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Meaningful Health Care Informatics Blog

January 13, 2011  9:37 PM

CMS encourages innovation around dual eligible individuals

Posted by: RedaChouffani
CMS, Medicare

When we discuss dual eligible patients we are talking about the beneficiaries of both Medicare and Medicaid. A group of patients that tend to meet the poverty level of Medicaid and cost over 300 billion dollars the federal and state governments. Recently, CMS has put forth proposals that will encourage innovation that can reduce the costs and improve the over health of this group.

In a recent RFP (Request for proposals) released by CMS targeted at the different Medicaid programs, states are to apply for grants under the CMS Innovations Initiative to integrate the Medicare and Medicaid for patients with dual eligibility. It is estimated that there are over 16 to 18% in Medicare Medicaid enrollees that are dual eligible. The estimated costs of these enrollees is estimated at $300 billion in state and federal spending.

CMS innovation is seeking to encourage innovative services delivery and payment models thought these funding which are contracts for up to $1 million per award contract.
The plan is to have the states structure, implement, and evaluate an intervention aimed at improving the quality, coordination, and cost-effectiveness of care for dual eligible individuals .

The Deliverables as part of the award contract are limited to the following:
Monthly conference calls
Progress Reports (Documentation on the development process and lessons learned)
Innovation Demonstration model

Currently this initiative is a first step toward the collaboration and information sharing for Medicare and state Medicaid. As the program aims to develop new care and payment models CMS will most likely seek the participation of the private sector to participate with the sates to help bridge the gap.

January 9, 2011  2:01 PM

CES 2011 and what it means to health care executives

Posted by: RedaChouffani
CES 2011, CIO, technology

Throughout the year there have been several opportunities for product manufacturers and vendors to display their latest gadgets and products.  For the health care market, there are several notable events, but the one that made significant buzz this month was CES for the latest and greatest consumer electronic goods.

While this event covers a wide range of products, and not just those in the health care field, there are many important innovations that would potentially be adopted by clinicians, patients and other health care organizational stakeholders. This makes it the more critical for hospital executives, especially CIOs, to tune into some of the products that are being showcased.

During the CES 2011 show, several health care and wellness products were introduced.  Some of which are:

  • Advanced hearing aid solutions
  • Moneual Silver Care Robot / Medical System
  • Cognitic software solutions for Smartphones
  • Heart beat monitoring tools that ca be paired with Smartphone and tablet devices
  • Personal medication dispensing system with visual and audible reminders and other health reminder activities
  • Genius Pen Mouse for digital signing of documents and health records

Of course several of the non health care specific technologies showcased are just as significant.  The consumer trends of electronics adoption moves into the business world fairly quickly. Some of the products that were significantly more present during this year’s show are: Google powered TV sets, and this can be significant for health care as it offers the users internet browsing, Market place for Apps. This technology can easily be a value add for hospitals to improve patient satisfaction simply by offering these units in each hospital room.  This would enable clinicians and  patients to view their chart directly on the TV available in their room and physicians can go through lab results, digital images or other health related document by simply using the TV remote.  Some of the other devices that have been covered are all the new Tablets from Windows based ones to the Android gingerbread pads.  These of course are the competing devices with the Apple iPad which has already been adopted in several medical organizations.

These are very exciting events for all technology enthusiasts and they continue to bring technologies that can be adopted successfully in the health care and be a value add.  There are clearly some products that are worth the hype and others deemed useless.  The influence of the consumer products on the business world is clear and it is critical to continue to evaluate what the market has to offer and identify what products will resolve what business need in the health organization.

January 3, 2011  9:37 PM

CMS opens registration for Hospitals and EPs

Posted by: RedaChouffani

The Medicare and Medicaid EHR incentive program has officially opened its registration     web portal for hospitals and EPs (eligible professionals) to report on meeting meaningful use criteria as part of stage 1.

While organizations will need to decide which of the programs they will participate in, the Medicaid program does not have all the states ready for registration.  So far about 11 states have participated.  Several other states are expected to participate in the upcoming months.

The web site is very easy to use and self explanatory.  When you visit the site (click here) you are asked to select one of two options (Hospitals or EP), then you will be requested to provide the credentials for the NPPES (national plan provider enumeration system).  The system also requires you to have an active NPI number.

The web site also provides a user guide (click here) for each the hospital and EPs applying for the incentives (Medicare/Medicaid).  In the 20 page guide you can preview the sections that the applicants must complete.  Starting from the registration, attestation, status of the application to the Account management.

January 2, 2011  11:22 PM

Microsoft offers 5 major benefits to using windows phone 7 platform

Posted by: RedaChouffani
windows phone 7

We continue to see more health professionals adopt mobile devices.  Whether to stay connected with family and friends, or for day to day business related items.  And with the ever increasing number of healthcare related apps available across multiple platforms from iOS, Android and recently Windows Mobile 7.

