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Hacking HIPAA – Patient Focused Common Notice of Privacy Practices

Posted on June 27, 2013 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.

How can you not be interested in an article that talks about hacking? Of course, in this case I’m talking about hacking in a much more general since. Most people think of hacking as some nefarious person compromising a system they shouldn’t be accessing. The broader use of the term hack is to create something that fixes a problem. You “hack” something together to make it work.

This is what David Harlow, Ian Eslick, and Fred Trotter had in mind when they got together to hack HIPAA. They wanted to create a HIPAA Notice of Privacy Practices (NPP) that would provide meaningful privacy choices for patients while still enabling the use of the latest technology. Far too often HIPAA as seen as an excuse for why doctors don’t use technology. However, if the NPP is set up correctly, it can enhance patient privacy while allowing use of the latest technologies in your practice.

The Hacking HIPAA team decided to leverage the power of crowdfunding to see if they could collaboratively develop a patient focused Notice of Privacy Practices. I really love the idea of a Common Notice of Privacy Practices. If you like this idea, you can help fund the Hacking HIPAA project on MedStartr.

For those not familiar with crowdfunding, imagine your healthcare organization getting $10,000 worth of legal work from one of the top healthcare lawyers for only $1000. Looked at another way, you get an updated Notice of Privacy Practices with all the latest HIPAA omnibus rules incorporated for only $1000. Call your lawyer and see if they’d be willing to provide an NPP for that price. Plus, your lawyer probably will just provide you some cookie cutter NPP they find as opposed to a well thought out NPP.

This is such a great idea. I hope that a large number of healthcare organizations get behind the project. I’d also love to see some of the HIPAA disclosure companies and EHR companies support the project as well. The NPP will have a creative commons license so those companies could help fund the project, provide feedback in the creation of the NPP and then distribute the NPP to all of their customers. What better way to build the relationship with your customers than to provide them a well thought out NPP?

If you want a little more information on how the Hacking HIPAA project came together, here’s a video of Fred Trotter talking about it. Also, be sure to read the details on the Hacking HIPAA MedStartr page.

Visualization of Healthcare Data, DocGraph, and Open Source — #HITsm Chat Highlights

Posted on February 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.

Topic One: How can we leverage referral and collaboration information in #HealthIT software? What is DocGraph good for?

Topic Two: Generally, what are the best examples of data visualization of healthcare data that you have seen or heard of?

Topic Three: What other open doctor data should we merge with DocGraph? #HealthIT

Topic Four: What open data or open source software do you use regularly as a #HIT professional? #HealthIT

Topic Five: What open data or open source software do you wish existed? #HealthIT

EMR and Meaningful Use Books

Posted on July 27, 2011 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 must admit that I’m not much of a book guy. Especially since there’s so much free information available on the internet about just about any subject you could want. However, I’ve been quite intrigued by the number of healthcare IT related books that I’ve seen coming out of late. Here’s a quick roundup of some of the ones I’ve seen.

Getting to Meaningful Use and Beyond: A Guide for IT Staff in Health Care by Fred Trotter and David Uhlman – I’ve been a big fan of Fred Trotter for a while. So, I’m glad he’s working on this book. Turns out the book isn’t even published, but in Fred Trotter open source style fashion, the book is available for free online right now. Of course, they’re hoping you’ll provide feedback.

The HITECH Act Made Easy: A Simple Guide to the Federal EHR Incentive Programs – I had this book sent to me. It’s a short book which I think is good. It tries to tackle not only the details of the Medicaid and Medicare stimulus program, but also has a number of sections on EHR selection and implementation as well. I love it’s question format where many of the chapters are a question and the chapter offers the answer.

Health Information Exchange Formation Guide: The Authoritative Guide for Planning and Forming an HIE in Your State, Region or Community – I haven’t really had a chance to dig into this book yet. It’s brought to you by HIMSS. It’s a pretty thick book which I think describes well the challenge that is forming an HIE. Without reading the book, I’m a little torn just by the subtitle of the book, “The Authoritative Guide for Planning and Forming an HIE in your State, Region or Community.” I guess it’s hard for me to imagine it being the “authoritative guide” when I think we’re still trying to figure out the right HIE business model. I don’t think we’ve found it yet. I guess I should read the book to find out.

