The Three Pillars of EHR. Part One: E

E is for Electronic.

Electronic Health Record systems have three strengths, all of which are built right in to the name. Electronic systems have faultless memories which can be backed up, retrieved at will and sent around the world in a split second. There is no other method that can compare to this level of utility.

Data held in paper-based systems is inherently subject to fire, flood, loss, and of course human error. Electronic systems have advantages which neatly sidestep these problems.

Setting the EHR Record Straight

A recent article in what shall remain an unnamed national newspaper linked the introduction of electronic health record (EHR) systems with heightened risks of medical errors, with consequences up to and including patient fatalities. The article cited the truly tragic case of a diabetic being incorrectly given multiple doses of Insulin, leading to hypoglycemia, and death. Lawyers for the estate of the deceased argue that there was a medication mistake. We will avoid that subject here. Suffice to say only this: Computers are annoying. They can be difficult, uncommunicative, and frustrating to use. Sometimes they crash, need to be rebooted, or totally replaced. They can in fact be just plain ornery. But do you know the one thing they don't do? Make mistakes.

IBM and Apple partner on Enterprise mobile platform

In a simultaneous press release from the Cupertino headquarters of Apple and the Armonk home of IBM, the two tech giant companies announced ‘an exclusive partnership that teams the market-leading strengths of each company to transform enterprise mobility through a new class of business apps-bringing IBM’s big data and analytics capabilities to iPhone and iPad’.

The collaboration is aimed squarely at Enterprise level organizations and will reach across industry sectors as diverse as retail, healthcare, banking, travel and transportation, telecommunications and insurance. The ultimate goal is to develop a secure, stable, massively scalable industry-standard mobile framework, a platform on which app developers and organizations can build to take mobile data, including mHealth, to whole new levels of both functionality and security.

BHDE Consortium Report Released

The Behavioral Health Data Exchange (BHDE) consortium falls under the umbrella of the ONC and comprises representatives from the states of Florida, Michigan, Kentucky, Alabama, New Mexico, Nebraska and Iowa.

The intent and aim of the BHDE Consortium is to facilitate effective information exchange between the participants across state lines and thereby overcome legal and technical barriers to the exchange of behavioral health data between health care providers and other stakeholder organizations.

The challenge is harder, as Behavioral Health practitioners and facilities are constrained by and held to higher degrees of accountability and responsibility than other fields of medicine, often exceeding the legal obligations of HIPAA. One such example is the requirement for adherence to 42 CFR Part 2, which limits the disclosure of identifiable information by a federally assisted substance abuse program to any entity, even for treatment, without signed consent from the patient to authorize the disclosure, with limited exceptions. Re-disclosure by the receiving party of such data, for any purpose, is restricted without similar consent.

Medical Data at Greater Risk Than Ever, Say FBI 

An April 2014 notification from the FBI Cyber Division to private industry warns of increased threats to medical data sources such as medical facilities, EHR's, HIE's, and interconnected business systems.

The FBI notification advises that the January 2015 EHR transition deadline will "...create an influx of new EHR coupled with more medical devices being connected to the Internet, generating a rich new environment for cyber-criminals to exploit". In other words, this will be the year that hackers turn to medicine.

Document PIN #: 140408-009, titled "(U) Health Care Systems and Medical Devices at Risk for Increased Cyber Intrusions for Financial Gain" warns of potentially dire consequences of poor security and advises constant vigilance in the upcoming year.

EHR: A Bright Future

Paper workflows for medicine are being replaced. Few doctors carry paper folders around with them anymore. In January 2015 medical records should all be electronic, by law. Where will this path end?

A recent article by Janet Woodcock, M.D. and Director of the FDA Center for Drug Evaluation and Research, discusses the increasing amount of medical data being shared over the Internet between increasingly large organizations. Woodcock rightly foresees a time when this data will be aggregated and used to develop new treatments, or new drug therapies. Many private organizations and Big Pharma are already developing their own strategies along these lines, for profit. The idea is not new. The technology which will allow this to happen, though? Ah well. That is.

With improved interoperability, more HIE's, centralized health plans, higher data input rates and growing EHR adoption, the volume of data available is growing exponentially. All this medical data is being linked, shared, collate, sifted and analyzed, faster and more accurately every day between increasing numbers of stakeholders. We live in exciting times. The challenge will be in storing it and, beyond that, making sense of it. And then, what?

EHR Incentive Program Adoption Rates Continue to Drop

The CMS has released a report detailing the active registrations for the Medicare and Medicaid incentive programs, from inception in 2011 right up to April 2014. The numbers have dropped steadily year over year, with roughly 25% of active registrants in 2013, compared to those of 2011.

The report is potentially misleading, due solely to the layout of the report, which uses a standard tabular format to display the information. The first three rows of the table give registrations for Medicare / Medicaid Eligible Professionals and Eligible Hospitals as totals for the year 2011, 2012 and 2013. The next four rows give the same info, but by month of 2014, January through April.

