HIPAA Guidelines: Understanding HIPAA Compliance on the Cloud

admin — Tue, 13 Apr 2021 18:42:07 +0000

HIPAA Guidelines: Understanding HIPAA Compliance on the Cloud

Sudish Mogli - Technology Advisor
Aug 10, 2018

Health Insurance Portability and Accountability Act (HIPAA) mandates industry-wide standards for protection and confidential handling of the electronic healthcare information for electronic billing and other processes. In order to maintain the HIPAA Privacy regulations, the Healthcare providers and organizations must develop and follow certain procedures to ensure the confidentiality and security of the Protected Health Information(PHI). The ‘Guidance on HIPAA and Cloud Computing’ released in 2016, by the US Government of Health and Human Services(HSS) provides information on maintaining HIPAA compliance while using cloud computing services for storing and managing ePHI. Based on this, the HealthCare organization and Cloud Service Provider(CSP) is directly liable for meeting both the business associate agreement(BSS) and compliance with the associated requirements of the HIPAA rules.

As the healthcare providers increase their dependence on the Cloud, the healthcare organizations face the pressure to constantly certify their cloud services to be HIPAA compliant. This blog is intended to throw light on the best practices, a healthcare organization needs to follow to keep the applications on cloud HIPAA-ready.

Best Practices for becoming HIPAA Compliant:

A reputable Cloud Service Provider(CSP) who can support and follow HIPAA compliance is a valuable ally. It is recommended to review the ‘HIPAA Compliance Checklist 2017-2018’, to ensure the organization complies with the security and privacy of patient data.

Below are the steps to follow to ensure HIPAA Compliance.

1. Risk assessment and management:

The Risk Assessment is foundational and conducting a risk analysis is the first step to identify and implement the safeguards that comply with the standards and implementation specification of the security rule. This helps in overcoming the ePHI data breach and reduce the risk to an appropriate level at regular intervals of time.

Look for major security and privacy assets from Cloud Providers:

2. Train the employees to be secure:

Provide training to the employees to raise the awareness of the policies and procedures governing access to ePHI and guide them to identify the malware and malicious software attacks. All training must be documented and develop a contingency plan to enable the continuation of the critical business process while protecting the integrity of the ePHI when the organization operates in emergency mode.

3. Conduct Regular Audits:

The goal is to identify and mitigate risks and assess organizational internal compliance with the policy. Conduct regular audits to check the security breach and evaluate the potential damage in terms of legal and financial aspects of the business and incorporate security protections to ensure the confidentiality and integrity of the ePHI database.

4. Begin the partnership with right strategy:

Develop a Service Level Agreement(SLA) with business definition and a comprehensive business associate agreement(BAA), a legal contract that describes how business associate adheres to HIPAA requirements to enhance maximum protection, to prioritize both the HIPAA compliance and the successful business outcomes.

Implementing these best practices on a continuous basis is the real challenge for many healthcare organizations, as their effort and time is gets deviated from their core business. This has led many organizations to adopt an enterprise-wide cloud platform as an additional layer to their cloud infrastructure, to handle HIPAA regulations on cloud. Nowadays, advanced Cloud solutions are also available in the market with inbuilt continuous compliance & security capabilities along with assisted auto remediation. 8K Miles’ CloudEz , is one such smart unique vendor-agnostic Enterprise Cloud Platform with inbuilt cloud foundational services to facilitate your enterprise to manage Pharma/Healthcare Business Processes, Security Protocols, GxP/HIPAA Compliance Standards and Cost through Automation and DevOps, across all business units.

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Ramping up Telecommute Capacity

admin — Tue, 13 Apr 2021 17:53:21 +0000

Ramping up Telecommute Capacity

Healthcare Triangle
Mar 10, 2020

Among the COVID-19 guidance provided by the Centers for Disease Control and Prevention (CDC) for business is to prepare for “social distancing” to minimize exposure. While not every job is eligible for telecommuting, many are, and this strategy can be an effective way for businesses to offer flexibility to their employees while allowing important work to continue.

For many organizations, providing easy access and flexible options for employees to telecommute while also maintaining security and control is a challenge under normal circumstances, let alone a time of potentially increased urgency.

Fortunately, the public cloud offers several options to ramp up telecommute capabilities. The good news is that these options are usually available on-demand and can scale up and down quickly.

In addition, telecommuting involves more than just the technical pieces. There are people and process considerations that must be included.

Virtual Desktops

While many employees may already have company issued portable computers if they currently telecommute for some of their work, it’s likely that many organizations will have many more employees suddenly needing a corporate remote desktop. Letting employees access company assets directly from a personal device is both a support challenge and a security / privacy risk.

Virtual desktops in the cloud can let employees use a personal device to connect to a company-controlled desktop that can be configured to match an organization’s standard image and controls. These virtual desktops can be managed and supported just like a corporate provided physical desktop. Network connections can be controlled, and data transfer can be managed.

Both AWS and Microsoft Azure offer cost-effective virtual desktop solutions that can be rapidly provisioned and are generally available on a pay-as-you-go model with little to no upfront investment and no long-term commitment. When the need for the additional desktops passes, they can be deleted and the cost stops.

These virtual desktops typically include a Microsoft Windows license as part of the cost; further simplifying the management process.

Virtual Collaboration

Most employees need more than a desktop. They need a way to collaborate with colleagues. Whether it’s a simple meeting or a complex brainstorming session, the cloud, again, offers several options that can help.

Microsoft (Office 365 and Teams) and Google (G Suite and Hangouts) both offer robust online collaboration platforms that range from basic file sharing and collaboration to full multi-media audio and video conferencing. Virtual white boards, screen sharing and real-time chat are all available. Most of the services can be securely accessed from employees’ personal devices with minimal support required.

