Community Health Information Collaborative Awarded Social Security Administration (SSA) Contract, MEDNET Technical Partner for NHIN Project

February 1st, 2010

February 1, 2010 - The Community Health Information Collaborative’s Health Information Exchange (HIE-Bridge) in Minnesota was today awarded a contract by the Social Security Administration (SSA) for CCD clinical data exchange over NHIN, the Nationwide Health Information Network. MEDNET, as technical partner to HIE-Bridge, will implement the NHIN connectivity, bi-directional clinical data exchange (CCD) and provide technical implementation for this SSA contract.

More on this NHIN project and HIE-Bridge MEDNET SSA award can be found on the Social Security Administration’s website HERE


HIELIX AND MEDNET TO DELIVER EDUCATIONAL WEBINARS ON HEALTH INFORMATION EXCHANGE IN FEBRUARY, 2010 - DUE TO OVERWHELMING DEMAND

January 20th, 2010

MEDNET and Hielix jointly announced they will again partner to deliver the free HIE educational webinar series in February, 2010, due to overwhelming demand. MEDNET and Hielix collaborated and delivered the HIE educational Webinar series in December, 2009 to extermely high demand and attendance, on the subjects of HIE solutions, process, organizational structure and HIE technology solutions.

Attendees can register for the Free Webinar Series by clicking the links below:
Webinar 1: HIE Building Blocks and HIE 101 - February 17th - 2pm EST
Webinar 2: HIE Infrastructure and Business Models - February 17th - 3pm EST
Webinar 3: NHIN the Nationwide Health Information Network - February 18th - 2pm EST
Webinar 4: HIE Growth and Sustainability - February 18th - 3pm EST


Health Information Exchange (HIE) and Change

January 18th, 2010

By Dale Emerson, COO of Hielix

HIE is not about technology - technology certainly helps but HIE is more about change. David Blumenthal, National Coordinator for Health Information at Department of Health and Human Services recently stated “People working in health IT should think about electronic health records, not as a technology project but as a change management project. Components of Meaningful Use include sociology, psychology, behavior change and the mobilization of levers to change complex systems and improve their performance”. Healthcare is now facing one of its biggest challenges in history as they convert to electronic records. The benefits seem obvious - better care coordination, lower costs, and higher quality of care. So why are healthcare providers not rushing to embrace HIE? It seems that many of them have been waiting for this whole computer fad to pass and for paper and pencil to resume its natural place as the leading technology. However, the more likely cause is people’s natural resistance to change.

Change forces to people to adopt new ways of doing their jobs. Routine in work related tasks has a calming effect on workers. Workers like to know what is expected of them and they take pleasure in knowing how to do their jobs satisfactorily. Whenever change is introduced into the workplace, it disrupts the normal flow of work and may cause people to resist the change. Even when workers understand the rational for the change and may even agree with it logically, emotionally they will remain skeptical.

Frequently, workers are not shown how the change impacts them directly. Will I be able to perform the new work tasks as well as I could the old tasks? If I don’t perform as well, will that impact my employment? Will I still have the same power and prestige in the organization? Will the change eliminate my job? Will I still be working with the same people who I know and trust? Does my superior know how the change will impact them and what does that mean for me? Faced with these questions, it is easy to understand why HIE has taken so long to gain traction. In order to help people with change, we offer six key concepts that will help make the transformation easier.

- Create a compelling vision that people can easily understand and embrace.

- Be open, honest and transparent in how you relate to your staff. Good communications is the most important attribute you have to help you manage through the process.

- Provide individual leadership and it starts with you. Change affects everyone, including you so lead by example.

- Change involves risk. Follow a sound change management process to reduce these risks and improve the probability of success.

- Be prepared to stay committed through the whole process. Any change process will have ups and downs and will meet some level of natural resistance so you have to be prepared to follow the plan even when it all seems to be so hard.

- Get the right resources to help you. You will certainly need support internally and maybe externally. Find the early adopters and get them to help lead the change effort. Reach out to a neutral, external resource that can help you change and offer an unbiased view of your world.

Following these simple tips can really accelerate the adoption of HIE in your organization. While these tips are simple in concept, they can be very difficult in reality so understand the challenge, be prepared to face it and your odds of success will improve.


The Impact of Medicaid and Administrative Transactions on NHIN

January 18th, 2010

By John Fraser, MEDNET

The federal government is continuing to develop NHIN, the Nationwide Health Information Network. NHIN has been focused on sharing clinical information between hospitals, clinics and federal agencies. Recently, however, the design of two new standards for NHIN, related to Medicaid insurance eligibility and Medicare quality reporting, has been of focus.

