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How to Control the Adverse Effects of Stress
April 21, 2016 3:17 PM by Monique Barrett

[Editor's note: This post was originally written by Larry Altshuler, MD.]

Stressit can be everywhere and anywhere and can occur in numerous forms: mental, emotional, physical, social and environmental. We can't avoid it, no matter what we do.

That's not to say that some stress is not beneficial. In the short term, stress allows us to react quickly and appropriately to harm or danger. The problem is, if stress continues on a chronic basis, it can instead cause a variety of medical problems.

Stress causes the production of various hormones, especially cortisol and catecholamines such as epinephrine. These hormones help gear us up to fight stress in the short term, but if they continue to be produced in excess due to chronic stress, they instead cause wear and tear on our bodies and can damage every organ system.

It is well established chronic stress can cause an increased risk of heart disease, stroke, high blood pressure, diabetes and acid reflux. It can worsen symptoms of asthma, cause disruption in digestion and elimination and depress the immune system, leading to a predisposition for infection. It can lead to chronic musculoskeletal problems and cause or worsen pain. It can induce infertility, erectile dysfunction and increase symptoms of PMS and menopause. It also can affect us mentally, causing anxiety, depression and even panic attacks. Additionally, it can cause premature aging and decreased longevity. Finally, it can worsen any existing medical condition.

Both men and women can be affected by stress, although each gender may deal with it differently. In women, hormones such as oxytocin and estrogen help prevent stress, but this may be lacking in post menopausal women. Men do produce oxytocin, but in smaller amounts, and their primary hormone is testosterone, which may increase the effects of stress. Women's brains are also wired differently than men; rather than a "fight or flight" response, women tend to negotiate, and stress can affect them more as a result.

The best way to deal with stress is to avoid it, but we all know that may be difficult to accomplish. So the next best solution is to prevent it from affecting you adversely by taking actions that block the effects or decrease the production of cortisol and catecholamines.

As April is Stress Awareness Month, explore the following tips on how prevent stress from affecting you adversely.

  • Meditating daily is one of the best and easiest ways, having a profound effect on preventing the harm of stress and being the most cost-effective method available.
  • Maintain a good, balanced diet (avoid junk food). Comfort foods, like a bowl of warm oatmeal, boost levels of serotonin, a calming brain chemical. Other foods can decrease the levels of cortisol and adrenaline. Complex carbs are the best, but fish, veggies, fruits, and nuts are all beneficial to counter stress.
  • Exercise regularly, especially aerobically. Although it has long been thought exercises reduce stress by the release of endorphins, it is now thought a different neurotransmitter, norepinephrine, is better at helping the brain deal with stress.
  • Another important step is psychological counseling, to either uncover the cause of the stress and/or find better ways to deal with it. An alternative method called Interactive Imagery (also called Active Imagination) may be even more powerful.
  • Several medications, called anxiolytics (Valium, Xanax and Ativan), can help reduce the symptoms of stress but often have side effects. I instead recommend a Chinese herbal formula called Ding Xin Wan, which is very effective at relieving stress with minimal to no side effects.
  • Acupuncture, which has a direct physiologic effect on the brain, can also be beneficial for anxiety and depression by rebalancing neurotransmitters such as serotonin and norepinephrine. The Chinese exercises Tai Chi and QiGong, as well as yoga, can be beneficial and may provide long-lasting relief.
  • There are also beneficial western herbs and supplements that can help you ‘chill out,' either in pill form, tea or through aromatherapy. These include St John's wort, dill, sage, chamomile, red clover, rosemary, tarragon, kava and valerian.

The bottom line is stress occurs in everyone's life and you can't avoid it. However, there are many actions you can take to deal with it more effectively and block its adverse effects on your body and mind.

Larry Altshuler, MD, is the author of the DOCTOR, SAY WHAT? Series; Part 1 - The Inside Scoop to Getting the Best Health Care and Part II - The Guides: What Works and What Doesn't for Over 90 Medical Conditions. He is a practicing internist, hospitalist and integrative practitioner at a major medical center in the Midwest.

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Five Questions to Ask Your Next Risk Adjustment Partner
April 11, 2016 11:34 AM by Monique Barrett

[Editor's note: This post was originally written by Steve Whitehurst, CEO, Health Fidelity.]

As the availability of healthcare data continues to grow, many new technologies for risk adjustment are entering the market. When thinking about adopting a new risk adjustment solution, conduct a realistic self-evaluation in addition to also considering the support capabilities and workflow expertise of potential partners.

It's important to understand your own risk adjustment organization's readiness in order to determine the best external approach for your needs. In particular, a look at your overall performance, operations and infrastructure is vital to understand which partners will best fit your team's characteristics. You should have a full understanding of where your current risk scores are, outstanding opportunities, staffing levels, data acquisition processes, etc., to get a baseline of your overall maturity and sophistication. A reputable partner will have expertise and processes to help with this step. 

Once you have a good understanding of your status quo, it will be easier to consider where outside support is warranted. Most vendors love to pontificate on their solution, so we recommend you probe on their support, industry expertise and overall workflow adaptability in order to ascertain their overall fit with your operations.

Here are a five key areas to explore:       

  1. What are the improvement opportunities present in my organization? This involves not only the quantification of risk capture potential, but also an understanding of where in the risk adjustment ecosystem the opportunities exist. This allows for meaningful prioritization of the opportunities.
  2. What is the best method of improvement to address these opportunities? Retrospective review, prospective campaigns, provider education, billing staff education, member outreach, etc.?. Depending on the type of opportunities that exist, the appropriate method for improvement may vary. This is critical to maximizing the ROI.
  3. Is my organization ready to implement the proposed methods? If not, what are the gaps and how can I close them? The best methods will not work if there aren't enough coding resources or if the appropriate data isn't available. Together with the solutions partner, the readiness gaps need to be addressed before moving forward. A vendor with the best interest of the customer will not want to implement a solution without a readiness check.
  4. What is a reasonable timeframe in which we can expect to see results? Organizations can often have unrealistic expectations on how long the newly implemented solution will take to demonstrate performance improvements. Establishing measurable goals with specific timelines will help to attribute tangible ROI of the solution for leadership while maintaining engagement from key stakeholders and users.
  5. What processes will be in place to ensure improvements are continuously sustained? The biggest value of a technology-enabled solution is scalability. But if implemented without sustainable processes, improvement gains will be short-term, or your reliance on partner services will continue to incur costs. A sustainability strategy aligned with your organizational needs is essential.

