Healthcare & Technology

Welcome!

Welcome to the Healthcare & Technology blog. After 17 years in technology, including various leadership roles, and now as a Registered Nurse, I turn my attention to the use of technology within the healthcare industry.

Healthcare is, and remains, one of the most pressing challenges facing our nation (and the world) in the 21st century. Almost any discussion related to improving healthcare, whether it implicates reducing costs or improving patient safety and satisfaction, usually has technology as a core component. Technology, in and of itself, will not solve the problem, but used appropriately will contribute to the transformation of healthcare, as it has in many other industries. However, in healthcare, the technology options appear even more complex and the number of vendors daunting. These are the critical challenges that confront us.

EHRs can improve Chronic Disease Management

Link: Kaiser Permanente Project Proves Electronic Health Information and Care Coordination Improve Chronic Disease Management.

A quality improvement project at Kaiser Permanente in Hawaii demonstrated that health care professionals can successfully use EHRs to monitor and treat patients with chronic illness.

Information from the electronic medical record provided physicians with information that enabled them to proactively treat high-risk patients with End-stage Renal Disease (ESRD). Use of the EHR provided the ability to coordinate care between primary and specialty care providers, and monitor treatments.

It was interesting to note in their press release that the data contained in the EHR not only provided monitoring capabilities, but also provided a method in which patients with preliminary/early signs of renal failure were identified, contacted, and referred to specialists or primary care providers with accompanying plans for medical care and treatment.

EHRs that enable providers with methods for early detection and treatment of illness can improve the delivery of health care and health outcomes.

Reaching patients before an illness worsens is a critical aspect of prevention and proactive medical care. Kaiser Permanente's 5 year project is a "real life" use case that demonstrates how proper use of an electronic medical record CAN improve delivery of health care.

Who/What are the National HIT Organizations?

Link: The National HIT organizations

Most Americans are probably aware that changes in healthcare are gaining momentum. We are in the early phases of change, impacted by recent ARRA legislation and incentives to adopt electronic healthcare records (EHRs).

There are a number of groups that previously existed, or have been established, to provide guidance, standards, and specifications in support of EHRs. Understanding the role of each group as it relates to ARRA may be interesting to those individuals who desire an improved understanding of how these groups are working to facilitate adoption of EHRs.

I came across John Halamka's blog where he shared his perspective and knowledge about these National Health IT organizations. Groups covered in his post include: (Brief summaries are paraphrased, details can be obtained from the link above or on the organization's website below.)

• Office of the National Coordinator (ONC): led by Dr. David Blumenthal, responsible for controlling and coordinating healthcare IT stimulus requirements/incentives associated with ARRA.

• Health IT Standards Committee (HIT): responsible for standards, implementation specifications, and criteria for electronic health information exchange.

• Health IT (HIT) Policy Committee: recommendations to ONC for development/implementation of the national Health IT infrastructure.

• Health Information Technology Standards Panel (HITSP): provides a consultative role to the HIT Standards Committee.

• National eHealth Collaborative (NeHC): developing a national prioritization process to advance interoperability for healthcare IT adoption.

• Certification Commission for Health Information Technology (CCHIT): Health IT (HIT) certification organization.

Back to the drawing board on meaningful use

Link: Healthcare IT News

After considerable discussion, the committee for EHR meaningful use has been asked to develop a new set of criteria by July 16th. Ultimately, "CMS will be the final word on meaningful use and how it applies to incentives..."

This is interesting news since the workgroup had provided its recommendations and its criteria on the same day. It would be interesting to learn "what was missing" from the initial set of criteria.

HITECH : HIPAA : CFR Regs

A future release of the HIPAA Survival Guide(HSG) will make the full regulatory text of the pertinent CFR sections available online. This will allow users to "drill down" into the regulatory text itself from the summary and commentary provided by the HSG.

The ability to review the regulatory text in its entirety, section by section, will improve the ability of primary care providers (and other interested parties) to use the online version as a reference tool.

The entire contents of the guide are available online here: http://www.hipaasurvivalguide.com/

ONC Website: Health IT Documents

Link: Health IT - Meaningful Use Matrix

Thanks to Josh Seidman and his blog post for pointing me to this matrix. A PDF containing a matrix for "meaningful use" objectives to address Health Outcomes Policy Priorities and Care Goals was published yesterday.

The matrix is easy to understand with columns for health outcomes, policy priorities, care goals. Objectives and measures are identified for each year, beginning 2011 and through 2015. The matrix can be downloaded from the link above.

I find the matrix to be useful not only from a health objective and policy priority standpoint, but it directly links these policies to patient care goals and states not only the objectives to achieve these priority care goals, but also how to measure them.

OK, maybe it's the Type A personality coming out.... but.... It makes me think of the quote from long ago...(author unknown) "You can't manage what you can't measure." Priorities need goals that are clearly stated and that can be measured before success is proclaimed.

