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Meaningful Health Care Informatics Blog


September 17, 2012  9:11 PM

The impact new releases such as iPhone 5 have on health care IT



Posted by: RedaChouffani
iphone5, Medical devices

Wednesday, September 12th 2012 was marked by the release of the much anticipated iPhone 5. The device itself is lighter and provides other benefits such as longer battery life, improved screen quality, and an upgraded operating system.

The increase in smartphone usage has brought some new challenges for IT departments, including the health care market. IT teams are continuously having to ensure that they have enough security, as well as management capability, to ensure that their staff’s new devices can adequately serve their purposes without jeopardizing security or limiting their deployments.

Mobile device selection tends to be end user driven, unlike with desktops and servers. It is hard to define clear differentiators for many of these products at the hardware level, which can be problematic for IT departments. The eight pin connector on the new iPhone has many people concerned. This mainly impacts manufacturers who have developed a remote medical device that connects to the iPhone through the traditional 30-pin connector. Ensuring compatibility by supplying enough adapters to convert use of a 30-pin connector into the new eight-pin connector will add more work for IT folks and device manufacturers.

The iPhone 5 will provide significantly better performance than its predecessor, despite this minor setback. It will enable more mHealth Apps to take advantage of the graphics chip, processor, and display to bring better quality medical imaging, faster response from the native apps, and improved information exchange speeds.

September 17, 2012  9:09 PM

Next generation unified messaging and 5 of its top benefits for hospitals



Posted by: RedaChouffani
Hospitals, Lync, Unified Messaging

Today’s hospitals are looking for effective solutions that can be leveraged to help consolidate systems as well as solve their challenges. Many are looking at identifying the appropriate solution to help upgrade their communication systems, given the aging private branch exchange (PBX) system.

There are many internet protocol (IP)-based telephony products that extend beyond the traditional telephony side, and provide collaboration tools from IM, voicemail to text, recording tools, interactive voice response (IVR), and mobility that are available in today’s marketplace.

Microsoft has provided a platform that resolves many of the challenges today’s hospitals are faced with, along with other successful products in the marketplace. Microsoft Lync is the enterprise-ready unified communications system that is competing with some of today’s top voice-over IP (VoIP) and PBX systems.

The following is a short list of use cases for hospitals to leverage as part of Microsoft Lync:

ACO and care coordination:  One of the best features on Lync is the ability to allow for collaboration with outside organizations that are using Lync simply by being federated with them.  This would be a significant benefit for health care providers who are actively collaborating in the care of a patient.  Imagine a physician reviewing a patient’s chart and from within the EHR they have the ability to reach out to a specialist and share with them their screen and be able to talk while reviewing the medical record of their patient. All the communication can then be stored or archived and become part of the patient’s record for future use.  This is basically the ability to use the contextual conversation capability that Microsoft Lync offers.

Mobility and platform agnostic: Microsoft recognized the importance of having their application compatible with multiple platforms early on. Microsoft Lync is almost fully functional on MacBooks, Windows, iPhones, iPads, and Android devices. This enables many to be able to utilize the IM, voice, and other capabilities no matter where they are.

Web based App:  Office web apps are some of the web-based tools that are available for Lync users to perform presentations and communicate with others completely via web. The need for software installations would be eliminated and calls about software deployment would be reduced thanks to this feature.

Consolidation of technologies and products: For many organizations it is critical to put their IT talent to greater use. The IT team will be able to properly focus on what is more important for the health organization when Microsoft Lync offers audio, video, conferencing, collaboration, voice archiving, and mobility all in one platform. There will not be a need for specialized IT folks, for each product, as traditionally seen when working with multiple vendors.

Ease of use: Lync’s ease of use is recognized by many current users. It has the ability to use one click calling, conferring capabilities, easy meeting schedule from outlook, and content sharing.  These capabilities increase the value that solutions such as Lync are bring to the different organizations adopting this technology.

A solution such as Microsoft Lync will enable clinicians and administrative staff to communicate and share health information effectively across organizations, a potential benefit for health care organizations trying to identify platforms to improve patient care. It will decrease operational costs through a significant reduction in management, and make for lower and and more predictable costs. It will also improve workflows, yielding increased productivity and allow for collaboration regardless of location. All this will help improve patient care.


