May 21, 2012 10:30 AM
Posted by: RedaChouffani
, BIG DATA
, google glass
This year we have seen some truly amazing innovations in the healthcare arena. We continue to hear about the breakthroughs in the drug industry for cancer treatment, Alzheimer’s and other diseases. On the technology front, voice recognition and interactive systems have reached new heights, the incredible power of natural language understanding, data collection and retrieval being seen in next generation platform’s such as IBM’s Watson. Not to mention the impact that mobile devices have had on the healthcare industry as well, with all of these advancements and innovations continuing to influence our lives every day.
Things can get a bit more interesting for healthcare professionals when evaluating how some of the current innovations in the test phase can assist in care delivery. Specifically, what do you get when you add RTLS, gig data, cloud computing and NLP to Google’s Project Glass?
Well, the easy answer is an incredible device that could change the way clinicians use technology to treat patients and deliver the highest quality of care. Google Glasses are a kind of wearable computing device, and while the current prototype only plans to initially bring GPS tracking, phone, camera, and search engine results, in a healthcare setting, this platform — combined with many currently available technologies — can bring significant improvement and a shift in the way physicians interact with their patients and surroundings.
Delivery of health information:
During many of today’s most common surgeries, surgeons can easily benefit from the availability of a patient’s vitals displayed directly onto the glasses. There is also the use case where the physician performing rounds enters a patient’s room and is immediately flashed the pertinent patient information, such as name, latest lab stats, and other test results, enabling a timely, more informed episode of care.
With the availability of commercialized NLP and intelligent voice recognition engines such as Nuance CLU, a physician can submit orders and document the encounter without touching a keyboard or using transcription services. Not only would NLP facilitate interacting with electronic health records (EHRs), but also enable information to be stored in a structured format.
When looking the functionality developed around location tracking and GPS, we have seen products ranging from apps that automatically prompt restaurant reviews when nearby and location based profiles where ring tones and settings are configured based on your location, to augmented reality apps that uses your Android camera, compass and GPS position to add info on your surroundings as you go.
Mobile devices provide multiple ways for information delivery and can be, at times, overwhelming. However, many begin to quickly suffer from alert fatigues and information overload. But if a device can deliver relevant information based on location, and the patient who the physician is visiting, then any information such as returned lab results and such would allow to clinician to discuss with patient immediately while in the room. This would increase efficiency and improve patient satisfaction.
As more health data is collected from different sources for patients — data such as calorie intake from mobile apps, information from medical records from other physicians, DNA sequencing, and the like — complex patient risk analysis combined with powerful cloud computing systems and interoperability will provide physicians with an incredible amount of information regarding the patient they are treating. All this information can be displayed via Google Glass.
Imagine a physician during a conversation with a patient who is told about a previous health condition for which the patient was treated and then the Google Glass platform is able to immediately query the information from an HIE and retrieve all the details available so that the physician can have immediate visibility of the medical notes and make any relevant changes or decisions based on adequate and comprehensive data.
While these ideas may seem to be too unrealistic and futuristic, the fact of the matter is that all these devices and technologies are being piloted in different environments today. For healthcare professionals, these devices should be monitored closely as they can significantly help reduce costs, improve patient’s satisfaction and increase efficiency. And until a computing device can read our thoughts (there are technologies being tested today for this), we will need to embrace the changes and innovations coming our way.
May 21, 2012 10:28 AM
Posted by: RedaChouffani
, IT Jobs
Technology continues to interest many healthcare professionals. New innovations provide the promise of improving care, increasing revenue as well as reducing costs. On a weekly if not daily new products and solutions enter the market place and bring new exciting possibilities. For healthcare there are a tremendous amount of products that continue to help healthcare organizations with many of their challenges.
For Healthcare IT professional, the fast moving technology is changing what they are supporting. Many of the on going changes and hard trends, show us that tomorrows HealthIT engineers will be working and supporting much different systems from what they are currently doing today. The following are some of the examples of the areas that will see the most change in the industry:
IT departments will see a much stronger and aggressive shift to cloud based services during 2013. Everything from cloud based network management, hosted print management, cloud based office productivity tools as well as hosted electronic medical records. This change is reducing the dependency on premises servers and complex software support needs and thus reducing the amount of hands-on server hardware support needed.
