Interoperability’s long journey to reality

Interoperability has been part of the healthcare lexicon for at least a couple of decades. At some level, data liquidity has been achieved – as demonstrated annually at the IHE Connecthathon and the Interoperability Showcase at the annualHIMSS Conference & Exhibition, popular venues that always garner enthusiastic participants and audience.

But it’s still not happening at the scale we need.

Karen DeSalvo, MDThankfully, at no other time in history has there been such a concentrated push for interoperability as there is today. Perhaps the need has become more obvious since the widespread adoption ofelectronic health record systems. Maybe the industry has gotten a second wind. Maybe the movers and shakers are finally impatient to make it happen. It could be simply that the stars are aligned.

Whatever the reason, interoperability is center-stage. It doesn’t mean that it is done, or that the road to interoperability will be an easy ride. But, suddenly industry insiders seem more abuzz and determined to push forward.

Roadmap to interoperability

On Jan. 30, the Office of the National Coordinator for Health IT released its draft roadmap to interoperability. The document, “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0,” recommended some actions to take toward interoperability.

The “time has come for us to be more explicit about standards,” National Coordinator Karen DeSalvo, MD, said in a Jan. 30 press call. The 150-page plus roadmap addresses everything from governance, standards and certification to privacy and security. “Health IT that facilitates the secure, efficient and effective sharing and use of electronic health information when and where it is needed is essential to better care, smarter spending and a healthier nation,” DeSalvo said in releasing the roadmap.

The ONC invited public comment on the draft document through April 3, 2015. By the beginning of March, more than 400 comments were posted, many of them long and detailed.

Doug Fridsma MD, president and CEO of the American Medical Informatics Association, and formerly chief science officer at ONC had not yet parsed the roadmap at the beginning of March.

But, when it comes to interoperability, he’s sure about many things.

Doug Fridsma, MD“I’ve always relied on IEEE definition for what interoperability is,” he said. “There’s a broad range of different definitions for interoperability that are out there, but I’ve always liked the IEEE definition because it’s actionable and it’s measureable.”

IEEE is the Institute of Electrical and Electronics Engineers. Its definition for interoperability is in two parts.

“It’s the ability of two or more systems to exchange information,” Fridsma said. “That’s the first part. The second part is the ability of the systems to use the information that’s been exchanged.”

Interoperability is defined as exchange and use. Exchange without use – without being able to achieve what you want to achieve with the exchange of information, is not interoperability, in his view.

“The thing that’s nice about that particular definition,” as Fridsma sees it, “is it means that you have to define interoperability in terms of this thing that you want to do.”

“So exchange and use,” Fridsma said. “And if you define the use in measureable ways, you can actually start measuring the progress that you’re making toward interoperability.”

So, you think measurable is really important? “I do,” he said. “Because you can’t improve the things you can’t measure.”

Fridsma also advocates getting very clear on what it is the nation wants to achieve with regards to interoperability. “We have to be very specific about what that is,” he stressed, adding that since the “P” in HIPAA stands for “portability,” one of the goals might be for patients to have truly portable electronic health records that can move from one system to another.

“You know, it can be exported from one and imported into another,” he said. “That may be a very laudable goal – and it’s measurable.”

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Phishing scam breach compromises data of 39K

Another healthcare employee opened an email that turned out to be a phishing scam that ended up compromising the protected health information and Social Security numbers of 39,000 patients. 

The Texas-based Seton Healthcare Family, part of Ascension health system, has notified affected patients after a December 2014 phishing attack compromised an email account. Following an investigation, officials determined at the end of February that the email accounts impacted by the phishing scam contained PHI for 39,000 patients.

Data compromised included patient demographics, medical record numbers, Social Security numbers, clinical data and insurance information.

“Seton sincerely apologizes for any inconvenience this unfortunate incident may cause,” officials wrote in a notice. In the wake of the breach, Seton officials say they are working with their email service provider to look at ways it can improve its current security program.

This is not Seton Healthcare’s first breach. In 2013, the health system reported that an unencrypted laptop containing PHI was stolen, according to data from the Office for Civil Rights.

PHIPrivacy.net also highlighted three additional data breaches that transpired at Seton since 2007, involving two other stolen laptop incidences compromising some 10,300 patients’ data. The third breach involved an error by one of the health system’s business associates, HealthLOGIX, and resulted in more than 500 patients being mailed the wrong member cards.

There’s been a trend in recent months of phishing attacks in the healthcare sector. Even earlier this year, the federal government notified consumers of the health insurance marketplaces that they’ve been the target of recent phishing scams. And, in the wake of the Anthem breach, there’s been a surge in reported phishing scams with members affected by the breach that compromised some 80 million records.

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Flare Capital, Slow Ventures raise new investment funds in health IT and tech

Money is flooding into startups and growing private companies, which means those investors need to reload.

Today, a pair of investment funds with Boston-area lead investors are announcing that they’ve put together new pools of cash to put into startups.

The larger of the two is Flare Capital, which was previously known as Foundation Medical Partners. Flare says it’s raised a new $200 million fund, with Boston-area startups Iora Health and Predilytics among the first few investments.

Flare Capital is led by general partners Bill Geary, Michael Greeley, and Lee Wrubel. Boston Children’s Hospital is one of the institutional investors backing the fund.

Also making news today is Slow Ventures, an early stage investment group made up of former Facebook executives. Slow started off life as a private investment club, but has now grown into a small investment fund, raising $65 million from an unnamed group of tech-industry entrepreneurs, executives, and venture capital firms.

Former Facebook sales executive Kevin Colleran, who is based in Boston, will manage Slow Ventures. Former Facebookers Dave Morin and Sam Lessin also are partners in the fund, although they are mainly focused on their own entrepreneurial ventures — Morin is the CEO of social app developer Path, and Lessin is helping build tech-news site The Information, which is led by his wife, journalist Jessica Lessin.

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How Do HIPAA Regulations Affect Workplace Wellness Programs?

The Department of Health and Human Services (HHS) recently posted clarification for how HIPAA regulations would potentially apply to workplace wellness programs. With the Equal Employment Opportunity Commission (EEOC) also publishing a proposed rule earlier this month concerning updates to workplace wellness programs, it is important for organizations to understand how the federal compliance rules could potentially affect them.

HIPAA regulations do not necessarily apply to workplace wellness programs, as HIPAA is designed for covered entities and business associates. However, HIPAA rules could potentially come into play for those workplaces depending on how the wellness programs are structured, according to HHS.

Where a workplace wellness program is offered as part of a group health plan, the individually identifiable health information collected from or created about participants in the wellness program is PHI and protected by the HIPAA Rules. While the HIPAA Rules do not directly apply to the employer, a group health plan sponsored by the employer is a covered entity under HIPAA, and HIPAA protects the individually identifiable health information held by the group health plan (or its business associates).

Moreover, when the plan sponsor is administering certain aspects of the plan, such as wellness program benefits, PHI could be held by the employer as plan sponsor. In that case, HIPAA regulations would also protect individuals’ PHI.

HHS also explained that there are restrictions to how a group health plan may allow an employer as plan sponsor access to PHI. If the employer administers certain aspects of the group health plan, possibly including administering wellness program benefits offered through the plan, then it must establish that it agrees to do the following:

• Establish adequate separation between employees who perform plan administration functions and those who do not;
• Not use or disclose PHI for employment-related actions or other purposes not permitted by the Privacy Rule;
• Where electronic PHI is involved, implement reasonable and appropriate administrative, technical, andphysical safeguards to protect the information, including by ensuring that there are firewalls or other security measures in place to support the required separation between plan administration and employment functions; and Report to the group health plan any unauthorized use or disclosure, or other security incident, of which it becomes aware.

The proposed rule by the EEOC centers around the regulations and interpretive guidance implementing Title I of the Americans with Disabilities Act (ADA) as they relate to employer wellness programs.

“This proposed rule provides guidance on the extent to which the ADA permits employers to offer incentives to employees to promote participation in wellness programs that are employee health programs,” the EEOC stated.

In a separate statement posted on its website, the EEOC explained that the proposed rule “does not change any of the exceptions to confidentiality requirements provided in the EEOC’s existing ADA regulations but adds a new subsection.” The new sections states that a covered entity can receive data from a wellness program “ in aggregate form that does not disclose, and is not reasonably likely to disclose, the identity of specific individuals except as is necessary to administer the plan.”

“Wellness programs that are part of a group health plan, including those administered by employers, generally are subject to HIPAA requirements that mandate certain safeguards to protect the privacy of personal health information and set limits and conditions on the uses and disclosures of that information,” the statement read.

