Healthcare & Technology

John Halamka shares Thoughts on the Year Ahead

Link: Thoughts on the Year Ahead

John Halamka presents his ideas about the major issues for 2012..

ICD10 - John predicts 25% of IT capacity will be consumed by ICD10 this year. Not good...

Meaningful Use Stage 2 including inpatient clinical documentation - now this is exciting. Potential criteria will likely include improvements to clinical records that improve care coordination and communication between providers. John suggested use of templates and social-networking like group documentation.   

ACO Planning - The reform changes for ACOs will include focus on prevention and wellness. New business intelligence (BI) and clinical decision support (CDS) capabilities will be helpful in meeting these goals.

Compliance - Compliance issues will include "conflict of interest tracking, learning management systems for compliance education, and enhanced revenue cycle systems that provide decision support."

Security - yes, the past year had a long list of data breaches, malware, and mobile devices so security of PHI must be improved, particularly if we intend to move clinical decision support to the bedside or engage in Health Information Exchanges.

Healthcare EHR "e-bilities"

Link: Usability and Successful EHR Meaningful Use

Recently the ONC posted on the Health IT Buzz Blog about the "challenges providers face in achieving Meaningful Use of electronic health records (EHRs)."

The concept of "useability" has long been known in other industries where new technology or applications enter the workplace. Some time ago I wrote about usability of health IT, however I expanded the definition to include a few more "E-bilities" as shown in the following graphic contained in the post: Part 4 of The Value of the Internet for Improving Healthcare.

This is the last post in the series and it focuses on capabilities, or "e-bilities" of technology to improve healthcare. Regardless of the mode of use (e.g. email or internet), technology must be easy to use, secure, reliable, and accessible.

For the past year, the SHARPC-Project 1 has focused on making use of technology easier for clinicians. One ONC staff member, Jacob Reider, MD had some interesting comments that focused on "The User Experience." His comments spanned the continuum of User Experience with a framework for how tools and/or applications can/should evolve.

 

Functional (it does what it is claimed to do)
Reliable (it works consistently)
Usable (it works in a way that is consistent with the user’s expectations)
Meaningful (it does something important or valuable)
Pleasurable (it is enjoyable to use)

So, I will end with one thought. Even if the system meets "Useability" standards for clinicians, achieving quality health data analytics still requires that accurate, timely and quality data is entered into the EHR avoiding the Garbage In-Garbage Out phenomenon. 

8 Key population health issues for 2012

Link: 8 Key issues for population health management in 2012

This article in Healthcare IT News caught my eye. A white paper written by the Care Continuum Alliance described significant market movement toward accountability and value driven healthcare outcomes as a result of collaborative models, such as ACOs. However, there are 8 key issues that could affect population health management in 2012:

1. Accountable care and the Medicare Shared Savings program
2. Consumer use of mobile and eHealth technologies
3. Reducing avoidable hospital readmissions in Medicare
4. Quality improvement in Medicare advantage
5. Opportunities to support insourced programs
6. Improving care coordination for dual eligibles
7. Federal support for prevention and wellness
8. Development of ACA health insurance exchanges

Each of these items contains a plethora of complex issues that will require agreement, alignment, and cooperation between distinct parties. In order to simplify my thoughts on this topic, I offer the following.

Accountable care and collaborative models certainly provide the opportunity with electronic records to capture and disseminate research and/or de-identified clinical data for surveillance. The link to "accountability" also provides the impetus to develop predictive analytics, a personal favorite.

It is well known that mobile technology, including smart phones, are changing the nature of "computer use" and internet access. According to the article the author stated that "a patient-centered, consumer-empowered, pull-rather-than-push model will dominate, with social media in a position of importance."

Reducing re-admissions? Well, we should already be doing this, unfortunately the quality of healthcare in certain situations, or the variable factors in a patient's condition and care makes this a tough goal to reach all the time. However, Medicare tracking is looking a 3 conditions - heart failure, acute myocardial infarction and pneumonia.

Finally, the other items tout the value of competitive forces in healthcare resulting from support of "insourced programs," development of health insurance exchanges in 2014, and the single idea that is near and dear to a nurse - support for prevention and wellness!

Prevention and wellness has not been a priority for most clinicians due to its non-reimbursable status. Let's hope that changes. Since the Prevention and Public Health Fund is under discussion, Medicare added annual wellness visits and expanded coverage of obesity and cardiovascular disease prevention services.

