Given the recent focus on the value of health IT (HIMSS recently asked those of us covering the space to respond to its importance; you can see my response here: HIMSS Asks: What is the Value of Health IT?), the topic remains an intriguing one. With ever-present changes to the landscape, we’re in the midst of major and continual upheaval about how technology can serve, yet improve care quality and outcomes.
The use of electronic health records, for example, continues to permeate the space. But even as pervasive as the technology is — during 2006 through 2013, the percentage of physicians using any EHR system increased 168 percent, from 29.2 percent in 2006 to 78.4 percent in 2013, according to the CDC. Nearly half of physicians (48.1 percent) were said the be using the more comprehensive “basic system” by 2013, up from 10.5 percent from 2006, but that doesn’t mean the solutions are completely meeting the needs of physicians.
That said, I asked Sean Morris, director of sales for Digitech Systems, for some perspective. He’s worked in health IT for more than 20 years. He agrees with me, that penetration of EHRs remains less than 50 percent. Even so, as physicians have moved aggressively toward the technology, in large part because of meaningful use, not all of the systems that have been deployed are working as expected.
“EHRs were the new shiny thing and everybody wanted to chase after them,” Morris said. “But issues came up as people began to evaluate and use the technology. They discovered that there’s really no bridge from the information stored in EHRs charts and other records outside the EHR. They need to bring it together without killing their practice.”
As the age of EHRs begins to fade past its prime and as practices begin to evaluate second generation solutions, Morris said history is likely going to repeat itself unless practices begin to deploy solutions that help them use all of the data stored in the records.
Morris said that in many cases, current EHRs don’t actually need to be replaced, rather built upon.
Mobile healthcare trends, they’re only going to get more prevalent. That said, drchrono provides its official take on the top six mobile healthcare trends that are on the minds of physicians, business leaders and patients.
Daniel Kivatinos, COO and Co-founder, drchrono throws his hat in the ring and takes a look at some noteworthy mobile healthcare trends and issues that will be headlines this year.
Consumer Accountable Care – Today’s mobile devices allow consumers to become more accountable for their care. As high deductible healthcare plans become more popular, consumers are empowered now more than ever with access to reviews of physicians and can also track comparison of prices for healthcare procedures. Education about how to manage their own health is now easier, so patients are savvier and more informed with access to more apps and websites.
Here are a few examples of some popular tools and apps that consumers are using to be more responsible and own their health:
Less is Now More – As physicians get paid less, physicians are finding tools to do more with less. For example, with just an iPad a physician can run its practice, accessing and managing patient data. According to a recent article in The USA Today, as the demand for healthcare goes up and as a shortage of 45,000 primary care physicians is predicted by 2020, more non-physicians are doing some of the work, such as nurse practitioners, pharmacists and physician assistants. Quality metrics software pushed through EHRs can also simplify digital health and assist with reimbursements, as well as quality and efficiency standards.
There is so much data coming at physicians on paper, they generally skim a medical record, sometimes missing key information. Organizing all of the data in a digital format flagging the most critical, relevant data pertaining to a patient is a key time saver. The reality of the situation is that with paper medical records this workflow isn’t possible.
ICD-10 has been delayed. Change has been left unchanged. The can has been kicked down the road by politicians in Washington, despite a great deal of opposition from those in healthcare. Of course, opposition to the delay seemed to matter little as it was voted upon, and passed, as part of the broader SGR patch.
Athenahealth, one of the better known vendor names in the health IT landscape issued the following statement in reaction to the news of the delay of ICD-10 for another year to October 2015. Ed Park, executive vice president and chief operating officer, athenahealth, said: “It is unfortunate that the government has once again chosen to delay ICD-10. athenahealth and its clients are/were prepared for the ICD-10 transition, and in fact we have national payer data showing that 78 percent of payers are currently proving readiness in line with the 2014 deadline. The moving goal line is a significant distraction to providers and inappropriately invokes massive additional investments of time and money for all. The issue is even more serious when considered in association with another short-term SGR fix and 2013’s meaningful use Stage 2 delay. It is alarmingly clear that healthcare is operating in an environment where there is no penalty for not being able to keep pace with necessary steps and deadlines to move health care forward. Our system is already woefully behind in embracing technology to drive information quality, data exchange, and efficiency, and delays like this only hinder us further.”
Sharp words, but appropriate. It’s nice to see a vendor come out and speak some truth, at least as they see it. Despite the somewhat shocking and seemingly inappropriate delay of ICD-10, it’s clear the waiting will continue for the new deadline.
Athenahealth is not alone. Others feel similarly about the delay. The following are responses from several healthcare practitioners and their partners about the ICD-10 delay. They provide some interesting insight about the move from October 1, 2014, to 2015 and express disappointment and, in some cases, anger about the postponement.