Moreover, the proposal explains that compliance with the ADA’s rules on voluntary employee health programs does not relieve CEs of their obligation to comply with other employment nondiscrimination laws.

“Employers must provide reasonable accommodations that allow employees with disabilities to participate in wellness programs and obtain any incentives offered,” the EEOC said on its website. “Employers also must ensure that they maintain any medical information they obtain from employees in a confidential manner.”

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A.M. Best downgrades Assurant Health ratings after sale/shutdown news

A.M. Best downgraded the financial strength and issuer credit ratings ofAssurant Health’s insurance lines Wednesday to “good” from “excellent” after Assurant Inc. announced it plans to exit the health insurance business either by selling it or closing it.

A.M. Best, of Oldwick, N.J., said the ratings are for Assurant’s Time Insurance Co. and John Alden Life Insurance Co. The outlook for the ratings is stable.

Assurant Health’s products are underwritten and issued by Time Insurance and John Alden Life Insurance Co.

The ratings downgrade follow Assurant Inc.’s (NYSE: AIZ) Tuesday announcement that it is exploring strategic alternatives for its health and employee benefits business segments, including a potential sale. If no buyer emerges, Assurant Inc. said it will exit the health insurance market in 2016.

Best’s financial strength rating represents the organization’s opinion of an insurer’s financial strength and ability to meet its ongoing insurance policy and contract obligations. The Assurant Health businesses now are rated as having a good ability to meet their ongoing insurance obligations instead of an excellent ability to do so.

“A.M. Best believes that Assurant will continue to support its obligations to customers and policyholders during the (sale or exit) process,” Best said in a press release.

A.M. Best noted that over the past several quarters, Assurant Health has reported higher-than-anticipated claims in certain blocks of business, resulting in significant operating losses. Assurant executives have said the losses resulted from a significant regulatory change in late 2013 related to the Affordable Care Act.

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Phishing Scam, Stolen Laptop Lead to Potential Data Breaches

Healthcare data breaches can be caused from a variety of incidents, such as an email phishing scam, misplaced medical records, and lost or stolen mobile devices. Without a comprehensive security plan and extensive understanding of HIPAA regulations, a facility could find itself notifying patients of a potential breach. However, even with the necessary protections in place, mistakes can still happen. From there, it is key to notify patients quickly and then make the right changes to ensure that the same incident does not take place again.

Email phishing scam hits Maryland facility

Maryland-based St. Agnes Health Care, Inc. recently posted an announcement on its website saying that one of its employees was the victim of an email phishing scam. St. Agnes said that it sent data breach notification letters to approximately 25,000 patients, warning them that their protected information was potentially exposed.

“Through a fraudulent e-mail communication, sophisticated hackers gained access to protected health information contained in an employee e-mail account,” the statement read.

Information that was possibly compromised includes patient names, dates of birth, genders, medical record numbers, insurance information, and limited clinical information. There were four cases where Social Security numbers were exposed.

“We are taking the necessary and appropriate steps to prevent this type of incident from occurring in the future,” Saint Agnes Corporate Responsibility Officer Sharon McNamara said in a statement. “Specifically, we will continue to implement administrative, technical and physical safeguards against unauthorized access of protected health information.  In this instance, we reported the incident to our email service provider and are evaluating additional ways to enhance our already robust security program.”

The statement did not specify when the breach occurred or when St. Agnes realized that an incident had taken place. However, St. Agnes is part of Ascension Health, which has had at least two other of its facilities fall victim to phishing scams recently. It has not yet been confirmed if any of the email attacks are related.

Laptop containing member data stolen from Oregon co-op

Oregon’s Health Co-op reported that a password protected laptop was stolen on April 3, 2015. The laptop contained member and dependent information, including current and former member and dependent names, addresses, health plan and identification numbers, dates of birth and Social Security numbers. However, there was no medical information on the laptop, according to Oregon’s Health.

Affected individuals can receive free identity protection services for one year, and can also have access to identity theft and fraud resolution assistance.

“We have engaged a cybersecurity firm to review the security of our systems and provide recommendations for reinforcing our security and technology protocols,” the facility explained on its website. “At this time, there is no evidence that there has been any use or attempted use of the information exposed in this incident.”

Oregon’s Health did not state how many members and dependents were possibly affected by the data breach, just that all former and current members who had data exposed, as well as their dependents will be properly notified.

However, the online question and answer section potentially revealed a disturbing aspect to the notification process, in that members may receive a notification letter meant for someone else. Oregon’s Health said it apologized for any confusion if individuals receive notice about a security incident, but the letter is addressed to another person.

“Yes, the CO-OP is notifying members about a recent security incident,” the answer read. “If you received a letter with someone else’s name, please destroy that letter. Another letter with correct information is on the way to you.”

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To err is human; EHRs must account for that, panelists say

Jacob Reider: We have not focused enough on the individual

To err is human, so when it comes to electronic health records, better technology is what’s needed to make the programs safer, panelists said Wednesday during Politico‘s Outside In kick-off event in the District of Columbia.

Currently, usability of the systems is “horrific,” Ross Koppel, Ph.D., of the University of Pennsylvania’s School of Medicine, said. Health technology has made healthcare better and safer, but Koppel wondered if it’s as good as it should be due to the cost and effort.

“Are we keeping track of the mistakes it enhances?” he said. “Are we making progress in making it better? And I think the answer to that is resoundingly ‘no.'”

Questions about the safety of EHRs–and who is responsible when things go wrong–were threaded throughout the hour-long discussion.

Professor Harold Thimbleby, who teaches computer science at Swansea University Wales, used the auto industry as an example of a place where user error has become more accepted. To improve safety for users, new technology like seat belts and more airbags are added.

Health IT needs to do the same with EHRs, he said.

“[Stuff] happens,” he said, “but with good technology, that doesn’t have to turn into a catastrophe … rather than blaming the nurses and that’s the end of the story, [mistakes] happen and the whole system needs fixing.”

Bernadette Loftus, associate executive director at Mid-Atlantic Permanente Medical Group, said at her organization, they are fortunate to have a good number of physicians who can write code and have thorough training in the underlying code of the EHR.

“We didn’t just buy an off-the-shelf product, we took that product and had tons of physicians and nurses who learned to write the code that tweaks it. And we tweak it all the time; we put through an upgrade a month,” she said.

Loftus reiterated later on the importance of a connection between the users of a system and those who can fix it, saying it’s the “key to ensuring everything is safe.”

Jacob Reider, M.D., chief strategy officer at Kyron and former Deputy National Coordinator for Health IT, also touched on the patient’s position.

“We have not focused enough on the individual … and when we talk about user-centered design and the clinician and the role of the clinician, we’re missing the patient, the individual, in that conversation,” he said.

“I think we have a great opportunity to think about what’s best for the individual, and if we use that as a valued principle, everything else actually falls into place.”

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ONC: Health IT Adoption, Use Has Improved Patient Safety

The increased adoption of electronic health records and other health IT has improved patient safety, according to an issue brief by the Office of the National Coordinator for Health IT, Health IT Analyticsreports (Bresnick, Health IT Analytics, 4/28).

The issue brief — which is the first of four that ONC plans to publish by September 2015 — examined four systematic literature reviews and various studies that show how health IT has influenced factors that affect patient safety (Gettinger/Kenyon, “Health IT Buzz,” 4/27).

Brief Details

In a blog post about the issue brief, ONC Chief Medical Information Officer and Office of Clinical Quality and Safety acting Director Andrew Gettinger and Senior Policy Analyst Kathy Kenyon wrote that the Institute of Medicine’s “To Err is Human” patient safety report recommended “health IT as part of ‘redesigned systems of care.'”

They noted that in the years following the report, studies have shown that health IT has resulted in more benefits than harm.

For example, the brief cited a series of four systematic reviews conducted between 2006 and 2014,one of which found that data-driven technologies — such as clinical decision support, computerized provider order entry and EHRs — were associated with:

• Better adherence to evidence-based protocols;
• Improved capability to monitor conditions and make better-educated decisions about care utilization; and
• Lower rates of medication errors.

Meanwhile, a 2011 study that examined health IT and patient safety literature found that:

• About 66% of analyzed papers found that EHR implementation and use resulted in “uniformly positive outcomes”; and
• 30% found health IT led to more positive outcomes than negative ones.

A separate 2014 report cited in the issue brief found that more than 75% of studies reviewed found “positive results” related to quality outcomes, safety and efficiency as a result of the meaningful use program.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments (Health IT Analytics, 4/28).

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Rubella Has Been Eliminated From the Americas, Health Officials Say

Insurers Navigate Health Overhaul to Rising Profits

Several of the nation’s biggest health insurers have hiked earnings expectations for 2015 after blowing past first-quarter forecasts and heading into a much more stable future than they faced this time last year.

