April 24, 2011 9:14 PM
Posted by: RedaChouffani
, EHR incentives
, Meaningful use
, Meaningful use incentives
On April 18, the Centers for Medicare and Medicaid Services (CMS) launched the Electronic Health Record (EHR) incentive website, allowing eligible providers (EPs) to utilize the web based system to attest that they have met meaningful use criteria, using certified EHR technology, in order to receive reimbursement from the Medicare EHR incentive program.
The recent CMS press release states that “providers will fill in numerators and denominators for the meaningful use objectives and clinical quality measures, indicate if they qualify for exclusions to specific objectives, and legally attest that they have successfully demonstrated meaningful use. A complete EHR system will provide a report of the numerators, denominators and other information. Then you will need to enter that data into our online Attestation System. Providers will qualify for a Medicare EHR incentive payment upon completing a successful online submission through the Attestation System-immediately after you submit your results you will see a summary of your attestation, and whether or not it was successful.”
The current site is for only the Medicare incentive program, so EPs who will engage in the Medicaid program will need to attest directly on their state’s individual Medicaid websites. The good news is that once providers have completed the online attestation process, they should receive incentive payments within approximately four to six weeks.
While this is only for meaningful use Stage 1, based on the comments made on the proposed Stages 2-3, it is clear that physicians, vendors and other key industry stakeholder groups are requesting pushing back the deadlines for the remaining stages. However, it will be up to the newly appointed ONC director, as well as the secretary of the DHHS, to decide what is the most viable option.
April 24, 2011 9:12 PM
Posted by: RedaChouffani
, mHealth applications
In previous articles, I have discussed the impact mobile health’s rise in the industry and the EHR vendors’ reactions toward the plethora of new mHealth products entering the market every day.Wireless capability and remote data exchange is becoming of vital importance to physicians, as it allows clinicians the ability to expand the continuum of care and push forward telehealth and remote patient monitoring capabilities in their every day practice.
But in a product evaluation session I recently attended, one of the software vendors described their product as being one of the few solutions that offered a truly mobile app for its physicians. Unfortunately, after careful review, what was meant by a “mobile app” was nothing more than the browser based view of the chart that was available to any device, specifically an iPad, Android tablet or a Blackberry.
So, the question I was asked was:What is the difference between a native iPad iOS/Android app and a web based app accessible from iOS/Android platforms?Keep in mind that it is important to recognize the difference between the two, as there are some key functionalities that are lost with the web based app.
There are two common types of apps available in the healthcare market place, the first being web based apps:
·A web based app relies on server side processing for rendering content — and while there are some web sites that use local resources on the device itself, simply put, it is a web page that had some additional scripting done to it to ensure the look and feel is somewhat similar to the look of the native apps.
·Easy to deploy and won’t require marketplace approval or Apple Store review.
·Healthcare providers can have access to most of the features and functionality currently offered via web portals from the software vendors on almost any platform.
·Server side processing means better performance in most cases, since the end user does not have to wait for the information to transferred and manipulated on the device itself.
·From a development standpoint, web solutions tend to be easier to develop than native mobile device apps.In fact, there seems to be a shortage in mHealth developers vs. web developers.
·Web based apps are also cross platform compatible, where they can run on any browser regardless of the device you are using.
·Loss of hardware integration: In a web based model you are most likely not going to have the ability to use the cam or capture data from an external device ,such as location from GPS, or download data from a heart monitor, read vitals and other data from medical devices.
·Loss of some features, such as multi-touch, gesture recognition.There are web sites that have created controls similar to iOS controls, but they still lack the typical experience that accompanies the native ones.
·Lack of strong support for offline functionality when physicians don’t have access to WiFi or internet access.
Native apps are the products or apps developed using the device’s own development kit or (SDK):
·With the ability to be completely offline and the availability of local databases, native apps can easily and securely make charts and other health information available offline for review.This would allow end user to capture data and then synchronize it with the main data store once the connection is made back.
·A native app has the ability to interact with all the available devices through the SDK (software development Kit).Whether the app needs to transmit instructions to an external device, or simply capturing the image of a skin condition, the native app has many options from which to choose.
·In most cases, there are specific guidelines and rules that are required from app developers prior to getting their app published in the online app catalog.
·Native apps are move difficult to develop and require specific platform knowledge and programming language.For the iPad/iPhone Objective-C is the common route taken to develop, although other programs, such as MonoTouch, allows software developers who are used to Microsoft c# or .net to write for iOS.
