Not so long ago, a resident of the old-fashioned “nursing home” might receive only palliative care from a nurse’s aide, RN and a general practitioner. A doctor would make rounds occasionally, prescribing treatments to ease the aging process. Nurses took care of patients on a healthcare island, separate from medical and public health communities.
A nurse’s aide would notice something with the patient and ask an RN or LPN for guidance. If the nurse could not resolve the problem, she would telephone the doctor’s office and wait for the physician to return her call – a process that arrests workflow for both busy environments. The nurse would describe the problem verbally. If the problem described seemed serious enough, staff members would trundle the frail resident off to the hospital where specialists could surround her bedside and collaborate about her condition. A family member was asked to leave work to accompany the patient and staff. Then, all together, they waited.
Residents in a skilled nursing facility are typically not robust, facing increased risk any time they are away from the facility. Elderly patients often become confused in the hospital, and they suffer an increased risk for falls and infections. Residents of skilled nursing facilities can introduce MRSA into hospital settings and vice versa. Collaboration would keep these individuals in their own beds, where the highly qualified CNAs and RNs they already know can deliver advanced skilled nursing techniques under the guidance of their trusted physician specialists.
Collaboration in today’s technically advanced skilled nursing facility
Today’s skilled nursing facility provides more than end-of-life care. Nurses and caretakers at these facilities provide special treatments, including enteral nutrition and intravenous injections.
The modern patient, especially one sick enough for placement at a skilled nursing facility, requires a team of specialists. Skilled nursing facilities now only provide palliative care. While a facility can grant privileges to multiple specialists, it is not feasible for all these physicians to maintain onsite offices or make rounds at the facility.
Caring for today’s skilled nursing facility resident requires a new approach to collaboration between everyone on the healthcare team, from the CNA to the oncologist. Collaboration provides feedback to the doctor regarding efficacy of treatment, and reassures the nurse’s aide that the physician was cognizant of her concerns regarding the patient’s health.
Medical collaboration is the communication and exchange of ideas between doctors, nurses, and other caregivers. Medical collaboration is an information superhighway connecting caretakers of all levels, from nurse’s aide to anesthesiologist.
The Association of American Medical Colleges says there are more than 200 types of physician specialists in the United States. Medical collaboration improves the likelihood a resident in a skilled nursing facility struggling with a specific condition will connect with a leading professional in that field. Before the advent of care coordination, chances of getting a nursing home patient into the hands of the right specialist were nearly infinitesimal.
Technology has driven medical collaboration. In 2010, the Apple iPhone led the way with the expanded adoption of smartphone apps. Today, clinicians use hybrid store and forward. This technology allows doctors to add personal health information for each patient at an intermediate, safe location and then send it to others on the collaborative team.
Collaboration keeps all caregivers in the loop without jostling the patient from office to office. A hospital radiology department can upload a chest x-ray, for example, to save the patient from repeating it for a consulting physician. A nurse’s aide can update pictures of a resident’s decubitis, or rash, or edema, frequently to the team of physicians and reduce the need for office visits.
Benefits of Medical Collaboration
Along with convenience, medical collaboration has many benefits to the patient and her healthcare team.
Benefits to the resident include:
· Improved healthcare
· Increased access to specialists without travel
· Reduced risk for hospital-acquired problems like infection
· Coordinated healthcare
· Family stays at work and at home instead of going on office visits
Benefits to doctors and other caregivers:
· Fewer errors
· Less redundancy
· Greater efficiency and productivity
· More appropriate use of expertise and medications
· More confidence that comes with support
Everyone benefits from medical collaboration; care coordination fully utilizes advancing technology to share patient information safely and effectively. This new approach to care brings together caregivers of all levels to provide superior care to patients in skilled nursing facilities. Nothing is needed except an iPhone, iPad or camera and computer.
American Telemedicine Association Meetings are always big and exciting!
ATA2013 is no different. We will be updating our experiences and impressions every couple of hours and try to share some of what we are learning. These comments will be both as professionals actively practicing in the field, and as founders of an exhibiting company. As we prepared for the meeting, we realize, that while we a part of a much bigger answer to a big question: How do we provide access for patients, collaboration and support for providers, and education for now and in the future? We will be listening for other answers.
