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Meaningful Health Care Informatics Blog


January 7, 2013  8:51 PM

Asthma app can help outsmart chronic disease



Posted by: RedaChouffani
mhealth, mHealth apps, telehealth

There are millions of people nationwide afflicted with asthma and most of us can understand how a patient’s condition will change if their symptoms are not treated.

This condition affects patients of all ages, and for most, the breath of a rescue inhaler provides a relief from the shortness of breath and other chest pains associated with an attack.

There are many triggers that cause these attacks, and for some patients it can be very difficult to track and predict when an attack will occur. This is why most continue to keep an inhaler by their side at all times.

One organization, Asthmapolis, whose CEO will be attending and speaking at the International Consumer Electronics Show, has identified a creative way to track and monitor the frequencies and location of asthma attacks by simply fitting the inhaler device with a small cap that records information through sensors when the device is used. The information is compiled and pushed through its mobile app to a central repository where a patient can access it, as well as their physicians, in order to gain more awareness of their asthma triggers.

The data that is collected from all the participants can also be used to help cities such as Louisville, KY, which has signed up for the program to track and see what areas of their city pose the highest triggers for asthma attacks for their residents.

Asthmapolis has created a simple device that can provide incredible value to researchers, payers, physicians, and most importantly patients. Patients’ awareness of their different triggers will reduce the number of hospital admissions due to asthma attacks which will also reduce costs for payers.

January 7, 2013  8:50 PM

CMS delays enforcement rules for HIPAA covered entities



Posted by: RedaChouffani
Affordable Care Act, CMS, HIPAA

The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services announced a delay to their enforcement of compliance with the operating rules around health care claim statuses and eligibility. This delay affects HIPAA covered entities, including  hospitals, physicians practices, clearinghouses and health plans.

The delay only affects the enforcement of the ruling, the deadline itself stayed as Jan. 1, 2013. The official announcement states that the delay was mainly due to industry feedback that suggested that a threshold has not been reached where most covered entities would be able to be in compliance with the operating rules by the deadline.

The press release also outlines the following:

Although enforcement action will not be taken, OESS will accept complaints associated with compliance with the operating rules beginning January 1, 2013. If requested by OESS, covered entities that are the subject of complaints (known as “filed-against entities”) must produce evidence of either compliance or a good faith effort to become compliant with the operating rules during the 90-day period. HHS will continue to work to align the requirements under Section 1104 of the Affordable Care Act to optimize industry’s ability to achieve timely compliance.

There are still organizations such as home health and other entities who utilize systems that are facing significant challenges adopting some of the new standards, though many of the covered entities have been upgrading their systems to ensure compatibility with the X12 standards version 5010 for claim status check and eligibility.


January 1, 2013  10:43 AM

ACO models will draw attention in 2013



Posted by: RedaChouffani
ACOs, CCHIT, CMS

Several organizations have taken steps in response to the increased interest in ACOs and the new payment models encouraged by HHS. Independent physicians have been evaluating their options to either join a hospital sponsored ACO or an alternative option. This decision will be a significant component of organizational goals.

There are clear signs that ACOs are not going anywhere, despite continued questions about whether they will be as widely adopted as predicted.

The Certification Commission for Health Information Technology (CCHIT) announced in December 2012 that it will develop an IT framework for ACOs. Their goal is to provide testing and certification around the necessary IT infrastructure components. The ruling from CCHIT provides a framework and requirements around eligibility, legality, leadership and management structure, required processes, patient population size, and some of the data sharing requirements. CCHIT will focus on the technology aspect of the requirements in detail. Systems that will provide reporting on high-risk patients, as well as capabilities to share and collaborate on the care of individuals were two areas CCHIT included as necessary for systems to engage patients.

CCHIT has also announced the re-appointment of Chairwoman Karen Bell, M.D. as part of this initiative. She will lead the advisory panel which will develop the ACO framework.

The Kelsey-Seybold Clinic was named the first organization to be officially accredited as an accountable care organization in the U.S., near the end of 2012. Many organizations curious about the ACO route will look to get more details and feedback in terms of the challenges and opportunities that this Texas-based facility will encounter.


January 1, 2013  10:35 AM

Health IT 2012 summary



Posted by: RedaChouffani
BIG DATA, Meaningful use, mhealth, RFID, RTLS, telemedicine

We are saying goodbye to the year 2012 and welcoming 2013. There are certainly few subjects that occupied the collective minds’ of health organizations in 2012 and some of which will continue to be around in the new year. Here is a short list of subjects that dominated the health IT arena:

EHR implementations: For many hospitals it has been a year full of EHR implementations within their facilities. Some either focused on deploying their EHR systems to their affiliated physician’s groups, while others have gone live with it within their ER, and other departments. This has proven to be a rewarding experience, despite its high cost and complexity.

