Best Practices For Hospital Peer Review

When done properly, peer review is an important process that helps hospitals and their doctors ensure consistent, high quality patient treatment. Hospitals can identify at-risk physicians; physicians can help improve quality of care for patients. Why is this process so difficult? It’s simple – hospital politics, economic advantage and personalities.

The current physician peer review system, created by Congress in 1986 through HCQIA legislation, was intended to promote higher quality patient healthcare. Unfortunately, Congress did not foresee that hospital peer review actually puts physicians into an environment where political, economic and personality conflicts can easily render the process ineffective. Nor did it foresee that hospitals would sanction doctors for speaking up on behalf of patients regarding quality of care concerns.

In the hospital environment, peer review is considered an ugly task that is just one more action item for a busy medical staff and is easily pushed to the bottom of the priority list. Often it just doesn’t get done. Why?

Physicians on peer review or quality management committees too often find themselves in conflict of interest situations. They compete for the same limited geographic pool of patients and for professional recognition within a very narrow specialty. There may also be personality conflicts with the physician under review or pressure by their hospitals not to seriously scrutinize a fellow physician who has stature in the medical community. The tight-knit social and professional relationships found in a hospital environment can lead to bias and reluctance to pass judgment on associates. This reluctance tends to lead to unusually long delays in resolving critical quality management issues. By the time a critical situation is actually dealt with, the costs and risks to a hospital or group can be catastrophic.


The breakdown in a hospital’s quality management system can be very damaging. Inadequate peer review can result (and has) in negative consequences for hospitals and hospital groups, such as:

o Negative publicity

o High profile lawsuits

o Multi-million dollar fines

o Management shake-ups

o Loss of investor confidence

o Damage to physicians’ careers and practices

o Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

sanctions and loss of accreditation

o Scrutiny by state and federal agencies and other public organizations.

These negative events, combined with rising consumer frustration with the healthcare system, make it increasingly imperative that hospitals pay close attention to their quality management and adopt best practices whenever possible.

Peer Review as a Risk Management Tool

A well-executed peer review process can easily avoid such negative events by using best practices in risk management. The earlier a physician performance issue is detected and dealt with, the lower the costs and potential negative consequences to the hospital and the physician.
Basing effective peer review on medical evidence and adhering to the intent of the law — to improve the quality of patient care — helps discover, highlight and deal with quality problems quickly and efficiently. Issues surrounding internal politics, competition, and personality conflicts should be considered when setting up a peer review committee.

Involving Outside Parties in Peer Review

The most effective quality management process involves using a “neutral” outside party in addition to the hospital’s own peer review committee. This neutral party can review sensitive cases where there is a potential conflict of interest. Hospitals with the need for an outside case review have often turned to affiliated hospitals or searched for “like” specialists through personal connections. While this is an effective method for solving the problem, it has its own set of challenges:

o How do you quickly locate the right specialist?

o How do you convince them to take time to do a peer review?

o How long do you have to wait to get it done?

Unless you have a well-developed process and pre-arranged agreements with affiliates or physicians to perform peer review, it can be very costly and time consuming to arrange for this each time it’s needed.

IROs: A Cost Effective Solution for Hospital Peer Review

Many hospitals, today, are turning to Independent Review Organizations (IRO) to aid in fixing their peer review process. An IRO serves as an objective third party that can provide hospital peer reviews based upon medical evidence and improve the fairness of the process for both physicians and the hospital.

An IRO can match doctors with the right specialist expertise to effectively review sensitive cases and reach an unbiased determination. Reviews are conducted by board-certified physicians in active practice, who are usually located in a different state than the physician being reviewed. Hospitals pay only for the reviewing physician’s time at pre-determined hourly rates.

Because these specialists are already on board, reviews can be completed in much less time and at significantly lower costs. Peer reviews are conducted using a standard reporting format, and the typical turn-around time is less than 21 days. Since IROs review thousands of cases annually, per case review costs are kept to a minimum.

