58%) believe healthcare technology has had a positive effect, 39% were neutral and only 3% were convinced technology has had a negative effect. Regardless of they may feel about technology in the exam room, most patients are aware of a change in its deployment in the last five years. During that timeframe, almost 70% have noticed a change in how often technology was used by their physician.

Patients’ approval of doctors using technology in the exam room varies depending on the device in question. More than three-quarters of patients in the U.S. and U.K. are comfortable with physicians using a desktop or laptop computer during a consultation. There is a steep decline to the next most-accepted device; only 27.4% of that group would be comfortable with physicians accessing mobile devices in the same scenario. At 18.2% and 7.5%, telemedicine and image sharing through the cloud were the next two technologies patients would be most secure with doctors using.

March 30, 2015  8:55 AM

Pages and pages of stage 3 rules — and moving on from stage 2; population health’s ties to machine learning; UIs hamstring VNAs



Posted by: Scott Wallask
athenahealth, CHIME, CMS, EHR certification, meaningful use stage 2, meaningful use stage 3, population health management, Storage and PACS, VNA, wearable devices

Spring break sure sounds good to me after CMS dropped 700-plus pages of proposed regulatory rules for stage 3 meaningful use and EHR certification for the healthcare IT industry to study up on. Opinions quickly flew around the Web about the most important parts of the proposals.

Reporter Shaun Sutner grabbed thoughts from two influential players in healthcare IT — athenahealth Inc. and the College of Healthcare Information Management Executives (CHIME) — and then followed up by looking at a critique of the proposed CMS rules that is bound to get attention because of who wrote it: Beth Israel Deaconess Medical Center CIO John Halamka, M.D., and Massachusetts eHealth Collaborative President Micky Tripathi.

CHIME and athenahealth expressed tepid responses to the CMS release, while Halamka and Tripathi jabbed the agency about the proposal’s page count.

As Sutner wrote, Tripathi and Halamka’s review “delves into the critical realm with sections labeled the ‘good,’ the ‘bad,’ and even the ‘ugly.'”

In better-looking news, the new issue of our premium e-zine Pulse came out this week on the related topic of transitioning from stage 2 to stage 3 meaningful use. The theme of the issue is whether providers are ready for the change, and I expect more answers to that question at the upcoming HIMSS 2015 conference in a couple of weeks.

Pulse March 2015

Population health management will also be a trigger topic at HIMSS 2015. As contributor Reda Chouffani noted in his piece about curbing rising healthcare costs, machine learning can improve population health efforts. Machine learning focuses on creating computer programs that teach themselves to grow when exposed to new data.

The CMS stage 3 proposal also touches on population health by inviting opinions about how to best use patient-generated data from wearable wellness devices and tracking systems.

Meanwhile, I weighed in on the buzz about vendor neutral archives, which don’t seem quite ready to take over from picture archiving and communications systems — the VNA versus PACS debate. Technology pros and cons aside, VNAs users get hampered by user interfaces that aren’t easy to, well, use.

Please follow @SearchHealthIT and @HITexchange for the latest news updates on Twitter throughout the week.

Scott Wallask is news director at SearchHealthIT. Follow him on Twitter @Scott_HighTech.


March 26, 2015  9:32 AM

Halamka and Tripathi take aim at meaningful use stage 3



Posted by: ShaunSutner
CMS, halamka, meaningful use stage 3, ONC

The health IT world reeled when CMS and the Office of the National Coordinator (ONC) for Health IT unleashed more than 700 pages of proposed rulemaking for meaningful use stage 3 for healthcare providers and EHR vendors.

Now two of health IT’s leading thinkers and innovators  — Beth Israel Deaconess Medical Center CIO John Halamka, M.D., and Massachusetts eHealth Collaborative president Micky Tripathi — have essentially deconstructed the verbiage in a co-written post on Halamka’s widely read blog.

