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Meaningful Health Care Informatics Blog


April 23, 2012  6:50 AM

CMS announces 1.1 million participants and more to come for ACOs



Posted by: RedaChouffani
Accountable care organizations, ACOs, CMS

On April 10, 2012, the Centers for Medicare and Medicaid Services (CMS) announced that over 1.1 million Medicare beneficiaries have been served by ACOs (Accountable Care Organizations), a statistic that shows a strong positive start to the proliferation of the ACO framework.

There have been 27 participating organizations in ACOs thus far under the Medicare Shared Savings Program, all serving an estimated 375,000 beneficiaries across 18 states.

“We are encouraged by this strong start and confident that by the end of this year, we will have a robust program in place, benefitting millions of seniors and people with disabilities across the country,” said CMS Acting Administrator Marilyn Tavenner.

For many of these participating organizations, and those who will join in the future, there are several criteria that must be met in order maintain membership.  Over 33 quality measures must be met, relating to care coordination, patient safety, preventative health services, improvement in care for at-risk population and the experience of both the patients and caregivers.

In addition to the 27 participants, CMS has also announced that there will be five additional ACOs participating in the Advanced Payment ACO model program.  It seems that CMS has had success thus far encouraging more physicians to participate in this initiative and become part of the care coordination team. It will be interesting to see the progress and how the model continues to develop over the next 6-12 months.

April 15, 2012  10:42 PM

Some of the highlights of collaborative tools available today



Posted by: RedaChouffani
data exchange, EHR integration, Open Source, sharepoint

For some time now, enterprise users and healthcare organizations have turned to different intranet tools (Open Source, commercial products) to help manage internal document storage, authoring and project collaboration. But one trend I’ve noticed in the recent months is that there continues to be a higher useage of Microsoft solutions, such as SharePoint.

Some of the reasons for this increased rate of engagement is because the platform can play well with many other products and solutions available through Microsoft, which offers tremendous flexibility when it comes to customizing the solution to fit and resolve the specific needs and challenges of various organizations.

Healthcare has some pretty unique challenges that require specific ways in which to resolve them.  Many result from some of the inefficiencies in workflows and lack of automation.  Some of the functionalities included in the latest version of SharePoint server proves to enable many IT executivse to implement creative solutions that have been able to significantly improve workflows and create new efficiencies.

There are many advantages to a platform such as Microsoft SharePoint for healthcare organizations:

Office Integration: Office users will be able to take advantage of many of the capabilities offered through the integration of SharePoint and Office tools. This tight integration with Office productivity tools is useful for many of the hospital back office staff.  With its file menu integration, document check in/out, document version tracking and workspaces, hospital teams can collaborate on complex projects, such as ICD-10, EHR adoption meaningful use compliance, and many others, with ease.

Workflow Engine: SharePoint engine provides an incredibly powerful workflow engine.  It uses Windows Workflow Foundation (WWF).  This server side engine provides the ability to convert an existing organization’s workflow processes into a digital workflow format that can be applied to everything from documents, tasks, items, and many other entities in SharePoint.  Things such as routing specific forms based on content to the appropriated users can provide a robust way to handle automatic document routing and approvals.

Collaboration: With the ability to create centralized locations for different team members to access contacts, links, calendars, announcements and documents SharePoint helps increase the productivity of teams from all departments in a health organization.

Performance Dashboard:  A tight integration of PerformancePoint Services and the latest SharePoint Server 2010 provides a perfect combination that delivers an integrated performance management service that can assist with monitoring, and analyzing healthcare data.  The system gives access through the portal to financial performance, hospital payer mix, compliance stats, or simply reviewing the clinical outcomes.

For healthcare organizations, the focus continues to be on the delivery of the highest quality of coordinated care. But in order to also successfully reduce operational costs, there are many available solutions in the market place that can — and should — be implemented.  These products provide the right tools that make sharing information, and access to data, easier and attainable.  I believe that SharePoint provides tangible benefits and enables organizations to streamline their processes and provide access to data, helping the care delivery process and improving outcomes to boot.


April 15, 2012  10:40 PM

Should health organizations consider cloud based storage?



Posted by: RedaChouffani
cloud, nas, san, storage

Every year technology trends continue to impact our decisions concerning the emerging solutions and technologies that we will explore. But the more health organizations that officially start their journeys toward electronic health information, the more their storage needs are significantly, immediately increased.  Data associated with digital imaging, structure documents, unstructured documents, lab results, and several other data sets have required many to continuously reexamine their storage strategy and expand their capacity.

