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The Cost of Encouraging Patient Engagement

Posted on June 15, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

We all know that healthcare providers want to encourage patient engagement to ensure patients have the information they need to manage conditions and share information with other providers. There has been a longstanding push for the adoption and maintenance of personal health records for many years to give patients the power to share and disseminate information wherever it is needed. We have seen a remarkable new interest in this with Meaningful Use and population health initiatives. Since HIM professionals are charged with maintaining and producing legal copies of records, we are aware that the tasks surrounding these processes can be very expensive. This is especially true if any of the tasks are not handled properly and breaches of protected information occur.

My concern is that lately I have heard many discussions that are pushing for more access yet with fewer costs to patients to encourage patient engagement. Some are even pushing for patients to have “free” access to records- paper or electronic. Don’t get me wrong, I am a huge proponent for patients having copies of their records and I personally keep copies of my own records. The Office of Civil Rights (OCR) recently published further guidance on charging for records. In a nutshell, the OCR says: “copying fees should be reasonable. They may include the cost of labor for creating and delivering electronic or paper copies; the cost of supplies, including paper and portable media such as CDs or USB drives; and the cost of postage when copies of records are mailed to patients at their request.” The OCR actually has the authority to audit the costs of producing records if they feel your organization is violating this patient right and overcharging for release of information.

Living in a state such as Florida where the state law has allowed facilities to charge up to $1 per page means most facilities have charged $1 per page without blinking an eye. The latest OCR guidance has led to questioning if that amount is actually “reasonable” or true to cost. Afterall, HIM professionals must use expensive systems, supplies, and labor costs to produce these records. Many organizations have outsourced release of information functions (another cost) but it is still the responsibility of the custodian of records to oversee the processes for compliance.

That being said, it is beneficial for HIM departments to evaluate the expenses and methods used to produce records as technologies and laws change. Dr. Karen Desalvo of the Office of the National Coordinator (ONC) strives to lead the EMR interoperability movement. At the top of the ONC’s list of commitments is consumer access to records. HIM professionals should continue to assist in the quest for interoperability and electronic data sharing at the notion of patient engagement. We must lead patients to use EMR patient portals and facilitate the efficient electronic data sharing among healthcare providers. We must be creative in lowering overhead costs to produce and maintain the records in order to ensure costs are affordable for healthcare consumers. There will always be costs associated with this important task, whether on the provider’s end or the patient’s end, just as costs are incurred with most services or products in every industry.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Susannah Fox Named As First Woman CTO of HHS

Posted on May 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In case you’ve been busy like me, this week Susannah Fox was named as the new CTO of HHS. She’s the first woman to be appointed to this position and is following in the footsteps of Todd Park (who later became the US CTO) and Bryan Sivak.

The HHS CTO position was started in 2009 and so it’s a relatively new position, but I think it’s exciting that HHS would choose Susannah Fox for this position. Fox has worked as the associate director of the Pew Research Center and as the entrepreneur in residence at the Robert Wood Johnson Foundation.

Those of us on social media know @SusannahFox very well since she was very active on Twitter and often joined in on various healthcare IT discussions that were happening online. Plus, Susannah Fox was a regular speaker at healthcare IT events.

What I love most about the prospect of Susannah Fox being involved at HHS is that she’s a total health data geek. I say that with the utmost respect and admiration. In fact, I don’t throw compliments like that out easily. She’s a true data geek that’s been diving into healthcare data for a long time. I think that’s going to be a very valuable quality in her new role at HHS.

Maybe I’m wrong, but I think that one of HHS’ major roles should be around using data to improve healthcare in the US. I think that’s the potential opportunity for them and one that they haven’t done a great job leveraging to date. I’m hopeful that Susannah Fox will be able to help in that regard.

Think about all the powerful women at the head of HHS: Sylvia Burwell, Karen DeSalvo, and now Susannah Fox (and I’m sure there are many more that I don’t know as well). I think that’s a great thing. I look forward to the future they’re paving. They don’t have an easy job ahead, but I do think they have tremendous opportunity.

The Healthcare Social Shakeup Infographic

Posted on February 3, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Yesterday, I tuned in for a bit of the ONC Annual meeting. I caught the tail end of the Fireside chat with Karen DeSalvo, and Thomas Daschle and Bill Frist, MD who were both previously senate majority leaders. Near the end of the discussion, Bill offered up that social media is going to be the way that the change happens. He even commented that many in DC (and I think he was including the medical community as well) aren’t that keen on social media. However, he said that 300 million people (seems to be referencing Facebook’s number) are on it and that’s where the conversation and influence are happening.

