There’s little argument that overwhelming responsibility is placed on practice leaders to protect the security of patient records. Maintaining the accuracy, privacy and control of this data is one of the most crucial roles within the care setting. Given the high level of risk for exposure of this information and because of expanded enforcement of HIPAA, practices managing the release of information (ROI) must be more vigilant now than they have been in the past. Their processes for handling ROI need to meet not only the requirements of the law, but what’s in the best interest of the practices’ patients.
Along with a significant rise in HIPAA enforcement, practices must remain sensitive of how they handle the data that’s released to third parties. Redaction of personal information from records is one important way practice administrators can improve security, though it’s not the only way. Automating the removal of PHI by integrating redaction solutions with existing practice technology – such as electronic health records – searching and removing any protected information becomes electronic, eliminating a manual, repetitive process.
Removing risks associated with the release of PHI is possible with automated solutions that can remove data fields like patient name, dates of service, medication lists and other general information in the health record. But, even though solutions exist to automate the redaction of protected PHI, most organizations process records manually even as they migrate to electronic systems in other areas. Continue Reading
Tapan Mehta, global healthcare lead, Cisco, brings more than 15 years of healthcare information technology, marketing and business development leadership as Cisco’s global healthcare lead. Mehta is responsible for managing the development and marketing efforts for healthcare solutions including clinical workflow improvement, telemedicine, patient safety, regulatory requirements and EHR integration.
Here he discusses the demand for telehealth, the changing role of hospital health IT, wearable technology and patient monitoring and what Cisco is doing to serve its healthcare clients.
Tell me about Cisco and how it serves healthcare.
At Cisco, we see the healthcare industry as ripe for technology disruption. After doing things the same way for years, we think technology can be the catalyst that brings positive changes to how care is delivered. Drawing from our experience as the worldwide networking leader, Cisco is well positioned to help improve the future of healthcare through networked technologies that transform how people connect, access and share information, and collaborate. New healthcare technologies, like those offered by Cisco, benefit everyone – from patients to providers, payers to life sciences organizations.
What is your role, specifically, and what is the most challenging aspect of it?
I have a global marketing role where my team is tasked to develop healthcare specific solutions, go-to-market strategy and field enablement, as well as serve as the “voice of the customer” by bringing the outside-in view to Cisco and its various business groups. Healthcare is at a very critical inflection point in the industry whereby there are several key underlying currents in areas such as mHealth, telehealth, data analytics, wearables, etc. While there are several interesting opportunities to pursue, what makes it difficult is to prioritize them as each segment has substantial market opportunity and growth prospects.
What inspires you and does this translate to your leadership style?
Healthcare is very personal. It touches everyone in the society in some shape or form. I have been in the healthcare space for the past 15 years and I am extremely fortunate that I am in an industry that is going to go through a transformational change over the next decade. Historically, healthcare has fundamentally lagged behind most industries when it comes to technology adoption, but I perceive that changing over the next several years. Healthcare “consumerism,” combined with government mandates around the globe, is going to force the industry to adopt technology if it truly wants to improve quality of patient care and workflows throughout the continuum of care. I am really excited to be part of this healthcare eco-system, whereby I can make a difference in how our customers do their business and more importantly how quality of patient care can be vastly improved.
Guest post by Anil Jain, MD, FACP, chief medical officer, Explorys, and staff, Department of Internal Medicine, Cleveland Clinic.
Nearly every aspect of our lives has been touched by advances in information technology, from searching to shopping and from calling to computing. Given the significant economic implications of spending 18 percent of our GDP, and the lack of a proportional impact on quality, there has been a concerted effort to promote the use of health information technology to drive better care at a lower cost. As part of the 2009 American Reinvestment and Recovery Act (ARRA), the Health Information Technology for Economic and Clinical Health (HITECH) Act incentivized the acquisition and adoption of the “meaningful use” of health IT.
