Health and the Virtual Photo Walk

 

Virtual Photo Walk

A  photo walk by Jared in the Mountains of Utah for M. Monica on Google Plus using a Hangout with an iPhone.

Watch as John Butterill moderates a Virtual Photo Walk for two challenged patients.

Social interaction is a critical factor in health and wellness. Many of our patients have reached a state where they are no longer well, however suitable means are available to improve quality of life.

Google Plus has several ways of collecting individuals with like interests and/or goals.  The circles of  G+ offer a collective approach for individuals with common interests, ie photography, disability, disease categories, etc.

Virtual Photo Walks provides a platform for invalids to participate in observation of scenic walks, visits to theme parks, cruise ships, casinos and perhaps even city council or other political activities.

Digital Health Space has partnered with Google, Veterans Today, and Virtual Photo Walk in this endeavour for patient advocacy for a group largely lost to social affairs due to limited mobility or very limited access to public spaces. While the Americans with Disabilites Act empowered the mobility impaired in the physical space, Virtual Photo Walks extends this Act into the virtual space with a flick of a mouse pointer.

Technorati Tags: digital health space,veterans today,ken smith,virtual photo walks,john butterill,google hanout

EMR vs. Paper Records:

 

  

[INFOGRAPHIC]

Remarkable changes in attitudes by healthcare providers has occurred in the past three years, in regard to electronic medical records.  Physicians were the leading naysayers with many reservations about cost, true effectiveness and return on investment.  Now a significant number have become adopters of EMR and those providers who use EMR doubt if they could be as efficient without EMR.

Patient Opinions

About 18% of patients in paper-based practices said they would not find it very valuable if their physician adopted an EHR system, and about 10% said they would not find it valuable at all.

About 21% of patients whose physician primarily uses a paper-based health record system said they would find it very valuable if their physician adopted an electronic health record system, and about 52% said
Read more: 

When asked about the possible effects of their physician transitioning to an EHR system, about 48% of patients in paper-based practices said the transition would have a very positive or somewhat positive effect on their quality of care.

About 41% of patients in paper-based practices said the shift to EHRs would have no effect on their quality of care, while 10% said it would have a somewhat negative or very negative effect on patient care.

Read more:

The report is based on an August 2011 online survey of 1,961 U.S. adults, including 808 U.S. adults whose physician primarily uses a paper-based health record system.
Read more: Physician Opinions

Eighty-four percent of health care providers say they consider health IT "invaluable" or "valuable," according to a survey by CDW Healthcare, FierceHealthIT
Read more:

Among the 202 surveyed caregivers, CDW Healthcare found that:

• 50% said they considered health IT "invaluable" because it "delivers capabilities that could not be replaced by non-IT tools;" and
• 34% said they considered health IT "valuable" because it "significantly aids in the delivery of care."

In addition, 71% of health care providers said they would not be able to complete more than 50% of their workload without health IT

Read more: Health IT Professionals

Among the 200 surveyed health IT professionals, CDW Healthcare found that:

• 56% said they have deployed an electronic health record system in their hospital in the past 18 months (FierceHealthIT, 2/27); and
• 48% said they have deployed a computerized provider order entry system in the past 18 months (CDW Healthcare report, 2/27).

In addition, the survey found that:

• Nearly 80% of health IT professionals said the infrastructure to support health IT sometimes is implemented as an afterthought; and
• 58% said they had implemented data storage, a server or a network program after adopting a new health IT system at least once (FierceHealthIT, 2/27).

Read more:

Social Media

   

Health Train Express believes that social media platforms and their use is at about 2008 in comparison.  EMRs rapidly evolved and purchased  during the period from 2008 to 2012 with the promise of $ 18 billion funding by the U.S.Government.

At first glance the medical market place for social media would seem to be much smaller than EMR, however given it’s popularity healthcare in  will fuel growth for the  space. Many medical equipment companies both in manufacturing and sales use social media daily. 

Social media has evolved from Twitter to Facebook to Google plus.  With each iteration the capabilities of the platforms continues to expand.

We will continue to follow healthcare and social media closely.

Technorati Tags: social media,hcsm,healthit,twitter,facebook,google plus,emr,stimulus funding,tarp

Using Social Media, Digital Resources and Health 2.0

 How to Health 2.0 Your Patient Portal

Using Social Media, Digital Resources and Health 2.0 to your advantage

Time for all of us is precious and is one of those resources like finances that is limited.

Fortunately many changes have occurred which increase efficiency in dealing with healthcare. Many of these improvements are on the patient side as well and the physician side of the equation.

Let's categorize these

Insurance:

1. Search engines can be use to identify appropriate insurance policies for you and your family. Many insurance companies now operate a central source for different companies as well as programs that compare rates and coverage limits.

