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Meaningful Health Care Informatics Blog


September 18, 2011  7:46 PM

Does an ACO need to wait for an HIE?



Posted by: RedaChouffani
Accountable care organizations, ACO, Health information exchange, HIE, Interoperability and health information exchange

When discussing the subject of Accountable Care Organizations (ACOs), the exchange of health information is most often assumed to be a must have component for the model. Rightfully so, since the intent of an ACO is the coordination of accountable care to reduce costs and improve population health.

But when looking at the infrastructure required to accomplish truly coordinated care, we often find that an HIE platform is a must have in order to succeed.

Clearly most ACO members would need to have an electronic medical record (EMR) system in order to efficiently and electronically communicate and review patients’ health data.It is also part of the ACO requirements to have a certified EHR for CMS.

While the current certification criteria does include some of the components required for the coordination of care (i.e., electronic lab results, exchange of health record, and PHRs), it is still far from being complete without an existence of an HIE, which would facilitate the exchange of the information amongst physician groups and hospital systems. This is especially important when patients seek certain treatments outside of their community, which requires the health data to move in and out beyond the community system boundaries.

Clearly this presents a challenge for ACOs that may form in states where HIE is still new, possibly in the infancy stages.

While having an HIE is ideal, it is not a must have.If the organization has the capital to implement its own private HIE to support its members in exchanging and collaborating on care, and the physician groups are using a certified EHR that has the ability to communicate with an HIE (state, national, or private) then information can flow in and out of these systems without having to wait on a community or state wide initiative.

September 11, 2011  10:08 PM

Independent physicians receiving solicitations to outsource all IT to the hospital system



Posted by: RedaChouffani
EHR implementation, Health information exchange, HIE, integration, Interoperability and health information exchange, Physician groups

Many specialists and independent health care providers affiliated with a local hospital system have already been solicited to come onboard and integrate with the larger organization’s EHR system, as well as utilize their IT resources to support services. This type of integration would allow them to take full advantage of one single chart per community, per patient. And as we continue to see the importance of health information exchange, both in terms of quality of care as well as federal mandates and compliance, for a small physician practice, being connected to the hospital system can mean direct connectivity to a state or regional HIE.

From a financial standponit, for some of the smaller size practices, this can also mean more purchasing and negotiation power when engaging in relationships with the large systems. However, these value add propositions are still not convincing enough for private practices just yet. Some have continued to stay independent and maintained their profitability despite the bigger competition.

But the reality is that there is no simple answer to whether joining a large health care system will boost profitability and improve care for the patient or not. From one perspective, you have the hospital who can convince practices to use its system and can provide a value add to both practices and consumers (patients) by having one central location for all their health data. On the other hand, many of the private practices continue to face high costs from implementing these new technologies and infrastructure upgrades, and must continually look for ways to reduce their up front costs as they move toward becoming paperless.

This cost/benefit analysis is not anything new, though, and as we continue to see different reform initiatives and new mandates, health care systems and private physician practices will continue to cross paths and evaluate and redefine their relationships. And in just these recent years, ACOs have been one subject of discussion, as everyone is wondering what it will all mean to them from not only from a technology perspective, but also distribution of savings or payments. Only time will tell.

 


September 11, 2011  9:05 PM

Top 5 reason why tablets are a favorable option for your next trip



Posted by: RedaChouffani
iPad, laptops, mhealth, mHealth devices, Mobile health devices, tablets

With the continuing increase in popularity for devices such as the iPad and Android based devices, many users are foregoing their laptops and are instead opting for mobile tablets, comfortably catching up on their work while out of town or during their commute. And there are many reasons why it is becoming a trend to simply do away with the laptop and stick with a tablet:

Top 5 reason why tablets are a favorable option for your next trip out of town:

1. Battery life: For many iPad users, the advertised battery life is about 10 hours. But many tests have shown that 6 is about what you can get out of it, and of course a lot less if you are watching videos or using wi-fi. Regardless, considering the lengthy battery life in comparison to a regular laptop, the tablets are an attractive choice for users looking not to be connected to a power source for too long.