Michele Hibbert-Iacobacci
Michele Hibbert-Iaccobacci, vice president of information management and support, Mitchell International
ICD-8 was not an industry standard, so when ICD-9 was introduced, it was a huge undertaking to try and get people trained. For the ICD-10 transition, we have a current standard to work with. The real roadblock for many are the intricacies of ICD-10 because despite all the preparation training you go through, if you don’t have an anatomy and physiology background, it’s going to be a lot harder. I can understand why then, the compliance date would be pushed back but with all the time the industry has spent talking about ICD-10, there are so many resources and educational materials by now that are readily available to healthcare entities. The 2014 ICD-10 compliance date was actually very realistic and attainable with the proper resources.
What’s more confusing in this scenario, is the fact that non-covered entities including property and casualty insurance health plans and worker’s compensation programs, along with others, have started to switch to ICD-10 codes in effort to seamlessly align with the rest of the industry. It’d be a mess if the vendor or partner you were using wasn’t prepared. So now there’s a disconnect. Half of the industry is prepared, half isn’t. There will always be bumps in the road when you’re talking about an entire industry switching to a new language, but a bit of tough love would have done the industry good here. Now we’ll see more time, more energy and more resources go to waste.
A new security risk assessment (SRA) tool to help guide health care providers in small to medium sized offices conduct risk assessments of their organizations is now available from HHS.
The SRA tool is the result of a collaborative effort by the HHS Office of the National Coordinator for Health Information Technology (ONC) and Office for Civil Rights (OCR). The tool is designed to help practices conduct and document a risk assessment in a thorough, organized fashion at their own pace by allowing them to assess the information security risks in their organizations under the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. The application, available for downloading at www.HealthIT.gov/security-risk-assessment also produces a report that can be provided to auditors.
HIPAA requires organizations that handle protected health information to regularly review the administrative, physical and technical safeguards they have in place to protect the security of the information. By conducting these risk assessments, health care providers can uncover potential weaknesses in their security policies, processes and systems. Risk assessments also help providers address vulnerabilities, potentially preventing health data breaches or other adverse security events. A vigorous risk assessment process supports improved security of patient health data.
Eric Munz, vice president of business process crowdsourcing at Lionbridge Technologies, where he manages and leads the delivery of in-person, telephonic and video crowd-enabled interpretation solutions to meet the unique needs of customers across a broad range of industries, discusses here the need for interpretation services in health systems.
He also touches upon interpretation mandates for hospitals, the struggles large and small health systems face with interpreting to ensure the best patient care; he discusses the benefits of using a secure interpretation solution; and provides advice for implementing such a solution.
What are interpretation mandates for hospitals? How has equal access to language changed recently with ACA?
There are about 10 different places in the Affordable Care Act (ACA) that require hospitals to develop and implement a system that provides interpretation services to patients with limited English proficiency (LEP), to have equal access to healthcare. For example, Section 1557 of the Patient Protection and Affordable Care Act focuses on non-discriminatory policies and procedures, including those based on the grounds of language and national origin.
Now, healthcare facilities are facing a renewed struggle to provide such interpretation services because of the influx of LEP patients newly enrolled in insurance plans under the ACA. According to the UCLA Center for Health Policy Research, 36 percent of newly insured individuals under the ACA in the state of California are LEPs — compared to only 9 percent of LEP patients prior to the ACA enactment. That is a dramatic increase in non-English speaking patients to serve.
Other states facing a jump in patients speaking foreign languages include Texas, Arizona and Florida. Across the nation, healthcare providers must be at the ready to interpret more than 300 languages to remain compliant. Otherwise, they risk incurring monetary penalties.
Why is it often a struggle to deliver interpretation for patients in large and small hospitals alike?
A big city hospital could serve patients representing a dozen different languages or more on any given day. That presents a very practical logistical problem for facilitating so many different conversations in so many different languages. This is why many facilities partner with vendors to provide on-site interpretation, but these interpreters often work on an on-call basis, delaying treatment. They also often charge two-hour minimum rates for their service even if it’s a 30-minute conversation. In a rural hospital, there simply may not be someone with the skillset to speak a particular language within the geographic area.
For these reasons, the biggest challenge for hospital management is determining how to efficiently meet the demand for interpretation services, which are required by law, while remaining cost conscious throughout the process.
Today, healthcare organizations are being challenged to provide quality care while improving accuracy, efficiency and accountability. With the additional strain of staff reductions, space constraints, budget cuts and technological advancements all competing with new regulations, there is almost a perfect storm of workflow changes for clinicians to address and adopt. While most focus on the immediate challenges of electronic health records, they may not think through all the implications when implementing the technology used to access it.
