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Takes a bit of time, but an excellent presentation about the culture of leadership and how things that aren't ethical are often quite legal

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Legal vs. Ethical Liability: A Crisis of Leadership and Culture | Mel Fugate | TEDxSMU

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How to Create EASY Infographics with the (improved!) Charts and Graphs Canva feature

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How to Create Infographics in Minutes (Canva)

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The Art of Visualizing Data, Examples of Common Visualization Techniques and When to Use Them.

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Telling Stories with Data in 3 Steps (Quick Study)

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What is Data Analytics? Told by a data analyst

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Just had to post this as its hilarious--and an excellent example of the silly things JCAHO (and hospital administration) get hung up on

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This video is another example of how patient portals are so useful and crucial in providing the best patient care

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Office of the National Coordinator for Health IT

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A company with a product to help hospitals combat medication alert fatigue

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Using FDB AlertSpace analytics saves us countless hours, but more importantly, it is also helping us quiet some of that noise for physicians, pharmacists and all our providers so they can better focus on delivering optimal care.

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Drug Alert Management Software | FDB AlertSpace | FDB (First Databank)

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Using FDB AlertSpace analytics saves us countless hours, but more importantly, it is also helping us quiet some of that noise for physicians, pharmacists and all our providers so they can better focus on delivering optimal care.

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Institute for Healthcare Improvement - IHI

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What are the patient safety risks of health technology?

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This article explains why gamification doesn't always work and how it will need to adapt to increase user participation and improve health outcomes.

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Rey Villar, founding partner at HealthChampion, discusses why previous approaches to health gamification haven't worked and why personalisation is the key to turning the tide.
Around one in three of all adults suffer from multiple chronic conditions, many of which can be avoided or whose symptoms can be mitigated through diet and exercise. Medical professionals have long understood that patient engagement and adherence is the simplest solution to improving our population's health.
Technology alone isn't the answer
Contrary to what some may believe, however, the problem isn't that people don't care about their health. The real problem is that telling people they need to improve their lifestyle is often not enough to produce consistent, long-term changes. The challenge is one of motivation, not interest.

Technology has disrupted almost every industry today, and it's had its eyes set on health for the last two decades. We all suspect technology holds one of the keys to driving greater patient engagement. But so far, no one has cracked the code on how.
Initial attempts at gamification
One solution the industry has wrestled with the past decade are digital health trackers and reminders. Using Fitbits, pedometers, apps or other devices, these solutions use alerts and messages to give patients timely nudges for making healthier choices. And while there are now literally thousands of these apps and devices available, studies continue to show that they don't make people healthier.

Many studies, such as a 2014 report from Health Informatics Journal, have indicated that gamification is a promising way to incentivise improved patient self-management. Understanding that motivation is the key challenge to patient engagement, hundreds of apps have emerged in the past years that used rewards - the simplest of gamification strategies - to motivate users to improve their health.

Healthy activity: Apple and Aetna recently launched a campaign that rewarded Apple Health users for maintaining a healthy, active lifestyle. MapMyRun is offering prizes to users who cover 1,020 km in 2020 in its latest challenge.

Weight management: Several apps like HealthyWage.com and DietBet.com literally pay people to lose weight, while MyFitnessPal regularly offers challenges and the potential to win prizes for users who log consecutive meals for a number of days

Check-ups: Start-ups like Healthereum and Clinicoin reward patients with cryptocurrency when they follow recommended health steps like regular check-ups and exercise.

These rewards-based health apps are attempts to follow the gamification success of non-health apps like Duolingo.com (for learning new languages) and ZyngaPoker.com (for online non-cash poker players).
Gamification that works for all
But while these gamified health apps have had some success, their singular approaches haven't been gamebreakers when it comes to moving the needle on population health. An article from The National Centre for Biotechnology Information reviews 19 studies on the effect of gamification on health and wellbeing with mixed results. While there is evidence that gamification can have a positive impact on health and wellbeing, several studies also reported mixed or neutral effect.

So why hasn't gamification worked for healthcare apps? The answer is that this single-focus approach gamification hasn't worked for most non-health apps either.

Whether for healthcare or other industries, the key to successfully implementing gamification strategies in apps is to first understand that gamification isn't a magic bullet. Gamification can't overcome the limitations of an app that doesn't deliver real value for its audience.

The second key to turning the tide is in understanding that app users are motivated by different rewards. Yes, many people are motivated by monetary rewards, but many others are motivated by other things beyond cash. In short, making health gamification more targeted and personalised to your audience segments is critical for long-term success.
People are motivated by different game dynamics.
To understand why, let's look at a few reasons health gamification hasn't made a bigger dent.

So far, most of our attempts to gamify health have been rudimentary and one-size-fits-all. A company might challenge its employees to a "walk-off" in which individuals or teams compete for prizes based on their step counts. A doctor might recommend an app that rewards a person with points or prizes for taking their medicine consistently.

The trouble is that not everyone is motivated by the game dynamic of goals and rewards. In fact, there are six user types when it comes to gaming:

Players - This group is motivated by extrinsic rewards and may respond well to the standard types of health games and competitions described above.

Socialisers - These folks are motivated by relatedness, so to grab them, games need to facilitate social connections.

Free Spirits - The motivation for free spirits is autonomy and self-expression, requiring games that allow them to create and explore.

Achievers - This type of individual is motivated by mastery, so it's important their games nurture learning, acquisition of new skills, and self-improvement.

Philanthropists - A philanthropist is motivated by purpose and meaning, so their games will need to enrich the lives of others in some way.

Disruptors - These people enjoy finding ways to skirt the game system.

