Christina's Considerations

Modernizing Rural Health Care

Earlier this week, United Health's Center for Health Reform & Modernization released a working paper, titled Modernizing Rural Health Care.  It notes that in recent years, rural areas in the South and West are attracting both younger populations and new retirees - which isn't really a surprise to me.

The paper explores a broad set of issues and also presents new information on:

• empirical research on rural versus urban quality of care
• projections for rural Medicaid and insurance exchange 2014 coverage expansions
• state-by-state and county-level analysis of future pressure on primary care capacity
• models for rural care delivery and care coordination
• national consumer and primary care physician survey data

It also specifically addresses health information technology and telemedicine (Chapter 6).  If you are a healthcare leader and have any responsibilities for rural health, I think this is a paper you should read.

One word of caution....  As I look at the map on page 6, I notice that many of the California counties are in black meaning that they have urban populations.  However, many of these geographically large (compared to the counties in the east) do have vast rural and remote areas.  This means that some of the large population centers in western states may skew some of the findings, so please keep this in mind during your review.

Social Media and Telehealth

I'm really pleased to have been invited by Tom Brewer, Program Manager, and the Northwest Regional Telehealth Resource Center (NRTRC) to prepare a social media toolkit for telehealth professionals and networks.  In addition to a guide and telehealth-specific examples, it will include a template policy, guidelines, worksheet and checklist.

To lauch the release of the toolkit, I'll present on some of the highlights during an interactive web conference on August 18th.  Both Tom and I invite you to register if you have an interest in this specific area of social media applications.

Also, if your telehealth organization is using social media for outreach or to enhance your program and service offerings, please leave a comment on this post with a link to your example (s).

Stanford Team Ready to Mobilize for Disaster Relief

@StanfordHosp just tweeted the link to their YouTube video describing their role in Haiti disaster relief and preparedness for responding to future events.  For more information on SEMPER (Stanford Emergency Medicine Program for Emergency Response) call 650-736-7373. 

It is a great example of Stanford Hospital sharing their story on social media with the global community!

Disaster Planning: Water Supply

I'm starting to prepare for the statewide health and medical disaster exercise in November and want to share the CDC's Emergency Water Supply Planning Guide for Hospitals and Healthcare Facilities with my readers.  I look forward to reading it and will post more at a later date.

Book Sale: Social Media in Healthcare

I'm cleaning out my office today and organizing.  I just pulled 40 copies of my book Social Media in Healthcare: Connect Communicate Collaborate out of the box and put them on a shelf.
It got me thinking that I should have a book sale!  

So, copies of my book are available for the original price of $44 and that includes shipping.  You can submit the payment through my Tip Jar/PayPal or contact me at Christina@cthielst.com to make other arrangements.  

I've received wonderful feedback from readers and it is truly a book for healthcare leaders wanting to see my vision for social media in our field.

For those of you who are interested in HIEs and RHIOs, I still have six copies of the HIMSS Guide for Establishing a Regional Health Information Organization and I'll let you have one for the HIMSS member rate of $65 (including shipping).

Updated:  April 2012  I also have copies of the Winter 2011 issue of Frontiers of Health Services Management Journal, which is focused on social media.  The title of the issue is Connect with Social Media: Strategies for Healthcare Organizatons and it includes two feature articles and three commentaries by healthcare and social media leaders.  My article is focused on patient engagement with social media.

This one is $30 and you can submit the payment through my Tip Jar/PayPal or contact me at Christina@cthielst.com to make other arrangements.  Please be sure to include your mailing address with your order.

 

CMS Proposed Rule: Reimbursement for Telestroke and TeleICU

I posted the news about CMS' new proposed rule on the Telestroke Initiative site, but not here.    It could improve reimbursement of telestroke and teleICU because of the consideration of broader factors in determining what procedure codes are approved for telehealth provision . Please note that there is a 90 day comment period and hopefully the change will take place in January 2012.

For more read the CMS summary or the full proposed rule.

