Guest post by Stephen Cobb, senior security researcher, ESET.
Whatever you thought of President Obama’s penultimate State of the Union address, you have to admit it set some sort of record for the most words devoted to issues of data privacy and security (198 by my count). Furthermore, those words alluded to a raft of statements and announcements on these topics that were published in the days leading up to the speech. In short, it is clear that this President wants to make some changes with respect to cybersecurity and data privacy. What is not yet clear is how those changes will affect healthcare IT and the management of electronic health records. Will breach notification requirements change? Will penalties for breaches be increased?
The answers are not entirely clear at the moment. For a start, the President is a Democrat, but Republicans control the House and Senate. In other words, it is hard to know which of his proposals will be enacted. That said, it is better to look at them now and ask questions, engaging in the debates they are bound to provoke rather than wait and see what new laws finally emerge. For example, the President proposes to erect a single national 30-day data breach notification law in place of the scores of different state data laws that companies currently have to comply with. How will that affect electronic health records?
The answer may be “very little” and that could be good news for electronic health records and health IT. In its current form, the proposed Personal Data Notification & Protection Act does not disrupt existing federal notification requirements related to health data breaches. The draft legislation does not apply to HIPAA covered entities and business associates, nor the FTC covered vendors of personal health records. Here is a boiled down version of the current language which I have put in quotes to show it comes from the bill: “Nothing in this Act shall apply to business entities to the extent that they act as covered entities and business associates subject to the HITECH act (section 17932 of title 42), including the data breach notification requirements and implementing regulations of that act. Nor will it apply to business entities to the extent that they act as vendors of personal health records and third party service providers subject to the HITECH act.”
If the law were to be passed with that language intact, it would leave in place what many of us still think of as the HIPAA 60-day notification deadline, as well as the FTC 30/60-day PHR regime. And when you’re trying to comply with a regulatory regime, a lack of change can be good. Another way of looking at the breach notification issue is that the healthcare sector, while often maligned for leaking data, is actually a pioneer in notification. The HIPAA privacy and security requirements were in play even before California passed the first of the state breach notification laws, which now exist in some form in more than 40 states (creating the patchwork regulatory nightmare that the President’s unified federal law seeks to dissolve).
Guest post by Mitchell Goldburgh, cloud clinical archive product manager, Dell.
Stage 2 meaningful use criteria require providers to make diagnostic reports and associated images accessible through a certified electronic health record. That presents a difficult hurdle for many hospitals, especially community hospitals that are not connected to a large health system. And with the plethora of EHRs in use across healthcare, the task may be difficult for some multi-hospital systems.
This is a watershed moment for many imaging practices, and Stage 2 requirements may be the factor that sends most imaging files to a vendor-neutral archive (VNA).
Knowing that Stage 2 will require facilities to integrate their medical images with EHRs, the best VNA providers have in place automated tools that can integrate these files with all of the major EHRs and with many of the smaller EHR vendors. The value of a VNA comes from local and remote content brought to EHRs with a consistent presentation of results and images at the point of clinical care. VNA solutions offer a global viewer with a common toolset to navigate documents and imaging content, thus simplifying the access and freeing users from the need to learn multiple application navigations.
As technology in imaging increases the complexity of data, the presentation of information consistently for non-imaging specialists within the accountable care group becomes crucial to “customer” satisfaction with the imaging services. But VNA software is only a part of the solution – an integrated model that simplifies delivery of content can best be achieved with a service delivery model enabled with cloud content management.
Archiving-as-a-serviceis the model for the future
So what does this model entail? A good vendor-neutral archiving solution enters the scenario once a clinical exam is reported. At that point, the job of the PACS is done. The exam file is transmitted to an on-site server (supported by your archiving service provider) that transforms it into a vendor-neutral format. Current files are stored on site for fast access and also uploaded to a secure cloud platform. At this point content notification occurs, informing external systems that the report and clinical imaging data are available. In this model clinicians can view content anywhere, from any device, either as a stand-alone application from the VNA or through the web-enabled EHR accessing the VNA.
