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Meaningful Health Care Informatics Blog

July 14, 2013  10:40 PM

Steps to ensure devices do not affect patient satisfaction

Posted by: RedaChouffani
patient satisfaction, tablets

A recent report explored the affect technological devices have on the patient and caregiver relationship. The report, presented to the American Medical Association, titled “Exam Room Computing & Patient-Physician Interactions” was presented by Steven J. Stack, M.D. It concluded there is not a significant negative impact of using these devices during care.

The report states,These concerns have been explored in several studies of patient satisfaction… Over the past two decades, research has consistently indicated that patient satisfaction does not appear to be adversely affected by the introduction of computers into the examination room.

There are few reported cases of patients being distracted by ringing phones during a care visit. There are discussions around the difference between having a tablet at hand versus a PC on a cart or mounted to the wall. Overall, the study outlined that the attention given to patients by their provider, not the devices they use, makes the biggest difference in patient engagement and satisfaction.

IT executives typically focus on four critical areas to ensure that the patient and caregiver relationship is not negatively affected by technology. The following are some of the criteria that IT executives consider when evaluating technology’s role in care settings.

Connectivity disruptions and performance issues: Tablets, PCs and laptops are the go-to tools for many hospital caregivers to gain access to their patients’ health information. It’s critical that the system is accessible at all times, whether the device has wireless access or via a wired connection.

Clinical application responsiveness: Managing all the applications that are being used in the hospital environment can be a challenging task for the IT department. Hospital staff members can be frustrated when network network bottlenecks or application issues affect patient care.

Ease of use: One of the tag used during a recent EHR sales presentation was “Our system can help you track everything and anything, and everything is extremely customizable.” A system’s level of complexity or capacity to track and organize data doesn’t always make it the best choice. A system that is easy to use and has a logical flow of data can help support providers. Physicians have described this as a key functionality when evaluating an EHR product.

Patient friendly system: When patients see their caregiver using an electronic device during their visit, it’s likely that patients are curious about how the device is assisting in their treatment. Physicians have been able to use care summaries and other tools to educate patients on this topic. Physicians can also share their screen to show patients how they are using their devices during a patient visit.

Disable distractions: Tablets, PCs and mobile devices frequently receive alerts and notifications. These can be distractions to the caregiver if they are continuously pop up during the care episode. The IT department can avoid these distractions by muting all alerts.

The majority of medical staff today use electronic devices for work purposes. We must insure these devices are fully capable of fulfilling their goals without risking a negative impact to the physician-patient relationship.

July 9, 2013  4:24 AM

Delay announced for employer insurance mandate

Posted by: RedaChouffani
affordable act, Affordable Care Act, insurance

The health insurance reporting requirements for employers with over 50 employees was pushed back until 2015. This one-year extension was authorized by the White House. The original requirement was part of the Affordable Care Act. The announcement was made on Valerie Jarrett’s blog and outlined the need for more time to revamp and simplify the reporting process, as well as provide businesses more time to comply with the requirement.

The blog post listed a summary of the changes, which are as follows.

  • If you are a small business with less than 50 workers, the law’s employer shared responsibility policies does not apply to you. Instead, you will gain access to the Small Business Health Options Program that gives you the purchasing power of large businesses. In fact, you may be eligible for a tax credit that covers up to half the cost of insurance if you offer quality coverage to your employees
  • If you own a business with more than 50 workers that already offers full-time workers affordable, quality coverage, you are fine – we’ll work with you to keep that coverage affordable.
  • And if you are a company with more than 50 employees but choose not to offer quality affordable coverage, we have provided as much flexibility and transition time as possible for you to move to providing affordable, quality coverage to your workers.

The decision for the delay has been received with mixed feelings. While some employers see this as a step toward having more time to prepare, others such as hospitals are concerned that uninsured patients will continue to seek ER care, possibly to costing hospitals ongoing write offs.

In addition to the concerns of some hospitals, a letter has been sent by the House to the secretary of HHS and the treasury department requesting additional information on the process used to decide on the extension.

July 7, 2013  9:54 PM

Application virtualization and its impact on tablet adoption

Posted by: RedaChouffani
applicaiton, Virtualization

There is a constant demand for more storage and computing power to support the implementation and upgrading of hospital systems. This often requires the presence of virtualization. Server, desktop, and storage virtualization all attempt to maximize the use of specific hardware while reducing its physical presence.

