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Meaningful Health Care Informatics Blog


March 18, 2012  8:44 PM

Healthcare systems are seeking slightly different IT talent



Posted by: RedaChouffani
HealthcareIT, HIT, Jobs

Since virtualization has been introduced to healthcare, it has brought with it the promise of reducing operational and hardware procurement costs, as well as offering a variety of new solutions for disaster recovery and business continuity planning (DR/BCP). While one can point to many more benefits that this technology brings, the path toward virtualization and cloud services has made many IT executives revisit their IT staff hiring strategy, placing less emphasis on traditional hardware and repair expertise, and putting more of a focus on having an understanding of core healthcare objectives and clinical concepts with strong problem solving and analytical skills.

This shift is being noticed most significantly in smaller healthcare practices. For many independent physicians, their infrastructures are moving to the cloud, or simply are using cloud-based services — from EHR and PM, to VoIP and accounting hosted services. This means that IT vendors and cloud solutions providers have had to make significant changes to their service offerings.

With this clear reduction in an organization’s need for hardware and the increase of use of thin client servers, IT staff members are now expected to know more about deploying, supporting and understanding the myriad of EHR solutions in the market. As a result, job descriptions and placement ads have made adjustments as well. Some of the common examples listed for many HIT jobs as part of the ‘preferred items’ list are:

  • Experience working with clinical information systems or system implementation teams for complex projects and/or application development is required
  • Knowledgeable in understanding of HIPAA, X12 5010, ICD10, HL7 …
  • Prior work with clinicians and providers

Fortunately there has been also an increase in educational programs in community colleges and universities to assist individuals in acquiring or brushing up on some of the healthcare IT specific items. These are in the form of graduate programs or simple crash courses providing hands on training and vendor specific education.

As the talent war continues in the healthcare IT field and pay scale for those positions continues to increase, both technicians and healthcare professionals will need to adapt and stay abreast of market demands. Many organizations will also begin to play a critical role in grooming this talent by partnering with local community colleges and universities. This will ensure that they can support some of the new academic initiatives around health IT, as well as recruit some of the top graduating talent and innovative minds.

March 11, 2012  8:17 PM

New features and functionality in the third generation iPad for health care



Posted by: RedaChouffani
Apple, iPad, ipad 3

Last week, Apple fans eagerly tuned in to the new product release event in San Francisco to hear details on some the latest innovations to come out of the Apple labs, specifically the next generation iPad. Apple CEO Tim Cook spent time describing the success of some the company’s recent products in the market, including both the iPad and Apple TV, and detailed how they have truly re-defined a new category of technology in a “post-PC world”.

As we have seen throughout the industry in the past few years, iPad tablets are now a staple for physician use in many health systems and continue to gain popularity in the clinical setting. Due to its long battery life, ease of use, light weight and incredible number of health specific apps available, the product line continues to draw health professionals into adopting it for increased access to data and an expanded care continuum. Referred to as simply “the iPad” rather than the iPad 3, the device goes on sale March 16 and starts at $499. However, if you prefer the souped up model with 64 gigabytes of storage, Wi-Fi and 4G capability, there’s an $829 sticker price.  

The third generation iPad contains a handful of new features that are not unexpected, and has already seen delays in shipping just days after it was announced. The following are just some of the functionality updates:

Sharper display: The third generation iPad has an improved display containing the highest resolution possible on a mobile device. With over 3.1 million pixels, this can provide much better viewing capabilities for digital medical imaging and video.

Better graphics chip: Includes a faster and more powerful graphics processor “A5X”. This is four times faster than its predecessor, A5, found in the previous versions of the iPad. While this pleases many of the game developers in the health care arena, many mHealth vendors have products that require faster and more powerful graphics chips.

Wireless connectivity: With the latest tablet, Apple has provided users with the ability to connect to the internet via cellular carriers at 10 times the speed of the previously released iPad. While this would provide enough bandwidth for health care professionals to gain access to patient information and utilize other mhealth apps, it is critical to note that the current vendors that do provide 4G LTE do not provide unlimited data plans.

Improved photo/video quality: The new iPad has a 5-mega-pixel camera built-in. It was reported during the Apple event that the new camera and its A5X Chip would provide the end user with the ability to record video at 1080p.

Dictation: Voice recognition functionality has been available in the iPhone 4S. But is a new addition to the iPad. Many physicians who are actively using this technology to dictate patient notes, and other clinical information have welcomed it.

Though some were hoping for different sized device and others dreamed of Siri on the iPad, these are still very exciting features, and the fact that the baseline model, third generation iPad is at the same price point as the previous ones will make many happy.


