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Rush University Medical Center Unveils Mobile Stroke Unit

October 31, 2016
by Rajiv Leventhal
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Rush University Medical Center in Chicago has unveiled a mobile stroke treatment unit that encompasses an ambulance outfitted with telemedicine technology and a CT scanner enabling brain imaging.

The event unveiling was at Rush Oak Park Hospital, where the mobile stroke treatment unit will be based. One of only a handful of specially designed and built units of its kind in the U.S., it will serve Illinois Region VII, which includes parts of the western suburbs, Rush officials stated. The mobile stroke unit brought to Rush Oak Park Hospital by the manufacturer, Excellence, is identical to one still being outfitted for Rush. It will be delivered in January.

“Presently patients cannot be treated for their stroke until they get to an emergency room. This new mobile stroke treatment unit will bring immediate stroke diagnosis and treatment to patients at their homes, or wherever they’re in need, which will improve their chances of a good recovery,” James Conners, M.D., medical director of the mobile stroke unit, said in a statement.

According to a Rush announcement, the mobile stroke treatment team will respond to 911 calls reporting symptoms indicating stroke along with a regular ambulance. If the paramedics determine the person did not have a stroke but has another medical problem, the mobile stroke unit will simply return to their base station. But, if a stroke is suspected, the team can perform CT scans of patients and using telemedicine, Rush stroke neurologists will evaluate the patients remotely and decide what kind of treatment is indicated.

At that point, the emergency medical technician and critical care nurse staffing the mobile unit will administer the appropriate stroke medication after conferring with the stroke neurologist at the same time they are transporting the patient to the most appropriate stroke center. The goal is to provide optimal treatment to stroke victims within the first "golden hour" after symptom onset, when it will do the most good, officials said.

"We know patients are up to four times more likely to have a good outcome if they are treated with tPA. Also, the sooner we treat patients, the more likely it is they will have minimal or even no disability,” Conners said. “With our standard process, it’s rare to be able to treat people within the first hour after onset, but with the mobile stroke unit we anticipate even better outcomes.”

The mobile stroke unit also will enhance treatment for patients who suffer from a hemorrhagic stroke, which occurs when a blood vessel in the brain leaks or bursts. Those patients can’t receive tPA, which could be fatal to them, and need a different type of medication to stop their bleeding.

The hope is that the new program will capture 75 percent of strokes in the service area in time to deliver optimal treatment for all stroke patients, officials attested.

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With $6.3M PCORI Contract, UPMC Health Plan to Study Tech-Based Approach to Chronic Disease

September 25, 2018
by Heather Landi, Associate Editor
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The UPMC Center for High-Value Health Care was recently awarded a $6.3 million contract from the Patient-Centered Outcomes Research Institute (PCORI) to study different care delivery models to improve outcomes for patients with chronic disease and a co-existing behavioral health condition.

The multi-year study will highlight payer-provider collaboration to support individuals with both physical and behavioral health conditions. The UPMC Center for High-Value Health Care is housed within the UPMC Insurance Services Division, which includes UPMC Health Plan, and is part of Pittsburgh-based UPMC health system.

The focus of the study is to better understand how to design systems to manage chronic disease and will compare a technology-centric approach with a team-based, high-touch intervention, according to UPMC.

PCORI awarded the UPMC Center for High-Value Health Care support for a five-year study with a long-term objective to enhance the ability of health care systems to better support individuals with chronic diseases like inflammatory bowel disease (IBD) and behavioral health conditions, reduce variations in practice, connect patients with care that is best for them, and improve meaningful, patient-centered health outcomes.

This PCORI study is related to a recently completed one-year pilot study, which showed that participation in an IBD specialty medical home, a care delivery model that is uniquely designed to provide comprehensive and well-coordinated health services, increases patients' quality of life while decreasing levels of disease activity and use of unplanned care. In fact, the pilot study demonstrated a 50 percent decline in emergency room visits and a 30 percent decline in hospitalizations among participants.

“The early successes of the pilot study are encouraging and now this multi-year PCORI study will allow us to further align the payer and provider to develop long-term benefits and applications in a variety of clinical settings," William Shrank, M.D., chief medical officer for UPMC Insurance Services Division, said in a statement. "The use of technology as a key component of the study underscores the role that emerging trends will play in the future of health care."

Participants who enroll in the study will receive IBD specialty medical home care through either a team-based or tech-based approach.

