Readers Write: Why a Unique Patient Identifier is Critical to Improve Patient Matching

Why a Unique Patient Identifier is Critical to Improve Patient Matching
By Barry Hieb, MD

In a recent HIStalk article entitled “National Patient Identifier: Why Patient Matching Technology May Be a Better Solution,” Vicki Wheatley argues that, “… healthcare organizations should instead focus on strengthening their existing enterprise matching strategies” rather than work to implement a national patient identifier (NPI). The article makes several valid points that contribute to the ongoing debate about an NPI:

• No solution, including an NPI, can solve all patient matching problems.
• Patient matching errors and healthcare fraud will continue to require special attention.
• Accurate tracking of an individual’s information across healthcare silos is becoming increasingly important.
• Any proposed patient matching solutions must not negatively influence privacy, security, or clinical outcomes.
• Accurate patient matching is essential for activities ranging from clinical care to healthcare analytics to population health management.

In these and several other areas, Ms. Wheatley’s article makes a valid contribution to the ongoing debate concerning a national unique patient identifier.

There were a few areas, however, where we have a somewhat different viewpoint. The first of these is the implied assumption that healthcare organizations must make a choice between having an EMPI and having a national patient identifier. We believe that this is a false dichotomy.

Clearly, healthcare organizations must continue to improve their existing EMPI systems as much as possible. However, years of analysis and experience indicate that this will not allow them to achieve the levels of patient matching accuracy that are being required going forward. Those requirements include identification of individuals across disparate healthcare systems, the need for matching against ever-increasing patient populations, and the fact that patient demographic data has known variability and ambiguities.

These represent just three of the reasons why unassisted EMPI demographic matching cannot represent the sole patient matching strategy. Rather, the EMPI approach will need to be supplemented by techniques such as the use of an NPI, biometrics, digital certificates, and other technologies.

Virtually every EMPI system uses a patient’s Social Security number as a data element to improve the performance of their demographic matching algorithm. I was puzzled by the statement, “… even in theory, every single potential patient in the country would need to be assigned one…” as a condition for an NPI to work. Ms. Wheatley acknowledges that there are many people in the US who require healthcare but do not have an SSN. Despite this deficiency, the use of the SSN clearly adds value in those situations where it is accurately available. Similarly, an NPI would benefit each patient who chooses to use one.

An important point to keep in mind is that there is no mechanism to check for data entry errors in most of the data elements currently used for demographic matching. This includes the SSN, names, and addresses. For example, there is no reliable way to detect transposition of digits when a SSN is manually entered. Nor is there an easy way to automate the capture of a patient’s SSN.

Contrast that with a well-designed national patient identifier system. In most situations, the NPI would be read using automated technology such as a barcode reader or a smart chip that would virtually eliminate errors. Even when the NPI is manually entered, embedded check digits can ensure that any data entry errors are immediately detected and the operator is prompted to re-enter the NPI. When added to a person’s demographic profile, the NPI thus becomes the single demographic element that can lead to accurate patient identification on its own. These proposals represent a major advance from the current situation – i.e., an 8 percent or more error rate in EMPI matches.

It is very clear that healthcare organizations will continue their use of EMPI systems for the foreseeable future. That fact, however, should not blind us to the reality that these EMPI systems need to be augmented by additional capabilities going forward if they are going to meet the patient matching accuracy needs that are emerging in healthcare.

The use of a national patient identifier, even if it is initially only chosen by a subset of providers (or patients, on a voluntary basis), will enhance the patient matching accuracy for those patients and help avoid the medical errors that are associated with patient matching errors.

Barry Hieb, MD is chief scientist with Global Patient Identifiers, Inc. of Tucson, AZ.

Readers Write: The Data Problem

The Data Problem
By Randy Thomas

Dr. Jayne asked important questions in her Curbside Consult about big data, EHR conversions, the “sheer magnitude of bad data out there,” and how best to insure the integrity of health data.

The best way to address the issue of bad data is to follow the old adage,“Begin with the end in mind.” Implementing an enterprise-wide EHR is a massive, complex undertaking. It involves considering the needs of many stakeholders when defining the build requirements. For example, workflow must support ease of use and not interfere in patient care delivery and related work processes. Furthermore, many implementation decisions focus on driving clinician adoption to ensure that both quality and efficiency objectives are met (not to mention regulatory requirements related to Meaningful Use.)

With all the multi-threaded work streams and decision processes involved in planning and executing an EHR implementation, the re-usability of captured data frequently falls out of scope. That leads to the bad data problem.

Re-usability means using data captured in any source system (EHR, ADT  materials management, patient accounting, registration, operating room, emergency department, etc.) for reporting, measurement, and analytics. Re-using the data captured in these source systems accelerates the value realized from implementing such systems and supports a virtuous cycle of performance improvement across an enterprise.

It all relates to, “You can’t manage what you don’t measure.” That is, you can’t measure something if you don’t have the right data. This leads back to the decisions made in implementing EHRs and other systems. You need to start with what data is required to measure and analyze what’s important to the organization and ensure that data can be consistently, reliably, and accurately captured at the point of origin (e.g., at registration or in the care process).

It’s not realistic, however, to expect that every bit of data about a patient should be captured in a discrete form for re-use. What’s required is a balance between supporting ease of use in the appropriate workflows and the availability of data for reusability.

An effective way to strike this balance is to create a list of data elements the organization agrees is necessary for analytics. Some detective work is required: tracing the journey of that data back to the source system and ensuring that each data element is captured as expected in the intended workflow. This requires collaboration across a multi-disciplinary team — one involving experts in quality reporting, data analysis, and clinical (or operational) workflow.

The inventory of data elements can be used to identify where each data element can be captured in the source system (e.g., EHR, ADT, etc.). This is the “data chain of trust.” Team discussion and compromise are required to design workflows that both support ease of use and capture data reliably and consistently.

With a documented inventory of data elements married to how that data will be captured in the source systems, data can start flowing into an analytics environment. Applying sound data governance principles and implementing a data profiling discipline will ensure data consistency and reliability.

Organizations don’t have to begin with a large set of discrete data, but they must recognize that any level of measurement, reporting, and analytics requires consistent, reliable, accurate data starting at the point of capture in the source systems. They should begin with the data most important to each organization and ensure that data can flow from origin to analytics in a chain of trust that is known and transparent.

From there, health systems can incrementally increase the available data as they come to understand why it’s important to capture data discretely and accurately and as more stakeholders benefit from access to that data. With the increasing value realized comes the understanding that, “It’s all about the data.”

Randy Thomas is associate partner of health analytics with Encore Health Resources.