The gaming "high" is subject to diminishing returns.
If we're going to engage patients in long-term change, we'll need to deploy a variety of gamification approaches that covers this spectrum.

Moreover, we need to understand how to keep our health games interesting over time. As most of us know, when a person has a goal or prize to work toward, it can trigger a dopamine release in his or her brain. Dopamine can be a powerful motivator, but it's subject to the law of diminishing returns, meaning it takes more and more of the game stimulus to produce the same effect in our brain.
Time is precious.
Professional game makers seek to avoid this effect by ramping up the intensity or difficulty of gameplay and/or incorporating several different types of challenges throughout the experience. If health games fail to account for diminishing returns, it doesn't take long before the dopamine reward for meeting a game goal is outweighed by the dopamine reward for smoking a cigarette, for instance.
How to engineer health gamification that works
Even people who can be motivated by a financial reward or prize can begin to lose interest if they feel the amount of time they're putting in isn't worth the reward at the end. Putting in time - e.g. time toward exercising or cooking healthier food - is one of the most difficult commitments to make on a long-term basis, so the more time is being required of the patient, the better tailored and more exciting the game needs to be.

Gamifying healthy decision making in a way that drives meaningful long-term engagement will not be easy. But there are a few things we can expect to be part of the solution:

We'll need to employ a variety of game styles to meet the different motivational needs of individuals. For example, Achievers might benefit from games that teach them about their illness, with rewards tied to completing learning modules. Socialisers may do well with games where they face off against other patients in a supportive, collaborative digital environment.

We'll need to design health gamification to have the same addictive qualities as video and mobile games by incorporating increasing levels of difficulty, multiple long- and short-term goals, and numerous types of challenges. So for a diabetic, one week's challenge may be completing an exercise routine, where the next week's might be cooking a healthy recipe.

Finally, we'll need to incorporate artificial intelligence in order to recognise when patients are beginning to disengage so it can recalibrate the person's gaming style or mix up the challenges in a way that reignites interest. Otherwise, people will stop choosing to spend their precious time engaging with something other than their health.

Chronic health conditions are an epidemic-level concern, which is why it's more than worthwhile to invest time and resources into cracking the code of gamifying healthcare. Gamification has the potential to help us turn this ship around, but only if we approach it with a strong understanding of how the best games work and why one-size-fits-all doesn't.

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One-size-fits-all gamification is not enough to improve patient outcomes

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Rey Villar, founding partner at HealthChampion, discusses why previous approaches to health gamification haven't worked and why personalisation is the key to turning the tide. Around one in three of all adults suffer from multiple chronic conditions, many of which can be avoided or whose symptoms can be mitigated through diet and exercise.

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Although this article is from 2017, the Medical Futurist has a ton of great information about all technology related to healthcare

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The Top 15 Examples of Gamification in Healthcare - The Medical Futurist

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Gamified apps and devices will appear in every field making behavior change easier and fun. Here are the greatest examples of gamification in healthcare!

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I think everyone should share this link with all their friends and urge them to take the quiz so we can facilitate Alzheimer's Research

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Introduction to the MindCrowd Alzheimer's Research Project

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Story of Telehealth Innovation before COVID!!

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Story of Telehealth Innovation before COVID!!

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I Am a Telehealth Nurse | Cincinnati Children's

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10 Popular Machine Learning Datasets, Explained

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Health Information Exchange in California

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Health Information Exchange in California

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A Demonstration of Health Information Exchange using Directory and Trust Services

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Article from the Medical Futurist.
Smart algorithms and AI are CDSS tools.

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Top A.I. Algorithms In Healthcare - The Medical Futurist

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The Medical Futurist made a list to keep track of the top A.I. algorithms aiming for better diagnosticsor further sighted predictions in healthcare.

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AI may be one of the best new CDSS tools we may soon have at our fingertips.

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Leverage data and AI to help optimize performance in the new normal

Helping healthcare providers succeed in a rapidly-changing world

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Healthcare provider solutions | Watson Health

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Healthcare providers solutions from IBM Watson Health enable clinicians and health system leaders to help accelerate transformation and optimize performance

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From the CDC

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Centers for Disease Control and Prevention

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Clinical decision support systems (CDSS) are computer-based programs that analyze data within EHRs to provide prompts and reminders to assist health care providers in implementing evidence-based clinical guidelines at the point of care. Applied to cardiovascular disease (CVD) prevention, this Domain 3 strategy can be used to facilitate care in various ways-for example, by reminding providers to screen for CVD risk factors, flagging cases of hypertension or hyperlipidemia, providing information on treatment protocols, prompting questions on medication adherence, and providing tailored recommendations for health behavior changes.

The evidence base demonstrating the effectiveness of CDSS is very strong. Research studies that examined CDSS had strong internal and external validity, the Community Preventive Services Task Force concluded that CDSS is effective, and CDSS trials have been replicated with positive results. Implementation guidance on CDSS is available from several sources.

Health Impact
A review by the Community Preventive Services Task Force found that CDSS leads to significant improvements in the following three quality-of-care practices for CVD prevention delivered by health care providers: 1,2

- Recommendations for screening (e.g., for blood pressure or cholesterol) and other preventive care (e.g., smoking cessation).

- Evidence-based clinical tests related to CVD.

- CVD-related treatments prescribed.

