Consortium News

  • 19 Sep 2015 10:21 PM | Denny Brennan (Administrator)

    Healthcare Informatics | September 18, 2015 by Rajiv Leventhal

    HIMSS Analytics has awarded the Massachusetts-based Cambridge Health Alliance (CHA) with Stage 7 ambulatory recognition for its advanced use of the electronic health record (EHR).

    Developed in 2011, the EMR Ambulatory Adoption Model provides a methodology for evaluating the progress and impact of electronic medical record systems for ambulatory facilities owned by hospitals in the HIMSS Analytics Database. Stage 7 represents the highest level of EHR adoption and indicates a health system’s advanced electronic patient record environment.

    As of the second quarter of 2015, only 7.40 percent of the more than 34,000 U.S. ambulatory clinics in the HIMSS Analytics Database received the Stage 7 Ambulatory Award.

    CHA is an academic community health system that provides essential services to Cambridge, Somerville and Boston’s metro-north communities. It includes three hospital campuses, a network of primary care and specialty practices, and the Cambridge Public Health Dept. CHA is a Harvard Medical School teaching affiliate and is also affiliated with Harvard School of Public Health, Harvard School of Dental Medicine and Tufts University School of Medicine.

    “The CHA is reaping significant benefits with its EHR for the patients they serve,” John Daniels, global vice president, healthcare advisory services group, HIMSS Analytics, said in a press release statement. “Their focus on population health is improving the health status of its community by reducing emergency department visits and hospital stays for patients with chronic diseases through proactive care management.”

    CHA will be recognized at the 2016 Annual HIMSS Conference & Exhibition on Feb. 29-March 4, in Las Vegas.

  • 17 Sep 2015 12:55 PM | Denny Brennan (Administrator)

    Controlling growth in health care costs will require cooperation between insurers on one side and providers on the other. This is a challenging task, given the historically adversarial relationship between the two groups. Payer–provider relationships have been complicated by distrust, conflicting objectives, and a lack of data transparency.

    What the Study Found

    Commonwealth Fund–supported researchers shared insights from interviews conducted with medical group and health plan leaders from four successful partnerships: Blue Cross of Michigan Physician Group Incentive Program, Colorado Multi-Payer Patient Centered Medical Home Pilot, Excellus Health Plan’s Upstate New York Non-Invasive Cardiology Project, and Blue Cross of Massachusetts Alternative Quality Contract. They identified three themes common to successful collaborations:

    • Building infrastructure. Traditionally, when designing contracts that include shared accountability for costs and outcomes, providers and payers have behaved competitively, with each side seeking to further its own interests. But in more successful partnerships, both sides are transparent in defining financial goals and work together to achieve the organizations’ objectives.
    • Engaging clinicians. If dollars are used as the primary incentive for physicians, there may be a return to previous, nonproductive behavior once the reward is removed. The researchers found that talking to practitioners primarily about cost reduced their enthusiasm for quality improvement initiatives. Instead, physicians were more responsive to the idea of improving care when they received peer comparison data.
    • Collecting and using data to improve outcomes. “Having accurate peer comparison data is a powerful, if not the most powerful, motivator of practitioner behavior change,” the authors say. Combining clinical data with claims data will allow providers to focus on the relationship between cost and quality, but the data merge requires transparency and trust.

    Conclusions

    Reining in escalating costs and improving care will depend largely on the effective partnering of health plans and medical groups. Working together will require a transparent articulation of mutually acceptable goals and data that allow for identifying and promoting low-cost, high-quality practices.

    Source: H. Beckman, P. Healey, and D. G. Safran, “Improving Partnerships Between Health Plans and Medical Groups,” American Journal of Managed Care, Sept. 2015 21(9):647–50.

  • 16 Sep 2015 2:23 PM | Denny Brennan (Administrator)

    by Carl Natale for ICD10Watch, Sep 16, 2015 - 12:00 AM

    It's time for 'meatball' ICD-10 preparation

    In the popular TV show M*A*S*H, army doctors performed 'meatball' surgery on U.S. soldiers during the Korean War. It wasn't pretty. The surgeons acted quickly to save lives. They didn't do everything that they would have if they weren't within shooting distance of the front lines.

