Mobile Healthcare Trends: Daniel Kivatinos, Co-founder, drchrono Offers His Perspective

Daniel Kivatinos
Daniel Kivatinos

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.

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ICD-10 Delay: Healthcare Leaders Respond

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-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.

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HHS releases security risk assessment tool to help providers with HIPAA compliance

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.

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Health IT Thought Leader Highlight: Eric Munz, Lionbridge Technologies

Eric Munz
Eric Munz

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.

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Ergotron Healthcare: How Ergonomics Can Improve Hospital Workflow and Neutralize Technological Challenges

Steve Reinecke
Steve Reinecke

Guest post by Steve Reinecke, CLS/MT, CPHIMS, AVP Ergotron Healthcare.

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.

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With the Rise of Mobile Computing and BYOD in Healthcare, Protecting Patient’s Personal Health Information Has Evolved into a Complex, Overwhelming Undertaking

Darren Leroux
Darren Leroux

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:

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Medical Apps are Here to Stay: So How Do We Keep the Value and Lose the Risk?

Domingo Guerra
Domingo Guerra

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.

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How Health IT Can Affect Individual Patient Outcomes

As someone passionate about patient engagement and using health IT and other technologies to improve care, I continue hear a great deal about how solutions can actually benefit population health. Even at the most recent HIMSS conference, “patient engagement” as a term clearly has become one of this year’s biggest buzz phrases.

Conference sessions were dedicated to the topic, vendors marketed their services to solving some of the issues associated with it and seemingly everyone in attendance had an opinion for what needs to be done or at least has some strategies for bringing more patients — or their data — directly into the care sphere.

Problem is, from my perspective, that, unfortunately, too much is still being said about population health and not nearly enough about individual health. In theory, I understand why this must be, but in practicality, I don’t understand the seemingly lack of attention individuals are receiving. Obviously, if population health outcomes improve then that must logically mean individual health outcomes are improving.

And while I understand that not everyone or every need can possibly be addressed, that doesn’t mean we shouldn’t be trying to fill those needs. The current conversations about improved population health remind me of a common business/life solution when addressing a major problem: How does one eat an elephant? One bite at a time. Likewise, it would seem the same approach could be taken to achieve improve population health outcomes: One individual patient at a time.

That said, I asked some folks within the health IT community how technology affects individual patient outcomes. Though some of the ideas here are still high level, perhaps they are a step in the right direction. Here are some of the responses I received:

Ben Quirk
Ben Quirk

Ben Quirk, CEO, Quirk Healthcare Solutions

What are the real-world benefits of electronic health records, for example, to a specific individual? To answer that question, let’s take a look at a fictional person we’ll call “Bill.” Bill is quite elderly and has a variety of age-related illnesses. He lives in Ohio, and decides spend the winter with his daughter in Florida.

Bill’s daughter, Susan, arranges for her father to be seen by a local specialist during his stay. Susan tries to get a voluminous paper file transferred from Ohio to the new doctor in Florida, but there are delays: phone messages are missed, handwriting is misread, and no one has time to copy and mail 100 pages of medical records.

In the end, Susan is unable to get her father’s records transferred in time for the appointment with the new physician. As a result, an unnecessary test is performed, and a drug is prescribed that had caused an allergic reaction in the past.

In the future, EHRs will enable the Florida clinic to have electronic access to the same records available in Ohio. Already, Medicare and some commercial carriers have websites that list physician visits, patient complaints, diagnoses made, lab/diagnostic tests performed, and drugs prescribed. Eventually, such websites may include a full medical profile, including doctor’s notes, lab results, x-ray images and more.

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Health IT Thought Leader Highlight: Dean Wiech, Tools4ever

Dean Wiech
Dean Wiech

Dean Wiech, managing director of Tools4ever, a global provider of identity and access management solutions, has worked in healthcare for more than 25 years. Here, he discusses how IAM enhances the ROI for health systems, and how the solutions make patient care more efficient, how they work in healthcare, and how systems and records can be made more secure — for patients and providers — because of the technology.

Tell me about yourself and your experience in healthcare.

I have been actively selling software solutions in the healthcare market for 25 years. I have sold and/or managed teams in about 50 percent of the country.  I have always focused on solutions that provided a definable ROI based on productivity and time savings.

Tell me about Tools4ever. How does the company serve the space? Tell me about your products and how they are used in healthcare.

Tools4ever is a company that focuses on the identity and access governance space. We assist the healthcare market in insuring that the lifecycle of user accounts are managed in a timely and accurate manner. We also have solutions that save care providers time by eliminating repetitive login tasks and avoiding the need to call the help desk for password resets

How is Tools4ever different than some of the competitors in your space?

I believe our primary differentiator is time to implement. We can get the basics up in running in a few days to a few weeks, depending on the solution. The majority of our competitors take months to years to complete an install. The result is the healthcare organization can realize a much quicker benefit from the product and a quicker ROI.

What’s your footprint like in healthcare and who are some of the organizations you work with? How do you help them?

We have numerous hospitals and long-term care providers across the country. One example is South County Hospital in Rhode Island. It utilizes our Self Service Reset Password Management (SSRPM) solution to allow end users to reset forgotten network passwords. We then synchronize that password to several other solutions to allow a reduction in the number of credentials the employee needs to remember.

Another example is a major university hospital in New York City. It uses our user management solution for several tasks. The most recent example is provisioning patients to the network to allow them to view their records on a mobile device provided by the hospital for the duration of their stay. We also implemented a password self-service reset function to allow the patients to reset their passwords without a further burden on the help desk.

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Aetna Foundation: Using Tecchnology to Improve Health Outcomes

Here’s an infographic from the Aetna Foundation that I thought paired well with the recent piece I posted about the organization: HIT Thought Leadership Highlight: Dr. Garth Graham, the Aetna Foundation.

The image provides a pretty concise view on some of the prevailing thoughts on the use of consumer’s mobile technology and how perceptions of the technology might potentially improve patient outcomes.

Not surprising, one third of smart phone users look up health information on their devices via the web. Most surprising to me, though, is that according to the graphic, 25 percent of low-income adults own a smartphone; I shouldn’t be surprised given people’s passion for the latest devices. Hopefully, though, this will help improve their care and outcomes, individuals who, of course, would likely fall into the class of people most likely needing care but not receiving it or receiving it through non-traditional means.

If nothing else, as Aetna suggests through the image is that technology and personal devices may allow greater access to care and to information to improve care.

Such technology, and its use, is clearly the future of individual care and actionable outcomes for individuals. I only wonder what it will take to harness and implement real programs that help real people received sustainable care and guidance at the individual level, and how long it will take to become wide spread

Aetna