Christina's Considerations

Tablets in Healthcare

The July/August issue of Government Health IT had an article about tablets making their way into healthcare workplaces and it suggests that we respond by harnessing these assets - cautiously. The article highlights the first tablet app cleared by the FDA allows physicians using the device to view medical images and make diagnoses based on computer tomography, magnetic resonance imaging and nuclear medicine technology, such as positron emission tomography.  It has safety features that mitigate the risk of poor image display due to improper screen luminance or lighting conditions.

The recent proposed guidance on Mobile Health Apps issued by the FDA is likely to result in new applications and approvals. So, we can expect to see more and more of approved smartphone and tablet apps -- and increasing numbers of physicians and other clinicians who want to apply them to their patient care practices.

Effective leaders will explore the availability of these new technologies in their healthcare organization's environment (and ecosystem) to identify any risks.  But, they will also determine whether the risks can be managed -- allowing patients and providers to realize the value and benefits offered by application of the new technology.  

I've collected a few ideas on minimizing the potential risk and invite you to share your suggestions, as well.  Effective healthcare leaders will explore mobile security and mitigation considerations including:

• Balance usability, preferences, security, & budgetary concerns
• Register personal devices used in workplace by those with a legitimate business use
• Adopt written terms of use with employees and contractors using personal devices in their work:
  • Agree to report if lost or stolen
  • Agree to allow remote erase
  • Agree to use in accordance Policies
  • Require Device Access Password
  • Require that No Patient Data be Stored on the device!!
• Central reconciliation of device usage (billing, monitoring, etc.)
• Capabilities for disabling or wiping devices clean (loss or theft)
• Remotely lock devices or change passwords
• Remotely configure/deploy applications globally (rather than one device at a time
• Flexible security configurations – settings changed on an individual basis from a central management dashboard
• Built-in encryption of all communication streams to prevent data leakage during configuration and deployment processed
• Only permit password protected thumb drives and check-out or account for all with any PHI

 

Childhood Obesity: It's Everyone's Business

The National Business Group on Heatlh has released a new toolkit, Childhood Obesity: It's Everyone's Business.  It was prepared in response to employer interest in today's realities:

• Nearly one third of children are overweight or obese.
  • Two thirds of children and teens do not meet daily exercise guidelines, and 10% do not participate in any physical activity at all.
  • 80% fail to meet daily fruit and vegetable consumption guidelines.
• An obese teenager has a 70% chance of becoming an obese adult. And with obesity-associated health care costs for employers currently running to at least $45 billion annually, the price tag of this childhood epidemic could become unaffordable if changes are not made.
• Employer activities and programming for children that can serve as models and the infrastructure and resources that can be leveraged.

These tools should be especially valued by any employers who are also healthcare providers. 

  Unfortunately, the state-wide rates speak for themselves!

 

Health Information Technology Online Seminar

I've been quite impressed by the  American College of Healthcare Executives interest in health information technology over the last few years and their desire to spark the imagination of healthcare leaders.  It was especially exciting to see us evolve to talking about creating a 6-week online seminar on the subject of Health Information Technology. 

The best thing about this seminar on IT stuff is that the course instructor and participants are all healthcare leaders who share their varied perspectives and experiences during the weekly discussions. We explore the disruptors, strategy, risks, emerging issues and review the interconnected nature of the technologies.  The six weekly topics brokend down into:

Week 1:  Introduction, Stats, Disruptors

Week 2:  Electronic Health Records

Week 3:  Health Information Exchange

Week 4:  Telehealth, Telemedicine, Remote Monitoring, Education/Mentoring

Week 5:  Social Media and Mobile Health

Week 6:  What the Future Holds for Healthcare!

I've really enjoyed the process of pulling this course together and thinking through what participants wanted and needed to know.  We are just finishing up our trial run through the program and will start the next session on October 12.  If you think you might like to join us visit the ACHE site for registration information.

1135 Waivers and Hospital Evacuation

I completed two evacuation tabletop exercises this month and also have started the review process of our plan template.  At the same time I learned about a great educational resource from FEMA & the American College of Emergency Physicians for administrators, anyone with a HICS leadership position and hospital emergency planners. Hospital Evacuation:  Principles and Practices 

This presentation reminded me of a recent hospital evacuation (Joplin, MO) that included a 1135 Waiver, which is important as an organization begins to consider recovery and re-entry.  

What is a 1135 Waiver?  

When a disaster or emergency is declared, the HHS Secretary may temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled.  In the case of Joplin, MO, the 1135 waiver allows Freeman Health System to temporarily expand their number of beds in the community to accomodate patient demand until the St. John's Medical Center can be re-built.  The result is that between the three Freeman hospitals in the area, 147-beds will be added to accommodate patient demand in the community.