Evidence shows that CDSS can be tied to lower blood pressure and cholesterol levels, but the findings on this association are inconsistent.
Health Disparity Impact
The ability of CDSS to reduce health disparities is understudied, and several researchers have suggested that further work is needed to directly examine this issue. Some have noted that providers working with underserved communities typically lag behind in the uptake of electronic health records (EHRs) and CDSS, and evidence exists that CDSS leads to successful health outcomes when used in underserved communities. 3,4 Thus, it is reasonable to conclude that CDSS has the potential to eliminate barriers and reduce disparities in hypertension-related care.
Economic Impact
Economic factors related to the implementation and maintenance of CDSS have not been well-documented. A review by the Community Preventive Services Task Force was inconclusive because of a lack of available data. The Task Force found that current studies are extremely heterogeneous in the range of CDSS functions and CVD risk factors studied and in the completeness or inclusion of major cost factors. Thus, the ability to determine an overall estimate of the cost or economic benefit of CDSS is limited. Of the studies available, health care costs appear to be more likely to decrease than increase after CDSS implementation, but the usefulness of this evidence is limited by incomplete and inconsistent data. ⁵ More data on the complete costs of developing, implementing, and operating CDSS systems are needed to fully assess its cost-effectiveness or return on investment.

1. Settings
Although CDSS has been implemented in a wide variety of health care settings, most published research has been within the context of primary outpatient care.

2. Policy and Law-Related Considerations
Legal considerations for CDSS begin with the vendors who interpret and translate guidelines into algorithms used by these systems. Vendors must fully disclose the sources used to build the knowledge base for their software and any limitations or weaknesses of the software. Providers must ensure that CDSS programming is updated regularly to account for changes in evidence and guidelines, and that EHRs associated with CDSS include complete and up-to-date information about patients' medical histories and allergies.1,8,13 Provider fatigue or avoidance of CDSS guidance has been raised as a barrier to successful outcomes, leading to suggestions that initial and repeat trainings be a mandatory part of CDSS implementation.

3. Implementation Guidance
Implementation guidance for CDSS is available from various sources. The following resources may be particularly useful:

Resources
CDSS is supported and promoted by many federal initiatives and agencies, including the following:

CDSS at South Omaha Medical Associates

South Omaha Medical Associates (SOMA) is a family-owned, family-operated clinic that is centrally located in South Omaha, Nebraska. It has a higher percentage of low-income patients than clinics in surrounding areas. SOMA collaborated with the Nebraska Department of Health and Human Services, Douglas County Health Department, and Wide River Health Information Technology to assess its technology needs and make plans to implement CDSS. As a result of this assessment, the clinic increased its use of EHRs and implemented systems to better identify patients with undiagnosed hypertension, increase use and monitoring of clinical quality measures, and increase use of clinically supported self-measured blood pressure monitoring. These changes improved workflow at the clinic and led to a 25% increase in patient visits since the start of the collaboration. In addition, Blue Cross Blue Shield awarded SOMA its Blue Distinction Award for meeting overall quality measures for patient safety and outcomes.

For more information:
Chronic Disease Prevention and Control Program
Nebraska Department of Health and Human Services
301 Centennial Mall South
Lincoln, NE 68509
Email: DHHS.CDPCProgram@nebraska.gov

1. Community Preventive Services Task Force. The Guide to Community Preventive Services. Cardiovascular Disease: Clinical Decision-Support Systems (CDSS). https://www.thecommunityguide.org/findings/cardiovascular-disease-clinical-decision-support-systems-cdssexternal icon . Accessed August 17, 2017.

2. Njie GJ, Proia KK, Thota AB, et al. Clinical decision support systems and prevention: a Community Guide cardiovascular disease systematic review. Am J Prev Med. 2015;49(5): 784-795.

3. NORC at the University of Chicago. Understanding the Impact of Health IT in Underserved Communities and Those with Health Disparities. https://www.healthit.gov/sites/default/files/pdf/hit-underserved-communities-health-disparities.pdf pdf icon [PDF-929 KB] external icon . Accessed February 9, 2017.

4. Mitchell J, Probst J, Brock-Martin A, Bennett K, Glover S, Hardin J. Association between clinical decision support system use and rural quality disparities in the treatment of pneumonia. J Rural Health. 2014;30(2):186-195.

5. Jacob V, Thota AB, Chattopadhyay SK, et al. Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a Community Guide systematic review. J Am Med Inform Assoc. 2017;24(3): 669-676.

6. American Medical Group Foundation. Measure Up Pressure Down: Provider Toolkit to Improve Hypertension Control. Alexandria, VA: American Medical Group Foundation; 2013.

7. Optimizing Strategies for Clinical Decision Support. https://www.healthit.gov/sites/default/files/page/2018-04/Optimizing_Strategies_508.pdf pdf icon [PDF - 1.4 MB] external icon . Accessed June 24, 2020

8. Kilsdonk E, Peute LW, Jaspers MWM. Factors influencing implementation success of guideline-based clinical decision support systems: A systematic review and gaps analysis. International Journal of Medical Informatics. 2017;98:56-64.

9. Centers for Disease Control and Prevention. Hypertension Control Change Package for Clinicians. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services; 2015.

10. gov. Policymaking, Regulation, & Strategy. Clinical Decision Support (CDS). https://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cdsexternal icon . Accessed April 12, 2017.

11. Merit-Based Incentive Payment System: Advancing Care Information. https://qpp.cms.gov/mips/advancing-care-informationexternal icon . Accessed September 26, 2017.

12. Agency for Healthcare Research and Quality. Health Information Technology. Clinical Decision Support (CDS). https://healthit.ahrq.gov/ahrq-funded-projects/clinical-decision-support-cdsexternal icon . Accessed April 12, 2017.

13. Fox J, Thomson R. Clinical decision support systems: a discussion of quality, safety and legal liability issues. Proc AMIA Symp. 2002:265-269.

