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HIPAA Slip Leads To PHI Being Posted on Facebook

Posted on July 1, 2014 I Written By

Katherine Rourke 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.

HHS has begun investigating a HIPAA breach at the University of Cincinnati Medical Center which ended with a patient’s STD status being posted on Facebook.

The disaster — for both the hospital and the patient — happened when a financial services employee shared detailed medical information with father of the patient’s then-unborn baby.  The father took the information, which included an STD diagnosis, and posted it publicly on Facebook, ridiculing the patient in the process.

The hospital fired the employee in question once it learned about the incident (and a related lawsuit) but there’s some question as to whether it reported the breach to HHS. The hospital says that it informed HHS about the breach in a timely manner, and has proof that it did so, but according to HealthcareITNews, the HHS Office of Civil Rights hadn’t heard about the breach when questioned by a reporter lastweek.

While the public posting of data and personal attacks on the patient weren’t done by the (ex) employee, that may or may not play a factor in how HHS sees the case. Given HHS’ increasingly low tolerance for breaches of any kind, I’d be surprised if the hospital didn’t end up facing a million-dollar OCR fine in addition to whatever liabilities it incurs from the privacy lawsuit.

HHS may be losing its patience because the pace of HIPAA violations doesn’t seem to be slowing.  Sometimes, breaches are taking place due to a lack of the most basic security protocols. (See this piece on last year’s wackiest HIPAA violations for a taste of what I’m talking about.)

Ultimately, some breaches will occur because a criminal outsmarted the hospital or medical practice. But sadly, far more seem to take place because providers have failed to give their staff an adequate education on why security measures matter. Experts note that staffers need to know not just what to do, but why they should do it, if you want them to act appropriately in unexpected situations.

While we’ll never know for sure, the financial staffer who gave the vengeful father his girlfriend’s PHI may not have known he was  up to no good. But the truth is, he should have.

EMR Market is Growing, But It’s Not What It Was

Posted on September 11, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

The EMR market is likely to grow at more than 7 percent per year through 2016, according to a new report.

The estimate comes from London-based research and advisory firm TechNavio. The company wrote in its analysis, “Global Hospital-based EMR Market 2012-2016,” that “demand for advanced health monitoring systems” and for cloud-computing services were major contributors to demand.

On the other hand, according to the company, implementation costs could be a limiting factor.

The TechNavio figure is actually a compound annual growth rate of 7.46 percent. That means substantial opportunity for the many companies referenced in the report, including Cerner Corp., Epic Systems Corp., AmazingCharts Inc. and NextGen Healthcare, to name a few.

Another research firm, Kalorama Information, in April reported that the EMR market reached nearly $21 billion in 2012, up 15 percent from the year before, driven by hospital upgrades and government incentives.

About 44 percent of U.S. hospitals had at least a basic EHR in 2012, up from 12 percent in 2009, according to the Office of the National Coordinator for Health IT.

In the United States, at least, future growth might require more resources and creativity to achieve. You might remember the recent post “The Golden Era of EHR Adoption is Over,” by Healthcare Scene’s John Lynn, positing that the low-hanging fruit for EMR vendors, the market of early adopters and the “early majority,” is gone, leaving a pool of harder-to-convince customers.

But the TechNavio report is broader, considering not only the Americas but also Europe, the Middle East, Africa and Asia Pacific. That’s truly a mixed bag, as while health IT is at a preliminary stage in many developing markets, it’s highly advanced in countries such as Norway, Australia and the United Kingdom, where, according to the Commonwealth Fund, EMR adoption by primary-care physicians exceeds 90 percent.

When EMR initiatives get a firmer foothold in countries such as China, where cloud-based solutions could well prevail, growth rates for those areas might exceed — several times over — the overall figure predicted by TechNavio.

And in the United States, certain pockets, such as the rural hospital market, still present huge opportunity. Fewer than 35 percent of rural hospitals had at least a basic EMR in 2012, but the enthusiasm is clearly there, as that number was up from only 10 percent in 2010, according to the Robert Wood Johnson Foundation.

It looks like it’s still a great time to be an EMR vendor. But it’s not the same market that it was even a couple of years ago, and success in the new era might require looking at new markets and approaches.

The EMRs You Don’t Hear About

Posted on September 4, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

The best-known EMRs got that way because they target the masses. About a third of the country’s physicians focus on primary care, with the remainder fragmented across dozens of specialties and subspecialties. It’s easy to see, then, why the major EMRs are primary-care centric.