The team-based approach is a personalized service design that includes gastroenterologists, behavioral health specialists, registered nurses, and health coaches who provide intensive, in-person support and resources. The tech-based approach leverages a digital platform using remote monitoring, digital behavioral interventions, and telehealth to deliver team-based care at the patient's convenience, at home and in the community, with the guidance of health coaches.

“By examining the effectiveness of a 'team vs. tech' approach, we expect that this research will provide insight on the most effective methods to provide both physical and behavioral health care to individuals with IBD and most importantly, a better quality of life for patients both now and into the future,"  principal investigator for the study, Dr. Eva Szigethy, professor of psychiatry at the University of Pittsburgh and senior faculty at the UPMC Center for High-Value Health Care, said in a statement.

Co-investigators of the study include clinical experts from the UPMC Center for High-Value Health Care, the University of Pittsburgh, Mount Sinai Health System in New York, and Brigham and Women's Hospital in Boston.

This marks the fifth PCORI contract awarded to the UPMC Center for High-Value Health Care over the past five years.

 

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Senate Passes Opioid Response Bill with Substantial Health IT Elements

September 18, 2018
by Rajiv Leventhal, Managing Editor
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The U.S. Senate yesterday passed The Opioid Crisis Response Act of 2018, which includes numerous important health IT provisions, by a vote of 99-1.

The bill was originally sponsored by Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.), and includes proposals from five Senate committees and over 70 senators. The House passed its version of the legislation in June and now it’s expected that a committee will be convened to reconcile the differences between the two.

The legislation’s core purpose is to improve the ability of various health departments and agencies—such as the Department of Health and Human Services (HHS), including the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), and the Departments of Education and Labor—to address the opioid crisis, including the ripple effects of the crisis on children, families, and communities, help states implement updates to their plans of safe care, and improve data sharing between states.

There are several key health IT provisions in the legislation, including: enabling the Centers for Medicare & Medicaid Services (CMS) to test various models that provide incentive payments to behavioral health providers for the adoption and use of certified electronic health record (EHR) technology to improve the quality and coordination of care through the electronic documentation and exchange of health information; requiring the use of electronic prescribing for controlled substances within Medicare Part D; facilitating the use of electronic prior authorization within Medicare Part D; and expanding access to telehealth services for substance use disorders.

Regarding telehealth specifically, the Senate version of the bill will allow for payment for substance use disorder treatment services, via telehealth, to Medicare beneficiaries at originating sites, including a beneficiary’s home, regardless of geographic location. It also requires guidance to cover state options for federal reimbursement for substance use disorder services and treatment using telehealth including, services addressing high-risk individuals, provider education through a hub-and-spoke model, and options for providing telehealth services to students in school-based health centers.

Health IT Now's Opioid Safety Alliance—a working group of prescribers, health systems, technology companies, pharmacies and pharmacists, professional societies, and patients advocating for the use of technology to fight illegitimate opioid use—supported the Senate’s passing of the bill. Said Joel White, HITN Opioid Safety Alliance executive director, “We are especially encouraged by the inclusion of commonsense Opioid Safety Alliance-endorsed language in this bill that will remove bureaucratic barriers to vital telehealth services for those suffering from addiction, modernize prescribing practices for controlled substances, and streamline prior authorization claims to improve efficiency while bolstering patient safety. These solutions can make a world of difference both in dollars saved and, more importantly, lives spared."

White did add, however, as Congress convenes a committee to reconcile the differences in the House and Senate-passed bills, lawmakers ought to include the House-passed OPPS Act (H.R. 6082) as part of any final conference agreement, “thereby ensuring that addiction treatment records are no longer needlessly isolated from the rest of a patient's medical history—a practice that has hindered informed decision making and threatened patient safety for too long.”

Indeed, the Senate version of the bill requires HHS “to develop best practices for prominently displaying substance use treatment information in electronic health records, when requested by the patient.”

White also noted, “Additionally, OSA remains concerned about the lack of real-time, actionable data provided to clinicians by states' prescription drug monitoring programs (PDMPs). With lawmakers poised to devote additional resources toward these programs, we should know if taxpayers are getting a return on their investment. We support the inclusion of language that would require an objective study and report on states' use of PDMP technology." 

As stated in the bill, states and localities would be provided with support to improve their PDMPs and "implement other evidence-based prevention strategies.” The bill also “encourages data sharing between states, and supports other prevention and research activities related to controlled substances."