Technology is only as good as the user. In a world as complex as risk adjustment, it is even more critical technology solutions are deployed to fit the specific needs of its stakeholders. When considering a new solution, organizations should ensure a potential partner's people and processes, in addition to the technology, are well-aligned with your strategy.

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A Nudge in the Right Direction
April 6, 2016 11:56 AM by Monique Barrett
[Editor’s note: This post was originally written by Kathleen Ellmore, vice president, engagement sciences, Silverlink.]
 
“Real people have trouble with long division if they don’t have a calculator, sometimes forget their spouse’s birthday, and have a hangover on New Year’s Day.” 
― Richard H. Thaler, Nudge: Improving Decisions About Health, Wealth, and Happiness

It’s not easy to be healthy. We all know we need to do certain things to get to our best version of our healthy selves; yet, very few of us do.
 
When Richard Thaler and Cass Sunstein published Nudge in 2008, they applied the important concepts of behavioral economics to healthcare, and included insights about consumer behavior towards their own health that are still true 8 years later. It seems like an overwhelming task to get people to make better choices about their healthcare, but what we know is that a small change (or two or three) can have a very powerful and lasting effect. More than a million times a day, we apply these very principles to help nudge people into the choices that aren’t always the easiest but are the best for their health.
   
And they work. The keys to driving behavior change can be as powerful yet simple as these nudges:
 
1. The Power of the Second Chance: How many times have we all been in the situation where we know we need to do something, and yet it seems so daunting we avoid it? If we find out something important we need to do may be easier than we feared, we are much more likely to change our minds when given the chance. As Thaler said, “First, never underestimate the power of inertia. Second, that power can be harnessed.” In healthcare, a consumer may delay or avoid an important test or screening, even when they know they need it, and for a whole variety of reasons, from lack of understanding the need for it to fear or avoidance of something that might be uncomfortable. Let’s face it: Who is going to jump at the chance for a colonoscopy? We use this “second chance” nudge in healthcare very effectively. When we ask consumers whether they want to enroll in a condition management program or schedule an appointment for that overdue screening and they say “no,” we find out why and address the why. Then, by simply asking “Are you sure?”, we convert up to 30% of those initial “no’s” into “yes’s.”
 
2. Harness FOMO: I don’t know a single person who hasn’t experienced “FOMO” or “Fear of Missing Out” at some point in their lives. In other words, you want to do something because everyone else is, and this doesn’t just apply to our teenage years, at the height of peer pressure. When applicable, we use social norm messaging to help nudge consumers to make the right choice in a variety of programs, and for those folks who are hesitant, understanding many others have also made the same decision adds a powerful testimonial and influence. For example, when we told consumers who were considering a health plan choice that they would have “access to the biggest network,” the campaign results soared by 57%. As for those tendencies we all have around FOMO? The good news is social norm messaging doesn’t work as well in the Medicare population. Phew, we can look forward to finally outgrowing peer pressure!
 
3. Stop at Three: It’s so important to make sure you don’t overwhelm consumers with too many choices or too many things to do, or you run the risk of sounding like Charlie Brown’s teacher. There has been terrific research that shows consumers prefer lists with odd numbers and find them easier to digest than even-numbered lists. Over our 14 years, we have found evidence time and again reminding consumers about no more than three specific gaps in care is most effective for people with three or more gaps to close. If you start to message about that fourth gap, you’ll lose their attention, and the opportunity to close any of those gaps drops significantly. (It’s also important that you don’t lose your readers, so I’m stopping at three as well!) 
 
Behavioral economic nudges are an effective, gentle way to help consumers take the actions we need them to take to achieve better health. What nudges are you using in your programs? 
 
References:
1. Richard H. Thaler, Nudge: Improving Decisions About Health, Wealth, and Happiness
2. Medium and Baker Marketing
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Consortium Forms to Mandate Electronic Monitoring of Hand Hygiene in Healthcare
April 5, 2016 11:37 AM by Monique Barrett
[Editor's note: This post was originally written by Paul Alper, chairman, EHCO.]

Leaders in healthcare face daily pressure to drive quality and economic efficiencies. This trend has become more prominent as the Centers for Medicare & Medicaid Services (CMS) imposes penalties that demand hospitals do more with less. Today's healthcare executives must find new evidence-based ways to improve practices and standards of care and choose methods that are relatively easy to implement into their organization's culture.

One patient safety area now attracting attention, thanks to the CMS Hospital Associated Condition (HAC) penalty, is the need for effective methods to reduce infections. Every year in the United States, more than 700,000 hospital patients contract an avoidable infection known as an HAI, healthcare-associated infection. Of those patients, approximately 75,000 will die.

While proper hand hygiene is critical to preventing the transmission of many infections, compliance with hand hygiene guidelines is less than 50% globally. Until recently, the only way to measure how well healthcare workers performed hand hygiene was manual direct observation, typically by infection preventionists or nursing staff often referred to as "secret shoppers." With direct observation, individuals know they are being observed and adjust their behavior, a phenomenon known as the "Hawthorne Effect," inflating a hospital's true compliance rate. A hospital may think its hand hygiene compliance rate is 90%; but in reality, it is closer to 30%.

Just as every other area of healthcare is adopting advanced technologies for improved efficiencies and care, innovative tools are now available to measure compliance accurately and reliably, which has been shown to help drive true improvement in hand hygiene compliance and reducing avoidable infections and their associated costs. Unfortunately, the awareness of the connection between increased hand hygiene compliance and enhanced patient care and reduced costs has remained low among healthcare leadership.

