Major initiatives in Health IT in 2013

As the push for infusing information technology into the healthcare space continues, each year is expected to have its own share of activities and initiatives which get implemented. All of these are finally expected to synergize and lead to a highly efficient and cost effective healthcare system in the future. Each such initiative has a starting time keeping in mind the change it is expected to bring about and the contribution it would make to the system over time. Also, all such initiatives are expected to have certain gestations periods to start offering real benefits. However, the build-up years are bound to result in certain levels of uncertainty and heartburn amongst all concerned stakeholders – owing to major changes affecting the status quo at any point in time.

Year 2013 saw some such Health IT initiatives getting implemented. A few of those were in response to concerns arising on the way and a few with the foresight of where the industry wants to reach. The important wants are as follows:

The HIPAA Omnibus Rule:

As an expansion to the Health Insurance Portability and Accountable Act, four new rules have been implemented. Contractors, subcontractors and other business associates of healthcare entities who deal with patient data are now expected to protect it as otherwise a provider would. There are penalties in place as well for cases of non-compliance. Also, how patient information is to be used for marketing purposes and for raising funds have defined guidelines to follow no. In short, no patient information can be sold without the required permission in place. With the digital world in a perennial expansion mode, the new rule is expected to protect patient privacy and safeguard patient health information.

Guidance for Mobile Medical Application:
This was provided by the Food and Drug Administration after an almost 2-year wait. The guidelines are enforced only on a certain percentage of apps which pose a threat to patients if they fail to perform what they intend to. Thus, only a small subset of the overall app market falls under its purview. In its current state, the oversight is on all those mobile medical applications which are aimed at being used as accessories to regulated mobile devices or which are likely to transform mobile platforms into regulated medical devices. The agency has been very particular to apply those regulatory standards which it otherwise applies to medical devices. This clarity is also very relevant to the developer community as they build newer and more effective solutions. There were some omissions in the guidelines which include:

• definition of what are regulated i.e. how to determine what requires regulation and what necessitates enforcement discretion
• defining the levels of risk for mobile devices & their accessories
• disease intended uses compared to unregulated, wellness intended uses
• exact meaning of an accessory to a medical device

Meaningful Use Stage 2 deadline extension:
Senators may have asked for a reboot of the system, some senior leaders might have questioned its true benefits; MU is here to stay. However, there is widespread consensus on some of the issues which stand as hurdles in its implementation - with the major one concerning the timeline. As a response to this, CMS proposed Meaningful Stage 2 implementation to be extended through 2016. This will result in the roll out of stage 3 getting pushed to 2017. There has however not been a shift in the start date resulting in drawing flak from some CIOs. They are not convinced about the intent of such a move – that of allowing time for fine tuning for the next stage by extending the deadline and not bring in flexibility in the start date which seems to be the need of the hour. Effectively, it means that those providers who do not start on time will miss out on a payment cycle.

Use of Big Data:
It might be early days for big data usage in healthcare systems; providers who have started using them for their clinical and administrative work have already started noticing the benefits. From reducing mortality rates, bringing down instances of readmission to performing evidence-based budgeting, there are predictions already of saving close to $450 billion in healthcare costs if the right usage of big data is made. People from some sections of the industry are however not overtly excited in jumping to such conclusions although they acknowledge the positives which are visible.

What will be new in 2014? Healthcare testing services would be in demand. Because of the large number of initiatives being rolled out and newer changes affecting healthcare, testing would peak during the year. Certified testing team would help you stay in line with your business goals while ensuring delivery of accurate healthcare solutions.

We provide healthcare software development services. If you would like to hire EMR software developers from us, we would be glad to assist you at Mindfire Solutions.

Will Computing take over the main tasks of Physicians?

Is it possible to automate a doctor-patient interaction with machines and algorithms handling 80% of the work? It might sound a bit outlandish but a reputed Silicon Valley investor feels it is quite a possibility. The person feels that general checkups can easily be handled by computer algorithms as well as an average physician. They may also have a lot of utility in recommending people for a physical visit to a doctor (when there is an actual need) after analyzing vital inputs shared by them and in the process save effort, time and money. Suggestions from these systems would also be based on history of illness, test results, symptoms etc. just like actual physicians would do.

