03 Sep 2014

Why GearTools – Security

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The GearTools software suite offers several security features that help keep sensitive information protected.  The dictation audio files and the resulting transcribed documents can be transferred between GearPlayer™, GearDictate™, and GearXport™ using encryption.  Dictations can be encrypted before being sent out from GearDictate™ or GearXport™ and GearPlayer™ can play these encrypted files importing the proper encryption key.  In addition, the GearPlayer™ software can then encrypt your typed transcription documents and send them back to the dictator.  When GearDictate™ or GearXport™ receives these typed documents back, they can then remove the encryption so the document can be opened.  All GearTools products also offer the capability to transmit files to an FTP site with an FTPS connection.  By utilizing GearTools throughout your entire workflow, it gives you the ability to add security to your entire dictation and transcription process.

28 Aug 2014

Heartbleed Bug – How Community Health Systems was hacked for 4.5 million Patients’ data

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Last week Community Health Systems (CHS), a hospital system containing a 206 hospital network, the second largest in the United States, announced that hackers stole data on 4.5 million patients. The hacker, who operated out of China gained access to names, Social Security numbers, physical addresses, birthdays, and telephone numbers of anyone who received treatment from a network-owned hospital within the last five years.

Fortunately, however, hackers did not gain access to information on patient’s credit card, medical, or clinical information. This theft is believed to have taken place sometime between April and June 2014.

This is not the first data breach this hospital system has experienced. Definitive Healthcare also reports that CHS has had data breaches in their facilities, Flowers Hospital and Lake Granbury Medical Center. The incident in Flowers Hospital, of Alabama involved an employee’s theft of 700 patients’ papers in an attempt for fraudulent tax returns, while the incident with Lake Granbury Medical Center, of Texas, involved a paper theft involving 502 individuals. These hacks occurred in 2013 and 2012 respectively.

For this most recent CHS attack, it is believed that hackers in China were using “highly sophisticated malware and technology” to attack the systems. The FBI said that the intruder sought “valuable intellectual property, such as medical device and equipment development data.”

As the situation is investigated further, reports from BBC News, among others, are now attributing the breach to the Heartbleed bug. If confirmed, this would be the biggest identified breach relating to this bug.

This situation is an important indicator of how we must continue to address security concerns. Keeping patient data and personal information both confidential and secure should be one of our health system’s top priorities.

26 Aug 2014

Stolen laptops lead to important HIPAA settlements (again)

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Two entities have paid the U.S. Department of Health and Human Services Office for Civil Rights (OCR) $1,975,220 collectively to resolve potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules.  These major enforcement actions underscore the significant risk to the security of patient information posed by unencrypted laptop computers and other mobile devices.

“Covered entities and business associates must understand that mobile device security is their obligation,” said Susan McAndrew, OCR’s deputy director of health information privacy. “Our message to these organizations is simple: encryption is your best defense against these incidents.”

OCR opened a compliance review of Concentra Health Services (Concentra) upon receiving a breach report that an unencrypted laptop was stolen from one of its facilities, the Springfield Missouri Physical Therapy Center.  OCR’s investigation revealed that Concentra had previously recognized in multiple risk analyses that a lack of encryption on its laptops, desktop computers, medical equipment, tablets and other devices containing electronic protected health information (ePHI) was a critical risk.  While steps were taken to begin encryption, Concentra’s efforts were incomplete and inconsistent over time leaving patient PHI vulnerable throughout the organization. OCR’s investigation further found Concentra had insufficient security management processes in place to safeguard patient information. Concentra has agreed to pay OCR $1,725,220 to settle potential violations and will adopt a corrective action plan to evidence their remediation of these findings.

OCR received a breach notice in February 2012 from QCA Health Plan, Inc. of Arkansas reporting that an unencrypted laptop computer containing the ePHI of 148 individuals was stolen from a workforce member’s car.  While QCA encrypted their devices following discovery of the breach, OCR’s investigation revealed that QCA failed to comply with multiple requirements of the HIPAA Privacy and Security Rules, beginning from the compliance date of the Security Rule in April 2005 and ending in June 2012.  QCA agreed to a $250,000 monetary settlement and is required to provide HHS with an updated risk analysis and corresponding risk management plan that includes specific security measures to reduce the risks to and vulnerabilities of its ePHI.  QCA is also required to retrain its workforce and document its ongoing compliance efforts.

