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Meaningful Health Care Informatics Blog

February 11, 2013  10:21 PM

EHR vendors help PHR portals succeed

Posted by: RedaChouffani
API, eClinicalWorks, EHR, Healow, mhealth, PHR

This week, eClinicalWorks announced its new PHR offering, Health and Online Wellness “healow.”  The device is a portal that has a mobile app. It helps patients manage both their and their family members’ health records. The first app to be released can be found in Apple’s iOS app store. No date, however, has been set for the Android native app.

In addition to healow, eClinicalWorks also released their study that documented how effective physicians found mobile health apps to productivity.

Already, there are several mHealth apps available that help patients manage their medical records.  Within them, we can identify three methods patients can use to capture or load their information into PHR systems:

  1. Manually Entered: Most PHR sites allow patients to manage their health records by offering web-based forms for data to be entered manually.  This method tends to be one of the least favorites, as it is tedious and requires data to be updated after every doctor visit.
  2. Import health information from a standardized format: Due to certain meaningful use requirements and the stipulation that certified EHR products must produce a CCR, many medical practices are able to generate a standardized medical record in a standardized electronic format for patients.  Some EHR systems do offer the option for patients to access a web portal and extract the medical record from a secure site, but this still forces the patient to download the necessary information and then upload it to the PHR.
  3. Live Feed from EHR systems: As described in the method above, many PHR vendors do offer the ability to import the HL7 or XML based medical record (CCR), with the EHR vendors offering their own PHR for patients.  One recent option growing in popularity is the availability of direct download of PHR from EHR systems.  For example, a patient can log onto a PHR system and request the download of their record from a connected physician’s or hospital’s EHR system. This option looks to be one of the most effective methods from a patient’s perspective, as it provides them with near real-time data without having to load data.

With the last option being ultimately the most efficient method, there are still challenges that arise when patients switch physicians or move. For one, there is a chance their next physician could not be using the same system as the one before.  The good news is if physicians continue to be asked for medical records exports and the updated requirements associated with Stage 2 and Stage 3 meaningful use, vendors will likely see physicians requesting to have functionality to enable patients to download their records easily or have access to it through their PHR.

This simply means that EHR vendors offering PHR services should consider building or making Application Program Interfaces available in their products to allow other developers to enable connectivity of PHR to those systems.  This will allow PHR systems to easily download records when authorized and allow patients to manage their records from the PHR of their choosing.

February 11, 2013  10:20 PM

Proposed child health record standards for EHR

Posted by: RedaChouffani
Child Records, EHR, HL7

In most cases, vendors that provide EHR products to primary care physicians or pediatricians also offer software packages that track data elements. These data elements in turn track  health information related to the children they care for, including items like immunizations, growth data and other preventative care items.

Most of the functionality available in those EHR packages are somewhat similar in terms of the data elements they capture. Accordingly, the Agency for Healthcare Research and Quality (AHRQ) recommended the creation of one common children EHR format.  The goal is to create a checklist for EHR developers looking to create solutions that capture health care information relevant to children.

The AHRQ cites the following areas as ones that should be discussed and accounted for when creating child EHR standards:

  • Patient Identifiers
  • Patient Portal – PHR
  • Prenatal Screening
  • Primary Care Management
  • Quality Measures
  • Registry Linkages
  • School-based Linkages
  • Security and Confidentiality
  • Special Terminology and Information
  • Specialized Scales/Scoring
  • Activity Clearance
  • Birth Information
  • Child Abuse Reporting
  • Child Welfare
  • Children with Special Healthcare Needs
  • Early Periodic Screening, Diagnostic, and Treatment (EPSDT)
  • Growth Data
  • Immunization
  • Medication Management
  • Newborn Screening
  • Parents, Guardians, Family Relationships

The current proposed format contains the HL7 child health functional profile specification R1.  Having this formatting recommendation will help guide current and future EHR developers in ensuring that all the relevant data is being captured as part of the ongoing record of children.

