Healthcare & Technology

Why McAllen, TX Should Have Mattered in the Health Reform Debate

2009-10-29T17:51:01-04:00

Link: Atul Gofigure: Why McAllen Should Have Mattered in the Health Reform Debate.

Jeff Goldsmith presents excellent commentary on The Health Care Blog regarding an article published in the New Yorker by Atul Gawande, describing problems with the physician community in McAllen, Texas.

According to Atul's article, McAllen physicians are some of the most expensive in the United States, second only to Miami and actions taken to eliminate this cost variation could reduce Medicare expense by as much as 30% while also improving the quality of care.

Although McAllen is one of the poorest communities in Texas, he reports "lavish physician-owned community hospitals that split their $64 million bottom line with admitting physicians and physician partners." To make matters worse, Atul reports that physician referrals are paid with sex or college tuition for family members. Interesting...

Atul claims this "across-the-board overuse of medicine....is happening across the sunbelt- Florida, Arizona, Nevada, Louisiana, Southern California, etc.- not just in south Texas."

Perhaps mitigating fraudulent health claims is one of the principle opportunities behind meaningful use criteria under the HITECH Act? Mandatory Audits come to mind...

Healthcare spending...$850 billion wasted annually?

2009-10-28T14:31:58-04:00

Link: Report: Americans waste up to $850 billion a year in healthcare | Healthcare Finance News.

According to a recent article from Healthcare Finance News, and a report from Thompson Reuters, unnecessary spending in healthcare is related to:

Unnecessary care (40%), defined as over-use of antibiotics and diagnostic lab tests to protect against malpractice exposure
Fraud (19%), covering everything from fraudulent Medicare claims to kickbacks for referrals of unnecessary services.
Administrative inefficiency (17%), focused on excess paperwork.
Healthcare provider errors (12%), defined as medical mistakes.
Preventable conditions (6%), focused on hospitalizations to treat uncontrolled chronic conditions such as diabetes, which is less costly to treat when the chronic condition is properly managed through timely access to outpatient care.
Lack of care coordination (6%), focused on inefficient communication between healthcare providers, leading to limited access to needed medical records and a resulting duplication of tests or inappropriate treatments.

How can an electronic health record and meaningful use help? A simple answer is in the form of fraud prevention, paperwork, coordination, health promotion/prevention and errors. Based on the figures from the report, these areas represent a potential savings of approximately 60%. Here are some examples:

Computer Provider Order Entry and e-Prescribing: addresses medications, allergies, interactions, diagnostic test and lab results, and clinical summaries. This information, if available at the point-of-care can mitigate errors, and provide alerts for high risk and key clinical data.
- Orders that use evidence-based order sets can provide guidance in clinical decision making at the point-of-care.
Secure PHI transmission: EHRs with the ability to transmit PHI securely, can address care coordination issues.
Mandatory Audits: Audits have the potential to identify areas of fraud.

CalOptima reports potential loss of claims data....A Breach Notification?

2009-10-26T19:43:20-04:00

Link: Health Data Management Article: Medicaid Payer Gives Breach Notification

Thanks to HISTalk for this post..

"CalOptima reports that its claims imaging vendor, ImageNet, accidentally sent out unencrypted DVDs that contained claims from 68,000 of its members. The DVDs were sent to CalOptima via certified mail, but never reached CalOptima. CalOptima actually posted this information and identified ImageNet on its home page."

CalOptima calls it the "potential loss of past medical claims information for approximately 68,000 of its members that was stored on electronic media devices." CalOptima reported that the information potentially breached included: member names, home addresses, dates of birth, medical procedure codes, diagnosis codes and member identification numbers, including some Social Security numbers. CalOptima provided a toll free number for their members to call.

It will be interesting to see how this situation develops.

Regardless of how you analyze it, this magnitude of a breach requires implementation of the Breach Notification Rules that went into effect September, 2009. The HITECH Act, Section 13402 rules call for:

Notification to individuals whose PHI was breached.
Notification to media outlets serving the state or jurisdiction, if unsecured PHI of more than 500 individuals is believed to have been disclosed.
Posting on HHS Public Website.

Notification must include:

A brief description of what happened, including the date of the breach and the date of the discovery of the breach, if known.
A description of the types of unsecured protected health information that were involved in the breach (such as full name, Social Security number, date of birth, home address, account number, or disability code).
The steps individuals should take to protect themselves from potential harm resulting from the breach.
A brief description of what the covered entity involved is doing to investigate the breach, to mitigate losses, and to protect against any further breaches.
Contact procedures for individuals to ask questions or learn additional information, which shall include a toll free telephone number, an e-mail address, Web site, or postal address.

For more information on HITECH / HIPAA Privacy and Security Rules go to The HIPAA Survival Guide website or sign up for Digital Business Law Group's free monthly compliance newsletter. Discussion/Social Networking sites containing information regarding the HIPAA Survival Guide include Facebook and LinkedIn groups.

Note: We will start conducting HITECH / HIPAA Risk Management Webinars beginning in January, 2010 that may also be of interest. These webinars will be managed as a forum of "round-table" discussions on the pertinent issues, with many opportunities for audience participation and questions.

Physicians double their time online?

2009-10-22T18:36:01-04:00

Link: Physicians have doubled their time online since 2004 | Healthcare IT News.

Thought this information was interesting. Not only are physicians spending more time online, but they are also carrying and using mobile devices at the point of care. Mark Bard, head of Manhattan Research reports,

Nine in 10 U.S. physicians surveyed now agree that the Internet is essential to their practice, according to Bard's research. Seventy-five percent now go online daily for work, he said.

