Christina's Considerations

Rural California Telehealth

This video comes to us from my friends at the California Telehealth Network and it focuses in on my interest in both rural and telemedicine.  It was also nice to see some familiar faces!  

But, please also notice the city view and think about how telemedicine can help us overcome the challenges in urban areas related to transportation and access to certain specialities.

 

SearchHealthIT Tips

A few weeks ago I was asked by SearchHealthIT to contribute some tips and I chose to focus in on leveraging portal technologies and recognizing some of the more subtle risks.  Links to both articles are below, but I'm also including some of the highlights here for those who ask for "Just the facts, Ma'am."

Enterprise portals improving patient engagement for meaningful use

1.  When patients and their family caregivers are not in front of providers (approximately 95% of the time)
2. Platform for the integration of disparate patient/consumer-facing information systems 
3. Scale to accommodate management of condition-specific or general populations
4. Personalize access to health records, education, self-management tools, social networking and support opportunities 
5. Support more transparent communication with patients and families about care transition and treatment processes.

Patient-facing information systems raise HIPAA concerns

1. Creating barriers to patient and family engagement
2. Lacking identification and assigned roles
3. Tagging sensitive data as "do not disclose"

If you can think of anything to add to either list, please leave your comment.

HIMSS Southern California Annual Health IT Conference

Soon I'll be heading back to the HIMSS Southern California  Annual Health IT Conference - April 10th in Los Angeles.  This is a special event for me because my presentations over the years have followed my expeditions across technologies:  RHIOs, Telehealth/Telemedicine, HIE, mHealth, Social Media

This year's theme is healthcare consumerism and I've been invited to participate in a panel to discuss

Social Media in Healthcare: Promoting Patient Empowerment and Engagement, Healthcare Value, and Patient Centered Care

My TOWER colleagues, Sue and Megan, will join a panel discussion on

PHRs and Patient Portals: Realizing Patient Empowerment and Personalized Healthcare

 Take a look at the entire agenda and register to join us at this event.  We hope to see you there!

Re-Engineering the Hospital Discharge and Reducing Readmissions

 Researchers at the Boston University Medical Center (BUMC) developed and tested Re-Engineered Discharge (RED); which has proven to be effective at reducing readmissions and posthospital emergency department (ED) visits.  The AHRQ and BUMC have levereged this research and developed a RED toolkit to assist hospitals, particularly those that serve diverse populations.  The major tools are:

Tool 1: Overview

Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital

Tool 3: How To Deliver the Re-Engineered Discharge at Your Hospital

Tool 4: How To Deliver the Re-Engineered Discharge to Diverse Populations

Tool 5: How To Conduct a Postdischarge Followup Phone Call

Tool 6: How To Monitor RED Implementation and Outcomes

If your wondering, this is the same program responsible for Louise, my favorite virtual discharge advocate.  She can be more effictive than a real person because she:

1. Relies minimally on text
2. Enhances recall
3. Provides redundant channels of information
4. Listeners pay attention to gestures
5. is more flexible and effective than a videotaped lecture
6. Individualizes consistent messages - every time
7. Cost effective - less need for clinician time
8. Easy-to-use
9. Has no time limit
10. Can assess competency and understanding
11. Can adapt to address issues of race, gender, ethnicity
12. Enhances learning

 To experience Louise, click here Download Medications and think about using a tablet.

Future of Information-Driven Healthcare Think Tank

 

I'm fortunate to have been invited to participate in a think tank hosted by Dell with some healthcare social media icons.  On Tuesday follow the live stream of the event on the widget below or on Twitter use the hashtag #DoMoreHIT.  You won't want to miss the first session from 10:30 to 11:15 am on the subject of empowering caregivers and consumers.

Other participants include:

• my old blogger buddies @ShahidNShah, @boltyboy and @techguy @ehrandhit.  
• newer social friends @ahier and @HealthcareWen
• new connections @DrAndyLitt, @norabelcher, @jloveloc, @2healthguru, @lsaldanamd and @egpierro - all of whom I look forward to getting to know.