Big data was another subject that was frequently discussed during 2012. We will continue to see increasing interest in this area due to some of the impressive new computing capabilities, and availability of storage and analytic tools. Big data received more attention in health care because it holds great potential to be a valuable assisting tool to physicians.

Some consider the combination of big data and machine learning as the new front for artificial intelligence (AI) that will someday enable physicians to be assisted during the diagnosis with this technology. The systems must mature and have access to good data in order to fulfill that goal.

Last year was also marked by the delay of ICD-10 deadlines.  The announcement was made by HHS to provided additional time to test and prepare their systems for the new deadline of October 2014. Last year also saw the release of meaningful use stage 2 requirements and the draft for meaningful use stage 3.

The data breaches that some hospitals and health care organizations faced were prominent during 2012. Many organizations continue to adopt new security measures as they move toward EHRs. It’s just as important to secure employees’ mobile devices by educating them about their organization’s bring your own device initiatives and social media policies in order to avoid a data breach.

More hospitals have actively solicited real-time locating system (RTLS) vendors to identity the potential benefits they can gain from those systems. The use of radio frequency identification (RFID) and RTLS systems has been explored by organizations seeking to improve efficiency and reduce usage of other equipment. This comes at a time where more RTLS vendors are available in the market and competition is driving solutions prices down as well as innovation in the Tags and reduced hardware costs.

The topic of mHealth has been receiving growing interest from the health care industry. The increased adoption of mobile devices and the need to have connected patients connected to their care providers continued to push for more mHealth development. Interest from clinicians, IT departments, as well patients has driven this increase.

For the New Year 2013 we will certainly see more emphasis on big data and analytics, mHealth, cloud storage, meaningful use, telemedicine, RTLS.  There are other areas that will continue to concern health care in general including policy changes and reimbursement cuts as which can force changes to budgets and initiative prioritization for health care organizations.


December 17, 2012  8:18 PM

Proposed bill will encourage healthcare innovation in the mHealth arena



Posted by: RedaChouffani
Grants, healthcare regulation, HR6626, mhealth

The Health Care Innovation and Marketplace Technologies Act of 2012 (HIMTA), was introduced by Rep. Mike Honda of California. It is intended to encourage more innovation around telehealth and clarify some of the existing FDA regulations around wireless health, according to Honda’s office.

The bill intends to establish an mHealth application development program within the HHS that will enable mobile app developers to receive support and guidance around current privacy regulations. It also aims to ensure that developing applications are building around an approved security framework that will protect patient health records.

“As we continue to improve our health care system, technology can and should play a prominent role in achieving better care for Americans,” said Rep Honda in a release. “Investments, development, and adoption of technologies remain stagnant. Why have the principles of Silicon Valley, which I represent – competition, innovation, and entrepreneurship – not fully manifested themselves in the healthcare information technology space?  This bill gets us closer to that space.”

“Currently, our healthcare system works against small-to-large startup entrepreneurs with a multitude of barriers to entry,” continued Honda. “There is also a lack of an established marketplace for new technologies and a lack of trained workers to handle the implementation and use of these technologies. This bill begins to bridge these gaps.”

If the bill passes, it would provide loan guarantees to support eligible professionals (EPs) with the implementation of health information technologies within their organization. The guaranteed amounts are $250,000 for single qualified EPs or $500,000 for a single group of affiliated qualified EPs.

The bill would also grant funds to “eligible entities” that develop products which will enhance patients’ use of health information technology. The grants awarded will be $75,000 or less.

This bill provides several incentives to encourage health information exchange (HIE) and mHealth innovation. The bill will help provide resources for software developers to leverage when creating mobile health apps, though it’s not clear whether there will be regulations and controls around mobile apps.


December 17, 2012  8:16 PM

Essential technologies for concierge medicine



Posted by: RedaChouffani
Concierge medicine, mhealth, telemedicine

Traditional communication models are proving to be too challenging and restricting for many patients who are looking for a direct channel of communication with their primary care physician. The rising number of concierge services being offered in major cities and some rural areas is adding to this trend of direct communication. Physicians are offering patients direct access to them via text messaging, video conferencing, and open schedules for same day appointments. This is causing many physicians to look for other technologies that will enable them to effectively communicate, give them better tracking capabilities, and offer quick and effective access.

