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Meaningful Health Care Informatics Blog


July 2, 2012  9:11 PM

Obama’s Administration makes additional funds available to help states implement Affordable Insurance Exchanges



Posted by: RedaChouffani
HIE, state exchange

After the Supreme Court ruling in the last week of June of 2012, the Obama administration made new funding available to help the states implement the affordable insurance Exchanges.

Despite some of the states announcing that they will not participate in the initiative, many will look toward 2014 where the affordable insurance exchange will provide people and eligible businesses with a central place to shop for affordable health insurance.

The secretary Kathleen Sebelius made the full announcement on June 29th, 2012.  She also outlined how the HHS issued additional details in regards to what activities will be covered by the funding.

“The federal government and our state partners are moving forward to implement the health care law,” Secretary Sebelius said.  “This new funding opportunity will give states the resources they need to establish affordable insurance exchanges and ensure Americans are no longer on their own when shopping for insurance.”

This exchange would require complex Exchange IT systems, and currently six states and a multi-state consortium led by the University of Massachusetts Medical School received over $241 million in Early Innovator grants to develop model around the Exchange IT systems.   This would provide significant support from a technology prospective to the rest of the states who have received funds, but are still looking to see what technologies can be implemented to facilitate the exchange.

The Center for Consumer Information & Insurance Oversight provided some frequently asked questions and answers on their web site regarding the funding made available through the Affordable care act section 1311(a). http://cciio.cms.gov/resources/factsheets/hie-est-grant-faq-06292012.html.

June 25, 2012  9:05 PM

Who are the next big data players and what data can they leverage



Posted by: RedaChouffani
BIG DATA, EHR, Electronic health records, Patient health information, Patient health record, PHI, PHR

Almost everyone in the tech world has now been exposed to the term big data.  This is one of the most significant growth areas standing to make a real impact in the health care landscape, a technology trend making good use of existing patient and health data collected within hospital facilities.  As many continue to hoard data that is captured in EHR systems, asset management systems and external sources of data, there is still the question of how all of this data will truly help improve our health care system.

Health information exchanges (HIEs) have a unique advantage when it comes to data access. They typically manage the exchange of PHI from multiple health data repositories across the industry.  While in most cases there is not direct access to the entire data set of patient health records, HIEs technically have the ability to do so if allowed. However, many see that as a major breach of privacy and patient confidentiality unless patient data has been deidentified — data extraction cleared by the connected health organization defined as the source.

But the reality is that there are very few organizations that currently have the potential to warehouse large patient data sets. Though in the market, there are many available entities that have access to, and the ability to store, a significant amount of health information that may be used for big data initiatives:

Personal Health Records:  PHR vendors host patient health information.  This provides them with direct access to patient health records that can be used as source for big data initiatives.

Electronic Health Records with HIE services: Some of the EHR vendors provide PHR and community based HIE services for all their clients.  This facilitates the exchange of information without some of the added costs of special interfaces with HIEs.  By doing so, it enables the EHR vendors access to patient information from provider organizations throughout the country.

Health Information Exchanges: HIEs do receive a significant amount of traffic in the form of exchanged health information and health record requests.  While the data comes from different EHR systems, it is still standardized and both structured and semi structured.

Payers:  By design payers do have access to claims information that holds some of the patient’s information.  And in many cases, insurance companies do store some medical records in an unstructured format relating to certain patient cases.

Patient Registries: Throughout health care system, there are several individual patient registries that allow for patients with specific conditions to capture patient’s health information that meet specific criteria.  These registries tend to have health information about patients with specific conditions, which has significances for scientists that are in need to study patients with specific conditions.

Large Health Systems with EHRs:  With hospitals continuing to grow and merge, EHR systems amongst them are also converging.  This will enable a central repository for patient electronic records that spans across a larger geographic area that crosses state lines.

