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Q&A With DeeAnn Broussard & Michelle Story

DeeAnn Michelle Aug 2017As noted in an earlier issue, the Quality Forum partnered with the Louisiana Department of Public Safety and Corrections (DPS&C) in late 2016 to select a certified electronic health record (EHR) system for their headquarters, seven state correctional facilities and more than 30 eligible providers. The two groups are currently working to implement and integrate the EHR system, which is designed to support the DPS&C’s ability to monitor and improve the health and safety of approximately 17,000 incarcerated offenders in their custody. DeeAnn Broussard (Client Executive) and Michelle Story (Project Manager) are among the Quality Forum team members supporting the DPS&C initiative. They recently spoke with me about the project’s scope and challenges.

http://zspskorcz.pl/pictose/eseit/3342 Q. What role does the Quality Forum team play?
cherche femme riche pour mariage 2015 A. Michelle Story: Currently, we have a six-person EHR development team working with the DPS&C representatives and the EHR vendor to identify correctional health functionality that is necessary to pilot the system; identify and resolve operational workflow issues; test the system; and assist with the primary data migration. As we move ahead, the team may include training and production support staff.

http://godswayradio.com/?rtyt=rencontre-des-femmes-riches-celibataires&f07=f0 Q. How do you support the DPS&C initiative?
site de rencontre d'ado de 13 ans A. Michelle Story: My role involves coordination with the EHR vendor to determine the next steps in implementation and to facilitate the collection of inputs and outputs that need to be mapped into the programming and development of the EHR. In addition, I collect workflows from the individual correctional centers. As a project manager, I’m also responsible for identifying and assessing potential risks as well as project planning, control and execution.
http://adetacher.com/misroe/jisdr/1256 A. DeeAnn Broussard: I work closely with all the groups involved – the DPS&C, the Quality Forum and the EHR vendor – to ensure open communication between the team members. Keeping everyone up-to-date and on the same page is critical for a project like this. Likewise, I also manage and coordinate the different meetings, workgroups and site visits so we can remain laser-focused on our objectives and the timeline.

http://surfscooter.com/?maska=mujer-busca-hombre-amistad&907=25 Q. What do you see as the project’s biggest challenge?
https://distillery244.com/frnew1/5472 A. Michelle Story: I think change itself always presents challenges, and the adoption of new technology in health care is a major change.
read more A. DeeAnn Broussard: I agree with Michelle regarding the challenge of change. This initiative, when successfully implemented, will make a huge difference in the daily work processes of the DPS&C. By remaining positive and encouraging, we feel the team can, and will, accomplish and overcome any challenges that come our way.

http://hivtestkit.ph/?melisa=rencontre-homme-libreville&9f6=22 Q. What is it that keeps you engaged and motivated regarding this project?
mujeres solteras new jersey A. Michelle Story: For me, it’s working with the medical staff. I think their commitment to excellence in providing care to offenders within Louisiana’s correctional facilities is impressive and commendable.
A. DeeAnn Broussard: This project has been, and will continue to be, an incredible learning experience for me. Having the opportunity to understand and appreciate the daily challenges the DPS&C faces from a health care provider perspective is extraordinary. And all the while, the staff remains committed to making this project successful. We have an incredible team, and everyone brings so much knowledge and experience to the table.

Editor’s Note: To learn more about this initiative, please see Cindy Munn’s Quality column in the September/October 2017 issue of Healthcare Journal of Baton Rouge and Healthcare Journal of New Orleans when the publications are posted online in early September. The column features an in-depth interview with Raman Singh, MD, Medical/Mental Health Director for the DPS&C.

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Q&A with Jody Marsh

Jody MarshSince the Quality Forum was established in 2007, the Patient-Centered Medical Home (PCMH) model of care has been a primary focus of the organization. Today, the Quality Forum team supports physicians across the state that are pursuing recognition as medical homes. According to the Patient-Centered Care Collaborative, providers must provide care that is “patient-centered, comprehensive, team-based, coordinated, accessible and focused on quality and safety.” Practice Consultant Jody Marsh has worked closely with different groups since 2012 as they transform primary and specialty care delivery for their patients. She recently shared her thoughts and experiences related to the PCMH model and the road to practice transformation.

Q. What do you see as the key benefits of PCMH recognition for a practice or group?
A. I think one of the main benefits is that becoming a PCMH creates and strengthens personal relationships between providers and their patients. The process itself builds a foundation within the practice for physicians and their staff to provide coordinated, comprehensive and personalized care plans for their patients. In addition, it also prepares the practice to better adapt to a value-based payment system.

Q. What type of services does the Quality Forum offer to help providers with this transformation?
A. Our team provides on- and off-site consulting/coaching for providers and their staff with regard to PCMH standards set by the National Committee on Quality Assurance (NCQA) as well as practice and workflow redesign, project management and education/outreach. It begins with a practice assessment to evaluate current processes and capabilities. Once the assessment is complete, we work with the office manager to implement necessary policies and procedures. Then, we assist with training the staff to incorporate medical home procedures into their daily operations and ensure that the documentation meets evidence-based standards for preventive, acute and chronic care management. Proper documentation is important because it is sent to NCQA for approval of recognition.

Q. What role does health information technology (IT) play in the PCMH model of care?
A. We have found that a practice’s health IT infrastructure plays a major role in the PCMH transformation process. Some electronic health record (EHR) systems are limited in reporting capabilities, and the practice may not be able to provide every detail on a report requested by NCQA to prove compliance. Because of the Quality Forum’s experience in helping providers implement and meaningfully use EHRs and administering Louisiana’s health information exchange – LaHIE – we can optimize a practice’s EHR utilization and HIE integration.

Q. What do you see as the biggest challenges that practices/groups face when pursuing PCMH recognition?
A. One of the major barriers is that our current health care environment still utilizes a fee-for-service payment model. Physicians and group practices are seeing as many patients as they can in a day, but they aren’t being properly reimbursed for taking the extra time to provide meaningful quality care and to document that care. As we move closer to a value-based payment system, I am hopeful that more and more small practices will turn to practice transformation. Other factors that may pose challenges include staff and patient engagement. The key to successfully working within these two areas lies in empowering the health care team and patients so they better understand the rationale for the coordinated services, the evidence-based care and increased access to the clinical staff.

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MACRA | A Brave, New World

Linda MorganLinda Morgan
Marketing/Communications Director
Louisiana Health Care Quality Forum

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) launched Jan. 1, 2017, and ushered in a “brave, new world” for health care stakeholders. Along with providers, payers and patients, purchasers/employers will also be impacted. By providing health insurance to employees, employers may experience increased productivity, reduced absenteeism and reduced costs related to workers’ compensation, in addition to enhanced employee recruitment/retention. Healthy workplaces can, in turn, play a key role in promoting healthy communities.

I asked Cheryl Tolbert, president and CEO of the Louisiana Business Group on Health, for her thoughts about MACRA and how these changes will affect employers.

Cheryl Tolbert, CHRS
President & CEO | Louisiana Business Group on Health

Do you believe that employers are knowledgeable about MACRA and ready for implementation?
Louisiana employers are very sophisticated when it comes to benefits, and this was especially evident with the implementation of the Affordable Care Act. Our employers are also very knowledgeable about MACRA. Generally, as Medicare makes changes, those changes also impact employer-sponsored plans. To ready themselves for implementation, the health plans will manage the process, therefore, employers should talk to their health plan/third party administrator.

How will the implementation of MACRA impact employers in the short-term? Long-term?
New payment models that reward value rather than volume not only help to increase efficiency, they also help improve the delivery of care. Some examples include greater care coordination, increased shared care planning and partnerships with patients at all levels of care as well as with patient experience of care.

For employers, what are the biggest challenges associated with MACRA?
In my opinion, there are several key challenges:

  • In general, employers will need to work with health care providers to gain enough leverage to influence the process.
  • The measures need to reflect private employers because measurement alignment puts all parties moving in the same direction.
  • It will be important to share feedback on metrics that employers feel are priorities with plans, brokers and providers.
  • Transparency will be vital for employees to be effective health care purchasers. As a result, information needs to be made available quickly. This will help encourage consumerism.

How do you see MACRA reshaping the health care landscape?
First, I think MACRA will help foster employer partnerships and collaboration that will in turn, support the move to value-based care. Similarly, it will drive more providers to value-based payment programs. In addition, I think it will encourage Increased benefits literacy and consumerism among employees while educating them on how to use the health care system. Finally, I believe new and creative employee engagement strategies will emerge to help employees take ownership of their health.

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A Life Lesson from Mike the Tiger

We are all saddened by the news that LSU’s live tiger mascot, Mike VI, passed away on Oct. 11 after a long battle with cancer. His illness also allows us to discuss the kind of care we might like to receive if we had to face our own serious advanced illness.

While many people think that it is very important to talk with physicians and family about the subject, few people actually do so and even fewer people write anything down. We should all consider and write down who we want to make decisions for us in the event that we can’t speak for ourselves (health care power of attorney) and what kind of decisions we would like the person to make on our behalf (living will/advance directive).

Mike VI couldn’t share his health care wishes with us, but I can only imagine that he wanted to be free of pain and other symptoms like nausea, shortness of breath, fatigue, insomnia, constipation and anxiety. We have excellent medications available to treat humans with these symptoms! He probably also would’ve liked to eat whatever he wanted to eat in whatever quantity he wanted – a few bites or a whole slab of meat. At some point, eating and drinking probably were of little or no interest to him. I also presume he would’ve preferred to be surrounded by his fans, but as his illness progressed, he may have become more reclusive and less interested in the world around him.

Appropriate end-of-life care is provided to humans by organizations known as hospices, and the care is provided in the patient’s home, or wherever the patient may live. The goal for any patient is to “live well until he/she dies.” Mike VI entered hospice care for a short time so that his caretakers could make sure he lived well and didn’t suffer. Rest in peace, Mike the Tiger – you’ve taught us a wonderful lesson.

Susan Nelson, MD
Hospice and Palliative Medicine Physician
LaPOST Coalition Chair

For more information about advance care planning, please visit www.la-post.org.

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Expanding the Value of Health IT

By Cindy Munn, CEO, Louisiana Health Care Quality Forum

For the last several years, the Louisiana Health Care Quality Forum has proudly partnered in National Health IT Week, Sept. 26-30, a weeklong, partner-driven effort to increase awareness about the value of health IT.

As an organization that has worked with more than 2,000 health care providers across the state in the transition to electronic health records (EHRs) and manages the statewide health information exchange (HIE), National Health IT Week provides us with an opportunity to educate others about the benefits of health IT.

These benefits speak for themselves, but there’s so much more that we can do – both as health care professionals and health care consumers – to drive health IT awareness. National Health IT Week is the perfect opportunity to do just that. Here are a few suggestions:

  • Visit our special website for patient engagement resources and information.

  • Are you a student? Take part in the NHIT Week Inaugural Student Challenge. HIMSS is challenging students from health policy, informatics, public policy, computer science, public health and related academic programs to develop and implement health IT advocacy issues in their state or region. (How great would it be if students at Louisiana’s wonderful colleges and universities took the lead on this?) The grand prizewinner will receive a travel stipend of $1,000 and free registration to the 2017 HIMSS Annual Conference and Exhibition, which is kind of like winning a free ticket to the Super Bowl.

  • Participate in a National Health IT Week event. From webinars and workshops to symposiums and events, there is a virtual smorgasbord of opportunities to get involved in health IT.

  • Share your story about health IT. The personal stories of health care professionals and patients can make a tremendous impact on policy related to health IT. By sharing your story, you can help promote the value of health IT to decision-makers across the country.

Regardless of how you choose to get involved, whether it’s attending an event or taking advantage of an opportunity to learn more about health IT through a webinar, we hope that you will take action. Health care is something that affects all of us, and together, we can make it better through health IT.

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A Forum For Inspiration

By Jamie Martin, Marketing & Communications Manager

There’s nothing like a HIMSS event to get you pumped up about the value and potential of health IT, and this week’s Pop Health Forum in Chicago was no exception – and not just because our Chief Technology Officer Brian Richmond and I were among the presenters.

The Pop Health Forum promised – and delivered – a deep dive into data and analytics, care coordination and patient engagement, the three primary pillars of any successful population health strategy. Brian and I were privileged to be among the many outstanding speakers at the Pop Health Forum, and we were excited by the positive response to our presentation of Louisiana’s successful efforts to reduce avoidable ED utilization and increase patient engagement.

But we were even more excited by the opportunity to learn about other successful population health strategies currently underway across the country. Among my personal favorites:

  • Michael Adcock, FACHE, Administrator of the University of Mississippi Medical Center’s Center for Telehealth, provided an incredible case study on remote patient monitoring (RPM) in rural Mississippi. With one of the highest national rates of diabetes among adults, Mississippi spent $2.74 billion in 2012 on diabetic medical expenses. To address the issue, the telehealth center developed and launched an RPM strategy that provided daily health sessions, targeted education, behavior modification, personalized interventions and health coach services directly to the patient via iPads. The program was so successful that the first 100 patients to enroll marked a decrease of 1.7 percent in HbA1c and a 96 percent increase in medication adherence. Beyond that, those patients lost a combined total of 91 pounds, were not hospitalized or seen in an ER for diabetes even one time and saved a total of 9,454 miles. Impressive results, and Adcock did a fantastic job of presenting them to a very attentive audience!
  • Adrian Zai, MD, PhD, MPH, Clinical Director of Population Informatics at Massachusetts General Hospital, did a fantastic job of describing the challenges related to population health across the stakeholder spectrum, from payers to operations, and provided an excellent case study of how MGH and Partners HealthCare addressed those barriers. By implementing a strategy that eliminated “sources of inertia and excuses” and cost only $7 per patient, said Zai, the results were 76 lives saved, $3.2 million in treatments avoided and a savings of $20 per patient. Incredible presentation of incredible results!

Of course, there were many other great presentations (there always are when it’s a HIMSS event), but the thread that tied them all together was clear: we truly can make meaningful, lasting improvements in population health. Perhaps the strategies we employ to make these improvements begin with small steps, but even the smallest of steps can take us somewhere new.

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Louisiana Strong



By Cindy Munn, Quality Forum CEO

Nearly 11 years ago, we watched in horror from points across the globe as homes and businesses and entire neighborhoods in southeast Louisiana were swallowed by the floodwaters during and after Hurricanes Katrina and Rita. That disastrous event so frightened us that our state took a strong, proactive stance in disaster planning and recovery, but when the floodwaters again began to rise – this time in the Baton Rouge region – on Aug. 12, 2016, we were still frightened.

It seemed to us that history was repeating itself: thousands of families left homeless, businesses destroyed, images of heroic rescues by everyday citizens, National Guard soldiers and response vehicles taking up posts across the region, desperate attempts to locate loved ones among the many shelters throughout the area, declarations of disaster zones, the list goes on and on.

Yet there was one very big difference. We were more prepared this time in terms of our health care delivery strategy, or as prepared as any region can be in the wake of a tremendous disaster – here in Louisiana, where natural disasters like hurricanes and floods happen all too often, we know first-hand that those are things for which no one can ever be fully prepared. But we try.

After Hurricanes Katrina and Rita devastated our state’s coastal region, we took stock of the issues in Louisiana, and one of the biggest of those issues was our state’s dependence on paper medical records. Eleven years ago, that dependence left hundreds of thousands of our state’s residents without access to their medical information and led to significant gaps and delays in care. In response, our state took advantage of the availability of ARRA funds and federal grant dollars to build a system of connected health care founded in health IT,with the Louisiana Health Information Exchange (LaHIE) as its centerpiece.

While health IT cannot stop the floodwaters from rising and cannot rebuild neighborhoods and businesses, it most certainly can – and does – save lives. LaHIE, in times of disaster, ensures that the health information of those forced to seek shelter in a designated facility is available to the health care providers who care for them. It ensures that patients who have opted into LaHIE are able to share information about their medical diagnoses, medications, test results and other critical data with their doctors and emergency responders.

These families have lost their homes, but they have not lost their health information. While that may not sound like much, it is comforting… Just ask those who survived Katrina and endured delayed treatment for their injuries and chronic conditions because their medical records were under 10 feet of water in New Orleans.

Yet that isn’t the only comfort we’ve found in the course of this latest disaster. We’ve found comfort in the arms of the Cajun Navy, an amazing group of men and women across the state who loaded up their personal watercraft and came to our rescue without ever being asked to do so. We’ve found strength in the many families, churches and businesses who have opened their doors to strangers, welcomed them and given them food and shelter in this time of need. We’ve found hope in the donations of supplies and monies that have begun to arrive in our beautiful state from across the country. We’ve found inspiration in the bravery of our state’s first responders, emergency personnel and law enforcement – men and women who selflessly gave their time and effort to help us all.

That comfort, strength, hope and inspiration give us courage for what comes next: the recovery. And we will recover. We will rebuild. We will learn and improve. We are Louisiana.

And we are Louisiana strong.

Editor’s Note: There are a number of resources available to those whose homes, businesses and/or properties were lost or damaged during the Flood of 2016. We are pleased to share this information here for those who may need it. Additional resources are welcome. Please contact Jamie Martin atjdavis@lhcqf.org to provide that information.


Disaster Assistance

FEMA: 1-800-621-3362 or click here

DSNAP Food Stamps: 1-888-524-3578 or click here

Louisiana Department of Insurance: 1-800-259-5300 or (225) 342-1258


Food & Shelter

Food and shelter are being offered at the following locations. Please note that this information is subject to change at any time.

  • Lamar Dixon Expo Center (allows pets and livestock)
  • North Corbin Junior High, 32725 N. Corbin Rd., Walker
  • River Center in downtown Baton Rouge


The following locations are serving food.

  • Healing Place Church, 4829 Winbourne Ave., Baton Rouge, and 569 Florida Ave. SW, Denham Springs
  • Bethany, 11107 Honore Lane, Baton Rouge
  • St. Jude, 9150 Highland Road, Baton Rouge
  • Tyson Foods (beginning Sat., Aug. 20), Cortana Mall, 9401 Cortana Place, Baton Rouge


Pets

  • Sherwood South Animal Hospital on S. Sherwood Forest Blvd. is providing shelter for pets. Veterinarians are on hand to provide care. For information, call (225) 293-6440.
  • BR Animal Control, 2680 Progress Road in Baton Rouge, is serving as an animal shelter.
  • A mobile pet shelter has been set up at the Baton Rouge River Center, 275 S. River Road.
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We Heart Health IT…You Should, Too

By Jamie Martin, Marketing & Communications Manager

For several years, the Louisiana Health Care Quality Forum has joined in national efforts to raise awareness of the value of health IT. We’ve partnered with organizations at community, state and national levels across the country to drive health IT adoption among health care professionals and to promote the use of health IT tools and resources among health care consumers both here in our beautiful state and across the U.S. And once again, we are proudly participating in National Health IT Week, observed this year Sept. 26-30.

