Sigmund Software, LLC is part of the VSS Medical Group
A 27 page report from the Centers for Medicare and Medicaid Services (CMS) outlines the state of Health Information Exchange adoption and interoperability across the nation.
Data sources used to collate the report include reported Meaningful Use data, the Electronic Health Record and NCHS Workflow surveys, the AHA Health IT Supplement, the ONC Survey of Clinical Laboratories, and self-reported data by State HIE program grantees.
The data itself examines Health Information Exchange activity between office based physicians and hospitals, individuals, and state HIE Program grantees. What we see is a snapshot of how interoperability is today, balanced against how it was a few years ago. The findings are interesting.
Some months ago in the Sigmund blog we covered a new mobile health app called Doctor on Demand. This innovative approach to healthcare links a growing network of practitioners across America with mobile phone users via video conferencing.
The simple idea is that non-emergencies can be handled more rapidly and more efficiently for patients, while practitioners can increase the number of patients they can effectively treat, generating a brand new and lucrative revenue stream as they go.
Doctor On Demand (DoD) announced on Tuesday the completion of a Series A round of funding which raised $21 million. Leading investors Venrock, whose partner Bryan Roberts joins the DoD board of directors as part of the deal, were joined by Shasta Ventures and angel investor Sir Richard Branson.
R is for Records
The third and final pillar of EHR is of course Records. Few can deny the benefits to be gained from an Electronic Health Record (EHR) system. No paper-based system can simultaneously handle many thousands of individual medical records, monitor medication programs, and remind you of upcoming tasks and appointments. Though many object to 'working for the machine', the truth is that prior to EHR they were working just as hard, if not harder, for the 'paper monster'. Late nights and hours spent digging through archives to find missing folders are things largely of the past, and that is in truth where they belong.
H is for Health
In this second article we cover the second pillar of EHR: Health. The primary purpose of a practice, hospital, or treatment facility is to treat the sick. Whether they are suffering from strep throat, a broken leg, a serious behavioral health issue or an addiction, the end goal is the same. Improved outcomes and better quality of life. Electronic Health Record systems (EHR) help practitioners and clinicians achieve more, more efficiently, and improve patient outcomes significantly. Well used, the EHR becomes an extension of the organization, a data crunching analytic tool which can predict outcomes, raise alarms, mark milestones and monitor progress. Think of them as an impartial consultant, but better.
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.
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.
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.
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.
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.
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?
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.
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.
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.