Healthcare at Home: The Rowan Report

CMS contractor Abt Associates is soliciting nominations for patients with current or past experience with Home Health Agency Services to participate on a Technical Expert Panel. Caregivers of such patients can also be nominated. Abt explains that patients and their caregivers are being sought because they can provide unique and essential input on quality measures based on their own experiences with these care areas. Patients and/or caregivers’ identities can be kept confidential if requested. Patient nominees should submit a completed and signed TEP Nomination Form and letter of interest as described below but are not required to submit a curriculum vitae.[Details are provided in this article about the expected requirements, including time commitmentsexpected by CMS of Technical Expert Panel Home Health nominees.  The project title is noted (“Development of Potentially Preventable Hospitalization Measures for Home Health Agencies”) and an overview of its scope is provided.]

Who can nominate?
Individuals with expertise in the relevant fields including clinicians, statisticians, quality improvement, methodologists, and pertinent measure developers, as well as consumers, are encouraged to submit nominations. Person and family membership on TEPs is a very important part of the measure development process. TEP members are chosen to provide input to the measure contractor based on their personal experience and training. It is critical to the success that TEP members represent a diversity of perspectives and backgrounds.

Project Title: “Development of Potentially Preventable Hospitalization Measures for Home Health Agencies”

Dates:

• The TEP nomination period opens on January 22, 2018 and closes on February 22, 2018. Please submit all nomination materials by the closing date.

Project Overview:

The contract name is Outcome and Assessment Information Set (OASIS) Quality Measure Development and Maintenance Project. The contract number is HHSM -500-2013-13001I, Task Order HHSM-500T0002. As part of its measure development process, CMS asks contractors to convene groups of stakeholders and experts who contribute direction and thoughtful input to the measure contractor during measure development and maintenance.

Project Objectives:

• To develop an approach for defining potentially preventable hospitalizations (PPH) for the home health setting
• To develop potentially preventable hospitalization measures for the home health setting, including standardized items and specifications such as inclusion/exclusion criteria, and patient and facility characteristics–factors associated with outcome measures (risk adjusters).

TEP Requirements:

A TEP of approximately 9-11 individuals will be selected to provide input. The TEP will be composed of individuals with the following areas of expertise and perspectives:

• Subject matter expertise: Home Health
• Consumer/patient/family perspective
• Performance measurement with respect to hospitalizations
• Claims-based quality measure development
• Quality improvement
• Research methodology, including statistical analysis and risk adjustment
• Data collection and implementation perspective
• Health and health care disparities

Potential TEP members must be aware that participation on the Technical Expert Panel is voluntary. As such, individuals wishing to participate on the TEP should understand that their input will be recorded in the meeting minutes. Proceedings of the TEP will be summarized in a report that is disclosed to the general public. If a participant has disclosed private, personal data by his or her own choice, then that material and those communications are not deemed to be covered by patient-provider confidentiality. If patient participants (only) wish to keep their names confidential, that request can be accommodated. Any questions about confidentiality will be answered by the TEP organizers.

All potential TEP members must disclose any current and past activities that may pose a potential conflict of interest for performing the tasks required of the TEP. All potential TEP members should be able to commit to the anticipated time frame needed to perform the functions of the TEP.

TEP Expected Time Commitment:

• One hour project orientation TEP webinar in March 2018
• Two-hour measure development TEP webinar in April 2018
• One day, in-person TEP meeting in May 2018
• Two-hour, follow-up TEP webinar mid-Summer 2018
• Potential email correspondence to address specific items that may come up during public comment posting of QMs

Required Information:

• A completed and signed TEP Nomination form (see below).
  • The nomination form includes a consent and confidentiality statement.
• A letter of interest (not to exceed two pages) highlighting experience/knowledge relevant to the expertise described above and involvement in measure development.
• Curriculum vitae or a summary of relevant experience for a maximum of 10 pages.
  • Patient participants are not required to submit a curriculum vitae and may elect to keep their names confidential in public documents.

