May 29, 2011 10:40 PM
Posted by: RedaChouffani
, interactive displays
, patient tracking
Many healthcare organizations are continuously trying to identify new ways to realize and create efficiencies through technology. One area that seems to be gaining popularity is the use of interactive displays or “boards” throughout the different hospital departments.
Over the years we have seen hospitals evolve from using blackboards to dry erase, and not too long after that, a digital display replaced all of the above. And in recent year,s more interactive electronic displays have surfaced and have successfully helped numerous hospitals realize costs savings and improved efficiencies.
Whiteboards have been used in many different areas of a hospital and are being replaced with digital displays. The new technology has been called different things such as surgery boards, electronic inpatient tracking boards, patient dashboards, grease boards, bed management dashboards, and many other variations. Some of the areas where these devices are being used are:
· The surgical ward. Here, these devices provide a patient’s information, as well as the status of orders and what stage the patient is in within the surgical workflow.
· ER: There is also the ER, which uses the whiteboard to display the wait time, status of orders as well as patient location within the ER.
· Nurses’ stations: We also see the dashboards in the nurses’ stations on the different hospital floors. These displays have more advanced functionality such as their capability to integrate with medical devices and remotely display real-time data about the patient’s oxygen levels, heart rate, and other vital clinical information.
· Environmental services are also utilizing this technology to monitor the status of beds and ensure that beds can be cleaned immediately when they become available.
· We are also seeing an increase use of digital dashboards to display the location of hospital assets.
Historically these devices were nothing more than larger display screens (or giant monitors), but the reality is that many of the newer devices, combined with advanced software functionality seen in the market today, are offering some incredibly useful benefits. Some of the new products seen out there provide the following:
· Increase use of visual indicators to communicate the status of patients and beds through the use of symbols, colors, and animations. A research by 3M concluded that we process visuals 60,00 times faster than text.
· Dashboards provide a floor plan layout of the hospital ward with alerts and statuses directly pinned to the location when the patient is.
· More vendors are providing interfacing capabilities to allow a comprehensive view of the patient’s orders (radiology, respitory, lab work, etc), visual and real-time, from one single view.
· Vendors are also adding capabilities to integrate with RTLS (Real Time Tracking Location System) to provide asset and resource locations directly on the displays.
There is no argument that interactive boards will replace the traditional static displays. They provide a strong value proposition when they are combined with a software solution that can integrate and communicate with different entities within the hospital’s infrastructure. These systems are able to communicate with everything from the HIS, RIS, PHR, to medical devices and bedside monitors, in addition to having the ability to display stats and proactive notifications based on predefined workflows, which will ensure everyone is well informed.
May 29, 2011 10:38 PM
Posted by: RedaChouffani
, public health data
In a recent post, I discussed the value of centralizing data and having the ability to analyze and review outcomes for patients within the VA system. And over the past few weeks, I have spent an incredible number of hours learning about ITP symptoms and treatment options. ITP, or Idiopathic thrombocytopenic purpura, is a bleeding disorder in which the immune system destroys platelets, which are necessary for normal blood clotting. While the internet has been a tremendous resource for education, with physicians providing a plethora of information, there were still many questions unanswered.
After hours of digging, the closest I was able to get to in terms of finding outcome measures based on the different treatment plan was a white paper and study that was done in Turkey on a set of 140+ patients.
The reason I wanted to discuss this subject is simply to identify the potential benefit from having access to a national data bank that will provide the public with statistical information and as well as raw data for educational purposes as reported through EHRs. The data can provide outcome information about recommended treatments for specific conditions, a format which would be similar to what CMS has previously done with various data sets on hospitals. Whether it is a CSV, Excel, mdf or any raw data format without of course any identification information.
While there are sites available that discuss medical conditions from a more personal experience of what patients are experiencing (PatientLikeMe.com is a great example, but still lacked actual medical data), there still lacks scientific and collective data.
During my research on ITP, I found myself asking for very simple data points. I needed to see visual representation that displayed the trend of the platelets counts for patients diagnosed with ITP (ICD9 287.31) and have received one of the three treatments available. The data also needed to have the age of the patient.
