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Meaningful Health Care Informatics Blog


February 12, 2012  8:57 PM

AMA continues to oppose the implementation of ICD-10



Posted by: RedaChouffani
AMA, HHS, ICD-10, ICD-9

On Feb. 2, the American Medical Association (AMA)’s CEO has urged HHS and congress once again, to halt the ICD-10 conversion. In a letter to secretary Kathleen Sebelius, James Madara, MD stated “On behalf of the physician and medical student members of the AMA, I am writing to urge you to immediately halt the Health Insurance Portability and Accountability Act (HIPAA) required implementation of ICD-10, and re-evaluate the penalty program timelines associated with the number of Medicare health IT programs underway today”.

In the letter address to congress in January, Dr. Madara also urged House Speaker John Boehner (R, Ohio) to block the mandate to ICD-10 scheduled for Oct. 1, 2013.

“Stopping the implementation of ICD-10, and calling on appropriate stakeholders including physicians, hospitals, payers, national and state medical and informatics associations, to assess an appropriate replacement for ICD-9 will help to keep adoption of EMRs and physician participation in quality and health IT programs on track and reduce costly burdens on physician practices,” Dr. Madara stated.

While the AMA has voiced clear opposition to the switch to ICD-10, highlighting the complexity and burden it puts on physicians, there are several groups who are proponents for the transition. For example, the American Health Information Management Association (AHIMA) has voiced strong support for the new code set as well as many of the areas it will benefit long term.

As the deadline for the switch gets closer, it is critical to ensure full organizational readiness for the switch. Since there are many areas affected by the transition  — including EHRs, clinical support tools, and administrative and billing function — all areas of the organization must come together and ensure that they are prepared, and that preparation must be underway now.

February 5, 2012  10:00 PM

AMA offers free health and fitness app



Posted by: RedaChouffani
AMA, Apps, mhealth, mHealth applications

On Jan. 30, 2012, the American Medical Association (AMA) released a mobile app called Weigh What Matters. Available for multiple platforms (Android, iPhone and iPad), the app is just one initiative in the family obesity prevention program.

The purpose of the app is to help patients track their progress toward a healthier lifestyle. Health and fitness apps have become very popular and continue to grow amongst consumers.But in order to truly have more aggressive adoption rates, it would require some additional functionalities, offerings and overall innovation to truly spur patient engagement.

There are four key areas that health and fitness apps need to include in order to provide real value to users:

  • Incentives for the use of the app: Health and fitness apps will see more use if payers could reward their members for the use of the app. This could be a reduction in premium costs when the users are actively using the app to track their healthier lifestyle. This is somewhat similar to the idea of having a GPS device in a car, which provides driving habits reports to the insurance companies and in return the consumer gets lower car insurance premiums for better and safer driving.
  • Connectivity to your care provider: While some apps provide access to reports and stats on the device, it is somewhat challenging in many cases to submit that data and then share it with a health provider.This type of real-time data sharing will enable physicians to send real-time feedback to patients.
  • Ability to collect and manage data from different sources: Patients with different conditions have different needs and require different sets of health data to be monitored.Some of Apps will need to track patient’s consumed calories, and food in take, others patients will have the app track their vitals, record reactions to medication, mood changes, and glucose levels.
  • PHR management: More and more patients are finding value in managing their own health records.And as more health apps come to market, they will need to have the ability to connect and push collected data to the different PHR providers.

The AMA has been able to provide a useful tool to consumers for free via the new app, which will help track patients’ activities as well as eating habits.This free app is a valuable tool to primary care physicians as well, who can offer it to their patients as part of their care plan and health coaching to help ensure they reach their goals.


February 5, 2012  9:57 PM

MGMA requesting delays on HIPAA 5010 from HHS



Posted by: RedaChouffani
5010, HIPAA, HIPAA 5010, Medical Group Management Association, MGMA

Being a member of the North Carolina Medical Group Managers (NCMGM), I’ve recently had direct exposure to the many challenges the industry is facing around the HIPAA 5010 transition. Through round table discussions and list serve feedback from health care administrators, it is very clear that despite much of the testing done in 2011, challenges abound since the passing of the implementation deadline last month.

Unfortunately, these challenges are not faced by North Carolina provider organizations alone. The Medical Group Management Association (MGMA) received feedback on 5010 obstacles and pitfalls from provider organizations around the country. In response, the MGMA sent a letter to HHS Sec. Kathleen Sebelius describing the problems and reimbursement issues faced by many of those who have gone through the transition.

