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Archive for the ‘Health Information Exchange’ Category

Includes Enterprise HIE and State-Wide HIE

A New Patient Adventure…A Hair Pulling Experience

I grew up in a small town in Iowa and lived in and around my hometown for 30 years. It wasn’t unusual for my commute to work to be interrupted by a John Deere tractor driving down the highway. When I hit 30 I traded in my rural roots and headed off to the booming metropolis of St. Louis for a change of scenery. I, like A Day At The Doctor...A Hair Pulling Experiencemany others, struggle to schedule routine and regular doctors appointments so when I moved, finding a new doctor was not a priority. I have been blessed with a relatively healthy life thus far and tend to view healthcare as sick care. (When I’m sick I will go to the doctor.) Needless to say, it took me a while to take the time to find a new doctor after moving to St. Louis. In fact, it didn’t happen until I had found a veterinarian and a groomer for my dogs, a hair stylist I liked and a car repair shop that was reliable and trustworthy. To be honest, I still may not have a doctor if it weren’t for the fact that I needed to get a refill on my prescription.

Who Uses FAX Machines? Doctors Do…
I took some time looking online to find doctor reviews and patient referrals and, of course, listened to word of mouth from my new friends in St. Louis. Once I settled on a doctor I made a call to schedule an appointment and then contacted my previous doctor back in Iowa to have my records FAXED to my new doctor. The fact that fax machines are still being used, not only as the primary technology but the only one, both humored and frightened me at the same time. But I thought whatever works to get my information to the new doctor, works for me. Having my previous medical history in the hands of my new doctor would save me time. I wouldn’t have to fill out the medical history paper work because I took the time prior to my appointment to have my records faxed to them…Right? Wrong, this didn’t save me any time at all.

A NEW Patient Again and Again…
I was advised to arrive 20 minutes early to fill out paperwork and when I arrived I checked in and was handed a blank stack of medical history forms to fill out. I began by filling in the easy stuff, name, social security number, birth date, address but when I got to the medical history part I felt like writing “check the records that were faxed to you.” I stumbled my way through the paperwork and turned it in, thinking to myself, if that were a test I would be happy with a C. I sat back down and waited for the nurse to call my name, and when she did, I followed her back as she proceeded to ask me questions about my medical history. The same questions that I had just struggled to answer on paper. And again, I felt like telling her to “look at the paper work I just wasted 20 minutes of my time filling out.”

At this point I was ready to see the doctor, get my prescription and be on my way. The doctor entered and I had a similar experience with her, a lot of repeated questions and answers, but I survived, got my prescription and set up another appointment for the following year. I was pretty proud of myself for scheduling a routine appointment! As painful as this visit was, I was glad that it is only a process that new patients have to endure, so I wouldn’t have to do it again…Right? Wrong, I received a letter in the mail that my doctor is closing shop, leaving me once again with the rigorous task of finding a new doctor and worse yet, becoming a NEW patient again.

Those Are MY Medical Records, Aren’t They…
As I began my search for a new doctor, I was able to seek additional referrals from friends now that I had lived in the area for a couple of years. I picked up the phone and called to make an appointment and the receptionist asked that I have my medical records faxed to them. After making the appointment I called my previous doctor and asked that my medical records be sent to my new doctor. I was told that they could fax the records from my single visit but that they could not fax my older records and that I would have to contact my doctor back in Iowa to have those faxed. Wait, aren’t those my medical records? I’m giving you permission to fax them, why do I have to contact the doctor in Iowa to fax them? The receptionist reiterated that she would be happy to fax my one record but I would need to fill out a release form in order for her to do that. She asked if I had a fax machine….seriously, why do all these doctors insist on the fax machine? I asked if she could email it, but email wasn’t an option. So I am now waiting for snail mail to deliver a release form that I have to fill out and drop back in snail mail in order for my request to be processed.Upon hanging up with her I called my doctor in Iowa and asked to have my medical records faxed to the new doctor. Again I was told that I would have to fill out a release form and that I could get that at my new doctor’s office. So, I now have to fill out 2 different release forms in order to get MY medical records faxed to my new doctor. And I am sure when I go to my new doctor I will have to fill out the same paperwork that I have jumped through so many hoops to get to them prior to my appointment.

