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

Healthcare Unbound #HITsm Chat Thoughts

Written by:

Most of you have seen that we’ve been working on a number of ways to stretch and deepen the amazing #HITsm community. Check out the EMR and HIPAA YouTube channel for some post #HITsm video chats we’ve done. Plus, we do our weekly #HITsm Twitter Roundups (Every other week our #HITsm roundup is on EMR and EHR). At the core of all of this is the weekly #HITsm twitter chat. If you’ve never participated, it’s an incredible community of people.

I’ve always wanted to do a blog post before the regularly scheduled #HITsm chat where I write some thoughts about the planned #HITsm topics. Leonard Kish (@leonardkish) got the topics for this week’s chat up early, so I thought it was the perfect opportunity for me to write a post based on his topics. Hopefully some can read it before the chat and it will enhance their chat experience.

Topic 1: So how long will it be before office visits are no longer the norm? (via Mark Blatt, MD, CMIO Intel)
This is a bit of a hard question because it depends on how you define office visit. Is an e-visit with the doctor considered an office visit. What if the visit is in a HealthSpot like kiosk? Is that an office visit. I’ll assume for the sake of this question that he means any visit where you didn’t have to go into the office. This could be a telemedicine visit or some other electronic method of interacting with a care provider.

My prediction is that it will probably be 3 years before it’s common for the early adopters to do an e-visit of some sort. It will probably be 6 years before someone like mom is doing an e-visit. Although, there’s a subtle caveat to my answer. Many office visit types will be perfect for an e-visit and some office visit types will never be possible in an e-visit. So, I’m mostly making my prediction based on the former visit type.

Topic 2: What technologies will lead the way?
The Google Plus hangout simplicity has made very clear to me that a video connection between two people is easily possible today. Of course, I’m not suggesting Google Plus will be used for a healthcare office visit, but video and audio using the off the shelf and built in cameras and microphones that come on every laptop, smartphone, and tablet is going to be the preferred method.

As for software, the early adoption is going to be based on which companies the insurance companies choose to reimburse. The insurance companies I’ve talked to are more than happy to have doctors reimbursed for an electronic visit. However, they need some way to know if an e-visit was actually done by the doctor. Even a small space for corruption can cost an insurance company billions of dollars because of their scale. Their method to battle this will be to reimburse only a few telemedicine companies for whom they’ve created deep ties.

Let’s also not count out secure text and secure email as a simple method to replace many unneeded visits.

Topic 3: How will these at-home and mobile technologies integrate with existing systems?
As Anne Zieger recently pointed out, Telemedicine is Not Connecting with EHRs. EHR vendors have so many interoperability challenges as is that integrating with Telemedicine is far down their list of priorities. Instead, I think we’ll see the insurance companies take the lead on integrating Telemedicine into their platforms. We may also see some PHR and patient portals work out deals with the companies that are recognized for reimbursement by the insurance companies.

The other beautiful area for this technology is the cash pay patients. I see a whole new group of cash pay patients emerging. Many people and companies will be willing to pay cash for an e-visit versus making the trip to a doctor’s office for a regular visit. The key question is how the company that provides these visits will get enough locally licensed doctors on board to make this happen, but someone will crack the nut.

Topic 4: Aetna’s CarePass will track customer behavior. Will this become the norm, is it a good thing?
I believe that this will be the norm. In fact, they’re already doing some of this customer behavior tracking already, but most people just don’t know about it. Things like CarePass will just be a public way to do it. I think many will hop on board. I think that this will be a good thing for insurance companies, a good thing for healthcare, and a good thing for many patients. However, a few patients will get really hurt by it.

Topic 5: We’ll need culture change to bring this massive about. what will it take to change culture?
1. Reimbursement 2. Medical Licensing Laws 3. Trusted Technology

If we figure out those 3 areas, we’re going to see the culture change that will unbind healthcare. I personally think we’re headed this direction already and I see nothing that will stop it. It’s just a question of how quickly we can get there.

June 21, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Health IT Interoperability, HIE, and mHealth — #HITsm Chat Highlights

Written by:

A couple of the Health IT regulars got together again this week to video chat during the #HITsm Chat Highlights. Here are some of their thoughts. If you want to participate, be sure to comment!


Topic One: How far off is a solution to the problem of #healthIT interoperability? Is one actually within reach?

Topic Two: Is patient consent being overshadowed by sustainability as the most significant obstacle to #HIE?

Topic 3: What is the role of #telehealth and #mHealth in #healthcare reform and patient engagement?


Topic Four: Are competing deadlines (e.g., Stage 2 Meaningful Use v. ICD-10) going to be responsible for undermining healthcare reform?