·Costly and longer development cycle comes with this type of product creation.
·Lack of cross platform compatibility, which requires the software vendors to choose a preferred platform or have multiple teams developing for multiple platforms.
Whether evaluating web based or native apps, the most important step during the selection process is ensuring that it meets your minimum set requirements and resolves a workflow challenge.At this point, there are four major players: RIM, Apple, Microsoft and Google.Each vendor has a different programming language and different functionalities. It’s hard to determine who will lead the market down the road, but it is important to focus on what the app can do for you now, as a first step, so that you have a tangible ROI to take back to the table.
April 17, 2011 9:16 PM
Posted by: RedaChouffani
With the electronic Prescription deadline fast approaching, there are still few organizations that are attempting to submit at least 10 electronic prescriptions by June 30th of 2011. This will allow them to avoid 1% penalty to their Medicare reimbursement. For some this maybe a simple task if they are already using EHR. This is the case since some of these paperless offices have already been prescribing electronically and it would be just a matter of having the EHR vendor turn on the electronic prescribing functionality. But for others who are still using paper charts, and are attempting to find a way out of the penalties there are very few options that will allow them to meet the minimum requirements this late in the game.
There are many online electronic prescribing certified systems that can allow physicians and PAs to use the web site and submit electronic prescription. These products provide a quick way to get on board, and with an easy web based GUI meet the requirements of CMS. Some of these products that are available are: Dr. First, AllScripts, Care 360, and few other ones. While AllScripts offer free e-prescribing (which they do), there are many areas that are not available for free on the site and can prove to be a major hassle for the practice. Things that require a monthly fee are: such as interfacing, or uploading patients files, viewing some of the medication’s detail and as well as some of the reports. But keep in mind that for something that’s free, they definitely have an advantage, they even offer easy to follow videos and tutorials to allow the group to self-train. Some of the other solution providers such as Dr. First that has packages that are very affordable and seem to work very well with the practices.
But one of the most important steps needed here is to review all the different vendors and their options. Many of them offer mobile Apps for e prescribing which can be critical if you are a surgeon and constantly on go. The good news is that many of them work well on the iPad/ and the Android Based tablets through the browser, so if you decide not to go the App route, the browser may just be what the doctor prescribed.
April 17, 2011 9:11 PM
Posted by: RedaChouffani
, Microsoft HealthVault
, personal health records
When it comes to personal health records (PHRs), there are several options to choose from in today’s market. The goal of a well designed PHR is to provide a wide range of functionality and ease of use, while being truly interoperable, and with some of the big players competing on all of these elements for your health information, the race is most certainly on. I have been using both Google and Microsoft HealthVault for few years now, and they both continue to add functionality and new capabilities that are proving hard to ignore.
But what has recently got my attention is how Microsoft continues to aggressively invest in interoperability and connectivity functionality, free of charge, making it continually easier for patients to upload and track their health data. Some of this functionality comes from interfacing with common health devices such as blood pressure monitors, pedometers, glucometers and even digital Images.
Another item that Microsoft has on the menu is a combination of HealthVault and Windows Azure capabilities. These fall under the cloud-computing services category of solutions that Microsoft is currently offering, where there are several reasons why these make such powerful platforms:
· Software vendors are looking for cost effective ways to make health information available in the cloud, and Windows Azure provides out of the box cloud storage with database backend support…(SaaS all the way).
· Microsoft has ensured that if you are a solutions provider, you will have access to HealthVault services through the Windows Azure platform.
· Microsoft has a large number of partner participation. Their partners range from CVS, Aetna, Quest, and few other ones, which allow patients the ability to retrieve some of their data across the wire in order to develop a comprehensive record without a lot of manual work.
· One of the items that’s even more impressive comes with the support of native DICOM (digital imaging) as part of the HealthVault connectivity capability.
· For health care organizations that have adopted a custom made (electronic health record) EHR, Microsoft HealthVault with Windows Azure will provide a flexible platform to host their application or health data.
With respect to digital imaging, DICOM has been the predominant format for almost every system out there. This made it very simple for organizations to simply just start pushing or pulling images over the wire. When it comes to health records, however, there are some challenges. Since not all PHR providers can agree on one single standard, it remains a challenge for many to decide whether it is going to be CCD or CCR. Google Health, for example supports a subset of the CCR, while Microsoft HealthVault supports the entire standards set.
