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.