Jim Tate’s EHR Incentive Roadmap – Ok, this is an e-Book, but I think it’s as good a value as any hard cover book. So, it’s worth mentioning. I wrote a whole post on Jim Tate’s EHR Incentive book before.

Any other books about EMR, Meaningful Use, and/or healthcare IT that are out that we should know about?

UPDATE: User EHR and Meaningful Use Recommendations from the comments below:
Electronic Health Records For Dummies – Recommended by Nate Osit

Electronic Health Records: Transforming Your Medical Practice, second edition – “This is a book from MGMA and was recommended to me by a coordinator from the REC (Ohio) that I have been shadowing.” – Mary Ellen Weber

Direct Model or HIE Model

Posted on February 15, 2011 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.

There’s a pretty fierce battle going on right now between all the various stakeholders interested in exchanging patient data. The stakeholders range from very large companies to government initiatives to startup companies. One of the major problems that I see is that it’s not completely clear which model of patient data exchange will win out. In fact, let’s not be surprised if a number of different options take hold.

With this said, I found it interesting that my favorite open source healthcare IT advocate, Fred Trotter, has chosen to get behind the Direct Project. In Fred’s post describing the challenges with the IHE-protocol HIE model approach is flawed and that the direct exchange of healthcare information is the way to go. In fact, he provides the following two illustrations in his post to show the difference:

HIE Model (click on the image to see it full size)

Direct Model (click on the image to see it full size)

Fred then offers this incredibly interesting conclusion:

At every level, organizations are deciding whether to invest in Direct or IHE-based exchange. At this point, I believe the only viable option is for a local exchange to either support Direct only, or both Direct and IHE. IHE is simply going to be too heavy weight for early adoption. Eventually, IHE may become dominate but for now Direct is much simpler, and puts the patient right in the center of everything. If you are a policy maker, you should be asking anyone involved with an HIE process to detail what their Direct-strategy is. If any effort is ignoring Direct and going with IHE-only I would lay odds that they will be broke and defunct before the decade is out.

Moreover, an IHE-only strategy is going to exclude direct participation from patients at this stage. If you care about patient empowerment, I recommend that you advocate for the Direct project at every level, including in your local HIE and REC.

Lots to consider with this complex challenge.

I guess you could say that the direct model is the patient centric model. Although, one could easily argue that the direct model doesn’t have the patient as the center of the model, but instead is a PHR centric model. So, the direct model will be a patient centered model only as much as the PHR software allows the patient to be involved.

Thus, it makes since why Microsoft HealthVault and Google Health are heavily involved in the Direct Project. Of course, they want to be involved in a project that puts them at the center of the communication.

The real question even with the direct model is what incentive do the various PHR vendors have to make this interaction happen? What will be the “cost” that PHR vendors pass on to consumers and/or doctors that use the PHR centric model? Basically, what’s the business model of the PHR vendors?

Unless we can find a PHR centric business model that works for the PHR vendor while still empowering the patient, even the direct model will fail or have adverse outcomes.

Stability of Propietary EMR Vendors vs. Open Source EMR

Posted on January 6, 2010 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 the comments of one of my open source (free) EMR posts, we started an interesting discussion about the way that you evaluate a proprietary vendor and how the same methods of evaluation aren’t always possible once you start talking about an open source EMR. To keep things simple, I’ll just focus on one part of the evaluation of an EMR vendor: Stability.

I’m not talking about whether the EMR vendor’s software product is stable. I’m talking about the stability of the company behind the EMR vendor. There are a lot of aspects to consider, but probably the most important is how successful the company is doing financially. Are they making new sells? Is the EMR vendor expanding the business or is their business contracting? Are their current customers renewing or fleeing to other software products? At the end of the day, you’re basically making a judgement on the financial viability of the company. No one wants to deal with the challenge of an EMR vendor going bankrupt, being sold, or going out of business (see my previous post about when a SaaS EMR goes out of business). So, this is a really important issue to consider. Your EMR vendor becomes your partner and you want a reliable one.

