These statistics are from the Redspin research report “Breach Report 2011: Protected Health Information.”

Of course certain things like encrypting data on all mobile devices is a necessity at any hospital nowadays. You’d be surprised, however, how many facilities don’t do it.

This problem is just going to get worse with employees bringing their smartphones, iPads, etc. to work.

In fact, 39% of all PHI breaches to date are from laptops or other portable devices. They’re the easiest things for thieves to steal and, even more likely, employees to loose. And — here’s the shocking part — 50% of respondents in a recent healthcare IT poll say their facilities aren’t doing anything to protect data on those devices.

Some options for securing PHI aren’t that expensive, but options that provide top of the line security are obviously more expensive.

For example, the Boyd Company estimates that healthcare data security spending in 2012 will go over $40 billion. That’s a 22% increase from 2011 levels. And it’ll top $70 billion by 2015.

The Boyd Company created an analysis of the costs of operating a healthcare data security center in U.S. cities. The analysis looked at the cost of skilled labor in health information and data security; land costs; construction costs; taxes; utilities; corporate travel and other occupancy costs.

The annual costs in the study were based on centers occupying 150,000 sq. ft of newly constructed space, and employing 150 workers.

It found that some cities are most cost effective for operating a healthcare data security center than others.

Top 3 most expensive locales

1. New York
2. San Francisco
3. Los Angeles

Top 3 lowest cost locales

1. Sioux Falls, SD
2. Tulsa, OK
3. Ft. Walton/Destin, FL

For more information about the Boyd Company report, “Healthcare Services Industry: A  Comparative Cost Analysis for Information Assurance Operations,” click here.

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Unfortunately, the answer may be no, according to a study published in The Journal of Pediatrics.

The study makes it appear that insurance coverage may play a vital role in the care children get.

Researchers from Children’s Hospital Boston found:

• compared to children with private insurance, those with public insurance (Medicaid or CHIP) or no insurance were 22% less likely to be tested or have a procedure when they went to the emergency room, and
• children who didn’t have insurance were less likely to receive any medication than those with public or private insurance.

However, these findings didn’t hold true for children diagnosed with a significant illness.

The study was based on an analysis of emergency department (ED) visits recorded in the National Hospital Ambulatory Medical Care Survey from 1999-2008. It’s based on approximately 33,000 annual visits.

So what’s the reason for the treatment disparity?

The study authors gave some possible explanations for it:

First, children with private insurance are 11 times more likely than children without insurance or with public insurance to have a primary care physician (PCP). Therefore, when children with insurance go to the emergency room (ER) they are usually referred there by their PCP with instructions from the PCP for a specific workup, including extra tests and procedures.

Secondly, children with PCPs are less likely to go to the ER for non-emergency care.

Finally, parents who don’t have insurance or their children have public insurance are more worried about money and request fewer tests and treatments.

So are ERs skimping on care to uninsured and publicly insured kids because private insurance pays more so those kids get more attention?

It’s highly unlikely. The clinicians that work in the ER don’t know whether a child has private insurance, Medicaid or no insurance.

What do you think is the behind the treatment disparity in these patient populations? Share your opinions in the comments area below.

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While healthcare coupons may offer discounts on items and services reimbursable by the federal healthcare program, there are a lot of stipulations that have to be taken into consideration.

To help keep providers and facilities safe so they don’t break any laws, like those of the Federal anti-kickback statute, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued an advisory opinion (No. 12-02) with the following guidelines:

