Using mHealth to reach Medicaid populations – mHealth News

Posted by timmreardon on 07/09/2014
Posted in: Uncategorized. Leave a comment

A text-messaging trial targeting high-cost Medicaid patients in New York has found that the interactive mHealth tool significantly improved patient adherence to medications, doctor appointments and care plans.

The project proves the value of patient engagement programs for high-cost, underserved populations. One of its organizers said it will next be introduced to larger Medicaid populations.

The trial, conducted by Montefiore Medical Center’s Universal Behavioral Associates and supported by a $100,000 Pilot Health Tech NYC grant, targeted 67 patients and 15 care managers involved in MMC’s Medicaid Health Home. Using a mobile care management program developed by New York-based Sense Health, the two-month project reportedly resulted in a 40 percent increase in self-reported adherence to appointments, a 12 percent increase in medication adherence and a 7 percent increase in reaching care plan goals.

[Product roundup: 10 mobile apps for evidence-based medicine.]

“Our goal was to understand whether mobile technology would help our care managers provide more consistent and efficient support and quality care for our Medicaid patients,” said Donald A. Bux, PhD, director of behavioral healthcare management at University Behavioral Associates, in a press release. “At first we were concerned that mobile technology might feel impersonal and lead to a disconnect, but we were pleasantly surprised by how well received the program was by our patients and care managers. Not only did clients using Sense Health report more engagement in their care plans, but patients and their care managers also reported greater ease in connecting with each other.”

The Sense Health platform develops interactive, text-message-based support plans that are shared between patients and their caregivers. They’re designed to help patients take control of their own health management by providing information, advice and encouragement – all key components of a successful patient engagement strategy. That strategy will now be developed by Sense Health in partnerships with Medicaid Managed Care Organizations.

“In the patient engagement arena, quantifying engagement in a meaningful way is a challenge in and of itself,” said Stan Berkow, co-founder and CEO of Sense Health, in the release. “We’re thrilled not only to have quantified key patient engagement outcomes, but to have demonstrated significant improvements in those critical areas.”

A survey of the project’s participants found that they were 21 percent more motivated, 26 percent more confident and 22 percent more knowledgeable about lifestyle changes recommended for their health when using the Sense Health platform, according to officials.

What’s more, tailoring health interventions and the support of care managers can help providers encourage people to take more accountability for their own health, added added Fred Muench, MD, a Sense Health advisor and member of the Columbia University College of Physicians and Surgeons, in the press release.

“Prior to helping people take their medications more consistently or attend their appointments more frequently,” Muench said, “it’s critical to ensure they feel sufficiently motivated, knowledgeable and confident to actually take all of the necessary actions to improve their health.”

Article link: http://www.mhealthnews.com/news/using-mhealth-reach-medicaid-populations?single-page=true

Study Critical of Federal EHR Programs, Says Interoperability Requirements ‘Watered Down’ – Health IT Law & Industry

Posted by timmreardon on 06/20/2014
Posted in: Uncategorized. Leave a comment

By Kendra Casey Plank  

June 17 — In the rush to meet legal deadlines in the Health Information Technology for Economic and Clinical Health (HITECH) Act for paying incentives to doctors and hospitals for adopting electronic health records, the federal government encouraged the uptake of existing technologies rather than promote the development of new products that would be better meet future demands for interoperability, researchers said in a new RAND report.

A case study of EHR adoption in the report, which is critical of federal initiatives to promote health IT adoption, said the meaningful use program has spurred growth in the EHR market but that adoption of health IT in the U.S. still lags behind other countries.

“The theoretical case for EHRs is strong, but the technology’s promised impact is currently blunted by limitations in its design, uptake and use,” according to the report.

The case study cites several challenges to health IT adoption, including provider readiness and data privacy and security concerns. But, the lack of interoperability is one of the biggest hurdles to clear for widespread data sharing, the key to improving quality and efficiency of health-care delivery, according to the report.

“The health IT systems that currently dominate the market are not designed to talk to each other,” the researchers wrote. “This problem might have been avoided if the federal government had pressed the issue when meaningful use standards were being drafted. Instead, interoperability standards were watered down, and vendors were allowed to apply for meaningful use certification post market. It is unclear how many, if any were rejected.”

“[I]nteroperability standards were watered down, and vendors were allowed to apply for meaningful use certification post market.”

—RAND report

Rather than promote interoperability—which was Congress’s main goal with HITECH Act—federal health IT initiatives have instead “accelerated the uptake of existing EHRs,” the researchers wrote. That “low bar” for interoperability also has thwarted efforts health information exchange initiatives, they added.

“Instead of using federal incentives to spur development and sale of interoperable EHRs, the Office of the National Coordinator for Health IT sought to bring the health care industry on board,” the researchers wrote.

Disappointing ROI

Among other concerns raised in the case study was that EHR adoption has had a disappointing return on investment for many health-care organizations, with many citing a gap between the perceived and realized benefits of health IT.

Among disappointments the report cited was the high cost to purchase and upgrade EHR systems to meet meaningful use requirements, coupled with the ongoing costs to maintain those systems.

And, the researchers noted, those costs typically are not fully covered by federal EHR incentives.

The report said the lack of EHR usability likewise has contributed to a lack of ROI for adopters as well as the failure by health-care organizations to redesign workflows to accommodate new technologies.

