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Meaningful Health Care Informatics Blog

May 22, 2013  9:39 PM

Google Glass and some of its early healthcare uses

Posted by: RedaChouffani
glasses, Google, mhealth

Google Glass will make an appearance in somewhere in  healthcare, possibly at the point of care. A limited number of the devices have been shipped and we have seen a number of interesting applications developed with connectivity to social media and tracking capabilities of images and locations.

Apps such as Twitter’s Glass app, Ice Breaker, and others have been developed and show some significant promise for the day-to-day use of Google Glass.

A recent Glass app — introduced by Lance Nanek — called MedRef, is looking to change the way caregivers pull medical records. The application uses a cloud-based face search to find patients photos. A site called Betaface provides the application programming interfaces that will enable the Google Glass user to simply look at the person and be able to retrieve their identity based the photo captured by the device. The application also provides the ability to add notes and perform other tasks. Some of these activities can help generate additional patient documentation to add to their digital medical records.

Some potential uses for Google Glass, combined with facial recognition and augmented reality, are as follows.

  • Physicians will be able to identify patients using facial recognition and pull their chart when they enter the room.
  • Augmented reality can provide stats and alerts on patients at the point of care, as well as potential simulations during surgery.
  • Voice recognition will be able to capture data and schedule followup appointments through the use of CLU or other voice recognition engines that integrate named-entity recognition and natural language processing.

There are several opportunities presented by Google Glass and there is potential for many more things that can be accomplished through the combination of Google Glass and other available tools. However, as privacy issues continue to be a concern when it comes to these popular gadgets, healthcare organizations will likely wait to see some more real world use cases and what safeguards can be put in place to ensure the security of the data being collected and transmitted from these devices.

May 22, 2013  9:37 PM

ONC mHealth challenge to help support cancer survivors

Posted by: RedaChouffani
mhealth, ONC

The ONC is launching a mobile app innovation challenge that will support cancer survivors during their follow-up care.

The challenge, as outlined by the ONC, will have two separate phases. In the first stage, all applicants will be required to submit documentation of the overall use cases and goals of their product. Once the submissions have been reviewed, up to three winners will each receive $5,000. Those winners will then continue to the second stage of the challenge. In this phase, the developers can share additional details about their proposed app and receive crowdfunding support to further develop their product. Once the apps have reached a functional stage, they will be submitted to judges to be reviewed and will become eligible for a grand prize of $25,000.

The criteria by which these submissions will be judged is as follows.

  • Appropriate integration capabilities with health data sources
  • The ability to be interoperable
  • The ability to connect with existing networks
  • Alerts and other tracking capabilities (medication, symptoms, and other needs)
  • The ability to maintain appointments and other care follow-up functions
  • The capability to connect with electronic care platforms

There are several successful online resources for cancer survivors; but the marketplace does not have a sufficient number of comprehensive solutions for mobile platforms. Some of the existing products are unable to address the complex needs of patients. This contest encourages further innovations, which will provide assistance for post-treatment cancer patients and may help increase survival rates.

May 14, 2013  10:05 PM

Hospital charge data shows significant gaps

Posted by: RedaChouffani
charges, hospital charges

Earlier this month CMS released hospital-specific charge data for the 100 most frequent discharge codes at more than 3,000 U.S. hospitals. The information has been made available and hospitals have been reviewing the data closely to identify how they rank against other institutes.

The same information has interested many patients who are looking to identify a measurable way to compare prices on certain procedures. In the current health system, procedure costs are not consistent across hospitals. This makes it challenging for patients to see how some hospitals rank against others.

With the publication of this data, and some of the other data released as part of the Open Data Initiative, patients can begin to see summary data (though it’s limited to CMS payments and doesn’t include some commercial payers).

There are a number of procedures that vary in cost significantly from location to location. Joint replacement procedures in one of Oklahoma’s hospitals averages $5,304, while the same procedure in one California facility costs in the $223,373 range.

There are other large gaps in pricing, which further explains the frustration that some patients have with the health system. There has been interests in some of the other available payment models, some of which have been proposed by CMS under the payments to ACOs. Others have been offered by individual hospitals for a fixed fee for various procedures. These new payment models aim to reduce overall costs, encourage health systems to review their fees, and simplify the fee schedule for their patients.