Labs:  There are several large lab organizations that currently participate and provide access to historical data for patients.  As active connections for many HIEs these entities hold large volumes of data regarding lab orders and results.

ePrescription Hubs:  With only a handful of electronic prescription hubs, much of the nations electronic data is spread across few systems.  This means that patients current and previous medication.  Similar to Lab firms, much of the data can be accessed through HIEs

While so much of the data is fragmented across several different silos, HIEs have the potential to pull all the information together and build one comprehensive data store for patient health information.  One effort that may lead us toward one centralized data repository is for a national health data bank is the NHIN which with big data provide tremendous insights to the overall health and outcome measures at a much larger scale.


June 25, 2012  9:02 PM

8 significant aspects of telemedicine



Posted by: RedaChouffani
CMS, healthcare IT trends, telehealth, telemedicine

For sometime many have predicted that telehealth will have a significant importance to healthcare.  This hard trend holds true, and is proven to bring value through its ability for: remote visits with patients, immediate access to healthcare professionals, real-time access to heath data and health monitoring capabilities.

We can review the following 10 items that make a strong case for telemedicine being a significant trend for healthcare:

Consumer Access: As the number of patients being exposed to video conferencing continues to grow, and all the conveniences it provides them with, many are continue to wonder when more physicians will be able to perform follow up visits over the internet. In some cases parents are looking for the convenience of their children seeing they primary care or FNP from the comfort of their home or even the nurses office at school. There have been many successful implementations of this use case that continues to make a strong case for the value of telemedicine.

Improved Outcomes: Telemedicine includes services such as remote health monitoring. In this model patients use devices such as smart phones or medical devices to transmit health data to health organizations that monitor. There have been several studies showing the value of remote monitoring.  It has been shown to improve the patient’s health and reduce emergency room readmissions. As these outcomes continue to be measures, telemedicine has the opportunity to provide significant impacts on quality and patient outcomes.

Telehealth will increase efficiency: With the right technology, health organizations can significantly have a reduction in operational costs by using these services.  By performing follow up visits remotely, medical practices can take better control of their schedules, waiting room and visits.

Governmental support and funding: CMS and many states have made significant efforts to support telemedicine. Last year CMS released ruling that simplified the credentialing for provides who treat patients remotely.  And in last May telemedicine initiative was a significant feature in the first round of projects from CMMI (Centers for Medicare and Medicaid Innovation).  There have also been significant changes have been around reimbursement from both public and private payers.

Technology is available to support stronger adoption: Whether you are a use of WebEx services, Microsoft Lync, Skype, Facetime, or simply Google Video Chat video conferencing is more popular and accessible than ever. And within healthcare some of those platforms are being used but with a little more focus on security. Several of the vendors above offer advanced functionality that is relevant in the healthcare arena such as archiving, document sharing and multi use conferencing.

Electronic Medical Records: EHR vendors are providing support for capturing and supporting new types and formats of data sets. While telemedicine provides several types of data (vitals, data from medical devices, videos and audios), today’s EHR packages are becoming more aware of the importance of support data variety.

Patient satisfaction: Patients are looking for convenience. And for many, the least they have to drive to a medical practice, find a baby sitter, and wait in the waiting room the happier they will are. In some cases patients are looking to get immediate access to a specialist, this can be made possible through telehealth services as well.

Care delivery change and the need to continuity of care: ACOs and the push for collaborative care and care continuity model play a strong role in supporting telemedicine.  With the ability to maintain contact with patients as well as monitor their health remotely, patients and the care team will benefit from the telemedicine significantly.

There is still a significant investment that has to be made by CMS and Hospitals to ensure the continuity of support and increase in adoption of telehealth. Many large hospital systems are actively engaging successfully their patients in their care through telemedicine services, but more needs to be done in order to make a bigger impact on outcome.  There are many benefits to be gained from this technology despite some workflow changes.


June 18, 2012  9:40 PM

What wearable medical devices mean to big data



Posted by: RedaChouffani
BIG DATA, Medical devices, mhealth, mobile health, wearable devices

With the increased adoption of electronic health records (EHRs), many health systems and providers now have both structured and unstructured patient data on which they are sitting.  This information is being stored either on the premises or in the cloud and serves as a valuable source of information from which clinicians and “datasticians” can cull. And though there is much promise of big data helping to improve care and increase efficiency, there are still some data points that are missing, such as vital signs and other health related information.