Even prior to the HITECH Act, patient care had been profoundly impacted by the use of health informationtechnology. Over the last decade we had seen significant adoption of electronic health records (EHRs), use of patient portals, creation of clinical data repositories and deployment of population health management (PHM) platforms — this has been accelerated even more over the last several years. These health IT tools have given rise to an environment in which providers, researchers, patients and policy experts are empowered for the first time to make clinically enabled data-driven decisions that not only at the population level but also at the individual person level. Not only did the 2010 Affordable Care Act (ACA) reform insurance, but it also has created incentive structures for payment reform models for participating health systems. The ability to assume risk on reimbursement requires leveraging clinical and claims data to understand the characteristics and needs of the contracted population. With this gradual shift of risk moving from health plans and payers to the provider, the need to empower providers with health IT tools is even more critical.
Many companies such as Explorys, a big data health analytics company spun-out from the Cleveland Clinic in 2009, experienced significant growth because of the need to be able to integrate, aggregate and analyze large amounts of information to make the right decision for the right patient at the right time. While EHRs are the workflow tool of choice at the point-of-care, an organization assuming both the clinical and financial risk for their patients/members needs a platform that can aggregate data from disparate sources. The growth of value-based care arrangements is increasing at a staggering rate – many organizations estimate that by 2017, approximately 15 percent to 20 percent of their patients will be in some form of risk-sharing arrangement, such as an Accountable Care Organization (ACO). Already today, there are currently several hundred commercial and Medicare-based ACOs across the U.S.
There is no doubt that there are operational efficiencies gained in a data-driven health system, such as better documentation, streamlined coding, less manual charting, scheduling and billing, etc. But the advantages of having data exhaust from health IT systems when done with the patient in mind extend to clinical improvements with care as well. We know that data-focused health IT is a necessary component of the “triple-aim.” Coined by Dr. Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services (CMS), the “triple-aim” consists of the following goals: 1) improving health and wellness of the individual; 2) improving the health and wellness of the population and 3) reducing the per-capita health care cost. To achieve these noble objectives providers need to use evidence-based guidelines to do the right thing for the right patient and the right time; provide transparency to reduce unnecessary or wasteful care across patients; provide predictive analytics to prospectively identify patients from the population that need additional resources and finally, use the big data to inform and enhance net new knowledge discovery.
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.
Garth Graham, M.D., M.P.H., specializing in cardiology, is the current president of the Aetna Foundation and former deputy assistant secretary at the U.S. Department of Health and Human Services (HHS) during both the Bush and Obama administrations. Here he discusses the Aetna Foundation, improving quality of care, how the health IT community continues to change, how can it best be used as a positive tool for better health outcomes, even at the individual level.
Tell me about the Aetna Foundation and your role within the organization? How does the Foundation impact healthcare community?
The Aetna Foundation is the philanthropic arm of Aetna, Inc. funding a number of activities across the country that promote thought-leadership and community-based impact as well as research around improving health outcomes. As the Foundation’s president, I oversee the philanthropic work, including grant-making strategies aimed at improving the health of people from underserved communities.
Overall, at the Aetna Foundation we seek to impact the healthcare community by supporting research and organizations focused on improving the health and wellness of individuals throughout the United States.
How do you go about working to improve the health status and quality of care of the individual and community?
Our Digital Health Initiative is the most recent example of our efforts to fund both national and local programs that are striving to limit healthcare disparities among vulnerable populations, as well as increase positive health and wellness outcomes for individuals. Through this initiative, we are supporting technology that can empower individuals with the convenience and control to meet their personal health and wellness goals.
We hope that by arming individuals with the best possible tools to improve their health, we can ultimately build healthier communities.
Guest post by Barbara Casey, Senior Executive Director for Healthcare Business Transformation at Cisco.
Imagine taking your car in for a routine service, only to be told you’ll need to visit five or six more garages on your own to procure an accurate assessment and treatment of the problem(s). In our current healthcare climate, this disconnected and complicated process is what most patients experience in assessing and treating their health conditions. Many of the most compromised patients, those that are elderly, co-morbid or chronically ill, are alone in their experience, left to connect the dots from cardiologist to radiologist to primary care. Layer in the emotional experience of, for example, being told you have stage four cancer and it’s difficult to focus on, let aloneremember, what the oncologist or surgeon says to do next. Yet, the onus falls solely on the patient, family member or caregiver to create continuity in the care experience.