May 14, 2013  9:56 PM

Top mobile device security considerations

Posted by: RedaChouffani
HIPAA, MDM, Mobile, security

Many IT executives are continuously reviewing the state of their mobile device management (MDM) strategy, in response to the increasing use of mobile devices and in order to meet compliance requirements. For many who are in the initial stages of implementing a BYOD policy, there are several key considerations to focus on to ensure the security of data that is being accessed through mobile devices.

There are two main mobile device security use cases. The first case is when hospital users bring their own devices and use them to access protected health information as well as internal data. The second case is corporate devices provided and managed by the organization.

For personal devices, IT departments must engage the users and apply some of the following steps to help ensure that when data is accessed remotely there are adequate safeguards to ensure its protection.

For employees personal devices, the following steps should be considered:

  • Implement applications, which would reside on mobile devices to set up a secure connection to the health system’s data and limit content access (disable copying text and other functions such as screen capture).
  • Provide users with self-management tools that will allow users to perform remote erase and locate their devices when lost.
  • Educate and encourage users to properly secure their devices with pass-codes, passwords and encryption when available.
  • Control the number of devices enrolled under a single user.
  • Ensure that data on mHealth apps installed directly on devices is encrypted or that no data is stored locally on the device such as patient information.

For corporate devices:

  • Use an MDM plan that provides adequate controls to lock down the devices.
  • Use MDM tools to remote wipe devices when lost or compromised.
  • Use antivirus and malware protection for the devices to ensure they are not infected.
  • Implement security policies for strong passwords.
  • Ensure that data on mHealth apps installed directly on the devices is encrypted.

It is critical to guide users to safely access information on their mobile devices, while complying with HIPAA and other regulatory requirements. There must be a clear separation of personal data and corporate data on the devices. There are several MDM platforms that have enabled hospitals to simplify the management and security of mobile devices and ensure successful BYOD implementation.

May 7, 2013  8:42 PM

Four cloud service providers competing for healthcare customers

Posted by: RedaChouffani

As more organizations move to the cloud and infrastructure management eases on IT departments, there is a steady shift from maintenance mode to more of a business and technology focus. Many IT executives are reviewing the full benefits and capabilities of cloud services, as part of the organization’s technology road map.

Management of infrastructure is one of the areas that many organizations are showing interest in. Organizations see value in layering cloud services on top of managed services (including application support, infrastructure support and maintenance) to handle some of the day-to-day support and maintenance activities. These support services must be provided by a qualified and somewhat specialized provider in order to work for a healthcare organization or other vertical businesses.

There are four potential vendor types best suited for healthcare customers.

Large health systems, hospitals or integrated deliver networks: An increasing number of independent physicians are looking to engage hospitals and other health systems’ existing hosted EHRs and other services. Some of these small to mid-size physician’s offices are being offered services such as IT support, EHR as a service, as well as other non-technology services. For some physicians this model would mean that their data is hosted within the hospital’s data center and support would be provided by hospital IT staff.

EHR vendors: Many EHR system vendors offer hosted services to their clients. By offering their customers a subscription model, they have been able to eliminate some of the large upfront costs that are associated with hardware and software. Some EHR vendors such as NextGen, and a few others, are offering managed services in addition to their SaaS model. This may not be a bad option for for small to mid-sized organizations. It is far better to have an EHR vendor offer support services than a non-healthcare technology provider with no prior understanding of the complexity of the industry.

Cloud service providers: Gartner’s Magic Quadrant for Managed Hosting for North America lists over 15 different vendors cloud vendors. While there are still far more hosting providers in the marketplace, many of these ranked leaders by Gartner offer standard managed services that must be taking into consideration. But for most of us in healthcare, there are specific challenges and requirements to consider before committing to any managed cloud services. Some areas to consider are HIPAA compliance, scalability, healthcare vendor management, and connectivity to multiple vendors and entities (labs, radiology, HIEs, etc.).

Technology service providers: The last category of vendors that are seeking to provide managed cloud services to healthcare organizations are the healthcare technology providers. These groups have established credibility by supporting the various technology needs of hospitals and physician practices. They are able to offer healthcare specific IT support and managed services tailored to the specific needs of their customers. This managed cloud provider typically leverages existing cloud services and simply layers their managed services on top of those offerings.

While a cloud strategy is a must have for any healthcare organization, identifying the long term plans to ensure the end users are getting the appropriate support is crucial. Cloud support service providers may be able to offer basic IT support at an affordable price, but they will fail without a true understanding of an organization’s clinical and administrative needs.

