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Downsides of Incorporating Behavioral and Social Data Into an EHR

Posted on June 19, 2015 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.

In response to my post about incorporating behavioral and social data into EHR, I got the following email from one of our readers:

My worry on the collection of such behavioral and social data is that it will get used to further prescribe people with the psychiatric drugs that have such horrendous side effects to the benefit of big pharma rather than move towards diet, health education, nutrition and other non-medical remedies that can have long lasting benefits for a lifetime.

It’s a very fine point. In my previous article I didn’t spend enough time talking about the potential downsides of incorporating all that data into an EHR. The reader pointed out the potential abuse by big pharma to sell more drugs. No doubt, pharma is trying to sell more drugs. I’m sure the creative minds at pharma will try and find ways to leverage this data and sell more drugs. That’s the nature of healthcare.

However, I think pharma would try to do this whether the data was in the EHR or not. In fact, having this data in the EHR for the doctor might mean the doctor makes better choices and doesn’t always default to pharma to treat a patient. For example, if you know they’re living in a poor area, then you can ask them if they have enough food or heat in the winter in order to avoid them returning to you a few weeks later with another cold. This would actually lead to less drugs because you’re actually treating the cause of the problem as opposed to just the presenting problem.

While this example paints a pretty picture, you could also paint an awful picture where this data is used for discrimination. This could be in the office itself or by insurance companies. Some of the new ACA laws help when it comes to insurance discrimination, but many fear that the move to ACOs will cause these organization to discriminate against the unhealthy and poor. I have this fear as well. When you pay to keep people healthy, who do you want to have in your patient population? The healthy.

When you start talking about including all this new data in an EHR, there are a lot of privacy and security questions that come up as well. We’ve always known that the patient record was a treasure trove of personal information that needed to be safeguarded and protected from abuse. Social and behavioral data makes the health record even that much more desirable to nefarious groups who want to abuse the data. HIPAA along with privacy and security will become that much more important.

I’m sure I’m just touching the surface on the challenges and problems associated with all this new data. Although, the thing that scares me most is the way people could abuse the data. I don’t think these are reasons to not use this data. We need to use this data to move healthcare forward. However, it is a call to be very thoughtful about how we collect, secure, and use the data we’re collecting.

What Are You Doing to Monitor Your Claims?

Posted on June 18, 2015 I Written By

The following is an interview with Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.
Vishal Gandhi
As practices prepare for the rollout of ICD-10, we’re seeing practices and hospitals make investments in upgrades to their technology to be able to support ICD-10. They’re investing in ICD-10 training in order to be ready for ICD-10. Some are even spending time and resources dual coding to make sure they’re ready for the change. While each of these are important, it’s surprising to me that we don’t see more healthcare organizations budgeting for additional help in following up with insurance companies to make sure that claims are being processed.

From my experience across hundreds of healthcare organizations, I’ve found that 20-25% claims are stuck in cyberspace at any one time. I’m talking about claims that practices assume have been delivered to the insurance company and are being processed, but instead the insurance company never received them or the claim was missing something and has gotten stuck in the insurance company’s claim process.

How many practices have a process for ensuring that their claims are being processed efficiently and effectively? Not many. That means they aren’t getting paid in a timely manner and in some cases aren’t getting paid at all.

When we send off an email or SMS, we don’t really think about whether those things are delivered to the recipient or not. We trust that they’re going to get there without issue because they usually do. It seems we’ve applied that same confidence to claims and that’s a problem. We can’t trust that claims have actually been delivered appropriately and are being processed since there are so many ways that they can fall through the cracks.

On October 1, 2015 (assuming no delays), ICD-10 is going to make this problem even bigger. ICD-10 presents a tremendous opportunity for insurance companies to lose more of the claims you’ve submitted. If you’re not checking with the insurance company regularly, you’ll have no way of knowing if an insurance company’s switch to ICD-10 has caused a glitch in their claims processing or not. The insurance company won’t care because the practice or hospital will be the ones left holding the bag.

This problem can be solved pretty easily. Your practice just needs to randomly select 100 or so claims and call (or hire an outside company to call) each insurance company to get an update on the status of those claims and verify that the claim is being adjudicated. We suggest you do this about 10-20 days after the claim is filed.