Patient data resides in many systems and in multiple locations, which requires adept coordination and collaboration to deliver quality healthcare. However, sometimes pertinent data slips through the cracks – as demonstrated at Texas Health Presbyterian Hospital in Dallas.
Dr. Daniel Vargi of Texas Health Resources explained the breakdown in EHR miscommunication in a recent CNN interview: “While we had all of the elements of information that were critical to understand a potential diagnosis of Ebola, the way we built them into our clinical process – not only the process of gathering the information but then communicating the information between caregivers – was not as front-of-mind as it should have been.”
This gap in information sharing needs to be bridged, especially to mitigate risk when dealing with significant diseases such as Ebola. It is critical that healthcare systems obtain a 360-degree view of patients, and achieve EHR interoperability.
Providers wrestle with EHR technology to enter patient information that is often never reconciled with patient history or existing data on countless other data sources including ancillary services, and other healthcare organization’s electronic medical record (EMR) system.
The HITECH Act (2009) initiated governmental incentives and penalties designed to nudge healthcare to adopt certified EHR technology for better patient outcomes. As of 2013, 59 percent of acute care hospitals (non-federal) have adopted at least a basic EHR system with clinician noted.
Being adiehard Kennedy fan, this is what I’d normally quote to someone purchasing the latest commodity, or acquiring the latest service that everyone is flocking to stores to get – Conformity is the jailer of freedom and the enemy of growth. However, outsourcing medical billing is a different ballgame altogether.
I’m often confronted by worried physicians who are already overwhelmed by a recent deployment of an electronic health record (EHR) system at their practice when they hear that the clinic next door is outsourcing medical billing. With an expression that could easily pass off as ICD-9 code number 564.0 (a person suffering from constipation), the hesitantly ask me this: “Why is everyone outsourcing medical billing; and even if they are, why should I?”
In response to all those people and all the physicians out there having similar questions, here’s why:
1. It costs significantly lesser
Medical billing companies charge rates as low as three percent of your monthly collections to handle this process for you. Compare this with the costs of a dedicated medical billing department at your practice, and the difference will be significantly lower.
The salaries of the staff won’t be the only cost there, as they’ll need a room or office space to work in, desks and chairs to work on, dedicated equipment (computers, fax machines, printers), and miscellaneous expenses, such as stationary in addition to utility costs. Now when you accumulate all of this with the insurance packages of these staff personnel and the maintenance of this equipment, you’ll realize that the percentage of collections work out a lot cheaper.
2. A large staff base
Each practice assigns a specific budget for billing according to which many small and medium sized practices are able to employ one or two billers who handle all of the practice’s billing related tasks.
More often than not, these understaffed and overworked personnel come across situations whereby they have to decide between negotiating over denied and underpaid claims, or moving on to the numerous pending cases. Given their constraints, they choose to move on, settling for lower (sometimes zero) payments on such claims.
The large staff base of a medical billing company will rid you of this problem as they’ll have different personnel to handle different processes, resulting in the maximization of reimbursements.
Electronic health records uptake in the U.S. has accelerated dramatically as a result of government initiatives and the considerable resources – both capital and time – healthcare providers have invested over the past five years. Electronic health records have become the heart of health IT, and U.S. clinicians use them on a daily basis.
Frost & Sullivan’s newest health IT analysis, “EHR Usability—CIOs Weigh in On What’s Needed to Improve Information Retrieval,” finds that as the market matures and the volume of EHR data proliferates, ensuring reliable information retrieval from EHRs at the point-of-care will become a priority for healthcare providers.
In spite of significant progress in EHR adoption, the road is paved with pitfalls for many providers. Frequently highlighted customer pain points include:
Slow and inaccurate information retrieval from EHRs, as well as difficulty in finding and reviewing data, both of which result in productivity losses for clinician end-users as well as potential risks to patient safety.