Social Media Best Practice: Hospital Evacuation

It has been a while since I highlighted one of the best practices from my book companion and I'm really surprised I didn't highlight this one sooner.  

This example comes to us from Children's Memorial Hospital Chicago and involves their use of a virtual world and avatars to facilitate emergency evacuation of the hospital.  Staff use this social media technology to train and exercise an evacuation scenario without any risk to actual patients.

It is truly a best practice and demonstrates, along with the discharge advocate, how social media are being applied to operational and clinical settings.

Ventura County Operation Medical Shelter

One of my former Ventura County co-workers and Public Health's lead for healthcare disaster response sent me a link to their YouTube Video from their recent exercise and training.  I'm glad he did, because I couldn't attend and I appreciate being able to see it for myself.

Connecting California to Improve Patient Care

I finally made it to Redwood MedNet Health Information Exchange Conference and share my learnings and thoughts below. I first learned about their activities when still working for the Santa Barbara County Care Data Exchange back in 2005.  It is great to see how far they have come!

Privacy

• Context is important when looking at privacy.  Each individual has a range of feelings toward privacy, so we need to demistify and look at type of data and from whom are we keeping it private.  Also, consider that our feelings toward privacy may change over time.
• Numbers are important - one paper chart vs. a disk with many.  Who will pay for security, currently an unfunded mandate in healthcare. 
• Need to start with transparancy and a rational conversation about privacy and defining it.

Security

• Security must align with business and not impact usability.
• Identity is soooooo important
• National Strategy for Trusted Identity in Cyberspace Paper - not just for healthcare 
  • Enabling services - need to add Identity Services
• Trust, but verify!
• Situational awareness - understand where threats exists
• Security - how much is enough?  - can we afford?
• HIE Security Architecture
• Reassessing Your Security Safeguards for small practices

Connecting CA to Achieve Meaningful Use

• Interstate Interoperability Workgroup and Western States Consortium - collaborating with neighbors
• CTN medical grade network architecture for disaster preparedness
• San Diego Beacon incorporating social media and mHealth in their project

HIE as a Community Care Platform

• More on longitudinal heatlh and presents a 360 degree view

All of the presentation slides are also available on the conference website

 

Social Media: Law and Risk

I recently came across two papers addressing social media risk and the law for healthcare organizations.  The first is from the HIPAA Collaborative of Wisconsin Security Networking Group and the second is from an attorney on the American Health Lawyers Association site, titled  "Triaging Social Media in the Healthcare Workplace:  Assessment, Analysis and Action.

Both documents present some great cautions, but I don't be afraid.  They can all be overcome!

Most Beautiful Hospitals

I went to San Diego this weekend and while there toured the USS Midway.  Of course, I couldn't resist a couple pictures of the ship's hospital.  Below you see the 20-bed unit with the two-bed ICU is in the room to the back-right.    The second picture is the OR.

Then, I saw the slideshow of the 20 most beautiful American hospitals.  I'm thinking the Midway Hospital didn't make the list, but that is ok.  I still think it is beautiful in its own way!

FDA Proposed Guidance on Mobile Health Apps

The FDA will release its proposed guidance on mobile health apps Wednesday with a 90 day comment period.  They propose overseeing those apps that: 

• Are used as an accessory to an FDA-regulated medical device. For example, an app could enable a health care professional to view medical images on an iPad and make a diagnosis;
• Transform a mobile platform into a regulated medical device. For example, an app that turns a smartphone into an electrocardiography, or ECG, machine to detect abnormal heart rhythms or determine if a patient is experiencing a heart attack.

@FDADeviceInfo will hold a twitter chat today at 3:00 pm using #FDAApps.

This news comes as I've learned about the work of mHealth Regulatory Coalition and their recent white paper on FDA regulation of mHealth.  Little did I know yesterday, that progress would come so quickly.

