14 Aug 2014

Apple prepares Healthkit rollout amid tangled regulatory web

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By Christina Farr, for Reuters.com

(Reuters) – Apple Inc has been discussing how its “HealthKit” service will work with health providers at Mount Sinai, the Cleveland Clinic and Johns Hopkins as well as with Allscripts, a competitor to electronic health records provider Epic Systems, people familiar with the discussions said.

While the talks may not amount to anything concrete, they underscore how Apple is intent on making health data, such as blood pressure, pulse and weight, available for consumers and health providers to view in one place.

Currently, this data is being collected by thousands of third-party health care software applications and medical devices, but it isn’t centrally stored. Apple also hopes physicians will use this data to better monitor patients between visits – with the patient’s consent — so the doctors can make better diagnostic and treatment decisions.

Apple has not divulged much specific detail on HealthKit, which is expected to be incorporated into the iPhone 6 come September. But Apple intends HealthKit to become a lynchpin in a broader push into mobile healthcare — a fertile field that rivals Google and Samsung are also exploring.

The iPhone maker has previously disclosed partnerships with Nike Inc, Epic, and the prestigious Minnesota-based Mayo Clinic, which boasts a suite of mobile apps. Mayo is reportedly testing a service to flag patients when results from apps and devices are abnormal, with follow-up information and treatment recommendations.

Dozens of major health systems that use Epic’s software will soon be able to integrate health and fitness data from HealthKit into Epic’s personal health record, called MyChart, according to a person briefed by Apple. Kaiser Permanente is currently piloting a number of mobile apps that leverage HealthKit, two people have said, and is expected to reach out to Apple to discuss a more formal partnership.

“Apple is going into this space with a data play,” said Forrester Research’s health care analyst Skip Snow. “They want to be a hub of health data.”

But some implementations with HealthKit may be a challenge due to a web of privacy and regulatory requirements and many decades-old IT systems, said Morgan Reed, executive director of ACT, a Washington-based organization that represents mobile app developers.

“Everybody is knocking on the door,” he said. “But I doubt that HealthKit will merge with all the existing systems.”

Apple declined to comment on upcoming partnerships for HealthKit. An Allscripts spokesperson said it did not publicly discuss contractual or prospective agreements. Mount Sinai and Johns Hopkins’ press officers had no information to share at this time.

Cleveland Clinic associate chief information officer William Morris said the clinical solutions team is experimenting with HealthKit’s beta and is providing feedback to Apple. HealthKit and related services could become a means for some technology teams at budget-strapped hospitals to save time and resources, as mobile developers won’t have to integrate with dozens of apps and devices like fitness trackers or Glucometers as they have to now, he said.

Kaiser Permanente’s Brian Gardner, who leads a research and development group responsible for Kaiser’s mobile offerings, said many physicians are thinking about how to leverage patient-generated data from apps and devices.

“Apple has engaged with some of the most important players in this space,” said Gardner. “Platforms like HealthKit are infusing the market with a lot of new ideas and making it easier for creative people to build for health care.”

LONG JOURNEY

Apple’s developer relations team has also been working with developers of popular fitness and medical apps, such as Mountain View, California-based iHealth Lab Inc.

Apple has taken pains to ensure that consumers are aware of how data is being collected and stored, said Jim Taschetta, chief marketing officer at iHealth Lab. For instance, an optional toggle will let patients decide if they wish to share data from third-party apps with Apple’s main health app. And if patients choose to store sensitive health data in iCloud, it’s encrypted when they’re in transit and at rest, one Apple employee said.

“It is consumer controlled and can be turned on or off at any time from the app that collects the data from the original source,” Taschetta said.

Health developers say Apple will not be immune to the challenges they have faced for many years, starting with safeguarding consumer privacy. And along with physicians and consumers, Apple will have to juggle the requirements of regulators at federal agencies or departments. Digital health accelerator Rock Health estimates that at least half a dozen government offices have a hand in some facet of mobile health.

HealthKit relies on the ability of users to share data. But depending on how that data is used, its partners – and potentially even Apple – may be subject to the requirements of the Health Insurance Portability and Accountability Act, or HIPAA.

HIPAA protects personally-identifiable health information – such as a medical report or hospital bill – stored or transmitted by a “covered entity,” like a care provider or health plan. Patient-generated information from a mobile app, for instance, has to be protected once the data is given to a covered entity or its agent.

Joy Pritts, recently-departed chief privacy officer for the Office of the National Coordinator for Healthcare IT (ONC), said Apple may need to re-determine its responsibility to safeguard data with each new partnership.