Currently, there is more emphasis on implementing solutions that enable the delivery of line of business applications to any device at any time. This has driven IT to identify technologies and seek vendors that can solve this challenge and deliver interactive systems that are accessible from any interface.

Tablets are here to stay, though they are not the most-used devices within hospital facilities. Some of the reasons for their unpopularity are:

  • Lack of native support for critical business applications
  • Limited processing capabilities
  • Lack of native apps for commonly used applications within clinical and other departments
  • Security concerns
  • Hardware limitation and lack of integration with third party vendors

However, there are clearly reasons why consumers choose tablets over traditional PCs and laptops. The innovations of virtualization vendors are shrinking the list of reasons  that previously discouraged tablet adoption.

Application virtualization platforms offered by vendors such as Citrix, Microsoft and VMWare have provided their users with on-demand availability of Web-based applications, native windows applications (EHR, registration,  PACS, and others), and more. This allows these applications to be streamed and accessed from any device, (mobile phone, tablets and desktops) while still allowing users to use the touch and gestures functions available on many of today’s tablets.

Some of the benefits offered by today’s application virtualization products are:

BYOD: Smartphone or tablet platforms can be used to access virtual desktops or virtualized hospital applications from anywhere and anytime.

Consumerization of IT: In the past, giving end users administrative privileges on their desktops was a big faux pas. Users can have instant and secure access to all their applications due to the the self-service capabilities of the current virtualization applications.

Follow me: Users can simply be set up with a profile and list of applications they can access on any device, because many applications are hosted within a public or private cloud. They can start working on one product or application on one device, and connect to another and resume where they left off. This provides tremendous flexibility, as users do not need to spend time reconfiguring or downloading all their apps to every new device they pick up.

Improved security: Through centralized application management, data storage and maintenance, IT is able to have more control over content and ensure the separation between hospital data and personal BYOD data.

There are several other factors that are playing significant roles in increasing the usage of tablets and mobile devices in the enterprise. Products such as Microsoft App-V and Citrix Receiver are enabling this shift and transforming applications into centrally managed services without the need to install anything on the devices.

July 2, 2013  7:26 AM

Are big technology vendors shifting their focus to the cloud?

Posted by: RedaChouffani
cloud services, solutions

Many technology vendors are gaining interest in the IP acquisitions and cloud services market. These types of products and services are being added to the portfolios of many healthcare IT executives. Within the healthcare arena, the need for storage will always be in demand. Though how data is being stored will change, as seen with the current shift toward electronic data. As data management, analysis and visualization solutions continue to grow, so does the need for cloud services. This has become an attractive market for many storage vendors.

Many hardware manufacturers are joining companies like IBM in pushing for more comprehensive offerings to help provide the biggest value to their clients.

The following is a list of products and services that are being considered by many technology vendors:

Mobile devices: With mobile devices and tablets outpacing the total PC sales during the past quarter, The increase in mobile device use is putting significant pressure on PC manufacturers to increase their mobile product selection. The market is dominated by the likes of Apples and Samsung, however some of the newcomers have seen success and have been able to leverage their client base from the PC world.

Consulting services: Companies such as IBM and Oracle have been able to help their clients by providing them with consulting services. In return, this provided a strong value proposition to their clients and ensured a long lasting relationship. By leveraging the existing relationship these vendors already have with the clients that purchase hardware from them, they are able to extend beyond the conversations around warranties and technology, and are able to offer more meaningful services.

The cloud: In the hardware business, storage and servers are a significant amount of a company’s revenue. More organizations are electing to move toward cloud based services and require less hardware. Whether it’s to store large amounts of DICOM or medical imaging files, or simply host emails online, the decrease in server and storage needs means that vendors must quickly adapt and offer cloud services of their own.

The software: For some time now we have seen Dell increasing their acquisitions. Products such as SonicWall, SecureWorks, and Quest Software are helping Dell push products of their own to clients and increase the value proposition to their clients. This gives Dell the ability to pick and choose what products their clients truly need.

Comments recently made in one of Michael Dell’s presentations to the company’s stakeholders outlined the need for their company to change their focus. His comments are a clear indication that most PC manufacturers must evaluate their offerings and ensure they are in line with where the market is heading.

June 24, 2013  10:23 PM

Pulse offers multi-purpose fitness tracking

Posted by: RedaChouffani
fitness device, Pulse

In the next 30 days, Withings, a fitness device manufacturer, will begin shipping Pulse out to its customers. Anyone looking to experience a device that can track heart rate and other physical activities make consider it.  But for those of us up-to-date on the wealth of new fitness gadgets, this one may look at the surface to be just another fitness tracker.  However, there is more functionality than meets the eye.

