Meaningful Use Stage 2: Hesitation could be costly

We often expect something we experienced before to be not as hard the second time around.     We are encouraged by software companies to not to think about MU2 until after we get the latest compliant version of the software installed in our system.       There are promises that if we have the software in place on day one of reporting that we will be able to attest.

Yet,  Meaningful Use Stage 2 has the potential to be the perfect storm.    

I have been on many calls and talked with other Meaningful Use SMEs (Subject Matter Experts) that are not just helping their clients through configuration, but working at warp speed both bailing the water and battening the hatches.   We can do it, we are great at it…but the frustrating thing is that we don’t have to let it get to this point.

Meaningful Use Stage 2 has a broader and deeper scope than Stage 1.       Many measures that at first glance look the same as last time around are actually much more specific in ways that affect how you organize your data and workflow – Computerized Provider Order Entry is a great example of this.   In Stage One, Providers just needed to be placing orders electronically, 90% of our clients were doing this so we were good.   In Stage 2 it becomes more specific about the types of orders and will be reporting a percentage for Medications, Labs and Imaging orders.     This means that we need to review those dictionaries and ensure that all Labs and Imaging orders are in the correct parent class and that there is nothing extraneous there that might alter our numbers.

“We’re not going to talk about MU2 until after the upgrade”    I have heard this from clients as well as software reps, and it’s maybe the most dangerous attitude that anyone on the team could present.    We are at a stage in this process that every Organization should have a Meaningful Use SME that they can call when implementing anything new and just ask “Is there anything I am missing here, what should I be thinking about in regards to MU?”

For MU Stage 2 specifically, we know that there is work to be done that is not dependent on the latest and greatest version of the software.   Dictionary updates, cleaning up the referring provider dictionary,  LOINC & SNOMED updates, identifying & thinking through the gaps between the present day workflow and future state workflow are among the items that can be done well in advance.

Most importantly, don’t rely on software timelines to drive your project.    MU2 work should start a full three months prior to the quarter that you want to attest, regardless of infrastructure timelines.     If you are planning on reporting in Q3 of this year, you should be looking at all of the measures and reporting requirements now.    If you are planning on reporting in Q4, then you should start your review no later than July first. If you doubt the need to start reviewing and configuring now, take a close look at the measure for closing the referral loop.  That should get you and your staff motivated to begin as early as possible.


Wearable Technology in the Hospital

Wearable technology, including things like the FitBit and smartwatches, are popular in tech circles. They are tools that generally allow the user to accomplish a few specific tasks with minimal effort. As with much of technology, they will grow in features and popularity until most people have access to and use them in their daily life. As a tool to be used in the workplace, their utility remains less well known. So far, the data that they provide tends to be highly specific and less for immediate use as much as tracking progress. Smartwatches are pushing those boundaries with the ability to display messages and provide certain controls, but even that is limited for now.

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Google Glass seems to be the exception. Worn like a pair of glasses, it includes a small screen and camera that can be controlled by voice, touch, or even a small head movement. Beth Israel Deaconess Medical Center in Boston is piloting a program to provide this technology to providers in the emergency room, with the goal of displaying pertinent information right when it’s needed. Dr. Steven Horng, who heads up the program, is confident that such devices can save lives. He gave an example of a patient who came into the ER with a brain hemorrhage. The patient was allergic to some blood pressure drugs but was unable to describe them to Horng. Using Glass, Horng was able to pull up the patient’s chart instantly and view the medication allergies, and could then administer the proper drug to the patient. Examples like this easily show the benefits of technology like Glass: up-to-date information about patients without needing a computer, uninterrupted face-to-face interaction, and the ability to capture images or text via dictation. Other hospitals have used Glass to conference in specialists from other locations for guidance or to record videos for training and review purposes.

Any new technology will also present challenges, and wearable technology is no different. In a healthcare setting, patient information is always a concern. At Beth Israel, QR codes are posted outside of patient rooms that allow providers to quickly pull up charts. Unless additional layers of security are added, these could be accessed by anyone with the proper credentials and a smartphone. Their Glass devices are running a modified version of Android which is limited to the hospital wi-fi network and does not share any data with Google, but this could be an issue for unmodified devices. Any photos or videos taken with Glass need to be screened for identifying information, either visual or auditory. Simple physical security for devices is a big part of it, especially as devices get smaller. Any data saved to a device must be able to be wiped remotely in the event of theft, and in a timely manner. On an individual side, they can be distracting. Providers will need to work out the best times to use wearable devices vs. a traditional EHR interface.

