Wednesday, January 25, 2012

Policy Form To Be Given To All Home Health Care Applicants

It can be very difficult and challenging for a disabled person or someone who cares for a disabled person to find a home health care aide who is compatible, honest, and reliable. All of the suggestions below come from my personal experience, having had MS for 40 years. My hope is that this list gives you some direction to follow in order to find a health care aide to suit your needs and to make your life better.
• You must be able to lift and transfer the person in your care to and from the toilet, bed, shower, or anywhere else the patient wishes to go in a safe and strong manner; not putting him or her in any danger. Learn how to properly and safely help your patient to transfer and move about.
• You must always retain a professional manner, not discussing your personal problems, money problems, health issues, or your family information. You are there to care for your patient and not to burden them with problems of your own.
• You must not take or make personal calls while you are on the job. Handle your personal life when you are not on the job.
• You must pay attention to your patient and do things that she requests in a manner that you are told.
• You must never ask for food or drinks other than water while you are on your job.
• DO NOT take advantage of your patient's disability in any way shape or form. Your patient has you there because there are things that they can no longer do. She is in a vulnerable position and to take advantage of them is unconscionable and will not be tolerated.
• Be on time. If you find it necessary to be late or cannot be there on the appointed day make sure that you call your patient as soon as possible. Do not make them wait for you unnecessarily thereby causing them stress and having to readjust their schedule to suit yours. And never make them have to track you down by calling you or the agency which has hired you.
• The person in your charge is your boss and as such you will act accordingly by being polite, cheerful, caring and by doing a professional and thorough job with whatever task is asked of you just as he would with any other employer.
• Do not rush or cut corners so that you can get out of there as soon as possible. You are being paid with taxpayer money or money from the patient's themselves or their family and as such you are expected to work hard and not to make excuses for substandard work ethics.
• Laziness will not be tolerated and if you are asked to do something do it with a concentrated effort and to the best of your ability. Take personal pride in your work knowing that you were doing something of worth and importance. Not everyone is able to take on being a home health care aide and if you do your job well you are invaluable.
• Make sure that you ask your patient if there is anything else you can do for them before you leave. Make sure that they are comfortable and satisfied with the work you do have done for them.
• If you have any questions about where something belongs or how the patient would like something to be done ask her and don't just put things where you feel like it or do things your own way no matter what the consequences. 
Just because the person in your care has a disability does not mean that she is ignorant or not aware of your actions. Realize that it may be hard for people with disabilities to ask for help and to be assertive so it is up to you to make sure that things are done for their convenience and not for yours.

• Never put your patient in an uncomfortable position of having to be afraid of you or to feel that you will take measures to intimidate herby being verbally or physically abusive or by your body language causing your patient to be uncomfortable or even afraid of you. To do so is not only immoral but also illegal and if you are such a person you must be prepared to take the consequences.
• Do not ever ask your patient for money. It is cause for immediate dismissal.
• Do not complain about circumstances in your own life. The person in your care has enough to worry about and should not be put through any more stress than they already have.
• If you are tired or having a bad day do not take it out on your patient. More than likely he or she is having a much worse day than you are.
• Theft of any kind will not be tolerated, is unconscionable, illegal, and cause for immediate dismissal as well as prosecutable.
• If your patient is in a wheelchair or lying in bed do not hover over them thereby making them uncomfortable that you are in a higher position than they. It is rude to your patient and your job is to make them feel as good about themselves as you possibly can.
• Always treat the person in your care as you would wish to be treated if you were in their situation. Be compassionate, caring, and helpful. There may come a day when you yourself will need the help of an aide and act as the aide that you would wish to have in your home and taking care of you.

Thursday, January 19, 2012

Health IT - Best Practices for PHI Data Security and Selecting the Right Cloud Computing Provider

