Archive for July 20, 2013

Medical Center Integrates Patient Care with Entertainment

In Miami, Fla., one medical center has taken patient care to a new level — one with the ultimate goal creating  improved interactive patient care.

On June 25, The Bruce W. Carter Veterans Affairs (VA)  Medical Center  launched a new interactive system to provide patients with touchscreen monitors at their bedside that assist with patient care, and provide education tools and entertainment.

With the touch of a screen, patients can watch cable TV, browse the Internet and pick from a library of 30 movies, such as The Avengers and The Bourne Legacy.

So far, more than 230 monitors have been installed in inpatient rooms, some of which provide special adaptive equipment to allow paralyzed patients full access to the new system. Paralyzed patients who don’t have use of their arms and hands may breathe through a special apparatus that can control navigation on the monitor.

To roll out the $2.4 million system, the Miami VA Healthcare System partnered with GetWellNetwork, a company that produces technology that focuses on patient care.

Paul Russo, director of the Miami VA Healthcare System, said patients can watch educational health-care videos on topics such as diabetes, heart disease and other chronic illnesses, but as the medical center continues to add content to the interactive system, more features that will help with patient care will soon be available.

“We’ve chosen four areas at the moment to build our content and questions,” Russo said. “It essentially allows an interaction between the veteran and his care needs through the system.”

The medical center plans to develop interactive patient-to-staff communication through the touchscreens that focuses on pain management, falls management (for patients who are more at risk to falling down), room cleanliness turnover and discharge planning. Russo said the plan is to continue building out the content in the GetWellNetwork system so that when a patient is watching television or a movie, a message will pop up on the screen in defined intervals that may ask a question like, “Are you in pain?”

The idea is that patients will be responsible for responding to the questions when they pop up, so medical center staff can respond and ensure patients receive the care they need.

Although the critical care functionality hasn’t yet been deployed in Miami’s VA medical center, Russo hopes the capability will be available to patients in the near future. TheGetWellNetwork provides the core functionality including the entertainment tools and educational videos, but critical care components, like the pain management function, can be customized and built out for each medical center so they get features more suitable for their respective facilities.

According to Bill Gilroy, director of Mid-Atlantic and Government Solutions for the GetWellNetwork, other VA medical centers including one in Burmingham, Ala., have implemented systems similar to the one deployed in Miami. The company has only worked with the U.S. Department of Veterans Affairs for the last four years, but now also works with 22 VA medical centers.

The GetWellNetwork was purchased for the Bruce W. Carter VA’s regional-based group called the Veteran Integrated Service Network (VISN), which spans eight medical centers including the Miami-based center.

Gilroy said while the touchscreen technology does integrate entertainment with care, the bigger goal is to create improved interactive patient care. “While the entertainment aspect of our system is a nice distraction and an amenity,” he said, “the real value of our system is how we can actually improve care by engaging patients.”

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Some State Health Exchanges Won’t be Finished by Deadline

Obamacare’s health insurance marketplaces go live on Oct. 1, but some of them won’t quite be finished by then.

People should be able to start shopping for health insurance on Oct. 1, the date set for the online marketplaces (also known as exchanges) to open in the Affordable Care Act. But once they find a plan they like, they might have to wait a few more weeks before making any payments. That’s because several state-based marketplaces say they’ll be busy finalizing the payment functions of the exchange after the website launches.

It shouldn’t be a problem — plans sold on the exchanges start on Jan. 1, 2014, so insurers just need to receive payments by then to begin covering people — but it’s yet another reminder that exchange implementation is happening on an incredibly tight timeline with little room for error.

Officials in Oregon and Washington say they expect to still be finalizing their exchange’s payment functions after Oct. 1. Sue Doby, a senior consultant at Oracle, which is building Oregon’s health exchange, says several exchange features might not be ready until Jan. 1, and the payment process is probably the most important.

“A lot of testing still needs to be done,” she says. “We have to prioritize what pieces of product and code can be deferred.”

Likewise, at Washington state’s health exchange, officials said in an email that they expect to have their payment functions ready during December, which is when the first round of premiums would be due for coverage starting on Jan. 1, 2014.

At least six other states are expected to facilitate premium payments through the exchange, according to StateReforum, which tracks exchange implementation. All of the 30-plus federally run exchanges will have insurers bill their new customers directly. That is one less thing for the U.S. Department of Health and Human Services to worry about, after a recent Government Accountability Office report questioned the Obama administration’s readiness to open the exchanges on time.

But even in states like Rhode Island that plan to have their exchange’s payment features ready for the Oct. 1 launch, there is an acknowledgement that it could be delayed, and officials say the state has done some contingency planning in case that becomes necessary. For example, when the consumer purchases a health plan, they could receive a message notifying them that their coverage will be contingent on the insurer receiving payment and a bill will be sent at a later date.

“Our intent here in Rhode Island is to have the functionality for Oct. 1,” says Brian Keane, who is overseeing the exchange’s technical implementation for Deloitte Consulting. “But we do have a contingency plan, and we may go to one of those other options.”

A state’s inability to process payments on Oct. 1 might delay HHS’s decision to officially approve the exchange, but that doesn’t mean they won’t be allowed to open. All 18 state-based exchanges are currently conditionally approved and must receive final approval from HHS, but can be launched with only conditional approval, according to HHS.

“The secretary can allow states to operate their exchanges under conditional approval while they finalize components of their exchange,” an HHS aide said in an email.

