Bulletin: Reviewing Vault Access by Users


Syndromic Surveillance collects a limited data set from participating healthcare facilities.  Under HIPAA, limited datasets do not require the same high security standards for data at rest and data in motion.  With the collection of data beyond Syndromic Surveillance data, which is not part of an evaluated limited data set, there is greater concern regarding handling of PHI and Other Sensitive Information (POSI).

To address this concern regarding proper handling of POSI, Health Monitoring has implemented a new component within EpiCenter (the Vault) and introduced audited access to data which may contain POSI.  EpiCenter users are prompted to enter a POSI Access Reason as well as provide a password verification in order to access reports that include POSI.

Vault Report Access Tracking

Health Monitoring has created a set of three reports that allows the appropriate personnel to see which EpiCenter users, within their region, have accessed the Vault along with their POSI Access Reason.

Each of the three reports serves a different purpose. The “Find Vault Report Usage” report shows each execution of a report per line. The “Find Vault Audit Entries” report shows each retrieval of a piece of sensitive information per line. The “Find Vault Value Entries” report is not listed directly under the Reports menu, as is it a pivot form the “Find Vault Audit Entries” report. This report shows the access history for a particular piece of sensitive information; one access per line (access types can be Create, Read, Write, etc.).

Effective Date

These three reports have been implemented into the Production environment and the appropriate users will be granted access to them.

Patient Locator Service – Building Efficiencies and Helping Providers Focus on Care

As Health Monitoring builds its Patient Locator Service, we continue to identify new ways that the service will benefit our clients. The concept, which grew out of unmet demand for one-stop patient location information, will soon be available to provide meaningful efficiencies in emergency situations. This allows providers to remain focused on patient care.

Our PLS will be a powerful tool that consolidates timely information, helps to meet regulatory requirements, and complements emergency preparedness plans.
With PLS, concerned family members only need to make one contact to obtain patient location information. This eliminates the need for calls to EMS, hospitals, or fire departments.
It allows physicians and first responders to do what they do best—provide life-saving care—without the added burden of administrative work.

PLS was conceived following numerous incidents where families were separated from loved ones during emergency situations. These occurrences included a New Jersey highway school bus crash and a Pennsylvania Turnpike motorcoach rollover. We quickly acknowledged that a central point of contact would benefit desperate people searching for relatives.

The concept transitions well to planned events, such as concerts or large conventions. For example, if an accident happened during a public parade, having PLS set up in advance allows for streamlined communication services between patients, families, and medical services.

Learn more about Health Monitoring’s Patient Locator Service (PLS) and how it could benefit you by contacting John Maletta, vice president of sales and service, 412.231.2020, ext. x115 john.maletta@hmsinc.com.

The Genesis of PLS

Health Monitoring has a strong presence in the state of New Jersey—providing syndromic surveillance via the EpiCenter system. We’ve also worked on a number of event-specific projects in the state, including syndromic surveillance for the Super Bowl and during/after the devastating impacts of Hurricane Sandy

Those experiences led the Northern New Jersey Urban Area Security Initiative to ask Health Monitoring for another service, following a tragic school bus crash in 2018. The accident, which occurred on a major highway, involved one of many buses taking middle school students to a field trip. The bus that crashed contained 46 passengers. Calls began pouring into 911 and emergency management lines as parents attempted to locate their children.

At the crash scene, drivers pulled over to assist. Calls began to come into EMS services, allowing help to arrive within minutes. Despite the best efforts of all involved, two people passed away as a result of the accident. The injured required differing levels of care, requiring transport to many local hospitals.

As news spread of the accident, worried parents began calling the school and hospitals for any information that was available. In the chaos of the situation, there were more questions than answers, leaving many frustrated and frightened.

Following the incident, the Northern New Jersey Urban Area Security Initiative recognized the need for a centralized information source to connect families and others to valuable, accurate information. Health Monitoring was tasked with developing a service that could meet these needs. The project was the first step toward our work to develop a Patient Locator Service or PLS.

As we continue to build the Health Monitoring PLS system, we recognize that it will be an important connection to patient information—during crisis situations, ongoing emergencies, and even planned events. PLS will serve as a central point of contact for all information about an incident, eliminating the need for calls to EMS, hospitals, or fire departments. It will also provide quick reassurance to those making inquiries.

Learn more about Health Monitoring’s Patient Locator Service (PLS) and how it could benefit you by contacting John Maletta, vice president of sales and service, 412.231.2020, ext. x115 john.maletta@hmsinc.com.

Syndromic Surveillance: Insights into Healthcare Policy

Health Monitoring Systems is discovering that syndromic surveillance can also provide a rich source of information for public policy. Recently an American College of Emergency Physicians (ACEP) study found that ER physicians believe they are busier now than they were before implementation of the Affordable Care Act’s individual mandate. The study was covered in USA Today, giving it national exposure. We read the article with great interest, wondering if the data we’d collected supported the physicians’ perceptions.

So we peeked at the data collected inHMS1A-pg1-WEB-OPTIMIZED EpiCenter, comparing the same ERs reporting quarter-by-quarter from California to New Jersey.   That data shows that the ACEP survey was indeed correct; most facilities had more visits after the inception of the individual mandate than before.   But—and this is significant—for most facilities we looked at, there were fewer visits than in 2012.  So, why the belief that more people were coming into the ER? And what does the ACA have to do with the perceived increase?

