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Health Information Technology [EMR] Update

2014 to 2017

 

 

 

 

 

 

By D. Kellus Pruitt DDS

Three years ago

“When Patients Fear EHR – When patients believe paper medical records are safer and more private than electronic ones, their health can suffer. Many members of the public mistakenly believe electronic health records (ehrs) are less secure than paper files. Magnified by misinformation and political distortion of facts, an unnecessary fear has taken root in the minds of many consumers — often with serious consequences.” 

-Mansur Hasib

Cybersecurity Professional – Author and Speaker in commentary for informationweek, July 28, 2014

Http://www.informationweek.com/healthcare/electronic-health-records/when-patients-fear-ehr/a/d-id/1297519

This week 

“Doctors claim medical records system puts patient safety at risk – PROBLEMS with Queensland Health’s electronic medical record system are angering health workers, with fed-up senior doctors circulating a document slamming the technology and those in charge of it.”

-Kara Vickery and Janelle Miles – The Courier-Mail, July 25, 2017.

Http://www.couriermail.com.au/news/queensland/doctors-claim-medical-records-system-puts-patient-safety-at-risk/news-story/dc18cb388552eb4d179629c298a28408

“300,000 records breached in ransomware attack on Pennsylvania health system – The breach on Women’s Health Care Group of Pennsylvania was discovered in May, but hackers had unauthorized access to the system as early as January.”

-Jessica Davis – Health Care IT News, July 26, 2017

Http://www.healthcareitnews.com/news/300000-records-breached-ransomware-attack-pennsylvania-health-system

“HIPAA Data Breaches, Cyber Attacks Reported by 47% of Orgs – KPMG found that there was a 10 percentage point increase in reported HIPAA data breaches or cyber attacks from 2015 to 2017.”

-Elizabeth Snell – Health IT Security, July 27, 2017

Https://healthitsecurity.com/news/hipaa-data-breaches-cyber-attacks-reported-by-47-of-orgs

“Doctors frustrated that electronic records steal time from patients – Dr. Rebekah Gardner has to make a choice each time she sees a patient in her Rhode Island office: she can scroll computer screens and click boxes, or she can focus on the patient and take home the computer work.”

-Ronnie Cohen – Reuters, July 28, 2017

Http://www.reuters.com/article/us-health-records-electronics-iduskbn1ad2gt

“Plastic Surgery Associates data breach: Patients’ records, payment card details possibly compromised – The company said it discovered that some of its systems were infected with ransomware in February.”

-Hyacinth Mascarenhas – International Business Times, July 29, 2017

Http://www.ibtimes.co.uk/plastic-surgery-associates-data-breach-patients-records-payment-card-details-possibly-compromised-1632555

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***

The Top Medical Specialties with the Biggest Potential in the Future

The Medical Futurist

[By Bertalan Meskó, MD PhD]

Some say technology will replace 80% of doctors in the future. I disagree.

Instead, technology will finally allow doctors to focus on what makes them good physicians: treating patients and innovating, while automation does the repetitive part of the work.

While every specialty will benefit from digital health, some will especially thrive due to these innovations.

Here, I enlisted the medical fields with the biggest potential for development in the future. Read more.

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Generational Attitudes Toward HIT

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By http://www.MCOL.com

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MORE: foreword-mata-2

MORE: Glossary IT Terms

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The State of Health Information Technology

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In Six Visuals

By Venture Scanner

The-State-of-Health-Technology

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http://www.HealthDictionarySeries.org

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Top Five Technology Enabled Features for Health Plans

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Sought by Consumers

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Top 40 Medical Technology Trends

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Changing Technology Trends

Bertalan Meskó, MD, PhD

By Bertalan Meskó MD PhD

How The Top 40 Medical Technology Trends Changed In 3 Years

Free Guide And Infographic http://bit.ly/1XxSA3g

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26a6e234-8f5a-4a9b-87fc-5ce6168c0d30-original

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The Economic Impact of UnHealthy Bio-Metrics

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For 20102 – 2014

http://www.MCOL.com

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[HEALTH INSURANCE, MANAGED CARE, ECONOMICS, FINANCE AND HEALTH INFORMATION TECHNOLOGY COMPANION DICTIONARY SET]

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[Mike Stahl PhD MBA] *** [Foreword Dr.Mata MD CIS] *** [Dr. Getzen PhD]

***

How Do Medical Students See Future Technologies?

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Disruptive Technologies in Medicine

[By Dr. Bertalan Meskó]

Bert Mesko

Recently, I gave a talk to medical students about what kind of trends and technologies might shape the future and I was very curious what they think about these.

The Question

I asked them to give a score between 1 and 3 about how beneficial or advantageous those can be for society; and a score between 1 and 3 about how big threats they will pose to us.

They also gave a score between 1 and 10 about how much they look forward to using a technology in action. See the full size infographics here.

The Answer

So, I just wrote about how our Disruptive Technologies in Medicine university course prepares medical students for the coming waves of change. I also recently published an infographic related to new technologies in medicine.

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ScreenShot2

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Assessment

Preparing them for the future is a real challenge but I remain confident that we need to to that and it is still possible.

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future

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FUTURISTIC MEDICAL INTERFACE

Interactive Touch Screen Application
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This interactive touch screen presentation is an outstanding example for the importance of nice interfaces. With them you are able to show information in a whole new way and exploring data is an adventure every time!We created a vertical interactive touch screen presentation that was controlled by a mobile device. We only focused on the futuristic design and the beautiful interfaces . Our aim – the future is here and now!

Our touch screen presentations bring the future directly to your exhibition stand, shop, museum, hospital or even your tv show or movie! No prerendered elements!

It’s realtime!

LINK: https://www.behance.net/gallery/14374555/FUTURISTIC-MEDICAL-INTERFACE

***

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Health Data Breaches Multiplying

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YET – Fines Remain Rare

By Charles Ornstein @charlesornstein

[ProPublica]

Federal health watchdogs say they are cracking down on organizations that don’t protect the privacy and security of patient records, but data suggests otherwise.

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Fines Remain Rare Even As Health Data Breaches Multiply

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data

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Why Your Medical Internet Marketing Campaign Isn’t as Effective as It Used to Be

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On the Crucial Online Presence

[By John Deutsch]

John DeutschA strong online presence is crucial to running a successful business, and healthcare is no exception.

However with constant change, especially in the past two years, many businesses are experiencing underperforming campaigns and struggling to figure out where to spend their marketing dollars. Should you invest heavily in pay-per-click (PPC) advertising, focus your efforts on search engine optimization (SEO) or hit the ground running with social media?

The answer is that you should never focus solely on one marketing channel, as it could take months or even years to recover when changes in the marketing industry occur – and they inevitably will occur. Another reason to diversify your efforts is that the success of some channels depends on the success of others – for example, social media influences your search rankings and display advertising heavily influences your brand recognition.

As a healthcare marketing company with over ten years of experience in internet marketing, we have seen the industry get flipped upside down more than once and have seen it affect organizations that have weak marketing campaigns with little to no diversification. A good mix of tactics is the best way to reach your target audience while allowing you to adapt quickly in the face of changes.

 cell

Three Elements Crucial to Any Marketing Campaign

Search marketing, direct marketing and social media are three components that healthcare organizations should incorporate for a healthy marketing campaign. Here’s what you need to know about these marketing elements, including the changes each channel has gone through in the last few years and what we could expect to see in the future.

  1. Search Marketing

Search marketing typically refers to PPC and SEO, the paid and unpaid efforts used to increase online visibility in search engine results. Early marketers were able to easily leverage SEO to gain top search engine rankings and also invest minimally in PPC for quick leads, but the search marketing landscape has changed significantly in the last three to four years, altering the online marketing game.

We might say it all started when Google modified its PageRank algorithm in 2011 and then again in 2012 (the update often referred to as “the death of SEO”), causing many organizations’ rankings to plummet. Marketers were forced to rethink their organic SEO efforts to stay in Google’s good graces. Instead of relying heavily on getting backlinks (even from low-quality websites) and stuffing content with keywords, the focus switched to creating quality content in order to get real clicks and page views.

Meanwhile, companies like Google started trying harder than ever to monetize their services. The highly saturated market contributed to driving advertising costs up – and beyond that, the actual efficacy of online ads went down. In some of our own campaigns, we have seen over 30% inflation in ad prices per year and a loss of efficacy (decreased traffic and leads) despite increasing ad spend to match inflation – and this isn’t just a result of market saturation. It also has to do with the fact that consumers are less and less receptive to online advertising due to the over publicizing of ads.

As a result of this, organizations have to constantly innovate so that their ads are seen among all the online advertising noise. This, in addition to rising ad prices means that a return on investment can be difficult to realize. Working with a true PPC expert who knows your industry well is the only way to make your budget go a long way.

The bottom line: SEO and PPC are still the number one ways to draw leads online, but they have both seen significant change in the past years and are likely to keep changing, so your marketing strategy should not depend on either channel alone.

  1. Direct Marketing

With SEO having lost some importance and PPC advertising requiring a skill set that many health organizations lack, we are seeing trends shifting towards a more direct form of marketing. This is evident by the number of lead generation companies that have cropped up in the last few years, such as Healthgrades and Vitals, which allow providers to attract more patients and referrals, often for a nominal fee. Similarly, in the medical software industry, SoftwareAdvice dominates the SEO/PPC channels.

Organizations are also increasingly employing alternative marketing channels like email newsletters and direct email marketing to reach out to clients and potential opportunities. This starts with a simply crafted email addressing a very specific issue to a specific audience. It is an extremely effective and budget-friendly tactic to diversify a marketing strategy.

  1. Social Media

Just like other marketing channels, social media is constantly evolving and also increasing in price. This is due, in large part, to major social media companies becoming publicly traded companies in recent years (i.e. Facebook in 2012 and Twitter in 2013), but also to market saturation.

According to a LinkedIn study, 81 percent of small- and medium-sized businesses are using social media and, of those, 94 percent do so for marketing purposes. While networks like Facebook and Twitter remain free to use, they have started trying to capitalize on their popularity by pushing paid advertisement, often to the point of risking the integrity of their sites.