I can’t wait for the day when all my medical records are stored in one place and I won’t have to get permission to have MY records sent to a new doctor. A secure and private location that is easily accessible by ALL of my doctors – both current and future!

 

Wearable Technology for All

The definition of wearable technology has changed as much as technology has in the last century. In the first waves of wearable technology we got the calculator watch, you know the one, featured in back to the future. Although we have yet to see a hover board, wearable technology has gone to unbelievable heights. From the iPhone 6, to Google Glass, the bar continues to be set higher.Calculator Watch

After the Google Glass Project (smart glasses), several other companies broke into the smart wearables market, including Apple (iWatch), Samsung (Galaxy Gear), and Sony (SmartWatch) shortly after Google. Now you can buy all types of devices, including watches, glasses, headbands, wigs, rings, etc. Using apps for personal and business computing, practical everyday tasks, fitness tracking, and healthcare monitoring.

I recently, purchased a Nike Fitband, hot pink and black of course. Syncing my iPhone with the app was the easy part, however, I learned that there was minimal features of use to me and this was not something I would keep (for $129). I returned it to the store. After that, my need for quick and convenient health data continued. I fed into the buzz around the Apple Healthkit. iPhone is wearable technology that I already was utilizing. So how could I optimize this device? The first thing I noticed was that it was automatically tracking my steps! “Sweet!” I then realized there was a plethora of data analysis tools that could keep track of my health, medical history, my fitness, and my nutrition. “Sweet, times three!”

Even as a psudo-millenial, as I attempted to use the app, I could not figure out how I could get data to input automatically. After doing some internet research, I was led to a list of Apps that can work/sync with the Healthkit. I was disappointed in the list as I was hoping to use the apps I already use, and are familiar with. They were not on the list. This list of new apps didn’t give me any indication if I needed any additional wearable technology (equals more money) to make them work. Some of them are free, some not, so how was I to choose? If I could find this information in one place, I may be able to quickly decide which apps to download or which piece(s) of wearable technology I would like to gather or start collecting.

All of this wearable technology is overwhelming. And I am only digging into the personal use market these apps are not so difficult to understand, it’s how to use them all together that is confusing. This is not only a common problem with all of our personal devices. There is a large business driven market calling for this problem to be resolved. Technology management is taking off; Hospitals have wearable and wireless technology in use all over a hospital, in many medical devices. The ability to capture and manage all the data and have it at one’s fingertips is one of the fastest going industries.

I love my wearable technology, however, just as with any market has quick progression, it may get messy before it gets better. As my life will only get busier, I am looking forward to learning all the opportunities this technology can give me to streamline my life. I encourage any busy person to look into free applications, they can simplify your day to day life in a great way. Can Siri be close to a personal assistant?! Not yet, but we are close!

3 Components for a Successful Hybrid Environment in Healthcare

It is no secret that healthcare organizations are collecting more information today than ever before. They’re collecting information about their own operations, their patients and the communities they serve. The challenge for healthcare organizations isn’t collecting the information, but analyzing the data and efficiently and securely storing it. Healthcare organizations that can overcome the data challenges and gain faster, fuller data insights will have the tools to positively impact patient care and overall business.3 Keys to a Successful Hybrid Environment in Healthcare

When it comes to data storage, healthcare organizations struggle with finding a balance between “on premise” and the cloud. Many CIOs recognize the need to expand beyond the home port and are quickly moving information to public clouds. However, they aren’t completely abandoning their data centers for fear they won’t have control or access to timely information. The hybrid IT solution helps to solve the data storage problem but it also brings a unique set of concerns in regards to data control, data access and data compliance.

Data Control
Data is much easier to control when it is housed in one central location. With a hybrid IT solution, however, you do not have that luxury. Data stored in multiple locations must be seamlessly connected, able to securely and efficiently move between locations and allow you to maintain full control across all platforms.