This push is also happening also within accountable care organizations (ACOs). Physicians are looking for communication platforms that can complement EHR packages that easily integrate to enable better ways to capture remote data as well as communicate quickly with patients without learning too many packages. Physicians don’t want to jump from product to product when they are treating their patients, as it can be a distraction and inefficient use of their time.
Some of the technologies being considered for faster and more effective service are:

Patient web portal integrated with existing EHR packages:

Patients opting to use concierge service when participating in an ACO will likely need to use a portal to securely communicate with physicians. They will also need electronic access to their chart as well as the details or messages from their care providers. These portals will also provide them with access to their health records, lab results, and treatment plans.

Telehealth and mHealth:

Patients will require the use of mobile apps and devices to enable the transmission of information and provide means of immediate access to data. This will provide them the ability to work closely with their physicians on their care and give them tools to help manage a chronic disease. Physicians would need to provide and operate on various platforms to enable these interactions.

Teleconferencing:

Teleconferencing is another technology aimed at improving communication. It includes the tools that allows patients to have a conference call with their caregiver without leaving their home. This could be a very significant step toward ensuring that patients can have immediate access to professional health advice. It can be more convenient and create a better health outcome.

Patient engagement is thought to be a critical step toward the overall improvement of the populations’ health. ACOs and concierge medicine focus primarily on improved outcome measures through active collaboration of care and patient engagement. These models are attracting patients and will continue to, as some offer quick or around the clock access to physicians.


December 10, 2012  10:40 PM

Meaningful use stage 2 revisions published by the HHS



Posted by: RedaChouffani
EHR, Meaningful use, Meaningful use stage 2

The Department of Health and Human Services (HHS) issued revisions to the 2014 Edition of Electronic Health Record (EHR) Certification Criteria, the Medicare and Medicaid Programs, and offered revisions to the EHR Incentive Program. This release also contains updates to stage 2 of meaningful use.

EHR certification specifications, adjustments to recently published measures around hospital lab order transmission measures, as clarification of patients’ capability to view health information electronically post-discharge were listed among the revisions.

One of the adjustments was to put an alternative measure for providing structured electronic lab results to ambulatory providers. Hospitals can meet either the existing measure or the alternative measure to satisfy the objective. The alternative measure states “Hospital labs send structured electronic clinical lab results to the ordering provider for more than 20 percent of lab orders received.”

The number of patients that should have the ability to view, download, and receive electronic medical information within 36 hours of their discharge was another area that received clarification in the revisions. In the previous measure the keywords “unique patients” were missed, and in order to adequately set the correct threshold, the measure was updated to reflect the current requirements. The object as listed was: Provide patients the ability to view online, download, and transmit information about a hospital admission.

Measures: (A) More than 50% of all patients who are discharged from the inpatient or emergency department (place of service (POS) 21 or 23) of an eligible hospital or critical access hospital (CAH) must have their information available online within 36 hours of discharge.

(B) More than 5% of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH (or their authorized representative) must view, download or transmit to a third party their information during the EHR reporting period.

There were additional comments around some of the technical errors discovered and reported during the public comment period. One of the errors involved the clinical quality measure e-specification. HHS announced that they will continue to accept feedback from developers and vendors up until December 10th, 2012, and then will released a finalized version by the end of the year, in response to discovery of the error.

For additional details the full document is available for review.


December 10, 2012  10:33 PM

Hot topics from mHealth summit 2012



Posted by: RedaChouffani
mhealth summit, Mobile

This year’s mHealth summit saw a significant turnout, and a wide range of topics were covered during the conference. There was innovation review, expert panels, and great speakers. Many of the subjects covered during the sessions provided great insights into the transformative capabilities of mHealth and the impact it is having and will continue to have on health care.

Mobile devices have shown they be used to capture information and coach patients with chronic diseases, in addition to being gateways to critical information. There were also mentions of some of the new voice integration capabilities that enable further use of mobile devices alongside voice recognition and clinical language understanding (CLU). Innovators such as Nuance discussed how they are enabling health care software developers to use mobile platforms and their engine to further enhance the capabilities of applications and enable the capture of information within a clinical context.

There were other discussions around EHR products that integrate with other mobile platforms such as WellDoc, and the new benefits that patients can derive from such mobile health applications.

These mobile applications have a patient-centric focus. Personal empowerment, health maintenance, real-time functions, personal record keeping, health coaching, education and self-care, and data capture are some of the services available via mobile applications.

