Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Philips Breathless Choir Video

Posted on June 24, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s Friday and so I always like to share something a little bit lighter or fun. This week I want to share this incredible video from Philips that documents the “Breathless Choir” that they put together:

What a brilliant idea (I guess I need to invite Philips marketing department to speak at my healthcare marketing conference) and a great story! In many ways it reminds me of the “Singing Sisters” which I covered when they were on America’s Got Talent. They both had cystic fibrosis and totally killed it singing on stage despite their unique challenges even just trying to breathe.

No doubt Philips did this partly as a way to promote their various medical devices like the SimplyGo Mini which is a portable oxygen concentrator, but the story is still beautiful. Many corporate products really can make patients’ lives better while a corporation makes a profit too. I have a great friend who has cystic fibrosis and I’m sure he’d enjoy a device that was as portable as this. Not to mention something much more stylish than that ugly green oxygen container I’ve seen him lugging around.

Considering the video above has gotten 8.4 million views, it’s fair to say that this story has resonated with millions of people. For me personally, it reminded me of the importance of the work we’re doing. When we do it well, we can improve patients’ lives and give them freedoms they didn’t think were possible. When we do it poorly, it can have the opposite impact. Thanks Philips for putting together this video.

Has Electronic Health Record Replacement Failed?

Posted on June 23, 2016 I Written By

The following is a guest blog post by Justin Campbell, Vice President, Galen Healthcare.
Justin Campbell
A recent Black Book survey of hospital executives and IT employees who have replaced their Electronic Health Record system in the past three years paints a grim picture. Respondents report higher than expected costs, layoffs, declining revenues, disenfranchised clinicians and serious misgivings about the benefits of switching systems. Specifically:

  • 14% of all hospitals that replaced their original EHR since 2011 were losing inpatient revenue at a pace that wouldn’t support the total cost of their replacement EHR
  • 87% of hospitals facing financial challenges now regret the decision to change systems
  • 63% of executive level respondents admitted they feared losing their jobs as a result of the EHR replacement process
  • 66% of system users believe that interoperability and patient data exchange functionality have declined

Surely, this was not the outcome expected when hospitals rushed to replace paper records in response to Congressional incentives (and penalties) included in the 2009 American Recovery and Reinvestment Act.

But the disappointment reflected in this survey only sheds light on part of the story. The majority of hospitals depicted here were already in financial difficulty. It is understandable that they felt impelled to make a significant change and to do so as quickly as possible. But installing an electronic record system, or replacing one that is antiquated, requires much more than a decision to do so. We should not be surprised that a complex undertaking like this would be burdened by complicated and confusing challenges, chief among which turned out to be “usability” and acceptance.

Another Black Book report, this one from 2013, revealed:

  • 66% of doctors using EHR systems did not do so willingly
  • 87% of those unwilling to use the system claimed usability as their primary complaint
  • 84% of physician groups chose their EHR to reach meaningful use incentives
  • 92% of practices described their EHR as “clunky” and/or difficult to use

None of this should surprise us but we need to ask: was usability really the key driver for EHR replacement? Is usability alone accountable for lost revenue, employment anxiety and buyers’ remorse? Surely organizations would not have dumped millions into failed EHR implementations only to rip-and-replace them due to usability problems and provider dissatisfaction. Indeed, despite the persistence of functional obstacles such as outdated technology, hospitals continue to make new EMR purchases. Maybe the “reason for the rip-and-replace approach by some hospitals is to reach interoperability between inpatient and outpatient data,” wrote Dr. Donald Voltz, MD in EMR and EHR.

Interoperability is linked to another one of the main drivers of EHR replacement: the mission to support value-based care, that is, to improve the delivery of care by streamlining operations and facilitating the exchange of health information between a hospital’s own providers and the caregivers at other hospitals or health facilities. This can be almost impossible to achieve if hospitals have legacy systems that include multiple and non-communicative EHRs.

As explained by Chief Nurse Executive Gail Carlson, in an article for Modern Healthcare, “Interoperability between EHRs has become crucial for their successful integration of operations – and sometimes requires dumping legacy systems that can’t talk to each other.

Many hospitals have numerous ancillary services, each with their own programs. The EHRs are often “best of breed.” That means they employ highly specialized software that provides excellent service in specific areas such as emergency departments, obstetrics or lab work. But communication between these departments is compromised because they display data differently.