2. Quick boot: As we’ve all experienced at some point, when you pull your laptop out of sleep mode or doing a fresh boot up, the system takes it a while to be fully loaded. This means that if you have an urgent email to write, you are most likely going to have to wait for the Windows / Linux splash screen to go away. But many of today’s tablets are just as quick as a smartphone, providing instand access to email and whatever applications you need in order complete urgent work.

3. Quick install: Selecting the right installer for your workstation operation system version requires some knowledge of your PC. It also means that some applications may not even be available for your version. But with many of the tablets and the existence of App Store/Marketplace and a single click installer, the simplicity and ease of application deployment on many of the tablets available today make them an increasingly attractive option.

4. Remote processing: As is the case many health care organizations, virtualizing environments, moving  desktops to data centers and going the way of the cloud is a new trend they’re exploring. This of course is in line with many of the capabilities of the tablets, which have apps that allow them direct access to a virtual desktop. Whether it is Citrix or VMware View, a user can have all the functionality that a standard business desktop with Windows has to offer directly from their device with full audio and video support.

5.Lightweight: For many of today’s leading laptop manufacturers, they recognized that users want lighter, more portable computers for ease of travel and use during a commute or on the go. But no matter how light or thin, it is very hard to compete with weight of iPads and tablets alike. They have been the ideal device for note taking, messaging, video conferencing, rich content viewing and even gaming.


September 4, 2011  8:49 PM

Business Intelligence tools on the go



Posted by: RedaChouffani
BI, BI tools, business intelligence, mhealth, Microsoft Analysis, mobile BI, mobile health, SAP BusinessObjects

With the health care market continuing to take advantage of business intelligence (BI) tools, there is a continuing interest in the market for the development of mobile BI tools for executives on the go.

Just as we have seen how smartphones and tablets keep health care leaders connected to their emails, social media sites and colleagues, we are starting to see more and more demand for mobile dashboards.  Having access to the different hospital scorecards and KPIs (key performance indicators) is helping executives react to changes and trends in real time, even when sitting in traffic or during their travel.

So far, there are many products available in the market that can plug and play into the current BI tools available in hospitals. Whether the organization is using Microsoft Analysis services, reporting services or SAP BusinessObjects, most of the new tools available on the iOS platform (iPhone/iPad) as well as the Android can easily integrate with those systems.

Some of the tools available in the market place are MicroStrategy Mobile for iPad, BIRT mobile and Roambi. Many of these products provide easy to use interfaces and allow for the internal IT team to customize the dashboards based on the end users preferences and job roles.


September 4, 2011  8:40 PM

Open Source initiative from the VA and DoD for VistA



Posted by: RedaChouffani
DoD, EHR implementation, Interoperability and health information exchange, Open Source, Open Source EHR, VA

The Department of Veterans Affairs (VA) announced on August 30, 2011 that it has engaged with the Department of Defense (DoD), working with the Informatics Application Group, to open access to its open source electronic health record (EHR) and provide governance so that outsiders can contribute and improve upon the VistA product.

The organizations will use the OSEHRA web site to oversee the community of EHR users, programmers and service providers that will work on the product.The web site currently provides additional resources such as design documentation, licensing terms, and system architecture and source code for VistA.

As many already know, the VA has been one of the largest medical systems in the US to implement and adopt electronic medical records.While VistA has been commercialized from groups such as Medsphere, it has not yet seen wide commercial adoption, though Medsphere did have an open source community for its modified version of VistA called Healthcare Open Source Ecosystem.

This new initiative will help create more modules of interest to the private sector and will also encourage wider adoption due to the potential added functionality that can be generated by outside contributors.In addition, the current VistA solution has the ability to connect to the NHIN due to the development of the VistANHIN adaptor.


