Health IT and Electronic Health Activate your FREE membership today |  Log-in

Meaningful Health Care Informatics Blog


December 11, 2010  8:34 PM

Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans



Posted by: RedaChouffani

Today the secretary of the health and human services released a statement praising the president and the leaders in congress for proposing legislation that will prevent a significant cut for doctors from taking effect on January 1st.  This is good news for many.

In addition on December 9th, 2010 the office of the National Coordinator for Health Information Technology Health Information Technology; Request for Information Regarding the President’s Council of Adviser on Science and Technology (PCAST) Report Entitled “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans:
The Path Forward.” With about 108 pages this document covers some very important points(http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.PDF).

This document was generated from the collaborative work of individuals like Christine Cassel President and CEO, American Board of Internal Medicine and the Eric Schmidt Chairman and CEO.

The first section cover the potential of Health IT” with some descriptions of value of electronic data, then the document describes the health IT Today with discussions of the Barriers to EHR adoption, health information exchanges, HITECH and shifting incentives and some of the challenges that face CMS and ONC.

Some of the other areas that are covered are technology for an integrated health it ecosystem, privacy and security considerations, and Economic and Regulatory Issues, Health Data and the Research Opportunity.

The PCAST in the document released reached six major conclusions and described them as:
HHS’s vigorous efforts have laid a foundation for progress in the adoption of electonic health records, including through projects launched by ONC, and through the issuance of the 2011 “meaningful use” rules under HITECH.
In analyzing the path forward, we conclude that achievement of the President’s goals requires significantly accelerated progress toward the robust exchange of health information
National decisions can and should be made soon to establish a “universal exchange language” that enables health IT data to be shared across institutions; and also to create the infrastructure that allows physicians and patients to assemble a patient’s data across institutional boundaries, subject to strong, persistent, privacy safeguards and consistent with applicable patient privacy preferences. Federal leadership is needed to create this infrastructure.
Creating the required capabilities is technically feasible, as demonstrated by technology frameworks with demonstrated success in other sectors of the economy.
ONC should move rapidly to ensure the development of these capabilities; and ONC and CMS should focus meaningful use guidelines for 2013 and 2015 on the more comprehensive ability to exchange healthcare information
Finally, as CMS leadership already understands, CMS will require major modernization and restructuring of its IT platforms and staff expertise to be able to engage in sophisticated exchange of health information and to drive major progress in health IT

The panel made recommendations for different organizations to ensure rapid adoption of HIT and the impact on our nations healthcare.  There were details lists of recommendations for the ONC, Medicare & Medicaid , and the department of Human and Health services.

December 5, 2010  10:24 PM

Updates on initiatives from Healthy People 2020



Posted by: RedaChouffani
healthy 2020, HHS

With the recent reveal of Healthy people 2020, the department of Health and Human Services is pushing further to help improve the health of nation.  This initiative was lunched on December 2nd, 2010 and it is focused on a 10-year agenda to accomplish its goals.

The organization’s mission as defined on their site is:

  • Identify nationwide health improvement priorities;
  • Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress;
  • Provide measurable objectives and goals that are applicable at the national, state, and local levels;
  • Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge;
  • Identify critical research, evaluation and data collection needs.

This organization is taking a scientific approach to monitoring and focusing on improving the health of the nation.  And with the access to the NHIN (Nationwide health information Network) it is insure meaningful data will be available and will be an integral part of the implementation and success of Healthy People 2020.

To encourage participation of several of healthy living choices HHS has released the website HealthyPeople.gov that has extensive resources and educational material.  One of the prevention web sites available is health finder.gov Quick Guide to Healthy Living (http://www.healthfinder.gov/prevention/)


December 5, 2010  8:15 PM

XBox 360 Kinect coming to health care



Posted by: RedaChouffani
EHR, Kinect, Touch-less Kiosk, X-Box 360

The recently released Xbox 360 Kinect has been a much anticipated event for many gamers. This device has enabled the human body to become the actual controller.  While this is not new technology by no means, it has still created a sensation amongst hackers and developers.  The goal was to utilize this $149 device to interact with our computers by simply using hand gestures.

Currently there is no official release of the drivers for this device from Microsoft. However, hackers have simply designed their own and published all the source code for it in the internet. These files enabled others to develop programs that can work with this wonderful device. Several individuals have already filled YouTube with different concepts running on all sort of platforms (Mac OS, Linux and of course Windows 7) and what they have designed to work with the Kinect.  But Microsoft has already been planning to do similar things with this technology.  Back in August of 2009 it applied for a patent (click here) titled “Gesture Keyboarding “.  It has described in this that it is looking to develop a concept that will allow a user to make a gesture by either making a pose or moving in a pre-defined way that is captured by a depth camera and this would control a PC or such device.

when thinking about gesture controlled PC, the Minority Report and Tom Cruise come to mind., except with the Kinect you will not need gloves. Or attachments to your fingers. Now with the availability of several SDK (Software development kits) and source code many are able to experiment with this technology.