For specialists, the solution is often to use a general EMR and tailor it, with templates and other features, for the field’s common diagnoses and treatments, as well as its workflow. The question is whether the customization is enough. After all, the practice of, say, a nephrologist, who focuses on kidney ailments, doesn’t look much like that of the average family practitioner. And that’s not even considering other health care providers, such as optometrists, who aren’t MDs but who are eligible for meaningful use incentives all the same.

Some providers, then, choose a single-specialty EMR. Sometimes it’s a specific product from a larger health IT company. In other cases, it’s software from a vendor operating in but one niche.

Here are a few specialties with very specific practice patterns and the vendors who serve them with EMRs and practice-management software.

  • Nephrology. Physicians in this specialty deal with conditions and treatments such as kidney stones, hypertension, renal biopsy and transplant. A major part of the workflow is dialysis. One vendor catering to this specialty is Denver-based Falcon, which claims that its electronic notes transfer feature can “bridge the gap between your office EMR and dialysis centers.”
  • Eye care. Care in this field is provided by ophthalmologists, optometrists and opticians. Diagnosis and treatment rely on equipment and techniques unlike those found anywhere else in medicine. If you’ve ever had your eyes dilated, you know this is true. Hillsboro, Ore.-based First Insight created MaximEyes with eye care’s peculiar workflows in mind.
  • Gastroenterology. More commonly referred to as Gastro or GI. Florida based gMed (Full Disclosure: gMed advertises on this site) focuses on GI practices with GI specific problem forms, order sets, history forms, and Endoscopy reports to name a few. Plus, they are the only EHR which reports directly to the AGA registry.
  • Podiatry. These specialists of the foot train in their own schools. Bunions, gout and diabetic complications are among the problems they treat with therapies ranging from shoe inserts to surgery. DOX Podiatry, based in Arizona, concentrates on this field, providing clinical, scheduling and billing and collections modules. Its clinical component starts with a graphic of a foot, allowing the podiatrist to specify the problem area and tissue type. DOX claims that the software can eliminate the need to type reports.
  • Addiction. Chemical dependency and behavioral health providers include a variety of specialists, including psychiatrists, psychologists and counselors. Documentation in the field must account for outpatient, inpatient and residential services and for individual and group counseling sessions. Buffalo, N.Y.-based Celerity addresses the heavily regulated industry with its CAM solution, developed by a clinical director in the field.
  • Oral Surgery. This field is a dental specialty focused on problems of the hard and soft tissues of the mouth, jaws, face and neck. As such, an oral-surgery EMR needs heavy-duty support for the anatomy in play. DSN Software, based in Centralia, Wash., sells Oral Surgery-Exec for this group of providers. You might actually have heard about this one, because I interviewed its creator, Dr. Terry Ellis, in July for a post called “Develop Your Own EMR Crazy, But This Guy Did It Anyway.” In fact, there’s nothing crazy about using an EMR custom-designed for the work you do.

Without This EMR Step, You Might Never Get It Right

Posted on August 29, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

It’s not hard to find physicians and nurses who say that far from improving health care, the EMRs they use are something to work around.

Billing problems, lost productivity and even diminished quality of care are common complaints, sometimes long after the implementation kinks should have been worked out. In some cases, doctors who bought into EMRs as a way to operate more effectively and efficiently have found themselves disappointed enough to look for hospital employment, try new practice models or even close their doors, as HealthcareScene.com founder John Lynn has written.

Often the problem lies deeper than the technology, according to a recent white paper from TechSolve, a Cincinnati-based consulting group. After all, an electronic overlay does little good when it serves only to automate bad processes.

TechSolve is promoting a process-mapping approach to EMR for hospitals through its Lean Healthcare Solutions unit. It’s part of a trend toward applying the efficiency techniques of Japanese manufacturers to EMRs and other aspects of health care.

Like Toyota and other pioneers of lean, health care providers should rely on line workers to help root out waste, according to TechSolve.

“While you may be inclined to dismiss negative comments as resistance to change, staff may be aware of design issues that the design team, PI facilitator, and vendor were not,” TechSolve consultants Sue Kozlowski and Alex Jones wrote.

