Health Information Exchange Consent processes differ across states and even local jurisdictions causing workflow problems for many users.
Variations in approach to consent pose challenges to interoperable health information exchange. Each state around the US and, in many states, each individual health information exchange differs in their approach to consent processes and management. This can affect workflow and decision-making capabilities for users of the HIEs. Some state models have been shown to increase regulatory barriers to health information exchange and place a greater administrative burden on those less technologically advanced organizations. Below, we will examine some of the issues, approaches to address them, and implications on key stakeholders including providers, payers, and patients. If your organization is looking to solve HIE consent problems, Strategic Interests and our partners have the ability to assess the current state of consent in your region, compare to best practices around the nation, isolate and evaluate the impacts of making changes, and develop a practical plan to move forward.
There are several model variations around the nation with different selections across the potential options. Model variations include:
Authorization models: range from opt-in, opt-out, and hybrids that require opt-in for sensitive information or other specific PHI or demographics.
Initiating Party: consent initiation may be performed by the provider, the patient, or either, in addition to a parent/guardian or healthcare proxy.
Initiation Domain: point of care, online, or a mixture of options. COVID-19 has led to waiver programs that temporarily change these policies. Such changes may become permanent, and in the meantime have already modified the everyday behavior of clinicians and care providers in their approach to patient care.
Data Sharing: basic choice to share all data or can be more granular to select certain types of data by sensitivity level and clinical application or need.
Provider Data Access: may be granted to a particular provider, organization, or multiple providers (community consent) based on the model deployed. Some models permit emergency access or blanket restrict all access regardless of an emergent event occurrence.
Patient Data Access: models may provide ability to access and/or suggest changes
Alteration and Revocation: patient changes to consent may be retrospective, prospective, or contain options of either. For example, revoking consent may or may not remove access to historic data. Changes to consent may be entered by the patient, provider, or either and may occur at the local or statewide level.
Alignment with Federal Policies: HIPAA, TEFCA, etc. does not necessarily reconcile fundamental policy differences across regions or states.
Migration Issues:
Process for providers who have a presence in geographies served by multiple QEs with varying policies
Process for patients who travel across HIE regions for healthcare in addition to travel out of state which may entail seasonal or emergency care
Governance Structures:
Centralized consent tracking system and standard consent form
Patients are asked to repeatedly sign consents for each HIE, leading to “consent overload.” Such overload not only affects the HIE and the interconnected systems, but also creates temporal inconsistencies as to when a particular consent was in effect and when data was shared or denied.
Patients ability to query for, or change their current state of consent without contacting each individual HIE
Sensitive PHI may be treated differently in different organizations
Complications:
Organizations may be steadfast in their own approach to consent and resistant to change on a statewide level
The benefits of a well-managed consent program far outweigh the challenges. In order to successfully define and deploy such capabilities, HIEs must incorporate stakeholder requirements, design solutions and an approach to address these requirements, embrace a funding and program management approach that allows organizations, providers, and other stakeholders to migrate from current approaches, and solve workflow issues related to the collection and management of consent while conforming to regulatory requirements for the management of sensitive substance use, mental health, and persistent viral data (HIV, herpes, COVID-19, etc.). In addition, the potential of legislative changes could streamline the process but may also pose distinct privacy and workflow challenges.
A successfully deployed statewide consent management system will yield increased patient clarity in the process, lessened effort for participants in the consent process, improvements in care delivery and coordination and the maintenance of patient desires and health information privacy choices. These, and other complex healthcare workflow and strategy quandaries are situations that SI and our partners are well-positioned to address. Let us know if you need help.
Helping clients determine the best course of action amidst a complex environment and then attain results from the subsequent implementation requires capabilities and approaches to address both strategy and execution. SI excels in both because of our experience, style and proven methodologies. The coronavirus pandemic has complicated the most straightforward environment and has heightened the complexities associated with conducting business in healthcare and the high tech sector that provides innovation to the industry. TechRochester asked us to share our perspective on ways to address a chaotic environment as part of their Virtual Leadership Summit – so we shared thoughts in a presentation “Bringing Clarity to Chaos”.
