Health IT Pulse

August 6, 2014  10:24 AM

Bipolar disorder most popular health mobile search

Shaun Sutner Shaun Sutner Profile: Shaun Sutner
bipolar disorder, desktop search, mobile search

Mobile searchers look for information about bipolar disorder more often than any other medical issue, according to new research by Internet marketing firm PageScience.

Mobile searchers look for information about bipolar disorder more often than any other medical issue, according to new research by Internet marketing firm PageScience.

Next for mobile searches, in descending order, are lupus, gastroesophageal reflux disease, and blood disorders.

PageScience’s search methodology uses impressions, not clicks, as the most accurate measure of whether information is being viewed.

The data contrasts mobile search behavior and results for health info searches with how consumers use personal computers to look for the same kind of info. In the desktop and laptop worlds, cancer and weight loss come in the two top slots, with obesity taking third place.

Filling in the top 10 most popular health conditions and issues that mobile users search for are: allergies; hepatitis C; heartburn; myasthenia gravis; birth control; sleep disorder; and anxiety.

The remainder of the top 10 for desktop searchers: restless leg syndrome; diet; HIV-AIDS; dry eye; dental; insomnia; and psychology.

Bipolar disorder registered 3.8 million mobile impressions during a 10-day period in late June analyzed by PageScience, compared to just 600,000 impressions on desktops. And cancer got just 2.6 million impressions on mobile, but 148 million on PCs.

Those patterns reflect clear differentiation in age-based platform preferences, according to Janet Taylor, M.D., a New York City psychiatrist quoted in PageScience’s release on its survey.

Taylor noted that the average age of people with bipolar disorder is 25, with women outnumbering men in having such mood disorders. And women in their 20s are also big mobile users, so they turn to their smartphones for research into symptoms, treatment and prevention, the doctor pointed out. Young people with psychological issues may also prefer using phones rather than computers because they offer better privacy and more convenience.

Other points of interest highlighted in the survey are that health conditions such as allergies vary by location and season, so consumers seek information about them on their mobile devices as they travel, and conditions such as heartburn are episodic and can appear suddenly.

The figures compiled by PageScience were based on 516.5 million total health-related impressions.

Also included in the PageScience info is a spreadsheet of 82 physical health conditions and their breakdown by device, plus bar graphs on mental health and episodic health conditions by device.

August 5, 2014  12:06 PM

Majority of U.S. providers ready to meet ICD-10 deadline

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
CMS, ICD-10 delay, ICD-10 implementation, ICD-10 readiness, WEDI

The decision to delay the ICD-10 deadline may prove advantageous for U.S. providers. Just over half of providers (51%) said they already have the proper resources and technology in place and are ready for the Oct. 1, 2015 deadline. The remainder are going to use outsourced technology and clinical documentation improvement programs, rather than rely solely on internal IT resources and staff training. Fewer than a quarter of hospitals currently outsource clinical documentation audits, a number that is expected to rise to 71% by the third quarter of 2015, according to a survey of 650 hospital technology and physician leaders done by Black Book Rankings.

Black Book isn’t alone in attempting to quantify where providers stand in their race to the ICD-10 deadline. The Workgroup for Electronic Data Interchange (WEDI) released an ICD-10 readiness survey, seeking responses from providers, health plans, vendors and clearinghouses. Respondents have until Aug. 21 to complete the survey. “Since 2009 WEDI has been conducting these surveys, allowing us to gain a broad perspective on the readiness status for different sections of the industry, and to gauge how quickly they are progressing,” said Jim Daley, WEDI chairman and ICD-10 Workgroup co-chair, in a WEDI release.

The Centers for Medicare and Medicaid Services recently finalized next October as the compliance date for healthcare providers and health plans to transition to ICD-10. CMS’ official news release states the deadline gives providers, insurance companies  and the rest of the industry time to ensure their systems and business processes  are adjusted to work with ICD-10 codes.

The decision to delay ICD-10 until 2015 could be among the first of the obstacles facing implementation of the coding set.  Two U.S. senators and four representatives sent a letter to CMS Administrator Marilyn Tavenner, asking her for “additional information and ongoing communication” as the compliance date gets closer. The letter pointed out that CMS expressed confidence that providers would be prepared to meet the previous Oct.1, 2014 deadline.