Like the virtual desktops, these services are offered on a pay-as-you-go model and both Google and Microsoft are offering special incentives during the COVID-19 situation. Organizations can rapidly provision accounts and employees can get online from wherever they are – even if it’s just by telephone.

Beyond the Technology

In addition to the technical components of telecommuting, there are people and process considerations that need to be addressed. As a highly virtual organization, Cornerstone Advisors has been dealing with these factors for a while.

Security and Privacy Are Primary

Employees should be required to assure the organization that they are taking appropriate steps to secure corporate information. Work locations should be chosen to offer security and privacy. Family members should not be permitted to access and use any company provided services or equipment. Printing should be avoided and, if not avoidable, all printed content must be appropriately disposed of, possibly including shredding depending on content.

Tips:

Reinforce existing privacy and security policies as part of communication and transition to telecommuting. Keep it front-of-mind for everyone.
Ask employees to take and share pictures of where they will be working. While helpful for verifying an appropriate environment, this can also be a fun way for everyone to share what their “office” looks like with the team.

Work / Life Balance Can be Harder when Telecommuting

Many people assume that “working from home” is the ultimate in work / life balance, those who have done it know that it’s sometimes the opposite. Having work “just down the hallway” can make it tempting to sacrifice personal and family time. Remote workers can also often feel pressure to make sure they are “putting their time in” and will stay at the keyboard non-stop.

Additionally, with current events, many employees may be trying to balance taking care of children home from school, ill family members, etc. It’s also important that employees recognize that their work needs to be prioritized appropriately. If sufficient time can’t be given to work, personal time off may be more appropriate than trying to telecommute.

Tips:

Practice flexibility whenever possible. If an employee needs to tend to children during the day but can work in the evening, provided the work is still able to get done, that’s a win for everyone!
Encourage employees to maintain normal business hours when working from home. This doesn’t necessarily mean nine to five as noted above but the number of hours per day should be like the hours they would spend in the office.
Avoid the temptation to micro-manage telecommuting employees. Focus on outcomes and results over tracking hours.
Remind employees that, when they’re in the office, they get up and go get coffee, take a walk, go to the restroom. It’s ok to do the same when they are telecommuting.

The Social Aspects of the Office Matter

A telecommuting employee can quickly begin to feel isolated from the team. For many people, the day-to-day interaction in the office is a critical part of their work experience.

Another challenge are employees that can’t telecommute either because of work requirements or personal circumstances. They can develop feelings of envy and feeling like they’re managing “more of the work” because they are at the office.

Tips:

Sponsor regular “all hands” calls to get people into a virtual meeting together. Go around “the table” and ask folks to share their circumstance, turn on webcams and show off their workspace.
Encourage employees to continue to communicate with coworkers they communicated with in the office. If you regularly took a few minutes to catch up with a coworker on their children, do the same thing; you just need to do it via chat and phone call.
Encourage groups that regularly collaborated in person to setup shared chat rooms, file shares etc. to continue that collaboration virtually.
Manager one-on-ones are critically important when telecommuting. Even if it’s just 10-15 minutes, it’s a way to avoid the feelings of isolation for both the manager and the employee.
Clearly explain the rationale for who can and can’t telecommute. Even if everyone doesn’t telecommute, every person not in the office is one less vector for spreading a disease.
Take extra steps to thank those that are not telecommuting. Food always goes a long way to make people feel more appreciated. Say thank you to them regularly. Acknowledge them to the bigger group.

We’re Here to Help

As mentioned above, Cornerstone Advisors is and has always been a virtualized organization. We are also a “cloud first” organization. Please reach out if you need assistance or just want to bounce around ideas.

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Top 4 Best Practices for Multi-Factor Authentication (MFA) Implementation

admin — Tue, 13 Apr 2021 17:21:20 +0000

Top 4 Best Practices for Multi-Factor Authentication (MFA) Implementation

Sudish Mogli - Technology Advisor
Mar 15, 2020

Hackers attack and continue to be hostile to many organizations. Despite all security measures like regular vulnerability tests, deployment of encryption technology, etc., today’s organizations are highly prone to IT security breaches. It’s high time to strategize and anticipate a defense mechanism to protect their system and data. Nowadays, many organizations are turning their eye to Multi Factor Authentication or MFA for securing their complex and nexus environment. In this blog, we will discuss the top 4 best practices to be followed while implementing the MFA solution.

1. 360Degree Approach: To strategize a successful implementation of Multi Factor Authentication, the organization must visualize and cover all end & access points such as Cloud / On-premise, Server, Active Directories, managed services, etc. This end-to-end approach helps enterprise to secure it from unauthorized access, password-based cyber-attacks & data breaches.
2. Ensure Consistency: Don’t be one of the countless number of startups who show agile interest in implementing MFA but fail to be consistent in terms of following industry standard protocols when implementing security across cloud components.
3. Deploy MFA right: Hackers have a cognizance towards cyber-attack chains such as active directory login and privilege elevation from remote network access. These networks are vulnerable and become easy prey for hackers to gain unauthorized access. Hence, when an organization plans to implement MFA, they should deploy MFA to remote network access for distributed employees and business partners across all servers.
4. Choose the right product: When deciding to implement an MFA solution, it’s vital to choose the right product for your organization. The organization needs to critically evaluate the factors like scalability, security, user experience, cost of deployment & support and ease of customization.

The above best practices when followed diligently, ensures the road to success in your security journey.