August 28, 2011  9:03 AM

Top 7 reasons why health systems are hosting their EHR with vendors



Posted by: RedaChouffani
EHR integration, EHR vendor, IaaS, Infrastructure, Infrastructure as a service, IT department, IT staffing

For the majority of hospital executives and health IT leaders, implementing a new electronic health record (EHR) is a complex and taunting task from both an organizational and technical prospective. Not only are there major hardware investments required up front, but there are also new resources and skills needed to be able to support and maintain the new system, and these may be completely different from what is currently in place.

This is where a hosted model, or infrastructure as a service (IaaS), becomes a more attractive alternative for hospital and health systems currently taking the steps toward EHR implementation. However, this framework will change the role of the IT department in-house, and this is an important distinction to make. With this model, the IT department will no longer be in the business of IT, but will instead be tasked with supporting the organization’s enterprise IT goals and objectives and ensuring that technology is there to improve efficiency within the IaaS model.

Top 7 reasons why hospitals why would consider IaaS for EHR implementation:

Faster resolution and support:

For many of the larger hospitals and health care systems, when implementing an EHR system across the different departments, the IT team spends a tremendous amount of time upgrading, troubleshooting and communicating with the EHR vendor to support the product and resolve technical issues. This creates a tremendous amount of additional work for the IT department. With a hosted or IaaS model, the vendor is fully responsible for maintaining the system, supporting it and ensuring uptime. This means that the hospital IT team spends less time troubleshooting and more time with end-users.

Less upfront capital:

Imagine you are a 500 bed hospital getting ready to implement a system like EPIC or Cerner. There are significant amount of capital investments that need to be made up-front, not only during the upgrade of the infrastructure that will support the system, but also with the additional resources needed to support it. Essentially, when a hospital decides to implement the IaaS model, they are changing the cost from a capital expense to an operational expense, where they are paying the vendors a monthly fee for the services and access to the system and support, which becomes a much more attractive option for many institutions.

Redundancy:

As the natural disasters that we have experienced in the recent months help to illustrate (i.e. tornados, hurricanes, earthquakes), it is critical to have system redundancy and continuous availability in case of system failure. This would mean that a hospital system will have to invest in a data center located in a different geographic area, which will allow them to switch systems quickly in the event they need to protect the hospital records and electronic patient data.

Focus on healthcare informatics:

Getting away from the business of learning and troubleshooting issues with a new EHR system and moving to providing business value through technology is what healthcare IT should be all about. With the quick availability of IaaS services, infrastructure delivered as a service, it enables IT to leverage and focus their time and resources in bringing innovations, solutions and improvements to the healthcare system.

Scalability:

IaaS providers offer a service model where you pay as you go, or as you grow. You can easily scale out the system as needed without any hardware upgrades, which can sometimes be as simple as submitting a request online for additional computing power or storage. And voila! The system can now accommodate additional users from a new hospital acquisition or outpatient practice.

Security:

Security is in the mind of every cloud computing adopter. Whether it is protecting sensitive intellectual property or patient medical information, many IaaS providers have implemented strong security practices and have been granted certifications such as ISO/..IEC 27001 and PCI. These have helped their customers meet the different regulatory and compliance requirements from HIPAA.

Less downtime during major upgrades:

Major upgrades have caused of a lot of headaches for IT folks. Requiring downtime during back-ups, coordinating with the vendors, scheduling onsite visits from vendors — these are all things that can easily be handled, more efficiently, by an EHR vendor in an offsite data center. The hosted model eliminates many of the challenges experienced during a local upgrade and shifts the responsibility and work from the organization and back to the EHR vendor.

Many health care executives and decision makers are beginning to see the benefits of the IaaS model and are starting to carefully evaluate what their IT departments could look like in the future. Employing the technologies and solutions that can help improve efficiency and cut operational costs, while transitioning IT from reactive support to a more proactive business/vendor partnership model.


