NIST Issues HIPAA Security Standards Guide
Washington Technology reports that the National Institute of Standards and Technology (NIST) has published a guide for meeting HIPAA security standards, set to go into effect April 21, 2005. Given the brief period before the law goes into effect, one would think this guide would be of little use. However, this study reports that as of a couple of months ago:
Nine percent of hospitals with 400 or more beds reported compliance with the security rule, compared with 18 percent of hospitals with less than 400 beds.
Most folks think of this as just an IT concern — it is not. The law refers to “electronic protected health information” (EPHI), i.e., patient identifiable data of any kind. This extends beyond Social Security or credit card numbers and lab results to include physiological parameters, vital signs and waveforms. Interestingly, while they define EPHI, the NIST resource guide does not mention “medical devices” once. You can read more about medical device security here.
You can download the 137 page Resource Guide here.
UPDATE: The Centers for Medicare and Medicaid Services published HIPAA enforcement procedures in the Federal Register last Friday. Details on how to file a complaint and the process that CMS will use to pursue a complaint are detailed. These procedures apply to the Security and Transaction and Code Set provisions and not the privacy portion of HIPAA, which is covered under separate procedures established and managed by the Office for Civil Rights.
The Department of Health and Human Services (HHS) has released the third of seven planned guidance papers on the Security provisions. You can get the latest HIPAA guidance and enforcement info here.
Wireless Monitoring Outside the Hospital
I've mentioned before that reducing avoidable admissions can have an impact on patient flow. Here is a story about a new wireless monitoring system developed in Europe. This new system starts with a variety of wireless sensors that can be attached to the patient. The sensors communicate via a wireless link with a mobile phone — this represents the body-LAN or personal area network (PAN). The mobile phone transmits alerts to a provider via the wireless carrier's cellular network.
The new system, which is called BodyKom, connects wireless to sensors on the patient. If dangerous changes are detected in the patients body, the hospital or health care services are automatically alerted over a secure mobile network connections.
The unit receiving the alarm will also be informed of the geographic position of the patient through the use of GPS technology.
Still vaporware, the concept will be tested this spring. The carrier, TeliaSonera, plans to sell to hospitals. The initial parameter to be measured is heart rate, with additional parameters to follow that will target diabetes, asthma, “and other diseases which may require timely interventions.” Two key benefits are touted: patient safety/quality of life, and more rapid hospital discharges to free up hospital beds.
The broad technology required for these types of products are almost available “off-the-shelf.” All wireless carriers offer secure communications. Mobile phones with Bluetooth (to talk to the sensors) and Java programmability have been on the market for a couple years. QualComm has a provisioning system that medical device vendors or disease management firms can use to manage the service. (If I recall, Sprint is the only carrier presently supporting this capability.) The technology gap is in the wireless sensors. Fortunately lots of people are working on solutions.
Grand Rounds
Grand Rounds, a weekly wrap up of medical bloggers is up at Over My Med Body. Go check it out! This site is mentioned in the same breath as Jennifer Aniston…
Do Smart Infusion Pumps Improve Medication Safety?
In an apparent medical device analog to the recent dust up about CPOE, this study confirms that its not what you have, its how you use it.
Rothschild, Keohane, et al., conclude that smart infusion pumps can detect intravenous medication errors and adverse drug events. However, “We found no measurable impact on the serious medication error rate, likely in part due to poor compliance. Although smart pumps have great promise, technological and nursing behavioral factors must be addressed if these pumps are to achieve their potential for improving medication safety.”
Improving Patient Flow at Seton Medical Center
Pat Ramming, manager of the Throughput department at Seton (see this post) was gracious enough to take the time to provide us with some additional background on their efforts at Seton:
I was curious how they selected the target areas for their patient flow improvement initiative. They spent more than a year on this project, starting with a hospital wide patient flow study. Based on analysis of the data, sixteen bottlenecks were identified; they selected bottlenecks with the biggest impact on flow for implementation. Once specific bottlenecks were chosen, teams were assembled to develop process changes and plan implementation. Each target bottleneck had its own team and plan.
The biggest challenge? “Changing nurses habits. And of course, finance.”
The article about Seton's experience mentioned using patient flow software, but not the name (Tele-Tracking). The software is used in Bed Control (in their Throughput Dept.), Nursing, Environmental Services, Dietary, and Finance (for reporting). When asked how much of a contributing factor capacity management software was to their success, Pat said, “We designed our processes around the [capabilities provided by] the application. I can't imagine doing the job without it.” She said the biggest impact of the software was bringing Environmental Services into the patient care arena.
One of the most effective patient flow optimization tools is the Universal Unit (AKA, variable acuity unit, flex beds, flexible monitoring, house-wide monitoring – description here). Even with their improvements, ICU capacity continues to be an issue at Seton — in fact, they were full this morning when we chatted. Because they look at inappropriate admissions across the hospital, they have identified Universal Beds as a future project for improving patient flow. (Most ICUs have around 20 percent inappropriate admissions, so they pay 3 to 4 times the cost of care delivered in a Med-Surg unit.)
The Seton Healthcare Network is a constant learning organization, and their patient flow team continues to meet monthly to drive continued improvement and respond to changes. One change to accommodate will be the new county policy of “no diversions” (starting July 1, 2005) where hospital emergency departments will no longer be able to go on divert. Pat and her team are also in the process of rolling out these process improvements across the Seton Healthcare Network (they have a total of 5 urban and 2 rural hospitals); this will provide common processes across the system and an enterprise level view of bed management. Their patient flow initiative is even extending to the design of a new facility that will incorporate their new patient flow processes into the design.
