Collaborating safely over the Internet 2011
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This presentation talks about the 4 elements that make for smoother transitions of care with fewer hospital readmits. Several free and low cost Internet tools are highlighted. As well there is a discussion of HIPAA considerations.
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Collaborating safely over the Internet 2011
- 1. Collaborating (safely) over the Internet Tasha Beauchamp,MSc Webmaster, Research Scientist [email_address] 707-477-0700 NHPCO Clinical Conference - October 6, 2011 - San Diego, CA
- 4. The Business Case for Collaboration
- 12. The pros and cons of Internet collaboration (aka “Working in the Cloud”)
- 15. Demographics Is this realistic?
- 16. Who is on the Net? By Age May 2011 Pew Internet & American Life, www.pewinternet.org
- 17. Who is on the Net? By Income May 2011 Pew Internet & American Life, www.pewinternet.org
- 18. Who is on the Net? By Location May 2011 Pew Internet & American Life, www.pewinternet.org
- 19. Who is on the Net? By Race May 2011 Pew Internet & American Life, www.pewinternet.org
- 21. 4 Key Interventions for Reducing Readmissions
- 22. 1. Medication Management (Real Time Medication Schedule)
- 23. 2. Follow-up appointment with MD (Appointment Calendar)
- 24. 3. Signs of a Problem and What to Do (Patient Education)
- 25. 4. Dynamic Tools (Assessments & Secure Communciations)
- 26. Meet Louise and Shirley
- 27. Medication Management & Follow-up Appointments MyMedSchedule.com: Patient & MedActionPlan.com: Provider iPhone and Android apps available
- 29. MyMedSchedule.com Schedule by Time: Pill box view
- 33. MyMedSchedule.com Can set daily reminders
- 35. MyMedSchedule.com Can set refill reminders
- 36. MedActionPlan.com Patient List in Provider View
- 38. MedActionPlan.com Change a medication
- 39. MedActionPlan.com Modify Doses & Instructions
- 40. MedActionPlan.com Print “contract” for client to sign
- 42. MedActionPlan.com Appt Calendar (Follow-up appt!)
- 46. Knowing Signs of Problem & Dynamic Communication Tools Heart 360 Microsoft HealthVault
- 47. Health Literacy Emergency – Caution – Looking Good
- 48. Heart 360: American Heart Association www.heart360.org
- 49. Heart 360 Enter Data Manually
- 50. Heart 360 Download from Devices
- 51. Heart 360 Provider View
- 52. Heart 360 Invite Patient
- 53. Heart 360 Patient Summary
- 54. Heart 360 Set Alerts
- 55. Heart 360 Secure Email
- 57. HIPAA & Privacy Concerns Disclaimer: I am not a lawyer!
- 59. Privacy Protections MyMedSch Microsoft HV Heart 360 Me & My CGs HIPAA Compliant √ √ √ De-identifies, aggregates for research √ √ √ Displays ads Pharma ads on provider side only No, but links to partners & sends emails Yes, for own products Shares info w/advertisers De-identified, aggregated Not without permission De-identified, aggregated Patient Price Provider Price Free Free Free Probably Free $16/mo $12/pt/mo
- 60. Care Transitions Who is on the team? PCP Hospital Hospice Nurse Social Worker Pharmacist DME SNF Cardiologist
- 62. Microsoft HealthVault A Cloud Ecosystem for Sharing Microsoft HealthVault
- 64. Microsoft HealthVault Storing Health Information
- 65. Microsoft HealthVault Uploading Documents (Advance Directive)
- 66. Microsoft HealthVault Entering Information Manually
- 67. Microsoft HealthVault Use Tools to Import Information
- 68. Microsoft HealthVault Click to MyMedSchedule.com
- 69. Microsoft HealthVault Business model based on tools
- 71. A Simpler Alternative Comprehensive But not as dynamic
- 72. Me and My Caregivers www.meandmycaregivers.com
- 73. Me and My Caregivers Medication List
- 74. Me and My Caregivers Adding Medications
- 75. Me and My Caregivers Calendar Feature
- 76. Me and My Caregivers Add follow-up appointment
- 77. Me and My Caregivers Post Assessments in Daily Log
- 78. Me and My Caregivers Enter Doctor List and Insurance Info
- 79. Me and My Caregivers Care Team Blog for “Signs” and Communication
- 80. Me and My Caregivers Quick Orientation for Paid Caregivers
- 82. Comparison Chart MedAction MS HealthVault Me & My CGs Medication Schedule √ (MyMedSchedule) √ Appt Calendar √ (MyMedSchedule) √ Signs of Problem (Pt Ed) Soon (Heart 360) ≈ Entered manually in blog Dynamic Assessments - - - (Heart 360) ≈ Entered manually in log Secure Communication - - - Secure email Blog-like thread Provider Version Free Probably Free ≈ $12/pt/mo
Notas del editor
- My background Strong emphasis in family caregiving and supporting the patient and family to be part of the team Collaboration across the continuum includes the patient, and if smart, especially with the elderly, the family caregivers
- Today’s objectives. Start off by saying, I am not an IT professional, a clinician or a lawyer. So even though I will be touching on all of these, I need you to know I am an Academic that knows enough programming to be dangerous. Have a bent for applied research and finding ways to put technology to meaningful use, in particular to bring together families with the services they need. Well informed researcher. Offer these insights based on 15+ years of swimming in the field, but again, not a clinician, a lawyer or an IT professional. My degree is in Health Promotion.
