ONC Training Modules Designed Around the Stage II Meaningful Use

The Office of the National Coordinator for Health Information Technology has launched a suite of electronic health records interoperability training tools.

The five modules cover Interoperability Basics, Transitions of Care, Laboratory Interoperability with Providers, the View/Download/Transmit Criteria in Stage II of Meaningful Use, and Transmitting Information to Public Health Agencies.

 Click Here to Visit ONC Site.

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Concussion Symptoms That Can Go Unrecognized

Concussions that are unrecognized or are mismanaged put athletes at considerable risk of potentially catastrophic sequelae from re-injury. Repetitive head trauma from participation in contact sports such as boxing, football, and ice hockey can lead to a permanent decrease in brain function, including:
Memory Loss, Early Alzheimer's Disease, Movement Disorders such as Parkinsonism, & Emotional Disturbances. The Most notable complication of concussions are the second impact syndrome. With this syndrome, an athlete who is recovering from an initial concussion sustains a subsequent concussive injury, resulting in diffuse brain swelling and severe, permanent neurological dysfunction or even death.

The most notable complication of concussion is second impact syndrome. In this syndrome, an athlete who is recovering from an initial concussion sustains a subsequent concussive injury, resulting in diffuse brain swelling and severe, permanent neurological dysfunction or death.

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Standard Neuro imaging studies are typically normal; therefore, concussion is a clinical diagnosis. The most common symptom is headache. Other signs and symptoms include:

Dizziness

Nausea

Vomiting

Balance problems

Fatigue

Sleep disturbance

Sensitivity to light and noise

Mood changes

Difficulty with concentration and memory

Each concussion presents in a unique manner, and it is well established that a concussion does not require a loss of consciousness. Furthermore, a brief loss of consciousness does not provide any information regarding concussion severity. What clinicians need to remember is that if an athlete sustains a blow to the body or head and post-concussive symptoms subsequently develop, by definition, that athlete has sustained a concussion.

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Report Validates Provider/Patient Interaction with Computers in the Exam

Having a Provider use a computer in the room during a patient visit does add a level of complexity to the actual visit itself. However, according to a new report from the American Medical Association, the actual patient/provider interaction and communication is not affected for the most part.

Fears of negative effects of using an Electronic Health Record while in the room with a patient have not materialized. This report notes. “Technical improvements in EHRs that focus required computer tasks on activities that meaningfully influence patient outcomes, or that streamline data input and reduce the time needed to complete common tasks in clinical work and decrease the potential for distraction, will help minimize the possibility for disruption.”

Based in large part on findings in 14 previously published studies of the introduction of EHRs into the exam room, an AMA committee developed the report hoping to extinguish the fears. The authors’ of the report found that physicians’ interacting with patients influences how complementary or distracting the EHR can be. Providers skilled in collecting data during patient visits, and recording it on paper charts, before there were EHRs; were better able to integrate use of the computer into the visit.

Also discovered in the study is that those providers who displayed discontent with the computer while in the room with the patient, could easily influence patients’ perceptions of using an EHR.  Those patients who understood the importance of recording the data, in their patient record, for quality of care, and less medical mishaps; were more accepting to the use of computers being used during the visit/exam.

You can view the study here:  Click Here

Five communication behaviors learned at Kaiser Permanente with the Interregional Clinical-Patient Communication Leaders that eased integration of a computer into the exam room:

1. Let the patient look on – move the computer screen so the patient can see it, invite the patient to view information, ask the patient to verify information as it is entered

2. Eye contact – greet the patient, maintain eye contact

3. Value the computer as a tool – acknowledge the computer, let the patient know how it improves care

4. Explain what you are doing – inform the patient about actions and decisions, tell the patient what you are doing, such as ordering lab tests

5. Log off and say you are doing so – tell the patient you are logging off to safeguard his or her clinical information

Ventres W, Kooienga S, Marlin R. EHRs in the exam room: tips on patient-centered care. Available at http://www.aafp.org/fpm/2006/0300/p45/ Accessed Feb 12, 2013.

