Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

The CIO’s Guide to HIPAA Compliant Text Messaging

Yesterday I wrote a piece on EMR and EHR where I talk about why Secure Text Messaging is Better Than SMS. I think it makes a solid case for why every organization should be using some sort of secure text messaging solution. Plus, I do so without trying to use fear of HIPAA violations to make the case.

However, you can certainly make the case for a secure text messaging solution in healthcare based on HIPAA compliance. In fact, the people at Imprivata have essentially made that case really well in their CIO Guide to HIPAA Compliant Text Messaging. This is well worth a read if you’re in a healthcare organization that could be at risk for insecure texting (yes, that’s every organization).

They break down the path to compliance into 3 steps:

  1. Policy – Establish an organizational policy
  2. Product – Identify and appropriate text messaging solution
  3. Practice – Implement and actively managing the text messaging solution.

Texting is a reality in hospitals today and the best solution isn’t suppression, but enabling users with a secure solution. The checklists in the CIO Guide to HIPAA Compliant Text Messaging provide a great foundation for making sure your organization is enabling your users in a HIPAA compliant manner.

January 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

ICUs Can Improve Survival, Speed Discharges Using Telehealth

ICUs can boost patient survival rates and speed ICU and hospital discharge rates if they use tele-ICU technologies, a study published  in CHEST Journal concludes, according to a report in iHealthBeat.

The study involved researching the impact of tele-ICU technologies in 56 ICUs that were part of 32 hospitals and 19 health systems, tracking them over a five-year period, according to iHealthBeat. The project, which was led by Craig Lilly, director of UMass Memorial Medical Center’s eICU Program, involved more than 110,000 patients.

The hospitals involved in the study used the Phillips Healthcare eICU technology, a comprehensive set-up which included bidirectional audio and video equipment, population management tools and real-time and retrospective reporting tools.

The study looked at how ICU doctors created treatments based on best practices, and responded to patient alerts and alarms, iHealthBeat notes.

Researchers found that patients who received care in hospitals using telemedicine were 26 percent more likely to survive in the ICU than patients in units that didn’t use tele-ICU technologies. It also found that patients were 16 percent more likely to survive their hospitalization than their counterparts who didn’t receive tele-ICU services.

What’s more, researchers found that patients in ICUs using telemedicine saw 20 percent faster discharges in the ICU and 15 percent faster hospital discharges.

This research strongly suggests that tele-ICU is maturing, and should be taken seriously as part of a hospital’s treatment arsenal.  In fact, your hospital might want to take a look at a new set of best practices created by the New England Healthcare Institute designed to make tele-ICU more scalable and accessible to hospitals.

Ultimately, the ideal is to connect telemedicine — and other remote sources of data — to hospital EMRs, allowing a new level of collaboration between far-flung clinicians. But in the mean time, it seems that tele-ICU can offer great benefits even if it creates a data silo for the time being.

December 10, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Deploying WiFi For Clinicians, Hospital Guests A Complex Problem

These days, offering WiFi for both hospital visitors and clinicians is pretty much de rigeur. The problem is, clinicians need different things from their Wi-Fi connection than consumers do. And as a recent story in Healthcare IT News notes, that can make it difficult to keep up with everyone’s demands.

According to Ali Youssef, senior clinical mobile solutions architect at Detroit-based Henry Ford Health System, maintaining a wireless network that suits everyone’s needs is “moving target.”

Youssef was responsible for planning and implementing the HFHS wireless network, which included expanding coverage from 4 million to 8 million square feet. What’s more, the network rollout had to take into account the needs of the HFHS enterprise EMR system, according to the HIN piece.

For Youssef, one of the most difficult problems health IT managers face in this situation is provisioning bandwidth appropriately to all the different types of devices that will share the bandwidth.

Not surprisingly, Youssef believes that one of the most important ways to see that everyone has enough bandwidth is regular contact with the system’s clinicians.

In some situations, clinicians may need far more bandwidth then the IT department had anticipated, for example, where clinician is launching a new project fueled by grant money, notes the Healthcare IT News piece. (We’re also increasingly see a growing list of wireless medical devices, such as wireless glucometers, edge into mainstream clinical care.)

To cope with these rapidly changing demands, Youssef recommends planning for a high level of wireless system redundancy and conducting site surveys.

And in what may be a more difficult challenge, he recommends that network architects keep continuous tabs on what types of devices are going to be used, and testing them see how they behave on their health system’s network.