February 4, 2013  10:29 PM

CMS to require full disclosure of physician and vendor financial dealings

Posted by: RedaChouffani
ACA, cmp, CMS, sunshine rule

A new CMS update will force some vendors and physicians to reveal their financial relationship with full disclosure, beginning Aug. 13, 2013.

The ruling is part of the Affordable Care Act “Sunshine” rule that will increase transparency, enabling both the public and patients to see more payment details between care providers and medicine and medical device manufacturers/suppliers.

Under the new legislation, any transfer of value or payments must be reported to CMS, who will then post the information on its website.  The data collection will begin Aug. 1, and applicable group purchasing organizations (GPOs) and manufacturers will have until March 31, 2014 to report the 2013 data. Finally, CMS will re-release the data to the public by September, 2014.

The data must be downloadable, easily searchable and aggregated.  It must also supply a National Provider Identifier.

As outlined in the ruling, the following are the final penalties set forth:

The applicable manufacturer or applicable GPO will be subject to a Civil Money Penalty (CMP) of at least $1,000, but no more than $10,000, for each payment or other transfer of value, or ownership or investment interest not reported as required. The maximum total CMP with respect to each annual submission for failure to report is $150,000. For knowing failure to submit required information in a timely manner, an applicable manufacturer or applicable GPO will be subject to a CMP of at least $10,000, but no more than $100,000, for each payment or other transfer of value, or ownership or investment interest not reported as required. The maximum total CMP with respect to each annual submission for a knowing failure to report is $1,000,000.

These regulations will require manufacture representatives who are visiting physicians around tracking trip or visit details to assign a financial value to their transactions. In some cases it may even reduce the number of visits made to physicians, as it may inevitably reveal that they are accepting gifts, which patients may deem  inappropriate.

February 4, 2013  10:22 PM

Tablets in health care: where’s the value?

Posted by: RedaChouffani
EHR, tablets

Clinical departments across all hospitals are continuing to adopt tablets at increasing rates. These devices have similar functionality to mobile phones or smart mobile devices, yet offer longer battery life as well as larger displays.

As we begin to question why these devices are, in some cases, fast becoming a new substitute for PCs, we can determine seven main reasons why tablets are becoming the new go-to device for enterprises and hospitals around the world.

  1. It’s all about the apps:  As more EHR and other health care application providers introduce mobile apps as part of their offerings, many clinicians and IT departments are evaluating these solutions to seek the benefits of having staff gain access to electronic health information on the go.  This helps increase interest in the tablets.
  2. Light weight:  Nurses through the hospital halls tend to have to push carts from patient room to patient room.  While many of these carts can easily be maneuvered, there is still the fact that they require management and supervision. But if we compare these computers on wheels to the lightweight tablet PCs and everything it has to offer, it becomes clear that giving staff these devices is a much better alternative.
  3. Low cost:  In some cases, specific tablet manufacturers can offer more than one model available and at different price points. Some of the platforms, like Android, provide a wide range of models with varying price points.  This encourages adoption, as the total cost of ownership is significantly lower than anticipated.
  4. Longer battery life:  In every case of tablet adoption, battery life was significantly higher than the estimate even included in the adoption plan. This helps nurses focus on patients, not battery levels and power sources.
  5. Easy to manage:  Similar to PCs, there are several packages that can be used to manage, update and support these devices.  But within the mobile arena, there are several mature products that provide similar functionality around managing assets.
  6. Connectivity support:  In hospital settings, some of the traditional carts mounted with PCs do typically require either barcode scanners or other types of data capture functionality.  Tablets are offering similar and comparable connectivity. What’s more, new connectivity methods have been introduced in some of the tablets available in the market place (such as Near Field Communication).  These show significant potential for replacing some of the traditional handheld scanners that match patients to medication, because it can be used to scan and confirm patients based on NFC.
  7. Touch screen: In addition to the functionality benefits offered and listed above, the last item offered is the touch user interface which allows for a robust and user-friendly experience.