April 10, 2011 8:57 PM
Posted by: RedaChouffani
, mHealth applications
, mobile apps
, mobile health
AirStrip Technologies has recently teamed up with GE healthcare to assist in rolling out the mobile app for the iPads and iPhones as part of the MUSE cardiology information system. And after looking up some of the demos available online and on YouTube, it looks to be a very useful app.
The new system allows the iPad to display ECG data, and allows for the end user to interact with it through eh ability to perform measurements and such. Some additional functionality that this application offers cardiologist is the ability to compare multiple ECGs, by overlaying one onto the other.
One challenge that remains for many is how to ensure long battery life on some such devices, especially when there is a lot of data being transmitted via wireless, which essentially demands more power.
This product is currently available for demos in iTunes, but if any physician is interested n the purchase of this product, they will need to contact GE directly.
But for all the Android fans out there, there will be a future release of this app on the Android platform.
April 10, 2011 8:32 PM
Posted by: RedaChouffani
, cloud computing
Information technology continues to see significant evolution, now more than ever, as the industry is truly on the verge of changing the way health IT infrastructures are managed, provisioned and protected. Cloud computing has become a new staple in health care IT, providing infrastructure from servers, virtual desktops, and unified messaging on demand.
We also continue to see growth in the hospital market. With more physicians aligning with hospitals systems and IDNs, executives and health IT leaders are looking for new ways to scale out their infrastructures while providing a measurable ROI for the organization.
Currently the market offers several models from which to pick, the selection needing to be based on organizational needs and future goals.
PaaS (Platform-as-a-service): In this model, a hospital would either have access to a private or public platform as a service. It will enable the organization to deploy a set of solutions (EHR, RIS, billing) without having to bear the burden of the hardware and software costs associated with those applications.
SaaS (Software-as-a-service): For this model, we actually see some hospitals providing this service to practices and physician affiliates. This model provides access to a software product (a web based EHR, for example) as a service without any hardware requirements. Some hospitals may decide to work with EHR vendors to gain access to their solutions via this model as well.
IaaS (Infrastructure-as-a-service): With some of the hospitals expanding their reach into smaller communities and rural areas, it becomes challenging to have to try and deploy new IT infrastructure from servers, software, VoIP, networking and technicians. This IaaS model eliminates the complexity, long deployment cycles and costs associated with the equipment.
Many organizations have adopted a variety of these service models and have been able to capture a realized ROI. The bottom line is that these models allow providers and IT leaders with the ability to provision and utilize servers, take advantage networking capabilities, and access storage on demand. These offerings will ensure that health IT leaders can continue to focus their efforts on other projects, from meaningful use and HIPAA 5010 compliance, to ICD10 implementation and more.
April 3, 2011 9:39 PM
Posted by: RedaChouffani
, software achitecture
As we continue to see the trend toward vendor consolidation in the EHR marketplace, there is always the question about which products and which vendors will be on top. But in my mind, the question is not so much a matter of who or what will be on top, but more importantly, can they stay ahead and constantly embrace innovation.
For the health care software market, there are several strong giants that provide robust products with every feature known to man. We continue to see the blurring line between the differentiators of these products, and it is common to hear the same sales pitch from each and every one, never having a clear picture of why product XYZ is different, or better, than product ABC.
So the question to be asked is, should health care organizations be concerned with the life of the products which they are purchasing and the acquisitions that are happening? Well, the good news is that EHR vendors are not going anywhere. Many of whom were originally considered too small to get certification and be listed on the certified EHR list worked hard to make the mark and are working even harder to maintain their market share. This is due to the fact that most of the requirements from the certification bodies for meaningful use are functionalities that good health care software firms should have in their products to start with. And thanks to a faster development life cycle, many application developers have been able to meet almost all of the requirements from the ONC-Authorized Testing and Certification Bodies.
The one thing that continues to be a critical aspect to whether a software solution will survive the ever-changing market, simply put, is how the actual EHR product is designed. Is it an open architecture? Can it easily adapt to changes without major redesigns, i.e., does the product support web services, cross platforms, have a strong database engine, as well as written using OOP (Object Oriented Programming)? Of course there are still top performing EHR vendors whose products were built using older development platforms and non-SQL based databases, products which have been very successful and are still demand, though this will continue to change as the market continues to evolve, and more sophisticated platforms with increased functionality and capabilities become a necessity.