In order to judge EHR replacement outcomes objectively, one needs to not just examine the near-term financials and sentiment (admittedly, replacement causes disruption and is not easy), but to also take a holistic view of the impact to the system’s portfolio by way of simplification and future positioning for value-based care. The majority of the negative sentiment and disappointing outcomes may actually stem from the migration and new system implementation process in and of itself. Many groups likely underestimated the scope of the undertaking and compromised new system adoption through a lackluster migration.

Not everyone plunged into the replacement frenzy. Some pursued a solution such as dBMotion to foster care for patients via intercommunications across all care venues. In fact, Allscripts acquired dBMotion to solve for interoperability between its inpatient solution (Eclipsys SCM) and its outpatient EMR offering (Touchworks). dBMotion provides a solution for those organizations with different inpatient and outpatient vendors, offering semantic interoperability, vocabulary management, EMPI and ultimately facilitating a true community-based record.

Yet others chose to optimize what they had, driven by financial constraints. There is a thin line separating EHR replacement from EHR optimization. This is especially true for those HCOs that are neither large enough nor sufficiently funded to be able to afford a replacement; they are instead forced to squeeze out the most value they can from their current investment.

The optimization path is much more pronounced with MEDITECH clients, where a large percentage of their base remains on the legacy MAGIC and C/S platforms.

Denni McColm, a hospital CIO, told healthsystemCIO why many MEDITECH clients are watching and waiting before they commit to a more advanced platform:

“We’re on MEDITECH’s Client/Server version, which is not their older version and not their newest version, and we have it implemented really everywhere that MEDITECH serves. So we have the hospital systems, home care, long-term care, emergency services, surgical center — all the way across the continuum. We plan to go to their latest version sometime in the next few years to get the ambulatory interface for the providers. It should be very efficient — reduced clicks, it’s mobile friendly, and our docs are anxious to move to it,” but we’ll decide when the time is right, she says.

What can we discern from these different approaches and studies?  It’s too early to be sure of the final score. One thing is certain though: the migrations and archival underpinnings of system replacement are essential. They allow the replacement to deliver on the promise of improved usability, enhanced interoperability and take us closer to the goal of value-based care.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell

AMA’s Digital Health ‘Snake Oil’ Claim Creates Needless Conflict

Posted on June 22, 2016 I Written By

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.

Earlier this month, the head of the American Medical Association issued a challenge which should resonate for years to come. At this year’s annual meeting, Dr. James Madara argued that many direct-to-consumer digital health products, apps and even EMRs were “the digital snake oil of the early 21st century,” and that doctors will need to serve as gatekeepers to the industry.

His comments, which have been controversial, weren’t quite as immoderate as some critics have suggested. He argued that some digital health tools were “potentially magnificent,” and called on doctors to separate useful products from “so-called advancements that don’t have an appropriate evidence base, or that just don’t work that well – or that actually impede care, confuse patients, and waste our time.”

It certainly makes sense to sort the digital wheat from the chaff. After all, as of late last year there were more than 165,000 mobile health apps on the market, more than double that available in 2013, according to a study by IMS Institute for Healthcare Informatics. And despite the increasing proliferation of wearable health trackers, there is little research available to suggest that they offer concrete health benefits or promote sustainable behavior change.

That being said, the term “snake oil” has a loaded historical meaning, and we should hold Dr. Madara accountable for using it. According to Wikipedia, “snake oil” is an expression associated with products that offer questionable or unverifiable quality or benefits – which may or may not be fair. But let’s take things a bit further. In the same entry, Wikipedia defines a snake oil salesman “is someone who knowingly sells fraudulent goods or who is themselves a fraud, quack or charlatan.” And that’s a pretty harsh way to describe digital health entrepreneurs.

Ultimately, though, the issue isn’t whether Dr. Madara hurt someone’s feelings. What troubles me about his comments is they create conflict where none needs to exist.

Back in the 1850s, when what can charitably be called “entrepreneurs” were selling useless or toxic elixirs, many were doubtless aware that the products they sold had no benefit or might even harm consumers. And if what I’ve read about that era is true, I doubt they cared.

But today’s digital health entrepreneurs, in contrast, desperately want to get it right. These innovators – and digital health product line leaders within firms like Samsung and Apple – are very open to working with clinicians. In fact, most if not all work directly with both staff doctors and clinicians in community practice, and are always open to getting guidance on how to support the practice of medicine.