Market Concerns

The case study also was critical of one of the EHR market’s largest players—Epic.

Epic provides EHR systems—and other software products—to many of the top health-care systems in the country, including Cleveland Clinic and Kaiser Permanente, the report said.

But, the researchers wrote that because Epic is a closed platform it is difficult for data to be shared with other EHR systems, even if they’re developed by Epic.

“One of the biggest concerns with Epic is its relative lack of interoperability,” according to the report. “Although the company has a strict structure and retains tight control of its software and data, it does customized installations for each client. This allows health care systems to tailor Epic’s applications and functionality to meet their own needs.”

That customization, the report said, means that interoperability between EHR systems is difficult.

By contrast, the report said the Department of Veterans Affairs VistA (Veterans Health Information Systems & Technology Architecture) system—which is the EHR system for the military veterans—is an open platform that allows for easier sharing of health data.

The EHR case study was conducted by Dr. Enesha Cobb and Dr. Kori Sauser, both fellows at the Robert Wood Johnson Foundation. They both also are affiliated with the VA Center for Clinical Management and Research at the Ann Arbor VA Healthcare System.

To contact the reporter on this story: Kendra Casey Plank at kcasey@bna.com

To contact the editor responsible for this story: Patty Logan at plogan@bna.com

Article link: http://www.bna.com/study-critical-federal-n17179891416/

 

 

Congress, FBI moving on VA health care – Army Times

Posted by timmreardon on 06/11/2014
Posted in: Health Care Costs, Health Care Economics, Health IT adoption, Health Outcomes, Healthcare Delivery, Integrated Electronic Health Records, Military Health System Reform, National Health IT System, Patient Centered Medical Home, Patient Portals, PCMH, Quadruple Aim, Uncategorized, Veterans Affairs. Leave a comment

WASHINGTON — Congress is moving with what one senator called “lightning speed” to help thousands of military veterans enduring long wait times for VA medical care.

The Senate was poised to vote by Thursday on a measure making it easier for veterans who have encountered delays getting initial visits to receive VA-paid treatment from local doctors instead. The measure closely resembles a bill approved unanimously Tuesday in the House, prompting optimism among lawmakers from both parties that a compromise version could be on its way soon to President Barack Obama for his signature.

“Maybe we can show the United States of America that people can come together on a very, very important issue and do it in rapid fashion,” said Sen. Bernie Sanders, I-Vt., chairman of the Senate Veterans Affairs Committee.

The legislative effort comes as a federal law enforcement official said the Justice Department has formally asked the FBI to review materials provided by the Veterans Affairs inspector general.

The official spoke on condition of anonymity because the official was not authorized to discuss an ongoing criminal investigation on the record.

Richard Griffin, the VA’s acting inspector general, issued a scathing report that confirmed allegations of excessive waiting time at VA hospitals and inappropriate scheduling practices. The report, which followed allegations that 40 patients died while awaiting care at a Phoenix hospital where employees kept a secret waiting list to cover up delays, found that 1,700 veterans seeking treatment at the Phoenix facility were at risk of being “forgotten or lost.”

While the Justice Department has not undertaken a full-fledged investigation, the request for FBI involvement represents an escalation into concerns of possible criminal conduct by VA employees. FBI Director James Comey had previously said that the FBI had not been asked to participate in any investigation. But the law enforcement official said Wednesday the situation has now changed.

The VA, which serves almost 9 million veterans, has been reeling from mounting evidence that workers falsified reports on wait times for medical appointments in an effort to mask frequent, long delays. An internal audit released this week showed that more than 57,000 new applicants for care have had to wait at least three months for initial appointments and an additional 64,000 newly enrolled vets who requested appointments never got them.

VA Secretary Eric Shinseki resigned May 30, but the situation remains a continuing embarrassment for Obama and a potential political liability for congressional Democrats seeking re-election in November.

“It’s urgent that we get this done to resolve some of the outstanding issues within the VA,” said Senate Democratic leader Harry Reid.

In a rare moment of agreement with Reid, Senate Republican leader Mitch McConnell also was upbeat about the prospects of the veterans bill.

“We have a bipartisan veterans bill negotiated the way we used to do business in the Senate, with members of both parties, ready to go,” McConnell said Tuesday. He added that he hoped the Senate could take up the bill “very quickly, maybe even finish it this week.”

Sen. John McCain, R-Ariz., a chief author of the Senate measure, said it shouldn’t be hard for the two chambers to craft a compromise version. “I don’t think there’s a lot of major differences,” he said.

Sanders, who co-wrote the Senate bill with McCain, said that by Senate standards, lawmakers were moving at “lightning speed.”

The legislative effort comes close on the heels of a Veterans Affairs Department audit showing that more than 57,000 new applicants for care have had to wait at least three months for initial appointments and an additional 64,000 newly enrolled vets who requested appointments never got them.

“I cannot state it strongly enough: This is a national disgrace,” said Rep. Jeff Miller, R-Fla, chairman of the House Veterans Affairs Committee and chief author of the House legislation.

Rep. Mike Michaud of Maine, top Democrat on the Veteran Affairs Committee, said veterans receive excellent care at VA facilities — if they can get into the system. “As we have recently learned, tens of thousands of veterans are not getting in.”