 

 

     

Update:

The products created from this event include:

• Dell Services Storify Recap
• Full Video Sessions – Dell-Livestream Event Page
• Photos of Sessions 1-3 – Dell Flickr Page
• Dell Services Facebook Photo Album – Session Topic 1
• Dell Services Facebook Photo Album – Session Topic 2
• Dell Services Facebook Photo Album – Session Topic 3
• Dell Services Facebook Photo Album – #DoMoreHIT Graphic Illustrations

 

Changes to HIPAA Impacting Healthcare Covered Entities & Business Associates

The 600ish pages of the HIPAA Final Omnibus Rule (published in January) affects nearly every aspect of patient privacy and data security and encompases the:

• HIPAA Privacy, Security and Enforcement Rules
• Breach Notification Rule
• HITECH Act
• Genetic Information Discrimination Act

idExperts boiled down the new rule in a new whitepaper and includes their recommendations for managing the risks. The most significant clarification is that patients now have the right to get electronic copies of all of their electronic medical records upon request.  In addition, new categories of PHI may be used or disclosed for fundraising for better targeted efforts.

Covered entities will be required to change their notice of privacy practices to reflect these new rulings.  They should also:

• Conduct and document annual privacy and security risk assessments (the HVA of Emergency Management)
• Identify, manage and document compliance of business associates and their downstream contractors
• Define and document your method for the security incident risk assessments; determining whether an incident is a breach or not.
• Document your policies and processes for complying with the limiting of access to patient information when a patient can restrict access.
• Encrypt PHI according to NIST specifications  to take advantage of the safe-harbor provision regarding notifications in the event of a breach.

Keep in mind, the compliance deadline is September 23rd and it will be here before you know it.

Digital Access and Patient Experience

FierceHealthIT reported on a study that finds 70% of consumers would be open to a virtual doctor visit.   Another key finding is that almost 50% of consumers and 66% of providers  would be comfortable sharing and receiving health information through social media

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Transitional Care Management: Non-Face-To-Face Reimbursement

Originally posted at TOWER's Latest Thinking

As of January 1, 2013, the Medicare Physician Fee Schedule includes reimbursement for transitional care management (TCM) services from the hospital to the community setting.  The two relevant codes are 99495 and 99496 and apply to physicians and other qualified non-physician professionals.  The goal of this investment is to generate savings from a reduction in the number of re-admissions.

While this new approach to reimbursing for care is truly welcome, the inclusion of non-face-to-face care management services is an opportunity to leverage enterprise portals and social technologies to facilitate these processes.  The following services are required be provided unless they have been determined to not be medically necessary:

Performed by a qualified professional:  obtain and review discharge information; review need for, or follow-up on, pending diagnostic tests and treatments; interact with other providers involved in patient’s care; educate patient, family, guardian, and/or caregiver; arrange for needed community resources.

Performed by clinical staff or case manager under direction of qualified professional:   communicate with home health agencies and other community services utilized by patient; educate patient and/or family/caretaker regarding self-management, independent living, and activities of daily living; assess and support treatment regimen adherence and medication management; identify available community and health resources; facilitate access to necessary care and services.

Now is the time for innovative providers to develop new processes and create strategies for leveraging technologies to support delivery of these important and reimbursable services.

For a detailed summary of the billing requirements for TCM, visit the PYA Healthcare Blog and the CMS FAQs.

Since this reimbursement fits with my current work in the post-treatment phase of the continuum of care, I'll discuss question that arise from this change with CMS officials and share what I learn here.

Diabetes: An Alarming Epidemic

From time to time, I'll syndicate my posts on the Tower Strategies blog.  The post below is really rich in data that will speak to effective healthcare leaders.

