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Health IT Pulse

April 16, 2014  3:15 PM

Automated software not ready to reduce hospital readmissions

Posted by: adelvecchio
ACO, Affordable Care Act, hospital readmission

Automated systems that predict hospital readmissions are in the works – but are not yet ready for deployment, according to several recent studies. Some systems show promise, as the U.S. healthcare system refines progressively more precise metrics to predict what causes readmissions.

Authors of a study appearing in BioMed Central manually reviewed 459 readmissions and then repeated the process using software from 3M, one vendor with a readmissions application in development.

Researchers found some overlap — both approaches agreed that 56% of the readmissions were preventable — but concluded that “not enough concordance currently exists between methods to use automated classification to replace manual review for quality improvement initiatives.”

Hospitals should have more than improving care quality as motivation to keep patients from making multiple visits. Facilities with high readmission rates are subject to fines under the Affordable Care Act. One estimate says preventable readmissions cost Medicare more than $17 billion every year. Without the use of an automated readmission prediction system, some hospitals have turned to building their own internal programs. One medical center relies on an application that collects patient data specifically to measure their likelihood of readmission. Another sends out text messages to remind patients to attend heart rehabilitation classes.

Reducing readmission rates can be a byproduct of improving the overall quality of care, something that is a goal of facilities that move to the ACO model. One hospital that deployed ACO support software from Lumeris documented an 18% reduction in readmission rates after moving to the pay-for-performance model. They also reported a 16% increase in follow-up visits by high-risk patients when offering incentives to physicians.

Technology may not be the surest way to prevent or predict readmission rates. The answer is much simpler, according to a study performed by Health Services Research. The study found that 58% of variation in hospital readmission rates is determined by a hospital’s geographic location and not based on the facility’s performance. That percentage was calculated by measuring the variation in 30-day readmission rates at the county level, as noted by the Health Behavior News Service.

April 9, 2014  11:13 AM

HIMSS Analytics study measures EHR governance programs

Posted by: adelvecchio
EHR certification, EHR governance, EHR implementation, HIMSS Analytics

According to study data collected by HIMSS Analytics, 60% of healthcare organizations have a formalized EHR governance program in place. And almost two-thirds of the time, it’s not just IT staffers doing the governing: Physicians and nurses are having their say in how the application and its use are structured.

HIMSS Analytics defines EHR governance as “an organizational entity that oversees the use of your EHR solution and the process by which changes can be made to the underlying structure of that solution.” The majority of the 238 respondents to the study work in either the C-suite or other executive/director positions in healthcare organizations.

“How organizations make decisions around enhancements to EHRs, including implementation can dramatically impact their ability to meet regulatory measures and create workflow efficiencies,” said HIMSS Analytics Research Director, Brendan FitzGerald.

Other data gathered in the study revealed that physician adoption and engagement in using EHRs are the biggest obstacles in the way of effective governance programs. Of those with a formalized EHR governance structure, 63% involve a multi-disciplinary advisory board or committee.

Healthcare facilities need to gain tighter control of their EHR systems amid shifting regulations and deadlines that create more frequent system upgrades. The ONC recently released their proposed rule for 2015′s voluntary EHR certification standards, following up on an earlier declaration where they promised to make more frequent EHR recommendations. The rule was open to a public comment period and was designed to promote interoperability, while improving upon the current EHR criteria. The College of Healthcare Information Management and 47 other healthcare groups will likely have something to offer in those comments as they asked for the 2015 standards to be delayed last HIMSS.

The increased input from ONC and adoption of EHR governance programs indicate a broadening interest in creating best practices for the proper use of EHR systems. Dedication to this cause, by both government agencies and providers, resulted in the EHR meaningful use program surpassing the $19 billion mark in reimbursements paid to providers. More than 88% of hospitals eligible for incentive payments have received them, according to data shared at a recent Health IT Policy Committee meeting. Some of the providers who received payments were still in the adoption/implementation phase with their EHR system.

April 2, 2014  11:31 AM

Big data projects uncommon in healthcare, executives hopeful for future

Posted by: adelvecchio
big data, preventive care

The majority of healthcare executives believe big data will positively influence patient care, though not all of them have gotten around to utilizing big data to meet organizational goals.

More than half (60%) of American healthcare executives agree that big data will improve preventive care and 63% think big data will help to more efficiently track and manage population, according a report from MeriTalk, underwritten by EMC Corp. The percentages reflecting use of big data applications are noticeably lower: Only 33% of those surveyed said their organizations have successfully deployed at least one big data project. Of those, 35% have used it to improve patient care and 28% said big data is improving health outcomes.