    That is where we are at now in ICD-10 preparation. It needs to get done by Oct. 1. It's not going to be pretty. There won't be steering committees or impact assessments.

    There will be getting it done.

    The Centers for Medicare and Medicaid Services (CMS) has broken down the process to what needs to get done quickly and offered an ICD-10 quickstart guide at Roadto10.org.

    Make a plan

    • "Assign target dates for completing steps outlined here" (I think by target dates they mean "ASAP")
    • Crucial: Get the ICD-10 codes, which are available:
      • Online (e.g., go to cms.gov/ICD10 and select “2016 ICD-10-CM and GEMS” to download 2016 Code Tables and Index)
      • CD/DVD and other digital media
      • Practice management systems
      • Electronic health record (EHR) products
      • Smartphone apps
    • Consider how your clearinghouse can help
      • Clearinghouses can help by:
        • "Identifying problems that lead to claims being rejected"
        • "Providing guidance about how to fix rejected claims (e.g., more or different data need to be included)"
      • "Clearinghouses cannot help you code in ICD-10 unless they offer third-party billing/ coding services"

    Train your staff

    •  Plenty of free resources from CMS
    • Also check:
      • Medical societies
      • Health care professional associations
      • Hospitals
      • Health systems
      • Health plans
      • Vendors
    • Crucial: Identify the top ICD-9 diagnoses
      • Target top 25 ICD-9 diagnoses (possibly your superbill already reflects this)
    • Code top ICD-9 diagnoses in ICD-10 codes
      • Note where more documentation is needed

    Update processes

    • Crucial: Update all printed and electronic forms
    • Fix clinical documentation gaps discovered when using ICD-10 codes
    • Key coding concepts in ICD-10 documentation:
      • Laterality
      • Initial or subsequent encounter for injuries
      • Trimester of pregnancy
      • Details about diabetes and related complications
      • Types of fractures

    Talk to vendors and health plans

    • Crucial: Confirm ICD-10 readiness of systems with vendors
    • Confirm that health plans, clearinghouses and billing services are ICD-10 ready
    • Check on testing opportunities

    Test your systems and processes

    • Crucial: Verify your medical practices can:
      • Crucial: Generate a claim
      • Perform eligibility and benefits verification
      • Schedule an office visit
      • Schedule an outpatient procedure
      • Prepare to submit quality data
      • Update a patient’s history and problems
      • Code a patient encounter
    • Test systems with vendors, clearinghouses, billing services and health plans
      • Acknowledgement testing is available through Medicare Administrative Contractors until Oct. 1.
    • Explore alternate ways to submit ICD-10 claims if your systems aren't ready for ICD-10 implementation.

    It still looks like a lot. But it needs to be done to get reimbursed after Oct. 1. Good luck and let us know how it's going.

  • 15 Sep 2015 11:13 AM | Denny Brennan (Administrator)

    Chilmark Research, September 10, 2015 by Naveen

    Welcome to Cambridge, Dr. Watson

    IBM Watson Health’s kickoff event this morning across the river in Cambridge had some demos and a number of executive guest speakers, but offered little new or substantive insight into a grand strategy for healthcare. What we did learn: The company will expand its partnership with Boston Children’s Hospital’s OPENPediatrics, a kind of Facebook for hospital-based pediatricians and clinicians around the world. It also appointed Deborah DiSanzo (former head of Philips Healthcare) as new General Manager of the Watson Health division. Finally, it announced a regulation-compliant cloud offering for companies seeking FDA approval.

    These are welcome developments for a brand that has gained major momentum in just a few years. Though IBM Watson Health was officiallly launched five months ago, IBM has spent most of the year feverishly investing in acquisitions, alliances, and other collaborations, amassing a constellation of technology vendors, research firms, drug developers, biotechnology companies, healthcare partners, and other organizations. In its acquisitions of Explorys, Phytel, and Merge Healthcare, IBM bought a foothold in mainstream HIT.

