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Posts Tagged ‘HIE’

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.

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.

7 Features the Market Wants in Your Patient Portal: Blog Series

In case you missed it, we recently concluded our blog series on What the Market Says You Need in Your Patient Portal. Two of our healthcare experts, Melody Smith Jones, Manager of Connected Health (@melsmithjones) and Nick Lecker, Director of Architecture and Interoperability teamed up to take a deeper look into the 7 features that the market wants in your patient portal:7 Features the Market Wants in Your Patient Portal Blog Series

Healthcare consumers are at the center of the industry’s evolution and patient portals are going to continue to be a vital tool for connecting, engaging and empowering them.

 

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.

Improve care coordination with direct secure messaging #HIMSS14

Direct secure messaging (DSM) is a transmission standard promoted by the Office of the National Coordinator for Health Information Technology that meets the Meaningful Use Stage 2 requirements of electronic health records (EHRs).  It works much the same way as regular email, but the message is encrypted, which prevents unintended use of the protected health information that is included within.  DSM can be used to send patient information among physicians, among provider organizations and to other 3rd parties, including patients.  

shutterstock_157839875Healthcare providers have been using direct secure messaging for care coordinating for a while but there may be ways to use it more fully to reduce readmissions, reduce unnecessary testing and procedures and even increase provider productivity.  Some benefits may include:

  1. Providers can insert secure messages into any point of their workflow.
  2. Primary care providers can interact with specialists to potentially result in fewer referrals; ultimately reducing costs to the healthcare system.
  3. Hospitals can improve transitions to nursing facilities and nursing homes can improve the communication with providers to reduce the need for readmissions back to the hospital.
  4. Medical records departments can interact with the patient send their records more easily saving them time and money.
  5. Researchers can seamlessly interact with patients on release of health sciences information.

Once HIEs are fully implemented, query based networks will provide robust data exchanges, but DSMs will continue to be valuable especially for smaller practices and hospitals that do not have the means to implement sophisticated EHRs.  Read the rest of this post »

Creating a single best view of the patient #HIMSS14

As healthcare organizations prepare for full scale integration of electronic medical records through EHR and enterprise wide data warehouse initiatives, identity resolution is a priority for everyone. 

shutterstock_128624354A Master Person Index (MPI) is a solution intended to solve the common problem where multiple systems or applications within the organization gradually become inconsistent with the most current data.  When this information changes and only one system is updated, the MPI solution ensures that the change is propagated to all other systems to create the single best view.  The MPI may be found at the single system level, facility level, enterprise or health information exchange (HIE) level.  A “person” in the healthcare context may be a physician, patient, member, payers, etc.

Data management is one of my favorite subjects and I’m very excited about the evolution of MPIs for identity resolution, as well as, other Master Data Management solutions. But let’s focus on the benefits of the Master Person Index.  Read the rest of this post »

Healthcare CIOs are carefully moving to the cloud

Recently our company has increased our focus on what healthcare organizations are looking for when it comes to cloud computing, in large part due to our acquisition last year of two fantastic Salesforce partners (ClearTask and CoreMatrix). I found this article in Healthcare Informatics to be very interesting. It’s titled “The Many Flavors of the Cloud” and includes interviews with some key CIOs regarding how they view private vs. public cloud solutions and the sensitivity – and often the mandated security requirements – around health data when stored in the cloud.

There are some obvious advantages to providers moving to private cloud storage for all types of data across the organization, but also some critical considerations for any CIO or CMIO. Here are the key takeaways I got from this article.

MedicalImaging_AndroidTabletApp

Medical imaging takes up a lot of storage space in the healthcare space. Imagine a 24 hour study of your heart that takes up a terabyte of space. The cloud can enable better scale for this type of need.

Key insights about cloud computing in healthcare:

  • CIOs interviewed prefer “private cloud” solutions over public cloud solutions like those of Google, Amazon and Microsoft – more control around access & rules
  • CIOs don’t want to deal with power issues, cooling issues, and capitalizing hardware over time – 3 reasons they enjoy Cloud
  • They enjoy reduced costs in scaling a storage room, servers, etc..
  • CIOs take personal ownership over creating their own stringent security requirements for their cloud vendor, making them feel better about storing PHI or other sensitive healthcare data in it.

Read the rest of this post »

Massachusetts launches important next phase of HIE

Today, Masachusetts moved into phase 2 of a very important Health Information Exchange (HIE) project. It’s called Mass HIway Health Information Exchange, and it was announced at Beth Israel Deaconess Medical Center, where Healthcare CIO, John D. Halamka works.

John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician.

John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician.

Halamka is one of my favorite people to follow in healthcare technology (@jhalamka). He blogs at “Life as a Healthcare CIO” and wrote about the news today in a post titled “The Next Phase of Healthcare Information Exchange.”

Halamka gives us a sense of all of the work that went into this next stage of the project, including:

  • a patient index to track which patients have opted into exchanging their patient data with other providers
  • a portal for providers to log in and access the data
  • an EMR request system to support the request & release workflow
  • a system to keep audit trails of all of the activity

For those who are fans of a “No More Clipboards” type of future in their own patient care experience, news like this is very exciting. Halamka talks about how this massive project taking place in Massachusetts is an example of how the future of healthcare information exchange can be convenient, secure, and lead to better care and health outcomes for us all.