Criteria for EHR "meaningful use"

Link: Officials outline criteria for meaningful use | Healthcare IT News

ONC Co-chairs Paul Tang, MD, Palo Alto Medical Foundation and Farzad Mostashari, New York City Health Department outlined the criteria for 2011 objectives and measures including:

• Capturing data in coded format;
• Documenting progress note for each encounter (outpatient only);
• Using CPOE for all order types (using e-prescribing and drug and allergy checks;
• Managing populations (generating list of patients by specific conditions and sending patient reminders);
• Engaging patients and their families in their health (providing access to personal health information, educational resources and encounters of clinical summaries);
• Improving care coordination (exchanging clinical info among providers and performing medication reconciliation);
• Improving Population and Public Health (submitting electronic data to immunization registries, electronic labs to public health agencies, and electronic syndrome surveillance data to public health agencies); and
• Complying with HIPAA Rules and state laws, and with fair data sharing practices set forth in the National Privacy and Security Framework.

If you are looking for more information about the HITECH Act and HIPAA go to http://hipaasurvivalguide.com/hitech-act.html and download The HITECH Act: HIPAA Survival Guide, a freely accessible document that I co-authored with my husband who is a Privacy Attorney.

In addition, the HIT Policy Committee will accept public"open comments" on their draft of "meaningful use" criteria until June 26th. Click here to provide your comments and feedback.

HITECH Act: HIPAA Survival Guide

I recently launched a website that has The HIPAA Survival Guide (HSG) viewable online. The HSG is a concise overview of the HIPAA Regulations in light of the new HITECH Act (part of President Obama's recent economic stimulus package.) I thought I'd pass it on in hopes it might be useful to some of you.

The entire contents of the guide are available online here:
http://www.hipaasurvivalguide.com/

The HITECH Act summary page is available here:
http://hipaasurvivalguide.com/hitech-act.html

or, you can download a .pdf file of the guide here:
http://www.hipaasurvivalguide.com/hipaa-survival-guide.html

If you find it useful, please feel free to pass it on to others, especially primary care providers that may be struggling to make sense of the new regulations.

Who has a shared EHR?

Link: A shared electronic health record in Australia, a report from the Medical Journal of Australia, June 2009

This publication presents the case of an electronic health exchange in Australia that has been sharing clinical data with an electronic health record (EHR) since 2005. The exchange contains a registration system, a clinical database and a communications system and uses HL7 as the standard for interoperability between providers and facilities.

As of April, 2008, there are 239 Practitioners, 2 public hospitals, 3 private hospitals, 11 allied health and community based providers and 1108 registered patients on the system.

The original trials that provided support for implementation of this electronic health exchange occurred between 2003 and 2005 and were funded by the Australian Commission on Safety and Quality in Health Care.

Trials demonstrated that patients with chronic and complex conditions can benefit from a multidisciplinary, multisector, team-based approach to the planning and provision of their care. The trial resulted in an average reduction of 26% in inpatient costs for intervention patients. Another key outcome from the trial was the understanding that an electronic health record system was required to facilitate the flow of information between care team members, as existing paper-based systems did not work.

Based on the quote above, I see a few interesting points. There are obviously more data points that can be accessed from document (PDF) contained in the link above.

• Chronic/Complex conditions can benefit from patient records to multidisciplinary access.
• Inpatient costs can be reduced for these conditions.
• Education is required for providers to understand use of EHR/EMRs.

The journal reports ...

Implementing an electronic health record system is incredibly difficult. It involves deploying an information system, managing patients and providers, dealing with the “cultural” issues of exchanging information across specialties, and introducing changes to long-established processes across the health sector.

However, these difficulties do not outweigh the significant benefits derived from electronic tools, which provide essential infrastructure to support the delivery of high-quality health care and, in particular, multidisciplinary care team management of complex patients.

This announcement raises many questions in my mind, such as.... How was Australia able to implement regional EHR/health exchanges in such a short time period (2005-08)? What implementation barriers did they overcome, and how? I think these are interesting questions to ponder...

HIT "Meaningful Use" Defined?

Link: Meaningful Use by June 16th

According to a post by Chilmark Research, Michael Fitzmaurice of AHRQ announced at an mHealth event in Washington DC, that he expects "meaningful use" of electronic health records to be defined by June 16, 2009.

This is a long-awaited definition for certification criteria of EHR/EMRs.

CCHIT 2009-2010 EHR Criteria

Link: Certification Commission for Healthcare Information Technology

The above link provides access to the recently published criteria for 2009-2010 CCHIT EHR/EMR criteria. This information describes the CCHIT requirements of an ARRA-qualified EHR. These guidelines are currently under review until August, 2009.