Katherine Rourke

Integrating Telemedicine And EMRs

Have you considered what an EMR would look and feel like if it integrated telemedicine? Rashid Bashshur, director of telemedicine at the University of Michigan Health System, has given the idea a lot of thought.

In an interview with InformationWeek Healthcare, Bashshur tells IW’s Ken Terry that it’s critical to integrate HIEs, ACOs, Meaningful Use and electronic health records.

Makes sense in theory. How would it work?

To begin with, Bashshur said, healthcare providers who have virtual encounters with patients via a telehealth set-up should create an electronic health record for that patient. The record could then be ported over to the patient’s PHR. The physician can also share the health record via an HIE with other providers.

When providers attempt mobile and home monitoring, it steps the complexity up a notch, as such activities generate a large flow of data. The key, in this situation, is to use the EMR to sensitively filter incoming data.

Unfortunately, few EMRs today can easily pinpoint the information providers need to process, so most organizations have nurse care managers sift through incoming monitoring data. That’s the case at University of Michigan Health System, where care managers sift data manually to determine whether patients seem to be seeing changes in their conditions.

Unfortunately, even attentive care managers can’t catch everything a properly-designed system can, Bashshur notes. To integrate EMRs and telemedicine/remote monitoring, it will be important for EMRs to have sophisticated filters in place which can pinpoint trouble spots in a patient’s condition, using a standard protocol which is applied uniformly.

According to InformationWeek, vendor eClinicalWorks has promised a new feature which can pick out relevant data from a large data stream. But until eCW or another EMR vendor produces such a feature, it seems that remote monitoring will be labor-intensive and expensive.

URMC Faces Third HIPAA Breach

Written by: Katherine Rourke

The University of Rochester Medical Center has seen a third HIPAA breach, this one caused by the loss of an unencrypted USB drive by a physician, reports Healthcare IT News. The drive, which belonged to a resident, contained protected health information on 537 patients.

Officials with URMC say they have notified the 537 former orthopedic patients whose information was lost on the drive. Lost information included patients’ names, genders, ages, dates of birth, telephone numbers, medical record numbers, and more, though it didn’t include addresses, Social Security numbers or insurance information.

According to Healthcare IT News, the resident’s unencrypted, unprotected drive runs counter to URMC’s campus-wide policy. URMC requires physicians and staff to use only encrypted drives — the only kind which are stored in its on-campus computer center. The latest URMC security policy also requires all mobile devices to be password protected, encrypted, and to have a time-out if unattended.

In an effort to make sure further security breaches don’t occur, the health organization is re-educating its faculty and staff on its security policy, and plans an annual education series to reinforce this training, a hospital spokesperson told Healthcare IT News.

This is URMC’s third data breach involving more than 500 patients reported to HHS, the magazine reports. The previous two breaches, which involved PHI for nearly 3,500 patients, both took place in 2010. One of the two involved the loss of an encrypted portable electronic device.

EMR Market Topped $20B Last Year

Written by: Katherine Rourke

As we all know, last year was a huge year for EMR adoption. How big? Well, according to new data from research firm Kalorama Information, the EMR market hit $20 billion in 2012, driven by health IT upgrades and the desire for Meaningful Use incentive payments.

According to Kalorama, the EMR market was $20.7 billion last year, up 15 percent from the $17.9 billion it reached in 2011. These numbers include revenue for EMR systems, CPOE systems and directly-related services such as installation, training, servicing and consulting.

Kalorama expects near year to be big as well, as providers implement EMR systems in an effort to avoid government penalties for sticking to paper charts.

More than $12.3 billion in Meaningful Use incentive payments had been doled out to 219,000 eligible hospitals and healthcare professionals as of March 1, 2013, with the incentives largely driving physician adoption of EMRs.

A recent CMS study reported that over 70 percent of physicians have used EMR systems, a huge jump from the 26 percent which had used these systems in 2006. Hospital EMR installlations, meanwhile, have been maturing, with 77 percent having reached Stage 3 or higher, compared with 71 percent in 2011.

