Progress on the Frontiers of Health and Medicine

The frontiers of medicine are not only in the development and transformation of delivering health care, but is also a physical impediment to delivering a level of quality health care.Rural health care presents unique challenges for delivery of care. There are fewer providers, facilities, and less economic support.

As described by Leila Samy, Meghan Gabriel, and   Jennifer King on HealthITBuzz , 

Leila Samy

  

                                                                Meghan Gabriel
                                                                                                               Jennifer King

              

Critical Access Hospitals (CAHs), some with a census of fewer than 10 patients, are the smallest of the small rural hospitals. In some regions, such as frontier areas, a CAH may be the only local health care provider serving an area the width of the state of Rhode Island! CAHs are small, geographically isolated and have limited resources.

CAHs are found in every region of the country, and represent roughly 30 percent of hospitals nationwide. Often serving as the focal point for all health care services in a rural area, CAHs often own and run the local rural health clinics and skilled nursing facilities. They may also be responsible for public health and emergency medical system services. These hospitals extend services to places where they wouldn’t otherwise be available. And those are the reasons why it is important for CAHs to have access to health IT systems and capabilities.

As of 2013, 89 percent of CAHs had an EHR in place; 62 percent of CAHs with an EHR had a fully electronic health record system, and 27 percent had a health record system that was part electronic and part paper.

Most CAHs adopted (as of 2013) or planned to adopt (by the end of 2014) the health IT capabilities evaluated in this study (i.e., telehealth, teleradiology, care coordination and health information exchange with other providers and patients).

As of 2013, CAHs reported the highest rates of adoption for teleradiology (70 percent) and telehealth (59 percent) capabilities. Fewer CAHs reported other capabilities related to electronic exchange of key clinical information with other providers. Even fewer (15 percent) of CAHs reported patient engagement capabilities (i.e., offer patients ability to view, download and transmit their health information

Among the challenges to health IT adoption among CAHs, financing and workforce related challenges were most commonly reported.

CAHs that pooled resources with other hospitals were more likely to have EHR and capabilities related to health information exchange and care coordination, compared to those that did not pool resources or engage in group purchasing.

CAHs with faster Internet upload speeds were more likely to have the capability to provide patients with the option to view, download, and transmit their health information compared to those with slower upload speeds.

The Federal Government is offering funding opportunities and offers Creative Solutions to Expand  Rural Health IT Funding

Benefits of Health IT adoption among CAHs and other small, rural hospitals

• 
  

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

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.

Health Reform to 2014 and Beyond or Back to the Future

The More You Understand About the 2014 Changes,  The Better.

If you had not noticed.

I am retired from clinical practice, and  admit I miss seeing patients.  My career goals have changed as some of you have noticed.

During the last decade I became interested in health information technology and set out to communicate with fellow professionals.  Readers of Health Train Express and it's predecessor will see an evolution, beginning with electronic medical records, health information exchange, health reform, mobile health applications, remote monitoring, and telehealth. They all serve to integrate our health communications for providers and patients.

During the last 12 months I was diverted by the Affordable Care Act and  the promises of Accountable Care Act. The potential for these new paradigms are great, however the day to day activities of providers and hospitals will  increase their load, and without additonal reimbursements. Providers have been expected to make huge capital outlays for health IT, design,implement and use these new systems.  They are directed at reductions in reimbursements to allow the large growth in patient access.  i doubt whether there will ber an actual decrease in the gross outlays for health care.  However during the past two years there have been reports of a decrease in the rate of growth.

There are some key actions to implement changes:  These webinars are designed to address specific areas that will require action.

Understanding Payment Reform - Beyond Fee For Service 

In the past decade there were some pre-paid and capitated models. The new paradigm is to approach payments connected to outcomes.  How they will be measured is open to great debate, and the subject should be addressed actively and with transparency before changes are made to avoid a catastophe such as the Health.gov benefit exchanges.  Some of these issues may be addressed by a 'global fee to hospitals and providers and/or medical groups as part and parcel of integrated medical systems.

Understanding The 2014 EHR Incentive Program 

The webinar addresses objective information for non-acute providers,practice and clinics on how to prepare for 2014 changes to the CMS EHR Incentiviei Programs.

An ICD-10 GEMS Crosswalk Overview

GEMS is a term which most providers are not familiar. CMS on it's web site offers these white papers. 

• 2013 General Equivalence Mappings - Diagnosis Codes and Guide [ZIP, 583KB]
• 
  

     The compressed zip files contain 3 white papers.