This story was originally published by

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LA County Environmental Health Launches $5.7M Tech Project

Thanks to the Los Angeles Public Health Department’s Environmental Health Division’s newest technology project, field employees from 16 county district offices can now record inspection data on a tablet and provide a printed inspection report in the field, according to a press release. And in the next three months, the remaining 15 district offices will come aboard this mobile system.

Using the EnvisionConnect Software Suite, which includes a mobile inspection app, the Environmental Health Division manages environmental health services such as inspections and permits for retail, food, swimming pools and housing programs, as well as smaller programs that deal with theaters, pet stores and self-service laundry facilities.

One phase of the project involved migrating more than 107,000 facility records and 117,000 permit records into the EnvisionConnect database, and another part of the migration process includes the county’s deployment of 300 tablets to meet its automation goals.

In the near future, the county is set to implement an EnvisionConnect portal to allow the public to submit online complaint forms and other applications. Through the portal, the public will have access to inspection results and closures.

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Several Agencies Linked in ACA ‘Hub’

Characterized as “one of the most complex computer projects in the government’s history” by Bloomberg, the technical aspects of Obamacare are far from settled. Some say that the success or failure of a $267 million computer system called the Hub, central to Obamacare, will likewise determine the success or failure of the Affordable Care Act (ACA) as a whole.

According to a Bloomberg report, the system links databases from seven federal agencies, including the Internal Revenue Service and the Peace Corps, to establish who is eligible to purchase health insurance and who can have their coverage subsidized.

Medicare administrator Marilyn Tavenner will oversee the hub, and expects system construction and testing to be complete by September 1 — one month before government-run health insurance exchanges open for business. Officials have indicated that all parties using the hub must adhere to strict rules and standards to ensure proper security.

“We have been engaged in a great deal of discussions to make sure these standards are incredibly strong,” said Chiquita Brooks-Lasure, deputy director of the Center for Consumer Information and Insurance Oversight.

But not everyone is convinced. Some lawmakers feel the system’s size and contents will make it a target for hackers. Others warn that the government may misuse the information.

In prepared comments before a congressional hearing on July 16, Tavenner defended the system, citing a “robust security monitoring system that reviews all security events, tools, requirements, and network device logs to identify, assess, and manage vulnerabilities and threats.”

The Congressional Budget Office expects roughly seven million Americans to seek coverage through the exchanges.

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Texas Groups Promote Health Exchange Without Help From State

Texas officials have declined to establish a state-based health insurance marketplace, a major provision of the federal Affordable Care Act. So private organizations are working to educate Texans about coverage options through the federal health insurance exchange, which opens on Oct. 1.

Of the more than 6.3 million uninsured Texans — the state has the country’s highest rate of uninsured residents — almost half will be eligible to buy insurance through the federal exchange, an online tool for coverage shopping.

But Texans suffer from a “general lack of knowledge” about the law, said Allison Brim, a director at the Texas Organizing Project, one of several groups working to reach uninsured families before the federal exchange’s rollout.

“Folks just don’t have a lot of information about the exchanges and what their options will be,” she said.

The Texas Department of Insurance has made no extra effort to publicize the federal exchange, said John Greeley, an agency spokesman. In 2010, it conducted a federally financed campaign about health insurance options but has done nothing comparable since, he said, adding that those with questions could use the department’s website or telephone service.

Brim criticized the state for not promoting the exchange, saying its help would make it possible to reach all eligible Texans by October.

“The state has, as far as we know, done nothing to spread the word to uninsured Texans about the exchanges or the Affordable Care Act,” she said. “It leaves a mountain of work for us.”

In response to questions about publicizing the exchange, Lucy Nashed, a spokeswoman for Gov. Rick Perry, wrote in an email that the state was “not interested in implementing Obamacare, including the exchange.”

On July 10, a division of the U.S. Department of Health and Human Services awarded about $9.9 million to Texas community health centers to make people aware of their options.

The department will also finance at least two “navigators” — organizations intended to guide people through the exchange — per state. Texas’ navigators will receive about $8 million.

But Jacob Cortes, the lead organizer of the group Austin Interfaith, said that might not be enough. “The private sector would have to step up,” he said.

Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, said navigators were just one federal resource. The agency also dispatches officials from its Dallas office and Washington headquarters to speak with health workers and organizers in Texas.

And it collaborates with local initiatives, Bataille said, including groups like Blue Cross Blue Shield, which started a Be Covered campaign; the Texas Organizing Project; and Enroll America, which promotes the health care act.

Be Covered has joined with churches, museums and other organizations in every Texas county to distribute literature on obtaining insurance, said Michelle Riddell, a Blue Cross Blue Shield of Texas spokeswoman. 

The Texas Organizing Project and Enroll America are canvassing and organizing community meetings where Texans can get more information.

Reaching exchange-eligible people will not be easy, said Mimi Garcia, Enroll America’s Texas director. She added that groups like hers will have to work beyond January 2014, the deadline for Americans to obtain coverage.

“I would love it if we could get everybody enrolled in the first year and that would be it and we would be done,” she said. “But that’s not going to be the case.”

Cortes said ambiguity about the federal exchange — including yet-undetermined providers and premiums — make it difficult to spread a clear message.

Texas’ size poses another challenge, Brim said, because in rural areas “we just can’t reach as many people as fast.”

“There will be some folks,” she added, “who just don’t get the word.”

This story was originally published by The Texas Tribune, and was produced in partnership with Kaiser Health News.

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