Have a Wonderful Labor Day Weekend

To all of the readers of this blog and to others around the country. Here’s wishing you a very enjoyable Labor Day weekend. The symbolic end to the American summer, we look forward to the final months of 2014. It’s been an interesting year so far. I hope that the months ahead will prove to be one of steadfastness and logic in how we plan our year ahead in healthcare during 2015.

Enjoy your holiday. We’ve got work to do when you get back.

Prefer HISP to HISP Connection? You’re not alone…

Some weeks ago, I sat in a room with a couple of CIOs and one of them said ” You know, instead of the HIE’s, I prefer direct HISP instead.”

So what is HISP? According to one of my favorite sources of information, (The Life as a Healthcare CIO), “a Health Information Services Provider (HISP) is an organization that manages security and transport for health information exchange among health care entities or individuals using the Direct standard for transport.  

HISPs issue security certificates and establish trust networks by defining policities and protocols for network participation and issuing security certificates and also issue direct addresses that are tied to what is called a HISP “anchor certificate” in accordance with conventions defined by what is called the “Direct Standard”.

A key goal of the Direct Standard was to have what is called a federated, scalable trust whereby each HISP maintains trust through contracts within the HISP, and doesn’t need further trust between HISPs. I call it “Ma Bell” for the 21st Healthcare Provider network.

In doing some research from documents that I discovered from Massachusetts online, we need to make sure that Core HISP capabilities should be well understood and transparent to all; inter HISP trust isn’t required due to encryption on both ends of the connection. The network relies on end-users’ trust across HISPs. It’s a trust network that is established point to point. Services integration (provider directory, certificate exchange, etc) does not require complex business and technical agreements from what I understand, though that may change possibly through legislation of some sort in the future.


Laughter: Healthcare’s Best Medicine – Behavioral Health and the loss of an Icon

LaughterSome months ago, I wrote about the role of happiness in our lives and the role it plays. Robin Williams played an important role for over 30 years in making the world a happier place. Sadly, he did not feel that he found that himself with his untimely passing last week, which shocked the world.

The role of mental health has taken a huge step into the limelight due to his passing. The closest I got to that was when I worked at a Neurology Clinic some years ago and saw the important work that was being done there by an interesting (pink haired) head of department who was an extremely empathetic person.

The disease, often stigmatized, has now been thrust front and center into a world that may not be ready for it, but we need to be. The need for behavioral health services are grave, from school shootings to celebrity suicides. The “Great Recession” also brought forth many losses, especially for people who lost their homes, their retirement savings and their former occupations and had to start from scratch.  A recent article (in US News – Health) after Mr. William’s death, said that according to WHO estimates, about 350 million people worldwide suffer from depression, which is a staggering number, and I suspect, rising. With the number of veterans coming back from two wars over the last dozen years and the toll it has taken on themselves, the atrocities that they have seen on the battlefield and the loss of a “normal” family life, the need for mental health facilities in our nation has been greater than it has ever been. The need for access and infrastructure for these facilities, trained mental health care providers and the appropriate infrastructure and support mechanisms for follow up or continuous access (do I see a role for mHealth in this?) and continuity of care for patients who travel across geographies make our role as healthcare IT professionals even more important than ever before.

For healthcare providers and individuals engaged in projects to re-mediate applications covering the behavioral health ecosystem, the American Psychiatric Association, in 2013, updated the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (aka DSM-5) which will impact clinical diagnosis, billing, contracts, compliance and more in the psychiatric world in terms of treatment recommendations as it is often determined by their DSM classifications. The need for up to date systems, continuity of care and relevant policies and protocols cannot come soon enough. Sadly, we have seen the effects of a system that hasn’t saved enough of our fellow Americans. All lives are precious and the loss of even one to the effects of depression is a sad event.

So, I ask you, after reading this, to find an old video of Robin Williams in one of his indelible roles; whether as a seemingly helpful Scottish Nanny to his children, an animated Genie from a lamp or, in his break out role as the lovable, yet quirky alien from Ork, watch it and remember an icon has passed and we are all the better for him being a part of our lives for as long as he was.

Thank you Robin Williams for the joy you gave us. You will be missed.

Advancing Clinical Processes with Meaningful Use Stage 2

As provider organizations work on the completion of stage 1 and think about implementation of stage 2, they will have their hands full with how to implement these initiatives with the constraints on their resources and bandwidth. The CMS site states that:

“Stage 2 uses a core and menu structure for objectives that providers must achieve in order to demonstrate meaningful use.

Core objectives are objectives that all providers must meet. There are also a predetermined number of menu objectives that providers must select from a list and meet in order to demonstrate meaningful use.

To demonstrate meaningful use under Stage 2 criteria—

  • Eligible professionals must meet:
    • 17 core objectives
    • 3 menu objectives that they select from a total list of 6
    • Total of 20 objectives
  • Eligible hospitals and CAHs must meet:
    • 16 core objectives
    • 3 menu objectives that they select from a total list of 6
    • Total of 19 objectives

In a recent article in Healthcare IT News (dated 8/4/14), it stated that only 3% of eligible hospitals and 1% of eligible providers attested to stage 2, which is anything but great as we are in the middle of 2014, when all of the provider organizations were expected to be greatly involved in completing their attestations. Have we reached “MU Fatigue”? I can imagine. I met a nurse earlier today who has now been in IT for sometime and she said that she did not believe CMS anymore after the ICD-10 delay occurred. I think that set off a wave of disinterest in the ecosystem that is still feeling the repercussions of a twice delayed regulatory mandate. “It doesn’t pay to be first!” said one CIO to me a few months ago. Going by the frequent delays in the provider world, one can empathize with that sentiment.

Will CMS give out “Red Cards” to Eligible Hospitals and Providers and penalize them or will there be some relief for the regulatory weary? In the same article, it mentioned that “71% of hospitals plan to attest by the end of 2014 and 22% in 2015”.

What of the HIEs and their ability to give the prospect of intereoperability it’s day?If we are truly to believe the data from the news article, the next 13-14 months will be a busy period for many as ICD-10 comes back around; payer testing, dual coding, physician training and organizational communications will be again an extremely busy period for many provider organizations.


News Flash! Cerner just bought Siemens Healthcare

This just in. According to news reports by the Kansas City Star, Cerner just announced the $1.3 billion dollar purchase of Siemens Healthcare making Cerner a 20,000 person company worldwide and their organization at $4.5 billion dollars in size and reportedly the largest healthcare IT workforce in the world. Siemens announced a strategic relationship with Cerner as well in the deal and the report goes on to mention that Cerner will go on to finance the deal with cash on hand.

This news is monumental.

Read the article here http://www.kansascity.com/news/business/article1067499.html