Amid the widespread adoption of EHRs, caregivers are equipped with a multitude of devices to access electronic reports – including tablets, handhelds, wall mounts and mobile carts. Furthermore, the logistics governing electrical, phone and network cabling, not to mention physical “real estate,” can stretch the ability to cope for some facilities. It’s not surprising to find cutting-edge IT equipment being used in cramped, stuffy rooms with inadequate furniture, mounting surfaces and storage. At the recent HIMSS conference, we presented to dozens of clinicians and explored how the enterprise-wide application of ergonomic principles within a hospital setting can help manage and sustain all of the often overlooked aspects of clinical workflow.
Ergonomic Factors
Ergonomics is the application of scientific knowledge to a workplace to improve the well-being and efficiency of workers. Ergonomic design considerations begin with human abilities and limitations and how they affect the work process. An ergonomic workplace increases workers’ efficiency and productivity, while helping to reduce fatigue, exertion, and musculoskeletal disorders.
Studies have shown that a good ergonomics program also favorably influences reduction of workplace injuries and absenteeism, and contributes to overall employee wellness.
Guest post by Darren Leroux, senior director of product marketing, WinMagic.
Gone are the days where all personal health information solely lived in giant filing cabinets behind a receptionist’s desk or in the administrative office of a hospital. Today, patient data resides everywhere – desktops, laptops, smartphones, tablets and USB drives. Understandably so – given the rise of mobile computing and bring-your-own-device (BYOD) policies in healthcare, the once straightforward process of protecting patient’s personal health information has since evolved into a complex and overwhelming undertaking.
Just the Facts
According to a recent study, 81 percent of healthcare organizations are now allowing employees and medical staff to use their personal laptops and mobile devices to connect to provider networks or access company email. Interestingly enough, the same study found that of that 81 percent of healthcare institutions enabling a BYOD strategy, 54 percent did not believe that those devices were secure enough in the workplace; 65 percent of data breaches reported to the Ponemon Institute occurred on laptops and mobile devices over the last five years — it’s no wonder that more than half of those surveyed aren’t confident in the security of their devices
When we refer to personal health information at risk, we’re not just talking about historical health records – the potential for a data breach casts a much wider net, including patient billing information, clinical trial data and even employee information like payroll numbers. With so much sensitive, unprotected data up for grabs, we’re inclined to ask ourselves – how? How is this significant rise in healthcare data breaches even possible, and how do we stop this from continuing?
Below are the top three gaping security holes in remote healthcare data practices that are answering our question of how is this rise in breaches in possible:
Guest post by Domingo Guerra, president & co-founder, Appthority.
Last year, 2013, was a big year for mobile applications, including medical and health-related apps. As many medical centers have sought to increase patient engagement, improve outcomes and reduce healthcare costs, digital tools, such as iPads, smartphones, online portals and text messaging in hospitals are rapidly becoming commonplace. Smart health tech has gotten serious. Patients and doctors alike use medical apps. Physicians can access symptom checkers, drug information, medical calculators and more via smartphone and tablet apps. Patients can use apps to find doctors, set appointments, order prescriptions, receive test results, track calories, measure their heart rates and even monitor chronic diseases like diabetes. Patients and doctors agree that the immediate feedback and increase in available data will change the face of medicine. But will the face of privacy change with it?
Acquiring huge amounts of personal data from individuals could enable a more personalized and data driven approach to medicine. This is a very seductive concept, based on the implicit assumption that the more healthcare providers know about the patient, from analyzing his or her data, the better (and more customized) care the patient will receive. However, personal data, now collected and collated by the user’s health gadget, will be incredibly valuable to more than just the patient and the provider. Devices, whether they’re Google Glass or fitness wristbands will need to be integrated with newly developed apps, and existing apps will need to be heavily adapted to work properly. These technology integrations can potentially open back doors that allow cybercriminals to enter and extract sensitive data.
The aggregated data gathered from a wearable wristband capable of tracking a user’s heart rate, and expiration rates along with their blood sugar level and, of course, location can offer a truly comprehensive view of a user. Yes, it’s still early in the healthcare wearables space, but it was “early” in the mobile and BYOD spaces not long ago. Just as BYOD has led to security concerns for sensitive corporate data, these new healthcare devices should be a concern for personal privacy. As users are now literally plugging themselves into the Internet, it’s important to remember that cyber attackers can gain details about daily routines, patterns, and lifestyle, as well as location. This private information, tied together in a dossier that can include a user’s location, income, health status, and other attributes such as sexual orientation, could be of interest to many other groups.
