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Meaningful Health Care Informatics Blog

August 14, 2011  9:38 PM

GE Centricity Advance comes to the iPad and iPhone

Posted by: RedaChouffani
EHR functionality, GE Centricity Advance, mhealth, mHealth applications, mobile health

The GE Centricity Advance mHealth app has finally hit the market, now released for the Apple iOS platform. GE’s official release date was on August 13th, 2011, where clinicians are now able to access their patients’ medical records, orders, lab results and documents directly from their iPhones and iPads. While the Centricity Advance package contains a fully web-based EHR and practice management system (PMS), the app is native to iPad.  

This mobile solution is the newest addition to the Centricity Advance product suite, previously part of MedPlexus. GE is providing the full suite (EHR and PMS) as a software as a service (SaaS) model for physician practices of 10 providers or less. And now, with the additoin of the app, small practices can work from anywhere, and from any device. With an SaaS model, GE provides a cost effective alternative to some of its other non-hosted models (GE Centricity CPS), which reduces the upfront costs that a typical medical practice will endure when purchasing an EHR.

As part of the product, physicians can receive patient lab results instantly, review messages, electronically prescribe medication, perform computer physician order entry (CPOE), sign-off on documents as well as fully detail a patient’s visit. For the most part, the app offers pick list control for almost everything, though it would most likely better viewed through an iPad due to the larger screen size.

We will most likely see more and more EHR vendors releasing similar applications, though only time will tell what functions will become standards, and in what new ways mHealth will continue to break down the brick and mortal barriers and drive EHR adoption.

August 7, 2011  10:06 PM

Other areas that physicians will look at closely when selecting a new EHR product

Posted by: RedaChouffani
EHR functionality, EHR selection, ONC-ATCB

To date, over 900 EHR applications have been certified through an ONC-Authorized Testing and Certification Body (ATCB). While this has added a plethora of choices for physicians in terms of which to choose and how to attain meaningful use, given the tight deadlines and limited timeframe, the high number of vendors and technology options can prove to create more challenges and added layers of complexity for many health care organizations still working to identify the best-fit solution for their needs.

For many products in the EHR market today, there are actually only subtle differences in terms of their capabilities and functionality. But at times, these are the exact features that can be the key to a successful implementation of the EHR, or not. One could almost apply the Pareto principle here, or the 80-20 rule, where approximately 20% of the features possess the key differentiators and and critical success functions, while the remaining 80% comprise the common features found in most EHR systems.

Some areas of consideration that have spurred conversations among decision makers regarding EHR package evaluation are:

  • How effective would some of the products be when interacting with HIEs?
  • How are the different EHR solutions going to take ACO models?
  • What are some of the different mobile capabilities would be available?

As we’ve been privy to watching unfold, technology has been playing an increasingly important role in the effective, efficient delivery of health care, and continues to present opportunities for innovation and offer a measurable value to both physicians and patients. From utilizing an HIE for better coordinated care to adopting mobile technology and integrating mHealth devices for the viewing of radiology images, lab results or e-prescribing, we are going to continue to see adoption of tools that will not only prove to drive down costs, but also improve the overall quality of care.

August 7, 2011  9:41 PM

Mobile health apps for the patients

Posted by: RedaChouffani
Consumer connectivity, mhealth, mHealth applications, mHealth apps, mobile apps, Patient engagement

The increasing popularity of smartphones and demand for broadband data access across all types of carriers has set the stage for major growth in the mobile application’s arena. Many vendors who have already taken steps to seize this opportunity have apps on the market that are making a notable difference in the lives of both physicians and patients, with the end-user action and results to prove it.

And many patients have begun to see the benefits and payoff themselves, utilizing mHealth apps for better care coordination and increased engagement. Whether it’s through apps that offer health coaching for the management and promotion of a healthier lifestyle, or those that allow for better treatment of chronic illnesses, we’re seeing new, patient-driven options truly start to make an impact.

For diabetes care, for example, the assistance can be found in many forms, such as the bant app that was unveiled at the ATA 2011 conference earlier this year, which focuses on increasing patient engagement in teens via the interaction of social media and an iTunes reward system. And at the University of Maryland School of Medicine, researchers have concluded that the use of mobile technology helped patients manage their type 2 diabetes, with results to back it up. Patients who used the app had their A1c levels drop significantly over the course of a year, results of which have helped increase consumer confidence in the app and help illustrate the efficacy of their usage in various patient populations.

There are several other solutions that have helped patients manage their chronic conditions.Asthma patients now have the ability to use a mobile app called Asthma Tracker, which can provide information on common medications, treatments, asthma triggers to avoid and additional resources and tools. Patients with high blood pressure or hypertension can also get assistance in tracking and measuring their BP over time, which allows for the constant monitoring of their levels and enables them to submit their data to their physicians electronically and in real time.