To put the significance of hand hygiene compliance in the spotlight, eight companies that developed such technologies have formed an alliance: Electronic Hand Hygiene Compliance Organization (EHCO) in February 2016. EHCO's purpose is to increase safety, reduce avoidable harm and eliminate unnecessary costs at hospitals nationwide by leading the change in hand hygiene measurement policy and guidelines at accreditation organizations, government agencies, health insurers and hospitals. The companies engaged in EHCO include Airista, BioVigil, CenTrak, Clean Hands-Safe Hands, DebMed, Hill-Rom, Inc., SwipeSense and Versus Technology.

EHCO goals align with those of hospital leadership in that each strives to reduce the risk of HAIs, their associated costs and potential penalties. EHCO invites executive and quality leadership to consider the real cost of using antiquated methods of measuring hand hygiene compliance and suggests that now is the time for hospitals to make the change in how they measure this key performance indicator of patient safety and quality and consider adoption of an electronic solution.

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Getting the Message Right in Health Data Analytics
March 28, 2016 2:11 PM by Monique Barrett

[Editor’s note: this article was contributed by Patrick George, director, healthcare practice, KP Public Affairs.]

There is no stopping big data. An entire industry, driven by identifying patterns from extremely large data sets, is set to grow at a blistering pace—26.4% annually through 2018, according to a recent forecast from research firm IDC. The trajectory would mean an additional $41.5 billion through 2018—roughly six times the growth rate of the rest of the entire information technology market. In this environment, it is understandable a large number of data analytics firms lie in bed at night wondering how to gobble up a larger market share.  

However, in the quest for domination, organizations have made their marketing approach needlessly complicated. Marketers and their consultants have failed to accept decision makers in the healthcare technology space remain surprisingly illiterate. Still, an endless stream of executive speeches and press releases carry on about “value-based, world-class, solutions.” Too few companies offer real examples and plain descriptions of how it works and why it works. Companies and the marketing firms that advise them need to regain their senses.  

Based on my experience in healthcare and IT, here are three ideas that can help:

Showcase Your Customers 
The mission and purpose of a business is to meet the needs of its customer. According to market research firm Nielsen, 83% of customers will take action based on recommendations from people they know. Testimonials, editorial media coverage, speaking at events—when customers deliver the message, there is no more trusted source to other customers. It is amazing how few organizations put the time and effort into directly or indirectly enlisting satisfied customers to make the case on their behalf. When a customer talks plainly and succinctly it resonates, particularly when it comes to highly complicated topics like analytics and big data in a healthcare setting.    

Frame the Message  
As much as the message itself, how it is “framed” influences customer choice. Discussing technical issues like data analytics is successful when it’s linked to what’s happening in the world. Much like the way a frame draws attention to a painting, message framing provides order and structure around the message. For example, data analytics and big data providers proclaim they have “proven solutions that deliver results.” However, too few take the time to tailor messages to the scope of the problem, the cost of inaction, the timeframe or human barriers that impede progress. For example, there is inherent conflict between sharing top-line messages for physicians or senior level executives and, say, a middle manager who needs to understand how data analytics can help coordinate coverage, coding, and payment processes for Medicare.

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Deliver the Message with a Point of View  
Hearing what someone believes to be true is more persuasive than a recitation of facts or products attributes. Offering a point of view means stating a position then giving reasons to believe and offering a conclusion. For example, a physician in a busy clinical setting might feel too overwhelmed to care to try a new technology. Similarly, senior-level executives are constantly bombarded with appeals for them to spend their budget (or their valuable time) on technology. A good argument enables key audiences to evaluate complex data analytics products and services for themselves.

Moving forward, companies in data analytics and other technology industries will have little choice but to deliver messages that are succinct, purposeful and loaded with direction. Failing to do so could mean the difference between shriveling on the vine and thriving in a growing, boundless technology market.

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Improving Physician Workflow and Patient Care
March 4, 2016 8:03 AM by Silas Gossman

[Editor’s Note: this blog was originally written by Mike Sutter, Carle Health System]

Several different “flavors” of telehealth have developed over the years, with varying degrees of popularity and adoption. Some hospitals have telehealth systems in an emergency room, allowing ER physicians to communicate directly with physicians at another site. Other hospitals have specialty physicians who leverage telehealth visits from one health facility to another.

Telehealth equipment is generally known to be costly and limited. Traditionally, telehealth tools were permanently located in one room and only accessible when that room was available—very similar to the advent of teleconferencing rooms in offices. Unless a mobile cart was available to move from room to room, the telehealth offerings remained limited.

Today, the steady increase of mobile devices being integrated into the workflow of hospitals is transforming telehealth and how we deliver care. Additionally, medical devices are getting more compact and leveraging the technology that is already in our pockets. The end result is not only improving workflow and physicians’ lives, but also improving patient care and satisfaction.

For example, Carle is a level-3 center for perinatal care. Our health system offers care to patients across a span of about 9,000 square miles. In dealing with high-risk obstetrics situations, patients may have to travel over an hour by ambulance or 30 minutes by helicopter just to determine if they actually need to be in our main facility. However, if a local community physician is able to leverage telehealth and apply a very simple device to read that fetal heart rate and contraction, then share that information with a specialist at the main campus, we can determine the level of risk and take the appropriate action. That may entail either arranging transport, or treating the patient without having to make an unnecessary trek. The ability to extend specialty services out to remote sites in a rural health environment, where the care is equivalent to that of the main campus, is the ultimate goal.

Additionally, telehealth changes how we think about data. If you look at how care has been provided in the past, it has always been based on static data. For example, I can call a hospitalist to report a patient’s blood pressure at a certain time. However, by the time I get the hospitalist on the phone, I’ll always be providing historical data, nothing in real time. With today’s technology, the hospitalist can now look at the data on his phone while we are on a call, thus enabling the hospitalist to make a more informed treatment decision.

With the help of telehealth, we are changing the way healthcare is delivered. Keeping our patients healthy, safe and happy is always our most important goal, and it’s an exciting time to see the technology keeping up.