The Nomination forms and proposed TEP Charter can be downloaded from this ZIP file: Development of Potentially Preventable Hospitalization Measures for Home Health Agencies (HHAs) [ZIP]

If you have difficult opening the ZIP file, go to the TEP information page and scroll to the bottom: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/TEP-Currently-Accepting-Nominations.html

If you wish to nominate yourself or other individuals for consideration, please complete the form and email it to: HH_QM_Comment@abtassoc.com by February 22, 2018.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

By Tim Rowan, Editor & Publisher of Home Care Technology Report, and Elizabeth Zink Pearson, Esq.

When you look at the entire landscape of Medicare regulations, a cloud parts and regulators’ ultimate goal appears. CMS is trying to push the entire Post-Acute Care sector toward patient-centered care, patient engagement, patient outcomes. According to home health attorney Elizabeth Zink Pearson, Esq., the array of regulations leading to this conclusion include new Home Health Conditions of Participation, the IMPACT Act, new data-based foundations for evidence-based medicine, new data-based targets for treatment plans, and stepped up audits to force clinical compliance. [Details about the patient assuming a priority position under the current CMS rendering of Home Health Conditions of Participation (CoPs) are spelled out in this article.]

“Each one of these regs is part of the plan to put the patient at the center of the care experience,” Pearson told assembled agency owners and clinical managers at this week’s “Compliance Cruise” somewhere in the Caribbean. “Especially keep an eye on the auditors. They are more aggressive than ever. I have already had a client pushed to the brink of being forced out of business over failure to comply with emergency preparedness requirement.”

While waiting for final Interpretive Guidelines — with release date still unknown — all we have, Pearson said, is the vague admonishment that CMS expects the “highest level of care.” “There is no guidance about how they are going to judge that,” she quipped. “The good news, if there is any, is that they said they will not sanction, only administer deficiency citations, while they ‘expect compliance.'”

Surveyor priority #1: patient rights, 484.50
A new protocol sent to state surveyors on January 12, with an effective date Saturday, January 13, places the Patient Rights condition of participation as the top surveyor priority, followed closely by the need to scrutinize your comprehensive patient assessment. Priority three of the top eight is care planning, service coordination, and quality of care, treated as a single survey category. The remaining five, in order, are:

1. Skilled Professional Services
2. HH Aide Services
3. Compliance with Federal, State, and Local Laws and Regulations
4. Organization and Administration of Services
5. Clinical Records

Time burden, using CMS math
CMS estimates that the newly required patient rights conversation should add no more than five minutes to your assessment visit. “I’m looking at 15 minutes at least,” Pearson declared, offering a spider’s web of interconnected reasons. “Prior to, or at the beginning of, your first visit, you must inform Medicare beneficiaries that you are going to explain their rights to them. Then you explain those rights, to the patient AND to his or her caregiver or legal representative, or patient advocate. This means you have to know before you begin the legal status of that son or daughter or neighbor or spouse in the room. If you hand them a printed sheet explaining their rights, you still have to do it verbally.

“Be aware though, the representative who gets to hear about the rights is is not necessarily the same person as the patient’s designated HIPAA-authorized patient representative. In some cases, you may be required to explain rights without disclosing PHI. You may need to ask one representative to leave the room and another to come into the room after you explain patient rights and before you begin OASIS questions.

“That’s just the beginning.” In cases where language is a barrier, not just English proficiency but also low healthcare literacy, you may have a third entity entering the equation, the interpreter. Is the interpreter a family member? Does he or she have HIPAA authorization? Is he or she also a legal representative? The patient has the right to choose his or her own interpreter but also has the right to have one provided, by you, at no charge. Online services are acceptable for this service.”

The regulations also specify clinicians use “plain English” and avoid technical medical terminology. (You will know when you have crossed that line when the daughter/interpreter/legal representative says “Hunh? I can’t translate that.”) This means every staff member who might ever be in the position of explaining patient rights must be put through communication training. Some professionals simply get so accustomed to their industry’s jargon and acronyms they do not even realize when they are using it.

In order to document that patient rights training has taken place prior to care and prior to assessment, it will be necessary for your EHR point-of-care software to affix a date and time stamp, two of them actually. One as the patient rights conversation commences and a second one as the usual visit activities start.

