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Health Information Privacy Law and Policy

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Health Information Privacy Law and Policy

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What Type of Patient Choice Exists Under HIPAA?

Most health care providers must follow the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (Privacy Rule), a federal privacy law that sets a baseline of protection for certain individually identifiable health information ("health information").

The Privacy Rule generally permits, but does not require, covered health care providers to give patients the choice as to whether their health information may be disclosed to others for certain key purposes. These key purposes include treatment, payment, and health care operations.

How Can Patient Choice Be Implemented in Electronic Health Information Exchange (eHIE)?

While it is not required, health care providers may decide to offer patients a choice as to whether their health information may be exchanged electronically, either directly or through a Health Information Exchange Organization (HIE). That is, they may offer an "opt-in" or "opt-out" policy [PDF - 713 KB] or a combination.

Are There Specific Legal Requirements for Opt-In or Opt-Out Policies?

The U.S. Department of Health and Human Services (HHS) does not set out specific steps or requirements for obtaining a patient's choice whether to participate in eHIE. However, adequately informing patients of these new models for exchange and giving them the choice whether to participate is one means of ensuring that patients trust these systems. Providers are therefore encouraged to enable patients to make a "meaningful" consent choice rather than an uninformed one.

You can read more about patient choice and eHIE in guidance released by the Office for Civil Rights (OCR): The HIPAA Privacy Rule and Electronic Health Information Exchange in a Networked Environment [PDF - 164KB].

Are There Privacy Laws that Require Patient Consent?

Yes. There are some federal and state privacy laws (e.g., 42 CFR Part 2, Title 10) that require health care providers to obtain patients' written consent before they disclose their health information to other people and organizations, even for treatment. Many of these privacy laws protect information that is related to health conditions considered "sensitive" by most people.

How Does HIPAA Affect These Other Privacy Laws?

HIPAA created a baseline of privacy protection. It overrides (or "preempts") other privacy laws that are less protective. But HIPAA leaves in effect other laws that are more privacy-protective. Under this legal framework, health care providers and other implementers must continue to follow other applicable federal and state laws that require obtaining patients' consent before disclosing their health information.

The resources listed below provide links to some federal, state, and organization resources that may be of interest for those setting up eHIE policies in consultation with legal counsel. Implementers may also want to visit their state's law and policy sites for additional information.

Federal, State, and Organization Resources about Consent, Personal Choice, and Confidentiality

We encourage providers, HIEs, and other health IT implementers to seek expert advice when evaluating these resources, as privacy laws and policies continually evolve. The resources are not intended to serve as legal advice or offer recommendations based on an implementer's specific circumstances.

Federal Law, Regulation, Guidance, and Policy

Health Information in General Sensitive Health Information (e.g., behavioral health information, HIV/AIDS status)Policy Federal Advisory Committee (FACA) Recommendations

State Law

Organizational Policy and Procedures

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Health Information Privacy Law and Policy

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What Type of Patient Choice Exists Under HIPAA? Most health care providers must follow the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (Privacy Rule), a federal privacy law that sets a baseline of protection for certain individually identifiable health information ("health information").

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The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Abstract

Contemporary bioethics was fledged and is sustained by challenges posed by new technologies. These technologies have affected many lives. Yet health informatics affects more lives than any of them. The challenges include the development and the appropriate uses and users of machine learning software, the balancing of privacy rights against the needs of public health and clinical practice in a time of Big Data analytics, whether and how to use this technology, and the role of ethics and standards in health policy. Historical antecedents in statistics and evidence-based practice foreshadow some of the difficulties now faced, but the scope and scale of these challenges requires that ethics, too, be brought to scale in parallel, especially given the size of contemporary data sets and the processing power of new computers. Fortunately, applied ethics affords a variety of tools to help identify and rank applicable values, support best practices, and contribute to standards. The bioethics community can in partnership with the informatics community arrive at policies that promote the health sciences while reaffirming the many and varied rights that patients expect will be honored.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

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national center for biotechnology information

# data[].attributes.attachment_link.description
Contemporary bioethics was fledged and is sustained by challenges posed by new technologies. These technologies have affected many lives. Yet health informatics affects more lives than any of them. The challenges include the development and the appropriate uses and users of machine learning software ...

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-Grabs interest
-Quickly see trends and outliers
-Easy to share information
-Visualize patterns and relationships

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Data visualization is the representation of data through use of common graphics, such as charts, plots, infographics and even animations.

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Your comments and likes are up month over month, and your new campaign hashtag has been used over 1,000 times, but what do those numbers mean? And, once you figure that out, how do you convey it to stakeholders? If you're asking these questions, you're not alone.

According to The Sprout Social Index™, brands' top use cases for social data include sales strategy, product development and content strategy. But without the right context, social and bottom-line business metrics exist in a state of disconnect. To bridge this gap, we need stories.

What is data storytelling?

Data storytelling is the art of translating raw data into a holistic narrative that describes the impact data has on an organization. It merges data science, graphic visualization and storytelling by providing necessary context.

As a social expert, you already have storytelling skills. Let's talk about how to incorporate them into your approach to reporting and analysis.

Where is the value in the data?

In order to earn buy-in from executive stakeholders, you need to weed out and highlight the value in the data, both quantitatively and qualitatively.

Quantitative data storytelling

In social media, quantitative data refers to the numbers behind social media metrics such as engagement, awareness, share of voice, ROI and customer care. These numbers focus on the "how many" of social media, as in how many:

new likes, comments or shares your content received

impressions you're achieving

posts you're mentioned or tagged in comparison to competitors

purchases driven by a social media referral

comments and questions about your brand that your team responds to

These are just a few examples of performance metrics. But, numbers can be deceiving. One viral post or brand crisis can skyrocket your numbers for a month (for better or worse), which could set unrealistic expectations for key performance indicators (KPIs) like impressions or engagements, if you don't put the data in context.

Bad data presenting: "Here are all my numbers. I'm very clever. Got it?"

Good data presenting: "Here's the story my numbers tell and THIS is why you should care about it".

Data storytelling is the difference between audience action and audience confusion.

- Tessa Davis (@TessaRDavis) November 23, 2022

Quantitative data storytelling

Comparing data month-over-month or year-over-year is meaningless without the story behind the trends. Plus increases and decreases aren't always black and white. For example, maybe your comments are way up this week. Sounds awesome, right? Not exactly. If they're mostly positive, that's great. If they're mostly negative, that's a problem.

There needs to be an explanation for changes over time. This is where qualitative data comes in. Think of your quantitative data as the plot of your story, and your qualitative data as the juicy details that help set the scene.

