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OpenNotes, changing roles in health IT and a Friday, um, funny

I’ve just had two new stories published on the US News & World Report Hospital of Tomorrow site: “OpenNotes Helps Keep Patients Informed and Engaged” and “The Evolution of Health IT Continues.” The latter is subtitled, “New roles signal new realities and priorities as hospital information technology changes,” and goes in depth and the changes underway in hospital HIS and HIM departments in response to various healthcare reform imperatives. I’d appreciate your feedback here, on the U.S. News pages and on Twitter.

Since it’s Friday, I’ll share something offbeat. I’ll let you decide if it’s a good idea or a gimmick. Nestlé Fitness has created the “Tweeting Bra,” with a Bluetooth-enabled sensor that sends a tweet every time the wearer unhooks the undergarment, reminding women daily of the importance of breast self-exams. Here’s a video, in Greek with English subtitles.

 

If you want more information, here’s a short interview with the keeper of the Tweeting Bra, Maria Bakodimus, a Greek celebrity. It’s only in Greek, without subtitles, but it does show the sensors in more detail.

If you want to get one, well, sorry.

 


It was a one-off prototype created for Breast Cancer Awareness Month in October.

February 7, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

My first portal experience

Yes, after all these years of writing about EMRs, EHRs, PHRs, patient portals and the like, I have had my first real personal experience with a patient portal, courtesy of my internist.

He still has a small practice, with four other physicians, including one fresh out of residency. Those small practices are a dying breed, but this doctor is changing with the times, too. He recently offered a concierge option for a few hundred patients. I declined because I don’t need to reach him that urgently.

The portal has been in place for a couple of years, and I may have logged in once or twice before to set up an account, but didn’t really do anything other than look around. This time, prompted by an e-mail informing me of a new URL, I logged in and checked my medication list. I remembered that another doctor had changed the dosage of one of my medications a while back, so I fired off a secure message informing this practice of the change. (It was a new URL presumably because the EHR vendor formerly known as Sage Healthcare adopted the Vitera Healthcare Solutions name a year ago and was switching its customers to a common, white-labeled portal.)

I also looked at some of my test results from a year and a half ago just to confirm that everything was more or less OK then, though I did see one abnormality with my HDL cholesterol. I last went for a physical in March 2011, about a month after I ungracefully cut my face open on a bathtub in Orlando during HIMSS11, so I was probably due. This practice lets patients request appointments — not actually choose open slots — online, so I sent my request. Tonight, about 24 hours later, I got my confirmation, and I’ll be seeing the doc in a couple of weeks.

It’s not a perfect system, but it was convenient enough for a night owl like myself who might not remember to call during business hours to make an appointment or simply not want to wait on hold or press a bunch of buttons to navigate a telephone menu. I did not see the Blue Button option to download my record that the federal government is pushing private vendors to adopt, but I’m sure that will be there by the time the practice is ready for “meaningful use” Stage 2 in a year or two. I don’t have a PHR anyway, so I wouldn’t be able to do anything with the data other than print it.

I suppose I should set up an emergency PHR at some point, even though I doubt any hospital or specialist I might get referred to would take the time to download my data from a USB drive or log into someone else’s portal. Untethered PHRs simply don’t fit physician workflow. That might change in MU Stage 2 when providers will have to send electronic discharge statements and patient summaries during transitions of care, but I’m still not convinced a patient-controlled PHR will be the right vehicle for these data transfers.

 

October 31, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Sampling of opinions on meaningful use Stage 2

I’ve been an absentee blogger yet again the last few weeks. Here’s something to chew on while I get caught up, a sampling of all the statements I received regarding the Stage 2 final rules for meaningful use, in the order I received them. Most interesting are what the consumer groups had to say because CMS lowered the threshold for sharing records through a patient portal to a laughable 5 percent of patients, down from the proposed (and almost equally laughable) level of 10 percent. Patients need to speak up and demand access to their own records. Providers need to stop fighting the inevitable.

National Partnership for Women & Families

Leading Consumer Advocate Lauds Stage 2 Meaningful Use Final Rule for Promoting Better Communication Among Doctors, Fewer Medical Errors and Lower Health Costs

Statement of Christine Bechtel, Vice President, National Partnership for Women & Families

“The Stage 2 Final Rule released by the Centers for Medicare & Medicaid Services (CMS) this afternoon is a huge step forward.  It brings us closer to the days when fewer overwhelmed patients and their family caregivers struggle to keep track of tests, diagnoses and medications; beg their doctors to talk to one another; suffer avoidable medical errors; and pay for duplicative and unnecessary care.  The rule issued today offers the promise of better, more efficient care, improved safety and fewer hospital readmissions.