 

Topic Five: Who or what will be most influential in determining the next phase in the evolution of #healthIT?

June 8, 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.

Integrating Telemedicine And EMRs

Written by:

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

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

Makes sense in theory. How would it work?

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

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

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

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

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

May 17, 2013 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.

The Anti-ACO / Hospital Medical Practice Consolidation

Written by:

A physician, Charles Beauchamp, recently left the following comment (shown below) on my ACO and Hospital Consolidation post on EMR and EHR. This might be another example of the EHR Physician Revolt. I wonder how many other doctors will go “against the grain” like Dr. Beauchamp.

As a physician who is going “against the grain” (ie “hospital owned” to private practice” rather than in the opposite direction) I have the following model of action to become part of a patient centered rather than exploitative ACO:

1) Establish my rural practice in my house at a very low cost, including asking some of my patients who volunteered to help with construction.

2) Employ myself, a front desk person and a Medical Assistant with backups

3) Establish Telemedicine links to needed specialties (rheumatology, pulmonary, cardiology) AND use physician social networks (eg, Sermo, MedLink Neurology Forum) for informal networking

4) Use LabCorp as a reference lab with negotiated discounts on high yield labs for one of the practice’s centerpieces: preventing stokes, heart attacks, renal insufficiency, onset of diabetes and diabetes complications. Likewise have a systematic literature scan process using EMBASE rather than PubMed for enhancing the testing and intervention effectiveness of the practice’s goals

5) Embed in the practice’s patient education, instruction and self-care facilitation expertise in efficiently discussing and following up on patient-centered discussions

6) Embed in the practice’s counseling activities the ability to counsel patients about which Part-D plan to choose and which health insurance plan to purchase (minus Medicare)

7) Use a general internist centric and concept driven EMR as the practice’s EMR and optimize its functionality for delivering efficacious brief interventions

8) Participate in community groups (eg, Rotarians) and recruit community leaders interested in enhancing the value of care that is being delivered to the community

9) Intersect with the state’s evolving HIE and structure information collection so that disease classification information can be transmitted to an HIE capable of accepting that information. Constantly improve the practice’s ability to collect disease classification information and include that information within the practice’s concept driven EMR.

10) Code reponsively with the help of a viable clinical concept parser, emphasize patient communication, use evidence and experience to follow-up on disease classification information by using efficacious brief interventions and systematically track outcomes while emphasizing 24 x 7 continuity of outpatient internal medicine care.

February 11, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Telemedicine Panel at CES Hosted by HealthSpot

Written by:

I had the chance to attend a Telemedicine panel today at CES that was put together by HealthSpot (see my previous post about HealthSpot at CES). They put together a good panel that included:
Peter Tippett, MD, PHD – Vice President, Connected Healthcare Solutions, Verizon
John F. Jesser – Vice President, Health Care Management, WellPoint
William Wulf, M.D. — Central Ohio Primary Care
Leslie Kelly Hall — Healthwise

The panel was an interesting discussion, but I think the underlying discussion really centered around how screwed up many parts of healthcare are right now. This showed itself in two different ways. One was that telemedicine could possibly fix some of those screwed up parts of healthcare. Second, telemedicine is actually hard to execute because of some of the screwed up parts of healthcare. It’s kind of odd to look at it that way.

I tweeted a number of the comments that struck me and so I thought I’d share them here for those who weren’t following along on Twitter.


This was a fitting comment at a “consumer” electronics show.


I think there are still some wackos;-), but I think the message they send is clear.


This would be a monumental achievement if we can embrace HIPAA and make the technology happen. I think the key message is: HIPAA should not be used as an excuse.


Such a no brainer question with an easy answer. Why is it so hard to do?


Will telemedicine become the “standard of care” so that this becomes a big issue? I hope we don’t reach the point that this is the reason we implement telemedicine, but it might take something like it to get people off the proverbial couch.

January 9, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

2013 Health IT Predictions – 3-D Printing in Healthcare

Written by:

I never can resist clicking on a tweet that looks at the future landscape of healthcare IT. I love to see what other people are saying about it. Although, as is the case above, I usually find that people are pretty cautious in their predictions. The challenge is that a year is probably not a big enough time frame to really make bold predictions.

For example, the above article suggests the following as major healthcare IT trends: patient portals, mobile devices, and telemedicine. They are absolutely right. Does anyone doubt that all of these things won’t be major happenings in 2013? We know they will because they’ve already started happening today. Next year will just be an extension of this year.

