Readers Write: Leveraging Technology to Ensure Reliable Hazardous Drug Disposal at Physician Practices

Leveraging Technology to Ensure Reliable Hazardous Drug Disposal
By Kathryn Evans

Hazardous drugs abound in healthcare. Consequently, well-defined disposal procedures for the resulting waste — such as remaining medication or packaging — are essential to prevent negative patient safety and environmental impacts, as well as penalties for noncompliance.

The Resource Conservation and Recovery Act (RCRA) established the rules that govern hazardous drug disposal back in 1976, yet adherence remains a challenge today. The law’s sheer size and scope makes it especially difficult for smaller practices with limited resources. Moreover, organizations also are responsible for complying with any additional, stricter state regulations on the books. As new hazardous drugs emerge that existing RCRA rules do not address, the compliance challenges are only intensified.

The Consequences of Noncompliance
Unfortunately, many healthcare organizations — especially physician practices and other smaller facilities — find themselves out of compliance with RCRA regulations. These entities often fail to accurately and reliably identify the hazardous drugs used in their facilities. As a result, staff might inadvertently place drug waste in the wrong receptacles.

RCRA waste must be treated in compliance with local, state, and federal requirements. When RCRA waste is disposed of as regulated medical waste (RMW), the generator is no longer in compliance and waste is not treated in a manner that protects the environment. If pharmaceutical material is placed in regular medical waste, the hazardous drug elements will not be treated appropriately and harmful chemicals may be released — leading to potential environmental impact.

In addition to harmful ecological impacts, failure to meet RCRA requirements has financial ramifications. Not only are there some fairly steep fines at the local, state, and federal levels, but a compliance issue can lead to negative public perceptions that can tarnish an organization’s reputation. If the compliance shortfall is severe or recurring, it may even lead to staff and patient retention issues.

The Role of Technology in Elevating Compliance
In the past, navigating RCRA standards often involved sifting through pages of legislation to figure out whether an organization was in compliance. However, with the advent of technology, meeting RCRA requirements has become much more straightforward and efficient.

For example, a key compliance step involves conducting a thorough assessment of the hazardous drugs that may be generated as waste. To assist with this effort, a facility can turn to comprehensive technology solutions that simplify drug identification. These tools may offer a checklist that staff members can easily work through to identify the pertinent pharmaceuticals. In addition to enabling a more efficient process, the tool also supports a comprehensive review and limits the possibility of potential hazards slipping through the cracks.

Similarly, practices can leverage technology to help with staff training. Once a practice determines which pharmaceuticals it administers, all staff members must be familiar with how to appropriately dispose of the relevant waste. By leveraging Web-based training, practices can offer detailed and convenient education options, encouraging employees to take the training whenever and wherever it is most convenient for them. Those individuals tasked with organization compliance can access the technology to see which team members have successfully completed the training and follow up with those who haven’t. This type of tool can even point out areas where the knowledge of staff members is weak, highlighting further training opportunities.

Technology can also enable better compliance tracking. Using an automated solution, organizations can go online to request a pickup from their waste disposal provider, and track that material throughout the entire disposal process. This helps practices keep related and comprehensive documentation and tracking information in one place. By shifting away from paper and embracing technology, organizations can not only reduce their reliance on antiquated processes and free up space, but also engage in more robust tracking, reporting, and compliance assessment.

Managing RCRA Compliance Through Technology
Ensuring proper drug disposal is an essential activity for healthcare organizations and practices. Technology can make the process go much more smoothly, promoting efficiency and effectiveness. Technology can help practices remain in compliance at all times by supporting thorough identification, training, and tracking of RCRA regulations and standards.

Kathryn Evans is a national director at Stericycle Inc.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 8/11/15

Top News

Google co-founder Larry Page announces the formation of Alphabet, a “collection of companies” containing businesses that are “pretty far afield of our main Internet products,” such as Google, X labs, Calico, and Life Sciences. Google will become a wholly-owned subsidiary of Alphabet, which will replace Google Inc. as the publicly-traded entity. Page stresses that, “[W]e are not intending for this to be a big consumer brand with related products—the whole point is that Alphabet companies should have independence and develop their own brands.” Page and co-founder Sergey Bring will head Alphabet, while Sundar Pichai will take over as CEO of Google.

Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Tweet Chat

Don’t miss the next #HIStalking tweet chat on August 20 at 1pm ET. Amy Gleason (@ThePatientsSide), COO of CareSync and White House Champion of Change for Precision Medicine, will host. Stay tuned for topics.

Announcements and Implementations

Aprima Medical Software launches Now cross-platform technology to enhance interface consistency across devices. The company will also use Now to launch new product enhancements, including Aprima Mobile for Apple and Android.