As we continue to monitor the mHealth arena and the many advancements to come, it is just as important for vendors to continue to strive for innovation and develop mobile devices with the patients in mind.Applications and devices that increase patient interaction and engagement are not only a win for the patients themselves, but are also a win for the market and industry as a whole, as they will continue to help drive the shift toward accountable care and frameworks that support and reward for qulity through care coordination.

July 31, 2011  10:35 PM

Concerns around IaaS in healthcare

Posted by: RedaChouffani
CIO, healthcare, IaaS

In a recent meeting with an industry colleauge and fellow health care consultant, we were discussing the trend of CIOs looking more closely at the IaaS (infrastructure as a service) model. And given the current economic climate and shrinking capital budgets, this model is proving to be an increasingly attractive option.

Initially, IaaS is worth the consideration to many simply because it does not require a costly, up-front capital investment to get started. However, there are several other considerations that need to be raised prior to engaging in a full IaaS.

With IaaS, the service provider is responsible for delivering support for all the IT areas, which is both convenient and cost effective. An IaaS model also allows for a better way to truly measure and quantify the ROI and direct value to the IT department via cost savings and productivity tracking, as compiling and aligning organizational IT spend on a monthly basis with what is generated in terms of tangible revenue is not a simple task.

One concern that needs careful consideration, however, is that some of the IaaS providers will only offer limited standard support, which will require that additional resources be supplemented to fill the gap in support for business specific applications, such as RIS, EHR, etcs.

The next area of concern is regarding the integration capability of the system.While the systems are hosted in state of the art data centers with high redundancy and system protection, a hospital’s integration requirements are growing in complexity.Integration amongst medical equipment and different systems should be discussed with the service provider to ensure support is adequate. In addition, some hospitals may use multiple IaaS providers, which means that each of the service providers must have the ability to interface and integrate with one another.

Adopting IaaS can be a great model, though it requires careful consideration. Identifying the benefits and looking at service providers who meets health care regulatory guidelines and organizational cost requirements is a great place to start.

July 31, 2011  9:56 PM

Patient identification using palm scanning technology

Posted by: RedaChouffani
Biometrics, EHR, Hospital, Palm Scanner, patient IDs

Now more than ever, hospital and health care leaders have to work tirelessly to ensure they are adequately protecting their patients’ health information. Whether it’s through secure, encrypted access to all digitized and EHR data, or through the close, careful monitoring of all areas of an institution that contain sensitive information, patient data privacy is something that is of the utmost concern to health care leaders today.

In the same light, another area that continues to present challenges for health care organizations is how to efficiently and effectively verify a patient’s identification. In some hospitals, state issued identification cards or other forms of ID suffice to identify a patient. But unfortunately, these identification methods can still leave the door wide open for fraud due to falsified information. Fakes IDs have been used in the past and continue to be a vehical for misrepresentation, leading to costly breaches of confidential information and patients receiving fradudlent bills for those receiving care under their names.

In an era where data breaches have a ripple effect felt well outside the walls of the hosptial and home of the patient, some organizations have begun to consider and implement new biometric technologies, such as palm scanners, which can not only help to ensure the proper identification of the patient, but can also provide a quick, automatic check-in process for all hospital departments.

Palm scans have been used in Asia for many years, found in ATM machines that opt for a more secure means of access than just a pin code. With one touchless scan of the palm, a system can confirm the identity of a person quickly and accurately.

As several hospitals in the US have already begun to adopt these systems, the following are some of the benefits that have been realized from implementing these increasingly complex patient identification safeguards:

Compliance: With Red Flag rules and the HIPAA regulations, a hospital system is required to ensure that the patient who is being cared is properly identified. Palm scans and other biometric based devices help ensure this is met.

Safety: For patients who have been admitted in the hospital and are receiving bedside medication, it is critical to confirm the patient’s identity when medication is given. Biometric technology can help to drive down medical errors and increase medication adherence through a more complex patient ID process.

Insurance fraud: When using palm scans to identify a returning patient, the system can ensure that the patient is who they say they are. There have been many reported instances in hospitals where family members share insurance information to receive medical services for no pay.

Streamlined registration process: In large hospital organization, having a single, common identification method will help quickly identify the patients who have previously been registered. Whether a patient is going to the imaging center or visiting the surgery center, they can do so simply by putting their palm on the scanner at department check-in.

So far, Fujitsu manufactures most of the palm systems currently in use and also provides a list of solution providers for the health care market place. In my opinion, these scanners present a cost effective solution, especially when compared to retina scanners and other existing finger print ID products, and can help to ensure that a patient’s information stays safe while helping to combat fraud in the system.