For those unfamiliar with NHIT Week, it’s a partner-driven, weeklong opportunity to raise health IT awareness and to drive improvements in health care delivery through the advancement of information technology. It’s an exciting, nationwide effort, and we invite you to join us.

Becoming an NHIT Week partner is simple. It doesn’t matter if you are representing a non-profit, a corporate entity or an organization; partnership opportunities are available at multiple levels, and it doesn’t cost a thing. Your participation lends your voice to a national effort to advance health IT across the spectrum of health care, and it provides you with the opportunity to inspire others by sharing your own story…like this one from Afton Wagner and this great video by Mandi Bishop.

Together, we can make a difference. We can drive improvements in the health care we receive as consumers and the care we deliver as providers. We can lead the charge to have better communication with our providers and greater connectivity among all members of our health care team.

We heart health IT.

You should, too.

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Q&A With Ray Peters

By Linda Morgan
Marketing and Communications Director
 
Cindy Munn, CEO, and Ray Peters, former Quality Forum Board President, recently joined a multi-stakeholder group of 100 senior health care leaders in Washington, D.C., for the National Payment Reform Summit. The group tackled key issues, identified barriers and provided a set of recommendations. 
 
Peters serves as Vice President of Human Resources and Marketing for RoyOMartin and its workforce of 1,100 employees. I asked him to reflect on his summit experience and to share his thoughts on the payment reform landscape from an employer’s perspective. 
 
Q. What are the key issues facing your company today with regard to providing health care benefits?
 
A.  “As a self-insured employer, RoyOMartin works diligently to help ensure that our employees and their families receive the very best value for their (and our) health care dollar. Generally speaking, our value proposition is defined as employees having access to quality care that is efficiently managed. We are fast recognizing that our value proposition, as defined above, is not supported in the traditional fee-for-service delivery system, where ‘quantity’ is often rewarded versus quality or efficiency.”
 
Q. How has RoyOMartin positioned itself for health care delivery/payment reform?
 
A. “Responding to the challenges associated with the current delivery and payment systems, RoyOMartin, along with two other enlightened employer partners, established a patient-centered primary care clinic for our employees and their dependent family members. The clinic provides easy access to outstanding care and treatment that is clearly efficiently managed. 
 
In a recent survey, 77 percent of RoyOMartin’s employee population identified the providers at the clinic as their primary care providers. A full-time care manager aids the providers in managing acute care follow-up as well as issues associated with longer-term population health. It is very important to note that employees are not ‘required’ to use clinic services. In our view, employee utilization must be driven by patient value.”
 
Q. As an engaged employer, do you have any final thoughts on payment reform?
 
A. “In my view, any discussion surrounding payment reform must include options beyond current funding methodology. I know that conversations around bundling services and capitation are currently taking place, but both methods are really recycled approaches, with some measure of nuance. In the end, quality outcomes must drive funding. Are behaviors being changed? Is population health improving?
 
Lastly, I believe that employers must continue to play a critical role in any discussion associated with changing payment options – remember our value proposition. It is in our/their best interest. There are two places where populations are ‘captive,’ and they are schools and workplaces. Longer term, school and employer participation is critical. Furthermore, there should never come a day when employers are penalized for providing outstanding health care options to their employers. In fact, they should be encouraged to do so.”
 
To learn more about RoyOMartin, click here
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Moving Forward With Health IT

By Jamie Martin
Marketing & Communications Manager
Louisiana Health Care Quality Forum

We were pleased to attend the annual meeting of the Office of the National Coordinator for Health IT (ONC) in Washington, D.C., last week, and as usual, we returned from the meeting excited about the future of health IT.

Technology, as we all know, moves and evolves very quickly, and in driving health IT, we have to move and evolve quickly as well. It is clear after last week’s meeting that ONC is meeting that challenge. A number of new resources were unveiled last week, including:

  • ONC’s Patient Engagement Playbook: We all know that patients who are engaged in their care have better outcomes, lower costs and better communication with their providers than those who don’t engage. Recognizing that patient engagement has a significant positive impact on patients as well as on providers, ONC has released a playbook billed as “an evolving resource for providers, practice staff, hospital staff and other innovators.” It features a compilation of patient engagement tips and best practices that ONC has collected from providers and health systems across the country.

  • Certified Health IT Developer Transparency: ONC is confident that a more transparent health IT marketplace will help promote competition, discourage data blocking and make developers accountable to the needs of providers and health IT purchasers. To promote transparency of certified health IT developers, ONC is requiring developers to publicly disclose detailed information about their products, including the costs that purchaser may encounter. Health IT purchasers can use this site to access a regularly updated list of developers’ mandatory disclosure statements.

  • Your Health Information, Your Rights: ONC has released a series of short videos to help patients understand their rights under HIPAA. These tools are available in both English and Spanish, and serve as a great resource for patients who want to learn more about their rights to get access to their data.
 
The release of these tools and resources are clear indicators that the national focus on health IT and the improvements it brings to health and health care is only growing stronger.

Here in our state, where we have suffered through the frightening situation of needing patient data and not having that data available during Hurricanes Katrina and Rita, we are also committed to driving health IT, not just for providers, but also for patients. We echo the sentiments of Karen DeSalvo, MD, ONC Director, former Quality Forum Board President and Louisiana native, who said at the close of the ONC 2016 meeting, “I want to reassure you all, as National Coordinator, that I am passionate and committed to seeing that we overcome any policy or technology or business case challenges that there might be so that we don’t have the kind of situations either in times of disaster or everyday life that interfere with people having the kind of health or health care that they choose and deserve and will help bring them the kind of quality of life that we all look for.”
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Measuring Success

By Jamie Martin, Marketing & Communications Manager
Louisiana Health Care Quality Forum

For several months, we’ve been leading a statewide campaign to educate Louisiana’s patients and families about health IT and to promote the use of health IT to manage their health and health care. It’s been an exciting effort –our state is one of the first in the country to launch such a campaign, and now it’s time to track our progress thus far.

One year ago, we conducted a statewide survey to identify health IT awareness levels among Louisiana’s health care consumers. The results were quite telling – for example, we learned the following:
  • 68 percent of respondents did not possess copies of their health information at that time, and only 51 percent had ever requested copies of their health records.
  • 58 percent tracked their health information by asking their doctors when they needed it.
  • 90 percent were familiar with electronic health records; 79 percent with patient portals; and 51 percent with the statewide health information exchange.
That survey also provided respondents with the ability to share personal feedback. This is what those respondents said:
  • 26 percent indicated they would use health IT to track and manage their care if the technology is easy to use.
  • 11 percent indicated they would use a patient portal if they had access to a working one through their doctors.
  • 6 percent indicated they would prefer a patient portal that included all information from their providers (i.e., single sign-on).
A year has passed since we gathered that data, and now it is time to measure how far we’ve come in the last 12 months. The new survey is now live, and you can take it by clicking here.
The survey takes less than two minutes to complete, and your feedback will help us to identify how we can continue to help educate Louisiana residents about the value of health IT and the importance of being pro-active in their health and health care.

Thank you in advance for sharing your insights and helping our state to improve health and health care for its residents.
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National Healthcare Decisions Day 2016: Q&A with Founder Nathan Kottkamp

By Jillian Washington, Marketing & Communications Coordinator
 
April 16, 2016 marks the ninth annual observance of National Healthcare Decisions Day (NHDD). Since 2008, NHDD has provided a platform to educate Americans about the importance of advance care planning and documenting their health care wishes in writing.
 
Discussing end-of-life treatment preferences with loved ones can be a difficult conversation to have; NHDD seeks to address this challenge by dedicating a specific day each year for patients to openly discuss their wishes without judgment.
 
In honor of National Healthcare Decisions Day, I reached out to NHDD Founder and Chair Nathan Kottkamp, who reflected on the progress of the advance care planning movement and explained why the topic does not belong exclusively to the elderly.
 
Q: How has the advance care planning landscape changed since the founding of NHDD in 2008?
 
A: “It has gained more acceptance, among other things. There seems to be greater willingness by the media to write articles about advance care planning. Furthermore, there has been an explosion in the number of websites and apps dedicated to advance care planning.”
 
Q: What do you feel is the greatest challenge to promoting advance care planning to health care consumers?
 
A: “It is a topic that most of us would rather ignore. We often assume that there will be time later to address the issues, but often people fail to do anything and tragedy strikes. This is one of the reasons that NHDD is so important, it creates a catalyst for people to mark their calendars, stop making excuses and just have the talk with their loved ones. The other challenge is knowing where to go for resources since there are so many options out there. At nhdd.org, we have assembled a collection of great, free resources.”
 
Q: Should young adults consider having an advance care plan? If so, why?
 
A: “Absolutely! Indeed, the three cases that made the law and the news with respect to advance care planning involved women in their 20s: Terri Schiavo, Karen Ann Quinlan and Nancy Cruzan. Advance directives are not just for end-of-life issues—they’re for any time a person cannot speak for himself or herself. This can be because of a car accident, a sports injury or some other random event.”
 
Q: How has NHDD impacted the advance care planning movement?
 
A: “NHDD has created a rallying point for the many organizations and individuals that work to support advance care planning year-round. It helps to have a day on which organizations of various sorts can create a massive initiative to support advance care planning.”
 
Q: Do you have a personal story about advance care planning?
 
A: “I created National Healthcare Decisions Day because of my work on several ethics committees where the case consults routinely resulted from a lack of having an advance care plan of any sort. When people have advance directives, the cases are easy.”
 
For more information about National Healthcare Decisions Day, visit nhdd.org. To learn more about the advance care planning documents available in Louisiana, visit la-post.org.

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Honor My Wishes

By Susan Nelson, MD
LaPOST Coalition Chair

Last November, the Louisiana Physician Orders for Scope of Treatment (LaPOST) program had the opportunity to collaborate with Our Lady of the Lake College (OLOL College) in Baton Rouge for a unique service-learning partnership. Students from OLOL College’s Health Service Administration – Health Care Marketing class were tasked with developing a social media campaign that would generate awareness and education, specifically among young adults, about LaPOST and the importance of advance care planning. One of the centerpieces of the campaign was a unifying hashtag that participants could use to show their support for the cause, and thus, #HonorMyWishes was born.

With every image that was posted, liked, shared or tweeted, our message expanded to new audiences, potentially inspiring people of various ages to begin contemplating their medical treatment preferences. Therein lies the beauty of social media; familiarity is not essential for impact. The only requirement is a message capable of resonating with the receiver. #HonorMyWishes is a rallying cry for patients, family members and others who believe in the power of the patient’s voice and support the importance of that voice being heard.

In honor of National Healthcare Decisions Day (NHDD), observed annually on April 16, LaPOST is reviving the #HonorMyWishes campaign to encourage people to have discussions with their loved ones and physicians about the kinds of medical treatment they would/would not want to receive if they could no longer speak for themselves. The goal is to prompt conversations about the advance care planning options available to them and to help remove the stigma associated with end-of-life care.

So, how can you get involved?

We’re asking you to take photos displaying a sign that describes what advance care planning means to you and/or why it should matter to others. Upload the images to the LaPOST Facebook page or tag us on Twitter @LouisianaPOLST, and be sure to include the hashtag #HonorMyWishes.

What began as a marketing concept for a college course project has the potential to evolve into a social movement driven by those who value the patient’s right to make their treatment wishes known, and those who take a proactive approach to managing their health care. The LaPOST Coalition invites everyone to take part in our push to drive the conversation on advance care planning, one image at a time.

For more information on advance care planning options in Louisiana, visit la-post.org.


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HIMSS16: Picks In Analytics

By Michael Efferson, LaHIE Implementation Services Manager
 
Having attended one HIMSS conference – HIMSS15 in Chicago – I am now a member of the Veterans Club, which means that this year, I have the added advantage of knowing what to expect (lots of crowds and walking), what to bring (comfortable footwear and extra business cards) and most importantly, how to prepare for the weeklong event.
 
For HIMSS, preparation is the key to a successful week, and the best way to start preparing is to pick out in advance the sessions you most want to attend. I’m a data guy – I approach things logically and analytically, which means that I evaluate all possibilities as I prepare my schedule. (The first thing you’ll learn about HIMSS, if you’ve never been, is that you will never make all those back-to-back sessions you’ve been looking at for weeks in the education schedule – between the crowds and the sheer size of the venue, if you give yourself anything less than 15-20 minutes to navigate from one session to the next, you’re doing yourself a major disservice.)
 
The best thing to do is decide early what your top picks are, then add in ample time for things like meetings with new and existing contacts, vendor hall exploration and after-hours gatherings. Once you’ve done that, you’ll likely find that your schedule is pretty full, but if it isn’t, you’ll know where the holes are so you can fill them with other opportunities. And in the spirit of putting my money where my mouth is, I’m happy to share with you my own top picks from the conference schedule:
 
  1. The Specialty Exhibit Areas: No matter what your role is in health IT or health care, you will find learning opportunities that apply to you in these areas, so be sure to make them a priority on your personal schedule. I’m particularly looking forward to exploring the Cybersecurity Command Center and seeing the newest technologies available in the war against cyber adversaries. (The FairWarning ‘Catch Me If You Can’ Challenge’ sounds especially intriguing.)
  2. HIMSS Analytics Health IT State of the Market: This session is scheduled for three different days during the week of HIMSS, so if you miss it the first time, not to worry – you can catch it on one of the other days, and I encourage you to do so. It promises to provide some valuable insight about how to utilize health IT to tap into previously untapped data resources.
  3. The Evolution of HL7 FHIR Implementation Across the Healthcare Continuum: Part of the Interoperability Showcase, this session will offer information and examples of how HL7 FHIR is changing interoperability standards across the spectrum of health care.
 
And of course, I don’t want to forget to mention that my colleagues, Nadine Robin and Jamie Martin, are presenting a session, too, so I hope you’ll add that one to your personal schedule, too, especially if you have an interest in successful strategies to engage patients in the use of health IT.

Hope to see you in Vegas, friends – safe travels!
 

 

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HIMSS16: The Focus On Innovation

By Brian Richmond, Chief Technology Officer

The Quality Forum has had a consistent presence at the annual HIMSS conference for several years, and as an organization with a broad scope of programs and initiatives, from EHR adoption and patient-centered care transformation to analytics and the statewide HIE, each member of our team tends to have a different focus when they go to HIMSS. Our HIE Operations Director, Allen Abshire, is focused on interoperability; our Marketing & Communications Manager, Jamie Martin, is committed to the conference’s patient engagement track; and our Health IT Program Director, Nadine Robin, says her focus is primarily connected care and the use of data and analytics.

As the Chief Technology Officer for Louisiana’s statewide HIE, my focus for this year’s HIMSS conference is innovation. Ensuring that our HIE and the technology that supports it is adaptable and innovative in an ever-changing health care environment is my top priority, and the annual HIMSS conference is a fantastic source for innovative technology, strategies and ideas. With that in mind, these are my top picks on this year’s conference schedule:

  1. Innovation Symposium: Spurring Innovation in a Highly Regulated Environment: Set for the first day of the conference, this symposium promises to provide a “deep dive” into successful examples of clinical innovations that have yielded improved care, reduced costs and greater access. I am particularly forward to discussions and case studies of future innovations because as health IT professionals and advocates, it is critical that we not only know what’s happening now, but also what’s coming down the pipes.
  2. The Interoperability Showcase: If you are looking for outstanding insight into innovations in interoperability, look no further than this showcase. With topics ranging from patient matching and consumer-directed data exchange to population health and smart device integration, the Interoperability Showcase is the place to be.
  3. The Exhibit Hall: With more than 1,300 exhibitors and specialty areas spread out across one of the largest meeting centers in the world, the cutting-edge technologies on display in the HIMSS Exhibit Hall never disappoint.

My schedule is also littered with networking opportunities and meet-ups, and if your schedule isn’t the same, you’re missing one of the best benefits of the HIMSS conference: being shoulder-to-shoulder with some of the greatest health IT professionals in the country, which puts you in a great position for some fantastic idea sharing.

Whether you’re new to the HIMSS scene or a veteran attendee, regardless of what your focus is, be prepared to go home inspired. I certainly will.

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A New Day for Advance Care Planning

By Susan Nelson, MD, LaPOST Coalition Chair (@geripaldoc)

A new year is a time for new beginnings, and from a health care perspective, 2016 marks the dawning of a new era for advance care planning in America. As of Jan. 1, Medicare will reimburse physicians who discuss advance care planning options with their patients. This new provision signals a shift toward broader acceptance of discussing the kind of medical treatments you would want if you couldn’t speak for yourself with your health care team and family. This helps all know in advance your treatment wishes and goals of care.

Many health care advocates would agree that this policy change is long overdue, having been shelved since 2009 after a well-known career politician’s successful fear mongering likened the funding of such services to the creation of government-sponsored “death panels.”

Since then, more Americans have come to understand that advance care planning is designed to improve the quality of life for patients with serious illnesses by enabling them to select the care options they prefer. This sentiment is reflected in the mounting public support for doctor-patient conversations of this nature. A recent poll by the Kaiser Family Foundation found that 81 percent of those surveyed favored Medicare coverage for end-of-life care discussions.

Because of the new policy, more than 49 million Medicare beneficiaries could potentially join in these conversations this year.

As a geriatrics and palliative care physician, I have witnessed during moments of crisis how having a care plan can alleviate stress for a patient’s family, allowing them to focus on supporting their loved one, instead of bearing the burden of deciding a course of treatment. The peace of mind that an advance care plan can provide during this difficult time is invaluable. However, despite its benefits, discussing end-of-life treatment options isn’t a conversation most people are ready and willing to have.

Often, patients and families delay having these discussions because it’s uncomfortable to think about or because they prefer to wait until the “right time.” But truthfully, there is no time like the present when it comes to documenting your health care wishes.

In Louisiana, residents have multiple advance care planning options to consider. In addition to the advance directive, or living will, and the health care power of attorney, patients seeking to express their medical preferences and goals of care may complete a Louisiana Physician Orders for Scope of Treatment (LaPOST) document. The LaPOST document is designed specifically for those with serious, advanced illnesses and allows patients to choose the medical treatments they would or would not want to receive as their illness progresses.

LaPOST is completely voluntary, can be revised or revoked at any time and transfers with patients across care settings. Because it is a physician’s order, doctors must take a leading role in guiding their patients through each section of the LaPOST document, ensuring they have enough information to make the best decisions for their health and wellbeing.