We are pleased that the new rule gives patients the ability to go online and view, download and transmit their health information from the Electronic Health Record (EHR) to secure places of their choosing.  A recent public opinion survey commissioned by the National Partnership for Women & Families found that this kind of feature helps consumers see great value in physicians’ use of EHRs, and helps them have more trust in electronic systems.  The fact that this is now a core requirement, and will apply to the hospital setting as well as to physicians, is key to finally recognizing the critical role patients play as partners in their own care. This is a huge advance that will allow patients to be more actively engaged in their care.  It helps realize the potential of health IT in ways the nation needs.

It is good that the new rule also recognizes the essential role that providers and their staff play in encouraging patients to use this online access.  It does that by holding physicians and hospitals accountable for ensuring that 5 percent of their patient population logs in once during the year.

In addition, enabling patients to download and transmit their health information electronically will help foster more of the kind of information sharing that is desperately needed to facilitate care coordination, improve safety and reduce costs.  Patients play a key role in information sharing, and this rule gives patients the tools they need to do just that.

The rule’s requirements that a summary of care document be sent from one provider to the next for at least one of every two transitions of care or referrals is a good step.  CMS is also requiring 10 percent of those transmissions to be electronic.  And providers will have to show they are capable of sending these documents to providers who have different EHRs.

Improving care coordination and patient engagement through these criteria (information sharing requirements and online access for patients) are cornerstones of building the foundation of interoperability that will support health system reform.  So many new models of care like Accountable Care Organizations and medical homes will crumble without this bedrock foundation.  This is a good day for consumers who urgently need a more efficient, safer, better coordinated health care system.”

Click the links below for:

  1. Interviews with physician leaders who have implemented patient portals (or online access for patients)
  2. A snapshot of the national HIT opinion survey results
  3. A full executive summary of the national HIT opinion survey results

 

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American Health Information Management Association

Meaningful Use Stage 2 Final Rule:

AHIMA Provides Initial Comments on CMS Ruling

 

CHICAGO – Aug. 23, 2012 Today the final rule on the Electronic Health Record Incentive Program Stage 2 Meaningful Use (MU2) was announced by the Centers for Medicare and Medicaid Services (CMS). This act focuses on incentive payments to eligible professionals, hospitals and critical access hospitals participating in this program that successfully demonstrate meaningful use of certified electronic health record (EHR) technology.

A full analysis of this complex ruling announced as part of the American Recovery and Reinvestment Act – Health Information Technology for Economic and Clinical Health (ARRA-HITECH) will be forthcoming from the American Health Information Management Association (AHIMA). AHIMA is the preeminent nonprofit association representing Health Information Management (HIM) professionals on the front lines for implementing the rule.

While AHIMA studies the complete text of the rule and its scope, the following points have been included:

  • Consistent with the proposed regulation, health information technology (HIT) measures will allow for patients to have the ability to view online, download, and transmit their health information within four business days of the information being available.
  • CMS continues to acknowledge and align Clinical Quality Measures with other reporting programs to reduce burden and duplication of efforts.
  • All HIT Menu Set measures have been transitioned to the Core Set of measures with the exception of electronic syndromic surveillance data and advance directives.

 “We are encouraged to see CMS’ continued push toward actively exchanging health information to improve coordination of care thus improving patient safety,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE.  “We are also pleased to learn of CMS’ continued commitment toward engaging patients and families in their healthcare through the ability to view online, download and transmit their health information.  We believe patients must be partners and work side-by-side with their providers to achieve the best possible healthcare outcomes.”

According to Thomas Gordon, the 2014 compliance date CMS provided will enable the industry – providers, hospitals and vendors – the appropriate time to plan and implement the necessary changes.

“As HIM professionals, we are a critical component to the reporting of clinical and HIT quality measures in achieving meaningful use,” said Allison Viola, MBA, RHIA, senior director of federal relations at AHIMA. “We are pleased to see that CMS has heard our calls for increased alignment of quality reporting programs and acknowledgement of making an effort to reduce the reporting burden and duplication of reporting.  We also stand ready to support patients and their ability to have online access to their health information to ensure its privacy, integrity, and timeliness for their continued care.”

Live webinars to discuss the rule’s provisions will be available free for AHIMA members and for $59 for non-members. Visit ahima.org for the schedule and registration information.