Whereas prior to companies like Facebook and Twitter having gone public, a well-crafted social media post (text, video or image) could go “viral” naturally, we are now seeing this happen less and less, often requiring an initial advertising spend to get the ball rolling. Facebook is a good example of this. In December 2013, Facebook changed the algorithm that determines what stories and updates users see in their News Feeds. This resulted in business pages losing viewership of their posts, as Facebook decided that brands would have to “pay to play.”

Stethoscope on a laptop keyboard

Assessment

While we don’t recommend social media being the focal point of any healthcare organization’s marketing campaign, much less the only element, it is an integral component – and definitely one you should stay on top of if you want to remain competitive. Social media is also a major factor in Google’s algorithm for organic search engine rankings, so there is some added value to having a strong social media presence.

More:

About the Author

John is the President and CEO of Medical Web Experts, developer of Bridge Patient Portal, the leading 2014 ONC certified solution for patient engagement and improved practice profitability. A vital component in the exponential growth of numerous healthcare IT and Internet companies over the last ten years, John has benefited immensely from a unique mix of professional experiences, boasting a strong background in both marketing and technology.

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On Healthcare Provider’s Use of Technology

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Most Important Tool for Effective Communications in ACO

By http://www.MCOL.com

MD Technology

 

Assessment

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Common Daily Clinician Health Technologies

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Most Commonly Provided to Support Daily Activities

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Health Technology

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The Percentage of Office-Based Doctors with EHRs

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US 2001-2013

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EHR

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On Health Websites and “Apps”

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Not Just a Fad – Anymore

By Jennifer Tomasik, Carey Huntington and Fabian Poliak

http://www.CFAR.com

Jennifer Tomasik

Health Information Technology [HIT] may have arrived slowly into clinics and insurance companies, but the pace of innovation and adoption in consumer electronics today is astounding (and accelerating).

Devices are quickly penetrating every facet of our lives in the form of laptops, smartphones, tablets, and beyond. Thousands of health and wellness websites and software applications (“apps”) already exist, and we believe their role in healthcare will be increasingly a central one. Some are crucial elements of health organizations’ programming, such as the online platform that ShapeUp is built on: www.ShapeUp.com

Are they Effective?

Many are stand-alone tools without an organization or programming per se—i.e. apps for counting calories, monitoring glucose levels, or tracking sleep. But are websites and applications effective means of engaging individuals in their own health? And if so, what separates the good ones from the bad ones?

The Data

A 2009 meta-analysis of web-based smoking cessation programs found the pooled quit rate for participants to be 14.8% after follow-up conducted three months out, and 11.7% after six months out. [i] These figures are an improvement over the rate of people attempting to quit without any help or resources, as previously cited.

Internal Studies

From our own study of health websites and applications, we are beginning to see that high-quality digital resources share many of the same characteristics as great products and services do in the physical world. They create pull by engaging users via explicit reward structures. They enable teamwork and foster social accountability. Their content is interactive, informative, and often individualized. Their use is intuitive, convenient (e.g. accessible by web on a laptop or tablet and by smartphone “mobile apps”), and even effortless to the user (e.g. automatically collecting, synchronizing, and analyzing information).

Apps

Fragmentation

The fragmented world of websites and applications is not without its problems.

In today’s “app market,” the void that many websites and applications fill is not necessarily in the best interest of “health consumers,” and the quality of their products or services is often questionable. We see such issues as a reality of any market in its early stages.

Assessment

However, we are optimistic that greater consultation with medical professionals, greater investment and competition among health organizations, and improved regulation can help this new market mature into an indispensable virtual ecosystem of resources for health-seeking individuals.

More:

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors


[i] Myung SK, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. “Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials.” Arch Intern Med 2009;169(10):929-37.

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The Danger of Used Health Information Technology

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Remember to destroy that hard drive!

By D. Kellus Pruitt DDS

1-darrellpruittNEWS FLASH!

Affinity Health Plan to Pay $1.2 Million+ for HIPAA Violations -The HHS Office for Civil Rights on August 14 sent the industry a message on the importance of erasing protected health information on hardware being sold, recycled or returned,” by Joseph Goedert, HealthDataManagement.

http://www.healthdatamanagement.com/news/breach-notification-hipaa-privacy-security-affinity-46483-1.html

Talk about bad luck

A photocopier once leased by Affinity Health was purchased by CBS Evening News – which discovered that the copier’s hard drive contains 344,579 individuals’ unencrypted Protected Health Information.

The Response

In response to the federal investigation triggered by the CBS discovery, the Office of Civil Rights announced: “OCR’s investigation indicated that Affinity impermissibly disclosed the protected health information of these affected individuals when it returned multiple photocopiers to leasing agents without erasing the data contained on the copier hard drives.

Moreover ….

In addition, the investigation revealed that Affinity failed to incorporate the electronic protected information stored on photocopier hard drives in its analysis of risks and vulnerabilities as required by the Security Rule, and failed to implement policies and procedures when returning the photocopiers to its leasing agents.”

Assessment

Before disposing of used technology, remember to destroy the hard drive.

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Impact of Health Information Technology

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An HIT Infographic

[By HIMSS Clinical Informatics Community]

Practicing clinicians have indicated strong support for the ability of health IT to overcome communication challenges among care providers. Considering that a series of Institute of Medicine reports on errors in healthcare have led to widespread recognition that siloed practices and inadequate communication are primary contributors to medical errors, continued endorsement for health IT will lead to better communication and enhanced quality of care.

The results come from the 2013 iHIT study conducted by HIMSS and HIMSS Analytics, released during HIMSS13, the organization’s annual conference and exhibition. The study was designed to explore the role of health IT from an inter-professional communication perspective. More than 500 clinician respondents working in a care delivery setting provided information on the value of health IT in support of quality care.

Read the Full Study & Final Report

HIMSS 2013 iHIT Study – Final Report
HIMSS 2013 iHIT Study – Executive Summary

 HIT

Assessment

According to the study, the health IT tools in place at the provider organizations of respondents support various clinical processes and provide improved access to the information needed to prepare for delivery of care. This includes having improved access to information needed on patients transferring to a clinician’s unit/caseload, ultimately resulting in enhanced levels of patient care.

Conclusion

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The Rise of Digital Doctors?

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Physicians and the Use of Social Media

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Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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The Cost of Technology Over The Decades

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Plunging – Yet, Why Hasn’t Medical Care Followed Suit?

We are grateful to live in this century. For example, movies of the 1980′s have been more than intriguing over the course of the past few months, but times were obviously hard back then. Cell phones weren’t nearly as mobile as they are now, cassette players reigned supreme, and we could talk until blue in the face about hair. Walkman’s and cellular phones with their twenty inch antennas set the pace for this ease of access society we lived in; price tags and all.

Paying for this convenience was quite a task just a few decades ago, as a cell phone cost $4,000+, an Atari was the same price as a Wii, and an Apple 2 ran close to $3,000. We’re still keeping in mind that these products were quite the advancement in their day and age, but footing the bill was not something we’d be interested in today.

Source: http://pinterest.com/pin/304638252/

Assessment

So, why hasn’t the cost of healthcare come down over the same period?

Conclusion

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Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Doctor – Is Your Mac Vulnerable to Viruses?

Not Just a PC Problem Anymore!

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We all know that PCs are more vulnerable to viruses, worms, trojans, malware, adware and other electronic miscreants, than are Macs. And, that some medical professionals absolutely love their iPads and Macs.

But doctor, are you leaving your Mac vulnerable to unwanted intrusions?

 

Source: MacKeeper

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Update on Tablet Usage in the Health Care Industry

A Growing Trend?

By Cyndi Laurenti

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The rapidly evolving technological era has ushered a host of industries into the digital world, including the medical field. Health care professionals in private and public institutions and even masters and PhD programs are quickly learning the immense benefits of utilizing technology in their practices and this has specifically included the use of the tablet computer.

Convenience and Mobility

In addition to the convenience tablets offer in size and mobility, more and more production companies are creating interfaces and programs specifically geared towards the healthcare industry and the tablet computer makes them more accessible and dynamic than the traditional clipboard. This is crucial in an industry where time is of the essence and life-changing decisions are made from moment to moment. Having a tablet computer puts the latest resources and tools in doctors and other health care professionals’ hands so they can make decisions efficiently.

Brand Neutral?

Although Tablet computers tend to be associated with the most popular brands like the iPad by Apple, a recent survey of 178 doctors indicated that even though the healthcare industry wants a tablet, it may not necessarily want the iPad in particular which does not have all the applications they require.

A whole industry of tablets has been specifically designed to meet the medical field’s particular needs, one example being the motion computing tablet PC. The West Clinic in Memphis which was founded by Supportive Oncology Services (SOS) and which caters for over 10,000 patients found that the motion computing tablet computer enabled them not only to streamline information between patients and physicians, but that it also lead to an improved quality of care and life for their patients and increased efficiency for their caregivers.

Other Healthcare Early Adopters

Another facility that adapted the use of tablet computers is the Lancaster General Hospital in Lancaster, PA, which has been rated as one of the top 100 hospitals for its efficiency and quality of care. The doctors and nurses are currently using 170 tablet computers in 21 units for a variety of tasks. Jon White, M.D. called it a ‘productivity tool’ and it is utilized around the hospital for patient safety through an application that assigns drugs through a unique bar code which ensures the right patient is getting the right medication and dose. It is also used to access patient records from anywhere in the hospital, review patient orders or test results, and access a library of medical reference information.

A third facility that utilizes the tablet computer is St. Mary’s Medical Center, an acute care facility in Evanville, Indiana, that provides inpatient and outpatient care. The tablet computer has currently replaced their paper-based patient charts, and cut down nurses’ charting times significantly.

Assessment

There is little doubt that the tablet computer has and will continue to revolutionize the healthcare industry. Tremendous positive changes have been made like the streamlining of once time-consuming and arduous processes. This increased efficiency ultimately translates into quality care for patients and the continued advancement of the medical field.

Conclusion      

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Health Dictionary Series: http://www.springerpub.com/Search/marcinko

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

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Hospitals Slowly Affiliating with RBACs

The Rise of Role-Based Access Controls

By Dr. David Edward Marcinko MBA CMP

Last month I visited the University of Pennsylvania in Philadelphia. Of course, I graduated from Temple University myself and worked as an admissions clerk in the ER, back in the day.

