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A HIPAA Compliance Dashboard

One of the interesting announcements coming out of HIMSS was a HIPAA Compliance Dashboard that was announced by INetU. The concept of a dashboard that shows you your HIPAA compliance is fascinating for me. The key question I’ve asked myself is can HIPAA compliance be automated into a dashboard?

Here’s a look at the HIPAA Compliance Dashboard they’ve created:

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INetU claims that the dashboard will keep track of both the business associate’s (in this case INetU’s) HIPAA compliance and the covered entities compliance with HIPAA. I need to dig into it some more, but I’d love to hear from some other HIPAA experts out there. Aren’t there pieces of HIPAA compliance that can’t be automated to a dashboard? I’d love to be proven wrong.

I also think the Dashboard is a nice building block to doing security beyond just HIPAA. It reminds me of this post titled, “Why HIPAA isn’t Enough to Keep Patient Data Secure.” This dashboard could provide a deeper look into security beyond just HIPAA. Although, it makes sense why they’re leading with HIPAA since organizations don’t mind coughing up money to ensure their HIPAA compliant.

What do you think of this idea? Can HIPAA Compliance benefit from a dashboard like this? Of course, this can be taken too far as well. We don’t need CIO’s that become complacent, because the dashboard says “HIPAA Compliant.”

March 26, 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.

What’s the Real Cause of Hospital Readmissions?

To a person, I’m sure that every hospital has a detailed understanding of their hospital readmission number. Reimbursement depends on it and so every one or them knows that number well. However, how many of them really know the cause of their hospital readmissions?

As I consider the various companies working to reduce hospital readmissions, the vast majority (possibly all) of the ones I’ve seen and heard have focused on home health technologies. In theory, the idea makes sense. Someone is discharged from a hospital and so we need to provide them better home health technologies that can prevent them from returning to the hospital. This is the promise of home health technology and the media loves to cover it.

However, in a recent pre-HIMSS Google+ video briefing I did with Capsule, Stuart Long, their Chief Marketing and Sales Officer, made a comment about hospital readmissions that I’d never heard before. He said that the majority of readmits were coming from long term care and skilled nursing facilities and not from the home.

I found this to be a fascinating finding and one that made a lot of sense. However, I pressed him to know where he got the data for it. Since it was done from an internal survey, he offered me the following explanation of the finding:

Recently, Capsule surveyed the market to assess the level of financial pain that hospitals were feeling due to the Medicare penalties associated with 30 day readmissions coming from the patient’s home. We found that technology, although market buzz suggests otherwise, was not the main driver for hospitals mitigating the risk of penalty expenses associated with readmissions. To our surprise our survey of hospital CFO’s revealed that to date it has been the improvement of existing and newly deployed care processes that has had the most significant impact on the management of – in some cases even the reduction of – patient readmissions.

However, a consistent theme that was discovered across our survey was that the hospital readmission issues are not primarily coming from the home, but from long-term care (LTC) facilities and skilled nursing facilities (SNFs). Key points discovered include:

  • 60%-80% of readmits come from LTC & SNF
    • Mostly due to high co-morbidity (High number of simultaneous chronic diseases).
    • Discharges can vary to location based upon relationships with LTC’s and SNF. As high as 33% of patients to SNF, LTC and Home Health to “in network partners” where they have control through people and process.
      • 66% of discharges, however are “outside the network” to LTC and SNF where they have no insight to the patient.

This survey data supports the need for healthcare facilities to have a Remote Patient Monitoring (RPM) System & Clinical Decision Support solution for this population due to Accountable Care Organizations (ACO) and capitated reimbursement. To be able to effectively reduce readmissions and provide the best treatment of patients, much better care coordination is needed. For starters,

  • Data MUST be communicated to the primary physician. There is a driving need to send data to multiple caregivers.
  • There is a need to notify the primary physician or responsible caregiver in the event the patient show’s early signs of deterioration.

The additional challenge with the home is how to manage patient compliance. The current trend is to send an RN, Nurse Assistant, Case Manager or other outside company to the home for care.