For instance, if Apple and Nike team up to collect running data, neither would be subject to HIPAA, she said. But if Apple gets and stores clinical information on behalf of the Mayo Clinic, both would likely have to abide by HIPAA.

“It is really difficult for consumers to know if their health information is protected by HIPAA because it’s so dependent on the specific facts,” Pritts said.

To smooth its path at a time when some other high-profile health-oriented initiatives have run into trouble in Washington — including the U.S. Food and Drug Administration’s decision to crack down on genetic testing firm 23andMe — Apple has consulted or hired health experts and attorneys, who are well-versed on privacy and regulatory requirements. Senior officials have paid a visit to key government offices, including the FDA and the ONC. Apple is expected to roll out HealthKit, so that providers – and not Apple — are responsible for adhering to privacy requirements.

But there’s the question of reliability. Joshua Landy, a Toronto-based internal medicine and critical care doctor, said physicians will need to learn over time which apps are useful for clinical purposes and safe to recommend to patients. This problem will grow in coming months with hundreds of new mobile medical apps expected to hit the App Store.

14 Aug 2014

Dallas County gets futuristic general hospital

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The new Parkland Memorial Hospital is more than a sleek mass of glass and steel, towering 17 stories above Harry Hines Boulevard.

Dallas County’s new $1.3 billion public hospital is one of the first “digital hospitals” in the United States. The new campus is teeming with technology that wasn’t even envisioned when planning for the hospital began in 2002.

“This building is a whole new world,” Lou Saksen, who is overseeing the five-year construction project, told The Dallas Morning News (http://bit.ly/1qVRFxy). “It’s no longer electrical or mechanical, it’s digital — run by a keypad, not a wrench.”

The digital technology, which cost about $80 million, should improve patient care, streamline record-keeping, enhance security and enable Parkland to operate more efficiently.

“It’s an apples-to-watermelons move — larger scale and new and advanced capability,” said Joe Longo, Parkland’s assistant vice president over information technology.

Visitors will sign in at touch-screen kiosks, which guide them from the lobby to their destinations in the hospital’s public areas. Patients will lie in smart beds that can weigh them and alert a nurse if they get up when they shouldn’t. The location of babies will be tracked by devices attached to their umbilical cords. Hospital corridors will be lined with video cameras that can detect movement in any direction.

Other hospitals may tout similar technology, but Parkland is among the few with a completely integrated digital system controlling nearly every aspect of its operations.

“Hospitals understand the importance of technology and connecting information across medical devices,” said Chantal Worzala, director of policy for the American Hospital Association. The national group tracks trends in 5,500 U.S. hospitals, including the adoption of electronic medical records, which has been mandated by the federal government.

“Only 44 percent of hospitals report having and using what we define as at least a basic (electronic records) system,” concluded a study of nearly 4,500 hospitals, published last year in the journal Health Affairs. The survey did not ask about other types of digital improvements.

“There are all sorts of exciting ways to involve technology in a hospital that go beyond medical records,” said Worzala, a co-author of the study. “The ultimate goal is having the highest-quality care. And as we learn how these technology systems can support that, hospitals will be adopting them across the board.”

At Parkland, the emphasis is on improving patient quality by promoting digital harmony.

“All of the technologies have merits to themselves, but the objective was to harmonize them to each other,” Longo said.

The new hospital will be similar to a smart home, said Fernando Martinez, the hospital’s chief information officer. “All the digital devices in a smart home can talk to each other because they’re connected to a common hub. That’s not unlike what we do, only we’re much bigger.”

Over the next nine months, Parkland staffers will learn how to use this cutting-edge technology. They won’t be taping homemade signs to patient doors anymore to warn of infectious diseases within. They won’t be filling out or filing stacks of paper as they manage thousands of patients. And they won’t be answering call buttons and scurrying up and down endless corridors.

Instead, about 2,500 nurses will receive hand-held digital devices that will alert them to patients’ needs, connect to medical and billing records, and enable them to communicate with other caregivers.

Instead of waiting for a patient to summon them, nurses will be automatically alerted by monitoring equipment in the room. They’ll know, for example, if an IV bag is empty or if a patient’s blood pressure is rising. The patient may not even realize what’s happening.

“Every bed is on the digital network with all its electronic information,” Longo noted. “The bed can create an alert to the nurse’s call system, which says, ‘You need to go see the patient.’ And the bed can shift a patient to remove the risk of bedsores.”

