The Story of Screens

 

We think of EMRs, Health Information Exchanges and Data capturing when we mention health information technology, however the digital health space extends to many more uses.

They include computerized laboratory devices, testing and diagnostic instruments, computer controlled robotic devices, monitoring and alarm systems, communication devices, and smartphones.

Add to this an important visual aid.

5 Ways Digital Hospital Displays Are Enhancing the Patient Experience   (for providers, as well)

Many facilities already use display devices to assist patients for directions, waiting times, and instructional purposes.

The following info graphic visualization created by CDW Healthcare, provider of technology solutions and services for the healthcare marketplace illustrates 5 ways to use visual solutions in a health care setting.

 

Technorati Tags: cdw,visual displays,hit,digital health space. healthit

HACKING HIPAA ?

 

Does HIPAA compliance really mean cyber-security ? Ask Ed Snowden.

The following video explains the added burden for programmers and software developers who previously used cloud based data bases and/or programs.

HIPAA compiance has a great deal to do with user compliance and fulfillment of HHS mandates as well as ‘civil rights’ in regard to privacy.

It does not guarrantee data is safe or secure.

 

Technorati Tags: hacking hipaa,hipaa,medstartr,hhs,privacy,security,compliance,cloud based,database

Upcoming Virtual Health IT Events for Providers

 

Next Week’s Health IT Webinars:

Event Calendar.

Learning Lunch Webinar: Strategies to Educate Patients on Electronic Access of their Health Information

ICD-10 Plug in to Knowledge Monthly Webinar Series – Plan, Organize, and Assess

Learning Lunch Webinar: Medicare/Medicaid Update – Reporting on Clinical Quality Measures

The Platform for Data Liquidity: Meeting the New Requirements for Interoperability

National Provider Call: Medicare and Medicaid EHR Incentive Programs and Certified EHR Technology

Regional Extension Center Health IT Events

These upcoming health IT events are being put on by the Regional Extension Centers. If you are a provider in their area you are invited to register.

Washington & Idaho REC – PQRS: The Payment Adjustments are Coming. Is your Practice Ready?

When: Tuesday, June 25, 2013 11:30 am – Pacific Daylight Time
Registration is required

Unravel the complexities of the Physician Quality Reporting System (PQRS) program in this webinar. If you’re seeing Medicare Part B fee for service patients and don’t have a PQRS submission plan, this webinar will give you several tips and tricks on how best to submit data to the CMS program.

Massachusetts Medicaid EHR Incentive Payment Program Webinar Series – Registration and Attestation

When: June 26, 2013, 12 PM – 1 PM ET
Register required

The Massachusetts eHealth Institute, the Commonwealth’s leading Health IT resource, will be hosting learning webinars throughout 2013 to provide healthcare organizations, providers, and their staff with comprehensive, actionable information on Health IT adoption and optimization.

Don’t forget to mark your calendars for these educational webinars.

 

Technorati Tags: hit,hix,onchit,eHealth,pqrs,physician quality reporting,icd10,medicare,medicaid updates,regional extension center

EHR backlash: What happens when your staff rebels?

 

Physicians are familiar with ‘disruptive technology’ ( I coined the term “catalytic innovation) as electronic medical records were introduced into office and clinic practice. The disruption caused decreases in efficiency and required altered work flow.

The introduction of Clinical Information Systems has an identical effect on patient care in hospitals. Training and satisfaction must be assured for the staff well before ‘going live’. There are many instances where staff have felt inadequate to the point where they have argued patient safety is involved.

And here is an example:

Affinity Medical Center registered nurses are asking hospital officials to delay a new electronic health record system set to begin this weekend.

The nurses, who would be the primary users of the Cerner electronic health record (EHR) system, cited inadequate training and short staffing.

Affinity registered nurses, who are represented by the National Nurses Organizing Committee in Ohio, an affiliate of National Nurses United (NNU), documented their concerns in a letter to hospital officials Friday. They said they tried to deliver it by hand along with a second letter demanding to negotiate a contract with the union. The letters were not accepted.

