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congress interoperability

Interoperability – Docs send Congress meaningful SOS

HealthCare IT News, Interoperability in Healthcare, November 6, 2015

The rallying cry about interoperability to do something about the meaningful use program is getting louder and more insistent.

Earlier this week, the American Medical Association and 111 medical societies sent please to Congress urging a reprieve – or at the very least, a “refocus” of Stage 3 of the program, they write.

“We are writing to express our strong concerns with the decision by the Administration to move ahead with implementation of Stage 3 of the Meaningful Use program despite the widespread failure of Stage 2,” they state in their Nov. 2 letter to Majority Leader Mitch McConnell and Minority Leader Harry Reid.

Interoperability should be front and center now, they say.

“We believe that the success of the program hinges on a laser-like focus on promoting interoperability and allowing innovation to flourish as vendors respond to the demands of physicians and hospitals rather than the current system where vendors must meet the ill-informed check-the-box requirements of the current program,” leaders of the medical organizations write.

They claim the Administration has not responded to this need and instead has chosen to perpetuate the current failed program through the release of Stage 3 Meaningful Use.

“It is unrealistic to expect that doing the same thing over and over again will result in a different outcome,” they write. “We believe, therefore, that it is time for Congress to act to refocus the Meaningful Use program on the goal of achieving a truly interoperable system of electronic health records that will support, rather than hinder, the delivery of high quality care.”

In their letter to House Majority Leader Paul Ryan and Minority Leader Nancy Pelosi, they write: “Congressional action to refocus this program is urgently needed before physicians, frustrated by the near impossibility of compliance with meaningless and ill-informed bureaucratic requirements, abandon the program.”

In a move that surprised many healthcare providers – both in hospitals and in physician practices – CMS released the final rules for both Stage 2 and Stage 3 in one fell swoop October 6.

In the months leading up to the reveal of the final rules, many stakeholders continued to hope for a delay of Stage 3 requirements.

By the time 600 or so CIOs met for CHIME’s Annual Fall Forum in Orlando in mid October, the rules were out – and CIOs Pamela McNutt and Liz Johnson were prepared to analyze and advise.

They were specific about their Stage 3 concerns:

  • Requires 365-day reporting
  • Increased thresholds on troublesome measures
    – Patient Engagement Threshold – 10%, includes use of APIs
    – Requires inclusion of patient-generated data or from non-clinical settings
    – Transitions of Care Threshold increased
    – Establishes six public health reporting measures, requires bi-directional exchange with immunization registries
  • Actions to meet measures must be electronic – paper-based methods will not suffice (e.g. summary of care and patient education)
  • 2015 Edition of CEHRT required for Stage 3 reporting
  • Vendor and Provider readiness
  • CQM’s can be reported by attestation through 2017, electronic submission required starting in 2018

There still remains an opportunity to comment on the rules through December 15.

“It is your right and duty to comment,” Johnson told a packed room one of CHIME forum’s sunrise sessions in Orlando.

*American Medical Association (AMA)
Centers for Medicare & Medicaid Services (CMS)
College of Healthcare Information Management Executives (CHIME)

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smatphone hipaa

HIPAA privacy and Mobile app. Check with OCR

HealthNews – ‘Building HIPAA privacy and security protections into technology products enhances their value’

Many mobile health developers — and rightfully so! — are curious about just what features and protections their devices need to have in order to comply with HIPAA privacy rules.

The U.S. Department of Health & Human Services’ Office for Civil Rights launched a website this week where mobile developers can get up to speed with the critical security issues at stake.

“We are experiencing an explosion of technology using data about the health of individuals in innovative ways to improve health outcomes,” write OCR officials. “Building privacy and security protections into technology products enhances their value by providing some assurance to users that the information is safe and secure and will be used and disclosed only as approved or expected.”

Even though state and federal laws – such as the HIPAA Privacy, Security and Breach Notification Rules – have specific prescriptions for IT privacy protections, many developers remain in the dark about just how those regulations are germane to their technology, according to OCR.

Anyone is welcome to browse the site: “Users who want to submit questions, offer comments on other submissions or vote on how relevant the topic is will sign in using their email address, but their identities and addresses will be anonymous to OCR,” officials write. “OCR will consider the input provided on this site in developing our guidance and technical assistance efforts.”