Cloud based storage:
Cloud storage provides access to limitless volumes for healthcare organizations. Wether it is to be used for medical imaging, electronic medical records, or other clinical and administrative data we are certain to see this as a way for organizations to pay for the storage needed.
As more of the computing shifts to the cloud and software solutions are hosted in large data centers,, IT folks will spend a significant amount of their time managing products, implementations, and holding vendors accountable for service delivery.
Analytics has been providing healthcare with vital information that is helping drive success. IT folks will work closely with the different departments in the healthcare organization to collect, consolidate and analyze the available data and help identify savings opportunities, and make evidence based decision for better management.
Today hospitals are juggling with EHR implementations, ACO planning, ICD-10, meaningful use and many more projects that rely on technology. This means that more healthcare executives are looking internally for potential PM to help with many of the on going projects. Currently many seeking outside consulting firms that can assist with those needs, however as more and more services and computing moves to the cloud, IT engineers have the technical skills, and healthcare expertise to effectively lead some of the initiatives from the technical side.
The HealthIT workforce continues to be on high demand, and as technology continues to improve, and services and storage shift to cloud based, adopting new skills that the future demands of the market place is critical.
May 13, 2012 6:20 PM
Posted by: RedaChouffani
, Meaningful use
Privacy and Security continue to be on top of the health IT priority list. And as some of the new measures associated with Meaningful Use Stage 2 open up Electronic Health Information to patients as well as health information Exchange qualified entities, many IT executives are gearing up for more steps to ensure future changes due to stage 2 will be met with the appropriate security measures.
Since the introduction of Meaningful Use through the Medicare and Medicaid EHR incentive Program, the HIPAA privacy and security rules were intentionally included in the program. As part of meaningful Use Stage 1 there are two main measures as part of the requirements:
- Core Objective & Measure 126: Provide patients with an electronic copy of their health information, upon request.
More than 50 percent of all patients who request an electronic copy of their health information are provided it within three business days.
- Core Objective & Measure 157: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.
Conduct or review a security risk analysis in accordance with the requirements under the HIPAA Security Rule (45 CFR 164.308(a)(1) (ii) (A)) implement security updates as necessary and correct identified security deficiencies as part of the risk management process.
The National Institute of Standards and Technology developed a security toolkit application that is intended to assist health organizations understand the requirements of the HIPAA security rule and implement them (Click here).
In addition, the office of National Coordinator for Health information Technology made available some additional resources. It has released a guide to privacy and security of health information that describes the process and details of the meaningful Use core measure 12 and 15 (Click here)
May 13, 2012 6:18 PM
Posted by: RedaChouffani
On May 11th, 2012 the ONC published Request for Information (RFI) on governance of the Nationwide Health Information Network (click here)
The ONC is seeking to develop a common set of rules to guide the development of a baseline “Rules of the Road”. This comes after having an ad-hoc governance approach for the NWHIN that was the result of the work from contractual relationships, state, federal laws and other self-regulating principles.
Some of the key components available in the proposal are:
Adoption of “conditions for trusted exchange (CTE)”:
CTEs would reflect the nationwide health information network’s portfolio of standards, services and policies. The initial set of CTEs has been included in the RFI.
Establishment of a voluntary framework for entities that facilitate electronic exchange to be validated to CTEs adopted for the electronic exchange services or activities they are capable of supporting:
This is a certification program similar to what the HIT certification done through the ONC. Once an entity meets the requirements it would be considered a network-validated entity NVE.
Approaches for monitoring and transparent oversight:
This would create a mechanism that will ensure the protection of consumer rights by ensuring the NEs are performing their services adequately, and having a formal process to revoke an NVE’s validation status.
Establishment of processes that could be used to adopt, revise, and retire CTEs that are no longer appropriate.
