Health IT Pulse

November 24, 2015  3:45 PM

Epic’s response to critical Mother Jones article

Kristen Lee Kristen Lee Profile: Kristen Lee
Epic, Interoperability

Mother Jones recently published a highly critical article on Epic Systems, claiming that the EHR vendor’s product lacked interoperability and therefore was hurting patients.

Well, Epic has responded.

In a letter to the editors of Mother Jones, Peter DeVault, Epic’s vice president of interoperability, defended the company. The letter was published online in the comments section of the original article, joining more than 300 other comments.

First, he wanted to make it clear that Epic customers own their own data, “and there are several easy-to-use tools to access and share it at the customer’s discretion,” DeVault wrote. He went on to say that customers can connect to and share patient records with thousands of organizations that may be using other vendors’ products. This includes, he asserted, the U.S. Department of Defense and the Veterans Health Administration.

DeVault also cites the Sequoia Project’s eHealth Exchange: “According to the eHealth Exchange, Epic shares more records with these government agencies than any other vendor,” he wrote. He added that Epic remains a leader in the improvement of interoperability standards.

Second, DeVault addressed the RAND report noted in the article and that the Mother Jones piece concluded was critical of Epic’s interoperability record.

“[Mother Jones] failed to mention that the report relied on uncited assertions, anonymous blog posts and an article from the 1990s,” DeVault wrote.

And finally, DeVault ends his letter by saying, “The world of EHR is developing rapidly, and there’s much good that remains to be done. Articles like this do nothing to illuminate the problems or the solutions ahead.”

November 24, 2015  1:12 PM

Department of Agriculture to distribute $23.4 million in telemedicine grants

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
Telemedicine, telemedicine services

Observers of last week’s National Rural Health Day had something extra to celebrate this year, after the U.S. Department of Agriculture (USDA) promised telemedicine grants to 31 states.

The USDA committed a total of $23.4 million in telemedicine grants to 75 projects. Tom Vilsack, secretary of agriculture, announced the investment and explained it is being made to extend quality care to people in remote areas. “Rural communities often lack access to specialized medical care or advanced educational opportunities,” he said.

The telemedicine grants are part of the USDA Rural Development Distance Learning and Telemedicine program, which is meant to connect rural populations with healthcare providers and educators through telecommunications.

The USDA announcement included details about the individual projects that the funds will be dedicated to. For example, Baptist Healthcare System, Inc. in Kentucky will receive more than $180,000 to purchase and set up videoconferencing equipment to interact with patients in Kentucky and Tennessee. The North Slope Borough in Alaska will get more than $420,000 to buy similar equipment and use it to link six clinics, a hospital and four end user sites.

Alaska’s well-established state telemedicine program dates back to 1999. The combination of isolated locations, small populations and vast land mass is why healthcare professionals in Alaska can’t always depend on traditional methods to treat patients. Some small communities in the state are without medical professionals. In those areas, community health aides enter patient data into the telemedicine system.

While the USDA telemedicine grants will go toward improving care for patients in rural areas, there’s another group that’s been the focus of other recent efforts for broadening the practice of telemedicine. U.S. veterans stand to benefit from the proposed Veterans E-Health & Telemedicine Support Act of 2015. The bill would allow qualified U.S. Department of Veterans Affairs healthcare professionals to treat veterans across state borders and forego state licensure requirements.

November 19, 2015  12:10 PM

Epic gets flak again on interoperability, this time in Mother Jones article

Kristen Lee Kristen Lee Profile: Kristen Lee
EHR, Epic

Epic Systems has been criticized for its lack of interoperability before, and now, in a recent Mother Jones article entitled “Epic Fail”, the EHR vendor is being put on the spot again.

For the writer, Patrick Caldwell, this issue is a personal one as he has dealt with a complex — and expensive — medical history since he was a child. He knows all too well the added burden the lack of access to medical records can put on a sick patient.

