The cyber-attack on Anthem, the nation’s second-largest health insurer, directly reflects the vulnerability of healthcare organizations, which are years behind other industries in regards to protecting personal information. In today’s healthcare industry, the federal government encourages sharing information across the continuum, which is critical to improving patient care. The challenge is the balancing act between protecting personal information and making it useful – the health information exchange teeter-totter. Current federal privacy regulations and the industry standard call for encrypting information that is sent from the database; however, on-premise data commonly remains unencrypted, making it vulnerable to an attack.
Anthem followed industry standards and encrypted the medical information that was shared outside of their database, but because they failed to secure their on-premise data, hackers gained access to up to 80 million records that include social security numbers, birthdays, addresses, email, employment information and income data for customers and employees. Scrambling personal data makes it less valuable to hackers, but also makes it more difficult for healthcare employees to track trends and share data with other healthcare providers and states.
Other industries such as the financial services industry keep personal information in separate databases that can be closed off in an attack. Avivah Litan, an analyst for Gartner who specializes in cyber-security, said healthcare organizations “are generally less secure than financial service companies who have the same type of customer data.” For example, the attack on JPMorgan Chase last summer compromised the personal information of over 80 million households and small businesses, but the breach was limited to non-financial information because the more sensitive information was walled off, which meant hackers could not penetrate it.
Unfortunately, in healthcare the question isn’t whether the next data breach will occur but rather when will it occur. Balancing out the health information exchange teeter-totter will continue to be a challenge for the healthcare industry. The criminal value of the information that healthcare organizations store combined with the slow adoption of security measures make healthcare organizations prime targets for hackers.
]]>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: 
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?
]]>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. 
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.
]]>I sometimes read information about symptoms from Dr. Google but generally, I think this is a pretty bad idea … one of the reasons is because I believe in the power of thought and visualization … but we won’t go there in this blog.
What I’d like to talk about is the powerful platform being used by Perficient which leverages Oracle cloud based customer experience solutions to implement symptom checker technology that is much more functional than Dr. Google.
For those patients outside the traditional medical setting, which is a growing population, the Perficient member/patient “Self-Service Symptom Portal” enhances the telemedicine 
experience by utilizing structured “symptom questionnaires” to guide the patient through a friendly intuitive process. This approach eliminates the phone consult and results in shorter cycle times (in most cases hours to minutes) for the patient. The underlying integrated platform has the capability to inform providers (whether it is the physician or the at-home care giver) of actionable data in a timely fashion.
I would use this symptom checker or trust it for use by those in my care in concert with the growing amount of at-home health technology which can be integrated.
Stop by and visit us at OOW14 to see our Self-Service Symptom Portal in action! We are located at the Healthcare Solutions Pavilion in Industry Central (Marriott Hotel Atrium Lobby booth HMH-003) and at the Perficient Main Booth #2221: Moscone South Exhibition Hall Level 1.
Also, watch Perficient.com for our upcoming webinar for a demo on the symptom checker on November 6, 2014 at 2:00 CST.
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]]>Having many siloed healthcare applications that don’t easily exchange information has been the trademark of health information technology, denying patients and providers the benefits that interoperable health information makes possible. Government regulations and the evolving healthcare landscape enforce the need for interoperability throughout the continuum of care. Integrated systems streamline data sharing, support population health initiatives and make accountable-care a reality; however, many organizations don’t have a clear vision for how to meet the demands of the ever-changing healthcare industry.
Health reform is also spurring hospitals to form Clinically Integrated Networks (CINs) to manage populations of patients. These networks are bringing data 
together for a region or city to analyze and improve patient care and outcomes and lower costs of care. Many are using data for precision medicine and/or cohort verification and identification for clinical trials.
While the technologies employed to achieve these goals most certainly include a data warehouse, analytic / predictive modeling and perhaps reasoning tools, I think the integration challenge is vast and perhaps overlooked. Most of what I read is very focused on the fancy dashboard or the cool visualization tool but integration of this sort requires state of the art integration technology to do the heavy lifting on moving data and correlating data for the CIN.
Perficient provides a robust portfolio of services that help transform enterprises from simply processing HL7 messages to one that provides an architecture using Oracle Fusion Middleware to:
- Automate workflow across your enterprise systems
- Facilitate a unified business process platform that can provide end-to-end tracking, visibility, auditing, business intelligence, governance and security
- Enable multiple integration message types including Web Services, HL7 (with Oracle HC Adapter for SOA Suite) or batch data transfers (with Oracle Data Integrator)
- Provide a single view of a patient or provider among disparate systems, using Oracle Master Person Index
- Leverage WebCenter Portal to connect patients to providers.
Perficient is helping the University of Colorado build an integrated environment for precision medicine utilizing many of these solutions.
Join us at #OOW14 to hear Michael Ames, MBI, Associate Director, Health Data Compass Center for Biomedical Informatics and Personalized Medicine, University of Colorado and my colleague Lesli Adams, MPA @LesliAdams during the session “Creating a Digital Healthcare Safety Net with EHA and OBI for Care Transitions” located at the Marriott Marquis – Salon 10/11; Wednesday, October 1, 11:30am – 12:15pm.