Establishment of a process to classify the readiness for nationwide adoption and use of technical standards and implementation specifications to support interoperability related CTEs.
Currently the document has been posted in the federal register as a pre-publication PDF document. It is scheduled to be officially available on May the 15th, 2012. The public period is open for 30 days after the publication date.
May 7, 2012 2:10 PM
Posted by: RedaChouffani
Baby boomers have started reaching their retirement age in 2011, and with over 78 million of them as patients they will require care during their senior years. Baby boomers are commonly known as the more self-reliant, gadget early adopters, and active individuals. But with their high population number they are bound to put demand more from our health system.
In the current care delivery model we have today for senior citizens, nursing homes, hospital visits and assisted living are costly to both payers and patients. And for that reason payers are looking to see what cost benefits would caring for patients at home and support their independences bring.
There are many reasons for the increase in demand for home health services and following is a short list to name a few:
Lower costs: As patients are being treated at home, this alternate care location eliminates the costs associated with transport, and beds associated with charges inside a healthcare facility.
Telemedicine: Baby boomers are known for being early adopters of technology and gadgets. And with many of the capabilities of today’s electronic medical devices and smart phones, patients are able to remotely transmit data and have a care giver review it as part of their care. In addition, patients can even have access to a nurse and physician through video conferencing and be able to discuss their health issues from the comfort of their home.
Active life style: As more baby boomers continue to enter retirement at a rate of 7,000 a day, many are continuing to stay active. This most likely influences their decision to try to seek receiving care in the home instead of in a healthcare facility.
Technology: In this area, we see that both patients and care providers benefiting from some of the technological advancements. For home health service providers, mobile devices, and tablets have provided many much needed improved efficiencies. Some of the examples are accessing records remotely, and transmitting information on the patient’s visit real time.
As we to see a shift toward keeping patients healthier and out of hospitals, it will become more critical for patients to receive care, participate in wellness programs and receive preventable care that can help ensure a healthier life. Homecare services will play a significant role in helping patients with their health needs and keep healthcare costs down by reducing long/short term stays in nursing home and other assisted facilities.
May 7, 2012 11:13 AM
Posted by: RedaChouffani
, Health information exchange
More independent physicians are being solicited to connect to a community, local, or state HIE. Since many of these entities have gone live in higher numbers this past year, and continue to see an increase especially due to the meaningful use stage 2 proposed ruling, physicians will continue to find themselves with several vendors and options from which to choose. Below are a few important areas of considerations for all providers taking the next steps forward in data exchange:
Connectivity with other existing community based (private HIEs) and state or national (NHIN):
One of the core components and purposes of an HIE is to provide continuous availability to medical records, enabling physicians to make better treatment decisions and deliver a higher quality of care in a more efficient manner. When joining an HIE, providers must also consider what other entities the HIE can use to locate charts electronically.
When joining an HIE, a physician would be subscribing to the services that will be offered. They will also be agreeing to local state laws around HIEs as well as specific liability and data security requirements set forth by the HIE. These contracts must be reviewed in great details, as they are very complex. The binding legal document will address privacy, security concerns, technical issues, as well as any obligations that maybe associated with early termination.
Usability of system and patient information:
There are several different methods of accessing a patient’s chart through an HIE. One of the most commonly used and simplest method is via the HIE’s web portal which allows the physician to connect securely and perform record searches for patients. This set up does not require any special software or interfacing to gain access to the record information. Another access method that provides a seamless and common interface is through the use of physician’s EHR to request and process incoming patient’s summary chart. This allows for some of the outside patient information to be combined with current physician’s patient records. It is important to consider the connectivity model that can help create efficiencies for the organization, so both must be evaluated to ensure the right option is selected.
Value added services:
A great example of how some of the HIE are providing subscribers value added services is what a NC based HIE is doing. CareConnect Carolinas a local HIE through Carolinas Health System is providing the following services:
· Comprehensive medication list from SureScipts as well as many other local and national pharmacy networks.