Many of these devices or especially the apps they host must provide tangible solutions that will provide with improvements in health record management, patient care giver interactions, health-monitoring, decision making and data security.

There are several mature platforms already in the market place that have already delivered great apps that are being implemented in many hospitals accross the country.  But with Microsoft re inventing its mobile platform, a new set of benefits are being proposed as part of the Windows Mobile 7.  According the Microsoft Life and sciense site there five major benefits as part of the new system:

*      Increased mobility and interoperability

Because it works seamlessly across a myriad of technologies—and with familiar Microsoft productivity tools, like Microsoft Office and Microsoft Exchange—Windows Phone 7 enables health and life science professionals to wirelessly connect to information and resources from virtually any environment. Training time for doctors, nurses, scientists, lab technicians, and other users can be minimized because the solution leverages existing systems with a smart, intuitive user interface.
*      Streamlined workflow and access to information

Windows Phone 7 can help you reduce or eliminate inefficient paper forms. Health and life science professionals and patients can enter information electronically, helping to minimize errors and streamline processes. Electronic data storage means that care providers can access up-to-date, comprehensive information when it’s needed, from virtually anywhere.
*      Improved patient monitoring and home care

With solutions based on Windows Phone 7, physicians can be alerted to patient risks in real time. Bedside access to patient data enables caregivers to evaluate data and to quickly make decisions that can improve the quality of care.
*      Enhanced collaboration

Windows Phone 7 creates new opportunities for health and life science professionals to share information and to consult with colleagues in real time.
*      Improved compliance with regulations and privacy concerns

A proven array of defense technologies, from 128-bit to 256-bit SSL encryption and security-enhanced access to on-premises applications and network resources using Microsoft Forefront Unified Access Gateway (UAG), helps providers comply with Health Insurance Portability and Accountability Act (HIPAA) guidelines for security and privacy requirements.

Microsoft continues to innovate in many different arenas, and while many still consider Microsoft a late comer to the mobile world, it is ultimately up to the consumers to judge.

January 2, 2011  10:40 PM

Thoughts for 2011

Posted by: RedaChouffani

As we start the new year we all start to wonder what will this new year bring in term of changes that may be a little out of our control.  For many health care professionals 2009 and 2010 were  very eventful years, and 2011 will most likely be as exciting as the previous two.

The new year will have a new majority in congress and the house, and with that some potential changes to the healthcare reform that was recently passed.  While most predict that there may not be a full repeal of the law, there may be blockage of funds for the bill.  some of the political uncertainties are too difficult to ignore as they do affect everyone and especially in healthcare.  The reality is that with the continuing growth of the deficit and having healthcare costs one of the highest on our government, no none really knows for certain what solutions will be proposed and how they will impact everyone.

In addition, during 2010 we have seen a surge of using tablet devices (e-Pads, Pads, Giant Smartphone, iPads, tablets or Internet tablets), and as these devices continue to see more healthcare apps being developed they are becoming more popular in healthcare settings across the world. While still many CIOs plan on deploying these devices in their facility along side their electronic medical records, many of them site their biggest concern as being security and deployment.

After a period of less than a month, the deadline on submitting public comments on the quality measures for Stages 2 and 3 of Meaningful Use has been passed.  The HHS received 37 official comments from a multitude of organizations.  Several of the comments provided strong support for the measures and few additional recommendations to the quality measures workgroup.  These measures will be critical to many healthcare professionals as they will require changes to the workflow, data being captures, in 2011 this will be something that many will keep an eye on very closely.

There are many things that will continue to advance in priority for 2011.  Meaningful use, additional budget adjustments, planning/implementing ICD10 and data protection.  And with many of the lessons learned from 2010, we will continue to strive to provide excellence and take pride in everything we do to ensure improving patient care, contain or even reduce operational costs and improve efficiency.

December 28, 2010  1:26 AM

Meaningful use proposed quality measures part 2

Posted by: RedaChouffani

Domain: Care Coordination:
It is without a doubt a critical step toward improving patient outcome when providers are coordinating care.  Through the three stages of Planning, care transition and Follow up post care, this area will encourage the exchange of information as well as the use of electronic health  records and personal Health records as well.
In this section we identify the first set as being the measure of the effectiveness of care planning. The focus of it is to identify collaborative work of care givers, patient self management and comprehensive care plan in the EHR.  Other subcategories listed were the Care transitions as well as the appropriate and timely follow-up.