Get to know Healthcare Triangles’ EzMFA offered as MFA-as-a-Service, a 360-degree Multi-Factor Authentication solution with the convenience of cloud-based & on-premise service. EzMFA provides robust capabilities for advanced authentication with one of the combinations such as Legacy SMS OTP, Email OTP, Face Recognition or Finger print which few other products give its customers in the market. Healthcare Triangle EzMFA can help organizations maintain business agility with a theft free solution while simultaneously minimizing administrative overhead.

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Envision Your Cloud Journey with Cloud Assessment

admin — Tue, 13 Apr 2021 15:00:49 +0000

Envision Your Cloud Journey with Cloud Assessment

Sudish Mogli - Technology Advisor
Mar 26, 2020

Helping Customers Chart their path to Cloud

We understand that successfully migrating to the cloud is not an easy task and requires a thorough assessment of the company’s requirements before we can create a relevant migration roadmap. Although adopting a cloud mindset is a good start, and assessing the cloud readiness of the organization is very important. It helps to find existing organizational gaps that need to be addressed.

The objective of Cloud Assessment

How cloud computing reduces the total cost of ownership by 30% to 40%?
To know which applications are suitable for the cloud? And why?
How can you prepare your application for the cloud?
How can you support the transition from an existing resource-intensive configuration to the cloud environment?
Helps you to choose an effective cloud service provider?

The Process:

The Healthcare Triangle cloud assessment is carried out in three phases. A thorough analysis of the system is conducted for a comprehensive understanding of readiness.

Discovery: In this phase, we collect data to analyze your business and the impact of cloud transformation. We also use automated tools to collect all information about infrastructure and your network.
Evaluation: Data collected during the discovery phase is evaluated to determine the availability of cloud migration from the customer’s infrastructure. According to the analysis, migration scenarios are created.
Suggestion: After analyzing each component of the infrastructure, we assign infrastructure and local applications to the corresponding cloud components. Next, a roadmap for the migration is created that determines what needs to be moved. You will benefit from using the best practices for migrating your infrastructure. After completing the cloud assessment, Healthcare Triangle will easily carry out the migration to the cloud.

Healthcare Triangle Cloud Assessment and ROI

Direct Ongoing Cloud Costs
The benefits of increased productivity and transforming opportunities are why cloud assessment is viewed as truly transformative.
Time migration costs
In addition to the direct costs associated with moving to the cloud, migrating to the cloud is a major change in the way IT works in infrastructure and people. All of this is not trivial; therefore, there will be certain investments in the beginning. With careful implementation, better savings will be achieved.
Risk
Risk management is a major factor in cloud assessment. Automation and standardization and add layers of security to the cloud more easily. However, the cloud carries the risk that companies are not confronted, but can eliminate or reduce human error.

Healthcare Triangle creates cloud solutions that stimulate the activities of our customers, particularly companies with software at the center of their digital transformation. Fill out the form below for more information.

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Delivering Telehealth Rapidly with Epic

admin — Tue, 13 Apr 2021 14:38:54 +0000

Delivering Telehealth Rapidly with Epic

Healthcare Triangle
Mar 31, 2020

Arm Your Frontline with Tools to Monitor, Diagnose, Manage, Treat, and Prevent the Spread of COVID-19

Health entities across the United States are rushing to address, mitigate, and take action against the evolving COVID-19 pandemic, and while impacts of the virus already weigh heavily on the supply chain and frontline health professionals, the need for immediate and scalable telehealth solutions is in the IT limelight now as well.

With the volume and risk of COVID-19 cases expanding across the US, telehealth technology is not only now relevant, but absolutely essential for combatting the virus. Provider-to-patient telehealth and other remote/distancing measures need to be of paramount focus across the country in order to stem the tide, contain exposure, and proactively manage the virus.

Epic offers a variety of invaluable telehealth features that all their organizations can take advantage of, along with new content and tools designed specifically for COVID-19. While the ability to adopt and scale some of the Epic features in mass is ultimately dependent on infrastructure, server capacity, and organizational communication, they can all be “turned on” and made available to staff and patients with minimal effort. Those in the greatest need of the tools can start using them immediately.

Let’s dive in and take a look at each of the features available to the Epic community for use during these challenging times.

MyChart & eVisits

You may have already seen the influx of specialized mobile apps in response to COVID-19 related needs, along with a host of other medical screening and tracking tools. These new options fill an important role in organizational surge protection and proactive risk mitigation via forward-triage methods. While there are now many options for patients to quickly gauge risk and determine next steps, Epic makes the same patient screening and next-step functions available via MyChart. Questionnaires can be seamlessly pushed to patients in mass, and integrated automatically with the medical record, with notifications to relevant care providers.
Based on these questionnaires (Epic provides one for COVID-19 or you can customize/create your own), and follow-up questions or needs that arise, an eVisit can be easily generated for back-and-forth secure communication between patient and provider. Once the electronic visit is established, media files can also be shared securely. It is an easy and convenient way to communicate about matters that are determined non-urgent, rather than coming into clinic to reach that decision.
The AHA, in connection with Jefferson Health, has cited that 80% of urgent/emergent visits scheduled virtually resolve the concern at hand without the need for an in-person trip.

Direct Screening & Triage

Schmitt-Thompson Clinical Content has partnered in the effort against COVID-19, allowing Epic to distribute relevant triage content without licensing fees or restrictions. You can use the Schmitt-Thompson COVID-19 protocols whether or not you are licensed for their content, and can upload them into your Nurse Triage screens, as well as distributing by PDF for use at phone banks.
Epic also provides updated travel screenings and rule-in/rule-out questionnaires, along with relevant best practices for isolation and infection follow-up steps for your clinicians on the front lines, whether corresponding with a patient in-person or remotely. With the click of an order set, all the necessary precautions, notifications, and tests/next steps can be automated.
Finally, for those areas exposed to a heavy influx and volume of patients, Epic has quick registration options to mitigate surge and help to expedite drive-through testing.

