The missed opportunity of Medicaid innovation

When CMS released a proposed rule to make significant changes to Medicaid last month, it was the first major change in 12 years. The proposed rule addresses a sweeping range of program goals, including a desire to “catch up” Medicaid to Affordable Care Act requirements and objectives now in place for Medicare and commercial plans.

One of the most important parts of the ACA is also the least controversial: the creation of the Center for Medicare and Medicaid Innovation (CMMI). Given a specific mandate and adequate funding, CMMI has already advanced innovation in healthcare. Today, CMMI has authored numerous value-based reimbursement innovations, all designed to improve quality and efficiency. These payment reform initiatives are critical to transforming healthcare from fee-for-service to fee-for-value.

Despite the equal size of both “Ms” in the acronym, CMMI has much broader authority in Medicare than Medicaid. In Medicare, they can create new initiatives, grant waivers and even adopt the best results as new Medicare policy without congressional action.

Medicaid is a different story. CMMI cannot simply create accountable care or medical home programs in Medicaid nor can they grant waivers to Medicaid policy. They also cannot apply the Medicare waivers to the program integrity laws (such as the Stark or Civil Monetary Penalty laws) to new Medicaid initiatives.

Instead, states must apply through a pre-ACA process to obtain waivers to Medicaid policy. This process is highly bureaucratic, needlessly complex and long. According to a recent study, it takes nearly a year for CMS to respond to a new waiver application.

In that same span of time, CMMI rolled out several new programs including ACOs, medical homes and the Bundled Payment for Care Improvement in Medicare. But not one of these applied to Medicaid.

To be clear, many states are trying to innovate in payment reform. Today, at least five states have various bundled payment programs in Medicaid and 19 states have Medicaid ACOs. In some states, such as Ohio, payment reform goals have been pursued for many years. But the states do not have enough authority on their own to innovate in the way CMMI has done with Medicare.

Among the barriers are the program integrity laws mentioned above. Medicare participants in CMMI projects receive exemptions that not only cover these laws relative to Medicare patients, but the waivers even cover care delivered under agreements with commercial payers. Without these waivers, providers currently participating in Medicaid payment reform may be taking an unacceptable legal risk.  Furthermore, once innovation is proven successful in a state, there is no CMS-based effort to translate these findings across states.

CMMI is trying to work with the law as it exists today. Rather than force a single medical home project for Medicare, it wisely chose to launch in key states where a Medicaid medical home program was already in place and tailor the program in each state to match the local Medicaid program. Recently, in creating the new Oncology Care Model, CMMI made great efforts to create a program that states could choose to enable for Medicaid. These multi-stakeholder approaches to payment reform are critical to their success.

Medicaid has its own specific attributes that make the ability to meaningfully innovate even more important.

• There is a sweeping trend in Medicaid to end the carve-outs of behavioral health, which is among the most expensive parts of the Medicaid system. The ability to innovate with payment reform methods would be a powerful tool for states to use as new models of delivering behavioral health with medical care emerge.

• Many states have a significant access problem, with providers unwilling to accept Medicaid patients, for a variety of business reasons, including rates. The ability of payment reform to make Medicaid more financially attractive would increase access and quality for patients who need care.

• Medicaid is intended to be a state/federal partnership. One reason to have 58 different Medicaid programs (50 states plus D.C. and the territories) is to allow for localized approaches. But the barriers created by CMS impeding local innovation do not allow the states the latitude they need.

• In many states, Medicaid is delivered by Managed Care Organizations, entities that could greatly benefit from direct participation in CMMI programs (either existing or new) for their Medicaid members. As many of these payers operate in multiple states, having national-level coordination and regulation of their efforts toward payment reform makes perfect sense.

There were many options available to CMS to address this problem in the new rule. They could have granted CMMI broader powers to extend the waivers of the program integrity laws that exist for Medicare to Medicaid. They could have allowed CMMI a broader role in partnership with states for payment reform initiatives.

Most importantly, they could have given CMMI the authority to grant waivers to Medicaid policy in the areas of payment reform and quality improvement, even if they insist on retaining the current year-long process for waivers to benefits or financing.

Another option would have been to advance the timing of a little known area of the ACA called Section 1332 or the Wyden waivers. This part of the ACA is now unavailable until 2017, but it will greatly ease the process for states to get any form of Medicaid waiver. Recently, President Obama expressed support for moving up the date when Section 1332 can apply. Doing so, either in full or limited to payment reform and quality related waivers through CMMI, was an obvious way CMS could have enabled innovation in Medicaid.

Perhaps during the current comment period, enough organizations will highlight the need for better innovation in the final rule. Medicare and commercial plans can innovate in payment reform; Medicaid also needs to do so.

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Debunking ICD-10 legends

Many healthcare organizations are focusing on being ready for the ICD-10 changeover on Oct. 1. Just as important is what will come after that.

Productivity losses
This is legend. The fear is that ICD-10 code set is so large and complex that medical coders aren’t going to be able to keep up with their current coding output.

ICD-10 opponents like to point to Canada’s 40 percent drop in coding productivity after their ICD-10-CA implementation. But they also switched from a paper-based system to PC-based system at the same time. Canadian coders had a lot to learn and get used to.

Whether American coders will face comparable challenges is something we won’t know until after Oct. 1. But those challenges could be mitigated by strong ICD-10 training and clinical documentation improvement (CDI) programs. These investments could help preserve medical claim productivity.

After Oct. 1, medical practices could look for other ways to streamline medical coding workflow. Remove inefficiencies. Add automation.

Denials
This is another legend. The American Medical Association (AMA) is predicting denial and rejection rates as high as 20 percent. Which is the basis of their call for an ICD-10 grace period.

Before medical practices panic over that possibility, they need to know their denial statistics now so they can compare what happens to claims after Oct. 1. They need to track:

• Days in accounts receivable by healthcare payer
• Denial rates
• Amount of reimbursements denied
• If reimbursements match the contracted rates
• If tracking waits for Oct. 1, medical practices won’t know if the numbers reveal problems or business as usual. Weekly tracking could help keep small problems from becoming big ones at the end of the month.

And if tracking spots problems, there needs to be a process to contact healthcare payers for find out what is the status of claims.

ICD-10 denial management starts now. Medical practices need to understand what triggers denials now and what could cause problems with ICD-10 claims. This will help prevent crippling reimbursement delays.

Queries
If physicians aren’t documenting at a level that supports ICD-10 specificity, the number of queries from medical coding staff will increase. And that’s going to affect productivity for coders and clinicians. To keep the documentation process moving smoothly, medical coders can improve their queries to make them as efficient and useful as possible:

• Write in clear, concise and precise language
• Use evidence specific to the case
• Avoid asking leading questions
• Include query in the clinical documentation
• Start using ICD-10 language
• Avoid writing queries

Unfortunately these issues will require resources after Oct. 1. That date is not the finish line. Medical practices need to keep running long after the ICD-10 deadline.

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Newspaper calls for resignation of Iowa Board of Medicine members who voted to ban telemedicine abortions

On the heels of a ruling from Iowa’s Supreme Court striking down a ban of telemedicine use for abortions previously made by the state’s board of medicine, the public is losing faith in the board, according to an editorial in the Des Moines Register.

The newspaper is calling for the four board members remaining who voted for the ban to resign. Those members are Hamed Tewfik, M.D., Diane Clark, Allison Schoenfelder and Julie Carmody.

“These individuals cannot be trusted to objectively carry out board duties,” the editorial says. “How will they handle a complaint against a physician who performs abortions or is openly prochoice? What other tactics will they pursue to try to make it more difficult to access a legal procedure or drug because they personally disagree with it?” Editorial

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Few Nursing Homes Use Health IT for External Communication

Few nursing homes use health IT to communicate with outside facilities, such as hospitals and off-site pharmacies, according to a study published in the journal Applied Clinical Informatics,FierceHealthIT reports.

Details of Study

For the study, researchers from the University of Missouri analyzed the health information exchange readiness of 16 nursing homes.

The study was part of a project, funded by a $14.8 million CMS grant, aimed at reducing avoidable hospital readmissions among nursing home residents (Hall, FierceHealthIT, 6/26).

Findings

According to the study, all of the reviewed nursing homes had technology to support patient care tasks.

Researchers found that health IT in nursing homes was often used for:

• Appointment scheduling;
• Admissions and pre-admissions;
• Laboratory specimen drawing;
• Pharmacy orders and reconciliation;
• Pharmacy-medication reconciliation; and
• Social work discharge planning (Alexander et al., ACI, June 2015).

Most nursing homes’ technology was mainly used to communicate internally, rather than externally, according to the study.

In addition, the study found that the nursing homes often used separate systems to track patients’ medications and schedule appointments (FierceHealthIT, 6/26).

