The Doctor's Lounge' The VA Crisis

The impact of Medical Information Technology, "meaningful use" HITECH regulations, and the ongoing VA scandal are on tap, at  America's Web Radio 

The Docs4Patient Care organization is featured on the initial episode of The Doctor's  Lounge, as Hal Scherz M.D. and Michael Koriwchak discuss HITECH and the V.A. Crisis.  Listen in

Dr. Koriwchak heads up the conversation, being the policy expert on Medical Information Technology and primary author of our D4PC white paper, "Policy on Medical Information Technology" - available online atwww.docs4patientcare.org/policy-emr

Tune in on Thursdays at 8 AM for 'The Doctor's Lounge" for future topics: 

Digital Health Space will carry these weekly presentations.

HealthCare.gov Online User Experiences

Similar to the roll out of Covered California, the nationwide Health.gov exchange was even more flawed and unreachable for more than one month.

Short Videos of Users on the HealthCare.gov Website

The brief videos below highlight some of the challenges faced by the study participants outside California as they used the federal HealthCare.gov website to enroll in health coverage under the Affordable Care Act.

• Positive Impressions: Participants had anxiety about applying for health insurance and were surprised and relieved by the ease-of-use and clean look and feel of HealthCare.gov. Watch Video
• Quitting Points: There were several points at which participants abandoned, or would have abandoned, the online process to seek phone or in-person help. Watch Video
• Areas of Uncertainty - General Context: Participants were unsure about some ACA concepts such as "deadlines" and "tax credits," and they didn't always find adequate explanations or help. Watch Video
• Areas of Uncertainty - Site Elements: Some participants had challenges providing income and household information, logging into the system and navigating through certain parts of the site. Watch Video

The Affordable Care Act expands coverage options and provides an opportunity to streamline the enrollment process in public and private coverage. CHCF funded an assessment of HealthCare.gov to identify actionable ways to improve consumer experience with online enrollment.

The assessment uses a methodology not common in the public sector — direct observation of consumers as they move through the website. This technique captures sources of consumer satisfaction, knowledge, confusion, and frustration. The most compelling findings relate to assisting consumers with plan shopping and selection, providing adequate help throughout the process, and ensuring accuracy in consumers' responses to application questions. The report concludes with researchers' recommendations for improvement.

Compare these findings with those of  Covered  California in our earlier blog post.

The California Health Care Foundation also published a study of Health.gov for comparison of states using the national Health.gov website.

Both reports illustrate the poor design and performance characteristics of sites not ready to 'go live'.

Were this a private enterprise it would have stood little chance of success. Supervision and implementation were poor from the bottom to the top of the chain of command.


Health.gov User Experience  download

Assessing the Covered California Online User Experience

The rollout of Covered  California presented many challenges, and turned out to be an expensive learning exercise. Many of the issues were clearly identified late in the game and are illuminated in this excellent report and videos sponsored by a grant from the the California Health Care Foundation

California enrolled 1.4 million people in new private health insurance plans during the first open enrollment period under the Affordable Care Act. In February, as state officials were administering the sign-up campaign, research supported by the California HealthCare Foundation (CHCF) was conducted to study the experiences of consumers attempting to enroll online at www.CoveredCA.com.

CHCF commissioned gotomedia, a San Francisco-based user interface research and design firm, to observe and interview a diverse group of Californians applying from computers in their own homes. Researchers observed consumers as they explored the site, created accounts, entered household and income data, and compared health plan options.

Online ACA Marketplaces: the Value of Consumer Experience Assessments

The result is reported and may be downloaded here in this white-paper.

Several videos are available which demonstrate several users attempting to use the Covered California Website.

 A video clip of a consumer trying to use the CoveredCA.com website shows this problem and illuminates how direct observation can be a revealing way to more fully understand the consumer experience.

Confusing Eligibility Results and Next Steps: Many users were not sure what they qualified for. Those eligible for Medi-Cal were disappointed at not being able to complete the enrollment process online. Watch Video

Understanding Questions: Some participants resorted to guessing and online searching when they didn't understand questions and when definitions and help were not available or inadequate. Watch Video

Steps and Sequences: Some participants were uncertain where to start on the site and about next steps as they progressed through the process. Watch Video

Entering Simple Data: Some users struggled to enter simple data, such as phone numbers, in the format required by the online system. Watch Video

State leaders and consumer advocates have identified several report recommendations as high priorities when planned enhancements are made to CoveredCA.com. The full reports on CoveredCA.com and HealthCare.gov are available on CHCF’s website.