“This is serious,” said Michelle Mahon, a representative based in Cleveland for NNU. “The nurses are concerned about patient safety.”

Mahon said she emailed and faxed the demand to bargain to hospital officials and also emailed the letter of concern to the chief nursing officer and received no response.

Susan Koosh, vice president of marketing and community relations at Affinity, said the use of EHRs will increase quality and safety at Affinity, and significant training opportunities and extra staff and trainers have been added for the transition.

“We are very excited about implementation of our new electronic health record, which will go live this weekend,” Koosh said in an email. “We have thoughtfully prepared for this conversion for months, involving our clinicians in the process, providing significant training opportunities and adding extra staff to the schedule to help ensure a smooth transition.”

PATIENT SAFETY

The system has the potential of violating the Ohio Nursing Practice Act because it doesn’t permit nurses to communicate individualized, potentially life-saving information about their patients, the union said in a statement.

Other concerns include placement of workstations, which require nurses to turn their backs to patients while they document. Also, during one education session, the system apparently crashed once because 17 users overloaded it, according to the union.

“The National Nurses Organizing Committee’s press release contains inaccurate and offensive statements,” Koosh said.

“To suggest that Affinity has not provided sufficient training or adequate staffing — or that we would ever put patients at risk — is blatantly false and irresponsible. Our computer system is built with safeguards to ensure continuous operations, while the external training site does not have such protections.”

Cerner guidelines call for 16 hours of training for each nurse and nearly 95 percent of nurses have met this requirement, Koosh said. Affinity has established six computer labs with more than 75 stations, and the hospital also is accommodating extra training for clinicians who feel they need additional practice on the system.

Some of these concerns involve union interference with implementation based upon other factors, such as low staffing ratios which may have already existed prior to HER installation, and other non-related conflicts about bargaining powers

The NNOC represents about 225 registered nurses at Affinity, which is part of Tennessee-based Community Health Systems, and continues to refuse to bargain a first contract. The National Labor Relations Board held a five-day hearing in May in Cleveland for a complaint filed by the nurses and NNOC. A decision by an NLRB administrative law judge is pending.

If the planned new system is launched this weekend, the union will file an unfair labor practice charge with the NLRB, Mahon said. Also, registered nurses will begin using Technology Despite Objection forms to document their concerns, as well as verbally notify management each time they fill them out, Mahon said. Nurses also will speak with elected officials and community groups about their concerns, she said.

The disagreement and conflict are patient safety issues which should have been addressed long before the system goes active.  The medical staff should play a major role in the decision making.  The scope of the issue goes way beyond the competency of a National Labor Relations Board and seems to  be an inappropriate use of Labor law.

Read more:

 

Technorati Tags: nurse,ehr,clnical ilnformation,affinity health,cerner emr,go live,disruptive technology,nnon,michelle mahon,union,union interference

The Virtual Health Assistant

 

Watch as a Virtual Health Assistant Engages a Patient on a Smartphone

nextIT       Find out more

 

                 

Alme    Mobile     Web     Chat     

Will virtual nurses and pocket health coaches improve patient engagement?

With the Alme natural language platform from Next IT, you can provide the personalized service of a concierge while delivering the business benefits of a technology-based self-service solution.

Alme is a multi-modal, multi-channel, multi-language platform designed to revolutionize customer service by creating intelligent virtual assistants capable of understanding what your customers actually mean. Alme uses this knowledge in unprecedented ways to deliver information and perform tasks, giving your customers an experience that’s all about them.

Talk, tap or type—Next IT virtual assistants are ready with the right answer, providing an integrated approach proven to boost customer satisfaction, user engagement and revenue.

Natural Language Processing has appeared in the business world. Much more powerful that a voice tree selection it offers a form of artificial intelligence able to understand selective questions and answers verbally.  Mobile  health and smartphone users are familiar with Apple’s Sirius, and Google Voice recognition.

Many companies have their own proprietary system specialized in their niche.

With Alme’s processing power,combining voice recognition and NL P (natural language processing) Your staff for  customer service, requests, and patient needs is multiplied and amplified many times.