The House and Senate bills each would spend hundreds of millions of dollars to hire more doctors and nurses, but that may be easier said than done, given a nationwide shortage of primary care physicians.

Primary care physicians are expected to become increasingly in demand as millions of people newly insured under the federal health care law start looking for regular doctors. The Association of American Medical Colleges has projected that by 2020, there will be 45,000 too few primary care physicians, as well as a shortage of 46,000 surgeons and specialists.

Shortages tend to be worse in both rural and inner-city areas.

The American Medical Association added its voice as the House was voting Tuesday. At its annual policy meeting in Chicago, the AMA approved a resolution urging Obama to take immediate action to enable veterans to get timely access to care from outside the VA system. The nation’s largest doctors group also recommended that state medical societies create and make available registries of outside physicians willing to treat vets.

The Senate bill would authorize the VA to lease 26 new health facilities in 17 states and Puerto Rico and spend $500 million to hire more doctors and nurses. The House bill does not include a specific dollar amount, but Miller said the VA would save $400 million annually by eliminating bonuses, money the agency could use for expanded care.

The House and Senate bills would let veterans facing long delays for appointments or living more than 40 miles from a VA facility choose to get care from non-agency providers for the next two years. Some veterans already get outside care, but the process is cumbersome and riddled with delays, veterans and their advocates say.

The Senate bill would make easier to fire top VA officials, although with more employee safeguards than in an earlier, House-passed bill.

Article link: http://www.armytimes.com/article/20140611/NEWS05/306110063?utm_source=twitterfeed&utm_medium=twitter

Associated Press writers Eric Tucker, Alan Fram and Lauran Neergaard in Washington and Lindsey Tanner in Chicago contributed to this report.

Washington promises to fix troubled VA, but overhaul won’t be easy – Stars & Stripes

Posted by timmreardon on 06/07/2014
Posted in: Health Outcomes, Healthcare Delivery, Military Health System Reform, Quadruple Aim, Uncategorized, Veterans Affairs. Leave a comment

Acting Veterans Affairs Secretary Sloan D. Gibson, right, visits with Bay Pines VA Healthcare System leadership and staff during a visit to the C.W. Bill Young VA Medical Center in Bay Pines, Florida, on April 10, 2014.
Jason Dangel/Department of Veterans Affairs
By Lindsay Wise

McClatchy Washington Bureau
Published: June 6, 2014
Article link: http://www.stripes.com/news/veterans/washington-promises-to-fix-troubled-va-but-overhaul-won-t-be-easy-1.287618

 
WASHINGTON — Eric Shinseki has been pushed out as the secretary of the Department of Veterans Affairs. The president vows changes. The Senate is moving with uncharacteristic speed toward a bipartisan response.

But fixing the sprawling agency with an entrenched bureaucracy won’t be easy.

It has a management culture marred by cronyism, intimidation and poor oversight from the VA’s central office. It has a performance-based bonus system that rewards those who falsify records to meet unrealistic quotas. And it simultaneously penalizes supervisors who don’t push their employees to “cook the books.”

“If you weren’t going to crack people’s heads, if you didn’t put people’s feet to the fire, they didn’t want you around,” said Charleston Ausby, a Marine Corps veteran from Sugar Land, Texas, who worked as a VA service representative from 2002 to 2012.

Ausby said he and his co-workers routinely came under pressure to reduce the VA’s record disability-claims backlog by misfiling or mislabeling old claims that had been pending for years to make them appear in the computer system as though they were new claims.

Like “cooking the books” at VA hospitals to conceal delays in medical care, the practice of manipulating claims data made it seem as though veterans weren’t waiting as long for decisions on their benefits as they really were, Ausby said.

Most underlings are too demoralized to complain or don’t know how to do so without risking retribution, he said.

Falsifying data isn’t a new phenomenon at VA, said Gerald Manar, who worked as an adjudication manager at the VA for 30 years before becoming the national veterans service deputy director for Veterans of Foreign Wars.

VA managers are reluctant to ask for more money and the staff they need to meet quotas because they don’t think their requests will go over well with higher-ups in Washington or politicians in Congress, Manar said.

“The attitude among managers is, ‘Why even bother asking, because we’re not going to get it,’” Manar said. “When you have that kind of culture, you feel so beaten down, so restricted, so disheartened by what’s happened before that you don’t even ask for what you need.”

Some VA employees resort to hiding the problem. As a result, politicians, the public and officials at the VA central office don’t get an accurate picture of what’s wrong from people in the field.

“In a bureaucracy when people are given orders to do things that can’t possibly be done, they become cynical,” said Ronald Abrams, a former VA official who is the joint executive director of the National Veterans Legal Services Program.

“For example, years and years ago I read that the post office made a rule that all mail coming in on Monday had to get out on Monday, otherwise people would lose their jobs … so in Pennsylvania employees rented a trailer and simply threw the letters into a trailer,” Abrams said.

“When the VA said, ‘OK we have to get all these appointments scheduled within 14 days,’ the cynical employees said, ‘We can’t possibly do that.’”

A new test is whether the massive agency needs to grow even more to accommodate a booming veterans population or whether it’s an outmoded model that should be re-imagined to simplify veterans’ benefits applications and give them more access to private care.