2. Enrollment applications can and are processed online. Much of your medical history can be entered because the online sites are encrypted and private in accordance with HIPAA regulations.

3. Insurance notifications and contact confirmation can be sent via email to confirm your application(s)

4. In addition to receiving ID cards via regular mail, some companies will also send you a copy via email.

 

Office or Clinic

1. Online web portals are becoming omni-present. These may include patient education, search engines by doctor location or specialty.

2. Not infrequently the web portal will contain significant information about physician's resumes, credentials, hospital staff memberships, office hours, and specialty interest.

3. Appointment scheduling.

4. Laboratory, Imaging result reporting online.

5. It's not necessary to sit and wait in a reception area with patients who may have infectious illnesses. If you have a cell phone or a smartphone ask your doctor's office to send you a text message or a 'tweet' when they are ready for you. (even a phone call works).

6. Bill payment online.

Pharmacy:

1.       Physicians now frequently use eRx a form of electronic transmission of your prescription to pharmacies. This eliminates errors due to illegible prescriptions. However, it is not foolproof and recent studies have shown significant errors still occur. Double check your prescription when you pick them up.. It is important to update your doctor as to where you want your prescription sent to for each visit.Many pharmacies offer automatic refill at no additional charge. Ask your local pharmacy for their requirements. It will save time, your prescription will be ready, you will not forget, and it will reduce effort.

 

Technorati Tags: health 2.0,web portal,electronic prescription,online appointment,digital health,social media

Comic book explains, Advocates Health Care Reform

 

The health care overhaul is complex. It’s confusing. There are multiple misconceptions about it.

So Jonathan Gruber decided to set the record straight in simple fashion: a comic book.

It’s classified as a “graphic novel,” illustrated by award-winning artist Nathan Schreiber. But it’s not fiction.

In fewer than 150 pages, the two combined their expertise in “Health Care Reform: What it is. Why it’s necessary. How it works.”

The paperback volume is a primer to help people understand — and buy into — the ideas contained in the Affordable Care Act.

There’s no question that Gruber, a professor of economics at Massachusetts Institute of Technology, is an advocate of the changes.

He is director of the health care program at the National Bureau of Economic Research. He was the main designer of Massachusetts’ health care law. The Obama administration consulted him to help construct the national act. He is a member of the Institute of Medicine.

Gruber walks the reader through the situations fostered for each in today’s health insurance climate and explains the financial consequences. Then he presents a case for the changes envisioned by the Affordable Care Act.

Read more here:

Perhaps Congress should have read this before they voted:

Now even doctors can understand the  new law.

Technorati Tags: obamacare,participatory medicine,institute of medicine

Is There an “Oscar” for Healthcare ?

 

 

Much like entertainment, health care information will become available on all media. The convergence of many technologies such as Television, cable, internet, smartphones, tablets, desktops and more devices stimulates openness and transparency. The convergence of all these formats is occurring rapidly each year.

We all know as according to Phil Bauman that “Health is Social” Yet why do physicians either recoil or are dismissive about social media?

Tonight I am watching the Academy Awards on an internet live stream with a choice of six different cameras with upfront face-to-face encounters. It’s all in HD. Television still does not yet have the events on live. (5PM PST).

I have four active windows to select from: Arrivals, Grand Entrance, Red Carpet and  Interviews. All windows are in real-time and simulcast.

Who are the  nominees for the Health Care Oscars in 2012 ?

Categories:

Best use of Health 2.0

Best Electronic Medical Record

Best Social Media Platform

Best mobile application

Best Health Information Exchange

Best Health Insurance Reform Plan

Best Translational Science application

Best genomic discovery an application in healthcare's

Best Health Blog

Best General Medicine Journal

Best Specialty Medicine Journal

Perhaps the Nobel Prize, Woman in Science Award, The National Academy of Sciences Awards,

LASKER AWARD

The Lasker Award, 

The Elliott Cressen Gold Medal Award, (now a part of The Franklin Institute)

The Alpha Omega Alpha Honorary Society (AOA),

Wolf Prize in Medicine,

Further suggestions are invited @glevin1 or email  gmlevinmd@gmail.com

Technorati Tags: oscar,academy award,lasker award,cressen award,wolf award,alpha omega alpha

Finding Fraud in Medicare Claims

 

Certainly one of the methods to reduce fraud is to catch the opportunists that see the U.S. Treasury as easy pickings.  Hidden in the maze of billing, coding, electronic claims is software coding that can easily be turned to the white collar thieves.

As physicians we need to be aware of the potential of careless, negligence and even possible misuse of your own billing system.  The buck stops and starts in your very own office.