“There is a circumstance where it is permissible to do the rights teaching during the second visit,” Pearson added. “In a case where the assessing clinician discovers a communication barrier for the first time when she arrives for the first visit, she may complete the OASIS assessment and initial treatment. However, efforts must be made by the intake, supervisory, and scheduling staff to avoid this. This pre-visit preparation helps to satisfy two regulatory requirements. You are more likely to have the right interpreter available at visit number one, plus you will know which printed materials your assessing clinician must bring. You see, another requirement is that you must have your patient rights documents printed in every language you are likely to encounter in your service area.”

She added that you should document the steps you took to achieve compliance with this requirement. Have patients sign that they received the explanation of rights. Have their personal representatives and HIPAA-authorized representatives sign too. You will need to get those signatures before you begin providing care.

Your Notice of Privacy Practices needs to be on paper and on your web site in the 13 most common languages in your area. It is a good idea to do this soon because surveyors are likely to check your web site for compliance with this requirement. It is also recommended to have Low English Proficiency forms available. Even your marketing materials must be printed in the three most common languages in your area. And they must be aimed at an 8th to 10th grade reading level.

Other rights
Your patients need to be informed that they have a right to complain about your services, provided or missed, or lack of respect shown them. You have to tell them how their complaint will be handled. If their care changes or if they are going to be discharged, they have a right to participate in and consent to your decision “in advance of and during treatments.”

Ask your EHR vendor. Can my software help customize my visit notes to the new requirements?

In general, your new task is to engage patients as much as possible on every step of the way. Your plan for these changes, including your compliance objectives, must be in process now but are not due until July 13. Focus on your high-risk areas such as IV therapy or problem-prone patients. Lastly, be sure your governing board is involved. They are ultimately responsible for your compliance efforts and success. You have to make sure they understand their responsibility in this regard.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

(January 23, New York, NY) – Swift Shift, a mobile-first workforce management platform for the home healthcare industry, is launching Boost – a recruitment solution for home healthcare agencies to address the nursing shortage. Boost helps agencies re-engage their inactive workforce with targeted, relevant cases, thereby shortening the recruitment funnel.By shifting the focus from job boards, digital ads, and other less targeted approaches to recruitment, Swift Shift’s Boost opens new pathways for agencies and nurses to connect based on value and relevance. 53% of the three billion dollars spent on recruitment in  Whome healthcare is allocated to re-engage nurses and caregivers who have already been recruited, vetted, and hired and have since become inactive. This leaves only 47% of home healthcare recruitment budgets attributing to net growth.[Two additional articles featured in this issue’s Vendor Watch are: one on BlackTree Healthcare Consulting  and its becoming a certified Forcurai implementation partner; and another on NASDAQ Chair Michael R. Splinter  being appointed to connected software firm Welbe, Inc.in Jan. 2018.]

Lack of transparency about case allocation and long recruitment processes account for 50% of the drop off in candidates. Through Boost, nurses and caregivers now discover available cases according to their work preferences, skill set, available hours, and location. Convenience and earnings are maximized for applicants with faster approval times through on-demand, in-app applications.

“We spent two years studying the recruitment metrics and challenges of Home Healthcare agencies and another year building a platform that delivers both what nurses and caregivers are looking for and also increases the productivity of recruiters,” said Assaf Shalvi, CEO and Founder of Swift Shift. “The best operators in the Home Healthcare market realize that their growth is dependent on their ability to hire and retain staff. Boost is a tool that is built to deliver exactly that.”