Further to this point, a paper published by the Department of Health and Human Services OFFICE OF INSPECTOR GENERAL; “MEDICARE NURSING HOME RESIDENT HOSPITALIZATION RATES MERIT ADDITIONAL MONITORING” November, 2013 can be found here. This paper substantiates the problem with a specific disease condition that contributes to the high readmission rates from LTC and SNF’s.

In FY 2011, nursing homes transferred one quarter of their Medicare residents to hospitals for inpatient admissions, and Medicare spent an astonishing $14.3 billion on these hospitalizations. Nursing home residents went to hospitals for a wide range of conditions, with septicemia the most common.

I think this is a really important finding and I’d love to have it validated by readers of this site who have data from their hospital. Do you see the same thing happening with your hospital readmissions or something else?

If we assume that this finding is true, then the solution to the problem of hospital readmissions is very different than I previously thought. I think Capsule sees it as a tremendous opportunity for them to leverage their skills with connected devices in places like long term care and skilled nursing facilities.

As part of this strategy, Capsule just announced at HIMSS 2014 a new medical device information system that they’re developing. At first this sounded more like a device tracking system for medical devices. Is the device working properly? Where is the device? etc. Certainly it will have those features, but Capsule is looking at this medical device information system from a much larger perspective. They want the system to Connect, Monitor, Analyze, and Act. Connecting is what they’ve always done. Monitoring is the medical device management piece. However, Analyzing and Acting on the data those devices collects puts Capsule in a very new space.

I’ll be interested to see how deep Capsule goes with this and who they choose to partner with to put together the intelligence behind the “Analyze” and “Act” components. This will take some work and many will argue that this type of stuff should be done in the EHR. However, you have to remember that long term care and skilled nursing facilities were left out of the EHR incentive money and are way behind the rest of healthcare in IT adoption. Could these post-acute facilities put in a medical device information system from Capsule as a way to reduce hospital readmissions? Seems like an interesting and reasonable strategy to me. Plus, the hospital would be happy to pay for it if will indeed reduce their hospital readmissions.

February 24, 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.

Healthcare Analytics

Each week, the #HITsm community does a Twitter chat. This week it was hosted by @ahier and was focused on the topics of analytics. It was good timing considering we’re going to be innundated with healthcare analytics discussions at HIMSS 2014. Here is a look at the questions asked during the chat:
T1: What true models for analytics and data driven healthcare actually exist?

T2: Who’s going to win the analytics market battle: EHR vendors or the analytics specialty vendors?

T3: Should certification for analytics and clinical data warehouses be included in meaningful use?

T4: What are the concerns and benefits around marrying clinical, claims, and consumer retail purchasing data?

You can find the full transcript of the chat here. For those not wanting to read the whole chat, here are some tweets of mine I think you’ll find interesting:

I think this gives you a pretty good view into what I think about healthcare analytics. I’d love to hear yours.

February 21, 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.

HIMSS CIO Forum

If you’re in the hospital space and you don’t know about the 2014 CIO Forum at HIMSS, then you’re really missing out. The event is put together by CHIME and HIMSS and it is one of the largest group of hospital CIO’s that you will find anywhere. The only place that might have more hospital CIOs is the CHIME Fall Forum. Imagine a ballroom full of the top hospital healthcare IT leaders and that’s the CIO Forum at HIMSS.

Sadly I won’t be arriving until late on Saturday and so I’ll miss the opening reception, but I’m definitely planning to stop by the Sunday sessions after I take care of my church duties (which during HIMSS is ironically a fun place to meet HIMSS attendees). Sunday they have a list of speakers, but the biggest value is being able to connect and learn from the hospital CIOs.

As I posted about today on EMR and EHR, I love the social media at HIMSS, but I also love the experience at the CIO Forum.

Wow..this sounds like a big sales pitch. Well, I have no reason to pitch it. I just thought some readers might not know about it and be interested. Plus, if any of you are attending as well, I’d love to meet you. It’s certainly become an important part of my time at HIMSS.