This health app that tracks physical activity, weight, and sleep patterns also monitors as  heart rate. Withings is clearly offering consumers a single device for all their mhealth needs. Compared to other medical devices such as blood pressure and baby monitors, this fitness device has a longer battery life and can be worn on the wrist.

Following are some highlights of Pulse:

Meaningful and simplified data

The mobile app that processes the data captured from the Pulse is set up in such a way that the majority of the information is easy to review. With charts showing trends and day-to-day progress, the product is able to keep end users engaged.

Application integration

Many of today’s application developers are leveraging the cloud’s scalability and flexibility. Pulse offers cloud storage of information, and also offers integration capability with other partner apps that specialize in weight loss coaching, calorie tracking and cardio fitness.

Multi sensory information collection

Patients or consumers are interested in multi functional devices. This is important as it eliminates the need to carry and maintain charge on multiple devices. Pulse has been able to show that manufacturers are in fact looking to create multi-purpose gadgets by including the following benefits and capabilities in the device:

  • Steps taken
  • Elevation climbed actively
  • Distance travelled (based on user’s profile for high precision)
  • Calories burned
  • Run (daily recap of duration and distance)
  • Instant heart rate
  • Sleep duration
  • Sleep quality
  • Light vs. deep sleep
  • Sleep interruptions
  • Long battery life (2 week average use between charges)

June 17, 2013  9:47 PM

300 medical devices across 40 vendors subject to password vulnerability

Posted by: RedaChouffani
FDA, ICS-CERT, Medical devices

As more medical devices enter the marketplace, payers, physicians and patients are paying close attention to the capabilities they desire, whether that be options for managing  chronic conditions or helping with a recovery process.  But one need is universal: reliability.

Whether it is hardware or software-based failure, electronic devices can malfunction.  Many patients understand and – to a degree – accept this. However, as data breaches increase, more people are concerned about security vulnerabilities in mobile and medical devices.

An alert by the Industrial Control Systems Cyber Emergency Response Team (ICS-CERT) on June 13, 2013 described researchers reporting hard-coded password vulnerability affecting about 300 medical devices across 40 different vendors.  These discoveries can potentially allow for access to the devices’ firmware. It goes unsaid that exploitation of this information could pose a significant danger to their users.

Because of the urgent nature of the threat, the ICS-CERT has been working closely with the Food and Drug Administration (FDA) to identify vendors and mitigate risks.

Some types of devices identified in the report:

  • Surgical and anesthesia devices
  • Ventilators
  • Drug infusion pumps
  • External defibrillators
  • Patient monitors
  • Laboratory and analysis equipment

The FDA has published best practices in an attempt to help individuals and healthcare facilities take appropriate steps from here.

June 8, 2013  8:37 PM

Near Field Communication: right for mHealth?

Posted by: RedaChouffani
mhealth, near field communications, NFC

In the U.S., there are a few mobile phones with Near Field Communication (NFC) technology, a service that facilitates secure exchange of information by simply putting a mobile device near a scanner.

This near contact allows people, for example, to use their smartphones as digital credit card, tickets, library cards and many other usages.  But while many discuss the potential of NFC technology in healthcare, the ultimate challenge is the low number of devices in the market with capability to support the tech..

NFC has the ability to allow for the following uses within healthcare:

  • Patient check-in during their visit to a provider or a healthcare facility
  • The ability to securely transmit and exchange of health information
  • The quick and easy collection of patient payment
  • Medication management and tracking for patients
  •  Securely signing into computer systems to access health information
  • Fitness tracking capabilities to help patients with wellness and fitness programs

The SD Association has released an SD card that can now be loaded into a smartphones to act as an NFC transceiver.  This will open up the door to a wider number of consumers to use devices enabled for NFC. These devices have seen an incredible adoption rate, and for consumers and patients functionality available through contact-less services enable us to interface and interact with systems in a much more efficient way.

June 8, 2013  7:53 PM

CMS releases big data on spending

Posted by: RedaChouffani
CMS, data, Datapalooza

This June, many in healthcare informatics watched Health Datapalooza IV closely. It was packed with valuable presentations showcasing uses and innovations around data.  For most, the data available through healthcare holds potential to improve patient care and population health.

At this year’s Datapalooza, Department for Health and Human Services (HHS) secretary Kathleen Sebelius announced that the Centers for Medicare and Medicaid Services is releasing data for average hospital charges for 30 types of procedures, such as: Endoscopies, cardiograms, Debridement & Destruction, Diagnostic and Screening Ultrasound, and a few more.

