Manage My Practice

Grand Rounds is a weekly summary of the best healthcare writing online, featuring stories, opinion and analysis from doctors, nurses, patients, researchers and administrators, as well as journalists. Each Tuesday, a different blogger takes the helm, publishing a new edition of Grand Rounds on their site. Each edition features the hosts picks for the ten best healthcare links of the week.

This week, one of my very favorite bloggers hosts Grand Rounds, Dr. Bryan Vartabedian of the famed blog 33charts.com. Dr. V. is a pediatric gastroenterologist at Texas Children’s Hospital/Baylor College of Medicine. If you’ve never read Dr. V’s blog, try it – his writing is excellent.

Here’s his intro:

Welcome to this edition of Medical Grand Rounds. I scoured the web and pulled together what I think are some of the more interesting posts and news items of the past couple of weeks. Ive tried to explore some voices that perhaps havent crossed your radar. Weve got sociologists, medical students, IT gurus, medical futurists and even a couple of doctors. Some of the discussions have related posts that you might find interesting. Posts are not listed in any particular order.

Give yourself a little gift and click here to read Grand Rounds.

There are two things I’ve found over the years that medical offices have a hard time giving up.

One is the appointment book.

The other is patient statements.

My first experience with creating patient statements was placing patient ledger cards on the copier. The copies were folded and slid into envelopes and mailed to patients. Despite a bad photocopy of handwriting of several different people squashed onto skinny lines, patients routinely understood what the bill said and paid the total. That was 25 years ago.

Today the process of sending statements to patients is largely outsourced along with electronic claims, but it’s not very electronic. If we can get paid by insurance companies electronically, why not get paid by patients electronically?

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One of the most exciting trends in modern healthcare can be found at the intersection of two larger societal changes: the shifting demographics of an aging Baby-Boomer population, and the fast adoption of smart mobile devices and mobile application platforms. As robust, secure and intuitive mHealth applications are adopted, patients are more empowered to monitor and share their health data outside of a traditional medical office or hospital setting. As healthcare delivery system already short on providers becomes even more taxed, mHealth applications will allow the system as a whole (patients, caregivers, loved ones, and payers) to navigate health decisions in a more efficient and informed way.

This quote from the Deloitte Center for Health Solutions 2010 Survey of Health Care Consumers says it all:

Boomers view tech-enabled health products as a way to foster control and ongoing independence for themselves, especially in light of the rise in incidence in chronic disease with aging, and their desire to reduce costs. Nearly 56% of boomers show a high willingness to use in-home health monitoring devices in tandem with care of their primary physician.

What are the advantages of pushing home health medical data from the source to the care provider?

• Minimum lag time between data collection and the clinicians ability to review it.
• Reduction in errors associated with human intervention in data entry.
• Intuitive and simple interfaces promote active patient involvement and caregiver communication in healthcare management.
• Secure sharing of PHI (Protected Health Information) with patient, family members, and approved internal and external stakeholders in health.

Here are just a few of the companies and products available now (or in the near future) that might change your mind about where and how health data is captured and shared. Each of these products automates the capture of health data and the transfer of the data in a usable format to an Electronic Health Record.

Near Field Communications

NFC (Near Field Communications) is a wireless technology that allows for quick transfer of data between two sensors that are fairly close (an inch or two) together. The secure transfer allows for seamless data tracking inside caregivers workflow. For example: medical supplies, drugs, injectables and fluids can be fitted with low cost sensors that are swiped past a patients sensor to indicate they will be administered to the patient, and then again past the providers sensor to indicate a finished procedure, capturing time of administration, dosage, and patient information without slowing down the care to enter this critical data by writing them down, typing them in, or just resolving to remember them for later entry.

Gentag makes the data sensors and applications that manufacturers can use to send data via cell phone to the hospital or physician for seamless inclusion in the electronic medical record (EMR). Monitoring of blood pressure, fever, weight management and urinalysis are just a few of the ways Gentag has improved data capture in healthcare.

iMPak Health makes a cholesterol monitor the size of a credit card that accepts a small blood sample to process for triglyceride levels. The data is uploaded wirelessly to a cell phone that transmits it to a health provider.

Smart Fabrics and Wearable Monitors

Researchers at the Universidad Carlos III de Madrid in Spain developed a fascinating concept for an Intelligent T-Shirt that uses sensors woven into a washable fabric to create a hospital garment that does more than preserve the patients modesty. The sensors in the fabric can detect and record temperature, bioelectric impulses (for ECG monitoring), as well as the patients location, current resting position, and level of physical activity.