Utilizing these five behaviors helped to establish a positive experience during and after the visit.
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Study on Youth Concussions Recovery Time vs. the Severity of the Symptoms

Sources: Mayo Clinic, Washington Post, Kaiser Permanente, Science Daily, kidshealth.org, and Denver Post

SOURCE: The Journal of Pediatrics, news release, April 2013

More severe concussion symptoms take longer to recover from their head injury than patients with milder symptoms. The study finds that most children recover from sports-related concussions within a few days, but some continue to have symptoms for months after the injury has occurred. The reasons for this have been undetermined. Authors of this study to identify have looked into risk factors that might be associated with longer recovery times.

One Hundred and Eighty Two children, who were analyzed, were seen at a Sports Concussion Clinic within three weeks of their injury. The patients completed the Post-Concussion Symptom Scale (PCSS), which uses a 0-6 scale to assess the severity of Twenty Two symptoms; the higher the number, the more severe the symptoms. The researchers found that the total score on the PCSS was independently associated with the length of time that patients had concussion symptoms. The higher the score, the more likely the youth would have symptoms for longer than 28 days, according to the study published in April’s The Journal of Pediatrics. Identifying risk factors for prolonged recovery from concussion will enable providers to provide the best treatment for patients, said the researchers.

A list of symptoms included on the PCSS questionnaire included:

1. Headache

2. Vomiting

3. Problems with keeping balance

4. Sleeping more or less than usual

5. Sensitivity to light or noise

6. Fatigue

7. Numbness

8. Memory or concentration issues

9. Visual Acuity

Dr. William P. Meehan, III and colleagues from Boston Children’s Hospital and the University of Pittsburgh Medical Center analyzed data.

"Parents, physicians and caregivers of athletes who suffer from a high-degree of symptoms after a sports-related concussion should start preparing for the possibility of a prolonged recovery," study author Dr. William Meehan said in a journal news release. ©The Journal of Pediatrics April 2013

In the previous studies, it was found that younger patients and those with memory loss had longer recovery times after suffering a concussion; results from this study do not suggest that age or amnesia are risk factors for prolonged recovery time. What were determined athletes will suffer prolonged recoveries after concussion; therefore, the analytical tools to deliver results, should be based on initial symptom scores. The researchers made this public out in a news release.

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Also, Check out the methods for which this study was conducted.

Cumulative Effects of Concussions

100 Most Common Medicare Inpatient Stays Now are Publicly Available

Pricing by hospitals across the nation for treating the 100 most common Medicare inpatient stays now is publicly available from the Centers for Medicare and Medicaid Services.


CMS, which is trying to use its claims data to bring transparency to hospital pricing, also has announced a funding opportunity totaling $87 million to help states enhance their rate review programs and extend price transparency.
Data released on May 8, 2013, shows how vast prices can vary across the nation’s hospitals and local healthcare organizations. The average inpatient hospital charges for services that may be provided to treat heart failure range from $21,000 to $46,000 in Denver, and from $9,000 to $51,000 in Jackson, Miss. For example, average inpatient charges for services a hospital may provide in connection with a joint replacement (MS-DRG 470) range from a low of $5,300 at a hospital in Ada, Oklahoma, to a high of $223,000 at a hospital in Monterey Park, California.

Map Provided by CMS Even within the same geographic area, hospital charges for similar services can vary significantly.

Please refer to the following links for more information:

-CMS-released pricing data is available here
-With a fact sheet showing national variations in hospital charges here
-Grant Funding opportunities for states are here

Retailers and the Partnership of Clinics maybe on the UpSwing!

    With an increase approximation of 200+ clinics opening at retails units (WalMart, Walgreen's, etc.), this means by the year 2015, there will be an estimated total of more than 3,300 units across the US.  The retailers are taking advantage of the ability to merge the care of the clinic, with the sale of the products referred or ordered by the clinician.  This is driving convienence for the patient. 
    MinuteClinic announced after the health system reform law was enacted in 2010 that it planned to double the number of clinics within five years in response. The company is the largest chain with 453 clinics, followed by Walgreens' Take Care, which operates 357 clinics. Take Care also announced expected growth after the enactment of health system reform last year. It netted only two new clinics since then and has made no predictions for 2011.
    The clinics are also exploiting the power of utilizing the Family Nurse Practitioner.  Having the clinic available to the public, for random walk-in traffic, the retailers are also seeing the need for many patients not having a PCP; the patients are seen for acute visits, usually clinic visits are less than 15 minutes, are ways to promote well being, and replenish well needed revenue.  The important venue of survival will be the retailers that bring quality care in a world reliant on HIT, the virtual practice, and not try to provide non-quality care at low prices. 
   