You will find iClickCare among the 300+ exhibitors, 500 sessions and 6000 attendees, but we are still the only service that offers full medical collaboration, hybid store and forward, and a way to manage both workflow, network and coverage management. Among the courses was one on modeling telemedicine and how appropriate planning and use of appropriate personnel can create not only cost savings, but revenue as well (Leistner and Ben-Arieh). Later, the opening plenary highlighted efforts made by institutions who touted their success.
The AM plenary was highlighted by the CEO of Oracle who clearly described how technology is available now. On the exhibit floor, we had MANY interesting conversations with people who were asking for hybrid store and forward technology and were trying so hard to understand how to it works and how they could use it to make patients lives better.
There was heavy metal, glass, and CPU technology, and also a lot of videoconferencing. Some, frankly, seemed to have forgotten the patient.
The highlight of learning was a superbly presented, inspirational, and clearly thought out talk
by Dr. Reed Tuckson. He remembered the patient and encourages us to bring value to the system. With 17 years of a coincident philosophy, we felt equally inspired as when Woz shouted out iClickCare last year (well, almost, that was hard to beat).
We look forward to participating as the shift toward value occurs in the next year. We will continue to leading and believing. Our colleagues in telemedicine are always inspiring.
We are grateful for the many friends and customers, old and new, with whom we shared and collaborated.
This comes to us via Emily Kerr, who works with amazing people to build brave and beautiful things. We would not have known, but she happened upon
this scene of courage, equipment and collaboration.
1700 miles away from the ClickCare corporate office, a cat was stuck in a tree. The story unfolded just as it does in so many children’s books.
Why was the cat stuck in a tree? We are sure the fireman asked. As health professionals we ask as well. And like the brave fireman we know that as Alfred Tennyson in Charge of the Light Brigade tells:
Some one had blunder'd.
Theirs not to make reply,
Theirs not to reason why,
Theirs but to do and die.
Relate this story of the cat caught in a tree to the story of medical collaboration.
Cat caught in the tree:
- The problem: Cat in a Tree
- The requestor: The passerby who heard the meows for help.
- The collaborator (or consultant): The fireman.
- The device: The crane which connected the fireman to the cat.
- The result: A live cat. A brave hero fireman. An inspired passerby.
Patient caught in the tree of healthcare:
- The problem: A patient looking for health, and figuratively caught in the tree of heathcare
- The requestor: The first person who bothers to listen and try a little harder (the passerby could have ignored the cat)
- The collaborator (or consultant): A brave, responsive person who goes a little farther and gets out of his silo of the firehouse (his office, hospital, or routine)
- The device: iClickCare, as the crane, the hybrid store and forward tool, between patient, requestor and consultant
- The result: A healthy patient. A hero collaborator. A satisfied requestor/consultant.
Everyday, there are healthcare heros. They are unknown. They are un-lauded. They are sometimes next door and not 1700 miles away.
They are like the noble six hundred. And often feel the same.
Photograph: Emily Kerr, "Seriously, Big Fat Cat on My Street"
Alfred Tennyson's recording of the Charge of the Light Brigade
Alfred Tennyson's handwritten poem.
The complete poem (do you feel the parallels as you work in healthcare?):
The Charge of the Light Brigade by Alfred Tennyson.
Half a league, half a league,
Half a league onward,
All in the valley of Death
Rode the six hundred.
"Forward the Light Brigade!
Charge for the guns!" he said.
Into the valley of Death
Rode the six hundred.
Forward, the Light Brigade!"
Was there a man dismay'd?
Not tho' the soldier knew
Some one had blunder'd.
Theirs not to make reply,
Theirs not to reason why,
Theirs but to do and die.
Into the valley of Death
Rode the six hundred.
Cannon to right of them,
Cannon to left of them,
Cannon in front of them
Volley'd and thunder'd;
Storm'd at with shot and shell,
Boldly they rode and well,
Into the jaws of Death,
Into the mouth of hell
Rode the six hundred.
