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Meaningful Health Care Informatics Blog

November 27, 2012  7:22 PM

Hacktivist uses health care data analytics to create physician rankings

Posted by: RedaChouffani
BI and data analytics, BIG DATA, Data analytics, FOIA, Freedom of Information Act, Medicare,, Open Data, Open Data Initiatives program, physician ranking

Many federal agencies have made data publicly available since the Open Data Initiatives program was started by the White House under the presidential innovation initiatives. Todd Park, chief technology officer at the White House made it very clear that it intends on making government data more useful and available to anyone.

Many of the apps showcased during Health Datapalooza provided examples of positive usages of data. This conference was geared toward engaging vendors, hacktivists, and other innovators to make good use of government data. But just recently, Fred Trotter, health care hacktivist and author of Hacking Healthcare, posted a project on the crowdsourcing site, the next level doctor social graph, to get funding to further develop a platform that would utilize data to rank physicians.

The data, as described by Trotter, was the result of a request for information through the Freedom of Information Act (FOIA). He was provided with a large data set from the Centers for Medicare and Medicaid Sevices (CMS) that contained all the details around the referral activities of Medicare participating physicians.

The goal for the funding is to assist in making meaningful use of the data, according to Combining state credential data and then creating a larger data set called a “DocGraph” would provide a rating system for physicians that would also be made publicly available after six months.

Examples of the released referral information currently reside in multiple data repositories across multiple medical billing systems in hospitals, integrated delivery networks, clearing houses and small medical practices. The released data from CMS represents the largest data set to date and provides the largest sampling size available. The scenario presented by Fred Trotter is one way health care data can be useful to patients. There are still many other ways data can be used, which makes a strong case for data analytics to improve the health care system.

November 27, 2012  7:18 PM

Affordable Care Act law to end discrimination against pre-existing conditions

Posted by: RedaChouffani
Affordable Care Act

A law that would make it illegal for payers to discriminate against patients with pre-existing conditions is one many of the laws from the Affordable Care Act (ACA) that has been kicked off since the end of the presidential election. Another patient-friendly initiative is centered around the health care exchange plans and would enable shoppers to compare the different plans available.

The proposed ruling would allow for payers to have variable premiums based only on age, tobacco use, family size, geography, and not based on pre-existing conditions. It would go into effect in 2014.

There are additional rules that could also go into effect. They involve employment-based wellness programs that promote health without running the risk of reduction in health benefits.

“The Affordable Care Act is building a health insurance market that works for consumers,” said Health and Human Services Secretary Kathleen Sebelius. “Thanks to the health care law, no one will be discriminated against because of a pre-existing condition.”

Several of these rules would enable more competition in the marketplace. There are still parts of the ruling that could potentially add more burden on payers which would possibly reduce reimbursements to providers and hospitals.

November 19, 2012  9:31 PM

EHR vendors going beyond IT services to big picture

Posted by: RedaChouffani
business intelligence, health care IT, technology value add services

More and more technology firms are ringing the phones of health care organizations and filling up their mailboxes with inquiries for appointments and demos. Many of the new approaches or solicitations come in with a very different message from what was previously seen. Tech companies are now offering non-technical services like business value add consulting, where in the past they simply offered IT services.

This move has been ongoing for sometime and has even been noticed by EHR vendors who have been offering added value services such meaningful use consulting, revenue cycle management, outsourced billing, collections, and few other new areas that may not be directly linked to the software but offer a sense of continuity and support for the health care providers.

Enterprise technology service providers have also been following in those footsteps. Many of them have become distribution centers and along with their partners, are able to provider a portfolio of services around health care needs that enable many organizations to find a one stop shop for all their needs as well as receive improved pricing on some of the offerings by only engaging service providers.

Hospitals and independent physician practices will continue to see hardware and software vendors providing more services that offer business value and provide tangible value around patient care and revenue. This model has worked well for several service providers such as IBM, Dell, HP and few others. These firms are making it easier for their health care clients to see their relationship as a true partnership and view them as more than just a simple hardware or software provider.