March 11, 2012  8:14 PM

ONC tapping public to set security standards for mobile health devices



Posted by: RedaChouffani
Data privacy and security, HIPAA, mhealth, Mobile, Mobile security, ONC

In the age of electronic data exchange, securing mobile devices has been a chief concern of IT professionals, with many devices handling sensitive protected health information (PHI) on a daily basis. And as the adoption of tablets and smartphones in the health care setting continues to grow, with studies reporting marked efficiencies from use, it has become the norm for clinicians and medical residents to actively use their devices as mHealth tools during the care delivery process. As with any new trend though, many have voiced their concerns in regards to the risks associated with these mobile devices, especially with stats like 19 million Americans being affected by a data breach since 2009 coming to light.

Most of the information that we use on these devices is accessed in real time, and we are relying more and more on centralized and cloud based services to deliver this information to us. The data is not stored on the device directly, but rather accessed via connecting to other services and sources that provide the data for authorized users.

While there are many standards and compliance mandates put forth by HIPAA to help outline the requirements for securing health information, there are still no clear definitions on standards to address the privacy and security of information in mobile devices.

The ONC is now taking on the task to put together, based on public input, a set of best practices related to the use of mobile devices by providers and other health care delivery professionals to access, store and transmit health information. The current public comment will remain open until Friday March 30th, 2012.

The ONC has outlined some of the details of what they are seeking as part of the feedback, including:

  1. World Usages of Mobile Devices by Providers and Other Health Care Delivery Professionals
  2. Real World Mobile Device Privacy & Security Practices, Strategies and Technology
  3. Any Other Comments on Provider and Other Health Care Delivery Professional Usages of Mobile Devices


March 4, 2012  11:22 PM

Speech recognition and CLU are changing EHR interactions



Posted by: RedaChouffani
CLU, dictation, EHR, m-module, NLP, NLU, nuance

During the HIMSS conference this year, I had the chance to visit the booths of two voice recognition providers. I was very interested in seeing the progress and innovations that these vendors continue to bring to the health care market. As I continue to receive questions and requests from physicians about how voice recognition can help reduce transcription costs while still maintaining high quality patient care and satisfaction, I am finding that M*Modal and Nuance are taking it to the next level with some of their newer versions and platforms.

Clinical language understanding (CLU) has begun to be utilized by Nuance. Through their CLU product, they offer EHR vendors and integrators the functionality to convert speech to discrete data that can directly be stored in the EHR. While this technology is not completely new, it does offer the incredible value of simplifying and reducing the amount of data entry and scribing that has traditionally been associated with EHRs.

In one of the videos on Nuance’s web site, their system transcribes with a very high accuracy what a physician is dictating into a microphone. But what was the most interesting about the video was the fact that after the clinician finished, the Nuance solution was able to extract specific data from the speech and populate the different EHR areas such as vitals, medication list and problem list, without a single click.

As we continue to see this type of advancement and innovation in the speech recognition arena, and the success of other products such as Siri and IBM’s Watson, we are certain to see a tangible shift from the traditional interaction model with EHR systems.

The following is a list of areas that will see a significant change due to advancements in voice recognition and clinical language understanding:

Data Capture: One of the challenges that physicians face today in deciding to jump on the voice recognition train is concern with the level of accuracy of the captured data.While precision is not at a 99.99% rate yet, the technological advancements that have been made thus far continues to improve and is spurring a recent increase in adoption.

EHR adoption rates: In working with many physicians who use Dragon Naturally Speaking and other solutions from M*Module, most tend to dictate notes and letters into a text field or word processor. Very few have had an EHR system that actually supports or is tightly integrated with these packages.Some of the few that do allow for specific discrete data to be captured with Dragon during point of care are GE, EPIC and few other ones. But as Nuance releases their latest software development kits (SDK), EHR developers will have access to some of the new functionality that is being offered as part of natural language processing (NLP). This will provide additional functionality in EHR products that will enable clinicians to capture discrete data and use voice commands to control electronic health records.

System interactions: For many of the voice interactive systems available in the market today, a precise response and command is a must-have in order for the system to function properly and answer requests successfully. Many of these are being used in banking as customer service auto-attendants to help callers. Unfortunately, there are major limitations for these systems. They limit the ability to provide a personal, satisfactory interactive experience with patients. But as more speech and voice recognition engine are used in combination with NLP, systems will be able to provide far more services than what is currently being offered. Patients will be able to simply ask for refills, lab results and also schedule an appointment simply by interacting with a voice system.