So much information, however, can cause “alert fatigue,” a feeling of being inundated with data to the point where the caregiver stops paying attention. “So we take a tiered approach, where the high-impact alerts go first,” said Martinez. Longo agrees: “We want to avoid alert whiplash.”

Despite the importance of these hand-held devices, Parkland has yet to select which ones it will use. Its IT staff is worried that the equipment could quickly become obsolete.

“We know we want to get years of useful life out of a device that doesn’t even last one year in the consumer world,” Martinez said. “We’re future-proofing the organization.”

Doctors will have to provide their own digital devices, probably smartphones, to be outfitted with hospital software that ties them into the communication system.

Some information, such as hourly blood-pressure readings, will go directly into patients’ medical records. Such automatic reporting tends to be more complete and accurate, since transcription errors are eliminated.

The hospital staff and visitors will be monitored by 1,200 digital video cameras.

Keeping track of movements throughout a 2.1 million-square-foot hospital could prove overwhelming. It’s more likely that the system will focus on aberrant behavior, such as a fight in a hallway or an unauthorized person trying to access a secure area.

Radio signals will be used to track mobile medical equipment. This will make it easier to find the equipment when it’s needed, and should also prevent thefts.

“We will get alerts when medical equipment that’s not supposed to leave a building is moving through an exit,” Saksen said.

Parkland’s most vulnerable patients, newborn babies, will get their own tracking system. Each infant’s umbilical cord will be tagged at birth, allowing the infant to be tracked within secure areas of the hospital. It also will be matched to the mother, reducing baby mix-ups.

“The tag on the baby is tamper-proof,” Longo said. “If someone carries the baby into an elevator, where it should not go, the tag can disable the door.”

Information from: The Dallas Morning News, http://www.dallasnews.com

 

14 Aug 2014

Just how far in usage and savings can telemedicine take U.S. healthcare?

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Erin McCann – Contributing Editor, mHealthnews

Imagine, if you will, that all in-person doctor and patient encounters were conducted virtually. It’s easy to understand that scenario would save money, but how much?

Towers Watson puts that at a jaw-dropping $6 billion.

The worldwide professional services firm’s estimate, however, could only be realized if all U.S. companies’ employees and their dependents ditch face-to-face physician and urgent care visits, swapping them for telemedicine interactions when available.

And that’s a lofty goal for even the most tech-savvy companies, but analysts say a much lower level of telehealth adoption could signify hundreds of millions of dollars in savings, still.

“Achieving this savings requires a shift in patient and physician mindsets, health plan willingness to integrate and reimburse such services and regulatory support in all states,” Allan Khoury, MD, senior consultant at Towers Watson, said in a prepared statement.

Indeed, the shift to telemedicine is already occurring in some ways, but at what rate?

After surveying some 420 midsize to large U.S. companies, 37 percent of employers said by next year they anticipate offering employees telehealth services as a low-cost alternative to face-to-face visits for nonemergency health issues. Some 34 percent, meanwhile, indicate it will be longer before they get onboard with telehealth, citing a two- or three-year time frame.

Of the employers Towers Watson surveyed, 22 percent currently offer telehealth alternatives, officials noted. But just because employers offer telehealth services doesn’t mean employees are actually using them, Khoury added. On the contrary, only 10 percent of members who have the services available actually utilize the services.

“With both insurance companies and employers encouraging its use, telemedicine is going to have a growing role in the spectrum of healthcare service delivery,” Khoury said. “We’re also likely to see that it’s just the tip of the iceberg.”

This tip of the iceberg for the telehealth market has seen a 237 percent growth within a five-year period, according to a recent Kalorama industry report. Already, the telemedicine patient monitoring market grew from $4.2 billion in 2007 to more than $10 billion in 2012.

14 Aug 2014

Spotlight is on mental health after Robin Williams’ death

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By Katie Bo Williams, HealthcareDive

In the wake of the apparent suicide of beloved comedian Robin Williams on Tuesday, the national spotlight is on how providers are managing a widespread disease that is present in the populations of hospitals, ACOs and clinics across the United States. Advocacy groups and legislators are already pushing for more scrutiny in how the U.S. care system delivers mental health services.

Mood disorders like depression are the third most common cause of hospitalization in the U.S. for individuals ages 18 to 44, according to the National Alliance on Mental Illness. Moreover, treatment of the disease has an impact on overall patient health: Individuals living with a serious mental illness have an increased risk of chronic medical conditions and die on average 25 years younger than other Americans.

How widespread is mental illness and what are the costs?