Video Conference Visits (integrated with 3rd party video vendors).

Epic provides several mechanisms specifically designed for video-conferencing visits. With the impact of volume already weighing on a number of organizations, and with the social-distancing measures being employed amidst the COVID-19 outbreak, staff can convert previously scheduled in-person appointments to video visits, set up visits for new and urgent video consult needs, and even configure on-demand queues for patients to wait in line to receive immediate face-to-face attention and care.
The patient can connect to the video conference visit seamlessly through MyChart web or mobile, and the clinician can connect through Hyperspace, Haiku for iOS, or Canto. Once these visits are initiated, the clinician and the patient interact through live audio and video, and documentation occurs on the patient's chart just like a regular office visit.
The “on-demand” queues function in the same manner but instead of engaging through a scheduled appointment, the patient is added to a real-time queue, for which designated telehealth providers at the organization can see information about and one-by-one open the video feeds to begin correspondence. This can be done across organizational boundaries as well, through EpicCare Link or Community Connect partnerships, minimizing the time it takes patients to get help with their concerns.
Epic has existing integration with a number of common telehealth video communication vendors deemed secure and HIPAA compliant, but with recent announcements from Health & Human Services expanding regulation to accommodate "any non-public facing remote communication product that is available to communicate with patients" even non-standardly supported options can be leveraged.

Tracking & Monitoring the Population

In addition to the direct telehealth tools mentioned above, Epic has robust options for tracking and managing at both the individual and population levels. For the duration of the COVID-19 outbreak, it is critical to be accurately tracking during and after potential exposure to COVID-19.
The first tool you should be leveraging is one of the newest - the CDC's Person Under Investigation (PUI) form - which is required to be submitted to state health agencies along with a Case Report for every person being tested. Epic has converted this to a fillable/checkbox version that can be embedded into your clinical workflows and displayed prominently anywhere on screen in the system.
Epic automatically makes available new diagnosis codes, and standard features including result components, groupers, flowsheets, order sets, and smartdata elements should be leveraged to track and monitor all patients presenting for COVID-19 reasons/testing.
Using your version of those mechanisms, you can configure a COVID-19 specific Pulse Dashboard, to help your managers and other leaders monitor relevant visit information, safety/compliance, and the status of test results.
For organizations with high demand, emergency needs, Capacity dashboards that include information on available ICU beds and ventilators are also available.
Finally, Epic’s Slicer Dicer tool and the COVID-19 Population Explorer dashboard can be used by anyone looking to drill down for more information or trends pertaining to a given region, population, or subset of information.

Telehealth Billing & Reimbursement

While Epic has always had everything you need to bill properly for telehealth services, the federal government has relaxed restrictions for the duration of the pandemic, and many private payers are following suit as well. While entities in the private sector likely each have their own policies and requirements for you to understand, a few specific modifications to existing Epic functions can at least immediately ensure that you will obtain maximum CMS reimbursement.
Use or create a specialty billing indicator that can be applied to all COVID-19 patient accounts.
Use or create rules to stop billing and send all COVID-19 accounts to a Workqueue for review, ensuring that video visit billing has the proper place of service code(s) listed, along with appropriate COVID-19 reason for visit, diagnoses, and any modifiers or additional documentation your private payers may need.
Consider holding the claims as well until both the state and federal submission and reimbursement rules have been clearly defined and communicated.
You may consider a rule in Epic to temporarily hold patient statements for these telehealth visits as well, for the same reasons.
Lastly, Epic’s charge router and charge handler actions can be used to automatically address any unique circumstances that you may have or come across specific to COVID-19 and the telehealth services you are providing.

Some locations have been seeing more than a 10x surge in requests and needs for telehealth since the outbreak of COVID-19, making it crucial to have the above system mechanisms in place and available to staff ASAP. The goals are the same everywhere - to provide our frontline healthcare teams with the tools and safety they need to effectively diagnose and manage the patient influx, to prevent the further spread of COVID-19, and to track, treat, and monitor all who are affected. Telehealth is rapidly becoming a literal lifeline for many, and the faster and more efficiently we get it deployed, the better everyone will be.

For further discussion or assistance with any of what has been outlined here, from video vendor options to billing logic and setup, feel free to contact. I’m connected with a number of Epic teams across the country and resources already hard at work advising, executing, and advancing these options for organizations large and small.

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Today’s Reality: Continuous Security & Compliance

admin — Tue, 13 Apr 2021 11:37:15 +0000

Today's Reality: Continuous Security & Compliance

Sudish Mogli - Technology Advisor
Apr 03, 2020

The Need to shift from Incident Security to Continuous Security

Compliance with industry regulations alone cannot protect businesses from security breaches. Changes in the cloud infrastructure are rapid, so an automatic and sustainable approach to cloud security must be in place.

Think the first responder on your network device receives an instant warning about new vulnerabilities, and how to fix them. This is called “continuous security”, and it has a significant increase in the security of your network.

Here are some reasons why Continuous Security is essential

Security Compliance

Continuous security is an ongoing process that configures and manages security controls. With security in mind, compliance is a “health measure” for business security, and you make it a by-product of good security.