Michael J. Sutter, CRNA, MSN, MSBA, is chief innovation officer for Carle Health System based in Urbana, Illinois.

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When Faster, Bigger Isn’t Always Better
February 29, 2016 9:02 AM by Silas Gossman

[Editor’s Note: this blog was originally written by Matthew Jacobson, President and CEO, SignatureMD ]       

The U.S. is experiencing an unprecedented healthcare shift as Baby Boomers age. This shift is delivering a one—two punch, namely this aging population requires more and more healthcare, while the boomer physicians that deliver it are retiring at record rates.  So, what does this mean? Simply put, a dangerous physician shortage and out of control medical expenses.

Our aging population exacerbates the situation, generating more incidences of chronic disease, with Americans 50+ years of age experiencing more multiple chronic diseases than any other age group. Indeed, 86% of the $3 trillion spent on healthcare last year in the U.S. was spent on people with one or more chronic medical conditions, according to the CDC.

As a result, both employers and employees have to pay more for healthcare. Healthcare premiums for employer-sponsored family coverage have increased by 87% since 2000. Healthcare coverage costs for people with a chronic condition average $6,032 annually—five times higher than for people without such a condition.

The great irony is that many of the chronic conditions that plague Americans are largely preventable, including heart disease, hypertension, stroke, diabetes, obesity, alcohol and drug addiction and, to a significant degree, arthritis and cancer.

To state a familiar refrain, the U.S. spends 50% more money on healthcare per capita than any other developed nation, yet has the lowest life expectancy and the worst overall health.

Now for punch number two:  primary care physicians are retiring at record rates, but new medical school graduates are not going into primary care because the economics do not work. This shortage has forced society to look for other delivery systems for primary care, like urgent care clinics utilizing non-physician medical providers. These new delivery systems provide disjointed care and poor patient service.  

Clearly, something is wrong with our current healthcare system. Now, if you have been to a doctor in the last few years, you’re likely to already have experienced the problem. Medicine today has become a business where speed and efficiency are valued as the endgame, in effect marginalizing the wellness of the patient. This assembly line approach to delivering services works well on scores of things like fast food and building automobiles. But healthcare demands a certain degree of personalization, and this is where the assembly line approach fails not only the individual, but also society as a whole.

So, what do we do? One approach is to bring medicine back to the basics where developing a patient-doctor bond is more important than ordering a myriad of diagnostic tests. A movement is afoot among primary care doctors (GPs, family doctors, internists, pediatricians) to re-focus health care on preventing chronic diseases in the first place rather than merely treating their symptoms. It’s called different things—concierge medicine, direct primary care, slow medicine—but doctors who practice it all share the common belief that there’s no substitute for time in attending to an individual patient’s needs.

Now you might think it costs more to obtain this kind of care. But industry studies have demonstrated that patients who receive a personalized approach to medicine have fewer hospitalizations, and it’s especially effective with Baby Boomers and others who have multiple chronic diseases.

The need to rethink and re-evaluate the shifting healthcare landscape is more critical than ever, starting with the fundamental concept of paying proper attention to patients’ wellbeing. 

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Notifying Patients When a Physician Leaves
February 23, 2016 10:10 AM by Silas Gossman

[Editor’s Note; this blog was originally written by Julie Simer]

The University of Rochester Medical Center (“URMC”) recently agreed to pay a $15,000 penalty for providing patient names, addresses and diagnoses to a departing nurse practitioner (“NP”) without first obtaining authorization from those patients. The penalty was the result of a settlement with New York Attorney General Eric Schneiderman.

The settlement arose from events in the spring of 2015. In March 2015, the NP was preparing to leave URMC for a position at Greater Rochester Neurology (“GRN”). Before leaving, she asked for a list of patients she treated while employed at URMC, and URMC provided her with a spreadsheet containing the protected health information (“PHI”) of 3,403 patients. Although the Health Information Portability and Accountability Act of 1996 (“HIPAA”) prohibits the unauthorized disclosure of PHI, the NP disclosed the PHI to her new employer, GRN, without the patients’ authorization. In April 2015, GRN sent letters to the patients whose names were on the spreadsheet announcing that the NP had joined the practice and advising them of how to switch to GRN. URMC began receiving calls from patients who were upset that their confidential medical information had been disclosed without their permission.

URMC responded by sending breach notification letters to the affected patients and notifying the media. The NP was interviewed, suspended and subsequently terminated. URMC also obtained an attestation from GRN that all PHI transmitted by URMC had been returned or deleted. URMC’s Privacy and Security Executive Committee formed a task force to review the hospital’s privacy and security requirements and the protocol for disclosure of PHI with respect to departing and incoming workforce members. On June 11, 2015, URMC reminded its workforce that all patient information was the property of URMC and could not be copied, shared, removed, or transferred without the permission of both URMC and the patient. It also informed URMC’s workforce of its policy that information regarding continuity of care was to be communicated to patients by URMC, not the individual healthcare providers.

Pursuant to the Health Information Technology for Economic and Clinical Health Act, state attorneys general are empowered to enforce HIPAA regulations through civil actions against violators. In addition to paying a $15,000 penalty, URMC agreed to train its workforce on policies and procedures related to PHI and notify the Attorney General of future breaches.

This settlement addresses several questions that often arise when a physician (or other healthcare professional) departs a hospital or medical group (“healthcare entity”).

What is the healthcare entity’s responsibility when a physician departs? The healthcare entity has the dual role of safeguarding the medical record while facilitating continuity of care. It must protect the patient’s medical record and not release it without patient authorization.

Should patients be notified of the physician’s departure? The answer is yes. The American Medical Association’s Ethical Opinion E-7.03 provides that “[t]he patients of a physician who leaves a group practice should be notified that the physician is leaving the group.”

Who should provide the notice? The healthcare entity, which is the party responsible for maintaining custody of the medical record, should send the notice. It may, if it chooses, permit the physician to have input as to the text of the notice. It may also resolve the issue in advance by including a provision in the physician’s written employment or other affiliation agreement that specifies the details of the notice that the healthcare entity will send in the event of the physician’s departure.