In the perfect world, a physician would have access to this information (some physicians do have access to statistical information that is shared within their specialty), but more importantly, this is information that would be useful for the patient or patient’s family who are looking to be involved in the treatment decision making process.
It is imperative to allow the patient to be engaged in the treatment selection when applicable. But to ensure that the patient understands what is being selected, it is key to have access to clinical data that provides concrete evidence on why one treatment is selected and what outcomes other patients have experienced. It is also critical to note that in order to have access to this type of information, it must first be district information. This simply means that EHR must become a means to capture and share clinical information and that is what we have to move towards.
May 22, 2011 8:57 PM
Posted by: RedaChouffani
During many EHR implementations, project managers and IT executives recognize that there are some gaps that many of the products out there are not able to fill. While 80% of the needs are fulfilled you are left with 20%. This leaves the organizations with the choice of either getting the 20% through some customization done by the vendors or accepts the unresolved business challenge. This is applies to almost all the healthcare products available there: EHR, PHR, HIS or PMS products.
But if you were to look at other markets (financial, manufacturing, etc.) and how many of them have successfully implemented an ERP (Enterprise Resource Planning) and CRM (Customer Relationship Management). Many of these products tend to resolve 70% of the business needs and allow third party vendors and the client’s IT departments to finish the last mile through customization capabilities and open framework. This software model creates tremendous value for the buyers. So one must wonder if we will ever have few EHR products in the market place that will allow IT departments and solution providers to easily customize and create plug-ins for these complex systems. There are several examples we can name here just a few that have been successful and had their products empowered through third party development: PeopleSoft, SAP, Microsoft CRM, Microsoft SharePoint, Google Health, Skyline, Exact, Saleforce.com, Facebook just to name a few.
But in order for any EHR vendors to receive the success of these products they will need to adopt some of new patterns in their products offerings:
· Provide the Development community with SDK and APIs to easily create enhancements to the solutions for their clients.
· Be large enough to fund bigger and better and bigger product functionality
· Provide plenty of documentation (tutorials, Podcasts, webinars, YouTube, etc.) on features and functionality
· Provide online forums where development and end users can discuss challenges
· Create an open framework in their solution to make it easier on clients to customize the product to resolve their specific business need
· Encourage partnerships with solution providers in order to encourage innovation
· Build the product with strong interoperability capabilities to ensure integration with multiple systems
In the way the market is at this point, it would not seem to be beneficial to only have few EHR vendors out there. Many of the systems have a closed architecture and for the few that widely used, they require specialized certifications. The successful EHR vendors of tomorrow will need to ensure they learn from the successful companies of today.
May 22, 2011 8:38 PM
Posted by: RedaChouffani
, Stage 2
With incentives payments well underway for health organizations that have met all meaningful use criteria for stage 1, many are still wondering what the final requirements will look like for Stage 2 and 3 of MU.
Meaningful use stage 2 drafts have recently been released for public comments and feedback with a deadline that was back in Feb 25th, 2011. And at this stage many revisions have been made and recommendations to HITPC.