Going forward, Kalorama predicts that EMR adoption will continue to increase, that hospital adoption will be more rapid than physician adoption and that hospitals currently at adoption Stage 3 will continue to increase their engagement with their systems. The research firm also predicts that current EMR owners will be upgrading their systems.

Meanwhile, researchers say, the threat of penalties for failing to use EMRs meaningfully will force both doctors and hospitals to make upgrades over the next year or so.

While Kalorama doesn’t mention this, the next year or two is also likely to be marked by “the big switch,” with doctors in particular changing out systems that haven’t proven effective to date. The likelihood that doctors will be buying new systems is likely to lead to a gangbuster year for ambulatory HIT vendors.

Android Security Risks May Outweigh Benefits

Written by: Katherine Rourke

Not long ago, my colleague John Lynn made a compelling pitch for the Android platform, arguing that it’s likely to take over healthcare eventually given its flexibility. That flexibility stands in sharp contrast to Apple phones and tablets, which work quite elegantly but also impose rigid requirements on app developers.

That being said, however, there’s security risks associated with Android that might outweigh its advantages. The major carriers are doing little or nothing to upgrade and patch the Android versions on the phones they sell, leaving them open to security breaches.

The Android security problem is so egregious that the American Civil Liberties Union has filed a complaint with the Federal Trade Commission, asking the agency to investigate how AT&T, Verizon, Sprint and T-Mobile handle software updates on their phones.

In the complaint, the civil liberties group argues that the carriers have been engaging in “unfair and deceptive business practices” by failing to let customers know about well-known unpatched security flaws in the Android devices that they sell.

What makes things worse, the ACLU suggests, is that the carriers aren’t even offering consumers the option to update their phones. Though Google has continued to fix flaws in the Android OS, these fixes aren’t being bundled and pushed out to the wireless carriers’ customers. As the ACLU rightly notes, such behavior is unheard of in the world of desktop operating systems, where consumers regularly get updates from Apple and Microsoft.

In its complaint the ACLU argues that the carriers must either provide security updates to customers or allow them to get refunds on their devices and terminate their contracts without any penalty. It’s asking the FTC to force the carriers’ hand.

In the mean time, with healthcare requiring strict data security under HIPAA, one has to wonder whether hospitals and medical practices should be using Android devices at all (at least for their work). Of course, clinicians who are accustomed to using their personal Android phones or tablets will be inconvenienced and probably fairly annoyed too. But as things stand, hospital CIOs better be really careful about how they handle Android phones in the healthcare environment.

Practice Fusion EMR Brings Patients Into The Picture

Written by: Katherine Rourke

Practice Fusion was one of the first free, advertising supported, cloud-based EMR to enter the market and has likely been the loudest proponent of free EMR software. Although, they have some interesting Free EMR competitors like Mitochon and Kareo. Since 2007, Practice Fusion has focused on offering unfettered access to its product in exchange for physicians being willing to accept advertisements relevant to the health records they’re using and the aggregate use of the EHR data.

The company, which has raked in venture capital in buckets since its founding, now says it has 150,000 healthcare providers using its EMR and records on 60 million patients, according to a piece in The New York Times.

Now, the company has taken another step in its free-for-all model with a new service it calls Patient Fusion. Patient Fusion is a new service which allows patients using the system to schedule appointments with any participating doctor who uses the EMR. It also allows patients to rate the doctors in question and to access their records with permission. So far, 27,000 of Practice Fusion’s EMR users have signed up for the service, the Times reports.

The Times columnist covering this announcement speculates that Practice Fusion has launched its new product as a means of building up patient traffic, but I don’t see how that would work. Patients may see more of their records, but this won’t necessarily do anything to increase the number of doctor-based views the network can sell to lab companies and pharmas.

On the other hand, Patient Fusion could prove to be a powerful way of attracting and keeping doctors who want to offer easy-to-administer appointment scheduling to patients. Also, getting patients engaged with their medical records is very much in the spirit of Meaningful Use and the ONC’s priorities generally, so this new patient feature could be a beacon for doctors going through MU-motivated EMR switching this year.

Bottom line, this seems like a nifty idea. I predict that most of Practice Fusion’s EMR customers will sign up over the next year or so.