Now rocketing around the Internet, their analysis is a mostly factual condensation of the sprawling proposed rules released last Friday, whose length and byzantine construction the authors gently make fun of.

“Providers and vendors alike were all hoping for something lean and clean,” write Halamka and Tripathi, who are colleagues in the Argonaut Project, a new coalition of competing vendors and other health IT players that have come together to develop the emerging Fast Health Interoperability Resources standard, or FHIR.

But their post also delves into the critical realm with sections labeled the “good,” the “bad,” and even the “ugly.” These two sometime iconoclasts chide federal health IT officials, with whom they have worked closely for many years, for what they see as needless complexity and trying to please too many people and thereby failing to prioritize.

As for the good, the authors call the proposed rules, which now will go through what is likely to be a spirited 10-week comment period, “a good first draft.”

Halamka and Tripathi say that while the rulemaking is long, CMS should be commended for essentially streamlining and consolidating “stray threads” from meaningful use stage 1 and stage 2.

They also give good marks to both CMS and ONC for their work on the new certification rules and their strong emphasis on APIs. This direction, they note, is in line with on dramatically boosting interoperability, efforts by ONC’s Health IT Standards Committee (HITSC), and the goals of the Argonaut Project, which is housed at Tripathi’s eHealth Collaborative.

Halamka is vice chairman of HITSC, Tripathi was a member of the JASON Task Force, and both advocate for stronger interoperability capabilities for EHRs.

The bloggers also say it’s good that all players will start off with stage 3 in 2017 and 2018, as opposed to stages 1 and 2, which have found different providers attesting to different stages in separate years.

Now for the ugly.

While they say stage 3 is more focused than previous stages, Halamka and Tripathi are convinced that meaningful use is still an onerous burden for the most part on providers and vendors.

Overall, they argue that meaningful use in many areas is disconnected from how physicians practice medicine in the real world.

“The sheer number of requirements may create a very high, expensive and complex set of barriers to product entry,” they write. “It may stifle innovation in our country and reduce the global competitiveness for the entire U.S. health IT industry by over-regulating features and functions with complicated requirements.”


March 24, 2015  11:15 AM

Patients confident, healthcare pros unsure of value of mHealth apps



Posted by: adelvecchio
mHealth, mHealth applications

Perhaps in response to users’ near-universal satisfaction with health apps, approximately half (46%) of healthcare professionals plan to integrate mobile apps into their practices within the next five years. Currently, only 16% of healthcare professionals use mHealth apps during patient care. All of this data resulted from the experience and opinions of 1,000 healthcare application users and 500 healthcare professionals, which were collected in a survey done by Research Now Group, Inc.

Nearly all users — 96%, to be exact — of healthcare applications agree that apps have positively affected their quality of life. Six-tenths of people that use mHealth apps do so to measure their workouts and physical activity levels. Slightly more than half of them work with mHealth apps as a way to prompt or remind themselves to exercise.

In the survey report, Vincent DeRobertis, senior vice president of global healthcare at Research Now, mentioned a few other services available to users through mHealth apps by saying: “Patients are gathering data about their condition or treatment… perhaps reducing visits to a physician.”

Healthcare professionals are confident mHealth apps have something to offer both sides of patient care situations. More than 70% of professionals believe apps will push patients to pay more attention to their physical conditions. Of the same group, 86% think health apps will give them more insight into their patients.

Not wanting to discount the value of years of medical education and experience, only 37% of healthcare professionals agree with the assessment of patients that using mHealth apps alone can lead to improvements in their health. Personal feelings of mHealth efficacy aside, most healthcare professionals recognize they are in the midst of an unavoidable onslaught of mobile technology. As such, only 19% think smartphones will never become part of their healthcare workflows.


March 19, 2015  12:05 PM

CHIME leads renewed push for national patient identifier



Posted by: ShaunSutner
CHIME, national patient ID, national patient identifier

Creating a national patient identification system has long been a goal for many healthcare system CIOs and other health IT leaders.