From Caldwell’s perspective, Epic has only helped to create a fragmented system that leaves doctors unable to share information. Patients should be assured that their records detailing drug allergies, test results, X-rays and more are available to their various doctors so that they can receive the best care possible, Caldwell writes.

A spokesperson from Epic told Mother Jones that the company has long supported “sharing patient records wherever the patient goes.” At the same time, Epic declined interview requests, Caldwell wrote.

“We’ve become a little uncharacteristically media exposed in recent months,” the spokesperson told Caldwell, “and I sense that the pendulum is headed back to a quieter spell.”

In a 2014 RAND report Epic was singled out as a roadblock to interoperability, Caldwell wrote.

“It can be challenging and costly for hospitals to interface their EHR with the clinical or billing software of other companies,” the report said. Caldwell also points out that Epic is not a member of the CommonWell Health Alliance Partnership, a nonprofit trade association devoted to setting standards for the exchange of information. Epic’s competitors, however, are part of this partnership.

He added that, in all fairness, Epic does work with healthcare organizations to link its system with competing ones, but it will cost a pretty penny and it will be labor intensive.

There are signs that the government has had enough with Epic, Caldwell wrote. The Department of Defense (DoD) choosing Cerner Corporation to take on  its EHR contract is one example. And the DoD has made it clear that interoperability is non-negotiable for the agency.

That said, Epic is firmly entrenched in healthcare. Duke University Health System reportedly spent $700 million on its Epic installation, Caldwell wrote. However, this success doesn’t mean that patients have to accept the status quo, Caldwell urged. With increased scrutiny, Epic may be pushed to open up their system a little more.



November 18, 2015  2:56 PM

Study shows lower hospitalization rate for patients treated with precision medicine

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
personalized medicine, precision medicine

The precision medicine approach to healthcare is thought to be a more personalized model that will improve individual and population health outcomes. That assertion now has more evidence in its favor after the publication of a study in the Journal of Medical Economics.

The study, conducted by researchers from the University of Utah, took patients 65 years and older and separated them into two groups. The first group underwent pharmacogenetic testing, which helps determine how patients will respond to medication based on their specific genetics. The first group was also treated with the help of a medication management clinical decision support tool, while the second group was excluded from both of those extra measures.

Over a four-month period, the hospitalization rate for the first group — the one treated by precision medicine — was 9.8%, noticeably lower than the 16.1% rate of the control group. The gap between the percentages of each group that made emergency room visits was also in favor of the patients treated via precision medicine. Less than 4.5% of that group received emergency attention, compared to 15.4% of the other group.

The first group did stay in contact with their caregivers, but 71.7% did so through outpatient visits, nearly doubling the total of the other group. The tactics used were well-received by healthcare providers involved in the study, as 95% of them believed the test was helpful. The survey results included a calculation that an average of $218 was saved by each member of the precision medicine group as a result of their participation.

Precision medicine treatment was touted by many — including President Barack Obama — as a way to improve outcomes for cancer patients, though it’s too soon to accept that as a universal truth. For example, a recent Boston Globe article disputed that notion by cautioning that the fluid nature of cancerous tumors makes it hard to counteract their growth with drug regimens created through precision medicine. There are still big plans for precision medicine, as the National Institutes of Health’s Advisory Committee to the Director recommended the compilation of a research group of one million patients to further the study of precision medicine.

November 16, 2015  6:16 PM

Lawyer suggests strategies to avoid texting risks with PHI

Shaun Sutner Profile: Shaun Sutner
HIPAA, HIPAA business associate, HIPAA Compliance, HIPAA security, PHI, PHI encryption

Healthcare providers and their business associates are fast getting hip to the reality that it’s not OK to text protected health information (PHI).

Not only does unsecure texting of PHI run afoul of HIPAA privacy rules, but it’s also just too easy for texted PHI to be stolen, hacked, leaked or lost unless it is not safeguarded.