What is most of interest to me at this point is the potential applications of such a device in the health care, following are some of the ideas where this technology can be applied to:

  • Develop add-ons to PowerPoint for Presentations can be fully controlled by human gestures.
  • Develop applications that can be used to interpret sign language to be used in health organizations.  This would reduce cost and time waiting for an interpreter.
  • Implement some of the functionality as part of the a PACS or Imaging viewing system.
  • Next generation Web meetings where you can collaborate and annotate on documents just by simply using your fingers are pointer devices.
  • Physical therapy where the software provides feedback and assistance in rehabilitation centers and help patients.
  • Meetings that use project on the wall can now annotate and draw in the air and the projected image shows reflects what their finger drew.
  • Tvs controlled by gestures
  • Surgery rooms where surgeons can interact with images by simply making specific gestures and seeing the desired result
  • Touch-less Kiosks with non physical keyboards to reduce disease due to spread of germ from touch

Since the first prototype of the mouse in the 60s that changed the way we interact with systems, Kinect can and will most likely enhance the way we interact with computers.  Today we continue to see it commercialized for gaming but clearly signs seen out there from the progress made by software enthusiasts, hackers, EHR vendors and many with vision for the future, one day we may see these types of devices embedded in our TVs where we can change the channel simply by waiving our hand from left to right.  But for now, I will continue to experiment in my own lab and see what other possibilities can be accomplished with this type of technology.


November 28, 2010  11:32 PM

Measuring patient satisfaction and making use of the results



Posted by: RedaChouffani

In today’s competitive market it is important to ensure that patient satisfaction is high.  For many this seems to be expected of any health organization, but the reality is that without measurable and reportable data, what may seem to be as “Our patients are happy” may be a dangerous assumption without any numbers to back it up.

With some of the new federal initiatives such as the Affordable Care Act and its comprehensive health care reform law that was enacted in March 2010.  One of the goals of the law is to improve quality of care. The Federal government created tools to allow people to compare a variety of quality measures of care providers online.(http://www.healthcare.gov/compare/index.html).  This can be another reminder that the patients are already exposed to this type of patient satisfaction or feedback already.

The general practice for many hospitals is to outsource the data collection for the surveys.  This can be performed through a phone call after the patients release, via web based questionnaires or social media apps.  The key is to realize that with the collected data, an organization can gains tremendous value:

Ensure patients retention
Identify areas and departments that need improvements
Collect contact information to share new procedures and services with the patients
Measure outcome of internal initiatives and gauge the improvement rate over time

For small to mid size organizations patient surveys may not be at a high priority for the group as meaningful use.  Many of this entities are still adjusting to the recent cuts and upcoming challenges, but it is important to start measuring the quality of care from the patient’s perspective.  This will help ensure that the practice is correcting any issues, or simply reward the collaborative work of everyone in the team.


November 28, 2010  10:06 PM

What the Apps of tomorrow will bring to your smart device



Posted by: RedaChouffani
Uncategorized

We continue to see Smart-phone with more processing power and advanced capabilities.  These devices have become part of our everyday life.  In some of recent years with some of integrations available such as GPS we have made new uses of these Smart-phones.  For example in many of my trips I find myself using my phone (Android based) for recommendations for restaurant, nearest coffee shops and checking to see if I have enough time to grab a bite to eat before I go to my next appointment.

The question we can ask ourselves is what else should these mobile devices be capable of performing and how can we expend their functionality to serve us in other ways.  I spent a day thinking of my own activities as well as what others may want to see available in these devices.

Here are some of the functionality of future phones will most likely have (Some have already been in use):

  • Cloud based music player that takes advantage of smart play list that recognizes your favorite tunes based on frequency of play and moods (mixing location aware play lists for Gym, or simply coffee shop in the corner of the street where you usually relax and listen to the Beatles).
  • Smart apps that recognize stress levels based on touch breathing,  or tone of voice and provide visual images to sooth the tension or audible cues.  It can also recommend the nearest massage parlor or schedule a therapy sessions for patients with advanced mental illnesses.
  • Apps that can interact with your physician and provide a gateway to interact and send data about your condition and basic vitals.  These apps can also schedule the appointment for you based on the next available appointment in both calendars with your favorite physician.
  • An app that makes healthy lunch recommendations and provides calorie count of meals selected by prompting the user to choose from the menu of the restaurant that was visited (uses GPS to select which menu from what restaurant to pull).
  • Provide a proxy for certain medical devices such as Insulin pump, blood sugar levels or medication reminders to interact with the medical home or simply persist the data into your PHI.
  • Smart app that can provide coupons and additional items recommendations that may be on sale that have been previously identified as your favorite.