He writes:

“I can imagine a day in the next few years, when all patients in the Commonwealth, with their consent, benefit from secure, coordinated care.    My mother suffered a major medical error in California because of inaccessible primary care records.   I truly believe that my 20 year old daughter, attending Tufts University, will see significant reduction in preventable harm in Massachusetts during her 20’s.”

That’s very inspiring.

 

Top 5 Technology Trends in Healthcare – October 2013

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

 HCBlog Top5 Trends

Mobile Medical Applications

Last month, the FDA released its final guidance for developers of mobile medical applications. The FDA will focus on regulating potentially harmful apps instead of policing applications that pose minimal risk to consumers. These more harmful apps include those which are using mobile technology to make a specific diagnosis and those which transform mobile devices into a regulated medical device.

Patient Engagement and Connected Health

With the progression of patient engagement, consumers are looking to become involved in their own care and health. The quantified-self movement helps patients track their health, physical activity, food consumption, heart rate, and more. From mobile apps to worn digital sensors like the FitBit to implanted devices, patients keep track of their own health data – which eventually may be used to create a more personalized experience.

Read the rest of this post »

HIE: 6 Opportunities for Increased Patient Safety

In my last blog post we explored the topic of shared decision making (SDM) and its impact on patient safety. This made me think of an experience we recently had with my dad. He had a stent placed about year and a half ago to open a blocked artery in his left anterior descending artery (LAD). Now I should tell you that the doctors, 3 to be exact, wanted to send him home because all of his tests came back negative, but the stubborn, yet lovable, man that my father is (I know, the apple doesn’t far fall!), found a cardiologist that was willing to listen to him and discuss his concerns and thoughts. He convinced this cardiologist to do an angiogram. They ended up finding, clear as day, a 90% blockage in the LAD and stented him right then and there, no questions asked. Needless to say he bypassed a major heart attack, (a.k.a. the Widowmaker) which could have very easily ended his life.

My brother and I both have clinical backgrounds, so it was a little unsettling how the events of the 48 hours with my dad transpired. We went from an emergency admission to nothing is wrong with him, he can go home, to he has a 90% blockage in his main artery that we need to stent right away. Talk about an emotional rollercoaster, but in the HIE benefitsend we were glad he was okay. However, at time of discharge, another shocking and disappointing incident occurred. The nurse was going over his discharge medication regime. As she was rattling off this medication list at a speed even a pharmacist couldn’t understand, she stated, “…and 10mg of Amaryl two times a day.” My dad, who has NEVER taken a pill in his life (we are Indian so turmeric is our answer to everything!) and was still a little out of it from the whole experience was unable to catch the error that just occurred. Luckily I was there to ask the nurse, “Are you sure it is 10mg and not 1mg of Amaryl?” Her response, “Yes that is what the order states.” Again, I challenged her, “Are you sure, because I thought the cardiologist told us after surgery it was 1mg of Amaryl.” She responded, “I can go check, but I am pretty sure this is correct”. I asked her to call the cardiologist and confirm as pretty sure was not good enough. Just as I suspected, it was an error in dosage. The order was for 1mg of Amaryl, twice a day, specific to before breakfast and dinner. At this point, given all that occurred, I began questioning everything she rattled off and requested (well, damn near demanded) that she go back and reconfirm the entire list. This was my dad, my best friend, I was not going to take any chances that his safety be compromised due to a medication error.

This is just one incident that thankfully didn’t end badly.  However, every day patient safety is being compromised because information is not accurately or readily available.  Up to 18% of the patient safety errors, generally, and as many as 70% of adverse drug events could be eliminated if the right information about the right patient is available at the right time. Health information exchange (HIE) makes this possible1.”

Read the rest of this post »

The Quest for My Complete, Portable Health Record

As I have written before, I currently see several physicians who do NOT use an EMR in the office.  They are awesome diagnosticians, people and mentors but they have not taken the leap to the electronic health world.  Now, add in two hospital networks that do NOT have patient portals for accessing my records and you get one big, fat medical record quagmire!   I would love to have my entire medical record in one place AND have portable access to it.  Will I ever reach that goal?  Do I need to establish a relationship with a new physician just to obtain my goal?  I certainly hope not!  So what can be done to make my dream a reality?

puzzle personThis quest has certainly led me to devour insights from industry experts, read countless blogs and articles and consider the drastic move to a new physician.  So I was intrigued when I read the Wall Street Journal article, “Image Sharing Seeks to Reduce Repeat Scans”, this week.  Allowing patients to have access and the ability to TRANSFER images to multiple providers reduces cost, redundancy and ultimately, radiation exposure for the patient.  In addition, it allows the patient to “own” their health.  Although this is certainly a step in the right direction, this is an isolated sharing of information, not connected to the rest of the patient’s history, just another piece of the puzzle.  How can we solve the entire puzzle?

Read the rest of this post »