Fraud can be construed when a charge is made for a procedure that has not been performed, or with creative 'up coding' to a higher management code. Another common procedure is a 'storefront' phantom medical practice.

 

LOST MONEY

Medicare billing errors, excessive payments and fraud have cost U.S. taxpayers hundreds of billions of dollars over the past decade. Medicare's annual estimates, however, do not account for all fraud nationwide.

FRAUD PROSECUTIONS

Federal prosecutors in South Florida scratched the surface of Medicare fraud in the 1990s. But it wasn't until a few years ago that they began to crack down on the corruption. Today the region's prosecutions account for more than one-third of all Medicare fraud cases nationwide.

Read more here:  Miami Herald 

 

Medicare fraud rampant in South Florida

 

BY JAY WEAVER

jweaver@MiamiHerald.com

 

Whenever Alexander McCray lights up his crack pipe, U.S. taxpayers help pay for his habit.

McCray has defrauded Medicare by selling his government-issued health card number to private clinics in exchange for kickbacks of $150 to $300 a visit -- as often as three times a day, three times a week over seven years, according to federal records and his own admission.

McCray has signed off on phony infusion treatments for his HIV illness -- therapy that is medically obsolete -- and he has received thousands of dollars from Medicare-licensed clinics all over South Florida.

Money that he has used to buy crack cocaine.

Dozens of clinic operators have in turn filed more than $1.1 million in false claims for fabricated HIV-infusion treatments billed in his name, according to Medicare records reviewed by The Miami Herald. Some 90 doctors, including one indicted in May, appeared on the phony prescriptions written on behalf of McCray.

''I'm the king of it all,'' the 40-year-old, unemployed Opa-locka man told The Miami Herald recently, when asked about his Medicare scams.

McCray, a ''professional patient'' with a 15-year criminal history of drug possession, is among thousands of con artists who have made South Florida the nation's capital of Medicare fraud. A six-month Miami Herald investigation has found that the corruption has spun out of control during the past decade with little effort by Medicare regulators to stop it here and in other major cities. This past week, during a policy forum to confront the crisis, federal lawmakers said Medicare fraud costs taxpayers nationwide at least $60 billion a year.

Read more here:  Rampant Fraud in South Florida

 

And in Brooklyn, New York

Federal agents raided health care facilities in nine states this morning, arresting dozens of suspects believed to be defrauding Medicare of tens of millions of dollars.

Federal authorities say this is one of the largest -- if not the largest -- take-down of Medicare fraud suspects ever conducted.

The raids began in morning in the pre-dawn hours. The targets: more than 100 doctors, nurses, therapists and healthcare company executives who have allegedly been stealing tax dollars to the tune of $200 million in recent months. Much of the fraud involved healthcare professionals billing the government for medical services never performed and medicine not provided.

Investigators say the Brooklyn scheme worked like this: Patients willing to go along with the scam were paid $40 per visit for three appointments per week, and were often diagnosed with vertigo or other ailments that would limit their mobility. Ambulettes provided by Medicare and Medicaid were transporting these patients back and forth for fraudulent appointments.

The clinic would then collect from Medicare or Medicaid for the ambulette rides, and the supposed services provided at the phony appointments. Taxpayers were billed millions for unnecessary treatment or treatment never provided.

The raids were conducted in Miami, Brooklyn, Tampa, Chicago, Baton Rouge, Houston, Dallas, and Los Angeles.

The Whistle Blower, and How to  Report Fraud

Here is another ‘tale of deceit’

A combination of events created this break in security.

Medicare received a series of paper claims for diabetic retinopathy laser photocoagulation from an ophthalmologist’s office. They were unusual, claiming a series of 8 treatments in a series for proliferative diabetic retinopathy.  While a series of PRP for PDR is not unusual 8 is highly unusual.  This medical practice used electronic billing exclusively, yet the claims were on paper forms. Each paper claim totaled 25,000 dollars and there was a series of claims totaling $ 875,000. The patient identification numbers and locations were not from the usual practice locations.

The paper claim had the correct MD name, Medicare Provider ID practice location ICD and CPT coding.

These events tripped off the Medicare fraud alert system. At the time the practice had been sold to another MD and a transition was in place. The original physician had relocated the to another state.

The claims were for procedures performed after the original physician had closed his medical practice.

The attorney general contacted the physician with many open-ended questions possibly suspecting the physician himself was the perpetrator of the fraud. It became readily apparent that this was not the case.

This physician's Medicare provider ID was compromised by a lack of security. It's important to remember that your insurance ID numbers are much like a credit card number, and are perhaps less secure since they do not require PIN numbers. The information is handled by many personnel in the billing office. In this particular situation there was also a change in office personnel.