August 28, 2011  8:58 AM

The features of tomorrow’s health care kiosk



Posted by: RedaChouffani
EHR, kiosk, Medical records, mobile health, PHRs and patient engagement, Revenue cycle

For the majority of us, seeing a kiosk in an airport, in a cell phone store, or even in a retail shop has become the norm. But we continue to lack the same high adoption rate in the health care arena. Why is this the case?

Some may contribute this to problems with ease-of-use and cost, while others point to the age range of users. Unfortunately, some of the current kiosks available tend to focus on what the vendor and developer group wants, instead of what the patient would like to see. The question we need to ask here is, how can we maximize the use and benefit of a kiosk, improve customer service and increase the adoption rate?

Below are some features that the “kiosk of tomorrow” would need to have, in my opinion, in order to attract patients and demonstrate value:

Help you find your way:

With every hospital I visit, I still manage to get lost and have to call the person I am meeting with to get some clear directions to get to where I need to be. I envision that tomorrow’s kiosks will begin to implement a “way finding” functionality which would allow me to tap on the screen, click on an icon that says “Help me find my way”, ask me if I am a patient and if I am an existing patient. The system would ask me to tap my phone on the screen, and with the magic of NFC, it recognizes me and tells me where my appointment is, while automatically notifying the front desk of my arrival. The kiosks can even prints a map or display an animation telling me how to get to where I need to be. If I am not a patient, it can simply allow me to select from an employee directory and show me the way.

What do I owe you?

Having dealt with hospital bills myself in the last 3 months, I cannot tell you how frustrating it was to get a list of itemized statements for what I owed. To me it is a very inefficient process, as you have staff answering phone calls, printing statements, and mailing them to patients. During one of my hospital visits, I could have easily logged onto the kiosk and viewed on the screen the detailed statement, and even paid for the balance! Of course some of this can be done directly through the web portal, but when you are in the waiting room, sometimes having kiosk right in front of you that can provide you with detailed information on your account and can help collect both current and outstanding payments.

Smart integration:

For outpatient surgery centers or even the ICU, having a kiosk that has some sort of connectivity to the medical records or patient tracking system can assist family members who are anxious to check on the status of their loved ones during all the stages of the surgery. This will significantly cut down on the calls to the nurses to check how the patient is doing and at what stage they are in.

Other integrations can also be done with the ER system. In this example, the kiosk can provide the estimated wait time in the ER, with some of this technology already being in place at the more connected hospitals.

Added services:

There are additional valuable services that kiosks can provide to patients. For example, patients requesting a copy of their medical records can be given access to their data directly from the kiosk. They can request and pay to get a digital copy of their medical records, downloaded to a USB flash drive or uploaded to Microsoft HealthVault or any supported PHR provider. This would reduce the volume of calls associated with ROI (request of information) and help provide more self-service products to patients.

Kiosks come in different shapes and forms. Some are PCs stored in attractive cabinets and others are in the form of tablet PCs. In more recent years, we are starting to see some of them running on Android based tablets and iPads. Today’s kiosks provide useful functionality and features such as self check-in, self-payment, and other basic features. But many vendors have recognized the need for more than just basic functionality and are actively developing more advanced features to increase adoption of these devices.


August 21, 2011  9:50 PM

Task and time management tools



Posted by: RedaChouffani
EHR messaging, Outlook, Physician workflow, Time management, Workflow

For several years now I have benefited from using a centralized to-do list integrated with my Outlook calendar. It offers a complete view of what activities and items I needed to accomplish everyday in an easy to use integrated fashion. But as I started relying more and more on mobile devices and tablets to conduct everyday business, I found out quickly that I needed to begin utilizing different apps that would allow me to easily view my tasks and calendars from any device, at any time.