The Percentage of adults with mental illness who received no mental health services in the previous year: 60%

The impact on healthcare

  • The age by which half of all chronic mental illnesses begin: 14
  • Annual earnings lost as a result of mental illness: $193.2B
  • American’s who live with mental illness in a given year: 61.5M

By the numbers

  • 1 in 17 Americans live with a serious mental illness
  • 1 in 4 Americans who live with mental illness in a given year
  • 6.7% of American adults with major depression

 

21 Mar 2014

45% of physicians say EMRs make care worse

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Post orginated from: http://www.healthcaredive.com/news/45-of-physicians-say-emrs-make-care-worse/232679/

Dive Brief:

  • A new study finds 45% of physicians believe EMRs are making patient care worse.
  • The research, according to marketing and research firm MPI Group and Medical Economics, concludes that Meaningful Use incentives aren’t enough to cover unexpected staffing expenses and lost physician productivity. In fact, 77% of the largest practices spent nearly $200,000 on their systems.
  • Findings also show that almost two-thirds of doctors would not purchase their current EMR system again because of poor functionality and high costs.

Dive Insight:

It looks like for too many doctors, their worst EMR fears have come true, proving to be expensive, a drain on staff and technically inadequate. And that is really bad news. After all, patients spend most of their time with doctors, not in a hospital with an IT staff on hand to address these issues. It’s even worse to hear that 45% of respondents to the study said that patient care is worse since implementing EMR. The health IT industry as a whole must do something to make doctors more comfortable with their EMRs.

05 Dec 2013

Updated healthcare.gov gets mixed reviews

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From Boston.com article by Kelli Kennedy – December 3, 2013

FORT LAUDERDALE, Fla. (AP) — Counselors helping people use the federal government’s online health exchange are giving mixed reviews to the updated site, with some zipping through the application process while others are facing the same old sputters and even crashes.

The Obama administration had promised a vastly improved shopping experience on healthcare.gov by the end of November, and Monday was the first business day since the date passed.

Brokers and online assisters in Utah say three of every four people successfully signed up for health coverage on the online within an hour of logging in. A state official overseeing North Dakota’s navigators said he had noticed improvements in the site, as did organizations helping people sign up in parts of Alabama and Wisconsin.

But staffers at an organization in South Florida and a hospital group with locations in Iowa and Illinois said they have seen no major improvements from the federal website, which 36 states are relying on.

Amanda Crowell, director of revenue cycle for UnityPoint Health-Trinity, which has four hospitals in Iowa and Illinois, said the organization’s 15 enrollment counselors did not see a marked improvement on the site.

‘‘We had very high hopes for today, but those hopes were very much quashed,’’ said Crowell. She said out of a dozen attempts online only one person was able to get to the point of plan selection, though the person decided to wait.

The site appeared to generally run smoothly early Monday morning before glitches began slowing people down. By 10 a.m., federal health officials deployed a new queue system that stalls new visitors on a waiting page so that those further along in the process can finish their application with fewer problems.

About 750,000 had visited the site by Monday night — about double the traffic for a typical Monday, according to figures from the Centers for Medicare and Medicaid Services.

Roberta Vann, a certified application counselor at the Hamilton Health Center, in Harrisburg, Pennsylvania, said the site worked well for her Monday morning but she became frustrated later when the site went down.

‘‘You can get to a point, but it does not allow you to select any plans, you can’t get eligibility (information). It stops there,’’ she said. ‘‘The thought of it working as well as it was didn’t last long.’’

In South Florida, John Foley and his team of navigators were only able to successfully enroll one of a handful of return applicants who came to their office before glitches started, including wonky estimates for subsidy eligibility. He worried about how they would fare with the roughly 50 other appointments scheduled later in the week.

Although frustrated, most were not deterred, he said.

‘‘These are people that have policies going away, who have health problems. These are people that are going to be very persistent,’’ said Foley, an attorney and certified counselor for Legal Aid Society of Palm Beach County.

Despite the Obama administration’s team of technicians working around the clock, it’s not clear if the site will be able to handle the surge of applicants expected by the Dec. 23 deadline to enroll for coverage starting at the beginning of the year. Many navigators also say they’re concerned the bad publicity plaguing the troubled website will prevent people from giving the system another try.

‘‘There’s a trust level that we feel like we broke with them. We told them we were here to help them and we can’t help them,’’ said Valerie Spencer, an enrollment counselor at Sarah Bush Lincoln Center, a small regional hospital in the central Illinois city of Mattoon.

