Deirdre Fulton

The research shows significant variability in EHR satisfaction among specialties, but high-quality training can help.

Cybersecurity experts at BakerHostetler document some bright spots and areas for improvement for healthcare organizations.

The collaboration allows health plans to pay for healthcare-related social services delivered by community benefit organizations.

Despite its clear potential to improve access to high-quality care in underserved communities, telehealth is underutilized by safety-net providers due to a range of barriers, according to a new report from the RAND Corporation. The analysis, based on interviews with Medicaid officials from seven states and representatives from 19 Federally Qualified Health Centers in those states, points to insufficient reimbursement as a leading culprit for this lag, in addition to other logistical, policy and operational barriers. WHY IT MATTERS Telehealth can help rural, low-income and vulnerable populations better access health care -- and analyses have shown use of this technology, particularly live video telehealth, is growing among FQHCs. In some cases, telehealth is the only way to bring specialists into remote places. But uptake, maintenance and expansion of telehealth services have been spotty at best. The RAND report, sponsored by the Department of Health and Human Services, seeks to find out why. Interviews with Medicaid and FQHC stakeholders revealed a lack of clarity around state telehealth policies and insufficient reimbursement as top barriers to adoption. Other limiting factors included: infrastructure issues (e.g., insufficient broadband), technology costs, telehealth as a cost center, billing challenges, lack of buy-in among FQHC providers, challenges specific to the patient population (e.g., elderly patients, homeless patients), complexities in adjusting clinic workflow, inadequate supply of specialists to provide telehealth services to FQHC patients, complex and time-consuming logistics around credentialing and licensing, and challenges in working with remote providers. The report suggests several possible solutions that address stakeholder concerns directly as well as areas for further research -- including surveying "the policy environment faced by FQHCs nationwide and explore whether certain policies seem to be associated with greater utilization of telehealth." THE LARGER TREND Given the advantages of using telehealth in underserved communities or to treat vulnerable patients, it is important that state officials and safety-net providers come to a mutual understanding of what's standing in the way of telehealth expansion for these populations -- and modify or clarify policies accordingly. Exciting developments in telemedicine technology must be evaluated in the context of whether they will provide benefits to all users, particularly those with the most need. ON THE RECORD "Telehealth is widely recognized as a tool that can increase access to care and improve quality, and, given that FQHCs are experimenting with telehealth across the United States, it is highly likely that many have confronted challenges and implemented strategies that can benefit others at different stages of implementation," the report authors write. "Studies such as this can support Medicaid programs and FQHCs in the important process of peer learning. Furthermore, our findings highlight the important role of policy, in combination with cultural, organizational, and infrastructure factors, in strengthening the delivery of telehealth services." Deirdre Fulton is communications professional and freelancer based in Maine. On Twitter: @deirdrefulton Healthcare IT News is a HIMSS Media publication. 

A new report in Health Affairs looks at the success rate of hospital IT system integration, post-consolidation.

As healthcare startups boom, providers must embrace disruption and forge new relationships with tech companies, says a new report from the Chartis Group.

The total number of breaches is at a three-year low, but the incidents are larger, affect more people – and are often caused by underprotected IT environments, according to a new Bitglass report.

It seems simple enough: If a piece of medical equipment is storing, receiving, transmitting, or processing electronic protected health information, it falls within the category of devices that are covered under HIPAA. Yet, “for many practitioners, it just hasn’t occurred to them that medical devices are computers or are interfaced with computers,” said Steve Spearman, vice president of HIPAA Compliance Services of Healthicity, an information security consulting and services firm focused exclusively on healthcare. In turn, they fail to include the security of medical devices in their risk analysis processes. And that, Spearman warned, can be a dangerous and costly mistake. “In addition to the standard problems with computer vulnerabilities, compromised security in medical devices are particularly prone to issues that can affect patient care, even patient safety,” he said. [Also: 21 awesome photos from past HIMSS conferences] As recently as November 2015, Lahey Hospital and Medical Center in Massachusetts agreed to pay $850,000 and implement a corrective action plan after settling with the Department of Health and Human Services Office for Civil Rights over a stolen laptop that was used to operate a portable CT scanner. The nonprofit teaching hospital was cited for failing to conduct an accurate and thorough risk analysis, failing to implement appropriate physical security measures, failure to assign a unique user name to identify and track users and, lastly, for disclosing the ePHI of 599 individuals whose data was stored on the laptop, Spearman said. “Medical devices pose risks similar to all other computers,” he said. “Vulnerabilities in medical devices can be exploited to gain inappropriate access to network resources.” Spearman, along with Mary McGuirl, Director of IT at Oneida Healthcare in New York, will present the session, “Assessing the Risk of Your Medical Devices,” at HIMSS16. [Like Healthcare IT News on Facebook] With Spearman as a “nuts-and-bolts kind of guy” and McGuirl providing perspective on practical issues such as resource constraints and organizational challenges related to meeting federal requirements at a small regional hospital, the pair hopes participants come away better equipped to include medical devices in their annual risk assessment. Left out of risk analyses, medical devices “can be a vector for malware,” Spearman said, noting that many run on software or firmware, and are therefore not easily updated to more secure versions. He pointed to “inappropriate access controls,” such as weak or non-existent credentials, as a common issue that can be exploited “to undermine the integrity of the medical record.” “Even worse,” he continued, “sometimes these credentials are hard-coded and they can’t be changed! If there are no ‘unique users’ how can you conduct audits, research complaints, respond appropriately to incidents? You can’t.” The session “Assessing the Risk of Your Medical Device,” will take place from 11:30 a.m.-12:30 p.m. on Thursday, March 3, in Palazzo L. Twitter: @HealthITNews This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