July 24, 2011  10:29 AM

A second chance to avoid penalties for not ePrescribing by 2011

Posted by: RedaChouffani
CMS, eprescribing, penalties

In one of my earlier posts, “How to avoid penalties related to CMS electronic prescribing in 2012,” I discussed the options available for eligible providers (EPs) to avoid the penalties should they not have met the required minimum 10 electronic prescriptions by the June 30th, 2011 deadline.  Then earlier this month, CMS announced that is actually planning to make it easier for health care providers, who have not met the previous requirements, to have a second chance at avoiding the penalties.

The new proposal from CMS allows clinicians to avoid the penalties in 2013 if they submit 10 or more e-prescriptions during the first half of 2012.  They can also avoid any future cuts in their reimbursements during 2014 if they continue to ePrescribe at least an additional 10 scripts during the first half of 2013.

The proposal also describes the addition of CPT and HCPCS codes in the denominator of the electronic prescribing measure as the following:

90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862,

92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310,

99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, and G0109.

The proposal also would apply the following exemptions from 2012 penalty to 2013/2014:

  • The inability to e-prescribe because of geographic restrictions; and
  • Submitting fewer than 100 prescriptions in a six-month reporting period.

CMS is currently accepting comments on the proposed adjustments until Aug. 30.

July 24, 2011  10:14 AM

The next big thing for hospitals: Cloud-based document management

Posted by: RedaChouffani
cloud, cloud computing, DMS, Document management systems, ECM, SaaS

For many health care organizations, going paperless is not simply about adopting electronic health records alone.  Many have discovered that there are additional paper-based documents that simply do not fit inside a patient’s electronic chart.  Within the hospital setting, there are several administrative processes that require paper-based content, which is just one of the key reasons why document management systems (DMS) or content management systems (CMS) continue to see high adoption rates in larger sized institutions.

DMS goes beyond simply scanning documents and organizing them according to folders or departments, however. Many contain advanced functionality and capabilities, such as:

  • Document processing (Content processing, digital signing, versioning)
  • Document access (Security management and remote access)
  • Workflow engine (distribution of documents, approval and review)
  • Document management
  • Indexing documents (OCR, tags)

While the main challenge in terms of DMS is the cost and complexity associated with the implementation of these projects, we are starting to see vendors stepping up to the plate and providing new alternatives. As we continue to see the software vendors shifting toward SaaS, we begin to wonder when we will see a true cloud-based DMS. Currently, there are very few vendors offering hosted document management products.  Some provide basic integration with Google docs (scanDrop), and other simply provide their products and services as a SaaS + HaaS or non-patient centric cloud based product (Spot Documents).

As we continue to overcome bandwidth and connectivity limitations, we’ll continue to see more and more products becoming cloud-based, which will prove to be an attractive alternative to many.  When shopping for a vendor in this space, there several key attributes their products must adhere to:

Simple subscription model: Simple pricing or agreement plan (s) must be available.  It would need to offer different price points based on storage, user count, bandwidth usage, length of contract, etc.

Easy to set up: A cloud based DMS/ECM must be simple and easy to set up.  With just few simple option selections, the end user should be able to get the system up and running fairly quickly, making the product a much more attractive and viable solution.  This would also include easy to use/setup integration or interfacing (HL7, and other healthcare standards).

Scalable:  Whether the organization needs 10 GB of storage with 10 users, or 10 TB with 150 users, the system should be able to scale quickly and easily.  Performance should not be affected by the size of the client.

Accessibility:  For the few vendors available out there, one UI that captured my attention was Spot Document.  While it may not be a good candidate for a large health care organization, they have a number of ways to access and manage documents.  They offer client apps and access from an iPhone, iPad, Mac, as well as native web clients on any platform.

Secure:  Since the information that is being captured and stored is sensitive and often contains patient health related information, it is critical that the vendor offer secure environment that meets HIPAA, PCI and other compliance requirements.

As we continue to see executives working toward reducing operational costs and increasing the value of technology in their organizations, SaaS will continue to gain acceptance, and it is important for CIOs and IT directors to include “Application as a Service” as part of their strategic plan.  With SaaS being a more economical and effective approach to implementing software solutions, a cloud based ECM/DSM might just be what the doctor prescribes as part of the next software purchase.

July 17, 2011  9:56 PM

The business of telehealth services

Posted by: RedaChouffani
mhealth, Remote patient monitoring, telehealth

Video conferencing has proven to be a cost effective, efficient and relatively easy way for people to communicate across state and national boarders. And with the increased adoption of VoIP and recessions, many organizations are reducing their travel expenses by transitioning to doing a bulk of their meetings over the wire. Though while it does seem that many organizations have seen the benefits of utilizing video/audio teleconferencing, when it comes to health care, there is still a long way to go before telehealth a remote patient monitoring goes mainstream.