The aim is a two-way flow of information, also helping OCR get a better handle on what HIPAA guidance is most helpful: “What current provisions leave you scratching your heads? How should this guidance look in order to make it more understandable, more accessible? Stakeholders can also use this page to submit questions about HIPAA, present a use case, or see what their peers are discussing. Users can comment on the discussions and vote on which topics or use cases would be the most helpful or important.”

Posting or commenting on the site “will not subject anyone to enforcement action,” officials are careful to note.

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Office 2016 – 3 data privacy features

Microsoft Office 2016 and Windows 10 coming on the heels. The new productivity and collaboration suite brings security features specifically for healthcare entities

Those were mostly lost amid most of the trade press and mainstream media coverage, which largely focused on the new collaboration functionalities. That makes sense given the new Office’s overarching themes as collaboration, productivity, and security.

While there are collaboration and productivity enhancements for health entities, healthcare CIOs and CISOs might be most interested in the privacy features.

Here are three of those:

1. PHI recognition: Outlook can now recognize protected health information in an attachment and warn the user before sending to avoid the common mishap of PHI landing in the inbox of someone who should not receive it. And different permissions can be set to stop some users from even sending PHI at all.

2. Smart Attachments: This feature gives users the option of sending a link in lieu of heavy documents that consume a lot of memory. The reason that matters: When clinicians send a link via OneDrive for Business, the security mechanism authenticates the user and Exchange can track whether a recipient even clicked on that link – which could help account for what happens should data be sent to unintended recipients.

3. Encryption, single sign-on and authentication: This is kind of a threefer, admittedly. They are connected enough to group together. In addition to Office, Microsoft injected encryption into Office 365 services, so now both documents and emails are encrypted, while Windows Hello serves as a single sign-on capability and Windows Passport is now being used by third-party apps, such as Allscripts EMR, for facial recognition.

Office 2016 comes on the heels of Windows 10, which also brought new features specifically for healthcare.

Those include the ability to “snap together” different applications so clinicians can view an EMR alongside, say, a home health app, business intelligence tools for visualizing care data, mapping techniques for population health, as well as care management and information sharing functions

Windows 10, Office 2016 and the forthcoming Windows 10 Mobile are the foundation of the company’s “One Windows” strategy — to enable healthcare organizations to sync apps and data across smartphones, PCs, tablets and a wide range of medical and IoT devices.

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Forbes – A Startup Poised To Disrupt In-Home Senior Care

The stark reality is that we will all grow old at some point.

The years have a way of catching up with us–and when they do, we generally have one common wish: to live out our years in our existing homes in a safe and comfortable manner.

But finding a qualified caregiver for our loved ones, if we are unable to care for them, may be the most difficult part of realizing that wish.

The statistics are daunting when it comes to home care for older persons. There are some 55 million adults taking care of their parents, with over 2 million caregivers.

And close to 92% of adults when surveyed would rather live in their own home as opposed to a nursing home. The fact is that in a large percentage of cases, family members have difficulty caring for a senior relative, so searching for a caregiver is a necessity.

While there are tens of thousands of agencies across the country that can match you with a caregiver, there is no customization of the process, and you have no way of seeing what’s going on when you are not home.

Programming since the age of 12, the computer engineer-turned-entrepreneur migrated to Silicon Valley working at Yahoo YHOO +0.00%, then transitioned to Bain Ventures.

After he and his family struggled to find a caregiver for his 93-year old grandfather who was previously living independently, Bruno decided to quit his job at Bain Ventures to start a company that would make it easier for families to locate and hire qualified caregivers.

“If you asked me four years ago what I would be doing now, there was no way I would have guessed that I would be working in aging—but these things all happen through personal experience,” said Bruno.

Bruno did some research, and after contacting and volunteering at several dozen homecare agencies, he realized what a huge need — and opportunity — exists in the $80 billion in-home senior care market, which today has a poorly organized workforce and a customer base often with chronic medical illnesses who may not receive the best possible care.

Bruno’s personal journey to find the best possible care for his grandfather uncovered myriad issues ranging from lack of coordinated training for caregivers to a feeling of emotional detachment that emanated in the quality and approach to geriatric care, he explained.

Without the proper tools for the families, and without the support from the caregivers themselves, there had to be another answer to providing high quality home care for seniors.