Readers Write: National Patient Identifier: Why Patient-Matching Technology May be a Better Solution

National Patient Identifier: Why Patient-Matching Technology May be a Better Solution
By Vicki Wheatley

Advances in technology, combined with The Patient Protection and Affordable Care Act, have begun to revive calls in the media for a national patient identifier—similar to the national provider identifier (NPI) assigned to physicians. The HIPAA legislation of 1996 included provisions for such an identifier, but they’ve never been enacted out of concerns for privacy and security.

Despite current law prohibiting the use of national patient identifiers, many proponents say creating such an identifier would make it easier to track patients across the continuum of care, leading to more effective treatments and better outcomes for patients. Others believe existing credentials such as Social Security numbers make a national patient identifier unnecessary. Lost in all the debate, however, are patient identification issues that will always exist—whether a national patient ID does or not.

Although adding a national patient identifier would provide one more data element to help confirm a patient’s identity, it still wouldn’t resolve some key record-matching challenges, nor would it fully enable organizations to use data for analytics, population health management or accountable care.

For a national identifier to work, even in theory, every single potential patient in the country would need to be assigned one—and only one—number and use it consistently. This holds true whether we generate a new identification number or use an existing one, such as a Social Security number.

For the sake of argument, let’s say Social Security numbers were to be used as national patient identifiers. Truth be told, many individuals living in or visiting the US don’t have Social Security numbers, like newborns or foreign visitors. Others may be fraudulently using someone else’s number for employment or other purposes. Additionally, using Social Security numbers as patient identifiers likely would raise security and privacy concerns due to the amount of financial and personal information already tied to them.

Just as the NPI has not been the fix-all for helping healthcare organizations exchange provider information, implementing a national patient identifier or using Social Security numbers will not resolve patient identification issues either. The reason: it won’t address concerns regarding existing information discrepancies or duplicate patient records. Additionally, like any identifier, it can be mis-keyed, transposed, or even stolen. Adding yet another identifier does not solve the patient matching conundrum.

Rather than advocating for a panacea that won’t solve the problem, healthcare organizations should instead focus on strengthening their existing enterprise patient-matching strategies, which can be easily implemented within individual organizations.

In order to provide optimal care, clinicians need to have an accurate view of the individuals they treat. Likewise, organizations as a whole must know who their patients are, what coverage they have, and which payer’s rules they must adhere to in order to receive payment. All of this information is particularly valuable when patient data is being used for analytics, accountable care, or population health management.

Thus, resolving patient identification problems is essential not only for enabling quality care, but also for supporting the financial viability of the healthcare organization. The challenges are further compounded by the fact that patient data resides across disparate systems encompassing the patient’s entire continuum of care. As a result, available patient data must be accurately linked together from within and across multiple organizations.

Unfortunately, however, errors occur. Registration staff may inadvertently transpose numbers, record nicknames instead of legal names, or fail to validate and update key data elements. Patients change addresses, phone numbers, insurance coverage, and names all the time. Data provided and collected is not always complete or accurate. Some patients forget information; others even want to hide it. To err is human, but mistakes introduced into patient records lead to discrepancies and duplicate patient records that complicate the patient identification process.

Patient-matching technology within an enterprise master patient index (EMPI) allows hospitals and health systems to bring together disparate information from various IT systems within or across organizations. This is essential for effectively managing the patient population and preparing for payment reforms. For example, an EMPI that compares patient data using probabilistic matching tools and algorithms can generate a unique enterprise identifier for each patient, eliminating the need to change information in source IT systems and enabling exchange of clinical and financial data. With an EMPI, multiple key data elements such as name, birth date, gender, address, other identifiers, and even biometrics can be used to accurately identify patients, ensuring the data in front of providers matches the patients they’re treating.

It’s a fact: as long as people are involved in providing and entering information, some level of human error remains inevitable. Yet by employing a strong strategy to address underlying identification issues, hospitals and health systems can compensate for some of the human elements that will always complicate patient identification—with or without a national patient identifier in place.

Vicki Wheatley is executive vice president of enterprise master person index solutions of QuadraMed of Reston,VA.

Readers Write: Dr. Gregg’s “HIStalk: The Movie”

HIStalk: The Movie
By Dr. Gregg

It’s Oscar night tonight. I know this because in my house, that’s a pretty big deal; my wife is one of the most star-struck people walking the planet.

And, as it’s a night of glam and glitz and red carpets and such, it seems an appropriate time to announce the upcoming release of the star-studded extravaganza, “HIStalk: The Movie.”

No doubt you’ve heard the rumors… and it’s true! HIStalk is coming to the big screen. Featuring a cast of some of HIT’s biggest stars, including:

The one, the only – MR. H! Nobody tells it like the inimitable, and wholly inscrutable, Mr. HIStalk. Now he tells it like it is in full, glorious Technicolor with thundering DTS surround sound. Hear Mr. H blast the blatantly bland and debunk buffaloing bloggers. See him – fully facially pixelated – tear through HIT hype and tripe. Watch as he snags rumors from the ethers and exposes the raw underbelly of the simmering underworld of HIT.

The perpetually 28 year old party girl – Inga! Nobody glides through the HIMSS exhibition halls with more panache than the sultry Swede. Watch her dance the night away with HIT celebs Farzad, Jonathan, Ivo, and many more meaningfully-used macho men. Sporting in the finest footwear this side of the Champs-Elysées, she’ll dance her way straight to your hard drive.

The ever-running, always stunning – Dr. Jayne! Hear the good doctor call out unscrupulous C-suite commands for harmful cost-cutting. Watch her shoot down ill-considered patient care policies and lambast ludicrous Luddites. She’ll run a marathon of mischief as she bears the banner for CMIOs everywhere.

The million dollar mobile man – Dr. Travis! Once again riding the WiFi waves of justice, Dr. Travis will keep you in mHealth stitches as he exposes new tech that doesn’t deliver and sorts out the portably important from the connectedly comic.

The man – Lt. Dan! Need we say more?

The vivacious new HIStalk vamp – Lorre! Supremely smart and stunningly sassy, this demure little vixen will warm your digital hearts as she becomes HIT’s newest pin-up girl. We’ve no doubt that after the world sees her stunning debut performance that she’ll be adorning screensavers like no one since Farah Fawcett.

You’ll gasp in awe at the beautiful panoramic sets designed and painted by the hand of Regina Holliday.

You’ll be blown away by the homespun humor and heartwarming insights into all things HIT based upon Ed Marx’s award-winning story.

You’ll never forget the effortless flow and seamless style of Dr. Rick’s screen adaptation.

You’ll delight in the scintillating score by the lyrical genious, Dr. HITECH, founder of The American College of Medical Informatimusicology (ACMImimi.) Performed by the entire ensemble of illustrious ACMImimi fellows, you’ll hear health information rock like you’ve never heard it before.