     The Dxgem file addresses specifics of conversion from ICD9 to ICD10.

MDs Everywhere's Vice-President of Development, Doug Salas explains the impact of 14,000 ICD codes expanding to 70,000 will have on documenting

Understanding HIPAA Requirements and Safety Measures 

HIPAA has been around since the mid 1990'. Providers have always known the standards of ehtical private confidentiality.  HIPAA was designed for others, institutions who deal with large amounts of patient health and financial data.  Penalties and fines are impressively high and the law has been enforced agains several large hospitals and other custodians of health records.

Recording and Archived:  (In case  you cannot attend the webinar at it's schedule time) At the time of registration you will receive a link and a date, which can be downloaded to an Outlook  .ics file.

All of the webinars will be archived for later viewing

Health IT in Asia at Health 2.0 India

Read more about it at Health Train Express including these topics of interest

• Designing an improved patient experience for a Billion people

• Trending – Startups, Funding and Accelerating Health 2.0

• Health 2.0 in the village

• Quantified self, wearable sensors and trackers

• Mobile health in real life

• Rise of big data and better decisions

• Pharma and better outcomes

• C-Level executives unplugged

• Unmentionables amplified – Sex, Sport & Rock n’ Roll

Visit Health Train Express to learn more........

HIPAA COMPLIANT GOOGLE + HANGOUTS

Google announces Helpouts: the Hangout that’s so good you’ll pay for it

This service marries the video chat features of Hangouts with the payment processing of Google Wallet, the identity management of Google+, and a slew of other Google service features. The end result is a gorgeous Frankenstein monster that lets you find expert help instantly via video.

Google + Helpouts is its own separate division within Google, but it uses all existing Google technologies.  And actually the service is free unless you charge for it.  Google's take is 20%.  The helpouts are scheduled or on demand.   

Many providers have been asking if Google + hangouts are HIPAA compliant. Up until now the answer has been 'no'.   Now for a charge it can be.  Further details are forthcoming from Google.

The challenges for telemedicine have been several. 1. Cost. 2. Non-reimbursement due to insurance limitations 3. Lack of an easily accessible platform.

Previous offerings have included expensive contracting with a telehealth provider. 

Providers and patients are now aware of new resources to provide an additional component to home health and alternative to time consuming  office visits.

Google also announced an API for Google Helpouts. For more information, Google hosts a 'help' tutorial.

Several medical offices and clinics may be available in your area.  Note that this service is so new that you should verify their participation.  It is not necessary to have a visit initially, however in many states,  for you to receive treatment advice law prohibits telemedicine treatment other than in an advisory capacity.

One Medical Group (Beverly Hills)

Meet the Doctors

• Michelle Grotz-Rhone, MD
• Bruce Olmscheid, MD
• Aarti Kulkarni, MD

There are other participating One Medical Groups in  San Francisco, New York,  Boston and Washington, D.C.

CES 2014 What's in IT for Digital Health ?

Many generic IT software and hardware have been adapted for health care by DIYers who are already physicians.  This year's CES will emphasize the expansion and new offerings for mobile health in health care, including new software for all  operating systems, and the new technology in smart devices.

Attending a CES show in Las Vegas offers much for physicians now. The offerings have expanded exponentially for both iOS, Windows, and Chrome/Android on a variety of hardware applicatons. Each OS serves different segments, depending on EMR, and legacy hardware.

CES offers a unique show, a one place visual carnival in a large exposition. The event is located in Las Vegas, where a global entertainment industry and gambling exist, side-by-side.

DHS will be focusing on the electronics at CES 2014 both health oriented and in the consumer space that could be applied to health care.

C-Net  also will offer full coverage specials on exhibitor booth and their offerings, for those who are couch potatos or unable to travel.

  .
For Las Vegas Information and general information about CES, Housing, Transportation, Reservations, and Information about Shows, Entertainment, and much more: CES hosts a Website.

For those who need the "intimate" social reality experience attend in person.  Make certain you have taken your flu shot .

Where to get urgent health care.  Turntable Health is a Primary Clinic in downtown Las Vegas whose medical director is Zubin Damania (stage name- ZdoggMD)  a physician well known in social media circles and  trained at UC San Francisco.

While you are in Las Vegas  he may even be producing one of his unique and outrageous "ZdoggMD" episodes   (not to be missed)

The area that Turntable Health is located is in  an area that is underutilized and developed by Zappos, the well known online retailer. It is the innovative ultra-modern Los Vegas Medical Clinic where Patient-Centered Care is given, and is a worthwhile tourist destination to see where all the CES and HIT is used.