By checking on these claims, you’ll pretty quickly see which insurance companies are processing claims effectively and which ones are having issues so you can address the problem(s). Plus, you can evaluate if there are any workflow issues on your end with the claims your submitting.

Especially as we start implementing ICD-10, but also today it’s extremely important to verify how well your claims are being processed. If you’re not doing so, you’re probably not getting all your claims paid in a timely manner and could be missing out on additional revenue for your practice.

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. ClinicSpectrum offers a Claims Watchdog service which monitors your claims for you to ensure you’re getting paid in a timely manner. Connect with Clinic Spectrum at HFMA ANI 2015 in Orlando, Booth #1256 or by tweeting @ClinicSpectrum.

Interoperability of Electronic Health Records– Benefits and Opportunities – Breakaway Thinking

Posted on June 17, 2015 I Written By

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer Bergeron
Electronic health records (EHR) aim to improve healthcare and processes for providers and patients on a number of fronts. In an ideal situation according to HealthIT.gov, the clinician benefits by having quick access to patient records and alerts, the ability to quickly and accurately report, and a path to safer prescribing. Patients should be able to spend less time filling out duplicative forms at clinics, have prescriptions sent automatically to pharmacies, and gain easier access to specialist referrals.

The International Journal of Innovation and Applied Studies points out that interoperability can work toward a resolution to several current problems including patient record accessibility and consolidation, and healthcare costs. As far as getting patient information and all available information when it’s needed, the report “estimated that 18% of medical errors that result in an adverse drug event were due to inadequate availability of patients’ information.” Healthcare costs are reduced when different entities can share and communicate common data and could save up to $77.8 billion annually.

Given the potential benefits, there are still opportunities to achieve interoperability. For example, not all healthcare organizations are using EHRs so data isn’t being collected consistently across the board. In 2014 there was an increase in the percentage of hospitals with EHRs. However, only 39% of physicians reported that they share data with other providers. Even though the data is available to share, some EHR users may still be living in a silo and haven’t reached full adoption. In addition, existing specification standards have not promoted interoperability. Even though there is data is available to share, few providers are tapping into that information.

To help increase data sharing, more attention is being paid to FHIR, or Fast Healthcare Interoperability Resources. FHIR stems from HL7 (Health Level Seven) data exchange and information modeling standards. HL7 has been around since 1987 to develop families of standards used to automate healthcare data sharing with the goal to improve patient care. FHIR builds upon the interoperability uses of HL7 and takes into consideration the changes in technology and requirements. According to the Office of the National Coordinator for Health Information Technology (ONC), FHIR is used to enable data access, is used as the container to return query results, and will be used to build necessary security and privacy controls.

FHIR combines what are called “resources” — also known as an instance of data – that define data and are used for specific content. Within a resource are characteristics including “a common way to define and represent them, building them from data types that define common reusable patterns of elements, a common set of metadata, and a human readable part.” Collected data can be used and exchanged, searched for individually or in groupings, analyzed and examined.

Interoperability and the role of FHIR is not yet clearly defined. Going forward, the roadmap for interoperability built by the ONC will be watched closely. Guidelines are broad at this point to allow appropriate decision-making as paths are forged. A group of organizations called the Argonaut Project has committed to working with FHIR. HI7.org defines the Argonaut Project as having the purpose of developing “a first-generation API (application programming interface) and Core Data Services specification to enable expanded information sharing for electronic health records, documents, and other health information based on the FHIR specification.”

APIs are at work behind the scenes when we’re accessing information online. Although healthcare is beginning to harness the power of APIs these interfaces are present everywhere in our day-to-day lives. For example, say you are listening to Spotify and want to connect that application with Facebook. An API helps make that translation of information from Spotify to Facebook happen.  Imagine the possibilities in the realm of data and healthcare. The development of APIs by the Argonaut Project is just the beginning stages of data sharing and interoperability.

In order to reach true interoperability and efficient use of FHIR, the first step is EHR adoption. Once data is captured into an EHR system, organizations can focus on data standards and clear data management, and have the ability to measure impacts to healthcare patients, providers, costs, and communication. Without the right, accurate data input, interpretation at the end of the process is not accurate or actionable. If clinicians are aware of how their engagement with data and proper input at the beginning of this process affects their practice, their patient’s experience and health, and healthcare on a broad spectrum, they can make a difference well into the future.