Let me know what other parts of HIMSS you’re looking forward to attending. I’ve mostly put off my schedule for now, but in the next couple days I’m going to start scheduling it all out. Any feedback or suggestions are certainly welcome.

February 11, 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.

Which Health IT Is Poised For Hospital Growth?

Wondering which hospital applications are likely to be popular in the near future?  According to HIMSS Analytics, contenders include patient portals, clinical data warehousing/mining, and radiology barcoding software are poised for faster uptake in hospitals.

To gather this information, HIMSS Analytics did an analysis of the current market penetration and projected five-year sales trajectory each application considered in its Electronic Medical Record Adoption Model (EMRAM) report.  Researchers found that first-time purchases of these advanced EMR applications should grow dramatically in hospitals across the U.S.

According to Healthcare Informatics, there are good reasons why each of these three technology should be on the upswing in hospitals.  For example, the patient portal market is growing because it’s tied to Meaningful Use Stage 2 requirements.  Expected growth in sales of clinical data warehousing/mining technology is tied to the need to leverage data held in EMRs, and it’s that that sales increases in and radiology barcoding are probably associated with patient safety initiatives.

Meanwhile, the report also noted that several basic applications which have already saturated the hospital market will be responsible for a high-volume IT replacement sales, including laboratory barcoding, pharmacy management systems and information systems for radiology and laboratorydepartments.

The report from HIMSS seemingly doesn’t take mobile applications and systems into account — I’d argue because they are not yet seen as enterprise-level tools — but I think hospitals will be spending more on mobile technology than anticipate over the next few years, as tablets and smartphones become a permanent part of their infrastructure.  Just how fast that will happen remains to be seen, but it will happen.

January 21, 2014 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.

Stages, Rankings, and Other Vanity Metrics

It seems like we’re always getting bombarded with the latest and greatest list of hospitals and EHR vendors being ranked, classified or sorted into the various levels of IT adoption. The most famous are probably the HIMSS stages, KLAS rankings, and Most Wired Hospitals. While I’m like most of you and can’t resist glancing at them, every time I do I wonder what value those rankings and classifications really have when it comes to Health IT adoption.

In the startup world there’s a term that’s very popular called vanity metrics. I believe it was first made popular by Eric Ries in this post. The idea is simple. Organizations (and the press that cover them) love to publish big numbers for an organization, but do those metrics really have any meaning?

When I look at the various stages and ranking systems out there in healthcare IT, I wonder if they’re all just vanity metrics. The press loves to put a number on something or to classify an organization versus another one. However, does the stage or ranking really say anything about what really matters to a healthcare organization?

I haven’t done any specific research on things like the quality of care or the financial qualities of organizations across these stages and rankings. Maybe organizations that rank higher or have achieved a higher stage actually do provide better care and have better financials. Although, no doubt that research would have to also inspect the causal relationship between rankings and these results. However, I wonder if these rankings and classifications are really just vanity metrics.

I wonder if there are other metrics we could use to evaluate a healthcare organization. I think the results of such metrics would find every institution wanting in some areas and excelling in others. Stages and rankings don’t take this into account. However, I believe it’s the reality at every institution.

This actually reminds me of Farzad Mostashari’s comments about Healthcare’s Inability to “Step on a Scale” Today. As Farzad asserts, healthcare can’t “step on a scale” today and know how they’re doing. This is partially because the “scales” we’re using today aren’t measuring the right metrics. It’s like the scale is telling us that we’re 5’9″ and so we’re concluding we’re overweight. Although I expect that many might argue that the scale is blank and we’re concluding whatever we want to conclude.

I’d love to hear what metrics you think a healthcare organization should be measuring. Let’s hear your thoughts in the comments.

November 18, 2013 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.

HIMSS: The FDA Should Tread Carefully With Health IT Oversight

Of late, the FDA has been looking at into how it will regulate health IT generally, and EMRs especially, under the authority of the Food and Drug Administration Safety Innovation Act of 2012.  This, of course, has the vendor community very nervous, as they’re not eager to have an agency as powerful as the FDA breathing down their neck.

