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Physician Group Cited For Sharing Patient Data Without Business Associate Agreement

Posted on December 12, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A group providing hospitalist physicians on contract has learned the hard way that sharing PHI with vendors is a no-no unless the vendor has signed a business associate agreement. The group, Advanced Care Hospitalists, which serves west-central Florida, has been fined $500,000 for this oversight along with other derelictions of its HIPAA duties.

Between November 2011 and June 2012, ACH farmed out medical billing to an individual identifying himself as a representative of a Florida-based company named Doctor’s First Choice Billings, Inc. (In an unusual twist, this individual apparently signed the ACH deal without knowledge or permission of First Choice’s owner, which raises other questions beyond the scope of this article.)

Later, in February 2014, a hospital let ACH know that patient information was viewable on the First Choice website, including name, date of birth and social security number. Of course, ACH’s first move was to ask First Choice to take the data off of the website. Then, it surveyed the damage done.

After assessing the situation, ACH notified the HHS Office for Civil Rights about the breach. The group eventually concluded that more than 9,000 patients could have been affected. In response, OCR conducted an investigation into the breach — and reviewers weren’t exactly happy with what they found.

The OCR concluded that ACH never entered into a business associate agreement with the individual, which HIPAA requires.

What’s more, it found that despite being in business since 2005, ACH didn’t have a policy requiring that it sign business associate agreements with relevant vendors until April 2014 (another HIPAA foul) and had neither conducted a risk analysis nor implemented security measures or other written HIPAA policies before 2014 (additional, major HIPAA fouls).

Given the extent to which its HIPAA compliance, well, didn’t exist, OCR is asking for more than the $500K.  ACH has agreed to a corrective action plan including the adoption of business associate agreements, a thorough risk analysis cutting across its entire business and the development of comprehensive policies and procedures needed to comply with HIPAA rules.

Perhaps if ACH had demanded that the unnamed medical billing contractor sign a business associate agreement, it might have avoided the patient data breach, or perhaps not. If nothing else, though, the hospitalist group might have stood a better chance of knowing with whom it had actually contracted with, which certainly wouldn’t have hurt.

Doctors Work 2 Hours on EHR Tasks For Every 1 Hour of Time With Patients – Are You OK With That?

Posted on December 10, 2018 I Written By

The following is a guest blog post by Wayne Crandall, President & CEO of NoteSwift.

At NoteSwift, we’re passionate about providing clinicians with the tools and workflow support they need so they can focus on delivering great care to their patients. It’s become increasingly clear over the past few years that EHR workflows are a big frustration for many doctors. This leads us to today’s question:

As a healthcare industry, are we satisfied with a system that forces clinicians to spend two hours inputting and completing EHR records for every one hour of actual time with patients? Is this the kind of health care we aspire to provide?

In thinking about this topic, I’m reminded of a blog I read a couple years ago which passionately addressed the issue of EHR time burdens from the perspective of a physician. Hear the passion in the author’s voice, and consider the tips and workflow adjustments he’s been forced to adopt in order to minimize the time they spend in EHR work.

The author calls the amount of time many EHRs require a “national disgrace” because it pulls doctors away from time with patients. We hear this story from nearly every clinician we talk to — it’s painful and frustrating to train for years to care for patients, yet feel forced to spend most of the day typing notes and clicking EHR check boxes.

A recent white paper looking at studies across the industry backs up this frustration with even more data. Doctors today are forced to spend two hours on EHR entry for every one hour of patient care. This EHR time burden is directly connected to the increase in physician burnout being reported across nearly every physician specialty. You can access this white paper here.

I believe it’s our obligation as an industry to continue improving our EHR workflows to better serve clinicians working on the front line of health care and who need more time to build relationships with patients, not EHR workflows.

At NoteSwift, we believe there is no reason for a clinician to spend 2 hours manually completing an EHR record, and we are working on exciting A.I. solutions to reduce the time doctors spend in their EHRs. Our solution, Samantha, the real-time EHR transcriptionist, allows clinicians to dictate the patient narrative one time; from there, powerful A.I. parses the narrative, creates structured data elements, adds those elements across the entire EHR, and offers the clinician a review screen to finalize the note. The entire process is automated, accurate, and efficient.

The author ends his blog with the following sentence: “Every day on my way into work I make a conscious decision to do everything possible to spend face-to-face time with patients.” I think this is a great mantra for doctors to adopt, and it’s the responsibility of all of us in health care to continue improving our EHR workflows to make better patient care a reality.

To receive your complimentary copy of this white paper, “Physician Burnout By The Numbers,” click here. You’ll receive instant access to the paper as a resource for you and your team.

About Wayne Crandall
Wayne Crandall’s career in technology spans sales, marketing, product management, strategic development and operations. Wayne was a co-founder, executive officer, and senior vice president of sales, marketing and business development at Nuance Communications and was responsible for growing the company to over $120M following the acquisition of Dragon and SpeechWorks.