So while Dr. Madara’s comments aren’t precisely wrong, they suggest a fear and distrust of technology which doesn’t become any 21st century professional organization.

Think I’m wrong? Well, then why didn’t the AMA leader announce the formation of an investment fund to back the “potentially magnificent” advances he admits exist? If the AMA did that, it would demonstrate that even a 169-year-old organization can adapt and grow. But otherwise, his words suggest that the venerable trade group still holds disappointingly Luddite views better suited for the dustbin of history.

NFL Players’ Medical Records Stolen

Posted on June 21, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’d been meaning to write about this story for a while now, but finally got around to it. In case you missed it, Thousands of NFL players’ medical records were stolen. Here’s a piece of the DeadSpin summary of the incident:

In late April, the NFL recently informed its players, a Skins athletic trainer’s car was broken into. The thief took a backpack, and inside that backpack was a cache of electronic and paper medical records for thousands of players, including NFL Combine attendees from the last 13 years. That would encompass the vast majority of NFL players

The Redskins later issues this statement:

The Washington Redskins can confirm that a theft occurred mid-morning on April 15 in downtown Indianapolis, where a thief broke through the window of an athletic trainer’s locked car. No social security numbers, Protected Health Information (PHI) under HIPAA, or financial information were stolen or are at risk of exposure.

The laptop was password-protected but unencrypted, but we have no reason to believe the laptop password was compromised. The NFL’s electronic medical records system was not impacted.

It’s interesting that the Redskins said that it didn’t include any PHI that would be covered by HIPAA rules and regulations. I was interested in how HIPAA would apply to an NFL team, so I reached out to David Harlow for the answer. David Harlow, Health Blawg writer, offered these insights into whether NFL records are required to comply with HIPAA or not:

These records fall in a gray zone between employment records and health records. Clearly the NFL understands what’s at stake if, as reported, they’ve proactively reached out to the HIPAA police. At least one federal court is on record in a similar case saying, essentially, C’mon, you know you’re a covered entity; get with the program.

Michael Magrath, current Chairman, HIMSS Identity Management Task Force, and Director of Healthcare Business, VASCO Data Security offered this insight into the breach:

This is a clear example that healthcare breaches are not isolated to healthcare organizations. They apply to employers, including the National Football League. Teams secure and protect their playbooks and need to apply that philosophy to securing their players’ medical information.

Laptop thefts are common place and one of the most common entries (310 incidents) on the HHS’ Office of Civil Rights portal listing Breaches Affecting 500 or More Individuals. Encryption is one of the basic requirements to secure a laptop, yet organizations continue to gamble without it and innocent victims can face a lifetime of identity theft and medical identity theft.

Assuming the laptop was Windows based, security can be enhanced by replacing the static Windows password with two-factor authentication in the form of a one-time password. Without the authenticator to generate the one-time password, gaining entry to the laptop will be extremely difficult. By combining encryption and strong authentication to gain entry into the laptop the players and prospects protected health information would not be at risk, all because organizations and members wish to avoid few moments of inconvenience.

This story brings up some important points. First, healthcare is far from the only industry that has issues with breaches and things like stolen or lost laptops. Second, healthcare isn’t the only one that sees the importance of encrypting mobile devices. However, despite the importance, many organizations still aren’t doing so. Third, HIPAA is an interesting law since it only covers PHI and covered entities. HIPAA omnibus expanded that to business associates. However, there are still a bunch of grey areas that aren’t sure if HIPAA applies. Plus, there are a lot of white areas where your health information is stored and HIPAA doesn’t apply.

Long story short, be smart and encrypt your health data no matter where it’s stored. Be careful where you share your health data. Anyone could be breached and HIPAA will only protect you so much (covered entity or not).

Sansoro Hopes Its Health Record API Will Unite Them All

Posted on June 20, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

After some seven years of watching the US government push interoperability among health records, and hearing how far we are from achieving it, I assumed that fundamental divergences among electronic health records at different sites posed problems of staggering complexity. I pricked up my ears, therefore, when John Orosco, CTO of Sansoro Health, said that they could get EHRs to expose real-time web services in a few hours, or at most a couple days.