The letter cited several challenges encountered since implementing, including:

  • Issues with practice management and/or billing systems that showed no problems during the testing phase with their MAC, but once the practice moved into production phase, found their claims being rejected
  • Issues with secondary payers
  • Rejections due to various address issues (pay-to address being stripped/lost from claims; Pay to address can no longer be the same as billing address; no PO Box address)
  • Crosswalk NPI numbers not being recognized
  • “Lost” claims with MACs
  • Old submitter validation information not being transferred
  • Certain “not otherwise specified” claims being denied due to not having a description on the claim (CMS sent a notice of correction of this issue Jan. 27, 2012)
  • Sporadic payment of re-submitted claims (with no explanation for rejections)
  • Protracted call hold times (most typically 1-2 hours) when attempting to contact
  • MACs for further explanation of unpaid and rejected claims (a problem that dates as far back as November 2011)
  • Unsuccessful claims processing (with no reason cited for rejection) despite using a “submitter” that was approved after successful testing with CMS

In the letter, the MGMA requests that the HHS considers delaying the enforcement of the rule, as well as provides advanced payments for physician practices who are struggling to meet the deadline in lieu of the simultaneous EHR meaningful use mandates and the compounding stress on capital.


January 29, 2012  9:52 PM

ONC offers $5,000 in HIT challenge



Posted by: RedaChouffani
HIT challanges, ONC

Thursday, Jan. 26, 2012 marked the beginning of the submission period for one of the new health care IT challenges set by the ONC. The challenge, designed for software developers, is for industry innovators create a new tool that will overcome some the hurdles associated with post-discharge care. Mainly, to help ensure a higher follow-up rate and adherence to patient care plans.

The ONC described on their site the challenge as follows:

“In order to support broader adoption and uptake of promising IT-enabled interventions that address care transitions, ONC is challenging software developers to create an easy-to-use web-based tool that will make post-discharge follow-up appointment scheduling a more effective and shared process for care providers, patients and caregivers. In addition, developers will need to articulate a plan for broader adoption at the community level. Submissions can be existing applications, or applications developed specifically for this challenge.”

According to the requirements, there are several components and functionalities that the web-based tool will need to offer:

  • Easy to use web interface
  • Interfacing capability to allow for health information exchange with EHR and other systems using some of the existing standards
  • Secure messaging capability that will enable patients and caregivers to communicate
  • Social services such as transportation and other programs that can assist patients
  • Automated appointment reminders to help reduce no shows

The Office of National Coordinator for Health Information Technology has been able to continuously add more projects and challenges on their site. These initiatives help create an environment that encourages innovation while continuously focusing on improving health, reducing costs and improving patient satisfaction.


January 28, 2012  9:31 PM

The value of mobile apps developed by health systems



Posted by: RedaChouffani
Apps, Kaiser Permanente, mhealth, Mobile, Mobile applications, mobile apps

This past week, Kaiser Permanente released their mobile health app for the Android platform. The app, simply a mobile optimized web portal, provides many of the functionalities that are available through the kp.org patient portal.

As more and more health organizations embrace the deployment of mobile apps that can provide patients with full access to their health data, Kaiser Permanente decided it was time to join in as well. With the launch of their new app, patients are now able to view their lab test results, diagnostics details, securely communicate with providers’ prescription refill requests, and much more, all through the application.

For patients living in areas with large health systems such as Kaiser, these apps provide tremendous value. The following are just some of the advantages of mobile apps made by larger systems:

Convenience: Accessibility of health information on mobile devices provides one of the most convenient ways for any patient to access his or her PHI. While some still have that information available directly online, having the mobile version or a mobile optimized site provides the most effective and user-friendly method to deliver and interact with information on the go.

Push notifications: For most mobile apps (mostly native apps), push notification is a very valuable functionality. For a healthcare app, this feature can help notify the patient on the arrival of lab results, outstanding balances, follow up reminders, prescription reminders and other potential valuable information that the patients need to know.

Feedback: Receiving feedback and survey responses from patients is very important to a health care system. And traditional methods require phone calls and filling up paper surveys. But with the use of mobile apps, health systems can prompt a patient to answer few questions right after a scheduled visit. Whether it is a hospital stay on a simply an outpatient visit, the app will provide an easy way for the patient to provide survey answers from the convenience of their mobile device.

Exchange of information: For some patients with chronic diseases, a mobile app that is provided by a health system can provide valuable patient education content that is specific to the patient’s condition, as well as breakthroughs in treatments and clinical trials that may be available. It can also help some patients by providing them with tips and health coaching.

As patients from all generations continue to use more mobile devices, more health systems and payers are seeing that as an opportunity to get connected and stay in touch with their patients. This not only provides an opportunity for better care, but also improved customer service through convenience and real-time information.