A physician’s role in a patient’s life is far greater than making diagnoses and writing prescriptions. We have a responsibility to provide patients with the best medical care we can, while maintaining their trust and offering guidance as needed. Through the Medicare policy change, our roles have expanded even further and it is imperative that we rise to the challenge by normalizing advance care planning discussions to help remove the stigma that has long surrounded end-of-life care. Let’s renew our commitment in 2016 to improving the lives of our patients, one conversation at a time.

For more information about LaPOST, visit la-post.org.
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HIMSS16: The Must-Not-Miss List

By Nadine Robin, Health IT Programs Director

The annual HIMSS conference is the Christmas of the health IT world: we look forward to it all year long, so much so that most of us make our travel reservations for the next one before we’ve even arrived home from the last one.

Though I’m a veteran HIMSS-goer – this will be my fourth – I never fail to find something new and interesting on the schedule, so for me, the hardest part of HIMSS is narrowing down my focus to make certain that I can actually do all the things that I want to do. (Tip for new HIMSS attendees: be sure to give yourself ample time between sessions to navigate the venue and the crowds. Once you arrive and get a visual of just how big the HIMSS conference really is, you’ll learn the hard way that you need far more than a few minutes to get from one session to the next.)

With about three weeks to go, I’ve already identified the must-not-miss items that top my personal HIMSS16 schedule:

  1. The ONC Sessions: The Office of the National Coordinator for Health IT (ONC) has a number of sessions planned throughout HIMSS16, with topics ranging from privacy and security to safety, interoperability and usability. ONC never fails to deliver great information in their sessions, and frankly, the remarks of the fabulous Dr. Karen DeSalvo and Lana Moriarty always leave me ready to conquer the health IT world.
  2. How Accountable Care Organizations Can Harness The Power Of Health Data And Analytics: As an organization that partners with Aledade in Louisiana, I can promise you won’t want to miss this session if you’re interested in ACOs or how to use data and analytics to support ACO work. (I’d also add that Farzad Mostashari, MD, ScM, is always a great speaker…and a great sport, too – we once presented him with a Star Wars light saber and dubbed him the Luke Skywalker of health IT for being such an awesome advocate for connected care.)
  3. Connected Health Experience: These sessions look like they’ll be 30-minute nuggets of gold, and as an added bonus, since they’re happening on the exhibit floor, I can most likely find popcorn or a cookie nearby and not even have to leave to search for food.

And of course, my personal schedule is filled with meetings with colleagues from across the country to share ideas and collaborate on news ways to work together – and it goes without saying that seeing our Louisiana HIMSS members and other chapters from the Gulf Coast States at our GC3 social is a priority event on my planner.

I’d encourage you to take a look at some of these events as you plan your week at HIMSS16, and I hope that you’ll add my session, “Patient Engagement: No Diamond Ring Required,” with colleague Jamie Martin, to your own must-not-miss list. I realize our session is mid-morning on the last day of the conference, and that after a week of education, vendor hall exploration and after-hours receptions, you’re going to be tired, but please remember: we’re from South Louisiana, home of world famous Bourbon Street/New Orleans-style excitement, and we’ll be presenting on a Friday in Sin City…we promise, it’ll be fun!

Meanwhile, pack your most comfortable shoes and your best rolling bag, and remember to leave lots of room in your luggage for that fabulous HIMSS swag – I’ll see you in Vegas!

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Interoperability: The Buzzword For HIMSS16

By Allen Abshire, HIE Operations Director

Tens of thousands of health IT professionals and industry leaders are making their final preparations for the trek to Las Vegas for the 2016 HIMSS Annual Conference in a few weeks, and I am one of them.

I look forward each year to the HIMSS conference because it’s a virtual breeding ground for innovative ideas and technology that serve as inspiration to an HIE Operations Director like me. Not only does the conference provide me with a front row seat to some great educational sessions, it also gives me a chance to visit with some outstanding HIE and health IT leaders from across the country. That said, as a veteran HIMSS-goer, I’ve already begun developing my schedule for the week, and at the top of my list are these three items:

  1. Interoperability and Health Information Exchange Symposium: The Road to Interoperability: With interoperability clearly one of the most complex and challenging barriers to effective information sharing in health care, I am looking forward to getting some great information in this pre-conference symposium about successful business models, use cases and technical standards focused on driving interoperability across the spectrum of health care stakeholders.
  2. HIMSS Interoperability Showcase: The showcase is always a favorite, and I never miss it. The technology on display never fails to amaze and inspire me, and I expect no different at this year’s showcase, which will feature 36,000 square feet, more than 100 systems and devices connected in one space and numerous sessions demonstrating the key new technologies from industry leaders highlighting the Federal Health Architecture as well as standards-based exchange showing real world solutions to interoperability.
  3. Meetups and Networking: The HIMSS conference provides a veritable smorgasbord of meetings and networking opportunities, and there are far too many of them to list individually. To new HIMSS attendees, I hope you’ll seek out and participate in these events – they are excellent brainstorming sessions that allow you to meet your peers, compare notes and develop new ideas and partnerships.

And of course, my schedule also includes several key sessions, including one by my colleagues, Jamie Martin and Nadine Robin, who will be presenting Louisiana’s statewide patient engagement campaign at the conference this year, as well as ample engagement in the #HIMSS16 discussion on Twitter, so be sure to follow me here.

The HIMSS conference is always an adventure, and it’s never a dull one. HIMSS16 will be no different. Safe travels to Vegas, my friends – I’ll see you there.

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Vegas, Baby: The HIMSS16 Countdown

Jamie Martin
Marketing and Communications Manager

 

I’m always excited about the annual HIMSS Conference – the latest innovations in health IT, the coolest health IT geeks in the country and an outstanding variety of educational opportunities all under one (very large) roof is enough to send a health IT advocate like me into a state of ecstasy. Add beautiful Las Vegas into the mix, and well, the word ‘orgasmic’ is probably a bit too over-the-top, so let’s just say I’ll be like that proverbial kid in the candy store.

Even though the conference is still a little more than a month away, I’ve learned from past experience that it’s best to identify the sessions in which I’m most interested early on. (I’ve also learned that it’s best to shop early for comfy shoes and a good rolling bag, but I digress…) It goes without saying that my own session – “Patient Engagement: No Diamond Ring Required,” Session 271 – with my fellow health IT advocate and Quality Forum Health IT Program Director Nadine Robin is my personal favorite on the schedule.

But apart from that bit of shameless self-promotion, with our statewide patient engagement campaign underway here in Louisiana, my primary focus this year is on patient/consumer-related topics, so bearing that in mind, here are a just few of my top picks thus far:

  1. Generational Factors in Patient Engagement, Session 100: Touted as a session that will provide insight on the impact of the various generations, from Boomers to Gen Z, I’m looking forward to hearing some WebMD experts discuss strategies to help providers, payers and systems engage their patient populations.
  2. Trends in Consumer Access and Use of Electronic Health Information, Session 116: It’s always a pleasure to hear from our friends at ONC, and in this session, they’ll be presenting data from national surveys regarding consumers’ access and use of their electronic health information as well as their current initiatives to improve consumer access and information sharing.
  3. Redesigning Mental Health: Technology Driving Outcomes, Session 219: Featuring UCSF Benioff Children’s Hospital Oakland’s successful, simultaneous implementations of an EHR system and business and clinical processes, this session is expected to provide some real-life solutions to improve patient access and care quality.

Of course, my personal schedule also includes ample time to explore the innovations in the exhibit hall, along with lots of time to network with peers and industry leaders because the HIMSS conference is an incredible place for idea-sharing opportunities.

And I should note, too, that one of the best parts of the HIMSS experience occurs in the Twittersphere, so I hope you’ll find and follow us (if you haven’t already) on Twitter because we’ll be Tweeting live throughout HIMSS16, both individually and organizationally. Be sure to follow us here and here, and follow me, Nadine and Allen Abshire, Health IT Operations Director, as well.

And – forgive me for this last bit of self-promotion – I hope also that we’ll see you in our session. I know it’s scheduled for the last day of HIMSS, and it’s slotted for 10:30 a.m. – 11:30 a.m., but it’s a great learning opportunity that gives you time to sleep a bit late that morning and grab lunch afterward before heading off to hear five-time NFL MVP and Super Bowl-winning quarterback Peyton Manning’s keynote address at 1:15 p.m. I call that a win-win situation!

See you in Vegas, baby!

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Advance Care Planning: A Perspective

Jillian Washington, Marketing & Communications Coordinator
Louisiana Health Care Quality Forum
 
Of the Louisiana Health Care Quality Forum’s many initiatives, perhaps the most intriguing is its Louisiana Physician Orders for Scope of Treatment (LaPOST) program because of its unique focus on quality care for patients with serious, life-limiting illnesses. So when Nancy Zionts, COO and Chief Program Officer of the Jewish Healthcare Foundation (JHF) in Pittsburgh, traveled to New Roads, La., last fall to present her organization’s Closure initiative at a Community Conversation on end-of-life care, I couldn’t resist the opportunity to engage her in a Q&A about advance care planning, Medicare policy changes and the value of conversations about end-of-life care wishes.
 
Q:What are your thoughts on Medicare’s recent policy change that provides reimbursements for doctors who discuss end-of-life care planning with their patients?
 
A: “I think it’s a blessing and an opportunity, but there are also some downsides and potential work that has to be done. There’s been a lot of talk about the reason why we’re not having more conversations between doctors and patients is because there wasn’t a code or a way to pay them. But once you remove that barrier, which this legislation has done, it doesn’t magically make everybody ready to have those conversations. It doesn’t make consumers, patients and families ready to have those conversations, and it certainly doesn’t make providers any more knowledgeable about how to have those conversations.”
 
Q: In your opinion, what is the greatest barrier to acceptance of advance care planning as a critical tool in patient care?
 
A: “I think it’s the sense in American society that death is optional. I think it is just that cultural lack of understanding that this is something we will all face. I also believe that people have misunderstood the fact that advance care planning, once done, is permanent, and it is not. If your circumstances change, whether that’s your family, your health or your philosophical circumstances, pull it up and change it. It is not carved in stone, nor is it something that goes into effect unless you can’t speak for yourself.”
 
Q:When is the best time to think about one’s end-of-life care plan?
 
A: “Early and often. When and with whom you talk about it are important. So have these discussions at various stages of your life – with your parents, your children, your spouse, your grandparents, your grandchildren. I think National Healthcare Decisions Day is a great time to consider an advance care plan, but it doesn’t have to be the only day. How about around the Thanksgiving table or during a family reunion in the summer? These types of family gatherings can be a platform for such conversations.”
 
Q: What are your reflections on the Community Conversation event?
 
A: “The event was particularly heartwarming for me. You know, we call our initiative Closure because that’s really what we’re looking for, for families - that ability to understand and put in perspective that which is very natural, which is losing people. We all know people who’ve gotten stuck in their grief. And we met a woman who very bravely opened up and talked about being stuck in her grief.”
 
“We created a safe environment in which this woman felt that she could say something she had held inside for 15 years that was clearly eating away at her – that woman was in pain. So to watch her feel safe enough to open up, and then to have somebody else in that room go over to her, hug her and wipe her tears – that shows community. We could not have staged something to show those beautiful pieces. This is about individuals dealing with loss, and it’s about a community dealing with their responsibility to help in the healing and how we all move forward together.”
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Patience, Please: Implementation In Progress

By Nadine Robin, Health IT Program Director

It happened to me again.

I walked in smiling, 10 minutes early for my 3:10 appointment. The receptionist looked up from her computer screen as I reached for the pen to sign in, and said, "You don't need to sign in, but please read the signs."

They were written like dozens of others I've seen over the last six years – a notice that the organization had just installed a new EHR with an apology for any delays. I smiled and the REC Director/EHR Champion/HIT is Wonderful person came out of me (I really can't stop it sometimes), and replied, "Your signs don't worry me. I've been involved with EHR implementations for the last six years. You're doing a great job– a couple more weeks and you will be feeling better about all of it."

She looked up skeptically – I smiled and took a seat.

And waited.

My appointment had been put on the wrong day's calendar, and the system wouldn't allow her to add me as a walk-in. She was frustrated. I kept smiling – even offered to reschedule if it would be easier for her.

But in that moment, I saw a familiar look... the fierce determination of someone who knew that she had the staffing to take care of the patient. This woman had no intention of letting something new get the best of her.

My appointment took a little (okay, a lot) longer that day than I had planned. But as I left, I turned back to see she and her co-worker waving goodbye to me. I returned the wave and said, "Have a great day! You are both doing wonderful!"

I guess my passion for health IT overflows sometimes. It's become personal to me when my own providers are going through their EHR transition, and I can only hope that a little encouragement from me will help to get them over a rough spot. I understand (and hope that my fellow patients also understand) that the complete implementation of their technology means my results will be in my patient portal in days, just waiting to be shared with my other providers.

So to all of you who have struggled (or are struggling) through an implementation or upgrade this year, and to all of you facing one in the near future, if neither I nor your patients have told you, here's a shout-out to you.

Hang in there - you are doing a wonderful job!

It's going to get better!

And thank you.
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Celebrating Health IT In Louisiana

By Cindy Munn, CEO

Louisiana Health Care Quality Forum

This week marks a momentous occasion: the 10th anniversary of National Health IT (NHIT) Week. For us, it’s a slightly smaller, but no less important, anniversary – it’s our third consecutive year to partner with hundreds of organizations across the country in NHIT Week.

The theme of this year’s NHIT Week, “One Voice, One Vision: Transforming Health,” is a special one to us because that’s just what we’re doing in Louisiana. Since our beginning in 2007, we have worked closely with our state and its many health care providers, facilities and organizations to build a comprehensive health IT infrastructure to improve the quality, delivery and cost of care as well as health outcomes. Thus, we are understandably proud this week to share an update on how far our state has come in the past eight years.

The Quality Forum, as the State-Designated Entity for health IT programs in Louisiana, continues to support health care providers and critical access/rural hospitals in the adoption and meaningful use of electronic health records (EHRs). To date, more than 2,000 health care providers across 37 specialties in Louisiana have utilized the resources available through the Quality Forum to adopt EHRs.

In addition, the Quality Forum implemented and manages the Louisiana Health Information Exchange (LaHIE), a secure, confidential network through which authorized health care providers and organizations can electronically access and share health-related information for the purpose of improving patient safety, quality of care and health outcomes. Since its launch just four years ago, LaHIE has grown to include more than 240 health care providers, hospitals, school-based health centers, home health agencies and other health care companies across the state. Currently, LaHIE features nearly four million unique patient records and processes more than 79 million transactions per month. Its footprint encompasses nearly every parish in Louisiana.

In addition, the Quality Forum, in partnership with the Louisiana Department of Health and Hospitals (DHH), is leading a statewide consumer engagement campaign to provide education to Louisiana’s patients and families about health IT tools such as patient portals, EHRs and LaHIE and how these tools can be used to improve their health and health care. Louisiana is the first state in the nation to launch such a statewide, direct-to-consumer health IT engagement campaign.

These initiatives are how our state is transforming health care for its residents. The successes Louisiana has had in health IT adoption would not have been possible without the commitment and dedication of countless health care, consumer and community organizations, state agencies and health care providers and entities. So as we celebrate this year’s NHIT Week, we do so by extending our heartfelt gratitude and appreciation to those organizations, agencies and individuals for their hard work.

Together, we truly are building a healthier state.

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Patient Engagement Campaign Underway In Louisiana

By Nadine Robin, Health IT Program Director

I’ve been talking (and blogging and tweeting) about it for months, and now it’s live: Louisiana’s patient engagement campaign, “Your Health In Your Hands,” officially launched Aug. 1. You may have already begun seeing and hearing campaign messaging in your area, or perhaps you already connected with the campaign via Facebook or Twitter.

I’d like to point out that this messaging is focused on two key items: one, educating Louisiana’s patients and families about health IT and promoting its use; and two, encouraging those patients and families to talk to their health care providers about health IT.

Before we launched this campaign, we conducted a web-based survey to identify the existing health IT awareness level among Louisiana residents. What we learned was this:

  • 68 percent of respondents do not have copies of their personal health records, and only 51 percent had ever requested copies.

  • 90 percent of respondents were familiar with EHRs; 79 percent were familiar with patient portals; and 51 percent were familiar with health information exchange, yet only 40 percent use health IT to track their personal health information.

  • 57 percent of respondents said that understanding the security measures around health IT would make them more likely to electronically access their information; 50 percent wanted to know more about the benefits of health IT; and 35 percent indicated that they would use health IT if their providers recommended it.

We also received a number of personalized responses in the survey. Health care consumers told us that they want their health information to be available electronically, and they want that technology to be easy to use.

These survey results tell us two things: our state’s health care consumers are interested in engaging in their care through health IT, and our health care providers can help drive this engagement by providing their patients with access to consumer-friendly tools and resources.

This campaign can help in both areas.

A cornerstone of “Your Health In Your Hands” is its website, a user-friendly, easy-to-understand repository of health and health IT-related information and resources. It features downloadable, printable guides about how and why to use patient portals, what an HIE does and the benefits of EHRs, among others. It provides patients with access to information about how to get copies of their health information and how to use that information to improve their health. It houses links to additional resources, FAQs and glossaries, all designed to help patients engage in their care.

And these are all resources and tools that can be used by health care providers as well.

As the state’s REC and HIE, we hear often from providers and health care organizations with patient engagement needs. We know that these providers not only want to meet Meaningful Use requirements related to patient engagement, but they also truly want their patients to engage in their health and health care. They know that patients who engage in their health and health care have better outcomes, and as providers, that’s their mission – to help their patients achieve better health.

So as we launch this campaign, we encourage and welcome our state’s health care providers, facilities, organizations and entities to join us in these efforts, to use the resources available and to help drive better health for Louisiana’s health care consumers.

 

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Louisiana: The Patient Engagement Pioneer

By Jamie Martin, Marketing & Communications Manager (@DavisJamie77)

Historically, Louisiana has all too often been at the wrong end of the health care rankings. We are ranked among the worst in the nation for overall health status, infant mortality, preventable hospitalizations, chronic disease and infectious disease incidences. Beyond that, Louisiana has some of the highest per capita health care costs in the nation, and shows significant geographic variations in care utilization, cost and quality that cannot be explained by patient race, gender, chronic disease status or payers.

Suffice it to say, it is rare to have our beautiful state called a “pioneer” when it comes to health care, so you can imagine our great pride when we were called just that in a Health Data Management article about our current patient engagement campaign.

Pioneer: we like the sound of that.

And in a way, that’s just what we are, because to our knowledge, no other state has yet attempted to take health IT messaging and education directly to the consumer, even though patient engagement remains a key challenge for health care providers and organizations across the country.

So let’s dive a little bit into our experiences with patient engagement.