    This event showcased these arrangements with participation from Medtronic, Teva, CVS Health, Merge, and others. Several presenters jousted over the right to call themselves IBM Watson Health’s most enthusiastic partner. Big names such as Apple, J&J, and a litany of health systems were briefly on display on the screen as well. We were pleasantly surprised to learn of other partnerships – like one with Bupa that will combine the patient engagement expertise of a platform like Health Dialog with an interactive, intelligent question & answer platform (complete with a sense of humor!) to help people set and achieve health goals. During this particular demo, I was thinking the whole time about how much my own mother would benefit from such a tool (and wondering if and when IBM would ever make this available for the common patient…)

    Watson Health is evidently on the fast track to becoming a health data crunching behemoth. Yet, we were left wondering what exactly IBM wants to do with it. While there was a lot of rhetoric and buzzwords, there was unfortunately no deeper strategy on display. We think we understand what IBM is trying to do: it has developed what it regards as a top-shelf search engine that it plans to use in healthcare. The actual technology seems to have something to do with collecting, organizing, normalizing, and aggregating data about patients which it then marries to genomics and device data — in other words a patient longitudinal record. How or if this will actually be done is anyone’s guess.

    IBM will integrate Watson Health into both its purchased technologies (Explorys, Phytel, Merge, etc.) and its partner’s technologies (Teva Pharmaceuticals, CVS Health, Medtronic and others). There were no timelines available; all we know is it will take place in the cloud. For now, IBM Watson Health’s emphasis seems to be skewed heavily toward pharma and devices.

    We hope that this isn’t the entire picture. Will Watson be the unifying thread to share data from medical devices and pharmacies with doctors at the point of care, using their EHRs? IBM has ambitions in a dozen or more different corners of healthcare, but has not connected the dots. During a panel session for example, Medtronic spoke about sending diabetics device data into Watson, and then CVS Health spoke about sending the encounter data from consumers with diabetes into Watson. Are these the same patients? Are there correlations? Who will benefit from or act on those insights – patients, care managers, primary care physicians? How, where, when will this all take place?

    To be fair, we are still very much in the early days of this undertaking. Speakers touched briefly on many of the big emerging themes in healthcare (shift to value, data liquidity, insight-driven business planning, etc.) but as a whole, IBM missed a couple of the most important ones:

    Patient-Centeredness – IBM paid little more than lip service to this critical element of healthcare transformation. Doctors, executives, researchers, technologists all had a chance to speak, but patients were left out of the picture, as always. The only patient narrative was fittingly, an ad, shown on stage, which was also run about a million times over the long weekend for the US Open.

    Payer Involvement — Without telling us how these major players will be involved, its story on supporting the shift to value-based care remains incomplete. We can only guess that IBM Watson Health and IBM’s insurance industry organization are still negotiating their respective turfs.

    Is there more behind the curtain?

    Zooming out, IBM’s big company ceremonial was on full display. The brand new glass and steel building and the fancy, haute-couture food prepared by “Chef Watson” were nice flourishes but the overall impression left something to be desired. The decision not to take any questions from the audience, the near-zero diversity among speakers, and the tight reliance on scripted teleprompters all left us questioning if there is truly a culture of innovation behind the curtain. In the end it is clear that IBM Watson Health has joined the fight to bend the cost curve and improve the healthcare system. While Watson Health’s technology may turn information into insight, IBM has a lot left to do beyond marketing.

     

    (Co-authored with Brian Murphy)

  • 15 Sep 2015 9:53 AM | Denny Brennan (Administrator)
    Jessica Bartlett Reporter Boston Business Journal, Sep 15, 2015

    Royal Philips is launching a new diabetes app, one that integrates medical records with large-scale data to help patients manage their disease on a new level.

    The prototype — developed in combination with the Radboud University Medical Center in the Netherlands, with California-based cloud computing company Salesforce, and with large help from Philips employees at the company’s North American headquarters in Andover — is largely geared towards type 1 diabetes, or patients that are born with the disease and have a lifelong dependence on injected insulin.

    A new app from Philips hopes to help those with Type I diabetes manage the disease.

    “It’s the moment when the shift to insulin dependence and insulin injection (where patients need to) manage it on a continuous basis that the burden starts going up and there you enter a new category of support and psychological need that our app is trying to answer,” said Thibaut Sevestre, senior director of Eco-System Management at Philips.

    The app, which is currently going through software validation and soon field testing with a limited number of patients, consists of an online community, and consolidated data, pulled from wireless glucose meters, activity monitors and even patient self-reported information.