Fortunately there were several mobile apps that allow me to maintain all my devices in sync with my Outlook tasks, with one of my favorites being toodledo. The toodledo app allows me to apply some of the principles of proper time management outlined in Steven Covey’s “The four discipline of execution,” and allows all of my “toys” to maintain the same list.

But one challenge that some face lies in deciding when to separate and manage multiple to-do lists. For example, for those physicians who are still practicing and also participating in leadership roles, managing their calendar requires a tremendous amount of discipline and time management skills. In a perfect world, a physician’s EHR messages should be able to easily integrate and populate with their Outlook tasks and calendar (securely and without any patient info). Unfortunately, not all systems integrate or sync with Outlook tasks, which means that many times users need to manage multiple lists or else rely on manual synchronization between different systems.

The good news is that many can still successfully and efficiently manage their time even when having to work with multiple lists. Best practice should always be to review your to-do list(s) daily and stick to deadlines, as this will ensure that you are continually monitoring progress are are aware of changing priorities.


August 21, 2011  9:44 PM

Differences between an EHR software vendor and an EHR solution provider



Posted by: RedaChouffani
EHR functionality, EHR vendors, IaaS, Solution providers

When the ARRA stimulus package was signed into law in 2009, health care organizations had to shift gears to full speed ahead in search of the perfect EHR solution. This, of course, excited software vendors in the marketplace and spurred economic growth in the industry. Furthermore, it encouraged many vendors to race for ONC certification and strive for HIPAA 5010 compliance, ICD10 transition success, HIE and mobility in their products.

The increase in both demand and supply of products and services, however, meant that vendors have had to continually find new ways to differentiate themselves in terms of their products’ core features and functionalities, which includes deciding to go the route of either a “software vendor” or “solution provider.”

The reality is that there are two types of EHR providers who can help a health care organization achieve its enterprise IT goals and adhere to federal compliance guidelines:

·EHR software vendor

·EHR solution provider

EHR software vendor: This grouping of companies refers simply to the vendor type that comes to your organization, shows you a PowerPoint or demo of the product and its functionality and generates a quote for the organization, often including a claim that said product is the “best EHR that ever existed”. These software vendors will often offer their product for download or purchase online. They are also the vendors that talk in terms of how physician’s can click on buttons to get from point A to point B, but stop there.

An electronic health record should help achieve positive results throughout the organization well after implementation, including improving patient care, reducing operational costs and increasing overall efficiency in the organization and system as a whole. In this respect type, one could argue that the software vendor’s limited involvement and lack of long-term strategic guidance might not provide the highest value-add or insight as to how their product will help accomplish an organization’s overarching IT goals in the long run.

EHR solution provider: On the opposite end of the spectrum you will find the vendors who work closely with an organization to assess if a product is a good fit for the group first, in terms of ensuring that their products and services will provide an attainable, tangible and measurable ROI. These are also the groups that will first learn about your organization’s challenges and strategic vision for the future prior to pulling up any presentation or quote.

In my opinion, these are the IBMs of the marketplace. They provide a comprehensive solution through offering their assistance with HIE integration, meaningful use compliance, mobile app development, revenue cycle management and consulting, patient portals, system integration assistance, clearinghouse services and many other services that can help with the myriad of IT challenges and projects health care organizations are currently spearheading.

In my opinion, tomorrow’s EHR vendor will look and act a lot like Microsoft and IBM, providing many of the following services:

·Expert consulting

·Health care informatics and data analytics

·IT and admin support

·Infrastructure as a Service (Iaas)

·Products and solutions

·Integration

·Connectivity and application customization

·Outsourcing

Clearly today’s health care IT leaders need to be considering more than just the software when assessing the right EHR vendor fit for their organizations. They must look for a company who will be a true strategic partner, working side by side for the long haul, not disappearing as soon as the install is complete, leaving only a support number to call. 