Federal health officials acknowledged the website is still a work in progress. They’ve also acknowledged the importance of fixing back-end problems as insurers struggle to process applications because of incomplete or inaccurate data. Even when consumers think they’ve gone through the whole process, their information may not get to the insurer without problems.

‘‘We do know that things are not perfect with the site. We will continue to make improvements and upgrades,’’ said Julie Bataille, communications director for the Centers for Medicare and Medicaid Services.

In less than an hour Monday, Starla Redmon, 58, of Paris, Ill., was able to successfully get into a health plan with help from an enrollment counselor. Redmon, who juggles two part-time jobs and has been uninsured for four years, said she was surprised the website worked so well after hearing reports about its problems.

‘‘Everything she typed in, it went through,’’ said Redmon, who chose a bronze plan and will pay about $75 a month after a tax credit. ‘‘It was the cheapest plan I could go with.’’

28 Nov 2013

Telemedicine consults may reduce errors at rural ERs

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Reuters Health article by Genevra Pittman, Nov 25, 2013

Emergency rooms in rural areas don’t see many very sick or badly injured children each year. When they do, bringing in a pediatric critical care specialist by videoconference to help with treatment could prevent errors, a new study suggests.

Researchers found rural ER doctors made errors in administering medication – such as giving the wrong dose or the wrong drug altogether – just 3 percent of the time when they used so-called telemedicine to connect with a specialist.

That compared to an 11 percent error rate when local doctors talked with a specialist by phone and a 13 percent error rate when they didn’t consult with a specialist at all.

“We know that we make a difference by being able to see the patient,” Dr. James Marcin said. The study’s senior author, he is on the telemedicine team at the University of California Davis Children’s Hospital in Sacramento.

Comparing telemedicine to a phone consultation, Marcin said, “It’s the difference between the doctor coming in to do an office visit with you with his or her eyes closed, versus with his or her eyes open.”

During a telemedicine conference, specialists also tend to get more involved in the patient’s care and may be more likely to speak up about their treatment opinion, Marcin told Reuters Health.

For the new study, he and his colleagues looked at data on 234 children with severe illnesses and injuries who were seen at one of eight rural hospital ERs in Northern California between 2003 and 2009.

Those rural hospitals were small and the only hospital in their vicinity.

The ERs were participating in a larger study on telemedicine. Rural doctors could use a video conferencing unit to consult with pediatric critical care specialists like Marcin whenever they chose.

Telemedicine was used for 73 of the sick or injured children. For another 85 patients, local doctors consulted with a specialist over the phone. For the remaining 76 kids, they did not ask for help.

Local doctors gave 72 percent of all children at least one medication while they were in the ER, according to the findings published in Pediatrics.

Among cases when doctors used telemedicine, they gave children a total of 146 medications. Five of those were the wrong drug for the child’s condition or were administered incorrectly.

In comparison, there were 18 errors out of 167 medications given to children when doctors consulted a specialist over the phone. And there were 16 errors out of the 128 drugs administered when there was no consultation.

“The amount of information that you can gather in a telemedicine consultation is typically much richer than what you can gather from a telephone conversation,” Dr. Alejandro J. Lopez-Magallon said.

“Also, the level of interaction with the remote care team widens because you’re not talking with a single person on the other side – you can interact with the remote physician or physicians and nursing staff, support staff and the patient and family themselves,” he told Reuters Health.

Lopez-Magallon studies telemedicine at the Children’s Hospital of Pittsburgh of UPMC but wasn’t involved in the new study. He said it “supports, in this case, the use of this technology to improve patient care.”

The researchers could not tell whether fewer medication errors meant sick and injured children fared better in the end. They also didn’t know if doctors administered the drugs before or after conferencing or calling a specialist.

Although this is one example of telemedicine, the researchers said it is more often used during outpatient visits – such as to connect with a specialist from a remote primary care doctor’s office.

“Telemedicine is becoming more and more mainstream, compared to what it was a decade back,” Dr. Madan Dharmar, the new study’s lead author, told Reuters Health. He is also from the UC Davis Children’s Hospital.

Marcin said in his team’s experience, telemedicine consultations cost about $2,000 each, including the price of the equipment.

But if the consultations can save a couple of emergency helicopter transfers to a larger hospital, they will more than pay for themselves, the researchers said. They are currently working on those cost analyses.

21 Nov 2013

ObamaCare will create healthcare jobs

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Article by Ira E. Shapiro, The Hill blog, November 14, 2013

Despite the negative attention Obamacare has had recently, Obamacare will also help create many new jobs in the healthcare arena in our country due to the shortage of coders in the healthcare industry.

