In the current care delivery model we have today for senior citizens, nursing homes, hospital visits and assisted living are costly to both payers and patients.  And for that reason payers are looking to see what cost benefits would caring for patients at home and support their independences bring.

There are many reasons for the increase in demand for home health services and following is a short list to name a few:

Lower costs:  As patients are being treated at home, this alternate care location eliminates the costs associated with transport, and beds associated with charges inside a healthcare facility.

Telemedicine:  Baby boomers are known for being early adopters of technology and gadgets.  And with many of the capabilities of today’s electronic medical devices and smart phones, patients are able to remotely transmit data and have a care giver review it as part of their care. In addition, patients can even have access to a nurse and physician through video conferencing and be able to discuss their health issues from the comfort of their home.

Active life style:  As more baby boomers continue to enter retirement at a rate of 7,000 a day, many are continuing to stay active.  This most likely influences their decision to try to seek receiving care in the home instead of in a healthcare facility.

Technology:  In this area, we see that both patients and care providers benefiting from some of the technological advancements.  For home health service providers, mobile devices, and tablets have provided many much needed improved efficiencies.  Some of the examples are accessing records remotely, and transmitting information on the patient’s visit real time.

As we to see a shift toward keeping patients healthier and out of hospitals, it will become more critical for patients to receive care, participate in wellness programs and receive preventable care that can help ensure a healthier life.  Homecare services will play a significant role in helping patients with their health needs and keep healthcare costs down by reducing long/short term stays in nursing home and other assisted facilities.

Connectivity with other existing community based (private HIEs) and state or national (NHIN):

One of the core components and purposes of an HIE is to provide continuous availability to medical records, enabling physicians to make better treatment decisions and deliver a higher quality of care in a more efficient manner.  When joining an HIE, providers must also consider what other entities the HIE can use to locate charts electronically.

Contracts:

When joining an HIE, a physician would be subscribing to the services that will be offered.  They will also be agreeing to local state laws around HIEs as well as specific liability and data security requirements set forth by the HIE. These contracts must be reviewed in great details, as they are very complex. The binding legal document will address privacy, security concerns, technical issues, as well as any obligations that maybe associated with early termination.

Usability of system and patient information:

There are several different methods of accessing a patient’s chart through an HIE.  One of the most commonly used and simplest method is via the HIE’s web portal which allows the physician to connect securely and perform record searches for patients.  This set up does not require any special software or interfacing to gain access to the record information.  Another access method that provides a seamless and common interface is through the use of physician’s EHR to request and process incoming patient’s summary chart.  This allows for some of the outside patient information to be combined with current physician’s patient records.  It is important to consider the connectivity model that can help create efficiencies for the organization, so both must be evaluated to ensure the right option is selected.

Value added services:

A great example of how some of the HIE are providing subscribers value added services is what a NC based HIE is doing.  CareConnect Carolinas a local HIE through Carolinas Health System is providing the following services:
·         Comprehensive medication list from SureScipts as well as many other local and national pharmacy networks.
·         Access to patient’s imaging records available through the hospital Information System
·         Access to Lab reports, Transcriptions, letter, Encounter details, Patient facesheet
·         Advanced alerting capabilities such as flags for drug seekers
·         Downloadable CCD (Continuity Care Document)
·         An EHR Lite to assist physicians with Meaningful Use
·         Referral management to digitize the information exchanged during the referral process
·         Web orders for certain labs at some of the health system facilities

There are other health systems that are also providing a PHR access feature for the patients.  This feature provides another method for the patient to be engaged and actively maintain their health record.  It also encourages up to date information even it is manually entered.

Pricing model:

Similar to many of the online subscription based services, HIEs fees are monthly.  Whether it is the physician or health system, they pay a reoccurring monthly fee for the length of the agreement. There is some setup fee associated with most and possibly additional third party charges when interfacing or integrating with an EHR.

Integration capabilities with existing system:

Not all HIEs provide integration with all EHR systems.  Ideally an HIE can provide a strong and tight integration with an EHR product and allow end users to simply use their electronic medical records application which they are already familiar with.  This will enable physicians to simply use the same application to manage patient charts as well as request medical records from an HIE.  But unfortunately, not all HIEs or EHRs allow for this integration.  So for some access to an HIE web portal that provides the ability to print/save the summary record is as far as the system will go.

With the proposed meaningful use stage 2, and 3 there is a stronger emphasis on the electronic exchange of medical records through a qualified Health Information Exchange.  And more physicians and organizations will begin to review some of the available HIEs in their community and state.

Fortunately there were several mobile apps that allow me to maintain all my devices in sync with my Outlook tasks, with one of my favorites being toodledo. The toodledo app allows me to apply some of the principles of proper time management outlined in Steven Covey’s “The four discipline of execution,” and allows all of my “toys” to maintain the same list.