What does Sansoro do? Its goal, like the FHIR standard, is to give health care providers and third-party developers a single go-to API where they can run their apps on any supported EHR. Done right, this service cuts down development costs and saves the developers from having to distribute a different version of their app for different customers. Note that the SMART project tries to achieve a similar goal by providing an API layer on top of EHRs for producing user interfaces, whereas Sansoro offers an API at a lower level on particular data items, like FHIR.

Sansoro was formed in the summer of 2014. Researching EHRs, its founders recognized that even though the vendors differed in many superficial ways (including the purportedly standard CCDs they create), all EHRs dealt at bottom with the same fields. Diagnoses, lab orders, allergies, medications, etc. are the same throughout the industry, so familiar items turn up under the varying semantics.

FHIR was just starting at that time, and is still maturing. Therefore, while planning to support FHIR as it becomes ready, Sansoro designed their own data model and API to meet industry’s needs right now. They are gradually adding FHIR interfaces that they consider mature to their Emissary application.

Sansoro aimed first at the acute care market, and is expanding to support ambulatory EHR platforms. At the beginning, based on market share, Sansoro chose to focus on the Cerner and Epic EHRs, both of which offer limited web services modules to their customers. Then, listening to customer needs, Sansoro added MEDITECH and Allscripts; it will continue to follow customer priorities.

Although Orosco acknowledged that EHR vendors are already moving toward interoperability, their services are currently limited and focus on their own platforms. For various reasons, they may implement the FHIR specification differently. (Health IT experts hope that Argonaut project will ensure semantic interoperability for at least the most common FHIR items.) Sansoro, in contrast can expose any field in the EHR using its APIs, thus serving the health care community’s immediate needs in an EHR-agnostic manner. Emissary may prevent the field from ending up again the way the CCD has fared, where each vendor can implement a different API and claim to be compliant.

This kind of fragmented interface is a constant risk in markets in which proprietary companies are rapidly entering an competing. There is also a risk, therefore, that many competitors will enter the API market as Sansoro has done, reproducing the minor and annoying differences between EHR vendors at a higher level.

But Orosco reminded me that Google, Facebook, and Microsoft all have competing APIs for messaging, identity management, and other services. The benefits of competition, even when people have to use different interfaces, drives a field forward, and the same can happen in healthcare. Two directions face us: to allow rapid entry of multiple vendors and learn from experience, or to spend a long time trying to develop a robust standard in an open manner for all to use. Luckily, given Sansoro and FHIR, we have both options.

Dear Nurses – Fun Friday

Posted on June 17, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week my cousin sent me a message late at night on Facebook. She’s a nurse and had just experienced her first patient who coded on her. Needless to say it was a traumatic experience and she was reeling from the experience. I’m not sure how much I helped her, but I tried to show some empathy and at least be there to listen to her in her time of need.

This experience reminded me of what a challenging job it is to be a nurse. We certainly don’t show them enough appreciation. With this in mind, it seemed fitting for this Fun Friday post to share ZDoggMD’s “Dear Nurses” parody of Tupac Shakur’s “Dear Mama.”

A big thank you to all the nurses out there that make healthcare great and don’t get nearly the recognition they deserve.

The 4 Learning Metrics Linked to Successful EHR Adoption – Breakaway Thinking

Posted on June 16, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Shawn Mazur, Instructional Writer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Shawn Mazur - The Breakaway Group
There seems to be a trend in the education processes of a go-live for large EHR implementations: they’re scary. For large hospitals, the task of providing learning to hundreds, if not thousands, of employees for a go-live is daunting, and no matter how much time and resources you pour into designing the perfect curriculum and planning out a detailed schedule, you may quickly end up feeling like your learning effort is falling short. Learning metrics can play a vital role in making the task of creating and managing learning for a big go-live a little less scary.

Despite high levels of EHR implementations since the HITECH Act, many organizations still have significant go-live events in their future. A majority of learners are at least somewhat familiar with EHR systems, so education needs to be focused on making learners comfortable with a new, or advanced, EHR rather than teaching all there is to know about the systems. Since 2014, the number of buyers replacing existing EHR software has increased 59%, according to a 2015 EHR BuyerView report. It was also reported that challenges facing an organization were not overcome by the implementation of a new EHR. A lack of education for any go-live event will discount the value behind a new EHR.