Lawyer Lisa Thompson of the LeClairRyan law firm amply underscores that message in a recent post on the Richmond, Va.-based firm’s blog.

Thompson notes that texting is popular for many reasons. It’s “easy, fast and efficient,” she points out. It’s also considerably less cumbersome than email, and you don’t need a computer to do it.

But for healthcare providers, all this convenience can be dangerous and can lead to unauthorized access to PHI, Thompson emphasizes.

Among the dangers:

  • Anyone with physical access to the mobile device can view text messages on it
  • Texts can be read when the device is lost, stolen or even returned or recycled
  • Traditional security protections used by IT departments of HIPAA-covered entities, such as firewalls, may not cover texts, and so texts can be intercepted and decrypted

Another problem is that HIPAA also mandates that patients and their representatives, such as lawyers and families, have timely access to their health records. Thompson astutely notes that when texts are used in healthcare decision making, providers could be out of compliance with HIPAA if patients ask for the texts in question and providers can’t turn them over.

Thompson acknowledges that there is no easy response to these risks.

However, at the least, providers and business associates should include mobile phones and other devices on which PHI is created, transmitted, received and maintained in text form in any risk analysis, a step that HIPAA requires.

The clearest path to protecting texts in healthcare settings is by using secure texting technology, many in health IT say.

Indeed, secure messaging is one of the strategies Thompson lists for combatting the potential scourge of unprotected texts that contain PHI.

Others steps include:

  • Establishing policies that require all texts to be deleted with a specified time period
  • Using technology that can wipe information from devices or remotely disable mobile phones if they are lost or stolen
  • Providing encryption and password protection
  • Setting policies and guidelines that limit information contained in texts, such as not using patient names or other identifiers
  • Requiring texted PHI to be added to formal health records and providing a technological mechanism for doing so
  • Training employees on texting policies and procedures
  • Handing down disciplinary measures for employees who violate texting policies

Healthcare providers would do well to heed Thompson’s advice.

November 12, 2015  3:00 PM

ICD-10’s appearance at my doctor’s visit

Kristen Lee Kristen Lee Profile: Kristen Lee

As a health IT journalist, it’s always interesting when you experience what you write about in real life. In my case, this happened when I went to the doctor yesterday.

I was sitting in the examination room as the nurse practitioner asked me questions and then clicked around on the computer updating my medical record. At this particular moment, she had been clicking around for a while, clearly trying to find something but having some trouble, and not talking to me. Then all-of-sudden she said under her breath, “I hate this new coding system.”

My ears perked up. We at SearchHealthIT had just done extensive coverage of ICD-10. We interviewed doctors, talked to CIOs, quizzed analysts and wrote articles with tips on how healthcare organizations can make sure they’re prepared for the new coding set. We even monitored Twitter on October 1, the day ICD-10 was implemented, to see how people were fairing.

So when the nurse uttered her words, I had to ask her about it.

I explained I was a health IT journalist and she began to tell me how new technology requirements like ICD-10 are taking her away from interacting with patients, and she feared it would get to the point where she’d be fiddling around with the computer so much she wouldn’t even get the chance to touch the patient and examine them, never mind have a conversation with them.

This is a sentiment I’ve come across quite a few times in my own reporting on ICD-10. This nurse is not alone.

She explained how difficult it is to find the appropriate ICD-10 code for the right ailment. For example, if someone is experiencing arm pain, she said she can’t just search arm pain and find it, she has to go through a series of steps to specify which arm and whether the pain is internal or external. She told me she’d much rather write a detailed note then click through and make sure everything was appropriately checked off.

As for me, the patient, I definitely noticed her preoccupation with the computer and I must admit, I do wish there had been more time to really have a conversation with her.

November 10, 2015  1:06 PM

Loss of interest, hidden costs drive away users of mHealth apps

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
Connected Health, mHealth, mHealth applications, quantified self

Getting Americans with smartphones to use mobile applications to monitor their health isn’t a difficult accomplishment, as a majority of them have already downloaded one. Getting them to stick with one mHealth app over a long-term period isn’t as straightforward because many of them have found non-performance related reasons to stop using mHealth apps.