The researchers concluded that each facility needed additional human and technological resources to support HIE networks (ACI, June 2015).

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More Health Coverage, And Perhaps More Health, For Same-Sex Couples

You know how it goes: You have the great joy of the wedding — or of the gay pride celebrations that followed the Supreme Court’s marriage decision — and then the honeymoon’s over and it’s time to talk about the mundanities of stuff like (sigh) health insurance.

But still, it can be at least quietly pleasing to contemplate the many a newlywed who’ll now qualify for insurance offered by their new spouse’s employer. (And that on top of the several million people whose health insurance subsidies were just saved by the previous Supreme Court decision, on Obamacare.)

Not to rain on the weddings, but it’s also likely that many employers’ “domestic partner” benefits will go away. The picture is complex, but a study just out in JAMA finds that legalizing gay marriage does indeed increase employer-based health insurance coverage for same-sex partners. It looked at New York after gay marriage was legalized there in 2011, and more than 12,000 same-sex couples wed. From the press release:

Compared with men in opposite-sex relationships, same-sex marriage was associated with a 6.3 percentage point increase in ESI [employer-sponsored health insurance] and a 2.2 percentage point reduction in Medicaid coverage for men in same-sex relationships. Same-sex marriage was also associated with an 8.9 percentage point increase in ESI and a 3.9 percentage point reduction in Medicaid coverage for women in same-sex relationships vs women in opposite-sex relationships.

I asked the study’s author, Gilbert Gonzales of the University of Minnesota, whether anyone had done a similar study in Massachusetts after our own pioneering legalization of gay marriage more than a decade ago.

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Texas Defends A Woman’s Right To Take Her Placenta Home

After giving birth, some women save the placenta in order to consume it in the following weeks. In fact, Texas just passed a law giving women the right to take the placenta home from the hospital, the third state to do so.

Science doesn’t support a lot of the claims of its purported benefits. But for Melissa Mathis, it’s about her rights. Last year she had her baby, Betsy, in a Dallas hospital. When Mathis took Betsy home, she wanted to take the placenta home, too.

“As far as I was concerned it was a part of my body that was in my body. So it wasn’t like something, it didn’t really feel that strange to me,” Mathis says.

Like many women, Mathis had heard through friends about eating a little placenta every day in the weeks after giving birth.

The placenta, sometimes called the afterbirth, is typically dehydrated, ground up and put into edible capsules. Many midwives and doulas believe that because the placenta grows along with the fetus, it contains hormones and nutrients that can help a woman recover from childbirth.

Some say it helps women breastfeed or can prevent postpartum depression.

Mathis took the capsules for six weeks.

“It’s hard for me to know what the effects were because I don’t have anything to compare it to,” she says, “But I had great success breastfeeding, I had no problems with emotional instability. I definitely feel that it helped me.”

Mathis says the hardest part was just getting her placenta in the first place.

Texas classifies placentas as medical waste. And hospitals have liability concerns because placentas could carry infectious disease. Mathis says she spent months during her pregnancy communicating with hospital administrators about arranging custody of her placenta when the time came, but she says the answers she got were too vague.

So when Betsy arrived, Mathis and her husband waited until nobody was looking.

“And we were able to grab it, and we got it and put it in a cooler and threw it in a backpack and my husband handed it off to the placenta handler in the lobby of the hospital and that’s not ideal. And, in my opinion, that’s not acceptable.”

Mathis talked about it with her state representative, Dallas Republican Kenneth Sheets.

“It seemed like an issue that involves freedom and liberty and just a basic right and we just decided we’d take it on,” he says.

Sheets wrote the new law that allows women to keep placentas, if they sign a waiver and don’t test positive for infectious disease.

Texas is the third state in less than a decade to put a placenta law on the books. The first were Hawaii and then Oregon.

And yet doctors say there’s no scientific evidence behind all the health claims. Some women say the placenta helped them, but researchers say it’s probably just a placebo effect.

“We don’t have any studies on this,” says Dr. Catherine Spong, deputy director of the National Institute of Child Health and Human Development.

Spong is much more interested in how the placenta functions during pregnancy, not after.

“The placenta is really the lifeline. It serves as the baby’s lungs, the baby’s kidney, it has functions of the liver, of the GI tract,” Spong says. “Interestingly, it also has immune functions and endocrine functions.”

Spong says her institute will spend $44 million on placenta research over the next few years. She says she doesn’t feel comfortable offering an opinion on moms who eat placenta, simply reiterating that science doesn’t support it.

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Health Briefs: Boehner visits West Chester Hospital

Greetings, Gentle Readers. Monday is the birthday of Amy Wilson, our fine storytelling coach here at The Cincinnati Enquirer/cincinnati.com. Our health as writers improves with her in the room.

Boehner cheers West Chester Hospital

House Speaker John Boehner stopped into his home town of West Chester last week to congratulate the staff of West Chester Hospital on receiving Level III Trauma Center status.

On the hospital’s helipad, as the traffic of Interstate 75 whizzed by, Boehner said, “I want to take a moment and say thanks to all of you who are associated with the hospital for what you do. For us mere mortals who aren’t involved in the health care delivery system, we don’t think much about it, until we need it. So on behalf of us in the community, thanks for what you do.”

Dr. Kevin Joseph, the hospital’s chief executive officer, said the speaker’s visit “uniquely illustrates and recognizes the numerous people and organizations who have helped to make this accreditation of a Level III trauma center possible.”

The American Trauma Society defines a Level III trauma center as demonstrating an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations.

Quit-smoking plan from Cradle Cincinnati

Cradle Cincinnati, the regional nonprofit focused on reducing infant deaths, has a new plan to help pregnant women quit smoking. Tobacco use more than doubles the risk of preterm birth, and each year, more than 1,100 Hamilton County pregnant women smoke during the second and third trimesters.

The plan has four components:

• Any pregnant mom can call 1-800-QUIT-NOW for resources. This week, in partnership with CVS Health, billboards go up around town with a message of support for moms.

• Motivational interviewing during prenatal care, with a technique called the Five As. When clinical staff ask, advise, assess, assist and arrange steps with patients, more moms quit smoking.

• Hamilton County also is hiring a full-time maternal smoking cessation health educator.

• The development of new support groups to bring pregnant women into a supportive atmosphere to discuss their pregnancies while also providing resources and fostering skill development to cope with tobacco cessation.

A pregnant woman in Ohio with a pack-a-day smoking habit spends $1,587 on cigarettes during her pregnancy. Hamilton County spends $2.6 million a year on medical costs for preterm babies whose early birth was related to cigarette smoking.

Galen College of Nursing honored

Quality Matters, a nationally recognized, faculty-centered, peer review of online courses, has recognized Galen College of Nursing in Cincinnati for its design of effective online courses and its rigorous application of standards.

Galen College of Nursing has an online program offering courses for registered nurses to receive a bachelor’s degree that it launched last summer.

“I am thrilled that our first RN to BSN courses have been Quality Matters certified,” said Kathy Burlingame, dean of online programs. “Because Quality Matters is a peer review process that is focused on the students’ online experience, this external validation is a testament to Galen’s commitment to create an exceptional online RN to BSN program experience.”

Lupus group meets in Forest Park

The Lupus Foundation of America, Greater Ohio Chapter will hold its monthly lupus support group in Forest Park Tuesday, July 7 at the Forest Park Library.

The support group is an open, small-group environment that encourages discussion among lupus patients and their families. It is a place where persons with lupus can share their experiences and ask questions. Most discussions focus on living with a chronic illness.

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DOJ Girds for Strict Review of Any Health-Insurer Mergers

The Justice Department is gearing up for an exacting look at any proposed mergers among the nation’s top health-insurance companies, amid questions inside and outside the department about whether industry consolidation could suppress competition.

The five biggest health insurers have been circling one another for potential deals.Anthem Inc. has made public a $47.5 billion bid for Cigna Corp., which Cigna has so far rejected. Aetna Inc., meanwhile, has made a takeover proposal for Humana Inc.

If the insurers succeed in striking such deals, it would leave the industry topped by three big companies, each with annual revenue of more than $100 billion. UnitedHealth GroupInc., currently the largest health insurer, also recently made a takeover approach to Aetna.

Many of the mergers under discussion have the potential to raise antitrust concerns, a senior Justice Department official said, adding that health insurers considering such deals should do a careful antitrust risk-assessment of the transactions.

Antitrust enforcers have had initial discussions about how they would approach any insurance tie-ups, and they are preparing for the possibility they could face multiple deals simultaneously, this official said.

If there were a wave of mergers at once, the department would look at the deals collectively, rather than each one in isolation. Enforcers would try to determine what effect the deals could have on the marketplace, and pursue questions about whether they would benefit consumers, the official said.

The big insurers declined to comment on the antitrust scrutiny that any potential deals in the industry might face.