Now the leading health IT CIO organization, the College of Health Information Management Executives (CHIME), is throwing its considerable intellectual capital behind a public campaign to find what it calls “a universal solution for accurately matching patients with their healthcare information.”

In a release, CHIME said it is launching a $1 million challenge to raise money on HeroX, the incentivized prize competition platform for tech innovation, to spur progress on national patient identifier technology.

“There is a growing consensus among payers and providers that a unique patient ID would radically reduce medical errors and save lives,” CHIME CEO and President Russell P. Branzell said in the release. “Incomplete or duplicate health records present significant issues in terms of patient safety, and there is a pressing need for preventing, detecting and removing inaccurate records so hospitals can positively match the right data with the right patient in order to provide the best possible care.”

Also signing onto the CHIME initiative were the American Health Information Management Association, Cerner Corp., the Health IT Now Coalition, the National Patient Safety Foundation, and the Healthcare Financial Management Association.

CHIME is also expected to advocate for a national patient identifier at the Health Information and Management Systems Society (HIMSS) 2015 Annual Conference and Exhibition in Chicago next month.

Despite an impressive array of supporters, movement toward a true national patient identification system has been blocked by conservative political activists and healthcare advocates who believe the concept runs counter to individual rights.

And while the original HIPAA legislation in 1996 contained language calling for a national patient identifier, Congress in 1998 rejected funding for HHS to implement the system, effectively killing the idea.

With the advent of the Obama administration six years ago, it looked like chances for a national patient identifier were pretty good. But even strong advocates such as Farzad Mostashari, M.D, former national health IT coordinator, weren’t able to push it through.

Let’s see if this latest coalition, led by CHIME and its members of diverse political persuasions, can succeed when others failed.


March 18, 2015  4:32 PM

Premera cyberattack shows medical info at risk



Posted by: ShaunSutner
encryption

The devastating cyberattack on Premera Blue Cross shows that medical information is becoming a top target for cybercriminals.

To avoid attacks such as the breach involving more than 11 million people’s medical information, hospital systems, other healthcare providers and insurers should ensure protected health information (PHI) and other sensitive data is locked down whether it’s being stored, moved or processed, data security experts say.

“Whether PHI is in a cloud or on premises, clearly medical data has become a big target,” Gerry Grealish, chief marketing officer for cloud security firm Perspecsys Inc. told SearchHealthIT in an interview. “And from what we’ve seen, it’s becoming even more of a lucrative target.”

Grealish and others in the growing security software and consulting sectors say encryption and tokenization are key to preventing such hacker incursions into both cloud and enterprise-based data networks, but it’s important that those protections be layered on top of firewalls and intrusion detection systems.

When giant insurer Anthem Inc. announced last month that customer data, including bank accounts and clinical records, of up to 80 million people had been breached, the company said no medical data had actually been stolen.

In Premera’s case this week, it’s more likely that medical data also was indeed compromised, the company acknowledged.

Grealish said that with the rapidly expanding digitization of health records, provider and insurer storehouses of PHI can be valuable repositories for criminals seeking to commit medical claim fraud.

Grealish said that while a small piece of medical information about an individual may not be worth more than, say $20, a patient’s entire medical file could fetch $500.

Multiply those prices by several million, and it’s easy to see why cybercriminals have expanded their purview from the financial and retail industries to the healthcare sphere.

In a post on its own blog, Premera, which operates mainly in the Pacific Northwest, with nearly 2 million customers in Alaska and Washington, offered victims two years of free credit and identity monitoring services and said it had hired Mandiant, a major cybersecurity firm.


March 17, 2015  2:11 PM

Nurses would trade time spent on medical devices for patient care



Posted by: adelvecchio
device interoperability, Interoperability, medical devices, nurses, transcription

Nurses would spend more time at patients’ bedsides if they could cut down on how often they have to operate medical devices. That sentiment was shared by 91% of 526 nurses that took part in a survey commissioned by Gary and Mary West Health Institute and conducted online by Harris Poll. More than two-thirds of nurses said the time they spend transcribing data from one device to another is likely to take time away from patient care.