More than 58% of respondents to a survey published in the Journal of Medical Internet Research (JMIR) mHealth and uHealth said they used an mHealth app to track an aspect of their health, such as their physical activity or to track their diets. There was a notable amount of dissatisfaction among that group,; with roughly 46% saying they stopped using an app they previously downloaded.

Surprisingly, unstable or poor performance of apps weren’t major reasons why users moved on to something else or gave up mHealth tracking entirely. In explaining their frustration, 36% cited hidden costs and more than 40% pointed to a loss of interest in an app as the reasons why they ceased using it. Only a third took issue with the effectiveness of their rejected apps, finding them too complicated to navigate. Nearly half of respondents who said they discontinued using an app did so because it took them too much time to enter data, a problem that could be blamed on poor design or the inexperience or impatience of the users.

Nearly 42% never downloaded an mHealth app. Those respondents’ primary reasons for not doing so were a lack of interest in the available apps, concerns over the costs of the apps and the apps’ ability to protect their personal data.

A panel at the recent Connected Health Symposium 2015 in Boston discussed the growth of mHealth apps and devices and cautioned that wireless technology alone won’t improve people’s health. The panel was encouraged by the advancement of wearable tech. If the JMIR survey is truly a microcosm of the consumer healthcare market, mHealth app developers should be focused on engaging current users to keep their business and not on building more powerful products.

November 5, 2015  2:02 PM

For those who need it most, wearables may be out of reach

Kristen Lee Kristen Lee Profile: Kristen Lee

It seems fitting that the rise in popularity of wearables comes at a time when Americans are facing such chronic diseases like diabetes, which the International Diabetes Federation estimates will affect one in 10 adults by 2030. Not only that but more than 80% of diabetes deaths occur in low and middle-income countries, according to the World Health Organization.

So, it’s good that wearables that so often motivate people to stay active, lose weight and monitor their health are out there for anyone and everyone to buy and use, right? 2014 was dubbed “the year of the wearable” after all.

But the truth is that the people who need wearables the most can’t afford them, a Forbes article said.

In fact, a 2014 CDC study shows an obesity disparity among varying racial groups in the United States, with the highest rates of obesity in the South and the most cases found in African-Americans followed by Hispanics. These numbers presents huge implications for future individual health costs, the article points out, because obesity often leads to other significant health problems like diabetes, heart disease and cancer.

As it turns out, this sort of finding isn’t new to the healthcare technology space. In fact, a recent study found that online health tools may actually contribute to health disparities.

And when it comes to doctors prescribing wearables to address such serious health problems, the cost can be anything but affordable.

Forbes interviewed a doctor in the Deep South who uses Mobile Cardiac Outpatient Telemetry with his patients. This wearable system monitors weight and heart rates and delivers a printout to physicians. However, the cost to use this wearable is $350 per month, and insurance coverage of such devices has been extremely limited thus far.

“But, even with expanded health insurance, low-income families are still not guaranteed access to health care services that offer wearables,” the article said.

A report by the NPD Group found that one in 10 U.S. adults now own a fitness tracker. Of those owners, 36% were between the ages of 35 and 54, and 41% had an average income of more than $100,000. However, after the first few months, at least a third ditched their wearable device, the Forbes article said.

The article points out that it’s difficult to get companies to work on these devices and make them more affordable for lower income — and more vulnerable — populations because these companies think lower income populations won’t walk into a store or go to to buy a wearable. However, studies say otherwise, the article said.


November 4, 2015  4:06 PM

Connected Health draws dreamers and big players

Shaun Sutner Profile: Shaun Sutner
Connected Health, mHealth, Telemedicine

Joseph Kvedar, M.D., is one of health IT’s best-known evangelists for mobile health technologies and is probably the originator of the decade-or-so-old term “connected health,” which Kvedar, a dermatologist by training and technologist by inclination, takes to incorporate both mHealth and telemedicine, among other things.