In other words, qualitative data gives context. Your interpretation of what it all means gives both types of data a narrative. If influencers are posting about you, what are they saying? Are mentions raving about your products, or are they pointing out a serious customer service issue? If comment threads are accumulating, what's driving the discussion, and what's the overall sentiment?

Use social listening tools to analyze trends in discussions about your brand, which can be particularly helpful if you're seeing a major spike. This can show you what people are talking about, sentiment, keywords and trending topics.

But even without social listening tools, you can look at your results and start to dig into the "why." Look at individual messages to identify what people mentioning you are talking about the most, what they're saying and so forth. Those specific examples will help you craft a report that puts your numbers in context, and allows you to identify future opportunities. This is where your story begins to develop.

Delivering analytics and metrics: Why is it important?

Executives and other stakeholders like quantitative data because it reflects how social impact's the brand's bottom line. They especially enjoy seeing a translation of social media numbers into revenue dollars, or growth in metrics that correlate with an increase in conversions. Although they might want to see quantitative data first, qualitative data is just as essential to telling your story.

Data doesn't exist in a factorless vacuum. Remember that qualitative data provides potential influencing factors that are likely contributing to performance metrics. Plus qualitative data can support persuasiveness. For example, seeing concrete examples, such as screenshots of @-mentions or positive comments can make your points stick.

A balanced combination of qualitative and quantitative data is what separates dry data from an enlightening data story that leads to executive buy-in and actionable strategy.

Using data driven storytelling can help you develop credibility because you're simplifying complex information into digestible key points and action items.

Without data storytelling, businesses are unlikely to have the 'a-ha' moments they need and want. Critical information may be lost and - importantly - data not encased in story form may not inspire action and change. #data #storytelling pic.twitter.com/VLehy4UZ1G

- DINMA 🦋 (@DINMA_GURL) November 27, 2022

Steps towards effective data storytelling

To ensure your data story demonstrates value, follow these steps before diving into creating your presentation:

Define your hypothesis. What do you think the data will tell you? What do you want to prove or disprove? Is there a trend or pattern you think will continue?

Collect the data. Gather all the data you need to shape your story.

Give purpose to your story. After reviewing and analyzing your data, summarize the goal of your story in one to two sentences. What is the data telling you and what story can you communicate?

Plan what you want to say. Outline everything you want to say in your presentation, including your intro, major data points and conclusion.

Ask questions. Does the data prove or disprove your hypothesis? Did you discover anything new that shapes your narrative? Your audience will likely have questions too so this is a good exercise to prepare.

Identify a goal for your audience. What would you like your audience to do after hearing or reading your story?

While there are creative writing workshops abound, few cover the artistry behind presenting numbers in an elegant, comprehensible way. If you're not sure where to begin, here's a step-by-step guide with a data storytelling example:

1. Identify the most interesting points

If you have a large data set(s), it can be overwhelming at first. Put on your author cap and ideate the structure of your data story.

You should already have a main objective in mind, whether it's relaying campaign status or justifying a bigger budget. What pieces of quantitative and qualitative data best support the main idea you want to convey? What data points directly contradict what you thought was going to happen? Perhaps the amount of website traffic driven by social has risen in conjunction with sales.

Even if you aren't using UTM tracking to map your social efforts all the way through to purchase, understanding which content drives traffic (and what kind doesn't) will provide some insight into what's fueling the fire.

2. Lead with your second most interesting piece of data

You don't want to show your whole hand, but you do want to demand attention right at the beginning. For instance you might say something like, "As you already know, sales are up this quarter. What you may not have seen is that this trend correlates with our increase in traffic from social." Include any other interesting points after this, but don't use your best one yet.

3. Leverage visual aids as you present

Lean on data visualization to drive home your points. "As you may already know, sales are up this quarter," (graph of this quarter's sales appears). "What you may not have seen is that this trend correlates with our increase in social media traffic," (the second graph of traffic by social platform appears as an overlay to the first graph). Accompanying your story with visuals would drive the impact of your data in this scenario.

4. Predict questions or challenges

Naturally, your audience will analyze what they are seeing. In the example we've used so far, they may ask something like, "How do we know sales are up because social traffic is up, and not the other way around?" Depending on whether you're presenting data to a group live or emailing a written report, incorporate slides or bullet points that answer the questions you expect your audience to ask. These questions are good: They keep your audience engaged long enough to deliver your grand finale data insight.

5. Share the most interesting piece last

Leave your audience with takeaways they will remember by sharing your most interesting piece of data last. For instance, you could say, "We considered that correlation might not indicate causation, so we dug a little deeper and looked at the shares, social referrals and conversions. We were able to trace 33% of our new customers this quarter to one particular influencer's post," (screenshot of post here) "in which she raved about how our product helped her. She has over 700,000 followers, many of whom also shared the post and clicked through to our site from it."

Notice how this example answers the question from the audience while providing both quantitative and qualitative data. This sweet spot is what will make your data story memorable and impactful.

6. Get to your next steps and the "so what"

Just because you've shared the data doesn't mean your analysis is done. Round out your presentation with why this matters to your overall social media and business goals. Then share how you will be using this data to inform new ideas moving forward. For example, because this one influencer post did so well, you're looking to partner with other influencers who have similar audiences.

Boom. Mic drop.

This flexible format can be repeated as needed and applied to just about any medium from presentations to reports and emails.

It is important to note the common data point threaded throughout this story: social traffic. Additional data points can help complement or emphasize your main point. Think of these related data points as significant moments in the running theme of your story. And your main data is your key plot point.

You may have lots of data to comb through to find the right points to cover. That's why the first step is picking out the most interesting ones. It's up to you to gather the data that best illustrates your main idea and use it to focus your audience on your key message. Here's how Lindsay Bruce, Marketing Manager at Twitter Business, approaches using data to both understand her target audience and create more impactful reports (serious reporting pro tip at 1:13).

Examples of effective storytelling with data

Get inspired with these data storytelling examples:

1. User Interviews

The State of User Research 2022 report by User Interviews uses plain language in the report copy and has informative illustrations throughout, along with a clickable table of contents to keep the audience engaged.

2. The Pudding

As a publication that specializes in data journalism, The Pudding is a master class in data driven storytelling. In How Artists Get Paid From Streaming, the Pudding breaks down the mechanics of the music industry and streaming platforms.

The story is scrollable, and as you maneuver down the page, animated data visualizations appear. Notice how the copy is short, simple and complements the graph to the right. Also note how the graph is colorful and vibrant, but isn't too distracting.

3. Sprout Social

I don't mean to toot our own horn, but Sprout has some excellent data storytelling as well. Our data reports, like the Creator Economy, feature digestible narratives and visual aids. Remember that your visuals don't have to be graphs and charts. You can use a graphic to emphasize a stand-out data point.