14. Norwegian Institute of Public Health. GUIDES checklist: A tool to assist professionals when implementing guidelines with computerized decision support. https://www.guidesproject.org/external icon . Accessed March 22, 2018.

Note: The web version has been updated in an effort to keep the linked resources current, and for this reason some of the content may differ with the PDF version.

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How to Implement Clinical Decision Support Systems

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Clinical decision support systems (CDSS) are computer-based programs that analyze data within EHRs to provide prompts and reminders to assist health care providers in implementing evidence-based clinical guidelines at the point of care.

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One of the best Youtube videos I've seen! I love this as it so accurately points out many of the flaws with our current EHRs. (Yes, EPIC. EPIC Fail).

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EHR State of Mind | #LetDoctorsBeDoctors | ZDoggMD.com

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EHR's suck. Let's make 'em better. Go to http://LetDoctorsBeDoctors.com and tell the IT and government folks what's up. And check out http://zdoggmd.com for lyrics, behind-the-scenes dopeness, and all our other videos. Please SHARE...or the machines win. Credits: The legendary Devin Moore of Rabbit!

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Promoting Interoperability Programs | CMS

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The Centers for Medicare & Medicaid Services (CMS) EHR Incentive Program-also known as Meaningful Use or MU-initially provided incentives to accelerate the adoption of electronic health records (EHRs) to meet program requirements.

Now, physicians who fail to participate in MU will receive a penalty in the form of reduced Medicare reimbursements. Physicians must use certified electronic health records technology (CEHRT) and demonstrate meaningful use through an attestation process at the end of each MU reporting period to avoid the penalty.

The AMA is encouraging all physicians subject to the 2015 Medicare MU program to apply for a hardship exception. CMS has stated that it will broadly accept hardship exemptions because of the delayed publication of the program regulations. Applying for the hardship will not prevent a physician from earning an incentive. Applications for physicians are due July 1, 2016.

CMS developed a program that requires physicians using CEHRT to capture, exchange and report specific clinical data and quality measures. The program, which began in 2011, evolved over the course of 3 stages:

Stage 1 established the base requirements for electronic capturing of clinical data.

Stage 2 encouraged the use of EHRs for increased exchange of information and continuous quality improvement at the point of care.

Modified Stage 2, released in October 2015, consolidated Stages 1 and 2 into a new program. These are the current requirements all physicians should follow. While some changes were made to reduce the complexity of the measures, many of the objectives were carried over from Stage 2.

Summary of 2015-2017 Meaningful Use (MU) Final Rule (PDF) (members only)

The requirements for Stage 3 have been published by CMS. Starting in 2018, all eligible physicians will be required to participate in Stage 3.

Summary of the Meaningful Use Stage 3 and 2015 certification rules requirements (PDF) (members only)

MU will eventually become part of the Medicare Merit-based Incentive Program.
Understanding Medicare's Merit-based Incentive Payment System (MIPS)
Physicians participating in MU for the first time in 2016 will not qualify for any MU incentive payments but will be subject to a penalty if they do not participate.

All physicians participating in MU in 2016 must demonstrate the 10 new Modified Stage 2 requirements.

Modified Stage 2 requirements (PDF)

CMS has developed a webpage on 2016 Program Requirements with detailed and downloadable lists of each requirement.
CMS 2016 program requirements
CMS has also posted their presentations on Modified Stage 2 and Stage 3 requirements from the HIMSS 2016 Annual Conference.
CMS presentations on Modified Stage 2 and Stage 3 requirements
To help physicians meet MU requirements, the AMA compiled tip sheets on some of the more complex measures.

Patient view, download and transmittal of health information (PDF) (members only)

Transition and summary of care (PDF) (members only)

Security Risk Analysis (PDF) (members only)

Part of participating in MU involves using technology certified by the U.S. Department of Health and Human Services (HHS). Certified technology includes both complete EHR systems and individual modules. Physicians can either purchase a comprehensive certified package from a single vendor or certified components from different vendors.

Physicians should ask their vendor about certification plans if they are unclear whether their EHR technology or module(s) are certified for use in the incentive program. Physicians can verify whether the equipment is certified at the Office of the National Coordinator for Health IT's (ONC) website.
Office of the National Coordinator for Health IT's (ONC)
For additional information about 2015 EHR certification criteria see ONC's final certification rule.
2015 EHR Final Certification Rule
Together with the AMA, AmericanEHR Partners provides the ability for a physician to rate or comment on EHR systems. There are also message boards that facilitate group discussion and allow users to refine their search for product information by using criteria that are most relevant to them, such as practice size and specialty.
AmericanEHR Partners
All ratings and discussion topics come from verified members who must register with AmericanEHR Partners and are compared against a physician master file, ensuring real users are discussing and rating real products.

Usability is the capacity for an individual to learn and easily use an object. Both utility (how well a system handles the work a user must do) and ease-of-use are factors in usability.

The AMA strongly believes that EHR technology should:

Facilitate a physician's practice

Improve patient care

Enhance care coordination, practice efficiencies and processes

Support decision-making, not circumvent the need for critical thinking

To improve patient care, EHRs and other health technology must work well for the people who use them. Unfortunately, the swift implementation of EHR technology compelled physicians to purchase tools not yet optimized for patients or doctors. As a result, EHR technology can often impede efficient care by making it difficult to find or understand what clinicians need. Sometimes the technology may be challenging to use effectively, efficiently and safely.