September 13, 2012  8:40 PM

Technologies that can assist with reducing hospital re-admissions amid penalties



Posted by: RedaChouffani
hospital readmission, mhealth, telemedicine

Hospital executives are working diligently at implementing initiatives that will help reduce the percentage of patients being readmitted to the hospital within 30 days of their hospital release.  This is the result of some of the penalties that have been established by the Centers for Medicare and Medicaid Services (CMS) and finalized during 2012.

These penalties are imposing pressures and pushing hospitals to identify ways to improve patient care by reducing readmission ratios and helping avoid cuts in 2013. While there are different methods for hospitals that can assist in reducing the admissions for patients discharged within 30 days, for many, technology has provided few possibilities that can actively make a difference.

Technology has been one of the tools which can help reduce some of the readmission rates. Some of the example areas that technology will be able to assist are as follows:

Patient Education:  Mobility and electronic access to health information for patients can be a helpful tool to keep in touch with patients after they have been discharged.  Also mobile apps that provide instructions on post hospitalization care and education can be of great assistance. For example, some hospitals have implemented mobile apps that patients can use from their mobile phone that are interactive and allow them to communicate with their caregiver and stay informed on how to spot anything that may require a trip to their primary care physician or the ER. These tools also help patients keep track of their post hospital visits.

Health Information Exchange: When patients return to their place of residence, they are typically required to follow up with their primary care physician or specialist.  In some cases their medical record may not be available for review or their physicians are not aware of their discharge. HIEs will assist in enabling more coordination of care. It will enable primary care physicians to gain immediate access to their patient’s comprehensive medical record. Upon review of this information, physicians will be able to help patients with some of the specifics on their medications and any general questions or concerns that they may have.

Telemedicine: Hospitals have the ability to coordinate post discharge virtual visits with patients via smartphone videoconferences. This allows them to assess their patient’s condition as well as answer any specific questions. This encourages patients not to miss appointments as they have the ability to meet with their physicians from the comfort of their homes.

Advanced risk assessment tools: In some cases, hospitals are evaluating patients’ risks during their stay at the hospital. By using some of the risk assessment tools available, nurses and hospitalists are able to assist if a patient is at a higher risk of readmission. This enables the staff to work with the patient more closely.

Health Monitoring devices: Remote vitals monitoring technology is another method of keeping in touch with and evaluating patients that have been released. These devices are able to transmit heart rates values, temperature, blood pressure and other indicators electronically and wirelessly to the hospital. Once the data is received, the computer system analyzes it and identifies if there are areas of concerns. It is  then able to alert clinicians who can immediately contact the patients and interact with them.

Technology is able to provide critical supporting tools to help hospitals reduce high readmission rates. By enabling improved collaboration with patients and community physicians, hospitals will be able to improve patient care and avoid some of the imposed penalties.


September 3, 2012  7:54 PM

NINA and SIRI virtual personal assistants are heading to health care



Posted by: RedaChouffani
NINA, NLP, Personal Assistant, SIRI

This has been an eventful year for speech recognition companies. We are seeing an increased development of intelligence systems that can interact via voice. Siri was simply a re-introduction of digital assistants into the consumer market and since then, other mobile platforms have implemented similar capabilities.

In hospitals and physician’s practices the use of voice recognition products tend to be around the traditional speech-to-text dictation for SOAP (subjective, objective, assessment, plan) notes, and some basic voice commands to interact with EHR systems.  While there are several new initiatives that will involve speech recognition, natural language understanding and decision support tools are becoming the focus of many technology firms. These changes will begin a new era for speech engine companies in the health care market.

While there is clearly tremendous value in using voice solutions to assist during the capture of medical information, there are several other uses that health care organizations can benefit from. Consider a recent product by Nuance called “NINA”, short for Nuance Interactive Natural Assistant. This product consists of speech recognition technologies that are combined with voice biometrics and natural language processing (NLP) that helps the system understand the intent of its users and deliver what is being asked of them.

This app can provide a new way to access health care services without the complexity that comes with cumbersome phone trees, and website mazes. From a patient’s perspective, the use of these virtual assistants means improved patient satisfaction, as well as quick and easy access to important information.