British Doctors Fear Repercussions Of Sharing EMR Data With Patients

Written by: Katherine Rourke

Like their American counterparts, British doctors fear giving patients too much access to their electronic health records, according to a new survey.

The survey was conducted by a non-profit group called the Medical Protection Society, which provides professional indemnity coverage to doctors, dentists and health professionals globally.

Researchers there found that 75 percent of patients responding to the survey want medical records to be written in “simple language” that patients can read without help, according to the British Journal of Healthcare Computing.

Doctors, on the other hand, aren’t so keen on the idea, with only 21 percent agreeing that medical records should be written in this manner. Moreover, 84 percent of physician respondents were afraid that sharing data would complicate their relationship with patients and potentially turn out to be a time sink.

It’s not so much that doctors fear sharing information with patients. Physicians seemed to agree that it’s good when patients understand their records and can make better decisions about their own care.

But it seems that doctors and patients have different expectations as to how to manage that sharing. While patients want readable records, physicians worry that it’ll be difficult to write records accurately if they have to avoid clinical terms, jargon, acronyms and shorthand that might confuse patients.

In fact, they believe that writing a record in non-professional English might cause those records to grow considerably longer while offering less value to other professionals, the BJHC reports.

To avoid such problems, it will be important to introduce comprehensive educational support for both doctors and patients, the researchers concluded.

Hospitals, Representative Ask For Extension of EMR “Safe Harbor”

Written by: Katherine Rourke

Right now, it’s legal for hospitals to give doctors EMRs under certain circumstances, despite the existence of the Stark law banning payments intended to induce referrals. Specifically, hospitals won’t face anti-kickback enforcement if doctors pay 15 percent of the cost of EMRs donated by hospitals.

But the Stark law exception established by CMS, plus a “safe harbor” rule established by the HHS Office of the Inspector General, are both due to expire at the end of 2013. This will take place despite the fact that Medicare incentives for EMR adoption will continue through 2016, notes iHealthBeat.

Hoping to address this state of affairs, the Federation of American Hospitals has made the renewal of EMR exceptions to the Stark law its top recommendation in a proposed list of safe harbors, reports Modern Healthcare. More recently, Rep. Jim McDermott (D-Wash.) wrote a letter to the chief counsel to HHS’ OIG to extend those exceptions soon.

Extending these safe harbor provisions at least through the life of the Meaningful Use program seems necessary and wise. After all, it’s hard enough to get smaller practices up on EMRs even with the promise of incentives. Letting hospitals pay for most of the cost of the system would meet the public policy objectives which prompted the creation of HITECH in the first place.

According to Modern Healthcare, the federal Office of Management and Budget is reviewing proposed rules regarding the Stark exception and the anti-kickback safe harbor. Let’s hope they’re finalized in time to solve the problem.

Kaiser Permanente Accused Of Using EMR As Smokescreen

Written by: Katherine Rourke

Kaiser Permanente, California’s largest healthcare provider, has been cited by state officials for using its EMR to work its way around requirements to see mental health patients promptly, reports EHR Intelligence.

Potentially risking their own jobs, Kaiser’s own mental health team brought the discrepancies to the attention of the state. Their complaint not only slams Kaiser’s practices regarding wait times, but also its overall clinical approach to treating mental health patients, going so far as to accuse the giant HMO of defrauding Medicare by upcoding cursory visits as complete.

According to the California Department of Managed Healthcare, Kaiser has been keeping two sets of records, one in its official EMR and another on paper that hid violations of the state’s law mandating short wait times for mental healthcare. The EMR also fails to retain a record of booking dates, so if an appointment date is changed, the wait time is being calculated from the most recent booking date, not the original date, the state charges.

The dual record keeping procedure allowed Kaiser to hide the fact that mental health patients may have waited weeks longer than the state’s “timely access” law requires, for illnesses such as schizophrenia, depression and suicidal ideation, as well as other serious conditions.

In defiance of the state-required two days between contacting an enrollee and booking an appointment, Kaiser had been recording initial contacts on paper, then asking patients to call back during the next window for appointments, up to four weeks later. The EMR would then record the initial contact as taking place during the later booking windows, leaving out completely the weeks of waiting mentally-ill patients endured.