Youssef didn’t offer any detailed advice on how to accommodate hospital visitors in this story, but clearly, they will pose a significant challenge to any hospital network architect as well.

Particularly as apps become part of patients’ health system experience, network architects will need to bear consumer experience of the network in mind as well. It will be interesting to see, over the next few years, whether consumer wireless health use demands a fresh approach to network architecture generally.

December 3, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Hospital Residents Question Value of iPad For Clinical Rounding

Though the iPad has a sexy reputation — the Apple mystique is alive and well — it may not not necessarily the best tool to use for clinical rounding or education, according to a new study published in the Journal of Mobile Technology in Medicine. That being said, there’s a lot of issues with the study, as you’ll see below.

First, the study design. During the 2011-2012 academic year, researchers gave iPads to 102 medical and surgical residents at Riverside Methodist Hospital in Ohio. The tablets were 16 GB iPad2 models with wireless Internet capabilities, reports iHealthBeat. The iPads had Wi-Fi but no cellular network connectivity, which left many residents complaining about hit-or-miss connectivity.

At the end of the academic year, researchers surveyed the residents to learn how iPad use had worked for them. What they found out was that while the residents largely liked the iPads, they didn’t find them useful for clinical rounding. On the other hand, though the study doesn’t address this directly, they had reason to be uncomfortable.

Of the 102 residents, only 14.7 percent used the iPad on rounds, and a scant 7.8 percent said the tablet helped them document care more efficiently. But it should be noted that the iPads were running only VMware View, not an iPad-native care system, forcing the residents to cope with an interface designed for seated users on keyboards.

Meanwhile, almost 58 percent of respondents said that the iPad was useful for sourcing articles outside of the hospital and 52 percent said the iPad was valuable for research.

The medical residents also valued the iPad for making recommendations to a colleague (58.3 percent), facilitating patient care (45.8 percent), as an educational tool (41.7 percent) and to view results and use as a guide for evidence-based practice (38.9 percent). (Surgical residents were much less impressed, with, for example, only 6.7 percent agreeing that the tablet was a valuable educational tool.)

Despite its flaws, the study does make one important point — that it’s well past time for EMR vendors to create iPad-usable interfaces, rather than forcing residents to use some awkwardly hacked version of their desktop/laptop product. If this study is any indication, large numbers of residents like the iPad a great deal, but they’re not going to use it for documentation unless they have a good user experience.  Vendors, your move.

P.S. By the way, if you want to read about a case in which iPads are being used in daily rounds, check out this piece from drChrono that was highlighted on the Apple iPad website.

November 13, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Patient’s Take On Making Hospital IT Patient-Friendly

Today I was talking with my mother about her experiences with hospitals and IT. My mother, you should know, is so computer averse that she won’t send or receive e-mails — she leaves that to Dad.  But despite her fear of home computing, she’s got some interesting opinions about how hospitals should use health IT to involve patients in the care process:

* If possible, she suggests, hospitals should assess a patient’s “electronic IQ” to see how comfortable they are with using technology. I liked this because it could apply not only to in-hospital info sharing but also the patient’s ability to participate in remote monitoring or other mHealth modalities.

*Give patients access to a schedule (via an app on a tablet, perhaps) which tells them when various tests, procedures and clinician visits are likely to happen. This not only calms the patient, it helps keep the family in synch with the patient’s routine, she notes.

* Display results of key tests — or if clinicians are concerned that patients won’t understand them, at least register when the results have been received, so  patients know their care process is progressing. She’d be happy with a note that said: “Dr. X will be in to discuss the results of your CT scan shortly.”

* Allow the patient and their family/caregivers to make notes within the system of what they want to discuss with clinicians.  Otherwise, as she rightly points out, they’re likely to forget what they wanted to say when the nurse or doctor swoops into the room with their own agenda.

Actually, my mother’s vision is already largely in place in at least one facility. As I reported last year, the Mayo Clinic has already begun a program using content- and app-loaded iPads to move the patient through their inpatient stay. Not only does the Mayo implementation do everything on my mother’s wish list, it also allows patients to report on pain levels and exchange messages with doctors.

Let’s hope more hospitals find a way to use IT to make the care process more transparent for patients. While it calls for a not-inconsiderable investment in time and resources, it seems like an excellent way to keep patients engaged in their care.

September 4, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Personality Traits Predict Nurse Acceptance of Mobile EMRs

As HIT leaders know well, clinical personnel have a wide range of responses to EMRs, ranging from enthusiastic adoption to outright panic. In most cases, hospitals can’t predict which doctors and nurses will need extra support and which will be power users until they roll out their EMR.