The February issue of H&HN has a great article that frames the issue of diabetes.  It also makes the case for innovative applications of technology to improve the health of the rapidly growing number diabetics.  Drivers for changing how the health delivery system responds include:

• 26 million Americans have diabetes and the number will soar to approximately half of all Americans by 2020
• Diabetes is responsible for $116 billion in direct medical and $58 billion in indirect costs annually
• Diabetics are at higher risk of heart disease, stroke and high blood pressure than the general populations
• Diabetics can be overwhelmed by the complexity of managing the disease – measuring their blood sugar, changing their diets, watching their weight, and taking insulin or other medications
• Diabetics’ LOS are typically one or two days longer than those of the general inpatient population
• Diabetics are more likely to be readmitted within 30 days of discharge than the general inpatient population
• Demand for diabetes management and outpatient care will increase sharply in coming years
• The demand for care already overwhelms the supply of physicians - 3000 endocrinologists and 150 new ones each year

Many hospitals are developing diabetes centers and management programs that involve teams of physicians, nurses, dietitians, pharmacists and diabetes educators.  But, there is a tremendous opportunity to also leverage technology to help enable diabetic patients and their care teams to exchange data easily, as well as, extending access to professionals for patient questions.

Technologies can facilitate the transmission of patient generated data – blood glucose readings directly from their glucose meters – along with blood pressure, weight, vital signs, caloric intake and exercise – to electronic health records.  In addition, these tools can also present data in an organized and understandable manner so patients and providers can see patterns.  They can also generate alerts to team members when pre-set triggers are reached, necessitating an intervention. And, social media can also facilitate support networks to help patients learn how to live with diabetes without always having to contact their physician.

All it takes to get started is to have a vision and cross-discipline support.  Then the work of creating a strategy and roadmap to guide the implementation process can begin.

 

 

Recommendations for Healthier Organizations in 2013: Data Security

It’s time for some New Year’s resolutions; and they have nothing to do with eating right, losing weight or exercising.  Instead, they have everything to do with protecting against the organizational and financial stresses of data breaches—which have become an everyday disaster.

As noted in a post last month, the Third Annual Benchmark Study on Patient Privacy & Data Security, reports that data breaches in healthcare are growing; insider negligence is the root cause; and mobile devices pose threats to patients’ protected health information (PHI). Despite the fact that 94 percent of healthcare organizations surveyed suffered data breaches, data breaches don’t have to be disastrous if organizations take steps to operationalize pre-breach and post-breach processes to better protect patient data and minimize breach impact.

The results of this survey have lead to a few of us bing invited to share our recommendations for a healthier organization in 2013 and beyond:

1. Establish mobile device and Bring Your Own Device (BYOD) policies that include technical controls and employee and management procedures.

Rick Kam, CIPP/US, president and co-founder, ID Experts

2.  Control the cloud or it'll control you. Make it a point to fully understand what cloud service-level agreements mean in practice and then push for meaningful information on failover and disaster recovery practices used.”

Richard Santalesa, senior counsel, InfoLawGroup LLP

3.  Have a current breach response plan that is ready and tested. This will help pave the way for a well-executed response that can mitigate the financial, legal and reputational harm caused by a security incident involving patient information.

Marcy Wilder, partner and director of global privacy and information management practice, Hogan Lovellis

 4.  Conduct small but focused risk assessments rotating control review on a monthly basis to continually understand and measure risk. Most importantly, have a plan to address the risk, through remediation, mitigation or risk transfer activities.

Chad Boeckmann, president and chief strategy officer, Secure Digital Solutions, LLC

5.     Immunize mobile devices against viruses that might steal patient data.

Dr. Larry Ponemon, chairman and founder, Ponemon Institute

 6.       Attack your leadership team with phishing and other social engineering campaigns. Nothing raises awareness like catching people and correcting them on the spot—and it's a lot more interesting than the annual 30-minute online security training.

Michael Boyd, Director of Information Security Management, Providence Health & Service

7.     Use a checklist to evaluate periodically whether covered entities and business associates are in compliance with all privacy and security requirements. Sign and date the checklist to show that your organization is not guilty of "willful neglect" in complying with privacy and security laws.

Jim Pyles, founding partner, Powers, Pyles, Sutter & Verville, P.C.

 8.      Educate all staff to recognize applications, mobile devices and medical equipment that collect, contain or transmit patient information and/or biometric data; and train them to communicate the risk to those responsible for information security management.  

Christina Thielst, FACHE, Vice President, Tower

 9.     Decide how to handle the residual risk of a data breach, how much risk to accept, and how much, if any, risk to transfer through cyber insurance.