A better understanding of the health care overhaul’s impact, lighter Medicare Advantage funding cuts and old-fashioned business growth all helped deliver a confidence boost to much of the sector.

KNOWING THE LAW

The federal overhaul launched a major coverage expansion in the fall of 2013, when public insurance exchanges debuted with the promise of providing millions of new customers who receive help buying coverage through income-based tax credits. But problems with those online exchanges slowed enrollment, and insurers still didn’t have a full picture of who was signing up for their coverage deep into last year’s first quarter.

They also weren’t certain about the risk they faced from this new population.

A year later, enrollment gains are more certain and companies are starting to understand those new customers. The Blue Cross-Blue Shield insurer Anthem Inc. said Wednesday that it has signed up nearly 900,000 people on the exchanges. Competitor Aetna Inc. has added more than 950,000.

Insurers also have a better understanding of how the law’s costs, which include fees and medical claims, affect their income statements.

“Overall costs have settled at a level that’s been very consistent with our expectations,” Aetna Chief Financial Officer Shawn Guertin said.

SURVIVING CUTS

Privately run Medicare Advantage plans are a growing source of business for UnitedHealth Group Inc., Humana Inc. and other insurers, but they’ve been pressured for a few years now by funding cuts. The federal government is scaling back funding for the coverage in part to help pay for the overhaul. In response, insurers have had to trim benefits and in some cases leave markets in order to preserve profitability.

They had to do more of that heading into 2014, when plans faced cuts ranging from 5 percent to 7 percent, said Thomas Carroll, who covers the industry for the investment bank Stifel. This year, insurers are probably dealing with a reduction of around 3 percent, on average, although that varies by plan.

“The heavy lifting was done in 2013 getting ready for 2014,” Carroll said regarding plan adjustments. “That … is probably enough to deal with this year.”

IMPROVING BUSINESS

Operating earnings soared 35 percent for UnitedHealth’s health insurance business in the first quarter. The nation’s largest insurer also saw strong growth from its Optum segment, which provides pharmacy benefits management as well as data technology services and runs clinics and doctor’s offices.

Anthem recorded a 25 percent Medicaid enrollment gain compared with last year’s quarter. The overhaul is helping to expand the state- and federally funded program for disabled people and those over age 65.

In addition to booking business gains, insurers also are keeping medical costs under control. That’s their biggest expense, and it continues to grow moderately, about as companies expected. Insurer profitability gets squeezed when medical costs grow faster than expected after they’ve set coverage prices.

That moderate cost growth could change by fall. People with high-deductible health plans tend to save bigger medical expenses for later in the year, after they’ve paid their deductibles and will have more of the bill covered by the insurer.

Humana Inc., the only top insurer to miss analyst expectations so far this quarter, said Wednesday that it saw signs that hospital admissions — a pricey form of care — were starting to pick up.

“Everybody is calling for cost trends to increase this year, but they still remain below longer-term trends,” Carroll said.

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UNC Health Care quadruples budgeted operating income

A smoothly integrated health records system contributed to UNC Health Care’space of reporting operating income of nearly four times the budget for this fiscal year.

At the beginning of the year, the health care system, based in Chapel Hill but with operations throughout North Carolina, planned an operating income of about $21 million through eight months. The latest financial reports show the hospital system recorded operating income of nearly $82 million through the first eight months.

All major health systems in the Triangle have implemented a health records system from Wisconsin-based health IT company Epic. UNC Health Care system spokeswoman Karen McCall says the implementation has happened more smoothly than expected, contributing to the strong operating income line.

Although total patient days came in nearly exactly in line with budget, total discharges were about 4 percent below expected. That means UNC Health Care is seeing fewer total patients than expected, but each patient is staying in the system longer, on average. Surgery cases were also below budget and only slightly above the same time last year.

Hospitals have been locked in a political battle battle that will rage on this summer. Private physician groups want North Carolina health care regulations changed so they can more easily open and operate independent surgery centers, something they argue will lower cost. The N.C. Hospital Association argues it needs those surgeries in order to cover expenses for areas like emergency preparedness that run up costs, but for which they are not always reimbursed. Hospital critics point to strong financial reports like the one from UNC Health Care to argue that hospitals should not cry poor, however, hospitals rightly counter that the financial performance of many rural hospitals is far less stellar.

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Arizona turns to telemedicine as physician shortage threatens care

Technology is expanding healthcare in states such as Arizona at a time when a shortage of physicians threatens the reach of care.

Arizona is about 500 to 750 doctors short, Dan Derksen, director of the Center for Rural Health at the University of Arizona, tells Arizona Public Media. That shortage is causing the state to turn to telemedicine and other health IT services to reach people in rural areas.

The Arizona Telemedicine Program at the University of Arizona, for example, reaches people in outlying areas who would have to drive into Phoenix or Tucson for care. In addition, the Mayo Clinic in Scottsdale uses telemedicine to help patients experiencing stroke symptoms get the proper care.

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CDS vendors, users: National standards could solve many problems

A study on the views of clinical decision support found tension between clinical users and vendors, as well as a shared belief that national standards could solve many of the problems.

The study, published at BMC Medical Informatics and Decision-making, sought out the views of three groups: clinical stakeholders, CDS content vendors and electronic health record vendors.

All three sides agreed on issues such as the importance of having the appropriate staff, careful knowledge management, fitting user workflow and the need for communication among the groups. However, they differed on issues such as usability, training, metrics and interoperability.

Among the issues:

• People: Clinical organizations need analysts with both technical skills and knowledge of healthcare to customize CDS. Content vendors need clinicians with skills in evidence-based medicine and writing; EHR vendors need physician consultants who help train staff within purchasing organizations to manage CDS and use it.
• Knowledge management: Clinical site staff members often are frustrated that they have to put so much effort into even the most basic CDS.
• Communication: All three groups believe the other groups do not understand what they do.
• Interoperability: Both clinical site and content vendor groups are frustrated that more progress has not been made by EHR vendors on interoperability and use of standard protocols.
• Training: Clinical site employees had mixed feelings about the quality of training they received from vendors. Conversely, the vendor representatives complained that clinical organizations often were too reluctant to pay for training.
• Measurement and metrics: Measurement of the use and effectiveness of CDS is a challenge. One vendor had offered it for free, but few customers used it.

The clinical participants would like to see national standards for interoperability that vendors actually use. Standards would provide a safe, legal environment, vendors say, that would empower them to provide more CDS tools to customers.

Buyers of CDS system need more and better information to make informed purchase decisions, according to an article published in the Journal of the American Medical Informatics Association. The authors said that available information often is too general to be useful, and that there’s little evaluation of outcomes.

In addition, a KLAS report found that CDS reference tools still lack the level of integration necessary to provide the strategic direction that providers need.

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Healthcare Big Data Analytics Confuses Half of Providers

More than half of providers are confused by the information collection requirements of healthcare big data analytics, finds the third annual Health IT Industry Outlook Survey by Stoltenberg Consulting. Despite a general sense that engaging in big data analytics is important for success in the current health IT landscape, 51 percent of organizations do not truly know what kind of data – or how much of it – they need to collect in order to generate actionable insights from their information.

The survey, conducted at HIMSS15 in Chicago earlier this month, revealed widespread consternation and frustration when it comes to healthcare big data analytics and other health IT initiatives that are critical for strategic success.

Key results from the poll include:

• Thirty-four percent of organizations feel a lack of organizational buy-in is the biggest barrier to health IT initiatives.

• Twenty-eight percent of participants highlighted budgetary constraints as a top barrier, while 13 percent cited restricted timeframes as a major reason they are having trouble participating in meaningful use or healthcare big data analytics initiatives.

• In addition to the 51 percent of organizations that have not been able to define their data collection needs, a quarter of participants said that confusion and ambiguity about federal regulations are preventing their progress.

• A third of providers don’t know what to do with the data they have or don’t know what to look for when it comes to analytics.  Ten percent of IT leaders believe the answers simply don’t exist: the necessary tools and strategies to be successful haven’t been devised yet.

• While 41 percent of participants believe that healthcare big data analytics and business intelligence are the biggest topics of 2015, six percent of organizations are too intimidated by the concept of diving into analytics to even begin trying.

• Other organizational initiatives like mHealth, ICD-10, and health information exchange are taking a back seat to the desire to squeeze insights out of big data.  Just 12 percent of organizations believe the October 1, 2015 conversion date for ICD-10 is a top priority.