Two areas we can see immediate value in are:

Customer service: Simpler is always better, and with NINA powered Apps, or Siri like products, patients can easily find what they are looking for.  Whether a patient is calling a payer to see if a procedure is covered under their plan, or contacting the hospital to inquire for information about the closest pediatric urgent care. These tools will provide a quick way to get access to the right information without having to navigate complex menus.

Accounting and PHR interaction: To truly see the potential of success for these solutions, we can consider some of the currently used cases that NUANCE has been exhibiting. In looking at it from a health care perspective, patients would have the ability to simply ask to schedule a visit without having to call. A patient also has the ability to call to refill their medication.

Nuance did address some of the security concerns by providing tools such as VocalPassword that will tackle authentication. This would help verify the identity of patients who are requesting services and giving commands. As more intelligence voice-driven systems mature, the areas to focus on will be operational costs, customer satisfaction, and data capture.


September 3, 2012  7:53 PM

Value Driven IT for health care organizations



Posted by: RedaChouffani
health care IT, IT partners, mhealth

Health care IT continues to be an exciting world. IT provides help with making a difference to patients, all the way to the ability to participate in true change in health delivery. But as we continue to see an increase in the number of technology providers and technology jobs, the health care market is getting picky about whom they are partnering with and hiring.

In the past, IT was constantly dealing with hardware upkeep, software upgrades and new installations. In some cases, this demanded a large number of IT folks to execute the work and keep the systems running smoothly in the health care settings. But as we continue to see the shift in using virtualization, cloud-based apps and virtual desktops, the market has been demanding less of the traditional IT support needs and more of proactive, consultative and value add services.

This is forcing technology providers to rethink their offerings and strategy to stay with the demand of the market. While there are several technology companies offering IT services and managed services, the market is looking for business value and how to maximize the use of existing systems and further align IT with core objectives. This simply means that technology partners must have a much deeper understanding of health care, and technologies in general.

The top 6 areas in which IT providers must provide strong value to health care organizations:

1.     A strong health care understanding, ranging from policy, clinical workflows, compliance, and regulatory requirements

2.     Emerging technologies such as mHealth, medical devices, telemedicine and other areas

3.     Upcoming technology hard and soft trends

4.     Seeing technology as an enabler for providing an organization with tangible value and not gadgets

5.     System integration abilities

6.     Strong project management experience especially around EHR implementations

The changes in health care continue to focus on improving patient care and identifying effective ways to reduce costs and improve efficiency. This provides technology partners with incredible opportunities to add value. Whether the partner is the internal IT department or an outside service provider, health care organizations will continue to be excited about how technology can help make a difference.


August 27, 2012  8:12 PM

Final ruling on meaningful use stage 2



Posted by: RedaChouffani
Meaningful use, Stage 2

On August 23rd, 2012 Federal officials released the final stage 2 rule for meaningful use here.  This marks the finalized revisions of the ruling.  The 672-page document outlines the stage 2 requirements that will commence in 2014 for anyone participating in the incentive program.

The Health Information Technology Policy Council (HITPC) and the National Quality Strategy (NQS) maintained the focus on the six main domains:

  • Patient and family engagement
  • Patient safety
  • Care coordination
  • Population and public health
  • Efficient use of healthcare resources
  • Clinical processes/effectiveness

Within the ruling, there are 17 core measures for eligible professionals (EPs), who must also qualify for three of six menu objectives. Eligible hospitals are required to meet a set of only 16 core measures and a similar count of three additional ones from six menu items.

The final ruling also describes the requirements for reporting on clinical quality measures (CQMs).  As described, EPs will submit nine CQMs, from at least three of the NQS domains, out of a potential list of 64 CQMs across six domains.  There have been also some additional requirements that will force some changes to the way applications interact with health information exchanges (HIEs) and other EHR systems.

For example, one of the menu objectives allows for the ability to provide electronic lab results to ambulatory community providers.  This would facilitate, as well as encourage, some hospitals to eliminate faxing lab results to community-based practices. The new ruling changed patient access from providing patients with electronic copies of their health record upon request to providing them with online access to their chart for the purpose of viewing, downloading and transmitting.

Also, in an effort to help medication errors by requiring eligible hospitals/critical access hospitals to track medications using assistive technologies in conjunction with an electronic medication administration record (eMAR).

