RNs and LVNs What's in your pocket? ?

 

CA Hospital Jettisons Nurse Communications Gear For iPhones

The transformation of medical care with mobile apps has become so ubiquitous that hospitals are discarding conventional devices such as overhead paging, pagers and telephones with smartphones.

USC-KECK  nurses will no longer use standard hospital communications gear.  In an effort to simplify and improve communications, the academic medical center is rolling out an initiative placing specialized adapted iPhones in the hands of each nurse.  Keck’s IT leaders  have ordered 300 “specialty” iPhones for  use by the nursing staff. “The idea is to give them one device to do everything,”

KECK chose to go with the iPhones when the firm installing its EMR said that they could link it with the smartphones. (The EMR is in the process of being rolled out, the paper reports.)

When the devices are completely functional, nurses will be able to receive secure messages from patients and other nurses, as well as emergency alerts, the article notes. The devices, which come with enhanced batteries and a tough casing, will also be able to show when a specific nurse is available.

Nurses are not going to be given their own phones, but instead, will pick up a phone at the start of their shift, entering their user ID and password to activate the device.  At the end of their shift, they’ll be asked to return the phones to a charging station. The phones they obtain will be assigned by work shift with individual logins for users. The devices will be ‘hardened’ to decrease the likelihood of physical damage.

One way in which the phones are unique is that they won’t have cellular capabilities. The modified iPhones will function only on the Keck campus, with calls made over the facility’s secure Internet infrastructure. This feature addresses HIPAA concerns for privacy and confidentiality

As we’ve previously reported, few smartphones are secure enough to meet even half of Meaningful Use or HIPAA requirements, according to ONCHIT. So it makes sense to run voice communications through a hospital-controlled voice-grade Internet network if you have the option (which Keck obviously did). But to date few hospitals (that I know of) have taken the plunge.

BYOD’S may be a thing of the past (bring your own device). These have caused concerned about reliability, and security, also few hospital IT departments support these devices.

These new devices invade the conventional hospital communications devices, such as Vocera. Incremental changes such as this may announce disruptive innovation and also influence market share for vendors.

Despite this early trend you don’t hear about a stampede of hospital IT departments rushing to establish support policies and deploy enterprise-class mobile management tools. I must say, I’m not sure what they’re waiting for.

Hospitals and medical facilities have a lot to gain by integrating mobile into their businesses. As it has done with other industries, a properly implemented mobile program can help medical facilities by increasing efficiency, accuracy, and consistency of care.

Some of this article was taken from: Hospital EMR and HER and Hoverstate

Patient Generated Health Data Project

 

At the inception of Digital Health Space I described it’s mission:

“DIGITAL HEALTH SPACE The distance between providers represents the space that Digital Health Space is attempting to close using virtual applications, websites, social media, email, web portals and telehealth.” Attend HealthSpace 2013 October 2013.The conference will include Social Media Learning events, and Start up Presentations. Equity and Venture Capital firms will be in attendance.Subscribe to digitalhealthspace@blogspot.com - See more at: http://digitalhealthspace.blogspot.com/#.dpuf

The vision is becoming a reality as patient-centered medicine moves into the digital health space.

Patient generated data will be an essential component of the medical record. The National eHealh Collaborative’s report is timely as meaningful use state III approaches. MU 3 adds patient engagement,

The Patient Generated Health Data Project includes evidence and reports by The Patient Generated Health Data Technical Expert Panel - See more.

These results were extracted by the  Panel Convened by NeHC on Behalf of ONC offers Results of Environmental Scan on Existing Practices - See more

The report is available as a ‘white paper’ (pdf)

On the consumer side of engagement is the CeRT (Consumer eHealth  Readiness Tool) 

The Ultimate  Business Intelligence Tool

The Patient Engagement Framework

Patient engagement is the blockbuster drug of the century. – according to Farzad Mostashari, National Coordinator for Health Information Technology.

 

Technorati Tags: mostashari,cert,nehc,onchit,onc

CAeHQ---The Status of Health Information Exchanges in California

 

California is large enough to be called a ‘nation-state’ with 35 million citizens, it is larger than many sovereign states in the world.  The diversity of it’s demographic is challenging not only for health systems and providers, and with social engineers as well.

The development of health information exchanges in California is a microcosm for what must take place nationally in regard to health reform and ObamaCare.

Early study and planning for HIX began in 2004 with a major impetus by the newly formed Office of the National Coordinator for Health Information Technology (ONCHIT). Rather than forming one monolithic organization a model for regional information exchanges evolved over time.

Simultaneous interoperability standards were developed to ensure a common system of harmony between disparate EMR system, laboratory systems, pharmacy systems and more.

Federal incentives in the form of the HITECH Act has fueled significant growth in HIT since 2009.