Christine Marciano, President, Cyber Data Risk Managers LLC

 10.Boards should ensure their organizations have robust, board-reviewed and approved security policies and procedures.

Larry W. Walker, president, The Walker Company

 11.   "Big data" is a source of both the disease and the cure for privacy and information security symptoms. Currently, we have to deal with data minimization, but in the future, look for applications that may collect broadly, but protect against unauthorized disclosure or misuse very, very well.

Jon Neiditz, partner, Nelson Mullins Riley & Scarborough LLP 

 Rick Kam, president and co-founder of ID Expertis isn't a physician, but he believes  “patient information is at risk for infection” and “organizations need to make a commitment to a healthier organization from top to bottom, otherwise a common cold data breach will turn into tuberculosis.”  I have to agree and in some respects it is just another HAI - hospital acquired infection.

Also, one more recommendation is in order.... be careful with #6.  It could lead to a bit of personal risk -- otherwise known as a CLM or "career limiting move".

Emerging Technologies and the Revenue Cycle Across the Care Continuum

Late last year, I presented on social media at the annual AAHAM conference .  I was also invited to submit an article for their Journal of Healthcare Administrative Management and chose to explore opportunities to leverage a variety of emerging technologies for improved revenue cycle processes across the entire care continuum.

In the article, I review the role of social media, mobile, remote monitoring and portals and list some specific opportunities for healthcare organizations.  Read the article and leave a comment if you can think of anything I've forgotten or haven't yet envisioned!

 

State by State Telemedicine Licensure

The Federation of State Medical Boards has produced an overview of telemedicine licensure across the US.  Highlights include:

• Ten (10) state boards issue a special purpose license, telemedicine license or certificate, or license to practice medicine across state lines to allow for the practice of telemedicine.
• Fifty-seven (57) state boards plus the DC Board of Medicine require that physicians engaging in telemedicine are licensed in the state in which the patient is located.
• Minnesota allows physicians to practice telemedicine if they are registered to practice telemedicine or are registered to practice across state lines.
• Fifteen (15) states currently require private insurance companies to cover telemedicine services to the same extent as face-to-face consultations.
• Massachusetts permits coverage for services provided through telemedicine as long as the deductible, copayment or coinsurance doesn’t exceed the deductible, copayment or coinsurance applicable to an in-person consultation. 

I had created a document outlining licensure across the northwest, but it is even better to have something covering the variations across all states.  Licensure that extends across state lines and private insurance coverage are huge issues, especially as we look forward to a new health delivery system, so I'm really happy to see increasing attention by state medical boards.

Knowledge Capital in the Digital Society: Information-Based Value Creation

I finished reading Peter Waegemann's book on knowledge capital in the digital society not long ago and wanted to share a few key take-aways.  

• the need to learn by memorizing is now replaced by the need to thrive in the digital world... to be creative, to research to connect the dots and to manage information and knowledge.

•  
  • Digital intelligence will mean the ability to smartly navigate the immense world of knowledge and information, not trying to memorize it.

• today... the smartest child is the one who can navigate information resources and connect the dots -- that is the one who understands the meaning and context of information.

•  
  • the new challenge concerns how one 
    • acquires knowledge, 
    • manages information, 
    • distinguishes useful from trivial, 
    • separates truth from spin, 
    • navigates information resources and 
    • identifies belief systems according to established values 
    • while remaining open to alternatives and 
    • how one continues to improve knowledge over a lifetime.

• Advertising is moving from printed media to digital product targeting

• Information fields such as medicine, law, engineering, and even language translation may ultimately be mapped like geography, using software to guide people accordingly

• predictive text, indexing and semantic software, that within seconds, can extract relevant subject matter out of millions of pages will help us manage the wealth of information

This is a book that makes you think and reflect back to look at the future! It is especially relevant to healthcare leaders, human resource professionals ... and parents!

3rd Annual Benchmark Study on Patient Privacy & Healthcare Data Security

The Third Annual Benchmark Study on Patient Privacy & Data Security by Ponemon Institute and ID Experts, has been released and reports that healthcare organizations face a huge challenge in stopping data breaches. 