An IRO can give peer review the high priority and timely consideration it deserves — without impacting the hospital staff or tarnishing a hospital’s reputation.

Using an IRO for objective peer review may be one of the best solutions for helping hospitals get back to the intent of the law – improving healthcare quality for patients. An IRO can also help reduce costs, avoid expensive litigation, enhance hospital reputation and protect JCAHO certification.

Peer Review Best Practices

To ensure an evidence-based outcome for peer reviews, hospitals should consider this nine step process:

1. Develop a culture of accountability within the hospital.

2. Make sure that the peer review process is well defined, understood, accepted and adhered to by all.

3. Watch for “sentinel events.” Bring patterns of recurring or clustered problems to management’s attention in a timely way.

4. Assure that questions posed during the process are precise, and that responses are precise as well, including the hard questions, with rationale and associated guidelines.

5. Make sure that each peer review case is reviewed by a “like” specialist

who is unbiased and has no potential for conflict of interest in

rendering an opinion.

6. Make sure the peer review committee meets monthly and that cases and replies are distributed, reviewed and responded to in a timely manner.

7. Make sure there is a re-review of each case after the subject physician input has been received.

8. As much as possible, conduct all reviews in a non-accusatory and

professional format.

9. Systematically send your most sensitive peer review cases out to an Independent Review Organization.

Choosing the Right IRO

Choosing the right IRO as a partner for hospital peer review can be as confusing as the process itself. Here are some simple questions to ask in the selection process:

1. Is the IRO URAC-accredited? – There are dozens of companies

that claim to offer medical review services. There are only a few

that are actually accredited by the American Accreditation

HealthCare Commission, also known as URAC. By selecting an IRO

with URAC accreditation, the hospital partner with a standards-

based organization can deliver the quality and objectivity

needed for the peer review process.

2. What types of doctors are on staff at the IRO? – It’s extremely

important to work with an IRO that has doctors on staff trained to

make fast decisions, who are board certified and still in active


3. How deep is the IRO specialty panel? – The IRO under consideration

should be able to deliver the specialists needed on a moment’s

notice. Not only do these physicians need to be in the same

specialty, but also from the same type of institution. A heart

specialist from Los Angeles may not be the right physician to review

a related case coming from a rural hospital in Iowa.

4. What are the standard turn-around times? – The IRO selected

should have a strong track record of turning around reviews quickly

and accurately. Find out what the average turn-around times are

and what process the IRO offers for expedited reviews. A standard

of 21 days or less for hospital peer review should be the minimum.

5. How accessible are the IRO physicians? – Many IROs offer basic

peer review services. The best IROs, however, are the ones that

truly act as partners to the hospital peer review committee and

make themselves fully accessible to the physicians under review. By

becoming a part of the process, the IRO can truly act as the neutral

third-party and help keep the relationships between all parties intact.

Healthcare and Life Sciences

Drug, pharmaceuticals, and biotechnology constitute the main constituents of Healthcare & Life Sciences field. Since the area caters to the lives and existence of humans, it is a matter to strict regulatory mechanisms needing dedicated expertise in knowledge processing, with enhanced quality, and devotion to international standards. Hence, it has become a chief thrust zone for the worldwide giants in the IT industry and also for corporates involved in investigation and development of new products.

IT solutions for healthcare

IT solutions for healthcare aid improve healthcare delivery and patient results by facilitating the respective solution providers being more capable, price effective, and inventive.