Flash'd all their sabres bare,
Flash'd as they turn'd in air
Sabring the gunners there,
Charging an army, while
All the world wonder'd.
Plunged in the battery-smoke
Right thro' the line they broke;
Cossack and Russian
Reel'd from the sabre-stroke
Shatter'd and sunder'd.
Then they rode back, but not,
Not the six hundred.
Cannon to right of them,
Cannon to left of them,
Cannon behind them
Volley'd and thunder'd;
Storm'd at with shot and shell,
While horse and hero fell,
They that had fought so well
Came thro' the jaws of Death,
Back from the mouth of hell,
All that was left of them,
Left of six hundred.
When can their glory fade?
O the wild charge they made!
All the world wonder'd.
Honor the charge they made!
Honor the Light Brigade,
Noble six hundred!
ATA 2013 in Austin May 5-7
Remember last year, The Woz said... he’d move to Alaska for the collaborative care that iClickCare enables, but May 5-7 we’re at Booth 847 in Austin for YOU. He loved having access and collaboration, secure on the iPhone and web browser. This year, we have even more for you!
BOOK AN APPOINTMENT to see how you can save with ClickCare and improve the patient care and satisfaction (and yours)!
Register today for your free Expo Only pass at ATA 2013.
Stop by Booth 847, meet our leadership team and be the first to enjoy a brief demo of iClickCare for the new iPad and iPad mini subscription software. We're looking forward to putting a face to your name and joining with you to improve healthcare, one person at a time.
And Celebrate with us, iClickCare NEW on the iPad and iPad Mini!
As healthcare providers, now when we look at a toddler’s rash on iClickCare, we see details we’ve never even seen in real life! The Retina display creates a crystal clear presentation –– and on screen, we don’t have to deal with the blurs of a moving child! Plus, our eyes are grateful for the larger display, and our fingers are finding typing a little easier on the iPad and Mini.
Furthermore, the patient/family member can join or view the collaboration if given the privilege of Invite Patient, now even from these mobile devices. And the mobile healthcare provider can make use of the Compare Visits button to evaluate patient progress (or not) over time. Our team wants to ensure that you have the most powerful, patent pending, Hybrid Store-and-Forward capability in the world. Together we will improve healthcare one person at a time!
Current pricing for this Version 2.0 will apply through May 20, 2013 if either a renewal or new subscription is confirmed. As an iClickCare customer, all you do is upgrade from the iTunes AppStore and contact your sales rep before May 20. New user subscription pricing is posted on www.clickcare.com, but, as a new customer you will receive a 2 week free trial to start. We want everyone to continue to see how incredible iClickCare can be with the ease and clarity of the new iPads and the iPad minis.
Learn one, you know them all -- any browser on any platform, also on the iPhone, the iPad, or the Mini... all as Version 2.0. You will also discover that the Search is faster, and the presentation of images is better than ever. And our Online Help is ready to serve YOU, as always.
We look forward to seeing you at Booth 847 at the Austin ATA!
The ClickCare Team
Which autobiographical account inspires you?
Lean In: Women, Work, and the Will to Lead, Facebook COO :Sheryl Sandberg (2013)
Until I Say Good-Bye: My Year of Living with Joy :Susan Spencer-Wendel (2013)
To give you a tiny taste of Sheryl Sandberg's book, here are a few of the chapter titles:
- Sit at the Table
- Success and Likeability
- Don't Leave Before You Leave
- Make Your Partner a Real Partner
- The Myth of Doing it All
Sheryl Sandberg is on Forbes' list of the most powerful people in the world. In her book, she encourages ambitious women to realize their own career goal, but also to make changes in their workplace so that other women can succeed, too. Sandberg tells women to have confidence in themselves and their knowledge, and to own their achievements.