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Society for Participatory Medicine

Statement of Sarah Krug, president of the Society for Participatory Medicine:

“Although we’re disappointed this final rule does not give patients next-day access to their electronic medical record after they leave the hospital, we believe that on balance the Stage 2 Meaningful Use requirements go a long ways towards patient empowerment and feature a number of important patient-centered innovations. Patients must be full partners in access to their health information so they can be full partners in their care. For that reason, the Society for Participatory Medicine intends to keep a sharp eye on how the new Meaningful Use rules are actually implemented.”

 

Healthcare Information and Management Systems Society

HIMSS Statement on Release of Meaningful Use Stage 2 and Standards & Certification Criteria Final Rules

August 24, 2012 – (Washington, DC) – HIMSS appreciates the release of the Meaningful Use Stage 2 and Standards & Certification Criteria final rules by the U.S. Department of Health and Human Services. The Stage 2 regulations allow the healthcare community to continue the necessary steps to ensure health information technology will support the transformation of healthcare delivery in the United States.

In our initial review of the Medicare and Medicaid Programs; Electronic Health Record Incentive Program–Stage 2 Final Rule from the Centers for Medicare and Medicaid, HIMSS has identified several significant policy decisions, including:

  • Setting the Meaningful Use Stage 2 start date as 2014, which will maximize the number of eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) prepared to meet Stage 2 requirements
  • Allowing a 90-day reporting period in Year 1 of Stage 2, which is consistent with HIMSS’ recommendations on the proposed rule
  • Accepting 2013 as the attestation deadline for EPs, EHs, and CAHs to avoid a Medicare payment adjustment, and allowing for exceptions, including limited availability of information technology
  • Finalizing Clinical Quality Measure submission specifications for EPs, EHs, and CAHs

ONC’s efforts in the Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition  appear to streamline the administrative process of certifying EHR products.  We note that the Final Rule both adopts and concurs with a number of HIMSS recommendations. The HIMSS response to the proposed rule had requested several points of clarity and additional specification around certain criterion, and we commend the government’s thorough review and inclusion of additional information to clarify many topics.

We are assessing impacts of each Final Rule regarding Clinical Quality Measurement, reporting options, standards specifications, and alignment with other federal quality reporting and performance improvement programs.

We look forward to continuing to work with the federal government and our members to ensure that the EHR Incentive Program makes impactful improvements to the quality of healthcare delivery in the United States.

Stay tuned for in-depth analysis on HIMSS’ Meaningful Use OneSource; a webinar series in September; and a full slate of Meaningful Use education and exhibition activities at HIMSS13, including a new Meaningful Use Experience.

MGMA-ACMPE

Statement from Susan Turney, MD, MS, president and CEO of MGMA-ACMPE

“MGMA is pleased that the Centers for Medicare & Medicaid Services (CMS) responded to our concerns regarding several of the proposed Stage 2 meaningful use requirements. Extending the start for stage 2 until 2014 was a necessary step to permit medical groups sufficient time to implement new software. Permitting group reporting will reduce administrative burden, as will lowering the thresholds for achieving certain measures such as mandatory online access and electronic exchange of summary of care documents. MGMA supports the rule’s expanded list of exclusions and believes it will allow physicians to achieve meaningful use with fewer hurdles.”

 

Health IT Now Coalition

Health IT Now Coalition Expresses Concern over Meaningful Use Stage 2 Final Rule
Stresses clinical exchange measures are insufficient

WASHINGTON – The Centers for Medicare and Medicaid Services (CMS) today issued its final rule detailing criteria for Stage 2 of the federal electronic health-record system incentive program. The following should be attributed to Joel White, executive director of the Health IT Now Coalition<http://www.healthitnow.org>:

“While we are encouraged that ONC and CMS have recognized that care coordination cannot be achieved exclusively through directed exchange, the rule still fails to adequately address the core issue of interoperability.  Providers, developers, and state health information exchanges have already adopted and implemented more mature and scalable standards that are functioning well in the market today.

“More could and should have been done to support the interoperability requirements necessary for advanced payment and delivery reforms to operate optimally.  The measures for clinical exchange laid out in the Stage 2 final rule will likely not be sufficient.”

Health IT Now is a coalition to promote the rapid deployment of heath information technology (health IT). Health IT will benefit patients and health care consumers while supporting health practitioners to make smart decisions about patient care and save money. For more information, visit www.healthitnow.org<http://www.healthitnow.org>.