What’s more, another section of the bill reauthorizes an HHS grant program “to allow states to develop, maintain, or improve PDMPs and improve the interoperability of PDMPs with other states and with other health information technology.”

Sen. Alexander, meanwhile, said yesterday he is “already working to combine the Senate and House-passed bills into an even stronger law to fight the nation’s worst public health crisis, and there is a bipartisan sense of urgency to send the bill to the President quickly.”

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Survey: Healthcare Organizations Report Gaps in Disaster Preparedness Plans

September 12, 2018
by Heather Landi, Associate Editor
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As Hurricane Florence churns toward the East Coast this week, disaster preparedness is a timely topic, yet a new survey finds that only 72 percent of healthcare providers believe their organization’s disaster plan is comprehensive enough to cover a variety of disaster scenarios both inside the organization and across the community.

The findings are even more troubling among specialty care providers, such as cardiologists and endocrinologists, who provide critical treatment to individuals with chronic diseases, with just 29 percent reporting that they have a comprehensive disaster plan in place. More than two-thirds (68 percent) of survey respondents were affected by two or more disasters in last five years, according to the survey, yet most respondents doubt their organization’s disaster plans are up to the task.

DrFirst, a provider of e-prescribing and medication management solutions, surveyed 109 healthcare professionals across acute, ambulatory, hospice and home care about disaster preparedness. According to the DrFirst, the results are critical for addressing potential safety issues that affect the health and lives of millions of Americans who are increasingly subject to hurricanes, wildfires, and floods as well as other man-made disasters like digital and criminal attacks.

“The fact that almost 70 percent of the surveyed healthcare providers have been affected by more than two disasters in the last 5 years should be a major wake-up call for the healthcare industry,” G. Cameron Deemer, president of DrFirst, said in a statement. “As we learned in the aftermath of major disasters such as hurricanes Maria and Harvey, natural disasters lead to surging demands for acute and emergency care, especially from the most vulnerable patients who may have been displaced from their homes without medications or critical medical supplies, like oxygen or diabetic testing equipment. We must take measures now to address the critical gaps impacting patient care and safety, such as communication challenges and ready-access to medical records and specialty care providers.”

The survey revealed another key vulnerability—the widespread dependence on disaster communications methods that fail to meet legal requirements for secure communications between medical teams, pharmacies, and patients, according to the survey. Under the federal law known as the Health Insurance Portability and Accountability Act (HIPAA), a patient’s private health information can only be shared with the patient or other providers via secure methods such as password-protected portals and secure messaging.

One-third or more of clinicians surveyed across acute, ambulatory and hospice/home health state that calling by phone is their top method for communicating with pharmacies, EMS units, patients and families, local authorities, and community health providers in times of disaster. Secure messaging and email complete the top three modes of communication.

A striking number of clinicians use regular unsecured text messaging to reach hospitals: more than one-quarter of respondents use this mode to communicate with hospitals during and immediately after a disaster strikes, and 22 percent report using unsecured texting to communicate with patients or their family members. According to the Centers for Medicare and Medicaid Services (CMS), the use of phones for texting of patient health information is only permissible through a secure messaging platform that provides message encryption. Encryption is also required when emailing patient health information.

Healthcare professionals working in hospitals were more aware of the need for secure messaging tools than individuals working in other settings, including specialty care providers. Forty-four percent of hospital-based respondents said that secure, HIPAA-compliant medical messaging is a key requirement of a disaster preparedness plan.

In fact, hospital-based respondents indicated that the only requirements more important than secure messaging were the installation of backup generators in case of power outages (56 percent) and the ordering and maintaining of extra inventory of supplies and medications (52 percent). Yet, specialty providers place the need for including secure messaging at the very bottom of their disaster planning requirements.

Survey respondents also see telehealth is a viable disaster solution, as 45 percent cited telehealth as an effective option to provide care to patients across the community during or immediately after disasters or emergencies. However, more than half expressed concerns that connectivity and other technical issues could impact the reliability of telehealth, and only 27 percent believe their organization has deployed adequate telehealth capabilities.

Another key finding from the survey is that many organizations preparing for an impending disaster still rely heavily on paper, with most advising patients to keep copies of their medical records. Just 40 percent of respondents believe their electronic health record (EHR) has sufficient information available to take care of all patients during a disaster.

 

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