This does not come as a big surprise, as most patients find it comforting to visit a physician and discuss their conditions face to face. There is also the stigma that telehealth will not allow for the highest quality of care delivery vs. an in-person consultation.

That aside, there is still one specialty that has seen a significant number of early adaptors is in the space: psychiatry.Remote therapy sessions with full video/audio support have shown to be very effective for patients, and with several pilot projects showing significant cost savings for the payers, we are now beginning to see a significant increase in the adoption rate.

In terms of increasing adoption in the industry as a whole though, there are a few items that need to be more widely available to physicians:

·Easy to use technology and simple applications such as Facetime, Skype and Microsoft Lync

·Standardization in medical device data exchange

·Patient education to encourage adoption and show value of how they can easily access services

·Ensuring secure communications from end-to-end

·Clear fee schedules and reimbursement structures to eliminate any burdens for the telehealth services

Telehealth has another significant value for patients, as it goes far beyond simply video chatting with a clinician. Remote monitoring services, where detailed medical data is transmitted from devices attached to the patient directly back to the physicians in near-real time.This can significantly improve patient care and provide a quick way to respond to specific conditions, without the burden of an office visit.

July 17, 2011  9:55 PM

Affordable Insurance Exchange for 2014

Posted by: RedaChouffani

On Friday President Obama announced that there will be some adjustments to healthcare. On Friday 15th, 2011 the president discussed the following: “envision a situation where for somebody in my position, having to pay a little bit more on premiums, or co-pays, or things like that would be appropriate. And, again, that could make a difference.”

This is a sign that some additional changes may be coming to Medicare possibly.

In the same week HHS announced the details for the affordable Insurance Exchange. As part of the healthcare reform, this was designed to create more options for health plans for businesses as well as individuals.

According to defines the exchange as the following:

An Exchange can help you:

  • Look for and compare private health plans
  • Get answers to questions about your health coverage options
  • Find out if you’re eligible for health programs or tax credits that make coverage more affordable
  • Enroll in a health plan that meets your needs

What this means for you:

  • For individuals and families, the Exchange is a single place where you can enroll in private or public health insurance coverage.
  • For small employers, the Exchange is a way to level the playing field, where you have better choice of plans and insurers at a lower cost, the way larger employers do now.

In Kathleen Sebelius, Secretary of Health and Human Services blog, she outlined how HHR new proposed ruling offers states guidance and options on how to structure the exchanges. The two models suggested were:

  • Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange, and;
  • Ensuring premium stability for plans and enrollees in the Exchange, especially in the early years as new people come in to Exchanges to shop for health insurance

July 10, 2011  9:37 PM

CMS is testing new reimbursement models for patients with dual membership

Posted by: RedaChouffani
Dual eligibles, Health care reform, HHS, Medicaid, Medicare, Reform

As we continue to be reminded of the state of our deficit and the need to raise the debt ceiling, the Center for Medicare & Medicaid Services (CMS) is continuing to push through and test different initiatives that will help cut costs in the health care arena. Many state leaders are already feeling the pressure, pleading against the looming Medicaid cuts included in the recent debt ceiling talks. This leaves no options for HHS except to test different models that focus on coordinated care, promoting and rewarding for healthier lifestyles, reducing the overall cost of care at a systemic level.

Currently, CMS is working to increase the number of enrollees in the Medicare-Medicaid system to coordinate care. The intent is to take advantage of collaborating on patient care to achieve an increase in quality and reduction in cost at both the state and federal levels.

The different initiatives that are being proposed for testing are specific to patients under the Medicare-Medicaid program, i.e. the dual eligibles. The idea is to test different models under which CMS will better align the financing of the two programs, integrating primary, acute, behavioral health and long term care services.

The models listed are:

  • Capitated Model: A State, CMS, and a health plan enter into a three-way contract, and the plan receives a prospective blended payment to provide comprehensive, coordinated care.
  • Managed Fee-for-Service Model: A State and CMS enter into an agreement by which the State would be eligible to benefit from savings resulting from initiatives designed to improve quality and reduce costs for both Medicare and Medicaid.

The CMS Center for Medicare and Medicaid Innovation will test these models to determine whether they save money while preserving or enhancing the quality of care for Medicare-Medicaid enrollees.  Interested States can send a letter of intent and work with CMS to determine whether they meet established standards and conditions.  The Innovation Center will approve qualifying States that collectively serve up to 1 to 2 million dual eligibles.

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