Having the perfect plan for EHR education from the beginning is not the only key to successfully preparing your employees for go-live. Additionally, you should implement a plan to monitor the training process, completing learning metrics as you go, and then be flexible in how you carry out the remainder of your learning. So, you decide to be flexible in the information you provide to learners, but when do you know it’s time for a change in direction? Going beyond the summary of what your users should learn if they complete all of their learning, the following four metrics tell you how learners are reacting to the content.

1. Completion Summary
A simple but effective metric that lets you know how much progress your users have made in their learning objectives. This metric is especially important with e-learning and with self-paced learning. Collecting this data will also help you identify problems with different learning roles throughout your organization. Flagler Hospital, a regional hospital, kept completion summary metrics throughout their large switch from Meditech to Allscripts. They reported that their completion metrics began to show users were completing their learning much faster than expected. This data allowed Flagler to actualize their education plan to make remarkable reductions in training schedule, time, and cost from their original plan. Had Flagler’s completion summary shown less than satisfactory numbers, it would have also provided an opportunity for changes to be made. Low completion rates may mean that one role’s users are getting stuck at a certain point of their learning or struggling to even begin. In these cases, use completion metrics to push learning requirements along in time for go-live.

2. Assessment Summary
If your organization isn’t planning on testing users on the education they’ve received, it may be time to consider doing so. Using a step-by-step simulated assessment is the easiest way to put a solid number on how prepared your users are for navigating workflows in the live system. After implementing tests, compile metrics on them at a high level, including how many learners took their test, how many times each user attempted a test, and of course, the percentage of assigned learners who successfully passed their test. Flagler hospital also used assessment metrics alongside their completion summary. As a result, they saw that that their completion summary aligned with their assessment summary. Along with the fast pace at which they were completing learning, Flagler’s learners had average testing scores of 94 percent. The high test scores solidified their decision to make changes to the original learning schedule.

3. Assessment Audits
After implementing step-by-step testing of your user’s knowledge, dig deeper into your testing scores to pinpoint exactly where users are falling short. You will often find that a deficiency in learning curriculum leads to users missing the same steps during their test. For example, let’s say you break down your scores by step and see that over 60 percent of users clicked the incorrect button for documenting current vitals. This is an advantage over less effective traditional testing methods, like multiple choice formats. From this metric, it is clear that you should delegate additional learning resources on best practices for entering vitals before your go-live approaches.

When you test users without using the metrics to facilitate better learning, your learners will feel frustrated with their lack of proficiency. In his book, Why High Tech Products Drive us Crazy, Alan Cooper defines two types of learners. He says, “Learners either feel frustrated and stupid for failing, or giddy with power at overcoming the extreme difficulty. These powerful emotions force people into being either an ‘apologist’ or a ‘survivor.’ They either adopt cognitive friction as a lifestyle, or they go underground and accept it as a necessary evil.” Auditing your tests by step gives you the opportunity to return to your curriculum to elaborate on topics with low testing proficiency. Pinning down topics that require additional learning will eliminate the frustration and feeling of defeat among learners failing their assessments.

4. Knowledge and Confidence Level
Confident learners are a good thing, but not always the best come go-live. It is important that your learners not only have confidence, but also the knowledge to back it up. When knowledge and confidence are not aligned, the user is in a bad place for not only lacking proficiency in the system, but for their education going forward. Users who are pushed to use the live system before they feel confident enough will be far from proficient in the system, and will feel a resentment against the organization moving forward. Equally so, users confident to get in the system but lacking the knowledge to be proficient will also fail, and be quick to blame it on poor learning. In his book, Cooper also says, “Users only care about achieving their goals.” When learners can’t achieve their goals for the learning, they are quick to find a way to reach their goal, defining their own workflows and workarounds instead of sticking to best practices outlined by your organization. Collecting data from your learners, usually through a survey-like format, on how confident they are to start working in the live system and how knowledgeable they feel about the information taught, will help you gauge how ready users are for go-live. When aligning this with your other learning metrics, you will quickly see how ready your users are to proficiently use the live system.

It is often the case that the education plans you spent countless amounts of time and resources on leaves learners feeling distant with the EHR. Think about how you can use metrics to track your learning and be flexible to make changes using those metrics to benefit your learners in the long run.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Value Based Reimbursement Research Results in Time for #AHIPInstitute

Posted on June 15, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

McKesson Health Solutions has commissioned a new National Research study on Value Based Reimbursement. Here’s a quick summary of some of the findings:

The rapid pace of change in healthcare payment continues unabated, with payers reporting they are 58% along the continuum towards full value-based reimbursement, a 10% leap since 2014. Hospitals aren’t far behind, reporting they’re now 50% along the value continuum, up 4% in the past two years.