A compromise bill crafted by Sens. John McCain, R-Ariz., and Bernard Sanders, a Vermont independent, aims to strike a balance between expansion and privatization.

It would allow veterans who live far from VA facilities or can’t get timely VA appointments to seek care from any doctor in the Medicare program, at federally qualified health centers, facilities funded by the Department of Defense or Indian health centers.

The bill would authorize the VA to lease 26 new health facilities and would allot $500 million in unobligated VA funds to hire more doctors and nurses.

Another provision in the bill would allow the VA secretary to demote or fire senior agency officials based on their performance. Unlike a similar bill that passed last month in the House of Representatives, this version doesn’t remove the right of poor-performing officials to appeal their terminations, but it expedites the process from 120 days to just three weeks, and withholds their pay until the appeal is resolved.

Among other legislative fixes offered by members of Congress in recent weeks are measures that would freeze bonuses to senior VA employees until changes are implemented, require the VA to identify officials accused of misconduct by name and publicly release Office of the Medical Inspector reports of investigations into wrongdoing at VA facilities.

Past efforts to overhaul the VA have met with a mixed record of success.

In the 1920s, for example, the government adopted strict civil service rules after the first director of the Veterans’ Bureau was caught selling surplus hospital supplies for personal profit.

The rules ended up stifling innovation and made it hard to recruit good doctors, said Colin Moore, an assistant professor of political science at the University of Hawaii who is working on a book about the history of the VA.

The consequences hit after World War II, when a series of articles exposed the abuse and neglect of returning veterans.

The VA responded to the crisis by establishing partnerships with medical schools that dramatically improved the quality of care for veterans.

But the downside of focusing VA resources on acute in-patient care in urban areas near medical schools became apparent after Vietnam, when returning veterans had trouble accessing local primary care. It wasn’t until Congress passed the 1996 Veterans Health Care Eligibility Reform Act that the VA became an integrated health system and expanded into hundreds of outpatient clinics in rural areas and across the South and Southwest.

The VA now has 152 hospitals and 800 clinics serving more than 6 million veterans across the country.

“It’s tragic for the veterans, but this pattern of scandals and reform is just more or less the entire history of the organization,” Moore said.

Should Doctors Work for Hospitals? – The Atlantic

Posted by timmreardon on 06/07/2014
Posted in: Emergency Medicine, Health Care Costs, Health Care Economics, Health IT adoption, Health Outcomes, Healthcare Informatics, Healthcare Security, Integrated Electronic Health Records, Lab Report Access, Open Data, Patient Centered Medical Home, PCMH, Quadruple Aim, Uncategorized. Leave a comment

A diabetes check-up at the International Community Health Services in Seattle (Ted S. Warren/AP)
Article link: http://m.theatlantic.com/health/archive/2014/05/should-doctors-work-for-hospitals/371638/?utm_content=bufferb2f47&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Hospitals are buying up medical practices at a feverish pace. According to data from the American Hospital Association, the number of physicians employed by hospitals grew by 34 percent between 2000 and 2010, and the pace shows no signs of slackening. In reviewing its data for the past decade, a large physician recruiting firm found that in 2004 only 11 percent of physician searches were conducted by hospitals, but by 2013 that figure had risen to 63 percent.

There are a number of reasons hospitals want to employ physicians. A major aim is to funnel patients to the hospital’s facilities. By law, it is illegal for hospitals to offer physicians inducements to refer patients to their facilities unless the physicians are hospital employees. A term that some hospitals use to describe the referral of patients to providers and facilities outside their system is “leakage.” Such leakage represents lost revenue, and by employing physicians hospitals hope to plug up the holes.

Of course, there are other factors. One is the ability to hospitals to charge more for a variety of procedures than independent physicians, by tacking on “facility fees.” By buying a physician practice, a hospital can charge more for the same test or procedure, even though it is performed in the same place by the same physician. In some cases, such facility fees can raise prices to Medicare by as much as 70 percent compared to what would be paid to an independent physician.

Another factor is negotiating clout with healthcare payers. When a hospital employs a greater proportion of physicians in a healthcare market, it can often negotiate more favorable payment rates with health insurers. The Federal Trade Commission has taken an interest in this trend, lodging complaints against hospitals for employing too high a percentage of local physicians. In some cases, the FTC has even filed lawsuits against such hospitals.

Hospitals also argue that by employing physicians, hospitals can achieve greater integration of care. For example, they say they can reduce needless variations in practice, including the use of different medical devices for the same procedure, such as knee joint replacement. They also argue that they can ensure better coordination of care between different medical specialties, as well as between physicians and other hospital-employed health professionals such as nurses.

This is not the first time that hospitals have gone on a medical practice buying spree. Something similar took place in the 1990s when the rise of managed care made it appear that hospitals needed to exert more control over patient referral patterns. But widespread public revolt against managed care quickly led to the opening up of such network restrictions. Moreover, as physicians became employees, their productivity fell. Before long, hospitals began divesting themselves of physician employees.

Hospitals hope that this time will be different. For one thing, more sophisticated information systems enable hospitals to do a better job of tracking physician behavior. Even if hospitals lose money on a per-physician basis, they hope that more favorable payment rates and control of referrals will enable them to make up the difference. If successful, they would both get more patients and generate more revenue per patient.