Read more: http://www.chcf.org/publications/2014/05/covered-california-online-user-experience#ixzz35iOhi5O2

HIPAA Fines having Major Impacr

Groups hit with record $4.8M HIPAA fine

HHS' Data Breach Report: 7 Key Findings

Stolen laptops lead to important HIPAA settlements

And finally, not all data breaches are electronic:

This breach involved records from a hospital emergency department that should have been shredded ending up in a dumpster in front of the hospital. "It was a windy day. Security forgot to put a lid on the dumpster. The records are down the street," Hinkley recounted. Ultimately, school children nearby ended up collecting the records and returned them to the hospital. "The security guard said, 'not my job,'" said Hinkley. "How could someone seeing papers (flying about) not think, 'Gee, is that something I should think about?'"

The incident could well serve as the poster child for inadequate employee training, added Hinkley. The key is to "have it be owned by everybody from the first person the patient sees to the last one they see and everybody that touches their data in between."

EHRs and other digital storage or HIT network has been delayed, despite HIPAA regulations. Implementation may be delayed due to a multitiude of mandated changes in health reform. Institutions are hard pressed to comply due to financial limitation meeting all their responsibilities. 

Referral Network in the Digital Age, and the Affordable Care Act

How do you build your referral network ?

How can your practice stand out.  What is your HUMP DAY ?

Most of us when beginning a medical practice would contact established physicians, and meet them personally, handing out a curriculum vita and business cards, then sit, hope and wait for referrals.

Today young physicians immediately sign up for any health insurer or health plan to join  their network  of providers. They will accept plans that have good reputations and avoid the ones with less quality. Young providers may even seek out word of mouth from fellow practitioners to select those that pay promptly and fairly.

What Triggers Word of Mouth?

How important is this tested by time methodology for building a medical practice following? Your medical services are a  product, and can be marketed in many ways the same as merchandise. This of course is anathema to some professionals.  However given the current state of transition in the marketplace of health care, such as accountable care organizations, and the affordable care act it is still foolish to depend upon a laundry list of providers and their networks.

The Power of Word of Mouth

Word of mouth drives all sorts of products and ideas to catch on. It’s 10 times more effective than traditional advertising and shapes everything from the products people buy to the services they use. But why do people talk about some things rather than others?

Generating word of mouth or getting something to go viral sometimes seems like magic. Like catching lightning in a bottle. But it’s not. There’s a science behind it. Triggers are only one of the six key principles that drives all sorts of things to catch on. Understand that science, and you can make your own services and ideas more contagious.

Those who are new to a community will often ask social contacts, church members or get a referral from the local medical society. The truth is that most patients have no idea of who the preferred and/or best qualfied physicians are in the community.

The final decision may be the result of a combination of word of mouth, direct referral from a friend, accessibility and a prompt appointment. Demographics play a large role in obtaining health care. A geriatric medical clinic would use methods different from a pediatric clinic. Subspecialist practices can market to consumers directly, or if in a monitored network...social networking with referral sources directly may be more effective in building your network.

Generating Word of Mouth

The best thing about word of mouth is it is available to everyone. It doesn't require large amounts of capital, it just requires people to talk. The challenge is how to start people talking. It just requires people to start talking, and how to make your message(s) stand out from the noise.

Today, social networking includes social media using Facebook pages, Google + pages and Linkedin ( a network of professional colleagues), and their are medical interest groups to join that narrows your interest to your target population. There is a variety of lesser known social media platforms such as Digg, Pinterest, Delicious, or Newsana. A professional blog with RSS feeds and a subscription tab also can be a resource for your practice. Backlinks, which are links between different platforms also enhances your visibility. If you are using social media the understanding of hashtags and their use magnifies and focuses your audience.

There are a large number of tutorials and courses covering these subjects. Finding an expert in social media is not difficult.

What are the limitations of Social Media?

When asked, most will estimate that social media accounts for 50% (average) of chatter. However 50% is wrong ! The actual numbere is 7%. Research by the Keller Fay Group fins that only 7% of word of mouth occurs online. This figure may not represent certain demographics, such as an age group 11 to 30, where use of social media is greater than 7%. Now even that may be changing as older adults use social media much more in the past four years as social media platforms have expanded in quality and quantity. There is also significant churn ie, those entering and departing the social media niche.

These details are in much greater detail in a book by Jonah Turner, CONTAGIOUS, WHY THINGS CATCH ON

One in 10 U.S. Residents Affected by Large Health Data Breaches

Monday, June 16, 2014

TOPIC ALERT:

• Privacy and Security

Click on topic to receive periodic emails.

More than 1,000 medical record breaches involving 500 or more people have been reported to HHS since federal reporting requirements took effect nearly five years ago, according to HHS,Modern Healthcare's "Vital Signs" reports (Conn, "Vital Signs,"Modern Healthcare, 6/13).