Is a list of patient names without information about the patient’s medical condition considered PHI? HIPAA protects information that relates to the past, present, or future physical or mental health or condition of an individual when there is a reasonable basis to believe the information can identify the individual. A physician’s list of patient names by itself is not PHI, but if the physician’s practice only serves patients with a certain health condition, then it may be reasonable to assume that every patient on the list must have the condition. In that circumstance, the list of names may be PHI.

What should be in the notice? The content of the notice will depend upon state law. For example, the Ohio Medical Board has adopted specific rules about the content of the notice, which must include the following (Rule 4731-27-03):

·         Notice to the patient that the physician will no longer be practicing medicine at the healthcare entity

·         The date the physician ceased or will cease to provide medicine services at the healthcare entity

·         If the physician will be practicing medicine in another location, contact information for the physician subsequent to leaving the healthcare entity

·         Contact information for an alternative physician or physicians employed by the healthcare entity or contact information for a group practice that can provide care for the patient

·         Contact information that enables the patient to obtain information on the patient’s medical records.

The Ohio rules require the healthcare entity to send the notice to patients, but it may satisfy its statutory obligation by providing patient contact information to the departing physician and requiring the physician to send the notice to patients.

The California Medical Board (“CMA”) advises that patients should be notified of changes in the medical practice and recommends “that due care should be exercised when closing or departing from a medical practice.” California healthcare entities should review CMA guidance before sending the notice.

What should a hospital or medical group do now?
Healthcare entities must be prepared for the departure of physicians and other healthcare professionals. According to Schneiderman, “Other medical centers, hospitals, healthcare providers, and healthcare entities should view this settlement as a warning, and take the time now to review and amend, as needed, their own policies and procedures to better protect private patient information.”

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Increase the Clinical Value of EHRs
February 16, 2016 2:36 PM by Silas Gossman

[Editor’s Note: this blog was originally written by Lorelle Lapstra, VP, Healthcare Products, with Calgary Scientific]

Over the past five years, hospitals and health systems have invested millions of dollars to implement electronic health records (EHR). Today 8 of 10 physicians have an EHR, but much of how they use them has been focused on meeting federal requirements for meaningful use. To give EHRs the clinical value and actual usefulness that providers expect, they need to be much more than data entry tools. For clinical use, physicians need EHRs that provide a full patient profile complete with images, medications, lab results and more.

Getting to that single point of access requires that EHRs have the ability to access and share patient information from clinical care systems, which requires new features and functions. Adding an enterprise image-viewer with FDA Class II clearance for diagnosis, for example, not only allows an EHR to access patient images but also turns it into a diagnostic tool. It’s also critical to have that clearance whether the image-viewer is running on a mobile, laptop or desktop platform.

Intermountain Healthcare (IMH), recognizing the need to get more value from their EHR, implemented an enterprise image-viewing tool for its network of 26 hospitals. The organization is also in the midst of converting from a home-grown EHR, called HELP2, to Cerner and wanted an enterprise image-viewer that would work with both. IMH has dubbed its Cerner implementation iCentra.

“We chose ResolutionMD because it is platform agnostic,” explains Randy Tebbs, imaging systems manager at IMH. “It provides a really light weight tool for our providers that enables them to access patient images from any PACS whether they’re using HELP2 or iCentra.”

When providers using iCentra want to access a patient image, the EHR defaults to this image-viewer allowing them to access any DICOM image without logging in again, re-selecting the patient and jumping through other access hoops. Tebbs has seen an increased use of the image-viewer, which demonstrates that this simple but powerful access solution is working for providers. Each time the image-viewer is implemented at an IMH hospital or clinic, Tebbs sees an uptick in overall image access. “Our affiliated physician use has also increased quite a bit,” he adds.

IMH’s investment in another tool in the midst of a long-term, large-scale EHR deployment underscores the need for added tools to make EHRs truly useful in clinical environments.

Take a page from IMH's experience and learn more about how an enterprise image-viewer can quickly increase the value of your EHR investment.

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Cybersecurity: New Area for Mobile Medical App Compliance, Part 2
February 8, 2016 9:04 AM by Silas Gossman

[Editor’s Note: this blog was originally written by Andy Miller]

A two-part series examining regulatory compliance to raise awareness around cybersecurity risks.

The trap many developers – from software architects to programmers to designers – fall into is thinking they know enough about cybersecurity to adequately identify and address the risks, while falsely relying on the underlying OS for protection.

It is important to remember, cyber criminals are professionals diligently working on new ways to exploit networks, mobile phones and applications. Anything connected to the Internet must be assumed to be actively under attack, and even more so if the information within these devices is considered valuable. Reuters reported in 2014 that patient health credentials are 10 to 20 times more valuable than credit card numbers. The reality is that any network connection enabled by an app may introduce new risk.

Assuming otherwise technically competent development teams have the acumen to defend medical devices can be a serious gamble. Unless actual security professionals are part of the engineering staff, software companies are potentially putting the security profile of medical devices at risk.

Cybersecurity is not a casual concern; it is a serious matter. Both the FDA and the Department of Homeland Security have issued warnings that hospital medical devices can be easily hacked. Further, U.S. HIPAA/HITECH regulations require that manufacturers of medical devices that transmit and/or store protected health information have a company security program in place.

Frustratingly, the FDA can only regulate the medical devices it knows about. Remember the wide swath of essentially unregulated devices, which the FDA deemed not to pose an immediate risk to patient safety? Since these devices are not regulated, there is no requirement for the device makers to comply with the agency’s minimal cybersecurity guidance. These devices, in many cases, connect directly to patient health records and/or present clinical data to their user. The vulnerability here should be obvious.

So, what can be done?

The first step to all recovery is admitting there is a problem and that help is needed. Someone on every software-containing medical device manufacturer’s staff should be an information-security professional. If not, one should be hired or developed internally, or consulting assets should be leveraged. There are several professional designations to look for – Certified Information Security Manager (CISM) being the most applicable. These professionals have been trained to take a comprehensive look at a company’s security posture, identify and prioritize risks and track their remediation.