Data Access
The key to collaboration and improved patient outcomes is ensuring everyone who needs access to data has it. On the flip side, broad data access needs to be secure and only available to authorized users. With a hybrid IT solution integrated data supports collaboration beyond the walls of the healthcare facility.

Data Compliance
Changing regulations are putting added pressure on healthcare organizations. Keeping up with the evolving regulatory landscape is a challenge in itself and having information stored in multiple locations only adds to this complexity. Developing a strategy to protect data and manage it to ensure it meets regulatory requirements is critical to a hybrid IT solution.

Hybrid IT environments provide the best of both worlds when it comes to data storage and analysis. Leveraging a hybrid environment will lead to timely and accurate analysis of data which will result in the delivery of actionable insights for improved collaboration, better patient outcomes and overall lower cost of care.

Considering implementing a hybrid IT environment or just want to learn more? Join Perficient and UnityPoint Health for a discussion on the benefits of Power BI and Office 365, and how one technology-savvy healthcare provider is leveraging its hybrid environment of Power BI, Excel-enabled dashboards and SharePoint 2013.

Sign up for the November 12th webinar

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In Healthcare, Connectivity Is Not Collaborating

Interoperability between different electronic health record (EHR) systems is one of the most important requirements that hospitals and physicians must meet as they prepare their systems for attestation in Meaningful Use Stage 2.

However, let’s examine the real goals of interoperability within healthcare: In Healthcare Connectivity is not Collaborating

1) To make sure “information follows the patient regardless of geographic, organizational, or vendor boundaries”

2) To have at least one or more instances in which providers exchange an electronic summary of care with all the clinical data elements between different EHRs. Establishing this connectivity does not insure the real goal of collaborating across the continuum of care for the patient’s benefit.

The debate still rages on the role of the patient in this interoperability process as well. We have all, as patients, had our medical files spread across a family doctor, multiple hospitals, specialists, health plans and today, even multiple pharmacies. The prospect of creating a complete picture is staggering, let alone having all of those healthcare providers really collaborate on our behalf. Is it the patient’s responsibility in this ever-changing healthcare electronic revolution to compile this electronic mess into a coordinated whole or will the industry magically create it as a result of Meaningful Use Stage 2?

It is worth arguing that interoperability in Meaningful Use Stage 2 only creates a baseline of connectivity between two or more systems to exchange information and puts in place the ability of those systems to use the information that has been exchanged. It does not create collaboration on behalf of patients within the healthcare provider community, especially between competing players like local hospital systems or healthcare providers versus payers. Having the ability to connect only trades fax machines for electronic transactions, if tools aren’t employed for physicians for example to collaborate over a single patient.

In advocating for collaboration, let’s examine the reality of an exchange of a set of electronic transactions about a patient versus where the process would need to be for genuine care coordination. Today, a fax from the hospital to the family physician is the notification that the patient was hospitalized and needs follow-up in coming weeks. Based on the type of hospitalization, a call between the attending physician and family physician may be warranted, and a potential referral to a subsequent specialist may be in order. Simply communicating electronic documents doesn’t address the interaction between key people in the decision-making process and the assumption that the inclusion of unstructured physician notes will suffice may be optimistic.

This means that health information exchange is different than health information interoperability. Exchange is necessary for interoperability, but it is not sufficient by itself to achieve health information interoperability, especially to streamline real collaboration on behalf of patients. It is time to examine an expanded view of both interoperability and health information exchange to promote ease of collaboration between the parties involved, including secure physician to physician communications – electronic or instant message, for example, and secure physician to patient communications. As an individual patient having to deal with multiple patient portals today for communicating with my healthcare providers, there is a real concern to address this issue sooner rather than clean up confusion later.

Can we define collaboration in a way that traverses healthcare’s landscape of emerging connectivity?