Disaster Planning HPP Grant

HHS released $352 million in grants for hospital to improve their disaster planning and response capabilities.  This is the grant that I work under with each of the hospitals and public health here in my own county.   We have accomplished a great deal over the last couple of years and continue to work hard to be prepared for all hazards.

To learn more about the Hospital Preparedness Program visit the HHS site.  If you think I can assist your HPP program, just let me know.

LSU Tigers in Print

The LSU Alumni Magazine included my book, Social Media in Healthcare:  Connect Communicate Collaborate in the Tigers in Print section of their Summer issue.  It might be cool for people who knew me when to see it and maybe I'll even get to reconnect with an old friend or two.

I loved my days at LSU!  Enough classes for a Communications Minor. The quite beauty (but not on football days) of the campus.  The warm and humid environment (really cold in the winter).  Being young and away from my family (a young girl's dream).  Off to Ft. Walton, FL for spring break, picking peaches in Clinton, LA and so many other new adventures!

It makes me smile! :)

Healthcare Unbound and Redwood MedNet

I'm attending two conferences next week.  The first is to speak on social media and join a panel at Healthcare Unbound in San Diego.  I'm really looking forward to it, because the audience will be non-traditional for me and I'm looking forward to hearing some new perspectives.  It will be a great place to talk about the new partnerships hospitals will have with other provider organizations.

The second is for fun and to support my friends on the Northern Coast of California at the Redwood MedNet HIE Conference.  This one takes me back to my technology roots and will give me a chance to see old friends and hear about new initiatives.

So, if you are in San Diego or Santa Rosa next week let me know and we can try to find each other.

Innovators and Quality of Care in CAHs

I'm having a really busy month, but just saw two documents I don't want to lose.  I hope you don't mind me just saying "hello" and leaving them here until I can breath again!

Innovators' Guide to Navigating Medicare

Quality of Care and Patient Outcomes in Critical Access Rural Hospitals

 

Red Tape and Telehealth for Cost Savings

I read my current issue of Modern Healthcare this weekend and saw a good idea for helping to cut down on the cost of some personal protective equipment (PPE) and the time needed to don and safely remove PPE when attending to a patient in isolation or with precautions.  The idea was to mark a red box outside of the door and for some communications and checks I can see this would be an effective strategy.

However, it also made me think (of course) of the power of video conferencing (telehealth) technologies that could be used to visualize and communicate with patients and avoiding the need to stand a certain distance and speak loudly into the patient's room.  (Can you imagine the hearing impaired patient?) I"ve seen very cool video phones and then there are the tablets that could be positioned near the patient for more discreet conversations where spread of infection or disease is a concern.

So, I don't have anything against the red tape.  It will really be useful for dietary checking to see if the patient is ready to have their tray picked up, or housekeeping asking if it is ok to enter and clean the room.  It might also be appropriate for the medical records or case management staff asking if they can come in to have papers signed or to discuss discharge plans.  Or even those pesky hospital administrator types that like to do rounds and check in on patients.  

Anyway, it isn't a bad idea.  I just think it opens up an opportunity to look at how video conferencing between the nurses station, key departments and, perhaps, even the patient's family.  Think about it and let me know how likely this could be in isolation rooms or those requiring PPE in the next three years.

New eHealth Initiative HIE Toolkit

eHI has released its new HIE toolkit.  I'd recommend reviewing the tools if you are establishing health information exchange within your system or across providers in the region.  

Also, I also still recommend the HIMSS Guide to Establishing a RHIO.  Much of the information is timeless and in a few areas you can really see just how far we have come since 2007.  

Critical Care in Disasters

I read the stories that came out of Joplin, MO after the tornado and evacuation of St. John's Hospital and then pulled out some of the lessons learned for a handout for some of my local disaster connections. Around the same time, I had been doing some thinking and talking about the value of preparing in advance and having an MOU for intensivist servicest via telemedine -- for those times when there is a surge (as occurred that evening at Freeman Memorial) or when physicians can't get into the hospital.

I'm still thinking and welcome your thoughts!