Bruno kept asking himself why the homecare industry was in such disarray, and by volunteering at several agencies, he became convinced that there was a more efficient way to improve delivery by using technology to power the change.

“We have focused on building a technology platform that supports caregivers and empowers them to do the best job possible, at the same time creating transparency for families so they can see what’s happening real-time in the home,” explains Bruno. “It also creates a very reliable service which demonstrates that we will do the work that requires older adults to be happy.”

Bruno’s core philosophy and company’s mission is simple: “Every older adult deserves a beautiful day.”

So, Bruno assembled a team of other like-minded 20-somethings, including Harry Heymann, who designed the architecture and wrote the backend code for Four Square, considered a pioneer of consumer mobile applications.

Hometeam, launched in 2013, is based in New York City, but also has clients in New Jersey and Philadelphia. The company plans to expand into nine more states within the next year. The company raised $11 million last year from Lux Capital, IA Ventures and Recruit Strategic Partners.

The company has already sent more than 250 caregivers into hundreds of homes throughout New York, New Jersey, and Pennsylvania.

The caregivers are made to feel part of a team, and are given employee status with health insurance and workers comp benefits, as opposed to being independent contractors or considered part-time workers. They are also compensated 30-50% more than a typical caregiver hired by a standard agency in current markets. While typical wages for a standard caregiver hover around $9-$10 per hour, Hometeam’s wages are closer to $15 per hour. Clients are charged from $20-$27 per hour.

The company’s mission is to transform the in-home care and aging experience by providing elderly clients with personalized care planning, expert caregiver matching, custom mobile technology, and proactive case management to improve older adults’ health and well-being while giving their families peace of mind.

Using technology to improve in-home care has other competitors currently in the marketplace. Among the notables, Honor, founded by Seth Sternberg, formerly of Google GOOGL -0.77%, launched earlier this year in the San Francisco Bay Area, and had raised 20 million by April of 2015. Touting itself as a technological solution to in-home care, its impressive line-up of supporters include Marc Andreessen, as well as Jeremy Stoppleman, CEO of Yelp. Its caregivers are not employees, but independent contractors.

CareZapp, a UK start-up in 2014, prides itself on its technological wizardry leading to more holistic care, allowing patients to communicate with other patients as well as doctors and family members. The app can also interface with other smart in-home technologies including motion sensors that can track movements and alert family members when there are aberrations.


The Hometeam Solution

Hometeam sets itself apart from its competitors by developing its own software that intelligently matches families with experienced caregivers, connects families to their loved ones through the use of mobile technology in the home, and helps caregivers plan days that improve the quality of life of older adults.

Hometeam also distinguishes itself is by having its caregivers identify activities which every patient prefers–something that can be challenging when a person has physical limitations which impair movement and mobility.
Hometeam iPad mood-3

The core foundation of technology for Hometown begins with an iPad for each home that is used by the caregiver to send texts, pictures, and update family members about any changes in medical conditions.

“I want older adults to live more comfortably and happily in their own homes,” said Bruno. “I want to imagine what a perfect day looks like for each of our clients and make it come alive with a combination of great mobile technology and the best caregiving team possible.”

The broader picture, however, may become the integration of technology-enabled apps that also can monitor key parameters of health such as blood pressure, heart rate, medication compliance, and ideally dispatch and communicate with a medical provider when there are aberrations in patterns of vital signs.

“America will face a tremendous challenge in caring for our senior citizens,” said Rich Able, Founder of X2 Biosystems and Partner, Stratos Group Seattle. ”It will be imperative to implement ‘The Connected Senior Citizen’.”

Family members, clinicians, and assisted care providers will need a new generation of technology platforms to help them stay informed, coordinated, and most importantly, connected,” added Able.

“Aging in place and staying in one’s own home environment is highly desirable to most senior citizens,” emphasizes Able, so in order to accomplish this goal, equipping the home with the most useful technology will become critical in the next few decades.

“Startups in the ‘Connected Senior’ vertical must develop meaningful biometric wearables that provide familty members, caregivers, and clinicians the information necessary to attenuate the need for costly emergency care, hospital stays, and multiple physician visits,” he added.

Bruno explains that his company is actively seeking partners to accomplish these higher level functions to advance the concept of such a “connected senior home.”