Receiving a life-threatening health diagnosis can be frightening, confusing, and overwhelming. Unfortunately, how hospitals deliver subsequent medical information to patients and families can contribute to those feelings, rather than ease them. At St. Jude Children’s Research Hospital in Memphis, for example, families used to receive a large notebook of information during their initial hospital admission -- just hours or days after they had been informed of their child’s cancer diagnosis. “Receipt of this notebook did not ensure education,” said Dana McLure, Nursing Administration and Patient Care Services Project Manager, at St. Jude. “As a matter of fact, at times nurses would find the ‘education notebook’ had not been reviewed by the patient or family days after admission.” [Also: 21 awesome photos from past HIMSS conferences] Through the facility’s Shared Decision Making model of leadership, clinical nurses reported that indeed, patients and their families often “had little or no retention of the information that had been presented.” By incorporating what McLure called the “bedside caregiver perspective,” information overload and timing of patient education were identified as obstructions to both the patient experience and caregivers’ satisfaction. In a HIMSS16 session, “Watch and Learn: Transforming Patient Education,” on March 3, McLure and her colleague and Neely James, Systems Analyst for Patient Care Services Informatics at St. Jude, will focus on key ways to improve the transmission of such vital information. Migration from verbal or paper education to digital delivery makes sense in today’s world, in which patients and families are accustomed to learning and communicating via technology such as email, text message, websites, and more. A major discovery, they report, was that use of video education, whether live action or animation, provides a broader and more effective platform for information transfer. “Because we are a pediatric hospital many of our parents are millennials and more likely to be comfortable with information being delivered in a video format,” McLure said. “Our patients are definitely of the YouTube generation.” See all of our HIMSS16 previews Video presentations can provide demonstrations of procedures, proper use of devices, or even visual examples of symptoms, “which can lead to enhanced comprehension,” they continue. What’s more, they add, placing education into an on-demand video format “allows the patient or family to watch the education when it is convenient for them, as opposed to when the clinician provider has time to provide it.” And such videos can also be viewed more than one time based on the individual patient and family learning needs. “Determining when a patient or family is ready to learn is as important as determining what they need to know,” McLure said. The session "Watch and Learn: Transforming Patient Education," will take place from 1-2 p.m. on Thursday, March 3, in Lando 4201. Twitter: @HealthITNews This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

It’s a futuristic idea to be sure: Harnessing the intelligence of IBM Watson, the Jeopardy-winning supercomputer, to support cardiac-care recovery, reduce hospital readmissions, and save healthcare costs. But that’s what the Colorado-based healthcare nonprofit Centura Health and consumer enterprise platform vendor Welltok are doing right now with CaféWell Concierge, currently in pilot with consumers who are transitioning back to everyday life after experiencing a heart condition. See all of our HIMSS16 previews “Cognitive computing mimics the way humans think by combining artificial intelligence and machine-learning algorithms,” said Jeff Margolis, CEO of Welltok. “IBM Watson understands natural language in context; it can determine the intent of a phrase or question and provide a pertinent, useful response.” Margolis, along with Pam Nicholson, senior vice president of strategy for Centura Health, will present “Applying Cognitive Computing to Population Health” at HIMSS16. Nicholson said that the technology the companies are piloting learns from interactions to provide personalized recommendations over time. For example, if a consumer has opportunities to join a team activity challenge and schedule a one-on-one coaching session, and consistently chooses the team activity, the app would recognize that this person favors social activities and recommend a support group at the local community center. [Also: IBM Watson picked to help tackle heart disease] Among the other ways that patients interact with CaféWell: Finding options for cardiac rehabilitation exercises and activities; researching new heart-healthy recipes and dishes at local restaurants, and identifying educational resources and videos on living with heart conditions. In these ways, cognitive computing is broadening the scope of healthcare delivery “so that it can happen outside what we normally think of as the healthcare setting,'” Nicholson said. “The contrast with traditional health care, where we only get to interact with the consumer when they step inside our four walls and temporarily become a patient, is profound.” As the real-world pilot users continue to train the application’s “brain,” as Margolis put it, these innovators see ample opportunities for cognitive computing to have an impact in the four areas of health: healthy behaviors, genetics, medical interventions, and environment. [Like Healthcare IT News on Facebook] “In five years, we believe that predictive analytics will further evolve and enable providers and consumers to make better health decisions while allowing for care to be highly personalized,” Nicholson said. “This will require us to continue to build solutions that incorporate timely and new data sources, offer reliable, consistent predictive models, deliver convenient and immediate personalized health and lifestyle recommendations, and learn intuitively and rapidly.” The session "Applying Cognitive Computing to Population Health,” is slated to take place March 3, 2016 from 1 to 2 p.m. in Rock of Ages Theater at the Sands Expo Convention Center. Twitter: @HenryPowderly This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.