Not many leaders from this field quite agree with this thought though. The argument broadly put across by them is in the lines of replacing human beings with robots. What a computer can replicate is the analytical and logical thinking which a physician would put in while treating a patient. However, it will fall short when qualities like creativity, experience and most importantly empathy comes into play. All these are adequately used by physicians when they arrive at conclusions related to a certain course of action for treatment. Also, another valid point to be taken into account is that each patient is different from the other; not necessarily reflected in terms of readings from tests, medical devices measuring vitals etc. This has led to the second school of thought by another bunch of healthcare leaders who take the middle path. According to them, the current state of affairs requires technology to permeate more into the healthcare domain but not so much so as to reduce the importance of physicians for making decisions. Ultimately physicians should have a role to play in validating technological inputs.

If the focus were to be shifted to the positives that technology has to offer, the list will be a long one. In fact, all the push from the Federal government for Health IT implementation under Obamacare is result of it. At an elementary level, technology in healthcare has led to marked improvement in provider adherence to clinical guidelines. At a more complex level, it has led to the process of “hot spotting”. This results in identifying problems in patients and making required interventions before a flare up happens; thereby saving high treatment cost and lives. Use of mobile devices like smartphones, tablets and other devices is also transforming the way healthcare delivery is taking place.

If we take a long-term perspective of the industry, within a few years from now there will be humungous amount of electronic healthcare related data created. Efforts are now being directed towards preventative care, population health, implementation of health insurance exchanges and a general shift from quantitative to qualitative healthcare. However, reaching a stage where disparate systems start talking to each other and are able exchange data will not be enough. There will be a need to have systems in place to mine the data available and come up with solutions to assist physicians in decision making – from suggesting the best treatment methods to other areas of decision making .These will become all the more relevant to the new healthcare delivery models e.g. ACOs which are emerging.

Thus, technology is proving to be very important in helping doctors to provide quality care. But expecting it to delivering the care outright would be a long shot. Also, the industry as a whole will improve only if the people at the core of the business i.e. the physicians are motivated to make a difference. Research done in this field has indicated that Physicians like to be given a certain level of autonomy in structuring their clinical activities and high control over the pace and content of patient care. The recent changes in terms of the compliance rules and regulations seems to be taking a toll on them as it indirectly reduces the time they get to spend with their patients . This problem is expected to be resolved over time as their familiarity with using new info systems and workflows gets better.

Leveraging newer technologies and building applications and systems which help make the tasks easier for physicians is the need of the hour and fortunately is on the rise as well. Healthcare software developers with solid domain expertise and strong technical know-how are making this a reality.

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What is stifling innovation at Health Information Exchanges?

Innovation is not what Health Information exchanges are focusing on right. The reason is that there is enough work pending to be done on improving deployment rates performance and usability. The Stages 2 and 3 implementation of the Meaningful Use program have HIEs as a major component. Its adoption although in higher single digits now has been steady. In the process there have been multiple instances of vendors exiting from the market and more expected to follow suit. Overall, their impact on better care co-ordination and interoperability has started becoming evident. A governance framework has been setup by the Office of the National Coordinator for Health IT to provide a guiding model for HIE governance. According to the framework, there are four principles of paramount importance which should pervade all governance models. These principles in reality are not binding in any form and are expected to act as guidance. The four tenets include:

• Trust: on matter involving patient privacy, meaningful choice and data management
• Business: Transparency in operations and finances
• Technical: Use standards to implement principles and further interoperability
• Organizational: Identify the best approaches to achieve the means

Reports done by surveys have indicated that HIEs have achieved commendable progress in areas like portal access, orders and results, and clinician messaging. The aim is to try and achieve a state where information related to a patient can flow electronically across organizations, vendors and geographic boundaries. A national information exchange governance forum has been also created to make it possible for the best practices followed across regional HIEs to be shared. This is not only going to help the members but also a go a long way is assuring privacy and security of electronic exchange.