· Access to patient’s imaging records available through the hospital Information System
· Access to Lab reports, Transcriptions, letter, Encounter details, Patient facesheet
· Advanced alerting capabilities such as flags for drug seekers
· Downloadable CCD (Continuity Care Document)
· An EHR Lite to assist physicians with Meaningful Use
· Referral management to digitize the information exchanged during the referral process
· Web orders for certain labs at some of the health system facilities
There are other health systems that are also providing a PHR access feature for the patients. This feature provides another method for the patient to be engaged and actively maintain their health record. It also encourages up to date information even it is manually entered.
Similar to many of the online subscription based services, HIEs fees are monthly. Whether it is the physician or health system, they pay a reoccurring monthly fee for the length of the agreement. There is some setup fee associated with most and possibly additional third party charges when interfacing or integrating with an EHR.
Integration capabilities with existing system:
Not all HIEs provide integration with all EHR systems. Ideally an HIE can provide a strong and tight integration with an EHR product and allow end users to simply use their electronic medical records application which they are already familiar with. This will enable physicians to simply use the same application to manage patient charts as well as request medical records from an HIE. But unfortunately, not all HIEs or EHRs allow for this integration. So for some access to an HIE web portal that provides the ability to print/save the summary record is as far as the system will go.
With the proposed meaningful use stage 2, and 3 there is a stronger emphasis on the electronic exchange of medical records through a qualified Health Information Exchange. And more physicians and organizations will begin to review some of the available HIEs in their community and state.
April 29, 2012 9:31 PM
Posted by: RedaChouffani
, Affordable Care Act
, FY 2013
, payment rule
On April 24, 2012 CMS issued a proposed rule for the updated payment policy and rates for inpatients stays to general acute care hospitals paid under the hospital inpatient prospective payment system and long-term care hospital PPS (IPPS and LTCH) proposed rule for fiscal year 2013.
“The proposed rule would implement key elements of the Affordable Care Act’s value-based purchasing program as well as the hospital readmissions reduction program. It also establishes the groundwork for extending Medicare’s quality reporting programs beyond general acute care hospitals to other types of facilities,” said CMS Acting Administrator Marilyn Tavenner. “It is part of a comprehensive strategy to use Medicare’s payment systems to foster better care and better value in all settings, thereby reducing overall Medicare spending.”
The current increase in payment rates is projected to be 2.3 percent in FY 2013. It has also been projected by CMS that the increase in payment rate and some of the projected utilization will increase Medicare’s operating payments by 0.9 percent in FY 2013.
The proposed ruling includes new outcome measures that will reward hospitals that avoid healthcare-associated infections (HAI) from central line-associated bloodstream infection. CMS is also proposed to include measures for perinatal care and readmission, including overall readmissions and readmissions relating to hip and knee replacements procedures, and for the use of surgery checklists.
In addition CMS is proposing to add a new survey to measure the HCAHPS measures to assess the quality of patients’ care transition.
Following are some of the proposed ruling additions:
- A one-year extension of the existing moratorium on the “25 percent threshold” policy, pending results of an on-going research initiative to re-define the role of LTCHs in the Medicare program.
- To apply an approximate 1.3 percent reduction (first year of a proposed three-year phase-in) for a one-time prospective budget neutrality adjustment. The proposed reduction would not apply to discharges occurring on or before December 28, 2012, because the law prohibits its application before that date. The budget neutrality adjustment reduces the update from 2.1 percent to 0.8 percent.
- To reduce Medicare payments for very short stay cases in LTCHs to the IPPS comparable per diem amount payment option for discharges occurring on or after December 29, 2012. The law prohibits application of this policy prior to that date
April 29, 2012 9:30 PM
Posted by: RedaChouffani
, hospital tablets
Patients who are admitted to the hospital for longer periods of time may benefit from having access to entertainment services as well as health information. Information in a hospital room can be delivered via interactive TV sets, emails, phone as well as one-on-one with a clinician. But as more and more patients turn to smartphones and tablets to receive information, hospitals may be able to take advantage of patients’ personal mobile platforms to deliver meaningful information effectively and efficiently.