Kaiser has said that it addressed the discrepancies noted by the government, which were first brought to its attention last August, but the Department of Managed Healthcare has concluded that the changes needed have not yet been made.

ACOs Want Advanced Analytics, Data Warehousing, But Are They Ready?

Written by: Katherine Rourke

ACOs are gunning to acquire advanced analytics tools and data warehousing capabilities, according to a report in iHealthBeat. This conclusion comes from a new report from IDC Health Insights, which did a May 2012 survey of 40 hospitals and health insurance companies plus interviews with vendors and industry talking heads.

As part of the survey, IDC asked about ACOs’ top investment priorities, and found 50 percent most want advanced analytics capabilities, while 46 percent cited data warehousing.

The report also noted that ACO-involved entities are picking up analytics capabilities by acquiring infrastructure and software, as well as bringing informatics and data analysis experts on staff.

When asked what kind of information they’d like to review using analytics, they stated the following, according to iHealthBeat:

73% of survey respondents cited clinical structured data
70% cited care management data
57% cited claims data
42% cited data from mobile devices
32% cited data from social media sources
29% cited unstructured clinical data

And when asked what functions they’d put the analytics data to use on, they responded as follows, iHealthBeat said:

66% of survey respondents cited identifying at-risk patients
64% cited tracking clinical outcomes
57% cited clinical decision-making at the point of care

All that being said, it’s not clear that the ACO participants know how to put these visions into action, argues John Moore of Chilmark Research. In a post-HIMSS wrap-up, Moore argues that the market for healthcare analytics tools is “hyped beyond imagination,” and that beyond the hype, many providers are actually clueless as to what they want from analytics.

At HIMSS, he says, he found a “very immature” buyers’ market in which providers aren’t even sure what they’re asking for in analytics, or why they need these tools in the first place. In fact, Moore notes, he talked to many vendors who have stopped responding to “horrible” RFPs which suggest that institutions aren’t at all ready to pursue an analytics solution.

This wouldn’t be the first time that the hype factor exceeded the industry’s actual understanding of a product or technology. But buying analytics tools before you have a clue how to use them is a particularly serious financial and strategic mistake, wouldn’t you say?

Bringing Long Term Care Into HIEs Without An EMR

Written by: Katherine Rourke

HIEs will never achieve their full potential if all players in the healthcare process aren’t included in the network. But without an EMR to connect to the HIE, how can a provider participate?

A new software package developed by Geisinger Health System and the Keystone Beacon Community Program offers a new option allowing nursing homes, home health agencies and other long-term care facilities without EMRs to upload data to HIEs, reports EHR Intelligence.

The package, KeyHIE Transform, extracts data from the Minimum Data Set and Outcome and Assessment Information Set that nursing homes already submit to CMS. It turns that information into a Continuity of Care Document usable by any EMR which is HL7-compatible.

This approach provides a bridge to a wide range of data which currently gets left behind by most HIEs. And as EHR Intelligence rightly notes, with telehealth and remote monitoring becoming more popular ways of managing senior health, as well as assisted living, it will be increasingly important for other providers to have access to all of the seniors’ data via the HIE.

Geisinger’s KeyHIE has already run several pilot programs using t his technology in long-term care facilities and home health agencies. It expects to launch the technology to the market in April of this year.

As is often the case, Geisinger seems to be ahead of the market with a solution that makes great sense. After all, finding a way to integrate new data into an HIE — especially one that draws on existing data — is likely to add significant value to that HIE. I’m eager to see whether this technology actually works as simply as it sounds.

Integrating Telemedicine And EMRs

URMC Faces Third HIPAA Breach

EMR Market Topped $20B Last Year

Android Security Risks May Outweigh Benefits

Practice Fusion EMR Brings Patients Into The Picture

British Doctors Fear Repercussions Of Sharing EMR Data With Patients

Hospitals, Representative Ask For Extension of EMR “Safe Harbor”

Kaiser Permanente Accused Of Using EMR As Smokescreen

ACOs Want Advanced Analytics, Data Warehousing, But Are They Ready?

Bringing Long Term Care Into HIEs Without An EMR

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