Tablets will continue to gain momentum in health care and see a significant increase in adoption.  While prices of these devices may still be somewhat matched to those of laptops, hospitals will continue to seek tablets and roll them out as part of their EHR implementation plans.

January 28, 2013  8:46 PM

What does a hospital-based EHR or SaaS mean to innovation?

Posted by: RedaChouffani

As we continue to see a shift toward new payment models for care delivery and more care collaboration and information sharing, adopting or participating in Software as a Service (SaaS) by a hospital for independent physicians seems to be the path of least resistance.

The costs and complexity of implementing on-premises EHR and attempting to connect to a local or regional HIE appear to be awfully difficult for some facilities. This is in contrast to a simple hosted solution offered by one or more of the local health systems, which offer built-in HIE and access to community patient records.

For these reasons, many are wondering what impact some of the hospital hosted EHRs or EMRs will have on independent physicians, as well as EHR vendors and innovators.

Many think these large EHR systems will not offer enough flexibility for independent physicians to adopt new ad hoc solutions that will plug into those systems without the approval of giant software vendors and hospital systems. Others are confident that these systems have all the modules that physicians need.

Traditionally we have seen innovation stem from open architectures and shared standards which under the prolific innovations are created. Many health systems argue that it is far more critical to impose specific standards to ensure systems are working properly and to avoid errors and bugs.

It is hard to predict the full impact and future outcome of some of these health care changes. I still hold to the belief that newcomers to the market will offer disruptive technologies, including technology that will eventually change how we view EHR products and how clinical information is used and shared.

January 28, 2013  8:44 PM

Microsoft betting on unified communication for health care

Posted by: RedaChouffani
Lync, UC, Unified communications, VoIP

It’s an increasingly complex process for hospital workers to communicate and collaborate within clinical and administrative areas.

Hospital staff members are constantly looking to stay connected and share information with each other. On-call physicians need to communicate with the nursing staff and other colleagues, nurses need to contact each other to follow up on patient’s needs, and administrative staff need to collaborate on certain activities.

Communication in the healthcare area takes many forms, such as: Email, short message service (SMS), telephone, video conferencing and messaging inside clinical applications.

While there are several strong enterprise players that use one or more of these communication methods in their platform, some have been able to dominate the marketplace with their unified communication solutions. Microsoft is the latest addition to the list of big vendors who are entering the market with a comprehensive solution that covers almost all of the communication methods and provides a strong return on investment (ROI) that is hard to ignore.

Microsoft Lync 2010, which has already released a 2013 version, is a voice over IP (VoIP) and collaboration platform all in one. Microsoft’s approach is to deliver all the traditional communications functionality to enterprise clients and enable them to leverage an easy to manage, cost-effective solution. Microsoft is focusing on the large health care and other markets and convincing them that it is possible to improve staff productivity, reduce costs and have a tangible ROI through its Lync offerings.

Some of the benefits for health care organizations in utilizing a platform like Microsoft Lync are:

  • Web and videoconferencing: This functionality can improve efficiency as well as support real-time decisions. Services such as telemedicine, translation services, and videoconferencing allow for staff collaboration, which can prove to be beneficial in a health care market that is moving toward collaboration of care in models such as ACOs.
  • Instant messaging: Clinical staff often communicate with each other using text messaging or SMS. Some messaging systems allow end users to safely and securely message each other and control or flag any data that may need to be archived as part of patient information.
  • VoIP: Most hospitals have migrated away from traditional PBX (telephony systems), and Lync enterprise voice seems to offer most of the functionality needed to enable telephone communication over IP (Lync supports IPv6). The availability of different vendors’ devices gives hospitals the option to select an option that is most affordable for them.
  • Mobility: VoIP users have continued to demand more mobile functionality in their systems. While Microsoft offers limited functionality for the voice over the data plans in its current release of mobile apps, there are many advanced functionalities such as IM, conferencing, and presence that can be used. Microsoft has also noted that there are several upcoming app updates currently under review that will provide more functionality to the mobile work force.