What to avoid when creating your data story

Social data in action is a beautiful thing, but there a few things to avoid when developing your data story:

Not considering your audience. Consider what information is the most relevant to your audience. If you show data that isn't valuable to them, your story will get lost.

Highlighting too many metrics. Again, consider your audience and what is the most important. Too many metrics can feel overwhelming.

Not using qualitative data to provide more context. Don't disserve your audience by leaving out necessary information that qualitative data provides.

Using data visualizations that are too distracting. Stick to simple, fresh visuals that are easy to interpret.

Omitting data visualizations altogether. Many people are visual learners, as visuals can make intaking information easier. Plus, graphics will make your presentation more engaging.

Using only text formatting. Avoid using text formatting (think: color, highlighting and font-weight) to emphasize key points.

Providing negative or lackluster results without context. Not every story has a happy ending, and that's okay. Instead provide more context or a solution to your audience.

The power of data visualizations

To tell a story with data, you need to show not just tell. Storytelling with data visualization can illustrate those findings. Data visualizations like graphs and charts synthesize complex data and make it easier to digest with a quick glance.

Social media networks offer native analytics tools that provide plenty of platform-specific data to work with. However, strong storytelling comes from a big picture view that takes all your social media marketing into account at once. Compiling that information takes a lot of work!

Fortunately, software like Sprout can alleviate the workload. Sprout pulls all of your metrics from various social media platforms into one place. It even provides presentation-ready reports and enables you to compare your metrics over time and to competitors.

When quantitative data is pulled together into one place, it leaves you with more time for strategic storytelling.

Sprout presents a bird's-eye view of what content is working, who is talking about your brand and the sentiment behind it. You can also uncover audience demographics, the best times to post and which platforms have the highest ROI.

Ready to get started? Sign up for a free trial and explore our data analytics and reporting features so you can write your brand's data story.

Rachael Samuels

Rachael is the Manager of Social Media at Sprout Social and was a mega Sprout fan and user prior to joining the team. Her main focus is to strategize and maintain our own social presence. Outside of work, Rachael is an avid squirrel enthusiast and massive meme-aholic!

Read all articles by Rachael Samuels

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Data storytelling: Adding meaning to metrics

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Your comments and likes are up month over month, and your new campaign hashtag has been used over 1,000 times, but what do those numbers mean? And, once you figure that out, how do you convey it to stakeholders? If you're asking these questions, you're not alone.

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Data analysis storytelling is a way to explain data by telling a story that people find interesting. First, you figure out what problem you want to solve. Then you look at the data and find patterns and trends. Finally, you use pictures and words to tell a story that helps people understand what the data means and what they can do about it.

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What is HIPAA? What do I Need to Know for HIPAA Compliance?

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Using AI in the healthcare setting to minimize alarm fatigue by customizing alerts to patient's physiology

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CalmWave harnesses the power of AI to analyze the health of a hospital's operations to improve nurse retention and patient outcomes.
, /PRNewswire/ -- CalmWave - the company leveraging artificial intelligence (AI) to bring operational health to hospitals - today announced the close of its oversubscribed $4 million seed round led by Bonfire Ventures with participation from Tau Ventures, AI2 Incubator, Seachange Ventures, Hike Ventures, and the co-founders of PagerDuty. CalmWave uses AI to gauge hospitals' Operations Health to improve nurse retention and patient outcomes by reducing alarm fatigue in intensive care units (ICUs).

"As the largest segment of the healthcare workforce, nurses are dramatically affected by false alarms and ICU noise. Nearly50% of nurses report suffering from burnout," said CalmWave CEO and Founder Ophir Ronen. "We envision a day where Operations Health is the definitive measure of performance for healthcare providers. We aim to provide an objective, repeatable, and comprehensive AI-powered analytical scoring system to improve hospital operations - starting with alarms - and improve the lives of patients, their caregivers, and providers."

Nearly 80% of alarms in ICUs are false positives. Combined with 12-hour work shifts, unbalanced nurse-to-patient ratios, and COVID-19's pressure on an already stressed healthcare system, nurses are nearly guaranteed to experience alarm fatigue and overall workplace exhaustion.

CalmWave's platform uses AI and expert services to help healthcare organizations optimize operations and make data-informed decisions. Utilizing a healthcare organization's data, CalmWave transparently empowers leadership to manage staff more efficiently, reduce turnover rates, and improve patient outcomes.

"As a practicing nurse, I've experienced the pressures and noise of working in the hospital. Alarm fatigue has become a hazard of the job, but it doesn't have to be," said Rachel Alesi, a nurse working at a major University Research Medical Center on the West Coast. "As hospitals struggle to respond and improve working conditions, CalmWave's platform fills that gap by providing actionable insights and direct engagement to improve care and help hospital staff."

"Nurses are leaving our healthcare system in droves-a critical problem for all of us-and alarm fatigue is a significant contributor to burnout. Nurses get triggered by small things like their microwave going off at home, and we can all do better. CalmWave is a major step forward," said Dr. Nick Mark at Swedish Hospital.

CalmWave's platform ingests data from all devices a patient is connected to and delivers customizable views for every clinician on the floor: individual patient views, summary views of patients across the ward, views of clustered patient alarms (incidents), and more. Calmwave "Operations Health Scores" describe each nurse's workload and well-being based on factors such as alarm volume, response times, patient length of stay, and nurse-to-patient ratio.

Additional CalmWave platform features include:

Smart Alarms to intelligently group alarms into "incidents" based on alert buffering, false alarm probability indicators, added inputs for medications, and early warning indicators

Device Thresholds customized to each patient's physiology & Alarm Monitoring to optimize devices for alarm reduction

Intelligent Patient Acuity to provide a comprehensive score of each patient's condition based on real-time insights

Staff Orchestration to optimize staff workloads based on patient acuity and alarm volume and to update scheduling for improved staff retention

Insights & Analytics to host all users - nurses, managers, administrators, IT, and executives - within an easy-to-navigate command center

Expert Services engagements built into the platform to provide assessment, training, consultation, and implementation

"Going from inception to seed funding in just five months is no small feat and is a testament to CalmWave's potential," said Bryan Hale at the AI2 Incubator. "CalmWave is a leading example of AI's power to implement positive change that will improve people's lives and in one of the most important industries serving communities and people across the world."

CalmWave is the fastest company to go from inception to funding at the AI2 Incubator, a pre-seed startup incubator partnered with theAllen Institute for AI. The impressive funding indicates that investors understand the critical, unmet need that CalmWave is addressing within the healthcare industry.

