News 7/3/12

House lawmakers introduce legislation allowing behavioral health providers, including clinical psychologists and licensed social workers, to qualify for MU incentive payments. The Senate introduced a similar bill last year.

The Pennsylvania eHealth Collaborative announces a grant program that gives providers a free year of DIRECT messaging services for secure health information exchange.

New York eHealth Collaborative says it’s the first REC to hit 1,000 providers qualifying for Meaningful Use money.

Waiting Room Solutions announces several new EMR clients, including Connecticut Behavioral Health, ENT and Facial Plastic Surgery (VA), and Okeechobee Family Practice (FL).

Kareo releases a free iPhone app for accessing physician schedules online.

Are you a physician office considering between multiple HIE options? Here is some advice from the AMA’s American Medical News:

• Physicians should determine who they need to share information with and find an HIE that provides those connections. Possible connections include hospitals, labs, and public health agencies.
• Identify the geographic region that the practice needs to be connected with and make sure the chosen HIE covers the required geographic footprint.
• Understand the business model of potential HIEs and assess their long term sustainability.

Mr. H and I are expecting a slow news week, so I’ll likely be celebrating Independence Day eating watermelon and grilling ribs and corn rather than gathering news for HIStalk Practice. I mention for all the die-hard HIT fans who were considering staying home from fireworks festivities in order to wait for a HIStalk Practice e-mail to hit their inbox. Happy 4th of July to all!

E-mail Inga.

Bowtie Confidential: The Internal Security Threat 6/30/12

Despite the potential impact of negative publicity, penalties, fines, and lawsuits, healthcare organizations continue to breach patient information. The threat to privacy and security is not only external; it is also internal, including employees, temporary staff, and third parties.

Technology can be a culprit (it is easier to access and transfer data online), but it can also be part of a solution. Although it is impossible to prevent all insider attacks, you can leverage technology to minimize the risk.

Culture is also a culprit. Look at Facebook – people are becoming comfortable putting personal information online. There is a cultural “loosening” of privacy boundaries, which can affect an organization’s culture and therefore its security.

The following action steps should be part of your plan for reducing internal security threats:

• Cultivate a leadership culture of respect for individual privacy regarding access to information
• Include the “insider threat” plan in the organizational strategic plan
• Create and assign the role of a chief information security / privacy officer
• Develop enhanced human resource screening processes and interview techniques to seek out potential insider threats
• Develop ongoing and consistent HIPAA (security and privacy) training and awareness programs that extend beyond orientation
• Implement appropriate data and application access monitoring software
• Establish clear policies and procedures to address identity, access management and overall data protection
• Develop and implement a system and data access monitoring process that includes summary dashboard reports to leadership
• Implement and schedule risk assessment audits

Internal threats are just as dangerous as external threats – or more. By creating and implementing a specific strategy to reduce and address insider threats, healthcare organizations can better manage their risk. Everyone is accountable for privacy and security. However, the message has to come from the top with policies, procedures, and monitoring to reinforce it.

Rob Drewniak is vice president, strategic and advisory services, for Hayes Management Consulting.

News 6/28/12

From MGMA: the biggest challenges of running a group practice include managing finances with the uncertainty of Medicare reimbursement rates, preparation for reimbursement models that place greater financial risk on the practice, the ICD-10 transition, rising operating costs, and participation in the EHR MU program.

The 38-provider Mowery Clinic (KS) selects NextGen Ambulatory EHR/PM and Patient Portal.

Mitochon, a provider of free EHR, launches a free, integrated e-prescribing solution.

Atlanta Women’s Health Group (GA) contracts with VeriStor Systems to provide cloud services, data protection, and disaster recovery for its 30 locations.

Physicians have until July 6 to comment on NCQA standards for specialty practices wanting to become part of a PCMH “neighborhood.” NCQA’s specialty practice recognition program will be designed to recognize specialty practices that work with PCMHs to coordinate care, provide timely access, use IT to reduce test duplication, and work toward quality improvement.

The president of CVS Caremark’s MinuteClinics says the company plans to expand from today’s 565 retail walk-in clinics to 1,000 by 2016. He adds that the clinics support continuity of care by providing each patient a copy of their medical records at the end of each visit and by sending patients’ physicians a copy of the records either electronically or via fax.

Wal-Mart, by the way, has closed 33 of its retail walk-in clinics this year and currently has only 149, which far less than the 2,000 the company had projected in 2007.

Medical billing and collections company Alleviant announces plans to open a facility in Vermillion, SD and hire 120 people by the end of 2013. Alleviant already employs about 240 workers in South Dakota.

In case you missed it, we had our first HIStalk Practice Advisory Panel post yesterday. We asked the provider participants to share impressions of their EMR and other office technologies. Participants offered feedback on eClinicalWorks, GE Centricity, Pulse, Cerner, and a few others and most responses were quite enlightening. Some highlights:

As we apply to be certified as a Patient Centered Medical Home, the EHR’s registry function is critical to our ability to manage registrations of patients with various demographic, clinical, or therapeutic criteria. Identifying all asthmatic patients, for example, who do not have a current Asthma Action Plan by a search of our registry allows proactive patient scheduling and improved care.

Our EHR has easily customizable templates to fit my workflow.

Our vendor’s technical support has historically and notoriously been abysmal. That could very well hold true for other EHR vendors.