The AMA believes that the addition of user-centered design (UCD) in the development of EHR products can improve usability and increase physician satisfaction with EHRs. This process focuses on analyzing and incorporating user requirements from the beginning of the development cycle. The AMA continues to work with key EHR-industry stakeholders and advocate that ONC include robust UCD when certifying technology.
Federal and State Correspondence Finder
However, EHR design is also heavily influenced by the federal requirements for MU and certification. While there are federal requirements on EHR usability, the design priority of EHR vendors continues to be meeting MU objectives, not the needs of physicians and patients. To help elevate this concern, the AMA worked with MedStar Health to identify issues with EHR certification and the incorporation of better UCD principles in the design of health IT products.

AMA and MedStar Health partner to drive improvements in EHR usability

As part of both HIPAA and MU requirements, physicians must conduct or review a security risk analysis at least once during each program year. A practice's size, complexity, capabilities, risk and cost are used to determine the proper methodology to meet this requirement. Conducting this analysis can provide insight into the vulnerabilities in a practice's heaIth IT. It is important to note that a health IT system is typically larger than just EHR.

The first step in protecting a practice and patients' health information from cyber attacks is evaluating a system's security. The rules for a risk analysis are not prescriptive; a number of different tactics can achieve compliance. The AMA has several free resources in the AMA Education Center for AMA PRA Category 1 Credit™ to help physicians build tailored compliance processes.

Additionally, the HHS has materials to help small-to-medium-sized practices become compliant, HHS EHR contracts: Key contract terms for users to understand. (PDF)

The AMA continues to advocate for making the MU program more workable for physicians by asking CMS to establish more reasonable reporting requirements, measurement thresholds and overall flexibility so that all physicians who want to participate are able to do so. Below are links to the most recent comments and letters to the administration and Congress.

As a result of significant AMA advocacy, CMS made several changes to the Stage 2 requirements, reducing the number of overall requirements and including exceptions to certain measures.

Following years of advocacy by the AMA, the CMS has removed the computerized physician order entry (CPOE) and clinical decision support (CDS) measures from the Medicare MU program and the ACI component of the Quality Payment Program (QPP). However, the Medicaid MU program continues to include CPOE and CDS measures.

While CPOE and CDS functionality will still be included in EHRs, CMS will no longer require a certain number of orders, that a physician enter the orders, and that physicians implement a certain number of CDS tools. This means that as of Jan. 1, 2017, physician practices are free to develop policies around CPOE and CDS in ways that blend with their workflows and improve care.

AMA letters

What to do if you are audited

The AMA has received a number of complaints and concerns associated with physicians undergoing an MU audit (currently 5 to 10% of eligible professionals) and is working to improve this process. Physicians should communicate any issues to the MU audit contractor:

Peter Figliozzi Figliozzi & Company, CPAs P.C. 585 Stewart Avenue Suite 416 Garden City, New York 11530[email protected] (516) 745-6400 ext. 302

The biggest issue physicians have faced in an audit was demonstrating the "yes/no" requirements that call for attestation proving the security risk analysis was successfully met. To help with the process, CMS posted information online and provided the following:

Related Links

CMS has an informal appeals process for those denied an EHR incentive payment, determined to be ineligible for the program, or given an unfavorable audit decision. Physicians looking to appeal an adverse decision should contact their state Medicaid Agency for information about filing an appeal. Under the CMS appeals process, physicians must file a claim and submit necessary documentation by the following deadlines:

Failed Audit Meaningful Use: 30 days from the date of the adverse audit determination letter

Failed Reporting Meaningful Use: March 31

Eligibility: March 31

All appeal decisions are final. More information on the MU appeals process can be found on the CMS website.

CMS appeals - If you have been denied an EHR incentive payment, you can appeal the decision.

The HHS Office of the Inspector General (OIG) and CMS published companion rules that allow physicians to accept donations of almost free EHR technology (must pay at least 15% of the cost of the technology) from certain health care entities without violating Stark and anti-kickback rules.

HHS Office of the Inspector General (OIG) - Exception for certain electronic health records arrangements (PDF)

CMS published companion rules - EHR safe harbor under the Anti-Kickback Statute; final rule (PDF)

The exception/safe harbor was scheduled to end on Dec. 31, 2013, but due to AMA advocacy, HHS extended the time through 2021. While the AMA pushed for a permanent exception, the extension brings welcomed relief for physicians continuing to struggle with the high cost of implementing EHR technology. The rules also made several other notable changes:

Excluded labs from the types of entities that may donate EHR technology

Updated the definition of what type of software is considered interoperable for the purposes of donations

Clarified the requirement prohibiting any action that limits or restricts the use, compatibility or interoperability of donated items or services

Removed from the exception the requirement related to electronic prescribing capability

HHS accepted the argument that labs should be removed from the types of entities permitted to donate EHRs to physicians due to concerns that the items could be used to secure inappropriate referrals. However, the AMA advocated that a preferable approach is one focused more on the need for better education around the limits of the safe harbor and exception for EHR donations.

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Meaningful Use: Electronic Health Record (EHR) incentive programs

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Get more information on the incentives Medicare and Medicaid provide for medical practices to adopt new records, billing and practice management procedures.

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Electronic Health Records and Meaningful Use

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Meaningful Use - A Patient's Perspective

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A funny video about healthcare reform and the government's meaningful use program

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Developing Understanding using the DIKW Pyramid

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How to turn data, information, knowledge into insight and wisdom

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I loved this video. I find it both fascinating and frightening; I disagree with the speaker about how our health data is less personal than our email. (What?? I think health data is very personal--and I'm glad we have HIPPA in this country).