In a recent call with industry analysts, Anthem Chief Executive Joseph Swedish said a combination of his company with Cigna would have “the scale to drive greater efficiency and affordability for our customers,” and would be able to “accelerate improvements in the total cost of care.”

A spokeswoman for America’s Health Insurance Plans, the industry trade group, said health-plan combinations don’t increase premiums, and that insurers’ “focus is on making sure consumers have affordable coverage.”

The prospect of consolidation poses high stakes for the Obama administration, whose signature domestic policy legacy is the 2010 health-care law. Some aspects of the health law were designed to increase insurance-industry competition, including marketplaces for health coverage and the creation of new nonprofit cooperative health plans around the country.

But the law also includes provisions that may have helped inspire consolidation, at least indirectly. For instance, it requires insurers to spend a certain percentage of premiums on health care, which adds to the pressure to trim administrative costs,—a benefit insurers are likely to seek from merging.

A Wall Street Journal analysis from earlier this month found some combinations of the top health insurers could damp competition in certain markets around the country.

The law also contains policies encouraging health-care providers to move to forms of payment that involve tracking the care of groups of patients, aiming to save money and improve care. Providers say they need size and resources to transform health care, one of the driving sentiments behind recent consolidation by hospital groups and other health-care providers.

Just as the Justice Department is eyeing the health-insurance side of the equation, the Federal Trade Commission, which also has antitrust enforcement powers, has raised concerns about consolidation on the hospital side, challenging several mergers.

In fact, insurers are bulking up partly to face off against the larger hospital systems in negotiations about rates and payment models.

“All of this consolidation is about bargaining power,” said Glenn Melnick, a professor at the University of Southern California who specializes in health-care finance. He co-wrote a study published in the journal Health Affairs that suggested increased health-insurer consolidation could benefit consumers by pushing down hospital rates, “as long as health-plan markets remain competitive.”

Some research has linked having fewer health insurers to higher insurance rates.

“There’s no good evidence out there that scale is associated with lower premiums or improvements in plan quality,” said Leemore Dafny, a former FTC official who is a professor at Northwestern University’s Kellogg School of Management. Ms. Dafny, who co-wrote a paper tying greater competition in the health-law marketplaces to lower rates, said it isn’t clear insurers would pass on to consumers the benefits of any hospital discounts they achieve.

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Which health system has higher list prices? What new Medicare data tells us about health care in Springfield

In 2013, the most common reason for a Medicare beneficiary to be admitted to one of CoxHealth’s hospitals in Springfield — and the second-most common reason for admission to Mercy Springfield — was code 871.

That’s the shortcut name for a particular treatment for septicemia or severe sepsis, or infection of the blood.

The list price for that treatment at Mercy that year was $43,630.99.

That’s 24.3 percent higher than the list price at CoxHealth that year — $35,100.38.

And the gap between the two predominant local health care systems was larger for some procedures. Code 207 — respiratory system diagnosis with more than 96 hours of ventilator support — had a list price of $101,901 at CoxHealth, compared to $179,127.88 at Mercy.

In general, the list price for the most common procedures tends to be higher at Mercy Springfield than rival CoxHealth, according to a News-Leader review of Medicare payment data released earlier this month. But list prices at both fall tend to be below state and national averages.

The data was released by the Centers for Medicare and Medicaid Services for the third straight year in an effort to increase transparency, according to the Obama administration.

The combined sticker price for 95 of the 100 most frequently-billed discharges adds up to $3.53 million at Mercy, 14.6 percent higher than CoxHealth’s total of $3.08 million. Mercy has the higher list price for 68 procedures, with Cox higher for 27. (Five discharges don’t have data from both health systems, due to a limited number billed at one or both).

A News-Leader reporter requested comment from Mercy and CoxHealth regarding the data and the findings on Monday. Spokeswomen for the two systems separately responded Friday afternoon, and recommended contacting the Missouri Hospital Association.

“Missouri Hospital Association is probably the best agency to explain the data you’re trying to understand,” CoxHealth spokeswoman Michelle Leroux said in an email. “As for the public it’s always a good idea for them to find out from their payer (insurance company) what the company will charge them for specific procedures or how much is covered by their insurance company.”

The hospital association’s vice president for media relations did not immediately respond to a message requesting comment.

Most people don’t pay hospitals’ list price, as a result of having Medicare or private insurance; insurance companies typically negotiate with health systems and pay a lower price. But list prices can still directly affect the uninsured — although those individuals are often candidates for financial assistance — and also can affect those using hospitals outside their insurance network.

The latter might become more common than it has been.

Gordon Kinne, president and owner of Springfield-based employee benefits company Med-Pay, said Wednesday that insurance companies have taken plans in diverging directions in recent years. Some more expensive plans being offered have a larger network than commonly seen in the past, sometimes with multiple tiers of coverage. But other plans, often being offered to cost-conscious customers through federal and state exchanges, have a narrower range of hospitals and doctors included, allowing for lower monthly premiums.

“Any source that provides transparency in procedure pricing is a valuable tool for consumers to have,” Kinne told the News-Leader.

And for those with private insurance, the list prices “at least give the consumer an indication of what the insurance company is going to pay,” Kinne said.

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An App a Day for LGBT Health

Now that the U.S. Supreme Court has made marriage equality the law of the land, researchers are hoping to learn more about the inequalities LGBT people face in health care. A new app, Pride Study, requires just 30 minutes of participation a year, and the data it gathers would inform the first large-scale, long-term health study of the LGBT community.

LGBT health advocates are optimistic about the potential of tapping into the iPhone’s massive user base to gather this vital data. The app, developed by the University of California, San Francisco, asks participants to answer demographic surveys, complete activities, and share health data.

There’s a real lack of evidence-based information on community health,” researcher Juno Obedin-Maliver said in a UCSF press release. “The current landscape for LGBT health is less of a map and more of a signpost in the desert. We aim to create that map.”

The Pride Study app is based on ResearchKit technology, launched last March, which relies on information collected by iPhone sensors and user surveys to conduct research on diabetes, breast cancer, asthma, cardiovascular disease, and Parkinson’s disease. Pride Study researchers hope to assess the impact of HIV/AIDS, smoking, cancer, obesity, and mental health issues in the LGBT community.

Previously, small-scale studies have hinted that members of the LGBT community are more susceptible to conditions such as depression and anxiety and are at higher risk of suicide. Scientists are hoping the app will help them learn more about those issues so that they can be addressed.

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Why nursing homes should embrace HIEs

Inefficient and unclear communication between hospitals and nursing homes can complicate care, so researchers are looking to health information exchanges to change that, according to research published at Applied Clinical Informatics.

Researchers from the University of Missouri undertook a project–using a $14.8 million grant from the Centers for Medicare & Medicaid Services–aimed at reducing avoidable re-hospitalizations among nursing home residents, according to an announcement.

In assessing the HIE readiness of 16 nursing homes, they found that while many used electronic record-keeping internally to support patient care tasks most of the technology was not used to communicate externally, such as with hospitals or off-site pharmacies. In additon, tracking patients’ medications or scheduling appointments often was done using separate systems.

The researchers identified areas most integral to patient care and how technology can facilitate those tasks. Using diagrams, the researchers developed visual representations of the communication flow and how technology could streamline and integrate existing processes.

In the next phase of the project, the researchers will evaluate whether HIE implementation improves communication about resident care and how clinicians and other staff feel about integrating the HIE into their workflow.

The information exchnages are continuing to evolve, as have providers’ needs regarding them, according to a new report from NORC at the University of Chicago researchers for the Office of the National Coordinator for Health IT. Researchers found that providers’ HIE needs have moved beyond simply connecting disparate electronic health record systems and the need to meet Meaningful Use requirements into more of a desire for information at the point of care to improve healthcare delivery.

In addition, statewide health information exchanges in four states–Colorado, Massachusetts, Maryland and Oklahoma–have used  “challenge grants” from the Office of the National Coordinator for Health IT to develop ways of connecting long-term and post-acute-care providers online with hospitals, physicians and other providers.

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Internet of Things just the beginning of disruptive healthcare innovation

The proliferation of Internet-connected devices is changing healthcare delivery, said panelists at last week’s 2015 BIO International Convention in Philadelphia. And there’s much more disruptive tech in the industry’s future.

Brandon Staglin, director of marketing communications at the One Mind Institute, discussed the role of digital therapeutics in the treatment of neurological disorders, according to an article in Bioscience Technology.

Staglin, who was diagnosed with schizophrenia in 1990, spoke of the healing potential of wearable sensors, saying they could help monitor his thoughts, set schedules and help with medication adherence.

Jack Hidary, chairman of Samba Energy and a board member of Google X and the Palo Alto Prize Foundation, spoke about “moonshot” technologies that were once thought of as a joke–such as self-driving cars–but are now mainstream.