Wearable devices are coming to your healthcare provider; it’s only a matter of time. Given experiences with Glass, it seems that there is potential for wearable devices to improve patient visits, increase provider knowledge and efficiency, and save patients from human error. The real trial will be integrating yet another technology into already busy workflows.

HIE is here to stay

Galen Healthcare Solutions announced its strategic partnership with Orion Health in a past January article. Since then, Galen has been heavily involved in the recent boom of Health Information Exchange (HIE). What’s an HIE? In a nutshell, HIE is the “secure health data exchange between two or more authorized and consenting trading partners” (HIE Implications in Meaningful Use Stage 1 Requirements). On one end is the data supplier; on the other end is the data receiver. A third party – in this case, Orion Health – facilitates the data transfer to ensure quality control and necessary HL7 specifications.

I’ve spent the past few months working with two promininent HIE projects: hundreds of hospitals in each state sending demographic information, clinical documents, laboratory results, radiology reports, and immunizations to the state’s data repository. Providers from those hospitals are then able to access a portal that can display a patient’s full medical history from multiple hospitals on one profile.

Engaging in an HIE is one way for a hospital to meet Stage 1 Meaningful Use objectives. HIE engagement will only grow in the future as Stage 2 and Stage 3 Meaningful Use requirements are initiated. At its core, Meaningful Use is using EHR technology to promote patient engagement, care coordination, and health security. A breakdown of the 3 stages are as follows:

An important criteria for Stage 2 is that providers who have met Stage 1 for two or three years will need to meet meaningful use Stage 2 criteria to continue collecting government incentives. As eligible providers move into the next phase of meaningful EHR utilization, we can expect the trend of HIE to continue, with increased attention on advanced clinical procedures.

Concept: Converted Clinical Data Warehouse

Galen’s process for performing health information system conversions is continually improved.  We want conversions to be as safe, flexible, predictable and seamless for our clients as possible.  This is why we develop workbooks, and it’s why we’ve invested countless hours incorporating premium functionality into our Galen ETL conversion platform.  Just this past Friday morning, four of the technical consultants from Burlington, VT secluded ourselves to a corner of our hundred year old converted manufacturing building’s basement to develop the functionality necessary to extract documents of varying  formats out of a system that stores documents as zipped archives in a binary column within its database.  This wasn’t something we’d encountered before, but the next time we run into this configuration, we’ll be ready.   Galen ETL quite literally represents the collective knowledge of all of our conversion analysts’ past experiences combined with our software developers’ innovative technical solutions.  Yet, Galen ETL can do even more for our clients.

The Galen ETL platform facilitates both discrete and non-discrete data conversions.  Galen ETL’s chart summary plugin has made non-discrete conversions of clinical data more popular by providing an easy way to summarize a patient’s chart in a single PDF document. One significant advantage to this approach is that it alleviates the need to complete large and intricate mapping workbooks designed to translate codes, types, and other dictionary-like data from the verbiage in the source system to values compatible with the target system.  It also alleviates the need to store dirty, conflicting, or duplicate data discretely in the target EHR system. However, the end result are documents which cannot be searched or analyzed easily. Therefore, while chart summaries are a great option, there are consequences.

It is because of these consequences and compromises that we are researching and developing a middle ground; a best of both worlds solution. Think of it as a discrete conversion, but not into your EHR, and with no required mapping workbooks.  We are developing a clinical data warehouse.

I mentioned earlier that Galen ETL represents our collective conversion knowledge.  Because of this, Galen ETL already has a robust data model for staging (temporarily storing and manipulating) clinical data from just about every EHR Galen conversion analysts have previously encountered.  Galen ETL’s comprehensive data model served as the ideal source system from which to design a data warehouse.  And that’s what we did – built a centralized repository for clinical data.  As we’d already developed means to extract and stage clinical data to facilitate our conversion process, we were already well on our way to developing a warehouse solution for storing clinical data.  Galen ETL still performs the heavy lifting when it comes to getting data from source EHR’s and transforming it.  But rather than load the data into a target EHR, or create chart summaries from the data, we store the data discretely in a separate database. However, we still needed to make the data readily accessible.