It was determined that a previous biller was part of a scheme to defraud Medicare, either selling or giving the Medicare numbers to acquaintances who knew enough to use them to defraud the taxpayer of almost a million dollars.

A 'sting' operation went into operation allowing the thieves access to the money cashing their checks and tracing the money to a racetrack and a person attempting to cash the US Treasury check. Even more interesting was the checks were negotiated at a well known horse racing track in the greater LA metro area.

The perpetrators were confronted at the teller window by several FBI agents who inquired how they got the checks. The suspect turned around and said, “from that doctor over there'... (there was no “doctor over there”.

Fast forward about a month, when the MD received a call from an FBI agent who asked him to send him a copy of a photo of himself, a driver's license and a sample of his signature and writing sample. Even though completely innocent the physician realized how easily he could have been implicated.

As events turned out he was found to be an innocent victim of the scheme. He was required to appear before a grand jury where the guilty perpetrators were indicted, tried and sent to prison for felony fraud.

This was my personal story…it happened to me

This scenario while somewhat unusual is not unique. The moral of the story...treat your ID numbers as if they were credit cards, and if you make paper claims do not allow them to be known other than by your billing personnel.

Technorati Tags: medicare,fraud,whistleblower,corruption,victims,hiv infusion fraud

Health Train at HIMSS 2012

Happy President’s Day !

Seems like a good time to visit Las Vegas for the latest on HIT.

Virtual HIMSS

HIMSS Mobile

HIMSS 2012 is the annual meeting of the minds where healthcare meets information technology, for better or sometimes worse.

It is one of those events where languages intermix. It is a cross-culture event where each side speaks, with the other side, sometimes with each party understanding the other party.

If you want detailed information in real time the best place to look is on twitter using the #himss12 to search or related #healthit.

KEYNOTE SPEAKERS:

SIMULCAST EVENTS:

ON-DEMAND EVENTS:

2012 promises to be the year of the health mobile app. The maturation of the  Android OS  adding to the force of iOS allows many applications to be available in open source greatly expanding the ability of software developers in health care

2012 is also the year of the explosion of interest in  social media. The number of providers using social media rose exponentially during 2011.  HIMMS 2012 provides a number of events revolving around Social Media. #hsmc

The number of tweets/hour using #hmss12 about 1000. (February 20, 2012 at 12:00 noon.

Five things to Watch at HIMSS

Here are some of my favorite tweeps at himss12:

https://twitter.com/#!/PhilSalm

https://twitter.com/#!/larrylin

https://twitter.com/#!/HealthTechMatch

https://twitter.com/#!/HealthTECHlive

https://twitter.com/#!/iHealthBeat

https://twitter.com/#!/ahier

https://twitter.com/#!/Cascadia

https://twitter.com/#!/imrantech

https://twitter.com/#!/theEHRGuy

https://twitter.com/#!/Awarepoint

We’ll be watching on a daily basis and updates will be posted later in the day.

Technorati Tags: hit,healthit,aco,himss 2012

How United Healthcare Got it Right

 

 

United Health Care to offer Software in the Cloud (Ducknet)

UHC fooled us all with their end run around IT vendors, EMRs, HIEs and physicians.  While the peanut gallery and bleachers were watching Howdy Doody, HHS, and CMS real entrepreneurs ran the pigskin into the end zone.

Insurers are much more than sending a bill and getting reimbursed for services. That is just the front end of their IT systems. IT experts know the real stuff in IT is in the ‘back end’, the guts of the system buried in non friendly code, algorithms, application interfaces, backdoors for different insurance companies, etc.

Dana Blankenhorn writes in “Seeking Alpha” , an investment newsletter,

“When I took on the health IT beat for ZDNet five years ago, it was with the assumption that this industry would act as every other industry had acted. That is, mainstream tech vendors would gradually take out the specialists.

It hasn't worked out that way. Last year Microsoft (MSFT) got out in favor of GE (GE), which has been involved all along. Google (GOOG) simply bugged-out, a rare failure for the company. Siemens (SI), long an also-ran in most enterprise computing, has also been a big player in health IT thanks to its imaging unit.

But the big winner may turn out to be UnitedHealth (UNH), a healthcare vendor based in insurance.”

While other insurers signed vendor deals seeing IT as an obligation, UNH bought small vendors, seeing it as an opportunity.

Last year it rolled out a new brand, Optum, for its health services, and this week it rolled out what it calls the Optum Cloud, backed by a new data center.

The healthcare law, meanwhile, will bring UnitedHealth and its competitors, like WellPoint (WLP) and Aetna (AET) millions of new customers, but also a level playing field in many cases. It's an incentive for insurers to cut physician costs. That would translate into lower rates on health exchanges, thus more income.