    Patients are provided continuous updates about diabetes metrics, such as blood glucose levels, and will offer coaching guidance.

    In the online community, patients and health care professionals can send private messages or even share posts.

    The app relies on Philips’s new virtual health record, which can pull data from a variety of electronic medical records — such as Epic and Cerner — and digital devices, and the Salesforce cloud, which will integrate the data and present it to the user in a digestible and actionable format.

    “We’re looking at exploring the space between clinical care and data driven health care … and on the other end the more informal, collaborative nature of health care you can have when you start using communities and social media structures,” Sevestre said.

    Sevestre said despite the many apps focused on diabetes, Philips’ focus on type 1 diabetes is unique in a market that is largely focused on type 2, which is more about lifestyle, nutrition and exercise than on clinical aspects like insulin injections, which fewer of patients with type 2 diabetes need.

    “There are lot of apps out there to manage their intake and carb intake – their nutrition and food, but we didn’t find something that was covering where we think we’re strong with our partners, making the link between clinical and everyday life and helping people in their every day life,” Sevestre said.

    Helping patients make the decisions five to 20 times a day necessary to their well-being is critical, Sevestre said, and where the app hopes to provide aid.

    Over time, the app may be broadened to include more aspects relevant to type 2 diabetes, Sevestre said.

    The platform is also open for other partners or startups to develop spinoffs, Sevestre said.

  • 10 Sep 2015 2:03 PM | Denny Brennan (Administrator)

    Beth Walsh (Clinical Innovation + Technology), Sep 10, 2015

    Partners Health Care and Health Catalyst have agreed to share best practices, intellectual property, technology and training in an unprecedented $30 million partnership focused on population health management (PHM) .

    The Boston-based provider already is invested in Health Catalyst and raised its equity ownership stake in the growing health data warehousing and analytics company. Salt Lake City-based Health Catalyst is investing in money, time and effort in the initiative.

    The initiative will enable the development and testing of innovative PHM strategies at Partners and, in collaboration with Health Catalyst, facilitate the transfer of the knowledge generated to other health care providers.

    “This agreement with Health Catalyst and our new Center for Population Health will accelerate our care management program and improve outcomes for Partners Health Care patients, as well as provide the infrastructure and knowledge base for broader outcomes transformation both here and across the country,” said Timothy G. Ferris, MD, senior vice president of Population Health Management for Partners Health Care, who will lead the new Center of Population Health. “We have made significant progress with population health and care management over the past decade, including using Health Catalyst technology and services over the past few years, and we now believe we can take our efforts to the next level by further leveraging the experience and know-how of both organizations.”

    The agreement between Partners Health Care and Health Catalyst includes four major elements:

    • Health Catalyst and Partners Health Care will collaborate through the creation of a new Partners Health Care Center for Population Health. The Center will train Health Catalyst and Partners Health Care clinical and administrative teams in best practices for care management and population health. Health Catalyst graduates of the program will disseminate these best practices to client healthcare organizations across the country.
    • Health Catalyst is licensing technology, content and analytics innovations that Partners Health Care, the Massachusetts General Physician Organization and the Brigham and Women’s Physician Organization developed as part of its decade-long care management and population health management programs. Health Catalyst intends to commercialize these innovations to further enhance Partners Healthcare population health and care management programs, and to benefit other health systems in their care management and population health initiatives.
    • Partners Health Care has signed an expanded enterprise-wide technology subscription agreement, giving it access to Health Catalyst’s full suite of technology solutions to accelerate outcomes improvement. In keeping with Health Catalyst’s mission to improve outcomes, a portion of the company’s revenue from the subscription will be tied to the attainment of measurable improvements in Partners Health Care clinical and financial performance.
    • Partners Health Care is increasing its equity ownership stake in Health Catalyst, after first investing in the company in 2013.
  • 02 Sep 2015 2:09 PM | Denny Brennan (Administrator)

    OCR Director Provides an Update, Announces a HIPAA Settlement

    Marianne Kolbasuk McGee (HealthInfoSec) • September 2, 2015   

    The Department of Health and Human Services' Office for Civil Rights is getting closer to resuming the random HIPAA compliance audit program. In addition, it's completed another HIPAA settlement related to a breach, and it's planning a number of compliance-related initiatives for the fall, OCR Director Jocelyn Samuels said in a Sept 2 presentation.

