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:

 

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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

 

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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.

 

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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 .

 

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