July 31, 2014  1:53 PM

Behavioral health providers lobby Congress for meaningful use inclusion

Don Fluckinger Profile: Don Fluckinger
AMA, behavioral health, certified EHR technology, EHR incentive program

While some lobbyists and healthcare associations such as the American Medical Association are using meaningful use rollouts, schedules, criteria and incentive program administration as a political battering ram this summer, behavioral health providers are knocking on the door of the federal EHR incentive program and asking to be included in the Medicare and Medicaid sides.

In various reports from sources as diverse as Politico and the McKeesport (Pennsylvania) TribLive website, two Senate bills and three House bills were introduced in 2013 to bring these providers into the meaningful use fold. The Behavioral Health IT Coalition, backed by the American Psychological Association has been fighting for that cause for four years, and sent some of its representatives to Capitol Hill to renew their arguments for inclusion in a briefing before Senate staffers.

Not only do bills such as H.R. 2957 (since rolled into H.R. 3717) include behavioral health providers in the “carrot” of meaningful use, but also may subject them to the “stick” of Medicare penalties for not implementing ONC Certified EHR technology.

Providers made their case not only by pointing out the technology gap between behavioral health and the less resource-strapped acute and ambulatory providers, but also by enumerating the ways behavioral patients typically require better care coordination. Not only do they typically have other health conditions such as diabetes and asthma, the providers said, but — because of their diagnoses — can have trouble keeping up with medication adherence.

EHRs would help bridge the gap between such patients’ providers and help improve outcomes for the patients and cut costs from bad outcomes brought on from the lack of data systems on the behavioral health side, they added.

July 30, 2014  12:48 PM

VNA CIO discourses on future of telehealth

Shaun Sutner Shaun Sutner Profile: Shaun Sutner
Data Analytics, homecare, smart beds, telehealth

Hugh Hale, CIO and senior vice president, information technology, of Visiting Nurse Service of New York, a veteran of three decades in the healthcare and tech businesses, says about the pace of technological advancement in telehealth and medical care today: “This is the most seismic amount of change I’ve seen not only in home care, but in healthcare overall,” Hale told an audience at the mHealth + Telehealth World 2014 conference in Boston.

This visiting nurse association (VNA) group — the biggest nonprofit home healthcare agency in the country — takes care of the urban population of the five boroughs of New York and parts of suburban Westchester and Suffolk counties.

That’s more than 70,000 patients, 2.2 million home visits — in total, 35,000 visits a day by the VNA’s 18,000 employees.

Telehealth is important to the VNA, Hale said, because “everything we do is aimed at keeping patients out of the hospital.”

Toward that goal, the New York VNA depends heavily on the backbone of population health: data analytics. The VNA mines data to see which patients have family histories of chronic disease, how many patients are making frequent trips to hospital emergency rooms, and who is showing up for doctor’s visits, among other trends.

Traditionally, Hale said, the nurses’ group has built its own applications, but in a major overhaul of the VNA’s technological infrastructure that is going on now, “we’re shifting from a build to a buy” with an emphasis on best of breed products.

In April, the VNA chose Delta Health Technologies, a homecare-specialized EHR vendor, to handle workflow using integrated clinical support and revenue cycle management.Recently, the VNA decided to swap out thousands of tablets used by nurses in the field in favor of new models. The new tablets were chosen by a panel of nurses whom Hale and other managers picked specifically because they were the most critical of the old devices.

As for the future of telehealth, Hale sees the horizon populated with super-advanced wearable devices that can instantaneously detect falls and “smart beds” that monitor a range of vital signs. There are smart beds on the market, such as one made by Vista Medical, that use pressure mapping to detect ulceration and other maladies that afflict bed-bound patients.

In a conversation with SearchHealthIT after his presentation, Hale said he expects smart beds to also be able to reliably monitor blood pressure, heart rate and sleep patterns.

“They are the wave of the future,” he said.

July 29, 2014  1:01 PM

Physician licensure compact revisions accommodate rise of telemedicine

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

The Federation of State Medical Boards, a nonprofit organization representing all of the 70 medical and osteopathic boards across U.S. states and territories, released an updated draft of its compact which proposes changes to streamline licensure for physicians to practice in multiple states.

The revisions to the compact were made with telemedicine in mind. “The revised compact helps ensure that as the practice of telemedicine continues to expand, patient protection remains a top priority,” said Humayun J. Chaudhry, D.O., MACP, president and CEO of The Federation of State Medical Boards (FSMB), in a release.