Interactive clinical decision support tools: Since HIMSS 2012 and seeing many of the sessions covering the capabilities that IBM’s Watson has, many are starting to realize that this super computer will be able to provide assistance with the diagnosis of patients. The super computer that combines the power of Nuance’s CLU and IBM’s Deep Questions and Answers (DeepQA) will lead to a new generation of computer–assisted decision support tools to help improve diagnostic accuracy.

Mobility factor: While all eyes are on the capabilities and power of the NLU, the fact that Nuance and other speech recognition vendors are deploying their solution to mobile devices makes them even more valuable. More and more physicians will begin to use smart phones as recorders, microphones and voice controllers that interact with their apps.

Many caregivers have expressed their concerns as to how EHRs have affected their productivity.This was in direct connection with the amount of data entry required by most EHR systems.It has also been known that patient satisfaction suffers from the distraction seen when a physician is looking at a laptop or PC screen to enter data. With advanced and effective clinical speech recognition systems, as well as the ability through CLU to capture discrete data, providers can get the best of both worlds: the use of electronic health records without over use of a keyboard and mouse.


March 4, 2012  11:19 PM

Windows 8 promises a different look and fee of windows



Posted by: RedaChouffani
Microsoft, Windows 8

With the latest release of Windows 8 Beta, Microsoft is providing a sneak peak into what ultimately will be the operating system that will provide a consistent experience through all hardware platforms. Whether it is a smart phone, tablet or a traditional desktop this version of windows provides the end user with rich and interactive OS that has taken the lessons learned from many of the smart phones that have been very successfully in the market.

In this upcoming version, Microsoft changed the way it provides access to it menu, as well as the placement of the different functionalities. There are several little changes that for a windows user, it will seem as if Microsoft took a lot from what mobile users are used to. For example, to close an application or App you will no longer need to click on the “x” on the top right hand side, you can just let the App suspended state be managed by windows itself for you. Also, windows do no longer need to be completely shut off. Similar to smartphones you can simply let it go to sleep when you are not using it.

As more and more applications move to the cloud, dependency on custom client installations and such becomes a lot less. Microsoft recognized that and has made the effort to build their operating system to allow for easy to deploy lightweight apps that require very little tweaking and management during the installation.

Several health organizations are still in the process of deploying windows 7. Despite the fact that Windows 8 is on its way to be released, it will not be adopted immediately. Many are still seeing it as an Operating system for tablets and smart mobile phones and not enterprise ready.


February 27, 2012  5:00 PM

Summary of my week at HIMSS 2012



Posted by: RedaChouffani
HIMSS 2012, RTLS

After attending HIMSS 2012 this year in Vegas, I could not wait to get back and share some of the knowledge and innovations I learned about from the conference. I sat through some incredible sessions, as well as viewed some exciting technologies and products that are bound to play a significant role in assisting with improving quality of care, safety and populations health.

In my walks through the different booths, I took the time to review some of the products being showcased.And this year there were several areas where I spent time evaluating and discussing the products and solutions with the vendors.

RTLS vendors:

This year I have seen a significant surge in the number of RTLS vendors.This was expected, as RFID products have seen a decrease in cost, and several bed management, asset management and patient flow software vendors incorporated that technology with their solution.But as I reviewed some of the products, I realized that only few stood out.Some of the vendors offered web view as part of their product, which made it accessible from any platform.Others provided a flexible workflow engine with custom workflow design tools.This functionality is extremely important, as it will allow the hospitals to implement specific workflows that will help resolve their specific challenges.These workflows consist of system actions when certain criteria are met (such as a device, staff, patient, temperature) or behave a certain way.

Business Intelligence: I had the opportunity to visit several booths that offered some incredible BI tools, from IBM to MicroStrategy.I was hoping to review and discuss mobile BI as well, but unfortunately I did not see examples of this product offering or vendors available.  

EMR vendors: As always, there was a enormous presence of EMR vendors and I was able to check out many of the products out there. I saw NextGen, Greenway, eCW (eClinicalWorks), GE, EPIC and Cerner and had the opportunity to view many of the new solutions and updated modules they are currently offering.

Knowledge Centers: This was something new to the HIMSS attendees.Inside the exhibit hall, knowledge centers are the areas where speakers and domain experts discussed specific subjects.Some of the topics were: Accountable Care Organizations, Cloud Computing to name a few.