Prior to joining the NoteSwift team, Wayne was President and CEO of CYA Technologies and then took over as President of enChoice, which specialized in ECM systems and services, when they purchased CYA.

Wayne joined NoteSwift, Inc. at its inception, working with founder Dr. Chris Russell to build the team from the ground up. Wayne has continued to guide the company’s growth and evolution, resulting in the development of the industry’s first AI-powered EHR Virtual Assistant, Samantha(TM).

NoteSwift is the leading provider of EHR Virtual Assistants and a proud sponsor of Healthcare Scene.

When Patient Communication with Doctors Becomes Ridiculously Easy

Posted on December 7, 2018 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s always nice to talk about the value of improved communication between doctors and patients. It’s another thing to read a story about the impact of making that communication easy.

That’s what I found when I read this amazing story by Ethan Bechtel, Co-Founder and CEO of OhMD. For those too lazy to read his whole write-up, Ethan received a late night email from one of his pediatric customers that said the following:

This is the type of email that every healthcare IT company founder dreams of getting. As Ethan says:

I always believed that we could truly have a positive impact on healthcare if we just made patient communication ridiculously easy.

But I never thought I’d get an email quite like that.

Pretty spectacular way to frame it. Although, he does offer this important perspective:

The obvious truth is, OhMD didn’t save that child’s life, the doctor did. She devotes her entire life to her patients and goes above and beyond to provide incredible care at all hours of the day.

But if we can just play a small a role in helping great doctors be amazing doctors, then we’ll have a real impact on patient care.

It’s great to hear stories like this. Thanks to Ethan for sharing it. Certainly there’s a balance we have to reach in this regard. We can’t expect our doctors to be at our beck and call 24/7. They need to have a life too and to not feel responsible for every patient’s whim. However, it’s great to see what simple communication can do to improve the experience for both patient and doctor.

The Rise of Urgent Care and Retail Clinics – Or Is It The Rise of Convenient Healthcare?

Posted on December 5, 2018 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It doesn’t take a rocket scientist to see that primary care faces more challenges than it’s ever faced before. Not the least of which is being one of the lowest paid medical professions with rising medical school prices which encourages more doctors to choose specialty medicine and eschew primary care. What’s astounding is that this trend stands in stark contrast to what patients want from primary care. Patients want more convenience while the medical establishment is turning out fewer primary care doctors which creates a shortage of doctors and long wait times for primary care visits.

As Lydia Ramsey notes in her tweet below, urgent care offices are popping up everywhere. Combine that with retail clinics and the future of primary care is facing a lot of serious questions.

The reality is that most patients don’t want to go to urgent care or retail clinics. They’d much rather go to their PCP. Why don’t they go? The simple answer is convenience.

It’s much more convenient to hit the urgent care or retail clinic than it is to go to their primary care doctor. Some of this has to do with a shortage of primary care doctors which means long wait times to be seen. In other cases, it’s the really poor experience patients have had visiting their doctor in the past. I don’t need to list off the litany of bad patient experiences that we’ve all had when visting doctors. It’s like a universal PTSD experience that everyone has gone through.

Dave Chase offered his take on the rise of urgent care:

I’m not sure about his reference to the “devastation of primary care.” I’d be interested to hear why he thinks primary care has been “devastated.” Is he referring to over-regulation and underpayment? Is he referring to the shortage of docs I mention above? Is he referring to the rubber stamp PCP visits that are required to see a specialist in many insurance plans and in many ways ruined the PCP visit?

No doubt, primary care has been one of the least appreciated medical professions. However, primary care doctors didn’t do themselves any favors either. In many ways it reminds me of what Uber and Lyft have done to the taxi industry. Taxis could have embraced all the conveniences that Uber and Lyft provide, but they chose not to do so. Why not? Because they felt like they didn’t need to change since they had a virtually monopoly on the industry. Would I rather get a taxi? Yes, but I don’t because Lyft is more convenient. Sounds a lot like PCPs, doesn’t it? We’d rather go to a PCP, but an urgent care or retail clinic is more convenient.

Going back to Dave Chase’s comment that “If there’s proper primary care in a community and ethical hospitals, there’s no need for separate urgent care.” I might agree if he’d say there was less need for a separate urgent care. Urgent care does some really great work in off hours. However, the real problem is defining what he calls “proper primary care.”

I do think that if PCPs would have embraced better patient experiences, urgent cares and retail clinics would be much smaller. That said, does anyone think we can put that genie back in the bottle? I don’t think so. I believe our future healthcare system is going to have urgent care, retail clinics, and primary care.

The real question is what can PCPs do to make sure they thrive in this new mixed environment? I’d suggest that the first place to start is convenience.