Zobreus Medical Corp. officially launches the Patient-Oriented Electronic Medical Record after raising over $50,000 via Kickstarter earlier this year. The POEM Record is an automated app that retrieves and processes a patient’s medical record from anywhere onto a mobile device. The company plans to launch a physician-friendly version of POEM in the near future. CEO L. Okey Onyejekwe Jr., MD has an interesting background, including stints as a U.S. Air Force flight surgeon, attending physician at the VA Palo Alto Medical Center, and as an attorney.

NueMD launches an ICD-10 Training Lab to help small practices prepare for the October 1 compliance date. The complimentary tool features training games, code search, and common codes organized by specialty.

Fresenius Health Partners implements Medhok’s risk, care, and quality software to streamline care management for patients with end-stage renal disease and Medicare Advantage Chronic Condition Special Needs Plans.

Acquisitions, Funding, Business, and Stock

The Wall Street Journal looks at the increasingly competitive field of startups looking to bring back house calls via mobile apps. (It also shows a lack of editorial prowess in coming up with a headline that includes the words “Uber” and “healthcare.”) The growing consumer bases of companies such as True Health Navigation, Heal, Pager, ReTraceHealth, and MedZed have yet to truly give physician practices a run for their money, though trade associations like the Urgent Care Association of America seem to already by on the defensive.

People

Somnoware Healthcare Systems appoints Jinesh Jain (Caldwell Labs) director of clinical technology and John Robinson (ResMed Corp.) director of sales and marketing.

Government and Politics

Booz Allen Hamilton will replace Optum as the next lead contractor to maintain Healthcare.gov, winning a five-year contract worth $202 million. Optum will continue on in its role as quality tester while protests from losing bidders for that segment of work are resolved.

A leaked document uncovered by Huffington Post finds that over 35,000 combat veterans have been denied healthcare coverage by the VA because it’s computer system mistakenly flagged their applications for lack of financial data, despite the fact that combat vets are eligible for five years of free care post discharge. Close to 16,000 applications have been pending for over five years.

ONC is soliciting applications through September 11 to fill a variety of volunteer positions on its Health IT Policy Committee and Health IT Standards Committee panels. Selected applicants will serve on the panels for three years.

The Health IT Policy Committee’s Privacy and Security Workgroup meets to discuss recommendations related to big data analytics. Draft recommendations include:

• Continue focusing on identifying gaps in legal protections against what are likely to be an evolving set of harms from big data analytics.
• Adopt measures that could increase transparency about actual health information uses.
• Explore how to increase transparency around use of the algorithms used in big health analytics, perhaps with an approach similar to that used in the Fair Credit Reporting Act.
• Modify rules around research uses of data to incentivize entities to use more privacy protecting architectures.
• Support an individual’s right to access their health information.
• Educate stakeholders about cybersecurity risks and recommended precautions.

HHS Secretary Sylvia Burwell announces $169 million in ACA funding for the opening of 266 health centers. The new funding, which will provide care access to over 1.2 million patients, follows the department’s announcement in May of $101 million to open 164 health centers.

Telemedicine

Kenyan First Lady Margaret Kenyatta unveils the Sema-Doc telemedicine app as part of an effort to increase healthcare access for the nation’s 30 million mobile-phone users. Subscribers to the app, also known as Hello Doctor, have 24-hour access to medical professionals, plus access to health and wellness content.

Research and Innovation

A survey gauging physician sentiment around HIPAA compliance and interoperability finds that just 17 percent of surveyed professionals are confident the industry will meet the 10-year goal for nationwide interoperability. It also reveals human error to be the biggest concern when it comes to potential HIPAA breaches, despite the fact that nearly 100 percent of respondents have policies in place to inform practice staff of changes in HIPAA compliance.

An AmericanEHR/AMA survey finds that physicians are, in fact, dissatisfied with their EHRs. I’ll save you the $100-$200 purchase price of the report and offer several key findings: Nearly half of surveyed physicians though their EHR’s ability to improve efficiency was difficult or very difficult, while 72 percent thought their EHR’s ability to decrease workload was of similar difficulty. Nearly half have found their EHR has increased total operating costs.  

Other

Good news for physicians looking to retire rather than face Meaningful Use Stage 3 regulations: Hawaii is one of the cheapest states for retiree healthcare, according to a study by cost projection software designer HealthView Services. (The bad news is that Hawaii is one of the most expensive places to live.) Vermont and Maine also received high marks for affordable, golden-years healthcare.