Social Media Meet Up: This year, many of the bloggersfrom the #HITsm (health care IT social media) crowd got to meet and discuss the entire HIMSS event as well as the topic of health IT. I personally enjoyed meeting with some of the talented and healthIT experts out there such as @TechGuy, @ShahidShah, as well as @JennyLaurello (@HITExchange).We had the opportunity to discuss some of the sessions and innovations we were looking forward to seeing at HIMSS as well as some of the current federal initiatives, such as the stage 2 meaningful use changes.

Managed IT Service Providers: During my visits to the exhibit hall, I identified many vendors who provided IT services combined with health specific PM and expertise.This continues to be a very important area that can help many of the health organizations who are looking to fill their gap in IT support.While more clinical and technology folks are attending certification and accelerated programs in health care IT, the shortage is significant. Many hospitals are looking to implement initiatives right away and are in need of the appropriate resources to accomplish that.

As with every year I attend the HIMSS conference, I am introduced to so many new, thought provoking innovations, challenges and successes.This helps refuel my drive to continue to provide technologies and solutions that will yield to meaningful health outcomes and workflow efficiencies.


February 27, 2012  4:56 PM

Highlights from Mostashari at HIMSS 2012



Posted by: RedaChouffani
Farzad Mostashari, HIMSS 2012, Meaningful use stage 2, ONC

On Thursday Feb. 23, 2012 during Farzad Mostashari’s keynote session, the ONC leader discussed his experience prior to coming into his current position.He went over some of the challenges faced implementing new programs, processes and technologies to assist physicians with improving population health in three different areas of NY.This was during his time with the New York City Department of Health and Mental Hygiene.

The results from the initiatives he piloted with physicians were positive, and this encouraged him to push for the similar adoption of HIT to assist with improving our nation’s health care. One of the areas he emphasized as part of the next stage in health IT adoption was the need for more interoperability, an area that will prove to have the most significant impact on improving patient health.

He repeated a few key phase several times, one of which being the need to achieve the “meaningful use of meaningful use”.He also outlined that technology will be a significant player in helping to improve a patient’s health and outcomes. “Tomorrow will be better, cheaper and easier”with technology”, Dr. Mostashari stated.

The Office of the National Coordinator for Health Information Technology’s NPRM was delivered to the Federal Register on Feb. 22, 2012.This was announced during the HIMSS 2012 town hall meeting. A day later, Dr. Mostashari outlined the overall underlining goals for this stage during his keynote session, highlighting that physicians will have the ability to send and receive documentation, images, and labs electronically.

After his talk, Dr. Mostashari answered several questions submitted to the LinkedIn HIMSS group, with one of the questions being around cloud computing.Dr. Mostashari took the opportunity to discuss how having cloud computing for health organizations will provide scalability and cost reduction industry wide, showing his clear support for and the validity of cloud computing in the health care arena.


February 19, 2012  5:15 PM

A new breed of revenue cycle management business models to assist independent physicians



Posted by: RedaChouffani
Billing, Collections, IaaS, RCM, Revenue cycle management

As many independent physician groups face the threat of reimbursement cuts, the high costs of software solutions and dwindling referrals, a new generation of billing service providers is offering creative packages and solutions to help these private organizations sustain profitability through new kinds of offerings.

For years now we have seen IDNs and hospital systems joining forces with private physician practices. But for some independent docs, this is raising concerns, as it is affecting referrals and revenue. There are also concerns that they may not have the ability to compete with the marketing dollars, negotiating powers and technology budgets of these health systems and their member practices.

For some revenue cycle management service providers, this was the best opportunity to assist the concerned private physician. The services that are being offered are tailored to help eliminate some of the typical challenges that small to mid-size physician practices face. Some of these include:

Hosted practice management and EHRs: Some of the companies have eliminated the high up front capital costs associated with a purchase of EHR and PM. By offering a full platform with services, a physician group can pay a monthly fee or part of their reimbursement and receive a fully operational PM/EHR system.

Revenue cycle management (RCM): Many of the RCM firms offer as part of their services some of the following:

  • Fully outsourced billing and collections
  • Coding solutions to increase reimbursement
  • Improved cash flow and collections
  • Lower overhead
  • Reduced bad debt

Technology: Technology has been a new territory for many of the billing service providers. By including hardware or infrastructure as a service (IaaS) options, many of their clients have the advantage of receiving support and services from one single group. This also provides a much more predictable cost and fee structure for an organization.

Consulting: For healthcare billing groups, their financial revenues are directly associated with the client’s reimbursements. This means that they are incentivized to get the highest reimbursements and are continuously working with physicians to assist them with coding challenges, as well as helping identify efficiencies and value-added solutions.