Complemented with comprehensive partnerships and established know-how, the IT solutions aid you to:

• Allow clinician movement through unified, safe access to acute Windows, web, mobile, and custom applications, along with file sharing services and collaboration tools, on their own device of preference

• Accomplish functioning competences and quicken time-to-value for acquisitions and healthcare consolidation by offering IT as a cloud service

• Guarantee confidentiality of individual health facts and guard sensitive data wherever, however and by whomever it is gained access to

• Strengthen patient-focused care and advance outcomes across locations and specialisms through, telemedicine, mobility, and social alliance

Healthcare IT solutions

Healthcare IT solutions make over healthcare IT with the help of desktop, enterprise mobility management, application virtualization, data sharing, societal collaboration, remote support, and cloud networking. The solutions help transmute healthcare IT with safe access to apps, information, and data to provide best care.
The innovative and all-inclusive clinical information solutions are the need of the hour for the Healthcare industry.

Healthcare solutions

Healthcare solutions increase the clinician contentment, develop care team competence, generate higher-quality clinical documentation and, finally, drive patient protection care. Healthcare & Life Sciences solutions aid the experts regain control over paper-intensive clinical, billing, supervisory, and managerial procedures.

The healthcare solutions aids healthcare experts accomplish extraordinary competence along with noteworthy cost savings, greater safety, enhanced traceability, and improved productivity.

Life science solutions

Life science solutions aid relevant companies respond effectively to challenges. Offering cohesive end-to-end Healthcare not just caters to the apparent needs, but brings about an assimilated change.

Healthcare solutions and services cover the complete Healthcare & life sciences value chain right from corporate to back office operations. Henceforth, they aid you to streamline costs, improve operational efficacies, and develop business agility all across all significant business procedures. Innovative solutions made help the industry to meet its dynamic requirements.

Evolving Healthcare Trends

The model trends in the healthcare system have been changing over the period of time. The old trend gave importance to the individual patients and the emphasis was on treating illness. The goal of the hospitals was to do inpatient admissions, fill up the beds and more emphasis was given to acute inpatient care. The role of managers in the old paradigm was to run the organization and coordinate services. In the old system, all providers were essentially the same. The hospitals, physicians and health plans were separate and not integrated.

The newer trends that evolved gave importance to the population as a whole. It not only treated illness, but emphasized on promoting the wellness of the people. The goals of the healthcare system after being transformed over the years is to provide care at all levels which is continued. The role of managers in the new paradigm is more broad. They see the market and help in quality and continued improvement. They not only run the organization, but also go beyond the organizational boundaries. In the evolving system, the providers are differentiated according to their ability. The hospitals, physicians and health plans have formed an integrated delivery system.

One of the current trend in the healthcare delivery model is that continued care is emphasized. The key professionals are not only treating patients for their illness, but they are promoting and managing quality of health. For example, a patient with high cholesterol visits a doctor. He is not only given one-on-one medical treatment, but he is also offered to attend a group session where information is provided on how lifestyle and behavioral change can help. The patients learn from the clinicians and also from each other. Another current trend is to take care of the health of the defined population and not only individual patients. All the health needs of the population as a whole are identified and served. It is emphasized that the community uses the health and social services provided. Healthcare has become more population-based. Another trend that has evolved is that the hospitals, physicians and health plans have got connected and have formed an integrated delivery system. More investments are being made with a goal of providing services to the customers and retaining them.

There is a beneficial impact in the transformation of healthcare towards emphasizing continued health. The way healthcare has been viewed in the past has been changing. The shifting of care from treating acute illnesses to providing continued care is resulting in enhancement of the health of the people. The only appropriate and feasible model is to provide a continuum of care with the emphasis firmly on the family and community. The health of the population and community is considered as a whole. This is advantageous as it creates value in the healthcare delivery system. The healthcare providers work with the community as a whole and consider to improve the health of the general population. Even though this requires new kinds of ways of organizing and managing healthcare services, it helps in understanding the health needs of the target population. By studying their needs, the right health and social services could be provided to them. Examples of promoting wellness of the whole community are organizing health campaigns and providing preventive education to the people in general. Another example is providing awareness about flu vaccines and encouraging people to get the vaccination.