By 2015, Gartner predicts that half of online customer self-service search activities will be via virtual assistant – that's just two years away. Companies will have a fire hose of patients coming at them – the smartest will know how to control and use it.

Every health facility and virtually every function within a company, wants better insight and greater confidence in understanding patient or provider needs, behavior, and preference. Which investments will give the greatest lift? Which processes or product improvements will create users that are loyal for life? Which touchpoints are triggers to grow share of market and yield increased efficiency and market share?

AMJMC

Virtual Health Assistants Poised to Revolutionize Healthcare Delivery - See more at: Technology continues to advance at such an incredible pace that it can be hard for many industries to keep up with the ways in which new systems and processes can help them be more effective. In this morning’s session, “Your Next Provider Will Be an Avatar,” presenter Thomas Morrow, MD, explained why it’s necessary for the healthcare industry to not only keep pace with technological innovations, but also to integrate these technologies into several aspects of care. - See more

The next revolutionary disruptive technology that needs to transform medicine, according to Dr Morrow, is the Virtual Health Assistant (VHA).   The VHA is a technology that is not only needed, but inevitable. There needs to be a sophisticated technology that is capable of cutting down on the high cost of medical care. Dramatic physician shortages—which are poised to only worsen—and the constant explosion of information that cannot be handled because of natural cognitive limitations are leading to less time for patients in the examination room. To prove this point, Dr Morrow mentioned that primary care physicians (PCPs), on average, take on 28% more patients than they are able to handle. Even worse, patients typically have only 27 seconds to explain their symptoms before being interrupted by their physician. Dr Morrow added a personal anecdote related to this statistic, telling the audience about how a patient he had been speaking to was having chest problems and went to see several doctors without having any improvement. The patient had been interrupted and misdiagnosed each time until Dr Morrow had actually stopped to listen to all of his symptoms and told him to ask his next doctor about potentially having an aneurysm, which turned out to be the case. The patient was admitted later that day. -

This may be one of those disruptive technologies that operate at the strategic level.

Here are some of the additional ways in which  VHAs will be able to transform the healthcare system:

• Managed Care Organizations: HEDIS and medication adherence improvements are the low hanging fruit right now.
• Disease management companies can utilize this technology to help patients better manage chronic conditions.
• Retail pharmacies can set medication reminders.
• Specialty pharmacies can use this technology for clinical assessments.
• Pharmacy benefit managers: can also use aspects of disease management and medication reminder programs.
• Pharmaceutical companies can use VHAs for patient recorded outcomes.
• Hospitals can use a variety of programs to reduce readmission rates.

The possibilities for VHAs in healthcare are endless. With the technology available at the disposal of patients, providers, and payers, it is essential to start incorporating these programs into daily life. With the potential for cost savings, no one can afford to ignore these technological advancements.   And as important as cost saving, better and more consistent outcomes may also be a by-product.

All Is Not Well in the HIT Space

 

Several upcoming deadlines are on the horizon that will impact operations of providers, hospitals, and intermediaries.

HHS has a fairly cavalier attitude about the changes mandated by Obamacare. Some of these issues are very serious and not to be taken lightly. For providers the impact will be major in terms of operations, ability to bill correctly and the liklihood for substantial expenses to convert ICD Coding from ICD-9 to ICD-10.

HHS and the ACA have set arbitrary and unrealistic deadlines for these changes.  Inexplicably Farzad Mostashari, who thus far has done an exemplary job planning, educating and implementing the changes cast upon us by the Affordable Care Act.   Farzad Mostashari, MD, is the National Coordinator for Health Information Technology. In this role, he oversees the Office of the National Coordinator for Health Information Technology (ONC), a division of the United States Department of Health and Human Services. He joined ONC in July 2009 and was appointed national coordinator in April 2011.

Farzad Mostashari, MD, the national coordinator for healthcare IT, asserted today there would be no extension of the deadline for switching from the ICD-9 medical coding system to ICD-10. The deadline for conversion would remain Oct. 1, 2014. 