But as other industries have shown, data can be an extremely valuable asset for scientists.  For health care, in order to capture more information, caregivers must turn to the patients and look to capture data outside the facility walls as well.  This can be accomplished by prescribing medical devices that can monitor and publish health information to a central repository, where the next generation of devices will provide the continuous flow of information for extended periods of time.

Many of the wearable medical devices that we look at in the market consist of infusion drug pumps, glucose monitors, vital-signs monitors, pressure meter, heart monitors and ovulation prediction system, all having the ability to generate information that can be uploaded to a centralized data store. While they are still somewhat large in size due to the nature of the electronics needing to capture, process, and transmit the information, many device manufacturers are looking to incorporate technology that will enable these devices to be much smaller and still have the ability to be worn for extended periods of time. As these devices continue to capture more health information by listening to our bodies, this data will serve as an almost unlimited, significant source for data scientists.


June 18, 2012  9:36 PM

Modernizing US government systems as part of technology roadmap



Posted by: RedaChouffani
CIO, Digital Government initiative, federal agencies, HITpol, mhealth, Mobile health implementation

During May of 2012, federal agencies received a directive issued by the President of United States to modernized the way government works.  Under that executive order, the federal CIO released a strategy entitled “Digital Government: Building a 21st Century Platform to Better Serve the America People”.

The orders issued included the following two items:

(1)  Implement the requirements of the Strategy within 12 months of the date of this memorandum and comply with the timeframes for specific actions specified therein; and

(2)  Within 90 days of the date of this memorandum, create a page on its website to publicly report progress in meeting the requirements of the Strategy is a machine-readable format.

The document outlines a 12-month technology roadmap that will encourage the different agencies to improve on their technology platform by enabling data to be available via mobile and web-based technologies.  Part of the road map also outlines the need to adopt a platform that will enable developers to utilize APIs to gain access to government information that is machine-readable.

Currently the strategies objectives were described as:

  • Enable the American people and an increasingly mobile workforce to access high-quality digital government information and services anywhere, anytime, on any device. Operationalizing an information-centric model, we can architect our systems for interoperability and openness, modernize our content publication model, and deliver better, device-agnostic digital services at a lower cost
  • Ensure that as the government adjusts to this new digital world, we seize the opportunity to procure and manage devices, applications, and data in smart, secure and affordable ways. Learning from the previous transition of moving information and services online, we now have an opportunity to break free from the inefficient, costly, and fragmented practices of the past, build a sound governance structure for digital services, and do mobile “right” from the beginning
  • Unlock the power of government data to spur innovation across our Nation and improve the quality of services for the American people. We must enable the public, entrepreneurs, and our own government programs to better lever- age the rich wealth of federal data to pour into applications and services by ensuring that data is open and machine-readable by default

This is yet another great resource that can provide additional data as a new source for Big Data initiatives.  As different federal agencies publish information, data scientists will be able to mine and capture use for specific purposes.


June 10, 2012  9:46 PM

Aetna helping accelerate innovation by making data freely accessible to developers



Posted by: RedaChouffani
Aetna, BIG DATA, mhealth, mHealth apps, mobile apps, mobile health, Online health services, Software applications

As we continue to see the fruits of the health care IT start-up boom, we see many new organizations introducing disruptive products and solutions as part of their offerings.  For the majority of the health care market, there are already many established major players for EHR, radiology, HIS, and other commonly used software solutions.  But with the popularity of mobility solutions, things are changing slightly. Specifically, many start-ups have been introducing innovative online health services, fitness and nutritional mobile solutions and mhealth products that have corresponding health and wellness social components.

That being said, health care technology can at times be quite intimidating for those who are not as familiar with the use of “big data” and the interpretation of numerous data sets being synthesized everyday to make these apps work.  At times, access to any data can be almost impossible due to sensitivity of the information and lack of a secure way in which to retrieve.

But recently Aetna has been helping developers in both US and around the world to accelerate their development of new software applications and mobile capabilities.  This was done through CarePass web portal that offers access to data via RESTful web services.

