Within the 696 page document, there are sections that outline the measures on which reporting will be required. Currently the number of measures has been decreased from the original count of 65 down to 33.

In addition, HHS has also announced that it has reduced its requirements for the number of physicians required to use a certified EHR system. Now, only 50% of participating members will need to be meaningful users for ACO participation, welcome news by many groups still in the laggard adoption phase. There was also the announcement for a new program that will provide funding for care providers to hire staff and upgrade IT infrastructure with EHRs in order to support their participation in an ACO.

Several health care associations welcomed the news and noted that HHS seems to have taken into consideration much of the feedback from providers and health care professionals as they’ve taken steps toward the meaningful use journey but have yet to reach the pot of incentives gold.

But as we continue to see EHR flyers and marketing brochures outline the benefits of not using paper charts, we can pause and recognize that there are factors other than the typical benefit that will eventually drive physicians to seriously consider adopting EHR. There are several reasons that can put a medical organization who still relies on paper chart at risk. Especially when we are seeing the transformation that is currently happening the US healthcare system.

Following is a list of 6 items that can put the paper based practice at risk in the near future if they don’t adopt an EHR?

More patients will be asking for it: As more patients get exposed to the benefits of their physicians using EHR and see how a healthcare providers who uses EHR can communicate as well as share medical information with them electronically (such as: X-Rays Lab results, treatment plans, e-prescriptions, and PHR), many of these health service consumers will begin to ask and look for physicians who are using these technologies. This would provide many organizations with a competitive edge and enable them to differentiate themselves from others. This could potentially penalize physicians who are not using electronic health records by losing new patients to their competitor.

Telemedicine and servicing a broader geographic area: Several large health systems are beginning to provide basic health services and specialists consults over video conferencing and for a reduce rate. Many of these services are provided via secure communication channel and do not require for the organization to have a physical office near the patient they are servicing. But many of these physicians that will provide telehealth services will be in need for an EHR to be able to share information quickly. This provides them with a competitive advantage as they can efficiently service a broader patient base outside of their immediate community.

Everyone will be collaborating but you: Some states have already implemented an HIE and as more adopt the health information exchange and some of the care delivery models, many physicians are starting to exchange and collaborate on care. These physicians are able to receive complete patient summary of record electronically and share their information about a patient with others as well. This is also the vehicle that will used by physicians to communicate and collaborate on care as well. But for physicians who are still paper based, they may encounter more challenges when attempting to collaborate and be a member of the care team for certain patient population.

Using remote health monitoring to manage chronic conditions: With the increase in patients with Chronic disease and the current competitive market, many health organizations are looking to adopt technologies to assist with remote patient monitoring services. These would be ways to capture health information and monitor patient’s vitals real time. These technologies would require physicians to have some sort of EHR in place to be able to transmit the information to.

Recruiting new physicians: As part of the medical school curriculum, many new graduating physicians have had exposure to electronic medical records. This would most likely suggest that many of them would favor practices and health organizations utilizing EHR for their future employment opportunities. This would make it difficult for paper-based practices to recruit talent.

Penalties, employers and payers will demand it: Some of the current incentives through MU may not fully cover the costs associated with software and hardware for a new EHR, however some predict that penalties and lower reimbursements may cause more heartburn for physicians who elect to stay with paper charts.These pressures will continue to mount, as there is an increasing push for modernizing the US healthcare.

For some time now, there have been many pilots in place for ACOs and medical homes. Some have been able to offset the costs associated with the initial capital investment through CMS grants that have been available; others have established a community base ACO and leverage collective funding, which has allowed several private physician practices to create the infrastructure needed to collaborate on patient care.

As ACOs and medical homes grow in numbers, some of the larger, privately owned physician groups would need to define and prepare their infrastructure and ensure that their business model can adapt to the changing landscape.