However, a new study suggests that by examining nurse attitudes, the HIT team can get some idea ahead of time which will jump on board with mobile EMRs and which will hang back.

Key personality traits can predict which nurses are more likely to accept and adopt EMRs, according to a new study appearing in a FierceEMR piece.

The study, which appeared in BMC Medical Informatics & Decision Making, analyzed a questionnaire filled out by 665 nurses to compute a “Technology Readiness Index.”  In so doing the researchers broke out a series of personality traits that impact on whether nurses see mobile EMRs as easy to use and useful.

Researchers concluded that four traits in particular — optimistic, innovative, secure and uncomfortable with technology — had a meaningful impact on their acceptance of technology, according to Fierce EMR:

* Optimistic nurses were more likely to see mobile EMRs as useful and easy to use
* Innovative nurses saw EMRs as being easy to use, but not necessarily useful
* Those who were insecure or technology-challenged saw the EMR negatively

According to the study write-up, researchers concluded that continuous educational programs aimed at increasing IT literacy should be provided for nurses. It also recommends that hospitals recruit, either internally or externally, more optimistic nurses as product champions for the mobile EMR.

Of course, figuring out the personality types of  nurses en masse isn’t practical in most situation. After all, most hospital IT administrators don’t have the time to do a scientific study prior to their launch, especially if they’re doing a multi-layered mobile launch using new tools and introducing new requirements. But it doesn’t hurt to know, informally at least, which types of nurses are likely to be able to lead the mobile EMR charge.

August 27, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Beth Israel Deaconess Uses Lessons Learned To Protect Bombing Patient Data

When terrorists exploded bombs at the Boston Marathon, Beth Israel Deaconess Medical Center was one of the hospitals that received patients injured in the attack. With world attention focused on the event and its aftermath, it wouldn’t have been surprising if someone managed to breach the patients’ medical information.

But as it turns out, BIDMC was able to keep private not only injured victims’ data, but also information on the condition of bombing suspect Dzhokhar Tsarnaev, reports iHealthBeat.  BIDMC CIO John Halamka told a conference this week that his facility was able to keep sure in part due to lessons learned from a data breach involving a stolen laptop.

During his presentation at the meeting, Halamka explained how the facility tightened up security after a July 2012 incident where a physician’s personal laptop.

The incident, which required  the hospital to notify about 3,900 patients about the data breach, led the hospital to immediately change its encryption policies for any device hospital personnel used that could contain protected health data, iHealthBeat reports. BIDMC also improved security in office buildings and launched a campaign to increase awareness regarding data security.

What’s more, after a second data privacy issue came up, BIDMC retained Deloitte to audit how employees use computers and personal devices.  Deloitte ended up recommending adding messages to portals to remind employees to take care with data; creating 26 new staff positions; deciding which records were the most restricted; and updating doctors’ record access permission when they were given new job titles, iHealthBeat says.

When the Boston Marathon event took place, Halamka was able to build on these precautions. Specifically, he took steps to make sure doctors working in the emergency department weren’t able to access patient records out of curiousity. IT leaders restricted access to the victims’ and Tsarnaev’s data, making employees who did seek access to explain why they did so, iHealthBeat said.

Health data security measures like those at BIDMC are too seldom implemented in full, as the countless reports of data breaches at hospitals demonstrate. But they’re increasingly necessary, particularly as mobile devices bring new layers of risk and health data grows more of a target for criminals. Unfortunately, given the desirability of health data as a target, this is a problem that can only get worse before it gets better.

August 23, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Building A Successful Hospital Mobile Strategy

Hospital leaders know that having a mobile strategy in place has become a necessity. Doing so not only accommodates physicians’ and nurses’ mobile workstyles, it leverages tablets and smartphones in a manner which makes hospital communication and EMR use more effective.

The thing is, making a mobile strategy work is far more complicated than simply giving caregivers with mobile devices and wishing them luck, notes Trey Lauderdale, founder and president of mobile communications firm Voalte. In a recent piece for the HIT Consultant blog, Lauderdale argues that there are a few key steps hospital CIOs need to take if their mobile initiatives are going to be successful. These include:

Assess and  prepare your infrastructure

Before you roll out a major mobile initiative, it’s critical to make sure both your physical and digital infrastructure can handle a new flood of mobile device traffic, Lauderdale says. Bear in mind that your Wi-Fi network will need to handle data, text and voice transmission on a level it hasn’t before, and what’s more, that this demand is likely to change and grow. You’re also going to need to figure out how to integrate mobile devices with alarms management middleware.