The HIT Policy Committee proposed several changes to the HIT standards committee. Some of them are listed below:
Improving Quality, Safety, Efficiency & Reducing Health Disparities
· CPOE for 60% of Rx and lab; radiology CPOE “in use” (≥ 1 order) (unless no radiology orders)
· Employ drug interaction (drug-drug, drug-allergy) checking; Providers have the ability to refine DDI [In stage 3, goal is to have nationally endorsed lists of DDI with higher positive predictive value and ability to record reason for overriding alert]
· 50% of outpatient medication orders and 20% of hospital discharge medication orders transmitted as eRx
· 80% of patients have demographics recorded and can use them to produce stratified quality reports using more granular demographic categories per IOM report—additions to value sets for existing fields for stage 2; new demographic fields for stage 3 (HITSC needs to work on standards)
· Report CQM electronically as per CMS
· Maintain problem list (80%)
· Maintain active med list (80%)
· 80% of patients have smoking status recorded [stage 3 add new field in certification for secondhand smoke]
· Maintain active med-allergy list (80%)
· 80% of patients have vital signs recorded during the reporting year; change age for peds BP from 2 yrs to 3 yrs
· Use CDS; HITSC: Suggest changing certification criteria definition as indicated on comment summary
· Implement drug formulary checks according to local needs (e.g., may use internal or external formularies, which may include generic substitution as a “formulary check”) (move to core)
· For hospitals, 50% of patients >65 who have recorded the result of an advance directive discussion and the directive itself if it exists; for EPs 10% of patients seen during reporting period (need more data on current use to decide on menu vs. core for EPs)
· Incorporate lab results as structured data (40%) (move to core); HITSC: Use LOINC where available
· EHs: Hospital labs send structured electronic lab results to outpatient providers for ≥ 40% of labs sent electronically HITSC: Use LOINC where available
Generate patient lists for multiple patient-specific parameters (move to core)
· EPs:10% of all active patients receive a clinical reminder (appointment reminder not count)
· 30% of EP visits have at least one electronic EP note and 30% of EH patient days have at least one electronic note by a physician, NP, or PA; non-searchable, scanned notes do not qualify [use broad definition of qualifying note types]
· EH medication orders automatically tracked via electronic medication administration record; (in-use in at least one hospital ward/unit)
· Consider adding recording of family health history in stage 3 (due to absence of standards for FH)
· EPs: Patient preferences for communication medium recorded for 20% of patients
· Hospitals: ≥ 25 patients receive electronic discharge instructions at time of discharge
· Hospitals: 10% of patients/families view and download relevant information about a hospital admission; information available for all patients within 36 hours of the encounter
· EPs: 10% of patients/families view & download their longitudinal health information; information available to all patients within 24 hours of an encounter
· EPs: patients are provided a clinical summary after 50% of all visits, within 24 hours (pending information, such as lab results, should be available to patients within 4 days of becoming available to EPs)
· Both EPs and hospitals: 10% of patients receive EHR-enabled patient-specific educational resources; make core; take out “if appropriate” instead of raising threshold
· EPs: patients are offered secure messaging online and > 25 patients have sent secure messages online
· Stage 3: Provide mechanism for patient-entered data (supply list); consider “information reconciliation” for stage 3 to correct errors
· Medication reconciliation conducted at 80% of transitions by receiving provider; keep threshold at 50% and move to core
· Summary of care record. EH: 10% of all discharges have summary of care record sent electronically to EP or LTC facility. EP: at least 25 transactions sent electronically (if exclusion for lack of electronic recipients, then must send on paper) [Need HIE preamble.]
· List of care team members available for 10-20% of patients via electronic exchange; 10% of patients have a list of care team members (including PCP, if available) (unstructured data for stage 2; for stage 3, code by NPI)
· For longitudinal care plan, merge with summary of care to create “summary and care plan” (old summary plus plan and patient engagement fields)
· Improve Population and Public Health
· EH and EP: Submit immunization data (attest to at least one) in accordance with applicable law and practice; move to core for both EH and EP [In Stage 3, view cumulative immunization record and recommendations]
· EH: Submit reportable lab results (attest to submitting to at least one organization) in accordance with applicable law and practice; move to core
· EH: Submit syndromic surveillance data (attest to at least one) in accordance with applicable law and practice; move to core
· EP: [CMS to consider]
· EP: [CMS to consider] Submit reportable cancer conditions (attest to at least one) in accordance with applicable law and practice (to HITSC: possible use of IHE cancer reporting implementation guide)
· For Stage 3: Patient-generated data submitted to public health agencies
Ensure adequate privacy and security protections for personal health information
· Perform, or update, security risk assessment and address deficiencies.
· Address encryption for data at rest and attest to policy (not required for all but need policy).
· FOR HITSC CERTIFICATION:
· Authentication of providers: certification of EHR needs two-factor authentication for controlled substances and providers to have digital certificates at entity level.
· Single factor authentication (user and password) for patient online account.
· Audit trails for access to patient online account.
· Provisions for data provenance.
· Portal should have secure download ability (e.g., to transfer to PHR).
· Instructions to standards committee about demographic fields, etc.
· Signal Stage 3 plans about NWHIN governance.