In an effort to soften the blow somewhat, the chairman  and CEO of HIMSS  have written a letter to HHS outlining why health IT products, especially EMRs, have unique functions and requirements.

In the letter, they argue that any regulatory efforts that are made should have the following characteristics:

• Holistic Approach: Any regulatory or oversight framework should recognize that health IT is part of a complex patient care ecosystem involving providers, product developers, vendors, a  wide array of use cases, and consumers as patients and caregivers.
• Shared Responsibility: The safety and efficacy of health IT as it fits within the patient care
system can be enhanced through non-punitive surveillance and reporting systems based on mutual trust and shared responsibility by all participants.
• Clear Oversight Direction: Clear and consistent guidance regarding proposed regulatory and/or  oversight activity is essential to ensure that health IT can continue to provide the innovation and tools necessary to achieve the patient safety and quality improvement goals, and cost efficiencies sought by all stakeholders.
• Role of Intended Use/Functionality: Regulation and oversight actions should be based on the  intended purpose and intended user of a particular product or service.

Cutting a nice wide path for EMRs and related clinical data systems, HIMSS argues that health IT products largely used for transmission, storage and management of data should not be considered medical devices. The execs also argue that there’s a big difference between products which are “integral to the functioning of a medical device,” and those that communicate with such devices. (While there’s definitely a move on to integrate EMRs and medical devices, progress has been scant to date.)

We’ll see how successful HIMSS was at shaping the FDA’s expectations next year, when the agency releases a joint report outlining its strategy in cooperation with the FCC and ONC.

In the mean time, the three agencies have formed a workgroup under the ONC’s HIT  Policy Committee which will provide recommendations to the Health IT Policy Committee.  If you’re as worried as HIMSS is, and there’s no reason not to be, the workgroup may offer a chance to make your voice heard. Getting involved, or at least commenting on draft report docs, is probably a good idea.

November 12, 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.

Study: Health IT Jobs 2.5% Of All Healthcare Hiring

New research has concluded that 2.5 percent of all healthcare hiring is health IT-related, according to a report in EHR Intelligence.

The study, which lumps EHR system implementation, informatics and other healtlh IT skills into the mix, was published Industrial Relations: A Journal of Economy and Society.

According to researcher Aaron Schwartz and colleagues, most of the 434,282 positions open are driven by opportunities created by the  HITECH Act. During the study period, which corresponded with the implementation of HITECH, researchers found an 86 percent increase in monthly job postings including “electronic health record” or “clinical informatics,” EHR Intelligence notes.

Implementation support was the most desired skill, with 43 percent of listings asking for recruits with system installation, purchasing or workflow design skills.

Only 39 percent of job listings were posted by healthcare providers, the study found. This suggests a very heavy reliance on recruiters to fill these positions, which require difficult-to-find skillsets.

Things haven’t changed much since 2011, where the study cuts off. Not surprisingly, health IT hiring continues at a fevered pace, with hospitals and IT vendors competing for employees with the same skills.

A HIMSS study released this summer, which surveyed 225 executives across hospital and health IT vendor sectors, found that 85 percent of respondents had hired at least one employee during 2012, and 79 percent of execs in these sectors plan to bring on more stuff during this year.

This survey found that providers were more likely to be hiring for clinical application support and help desk staff, while vendors were more likely to be hiring on sales and marketing personnel.

Unfortunately, the supply of HIT talent seems to be inadequate — CIOs say that they’re barely meeting their needs — and the educational system can only crank out graduates so quickly. This doesn’t bode well for hospitals, which can only rely on pricey consultants for so long.  Let’s hope someone comes up with a strategy for training up new health IT workers more quickly!

October 16, 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.

Most US Hospitals Are Ready For Meaningful Use Stage 2

So, it looks like most US hospitals are prepared for Meaningful Use Stage 2. New data from HIMSS suggests that approximately 68 percent of US hospitals have purchased technology from a software vendor that has been certified to the 2014 Edition certification criteria, according to Healthcare IT News.