Hidary went on to talk about combining computational immunotherapy and genomics to create a replacement for traditional methods of treating cancer. In his view, this data-driven approach will require better modeling of the immune system to find new breakthroughs.

As the cost of genomic analysis drops, he added, more companies can conduct larger genomic analyses of patient populations, leading to further breakthroughs.

That’s already happening, of course. The Broad Institute of MIT and Harvard recently announced that they are teaming up with Google Genomics to explore how to break down major technical barriers that increasingly hinder biomedical research. They’ll work to anser the call for computing infrastructure to store and process enormous datasets and create tools to analyze such data as they aim to unravel long-standing mysteries about human health.

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24 Health Care Groups Included on List of ‘100 Best IT Workplaces’

Sixteen hospitals and health care systems and several other health care organizations were included on Computerworld‘s 22nd annual list of the “100 Best Places to Work in IT,” Computerworld reports.

Methodology

Nationwide, 461 organizations were nominated for the list.

To qualify for the list, U.S.-based companies had to have at least 30 IT workers, and companies based outside of the U.S. had to have at least 300 workers overall in the U.S and at least 30 IT workers, of whom 50% had to be in the U.S.

The magazine surveyed the nominees to determine various job characteristics, such as:

• Average salary and bonus increases;
• Benefits;
• Career development;
• Training opportunities; and
• Turnover rates among IT staff.

The magazine then surveyed a random sample of IT employees at the eligible companies on topics such as:

• Satisfaction with training; and
• Work-life balance.

The magazine’s rankings were grouped into three categories:

• Small firms, or those with fewer than 1,000 U.S. employees;
• Midsize firms, or those with 1,000 to 4,999 U.S. employees; and
• Large firms, or those with 5,000 or more U.S. employees (Keefe/Mayor, Computerworld, 6/22).

Hospitals, Health Systems on List

The hospitals and health care systems included on the large firm list include:

• Sharp Healthcare in San Diego (No. 4);
• Kaiser Permanente in Oakland, Calif. (No. 13);
• HCA in Nashville, Tenn. (No. 15);
• Children’s Hospital of Philadelphia (No. 16);
• Cedars-Sinai Health System in Los Angeles (No. 21);
• Adventist Health System in Altamonte Springs, Fla. (No. 25);
• OhioHealth in Columbus, Ohio (No. 32);
• Cancer Treatment Centers of America in Boca Raton, Fla. (No. 33);
• Palmetto Health in Columbia, S.C. (No. 39);
• Intermountain Healthcare in Salt Lake City (No. 41);
• Carolinas HealthCare System in Charlotte, N.C. (No. 53); and
• Cook Children’s Health Care System in Fort Worth, Texas (No. 55).

The hospitals and health care systems included on the midsize firm list include:

• Lafayette General Health in Lafayette, La. (No. 2);
• Nicklaus (formerly Miami) Children’s Hospital in Miami (No. 5);
• Halifax Health in Dayton Beach, Fla. (No. 10); and
• Genesis HealthCare System in Zanesville, Ohio (No. 16).

No hospitals or health systems were included on the small firm list rankings.

Other Health Care Companies on the List

Meanwhile, the list also included several companies that provide health care-related services, including:

• Biotechnology company Genentech in San Francisco (No. 10 among large firms);
• Health care consulting firm S&P Consultants in Braintree, Mass. (No. 24 among small firms);
• Health care services company McKesson in San Francisco (No. 46 among large firms);
• Health IT systems vendor Cerner in Kansas City, Mo. (No. 29 among large firms);
• Health insurer Humana in Louisville, Ky. (No. 22 among large firms);
• Home health software vendor Axxess in Dallas (No. 6 among small firms);
• Medical device maker Medtronic in Minneapolis (No. 14 among large firms); and
• Staffing firm CHG Healthcare Services in Salt Lake City (No. 7 among midsize firms) (“100 Best Places to Work in IT” list, 6/22).

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Threat Situational Awareness- Navigating The Flood Of Security Data

One of the top challenges facing security practitioners today is not simply defending themselves from the risk of attack, but prioritizing the constant stream of threat data they receive from security tool designed to protect them. “Too Much Information” is the new reality for many organizations and the question has now become how to identify important incidents from low-priority events.

During this interview with ICIT Fellow Danyetta Magana, Parham Eftekhari (Sr. Fellow, ICIT) will explore these topics and more as the two identify solutions to overcome this growing challenge.

 

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Proposed Cyber Legislation And Their Impact On The Security Community

As the number of breach incidents continues to climb, the importance of a highly skilled cybersecurity workforce on protecting our nation’s critical infrastructure sectors continues to grow. But how does proposed legislation impact the cyber communities ability to do their job?

During this podcast with ICIT Fellow Dan Waddell (Managing Director, National Capital Region, (ISC)2) we asses this question and look at issues including net neutrality and threat information sharing.

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AHIMA starts campaign against ICD-10 ‘grace period’

The American Health Information Management Association is not a fan of a bill that would create a two-year grace period for ICD-10, and is asking its members to contact lawmakers about the legislation.

On its website, AHIMA has a letter template for members to use when contacting legislators. It says that the grace period could lead to waste, fraud and abuse and calls the bill “unnecessary.”

The bill was proposed by Rep. Gary Palmer (R-Ala.). During the grace period, physicians and other providers would not be “penalized for errors, mistakes and malfunctions relating to the transition,” FierceHealthIT previously reported.

“H.R. 2652 is a well-intentioned yet misguided effort to improve the claims process. The unintended consequences of this bill have the potential to lead to waste, fraud and abuse in medical billing and claims systems,” the AHIMA letter concludes.Letter

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CVS connects with providers via Epic

CVS Health has partnered with four health systems nationwide to provide them patient prescription and visit information, securely sharing data through its Epic electronic health record system.

CVS has entered into new clinical affiliations with Sutter Health in California, Millennium Physician Group in Florida, Bryan Health Connect in Nebraska and Mount Kisco Medical Group in New York.

Through the partnerships – which bring the number of clinical collaborations for CVS Health and MinuteClinic to nearly 60 major health systems – these organizations’ patients will continue to have access to clinical support, medication counseling, chronic disease monitoring and wellness programs at CVS/pharmacy stores and MinuteClinic, the retail medical clinic of CVS Health, officials say.

These providers will receive data on interventions conducted by CVS pharmacists, with the aim of improving patients’ medication adherence for their patients. The affiliation encourages collaboration between the health systems and MinuteClinic providers to improve coordination of care for patients seen at MinuteClinic locations.

Affiliate organizations and MinuteClinic practitioners will also work together on planning strategies around chronic care and wellness, officials say: If more comprehensive care is needed, patients can follow up with their primary care provider and have access to the services at the health care provider as appropriate.

“In this era of health care reform, we are pleased to work with these health care organizations to develop collaborative programs that enhance access to patient care, improve health outcomes and lower healthcare costs in the communities they serve,” said CVS Health Chief Medical Officer Troyen A. Brennan, MD, in a press statement.

MinuteClinic, CVS/pharmacy and participating providers will work to streamline and enhance communication through their EHRs, such as the electronic sharing of messages and alerts from CVS/pharmacy to the health care organizations’ physicians regarding medication non-adherence issues. MinuteClinic will electronically share patient visit summaries with patients’ primary care physician when they are part of an affiliate organization and with the patient’s consent.

“By allowing our electronic health records and information systems to communicate and share important information about the patients we collectively serve, we will have a more comprehensive view of our patients, which can aid in health care decision making and help ensure patients adhere to important medications for chronic diseases,” said Brennan.

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Work remains in understanding BA security risks

While business associate agreements are likely to be a bigger target of 2015 OCR HIPAA enforcement, there’s a lot of work yet to be done in that area, David Szabo, a partner in the Boston office of the law firm Locke Lord LLP, tellsHealthcare Info Security.

A key distinction to understand, he says, is whether a business associate is your agent, subject to your control, or independent, in which case a breach would be that organization’s own problem.

“If the business associate is your agent … you are responsible for anything that happens within that scope of work. If the business associate has a breach, makes an improper disclosure … the covered entity can be held directly accountable, as if they did it themselves,” he explains.

A lot of organizations have problems where business associates won’t sign an agreement, or some providers have BAs who want to sign the agreement and do no more. “There’s a lot more to it than just signing an agreement,” Szabo says.

Covered entities can spend a lot of lawyer time on indemnity clauses, insurance, what responsibilities a BA has, who covers breach costs, who controls notification and other issues, he says. It might not be worth all that for a BA who plays a minor role in the organization and has little to do with sensitive data. However, those that are mission-critical, host large amounts of your data and are involved in other sensitive areas require a lot more attention.