In addition to the recommendations on the MU stage 2 objectives, the group also recommended adjustments on the timelines. In the document submitted to the committee one of the options suggested seems to have the best overall impact on almost all the attributes: delay transition from stage 1 to stage 2 by one year. This would only affect the providers who have begun MU program during 2011.
It is clear that a lot of the feedback that was received was taken in consideration according to the changes and recommendations made. While we are still months if not at least a year before we receive the HHS MU Final rule, some of the objectives can be used as a guide for many who have already began their MU stage 1.
May 15, 2011 9:48 PM
Posted by: RedaChouffani
, health care IT
, IT engineers
, soft skills
In the IT world, nothing is routine. There are always new and exciting technologies that come out everyday, and new ways to create efficiencies and improve workflows for an organization. The healthcare industry is no exception. On a recent survey we performed for over 150 selected healthcare organizations, we identified that 1 in 5 organizations had benefited from some unique custom solution or product. Some were either developed internally, or else through the use of third party vendors and consultants.
This was a interesting statistic. In most cases, one would assume that if the organization has electronic medical records implemented, they should have everything they need. But the reality is that each organization has its own unique challenges, and at any point in time a hospital or health organization may be hosting 20 to 30 different packages; this generates more than a few challenges for many IT directors, support members and end users.
One challenge that organizations face is maintaining a balance between the reactive natures of IT, and transition more to the proactive side of the fence. But in order to create an atmosphere for innovation and solution creation, there are few steps that one must follow:
Hire, and don’t just look for knowledge; Look for talent and self-drive:
While it is important to hire experts in the domain (certification and years of experience), it is equally important to be able to identify during the interview process those individuals with good problem solving skills, self-drive and soft skills. This will be critical to ensure that IT engineers can identify and apply technical solutions to business problems.
Involve IT in the mission of the organization, as well as training them on the systems they support:
It is not uncommon to find IT not fully familiar with each application or product implemented. Given the complexity of healthcare and all of its software packages, it becomes challenging for many to be aware of each package running through the hospital. It is critical to involve the IT leaders in what some of the business critical packages perform and what they provide to the end user. This not only helps supporting roles better communicate with the nurses and physicians, but it also empowers them and allows them to better understand the environment, which will enable them to provide better recommendations.
Provide opportunities to innovate:
For many companies, such as Google, Facebook, DELL and Microsoft, allowing the employees to “play” or work on their individual projects and ideas is common practice. This allows the technology folks to experiment with new technologies and even innovate and identify new ways to resolve business challenges.
Keep in contact with vendors:
Consultants and software vendors are continuously looking to provide more value for their products. But this does not always mean that they efficiently communicate all of their new features and functionalities that matter most to you. It is recommended to have sales meetings — including sales and engineers — to discuss your needs and how some of the upgrades/new products they offer might help your organization.
There are many other ways to encourage innovation and identify new solutions to business challenges. In-house IT members and third party vendors may develop many of these by continuously reviewing current systems and feedback from end users. Any proposed solution must have tangible returns on investment and needs to offer real efficiencies that reduce operational costs and help improve workflows.
May 15, 2011 9:46 PM
Posted by: RedaChouffani
, EHR adoption
On May 11, Surescripts released the National Progress Report on E-Prescribing and Interoperable Healthcare for 2010. The report provided several statistics in regards to transactions processed through Surescripts.
Since Surescripts was founded in 2001, it has approximately served over 190,000 office-based physicians. This shows that e-Prescribing is slowing becoming the new preferred method of transmission and slowly replacing paper based or fax based prescribing. But for many the value comes in the form of having access to the patient’s full medication history, as well as the reduction of medical errors that was previously associated with drug interactions, poor handwriting and the like.
Some of the additional drivers that are encouraging physician adoption are the Medicare electronic prescribing incentive program (via MIPPA, the Medicare Improvements for Patients and Providers Act), HITECH and meaningful use mandates, as well as EPCS, which is helping surgeons and other physicians securely and safely prescribe controlled substances electronically.