Next, manufacturers should stop looking at cybersecurity as a technical issue. Cybersecurity is not a bug. Mitigations to many cybersecurity risks are technical in nature, but the best answer is to institute a comprehensive compliance and security program, which encompasses all aspects of corporate operations and has executive sponsorship. Many corporations allow compliance programs to become paperwork exercises. They do this at their peril.

Finally, there is no need to reinvent the wheel. All compliance programs should follow an established standard, and information security has several to choose from. Internationally, the obvious choice is ISO 27001. Domestically, the HHS website cites the National Institute of Standards and Technology (NIST) Cybersecurity Framework for security compliance. NIST is a federal agency that sets security standards for the federal government. Whichever one is chosen depends largely on where the product is marketed. While the two have similarities, apps marketed in the U.S. – especially to the government – should follow the NIST Framework.

It is important to remember that simple regulatory compliance is only the first part of a successful mobile health application. When it comes to cybersecurity, it is vital to be proactive instead of reactive, especially when the system being secured can potentially leave a patient exposed to harm.

Andy Miller is VP of Quality Assurance and Regulatory Affairs at AirStrip, where he has led regulatory compliance efforts for the last six years. Previously, Andy managed quality management information systems for various pharmaceutical and medical device companies, with a focus on product and non-product software validations. Andy resides in San Antonio, Texas.

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Cybersecurity: New Area for Mobile Medical App Compliance, Part 1
February 2, 2016 11:41 AM by Silas Gossman

[Editor’s Note: this blog was originally written by Andy Miller]

A two-part series examining regulatory compliance to raise awareness around cybersecurity risks.

Regulatory compliance. While this phrase may strike an ominous tone for many traditional mobile app software companies, it is familiar territory for veterans in the mobile medical app space. It is unlikely the software developers behind the first calorie counting app gave regulatory compliance much thought. Applications, after all, have been a source of convenience, entertainment and education for years. However, as mobile apps have grown more integrated and mobile device sensor technology has become more sophisticated, that calorie counting app may be transformed into a tool for treating obesity, diabetes and sleep disorders. Smart software developers have come to realize that mobile medical apps are a way to future profits as well as a benefit to patients.

That is where the regulatory compliance piece of the puzzle comes in. We are all now familiar with the FDA and their Guidance on Mobile Medical App regulation, issued this past February. In my opinion, the guidance leaves far too many apps essentially unregulated. However, it does corral the applications posing the greatest patient risk and provides app developers with a pathway to obtain clearance before being marketed.

However, simple regulatory compliance is only part of the picture. Providing assurance of mobile medical application security is as essential to delivering a safe and effective product as is functional and performance testing. What good is a mobile medical app if it cannot upload health information to its central server securely? What if the app is compromised, leading to a breach of patient health information? Or even worse, what if an app is subject to hacking, and as a result the patient medical device it connects to can be somehow manipulated? Now we are speaking of actual patient harm.

Some potential cybersecurity risks to medical devices include:

-          Breaches of protected health information

-          Stolen financial information and identity theft

-          Loss of device availability at a time of need

-          Compromised device performance and malfunctions

-          Theft of device intellectual property

My intent is not to scare anyone, but rather, raise awareness. App developers likely rely on clinical and technical experts to ensure they have mitigated risk and met their functional and performance requirements. The question becomes whether or not these developers have analyzed the cybersecurity risks posed by, and to, their applications. The FDA requires that cybersecurity be addressed in 510(k) filings, but like much of the agency’s guidance, the requirement is described at a high level. It is left up to the app developer to essentially self-police based on an analysis of cybersecurity risks – and therein lies the problem.

[Editor’s Note: this blog was originally written by Andy Miller]

A two-part series examining regulatory compliance to raise awareness around cybersecurity risks.

Regulatory compliance. While this phrase may strike an ominous tone for many traditional mobile app software companies, it is familiar territory for veterans in the mobile medical app space. It is unlikely the software developers behind the first calorie counting app gave regulatory compliance much thought. Applications, after all, have been a source of convenience, entertainment and education for years. However, as mobile apps have grown more integrated and mobile device sensor technology has become more sophisticated, that calorie counting app may be transformed into a tool for treating obesity, diabetes and sleep disorders. Smart software developers have come to realize that mobile medical apps are a way to future profits as well as a benefit to patients.

That is where the regulatory compliance piece of the puzzle comes in. We are all now familiar with the FDA and their Guidance on Mobile Medical App regulation, issued this past February. In my opinion, the guidance leaves far too many apps essentially unregulated. However, it does corral the applications posing the greatest patient risk and provides app developers with a pathway to obtain clearance before being marketed.

However, simple regulatory compliance is only part of the picture. Providing assurance of mobile medical application security is as essential to delivering a safe and effective product as is functional and performance testing. What good is a mobile medical app if it cannot upload health information to its central server securely? What if the app is compromised, leading to a breach of patient health information? Or even worse, what if an app is subject to hacking, and as a result the patient medical device it connects to can be somehow manipulated? Now we are speaking of actual patient harm.

Some potential cybersecurity risks to medical devices include:

-          Breaches of protected health information

-          Stolen financial information and identity theft

-          Loss of device availability at a time of need

-          Compromised device performance and malfunctions

-          Theft of device intellectual property

My intent is not to scare anyone, but rather, raise awareness. App developers likely rely on clinical and technical experts to ensure they have mitigated risk and met their functional and performance requirements. The question becomes whether or not these developers have analyzed the cybersecurity risks posed by, and to, their applications. The FDA requires that cybersecurity be addressed in 510(k) filings, but like much of the agency’s guidance, the requirement is described at a high level. It is left up to the app developer to essentially self-police based on an analysis of cybersecurity risks – and therein lies the problem.