In recent months, a natural disaster in Asia  caused significant downtime for some of the country’s leading storage and drive manufacturers, sending storage costs up. While this subtle change has not decreased the demand, many are beginning to plan for alternatives and potentials for future models that will provide a more cost effective way to store information.

Cloud-based storage is seen as the next destination for home and enterprise users when it comes to storing their data without the need of physical drives or servers locally. Similar to what DropBox, Dell, iCloud and now the new Google cloud-based storage platform, many have recognized the clear advantages to this new data destination.

Centralized Storage:

Most cloud-based services provide a single destination for all data needs. With this model, information can be accessed from any Internet enabled device ranging from smartphones to traditional desktops.  This has been one of the biggest drivers in the consumers market. With the high rates of usage of devices such as tablets and smartphones, which offer limited storage capabilities, many have pursued centralized storage solution to help maintain all their private data stored in one place.

Protected Data:

In healthcare, the majority of data must be secured and protected against any unauthorized accessed. Organizations must be HIPAA compliant to ensure that they have actively adopted and taking the appropriate steps to secure and protect health information. Cloud-based solutions provide the extra layer of security, as the information is not physically stored in local storage devices inside the facilities.

Scalability:

Similar to cloud computing, cloud-based storage is very scalable. An organization may start with very small storage needs, and as soon as a health organization merges or acquires additional entities the storage needs can easily double or even triple over a short period of time. With Cloud based storage, increasing the capacity is a quick and easy step for the Health IT engineers.

Cost:

Traditionally storage devices, such as SAN and NAS, require up front capital investment. And as features are added to these devices and capacity is increased, the cost follows. With cloud-based storage, an organization is able to pay for what it is using, only. This provides a way to reduce the up front costs and an effective way to pay for only the used space.

Cloud-computing:

There are several vendors in the marketplace that go beyond offering just simple cloud-based services. For example, Dell and Amazon are able to add cloud-computing capabilities to their cloud storage solutions. This makes the data accessible for cloud computing. This can be a valuable bundle of services especially when a hospital or health system is seeking to warehouse large data sets and perform analysis on it.

Whether an organization is seeking to eliminate the need for internal data management and eliminate the need for complex backups and disaster recovery procedures and processes, or simply looking for predictable costs and limitless scalability, cloud-based storage is ultimately here to stay. And as adoption increases, so will the concerns surrounding the security of the data and speed. The fun never ends.


April 8, 2012  9:07 PM

An updated view on meaningful use exchange standards for clinical information



Posted by: RedaChouffani
CCD, CCR, consilidated CDA, HL7, Meaningful use Stage2

One of the areas that has seen changes in the NPRM for meaningful use stage 2 includes the standards according to which health data is exchanged. In this case, the affected areas are related to clinical messaging, electronic prescribing, and patient summary and transport specifications.

Specifically, one of the standards has been substituted for another.  In meaningful use stage 1, the selected standard was CCD/CCR  (HITSP C32); however, in the new ruling this was replaced with consolidated CDA.  The original standards (C32) included administrative and clinical information — registration, demographics, insurance, problem list, medication list, allergies, test results, etc.

One of the reasons the consolidated CDA was selected as the standard is due to its single implementation guide, as well as the centralization of many of its templates.  These templates allow for more information to be exchanged amongst different clinical applications and systems.

The consolidated CDA provides a library of reusable templates, such as:

  • CCD
  • Consultation Note
  • Diagnostic Imaging Report
  • Discharge Summary
  • H&P
  • Operative Note
  • Procedure Note
  • Progress Note
  • Unstructured Document

Meaningful use stages 1, 2 and 3 all call for clinical information and summary records to be exchanged.  In section § 170.210, Standards for health information technology to protect electronic health information created, maintained, and exchanged”, as documented in the proposed ruling ” Health Information Technology; Implementation Specifications, and Certification Criteria”, there is a clear outline of the different data elements that will be required from vendors seeking certification of their products as certified EHR.

As these standards become widely adopted by vendors, they will help facilitate the exchange of meaningful health information.  Enabling clinicians to access health information and having the ability to work with a more comprehensive data set will have a significant value in terms of real time information extraction, as well as for data analytics capabilities.


April 8, 2012  9:04 PM

Big Data initiative to support different federal agencies including healthcare



Posted by: RedaChouffani
BIG DATA, XDATA

On March 29, 2012 the Office of Science and Technology Policy in the Executive Office of the President (EOP) released the “Big Data Research and Development Initiative“, which “promises to help accelerate the pace of discovery in science and engineering, strengthen our national security, and transform teaching and learning”, according to the OSTP blog. This is aimed at mining collections of digital information in order to extract knowledge and glean insights in many different areas.