Converting from the old ICD-9 diagnostic coding to ICD-10 is much more complex than adding or changing a few codes. The ICD codes are deeply embedded in provider actions and insurance company process. Most providers will be unable to accept ICD 10 codes as of the original deadline of October 2013, so the original deadline was pushed back 12 months until October 2014.

However even at that date most providers and/or insurers will have to use a dual system of legacy ICD 9 and ICD 10.

The consulting firm Deloitte’s White Paper elaborates in detail about the process of the conversion, the expense, and complex inter-relationship of HIT systems, including Electronic Medical Records, and coding. Switching to ICD 10 involves much more than adding codes (the increase is about 7,000 in ICD 9 to over 40,000 codes.

The lofty goal is worthwhile and obtainable. The process is well explained and oulined in this chart.

Mostashari is on the ‘firing line’ from both side s of the table for other issues as well.

Today in the third of three hearings held by subcommittees of the House Energy and Commerce Committee, Farzad Mostashari, National Coordinator for Health Information Technology reassured a congressional panel that health IT interoperability will take some dramatic leaps forward within the next two years.

Michael Burgess, MD (R-TX) vice-chairman of the House Subcommittee on Oversight and Investigation, questioned the sluggishness of interoperability.

“We do hear about this a lot,” Burgess said. “Even anecdotally, hospital systems in the same city, that have the same operating system aren’t talking to each other.”

“You’re the head, why don’t you fix that?,” he asked Mostshari. “Why don’t you just make that happen?” Was this a rhetorical question ?

This statement reveals the lack of understanding by congress how our health system operates and the complexity and workings of daily operations by hospitals and providers.  This type of political grandstanding serves no productive purpose, especially when all the principals  had mulitple reform deadlines given to them in an arbitrary fashion by HHS.

It also points out the misguided perception that throwing money at  issues is not the entire solution and also that ‘haste makes waste’  It appears that Congress learns slowly.

 

Technorati Tags: icd10,icd9,mostashari,hhs,affordable care act,interoperability,congress,onchit,hit,deloitte,emr

Not having an Electronic Health Record

From:  The Glass Hospital

 

The 92 year old lady with a hip fracture, a not uncommon story.  What will happen?  Here’s one scenario.

 

l

This frequent occurrence played out as such:

Orthopedic Dialogue

Six months ago I posted a story about a demented 94 year old patient who’d fractured her hip. She’d lost more than thirty pounds in the preceding months and had already had a collarbone fracture from a previous fall.

The course of action in this case resulted in a breach of ethical conduct, bad feelings in the department, and the opening for a medical malpractice incident. Fortunately only the first two occurred.

All of the above could have been avoided had there been an electronic health record.

After the outcome, the chairman of the department had this to say, which says it all,

At the end of our chat, the chairman handed me copies of pages from the patient’s chart.

“Is that your note?” he asked me. I nodded.

 

“I can’t read a word of it,” he told me.

The day is coming when this will no longer occur.

Electronic health records, health informaton exchanges, a national and/or regional health information network and interoperability will break the glass barriers between health information ‘silos’.

 

Technorati Tags: emr,ehr,hie

BIG DATA META-DATA DATA-ANALYTICS DATA SCIENCE

 

Health care and health care informatics have an annual ‘buzz-word’. Physicians in clinical practice are bombarded with may medical terms which are fairly well mastered during the course of a career. Their has been many advances in science, biology, medicine and healthcare.

During the pre-clinical years students and physicians use some statitical means to measure probabilities, media, means, averages, standard deviations to determine risks and benefits of treatments. Statistics were taught as a separate free standing course, however unless one was going to be a researcher it was rarely used in every day practice.

In the current environment it has become vital to understand what informaticists learn and teach. Future practice patterns and evidence based medicine will be based on these studies.

In the past clinical situations have been measured fairly subjectively. Now with electronic data storage the data is much more objective, measured and quantified to be recorded.  Whether what we are measuring and recording are accurate is another story.  However it is the best we have for now.