In addition, more organizations are asking about cybersecurity insurance, an area Szabo predicts will get a lot more attention going forward.

In May, the Office of Civil Rights sent pre-audit screening surveys to covered entities that could be selected to participate in much-delayed Phase 2 of the HIPAA audit program.

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Keeping Smart Cities Smart Preempting Emerging Cyber Attacks in U.S. Cities

The Institute for Critical Infrastructure Technology, working closely with IOActive and other Fellows, has published its latest legislative briefing titled “Keeping Smart Cities Smart: Preempting Emerging Cyber Attacks in U.S. Cities“.   As more and more U.S. cities adopt ‘smart’ technologies,  America finds its urban centers  increasingly at risk for cyber-attacks which could bring entire cities to a standstill, wreak havoc for citizens and cost billions for governments and the private sector.

In this analysis, ICIT identifies the various types of technologies that are used in smart cities and how each type of technology is vulnerable to an attack (including likely attack scenarios).  The report closes by making recommendations on what vendors and policy makers must do to ensure that the technologies manufactured for use in smart cities are adequately secure.

This brief was sent to members of the House of Representatives Homeland Security Committee and Cybersecurity Caucus, presented to Representatives and Senators including Senators Markey and Alexandar and Congressmans Marchant, Ratcliffe and Langevin, federal agencies and select ISACs and DHS Sector Coordinating Councils.

The following experts contributed to this brief:

Author:

• Cesar Cerrudo, ICIT Fellow (CTO, IOActive)

Contributions by:

• James Scott (ICIT Senior Fellow – Institute for Critical Infrastructure Technology)
• Drew Spaniel (ICIT Visiting Scholar, Carnegie Mellon University)
• Chris Schumacher (ICIT Fellow – Sr. Technology Consultant, New Light Technologies)

GO HERE TO DOWNLOAD BRIEF

 

 

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Securing Federal Data Post OPM : Lunch and Learn

This week the Institute for Critical Infrastructure Technology held a Lunch and Learn called “Securing Data for Today’s Federal Agency” which focused on the increasingly daunting task of protecting federal data in an age of information sharing and increased threats both inside and outside an agency.  An all-star cast of current and former federal agency leaders along with ICIT Fellows and industry partners shared cutting edge strategies, technologies and best practices to guide agencies through the uncertainty they face as they work to protect their assets.

Some of the key takeaways from the session included:

1. The importance of encrypting your data using technologies that enable the data owner to revoke access

2. Understanding the difference between secure information sharing and creating cultures of trusted information sharing

3. Accepting that there is no way to prevent data leakage from happening, so the mindset must change to ‘how do I gain better control over data knowing I will eventually lose control?”

4. The importance of integrating the various security products an agency uses into one security system, and taking the knowledge gleaned from that system and delivering it into the hands of end users who can use it to make decisions to protect the network and its assets

5. The emergence of predictive technologies like Behavioral Analytics which are providing agencies the ability to foresee breaches and prevent them from occurring

 

A special thanks to our Fellow Dan Skinner (Federal Practice Manager, WatchDox by Blackberry) and to Richard Spires (CEO, Resilient Networks; Former CIO, U.S. Department of Homeland Security) for hosting the Luncheon.

 

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How hospital IT teams maintain continuity amid chaos

In the midst of disaster, hospitals often serve as a refuge, a place of comfort for those in need of care or shelter. But even hospitals aren’t immune to chaos, as electronic health record systems, network connections and even whole power grids can be rendered useless in the blink of an eye.

Response to and recovery from IT outages are critical, as UC Irvine Health’s Charles Podesta knows all too well. Prior to accepting a role as chief information officer for the Orange, California, health system in September 2014, he served for five years in the same capacity for University of (Burlington) Vermont Medical Center (then known as Fletcher Allen Health Care). A little more than one year into his tenure—and roughly one month after completing implementation of a brand new electronic health record system—the 562-bed hospital suffered a freak power outage that left its EHR system out of commission for nearly half a day.

A Domino Effect

“It started with a squirrel getting blown up on a transformer,” Podesta recalls. “It was on a wire, which knocked out a transformer, which sent a surge to the system, and actually blew out some of our electrical and mechanical equipment.”

From there, the situation only got worse. The uninterruptible power supply did not kick in. Then the failover software didn’t activate.

“I remember those events happening and just shaking my head, [thinking] ‘how could all those things occur?'” Podesta says.

Maintaining Care Quality

The one thing that did go right during the outage, according to Podesta, was business continuity. To maintain high quality of patient care, staffers reverted back to using paper records during the outage.

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Report Identifies Five Health IT Trends for Health Care Systems

The future of the health care industry will be shaped by five health IT trends, according to a new report released by Accenture,Healthcare IT News reports (McCann, Healthcare IT News, 6/23).

For the Accenture 2015 Healthcare IT Vision report, researchers surveyed:

• 101 health care executives;
• 601 doctors; and
• 1,000 consumers (Pai, MobiHealthNews, 6/23).

Findings

The five trends identified by the report were:

• “Intelligent Enterprise,” or a focus on data to help improve clinical outcomes;
• “Internet of Me,” or personalized medicine;
• “Outcome Economy,” or a system focused on “delivering results,” in part through increased data accessibility;
• “Platform (R)evolution,” or the increasing prevalence of mobile and cloud platforms that focus on interoperability; and
• “Workforce Reimagined,” or the emergence and implementation of new machine technologies.

The report found that 73% of health executives said they have seen a positive return on investment in personalized medicine technologies (Healthcare IT News, 6/23). Such tools include wearable devices that can track patients’ fitness and vital signs.

Further, the report found that:

• 85% of physicians said wearable devices can help patients better engage with their own health; and
• 76% of patients said that wearable devices have the potential to help them manage or improve their health (MobiHealthNews, 6/23).

Meanwhile, 41% of executives said their data volumes have jumped by 50%, compared with a year ago (Healthcare IT News, 6/23).

In terms of intelligent machine technologies, the report found that:

• 84% of executives expect that the health care industry within the next three years will need to focus on training machines — such as algorithms, intelligent software and learning tools — as much as they focus on training people; and
• 83% of respondents believe that providers will have to manage such machines, as well as employees, due to the increase in clinical data (MobiHealthNews, 6/23).

The report also projected that 66% of health systems in the U.S. will have self-scheduling technologies by 2020 (Healthcare IT News, 6/23).

Kaveh Safavi, global managing director of health care industry at Accenture, in a statement said, “As the digital revolution gains momentum, doctors and clinicians will use machines to augment human labor, personalize care and manage more complex tasks” (MobiHealthNews, 6/23).

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73% of Orgs See ROI from PGHD, Healthcare Big Data Analytics

Before it can be used for analytics, healthcare’s big data has to come from somewhere.  Wearable devices, mHealth apps, and remote sensors are increasingly becoming the source of patient-generated health data (PGHD) that can aid in chronic disease management and population health, even as providers continue to struggle with accepting and synthesizing this information within the EHR.

But healthcare organizations that successfully meet the challenges of patient-generated health data are seeing a return on their investment, claims a new survey from Accenture.  Seventy-three percent of organizations that have adopted personalization technologies have seen positive financial resultsfrom the decision so far.

Physicians are also cautiously optimistic about integrating wearables into their treatment plans.  Despite the results of a recent MedPanel survey, which indicated that only 15 percent of providers discuss wearables with their patients, eighty-five percent of physicians participating in the Accenture poll say that the use of wearable health devices improves patient engagement by keeping users on track with daily management of their conditions.

Patients, too, are eagerly embracing wearables and mHealth technologies as they drive the rapid growth of the Internet of Things.  Seventy-six percent say that the use of these personal devices has the potential to improve their health.  Fifty-four percent of patients say that monitoring their vitals and other statistics is one of the primary reasons they use any type of smartphone apps.

“We’re entering an era of personalized healthcare where patients expect to have a meaningful and convenient individual health experience, both virtually and in-person,” says Kaveh Safavi JD, MD, who leads Accenture’s health business. “The advent of real-time patient data, smarter technologies and individualized services will help health providers break from their traditional business models and provide outcome-focused services for individuals.”

Patient-generated health data has the potential to become a major asset for healthcare organizations, especially those that embrace the idea that big data analytics is quickly becoming a core competency they can no longer avoid.

More than 40 percent of health executives responding to the survey said that the volume of data generated and stored by their organization has grown more than fifty percent in just one year.  Eighty three percent of executives think that the industry’s massive data growth spurt will require providers to develop the ability to manage intelligent machines over the next three years.

A similar number believe that they will soon have to spend just as much time training machines to perform big data analytics as they spend on training their human staff members to deliver high-quality care.

Organizations are investing in a variety of machine learning techniques to develop and refine their big data analytics capabilities, the survey found.  Fifty-nine percent are using rule-based algorithms to build their systems’ intellects, while 45 percent are focused on predictive analytics to turn raw data into actionable insights.