Know your responsibility
Preparing for a compliance audit is a good job, so the idea of maintaining it permanently may seem overwhelming. Therefore, it can be comforting to see that some areas of cloud compliance are your area of responsibility.
Configure the alerts properly
Alerts are useful as long as you can follow them. They allow you to see abnormal behaviors that require further investigation in real-time. However, if they are not properly configured or too hard, your team can quickly close their eyes and place them in the gray compliance areas.
Ensure visibility
It’s not always a direct way to ensure cloud compliance as your business grows. If a new server is simplified, more and more employees have access to the corporate system and more data is processed and stored, and be sure that they meet the requirements.
Being incessantly compliant
Continuous cloud compliance is an achievable goal with a little preparation. As long as you know which compliance requirements, you need to comply with, your warnings are adjusted and your security solutions can be measured, you can say with certainty that you meet 24/365 compliance.

How to Achieve Continuous Security

Of course, humans cannot check multiple builds a day; we need a security team that can think about security requirements, restrictions, and best practices and automates the process.

Best Practices and Continuous Security

Here are the best methods to sustain Continuous Security.

Network Security should be implemented from the inception to execution not be an afterthought. Best practices for sustainable continuous security.

Focus on Tools to implement all the processes & keep on improving them
Enable monitoring of all relevant components of your infrastructure
Ensure quality through regular deployment
Setup notifications and actionable alerts
Prepare user-based dashboards for reporting

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Cloud Vendors Offering Assistance During COVID-19

admin — Tue, 13 Apr 2021 09:00:28 +0000

Cloud Vendors Offering Assistance During COVID-19

Healthcare Triangle
Apr 06, 2020

A couple weeks ago, I published Ramping Up Telecommute Capacity. In that article, I mentioned that several cloud vendors were offering some incentives to organizations to help them take advantage of their services to support telecommuting and other changes to IT operations.

In this article, I’ll dive a bit deeper into what the “big three” cloud vendors are offering and discuss how they may fit into your response to current events and may fit well into your overall infrastructure strategy going forward.

COVID-19 is reinforcing that successful IT organizations must be highly agile and scalable with little to no notice. Cloud solutions are key to enabling this agility and scalability in a secure and budget friendly way. These offers give you a chance to bridge needs your organization has now to respond to current events and will also give you a chance to try out the technologies and see how they may fit in your organization going forward.

If you need assistance in exploring any of these services, Cornerstone Advisors is ready. Reach out to me!

Virtual Desktops and Application Virtualization

Organizations have been deploying virtual desktops and virtualizing applications with tools like Citrix, VMWare and Microsoft Terminal Services for quite a long time. These solutions let organizations deploy desktops that can be accessed virtually from almost anywhere from most any computer, tablet or mobile device. These virtual desktops let organizations give their users access to a full corporate desktop environment while also allowing security controls to be applied and keeping critical corporate data in the control of the corporation.

Classic, on-premises installations of virtual desktops and application virtualization require significant investment in servers, storage, software and human expertise to deploy an operate the environment. These are usually both capital and operating expense intensive and organizations must invest for “maximum” capacity to assure capacity for the busiest time periods, leaving significant capacity (and investment) sitting unused much of the time.

Cloud solutions offer a more on-demand, variable and scalable approach that minimizes capital outlay and allows operating expense to flex more dynamically with organizational need in the moment.

During COVID-19, Virtual Desktops and Application Virtualization can let more workers work from home without needing to procure and issue corporate devices. Workers can use personal home computers, tablets or mobile devices to access the virtual desktops.

AWS Workspaces is a managed, secure “Desktop-as-a-Service (DaaS)” that lets organizations deploy virtual Windows desktops in the AWS cloud. Users can access and use these Windows desktops from almost any device they may have. Virtual desktops can be deployed using standard images that incorporate corporate security and control policies and tools. The desktops can be monitored and managed just like any computer desktop running in a department. Each desktop includes Microsoft Windows licensing, further reducing management overhead. Workspaces can be paid for at a fixed rate per user per month or by the hour depending on the expected utilization of the desktop.

Starting April 1st, AWS is offering WorkDocs to up to 50 users at no charge through June 30, 2020 for new customers. As part of this, they are bundling Amazon WorkDocs (see below) file storage with each Workspace.

Microsoft Azure Windows Virtual Desktop is a desktop and app virtualization service running on the Azure public cloud. For organizations already using Windows virtual desktops on-premises, this can be a simple way to extend virtual desktop capacity in a secure and scalable manner. Virtual desktops are fully functional Windows desktops and can be accessed by users from another Windows desktop (e.g. a home computer) as well as clients for Android, iOS and MacOS.

At present, I couldn’t find any sign of special offers from Microsoft on Azure Windows Virtual Desktop but I did not that this service is included under many other services customers may already own from Microsoft such as Office 365 and Windows 10.

Virtual Collaboration

Virtual collaboration tools enable workers to still collaborate with team members regardless of geography. The solutions here include virtual document collaboration (shared editing) as well as audio and video conferencing.

Amazon Chime is a pay-as-you-go communication service that includes audio and video conferencing as well as content sharing. It also includes chat capabilities.

Amazon is offering free use of Amazon Chime Pro from March 4 to June 30, 2020 for new customers.

Amazon WorkDocs provides secure collaboration on files that allows users to work together to create and share content.

Starting April 1st, AWS is offering WorkDocs to up to 50 users at no charge through June 30, 2020 for new customers.

Google Meet is a full featured meeting platform including voice and video conferencing as well as content sharing. One nice feature of Google Meet is that it works right within the Google Chrome browser without needing separate programs or downloads.

Google is extending advanced features to GSuite customers to allow for larger meetings and the ability to record meetings through July 1st.