January 22, 2012  11:26 PM

EHR-Lite through HIEs: The new EHR alternative?



Posted by: RedaChouffani
EHR, EHR certification, EHR-Lite, Health Information Exchanges, HIE, HIEs, Meaningful use

As providers continue to connect and use HIEs (Health Information Exchanges), several other non-EHR/HIE users are beginning to see the value that it can provide if they, too, become paperless and get connected. Because of this, some of these caregivers are turning to the new EHR alternative being offered as part of the HIE services in the form of “EHR-Lite.”

EHR-Lite is being advertised by several HIEs as the easy way to send and receive structured health information without the use of and investment into a full EHR product. While these products don’t have all the functionality and capability that a traditional EHR presents, they do, however, meet the meaningful use certification criteria and provide a cost effective alternative.

The following highlights some of the values that an HIE EHR-Lite product offers:

Cost effective:
For the most part, almost all EHR-Lite solutions that are currently being offered as part of HIE services are web based. The cost model is simply a subscription-based one. This hosted solution provides a cost effective alternative to the small to mid-size health organizations.

HIE services:
When a physician or a health organization decides to use an HIE based EHR-Lite, they are most likely going to have access to all services that are offered through the HIE, such as e-prescribing, imaging, lab orders and results, clinical decision support tools, referral management, health information access and medication history.

Collaboration platform:
Unlike traditional EHR products, the EHR-Lite that have been developed as part of the HIE offering were created with care coordination and collaboration in mind. This makes it to be a much better platform for collaboration on care and can be a significant tool to be used for ACO members.

EHR-Lite products are not necessarily a substitute for a standard EHR. They are, however, showing tangible value in terms of fulfilling basic meaningful use needs and provide interoperability without the complexity of interfaces or a major capital investment. The use of these products is on the rise as HIEs continue to mature, and as the needs for collaboration on care increases, these tools will gain popularity as they offer they offer a simple, easy to use platform for shared patient health information and data exchange.


January 22, 2012  11:23 PM

MU attestation vendor data available for analysis



Posted by: RedaChouffani
attestation, EHR incentives, Meaningful use, MU

Meaningful use attestation data is now available on Data.gov. The information represents the reported attestations by eligible providers (EPs) to CMS. The data provided consists of the name of the EHR vendors, specialties and state or territory of the reporting EP. By simply analyzing this data, we can identify the following findings:

Geographic distribution:

Based on the data, the following states rank as the top 20 for reported attestations for MU. As some of these high figures may be simply be linked to the larger population density, they can also be linked to the incentives and grants that have been awarded to each state from some of the federal programs available as part of HIE monies and HERSA.

Ranking

State

Total Attestations

1

Texas

1761

2

Ohio

1653

3

Illinois

1533

4

Pennsylvania

1450

5

Florida

1387

6

California

1287

7

New York

1272

8

Minnesota

963

9

Massachusetts

931

10

Wisconsin

812

11

New Jersey

752

12

New Hampshire

638

13

Oregon

606

14

Virginia

588

15

North Carolina

525

16

Michigan

520

17

Georgia

502

18

Washington

457

19

Tennessee

384

20

Arizona

370

Top 20 specialties with the most attestations:

Based on the reported information, it comes as no surprise that family practices and internal medicine rank as having the top number of attestations made as part of MU stage one. There are several other specialty types that have shown a positive number of early adopters of certified EHR and MU.

Ranking

Specialty

Attestations

1

FAMILY PRACTICE

4742

2

INTERNAL MEDICINE

4146

3

CARDIOVASCULAR DISEASE (CARDIOLOGY)

1432

4

PODIATRY

1124

5

OBSTETRICS/GYNECOLOGY

955

6

GASTROENTEROLOGY

872

7

ORTHOPEDIC SURGERY

676

8

UROLOGY

628

9

OPTOMETRY

614

10

GENERAL SURGERY

606

11

NEUROLOGY

520

12

PULMONARY DISEASE

479

13

NEPHROLOGY

472

14

ACUTE CARE

467

15

OTOLARYNGOLOGY

397

16

OPHTHALMOLOGY

386

17

REHABILITATION UNIT

357

18

DERMATOLOGY

330

19

ENDOCRINOLOGY

273

20

HEMATOLOGY/ONCOLOGY

266

Top 20 EHR products reporting meaningful use 1:

The following table lists the top 20 EHR products/Vendors reported Attestations:

Ranking

EHR Product

Total Attestation

1

EpicCare Ambulatory – Core EMR

6046

2

eClinicalWorks

1847

3

Allscripts Professional EHR

1203

4

athenaClinicals

1158

5

MEDENT

999

6

NextGen Ambulatory EHR

884

7

e-MDs Solution Series

770

8

PrimeSuite

712

9

Centricity EMR

590

10

Sage Intergy Meaningful Use Edition

565

11

TRAKnet Practice Management Software

397

12

Centricity Practice Solution

320

13

EpicCare Inpatient – Core EMR

284

14

Amazing Charts

252

15

OfficeMate/ExamWRITER

236

16

meridianEMR

210

17

Allscripts MyWay EHR

209

18

SammyEHR

199

19

SOAPware

179

20

Acumen EHR

174

As such information continues to be made available to the public, it will help identify current trends on adoption rates, as well as provide many ways to analyze the data that has been provided.