 

 

Data Breach Due to Poor Business Associate Safeguards

Here is a great example of why hospitals need to assess/test the data/information safeguards of their business associates.  In this case 300,000 individuals had their health information and SS#'s freely available on a provider business associate's website.

As a consumer, it is also a good example of why you should periodically search your name and each of your children to see what is out there on the Internet.  This could have easily been found by a hospital's patient, as I noted in my data breach article.

Hospital Marketing: Are you ready for the patient experience?

Social media in healthcare is evolving and finding its way into operational and clinical tools and this has been where much of my focus has been lately.  However, I do want to check-in with where healthcare social media got it's start and a recent survey of hospital marketers will help us with this.

Some interesting survey results were released not long ago and I want to share the link to the report and highlight a couple of things.  By 2013, hospital marketers predict:

• that traditional and digital marketing channels will flip-flop in terms of importance (in their strategy).  This is in part due to to the expectation that they step outside of their traditional roles and improve customer experience on other platforms.
• digital marketing will move from a "tag-along" afterthought role (to traditional marketing) to the lead role.

This interest in patient experience is in part a result of CMS' Value Based Purchasing, which places a portion of reimbursement at risk and ties 70% to quality and 30% to patient expereince (HCAHPS scores.)  Hospital marketers have always had both internal and external customers and strategies, but their new role affecting the patient experience will take them into a new dimension.

Another indicator of the role and importance of patient experience is meaningful use and the criteria:

• Fully engaging patients & their families in their healthcare
• Patient messaging in their preferred communication medium (multi-channel)
• Self-management tools for patients with high priority health conditions
• Report experience of care measures online & upload and incorporate patient generated data into EHR & clinician workflow
• Longitudinal Health – capture data for upload to EHR/PHR

My advice to hospital marketers?  Focus on using social media to help patients:

• with a new diagnosis or condition – medical emergency, chronic illness, pregnancy, etc.
• navigate behavioral changes – weight loss, smoking cessation, recovery from addictions, exercise, taking medications…
• peer-to-peer connections – support
• communications with providers
• caregiver education and support
• data collection and remote monitoring
• transitions in care (environments)

 

 

HIMSS HIE Toolkit

The HIMSS HIE Workgroup is getting started on developing some new tools for the HIMSS HIE Toolkit and I thought I should remind my readers about this resource.  Last year a technical architecture checklist and master provider index tools were created.  Access to some of the items is limited to members, but there are others available to the public.

We are picking topics this next week, so I'll add them once they are selected.  Check out the list of tools and let me know if you think anything is missing.

 

VA Encourages Employee Use of Social Media

The VA has gotten it right with their June 28th directive and policy on use of social media.  It is so perfect, especially the last line, I've quoted it below.

The Department of Veterans Affairs (VA) endorses the secure use of Web-based collaboration and social media tools to enhance communication, stakeholder outreach collaboration, and information exchange; streamline processes; and foster productivity improvements. Use of these tools supports VA and VA’s goal of achieving an interoperable, net-centric environment by improving employee effectiveness through seamless access to information. Web-based collaboration tools enable widely dispersed facilities and VA personnel to more effectively collaborate and share information—which can result in better productivity, higher efficiency, and foster innovation. This Directive establishes policy on the proper use of these tools, consistent with applicable laws, regulations, and policies.

Today's VA customers (including hospital and clinic patients) are different and they have new expectations for communications.  It is obvious that the VA has been listening and is prepared to implement needed technologies to facilitate effective engagement and communications as their customers prefer.

 

Three Steps Towards Adopting EHRs

I'm a featured blogger of Healthworks Collective and they recently invited me to write a guest post putting EHRs into perspective for their readers. The article defines the landscape, addresses a couple of real challenges related to privacy and security and describes the role of social media.

I think my readers will also like the results and hope you enjoy your visit to the Healthworks Collective Community.

Top Social Media Voice for the HIT Industry

For the last couple of days I've been getting a lot of new Twitter followers and their profiles seem to demonstrate a common interest in EHRs and HIE.  So I've been wondering... where are they learning about me?  

Well, I may have figured it out.  Health Data Management (one of the magazines I use to keep on top of industry issues) has a slideshow of the top social media voices for the HIT industry.  So, I'm quite thrilled to find out I'm included as # 15!  I known some of my fellow top tweeters as fellow bloggers since 2005ish, so I know I'm in great company!

Wow!  

Louisiana State Medical Society: Healthcare and Disaster Planning

I just learned about a resource on disaster planning for healthcare, a project of the Louisiana State Medical Society, and want to share it with my readers.  I've only quickly reviewed the 122-pages, but notice it has some great pictures to give readers a real perspective on the issues discussed.  I also noticed one chapter includes a section on leadership and organization effectiveness (one of my favorite topics), so I can wait to read this one.

