An Evaluation of the ICD-10-CM System: Documentation Specificity, Reimbursement, and Methods for Improvement (International Classification of Diseases; 10th Revision; Clinical Modification)

The research project consists of three studies to identify the documentation specificity, reimbursement and documentation improvement for the upcoming International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system. A descriptive research study using quantitative methods was conducted for the first study, which focused on coding electronic documents across each major diagnostic chapter for ICD-10-CM. The coding was ranked according to the Watzlaf et al (2007) study where a ranking score was provided if the diagnosis was fully captured by the ICD-10-CM code sets. The ICD-10-CM codes were then compared to the current ICD-9-CM codes to evaluate the details on the descriptions of the codes. The rankings were determined by comparing the ICD-10-CM systems for the number of codes, the level of specificity and the ability of the code description to fully capture the diagnostic term based on the resources available at the time of coding. A descriptive research study using quantitative methods was conducted for the second study, which focused on evaluating the reimbursement differences in coding with ICD-10- CM with and without the supporting documentation. Reimbursement amounts or the MS-DRG (Medicare Severity Diagnosis Related Groups) weight differences were examined to demonstrate the amount of dollars lost due to incomplete documentation. Reimbursement amounts were calculated by running the code set on the CMS ICD-10 grouper. An exploratory descriptive research study using qualitative methods was conducted for the third study which focused on developing a documentation improvement toolkit for providers and technology experts to guide them towards an accurate selection of codes. Furthermore a quick reference checklist geared towards the physician, coders and the information technology development team was developed based on their feedback and documentation needs. The results of the studies highlighted the clinical areas which needed the most documentation attention in order to accurately code in ICD-10-CM and the associated potential loss of revenue due to absent documentation. Further, the results from the educational tool kit could be used in the development of a better inpatient Computer Assisted Coding (CAC) product

A Telehealth Privacy and Security Self-Assessment Questionnaire for Telehealth Providers: Development and Validation

Background: Telehealth is a great approach for providing high quality health care services to people who cannot easily access these services in person. However, because of frequently reported health data breaches, many people may hesitate to use telehealth-based health care services. It is necessary for telehealth care providers to demonstrate that they have taken sufficient actions to protect their patients’ data security and privacy. The government provided a HIPAA audit protocol that is highly useful for internal security and privacy auditing on health care systems, however, this protocol includes extensive details that are not always specific to telehealth and therefore is difficult to be used by telehealth practitioners.Objective: The goal of this study was to develop and validate a telehealth privacy and security self-assessment questionnaire for telehealth providers. Methods: In our previous work, we performed a systematic review on the security and privacy protection offered in various telehealth systems. The results from this systematic review and the HIPAA audit protocol were used to guide the development of the self-assessment questionnaire. The draft of the questionnaire was created by the research team and distributed to a group of telehealth providers for evaluating the relevance and clarity of each statement in the draft. The questionnaire was adjusted and finalized according to the collected feedback and face-to-face discussions by the research team. A website was created to distribute the questionnaire and manage the answers from study participants. A psychometric analysis was performed to evaluate the reliability of the questionnaire.Results: There were 84 statements in the draft questionnaire. Five telehealth providers provided their feedback to the statements in this draft. They indicated that a number of these statements were either redundant or beyond the capacity of telehealth care practitioners, who typically do not have formal training in information security. They also pointed out that the wording of some statements needed to be adjusted. The final released version of the questionnaire had 49 statements. In total, 31 telehealth providers across the nation participated in the study by answering all the statements in this questionnaire. The psychometric analysis indicated that the reliability of this questionnaire was high.   Conclusion: With the availability of this self-assessment questionnaire, telehealth providers can perform a quick self-assessment on their telehealth systems. The assessment results may be used to identify possible vulnerabilities in telehealth systems and practice or demonstrate to patients the sufficient security and privacy protection to patients’ data

Privacy and Security in Multi-User Health Kiosks

Enforcement of the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH) has gotten stricter and penalties have become more severe in response to a significant increase in computer-related information breaches in recent years. With health information said to be worth twice as much as other forms of information on the underground market, making preservation of privacy and security an integral part of health technology development, rather than an afterthought, not only mitigates risks but also helps to ensure HIPAA and HITECH compliance. This paper provides a guide, based on the Office for Civil Rights (OCR) audit protocol, for creating and maintaining an audit checklist for multi-user health kiosks. Implementation of selected audit elements for a multi-user health kiosk designed for use by community-residing older adults illustrates how the guide can be applied.

