Telemedicine

Using most available measures, there are three Pharmacy chains that matter, 2 of them closer to pure plays in the sector. Walgreen’s is the largest, CVS is not far behind, and of course, Wal-Mart. CVS is the one making the most noise and expansion of technology with Telemedicine availability inside their Minute Clinic locations. The latest is the famous Cleveland Clinic coming on board in Ohio. When a patient enters a Minute Clinic, a Nurse Practitioner evaluates the situation and if they need further consultation, the links become active in a few minutes at an additional cost of $50 over the office visit (Katie Dvorak, 2016b, para. 2–3) Locally in Charlotte, 27 locations in the Metro, which include Target stores. All but two stores in the area have an affiliation with Carolinas Healthcare System, the dominant system in our area. The partnership locally has been active for five years, but no sign of telehealth that can be found or promoted.

According to a report from the Center for American Progress, telehealth is “high quality and cost saving” which grinds to a halt such progress is arcane state laws and licensing requirements. Only New York and the Capitol Region of Maryland, Virginia, and Washington DC allow reciprocity (Katie Dvorak, 2016a, para. 2–3). The mind is boggled when living on the border of two or more states that each doctor has to stay on their side. Not enlightened in the least. Then there is the matter of paying for all of this. As mentioned in the previous paragraph, the extra fee may be a showstopper for most, even with insurance. Seems to be agreement on the merits; most aspects encounter bumps early in the product/service cycle and this is no exception. As with most facets of healthcare, geography plays an out sized role in quality of care and coverages available to their populations. As of February 2016, 29 states and the District of Columbia have laws for private payer policies for telehealth, and 23 states have parity laws that require insurers to cover telehealth services at the same rates as in-person services (Zeke Emanuel, Joshua Sharfstein, Topher Spiro, & Meghan O’Toole, 2016, pp. 40–41).


Bibliography

Katie Dvorak. (2016a, April 13). CAP: Telemedicine licensure, reimbursement issues states must address. Retrieved April 14, 2016, from http://www.fiercehealthit.com/story/cap-telemedicine-licensure-reimbursement-issues-states-must-address/2016-04-13

Katie Dvorak. (2016b, April 13). Cleveland Clinic to work with CVS on MinuteClinic telemed services. Retrieved April 14, 2016, from http://www.fiercehealthit.com/story/cleveland-clinic-work-cvs-minuteclinic-telemed-services/2016-04-13

Zeke Emanuel, Joshua Sharfstein, Topher Spiro, & Meghan O’Toole. (2016, April). State Options to Control Health Care Costs and Improve Quality. Center for American Progress. Retrieved from https://cdn.americanprogress.org/wp-content/uploads/2016/04/07050836/CostContainment-report.pdf

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Stream 04/07

Healthcare EMRs [personal]

I had the misfortune to sprain my wrist recently that required a medical facility visit. After lengthy waits and treatment, discharge papers (handout with no digital option) disclosed the usual suspects such as purpose of visit and treatment, meds given and prescribed, and follow up procedures. Here is where the follow-up gets hairy approaching fubar. At the left is the first page of an actual discharge paper given out by the Emergency Department. It touts their secure access to your health records and provides a way to contact your doctors and allied professionals. Near the bottom are follow-up instructions, who to see, address info, phone number, and timeframe. The mistake I made was depending on the forms in the service to set up an appointment for today. Their system did not work and when a call was made late Thursday about it, the staff was unapologetic and less than helpful about. This is but one example of how Electronic Medical Records (EMR) failed in real world applications, the kind that drives costs up and reduces outcomes. A copy of the record that I was given was sent to the specialists’ office, which they acknowledged; made its way to the digital equivalent of the circular filing cabinet, the “ignore” bin. An education about how EMR’s are not really what is needed for healthcare reform and cost containment sheds light on the subject. There is the concept of Electronic Health Records (EHR). EMR is a digital version of paper charts in the Doctor’s office, scanned for archival and supposedly sharing purposes among vetted parties. Right answer, wrong question. A move to EHR takes these digitized documents and facilitates sharing throughout the whole system by design. “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual” (Peter Garrett & Joshua Seidman PhD, 2011, para. 6). This was five years ago little action taken on this. The facility certainly dropped the ball with the information passing with the patient suffering negative outcomes because someone did not think through a system promoted by “suits” who generally do not have a clue on what happens on the front lines of care. This leads us to the present. National Coordinator for Health IT Karen DeSalvo wants to move forward with public access of their own data with a measure of control that is anathema to the profitable business of “blocking” data. the Office of the National Coordinator (ONC) said its 2016 goals include continuing to “build the economic case for interoperability,” coordinate with industry stakeholders to increase enhance consumer access to data, and to discourage health information blocking (Hall, 2016, para. 8). There are many avenues to making dollars in the corporate world; I do not understand how blocking data allows happening beyond a potential lock-in similar to Windows lock in for personal computing back in the day.