The Problem with Health IT is in the Definition

There has been a lot of debate around the challenges within the healthcare industry. Much of the discussion stems from the fee-for-service model and the focus on services and reimbursement rather than the patient. Health information technology has its own set of challenges when it comes to addressing healthcare issues. The Problem with Health IT is in the Definition

If we truly want to put the patient at the center of their own healthcare experience than we need to take a step back and look at the relationship of the patient and the entire healthcare ecosystem. Healthcare should focus less on the products and services and more on the patient and provider relationship. Furthermore, health IT should support these relationships, however, by its own definition it doesn’t.

By definition,  Health information technology (IT) encompasses a wide range of products and services—including software, hardware and infrastructure—designed to collect, store and exchange patient data throughout the clinical practice of medicine.

The definition does not mention the patient and provider relationship and the emphasis is on products and services, software and hardware and does not reflect on the benefits of patient data exchange.

A better health IT definition: An automated approach that facilitates the relationship between the patient and the healthcare system through the accurate and secure electronic exchange of data, ensuring the right data is available at the right time for everyone that is engaged in the patient’s care.

This definition includes 3 critical components:

  • The importance of the patient relationship with the healthcare system
  • The importance of accurate and secure electronic data exchange
  • The benefits of data exchange in regards to patient care

A new definition will not solve the challenges of the healthcare industry, but it is a good place to start. It may be enough of a push to ensure technology developers are developing meaningful applications that improve patient outcomes, which should be the ultimate goal of health IT.

ACA and QRS – Shoot for the Stars Part 3

In ACA and QRS – Shoot for the Stars Part 1, I laid out the overall domains that are going to be used to score QHP plans offered through the Marketplace. In Part 2, I discussed some factors to consider for the data derived measures. In this blog, we will take a closer look at the survey derived measures and what factors a QHP issuer should consider to achieve high scores.

surveyAgain, for reference all 43 of the required measures can be found on the CMS website (click here).

Now let’s take a look at some factors to keep in mind when dealing with the Enrollee Satisfaction Survey (ESS) derived measures:

Leverage CAHPS Processes
As mentioned in Part 2, it was required to get Health Plans Accredited to offer on-market. In addition, CMS aligned required QRS ESS measures with current CAHPS measures that are typically required during accreditation. And just as an organization should leverage HEDIS for data, make sure to leverage current investments in CAHPS to keep initial costs low while jump starting ESS efforts.
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3 Questions Apple Must Answer to Reduce HealthKit Skepticism

There has been a lot of buzz around Apple’s announcement to enter the healthcare space with the unveiling of their Apple Watch and HealthKit app. HealthKit seems to be gaining momentum due in large part to Apple’s strategic partnerships with healthcare industry heavy-hitters. However, many questions remain 3 Questions Apple Must Answer to Reduce Skepticismunanswered and Apple must address them to gain buy-in from skeptics.

PRIVACY: How will patient information be kept private?
Having all patient information in one place seems like a necessary step to improve quality of care. A centralized location means the right person can have access to the right information at the right time. However, people are concerned about having all their private information in one location is too risky and makes them susceptible to hackers. Recently, Apple addressed privacy concerns by updating their privacy policy and their guidelines for app developers. Apps working with HealthKit, may not use the personal data gathered for advertising or data-mining uses other than for helping manage an individual’s health and fitness, or for medical research. Apple is also considering a “HealthKit Certification” for developers to help address the privacy concerns.

SECURITY: How will patient information be protected?
For years, there have been very little security concerns surrounding Apple, however, concerns over Apple’s security have risen recently after an alleged hack on iCloud led to several risque celebrity photos being published. According to cloud security vendor Skyhigh Networks, over 90% of cloud services used in healthcare pose medium to high security risk. Apple has promised to tighten up security on the iCloud to protect patient information. Healthcare consumers must regain confidence in Apple’s ability to keep their information secure and safe from hackers.

REAL-WORLD USE: How does the HealthKit work?
Lets face it, people are busy, Healthcare professionals are overloaded, and focused first and foremost on providing quality care to their patients. They do not have time to play with an iPhone app, needless to say,  HealthKit data must be streamlined. It must be convenient, provide accurate and timely information and integrate seamlessly into a patient’s electronic medical records. Simply put people aren’t just going to use HealthKit because it is an Apple app, they aren’t going to use it because it is a fad (at least not long-term), they will use it because it is convenient and can improve patient outcomes.