"With CalmWave, healthcare organizations now have the technology they need to prioritize staff wellbeing and retention by significantly reducing alarm fatigue," said Mark Mullen, co-founder at Bonfire Ventures. "CalmWave enables a future where unnecessary noise and alerts and their effects on staff and patient stress are the exceptions, not the rule.

CalmWave will leverage the funding for recruiting top talent, new marketing initiatives and continuing to create and launch innovative products to bring operations health to health care. To learn more about CalmWave, please visit https://calmwave.ai/.
About CalmWave:
CalmWave's primary objective is to support nurses and provide a crucial solution to their noisy and chaotic environments. The platform remediates alarm fatigue, improves staff retention, and transforms operations health through data science and AI. CalmWave takes inspiration from hard-won lessons learned in Enterprise IT to help the healthcare industry improve talent retention, reduce burnout and improve patient outcomes. CalmWave recently closed a $4M seed round and is on track to solve the healthcare industry's most significant pain points.

View original content: https://www.prnewswire.com/news-releases/calmwave-announces-4-million-to-reduce-nurse-burnout-and-alarm-fatigue-301675186.html

SOURCE CalmWave

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CalmWave Announces $4 Million to Reduce Nurse Burnout and Alarm Fatigue

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CalmWave - the company leveraging artificial intelligence (AI) to bring operational health to hospitals - today announced the close of its oversubscribed $4 million seed round led by Bonfire Ventures with participation from Tau Ventures, AI2 Incubator, Seachange Ventures, Hike Ventures, and the co-founders of PagerDuty.

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Games For Health 101: Using Videogames to Improve Patient Engagement

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In the healthcare industry, gamification is used to improve clinical outcomes of physical and mental diseases by reinforcing healthy habits, disease prevention, and adherence to medical advice. The core objective is to personalize the healthcare journey of patients, thereby improving patient engagement.

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Two US Drug Enforcement Administration (DEA) proposals on how telehealth can be used going forward to prescribe controlled substances are drawing criticism from mental health and addiction treatment specialists.

The proposed rules - one for Schedule III-V substances, and the other for buprenorphine - are due to go into effect on May 11, when the COVID-19 public health emergency (PHE), and temporary flexibilities, end.

Essentially, both proposals would allow providers to prescribe a 30-day supply of a controlled substance or buprenorphine, but then require a face-to-face meeting for patients to receive additional prescriptions.

The DEA says that the rules are aimed at preventing abuse and diversion of the substances, but clinicians claim they are creating unnecessary hurdles that will probably lead to some patients dropping out of treatment.

"We were happy to see that there is ongoing flexibility to be able to initiate buprenorphine through telehealth, but we were disappointed to see that the DEA set an arbitrary timeframe, in this case, a 30-day timeframe after which the patient would have to be seen in person before ongoing care with buprenorphine for opioid use disorder could be provided," Brian Hurley, MD, MBA, the president-elect of the American Society of Addiction Medicine told Medscape Medical News.

Hurley agreed that it is best practice to see patients in person for ongoing care, but he noted they have many reasons why they might not be able to make it into an office every month.

"What this rule would do if instituted as written is prevent me from continuing care for patients unless I can get them in in person, he said. "And while I'd make every effort as a clinician, it's not always feasible to do so," said Hurley.

The addiction specialist noted that only about 20% of Americans with opioid use disorder have access to medications for the disorder. "I would posit that untreated opioid use disorder is a bigger threat to public safety currently than the risk of diversion," he said.

The DEA is also proposing to allow state laws to supersede its regulations, which concerns Hurley and other clinicians because some states are more restrictive. "Our position is that state laws that restrict access to medications for opioid use disorder through telehealth means are inconsistent with our policy recommendation. I certainly hope that the DEA hears our concerns and amends the proposal," said Hurley.

A Potential 'Telehealth Cliff'

Shabana Khan, MD, chair of the American Psychiatric Association's (APA's) telepsychiatry committee, said that "because of potential overlap with state rules that may be more stringent than these new regulations, APA is concerned that the proposed rules will create a telehealth cliff for those in most need of critical psychiatric and opioid use disorder treatment, particularly in communities where this specialty care is limited or nonexistent."

In a statement to Medscape Medical News, Khan noted that "clarification is necessary on how patients who started treatment during the PHE can continue treatment with a prescribing provider, if at all, through an in-person evaluation with a DEA-registered provider referral."

Telehealth companies were also disappointed in the DEA proposals.

"The continuity of care for countless Americans will be severed, potentially leaving these patients to fall through the cracks of our healthcare system without access to needed medications," said Kyle Zebley, the American Telemedicine Association's senior vice president of public policy, in a statement.

"Requiring every patient who has initiated treatment via telemedicine during the pandemic to now visit a provider in-person clearly falls on the side of being overly restrictive," Zebley added.

The DEA is proposing to allow patients who have been receiving telehealth over the past 3 years to continue to do so for 180 days after the PHE ends.

But the American Telemedicine Association and others said that they still want to see a change in the proposal as written. "Our hope is that the DEA works with us to avoid unnecessary and inappropriate restrictions on the prescription of essential medications for these vulnerable and underserved populations," Zebley said in the statement.

DEA Administrator Anne Milgram said in a statement that the agency believes that "the telemedicine regulations would continue to expand access to buprenorphine for patients with opioid use disorder," and that the DEA "is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm."

In addition, Rahul Gupta, MD, director of the White House Office of National Drug Control Policy, said in a statement that "This proposed rule builds on President Biden's historic move to eliminate the X-waiver that prevented many prescribers from treating patients with buprenorphine." He added, "Thanks to these changes, millions of Americans will be able to access the lifesaving care they need."

DEA estimated that there were 15.7 million prescriptions for buprenorphine in 2021 and that about 67,000 were for initial prescriptions.

Ketamine Confusion

The rule on controlled substances has also caused some consternation, especially given that it does not differentiate between racemic ketamine and esketamine, said Lisa Marie Harding, MD, vice president of the board of American Society of Ketamine Physicians, Psychotherapists & Practitioners.

Esketamine (Spravato) is approved by the US Food and Drug Administration (FDA) and, under a Risk Evaluation and Mitigation Strategy, can only be administered in FDA-monitored treatment facilities. Racemic ketamine is being prescribed - often for home use - with almost no regulatory oversight.

Harding, who is an approved Spravato provider and also administers intravenous ketamine in her practice, does not believe that ketamine should be used at home without supervision.

"I had a patient who had a very powerful dissociative experience in my office earlier this week," Harding told Medscape Medical News. One of her staff asked what would happen if the patient had experienced that at home. "We don't know. Nor do we want this to happen," said Harding.