And Remember..."what happens in Vegas stays in Vegas.

This has been an unpaid public announcement.  See it, or pay the price.

The CES has already started, and there is already much appearing on YouTube, and all the standard social media platforms, if you cannot attend.

Watch for Digital Health Space on Google +

Networked Intelligence in Health and Medicine fueled by Social Media

Attribution given to Bryan Vartabedian, MD

How does a hospital or provider move into the digital space ? And what part of the space should you participate ?

Are you a part of it, and do you want to be a part of it? Is this a necessity, or just a fad ?

Do you have an overall marketing plan, or separate department for marketing?

You will need to assess your reasons for HIT and social media.  Electronic Health Records, Health Information Exchanges, mHealth, social media, all serve different needs, some elective and some necessary.

An important component is time and money, neither of which are an infinite resource. Given the current massive health reform that is being legislated practice resources must be aligned with regulatory mandates.

Reality plays a big role.  Many social media users do it for pure enjoyment as a break from conventional routines of their day.  Some do it for making new contacts, social or medical, based on current interests.  Others look for new vistas, hobbies, and activities one would never entertain,unless in the process of social media it happens spontaneously.  Some social media hobbyists transition into a vocation in marketing, education, or entertainment.

Your regional  social media politically correct standards may play a role in your decision making. Social media is just that…….voluntary.  Let’s compare social events such as medical staff meetings, part business, part pleasure, and a source of much information and communication.  If you think about your daily activities, meetings, learning experiences, creative thinking can create reasons for using social media.

You may want to expand your visibility either locally, regionally, nationally, or internationally.

There are choices:

1. Do it yourself.  This requires significant time and effort as well as a learning curve to

do it efficiently. There are many who are willing and able to teach you, some for free, and

others who charge a fee.  One example is the Social Media Residency offered by Lee

Aase and the Mayo Clinic.

2.Hire someone or a professional digital marketer to do it for you. Since you are in

the business of medicine, highly skilled and have a relatively high ability to generate

income. Why bother yourself with these tasks.

There are innumerable online companies offering software products to encompass

a marketing plan.

3. Like Real Estate the main concern is ‘location, location, location. So too is social

media.  Your choices and perhaps limitations will depend on where you practice ?

Factors such as the form of your medical practice, solo,group, specialty, or academic

will more than influence your options. Listen to this story from “33 Charts”, a well known

blog.

DECEMBER 14, 2013Albert Flexner, M.D. (courtesy, National Library of Medicine)

Last year was part of a small group charged with building a social media toolkit for medical schools.  An early conference call participant made it clear that if the project didn’t meet certain criteria for academic advancement, he’d be unable to participate.  It was the last time we heard from him.  Unfortunate but predictable.

There is a movement to qualify and/or quantify social media publishing by clinicians and scientists. In an article published on iMedicalApps, one pharmacist had this to say about this prospect,

“The movement to start evaluating blogging and tweets on par with academic publications”

by Timothy Aungst, PharmD

What counts is what brings value

New forms of knowledge creation and how they fit into a dated system of promotion is a growing preoccupation for many physicians.  And the question of what should ‘count’ toward academic advancement is one that’s received attention lately.  Some have approached advancement committees to have their blogs recognized as evidence of scholarship.  I haven’t decided whether these attempts are noble or laughable.

What counts is what brings value.  And what brings value in medicine are cameos in peer-reviewed publications.  This makes sense.  Because in the era of analog medicine, this was the only means by which physicians communicated ideas and findings.  Appearance in this 17th century tool of idea transmission has defined leadership through most of medical history.

Embedded habits are slowly eroded, as better solutions appear.

The age of networked intelligence will spawn a new kind of leader

But things have changed and doctors have new ways to share ideas and change minds.  Now every doctor, independent of institutional affiliation, tenure, pedigree or lineage is empowered with the capacity to grow, share and develop ideas.

And so the age of networked intelligence will spawn a new type of leader.  Expect to see regular doctors emerge as influential not based on lists of publications but on the strength and novelty of their ideas.  Leadership will be determined in part by the capacity to leverage new tools to build, communicate and influence.

But don’t expect them to be promoted.  For now.

Think much, publish little

Despite how we connect and communicate, peer-reviewed research will remain an important element in the advancement of medicine.  But it represents only one way to lead.  For those early in their career, there are some things you can do.

Perhaps we should think more before we publish our blogs, tweet or build facebook and/or google pages.  (or at least make our posts less often, and shorter.

Thanks to Dr. Vartabedian for his insights.