There I learned that some local hospitals are affiliating in role-based access control (RBAC) electronic networks by controlling which patients, medical providers or health plans have access based on the needs of patients, payors, physicians, or insurers. User, doctor, and patient rights and services are then grouped by name, and access to medical resources is restricted to only those authorized.

The technology was first pioneered and used in London hospitals several years ago.

Example:

For example, when an RBAC network system is used by a hospital, each individual that is allowed access to the hospital’s network would have a pre-defined role (doctor, nurse, lab technician, administrator, patient, etc.).

If someone is defined as having the role of doctor, for example, then that user can access only resources of the healthcare network that the role of doctor has been allowed access to (electronic medical records, for example).

If another user has access as a diabetic patient, then that user cannot access unapproved health services, like OB-GYN. Each user is assigned one or more roles, and each role is assigned one or more privileges for users in that role.

Assessment

Link: http://www.computerweekly.com/Articles/2007/10/19/227566/How-to-implement-role-based-access-control.htm

Conclusion

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Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Is HI-TECH Dead?

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You Decide!

[By D. Kellus Pruitt DDS]

Yesterday, Don Fluckinger, Features Writer for SearchhealthIT, posted “Blumenthal: Building national health network could take decades”

“When Dr. David Blumenthal was national health IT coordinator, he focused on 2015, the HITECH Act’s original target date for meeting meaningful use criteria. Now that he’s back in civilian life, he’s taking a longer view of the initiative to create a national health network triggered by the HITECH Act’s cash incentives to physicians and hospitals using electronic health record (EHR) systems.”

http://searchhealthit.techtarget.com/news/2240035845/Blumenthal-Building-national-health-network-could-take-decades

Even though Fluckinger assures us that post-ONC, Blumenthal is still a “HITECH Act champion,” I’m not so sure. Perhaps in spirit only!

A Multi-Decade Project?

Last week, Dr. Blumenthal was the keynote speaker at the Massachusetts annual health IT conference. According to Fluckinger, he told the audience that building a secure, national, interoperable health information system “was always going to be a multi-year, maybe even multi-decade project.” That’s not what I remember. I remember being told that if I didn’t purchase a network-ready EHR for my dental practice by 2014, I wouldn’t be paid by insurance companies.

What Happened?

So, what happened to President Bush’s 2004 Executive Order of “interoperability (even with dentists) by 2014”? Is it too soon to say that he failed? So who is going to tell the thousands of HIT stakeholders who have been attracted by the smell of stimulus billions? Blumenthal?

Assessment 

I can only imagine that now that Dr. Blumenthal left his job as head of the ONC for a new job as a health policy professor at Harvard School of Public Health, the openness of life outside government makes him uncomfortable with the lame talking points he once pushed as part of his job, without cracking a smile.

Conclusion

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A Video Vision of Healthcare’s Future from Microsoft

By Staff Reporters

Medical Tourism and Health Information Technology in Malaysia

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According to Dan Dunlop, over at The Healthcare Marketer, the following video promotes Malaysia as a preferred healthcare destination. It positions the country as a one stop destination for all medical and tourism related needs, bringing together related service providers on a single platform. Malaysia would like to be seen as being on the leading edge of technology.

Malaysia Healthcare

In fact, here’s what the Malaysia Healthcare website had to say about the video:

“With state of the art hospitals being built in Malaysia; it’s just a matter of time before we experience seamless healthcare delivery. Malaysia Healthcare patients use a portable Personal Health Record (PHR) called the iPHER that carries all their PHI which includes, medications, lab tests, diagnosis, immunizations, alternative procedures, digital images, dental records, ophthalmic care (lens and contact prescriptions) and DNA any where in the world with no need to access the Internet to view the information. Malaysia Healthcare currently uses this PHR to reduce medical errors and create continuity of care for all their patients and to provide seamless healthcare delivery.”

Assessment

This is an incredible video that demonstrates how Microsoft sees the future of healthcare and shows one vision for how technology will potentially improve our way of life!

***

ME-P medical malpractice education

***

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Link: http://www.youtube.com/watch?v=6aKNK7OTHKs&feature=player_embedded#at=235

Conclusion

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Building a Modern Electronic Heath Data Warehouse

A Brief “How-to” Essay with Commentary

By Staff Reporters

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According to a Standish Group survey, more than 70% of Health Information Technology applications go over budget and time and medical data warehouse applications are no exception. However, if you adopt a process, an oriented development approach and implement a rigorous project management discipline, your increase the likelihood that your medical data warehouse will be effective.

Key Steps

This is a simplified list, but reveals some of the key steps needed to build a medical data warehouse.

  • Extracting data from the data sources – can be very challenging as data might reside on different systems and this forces you to prioritize what data you want and what role that plays in your patient relations management decision-making. This step involves moving data from the source (for example to your Web site) to a central location (e.g. your marketing data mart).
  • Transforming the data – a key activity after data extraction.  This is critical to have cleaner data and involves modification, enhancement or elimination of data based on the job instructions.
  • Loading the transformed data into a dimensional database.
  • Building reports for decision makers (e.g. this could be a report for your marketing management outlining the analysis of your latest patient acquisition campaign).

Assessment

The first 3 steps – Effective data extract, transform and load (ETL) processes represent the number one success factor for your medical data warehouse project and can absorb up to 70 percent of the time spent on a typical warehousing project.

Conclusion

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Content Exchange and Vocabulary Standards for eMRs

Understanding Terms and Definitions

By Shahid N. Shah MS

As per the HHS rules, vocabulary standards are standardized nomenclatures and e-code sets used to describe clinical problems and procedures, medications, and allergies for eMRs. Some commons terms and definitions are listed below:

Terms and Definitions

  • ASTM’s CCR – for most of your basic patient summary exchange needs the CCR will meet your needs. If you’re moving from low or no interoperability today to some interoperable capabilities then CCR is your best starting place.
  • International Classification of Diseases, 9th Revision, Clinical Modifications (ICD-9- CM) or SNOMED CT® should populate a problem list. If you’re not familiar with both standards and are unsure where to start, go with ICD-9 for problem lists. SNOMED is not commonly supported in the broad EMR industry but ICD-9 support is quite common so start there.
  • Health Level Seven (HL7) Clinical Document Architecture (CDA) Release 2 (R2) Level 2 CCD – for more advanced patient summary exchange needs the HL7 CDA is recommended. If you’re already supporting CCR exchange and it’s not meeting your needs then HL7 CDA is the next logical place to go.
  • For patient summary exchanges, HHS expect the following fields to be populated: problem list; medication list; medication allergy list; procedures; vital signs; units of measure; lab orders and results; and, where appropriate, discharge summary.
  • ICD-9-CM [ACD-10] or American Medical Association (AMA) Current Procedural Terminology (CPT®) Fourth Edition (CPT–4) to populate information related to procedures. Both of these standards are support broadly by most existing vendors so going with either or both is good.
  • For medication lists, HHS requires the use of codes from a drug vocabulary the National Library of Medicine has identified as an RxNorm drug data source provider with a complete data set integrated within RxNorm.
  • For lab results, HHS requires the use of LOINC® to populate information in a patient summary record related to lab orders and results when LOINC® codes have been received from a laboratory and are retained and subsequently available in your EMR. HHS states that in instances where LOINC® codes have not been received from a laboratory, the use of any local or proprietary code is permitted. HHS does not require these local or proprietary codes to be converted to LOINC® codes in order to populate a patient summary record.
  • For the purposes of electronic prescribing, your vendor must be capable of using NCPDP SCRIPT 8.1 or NCPDP SCRIPT 8.1 and 10.6. With respect to a vocabulary standard, your vendor must use codes from a drug vocabulary currently integrated into the NLM’s RxNorm. For the purposes of performing a drug formulary check, your vendor must be capable of using NCPDP Formulary & Benefits Standard 1.0 adopted by HHS (73 FR 18918).
  • There are standards required for insurance data like eligibility checking and submissions of claims. ASC X12N and NCPDP standards (Versions 4010/4010A and 5010 and Versions 5.1 and D.0, respectively) should be used for these transactions. It’s important to realize that Version 4010 is being phased out in favor of Version 5010 so your vendors need to support both at this time and must be able to move exclusively to Version 5010 in the future.
  • For the purposes of electronically submitting calculated quality measures required by CMS or by States, your vendor must be capable of using the CMS PQRI 2008 Registry XML Specification. Going forward, HL7 Quality Reporting Document Architecture (QRDA) Implementation Guide based on HL7 CDA Release 2 may be allowed but for now focus on the CMS PQRI requirements until HHS provides more guidance in the future.
  • For the purposes of submitting lab results to public health agencies, your vendor must be capable of using HL7 2.5.1.
  • For the purposes of electronically submitting information to public health agencies for surveillance and reporting, your vendor must be capable of using HL7 2.3.1 or HL7 2.5.1 as a content exchange standard. At this time HHS not required adverse event reporting nor have they adopted a specific vocabulary standard for submitting information to public health agencies for surveillance and reporting.
  • For the purposes of electronically submitting information to immunization registries your vendor must be capable of using HL7 2.3.1 or HL7 2.5.1 as a content exchange standard and the CDC maintained HL7 standard code set CVX -Vaccines Administered18 as the vocabulary standard.

Assessment

www.BusinessofMedicalPractice.com

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.  

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com and http://www.springerpub.com/Search/marcinko

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko 

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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Understanding HIT Security Risks – The Ugly Truth!

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On the Privacy and Security of Healthcare Records

Dr. Mata

[By Richard J. Mata, MD, CIS]

There is no privacy …  get over it.

Scott McNealy, Former Sun Microsystems CEO

Storing and transmitting health information in electronic form exposes it to risks that do not exist, or exist to a lesser extent, when the information is maintained in paper.  For example, although both paper-based and electronic systems need protection from fire, water, and wear and tear because of aging, electronic data is also vulnerable to hardware or software malfunctions that can make data inaccessible or become corrupt, and to non-secure policies that can make data vulnerable to illegal access.  In addition, cyber-crimes, and unauthorized intrusions originating both internally and externally, are increasing dramatically every year, costing companies millions of dollars.  Nonetheless, electronic medical records (EMRs) are usually considered more secure than paper patient charts because paper records lack an audit trail, papers are easily lost, and their contents can be illegible.