• 94% of healthcare organizations surveyed suffered at least one data breach
• 45% of organizations experienced more than five data breaches during the past two years
• Astonishingly,  69% off organizations still have not secure medical devices—such as mammogram imaging and insulin pumps (IT and Biomed have to talk!)
• The cost to the industry could average $7 billion annually. 
  

Most organizations surveyed say they have insufficient resources to prevent and detect data breaches, but consider the alternatives.  Patients are at increased risk for medical identity theft and their PHI and privacy could be violated as mobile and cloud technology becomes pervasive.

Change is needed and recommendations include:

1. Operationalize pre-breach and post-breach processes, including incident assessment and incident response processes
2. Restructure the information security function to report directly to the board to symbolize commitment to data privacy and security
3. Conduct combined privacy and security compliance assessments annually
4. Update policies and procedures to include mobile devices and cloud
5. Ensure the Incident Response Plan (IRP) covers business associates, partners, cyber insurance

If you like visuals, check out the infographic.  If you are into details, read the entire report and consider:

• Information breached is largely medical files and billing and insurance records. According to the research, 54% of organizations have little or no confidence that they can detect all patient data loss or theft. Based on the experience of the 80 healthcare organizations participating in this research, the resulting cost to the U.S. healthcare industry could be $6.87 billion, up from 2011. The average impact of a data breach is $1.2 million per organization.

• The causes of data breach cited were loss of equipment (46%), employee errors (42%), third-party snafu (42%), criminal attack (33 %), and technology glitches (31%). Cases of medical identity theft occurred at 52% of the organizations, and it lead to inaccuracies in the patient’s medical record (39%) and/or affected the patient’s medical treatment (26%).

• Mobile devices in the workplace pose threats to patients’ PHI.  Employees are permitted to use their own mobile devices—commonly called Bring Your Own Device (BYOD)—often to access organization data (81%), yet organizations are not confident that these personally owned mobile devices are secure (54%). Hospitals surveyed are using cloud-based services (91%) to store patient records, patient billing information, and financial information, but 47% percent lack confidence in the data security of the cloud.

• This past year, 36% of healthcare organizations made improvements in their privacy and security programs, in response to the threat of audits conducted by the U.S. Department of Health and Human Services Office for Civil Rights. While 48% of organizations are now conducing security risk assessments, only 16% are conducting privacy risk assessments. Organizations still have insufficient resources to prevent and detect data breaches (73%) and/or don’t have controls to prevent and/or quickly detect medical identity theft (67%).

Now that I have an headache, I think I'll stop here.

Hospitals: Take down those walls!

A new article in HealthcareITNews highlights the hospitals of the future and their need to become more virtual.  I love the five key design elements for hospitals of the future -- without walls:

1. The ability to design a digital profile of each individual  -  i.e. healthcare CRM
2. The ability to see and engage virtually via high-definition video, anytime, anywhere and on any device
3. The ability to create centers of collaboration excellence both inside and outside of our communities
4. The ability to access massive amounts of data without putting it in one container
5. The ability to leverage social media as a care coordination platform, not merely a collaboration platform 

I, like Ash Shehata, have envisioned this and am so happy to see I'm not alone.

Health Information Technology for Healthcare Leaders

For the last two years I've been presenting a six-week online seminar exploring health information technologies for the American College of Healthcare Executives. This followed an invitation from them to write a column on technology for the 2007 issues of Journal of Healthcare Management and their willingness to publish my book on social media in 2010.

My journey into health information technology began in 2004 and at one time a blogger buddy referred to me as the "RHIO queen."  Given my passion for hospital leadership and administration I still think it is funny that I developed expertise in this area and a title. However, back in 2004 I could see the importance of healthcare leaders understanding technology applications and was a bit frustrated that some of my peers weren't willing to learn.  

I worked hard to catch up and keep up with my own learning, knocked on a few doors and maintained some patience.  Today, I'm so pleased to see that healthcare leaders have taken a much more active role in developing their own understanding of the technologies and the importance of implementing the right tool for the right purpose and right auidence.  More and more, they also recognize the importance of having a clear strategy and clean workflows before any applying technology tools.