A lack of preparation may be the culprit for the low adoption numbers. Fewer than one in five executives indicated their organization is fully ready to work with big data and just 29% have educated senior management on big data issues.

Defining big data and specifying how it will be used in your organization is the fastest way to see positive results, according to John Halamka, M.D., chief information officer at Beth Israel Deaconess Medical Center. Beth Israel uses big data to identify patients who fail to schedule follow-up visits and then contact them. Other hospitals report using big data to observe patient trends and adjust their care to best suit patients’ needs.

In addition to narrowing focus when it comes to applying big data, it’s recommended healthcare providers to have a team and system in place before digging into heavy data analysis. The big data team will include technical people to perform the analysis and nontechnical members who will establish the use case and goals for your big data project. After the desired data and project goals have been identified, the analytics system purchasing process can begin.

New medical technology, combined with reimbursement and reporting requirements has increased providers’ demand for fast analysis of patient data. Most hospitals have found a way to store all of the new data being created, but are working to find ways to analyze that data and present it to physicians to save them from being overwhelmed with information. For many, that’s where a big data project comes in.

March 26, 2014  1:43 PM

FDA must be clearer with rules on mobile medical applications

Posted by: adelvecchio
FDA, medical device regulation, medical devices, mobile apps

A bipartisan group of six U.S. Senators pressed FDA Commissioner Margaret Hamburg to share the FDA’s regulatory plans with the public to avoid consumer, vendor and healthcare practitioner confusion. The group also cautioned the FDA against overly-aggressive regulations.

In a letter, the Senators also expressed concern that FDA signals about its intent to regulate mobile medical applications fail to go into sufficient detail about the governance of mobile software.

“It is important for the FDA to be well-equipped with the proper tools to be able to advance public health,” stated the letter, “while taking care that innovation is not stifled through uncertainty or over-regulation.”

Released last year, the FDA’s plan for regulating mobile apps entails evaluating an app and determining potential risk to its users. Lower-risk apps – the majority of all medical apps – will go unregulated. A benefit of this less stringent approach is that it won’t discourage developers from producing new applications. Regulated apps will be put in one of three categories by the FDA: Class I (low risk), Class II, or Class III (high risk).

The bulk of regulated medical apps, including most smartphone apps, will fall in the middle of the spectrum and be categorized as Class II devices. Class II devices are those for which “general controls” alone aren’t enough to ensure the safety of their use. Improper use or malfunctioning of Class II devices could result in adverse effects for a user.

The FDA’s decision a year ago to not regulate the sale of mobile devices had some healthcare decision-makers looking toward the future with guarded optimism. The tenor of the response was the same then as it is in the latest letter to Margaret Hamburg. In response to the FDA’s March 2013 ruling, Energy and Commerce Committee Chairman Fred Upton said, (R-MI) “We can only hope FDA sticks to its word and continues to allow doctors and developers to operate in an environment that promotes innovation.”

March 20, 2014  1:03 PM

Patients worry over privacy, ownership of personal health data

Posted by: adelvecchio
patient data privacy, personal health records, quantified self, self-tracking

While the “quantified self” movement is widely written about, who is quantifying what patients actually care about? Three new studies shed light on this trend.

Three-quarters of patients believe they should own their personal health data, including that which is self-tracked or captured by patient-owned devices. This is detailed in a report on the Health Data Exploration project performed by California Institute for Telecommunications and Information Technology and supported by the Robert Wood Johnson Foundation. The project seeks to provide researchers with self-tracking data recorded by patients. Patient worries about the privacy of their data may prevent this connection, as 57% said their privacy must be assured before they would share their data with researchers.

Researchers were also surveyed as part of the project and 89% of them agreed or strongly agreed that self-tracking data will be helpful to them and their work. Nearly all (95%) of researchers agreed that self-tracking data could answer questions that other data could not.

A Pew Research Center survey showed that patients with chronic conditions are more likely than others to both measure and share their health data. Of those with one chronic condition, 70% said they track at least one of the following indicators: frequency of headaches, diet or exercise. More than half (64%) reported that they share data with their physician. This survey is evidence that today’s technology isn’t needed for patients to take part in the self-monitoring or “quantified self” movement. Only 4% used an mHealth app to track a condition, while 41% did so with pen and paper.