The FSMB will work with state medical boards separately to fit the proposed regulation into their current state laws. Two of the revisions to the proposal require physicians that want to practice in multiple states submit to fingerprinting or other biometric checks. They will also be required to have passed all components of the U.S. Medical Licensing Examination or the Comprehensive Osteopathic Medicine Licensing Examination within three attempts.

The maze of rules governing telemedicine licensure across state borders was the subject of a presentation by Christa Natoli, vice president of telemedicine research firm CTel Innovations, at the mHealth + Telehealth World 2014 conference. SearchHealthIT News Director Don Fluckinger broke her presentation down into 13 facts you might not know about telemedicine licensure. Some of her key points were that only nine states require a special license for physicians to legally qualify to practice telemedicine, 36 states require full medical licensure to practice telemedicine and 28 states have exceptions for occasional telemedicine consults.

Telemedicine extended beyond state borders in a recent study, crossing international lines to support cooperation between Children’s Hospital of the University of Pittsburgh Medical Center (UPMC) and four Latin American Hospitals. Physicians at the three Colombia-based and one Mexico-headquartered hospitals were nearly unanimous in their approval of the pediatric cardiac critical care assistance they received remotely from UPMC, with 96% indicating they were “satisfied or very satisfied with the telemedicine service.” The activities that took place during the recorded telemedicine consultations included discussions of medical history, diagnostic study interpretations and real-time interventions.

July 25, 2014  2:59 PM

Congress puts ICD-10 delay under scrutiny

Don Fluckinger Profile: Don Fluckinger
EHR safety, EHR usability, ICD-10, ICD-10 delay

Meaningful use and EHR safety are in Washington lawmakers’ sights, as we’ve highlighted recently in a story and a blog post. Congress isn’t done yet: Looks like they’re going after ICD-10, too.

Earlier this year, Congress mysteriously hardwired an eleventh-hour ICD-10 delay into the yearly Medicare reimbursement bill known informally as the “doc fix,” which was signed by President Obama without debate. Since then, CMS Administrator Marilyn Tavenner announced that transition will be Oct. 1, 2015; the earliest Congress would permit it. Last month, two senators and four representatives wrote a letter seeking additional information and assurances that CMS and private industry will be ready to go on that day. On top of that, they asked for regular reporting of “ICD-10 activities associated with both the Medicare and Medicaid programs” to Congress.

Carl Natale, top-notch ICD-10 blogger, thinks the letter could be a precursor to Congressional hearings, which would shape up to be as exciting as watching paint dry. Natale makes a great point: “…just one round of testimony on ICD-10 preparation should be enough to persuade lawmakers that they have more interesting things to worry about.” Because on the surface, ICD-10 may look like a fun hot potato with which political pot-stirrers can play catch. But it’s not.

Imagining pols like Representative. Dave Camp (R-Mich.) and Representative Sander Levin (D-Mich.) getting down and dirty with justifying the implementation of more granular diagnostic codes (“Tell me precisely why it’s important to note whether it was the left or right hand on which the patient broke his finger, and enumerate which digit!” someone could question Tavenner, dramatically, peering over his half-lenses with a holier than thou look) might be fun, but it’s unrealistic. You think C-SPAN is boring now? Wait ’til this one hits the docket.

While imagining some of these bitter HITECH program rivals — Reps. Camp and Fred Upton (R-Mich.), signatories to the letter, have been challenging it for years — attempt to boil down ICD-10’s complexities to TV news sound bites might make for a fun lunch hour among us HIT observers, there’s a very serious undertow to this letter. If Natale’s right, there’s more potential lambasting of HIT systems at public hearings to come. It could be one more thing Congress goes after this upcoming election season.

Healthcare provider CIOs and CFOs have enough problems figuring out how to spend their already inadequate budgets. Playing guessing games about what federal technology initiatives will or won’t be in place next year is by extension playing games with patient care quality….especially for those living in underserved areas already strapped for resources. It’s time for Congress, vendors and regulators to come to a consensus for the benefit of the patients, healthcare providers and constituents they serve and drop the political battles.

July 24, 2014  11:58 AM

EHR safety battle could be looming

Don Fluckinger Profile: Don Fluckinger
CDC, EHR, EHR safety, interoper

Both the Centers for Disease Control and Prevention and the U.S. Senate are examining the matter of EHR safety and preventing errors. That’s nothing new. But, as they tie into matters of meaningful use, these fresh looks at EHR safety could point to louder drumbeats come this fall.