What individuals in the HIT world have been waiting for, the long-awaited “meaningful use” rule appears to be on the way. A final rule has been sent for review to the Office of Management and Budget, a required step prior to publication.


Although OMB is under no strict deadline to review the rule, high-profile regulation typically does not remain in its queue for long. Thus the meaningful use rule could be published, or at least announced, this week.

The rule sets the criteria for the EHR incentive program called for in the American Recovery and Reinvestment Act. ARRA established the outline of the program, intended to promote the adoption and meaningful use of EHR technology, and called on Health and Human Services to promulgate the regulations enacting it.

Also in OMB’s queue is a related rule on EHR implementation standards and criteria, which supports the meaningful use program.

Health and Human Services Awards $83.9 Million in Recovery Act Funds for HIT

HHS Secretary Kathleen Sebelius announces $83.9 Million Dollars for the networking and integration of Health Care Information Technology, which is a part of the $2 Billion Dollars under the American Recovery and Reinvestment Act of 2009 to expand these functions and services to low income and uninsured citizens.

45 Grants:  Listed below are the funds and the organizations, city and state of where they are located.

Canadian Doctor Infuses Pro Athletes with HGH read more...

Dr Anthony Galea has taken healthcare to a new low....Now not only do these athletes cheat, but they have to go to Canada to do so.  I have added a link to Wikipedia to read a little more about Dr Galea...Please just keep some of these athletes in Canada with you!

Just my opinion for what it is worth.

Integration Incentives within the Practices to move to Electronic Healthcare

In  preparing for the new push for "meaningful use", final rules will be issued on health IT standards, implementation specifications, EHR certification technology, meaningful use, and incentive programs for eligible professionals and hospitals.

Overview:

The American Recovery and Reinvestment Act of 2009 (Recovery Act) authorizes the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives for eligible professionals and hospitals who are successful in becoming “meaningful users” of certified electronic health record (EHR) technology. The Medicare EHR incentive program will provide incentive payments to eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) that are meaningful users of certified EHR technology. The Medicaid EHR incentive program will provide incentive payments to eligible professionals and hospitals for efforts to adopt, implement, or upgrade certified EHR technology or for meaningful use in the first year of their participation in the program and for demonstrating meaningful use during each of five subsequent years.

Monies actually allocated for these projects are as listed:
HITECH Funds Allocation


o $18 billion through the Medicare and Medicaid reimbursement systems as incentives for hospitals and physicians who are “meaningful users” of EHR systems.
o $2 billion to the Office of the National Coordinator for infrastructure necessary to allow for, and promote, the electronic exchange and use of health information for each individual in the United States; updating the Department of Health & Human Services’ technologies to allow for the electronic flow of information; integrating health IT education into the training of healthcare professionals; and, promoting interoperable clinical data repositories.
o $1 billion to be made available for renovation and repair of health centers and for the acquisition of health IT systems.
o $550 million for – among other things – the purchase of equipment and services including, but not limited to, health IT within Indian Health Service facilities.
o $400 million for comparative effectiveness research on how use of electronic data impacts healthcare treatments and strategies.
o $300 million to support regional and sub-national efforts towards health information exchange.
o $40 million to be used by the Social Security Administration to use EHRs to submit disability claims.

What does this mean for the average physician?

Each physician will run into barriers such as bringing on more staff to implement these systems, workflow development will have to be standardized within the practice, the decision of choosing the right application that has the ability to integrate with other softwares securily, and the ability to report the data they record for measures of quality of care will have a new strain on these physician groups.  Chris Thorman at Software Advice lays that out pretty well on his blog. 

Partnering with a strong IT group will be crucial to the success of the implememntation for these physicians.  The IT group will be able to pull the pieces together: IT devices, HL7 interfaces, using the software efficiently, and having the policies and clinical flows down to give the clinical staff the time to see their patients.

Waiting will not be an option anymore the age of technology has reached the average family physician.  They are now going to started being penalized (dinged) after 2014 if they are not using some sort of CCHIT electronic medical by CMS.  Their only other option will be to stop seeing Medicare patients.  Another discussion for another day....

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