• Coupons may only offer discount services, not free services. And providers must give the same discount to any third-party payor or insurance carrier that the provider offers to the patient. For example, a provider may not offer a 20% discount directed only at the patient’s cost-sharing amount. The website must include information explaining that the coupons apply to the entire service, and the coupons themselves must include similar language.
• The website offering the coupon can’t be that of a provider. It would have to be a third-party marketer that charges providers a flat fee to host the coupons. Any marketing done by a healthcare provider of any type would be subject to extra scrutiny. Reason: The OIG says “healthcare providers and suppliers are in a position of trust and may exert undue influence when recommending healthcare-related items or services.”
• Coupon use can’t be relied on by providers. The OIG states that providers and advertisers would pay a set fee, consistent with fair market value to purchase the space for posting their coupons on the website. And the fee wouldn’t take into account the volume or value of any business garnered by the coupon. For example, providers would be able to see statistics regarding how many times their profile was viewed and how many times customers downloaded their coupon, but the fee charged wouldn’t vary based on these statistics.
• Personal information about the coupon purchaser can’t be shared with the provider. In other words, an account can’t be a requirement to download the coupon, and any personal information provided, such as an email address, can’t be shared with the provider.
• The coupon has to be structured like the ones people get through snail mail. To decrease the risk of violating the anti-kickback statute, the customer can’t pay anything up-front for the coupon. Prepayment of a coupon increases the likelihood of service over-utilization. The example the OIG gave was, if a person bought a prepaid coupon for service x, when that person walks into the offering provider’s office requesting service x — having already paid for service x — the offering provider might feel pressure to render it even if it isn’t medically necessary.
• Providers must comply with the discount safe harbor. Under the arrangement, providers would be the “sellers” and the customers would be the “buyers” for purposes of the discount safe harbor.  To qualify for protection under the discount safe harbor, buyers and sellers have certain reporting obligations to ensure that any discounts are shared with federal healthcare programs.

What do you think about providers offering service coupons — good idea or just too risky? Share your thoughts below.

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Twenty-six organizations received the honor of being the first granted with the Healthcare Innovation Awards. Check out what these groups did to win a total of $122.6 million.

Award winners were chosen for their:

• innovative solutions to the healthcare challenges facing their communities
• focus on creating a well-trained healthcare workforce equipped to meet the needs of the 21st century healthcare system, and
• money-saving practices.

The preliminary award winners are expected to reduce healthcare spending by $254 million over the next three years.

The projects, which receive funding for three years, include collaborations among the country’s leading hospitals, doctors, nurses, pharmacists, technology innovators, community-based organizations and patients’ advocacy groups.

“We can’t wait to support innovative projects that will save money and make our healthcare system stronger,” said Health and Human Services Secretary Kathleen Sebelius in a CMS press release. “It’s yet another way we are supporting local communities now in their efforts to provide better care and lower costs.”

This is only the first batch of award winners. More will be announced in early June 2012.

Here’s an overview of a few of the winning projects:

• Beth Israel Deaconess  Medical Center, Boston.  The facility is receiving $4,937,191 for its project “Preventing avoidable re-hospitalizations: Post-Acute Care Transition Program (PACT)”. It’s estimated that the project’s three-year savings will be $12.9 million. The goal of the project is to improve care and reduce hospital re-admissions for Medicare beneficiaries dually eligible for Medicare and Medicaid. These patients represent over 8,000 discharges for conditions such as congestive heart failure, acute myocardial infarction and pneumonia.

  By integrating care, improving patients’ transitions between locations of care, and focusing on a battery of evidence-based best practices, this model is expected to prevent complications and reduce preventable re-admissions. The results would be better quality health care at a lower cost in the urban Boston area.

• Pittsburgh Regional Health Initiative, Pittsburgh.The initiative is getting $10,419,511 for its project “Creating a virtual accountable care network for complex medical patients.” It’s estimated that the initiative’s three-year savings will total $74.1 million.

  The organization plans to create specialized support centers, staffed by nurse care managers and pharmacists, to help small primary care practices offer more integrated care within the service areas of seven regional hospitals in Western Pennsylvania.

  The resulting teams will provide support for care transitions, intensive chronic disease management, medication adherence, and other problems associated with a lack of communication in healthcare systems at large and the resulting fragmentation of health care for patients. This approach is expected to reduce 30-day re-admissions and avoidable disease-specific admissions.

• Regents of the University of California, Los Angeles.“UCLA Alzheimer’s and dementia care:  comprehensive, coordinated, patient-centered” project will be awarded $3,208,540, and it’s estimated three-year savings is $6.9 million.

  This award will expand a new program to provide coordinated, comprehensive patient- and family-centered care for 1,000 Medicare and Medicaid beneficiaries with Alzheimer’s disease or other forms of dementia. The goal is to reduce hospitalizations and shorten hospital stays, reduce emergency room visits, and improve patient health, caregiver health, and quality of care.

  The program will train and deploy professional and non-professional workers, and unpaid volunteers, expand a dementia registry, conduct patient needs assessments, and create individualized dementia care plans.