Some of the areas in where HIEs are falling short of expectations include notifications and alerts, queries across networks and clinical alignment. Other issues of concern include the variability of technical standards and policies related to who should have access to patient information. All these are acting as major hurdles which need to be overcome. The stakeholders are looking up to ONC to find solutions to these issues. One of the suggestions put forth is to define the baseline standards and modify them when the market by and large moves to it. But all future standards and related certifications have to be such so has to enable complete interoperability. For e.g. an EHR which receives data should be able to use right away. This will also require a synergized effort directed towards making key stakeholders IT literate with in quick time. They will need to be aware of all the relevant technical standards and protocols related to data exchange. ONC on its part has acknowledged the concerns of the stakeholders and is constantly taking feedback from vendors, providers and others involved enabling them to suggest solutions. That matters are in a state of flux and that solutions will have to evolve with time is understood by all.

Given how things stand today, HIEs are more or less to be looked upon as startup businesses. People who currently are and will be part of the workforce will need to have a set of diverse skills. They will be expected to learn and deliver as various models start taking shape. From governance to policies to technical infrastructure, everything is expected to evolve into something tangible and reliable in the future so as to ensure long-term sustainability. All the neo care concepts which are being promoted like patient-centered medical home and population health management depend heavily on information exchange. Also, with the widespread use of electronic health records, HIE will end up a “necessary tool“ for providing affordable and high quality care. In fact many leaders in the Health IT have recommended that the best way to further HIE adoption could be by showing its value to healthcare reforms rather than pushing it as a regulatory step.

Healthcare software testing can be an eye-opener in this case as well. The feedback collated from user acceptance testing can also help provide insights into the needs of the patients and users of the systems. If there is a regular mechanism to test and record the feedback, that would also help HIEs.

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The future of Health Information Exchanges

Health Information Exchanges (HIEs) are expected to bring about a huge difference in the healthcare industry because of the nimbleness they are to suppose bring to data availability. This will also mean healthcare software testing will also pick up steam. There are some EHR vendors who currently offer the provision to physicians to exchange data with other practices which are registered to them. Some even go to the extent of offering all other features as are found in standard HIEs to them. But they are restricted in size and scale since it is only those physicians which are registered with the vendors which get entitled to draw the benefits.

HIEs go much beyond. These can be privately or publicly held and help in the transmission of clinical information from EHRs to participating physicians and providers. Most of the information is very holistic and helps in reducing the operational costs and improving the efficiency of practices. EHRs on the contrary hold a lot of information apart from the clinical data like demographics, allergies, laboratory reports etc. The potential benefits made available to group practices and physicians are many. By receiving and sending information, these entities benefit in a number of ways like

• Automation of their administrative tasks
• Availability of real time information at the point of care
• Transparency of processes
• Availability of Decision Support Tools
• Reduction in operational costs
• Qualification for Meaningful Use Incentives
• Increased Competitive advantage
• Improved quality of services

There are many other benefits offered by HIEs in addition to the ones listed above. However, it is not mandatory to find all of these offerings at a single HIE. It is left to the physicians to exercise their judgment before deciding to join one such organization. There are many reasons for the buzz around creation of HIEs. Needlessly to say that they enhance the degree of safety, quality and cost reduction otherwise possible without their usage. But one of the major driving factors has been the push provided by the Federal Funding.

Through the HITECH ACT, which stands for Health Information Technology for Economic and Clinical Health, an amount of 2 billion dollars has been put aside by the federal reserve for creation and expansion of HIE infrastructure. HIEs fall under the purview of both the State, as well as the Federal government laws for finalizing the regulations of its operations esp. related to the privacy and security concerns of handling patient information. With the broad guidelines made available by the Federal government, the state laws determine the rules to be followed to set up the infrastructure, get the required certification to operate and specific ones for patient information protection. HIEs as such do not directly fall under the HIPAA act. But since it has to deal with entities which are covered by HIPAA e.g. providers, clearing houses etc. HIEs are expected to exercise and follow all the rules so as to comply with the privacy and security provisions as per the Act.