 


January 15, 2012  6:00 PM

The CES 2012 products and what they can do to healthcare



Posted by: RedaChouffani
CES 2012, healthcare, mhealth, mHealth devices, mobile health, tablets, telehealth, ultrabooks

When looking at the myriad of products available and introduced during CES 2012, there were several neat gadgets that were also truly innovative. Many of these items will eventually make their way to the healthcare space, aiding in care delivery and expanding the care continuum.

Overall, there were a few categories of products worth highlighting that are of interest to technology enthusiasts:

Ultrabooks:  After watching the success of the MacBook Air, many notebook manufacturers clearly recognized that thinner, lighter machines that had longer battery life were critical to spurring market interest in their products. During CES 2012, many vendors captured the attention of bloggers and attendees with their ultrathin notebooks. HP was one of those manufacturers with their HP Envy 14 Spectre Ultrabook. In terms of healthcare, the business value that these devices would bring is longer battery life and the fact that they are much lighter, thus attracting more healthcare professionals.

New apps and software: There were two products that I found very interesting featured at the show, one being OnLive, which is bringing cloud-based gaming to Android based devices as well as other platforms. Another product, the BlueStacks App Player, allows mobile apps to run on any Windows based desktop, keeping all of the apps on the different platforms completely in sync. From a healthcare perspective these products shows the potential of having a completely hosted application platform (EHR, RIS, registration, ERP, LIS) in the cloud, with access to any of them being OnDemand. IT departments will create and manage one application repository where staff can then have access to the different apps, on the device of their choice, without needing to involve IT in the process, significantly reducing costs. Essentially, you could pick up an iPad or ultrabook from the store, connect to the network and you are ready to roll.

Smart TVs: I wrote about the value of smart TVs for the first time last year, as I see this as as area of technology poised for growth in healthcare. Experimenting with Google TV, Apple TV and XBMC in recent months, I was able to learn a lot about what smarter TV offers and the potential capabilities in the future. While CES 2012 did not offer that much in terms of smarter TVs, most of the focus was on some of the newest TV sets utilizing Google TV or having their own built-in apps.

Tablets and e-readers: Samsung, Asus, Acer and others showed a demo of their tablets with the latest version of Android (Ice Cream) and Windows 8. While it was hard to see any real incredible differentiators amongst these products, these devices will most likely increase the popularity of Android tablets. From a healthcare perspective, we will likely begin to see these devices in the waiting room of medical practices while filling up medical history forms (eDocForms) as well as in the hands of home health nurses and patients in infusion centers to replace paper forms and magazines.

Wireless medical devices: A wireless blood sugar meter was another healthcare specific product worth noting at CES 2012. It was a wireless medical gadget that can read the glucose levels from a drop of blood and sends the results to an online data service using its internal wireless connectivity. These results can be shared with a patient’s physicians and ensures that both the patient and physicians have the data available to them without relying on paper based forms for tracking the information.

CES is an exciting event for all gadget and technology lovers. It introduces us to many of the latest and greatest innovations and also gives us indicators as to what some of the trends are from a consumer perspective. Healthcare professionals and executives must keep an eye on these products and seek to integrate and adopt the ones that not only can bring significant cost savings and increase efficiency, but ones that also work to expand the care delivery continuum and improve patient care.


January 15, 2012  5:55 PM

The publication of the Interim Final Rule for the adoption of standards and operating rules



Posted by: RedaChouffani
EHR, EHR compliance, Electronic claims submission, Interim Final Rule, Meaningful use, MU, Revenue cycle

The Interim Final Rule for the adoption of standards and operating rules for electronic funds transfer and operation rules for remittance advice was published in the Federal Register on Tuesday, Jan. 10, 2012.

The rules released in July of 2011 stated standards with which some health plans had to comply by Jan. 1, 2012 that will now not go in effect until 2014 (i.e., transmitting claim payments to providers electronically). In addition, the document defines the standards for the data content of the EFT.