In recent months, cloud computing is a topic that is getting a lot of attention especially when applying the technology in healthcare. Cloud computing is becoming more attractive to medical organizations predominately due to the benefits that the technology offers including reduced enterprise IT infrastructure and power consumption costs, scalability, flexibility, and accessibility.
At the same time, cloud computing pose significant potential risks for medical organizations that must safeguard their patients protected health information or PHI while complying with HIPAA Privacy and Security rules. The increased number of reported PHI breaches occurring over the past two years along with ongoing HIPAA compliance and PHI data privacy concerns, has slowed down the adoption of cloud technology in healthcare.
To help medical organizations and providers mitigate PHI data security risks associated with cloud technology, consider the following five best practices when selecting the right cloud computing provider:
1. Understand the importance of SSL. Secure socket layer (SSL) is a security protocol used by web browsers and servers to help users protect data during transfer. SSL is the standard for establishing trusted exchanges of information over the internet. SSL delivers two services that help solve some cloud security issues which includes SSL encryption and establishing a trusted server and domain. Understanding how the SSL and cloud technology relationship works means knowing the importance of public and private key pairs as well as verified identification information. SSL is a critical component to achieving a secure session in a cloud environment that protects data privacy and integrity
2. Not all SSL is created equal. The trust established between a medical organization and their cloud computing provider should also extend to the cloud security provider. The cloud provider's security is only as good as the reliability of the security technology they use. Furthermore, healthcare organizations need to make sure their cloud provider uses an SSL certificate that can't be compromised. In addition to ensuring the SSL comes from an authorized third party, the organization should demand security requirements from the cloud provider such as a certificate authority that safeguards its global roots, a certificate authority that maintains a disaster recovery backup, a chained hierarchy supporting their SSL certificated, global roots using new encryption standards, and secure hashing using the SHA-1 standard. These measures will ensure that the content of the certificated can't be tampered with.
3. Recognize the additional security challenges with cloud technology. There are five specific areas of security risk associated with enterprise cloud computing and medical organizations should consider several of them when selecting the right cloud computing provider. The five cloud computing security risks include HIPAA Privacy and Security compliance, user access privileges, data location, user and data monitoring, and user/session reporting. In order for medical organizations and providers to reap the benefits of cloud computing without increasing PHI data security and HIPAA compliance risks, they must select a trusted service provider that can address these and other cloud security challenges.
4. Ensure data segregation and secure access. Data segregation risks are a constant in cloud storage. In a traditional client hosted IT environment, the internal IT administrators of the organization controls where the data is located and the access granted to clinicians and support staff. In a cloud computing environment, the cloud computing provider controls where the servers and the data are located. Even though certain controls are lost in a cloud environment, proper implementation of SSL can secure sensitive data and access. A medical organization will know that they are on the right path to selecting the right cloud provider if they provide the organization with three key elements as part of their cloud hosting solution: encryption, authentication, and certificate validity. It is highly recommended for organizations to require their cloud provider to use a combination of SSL and servers that support 128-bit session encryption and should also demand that sever ownership be authenticated before one bit of data transfers between servers.
5. Make sure the cloud provider understands HIPAA compliance. When a medical organization outsources their IT infrastructure to a cloud computing provider, the organization is still responsible for maintaining HIPAA compliance with all Privacy and Security rules. Since healthcare organizations can't rely solely on their cloud provider to meet HIPAA requirements, it is highly recommended to select a cloud provider that has experience with HIPAA compliance and has compliance oversight processes and routines in place. Cloud computing providers that refuse to participate in external audits and security certifications are signaling a significant red flag and should be dismissed from further consideration.
SSL is a proven technology and a cornerstone of cloud computing security. When a medical organization is evaluating a cloud computing provider, the organization should consider the security options selected by that cloud provider. Knowing that a cloud provider uses SSL can go a long way toward establishing confidence. The right cloud computing provider should be using SSL from an established, reliable and secure independent certificate authority. Furthermore, when selecting a cloud computing provider, healthcare organizations should be very clear with their cloud provider regarding the handling and mitigation of risk factors beyond SSL.
Medical organizations that effectively performs PHI security and HIPAA compliance due diligence as part of their cloud computing provider selection process, will be best positioned to consolidate IT infrastructure, reduce IT cost, mitigate the risk of PHI data breaches, and increase business sustainability resulting from the adoption of cloud technology. This outcome will allow healthcare providers to focus more of their energy and resources to patients thus improving care and outcomes.

Friday, January 13, 2012

How To Choose A Team Oriented Transplant Program

Facing the challenges of organ transplant is emotional. Whether you are the patient or a loved one looking for a transplant program, the task can seem insurmountable. Every transplant center has an extensive team of medical professionals that work together before, during and after a patient receives an organ replacement. It is imperative that patients and their families have a general idea of what to expect as the process progresses.
A team of doctors and care givers is necessary because our organs are not independent from the rest of our body. The human body is wonderfully and intricately connected, like the children's song says, "the foot bone is connected to the leg bone," and in a healthy individual all of our body organs work in a perfect rhythm. Patients that have a failing organ normally have negative conditions in other organs as well.
In order to identify patients who will be good candidates for transplant surgeries, lots of exhausting and extensive testing has to be completed. Depending on the patient's circumstances, there will be many x-rays, MRI's, CAT scans and blood tests performed to diagnose the organ failure. In order to confirm and refine the diagnosis, many tests will have to be repeated and patients should seek a second opinion from specialists.
Unfortunately there are thousands of people with failing organs, but there are not enough healthy organs available. This means candidates will be screened on several factors before acceptance into whichever transplant programs they'll need to be a part of. Their general overall health, financial circumstances and motivation are all evaluated. To be blunt, physicians do not want to "waste" a healthy kidney on a non-compliant diabetic. If patients are not willing to take medication, show up for appointments on time or they have a poor attitude they may be refused access to a program.
Once a patient is accepted into a medically approved program, he will be introduced to his medical coordinator and the supporting team member. The team will naturally include transplant surgeons; some other professionals are listed below.
1. Infectious disease specialists: These specialists will monitor patients after the transplant for any infections that are possible. 
2. Psychiatrists: Provide counseling to assist patients with the emotional aspects of transplant procedures and coping skills. 
3. Nurse coordinators: Help with medication, scheduling appointments and patient education. 
4. Immunologists: Develop plans to prevent rejection. 
5. Pharmacists: Assist with inpatient and outpatient medications. Starting before surgery, medication will be a life-long daily necessity. 
6. Social workers and Financial services personnel: Even though many insurance companies will pay the bulk of the transplant process, the patient will still have a lot of expenses to deal with. These people find ways to help patients to afford the surgery as well as support costs after the surgery is completed

A successful team approach in transplant programs revolve around constant communication between the patient and the team of specialists. The team should be supportive from the start of the relationship and make it a priority from the beginning to keep the patient informed through every step of their transplant program.