Approximately $200 million in commitments will go to six different federal departments to launch the initiative forward, with the funds being used to help acquire the tools, technologies and techniques needed to make sense of such large amounts of data, which stand to have a marked impact on health data analytics and improved population health.

One of the areas that will be receiving assistance is the NSF and NIH, where the document states the following:

The National Science Foundation and the National Institutes of Health – Core Techniques and Technologies for Advancing Big Data Science & Engineering “Big Data” is a new joint solicitation supported by the National Science Foundation (NSF) and the National Institutes of Health (NIH) that will advance the core scientific and technological means of managing, analyzing, visualizing, and extracting useful information from large and diverse data sets. This will accelerate scientific discovery and lead to new fields of inquiry that would otherwise not be possible. NIH is particularly interested in imaging, molecular, cellular, electrophysiological, chemical, behavioral, epidemiological, clinical, and other data sets related to health and disease.

Another area that may also have an impact and affect healthcare is the XDATA project.  This is the computational technique under open source tools that will be developed over a four year period using $25 million annually in funding which will provide new tools and avenues for analyzing large volumes of unstructured and semi-structured sets of data.  This could also potentially provide free tools specific to health IT, which would be used to analyze large volumes of clinical data for research and population health analysis.

This initiative aims to provide new, improved tools to maximize the benefits of super computing powers available today. Where this big trend in big data will lead, and how will healthcare be impacted by the improved powers of data analytics? Only time will tell.


April 1, 2012  10:01 PM

The race to keep patients out of hospitals will change the way health systems generate revenue



Posted by: RedaChouffani
Accountable care organizations, ACO, Health care reform, Quality, Quality reporting

There are many initiatiaves that large health system can begin employing now to ensure the revenues are not threatened by the changing health care payment landscape. Many are predicting that health care is moving toward a system where providers will be rewarded based on outcomes, with compensation being mainly based on quality measures.  This is no different than the framework used by participants of the ACO pilot program, which provides these groups with bundled payment for an entire episode of patient care. This encourages physicians to keep patients healthy, and out of the their practice / hosptial.

This would mean that while the current model rewards hospitals for the number of patients admitted along with the number of procedures performed, the new direction will aim to keep a subset of patients at bay by ensuring that they are leading a healthier lifestyle with less hospitalizations.  This will significantly impact the bottom line at health organizations that are unwilling to change and adjust to the changing landscape.

There are several areas that health systems must consider to ensure that they are addressing the changes and are continuing to provide value patients who may never even come into their facilities:

Coordinated care teams:  Many hospitals today are providing their patients with a dedicated team of providers who collaborate on their care plan during their hospital stay.  However, many will need to take that beyond the hospital walls and maintain some consistency in terms of maintaining a relationship with patients.  A similar approach has been introduced in the pilot ACOs that are currently up and running.

Health coaching:  To ensure a that the patient / provider relationship is truly a strong partnership, many will need to rely on health coaches who can work with patients on a one-on-one basis.  This will help ensure that patients are also active participants in staying healthy through the relationship and suppor they receive from their health coaches.

HIE connectivity: Even though HIEs are facing sustainability challenges, they are going to play a critical role in patient care. And as the care delivery model shifts, more and more caregivers with diverse EHRs will rely on these exchanges to provide them with cost effective and immediate access to patient information.   HIE is a must have for ACOs and collaborating caregivers.

Integrated mobile platform:  Today, many of the larger health systems (example: Kaiser Permanente) are providing access to health records, reminders, schedules and billing information via a mobile app component of their patient portal.  And as more users continue to adopt the use of mobile technology, this provides an incredible opportunity for health systems to reach their patients. With many of the apps currently available and in development, patients can have medical data uploaded directly to their care team’s systems and continually monitored.  This will not only facilitate communication, but also facilitate ongoing care of the patients. Using mobile technology will allow hospitals to create a new channel of communication and a collaborative way to work with their patients and drive them to be health champions.

Social media:  Patients are customers, and that means that they need to want or desire the services of one health system more than another.  Social media has significantly changed the way organizations advertise their services, and will only continue to do so in the future.  As technology continues to enable patients to see physician’s via video conferencing from anywhere in the country, health systems must continue to aggressively seek to reach their target audience via new methods.

Reduce operational costs:  As it was discussed earlier in the article, the aim of many of the up coming changes at the federal level are intended to improve population health and keep patients out of hospitals.  While this is not something that is coming right away, it must be on the minds of all health system executives.  In order to adequately navigate through the changes, a health system must be able to continue to find new ways to reduce operational costs and stay fiscally sound.