We have seen many software vendors today in a race to provide mobile apps for their products in order to ensure that you are not left “on the bench.” But it remains to be seen whether the “app” is worthy of its title. These mHealth apps must, first and foremost, provide VALUE to the end user (in this, the clinicians and care givers), and not simply be the manifestation of another marketing bullet in the product’s brochure or another costly feature on the price schedule.
April 3, 2011 9:29 PM
Posted by: RedaChouffani
The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule under the Affordable Care Act (ACA) to help doctors and hospitals improve coordination of care for Medicare patients. The proposed rule is in relation to Medicare payments to providers and suppliers participating in ACOs (Accountable Care Organizations), and has a 60 day public comment period, allowing all providers and other entities to comment and provide feedback for CMS to review.
There are five areas discussed in the proposed ruling:
· Patient/Caregiver Experience
· Care Coordination
· Patient Safety
· Preventive Health
· At-Risk Population/Frail Elderly Health
It is clear from the document and some of the requirements that there is a significant continuum of push for electronic health records (EHRs). Currently, the ruling requires that at least 50% of an ACO’s primary care physicians must be meaningful EHR users, using certified EHR technology as defined in §495.4, in the HITECH Act and subsequent Medicare regulations, by the start of the second performance year in order to continue participating in the Shared Savings Program.
One addition whose development will be interesting to follow is the need to report the data out to CMS. It has been proposed to use similar methods that have been successfully utilized in the past, such as PQRI registries. However, with the new measures required for ACO reports, it has been indicated in the document that there will be a new method for reporting the data back to CMS. Based on the different measures proposed, there are approximately five different types of data submission methods:
· Information submitted via Claims (x12 or CMS 1500) for a subset of the measures.
· Group Practice Reporting Option (GPRO) Data Collection Tool for some of the clinical data
· Electronic prescriptions (which is tracked currently under the submitted G-Codes via claims data)
· Data on meaningful use and what will likely come out of the current MU web portal
· Claims or CDC National Healthcare Safety Network
The GPRO tool would most likely have the most significance in terms of data reporting for ACOs. The tool will allow submission of clinical and administrative information from EHRs, registries, and the like. The current tool is web based, but we will most likely see interfaces being developed for this tool in the future.
The rules can be accessed via the following link: www.ofr.gov/OFRUpload/OFRData/2011-07880_PI.pdf. The document contains several details on what the ACOs will require. This is a good time for many to review the proposed ruling and provide comments on things that may be of concern to them. Public comments are due by May 30.
March 27, 2011 2:12 PM
Posted by: RedaChouffani
nurse calling systems
For many years hospitals have been working hard to eliminate communication challenges and improve nursing workflows. Whether it’s locating a nurse, or responding to a patient’s request for more pain medication — it has been notoriously time consuming and difficult to streamline these workflows. One of the approaches to resolving this is through the implementation of a unified nurse calling system. This solution offers a way for nurses and patients to interact, and for nurses to get real-time notification on patient status and respond to patient requests. Previously for some of these systems, excessive wiring in patient rooms and nurses’ areas was a must, which made installation expensive and hard quite cumbersome. Fortunately though, they did end up providing tremendous value, and thus were worth the costs in the end.
Nurse calling systems have seen several changes throughout the years. Some of the early models were based on simple light indicators — some still being used in doctors offices today — where a patient has the option to press one of few color coded buttons, causing a board at the nurses’ station to light up, indicating the room number and the color pressed.
But in today’s market, there have been many new solutions that can do more than just light exchange. Many are IP based systems that can exchange messages, voice and data. Some of the newer nurse calling systems offer several advantages, such as:
- The ability to use RTLS (Real-time Location System) to locate a nurse on the floor
- Two-way communication between patient-nurse or physician-nurse
- Integration with heart monitors and other medical devices to alert nurses of a patient’s critical condition
- Computerized dashboards that show real-time location of nurses, room status, patient info and current staff distributions
- Wireless communication as the backbone to utilizing existing infrastructure without incurring additional wiring costs
- IP based
- Scalable, which enables the system to grow with demand
- Ease of manageability and enabling IT departments to manage and support the solution
- “There is an App for that” — well I have not seen a system with a mobile app yet, but I am certain there has to be one out there
- Interoperability where the system can interact with other medical devices as well as HIS (Hospital Information System)
It is very clear that new nurse calling systems will help improve patient care, as they are a good way to increase efficiency, drive positive outcomes, and help nurses provide better care for their patients.