Meaningful use, it appears, could be under scrutiny; sources told us earlier this month that some D.C. forces are considering bringing it to a peak this fall during midterm elections.

Earlier this year a CDC report examined the lack of interoperability between lab systems and EHRs as a source of adverse events, and  Megan Sawchuk, lead health scientist for CDC’s Office of Public Health Scientific Services, in the Division of Laboratory Programs, Standards and Services told Healthcare IT News “Enough’s enough.” ECRI Institute named interoperability problems one of its top 10 health technology hazards of 2014.

Health Data Management reports that Ashish Jha, M.D., professor of health policy and management at the Harvard School of Public Health, testified most hospitals don’t even know when adverse events occur before the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging.

EHR safety is a matter industry watchdogs and patient advocates have discussed for years. But the crescendo is getting louder this month. Why? With health data interoperability a focus of meaningful use, and pressure mounting on ONC from groups like the American Medical Association regarding its rollout and schedule, its safety implications appear to be another wedge being driven between federal HIT authorities and the healthcare system.

Jha, for his part, deflected that pressure off ONC and on to the vendors in his Senate testimony, suggesting that automated adverse event reporting be built into federal EHR certification. Peter Pronovost, M.D., senior vice president for patient safety and quality, and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, testified that while the federal government and healthcare providers have spent billions of dollars on HIT upgrades, they “have little to show for it.” He said productivity has decreased, in part, because of another vendor issue: Poor usability.

It will be interesting to watch the coming months, as HIT thought leaders, policymakers and pols line up to assess a very real problem and assign blame when given public platforms. No matter who’s at fault, one truth remains: Patients deserve better, and no matter the political stripe of who’s elected this November, EHR safety should be addressed together by vendors, healthcare providers and ONC.

July 23, 2014  12:08 PM

Substance abuse research comes to social media

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
Data Analytics, drug diversion, drug tracking

For those trying to track and shut down the spread of illicit drugs, there may be no need to hit the streets. A developing product, the National Drug Early Warning System, will help health experts scan social media to spot and combat the outbreak of common illicit drugs such as heroin as well as newer “designer synthetic compounds.” The identification system will also pull information from traditional national and local resources.

The National Drug Early Warning System is being developed by The University of Maryland’s Center for Substance Abuse Research, with funding from National Institute on Drug Abuse (NIDA). “By monitoring trends at the local level, we hope to prevent emerging drug problems from escalating or spreading to surrounding regions,” NIDA Director Nora D. Volkow, M.D., said in a release. Mining social media holds a few time-sensitive advantages over standard resources, which typically don’t report on emerging drugs and take more than a year to collect to obtain and analyze data.

Though social media outlets can be good places to source patient opinions and population health trends, healthcare policy researchers are reluctant to use those channels as means to spread their findings. Of 325 health policy researchers registered for the 2013 Academy Health Annual Research Meeting, only 14% said they tweeted, and 21% said they blogged about their research or other healthcare policies in the past year. Some of the reasons respondents used to explain their collective lack of interest in social media for professional purposes included: it’s incompatible with their research, it puts them at risk and they are unfamiliar with the technology.

Even in a controlled environment of medical professionals, inappropriate drug use can still be problematic. Hospitals have taken to using data analytics to stop drug theft, or drug diversion, among employees. Facilities that deploy automated drug-dispensing machines can set their analytics systems to trigger an alert whenever they come across irregular drug patterns, something that isn’t readily apparent when drug records are manually reviewed.

July 21, 2014  4:04 PM

American Medical Association blasts meaningful use guidelines

Shaun Sutner Shaun Sutner Profile: Shaun Sutner
AMA, EHR attestation process, Meaningful use

The American Medical Association is blasting the federal government’s proposed changes to the EHR meaningful use incentive program for 2014.

“The proposed rule does not address our overarching concern with the MU program, which is the “all-or-nothing” mandate on physicians, James Madara, M.D., executive vice president and CEO of the American Medical Association (AMA), wrote in comments on the proposed rulemaking addressed to CMS Administrator Marilyn Tavenner. “The proposed rule is generally aimed at early adopters of electronic health records and larger providers, leaving other participants with little relief.”