Many of the apps of the future will have access to our likes and dislikes, our location, our health, our treatment plans, our daily schedules, our favorite trails, our favorite restaurants and even our personal business such as friends, criminal record, credit scores and the foods we buy at the stores.  In most cases today companies such as Google and Facebook tend to know a little more than what think they know and at times share it with others without prior approval (see WSJ article on: Facebook in Privacy Breach ). But if we have smart apps that provide value and act as our digital assistant while still protecting our privacy  then everyone can start to take advantage of smarter apps and technology.


November 21, 2010  4:37 PM

Additional adjustment recommendations for Medicare/Medicaid



Posted by: RedaChouffani
Whether you are the head of the house hold, an chief financial officer or president of our nation, balancing a budget is a challenging tasks especially when you may not have full control of spending or have too many variables to work with. For the healthcare industry several ranking members of our government are reviewing Medicaid and Medicare costs to see if there are areas where we can realize some cost savings through additional cuts document can be found here(http://www.cbo.gov/ftpdocs/119xx/doc11966/11-17-Rivlin-Ryan_Preliminary_Analysis.PDF).

On a recent response from Congressional budget Office to ranking member Paul D. Ryan, there were several recommendations outlined in the document:

People who turn 65 in 2021 or later years would be provided with vouchers to help with the purchase of private health insurance.

The voucher amount would be calculated by taking the average federal cost per Medicare enrollee in 2012

Patients with Dual eligibility for Medicare/Medicaid would be provided with medical savings account with an annual contribution to help with Medicare premiums instead of Medicaid.

Starting in 2021, the age of eligibility for Medicare would increase by two months per year until it reached 67 in 2032.

Making adjustments to the professional liability policies on no economic and punitive damages.

Repeal the CLASS program for long-term care insurance

While we continue to see disagreements on several of the proposed recommended cuts, we need to all take responsibility and do our part. Being a responsible patient and helping curve the costs by ensuring we take constructive and proactive steps to our own wellness. We must ensure that we are part of the solution.

 


November 20, 2010  12:48 PM

What would the best VoIP system offer CIOs



Posted by: RedaChouffani

In a time where the emphasis is on electronic health record, interoperability and standardization we continue to recognize the need for more “Integrative technologies” and the use of platforms for applications where everything works well together. In recent years VoIP providers have been aggressive toward making their products more integrable especially for healthcare. With the fading lines between “phones” and “desktop” we are moving toward the elimination of handsets or the use of more mobile and WiFi based voice units and smart phones with VoIP capabilities.

The goal is to keep health professional connected at ALL time. Whether it is the ability to receive calls anywhere in the building, or instant voice to Text capability on a smart phone.

For many early adopters of VoIP systems there has been some much needed return on their investment for several of these systems. While the TCO are usually high, there are several immediate prolific benefits to gain from such integrable VoIP systems.

So with the demand for tightly integrated solutions from many healthcare enterprises continues to grow, several of the VoIP vendors and other system integrators are hard at work. Some of the vendors such as CISCO and ShoreTel have telephony systems that enable strong integration with Hospital systems such as (EHR, registration systems, scheduling, Collections modules, Patient calling system and patient check-in).

In order to better identify what are some of the potential benefits from a tightly integrated VoIP within a healthcare organization let’s visit some of the different departments and what benefits they can gain from such solutions:

Clinical Department:

  1. The ability to dial patients using a single click. The simplicity of having a care giver contact a patient without knowing their phone number helps eliminate unnecessary steps. The call is made and an entry is generated within the chart that identifies that an interaction or action has been taken. This call may also be as part of the e-visit or Telehealth. This can also be a requirement from professional liability.

  2. The ability for the messages from a patient to be in text/audio format and part of the chart using some of the enterprise Voice to Speech engines (Microsoft Speech engine and Nuance). This is very useful functionality as patients requests can be routed to queue where clinical staff can view the content or still listen to the message without dialing into the voicemail system. This provides a more efficient way to distribute the work or messages to the different individuals or groups. (Also, the ability to read what the message was when you are in a meeting without putting your smart phone to your ear).