Nearly every nurse that responded said they interact with a form of technology during a shift. Not all of their opinions supported the notion that technology has simplified care coordination and improved patient outcomes. In fact, half of the nurses said they’ve seen a medical error occur from faulty device coordination and 74% find it burdensome to gather and organize all of the data produced by medical devices.

As it stands, nearly half (47%) of nurses — a group of medical professionals that spends a lot of time working with technology — feel interacting with medical devices is one of the least effective ways to spend their time. More interoperability between medical devices would lessen the technology burden on nurses and free them up to spend more of their days caring for patients. Three out of five nurses believe that medical errors would be significantly reduced if their facility’s medical devices automatically shared data. Respondents were nearly unanimous in their belief that it would be beneficial if medical devices were able to share data with one another, with 91% saying that would be very or extremely helpful.

The survey also asked nurses to share what tasks of theirs require them to interact with technology. The majority (89%) indicated they access EHRs and two-thirds use medical devices at patients’ bedsides. Transcribing patient data and managing alarms were other common answers, with 58% and 54% of nurses offering those as reasons.


March 13, 2015  4:02 PM

Why I’m more worried about EHR theft today than I was last week



Posted by: Scott Wallask
cybersecurity, EHR, Electronic Medical Record, prescriptions

I had not been convinced about the dangers of one’s EHR getting stolen in a data breach — until now.

If a cyberthief robs you of your financial information, that clearly brings long-term risk of fraudulent charges to a credit card or identity theft.

But I was dubious about what illicit acts someone could take with stolen medical records. My most recent electronic entries mention that I had a physical in February and that my cholesterol lab work looked good. Who cares if someone comes into possession of that info?

Sure, a thief could aggregate electronic cholesterol test data, whittle it down to people who had bad cholesterol tests, and perhaps sell that list to some shadowy company marketing drugs to treat high cholesterol. But that act won’t bring a halt to your day that same way a stolen credit card number will.

 

theft2

I have also heard some observers argue that if crooks swipe your EHR, they could alter it. But short of the victim being someone famous or rich, few fraudsters will waste their time fiddling with Joe Q. Public’s records because there’s no gain to be had.

However, this week I read through the results of a healthcare data breach survey by Software Advice, a Gartner-owned company that reviews software applications in 250-plus industry categories, including electronic health record systems and features. Nestled among the results — which indicated, for example, that one out of five patients withholds personal health information from his or her physician due to data security fears — was a nugget of information that made me change my thinking of EHR theft.

In short, cybercriminals could use a medical record to fraudulently order prescriptions. Imagine if you found out while trying to refill a script that the pharmacy locked down your account because you had allegedly refilled the order already. Not only does a thief have a dose of your meds that could be sold on the street, but you’re also on ice trying to prove you need more of the drug.

I’m often the go-to person in my household for picking up prescriptions for my family. I have not shown my ID at a pharmacy in years, beyond having to verbally give an address. Anyone who performed little bit of research on my family, and had stolen medical information, could walk into our pharmacy and walk out with a prescription.

This risk isn’t even considering the added layers of security needed with electronic prescriptions.

After thinking about Software Advice’s comments, I believe the biggest widespread threat with medical information theft is indeed prescription fraud. This crime is easy to carry out, initially hard to detect, and potentially profitable. And for the victims, such an act would lead to plenty of headaches, calls to prescribing physicians, and arguments with the pharmacy.

As we here at SearchHealthIT prepare for next month’s HIMSS 2015 conference, I plan to keep my ears open about prescription theft and how e-prescribing fits into this picture.

I’m more worried about medical records theft today than I was last week.

Scott Wallask is news director at SearchHealthIT. Follow him on Twitter @Scott_HighTech.