OCR has six educational programs for health care providers on compliance with various aspects of the HIPAA Privacy and Security Rules.  Each of these programs is available with free Continuing Medical Education credits for physicians and Continuing Education credits for health care professionals, with one module focusing specifically on mobile device security:  http://www.hhs.gov/ocr/privacy/hipaa/understanding/training

The Resolution Agreements can be found on the OCR website at http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/stolenlaptops-agreements.html

To learn more about non-discrimination and health information privacy laws, your civil rights and privacy rights in health care and human service settings, and to find information on filing a complaint, visit HHS at www.HHS.gov/OCR

22 Aug 2014

Hospital systems supplementing revenue by selling technology

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By Mohana Ravindranath, The Washington Post

For MedStar Health, a system with hospitals in the Baltimore and Washington regions, health-care services are just one source of revenue.

During the past couple of years, MedStar has been experimenting with a new business model: developing and selling health technology to outside customers. In 2009, it launched the MedStar Institute for Innovation, a District-based office with about 25 employees. Many of them are engineers and software developers who build, and in some cases sell, technology concepts dreamed up by hospital staff members.

MedStar is part of a growing group of health-care systems investing in “innovation centers” — teams that develop nascent ideas into commercially viable products. Some, such as MedStar, use sales to supplement their overall revenue. Others, such as the University of California at San Francisco’s Center for Digital Health Innovation, aim eventually to fund themselves entirely from technology sales and royalties.

This industry-wide interest in selling technology for profit has been helped in part by the ubiquity of electronic medical records, Forrester Research health-care analyst Skip Snow said. These software systems let hospitals gather data about their own organizations, “driving [them] to say, ‘If we have all this data, we should mon­etize it,’ ” he said.

It’s not just data; hospitals also rely heavily on technology for many purposes. Last year, MedStar licensed the patent for a diaphragm-implant — designed by a MedStar physician to help patients breathe — to Beltsville, Md.-based technology company InnoVital Systems for further development. Among other applications, it is preparing to license an iPad app to guide patients with Bell’s palsy through facial rehabilitation exercises. MedStar also has a partnership with 1776, an accelerator-incubator in downtown Washington, in which MedStar physicians work with start-ups building health-care products.

“I think the theme is there’s a huge amount of intellectual and creative talent capital in these large health-care systems,” said MedStar Institute for Innovation director Mark Smith.

In 2006, for instance, MedStar sold software co-developed by Smith at its Georgetown University Hospital to Microsoft for a sum that wasn’t disclosed. The software, called Azyxxi, was a repository for patient clinical information as well as EKGs, scanned documents and other images. (Microsoft subsequently spun the product, renamed Amalga, into a joint health IT venture with General Electric called Caradigm.)

For MedStar, these technologies have not yet generated significant revenue. Since 2011, MedStar has partnered with Cleveland Clinic Innovations, a similar entre­pre­neur­ship hub within Cleveland Clinic health system, to navigate the patenting and commercialization process. (CCI has similar partnerships with several other health systems, such as ProMedica and North Shore-Long Island Jewish Medical Center, in which it provides such services for a fee. Since 2000, CCI has spun at least 67 companies out of software developed internally by hospital staffers and has raised nearly $1 billion in equity for these start-ups.)

Not all ideas emerging from MedStar’s innovation center gain traction outside the health system, Smith said, although he noted, “Even ideas that don’t have commercial value may have clinical value.”

For instance, a MedStar pharmacist developed a system for managing pharmacy inventory that MedStar uses internally today. “We actually tried to see if the big hospital pharmacies were interested. They weren’t.”

Still, he said, “it’s also huge value for the associate who gets to see the product of his or her creativity actually be used and make a difference.”

Employees who design technology are also entitled to a portion of financial returns.

At Cleveland Clinic, the opportunity to develop and sell technology is a draw for hospital staffers, according to Gary Fingerhut, CCI’s executive director. “We use it as a method of retaining and recruiting the caregivers.”

He added that hospital staffers sometimes identify technology needs that an outside company — one that does not spend all day interacting with patients — might miss. For instance, one of CCI’s spinoff companies, called iVHR, developed software that takes data from electronic health records and presents it visually, so physicians can assess patients more quickly. IVHR was developed by four physicians in the clinic who used the electronic health system every day and struggled with the way its software design caused it to present information.