The question becomes, can UNH break out of this high? Well, consider that now it only has to execute on a strategy that has government approval, with new services and new platforms coming on quickly. Signs point to yes. This administration has done UnitedHealth some big favors.

So, Meaningful use fueled interest in insurers to maximize their profits through health insurance exchanges, if those ever come to pass in some states. The money invested by the tax-payer will come around into insurers and Medicare (federal government)

Care-Zone

 

How do Google + Social Media Impact upon Healthcare ?

How to sign up for Google + (even if you don’t have an EMR)

Besides +Peter McDermott there are many other YouTube video tutorials or you can contact me +Gary Levin and I will bring you into the fold.

Many of you already know I am a fanatical proponent of Google Hangouts and Google +

My enthusiasm is borne from the innovative IT and developers using this platforms interacting amongst each other in the google plus space. G+ allows me access to sources before they are released to the general public or those in the HIT space.

In order to obtain this level of efficiency I organized my Google + circle of friends into categories for healthcare, providers, mobile apps, Health 2.0 and others.

Once I had my circles organized it became productive and efficient to just open my 'stream' and information “streamed” out in ways that Facebook could not deliver. Twitter also has some of these attributes if you know how to use the hashtag to filter what you are interested in reading. It's main limitation is 140 characters which do not tell a story unless a hyperlink is eymbedded in the tweet.

My morning is spent reviewing my feeds, twitter, facebook and Google +. Although I am intrigued by the possibilities of using Google Hangouts it is restricted by it's lack of security and privacy required by HIPAA for healtcare.

Jonathon Schwartz CEO of Care-Zone has developed an application, Care-Zone which is a secure private system that providers, patients, and family can trust in communicating private information that should not be in the public domain.

Jonathon is interviewed here by Robert Scoble of Rackspace.

Care-Zone has both a desktop and a mobile app availble in iOS, or iPhone.

The website uses https// a secured internet protocol. Care-zone allows you to upload files, created a medication list, create a contact list, but has multiple short-comings that render it almost useless for caregivers.

1.It is little more than a private secure notepad

2.There is no ability to chat in real time, nor interface visually or audibly

3.Different care givers must log in after being invited to Care-Zone

4. The application has no ability to interface with either a PHR or EMR.

 

Could a Smartphone know you’re depressed before you do ?

A team of researchers at Harvard University are working on the logical next step: A smartphone app that can help treat mental health issues.

Mobilyze is a development tool that would work much like the Nike+Fuel Band.

The FuelBand has a few neat tricks to set it apart. Sure, it'll track your perambulations, but it also converts all of your physical activity into a kind of health currency called NikeFuel. It tracks steps walked and calories burned, but it also uses oxygen kinetics to take a more precise measurement of your exertion — and in true Nike fashion, it turns the result into a competitive sport.

The app uses a simple approach developed by an Australian psychologist. Users of the app are shown two different faces on their phone screen: One friendly and one hostile. The program merges the faces together, and then flashes a letter that you need to correctly identify.
It's believed that those with social anxiety tend to fixate on faces in the crowd who are hostile. The app helps break this fixation, re-training the brain and reducing anxiety. 

Recent studies show that using the new smartphone app helped reduce subjects' anxiety by 22 points on a questionnaire, as compared to an 8-point drop experienced by a group who didn't use the app.

But before you start trading in your doctor for an iPhone, it's important to note that not everyone believes that the app is special: A similar 22-point drop was experienced by a control group who looked at pairs of faces without the letter to distract them.
It could just be that the key to feeling better is simply the act of taking the initiative and doing something about your anxiety. According to one Chicago-area control group participant in the study, "I felt good about myself, that I was doing something for my issues, and a lot happened in those two months outside the study that could have helped."  (source)

Technorati Tags: google +,mobylize,iphone,care-zone,nike fuel,robert scoble,rackspace

Social Media for Veterans and Health Train Express

The VA has launched social media platforms for 152 VA Medical Centers

Gradually during the past ten years the Veteran’s Administration has taken on a new cadre of wounded and/or disabled Veterans. Today the Army and other branches do  not discharge soldiers until they have been through a vigorous appraisal while still on active duty.  This becomes an important part of their permanent medical record (via the VA AHLTA EMR if they ever have to apply for service  connected disability. At the time of discharge many are not yet aware that they may have PTSD (Post-traumatic Stress Disorder) or post-TBI  (Traumatic Brain Injury).

If you haven’t been to a VA Medical Center lately you would be surprised at the gradual metamorphosis the VA Centers have gone through since 1992 and the first Gulf war.

Many PCPs and other specialty providers may not be familiar with DOD process, nor VA Hospital paradigms for treating military personnel, nor the signs and/or symptoms of PTSD and TBI or how the two can be related to created a synergy that is challenging both to  provider and patient.