There are 6 primary areas that Microsoft Lync can have a significant impact for hospitals adopting this platform:

  • Eliminate the costs associated with purchase, maintenance and up keeping with PBX systems.
  • Elimination of costs associated with Web conferencing subscriptions
  • A reduction in the internal labor costs of IT regarding telephony support and maintenance
  • A reduction of help desk call volume associated with setup and telephony problems
  • Improved productivity of clinical and administrative staff
  • Reduction in travel cost through the improved collaboration tools

There still other areas in which Lync and other platforms can offer more benefits to health care. There are a number of emerging solutions that are integrating the functionality of Lync into their solutions. Some real-time locating system (RTLS) vendors such as Luminosity have packages of the single click calling functionality in its RTLS application, which allows a single touch to dial the person identified through an organtization’s floor plan. Other providers and Microsoft partners have leveraged the capabilities of Lync servers to offer a fully functional and robust IVR (Interactive voice response) system for hospital organizations. Applications have been developed that enable patients to call in and receive account balance information as well as other clinical and health related details.

January 21, 2013  10:00 PM

Latest HIPAA rule protects EHRs

Posted by: RedaChouffani
data breach, EHR, EHR implementation, HIPAA, Updated security

Many consider the several data breaches in hospitals across the nation clear indications that more should be done to ensure the security and protection of EHRs. In recent months, some breaches, like those at the University of Virginia’s Medical/Continuum Home Infusion Center, Alere Home Monitoring in Waltham, Mass., and Kaiser Permanente (as reported by – pose a major concern for all.

The alarming rate of breaches and the recognition that HIPAA, enacted 15 years ago, must be updated, signal it is time to make changes to ensure patients’ medical data is being protected. Accordingly, the HHS has been pushed to move and update HIPAA regulations. The CMS announced changes to HIPAA in a press release revealed last Thursday, Jan. 17.

Some of the changes to the HIPAA regulations include the following:

  • All business associates (contractors, subcontractors, etc.) now face increased penalties associated with data breaches. Any breach due to noncompliance (based on the level of negligence) holds a maximum penalty of $1.5 million per violation.
  • Patients have the right to ask for a copy of their EHRs in an electronic form.
  • When they pay out of pocket, patients have the right to ask that providers not share information about their treatment with their health plan.
  • New limits regulate the use of patient information for marketing and fundraising purposes, as well as prohibit the sale of individual health information without patient permission or consent.
  • A rule streamlines individuals’ abilities to authorize the use of their health information for research purposes, making it easier for parents and others to give permission to share proof of a child’s immunization with a school. The rule gives covered entities and business associates up to one year after the 180-day compliance date to modify contracts to comply with the rule.
  • Lastly, a rule clarifies that genetic information is protected under the HIPAA Privacy Rule and prohibits most health plans from using or disclosing genetic information for underwriting purposes. This was in relation to the statutory changes under the HITECH Act, and the Genetic Information Nondiscrimination Act of 2008 (GINA).

These changes will require business associates to reevaluate their security practices and ensure that proper safeguards are in place to protect electronic data. In addition, hospitals and healthcare providers will need to make changes in their systems to track authorizations and ensure that their data usage and management associated with marketing and research are in full compliance with the new rules.

See ten more grains of wisdom from the final HIPAA omnibus rule here.

January 21, 2013  9:55 PM

VA RTLS contract re-awarded to HP

Posted by: RedaChouffani
HP, RFID, RTLS, Uncategorized, VA

The US Department of Veterans Affairs (VA) re-awarded $543 million to HP’s Real Time Location System (RTLS) contract this week. The technology the VA selected will help them track over 152 medical centers and several ancillary facilities.

The contract is using vendors such as CenTrak and WaveMark. HP recently had to reengage with the VA after IBM challenged the initial selection. In addition, the VA is requesting that the HP Enterprise Services division build a data repository which will not only centralize all the collected data, but allow them to perform analysis on it as well.