As the State-Designated Entity for health IT programs, our organization administers both Louisiana’s Regional Extension Center (REC) and its statewide health information exchange (HIE). This puts us in the unique position of having relationships with health care providers and organizations across the spectrum of care and of all sizes and geographic locations within our state. And what those providers tell us is this: getting patients to engage in their care through health IT is often difficult.

We listened to their concerns, and a few years ago, we began providing patient-facing educational resources to the providers who receive REC services and who are participating in the HIE. This value-added service helped many of these providers meet the patient engagement requirements of the Meaningful Use program, and it was a forerunner to the direct-to-consumer engagement campaign that we are administering now.

We are very fortunate in that we have a wonderful, collaborative relationship with our state’s Department of Health and Hospitals (DHH). Our state, due in large part to our experiences with Katrina, is a strong supporter of health IT advancements, and our state – here comes the “pioneer” part – recognized that engaging patients and families in their care is a critical component in achieving meaningful improvements in care quality, delivery and outcomes.

So we here we are, about to launch what may very well be the first statewide direct-to-consumer health IT engagement campaign. It’s an exciting time in Louisiana, and we are excited to be part of it. 

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I’ll Take a Three-Piece Big Data Value Meal and a Sweet Tea, Please


By John Fielding

Earlier this month, we were excited to meet with some very smart partners of the Quality Forum who wanted to show us how one of their recently completed big data projects might benefit us. This particular tool used an innovative algorithm to combine our clinical data with a wide variety of historical and projected environmental, socio-economic, political and social information to predict the emergence, over time, of disease hotspots on a map. The tool had proven itself in the lab to be more accurate and timelier than other well-known instruments out there.

It was really quite impressive.

But while our partner's impressive work was ready for "selling" to us, it occurred to me that it only exposed one-third of what is needed for our customers. If I used the tool to show a major health care organization in, say, Alexandria, that there will be an outbreak of influenza in their area next November, that would certainly spark interest, but it only answers the question "What will happen?" Still out there haunting the organization like a teenage ex-girlfriend are:

  • What happened to those "underlying factors" over the same time period, and which of them had a more significant impact on the predicted outbreak?
  • Did the tool give us any indication of appropriate times to start enacting proactive responses to each underlying factor that might allow us to meet the outbreak before it reaches the OK Corral?
The point is, always look way downstream when developing new analytics. If your customer sells to other customers, then you have to ensure that what you're developing meets the needs of your customer's customers. With such appropriate tweaks to the tool our partner presented, our customers would receive the holy triumvirate of analytics: the Descriptive (what happened yesterday and what contributed to it?), the Predictive (what will happen and why?), and the Prescriptive (how and when should I react?).

And that's a three-piece Big Data Happy Meal that don't need no stinkin' bag of chips!
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HIMSS15: Reflections Of A Health IT Team

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Allen Abshire, HIT Operations Director (@AllenKnowsHIE): “Interoperability was the word of the week at HIMSS. To me, interoperability is defined as ‘everyone playing together nicely.’ It was definitely a key point that ran throughout the sessions and the exhibits, especially with the recently released ONC interoperability roadmap. It’s all about doing the right thing for the patient.”

“I really enjoyed the HIE symposium on Sunday and every session at the Interoperability Showcase that showed true use case examples. I thought those really showed the impact on care for the patient.”


Nadine Robin, Health IT Program Director (@HITNadine): “My ‘Your Turn’ session about patient engagement and Meaningful Use was great for me! It’s always a privilege and a pleasure to interact and collaborate with health care providers regarding Meaningful Use!”

“The HIMSS-related events are always fun, with personal favorites being the reception for the Louisiana HIMSS Chapter and the HIMSS Block Party. The Gulf Coast Chapters of HIMSS are doing some wonderful things, and it was great to visit and compare notes with other chapters from across the country.”

“The ONC sessions on patient engagement were very enlightening. With our state launching its patient engagement campaign, it was exciting to learn that ONC is building patient engagement into its interoperability plan and to have the opportunity to discuss strategies with organizations like ours.”


Jamie Martin, Marketing & Communications Manager (@DavisJamie77): “Because we are launching a campaign in Louisiana to get consumers engaged in the use of health IT to improve their health, my personal focus at HIMSS this year was the patient engagement track. My biggest takeaway from those sessions was this: if you have 10,000 people in the same room and they’re all shouting the same thing, the overall message is lost. To achieve true patient engagement, we have to step out of the box and deliver the message little differently so that it is truly heard by the patients. I think that’s what we’re doing here in Louisiana.”


“I particularly enjoyed the session by Kentucky’s State HIT Coordinator Polly Mullins-Bentley, “HIT Alone Isn’t Enough: Humanizing Patient Engagement.” I was intrigued by Kentucky’s use of its REC to educate providers in patient engagement activities – I absolutely agree that providers need to be on the front lines of patient engagement efforts.”

“As the social media manager for the Quality Forum, I was very excited to finally meet in person some of the great and innovative people we converse with on Twitter. And yes, I’m happy to admit: singing Journey’s “Don’t Stop Believin’” at the Dell reception with the incredible Mandi Bishop was definitely a highlight!”


Darren Cavalier, Project Manager: “As a first-time HIMSS-goer, I thought it was very overwhelming with lots of sessions on a wide variety of topics, and the extravagance of the exhibit hall and vendor displays was incredible. It was a very positive experience.”

“Personal favorites were the hybrid HIE presentation, the use of HIEs for population health management and the successes of the New York Million Hearts campaign, and I can’t fail to mention the session on how payers and providers are working together to build an HIE. It was impressive how well they are working together and complementing each other.”


Michael Efferson, Implementation Manager: “It was my first time at HIMSS, and I can describe it in one word: overwhelming. The vendor hall, the sessions, the people….it was a lot to take in and process.”

“All the sessions I attended were great, but I really enjoyed the one about Kentucky’s health IT successes. Overall, I was very impressed with the innovation on display and under discussion at HIMSS.”


John Fielding, Analytics Program Manager: “What an experience for this HIMSS rookie! I was able to open a number of relationships with analytics vendors, spanning the spectrum from well-known heavyweights to organizations just now looking to jump in the pool.”

“The sessions were good, with the conversation with Dubya clearly being the highpoint for me.”

“I was so impressed with the city of Chicago! She is big, beautiful, clean and bustling, and the people are friendly, wildly inclusive, and in desperate need of a decent Cajun restaurant.”

“Added bonus: meeting the fabulous Counselor Mandi Bishop, fellow Star Trek aficionado, at the Dell reception!”


Phil Catalano, HIE Consultant: “One word to describe HIMSS: OVERWHELMING!

For me, the message that came through loud and clear in nearly every session I attended was this: SMART, FHIR and other interoperability standards are needed yesterday and everyone agrees. Overall, I really think Dr. DeSalvoand many others said it best: It’s time to get a return on this investment in Hi-Tech.”

“I was interested to learn that Andy Slavitt, Acting Administrator for CMS, is not high on wearables, but is adamant about sharing data. It left me wondering: Could it be the data is needed to support alternative payments, or is his feeling driven by his previous experience as an executive for Optum, a division of United Health?”

“Throughout HIMSS, the theme seemed to be ‘Analytics and Big Data.’ Maybe it should be Reliable, Accessible, and Meaningful Data…maybe we could call it RAM…And I have to ask, did they put the Security Exhibits in the back of the exhibit hall for a reason? Out of sight, out of mind, perhaps?”

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National Healthcare Decisions Day: Have The Conversation

By Susan Nelson, MD, LaPOST Coalition Chair (@geripaldoc)

As a geriatrics and palliative care physician, my focus is on improving the quality of life for patients with serious illnesses, and knowing what my patients’ goals of care and treatment wishes are, is a necessary component in that process.

While many of my patients are able to engage in meaningful discussions with me about their diagnoses, prognoses and personal preferences, many others cannot. And unfortunately, a significant number of these patients have no one to speak for them, and even worse, some of them have no advance care plans in place, leaving their loved ones to make decisions about their care with no knowledge of what their wishes might be.

Thus, I’ve become a vocal advocate for advance care planning. In my role as chair of the Louisiana Physician Orders for Scope of Treatment (LaPOST) Coalition, I’ve traveled the state educating health care professionals, patients and families about advance care planning and the importance of discussing and documenting our health care wishes and goals of care.

And perhaps unsurprisingly, I am also a proud supporter of National Healthcare Decisions Day. Observed annually on April 16, NHDD serves to inspire, educate and empower health care providers and patients and families about the importance of advance care planning. It is an initiative focused on educating patients about how to express their wishes regarding their health care and encouraging health care providers and organizations to respect those wishes, whatever they may be. And in recognition of NHDD, I’d like to express a few thoughts of my own about advance care planning.

It’s Not Just For Old People

Illness is difficult to predict, and it’s non-discriminatory. It can happen at any time, at any age, when you least expect it, and it can leave you unable to make your own decisions about your care. Making health care plans for the future – even if you aren’t sick now – can help to ensure that if a medical crisis does occur, you will receive the care you want in the setting you prefer.

It’s Okay If You Aren’t Sure What You Want

There is no ‘one size fits all’ approach to advance care planning. What is right for you may not be right for someone else. The key is to identify what’s important to you, and you can start that process by asking yourself what matters most to you in your life, who you would want to make decisions about your care if you became unable to do so and what types of medical care you do and do not want.

“Conversations Change Lives: A Guidebook to Advance Care Planning” is a wonderful free resource that can help you to prepare your thoughts before you begin the advance care planning process.

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The Official Unofficial Guide to HIMSS15

The annual HIMSS Conference…. we look forward to it every year the way a five-year-old looks forward to the arrival of Santa Claus. It’s a veritable smorgasbord of networking and educational opportunities enhanced by a gigantic exhibit hall filled with adult trick-or-tricking, and we never come away without fresh ideas to supplement our efforts to drive health IT-enabled health care systems.

But if you’re new to the HIMSS scene, it can be a bit overwhelming at first sight. More than 35,000 attendees? A dozen or more educational sessions underway simultaneously throughout the day? HIMSS Spots? A former U.S. president? More than 1,200 vendors? Tweet-ups? Shuttles? Showcases?

Yeah. It’s a lot to take in, even for veteran HIMSS-goers, so we put together this official unofficial guide to help. Here you have it: tips from our own HIMSS veterans!

Plan to get lost: With more than 35,000 people, HIMSS’ attendance is higher than most U.S. cities’ populations. Pair that with the fact that the McCormick Place, with its 2.6 million square feet, is the nation’s largest convention center, and it helps to think of HIMSS like a strange, new city that you’ll spend the next few days trying to navigate. Approach it with the understanding that yes, you are going to get lost, and yes, you will miss some of the sessions you want to see if for no other reason than they are too far away from the sessions you just came from to make it to them on time. You don’t really understand the true size of HIMSS until you’re there, but trust us - you won’t be the only one wandering around the venue with the same dazed expression as a tourist in New York City. Our tip: pick our your sessions and download the venue map in advance and plan your attack, but plan for your plan to fail, too.

Your feet will hurt: Every HIMSS veteran has his/her own special tips about the conference, but the one that they’re always in agreement on is this: wear comfortable shoes. If fashionable footwear is a non-negotiable item for you, and you simply cannot go without those platform stiletto heels or shiny new wingtips, you – or rather, your poor feet - have our sympathy. We’ll be able to spot you a mile away – you’ll be the one sitting on a bench, fashionable shoes on the floor next to you while you massage your aching dogs. Our tip: save the fashion statement for the after-hours networking events and go for comfort during the day.

So that’s how a pack mule feels: Between laptops, phones, chargers, session schedules and maps, your hands will be full before you even step away from the registration table, and your load will triple after 10 minutes in the exhibit hall. Right now, you’re probably thinking to yourself, “So I need to bring my larger shoulder bag or a big backpack, what’s the big deal?” Uh-huh. You do that – you’ll be the one sitting on the bench next to the aforementioned fashion plate, only you’ll be rubbing your shoulders and lower back instead of your feet. Our tip: bring a bag that rolls.

Don’t bring your shy to Chi-town: There are literally thousands of opportunities to network at HIMSS, and if you miss any of them, you’re doing yourself a major disservice. Our veterans tell of meeting great people with great ideas during sessions, while getting coffee, on the shuttle buses and even while standing in line at the restroom. The folks who attend HIMSS are generally there to learn - truly, the freebies in the exhibit hall are just a bonus – and not just from the speakers, either. They want to learn from you, and you can learn from them, too. Our tip: Strike up random conversations with the people around you. You never know what could result.

It’s gonna be Tweet: We still have two weeks until HIMSS officially begins, and already there’s an entire catalog of related hashtags on Twitter. Just do a hashtag search for things like #HIMSShacks or #HIMSSbingo, or take a few minutes to review The Totally Unofficial Guide to #HIMSS15 Hashtags. The important thing to remember is, a lot of great conversations during HIMSS will occur on Twitter, and you can maximize your attendance by being part of them. Our tip: Tweet, tweet and tweet some more….and if you aren’t on Twitter, get on it and learn to use it before HIMSS.

Editor’s Note: For live Tweets from the HIMSS15 Conference, follow the Quality Forum on Twitter at @LHCQF1. Be sure to also follow Nadine Robin, Health IT Program Director, at @HITNadine; Allen Abshire, Health IT Operations Director, at @AllenKnowsHIE; and Jamie Martin, Marketing and Communications Manager, at @DavisJamie77.

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The Future of Patient Engagement: A Look Ahead For Caregivers

By Cindy Munn, Chief Executive Officer (@CindyMunnCEO)

You’ve heard about it, you’ve read about it and you’ve felt it coming for a long time. It’s been a buzz phrase and a trending topic for several years, but at long last, patient engagement is taking center stage.

With EHRs and patient portals literally at our fingertips, we’re discovering that we have round-the-clock access to our health information, and we’re learning how to use it to manage and improve our health. We’re learning, too, that while these techno-tools facilitate patient engagement, our personal participation via action and behavior is the key.

As a professional, I’ve been looking forward to the rise of patient engagement since 2010 when our state received federal grant funds to establish an REC and a statewide HIE. But as a wife, mother and working woman, I’ve been waiting much longer for this moment, and based on my personal experiences, I have my own special predictions for the future of patient engagement.

Like many women, I learned to juggle my health care needs along with those of my husband and my two sons. For the past 20 years or so, patient engagement for me has meant scribbling physician appointment in datebooks, waiting at the pharmacy, second-guessing the name of a medication or the timing of a shot, trying to remember annual exams, interpreting messages from the doctor via the office staff and similar health care scenarios. No online scheduling, no email appointment reminders, no e-prescribing, no secure text messaging. Access to today’s health IT tools could’ve made the balancing act of this wife and mother less stressful and more effective.

But then the balancing act became even more difficult with the addition of a new role in my life: caregiver.

My mother fell seriously ill, and my two sisters and I became double-duty caregivers, living in different cities. We were now officially part of the nation’s growing Sandwich Generation, caring and advocating for our mother while balancing our own family and work responsibilities.

My mother’s health and quality of life slowly eroded over the course of three years.

Because of this, my sisters and I had to make decisions regarding her ongoing medical care as well as those related to end-of-life care. Should she receive treatment at home or in a health care facility? If a facility was the appropriate place, where would it be located? Should her antibiotic regimen be continued? What about resuscitation efforts? 

These were a few of the difficult choices we had to consider via phone calls and in-person visits. Tools like patient portals, secure electronic messaging and mobile apps would’ve been invaluable aids to connect us with my mother’s providers, her medical records and with each other.

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The Future of Connected Health Care Systems

By Allen Abshire, Health IT Operations Director (@AllenKnowsHIE)

As I walk into my doctor’s office, I am immediately greeted by name and asked to have a seat for a few minutes, and as I do, my phone chimes to inform me of a request to authorize payment for my visit.

As I wait, I use my Blue Button patient portal to review my medical information – a nifty account that links my provider, pharmacy and hospital along with my biometric wearable device that tracks my heart, pulse rate, physical activity and sleep patterns – and make sure that everything is up-to-date, from my pharmacy fill data to the discharge instructions from my recent hospital stay.

After a short wait, the nurse calls my name, and I’m taken to an exam room where she places a blood pressure cuff on my arm and scans my forehead to obtain my temperature while the table on which I’m sitting records my weight. Using a tablet, she notes that the data from those devices has been accepted into my electronic health record, and then she mentions that a notification has been received that the C-CDA from my hospital visit is available along with the lab work requested by my doctor prior to my visit today. She inquires about any issues or concerns I may have related to my procedure, and adds the fact that I have none to my electronic chart.

When my doctor enters the exam room, he is already reviewing my information via his own tablet. We discuss the reason for my visit, and he carefully reviews my discharge instructions from the hospital to ensure that I understand and am following them. He mentions by name the medication that I was prescribed when discharged, and he asks about any side effects. He pulls up the results of my lab work and discusses them with me. Together, we use this information to develop a care plan specific to me, and he makes certain that I have no questions when I leave.

That night, as I discuss my doctor’s visit with my wife, she reminds me that I’d wanted to ask about a certain exercise plan and whether or not it’s safe for me to try it. Using my phone, I send a secure direct message to my doctor via the patient portal, and 20 minutes later, I have my answer.

Two days later, my doctor messages me to check on my progress, and I respond to let him know that the medication I was prescribed seems to be working fine, the exercise plan is going well and I’m following my care plan to the letter, and I schedule a follow-up visit in 30 days.

This is the kind of health care experience those of us in health IT are referring to when we talk about ‘connected health care systems,’ and that level of connectivity is undeniably the future of health care.

A connected health care system is one that’s connected no matter where services are received – hospital, clinic, physical therapy, pharmacy, wearable devices, the gym, et cetera – and it’s effortless for health care providers across the care continuum to access the information generated within those settings.

It’s a system in which patients are able – and encouraged – to submit their own information through patient portals, and their providers can see and use that information to improve their care.

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The Future of Patient Engagement

By Nadine Robin, Health IT Program Manager (@HITNadine)

When I discussed my Christmas wish list in December 2013, I predicted 2014 as, “The Year of the Patient.” Patient portals, secure messaging, and Stage 2 Meaningful Use were on the horizon…would it be all that so many consumer and health IT advocates had hoped?

The results were certainly mixed. Many providers struggled with just implementing a portal, and even after all their hard work, they were met with disinterest in many communities. To help, health IT proponents (think Regional Extension Centers and HIEs) developed and provided them with consumer-facing materials explaining the benefits of sending secure messages, the value of EHRs and the role of HIEs among other resources. Beyond that, we health IT advocates worked with providers to give suggestions about how to engage patients in their health care, and yes, even then, a few providers fell short in those Meaningful Use measures.