Following are some of the changes that will affect the larger private health organizations:

The need for a community based HIE or Registry:

HIE is one of the core components that will be required in order to have a successful ACO or medical homes.This is the engine that will facilitate the exchange of patient health information. So for many organizations, having connectivity and the ability to exchange information is a must have. Unfortunately not all states will be able to provide an operational HIE when some practices will look to engage in ACO’s. This would leave many of the privately owned physician’s group looking to their local health system for similar infrastructure or create their own community based HIE. In Charlotte N.C. for example since there are two large health systems, one of which has taken the initial steps to implement an enterprise wide HIE and maybe on its way to enable future ambulatory practices to connect and exchange health records.

The need to create and fill more health IT (HIT) positions:

For sometime now, many of the mid to large physician owned groups have not required extensive health informatics knowledge as a perquisite for internal IT positions. As some begin to implement EHR and participate in ACOs and become medical homes, they are requiring additional staff with more healthcare specific training. Some of the skills needed in the candidate pool will be: healthcare data analysis, interface and integration experience, EHR experience, EDI, HL7, and an understanding of clinical and administrative workflow.

Establishing community-based collaboration that goes beyond care:

Since some of the reforms call for bundled payments for services and care, many of the physicians will need to work collectively at all different levels. When we discuss ACOs, we focus mostly on the collaborative efforts that physicians will be able to participate in when providing care for their patients. But there will also be additional collective work that will need to happen behind the scene to ensure payments are received, processed and distributed accordingly. CFO, coders, administrators and scheduling staff will need to work together to ensure that the practices are working toward the same goal and ensuring that they are collectively identifying process bottlenecks to better streamline the workflows.

Process reengineering:

For many practices that have continuously reevaluated their processes and improved on them, they will be challenged again to make further modifications. As with the shift toward preventative care, outcome based fee, bundled payment model, organizations will need to quickly adapt to the changes and rework their processes and workflows to ensure sustainability.

mhealth will play a bigger role:

As it stands today, smartphones and mobile devices are as far as IT is concerned are in the hands of very few clinicians. But as telehealth becomes more popular, health organizations will begin to use it to engage patients in their care as well as communicated with them. There are very few services that are covered under telehealth. But with the new ACO model and Medical home, providers now can be reimbursed for both virtual or home visits. In addition, many providers will need to monitor patients outside the practice settings and coach them. Mobile devices will then play a much greater role as they can provide the vehicle to transfer information regarding the patient to their health provider.

It is fair to assume that the only constant in health care is change. Whether it is through new mandates or simply moving toward a more sustainable health care system, many of the upcoming changes will require the organizations to reinvent themselves to navigate through the tough economy and ensure its success.

For many products in the EHR market today, there are actually only subtle differences in terms of their capabilities and functionality. But at times, these are the exact features that can be the key to a successful implementation of the EHR, or not. One could almost apply the Pareto principle here, or the 80-20 rule, where approximately 20% of the features possess the key differentiators and and critical success functions, while the remaining 80% comprise the common features found in most EHR systems.

Some areas of consideration that have spurred conversations among decision makers regarding EHR package evaluation are:

• How effective would some of the products be when interacting with HIEs?
• How are the different EHR solutions going to take ACO models?
• What are some of the different mobile capabilities would be available?

As we’ve been privy to watching unfold, technology has been playing an increasingly important role in the effective, efficient delivery of health care, and continues to present opportunities for innovation and offer a measurable value to both physicians and patients. From utilizing an HIE for better coordinated care to adopting mobile technology and integrating mHealth devices for the viewing of radiology images, lab results or e-prescribing, we are going to continue to see adoption of tools that will not only prove to drive down costs, but also improve the overall quality of care.

For organizations that have selected an electronic method to capture patient information and clinical data, there are several options from which to choose:

Web-based forms: These forms are browsers based (such as html forms) and offer the flexibility of being available and accessible without the need to pre-install anything. They also can be viewed using almost all current platforms and provide the ability to store all data captured from the users as discrete. However, the organization would still rely on web developers to make changes to these forms.