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How Big Data Could Transform The Health Care Industry

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Interoperability Standards -- from the American Health Information Management Association

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Interoperability Standards -- from the American Health Information Management Association

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By Michael Glickman, MSE, and Anna Orlova, PhD

Anyone who has ever developed a standard knows well the many challenges that must be surmounted. Once a standard is published, however, it's not the end but in many respects only the beginning. Moving standards from specification to practice requires an equivalent if not greater effort, as does ensuring that standards are not stuck at a point in time but are "living" and are periodically updated to reflect experience from users as well as advances in the state-of-the-art health information and communication technology. More importantly, individual standards have to work together to enable information sharing and interoperability across various health information and communication technology (HICT) products.

The result of 16 years of standards development has led the International Organization of Standardization (ISO) Technical Committee 215, Health Informatics (ISO/TC 215) to the practical realization that a "bundle" of individual standards is required to create interoperable health information technology (health IT) standards that will ensure both adoption and sustainability.

Building Interoperability Standards

A bundle of individual standards that work together to enable interoperability represents a high-level standard specification-an assembly of individual standards that move information from sender to receiver. Interoperability standards are harmonized and intergrated individual standards constrained to meet healthcare and business needs for sharing information among organizations and systems for a specific scenario (use case) of health information exchanges.

According to the Health Level Seven (HL7) definition, interoperability is comprised of the following three components (pillars):

1. Semantic interoperability-shared content

2. Technical interoperability-shared information exchange infrastructure (transport)

3. Functional interoperability-shared rules of information exchanges (i.e., business rules and information governance (IG), "the rules of the road")

Thus, the interoperability standard-a bundle or assembly of individual standards-has to include individual standards from these three components of interoperability. The concept of "a bundle" of individual standards working together was first introduced by the Health Information Technology Standards Panel (HITSP, www.hitsp.org) in 2005. HITSP operated as a public and private collaborative supported through a contract from the Office of the National Coordinator for Health IT (ONC) to the American National Standards Institute (ANSI). The HITSP bundle was formally called "Interoperability Specification (IS)." Between 2005 and 2009, HITSP developed 19 ISs for various national use cases including Electronic Health Record (EHR) Laboratory Result Reporting (IS 01), Biosurveillance (IS 02), Consumer Empowerment (IS 03), Quality (IS 06), and Consultation and Transfer of Care (IS 09), among many others.

HITSP IS included specific individual standards grouped by the following categories:

Semantic Interoperability

Data Standards (vocabularies and terminology standards)

Information Standards (reference information models, information templates, and other)

Technical Interoperability

Information Exchange Standards (message-based and document-based)

Identifier Standards

Privacy and Security Standards

Functional Interoperability

Functional Standards (requirements for health information and communication technology derived from the analysis of the use case)

Business Processes Standards (guidelines and best practices described in the use cases)

<
Figure 1: Number of Individual Standards Included in the
HITSP Biosurveillance IS 02

Standard Category

Number of Standards

Semantic Interoperability (Content)

Technical Interoperability (Transport)

Functional Interoperability (Rules)

Business Processes Standards
(guidelines, best practices, use cases)

1

Total

109

For example, HITSP Biosurveillance IS 02 included 110 individual standards (see Figure 1).1 This assembly of standards supported a charge formulated in the National Biosurveillance Use Case of transmiting "essential data from electronically enabled healthcare to authorized public health agencies in real-time."

Essential data included 40 data elements defined by the Centers for Disease Control and Prevention (CDC). Biosurveillance use case was the first of the three national use cases developed for HITSP by the American Health Information Community (AHIC)-an ONC advisory committee that identified priorities for health IT interoperability and developed national use cases. The first three use cases included biosurveillance, EHR laboratory result reporting, and consumer empowerment. A total of 152 national use cases were developed by AHIC between 2005 and 2009. These use cases served as business requirements for the HITSP interoperability specifications.

Built upon the HITSP methodology, ISO/TC 215 decided to move forward with developing interoperability standards. The working title for the ISO "bundle" is "Standards Reference Portfolio (RSP)." The first domain selected for developing ISO RSP is clinical imaging. The work has been conducted in collaboration between ISO/TC 215 and DICOM, a standards development organization.2

ISO RSP includes standards for content and payload (semantic interoperability), transport (technical interoperability), and rules (functional interoperability) (i.e., standards for information governance and information management practices-which are strategic AHIMA imperatives).3,4,5,6

Critical constituents of the RSP bundle's functional interoperability standards include standards that enable data capture (information availability), data quality validation (data integrity), data protection (capture of patient consent for healthcare procedure as well as information sharing; protection of privacy, confidentiality, and security of information), and other standards for information governance principles in healthcare defined by AHIMA.7

ISO RSP also defines conformance criteria, which are statements that specify how various individual standards should work together. These criteria will be used by vendors to test RSP and to deploy standards into their products. They also will be used in HICT certification processes, so users know that the product is compliant with the interoperability standard.

Maintenance is important to keep RSP up-to-date. In order to ensure that standards remain relevant ISO has developed directives that govern all ISO standards. One of these is the compulsory five-year systematic review when standards developers employ a systematic review process to determine whether a standard is (a) still relevant and in use, (b) is no longer needed and should be retired, or (c) is in use but should be revised to ensure its continued value to the industry. Adoption and continuing feedback from the users regarding the standards-based capabilities allows them to keep the standard updated to meet user needs.

Figure 2 below presents the interoperability standard framework with various RSP components and enablers.