Value for Home Healthcare Agencies
The company states that Boost reduces recruitment costs and increases nurse lifetime value by:

• Decreasing time spent screening applicants and higher conversions with targeted cases to relevant candidates
• Shortening recruitment funnel with rich, pre-vetted profiles that include experience, rating, certifications and endorsements
• Reducing “bench time” once application is complete with one click approvals leading to work  assignments in less than 24 hours
• Longer tenures/higher retention of nurses with features such as in-app chat, multiple case application and management
• Real-time operational data insights empowers agencies to make data driven operational decisions
• 100% success based recruitment tool is the first and only pay for performance model in the industry

Value for Nurses and Caregivers
Boost creates a meaningful engagement for nurses and caregivers by:

• Reducing travel time and expenses with location-based technology
• Enabling nurses and caregivers to control their work schedule from a mobile-app
• Offering in-app messaging to streamline communication with agencies
• Empowering nurses and caregivers to apply for jobs that they actually want

About Swift Shift
Swift Shift, a HIPAA-compliant workforce recruitment and management platform for home healthcare enterprises, connects home healthcare providers with qualified caregivers and nurses to address the national nursing shortage. With real-time digital communications between provider and their staff, Swift Shift is pioneering mobile-first solutions to revolutionize recruitment and management processes in home health. Swift Shift’s nurse-facing mobile app, leverages cloud technology to offer home healthcare field staff control over the visits they apply for from the palm of their hand. Swift Shift clients include BAYADA Home Health Care, Interim HealthCare, Aveanna Healthcare, and more. Founded in 2014 by entrepreneur and Swift Shift CEO, Assaf Shalvi, the company has raised $5.7 million in funding. Swift Shift is headquartered in New York City.

BlackTree Healthcare Consulting Becomes Certified Forcura Implementation Partner

January 25 – Jacksonville, Florida – Forcura, a healthcare technology company focused on streamlining document workflow and secure communication for home health and hospice organizations, today announces that BlackTree Healthcare Consulting (BlackTree) is now a certified Forcura implementation partner.

BlackTree Healthcare Consulting is a leader in revenue cycle management, back-office outsourcing and clinical consulting for the post-acute healthcare industry. BlackTree will provide strategic implementation and ongoing analysis, reporting and optimization to Forcura clients. BlackTree’s people and process expertise combined with Forcura’s industry-leading document workflow and communication technology solutions will enable post-acute care providers to optimize revenue cycle management, back-office administration and clinical team communication.

“BlackTree and Forcura share a common vision for the industry, have similar cultures and a passion for great work,” said Nick Seabrook, BlackTree Healthcare Consulting Managing Director. “As a certified Forcura implementation partner we have a real opportunity to drive positive revenue cycle management and workflow for the entire home health and hospice industry.”

“BlackTree’s commitment to the home health and hospice industry and expertise in optimizing people and process to drive productivity is the perfect complement to Forcura’s technology solutions,” said Craig Mandeville, Forcura CEO. “Together we can help our clients grow their businesses and focus on what they do best: take care of patients.”

BlackTree’s consulting team has been through an extensive Forcura training program and has been a consulting partner with many existing Forcura clients. BlackTree’s consulting team provides Forcura customers with a solid operational efficiency understanding and a comprehensive roadmap that has allowed them to leverage the Forcura platform to drive significant ROI. The typical Forcura client that has utilized BlackTree through implementation is realizing over 450% return on their administrative technology investments.

About BlackTree Healthcare Consulting
BlackTree Healthcare Consulting provides revenue cycle management, outsourcing and clinical consulting services exclusively to the healthcare industry. It is BlackTree’s goal to partner with healthcare organizations to assist them in better achieving financial, operational and clinical goals through the delivery of exceptional client-centric consulting services.
blacktreehealthcareconsulting.com

About Forcura
Forcura, a leading healthcare technology company headquartered in Jacksonville, Florida helps post acute healthcare organizations deliver better patient care, improve cash flow and reduced administrative expenses through document management and HIPAA-secure communication solutions. The company has recently received awards for Fastest Growing Company, Best Use of Cloud Computing, Best CEO and Best Places to Work. forcura.com.

Nasdaq Chair Joins Connected Care Software Firm Wellbe
MADISON, WI — January 25 – Madison-based health tech company, Wellbe Inc., announced today the appointment of Michael R. Splinter to its board of directors. Splinter is chairman of the board at Nasdaq, Inc. and general partner at WISC Partners. Splinter, an electrical engineer and innovator, has played a major role in driving advances in the high tech industry, with more than four decades of executive leadership experience at organizations including Applied Materials, Inc. and Intel.