Thick forms: These are the forms that run within specific applications. They are similar to the forms that are available in most EHR packages that are used to capture clinical data as well as registration data. Unfortunately, these forms often are fixed and not easily changeable. They are also only available in the package of which they are a part. We can classify some of the forms available through mobile devices, such as the iPad and Android tablets, under this category as well. MHealth tablets have already seen several apps in their repositories that enable end users and/or patients to enter the data directly into the devices. These forms are, in most cases, written specifically for that platform (iOS or Android).

PDF forms: PDF forms have been one of the most commonly used forms in the industry. These forms can be generated from MS Word documents, or simply by using many of the available off the shelve form builders. They also offer the flexibility to store the data in XML and/or directly to a database. They provide the ability to perform front-end data validation and can run on almost any platform.

Digital Pen: These not so ordinary ballpoint pens can capture handwriting and drawings from special digital paper forms. The information is captured in the device and then uploaded to a central server, where it is then processed and automatically converted into text. While this concept simplifies the capture of data, unfortunately there is still the dependency on the accuracy of the handwriting recognition software and quality of the symbols, which may cause some concerns if the information is not readable.

OCR-based forms: Optical Character Recognition, or OCO, has been around for a while and utilized in many markets, from banking, to the justice system having the ability to scan through a document and recognize the handwriting. An organization can use any form, which provide tremendous flexibility, but unfortunately you are still dealing with a paper document that requires scanning and then disposal as part of the workflow.

The reality is that we are simply finding hospitals using a combination of the above solutions to resolve their data capture challenges. The market had some promising technologies out there, and at one point, xforms showed some promising results, but lacked wide adoption. I was very disappointed to see that xforms did not gain popularity, as it made a lot of sense from a conceptual design standpoint. Similar to XML (XML is a widely adopted method to exchange data across systems in a standardize format), xforms relied on a standard “xml” like method to describe the fields, data types. That meant that many applications had the ability to easily display the forms included mobile devices, as part of an application or simply viewed via browser.

But luckily the dream of having standardized coding for form building has been reborn again through HTML5. Not only can HMTL5 be viewed from any browser or device, but it also means that the forms can easily be modified using web based tools and some of the advanced web authoring applications.

I am most definitely not asserting that HTML5 is the only way to go. There have been many more successful technologies available that enabled efficient data capture across applications and platforms. But we simply need to have some standardization and interoperability in these forms.

Healthcare will always require some data input from patients, family members, clinicians and other staff members. Different devices will be made available for this purpose from tablets, kiosks, mobile devices and desktops. And to ensure ease of use and improved workflow, the technology has to be there to support the overall mission, and so far it’s still too early to tell which technologies will be best suited for the age of electronic data exchange.

Original Article

Within hours, I was able to identify several tools that helped with this issue, and it was to my surprise, it was very easy to recover all data without even having the phone available!

With many of the smartphones used in the market place, end users tend to plug them into their PCs/Laptops to sync with their music and documents; this specific smartphone was no exception. Apparently the utility that comes with the phone allows a full –  I mean “full” – backup of the entire phone to your PC.

Now that I found the backups of this smartphone and where they were sitting in the file system, it was just a matter of figuring out what how to make sense of any of the files.

The second item of business was to identify tools that can browse the actual backups. With the use of some widely available freeware utilities, I was able to simply browse to the backup folder, and then, voila! I was able to see all the backup files, and their full names (the backup replaced the original file names with unique identifiers).

The next step was to review all the files that were listed under his utilities, and to my surprise I was able to identify certain files, such as SMS (sms.db, cookies, websites, cached images,..etc.) With a little bit more research, I discovered that all the files with the extension db were nothing more than SQLLite files (flat database files). So I proceeded to download SQLLite database browser.

Sure enough, by simply viewing the sms.db file, the entire history of text messages (including the deleted ones) was available to me with no prior knowledge of passwords or access to the phone itself.