They offered seven steps to ensure maximum benefit from an EMR, a few of which I’ll share. I suggest downloading the full paper for a complete view.

TechSolve recommends thinking about process improvement before getting started with an EMR. Of course, if it’s too late for that, the firm and others in the space are happy to step in later, as well.

Here’s what TechSolve advises:

  • Map your current processes. This can be done with help from your process improvement team or an outside group. In some cases, it’s best to assign a team to each service line.
  • Compare current and future states. Color-coding is one way to do this, highlighting visually for staff members how their work will change.
  • Prioritize issues that affect patient care and payment timing. An “issues list” can be created and then reviewed after “go live” to make sure problems have been corrected. Also, examine how well staff members are adhering to the new processes, asking questions such as, “Where are they using work-arounds, and where have they found new capabilities in the system?”
  • Process map again. This new snapshot is the baseline going forward. It can serve as a reference for staff members when they’re in doubt and as a training tool for new hires.

We’re all looking for technology that makes our lives easier right away. But when it comes to EMRs, there’s no true turnkey solution. Making a system pay off requires investments, particularly of time, well beyond the sticker price.

Under traditional reimbursement models, though, planning is not what brings in the revenue. It’s easy enough to see why hospital employment, with guarantees of a salary and IT assistance, is becoming a more and more attractive option for physicians who want to limit expenses and risk.

Hospitals, though, have no plan B. They’ll have to marry their IT to efficient processes or else.

Is Your EMR Charting Accurately?

Posted on August 23, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

For all the hope — not to mention time and money — being invested in EMRs as a way to improve health care, they’re still exquisitely prone to the age-old problem in IT: garbage in, garbage out.

Several writers have commented recently on whether you can believe what you read in an EMR. They raise serious questions as meaningful use Stage 2 draws near and providers’ care patterns become further enmeshed with their record systems.

One problem, wrote Dr. Rebecca Bechhold, a medical oncologist, is the information overload that an EMR can generate: “page after page of predetermined queries and stock answers that are repetitive and irrelevant after the first visit.” The truth, as in what’s really going on with the patient, might be in there somewhere, but she finds it hard to dig out.

Worse still, doctors sometimes just check “normal” for everything under the physical exam section because they’re in a hurry and entering the information is tedious, Bechhold wrote. Some pretty important history, such as an enlarged liver or an amputation, can be left out.

It might sound bad, but it’s human nature whenever there are too many boxes to check. However, for Bechhold, the key disadvantage isn’t a lack of facts, but of feelings.

“You cannot express the emotion and anxiety that is part of oncology care in a prepackaged document,” she wrote.

Software selection consultant Sheldon Needle, meanwhile, wrote about the pitfalls of taking an EMR prescription list at face value.

Take the patient who comes to the emergency room because of a car accident. If the patient’s regular doctor is linked with the hospital’s e-prescription system, a medication list might soon be forthcoming. But who’s to say there aren’t other medications in the picture, prescriptions written by a doctor who’s not tied in?

Needle’s advice: Ask a human, such as the patient or a relative.

“If something looks off on the electronic medical record,” he wrote, “question it.”

HealthcareScene.com’s own John Lynn, too, addressed the issue of trusting health care data, noting that doctors are receiving information from more sources than ever, including health information exchanges, patients and patient devices. It’s hard for physicians to know what’s reliable.

The obvious solution to trust issues seems to lie in user interface design. If the EMR is a good fit for the doctor’s workflow, the right data should end up in there.

Unfortunately, it’s not quite that simple. Bechhold noted that charts she receives from other doctors are sometimes configured to include every piece of data available for the patient, including all medications and test results.

The physicians, she wrote, want to be able to show that they reviewed all information if they’re ever sued.

Doctors and health IT companies have a way to go in understanding each other. Only then can there be full trust in EMRs.

Things Your EMR Will Never Do

Posted on August 15, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

EMRs can be powerful tools for building practice efficiency.

But they can’t do it all.

Ruth Sara Hart-Schneider, sales and marketing director for Cincinnati-based Salix, says health care providers are still paying too many people to move too much paper. Her firm helps them to fill the gaps left after even the most successful EMR implementation.
Ruth Sara Hart-Schneider is sales and marketing director for Salix
Salix specializes in workflow automation, business process outsourcing and litigation support. Health care makes up about 30 percent of its workload.