Under Obamacare, roughly 40 million new patients will enter our healthcare system and that will create the need to code hundreds of millions of new charts each year. Under ICD-10 productivity estimates, a coder will take half an hour to code an average outpatient chart and an hour on average to code an inpatient chart. Think of the millions of new coders and billers that will have to be hired within the healthcare industry over the next 5 years. This will make medical coding one of the fastest growing professions in the country.

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problem, a list maintained by the World Health Organization.

Secondly, the new medical coding requirements under ICD-10 are much more specific and requires more in-depth knowledge from a medical coder, such as subject matter expertise in medical terminology, anatomy, physiology, pharmacology, and pathophysiology. This paradigm shift in the elevation of a medical coder’s importance to the revenue cycle of a healthcare facility and level of expertise required, along with an aging medical coding population is causing a significant shortage of coders and billers in healthcare.

Furthermore, it is expected that productivity will drop by at least 50 percent for coders and billers in the new world of ICD-10, as it happened in the other countries as they transitioned into ICD-10. The increased workload may even have a more severe impact on productivity here in the U.S. because our ICD-10 is different and more rigorous as we will code for reimbursement, different from other countries that are single payer systems. Even under ICD-9 today, which is less complex, there is a severe shortage of coders and this will be magnified by ICD-10.

The Affordable Care Act has helped create a great opportunity for many people who need to work remotely because of its flexible nature and many can work from home. An example would be wounded warriors, the unemployed, returning veterans and spouses, single parents, high school graduates who don’t want to go on to a degree program, all whom are great candidates for a career in medical coding. Even other existing healthcare professionals and clinical people who are interested in a more administrative role would be interested in this career. It will pay very well, as it is predicted that a new medical coder in ICD-10 with no experience will command between $45k and 60k on average. No college degree required.

The biggest challenge from ICD-10 will be the vacuum created by the huge shortage of talent. Medical Coders, clinical documentation specialists, and other health IT professionals will all be in great demand. Intended or unintended, we have the Department of Health and Human Services and the Obama administration to thank for all these new job possibilities in healthcare.Despite the negative attention Obamacare has had recently, Obamacare will also help create many new jobs in the healthcare arena in our country due to the shortage of coders in the healthcare industry.

Under Obamacare, roughly 40 million new patients will enter our healthcare system and that will create the need to code hundreds of millions of new charts each year. Under ICD-10 productivity estimates, a coder will take half an hour to code an average outpatient chart and an hour on average to code an inpatient chart. Think of the millions of new coders and billers that will have to be hired within the healthcare industry over the next 5 years. This will make medical coding one of the fastest growing professions in the country.

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problem, a list maintained by the World Health Organization.

Secondly, the new medical coding requirements under ICD-10 are much more specific and requires more in-depth knowledge from a medical coder, such as subject matter expertise in medical terminology, anatomy, physiology, pharmacology, and pathophysiology. This paradigm shift in the elevation of a medical coder’s importance to the revenue cycle of a healthcare facility and level of expertise required, along with an aging medical coding population is causing a significant shortage of coders and billers in healthcare.

Furthermore, it is expected that productivity will drop by at least 50 percent for coders and billers in the new world of ICD-10, as it happened in the other countries as they transitioned into ICD-10. The increased workload may even have a more severe impact on productivity here in the U.S. because our ICD-10 is different and more rigorous as we will code for reimbursement, different from other countries that are single payer systems. Even under ICD-9 today, which is less complex, there is a severe shortage of coders and this will be magnified by ICD-10.

The Affordable Care Act has helped create a great opportunity for many people who need to work remotely because of its flexible nature and many can work from home. An example would be wounded warriors, the unemployed, returning veterans and spouses, single parents, high school graduates who don’t want to go on to a degree program, all whom are great candidates for a career in medical coding. Even other existing healthcare professionals and clinical people who are interested in a more administrative role would be interested in this career. It will pay very well, as it is predicted that a new medical coder in ICD-10 with no experience will command between $45k and 60k on average. No college degree required.

The biggest challenge from ICD-10 will be the vacuum created by the huge shortage of talent. Medical Coders, clinical documentation specialists, and other health IT professionals will all be in great demand. Intended or unintended, we have the Department of Health and Human Services and the Obama administration to thank for all these new job possibilities in healthcare.