Copenhagen Institute of Interaction Design graduate Pedro Nakazato Andrade has designed a dynamic cast called Bones that collects muscle activity data around a fracture area by using electromyographic (EMG) sensors to report the patients progress to physicians automatically. This could reduce the need for follow-up visits and imaging, or change the specifics of rehabilitation.

The Basis Band is a wristwatch-type accessory that monitors heart rate by directing light into the skin to image blood flow. It also uses a heat sensor for skin temperature changes, an accelerometer for recording movement and activity, and sensors for galvanic skin response. The band also gives customers access to a free, web-based health dashboard to oversee the data the device collects and transmits.

There are still some considerable hurdles to full adoption of mobile home health monitoring. Very few patients use only one medical device, so not only do monitoring devices need to work with networked EHR technologies, they have to be integrated with each other to present a comprehensive picture of health to providers and Health Information Exchanges (HIEs). Also, as patients navigate the system of generalists, specialists, and emergency care providers, the possibility of encountering multiple software and hardware platforms will require flexible, integrated solutions that can run on any device. As with any networked application of sensitive data, security and availability are major factors in a success deployment. Unless patients can count on the privacy of their data, and providers can count on the uptime of their software, healthcare systems wont be able to realize the full benefit of mHealth installations. On top of that, more monitoring of patient health means that there will be even more data to be collected on each patient, and on the population as a whole. While more data means more opportunity for large scale research and analysis for the public benefit, it also means more data has to be secured and protected as a part of the health record, requiring even more security and storage resources. And finally, the Food and Drug Administration will have a large say in the future of mHealth application development through industry regulation. Device makers and application developers will certainly have to work within a governmental framework which will have a large say in the time-to-market of many possible products.

With all that being said, the opportunity to meet the demographic challenges of an already stressed healthcare system with mobile home health monitoring and Electronic Health Records will be one of the major themes of the future of both the heath and technology industries.

A personal health record (or PHR) is an individual electronic health record that is stored securely on the Internet so it can be accessed by medical providers and caregivers who have permission.

PHRs allow the storage of all critical health history information in one place. In the event of an emergency, the patient, caregiver or family member can give providers access to health information. By having the most current information always available, duplicate or unnecessary tests can be avoided as can possible drug interactions. This benefit is achieved without having to rely on the memory or incomplete records of the patient. PHRs also allow patients, caregivers or third-party vendors to update information regularly over the Internet so that new data can always be accessed by stakeholders.

Although Personal Health Records have been around for more than 10 years, they have gained little traction. Amidst a healthcare environment that is increasingly supportive of the empowered patient, most patients have neither the time nor the knowledge to enter their own records into a PHR. Many PHRs can interface with an individual hospital or physicians EHR system, but most are unable to share information bi-directionally with more than one entity or flow seamlessly into a Health Information Exchange (HIE).

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Record retention can be a significant problem for healthcare groups. Different federal and state regulations require different retention schedules for medical records and other medical-service related documents. Many managers and physicians are confused on how long they should maintain records and how best to store all this paper. Here’s an updated record retention schedule that is in sync with medical malpractice insurers (check with your malpractice carrier) and accounting firms.

There are all kinds of numbers floating around for retaining records, but unless you are focusing ONLY on record retention, you”d have to be very organized to separate what can be shredded in 1 year, 3 years, 6 years, 7 years, etc. I prefer to categorize everything into three basic categories: Save it Forever, Save it for 7 years, and Save it according to state requirements. Here is (almost) everything broken into my three categories.

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At Manage My Practice, we have always been fascinated by the opportunities created when innovation and technical advancements are applied to the Healthcare system. The intersection of technology and medical practice has always been one of the most exciting spaces in research and development because the challenges of the Human Body are some of the most daunting and emotionally charged of our endeavors. Curing diseases, diagnosing symptoms and improving and saving lives are among our most noble callings, so naturally they inspire some of our brightest thinkers and industry leaders.

As managers, providers and employees, we always have to be looking ahead at how the technology on our horizon will affect how our organizations administer health care. In the spirit of looking forward to the future, we present “2.0 Tuesday”, a weekly feature on Manage My Practice about how technology is impacting our practices, and our patient and group outcomes.

We hope you enjoy looking ahead with us, and share your ideas, reactions and comments below!