Hart-Schneider works with physician practices, hospitals and a variety of other health care clients, such as durable medical equipment firms and clinical research organizations. She deals with 26 EMR systems.

Note: If you catch her hanging out by your fax machine, don’t be alarmed. It’s part of her job.

Here’s what Hart-Schneider had to say:

Can you explain more about what your company does in health care IT?

We support health care companies in leveraging the electronic data they already have. We help them to avoid having redundant systems or people hand-filling forms or electronic systems generating paper systems. We work around the electronic systems in an office, like EMRs and practice management systems. Usually an office will have both, but there are all these other functions that have been left on the table.

What are some examples?

Most EMRs we deal with are not set up for prior authorization requests. And every state has its own forms for different programs — Medicaid HMOs, workers’ compensation. Particularly for practices dealing across state lines, it becomes cumbersome for the staff. EMR companies don’t want to program all these forms for all the states, and they change constantly anyway. That’s a sweet spot for us. Prescription monitoring is another one if the practice is giving many narcotics. Also, EMRs don’t interface with many of the tools the carriers have out there for eligibility, benefits and claims status. Some other areas are disability, return-to-work forms, immunization logs for pediatrics and certificates of medical necessity for things like wheelchairs and oxygen.

When practices invest in EMRs, do they realize how much they’ll still need to do on paper?

They’re trying to meet meaningful use. When they choose a system, they know what it will do. It’s not a tool to manage your office. Still, people get frustrated with how many repetitive tasks their employees have to do even after all this money has been spent. For example, a group had a pulmonary function testing machine that wouldn’t talk to the EMR. They would print the report and then walk over and scan it into the EMR. A lot of equipment is like that.

How do you identify the inefficiencies in a practice?

If you stand by the fax for 10 minutes and watch what comes through, you’ll have a pretty good idea. You can also look around at the stacks of paper. You can ask people what they’re behind on.

How do you help?

Salix will work with an organization to help them identify their biggest pain points and then customize a solution that will free up staff time and save them money. We look for the best tools for each application. We like FileBound, which has an ASP model product that meets all the HIPAA security requirements, has a very reasonable price point and allows unlimited users without user fees.

Among our services: We can help with the auto-population of forms, we can provide data-entry services for labs and test results that are faxed in and we can help provide interface solutions for equipment that’s not hooked to the EMR. For a surgery practice, as one example, we can help design and implement systems so that the manager can look at tomorrow’s schedule and ensure that all pre-certs have been completed.

How important is it to address these areas?

Most often, there are higher-level tasks that aren’t getting done because staff is bogged down in some very menial, basic and repetitive tasks. You don’t need your nurse spending time on data entry or filling out school forms.

Is it realistic for a practice to go completely paperless?

Yes, but not in the near future. You couldn’t do it yourself. Vendors and everyone else that you deal with would have to be paperless, too, and that’s not happening. Many of the nursing home and hospice operators I talk to say they’re not going electronic because they don’t have the money. I think some things will always come in on paper.

Benefits and Struggles of EMRs, and More – Around Healthcare Scene

Posted on June 9, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Are tablets going to take the place of traditional laptops and desktops? Well, Dr. Michael West seems to think so. He talks about his new-found love for his iPad mini, and how it fulfills all his current needs. Have you traded your desktop in for a tablet yet? The new Microsoft Surface is making me kind of want to!

Having a PHR on your phone doesn’t have to be complicated. In fact, if your phone has a camera (what phone doesn’t nowadays?) you can create when quickly and easily. Here are five health-related snapshots you could keep on your phone to assist in a variety of situations.

If you have been following the Affordable Health Care Act, you’ll know that an optional Medicaid State Plan called Medicaid Health Homes was introduced. There are, of course, many questions that people have about this, including what kind of technology will be required for successful implementation. Lori Bernstein, president of GSI Health, addresses some questions and lays out the benefits that this new model has to offer in her guest post at EMR and EHR last week. what kind of technology will Medicaid Health Homes require to ensure successful implementation?

Paper to EMR is a necessary evil for for hospitals, therefore, it’s easy to justify the expense required to do so. But what about when you decide to switch EMRs. Is it justifiable? Not always. There is no ROI to switch from EMR and EMR, and it can be a big risk.