The HIMSS report, Hospital Readiness to Meet Meaningful Use Stage 2, was released this week during National Health IT Week in Washington, D.C.

Researchers found that at least 60 percent of hospitals in their sample had met requirements for at least nine of the core metrics that define Stage 2 Meaningful Use. They also found that roughly 70 percent of respondents are actively moving toward meeting stage two meaningful use requirements across all metrics, Healthcare IT News reports.

These latest findings from HIMSS fit well with other data from previous reports done by the organization. The 24th Annual HIMSS Leadership Survey, which was released this February, found that 75 percent of respondents expected their organization to qualify for Stage 2 incentives in 2014.

Things aren’t nearly so rosy, however, when it comes to Stage 2 compliance for physicians. Several trade groups have written to HHS asking the agency to postpone or even put on hold the requirements of Stage 2.  In August, for example, the MGMA wrote a letter to HHS asking the agency to put Stage 2 requirements on an indefinite moratorium for practices that have successfully nailed Stage 1 Meaningful Use requirements.

The MGMA argues that it’s unfair to expect medical practices to comply with Stage 2 Meaningful Use as of yet, given that at present there are only 75 products and 21 complete EMRs for ambulatory care which are currently certified for Stage 2 criteria. As I see it, they have an excellent point.

This is an untenable situation. It’s all well and good that hospitals are approaching Stage 2 readiness, but if ambulatory care is being left behind, Meaningful Use Stage 2 can’t be said to be accomplishing its true purpose. I believe HHS will grant the request of MGMA and other groups like it – and ease Stage 2 deadlines for ambulatory care providers – or it risks creating a digital divide between hospitals and medical practices which does no one any good.

September 19, 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.

Hospitals, Vendors Seek New Hires

Hospitals and health IT vendors are on something of a hiring binge, with the majority of both groups planning new recruitment over the next 12 months, according to a new study of the health IT workforce from HIMSS Analytics, Healthcare IT News reports.

The HIMSS study, which was published last week, was based on the responses of about 225 executives in the two industry sectors.

More than 85 percent of respondents to the survey said they’d hired at least one employee during 2012, and 79 percent of execs in both industry categories plan to hire additional IT staff during the next year. In sharp contrast, only 13 percent went through layoffs during 2012.

Providers were more likely to say that they were hiring for clinical application support positions and help desk IT staff, while vendors were more likely to be looking for sales and marketing personnel.

Though both segments were hiring, industry vendors were more likely to report having hired staff than providers, according to the Healthcare IT News write-up.

To attract these new hires, both groups cited competitive salary and benefits programs as key, with job boards (70 percent) and employee referrals (69 percent) most frequently used to recruit in both cases.

To retain the staff they recruited, both groups were most likely to use professional development opportunities; telecommuting and tuition reimbursement were also popular.

Despite all of this recruitment activity, some healthcare organizations are falling behind, largely due to the lack of a local qualified talent pool, survey respondents said. And it’s causing problems. In fact, about one-third of providers said that they’d had to put an IT initiative on hold due to staffing shortage.

It’d be nice to think that with the right recruiting razzmatazz in place, these staffing shortages would be a thing of the past. But the reality is, the pool of health IT experts can’t be expanded overnight  – it takes training, possibly subsidized training, and the right kind of training at that.

And as my colleague Jennifer Dennard notes, while certain troublespots are being addressed (for example, building a talent pool for rural hospitals), even those efforts are hamstrung by the reality that students aren’t getting trained on the systems they’ll need to work on when hired.

The reality is that this will continue to be a great time for health IT consultants, even as hospitals and vendors duke it out for permanent  hires.  Hospitals simply can’t put projects of importance off forever.

If you’re looking for a job in healthcare IT or looking to hire someone for a healthcare IT position, be sure to check out the EMR and EHR Job board. It gets a lot of visibility in the sidebar of all the Healthcare Scene blogs.

July 16, 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.