The most recent meeting of the CAeHQ nicely summarizes the progress of health information exchanges, and it’s relationship to the national plan. It is anticipated that as the system matures individual HIOs may vanish to be replaced by the national HIE.

The development of each individual health information exchange has been sporadic and dependent upon local interests and the development of sustainable business models. Other items include trust agreements among the users of the exchanges.

Whilst some HIXs are working well, each one delivers different data fields and the comprehensiveness of it’s data. Some are simple messaging functionality, some allow transmission of continuity of care records, while  others are more complete.

As yet there is little if any transparency from an electronic medical record. Rather than true integration of the data into a trusted partner’s EMR a separate portal must be engaged to retrieve patient data.

The ONCHIT Direct program remains a national infrastructure, while each region has it’s own network.  There is no uniformity of size.  The current size appears to be guided by the hospital systems and the individual state. Few cross state jurisdictions except for a few.

The CAeHQC recent stakeholder meeting took place on July 18,2013 via a webinar.

The slide deck of the meeting (24 slides) is linked here. (may take a moment to load)

ref: CAeHC Webinar July 18,2013  Recorded TBA available at www.ehealth.ca.gov

 

Technorati Tags: caehq,onchit,rhio,hix,california hix,emr.interoperability,hitech act,trusted framework

The Advances in Mobile Health/Smartphone Apps

 

January 22, 2013: The iExaminer System from Welch Allyn, an iPhone app and peripheral device that allows doctors to use the iPhone camera to take photographs of the interior surface of the eye receives 510(k) FDA clearance. It builds on the company’s existing PanOptic Opthalmoscope, a device that lets a physician see into the back of a patient’s eye

Timeline: Smartphone-enabled health devices:

Mobile health has come a long way since the start of 2009 when Apple demonstrated on-stage at its World Wide Developer Conference how blood pressure monitors and blood glucose meters could connect to the iPhone 3G via cables or Bluetooth. MobiHealthNews has tracked health-related wearable devices from their infancy as research projects at university labs to the commercially available products they are today. The past three Consumer Electronics Shows, especially, have yielded a wide range of smartphone-enabled health and fitness devices, from smart forks to connected pulse oximeters and, of course, the numerous wearable activity trackers.

As I have noted in previous posts, “It’s All in the Wrist'”. If you play tennis, that is a non-sequitor.

Whether it is worn on the wrist, finger tip, tatooed on the skin, swallowed,or injected subcutaneously, Wi-Fi and/or cell phone connection can connect you directly to your doctor’s EMR or your personal  health record.  Eventually if you have a pacemaker it will be able to signal your cardiologist when your heart stops and get a shock in return.

Some of these were science fiction less than ten years ago.

Although smartphone are usually thought of as consumer devices, they offer computing power far in excess of what is used for the original missions to the moon.  Even the space shuttles digital computing power is meager as compared to an ordinary Android or iOS device.

Even Steven Colbert will submit to an iPhone invasion of his auricular orifice.

Beginning in 2009 there were few mobile applications, however by 2013 the list has grown.  The uptick in smartphone apps has drawn the attention of the FDA and congress in an ATTEMPT to classify health apps/smartphones as a medical device.

Within the spectrum of medicine and science expensive lab equipment costing $ 50,000 or more can be replaced by a smartphone. In one case a spectrophotometer designed by researchers at the University of Illinois at Urbana-Champaign have developed a versatile iPhone-based biosensor that, with about $200 worth of parts, is just as accurate as a $50,000 laboratory spectrophotometer.

The system, consisting of an iPhone cradle and an app, can detect viruses, bacteria, toxins, proteins and even allergens in food using the smartphone’s camera as a spectrometer and the powerful processor to make calculations.

The advances since 2009 are remarkable.

Technorati Tags: iPhone,smartphone,android,moble apps,#mhealth,spectrometer,ecg,pulse oximeter,mobihealth,steven colbert,emr phr,welch-allyn,ophthalmoscope

Digital Health Social and Semantic Search

 

The word for 2013 is not only mobile, it is “semantic” Semantic is appearing as an adverb, or adjective  in many of the realms of health.  Semantic search, semantic interoperability, semantic natural language processing all seem relevant.  Semantics' are almost everywhere.

David Amerland writes about Google Semantic Search for SEO and marketing, as well as it’s foundational aspects for any web search.

David Amerland helps multi-national clients and start-ups to organize their SEO and Social Media strategies. He is a business journalist, author and international speaker. He blogs about social media and search engine optimization, writes for a number of prominent websites and advises a handful of corporations on their social media crisis management techniques.

His books on SEO and Social Media demystify the complexity of the subjects they cover for readers around the world providing an accessible blueprints to better understand and take advantage of the opportunities offered by the connected economy.

David has written several publications relevant to health research as well as searches for other topics 

The Primacy of Search in the Semantic Enterprise

 

Digital Health Space predicts that semantic search will become embedded in health IT for natural language processing (NLP). It can be used to reference material in real time, for defined specifics and metrics.