But there is another pitfall in physician employment. Compared to the independent physicians of 20 years ago, today’s employed physicians often exhibit poor morale. It is easy to see why. When physicians become employees, they forfeit a substantial degree of professional autonomy. They are subjected to more institutional rules and regulations, feel increasing pressure to practice according to prescribed patterns, and often labor under escalating productivity quotas.

A related danger is a loss of autonomy on the part of the entire profession of medicine. Increasingly, physicians find themselves working for non-physicians, individuals who never trained in the health professions or cared for the sick. As the trend toward physician employment continues, the people in charge of medical practices are less likely to sport white coats and stethoscopes and more likely to be in business suits. Many physicians feel they are losing control of their profession.

A sense of control can exert a profound effect on morale, energy, and even health. One of the best-known social psychology experiments of the 1970s compared residents of different floors of a nursing home. On one floor, residents were encouraged to make decisions for themselves. For example, they were allowed to choose where to receive visitors, what movies to watch, and how to care for a houseplant they had been given.

On another floor, residents were told that the nursing staff would take care of them. They were not allowed to make choices about where to receive visitors or what movies to watch. They were given houseplants, but were not allowed to determine where to position them or how to care for them. Instead they were told that the staff would take care of things. In contrast to the first group, they were encouraged to see themselves as dependent on the nursing staff.

The two groups were followed for 18 months. At the end of this period, striking differences emerged. The members of the first group were more alert, active, and cheerful than the second group. They were also significantly healthier. In fact, less than half as many members of the first group had died as in the second group. The findings strongly suggest that our ability to choose for ourselves plays an important role in our psychological and physical well-being.

There is a lesson here for physicians and hospitals. A recent nationwide survey showed that the single most important factor in promoting professional fulfillment among physicians is providing high-quality care to patients. Where the health of medicine is concerned, infringing on physicians’ ability to care for patients as they think best can prove toxic. By contrast, one of the best tonics is ensuring that physicians can continue to care for patients as they see fit.

In the short term, hospitals may reap financial rewards by employing large numbers of physicians. Over the longer term, however, the vitality of both individual physicians and the entire profession of medicine seems likely to decline, with deleterious consequences for patient care. To protect and promote the future health of the medical profession, it is important that physicians continue to base their decisions primarily on what is best for the patient, not what is best for the hospital.

Who Owns Your Genetic Data? Hint: It’s Probably Not You – Techonomy

Posted by timmreardon on 06/07/2014
Posted in: Big Data, Genetic Data, Health Care Costs, Health Care Economics, Health IT adoption, Health Outcomes, Healthcare Delivery, HIPAA, Innovation, Uncategorized. Leave a comment

(Image via Shutterstock)

By  |  June 6, 2014, 9:49 AM  |  Techonomy Exclusive

As we move closer to an era when a sequence of every human genome is the norm, an important question looms: who will own this data? It seems intuitive to many of us that each person owns his or her genetic data and therefore should control access. But the reality is more complex.

Consider any number of analogies: cell phone data, credit card data, email information. You have a sense of ownership for all of that, right? But it’s hard to make the case that you truly own it when Verizon Wireless, American Express, or Google has more control than you do over account access, data storage, and which other parties get to see your information. (Ahem, NSA.)

The concept of data ownership is so contentious in part because of its nature. Data moves, it morphs, and most of us can’t even say where it lives. (“The cloud” is not an answer.) For people who grew up thinking that possession is nine-tenths of the law, data is too slippery to fit into the usual framework.

Throw in the morass of regulations surrounding medical data, and you get an idea of why ownership of genetic data is such a complex issue. The Supreme Court’s verdict that companies cannot patent naturally occurring genes told us who doesn’t own our genes—that’s a start.

Depending on circumstance, genomic information may or may not be considered protected health information under the U.S. Health Insurance Portability and Accountability Act of 1996, better known as HIPAA. That means sometimes there will be a number of barriers between you (or anyone) and that information, and other times it will be freely accessible, but in ways that supposedly prevent anyone from knowing whom the data comes from. In fact, scientists have already demonstrated that it takes remarkably little know-how to link this de-identified information, as it is known, back to its source.

With that basic protection up in the air, the federal government and many states have passed or are considering legislation that would settle the ownership question, or at least prevent discrimination based on the data. The landmark Genetic Information Nondiscrimination Act was passed by U.S. Congress in 2008 to prohibit unfair treatment based on DNA information—particularly among health insurance companies—but does not apply to providers of life, disability, or long-term care insurance. Bills introduced since then in Massachusetts, Vermont, and California aim to close those loopholes and also establish clear property rules to ensure that each individual is the sole owner of his or her genetic information.

As that piece of the puzzle is addressed, some companies are trying to solve the issue of how and where this data will be stored. Coriell Life Sciences, for example, was spun out of the nonprofit Coriell Institute for Medical Research to offer a data-hosting service for genetic information. A person’s genome sequence is stored on Coriell’s computers, and as that person needs to know more about it, approved providers can access that sequence and interpret certain sections of it.

For example, let’s say you have your genome sequenced at age 35. At the time, what you really care about is whether you’re a carrier of certain diseases, so you give permission to one interpretation service to scan the associated portions of your genome and tell you about those diseases. Later in life, you decide you want to know whether you’re at increased risk for developing Alzheimer’s disease, so you allow another interpretation company to access your DNA sequence and look for that specific genetic marker. The idea is that genetic information is safest when it is stored in one place for a person’s whole life, rather than being shipped here and there for various interpretations. The use of permissions to access certain parts of the DNA sequence adds another layer of protection.