This has also forced many vendors to reconsider the traditional sales approach to these clients and to employ account executives with a greater understanding of the health care marketplace. Health care IT executives are beginning to look beyond the technical certifications and more toward domain expertise and strong consulting, as we continue to see less emphasis of day-to-day fixes, and more focus on business value.

November 19, 2012  9:29 PM

Extensions provided by HHS for the state Health Insurance Exchange (HIX)

Posted by: RedaChouffani

The secretary of the Department of Health and Human Services (HHS) is still faced with the challenge of getting states to participate in health care exchanges, despite the end of the election season and removal of much of the doubt around existing health care laws and reforms.

This was a key area of discussion during the governor’s conference earlier this month. Many republican governors requested an extension as the deadline approached for submitting a letter of intent to participate in the key state health care plan exchange program. HHS Secretary Kathleen Sebelius moved the deadline to Dec. 15, 2012, in response to that.

A limited set of states have already submitted their letters of intent for their state exchanges, along with others who have publicly stated their intent. The federal government has already provided grants for assisting different states in the planning stages for the exchanges.

There are clearly some benefits that consumers can take advantage of due to the program, though there has been significant criticism of the exchange plans because of the requirements set under the law. When purchasing online, many of use prefer to have access to pricing details, and comparative reviews of products with end user feedback. The state exchange will offer similar benefits to health care plan shoppers. According to the requirements of the state exchange, the following are some of the functions that would be made available:

Section 1311(d)(4) specifies core functions that an exchange must meet:

  • Certification, recertification and decertification of plans
  • Operation of a toll-free hotline
  • Maintenance of a website for providing information on plans to current and prospective enrollees
  • Assignment of a price and quality rating to plans
  • Presentation of plan benefit options in a standardized format
  • Provision of information on Medicaid and Children’s Health Insurance Plan (CHIP) eligibility and determination of eligibility for individuals in these programs
  • Provision of an electronic calculator to determine the actual cost of coverage taking into account eligibility for premium tax credits and cost sharing reductions
  • Certification of individuals exempt from the individual responsibility requirement
  • Provision of information on certain individuals identified in Section 1311 (d)(4)(I) to the Treasury Department and to employers
  • Establishment of a Navigator program that provides grants to entities assisting consumers as described in Section 1311(i) 

Additional exchange functions include:

  • Presentation of enrollee satisfaction survey results under Section 1311(c)(4)
  • Provision for open enrollment periods under Section 1311(c)(6)
  • Consultation with stakeholders, including tribes, under Section 1311(d)(6)
  • Publication of data on the exchange’s administrative costs under Section 1311(d)(7)


November 13, 2012  6:43 PM

HIT committees looking for input on patients’ access to PHI

Posted by: RedaChouffani
HIPAA, PHI, PHR, security

The Privacy and Security Tiger Team of the Health IT Policy Committee, and the Privacy and Security Working Group of the Health IT Standards Committee, will host a web hearing on credentialing patients on November 29, 2012 from 12pm to 4pm, Deven McGraw, chair of ONC’s Privacy and Security Tiger team shared on the blog.

This will open a public conversation to help gather feedback from patients and other health care stakeholders on how they are currently accessing and consuming their personal health records, as well as what their input is in terms of digital credentials. Some of the issues that the post is asking for feedback on are:

  • Did you have to show up in person at your doctor’s office or were you able to establish the account online?
  • If you were able to establish the account online, what steps did you have to go through to prove your identity?
  • Once you established the account, what steps do you have to go through to access it?
  • Do you believe the process for giving you access to your account will keep your information secure?
  • What other approaches would you recommend to provide patients with secure online access to their medical information?

It is fair to say that if the parameters of a digital identity in the health care would follow the same methods that other markets like financial institutes, credit bureaus and some federal branches of government currently utilize, it would provide the adequate minimum requirements and best practices to ensure the patient is who they claim to be.

Individuals of all ages and backgrounds have been successful at electronically accessing their private information, though there have also been many occasions of security concerns and breaches that were caused due to phishing attempts. These have been mostly caused by fake emails which redirect individuals to a website that may have the same look and feel of a legitimate website, and require users to enter their credentials. This information would then be used by the criminal to log in into the real website and steal private information. These phishing attempts pose the highest risk for patients to have their medical information compromised. Patients must be aware of these scams and not trust the validity of every email and contact their health provider when in doubt.