So what is web 3.0, and why is it called the semanticweb (table⇓)? Although both terms are used interchangeably, they convey slightly different, if complementary, views of the new web. The web 3.0 label is often used as a marketing ploy for “the next big thing.” An important feature of web 3.0 is that it enables computers to talk to each other so that they can perform the tasks necessary for us to do our work. However, a primary feature of web 3.0 is that it uses metadata—data about data. This will transform the web into a giant database, and organise it along the lines of PubMed, or one of our trusted medical library catalogues.2

 

 

Technorati Tags: sematic,semantic search,semantic web,natural language processing,david amerland,seo,marketing

Incentive Payments a Dangerous Double Edged Sword

 

The letter the hospital received said it all, “Based on our desk review of the supporting documentation furnished by the facility, we have determined that Hospital X has not met the meaningful use criteria………….Since your facility did not meet the meaningful use criteria, the EHR incentive payment will be recouped. You will receive a demand for  your total Medicare EHR incentive payment shortly from the EHR HITECH Incentive Payment Center.”

A significant number of hospitals and providers will receive a letter such as this. which reminds me of a song “Money for Nothing” by Dire Straits .

The Appeal of a Failed EHR Incentive Audit.

If that doesn’t get your attention, nothing else will. I wouldn’t want to be the one that received the email and have to be the one to show it to the hospital CEO or Board. I would imagine the CFO also would not be too pleased. It sounds so final, “did not meet the meaningful use criteria” and “will receive a demand for  your total Medicare EHR incentive payment shortly”. I guess that is why it is call Final Determination. It sounds like a death sentence. But it doesn’t have to be.

A whole new  industry of consultant experts will now descend upon unsuspecting hospitals and providers.

As consultant Jim Tate (EMR Advocate)  goes on to say,

“I was contacted by the hospital the week after they received notification they had failed their EHR incentive audit and to expect a demand letter for a seven figure recoupment. They only failed one meaningful use measure, and it wasn’t the infamous Security Risk Analysis. If I had been on board earlier I could have perhaps helped with documentation and clarification that would have met the expectations of the auditor. It is hard to go back and reconstruct what happened during the 2011 attestation. Staff changes and memory fades. By the time I knew anything the audit was failed and they were behind the eight ball. Not a good place to be.

We were told we were the first hospital that took a failed audit decision to the appeal level. That’s right, we were #001. We worked through the appeal process by providing additional clarifying documentation and participating in a number of conference calls. I felt we received a fair and transparent hearing. Last week the hospital received an email stating, “….we are reversing the adverse audit determination”. Now that is one email I bet everyone was glad to share. Thank their lucky stars. I hope you have a few of those lucky stars in your sky if you need them.”

Lesson #1   Bring in the consultant before you submit the original data. The investment will be much less than afterward financially, to say nothing about the angst and discord for hospital administration.

HHS seems shortsighted in that this is only the first or second round of attestation for meaningful use. There are sure to be problems with the process.

It seems unjust that providers and hospitals should have to pay for the continuing recalcitrance of HHS to plan a workable schedule for implementing their laundry list of things which must be done.

Our faith and trust are wearing very thin….not just in health care. Here is another example of incompetent management style……along with the necessity of delaying the employer mandate.  The fabric of Obama Care is unraveling quickly.

 

Technorati Tags: meaningful use,hhs,meaningful use appeal,jim tate,emr,emr advocate,incentive payment,penalty

Patient-Centered Health Care

 

Medical Home---What is.

Will this really encourage patient involvement ? Or is it another boondoggle?

The term “patient engagement” has become entrenched in the healthcare lexicon. Many have written about how important it will be to achieve the Institute for Healthcare Improvement’s Triple Aim—improved care, better health, and reduced healthcare costs. Others have written about the challenges of improving communications between physicians and patients.

Stage IIII of Meaningful use takes a bite into patient apathy regarding their engagement in     personal health records, and use of HIT in their own healthcare.

All of health reform requires significant behavioral modifications. Psychologists have studied this for decades. The Federal Government’s prime methodology includes funding and grants, incentives and penalties (approach-avoidance behavior) along with significant bureaucratic barriers to using old behavioral habits.

As a result of this mandate coupling HIT and clinical practice further data systems must be developed prior to  M.U. deadlines more……..

 

Technorati Tags: medical home,patient engagement,hit,meaningful use,m.u.,meaningful use state 3,patient centered,health reform law

Happy 4th of July from Digital Health Space

 

We interrupt our regularly scheduled posting to bring you a much more  Important message.

On this 4th of July I cannot think of anything more important nor seminal for us here in the U.S.A.

Take these images to heart.

Give this a moment as you enjoy our freedoms, your barbecue, baseball games and fireworks.  Freedom takes work, and constant vigilance.