At the moment, Coriell’s business model is geared toward physicians; it assumes they are the ones depositing data on their patients’ behalf, and they control access permissions. But as people demand more control over their data, the model could shift to put consumers in the driver’s seat. Coriell Life Sciences is just one player in a rapidly shifting field; we will see many variations on it, both better and worse, in the coming years.

Right now, few of us have personal genomic data. But consider results from any individual gene tests you may have had—or, failing that, any result from a medical test. Chances are, your physicians or hospital have a stronger ownership claim to that information than you do: they probably keep it in a file and have the authority to grant access to it as needed, whereas you might not even remember what the results were. Until consumers find it important to stake their claim for their own genetic data, this situation is likely to remain the status quo in the coming years.

Article link: http://linkis.com/shar.es/cIFaK

This aspect of the convergence of technology and healthcare will be included at our first-ever Techonomy Bio event, taking place June 17th in Mountain View, Calif.

VA And Military Care Are Different, But Often Confused – Kaiser Health News

Posted by timmreardon on 05/30/2014
Posted in: Blue Button, DoD, Global Standards, Health Care Costs, Health Care Economics, Health IT adoption, Health Outcomes, Healthcare Delivery, Healthcare Informatics, Healthcare Security, Innovation, Integrated Electronic Health Records, Military Health System Reform, National Health IT System, Open Data, Patient Centered Medical Home, Patient Portals, PCMH, Quadruple Aim, Quality Measures, U.S. Air Force Medicine, U.S. Army, U.S. Army Medicine, U.S. Navy Medicine, Uncategorized, Veterans Affairs, Warrior Transistion Units. Leave a comment

By Julie Rovner

KHN Staff Writer

May 29, 2014

 Article link: http://www.kaiserhealthnews.org/Stories/2014/May/29/VA-military-health-care-FAQ-similar-scrutiny.aspx

It’s not just veterans who are having trouble with health care. Now the health system for active duty military is under the microscope, too.

Longstanding issues with an overburdened system for caring for the nation’s veterans have burst into the news recently, particularly with allegations of fraudulent record-keeping to hide the size of the waiting list for care at the Phoenix Veterans Affairs Health Care System.

U.S. Veterans Affairs Secretary Eric Shinseki (background) listens to American Legion National Commander Daniel Dellinger speak during a Senate Veterans’ Affairs Committee hearing focusing on wait times veterans face to get medical care May 15 in Washington (Photo by Mark Wilson/Getty Images).

And just this week, Defense Secretary Chuck Hagel ordered a 90-day review of quality issues in the military health system. That action came following two unexplained deaths at an Army hospital in North Carolina that led to the sacking of several top officials there, although Defense officials said the actions were unrelated.

Yet the VA and military health systems are completely separate entities. They are not even part of the same cabinet department – the VA system is part of the Department of Veterans Affairs, while the military system is overseen by the Department of Defense. Here are some common questions about the two systems.

What is the VA health system?

The Veterans Health Administration, part of the Department of Veterans Affairs, is a system of approximately 1,700 hospitals, outpatient clinics, counseling centers and long-term care facilities that provides care to nearly 9 million veterans annually. Congress has appropriated $55.6 billion for VA health care services and facilities for the fiscal year that starts Oct. 1. Unlike Medicare, where the federal government pays for care provided by private doctors and hospitals, VA facilities are owned and run by the federal government, and its health care providers are largely, although not exclusively, government employees. 

Through agreements with various medical, dental and other medical education programs, the VA has become the single largest provider of health care training in the country. In 2013 VA facilities participated in the training of more than 63,000 doctors and dentists.

Who is eligible for VA health services?

Just about any individual who serves on active duty in the armed forces and is discharged other than dishonorably is technically eligible to receive health services from the VA.

But because demand far outstrips capacity, the VA health system, under orders from Congress, created a priority system to provide care to those deemed most in need. The top priority group consists of those who are more than 50 percent disabled as a result of their military service and/or deemed unemployable due to conditions connected to their service. The second group are veterans with slightly less severe disabilities;  the third group  includes those who are former POWs or who were awarded Purple Hearts or Medals of Honor. There are currently  eight groups; rankings include not only health status, but also income and age.

Dependents of veterans who are permanently and totally disabled or who die of a service-connected disability can qualify for CHAMPVA, a health insurance program that largely uses private doctors and hospitals to provide care. Unlike active-duty military, most other veterans’ dependents do not qualify for government-paid or subsidized care.

Why is the VA so overburdened right now?

This is at the heart of the current debate, but there is general agreement that a number of factors are converging to put significant pressure on the VA health care system. One is simply the aging of baby boom-era Vietnam veterans, whose medical needs are increasing.  Another is a large influx of wounded warriors from more than a dozen years of combat in Iraq and Afghanistan with  serious disabilities. A third factor is recent changes in the law making it easier for veterans who were exposed to the herbicide Agent Orange or to hazardous substances in Iraq and the areas around the Persian Gulf to qualify for benefits.

How does the Department of Defense provide health services to active duty members of the military and their dependents?