2012 brings a year of great change and challenge. Best wishes to all for a safe, happy, and prosperous new year!

 

Healthcare Analytics: What does it take to provide excellent care for patients?

As clinicians, do we ever wonder how excellent patient care can be achieved? Do we become too involved in our deadlines, our tasks, or our own needs and lack the time to reflect and to improve? It is certainly an issue in today's healthcare environment as the delivery of care changes in the path to Meaningful Use...

Well, I watched this video today, posted by Brian Ahier. It is an epic portrait of how one individual came up with an idea that would provide quality care/experience to customers.

Click this link to watch the video - a moving and heart-felt story.

The Simple Truths of Service: Inspired by Johnny the Bagger 

May you have a Happy and Safe Holiday Season!

Healthcare Analytics: Top 5 Benefits of Clinical Decision Support (CDS)

Link: The Health Record Review by Dr. Robert Hitchcock

In Monday's EHR Watch news, Dr. Hitchcock presented five key reasons why CDS should be used in the hospital ED. Robert Hitchcock, M.D., F.A.C.E.P., is vice president and CMIO, T-System, Inc.

1. Reduce the risk of medication errors. 
2. Reduce misdiagnoses. 
3. Provide the entire care team with consistent, reliable information.
4. Improve efficiency and patient throughput. 
5. Access all information in one place. 

While clinical decision support should not replace a provider’s knowledge, experience, intuition or judgment, it can complement the clinician’s skills and enhance the quality of care provided. The ED is an ideal setting for tools that help reduce the incidence of preventable medical errors and adverse events.

I am very supportive of the need for better information at the point of care. ED environments are fast paced and filled with opportunities for mistakes. Given the history of medical errors in the US, the need for better information, for the right patient, the right provider, at the right time and for the right reasons, effective use of Clinicial Decision Support Systems has strong potential to improve clinical decision making.

More information can be found at the link for this article.

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To stay current on the HITECH Act and its quickly changing regulatory scheme visit the HITECH Survival Guide website and/or sign up for our free monthly compliance newsletter. Also, check out our FREE EHR Checklist.

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Telemedicine hits the Delta...

Link: USDA grants $6M for telemedicine in the Delta

Last week in Healthcare IT News, this article described grants for the following states and healthcare institutions that will fund telemedicine projects in rural areas. "The U.S. Department of Agriculture's $6 million in grants will fund 10 telemedicine projects in the Delta Region. The grants will help deliver health services to areas currently lacking adequate care and deliver services to 25 counties with persistent poverty." This news follows the recent announcement of the VHA to implement telehealth for veterans.

Grants are distributed as follows:

Alabama 

• The Tombigbee Health Care Authority 

Arkansas 

• Arkansas State University, Mountain Home
• University of Arkansas for Medical Sciences 

Illinois 

• Connect SI Foundation

Kentucky 

• Murray State University 

Mississippi 

• Delta Health Alliance 
• City of Mound Bayou 

Louisiana 

• Building Healthy Communities 
• Franklin Parish Hospital, Service District No. 1
• Ochsner Clinic Foundation 

What I find especially interesting about this news item is that it wasn't too long ago that telemedicine and telehealth was only a prospective opportunity on the horizon. I have heard (through the grapevine) that there is also special funding for broadband internet to rural areas and it seems that a telemedicine platform may rely on its availability.

The article (at the link above) describes methods that will be used to provide care or support services for these rural communities. More information can be found in the article, however a sample of the projects are listed below:

• Mobile Health Van Program (MHVP)
• Link hospitals in rural and impoverished counties.
• Neonatal Resuscitation Program (NRP) in Arkansas where there is high incidence of teen pregnancies.
• Equipment and support for the Delta Telecommunications Centers (DTC) project to address long-term care needs.
• Simulation and Medical Learning Lab Project that will provide distance learning equipment and support.

From a nursing perspective, the longer an individual can remain in their home environment, assuming a solid support group, the more they remain independent. Perhaps telemedicine will be the incentive that encourages people to become more proactive in their health. It will be interesting to learn about health outcomes resulting from telemedicine. There are many positive results of its use in Europe. I am hopeful we will discover the same here at home.

 

Healthcare Analytics: Occupy Healthcare Arrives...