A Systematic Review of Research Studies Examining Telehealth Privacy and Security Practices Used By Healthcare Providers

The objective of this systematic review was to systematically review papers in the United States that examine current practices in privacy and security when telehealth technologies are used by healthcare providers. A literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). PubMed, CINAHL and INSPEC from 2003 – 2016 were searched and returned 25,404 papers (after duplications were removed). Inclusion and exclusion criteria were strictly followed to examine title, abstract, and full text for 21 published papers which reported on privacy and security practices used by healthcare providers using telehealth.  Data on confidentiality, integrity, privacy, informed consent, access control, availability, retention, encryption, and authentication were all searched and retrieved from the papers examined. Papers were selected by two independent reviewers, first per inclusion/exclusion criteria and, where there was disagreement, a third reviewer was consulted. The percentage of agreement and Cohen’s kappa was 99.04% and 0.7331 respectively. The papers reviewed ranged from 2004 to 2016 and included several types of telehealth specialties. Sixty-seven percent were policy type studies, and 14 percent were survey/interview studies. There were no randomized controlled trials. Based upon the results, we conclude that it is necessary to have more studies with specific information about the use of privacy and security practices when using telehealth technologies as well as studies that examine patient and provider preferences on how data is kept private and secure during and after telehealth sessions.Keywords: Computer security, Health personnel, Privacy, Systematic review, Telehealth

Peptides as potent antimicrobials tethered to a solid surface: Implications for medical devices

Medical devices are an integral part of therapeutic management; despite their importance, they carry a significant risk of microbial infection. Bacterial attachment to a medical device is established by a single, multiplying organism, leading to subsequent biofilm formation. To date, no preventative measures have impacted the incidence of device-related infection. We report the bidirectional covalent coupling of an engineered cationic antimicrobial peptide (eCAP), WLBU2, to various biological surfaces is accomplished. These surfaces included (i) a carbohydrate-based gel matrix, (ii) a complex polymeric plastic bead, and (iii) a silica-calcium phosphate nanocomposite associated with bone reconstruction. WLBU2-conjugated surfaces are shown to retain potent antimicrobial activity related to bacterial surface adhesion. This study provides proof of principle that covalently coating laboratory and bone-regenerating materials with eCAPs has the potential for decreasing infection rates of implanted devices. These findings have important consequences to the patient management component of our current health care technology

Protocol for Systematic Review in Privacy and Security in Telehealth: Best Practices for Healthcare Professionals

Healthcare professionals engaged in telehealth are faced with complex US federal regulations (e.g., HIPAA/HITECH) and could benefit from the guidance provided by best practices in Privacy and Security (P&S). This article describes a systematic review protocol to address this need. The protocol described herein uses the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The PRISMA-P contains 17 items that are considered essential, as well as minimum components to include in systematic reviews. PICOS (participants, interventions, comparisons, outcome(s) and study design of the systematic review) are also relevant to the development of best practices in P&S in telehealth systems. A systematic process can best determine what information should be included and how this information should be retrieved, condensed, analyzed, organized, and disseminated

De novo-derived cationic antimicrobial peptide activity in a murine model of Pseudomonas aeruginosa bacteraemia

Objectives We describe the antimicrobial activity against Pseudomonas aeruginosa of the de novo-derived antimicrobial peptide WLBU2 in an animal model of infection. Methods For this study, an intravenous (iv) model of P. aeruginosa infection was established. The minimum lethal murine dose of P. aeruginosa strain PA01 was determined to be 3 × 107 cfu when bacteria were administered iv. Increasing concentrations of WLBU2 were instilled either prior to or following PA01 septic exposure. Results For the mice given peptide post-bacterial infection, in the 1 mg/kg group, nine of nine animals died because of Pseudomonas sepsis; in the 3 mg/kg group, only one of nine succumbed to infection and in the 4 mg/kg group, all mice were protected (P < 0.0001). Similar results were obtained when WLBU2 was given 1 h prior to Pseudomonas infection. Conclusions Although the therapeutic window in this model is narrow, the results nonetheless provide encouraging evidence for WLBU2 as a potential prophylactic or treatment of bacterial infection

Use of an Electronic Medical Record (EMR) to Identify Glycemic Intensification Strategies in Type 2 Diabetes.