“Organizations feel they need to jump on the big data bandwagon, yet they approach this emerging issue reactively versus proactively,” said Shane Pilcher, vice president of Stoltenberg Consulting. “Healthcare IT leaders should instead focus on collecting smart healthcare data, monitoring what data they’re saving, and concentrating on the quality, quantify and validity of data needed to answer future questions for organizations.”

Healthcare organizations that are feeling a little lost may wish to take their cues from providers already seeing success in the healthcare big data analytics arena.  EHRs provide an initial pool of relatively structured, patient data that can be harnessed for clinical analytics, the foundation of population health management and future efforts to engage in operational modeling.  EHR data can also be leveragedinto predictive insights that can help to reduce hospital readmissions, improve patient safety, and raise the quality of care.

Securing executive support for a healthcare big data analytics program is critical for jumpstarting the process of building an analytics team that can convince clinicians that the efforts are worthwhile, establish the necessary infrastructure, and ensure the integrity, completeness, and accuracy of data that will eventually be used for analytics.

“Ultimately, data analytics is only as good as the data being analyzed. Therefore, adoption is critical among all users along the data collection pathway,” Pilcher added. “Identifying early wins in decreasing cost of care and increasing overall patient outcomes is essential to developing confidence and buy-in for an organization’s data analytics program.”

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Bill Would Ease FDA Oversight of Mobile Apps, Health IT Software

On Monday, Sens. Michael Bennet (D-Colo.) and Orrin Hatch (R-Utah) re-introduced a bill (S 1101) that would exempt certain medical software and mobile applications from FDA regulation,Health Data Management reports.

The Medical Electronic Data Technology Enhancement for Consumers’ Health — or MEDTECH — Act (S 2977) was first introduced in December 2014.

Bill Details

The reintroduced bill seeks to revise the definition of medical devices in the Federal Food, Drug and Cosmetic Act to limit and clarify FDA’s role in overseeing administrative and financial software, certain parts of electronic health records, clinical decision-support software and wellness and lifestyle products. The senators said the bill will use a “risk-based approach” for such tools.

According to Bradley Merrill Thompson, general counsel for the mHealth Regulatory Coalition, the new version of the bill includes more types of software that would be exempted from FDA oversight (Slabodkin, Health Data Management, 4/28). For example, the new bill would bar FDA from regulating software that is used for:

• Appointment scheduling;
• Business analytics and communication;
• Patient population and laboratory workflow process information;
• Maintaining healthy lifestyles; and
• Maintenance of financial records (Gold et al., “Morning eHealth,” Politico, 4/28).

Other exempted software would include tools that are used to:

• Analyze and support the display of patient data for diagnostics, prevention and treatment recommendations; and
• Format, organize and present clinical lab test report data prior to analysis, as well as laboratory test report findings and related patient education data (iHealthBeat, 12/5/14).

Merrill Thompson said that under the bill FDA would maintain regulation of software that is used to interpret clinical lab data (Health Data Management, 4/28).

Meanwhile, an aide to Hatch said that the bill also clarifies how “products with multiple functionality” would be regulated and would require that device accessories be regulated based on their independent risk levels (“Morning eHealth,” Politico, 4/28).

In addition, Merrill Thompson said that under the latest bill EHR vendors would only have to comply with the Office of the National Coordinator for Health IT’s voluntary certification process.

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Innovative Health IT Products Sought Through ONC Challenge

Ever since the Medicare and Medicaid EHR Incentive Programs have been established, the adoption and implementation of EHR systems and other health IT products has been tremendous. The health IT sector in general has been expanding greatly over the last several years.

The Office of the National Coordinator for Health IT (ONC) reports that almost $700 million was invested in medical technologies during the first quarter of 2014, which shows an 87 percent growth when compared to the first quarter of 2013. Health IT products and mobile health applications are all leading the way in changing the way doctors and consumers interact across the healthcare continuum.

Nonetheless, ONC explains that even with the evident growth in the health IT sector, many startups are still challenged in acquiring pilot partners that will help develop their health IT systems and show that their product is effective for the industry. These pilot partners are necessary for acquiring the data needed to establish a health IT product as successful among potential investors and customers including healthcare systems, payers, and the patient community.

As such, ONC is looking to create stronger relationships to help innovators bring new health IT products to the market. ONC has announced a new challenge program: the Market Research and Development Pilot Challenge.

To participate in the challenge, health IT developers will need to work with host sites like hospitals, clinics, pharmacies, or laboratories to create pilot proposals. ONC will be offering $300,000 through a year-long commitment to truly develop new and revolutionary health IT products for the medical sector.

The funding will be distributed among six teams who will then initiate the pilot, collect a variety of data, evaluate the product, and distribute the results with ONC’s assistance. After six months, the teams will be expected to return an evaluation report about their findings. The very first steps to take, however, is to select the right team, create an overall plan, and prepare the pilot proposal.

For each team, ONC will first award $25,000 when the pilot teams are selected and then another $25,000 after the pilot development and evaluation period is completed. In addition to this challenge, ONC will also be initiating sessions around the nation to train the health IT startup community on federal regulations, privacy and security standards, payment reforms, and funding opportunities that will affect the outcome of their services or health IT products.

The forward push for increasing the number of health IT solutions among providers and medical systems leads a pathway toward sharing patient data quickly and efficiently across the healthcare continuum. The National Coordinator for Health IT Karen B. DeSalvo has spoken about the need for EHR interoperability and helped develop the ONC roadmap to reach this goal.

“We heard loudly and clearly that it was time to focus on interoperability as a priority and we articulated why the time is now to achieve the vision.  First, as a nation, we have made significant progress in digitizing the care experience such that there is now data to be shared.  Second, consumers increasingly expect and demand real-time access to their electronic health information,” DeSalvo stated. “Informed by your input and feedback we acted on this opportunity.”

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Colombia’s health ministry calls to suspend coca crop spraying

BOGOTA (Thomson Reuters Foundation) – Colombia’s health ministry has recommended suspending a herbicide used in aerial spraying of cocaine crops after a report by the World Health Organization (WHO) found it to be a likely cause of cancer.

In a March report, the WHO’s cancer arm, the International Agency for Research on Cancer, reclassified the herbicide glyphosate, saying it was “probably carcinogenic to humans”.

Over the past three decades, more than 1.6 million hectares of land in Colombia have been sprayed using glyphosate to wipe out coca plants, the raw ingredient used to make cocaine.

“What’s important about this study is that it summarizes scientific evidence on the issue (of glyphosate) .. we don’t have another option but to ask for the suspension of glyphosate,” Colombia’s health minister, Alejandro Gaviria, told local W Radio station on Tuesday.

He said his recommendation heeded a 2014 ruling by Colombia’s constitutional court that said precautions in the use of glyphosate should be taken when there are credible health risks to humans.

Colombia’s President Juan Manuel Santos has yet to respond to the health ministry’s recommendation.

Glyphosate is a key ingredient in the world’s most widely used herbicide, Roundup, produced by Monsanto Co.

Monsanto officials have said glyphosate has been proven safe for decades, and the company has demanded a retraction from the WHO over its report linking the chief ingredient in Roundup to cancer.

Colombia, a major cocaine producer, manufactures some 300 tonnes of the drug annually, according to the United Nations Office on Drugs and Crime.

While it has scaled back aerial coca crop spraying in recent years, and has focused more on eradicating coca plants by hand, it remains the only country in the world where drug plantations are targeted from the air.

The U.S.-backed coca fumigation program, carried out by U.S. contractors working in Colombia and national anti-narcotics police, is part of longstanding efforts to eradicate coca fields and in turn stem cocaine production.

Critics say coca crop spraying using glyphosate is not only harmful to humans but damages the environment because it contaminates the soil, rivers and drinking water.

In 2013, Colombia agreed to pay its neighbor Ecuador a $15 million settlement after the Quito government filed a lawsuit before the International Court of Justice in the Hague.

The lawsuit said that the herbicide released from planes spraying along their shared border had blown into Ecuador causing environmental damage and health problems in humans.

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This Desk Makes You Stand Up for Your Health

The Stir Kinetic M1 connected standing desk nudges you when it’s time to stretch your legs

One day, when the machines are our overlords, I may regret saying this: I do the bidding of a robot desk, and I’m the better for it.

“Whirrr, whirrr,” goes my Stir Kinetic M1, undulating its desktop to signal it’s time to stand for a while. I oblige, and its mechanized legs rise to meet me.

Twenty minutes later, the desk purrs again. I’ve earned the right to sit back down.

All day long, the M1 logs my ups and downs and coaxes my derrière out of the comfy office chair that doctors agree is nearly as bad as cigarettes and almost certainly turning us into the human whales from the film “WALL-E.”