“A more data driven and transparent health care marketplace can help consumers and their families make important decisions about their care,” said Sebelius. “The administration is committed to making the health system more transparent and harnessing data to empower consumers.”

The 2011 data has been received with resistance from hospitals, as patients can sometimes see wide differences between prices for the same procedures, and may misinterpret the data’s function.

For healthcare leaders, this was another example of administration working toward making more data available to the public in order to encourage innovation through active data use.  However, as Jonathan Bush, CEO of Athenahealth, outlined during his keynote address, HHS needs to release even more data in order to enable vendors, data scientists and other researchers to use data in meaningful ways. 

May 31, 2013  8:37 AM

Mobile charge capture and more: how mHealth apps can fill EHR gaps

Posted by: RedaChouffani
Apps, mhealth, mobile charge capture

As more physicians use electronic medical records (EHRs), the way we document, bill and consume patient health information is changing. Typically, interactions with EHRs begin and stay within the boundaries of the medical practice. But some healthcare disciplines still have plenty of gaps where care providers use paper-based processes and documentation – despite the potential for EHR implementation at their offices.

If we consider independent physicians with privileges in hospitals and observe their workflows and patient interactions, we can clearly see the challenges they face when it comes to tracking the patients they round on and procedures they perform via digital documentation.

Health Information access:  For physicians who must see patients outside of their facilities and lack easy access remotely to their EHR from the hospital, the lack of access can at times force them to track cases and procedures of patients on paper-based documents.

Charge capture:  When procedures are performed within surgery centers of operating rooms, there are cases where some surgeons have to document these cases on paper-based encounters.  Having to see several patients a day and relying heavily on the process of getting the paper encounters back to the office to bill can increase the chances of missing charges and delay billing and payment.

Coordination of Care:  There are many episodes where one care giver may not be the one rounding or following up on patients who have been admitted to a hospital after a specific procedure.  And for those providers who don’t document the procedure during the initial day of admission, they must rely on methods that may not be very effective to document and communicate to other rounding physicians.

Quality and Compliance: When physicians rely on paper-based documentation for charge capture and rounding lists, it’s hard to impose certain criteria related to pay for performance initiatives. This poses a challenge as there are no easy ways to assist in tracking and reporting on the compliance of these rules, not to mention added costs from outdated technology.

Fortunately, with the onset of mobile devices, many mHealth apps can help resolve some of these challenges for providers.  Whether they are mobile apps provided by EHR vendors, or charge capture apps with secure messaging,  having the ability to leverage mobile apps to efficiently capture health information as well as streamline workflows and processes would be valuable to these physicians without full access to their EHR systems.  Through this model of data collection and communication platform, these mobile charge capture and rounding apps have the ability to reduce and in many cases eliminate missing hospital charges and provide to have a significant ROI.

May 29, 2013  9:13 PM

CMS stats on EHR adoption

Posted by: RedaChouffani
ARRA, EHR implementation, HHS

Health IT initiatives have been on the rise since the enactment of the American Recovery and Reinvestment Act of 2009. Recently, department of Health and Human Services (HHS) Secretary Kathleen Sebelius provided some key statistics to support the claim that there is an increase in electronic health records (EHR) adoption as well.  In a press release made public on May 22, 2013, HHS announced that it had met and exceeded its goal for 50% of doctor offices and 80% of eligible hospitals to have EHRs by the end of 2013.

“We have reached a tipping point in adoption of electronic health records,” Sebelius said. “More than half of eligible professionals and 80% of eligible hospitals have adopted these systems, which are critical to modernizing our health care system. Health IT helps providers better coordinate care, which can improve patients’ health and save money at the same time.”

In contrast to some of the low adoption rates seen during 2008, this increase has shown that despite the challenges that some have faced during the implementation of an EHR system, more physicians are recognizing the value they can gain from them.

The press release included the following statistics:

  • More than 291,000 eligible professionals and over 3,800 eligible hospitals have received incentive payments from the Medicare and Medicaid EHR Incentive Programs.
  • Approximately 80% of all eligible hospitals and critical access hospitals in the U.S. have received an incentive payment for adopting, implementing, upgrading, or meaningfully using an EHR.
  • More than half of physicians and other eligible professionals in the U.S. have received an incentive payment for adopting, implementing, upgrading, or meaningfully using an EHR.

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