Fast Company offers an amusing take on “How to Act at a Business Lunch.” My favorite tip: Don’t keep checking your phone, as it will prompt your fellow diners to stare into space contemplating the end of their existence.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 8/10/15

Top News

Indiana resident James Young files a class-action lawsuit against Indiana-based Medical Informatics Engineering alleging that the company did not adequately protect its software from a cyberattack, disclose the attack in a timely manner, or disclose pertinent facts related to the breach. MIE discovered in early May that its NoMoreClipboard subsidiary had been breached, potentially compromising the personal data of up to 3.9 million consumers. Young, who is joined by over 100 plaintiffs in the lawsuit, contends that he “suffered actual injury from having his [personally identifiable information] and [personal health information] compromised and stolen in and as a result of the MIE data breach.” A similar suit from a trio of patients was also initiated in Indiana against MIE within days of Young’s legal action.

Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Tweet Chat

Don’t miss the next #HIStalking tweet chat on August 20 at 1pm ET. Amy Gleason (@ThePatientsSide), COO of CareSync and White House Champion of Change for Precision Medicine, will host. Stay tuned for topics.

Acquisitions, Funding, Business, and Stock

The local paper highlights the building buzz around Epharmix, a St. Louis-based startup that has tapped into local physician expertise to develop technology that sends automated, follow-up text messages to patients. Twenty two year-old founder and CEO Blake Marggraff has already helped the company secure $100,000 in seed funding from BioGenerator, plus undisclosed amounts from Google and Yahoo executives. Express Scripts has also shown interest in the technology’s ability to improve medication adherence among health plan members.

Announcements and Implementations

The SmartCare Version 4.0 EHR from behavioral health technology company Streamline Healthcare Solutions achieves ONC Meaningful Use 2014 Edition Certification for ambulatory and inpatient facilities.

Hoke County Health Department (NC) implements Patagonia Health’s Pharmacy App in lieu of purchasing a pharmacy software system. Health Director Helene Edwards noted the app’s ability to document dispensing pharmaceuticals from the pharmacy through the patient’s EHR was a key factor in the decision. I’m willing to bet price was also a factor.

RelayHealth Financial launches ICD10Central.com to equip physicians with specialty coding resources, peer support, payer guidance, and real-time performance indicators.

Summit Software Technologies integrates SwervePay Health’s cloud-based payment processing technology into the GE Centricity platforms of its customers.

Athenahealth updates its Patient-Centered Medical Home Accelerator Program with automatic NCQA credits to help streamline physician pathways towards formal PCMH recognition.

Telemedicine

HelloMD pivots from offering traditional telemedicine visits to focusing strictly on member-based services for medical marijuana patients. In addition to video consults, the company offers users on-demand membership with vetted dispensaries.

HealthGains, an Aventura, FL-based chain of health and wellness facilities, launches a virtual wellness video portal as part of its age-management program. In addition to video consults, the portal can sync with  wearable fitness devices to track and monitor a patient’s progress.

Hot on the heels of Mr. H’s assessment of China’s dismal attempts at healthcare reform comes news that the country’s largest mobile health platform will offer USARad’s Second Division telemedicine and teleradiology services to its 70 million customers.

An analysis from global analytics firm IHS finds that an increase in health insurance coverage will cause the number of virtual video consults between PCPs and patients to double in the next five years, jumping to nearly 27 million in the U.S. market. Specialty consultations via video are predicted to increase from 14.5 million to 21.5 million.

Government and Politics

The House Energy & Commerce Committee releases findings from a year-long study on HHS network security, highlighting the fact that hackers have breached at least five HHS divisions within the last three years. Blame is laid squarely at the feet of the agency, which lacks transparency into its own networks and suffers from poor staff training. The study authors recommend transferring all information security responsibilities from the CIO to the CISO, who should be the primary authority responsible for information security at HHS and its operating divisions.

The Indiana Business Journal puts its own spin on the rising tide of healthcare hacks, noting that the cost of data breaches over the last six years – about $30 billion – has already surpassed the amount of Meaningful Use incentives that the federal government has paid out to providers.

The Senate unanimously approves The Electronic Health Fairness Act before its summer recess. If approved by the President, the bill will exempt patient encounters in ambulatory surgery centers from Meaningful Use requirements – a logical and likely long overdue move given that ASC MU certification standards were not included in the HITECH Act.

Research and Innovation

A study of patient and staff experience during the primary care process at three clinics in Philadelphia finds technology to be one of the biggest impediments to a smooth visit for both parties. Surveyed staff noted that, “The sheer volume of information in the electronic health record can obscure some of the important details,” while patients expressed frustration at having to repeat their health histories – supposedly stored in their EHRs -multiple times to different staff members.