The military – the Army, Navy, Air Force, Marines, and Coast Guard – has its own integrated health care system known as the Military Health System. In addition to providing medical care in combat situations and at bases overseas (as well as on ships), the system has 57 hospitals and 400 clinics.

The military also has its own medical school, the Uniformed Services University of the Health Sciences, in Bethesda, Maryland, on the campus of what was the Bethesda Naval Hospital and is now the merged Walter Reed National Military Medical Center. The university trains doctors, dentists, nurses and PhD scientists.

Like the VA, however, the military’s health facilities cannot accommodate the demand for care by all active duty service people, their dependents, and retirees (many of whom are not eligible for VA services). So it has its own government-provided insurance plan, called TRICARE, for those who cannot get care at a military health hospitals or clinics.

TRICARE, much like Medicare, is insurance that is paid by the government, but uses private doctors and hospitals. In fact, TRICARE rates are tied to Medicare rates. 

 

Why Did It Take So Long for the VA Scandal to Go Public? – Defense One

Posted by timmreardon on 05/30/2014
Posted in: Blue Button, Global Standards, Health Care Costs, Health Care Economics, Health IT adoption, Health Outcomes, Healthcare Delivery, Healthcare Informatics, Healthcare Security, Innovation, Integrated Electronic Health Records, National Health IT System, Patient Centered Medical Home, Patient Portals, PCMH, Quadruple Aim, Uncategorized, Veterans Affairs. Leave a comment

The St. Louis VA Medical Center, seen here on Wednesday, May 28, 2014 has come under scrutiny after the former chief of psychiatry said too many mental health patients must wait for treatment, sometimes for 30 days or more.

The St. Louis VA Medical Center, seen here on Wednesday, May 28, 2014 has come under scrutiny after the former chief of psychiatry said too many mental health patients must wait for treatment, sometimes for 30 days or more. // Jim Salter/AP

Alesh Houdek The AtlanticMay 29, 2014

Article link: http://www.defenseone.com/management/2014/05/why-did-it-take-so-long-va-scandal-go-public/85438/?oref=defenseone_today_nl

When the Veterans Administration in Phoenix began to fall significantly behind on a policy stating that veterans should get the care they need within 30 days, workers devised a solution that involved entering information into a computer screen, printing the screen, and then not saving the record. This allowed them to hide the long wait times some veterans endured, sometimes longer than a year, from oversight. The nation’s veterans were denied healthcare they were promised, and the organization responsible for providing that care was hiding its failures with a scheme that apparently involved Arizona VA employees from front-line administrators all the way up to the top management. It turns out VA offices around the country were using similar tricks.

The speed and success of the VA and the Obama administration’s response to the scandal will inevitably be measured against the speed and success with which it fixed Healthcare.gov: We’ve seen the administration fix a gigantic catastrophe; now point that response over there at that. This is an unfair standard. Healthcare.gov was a major technological failure, but it wasn’t nearly as large or as entrenched as the bureaucracy of the Department of Veterans Affairs. The VA has a staff of more than 300,000 spread over thousands of facilities. And while the root problem is with the scheduling system they use and the overall shortage of resources and explosion of veterans requiring services, the immediate problem here is staffers in the Phoenix office submitting deliberately incorrect information to hide the amount of time veterans were waiting. This type of deception has to involve both regular employees and supervisors: a true conspiracy.

“I feel very sorry for the people who work at the Phoenix VA,” said Foote. “They’re all frustrated. They’re all upset. They all wish they could leave ‘cause they know what they’re doing is wrong.

“But they have families, they have mortgages and if they speak out or say anything to anybody about it, they will be fired and they know that.”

It’s telling that Foote went to the press only after retiring. Despite the Whistleblower Protection Act of 1989, the federal government during the Bush and Obama administrations has grown increasingly hostile to whistleblowers. Barack Obama campaigned on transparency and whistleblower protection; his transition agenda said, “Often the best source of information about waste, fraud, and abuse in government is an existing government employee committed to public integrity and willing to speak out. Such acts of courage and patriotism, which can sometimes save lives and often save taxpayer dollars, should be encouraged rather than stifled.” Since taking office, however, he has prosecuted twice as many people under the 1917 Espionage Act as all the previous administrations combined. These are the most extreme cases, but they represent a culture and ethos that appears to permeate the federal government.

In 2011, the Office of Special Counsel received more than 1,000 whistleblower disclosures of waste, fraud, abuse, and health/safety problems. It referred only 62 of those cases back to the relevant agency for further investigation. Meanwhile, the protections for whistleblowers who remain in their jobs are famously porous, and many are fired or retaliated against. The Obama administration was widely lauded for the passage of the Whistleblower Protection Enhancement Act, but its effects are apparently not being felt in the front lines of government offices. Since the Phoenix revelations, employees from VA offices around the country have gone to the press with reports that similar practices exist at their offices. Had there been a robust and reactive system for internal whistleblowing, this would not have happened.

In this environment, it’s not surprising that federal employees are reluctant to come forward with complaints. Until the message that whistleblowing is accepted and encouraged filters down through the ranks of the 5 million executive-branch employees, those at the bottom won’t feel comfortable doing the right thing. Perhaps we’ll hear the stories of what ends up happening to those who have come forward from VA offices around the country since the Phoenix revelations to cast light on problems in their own departments, and perhaps that will help bring about the change we need.