In large health-care organizations, Fingerhut said, “it is critical that the technology fits within the work-flow of the environment that we’re in.”

21 Aug 2014

Have insurers found new ways to avoid the sick?

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Ending insurance discrimination against the sick was a central goal of the nation’s healthcare overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers.

The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there’s reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors.

With open enrollment for 2015 three months away, the Obama administration is being pressed to enforce the Affordable Care Act’s anti-discrimination provisions. Some regulations have been issued; others are pending after more than four years.

More than 300 patient advocacy groups recently wrote HHS Secretary Sylvia Mathews Burwell to complain about some insurer tactics that “are highly discriminatory against patients with chronic health conditions and may … violate the (law’s) nondiscrimination provisions.”

Among the groups were the AIDS Institute, the American Lung Association, Easter Seals, the Epilepsy Foundation, the Leukemia & Lymphoma Society, the National Alliance on Mental Illness, the National Kidney Foundation and United Cerebral Palsy. All supported the law.

Coverage of expensive drugs tops their concerns.

The advocates also say they are disappointed by how difficult it’s proved for consumers to get a full picture of plans sold on the new insurance exchanges. Digging is often required to learn crucial details such as drugs covered, exact copayments and which doctors and hospitals are in the network.

Washington state’s insurance commissioner, Mike Kreidler, said “there is no question” that discrimination is creeping back. “The question is whether we are catching it or not,” added Kreidler, a Democrat.

Kansas’ commissioner, Sandy Praeger, a Republican, said the jury is out on whether some insurers are back to shunning the sick. Nonetheless, Praeger said the administration needs to take a strong stand.

“They ought to make it very clear that if there is any kind of discrimination against people with chronic conditions, there will be enforcement action,” Praeger said. “The whole goal here was to use the private insurance market to create a system that provides health insurance for all Americans.”

The Obama administration turned down interview requests.

An HHS spokeswoman said the department is preparing a formal response to the advocates and stressed that today’s level of consumer protection is far superior to what existed before President Barack Obama’s law, when an insurance company could use any existing medical condition to deny coverage.

The law also takes away some of the motivation insurers have for chasing healthy patients. Those attracting a healthy population must pay into a pool that will reimburse plans with a higher share of patients with health problems. But that backstop is under attack from congressional Republicans as an insurer “bailout.”

Compounding the uncertainty is that Washington and the states now share responsibility for policing health plans sold to individuals.

Although the federal government is running insurance markets in 36 states, state regulators are still in charge of consumer protection. A few states refuse to enforce any aspect of the law.

Kreidler said the federal government should establish a basic level of protection that states can build on. “We’re kind of piecemealing it right now,” he said.

Much of the concern is about coverage for prescription drugs. Also worrisome are the narrow networks of hospitals and doctors that insurers are using to keep premiums down. Healthy people generally shop for lower premiums, while people with health problems look for access to specialists and the best hospitals.

Before Obama’s overhaul, insurance plans sold on the individual market could exclude prescription coverage. Now the debate is over what’s fair to charge patients.

Some plans are requiring patients to pay 30 percent or more for drugs that go for several thousand dollars a month. HIV drugs, certain cancer medications, and multiple sclerosis drugs are among them.

Although the law sets an overall annual limit on what patients are required to pay, the initial medication cost can be a shock.

California resident Charis Hill has ankylosing spondylitis, a painful, progressive form of spinal arthritis. To manage it, she relies on an expensive medication called Enbrel. When she tried to fill her prescription the pharmacy wanted $2,000, more than she could afford.

“Insurance companies are basically singling out certain conditions by placing some medications on high-cost tiers,” said Hill. That “is pretty blatant discrimination in my mind.”

Hill, a biking advocate from the Sacramento area, has been able to get her medication through the manufacturer’s patient assistance program.

The insurance industry trade group America’s Health Insurance Plans says there’s no discrimination because patients have many options on the insurance exchanges. Gold and platinum plans feature lower cost-sharing, but have higher premiums. Standard silver plans generally require patients to pay a greater share of medical bills, but some have fairly robust drug coverage.

“There are plans on the exchanges that are right for people who have these health conditions,” said Brendan Buck, a spokesman for the group.