HHS has been tracking data breaches since September 2009, when the HIPAA breach notification rule went into effect. The agency reports health information breaches affecting more than 500 individuals on its "wall of shame" website (iHealthBeat, 4/1).

Since 2009, HHS has received:

• 1,026 reports of breaches involving 500 or more individuals; and
• More than 116,000 breach reports involving records of fewer than 500 individuals through March 1, 2013.

In total, large health data breaches reported by health care providers and their business associates have affected the medical records of about one in 10 U.S. residents, or 31.7 million people. 

Meanwhile, more than 32,600 HIPAA complaint cases have been investigated, with more than 22,500 of them closing with corrective action, according to HHS Office for Civil Rights spokesperson Rachel Seeger ("Vital Signs," Modern Healthcare, 6/13)

Privacy Penalties on the Rise

In related news, HHS Chief Regional Civil Rights Counsel Jerome Meites at an American Bar Association Conference last week said he expects penalties under HIPAA to increase drastically in the next year, The Hill reports.

Since June 2013, HHS has received more than $10 million for HIPAA violations, according toLaw360. However, Meites said, "I suspect that that number will be low compared [with] what's coming up" (Viebeck, The Hill, 6/13).

Many EMR and EHR services are cloud based, and dependent upon internet connectivity.  Despite HIPAA we can expect breaches from otherwise secure sites. It is important to notify patients when breaches occur.

Healtlh IT Tsunami

It is a bit overwhelming for physicians to maintain clinical competence, run a financially sound medical enterprise, solo or otherwise, and keep current on health information technology.

Physicians pride themselves on efficiency due to the current reimbursement method of volume based reimbursement. The government and some insurers are intent upon a value based system of reimbursement, however the mechanisms are still murky.  Staying current on health reform and health IT systems have become overwhelming, while most physicians would like to ignore the chaos focusing on patient matters the chaos and noise filter through daily activities.

Physicians are multi-taskers and there are some conventional non health related tools to help organize you days.

Our next series of articles will address solutions that may assist in organizing your projects and daily activities.

Some are content with reading blogs and social media and others are interested in the tools for social media.

This week’s focus is on productivity—a favorite topic of ours.

Here are some of the highlights:

What productivity tools do you use on a daily basis? - Part I

Here’s a list of some the apps mentioned during the chat (in no particular order):

• Lastpass
• Google Analytics URL Builder
• WeTransfer
• Buzzsumo
• Social Crawlytics
• GoogleApps
• Basecamp
• Slack
• GotoMeeting
• Microsoft One Note

My favorite is Laspass. This is a secure cloud based password manager. It can be accessed from any device on the internet.  Check it out.

GotoMeeting is disappointing since it will not work on Chrome, an operating system (browser) that many use due to it’s tight integration with all things Google, including Youtube, Drive, Gmail, and many others.  Chrome and chromebook as well as the new chromebox have become very popular. Chrome is now the most popular internet web browser.

Glass To Get HIPAA Compliance, Surgery Ready!

If you are a practicing physician, it woul be hard to miss all the changes due to EHR adoption, and Health Information Exchanges.

The HIT space is also being invaded by other applications and consumer hardware/software platforms easily adapted to medical practice.  Some innovator surgeons and medical physicians also have taken available platforms and adapting them to patient care.  HIPAA has prepared the innovators for security and privacy of patient medical information.

Google has many apps that can be used in a medical environment.

Google glass has been used by  some surgeons to teach and/or get consultations in real time.

Google Glass has been of interest to the healthcare industry for a while, and while performing surgery with Glass is nothing new, complying with HIPAA standards while doing it is. Video streaming software company CrowdOptic has teamed up with University of California, San Francisco (UCSF) to produce streaming software that lets surgeons share their live recording with others off site. But now they are looking to include a feature to that software that allows for HIPAA compliance.

The video shown here illustrates several real-time uses for google glass.  These are actual real-time uses for google glass. The system offers an effective user friendly interface of both video and audio communication 

Just five or less  years ago this would have been science fiction, or featured as a futuristic view of medical care.  How quickly things advance.  By the time many of these advances become published or well known...another new wave of innovation occurs.

We’ve heard of the uses of Glass within the hospital before, and the team at Beth Israel is part of a specific pilot program that uses heavily modified Google Glass units to help with scenarios like this one. The Google Glass units that the hospital uses for this program are tweaked by a company called Wearable Intelligence, which removes the stock Google Glass software from devices and puts a reworked version of the Android OS on the units. The software is completely locked down so the only use applications for Glass here is for Hospital purposes only. This is just one of the many different instances where Google Glass is being used in the workplace, and is part of the Glass at Work program that Google is driving heavily forward.