The Stir M1 desk retails for $2,990. PHOTO: JASON HENRY FOR THE WALL STREET JOURNAL

I burned an extra 850 calories last week as a result of all the extra standing I’ve done in the course of ordinary desk work. That’s equal to 3½ Snickers bars or two sessions of spin class, depending on how you see the world. Standing at work doesn’t strengthen your heart as much as vigorous exercise, but researchers say it can even benefit people who do exercise.

To get this health benefit, all you have to do is let a desk nag you. And shell out $2,990 for the privilege.

That’s a hefty sum, even in the money-pit world of office furniture. Motorized sit/stand desks without computerized brains can be had for a quarter as much. Without question, the M1 smart desk is a luxury—it has its own touch screen, for goodness’ sake. But a dumb desk can’t address the root of the problem: feeble willpower.

If you work with colleagues with sit/stand desks, you’ve probably noticed a good portion still spend most days slumped in their chairs. When the M1’s makers at Stir studied the issue, they found only 30% of people with push-button, height-adjustable desks changed positions at their desks more than once a week. But 95% of Stir desk owners avoided constant sitting each day. These stats will come in handy when you’re trying to persuade your boss to buy you the Tesla of standing desks.

The M1 is just the beginning. Inventors are building sensors and software into all kinds of everyday things like light bulbs, toothbrushes, clothes and, yes, furniture to monitor all the things we don’t have the self-control or attention to do ourselves. It’s called Big Mother tech—like George Orwell’s Big Brother, only with more nagging.

A touch screen embedded in the desk lets you change positions with a few taps and check out your progress. PHOTO:JASON HENRY FOR THE WALL STREET JOURNAL

While not every dumb thing gets smarter when you stick a computer in it, the M1 turned out to be quite helpful. The best thing about the M1’s take on data-driven motivation is its subtlety. The desk doesn’t sit-shame you by making an annoying beep or, egads, just rising on its own—two bad ideas that the M1’s makers ruled out early on. Instead, it makes the desk equivalent of a sigh, going up and down about an inch for a few seconds. They call this move a whisper breath.

You might wonder: How does this whispering desk know you’re actually there, instead of stuck in some interminable meeting? The M1 has heat sensors. It detects the warmth of a live human, and only tallies sitting or standing time when one is there. (It could be fooled by a dog at your feet.) If you share a desk with someone else, it identifies people by their unique Fitbit trackers. Soon, it will also be able to ID you by the smartphone you carry.

A profile of one of the desk’s legs while extended for standing height. The M1 remembers your ideal sitting and standing height. PHOTO: JASON HENRY FOR THE WALL STREET JOURNAL

You’re always in control. The M1 won’t rise or fall without your explicit say-so, and you can temporarily disable the heaving reminders. You double-tap the integrated touch screen to raise or lower the desk to your desired heights—which it remembers. Touch menus let you adjust settings (like how often you want to stand) and find out how well you’re living up to the desk’s expectations.

There’s a power strip built along the back of the desk so you can hide away unsightly power bricks and keep from accidentally strangling your gear as the desk rises. I occasionally brushed the screen by accident and set the desk moving. But it’s slow enough that it didn’t do any damage.

Living with the M1 for two weeks has convinced me of the virtues of a sit/stand desk. Without one, I lose all sense of time and could easily not move out of my chair for three hours—especially when I’m writing. The M1 shifts me up and down without robbing me of focus. And I appreciated the push, since I’m one of those people who needs a trainer for motivation at the gym.

But all this getting up and down also wears me out. It’s a slow-motion squat workout for your legs, much better even than just standing all day. I find myself sometimes leaning on the desk like a crutch, though. People who’ve used sit/stand desks for much longer than me say the fatigue passes as your muscles grow stronger. You’ll need comfy shoes, which may be easier for men to get away with at work. Unfortunately, standing desks contribute to a potential workplace gender divide.

Built-in outlets allow you to plug in devices on the back of the desk. The set-up is designed to keep wires from getting tangled when the desk changes positions. PHOTO: JASON HENRY FOR THE WALL STREET JOURNAL

I was initially skeptical of the desk’s estimates of extra calorie burn. Doctors measure the energy cost of different activities based on what’s called a metabolic equivalent of a task, or MET. The M1 calculates extra calorie burn using a MET calculator created by Linak, a business partner that makes the actuators in its legs. But there’s general consensus among researchers that standing requires more energy. Harvard’s School of Public Health’sonline Nutrition Source says standing doing light work can use at least a third more energythan sitting at a computer.

I just wish the M1 could give me credit for jogging before work, and maybe go a little easier on me on those days. Stir creator JP Labrosse, a member of Apple’s original iPod team, says that kind of thing is possible in the future. The M1’s computer already connects to the Internet via Wi-Fi, and can upload your activity to Fitbit’s database.

M1 desks are sold on Stir’s website, at Relax The Back stores and through corporate furniture wholesalers. If you’re still reading, you’re probably trying to figure out how to justify the M1’s borderline ridiculous cost to your boss or spouse. Let me share a few talking points that I’ve been preparing to make my own case after I return my loaner:

Research shows that sitting at a desk for just three hours a day can have several negative consequences for your health. PHOTO: JASON HENRY FOR THE WALL STREET JOURNAL

• This version of the Stir M1 actually costs $1,000 less than the first model that came out last year. $3,000 is a steal!

• The average Stir desk user stands 50% of the day.

• According to science, sitting down for more than three hours a day can shave a person’s life expectancy by two years. WHY IS THIS JOB TRYING TO KILL ME?

• IKEA makes a standing desk for just $489, butassembling that could lead to divorce.

• The desk’s little computer can be upgraded, so hey, futureproofing!

• Buying this desk actually costs about as much as two fancy spin classes a week for a year. I’ll burn the same amount of calories—and nobody has to see me in Spandex.

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Is Healthcare Improving Data Breach Prevention Measures?

Healthcare data breach prevention measures are essential in today’s industry, especially as technology continues to evolve and more facilities begin to connect to other networks. Secure data sharing is more prevalent, and organizations need to ensure that as they store, transfer, and use information, they remain compliant with all federal, state, and local laws along the way.

Recent reports show that even though healthcare might be concerned with its data security and data breach prevention measures, it might not always have the necessary tools available. Moreover, research shows that cybersecurity threats are continuously evolving, but there are still some older types of cyber attacks that entities across numerous sectors fall for. A comprehensive data security plan is essential for data breach prevention, especially as data storing, syncing, and sharing grows in popularity.

A recent Biscom survey found that the healthcare industry is greatly concerned with its data security measures, but it is the least likely to use secure data sharing methods.

Organizations across 13 industries stated that security is a major deterrent when it comes to file synchronization and sharing, but “the healthcare industry is one of the most polarizing when it comes to security,” according to Biscom.

The research also found that 100 percent of surveyed healthcare facilities said that ranked security as either the top issue or second most important feature when it comes to secure file transfer (SFT) services. However, healthcare respondents also reported that they may not be using the best tools. For example, respondents that ranked security and encryption as the most important feature, 81 still use email to share files and 45 percent still use FTP.

Other key findings from the report showed how healthcare respondents viewed the features of secure synchronization options:

• 80 percent of respondents said security was “critical”
• 86 percent said ease of use was either “critical” or “very important”
• 60 percent reported that speed was either “critical” or “very important”
• 43 percent said storage and large file support were either “critical” or “very important”

A particularly disturbing find in the survey though was that 93 percent of healthcare respondents would opt for a “simple and easy to use solution” instead of a “complex, but full featured solution.”

Verizon’s “2015 Data Breach Investigations Report” also surveyed numerous industries, including healthcare, and found that 70 percent of today’s cyberattacks use a combination of sophisticated attacks and older methods, such as phishing and hacking.

The report also found that many existing vulnerabilities remain open, due in large part to security patches never being implemented – even though solutions have been available for some time.

“No industry is immune to security failures,” the report’s authors wrote. “Don’t let a ‘that won’t happen to me because I’m too X’ attitude catch you napping.”

Verizon also outlined nine threat patterns that make up 96 percent of security incidents:

• miscellaneous errors, such as sending an email to the wrong person;
• crimeware (various malware aimed at gaining control of systems);
• insider/privilege misuse;
• physical theft/loss;
• Web app attacks;
• denial-of-service attacks;
• cyberespionage;
• point-of-sale intrusions;
• payment card skimmers.

Healthcare was also one of the leading industries when it came to data breaches being caused by physical theft or loss, according to the Verizon report.

“Full-disk encryption, locking down USB ports, password protection, and the ability to remote wipe continue to be the recommended countermeasures, as it’s much better to be ahead of these incidents than be behind the eight-ball,” the report read. “Protecting the data and documenting the steps you have taken to do so is likely the best you can do to avoid a painful post-incident series of events.”