Secure messaging has gotten pretty hot recently. I’d love to it see fully implemented at my facility.

We do use a nifty system for security which involves initial authentication with a card swipe, but then system security via a sensor on the door.

The vendor needs to stop making claims that are not true.

If you’d like to share your impressions of the Panel post or if you are a provider interested in participating, let me know.

E-mail Inga.

News 6/26/12

The Office of Inspector General finds that 57% of Medicare physicians used an EMR in 2011; 75% of those EMRs were certified to document E/M services. Allscripts, eClinicalWorks, and GE Healthcare were the vendors most widely used by physicians for documenting E/M services.

Gateway EDI completes it purchase of RCM provider National Healthcare Exchange Services (NHXS) for more than $8 million.

Physicians say their biggest practice management challenges are administrative tasks tied to payers and and integrating EMR. The same survey found that only 39% of physicians believe EMRs will improve care, while 34% say it will cause care to deteriorate.

Health Nuts Media launches a Spanish-language version of its animated asthma education series Huff & Puff: An Asthma Tale. Health Nuts Media uses digital media to communicate health issues and HIStalk Practice’s own Dr. Gregg Alexander is the company’s chief medical officer.

EMR/PM provider Cloud-MDs acquires Doctors Network of America, a physician billing and consulting firm.

ChartLogic names Brenner Adams SVP of business development. Most recently Adams was director of business development for Microsoft’s X-Box Games Studio.

Humana is named the top payer among US health insurers in athenahealth’s PayerView Rankings, which measure the financial and administration performance of health insurers, as well as their transaction efficacy. For the first time since 2008, Payerview metrics dipped slightly from the previous year, likely due to disruptions associated with the ANSI 5010 transition.

Hackensack University Medical Center (NJ) expands it billing service contract with SPi Healthcare to include 300 providers in 55 practices.

Wayne County Health Clinic (IN) selects iSALUS Healthcare’s OfficeEMR solution.

Reminder: eligible providers and group practices participating in CMS’s eRx Group Practice Reporting Option must report on a minimum of 10 e-prescribing events before June 30, 2012 in order to avoid a 1.5% payment reduction on their 2013 Medicare Part B services.

E-mail Inga.

Physicians at 2,600 hospitals linked in new health care database
The project by the Premier alliance is part of wider efforts to get doctors to use EHR data to identify ways to improve medical practice.
http://www.elabs10.com/ct.html?rtr=on&s=x8pbgr,12ocp,2kdo,b0y4,c5bb,bbxn,fyg8

Healthcare Informatics 6/22/12

Healthcare Infrastructure Data Models
Option 2 — The Federated Model 

Option 1: The Centralized Repository is described in my previous post.

While this may evoke images of the United Federation of Planets for Star Trek fans, there is unfortunately no Starfleet here. Instead of pushing all the data to a single repository (option 1), this model lets the data sit wherever it is recorded. With this option, the desire by some institutions to keep patient health record data within their own walls is fulfilled. 

Although the data isn’t legally the property of healthcare providers, patients have entrusted them to maintain the data, mainly because we really wouldn’t know what to do with it anyway. Secondarily, we secretly hope they can do some cool visualization with it much like those that have been done for Facebook or make us all amateur epidemiologists much like Google has done. They haven’t yet, but here’s to hoping.

Given that all of the data is locked over a multitude of institutions, we need a sneaky way of coaxing it out. Therefore, to access the data, a query or request is sent to multiple locations asking if they have any patients that meet certain criteria. The system (i.e. an EHR at your local healthcare organization) then performs a subquery on its own system to find what the original query wants. For those that are SQL-minded, this is the same concept as a nested query. For those that are not SQL-minded, this is what children commonly refer to as a scavenger hunt. The end result is that each location responds with an aggregated number or numerator / denominator and all that is left is to total them up.  

On paper, this looks very fancy and is being carried out in some form on a limited basis with the HMO Research Network and potentially on a large-scale basis with Query Health. While this process is the modus operandi  of an actual bureaucratic federation ("You’ll have to fill out form 156B, then take it to the first floor department to get a stamp, then take it up to room 237 to copy it to form 198-2C…"), a computer scientist would tell you that messing about with subqueries is not the most efficient way of doing things.

In terms of record portability, this surely isn’t the most efficient process either. Sending out a mass query hoping to find information about one patient? That leads to the other looming problem: the issue of duplication and/or incomplete data. How can we be sure we aren’t counting some patients twice or missing some of their data if they travel around? We would need some unique identifier for every person in America (don’t say national patient identifier; 1% of the population will scream.)

We are also left with a struggle to analyze population data. The HMO Research Network has shown that this can be done, but each time a query goes out, there is an actual person at each location that manually looks over the query result and modifies it because “They know their data best.” 

On top of all of this, if the Query Health initiative takes hold (they want it part of Meaningful Use Stage 3) every healthcare provider will need to not only have an EHR, but have a secondary database used for querying and possibly someone manually taking a look at all of the results. Job creation and economic stimulus? Check. While this clearly isn’t the most efficient solution, it does get around some of the political problems that come along with acquiring and storing health information. However, what neither of the options so far has addressed is actually letting the patient get in on the action. 

Aaron Berdofe is an independent health information technology contractor specializing in Meditech’s’s Medical and Practice Management Suite and EHR design and development.