Microsoft Teams combines content sharing and collaboration with audio and video conferencing. Teams is included for Office 365 users. All activities in Teams can be done within any modern browser.

Microsoft is offering several options or to enable free access to Teams for both organizations and individuals.

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COVID-19 Highlights the New Interoperability Imperative for Healthcare Information Technology

admin — Tue, 13 Apr 2021 07:32:10 +0000

COVID-19 Highlights the New Interoperability Imperative for Healthcare Information Technology

Healthcare Triangle
Apr 06, 2020

COVID-19 is a national health care crisis that requires efforts by every part of the U.S. healthcare sector to combat. Researchers, clinicians, policy makers, and others are asking the right questions to try and formulate the best strategy to mitigate the impacts of the crisis. They want to help the public by determining where and how should we strengthen containment measures as well as where and when can we re-open economically vital businesses. After two decades of massive investment by the public and private sectors in healthcare information technology, however, they remain hamstrung by a lack of meaningful interoperability and access to data.

The Data We Need

1. Confirmed COVID-19 Cases. To get a full picture of the COVID-19 epidemic at any point in time, it is necessary to have the number of confirmed COVID-19 cases. The federal government has issued coding guidance to improve consistency in reporting of confirmed case data, but because there is still not widespread testing, relying on confirmed cases is not enough.
2. Suspected COVID-19 Cases. Any “suspected” COVID-19 cases are coded as the reason for encounter such as cough, shortness of breath, or fever. As a result, suspected COVID-19 cases cannot be easily differentiated from other illnesses that present with one of these symptoms. It may be possible to estimate the number of suspected cases in the presence of an order for a COVID-19 test, except that when symptoms are mild, tests have not been consistently ordered because of the lack of availability.
3. Other Medical Conditions. Data is essential to accurately model risk of developing complications, identify cases where testing should occur but perhaps has not been done, and research COVID-19 complications. That means looking far beyond test results to data on demographics, chief complaint, problem list, medical history, allergies, medication lists, vitals, diagnostic results, and admission, discharge, and transfer events.

The data we need to fight the pandemic exists. It is documented every day in technology solutions used by the health care system, but the data is locked in thousands of silos across the nation.

Data Held Under Lock and Key

The data we need to fight the pandemic exists. It is documented every day in technology solutions used by the health care system, but the data is locked in thousands of silos across the nation. Policy makers and researchers would have an easier time penetrating a bank vault than they do obtaining key COVID-19 related data. Persistent interoperability and structural problems within health IT have not been solved, and so key data sits in systems controlled by various players in the health care industry.

The data we need to fight the pandemic exists. It is documented every day in technology solutions used by the health care system, but the data is locked in thousands of silos across the nation.

Electronic Medical Records (EMRs). Certified EMRs contain nearly all the critical data for surveillance and research into COVID-19. Much of the data in the EMRs has a relatively standardized data architecture, making it technically possible to share and aggregate it. The problem lies in the fact that nearly every health care provider organization has its own instance of an EMR, and interoperability requirements for these systems necessitate that information must be shared primarily with other healthcare provider organizations. The requirements do not extend to ensuring clinical researchers and the federal government can get data from the EHRs.
Lab Information Systems (LIS). Every commercial lab and most healthcare provider organizations have their own instance of a LIS. There are not requirements to share information between LIS systems, and the architecture of the data is not fully standardized to allow them to interoperate. Also, this data is limited in scope and includes demographics, lab orders, and results. It often omits symptoms, underlying health conditions, and more.
Local and state surveillance systems. These tools do not have a standardized data architecture across geographic borders. Data, therefore, cannot be fully and easily shared between states, with the federal government, or with researchers. Also, this data is limited in scope and predominantly includes demographics, confirmed diagnoses, and immunizations.
Health Information Exchanges (HIEs). Most healthcare providers organizations participate in health information exchanges. Theoretically, much of the important data to assess COVID-19 is passed through an HIE, but there are limitations here too. Often HIEs are state-based so that data with which they interact is geographically limited. National HIEs help to overcome this barrier, but participation in any HIE, let alone a national HIE, is not consistently in place for all healthcare providers. This leaves data again unable to be meaningfully shared within the health care industry or with government.

The Workarounds

With data locked in thousands of silos, the entire industry is forced to use workarounds. On March 29, 2020, the federal government requested that hospitals report COVID-19 testing data to the U.S. Department of Health and Human Services (HHS) directly by emailing spreadsheets. Privacy and security concerns with this approach are material, so on April 2, 2020, HHS relaxed the rules regarding data sharing with public health authorities in order to obtain more of this data from frontline healthcare providers. Even when hospitals comply with this request, data has to be compiled once by the provide organization, emails, and compiled again by HHS. Statistics and insights are at least a day old, if not older. With hundreds of new cases a day, 48 or 72 hours worth of information is critically necessary.

As another work around, some IT system vendors and other partners in health care and academia are now attempting to help consolidate data and more robustly analyze it. On March 23, the COVID-19 Healthcare Coalition, a collaborative with a goal in part to aggregate de-identified data to gain clinical insights and inform resource planning was formed. It includes well know technology companies as members including Amazon Web Services (AWS), athenahealth, CommonWell Health Alliance, Epic, Microsoft, and Salesforce. Cerner announced March 24 that it is working with the federal government to inform a national COVID-19 surveillance network and share relevant data elements with the consent of their customers.

If these IT vendors, academic partners, and government agencies can come together to use data to meaningfully inform policy and health care delivery decisions is yet to be seen. Data aggregation, normalization, and analysis on the overall population will undoubtedly be very challenging.

What Next?