Integrating the healthcare delivery system has led to certain advantages to the patients. For example, they can be offered alternative sites of care depending on their convenience. It helps in meeting the needs of the customers and their preferences which is taken into account. The number of providers are expanded and the patients get to have a choice. The relationship between providers and health plans are organized in the current trend and this ensures that the right care is provided in a convenient way to the customers.

There are defined budgets and expenditure targets for the populations which implies that there is a need to be efficient and productive. The formation of strategic alliances, networks, systems and physician groups can also add value. There are capitated payments and budgets allotted to the healthcare organizations. These are used to provide care to the defined population. The organization might like to improve on the payments and budgets as the expenditures of the companies increase. This results in the management to make decisions like forming strategic alliances with other organizations and increase the total resources. The growth of such networks will help in providing better care to the customers. Financial resources greatly influence the efficiency and productivity of the organization.

The aging population is influencing the healthcare delivery. There is increased demand for primary care of people over 65 years and for chronic care of people over 75. The ethnic and cultural diversity is also influencing the healthcare delivery. This provides a challenge in meeting patient expectations on one hand and diverse workforce on the other. Biological and clinical sciences have met with technological advances and have led to new treatment modalities. This has led to open new treatment sites and manage across the organization. External forces change the supply of certain areas of health professionals like physical therapy and some areas of nursing. The management needs to compensate for such shortages and they need to develop different teams of caregivers at different work sites. Changes in education of health professionals implies that the management be more creative in offering healthcare services. With an increase in diseases like AIDS and morbidity from drugs and violence, there is more and more need to work with community agencies, form social support systems and there is a need for more chronic care management. Advances in information technology is another area where there is a need to train the healthcare employees in new advances. They also need to manage issues of confidentiality and rapid information transfer. Increasing expansion of world economy has led to more competitive management of strategic alliances, care of patients across the nations and of different cultures.

Current environmental trends impact the healthcare delivery model. Organization’s success depends on its external and internal environment. The complex environments made up of uncertainties and heterogeneity of components leads to different organizational designs. The current environmental trends influence managerial and organizational decision making. The unique challenges facing the healthcare delivery organizations should be analyzed in order to develop and implement new and effective operational processes and strategies. As an impact of current environmental trends, the healthcare delivery system needs to improve individual, team, and organizational accountability and performance. The impact of advances in medical knowledge and information technology on the process of healthcare delivery should also be examined, and it should be leveraged to improve quality of care, process and cost controls, and revenue. New strategies would need to be identified and implemented for learning and performance improvement to create a culture that supports accountability, safety, and high-quality care. Innovative models in healthcare delivery would also be required in order to develop and implement strategies that promote organizational success and competitiveness.

Due to the current environmental trends, more emphasis is given to the customers and there is more of a patient-focused care. The healthcare delivery model has been shifting to the community based care. There has been an increased modification in care processes. The traditional ways are being challenged and more experiments are being performed to fulfill the demands to improve the quality of care. Due to the shift in the environmental trends in the healthcare delivery model, more emphasis is given to quality improvement. This will help improve the performance levels of key processes in the organization. The performance levels are being measured, the defects are eliminated and new features are being added to meet the customer’s need efficiently.

There is a new emerging contemporary trend in the U.S. healthcare system. Presently, the management research and assessment have been offered increased recognition. The emerging trend seen is that this is slowly forming an integral part of managerial and organizational effectiveness. With the emerging efforts in information management, it is leading towards clinical and financial networking. The trend seen among the physicians and nurses is that they are being increasingly involved in managerial activities. The managerial trends are also changing with respect to role performance and changing values. The managers role is getting more and more recognized in managing finance and human resources. Management training, lifelong and distance learning is being offered in preparing future managers.

The healthcare executives and managers will be faced with the major responsibility and challenge in the years ahead. They will be working with other healthcare providers and will be creating a competitive future for their organizations. They will not only be managing organizations but also a network of markets, services and joint ventures. Formation of more and more strategic alliances and partnerships will lead the management to manage across boundaries. The management will change from managing a department to managing the continuum of care. The management will be following a community-based approach. Trend in management is also shifting from just coordinating services to providing improvements in quality.