 

Introduction to Traumatic Brain Injury <VIDEO>

The Defense and Veteran’s Brain Injury website also offers a centralized information source.

For practitioners not directly affiliated Veteran’s Health Facilities the Department of The Army offers some practical information guides and brochures for both the veteran and his physician.

What is Traumatic Brain Injury ?  During the Iraqi and Afghanistan War the typical head injury changed from massive trauma and hemorrhagic injuries to chronic repetitive concussive (blast) injury from IEDs (Improvised Explosive Devices). In these cases the importance of a history of the injury, the distance from the blast(s) and the number of incidents to which the soldier sustained.

Important  Information For Every Soldier Regarding Traumatic Brain Injury (TBI)

Traumatic Brain Injury (TBI) Program Validation  AMEDD (Army Medical Department) maintains several programs which are linked to TBI and PTSD at Regional Centers. These are staffed with a multi-disciplinary team.

Here are some of the IEDs our troops faced:

Vehicle-Borne IEDs (VBIEDs)

The potential range for harm is impressive and exposes tens and possibly hundreds to injuries or death.

Other devices include:

Suicide Devices

Package Type IED

Many soldiers develop social anxiety disorders as part of the PTSD and post-Traumatic Brain Injury Syndrome.

What role does Social Media play in rehabilitation for these veterans? Would developing relationships on Facebook, twitter, and Google + hangouts benefit these returning soldiers.

There are already a number of advocacy groups for TBI and PTSD active on Facebook, which can easily be found by searching for TBI or PTSD.   For Twitter #tbi and #ptsd already exist.

The Road out of PTSD Hell  from Veterans Today

PTSD and TBI patients do not wear their scars externally. That person sitting opposite of you in the bus, in the restaurant may suffer each day for serving our country.

Technorati Tags: veterans hospitals,google plus,facebook,traumatic brain injury,ied,ptsd,rehabilitation

Will Accountable Care be the Final Straw for US Economy and Healthcare system?

 

     

Few readers do not know about our present economic failures, and the prospect of inventing an unproven model to contain health costs could have the opposite intended effect, further increasing the %age of GDP devoted to US health care

Good afternoon readers. I tried to think of a short, catchy phrase for this subject, but failed miserably

For this post, however you will see with what I came up.

I have been pondering what a 'Project Manager' recruitment ad would read for establishing an Accountable Care Organization. I was about to construct my own plan and came upon this article from eHealthInitiative.

I found out very quickly what is involved.

Essential to the development of an ACO, small or large is Health Information Technology.

Key recommendations include:

• a health IT infrastructure that is flexible to support the changing needs of an accountable care organizational model; (unknown at this time)

• an infrastructure that supports the secure transfer, collection and storage of personal health data;

• a patient-centered system to engage and educate patients and caregivers;

• and a system that supports care coordination across the healthcare team and the patient.

 

"It may be difficult (read impossible) for accountable care organizations to accomplish all of their objectives without a strong technology base that facilitates care coordination and gives doctors the tools they need to provide quality and affordable care," said Jennifer Covich-Bordenick, eHealth Initiative's chief executive officer.

Accountable care is an issue of critical importance to physicians.................. With the right technology in place, these organizations have the potential to improve the health and well-being of their patient populations," said Michael S. Barr, MD, MBA, FACP, Senior Vice President, American College of Physicians.

The report was developed by a multi-stakeholder council which met over an eight month period, and involved the input of over 100 individuals and organizations across the healthcare industry. The council was co-chaired by Michael S. Barr, MD, MBA, FACP, Senior Vice President, American College of Physicians and Marcia Guida James, MS, MBA, CPC of Humana Inc.

The report can be downloaded on the eHealth Initiative Website at www.ehealthinitiative.org.

Of some significance was that 50% of hospitals/groups are not interested in the ACO model.

eHealth Initiative 2011 Accountable Care Organizational Model Survey (ACOM)

The eHealth Initiative launched the Accountable Care Organizational Model Survey on October 7, 2011, and concluded the survey on November 29, 2011.

The survey of 20 regionally diverse groups revealed:

The majority of respondents were unsure or did not intend on applying for the Medicare Shared Savings Program or the CMS Innovation Center Pioneer ACO Model.

50% indicated that they did not intend on applying for the CMS MSSP program.

37.5% were unsure if their organizations intended on applying for the MSSP program.

12.5% stated that they intended on applying for the CMS MSSP program

ACOMS are utilizing a variety of payment models to achieve shared savings. Several organizations reported utilizing or planning to utilize a combination of models:

1. Twelve organizations reported utilizing or planning to utilize a FFS plus a shared savings payment model.

2. Eight organizations reported using an upside potential model.

3. Five models reported utilizing or plan to utilize a downside risk model.

4. Four organizations are utilizing or plan to utilize a bundled payment model.

Two organizations were utilizing a global risk model.