I don't know if Susan Spencer-Wendell read or is trying to read Sheryl Sandberg's book. Susan is an award-winning journalist for the Palm Beach Post, who learned in June 2011 that she had amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). At that time, she was 44 years old, with a devoted husband and 3 young children. She was so determined to complete a book describing this experience for her children and the rest of us, that with her minimal strength, she typed the manuscript with one thumb on her iPhone. No longer able to walk or even lift her arms, she tapped it out letter by letter. USA Today on March 11, 2013 speaks of some of the fabulous lessons expressed in this memoir:
"Her "year of joy" included everything from traveling in hopes of witnessing the Northern Lights — she did not — to tracking down family roots on Cyprus — she did — to visiting Kleinfeld Bridal in New York with her teenage daughter, Marina, only because she knows she won't be around when the real pilgrimage will take place."
Her children Marin, 15, Aubrey, 11. and Wesley, 9, have been adapting to the situation. Their Aunt Stephanie says: "They rub her nose. They brush her hair out of her eyes. They have very normal routines with their mother. Nothing is strange."
This goes to show that there are a lot of heroes here. Reportedly, Susan didn't want to switch to another piece of high-tech equipment because she didn't want to lose the time needed to learn another system. With her laser focus, her habit of meeting deadlines, AND HER RIGHT THUMB, she wrote the 362-page book Until I Say Good-Bye. It's now available on Amazon, and movie rights have been sold to Universal.
This is definitely a new twist on Store-and-Forward. After reading this book, like the effect of all good medicine, I felt lighter and stronger and more accepting. Susan says: "don't force the world to be the one you dream; the reality is better." If she can say that, most all of us can say it more and do more.
Sheryl Sandberg's Lean In is also inspirational. "Sit at the Table" is up front and center; otherwise how can one hear or be heard. She says that opportunities are rarely offered; they are seized. That's an understatement!
There are many criticisms (jealousies?) of Lean In, but it is an important follow-on to Betty Friedan's The Feminine Mystique and Gloria Steinem's Revolution from Within. Sheryl is a 43-year-old former Google executive with two Harvard degrees, who is calling on other women, as she puts it, to "lean in" and embrace success. Even though Sheryl knew the business world was listening, she had the intestinal fortitude to include personal examples, that readers are dying for, which are definitely supportive and inspiring. Moreover, the cited research is impressive, for instance the data showing positive correlations between success and likeability for men, and negative correlations between success and likeability for women. Sheryl's bibliography and footnotes are lengthy, and the statistics support the thesis that even in 2013 — women simply aren't making it to the top. She says: "Ten years of no progress is no progress" (spoken like a real COO).
NPR relates: "Warren Buffet has very generously said that one of the reasons he was so successful is that he was only competing with half the population. Companies that use the full talents of everyone — those companies do better."
One of the HUFFPOST quotes from Sheryl's book is: "if we want a world with greater equality, we need to acknowledge that women are less likely to keep their hands up." Further a quote about working together: "As women must be more empowered at work, men must be more empowered at home." Download "Caring for Baby" to help with that effort.
We need all of the people in this country and the world striving to be better, helping each other, and sticking their neck out to do that. She says: "This revolution will happen one family at a time."
Where have you heard that before? Give your patients access, collaborate with their other providers, and leave a legacy of education. Let's get on with it...one step at a time; one thumb, one family, one patient, at a time.
iClickCare is a hybrid Store-and-Forward of text messages, video, PDFs and still images.
It is also a hybrid of platforms because as providers we are not always mobile nor sedentary. We need the right tool for the right job at the right time. Indeed, that is what medical collaboration and telemedicine is all about anyway — the right provider, at the right time and at the right place — for the patient.
We have had the web-based browser of iClickCare for years. Eighteen months ago, we added the mobility of the iPhone. As physicians, we also found a need for an in-between size and thus we started work on the iPad. The iPad mini came along as we developed our solution. So now we have an in between with an in-between. And as the image shows, we are putting our party hat on as well!
Fortunately, you don't have to learn something new. The same relationship you have with iClickCare on the web applies directly to the iPad, iPad/mini and the iPhone.
Meaningful Use and Meaningful Records:
We have added features to the iPhone as well, and now you can use Invite Patient to give true meaningful use to your care as you collaborate with your colleagues. The patient is, if you choose, part of the process.
Also added is the Compare Visits function. There is nothing quite so satisfying as seeing improvement over time, and nothing quite so educational as following decline over time. Visits can now be compared on both the iPhone/iPod and the iPad and mini, as well as the browser.