A casual glance down the columns would indicate a much larger drop in registrations in 2014, whereas this is not actually the case.

And The Winner Is…

Congratulations go to Jamie, of the Gateway Foundation in Hondo, TX! Jamie nominated colleague Ivy for our "Reward A Colleague" contest, in which the winner passes their prize on to the person they nominated.

Jamie's selfless act wins for her nominee Ivy a Dell Venue 11 Windows 8 Tablet! Jamie's nomination was full of praise for Ivy and said in part that Ivy is “the most selfless person I know and sacrifices things to make sure everyone else has what they need.” It went on to say that "She is caring, compassionate, and truly loves what she does."

This kind of praise defined the tone of the contest entries we received, which came in from around the USA and gave inspiration to everyone here at Sigmund. It confirmed what we already knew when we began this contest - that there are some exceptional people in the healthcare industry.

Mobile Health Grows alongside App Development

The growth of healthcare applications in the mobile arena has grown exponentially in recent months and is showing no sign of slowing.

Android, iOS and Blackberry are the three most common mobile platforms on tablets and smartphones, and as at the time of writing the Amazon Fire phone has recently launched it could be fairly argued that a fourth platform, the Amazon Store, has just entered the fray.

Zoning in to one specific player (only because I happen to already have the stats at my fingertips for this one), Apple has 31,597 apps in the Apple Store in the category they title Health and Fitness. Separately, the Medical category (devoted to apps with practical medical functionality) lists 24,797 apps. Between the two, that's 4.93% of the total number of apps in their whole store. Almost one in every twenty. Together, that makes 56,394 apps available for immediate download. And again, that's just one of four platforms.

EHR: Some Things Don't Change

I recently came across a 2005 study from Medical Economics magazine, which listed the top 50 reasons to go out and get an EHR.

It made very interesting reading. Although everyone today is familiar with Electronic Health Record systems, and many now use them daily, on reading through this document I came to the realization that not much has really changed in the last nine years. At least not in terms of what is to be gained from correct use of an EHR for practice, patient, or facility management.

In the technology news of today, emphasis is placed primarily on the perils and pitfalls of HIPAA, Meaningful Use attestation and ICD coding. Bad news sells newspapers, as they used to say. I would like to revisit that and flip it. I want to show the other side of the coin: That some things don't change. That what held true nine years ago still holds true today. Here we go.

The Sigmund Software 'Reward A Colleague' contest has now closed.

We received an unprecedented number of entries for this contest and we here at Sigmund want to thank every single one of you that shared with us your story of an inspirational colleague. Many stories reflected the raw dedication and sheer personal commitment of the behavioral health specialists nominated by you, their peers.

It will come as no surprise that all the nominees went above and beyond their own calls of duty, routinely spending personal hours, even evenings and weekends, helping their patients and their peers. They often do this with no thought of gain or reward, simply because they care. Counsellors, doctors, administration personnel and janitorial staff were all represented in the entries, showing once more that this section of the healthcare industry draws the best of the best across all vocations. 

A random draw will determine the lucky recipient of the Dell Venue 11 Windows 8 Pro tablet prize. Once we have that winner, we'll let you know.

The best thing about this contest is that the ultimate winner is not going to be someone that solicited any reward. Many do not even know they have been nominated. They seek neither glory, nor praise, nor power. They do what they do only to help others. And that is why we ran this drawing. This contest is a way we can all say to those that go those extra miles, 'We notice what you do. Thanks."

ONC Overhaul Will Not Lose Focus on Data Security

In January, Karen DeSalvo, M.D., was brought in to head up the Office of the National Coordinator (ONC.) Fast forward six months, and the ONC is downsizing. A lot.

Going from 17 departments to only 10, DeSalvo explains the adjustments as ‘pivoting for the future’. ONC is also reducing by one half their advisory workgroups, those which make recommendations on health IT policies and standards. Spearheading the HITECH act, the ONC, as part of the Department of Health and Human Services, is tasked with setting policies and standards for electronic health record and health information exchange security at a national level. HITECH act funding is already being phased out for many programs, and much of the early implementation work and heavy-lifting has been completed. With all the broad-strokes policies and standards now in place, it makes a lot of sense to redirect the ONC resources in preparation for new challenges.

Florida Battles Identity Theft Using Old-School Security

The Federal Trade Commission (FTC) reported in February 2014 that Florida has the dubious distinction of being the State with the highest reported rate of ID theft and medical fraud.

The majority of this is perpetrated online. Using social engineering and other techniques to gather data, criminals can pretend to be someone they are not – and get paid. To combat this, the Florida Department of Children and Families (DCF) has implemented a state wide program to use knowledge-based authentication on their web portal. In other words, they ask questions that only the real person is likely to know the answer to. Just like banks and other organizations did, way back before the Internet was born.

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