Business intelligence (BI) for clinical transformation: One final item that must be considered is the value that BI can provide in the clinical side to assist with outcomes measurement.  With the tremendous amount of clinical data becoming available through many of the new EHR implementations system-wide, BI will assist with evidence based decisions, improve patient care and aid in clinical data analysis.

For now, the changes are subtle, and many are awaiting the outcomes of ACOs. Preliminary pilots have shown positive signs, but only time will tell how the shift from fee for service to outcomes based payment will affect the population’s health.   One constant remains though, and that is change; hospitals must be ready and able to adapt and change along with the demands and hard trends.


April 1, 2012  9:59 PM

A new ecosystem where IT and biomed engineers may work better under one leadership



Posted by: RedaChouffani
Bioengineering, BioMed, Biomedical engineering, CIO, CTO

For many health organizations, the biomedical engineering and IT teams do not both directly report to the CIO.  While in the past that would be somewhat acceptable, nowadays biomed engineers can significantly benefit from working more closely with the IT department, which has encouraged many hospital and health system CIOs to begin looking for ways to combine IT and biomed together under the management umbrella.

In many of the top wired hospitals in the nation today, the integration of medical devices and connectivity of systems is key to their success.  This only highlights the importance of IT and bioengineering working together to ensure that all medical device vendors are providing systems that can play nice in this new ecosystem where devices are expected to push / pull data sets and eliminate manual data entry when it comes to patient data.

Hospital CIOs and CTOs are creating strategies that leverage the expertise of both biomedical engineers and IT analysts, which will produce significant benefits for patients and clinicians alike.   This approach also has a significant impact when establishing support for the integration of medical devices with existing hospital information systems.  IT can support and push for better integration needs while bio engineering can ensure the devices will deliver the appropriate, data rich results for the staff.

As EHR systems continue to improve in functionality and user experience, vendors are recognizing the need for their products to be able to capture and store comprehensive patient data that can be extracted from medical devices.  As such, bio engineers and IT innovators must begin working together under the leadership of the CIO, who can help ensure that medical device and EHR integration are fully aligned with organization’s long-term IT adoption goals.


March 25, 2012  8:37 PM

When is replacing a practice management system justified?



Posted by: RedaChouffani
PMS, Practice management, Practice management systems

As we look at the causes driving EHR adoption, there are many that immediately come to mind.  Providers are looking to improve care and patient safety, as well as get their piece of the EHR incentive program pie. There is also the movement toward paying for performance (P4P), reducing waste by eliminating paper records, and supporting access to health information from anywhere, at anytime. 

But for many physician groups, there is a significant impact on the organization from the practice management system standpoint that cannot be ignored.

There are many strong motives that drive the decision to replace a practice management system, including:

Revenue cycle management: Unfortunately not all PM software vendors provide tools and functionality to help improve and maintain a strong cash flow for practices.  Features such as automated statements, patient reminders, claims scrubbing prior to sending them to a clearinghouse, claim adjudication, as well as patient eligibility are all critical functionalities that should be present in a PM system.   In addition, PMS companies offer consulting services as well as billing services to help the organization further their success through their system.

Accuracy in reporting:  Since every practice has specific and unique requirements, it is very critical for a new PMS system to have accurate data in its reports.  Unfortunately while everyone does assume this being a must have in any PM system, it is not always the case.  The reporting side of these packages is also another critical piece for these systems.  All successful administrators and executives in the independent physician groups seek to use data to enable them to gauge how well the practice is performing and areas that many require improvements.

Flexibility and customization: When choosing a software solution, it is crucial that it be capable of adapting to a client’s unique requirements and workflows — not the other way around.  One size does not fit all, so a PMS must have the ability to be customized to the specific business needs and objectives of the practice. These features include:

  • Ability to require specific fields to be populated
  • Ability to create workflows and enforce them when registering patients and or scheduling surgeries
  • Ability to create custom fields
  • Access to the data dictionary to enable integration with any ad hoc in house applications
  • Allow for custom edits when it comes to claims scrubbing and patient registration

Scalability of the application: For some of the billing systems available in today’s market, there are still a few that struggle with scalability.  This comes at times as a result of the database backend that is used for many non-scalable applications.  In order to ensure a robust solution is implemented and is reliable for mid-size practices, this factor becomes very important.  There have been many cases where poor performance causes a significant loss of revenue and productivity, simply because the number of users on the system exceeds a 200.