Current treatment guidelines for type 2 diabetes (T2D) recommend individualized intensification of therapy for glycated hemoglobin (A1C) ≥ 7% in most patients. The purpose of this investigation was to explore the ability of an electronic medical record (EMR) to identify glycemic intensification strategies among T2D patients receiving pharmacologic therapy. Patient records between 2005 and 2011 with documentation of A1C and active prescriptions for any diabetes medications were queried to identify potential candidates for intensification based on A1C ≥ 7% while on 1-2 oral diabetes medications (ODM). Patients with follow-up A1C values within 1 year of index A1C were grouped according to intensification with insulin, GLP-1 receptor agonists (GLP-1RA), a new class of ODM, or no intensification. Changes in A1C and continuation of intensification therapy were determined. A total of 4921 patients meeting inclusion criteria were intensified with insulin (n = 416), GLP-1RA (n = 68), ODM (n = 1408), or no additional therapy (n = 3029). Patients receiving insulin had higher baseline (9.3 ± 2.0 vs 8.3 ± 1.2 vs 8.3 ± 1.3 vs 7.6 ± 1.0%, P \u3c .0001) and follow-up A1C (8.1 ± 1.6 vs 7.5 ± 1.2 vs 7.6 ± 1.3 vs 7.2 ± 1.1%, P \u3c .0001) despite experiencing larger absolute A1C reductions (-1.2 ± 2.1 vs -0.8 ± 1.4 vs -0.7 ± 1.4 vs -0.3 ± 1.1%, P \u3c .0001). Patients receiving GLP-1RA were more obese at baseline (BMI: 33.6 ± 7.1 vs 37.7 ± 6.1 vs 33.7 ± 6.8 vs 32.9 ± 7.1 kg/m(2), P \u3c .0001) and follow-up (BMI: 33.9 ± 7.3 vs 36.6 ± 6.1 vs 33.8 ± 7.0 vs 32.4 ± 7.0 kg/m(2), P \u3c .0001) despite experiencing more absolute weight reduction. Insulin was the most and GLP-1RA the least likely therapy to be continued. An EMR allows identification of prescribing practices and compliance with T2D treatment guidelines. Patients receiving intensification of glycemic medications had baseline A1C \u3e8% suggesting that treatment recommendations are not being followed

Use of an electronic health record to identify prevalent and incident cardiovascular disease in type 2 diabetes according to treatment strategy.

BACKGROUND: The increasing use of electronic health records (EHRs) in clinical practice offers the potential to investigate cardiovascular outcomes over time in patients with type 2 diabetes (T2D). OBJECTIVE: To develop a methodology for identifying prevalent and incident cardiovascular disease (CVD) in patients with T2D who are candidates for therapeutic intensification of glucose-lowering therapy. METHODS: Patients with glycated hemoglobin (HbA1c) ≥7% (53 mmol/mol) while receiving 1-2 oral diabetes medications (ODMs) were identified from an EHR (2005-2011) and grouped according to intensification with insulin (INS) (n=372), a different class of ODM (n=833), a glucagon-like peptide receptor 1 agonist (GLP-1RA) (n=59), or no additional therapy (NAT) (n=2017). Baseline prevalence of CVD was defined by documented International Classification of Diseases Ninth Edition (ICD-9) codes for coronary artery disease, cerebrovascular disease, or other CVD with first HbA1c ≥7% (53 mmol/mol). Incident CVD was defined as a new ICD-9 code different from existing codes over 4 years of follow-up. ICD-9 codes were validated by a chart review in a subset of patients. RESULTS: Sensitivity of ICD-9 codes for CVD ranged from 0.83 to 0.89 and specificity from 0.90 to 0.96. Baseline prevalent (INS vs ODM vs GLP-1RA vs NAT: 65% vs 39% vs 54% vs 59%, p CONCLUSIONS: An EHR can be an effective method for identifying prevalent and incident CVD in patients with T2D