The tools we use now are far more advanced and capable of storing almost an infinite numbe of data points.  Complex algorithms can be derived for calculating multi-factoral variables and to extract hidden relationships in a blizzard of seemingly unintelligible data.

Physicians and patients are just beginning to benefit from these new tools.  The evolution of ‘preferred practice patterns’, the cochrane studies, present more objective evidence based studies for clinicians. Meta-studies aggregate multiple related studies to build a greater and/or more diverse cohort.

Medical students and trainees are learning these techniques during their formal education.  However the current generation of clinicians have been left behind, as the current knowledge base explodes in size and in  methodology.

The growth is fueled by connectivity and also studies done in the late 20th century indicating the exponential growth of information and the technology to run it.

Reversal of HHS policy has Positive Outcome

 

DIGITAL HEALTH SPACE INTERRUPTS IT’S SERIES ON ACO’S TO BRING YOU THIS HEARTENING STORY

Dying child was on life support when new lungs became available

Ten-year-old Sarah Murnaghan, who has cystic fibrosis, is receiving a lung transplant, at this moment.

The previous policy regarding the prohibition of children less than 12 years old with cystic fibrosis  receiving an adult lung transplant was reversed several weeks ago by the Dept of HHS in response to a public outcry  regarding the policy.  The policy was the result of obsolete statistics regarding survival statistics of children with the fatal genetic disease, cystic fibrosis which affect the lungs.  Previously adult lungs were also avoided due to size discrepancy between adult lungs and those of children.  The availability of adult lungs is much greater than children.

HHS Secretary Sibelius approves recommendations for lung transplant in child.

 

The criteria for lung transplantation in children with cystic fibrosis has been expanded .

 

 

Technorati Tags: lung transplants,cystic fibrosis foundation,children,rejection,survival rates,sarah murnaghan,life support

The Marriage of Health Information Technology and the Practice of Medicine

 

Beginning in the middle of the first decade of this century digital information became essential in the business and clinical aspects of medicine.

Health care and Information technology have become inextricably bound together, and the prospects for a divorce are unthinkable despite complaints and the challenge of maintaining security.

The demand for HIT personnel continues to grow and the success of HIT is not so much technical as the most important component….human beings…who will run the system. After all HIT is merely a tool and we should never forget it, to be used like a surgeon’s scalpel controlled by a human hand and able to be over-ruled.  IT will never have the judgment of a   health care professional, despite what technologists dream about.

Requirements for HIT personnel are diagramed in this MAP. This interactive MAP indicates the areas of competence needed for each type of HIM  position.

A key component of this recognition is the HIMSS  EHR   Developer’s Code of Conduct. “Representing the majority of operational EHRs in physicians’ practices and hospitals in the U.S., today, we understand firsthand the transformative power of health IT, and we offer this Code of Conduct as a reflection of our industry’s ongoing commitment to collaborate as trusted partners with all stakeholders,” said EHR Association Chair Mickey McGlynn, senior director, strategy & operations at Siemens Healthcare, in making the announcement.

ONC chief Farzad Mostashari, MD, who has been critical of some vendor practices, today gave the EHRA kudos on its initiative, especially as it pertains to patient safety.

"The commitment here is very much in line with our national plan," he said. "No customer will feel that they can’t report a patient safety event, and the vendors will investigate them, will remediate them," he said. "It’s really very positive to see the association coming together and making a statement about what we stand for. This is what we believe is the right way to treat our customers."

Medicine and health care cannot stand alone, however we must be certain that vendors and providers of our tools share and aspire to the same bar of excellence to which they serve.

Next edition will feature accountable care organizations and the changes to health information systems to support them.