In particular, the AMA is urging CMS to remove what the medical group calls the “existing pass-fail approach” and replace it with a 75% pass rate and to allow physicians who meet at least 50% of the meaningful use requirements to avoid a financial penalty.

The AMA’s position, according to Madara’s letter, is that unless the meaningful use program itself is modified, most doctors won’t move to stage 2 of the program and will never reach stage 3. He reiterated previous AMA complaints that many doctors are facing major problems using certified EHR software systems to meet information exchange and patient engagement objectives.

“Too much emphasis has been placed on future stages of MU, when 50 percent of physicians have yet to even make it to stage 1,” Madara added. “We are concerned that CMS and ONC (the Office of the National Coordinator for Health Information Technology) have not spent enough time learning from those who have participated in stage 1 before the agencies design, propose and execute subsequent stages. We therefore believe that CMS and ONC should conduct a rigorous study of the meaningful use timetable before proposing any future stages.”

The AMA says the hardship provisions and extensions proposed to allow doctors who were scheduled to move to stage 2 to stay another year in stage 1 are inadequate, with CMS’ own data indicating that only 1% of physicians have attested to stage 2 so far in 2014. “Accordingly, the one-year exception provides little relief,” Madara wrote.

The AMA also criticized the time of the proposed rule. The comment period closes July 21 and the final rule is not expected before Sept. 1, so doctors will not know meaningful use requirements until the year is almost over, Madara argued.

Therefore, the group is again asking CMS to extend the hardship deadline until 30 days after the final rule is published.

July 16, 2014  2:13 PM

Doctors must register now to dispute Open Payments info

Shaun Sutner Shaun Sutner Profile: Shaun Sutner
conflicts of interest, Open Payments, sunshine act, Transparency

It’s decision time for doctors.

At least it is for those docs and teaching hospitals that will dispute or think they may want to dispute public postings of certain payments or items of value given to them by drug manufacturers and makers of medical and biomedical devices as stipulated by the Physician Payments Sunshine Act.

The Sunshine law and accompanying Open Payments system, which is part of the Affordable Care Act, really kicks off Sept. 30, when the Centers for Medicare & Medicaid Services (CMS) first releases the information publicly.

But docs and officials at teaching hospitals need to act quickly if they want to be able to question payments. CMS will not mediate disputes; if payments are disputed and not resolved by Aug. 27 they will appear on the Open Payments system as “under dispute” while the doc or hospital tries to resolve things with manufacturers or group purchasing organizations (GPOs).

So, doctors and hospitals have from July 14 to Aug. 27 to review and initiate disputes of data submitted about them. That’s the first 45-day period of the process. The next step is a correction period from Aug. 28 to Sept. 11 during which applicable manufacturers and GPOs can try to resolve disputes. Corrected data will be noted as resolved on the Open Payments system.

In the meantime, CMS recently updated its Open Payments User Guide.

CMS says Open Payments is about helping beneficiaries, consumers and healthcare providers better understand relationships between teaching hospitals and companies Agency officials also say they are hoping to encourage transparency; prevent inappropriate influence on research, education and clinical decision-making; avoiding conflicts of interest; and minimize risk of increased healthcare costs.

“Collaboration among physicians, teaching hospitals, and industry manufacturers can contribute to the design and delivery of life-saving drugs and devices,” CMS says on its Open Payments website. “However, while some collaboration is beneficial, payments from manufacturers to physicians and teaching hospitals can also introduce conflicts of interests.”

Naturally, all this hubbub around sunshine has some physicians worried, and the AMA is urging members to get moving if they’re concerned about their data.

The front page of the physician trade association’s Web site right now is emblazoned with a step-by-step process urging physicians to complete the CMS e-verification, register with the Open Payments system, and review and dispute data by Aug. 27.

In a statement emailed to SearchHealthIT, Robert Wah, M.D., president of the American Medical Association, said:

“It is imperative that physicians make sure to register, review, and if necessary, dispute inaccurate reporting under the Physician Payments Sunshine Act as soon as possible since the limited, 45-day review period before the information goes public has already begun.

“The American Medical Association (AMA) is aggressively spreading the word about how physicians can protect themselves from potentially inaccurate reporting, raising awareness of the August 27 deadline to have potentially erroneous data flagged in the initial public release, and is providing an online toolkit to help physicians go through the registration, review and dispute process.”

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