Take Care the Risks

Healthcare organizations must take the new risks seriously, however, because health information is a vital business asset, and protecting it preserves the value of this asset.  In addition, securing patients’ information protects their privacy and enhances the organization’s reputation for professionalism, patient well-being, and trustworthiness.  Hospitals, emerging healthcare organizations (EHOs), physicians, and healthcare entities long ago recognized the value of health information, and implemented security policies and procedures, but as they move more into the electronic arena, it is vital to revise and update policies and procedures to acknowledge the different risks inherent in the digital age.

Three Components of Security

The three classic components of information security are confidentiality, integrity, and availability.  Donn B. Parker, a pioneer in the field of computer information protection,[1] added possession, authenticity, and utility to the original three.  These six attributes of information that need to be protected by information security measures can be defined as follows:  

  • Confidentiality: The protection and ethics of guarding personal information — for example, being cognizant of verbal communication leaks beyond conversation with associated healthcare colleagues.
  • Possession: The ownership or control of information, as distinct from confidentiality — a database of protected health information (PHI) belongs to the patients.
  • Data integrity: The process of retaining the original intention of the definition of the data by an authorized user — this is achieved by preventing accidental or deliberate but unauthorized insertion, modification or destruction of data in a database.  Make frequent backups of data to compare with other versions for changes made.
  • Authenticity: The correct attribution of origin — such as the authorship of an e-mail message or the correct description of information such as a data field that is properly named.  Authenticity may require encryption.
  • Availability: The accessibility of a system resource in a timely manner — for example, the measurement of a system’s uptime.  Is the intranet available?
  • Utility: Usefulness; fitness for a particular use — for example, if data are encrypted and the decryption key is unavailable, the breach of security is in the lack of utility of the data (they are still confidential, possessed, integral, authentic and available).

Ethics

When these attributes are considered in the healthcare context, another factor comes into play: ethics.  According to Dr. J. A. Magnuson, professor of public health informatics at Oregon Health Science University’s Medical Informatics Program, privacy,[2] security, and ethics are inextricably intertwined, and all are critical to public health’s role as a trustee of the public’s data.  As public health becomes increasingly involved in Electronic Data Interchange (EDI;[3]), the information aspects of privacy, security, and ethics become ever more critical.  All doctors take an ethical oath to protect the patient, and the obligation to uphold this oath extends to health data management, even for employees who do not take an oath.

The fields of medicine and information technology (IT) each have separate and related ethical considerations.  Ethics may prohibit technology, for example, when using a specific application that would make a security breach likely.  However, ethics may also demand technology.  Suppose that a new surveillance application would improve public health — is it not ethically imperative to utilize it to save countless lives?  But suppose it also almost guarantees a security breach — what does the ethical position on use of the application become then?  That is an extreme example, though not completely unrealistic.

FISA

Varied Uses

Complicating the picture is the fact that IT in the healthcare arena has so many and varied uses.  For instance, office-, clinic-, and hospital-based medical enterprise resource planning (ERP) is based on the same back-end functions that a company requires, including manufacturing, logistics, distribution, inventory, shipping, invoicing, and accounting.  ERP software can also aid in the control of many business activities, like sales, delivery, billing, production, inventory management, quality management, and human resources management.  However, other applications particular to the medical setting include the following:

  • The EMR, which has the potential to replace medical charts in the future, is feasible.[4]
  • Healthcare application service providers (ASPs)[5] are available via Internet portals.
  • Custom software production may produce more solution-specific applications.
  • Medical speech recognition systems and implementation are replacing dictation systems.
  • Healthcare local area networks (LANs), wide area networks (WANs), voice-over Internet protocol (IP) networks, Web and ATM file servers are ubiquitous.
  • The use of barcodes to monitor pharmaceuticals is decreasing the chance of medication errors and warns providers of potential adverse reactions.
  • Telemedicine and real-time video conferencing are already a reality.
  • Biometrics will be used more often for data access.
  • Personal digital assistant (PDA) wireless connectivity, which relies on digital or broadband technology including satellites, and radio-wave communications are increasingly common.
  • The use of wireless technology in medical devices will be increasing.

No Healthcare Standardization

All of these applications offer advantages, but the security of these IT methods and devices is not yet fully standardized or familiar to health professionals; despite the CCHIT, Office of the National Coordinator for Health Information Technology, etc.  They all involve inherent security and privacy risks, and the prudent healthcare organization will want to ensure that these risks are identified and contained.  For instance, a single firewall or intrusion detection system (IDS) may not be enough.

The process must begin by conducting a security risk assessment — that is, doing a thorough assessment of current systems and data, and performing checks such as real-time intrusion testing, validation of data audit trails, firewall testing, and remediation when gaps or failed systems are exposed.  These activities are part of developing a healthcare security plan, including disaster recovery.

Privacy Officers

To ensure that the risk assessment is thorough, hospital network administrators and Privacy Officers should have a working knowledge of federal regulations and of the following security mechanisms:

  • vulnerability assessment;
  • security policy development;
  • risk management;
  • firewall assessment;
  • security application assessment;
  • network security assessment;
  • incident response and recovery assessment;
  • authentication and authorization systems;
  • security products;
  • firewall implementation;
  • public key infrastructure (PKI) design;
  • virtual private network (VPN) design and implementation
  • intrusion detection systems;
  • penetration testing;
  • security program implementation;
  • security policy assessment; and
  • security awareness training.

The federal government has recognized the importance of health information security by establishing regulatory guidance with its Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The International Standards Organization

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IT system managers in healthcare settings are also familiar with the comprehensive security model offered by the International Standards Organization (ISO).  For instance, using ISO’s 17799 Code of Practice for Information Security Management, versions 2000, 2005, or 2010 information security is achieved by implementing a suitable set of controls to govern policies, processes, procedures, organizational structures and software and hardware functions.  The Code requires the IT manager to establish, implement, monitor, review, and where necessary, improve these controls to ensure that the specific security and business objectives of a healthcare organization are met.

Assessment

The work of the National Institute of Science and Technology (NIST) in developing innovative technology for the healthcare sector is also of interest to IT system managers.  For instance, research on a computer note-writing system that captures clinical data automatically and a data repository system that captures patient data and integrates it with clinical decision support and knowledge bases are two of the initiatives that have originated with NIST.  In addition, the organization publishes numerous Special Publications that provide guidance on how to establish and maintain IT security.

CASE MODEL: HIT Security

Conclusion

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References:


[1]   Donn B. Parker developed the so-called Parkerian Hexad Principles, which discuss the attributes of information security.

[2]   Privacy generally refers to a ‘people’ context, a state of being free from unauthorized intrusion or invasion.  This concept is as applicable to medical records as it is to your own house.  Confidentiality is viewed more in the context of information, usually dealing with accessing and sharing information or data.

[3]   EDI involves electronic transmission methods, often utilizing networks or the Internet.[3]  The benefits of EDI include speed, data entry savings, and reduction of manual errors; the risks are legion.

[4]   Terms used in the field include electronic medical record (EMR), electronic patient record (EPR), electronic health record (EHR), computer-based patient record (CPR), etc.  These terms can be used interchangeably or generically, but some specific differences have been identified.  For example, an EPR has been defined as encapsulating a record of care provided by a single site, in contrast to an EHR, which provides a longitudinal record of a patient’s care carried out across different institutions and sectors.  However, such differentiations are not consistently observed.

[5]   An application service provider (ASP) is a business that provides computer-based services to customers over a network.

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The Pros and Cons of eMRs

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Delving Deeper into the Historic Origins of Debate

Dr. Mata

[By Richard J. Mata MD, CIS, CMP™]

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According to Wager, Ornstein, and Jenkins, in 2005, the perceived advantages of an EHR system include the following:

  •  Quality of the patient records (legible, complete, organized) — 86%
  •  Better access to patient records (available, convenient, fast) — 86%
  •  Improved documentation for patient care purposes — 93%
  •  Improved documentation of preventive services — 82%
  •  Improved documentation for quality improvement activities — 82%

Items viewed as an advantage by fewer respondents include the following:

  •  Administrative cost savings — 38%
  •  Improved efficiency — 61%
  •  Security of patient records — 64%

Nothing directly was said about cost savings or increased medical care quality. These topics have become more contentious issues during the past few years.

The Gurley Opinion

According to HIT expert Lori Gurley, in 2006, of the American Academy of Medical Administrators:

“The EHR provides the essential infrastructure required to enable the adoption and effective use of new healthcare modalities and information management tools such as integrated care,  evidenced-based medicine, computer-based decision support, care planning and pathways, and outcomes analysis” (Schloefell et al).  Although the benefits that support implementation of an EHR are clear, there are still barriers too, therefore the concept is still not accepted. “However, this could also be said of almost every other area of positive change and improvement within healthcare systems […]” (Schloefell et al).  There must be more involvement by the government and the private sector “to make changes where possible to instigate, motivate, and provide incentives to accelerate the development of solutions to overcome the barriers” (Young).

THINK: ARRA and HITECH, today. Of course, there are obviously advantages and disadvantages to both the paper medical record and the EHR.

Multi-Factorial Issues

Many factors must be considered before any healthcare organization or medical practice should implement an EHR.  The organization must first obtain as much information as possible about this new concept, and then the information must be carefully reviewed and the pros and cons discussed. Only then should the organization make their decision about this very important issue.

“The [EHR] as a part of a Clinical Information System (CIS) is a powerful tool which ties together documentation of the patient visit (clinical information), coding (diagnosis, and treatment procedures), which then translates into more accurate billing processes, reduces reprocessing of medical claims, and that translates into increased customer satisfaction with a provider” (Koeller). Although the technology is available, progress towards an EHR has been slower than expected. “Widespread use of [EHRs] would serve both private-and public-sector objectives to transform healthcare delivery in the United States” […] EHRs would also “enhance the health of citizens and reduce the costs of care” (Dick, Steen, and Detmer).