November 13, 2012  6:40 PM

Public, private and maybe a personal virtual cloud

Posted by: RedaChouffani
cloud, EHR, Social media, virtual assistant

We are seeing more of a clear distinction of public, private and occasionally hybrid cloud adoption, after considerable conversation around the available adoption models. These are the different setups that organizations consider when establishing how to consolidate and substitute their on-premises server infrastructure for a more robust, flexible, and scalable one in the cloud.

The choice between public and private receives much more attention in health care and there is generally more hesitation toward the public option. With the privacy regulations and security concerns surrounding the cloud, some are hesitant to make the leap to release their complete electronic health records to a storage device that is not secure within their facilities. Some are still in doubt despite the tremendous advancements and available products which provide more robust security protocols for the data.

However, when we look at all the digital data that is being stored online and offered via the cloud that is more consumer centric, it would seem natural to shift toward a centralized and connected cloud-based personal data bank. This stored data includes cloud-based music libraries, personal files, family photos, videos, blogs, tweets, Facebook, messages, searches, product reviews, connections, professional skills, personal health records, and more. This will become the virtual personal cloud from which a virtual assistant will one day get a Google car to drive itself out from the parking lot and pick us up at the door without the need for a valet. Also, this will also enable us to centrally store our most valuable memories and have access to all of our digital world from anywhere at anytime without the worry of making backups of our growing private digital collection.

Health care will be a critical branch of our digital tree. Vendors must consider how we will consume future information in a world where our data must be able to  connect with other data and collectively offer a much bigger value, as they project how tomorrow’s personal health record will look.

November 6, 2012  11:10 PM

Top considerations when performing an EHR and billing conversion

Posted by: RedaChouffani
Conversion, EHR, PM

In recent years, a number of health organizations have engaged in implementing a new EHR patient scheduling system, or a patient billing and registration system. However, many faced the daunting task of identifying how staff would be able to operate in a new system when much of the data will most likely continue to live for many months in the legacy application. Many organizations acquire conversion services from the software vendors or third party vendors in order to reduce added data entry during the transition to a new system.

For the most part a system conversion is defined as: Having data (clinical, billing, scheduling, and other data) extracted from the legacy system and then adjusted and loaded into the new system in order to reduce manual data entry and provide continuity of the records.

There are eight main considerations to reduce duplicating the staff’s work, maintaining clean data, and reducing the challenges associated with working in two systems.

Data set definition: As with any conversion, it is critical to define the scope of which data sets will be converted and brought over from the legacy system. This requires collaboration amongst the new vendor, data analysts, database administrators, and, in some cases, the legacy system support team. All stakeholders will agree and define what data sets would be available for extraction during this stage, and then the new system team will then confirm if all or parts of the extracted data will be transferable into the new system. It is ideal if the legacy system supports continuity of care document (CCD)/continuity of care record(CCR) data exports for a clinical data conversion. This allows for all clinical data to be extracted and stored in a standard format that most certified EHR packages can process.  However, there still many known case where this functionality is not available, and the conversion team has to either go through the data dictionary and select a subset of information to be converted, or simply maintain the legacy system and keep it online. For non-clinical data such as billing and schedules, it is common practice to simply bring over patient demographics alone with account notes and balances. This is mostly due to the variations of how different systems handle patient billing internally.

Data format: In data conversions the data can be made available as a PDF, XML, raw text, HL7 and many other available formats. These are formats that are based on the source system and would sometimes need to be modified and exported into other formats to match the format needed by the new destination. The information can be maintained in a database and is then directly pushed into the new system, in other cases.

Workflow post conversion: Post-conversion workflow is one of the areas that requires significant consideration. There are different approaches being used post conversion some of which are:

Same staff with two systems: This is one of one of the least favorable models but can be successful if the organization is willing to do whatever it takes to ensure  success maintaining two systems with the same number of staff (after going live). This typically requires additional hours from the team working on the systems.