Here in Santa Barbara County we continue to work on our hospital and public health preparedness and I look forward to learning from and incorporating Louisiana's lessons learned.

Connecting Healthcare IT and Disaster Planning

Mind the Gap is a blog post I wrote specifically for my friends at Health IT Exchange.  I love to combine multiple interests and this one connects my hospital disaster planning and preparedness work with my interest in health information technology.

I'm thinking I might also want to draft the forms I referenced in the article.  Let me know if this would be of value.  Also, stay tuned for an Health IT Exchange chat about this subject.

Hospital Reporting of Surgical-Site Infection Rates

California hospitals are required to report surgical-site infection rates for 26 procedures to the CDC, and ultimately the public.  Beginning January 2012 the following information will be available on the CDPH website.  

Information regarding the incidence rate of deep or organ space surgical site infections, orthopedic, cardiac, and gastrointestinal surgical procedures designated as clean and clean-contaminated, acquired at each health facility in California, including information on the number of inpatient days

Hospitals need to prepare for the response of the public and also expect that this information will find its way into reimbursement decisions and the assignment of penalties for high rates.

Hospital-acquired infections do lead to higher costs and poorer patient outcomes.  In this case, prevention truly is the best medicine for both patients and hospitals.

Healthcare Emergency Codes and Information Technology

I'm not really sure what is happening, but I seem to have had a surge in emergency and disaster posts.  I also just submitted an article that will be published soon on disaster planning for information services and technology departments.

Today I'm sharing a resource that I often wondered about when I worked in my hospitals. Healthcare Emergency Codes:  A Guide for  Code Standardization is an effort to standardize codes across hospitals so that there is consistency given that our staff usually move across facilities.  In healthcare and disasters, standardization is wonderful whenever possible.  The standard codes for hospitals are:

RED for fire Š

BLUE for adult medical emergency Š

WHITE for pediatric medical emergency Š

PINK for infant abduction Š

PURPLE for child abduction Š

YELLOW for bomb threat Š

GRAY for a combative person Š

SILVER for a person with a weapon and/or hostage situation Š

ORANGE for a hazardous material spill/release Š

GREEN Patient Elopement

TRIAGE INTERNAL for ALERT internal disaster  Š

TRIAGE EXTERNAL for ALERT external disaster

Many hospitals are also starting to call codes for bed capacity to speed patient flow and avoid the need for diversion.  At some point, we may see an attempt to standardize this one.

Information technology is increasingly becoming a critical tool to business and clinical functions.  So, having just written the HIT disaster paper, I'm wondering if there should be some sort of information code.  For example, if malware or a virus is identified should a code be called to alert users to not use a particular system or to be cautious of suspicious emails.  In the past I would receive an email, but how many did I open before I got to that one.

Since I'm not a techie, I'm wondering what my techie readers think.  Can you see an information technology event that would warrant alerting electronic information users by calling a code?  Lets think and post this through and see what we can come up with together.

Integrating Social Media into Emergency-Preparedness Efforts

The NEJM includes an article that addresses the integration of social media in emergency preparedness efforts from the perspective of physicians.  I appreciate the examples they share and agree with the authors.  Key issues include:

• The effectiveness of our public health emergency system relies on routine attention to ppreparedness, agility in responding to daily stresses and catastrophes, and the resilience that promotes rapid recovery. Social media can influence each of these component efforts.
• Medical providers do need communities who are prepared for their role in a response and integrating social media into local activities could help build social capital and community resilience.
• GPS software used in some social media (Four Square) can facilitate "check in" and reporting of conditions in the individual's immediate surroundings. 
• Social media cannot and should not supersede current approaches to disaster management communication or replace public health infrastructures, but if leveraged strategically, they can be used to bolster current systems
• Social media might well enhance our systems of communication, thereby substantially increasing our ability to prepare for, respond to, and recover from events that threaten the public's health.

Patient Families and Social Media

This article has some wonderful stories about how social media has helped support families with communications after a family illness or injury.  Hospitals, take note of how social media is of value to patients, their families and friends!

Lunch & Learns featuring the HIT Workforce Curriculum

DocNotes posted on his first impression of the HIT Workforce Curriculum and I realized I had covered this in my HIT course for ACHE, but not posted on it here.

The ONC has released its HIT Workforce Curriculum, which is a set of 20 components and available to the public at no cost.  This is the same curriculum being used to train HIT workers with stimulus funding.

If I were a hospital administrator today, I'd make sure my staff were aware that this resource exists and maybe even use some of the components for a few "lunch and learn" sessions with staff.  I think it would be a good investment of free lunch for clinical and ancillary employees. Oh, and the docs, too!