As an Oracle Platinum partner and we’ve gained expertise from nearly 2,000 Oracle projects with our clients the past 15 years and we have amassed vast amounts of best practices and ideas to share. Stop by and visit with our Healthcare experts at the Healthcare Solutions in Industry Central (Marriott Hotel Atrium Lobby) at the Perficient kiosk (HMH-003) for a demo of the Translational Research Center.
Not attending #OOW14? Join our webinar Combining Patient Records, Genomic Data and Other Data to Enable Translational Medicine Wednesday, October 15, 2014 1:00 PM – 2:00 PM CT.
Follow me on twitter @teriemc
Learn more about our presence at Oracle OpenWorld here.
See all of our blog posts from Oracle OpenWorld.
Follow us on Twitter @PRFT_Oracle ]]>
Technology is opening up opportunities to move us further down the path of “best” outcomes AND more cost effectively than ever before. That is a tsunami that cannot be stopped. The use of personal health information in the delivery of care, optimizing outcomes and administering care within a cost context that our nation can afford will happen. Is it five years, ten years or fifty years out – we can all speculate. It will happen.
One of the areas that really “gets to me” as needing timely attention is the transition of care from hospital to skilled nursing homes … and a close second is the tele health aspects of elderly remote at home care … having experienced both in recent years in a personal way with caring for my mom. It is just tragic to see how our elderly are managed and the not huge but expansive gaps in this process. And … we were dealing with quite reputable organizations.
This is why I’m so passionate about subjects like healthcare interoperability. My colleagues at Perficient provide a robust portfolio of services that help transform enterprises from simply processing HL7 messages to providing an architecture using Oracle Fusion Middleware to:
- Automate workflow across enterprise systems
- Facilitate a unified business process platform that can provide end-to-end tracking, visibility, auditing, business intelligence, governance and security
- Enable multiple integration message types including Web Services, HL7 or batch data transfers
- Provide a single view of a patient or provider among disparate systems, using Oracle Master Person Index
- Leverage WebCenter Portal to connect patients to providers
As an Oracle Platinum partner and we’ve gained expertise from nearly 2,000 Oracle projects with our clients the past 15 years and we have amassed vast amounts of best practices and ideas to share.
Join our webinar “Tackle Healthcare Interoperability Challenges and Improve Transitions of Care” on Thursday, September 25, 2014 12:00 PM – 1:00 PM CT to learn more about modernizing your Oracle Healthcare Interoperability environment.
We will also be at #OOW14 so stop by and visit with our Healthcare experts at the Healthcare Solutions in Industry Central (Marriott Hotel Atrium Lobby) at the Perficient kiosk (HMH-003) to discuss healthcare interoperability!
Follow me on twitter @teriemc
Learn more about our presence at Oracle OpenWorld here.
See all of our blog posts from Oracle OpenWorld.
Follow us on Twitter @PRFT_Oracle ]]>
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 
unanswered 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.
]]>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:
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.
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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 
with 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.
]]>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.
Healthcare 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:
- Providers can insert secure messages into any point of their workflow.
- Primary care providers can interact with specialists to potentially result in fewer referrals; ultimately reducing costs to the healthcare system.
- 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.
- Medical records departments can interact with the patient send their records more easily saving them time and money.
- 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.
Perficient places the consumer at the forefront of healthcare technology solutions. Our dedicated national practice, combined with Perficient’s more than 1,000 business and technology professionals, delivers innovative and intelligent solutions for hospitals and health systems, integrated delivery networks, health plans, life sciences and state and federal government agencies. Perficient is uniquely positioned to deliver HIE assessments and strategic roadmaps. Stop by our booth at #HIMSS14 booth #2035 to view our case studies.
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See my blog “What is the role of health exchanges to maximize our time in the doctor’s office?” to learn more.
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.
A 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. Some examples are:
- Correctly matching a point of reference to patient, clinician, payer or other entities within and across the organization can improve care coordination and ensure trusted information in an emergency.
- Accuracy in building the “best single view” of the patient will empower both disease management and research activities.
- Using an MPI solution will enhance governance and risk management capabilities since MPI solutions are compliant with IHE audit messaging and recording standards.
- Using an MPI automated solutions provide a means to interpret and analyze patterns in incoming data to help trace lineage of the values to determine original source of bad data.
Perficient’s dedicated national practice, combined with hundreds of business and technology professionals, delivers innovative and intelligent solutions for hospitals and health systems, integrated delivery networks, health plans, life sciences and state and federal government agencies. We are uniquely positioned to deliver identify management assessments and strategic roadmaps. Stop by our booth at #HIMSS14 booth #2035 to view our case studies.
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See my blog “Direct Secure Messaging and Improved Care Coordination” to learn more about the Oracle HIE platform.
]]>
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.
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.
- They also lean on a shared-risk model with their vendors. (Trust is key to building relationships here.)
- Data storage requirements in Healthcare are growing at a fast clip, which is why the cloud is often the best solution for scale. Imaging takes up a lot of space here – imagine a 24 hour study of your heart that takes up a terabyte of space.
- Virtualization is driving them to the cloud.
- CIOs want vendors who:
- Understand policy requirements under HITECH Act
- Follow best practices that closely match those of the clients’ IT org.
Read more about how our salesforce.com team at Perficient has helped healthcare organizations with cloud solutions:
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