An additional measure was added to encourage patient and physician communications through electronic messaging.  It requires the use of secure communication with 10 percent or more of unique patients seen by EPs during the EHR reporting period.

There are still additional changes and requirements that will challenges EHR vendors and participants in the incentive program. As we continue to see the push for more collaboration, and care coordination, more measures in stage 3 are expected to follow the same direction as stage 2.


August 27, 2012  8:11 PM

Big data, machine learning and powerful processing platforms in health care



Posted by: RedaChouffani
AI, BIG DATA

For the most part, big data continues to intrigue technology executives.  In the healthcare market it has the potential to make great use of some of the existing data sets that are available.

The interesting part about big data is that there are other technology advancements that will truly be a game changer when it comes to making good and significant use of all this digital information.  AI or artificial intelligence as we know it, is when machines can learn and adapt based on data inputs.  While machine learning has been around for a while within health care, combining machine learning, powerful computing platforms and big data will ultimately create an incredible platform that can soon transform our health care and work environment.

We can take some simple examples of how many of these technologies can be applied in a real life scenario:

Business workflow engines:

Traditionally when we attempt to automate specific business processes and tasks we find ourselves continuously adjusting and adding to our workflow branches.  With the increased complexity of today’s health care environment, whether it is dealing with payer payment rules, or simply the different diagnoses of a patient who came into the ER with specific symptoms, a machine-learning platform will be able to adapt and improve results over time by simply reviewing a past patient data. This is no different than some of the existing technologies and solutions available today, where computer assisted coding is able, through the analysis of audio files and medical charts, to correct or recommend the appropriate charge codes and helping hospitals avoid payment delays and reduce denials.

Predictive analytics:

Data scientists find themselves constantly working on complex forecast models, and other predictive analytics for disease outbreak scenarios, availability of supplies based on certain variables and simply identifying possible future outcomes of patients based on their DNA and the different treatments available.  With the combination of big data, clinical trials registries, and powerful analytics tools, systems will be able to forecast the outcome of specific treatments in cases of cancer and other diseases. They are will be able to do this based on a patient’s treatment history and their DNA.

Personal Health assistant and mobile coach:

There have been several startups and mobile apps in the marketplace that track the mobile users’ locations, habits, and are able to predict or suggest the next restaurant that the patients should visit based on analysis of historical data.  Taking this same model and providing a digital assistant to patients with a chronic disease, the assistant can relay the patient’s vitals and communicate with physicians by providing information on the patient’s condition.

These are just few simple existing and future applications made available through big data, machine learning, analytical tools and computer processes.  But, as some of the platforms continue to be available commercially and through open source licensing, more innovation will penetrate the health care segment and prove to help overall patient safety, improve efficiency and discover new insights toward cures that were not previously possible.


August 20, 2012  8:06 PM

Big data starts from existing data within



Posted by: RedaChouffani
BIG DATA, small data

It is very easy to get carried away and look to engage in big data projects, the buzzworthy trend on which everyone is looking to capitalize. However, the reality is that big data can only be successful after mastering internal existing data, prior to seeking data outside out firewalls.

For larger enterprises, data in general holds the potential to help improve workflows, gain insights into operations, measure outcomes and reduce operational costs.  So regardless if it’s big or small, an organization must first engage in getting a full understanding of what data it has and what benefits it can provide them with. Once that step is taken, then a shift to the next big data would be an easier transition.

It is far too important to begin to take look from the outside in and define the potential of all that is available in an organization’s own data, than to simply chase a trend that should be a data 2.0 and completely skipping existing data 1.0 that is available.

Within the increasingly standardized and electronic healthcare arena, most IT leaders and healthcare organizations now have access to a wealth of relevant information that is simply too powerful and too valuable a tool to ignore.  This data truly holds some the most powerful potential in offering insights into patient care and operations.  Data from lab systems, patient medical history, clinical trials, outcomes measurement and treatments plans, just to name a few. All this data is fragmented throughout multiple systems and should be the focus of many to use as a primary source for any big data project.


August 20, 2012  8:05 PM

Small to mid-size practices may have the biggest security vulnerabilities



Posted by: RedaChouffani
data breach, HIPAA, security

Protecting patient electronic medical records continues to be a very key focus area for all organizations who have adopted EMR. However, the approach and steps that are being taken to ensure that tend to vary significantly from one organization to another.