*Plan for deploying your smartphones

As you think through the nuts and bolts of handing out smartphones, be aware than you’ll need to see to their day-to-day functioning, Lauderdale points out. For example, you’ll need battery cases to protect the phones and keep them charged shift-long, and screen shields to  protect against accidents, and possibly a custom holster to help nurses work comfortably with phones. You’ll also need to decide whether smartphones will be shared or assigned to specific caregivers, and how you’ll store and charge them when they’re not being used.

Manage and update smartphones

With caregivers using smartphones as an official work device, you’ll then need to implement a mobile device management strategy, an approach which allows you to download apps to phones, update operating systems and make repairs when necessary. You will also want to include mobile devices in your security strategy, for functions such as password protection, lockout protocols and provisioning access, Lauderdale says.

Not every healthcare organization is ready to invest in its own stock of smartphones or tablets. Many are still struggling to implement a BYOD strategy that meets the institution’s needs without asking doctors and nurses to check their personal device at the door. But if you’re ready to supply and control mobile devices, Lauderdale’s suggestions make sense.

August 20, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

CA Hospital Jettisons Nurse Communications Gear For iPhones

At Keck Medical Center of USC, nurses will no longer use standard hospital communications gear.  In an effort to simplify and improve communications, the academic medical center is rolling out an initiative placing specialized adapted iPhones in the hands of each nurse.

According to an article in USC’s The Weekly, Keck’s IT leaders  have ordered 300 “specialty” iPhones for  use by the nursing staff. “The idea is to give them one device to do everything,” Keith  Paul, chief technology officer for USC Health Sciences, told The Weekly.

Paul chose to go with the iPhones when the firm installing its EMR said that they could link it with the smartphones. (The EMR is in the process of being rolled out, the paper reports.)

When the devices are completely functional, nurses will be able to receive secure messages from patients and other nurses, as well as emergency alerts, the article notes. The devices, which come with enhanced batteries and a tough casing, will also be able to show when a specific nurse is available.

Nurses are not going to be given their own phones, but instead, will pick up a phone at the start of their shift, entering their user ID and password to activate the device.  At the end of their shift, they’ll be asked to return the phones to a charging station.

One way in which the phones are unique is that they won’t have cellular capabilities. The modified iPhones will function only on the Keck campus, with calls made over the facility’s secure Internet infrastructure.

This is the first time I’ve heard about a smartphone or tablet rollout which crippled the cellular communications functions of the device, but it probably won’t be the last.

As we’ve previously reported, few smartphones are secure enough to meet even half of Meaningful Use or HIPAA requirements, according to ONCHIT. So it makes sense to run voice communications through a hospital-controlled voice-grade Internet network if you have the option (which Keck obviously did). But to date few hospitals (that I know of) have taken the plunge.

What’s equally interesting here is the extent to which the new iPhone rollout superceded investment in standard nurse communication platforms such as, say, Vocera phones. I wonder if vendors of such equipment will see iPhones or other smartphones begin to eat into their market share. What do you think?

July 22, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Howard University Hospital Rolls Out Mobile PHR for Pre-Diabetic Young Adults

Howard University Hospital has kicked off a research study, using wireless technology, to help at-risk young adults in the District of Columbia change their behavior to prevent their developing diabetes.

The program involves giving African-American adults aged 18 to 24 who are diagnosed with pre-diabetes access to a mobile PHR and activity tracker which are synchronized wirelessly with the Web-based PHR.

Howard is giving young adults in the program free access to the NoMoreClipboard PHR for their smartphones, along with a FitBit Zip wireless activity tracker which counts the number of steps taken, distance covered and calories burned per user. The study also includes a separate “lifestyle group” which will not receive the technology, but will attend group meetings addressing their condition.

Once synched up with the Web-based PHR, the technology group’s data will be available to clinicians with Howard’s Diabetes Treatment Center, who will use the data to provide coaching to program participants.  Data from the Center’s EMR will also populate the PHR, creating a patient health record participants can bring with them to other providers.

The program will also include sending a variety of text messages to the young adults in the technology group, including reminders to interact with the PHR and 75 health and behavioral tips which will be dispatched over the course of a year.

To examine results of this intervention, the program will study changes in Patient Activation Measure scores — a validated 13-item measure used to assess patients’ ability to self-manage their chronic disease – at three months and one year.  Researchers also plan to look at changes in BMI and hemoglobin A1c levels at the same intervals.

June 26, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.