A current pilot program is currently underway to help identify high-risk pregnancies by using an EMR. This pilot program is being led by researchers and people from Johns Hopkins University’s Center for Population Health IT to find hints in a mother’s health history to help determine if her pregnancy is high-risk. It’s a slow-moving project, but may prove to be worth it if it helps get mothers the help they nee.d

Healthcare IT and EMRs – Around Healthcare Scene

Posted on May 26, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

There are different challenges that come with creating PHRs, especially with adolescents. Certain aspects of PHRs can be hidden from parents, such a pregnancy tests or information on reproductive health. Boston Children’s Hospital has created a special adolescent PHR, that will allow parent’s access to certain files, while keeping some available only for the eyes of the the adolescent.

EMRs are created to increase efficiency of care, eliminate paper records, and optimize care. However, when a person wants to access medical records, they often have to wait days, if not weeks, for the results. Is there a way to have EMRs help patients easily retrieve medical records?

There are many great EMR bloggers out there. John took a trip down memory lane to remember the blogs he first read when he started blogging 7.5 years ago. Do you recognize any of these legacy EMR bloggers?

Do you consider EMRs to be “cool” in the world of Health IT? In this light-hearted post, Jennifer reflects on different parts of Health IT, specifically EMRs, and what she would define as cool. Be sure to chime in on this conversation.

Some people really love their EMRs (or, at least, try to convince themselves that they do!) Two physicians from North Carolina made this clever video, as a way to express some of their frustrations with EMRs in a lighthearted, and fun way. You definitely won’t want to miss this!

The latest innovation from Google may have a big effect on the future of healthcare. Google Glasses, though not created specifically for the healthcare community, could prove to transform healthcare as we know it. From helping medical students learn material, to assisting in the ER, the possibilities appear to be endless.

The Rise Of mHealth And EHR Use, And The World Of Telehealth – Around Healthcare Scene

Posted on May 12, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

mHealth is on the rise, and it looks like usage of smart phones among physicians is following that same trend. A recent study shows that usage rose about nine percent in 2012, which shows that it is becoming more accepted in the medical world. It will be interesting to see if it increases even more this year (I have a feeling it might.)

Similar to the increase in doctors using smartphones, there has been a jump in EMR and HIE use as well. A survey from Accenture found that over 90 percent of doctors are using an EMR in either their practice or at a hospital, and over 50 percent are using an HIE. This increase was highest among doctors in the United States. Be sure to read more of the interesting facts this survey found about EMR and HIE use in the U.S., and around the world.

Even though 90 percent of doctors are using an EMR at one point or another, only about 55 percent have actually adopted an EHR into their practice. It can be nerve-racking trying to find the perfect EHR. If you are finding yourself at that crossroad, be sure to read these five tips from ADP AdvancedMD on how to have a successful EHR implementation.

Still, some of you may be hesitant to implement an EHR. You may ask, is it worth it? Does it takeaway from healthcare? There is debate from both sides, each with compelling arguments. John believes that technology is overall positive in any industry, and discusses his thoughts, and some of the challenges that faces the industry.

Telehealth and medicine is so huge, it can be hard to digest. Neil Versel recently attended the American Telemedicine Association’s annual conference in Austin, Texas, and saw just how huge this market was. Be sure to check out this video he created from his experience, and to perhaps get a better idea about the many types of telehealth. Similar to the increase in doctors using smartphones, there has been a jump in EMR and HIE use as well. A survey from Accenture found that over 90 percent of doctors are using an EMR in either their practice or at a hospital, and over 50 percent are using an HIE. This increase was highest among doctors in the United States. Be sure to read more of the interesting facts this survey found about EMR and HIE use in the U.S., and around the world.

With summer quickly approaching, it’s more important than ever to stay hydrated. But if you need a little reminder, be sure to look into the Jomi Band.  It gives you warnings when you might be on the brink of dehydration, and makes it easy to keep track of how much water you’ve consumed in a day’s time.

EHRMagic, EHR Certification, and the Great EHR Switch — #HITsm Chat Highlights

Posted on May 4, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: What lessons can be learned from the ONC’s decision to revoke #EHR Incentive Program certification of EHRMagic? #HealthIT

Topic Two: Does this action make EHR certification more meaningful or does it reduce confidence in certified products?

Topic Three: Who suffers the most from the ONC’s decision? The vendor or the physicians who purchased the product?

#HITsm T4: ”2013 is the year of the great #EHR switch.” With data migration and implementation hassles, is this truly a possibility?