    Samuels' comments came during a keynote address at an annual HIPAA security conference in Washington, D.C., hosted by OCR and the National Institute of Standards and Technology.

    More HIPAA compliance audits "are coming," Samuel said, but she stopped short of offering a timeline or revealing how many covered entities and business associates that will be audited. "Audits are a critical tool. It enables us to get in front before [HIPAA noncompliance results in] a breach," she says. The audits provide technical assistance to address the most common problems in HIPAA non-compliance, she notes.

    OCR recently hired a vendor to assist in the audit program, Samuels revealed in her presentation. An OCR spokeswoman tells Information Security Media Group that FEi Federal recently signed a contract to provide support management services for the audits, which will actually be performed by OCR staff.

    The majority of the audits will be "desk" or remote audits, but there will also be "some" onsite audits, Samuels said. The audits will look a key areas of HIPAA compliance, especially those problem areas pinpointed during OCR's breach investigations, such as a lack of comprehensive, timely risk assessment and mitigation. "We're hopeful the audit program will send a message that complying with HIPAA is serious business," Samuels said.

    Privacy attorney David Holtzman, vice president of compliance at security consulting firm CynergisTek, who attended the HIPAA conference, says Samuels' announcement about the audit program is "reaffirmation" that OCR is ramping-up HIPAA enforcement efforts. "The biggest change is OCR saying it will use a contractor" to assist in the audits, he says, which could help OCR to better utilize its own stretched internal resources.

    Breach Settlement

    The lack of a timely risk analysis has been a reoccurring theme in OCR enforcement actions, including a new settlement and resolution agreement announced by Samuels during her Sept. 2 keynote.

    OCR has reached to a $750,000 settlement with Cancer Care Group, P.C., a radiology oncology practice in Indiana with 13 clinicians, which suffered a health data breach in 2012 as a result of the theft of an unencrypted laptop computer and back-up media from an employee's car. The computer and storage device contained names, addresses, dates of birth, Social Security numbers, insurance information and clinical information of approximately 55,000 current and former Cancer Care Group patients.

    An OCR investigation into the breach found widespread non-compliance issues, she says, including the lack of an enterprise-wide risk analysis. In addition, Cancer Care Group did not have in place a written policy specific to the removal of hardware and electronic media containing ePHI from its facilities, even though this was common practice within the organization, she says.

    "An enterprise-wide risk analysis could have identified the removal of unencrypted backup media as an area of significant risk to Cancer Care's ePHI, and a comprehensive device and media control policy could have provided employees with direction in regard to their responsibilities when removing devices containing ePHI from the facility," she says.

    A resolution agreement signed with the cancer practice includes a corrective action plan that includes a number of steps, including conducting a risk analysis, that the organization must take to improve its HIPAA compliance.

    Other Efforts

    Other OCR projects in the works that Samuels highlighted in her keynote address included:

    • Working with the National Institutes of Health on President Obama's Precision Medicine initiative announced in January. OCR is working with NIH on patient privacy protections "to be built into" the efforts, which focuses on the use of genomic, lifestyle and other patient information for "transformative developments" related to more personalized medical treatments.
    • Preparing new OCR guidance this fall that will provide patients and healthcare providers with information about patients' rights to access their health information and send it to third parties.
    • Developing guidance on cloud computing and HIPAA privacy and security.
    • Introducing a new Web portal, likely this fall, to help software developers navigate HIPAA compliance for emerging technologies. "We want to offer those developers of new technologies to have a dialogue with us," Samuels said.
  • 27 Aug 2015 2:58 PM | Denny Brennan (Administrator)
    Tony Bradley | CSO | Aug 27, 2015 8:52 AM PT

    Secure authentication is crucial to protect data and guard your identity from being stolen or hijacked. The vast majority of authentication used today is based simply on a username and password, which has proven time and time again to be inherently insecure. Perhaps it’s time to change our definition of authentication.

