Tuesday, January 1, 2019

Telehealth Regulations, U.S. Current State Laws and Reimbursement Policies |

Ten years ago few providers or patients knew much about telehealth. State regulators and medical boards had few if any rules about using tele-health. In fact there were issues surrounding the lack of a physical examination using tele-health.  However because broadband internet has become more available except in rural areas it is possible to talk and view patients in real time.

There are now commercial vendors that offer these services to any providers wishing to adopt tele-health for their practices. Some of these have become public companies.

Zoom can be deemed a HIPAA compliant web and video conferencing service that is appropriate for use in healthcare, provided a HIPAA-covered body completes a business associate agreement with Zoom prior to using the service.  Zoom has already been put in place by many healthcare groups worldwide who use the platform to interact with other providers and communicate with patients. However, in the USA healthcare groups must adhere with HIPAA Regulations. 

Zoom, as a business associate, would need to complete a contract with a HIPAA covered body before its service can be used with ePHI. That agreement – a Business Associate Agreement – acts as a confirmation that Zoom is aware of its obligations in relation to the privacy and security of PHI.
Zoom is willing to complete a business associate agreement with healthcare groups and has ensured that its platform includes all of the required security controls to meet the strict requirements of HIPAA.
In April 2017 Zoom revealed that it had introduced the first scalable cloud-based tele-health service for the healthcare sector. Zoom for Telehealth allows enterprises and providers to communicate simply with other group, care teams, and patients in a HIPAA compliant fashion.

A HIPAA compliance agreement  must be signed by a medical practice with Zoom.com which defines HIPAA security, privacy and confidentiality issues.

Only until recently the rules and regulations governing telemedicine were not well defined by regulators leaving users open to criticism and possible vulnerable to  medico-legal issues.

You will find here the state by state rules at the present day, January 1, 2019.

Physicians should otherwise use their own judgment as to how to use tele-health and instruct patients as to it's limitations and seek direct provider contact. A tele-health portal should have a sign in agreement with instructions,   precautions, and suitable waivers.

Current State Laws and Reimbursement Policies | CCHP Website

Saturday, December 29, 2018

The Disconnect between Doctors and Software Designers

Doctors are asking Silicon Valley engineers to spend more time in the hospital before building apps

  • Richard Zane, an emergency room physician, developed a program so that engineers can understand the clinician's workflow before they build their products
  • RxRevu is one start-up that shadows Zane on the job.
  • In the Bay Area, it's become common for doctors to invite technologists from Google and elsewhere to follow them on the job
As an emergency room physician, Richard Zane often considers how software can help him with patients. The problem is that engineers and doctors are from different worlds.
Zane, who's also the chief innovation officer at UCHealth in Colorado, said that most technologists he's met have never seen the inner workings of a hospital and don't have a deep understanding of what doctors want and need.
"We found that tech companies more often than not had a preconceived notion of how health care worked," Zane told CNBC. They've "gone very far down the path of building a product" without that input, he said.
Zane decided one way to bridge the gap was by inviting in developers from companies to see how he works. For now, that involves monitoring how he uses computers and other software tools to document and make decisions, but keeping them out of the operating environment and away from patient information.
Start up developers are much more inclined toward working with doctors one on one, with their efforts to build better software by attending clinics and surgery to observe.  One possible barrier to this is HIPAA which requires additional permissions and a business associate agreement. Established companies such as EPIC,  CERNER and others have little to gain since they have a huge market share and little motivation to improve their product(s).
Epic Systems, the largest privately-held medical records company, reportedly sends its engineers along to open heart surgeries so they can see how important it is for their software to function in critical situations. Even so, many doctors see plenty of room for improvement when it comes to Epic's user experience.

Physicians need more from their software. In general, they're spending less time with patients, and more on so-called desktop medicine, which involves hours of documentation in front of a computer after a long day at the clinic. Studies find that so much time on administrative tasks related to things like billing is contributing to increased levels of physician burnout.
Zane wants better technology, built with an understanding of how doctors work.

'Your engineers, my clinicians'

Carm Huntress, the founder of a start-up called RxRevu, shadowed Zane and is applying what he learned.
RxRevu, based in Denver, worked with the hospital on a service to help physicians figure out how to prescribe better. The company's software aims to quickly figure out whether certain drugs will interact negatively with each other, if a patient is allergic to a medication or if insurance covers a specific drug. The goal is to help doctors have informed conversations with their patients about their options.
Huntress said one thing he noticed in observing doctors at their desks is that many automatically move their mouse to delete a notification before reading it. He could tell that clinicians were suffering from alert fatigue and might be missing out on important information amid all this noise. Doctors work extremely long shifts and see dozens of patients, so they need to avoid anything that's even more "taxing on their brain," Huntress said.

Despite more than ten years of criticism by users of their software systems, little has changed....

Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout.

Doctors are asking technologists to shadow them before they build apps: Doctors have had enough with software that's not useful, so they're inviting entrepreneurs to shadow them.