Link: Healthcare IT News 6 things to know about Occupy Healthcare

I first saw the announcement about Occupy Healthcare on Facebook. Then I read this Article about 6 things to know about Occupy Healthcare. Now there is a website for Occupy Healthcare. There is movement stirring among the Autumn leaves...

The Occupy Healthcare message ...

When one sets out to occupy healthcare, what is the end goal? How will we know we have successfully made a difference in healthcare and created the system we all want and deserve?

As stated on our about page: “It has always been the right time to take on the issue of healthcare, but now we have the tools, the ability to organize and the knowledge to make a difference.” But yet, as we build momentum for our movement, how will we know what success has been and what impact, if any, we have had with our movement.

One thing we all do know – the healthcare system will not easily change."

According to Healthcare IT News the following are 6 need-to-know Occupy Healthcare themes:

1. It has clear principles.

2. Supporters recognize American healthcare isn’t the best in the world.  

3. It’s bringing significant issues to light.

4. It’s demanding more attention. 

5. It has noteworthy ties to the insurance industry. 

6. It has somewhat specific demands. 

To read more about these items, click on the link above.

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 Looking for best of breed HIPAA Training?

To stay current on the HITECH Act and its quickly changing regulatory scheme visit the HITECH Survival Guide website and/or sign up for our free monthly compliance newsletter. Also, check out our FREE EHR Checklist.

If you need tools that will help with your compliance initiatives then check out the HSG Store. Do you need an Internet Lawyer with HITECH /HIPAA experience?

Tough Decisions in "A Difficult Moment"

In recent times we have all come across situations in which difficult healthcare decisions must be made. I share this young man's story.. "Live simply so other people can simply live.." 

Department of Veterans Affairs to Implement Telehealth

Link: Department of Veterans Affairs to Implement Telehealth

As reported in Healthcare Informatics on Nov, 7th, "The Online Care service will aim to improve access by allowing Veterans to have online visits with their own providers, as well as multi-disciplinary care teams when needed, through the Internet. Using two-way video, secure text chat and/or phone, providers will be able to review patients’ clinical information, discuss symptoms, provide medical advice, and diagnose and prescribe medications as appropriate. At the end of each online consultation, a record will be captured automatically that the Veteran can share with appropriate healthcare providers, maintaining continuity of care."

Just a few months ago I was on a panel to discuss Telehealth at Bloomberg/BusinessWeek's NYC studio.

In January, 2011 the World Health Organization produces report on Telehealth.

This is great news for rural America and for our Veterans. In fact, last night it was reported that internet broadband services are to be provided to low income Americans for $9 per month. Amazing! After I heard that I said to my husband.. they're preparing for Telehealth and Telemedicine!

Wow, things are moving so fast it is becoming difficult to stay informed!

Happy Veteran's Day and the Blue Button

Link: ONC Celebrates Veteran's Day with the Blue Button!

Today is a special day for several reasons. First, it is a day of respectful celebration for all our military and their families who have sacrificed to serve our country. My family has been involved with the military over the course of generations. My grandfather was in the Navy during WWII, my brother, daughter, and her husband have all served or are currently serving in our Armed Forces - in Iraq and Afghanistan.

When I first became a Registered Nurse, I chose to work at a VA Hospital for two simple reasons. First, to honor my family's valor and service, and to provide compassionate care for veterans in their time of need. Second, as a former IT Exec I wanted to experience the Veterans Health Administration's VistA CPRS System not only to document and analyze patient data, but also because I knew (from previous IT experience) that any data in an electronic format could be used to make better informed health care decisions. It was an honor for me to serve in this way; my small contribution to our servicemen and women.

Recently, I learned about the "Blue Button" that is on My HealthyVet, a secure Web portal, that enables veterans to easily download and share their electronic VA medical records with physicians or family members. 

When the news was first released about its availability on Veteran's Day, it confirmed something that I have thought for quite a while - the VHA takes a proactive stance in delivering effective medical treatment, education, and healthcare to its servicemen and women.

In addition to providing access to patient records, the blue button provides other important healthcare benefits. "Veterans can also download medical appointment schedules and prescription history, as well as actively participate and manage their health and health care by updating their records online.

More than 400,000 veterans and members of the military have used the Blue Button, which is a definite sign of success given it’s only been in existence for a year."

Click on this link or the one above to read a story on the U.S. Department of Veterans Affairs’ (VA) Blue Button, that allows veterans with online access, to download, and manage their electronically-stored health data.