Healthcare leaders play a crucial role and their decisions can instantly impact the spark of innovation and success of an implementation.  That is why it is so important that they develop at least a baseline understanding of the technologies, risks and rewards.

Today we start the second six week seminar of 2012 and I look forward to working with a new group of healthcare leaders to envision innovative applications in their organizations for the benefit of our patients!

There is still time to register, so consider joining us!  For more information Click Here!

Age of the Healthcare Consumer

A recent Harris Poll had some great data, but one point struck me as particularily funny.  Well, it really isn't funny, but it is ironic.  The data point is that of 84% of Americans who visited a doctor's office within the past year, nearly half (47%) reported being very satisfied with their last medical visit.  What is funny (ok, ironic) is that it is the same rate as consumers who were very satisfied with their last car purchase.

Really??  Are our patients just as satisfied with their last medical visit as they are with car purchases? Of all the data that I see, this by far has to be one that starts us over the tipping point.  At least I hope so!

Other findings of particular interest to me were:

• Online access to medical records is available to 17% of patients
• 32% of patients consider online access to medical records as very important and 33% see it as important; however, it is not available to these consumers.
• Email access to doctors -- 12% of patients have it; 23% consider it very important and 30% consider it important
• Online appointment setting -- 11% have it, 21% consider it very important, 30% feel it is important
• Online billing and payments -- 10% have it, 21% consider it very important and 29% feel it is important
• Online cost estimator -- 6% have been offered this service and just over three of five patients are without the services, but describe it as either very important (26%) or important (36%)

What do you think?  Is this really ironic?  Or is it funny, or perhaps even sad?

Health IT Promotion - for Patients and Families

The Office of National Coordinator released a video to help promote health IT.  It is the newest resource on their patients and families page.  

Engaging patients and families in their healthcare is also about educating them on the changes in the delivery system, technology and resouces and I like that their outreach includes social media.

Tower's Latest Thinking

I'm starting to post on the Tower Strategies blog about patient engagement, their experience and leveraging emerging technologies.  My first posts are on:

Best Care at Lower Cost: Continuously Learning Health Care

The Truth About Patient Engagement

Patient Experience – The #1 Priority Among Health Leaders in 2012

Please visit the site to see all of our posts, but know I'll also include a few here on this blog.  The one I've set for Monday is on what patients want... online access to data!

First EHRs... Now Social Engagement of Patients

West County Health Centers, a Northern California private, non-profit health organization, has deployed what may be the nation’s first social platform designed to engage patients in their own healthcare. The Health Center has rolled out a private, cloud-based social healthcare platform, within its patient population. Extending care and patient engagement outside provider visits is proven to improve healthcare outcomes and reduce costs. 

The platform, WellFX, is a private, secure, HIPAA compliant social platform for providers to deploy in their patient, staff and agency communities.  Because it is provider directed, both patient and provider have confidence in the efficacy of the information, education and motivation being given.  Providers can create managed and unmanaged communities for patients to meet and share experiences while accessing provider created education and healthcare content.  It works to provide complete patient confidentiality, anonymity and data protection. 

The social platform deployed at West County Health Centers will create an extension of the health center by connecting patients with one another, augmented by educational content that is germane to their condition, ensuring that patients are connected with the right people and the right information at the right time. The success of the initiative will be measured in the short term by patient adoption and feedback, in the mid-term by the level of patient activity on the platform, and in the long term on measurable healthcare outcomes such as improved hemoglobin levels in diabetes patients, and reduced recidivism in addiction patients.   It will also be deployed in staff-only community groups where staff can participate and share best practices and success stories across teams and agencies.

“Engaging and motivating patients to change behaviors that result in improved healthcare outcomes is the holy grail of primary care,” said Dr. Jason Cunningham, Agency Medical Director at West County Health Centers. “It is a brutal truth that primary care doesn’t do behavioral change well.   It demands that we think and act differently; and we need new tools and technology to make this happen.  The potential we see in WellFX is enormous – it is a tool to effect profound change whereby the provider can act as both educator and facilitator of improved patient behaviors beyond the boundaries of the healthcare visit.”