Inability to create targeted queries or easily access unstructured data such as clinician notes.
Time-consuming data entry tasks.
“U.S. regulatory authorities will take notice of the growing chorus of complaints about EHR usability, resulting in a push to devote more resources to solving this issue,” saidFrost & Sullivan Connected Health Principal Analyst Nancy Fabozzi. “Further, the high levels of end-user frustration with usability present strong business opportunities for pioneering technology vendors.”
Health IT pain points seem to be lingering long despite the never ending promises and hope eternal new technology innovation seems to offer. Every sector has its prickles, no doubt, and much is left to overcome in healthcare, but given the complexity and the copious amount of change and development here, it’s of little surprise that pain is being felt.
What may be surprising, though, is that like patient engagement, there seems to be a different type of pain, and severity of pain, depending on who you ask.
With that, for greater clarity, I decided to ask some of health IT industry insiders what they’re pain points were and why. Their responses follow:
Dr. Trishan Panch, chief medical officer, Wellframe
One of the biggest pain points for hospitals is that we’ve come across a health system’s inability to scale care management resources. They are effective in improving outcomes when patients are engaged, but because of limitations around existing models (i.e. human interaction via phone or in-person) only a small proportion of the patient population can be engaged. That’s why organizations are turning to technology solutions to scale care management resources to reach more people.
One of the biggest pain points for physicians today is the lack of interconnectivity between different IT systems. Participation in the meaningful use program has helped create some common standards for communication but, for a variety of reasons, these have not yet lead to widespread, effective clinical data sharing. Few physicians can operate in the ecosystem of a single electronic medical record, since they often work in systems that are different, from practice, various hospitals and other places of care.
Interoperability is a pain point in healthcare IT, particularly when it comes to transitions in senior care. Connecting the care delivery ecosystem to provide safer transitions of care is critical to long-term care. While some individuals may require short-term rehabilitative care, others may need home-based care, assisted living or long-term and hospice care. As seniors move through these different stages or between acute care and post-acute care, these transitions pose challenges for healthcare providers. Ideally, all the information that clinicians need to treat the individual will be available when he arrives at his new destination. However, this is not always the case. Healthcare providers, both long-term and acute, must invest in an infrastructure that supports seamless transitions of care; interoperability plays a vital role. Connecting healthcare providers across the care continuum will allow for better health outcomes, help reduce unnecessary hospital re-admissions, as well as keep healthcare costs down.
There are various statistics about the negative impact paperwork has upon providing healthcare. The AHA has estimated it adds at least 30 minutes to every hour of patient care provided. A main pain point continues to be the ability for IT to implement efficient EHR systems. At the core of any EHR system are its image capture capabilities. It must be simple to use throughout the workflow process. This includes image capture, editing, saving and sharing. The capture, or scanning, must be speedy. Editing features must be clear in how to use. This minimizes learning curves at the start. It also optimizes the speed of processing documents during the life of its use. Easy saving to local or network locations should also enable simple and secure sharing too. When one, some or all of these areas stall, it can cripple the realization of benefits from digital document management.
Dissatisfaction with inpatient electronic health record systems among nurses has escalated to an all time high of 92 percent, according to the Q3 2014 Black Book Loyalty survey results to be published later this month. Disruption in productivity and workflow has also negatively influenced job dissatisfaction according to nurses in 84 percent of US hospitals. Eighty-five percent of nurses state they are struggling with continually flawed EHR systems and 88 percent blame financial administrators and CIOs for selecting low performance systems based on EHR pricing, government incentives and cutting corners at the expense of quality of care.
Eighty-four percent of nursing administrators in not-for-profit hospitals, and 97 percent of nursing administrators in for-profit hospitals confirm that the impact on nurses’ workloads including the efficient flow of direct patient care duties were not considered highly enough in their administration’s final EHR selection decision.