Security experts agree that regardless of size everyone should take all the appropriate steps to ensure they properly safeguard the medical records of the patients. But for many of the smaller medical organizations there tends to be many obstacles they face that increase their vulnerabilities.

Despite some of the recent events such as the announcements by HHS in November of 2011 where the Office for Civil Rights (OCR) began auditing selected covered entities’ compliance with the privacy and security (Article link), as well as a recently fined small surgery practice in Phoenix (fined $100,000.00), many small to mid-size medical groups are still not adequately protected against data breaches.  Parts of the challenge they face are:

Scans and network assessment scans: For many of the smaller practices, getting a thorough assessment can be costly. From receiving network penetration testing, to deploying the appropriate tools to evaluate their network and systems periodical does not always get the highest priority. This can cause a physician’s group to overlook potentially dangerous vulnerabilities within the network that can co allow for serious breaches.

Inadequate security practices: I discover from time to time poor security practices when I visit some medical organizations. Simple things such as leaving a workstation in the exam room unlocked and the patients sitting in that room can potentially enable one to install malicious applications and possibly allow for data theft.  Not only that, but there are actively many cases where clinicians and nurses are communicating via email and transmitting patient information without the use of encryption and secure channel.  One must ensure that any and every information communicated about patients or is made available through any device is a potential point of entry for data seeker.

Mobility:  Mobile phones have gained significant momentum in the healthcare market. Clinicians are using these devices to view patient charts, prescribe medication and communicate with their colleagues and patients. But there are many risks associated with those devices when they are lost or stolen. These mobile units are in some cases an easy way to gain access to significant data if they are not properly protected.  Furthermore, with the recent reports of malware targeting mobile devices, it becomes even more critical to adopt mobile app and mobile device policies that ensure the protection of the data being accessed through them.

Social media use: Staff from different organizations periodically check into their preferred social site. Social media has been the source of virus infections, in addition to creating a decline in productivity and distracting employees. It become very important to set expectations and controls in place to ensure that if access is allowed to these sites adequate safeguards are put in place to ensure that systems stay protected.

There are few steps to take when evaluating the risks and what to do to manage them within an organization regardless of size:

EXAMPLE RISK ANALYSIS STEPS:

  • Identify the scope of the analysis.
  • Gather data.
  • Identify and document potential threats and vulnerabilities.
  • Assess current security measures.
  • Determine the likelihood of threat occurrence.
  • Determine the potential impact of threat occurrence.
  • Determine the level of risk.
  • Identify security measures and finalize documentation.

EXAMPLE RISK MANAGEMENT STEPS:

  • Develop and implement a risk management plan.
  • Implement security measures.
  • Evaluate and maintain security measures.

Many things motivate data breaches, such as cyber warfare, black mailing, slanders, or just the need for recognition. Ultimately, patients are the the stakeholders who lose the most. While there are requirements that have not been fully enforced, every organization must take security very seriously.  A data breach can be the beginning of the end of organizations, and there are some very simple steps to take to ensure patient’s data is protected.


August 13, 2012  9:06 PM

Physicians to begin prescribing controlled substances



Posted by: RedaChouffani

Two years after the DEA released ruling on electronic prescribing of controlled substances, physicians are still very eager to actively eliminate the current prescription pads that have been in use.  For some who have adopted Electronic Medical Records, having two separate workflows for handling prescriptions was usually was not clearly the preferred method.

The DEA has set forth requirements to get certify software vendors through the EPCS certification.  Similar to using some certification bodies approved by the ONC for EHR certification, the EPCS has been established to ensure that both software vendors with their products are certified to ensure compliance with the rules.  There are currently found certifying bodies approved by the DEA:

· Drummond Group Inc.

· InfoGard Laboratories, Inc.

· iBeta LLC

 

Thus far there have been only five organizations that have been successfully certified and are allowed in some states to electronically transmit controlled substances:

  • DrFirst
  • GE Healthcare
  • NewCrop
  • NextGen
  • RxNT

With software packages such as NextGen and GE and their large physician’s base using their products, this may help increase the adoption rate of electronically transmitting controlled substance.  While standard drugs have been simple to e prescribe, prescribing controlled substances would require additional authentication models.


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