The MRI Study

According to a 2005-07 survey by the Medical Records Institute, the following factors are driving the push towards EHR systems within medical organizations:

Motivating Factors 2005 Ambulatory
The need to improve clinical processes or workflow efficiency. 89.3% 91.2%
The need to improve quality of care. 85.0% 85.3%
The need to share patient record information among healthcare practitioners and professionals. 81.1% 66.9%
The need to reduce medical errors (improve patient safety). 76.1% 69.1%
The need to provide access to patient records at remote locations. 67.9% 65.4%
The need to improve clinical documentation to support appropriate billing service levels. 67.1% 76.5%
The need to improve clinical data capture. 64.6% 61.0%
The need to facilitate clinical decision support. 60.7% 50.7%
The requirement to contain or reduce healthcare delivery costs. 54.6% 61.8%
The need to establish a more efficient and effective information infrastructure as a competitive advantage. 53.6% 53.7%
The need to meet the requirements of legal, regulatory, or accreditation standards. 50.0% 44.1%
Other 5.7% 5.1%
Totals 280 136
Margin of Error +/- 5.8% +/- 8.4%

Now, compare this with the results of the 2007 survey that focused on the factors driving hospitals to expand their use of EHR.

Driving Factors in a Hospital 2007
Efficiency and convenience, e.g., better networking to the medical community and patients and remote access 57.8%
Satisfaction of physicians and clinician employees 42.2%
The need to survive and thrive in a much more competitive, interconnected world. 41.0%
Regulatory requirements of JCAHO or NCQA. 35.6%
Savings in the Medical Record Department and elsewhere, including transcription. 24.0%
Value-based purchasing/pay for performance 17.7%
Pressure from payer groups, such as Leapfrog Group 15.2%
Possibility of subsidized purchase of HER, e-prescribing systems, etc. by purchasers/payers/large health systems. 8.8%
Totals 329
Margin of Error +/- 5.4%

Assessment

How have these motivating and driving factors changed today; have they really changed in 2010?

Does this deeper dive reveal any other truths; political, social, business or economic? Is this historical review helpful in understanding the reluctance or eagerness for EMR acceptance, or not?

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Defining Electronic Medical Record Systems

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Does Linguistic Obfuscation Exacerbate our Use Ambivalence?

[By Dr. Richard J. Mata; CIS, CMP™]

[By Dr. David E. Marcinko; MBA, CMP™]

The 2003 Institute of Medicine (IOM) Patient Safety Report [1] described an EHR [2] as encompassing:

  • a longitudinal collection of electronic health information for and about persons;
  • [immediate] electronic access to person- and population-level information by authorized users;
  • provision of knowledge and decision-support systems [that enhance the quality, safety, and;
  • efficiency of patient care] with support for efficient processes for health care delivery.

The IOM Report

A 1997 IOM report, The Computer-Based Patient Record: An Essential Technology for Health Care, provides a more extensive definition:

A patient record system is a type of clinical information system, which is dedicated to collecting, storing, manipulating, and making available clinical information important to the delivery of patient care. The central focus of such systems is clinical data and not financial or billing information. Such systems may be limited in their scope to a single area of clinical information (e.g., dedicated to laboratory data), or they may be comprehensive and cover virtually every facet of clinical information pertinent to patient care (e.g., computer-based patient record systems).

The HIMSS Model

The EHR definitional model document developed by the Health Information and Management Systems Society (HIMSS, 2003) includes:

“a working definition of an EHR, attributes, key requirements to meet attributes, and measures or ‘evidence’ to assess the degree to which essential requirements have been met once EHR is implemented.”

 

The IOM Model

Another IOM report, Key Capabilities of an Electronic Health Record System [Tang, 2003], identifies a set of eight core care delivery functions that EHR systems should be capable of performing in order to promote greater safety, quality and efficiency in health care delivery:

8 Core Principles

Today, we realize that the eight core capabilities that Electronic Health [Medical] Records should possess are:

  1. — Health information and data. Having immediate access to key information – such as patients’ diagnoses, allergies, lab test results, and medications – would improve caregivers’ ability to make sound clinical decisions in a timely manner.
  2. — Result management. The ability for all providers participating in the care of a patient in multiple settings to quickly access new and past test results would increase patient safety and the effectiveness of care.
  3. — Order management. The ability to enter and store orders for prescriptions, tests, and other services in a computer-based system should enhance legibility, reduce duplication, and improve the speed with which orders are executed.
  4. — Decision support. Using reminders, prompts, and alerts, computerized decision-support systems would help improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments.
  5. — Electronic communication and connectivity. Efficient, secure, and readily accessible communication among providers and patients would improve the continuity of care, increase the timeliness of diagnoses and treatments, and reduce the frequency of adverse events.
  6. — Patient support. Tools that give patients access to their health records, provide interactive patient education, and help them carry out home monitoring and self-testing can improve control of chronic conditions, such as diabetes.
  7. — Administrative processes. Computerized administrative tools, such as scheduling systems, would greatly improve hospitals’ and clinics’ efficiency and provide more timely service to patients.
  8. — Reporting. Electronic data storage that employs uniform data standards will enable health care organizations to respond more quickly to federal, state, and private reporting requirements, including those that support patient safety and disease surveillance.” [3]

Assessment

With all the confusion surrounding terms like quality improvement and “meaningful use” which can mean major Federal dollars to the coffers of a medical practice, clinic or hospital; are we still confused about basic definitional terms?

And, does eMR linguistic obfuscation exacerbate our use ambivalence and encourage physician/dentist eMR avoidance?

Conclusion

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References:

[1]   See http://www.himss.org/content/files/PatientSafetyFinalReport8252003.pdf.

[2]   EHR (electronic health record) is often used interchangeably with EMR (electronic medical record).  In this discussion, EHR will be used consistently.

[3]   See http://www.iom.edu/.

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Seeking ME-P Readership Opinions on eMRs

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An Exercise in Crowd-Sourcing

By Chris Thorman

Senior Marketing Manager
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I just finished an essay about market share in the EMR industry and I wanted to give ME-P readers a heads up about it.

Here is the link: http://www.softwareadvice.com/articles/medical/ehr-software-market-share-analysis-1051410/

Essay Content

In the article, I break down:

  • The size of the outpatient EMR market;
  • What EMR vendors have the most physicians using their system; and,
  • What EMR vendors have the most practices using their systems?

Assessment

As I’m sure you can imagine; it was a tough project to get accurate numbers on. And, I’d like to get more eyes on it so we can clear up any discrepancies.  Sort of a ME-P reader “crowd sourcing” project if you will. So, all thoughts on our findings are appreciated. I can be contacted directly here by email, or below: chris@softwareadvice.com

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PR Firm Behind Propaganda Videos Wins HIT Stimulus Contract

Ketchum Deep in Controversy

By Sebastian Jones and Michael Grabell

ProPublica – March 30, 2010 12:26 pm EDT

President Obama’s push for electronic medical records [1] has faced resistance from those who question whether health information technology systems can protect patient privacy. So last week, the U.S Department of Health and Human Services hired a public relations firm to try to win consumer trust.

The irony?

The firm chosen for the job — Ketchum Inc. [2] — was hip-deep in controversy a few years ago for producing a series of fake TV news stories that violated a federal ban on propaganda. The company also drew fire for channeling taxpayer funds to a conservative pundit to promote the Bush administration’s education policies.

About Ketchum

Ketchum, based in New York, is one of the world’s largest public relations firms, with a host of large corporate clients and a history of winning government contracts. Company spokeswoman Alicia Stetzer declined to answer questions about the $25.8 million contract, funded by the federal stimulus package. Nancy Szemraj, a spokeswoman for the government’s health IT initiative, said the PR firm won the contract over four other companies because of its ability to attract public acceptance. “Ketchum has a long rich history of doing outstanding communication outreach work for large social marketing endeavors,” Szemraj said. “They are very capable of moving the needle, with has to happen here.”

She noted that Ketchum’s work helped HHS enroll 35 million people in the Medicare prescription drug program. And she said all of the firm’s marketing ideas would be reviewed by senior managers at HHS.

Consumer advocates warned that the PR contract will only heighten skepticism about the security of online health records. A poll [3] conducted last year by NPR, the Kaiser Family Foundation and the Harvard School of Public Health found that roughly six in 10 Americans lack confidence in the privacy of online health records.

Public Suspicions

“The public has always been very suspicious over whether electronic health information will be safe,” said Dr. Deborah C. Peel, a physician and founder of the Coalition for Patient Privacy, which includes consumer, privacy and health groups. Peel called Ketchum a “very, very troubling choice because the last thing the public needs are more tricks being pulled on them.”

During the Bush administration, Ketchum and its former lobbying arm, the Washington Group, had several prominent Republicans on the payroll, including former New York Rep. Susan Molinari. In the last year, it has beefed up its Democratic credentials, hiring Jonathan Kopp, a member of the Obama campaign’s national media team, and Donald J. Foley, a longtime Democratic strategist.

Ketchum has continued to draw government work – particularly from HHS – despite a series of reports in 2004 [4] and 2005 [5], in which Government Accountability Office investigators found it had produced a series of video news releases that constituted “covert propaganda” because they did not disclose they were paid for by the federal government.

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The segments aired during local television broadcasts on at least 40 stations across the country. Designed to look like news reports, each concluded with a paid actor posing as a journalist reporting from Washington.

One series was produced for HHS in an effort to promote the Medicare prescription drug program to seniors. The others were paid for by the Department of Education. Overall, video news releases have become increasingly common, used by large public relations firms and companies to repackage advertisements as news. [6]

Prior Controversy

Ketchum was involved in a separate controversy in 2005, when reports surfaced that it had used taxpayer funds to pay syndicated columnist Armstrong Williams $240,000 to promote the No Child Left Behind [7] education bill during radio broadcasts as part of outreach to the African-American community.

In both instances, Ketchum defended its tactics. Stetzer referred reporters to a 2005 PR Week article, in which CEO Ray Kotcher said, “There is no indication that it was ever the intent of Ketchum or any of our people to mislead anyone.”