Apple continues to build on their partnerships with major players in the healthcare industry. They are preparing to launch trials with two prominent hospitals in the United States. The trials will focus on a group of people with diabetes and chronic diseases and will offer a glimpse on how the HealthKit will work. The HealthKit app will receive information from regulated medical devices such as glucose monitors and blood pressure meters.

Standford University Hospital is working with Apple to track blood sugar levels in children with diabetes and Duke University is helping to develop a pilot program to track blood pressure, weight and other measurements for patients with heart disease and cancer. The goal with both of these trials is to improve speed and accuracy of data reported. If these pilot programs run smoothly you can expect to see them rapidly expand to other hospitals.

It is still too early to tell what impact Apple will have on the healthcare industry, but they are certainly putting the right pieces together. More work needs to be done to address privacy and security concerns and gain trust from the healthcare community.  Their partnerships with hospitals, medical information services and medical device makers may be the perfect storm,  but the success of HealthKit will depend on those that actually “use” it.

ACA and QRS – Shoot for the Stars Part 2

In ACA and QRS – Shoot for the Stars Part 1, I laid out the overall domains that are going to be used to score QHP plans offered through the Marketplace. In this blog, we will take a closer look at the data derived measures and what factors a QHP issuer should consider to achieve high scores.

HC DataFor reference all 43 of the required measures can be found on the CMS website (click here).

Now let’s take a look at some factors to keep in mind when dealing with the data derived measures:

Leverage Accreditation Processes

It was required to get Health Plans Accredited to offer on-market. In addition, CMS aligned required QRS data measures with HEDIS measures that are typically required during accreditation. So, make sure to leverage current investments to keep initial costs low while jump starting QRS efforts.
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Market Driven Patient Portal: HIE Across Diverse Care Settings

So far in this discussion about “What the market says you need in your patient portal” we have been driving toward changes that are core to new engagement models. However, we have not addressed a core enabler: “It’s all about the data!”

Consumers demand access to information that meets their needs and they are not complacent Market Driven Patient Portal: Health Information Exchange Across Diverse Care Settingswith becoming hunters and gatherers for the information is truly about them. Consumers in today’s market demand accurate and up-to-date information about their health profile, just like they do with respect to their financial profile. However, the systems and processes to make that information available are not all there.

There are various sources of the information that are relevant to the patients/consumers (and also to the providers providing care to their patients). Much of this data has been distributed through the provider community. Some of the data is in the provider’s own systems. Some of the data is in the hospitals EHR systems. Some of the data is in outpatient facility systems. Other data is isolated and hard to locate.

With the push to HIEs some of the data is now becoming more available to the providers and to the patients they serve. However integrating the data into a holistic view is still a challenge. The information still needs to be gathered / extracted from the source systems, transformed into a structure that the HIE can understand and then there are the issues of translating the codes and values to normalized/consistent terms following a defined set of vocabularies. Additionally, ensuring a unified view of the individual can be a challenge. Enterprises IT groups are leveraging Enterprise Master Person Index (EMPI) solutions to construct the golden record of the individual but this also has its challenges.

Once all of the data is assembled (assuming that it is) the next challenge is to get the information to the right person at the right time. The HIE now needs to be integrated to the rest of the enterprise. Exposing the information in terms of the services or APIs can now begin. Finally the Portal (and this is just one of the consumers) can begin to consume these services and make the information available to the consumers. What’s also of importance is that the consumers can access this data from multiple perspectives. The provider can see full episodes of care across multiple care locations. The patient can see their health profile all in one location.

Having a single view of one’s health profile (or even the illusion of) is a powerful tool. Not only does it provide insights for better care, it breaks down the walls of information silos that have challenged providers and patient’s alike. Again, it is all about the data, and integration and interoperability are the key.