Saturday, January 7, 2012

Transition From ICD-9 to ICD-10 May Cause a Change to a New EMR/EHR, Some Pitfalls to Watch For

We are seeing a lot of posturing by ICD-10 vendors of all types to gain market share by helping clinics and coders learn how to adapt to the ICD-10 coding structure.
One result of these efforts will be that a number of clinics will upgrade or change software to better manage the coding for their clinical care standards. These changes will incur new problems not associated with ICD-10 as well as the run-of-the-mill (tongue in cheek) data migration problems.
It is important, perhaps critical to carefully identify what data you want converted. It does not help to simply check the box "all" when some data types may not be present in your legacy system. For example if you do not have ICD-10 coding in place there is nothing to convert. Along the same lines Race, Ethnicity and Religion are necessary components of a good clinical (EMR) patient record but are rarely present in legacy databases, at least not yet.
However, if your new system requires the new coding structure, there needs to be a path defined to move the "9" codes to "10" codes. Simply stated this can be a translate table. Regardless of how this is defined it will not be simple and should be approached with an eye to detail and a clearly defined end result.
Some will be fooled by a catch-all phrase "yes, we can convert ICD-9 to ICD-10". Sterile examples of that conversion provided during the early stages of the sales cycle will help shape the list of vendors you are considering, down for the final choice.
Before making that final choice however it is prudent to provide the vendors with a representative subset of actual codes you are using and ask them to show you how they will be translated into "10" codes in their EMR system. Your task is then to take that translation and apply it to specific examples in you current patient files and ask yourself the question "is this the result I want for this patient for this visit?" Allow yourself time for this to be an iterative, learning process. Your clinic and your patients are unique. Running a few trails will quickly bring clarity to your decision.
When you select a data migration vendor the same question of translating ICD-9 to ICD-10 codes needs to be asked of them. Not only will this satisfy you that they know what data migration is all about but a heads-up data migration team will appreciate the clarity this exercise adds to their conversion requirements specification.
Turnkey data migrations are rarely satisfactory. Clinic operatives need hands-on evaluation of test and final results before acceptance is granted. It is this author's experience that two test runs of a clinical data migration is the minimum.
The requirement to implement ICD-10 coding is yet another of many reasons for clinics to make the choice to change EMR software or to finally adopt an EMR for the first time. These can be intimidating decisions. Careful planning will reduce the pain and improve the results. The bottom line will be better patient care and a happier staff.

Sunday, January 1, 2012

5 Steps for Preparing an Advanced Healthcare Directive

An advanced healthcare directive made out to tackle any health problems will kick in the event where you are temporarily or permanently unable to make your own decisions due to any physical or mental conditions. Such a directive should be made thoughtfully, and if you want it to be truly effective, the following steps will tell you how.
• Plan the Contents: The first and most important thing when setting out to make an advanced directive is to decide how you want your treatment to be handled for the period when you cannot take a call. Your wishes can be generalized for accidents or ill-health or can specify particular ailments and medications, and the extent to which invasive treatment or life-sustaining techniques should be administered or even end-of-life wishes. The content will vary depending on your age, unique circumstances, or any particular wishes that you may have.
• Type of Directive: Next you will have to choose the kind of directive you want to have. You can make a set of instructions referred to as a living will or can appoint an agent or proxy to take decisions on your behalf by creating a power of attorney specifically for healthcare. However the most effective way is to combine both in the advanced directive to make it more effective in different conditions.
• Communicate: Before you finalize the directive you must talk to your doctor or any healthcare personnel who will not only tell you about the different aspects of such a directive but also the pros and cons of specific treatments, and how they can affect you in the future. In addition to the doctor you must speak with your family and take them into complete confidence so that there is no confusion when the time comes.
• Preparing the Directive: Once your mind is clear you can proceed to put down your directive on paper. At times a state may have a set of advanced healthcare directive forms that you can fill, but these may be too generalized in which case you can create your own directive to be more specific and customized. Most directives will require your signature along with those of two other witnesses, however you must find out for any other requirement of your particular region. Personnel at the healthcare facility can provide you with the proper guidance or may alternatively direct you to professionals who are well trained for such purposes.
• Pass on the Directive: The last but equally important step is to provide the concerned people with a copy of the directive. Ask your doctor to place the directive in your medical file so that anyone dispensing treatment at that time will be aware of your wishes. Also make sure your appointed agent has one and is thoroughly briefed about the contents. Finally make sure your family or close friends have a copy too.
One more thing to remember is that the advanced healthcare directive is a document that can be changed whenever you wish. Periodically you must review its contents and make the necessary changes to maintain its effectiveness.