We will be looking at:

Intersystems Healtlhcare

The Essentials of Accountable Care and HIT Systems:

 

Technorati Tags: himss,hit,health information exchange,emr,ehr,hie,ehra,onchit,cchit,farzad mostashari,hit personell

More HIPAA Breaches

 

HealthCare IT News

In the past several weeks additional breaches of HIPAA were reported by Sutter Health System , in California, and also the Samaritan Hospital in Eastern New York State;

“Sutter Health is no stranger to healthcare data breaches. Back in 2011, nearly one million Sutter Health patients had their protected health information compromised after the theft of an unencrypted company desktop computer, making the breach one of the biggest HIPAA breaches in the United States. In its aftermath, Sutter Health is still facing up to $4.25 billion in class action lawsuits.

The California-based Sutter Health is notifying nearly 5,000 patients that their personally identifiable information has been stolen after local law enforcement officials discovered a list of patient data during an unrelated criminal investigation. The list of patient information was discovered during a drug related investigation in Oakland, Calif., KTVU reports. 

Patient names, Social Security numbers, dates of birth, addresses, names of employer, work numbers and marital statuses were compromised. 

Sutter Health system officials say the breach could involve patients from Sutter Health's Oakland-based Alta Bates Summit Medical Center; Antioch, Calif.-based Delta Medical Center or Eden Medical Center in Castro Valley

A consequence of HIPAA is possible multi-billion dollar fines and law suits. These costs will be passed through to patients. the ultimate pocket. Perhaps there needs to be a limit on penalties both in civil suits and HIPAA fines. The HIPAA law invited a feeding frenzy for class action legal firms.

A New York hospital waits 15 months to announce HIPAA breach, and to notify patients.

“The Samaritan Hospital in eastern New York, just outside of Albany may eventually face some hefty fines from the Office for Civil Rights as the hospital just Friday notified the public of a HIPAA privacy breach stemming from a November 2011 incident.

The issue here was a conflict between judicial authorities, which were the Department of HHS, the office of Civil Rights, and the local Sherriff’s office.

    

When the breach was discovered at the time in 2011 the hospital was about to notify patients and HIPAA about the  breach.

According to officials, when the 238-bed Samaritan hospital discovered the breach back in November 2011, hospital officials notified the sheriff's office, who then asked the hospital to refrain from notifying patients and the OCR, the Troy Record reports.

Sheriff Jack Mahar , Rennsalaer County New York

"If a law enforcement agency asks to delay notification so as not to impede an investigation of a potentially criminal nature, we have to comply,” Streeter added.

“We received an inquiry that suggested that protected health information contained in electronic medical records that related to a patient at Samaritan Hospital may have been improperly accessed by a supervisory nursing staff member employed at the Rensselaer County Jail,” Elmer Streeter, director of communications at St. Peter's Health Partners, the system Samaritan Hospital is part of, told the Troy Record”

HIPAA is a complex law regulating a complex industry, both technologically and clinically.  It becomes obvious that the law will require several more years of ‘flushing out’.  At the time in 1996 when HIPAA was passed few medical facilities were using HIT, EMR and  HIX. In the next several years we can expect many more breaches resulting  from ambiguous situations.

The issue become more complex since the Office of Civil Rights is charged with enforcement of HIPAA violations. Many institutions which are not clinical may have unintended access to patient’s medical records, and who are not at all educated about HIPAA.

Attribution:  HealthCare IT News

 

Technorati Tags: hipaa,hipaa breaches,office of civil rights,penalties,samaritan hospital,sutter health,st peter's health partners,troy,rensselaer countycounty,john mahar,delta medical center,alta bates summit medical center,eden medical center

STATES REBUFF FEDS REGARDING FORMATION OF HEALTH BENEFIT EXCHANGES

 

Another lesson in the Affordable Care Act:

Our series today discusses Health Benefit Exchanges, also known as Health Information Exchanges.  (HBX HIX) twitter #hix #hbx

curated from HealthCare IT News

The GAO has concluded that the states across the country setting up health insurance exchanges will be ready for enrollment by the Oct. 1, 2013 deadline. Coverage is set to begin Jan. 1, 2014.

The Patient Protection and Affordable Care Act and the Department of Health and Human Services regulations and guidance require states and exchanges to carry out a number of key functions, for which state responsibilities vary by exchange type.