5. One model reported unsure.

I had not realized the ACO has the choice of a number of payment models and cost containment ranging from prepay HMO like contracts all the way to FFS with shared payment and cost containment measures

One of the key ingredients is the component of patient participation in health 2.0 which include:

Telehealth monitors.

Telephonic support.

Mobile technology.

Patient Portal.

Internet-based patient education programs.

Personal Health Comprehensive assessment tools to help providers determine the patient’s level of health literacy so that education can be tailored accordingly.

Online communications such as viewing a summarized patient record, enabling patient input, enrolling in health and wellness programs, linking to health information sites, managing permissions for record access.

I addressed these issues in my last article at HealthTrain Express “ Is The Patient Ready for Physician 2.0 ?

Whether it is a federally or provider-supported model, successful ACOMs will be judged on the basis of their ability to achieve progress in achieving the Triple Aim–improving the individual experience of care, improving the health of populations, and reducing the per- capita costs of care for populations

^{Key Attributes Needed for a Successful Health Information Technology Structure in the Accountable Care Organizational Model}

Health information technology is essential to the success of the Accountable Care Organizational Model. The following list identifies key attributes needed for the development of a successful health IT infrastructure.

The health IT infrastructure must enable care coordination and collaboration.

The health IT infrastructure must enable and support the comprehensive and systematic collection, storage, management, and exchange of secure personal health information between and among healthcare providers, patients and other members of a patient’s healthcare team in the process of care delivery and care management.²¹

The health IT infrastructure must include revenue cycle management technology to successfully support the financial analyses associated with accepting, negotiating, and managing new and changing payment structures. The infrastructure should enable electronic acceptance, tracking and allocation of payments and should be able to handle the distribution of payments to individuals, practices, and other appropriate organizations within the ACOM based on performance associated with specific metrics of quality, cost and patient experience.²²

Data exchanged by the health IT infrastructure should be maintained in a secure, HIPAA-compliant, online environment that allows role-based access to and sharing of data among and between stakeholders (including hospitals, physician practices, healthcare providers and payers).²³

The health IT infrastructure should support the collection of information embedded in the workflow of healthcare delivery.

The health IT infrastructure should support the use of telehealth, remote patient monitoring, shared care plans, and other patient-centered enabling technologies between facilities, healthcare providers, and patients that securely exchange information.²⁴

The information shared through the health IT infrastructure should be collected and stored in a manner that facilitates ongoing measurement of processes and outcomes related to quality, cost, and patient experiences at an individual and population level. The identified

The identified metrics will be important for the assessment of ACOMs.²⁵

The health IT infrastructure should enable information to be transmitted, and accessible to all patients and healthcare providers authorized to view it.

The health IT infrastructure should integrate evidence-based clinical decision support system (CDSS) services into the workflow of care delivered by healthcare providers and their practices.²⁶

The health IT infrastructure should support and facilitate shared decision-making and care plan development through the integration of information from all healthcare providers involved in the care of a patient. There should be convenient access to user-friendly personal health information organized to be meaningful for patients/caregivers and presented in a constant format across the organization.

The health IT infrastructure should support services for patients and caregivers to help them be informed, educated, and literate about personal health and medical conditions and to enable patient self-management of care.

The health IT infrastructure should offer support on-going self-care and wellness management functionalities including, but not limited to, coaching from healthcare providers and ongoing monitoring of progress to promote a dialogue between patients and healthcare providers.²⁷

The health IT infrastructure should support the analysis of clinical, administrative, and financial data to support operations, improve care and better patient outcomes while optimizing the overall performance of the organization.²⁸

To achieve the specific benefits health IT can bring to the ACOM; industry should focus on creating and implementing tools that address the key concepts. This report identifies three key concepts that the health IT infrastructure of the ACOM should support .

ehealthinitiative identified three main components that should be addressed by HIT

1. Patient Safety

2. At Risk Patient Populations

3. Financial Accountability and Quality Management

The report can be downloaded on the eHealth Initiative Website at www.ehealthinitiative.org.

Technorati Tags: accountable care summit,health information technology,cms,medicare,acom,health 2.0,patient safety,risk

Participatory Medicine

 

Hacking Health - Part 1 from J Participatory Medicine on Vimeo.

Participatory medicine  is a  relatively new term coined by patient advocacy groups. It sounds good, so how do we define it?  Does it include knowing your medical history, maintaining a personal health record, being observant of maintaining one’s health with proper exercise, being knowledgeable about good nutrition, compliance with medication instructions, reading your medication side effects and/or contra-indications, knowing and telling your providers about allergies (on every visit), getting recommended vaccinations each year for flu, and pneumovax at the appropriate times?