ACA and QRS – Shoot for the stars! Part 1

Last month I posted “ACA’s Quality Rating System – An opportunity to gain market share”, which explained how QHP issuers can gain market share in the individual space.  In that blog I mentioned that, as part of the Quality Rating System, plans offered on the Marketplace will receive a “Star” rating based on a 5 star rating system. Over the next few Shoot for the stars!posts, I would like to take a look at what this means from a health plan’s perspective.
As background, there are 43 measures that will need to be tracked. Out of the 43 measures, 31 are derived from data and 12 are derived from the survey. In addition, the draft QRS scoring specifications published by CMS organizes the 43 required measures into composites that roll up into eight domains. These domains are as follows:

  • Clinical Effectiveness
  • Patient Safety
  • Care Coordination
  • Prevention
  • Access
  • Doctor and Care
  • Efficiency and Affordability
  • Plan Services

The eight domains are then rolled up in to three summary indicators: 1) Clinical Quality Management; 2) Member Experience; and 3) Plan Efficiency, Affordability and Management. And of course, the final result is a star rating.

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Apple HealthKit: A Game Changer

I have been an athlete all my life, but since I’ve reached my 30’s, had 5 reconstructive surgeries, and moved back to the Midwest to a completely sedentary job, staying fit and healthy has become more challenging than ever before.

As an Apple lover for years, I have a myriad of Apps I enlisted to help. Between TargetWEIGHT, MYFitnesspal, MapMyFitness, myWOD, and Nike Fit Band, I have been unsuccessful in maintaining the health and fitness level of my satisfaction.Apple HealthKit: A Game Changer

When I heard about the Apple HealthKit platform and the ability for it to sync with third party application data, the question I posed to myself was, will this help me? I have no chronic illness. I’m not sick. I just want to be healthy. After doing some primitive research, if Apple can pull this off as they say they can, it will revolutionize not just my health technology experience, but the way any doctor in my future will diagnose and treat me.

The Apple HealthKit in addition to the Myhealth App promises to connect Apple Applications & other devices to one another, and to your physician if you choose to. Alleged, my myriad of applications will update one another automatically so I can work (at my nutrition & fitness) smarter and more accurately. Or, if I choose to use the Myhealth, this data will aggregate within the application in a single profile to use and share. Myhealth has 47 different tracking options to help me reach my goals, along with tracking my health milestones and medications/allergies. Furthermore, in case of an emergency, this historical account of my vitals, fitness level, and health milestones such as a chronic illness diagnosis are logged and can be shared with the ER Doctor. This may be critical in saving my life.

I am very conscious however that many folks are extremely uncomfortable with having this type of data in the cloud. I believe this will be a large barrier for Apple along with other 3rd party development partners to overcome. However the technology to keep this information secure exists, and I believe it can be done right. The challenge for Apple is to relay to the public the capabilities of internet security. Now educating Baby Boomers, Generation X, and Y’ers on Cloud Security and gaining the trust to make this Application helpful to all generations may be a challenge and will come with time.

Luckily, as a thirty-something that needs to keep track of my own family’s health along with my aging parent’s health, having health information at my fingertips may not just be convenient but literally may be a life saver. The Mayo Clinic thinks so, they have partnered with Apple along with Epic to make this endeavor successful. You can read more at:

http://www.imedicalapps.com/2014/06/apple-partnership-epic-game-changer/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+iMedicalApps+%28iMedicalApps%29

It’s IaaS not IaaS – Creating a nimble Healthcare organization

I always find industry acronyms amusing. Sometimes they describe new technologies, other times they are a new name for an existing technology (maybe with a slight twist).  And then there are those times when two different technologies, models, theories, etc. end upwith the same acronym. Such is the case with Information as a Service and Infrastructure as a Service. Both are interesting concepts that deserve equal time, but today I would like to talk about Information as a Service (IaaS).

IaaS PicIaaS is certainly not a new concept. It has been around for a while. But it does merit a re-visit every now and then, since many healthcare organizations still struggle with integrating multiple systems and data sources.

At the core of IaaS is the concept of developing a common data model (also known as a canonical model) using schematic mapping and master data management. The common data model that is exposed represents multiple autonomous information sources that organizations use in order to transact business on a daily basis. Read the rest of this post »