Domain: Patient Safety:
From Medication safety to hospital associated events, this domain does outline some key measures.  Whether it is monitoring the drug safety for patients who are on chronic medical therapy or simply measuring the VTE (venous thromboembolism) rates.  To truly appreciate this measure is to simply look at the facts.  For Deep venous thrombosis (DVT) which happens to be a  common but highly preventable preoperative complication for patients undergoing surgeries the measure here will tremendously help identify additional preventative measure some organizations must implement.

Domain: Population and Public Health:
For these measures it would most definitely provide valuable data on the availability of services that promote healthy lifestyles.  while it would be very difficult for many organizations to “force” patients to exercise and eat healthy. it would improve the outcome results once more care providers actively educate patients more and provide them with tools to measure progress and create a deeper connection with the patients to maximize the effectiveness of preventative services.

There were several additional measures recommended outside of the previously defined domains.  Some examples were the measure of preventable ED visits, measure of patient identification errors and near misses.

I applaud the effort made by all the tiger teams to put forth such measures.  While certainly several organizations have voices and recommended some changes to the measures, it is important to see that all measures are there to help maintain the focus on improved patient safety, improved patient outcome, promote the meaningful use goals and help creating a more efficient and cost effective health system

December 28, 2010  1:25 AM

Meaningful Use Proposed Quality Measures Part 1

Posted by: RedaChouffani
MU, outcome, quality measures

During the month of December 2010 the HIT policy committee formed the quality measures workgroup.  Their goal was to promote new clinical quality measures for meaningful use Stage 2 and 3.  The groups focused on five different areas which were lead by individual teams or five tiger teams. The areas were as follows:

Patient and Family Engagement
Clinical Appropriateness/Efficiency
Care Coordination, Patient Safety
Population and Public Health

The groups have submitted their recommendations which have been available for public comment up until the 23rd of December 2010.  However, at that deadline an extension was granted for ups until December 31 2010.

In order to understand the details of each of the five areas the recommendations outlined, we will describe briefly what each one consists of based on the submitted matrix (

Domain: Patient and Family Engagement: Within this section there were four different areas described as having measures applied to them.  The focus is to assess the patient self management abilities. Also several other measures have been recommended that would provide an insight on the patient health outcomes and the level of access they has to the community resources for improved and sustainable care coordination.  In this area the existence of a regional HIE or community based HIE is a must in other to achieve this goal and to adequately measure.

Domain Clinical Appropriateness:
This quality measure will assess the LOS (Length of stay) and readmission rate for hospitals.  Although several hospitals and organizations have already suggested that the measure should take in consideration the medical record of the readmitted patients to ensure that reasons of readmissions such as new diagnosis are taking in consideration as part of the overall measure.  In this quality measure section we can also see the HIT committee recommending the measure of the appropriate and use of diagnostic tests.  In implement this, the goal would be to reduce unnecessary procedures or repeated tests.  As for the appropriate/Efficient use of medications section the measures are clear and to the point.  The goal is to measure the appropriate medication treatment (Overuse and under use) which in many case is a valid concern (overuse of antibiotic can lead to the development of antibacterial resistance).  The measure also calls for the tracking of medication that was linked to adherence outcomes.  This can be a powerful measure as it can provide a gold mine in terms of data which can be used to identify based on tangible statistics the drugs that may have been approved by the FDA (with possibly weak clinical trials) and do have negative side effects on patients.
As for the measure for rates of generic vs. brand names, these statistics may benefit payers or CMS to potentially understand the factors behind physicians prescribing generic and brand name medication.

December 19, 2010  10:12 PM

Using the new Tax law to help with EHR implementations

Posted by: RedaChouffani

While many IT budgets have been coming under constraint due the economy state, many healthcare organizations are looking at IT to help them meet their organizational goals, meaningful use criteria and to help identify additional ways to reduce operational costs. But unfortunately some of the recent initiatives such as implementation of a certified EHR as part of the requirements for the ARRA are requiring a lot more up front.  This pressures many to  work harder at persuade the stakeholders of the additional funds.

But with the passing of the recent tax legislation on mid December of 2010 with an 81 to 19 vote in the senate, approval of the house and president Obama’s signature many are welcoming some additional extensions for equipment tax write off. Which would help several businesses. For healthcare, the recent passing of the block of Medicare reimbursement cuts was a great celebration. But with the new tax legislation or HR 4853, businesses will be able to write-off 100% of new equipment business investments in 2011, which is still somewhat will extend a similar bill recently used “Section 179 deduction“.

This year already has seen a surge in interest of purchase of EHR  packages (Certified her to be exact). With the ARRA incentives. However, the incentive payments may not completely offset the costs associated with an EHR implementation. The reality is that there are several costs associated with such an investment. Ranging from Hardware costs from purchasing news servers, workstations, Laptops, wireless, Software licensing, training, interfacing, deployment, loss of income due to slow downs in the initial phase, and so forth.