  3. Ability to record a customized voice message in regards to a lab result for a specific patient and have it routed to a message board awaiting the patient to retrieve it securely. As there are several states that have mandates on patient call backs with labs this can ensure compliance with the state/federal mandates.

  4. Ability to automatically retrieve the chart of the calling patient. This would free up the staff from some having to look up and spell the patients name. There will still be a verification stage however this still provides useful value from a customer service prospective and cutting costs by reducing time per task.

  5. Ability to send reminder and instructions for certain procedures (these can be in the form of Text to voice) and tracked as part of the patient health records. This would also help with compliance and reduce risks for the organization.

  6. Ability to provide real time or Instant Messaging. While many EHR systems provide this functionality within the product, in cases where a care giver is not in front of a PC , there are other vehicules such as texting or voice to text that can be used to communicate. These communications can be in a form of tasks that are assigned by physicians who are out of the office but can still be associated with the patient who is being care for.

  7. Ability to consolidate devices: Having the ability to reduce the number of mobile devices (Pages, Personal Phones, Hospital Phone, emergency phone) that health professionals have to carry around is useful. This will assist in ensuring that only one reliable device can be used to communicate. This is done by using the data plan of the smart phones and specific pre-installed apps on the device to interact with the organization’s VoIP system. Tasks that can be performed are:Receiving voicemails, sending messages or even dictating a patients progress note. Many successful vendors have developed some of these technologies to work with the iPhone.

  8. Picture the patient: In most smart phones the directory provides the ability to view the callers photo. This allows you to have a visual cue on who is calling you. By having a smart VoIP system that is tightly integrated with your HIS or EHR we can preview the patient’s photo when they call. This can be a valuable tool for getting to know the patients especially in the primary care area.

  9. As we continue to see signs and the push toward coordination of care, having the ability to efficiently collaborate and discuss patient’s health is paramount. By using an integrated system where you can start a Patient Round table meeting by simply using your EHR to connect all linked physicians would bring tremendous value and efficiency. This will reduce the costs associated with conferencing and telecommunication.

  10. Some additional advancements that take advantage of some of the integrations with VoIP and IVR(integrative Voice Response) through VoiceXML services (This was one of my senior projects in my university) is the ability to educate patients that would not be interested in using email for communication (possibly elderly patients) by providing smart instructional messages for specific conditions and procedures associated with the patient’s diagnosis’s in a secure fashion.

Registration and Billing department:

  1. The ability to track call statuses of patients during the collection calls.

  2. Automate monthly reminder calls to delinquent accounts in the system

  3. Collect payments and post them to the system by using IVR (integrated voice response) systems. The patient can make the payments via phone and interact with the system 24/7/365 that is tied directly to the hospital without the use of a third party or hosted solution.

  4. Mobility is also an example where even if the health organization outsources the billing or collection component of the revenue cycle, outside entities can easily report back statuses of accounts and reduce data reentry and other costs related to a second system that is outside of the organization.

  5. The ability to identify the calling patient and acknowledge them by name.

  6. Provide specific and non confidential alerts on all desktops or soft phones that receive calls from patients who have outstanding balances or specific alerts associated with them.

  7. Generate appointment reminders for patients and help reduce the no-shows.

  8. Some of the general functionalities that may be integrable and help gage patient outcome measures are the possibility of preforming surveys that are tailored to a specific patient condition. Whether it is to follow up with the patient and check the pain levels or a simple patient satisfaction survey that is linked with their chart can prove to be a valuable tool to any health organization.

In conclusion for health organizations the focus is always in identifying platforms and business solutions that will ensure enhanced patient care, streamline workflow and help whether some of the increased costs of operations and cuts in reimbursement. A VoIP solution can provide assistance in archiving these goals, but it is note worthy to recognize that you may be reducing the personal interaction of staff with patients when using these integrations. In this competitive market it is important to ensure that your patients who are your customers feel comfortable with the organization and phones tend to be a commonly used vehicle for communication.

 


November 14, 2010  8:53 PM

ICD-10 not taken lightly by many



Posted by: RedaChouffani

 As the year 2013 draws near and the implementation and testing of ICD-10 becomes a common conversational piece for the health care professionals, many are starting to review their internal processes, and system to ensure readiness. This project has started to get more priority than many others in the complex and costly items in the CIO’s list. While it may be considered for some as important as meeting the Meaningful criteria, its dead line is still far away. The over 155,000 different codes that are part of the ICD-10 10th revision still present serious challenges for many today.