SI applies our proven methodologies and approaches with refined facilitation skills to accomplish the objectives of each unique situation while ensuring stakeholder alignment. We characterize the situation in terms of problems and opportunities facing a client, and then perform an assessment of the landscape and complications associated with the specific issues. Defining the relationships between the issues and opportunities helps clarify how answering individual questions can inform the ideal overall course of action. A stakeholder analysis yields the perspectives of key individuals within the organization and throughout the eco-system – and identifies potential reactions to different courses of action. We have assembled a panel of experts with clinical, technical, and financial acumen that we engage for specific purposes. We then collaborate with our clients to define the data and events that can best inform the ideal answer to each individual issue, opportunity or question. A combination of primary research, interviews, surveys and facilitated group discussions serves up the data to make these decisions. Analysis and discussions with key stakeholders within the client organization and the beyond will ensue that the best decisions are made. This comprises the clarity of strategy
Once strategy is formulated, it is important to execute well to bring the clarity to life amidst the chaos. There are many different approaches of Program Management that can be applied to successfully execute a myriad of activities amongst a myriad of stakeholders within a cross-functional or cross-organizational team. SI has experience selecting and applying these methods to plan, manage, and deploy initiatives with effective change management to align individuals to adopt technology, workflow, etc.
We hope you can apply some of these principles to Bring Clarity to the Chaos facing you and your organization. Reach out to us if you need help doing so.
Throughout the course of this pandemic, a great deal of attention has been paid to testing. Most of us think of testing as a single person driving through a tented testing site and waiting a few days for their swabbed results to be returned to them. Pooled testing is no different from the tested person’s standpoint: you still have a swab test just as if you were being individually tested, but the difference is in how the lab processes the collected tests and how the results are reported.
In pooled testing, biological samples from several people are mixed together prior to analysis. If the pool is negative, a large group of people can be deemed to be negative. The advantages to doing so are several:
Performing a single pooled test can quickly and efficiently check a large sample of people for presence of COVID.
The cost of a pooled test that includes many people is substantially less than the costs of individual tests for the same number of people.
Capacity of testing increases tremendously, permitting high numbers of people to be tested frequently with much less strain on the laboratory systems.
There are several caveats to be aware of, however, that make pooled testing slightly less than perfect. When pooled testing yields a positive test, it is impossible to know which pooled specimen is positive, so they must be retested individually. This is fine if a positive test appears only infrequently of if the pool is small. Pooled testing is best used in populations where positive tests are not expected: think colleges rather than nursing homes; communities who have not seen an outbreak versus an area with a lot of COVID hospitalizations.
Strategies such as split testing can help with the work of retesting positive results. If a pooled test shows a positive, the pool samples are split in two groups and retested. If one of the splits is positive, that sample is split again and retested while the negative split is cleared. Rinse and repeat as necessary. This reduces the amount of retesting necessary and eliminates fairly large groups of negatives.
There is also the issue of false negatives, which are slightly higher in pooled tests than in individual tests due to the diluted samples in a pool. Analyzing the pooled sample more than once appears to reduce this risk, but even single tests have false negatives.
Pooled testing is an effective, efficient strategy in communities where COVID-19 is not prevalent and early detection is desired. It safes time, money, and leads to earlier control through contact tracing and quarantine. Every day people with COVID are undetected and mix with their immediate population, the risk of uncontrollable spread rises exponentially. Several of the countries who have had the most success in managing their pandemic outbreaks have relied on pooled testing and research from Israel has shown that pools of 32 samples can detect a single positive sample (with a 10% false negative rate). Greater samples, up to 64, can be detected as well but require a technique called amplification samples. The US should be leveraging the pooled methodology immediately in areas where it is applicable to improve our capacity for testing and increase the speed of detection in the community. And once there are detected positives, using a remote patient monitoring solution to track progress of those who are positive will further help extend thinning healthcare resources.
Two clients of Strategic Interests: Rochester Regional Health and the Monroe County Department of Public Health presented their experiences and best practices of COVID-19 remote patient monitoring. The webinar was recorded and is available here:
AZ HIMSS Remote Patient Monitoring for COVID-19 Webinar
SI was proud to help reduce the spread of COVID-19 in Monroe County – a key step in progressing our region to the highest phase of reopening in NY so far. Read the press release below:
Telehealth has always been viewed as a key pillar of the technology-enabled care delivery… of the future. Each year, we have said “This is the year for Telehealth” and that could not be more true than at the current moment. There is an urgent need for solutions that serve and protect patients and providers at the same time. As we know, Telehealth helps hospitals, health systems, LTC and group practices deliver quality care while gaining efficiency, improving patient care and satisfaction, increasing provider satisfaction, reducing risk and decreasing costs.
As 2020 unfolds, with the COVID-19 pandemic severely testing our health-system capacity, telehealth is providing solutions. Virtual care and remote monitoring have taken centerstage during this crisis. Keeping patients home but engaged is especially important along with tracking the health of employees and their return to work status.