But one challenge that some face lies in deciding when to separate and manage multiple to-do lists. For example, for those physicians who are still practicing and also participating in leadership roles, managing their calendar requires a tremendous amount of discipline and time management skills. In a perfect world, a physician’s EHR messages should be able to easily integrate and populate with their Outlook tasks and calendar (securely and without any patient info). Unfortunately, not all systems integrate or sync with Outlook tasks, which means that many times users need to manage multiple lists or else rely on manual synchronization between different systems.

The good news is that many can still successfully and efficiently manage their time even when having to work with multiple lists. Best practice should always be to review your to-do list(s) daily and stick to deadlines, as this will ensure that you are continually monitoring progress are are aware of changing priorities.

The goal of an ACO, or a set of health care organizations that work together and collaborate on and coordinate care for a set of patients, is to not only reduce costs and increase efficiencies in the system, but also improve patient outcomes and the overall coordination of care. But while ACOs are still evolving and taking shape, it is important to dive into some of the core infrastructure components that will be required to ensure success and long-term sustainability.

In order for an ACO to succeed, it must operate a provider network that will enable the electronic exchange of information, provide a platform for care management and offer a payment distribution system. Underlying all of these attributes, of course, are the technology implications, some of which are the following:

Health Information Exchange (HIE): This is a standards based exchange for electronic health records. The current standard being used is the HL7 CDA or CCR (Continuity Care record), which is the format in which health information is stored and exchanged across systems. The HIE is the facilitator that will enable systems to identify patients as well as locate their chart and route it to the requestor. This does not necessarily mean that an ACO will need to operate its own HIE, however. In fact, most ACO will likely connect, or have the option to connect, to one or more HIEs, especially when working across state lines.

Certified Electronic Health Records (EHRs): For participating caregivers, having EHRs to view and document care during a visit is a must. An ACO might offer a hosted EHR or patient tracking system to help boost participation, though it is not required to have one common EHR system for all the members simply due to the fact that most certified products do have the capability to exchange medical information in a standardized format.

Patient portals: In order to improve patient engagement, an ACO will need to provide a patient portal to facilitate secure electronic communication. This will provide the patients with web based and interactive personal healthcare records. The ACO should also offer integration with all major PHR providers.

Data warehousing and business intelligence (BI): There are over 65 measures in the proposed ruling for ACOs. All these quality measures must be reported on in order to be eligible for shared savings. The measures cover everything from care coordination and preventative health to patient experience. Much of the information will be submitted via GPRO tools. In addition, each measure has a minimum attainment threshold and performance benchmark, which requires the ACO to continuously monitor its performance over time.

IT support: In order to ensure system uptime and reduce disruptions to data flow, an ACO will need to provide IT support not only to support the connectivity amongst the members, but will also need a team of HIT specialists to maintain the internal ACO platform.

Unified communications: In a recent article, I discussed the need for sites or platforms that will facility coordination of care similar to Facebook , except more business oriented (similar to Chatter). These solutions will not only allow caregivers to communicate with each other regardless of distance, but it can provide them cost effective ways to have video conferencing, including telehealth services, and a platform for discussing patient cases.

ACO management technology: Since an ACO is the result of the collaboration of cross-disciplinary services and multi organizations collectivity accountable for the total patient care, it is critical to have a system that will support governance and management of the ACO care-delivery model.

Document management: While this may not be obvious at first, the reality is that there are still patients that bring their medical information in paper format. This may require the ACO to provide tools to digitize that information and make it available to everyone. The ACO may be forced to identify alternatives such as cloud-based document management system to be able to provide easy to use and widely accessible system to retrieve and review paper based documents.

Preventative health: In order for an ACO to have a proactive role in the population’s health, the organization must ensure that it is continuously working with patient through reminders and alerts for preventative care. This is especially important for patients with chronic disease.

Clearly an ACO will require a lot of technology as part of its foundation. This means significant capital upfront as well as resources and a strong strategic plan to ensure sustainability. Some hospital led ACOs may have some of the infrastructure components already available to them, while other ACOs may integrate with a payer system which has most of the components. Either way, the ACO and medical home models are not going away, and health IT leaders will continue to be faced with a unique set of challenges as the industry leaders continue to pave the way toward true coordination of care through health IT collaboration.

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.

And many patients have begun to see the benefits and payoff themselves, utilizing mHealth apps for better care coordination and increased engagement. Whether it’s through apps that offer health coaching for the management and promotion of a healthier lifestyle, or those that allow for better treatment of chronic illnesses, we’re seeing new, patient-driven options truly start to make an impact.