As the demands in healthcare are increasing, the management is responsible for forming performance standards. The management is also challenged to maximize the productivity and quality to serve the health needs of the community. The management is looking after the demands of the external environment as well as attending to the performance of the internal environment. The management is responsible for the performance of the organization.

Healthcare organization leadership will be responding to new trends and competitive forces. It will respond to continuum of care, overall health status of the population and more complex organizational structures. These emerging trends in the healthcare system will effect the organization’s leadership. The future managers would need leadership skills and vision to integrate the organizations and help in providing the best care. The managers will have to be committed to leadership and work on giving their organizations the best place and help their organizations adapt to the changing circumstances. More value will be given to leaders who will be able to lead the change process. As changes are inevitable for the betterment of the organization, the leaders should be able to identify how the change is to be received and how it is to be communicated at all levels of the organization without damaging the implementation process. The leaders might have to deal with increased pressures due to organizational complexity.

The leader in the organization provides strategic direction to the organization, manages diverse stakeholders, becomes mentors for management, is willing to take risks, helps the organization interact with the external environment and attends to the internal needs as well. Where required the leader will involve physicians in governance process and align physician and organizational interests. There will be a need for formation of learning organizations. Transformational leadership will create the required vision for the organization. Leaders will have a greater role complexity and they themselves will have to adjust rapidly to new situations. The healthcare organization leadership will have to live up to the values of the organization and will help in fulfilling the mission of the organization.

Individuals and groups within the healthcare organizations require more and more competencies. An enhanced lifelong learning is required due to the fast, changing environment. The individuals and groups within the healthcare organizations will be benefitted as there will be rapidly developing medical technologies which will result in increased services. More sophisticated health services will be provided to the consumers. The range and quality of services provided will be regulated for the benefit of people requiring home care, long term care and ambulatory care. The anticipated future development will also result in the increased competition among the health services organization. The individuals and groups will be involved more and more with the community for issues like drug abuse, teenage pregnancy and violence.

Individuals and groups will be faced with increased strategic planning and management in the healthcare organizations as there will be ever increasing involvement by the trustees and physicians. As the future environment in the organizations will be more complex, the individuals and groups in the healthcare organizations might feel more pressurized. They will need to serve the changing demands of the community as the population of elderly patients will increase. These individuals will require more professional training, increased levels of education and should be taking part in continuing education programs.

Due to the anticipated future development in the healthcare organizations, those individuals and groups will be valued, who are adaptable, committed, are able to add value and embrace change. These individuals will be required to experiment more and help in redefining the mission and goals of the healthcare organizations.

Meenu Arora has contributed her articles for both online and hard copy magazines. Her articles have also been published in international magazines. Presently working in the healthcare industry, she has also written and edited Health Q-A columns for international magazine for 5 years.

Hospitals In Philadelphia – Three Of The Top Rated Facilities

Philadelphia is well known for many things whether it is in the professional industry or with regards to the extensive recreational opportunities. The medical facilities in particular are amongst the most renowned, and doctors are falling all over themselves trying to find posts in and around the area. Here are three of the top rated hospitals in Philadelphia you should get to know about.

Mercy Philadelphia Hospital

Mercy Philadelphia hospital is renowned for its services particularly when it comes to acute care and emergencies. It has recently received the Premier Award for its quality from the Premier Healthcare Alliance. Within the hospital are a number of divisions, each of which is accredited and acclaimed in its own right. The radiology division has received numerous accreditations for ultrasound, MRI and nuclear medicine. The cancer, heart and stroke divisions have also been named for outstanding performance. This is just some of why Mercy is one of the top hospitals in Philadelphia.