Data breach prevention measures cannot just be relegated to one area. Hacking and cyberattacksmade headlines for the first part of 2015, but email phishing attacks still take place, and facilities cannot ignore the importance of employee training. Therefore, healthcare facilities must use a well-rounded approach to their data security measures.

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D.C. Health Link requests funding for more hires, IT improvements

D.C. Health Link officials are requesting $32.5 million for their budget next year, a $3.8 million increase they say will go toward addressing IT and call center concerns.
Officials told the D.C. Council’s Health and Human Services Committee on Tuesday that they want to add 19 full-time positions to their staff of 54 next year. The new hires will allow the exchange to ultimately save money by reducing its use of consultants, D.C. Health Benefit Exchange Authority Executive Director Mila Kofman said.

“We recognize federal grants are going away,” she told the panel. “We also realize we rely heavily on consultants who are paid for with those grants.”

D.C. Councilwoman Yvette Alexander, who chairs the health panel, pointed out D.C. Health Link already has more employees that the Maryland health exchange, though it is significantly smaller.

“How can you explain the need for that many more staffers?” Alexander asked.

“There are certain fixed costs no matter how large or small a state is,” Kofman responded.

As part of its $11.3 million IT budget, D.C. Health Link is requesting eight full-time IT positions in addition to the three full-time equivalents the agency already employs to build out new features and addressing problem on its website. A number of customers on the individual and small business exchange have complained about numerous glitches and confusing elements on the website in its second year of enrollment.

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Rush University Medical Center VP: Bad guys winning when it comes to security

How healthcare providers mitigate cybersecurity threats has changed greatly over the years, but one thing that has stayed the same is the importance of user education, according to Rush University Medical Center Vice President of IT Operations and Associate CIO Jaime Parent.

Educating employees and ensuring they are aware of a health system’s plan when it comes to cybersecurity is vital to success, he says in a recent interview with HealthITSecurity.com. Rush has an awareness campaign called ICARE/IProtect, which Parent says helps to ensure everyone at the organization stays vigilant.

The workforce must be aware and know what to do in the event of a hack, especially because employees are the leading sources of incidents, law professor Daniel Solove said at the 23rd National HIPAA Summit in March. “It really just takes one person to make a big mess of things,” he said.

The healthcare industry has seen many attacks on security already this year–with the two biggest breaches impacting health insurance companies Anthem andPremera.

Parent says that incidents like those are learning experiences for any provider.

“After these events, the question I get asked most often is–could this thing happen to us?” he says. “And the short answer is that there really is no 100 percent ironclad way to keep all threats out.”

The best start to protecting patients is doing things as basic as installing the most recent anti-virus updates and patch management, he says.

Not everyone is always thinking about security, and the “bad guys are winning right now,” he adds.

“The genie is out of the bottle and it’s going to stay out of the bottle for a long time,” Parent says. “Healthcare will continue to be a target.”

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How to Leverage the Internet of Things for Patient Engagement

Increasing meaningful, effective patient engagement is such a high priority for the healthcare industry that it is included as one of the three branches of the Triple Aim.  Along with reducing spending and improving population health management, however, the process of reengineering the patient experience of healthcare to produce better outcomes is not a simple or speedy task.

Luckily for providers, health IT and consumer technologies are both advancing to the point where patients stay connected to the Internet of Things more often than not, giving healthcare organizations a prime opportunity to leverage that constant engagement for their own needs.

Patient portals are already familiar to many patients, and their demand for mHealth-based solutions for basic care problems is off the charts.  As smartphones, wearables, home monitoring devices, and other internet-enabled tools continue to drive the sense that healthcare help is only an app away, providers must develop the skills and techniques to assimilate and analytics patient-generated health information without overwhelming their workflows.

With so many devices producing so much big data that could have an impact on how patients interact with their healthcare system, how can provider organizations turn the burgeoning Internet of Things environment into truly meaningful patient engagement?

Understand your particular Internet of Things landscape

Securing uniformly high levels of patient engagement has been so difficult for the nation’s healthcare providers that CMS has proposed slashing its Stage 2 meaningful use patient portal requirement from 5 percent of patients to just one single user within the reporting period.  While this change may seem drastic to some providers who are lucky enough to have a tech-savvy population of patients and an effective outreach program, it’s indicative of how important it is to know your limits and set reasonable goals.

Smartphones may seem ubiquitous, but the reality is that only about 80 percent of adults own an internet-enabled mobile device.  For providers operating in low-income areas, that number is going to be significantly lower, and may be coupled with a lack of home internet access, poor computer literacy, and restricted access to community resources like public libraries that can supplement a patient’s connection to the web.

That doesn’t mean that the Internet of Things is absent in these environment, or that patient engagement is a lost cause.  It simply means that providers and their partners may be more responsible for developing a patient engagement infrastructure than those organizations operating in areas where patients purchase tablets, iWatches, and Bluetooth scales themselves.

Pilot programs that provide tablets to patients seeking help with chronic disease management fordiabetes or veterans and their families coping with post-traumatic stress disorder have proven highly successful, while sending teams of telehealth professionals into the homes of seniors to deploy remote monitoring technologies can help elderly patients develop the skills to become engaged while staying out of the hospital.

In order to succeed with a patient engagement strategy based on the availability of connected devices, healthcare providers must remember to develop their programs in accordance with their patients’ resources, not only their own.

Provide simple tools and meaningful functionalities

One of the biggest stumbling blocks for providers looking to boost their patient engagement numbers is the selection of inadequate technologies.  Flat, featureless patient portals and mHealth apps that don’t give users a reason to come back – or leave them too confused to try – can send even the most earnest providers awry.

Patients, especially younger ones with innate Internet of Things experience and expectations, desire a rich, seamless, tailored experience that does most of the work for them.    “When we think of millennials, we know that they want to see things that are individualized for them,” said Tamara St. Claire, Chief Innovation Officer of Commercial Healthcare for Xerox in an interview withHealthITAnalytics.com.  “Engaging them is about providing them with an interaction that really suits their lifestyle, whether that’s through smartphones or tablets or other devices.”

As of late last year, nearly one-fifth of adults planned to add a wearable tracking device to their personal technology suite.  That number includes more than 30 percent of so-called millennials in a poll conducted before Apple even threw its hat into the smartwatch ring.

While wearable devices vary in sophistication from glorified pedometers to streamlined, data-driven tools for developing the quantified self, they require relatively little input from the user in order to fulfill their promises.  Passivity is the key to establishing lasting relationships between a patient and a technology, says John Halamka, CIO at Beth Israel Deaconess Medical Center.  Few patients actively keep their online personal health records up to date, Halamka says, “because it requires time and energy to maintain that data.”

When devices collect information automatically, however, and integrate the data into a single portrait of a patient’s various vitals and statistics, the process of engagement becomes a significantly more attractive one.  “There is nothing I have to do,” Halamka says, when his bathroom scale measures his weight and BMI and sends that data to the manufacturer’s cloud, which then routes the results to an iPhone app and personal health record account.

“All of this just happens as part of my activities of daily living,” he explains.  The data is simply available when and how he wants to use it, whether it’s to track his progress, make decisions about his lifestyle, or schedule a visit to a clinician when something seems amiss.

That is the promise of the Internet of Things in healthcare, and the challenge for healthcare providers who must invest wisely in the right tools to entice patients to engage.

Consume and analyze patient-generated health data within the EHR workflow

Simplicity and automation aren’t just important on the consumer side.  Healthcare providers have been wary of the patient-generated data (PGHD) influx since the EHR Incentive Programs were just a twinkle in the federal government’s eye.

There is no question that PGHD contains significant opportunities to make patient engagement meaningful – if providers can figure out how to integrate it into their workflows.  “Data rests at the heart of health IT’s capacity to help improve care quality and health outcomes: standards-based, interoperable electronic systems make it possible to access, share, use and re-use information that was once locked in paper charts kept by individual providers,” wrote ONC Program Analytics Michael A. Wittie, MPH and Simone Myrie in a blog post earlier this year.

“As more and more consumers engage and adopt mobile health technologies to help them better track their daily health and wellbeing, it will be increasingly important to consider how those data can flow seamlessly from consumers to providers – and back – to help everyone achieve better health.”

The proposed Stage 3 meaningful use rule, which would require more than 15 percent of patients to contribute patient-generated health data from a non-clinical setting, is going to push providers to develop these new big data analytics and interoperability competencies very quickly indeed.