Two-thirds of doctors carry a smart phone – with some of that growth credited to the launch of the iPhone in 2007.

And they use it at the point of care," Bard said, "fifteeen to 20 times a day.

Manhattan Research forecasts that the physician adoption rate of smart phones will reach 81 percent by 2012.

If that's the case, I wonder how EHR adoption will correlate with physician use of the Internet?

The VHA and state-of-the-art EHRs?

2009-10-21T11:56:11-04:00

Want to understand more about how the Veterans Health Administration uses EHRs for their patients? For an interesting perspective on patient electronic health data availability and use, watch this video segment from ABC News, Critical Condition Rx for America.

Barriers to exchange lab results electronically?

2009-10-21T11:15:42-04:00

Link: Physicians encounter barriers in exchanging lab results electronically

According to Diana Manos, Senior Editor, Healthcare IT News, one of the problems is that state laws regulate the exchange of electronic laboratory results, and standards don't exist to allow this information to flow easily between labs and physician offices. According to experts, labs are required to pay for the exchange of data, so they build connections with larger providers first – leaving small physician practices on their own, since there aren't enough lab results to justify the interface.

One of the many barriers to overcome in our journey to EHR Meaningful Use...

HIPAA Survival Guide Version 2.0 released and Webinar Series?

2009-10-19T12:54:38-04:00

Link: DBLG Announces Release 2.0 of The HITECH/HIPAA Survival Guide and a HITECH Risk Management Webinar Series.

The Digital Business Law Group announced Release 2.0 of the HITECH/HIPAA Survival Guide (see above link) and a HITECH Risk Management Webinar Series starting in January 2010 (final date TBD). New information on the site includes:

The Webinar Series will focus on developing a set of HITECH/HIPAA compliance frameworks:

HITECH Act Fundamentals (basic tenets of the new compliance regime)
Organizational (training and process change organization wide)
Breach Notification (Response teams and response templates)
Internal Audits (substance and frequency)
Legal (business associate contracts, compliance tools, input into all other frameworks)
Attacking the HIPAA Privacy and Security Rules (coverage, budgets, staff skills)

DBLG will be introducing these frameworks in their FREE HITECH/HIPAA Compliance Newsletter with full coverage continued in the Webinars. The HITECH Act has introduced a furious pace of change into the health care industry and annual conferences no longer suffice as the sole primary tools for tracking industry wide game changing events.

The e-Patient Revolution?

2009-10-04T17:37:54-04:00

Thanks to e-Patient Dave for sharing this great video that describes how the Internet is becoming a "fast-track" option for patient education on health conditions and disease. Although it is a plug for a conference this month, it presents real examples of the movement for health information online.

In a prior post describing use of the Internet for online health information, it was mentioned that the Internet is quickly becoming a primary source for health related information, sometimes even before patients speak with their physicians. As more people are able to acquire information related to their health status and medical treatments, they may play a more active role in managing their healthcare (e.g. "the empowered patient") with the goal of improved health outcomes. Perhaps this signifies the beginning of the "e-Patient Revolution"?

Telemedicine allows for long-distance diagnoses

2009-10-04T16:33:32-04:00

Link: Telemedicine allows for long-distance diagnoses - The Washington Times.

As mentioned in an earlier post, 4 years ago Telemedicine was in its infancy, perhaps used for monitoring status of patients with pacemakers... Now, according to this article in the Washington Times, Dr. Kenneth Bird, a Harvard professor affiliated with Massachusetts General Hospital, innovated an approach to patient care using monitors and remote access to hospitals to examine, diagnose and treat his patients.

Also, according to the article, patients are wearing monitors that can be remotely tracked and physicians can be notified and/or paged when necessary. Telemedicine (a.k.a. Telehealth) is not a substitute for direct patient care, but rather, it is an augmentation to the existing delivery of care. That said, installation/implementation can be a huge expense (ranging between $2.5 and $3.5 million), so larger hospitals are more likely to implement remote monitoring.

The article continues with explanation of "concierge" medicine approaches, which are light years ahead of the status quo. The benefits to patients is purportedly rapid care from providers, from home or within a specialized, technology enabled facility.

It's an interesting thought, and another example of how technologies can be used to improve patient care if used appropriately. That said, there are likely significant privacy and security issues related to the "transaction" between patient and providers. For more information about HIPAA Requirements, The HIPAA Privacy Rule, The Security Rule, or The HITECH Act visit The Online HIPAA Survival Guide.

And, if you are interested in keeping current on the issues, sign up for the FREE HITECH/HIPAA Compliance Newsletter.

Federal Web portal USA.gov moved to the cloud?

2009-09-30T11:30:27-04:00

Link: USA.gov's successful shift to cloud computing could become the model - Nextgov.

Cloud-computing? Security? Privacy? Costs? According to a study by Forrester the General Services Administration has "achieved significant cost savings by transitioning" [to the cloud] - see the above link. For more information on cloud-computing in general and for medical offices, visit Office on the Cloud.

The cloud does provide value and reduce costs for medical offices desiring to implement new software for electronic records, and to engage patients and families in their healthcare options.

Security for EHRs? Existing technology standards for authentication and encryption exist for other industries and can serve the healthcare industry in a similar fashion.

Privacy for EHRs? Secure log-in and appropriate use and disclosure of personal health information can also be achieved through the various standards that exist elsewhere.

Costs? Rather than investing in-house hardware, software and technical support, in addition to implementation costs, the cloud provides significant costs advantages.

For more information on technology security and privacy issues related to EHRs and their implementation, sign up for the FREE HITECH/HIPAA Compliance Newsletter or visit the online HIPAA Survival Guide where the new HITECH/HIPAA Security and Privacy Rules are more fully explained.