Get out the popcorn and pull up your favorite easy chair for tonight’s Oscars, but get ready really enjoy them next year when “HIStalk: The Movie” will undoubtedly take home all the golden statues setting new standards for both Hollywood and HIT.

From the trenches…

"Never give up. And never, under any circumstances, face the facts.” – Ruth Gordon, Best Supporting Actress, “Rosemary’s Baby”

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

Readers Write: Little Data

Little Data
By Greg Park

Today’s topic is the methods by which employees and partners obtain information to perform their function, or as I like to call this, the Push vs. Pull method of information dissemination.

Let’s step inside the way-back machine to observe how this was accomplished in 1986.

I was cutting my HIT teeth first as a computer operator and then as “do-everything” guy at a mid-sized hospital in Philadelphia. There were few standards and no one with HIT degrees. You learned from the vendors, by reading technical manuals, and by putting out fires.

My first big hospital project was implementing Shared Medical Systems Spirit platform, which was SMS’s first turn-key mini platform. This led to managing other tertiary clinical applications and methods of creating information.

Each new platform we installed was bundled with standardized reports focused on daily activities, DNFB accounts, and payments by patient type. All reports were QA’d by vendor and staff prior to go-live to certify accuracy. These standard out-of-the-box reports were the lifeblood of staff’s workflows, and believe me, I would hear it if they weren’t delivered by 6:00 a.m.

Reporting exploded as data became richer and tools emerged to create specialized ad-hoc reports. Soon we were creating ER patient flow analysis, profitability by attending physician, nurse staffing by patient acuity, and then linking data between disparate platforms.

Life was good, but we were killing thousands of trees each month. End users were happy because the process of creating these ad-hoc reports was very personal. I would sit with end users to analyze their needs against the data collected. When required, we would add new data fields and workflows to collect that information accurately in our various platforms. Finally we would validate output structures, ensure accuracy, and finally schedule the reports for the desired timeframe.

Each day or week or month, the report would print. As time marched along into the 1990s, we downloaded all reports into our content management platform. Now all reports were readily accessible and audit trails let us know exactly who was (or was not) reviewing their reports.

My formative years were spent in this way understanding need, locating data, and constructing formats to enable user workflows. These were the “Push” years, because it was our responsibility to ensure the report, spreadsheet, or database was created and pushed to users and business partners in a timely way.

Somewhere in the mid-1990s it became clear that something was changing. During a PeopleSoft implementation, I noted that disk space and CPU resources were significantly more robust than the platforms I had encountered. Data could be kept almost indefinitely and sophisticated queries could be run in real time rather than waiting for a day-end process. The writing was on the wall, but the major HIT platforms would take years to catch up. Many hospitals still operate like its 1985, some with basically the same HIT platforms.

The rest of this writing involves relaying the conversations I have had with my customers, so if this is not your experience, please chime in.

Most new EMRs are fashioned with limited standard reports. End users have become the focal point in the process of generating all reports. Generating reports and pushing them to their intended audience has become an anachronism. Let’s call this new method the “Pull” method, because users are expected to pull the data themselves. In this Pull method, users access report writing tools and pull data on their own terms as needed. To the system designers, this must have been intended as empowerment, but for many users it is a speed bump that did not exist before.

This Pull method can be implemented in various ways. In some, the IT department creates general templates for users to enter query parameters. This works fairly well, but does not address those reporting situations where the timing of data generation is critical. The report will look different if run on August 31 as opposed to September 10, and sometimes this is a problem.

Another method is to provide the user with a full query interface. Now end users are playing the role of IT analyst. Maybe this is fair and is a reflection of how IT is part of everyone’s jobs today, but it can be problematic when users select the wrong data or create a query that is particularly taxing to the EMR or its reporting database. In this world, we have a real problem of focusing on the wrong data, or worst yet, not focusing on the data at all.

For the moment (because I know that once HIT is exposed to big data this will change) patient accounting and general finance are your biggest data consumers. From my perspective, they seem particularly annoyed with this new Pull mentality. Many of these users access these new systems exclusively to generate their own reports.

For me, life is always about balance, and I think both the Pull and Push methods have their place. Pull methods are fine in some scenarios, assuming your end users know how to data mine and construct data exports. But when the situation is time sensitive, I want tools that Push information to responsible parties. This means end users are immediately notified the information exists, that it is readily accessible, and that they are expected to review it immediately.

I know this topic is not at the top of your mind considering MU, ICD-10, and all of your other requirements, but think about it during some downtime and consider whether you are doing your best to get the right information to the right people at the right time.

Greg Park is director of enterprise solutions for Dbtech of Edison, NJ.

Readers Write: How Many More Reasons Do You Need?

How Many More Reasons Do You Need?
By Tom Furr

The US Postal Service recently raised the cost of a first class stamp to $0.49, a 6.5 percent increase. Darrell Issa, the Congressman chairing the committee that approved the rate hike, admits, "This rate hike and the ones sure to follow will only push more and more private sector customers to stop using the mail altogether. The rate increase poses a direct threat to the 8 million private sector jobs that are part of the mailing industry as businesses shift from paper-based to electronic communication and mailers are priced out of business."

Think about it. If you had a supplier that said, “We are losing money because nobody really needs our product any more, but we are raising our prices so we can try to hang on a little longer,” how much longer would you stay with them? Or if I told you that your COGS was going up 6.5 percent and you had no alternative in vendors or processes, you might start looking at your business model and thinking about a way to work around that vendor.

In addition, bulk paper costs are expected to rise 2.5 to 6 percent over the next year. I can promise you that your vendors are not going to absorb those costs. If you are responsible for collecting payments from patients on behalf of hospitals and practices, it is a stone cold fact that you are going to see your costs rise next year. I wish I had better news for you, but unless you change something soon, you are going to have some very hard choices to make.

Once choice you can make now is to look at shifting to an online solution that allows you to present patient statements and collect payments easily. It’s not just what you need, it’s what patients want. I was talking to Allen Warren of A&H Billing last week and he explained that he adopted online bill pay because that’s what he prefers when he pays his bills. “When I talk to folks in this business, I ask them, ‘How do you pay your bills?’”, he said. “The funny thing is they all sort of laugh when they think about it. It seems so obvious when you step back from it.”

It’s no secret that I have been looking to drive online payments for our partners, but when the USPS admits that today more than 60 percent of Americans are paying their bills online and their response is to raise rates, how is that good business? It’s going to make consumers look for ways to not use their service. The question is do you want to go for that ride to the bottom with them? I know I don’t, and while I used to look at companies that offered online bill pay as innovative, I now just look at them as sensible.

The cost of postage is going up, the cost of paper is going up, and consumers want to pay their bills online. How many more reasons do you need?