March 11, 2015  4:15 PM

HHS unveils “Next Generation ACO Model”



Posted by: ShaunSutner
ACA, ACO, hhs

One of the more interesting but lesser known offspring of the Affordable Care Act (ACA), the accountable care organization (ACO), appears to be holding strong as a model of how healthcare will be delivered in the future.

ACOs have depended heavily, perhaps more than any other form of healthcare provider up to now, on managing population health and using data analytics to do it.

While some ACOs have struggled, the U.S. Department of Health and Human Services’ (HHS) new value-based reimbursement direction dovetails pretty neatly with the rationale for ACOs themselves: pay doctors for how well they treat patients, not how often they do.

And so, about a month after HHS Secretary Sylvia Burwell unveiled her value-based reimbursement roadmap, the agency has followed up by unveiling its new “Next Generation ACO Model.”

According to HHS, the new ACO payment model builds on the experience of Pioneer ACOs and the Medicaid Shared Savings Program by using the same methods:

  • Setting predictable financial targets
  • Giving providers and beneficiaries more opportunities to coordinate care
  • Aiming to raise standards of care

However, under the Next Generation program, ACOs will assume even greater financial risk than previous ACO models, but will also potentially share a greater portion of any savings.

Burwell, in the release announcing the new program, said HHS will make available to Next Generation ACOs new tools to help them manage care.

They include:

  • Rewards to beneficiaries for receiving care from physicians and other caregivers participating in their ACOs
  • Coverage of skilled nursing care without prior hospitalization
  • Incentives to expand coverage of telehealth and post-discharge home services to support coordinated care at home

ACOs can join the Next Generation program via two rounds of applications in 2015 and 2016. Participation is expected for a five-year period. For this year, healthcare organizations that want to apply must submit a letter of intent by May 1 and an application by June 1. Second round letters of intent and applications will be available in spring 2016.

Under the value-based reimbursement system Burwell announced in January, HHS has set goals of tying 30% of traditional Medicare payments to alternative ACO-like quality or value measures by the end of 2016; 50% to alternative payments by 2018.

HHS also set new goals for tying reimbursement in other programs, such as hospital value-based purchasing and hospital readmission reduction programs. The agency aims to tie 85% of payments in these programs to quality or value by 2016 and 90% by 2018.

 

 


March 10, 2015  10:40 AM

Healthcare spending, EHR market share divulged in survey



Posted by: adelvecchio
EHR vendors, ICD-10, ICD-10 implementation, population health management, purchasing intentions

ICD-10 and population health management are more than just buzzwords for healthcare providers in 2015. More healthcare systems are projected to invest in those two areas than in any others, according to a survey conducted by peer60. The polled group represents 25% of the American hospital market, and four-fifths of the respondents were C-suite hospital executives.

Nearly 60% of hospitals are going to spend money on ICD-10 preparations in the remainder of this year, and more than half will make purchases to support population health management. Patient engagement will be the third most common area of investment for providers in 2015, coming in at just under 50%. Revenue cycle management was the only other business segment that greater than 30% of respondents indicated they would fund this year.

Healthcare spending in 2015 will vary depending on the size of the facility. For hospitals with 250 or fewer beds, ICD-10 migration expenses were the most recurrent survey answer. Representatives from larger hospitals most frequently mentioned their organizations would allocate some funds toward population health management.

The peer60 survey report also separated EHR market share according to the size of participating hospitals. Computer Programs and Systems, Inc. and eClinicalWorks, LLC lead the less-than-100-bed market, with each in business with 20% of such facilities. Meditech, Inc. is tops in the 100-to-250-bed range with 40% of the market there.

EHR vendors looking to do business with midsized hospitals are chasing McKesson Corp. and Siemens AG, as those two companies lead the competition in the 251-to-500- and 501-to-1,000-beds sectors. Epic Systems Corp. and Cerner Corp. are neck and neck for the biggest market share among hospitals with more than 1,000 beds — with each holding 30% of that group.


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