Data recorded via self-tracking devices is valuable to patients and researchers if it’s accurate. Researchers from Arizona State University measured the accuracy of data recorded via wrist or waistband-worn devices against that of masks worn over the mouth and found the former didn’t always paint a full picture. Specifically, the wrist and waistband devices “do not detect light-intensity activities very well,” said Glenn Gaesser, a professor and the director of the Healthy Lifestyles Research Center at Arizona State University.


March 12, 2014  11:40 AM

ONC asks for $14 million health IT budget increase for 2015

Posted by: adelvecchio
FDASIA, health IT budget, Karen DeSalvo, ONC

The Office of the National Coordinator for Health IT’s budget request for 2015 is $14.3 million more than the enacted budget for 2014. The 2015 health IT budget request comes in at $74.7 million and includes funds for establishing a Health IT Safety Center.

“New investments would support a new public-private partnership aimed at enhancing patient safety and health IT usability through surveillance and analysis of safety incidents,” Karen DeSalvo, M.D., national coordinator for health IT, wrote in the agency’s official budget proposal. Congress has funded ONC’s budget at a flat $60 million for many years.

The budget is also intended to help ONC develop and support health IT standards and help federal agencies enable healthcare reform. Part of these duties includes overseeing the Health IT Certification Program in partnership with CMS, which was shaken up earlier this year when The Certification Commission for Health Information Technology announced it would no longer certify EHR technology for meaningful use.

ONC, the FDA and FCC jointly announced at HIMSS 2014 that they plan to release draft guidance sometime this month on the safety of health IT and how it should be regulated in the future.

This plan will include a section on mobile devices and applications, something that has been in development for some time. The FDA Safety and Innovation Act (FDASIA) Workgroup published draft recommendations on the subject in September, 2013 and turned them over to ONC, the FDA and FCC to be factored in to their larger health IT regulatory plan. The EHR Association cautioned policymakers against changing medical regulations until those three federal agencies perform further analysis and complete their regulatory framework.

In late 2012 — as part of its continuing patient safety efforts — ONC released its Health IT Patient Safety Action & Surveillance Plan for Public Comment. The plan targeted improving the use of EHRs. Specifically, it sought to utilize EHR capabilities to help providers report adverse safety events and guide them on what to avoid when implementing EHR systems. The plan didn’t propose a new quality reporting system, likely due to the fact that the ONC knew a more encompassing set of recommendations were in development.

March 6, 2014  1:56 PM

Physicians capturing data with mobile devices, finds HIMSS analytics

Posted by: adelvecchio
BYOD, HIMSS 2014, HIMSS Analytics, mHealth

Three research reports confirm that clinician and patient mobility — and the technology that serves them — will be a focus of investment for the next several years.

According to the 2014 HIMSS Analytics Mobile Survey, more than a third of physicians (36%) use mobile devices to record patient data at the bedside and 69% view patient data on their mobile devices. Privacy and legal ramifications are concerns of healthcare organizations, as evidenced by the 95% of respondents that indicated their organization uses at least one security tool to protect data viewed on mobile devices. More than half (59%) also revealed their facility has a mobile security plan in place, and 29% said their security plan was in development.

A second survey indicated that safe mobile data practices should continue to be a focus of healthcare providers. A recent mHealth report from Grand View Research, Inc. projects that the global market for mHealth will reach more than $49 billion in 2020.

Many hospitals have BYOD policies in place to protect their employees’ devices and any data they access. The HIPAA omnibus rule’s enforcers are levying an average of $1.5 million in penalties for loss of a laptop with unecrypted clinical data on it, and that’s just a starting point for privacy breaches. Such new rigorous enforcement has caused providers to reevaluate their security plans. Encrypting laptops and smartphones, as well as the ability to remotely wipe stolen employee devices are just a few of the steps some facilities have taken to protect themselves.

Mobile patient monitoring services — the largest market segment of mHealth — possessed a $1.2 billion market value in 2012 and the segment is expected to have a compound annual growth rate of 49.7% from 2014 to 2020, according to Grand View. The cost benefits of mHealth are part of the reason its use is expected to continue to grow.

A third report from the Groupe Speciale Mobile Association and PricewaterhouseCoopers showed that mHealth could save healthcare $400 billion over the next five years. The versatility of mHealth is another factor contributing to its popularity. What started with simple mobile applications has expanded to include videoconferencing and remote patient monitoring.

February 27, 2014  11:48 AM

ONC’s proposed 2015 EHR certification standards open to comment period

Posted by: adelvecchio
EHR certification, EHR implementation, meaningful use stage 2

Following through on their promise to update certification criteria more frequently, the ONC has released its proposed rule for 2015 voluntary EHR certification standards. The federal agency currently is seeking feedback on its rule and specifies that providers using products certified to the 2014 standards do not need to upgrade to remain eligible for meaningful use stage 2 incentives.