West County Health Centers was one of the first community health centers in Northern California to deploy Electronic Health Records.  Now it is trail-blazing by using an innovative social platform to disrupt the status quo of patient engagement.  By getting patients to engage with each other outside of on-site visits they are setting the stage for achieving better outcomes for patients.

Meaningful Use Stage 2 Comparison: Infographic

This morning in my Tweetdeck inbox I received this infographic from the tweeps a healthPOINT at Dakota State University. I like to see my health IT friends using social media for more engaging education.

Meaningful Use: Transforming Patient Engagement

This morning sent out a press release for Tower and also want to also share it with my blogosphere readers.  As always, I'm interested in your thoughts and hope you will consider leaving a comment. (PDF Version of Press Release)

The Office of the National Coordinator for Health IT (ONC) and The Centers for Medicare & Medicaid Services (CMS) has released the long awaited final requirements for State 2 Electronic Health Records Incentive programs.  Included in the rules is an emphasis on patient engagement.

 New rules specific to patient engagement include:

•  The “provide patients with an electronic copy of their health information” objective is being replaced with an “electronic/online access” core objective.
•  A new core objective for eligible providers is “use secure electronic messaging to communicate with patients on relevant health information“
•  CMS proposed two new core objectives related to patient engagement with measures that require patients to take specific actions in order for a provider to achieve meaningful use and receive an EHR incentive payment.  For both, the threshold was lowered from the proposed 10% of patients to 5% in the final rule.  CMS also recognizes broadband availability limitations in some provider practice areas and introduced an exclusion.
•  Patient and Family Engagement is one of the six key health care policy domains of which all providers must selection at least three for clinical quality measures (CQM) and reporting.  These are the CQMs that reflect the potential to improve patient-centered care and the quality of care delivered to patients. They emphasize the importance of collecting patient-reported data and the ability to impact care at the individual patient level as well as the population level through greater involvement of patients and families in decision making, self care, activation, and understanding of their health condition and its effective management.
•  More than 50% of all unique patients seen by the eligible provider are provided timely (within 4 business days) online access to their health information.  More than 50% of all patients who are discharged from the inpatient or emergency department of an eligible hospital or Critical Access Hospital have their information available online within 36 hours of discharge.

The ONC final rule complements the newly released CMS final rule and reflects their commitment to promote patient engagement and safety.

 As hospitals and other providers prepare to comply, they must first acknowledge that this isn’t just an issue for their IT departments to address.  Instead, attaining meaningful use of one’s electronic health records/systems for patient engagement will require the collective involvement and collaboration of disciplines from across the organization… clinical, operations, information services and communications/marketing.

“Healthcare leaders will need to be strategic and put every decision in the context of the patient experience.  Having an effective patient strategy will lead to happy customers, staff and a healthcare organization exceeding their business objectives” said Dr. Sue Sutton, CEO at Tower, a patient experience consulting group based in Los Angeles, California.

The approach required is one of re-defining patient engagement across all touchpoints, both physical and virtual, to positively transform the patient’s experience – as perceived by the patient. “The research tells us where the patients are going, but institutions aren’t paying attention. If the approach taken doesn’t actually engage patients, the organization won’t meet the meaningful use criteria and they may actually lose some patients to healthcare providers who have implemented more patient-centered engagement strategies“, added Dr. Sutton.

Enterprise portals can facilitate electronic access by making information within existing systems available in a more patient-friendly manner.  The portal helps accomplish the goal of compliance with the MU criteria, but it does so at the same time it can accommodate additional features and personalization for enhanced engagement and a better patient experience.  Ultimately, this is what will lead to improved outcomes – the ultimate goal of meaningful use.  

CMS will audit healthcare providers who are participating in the meaningful use program and will focus in on those who show substantial noncompliance.  For detailed information, see

 CMS Final Rule Regulations                   ONC Final Rule Regulations

CMS Final Rule Fact Sheet                    ONC Standards and Certification Final Rule Fact Sheet

Getting Personal: My patient experience - #3

When I moved to town several years ago, I needed to select a new physician.  My brother-in-law was the CEO of a local clinic, so I thought I'd choose one of his physicians.  I called, was first asked a series of questions and then given an appointment to meet one of the physicians several weeks later.  The many questions focused on my demographics and insurance.