The ability and ease of viewing data stored in the warehouse is crucial.  But how do we make viewing the data in our warehouse as seamless for providers as using their EHR?  This question necessitated the development of a warehouse clinical data viewer that resides inside EHR systems, such as Allscripts TouchWorks. By doing so, not only is authentication seamless, but we can utilize contextual information like the currently viewed patient, and other relevant details such as the specialty of the provider, in order to provide valuable information to the provider from the moment our warehouse data viewer is accessed.  Our vision is for the warehouse viewer to be situated adjacent to the Chart Viewer in your EHR.  The provider knows that the data either exists in the EHR, or has been converted/archived form another clinic and exists in the warehouse. Another requirement was that the viewer not feel like an external application, but instead like a logical extension of the EHR.  From the start, Galen Warehouse was designed to complement rather than disrupt existing workflows.

Still, this is R&D. Whether or not Galen Warehouse will evolve past the functioning prototype stage is yet to be seen. Nonetheless, it is a testament to Galen’s ever evolving definition of what a conversion is. We will continue to question what converting a health information system’s data means and what options should be presented to organizations.  Conversion workbooks and large volumes dirty data are deterrents to pursuing discrete conversions.  Yet, non-discrete document conversions with chart summaries means storing important clinical information in a relatively less accessible format.  We think that a data warehouse built specifically to house converted clinical data, paired with an EHR-integrated viewer, can represent the best of both worlds. It provides a fast and approachable means of accessing all of the vital patient information from converted systems, while maintaining the discrete nature of your EHR’s data.  Even if our conversion warehouse never comes to fruition, its development represents Galen’s continuing effort to improve our conversion processes so that each conversion we perform is faster, safer and easier for you, our valued clients, than the previous.

MIT-KIT Workshop of Private Health Data

Last Friday, March 29th I attended MIT-KIT Workshop of Private Health Data in Boston, MA.  The conference was co-sponsored by MIT-KIT and Professor Sandy Pentland of the MIT Media Lab.  The format of the conference was a short presentation followed by a discussion between the approximately 50 attendees of the conference.

Sandy Pentland gave the opening talk; in 2012 he was named one of the ‘seven most powerful data scientists in the world’.  He wrote WISH Report on Big Data: Revolutionizing Medicine and Public Health  and just released a new book Social Physics.

The first topic of discussion was Open Issues in Patient Data Sharing lead by Adrian Gropper, principal of HealthURL.  He spoke about The Code of Fair Information Practices and the necessity of the 5 principles to be implemented into a healthcare technology product for that product to be scalable.  The 5 principles of the Code of Fair Information Practice are as follows:

  1. There must be no personal data record-keeping systems whose very existence is secret.
  2. There must be a way for a person to find out what information about the person is in a record and how it is used.
  3. There must be a way for a person to prevent information about the person that was obtained for one purpose from being used or made available for other purposes without the person’s consent.
  4. There must be a way for a person to correct or amend a record of identifiable information about the person.
  5. Any organization creating, maintaining, using, or disseminating records of identifiable personal data must assure the reliability of the data for their intended use and must take precautions to prevent misuses of the data.

The second discussion was based on Emerging Standards and Technologies presented by Debbie Bucci from the Office of the National Coordinator for Health IT and Machiej Machulak from Cloud Identity Limited.  Web 2.0 access control is inconsistent and unsophisticated and federation is obsolete in the healthcare field.  User-Managed-Access is an OAuth-based web management protocol that gives users a central point where they can see data that is hosted on different applications. The UMA protocol requires clients to have a token to access the authorization server.  This is useful in healthcare as you can unify access to control under one app and to share data with a user they need to be listed.   OpenID Connect was another topic of discussion, it builds off the oauth2 protocol and allows clients to authorize users based on identity information provided by a 3rd party, trusted authentication server.  In short, this allows applications to authorize their users without having to manage and own passwords in their database.

The third discussion focused on BlueButton+, moderated by Josh Mandel of Harvard Medical School and Justin Richer of MITRE Corporation.  The original idea behind BlueButton was to allow patients to have easy access to view and download their medical records.  BlueButton+ takes this idea one step further by allowing users to connect to their data directly with S/MIME encrypted email or through RESTful API and web technologies.  Using BlueButton+ a patient could use any application to connect to BlueButton directly from their smart phone while they are in their doctor’s office.

The slides from the conference can be found here

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