Medicaid is a government program for low income Americans, partially funded by the federal government, and administered and run by each state / territory (there are 54 current Medicaid systems today). Each of these 54 Medicaid programs run eligibility systems to help providers check Medicaid insurance eligibility, ensuring providers properly bill and provide appropriate services for patients. Providers check Medicaid eligibility frequently, since many Medicaid enrollees enter and leave the Medicaid program monthly. Given this turnover, and the number of different Medicaid systems, it has been challenging for providers to directly check Medicaid eligibility within their states and in bordering states.

In 2005, the Center for Medicaid and State Operations (CMSO) within the Department of Health and Human Services (DHHS) developed the MITA program to directly address this issue. The MITA program is a collaboration of all the state Medicaid systems and CMSO to “establish national guidelines for technologies and processes that can enable improved program administration for Medicaid enterprises.”

One MITA-sponsored project is to develop and prototype a national NHIN service that would allow providers to quickly check a patient’s Medicaid status using a single system. This single system service would allow Medicaid providers a secure way to check any one of the 54 Medicaid systems with the click of a mouse (using the Internet). All a provider would need is an Internet connection, proper security credentials and connectivity to a health information exchange that has NHIN connectivity. Once installed, providers could see such benefits as improved patient care, improved cash flow, and an overall improved process from the Medicaid single system service.

Seonho Kim, Chief Architect at MEDNET, is leading the NHIN planning group to develop and test this new Medicaid single system service. MEDNET and Seonho will be demonstrating the Medicaid MITA NHIN service with the Department of Health and Human Services in the upcoming HIMSS conference in Atlanta in March. Please feel free to stop by at the Interoperability Demonstration area to see how this new Medicaid system works, and impact this system would have on healthcare.


MEDNET supporting Federal Health Architecture and NHIN CONNECT

January 12th, 2010

MEDNET, a leader in NHIN connectivity and HIE applications, is proud to support the Federal Health Architecture and NHIN CONNECT (NHIN CONNECT Open Source) program and project, as well as be listed as an active partner for NHIN CONNECT.

Please visit the new CONNECT Open Source website for more information about the overall project, partners, and NHIN CONNECT at www.connectopensource.org


HIEs and Security, and the Impact of Breach

December 15th, 2009

- By Jesse Erdmann

Once again there is news of another data breach (article here) in the health industry. This time around, a Connecticut company by the name of Health Net reported the loss of a disc containing health information, social security numbers and bank account information of 446,000 patients, as well as potentially another two laptops.

This news comes on the back of a November survey and report  (article here) by HIMSS, paid for by Symantec, that only 67% of healthcare encrypts data transmissions, and less than half encrypt the data stored on disk. Obviously, if Health Net had encrypted their data properly, the loss of the disc and laptops would not be as significant a loss (due to the difficulty, if not impossibility, of the data being accessed by the thieves). Another important thing to note about the survey is that Symantec is one of the largest vendors of security software, thus the numbers reported may need to be taken with a grain of salt.

However, there are some things to take away from this breach and HIMSS report. One such takeaway is that while there is a lot of additional complexity in securing health data (that needs to be handled by those that understand the industry), there are well-established resources that can cover the basics for health organizations. There are also accreditations, like the Certified Information Systems Security Professional, CISSP, which can be used to vet potential employees or benchmark training for employees in key security positions.

A general rule of thumb for health organizations would be to hire a person to manage organization-wide security issues. Key deliverables from such a person would be to write and deliver a security policy for the organization, purchase or recommend non-domain specific security software and be responsible for the training of all employees that handle sensitive data. Special emphasis should also be placed on the training of software engineers and system administrators. With proper policies, training, and oversight, health organizations can protect themselves and their data from breach or loss.


Quality Reporting, Stimulus Dollars and NHIN

December 15th, 2009

-By John Fraser

Did you know you’ll need to report certain quality measures to Medicare in order to collect stimulus dollars starting in January 2011? Do you know how to report quality measures, or what types of quality reporting will be required?

While the final regulations have yet to be released, they will deal with the type of information that needs to be reported, how it will be reported and on what frequency. We expect the quality regulations will be based on the current Physician Quality Reporting Initiative, or PQRI system.

In 2006 a new federal law established what is now known as the Physician Quality Reporting Initiative, or PQRI. PQRI reimburses most types of physicians, practitioners and therapists up to 2% of Medicare billings if they report on PQRI’s 200 quality measures, which change annually. Each measure is detailed in the regulations (for example the 200+ measures in the 2010 PQRI program) and each measure include a reporting frequency requirement. Providers currently have several options for getting this information to CMS — these options include reporting directly to CMS or using a CMS certified PQRI registry.