Wednesday, December 26, 2018

Data Demands Still Tax Physicians | Healthcare IT Today

Though most medical groups have invested heavily in health IT, particularly EHRs, most are still struggling to manage the data necessary for running the practice.

The federal government incentivized the adoption of the EHR by giving a bonus to practices which purchased EHRs. while at the same time imposing a perverse penalty for those who did not do so.  A comopressed time frame forced practices to purchase inadequate, poorly designed software.  The feds also imposed requirement which they called meaningful use (MU). Meaningful use (MU), in a health information technology (HIT) context, defines minimum U.S. government standards for using electronic health records (EHR) and for exchanging patient clinical data between healthcare providers, between healthcare providers and insurers, and between healthcare providers and patients.


Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A considerable investment burden was placed on vendors in lieu of prioritizing an adequate user interface. In fact most doctors remain very dissatisfied with lack of user efficiency leading to lower productivity of their practices.  A few specialty providers have a niche of customized software that is properly designed .

Meaningful Use stages
  • Stage 1. Promotes basic EHR adoption and data gathering.
  • Stage 2. Emphasizes care coordination and exchange of patient information.
  • Stage 3. Improves healthcare outcomes.

Select the links below to learn more about the measures for Stage 1/Modified Stage 2 , Stage 2 , and Electronic Clinical Quality Measures (eCQMs).
Though most medical groups have invested heavily in health IT, particularly EHRs, most are still struggling to manage the data necessary for running the practice. Sure, Meaningful Use incentives helped them get the technology in the door, squeezing the best performance out of it calls for institutional and financial resources that many can’t afford.    

As a result. new survey results underscoring the difficulty practices face in managing data came as little surprise to me.  The survey, which was sponsored by Geneia found that 89% of responding physicians felt that the “business and regulation of healthcare” has had a negative effect on the practice of medicine.   Fifty-two percent of those responding were ambivalent about the impact of EHRs in their workplace. This included 21% who had a positive view and 22% a negative view of the role of EHRs.  In addition, while 96% of respondents said that they believe that EHRs should integrate better with technology systems used by the office and insurance providers, 57% said that their EHRs don’t integrate these systems. Meanwhile, more than two-thirds of respondents said they didn’t have the staff and resources needed to analyze and use EHR data efficiently.

Seventy-nine percent of respondents said they’d like to use an integrated EHR analytics tool to access predictive and reporting on existing data. Also, many said they’d like to have population health tools available to identify high-risk patients, find patients who need proactive screenings or monitoring and stratify patients into low-, rising- and high-risk categories.     
Also, 68% said they need advanced analytics tools to be successful under value-based care arrangements, with 64% of population health users reporting that they think they such tools can help them assess patient history and needs more efficiently.
As things stand, however, these physicians don’t seem to be getting enough IT bang for their buck. Virtually all (96%) reported that the amount of time they spend on data input and reporting has grown over the last 10 years, and they’re having trouble keeping up with the pace. Also, 86% agreed that “the heightened demand for data reporting to support quality metrics and the business side of healthcare has diminished my joy in practicing medicine.”

Monday, December 24, 2018

The End Well Project: Reimaginging Dying, with Dr. Shoshana Ungerleider ...

We will all face death. Few are prepared to think about how or where they will die.. One should not be passive in preparing for death. I am not referring to financial or legal preparation such as wills, estates, burial plots or other things.

Watch this video, and contemplate the inevitable.  Some of us will go out kicking and screaming. You will often hear family and friends tellling us what a 'fighter'  he/she was, how she never gave up. Others will say he accepted his end, having accomplished many of his own important goals.

The talk was given at Exponential University 2017, by Shoshana Ungerleider, MD

Do you want to die in your own bed, in a nursing home, in a hospital ? There are many ways to approach this challenge.  None of us can predict how, where or how quickly we die. We have a large amount of emotional baggage, our family also carries emotional baggage of which we may not even be aware.

How often I have heard about the son or relative that lives at a distance who will take time to arrive to see their loved one before they pass on.  Each case has it's own set of circumstances which determine how and when you may die.

Much of this sounds pretty morbid to write or speak about, yet it happens thousands of time each day, as often as other events, birthdays, bar mitzvahs, weddings, and births.  It is a passage and a rite of life.  Dying is a part of what we call life.  For certain no one knows what happens after we 'die'. In fact there are different definitions of death. At one time we thought it was when our heart stopped beating. Today it can be defined as brain death (when the brain ceases it's electrical/chemical activity. Yet the body goes on living, in some cases breathing on it's own or with ventilatory assistance.

80% of patients wish to die at home while only 20% actually do die at home.
Doctors do not know how to share this information, They lack the training.
30% of patients die in the ICU
Some doctors perceive death as a failure.

Palliative care is meant to extend quality of life, decrease suffering and match patient wishes for dying.     

There are many participants family, friends, nurses, doctors, and volunteers. Dying is not an easy experience.  We need major changes.

The baby boomer generation is now upon us, 10,000 boomers will turn 65 each day. The major cause of death in this group is due to chronic disease. 

Fill out your advanced directives today, specifying how you want to be treated and specify what measures you do not want to take place on your road to dying.