 

Technorati Tags: freedom,july 4,nsa,spying,human rights

ICD 10 State of Provider Readiness

 

The path to more complexity .

 

How Do Physician Groups Rate Their Overall Readiness for ICD-10 Implementation?

More than 55% of physician practices surveyed said they have not yet started ICD-10 implementation, according to a new report from the Medical Group Management Association.

In August 2012, HHS released a final rule that officially delayed the ICD-10 compliance date until Oct. 1, 2014.

The switch from ICD-9 to ICD-10 code sets means that health care providers and insurers will have to change out about 14,000 codes for about 69,000 codes.
This is based on a survey of 1,200 physician practices.

Source: MGMA, "ICD-10 Implementation Study, June 2013"

Read more:

Why all the fuss ?  In the interest of simplicity and understanding, see images:

 

Pros:

 

Cons:

 

Technorati Tags: icd10,icd9,mgma,medical group management association

Doctors And Spies Are Both Data Mining With The Same Tools by Taylor Bec|June 27, 2013

 

Imagine you've got some really important news--like, life-or-death information. Say, there's been a zombie apocalypse or a nuclear attack, and you're the only one who knows the location of meds or food that could save the world from pain or famine.

No, the doctors are not spying on you, however big pharma, medical devices manufacturing, marketing firms, even the Dept. of HHS and soon the IRS may be right by your bedside.   Theoretically HIPAA prevents you from being personally identified by safeguards in software. 

HIPAA however does not guarantee security…Anything on the internet can be hacked, now more providers are using ‘cloud solution’ for cost containment and minimizing maintenance tasks.

Activate Networks, Inc. tries to do this for the healthcare industry: data mining of doctors and patients' contacts, to find the key nodes of medical social networks. They sell the network maps they make--charting the most powerful doctors in the U.S.--to hospitals and (you guessed it) to drug companies--the wealthiest clients with incentives to access the most influential doctors to pitch them pills. By monitoring ties between people through patient records, doctors' referrals, census data, and even corporate email traffic patterns, Activate N determines people's relative "impact" or influence on their professional social network.

Meta-data derived from networks will dissect out relationships,and referral patterns. As health-care providers shift some of their care to their ACO units, there is an opportunity to control health-care costs by creating formal ACOs out of existing networks of providers in the community who already work together effectively.

These close-knit groups of physicians, or “organic ACOs,” are already coordinating care and can give the new ACO the ability to manage care processes and costs more effectively.

Better coordination almost always translates to lower costs. For example, a recent study by Craig Pollack and colleagues from Johns Hopkins found the cost of care for patients who stayed within existing closely collaborating clusters of physicians was 10 to 15 percent lower compared to organizations where physicians do not closely collaborate.

 

Technorati Tags: craig pollack,johns hopkins,meta-database,activate networks,pharma,drug companies,hipaa,hhs,irs,data mining

All is Well ! (According to John Galt)

 

John Galt is that ethereal character Ayn Rand writes about in “Atlas Shrugged’.

She was asked "Who is John Galt?" to which she replied, "We are!"

Who is John Galt?  John Galt is a character in Ayn Rand's novel Atlas Shrugged (1957)

Or is it in health information technology.

ONC recently posted the “Update on the Adoption of Health Information Technology and Related Efforts to Facilitate the Electronic Use and Exchange of Information.” The report provides updates on the adoption of health IT from January 1, 2012 to April 30, 2013. The report also describes CMS’ and ONC’s efforts to facilitate the nationwide adoption and exchange of electronic health information, identifies and discusses barriers to the adoption and exchange of electronic clinical data, and how HHS’ programs are helping to address those barriers.

Here’s the full PDF report.

If you read the report the glass is filling up, albeit slowly. What the report does not show is the 25% leak,or so who drop out of meaningful use and forfeit the incentive after year one and MU 2 came into existence. The glass may be filling up but it is also ‘leaking’ from the bottom.

This occurred either because an unrealistic deadline prevented compliance, or a demonstrated lack of ROI for the medical practice, even with penalties for non compliance.  (sounds a bit like the model for the Affordable Care Act.

The implementation of M.U. is complex, and dependent upon software, which constantly requires updating placing a financial burden on vendors and providers alike.

Since current incentive payments barely cover the cost (users do not receive the full amount, only a portion thereof for each step in M.U. the full expense is assigned to the provider (which is considerable for small size practices.

HHS should be responsible for the cost of M.U. upgrades.

Then again billions have already been spent in the effort to startup HIT, EMR, and HIX.  What will happen when the money stops.  Who will pay for maintenance, upgrades, and increased HIT operation. 

Silly question…………….you will

 

 

Technorati Tags: meaningful use,m.u.,john galt,hhs,incentive payment,roi,hix,hit,emr,onchit,ayn rand,atlas shrugged