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College of Healthcare Information Management Executives

The College of Healthcare Information Management Executives (CHIME) today issued a statement in response to final rules on Stage 2 of the EHR Incentive Payments program, also known as Meaningful Use:

“CHIME applauds efforts made by officials at the Department of Health and Human Services in working diligently to prepare final rules on Stage 2 of the EHR Incentive Payments program,” said CHIME President and CEO Richard A. Correll.

“We commend the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT for seeing the wisdom and practicality of heeding many of CHIME’s recommendations, filed during the spring public comment period. By allowing providers to demonstrate Meaningful Use through a 90-day EHR reporting period for 2014, government rule-makers have ensured greater levels of program success. And by including additional measures to the menu set, providers have a better chance of receiving funds for meeting Stage 2.

“However, we also recognize that these points are conciliatory and that many details may need further clarification. The final rule still puts providers at risk of not demonstrating meaningful use based on measures that are outside their control, such as requiring 5 percent of patients to view, download or transmit their health information during a 3-month period. Some areas of clarification include some of the exclusionary language as well as nuances around health information exchange provisions, clinical quality measures and accessing images through a certified EHR.

“CHIME will continue to delve into this sizable and weighty effort, including the technical specifications and certification criteria,” Correll added.

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September 5, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: Carrie Handley on patient empowerment with an iPad

Did you happen to catch my story in MobiHealthNews on Thursday about Carrie Handley, the IT consultant-turned-cancer patient? She got frustrated with first a misdiagnosis and then the hassle of lugging around a binder full of paper records that she had to go to multiple sites to collect to assure continuity of care during her treatment and surgeries. So Handley digitized all her records.

Initially, she transported the information on a USB drive, but that got lost in a doctor’s lab coat. Then, her son brought over an iPad. The tablet provided the right balance of portability and shareability. In this interview, Handley, a resident of Waterloo, Ontario (you know, the home of BlackBerry maker Research in Motion), describes the process and shares her thoughts in general on mobility in healthcare.

We wouldn’t have connected if she hadn’t read my tribute to my dad last month. After reading Handley’s story in the e-mail she sent me, I knew we had to do this podcast to help spread the idea that communication can help foster the kind of patient-centric care that eluded my dad, that initially eluded her and that probably eludes millions of people every year.

This Sunday is Father’s Day. I miss my dad terribly. But I take comfort in knowing that I’m doing a small part to raise awareness of multiple system atrophy (MSA) — the rare neurodegenerative disease that killed him — and perhaps advancing the cause of patient safety ever so slightly.

Podcast details: Interview with health IT consultant and cancer survivor Carrie Handley about mobility in healthcare. MP3, mono, 128 kbps, 26.7 MB. Running time 29:13.

June 14, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Yes, you do have a right to your health records

Lest anyone forget — including the American Hospital Association, which wants to take 30 days post-discharge to supply copies of medical records to patients — HIPAA explicitly gives patients the right to access their own records. This is not new. The HIPAA privacy rules have been in force since 2002. Yet, far too many patients have no idea of this right and far too many providers don’t inform patients of this right or do what they can to prevent access.

Fortunately, the HHS Office for Civil Rights, which enforces HIPAA privacy and security standards, is trying to change that with an outreach campaign, including this video.

 

Unfortunately, the video has been viewed just 556 times as of this writing. Equally unfortunately, the video directs viewers to visit HHS.gov/OCR. But the real information you need is at http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. I found that page using Google, not by trying to navigate the menu, which is not very intuitive, even for someone who knows the healthcare industry. I can’t imagine the average consumer finding that page without help or plain old dumb luck.

Various HHS agencies are trying hard to disseminate messages to the public. I think of AHRQ’s Questions are the Answer campaign. I’ve seen poster-size ads around Chicago telling people to visit ahrq.gov for a list of questions they should be asking their healthcare providers, but the better link, not mentioned in the ads, is ahrq.gov/questions.

For that matter — and I mentioned this to one of the AHRQ higher-ups at the HIMSS conference a few months ago — how many people really know what the Agency for Healthcare Research and Quality is? Wouldn’t it be better to have a more memorable URL? The Obama administration is good at setting up URLs for programs it wants to promote for political reasons — think recovery.gov and even the consumer-friendly healthcare.gov — but the less-politicized divisions such as AHRQ (remember, Director Dr. Carolyn Clancy is a career professional who has run AHRQ for two presidents since 2003) and OCR haven’t done so. They need to come up with easy-to-remember URLs that the general public can remember. Bureaucrat-speak just isn’t getting the job done.