After a couple of weeks I found that I needed to change the appointment and called to get a new one. Unfortunately, when I called they did not have any record of an appointment for me with the doctor at the time and on the date originally specified.  In addition, they had no record of all of the information I had provided during the initial call. 

So, what did I do?  I politely explained that I believed it would be a huge mistake for me to see one of the clinic physicians.  I explained that this situation had given me a poor first impression and that I didn't want to risk repeating this again.  I hung up and called a physician in private practice... whom I still see today.  

Now, if I could just get her onto secure messaging!!!!  :)

 

Getting Personal: My patient experience - #2

Fast forward several years and now I'm going through "the change" that effects us aging women.  For the last couple of years I've had to keep track of my cycle and report any variations outside of a specific range. My physician is great and I trust her, but even though we are close in age, she is a bit behind the times.

She has given me a card (for which she had to have printed) for me to making my recordings and turn in at my annual visit.  I keep it on my desk and given my recent travel schedule it has gotten harder to keep up with where I am in the cycle. But, a couple of weeks ago I suspected while traveling that I might need to make a call and when I returned, found out I indeed needed to place a call to my doctors office. I did and she returned my call and left a message.  

The result is that we played phone tag because she doesn't accept email and doesn't have secure messaging.  This is one ideal situation where secure messaging, would help facilitate more timely patient/physician communications and for me a WOW patient experience.  Instead, I got tired of the phone tag.

In addition, it would have been great for her to recommend an app for me that could help facilitate more timely tracking and reporting of outliers.

This is an opportunity for improvement!  I suspect that things will be different when my daughters are my age.

10 Innovative Ways to Improve the Patient Experience

Catalyst surveyed 400 Baby Boomer patients and came up with a list of 10 DOs & DON'Ts  -- new ways for doctors and doctors' office staff to improve the patient experience. "While many practices are struggling to meet basic patient expectations, some are doing very well and want to go further in providing an exemplary patient experience," says Dan Prince, President of Catalyst Healthcare Research. "Ten of the ideas we tested in the study were in that spirit. We feel that innovators in healthcare will ultimately implement one or more of these ideas as a way of building stronger patient loyalty and differentiated brands." Here are a few...

DO... (% of respondents who said that this behavior would make their patient experience better)

• ...hand a patient a printed summary of their visit as they leave the office, including the diagnosis and recommended plan of action (88%)
• ...talk to a patient about changing their behavior rather than immediately prescribing a drug for their situation (86%)
• ...provide a patient with a reliable estimate of their charges for a specific surgical procedure that they need (82%)
• ...offer an app that allows a patient to log in securely to see their test results, send private messages to the doctor, etc. (66%)
• ...send a patient a text message about 30 minutes before their scheduled appointment to tell them if the doctor is running on schedule (64%)
• ...use a mobile device (smart phone or tablet) to look up information about a drug before telling a patient about it (60%)
• ...offer free WiFi so that a patient can connect to the Internet while they are waiting to see the doctor (35%)

DON'T... (% of respondents who said that this behavior would make their patient experience worse)

• ...spend most of your time typing on a computer, not making eye contact with a patient (84%)

• ...schedule a patient to see their doctor but then have a nurse practitioner visit with them (67%)

• ...avoid confronting or encouraging a patient to change their personal behaviors that are affecting their health (like smoking or obesity) (59%)

Baby Boomers were selected as the focus of this study because they represent a large and vocal segment of society. In addition, they are becoming heavy users of healthcare as they age, with 10,000 Baby Boomers becoming eligible for Medicare every day. "If we take this population's perspective seriously, doctors and practice staff have the opportunity to change their behaviors such that today's patient experience will be more in line with today's patient expectations," Prince adds.

Did you see emerging technologies on the list? OK, so I helped highlight them and you couldn't miss them.  Just keep in mind, boomers aren't yesterday's seniors-- they are a whole new breed and they have arrived!