From the prosecution of Chelsea Manning and Edward Snowden to the woefully inadequate implementation of the Whistleblower Protection Enhancement Act, the Obama administration has helped to maintain an environment of fear among federal-government employees. Internal and external reports of wrongdoing by those on the ground are an essential part of keeping any organization running reasonably well, and they’re being actively prevented. Until that system is addressed, we won’t know what other horrific problems exist in the government’s vast bureaucracy. We won’t even know whether the VA scheduling abuses have been corrected. Unlike Healthcare.gov, there’s not a publicly visible website that anyone can try out. Whistleblowers are the only avenue for accountability.

Author

Alesh Houdek lives and works in Miami. He writes occasionally at Critical Miami. Full Bio

VA Failed to Protect Critical Computer Systems, Audit Finds – Nextgov

Posted by timmreardon on 05/30/2014
Posted in: Blue Button, DoD, Global Standards, Health Care Costs, Health Care Economics, Health IT adoption, Health Outcomes, Healthcare Delivery, Healthcare Security, HIPAA, Innovation, Integrated Electronic Health Records, Military Health System Reform, Mobile Healthcare, National Health IT System, Patient Centered Medical Home, Patient Portals, PCMH, Quadruple Aim, Uncategorized, Veterans Affairs. Leave a comment

amaze646/Shutterstock.com

Article link: http://www.nextgov.com/defense/whats-brewin/2014/05/va-failed-protect-critical-computer-systems-audit-finds/85429/?oref=nextgov_today_nl

By Bob Brewin May 29, 2014

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In another blow to the beleaguered Veterans Affairs Department, the VA inspector general reported today that an audit by an outside accounting firm revealed continuing problems protecting mission critical systems.

The audit, conducted by CliftonLarsonAllen LLP, said that although VA has made progress developing security policies and procedures, it suffers from “significant deficiencies related to access controls, configuration management controls, continuous monitoring controls, and service continuity practices designed to protect mission-critical systems.”

These problems, in part, stem from the fact that VA hasn’t instituted security standards on all its servers and network gadgets, and still needs to remediate 6,000 previously identified risks.

(Image via amaze646/Shutterstock.com)

Why Interoperability is “A Bridge Too Far” and integrated EHRs are needed

Posted by timmreardon on 05/30/2014
Posted in: Blue Button, DoD, Global Standards, Health Care Costs, Health Care Economics, Health IT adoption, Health Outcomes, Healthcare Delivery, Healthcare Informatics, Innovation, Integrated Electronic Health Records, Military Health System Reform, Mobile Healthcare, National Health IT System, Patient Portals, PCMH, Quadruple Aim, U.S. Air Force Medicine, U.S. Army, U.S. Army Medicine, U.S. Navy Medicine, Veterans Affairs, Warrior Transistion Units. Leave a comment
HIE Watch
Article link: http://www.hiewatch.com/news/tough-work-connecting-giant
Tough work connecting with giant
Source: Bernie Monegain Date: May 21, 2014

Epic to non-Epic clinical data sharing can be done, but it is not without challenges, according to a new report from research firm KLAS. The report examines what health organizations not using an Epic system have to do in order to share data with health systems that employ an Epic EHR.

Providers using non-Epic clinical systems say that while it isn’t easy, they are able to share data with Epic.

KLAS takes a look at the methods being used to accomplish data exchange non-Epic to Epic data sharing in the report “Epic HIE 2014: Everywhere, Elsewhere, or Nowhere Else?”

“Epic is seen by many competitors and providers as not playing well with others,” said report author Mark Allphin, in a news release. “Yet the providers we interviewed told us a more complex story. Data is being shared, but the effort required to get there can be very different depending on whether you are on the Epic side of the exchange or with some other vendor.”

As part of this study, KLAS interviewed 28 providers about their experiences with sharing data between Epic and non-Epic systems. Some of the areas looked at include the ease of interoperability, the stresses associated with sharing clinical data and the methods currently being used to share the data.

Healthcare IT News recently reported on how one hospital with an Epic system was able to share data with the physician group using a Greenway EHR system.

The Epic EHR at Lancaster General Health’s Women & Babies Hospital in Lancaster, Pa., now interoperates with the Greenway EHR at ob/gyn practice May-Grant Associates, making it possible for both to exchange continuity of care documents and securely share patient data.

Greenway is a member of the CommonWell Health Alliance, the interoperability vendor group announced at HIMSS13.

Edmund Billings, MD, chief medical officer for Medsphere Systems, the developer of the OpenVista electronic health record, is a longtime proponent of interoperability.

“Anyone who understands the importance of continuity of care knows that health information exchange is essential,” he wrote in a Feb. 14, 2013 blog. “How are we supposed to cut waste and duplication from the healthcare system and truly focus on patient welfare if doctor B has no idea what tests doctor A conducted, or what the results were?”

As Billings see it, the problem is with proprietary business models.

“In the proprietary world, interfacing with third-party products is a revenue generation strategy and technical challenge; the latter, though unnecessary, justifies the former. When we go looking for the reasons that healthcare is a laggard compared with other industries, this single-source model – the obstacle to much-needed competition and innovation – is a primary culprit.”