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

Windows Server 2003 Support Ends July 14, 2015 – No Longer HIPAA Compliant

Posted on June 16, 2015 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.

If this post feels like groundhog day, then you are probably remembering our previous post about Windows XP being retired and therefore no longer HIPAA compliant and our follow up article about a case where “unpatched and unsupported software” was penalized by OCR as a HIPAA violation.

With those posts as background, the same thing applies to Microsoft ending support for Windows Server 2003 on July 14, 2015. Many of you are probably wondering why I’m talking about a 2003 software that’s being sunset. Could people really still be using this software in healthcare? The simple answer is that yes they are still using Windows Server 2003.

Mike Semel has a really great post about how to deal with the change to ensure you avoid any breaches or HIPAA penalties. In his post he highlights how replacing Windows Server 2003 is a much larger change than it was to replace Windows XP.

In the later case, you were disrupting one user. In the former case, you’re likely disrupting a whole group of users. Plus, the process of moving a server to a new server and operating system is much harder than moving a desktop user to a new desktop. In fact, in most cases the only reason organizations hadn’t moved off Windows XP was because of budget. My guess is that many that are still on Windows Server 2003 are still on it because the migration path to a newer server is hard or even impossible. This is why you better start planning now to move off Windows Server 2003.

I also love this section of Mike Semel’s post linked above which talks about the costs of a breach (which is likely to happen if you continue using unsupported and unpatched software):

The 2015 IBM Cost of a Data Breach Report was just released and the Ponemon Institute determined that a data breach of healthcare records averages $ 398 per record. You are thinking that it would never cost that much to notify patients, hire attorneys, and plug the holes in your network. You’re right. The report goes on to say that almost ¾ of the cost of a breach is in loss of business and other consequences of the breach. If you are a non-profit that means fewer donations. If you are a doctor or a hospital it could mean your patients lose trust and go somewhere else.

I’m sure that some will come on here like they did on the Windows XP post and suggest that you can keep using Windows Server 2003 in a HIPAA compliant manner. This penalty tells me otherwise. I believe it’s a very risky proposition to continue using unsupported and unpatched software. Might there be some edge case where a specific software requires you to use Windows Server 2003 and you could set up some mix of private network/firewalls/access lists and other security to mitigate the risk of a breach of the unsupported software. In theory, that’s possible, but it’s unlikely most of you reading this are in that position. So, you better get to work updating from Windows Server 2003.

Farzad Mostashari’s Aledade Raises $30 Million on the Back of the Switch to Value Based Care

Posted on June 15, 2015 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.

On Aledade’s 1 year anniversary, they just announced that they’ve raised a $30 million Series B round of funding from new investor ARCH Venture Partners and return investor Venrock. That brings their total funding to $35 million. For those not familiar with Aledade, it was Founded by Farzad Mostashari and Mat Kendall soon after Farzad left ONC. They work with independent, primary care physicians who want to participate in ACOs and value based reimbursement programs.

Farzad’s blog post announcing the funding says that by end of the year Aledade will have 100 physician practices managing 75,000 Medicare Patients. With such small numbers, this should illustrate what a huge opportunity value based reimbursement will be for many companies that get it right.

Aledade has an interesting business model. They take about $500/provider as a membership fee and then they split the value based reimbursement commission with the provider. 60% of the reimbursement goes to the provider and 40% goes to Aledade. I’ll be interested to see how well this commission structure holds up. While certainly not an Apple to Apples comparison, doctors are use to paying 5-10% commission to billing companies. Will they be ok with paying 40% to what will feel like a billing company to many? Is this an opportunity for medical billing companies?

I have no doubt that physicians and hospitals are going to need a great mix of technology and healthcare knowledge to be successful in this new world of value based reimbursement. Aledade is on the cutting edge of this trend. Time will tell if they’re too early or right on time for the change.

In a recent article in the Palm Beach Post, they said the following about Aledade:

Thanks to Aledade’s focus on data analytics and physician reminders, Mostashari’s doctors became five times more likely to give recommended preventative care to their older patients, such as annual wellness visits and vaccinations against pneumonia.

This sounds great on face. It’s great that primary care physicians are interested in the wellness of their patients. I also think it’s great that we have a method for incentivizing these kinds of actions. However, my fear with this trend is that we’ll push out guidelines for “wellness care” without knowing if those guidelines actually improve someone’s health.