Security and Speed:
There are many, many improvements and tweaks to security and speed. Even though information about your patient is delivered to you faster, the security is solid. Our security systems surpassed stringent HIPAA requirements before, but, they are even more robust now. We would remind you to use strong passwords. Passwords can be changed by you as often as, and whenever, you wish from the top of the login page.
Searches and the “serving up” of images, video and PDFs are faster because our developers really understand the tasks and demands on providers, and know how to make things work in very sophisticated ways.
Current pricing for version 2.0 will apply through May 20, 2013 if either a renewal or new subscription is confirmed. As an iClickCare customer, all you do is upgrade from the iTunes AppStore and contact your sales rep before May 20. New user subscription pricing is posted on www.clickcare.com, but, as a new customer you will receive a 2 week free trial to start. We want everyone to continue to see how incredible iClickCare can be with the ease and clarity of the new iPads and the iPad minis.
Learn one, you know them all... any browser, the iPhone, the iPad, or the Mini... all as Version 2.0 on the iPhone. You will also discover that the Search is faster, and the presentation of images is better than ever. And our Online Help is ready to serve YOU, as always.
You can use iClickCare on your browser, your iPhone and now your iPad all with one click.
What do you see here?
One of our favorite and most rewarding parts of managing patients was a trip to the radiology suite and a talk with the radiologist. We became Watson and Holmes together as we tried to unravel the mystery of disease. We also became friends. We talked pollitics and kids. We enjoyed both the mystery and the company.
We were doing what was both expected and was fun, but now it needs a special label... "medical collaboration." We shared a little bit of suspense and mystery and a little bit of joy. We miss all of that.
Without collaboration, what did you think of the above CT scan? This study was about perception, but really there is more to it than that. As described in the referenced below, 83 percent of the participating radiologists overlooked an image of a gorilla superimposed on lung scan (it's small and up on the right, in the left anterior lung!). This finding is worrisome in its own right, but the truly alarming implication is the increasing likelihood of such "misses" in a highly technological environment that encourages efficiency and cost-effectiveness at the expense of medical collaboration and open communication.
The recent push towards incorporating innovative technologies into health care has encouraged the adoption of Store and Forward methods such as picture archiving and communication systems (PACS). While this technique has created cost savings by changing how films are obtained, processed, distributed, read and stored, it has reduced or eliminated the need for physicians to consult in person –– and talk about the case. By cutting out the most natural and primary means of sharing knowledge and information, we have inadvertently removed both the context and the human element from radiologic images.
Most people would agree that a team of individuals working together can create synergy. Traditionally, health care providers met with a radiologist to view and discuss a patient's film. Although the conversation might cover everything from the patient's image and test results to their kids' baseball game, the setting encouraged physicians to quickly and easily apply their combined knowledge and experience to the case at hand. This created context for the radiologist, helping him to understand what he's looking for and making him more effective at examining the film –– especially if the referring doctor had a suspicion but needed confirmation from someone with more expertise.
If a Store and Forward system lacks a component that enables and promotes similar collaboration and communication, then context vanishes. Even the best radiologists are only human, and without specific indications on what the referring physician has noticed, the radiologist may unintentionally overlook something important. Even more significantly, any potential synergistic effect has been lost due to the lack of communication. At best, this may fail to enhance the patient's care; at worst, this could lead to a delayed or missed diagnosis.
Behind Every Film Is a VIP
As if losing context were not troublesome enough, Store and Forward systems separate the film from the individual, which risks creating the illusion that the imaged lung is being treated rather than the person. Without effective medical collaboration, teamwork becomes non-existent, and it becomes too easy for each provider to lose sight of the goal: restoring the health of the entire human being. In such a scenario, the patient may not even feel like a valued member of his healthcare team, instead feeling like a number, a piece of data or a diseased lung.
What Can We Do?
As healthcare providers, we are ultimately responsible for determining how we balance the savings and efficiencies of new technologies with our patients' best interests. When we choose to communicate and collaborate with our colleagues and patients, we create context that can enhance the quality of care and reassure the patient that we are working together for his care. A system that encourages Store and Forward medical collaboration can only help achieve the end goal of a patient's restored health.