During his 12-year tenure with Applied Materials, Inc., Splinter served as chairman and CEO. Over his 20 years with Intel, he was executive vice president of sales and marketing, and executive vice president of the Technology and Manufacturing Group. Throughout his career, Splinter has demonstrated an abiding commitment to shaping a better world. He has been recognized for this commitment as the 2013 recipient of the Robert Noyce Award, the semiconductor industry’s highest honor. In 2015, he was awarded an honorary Doctorate of Engineering by the University of Wisconsin.

Wellbe founder and CEO James Dias welcomes Splinter: “We’re extremely pleased to have Mike joining our board of directors. He brings an extraordinary perspective on the transformational power of technology to shape the human experience.” Splinter arrives as healthcare consumers’ increasing expectations for ease and convenience are converging with payers’ increasing demands for lower costs and better outcomes. Dias explains, “Mike’s focus on growth strategies and the development of leading technologies driving major industry transitions, particularly his leadership in the mobility revolution, will be key in guiding Wellbe’s ongoing efforts to address these major healthcare industry challenges.”

Splinter adds, “I am very excited to be joining the board of Wellbe to support the positive changes technology can bring to healthcare, and to dramatically improve patient outcomes while reducing costs. It is clear Wellbe’s products will be clear enablers to those solutions. I look forward to working closely with James and the outstanding team at Wellbe.”

About Wellbe
Wellbe enables high-performing health systems across the U.S. to advance the coordination and quality of care. Founded in 2009, Wellbe’s 2nd generation Connected Care platform engages and empowers thousands of patients each day to participate as active partners with their providers across an episode of care. This coordinated participation in their treatments and procedures delivers higher satisfaction, fewer setbacks, better outcomes, and improved efficiencies. Automated workflows and integrated pathways drive smart systems of care to reduce administrative and operational costs and increase care team productivity.

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

UnityBPO has clients throughout the United States and specializes in providing clinician and patient engagement, managed, professional, and telehealth services and solutions to health care entities including home health and hospice agencies, physician practices, long-term care, and integrated health care systems.

“We understand the business of home health and recognize that a truly customized approach to each agency’s needs is the best way to ensure that providers and clinicians achieve both patient satisfaction and agency productivity goals,” said UnityBPO CEO, Stephen V. Wade.  “We believe VNSNY’s investment in a robust EHR will significantly enhance the quality of care in serving the people of the 5 boroughs of New York.  We are proud to partner with the IT team at VNSNY. Together, we will help VNSNY clinicians use technology to care for their patients and minimize disruption during this complicated transition.”

“We are pleased to have partnered with UnityBPO,” said Michael Orlando, Director of IT Services for The Visiting Nurse Service of New York.  “We are able to see that the knowledge they bring will make this transition easy for our clinicians and allowing us to focus on other innovations within our IT offerings to better serve our clinicians and patients.”  The two organizations have been collaborating on the partnership in preparation for the transition for several weeks.

About UnityBPO
Serving over 100,000 clinicians in over 35 states, UnityBPO is the premier homehealth/hospice technology company.  UnityBPO creates value for Home Health agencies by reducing costs while dramatically improving dedicated patient time.  Our remote support model allows field clinicians to learn and use their EHR on the spot, as they progress from visit to visit.  Our clinical/technical services are unique in the Home market, providing agencies with turnkey EHR, clinical and technical support solutions and services that will optimally manage the total technology enterprise.  Our day-to-day HIT operations ensure patients, providers, and administrators alike experience a more efficient approach to using technology within Healthcare.  Learn more at www.UnityBPO.com.

About The Visiting Nurse Service of New York
The Visiting Nurse Service of New York (VNSNY) is the largest not-for-profit home health care organization in the United States, serving the five boroughs of New York as well as Westchester, Nassau and Suffolk counties. VNSNY’s programs are designed to help patients improve their quality of life, and to reduce the number and length of hospitalizations. VNSNY offers a comprehensive array of home-and community-based programs to meet the diverse health and personal care needs of its patients, improve the quality of life, and reduce the number and length of hospital stays. On any given day, VNSNY has more than 35,000 patients in its care.