Have you signed an advanced directive, and is it in your medical chart? When you enter a hospital  do you instruct registration and/or your nurse that you do or do not have an advanced directive? Do you bring all your medication bottles to the hospital? (Yes, even aspirin, Tylenol, decongestants, eye drops and sleeping medications. Do you tell providers about the supplements and vitamins you use, including herbals? Have you travelled recently? Many of our modern day powerful drugs are concentrates or synthetics developed from herbs. Do you practice yoga, meditation, reiki, acupuncture, massage therapy?  Have you travelled recently?

How far can you participate? You cannot hold a retractor or make your own incision for surgery, however you can be certain your nurse or other health care personnel know your name and to be certain that you are not getting someone else's medications or being taken for a procedure intended for someone else. You can tell personnel which side of your body is being operated upon.  Operating rooms now have a standard check-off list including a “time out” in which everyone participates.

There are a great number of items in which you can participate  and many that you cannot.  You can tell your nurse and/or doctor to wash their hands (they often just plain forget in the rush that has become part of medical care.

You can take a shower or bath prior to entering a hospital to reduce the possibility of transmitting an unknown pathogen on your skin, such as drug resistant bacteria like MRSA (methicillin resistant staphylococcus)  And if you are a known carrier of MRSA or someone in your family is a MRSA carrier, certain precautions will be taken by hospital staff (if you tell them)

Hacking Health - Part 2 from J Participatory Medicine on Vimeo.

None of these items create any increase in cost, all likely improve outcomes, decrease “never happen” events and do not increase the paperwork burden on the system.

And best of all it is a bipartisan decision on your part by a Committee of ONE , requiring no political action committees, nor 1200 page Federal Register entries.

Technorati Tags: advocacy,outcomes,obamacare,participatory medicine

Is The Patient Ready for Physician 2.0 ?

Gotta Webcam?

Health IT developers are producing medical applications for mobile users rapidly for both Android and iPhone, and soon for Window Phones.  Most of these are educational or for reference. There are some software applications for remote monitoring which are presently in the FDA approval process.

While pundits proclaim that patients clamor for direct “physician-patient” telemedicine”  Few if any real studies have been done to demonstrate this demand.

Until now there were few if any teleconference software that was affordable for medical practices and patients. In fact a teleconference room and/or facility costs in the range of five figures.  Skype has been available however it presents some limitations in regard to the number of participants unless users are subscribed to the paying service.

Health Train Express will be sponsoring a “Demonstration Project” on Physician-Patient Telemedicine.

I know, I know many will tell me I should not do this due to regulations and all, however progress is made by those willing to risk something in the name of REAL PROGRESS  instead of a bunch of committee meetings. Lett MDs be the arbiters of what works and doesn’t work. Once we demonstrate the need and demand for these services some innovator and entrepreneur will find a way to host medical teleconferences for an acceptable stipend.

The following caveats and disclaimers will be posted for each telemedicine conference to be held on Google + Hangouts.

[This is a “Demonstration Project in  telemedicine. The project will attempt to  determine what the demand is from patients for Primary Care and/or Specialty Care using Telemedicine  Because the Google + Hangouts are not encrypted we will only answer non specific general questions To be in compliance with HIPAA privacy and confidentiality laws DO NOT identify a problem or question with yourself. Please ask your questions in the third person (he, she, we, it)

We appreciate your interest in this telemedicine demonstration project. At the end of thirty (30) days the results will be published here in Health Train Express. The announcement will be posted on Twitter @glevin1  Facebook/gmlevin and Google +.

“During the Google + Telemedicine Hangout you will be asked if you agree to having your interview recorded.  If you decline it will not be recorded.  The recordings will be available to a closed panel of physicians and well known patient advocate and will not be released to the general public.  The review committee will comply with HIPAA regulations to protect your identity.  Your waiver of HIPAA regulations will only apply to the G+ interview.

AGAIN, DO NOT IDENTIFY YOURSELF IN THE INTERVIEW ]

Health Bloggers, #hcsm, #healthit #mapp # healthreform and #telemedicine readers, if you wish to join a telemedicine hangout contact me via email  at  gmlevinmd@gmail.com. You will receive an invite for each conference.

I invite other physicians to join as part of this ‘ground breaking use of affordable and existing platforms. The platform will allow multiple consultations for an individual or group of patients.

Google has “mothballed” the Google Health personal health record for the time being. The statistical results of the study will be shared with Google in the interest of a professional encrypted platform in the future. 

Providers, I hope to see  many of you in this hangout.   Please use twitter, FB, and/or email to communicate with other physicians and providers regarding the demonstration project.