Currently the site makes the following data available:

  • Health Data by HHS: The data currently contains NDC Drug information, FDA Drugs, documented Recalls, clinical Trials information in the US and around the word.
  • Retail Rx Pricing through GoodRx: This provides estimated pricing on drugs from retail pharmacies
  • Cost of Care by Aetna: This estimated cost information comes from Aetna Life Insurance Company’s Cost of Care Estimator. The Aetna Cost of Care Estimator provides information on the Aetna’s average contracted rates with providers in your area (“In Network”) or the average price that providers who do not contract with Aetna billed Aetna for that service in your area (“Out of Network”). Aetna estimates costs by averaging sufficient available charges and adjusting the average for inflation and other factors. The Aetna cost estimates are based on a year of care.
  • CarePass Sync: That provides personal health, wellness and nutrition for consumers.  This has not been released yet.
  • De-identified claims data: This data set will most likely be one of the most sought after.  Claims information as we all know contains diagnosis information, procedures, date of service, location and facility information.  The information would be a gold mine for many analysts.  Traditionally access to this information for software developers was limited, and unless you worked for a healthcare organizations most would not have access to this data.

This is a great example of online services that will help shape how data can be used in the future.  In addition, access to this information will help innovators utilize and create products and services that can truly help improve the health of all consumers.


June 10, 2012  9:38 PM

New Comprehensive Primary Care initiative from CMS to help pay for coordination of care



Posted by: RedaChouffani
Care coordination, CMS, Marilyn Tavenner

CMS announced in a news release on June the 6th, 2012 a new Primary Care initiative that will provide primary care practices a care management fee set at $20 dollars per beneficiary per month.   The proposed fee is designed to support enhanced and coordinated services from CMS and other insurance entities.

This is will be the result of a commitment from 45 commercial, federal and state insurers in seven markets who will work with CMS to provide improved care.

“We know that when we support primary care, we get healthier patients and lower costs,” said Acting CMS Administrator Marilyn Tavenner, “This initiative shows that the public and private sectors can come together to meet the critical need for these services.”

 

In order for primary care practices to receive this incentive they must offer the following:

  • Flexible hours to see the beneficiaries
  • The use of a certified electronic health records system
  • Delivery of preventative care
  • Coordination of care with patients and other healthcare providers
  • Working with caregivers and patients to engage them
  • Enhancing care for patients living with multiple chronic diseases and higher needs

There will be about 75 practices according to the news release that will be selected to participate in this initiative.   To start a practice must first fill the following application online:

http://www.innovations.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/index.html

So far several states have payers who have signed an agreement with CMS to participate in this initiative.  The sates are: Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley Region, Ohio’s and Kentucky’s Cincinnati-Dayton Region, and greater Tulsa, Oklahoma.

This initiative might provide a great first step for many primary care physicians and practices to move toward the coordination of care and help improve care for high-risk patients and ones with chronic disease.   However the lack of affordable technology components for small primary care physicians that will help with data sharing, patient engagement tools, collaboration and coordination of care might still pose the biggest hurdle for many to overcome.


June 4, 2012  9:32 PM

What to expect from Big Data in healthcare



Posted by: RedaChouffani
BI, BIG DATA, EHR

There has been a lot of talk about Big Data and Business Intelligence applications in the healthcare. Big data is one of the biggest trends, and as with any other technology, if it provides opportunity to improve care then it is worth looking into.  There are numerous examples and articles on the value and advantages of data use in healthcare, but not enough on how to utilize the data within a hospital facility and what systems to collect data from.

First started, many healthcare facilities that have moved to electronic medical records have collected a significant amount of data regarding patients who have passed through the system.  While the data is managed and distributed across multiple software solutions (radiology, surgery, nutrition services, Nursing notes, labs and other applications), with the move toward HIE, several hospitals have adopted solutions that help centralize and consolidate some of the into one summarized comprehensive record.

As this data continues to grow, it has provided organization with endless possibilities for meaningful usage.  But in order to do so, many needed to deploy business intelligence tools that can assist them through this data mining journey.