States can choose to establish and operate an exchange or give the authority to HHS to establish and run  the exchange. States may also choose to enter into a partnership with HHS whereby HHS establishes the exchange and the state assists with operating various functions. Exchanges are online marketplaces – websites – where eligible individuals and small business employers can compare and select health insurance coverage from participating health plans.

According to HHS, 18 states will establish a state-based exchange, while 26 will have a federally facilitated exchange. Seven states will partner with HHS.

A state that chooses to operate its exchange is responsible for:

• Establishing an operating and governance structure
• Ensuring exchanges are capable of certifying qualified health plans and making them available to qualified individuals
• Developing electronic, streamlined, and coordinated eligibility and enrollment systems
• Conducting consumer outreach and assistance
• Ensuring the financial sustainability of the exchange
• A state that partners with HHS may assist HHS with certain functions, such as making qualified health plan recommendations and conducting aspects of consumer outreach and assistance
• Despite some challenges, the seven selected states in GAO's review reported they have taken actions to create exchanges, which they expect will be ready for enrollment by the deadline

Clearly 2/3rds of the states do not wish to be involved in setting up or running a HBX. There has been much discussion in recent months about  Governors reticence to have mandates by the federal government that will cost states money.

The role of expanding Medi-caid to accommodate several million uninsured places a new strain on state budgets. Although the federal government has agreed to subsidize this expansion for several years it is very unclear what will happen after the initial two years.

Some quarters remain optimistic about the success of introducing the Patient Affordable Care Act. However, there are many uncertainties about the long term eventualities as the program roles out over the next several years.  Each step depends upon success of a prior step.  The domino effect has the potential to go either way.  Hope is a poor guarantee for success.

Financing HIX is no small ticket and HIX are using a variety of methods to recoup expenses:  State health insurance exchanges are putting together financing and revenue sources, with many likely relying on insurer fees, as long-term state or federal support remains uncertain.

State health insurance exchanges are putting together financing and revenue sources, with many likely relying on insurer fees, as long-term state or federal support remains uncertain.

Fees and Premium Support:

State by State:

Colorado HIX

The Colorado exchange, is estimated to need up to $24 million annually for its operations. The exchange was awarded two federal grants totaling about $60 million, only about $15 million of which was spent as of December 2012.

The Colorado Health Benefit Exchange is aiming to create multiple revenue streams, with the board approving a 1.4 percent premium fee and now urging lawmakers to pass legislation permitting a $1.80 per member monthly fee for up to three years.

Connecticut HIX

Called Access Health CT, has been keen to note on its website that it will not be funded with state dollars (something Covered California stresses as well). The HIX is running on federal funds through 2014, and it’s likely going to have a premium fee of up to 2.8 percent.

With an estimated 360,000 uninsured residents in Connecticut, Access Health CT is going to be on the smaller side in its membership. Even so, implementation — or the pace of it, combined with the backdrop to state budget realities in Connecticut — has been such that Access Health CEO Kevin Counihan, the former chief market officer at the Massachusetts Health Insurance Connector Authority, has told the federal government the staff won’t be implementing any new federal regulations after March, until they’re sure the user interfaces are ready to work, which they’re testing in June.

The New York Health Benefit Exchange,

has received about $370 million in federal funding and will be enrolling an estimated 1 million individuals and small business employees.

Created as a program of the Department of Health, with five regional advisory committees, the exchange is being built with federal funds and is required to be self-sustaining by 2015.

In Minnesota,

Democrats in the house and senate disagreed over whether the exchange, now called MNsure, should be funded by premium fees or from the state’s tobacco sales tax fund, which critics of that idea said basically meant the state general fund. In the reconciled bill the Minnesota governor signed into law in March, MNsure will be financed by a premium fee of up to 3.5 percent, along with the remaining dollars from about $110 million in federal grants.

The Silver State Health Insurance Exchange in Nevada

recently finalized long-term financing plans with a $8.04 per member monthly fee on health plans. In its annual report, Nevada exchange officials expect that insurers will likely build the fee into premiums and that “the fee will generally be paid by the advance premium tax credit for individuals” with incomes between 100 percent and 400 percent of the federal poverty level.

premium tax credit for individuals” with incomes between 100 percent and 400 percent of the federal poverty level.