Tom Furr is founder and CEO of PatientPay of Durham, NC.

Readers Write: The Symbiosis of Care: The Re-Emergence of Professionalism and the Patient Satisfaction Impact

The Symbiosis of Care: The Re-Emergence of Professionalism and the Patient Satisfaction Impact
By Paul Weygandt

As a physician, it’s second nature for us to make sacrifices for the betterment of others, whether that entails missing the first half of your daughter’s soccer game to listen to a husband who is losing his wife to cancer or working 80 hours a week.

Having been in these situations, I can honestly say – and I believe the vast majority of physicians would agree – it doesn’t feel like a sacrifice. It is an unconscious reaction to another person who is in emotional or physical pain. In many ways, being a physician is instinctual – you automatically prioritize others’ needs over your own. And again, quite honestly, in my many years of practicing medicine, I rarely had to deliberate on where I needed to be – when you’re a physician, you just know.

The ability to provide care may come as second nature, but things like using ICD-10 compliant clinical documentation do not. It is no secret that changes in regulatory policies are placing new pressures on physicians and taking our focus away from patient care and practicing the art of medicine. Regulatory requirements are directly impacting the physician-patient relationship. 

While capturing data on the patient experience is important, evaluating the physician experience and then acting on that data is of equal value. According to a recent American Medical Association/Rand study on physician satisfaction, quality of care is inextricably tied to professional satisfaction, and many obstacles to high-quality care are seen as major sources of dissatisfaction. The converse is also true. Any major source of physician dissatisfaction is an obstacle to high quality care.

We’ve found ourselves in a Catch-22. Government regulations are designed to improve patient outcomes, but they are doing so at the expense of those who are providing that care. The two most visible groups in healthcare are patients and physicians, and right now both are suffering under the burdens of a poorly designed system. Patients feel neglected and physicians feel like cogs in a wheel or workers on the healthcare assembly line, devastating medical professionalism and negating the patient benefits of that professionalism.

The ramifications of this situation are severe. After all, everyone has a breaking point. When 60 percent of physicians admit they would retire if they had the means to do so, it’s no longer just an isolated incidence of one or two hospitals’ poor processes or a few old physicians struggling to embrace new technology that is causing the problem. This has become an epidemic that is threatening to decimate our physician community across the country. It isn’t just a handful of luddites refusing to change with the times; it is something much deeper that is cutting at the very core of the medical profession and the physician’s vocation.

Now we’re back to that second nature ability that physicians possess. Physicians willingly made the conscious decision to dedicate their lives to others — to sacrifice for others. They didn’t pledge themselves to filling out onerous paperwork or to looking at a computer screen instead of into the eyes of their patients. It is time for the innovators, particularly those in the health IT community, to listen to physicians, conduct pain tests or do an Apgar score of sorts to closely monitor the health of the profession, and suggest new solutions that can begin to alleviate the discomfort of a sick healthcare system.

If non-essential busy work and non-patient demands can be decreased or eliminated, I think we will find that, once again, that physicians are able to spend their days caring for their patients. Addressing and fixing the myriad of non-clinical issues facing physicians will allow a rebirth of professionalism. That professionalism is, in turn, the basis for high quality care and patient satisfaction.

Paul Weygandt, MD, JD, MPH, MBA, CCS, FACPE is vice president of physician services of Nuance Communications of Burlington, MA.

Readers Write: Ominous Outlook for Meaningful Use

Ominous Outlook for Meaningful Use
By Evan Steele

CMS passed up a golden opportunity to stave off the potential demise of the EHR incentive program when it failed to delay the start of Stage 2. What was already a complex program in Stage 1 becomes exponentially so in Stage 2, and its pace is outstripping the realities of medical practice and of software development. The facts speak for themselves:

• 17 percent of the physicians who successfully attested to 90 days of Meaningful Use at Stage 1 in 2011 walked away from the second incentive ($12,000) in 2012, which required a full year of Meaningful Use. I find this dropout rate very surprising. The requirements were exactly the same as the first reporting period for these physicians, so they and their staffs had already established the necessary workflows. The fact that many of these first attesters were early EHR adopters and therefore already more adept at EHR use than the average physician makes this statistic even more alarming. When surveyed by CMS, many of the dropouts cited the program’s complexity as a key reason for their failure in Year 2. Physicians who gave up on Stage 1 will likely not even attempt Stage 2.
• 12 percent of attesters who used one of the top 25 EHRs to demonstrate Meaningful Use in Stage 1 do not yet have access to a 2014-certified EHR, according to a January report issued by Wells Fargo Securities, while this year’s reporting period must begin within nine months. Some EHRs will never achieve 2014 certification. The first announcement of a vendor abandoning Meaningful Use came a few weeks ago, leaving its physicians out in the cold. Of the 49 ambulatory EHRs that have been 2014 certified to date — winnowed down from a Stage 1 field of 472 — very few have yet been deployed to physicians. This is clear evidence of the complexities associated with Stage 2 and the significant challenges facing vendors in making their EHRs compliant yet practical.
• I would estimate that at least another 15 percent will walk away from Stage 2 because of its dramatically increased complexity, added costs, and impact on productivity, particularly when weighed against the declining incentives (as little as $4,000 and $2,000 for physicians whose first year of Meaningful Use was 2011) and penalties that will average only a few thousand dollars.
• How many additional physicians will be driven to cry “Uncle” and abandon Meaningful Use because they are besieged by the demands of so many other programs at the same time—ICD-10, PQRS, Value-Based Payment Modifier, ACO participation, etc.? Physicians and their clinical teams are weary and can only do so much.

If you add these numbers together (acknowledging some overlap), the conclusion that 40 percent of past attesters will give up on Meaningful Use is inescapable. Then there’s the 37 percent of eligible professionals who have never earned an EHR incentive, including 18 percent who—if failure to even register is an indication of lack of intent—are so overwhelmed by the program that they have no interest in participation even in the “easiest” first stage (Source: CMS Presentation to HIT Policy Committee, January 14, 2014).

The delay of Stage 3 will be too little, too late. What was needed was a more reasonable approach to Stage 2.

Evan Steele is CEO of SRS, Montvale, NJ.

Readers Write: Once a Nurse, Always a Nurse

Once a Nurse, Always a Nurse
By Lisa Cannon

We all wear various hats in our lives, but some experiences are never forgotten. Through the years, I’ve been the road warrior healthcare consultant and then moved to positions supporting consulting operations. Yet nothing remains in my heart more than my early days as a nurse. I never knew how much I would appreciate having been a nurse until my mom’s health took a sizeable downward turn last year.