However, the DEA proposal would continue to allow for home use, at least initially. "If it's open to interpretation, those people that prescribe ketamine for home use can use that leeway to then continue to do it," she said. "That is not safe."

Harding approves of the proposed DEA requirement for face-to-face visits. "It's good patient care," she said. But she wants the administration to adjust the rules to make it harder to offer home ketamine therapy.

"Lots of people are using racemic ketamine off-label for treating depression with success but doing it in treatment settings that are appropriate," said Harding.

Hurley and Harding report no relevant financial relationships.

Alicia Ault is a St. Petersburg, Florida-based freelance journalist whose work has appeared in publications including JAMA and Smithsonian.com. You can find her on Twitter @aliciaault.

For more Medscape Psychiatry news, join us on Twitter and Facebook

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

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united states food and drug administration

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risk evaluation and mitigation strategies (rems)

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DEA Controlled Substance Telehealth Proposals Draw Fire

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Two US Drug Enforcement Administration (DEA) proposals on how telehealth can be used going forward to prescribe controlled substances are drawing criticism from mental health and addiction treatment specialists. The proposed rules - one for Schedule III-V substances, and the other for buprenorphine - are due to go into effect on May 11, when the COVID-19 public health emergency (PHE), and temporary flexibilities, end.

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Benefits:
-Improved access to Care
-Convenience
-Cost savings
-Patient engagement
-Better health outcomes

Challenges:
-Technology barriers
-Privacy and security concerns
-Lack of in-person interactions
-Legal and regulatory challenges
-Resistance to change

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How CDC Develops Programs That Deliver Care in New Ways

People who live in rural areas of the United States are more likely than urban residents to die prematurely from all of the five leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke.

CDC's National Center for Chronic Disease Prevention and Health Promotion uses several approaches to help improve the health of rural residents. One approach is telehealth, which is the delivery of health care through technology such as mobile phones or computers. It can help reduce barriers to care for people who live far away from specialists or who have transportation or mobility issues.

Telehealth can be an effective approach for communication and counseling. It's also a good way for doctors to monitor their patients' chronic conditions, like heart or lung disease. Better monitoring can improve patients' quality of life and reduce hospital admissions and deaths from chronic diseases. In addition, telehealth is a good way to deliver care quickly in an emergency, such as a stroke.

CDC is supporting telehealth projects across the country to give rural residents better access to chronic disease prevention and management programs and specialist care, including:

Stroke care and cardiac rehabilitation.

Diabetes management and prevention.

Vision care for people with diabetes.

Tobacco cessation.

Epilepsy management.

Stroke Care and Cardiac Rehabilitation

CDC's Division for Heart Disease and Stroke Prevention promotes the use of telehealth as a way to reduce heart disease and stroke risk factors in rural areas. A recent studyexternal icon looked at the use of telestroke services, which use videoconferencing to connect specialists in stroke centers to health care providers in smaller hospitals with fewer resources. The study found that these services had increased significantly during 2008-2015, especially in rural areas. Telestroke services help increase the use of lifesaving treatments, such as ensuring that stroke patients get a clot-busting drug called alteplase within the national standard of 60 minutes of arriving at the hospital.

Compared to urban areas, rural areas have:

higher rates of unhealthy behaviors

less access to health care

less access to healthy foods

Grantees in CDC's Paul Coverdell National Acute Stroke Program are working to help rural hospitals develop partnerships with hospitals that have telestroke capacity to improve outcomes and reduce deaths. The Coverdell Program is also collecting information to better understand the current use of telestroke services in hospitals and its potential benefits.

Cardiac rehabilitation-or cardiac rehab-is a prevention program that typically occurs in an outpatient hospital facility. It is designed to help patients improve their heart health after a cardiac event or procedure and prevent future events. However, participation is low, ranging from 19% to 34% among eligible patients across the country. Rural residents may have trouble participating in cardiac rehab because they cannot afford copayments, they lack transportation to a facility, or they do not live near a program.

Home-based cardiac rehab, alone or in combination with facility-based rehab, could help rural residents overcome some of these barriers. It typically involves smart devices and apps that allow doctors and other clinical staff to interact with patients and supervise them as they exercise in their homes or community fitness centers.

Evidence has shown that the safety and effectiveness of home-based cardiac rehab is equal to the care delivered in facilities. Million Heartsexternal icon ® 2022 is a national initiative co-led by CDC and the Centers for Medicare & Medicaid Services to prevent 1 million heart attacks and strokes within 5 years. Its priorities include increasing the use of cardiac rehab. One component of this effort is the Cardiac Rehabilitation Change Package pdf icon [PDF - 880 KB] external icon for health care providers, which advocates home-based cardiac rehab or a hybrid model of facility-based and home-based rehab.

Diabetes Management and Prevention

In the United States, 34.2 million people (about 1 in 10) have diabetes. Rural populations have higher rates of diabetes and lower rates of participation in diabetes self-management education and support (DSMES) compared to residents of urban areas.

DSMES services help people manage their diabetes by eating healthy food, being active, checking their blood sugar, taking medicines, and handling stress. DSMES improves health and reduces diabetes complications and can be cost-effective or cost-saving for employers, insurers, and the US health care system. However, 62% of rural counties don't have DSMES services.

In 2012, the Eastern Montana Telemedicine Network began a DSMES initiative called Promoting Realistic Individual Self-Management. This initiative included a 3-year telehealth component conducted in five rural clinics, each serving 30 to 300 patients with diabetes each year. Among participating patients, 61% reported that they were checking their blood sugar correctly after 6 months, compared to 31% before the program started. In addition, 29% said they were following an appropriate diet, compared to 8% before the program.

The CDC-led National Diabetes Prevention Program (National DPP) is a public-private partnership working to build a nationwide system to deliver an affordable, evidence-based lifestyle change program to prevent or delay type 2 diabetes. Programs can be delivered in person or online, and online programs allow more access and flexibility. About 200 programs are available online.

The National DPP lifestyle change program can also be delivered by telehealth. For example, the Montana Department of Health and Human Services worked with Holy Rosary Healthcare of Miles City to start a telehealth pilot in eight remote communities.

From 2008 to 2015, almost 900 participants were enrolled in the pilot program, 29% of them at telehealth sites that connected to "host sites" through video conferencing. An evaluation of the program showed that weight loss and participation rates were the same for telehealth and in-person participants and suggested that telehealth delivery could increase access and participation.

Vision Care for People With Diabetes

One complication of diabetes is blindness. CDC funds several telehealth projects to screen for eye disease in rural areas. For example, for the Global Network Diabetic Retinopathy Projectexternal icon , the Yale-Griffin Prevention Resource Center is working to adapt a successful program from India for rural Ansonia, Connecticut.