But really, with the tax write off as part of the new Tax extension law, it would generally help push many into making the commitment to get the necessary equipment needed for the new EHR. Some may consider virtualization their servers, and others may decide to replace all the workstations or even their legacy phone system.  The most important thing to do here would to invest into a technology that has clear and attainable ROI.

There are several areas that an organization can look at upgrading to ensure that they are ready for a new EHR.

Strong network infrastructure to ensure proper connectivity and optimal speed.  This is done by ensuring the proper switches, routers, wireless and other networking devices.
Secured infrastructure by ensuring that the appropriate firewalls, routers, intrusion detection, software updates, AV, spy ware/Malware protection are implemented throughout the organization.
DR/BCP while the new equipment maybe more reliable than the previous legacy hardware, it is crucial to ensure that there is redundancy, and especially when you are going paperless.  This would require making investment in getting virtualization, updating the backup system, and having spare parts such as switches, routers.
Upgrading current servers with virtualization (I am only suggesting virtual as it has already been proven to have high ROI and is more scalable, has high System availability)
The purchase of high speed scanners, new workstations, laptops and any other devices needed.
Purchasing of medical devices that have interfaces which will help with capture data electronically and increase efficiency.

While these are basic recommendations for hardware or equipment investment that will be necessary for any new EHR implementation, it is important to note that the most critical investment any organization can do is in its people.

December 19, 2010  9:48 PM

Would Implantable medical devices need to be rebooted too

Posted by: RedaChouffani

It is extra ordinary the speed at which new software products are emerging in the market place. Ranging from Apps developed for smart phones, to fully functional web based EHR systems. But many of the products certainly come with a disclaimer. This is called the “Limited Liability” and all the fine print in the bottom of the contract. In healthcare this at times raises concerns, especially when you are dealing with patient’s lives.

So, many end users are wondering why products are not bug free and for all the money being paid, they are periodically facing errors and application crash. The reality is that every software program will potentially have some sort of bug in it (yes! including apple products). Even NASA is not capable of predicting the behavior of the software and hardware at times.  Taking for an example the issues that were encountered aboard the Voyager 2 in space. So, this raises the question of the reliability of programs and if we should be concerned about them being embedded in our bodies knowing that they may need to be “Rebooted”.

For orthopedics and spine specialists the solution to many patients with chronic back and leg disorders have benefited from the neurostimulators that have been implanted in the patient’s body.  This helped detect and block pain signals traveling to the brain, which improved the quality of life for many of the patients. There are several other devices that hold some sort of software package that has been coded, from insulin dispensers to hearing aid devices.

We will continue to see further advancement of the technology and as a result a better and improved health of patients with specific conditions and disorders. For most of these devices they do in fact have programs inside of their boards and chips. and just like any other development, there are potential risks from possible bugs or even these devices being hacked or tempered with.

Healthcare devices that are being used today and the ones for tomorrow must be developed with the up most consideration for privacy protection and security.  Following best practices, development partners and strict security and data protection guideline is essential to ensure safety.

December 12, 2010  9:56 PM

The costs of the recommendations made by the PCAST on Health Information

Posted by: RedaChouffani
PCAST, Universal Exchange, white house

My previous post I discussed the report submitted by (PCAST) Entitled “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans” to the white house.  The article focused on the recommendations that were made by the group members to improve and accelerate the realization of the full potential of HIT.

In the report the authors have provided additional insight to what it would cost to accomplish the recommendations that have been made.  It was also suggested that a lot of the costs will initially be investments made mostly by EHR vendors, government agencies and healthcare providers.

The first line item discussed is the cost associated with the development of the universal exchange language, security protocol as well as associated privacy.   The estimate for the development of this standard would range from $20 to $40 million.  The universal exchange language will be some kind of extensible markup language (an XML variant, for example).

The second cost discussed was the costs associated with the upgrade of physician systems that have been using an EHR system, however may need the upgrade to enable them to exchange health records utilizing the new exchange protocols.  The costs estimated would be from 5 to 10 % of the total cost of their current EHR.

For physicians that have not adopted a certified HER, the costs associated with having the ability of exchange data using the new universal approach, would most likely be already part of the new products as many of the vendors (over 300 vendors) have already shifted to cloud-based products which many of which would most likely have already adopted the universal exchange language.

The fifth item would be the costs associated with indexing and searching for patient specific health data.   Fortunately this technology has been around for years and much of the capital investment has already been made many years ago. Search engine giants and contributing authors in the  PCAST group estimate that it would most likely cost about $.20 cents per patient per year.  This would mean that it would cost our nation about $62 million a year which can be initially supported by the federal government.

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