May 7, 2013  8:40 PM

Should EMR vendors target and market to patients or physicians

Posted by: RedaChouffani
EHR vendors, mhealth, mobile apps

The outcome of much of research done around the value of mHealth Apps to patient care has been consistent across the board. The results show that patients benefit tremendously from these tools because they provide caregivers with critical information about the patient’s health. Adoption of these tools has yet to been fully endorsed by many providers.

The reality is that some of the popular mHealth apps do not necessarily provide direct value to physicians. Some of the health and wellness programs or apps lack interoperability and don’t integrate with the EHRs used by many physicians. This forces physicians to manage another data set, which can be costly and time- consuming.

So, how can mHealth apps receive wider adoption, engage more patients and gain the support of physicians?

One approach would be for EHR vendors to help and participate in the development of these mobile apps by pushing for integration with their own suite of products. This would make it easier for the information to flow back into their EHR systems and into the hands of the care providers. This approach would receive the endorsement of physicians because it would centralize a patient’s mHealth app data with their EHR data.

Allowing patients to share their mHealth app data with their providers is another approach to gaining physician support. If patients could suggest that their physicians review information collected by an mHealth app, it would encourage more physician interaction and adoption of mHealth apps.

The use of tablets and mobile devices is helping more patients manage chronic conditions and maintain a healthy lifestyle. A recent FDA comment to a congressional committee that suggested that they are not actively seeking to regulate mobile devices and tablets means that innovators will continue to march forward.

April 1, 2013  8:50 PM

Private or public? State or Federal? Hospitals choose HIEs

Posted by: RedaChouffani
CommonWell, HIE, Interoperability and health information exchange, Private, Public HIEs, State HIE

Meaningful use stage 2 and meaningful use stage 3 contain measures that stipulate the exchange of electronic health records (EHRs). For many providers participating in the incentive program, the question is: which HIE is the best?

Some hospital have been addressing their HIE needs by creating and sharing electronic health information with other participating hospitals and physicians, exhibiting the notion that HIE is not that complicated at a basic level. What’s more, this enables those hospitals to offer community physicians the ability to share and access population health information and improve care.

For some of the states whose HIEs are still in the infancy stages, hospital-based HIE can be advantageous and allow most to immediately meet some of the meaningful measures without relying on state funded initiatives – which some say aren’t necessary at all.

There are also additional changes in the market that may create a faster path to true interoperability and native support for data exchange, such as a recently announced collaboration among some of the biggest names in hospital-based EHR, CommonWell Health Alliance will be a joined venture started by the likes of Cerner, AllScripts, McKesson and few others.

Fortunately, some states have been able to take advantage of the federal grants made available to help fund the development of a state HIE. To get more details on the status of the state HIEs, the ONC offers a website that provides frequent updates on the currently recognized state HIEs, as well as milestones in e-prescribing, directed exchange, and query-based exchange.

Whether it is independent physicians or hospital systems looking to participate in an HIE, participating in an HIE will clearly require careful selection and evaluation, as well as a solid foundation for HIE implementation. Not only about pricing models that are available, but also connectivity to other HIEs and groups.

April 1, 2013  8:41 PM

Counties lose Medicare telehealth reimbursments

Posted by: RedaChouffani
ATA, Teleconferencing, telehealth, telemedicine, videoconferencing

Telehealth is not only an area of interest for many, but is furthermore the next logical step to providing health care to patients in some way unable to reach care facilities. It also allows patients to access specialists via videoconferencing services.  This technology has seen significant progress.  It has also seen significant support from many payers, including Medicare.

However, there will be some changes to reimbursement policies for telehealth, changes that may affect adoption and use of these services in certain counties and changes that conflict with previous reports of increased funding for telehealth.

As a result of 2010 census surveys, 97 counties lost rural categorizations. Under the new federal urban/rural law, beneficiaries living in those counties, along with an additional 28 who will now fall under that category, are now ineligible for telehealth benefits through Medicare.

In a press release from the American Telemedicine Association, the following statements were made regarding the change:

”When it comes to telemedicine, Congress has long overlooked the need for telemedicine services to residents of urban counties, despite the fact that they often suffer similar problems accessing healthcare. Now, because of a statistical quirk, even more people will lose coverage of these services, reducing access and care,” said Jonathan Linkous, CEO of the American Telemedicine Association. “Medicare should cover remote health services for all beneficiaries, regardless of location. We call on Congress to ensure that existing beneficiaries will not lose coverage for these services.”