This time around, HHS has hired Ketchum to provide a “comprehensive campaign for communications and education,” to encourage doctors and hospitals to adopt health IT and to assure the public that their information will be safe.

Assessment

The campaign is part of the administration’s $26 billion health IT program, also backed by the stimulus package, which aims to spearhead the transition to online medical records through grants, bonuses to doctors and hospitals, and the development of national standards.

Link: http://www.propublica.org/ion/stimulus/item/pr-firm-behind-propaganda-videos-wins-stimulus-contract

Conclusion

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About the eHealth Initiative and the Foundation for eHealth

What they are – How they work

By Staff Reporters

The eHealth Initiative and the Foundation for eHealth Initiative are independent, non-profit affiliated organizations, whose shared mission is to improve the quality, safety, and efficiency of healthcare information technology [HIT].

Protean Stakeholders

Both organizations are focused on engaging diverse stakeholders–including hospitals and other healthcare organizations, clinician, consumers and patient groups, employers and purchasers, health plans, manufacturers, public health agencies, academic and research institutions, and public sector stakeholders–to define and then implement specific actions that will address the quality, safety and efficiency challenges of domestic medical care through the use of interoperable HIT.

Membership

Since 2001, the eHealth Initiative has represented a diverse membership that is improving HIT. Over the years, eHI membership has grown to over 200 organizations.

Coalition Growth

In 2005, eHI launched the eHI Connecting Communities Membership, a rapidly growing coalition of leaders representing more than 200 state, regional and community-based initiatives focused on improving health through information exchange.

In 2009, eHI adopted the Information Therapy (Ix) Action Alliance. The IxAction Alliance, previously a part of the Center for Information Therapy – an eHI member – resides at the intersection of patient-centered care and HIT, focusing on issues relating to the prescription and use of targeted health information to help people make good health decisions and lead healthy lives.

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Assessment

The adoption of e-health initiatives promises to revolutionize health care in the United States by reducing errors, improving the quality of care delivered, reducing costs, and empowering consumers to better understand and address their own health care needs.

eHI is one of the few organization that represents all stakeholders in the industry. eHI advocates for the use of health IT that is practical, sustainable and addresses stakeholder needs, particularly those of patients.

Conclusion

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Protected Health Information Data Breaches

Affecting 500 or More Individuals

[By Staff Reporters]

As required by section 13402(e)(4) of the HITECH Act, the Secretary must post a list of breaches of unsecured protected health information affecting 500 or more individuals.

The following breaches have been reported to the Secretary of the US Department of Health and Human Services [DHHS].

Full Report

This link was sent in by our own investigative reporter Darrell K. Pruitt, DDS.

Link: http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/postedbreaches.html

Assessment

Shall we await a response from Kathleen Sebelius, who was sworn in as the 21st Secretary of the Department of Health and Human Services (HHS) on April 28, 2009?

Currently, she leads the principal agency charged with keeping Americans healthy, ensuring they get the health care they need, and providing children, families, and seniors with the essential human services they depend on. She also oversees one of the largest civilian departments in the federal government, with nearly 80,000 employees.

Conclusion

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Asking Uncle Sam – Why Health IT?

Let ONC and CMS Explain

By Staff Reporters

On December 30, 2009, CMS and ONC issued proposed regulations on the definition of meaningful use and the initial set of standards, implementation specifications, and certification criteria for EHR technology.

According to the DDHS

Health information technology (health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of HIT has the potential to improve health care quality, prevent medical errors, increase the efficiency of care provision and reduce unnecessary health care costs, increase administrative efficiencies, decrease paperwork, expand access to affordable care, and improve population health.

Improving Patient Care

Furthermore, according to the DHHS, interoperable health IT can improve individual patient care in numerous ways, including:

  • Complete, accurate, and searchable health information, available at the point of diagnosis and care, allowing for more informed decision making to enhance the quality and reliability of health care delivery.
  • More efficient and convenient delivery of care, without having to wait for the exchange of records or paperwork and without requiring unnecessary or repetitive tests or procedures.
  • Earlier diagnosis and characterization of disease, with the potential to thereby improve outcomes and reduce costs.
  • Reductions in adverse events through an improved understanding of each patient’s particular medical history, potential for drug-drug interactions, or (eventually) enhanced understanding of a patient’s metabolism or even genetic profile and likelihood of a positive or potentially harmful response to a course of treatment.
  • Increased efficiencies related to administrative tasks, allowing for more interaction with and transfer of information to patients, caregivers, and clinical care coordinators, and monitoring of patient care.

Assessment

Is the above really true in light of these two recently released reports on meaningful use?

More information is available at http://healthit.hhs.gov

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Meet Shahid N. Shah MS [Our Newest IT Thought-Leader]

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And Textbook Contributor, Too!

By Ann Miller; RN, MHA

[Executive Director]

Shahid N. Shah is an internationally recognized healthcare thought-leader across the Internet. He is a consultant to various federal agencies on technology matters and winner of Federal Computer Week’s coveted “Fed 100” Award, in 2009.

Professional Career

Over a twenty year career, Shahid built multiple clinical solutions and helped design-deploy an electronic health record solution for the American Red Cross and two web-based eMRs used by hundreds of physicians with many large groupware and collaboration sites. As ex-CTO for a billion dollar division of CardinalHealth, he helped design advanced clinical interfaces for medical devices and hospitals. Mr. Shah is senior technology strategy advisor to NIH’s SBIR/STTR program helping small businesses commercialize healthcare applications.

He runs four successful blogs: At http://shahid.shah.org he writes about architecture issues; at http://www.healthcareguy.com he provides valuable insights on applying technology in health care; at http://www.federalarchitect.com he advises senior federal technologists; and at http://www.hitsphere.com he gives a glimpse of HIT as an aggregator.

Industry Awards

Mr. Shah is a Microsoft MVP (Solutions Architect) Award Winner for 2007, and a Microsoft MVP (Solutions Architect) Award Winner for 2006. He also served as a HIMSS Enterprise IT Committee Member. Mr. Shah received a BS in computer science from the Pennsylvania State University and MS in Technology Management from the University of Maryland.

Assessment

Shahid is also contributing the chapter on HIT in the third edition of our book “Business of Medical Practice” [Transformational Health 2.0 Profit Maximization for Savvy Doctors], now in-progress www.BusinessofMedicalPractice.com

Channel Surfing

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register.

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Prominent Politician Views on Health Information Technology

A Guest Thought-Leader Op-Ed Piece

Ann Miller; RN, MHA [Executive-Director]  

By Alberto Borges; MD

In this review, ME-P thought-leader and colleague, Al Borges MD dissects and presents the political views of HIT by several prominent politicians.  WHY?

He believes that only a handful of politicians are questioning whether the cost of HIT will actually improve healthcare as promised, which can end up in wasted taxpayer money, and worse, become a slow-moving HIT blunder which puts patient lives at risk. Even President Obama’s staff quietly admits that these statements are unproven.

Assessment

For example, Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel and the current health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research stated last year that:

“Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely ‘lipstick’ cost control, more for show and public relations than for true change.”

Link: Politician Views of HIT [updated November 2009]

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Dear Doctor – “I’m from the Government and I’m Here to Help”

Only-in-America

By Staff ReportersGetting Squeezed

CMS Cuts Medicare 21% for Doctors Unless Congress Acts

The Centers for Medicare and Medicaid [CMS] just reported to the American Medical News that the final 2010 Medicare physician fee schedule confirms 21.2% pay cut starting Jan. 1, 2010, unless Congress adopts legislation to avert it.  

So, enter John Kerry to the Rescue

Kerry Bill Helps Physicians Borrow Money for eMRs

But to qualify for electronic health record government subsidies, to be paid in increments over five years starting in 2011, physicians must lay out a substantial sum, take a lease, or borrow the money. So, to make it easier for doctors to purchase eMR systems, Sen. John Kerry (D-Mass) has proposed legislation that would allow small practices to get loans backed by the Small Business Administration (SBA).

Moreover, a press release from Kerry’s office stated that the money could be spent on “computer hardware, software, and other technology that will assist in the use of electronic health records and prescriptions.” 

Link: Continued at BNet Healthcare.

Assessment

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Yet, health economist and ME-P Publisher-in-Chief Dr. David Edward Marcinko opined:

“Is this sleight-of-hand chicanery akin to stealing from Peter to pay Paul”?   

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Spotlight on the “Health Tech Today” Video Launch

Video Clip from Microsoft

By Staff ReportersConnected Doctor Health 2.0

Health Tech Today is a new monthly, on-line video series at the intersection of health and information technology.  The show premiers November 10th 2009, but you can view a video trailer of their first show on the link below, right now

HealthBog

HealthBlog includes thoughts, comments, news, and reflections about healthcare IT from Microsoft’s worldwide health senior director Bill Crounse MD, on how information technology can improve healthcare delivery and services around the world.

Link: http://blogs.msdn.com/healthblog/default.aspx

Assessment

Please help them spread the word. Blog about it. Tweet your friends. Post information about Health Tech Today on Facebook.  Health IT has a new voice. We think you’ll like what you see.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. So, give em’ a click and tell us what you think! Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Sponsors Welcomed

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Championing Electronic Medical Records?

By Brent A. Metfessel; MD, MS

By Staff Writers

www.HealthcareFinancials.comHOFMS

eMRs involve accessibility at the bedside either through bedside terminals, portable workstations, laptops, wireless tablets, and hand-held computers and personal digital assistants (PDAs), (e.g., 3ComtmPalm Pilot®). The inputs can either be uploaded into the main computer system after rounds or transmitted immediately to the system in the case of wireless technology. Bedside technology obviates the need to re-enter data from notes after rounds are complete. This improves recall and avoids redundancy in the work process, saving time that can instead be devoted to patient care. 

Usual eMR Features

Common features of an eMR include the following:

  • history and physical exam documentation, progress notes, and patient demographics;
  • medication and medication allergy information;
  • CPOEs and laboratory results;
  • graphical displays of medical imaging studies including X-rays, CT, and MRI;
  • ordering of drugs, diagnostic tests, and treatments, including decision support and drug interaction alerts;
  • clinical practice guidelines (evidence-based) to aid diagnostic and treatment decisions;
  • alerts that can be sent to patients reminding them of appointments and necessary preventive care;
  • scheduling of appointments;
  • processing of claims for payment; and
  • a GUI, which may include secure Web-based and wireless technologies that allows providers or other authorized healthcare personnel access to health information from remote sites, including outside offices and home.