- Any other digital media or tools you are using?
- Is it realistic to think we can collaborate? Between professionals, yes. Interoperability has been a big issue, but everyone is in agreement now about standards so that systems can talk with each other. Especially with the family, is Internet penetration high enough?
- Demonstration projects are a great window into the future as Medicare sees it. Look at what’s happening in CMS. Even though it may not currently impact hospice (e.g., the target is Home Health), there are opportunities here, especially if you have a palliative care program. There are also initiatives where the writing is on the wall and it’s simply a matter of time.
- Basic take is that re-admissions mean that the person was sent home too early, or with not enough support at home to do the follow-up care. CMS is going to start penalizing hospitals and physicians with high re-admission rates. They will get a reduction in their reimbursements. “ The stick” Isn’t this our population base? High proportion of CHF and COPD patients, for instance. Died or re-hospitalized within 1 year 51.5% originally admitted for surgeries 67.1% originally admitted for medical condition
- CMS is becoming an informed consumer. Priority is placed on outcomes in the context of cost. This is what’s happening to home health, but don’t be naïve in thinking hospice is immune. Value = Quality/Cost. Value increases as quality increases if costs can stay the same. P4P “ The carrot” Share the savings Emphasis on evidence-based practice. Rewards will be given to those providers that adopt best practices. Looking for improvements. Focus of Home Health is Medication reconciliation, home assessment, pain management, education (explain things in a way you could understand),
- 6 month study in a closed university health system A one month touch, resulted in significantly lower readmission rates even 6 months out. Many of the materials are available for free download.
- So what does this mean? Recognition that transition to home is problemmatic - going too early - more care needed than home is able to provide Emphasis on coordination between provider Increasing emphasis on patient self-care (in case of elders, that means the patient/family)
- Is it realistic to think we can collaborate? Between professionals, yes. Interoperability has been a big issue, but everyone is in agreement now about standards so that systems can talk with each other. Especially with the family, is Internet penetration high enough?
- • Information exists in cybersapce. Is available 24/7, from anywhere. No longer have to physically have a piece of paper in hand. • Interactive. Can post information out, but also get information back in, and from more than one person. Absolutely promotes a team approach. • Can have multiple levels of access (Read only; Read and write) • Password-protected. Only those given a password can enter. This is the beginning of being truly patient-centered. Patient now has access. • Asynchronous, not dependent on being available at the same time to communicate
- In professional context, most of these are surmountable • Requires electricity. Katrina! • Computer, computer literacy & Internet access. Not a problem professionally, but for patients/families may be an issue. Truthfully, with wifi and iPads, can see that it won’t be an issue for long. • Protection against hacking. HIPAA. Biggest threat • Remembering your password! (providers don’t want multiple passwords; patients/families)
- Is it realistic to think we can collaborate? Between professionals, yes. Interoperability has been a big issue, but everyone is in agreement now about standards so that systems can talk with each other. Especially with the family, is Internet penetration high enough?
- Clearly age is a big determinant. But look at those age 50-64. These are the adult daughters and sons who are so often the caregivers.
- Hispanics and Caucasians neck and neck (large youth population of Hispanics; but culturally not unusual for grandkids to be doing the Internet work for the family)
- Hispanics and Caucasians neck and neck (large youth population of Hispanics; but culturally not unusual for grandkids to be doing the Internet work for the family)
- Remember I said Boomer daughters and sons are the ones to watch. This is why Family caregivers turn to the Internet first. 39% of ALL Internet users report using the Internet to find info for a sick friend or relative. Typically Boomer children. 26% of Internet seekers say Internet played a crucial role One out of 3 said it helped them to find professional service. You want that to be YOU, not your competition.
- Is it realistic to think we can collaborate? Between professionals, yes. Interoperability has been a big issue, but everyone is in agreement now about standards so that systems can talk with each other. Especially with the family, is Internet penetration high enough?
- Incredibly versatile and very responsive to feedback. Received the Caregiver Friendly Award in 2011 from caregiver.com
- Imagine being able to push out a schedule like this to your patients and families. You give them a password. At any time, they can log on: • No more wondering if the list sitting on the table is the most current. • If they have to go to Dr. or ER, med list can be accessed • If Dr. wants to change, you can give them access to do so.