The bottom line: We have providers ready to share information, yet a year later, we still have lagging numbers in the use of most patient portals and secure messaging functions in providers’ offices, which begs the question: “Does the average person realize the value of the information in their medical record?” 

Imagine buying a lottery ticket and its potential value. Would you buy it and then tell the cashier to just keep it and you’ll come back if you win and need it? Seems ridiculous, right? But the reality is, our medical records hold much more accurate data with a lot more likelihood that we will need it at some point – yet so many of us don’t ask for a copy or for electronic access. 

Yes, I said “copy.” And I use that word because my experiences over the years as a Meaningful Use expert and health IT advocate – not to mention as a health care consumer - have led me to recognize a hard truth: While we are committed to promoting and encouraging the interoperable sharing of health information among health care providers and consumers, the reality is that we have to get people to realize the value of their health information in any form. 

Here in Louisiana, over the next 18 months, in coordination with the Louisiana Department of Health and Hospitals (DHH), there will be a focused effort to educate the public on the value of their health information; their rights to access their health information; the importance of asking questions when they are with their providers; and yes, to help the public understand how great it all is when they can get that information through a patient portal.  

It’s a project with which I can personally identify. After writing out my Christmas wish list in 2013, I decided it was time to fulfill my own wish. I switched to a new primary care provider that could not only offer me a patient portal, but is also a Level 3 Recognized Patient-Centered Medical Home (PCMH).

The results: I receive responses to secure messages in less than 20 minutes, make appointments through the portal and enjoy better, faster care that is focused on my family. Even my young children have noticed the difference – they regularly comment on how much they appreciate our new provider taking the time to talk to them, even when they aren’t the focus of our visit.

That’s precisely the kind of health care for which I’ve been advocating for years.

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The Future of Big Data

By John Fielding Jr, Analytics Project Manager

I’ve been in IT for 35+ years and fooling with this thing we call ‘Big Data’ knowingly for 14 years, and unknowingly for five years before that. For much of that time, my colleagues and I have been trying to uncover the proverbial “next big thing” in big data.

As it turns out, everybody (except maybe the guys wearing red shirts in a Star Trek landing party) has been looking for the same thing. A web search shows these predictions made just in the last year: Prescriptive Analytics, People Analytics, Small Data Analysis, Plug-N-Play Analytics, SAAS Analytics Marketplaces, Fast Clusters, Knowledge Clouds, Video Analytics, Quantified Self and Vehicle-to-Vehicle Connections. That’s a new one every few months. (I really like Prescriptive Analytics. One project was designed to help farmers look at weather data to decide when to buy crop insurance…I’ll be really impressed when they can tell me the perfect time to buy life insurance.)

Anyway, I figured it’s time to put in my two cents using my own direct experience to predict the future.

In the decade that I toiled at the Department of Education, the amount and variety of data we collected exploded. Despite all the aggregating and calculating we did, what was it that generated the most publicity? School letter grades. We had the most complicated algorithms for awarding scholarships, but everybody was more interested in hearing that Smallville Elementary got slammed with a D+.

In the years I spent in manufacturing, we collected a deep sludge pit of data, but what did the guys who didn’t come to work in shirts with their names on it want to see first? Give me my margins!

I spent eight years with a company that sold mortgage servicing software. We gathered enough data to make Fannie Mae’s fanny look fat in any dress. And what did the heads atop the totem pole want to see? Credit risk. Period.

In health care, we collect an industrial-size bedpan of information daily. But what is it that the guys who are paying for the analytics want to see? How they can keep people from going to the ER for a sinus headache.

Okay … so what’s the trend here? What does my data show? That despite the myriad of data being shoveled into our data warehouse, we have to simplify our results. The more simplified, the better.

Simplicity is the ultimate sophistication. –Leonardo Da Vinci

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The Future of Connected Health Care Systems Is Now

Marcia-Blanchard.jpgBy Marcia Blanchard, Vice President of Operations

In 1965, a visit to your doctor cost all of $5. Now, 50 years later, that doctor’s visit is more likely to cost $105.

What, you aren’t shocked?

Of course you aren’t.

The escalating costs of health care are hardly considered breaking news. Across the nation, health systems are being challenged to reduce those costs by increasing efficiency and maximizing resources. That’s no easy feat considering the industry-wide challenges they face: a growing population of aging patients, increasing rates of chronic conditions and health care professional shortages, not to mention the evolution of health care reform.

And across the nation, many health systems are increasingly realizing that health IT is the bridge that closes the gap between limited resources and growing focuses on quality, access and outcomes.

Electronic health records, health information exchanges, patient portals, telehealth, mobile technology….these are game-changing factors in today’s struggle to reverse the rising costs of health care. They’ve made possible a model of connected care that would have been unimaginable in 1965.

Yet in spite of the incredible growth in health IT adoption, in spite of the astounding capabilities of today’s technology, many of our health care systems remain largely disconnected, siloed and fragmented. While they are well connected within themselves – internal HIEs, impressive EHR systems and the like – they’ve not maximized their own technology to connect to others outside their walls.

Still, the vision - that of a seamlessly connected system in which information is available at all points along the continuum of care – is real, and more importantly, it is attainable.

But – and there’s always a ‘but,’ isn’t there? – a few things must happen before that vision becomes reality. Certain barriers – providers who continue to record medical care on paper, slow and/or sporadic health IT integration and the reluctance among some providers to share data due to HIPAA concerns, for example – must be overcome. Interoperability standards must be developed and mandated. Care should be collaborative and patient-centered across the health care spectrum.

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Running For Health To Running My Health: An Engaged Patient’s Story








By Bonny Kennedy, Lead Implementation Specialist


My Midlife Crisis 

In 2011, just a few months after my 47th birthday - I think I was in the middle of a midlife crisis - I decided to take up running.  

I hated it.   

But as time went on and I met others in the local running community, that hate turned into love. In a short amount of time, I was running my first 5k followed by my first 10k in April 2012. I joined a local running group and trained for the first of three half marathons that I would run that fall.  

I was 49 and in the best shape of my life, and I decided I would celebrate my 50th birthday with a full marathon - yes, 26.2 miles! I had 11 months to prepare and no doubts whatsoever about my ability to accomplish my goal.   

Trusting the Professionals 

In January 2013, I was feeling a bit sluggish and tired but chalked it up to all the miles I was putting in. It wasn't until I went for my annual checkup that I discovered my thyroid was out of whack (along with every other hormone in my body), and I was sent to a highly recommended hormone specialist, who assured me I would be feeling better in no time.  She increased my thyroid meds and added some other colorful pills and I trustingly obeyed her orders. I went about my life, continued my training and hoped for the best.   

The Bottom Falls Out

On a beautiful spring morning in 2013, I was enjoying a cup of coffee with my husband when I began to experience a feeling I will never forget... It took a few minutes to process what was happening, but I had seen all of the public service messages... it was a heart attack.   

Could it be? I'm a runner! I'm healthy! Right?  

Lying in the ER of the nearest hospital it was quickly discovered that my prescribing physician had made an error - it wasn't a heart attack after all but I was most definitely seriously ill.   

Every doctor I saw wanted to throw another pill at the problem and at that time, I would have done anything for a moment of relief. Thus began the darkest 12 months of my life.   

Taking Control 

I spent most of 2013 scared and confused. I was in and out of emergency rooms and hospitals, referred to specialists and subspecialists. Everyone had a different opinion and no one was talking to anyone else.  

I was seeing four doctors regularly. When I left one office, I would demand a copy of those lab results and notes and bring them to the next appointment.  

In my spare time, I read. I researched my diagnoses and found experts. I attended lectures. I joined online communities. I walked into every appointment, armed with knowledge and information.  

I knew what had to be done and was determined to find the right doctors who would treat the cause and quit treating the symptoms. I prayed a lot and relied on my faith that God would pull me through.   

That November, I quietly celebrated my 50th birthday with my family.  

I hadn't run in months.  

The Long Road Back

I knew I had to make some drastic changes. I was on the road to recovery and was finally being treated by the right doctors but now had the daunting task of tapering off the drugs...one by one. My daughter’s wedding was in February, and I was determined to be free by then.  

Little by little, things began to look up. I was thinking more clearly. I was alive and feeling like myself again. In April, with my doctor’s blessing, I decided to lace up my running shoes.  

I couldn't run a mile.   

But I refused to give up, and before I knew it I was running a 5k again. A month after that, it was a 10k. In June, I decided I was feeling well enough to start training again and set my sights on a fall marathon. I got up at 6 a.m. every day, all summer, and I ran… six, then eight, then 10 miles... a half marathon... and this past weekend, I celebrated my 51st birthday crossing the finish line of the Savannah Marathon in five hours and 22 minutes. 

The Lessons  

This past year has taught me many things. It's taught me that I have to take control of my health care and become educated. 

It’s taught me that I have to learn to question providers when something doesn't sound right. 

It’s taught me that I am stronger than I ever thought I was. 

But most importantly, I’ve learned to never, ever give up!











Bonny Kennedy celebrated her 51st birthday by crossing the finish line of the Rock ‘n’ Roll Savannah Marathon in Savannah, Ga., on Nov. 8, 2014.

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Pink Is My New Black






By Linda Morgan, Quality Forum Director of Marketing & Communications

Are you seeing pink? October is Breast Cancer Awareness Month, and pink is almost everywhere. The color has symbolized the disease since the early 1990s, and pink ribbons are worn to increase awareness, to honor survivors, to recognize those who have died and to support research efforts.

I was diagnosed with breast cancer in 1995. Needless to say, I’m happy to be a survivor and proud to wear pink whenever, wherever and forever.

Since my diagnosis, there have been great advances in breast cancer screening, treatment and research as well as in identification of risk factors and healthy lifestyles choices. Even so, the American Cancer Society estimates that nearly 233,000 women will face a diagnosis of invasive breast cancer this year and about 40,000 will die from the disease. It’s equally important to note that more than 2,300 men will be diagnosed, and 430 will die because of it in 2014.

A key message that still rings loud and clear during Breast Cancer Awareness Month is the importance of early detection and screening to check for the disease before there are signs or symptoms. Bottom line, many people – not all – can survive breast cancer if it’s found and treated early. And according to the Centers for Disease Control and Prevention and other associations, a mammogram is the best screening tool used today to detect breast cancer. On a personal note, I really, really hope that’s true.

Living as a breast cancer survivor for many years, I’ve been a fairly compliant patient … following the mammography screening guidelines and seeing my GYN regularly. I honestly think about recurrence at some point every single day, knowing how fortunate I am to be here. I also have to admit that as the years have gone by, I’ve felt increasingly confident that the disease was in my past.

This year, I delayed my annual exam and mammogram for the usual reasons: I’m too busy, I’m feeling fine, I’m untouchable. But because October focuses so much attention on breast cancer, I knew I had to schedule my exam-o-gram. I’m glad I did, even though the results of the radiology report sent chills up my spine with words I’ve dreaded for nearly 20 years: suspicious abnormality, cluster of calcifications, further evaluation, etc.

I left the office with an uneasy feeling, but for some reason, I didn’t panic. For starters, I didn’t notice or feel any changes in my breasts or underarm area. Likewise, my GYN couldn’t detect anything via a clinical breast exam. It took a digital mammogram to pick up the small, questionable spot. And because my most recent mammograms are also digital and available, the radiologists were able to compare them and determine that this 3mm x 9mm intruder was new and warranted more testing.  Quite honestly, I feel like early detection and screening may be working in my favor this time. Because of the results from this mammogram, my next step is a biopsy … and that’s another blog!

In closing, I’d like to share my personal takeaways from this “to be continued” experience:

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Another Great National Health IT Week

By Quality Forum Staff

Today marks the end of National Health IT Week 2014, and for our organization, it’s been quite an eventful week.

A few highlights:

·      - We received a proclamation from Louisiana Gov. Bobby Jindal officially recognizing National Health IT Week in our state.

·      - We launched our brand new, user-friendly website (and we hope you’ll check it out – www.lhcqf.org).

·      - We published daily blog posts to highlight key initiatives in health IT.

·      - Our CEO, Cindy Munn, penned a health IT-focused op-ed piece that was published in several newspapers across the state. (You can follow her on Twitter at @CindyMunnCEO.)

·      - We led a week-long Twitter campaign in which we challenged our fellow health IT advocates and organizations to Tweet photos of themselves wearing their “health IT hats.” (If you haven’t already, please join in the fun by Tweeting out your health IT hats with the hashtags, #HIThat and #NHITWeek!)

·      - We attended the Consumer Health IT Summit, hosted by the Office of the National Coordinator for Health IT (ONC), on Monday in Washington, DC.

·      - We held an internal luncheon Wednesday for our employees to thank them for their hard work in driving health IT advancements in our state.

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Where Health IT Meets End-Of-Life Care

 alt By Susan Nelson, MD, LaPOST Coalition Chair (@geripaldoc)
 

This week marks a nationwide celebration of health information technology (IT), and those of us in health care can quote almost verbatim the arguments for health IT: It improves care coordination; it decreases gaps in care; it empowers patients with greater access to their personal health information; and so on, but rarely do we hear about what it can do for end-of-life care.

Quite frankly, it can do a lot.

Documentation Is Key

As a health care provider and advocate for advance care planning, I encourage patients to not only discuss their end-of-life care goals and treatment wishes with their loved ones, but also to record those wishes with the appropriate documentation – an advance directive, or ‘living will,’ a health care power of attorney or, if the patient has a serious, advanced illness from which he/she is not expected to recover, a Physician Orders for Life-Sustaining Treatment (POLST) document.

In the best of scenarios, patients complete these documents and let their loved ones know where to find them when they’re needed and let their health care providers know that these documents are in place. In doing so, their loved ones are not left to make difficult decisions regarding their end-of-life care, and their providers know precisely how to proceed with their treatment.

Unfortunately, in health care, we don’t always see those best-case scenarios. More often, our patients have not completed any advance care planning, and their loved ones aren’t sure what they would and would not have wanted. Often, too, even when advance care planning has been initiated and completed, these documents are out-of-date or not readily available, particularly in emergency care settings and during transitions of care.

But there is a solution, and health IT is that solution.

Moving Beyond Paper

As health care becomes increasingly digitized, we are slowly coming to realize the role of health IT in advance care planning. More and more providers are transitioning from paper-based charts to electronic health records (EHRs), and this transition provides a unique opportunity to improve the availability of advance care planning documents within and between care settings.

Historically, according to the U.S. Department of Health and Human Services (HHS), less than 36 percent of the adult population has completed advance care planning, and those with serious, advanced illnesses have done so at only a slightly higher rate. Further, HHS data shows that physicians are largely unaware of their patients advance care planning documents and for the most part, don’t discuss end-of-life care planning with their patients.

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Celebrating Health IT And Patient-Centric Care


 
By Bobbie LeBlanc, PCMH Program Director
 
It’s National Health IT Week, and around the country, organizations like ours are joining forces to celebrate the continued advancement of health IT tools like electronic health records (EHRs) and health information exchanges (HIEs).

But I’d like to take that celebration one step further by recognizing and applauding the thousands of health care providers – both here in Louisiana and in other states – who have taken the use of those tools to the next level through patient-centered medical home (PCMH) transformation.

Building A Better System Of Care

The PCMH model is built on a physician-led, team-based, whole person approach to health care. It’s about coordinating all aspects of the patient’s health care needs at all stages of life and across all health care settings, and yes, it’s a model that’s facilitated by health IT to ensure that patients get the care they need when and where they need it.

In an ideal world, the PCMH model – which, numerous studies have proven, yields improved outcomes, higher quality and lower costs - would receive as much attention and be just as incentivized as health IT adoption.

Unfortunately, we haven’t quite reached that point yet – and really, that subject alone is enough to inspire another blog post entirely – and so we must settle for heaping accolades on those providers who have achieved both PCMH and health IT implementation.

Beyond Meaningful Use

The Meaningful Use program has done much to drive quality improvements in health care. Its key objectives for EHR implementation – data capture and sharing, advanced clinical processes and improved outcomes – are perfectly aligned with PCMH transformation.

Yet the PCMH model goes well beyond meaningful use of EHRs. Not only can PCMH providers run reports to meet the requirements of meaningful use, they also use those reports to better track and manage patient care.

PCMH providers know that patient-centric care and health IT go hand-in-hand, and it is these providers who deserve our recognition during National Health IT Week.

Confetti, Balloons and Cheers

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The Health Care Evolution, Part 2

  By Cindy Munn, CEO (@CindyMunnCEO)

Editor's Note: What follows is the second and final installment to a blog post published Monday, Sept. 15, 2014 - the first day of National Health IT Week. Each day throughout the week, the Quality Forum will publish a new post designed to highlight specific initiatives related to health information technology (IT).

The Fact of the Matter

As a Louisiana resident and a health care professional who witnessed the damage Hurricanes Katrina and Rita did to our state’s health care system, I was among the first crowd of cheerleaders for EHR adoption. There is nothing like a front row seat to the confusion and havoc of attempting to provide care to thousands of people whose medical records are underwater and lost forever to turn you into a devout advocate for EHRs, believe me.

Yet I will also be among the first to join the crowds clamoring for interoperability standards. Personally, I tend to like the comment of ONC’s Deputy National Coordinator for Programs and Policy Judy Murphy, RN, who compared EHRs to telephones.

“If you buy a telephone, it’s only as good as the other people who have telephones and can call,” Murphy said.

And she is correct. Look at like this: Patient Jane sees a primary care physician and a cardiologist. Both the PCP and the cardiologist have EHR systems, yet those systems cannot communicate with each other. Both providers are thus forced to fall back on telephone, email, fax and - unfortunately for Patient Jane – their patients to transport their own health information between their two offices. So has either of these providers been able to truly realize the value of EHRs?

No. And although there are hundreds, if not thousands, of surveys, studies and reports that tout the benefits of EHR implementation - including an improved ability to respond to patient issues; more effective management of patient treatment plans; and improved documentation, collections, patient service and clinical operations – these benefits mean little if the systems that deliver them cannot simultaneously deliver global communication with other systems.

Of course, hindsight is 20-20, as we all well know, and when the EHR movement was adopted at the federal level, I don’t think anyone realized how quickly and exponentially the EHR market would grow, which is why no interoperability standards were mandated at that point.

Now, however, the EHR market in North America alone is expected to reach $10.1 billion by the end of next year, and the pressure is on at the federal level to develop and implement those standards sooner rather than later.

But beyond interoperability, physicians must also occasionally deal with vendors that convince them they must purchase expensive EHR systems that are well beyond the actual needs of their practices. This leaves unsuspecting physicians encumbered with systems they cannot use, do not need and can’t afford. And in many of these cases, when the physician seeks help from the vendor in correcting an issue, understanding the functionality or evaluating an upgrade, the vendor has disappeared into the wind.