Assessment

There are also other benefits, as well. For example, instead of calculating fluid balance off-line, the computer can perform calculations immediately, once again saving time and ensuring accurate values. Medication orders can also be entered in real-time, giving the provider the option to react to alerts at the bedside rather than waiting to load the orders into the system in “batch” mode.

Conclusion

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsors Welcomed

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Congressional Budget Office Healthcare Reports of Interest

Ten [10] Aggregated CBO Reports

By Staff ReportersIntegration

Courtesy of Healthcare Town Hall:

 

 

 

 

 

Assessment

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Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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A Personal Health Records [PHRs] Video

Where We’ve Been … Where We’re Going!

By John Moore

Channel Surfing

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Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register.  

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Whither Health Information Technology – Seriously?

Is it Really About Quality Improvement?

By Staff ReportersSurgeons

Health information technology (HIT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of HIT has the potential to improve health care quality, prevent medical errors, increase the efficiency of care provision and reduce unnecessary health care costs, increase administrative efficiencies, decrease paperwork, expand access to affordable care, and improve population health.

Improving Patient Care

  • Interoperable HIT can improve individual patient care in numerous ways, including:
  • Complete, accurate, and searchable health information, available at the point of diagnosis and care, allowing for more informed decision-making to enhance the quality and reliability of health care delivery.
  • More efficient and convenient delivery of care, without having to wait for the exchange of records or paperwork, and without requiring unnecessary or repetitive tests or procedures.
  • Earlier diagnosis and characterization of disease, with the potential to thereby improve outcomes and reduce costs.
  • Reductions in adverse events through an improved understanding of each patient’s particular medical history, potential for drug-drug interactions, or (eventually) enhanced understanding of a patient’s metabolism or even genetic profile and likelihood of a positive or potentially harmful response to a course of treatment.
  • Increased efficiencies related to administrative tasks, allowing for more interaction with and transfer of information to patients, caregivers, and clinical care coordinators and monitoring of patient care.

Assessment

Link: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1327&parentname=CommunityPage&parentid=112&mode=2&in_hi_userid=11113&cached=true A Letter from David Blumenthal, MD.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is HIT really about medical quality improvement? Is Dr. Dave Blumenthal correct? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

The VistA Client Server System

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What it is – How it works

By ME-P Staff ReportersME-P Rack Servers

According to Dr. Richard Mata MS, a client-server system configuration occurs when one or more “repository” computers [ known as “servers”] store large amounts of data but perform limited processing. Communicating with the server(s) are client workstations that perform much of the data processing and often have graphical user interfaces (GUIs) for ease of use.

High Functionality

Both customizability and resource use is high, depending on the desired sophistication. Many clinical medical information systems that process data directly related to patient care use this configuration.

VA Example

For instance, the Veterans Health Administration, which has implemented what is likely the largest integrated healthcare information system in the United States, uses client-server architecture. Known as the Veterans Health Information Systems and Technology Architecture (VistA), this system provides technology infrastructure to about 1,300 care facilities, including hospitals and medical centers, outpatient facilities, and long-term care centers. VistA utilizes a client-server architecture that links together workstations and personal computers using software that is accessed via a graphical user interface.

Assessment

Overall, for hospitals that have the financial and manpower resources for a significant investment in IT, client-server architectures are the fastest-growing and typically the most preferred of the system architectures, due in large part to their local adaptability and flexibility to meet changing hospital and medical center needs.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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List of Healthcare IT Trade Associations

Advancing Medical Practice Success with Strategic Relationships

By Staff ReportersHDS

To be efficient in healthcare delivery today, doctors must partner and understand the resources and affiliations that are available to them. Here is a brief list of several healthcare trade associations and leading industry vendors submitted for your review.

AHIMA
The American Health Information Management Association (AHIMA) is the premier association of health information management professionals. AHIMA’s 51,000 members are dedicated to the effective management of personal health information needed to deliver quality healthcare to the public. Founded in 1928 to improve the quality of medical records, AHIMA is committed to advancing the health information management profession in an increasingly electronic and global environment through leadership in advocacy, education, certification, and lifelong learning.

EHRA
HIMSS EHRA is a trade association of Electronic Health Record (EHR) vendors that addresses national efforts to create interoperable EHRs in hospital and ambulatory care settings. HIMSS EHRA operates on the premise that the rapid, widespread adoption of EHRs will help improve the quality of patient care and the productivity of the healthcare system. The primary mission of the association is to provide a forum for the EHR vendor community relative to standards development, the EHR certification process, interoperability, performance and quality measures, and other EHR issues that may become the subject of increasing government, insurance and physician association initiatives and requests.

HIMSS
HIMSS (Healthcare Information and Management Systems Society) is the healthcare industry’s membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology and management systems for the betterment of human health. Founded in 1961 with offices in Chicago, Washington D.C., and other locations across the country, HIMSS represents approximately 17,000 individual members and some 275 member corporations that employ more than 1 million people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems’ contributions to ensuring quality patient care.

HITSP
The Healthcare Information Technology Standards Panel serves as a cooperative partnership between the public and private sectors for achieving a widely accepted and useful set of standards specifically to enable and support widespread interoperability among healthcare software applications, as they will interact in a local, regional, and national health information network for the United States. Comprised of a wide range of stakeholders, the Panel will assist in the development of the U.S. Nationwide Health Information Network (NHIN) by addressing issues such as privacy and security within a shared healthcare information system. The Panel is sponsored by the American National Standards Institute (ANSI) in cooperation with strategic partners such as the Healthcare Information and Management Systems Society (HIMSS), the Advanced Technology Institute (ATI), and Booz Allen Hamilton. Funding for the Panel is being provided via the ONCHIT contract award from the U.S. Department of Health and Human Services.

HL7
Health Level Seven is an American National Standards Institute (ANSI)-accredited Standards Developing Organization (SDO) operating in the healthcare clinical and administrative data arena. It is a not-for-profit volunteer organization made up of providers, vendors, payers, consultants, government groups, and others who develop clinical and administrative data standards for healthcare. Health Level Seven develops specifications; the most widely used being a messaging standard that enables disparate healthcare applications to exchange keys sets of clinical and administrative data.

MSHUG
Microsoft Healthcare Users Group (MS-HUG) unified with the Healthcare Information and Management Systems Society (HIMSS) as part of the HIMSS Users Group Alliance Program in October 2003. The unification strengthens the commitment of HIMSS and MS-HUG to better serve their members and the industry through a shared strategic vision to provide leadership and healthcare information technology solutions that improve the delivery of patient care.

WEDI
The Workgroup for Electronic Data Interchange [WEDI’s] goal is to improve the quality of healthcare through effective and efficient information exchange and management. They aim to provide leadership and guidance to the healthcare industry on how to use and leverage the industry’s collective knowledge, expertise, and information resources to improve the quality, affordability, and availability of healthcare.

Assessment

As the health information technology industry evolves, we will continue to contribute our expertise to foster ideas that shape the future of healthcare by offering more examples similar to the above.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Who did we miss? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe

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Dr. Pruitt Invites Dr. Cohen to Discuss eDRs

Where is the ADA’s Representative?

By Darrell K. Pruittpruitt; DDS

He or she should have been talking with me long ago. I have the audience and I’m giving you that opportunity I promised you, Dr. Donald Cohen.

Rest Easy

I’m aware that I possibly make you uncomfortable, considering how “unprofessionally” I’ve publicly treated lesser devoted HIPAA consultants. Rest easy! As soon as I read your article, I could tell that you’re different from your colleagues I’ve met. First of all, like me, you’re a dentist. That’s very important. Secondly, your credentials are impressive and reveal that compliancy is not a hobby for you like it is for others. Nobody can accumulate a history as impressive as yours without professional dedication. The last point, and the most important of the three, you seem honest about HIPAA compliance.

A Professional

It wasn’t lost on me that in your article you were professionally non-judgmental of the Rule. Instead of trying to justify a defenseless law, your job is to help dentists comply with the mandate as it is written or risk significant fines. Like tax-collecting, someone’s got to do the job of delivering bad news. You have a legitimate purpose to be involved in the dental industry, even if what you teach makes little difference at all if a dentist’s records are breached. I argue that following the inevitable bankruptcy from a breach, HHS fines are hardly a deterrent. And that is the issue: eDRs containing patient identifiers are too risky for the marketplace.

Electronic Dental Records

I think you would have to agree that eDRs are going nowhere until records are safe, and encryption is not going to be sufficient to protect dentists against dishonest employees. Ambitious bureaucrats in waiting, such as HIPAA consultants Travis Criswell, Sharalyn Fichtl, Kelly Mclendon and Olivia Wann – not a dentist among them – hooked their careers to the HIPAA mandate to avoid the tough sales jobs competition otherwise demands in the free market. All four share an authoritarian misconception that since it is the law, dentists will be forced to purchase their products – even if they are utterly senseless. I think we both know that they are oh so wrong. I promised earlier to give you an opportunity to publicly support truth in eDRs if you so choose. Perhaps we could rationally discuss in front of everyone how dentists can wriggle free of the approaching mess. There is no pressure here, other than this is public invitation. Since you haven’t made unrealistic claims about eDRs like others have, I am not interested in hounding you further. I simply ask you to consider responding to the article I posted in your name on PennWell titled “Dr. Donald Cohen’s opportunity.”

http://community.pennwelldentalgroup.com/forum/topics/dr-donald-cohens-opportunity

Assessment

I sincerely appreciate the respect you have shown me, and I pledge to afford you the same. Of all the consultants I have approached with my concerns about HIPAA and eDRs, you are the first to even acknowledge a problem simply by posting my concerns. I think you have the courage to face the realities of the marketplace, while others foolishly think dentists are a captive market.