Big data, BYOD and innovative communication models using short message service (SMS) and other means to share information with patients were other topics discussed during this year’s summit. All these topics provide insight into some of the current opportunities and challenges that health care is faced with in the mHealth arena.

 


December 4, 2012  8:03 AM

Social media in healthcare: Its role in patient engagement



Posted by: RedaChouffani
HIPAA, patient portal, privacy, Social media

Last year the U.S Department of Veterans Affairs (VA) implemented a policy that encourages employees to leverage the emerging social media platforms to enhance communication and information exchange. The implementation of procedures for social media focuses on how staff can interact freely while still ensuring the protection of patient information, a concern shared by many healthcare organizations.

The high adoption rate of social media makes a compelling reason for many health organizations to leverage their various advantages. Social media provides a faster way for some patients to follow up with physicians if they are concerned about certain symptoms. Others view it as a way to stay engaged in their care because they are able to interact with care providers electronically to discuss their conditions. These are just some of the areas that can receive benefits. Many EHR vendors offer online portals where physicians can communicate with their patients by leaving messages, similar to sending emails. Patients are finding it easier to send text messages and social media sites to receive medical information and seek advice.

Mobility and high engagement of patients with social media provides a greater opportunity for a cost effective method to communicate with patients. This collaboration of care and communication framework between doctors and patients would provide the most effective solution for patients with complex conditions or chronic diseases.

Ensuring the privacy and security of such practices and ensuring appropriate policies are available to organizations engaging in such initiatives is the main challenge that remains during this early adoption stage.


December 4, 2012  7:56 AM

Health care technologies that can help independent physicians



Posted by: RedaChouffani
cloud, EHR systems, HIE, SaaS, smartphones, tablets, voice recognition

A recent study performed by Accenture provided evidence that the number of private practices and independent physicians is continuing on its decreasing trend.

The study cites that 87% of the survey recipients noted that business expenses are one of the driving reasons to elect to join larger hospital systems and integrated delivery networks (IDNs). Prevalence of managed care and EHR requirements were two other concerns reported by a majority of respondents.

Many of the new health IT innovations will likely provide for a great opportunity for physicians to realize more cost savings and improved efficiencies, as the results of this research and current technology trends are reviewed.

The following are some of the areas that will have a positive impact on independent physicians and help reduce some of the challenges they face:

The cloud: The cloud is significantly  reducing the upfront investment costs needed for the technology infrastructure. Shifting the traditional client server on premises to a subscription based service, and in some cases software as a service (SaaS), is eliminating the complexity of implementing and maintaining the infrastructure.

Clinical Support Systems: More and more EHR vendors are providing powerful clinical support systems that provide physicians with assistance while diagnosing patients. Physicians are discovering significant values, as these tool continue to advance

Voice recognition: Voice recognition has significantly increased in accuracy. The new possibilities that are available due to the tight integration with some of the EHR products are what makes the technology a much more attractive and viable alternative to typing. Many vendors are now ensuring that what is spoken into the microphone is converted into discrete data that is populated into the medical record easily without too many clicks or extra manual data entry or transcription costs.

Smart phones and tablets: Whether the device is 4 inches, 7 inches or a full 10-inch tablet, many of the early adopters have seen tremendous value with these devices. The easy to use interfaces and long battery life are factors which favor today’s tablets as an alternative to laptops. Tablets outsold PCs for the first time, a clear sign of the adoption rate. Also, smartphones with high speed Internet have become widely used by patients. This provides endless possibilities for instant access to the care team. Vitals can be transmitted and other data can be accessed via mobile devices. Many of these gadgets will help enable better communication, improved methods of data usage, as well as better care.

HIE: Today it can be very challenging to electronically collaborate on patient care as well as access medical records from different health systems. For most physicians affiliated with or employed by hospitals, this task can be easily be achieved with the internal systems these organizations have in place. The costs associated with participating with an HIE, as well as having a product with HIE connectivity, can create unnecessary obstacles for independent physicians and increase costs of exchanging data. Costs of adoption will drop as more HIEs are deployed at state and regional levels.

Technology will continue to provide the appropriate tools that will help drive efficiency, improve patient care, and lower costs. The right technology will provide tangible results and enable physicians to easily adapt and be rewarded. There is a continuous flow of disruptive solutions that are being introduced that keep changing the way to communicate, collaborate, as well as care for patients. There are still technologies that are beneficially to the shrinking number of independent physicians.


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