My mom’s chronic cardiac condition resulted in several hospital visits and treatment by various specialists in her last months. At home, coordinating her care among her medical team was no easy task. Keeping her out of a nursing home meant visits from home health nurses, nurse aides, and multiple therapists. This was a great deal of care synchronization for my aging father to deal with, but he welcomed it, knowing the alternative. He organized her medications and had everything written down. Thanks to my nursing background, I trained him in the art of taking her blood pressure, doing daily glucose checks, and measuring her oxygen saturation.

I was constantly running cover on what was being prescribed for Mom and monitoring how Dad was delivering the recommendations. Sadly, we hit an issue that in hindsight makes me question if it was the action that ultimately caused her death. Could information technology (IT) have made a difference? Perhaps. Maybe the application of common sense and additional family education could have.

Mom’s renal specialist ordered a diuretic water-releasing medication to be given once a day for seven days with a quantity prescribed of 14. The discrepancy between the dose and the quantity wasn’t realized immediately. After Mom fell twice, at a subsequent visit to her primary care physician, my dad indicated he was still giving this medication. That’s when we realized we had a serious issue. This was Day 13, well past the seven-day mark. Mom had received the medication for almost a full week more than had been intended. We realized it was significantly lowering her blood pressure.

I questioned the pharmacy that filled the prescription. They indicated they just did what the physician had written. I was outraged. Could they have provided some family education and made that clear? Since there were still pills in the bottle, Dad merely was continuing to give the medicine. Could a computer system combined with standard operating procedures prompt alerting of education requirements for a time-limited dosing medication helped? I think so.

After subsequent falls, my mom ultimately was admitted to the hospital, where a CT scan showed she had developed a massive brain hemorrhage. Dad and I were told that the combination of falls and blood-thinning medication resulted in a weakened blood vessel in her brain, which finally gave out.

Afterwards, when the renal specialist was asked why the prescription was written the way it was, she remarked that it was so we wouldn’t have to return to the office should we have needed to continue it. In her mind, she was doing us a favor.

This experience made me wonder how patients without involved family members manage their medical care journey as their health deteriorates. While I may have forgotten all of the details of the ICU setting I spent so much time in years ago, I am very thankful for the skills I learned and my ability to recognize the situation regarding the healthcare needs that come to the surface.

Having witnessed firsthand patients struggling with understanding their care requirements, it reiterates to me the imperative that health professionals do their part in educating patients and their families and communicating specifics. Training my dad to take blood pressure and glucose checks was possible (and these days, essential). His recognizing a perfect storm of low blood pressure, over diuresis, and blood-thinning medicines was not.

As healthcare IT professionals, we can’t forget that the role of IT is to supplement common sense and standard operating procedures, not to replace it. There is no fail-proof means to ensure mistakes don’t occur, even with the best of intentions and systems. We must remember that the people, process, and technology changes we’re making impact real people every day. Are we making healthcare better? We must –our families are counting on us. 

Lisa Cannon is director of resource management for Aspen Advisors of Pittsburgh, PA.

Readers Write: The Revenue Cycle’s Transformation with Big Data

The Revenue Cycle’s Transformation with Big Data
By Steve Johnson

Big data is pushing clinical care to new heights as healthcare organizations use it to support diagnoses, target care delivery, and improve patient health outcomes. Organizations can realize a similar level of success in the revenue cycle when they apply data and analytics to the myriad of steps involved in billing and collections.

When organizations effectively leverage financial and administrative information — such as claims, payer payment, cost, patient financial, and patient demographic data — they can see improvement on both the front and back end of the revenue cycle. For example, organizations can use data to increase collections by detecting fraud at registration, quantifying patient payment responsibility, identifying patients who qualify for financial assistance, and revealing errors that impact billing.

Strong data and analytics can also drive more accurate revenue forecasting. Unlike the past, where healthcare organizations relied on historical summary statistics to predict future financial trends, big data empowers a real-time view of individual patients and their financial situations. When aggregated, this data allows an organization to make an accurate bottom-up forecast of revenue. In other words, organizations can leverage specific account information to build a collective model of overall performance based on each patient’s unique financial situation.

Just as big data can improve forecasting, it also can enable more exact patient population benchmarking and assist in decision-making relative to those populations. For instance, data and analytics can show how a facility’s patient population compares with the general patient population regarding financial need. This level of data and analysis facilitates deeper patient segmentation, clearly differentiating those more likely to qualify for assistance compared to the surrounding geographic area. In addition, data and analytics help define optimal workflows or interventions for specific groups.

Organizations already have all the big data they need to effect change: financial, administrative, and claims and payment data are all present in an organization. To get the most out of this data, organizations need to link it together and form one complete picture of the patient experience. This will provide a better understanding of the patient’s current and historical situation and allow for stronger forecasting and risk mitigation as well as enable better financial conversations with patients.

Patients usually welcome conversations about their financial responsibility and how they can meet it, especially those who do not understand the complexity of their coverage and may not know the right questions to ask. By using financial and administrative data to determine the best financial course of action for a patient, staff can proactively offer different payment options and answer patient questions, increasing the likelihood of patient payment, improving collections, and strengthening the revenue cycle. This data-driven, customer-focused approach also reaps the added benefit of higher levels of patient satisfaction.

Clinical use of big data has dramatically impacted care delivery. The time is right to adopt the same philosophy for the revenue cycle and leverage big data as a business tool to strengthen billing, collections, and overall financial operations.

Steve Johnson is chief technology officer and vice president of data and analytics at Experian Healthcare of Austin, TX.

Readers Write: Next Steps at ONC

Next Steps at ONC
By Helen Figge

The new leader, Karen DeSalvo, MD, has been appointed at ONC. It is anticipated that ONC is set to continue  the creation of an interoperable, private, and secure nationwide health information system  with the ultimate goal of supporting widespread distribution of data. More importantly, widespread implementation of Meaningful Use of healthcare technology.  

Many, however, still struggle to gauge what ultimately will be developed to facilitate the electronic exchange of health information. How will we launch the system, maintaining high quality along with security so that patient records are impenetrable to tampering?

The nirvana of the ONC program was to improve healthcare delivery alongside reducing healthcare costs.  But with uncertainty of where Obamacare eventually will land, and with all the other moving pieces like ICD-10, additional worries play into the overall scheme of just what the final healthcare landscape will look like. Not only to the healthcare providers, but to the consumer of healthcare, like you and me.

Besides the obvious conversations that we all hear centered around Meaningful Use, ONC has many opportunities to improve healthcare globally, most notably stressing and promoting early detection, prevention, and management of chronic diseases, which account for most of the healthcare expenditures we see today.

As we continue to see ONC evolve, let’s hope that the emphasis will not only zero in on Meaningful Use,  but also be energized for promoting such things as staying well through good health habits – wellness – in the various stages of our life cycles. Regardless of the technologies in play or the governmental regulations already set in motion, the key to the healthcare game is for consumers to stay healthier longer and be rewarded for maintaining a healthy state versus dealing with the aftermath of illness. 