Availability of good end user support:  For some organizations who rely heavily on vendor support, a high rating for customer support is extremely important. Others simply rely on internal resources for support, whether it is from an IT department or internal super users of the system to help deliver the necessary support.   Some vendors have been branded with having the worst support ever due to out of control growth, while others have seemed to sustain the same quality of support through the years regardless of growth rate. But nevertheless, support is an important aspect of a new PM application for organizations considering the switch.

While many organizations may not clearly identify with all of the reasons supporting the need for a complete PMS, the above list is usually a good starting point for consideration.  However, it is very crucial to properly assess all of the reasons for change, as switching is a a costly task, requiring not only some capital investment, but also the added stress and labor hours as part of the transition.  This means that just not liking the software may not be a sufficient reason to replace it.


March 25, 2012  8:30 PM

ONC announces updated version of the Connect 3.3



Posted by: RedaChouffani
CONNECT, NHIN, ONC

On March 16, the ONC announced the availability of Connect 3.3, the open source software solution that supports the health information exchange of protected health information (PHI) both locally (regionally through community based groups) and nationally.  It has been developed using the Nationwide Health Information Network (NwHIN) standards.

Currently, there are over 44 organizations — including health systems and IDNs, HMOs, software vendors, and public and federal entities — who are either in the planning phases or have already implemented the CONNECT platform.  And as the product continues to receive enhancements — and being that it is free of charge — CONNECT will continue to see a growing number of organizations pilot and implement it in a production environment.

The current Connect 3.3 release comes with many enhancements, including:

  • Complying with July 2011 Approved Nationwide Health Information Network Specifications
  • Creating Backwards Compatibility between the January 2010 and July 2011 Nationwide Health Information Network Specifications and among CONNECT Versions
  • Incorporating Technology Stack Upgrades
  • Implementing a Configurable Set of Services for Targeted Selection during Installation
  • Providing Parallel Message Initiation and Processing (Fan Out)
  • Preparing CONNECT for a Clustered Environment
  • Providing Performance-Related Configurable Parameters
  • Enhancing Implementation Instructions

Theses changes represent new features, bug fixes as well as performance improvement enhancements.

With the release of the NPRM for meaningful use stage 2 criteria, the exchange health information becomes a requirement in order to be qualified for incentive payment.  This puts CONNECT and the Direct Project as the required communication protocols that all EHR vendors need to use for compliance.


March 18, 2012  9:12 PM

RTLS areas of impact for health care systems



Posted by: RedaChouffani
RFID, RTLS

Able to provide hospitals and health care systems with improved patient safety capabilities, assistance with asset tracking and a tool for achieving clinical compliance, real-time location systems (RTLS) have been named by many as one of the most beneficial, sought-after technologies in the health care industry (aside from / after EHRs, that is). This technology, in combination with patient flow or bed management solutions, can track the location of different entities in real time, as the name suggests — medical devices, equipment, clinical staff and even patients themselves — as well as can track length of exposure of these entities amongst each other.

With the ability to track patients, assets and staff in a facility over time, applying analytics to the collected data has enabled many health organizations to optimize and improve their workflows, as well as increase patient safety measures and meet compliance requirements of AORN, JCAHO and the CDC.

Though there are many, just some of the areas that stand to benefit from this technology in the realm of patient safety are:

Locating equipment for maintenance and cleaning: Having the ability to identify the location of equipment that is due for routine maintenance or cleaning is critical to ensuring the safety of patients. RTLS is capable of providing alerts on equipment to staff.

Locating equipment for clinical care: One hospital spent two months on a benchmarking analysis and found that it took on average 22 minutes to find an infusion pump. After the implementation of RTLS, it took on average of two minutes to find a pump. This cuts down on lag time in care and can help ensure that clinicians can have the tools and equipment they need, when the patient needs it.

Outbreak detection / disease surveillance: RTLS technology can determine each and every staff member who could have potentially been in contact with a patient classified as highly contagious or with a specific condition.

Hand hygiene compliance: Many health systems are reporting hand hygiene compliance 24 hours a day. Some use “look-out” staff to walk the halls and record all hand hygiene actives. However, with the introduction of RTLS to dynamically track and report on hand hygiene protocol compliance, many of the systems that are available today are also providing active alters to the clinicians whenever they enter a patient’s room and haven’t complied with the hand hygiene guidelines.

There are many areas that RTLS solutions can improve in the health care setting, ranging from patient safety, staff productivity and asset management, as well as equipment maintenance and workflow improvement. While there are several different hardware options to choose from, and technologies ranging from Wifi to IR/RF, this technology has been showing real value and savings that health care IT and supply chain executives alike can’t ignore.


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