While the final rules for stimulus-required reporting have not been released, CMS has publically stated an interest in using NHIN, the Nationwide Health Information Network, for quality reporting purposes. We therefore expect some type of NHIN reporting system to be developed in time for the 2011 stimulus-required reporting deadlines.

As part of the stimulus bill, providers will be required to report quality (PQRI) information to CMS in order to collect stimulus dollars. This requirement could mean that providers would be encouraged to use NHIN, with current submission mechanisms supported (adding an NHIN option to the mix). This will mean that providers who have access to NHIN will have a new, streamlined option for submission of quality measures.

For example, health information exchanges (HIE) that install an NHIN connection could add quality reporting capabilities as a core service for their HIE. This NHIN-based reporting would drive better patient care, as more providers collect and submit quality data, while modifying care to improve quality metrics. EMR vendors who add NHIN quality reporting will also be able to more easily report to CMS.

Overall, NHIN quality reporting to CMS offers multiple benefits, including improved workflows for physicians, more comprehensive quality reporting and compliance with stimulus requirements. By utilizing NHIN for quality reporting, providers will comply with, and therefore collect, all of the new stimulus dollars due them.


MEDNET’s Seonho Kim appointed to lead CMS NHIN Medicaid Eligibility Project

December 11th, 2009

Seonho Kim, Chief Architect of MEDNET, has been appointed to lead the NHIN Team to address the Centers for Medicare and Medicaid Services (CMS)’s requests to enable Medicaid Eligibility Verification through the NHIN.

The goal of this team effort is to develop new NHIN specifications for CMS MITA (Medicaid Information Technology Architecture) Medicaid Eligibility Verification. As team lead, Seonho Kim will work with other NHIN Specification Factory team members and drive the development of a technical solution to address CMS’s request.


Be sure to attend Education Session 246 on NHIN - HIMSS 2010 - Atlanta

November 30th, 2009

Make sure you attend Education Session 246 at HIMSS 2010 Atlanta to hear John Fraser, CEO of MEDNET, speak about NHIN and Federated Identity Management!

Thursday, March 4, 11:15 AM - 12:15 PM Room B405

HIMSS10 » Education » Healthcare Identity Management and Role-Based Access in a Federated NHIN: http://bit.ly/6xfmeu


HIE Security and Internal Vs. External Usage

November 17th, 2009

- By Jesse Erdmann

This month, Jesse Erdmann, Certified Information Systems Security Professional (CISSP), explains how to segregate services for internal versus external usage, as well as approved HIE to HIE communication versus public dissemination of information.

Security systems, like castles of yore, are designed in concentric circles of protection. Each ring should be more restrictive as to whom is allowed access and more difficult for attackers to bypass. On the outermost ring, everyone is allowed as long as they don’t misbehave and there are some general controls as to what the milling masses have access to. In our castle example, people from outside of the castle are allowed in to visit shops and trade services, but the guards generally frown on people fiddling with the lock to the stores or treasury. In a network security scenario, the same principles are applied in such a way that anyone can access a web server via the standard web protocol, but they cannot access the administrative protocol. Users that display certain poor behavior, port scanning, password guessing, etc can be sanctioned as appropriate.

In the next ring, privileged users are granted access to a few more services, but have a few more hurdles to clear. Merchants and other select persons have their housing and stores within the next ring of the castle. In the network, users from specific addresses on machines that provide an acceptable digital signature are allowed read only access to restricted data sets. For instance, an organization might select reportable, de-identified data for the CDC from their master database and publish it to a restricted, smaller database outside of their core infrastructure. When a machine from the approved CDC address range that provides digital credentials matching the appropriate certificate from the CDC it is allowed to query the restricted database for the de-identified case information. Likewise in an HIE to HIE setting, specific machines from HIEs that have established business agreements could access whatever information has
been approved for exchange without allowing those business partners access to the innermost core network infrastructure.

Finally, only the most privileged users are allowed access to core infrastructure. To conclude the castle example, only the king, his family, personal guests and personal guard are allowed access to the throne room. In the network example, machines access core infrastructure can be required to have physical access to the local network, a non-internet routable address, provide appropriate credentials and require the user of the machine to provide their own personal credentials. None of these requirements on their own is enough to grant access, but all of these factors combined can provide a high enough level of certainty to allow access. Depending on the needs of the organization, different users can be granted access as appropriate for their role.

It is important to keep in mind when designing a security system that traditional security methodologies are not all that different from modern digital security methodologies even though the details of implementing the methodologies are drastically different. Prized assets should be positioned nearest to the center of the security infrastructure with the most layers of controls and the fewest people with access. As assets become less valuable and need to have greater access the controls can be peeled back. Also, never lose sight of the fact that a network’s digital security is only as strong as its weakest point, including physical security. An attacker with physical access can, with time, bypass practically any software controls put in their way.