Yet I do believe relief is in sight. Interoperability standards are being developed that will eliminate much of the fly-by-night vendor issues, and an increasing number of providers are turning to Regional Extension Centers (RECs) for vendor-neutral assistance in determining precisely what type of system is needed to meet specific practice needs.

It is important, too, to understand that much in the same way that health care has evolved, so have EHRs.

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The Health Care Evolution, Part I


 By Cindy Munn, Quality Forum CEO

How often – especially in the last couple of years – have you heard the statement, “Health care is changing”? My guess is, you’ve heard it often enough that it now makes you roll your eyes and say, “Duh,” before moving on to the next health care-related news item.

And yet, as commonplace as that statement may be, it’s still very much a true one – health care really is changing, and it’s changing at a faster and faster pace. We live in a world that is increasingly reliant upon technology – we get our news electronically, we do our banking and shopping online, we do our research online, and we even do our socializing online, thanks to Facebook, Twitter, Instagram and LinkedIn. It only stands to reason that health care has a growing place in this tech-dependent world, right?

So why, then, is there still an element of hesitancy to adopt health information technology (IT)?

The Old Days

Since the beginning of time, health care has been in a constant state of evolution. In the Middle Ages, diseases were treated by blood letting; diagnoses were influenced by astrology; and pharmacology was little more than simplified herb-based folk medicine. It wasn’t until the 17th century that health care began to advance beyond these primitive measures – until then, these early physicians believed a positive outcome was attained if the patient didn’t die during treatment.

These days, however, technology has enabled us to reach new heights in health care – bio-artificial organs, bionic limbs, surgical robots, minimally invasive surgical techniques, hormone replacement therapy…these are just a few of the greatest health care achievements of the 21st century. 

Imagine how the “doctors” of the Middle Ages would react to these advancements. If they didn’t faint dead away from the shock, they’d likely invoke the symbol of the Evil Eye and run screaming into the night…and their patients almost certainly would.

But – and pardon me for saying it again – health care is changing, and these changes have reached lightning speed over the last few decades. It’s become an environment ripe with – and for – innovation, and it is this environment that has spurred the advancement of health IT tools like electronic health records (EHRs).

Yet – hard as it is to believe - there still remain naysayers, and while these naysayers are not exactly forking the Evil Eye at EHRs, they are clearly hesitant to adopt them.

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The Spirit of Louisiana

  By Cindy Munn, CEO
 

Nine years ago today, Hurricane Katrina arrived on the Gulf Coast. The storm brought with it death and destruction, fear and sadness, grief and misery, and even now, nearly a decade later, most Louisiana residents have horror stories about their experiences during and after Katrina.

In Louisiana, in many ways and on many fronts, Katrina will forever be a benchmark by which we measure ourselves.

The Costliest Disaster in U.S. History

Katrina made landfall at about 6 a.m. on Aug. 29, 2005, near Grand Isle, La. Within hours, there was severe flooding in New Orleans and the levees had begun to give way to rising floodwaters that would not recede for several weeks. 

The destruction left in Katrina’s wake was immediate – homes and businesses destroyed, lives lost, families displaced – and expensive. More than $127 billion in federal funding was provided for infrastructure repairs, temporary housing and aid to victims, and insured losses attributed to Katrina are estimated at approximately $60 billion. Even now, almost a decade later, we still have no precise figure for how much the storm cost, but for many Louisiana families, no estimate will ever be enough to adequately cover the lost lives.

The Stories We Tell

The stories about lost lives, missing persons, destroyed homes and infrastructure and political fallout were covered from nearly every angle by media around the world in the days, weeks and months after the hurricane. Thousands of evacuated Louisiana residents watched these stories unfold from afar on televisions in motel rooms, in their relatives’ living rooms and in temporary shelters in distant cities and states. The ones who remained were interviewed at length about their experiences and shared heartbreaking stories that left the world in tears.

For most of us in south Louisiana, the question, “Where were you when Katrina hit?” yields a torrent of these tales, and it probably always will. Someday, much as grandparents today tell their grandchildren about where they were and what they were doing on the day President John F. Kennedy was shot, the future generations of Louisiana will hear stories from their grandparents about the day Katrina arrived in our beautiful state.

The Untold Story

Yet in the midst of the stories told about Katrina, the one story that never received quite as much attention is the one about what the storm did to health care in our state.

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A Conversation for Caregivers: The Value of Health IT

By Quality Forum Staff
 
As the state-designated entity for health IT advancements in Louisiana, we spend a great deal of time talking to health care professionals and consumers about the benefits of things like electronic health records (EHRs) and the statewide health information exchange (HIE): how they drive improvements in health care quality and outcomes, how they reduce our reliance on fragmented and uncoordinated health care systems, how they lower health care costs, and so on.

But we don’t often get to talk about the benefits of health IT for caregivers, which is why we’re thrilled to have been asked to serve as a guest for a Twitter chat on that very subject this week.

On Wednesday, July 2, at noon (CST), under the Twitter hashtag #ElderCareChat, we will join @ElderCareChat and @Seniors4Living in a dynamic one-hour chat on health IT for caregivers.

Topics will include:   

- Information regarding caregiver and senior use of health IT

- The barriers and challenges to health IT use

- Existing and emerging care management technologies 

- EHRs, HIEs and how caregivers can use them 

- Patient portals

- Concerns about health IT use

- Health IT tools of the future

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The Truth About The Patient-Centered Medical Home Model

 
Bobbie LeBlanc,
Quality Forum PCMH Program Manager
 

As the nation continues its efforts to transition from a volume-based health care system to one based on value, there’s been a growing emphasis on patient-centered care. This emphasis has led to a revived interest in the Patient-Centered Medical Home (PCMH) model, which has, in turn, led to a great deal of confusion among health care providers.

So let’s talk about it...

An Egg-cellent Comparison

Few items have received as much scrutiny as the egg.

In 2010, the USDA released a study proving that eating an egg each day had no real negative impact on cholesterol. Two years later, a group of researchers at Western University in Canada announced that extensive studies had revealed conclusive evidence that eggs increased the cholesterol so greatly that eating them was as bad for you as smoking cigarettes.

Those studies are only two of more than four decades’ worth of research into eggs. Over the course of that 40+ years, we’ve been bombarded with conflicting messages about eggs – eat them, don’t eat them, eat them in moderation, don’t eat the yolk, etc. – and every single one of those messages has a study to support it.

The PCMH model of care is much the same way. One day, you’re overwhelmed with studies that say PCMH has been proven to improve quality and outcomes; the next day, you’re bombarded with studies that tout the failure of PCMH. (Surely you didn’t doubt my ability to find a connection between eggs and PCMH, did you?)

Doing The Head-Scratch

In an environment that’s jam-packed with these contradictory studies, physicians considering adoption of the PCMH model are undoubtedly scratching their heads and wondering which study to believe.

Is it the Patient-Centered Primary Care Collaborative’s study, which says the PCMH model is responsible for demonstrated improvements in cost, utilization, population health, prevention, access to care and patient satisfaction?

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The Truth About Advance Care Planning







By Susan Nelson, MD, LaPOST Coalition Chair

If you are in an accident or suffer an illness that leaves you unable to tell your loved ones and health care providers what kinds of medical treatments you do and do not want, who will speak for you?

Does that spokesperson know what you would want under those circumstances?

Have you taken the time to document your wishes?

Advance care planning is making decisions about the kind of care you do and do not want to receive if you become unable to speak for yourself. It involves not only telling your loved ones and physicians about your wishes, but also recording those wishes through the appropriate documents. These two very important steps can save your loved ones and doctors from the difficult position of having to guess what you might have wanted at the end of life.

On April 16, the Louisiana Physician Orders for Scope of Treatment (LaPOST) Coalition will join hundreds of other organizations across the nation in support of National Healthcare Decisions Day (NHDD), a national initiative to increase awareness about the value of advance care planning. In recognition of NHDD, the Coalition would like to debunk some of the common misconceptions about advance care planning:

Myth 1: Only the elderly and/or very ill need to worry about advance care planning.

The Truth: Advance care planning is a process that needs to be completed regardless of age or health status. Consider this hypothetical case: a seemingly healthy 30-year-old man – let’s call him Jack - collapses suddenly at home, losing oxygen flow to his brain for several minutes. He is left severely brain-damaged and completely dependent upon a feeding tube for nutrition. Jack’s wife claims that he would not have wished to be kept alive through such means, but his brothers and sisters argue to the contrary. Jack has no advance care planning documents in place to help his loved ones know his precise wishes, leaving them to ‘fight it out’ in court for years to come. This hypothetical scenario underlines the fragility of life – we cannot know when tragedy might strike. As human beings, we are all susceptible to the unexpected – events such as car accidents, sudden illness and the like – but we can be prepared to some degree through advance care planning, which empowers us with the ability to document our wishes for our loved ones and health care providers. Without that documentation, our loved ones may not know what we wanted at the end of life, or worse, they may not agree with each other about what our wishes would have been.

Myth 2: Advance directives, or living wills, are the same as ‘Do Not Resuscitate’ orders.

The Truth: Advance directives do not mean ‘Don’t treat me.’ They mean, ‘Treat me the way I want to be treated.’ We can use an advance directive to identify the kinds of treatments we do – and do not – want, and our loved ones can use this documentation to help our doctors develop a plan of care that matches our wishes. An advance directive can also be used to identify the person we want to speak for us if we cannot speak for ourselves. These legal documents take effect only when we lose the ability to make decisions for ourselves, and we can change or update them at any time.

Myth 3: I will have to hire an attorney to complete advance care planning documents.

The Truth: We can complete advance care planning documents without the assistance of an attorney. Here in Louisiana, we have three advance care planning documents available, and none of them require the services of a lawyer for completion. These documents include:

Advance directives, or living wills: We can complete these documents ourselves. In order for them to be valid, they need only be witnessed by two people. It does not have to be notarized.

Health care power of attorney: This document is used to formally authorize someone else to speak for us when/if we become unable to speak for ourselves. Our state has a specific order of who can make our health care decisions for us if these written instructions are not available, so to be certain that our spokesperson is the individual who we feel would best honor our wishes, it is important to have this document in place. Like an advance directive, we can complete this document ourselves. It does not need to be notarized, but does need to be witnessed by two people to become valid.

Louisiana Physician Orders for Scope of Treatment (LaPOST): The LaPOST document is more than an advance directive or a health care power of attorney. Designed specifically for patients with serious, advanced illnesses, it is a medical order that outlines our wishes and goals of care, and it can be used to translate an advance directive into a physician order. To become valid, the LaPOST document must be discussed by us and/or our health care representative and be signed by a physician. When completed, it must be honored by all health care professionals.

Myth 4: Once my advance care planning documents are completed, I can’t change my mind about my health care goals and wishes.

The Truth: Nothing is ever carved in stone when it comes to advance care planning. As our lives, circumstances and/or conditions change, so do our personal goals of care – for example, what we wanted when we were young and healthy may not be the same as what we want when we are elderly and/or seriously ill. We can change our advance care planning documents any time we wish.

Myth 5: Signing a health care power of attorney means I am giving away control of my health care.

The Truth: Signing a health care power of attorney means only that you are designating the person you would trust to make decisions about your care if and when you become unable to make those decisions for yourself. After signing the document, you still have the power to make your own health care decisions for as long as you are able to do so – treatment cannot be given to you or stopped over your objections. Your designated health care representative steps in only when your physician certifies that you lack the capacity to make your own decisions. It is also important to know that you can change your health care representative at any time you choose by simply completing a new health care power of attorney document.

As National Healthcare Decisions Day approaches, please take the time to have the conversation about your personal goals of care with your loved ones and your health care providers and then take the appropriate steps to document your health care wishes. These conversations, though often difficult, truly have the power to change lives. If you’d like to know more about advance care planning, please click here to download the LaPOST Coalition’s free ‘Conversations Change Lives’ toolkit, which includes a guidebook designed to help you identify and discuss your health care wishes.

Editor's Note: The LaPOST Coalition will kick off its third 'LaPOST Ready' campaign on National Healthcare Decisions Day, April 16, with a workshop featuring Dr. Nelson at Bayou Desiard Country Club, 3501 Forsythe, in Monroe, 11 a.m. - 1 p.m. To register to attend this free event, click here.
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You Ain't Seen Nothing Yet...

 By Nadine Robin

March 15, 2010, is a date that will never be found in the history books, yet it’s an important one for Louisiana residents: It’s the day the Louisiana Health Care Quality Forum received word from the Office of the National Coordinator for Health Information Technology (ONC) that we’d been awarded a grant to build a statewide health information exchange (HIE) in Louisiana.  

There were only six of us in a small office on that date four years ago, but there were countless individuals across the state who helped work on the grant proposal. Today, the Quality Forum has grown to include 35 employees and moved to a larger office, and our list of collaborative partners continues to expand. But one thing hasn’t changed: our volunteer board, committees and other volunteers remain the key to our success.  

After the initial award, we focused on stakeholder engagement – bringing together providers, payers, and consumer representatives to plan a path for health information exchange in Louisiana. We went on to launch LaHIE in November 2011. Our pilot hospitals, Lafayette General and Opelousas General, continue to be recognized for their innovation, most recently receiving recognition for being among the "Most Wired" hospitals in the nation. Meeting so many of our hospitals, providers and stakeholders and seeing their enthusiasm for what health IT can do to improve care in their communities has been our extreme pleasure.  

To date, LaHIE has participation agreements with more than 190 hospitals, providers, home health companies and other health care organizations across the state, and these numbers continue to grow. That’s just the technology part, though… bigger than the technology is our focus on improving care for patients. To date, more than 630,000 patients have their information available at the point of care at LaHIE participating organizations. In fact, in the time it took you to read this article, at least two or three new patients have been added to LaHIE.

Today is also a day of significance for LaHIE: March 14, 2014, is the final day of federal funding for our state's health information exchange.  In a way, we are glad to see this “end date” pass. The fact that we are still growing strong means we laid the right foundation and that we can now proceed without an “end” - only a laser-focus on improving the quality of health care in Louisiana. We would be remiss, however, to not acknowledge those who helped us as a result of this federal effort.  So, to those who worked to make LaHIE a reality - to every employee of LHCQF, past and present; every stakeholder volunteer; every organization that helped us spread the word about LaHIE; every ONC project officer, grantee, or contractor who shared ideas and time with us; every participant of LaHIE – thank you! 

Yet the work is not done. As LaHIE has grown, so has our vision for the benefits it will bring to health care in Louisiana. We foresee the development of value-added services designed to improve health at the community level, a registry of end-of-life care wishes and treatment plans, the roll-out of a patient-friendly portal that will provide Louisiana residents with access to their personal health information…. Even as we close the first brief chapter in LaHIE’s short history, we are already looking to the future. 

And in a few years, we will look back on today as one more milestone on a long timeline. It has taken countless individuals giving of themselves to grow LaHIE into what it is today, and while we are proud of what we’ve accomplished in four short years, we know there is a bright future ahead for LaHIE.

To quote the old Bachman-Turner Overdrive song, “You ain’t seen nothin’ yet.”
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HIMSS14: Reflections

 

The Louisiana Health Care Quality Forum recently returned from the annual HIMSS Conference, held this year in Orlando, Fla. Below, several of the team members who attended HIMSS14 share their thoughts on key take-aways, new ideas and interesting lessons learned at the event.

 By Cindy Munn, CEO (Twitter: @CindyMunnCEO)

The opportunity to discuss HIE sustainability at HIMSS was an incredible privilege for me. This issue is one that so many HIEs across the nation are facing, and I was quite proud to discuss not only what has worked for the Louisiana Health Information Exchange, but also to talk about what didn’t work for us. My goal was for those who attended my session to come away with an understanding of how important it is to know their environment, to identify the needs of their stakeholders and to collaborate across stakeholder lines to build a sustainable business model.

And that is one of the reasons I enjoy attending HIMSS each year: because it’s an environment that is focused on collaboration with others…not just providers and vendors, but also consumers, patients, payers, businesses and others. The message of collaboration is one that resounded through the halls of HIMSS14, and I was very excited to be able to share in the delivery of that message.

I was also very impressed with the excitement and discussion around the issue of interoperability. This, to me, is a critical component of what we are all trying to accomplish through health IT. If our systems cannot communicate, cannot meaningfully share information, we will not be successful in our mission to improve health and health care in our nation.

Innovation, interoperability, patient engagement, meaningful use – these concepts represent exciting and positive changes in the delivery of care in our country, and through events like HIMSS, we all have the opportunity to share in those changes.

 By Nadine Robin, HIT Program Manager (Twitter: @HITNadine)

One of the key words for me at HIMSS14 was “collaboration.” The conference gave me a chance to meet with other HIEs and RECs and get new ideas not just on things we can do, but on how we can collaborate with them on projects together. Collaboration is a crucial element in bringing these health IT measures together, not just in our individual states, but in the nation as a whole.

Another hot-button word for HIMSS14 was “innovation.” I always love the vendor hall and seeing the innovation and creativity.  There were several new-to-me companies that I am looking forward to talking to some more. The technology on display in the exhibition hall is always fascinating, and this year was no different. These companies were excited to be a part of HIMSS and to showcase their incredible services.

I also enjoyed my HIMSS duties this year as president-elect of Louisiana HIMSS. I had the opportunity to attend chapter leaders meetings, president/president-elect "meet-ups," and was a part of our Gulf Coast Chapters reception with Alabama and Mississippi. There was a lot of interesting discussion about how HIMSS can support members in local chapters.

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Health IT: Adding Value To Health Care For The Average Joe

By Cindy Munn

If you ask a health care professional or a technology guru why health IT is valuable, you’ll get answers that focus on “evidence-based care models,” “data integrity” and “continuity of care,” but as with most things, there’s a much simpler answer to that question.

Let’s start with a hypothetical situation: Joe is 48 years old and overweight with a history of high cholesterol and high blood pressure. He’s already had one bypass and lives in fear of another one, so he sees his regular physician often, and every three months, he travels 80 miles to his cardiologist’s office for stress tests and check-ups. Joe also has enlisted the services of a dietitian in an effort to reduce his weight, and once every month, he drives 60 miles to her office. He carries his latest medical test results to each of these visits so every member of his care team is aware of what the others are doing. It’s a stressful situation for Joe, yet he continues because he’s made his health a priority for himself and his family – he is the very definition of an engaged patient.

We all know someone like Joe, so let’s talk about how health IT can make their situations better.

We must first recognize that we are no longer living in the 1950s, when we communicated via ‘snail mail’ and rotary-dial telephones, and computers and cell phones were thought to be the futuristic imaginings of sci-fi writers. We aren’t in the 1980s, when cell phones weighed three pounds, data was stored on floppy disks and email was unheard of. We are in the New Millennium, and technology has soared to new heights. Today, we get our news instantly via mobile apps on our cell phones, do our shopping and banking on the internet and talk to our loved ones through Skype and FaceTime.