So what this mean to health care? Simply put, if you are a health care security administrator, or a physician, you will have the following concerns to deal with:

• Ensure that any patient related information is not stored permanently on the mobile phone
• Ensure that any backups that are being performed are encrypted and stored in the cloud securely and not on end user PCs
• Ensure that the mobile device is secured via passwords or patterns
• Keep in mind that if the device is lost or stolen then its data can easily be accessible
• Keep in mind that even when a laptop that was used to synchronized is lost or stolen then the data can also be jeopardized

My friend was able to gain access to the full contact list, call history, text messages and all images taken by the phone cam. There were some great lessons learned throughout this process. The bottom line, we all need to be aware that we must always question the security of the devices we may use and especially when it is dealing with patient information.

Original Article

Reda Chouffani is the Co-Founder of Biz Technology Solutions, Inc and an active Healthcare Information Technology writer for Healthcare IT Insider and TechTarget’s Health IT Exchange.

Currently, almost every medical organization gathers vitals at almost every date of service. And now with meaningful use requiring clinical staff to track patient vitals electronically, some  are considering ways of how to use digital vitals capture systems, and do away with a nurse having to manually enter the data into the chart or on paper.  Even though it may not be lots of data to enter, it is easy to see how such devices can speed up the data capturing process.  Several products are available in the market place from vendors like MidMark and Welch Allyn that provide wireless/wired medical devices that can interface with some of the commonly used EHR products in the market.  This simple integration can reduce the time to capture vitals that is commonly associated with the need for clinical staff to read thermometers, blood pressure gauges and other commonly used equipment. Read More

Reda Chouffani is the Co-Founder of Biz Technology Solutions, Inc and an active Healthcare Information Technology writer for Healthcare IT Insider and TechTarget’s Health IT Exchange.

164.308 Administrative safeguards (7)(ii)(A) Data backup plan (Required). Establish and implement procedures to create and maintain retrievable exact copies of electronic protected health information.

A recent survey stated that only 37 percent of companies that back up their data actually test its integrity and recoverability. And about 77 percent of that group fail to restore their data within the defined business recovery window or don’t recover at all. Hence, less than 10 percent of companies succeed at recovering vital business data using their existing data backup processes.

The Security aspect of HIPAA is the specific measures a health care entity must take to protect personal health information from unauthorized breaches of privacy and measures taken to ensure against the loss of integrity of personal health information, such as might occur if patients’ records are lost or destroyed by accident. The intent of backing-up data is to help ensure its availability by transferring and storing duplicate data at a secondary location. However, simply transferring data to another environment without verifying its integrity or the ability to restore it within a defined business timeframe is a recipe for disaster.

An important facet of computer security involves protecting electronic data from loss or corruption – that is, ensuring its integrity. Although there are many ways data integrity can be affected, the most common is loss of data from some sort of emergency or disaster, including human error, mechanical hard disk failure, equipment damage due to flooding, or computer virus infection.

HIPAA requires organizations to have a contingency plan to continue operations in the event of data loss. This contingency plan MUST include details concerning the data backup and recovery process, who handles the backup media, the media rotation process, where the media is stored off-site, how quickly it can be retrieved in the event of a disaster, and all other aspects associated with data backups, protection, security, storage, and recovery. Data loss can result in further losses of productivity, patients/customers, and revenue. In many cases significant data loss will result in lost business. Fortunately, the damaging impact of data loss can be negated with a qualified data protection solution as part of your contingency plan.

A backup system is a combination of hardware and software that lets you retrieve exact copies of information if the originals become lost or damaged. There are several kinds of commonly used backup systems, including those that store data to tapes, compact discs or off-site devices. The equipment and service can cost from hundreds to thousands of dollars, and the best method for your practice can only be determined after you know how much data needs to be backed up. Your choice also will be influenced by cost, convenience and ease of use. At a minimum, your practice’s backup system should store all of the critical data needed to run the practice in the event of a disaster. Practices should conduct an analysis to identify these critical data.