For diabetes care, for example, the assistance can be found in many forms, such as the bant app that was unveiled at the ATA 2011 conference earlier this year, which focuses on increasing patient engagement in teens via the interaction of social media and an iTunes reward system. And at the University of Maryland School of Medicine, researchers have concluded that the use of mobile technology helped patients manage their type 2 diabetes, with results to back it up. Patients who used the app had their A1c levels drop significantly over the course of a year, results of which have helped increase consumer confidence in the app and help illustrate the efficacy of their usage in various patient populations.

There are several other solutions that have helped patients manage their chronic conditions. Asthma patients now have the ability to use a mobile app called Asthma Tracker, which can provide information on common medications, treatments, asthma triggers to avoid and additional resources and tools. Patients with high blood pressure or hypertension can also get assistance in tracking and measuring their BP over time, which allows for the constant monitoring of their levels and enables them to submit their data to their physicians electronically and in real time.

As we continue to monitor the mHealth arena and the many advancements to come, it is just as important for vendors to continue to strive for innovation and develop mobile devices with the patients in mind. Applications and devices that increase patient interaction and engagement are not only a win for the patients themselves, but are also a win for the market and industry as a whole, as they will continue to help drive the shift toward accountable care and frameworks that support and reward for qulity through care coordination.

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

The new system allows the iPad to display ECG data, and allows for the end user to interact with it through eh ability to perform measurements and such. Some additional functionality that this application offers cardiologist is the ability to compare multiple ECGs, by overlaying one onto the other.

One challenge that remains for many is how to ensure long battery life on some such devices, especially when there is a lot of data being transmitted via wireless, which essentially demands more power.

This product is currently available for demos in iTunes, but if any physician is interested n the purchase of this product, they will need to contact GE directly.

But for all the Android fans out there, there will be a future release of this app on the Android platform.

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.

We also continue to see growth in the hospital market. With more physicians aligning with hospitals systems and IDNs, executives and health IT leaders are looking for new ways to scale out their infrastructures while providing a measurable ROI for the organization.

Currently the market offers several models from which to pick, the selection needing to be based on organizational needs and future goals.

PaaS (Platform-as-a-service): In this model, a hospital would either have access to a private or public platform as a service. It will enable the organization to deploy a set of solutions (EHR, RIS, billing) without having to bear the burden of the hardware and software costs associated with those applications.

SaaS (Software-as-a-service): For this model, we actually see some hospitals providing this service to practices and physician affiliates. This model provides access to a software product (a web based EHR, for example) as a service without any hardware requirements. Some hospitals may decide to work with EHR vendors to gain access to their solutions via this model as well.

IaaS (Infrastructure-as-a-service): With some of the hospitals expanding their reach into smaller communities and rural areas, it becomes challenging to have to try and deploy new IT infrastructure from servers, software, VoIP, networking and technicians. This IaaS model eliminates the complexity, long deployment cycles and costs associated with the equipment.

Many organizations have adopted a variety of these service models and have been able to capture a realized ROI. The bottom line is that these models allow providers and IT leaders with the ability to provision and utilize servers, take advantage networking capabilities, and access storage on demand. These offerings will ensure that health IT leaders can continue to focus their efforts on other projects, from meaningful use and HIPAA 5010 compliance, to ICD10 implementation and more.

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.

But what has recently got my attention is how Microsoft continues to aggressively invest in interoperability and connectivity functionality, free of charge, making it continually easier for patients to upload and track their health data. Some of this functionality comes from interfacing with common health devices such as blood pressure monitors, pedometers, glucometers and even digital Images.

Another item that Microsoft has on the menu is a combination of HealthVault and Windows Azure capabilities. These fall under the cloud-computing services category of solutions that Microsoft is currently offering, where there are several reasons why these make such powerful platforms:

• Software vendors are looking for cost effective ways to make health information available in the cloud, and Windows Azure provides out of the box cloud storage with database backend support…(SaaS all the way).
• Microsoft has ensured that if you are a solutions provider, you will have access to HealthVault services through the Windows Azure platform.
• Microsoft has a large number of partner participation. Their partners range from CVS, Aetna, Quest, and few other ones, which allow patients the ability to retrieve some of their data across the wire in order to develop a comprehensive record without a lot of manual work.
• One of the items that’s even more impressive comes with the support of native DICOM (digital imaging) as part of the HealthVault connectivity capability.
• For health care organizations that have adopted a custom made (electronic health record) EHR, Microsoft HealthVault with Windows Azure will provide a flexible platform to host their application or health data.

With respect to digital imaging, DICOM has been the predominant format for almost every system out there. This made it very simple for organizations to simply just start pushing or pulling images over the wire. When it comes to health records, however, there are some challenges. Since not all PHR providers can agree on one single standard, it remains a challenge for many to decide whether it is going to be CCD or CCR. Google Health, for example supports a subset of the CCR, while Microsoft HealthVault supports the entire standards set.

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.