Technology has changed our lives, and it is changing our health care, too.

For patients like Joe, it means no more hauling around paper medical records because electronic health records (EHRs) and health information exchanges (HIEs) have instantly connected all the members of his health care team to his complete medical history. It means no more long treks to distant doctors’ offices for routine checkups because Joe can now get his cardiology and dietary checkups via e-health technology at his local doctor’s office. It means Joe can use instant messaging to contact his dietitian to clarify an issue with his weight loss plan or to ask his cardiologist a question about his cholesterol medication. It means Joe’s care team can provide him with additional resources and tools to make informed decisions about his health and health care.

Health IT puts patients like Joe ‘in the know.’

As health care and health IT professionals, we use phrases like “clinical decision support systems,” “population health surveillance” and “integrated practice management,” but the bottom line is this: health IT is valuable because it makes health care better, safer and easier for people like Joe.

And in that way, health IT, as the saying goes, is ‘priceless.’

Editor’s Note: Cindy Munn, CEO of the Louisiana Health Care Quality Forum, will present, “Aim to Sustain: Building a Business Model for HIE,” at the HIMSS 2014 Annual Conference & Exhibition in Orlando, Fla., on Feb. 26. Her presentation will include remarks on the value of health information technology in Louisiana. For details on this education session, click here.
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The Time Is Now

 By Nadine Robin

As a health IT advocate, I’ve long declared 2014 as “The Year of the Patient,” so it’s with great pleasure that I’ll be leading a roundtable discussion on the topic at the Annual HIMSS Conference in Orlando, Fla., later this month.  During “Patient Engagement: It’s for Small Clinics, Too,” we’ll discuss how small and rural providers can encourage their patients to use patient portals and secure messaging.

But while I’m thrilled to play a role in the education of health care providers about patient engagement, I’m even more excited to help educate health care consumers – especially those who live in rural areas – about how health information technology (IT) can bridge the gap in their health care.

In Louisiana, more than 25 percent of our population lives in rural and underserved areas. While these residents may have access to wonderful primary care physicians, they may also live up to two hours away from the nearest medical center or specialty care provider. This presents a unique problem: how to coordinate quality care from a health care team that is geographically dispersed across the state.

Health IT is the solution to that problem.

Imagine, if you will, a patient who can electronically message his or her physician from a smart phone to clarify a health issue or concern – a patient who can log in to the patient portal and show his or her specialty care provider a complete list of current medications and test results. This patient’s information is available, no matter where he or she is located.

This, my friends, is an empowered patient, and health IT is the key to that empowerment.

As health care consumers – for really, we are all health care consumers - we need to ask the question, “How can I use this technology to improve my health care?” By understanding the value of health IT and the role it plays in the delivery of our health care, we can all be empowered patients – even those of us who live far away from our health care providers.

Yet, we must remember this: Our health care providers may have to meet certain patient engagement requirements for meaningful use, but in reality, ‘patient engagement’ is a two-way street. The dedicated doctors who care for us can only do so much – it is up to us, as patients, as health care consumers, to take the knowledge they impart and use it to make healthy, informed decisions about our care. It is up to us to become engaged in our care, and learning how to use health IT to our advantage is the first step.

The technology is in place. The care teams are in place. The possibilities are endless, and the excuses are obsolete. The time for us to become empowered, engaged health care consumers, regardless of where we live, is now.

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The Magic of Transmitting Health Information

By Diete Dobroski
 

As we’re wrapping up another Stage 1 Meaningful Use attestation, the provider turns and asks, “How am I to communicate with the guy down the street…you know, the specialist that I refer 90 percent of my patients to?” 

It’s one of the more common questions we get as we work with those practices facing Stage 2 Meaningful Use and the new care transition requirements. For providers to remain meaningful users in the coming years, they must begin electronically transmitting a summary of care document when referring their patients. To a small, independent practice, this capability may only seem possible with Harry Potter-style magic, but in reality, you only need know the magic words to use when speaking with your EHR vendor to get on the right track. So we could conjure a little Harry Potter magic, and say, “Expelliarmus!” But, let’s break it down first. 

Think back to the mobile phones of the 'old days' – remember how you could only call those who were on your same network or within your ‘circle of friends?’ Now apply that thought to health information exchange (HIE) - your vendor may only have the ability to exchange data with providers who are on your same electronic health record (EHR) system or they may have a ‘circle’ of vendors that have agreed to exchange data. In some cases, an EHR vendor may decide to partner with a Health Information Service Provider (HISP) to transport data. A HISP may include even more vendors that have all agreed to exchanging data thus expanding your ‘circle of friends’ even further. 

Vendors will vary in how they integrate this technology, and providers may also have the option to choose a third party such as their state’s HIE. 

If you’re a provider or organization who is just beginning to sort all this out, begin a dialogue with your EHR vendor as soon as possible. Some of the ‘magic’ questions you’ll need to ask include:

·         What integration will be available for data exchange?

·         When will these functionalities be available?

·         Will this be a standard offer or will the vendor work with third parties?

·         Who will you be able to exchange data with - the same vendor or other vendors? 

·         Will there be a provider directory?

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All I Want For Christmas....

 By Nadine Robin
 

While my children’s wish lists are filled with toys, electronics, and every “as seen on TV” creation known to man, my list is much shorter: I want electronic access to my family’s health information.

In the past 12 months, we’ve received medical care in at least a dozen different locations and from even more individual providers – urgent care, emergency room, orthopedist, labs, pediatrician, internal medicine and more. Being the informed health care consumer that I am, I read every insurance explanation of benefits. I go across town to pick up X-rays and records for the next provider of care. I ask questions about recurring health issues and any trends that I’ve noticed. 

As an advocate and promoter of health IT, I’m ready for the next step. I’m ready to be able to share those hospital discharge reports with my primary care provider on my computer at 10 pm. I’m ready to have the same insight into my health care history as I do into my online shopping purchase history. 

And I don’t think I’m alone.  

As consumers of health care, it’s time to expect and embrace electronic access and electronic communications with our providers, just as we’ve embraced shopping online, banking online and even our children’s school progress. It’s time to do our part. Our doctors and hospitals have been busy taking care of patients, implementing electronic health records (EHRs), and keeping up with changing regulations. So let’s give them a word of encouragement and tell them we support their efforts and encourage them to take the next step. If you happen to be a lucky person whose provider offers a patient portal, sign up, log in and say, “Thank you!”

To the hardworking doctors, nurses, and staff of their clinics who have cared for my family this year, thank you! You did an amazing job taking care of my family. As you continue advancing health IT in your clinic, know that I’m here to be your cheerleader…to be the first to log in to your new patient portal…to tell your front desk person that he or she is doing great on her third day on the new EHR…to readily give you the name of my preferred pharmacy for the electronic prescribing you can now do.  

With 2014 on the horizon, I am filled with excitement. New meaningful use guidelines mean more providers than ever will be promoting patient portals. They will be encouraging patients to communicate through secure electronic messaging. The stage is set for 2014 to be the year of the patient.  

Let’s do our part.

Yes, this year all I want for Christmas is electronic access and communication with my family’s care team…oh, yes, and chocolate!
 
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LaPOST Ready: Championing The Message About Advance Care Planning

 By Susan Nelson, MD
 
On Thursday, Nov. 21, the Louisiana Physician Orders for Scope of Treatment (LaPOST) Coalition will present Conversations Change Lives, a special, complimentary event at which the Greater Lafayette region will be declared ‘LaPOST Ready.’ This event will culminate the second of the LaPOST Ready campaigns, which are designed to increase awareness of, and to provide education about, advance care planning and the LaPOST document to health care professionals, faith-based organizations, social workers and caregivers in targeted areas of Louisiana.
 
The LaPOST Coalition created and implemented these campaigns to share the message about the importance of advance care planning and the value of sharing end-of-life care goals and treatment preferences with loved ones. According to the Pew Research Center, 71 percent of Americans have thought about what they do and do not want at the end of life, and while 95 percent of Americans know what an advance directive, or ‘living will,’ is, only 29 percent actually have one. The LaPOST Coalition seeks to improve these numbers by providing patients and families, health care professionals, social workers, spiritual leaders and caregivers with information about advance care planning tools in Louisiana.
 
However, the fact is, advance care planning involves much more than simply deciding what treatments are and are not wanted at the end of life. The process starts with identifying personal care goals, clarifying personal beliefs and values and sharing these preferences with loved ones and health care providers.
 
Thus, as part of the LaPOST Ready campaign efforts, the LaPOST Coalition and the Louisiana Health Care Quality Forum developed the Conversations Change Lives Toolkit for patients and families. This toolkit includes many wonderful resources for patients and loved ones, including the Conversations Change Lives Guidebook, guides to advance care planning and medical treatments, the LaPOST Consumer Handbook, frequently asked questions, fact sheets and even a PowerPoint presentation that explains the usage of the LaPOST document. This toolkit, as well as a video about LaPOST, is available for free download on theLaPOST website.
 
 
As the LaPOST Coalition continues its education and outreach efforts across the state, it welcomes patients, caregivers, health care professionals, faith-based organizations and others who wish to help further the message about advance care planning to become LaPOST champions. To find information about upcoming LaPOST Ready campaigns, educational opportunities, special events and how to get involved in outreach efforts, visit the LaPOST Events page often, sign up for the Quality Forum’s monthly eNews or contact Cynthia Michael at This email address is being protected from spambots. You need JavaScript enabled to view it..
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Health IT: It's For Caregivers, Too

 By Jamie Davis
 
Hypothetical situation: You are the caregiver for your mother and your grandfather. You live in New Orleans, your mother lives in Shreveport and your grandfather lives in Lake Charles. Your mother calls you at 7 a.m. and complains of dizziness and nausea, perhaps caused by an adverse reaction between medications prescribed by her cardiologist and primary care physician. While you’re on hold with her physician and waiting for a call back from her cardiologist, your grandfather calls with concerns about chest pains he’s had throughout the night. Meanwhile, you have a sick two-year-old, an important meeting at work and no remaining vacation and sick days.
 
Welcome to the ‘Sandwich Generation.’
 
Formerly known as Generation X, the more than 66 million Americans who make up the Sandwich Generation are caring not only for themselves and their children, but also their parents and in some cases, their grandparents…and all while balancing careers and other obligations and responsibilities. And statistically, more than one-third of them are playing the role of caregiver from a distance, which makes the job even harder - particularly when it comes to managing health and health care for their loved ones. Imagine trying to keep an up-to-date journal of all the medications Mother must take and when she’s supposed to take them, or attempting to explain by phone to one doctor that Father has already had that medical test done and doesn’t need it again, or having to fax a request to one provider to send Grandma’s lab results to a new specialist…these are just a few of the day-to-day issues faced by the Sandwich Generation.
 
But advancements are being made that can help – specifically, electronic health records (EHRs), patient portals and health information exchanges (HIEs).
 
For the caregivers who make up the Sandwich Generation, these advancements may present solutions to many health care-related issues. EHRs are designed to be accessible to caregivers through patient portals and can be securely and confidentially shared among the appropriate health care providers through HIEs. These technologies may help to ensure that caregivers have access to the most up-to-date information about their loved ones’ health and provide their loved ones’ doctors with timely access to the information necessary to provide the best care possible.
 
Although those who’ve assumed caregiver roles would hardly call that responsibility a ‘burden,’ many would quietly admit that it can be stressful – after all, as human beings, they can only be in so many places at once and they can only stretch themselves and their schedules so far. But health IT advancements can help alleviate some of that stress through greater organization of, and more timely access to, their loved ones’ health information.
 
Caregivers can visit with their loved ones’ physicians to learn more about the availability of EHRs and other methods of improving care coordination through health IT. Additional information about EHRs can also be found clicking here. To learn more about Louisiana’s HIE, click here.
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Be Empowered: Access Your Health

 By Diete Dobroski
 
 
I recently visited my primary care provider who asked for a copy of some lab work I’d had done at another facility. It was a simple request so I left the doctor’s office and phoned the other clinic straight away. The first call had me on hold so long that I had to hang up, and when I finally got through several hours later, I was told my physician was out and I needed to call back…Then, the following day, during my second round of being on hold, I got disconnected. 
 
Many people could share similar stories of attempts at communicating with their medical providers and it gets quite frustrating, especially in urgent situations. But what if we had more control?  What if there was no need to get caught in the cycle of phone calls, messages, faxes or snail mail? 
 
Most of us access our bank accounts online, pay bills online and communicate electronically, but how many of us realize that we also have the option of accessing our medical information online? 
 
Patient portals have been around since the 1990’s, but they are fast becoming more common with the increased use of electronic health record (EHR) technology in provider practices. A patient portal allows us to securely access our personal health information from anywhere at any time via a confidential website using our own personal logins and passwords.  
 
Although the features of these portals may vary, provider practices participating in Medicare and Medicaid EHR incentive programs in 2014 will be required to provide us with the ability to view our health information, print portions of our records and even securely exchange messages with our health care providers.
 
The availability of this technology gives us, as patients, more control in managing our health information and allows us to be more actively involved in our health and wellness. Had my health care provider granted me access to a patient portal, my primary care physician would have had the requested results within minutes of the request, and I wouldn’t have been caught in the frustrating cycle of phone calls, disconnects and time wasted on hold.
 
The next time you visit your health care professional, ask if he or she offers a patient portal or has plans to implement one in the near future. This convenience may save you valuable time or even an unnecessary visit to your doctor. So let’s get empowered and get involved - after all, it’s our health. 
 
For more information on patient portals, visit the Office of the National Coordinator for Health Information Technology (ONC) website at http://www.healthit.gov/providers-professionals/faqs/what-patient-portal.
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Speaking the Same Language: A Challenge for Health Information Exchanges

 By Taylor Simpson
 
Imagine living in a neighborhood where people speak a different language in every house on your block. Now imagine that it’s your job to work with the people in each of those houses to get them all speaking a common language that enables them to work together toward a common goal. Finally, imagine that your own well-being depends upon how well the people in the various houses communicate with each other. 
 
Does that sound like a difficult task?
 
Of course it does, and essentially, it is one of the biggest challenges that health information exchanges (HIEs) across the nation currently face. Each hospital and clinic has its own electronic health record (EHR) system in which patients’ medical records are stored. Each EHR speaks its own language, making it difficult to exchange data between different EHR systems at different locations.
 
But how does this affect you?
 
As a patient, you may receive care at multiple locations and perhaps you would like for the health care providers at all those facilities to have access to your information. Without having a common language, it’s difficult to exchange that data between providers at different locations quickly and easily. However, if each facility speaks a common language, it enables better transfer of information, potentially leading to better care because those providers have more complete and timely information with which they can better treat you.
 
HIEs across the country, and the Louisiana Health Information Exchange (LaHIE) in particular, are paving the way for standardization of communication between providers, partnering with EHR vendors, government agencies and non-profit organizations to push forward the use of “common languages” between organizations that provide health care for you.
The goal is to have everyone involved in your community of care speaking the same language, so that your health records flow seamlessly and quickly from provider to provider and are available where and when they’re needed. For patients like you, the end result of having this ‘common language’ in place will be better, safer care, and that’s a language we can all speak.
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National Breast Cancer Awareness Month: Celebrating Life & Survivorship

 
By Linda Morgan

National Breast Cancer Awareness Month provides an opportunity to raise awareness about breast cancer, to educate people about it and to celebrate survivorship. The last topic is very close to my heart because I’m a breast cancer survivor.
 
I was diagnosed with the disease 18 years ago, and from the second I found out, my life changed. My journey included surgery, regular chemotherapy, high-dose chemo and radiation. I’m very fortunate in that I haven’t had a recurrence or a new cancer diagnosis. Still, I think about breast cancer every single day as well as the many lessons I’ve learned from this bittersweet adventure. I’d like to share a few of them with you.
 
It might sound trite or cliché, but breast cancer has given me much more than it’s taken from me. It gave me a second chance, and in a special way, it has made my life richer, fuller and happier. It forced me to rethink what was valuable and meaningful to me while strengthening my love for family, friends and faith. It challenged me to be a better person, encouraged me to take risks and made me realize what an incredibly strong woman I am.  Because of this, I have a new appreciation for life, respect for death and hope for the future.   
 
For me, cancer has been an opportunity, not a loss; a challenge, not a curse. It’s hard to explain and may be harder to understand, but I found a sense of freedom in facing death and in recognizing that life has limits.  It’s amazing to me how a life-threatening disease could be so life-enhancing. For all of these lessons, I am grateful. 
 
And along the way, this disease has introduced me to many brave and strong breast cancer survivors in addition to the wonderful people who care for them. I’ve learned so much from talking with others and listening to their stories. An important part of my recovery was connecting with these individuals via support groups in my community and through volunteer work with related organizations and groups. I discovered I wasn’t alone and that maybe, just maybe, I could help others by using my communication background and skills.   
 
Encouraging words from those survivors inspire me to this day, and I’d like to recognize all of them because they taught me the best lesson of all: breast cancer is a beginning, not an end.
 
Be healthy, be hopeful, be happy – wishing you the best of luck on your journey!
 
If you’re a survivor, what lessons have you learned?  Who or what inspires you? How do you celebrate life? If you like, feel free to share your thoughts with me by emailing This email address is being protected from spambots. You need JavaScript enabled to view it.. 
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Information is Power

 By Emory Dossmann
 
Most of us have heard of the Health Insurance Portability and Accountability Act, commonly called ‘HIPAA,’ but few of us truly understand what it means to us as patients. Simply put, HIPAA, or more specifically, the HIPAA Privacy Rule, gives us rights over our health information, sets rules and limits on who can access our information and establishes security safeguards to protect our information.
 
But HIPAA does something else for us – it mandates that we, as patients, have a right to access our own health records. This access allows us to have corrections made to our information if necessary, and it ensures that we are advised about how our information can be used and who has had access to it.
 
These rights are protected by the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR), which encourages us, as patients and health care consumers, to do the following:
 
·        Get copies of our medical records and other health information. We should be prepared to make the request in writing and to pay for the cost of copying or mailing the records, but we should remember that health care providers are required to provide these records in electronic form if that is how they are kept. Typically, health care providers must comply with our requests within 30 days.
 
·        Review our medical records to ensure that all information is accurate. If we notice that something is missing, incomplete or incorrect, we can ask our health care providers to update our records. Generally speaking, these corrections must be made within 60 days.
 
·        Find out who has accessed our medical records. By law, our health information can be used and shared for reasons not related directly to our care, but in many of these cases, we can find out who has seen our information. We can ask that our health information not be shared with certain people, groups or companies, and although we can ask for other restrictions, we should remember that our health care providers do not always have to agree with those requests, particularly if they could affect our care.
 