Portals: Payment and referral portals have been a new addition that many of the billing firms have started to adds to their offerings. This significantly improves cash flow as well as allows for all of their clients in a community to interact with each other and share patient information electronically.

Compliance: With all many of the pay for performance (P4P) programs available, as well as meaningful use and other federal programs, billing firms are helping physicians receive some of the incentives available.

It seems that in the past, most of what has been written about the revenue cycle sector has focused on the outsourced collections and billing aspect of services. There are many new RCM providers that are bundling additional services that bring tremendous value to independent physicians. Despite the current complexity and changing landscape of health care, many physicians are able to focus on patient care while having increased assistance in their revenue cycle management from the front to the back.


February 19, 2012  5:13 PM

HIMSS 2012 and a week long full of education and discovery



Posted by: RedaChouffani
HIMSS 2012

Every year the HIMSS attendees get to take advantage of many educational activities and sessions offered during the yearly conference event. In addition, many can spend time visit the exhibit halls and learn about some of the latest products available out there.

This year, there are many events that I will be attending and looking forward to. For starters, I am very interested in seeing some of the sessions presented by the ONC, and HHS. These would be the presentations in which we are expecting some additional details on the Meaningful Use Stage 2 dates. I will also be spending sometime on some of the sessions about HIE, EHR best practices, business intelligence, and mhealth.

There are several vendors that I am interested in visiting and discussing some of the products being offered. Some of these range from EHR, RFID, cloud computing, robotics, medical equipment and others vendors.

During this week-long conference, I will also spend sometime meeting and networking with health professionals, fellow bloggers, technology enthusiasts and old friends.


February 12, 2012  8:59 PM

What’s needed from tomorrow’s HIT talent?



Posted by: RedaChouffani
Jobs, Leadership, Recruiting talent

As the health care landscape continues to change, hosptials, health systems and other provider organizations are faced with a growing number of increasingly complex projects —  ICD-10 conversion, HIPAA 5010, EHR implementations, meaningful use complaince and and IT system merges, just to name a few. Because of the new demand on IT innovations, several health IT leaders are finding it difficult to recruit and maintain staff with the appropriate skills to help lead and manage these challenging projects. 

Over the past 12 years that I have spent working in health care technology, I have had the opportunity to work with many talented health care IT individuals, coming from varied backgrounds — some clinical, some technical and others from engineering. This goes to show, once again, that sometimes the ideal candidates and health IT superstars do not necessarily come from IT backgrounds.

There are several traits that a top HIT pick would have, and out of many I will discuss the top six that I feel are most significant:

Personal skills: Most IT folks in health care recognize that there are continuously being challenged. In this complex environment, many of the rising stars are empowered through self-motivation and drive. These candidates tend to be the ones taking on projects and experimenting with new solutions that may be out of their comfort zone.

Clinical workflows knowledge: For IT directors, having a candidate with a clinical background provides an incredible value. In many cases, analysts and support specialists who have been in the front lines working with physicians and nurses during the implementation of an EHR and other projects have  learned about the processes and clinical workflows. And with the ability to understand how technology can help streamline and facilitate the care of patients, super stars are empowered. They bring the best of both worlds and become one of the organization’s strongest supporters. 

Strong communication skills: An important aspect of working in health care IT is the requirement to implement new products and support clinical and administrative staff on those endeavors. In those roles, strong communication skills becomes even more critical to ensure buy in from the group. Not only does it becomes critical for the IT candidate to have effective soft skills, but they also must have a positive attitude.

Technical skills: While having the technical background on specific products (EHR vendor products and other clinical tools) may not exist in many of the new candidates, it is very important for the top performers to be exposed to many of today’s technologies. Whether it is some sort of programming, mobility, or even other ERP systems, having that diversity in experience will help when dealing with different health care applications.

Leadership skills: Many times, there are opportunities to grow and expand your role within an organization. Having strong leadership skills will help advance the strong HIT candidate quickly.

Everyday is training day: Hospitals and other health organizations continue to face software upgrades, staff turnover and regulatory changes. The only constant for healthIT is, in fact, change. A superstar not only needs to maintain a finger on what changes are coming down the pike, but must also continue to attend trainings, conferences and educate themselves on the latest and greatest technologies and collaborative projects going on in the industry.

One of the best sources for raw talent is the candidate pool of graduating students from the new health IT specific certifications. Whether it’s a post graduate degree or college level certification, these individuals may be the superstars that will help a hospital accomplish its goals and stay ahead of the curve in the coming years.


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