If the needed data on patients with confirmed or suspected COVID-19 and other communicable diseases was required to be interoperable and shared among healthcare provider organizations and state and federal governments, these workarounds would not be necessary.

Meaningful interoperability of key data would allow for a quicker and more comprehensive response to disease outbreaks, saving money and lives.

Providers on the front line of care delivery would be able to quickly assess a patient's risk and comorbidities. Meaningful interoperability would alleviate additional administrative work for hospitals. Researchers could more quickly and with larger sample sizes assess risk, treatment effectiveness, early onset symptoms, and more. Policy health agencies would have near real time monitoring and tracking of COVID-19 rates of infection and mortality under a model that could be used with other communicable diseases going forward. Meaningful interoperability of key data would allow for a quicker and more comprehensive response to disease outbreaks, saving money and lives.

The Federal government and HHS can and must work with Health IT vendors and healthcare provider organizations to address this issue. Because of the structural problems present with data and interoperability within the health care system, we continue to wait for solutions at great expense to our country.

For further discussion or immediate healthcare project-related assistance, drop an email to info@healthceretriangle.com or schedule a consultation.

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The Business of Healthcare after COVID-19 Is Gone

admin — Tue, 13 Apr 2021 06:47:57 +0000

The Business of Healthcare after COVID-19 Is Gone

Healthcare Triangle
Apr 28, 2020

Whether it is next week, next month, or next year, affairs in the US will open back up and return to a state of relative calm. But most agree that business as we know it will change significantly. Very few entities, be they small businesses or publicly traded international conglomerates, can weather repeated impacts of something like the COVID epidemic. And healthcare businesses in the United States have already been doubly affected, as they face the same financial and operational stresses that all businesses do, while simultaneously bearing the burden of day-to-day combat and execution just to get everyone through to the other side of the storm. Nobody wants to see and experience another mass-impact event such as this, but there will be more, and whether the next one is another health pandemic, a financial crash, or international conflict, there are things every smart organization will be doing to pivot their business to improve and prepare. Some of the changes will be seen relatively quickly, while others will still take some time, but one thing is almost certain, COVID-19 has become a tipping point from which there will be no simple return to “business as usual”.

With regard to Healthcare in the US specifically, below are 4 critical shifts that all businesses will need to strategize and prepare for. If you aren’t already thinking and planning around these considerations, you’re already falling even further behind and will see an almost inevitable extension to the negative impacts COVID has brought.

Shift #1 - Telehealth will go mainstream and take center stage. In one sense, it already has out of necessity, but it will go much further. If COVID has shown anything in the business arena, it is that entities simply can no longer survive on 100% in-person services. Everyone will need to take a strategic look at the services they offer and their opportunities for doing so in more flexible and accommodating ways. And, it may not be instantaneous, but regulation and reimbursement will pivot accordingly. So, are you ready? In the rush to get immediate Telehealth capabilities up and running for COVID, have you considered:

a. The unique advantages and disadvantages to your system with each of the primary video vendors?

b. Your plan to scale, deploy, and support across the enterprise?

c. How you will structure and schedule in-person and virtual visits in a blended model for maximum efficiency?

d. What does the appetite and comfort level look like for digital interaction within your patient and provider populations?

e. Financial fool-proofing - steps to assure revenue integrity and maximize reimbursement?

Shift #2 – Improved affairs for front-line healthcare workers. Provider burnout and healthcare resource shortages (Nurses, Pharmacists, etc) will get worse after COVID is through. While staff around the country have come together beautifully in a mission-oriented manner to address the deadly situation, it is certainly taking an added toll on already fatigued, dissatisfied healthcare personnel. We are losing many highly-skilled practitioners directly to the disease along with the patients they are working to save, and we’ll lose more indirectly once COVID is officially beaten and past. The added stress and fatigue is causing spikes to suicide rates and industry departures, which have already been at all-time highs in recent years. Organizations never having experienced the burnout problem directly unfortunately now will. Those that have already begun to mitigate and pivot toward clinician wellness and efficiency will need to supercharge their efforts, and those who haven’t yet, will need to make a rapid and significant leap forward. For the clinicians and staff who remain in service, combating burnout and creating efficiency - in their EHR systems, in day-to-day operations, and in administrative burdens will be paramount. Fortunately, there’s a lot we can still do to help:

a. Chat bots are here to stay and already taking some of the load off.

b. The major EHRs have never been more ripe and capable of providing efficiency backed directly by data. Many resources still have the potential for 25% efficiency gains.

c. They may be slow-going, but legislative and regulatory changes are on the way.

d. Digital and analytical technology integration has never been more possible and impactful, along with interoperability and cloud-connected services.

Shift #3 - IT expectations will rise. IT departments will be expected to do more, to do it at a quicker pace, and to do more of it remotely. The needs surrounding COVID have reminded everyone what is possible to achieve in short order when everyone comes together to simply “get it done”. Nobody is going to want to go back to the days where 27 IT projects are in flight but take forever and a day to actually complete. Nor will the state of business operations and rapid-demand digital/remote relevance allow for it any longer. We’ll all expect execution of more projects in a COVID-like manner - rapid, deliberate planning, integrated and innovative teamwork/execution, and a willingness to simply “go” without having every minor detail ironed-out. We’ll see projects take an approach where you get to 80% of the goal or what is needed/desired, get there quickly, and figure out the remaining pieces along the way or even after. Having an end-product and capability in place is better than nothing at all, even if there are a few kinks that need to get worked out. Questions to ponder:

a. Does your business currently operate in a “perfection is the enemy of good enough” model?

b. What is the average duration of your IT-related projects? What does the ideal timeframe look like for a majority?

c. Are there ways you can improve and compress the critical path for your projects?

d. Where do you have opportunities for better cross-functional work and improved collaboration between disparate teams?