One lesson Mostashari should have learned well from meaningful use is that if you regulate something too early, you might freeze something in regulation that adds a lot of burden without actually improving healthcare. I’m glad they’re on the cutting edge of this trend. Let’s just be thoughtful that we don’t give our doctors more hoops to jump through that don’t actually provide value. That’s the massive challenge we face with the shift to value based reimbursement and we’re just getting started.

Aledade and company are explorers of a new land. I think we’ve only found the Bahamas. Most of us believe the Americas are still out there to be discovered, but we haven’t found it yet. So, let’s be careful drawing the final maps.

Meaningful Use EHR Adoption Charts – EHR Market Analysis

Posted on June 12, 2015 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.

ONC continues to push out more data when it comes to meaningful use, EHR adoption, RECs, and related areas. As a data addict, I could spend forever looking through and analyzing this data. So, I’ll probably do a series of posts across Healthcare Scene over the next couple weeks looking at the charts and data that ONC has made public about meaningful use and EHR adoption. I know some of the charts have been out for a while, but the analysis should still prove useful.

If you want to join in on the analysis of this data, I welcome you in the comments of each post. Plus, if you want to find your own nuggets to share, I’d suggest starting with their quick stats and dashboards pages.

First up in our look at the ONC EHR data is a look at the meaningful use participation chart for ambulatory EHR vendors (eligible providers if you prefer):
Ambulatory Practice EHR Adoption - Meaningful Use Participation
The most important part of this chart to me is that the two largest bars on the chart. The largest bar is the 749 “Other EHR Vendors” category at the bottom of the chart. It’s easy to miss this bar, but I believe it’s extremely important to note how big the long tail is when it comes to ambulatory EHR adoption. I’ve often said that it doesn’t take that many doctors to make yourself a decent EHR business. This chart illustrates how many EHR vendors are still in the game. There are only 3 EHR vendors that have over 40,000 providers. I know that many think that EHR vendor consolidation is bound to happen. Some certainly will, but I don’t see it happening at a massive scale in the ambulatory EHR world.

The second largest bar on the chart is the Epic EHR adoption. What’s important about this bar is that this totally represents that hospital owned ambulatory EHR adoption. Epic does not and will not sell Epic directly to a small ambulatory provider. All of these “eligible providers” for Epic are in hospital systems. I take away two important things from this. First, we see in plain sight how big the roll up of ambulatory practices is by hospitals. Second, this chart illustrates the opportunity that Cerner and Meditech have available to them. As you’ll see in the next chart, Cerner and Meditech have more hospital installs than Epic, but they’re much farther down on the ambulatory side. A look at history explains why they’ve had trouble penetrating the ambulatory market, but I believe it’s a huge opportunity for them going forward.

I’ll be interested to see how this chart continues to evolve over time. Will we doctors leaving hospitals to go back on their own shift the balance of power? Will we see massive EHR consolidation? I also can’t help but note that Mitochon Systems Inc shows up on the list and they don’t even sell an EHR to doctors directly any more. I assume this must be their white label business? I’ll have to follow up with them to get an update on their business.

Now let’s take a look at the chart for Hospital EHR vendors participating in the EHR incentive programs:
Hospital EHR Adoption - Meaningful Use Participation
This chart illustrates really well the 3 horse hospital EHR race which we’ve all known for a while. Although, given healthcare IT’s love affair with Epic (kind of like Apple in the IT world), I think some will be a bit surprised that Cerner and MEDITECH are both listed ahead of Epic. If you looked only at large hospital systems, I think the chart would look very different though.

It’s worth also mentioning the other horses in the race: McKesson, CPSI, MEDHOST, Healthland and Allscripts. They’ve all carved out their niche in the hospital space. We’ll see if they can continue to defend their territory. Hospital EHR switching is not easy.

My favorite observation from this chart versus the ambulatory chart is how well it illustrates the importance of secondary EHR vendors (the brownish gold color) in hospitals. I’ll never forget when Alan Portela of Airstrip told me that the EHR world will be a heterogenous environment. That absolutely resonated with me and this chart proves out what he said. Health systems are going to have multiple EHR vendors even if some EHR vendors would like it to be otherwise.