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Innovating at the Intersection of IT and Care
January 26, 2016 11:58 AM by Silas Gossman

[Editor’s Note: this blog was originally written by Jonathan Draper]

Breaking down the silos between data sources and departments involves a complex blend of technology and people that, not surprisingly, can result in conflict along the way. However, the ultimate goal remains the same for all: protect the patient. Understanding the concerns of each department and encouraging communication amongst the groups can reduce this tension, allowing for innovation1 to take hold and enhance care throughout an organization.

For example, consider the implementation of mobile platforms across a health system. In the past, IT departments deployed and rolled out the technology–in a way, forcing physicians into it without giving them a say in the matter. As the bring your own device (BYOD)3 trend gained traction, physicians began to demand the ability to have access and leverage mobile technology, similar to their peers in other industries. This was a scary thought for hospital IT departments that had to think about not only their own systems, but also how physician behavior might affect security. It took time for the trend to become a norm; but more importantly, it required the IT team to acknowledge that mobility is a permanent healthcare tool – not just another temporary Band-Aid or fad–while care teams had to prove the value of this access while showing they could manage this power responsibly. These realizations, in conjunction with the benefits (providing improved access to information), give everyone a common goal and common direction to work toward.

This shift to a collaborative understanding also means that innovators need to be able to deliver features that are tailored to both audiences–the IT department and the physicians. It’s a delicate balance in focusing on the usability features that physicians are looking for, while also making sure that the solution is deployed in a way that adheres to IT department policies. 

For an innovator, having the ability to understand both of these worlds is vital in merging them together and bringing technology trends to a nuanced market. Bringing only a physician’s perspective reduces the likelihood that you understand emerging trends that are proving worthwhile in other tech-focused fields and that will need reshaping to fit a healthcare need. On the other hand, if you’re only looking at things from a technology/IT perspective, you may not realize what the healthcare need is in the first place to build something caregivers are actually willing to adopt!

As innovators seek to balance these worlds, they should take inspiration from four key areas:

 

  1. Industry Issues: Knowing which regulations, buzzwords or pain points keep popping up puts innovators at the forefront of addressing problems on the horizon – before anyone else sees them coming.
  2. Competition: As an extension of industry trends, it is key to know what competitors (including vendors and leading health systems) are offering customers (who could be patients!).
  3. Market Development: Both in healthcare and IT, “hot breakthroughs” should help guide developments to address key pain points and drive efficiency, usability and access to information.
  4. Regulatory: Staying informed on regulatory approaches and issues worldwide can position you as a leader in terms of protecting and investing in patients and their data. Particularly for global technology, it is critical to make sure that you have the appropriate features and follow the expected standards to ensure that your product can be accredited globally.

As mobility has demonstrated, the traditional means of care can benefit greatly by leveraging technology. By working with both IT and caregivers, innovators can make this a reality.

Jonathan Draper is the Director of Product Management, Healthcare at Calgary Scientific. Jonathan directs the product roadmap and works closely with healthcare partners and institutions globally to develop innovative solutions that address clinical needs and meet the technical requirements of healthcare enterprises.

References:
1. Pratt, Nancy. “Navigating the Sea of Innovation: Targeting the Right Audience with the Right Tools.” Mobile Health Matters. October. http://mobilehealthmatters.com/2015/10/13/navigating-the-sea-of-innovation-targeting-the-right-audience-with-the-right-tools/
3. BYOD Definition: http://whatis.techtarget.com/definition/BYOD-bring-your-own-device

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5 Questions to Ask Your Next Risk Adjustment Partner
January 15, 2016 8:10 AM by Silas Gossman

[Editor’s note: this blog was originally written by Steve Whitehurst]

As the availability of healthcare data continues to grow, many new technologies for risk adjustment are entering the market. When thinking about adopting a new risk adjustment solution, plans should conduct a realistic self-evaluation in addition to also considering the support capabilities and workflow expertise of their potential partners.

It’s important to understand your own risk adjustment organization’s readiness in order to determine the best external approach for your needs. In particular, a look at your overall performance, operations, and infrastructure is vital to understand which partners will best fit your team’s characteristics. You should have a full understanding of where your current risk scores are, outstanding opportunities, staffing levels, data acquisition processes, etc. to get a baseline of your overall maturity and sophistication. A reputable partner will have expertise and processes to help with this step. 

Once you have a good understanding of your status quo, it will be easier to consider where outside support is warranted. Most vendors love to pontificate on their solution, so we recommend you probe on their support, industry expertise, and overall workflow adaptability in order to ascertain their overall fit with your operations. Here are a five key areas to explore:      

1.            What are the improvement opportunities that are present in my organization? This involves not only the quantification of risk capture potential, but also an understanding of where in the risk adjustment ecosystem the opportunities exist. This allows for meaningful prioritization of the opportunities.

2.            What is the best method of improvement to address these opportunities? Retrospective review, prospective campaigns, provider education, billing staff education, member outreach, etc. – depending on the type of opportunities that exist, the appropriate method for improvement may vary. This is critical to maximizing the ROI.

3.            Is my organization ready to implement the proposed methods? If not, what are the gaps and how can I close them? The best methods will not work if there aren’t enough coding resources or if the appropriate data isn’t available. Together with the solutions partner, the readiness gaps need to be addressed before moving forward. A vendor with the best interest of the customer will not want to implement a solution without a readiness check.

4.            What is a reasonable timeframe in which we can expect to see results? Organizations can often have unrealistic expectations on how long the newly implemented solution will take to demonstrate performance improvements. Establishing measurable goals with specific timelines will help to attribute tangible ROI of the solution for leadership while maintaining engagement from key stakeholders and users.

5.            What processes will be in place to ensure improvements are continuously sustained? The biggest value of a technology-enabled solution is scalability. But if implemented without sustainable processes, improvement gains will be short-term, or your reliance on partner services will continue to incur costs. It is essential that there is a sustainability strategy aligned with your organizational needs.

Technology is only as good as the user. In a world as complex as risk adjustment, it is even more critical that technology solutions are deployed to fit the specific needs of its stakeholders. When considering a new solution, organizations should ensure that a potential partner’s people and processes, in addition to the technology, are well-aligned with your strategy. 