• University Hospitals of Cleveland, Ohio.The facilities are getting $12,774,935 for the project “Transforming pediatric ambulatory care: the physician extension team.” The estimated three-year savings will be $13.5 million. University Hospitals (UH) Rainbow Babies and Children’s Hospital at UH Case Medical Center award is for improving care for 65,000 children in Medicaid with high rates of ER visits, complex chronic conditions and significant behavioral health problems. The intervention will offer healthcare advice, referrals and coordinated services through telehealth and home nurse hotlines.

  It will also provide practice-tailored facilitation for primary care providers and financial incentives to physicians who reach quality performance targets, agree to offer extended hours and make themselves available to treat these kids.

For a complete list of award winners, click here.

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Rosen pleased guilty to participating in a scheme which involved former state Sen. Carl Kruger (D-Brooklyn), Assemblyman William Boyland Jr., (D-Brooklyn) and the late Assemblyman Anthony Seminerio (D-Richmond Hill). The scheme funneled hundreds of thousands of dollars to the politicians in return for using their influence in Albany to benefit Rosen’s healthcare organization.

At Rosen’s request, he was tried before a judge rather than a jury. After a three-week trial last year, Judge Jed Rakoff found him guilty.

His lawyer, Elkan Abramowitz, argued that Rosen did what he had to do to secure the survival of his hospitals — which served New York’s poor — and that he didn’t ask for any of the money for himself. He also asked the judge to let Rosen off on probation and community service.

The courts probation office recommended a sentence of 10 years.

The NYDailyNews reported that Judge Rakoff said that while he had no doubt Rosen was “a good man in many respects,”  the seriousness of the crimes required him to send Rosen to prison. Rakoff added this case was tragic because it showed how someone who had been widely admired and sought to better the health care of poor communities used his position to bribe state legislators.

After serving three years in prison, Rosen will also spend two years under supervised release and is required to pay a $500 special assessment fee.

Rosen maintains his innocence. That’s why Abramowitz told the judge he would be filing an expeditious appeal on Rosen’s behalf.

Kruger resigned and pleaded guilty to corruption charges in December and was sentenced to seven years in prison. Boyland was acquitted, but later arrested on new bribery charges. Seminerio, plead guilty to an earlier case of fraud and died in prison.

What’s your opinion on this case? Share your thoughts in the comments section below.

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With initial symptoms reflecting those of the common influenza virus or forms of pneumonia, a diagnosis for Legionnaires takes more extensive testing, allowing symptoms to worsen and more people to be exposed.

This dangerous strain of bacteria spreads through infected water or aerosols in areas where there’s poor air ventilation.

The worst outbreak in history exposed the bacterium to nearly 16,000 people before it was contained, and in other cases, death rates reached into the double digits.

Take a look at the 12 worst Legionnaires’ outbreaks in the world, listed in chronological order:

1. Philadelphia, PA, USA |  1976
Source: Air conditioning
Death-to-infection rate: 34/221, or 15.4%
Fact: This was the first recorded outbreak of the disease, and the mysterious strain of bacteria that caused it was finally identified. 

 2. Stafford, England | 1985
Source: Hospital air conditioning unit
Death-to-infection rate: 28/175, or 16%
Fact: This marked the largest outbreak of Legionnaires disease in Britain.

3. Bovenkarspel, Netherlands | 1999
Source: Hot tub
Death-to-infection rate: 32/318, or 10%.
Fact: More deaths from this bacteria could have been recorded, but bodies had already been buried before they had identified Legionnaires as the cause of the outbreak.

4. Melbourne, Australia | 2000
Source: Cooling tower at a newly opened aquarium
Death-to-infection rate:  4/95, or 4.2%
Fact: 100% of those diagnosed with the disease had visited or passed within 500 m of the the Melbourne Aquarium in the same 4 week period, allowing scientists to pinpoint the exact source of exposure.

5. Murcia, Spain | 2001
Source: Hospital air conditioning
Death-to-infection rate: 6/100, or 1%
Fact: This is the world’s largest outbreak of the disease, where at least 16,000 people were exposed to the bacterium.

6. Barrow-in-Furness, England | 2002
Source: Contaminated cooling tower in a neighborhood arts center
Death-to-infection rate: 7/172, or 4%
Fact: The Barrow Borough Council and the architect of the arts center were charged with, but cleared of, corporate manslaughter charges, and were later fined for breaches of health and safety regulations.