Outsource legacy system: There are companies available that would take over billing for an organization while the staff is on the new system during a billing or clinical data conversion. This is viable for a clinical conversion where the information is available on demand and can be added to the returning patient chart.

Add additional temporary supporting staff: In this model we typically see that the staff can ensure that the legacy system is properly maintained and all patient information is successfully managed, whether the organization brings temporary staff on board or simply uses resources from other departments to help during the few months after adoption.

Test conversion: Testing the converted information in the new system is extremely important, as with any major system change, especially those with data conversions. These tests must be performed by the staff who will be actively be using the new system, not just by the technical folks. Feedback must be provided once the tests have been completed and all the issues must be addressed prior to going live.

Maintenance of dual systems: The inability to efficiently report on all the data as a whole is a challenge that most organizations face when having their data stored and maintained in two systems. Use of methods that may require temporarily warehousing data from both systems in a central location to enable reporting on all of the data is necessary in some cases.

Data conversions can have a significant impact on a new system. If the workload is such that the staff is unable to perform efficiently in the new system, it can cause challenges for the organization and lead to further issues. Conversion must be well planned out and involve all the appropriate parties to ensure a successful transition.

November 6, 2012  11:03 PM

Does a hurricane make for a stronger case for an EHR?

Posted by: RedaChouffani
Disaster recovery and business continuity

Hurricane Sandy recently passed the through the Northeast and left many residential and business areas in chaos. The financial impact is estimated in the range of $20 billion and climbing. Families and businesses felt the storm’s impact throughout its duration.

Several hospitals and health care organizations have been evacuated during and after the storm due to power outages and safety concerns. Many in the health care IT arena are evaluating how well prepared their organizations would be if they faced a similar problem, and most are working hard at attempting to get things back to normal.

The damage from the winds, storm surge, and standing water for days challenged every disaster recovery (DR) and business continuity plan (BCP) that was in place for many of the hospitals in the Northeast.

Considerable record losses due to the flooding were faced by facilities where they maintained patient records on paper. Those facilities are uncertain of their ability to restore operations to their practices and restore their patients’ confidence in them despite the loss of patient records.

The use of EHRs provides an effective way of storing clinical information as well as additional protections if the systems are properly deployed and DR/BCP are correctly put in place, because simply having digital records does not necessary mean the clinical information is protected.


October 30, 2012  6:56 AM

Top considerations when using cloud computing

Posted by: RedaChouffani
cloud, IaaS, SaaS, vcloud, VMWare

Health care organizations are recognizing the benefits of what technology has been able to deliver in terns of automation, consolidation and innovation. Cloud computing continues to promise a much more robust, scalable, and on demand infrastructure in the server and storage space. Health care organizations have the ability to choose from the model that best fits their organizational goals and technical needs whether it’s software-as-a-service, infrastructure-as-a-service or platform-as-a-service.

One of the areas that has seen a significant interest of health care IT professionals and executives is cloud computing as technology continues to be utilized as one of the vehicles to assist providersc in improving health care and reducing costs. This is also the area that enables organizations to simply leverage existing enterprise capabilities when some or all of their servers are available as virtual servers and hosted for a monthly fee.

However, there are many considerations to be reviewed prior to seeking a cloud provider to shift some or the entire infrastructure to. The following are some of the considerations when evaluating a cloud based option for your health care organization:


For many health care organizations such as CRO, IDNs, ACOs and independent physicians are required to protect and safeguard patient health records.  Under the HIPAA rules and the FDA regulations there are many regulatory compliance requirements that force the implementation of specific practices to ensure the appropriate safe guards are in place to protect the data from unauthorized access and improper use.

Public, private and hybrid tcloud: As health IT executives and professionals evaluate the cloud offerings, three distinct offering can be found in the market place.

Public cloud: This refers to a shared infrastructure that would be offered to the tenants in which they will have some significant cost savings when comparing it to the private cloud.  In this model there maybe some limitations to how the infrastructure is configured.  Which can be a challenge for some who may be under specific system requirements of certain EHR packages as well as other health specific applications.