This plays well into the ONC mission of eliminating health disparities among different populations and ensuring best practices regardless of geographic confines as well. There is a lot on the ONC table to continue to execute. Hopefully ONC will also affirm the need to have promotional campaigns for promoting early detection and prevention more effectively in the marketplace. This seems still to be void or at least not very noticeable from some vantage points.

Let’s not forget the ONC charge of establishing a governance for the Nationwide Health Information Network (now coined the eHealth Exchange), which when successfully executed, would be a Web-services based series of specifications designed to securely exchange healthcare related data.  

Independent of the leaders named at ONC, the arduous task of moving healthcare to the next level of quality will be at the forefront. A big sigh and a long pause will be needed to start the conversations with enthusiasm for sure, but in the end it will be just another day in the life of a CIO and the technology teams along with all of the healthcare providers in this era of Obamacare.

Helen Figge, CPHIMS, FHIMSS is is VP of clinical integration for Alere ACS.

Readers Write: Alerts versus Alarms – Not Just Semantics

Alerts versus Alarms – Not Just Semantics
By Brian McAlpine

We often hear references to “alerts” in the context of clinicians experiencing overload or becoming fatigued. For example, alert fatigue is a well-known problem whereby clinicians are constantly bombarded with multiple types of alerts, each designed to get their attention.

Alerts can come from many different sources, including the EMR/EHR, lab systems, CPOE, medication administration software, imaging systems, nurse call systems, and many other sources. Almost any system in the clinical environment can generate an alert.

For the purposes of limiting the scope of this discussion, let’s limit the definition of “alerts” to the patient care environment and direct patient care. Using this working definition, I would also say that a nurse’s phone that receives alerts or can process text messages can also generate alerts (i.e. via a beep or vibrate) that let the nurse know when a new message has arrived.

Recently there has been increasing industry discussion and focus on “alarms” and the problem of alarm fatigue. The Joint Commission’s NPSG06.01.01 has raised the awareness of this problem and now hospitals must start to pay close attention to which medical devices and corresponding alarms are contributors to alarm fatigue. 

Both alerts and alarms interrupt the clinician and can be a source of distraction that leads to critical errors, so what’s the difference? There is a big difference, especially when provider organizations attempt to get their arms around these problems.

This is really a problem where healthcare as an industry needs to focus and prioritize what is most critical. When you look at the key differences between alerts and alarms, you can further appreciate why the Joint Commission has taken action for the second time in the last 10 years, the first time being here with the National Patient Safety goal for managing audible alarms.

Alarms are typically derived from medical devices and often communicate an immediate life-threatening patient condition. Think a v-fib or asystole alarm from a patient monitor. Alarms are always more time sensitive and a delay of a few seconds may matter to the safety of the patient. Another key characteristic of alarms is that they are almost always intended for nurses or respiratory therapists (i.e. non-physicians). Physicians do not deal with alarm response – that is for nursing to handle. Finally, alarms are always regulated by the FDA from both the medical device side (alarm generation) and from the perspective of an alarm management middleware. The FDA regulates the alarm management middleware vendors through the 510k process. As a result, only a few vendors can offer an alarm notification capability because of strict FDA 510k regulations.

But what about alerts and vendors that integrate alerts? Shouldn’t these be regulated just like alarms? The answer lies in the definition of alerts and the key differences as compared to alarms. Alerts are usually not associated with medical devices and are not immediately life threatening, but could be very serious. A big difference is that alerts are not always immediately time sensitive — a delay of 30 seconds or even several minutes often does not matter like it does with a patient monitoring alarm. In terms of who typically receives alerts, these can be intended for any clinician, and often physicians receive alerts generated by systems such as the EMR. Another major difference is that alerts are generally not regulated by the FDA like medical device alarms are.

Because of these differences, many vendors can (and do) offer an “alerting” capability. The barriers to developing an alerting or alert notification feature are simply a lot lower when compared to developing alarm management middleware. But what does this mean in practical terms to a hospital looking at the diverse set of vendors that blend alarms and alerts all together into one confusing message about what their solution is really capable of? One key way to cut through all the hype is to follow the Joint Commission’s lead and focus on medical device alarms as a key starting point.

The Joint Commission just recently released its R3 Rationale report in response to its NPSG.06.01.01 for alarm system safety. A key statement in this report outlines clinical alarms as being more critical and a higher threat to patient safety as compared to “alerts”. In fact, the report explicitly states that the NPSG does not address “items such as nurse call systems, alerts from computerized provider order entry (CPOE), or other information technology (IT) systems.” It is obvious that the Joint Commission thinks the best starting point is with an evaluation of medical device alarms.

This is clearly only the starting point because we have to go back to the bigger problem as stated at the beginning of this post . Alerts and alarms interrupt the nurse and increase potential for errors in the care environment. You have to start somewhere, and by starting with alarms, you can get a handle on addressing a very key issue. This will lead to a foundation and framework that will enable you to more effectively address the alerting problem in the future.

What do you think? Are alarms the right place to start?

Brian McAlpine is VP of product management and marketing at Extension Healthcare.

Readers Write: Ten Steps for Surviving ARRA and ACA Requirements in 2014

Ten Steps for Surviving ARRA and ACA Requirements in 2014
By Dick Taylor, MD

The 2009 American Recovery and Reinvestment Act (ARRA) changed the healthcare IT landscape for providers by offering money in exchange for the adoption and implementation of electronic medical records. One year later, the Affordable Care Act (ACA) upped the ante with new regulations for privacy, accountable care, and insurance coverage. The combination of the two acts has left most providers and provider organizations struggling to see the forest through the trees as we enter 2014, and the deadlines for both acts draw ever closer.

Controversial from the start, the Affordable Care Act (ACA) was landmark legislation three years ago. It remains front and center after being tested by the Supreme Court, a presidential re-election, and most recently, a government shutdown. Like the ARRA, much of it is yet to be written, requiring tens of thousands of pages of regulations to explain the details. Like the ARRA, it is deeply flawed in places and will require many years of refinement.

The ACA tries to supercharge the required transition from a reactive, episodic care based payment system to one that might reward preventive care, wellness, and patient outcomes. Providers generally see the promise, but they almost universally question the ability of the law to achieve its outcomes, particularly in light of modern medicine’s rapidly changing cost factors.

Healthcare is getting more expensive, and the healthcare IT transition mandated by the ARRA has not yet reached the break-even point for expense control for many (if not most) provider organizations. Demand is down in many segments, particularly for inpatient and elective procedures, and margins are under heavy pressure.