If you want to look at the potential disruptors in the world of EHR, I’d take a look at these secondary EHR vendors. Their foothold in hospitals provides them a really great opportunity to disrupt the status quo as we know it. Most of them won’t, but they’re all sitting on an opportunity. I’d start with the companies that make up the “Other Vendors” brownish gold bar. I bet there are some really interesting ones in that list.

I’d love to hear your observations from these charts in the comments. Anything I missed? Do you disagree with my observations? I look forward to hearing your thoughts.

Incorporating More Social and Behavioral Data Into an EHR

Posted on June 11, 2015 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.

You all have seen the stats about how our social and behavioral data is a much bigger predictor of our health and wellness than the 15 minutes of data that’s collected during a doctors visit. When people talk about the out of control costs of US healthcare, they often point to these stats and talk about how we have to focus on factors outside of our current healthcare system if we really want to bend the cost curve.

If in fact we had a true healthcare system that was trying to treat the health of a patient and not the symptoms, then we’d take a much more serious look at the social and behavioral determinants of health. The shift in healthcare is to try and make this a reality and to shift the current reimbursement model to one that pays our healthcare organizations to keep the patient healthy and not just treat their chief complaint.

With this in mind, I was intrigued by this IOM report on Capturing Social and Behavioral Domains and Measures in Electronic Health Records. In the report (there are actually 2 phases of the report) they identify 17 areas that influence a patient’s health and wellness. Then, they narrowed it down to 11 domains to consider incorporating into all EHRs.

You can take a look at the report to find all the details of their findings. However, I found their list of 17 social and behavioral domains that influence your health and wellness absolutely fascinating. Here’s the list:

Sociodemographic Domains

  • Sexual orientation
  • Race and ethnicity
  • Country of origin/U.S. born or non-U.S. born
  • Education
  • Employment
  • Financial resource strain: Food and housing insecurity

Psychological Domains

  • Health literacy
  • Stress
  • Negative mood and affect: Depression and anxiety
  • Psychological assets: Conscientiousness, patient engagement/activation, optimism, and self-efficacy

Behavioral Domains

  • Dietary patterns
  • Physical activity
  • Tobacco use and exposure
  • Alcohol use

Individual-Level Social Relationships and Living Conditions Domains

  • Social connections and social isolation
  • Exposure to violence

Neighborhoods and Communities

  • Neighborhood and community compositional characteristics

As we start to see EHR vendors move from digital filing cabinets to actually keeping a population healthy, I’m going to be watching how they incorporate all of this social and behavioral health data into the EHR.

I think you could break out every one of these domain areas and create a company around collecting this data which could then be made to be consumable by an EHR vendor. In fact, if you look at the world of healthcare IT startups we already see a lot of companies that are working in these areas. The most obvious is the dietary patterns and physical activity domains. How many hundreds of healthcare IT startup companies are working on quantifying those areas of our lives? A wise entrepreneur might look at this list and find a less obvious area where they could improve people’s health.

My biggest takeaway from this list: Healthcare still has such an amazing opportunity to improve health. We’ve barely just begun to tap into this data.

Applying Technology to Healthcare Workforce Management

Posted on June 10, 2015 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 mentioned before that at HIMSS this year I made a shift in focus from EHR technology to a look at what’s next after EHR. In most cases, the technology has some connection or tie to the EHR, but I was really interested to see where else a healthcare organization can apply technology beyond the EHR software.

I found one such case when I met with Ron Rheinheimer from Avantas. For those not familiar with Avantas, they’re a healthcare scheduling and labor management solution. In most cases, their workforce solution is something the nurses choose and often the CNO. I imagine that’s why it’s not talked about nearly as much as things like the EHR. It takes a pretty progressive CIO at a hospital to be able to see through all the noise of other regulations and work with the CNO on a workforce management solution. Or it takes a pretty vocal CNO who can make the case for the solution.

Ron Rheinheimer from Avantas made a pretty good case for why workforce management should have a much higher priority for hospital CIOs. He noted that about 60% of a hospital’s budget is labor expenses and 50% of the labor budget is for nursing. It’s no wonder that nurses take it hard when a hospital goes through layoffs thanks to an EHR implementation. However, given those numbers, optimizing your workforce could save your organization a lot of money.