There is the case for some EHR vendors providing some basic BI tools to use, however, when talking about Big Data, we are also talking about utilizing several different sources of data from many systems and being able to connect information from different vendors and identify specific trends and abnormal things.

Big Data cannot be handled with the same traditional approach used for reporting.  The challenge is not just limited to the mammoth amounts of data that is to be used, but also security and integration with other non EHR based data sources.  Some of the examples of data sources that would be available:

Voice data files:  Nuance provides solutions that utilize their latest smart voice recognition technology and CLU (clinical language understanding) to create structured data out of voice data dictated by hospital physicians.

Personal fitness monitoring devices data: With the rise of these monitoring devices in the consumer arena, the data that is being made available ranging from physical activities, sleeping habits, heart, calories in take and such are also providing some insight to what patients are doing outside the hospital that can affect their health and well-being.

Patient Genome: As molecular biology continues to make strides toward identifying patients are higher risks for some disease and response to drugs.   As some of this data becomes available, hospitals can use some of that data.

Analytics competency can help these healthcare organizations harness “big data” to truly discover new insights, set their future vision, improve population health and improve operations.


June 4, 2012  9:29 PM

The surgeon will prescribe along with medications a mobile App



Posted by: RedaChouffani
Uncategorized

One of the challenges that hospitals face is how to continue to reduce infection related and post-surgery ER visit cases they see. Many executives are looking to identify ways to improve safety and compliance internally.  But in some cases, post-surgery ER readmissions are simply due lack of communication between patient and clinician which results in delays in identifying issues that could be treated easily.

Some have taken an innovative way to resolve to help curb the readmission rate. By monitoring the patient’s wounds and health remotely, they are able to catch things earlier and potentially avoid ER visits all together.

This is being done via smartphones and mobile devices.  When a patient has been discharged post an ambulatory surgery, they are provided with an app to download to their mobile device, and with that they receive daily questions and follow ups, as well as requests for incision photos that are uploaded and monitored by clinicians.  If at any point the patient’s condition is cause for concern, they are requested to visit a clinician or an emergency room.

By remotely monitoring the patients this close, hospitals are able to save healthcare dollars and provide better care.

Some of these Apps also provide additional information such as:  How to properly care for incisions, medication management as well as general patient services.

Mobile Apps continue to help reshape the future of healthcare and with the increase of user adoption; this technology has tremendous potential to save healthcare dollars while providing improved care.


May 28, 2012  9:01 PM

New start up to provide new online destination for patients looking for aggregated health information



Posted by: RedaChouffani
health education, Meddik, patient portal, social health network

While it is common advice to always seek a medical professional when there are health issues we face, many patients seek Internet search engines as a first attempt at self-diagnosis.  There are also many instances where some find more comfort in reading about the story of others that may be experiencing and living with the same condition as them.

There are several online resources that provide medical information on medical conditions and treatment options available.  These resources such as WebMD, or Mayo Clinic are in many cases used by clinicians as a recommended resource for reading more about the condition as patient education.

But with the rise of social media and constant demand for information, many community based forums have sprung up where patients are sharing their personal experiences living with specific conditions, remedies, side affects of treatments, new treatment options, and improvement stories.  Unfortunately, there have been very few sites that offer a central place with all this information resides.

But recently, Meddik, which is a new startup, founded by one electrical engineer Ben Shyong and a medical student from the university of Pennsylvania took a new approach to delivering health information to patients.  It provides a new way for its members to access aggregated health related content that is submitted and identified via tags in one central place.

The content ranges from articles, personal stories as well as multimedia that are around specific topics of the member’s interest.

In the last week, I have had the opportunity to signup for the site while in the Beta stage, and when I shared it with my family, I have received tremendous positive feedback on how easy to use it was.  The website will provide a valuable resource to patients that have chronic disease and are sharing their stories and what had helped them with their condition, as well as any user who has just been diagnosed with a condition and is looking to learn about how others in the global community dealt with it.  The website will also provide a way for the members to share articles and other outside links that would be relevant to any of the topics that have of interest to the readers.


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