EHR vendors are helping by retooling their products with patient engagement and PGHD in mind, and providers are beginning to understand the critical importance of having access to data about patients that reflects their experiences outside of the provider’s office.  Rulemakers and payers are doing their part by making satisfaction with the patient-provider interaction a key metric for value-based reimbursement and public quality rankings that can have a direct impact on the revenue cycle.  It is up to providers to ensure that the patient is getting something meaningful from their contact with the healthcare system – and PGHD can help.

“If I don’t have an objective measure in my communication with you, then our communication is much less powerful,” Joseph Kvedar, MD, Vice President of the Center for Connected Health at Partners HealthCare, told EHRintelligence.com. “When we’re communicating remotely, it’s so much better to have an objective measure and that’s what the sensors and monitoring are all about — just creating that effective feedback loop that we can use as a tool to both educate consumers and patients about their health but also hold them accountable to care plans.”

But providers who are already feeling overwhelmed with clumsy EHR interfaces, data collection demands, overstuffed calendars, and a diminishing sense of job satisfaction don’t always feel like they need more input sources in order to make their best clinical decisions.  “Doctors have said for about a decade now as we have been talking about this and doing it, ‘I am not sure I want all this data,’” Kvedar said. “But what they’re really saying is, ‘Don’t give me data; I want information.’”

Turn actionable insights into real actions

As patient engagement technologies continue to rapidly evolve, and the Internet of Things becomes less of a futuristic prediction and more of a commonplace reality, healthcare providers cannot be satisfied with just having the tools in place and the data available to them.  They have to actually do something with it.

While Stage 3 meaningful use hopes to jumpstart the industry’s abilities to turn big data into meaningful care improvements, plenty of providers, vendors, and other organizations are already harnessing the concept of the IoT to make patient engagement a reality.

From the OpenNotes project that makes it significantly easier to allow patients to view and add to their personal health records to Apple’s ResearchKit, which collects large-scale PGHD from smartphones to further academic study, the integration of mHealth devices, wearables, patient portals, and other engagement technologies into the daily work of healthcare providers has already begun.

Population health management programs that connect providers with patients through text messaging, mHealth apps that reduce hospital readmissions by tracking chronic disease management or even identifying prescriptions with a picture can significantly improve the quality of life for patients who now rely on their smartphones for everything from mobile banking to hailing a cab or ordering takeout.

The mobile revolution has already swept through the majority of other industries, and healthcare is next.  Healthcare organizations who wish to put the Internet of Things into action for patient engagement should focus their efforts on the development of a simple, integrated, attractive suite of health IT features that can meet consumer demand without overwhelming providers.  If the industry can manage to embrace the idea of patient-generated health data from connected devices as the foundation for meaningful patient engagement, providers will be taking a significant step towards achieving the goals of the Triple Aim.

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What Employers Need to Know About the Hottest Trend In Health Insurance

There are a number of industry trends employers should be aware of in preparation for open enrollment. Of those trends, there’s one that continues to rise in popularity: consumer-driven healthcare plans (CDHPs).

In fact, last year, offerings of consumer-driven healthcare plans jumped from 39 percent to 48 percent among employers with 500 or more employees, according to Mercer’s National Survey of Employer-Sponsored Health Plans.

Consumer-driven healthcare options typically include high-deductible health plans (HDHPs) and health savings accounts (HSAs). For employers, a higher deductible means employees are responsible for a greater amount of their initial healthcare costs. For their employees, the benefit comes in lower monthly premiums.

What’s more, employees who have a high-deductible plan are eligible for health savings accounts. These accounts allow employees to save money, tax-free, for medical expenses. HSAs help employees meet the deductible or, if they remain healthy, can lead to considerable pre-tax savings — especially when employers contribute to those accounts.

The rise of CDHPs. 

Why is the market moving in this direction? For starters, high-deductible plans are attractive to employers because it means managing less of the insurance cost. On the employee side, both high-deductible health plans and health savings accounts encourage employees to be more mindful about their health and more involved in making decisions for the best-value care.

This rise in popularity may also be in an effort to prepare for the “Cadillac” tax, an excise tax scheduled to take effect in 2018 to reduce healthcare usage and costs by imposing a 40 percent excise tax on the value of health insurance benefits that surpass a certain threshold ($10,200 for individuals and $27,500 for families).

How to make the shift.

As more employers include high-deductible health plans and health savings accounts in their list of plan options, it’s important to make the shift smooth for employees. Here are three steps employers should take when shifting to consumer-driven healthcare options:

1. Educate employees.

With only 20 percent of the 5,209 employees surveyed in Aflac’s 2014 WorkForces Report saying they had enough information to prepare them to select benefits, it’s crucial that employers keep employees in the loop — especially when changes are made to their plans.

Help employees better understand their benefits with the following:

• Hold meetings, seminars, and other such events to keep employees informed and up-to-date.
• Invite family members to take part in after-work benefit fairs, as healthcare concerns the entire family.
• Bring in a third-party expert to help employees understand their health plans and make more informed decisions.

2. Embrace transparency.

Like many healthcare options, there are pros and cons to high-deductible health plans. When shifting to consumer-driven health options, be open and honest about what that shift will mean for employees.

Encourage employees to ask themselves whether they can pay for all medical expenses until the deductible is met, whether they can afford the out-of-pocket maximum, etc. Help them make more informed decisions. If a high-deductible plan is all that’s being offered, consider making the plan more attractive by contributing or matching employee contributions to their HSAs.

3. Streamline open enrollment.

When it comes to streamlining the open enrollment process for employers and their employees, modern enrollment technology is a must. Automating the open enrollment process not only saves valuable time for all parties involved, it makes it simple for employees to learn about and manage their benefits, at anyplace and at any time.

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Researchers examine balancing privacy risk, utility of de-identified health data

Researchers have shown how easy it is to re-identify patients in de-identified data, yet de-identified data can lose its value as more identifying factors are stripped out.

In a study published in the Journal of the American Medical Informatics Association, researchers from Vanderbilt University and elsewhere extended an algorithm to explore policy options that balance risk of violating a patient’s privacy vs. the use of data for society.

The Safe Harbor model defined by HIPAA is one policy that specifies 18 rules, including suppression of explicit identifiers such as names, and generalization of “quasi-identifiers,” such as date of birth, requiring recording the age of all patients over 90 as 90+. This rigid rule-based policy might not be ideal for sharing every data set, such as studies on dementia patients.

So the law allows alternatives, provided the risk of re-identification is appropriately measured and mitigated. A Centers for Medicare & Medicaid Services dataset, for instance, published on the Internet would carry a high risk because the system is completely open and the users unknown. Health data to be used by a trusted party with a data-use agreement and strong information security practices could be allowed a policy that favors utility over risk.

The researchers used the Sublattice Heuristic Search algorithm with U.S. census data from 10 states to show it can be applied to recommended rule-based de-identification policy alternatives for patient-level datasets with less risk and more utility than Safe Harbor and other models.

Harvard researchers have shown that patients can be re-identified with just their Zip code, date of birth and gender, along with other publicly available data such as voter rolls.

The Health Information Trust Alliance recently released a new framework for de-identification of sensitive patient information as part of a risk-management strategy.

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Lawmakers Look to Ban Abortion From Health Plans

Health insurers could be prohibited from offering Texans plans covering abortions under a proposal by Republican state Sen. Larry Taylor of Friendswood that passed a Senate committee Monday.

Under Senate Bill 575, private health insurance plans and those offered through the federal Affordable Care Act’s marketplace could only provide coverage for abortions in cases of medical emergencies. Women seeking coverage for what Taylor calls “elective” abortions would be required to purchase supplemental health insurance plans.

“This bill is not a ban on elective abortions. In fact, this bill is all about choice,” Taylor told the Senate State Affairs Committee on Monday as it considered his proposal.

The bill intends to keep premiums being paid to an insurance provider from underwriting abortion coverage, Taylor said. “Under this bill, you can choose to pay for abortions or you can choose not to pay for the abortions of others,” Taylor added.
Ten states now prohibit all health plans from covering abortion, and 15 prohibit abortion coverage on federal marketplace plans, according to the American Civil Liberties Union. Texas currently allows health plans to offer abortion coverage.

Under the federal reform law, states can set their own rules for abortion coverage on insurance plans sold through the federal marketplace. In states where abortion coverage is permitted on marketplace plans, the insurance providers must separate funds that go toward abortion coverage from money that consumers pay for other medical care.

State Sen. Judith Zaffirini, a Democrat from Laredo, said she had heard concerns that requiring women to purchase supplemental plans could lead to high premium rates and questioned whether “the practical effect of this bill would make abortion uninsurable.”

Without insurance coverage for abortions, opponents of Taylor’s bill said they also worried women may seek cheap and unsafe abortion methods and providers.