January 15, 2018 – Jacksonville, Florida – Forcura, a healthcare technology company, today announces Forcura Connect, a framework for standardizing interoperability and integration between home health and hospice organizations, physicians, electronic health records and other supporting technology vendors.

Forcura’s Connect framework utilizes a proprietary methodology and bi-directional API enabling EHRs and other technology vendors to share authorized health information in real-time with the highest level of security. Connect was developed to support the core document management functionality that Forcura provides by allowing any EHR or supporting technology vendor to easily plug in and facilitate the sending, sharing and receiving of data and documentation for all of its users.

“Our core document management platform exists to simplify and streamline back-office operations so that home health and hospice organizations, can provide better, more-informed patient care,” said Craig Mandeville, Forcura CEO. “We’ve been doing this successfully for the last 6 years. In 2018, interoperability is a huge focus across all of healthcare. The Forcura Connect framework is moving this segment of the industry closer to true interoperability and allows our clients to increase the ROI they are realizing across all of their administrative technology investments.”

Connect provides a standardized integration approach and API between systems and sources of information that is easy to plug into with minimal development and investment by the partner. Forcura’s vision is to be the standard connectivity platform supporting the home health and hospice segment of healthcare.

About Forcura
Forcura, a leading healthcare technology company headquartered in Jacksonville, Florida, helps healthcare organizations deliver better patient care, improve cash flow and reduce administrative expenses through document management and HIPAA-compliant secure communication tools. The company has recently received awards for Fastest Growing Company, Best Use of Cloud Computing, Best CEO and Best Places to Work.
forcura.com
Twitter @forcura

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com

If you have office PCs that are suddenly unable to boot up, it may be Microsoft’s fault, not yours or that of some hacker in Russia.

The software behemoth announced on January 9 that it was canceling its January 8 Windows 10 upgrade because of a serious flaw. This is what we know so far:

• PCs with AMD processors and Windows 10 Home are the only ones affected.
• AMD processors are sent into an endless loop after the upgrade.
• Windows 10 Home is not capable of delaying automatic Windows updates.

A Windows patch to reduce the risk from exploits for the Meltdown and Spectre CPU flaws is reportedly preventing PCs with older AMD processors from booting.

The recent update, KB4056892, seems to be causing problems for computers running on Athlon X2 processors. [Details are provided on Microsoft’s investigations of design flaws in modern processors, Spectre and Meltdown, [which opened] a massive range of PCs, phones, tablets and servers to attack. Microsoft’s timely response  to users’ multiple reported problems with this version of Windows 10 was to cancel this software as of Jan. 2018.]

AMD users have been reporting that their PCs were running Windows 10 without issue before installing the update. After installing the update users say their PCs are unable to boot and eventually get stuck in an endless loop, as they try to roll back to an earlier version of the OS.

Some users report they were able to block the update by using the Hide/Show troubleshooter, but Microsoft is yet to provide official guidance for affected users.

Windows 10 Home users have no easy way of deferring updates, and some users with affected PCs express frustration at suffering as a result of a patch primarily aimed at Intel processors.

What was supposed to happen
Two design flaws in modern processors, Spectre and Meltdown, open a massive range of PCs, phones, tablets and servers to attack. These two vulnerabilities in modern chip design could allow attackers to bypass system protections to read sensitive information, such as passwords, from memory. AMD chip sets were not subject to Spectre and Meltdown.

The recent Microsoft patch applies to all supported versions of Windows and Windows Server, Microsoft SQL Server and the Edge and Internet Explorer 11 browsers. Microsoft reports that it cannot be certain if its patches for the two vulnerabilities actually caused the problems for AMD users because the Windows update itself included more changes than just those specific security fixes. Either way, AMD users with older hardware and Windows 10 home were grounded.

A Microsoft spokeswoman said of the Meltdown/Spectre chip flaws: “We’re aware of this industry-wide issue and have been working closely with chip manufacturers to develop and test mitigations to protect our customers.”

Following reports of disabled AMD computers, Microsoft immediately delayed rolling out the upgrade to affected machines. “To prevent AMD customers from getting into an unbootable state, Microsoft will temporarily pause sending the following Windows operating system updates to devices with impacted AMD processors at this time,” Microsoft said in a statement on its support site.