“As the digital revolution gains momentum, doctors and clinicians will use machines to augment human labor, personalize care and manage more complex tasks,” predicts Safavi. “The digital revolution is also creating a data goldmine that can spark medical breakthroughs and improve individualized treatment plans.”

Wearables have already found a niche in the realms of chronic disease management and medical research, but many mHealth applications are still searching for a way to add meaning and effectiveness to patient care.

With a new framework for behavioral health providers, the non-profit Centerstone Research Institutesuggests that mHealth apps running on a patient’s omnipresent smartphone could help patients maintain steady progress with their treatment by bridging the gap between the difficulties of daily life and their scheduled visits with a healthcare professional.

“More than 90 percent of Americans own a cell phone and 64 percent own smartphones,” said Tom Doub, PhD, CEO of Centerstone Research Institute. “Our goal is to capitalize on these widely available technologies to help make healthcare more convenient, accessible and effective for both clinicians and patients.”

mHealth apps have suffered from image problems thanks to thousands of free, low-quality programs with little clinical relevance that have flooded the market since smartphones made their debut.  Understanding how to use mHealth to collect meaningful and effective patient-generated health data has been a challenge that CRI is hoping to address with its appImpact guide for behavioral health providers.

“There are heaps of health-related apps available on the market. Some are great, but others aren’t,” Doub said. “appImpact helps providers cut through the clutter to use the best tool in the right program to effectively treat patients. These technologies are changing the behavioral healthcare landscape, and CRI’s framework and best practices help providers stay on the leading edge of mHealth solutions.”

The guide proposes that mHealth apps could have the most impact on two populations of patients: adolescents at risk for mental health issues and Medicaid “superusers” who incur high expenses from preventable emergency department visits and frequent utilization of services.

Patient-generated health data from mHealth apps can alert providers to potential crisis events, encourage patients to adhere to treatment plans, bolster connections to care coordinators or physicians, and collect passively generated data on symptoms or vitals through the app itself or an associated wearable device.

While mHealth apps and wearables have the potential to improve care coordination and chronic disease management, they will also vastly increase the amount of data flowing into a healthcare organization’s EHR or data warehouse.  Providers must proactively address this upcoming avalanche of information if they wish to turn patient-generated health data into an asset that can produce ameasurable financial return.

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Cybersecurity Especially Tough in Health Care

Security experts have a lot of concerns and added responsibilities as connected devices, large and small, burrow their way ever deeper into people’s lives. Nowhere is the increasing need for oversight greater than in health care.

This week, the Workgroup for Electronic Data Interchange(WEDI) released a primer on how a health care organization should protect itself in cyberspace. In its story on the primer, Health IT Security carries a statement from WEDI President and CEO Devin Jopp illustrating the acceleration of health care compromises. From 2010 to 2014, 37 million health care records were compromised in breaches. That sounds like a lot, until it is considered that there were 99 million compromises in just the first quarter of this year. The primer has sections on the lifecycle of cyberattacks and defense, the anatomy of an attack, and ways of “building a culture of prevention.”

Those attacks were aimed at gathering patients’ financial and related data. Another health care vulnerability – and one that is in many ways even more frightening – is attacking connected health care devices in order to hurt people. For some reason, there are people in this world who find it okay to interfere with a heart patient’s pacemaker.

Dark Reading discusses a report that looks at hybrid initiatives in which crackers attack medical devices – but do so in order to gain access to financial and personal data:

A report by TrapX scheduled to publish next week reveals three cases where hospitals were hit by data breaches after their medical devices had been infected with malware backdoors to move laterally within the health care network. In all three cases, the hospitals were unaware that these devices–a blood gas analyzer, a picture archive and communications system (PACS) and an x-ray system–were infiltrated with malware. The devices were spotted when TrapX installed its sensor-based technology in the hospitals, which TrapX declined to identify by name.

The details of the attacks were different. The bottom line is that once crackers get behind the firewall, they are capable of doing much damage. There also are no silver bullets or absolutes. In a Q&A with Healthcare Informatics, Reid Stephan, the chief information officer for St. Luke’s Health System in Boise, Idaho, said that the keys are to accept that breaches will occur and focus on finding them quickly.

The company has an array of systems that monitor, collect and interpret indicators of compromise (IoC). A second useful source of information about breaches simply is maintaining good communications with related organizations, such as insurance companies, that have been hacked. St. Luke’s has nine hospitals, more than 200 clinics, and 14,000 employees in Idaho and Oregon.

The medical and financial industries have a higher level of difficulty when it comes to security. In health care, the stricter requirements are embodied in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Health Leaders Media takes a look at issue through the prism of cyber insurance. There are three types of insurances: liability coverage, business interruption coverage and regulatory fines and penalties coverage. The bottom line is that the explosion of connected devices – both diagnostic and those that help patients directly – is increasing the vulnerabilities.

The increasing use of the Internet for health care guarantees that crackers will sharpen their attacks as time goes on. Hopefully, the good guys will, as well.

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New Software Enables Secure EHR Data Linkage, Study Finds

A recent study found a way to ensure that secure EHR data can be exchanged and linked across multiple sites, improving patient care and further benefitting future research.

Published in the Journal of the American Medical Informatics Association, the study’s authors “developed and distributed a software application that performs standardized data cleaning, preprocessing, and hashing of patient identifiers to remove all protected health information.” From there, the authors “linked individual records using a central honest broker with an algorithm that assigns weights to hash combinations in order to generate high specificity matches.”

While the study was relegated to the Chicago metropolitan area, results showed that by using software that standardizes the assignment of a unique seeded hash identifier merged through a third-party, facilities “can enable large-scale secure linkage of EHR data for epidemiologic and public health research.”

While there has been an increased push for secure HIE use across the nation, the report’s authors explained that many areas lack central HIEs “that meet the needs and concerns of local healthcare systems, researchers, and networks.”

To overcome this problem, we successfully developed and implemented an IRB-approved approach using a distributed software application that enabled multiple, otherwise unaffiliated (and competing), healthcare institutions to aggregate longitudinal clinical data on approximately 5 million residents of a large United States city…With the rapid increase in adoption of EHRs as part of routine clinical care, a secure method of aggregating records across care sites may present an efficient complement to prospective data collection for research or public health purposes.

The authors used pre-existing EHR data, which came from either local data warehouses or medical record systems.

“The data proposed for use in the HealthLNK research project included none of the elements defined as PHI under federal HIPAA regulations other than patient ZIP codes (included to enable later mapping of disease distribution),” the report stated.

Health data privacy and security concerns were also addressed. Certain patient information, such as names and dates of birth, was combined with other patient information to create uniformly distributed information groups, the authors explained.

“To protect against dictionary or ‘rainbow-table; attacks, we seeded the hash algorithm by requiring users of the hashing application to enter a passphrase and passcode distributed by a team member not involved in managing the inbound hashed files,” the report said. “Seeding the hashing algorithm ensured that only users knowing the seed could use the HashIDs to link individual records.”

The authors added that there can be an improved framework for accurate measuerment of a population’s health with “a combination of distributed query methods with secure and encrypted identity disambiguation.”

Overall, the authors were optimistic about using such options in the future, especially as EHRs increase in popularity and healthcare officials seek out ways to improve care. Using secure EHR data that can be linked to multiple sites presents researchers and public health officials with “an opportunity to efficiently re-purpose existing clinical data to generate new insights and guide regional interventions,” the authors stated.

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5 health IT trends set to shake up industry

For those healthcare providers still resistant to technology, you’ve got a problem on your hands: You’re going to be left behind. This is where healthcare it going – with or without you.

That’s according to a new Accenture report, Healthcare Technology Vision 2015, which lays out five key trends in the industry that show adaptation might be the best business model.

First, Accenture analytics are calling it the “platform revolution” – that is the ever-increasing ubiquity of mobile and cloud platforms that far surpass merely the ability to track in real-time a patient’s health. Rather, this is a platform that addresses interoperability, “that captures the data from disparate sources such as wearables, phones and glucometers, and pulls it all together to give a patient and caregiver a holistic and real-time view of the patient’s health,” they write.

[See also: Healthcare to enter ‘third wave of digital’.]

The second trend, as the report emphasizes, is around the “outcome economy.” In other words, “it’s about delivering results.” Hardware, nowadays, brings with it new intelligence. Better intelligence than ever before. And that’s going to make patient data accessible with a mere click. It’s going to give patients the convenience, and it’s ultimately going to lead to better outcomes, according to the report.

The third trend is around data, what’s billed in the report as the “intelligent enterprise” – essentially a “data explosion” that will lead to tremendous clinical outcomes opportunities.