·        File a complaint if our rights are violated. OCR empowers all of us with the ability to file a formal complaint if we believe our health information privacy or access rights have been violated. We can complain in writing by email, fax, letter or electronic means within 180 days of when the violation occurred.
 
Having copies of our medical records is crucial. We may need them if we’re evacuated to another area during a disaster, or if we switch to a new doctor, or if we want to find out if something in those records is inaccurate. There are dozens of reasons we might need our medical records, but the most important one is that having our records provides us with a bird’s eye view of our own health histories. By having this complete picture of our health, we can make better, more informed decisions about our care.
 
We can be proactive in our health, but action requires information, and information is power. Thanks to HIPAA, we can take power over our health. Learn more about your rights by reading this informational piece from the OCR.
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National Breast Cancer Awareness Month: A Survivor Story


By Linda Morgan


The Quality Forum, like many other organizations and groups, is sharing wonderful information with you throughout October about breast cancer awareness, but I think one of the most important takeaways you may hear or read about is the importance of early detection.


According to the American Cancer Society (ACS), early detection is “an approach that lets breast cancer get diagnosed earlier than otherwise might have occurred.” The ACS guidelines for most adults include regular breast self-exams, clinical breast exams and mammograms as well as MRIs for some women with certain health factors.

Although early detection may not prevent the disease, it helps improve chances for early diagnosis and treatment. As a breast cancer survivor, I know first-hand the value of early detection and its equally important partner, timely follow-through.

Back in June 1995, while taking a shower, I felt something strange under my left arm. It was hard … about the size of a pea. I had never felt anything like that before. Quite honestly, my first thought was – cancer. I then quickly came up with other less dramatic, frightening and life-threatening explanations: an insect bite, a cyst, an infection, a cut, a blemish – anything but cancer.

Granted, my gender put me (and all women) at risk for starters, but I was only in my late 30s. I also watched my diet, regularly exercised and didn’t smoke. How could it possibly be cancer? I couldn’t handle the thought that this little lump might be signaling a serious health condition. I was terrified, but I didn’t say anything to anyone. In fact, I felt quite sure that if I didn’t touch it, see it or talk about it, this “thing” would definitely go away and leave me alone.

So I let a week go by, and then another one, and then several more. That little swelling didn’t go away – it actually became larger. As it grew, so did my anxiety. And then, after pretending it didn’t exist for about five weeks, it became painful and started to hurt. I finally decided to talk to a friend who happened to be a breast cancer educator. I was so scared that initially, I couldn’t bring myself to ask her about this. But when I did, she advised me to see my physician as soon as possible, who advised me to see a surgeon as soon as possible, who advised me to see an oncologist as soon as possible. I had Stage IIB breast cancer, and that lump meant it had spread to my lymph nodes.

Well, the good news is that this happened 18 years ago, and I’m proud to be a breast cancer survivor. But I still think back to those five weeks in 1995, and what I experienced due to my fear of the unknown. Emotionally, it was as tough as some of the treatment and procedures I went through after the diagnosis. I found the mass under my arm early on, but it took me far too long to report it to my doctor.

So, I‘d like to add a little something extra – lagniappe – to the early detection plan: be relentless about it. If you notice something different about your body or skin, don’t ignore it. Have it checked by a health care professional experienced in diagnosing breast diseases. It’s often said that information is power, and when it comes to breast cancer, that can be a huge advantage in terms of timing, choices, outlook, etc.

Be healthy … be hopeful … be  happy!  
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Health Care Reform and You: Professional Viewpoints


By Cynthia Michael

As the Affordable Care Act (ACA) moves forward in 2014, there is much to learn and discuss about health care reform. In an effort to begin that dialogue, the Louisiana Health Care Quality Forum will host a fall summit, “Health Care Reform and You: Professional Viewpoints,” on October 31 at the Marriott Hotel in Baton Rouge. This event will provide insight from various stakeholders on the impact of health care reform in Louisiana.

Sheila P. Burke, Senior Public Policy Advisor with Baker Donelson’s Washington, DC, office, will serve as the keynote speaker. In addition to her role at Baker Donelson, Burke serves as a faculty member at the John F. Kennedy School of Government at Harvard University where she teaches a health policy course and co-directs a public policy simulation exercise. She is also a faculty research fellow at Harvard’s Malcolm Weiner School for Social Policy, a Research Professor at the Public Policy Institute and Distinguished Visitor at the O’Neill Institute for National and Global Health Law at Georgetown University. Her distinguished career includes 19 years on Capitol Hill where she served as Deputy Staff Director of the Finance Committee, Chief of Staff to Senate Majority Leader Bob Dole, and Secretary of the Senate. In these roles, she was involved with numerous legislative issues including those related to Medicare, Medicaid, Maternal and Child Health programs, welfare reform, budget reconciliation and previous legislative efforts to reform health care.

Burke’s career also includes a seven-year tenure as Deputy Secretary and Chief Operating Officer of the Smithsonian Institution with responsibility for the overall operations of the 19 individual museums and galleries, the National Zoo and nine research facilities.

The fall summit will also feature Quality Forum Board Member Donna D. Fraiche, Esq., attorney with Baker, Donelson, Bearman, Caldwell & Berkowitz, PC, who will lead a panel discussion among David Callecod, President and CEO of Lafayette General Health System; Ray Peters, Vice-President of Roy O. Martin Lumber Company and President of the Quality Forum Board of Directors; Vincent Culotta, M.D., President of the Louisiana State Medical Society; and Carol Solomon, President and CEO of Peoples Health. Mike Bertaut, Health Care Economist with Blue Cross and Blue Shield of Louisiana, will be the closing speaker.


As health care continues to evolve, both in Louisiana and the rest of the nation, it is important that we all take an active role in the conversation about the impact of health care reform on consumers, businesses and health care providers, payers and organizations. We encourage you to attend this event to learn more about health care reform in our state.


Reserve your seat now by clicking
here.

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REC Assistance Available For Medicaid Specialists


By Nadine Robin

Over the last several years, I have spoken before numerous audiences across the state filled with health care professionals. Many of the specialists in these audiences have voiced a common interest in receiving assistance from Louisiana’s Regional Extension Center (REC) in meeting Meaningful Use (MU) objectives.

That assistance is now available, thanks to funding received from the Louisiana Department of Health and Hospitals (DHH) Medicaid Office through the Centers for Medicare and Medicaid Services (CMS).

This funding enables Louisiana’s providers of specialty care to receive subsidized assistance from the Louisiana Health Information Technology (LHIT) Resource Center, the state’s REC, in achieving MU. To be eligible for REC services at the same subsidized rate as primary care providers (PCPs), these specialty care providers must have 30 percent or greater Medicaid patient volume, and must not have received a Year 2 payment from Medicaid.

Having assisted more than 1,700 providers across 37 different specialties, the LHIT Resource Center, administered by the Louisiana Health Care Quality Forum, is well-positioned to help providers of all types in achieving MU.  While we may be better known among PCPs, we are also very experienced in helping a variety of provider types - including those practicing behavioral health, dental and cardiology specialties, to name just a few.

Providers of all types will benefit from the vendor-neutral support available through the LHIT Resource Center, which guides providers through all steps to receiving incentive dollars.  The LHIT Resource Center has supported providers using more than 40 different electronic health record (EHR) products. We are able to do this because we aren’t experts on any specific EHR technology; we are experts at helping providers achieve MU on any certified EHR technology. 

The providers who’ve worked with our REC team know that our support is geared toward their organizations’ specific needs and goes well beyond the mechanics of health information technology (IT). In addition to aiding providers in the adoption and implementation of EHRs, we also help them to maximize financial incentives and to minimize administrative burdens associated with that implementation. We also help these providers prepare for future health care initiatives such as adoption of the Patient-Centered Medical Home (PCMH) model of care.

All providers in Louisiana can access our services, but those who have a Medicaid patient volume which is 30 percent or greater should contact us. DHH-Medicaid has made these funds available to reduce the cost for these providers to receive our assistance with meeting the requirements of MU. The journey toward achieving MU may be a difficult one to navigate - we can help make that journey an easier one.

To learn more about our Medicaid Specialists Program, please contact me via email at
This email address is being protected from spambots. You need JavaScript enabled to view it..
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Putting You At The Center Of Your Health Care


By Bobbie LeBlanc

When you select a bank, you seek out the one that can provide you with the type of accounts that best suit your needs and the needs of your family. You look for the bank that has outstanding safety and service ratings – a bank that is always willing to discuss, without time constraints, your financial future and that places your thoughts and concerns at the top of its priority list. You want the bank that offers special services such as online banking, after-hours customer service assistance and mobile deposits. 

So shouldn’t you expect that same level of personalized service from your health care team? You should, and many of Louisiana’s health care providers are transitioning to the patient-centered medical home (PCMH) model of care in order to provide you with it. 

The PCMH model is designed to put you, as the patient, at the center of your care – because really, as the patient, you are the most important person in your health care. And as such, you can work with your PCMH provider to coordinate a team of health care specialists – nurses, dieticians, cardiologists, oncologists, pharmacists, radiologists, et cetera – to develop a care plan that best fits your needs and the needs of your family.

The PCMH model of care has existed in the U.S. for more than forty years. It has evolved into a model of care in which you have a direct relationship with a health care provider who coordinates a team of health care professionals, takes responsibility for your care and arranges for appropriate care with other qualified providers as needed. This innovative care model is founded in the principles of health information technology (IT) and health information exchanges (HIEs) and other means designed to ensure that you receive the best care possible when and where they need it.

For you, as the patient, the PCMH model means greater access to your health care team. It means your doctor takes care of you, and not just when you’re sick. It means your care team works closely with you to make certain that you have the information necessary to make informed decisions about your health and your care, and that you have access to community resources and other tools that can help you take charge of your health.

But there’s so much more to the PCMH model of care. Do you need same- or next-day appointment scheduling? Do you need an appointment outside the traditional 9-5 office day? Do you want to ask your doctor a question via email? Do you want to access your personal health records electronically? Do you want your doctor’s office to call you with reminders about blood pressure or blood sugar screenings? Do you want to increase your access to preventive care?

If the answer is yes, you should speak to your doctor about the PCMH model of care. PCMH providers have the tools in place to offer these benefits to their patients. And early studies have shown that providers who have transitioned to the PCMH model of care have higher rates of patient satisfaction, enhanced care quality, fewer patient hospitalizations and reduced medical costs.

The goal of the PCMH model is to eliminate the days of waiting for weeks or even months to see your health care providers, to reduce the delays in finding out the results of your lab tests, and to make it unnecessary to schedule an appointment just to ask your doctor a single question. As a health care consumer, you can have the same level of service from your health care team that you’d expect from your bank and favorite retail stores, and the PCMH model of care is designed to ensure that you receive it.

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End-of-Life Care Planning Begins With A Conversation


By Susan Nelson, MD

While many Americans may believe death comes suddenly and at the end of a long and productive life, that may not always be the case. For approximately 80 percent of the population, death comes after several weeks, or even several years, of progressive illness and debility. 

Many years ago, patients had limited options when it came to the selection of treatments at the end of life. Today, in some cases, medical advancements have made it possible for doctors to significantly extend patients’ lives, but while some patients could benefit from those advancements, they may not be ideal for everybody.

Numerous studies have shown that patients and families who discuss advanced care planning may receive a higher quality of patient-centered medical care. Advance care planning includes documents such as the advance directive, also known as a ‘living will,’ and the health care power of attorney.

A living will is typically written well in advance of any known illness and describes the type of care a patient wants if something occurs, particularly scenarios in which the patient does not wish to receive aggressive medical care. Unfortunately, less than 25 percent of Americans have this level of planning, and even with an advance directive in place, the document requires interpretation and a physician’s order before it can be implemented.

The health care power of attorney document identifies the person who makes health care decisions if the patient becomes unable to do so, and requires the patient to state the kinds of decisions this person would make. If a health care power of attorney is unavailable, the state stipulates who would make those decisions.

Here in Louisiana, residents have another document available to them that helps to ensure their end-of-life care wishes are recorded and honored.

Created with input from health care and legal professionals across the state and approved in 2010 by the Louisiana Legislature, the Louisiana Physician Orders for Scope of Treatment (LaPOST) document is a best-practice model for patients with life-limiting or irreversible conditions to state their preferences for end-of-life treatment in a physician’s order. The document conforms to the recommendations of the National POLST Paradigm Task Force and program.

The LaPOST document, unlike a living will or health care power of attorney, is designed specifically for patients with seriously advanced illnesses and lists some of the medical treatments they would or would not want. It is completely voluntary and is biased neither for nor against treatment. Once completed, it becomes a binding medical document and can be used independently from a living will or to make a living will operational. In addition, the LaPOST document can be modified or revoked at any time based on new information or changes in a patient’s condition or treatment preferences.

Studies show that for patients who use POLST documents, treatment preferences are respected 98 percent of the time, and no one received unwanted CPR, intubation, intensive care or feeding tubes. As a result, POLST has helped bridge the gap between the treatments patients want and those they receive.

The LaPOST document improves communication between patients and doctors by providing the mechanism for those with seriously advanced illnesses to express their preferences about medical care, and because the document travels with them across health care settings, it ensures that those wishes are honored, no matter where they are.

LaPOST gives patients greater control in deciding the point at which curative treatment is no longer attempted, and focus then shifts to comfort and symptom management. This is why it is important for health care providers to be willing to discuss advance care planning by educating their patients and their families about the types of care available, who provides it, who pays for it and other related issues. Caregivers and patients with seriously advanced illnesses and their families need to be prepared to discuss the patient’s personal goals, values and religious or cultural beliefs that affect decisions about end-of-life care.

And those discussions about end-of-life care wishes are an integral part of the LaPOST document – it requires patients and caregivers to have real conversations about treatment options for end-of-life care. These can be difficult conversations to have, but by discussing treatment options and personal goals, values and beliefs, patients can make their final days easier on themselves and their loved ones.
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The Health Information Exchange: Imagine the Difference


By Nadine Robin

Imagine: you’re all alone and in a terrible car accident. An ambulance takes you to the nearest emergency room where the doctors need to know about your medical history and allergies before they can treat you. You’re unconscious, and you can’t provide that information yourself.

The Louisiana Health Information Exchange (LaHIE) is designed to help in situations like this.

In the past, physicians shared your health information by telephone, fax, mail, email or even messenger services, but these processes take time and ma
y not give your health care provider a clear record of your medical history when it’s most needed. As Louisiana’s ‘super highway’ for health information exchange, LaHIE is striving to change that by leading the state into a modern era of health information technology (IT) while simultaneously improving health care delivery and reducing costs for residents.

LaHIE is Louisiana’s only statewide health information exchange. Unveiled in November 2011, the exchange now has participation agreements with more than 170 hospitals, clinics, providers, specialists, school-based health centers and other health care companies across the state. Its footprint currently includes almost every parish in Louisiana.

LaHIE enables enrolled health care professionals to electronically and securely share your health information in real time by providing them with access to your electronic health record (EHR), which may include your medical history, allergies, prescriptions, specialist visits, lab results and more. Having this information available through LaHIE helps to ensure that authorized health care providers can access your information when it’s most needed, regardless of where you’re located.

In addition, as a central location through which your health information can be electronically accessed, LaHIE significantly reduces the likelihood that your medical records will be lost, stolen or damaged. We’ve all been to our doctors’ offices and seen the endless rows of paper medical charts stored on shelves behind the receptionists’ desks, and we know our doctors do all they can to ensure that unauthorized personnel don’t have access to those charts.

But think about it: which sounds more secure – having your medical records in a folder on a shelf or having them electronically-stored, password-protected and encrypted to prevent unauthorized people from reading them?

The answer seems obvious, doesn’t it?

But LaHIE offers something else, something that Louisiana residents who endured Hurricanes Katrina and Rita in 2005 will certainly appreciate: protection for our medical records from disasters.

As most Louisianans can recall, when Hurricanes Katrina and Rita struck our state in 2005, thousands of residents in our coastal regions were evacuated to other areas, many of them in need of medical treatment for injuries sustained in the storms or for chronic conditions. Because our state’s health care system relied largely on paper medical records at that time, many of those residents were left without access to their own medical histories. LaHIE helps to ensure that if our state faces another disaster of Katrina-like proportions, residents’ medical records will be safe and accessible, no matter where they are.

Ultimately, LaHIE is designed to improve the quality of health care delivery for the residents of Louisiana. Its continued growth and expansion represent important investments in individual and overall health, and these investments will continue to benefit our state for generations to come.
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Building A Healthier State Through Health IT


By Cindy Munn -


Our nation and state stand on the threshold of dynamic improvements in health care. Through advancements in health information technology, true health care reform is within our reach, but not without system-wide adoption of electronic health records and health information exchange.

In support of National Health IT Week, observed Sept. 16-20, the Louisiana Health Care Quality Forum, a private, not-for-profit organization dedicated to advancing health IT in our state, seeks to provide residents with information about the value and benefits of this technology, or more specifically, what the increased use of EHRs and HIEs could mean for patients.  An EHR is an electronic version of the paper charts kept by our doctors. It may include clinical information such as medical histories, lab results, radiology reports, medications, allergies and notes that may help our doctors diagnose and treat us. Unlike paper records, which can be lost, stolen or damaged, EHRs are designed so that only authorized providers who are actively participating in our care can access our information, and only from an authorized location.

In our state, we can consent to having our EHRs shared through the Louisiana Health Information Exchange (LaHIE), a secure electronic system designed to ensure that our EHRs move with us as we seek care from enrolled providers at authorized locations. Having this information available through LaHIE has many benefits. We may not have to fill out the same forms over and over at doctors’ offices because that information will already be in the system. We may not have to undergo repetitive medical procedures and tests because the results of those tests will be included in our health information. If there is a public emergency like a hurricane, LaHIE helps ensure that our EHRs are safe and that enrolled health care providers can access them from any authorized location.

As the State-Designated Entity for health IT advancements in Louisiana, the Quality Forum is bringing these benefits to fruition for the residents of our state. Our Regional Extension Center, the Louisiana Health Information Technology Resource Center, is now working with more than 2,000 health care providers in the adoption and implementation of EHRs. In addition, LaHIE now has participation agreements with more than 170 hospitals, providers, school-based health centers, home health agencies and other health care companies across Louisiana.

By providing our state with a strong health IT infrastructure, we are well-positioned to overcome our long-held rankings as among the highest in per capita costs and the lowest in clinical quality and health outcomes. We encourage our fellow residents to visit with their doctors about EHRs and LaHIE. We have the right to demand a higher quality of care, and through health IT, we can receive it.

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