As more tablets and mHealth apps are released in the market, health can organizations will continue to have more options than ever for bedside solutions to implement throughout their facilities. Some EHR vendors have actually begun to provide bedside solutions that tightly integrate with mobile platforms.
The following is a list of useful functionalities that current and future bedside tablets should incorporate to ensure success in an inpatient setting:
- Connectivity to an EHR or PHR that will provide access to the patient’s full information
- Teleconferencing / telemedicine capabilities with family and care team
- Long battery life
- Remote TV control
- Social media engagement / connectivity
- Menu option information and nutrition services
- Interactive patient education tools
- Access to patient health information
There are many ways in which this type of device can have a positive impact in the hospital setting on the patient experience:
- Improving patient satisfaction
- Help educate patients on their condition and procedures
- Reduce entertainment device cost through consolidation
- Improve communication with patients
- Improve care through telehealth and telemedicine service
- Allow for an overall more positive patient experience
So far, there are very few platforms that support strong customization and integration. Bedside solutions have been using Android and iOS platforms, where some software vendors have been utilizing Google TV to deliver information to patients that is integrated with their EHRs. Unfortunately, the technology must mature a bit more and show a real ROI and prove itself to health IT executives. Hopefully part of the ROI equation is patient satisfaction and enhancing the patient experience.
April 23, 2012 6:53 AM
Posted by: RedaChouffani
, private cloud
For Healthcare IT, cloud computing has been the hottest subject which is helping by bringing more storage for health information, flexible infrastructure, reliable DR/BCP and ease of support and scalability. While there are many additional advantages to the cloud, some of the most interesting areas of impact that cloud computing is bring will be to the shift that the technical roles will see in the next 4 to 5 years.
Many years ago enterprises including healthcare were using thin clients or terminals that connected to a mainframe. This provided them with centralized data and easy access to the business critical applications needed. That model did not require too many IT engineers to support desktops or in house servers. But as Windows and Apple introduced the personal PC where you can install applications that resolve specific business challenges, software and hardware support needs increased, and with that increased the number of IT folks.
But in some cases we are seeing that old trend somewhat reemerging again. In today’s model, any healthcare enterprises have an IT department made up of hardware, networking, communication, and software support. This keeps the organization running and ensures all the systems are operational. However this delicate balance is being challenged by current migration to the cloud. Companies like IBM and DELL are working with different size organizations to be able to get them to the cloud and provide them with full IaaS. The timing happens to be just right. Currently any organization can easily and quickly procure a private cloud or virtual data center that will ensure itself a fully operational cloud based environment for everything from: Unified messaging, EHR applications, messaging, Intranet, productivity tools, and many more). Products like vCloud and IBM smartCloud are also making too easy to manage an entire enterprise data center from one single application. What used to take days to implement (domain controller, email server, database server and such), can take minutes to deploy by simply using some of the already created vApp Templates.
It does not stop there, clearly with the advantages of virtual desktops as well; client or end user support just became easier than ever.
Today, it is completely possible to purchase a private cloud or even a data center (IBM PureSystem or DELL’s Cloud), which happens for some to be a fully operational environment that can even self heal. Just to recap, for a medical organization with 40 physicians, who has recently purchased a new EHR. The complete infrastructure can be fully cloud based and up and running within a day. Not only it can quickly be deployed, but also is fully scalable and has High availability. All the costs will be subscription based.
One change that this trend is bringing to many third-party IT service providers is the sense of urgency for them to push more aggressively toward more cloud based service offerings. This would in turn reduce the significance of services relating to big physical server deployments as well as workstation support.
In few years, similar to how when we purchase a smartphone we have the ability to purchase or install with a single clicks all sorts of Apps, the infrastructure as a service and cloud computing will enable physicians and health organizations to customize the entire infrastructure simply by selecting all the needed modules and components (HIE services, EHR, Radiology, SharePoint, Email, Messaging, Patient Flow and more) and then have the infrastructure available within hours.