In Kentucky,

a traditionally conservative state with a Democratic governor and majority legislature, the Kentucky Health Benefit Exchange is still considering financing mechanisms (with tobacco settlement funds being floated as one source), and like other HIXs it has to be self-sustaining by 2015. Housed at the Cabinet for Health and Family Services, the exchange is permitted by the state to place a premium fee of 1 percent on health plans, but has not made any final decisions.

Exchange executive director a long-time state employees who’s worked in the insurance and Medicaid departments, told the Associated Press that the 1 percent fee would probably generate about $26 million annually, which may or may not be enough to sustain operations. The exchange has received about $252 million in federal grants, and so far spent about $35 million on staffing and IT.

 

Technorati Tags: hix,hbx,health benefits exchange,health insurance exchange,connecticut connect,kentucky health information exchange,New york health benefit exchange,colorado health benefit exchange,hhs,medicaid,healthcareit news affordable care act,academic,obamacare

Password Bypass and be Secure

 

Entering a password is so irritating and clumsy that only about half of smartphone owners set up lock screens on their phones, notes Regina Dugan, the former DARPA  chief now heading bleeding-edge research at Motorola.

Not only is entering a password a pain on mobile,  it also frustrates physicians and health  care personnel when it comes to EMRs on the desk and tablet PC.

What might be better? Passwords that emanate out of your body after being embedded with a tattoo or swallowed via an electronic pill.

Enter the flexible, stretchable MC10 I,  a company that makes “stretchable circuits” that can be used for skullcaps to detect concussions in sports, or baby thermometers that constantly track an infant’s vitals. In the form of a temporary tattoo, the technology can attach an antenna and sensors directly on the body.

Proteus Digital Health that already has FDA clearance for an ingestible sensor as a medical device.

These early devices are temporary tattoos, however technically there would be nothing preventing a more permanent device into the skin.

But the question is, would people actually do this? How odd would it be to swallow a pill or glue something to your arm to avoid entering a password or pulling out a key? Would you?

The general public would most likely rebel having this done to them, as a threat to individual liberty and just one more step for ‘big brother’. However in select professions this would be adopted quickly.

Busy professionals complain about logging on and off many times during the day, slowed down by this process it leads to fatigue, and often times they will neglect signing off when called away for an urgent or emergency matter. Screen savers currently automatically log off users if there is no activity for a predetermined amount of time.

It eliminates the ‘forgotten password’ or the routine of changing a password every 30-90 days.

 

Proteus Digital Health that already has FDA clearance for an ingestible sensor as a medical device. The chip can  be used  for passwords, too.

“This pill has a small chip inside of it, with a switch. It also has what amounts to an inside-out potato battery,” she said. “When you swallow it, the acids in your stomach serve as the electrolyte, and they power it up and the switch goes on and off and it creates an 18-bit ECG-like signal in your body. Essentially, your entire body becomes your authentication token.”  it would be medically safe to ingest 30 of these pills every day for the rest of your life, and that the only thing the pill exposes about its swallower is whether or not it has been taken.

Once swallowed, “it means that arms are like wires, hands are like alligator clips — when I touch my phone, my computer, my door, my car, I’m authenticated in. It’s my first super power. I want that.”

Most social media sites use passwords, email, and almost every application, desktop, tablet or smartphone as wall

The general public would most likely rebel having this done to them, as a threat to individual liberty and just one more step for ‘big brother’. However in select professions this would be adopted quickly.

Brave New World by Aldous Huxley

But the question is, would people actually do this? How odd would it be to swallow a pill or glue something to your arm to avoid entering a password or pulling out a key? Would you?

Yes, I would. (but then again I am a physician and can’t remember all my passwords, so I use Last Pass, which for me works well .

 

Technorati Tags: password,tattoo,darpa,mc10,embeddable chip,pill chip,mobile health,proteus digital health,ingestible pill