Finding someone to blame, Microsoft explained that it had “determined that some AMD chipsets do not conform to the documentation previously provided to Microsoft to develop the Windows operating system mitigations to protect against the chipset vulnerabilities known as Spectre and Meltdown.”

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only.editor@homecaretechreport.com

By Tim Rowan, Editor & Publisher of Home Care Technology Report

Healthcare at home providers can use a secure, encrypted texting application to discuss patient conditions with each other, take photographs of wounds or medicine bottles, or attach documents for signature. Physicians cannot, however, send patient orders by text, even via an encrypted system. On December 28, the director of the CMS Survey and Certification Group issued a clarification to state survey agency directors regarding texting of patient information among healthcare providers.[This article provides explicit details about in-home healthcare providers—except physicians–that are permitted to text patient healthcare-related information and maintain this information in recorded form. Details are also provided about QliqSoft, a secure texting application that safeguards health caregivers’ documentation through its application– the Computerized Provider Order Entry (CPOE)– a HIPAA-secure transmission method that is preferred by the CMS for at-home healthcare providers to enter texted patient information online.]

In an effort to clarify the position of the Centers for Medicare & Medicaid Services (CMS) as it relates to texting, CMS does not permit the texting of orders by physicians or other health care providers. The practice of texting orders from a provider to a member of the care team is not in compliance with the Conditions of Participation (CoPs) or Conditions for Coverage (CfCs). The following CMS hospital Condition of Participation for Medical Records requirements apply:

§489.24(b) Standard: Form and retention of record. The hospital must maintain a medical record for each inpatient and outpatient. Medical records must be accurately written, promptly completed, properly filed and retained, and accessible. The hospital must use a system of author identification and record maintenance that ensures the integrity of the authentication and protects the security of all record entries.

“What CMS is doing is aligning its policy with the Joint Commission,” explained John Skowlund, VP of Business Development with QliqSoft, a secure texting application. “The goal has been to ensure that Computerized Provider Order Entry (CPOE) remains the standard for critical documents. Orders entered into the physician’s EMR are dated, signed, uneditable, and permanent. Text messages, even in a secure system, cannot have those safeguards.”

The CMS directive added that physicians must maintain medical records in their original or legally reproduced form for a period of at least five years. The document also reiterated the CMS position that

§489.24(b) Standard: Form and retention of record. The hospital must maintain a medical record for each inpatient and outpatient. Medical records must be accurately written, promptly completed, properly filed and retained, and accessible. The hospital must use a system of author identification and record maintenance that ensures the integrity of the authentication and protects the security of all record entries.

“What CMS is doing is aligning its policy with the Joint Commission,” explained John Skowlund, VP of Business Development with QliqSoft, a secure texting application. “The goal has been to ensure that Computerized Provider Order Entry (CPOE) remains the standard for critical documents. Orders entered into the physician’s EMR are dated, signed, uneditable, and permanent. Text messages, even in a secure system, cannot have those safeguards.”

The CMS directive added that physicians must maintain medical records in their original or legally reproduced form for a period of at least five years. The document also reiterated the CMS position that

“CPOE is the preferred method of order entry by a provider. CMS has held to the long standing practice that a physician or Licensed Independent Practitioner (LIP) should enter orders into the medical record via a hand written order or via CPOE. An order, if entered via CPOE, with an immediate download into the provider’s electronic health records (EHR), is permitted as the order would be dated, timed, authenticated, and promptly placed in the medical record.

CMS recognizes that the use of texting as a means of communication with other members of the healthcare team has become an essential and valuable means of communication among the team members. In order to be compliant with the CoPs or CfCs, all providers must utilize and maintain systems/platforms that are secure, encrypted, and minimize the risks to patient privacy and confidentiality as per HIPAA regulations and the CoPs or CfCs. It is expected that providers/organizations will implement procedures/processes that routinely assess the security and integrity of the texting systems/platforms that are being utilized, in order to avoid negative outcomes that could compromise the care of patients.”

©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com