Private cloud: In this private configuration the healthcare tenant will have full control over the specifics of the configuration of the system, and its networking components.  This is typically the setup that specific health organizations that are seeking a complete isolation form other cloud tenants.

Hybrid Cloud: Many organizations are approaching the cloud through this model.  By slowly operating only a limited and particular set of systems in the cloud and maintaining some of the remainder of resources within the boundaries of the private network.

Management and added value services: Many of the cloud service providers are providing IaaS.  This is helping many IT departments by outsourcing the management, monitoring and day-to-day maintenance needed for the infrastructure.  It also provides an added value service that enables the organization to refocus their internal IT assets to focus on more specific healthcare related projects instead of the traditional support and reactive model that is usually associated with hosting internally the server infrastructure.

Emergency access: One of the significant benefits to the Cloud is its high availability.  And as we face natural disasters such as Hurricane Irene or Sandy, having the infrastructure hosted in the cloud ensures the protection of the information.  However, one challenge is always the availability of the data and system when the cloud provider or connection to the data center is unavailable.  While there have been very limited number of outages that were related to the data center system failures, many hosting providers offer failover clouds that are located through out the US and across the world and are fully accessible to the tenants.

Pay as you go: As data storage needs continue to increase and the need for health information analysis requires additional computing resources from time to time, a cloud infrastructure deployment will have the ability to provide temporary additional resources that may only be needed during the analysis of large sets of data.  This helps reduce the up front costs that would traditionally with required for additional servers and storage that may only be needed on a temporary basis.

Simplified and consolidated management tools: Preparing designing and deploying an enterprise grade infrastructure for large healthcare systems typically requires a significant number of networking and system engineers.   However, with some of the advancements of automation and abstraction of the components such as security, networking and storage, products like vCloud Director as well as nicira are able to simplify dramatically the provisioning of many of the complex services needed to operate and completely get an infrastructure ready without worry.

While much of the early adopters of the clouds have been small to mid size companies, many more healthcare organizations and their growing demand of affordable and scalable infrastructure is forcing many to evaluate the many offerings available through some of the cloud service providers.  IT departments are looking beyond SaaS but at the full scope of capabilities available and benefits that they can gained from IaaS.

October 30, 2012  6:55 AM

Personalized health care through social media

Posted by: RedaChouffani
Social media

There continues to be significant challenges in communication and staying in touch between physician and patients, as today’s physicians see an increasing number of patients with chronic disease and are required to create personalized treatment plans that may require the collaboration and coordination with other specialists.   This is one of the areas in which many see the value of adding life coaches or clinical case managers to assist patients outside of the exam rooms and provide a support system that continuously stays in touch and provides patients with feedback.

There are clearly some real challenges that we face when it comes to effectively staying in touch and communicating with health providers. Unfortunately, though smart phones hold the potential of enabling improved communication, and would help patients and caregivers communicate near real time, there is still gap. Physicians are required to review their patient’s chart and active medication in order for them to be able to effectively respond to a patient’s requests. This means that it would be far more complicated to expect physicians to respond and communicate with patients and provide them with medical advice via text without prior review of that patient’s clinical information.

But if we begin to think of what a platform such as Facebook provides (photos, likes, dislikes, status, historical data, and other individual information), a health care flavored Facebook with patients, where primary care physicians and specialists can collaborate and communicate can possibly unlock the door that would enable a physician and caregiver to know more about their patients. It would also give patients a better understanding of their condition and allow them to take an active role in their care.

A platform such as the one listed above would also provide some of the online retailers and health organizations authorization to access the patient’s diagnosis (similar to how Facebook authorizes outside applications to access basic info of the profile). Sites such as webMD and other online resources can present the site visitors who may suffer from diabetes or specific allergies with patient education as well as ads that may be related to the results of some of the new drugs.

As patients, we will continuously seek to understand our conditions and manage any symptoms that maybe associated with our condition. And in many cases we want to get the personalized care from the caregivers without having to schedule an appointment for a later time. Online platforms such as Facebook and others will be the vehicle in which many of the collaborations and sharing of information will happen.

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