BCBSNC Shakeup

A recent media report has the #2 person at Blue Cross Blue Shield of North Carolina (BCBSNC) has resigned leaving behind a mess of a computer system tied to mistaken billing of customers and other software issues.

name Alan Hughes
title Chief Operating Officer (COO)
compensation $1.77M (2014)

(John Murawski, 2016)

I was a customer of BCBSNC during my “interim” period prior to Medicare [long story] and based on most of my interactions with them on the phone and in person, no surprise of their flawed systems. Someone has to fall on their sword and there is usually a severance associated with this, which was not disclosed in the piece, but I do not think he will visit the poor side of Durham County anytime soon. When your background is the Chief Information Officer (CIO) and the information system does not work properly, it happens. The Department of Insurance has reported 11,162 customer calls as of April 1, including 2,346 complaints against the insurer. The agency’s investigation could result in fines against Blue Cross up to $1,000 per violation per day (John Murawski, 2016). That has to leave a mark, but it is election year in North Carolina, so “stay tuned”.

Ransomware

UPDATED: Symantec said, “The 2007 and 2010 fixes referenced in the article were not contributing factors in this event” (Ann C Nickels, 2016). Further comment will not emanate from MedStar concurrent to the advice of IT, cybersecurity and law enforcement experts.

This topic will not go away. The hackers that penetrated MedStar Health in the Maryland/DC region came in through a 9 year exploit named JBoss, an application server courtesy of Red Hat Inc. (Tami Abdollah, 2016). As night turns into day, the hospital chain denies this. It must be stated that part of the mission of hackers is to expose weak spots where found. This time, it is the Samas or “samsam” vector specifically for JBoss middleware and other Java based servers. More details can be found here and here. When an IT person in charge of security ignore application threats from the writers of such software and the government on at least 2 other occasions, that would fit the definition of maleficence. MedStar is in deep doo doo, but admitting it would bring more of the wrong kind of attention in a competitive marketplace. Never mind these breaches are not specific to this chain.

Bibliography

Ann C Nickels. (2016, April 6). MedStar Response to Incorrect Media Reports. MedStar Health. Retrieved from http://www.medstarhealth.org/mhs/2016/04/06/medstar-response-incorrect-media-reports/

Susan D Hall. (2016, April 7). Karen DeSalvo: Tech can improve patients’ access to health data. Retrieved April 7, 2016, from http://www.fiercehealthit.com/story/karen-desalvo-tech-can-improve-patients-acesss-health-data/2016-04-07

John Murawski. (2016, April 5). Blue Cross executive resigns amid technology fiasco | News & Observer. The News and Observer. Raleigh, NC. Retrieved from http://www.newsobserver.com/news/business/article70020192.html

Peter Garrett, & Joshua Seidman PhD. (2011, January 4). EMR vs EHR – What is the Difference? Retrieved from https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/

Tami Abdollah. (2016, April 5). Hackers broke into hospitals despite software flaw warnings. AP The Big Story. Washington DC. Retrieved from http://bigstory.ap.org/article/86401c5c2f7e43b79d7decb04a0022b4/hackers-broke-hospitals-despite-software-flaw-warnings

 

Healthcare Stream 04/02

Does Federal Credit Reporting Act covers the Healthcare industry?

One of the suits against 21st Century Oncology notes that “FCRA requires any business that shares data for consumer credit reporting purposes to maintain reasonable procedures designed to limit the furnishing of data to the purposes listed in the statute.” Under FCRA, a person who receives medical information “shall not disclose such information to any other person, except as necessary to carry out the purpose for which the information was initially disclosed, or as otherwise permitted by statute,” the lawsuit notes.

That lawsuit claims that, according to the company’s notice of privacy practices, “21st Century Oncology collects and shares personally identifiable information and protected health information for purposes of collecting payment from insurers or third-party payers, subjecting it to the FCRA’s requirements to safeguard PII and PHI and limit unauthorized disclosures.”

CasS Compliance as a Service

Buzzwords such as insert Letter as a Service is possible in Web 2.0 are commonplace. They only mean something to the web elite intelligentsia if you will. A S and G search on Google for CaaS; actually found some hits. I guess nothing is really original anymore or it would seem.