- Can select several views: By time, for filling the pill box
- Can keep in wallet, to remember, or incase there’s an emergency. Family Caregiver can keep in wallet so can refer to it during the day if need to call to remind parent to take meds.
- Perhaps you’d like to have special instructions or explanations. This is the view that will let you do this.
- Everything is available in Spanish (See pull down upper left)
- Email or text reminders for the 8:00 a.m., 10:00 a.m. and 10:00 p.m. doses. (Only one cell number so one gets texts, another emails)
- Can be sure took meds. If for some reason if pre-filling a pill box doesn’t work, can stay on top of things using this mode.
- Can have refill reminders sent a week or two earlier to make sure you don’t run out of meds…
- From My Med Action Plan, provider view, can organize all your patients. Can group by disease condition, or physician, or hospital affiliation, or program of yours… Here’s the greatnews. This program is FREE! Sponsored by drug companies, but that just means a drug add on the home page of the provider view. Nothing the patient sees. Really, very tasteful. This is HL7 Compliant, meaning can port back and forth with an HL7 EMR. (That will cost money to set up; but my impression is the fees are reasonable.) HIPAA compliant on both the provider AND the patient side, but there is a difference.
- You may want to begin a new patient by selecting from a pre-determined set of regimens you have created.
- Can readily change a medication. Have literally THOUSANDS of pictures in here. Generic listed, but no images.
- Can enter dosage times and quantities, with purpose, and even special instructions if you want (eat with food…)
- Some providers like having a contract format, where patient/family signs that they understand.
- Again, everything is available in Spanish. Once is the way you want, can print or push out to pt’s MyMedSchedule account
- Has a calendar feature (unfortunately this does not push out to client account quite yet, but will in next version). But, can print out, especially with that FU appt so crucial after a discharge.
- Can print out pt. edn. Also available in Spanish. Again, can’t push out to pt acct now, but next version will be able to.
- Can print out trackng form. Again, not interactive. For that, we have a different program to show you later in the session.
- Incredibly useful place to store information for patients. If nothing else, frustrating for them as they move across the silos to be having to give the same info to each group: Insurance, Doctors, Medications, Allergies… Can upload files, in our case, a pdf of the signed advance directive.
- This is not a medical record. It is an information transmission application.
- If you appear to be sponsoring the service, then the service needs to comply Technological security, for covered entities, but now also for Business Associates Make sure only those who are supposed to have access can access(password-protection, with ability to remove access) Encryption (scramble the data where it is stored and so only those entering through the approved password-protected portals can make sense of the data (hacker proofing) Security Audits Access logs (what passwords logged in when) Notification if there has been a breach Physical security: Can people see over your shoulder when you are online? What if you go to the restroom? Where data is stored is protected. Laptops walk! Administrative security: Staff policies and training in place, need-to-know access, and some teeth behind them for infractions.
- Private companies with data storage services are sensitive, and often go the the level of protection required of a covered entity. BUT they have other factors that may creep into play, such as sharing info, or not, with other companies. Depends on the business model of the service. All three presenting today are so far HIPAA-compliant even on the “private” patient side: Password-protected Encrypted Security audits Access logs Breach notification In addition, though, there are other security issues, e.g., advertisers. Note that this is also related to cost. MyMedSchedule is incredibly robust, and yet free, but comes at the price of advertising on the provider side and sharing de-identified, aggregate data. MyRemCare, awesome program, no advertising, BUT costs money.
- Great storage and aggregating service Makes perfect sense that the chart belongs and moves with the patient (HIPAA has “portability” in the title for a reason. The people who set this up were exactly thinking about EMRs way back in 1995.) Lots of work to populate the record with your information. And especially if all you have are chart notes, etc. there are partner services that will, for a fee, create your documents into pdfs and upload (like the AD), or even interpret the documents and fill out the forms from the paper-based versions.
- Microsoft HealthVault is really a space in the cloud that facilitates pulling numerous tools developed by others together in one spot.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Participants in the study transmitted readings from a blood pressure cuff to the Heart360 website and a HealthVault record. The data was uploaded to Kaiser, whose clinical pharmacists used the information to monitor readings and adjust antihypertensive medications accordingly. They found that patients who used home monitoring were 50 percent more likely to have their blood pressure in control than those who were monitored in the doctor’s office. Kaiser Permanente, Institute for Health Research, 2010.
- Communication has a blog-like format. Family can post question (elect to have it emailed securely also). Replies happen as a thread in the message. Can use this as a place to enter and store reference information, like signs, for looking up later.
- So what does this mean? Recognition that transition to home is problemmatic - going too early - more care needed than home is able to provide Emphasis on coordination between provider Increasing emphasis on patient self-care (in case of elders, that means the patient/family), looking a the 4 key factors for reducing readmissions