And in the case of the gorilla on the CT scan, what type of note could a provider leave for the radiologist? Anything from "There's something funny about the left anterior lung (upper right side of this scan)" to "I heard a snort, heavy footsteps and a Tarzan yell" would do.
A two page primer on the upcoming ICD-10 codes is available. They are the opposite of fun and collaboration, but the whitepaper is offered to you with the hope that it will make your life a little easier. Don't forget to enjoy the mystery. Life has a lot not to be missed.
Do patients qualify as a person or a thing?
Hopefully, we all answered "person." In the interest of maximizing patient care while reducing costs, there's been recent hype about "care coordination" and its purported benefits. On the other hand, "medical collaboration" has been sitting quietly on the sidelines, waiting for us to understand its importance. What's the difference?
On the surface, this may sound great, but as we dig deeper, we find that it focuses on numbers–number of events, number of patients, number of payments, number of workers, and so on.
Why is this a problem? This philosophy prioritizes the workflow and finances, not the patient. The Merriam-Webster Dictionary defines coordination as the act of bringing "into a common action, movement, or condition; harmonize." If we explore what is being harmonized, we discover that care providers, who are entrusted with the care and nurturing of a valuable human being, are ultimately being judged according to how quickly and efficiently they can restore a patient's health and thus minimize costs while collecting reimbursement. And this is accomplished through controlling and commanding every aspect of patient care – micro-managing, perhaps.
On the other hand, this strategy asks providers to combine their experiences and judgment by sharing information, exchanging thoughts and ideas, and involving the patient as a valuable team member. In this case, the goal is to work as a cohesive, constructive team to maximize the patient's health outcome.
Our old friend, Merriam-Webster, defines collaboration as working "jointly with others or together, especially in an intellectual endeavor." It's an excellent principle, but in real life, several obstacles often prevent healthcare providers from collaborating effectively:
* Poor communication
* An attitude that devalues teamwork
* Insensitivity to patient input
* Lack of infrastructure
Some of these issues may require considerable time and effort to overcome, but a solid infrastructure is already being built, right under our noses. The prevalence of mobile devices introduces huge possibilities for effective communication and collaboration. What if a provider could snap a picture, attach a question, and send it securely to her colleagues? And what if a colleague, upon receiving a prompt notification of the post, were able to reply immediately and easily based on his or her experiences? A qualified answer could be retrieved within minutes. The prospects are endless.
As healthcare systems seek innovative and cost-effective ways to increase the quality of care provided, we encourage medical collaboration, particularly store-and-forward medical collaboration. Care coordination focuses on finances, but a medical collaboration approach that capitalizes on providers' combined experiences and centers on the patient offers the best long-term solution. When combined with growing technologies and changing attitudes, this philosophy has the potential to revolutionize patient care for the better.
1. http://www.merriam-webster.com/dictionary/coordinate; http://www.merriam-webster.com/dictionary/collaborate?show=0&t=1363581794
2. Image in movie:
At least someone is thinking bigger. Making a big pile of data without doing anythng with it is about the same as a big pile of data building up outside a barn. We applaud Judy Murphy, RN, deputy national coordinator for programs and policy at the Office of the National Coordinator for Health IT (ONC), for recognizing the importance of putting health care data to real use. During her recent speech in New Orleans, Murphy emphasized the significance of providers not only having the ability to send and receive data, but also, to deeply utilize the data. She suggested that data should be shared, analyzed, and used by both patients and providers towards better decision-making.
Specifically, she offered an example of allowing patients access to electronic immunization registries through patient portals. Also, she addressed the issue of interoperability, noting the complexity involved in creating seamless healthcare IT systems.
Murphy spoke about the ONC’s focus on Meaningful Use, encouraging patients to access their own data, and emphasizing data sharing. The ONC plans to concentrate on projects such as online patient-education videos, making additional training sessions available on ONC’s website, and ONC challenges like the Blue Button Mash Up.