To make matters worse, regulatory oversight is rising and is highly unpredictable. As an example, on September 1, 2012, CMS finalized a rule that gave eligible providers until July 1, 2014 to begin attestation for Meaningful Use. Up to that point, providers generally believed that they had 15 months longer. In contrast, the ICD-10 implementation date was arbitrarily delayed a full year in August 2012 from October 1, 2013 to October 1, 2014. Regulatory changes of this nature are difficult to predict and require both flexibility and preparation from providers.

As we enter 2014, the final sprint toward ARRA and ACA’s deadlines, surviving this environment will require providers to focus on achieving the following goals over the course of the coming year.

1. Reduce expenses, both per-patient and fixed overhead. Admittedly, this is easier said than done.
2. Where practical, grow larger through acquisition or affiliation. This spreads fixed overhead over a larger patient volume and allows much more efficient team-based and whole-patient care. Growth must however, be calculated and managed to capture these savings. Rapidly growing organizations must be especially watchful to avoid operational and cultural traps.
3. Achieve Meaningful Use and avoid ARRA Medicare penalties. Providers who have missed Meaningful Use to date are now looking at reduced awards and penalties (amounting to small but significant percentages of CMS billing) beginning in just over a year.
4. Achieve ICD-10 compliance on time (by 10/1/14) without destroying the organization. While ICD-10 is critical (not billing with ICD-10 is simply not survivable for most providers), this has become the Y2K for healthcare. Caution, particularly around involving physicians and mid-level providers in the minutiae of coding, is strongly advised.
5. Pursue transparency for quality outcomes and cost. Payors, employers, and patients are all watching these very carefully, and organizations who are not forthcoming will become less favored over time.
6. Pursue transformation in long-term healthcare, including population health, chronic disease management, and wellness. Fee-for-service is likely to become far less sustainable as a primary business model over time.
7. Reduce clinical variation, both by pursuing good evidence (where available) and by achieving agreement on leading practices among providers. Much of the variability in clinical care is not associated with improved outcomes and some of it is actively harmful, both in cost and patient outcomes.
8. Recognize and honor the risk you own. Health systems have always owned the risk for charity and self-pay patients. The ones who recognize and accept this are much more likely to provide good care and keep costs under control.
9. Look for whole-patient (“accountable”) care opportunities within your own orbit. While the ACA set out the framework for Accountable Care Organizations, the reality is that these are still embryonic. Organizations that begin at home will be ready for risk-sharing moving forward.
10. Treat your IT expenditures as long-term investments, not expenses. Organizations should expect to spend an increasing percentage of capital dollars building technology assets. Acquire standards-based IT assets that will stand the test of time. Expect, plan, and capture the hard- and soft-dollar returns from them. Organizations that view IT simply as an expense will forego future profits in the pursuit of short-term efficiency.

Dick Taylor is managing director and chief medical officer of MedSys Group of Plano, TX.

Readers Write: 2014 Resolutions

2014 Resolutions
By Vince Ciotti

I’m getting ready to wrap up the HIS-tory series with the final episodes on McKesson, so it’s apropos to take a break and look at the future a bit with these 2014 New Year’s resolutions for today’s leading HIS vendors (in order of their 2012 annual revenue).

McKesson

They’re doing so well with Paragon that they made a resolution to rename their other legacy systems:

• Horizon = Parazon
• Series = Seriegon
• Star = Staragon
• Practice Partner = Practice Partagon
• RelayHealth = ParlayHealth
• Homecare = Homecaragon
• InterQual Online = InterQual Paragonline
• Capacity Planner = Capacity Paranagon
• Performance Analytics = Performagonalytics
• Patient Folder = Patient-Paper-Folder-Gone
• (you get the idea…)

On another front, McKesson announced plans to open Paragon’s first international office in either Aragon or Patagonia, depending on negotiations with their governments about minor changes to the spelling of their names.

Cerner

Will make an epic move of their HQ from Kansas City to Salt Lake City and re-name Millennium HNA as Millennium IHCNA.

Siemens

After cutting 15,000 jobs worldwide over the past two years, Siemens will announce several openings in its HR recruiting department for 2014.

Allscripts

Will join Cerner, McKesson, athenahealth, Greenway, and RelayHealth in the CommonWell Health Alliance to promote EHR interoperability in 2014 in 49 states (excluding Wisconsin).

Epic

Will be recognized as the KLAS act in 2014 by becoming the only HIMSS Stage 8 vendor in Gartner’s Magic Quadrant.

GE

Will announce a program in 2014 whereby any hospital buying Centricity will receive a free refrigerator for every nurse station.

Meditech

Will announce the 2014 version of Release 6.0, which will be called Focus, er, MAT, I mean, 6.0.1, that is 6.1, or maybe 6.0.A…

NextGen

Will announce the 2014 re-packaging of Opus, Sphere, and IntraNexus as “ThisGen.”

CPSI

Will sets the goal of having 500 of their clients attest for MU by the end of 2014, a total of over 1,000 beds.

Harris

A subsidiary of Constellation Software Inc. (from Canada) announces a project for 2014 of using the other Harris (from Melbourne, FL) CareFX interoperability workflow solutions to differentiate their company names.

NTT Data

ヴィンスがこれらの不快な言語の策略を用いるのを止めてください。

HMS

After being re-named Medhost, company executives will announce a joint effort with the AHA to launch a campaign in 2014 that re-defines all US hospitals as ancillary departments of their emergency rooms. 

Healthland

Will resolve to combine its two corporate offices in Minnesota (Glenwood and Minneapolis) once the roads are plowed in August 2014.

Vince Ciotti is a principal with H.I.S. Professionals LLC.

Readers Write: ‘Twas the Night Before ICD-10

‘Twas the Night Before ICD-10
By Luke O’Cyte

‘Twas the night before ICD-10, when all through the payer
Not a claims engine was stirring, not even a benefits layer;
The mappings were hung in the systems with care,
In hopes that St. Remediolas soon would be there.

The coders were nestled all snug in their beds,
While visions of F30.2’s danced in their heads;
And the CTO in her ‘kerchief, and I in my cap,
Had just settled down for a long winter’s nap,
When out in the data warehouse there arose such a clatter,
I sprang from the bed to see what was the matter.

Away to the office I flew like a fiend,
Tore open the laptop and threw up the screen.
The moon on the breast of the new-fallen snow
Gave the lustre of mid-day to my screensaver though,
When, what to my wondering H54.2’s should touch base,
But a miniature claim, and eight tiny 278s,

With a little old coder, so lively and fast,
I knew in a moment it must be St. Remediolas.
More rapid than eagles his W55.39XA’s they came,
And he whistled, and shouted, and called them by name;

“Now, Procedure! Now, Diag! Now, Surgical and Provider!
On, Vendor! On Member! On, EPM and Auditor!
To the top of the pend list! to the top of the queue!
Now adjudicate! adjudicate! adjudicate do!”