The problem is that the same analysis can’t be done on an open source EMR. There is no company behind an open source EMR (usually) and so you can’t look at the company to make a prediction on whether the open source EMR software will be around a couple years from now. Instead you have to look to other indicators.

The most important point to consider with an open source EMR is the health of the community surrounding the open source EMR. If the community is strong, then you’ll see some amazing things happen. If the community is weak, then the open source EMR will still be around in a few years, but no improvements to the software will be made. The way technology progresses means that your software must improve or it will be outdated in a couple years time.

What makes a strong open source community? It can come in a variety of ways. Here’s just a few of them:
-Number of software releases that are made
-Method for delivering software releases
-Number of people with commit privileges on the project
-Number of people contributing code to the project
-Commercial entities backing the project
-Online activity and discussion around the project
-Software downloads over time

I’m sure there’s a lot more. I hope that people like open source EMR fanatic, Fred Trotter, will add to my short list.

It’s just as important to evaluate the health of the open source EMR community as it is for you to evaluate the financial stability of a commercial EMR vendor.

Definition of Meaningful Use

Posted on May 5, 2009 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.

We’re all still sitting here waiting for the government to finally decide two key terms in regards to gaining access to the $18 billion in stimulus money in the HITECH act (ARRA). I’ve been interested in the subject myself since before it was even settled that we’d call it meaningful use as opposed to meaningful EMR user. From the looks of that post back in February, there was still a lot of confusion about “meaningful use” and “certified EHR.”

Turns out that a few months later, we still have very little clarification about what these two terms mean. Certified EHR discussion has really revolved around CCHIT certification or some other alternative. We’ll try to leave that discussion for other posts. What has been interesting is in just the past week or two there has been a literal flood of people offering their perspective on meaningful use. Sometimes I like to be on the cutting edge of these definitions (like I was in the link above) and other times I like to sit back and let them play out. This time I’ve been letting it play out and it’s really interesting to see the multitude of perspectives.

I’m not planning on writing my own plan for how they should do meaningful use. I may do that at a later time if so inclined. For now, I’ll just focus on highlighting points from what other people have suggested and provide commentary that will hopefully enhance people’s understanding of this complicated mandate (yes, that means this post will be quite long).

I think it’s reasonable to first point you to the NCVHS hearing on “Meaningful Use” of Health Information Technology. This matters, because at the end of the days hearings like these are where most of the information are going to come. Then, with the information from these hearing decisions will be made. The other sources like blogs won’t carry nearly as much weight (although it’s unfortunate that more politicians aren’t listening).

John Chilmark on Meaningful Use
Next, I’ll go to one of my newly found favorite bloggers named John Chilmark (any coincidence we’re both named John). John from Chilmark Research commented that HHS is bringing together the “usual suspects” to discuss “meaningful use. Chilmark also states that the following criteria are what’s required for meaningful use:

  1. Electronic Prescribing
  2. Quality Metrics Reporting
  3. Care Coordination

I’m not sure where he got this list, but this list feels kind of weak if you ask me. In fact, John suggests that these requirements will be simple and straightforward and first and then ratcheted-up in future years. Interesting idea to consider. I hope that they do draft the requirements for meaningful use in a way that it can be changed in the future if it turns out to not be producing the results it should be producing.

John Halamka on Meaningful Use
Next up, the famous John (another John) Halamka, Chief of every Health IT thing (at least in Boston), calls defining “meaningful use” “the most critical decision points of the new administration’s healthcare IT efforts.” He’s dead on here. In fact, it might not be the most critical decision for healthcare IT, but for healthcare in general as well. Here’s John Halamka’s prediction for how “meaningful use” will be defined:

My prediction of meaningful use is that it will focus on quality and efficiency. It will require electronic exchange of quality measures including process and outcome metrics. It will require coordination of care through the transmission of clinical summaries. It will require decision support driven medication management with comprehensive eRx implementation (eligibility, formulary, history, drug/drug interaction, routing, refills).

Basically, he’s predicting inter operable EMR software and ePrescribing with a little decision support sprinkled on top. I won’t be surprised if this is close to the final definition. The only thing missing is the reporting that will be required to the government. The government needs this data to fix Medicare and Medicaid (more on that in another post).