I think this is particularly true as hospital systems get larger and larger. We’ve all seen the trend around hospital system consolidation and as these organizations get larger their staffing requirements get much more complex. Most of them start moving towards a centralized nurse staffing model. They start working on a floating pool of nurses in the hospital. While humans are amazing, once things get complex, it’s a great place for technology to assist humans.

Ron Rheinheimer also told me about the new incentive models that many hospitals are employing to be able to incentivize nurses to take the hard to fill shifts. Night shift differential has long been apart of every workforce, but with technology you can use analytics to really understand which shifts are the hardest to fill and reward your nurses appropriately for taking those hard to fill shifts. My guess is that we’re still on the leading edge of what will be possible with technology and managing the schedule in a hospital. Real time dynamic pricing for shifts is something that only technology could really do well.

As you can tell, I’m new to this area of healthcare technology. However, I find it fascinating and I believe it’s an area where technology can really improve the current workflow. I look forward to learning more.

Phase 2 HIPAA Audits Kick Off With Random Surveys

Posted on June 9, 2015 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.

Ideally, the only reason you would know about the following is due to scribes such as myself — but for the record, the HHS Office for Civil Rights has sent out a bunch of pre-audit screening surveys to covered entities. Once it gets responses, it will do a Phase 2 audit not only of covered entities but also business associates, so things should get heated.

While these take the form of Meaningful Use audits, covering incentives paid from January 1, 2011 through June 30, 2014, it’s really more about checking how well you protect ePHI.

This effort is a drive to be sure that providers and BAs are complying with the HIPAA privacy, security and breach notification requirements. Apparently OCR found, during Phase 1 pilot audits in 2011 and 2012, that there was “pervasive non-compliance” with regs designed to safeguard protected health information, the National Law Review reports.

However, these audits aren’t targeting the “bad guys.” Selection for the audits is random, according to HHS Office of the Inspector General.

So if you get one of the dreaded pre-screening letters, how should you respond? According a thoughtful blog post by Maryanne Lambert for CureMD, auditors will be focused on the following areas:

  • Risk Assessment audits and reports
  • EHR security plan
  • Organizational chart
  • Network diagram
  • EHR web sites and patient portals
  • Policies and procedures
  • System inventory
  • Tools to perform vulnerability scans
  • Central log and event reports
  • EHR system users list
  • Contractors supporting the EHR and network perimeter devices.

According to Lambert, the feds will want to talk to the person primarily responsible for each of these areas, a process which could quickly devolve into a disaster if those people aren’t prepared. She recommends that if you’re selected for an audit, you run through a mock audit ahead of time to make sure these staff members can answer questions about how well policies and processed are followed.

Not that anyone would take the presence of HHS on their premises lightly, but it’s worth bearing in mind that a stumble in one corner of your operation could have widespread consequences. Lambert notes that in addition to defending your security precautions, you have to make sure that all parts of your organization are in line:

Be mindful while planning for this audit as deficiencies identified for one physician in a physician group or one hospital within a multi-hospital system, may apply to the other physicians and hospitals using the same EHR system and/or implementing meaningful use in the same way.  Thus, the incentive payments at risk in this audit may be greater than the payments to the particular provider being audited.

But as she points out, there is one possible benefit to being audited. If you prepare well, it might save you not only trouble with HHS but possibly lawsuits for breaches of information. Hey, everything has some kind of silver lining, right?

One Challenge with Evidence Based Medicine

Posted on June 8, 2015 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’ve often wondered how medical professionals work through all of the different studies which seemingly say the opposite thing. This chart below illustrated the challenge perfectly:

The key question is, “What happens when the evidence says 2 things?

I’ll be interested to hear some doctors perspectives on it. My guess is that when you start to dig into the details of each of these studies and don’t just read the sensationalized headlines that you probably see a lot more consistency than what is represented in the chart above.

I know I’ve seen that when it comes to studies on EHR software. One study will say that an EHR is inefficient and the next study will save millions of dollars for the institution and make them more efficient. Once you get past the headlines of the studies you usually find that the studies don’t conflict. Instead the studies were looking at very specific situations and parameters. So, it’s really important to look past the headlines and know what the study is really saying.

The question I have for doctors is when do they have time to do all of this research to reconcile the differences? They tell me they’re too busy clicking check boxes.