Both Federal and payer support has helped kick start many areas in healthIT, including telehealth services and combating the widespread physician shortage.  While the loss of Medicare reimbursements for 97 counties is a minor setback, videoconferencing and other telemedicine services will continue to grow and improve access to care.

March 25, 2013  9:14 PM

Smartwatch: next on physician wish list?

Posted by: RedaChouffani
coocoo, iwatch, mhealth, mHealth devices, Motoactv, smartwatch

As more rumors of Apple’s “iWatch” float around the internet, there’s little talk of the other products that already occupy the crowded market. But smartwatches are interesting for a reason: they could be valuable to both patients and staff.

Just like mobile devices, smartwatches will inevitably make their way to healthcare facilities, and should be taken seriously once there.  In today’s market, mobile devices allow patients to manage their own treatment, medical information and conditions. They have provided them with the ability to collect data through a variety of sensory data capture features including glucose levels readers, heart monitors and other vitals tracking sensors. The question remains, can smartwatches do the same?

While smartwatches can be potentially limited by their size and/or processing power and batter life, they still offer easy information access and the ability to operate with other mobile devices. Plus, they don’t have to be taken out of a pocket to be used.

Some smartwatches offer:

  • Alerts and notifications: These range from SMS, call alerts, emails, appointment reminders and other third-party notification apps that pertain to health information, such as medication and vitals.
  • Controls: Enticing for sports fans in particular, smartwatches offer controls for playback, among others.
  • Sensory data capture:  Many smartwatches contain the ability to track heartbeat monitoring, location and connectivity with other vitals data.

Not only can they be used as fashion accessories, smartwatches can also be used for mhealth. There are currently a number of smartwatches available, including Pebble, Motoactv, I’m watch, Metawatch, Cookoo – not to mention the rumored iWatch and thus, a possible Google watch as well. The products indicate a growing market, and innovation will continue to increase.

March 25, 2013  9:12 PM

When choosing an EHR, consider all options

Posted by: RedaChouffani
cloud EHR, EHR, EHR systems, Electronic health records, ONC, SaaS

Since the enactment of ARRA and the stimulus package, which offered financial incentives for the implementation of electronic health records (EHRs) for eligible physicians and hospitals, the adoption rate of EHRs has increased significantly.  According to a report by the ONC in December 2012, since 2009 and as of 2012, two-thirds of physicians surveyed have adopted computerized capabilities such as electronic medication lists and drug interactions.

Yet among others that fluctuate, one challenge remains the same for physicians, and that is the process of selecting an EHR solution to help achieve meaningful use.  There are several critical steps that must be taken in consideration as part of this careful selection process. Some  include:

  • Performing a practice readiness assessment
  • Reviewing the plan and GAP analysis
  • Reviewing and performing an EHR comparative analysis to review functionality, compliance and return on investment
  • Implementing the EHR solution of choice
  • Post-implementation reviewing and optimization

However, part of this process includes stages that have long-term organizational consequences.  One of those stages is defining which EHR implementation model should be selected.  There are currently several implementation paths organizations can take:

  • Software as a Service(SaaS)/Cloud based EHR: Leverages vendor-hosted EHR systems available via Citrix or terminal services to the workstations, eliminates the need for a significant capital investment on the hardware infrastructure within the facility, also has option of cloud and web based EHR systems that provide the application via standard internet browsers.
  • Outsourced billing with on premise EHR: commonly offered by billing providers and revenue cycle management groups, enables the practice to go on an EHR system but outsource all their billing roles and activities.
  • On-premise EHR implementation: common choice, requires significant investments up front but  provides improved performance, may require more support and maintenance of backups, disaster recovery planning and other internal IT functions.
  • Hospital hosted implementation with add value services:  A fourth model has been available around large health systems and that is the IDNs offering EHR to the surrounding independent physicians.  By offering the same EHR system that is being used within the hospital physicians are able to get the benefit of gaining immediate access to relevant hospital data for their patients, which traditionally would have required interfaces and connectivity to HIEs.

The selection process of an EHR system can be intimidating at first.  ONC offers many useful resources. Third-party consultants can also provide valuable assistance.

On the whole, a successful selection can mean a successful implementation, not to mention improved care, safety and workflow.

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