Blumenthal Comment to Government Health IT
Government Health IT has a nice quote from David Blumenthal that says: “The forthcoming definition of the “meaningful use” of health information technology will set the direction of the Obama administration’s strategy for health IT adoption, said David Blumenthal, the new national coordinator for health IT.”

I think there’s little doubt that David Blumenthal has a good idea of the importance of the decisions ahead. What should be interesting is to see how involved Obama is in these very important decisions. I’m guessing Obama won’t do much more than sign a paper to make it happen. I just hope I’m wrong.

HIMSS Definition of Meaningful Use
Here’s a short summary of the HIMSS definition of “meaningful use”

According to HIMSS officials, EHR technology is “meaningful” when it has capabilities including e-prescribing, exchanging electronic health information to improve the quality of care, having the capacity to provide clinical decision support to support practitioner order entry and submitting clinical quality measures – and other measures – as selected by the Secretary of Health and Human Services.

Basically, e-prescribing, interoperability and clinical decision support. Turns out a BNET Healthcare article suggested the same conclusion “The consensus of physician and industry representatives was that meaningful use should include interoperability, the ability to report standard quality measures, and advanced clinical decision-making.”

I think we’re starting to see a bit of a pattern here. I should say that these are all very good things, but the challenge I see is that any requirement needs to be easily and consistently measured. Interoperability and clinical decision support are both very difficult to measure. Just wait until they see the variety of software that tries to do those two things. It’s very difficult to measure it consistently across so many EHR software.

Wow!! I barely even got started on this subject. Instead of belaboring the point, let me just point you to some other interesting readings about the HITECH Act, ARRA, and “meaningful use.”

Please let me know if there are other good sources for perspectives on defining “meaningful use.” This really is a landmark decision for healthcare IT.

Medsphere VW Bus and Cerner Semi Picture at HIMSS

Posted on April 10, 2009 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.

So many good things to post about and so little time. This one I couldn’t wait any longer. I first saw this on Fred Trotter’s blog, but the picture’s been making the rounds. I got his permission to post it here.

I can’t think of a better image to portray the difference between Big EHR vendors (I call them jabba the hut EHR) and small/open source EHR vendors. Check it out.
Medsphere VW Bus Next to Cerner Semi Truck

CCHIT and Open Source (FOSS) Meet at HIMSS

Posted on April 1, 2009 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 post this for a while, because I hope that it will be well attended. CCHIT and various open source EMR groups, advocates and friends will be meeting with CCHIT during HIMSS. I first read about this from Neil Versel where he said this:

Healthcare FOSS guru Fred Trotter and Linux Medical News editor Ignacio Valdes, M.D., are leading the event, Monday, April 6, at 2 p.m. in Room 10d at the Hyatt Regency McCormick Place at 22nd Street and South King Drive in Chicago. Trotter called the encounter “like offering to meet with the Rebel Alliance at the annual Death Star conference,”, but I imagine they intend for things to be civil.

I love the Death Star reference. This should be a pretty interesting meeting. I was talking to someone today who suggested that they were going to come to some sort of consensus at that meeting. I suggested that they probably wouldn’t come to a consensus, but at most agree to disagree. However, I’m a strong advocate for communication and understanding between parties. So this is a good thing.

The best part for those who can’t attend HIMSS is that they’re planning on doing a webcast of the event. Here’s the details:

Date: Monday, April 6, 2009

Room 10d, Hyatt McCormick Conference Center, Chicago

Session #1 1:00 – 2:00 PM CDT

Interoperability 09 and Beyond: a look at CCHIT’s roadmap for the future

Session #2 2:00 – 3:00 PM CDT

Open Source Forum: a dialogue on certification for open source EHRs

Here is the link to register for the webinar:

https://www1.gotomeeting.com/register/429901059

After registering you will receive a confirmation email containing
information about joining the webinar. We will also be recording
these sessions, and plan to make the media files available on the web
for later downloads.

There’s actually 2 sessions and I’m really interested to see how it goes. I wish I could be present, but I’ll definitely be at the webinar and posting my thoughts on twitter. I do wish that CCHIT would add a ustream video feed of it as well.