Black Book polled nearly 14,000 licensed registered nurses from forty states, all utilizing implemented hospital EHRs over the last six months. Survey respondents also ranked the vendor performance of 19 inpatient EHR systems from a nursing satisfaction perspective.
“Although the inpatient EHR replacement frenzy has calmed temporarily, the frustration from nursing EHR users has increased exponentially,” said Doug Brown, managing partner of the survey firm Black Book Market Research. “The meaningful use financial incentives for hospitals have many IT departments scurrying to implement these EHR’s without consulting direct care nurses, according to the majority of those polled by Black Book.”
I’m a huge fan of infographics. I think they provide simple and very easy to understand explanations of often difficult to comprehend subjects, like health IT. The following health IT infographic shows the evolution of the electronic health record since 2009 when they really started to gain attention. One of the things I particularly like about this image is that it defines the difference between EMRs and EHRs, something that is often confused, which is a huge pet peeve of mine.
What’s somewhat interesting about the information here, too, is that large, teaching hospitals utilize EHRs more than other organizations. Ironically, in the past, it’s been reported and much discussed that teaching hospitals don’t actually spend much time teaching student how the use the electronic health records.
Also, the bigger the practice, the more likely they are to have an EHR. This suggests that size does matter.
There’s some other good info buried in the following piece. Take a look; I look forward to your feedback.
The Affordable Care Act supports healthcare providers in reducing costs and improving efficiency while delivering quality care. Accountable care organizations (ACOs) achieve these goals by enabling physicians, hospitals and other healthcare providers to create networks and share responsibility to deliver care to Medicare and other patients.
At the heart of the ACO model are three core principles:
ACOs are provider-led organizations with a strong primary care base, and collective responsibility for quality and per capita costs.
ACO payments are linked to improvements in quality that also reduce costs.
Performance measures that support improvement are sophisticated and reliable, and demonstrate that savings are achieved through improvements in care.
Joining an ACO is voluntary, but the federal government encourages participation to reduce unnecessary or duplicated services, prevent errors and keep patients healthier. When providers successfully coordinate services to meet a long list of quality measures, they become eligible for bonuses.
The Current Environmment
Medicare offers several ACO programs, including the Medicare Shared Savings Program, the Advance Payment ACO Model and the Pioneer ACO Model, but many other public and private models exist. Some are sponsored by physicians groups, while nonprofit organizations, hospital systems and health insurers sponsor others. The Pioneer Model was designed for early adopters of coordinated care, and is no longer accepting new members.
To date, more than 600 public and private ACOs have formed; in 2012, the first year of the program, they generated $87.6 million in gross savings. Government support is spurring considerable growth, and ACOs could well become the dominant model in healthcare.
Guest post by Cliff Bleustein, M.D., M.B.A., chief medical officer, Dell Services.
For decades, reimbursement for the time spent coordinating care and keeping people healthy has been mostly non-existent. But the tide is turning, as government and private payers see that coordinated care and the time spent keeping people healthy can lower the amount of money they spend treating illness.
Primary care physicians are even seeing higher reimbursements in some areas. For example, beginning in 2011, CareFirst BlueCross BlueShield, the largest insurer in the Washington, D.C., area, substantially raised reimbursement rates for general internists and family practitioners who adopted the medical home model, which emphasizes care coordination. They also rewarded them with significant bonuses if they met quality standards and reduced costs. They also provided the physicians with round-the-clock nursing assistance to help with their sickest and riskiest patients.
CareFirst CEO Chet Burrell said in news reports that the program is saving “hundreds of millions of dollars in accumulated, avoided costs.”
That’s good news for everyone. Coordinated care requires an upfront-investment in people and technology that is often beyond the resources of a primary care practice, but it is far less expensive than the business-as-usual, uncoordinated care that has seen costs rise at double the rate of inflation for most of the past two decades. If public and private health plans make that upfront investment, paying for the time and the needed resources, they can reap the financial benefits while patients reap the benefit of better health.