For starters all coders would be required to retrain using the new codes. This would also prove to be an opportunity to sharpen the saw for many billing specialists. There would also be training needed for providers as well. This may be more difficult for physicians who are near retirement and might not see it as cost effective and realistic to be retrained on all ICD-10 in order to practice for a short period of time. In addition despite the published crosswalks by CMS “Generalized Equivalency Mappings” still some ICD-9 have more than one corresponding ICD-10 code and there are also cases where these crosswalks are incomplete and are less detailed than the previous code or ICD 9.

ICD-10 would be a manageable project for many, however it is not the only one that is nearing its implementation deadline. Currently many are starting to test the changes that have been made under the HIPAA 5010 in X12. This has a compliance date of 1/1/2012 and poses a signification challenge for many.


November 14, 2010  8:09 PM

Round three for Healthcare & more changes from the Deficit Panel



Posted by: RedaChouffani

Clearly with the recent election results there is a sentiment that some are seeking change. As Americans we look to our government to implement and adopt laws that will allow our nation to prosper and continue to be an economic power house and model for democracy. So with that in mind, a recent Deficit panel made some recommendation to ensure that our economy continues to grow and compete with the rest of the globe by focusing on fixing our “big“ deficit problem.

In a recently published plan from a bipartisan commission it stated some simple and drastic (real solutions) to the current US deficit. To sum up the document content a statement was listed in the document as a good way to set the tone for what is to come in these list of recommendations and the statement goes “The Problem Is Real the Solution Is Painful”. Clearly this is no news to anyone, but what seems to be more concerning is how healthcare is a current and future contributor to the deficit.

Healthcare in the US has won us the top spot in the healthcare spending as % GDP in the world. So simply put the newly created bipartisan National Commission on Fiscal Responsibility and Reform is taking a real good look at it and attempting to set several mandatory spending cuts. These would enable savings and would be applied to programs in Medicare/Medicaid and other healthcare related programs. These changes are meant curb the current growing deficit.

From the proposed draft that was released on November 10th, of 2010 there were five basic recommendations. One of which will be how to address the “Doc Fix” through the payment reforms, cost-sharing, malpractice reform, and long-term measures to control health care cost growth..

Some of the recommendations details are still unknown, but so far there are clear indications to where many of these would go:

Speeding up payment reform and increasing drug rebates

Reducing the cost of defensive medicine through tort reform

Expending cost sharing in Medicare

Strengthening IPAB

Expending successful cost containment demonstrations

Implementing additional health savings

Implementing new payment system in 2015 and reduce the upcoming cuts with more modest reductions

Increasing Medicaid copays

Cutting Medicare payments for bad dept

Expanding ACOs, payment bundling

 

So far the only details available are relating to how our government may be able to save over 200 Billion dollars through cutting domestic and defense costs. The healthcare system maybe a bit more difficult to have measurable and concrete predictions of savings. So far the details that were released on November 12th, 2010 are in the right direction and are most likely a positive step toward getting rid of wasteful spending, however healthcare can and will be a more difficult area.

 


November 7, 2010  10:31 PM

Is Microsoft ready for round 2 in the mobile arena



Posted by: RedaChouffani
Microsoft

When covering the subject of mobile computing one can think of only few successful platforms. From the iPad, iPhone to the Android and Blackberry. But recently Microsoft has attempted to reenter the mobile area with their Windows 7 Phone WP7. Critics of Microsoft say that it is too late in the game to compete with products from Apple and others. But in technology it is never clear what the outcome would be until a product is released and end users test drive it. In the gaming market we have seen Microsoft win against all odds in that market with the xbox. So can Microsoft with its second attempt in the mobile arena be able to succeed?

In health care some of the most important functionalities that are a must have in a mobile device are: ease of use, hardware flexibility, integration capability, and performance. So far there are few positive indicators that show that they maybe on the right path.

First Microsoft is enabling the use XNA for developers to create Apps for the phone. This is the preferred development language used to create Xbox games, this would be more games being developed for the phone as well as advanced graphics and rendering. In addition to XNA Silverlight is the preferred method to get content on the phone. Silverlight is a similar environment as FLASH. It would enable content to be displayed across multiple phone models and platforms from Windows desktops to Linux workstations.

So if you have a medical application developed in WPF or Silverlight, then you will be able to enjoy it immediately in your new WP7 phone.

For most, the success or failure of the WP7 will ultimately depend on the number of Apps developed, the adoption rate and the usability of the phone. And with the holiday season nearing with some WP7 phones coming to the market, it maybe sooner rather than later when will find out what the faith of the Microsoft Mobile platform would be.

 


Forgot Password

No problem! Submit your e-mail address below. We'll send you an e-mail containing your password.

Your password has been sent to: