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Archive for November, 2011

Sending out an SOS for SSO: A Case for Single Sign On in Healthcare

Ever have one of those mornings where you enter your password 4-5 times before getting it right?  Ever enter every possible iteration of your password and still fail to unlock a store of data you only seldom access?  Imagine being in that situation while trying to provide life saving treatment in a busy medical setting.  In the everyday world of a clinician, a patient’s trip to the hospital often prompts a reactionary call to the IT help desk in search of that ever elusive password.

In order to help clinicians make more informed decisions and increase the quality of care, healthcare data has gone electronic.  With this increased access to health information, many healthcare organizations feel unprepared to protect patient privacy and secure data.  In fact, a number one compliant of clinicians is having to remember multiple passwords in order to protect health information from prying eyes.

Securing the Most Private of All Data

Open to the public 24/7, and being the keeper of the most private of all data, healthcare organizations are unlike any other in terms of security challenges.  A doctor cannot expect a patient to openly disclose private information if that patient fears that they may be harmed by that disclosure.  Any information withheld out of fear can have a dramatic impact on the care received.  It is easy to understand why one may feel tempted to leave a data source open for ease of access.  This risk increases when multiple sources of data require different log in credentials.  While no one questions the importance of privacy in the practice of medicine, human error and inside data breaches are the most common sources of data security troubles for a healthcare organization. 

A Difficult Problem with a Simple Solution

The answer is not to create a policy promising 30 lashes for each unlocked workstation.  The answer is to make securing data easier on busy clinicians.  For many the increasingly common answer is single sign-on technology (SSO).  With SSO, a clinician is given a single set of log in credentials to all applications they are authorized to view.  SSO also provides clinicians with self-service password reset, which lessens the burden on an already taxed IT department and increases a clinician’s EHR experience at the same time. 

When it comes to protecting workstations, Microsoft’s Vergence is one example of a healthcare specific SSO solution.  With Vergence, healthcare organizations can minimize time-consuming and error-prone activities that clinicians attempt to hurdle while accessing patient records.  With fast user switching that is role-based, clinicians can easily share workstations without compromising the most private of all data.  One of my favorite features is context management, which allows clinicians to select the patient of interest once, in any application, in order to tune all applications to the same patient, which saves time and minimizes the risk of mixing patient data.  A drop-down list of recently viewed patients can also be used for selecting a patient’s record for viewing across multiple applications. The built-in privacy auditor can also be used to provide a centralized audit capability that tracks access to each patient’s records, which will make the CFO breath easier as well.

New Perficient White Paper! Breaking Down the Barriers to Healthcare with Telehealth Technology

In Cincinnati, a man boards a MegaBus bound for Chicago twice per month. Unlike the business travelers sitting next to him, he’s not lured by the promise of free Wi-Fi and power outlets. Rather, this Cincinnati native sits on a bus 12 hours round trip so that he can have access to a particular physician that specializes in treating his illness.

In rural Pennsylvania, a middle-aged woman is diagnosed with Stage 4 glioblastoma multiforme. Her doctor gives her three-to-six months to live, but the closest hospital is a one hour drive from her home. Not wanting to spend her remaining days in a hospital room so far from loved ones, her family takes shifts around the clock to provide her care during her battle with cancer.

In California, a young man is self-employed and dealing with the pressures of providing for a young family given tough economic circumstances. His family is self-insured under a high-deductible plan, and he finds it difficult to make room in his busy schedule to sit in a waiting room for a preventive care visit or to correctly manage his diabetes protocol.

Download this telehealth white paper today to find out more about how telelhealth technologies can be used to help these patients and millions more like them across the nation!

Pay-for-performance and Readmissions Solutions

According to the AHRQ, there are an approximate 4.4 million preventable discharges which contribute to $30 billion in healthcare costs annually. Beginning in October 2012, the Centers for Medicare & Medicaid will begin punishing hospitals by withholding reimbursements to hospitals with higher-than-average readmission rates for patients with three types of diagnoses or health issues:
1. Heart attacks
2. Heart failure, and
3. Pneumonia
The penalty will begin with a deduction of 1% of Medicare and Medicaid’s regular reimbursement rate and rise to 3% within a couple years. A total of 4,626 (7%) hospitals have higher-than -expected readmission rates in these three categories. (Average readmission rates are 19.8% for heart attacks, 24.8% for heart failure patients and 18.4% for pneumonia patients.)

CMS is focusing on readmission rates, because readmissions are costly and a whopping 9-48% of all readmissions are deemed “preventable”. Preventable readmissions are categorized as readmissions caused by indicators of sub-standard care during hospitalization, such as discharging patients before they are stable, poor resolution of the health issue and inadequate post-discharge care. However, random trials have shown that patient education is one of three inputs that reduce readmissions by 12% to 75%.

What does this mean to providers? It means two things: First, some healthcare issues may be caused by a “failure to communicate”. Second, accountable care is most effective when accountability trickles-down to patients. Tools that enable better communication throughout the continuum of care and educate the patient must be explored. And these education tools need to be combined with other pre-discharge actions such as a scheduled PCP follow-up appointment and sending their medical records to the PCP within 24-hours of discharge to reduce readmission rates by 30%.

The point here is simple: Unnecessary readmissions are going to become painful events for providers. Solutions that reduce unnecessary readmissions will ensure a healthier patient and healthier bottom-line.  Non-traditional methods such as telemedicine, mobile technologies and technologies that close gaps in the continuum of care must be explored.

Protecting Personal Health Information in the World of Mobile Healthcare

The push for electronic health records (EHRs) kicked into high gear in 2010 when providers spent a record breaking $88.6 billion on health IT initiatives based in adopting EHRs. While many are cheering on the movement, others are more hesitant as security concerns emerge.

Price Water Cooper claims that the use of EHRs drastically increases the odds of PHI being exposed. This notion is further supported by the HHS Office for Civil Rights database which reveals that there were PHI security breaches every other day for the past year and a half and a recent report claiming that “there may be a direct correlation between increasing levels of adoption of medical informatics systems and breaches in patient health information.” All in all, this makes perfect sense – an increase in EHRs lends itself to an increase in breaches, right? But the real question is – Does it have to be this way?
Recent regulations have specified standards to protect healthcare data during electronic transport, required encryption and breach of notification and defined “meaningful consent”. Despite the concern with protecting PHI, the adoption of mobile technologies, a medium that raises major security concerns, continues to gain momentum.

At the recent American Medical Informatics Association annual meeting, Drs. Henry Feldman, Larry Nathanson and Janet Meyers, R.N. presented “Tablets in Healthcare: Not Just for Pills Anymore”. The presentation highlights how valuable the iPad is to the healthcare industry. The iPad is just one of many mobile devices “transforming” healthcare from both the provider and patient’s perspective. Patients are able to become more involved in their care – which is noted to improve the overall outcome of care, while physicians are able to provide more timely, informed care.

All of this comes at a time when healthcare is experiencing major changes stemming from need to contain costs, improve quality and outcomes and decrease waste. So while some people still question if mobile devices, such as the iPad, which have operating systems which are more secure than a standard PC are secure enough – others are addressing the healthcare challenge and patient demands for involvement with mobile apps and placing security on the back-burner to quality of care. It is an interesting phenomenon that will surely encourage a quick solution.

Is your ICD-10 Impact Analysis capacity in place yet??

The conversion to ICD-10 will be of a larger scale (just from the IT perspective – not including all the retraining of medical coders and other business changes) than the Y2K conversion. With Y2K, we just had to find those 2 digit year fields and change them to 4 digits. In addition to expanding the length of diagnosis and procedure code fields – there are all the system changes to support new business rules and changes to processes.

If you’re not sufficiently concerned about being able to perform a thorough Impact Analysis (enabled by effective enterprise meta data repositories with integrated meta data across many meta data subject areas) this should serve as a shot across the bow – “On the payer side, UnitedHealth Group has inventoried over 700 systems affected by ICD-10, including “claims platforms, processing applications and decision support tools,” says Ross Lippincott, vice president, 5010 and ICD-10 programs.” Health Information Management http://bit.ly/vTIitl

IT organizations should take advantage of funding made available for ICD-10 conversions to make architectural changes which will allow IT to change its systems more rapidly – as the pace of change is not going to slow down. Implementing an enterprise meta data repository is a solid investment which will pay dividiends well beyond the ICD-10 conversion.

Providing Health Information to Busy Patients

“People are not built to pay attention.” – Dr. Clifford Nass, Connected Health Symposium 2011

This priceless piece of wisdom was provided during last month’s Connected Health Symposium in Boston.  What Dr. Nass successfully communicating to symposium attendees is that while we envision a world where patients are consuming healthcare information in isolation of all else, they are actually consuming information the way that we all actually do in this real-time, fast paced environment.  In essence, providing health information in isolation can’t happen.

The volume of information in patient portals can be overwhelming.  Add to this information that is provided by web sources, personal relationships, and from the body itself by way of general aches and pains, and it is easy to see how patients can get confused.  While recognition technology built into portals is just around the corner, there is an outlet that patients can use that is quite similar to the environments that physicians use to comb through the vast amount of information they need to perform medicine: online communities. 

Should doctors, nurses, and social workers recommend online patient communities to patients?

Doctors use physician social networks, such as Ozmosis, to communicate with one another, share medical information and refine treatment protocols.  Online patient communities, on the other hand, allow patients to network socially, support one another emotionally, and help each other comb through the vast amounts of information available to them as patients as well. 

Coincidentally, the doctor that prescribed an online patient community to “ePatient Dave” was seated directly behind me at a particular panel discussion.  He is obviously an advocate for prescribing these online patient communities, but he mentioned that many providers either do not know they exist or do not know how to recommend them. 

Is it the responsibility of physicians to keep abreast of these online patient communities so that all available options for treatment are available to patients?  Should patients have to wait?

Replay and Slides! ACO = HIE + Analytics: Managing Population Health

Last Thursday I spoke in a webinar entitledACO = HIE + Analytics: Managing Population Health with Information Exchange and Analytics”.  You can view the slides below, and you can view a full recast of the webinar here: http://www.perficient.com/webinars/

Let me know what you think!

New Tools for Managing a Public Health Crisis

Public health is defined as the science of protecting, improving, and promoting health through the organized efforts and informed choices of societies, organizations, public and private, communities, and individuals.  In one of our most recent white papers, The HIT Trifecta, we highlighted the most important component of managing public health: data.

This was done by outlining, of all things, the London cholera outbreak of 1854.  We wrote:

Cholera was responsible for the death of tens of millions of individuals in the 19th century. By 1854 the cholera epidemic, believed to be related to polluted air, was taking lives in London, England. Physician John Snow did not believe that dirty air was the cause of the disease and began conducting his own research. By speaking with local residents, he determined that nearly all deaths had taken place within a short distance of a specific water pump or pumps that received water from the specific pump. By mapping the home location of each cholera related death on a city infrastructure map, Snow determined that sewage-polluted water, not polluted air, was responsible for the disease and deaths. Snow’s findings saved millions of lives and resulted in the implementation of sanitation practices, clean water legislation and life-saving vaccines.

Today, mortality rates for individuals with cholera are less than 1%. In healthcare, good data and exhaustive data are synonymous. The need to capture more data goes beyond compliance and reimbursements. Ultimately, capturing additional data points changes the way healthcare is administered by connecting the dots between direct and indirect inputs.

The science of public health has come a long way since 1854.  However, it still takes precious time and resources to manage the health of a planet inhabited by 7 billion people.  This is an interconnected planet, and as shown in the recent movie Contagion, public health crisis known no barriers and time does matter.  (If you haven’t checked it out, then see the Pandemic Pulse shown in the picture above, which outlines public health data.  It looks like, among many others, there is an outbreak of Legionnaires’ in Florida)

So, how does one harvest this meaningful data quickly when time is of the essence?  At last month’s Connected Health Symposium in Boston, experts demonstrated why online and social media sources are seen as imperative to public health.  This is because:

  • “epatient” populations are on the rise.  Online is often a first source of health information, and patients often turn to their own network for help and comfort during illness.
  • 80% of physicians use social media channels to create, consume, and share medical content.  Many physicians actively use the Ozmosis/Veratect public health alert system.
  • Public health officials can receive data about disease disclosure through online patient communities faster than they can receive that same data through a claims database.

“Like Things Tend to Cluster”

One of the breakthrough lessons I received in my life was from Dr. Greg Smith, my graduate data mining professor at Xavier University.  He explained that “like things tend to cluster”.  This makes social media a great way to find the useful data needed to uncover a public health crisis.

Social media technology enables two-way communication.  As such, experts are turning to social media outlets like Facebook and Twitter to not only communicate with the public about disease outbreaks and health issues but to also gather necessary data to discover outbreaks at their source.  Social media can also be used to recruit medical volunteers to a location and align response efforts once on the ground.  However, to make this all work, public health officials need to be given access to social media data, and this is often an issue.

So what are your thoughts of mapping public health using social media data?

New White Paper! Reap the Rewards of HIE with Patient Organization and Community Opt-In/Opt-Out

Open to the public 24/7, and being the keeper of the most private of all data, healthcare organizations are unlike any other in terms of security challenges.  A doctor cannot expect a patient to openly disclose private information if that patient fears that they may be harmed by that disclosure.

As a new era dawns in the healthcare industry, methods such as electronic health records (EHR) and health information exchanges (HIE) have emerged to overcome the healthcare cost, quality and access conundrum.  It is important to examine how removing siloed data and changing healthcare practices impact patient data security.  Organizations that fail to protect patient information can be fined up to $50,000 per violation and are required to report specific types of security breaches to the media. These stiff penalties have added an element of urgency to identify and address potential security risks.

This paper outlines privacy and security, and then evaluates privacy and security issues associated with HIE opt-in and opt-out models.  Download it today!

Want to learn more about managing population health using HIE technologies and new payment models?  Join us on November 10th for “ACO = HIE + Analytics: Managing Population Health with Information Exchange and Analytics”.  Register today!

When Containing Costs Contains Solutions

Perficient has created this series, “Healthcare Analytics and Meaningful Use” to drive discussions around unlocking the true potential of EHRs with analytics. Stay tuned for this four-part series to be published throughout October and November.  We welcome your comments and questions below.

Henry Ford claimed that a good business rule of thumb is to “make the best quality of goods at the lowest cost possible”. In an industry that is experiencing record-breaking numbers of uninsured patients with little or no ability to pay, funding the changes necessary to comply with the HITECH Act and ICD-10 are a challenge.  Integrating systems, implementing EHRs, training and educating employees and developing analytics that serve healthcare organizations are time consuming and expensive feats.

To help soften this blow, the HITECH Act provides incentives and, in the final ruling, a relaxing of the Stage hurdles required to be met in order to qualify for the incentives. Organizations that qualify must keep in mind that in taking the incentives, they are attesting to already having made a good deal of progress down the path of utilizing certified-EHR technologies.  The resulting impact of both HITECH and ICD-10 are enterprise-wide.  Organizations can either react by doing only what is needed to comply or embrace the change and take advantage of the situation for process improvement.

Through deliberate and managed improvement, organizations can generate a Return-on-Investment (ROI).  The increases in efficiencies, efficacy of treatment, human resource utilization, reduction in waste and subsequent quality increases will reduce the cost to deliver.  Given the complexity of the overall effort, establishing a data integration backbone and analytics with a monitoring solution at the beginning will be critical.  With the provision of care never-ending and the complexity of the supporting technologies, the management of change will need to be incremental, a step, module and/or department at a time.  Being able to monitor closely the performance of the organization, with the ability to fine-tune or react quickly, will help to ensure the success of the move to the certified-EHR solutions. By adopting early on and encouraging the use of a common “dashboard” service covering Clinicals, Quality, Finance, Operations and Regulatory, organizations can help create an awareness and understanding that lasts beyond the needed change.

As organizations move beyond this time of change, ubiquitous and appropriate access to analytics for all will continue to drive cost down to a reasonable level and quality ever higher.

Want to learn more?  Register for our upcoming analytics webinar and you will be entered to win one of two Perficient client badges to the February HIMSS Conference in Las Vegas!

Helping Sick Kids Get Better With Healthcare Gamification

During the Connected Health conference last month there were a lot of great conversations around enabling patients around their health.  One particular panel on the psychology of game mechanics asked an important question about children and teenagers and their health: Can young people learn and adopt healthy behavior skills that they continue to use into adulthood?

Of the tools physicians are increasingly using to better the health of young people, you probably would not have guessed that that video games are among them.  However, one of the key challenges to communicating healthful behaviors in hopes of making them routine behaviors is integrating that information with natural behavior.  Ultimately, we need to communicate using platforms that young people are already using.  In this case, mobile, social, computers, and gaming can be the perfect antidote to unhealthy behavior.

Is it time for physicians to prescribe mobile health to kids?

So, why would kids play health games when they could play Fruit Ninja instead?  Well, nobody said it would be easy.  However, the goal is actually not to compete with Fruit Ninja at all.  The goal is to make dealing with illness easier.  Sometimes games just organize information better.  This has been seen with games that teach chemistry and math.  Further, it has been seen in the success of health-related social media campaigns that make disease management for chronic conditions more engaging.  Here are two successful examples in the gaming world:

Max On Snax: “My Plate” Tracking for Kids

Max On Snax is a fictional character “just this side of 5” who hosts a television program and a nutrition tracking game for young children. Max has his own theme song, and he likes to remind children to wash their hands.  He recommends recipes that are cold or room temperature, and makes sure to remind his friends to check with “one of those big people” before they begin.  Max helps children drag pictures of the food they eat onto “My Plate” so they can track to make sure they are eating well.  Max also stays active.  He enjoys jumping rope, bike riding, and other forms of exercise.

Re-Mission

Re-Mission is a video game for teens and young adults with cancer that was released by the HopeLab after receiving direct input from young cancer patients and oncology clinicians. The game was designed to engage young cancer patients through gamification while also impacting the outcome of their disease through visualization and behavior change that comes from being educated and enabled in care.

In Re-Mission, a nanobot named Roxxi is injected into the human body to fight particular types of cancer at the cellular level. Those playing the game are also asked to monitor the patient’s health and report any symptoms to the fictional Dr. West.  Each level of the game informs the player on a variety of treatments and on the importance of staying compliant with medical protocol.  HopeLab trial studies, that were published in peer-reviewed journals, revealed that playing Re-Mission led to more consistent treatment adherence, faster rate of increase in cancer knowledge, and faster rate of increase in self-efficacy. Most notably are blood test results, that showed the measured level of chemotherapy drugs in blood to be higher in players versus the control group.

Will ACOs Produce Accountable Patients?

I had the privilege of attending the Connected Health Symposium 2011 in Boston on October 20-21.  One of great ideas from that Symposium was to debate the key topics in healthcare today including the idea of Accountable Care Organizations and their ability to drive quality up and costs down.  At the heart of that idea is whether or not ACOs will produce more accountable patients.  This topic was debated by Timothy Ferris, MD, Medical Director, Mass. General Physicians Organization, Jonathan Gruber, PhD, Professor of Economics, MIT and Dana Safran, ScD, Senior Vice President, BCBSMA.  As you might imagine, Dr. Ferris took the negative point of view arguing that ACOs won’t produce accountable patients due to the need for new incentives.  Dr. Safran took the affirmative argument that ACOs would produce accountable patients by reducing fragmentation and chaos in the healthcare system.  Dr. Gruber, the economist, argued that the only way to change patient behavior was to use price signals, i.e. a higher cost burden.  Dr. Gruber noted that “patients hate paying when they go to the doctor” and that was the only way to produce accountable patients.

Dr. Ferris: ACO Will Not Produce Accountable Patients

It was not surprising to see that Dr. Ferris was pessimistic about producing accountable patients.  He felt that three systemic items must change:

  1. Access to care, the design of care and the measurement of care.  Dr. Ferris felt strongly that a mechanism for virtual visits must be created with both patient and physician portals to improve access to healthcare information and lower the cost of patient and physician interactions. 
  2. He wanted more from electronic health record systems to improve the decision making process and ease computerized physician order entry. 
  3. Most importantly, Dr. Ferris argued that measurements and reporting were keys to improving accountable patients including quality metrics, clinical outcomes and patient satisfaction.  He concluded that benchmarking, variance reporting and dashboards were improvements required to improve patient care.

Dr. Safran: ACO Will Increase Accountability

Dr. Dana Safran of BCBS of Massachusetts was positive that ACOs would increase accountability across the entire continuum of care including patients.  She noted that the chaos and fragmentation of healthcare industry must be addressed by aligning clinical and financial incentives to make accountable care organizations work.  Dr. Safran fielded a question from the floor about whether payers have enough interest to address the accountable patient due to “churn” or the turnover of patients covered over a longer period of time.  Her response was that “payers have a large incentive to look for effectiveness in the long term despite churn.” Dr. Safran went on to note that one of the challenges of accountable care was that “doctors are responsible for delivering less to patients.”  This statement provoked an immediate reaction from the physicians in the audience and Dr. Ferris.  One emergency room physician reacted that capitation didn’t work in the 90s and it won’t work now.  Another doctor pointed out that reimbursements today are too low to attract primary care physicians.

But what do the patients think?

Clearly, it was a lively debate with the doctors arguing to retain the current fee for service status quo and the economist/healthcare payer arguing that things must change.  One startling fact that Dr. Jonathan Gruber noted was that a middle class family income went up by $28,000 in the last 10 years but due to increased healthcare costs, they only pocketed $93. Clearly, employees are facing higher cost sharing but this fact drove the point home.  In the course of this debate, no one argued that we didn’t need to get control of healthcare costs and that those costs were a drag on the current economy.

The only voice missing in the debate was the patient.  Several of the folks on social media noted the absence and discussed that need in the future.  I’m curious what regular folks think about this issue – what is needed to get you to be more accountable about your health? What incentive really motives you?

Want to learn more about managing population health under new reimbursement models?  Register for our upcoming ACO webinar and you will be entered to win one of two Perficient client badges to the February HIMSS Conference in Las Vegas!