HIEs can act both as repositories and conduits for health information based entirely on the model that they want to follow. In the centralized model, data is stored in a central repository and is made available to members based on need. The advantage of doing this is that it leads to standardization of data. There are policies defined for ensuring this. In the federated model, the data stays at the source with HIEs providing pointers to them. This makes it possible for providers and physicians to get more control over the data unlike the previous one.

Overall, the involvement required by physicians in HIE governance is critical to their fraternity. From knowing how the model is developing in their states to how their data will be used, all this is important for physicians they decide to join one. There is one school of thought which is kind of making the physicians slightly apprehensive about their participation in HIEs. According to them, the data which is available with HIEs could be used to evaluate physicians or for profiling purpose. Thus all the more reason for physicians to know who has what access to the data available with HIEs and how is it supposed to be used.

We provide healthcare IT services. If you would like to hire healthcare software development experts from our team, please get in touch with us at Mindfire Solutions.

Concierge Medical Care System

Some of the Health policy makers in the US feel that the current system is highly expensive and is not producing the desired effect in terms of outcomes. Their belief is based on a trend which is seeing a lot of physicians opting out of insurance-driven traditional model and shifting to a concierge medical care model. This is primarily the result of high administrative costs and below expectation payout by insurance companies. In fact some are struggling to stay afloat because of this. This has resulted in quite a number of Physicians moving to a Concierge Medical Service model. Also, Patients assigned to Primary Care Physicians have to wait for hours and days before being able to get an appointment, that too for short time durations, with them. Concierge system of providing medical care is one in which a patient pays an annual fee or retainer to a primary care physician. Depending upon the agreement there may or may not be some additional amount charged.

This can come as a relief for people who have had to wait for weeks to see the doctor. For some additional fees, patients get the opportunity to enjoy same-day appointments with 24-hour access, get more time with the doctor and invest in extra preventative care. Although the broad factors remain the same, variants exist in terms of payment requirements, operation and structure. In this, the insurance companies are completely taken out of the loop and patients pay for the service that is rendered. Currently, the most common type of Concierge model in practice has physicians holding on to their traditional practice but charging an additional fees from a small group of patients who are then entitled to special treatment and services which are not otherwise covered by traditional insurance. The variant at the other extreme has the physicians cancelling relationships with Medicare, Medicaid and insurance carriers. They build their practices aimed exclusively for patients willing to pay a retainer fees. The amount paid as retainer depends entirely on the range of services a particular patient wants to cover. Generally these patients carry insurance cover for all those types of services which are unavailable with their concierge physicians.

It enables physicians to focus more on their patients, spend more time on them rather than having to deal with the payment issues which generally arise out of handling insurance companies. Also, the physicians are absolved of being influenced by the insurance companies changing their ways of practice or suggesting what drugs to suggest, etc. They now have to decide on the number of patients they would like to attend to and do everything they possibly can to provide them with the best of care. The patients on their part however are responsible for prescription drugs and other ancillary medical devices and testing. Patients are required to use their insurance to pay for visits to specialists and hospitals. Many feel that this approach is going to lead to a two-tiered health-care system - one in which the rich will get preference for care over the ones who are not financially at par. There is also another problem likely to arise. Because of the inherent nature of the model, physicians will be required to reduce the number of patients they can handle which over a period of time, if the system gets widely accepted, will lead to a dearth of primary care physicians.

Besides this, Affordable Care Act will compel approximately 30 more million people to be insured. This again will lead to a demand for PCPs. So there is a high possibility of the overall healthcare system taking a hit because it widespread use of concierge practice will mean that more and more people, esp. with lower income levels, will be left without any access to primary care. Presently, the number of physicians who have chosen to adopt this new model is very low. For the model to succeed it has to be gain acceptance from a bigger and wider audience. There are some physicians who are moving to a model with the intent of directing their focus is entirely towards wealthy patients. Besides visiting them at their homes they also accompany them to the specialists.

In all such situations, online applications which impart healthcare services or at least assist the physicians in servicing patients are picking up steam. Needless to say, healthcare software testing also has to be done to ensure the effectiveness of the systems are maintained.

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