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Politics, Privacy and Pulling the Trigger
January 11, 2016 2:34 PM by Silas Gossman

By ADVANCE for Health Information Professionals

On Monday, January 4, 2016, President Obama spoke to the nation, as expected, and issued an executive order regarding gun safety and measures he feels will help to curb what he called the “epidemic of gun violence.”

His address was heartfelt, emotional and — predictably — polarizing. Conservatives panned what they perceived to be an overreach and an attack on the Second Amendment, while liberals lauded the president taking action where Congress hadn’t. Both sides conceded that the enhancement on background checks would not have affected or prevented recent mass shootings such as the tragedy in San Bernardino.

One of the more sweeping, lesser noted aspects of the executive order’s proposal was its enabling mental health providers a simpler way to disclose information to National Instant Criminal Background Check System (NCIS). Billed largely as a way to prevent suicides — which account for about two-thirds of all annual gun deaths in America, according to the CDC — it was noted by Healthcare Informatics that “… the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued a final rule, which takes effect next month, removing legal barriers preventing states from reporting relevant information to NICS.”

This idea of removing the legal barriers put in place by HIPAA has actually been a few years in the making, according to Politico’s Morning eHealth report.

“The idea initially came three years ago in the wake of the Newtown, Conn., shootings, but has been languishing. The 1993 Brady law disqualified certain people from buying guns, including individuals involuntarily committed to mental health care and those found incompetent to stand trial or otherwise deemed to be a danger to themselves or others. But HIPAA prohibited providers from sharing the information with the FBI’s National Instant Criminal Background Check System. The rule, which takes effect next month, changes that.”

The complete text of the rule can be found at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-33181.pdf

The overarching question is whether or not this amendment of HIPAA will prove to be problematic. While the United States government in the 21st century has consistently found itself infringing upon privacy and civil liberties in the name of security — NSA, anyone? — it is, as Healthcare Informatics senior editor, Rajiv Leventhal put it, “ … an issue that can certainly become very fuzzy.”

Leventhal continued, citing a blog post from Mental Health America, which stated, “ … what the rule says is this: (1) a firearms control data center housed in a HIPAA-covered entity can share limited demographic information with the national registry; and (2) a HIPAA-covered entity that is participating in a judicial proceeding to determine that a person cannot lawfully have a firearm (such as ordering an involuntary commitment) can share limited demographic information with the registry.”

Mental Health America’s CEO, Paul Gionfriddo added, “This change will affect a relatively small number of people (maybe in the hundreds, maybe in the thousands). So why does it matter? It has already been determined that it is illegal for the individuals whose names will be added to the list to own or possess firearms. So this might prevent a tragic event without infringing on the rights of anyone who can possess firearms.”

Ultimately, Leventhal agrees in his analysis that this is both a targeted, specific change that will not wrongfully affect the wrong people — and that privacy for those individuals should not supersede public safety. “Indeed, while the patient-provider relationship is one that should certainly be respected, it is more important to potentially save lives by providing these mental health records to the people who need them,” he said.

While the more libertarian-leaning among us may raise an eyebrow at statements like that — and more conspiratorial sorts would note that nothing is explicitly stopping the administration from tweaking or changing HIPAA further to expand this information disclosure to more patients with mental health issues, it’s certainly a topic that has the American people talking and has smart people working around the clock to address.

The president’s executive order takes aim at the gun violence problem. Time will tell if he hits the mark.

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Health IT in 2016: Where are we headed?
January 8, 2016 8:23 AM by Silas Gossman

By Betsy Jones, EBSCO Health

Health IT took some big steps forward in 2015, as more mobile and cloud platforms came online, providing easier access to patient records and clinical support resources. The health data interoperability discussion significantly advanced this year as well, with the Office of the National Coordinator for Health IT unveiling its 10-year interoperability roadmap.

While it might take a decade to achieve the deep health data interoperability the ONC envisions, healthcare already enjoyed some early benefits in 2015, as physicians and caregivers began pulling patient information from wearables, phones and other electronics to provide them with real-time analysis of their patients’ conditions.

With 2016 just around the corner, our trend-spotting physician editors and researchers have come up with five predictions for what they see happening in 2016: 

1. Physician practice consolidation will bring greater access to content:  Hospitals and health systems are buying up more privately owned practices than ever, it seems, to fulfill ACO participation goals. While some in healthcare aren’t sure this consolidation is positive, there is a silver lining: Physicians typically gain access to more sophisticated EHRs, including a subscription to integrated clinical content that enables more accurate, efficient patient care.

2. Evidence-based quality standards will continue to gain traction: Practices are tasked with improving care in order to share in incentives in new payment models. We predict that evidence-based quality measures will gain traction in the healthcare as payers and providers alike look for ways to improve the health of their patients, especially those with chronic diseases.

3. There will be an increase in the amount of Certified Medical Assistants: Meaningful Use Stage 2 states that only credentialed medical assistants are permitted to do order entry for electronic patient records; CMAs will take on entering more documentation and providing physicians with reference information to determine care plans. It’s more critical than ever that the industry include CMAs as part of the clinical team accessing valuable clinical information and decision support tools.

4. Physicians will work to consistently assess and consider patient risk: In order to reduce healthcare costs, physicians will aim to consistently use overall risk prediction and absolute risk estimates for individual patients to guide decision-making. They should forego the practice of chasing and treating for lab test values without considering the overall absolute risk to the patient.

5. Patient-Physician Communication will improve: Now more than ever, patients are expected to take on more responsibility for their care, both in co-pays and care decisions. To facilitate more patient engagement, providers will have to better explain diagnoses—what they know and what they don’t—along with treatment options, to help patients participate in this shared decision-making process. 

As technology continues to be adopted into the world of healthcare, physicians, hospital executives and decision makers will find novel applications of these new software tools to improve care. The already fast-paced world of healthcare will find new efficiencies brought on by technology, enhancing patient care by providing physicians with quick access to the information and resources they need at the point of care.

Betsy Jones is vice president of medical product management and chief content officer, EBSCO Health

 

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