7. Lens, France | 2004
Source: Cooling tower at a petrochemical plant
Death-to-infection rate: 7/59, or 11.8%
Fact: This marked the worst Legionnaires outbreak ever recorded in France.

8. Zaragoza, Spain | 2004
Source: Hospital cooling tower
Death-to-infection rate: 7/27, or 26%
Fact: Five of the seven victims of this outbreak were above the age of fifty.

9. Fredrikstad, Norway | 2005
Source: Air scrubber of a nearby factory
Death-to-infection rate: 10/56, or 17.8%
Fact: The patients that became ill in this outbreak lived over 20 km apart, but the high velocity, large drift and high humidity in the air scrubber were linked to the long-distance spread.

10. New Brunswick, NJ, USA | 2008
Source: Contaminated supply of drinking water
Death-to-infection rate: 2/6,  or 33%
Fact: Exposure to patients in the hospital where the outbreak occurred has been traced back to a sudden drop in chlorine levels in the hospital’s drinking water.

11. Dayton, OH, USA | 2011
Source: Hospital air conditioning
Death-to-infection rate: 5/11, or 45%
Fact: This was the largest outbreak of Legionnaires’ disease in Ohio since 1994.

12. Calpe, Spain | 2012
Source: Currently unknown
Death-to-infection rate: 3/18, or 17%
Fact: The infection quickly spread through a beach hotel and claimed the lives of three British vacationers before being contained.

http://www.legionellacontrol.com

http://www.hcinfo.com/

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Just how much of a risk do they pose?

To find out the answer to this question, Symantec, a provider of security, storage and system management solutions, lost 50 smartphones … on purpose. The phones were left in very public places in five major cities. And the devices were loaded with simulated corporate and personal data, as well as software that allowed the company to monitor phone use.

Here’s what was discovered:

• 96% of the phones were turned on by their finders
• Nearly half of the finders tried to access the phone owner’s bank account
• 60% of the finders tried to view social media info and email
• 80% of finders tried to access corporate info including files marked as human resource salaries, human resource cases and other corporate info, and
• 50% of the people who found the phones tried to return them.

So if your hospital uses mobile devices, what can you do to protect the data on them?

• Develop and enforce security policies for employees using mobile devices for work. For example, all mobile devices must have password-enabled screen locks.
• Don’t just focus on securing the device. The patient data on the phone must also be protected no matter where it’s exchanged.
• If a mobile device is lost, have a formal process in place so everyone knows what to do.
• Integrate mobile device security and management into the overall facility security and management, and
• Take inventory of the mobile devices connecting to your hospitals  network.

Simply having a password on the phone and the ability to remotely wipe data off the phone, could have prevented most of the problems that arose in the Symantec study.

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As an academic medical center and the safety net for the St. Louis region, Barnes-Jewish Hospital sees any and all kinds of patients and conditions — making its drive for excellence especially tough.

After all, if you specialize in a few things, it’s easier to excel at them because you have a limited focus. Trying to be the best at everything, is a lot more difficult. So the hospital took on one issue at a time.

Step 1

The first step in achieving its goals was to employ “lean management.” This management system was designed to minimize waste, standardize processes and drive continuous improvement.

Standardizing patient care was key. While Barnes-Jewish Hospital standardized its processes for patient care, it allowed tailored intervention per individual patient — when appropriate. This “variation” was allowed because it benefits patients by providing care specific to their needs.

Step 2

The next step involved training the facility’s future providers. The hospital requires residents to have four hours of lean training and then they have to participate in a process improvement project.

One of these projects was for central line-associated blood stream infections (CLABSIs). Previously, the hospital’s seven intensive care units (ICUs) each had its own method for reducing CLABSI. Under the lean system, all ICUs standardized their practices in insertion, maintenance and follow-up.

For example, the clinicians who insert central lines were trained in a simulation to use evidence-based, standard practices, such as being required to wear a gown, gloves and have a sterile field.

The nurses, who maintained the catheters, had a standardized schedule for changing dressings and the hubcaps of the line.

And finally, the clinicians were trained to question the patient’s need for continued use of a central line on a daily basis using a standard checklist.

Thanks to this process improvement project, the hospital experienced a dramatic drop in CLABSIs.

Other projects tackled at the facility included: diabetes medication errors, pressure ulcers and transition of care. To read more about these click here.

Has your facility implemented any quality improvement projects? If so, tell us about them in the space provided below.

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