As shown in the reports, 1 in every 4 prescriptions at the end of 2010 was an electronic one. This is an increase of 72% from the previous year. And as we look at the sources of electronic prescriptions, the statistics show that over 83% of deployed e-prescribing software applications are included in EHRs, with 17% being standalone. In addition, there was an increase from 78% in 2009 to 91% during 2010 of prescribers who used EHRs for all three major Surescripts services (prescription benefit, medication history, and prescription routing), a clear indicator of climbing EHR adoption rates in the marketplace.
Another interesting statistic is regarding the distribution of e-prescribers based on practice size. The report findings show that practices actually with 2 to 10 physicians lead the e-prescribing adoption trend, with over 57% of the overall prescriptions. This supports that while the barriers to adoption — cost, complexity, and resources, just to name a few — are great, the opportunities for decreased cost, increased efficiencies and a better quality of care, are simply greater.
May 8, 2011 9:36 PM
Posted by: RedaChouffani
, data breach
, data security
, Privacy Rule
By now we have all heard and seen the headlines surrounding the recent trouble Sony is facing due to their IT security breach. Not only has it been reported that their gaming network has been compromised and consumer data stolen, but some of their internal servers have been reported as breached as well. This illustrates the growing capabilities of organized hackers and supports the fact that, no matter how big the firm, there is always the potential for real vulnerabilities in their systems. This most recent event was a PR nightmare for Sony, and with the reports of what actually happened not being released until many days later, it begs the question: How should an organization react?
In the health care setting, patient information is extremely sensitive, with records containing social security numbers and detailed medical history. As such, an organization must have an action plan and place and always be ready to defend its infrastructure as well as respond appropriately — and timely — to any breaches of data.
When a breach occurs in health care, meaning that there was an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of the protected health information, such that the use or disclosure poses a significant risk of financial, reputational, or other harm to the affected individual, then the following steps must be taken:
Local authorities notification and report filing:
- Notify the local police and file a police with report with the details
- Internal organizations notification:
Notify the IT director, CIO, security officer, legal team, etc.
- Begin taken steps based on any existing procedures to isolate or take offline the affected systems in order to stop further unauthorized access
Contact security groups:
- Enlist assistance from security experts to ensure that all unauthorized access is blocked
- Perform system analysis to ensure no other systems have been compromised
Notify any authorities and entities listed under the breach notification from DHHS:
- In August of 2009, HHS issued final breach notification regulations which required HIPAA covered entities and their business associates to provide notification following a breach of unsecured protected health information. HHS required the following steps after a breach of unsecured protected Health information (as listed in the HHS web site)
Covered entities must notify affected individuals following the discovery of a breach of unsecured protected health information. Covered entities must provide this individual notice in written form by first-class mail, or alternatively, by e-mail if the affected individual has agreed to receive such notices electronically. If the covered entity has insufficient or out-of-date contact information for 10 or more individuals, the covered entity must provide substitute individual notice by either posting the notice on the home page of its web site or by providing the notice in major print or broadcast media where the affected individuals likely reside. If the covered entity has insufficient or out-of-date contact information for fewer than 10 individuals, the covered entity may provide substitute notice by an alternative form of written, telephone, or other means.
These individual notifications must be provided without unreasonable delay and in no case later than 60 days following the discovery of a breach and must include, to the extent possible, a description of the breach, a description of the types of information that were involved in the breach, the steps affected individuals should take to protect themselves from potential harm, a brief description of what the covered entity is doing to investigate the breach, mitigate the harm, and prevent further breaches, as well as contact information for the covered entity. Additionally, for substitute notice provided via web posting or major print or broadcast media, the notification must include a toll-free number for individuals to contact the covered entity to determine if their protected health information was involved in the breach.
Covered entities that experience a breach affecting more than 500 residents of a State or jurisdiction are, in addition to notifying the affected individuals, required to provide notice to prominent media outlets serving the State or jurisdiction. Covered entities will likely provide this notification in the form of a press release to appropriate media outlets serving the affected area. Like individual notice, this media notification must be provided without unreasonable delay and in no case later than 60 days following the discovery of a breach and must include the same information required for the individual notice.