The 2015 standards are designed to promote interoperability and improve upon the 2014 standards, according to the ONC’s release. Jacob Reider, former acting national coordinator for health IT, last year discussed the agency’s plan to continually upgrade EHR certification standards in a Q&A with SearchHealthIT. He asserted that securing EHR certification, though voluntary, makes sense for vendors trying to sell their products in today’s EHR market.

Providers and vendors both have expressed concern about trying to meet a slew of health IT initiatives in rapid succession. Reider said the ONC understands providers feel buried by the numerous health IT laws and certification requirements heading their way, but added that taking these steps will benefit patient care.

Meeting meaningful use guidelines starts with picking the right certified system. This process is one that some providers are more familiar with because they’ve had to perform more than one EHR installation. According to a Software Advice report, 31% of EHR buyers have replaced their system since the 2009 introduction of the HITECH Act. Half of those surveyed named forced upgrades and connected costs as prominent issues that come with maintaining an EHR system.

February 25, 2014  2:39 PM

HIMSS survey respondents say more money needed to help meet stage 2

Posted by: adelvecchio
health IT, HIMSS, HIMSS 2014, meaningful use stage 1, meaningful use stage 2

More than 90% of respondents to the annual HIMSS Leadership Survey reported that their organizations have met the requirements for stage 1 of meaningful use. The survey also found a shift in the primary barrier to successful health IT implementations. This year’s respondents cited limited financial resources as their main problem — though 65% also reported IT budget increases — while the past two surveys both had insufficient and untrained staff as the top concern.

Healthcare organizations striving to receive reimbursement payments will allocate some of their health IT budget toward qualifying for meaningful use stage 2. A quarter of last year’s leadership survey respondents stated that their facility planned to invest a minimum of $1 million toward that goal. The expectations for stage 2 adoption have held steady since a year ago, when three-quarters of HIMSS leadership respondents said they expected their organizations to attest to stage 2 in 2014. Only 4% of respondents to last year’s survey said their organizations had no plans to qualify for stage 2.

The HIMSS survey results project confidence in widespread meaningful use attestation in 2014, which seems to be at odds with the recent decision to extend the attestation period for stage 2 an extra year through 2016. The extension came after the College of Healthcare Information Management Executives and 17 Republican Senators made a formal request to HHS Secretary Kathleen Sebelius.

Some providers have expressed concern that a lack of interoperable data will hinder their ability to meet stage 2 obligations, as documented in a white paper by Corepoint Health LLC. The interoperability problems — including difficulties exchanging patients’ continuity of care documents — limit providers’ participation in statewide HIEs.  The health IT executives who participated in Corepoint’s focus group expressed confidence that they had the tools necessary to work around these interoperability blockades.

February 19, 2014  11:07 AM

Electronic submission of medical device reports now a requirement

Posted by: adelvecchio
FDA, FDASIA, investigational device exemption, UDI

The Food and Drug Administration’s finalized rule for medical device surveillance requires manufacturers to submit reports for individual medical device adverse events. The medical device reports (MDRs) are now required to be submitted electronically to the FDA, which can then analyze and store the information. The final rule specifies how to submit a report and what information must be included in each MDR.

This ruling is the latest in a line of medical device-related rules and comments from the FDA. Last year, the FDA released the final rule requiring a unique device identification (UDI) system for medical devices. This rule is enforced to simplify adverse event reporting and recall of faulty medical devices. The UDI system will be used to build a public database of medical devices.

The FDA is also asking for public responses on their latest guidelines for companies who are seeking feedback on medical device investigational device exemption (IDE). Devices that receive an IDE can be used in clinical studies to observe the safety and effectiveness of the product. The new FDA guidelines suggest that businesses should ask for their feedback before conducting any trials or studies. The name of the program has changed from the pre-IDE program to the Pre-Sub[mission] program and has expanded to offer advice on products regulated by the Center for Biologics Evaluation and Research.

The FDA Safety and Innovation Act (FDASIA) Workgroup has teamed up with HHS to create a regulatory outline for the continued regulation of medical devices. The HIMSS EHR Association sent a letter to HHS in response to this partnership, and warned them not to extend medical device regulations beyond the current list of products until further analysis has been completed. FDASIA’s recommendations will be given to the FDA, ONC and FCC. Those three agencies will then create a final report for the regulatory framework.

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