So, as healthcare professionals, how do we help patients navigate the continuum of care when they are seeing an array of physicians and specialists in currently disconnected care settings? We need to treat the patient more like a true customer, which means upgrading the tools and methods we use to interact with them to be more intuitive and user-friendly so we touch base with them on a more regular basis.
Take for example the retail industry—Amazon and Netflix invest in complex algorithms to understand us better as individuals. As online businesses, they have enough information to recommend the next Father’s Day gift or determine if we prefer science fiction to drama. Can we apply that same logic to healthcare? Wouldn’t you want your own doctor and healthcare network to know you as well as Amazon does—for example, the medications you take, what you’re allergic to and the surgeries you’ve had—so they can recommend what you need to do next to advance your health and wellbeing?
It’s our obligation as technology experts and partners to those in the healthcare industry to find the answers and provide patients guidance in what they need before they need it. So in the end, patients can make the choice about how to approach their health can make the choice. After all, where else would you want to be known more intimately as an individual than in your own healthcare network?
mHealth, video and collaboration tools offer an opportunity to create a true continuum of care and a more seamless patient experience. Communication tools which integrate voice, video and data can also help deliver healthcare more effectively and efficiently. If these mechanisms are in place, the patient is more in control of where, when and how to communicate with care providers. She has the choice of how she wants to connect and communicate with her caregiver—the only question is will it be live in a doctor’s office, via video from her home living room, from a desk chair at the office, or from the path where she’s fulfilling a lifelong goal to hike the Appalachian Trail?
With another new year on the horizon, many are wondering what 2014 will bring. For those in health IT, the more important question might actually be wear – as in wearable devices. The popularity of wearables will continue to explode and the burgeoning trend will move from a mainstay primarily in Silicon Valley and other tech meccas to mainstream America.
Wearables on the rise
Just as smartphones have evolved from being the hot gadgets of the early adopter set into the must-have devices for teens, soccer moms and business people alike — after all, 55 percent of global phone sales in the last quarter were smartphones — so too will wearables proliferate in the year ahead. Indeed, ABI Research has predicted the wearables space is in for a huge growth spurt, estimating the global market for health and fitness wearables to reach 170 million devices by 2017 (2).
2014 will see evolutionary advancements in wearable devices: they’re going to get smaller, sleeker, and more beautiful; battery life will increase; syncing will go wireless for everyone; a huge new generation of devices will emerge both from existing players and new players, and an even larger number of applications based on the new chips phone manufactures are building directly into smartphones will emerge with user interfaces as varied as ice cream flavors. But, at the current rate of innovation, I’m really hoping to see more revolutionary changes in the year ahead as well. My favorite would be anything that cracks the laborious food and calorie tracking nightmare for consumers.
Healthcare organizations maintain a juggling act of caring not only for their patients’ well being, but also the safety and security of the sensitive information that comes in the front door with every patient, doctor, technician and nurse. Data security issues are top-of-mind for information technology professionals in healthcare today, driven by a trifecta of factors: the large number of endpoint devices in use; a rise in the number and frequency of malicious attacks; and strict privacy laws such as HIPAA and regulations related to the Affordable Care Act.
For healthcare IT professionals, it has never been more important to ensure that endpoint security systems are up-to-date and functioning properly so that every endpoint is constantly secure and meeting compliance.
Take HIPAA regulations, which require that end user devices containing sensitive data cannot also have unapproved software running on them. Knowing exactly what software is installed on hundreds or even thousands of endpoints can be tremendously difficult, especially when there isn’t an easy automated way to track this information. Unapproved software is just the tip of the iceberg. What about approved software that isn’t working properly? For example, antivirus software installed on a PC running in a doctor’s office may be outdated, or completely disabled, without the administrator’s knowledge. This gives attackers an open door from this individual endpoint to gain access to the larger network—and a whole host of private information.