Meantime, physicians need to become more patient-friendly, too. I invite you to check out this Salon article from a few weeks ago entitled, “Listen up, doctors: Here’s how to talk to your patients.” Please share with family, friends and, yes, your doctors. Share the OCR video, too. If OCR can’t make the information easy to find, I will.

 

June 12, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

On the road to meaningful use

If you follow my Twitter feed, you know I had a little accident early Wednesday morning during the just-concluded HIMSS conference. I stumbled into the bathroom in my Orlando, Fla., hotel room in the dark about 6:30 a.m., did my business, then turned to my left to use the sink. Unfortunately, the sink was not to my left. I fell down and hit my face against the edge of the bathtub and immediately started gushing blood.

It took a while, but I mostly got the bleeding stopped with the help of some towels (I’m sure the cleaning

The result of my clumsiness

The result of my clumsiness

staff wondered if I had murdered someone), ice and, courtesy of the front desk, moist towelettes, antibiotic ointment, gauze pads and surgical tape.

The clerk at the front desk offered to call an ambulance to get me to an ER. I have a high-deductible health plan, so this early in the year, I’d have to pay the hefty bill entirely out of pocket. I wasn’t going to die from a cut just above my eye. Fortunately, there was a Walgreens right across a parking lot from the hotel, so I was able to get some other first-aid materials to clean the wound and completely stop the bleeding.

After going back to sleep for a couple hours, I got myself over to the convention center around lunchtime, still wondering if I needed to get the cut checked out. This being HIMSS, there were plenty of clinicians around. I happened to be in a session where HIMSS Vice President Pat Wise, R.N., and Chicago medical informaticist Lyle Berkowitz, M.D., were present. They both recommended I get medical attention as soon as possible. (Too bad nobody carries suture kits to IT conferences.)

With the help of Google Maps on my BlackBerry, I found two options: a hospital 0.7 miles south of where I was in the convention center or a walk-in urgent care clinic 0.9 miles north. The single review connected to the clinic listing said it wasn’t worth it, go to a real hospital instead. Again, though, I have a high-deductible plan and this wasn’t a life-threatening injury. Having followed this industry closely for more than 10 years, I think I have more realistic expectations of how a healthcare consumer should behave. I chose the urgent care clinic.

Rather than waiting hours in an ER, I was in and out in about an hour with six stitches slightly below my eyebrow. Instead of a $300 (minimum) ambulance ride plus who knows how many hundreds—if not $1,000 or more—for ER services, I got there for $7 in a taxi. This clinic, which doesn’t accept insurance as a way to keep costs down, charged $55 for the visit (after a $20 coupon that I didn’t know about until they volunteered it), plus a couple hundred for a physician assistant to clean and stitch up the wound.

This clinic was in an aging, shabby strip mall not far from the tourist traps and second-class chain restaurants of International Drive. It seemed like a typical, old-fashioned, paper-based practice. I filled out my medical history and presenting condition on the hated, ubiquitous clipboard, then sat down in the waiting room, surrounded by outdated magazines. Shortly thereafter, a nurse brought me back into an exam room, took my vitals and got everything ready for the PA to fix the cut.

After the stitching, I was pleasantly surprised to learn that the practice wasn’t so stuck in the past after all. The PA ran my credit card, then told me to sit tight for a few minutes while he documented my case so I can take a report back to my own physician when I get the stitches removed next week. He sat down at a computer and started typing away. About five minutes later, I was handed a printed, detailed, discharge summary.

That’s right, this practice, that seemed old-fashioned on the surface, had an electronic medical record (I didn’t catch or bother to ask who the vendor was). Since the practice doesn’t accept Medicare, Medicaid or any other insurance plans, it’s not eligible for federal EMR incentive payments, but it probably wouldn’t qualify for “meaningful use” anyway since it’s not totally electronic. I didn’t see any orders entered electronically (though they still may have been), nor was I offered the option of receiving the clinical summary electronically. I think they ran the lidocaine they ordered as a topical anesthetic through an interaction checker to make sure it didn’t contain any sulfa, which I had indicated I’m allergic to.

I imagine this is where countless thousands of small medical practices are on the road to meaningful use. They have some elements of an EMR that fit existing workflow, but nothing comprehensive and no interoperability. I’m glad the summary was at least typed so there won’t be any issues with handwriting when I go to my regular internist next week. I’m also happy they checked for drug-allergy interactions.

Score two points for patient safety and one more for consumerism. I’m confident I got the right care for a reasonable cost, and that I’ll recover quite nicely.

February 25, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.