We reached out to the author of the USA Today article, healthcare reporter Laura Ungar, to learn more about the policy implications of what ACEP’s respondents believe to be going on in ERs across the country.  Ms. Ungar explained that ACEP doesn’t have recent data related to physicians’ perceptions.
And that too is significant.  Public health departments operating syndromic surveillance systems have unique insight into healthcare utilization—insights not available elsewhere.

The peek at our data showed that from 2014 to 2015, out of 324 ERs that reported consistently in that period, 254 (78%) saw an increase in visits. By contrast, from 2012 to 2015 only 42.7% (117 of 274) of ERs had increased visits. Variation like that seems to indicate something is happening beyond the ACA’s individual mandate, which took effect on January 1, 2014.

HMS1A-pg2-WEB-OPTIMIZEDThat said, the effect of the Affordable Care Act on emergency departments is a real concern.  The promise of increased health insurance coverage is that emergency department usage for non-urgent visits will decline.  The theory goes that the uninsured population uses the emergency department as a surrogate for a primary care physician.  But for this promise to be fulfilled, the uninsured  —who live mainly in lower-income urban or rural areas with poor access to healthcare options — need access to more healthcare options.   That won’t happen overnight.

A deeper look at emergency department visits shows that the ACA’s individual mandate and the expansion of Medicaid may not be the only factors affecting ER visits and physician perceptions:

  • Through the 2000s, a long-term trend in ER visits resulted in an increase of over 35% from 2000 to 2010.
  • At the same time, the number of ERs decreased by nearly 10%.
  • Urgent care centers, which can be a substitute for ERs, have multiplied: from none in the 1980s, there are now some 9,000 facilities in the United States, about twice the number of hospitals.
  • The Oregon Study [http://www.nber.org/oregon/] showed that the newly insured Medicaid patients used emergency departments at a rate 40% higher than average.
  • For the four years after the 2008 economic downturn, healthcare spending was at its lowest level in five decades; this was due to changes in the economy, not the ACA.
  • Part of the ARRA, Meaningful Use requirements ushered in the era of EMR. The results are an increase in non-patient-related administrative tasks, making physicians even busier.

There’s no simple answer to the complex problem of ER utilization. But our data does indicate that the individual mandate in the Affordable Care Act can’t be the primary cause of rising visits by 2015.

All of this proves it’s time to rethink the role of syndromic surveillance: It’s not just a monitoring tool, but also a platform upon which the public health community can build healthcare policy.  The ACEP survey demonstrates just such an occasion.  ER physicians are concerned with the impact of the ACA on patient visits, but other factors confound their ability to understand what is affecting ER utilization.

Public health syndromic surveillance infrastructure can help address these policy concerns. No one else is as well equipped to tackle this challenging problem.

Perspective: Foreign Travel Classification

In the event of an outbreak, public health routinely strives to accurately identify all potential cases of disease. This process includes differentiating between the “worried well,” who may reference an infectious disease by name simply because it is receiving widespread media coverage, and patients who cite genuine causes for concern, like contact with an infected person or travel to a region where an outbreak is peaking. To help address these concerns, EpiCenter users in public health have requested the implementation of a foreign travel classification.
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Diagnosis Codes and Syndromic Surveillance

The long-awaited ICD-10 compliance date of October 1, 2015 is fast approaching, and we’ve spoken with many concerned physicians and technical contacts at acute care facilities about how these changes may affect EpiCenter senders. EpiCenter has been capable of accepting ICD-10 codes since the initial ICD-10 compliance date of October 1, 2013, and over the past year we have worked with dozens of hospitals and ambulatory care offices on successfully testing their syndromic surveillance feeds with ICD-10 codes.
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Welcome to EpiCenter 3.1

EpiCenter 3.1 is now live. Along with several bug fixes, there’s some new functionality geared toward making medical and triage notes reports more easily navigable.

When a cell in the report contains lengthy triage or observation notes, it was previously difficult to expand the window enough to be able to read the full text. Now, double clicking on a row will bring up a detailed report window where the full text can be browsed and even copied to be pasted outside the application.
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ISDS 2014: 'Twixt Miami and Denver

Moose ornament labeled 'Park City'Since the ISDS annual meeting is in December, every year I bring home Christmas ornaments for my kids representing the city I visited. The other night we hung 6 years worth of those ornaments on the tree–a moose from Park City, St. Louis Cathedral in New Orleans, the Constitution from Philadelphia–bringing back quite a few memories in the process.
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Philadelphia-Bound: ISDS 2014

Several HMS staff members are headed to Philadelphia next week for the 2014 ISDS Conference.

You can hear from us at the following talks:

Impact of Demographics on Healthcare Utilization
Who: Dr. Andrew Walsh
Where: Columbus Ballroom C
When: 10:30am to 10:50am on Wednesday December 10th*
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Big Changes in EpiCenter 3.0

As we’ve mentioned previously, the Health Monitoring Systems team has been hard at work on incorporating extensible data types into EpiCenter. These extensible data types include Triage Notes and Observations. Now that EpiCenter 3.0 has been released, we’re excited to share these new enhancements with our users.
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