In addition to notifying affected individuals and the media (where appropriate), covered entities must notify the Secretary of breaches of unsecured protected health information. Covered entities will notify the Secretary by visiting the HHS web site and filling out and electronically submitting a breach report form. If a breach affects 500 or more individuals, covered entities must notify the Secretary without unreasonable delay and in no case later than 60 days following a breach. If, however, a breach affects fewer than 500 individuals, the covered entity may notify the Secretary of such breaches on an annual basis. Reports of breaches affecting fewer than 500 individuals are due to the Secretary no later than 60 days after the end of the calendar year in which the breaches occurred.
- Notification by a Business Associate
If a breach of unsecured protected health information occurs at or by a business associate, the business associate must notify the covered entity following the discovery of the breach. A business associate must provide notice to the covered entity without unreasonable delay and no later than 60 days from the discovery of the breach. To the extent possible, the business associate should provide the covered entity with the identification of each individual affected by the breach as well as any information required to be provided by the covered entity in its notification to affected individuals.
As the industry navigates the slippery slope of electronic health record security, it is important to learn from the breaches and PR nightmares of others; make sure you learn the current breach framework and reevaluate your systems, and realize that it is critical to have recurring security reviews of your infrastructure. And while we can never be too protected, it seems we are yet to be protected enough, and thus one must continuously strive to follow best practices and recommendations from security officers and experts in this domain as we continue to exist, securely, in an increasingly digital world.
May 8, 2011 9:22 PM
Posted by: RedaChouffani
, Million Veteran Program
, Veteran's Affairs Office
Earlier this month, the Veteran’s Affairs (VA) Office of Research and Development launched a new program called MVP, the Million Veteran Program. This program establishes a partnership between the VA and veterans, specifically creating a centralized data repository that will house the healthcare information from volunteer veterans around the nation. The goal of this is program is to aid researchers in their understanding of how genes affect overall health and potential illness. And once the patients’ data have captured and de-identified, it will then be made available to researchers — MVP has implemented stringent security measures to ensure that the Veteran’s information is protected.
The program will capture the following information from volunteers:
· Health related information such as medical history, health-related behaviors
· DNA and additional information extracted form blood sample
· A health assessment
· Future health information through VA-linked medical and health information
Currently this program is only available in nice VA health centers, including Boston, Buffalo, NY, Cleveland, OH, Durham, NC, Gainesville, FL, New York, New York, Palo Alto, CA, Seattle, WA, and West Haven, CT.
This is a first step toward utilizing large data sets and analyzing the link between DNA and illnesses as well as explaining why some individuals respond better to treatment than others. Additional information about this project can be found at the following site: http://www.research.va.gov/MVP/
May 2, 2011 8:00 AM
Posted by: RedaChouffani
This week I spent some time with Microsoft’s new Lync 2010 or should I say the big upgrade of one of their existing application Microsoft Communicator. This product is very promising to mid and large size organizations in various ways. It is a tool that is designed to facilitate communication between different users in the organization.
But what seems to get many IT directors and CIOs attention is the possibility that this product can potentially be a viable option to replace any existing phone systems. With the ability to use either a simple USB or Bluetooth headset, you can be on the phone from your desk or from home without having to use a traditional handset.
On the administration side Microsoft made it very user friendly. IT engineers have the ability to support the system in house without the need for third party vendors in most cases. While it may be required at first during the architecture and initial deploying, this platform is not out of reach for most system administrators.
Some of the features available are:
· Through the Microsoft Lync 2010 client users will have access to presence, instant messaging, voice, video, audio and web conferencing
· Integration with Microsoft Outlook and SharePoint
· Collaboration capability through application sharing, white boarding
· Schedule meetings with single click from Microsoft Outlook
· The availability of IP and USB devices for onsite or remote use
· The availability of E911 in the system
· For solution providers, the system APIs allows the developers to easily embed Communicator UI elements in your application
· The system offers mobile apps (currently only windows phone 7 is support and they are planning on releasing future mobile Apps for Android and Apple).
Microsoft Lync 2010 provides many features to facilitate and streamline communication within the organization. And with its integration capabilities with other Microsoft server and productivity tools integration it may provide to be a product worth reviewing.