The American Academy of Private Physicians partners with EHR and PM vendor Kareo to launch an annual study on independent physician perceptions of payment models including fee-for-service, concierge, and private pay. Results will be presented at AAPP’s Fall Summit September 25-26 in Washington, D.C.

Researchers find Twitter to be a highly effective tool for breast cancer education and support. Of 200-plus cancer patients surveyed, 80 percent noted an increase in overall knowledge about their disease, while nearly 86 percent felt more knowledgeable about survivorship. Similar figures were reported across a variety of categories including cancer types and biology, and clinical trials and research. My only gripe with the survey results is that the survey was issued on Twitter and Facebook, where respondents had already likely become quite comfortable with using the social networks as data-gathering tools and support networks. It would be more interesting to me to discover the value Twitter holds for cancer patients who have little to no experience with it.

Other

The Houston Chronicle spotlights the mounting struggles faced by independent physicians in Texas, including (but not limited to) technology expenses, declining reimbursements, and ever-aggressive hospitals looking to gobble up practices. “The fun-to-hassle ratio has gone way down,” explains Michael Gorback, MD. “It gets harder and harder every year. They just keep heaping more and more on us.” Texas takes its independence seriously – 29.2 percent of physicians in the state are in solo practice, while 32 percent are in practice with 10 or fewer physicians.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

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Contact us online.
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Population Health Management Weekly Wrap Up 8/7/15

Top News

Premier acquires supply chain and performance services vendor CeCity for $400 million. The company offers PQRS reporting, an educational platform, clinical data registries, and a performance and population health management system. CEO Lloyd Myers, a pharmacist, founded the Pittsburgh-based company in 1996.

Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Acquisitions, Funding, Business, and Stock

Healthcare analytics startup Care at Hand raises $560,000 from financial management services firm PCG Public Partnerships. The San Francisco-based company’s mobile-friendly technology, geared towards home and community-based case managers, uses survey data from non-clinical workers to predict and prevent hospitalizations.

Announcements and Implementations

Reid Health (IN) implements Influence Health’s Patient Engagement Cloud solution, including the Empower enterprise patient portal and Navigate population health management solutions.

The Delaware Valley ACO signs a five-year agreement with Wellcentive for expanded care management and population outreach capabilities, data aggregation, and analytic and workflow solutions. DVACO, which covers 65,000 Medicare patients, is owned by five Philadelphia-based health systems including Thomas Jefferson University Health System, Main Line Health, Doylestown Health, Holy Redeemer Health System, and Magee Rehabilitation Hospital.

Department of Vermont Health Access chooses eQHealth Solutions for population health management technology.

Inovalon signs a multi-year agreement with HP to provide quality analytics technologies to the State of Georgia Dept. of Community Health’s Medicaid and PeachCare for Kids programs. HP will integrate Inovalon’s iPORT cloud-based data integration platform and QSI healthcare data quality analytics platform into the enterprise IT services it provides to the department.

People

Raymond Vogel, Jr. (VA) joins Phase One as director of healthcare development.

SRG Technology, which offers population health management technology it developed with Massachusetts General Hospital, hires Adrian Zai, MD as CMIO.

Research and Innovation

Apple’s ResearchKit gets its first international use as Stanford’s MyHeart Counts app is made available to people living in Hong Kong and UK. The app asks participants once every three months to monitor a week’s worth of physical activity, complete a 6-minute walk fitness test, and provide feedback on their behaviors and risks. “Every type of research study is different,” explains Michael McConnell, MyHeartCounts researcher and professor of medicine at Stanford, “so this may not apply to all future research, but for studying population health and the impact of real-world, daily activities, a mobile research platform has many advantages."

Government and Politics

HHS awards $2.2 million to the Community Health Peer Learning Program as part of a $38 million bundle of funding for three national health IT programs. (I covered the other programs in an update earlier this week.) The two-year CHPLP program will turn the funding over to health services and policy research organization AcademyHealth to work with 15 communities on population health strategies. Communities will be required to identify data solutions, accelerate local progress, share best practices and learning guides, and help inform national strategy around population health challenges.

Other

The National Quality Forum releases “Multistakeholder Input on a National Priority: Improving Population Health by Working with Communities,” the latest version of its Community Action Guide. The 66-page report incorporates feedback from 10 field testing groups engaged in population health improvement work across the country.

Wired highlights the work of Danish researchers in collecting and analyzing the fecal emissions of global airline passengers in an effort to identify impending epidemics. As one of the researchers so succinctly put it, “DNA analysis of airplane poop could help flush out signs of emerging outbreaks.”