On the other hand, I was intrigued by this tweet about 3-D Printing in healthcare:

If you don’t know about 3-D printing, then check it out on Wikipedia. It is an absolutely incredible technology that’s going to absolutely revolutionize manufacturing products as we know it. That includes many of the products we use in healthcare. Is it going to happen next year? I don’t think so. Certainly much progress will be made in 2013, but 5 years from now 3D printing is going to be able to do insane things when it comes to creating your own products with a simple 3D printer.

I’d love to hear your thoughts. What drastic things do you think will happen in healthcare 5 years from now? Feel free to look even farther out if you prefer.

January 6, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Skype HIPAA Risks Not Given Enough Attention

Written by:

At this point, I don’t imagine too many providers use Skype to communicate with patients, if for no other reason than I haven’t heard my wired physician friends mention it.

But even if the numbers are small, it seems we may not have been paying enough attention to services like Skype, whose security may be good enough for personal conversation, but not for patient communication.

A recent item on a legal blog offers a reminder that Skype — and other Web-based communications platforms — pose security risks that may compromise a provider’s ability to comply with HIPAA.

Why should providers be concerned about using Skype and its kin to conduct free videoconferences with patients?  Well, a quick look at the security requirements HIPAA imposes, as cited by Epstein Becker Green attorney Rene Quashie, offers an idea:

  • Access controls.
  • Audit controls.
  • Person or entity authentication.
  • Transmission security.
  • Business Associate access controls.
  • Risk analysis.
  • Workstation security.
  • Device and media controls.
  • Security management processes.
  • Breach notification.

I have no in-depth knowledge of the Skype infrastructure, but my guess is that it fails most of the tests above.  And given that it’s a proprietary platform, it’s not as though hospitals or medical practices can build these controls onto Skype with any ease.

However, Mr. Quashie does offer a series of procedures to help mitigate the risks associates with Skype and its relatives:

  • Request audit, breach notification, and other information from web vendors.
  • Have patients sign HIPAA authorization and separate informed consent as part of intake procedures when using web-based platforms.
  • Develop specific procedures regarding the use of Skype and similar platforms (interrupted transmissions, backups, etc.).
  • Train workforce regarding the privacy and security risks associated with these platforms.
  • Exclude the use of these platforms for vulnerable populations (i.e., severely mentally ill, minors, those with protected conditions such as HIV).
  • Limit to certain clinical uses (i.e., only intake or follow up).

All of that being said, this clearly suggests the need for HIPAA-compliant videoconferencing services via the Web. And while they may exist, I’m certainly not aware of any market leaders. Your turn, readers?  Do you agree that there’s a need for such services?  Do any exist already that have traction in the arena?

December 5, 2012 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.

Broadband Mobile Should Change mHealth Game

Written by:

You never know what you’re going to learn when you wander into a cell phone store,  other than being hit with some fairly slick marketing slicks and rapid-fire pitched on that sweet, sweet iPhone upgrade. (Sorry, letting my Apple lust get in the way here.)

In all seriousness, this time I learned something which excited the heck out of me. While this is probably old news to some readers, I was surprised to learn that the cellphone industry is now rolling out support for new mobile protocols allowing for dramatic improvements in broadband mobile speeds.

One standard, LTE, can offer peak downlink rates of 300 Mbps and peak uplinks of 75 Mbps.  LTE, which takes advantage of new digital signal processing techniques developed roughly 10 years ago, is being rolled out by more or less every major U.S. carrier. Existing 4G networks are should shoot up in capacity as well. The next revision of the family to which 4G belongs, standards-wise,  should have a throughput capacity of 627 Mbps.

So let’s bring this around to our ongoing EMR discussions.  What are the HIT implications of these mobile nodes having the throughput to process live streaming video, download multiple imaging studies, conference effortlessly with parties across the world and more?

Well, for one thing, it’s pretty clear that our idea of mHealth will have to change. It makes no sense to plan networks around data sipping apps like the current iPhone crop when you’ll soon have iPads, Android devices and even Microsoft’s Surface tablet drinking it in gulps.

Obviously, the whole notion of telemedicine will evolve dramatically, with roving doctors and nurses consulting effortlessly over mobile video.  Skype calls will be as easy to conduct as traditional calls. And reviewing charts from the road will make much more sense, including looks at, say, CT scan results.

But all of this wonderfulness will be severely constrained if EMR makers keep forcing clinicians to use their systems via mobile-hostile devices. This is the time — this month, week and even day — to admit that desktop computers aren’t the platform of choice for smart clinicians.Vendors will have to step up with native clients for remote devices, and moreover, clients that take advantage of the emerging high-speed phones and tablets. If they hang back, the whole mobile high-speed revolution won’t be happpening.

June 22, 2012 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.