14 Nov 2013

EHR Interoperability Remains Elusive

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John Commins, Senior editor, HealthLeaders Media, November 8, 2013

A lack of standards, privacy concerns, and proprietary and competition issues are just a few of the hurdles hampering the interoperability of EHR data among participants in health information exchanges.

Healthcare providers have made solid progress over the last decade building in-house electronic health records systems to share patient data within their networks. However, interoperability with outside providers and payers remains a significant barrier, according to eHealth Initiative’s 10th annual survey of health information exchanges.

Three-quarters of the nearly 200 eHI survey respondents said they’ve had to build numerous time-consuming and expensive interfaces between different systems to facilitate information sharing, including 68 organizations that said they had to build 10 or more interfaces with different systems. More than 140 respondents cited interoperability as a pressing concern.

Jennifer Covich Bordenick, CEO of the nonprofit, independent eHI, says the results of the survey are “mixed,” but adds that it would be a mistake to say that no progress is being made.

“If you look back five years you can see huge leaps in progress, but when you are looking year-to-year it is very slow. It is hard to look at these things in such a small period of time,” she says. “The type of problems we are having now is a sign of moving in the right direction. These issues wouldn’t have arisen five years ago because we didn’t have enough knowledge or we weren’t connected enough. Now we’re having connection issues, which is a good thing, whereas before we were just trying to convince people that they should do this.”

Bordenick says the hurdles in front of interoperability aren’t necessarily technical.

“There are proprietary and competition issues where people don’t want to share data with other organizations,” she says. “While we are all focused on the patient there are a lot of concerns that competitors are going to use their data to their advantage. So competition is one barrier and the other is standards.”

“We talk about standards all the time,” she says, “but really requiring standards on some of these simple areas would be helpful because right now you have a lot of systems that are proprietary. You have vendors who don’t necessarily want to interface with their competitors. So you have competition both with the groups with data, and completion just with connecting. There are all kinds of different politics involved here.”

To her surprise, Bordenick says the survey also shows that many HIEs have not yet developed ways to allow patients to enter or view their own data in the health exchanges. As part of the federal EHR Meaningful Use Program, patient engagement is a critical step for providers looking to receive incentive payments for using EHRs.

This could change in future years, as 102 organizations reported that they have plans to offer patients access to their data. However, only 31 organizations currently offer patients access to their information. Even simple patient engagement services, like tools for managing appointments or prescriptions, are rare Bordenick says.

“I would love to know what people in the field think about this,” she says. “It’s not clear why it’s not moving. Is it because somebody else is doing it? Are the exchanges relying on providers, the individual doctors? Somebody has to be doing it. So, is it that we don’t know who is doing it or is it that they’re not doing it because of privacy concerns?”

“While it’s a little disheartening to see such low patient engagement, overall I think we’re in a better place than we were last year. Awareness around healthcare reform has helped build the business case for data sharing and engaging consumers.”

Bordenick rejects suggestions that the federal government step in to play a greater role in setting interoperability standards. “The last four years have shown us that HITECH has done some wonderful things and Meaningful Use has pushed the envelope, but it has to come from the market,” she says.

“The more that customers or consumers or providers [push] for these connections, the more likely it is that vendors are going to do it because we have the capability to do it. Again, it is not about not having the capability. It’s about everyone having the same desire to connect.”

07 Nov 2013

3 in 4 Patients Want E-mail Consultations with Doctors

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From Health Leaders Media article by Ryan Chiavetta, November 1, 2013

Research reveals a large discrepancy between how parents say they would like to communicate with pediatricians and how they actually do communicate with doctors. Three quarters (77%) of parents said they would seek out email advice from their doctors, but only 6% said that they are actually able to communicate with their doctors this way, a study released by the C.S. Mott Children’s Hospital National Poll on Children’s Health has found.

How physicians practices are accommodating the growing patient demand for e-mail consultations involves settling on a reimbursement strategy that makes financial sense and resolving questions about patient privacy concerns.

The study highlights the providers’ concerns which revolve chiefly around how they will be paid for providing e-mail consultation services. Specific financial concerns noted are the variable nature of reimbursement for e-mail consultations, rather than the established ones for office visits, and the costs of implementing privacy and security systems for the communication exchanges.

A Time-Intensive Task
Matthew M. Davis, MD, MAPP, one of the authors of the study, said that providers consider carefully whether and how it is appropriate to charge patients for electronic availability due to the time it takes to review information and respond to an e-mail, rather than the instant access coming from a telephone call.