Those numbers were a bit shocking to me. It doesn’t feel like we’ve gotten that far in the shift to value based reimbursement. Does it feel like it to you? I knew we were headed that direction, but definitely thought we had just begun. These numbers paint a much different story.

This week I’m excited to attend my first AHIP Institute. I’ll be exploring this shift in all its gory details.

Along with this study and with AHIP starting tomorrow, McKesson has been sharing a number of cartoons about the healthcare industry. Here are a few of them they tweeted out:

Healthcare Costs

Healthcare Payment Pathway

A Great Look Into Healthcare Quality Improvement

Posted on June 14, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I think back on the evolution of EHR software and healthcare IT, it’s been incredible to see how EHR has moved from being something that could help improve your billing to now trying to be something to improve the quality of healthcare that’s being provided. In fact, I’ve long argued that the expectation of EHR was far ahead of the EHR reality. EHRs weren’t designed for quality and so it was a mistake for many to believe that it would improve quality.

While that’s the reality of history, going forward the new EHR reality is that they better figure out how to improve healthcare quality. In fact, the ones that are able to do this are going to be the most successful.

As we shift our focus to healthcare quality, I was intrigued by this video animation by Doc Mike Evans describing healthcare quality. It’s fascinating to look at the history and consider healthcare quality going forward.

What do you think of Doc Mike Evans’ thoughts on Healthcare Quality Improvement? Is he spot on? Is there something he’s missing?

Don’t Blame HIPAA: It Didn’t Require Orlando Regional Medical Center To Call the President

Posted on June 13, 2016 I Written By

The following is a guest blog post by Mike Semel, President of Semel Consulting. As a Healthcare Scene community, our hearts go out to all the victims of this tragedy.

Orlando Mayor Buddy Dyer said the influx of patients to the hospitals created problems due to confidentiality regulations, which he worked to have waived for victims’ families.

“The CEO of the hospital came to me and said they had an issue related to the families who came to the emergency room. Because of HIPAA regulations, they could not give them any information,” Dyer said. “So I reached out to the White House to see if we could get the HIPAA regulations waived. The White House went through the appropriate channels to waive those so the hospital could communicate with the families who were there.”    Source: WBTV.com

I applaud the Orlando Regional Medical Center for its efforts to help the shooting victims. As the region’s trauma center, I think it could have done a lot better by not letting HIPAA get in the way of communicating with the patients’ families and friends.

In the wake of the horrific nightclub shooting, the hospital made things worse for the victim’s families and friends. And it wasn’t necessary, because built into HIPAA is a hospital’s ability to share information without calling the President of the United States. There are other exemptions for communicating with law enforcement.

The Orlando hospital made this situation worse for the families when its Mass Casualty Incident (MCI) plan should have anticipated the situation. A trauma center should have been better prepared than to ask the mayor for help.

As usual, HIPAA got the blame for someone’s lack of understanding about HIPAA. Based on my experience, many executives think they are too busy, or think themselves too important, to learn about HIPAA’s fundamental civil rights for patients. Civil Rights? HIPAA is enforced by the US Department of Health & Human Services’ Office for Civil Rights.

HIPAA compliance and data security are both executive level responsibilities, although many executives think it is something that should get tasked out to a subordinate. Having to call the White House because the hospital didn’t understand that HIPAA already gave it the right to talk to the families is shameful. It added unnecessary delays and more stress to the distraught families.

Doctors are often just as guilty as hospital executives of not taking HIPAA training and then giving HIPAA a bad rap. (I can imagine the medical practice managers and compliance officers silently nodding their heads.)

“HIPAA interferes with patient care” is something I hear often from doctors. When I ask how, I am told by the doctors that they can’t communicate with specialists, call for a consult, or talk to their patients’ families. These are ALL WRONG.

I ask those doctors two questions that are usually met with a silent stare:

  1. When was the last time you received HIPAA training?
  2. If you did get trained, did it take more than 5 minutes or was it just to get the requirement out of the way?

HIPAA allows doctors to share patient information with other doctors, hospitals, pharmacies, and Business Associates as long as it is for a patient’s Treatment, Payment, and for healthcare Operations (TPO.) This is communicated to patients through a Notice of Privacy Practices.