In fact, big data has gotten so big that some 41 percent of healthcare executives say the data volume their organization manages has increased by a whopping 50 percent just from a year ago.

Tomorrow, Accenture officials say, this trend will turn into an EMR including a “lifetime’s worth of data”; it will be used regularly to predict ER visits. Consumers will be able to snap a photo of a skin rash and have a diagnosis shortly. Considering this trend, it may come as surprising that still only 28 percent of docs say they routinely use CPOE systems.

Coming it at No. 4 is the “Internet of me” trend – that is personalized medicine. And as more healthcare organizations invest in this technologies and system capabilities, they’re seeing positive results. In fact, an overwhelming 73 percent of health execs surveyed say they’ve seen ROI after investments in personalization technologies.

The last trend may make some feel a bit uneasy. And it’s about the emergence of machines. It’s the “workforce re-imagined.” Think digital self-scheduling, sharing your own electronic medical record, training machines and connecting with physicians via social platforms.

According to Accenture data, 66 percent of health systems in the U.S. will have self-scheduling by the start of 2020. And nearly half of health execs strongly agree that within three years, they’ll need to focus on training machines just as much as training employees. What does this mean exactly? Just think algorithms, machine learning and intelligent software.

“Patients can actually begin to care for themselves – relieve the burden of the delivery system and get a better result,” says Kaveh Safavi, MD, global managing director of Accenture’s healthcare business, in a video announcing the report. “That’s truly workforce reimagined, because now you’ve made the patient part of their own care-giving team, and the technology makes it possible.”

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Patient-Centered Medical Home Is a “Pragmatic” Shift in Care

Becoming a patient-centered medical home takes a great deal of hard work and a steady commitment to continual practice improvement.  To achieve the coveted Level III NCQA recognition, providers must operate at peak performance, leveraging health IT to bring coordinated, high-quality population health management to their communities.

But the patient-centered medical home (PCMH) recognition brings more than bragging rights to successful organizations.  As payers get serious about value-based reimbursement, providers that align themselves with emerging care delivery strategies may be in line for some financial success, as well.

At Valley Health Partners (VHP), the Physician Hospital Organization (PHO) centered at Holyoke Medical Center in Western Massachusetts, achieving PCMH recognition has been one part of the region’s overall acknowledgement that coordinated, value-based care is the wave of the future.

After significant investment in EHR infrastructure and a close working partnership with the Massachusetts eHealth Collaborative (MAeHC), Valley Health Partners took an incremental approach to PCMH recognition that emphasized manageable, meaningful steps towards embracing the high level of quality care its business partners are now demanding.

“Health New England, which is one of our local payers, was beginning to explore this budding concept of patient-centered care, and they really very much wanted us to dangle our feet in the water,” said Dr. Robert M. Fishman, DO, FACP, in an interview with HealthITAnalytics.com.

The program didn’t start with patient-centered medical home recognition as its ultimate goal, but as a more tailored accountable care project that would bring Valley Health Partners physicians a year-end bonus for meeting certain quality benchmarks for Health New England patients, Fishman explained.

With MAeHC’s help, Valley Health Partners had already made a concerted effort to participate in the EHR Incentive Programs close to the beginning of the meaningful use era.  Most providers had chosen to implement a single vendor’s EHR products, which made further efforts to coordinate care across the community that much simpler.

“We set up a very modest program with Health New England, where we would pick a couple of diagnoses in internal medicine and a couple of diagnoses in pediatrics and we would begin to set up policies and think in a more patient-centric way to reach certain goals,” he said.

“We concentrated on CHF and COPD, because those two conditions produce a lot of readmissions and emergency department visits.  There’s a lot of expense.  If we could really get a handle on those conditions, we could improve care, improve outcomes and decrease costs.  Three things that we’re all very interested in.”

After several years of focusing on diagnosis-specific population health management, MAeHC had an interesting proposition for building on the organization’s success.

“The Mass eHealth Collaborative approached us and they said, ‘You know, if we do an assessment of each of your practices in terms of the 2011 criteria for NCQA PCMH accreditation, we can find out how far away you are from actually doing a patient centered medical home for all of your patients, not just your Health New England patients, and becoming NCQA certified,’” Fishman explained.

The National Committee for Quality Assurance framework for PCMH recognition demands a number of data-driven quality improvements from potential applicants, including individualized care management, a heightened emphasis on chronic disease care, referral tracking and care coordination, and a plan for sustained improvement over time.  For some providers, the process seems daunting.  For Valley Health Partners, it was just a continuation of what was already being accomplished.

“During the assessment, our MAeHC consultants found that we weren’t too far away,” Fishman said.  “We had a lot of work to do, but a lot of it had already been done.  And if we could ramp up our efforts, we could probably get it done.”

“Most of us signed up for it.  A couple of providers opted not to.  Two providers who were still using paper-based workflows opted in, and we went ahead,” he continued.  “The eHealth Collaborative helped train our staff, and they stayed on us to make the necessary improvements.”

“We started using our patient portals to send messages to patients when they hadn’t been seen for a year, or they were overdue for a mammogram or a colonoscopy.  It was very easy to communicate with patients and say, ‘Hey, you’re a diabetic and you haven’t been seen in five months.  You should have been in two months ago.  Set up an appointment.  We’ve got things to discuss.’”

Implementing the workflow changes that support the patient-centered medical home requires a shift in perspective that can be challenging to some providers who feel overwhelmed by the basic necessities of providing care.  Expanding access to care is one of the fundamental “must-pass” requirements for recognition, but can be stressful for organizations that have trouble juggling their patient schedules.

“We changed the philosophy in all of our practices when it came to patient access to same-day appointments,” said Fishman.  “It used to be that we would have emergency slots that we could fill if someone needs to be seen, but now we think of them as same-day appointments.”

“If a patient calls and they want to be seen, put them in.  Patients are more likely to call if they don’t think that it has to be some sort of emergency for us to let them in.  That’s not what we want them to think.  We want to reduce as many barriers to quicker care as possible.”

The effort has paid off handsomely.  “We found out last month that everyone who committed to the patient-centered medical home initiative succeeded,” Fishman was pleased to report. “And everyone succeeded at Level III, with the exception of the two paper-based practices.  Going into it, they knew that the highest they would be eligible for was Level II, because they didn’t have an EHR, and they made Level II.  So we think this was a slam dunk, massive success.”

Fishman credits the achievement largely to the slow-and-steady pace of practice transformation his organization has adopted.  “We got our staff onboard with all these changes by doing the pilot project with Health New England,” he explained.  “So by the time we said that we’re going to do this full tilt, it wasn’t really a major shift.  It was just an expansion of what we were doing already.”

“We started out with a few slow baby steps.  Those baby steps became larger steps for about two to three years.  And then the state assessment that was done showed that hey, we’re not that far from the finish line.  So it wasn’t an overnight deluge of issues.”

The cultural and organizational changes that made patient-centered medical home recognition a possibility were rooted in Valley Health Partners’ approach to EHR adoption when the EHR Incentive Programs first enticed physicians to invest in health IT by offering financial rewards.

“We felt we should adopt electronic health records is because we couldn’t get past thinking that if the federal government wants to spend $44,000 on every single physician in this country, they must be pretty serious about it, and we shouldn’t be blind to that,” Fishman recalled.

“I think that providers who haven’t adopted EHRs by now are all behind the eight ball, because things are moving quickly, he added. “A lot of the payers looking at contracts with us want to know that we’re doing patient-centered activities, and that we’re beginning to do registry work and population health management.”

“The biggest challenge is always physician buy-in and physician engagement,” he acknowledged.  “I think we’ve done a very, very good job of engaging the physicians and getting them to understand what we’re trying to accomplish.”

“And even if they don’t philosophically agree with it, which is fine, they know that this is how reimbursement is going to look as we move forward.  We have seen that has been no increase in fee-for-service payments by most of the insurance companies for the past few years.  They want us to report on quality measures.  They want us to raise the level of care.  So if you want to get paid, be a pragmatist and get it done.”

EHR adoption, coupled with such significant operational change, isn’t without its pitfalls, Fishman admitted.  Productivity has been a casualty of the process, even as Fishman dedicates more time to consulting with his patients to provide them with the personalized care they crave.

“I spend a lot more time with my patients now, and the kick in the head is that I don’t really want to spend less time with them, because we all find it very satisfying to work together like that,” he said.  “The patients have responded well to this.  They enjoy when we reach out to them by letter or by portal.  They respond favorably.”

“But since adopting the EHR, I have been very slow to get back to my baseline productivity, which has hurt me financially.  My documentation is far greater than it’s ever been, and that takes time. And I’m home at nights documenting, which I don’t like.  But I’m hopeful that as our value-based reimbursements take off, I might be able to get back to what I once was financially, without cramming in 25 patients a day,” he added.