August 14, 2011  9:39 PM

The building blocks for an ACO technology infrastructure



Posted by: RedaChouffani
ACO, HIE, Infrastructure, technology

ACOs have become quite a hot topic among health care leaders today, with some of the main concerns being governance, payment structure, infrastructure and architecture challenges. Some feel strongly that ACOs will require a more complex and advanced technology infrastructure than the ones currently being employed in HIEs, and many are left wondering just what that will mean to providers in terms of moving forward.

The goal of an ACO, or a set of health care organizations that work together and collaborate on and coordinate care for a set of patients, is to not only reduce costs and increase efficiencies in the system, but also improve patient outcomes and the overall coordination of care. But while ACOs are still evolving and taking shape, it is important to dive into some of the core infrastructure components that will be required to ensure success and long-term sustainability.

In order for an ACO to succeed, it must operate a provider network that will enable the electronic exchange of information, provide a platform for care management and offer a payment distribution system. Underlying all of these attributes, of course, are the technology implications, some of which are the following:

Health Information Exchange (HIE): This is a standards based exchange for electronic health records. The current standard being used is the HL7 CDA or CCR (Continuity Care record), which is the format in which health information is stored and exchanged across systems. The HIE is the facilitator that will enable systems to identify patients as well as locate their chart and route it to the requestor. This does not necessarily mean that an ACO will need to operate its own HIE, however. In fact, most ACO will likely connect, or have the option to connect, to one or more HIEs, especially when working across state lines.

Certified Electronic Health Records (EHRs): For participating caregivers, having EHRs to view and document care during a visit is a must. An ACO might offer a hosted EHR or patient tracking system to help boost participation, though it is not required to have one common EHR system for all the members simply due to the fact that most certified products do have the capability to exchange medical information in a standardized format.

Patient portals: In order to improve patient engagement, an ACO will need to provide a patient portal to facilitate secure electronic communication. This will provide the patients with web based and interactive personal healthcare records. The ACO should also offer integration with all major PHR providers.

Data warehousing and business intelligence (BI): There are over 65 measures in the proposed ruling for ACOs. All these quality measures must be reported on in order to be eligible for shared savings. The measures cover everything from care coordination and preventative health to patient experience. Much of the information will be submitted via GPRO tools. In addition, each measure has a minimum attainment threshold and performance benchmark, which requires the ACO to continuously monitor its performance over time.

IT support: In order to ensure system uptime and reduce disruptions to data flow, an ACO will need to provide IT support not only to support the connectivity amongst the members, but will also need a team of HIT specialists to maintain the internal ACO platform.

Unified communications: In a recent article, I discussed the need for sites or platforms that will facility coordination of care similar to Facebook , except more business oriented (similar to Chatter). These solutions will not only allow caregivers to communicate with each other regardless of distance, but it can provide them cost effective ways to have video conferencing, including telehealth services, and a platform for discussing patient cases.

ACO management technology: Since an ACO is the result of the collaboration of cross-disciplinary services and multi organizations collectivity accountable for the total patient care, it is critical to have a system that will support governance and management of the ACO care-delivery model.

Document management: While this may not be obvious at first, the reality is that there are still patients that bring their medical information in paper format. This may require the ACO to provide tools to digitize that information and make it available to everyone. The ACO may be forced to identify alternatives such as cloud-based document management system to be able to provide easy to use and widely accessible system to retrieve and review paper based documents.

Preventative health: In order for an ACO to have a proactive role in the population’s health, the organization must ensure that it is continuously working with patient through reminders and alerts for preventative care. This is especially important for patients with chronic disease.

Clearly an ACO will require a lot of technology as part of its foundation. This means significant capital upfront as well as resources and a strong strategic plan to ensure sustainability. Some hospital led ACOs may have some of the infrastructure components already available to them, while other ACOs may integrate with a payer system which has most of the components. Either way, the ACO and medical home models are not going away, and health IT leaders will continue to be faced with a unique set of challenges as the industry leaders continue to pave the way toward true coordination of care through health IT collaboration.


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