HIPAA allows doctors to use their judgment to determine what to say to friends and families of patients who are incapacitated or incompetent. The Orlando hospital could have communicated with family members and friends.

From Frequently Asked Questions at the HHS website:

Does the HIPAA Privacy Rule permit a hospital to inform callers or visitors of a patient’s location and general condition in the emergency room, even if the patient’s information would not normally be included in the main hospital directory of admitted patients?

Answer: Yes.

If a patient’s family member, friend, or other person involved in the patient’s care or payment for care calls a health care provider to ask about the patient’s condition, does HIPAA require the health care provider to obtain proof of who the person is before speaking with them?

Answer: No.  If the caller states that he or she is a family member or friend of the patient, or is involved in the patient’s care or payment for care, then HIPAA doesn’t require proof of identity in this case.  However, a health care provider may establish his or her own rules for verifying who is on the phone.  In addition, when someone other than a friend or family member is involved, the health care provider must be reasonably sure that the patient asked the person to be involved in his or her care or payment for care.

Can the fact that a patient has been “treated and released,” or that a patient has died, be released as part of the facility directory?

Answer: Yes.

Does the HIPAA Privacy Rule permit a doctor to discuss a patient’s health status, treatment, or payment arrangements with the patient’s family and friends?

Answer: Yes. The HIPAA Privacy Rule at 45 CFR 164.510(b) specifically permits covered entities to share information that is directly relevant to the involvement of a spouse, family members, friends, or other persons identified by a patient, in the patient’s care or payment for health care. If the patient is present, or is otherwise available prior to the disclosure, and has the capacity to make health care decisions, the covered entity may discuss this information with the family and these other persons if the patient agrees or, when given the opportunity, does not object. The covered entity may also share relevant information with the family and these other persons if it can reasonably infer, based on professional judgment, that the patient does not object. Under these circumstances, for example:

  • A doctor may give information about a patient’s mobility limitations to a friend driving the patient home from the hospital.
  • A hospital may discuss a patient’s payment options with her adult daughter.
  • A doctor may instruct a patient’s roommate about proper medicine dosage when she comes to pick up her friend from the hospital.
  • A physician may discuss a patient’s treatment with the patient in the presence of a friend when the patient brings the friend to a medical appointment and asks if the friend can come into the treatment room.

Even when the patient is not present or it is impracticable because of emergency circumstances or the patient’s incapacity for the covered entity to ask the patient about discussing her care or payment with a family member or other person, a covered entity may share this information with the person when, in exercising professional judgment, it determines that doing so would be in the best interest of the patient. See 45 CFR 164.510(b).

Thus, for example:

  • A surgeon may, if consistent with such professional judgment, inform a patient’s spouse, who accompanied her husband to the emergency room, that the patient has suffered a heart attack and provide periodic updates on the patient’s progress and prognosis.
  • A doctor may, if consistent with such professional judgment, discuss an incapacitated patient’s condition with a family member over the phone.
  • In addition, the Privacy Rule expressly permits a covered entity to use professional judgment and experience with common practice to make reasonable inferences about the patient’s best interests in allowing another person to act on behalf of the patient to pick up a filled prescription, medical supplies, X-rays, or other similar forms of protected health information. For example, when a person comes to a pharmacy requesting to pick up a prescription on behalf of an individual he identifies by name, a pharmacist, based on professional judgment and experience with common practice, may allow the person to do so.

Other examples of hospital executives’ lack of HIPAA knowledge include:

  • Shasta Regional Medical Center, where the CEO and Chief Medical Officer took a patient’s chart to the local newspaper and shared details of her treatment without her permission.
  • NY Presbyterian Hospital, which allowed the film crew from ABC’s ‘NY Med’ TV show to film dying and incapacitated patients.

To healthcare executives and doctors, many of your imagined challenges caused by HIPAA can be eliminated by learning more about the rules. You need to be prepared for the 3 a.m. phone call. And you don’t have to call the White House for help.

About Mike Semel
Mike Semel, President of Semel Consulting,  is a certified HIPAA expert with over 12 years’ HIPAA experience and 30 years in IT. He has been the CIO for a hospital and a K-12 school district; owned and managed IT companies; ran operations at an online backup provider; and is a recognized HIPAA expert and speaker. He can be reached at mike@semelconsulting.com or 888-997-3635 x 101.