Figure 2: Interoperability Standard Framework: Components and Enablers

Ensuring Patient Safety through Interoperability Standards

One of the keys of health IT adoption is enabling patient safety while using the means of standards-based health information and communication technology. Specific aspects of ensuring health technology safety through standardization is specified in the ISO/IEC 80001 standard published in 2010.8 It was up for a systematic review in 2015. This standard was born out of the recognition that networked medical devices are increasingly being deployed on general purpose IT infrastructure. Though the manufacturers have to rigorously apply risk management to identify and manage potential safety issues and receive regulatory clearance to place their technology on the market, once the product is purchased, implemented, and placed in use, risk management processes are rarely applied to the resulting network of integrated devices, health information and communication technology systems, and applications. Unintended consequences that compromise patient safety had been occurring far too frequently and overall confidence in the technology had been suffering accordingly.

Specific safety risks associated with non-interoperability of health IT products include:

Data quality, misidentification and integration of patient data from multiple sources (record matching on a patient represents a critical record management step, so that the information from one patient cannot be added to the chart of another patient)

Data accuracy, availability, and integrity issues due to configuration, security, or IT operations failures

Decision support failures due to incorrect or outdated medical logic, reference data, algorithms or alert triggers

Failures and inconsistencies in delivery, integration, or presentation of diagnostic information results

Failures and inconsistencies in delivery, integration or presentation of therapy information (such as radiotherapy information)

Insufficient attention to workflow, human factors, change management, or training of clinicians

Privacy breaches, data governance issues, or other causes that erode provider and consumer confidence

The risk management for health information and communication technology can be formulated in four questions:

1. What can go wrong?

2. How can it happen?

3. What can be done about it?

4. How do we know we have done enough?

The ISO/IEC 80001 standard evaluated under the ISO systematic review process demonstrated that:

Yes, the ISO/IEC 80001 standard remains highly relevant, even more so given the increasingly complex health IT environments and the increased integration of medical devices and various health IT products

No, ISO/IEC 80001 standard has not been widely implemented; as much as ever, it is widely recognized as a key component of addressing safety and security when interoperable technology is deployed

Yes, the state-of-the-art health information and communication technology has been advanced

Yes, much has been learned about what is needed to ensure the safe use of information in healthcare

There is a need for new understanding of medical device safety, and of the safety of any collection of objects running software and being connected, such as the Internet of Things, in the context of a specific use or use case.

ISO/TC 215 Health Software Ad Hoc Group looked at the broader issue of health software safety standards to admit that "while our initial focus was on health software, we have recognized that the architecture of health software safety standards must also address the safety of the broader health IT system, and the socio-technical environment of which health software is a component."

This "environment" includes not only the information technology (i.e., hardware, software, networks, interfaces to other systems and data), but also the:

People (i.e., clinicians, patients, consumers, caregivers, administrators)

Care processes (i.e., clinical workflow, decision algorithms and care protocols)

Organization (i.e., capacity, governance, configuration decisions about how health IT is applied)

External environment (i.e., regulations, public opinion, ambient conditions)

The group further focused on defining end-to-end safety management strategy, leveraging standards in areas such as risk, quality, security, IT lifecycle, information governance, etc., and identifying gaps that need to be filled. The report finalized during spring 2015 identified the technology lifecycle over which safety must be established and maintained. Eight key topics are integral to achieving health information and communication technology safety. Grouped under the three categories-people, technology, and policies-they include:

People

1. Organization's culture, roles, and competencies

2. Human factors, usability, and change management

Technology

1. Systems and software lifecycle processes

2. Safety management processes across software lifecycle

Policies

1. IT and information governance

2. Risk management

3. Quality management

4. Information privacy and security management

The ISO/IEC 80001 standard is an example of a standard that will be included in the ISO/TC 215 RSP (bundle) to ensure that standards included in the RSP properly address risks associated with semantic, technical, and functional components of interoperability.

Notes

1. Health Information Technology Standardization Panel (HITSP). "Biosurveillance Interoperability Specification (IS) Number 02." 2009.

2. Digital Imaging and Communication in Medicine (DICOM).

3. Tech Terms. "Payload definition."

4. Cohasset Associates and AHIMA. "A Call to Adopt Information Governance Practices: 2014 Information Governance in Healthcare." 2014.

5. Cohasset Associates and AHIMA. "Professional Readiness and Opportunity: 2015 Information Governance in Healthcare." 2015.

6. AHIMA. "A Call to Adopt Information Governance... ."

7. Ibid.

8. International Organization for Standardization (ISO) and International Electrotechnical Commission (IEC). "ISO/IEC 80001-1:2010. Application of risk management for IT-networks incorporating medical devices-Part 1: Roles, responsibilities and activities." October 1, 2010.

Michael L. Glickman ( MGlickman@CNAInc.com) is CEO of Computer Network Architects and chair of ISO/TC 215 Health Informatics. Anna Orlova ( anna.orlova@ahima.org) is senior director for standards at AHIMA and an ISO/TC 215 member.

Article citation:
Glickman, Michael; Orlova, Anna. "Building Interoperability Standards and Ensuring Patient Safety" Journal of AHIMA 86, no.11 (November 2015): 48-51.

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Building Interoperability Standards and Ensuring Patient Safety

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By Michael Glickman, MSE, and Anna Orlova, PhD Anyone who has ever developed a standard knows well the many challenges that must be surmounted. Once a standard is published, however, it's not the end but in many respects only the beginning.

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A very helpful snapshot

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The work promoting the adoption and uptake of health information technology is key to ensuring the goals of the HITECH Act of 2009. Work being done to ensure the technical standards and specifications are in place to support this technology is also critical to the development and success of a fully functional nationwide health IT ecosystem.