“When I receive an e-mail from a patient, I have to consider that patient’s relevant past history and recent history of illness, diagnostic options and what’s the best course of action,” said Davis. “That’s not a simple thing to manage in all or even most circumstances. So that’s where I think physicians are starting to think that having some expectation of payment for an e-mail consultation would be reasonable.”

How much patients are willing to pay for the service, may not meet physicians’ expectations. Half of the parents surveyed (49%) said they believed a co-pay for an email consultation should be less than a co-pay from an office visit and nearly half said e-mail consultations should be a free service.

Healthcare providers, however, are finding ways to work around these cost issues. Davis notes two ways that providers are working around the co-pay obstacle. One is a bill-as-you-go system that focuses on the provider tracking the e-mail exchanges and billing accordingly. The method hasn’t proven to be popular, as it is already difficult to bill for telephone consultations, and billing per e-mail might cause patients to be hesitant to contact or follow up with providers.

A much more successful method is to charge a fee for e-mail services that comes as a package, Davis says.

“Let’s just charge a general service fee to make certain that patients who want to have this service can buy it essentially as a bundled package, and just go ahead and use it if they have that particular service… That allows them to use the service as they need to whenever they need to, and pay a set flat rate accordingly.”

One provider that has already started using this approach is Group Health Cooperative, a non-profit healthcare system based in Seattle, WA, which currently runs a successful e-mail consultation service, covered by a fee included in the patients’ premium.

Matt Handley, MD, Associate Medical Director of Quality & Informatics at Group Health Cooperative is one of the group’s many physicians who uses e-mail to communicate with his patients. He says the this payment structure enables GHC to maintain financial feasibility.

A Cost Cutter
Since in-person visits carrying a higher cost than e-mail consultations, Handley says the organization has been able to trim practice costs.

Davis also views e-mail as a cost cutter for medical practices, mainly because it allows doctors to focus on their most complex patients who need to visit the office in order to be properly treated. “We need the patients who have the more minor complaints taking care of themselves or using other modes of care that may not necessarily involve us,” Davis said.

“A patient who may have cold symptoms should probably stay at home and use simple home remedies and not necessarily come in for a visit that day. If an e-mail note about those cold symptoms can help a doctor or a nurse tell a patient ‘you don’t need to come in today,’ that appointment slot is still open for that patient who may have a worsening of their heart disease or diabetes that day.”

E-mail in Boutique Practices
Traditional health systems aren’t the only ones using e-mail consultations. Choice Physicians is a concierge medicine practice that utilizes electronic messaging. Tiffany Sizemore-Ruiz, D.O., one of the co-founders of the practice, says that an e-mail consultation fee is built into the $1,500 retainer fee patients pay when they sign up.

Choice Physicians has a much smaller patient base than traditional physicians practices, so adding the service in the retainer fee is the only payment needed to finance the service.

“This is a 500−600 patient practice,” said Sizemore-Ruiz. “So if you do the math, and you take the $1,500 and multiply it by 500 patients, that $750,000 a year. I don’t need an extra $15−$20 to do an e-mail consultation.”

Sizemore-Ruiz says she is available for her patients 24/7, and with her smaller patient base at its current size, is able to answer all the e-mails that come her way.

For a larger practice such as Group Health Cooperative, it’s a team effort to keep up with patient e-mails. Increased workload was cited as an initial concern, but at GHC in Seattle, everyone has to come together to make sure all the patient inquiries are met, with the bulk falling to the primary physicians.

“A percent are answered by other members of the team, usually around a quarter to a third, and that’s things like ‘when did I last have my tetanus shot?’ But two-thirds to three quarters are answered by their doctor,” said Handley.

Privacy Matters
Privacy is another element that is vital to the e-mail consultation process, and it’s an area of concern that Davis, Sizemore-Ruiz and Handley all take seriously in their practices.

“We actually share their whole health record online with them so they can see their immunizations, medications, [and] make appointments online,” said Handley. “It’s much more secure than a paper chart. We do that in a compliant way that meets all the industry standards for privacy.”

“There are HIPAA-compliant e-mail companies that you can use and you can also password protect the e-mail and the patient also has a password,” said Sizemore-Ruiz. “Also in our particular electronic medical records system, we can send e-mails through our EMR, which is HIPAA-compliant.”

Patient demand for email consultations is clearly growing, but how quickly remains to be seen.

“I don’t know how quickly this will move,” said Davis. “There is such high patient expectation and demand that I think the opportunity is there for physician practices and health plans to try to sort this out sooner rather than later and capture the appeal of this particular way of interacting with physicians that patients are obviously seeking.”