    The All-in-One CISSP Exam Guide (a book I *highly* recommend if you’re studying for the CISSP exam) describes authentication like this: “Three general factors can be used for authentication: something a person knows, something a person has, and something a person is. They are also commonly called authentication by knowledge, authentication by ownership, and authentication by characteristic.”

    Let’s use the front door of your home as an example scenario. Something you know can be a secret knock or secret password or possibly a PIN code used to unlock a door. Something you have would be a physical key required to unlock the door. Something you are would be a fingerprint or retinal scan or facial recognition. It doesn’t even have to be high-tech. It can be as simple as me knowing what my brother looks like and granting him access based on a cursory visual inspection of the person standing on my porch.

    Now, let’s examine each of those a little closer. Something you are is difficult to replicate or steal. Your unique biometric characteristics are yours and yours alone. It is technically possible to clone a fingerprint or trick some facial recognition tools with a photo or mask, but even that is becoming less feasible. Microsoft recently revealed that Windows Hello can differentiate between two identical twins.

    Something you have is easier to steal or copy but requires some physical access or possession of the authentication method in most cases. For example, someone can steal the key to your front door or make a copy of the key to your front door so it’s possible for someone else to be in possession of your authentication method or for there to be more than one copy of the authentication method in existence.

    Then there’s something you know. Something you know is very easy to compromise or steal. Someone can eavesdrop on your secret knock or secret password. A password can be written down. It can be shared with others. It’s possible for five, fifty, or five thousand people to all know what your password is. It’s also possible to guess or crack something you know in most cases. It may take weeks, months, or years—but there is a finite number of possible things to know.

    That is the problem.

    There is only one you to be something you are. You only have one physical key, or USB device, or mobile device to be something you have—possibly a few in the case of a physical key. Something you know, however, can literally be something that everyone knows. There is no limit on how many people can know your special something. Something you know can be easily cracked or compromised. It is innately the least secure of the three authentication methods and it has been the direct cause of many—if not most—of the major security and data breaches in recent years.

    We need more devices with fingerprint scanners and more PCs equipped with the Intel Real Sense 3D camera necessary for Windows Hello facial recognition because it’s time to stop using passwords, PINs, or anything else in the something you know category as a means of authentication.

  • 26 Aug 2015 4:44 PM | Denny Brennan (Administrator)

    Aug 26, 2015, 4:11pm EDT: Jessica Bartlett, Reporter Boston Business Journal

    CVS Health is partnering with Boston-based American Well and two other virtual health care companies to explore collaborations into the area of remote medicine.

    CVS Health (NYSE: CVS) announced partnerships with Boston-based American Well, California-based Doctor on Demand, and Texas-based Teladoc to explore how the groups can all work together to deliver so-called telehealth — care that is delivered via either phone or video chat.

    “During our initial phase of exploration of telehealth in our store-based clinics, we learned that we could deliver excellent quality care and that patients were extremely satisfied with the care provided,” said Dr. Andrew Sussman, executive vice president/associate chief medical officer of CVS Health and president of MinuteClinic, in a release. “As we examine additional ways to utilize telehealth to improve and expand patient care, we have the opportunity to partner with telehealth organizations in the care of patients at home.”

    Brian Tilzer, senior vice president and chief digital officer for CVS Health, said in a statement that "some of the best ideas are already being developed."

    "We’re committed to partnering with other companies to explore and expand on these ideas together,” he said.

    While CVS will partner with all three companies, American Well recently filed a lawsuit against Teladoc for patent infringement.

    The partnerships follow several related moves on the part of CVS. In June it purchased Target pharmacies, then said it would open a Digital Lab in Boston. In July the company said it would partner with IBM's supercomputer Watson to analyze patient data, showcasing a broader business move to bring health care into increasingly retail and readily accessible environments.

    CVS is hoping to make telehealth available through CVS Health’s digital properties, and would explore enabling its 1,000 MinuteClinics to consult with physicians to expand the scope of the retail provider, or to even be a site for in-person exams to facilitate telehealth visits.

    “With the increased demand for patient care anticipated in future years as a result of the expansion of coverage through the Affordable Care Act, the primary care physician shortage, aging of the population and epidemic of chronic disease, telehealth gives us the opportunity to offer high quality care to an expanded group of patients in a variety of convenient and cost-effective locations,” Sussman said.

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