As with the technology that people use everyday - telephone, email, Internet, mobile technology - interoperable health information exchange is not a "one-size-fits-all" solution. Different providers will have different uses, and the standards and specifications supporting those needs are being developed and harmonized within ONC's Office of Science & Technology (OST).
ONC is working to standardize the following, fundamental building blocks of interoperability:

Health care vocabularies

Structures as specified by HL7

Transport, using secure email protocols

Security, through the use of NIST-adopted encryption standards

Services, with open and accessible APIs

ONC is working to enable the health IT community to convene and rapidly prioritize health IT challenges and subsequently develop and harmonize standards, specifications and implementation guidance to solve those challenges. ONC is also responsible for curating the set of standards and specifications that support interoperability and ensuring that they can be assembled into solutions for a variety of health information exchange scenarios.

For more information about ONC's work in standards development and harmonization, please visit www.healthit.gov/techlab.

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Standards & Interoperability (S&I) Framework

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The work promoting the adoption and uptake of health information technology is key to ensuring the goals of the HITECH Act of 2009. Work being done to ensure the technical standards and specifications are in place to support this technology is also critical to the development and success of a fully functional nationwide health IT ecosystem.

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Key Stake Holders responsible for Informatics Competencies

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Key Stake Holders responsible for Informatics Competencies

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TIGER International Task Force

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An Initiative for Technology and Health Informatics Education

The Technology Informatics Guiding Education Reform (TIGER) initiative from HIMSS provides the global health workforce with innovative informatics/eHealth tools and resources to transform health for all.

The global TIGER network collaborates to integrate informatics/eHealth into healthcare education, certification, practice and research through an inclusive, interdisciplinary, intergenerational approach.

Education Reform

We create an environment that maximizes the possibilities of technology toward knowledge development and dissemination, driving rapid implementation of best practices as well as competency and curriculum development.

Interprofessional Community Development and Growth

We actively engage and collaborate with the global healthcare workforce, students and adult learners to encourage standardized, person-centered and technology-enabled processes to facilitate teamwork and relationships across the continuum of care worldwide.

Global Workforce Development

We foster a respectful learning community of diverse stakeholders that embrace shared values to drive innovation and technology around the world.

Global Recommendations

While informatics recommendations on competencies and education support the design of curricula and courses, they are unable to inform educators on how to customize content for local needs and requirements. That's why the TIGER International Competency Synthesis Project (ICSP) and the EU*US eHealth Work Project came together to describe and validate the TIGER initiative's framework of global informatics core competencies for health professionals.

Together, these projects compiled a recommendation framework of health informatics competencies (v2.0) to measure, inform, educate and advance development of a skilled workforce throughout the EU and U.S. and around the world. Although the EU*US eHealth Work Project has ended, we are compiling global case studies to continue bringing our findings to life, with a focus on all states within the EU.
Hear TIGER International Task Force Former Co-Chairs Ursula Hübner, PhD, professor, University of Applied Sciences Osnabrück, Germany, and Beth L. Elias, PhD, MS, FHIMSS, adjunct faculty, Panuska College of Professional Studies, University of Scranton, present these important project findings at the HIMSS19 Global Health Conference.
TIGER International Task Force

The TIGER International Task Force, seated under the HIMSS Professional Development Committee, provides our global community of 34 countries with knowledge, leadership and guidance in its efforts to reform technology and informatics education. It provides domain expertise through activities, projects and collaborations within the interprofessional community to support faculty, students, adult learners and providers.

TIGER Resources

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The Technology Informatics Guiding Education Reform (TIGER) initiative offers tools and resources for learners to advance their technology and health informatics skills and for educators to develop valuable curricula.

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Key Stake Holders responsible for Informatics Competencies

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Key Stake Holders responsible for Informatics Competencies

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This is an excellent PDF presentation from the AACN toolkit

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Key Stake Holders responsible for Informatics Competencies:

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Key Stake Holders responsible for Informatics Competencies:

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OVERVIEW

The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work.

Using the Institute of Medicine competencies, QSEN faculty, a National Advisory Board, and 17 representatives from 11 professional organizations representing advanced nursing practice defined quality and safety competencies for nursing and proposed targets for the knowledge, skills, and attitudes to be developed in nursing graduate programs for each competency. These definitions are shared in the six tables below as a resource to serve as guides to curricular development for formal academic graduate programs and for use as criteria for certification and continuing education of advanced practice nurses .

For information on applying the competencies at a prelicensure level, see the Prelicensure KSAs page.

Note: This content is reprinted with permission from the " Quality and Safety Education for Nurses" article originally printed in Nursing Outlook Special Issue: Quality and Safety Education. For guidelines on use of this material, please read our terms and conditions.

DEFINITIONS AND GRADUATE KSAS

REFERENCES

¹ Institute of Medicine. Health professions education: A bridge to quality. Washington DC: National Academies Press; 2003.

² Cronenwett, L., Sherwood, G., Pohl, J., Barnsteiner, J., Moore, S., Sullivan, D., Ward, D., Warren, J. (2009). Quality and safety education for advanced nursing practice. Nursing Outlook 57(6), 338-348.

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The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work.

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Key takeaway for week 1 is from the link provided by Professor Kuiper. This helps me to understand how HIT intersects with a clinical FNP's career.

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Key takeaway for week 1 is from the link provided by Professor Kuiper. This helps me to understand how HIT intersects with a clinical FNP's career.

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1. Informatics and healthcare technologies encompass five broad areas:

Use of patient care and other technologies to deliver and enhance care;

Communication technologies to integrate and coordinate care;

Data management to analyze and improve outcomes of care;

Health information management for evidence-based care and health education; and

• Facilitation and use of electronic health records to improve patient care.

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Health Information Technology in California