CDC also funds Wills Eye Hospital in Philadelphia, Pennsylvania, to work with Federally Qualified Health Centers (FQHCs) and community-based eye care providers to reach people who are at high risk of glaucoma and other age-related eye disease by focusing on African American, Hispanic, and Asian populations and older adults. From April 1, 2015, to February 6, 2017, an integrated telemedicine screening intervention in primary care offices and FQHCs found a high rate of eye diseases.

Tobacco Cessation

The health of people living in rural areas is affected by tobacco use more so than those in urban and metropolitan areas, often because of socioeconomic factors, culture, policies, and lack of proper health care. The 2019 report Advancing Tobacco Prevention and Control in Rural America pdf icon [PDF - 4 MB] external icon summarizes aspects of the rural context that may have implications for tobacco prevention and cessation, as well as evidence-based interventions to address tobacco use in this environment. It was published by the National Network of Public Health Institutes with funding from CDC.

Telehealth programs can provide a variety of tobacco use cessation services, but they often rely on high-speed Internet connections. Unfortunately, only about 60% of residents living in rural or tribal areas have such access, compared to over 95% of urban residents. As a result, the use of telehealth for tobacco control interventions is limited in rural areas.

Strategies that use cell phones are another option for reaching rural communities for tobacco cessation interventions. More than 90% of rural residents own cell phones, with more than 3 in 4 sending or receiving text messages. One way to overcome access barriers is to use mobile-friendly short message service (SMS) texting, which provides a direct, immediate channel to communicate your message to residents who may not have high-speed internet service.

In 2018, CDC and the American Lung Association developed a document called Telehealth as a Vehicle for Tobacco Cessation pdf icon [PDF - 891 KB] external icon that explores the barriers to and potential benefits of using telehealth to improve access to evidence-based tobacco cessation services.

Epilepsy Management

In 2015, about 3.4 million Americans had epilepsy. People with epilepsy benefit from regular care by a neurologist, but few neurology practices are found in rural areas. Adults with epilepsy are 5 times more likely to report lack of access to transportation as a barrier to health care than adults without the disorder, likely because of common transportation barriers.

CDC's Epilepsy Program funds the following telehealth interventions to reduce barriers to care:
Epilepsy self-management programs:

Project UPLIFTexternal icon (Using Practice and Learning to Increase Favorable Thoughts) is a program delivered entirely by phone that significantly reduces and prevents depressive symptoms in adults with epilepsy. UPLIFT has been piloted in nine states. Reductions in depressive symptoms among participants ranged from 24% to 43%.

HOBSCOTCHexternal icon (HOme-Based Self-management and COgnitive Training CHanges lives) is an evidence-based program delivered primarily by phone that is shown to improve memory and quality of life in adults with epilepsy and memory problems.

Epilepsy telementoring programs:

Project ECHO (Extension for Community Healthcare Outcomes) connects family practitioners, general neurologists, school nurses, and other providers to epilepsy specialists to improve the care of adults and children with epilepsy. It is supported by the Epilepsy Foundation.

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national center for chronic disease prevention and health promotion

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How CDC Develops Programs That Deliver Care in New Ways People who live in rural areas of the United States are more likely than urban residents to die prematurely from all of the five leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke.

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Healthcare Cost and Utilization Project (HCUP)

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Healthcare Cost and Utilization Project (HCUP)

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HCUP is the Nation's most comprehensive source of hospital care data, including information on inpatient stays, ambulatory surgery and services visits, and emergency department encounters.

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Find complete program information on the HCUP-US website.

Generate your own health care statistics and visual displays on HCUPnet.

View displays of HCUP-based statistics on selected priority topics on HCUP Fast Stats.

Overview of HCUP

The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of databases, software tools and related products developed through a Federal-State-Industry partnership and sponsored by AHRQ. HCUP databases are derived from administrative data and contain encounter-level, clinical and nonclinical information including all-listed diagnoses and procedures, discharge status, patient demographics, and charges for all patients, regardless of payer (e.g., Medicare, Medicaid, private insurance, uninsured), beginning in 1988. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, State, and local market levels.

The HCUP databases are based on the data collection efforts of data organizations in participating States that have partnered with AHRQ.

HCUP Databases

National (Nationwide) Inpatient Sample (NIS)

The National (Nationwide) Inpatient Sample (NIS) is the largest publicly available all-payer hospital inpatient care database in the United States. Researchers and policymakers use NIS data to identify, track, and analyze trends in health care utilization, access, charges, quality, and outcomes.

Kids' Inpatient Database (KID)

The Kids' Inpatient Database (KID) is composed of hospital inpatient stays for children and is specifically designed to allow researchers to study a broad range of conditions and procedures related to children's health. Researchers and policymakers can use KID data to identify, track, and analyze health care utilization, access, charges, quality, and outcomes.

Nationwide Emergency Department Sample (NEDS)

The Nationwide Emergency Department Sample (NEDS) captures information on emergency department (ED) visits that do not result in an admission as well as ED visits that result in an admission to the same hospital. The NEDS enables analyses of ED utilization patterns and supports public health professionals, administrators, policymakers, and clinicians in their decisionmaking regarding this critical source of care.

Nationwide Readmissions Database

The Nationwide Readmissions Database (NRD) is a unique and powerful database designed to support various types of analyses of national readmission rates for all payers and uninsured individuals. This database addresses a large gap in health care data-the lack of nationally representative information on hospital readmissions for all ages.

State Inpatient Databases (SID)

The State Inpatient Databases (SID) are a set of hospital databases containing the universe of the inpatient discharge abstracts from participating States, translated into a uniform format to facilitate multi-State comparisons and analyses. Researchers and policymakers use the SID to investigate questions and identify trends unique to one State, to compare data from two or more States, and to conduct market area research or small area variation analyses.

State Ambulatory Surgery and Services Databases (SASD)

The State Ambulatory Surgery and Services Databases (SASD)include encounter-level data for ambulatory surgery and other outpatient services from hospital-owned facilities. In addition, some States provide data for ambulatory surgery and outpatient services from nonhospital-owned facilities.

State Emergency Department Databases (SEDD)

The State Emergency Department Databases (SEDD) are a set of databases that capture discharge information on all emergency department visits that do not result in an admission. The SEDD combined with SID discharges that originate in the emergency department are well suited for research and policy questions that require complete enumeration of hospital-based emergency departments within market areas or States.

HCUP databases can be purchased through the Online HCUP Central Distributor.

HCUP Statistical Briefs

HCUP Statistical Briefs present simple, descriptive statistics on a variety of topics including specific medical conditions as well as hospital characteristics, utilization, quality, and cost.

HCUP Publication Searches

Research Spotlights features recent examples of peer-reviewed publications utilizing HCUP data.