“We believe every woman should be able to make the personal decision she thinks is best for her and her family and privately purchase the insurance plan that is best for her and her family,” said Ana Rodriguez DeFrates, state policy and advocacy director for the Texas Latina Advocacy Network.

She added that the measure does not provide exceptions for rape, incest and severe fetal abnormalities.

Lawmakers in the House are considering a similar proposal by state Rep. Marsha Farney, R-Georgetown, that would ban abortion coverage from federal marketplace health insurance plans. The House State Affairs Committee considered the measure earlier this month and has not voted on it.

Some anti-abortion advocates have said Farney’s measure doesn’t go far enough.
During the Senate hearing, supporters of Taylor’s measure told the committee that it would better protect Texans who oppose abortion from subsidizing the procedure for others by banning it in all health plans.

Elizabeth Graham, director of the anti-abortion Texas Right to Life, added that insurance is not necessary to pay for the procedure because abortion providers often offer payment plans to women seeking abortions.

“So no woman goes to a clinic without being able to pay for an abortion,” Graham said.

Taylor’s proposal is among several bills making their way through the Legislature that would further restrict abortion in the state two years after lawmakers passed one of the strictest abortion laws in the country. Texas’ abortion law, also known as House Bill 2, requires doctors who perform abortions to have admitting privileges at a hospital within 30 miles of an abortion clinic. It also requires facilities that perform abortions to meet the same hospital-like standards as ambulatory surgical centers, including pipelines for anesthesia and larger hallway sizes.

The passage of HB 2 has led to the closure of dozens of clinics in the state and could leave Texas with fewer than 10 clinics — all in major metropolitan areas — if the abortion law holds up against an ongoing legal challenge.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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For young and old, it’s wise to have a living will to state health-care wishes

Many seniors — perhaps even a majority of Americans older than 65 — don’t have a living will, also called an advance directive.

“The ramifications of not having one are so severe that it’s bewildering that more people don’t do it,” says Howard Krooks, past president of the National Academy of Elder Law Attorneys. Without that document, which spells out your health-care wishes if you are unable to speak for yourself, your loved ones will have to guess. If they disagree, the problem could end up in court. (You can download state-specific forms at www.caringinfo.org.)

Important as these documents are for older people, young adults should also put their wishes in writing. Only 7 percent of those ages 18 to 29 have an advance directive. But at age 18, a person is an adult for purposes of medical decision-making. Before leaving for college, he or she should sign a Health Insurance Portability and Accountability Act release form and a health-care proxy giving someone — typically, a parent — the right to review personal medical information and to make decisions in an emergency. Otherwise, the young person’s loved ones may be locked out of information and decisions.

Your proxy is the person you designate to make health-care decisions for you if you can’t. Not having a proxy is like not having a will: Without it, your decisions will be made by the default person specified in your state’s law. That is especially critical for same-sex married couples in states that don’t recognize their union. Needless to say, it’s important that your proxy understands your wishes and agrees with them. Make sure you update your proxy on any changes in your documents.

“If you have a medical crisis and somebody calls 911, EMTs will come to your house and be on you quickly,” says California geriatric-care manager Linda Fodrini-Johnson. “They won’t read through a long advance directive.” If your health has deteriorated to the point where you don’t want resuscitation, have your doctor sign a do-not-resuscitate (DNR) order. Keep it where it can be easily found by EMTs — perhaps hanging it near your front door in a clear plastic sleeve.

An advance directive isn’t always enough. Those who are so ill or frail that they might die within a year may benefit from a POLST form. Short for “Physician Orders for Life-Sustaining Treatment,” it is much more detailed than a DNR. For instance, in a POLST you can specify whether you want to be tube-fed indefinitely, on a trial basis or not at all. (POLST is not available in every state. To learn more, go to www.polst.org.)

Your family and your health-care proxy need copies, and they should have easy access to duplicates of other key documents. If you are in fragile health, it’s wise to “have a hospital-ready packet close to your front door,” Fodrini-Johnson advises. In addition to documents, the packet should have the names and contact numbers of family members and doctors, your medication list and your POLST form (if you have one). Two free ways for family members to electronically share such documents are by using the My Health Care Wishes app (for Android and Apple) and by visiting the MyDirectives Web site (www.mydirectives.com).

Must-ask questions

After Boston Globe columnist Ellen Goodman was overwhelmed by end-of-life medical decisions for her mother, she co-founded the Conversation Project (http://ift.tt/1pa1erx). To start talking about your concerns, it suggests such questions as:

Do you want to live as long as possible no matter what, or is quality of life more important than quantity?

Would you accept nursing-home care? Or is independent living a priority for you?

Do you want to know just the basics about your condition, or as much as you can?

Do you want your doctors to do what they think is best, or do you want to have a say in every decision?

Are there any disagreements or family tensions that you’re concerned about?

Are there circumstances you’d consider worse than death, such as not being able to recognize family?

Copyright 2015. Consumers Union of United States Inc.

For further guidance, go to http://ift.tt/16ck0jP, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.

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Digital Health Funding Down by About 35% in Q1 2015, Report Finds

While overall digital health funding declined in the first quarter of 2015, mobile health companies were an exception, raising about $282 million, according to a report by Mercom Capital Group,mHealth Intelligence reports.

Report Details

According to the report, digital health funding as a whole decreased by about 35% in Q1 2015, from $1.2 billion across 134 deals in Q4 2014 to $784 million across 142 deals.

However, while digital health funding “fell across the board,” mobile health was “the bright spot” in Q1 2015, according to Mercom CEO and Co-Founder Raj Prabhu.

For example, Prabhu said the mobile health sector saw “significant” merger and acquisition activity, with 10 transactions in Q1, compared with 21 in all of 2014. Of the $282 million in mobile health funding, about $220 million was raised by mobile health app developers, according to the report (Gruessner, mHealth Intelligence, 4/24).

Some of the largest mobile app funding deals included:

• Advance Health, which raised $40 million for its chronic care management and in-home risk assessment data capture apps;
• ClassPass, which raised $40 million for its mobile fitness and wellness membership app; and
• Clinical Ink, which raised $20 million for its clinical trial mobile data capture apps (Baum,MedCity News, 4/23).

Meanwhile, the report found that:

• Telehealth companies raised $65 million in Q1 2015 (mHealth Intelligence, 4/24);
• Wearable sensor companies raised $42 million across nine deals; and
• Mobile wireless technology companies raised $21 million across 12 deals (MedCity News, 4/23).

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There’s lots of health-care technology out there. How do you choose?

The increasing digitization of health care has ushered in a wide array of technological options, pushing patients to read up on them and make good choices. Here’s what the experts say

● Be a wise consumer. You wouldn’t buy a car without reading the reviews and making sure it’s safe. “Patients should use the same approach with health technologies,” said Enid Montague, an assistant professor of engineering and medicine at Northwestern University.

● Tinker and experiment. It’s a good idea to test technology that interests you to discover what “helps you feel in control of your health or a disease or condition that you may have,” said Wendy Sue Swanson, a pediatrician and author of “Mama Doc Medicine” and the Seattle Mama Doc blog. Find the tools that make sense for your life. Maybe you’ll like wearable devices such as watches that help you track your health or maybe you’ll find they’re not for you, she said.

● Go with trusted sources for advice. If you’re wondering if an app or device is really useful, check with your provider or with well-known organizations, said Karen DeSalvo, national coordinator for health information technology in the Department of Health and Human Services. For example, someone wanting to know about an app for diabetes should look to the American Diabetes Association Web site or Web sites for organizations representing endocrinology or internal or family medicine. Networking communities can also be a good source for feedback.

● Think before you click “I agree” on that health app. DeSalvo advises that consumers “be really thoughtful” about what health information or personal data is required from them for a given app. Read very carefully about how your data is going to be used by those who operate the app.

● Be mindful when messaging your doctor. Use secure messaging to share information or to ask questions that don’t need an immediate reply, said Danny Sands, a primary care doctor at Beth Israel Deaconess Medical Center and Harvard Medical School. An office visit or phone call is more appropriate for urgent, time-sensitive symptoms and for topics that take more than a few paragraphs to explain or that require much back-and-forth.

● Use your patient portal to prep for your next doctor visit. Look at your test results. Review notes after a visit. Know what your care plan is, Sands says, and you will be better able to make the best use of your next appointment.

● Ask for what you need. “Keep demanding what you want,” Swanson said. “As patients, we have to be really squeaky wheels.” If you see lab results in your health record that conflict with what you discussed with your doctor or need clarification about instructions for taking a medication, speak up. “If you’re ever concerned that something is going wrong, don’t ever hesitate to speak up and draw attention to it,” she said.

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