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icon form health care hospital

Patient Home Care Monitoring Will Revolutionize the Health sector in 2016

Real-time health care monitoring including the patient’s home continues to gain importance as pressures come from a variety of sources to reduce risks and costs of readmissions and hospitalizations.

The Centers for the Medicare and Medicaid Services (CMS), enforcing the 2012 Medicare Readmission Reduction Program, the States and managed organizations have to deal with tighter budgets, rising costs of service, and stricter capitation rates.

Until recently, homecare reporting was archaic at best. The home was a “black box” where no information was generated when a home aide entered the residence and closed the door. Well-intentioned aides and nurses visited a patient’s home, administered and documented their visit in piles of paperwork that were often not reviewed or actionable.

Data input was first “modernized” to record home aide hours and minimal data about care by telephone. Such systems are used primarily for time and attendance. Aides visit the patient’s homes and use the patient’s home phone to document that their work shift has started. When the shift ends (and only when the shift is over), the home aide dials the phone to report the end of their shift, and with all the limitations inherent in pressing numbers on a dial pad, report that they had administered a few elements of care. Since they cannot see the output of what they entered, such data entry is error prone and of limited value.

To move home health care forward and to reduce costs requires a new approach. Forward thinking home aide agencies, health care providers, managed care organizations and hospitals are looking for innovative solutions that leverage the proliferation of tablets, smartphones and the ubiquitous Cloud to improve care at home, where patients spend most of their lives and where so many significant health events occur.

Thanks to technology, the “black box” of healthcare monitoring can be transformed into a sea of data where home health aides can gather 500-1,000 data points per month. The real-time collection and utilization of data from the home will offer these ten key benefits for specific patient populations, their families and every member of the patient’s care team in 2016.

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Reality check-up for health care in Canada

Reality check-up for health care in Canada

Canada’s health care system has had an unhealthy cough for years and it’s not getting better on its own.

According to the Fraser Institute the median wait time for treatment after seeing a doctor is now 18.2 weeks. So, on Jan. 1, your doctor tells you that discomfort on your backside might be a disorder that causes you to grow a tail. He refers you to a specialist who confirms the diagnosis. Alarming news for sure.

You could try to manage your condition but you’ve noticed that your golden retriever is forever coming home with twigs and brambles in his tail, which would be embarrassing in an office setting. So, you opt for the surgery. Then your specialist delivers the bombshell. You can’t get in until May.

You briefly consider going to a veterinarian before accepting that you have to live with the pain and embarrassment. You will need to get your pants altered.

Now, please understand that the situation I have described is not based on an actual case. I use it only to illustrate the seriousness of the situation in Canada. In 1993 the same process would have taken 9.3 weeks, or about half as long as it does today. Doctors tells us the median time between seeing a specialist and getting treatment is three weeks longer than is “clinically reasonable.” This is health care in Canada.

Note too that spending on health care is rising. Depending on the province it may now consume as much as half of all provincial spending. The polls tell us that timely access to health care is always the public’s first or second priority. And yet after 20 years, many great speeches and campaign promises and trillions of dollars in government spending, the time it takes to access treatment has essentially doubled.

Let’s get specific and look at one medical condition and one province. Consider lung cancer treatment in Alberta.

On Dec. 15, 2011, Alberta Health Services announced “the Expedited Management of Lung Cancer Program aims to ensure that, by March 2013, 75% of patients will wait no longer than 30 days from the time of referral from their primary care physician to when a treatment decision is made, and 60 days from the time of referral from their primary care physician to surgery.” They proclaimed it a “top priority” and allocated $15 million to make it happen.

But on March 27, 2014, the Canadian Institute for Health Information announced that the average wait time in Alberta between a specialist booking a date and the actual surgery was 85 days vs. 49 days, the national average. An epic fail.

I am not picking on Alberta. If the average wait times in Canada have doubled over the last 20 years then Alberta is clearly not alone. Canada’s health care system does not provide timely care and it’s not financially sustainable. Baby boomers are retiring in huge numbers. We are losing them as big taxpayers and gaining them as big patients.

There are a range of possible solutions. We shouldn’t shrink from discussing them just because they challenge old beliefs, many of which are crumbling under the weight of reality.

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October 10, 2015 / Posted by / Reality check-up for health care in Canada