Sponsor Updates

• Medicity CEO Nancy Ham co-authors the HFMA article “The Financial Impact of Population Health Analytics in the Shift to Value-Based Models.”
• Billian’s HealthData invites responses from professional marketers in a survey on marketing practices.
• Nordic offers the latest video in its “Making the Cut” series on Epic conversion planning.
• NVoq offers “Your iPhone has Good Dictation. Why Doesn’t Your Enterprise Application?”
• PerfectServe offers “Put down the phone, and other communication lessons from healthcare professionals.”
• EClinicalWorks offers “1.5 Million Referrals Exchanged via P2POpen.”
• Greenway Health offers “CMS Expands ICD-10 Grace Period Guidance.”

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.
Become a sponsor.

News 8/6/15

Top News

ADP announces that its AdvancedMD  division will be acquired by Marlin Equity Partners for an undisclosed sum. ADP AdvancedMD President Raul Villar will continue as CEO of the now independent company. He notes that, “Under Marlin ownership, we are well positioned to accelerate product investment and will continue to deliver best-in-class implementation and service to our loyal clients and partners.”

Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Acquisitions, Funding, Business, and Stock

Blue Cross & Blue Shield of Illinois partners with DuPage Medical Group, the largest independent physicians group in Chicago, to give physicians access to its data on the cost and quality of services patients receive when they get care outside the group. DMG’s 425 physicians will likely use the data to determine which hospital provides the best quality and cost for a particular procedure in the hopes of receiving incentives for sending patients to that facility.

Telemedicine

The local paper covers Oregon’s recent decision to pass Senate Bill 144A, legislation that will require private payers to cover telemedicine services regardless of where the patient is located. Telehealth Alliance of Oregon Executive Director Cathy Britain calls the move “a really exciting time for telemedicine.” The Alliance plans to launch a statewide registry of physicians offering telemedicine services next year.

San Diego’s Craigslist posts a pretty sweet deal for qualified physicians: $100-$200 per hour to provide medical marijuana evaluations over video. Perks from the unnamed company include cloud-based EHRs, an “excellent” bonus structure, and the ability to “work as little or as much as you want.”

Announcements and Implementations

Madison, WI-based Tascet grandly announces the launch of its Unique Patient Identifier solution, yet offers little detail about how the UPI and its security features will ensure the safety of patient records. The website it directs confused readers to is almost as vague.

AAFP partners with HealthFusion to offer the company’s MediTouch EHR to its 120,900 family physician members.

Government and Politics

The Senate HELP committee postpones today’s hearing on Karen DeSalvo,MD’s nomination to be HHS Assistant Secretary until after its summer recess. Kudos to @AmyOnHealth for calming the health IT masses.

Research and Innovation

Black Book Research’s latest study finds that 77 percent of all orthopedic practices have rolled out, are implementing, or are in the midst of selecting an EHR system. Survey respondents ranked Modernizing Medicine, which recently acquired GMed and its gastroenterology EHR, first in orthopedic EHR systems.

Other

Press Ganey is accepting nominations for its inaugural Physician of the Year Award, which will recognize a physician who “demonstrates exceptional leadership; practices compassionate, connected care; and has realized tangible success in improving the patient experience by reducing both patient and caregiver suffering.” Nominations will be accepted through September 25. The award will be presented at the Press Ganey National Client Conference November 10-12 in Orlando.

Charleston, S.C. physician Edward Gilbreth puts a humorous spin on his favorite ICD-10 codes highlighted in “Struck by Orca; ICD-10 Illustrated,” edited by HIStalk contributor Niko Skievaski:

• R46.1 — Bizarre personal appearance. (And who’s to be the judge of that, may I ask?)
• Z62.891 — Sibling rivalry. (Don’t we need one for “Modern Family” as well?)
• W56.22xA — Struck by orca, initial encounter. (I’m not making this up, as Dave Barry would say.)
• S10.87XA — Other superficial bite of other specified part of neck, initial encounter. (This code is found only in the teen version of ICD-10.)
• W220.2XD — Walked into lamppost, subsequent encounter. (Or as my grandpappy used to say, “Son, there ain’t much edication in the second kick of a mule.”)
• W61.62XD — Struck by duck, subsequent encounter. (As opposed to President Jimmy Carter’s attacking rabbit.)

For my fellow tennis fans: Women’s professional tennis comes out of the “data dark ages” with the introduction of courtside iPads loaded with tennis stats fed to the devices from the chair umpire’s electronic scoring system. Coaches, who have the opportunity to confer with players for 90 seconds during each set, will use the data to point out areas for improvement. Both parties will wear live mics during the exchange, which could make for some fun live television.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.
Become a sponsor.