When the VA released the request for proposal in November, 2011, the stated goal was to take advantage of an RTLS’s ability to facilitate processes that improve patient care efficiency and effectiveness, reduce staff hours spent searching for equipment, and allow for more accurate and less expensive inventory levels within the VA. The RTLS would also help improve the efficiency of targeted business processes in its hospitals, clinics, offices and cemeteries to support the missions of Veterans Health Administration and other VA entities.

RTLS solutions continue to attract more and more hospitals, as the systems allow them to track assets, patients and staff, thus improving safety and care. Accordingly, RTLS vendors continue to tout the different benefits implementing the tracking systems can produce. Still, some hospitals use a variety of solutions; from passive to active radio-frequency identification tags.

As we continue to see the number of hospitals implementing RTLS solutions grow, the corresponding increase in data is being processed and analyzed for new insights. In some cases, organizations are leveraging the combination of instant contact or communication to alert nurses or clinical staff within a specific proximity, others are utilizing workflow engines to execute specific events that are triggered through specific events.

January 14, 2013  9:35 PM

Seen at CES 2013: Bluetooth-enabled fork and more

Posted by: RedaChouffani
CES 2013, Hapifork, HealthSpot, kiosk, telemedicine

More than 35, 000 people visited Las Vegas for last week’s Consumer Electronics Show (CES) 2013, to catch a peek at some of the latest developments in consumer electronics. The Digital Health Summit within the conference hosted some nationally recognized speakers and showcased some interesting products. The conference showed that vendors who develop and provide consumer health care related products are increasing in number.

One of the products that was especially intriguing was a retail clinic in the shape of an enclosed kiosk, i.e. exam room in a box. This very well may be a feasible solution for busy patients or parents looking to get medical advice quickly for colds, ear infections or other common sicknesses. HealthSpot’s device includes many of the medical devices used during a traditional office visit. Within the unit a patient will be greeted by a licensed physician or nurse practitioner through video conferencing, who will then instruct the patient through the process of checking and capturing some of their own vitals.

Patients can also schedule appointments ahead of time, access their vitals, and get both prescriptions and follow-up care reminders, according to the HealthSpot website.

Another interesting wellness gadget was the Hapifork. Just like the name indicates, it is a fork – with some fascinating electronics in it. This utensil can communicate via USB or Bluetooth with smartphones or PCs and transmit information about how much time the user spends eating. This gadget provides a creative way to encourage slower eating as well as track food intake, though I won’t be eating my sandwiches with a fork anytime soon.

These are just two examples of what some innovators were showcasing to the media and technology enthusiasts at this year’s CES.

January 14, 2013  9:34 PM

New ACOs announced by HHS

Posted by: RedaChouffani
ACO, advanced funding, advanced payement model, CMS

Department of Human and Health Services (HHS) continues to see a steady interest and participation in the available Accountable Care Organization (ACO) incentive program. There have been 106 new ACOs have been formed, in addition to the more than 250 current ACOs, according to an HHS release.

“Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare,” Secretary Sebelius said. “Thanks to the Affordable Care Act, more doctors and hospitals are working together to give people with Medicare the high-quality care they expect and deserve.”

Over half of the newly formed ACOs are physician-led organizations, while 20% are community health centers and critical access hospitals.

An additional 35 ACOs will receive advanced funding to invest in their infrastructure, training, and staff as part of the advance payment ACO model. These applicants will receive the following:

  • An upfront, fixed payment: Each ACO will receive a fixed payment.
  • An upfront, variable payment: Each ACO will receive a payment based on the number of its historically assigned beneficiaries.
  • A monthly payment of varying amount depending on the size of the ACO: Each ACO will receive a monthly payment based on the number of its historically assigned beneficiaries.

It is no surprise that the most recent ACOs are located in the Eastern and central part of the country, as these are the regions in which we’ve seen some of the highest numbers of Medicare beneficiaries as listed in State Health Facts website.


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