It was quite an interesting moment to hear someone like him talk about many people in his position’s opposition (or at least dislike of) social media and how it was going to happen anyway. With that as context, I was intrigued by this Healthcare Social Shakeup Infographic by CDW Healthcare. The title of their post sharing this infographic was called “Healthcare has officially gone social!” The same sentiment that Bill Frist shared. I love this excerpt from their post:

So no matter which role you play in the giving and receiving of care, social media is shaking things up and beginning to foster some amazing results: better knowledge of health conditions, increased dialogue, connected support and more patient engagement.[emphasis added]

Healthcare social media is here to stay. The problem is that in most hospitals we’ve treated social media as a marketing task. It’s a technology, but tech doesn’t take any ownership of it. It’s interaction with patients and possibly patient care, but medical doesn’t want to be part of it. It will take all three groups at a hospital to really do it well.

Here’s the infographic mentioned (Thanks CDW Healthcare):
Healthcare Social Media Infographic

New Federal Health IT Strategic Plan for 2015-2020

Posted on December 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The big news came out today that HHS had released its Health IT Strategic Plan for 2015-2020. You can find more details about the plan and also read the 28 page Federal Health IT Strategic plan online. Unlike many of the regulations, this strategic plan is very readable and gives a pretty good idea of where ONC wants to take healthcare IT (hint: interoperability). Although, the document is available for comment, so your comments could help to improve the proposed plan.

I think this image from the document really does a nice job summarizing the plan’s goals:
Federal Health IT Strategic Plan Summary

When I see a plan like this, the goals are noble and appropriate. No doubt we could argue about some of the details, but I think this is directionally good. What I’m not so sure about is how this plan will really help healthcare reach the specified goals. I need to dive into the specific strategies offered in the document to know if they really have the ability to reach these goals. I might have to take each goal and strategy and make a series out of it.

What do you think of this new health IT strategic plan?

The State of Government Healthcare IT Initiatives

Posted on November 12, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Brian Eastwood has created a really great article on CIO.com that looks at why Healthcare IT is under fire. His finally couple paragraphs summarize the current challenge for government healthcare IT initiatives:

ONC – as well as HHS at large – admittedly finds itself between Scylla and Charybdis. Too much regulation (medical devices) can do just as much harm as too little regulation (interoperability). Moving too quickly (meaningful use) can cause as much frustration as moving too slowly (telehealth). Politics can explain some industry challenges (reform’s uncertain future) but not others (public perception of Healthcare.gov).

That said, healthcare wants to change. Healthcare has to change. As healthcare continues its rapid, unprecedented march toward modernity, industry leaders have every right to expect – no, demand – a strong, confident voice in their corner. Right now, ONC can barely muster a whisper when, instead, it should be shouting.

I don’t think I’ve seen a better concise summary of the challenges that ONC, CMS, FDA, etc face. This shouldn’t be seen as an excuse for these organizations. We all face challenges in our job and we have to learn to balance them all. The same is true for organizations like ONC.

What makes this challenge even harder for ONC is that they’re in the midst of a massive change in leadership. Not to mention a leader, Karen DeSalvo, who at best has her time split between important issues like Ebola and her work as National Coordinator over healthcare IT. Considering DeSalvo’s passion for public health, you can guess where she’s going to spend most of her time.

In some ways it reminds me of when I started my first healthcare IT blog: EMR and HIPAA. As I started blogging, I realized that I had a real passion for writing about EMR. The same could not be said for HIPAA. Despite it’s name, I was spending most of my time writing about EMR and only covering HIPAA when breaches or other major changes happened. I imagine that DeSalvo will take a similar path.

Without a dedicated leader, I don’t see any way that Brian Eastwood’s vision of ONC shouting with confidence becoming a reality. A bifurcated leader won’t likely be able to muster more than the current whisper. It’s no wonder that CHIME, HIMSS and other major organizations are asking for DeSalvo to be full time at ONC or for her to be replaced with someone who can be dedicated full time to ONC.

What should be clear to us all is that healthcare IT isn’t going anywhere. Technology is going to be a major part of healthcare going forward. Why the government wouldn’t want to make a sound investment with strong leadership is beyond me.

What’s Happening with All the Departures at ONC?

Posted on October 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In many ways, it’s expected that there will be a fair amount of change in the leadership of an organization when the leader leaves. The new leader often wants to bring in their people with whom they’ve worked with before and trust. Plus, I’ve previously noted that the Golden Age of EHR is over and so it’s not surprising that many people would leave ONC as the MU money is running out and the future of ONC is uncertain.