As invalid claims that before the wild eligibility fly,
When they meet with a benefit rule, mount to the sky,
So up to the mainframe the W55.39XA’s they flew,
With the sleigh full of ICD-10 codes, and St. Remediolas too.

And then, in a twinkling, I heard on the servers
The prancing and pawing of each little W55.32XS.
As I threw down my mouse, and was turning around,
Down the office hall St. Remediolas came with a bound.
He was dressed all in fur, from his S00.93 to his T69.02,
And his clothes were tarnished with rejects and errors too;
A bundle of claims he had flung on his back,
And he looked like a payer just opening his pack.

His eyes — how they twinkled! his dimples how merry!
His cheeks were like 284.81, his nose like a cherry!
His droll little mouth was drawn up like a bow,
And the beard of his chin was as white as the snow;
The stump of a pipe he held tight in his teeth,
And the E869.4 it encircled his head like a T59.81;
He had a broad face and a little round belly,
That shook, when he laughed like a bowlful of jelly.
He was 278.00 and E66.3, a right jolly old elf,
And I laughed when I saw him, in spite of myself;
A wink of his eye and a W50.2 of his head,
Soon gave me to know I had nothing to dread;

He spoke not a word, but went straight to remediation,
And ICD-10 coded all claims; then turned with attention,
And laying his finger aside of his nose,
And giving a nod, up the elevator he rose;
He sprang to his claims, to his team gave a 271,
And away they all flew like a mainframe batch run.
But I heard him exclaim, ere he migrated from sight,

“Happy Remediation to all, and to all a good-night.”

….with apologies to Clement Clarke Moore

Readers Write: Santa Claus, Flying Reindeer, and the HIPAA-Compliant Data Center

Santa Claus, Flying Reindeer, and the HIPAA-Compliant Data Center
By Grant Elliott

This holiday period will see a rerun of many classic holiday movies, with one of my particular favorites being Miracle on 34th Street. A delightful film about the importance of retaining faith, even in the absence of any evidence – in this case, whether Santa Clause is real. As C.F. Cole puts it in the 1994 remake of the movie, “We invite you to ask yourself this one simple question: do you believe in Santa Claus?” following which all across the city people start putting up signs proclaiming, “We believe.”

As I walked around the exhibition floor of the 2013 mHealth Summit last week, I felt I was being asked to take a similar leap of faith. Specifically, that every company there was HIPAA compliant simply because they said so. For most, it would be part of their sales pitch. The term “HIPAA compliant” would be sprinkled liberally throughout the description of their service. For some, it was actually emblazoned on their wall posters. “HIPAA Compliant Data Hosting” and “HIPAA Compliant Mobile Development” are two I specifically recall.

When I challenged them on what they were actually doing to be HIPAA compliant, the answer was too often limited to, “We store our data in an encrypted database,” or, “We use a HIPAA-compliant data center.” Therein lies a key challenge within the SMB health tech marketplace. Too many companies simply do not know what it means to be HIPAA compliant. That is a particular concern given that recent changes in the law mean they are now federally required to be so.

Why is simply storing data in an encrypted database an insufficient response?

The objective of HIPAA is to protect the “confidentiality, integrity, and security” of electronic Protected Health Information (ePHI). While encrypting data can certainly be a part of this, it does not cover the many other aspects also required, including determining who has access to the data; how and where the data is being shared; who can edit or delete the data; and so on.

The HIPAA security rule alone contains 42 standards and implementation specifications spread across three groups – administrative, physical, and technical. This is separate from the HIPAA Privacy and Breach Notification Rules, both of which are part of the overall HIPAA compliance requirements.

Even if you scratch a little deeper into the companies that claim to offer HIPAA-compliant hosting services, you should pay particular attention to the wording they use. While they may be willing to sign a Business Associate Agreement, they deliberately stop short of promising to provide a HIPAA-compliant solution. This is because they do not control access to the application — the solution provider does.

The next time a company tells you they are HIPAA compliant because they store their data in a HIPAA-compliant database or data center, you are certainly welcome to take a leap of faith. In the movie, after Judge Henry Harper is presented with evidence that the US Postal Service is delivering letters addressed to Santa Clause, he declares that, “…since the United States Government declares this man to be Santa Claus, this court will not dispute it.” However, I doubt that the enforcement arm of the Office for Civil Rights will be as liberal in its judgments.

Grant Elliott is founder and CEO of Ostendio of Washington, DC.

Readers Write: My First Experience at the mHealth Summit

My First Experience at the mHealth Summit
By Kevin Lasser

I was inspired by Mr. H’s comments regarding his experience at the fifth annual mHealth Summit. So much so that I want to share my experiences from a little different vantage point.

I was kindly invited to not only speak on the topic of return on investment,  but also to talk to the press about my participation in mHIMSS Roadmap V2.0. Honestly, I am not sure I would have gone otherwise, but I am happy I went. Here are my thoughts.

Exhibit Hall

It was filled with very large and small companies with a few exceptions. I did not get a sense that the large companies were really doing much in the mHealth space. However, they were happy to be at the Summit because they may be able to form ventures with some of the smaller companies.

Those smaller companies seemed to be primarily looking for three things:

• Validation of product
• Money from “bankers”
• A venture with a larger company

Unabashed Product Pushes

These were also called breakout sessions and executive spotlights.

I did a breakout session on ROI. The thing I was most proud of was the number of audience members who approached afterwards who said, “I have no idea what you do. Can you tell me…..” I considered that a great compliment.

I witnessed one session where a panelist had company logos and diagrams in his slide presentation. He turned every question from the audience into a product pitch. Based on those in the audience rolling their eyes and lack of people who approached this individual afterwards, I would say I was not the only one sick of his vendor pitch.

When are people going to learn that being a self-serving shill pitching your products under the guise of education works exactly the opposite way? (i.e. nobody cares about you or your product – YOU TURN PEOPLE OFF.)

State of the Industry

As a synopsis, I believe the following as it pertains to the mHealth industry:

• There is a lot of confusion. It is hard to distinguish one app from the next.
• Exhibiting a “real” ROI to prospective clients is a must. If a vendor answers a question regarding ROI with, “Imagine if …” that is not a real ROI.
• That HIMSS designated talented people and monetary resources to mHealth is a very encouraging sign for the future.
• Technology needs to be invisible. Nobody really cares about the technology. It is what the technology can do to lower costs, keep costs contained, and improve healthcare.

Lastly, regarding Mr. H’s comment that he snickers any time she sees someone wearing Google Glass, personally, I get a little nauseous.

Kevin Lasser is CEO of JEMS Technology of Orion, MI.