Search for peer-reviewed articles and other reports based on HCUP data or products.
And More, Including:

HCUP Methods Series.

HCUP Projections.

HCUP Nationwide Database Reports.

HCUP State Database Reports.

Tools and Software

HCUPnet: Instant Access to Hospital Statistics

HCUPnet is a free, online query system based on data from HCUP that provides access to health statistics and information on hospital inpatient and emergency department utilization.

HCUP Fast Stats: The Latest Visually-Displayed HCUP-Based Statistics for Health Information Topics

HCUP Fast Stats provides easy access to the latest statistics in hospital and ED use for specific topics. You can monitor state-level trends to look at the effect of Health Insurance Expansion on inpatient and ED Use by State. You can get national statistics on use and costs in ready-to-use tables and graphs.

AHRQ Quality Indicators

AHRQ Quality Indicators (QIs) are measures of health care quality that use hospital inpatient administrative data and can be used to highlight potential quality concerns, identify areas that need further study and investigation, and track changes over time.
And More, Including:

Clinical Classifications Software (CCS).

Chronic Condition Indicator (CCI).

Comorbidity Software.

Procedure Classes.

Utilization Flags.

Cost-to-Charge Ratio (CCR) Files.

Hospital Market Structure (HMS) Files.

HCUP Supplemental Variables for Revisit Analyses.

American Hospital Association (AHA) Linkage Files.

National (Nationwide) Inpatient Sample (NIS) Hospital Ownership Files.

National (Nationwide) Inpatient Sample Trends (NIS-Trends) Files.

Kids' Inpatient Database Trends (KID-Trends) File.

Send Questions and Comments to: hcup@ahrq.gov

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Healthcare Cost and Utilization Project (HCUP)

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HCUP is the Nation's most comprehensive source of hospital data, including information on in-patient care, ambulatory care, and emergency department visits. HCUP enables researchers, insurers, policymakers and others to study health care delivery and patient outcomes over time, and at the national, regional, State, and community levels.

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Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety and cost of patient care.

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Clinical Decision Support Systems (CDSS)

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Clinical Decision Support Systems (CDSS)

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Understanding the Basics of Clinical Decision Support Systems

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Electronic Medical Record (EMR) refers to a digital version of a patient medical record that is created and maintained within a single healthcare organization, such a doctor's office or hospital. It can be used to track a patient's medical history, diagnosis, and treatment plans.

Electronic Health Record (EHR) refers to a digital health record that is designed to be shared across multiple health care organizations. It contains information from all healthcare providers involved in a patient's care including, primary care, hospitals, and specialists. It allows providers to share information and coordinate care more effectively.

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Journal of Ethics | American Medical Association

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Before the Patient Protection and Affordable Care Act, otherwise known as "Obamacare," or, more generally, health reform, Congress had already passed the most sweeping health care reform measures since Medicare was created nearly 45 years ago. As part of the American Recovery and Reinvestment Act (ARRA), Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH changed the nature of the relationships among health care professionals, organizations, patients, and payors by focusing on the implementation and use of health information technology. It puts particular emphasis on privacy and security, including expanded application and enforcement. HITECH also provides incentives and subsidies for health information exchanges and education, which are outside the scope of this article.

Incentives

HITECH provides financial incentives to "eligible professionals" for the meaningful use of certified qualified electronic health records (EHRs). An eligible professional is generally a physician, though there are incentives for hospitals as well. Certified EHR technology includes those EHRs that have been certified by an authorized testing and certification body (ATCB) [1].

The incentive payments under HITECH are substantial: eligible professionals who demonstrate the meaningful use of an EHR in 2011 or 2012 will be entitled to incentive payments of $18,000 in the first year (only $15,000 after 2012); $12,000 for the second year; $8,000 for the third year; $4,000 for the fourth year; and $2,000 for the fifth year [2]. After 2015, physicians who fail to meaningfully use EHRs will be subject to reductions in Medicare and Medicaid reimbursement [2].

The criteria for meaningful use are based on a series of specific objectives, each of which is tied to a measure that allows physicians to demonstrate that they are meaningful users of certified EHR technology. The final meaningful use standards for Stage 1 (of three) were published by the Department of Health and Human Services in 2010. For Stage 1, which begins in 2011, physicians must meet 15 mandatory (core) criteria and choose 5 of the 10 "menu" criteria. Each objective was evaluated for its potential applicability to all physicians and eligible hospitals. Where it is impossible for a physician to meet a specific measure, an exclusion defined in the final rule will apply [3].

The Stage 1 standards for meaningful use focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information. All certified EHRs should enable a physician to meet these standards [1, 2]. Examples of meaningful use in Stage 1 include entry of patient demographic and insurance information, use of drug interaction software, and e-prescribing.

Stage 2 and 3 Criteria for Meaningful Use

Stage 2 meaningful use criteria will expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bidirectional communication with public health agencies. Information exchange is a critical part of care coordination, and Stage 2 criteria are expected to support health information exchanges and health information exchange activities [3].

Stage 3 criteria are expected to address improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self-management tools, access to comprehensive patient data, and improving population health outcomes [3].

The criteria will become more stringent over time [4].

Privacy and Security under HITECH

HITECH expands on the notions of privacy and security found in the Health Insurance Portability and Accountability Act of 1996, known as HIPAA. The HIPAA regulations, in brief, prohibit the disclosure of individually identifiable health information, otherwise known as protected health information or PHI, without the consent of the patient (or guardian or other responsible person) except for three purposes: treatment, payment, or health care operations. HIPAA applies directly to "covered entities," defined as health care payors, providers, and clearinghouses.

Under HIPAA, "business associates"-a term referring to people or entities who, on behalf of covered entities, perform tasks that necessitate access to PHI-were not directly regulated, but were bound to comply with HIPAA pursuant to mandatory written agreements with the covered entities. HITECH, by contrast, provides for direct regulation of business associates and stipulates that HIPAA's privacy and security rules apply to them.

HITECH also dramatically increases the required response to breaches of PHI and the enforcement of such requirements [5, 6].

Notification of Breach

HITECH mandates public notification of security breaches when "unsecure PHI" is disclosed or used for an unauthorized purpose. ("Secure PHI," on the other hand, is not subject to such requirements because it is encrypted and cannot be breached [6].) These notification requirements are similar to many state and federal data breach laws pertaining to financial information.

In general, the act requires that patients be notified of any breach of their data security, whether external or internal. If a breach affects 500 patients or more, then HHS must also be notified and the name of the institution where the breach occurred will be posted on the HHS web site. Under certain conditions, local media will also need to be notified. This provision is yet another example of the act's emphasis on privacy and security concerns [4].