Shift #4 – Remote is here to stay. Sure, many, many Americans and workers in the healthcare industry will return to their offices and day-to-day operations once the COVID-19 risks have cleared, but not everyone, and not everyone permanently. The necessity to continue work operations under stay-at-home orders and measures of social distancing have for a lot of entities brought to light just how much can still be accomplished (and in some cases more) without forcing people together into the same physical space. And what’s more, there is a lot of efficiency to be gained in the remote approach. Workers are not weary from travel and commute, and can function free of office distractions and interruptions. Sure, at home interruptions and other distractions still arise, but if supported properly and provided with proper expectations and management, most individuals can function at equal or better levels than in a mass office environment, and find efficiencies in their home life and dependent care scenarios as well. And let’s not also forget the impact to workplace satisfaction. Happy employees are typically the most loyal and productive employees. Remote work can truly be a win-win for everyone if structured intelligently. As you continue to embark on this journey and plan for the future, consider the following:

a. What technologies are you leveraging or planning to leverage to facilitate remote work, communication, and collaboration? Teams, Zoom, Skype, Slack, etc.

b. Do you have a plan and analytics to accommodate remote resource monitoring and measure productivity?

c. What services or areas does it make the most sense for you to begin the remote transition with? What departments could see the most benefit or gain?

The organizations that strategically and proactively take the lead in the transition with these items are inevitably those that will capitalize on and realize the largest direct gains, along with the quickest return to “business as usual” or really what will eventually become for all “the new normal”. Here’s wishing a smooth and speedy road ahead to those already at the forefront of these ventures, along with those about to embark in earnest.

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Return to Revenue: Accelerate Your Return to Revenue

admin — Tue, 13 Apr 2021 04:58:14 +0000

Return to Revenue: Accelerate Your Return to Revenue

Healthcare Triangle
Jun 09, 2020

Proactively communicating with patients and the extended health community is now an absolutely essential part of business for healthcare organizations of all sizes. Surveys have indicated that 3 out of 4 consumers today will consider switching providers based on a single negative experience. In the midst of COVID-19 uncertainty, changing regulations, protocols, and financial circumstances, people need to know what to expect now more than ever before. What follows is a list of what should be considered essential business for health entities seeking to service, retain, and improve relations with patients in a greater capacity.

A Strong Communication Plan

Consistent, regular messaging is now mission critical for items such as: hours and operations, services available, safety measures and “safe care” protocols employed, contactless procedures, and options for virtual care.

Essential information needs to get distributed at extremely regular intervals for the foreseeable future. For most, that means at minimum weekly formal communication or announcements, and potentially more frequently.

An array of communication and engagement platforms. The Center for Connected Medicine reports 82% indicating the dominant patient engagement technology is the health system’s patient portal, commonly an extension of the EHR, so using that as a vehicle for regular information and correspondence should be priority #1. However, patients of all types also have an increasing desire for digital engagement avenues, as evidenced by the 2019 Salesforce Connected Healthcare Consumer Report

Educating – Internally & Externally

With service volumes still below capacity and at manageable daily workloads, now is a great time to invest in review, revision, and education around patient financial assistance. Uninsured write-offs and discount policies, and alignment of patient-friendly payment plan options are good initial topics.
Price transparency, coinsurance, deductibles, out-of-pocket costs, and general staff awareness of patient financial assistance options/impacts can follow. Use this extra time to make front-line staff informed patient advocates expressing empathy.
Improve soft skills. Incredibly important for revenue cycle and front desk staff now is the ability to ask financial questions in a meaningful and appropriate manner. Organizations that have developed dedicated compassionate collection education programs have seen impressive results.
It is also more important at this time for physicians, nurses, and APPs to have a degree of financial understanding and empathy that can be communicated to patients
Things have changed dramatically for your primary payers as well. Don’t forget about working with them to ensure everyone has a shared understanding about new codes, regulations, documentation requirements, and telehealth-related procedures. Insurers and health plans consistently provide underwhelming communication and information to patients. Be a partner and ensure your patients have the information they need.

Community Engagement & Partnership

Not only is it essential to engage with your historic patient population, but also now your entire extended community, including targeted competitor space.
Local health entities, affiliates, referral partners, and really any establishment servicing patients need to know what to expect and how they can direct and inform customers.
Partner with local financial institutions to find new ways and options for patients to pay during these potential periods of financial hardship. One great client summary of work is here.
Reach out and solidify information and opportunities with entities that may help patients navigate or improve their social circumstances. Social determinants of health such as housing and food security continue to be key drivers in patient’s ability, motivation, and follow-through for proper care.
Work with local collection agencies to develop scripts that are sensitive to circumstances and compassionate to the patient’s situation and financial welfare.
Leverage vendor relationships and capabilities that help to achieve revenue efficiency, value, and cost control. If you don’t already have preferred and trusted partners, I can advise on a number that do excellent work (and some on contingency) in outsourced revenue assurance, IT/EHR optimization, and Managed Services/Support. Whether your goal is to plug holes in your revenue cycle, enhance billing and reimbursement streams, or continue with existing project and support needs with reduced staff and costs, proven partners are available at no-risk price points.

COVID-19 hit the US fast and hard, and it continues to wreak havoc on the financial health of both healthcare institutions and the patients they serve. The considerations above will help to ensure the journey back to comfortable financial positions is as smooth and quick as possible, and lasting long after the Coronavirus is gone.

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