• Steve Jobs thought iCloud had the potential to store Medical Data

Apple’s recently announced iCloud service let’s you store pictures, movies, music, and documents in Apple’s “cloud”, or Internet storage system, and retrieve them with your iPhones, iPods, iPads, and Mac computers. Dr. Iltifat Husain, writing for the IMedicalApps blog notes that in the new biography of the Apple founder, Jobs mentioned that he thought even personal medical data would one day be stored in Apple’s iCloud. Cloud storage is all the rage right now in a lot of different areas of technology, but Jobs saying that medical data would be stored on the consumer end next to vacation photos and favorite songs represents a very bold vision of the future of patient data.

• Researchers using Social Media to study attitudes about Public Health

A team led by Marcel Salath, PhD at Pennsylvania State University published a study last month in PLoS Computational Biology that used “tweets” gathered from the social network Twitter to analyze how the public felt about the H1N1 influenza vaccine in 2009. Although Social Media research has limitations, Christine S. Moyer, writing for the American Medical Association’s Amednews.com notes that the results were similar to traditional phone surveys conducted by the Centers for Disease Control, and provides some other examples of how Social Media has been used to understand public health trends.

• Interesting EHR/EMR data from the Soliant Health Blog

Medical staffing specialist Soliant Health had very eye-opening list of statistics about EHR/EMR implementations on their blog last week. My personal favorite: Hospitals using EHR/EMR systems have a 3 to 4% lower mortality rate than those that dont. Very interesting numbers.

• HealthWorks Collective predicts changes in healthcare communications after ACA

Healthworks Collective‘s Susan Gosselin makes some predictions about how the communications between and among providers and patients are going to be changed by the Affordable Care Act (or Healthcare Reform)- and what both groups will demand from a changing system. Great stuff!

• Oregon to help disabled voters cast ballots using iPads

In today’s local and congressional elections, five counties in the state of Oregon are going to be equipping local officials with iPads preloaded with special touch-interface software to accompany people with physical or visual impairments, or who would otherwise have a hard time making it to the polls. The 9 to 5 Mac blog is reporting that the pilot program features hardware donated by Apple, and could soon spread statewide by the next election.

Be sure to check back next week for another 2.0 Tuesday!

In a traditional healthcare setting, the revenue cycle begins with the insurance companies who pay the majority of the bill. There are multitudes of payers and each payer can have many plans. How can a healthcare organization catalog this information, keep this information updated and make this information easily accessible to staff so they can discuss payments with patients in an informed and confident way?

Start by breaking your payers into five main categories as a logical way to organize the data.

1. Payers with whom you have a contract
2. Payers with whom you do not have a contract
3. State and Federal government payers (Medicare, Medicaid, TriCare)
4. Medicare Advantage payers
5. Patients

Payers with whom you have a contract

Your organization has signed a contract with a payer and you have agreed to accept a discounted fee called an allowable, and to abide by their rules. What is the information you need to collect?

• A copy of the contract
• A detailed fee schedule, or a basis for the fees, such as 150% of the 2008 Medicare fee schedule.
• Any information about the fees being increased periodically based on economic indicators, or rules (notification, timeline, appeals) on how the payer can change the fee schedule.
• The process and a contact name for appealing incorrect payments.
• Information on what can be collected at time of service. Hopefully your contract does not have any language that prohibits collections at time of service, but you must know what the contract states.
• Process for checking on patients eligibility and benefits: representative by phone, interactive voice response (IVR), website or third-party access.

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At long last, my two-year contract with my current cell phone carrier is over and I am free again! Of course, I immediately turned to my son & partner Abraham for some sage smartphone advice. Here’s the conversation we had.

Mary Pat: What things should I consider when choosing a smartphone?

Abraham: Smartphones are so much more than just telephones, so the first question is always “How will you be using it?”. If you really just need to make the occasional phone call from the road and nothing else, you probably don’t even need a smartphone. A simple, old-fashioned flip phone, or bar-style device will do just fine. For everyone else, picture the things you’ll want to do on the phone. Is it mostly a business device- checking emails, editing documents, and having access to critical data? Or will you also want to watch streaming videos in your downtime, play games, or take pictures and movies to send to friends and family? It’s easy to look at a phone’s capabilities and stereotype what the average user would be like: iPhones seem so hip, Blackberrys seem so serious, Androids seem so geeky. The reality is that all smartphones on the market today probably have enough muscle (and apps!) to make anyone happy. So choose a phone based on features, comfort, and specifications – not the label or the image that comes with it.

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Podcaster Dr. Polack of Medical Practice Trends

Peter Polack, MD of Medical Practice Trends interviewed me recently for a series of podcasts for his site. Here’s the first one, on Why Does a Physician’s Practice Need a Website?