Many of the regulatory and reimbursement constraints that have created barriers to telehealth adoption prior to COVID-19 have been eased. There is increased grant funding available as well. Our hospital systems and other organizations need to leverage technology to deliver care during social distancing efforts to prevent the spread of the virus. Many vendors are offering low cost and deeply discounted plans to help meet these needs.
Finding the right Telehealth vendor to best meet your organization’s needs can still be a challenge. How do you find the right vendor during a crisis? Can you afford the time to research and vet those companies so you don’t make a mistake that costs time and money?
Strategic Interests, LLC has extensive experience and knowledge in Telehealth. SI can help you select a vendor, implement a program, training your staff, and identify revenue and/or funding sources. SI will quickly learn your use cases and requirements and propose appropriate solutions. If you would like to explore how Telehealth could benefit your organization during this unprecedented time, please use the contact us page on our website or email SI at info@strategicinterests.com.
The Coronavirus Aid, Relief and Economic Security Act (CARES) that passed on March 27, 2020 was the largest in US history, representing a $2 trillion aid package. Congress was encouraged to provide increased access, funding and guidance for Telehealth and related health IT from the eHealth Initiative (eHi) and other leading organizations. The CARES Act addresses and relieves some of the immediate challenges in delivering quality healthcare during the COVID-19 pandemic.
Telehealth and other health related technology is a natural solution to some of these current healthcare delivery challenges. The CARES Act provides increased telehealth grants by reauthorizing the Health Resources and Services Administration (HRSA) grant funding for 2021-2025 making $29 million per year available. It also eases some of the previous restrictions on Telehealth visits including the requirement that the patient was seen within the past three years for an in person visit.
The range of Telehealth solutions has expanded considerably. The CARES Act acknowledges this by redefining Telehealth beyond just real-time video technology. In particular, the ability to monitor the health and symptom status of a patient remotely will prove to be life-saving technology for patients and providers.
The CARES Act also allows the designation of FQHCs and some rural clinics as Medicare Telehealth “distant sites” to make reimbursement for Telehealth visits easier. Additional appropriations provide funding for specific Telehealth activities and initiatives.
Strategic Interests worked tirelessly with Rochester Regional Health and Datos to rapidly deploy a COVID-19 remote patient monitoring solution in under a week! See the press release below for more details…
The number of COVID-19 cases in the United States is accelerating rapidly and if you or your organization is responsible to monitor these people, you know it requires immediate efforts to practically manage patient care. Hospitals soon will be swamped with patients and we need, as much as possible, to keep the ill and those suspected to be ill at home while providing them with care and the ability to monitor them closely.
Datos, a leading digital health startup from Israel, in conjunction with Strategic Interests, a health tech consulting firm, are offering a capability to your organization to implement and begin monitoring your patients in as few as two days. The Datos Automated Remote Care Platform utilizes proven technology and is already monitoring and caring for COVID-19 and flu/virus symptomatic patients in Israel. (See the video: Datos Automated Remote Care Platform – You Tube)
Jointly we are now offering this service in the United States, at a very low cost to help our providers care for us. We prioritize community care over profits – especially at this critical time.
The Datos Automated Remote Care Platform features capabilities via our HIPAA Compliant, private cloud-based solution with a mobile app that can be private branded for your practice, IPA, health system.
Patient Monitoring
Two electronic patient reported outcome (ePro) surveys – Assessment form and daily symptoms
Clinical Data – Temperature/Blood Pressure/Pulse Oximetry
Built-in/configured reminders and automatic messages to patients
Virtual visit capabilities
Care Team – Patient Management
Fully configured COVID-19 dashboards
All patient views, sorted by alerts based on symptoms severity
Detailed statistics on vitals and symptoms, including locations updates if/when needed
Virtual visit capabilities
Strategic Interests will work with your organization/practice to implement in as few as two days. Please visit https://www.strategicinterests.com/covid19 and let’s schedule a short conference call to get started. If you know of someone who can use this platform to save lives and manage scarce resources, please let them know.
Stay safe, stay home (if you can), and wash your hands.
Strategic Interests’ Al Kinel joins panel experts from AT&T and RIT to explore what opportunities are ahead for Rochester as 5G rolls out. Kinel will provide perspectives on how 5G will enhance telehealth and healthcare technology overall.
Event is free. Jan 22, 2020 5:30pm at NextCorps in Rochester
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