Note: I submitted this to be posted following an August 28th press release posted by HIPAA consultant Dr. Donald Cohen titled, “Dentists Should Know about New HIPAA Rules.”

http://www.dentalblogs.com/archives/administrator/dentists-should-know-about-new-hipaa-rules/comment-page-1/#comment-35672

If you are interested in discussing the topics of interoperability with fax machines, de-identified eDRs and security that surpasses paper records, in front of you is the opportunity to address your largest audience yet, Dr. Cohen. I’m self-syndicated.

Note: Do you realize that if Dr. Cohen takes me up on the offer, this will be the first time two dentists have openly discussed eDRs on the Internet? Do you think it’s about time?

Conclusion

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How Proprietary HIT Vendors May Demolish Health Reform

Top Five Issues from the Longman Report

By Staff ReportersNetwork

Here are the top five quotes from the Longman Report. The author, Phillip Longman, is a senior fellow at the New America Foundation and the author of: “Best Care Anywhere: Why VA Health Care Is Better than Yours as well as The Next Progressive Era: A Blueprint for Broad Prosperity.

http://www.newamerica.net/people/phillip_longman

The List 

1. Twenty years after the digital revolution, only an astonishing 1.5 percent of hospitals have integrated information technology systems. Almost all experts agree that in order to begin to deal with the problems of the health care system, this has to change. 

2. Done right, digitized health care could help save the nation from insolvency while improving and extending millions of lives at the same time. Done wrong, it could reconfirm Americans’ deepest suspicions of government and set back the cause of health care reform for yet another generation. 

3. Thanks to the stimulus bill, $20 billion is about to be poured into buggy, expensive, proprietary software that will not bring the benefits the Obama administration hopes for. Rather, it will amount to a giant bailout of a health IT industry whose business model has never really worked. 

4. The VA’s open-source software allowed a nurse in Topeka, Kansas, to adapt for her own work a bar-code scanner she saw used at a rental-car agency. Her innovation cut the number of medication-dispensing errors in half at some facilities, and saved thousands of lives. 

5. While a few large institutions have managed to make meaningful use of proprietary health IT, these systems have just as often been expensive failures. In 2003, Cedars-Sinai Medical Center in Los Angeles tore out a “state-of-the-art” $34 million proprietary system after doctors rebelled and refused to use it.

Assessment 

http://www.newamerica.net/publications/articles/2004/the_best_care_anywhere 

Conclusion

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Take the Hospital eHR Implementation Challenge!

Illustrative Case Model – Are You CMP™ Worthy?

By Staff Reporters Washington DC

The fictitional Washington Hospital is embroiled in the healthcare reform debate and interested in implementing an electronic health record (EHR) for its major clinic areas. The flagship hospital currently utilizes a legacy-based system and several of the clinics have independently purchased software programs to provide a more inclusive electronic data base particular to that clinic.

Scenario

In addition, each of the software programs purchased in specific clinics has been modified to serve their own needs. The other satellite hospitals and clinics are not linked to the flagship hospital and have independent systems, applications and software in place. The hospital is interested in obtaining one EHR system that can be used in a standardized and uniform methodology and process throughout all of its hospitals and clinics.

Key Issues

Should the Washington Hospital?

1) Abandon the clinic’s software programs in lieu of a more centralized EHR?

2) Assess various EHR systems for healthcare providers available in the marketplace, comparing a series of hospital and clinic developed requirements against vendor capabilities?

3) Obtain an EHR product that provides interface to the existing clinic software products?

4) Assess whether the EHR vendors totally comply with HIPAA and privacy regulations as well as update their systems automatically with HIPAA changes?

5) Have the vendors assess the existing system/applications/software programs currently in use at each of the hospitals and clinics and determine the best application configuration?

6) Utilize the internal Information Technology staff to develop an interface solution?

Assessment

Medical management consultants, are you up to answering this challenge? We dare you to respond! Visit: www.CertifiedMedicalPlanner.com

Conclusion

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On Regional Extension Centers [RECs]

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Another New Governmental Machination?

[By Staff Reporters]

A Regional (health information) Extension Center [REC] is similar to a Health Information Organization [HIO] that brings together healthcare stakeholders within a defined geographic area and governs Health Information Exchange [HIE] among them for the purpose of improving health and care in that community.

Fundamental to this definition is the meaning of Health Information Exchange and Health Information Organization. A Health Information Organization (HIO) is an organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards.

Thus, the goal of an REC is to act as a local support organization to help doctors install electronic health records and use them to achieve improved quality, efficiency, and continuity of care.

Past and Present

The RECs are based on the example of agricultural extension offices, established over 100 years ago by Congress, which offered rural outreach and educational services across the country.

Today, the HITECH Act amends Title XXX of the Public Health Service Act by adding Section 3012, Health Information Technology Implementation Assistance. This section provides supportive services for the rest of the HITECH Act. Section 3012 (a) establishes the Health Information Technology Extension Program (Extension Program). The Extension Program provides grants for the establishment of Health Information Technology 

Assessment

Link: Regional Extension Center

Link: http://www.chhs.ca.gov/initiatives/HealthInfoEx/Documents/SUMMIT%20DOCUMENTS/RECSummitSlides_FinalDraft-7-15.pdf

Link: HIT Extension Program – Regional Centers Cooperative Agreement Program

Conclusion

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About HealthDataRights.org

Mitigating the Unintended Consequences of HIPAA

By Staff ReportersWaiting for Medical Records

Many patients and pundits opine how today’s HIPAA regulations [written in the relative paper based stone age] say that while doctors must provide a copy of your records, they can take a month to do so. And, if they want, they can say that’s not enough and take another month. However, when a patient needs medical care; that time-line is not acceptable.

Enter a Website and Start a Movement

According to the website www.HealthDataRights.org, in an era when technology allows personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. We the people:

  • Have the right to our own health data.
  • Have the right to know the source of each health data element.
  • Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost; if data exist in computable form, they must be made available in that form.
  • Have the right to share our health data with others as we see fit.

Assessment

These principles express basic human rights as well as essential elements of health care that is participatory, Health 2.0 appropriate and in the interests of each patient. No law or policy should abridge these rights.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Visit the site, join the movement by signing their petition, and tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Henry Louis Gehrig, eMRs and Healthcare Reform

What’s the “Iron Horse” Got to Do with Health IT?

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Jacobetti VA

According to UPI reports from Charlestown, WVa on August 24 2009, at least 1,200 veterans across the country were mistakenly told by the Veterans Administration [VA] that they suffered from a fatal neurological disorder.

Link: http://www.msnbc.msn.com/id/32541579/ns/health-health_care/

Panicked Veterans

One of the leaders of a Gulf War veterans group is reported to have said that panicked veterans from the states of Alabama, Florida, Kansas, North Carolina, West Virginia and Wyoming contacted the group about the error. Denise Nichols, the vice president of the National Gulf War Resource Center, reportedly blamed a “coding error” for the mistake. In medicine, we call this a “false positive.”

About Henry Louis “Lou” Gehrig

Henry Louis “Lou” Gehrig (June 19, 1903 – June 2, 1941), born Ludwig Heinrich Gehrig, was an American baseball player in the 1920s and 1930s; chiefly remembered for his prowess as a hitter, the longevity of his consecutive games played record and the pathos of his tearful farewell from baseball at age 36, when he was stricken with a fatal disease. Of course, Gehrig was known as the “The Iron Horse” for his durability. Yet, the irony is that Amyotrophic Lateral Sclerosis [ALS], or Lou Gehrig’s disease [sometimes also called Maladie de Charcot] is progressive and fatal. Lou died in 1941 after developing the illness. Will the same death-spiral happen to eHRs and Obama care?

Link: http://www.lougehrig.com

Assessment

Having rotated through the VA system as a young medical student back-in-the-day, I have never been a fan. It smacked of socialized medicine and government plutocracy, and was never a leading-edge example of domestic healthcare, in my informed opinion. Recent HIPAA administrative, security, IT and clinical medical errors are well known. So, to blame the mix-up on an insurance billing and “coding error” seems somewhat disingenuous. Especially now, at a time when eMRs and the Obama Administration’s healthcare reform itself is being vigorously debated by the citizenry. I mean, are there no human checks and balances? Would there be any human intervention if a public healthcare policy was adopted?

Of course, we have written about military medicine previously on this Medical Executive-Post, and devoted an entire channel to it. And, I do realize that more than fifty percent of us receive similar governmental care in some form, or another [Medicare, Medicaid, CHIPS, the Indian and Prison Healthcare Systems, etc].

Link: https://healthcarefinancials.wordpress.com/category/military-medicine/

Nevertheless, shall we give a new moniker to this mistake? How about “Lou Gehrig’s coding error”, and document it in our www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is it even fair to relate this “isolated incident” to the current healthcare reform debate, the eMR conundrum and/or similar discussions on health Information Technology [IT]? Tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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About Practice Fusion and Free eHRs

A Web Based Concept in the Clouds

By Staff ReportersOpen

Practice Fusion is a firm that reports to address the complexities and critical needs of today’s healthcare environment by providing a free, web-based electronic Health Record (eHR) application to physicians.

America’s Fastest Growing EHR community

Practice Fusion is also a fast growing electronic Health Record community. Founded in 2005, they are rapidly expanding and adding new users regularly. Over 18,000 physicians and practice managers in 50 states currently use Practice Fusion’s electronic Health Record.

Online and Free

Practice Fusion stands out in a marketplace dominated by complicated, expensive and often inefficient eHR services. Their user-friendly eHR is reported to be activated in less than five minutes, with no downtime or extensive training; eliminating the difficult conversion process that has become an industry-standard.

Secure and Reliable

The firm understands the mission-critical nature of their application. Practice Fusion’s electronic Health Record is developed for the highest levels of security and performance with world-class data centers equipped with best-in-class technology to securely house sensitive data.

Assessment

Although Practice Fusion is a young company, they are led by a well-established team of healthcare and technology veterans. Practice Fusion is directed by a group of investors and medical practitioners who believe in the power of electronic Health Records. Investors include Band of Angels, Salesforce.com and Felicis Ventures. So, give the site a click, and tell us what you think! www.PracticeFusion.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Comments from users and early adopters are especially appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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