While there may be negatives that must be mitigated, EHR adoption and the patient-centered medical home has helped to coordinate care across the Holyoke community.  Dr. Fishman has some simple advice for other healthcare providers who are investigating the PCMH as a way to invest in the care strategies and frameworks that will support future value-based reimbursement structures.

“Number one, get an EHR,” he stated.  “Number two, work with someone who is invested in your wellbeing, like your local hospital.  Number three, start out slow and have realistic goals.  And when you achieve those goals, set out new goals.  And number four, which is absolutely important, have a consultant that knows what they’re doing.”

“We couldn’t do any of this without our consultants,” he reiterated.  “We have a lot of folks here who are pretty sharp and savvy with health IT, but this wasn’t their niche.  We needed to consult with someone who really understood the patient-centered medical home and everything that had to go into it.”

“The folks that work for the Massachusetts eHealth Collaborative have been certified in doing this stuff, and they’re very good at what they do.  And I applaud them for that.  I know they applaud us for the hard work that we’ve done.  Just like every other part of the patient-centered medical home, you need to take a team-based approach to healthcare.”

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Google unveils smart wristband for health tracking, but it’s not for consumers

Google’s latest device is aimed at letting doctors know how you’re doing, even between checkups.

The company unveiled on Tuesday a new sensor-packed wristband, meant to collect information on vital signs for medical professionals. The device will measure pulse, heart rhythm and skin temperature, as well as things like light exposure and noise levels. Bloomberg earlierreported the news.

The device was developed by Google X, the search giant’s experimental-research division. But unlike other smartwatches that are powered by Google’s Android Wear software and also have health tracking features, the new device isn’t targeted at consumers. Instead, the aim is for patients to wear the band during clinical trials and drug tests, so the data can be used by medical researchers and physicians. The idea is for doctors to get a complete picture of patients’ activity as it relates to their health, even if they rarely come in for an examination.

“Our hope is that this technology could unlock a new class of continuous, medical-grade information that makes it easier to understand these patterns and manage serious health conditions,” Andy Conrad, head of Google’s life sciences team, said in a statement.

The move comes as Google has become increasingly ambitious about expanding its scope of products beyond its juggernaut search engine. Its search and advertising business is still the most dominant in the world, making more than $50 billion a year. But as the Internet evolves, CEO Larry Page has been looking to new categories and directions for the company. Google has made big bets on everything from smartphones to wearable devices to driverless cars.

Google said the device is still in a very experimental phase. The company is working with academic researchers and drugmakers to make sure the device and its sensors are actually accurate and helpful to medical professionals. Google said that process could take years, but once the device is ready, the company will work with partners to build and distribute the wristband to a larger audience.

It’s the same approach Google has taken with development of its smart contact lens, another Google X product, which has sensors that measure glucose levels in tears for diabetes patients. Last July, Google announced it was partnering with the pharmaceutical giant Novartis to produce the contact lenses.

Google is also working on software to help clinicians securely store, analyze and interpret the data gathered from the device, a Google spokeswoman told CNET. The company is working with medical partners to refine the user interfaces of the software and the analytics that support the system, the spokesperson said.

The move may raise concern from privacy advocates who worry that Google already has access to too much of people’s personal data. Google, which makes the bulk of its revenue on advertising, lives on knowing information about its users, including where they travel on a map or what they search for online.

But the company stressed it has teams in place to ensure privacy and security. Institutional review boards — independent ethics committees that review medical research involving humans — also have oversight of the project, a Google spokeswoman said.

Google also has other life science projects under way. In 2013, Google launched Calico, a company with the overarching goal of extending the human lifespan. The company is run by former Genentech CEO Arthur Levinson. Last September, Calico announced a partnership with the biopharmaceutical firm AbbVie to pour up to $1.5 billion into a research facility focused on fighting age-related diseases.

Google also announced a project last summer called the Baseline study, also led by Conrad, aimed at learning enough about the human body to be able to detect fatal diseases like cancer or heart disease earlier, so treatment is more preventative and not reactive. Google said the new wristband would be used to help further the study.

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‘Wireless health’ has become redundant

We have mobile health, connected health, e-health, digital health, but no longer “wireless” health. Wireless technology has become so ubiquitous in healthcare that the word itself has lost its cachet.

I have a saved search on Google News for “wireless health.” It used to be fertile ground for finding stories related to health IT. That’s no longer the case.

This morning’s scan of the news turned up a lot more “noise” than anything relevant to my beat covering health IT. I’ll be deleting that from my saved searches shortly.

Meanwhile, this week, the West Health Institute tweaking its focus once again by debuting a new website and, more importantly, adding a section called Successful Aging. That means ” enabling seniors to live their lives on their own terms with access to high-quality health and support services that preserve and protect one’s dignity, quality of life and independence,” according to a blog post from West Health Institute CEO Nicholas Valeriani.

“[W]e are leveraging all of our previous work, such as our drive to advance medical device interoperability, in support of enabling successful aging for all seniors,” Valeriani continued. In other words, wireless technology will be a central part of this, but it’s not explicitly stated. That probably was intentional.

West Health Institute, née West Wireless Health Institute, dropped the second word from its name in 2012. At the time of its founding, the La Jolla, Calif.-based institute was closely tied to wireless chip-maker Qualcomm, but West Health wanted to dispel the notion that it was an arm of Qualcomm.

In a larger sense, wireless probably seemed too narrow a focus because, after all, technology is just a tool to provide better care. It doesn’t matter if it’s called wireless, mobile, digital, connected or e-health. When it comes down to it, it’s all just health. We’ve seen the term “wireless health” wane, and are starting to see the same for “m-health.”

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Google’s new health watch will keep tabs on patients’ vitals

Google unveiled a new wearable today, though it won’t be competing with the Apple Watch any time soon. Developed by Google X (the company’s advanced research division), the experimental device is geared specifically for clinical research. It monitors not just the wearer’s stats (including pulse, heart rhythm and temperature) but also environmental variables like light and noise levels as well.

This device could be a boon to medical research as it allows doctors to continually gather important data on their patients in real life conditions. “Historically, doctors do everything — patients just need to turn up at the trial site,” Kara Dennis, managing director of mobile health at Medidata, told Bloomberg. “Now, we’re asking patients to take on meaningful responsibility in gathering information.” Google plans to partner with academic institutions to ensure the device’s accuracy before seeking regulatory approval in both the US and Europe later this summer.

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UC Irvine Health Data Breach Affects 4,800 Patients

UC Irvine Medical Center announced last week that an employee viewed thousands of patient records over a four-year period “without a job-related purpose,” potentially compromising the information of 4,859 patients and leading to a health data breach.

UC Irvine officials discovered on March 13, 2015, that an employee had viewed records between June 2011 and March 2015. Some PHI may have been viewed, according to a medical center statement.

Information inappropriately accessed includes names, dates of birth, gender, medical record numbers, height, weight, medical center account numbers, allergy information, home address, medical documentation, diagnoses, test orders and results, medications, employment status, and the names of patient’s health plans and employers. However, Social Security numbers, driver’s licenses or state ID card numbers, and credit or debit card information were not accessed.

Hospital spokesperson John Murray told The Orange County Register that there is no evidence that the records were downloaded or distributed via e-mail. Murray added that while he could not comment on whether or not the employee in question still worked for UC Irvine, the employee was disciplined and no longer has access to the medical center’s computer systems.

A copy of notification letters being sent patients was posted on the California Office of Attorney General website. In that letter, UC Irvine explained why patients were being alerted of this incident months after the initial discovery was made:

“Due to its on-going investigation, local law enforcement asked us not to notify patients right away, because sending out notifications could have interfered with its investigation. Local law enforcement has now informed us that we are free to notify patients.”

The notification letter added that the hospital “hired independent experts in computer forensics to conduct a thorough investigation,” after the breach discovery. Those experts reported that there was no evidence that patient information was removed from the medical center. Local law enforcement were also notified, and they are conducting an on-going investigation. The letter also verified that the employee’s access to medical center computer systems was removed and that “disciplinary action” was imposed.

Affected patients will also be offered one year of free credit monitoring and identity theft protection, according to UC Irvine.

This is not the first health data security incident that UC Irvine has faced in recent years. Just over one year ago, the medical center reported that 1,813 students and some non-students were impacted by a data breach involving keylogging software malware.

The security office learned that the breach had affected three student health center computers on March 26, 2014 and that they had been infected for about six weeks.

Patient names, health or dental insurance numbers, CPT code(s), ICD9 code(s) and/or diagnoses and student ID numbers may have been transmitted to unauthorized servers.

“UC Irvine is committed to maintaining the privacy of students’ and non-student patients’ personally identified information and takes many precautions for the security of personal and medical information,” the medical center said at the time. “The University is continually modifying its systems and practices to enhance the security of sensitive information.”

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