You’ll see the letter below that Karen DeSalvo just sent out about the latest ONC departure: Judy Murphy, Chief Nursing Officer (CNO) at ONC. This is the fourth high level leader that’s left ONC in the past few months. For those keeping track at home, Doug Fridsma MD, ONC’s Chief Science Officer, Joy Pritts, the first Chief Privacy Officer at ONC, and Lygeia Ricciardi, Director of the Office of Consumer eHealth, are the other 3 that have left ONC.

When Karen DeSalvo announced the ONC reorganization, here’s the leadership team she outlined:
Office of Care Transformation: Kelly Cronin
Office of the Chief Privacy Officer: Joy Pritts
Office of the Chief Operating Officer: Lisa Lewis
Office of the Chief Scientist: Doug Fridsma, MD, PhD
Office of Clinical Quality and Safety: Judy Murphy, RN
Office of Planning, Evaluation, and Analysis: Seth Pazinski
Office of Policy: Jodi Daniel
Office of Programs: Kim Lynch
Office of Public Affairs and Communications: Nora Super
Office of Standards and Technology: Steve Posnack

Three of the people on this list have already left ONC. That’s a pretty big hit to an organization that will likely have to do some hard work to ensure they’re included in future budgets in a post-MU era. It’s hard to fault any of these people who have an opportunity to make a lot more money working in industry. It will be fun to see who steps in to replace all these departures (including Dr. Jon White and Dr. Andy Gettinger who DeSalvo talks about in her letter below).

Must be an interesting time in the hallways of ONC.

Letter from Karen DeSalvo to ONC team about the departure of Judy Murphy, CNO of ONC:

ONC Team:

I am writing to let you know that Judy Murphy, our Chief Nursing Officer (CNO) and Director of the Office of Clinical Quality and Safety (OCQS), will be leaving ONC to take on an exciting new position as Chief Nursing Officer with IBM Healthcare Global Business Services. Her last day will be October 17.

Judy came to ONC in December 2011 and continued her established tradition of giving passionately and tirelessly to the entire health IT community. As Deputy National Coordinator for Programs and Policy, she led the HITECH funded program offices to achieve key milestones, such as the RECs providing assistance to 150,000 providers and helping 100,000 of them meet the meaningful use incentive requirements (exceeding the goal by 150%). She ensured that dedicated resources were available to help 1,300 critical access and rural hospitals exceed the same goals by 200%. She helped grow the MUVer (Meaningful Use Vanguard) Program to 1,000 providers and the Health IT Fellows Program to 45, giving us real boots on the ground to help providers adopt and use EHRs.

Her long-standing reputation of patient advocacy and maintaining a “patient-centric” point of view helped in ONC’s creation of the Office of Consumer eHealth, as well as identify annual strategic goals to promote consumer engagement. With the office, she helped launch the now very successful “Blue Button: Download your Health Data” campaign initiative.

Most recently, as CNO, she championed a Nursing Engagement Strategy for ONC and initiated the joint ONC and American Nurses Association Health IT for Nurses Summit which was attended by 200 RNs and NPs. In addition, her astute organizational and project management skills were put to use strengthening portfolio management and project performance management at ONC.

In her time here, she received several awards spotlighting her work, including the HIMSS Federal Health IT Leadership Award, the AMIA President’s Leadership Award, and the Distinguished Alumni Achievement Award from her alma mater, Alverno College, in Wisconsin.

We are planning a smooth transition of Judy’s current duties. Judy’s CNO responsibilities will be entrusted to the other nurses at ONC until a replacement CNO can be named.

Dr. Jon White will be on a part-time detail to ONC from the Agency for Healthcare Research and Quality (AHRQ) to serve as interim lead of OCQS and serve as ONC’s Acting Chief Medical Officer, reporting to Deputy National Coordinator Jacob Reider, while ONC searches for permanent staff to fill these positions. Dr. White directs AHRQ’s Health IT portfolio and will continue in that role part-time.

Dr. Andy Gettinger, from Dartmouth Hitchcock Medical Center, has agreed to lead the OCQS Safety team and the patient safety work. Dr. Gettinger comes to us with vast experience in many areas of health IT and we are excited to welcome him to the team. Judy is working closely with Jon, Andy, the extraordinary OCQS team, and me to ensure a seamless transition of her responsibilities.

Please join me in wishing Judy all the best in her new role, thanking her for her public service to our nation, and welcoming Andy and Jon to our team.

kd