Electronic Health Record Access

When a health care practice or organization implements an EHR system, the act gives patients in those practices (or third parties they designate) the right to obtain their PHI in an electronic format. This requirement is similar to state laws that mandate patient access to their own paper medical records. The act specifies that charges for such requests may only cover the labor cost of fulfilling the request. Although one might presume that such a request requires a few clicks, the reality is that even practices with an EHR system already in place may not have this capability.

Penalties and Enforcement

While HITECH is a federal law, it grants both the Department of Health and Human Services and state attorneys general the authority to enforce the law. This dual enforcement authority raises the specter of politically motivated investigations of PHI disclosures by ambitious state attorneys general. As health lawyers have advised physicians for years, the investigation will do as much damage as the penalty. The key is compliance in advance.

Civil penalties are mandatory if there is a violation due to willful neglect. For example, in situations in which a person is unaware of a violation (despite due diligence), the minimum penalty is $100 per violation, with a cap of $25,000 for violations of an identical requirement during a calendar year. If the violation is due to "willful neglect," however, the minimum penalty is $10,000 per violation, with a cap of $250,000 for violations of an identical requirement during a calendar year, and the maximum penalty is $50,000 per violation, with a cap of $1.5 million [7, 8].

Conclusion

HITECH has laid the groundwork for a positive revolution in the delivery of health care. Compliance is key, and HITECH provides both positive incentives in the form of meaningful use payments and negative incentives in the form of civil penalties and the threat of prosecution at the state level.

Citation

Virtual Mentor. 2011;13(3):172-175.

DOI
10.1001/virtualmentor.2011.13.3.hlaw1-1103.
The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.

Author Information

Howard Burde, JD provides general counsel and health law advice to health information technology and health care organizations, payors, and associations such as the Health Information Management Systems Society (HIMSS), the bipartisan Pennsylvania Joint Legislative Committee on Health Reform, and the National Governors Association's State Alliance for e-Health. He serves on the editorial boards of health law publications, including the BNA Health Law Reporter and the Journal of Health and Life Sciences Law, and has written four books.

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Before the Patient Protection and Affordable Care Act, otherwise known as "Obamacare," or, more generally, health reform, Congress had already passed the most sweeping health care reform measures since Medicare was created nearly 45 years ago. As part of the American Recovery and Reinvestment Act (ARRA), Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH).

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The DIKW hierarchy is a framework that outlines the relationships between data, information, knowledge, and wisdom. The hierarchy suggests that data is the foundation of the structure and is transformed into information, which is then transformed into knowledge, and finally into wisdom. The goal of the DIKW hierarchy is to provide a structured approach to understanding how data is transformed into insights and decision-making.

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Challenges to Healthcare Interoperability 

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Challenges to Healthcare Interoperability 

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Achieving interoperability is a complex and challenging task that requires significant effort and resources from government, industry, and healthcare providers.
Challenges include:
-national standard for EHR data
-national infrastructure for EHR data exchange
-lack of governance and oversight for EHR data exchange
-incentives for healthcare providers to adopt interoperable systems

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healthcare interoperability - Google Search

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Fast Healthcare Interoperability Resources 

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Fast Healthcare Interoperability Resources 

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Technology Solutions That Drive Government

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Healthcare Providers Benefit When Industry Participates

While standardizing on FHIR aligns with Biden administration equity priorities, healthcare providers will reap benefits as well, Tabe-Bedward said.

DOD, the Department of Veterans Affairs and industry partners share health data through MHS GENESIS using the joint Health Information Exchange, which connects to about 122,000 healthcare providers. The FHIR standard, which allows for auto-ingestion of data from trusted partners, improves data transfer efficiency by reducing the burden on clinicians to manually input information, said Lance Scott, acting technical director for the Federal EHR Modernization office.

Soon the joint HIE will include long-sought-after data from state immunization registries, which FEHRM is working on with the Centers for Disease Control and Prevention.

In the past two years, FEHRM's success in transferring data using FHIR has made it an "actual player" in national standards discussions, Scott said. The eHealth Exchange, a nonprofit health information network, reached out for help sharing data using FHIR.

"We cannot do any of this without close partnering," Scott said.
DIVE DEEPER: How the VA is playing 'catch-up' on machine learning integration.
The Future of Electronic Health Records

Johns' team at the Defense Healthcare Management Systems PEO is already working on the Revenue Cycle Expansion for MHS GENESIS. RevX will have a "huge" impact on patient administration by enabling military treatment facility administrators to make real-time, data-driven decisions, he said. Deployed forces will have access to new commercial software solutions for healthcare recording work, including the ViiMed platform and T6 Health Systems mobile application used in most medical trauma centers worldwide.

Between the data coming in from RevX software and the forthcoming immunization tracking and reporting tool, the MHS Information Platform will grow substantially with immediately actionable data, all thanks to FHIR.

"It's huge - the opportunity to have all of that legacy data and all of that new data in one place to do Big Data analytics on, to bring in and leverage artificial intelligence, machine learning and data analytics," Johns said.

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Federal Officials Urge Healthcare Industry's Adoption of FHIR for Interoperability

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While standardizing on FHIR aligns with Biden administration equity priorities, healthcare providers will reap benefits as well, Tabe-Bedward said. DOD, the Department of Veterans Affairs and industry partners share health data through MHS GENESIS using the joint Health Information Exchange, which connects to about 122,000 healthcare providers.

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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 and a National Advisory Board have defined quality and safety competencies for nursing and proposed targets for the knowledge, skills, and attitudes to be developed in nursing pre-licensure 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 programs, transition to practice and continuing education programs .

For information on applying the competencies at a graduate level, see the Graduate 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 PRE-LICENSURE KSAS

Click here to download the PDF version

REFERENCES

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

² Cronenwett, L., Sherwood, G., Barnsteiner J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D., Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3)122-131.

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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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Nursing informatics competencies refer to the specific knowledge, skills, and abilities that nurses must possess in order to effectively use and manage technology and information systems in their practice. These competencies include:
-Understanding basic concepts of informatics and healthcare technology
-Knowledge of data management and analysis
-Ability to use electronic health record systems and other clinical information systems
-Proficiency in communication and collaboration technologies
-Understanding of privacy and security issues related to healthcare information

Nurses with informatics competencies are able to apply their knowledge of technology and information systems to improve patient outcomes and support the delivery of high-quality care.

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Role of Informatics in Promoting Patient Centered Care

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Role of Informatics in Promoting Patient Centered Care

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Health information technology pertains to the digital systems that collect and organize health information. Health information management not only incorporates the data that go into those systems but also analyzes and protects those data, according to the American Health Information Management Association.