Our goals are also to employ, analyze and share health care data centered on improving patient care and outcomes. Furthermore, we want to expand the scope of data sharing broadly to include clear communication among all types of providers. Valuable partnerships and quality patient care can be obtained through medical collaboration, by fully utilizing today’s advances in data gathering and communication tools. What is still needed is encouragement for stressed and busy people to do so.
The volumes of health care data now available can enhance the quality of medical collaboration by increasing both the speed and accuracy of communication between care providers. Succinct and beneficial information can be combined from a variety of sources into one transmission, increasing the efficiency and clarity of information, which allows for better care. Providers can be empowered to more easily reach out to others and exchange needed information quickly and simply.
We commend Judy Murphy for her forward thinking approach to health care information technology and her focus on medical collaboration among providers and patients. We strongly support her position and her emphasis on quality patient care. Lastly, we concur with her belief that the use of technology for health care data collection is not in itself the end goal. Instead, putting that data to full use through human analysis, medical collaboration, and patient involvement will result in the best patient centered care.
Reference and attribution:
Fierce Health IT: http://www.fiercehealthit.com/story/oncs-judy-murphy-ability-send-and-receive-health-data-not-good-enough/2013-03-04?utm_medium=nl&utm_source=internal
Judy Murphy, RN, FACMI, FHIMSS: http://www.healthit.gov/newsroom/judy-murphy-rn-facmi-fhimss-faan
Image: By Inductiveload via Wikimedia Commons: https://commons.wikimedia.org/wiki/File%3ABinary-reflected_Gray_code_construction.svg
HIPAA? I know about it, but I text anyway because it is good patient care.
Do you really want to say that?
Our advice: Don’t even think about it! And moreover, forget it and move on -- there is too much to worry about that you can change, and this, you can’t.
We are taught to understand as well as follow. Here is some understanding.
The Federal Register, on January 25, 2013, added another 563 pages (78 Fed Reg. 5566) to the voluminous hundreds of pages that constitute three acts over the past 17 years. These are HIPAA, HITECH and GINA, and an entire industry has been built on these rules. The 563 pages as a totality constitute the Omnibus Rule of 2013.
What does all of this mean to us providers? What does all of this mean to us who help providers? Since this post is conversing with patient care professionals, many of whom are mere HIPAA laymen, these answers are brief and focused.
Four main points for day-to-day care:
1. There is increased penalty and enforcement.
2. Business associates are responsible for all their subcontractors. Did a cleaning lady, employed by a cleaning service pick up a CD? Reasonable Cause -- an act or omission in which a CE or BA knew, or by exercising reasonable diligence would have known, that the act or omission violated an administrative simplification provision, but in which the CE or BA did not act with willful neglect.
3. Any disclosure of PHI will be presumed to be a breach, and HHS will, not may, investigate.
4. Individuals have enhanced rights to obtain electronic copies of their records. With this, is an enhanced right to restrict disclosure of PHI. Patients who pay solely for care by cash can restrict release to insurance companies and billers.
Some collateral damage to be aware of:
- Schools -- Immunizations can be shared.
- Research -- Special notes about current research releases, and how they may apply to future analysis of the same data with different research.
- Genetics -- Genetic information is protected and cannot be used against the patient.
- Marketing and Fundraising -- Defines how information is used. Can you ask for money from patients for a cause you know that they are near and dear to?
How much time is there to comply?
The final rule was announced on January 25, 2013. It is effective March 26, 2013 (including penalties), and compliance (such as notifications) must be completed by September 23, 2013.
Cost and Conclusion.
The cost of all of this...114 to 225.4 million dollars (government estimate, your experience may vary). In 2011, the CDC estimates 1 billion physician office visits. That works out to 23 cents per visit.
Finally, there is a lot to this and a lot to read. Download the "Omnibus Rule -- High Overview" to learn more and send you speedily on your way.
It is not totally depressing. But, as Jim Croce says,
"You don't tug on superman's cape
You dont' spit into the wind
You don't pull the mask of the ol' lone ranger
And you don't mess around with ..."
Find the compilation of References here:
2. Debbie Tokos, RHIT, CHPS, United Health Service, Johnson City, NY 13790