These mandates provide a significant value to providers and hospitals. Currently many of the organizations receive the EFT or payments after the in electronic remit is received and posted. This means that there are several stops to ensure the appropriate payment was sent and posting is done in time with them.

The published document is available for public viewing and comments. The comments must be received within 60 days of the document’s publication, by mid-March 2012.


January 8, 2012  8:09 PM

The next generation mHealth applications may just be the right prescription for EHR



Posted by: RedaChouffani
EHR, mhealth, mHealth functionality, mobile health, SIRI

An increasing majority of mobile technology and mHealth device users in the health care industry are recognizing the value of their connected health devices. Tablets and smartphones are allowing health care professionals to gain access to patient information and care specific content before, during and after a patient’s visit. Given their ease of use, lightweight nature, long battery life and connectivity, many users are seeing real efficiencies gained in areas of their day-to-day workload.

Be that as it may, the reality is that we may not see these devices completely replacing desktops or notebooks right away. For health care professionals, there is still a gap in the functionality currently available in the mobile devices. For example, when documenting the patient’s chart there are several methods by which to capture that information:

  • Voice recognition tools
  • Point touch and easy to use note generating functionality as part of the EHR app
  • Hand writing recognition features
  • Utilization of a keyboard connected to the tablet

But a greater challenge exists for physicians other than simply how to capture patient data in the system. Part of the difficulty with some of today’s applications and systems is the way that these products allow the review of information needed during care delivery. In most cases, when caring for patients, clinicians are constantly looking for information and test results such as labs, imaging, specific medical history data as well as data from other departments and possible other systems altogether. Most apps available today do not currently have the capability for the easy extraction and display of information from such fragmented sources.

That said, what would be some of the functional capabilities that will make the most sense for physicians as well as justify the cost and investment in the next generation of mhealth apps and mobile health technologies?

Timeline view of the patient record: Adopted from Facebook’s timeline concept, this would be a useful feature for physicians. This functionality would collect and group related information into a timeline of the patient’s health history and display the different conditions and their progression over time. For some patients with cancer and other life threatening conditions, the timeline would allow the physician to view the progression of the disease over time and accurately plan for the treatment. The information would be collected from HIEs, PHRs, payer data, eRx, major lab companies and any other health data repositories.

Contextual functionality:  As any care giver will tell you, there are several common tests and order sets associated with certain types of conditions. So, it would be valuable functionality to have a smart app that is capable of automatically filtering the order list, medication list and other content based on the patient’s condition and or evidence-based data. This will help reduce the amount of time a caregiver has to spend going between different screens and areas in the app to get to what they want for that patient.

Leveraging connected content and social media integration: There are several examples in the industry today that showcase how more and more apps now come equip with some sort of connectivity to one or more social media sites (LinkedIn, Twitter, Facebook and the like). You can upload your fitness stats to your Facebook, send an article from your Twitter account and even post a video or photo directly from your phone. The next generation of health care apps will come with the capability to securely connect with HIEs, drug interaction databases (i.e., Next generation of Lexicomp), clinical support services and more.

Tag like functionality: Similar to Wikis and online keyword tagging, the next generation of apps needs to allow care givers the opportunity to review patient charts and easily access specific areas simply by clicking on the tags in the document (#labs, #imaging, etc).

Natural Language Processing (NLP think Siri): Siri, from the iPhone 4S, is no longer just a conversational piece that you ask to marry for sheer entertainment. Many have begun to actively adopt Siri and its functionality has thus been extended. In a recent experiment, I spent some time writing some prototypes in Ruby with web services on top of an EHR database. I was able to build a small sample that allowed me to make simple commands on my iPhone and get Siri to provide me with useful information. This provides a proof of concept of how Siri would work in health care in the future.

For example, some of the commands that I used were “Siri, look up patient Id 12345”, “Siri, please tell me about the active medications that the patient is on”,  “Siri, send a message to my assigned nurse and tell her the patient is ready for x-rays” , and even “Siri, when is my next surgery and where?”.  All of these commands seem to be futuristic at first, but given the hard work of programmers who identified the Siri Protocol and developed Siri Proxy, they have opened the door for an incredible new way for clinicians and health care staff to interact with smartphones and patient data content. The increasing popularity of voice command technologies, such as Siri, Dragon voice command tools and IBM’s Dr. Watson all show that future products will have the ability to provide support for any virtual assistance able to perform tasks that traditionally require several clicks and manual data entry.

Mobile health applications may be gaining traction and more popularity, but there are still several areas that can use improvement. As the products continue to evolve, health care will begin to see more incredible features and even more highly integrated, intelligent functionalities as part of the next phase in mobility.


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