For 2015, the administration says it will identify plans that require unusually high patient cost-sharing in states where Washington is running the exchange. Insurers may get an opportunity to make changes. Regulators will collect and analyze data on insurers’ networks.

“People who have high cost health conditions are still having a problem accessing care,” said law professor Timothy Jost of Washington and Lee University in Virginia. “We are in the early stages of trying to figure out what the problems are, and to what extent they are based on insurance company discrimination, or inherent in the structure of the program.”

19 Aug 2014

Lawsuit Filed After Doctor Lists Homosexuality as “Chronic Condition”

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A Los Angeles man is suing his doctor and a Southern California healthcare network, saying they ignored his request to remove a notation describing “homosexual behavior” as a “chronic problem” on his medical records.

Matthew Moore, 46, who is openly gay, said he was shocked to see his sexual orientation still described as a chronic condition more than a year after he complained about the use of the archaic medical classification.

“It was infuriating. It was painful,” he said of his decision to sue. “It was another attempt by this doctor and this medical group to impose their agenda of discrimination and hate onto a gay patient.”

As reported in September by NCB4, Moore discovered the description in his medical records after undergoing a routine physical in April 2013 by Dr. Elaine Jones of the Torrance Health Association.

The diagnosis was coded as 302.0, an archaic classification from The International Statistical Classification of Diseases and Related Health Problems (commonly known as the ICD). Code 302.0 “homosexual behavior” was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973.

Moore said when he confronted Jones in May 2013, she defended the description by saying that the medical community goes “back and forth” on whether or not homosexuality is considered a chronic condition.

Moore wrote a letter complaining about the designation to the Torrance Memorial Health Association and received a prompt apology:

“We would like to unequivocally state that the Torrance Memorial Physician Network does not view homosexuality as a disease or a chronic condition, and we do not endorse or approve of the use of Code 302.0 as a diagnosis for homosexuality,” Torrance Health Association Senior Director Heidi Assigal wrote to Moore.

The association also issued a media statement saying the designation had been used as a result of “human error” and claiming that “upon notification by the patient the record was corrected.”

Moore said he let the issue go, thinking the problem had been solved. But when he obtained a copy of his medical records in May, he said he was stunned to see that while the 302.0 code had been removed, “homosexual behavior” was still listed under “chronic problems.”

He said he later was given a second copy of his records on a CD, which did not contain the entry.

That prompted him to file suit in July against Dr. Jones, the Torrance Health Association Inc. and the related Torrance Memorial Physician Network, alleging intentional infliction of emotional distress and libel.

That suit also alleges that the defendants “engaged in a pattern of deceit and medical record doctoring in an attempt to establish that they had earlier removed and retracted the defamatory content, when in fact they had not removed and retracted the defamatory content until the latter part of May 2014.”

18 Aug 2014

Community Health Systems says personal data stolen in cyber attack

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(Reuters) – U.S. hospital operator Community Health Systems Inc said on Monday personal data, including patient names and addresses, of about 4.5 million people were stolen by hackers from its computer network, likely in April and June.

The company said the data, considered protected under the Health Insurance Portability and Accountability Act, included patient names, addresses, birth dates, telephone numbers and Social Security numbers. It did not include patient credit card or medical information, Community Health Systems said in a regulatory filing.

It said the security breach had affected about 4.5 million people who were referred for or received services from doctors affiliated with the hospital group in the last five years.

The FBI warned healthcare providers in April that their cybersecurity systems were lax compared to other sectors, making them vulnerable to hackers looking for details that could be used to access bank accounts or obtain prescriptions, Reuters previously reported.

The company said it and its security contractor, FireEye Inc unit Mandiant, believed the attackers originated from China. They did not provide further information about why they believed this was the case. They said they used malware and other technology to copy and transfer this data and information from its system.

Community Health, which is one of the largest hospital operators in the country with 206 hospitals in 29 states, said it was working with federal law enforcement authorities in connection with their investigation into the attack. It said federal authorities said these attacks are typically aimed at gathering intellectual property, such as medical device and equipment development data.

It said that prior to filing the regulatory document, it had eradicated the malware from its systems and finalised the implementation of remediation efforts. It is notifying patients and regulatory agencies as required by law, it said.

It also said it is insured against such losses and does not at this time expect a material adverse effect on financial results.

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.”


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.