Kvedar, vice president for connected health of Boston’s Partners Healthcare System Inc., founded and continues to preside over the Connected Health Symposium, presented by his employer and held annually in Boston.

This year’s symposium, the 12th, wrapped up last week at the Seaport World Trade Center, drawing its usual dozens of expert and influential thinkers and doers in health IT, wearable health technology, mHealth, telemedicine and other variants of healthcare tech that probably don’t even have their own monikers.

When I caught up with Kvedar in an upstairs hallway as the conference wound down last Friday afternoon, I asked him to sum up concisely what he felt differentiated the 2015 edition of Connected Health.

“I think it’s the idea of not just measuring vital signs, but adding an emotional component,” he said, referring to  speakers who emphasized the importance of human communication amid the welter of devices and machines talking to each other or affixed to patients.

But beyond the software and hardware startups, the innovators and the dreamers that typically populate the expo attached to the symposium, some — including health IT vendors, a nonprofit and more horizontally oriented organizations with significant designs on the health IT and healthcare spaces — were working quietly and not so quietly at the event to reel in business.

Among these larger-scale enterprises (some of which paid out big bucks for various levels of sponsorship for the show) were:

  • Cognizant Technology Solutions Corporation, a $12 billion, multinational IT, consulting and business process outsourcing firm
  • InterSystems Corporation, an interoperability-focused software company with a major health IT presence
  • Philips United States, the U.S.-based arm of the Dutch multinational, which sells everything from medical imaging devices and software to electric razors, LED lighting and other consumer items
  • Salesforce’s healthcare division, which is making a major push for its newly announced Health Cloud healthcare CRM system
  • California Healthcare Foundation, a $747 million philanthropy
  • Cognition Corporation, a vendor of product and process development services to medical device companies
  • Cooley LLP, an international law firm and heavyweight in intellectual property and regulatory law
  • Validic, a leading medical device and wearable health technology integrator

Kvedar, meanwhile, is already planning the 2016 Connected Health Symposium, scheduled for Oct. 20-21, 2016.

November 3, 2015  12:42 PM

ICD-10 conversion goes quietly in its first month

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
CMS, ICD-10, ICD-10 conversion, ICD-10 implementation

The number of codes increased, but not much else has changed in the world of U.S. medical coding since the Oct. 1 ICD-10 conversion date. At least that’s the message conveyed by CMS’ recent update on the first month post-ICD-10.

A CMS report — comparing claims made from Oct. 1 through Oct. 27 to historical claims data — found that 10.1% of total submitted claims were denied in October. That figure was only 0.1% higher than the historical baseline — an increase of slightly more than 124,000 claims. The percentage of claims rejected in October because of invalid ICD-10 codes was only 0.09% of total claims, down from an average of 0.17% of claims rejected during end-to-end ICD-10 testing periods conducted previously this year. During a testing period in January and February, 13% of claims submitted to CMS were denied for reasons unrelated to ICD-10, far exceeding the 3% of denials caused by improper ICD-10 claims.

The number of claims submitted per day during the October stretch was 4.6 million. That number didn’t budge from the historical daily figure, according to CMS. The number of claims rejected due to incomplete or invalid information also stayed the same, sticking at 2% of all claims.

The years-long buildup to the ICD-10 conversion had some healthcare professionals planning for worst-case scenarios; planning for retirement from their physician practices, expecting interruptions to their revenue cycles and projecting reductions in their productivity once they started working with the new codes. The early returns indicate all that worrying hasn’t yet resulted in a proportional amount of post-implementation problems.

Though CMS said claims have been processed normally since the ICD-10 conversion, it could be too soon to declare the move a complete success. It can take as many as 30 days for states to process Medicaid claims, meaning some claims made shortly after Oct. 1 may still be in process.

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