Temple University Hospital

Temple University is one of the great academic hospitals in Philadelphia. It is best known for its superb clinical training of students and doctors who are specializing. It boasts over 700 beds and services a comprehensive range of people in the surrounding community. It is one of the major attractions for those hopefuls who want to study at the Temple University School of Medicine.

Thomas Jefferson University Hospitals

The Thomas Jefferson University Hospitals are well known for their attention to patient-centered care. They feature world renowned specialists in the fields of orthopedics, gynecology, pulmonology and rehabilitation, to name but a few. As with any academic hospital the teaching that future doctors get is top drawer. The state of the art equipment and skilled team of specialists is a big part of why these are top hospitals in Philadelphia.

EMR Is the Building Block for Healthcare Software

The Patient Protection and Affordable Care Act encourages the optimum use of technology in providing healthcare to the residents. A well maintained database of health records is the first step in integrating technology in the healthcare and health insurance sector.

Electronic Medical Record (EMR) is a healthcare software that precisely addresses this problem of storing the medical information of every individual. An EMR, as defined by the National Alliance for Health Information Technology (NAHIT), is an electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.

The biggest advantage of EMR is that it is much easier to maintain the data and it can be accessed easily by anyone who is authorized to do so. It saves time and money as patients do not have to undergo repeated tests when they change doctors. Also in cases of emergencies, a doctor can easily check the medical history of the patient before administering healthcare.

Here is a look at some of the other advantages of adopting the Electronic Medical Record software:

1. With all the medical information in electronic form, it will now become much easier to trace date over a period of time.

2. It will be easy to keep a record of the patients who are due for preventive screenings and check-ups.

3. It will be convenient to keep a tab on how the patients are doing on certain parameters such as controlling blood pressures and getting vaccinations.

4. The easily available and well maintained catalogue of health records will facilitate monitoring and improving the overall quality of care within medical practice.

A EMR is basically a compilation of all the patient’ s data such as his basic information, his records of medical consultation check- ups and follow- ups, medical complaints presenting signs and symptoms of the illness, and the impression of the medical doctor examining the patient.

The EMR is also a record of the medical treatment administered to the patient. It includes the medical prescriptions given, the lab tests done, surgeries undergone, name and dose of the drugs and also the duration for which the medicines were prescribed. This will help the new doctor to understand the degree and nature of the disease, give him a basis to start a new prescription and evaluate the efficiency of the treatment. Information about medical history and previous course of treatment will ensure that the new treatment has lesser glitches and is more effective.

The EMR is like the basic framework upon which other useful healthcare software such as EHR (Electronic Health Records), Health Information Exchange, Health Insurance Exchange, Insurance quoting platforms and Quote comparison engines can be built. All this software needs access to medical information about the residents before they can process it further to give the required results.

How Strategic Alliances Can Grow Your Business Exponentially (Example: Cash Flow Consultant)

The smartest marketers nowadays form strategic alliances with other companies that sell “complementary” products or services, whose “image” fits well with their own product or service.

Cross-promotions and cross-advertising can save big on marketing support dollars, while creating more awareness and an even better image for each of the products or services through reciprocal endorsement. Think Pillsbury chocolate chip cookies made with Hershey’s chocolate.

Sometimes the products aren’t even that complementary and a connection between them is almost impossible to see. But why not have a gecko advertise insurance and diamonds in the same ad, if it means shared advertising and media cost?

It’s called “Relationship Marketing” and is indeed a very powerful tool and a very smart move, as long as both products or services

• target the same customer

• do not compete

• have a compatible, positive image

How could this work in the cash flow industry? Let’s say you provide access to factoring dollars. You might “team up” with someone who specializes in purchase order financing or equipment leasing.

You can easily market to the same businesses and customers without competing with each other, as the two of you provide different, yet possibly very complementary products.

Imagine if both of you did the same amount of marketing for your own product. By cross-promoting each other, you would immediately double your marketing reach without any extra costs to either of you.

Now think about having another person on your team who specializes in, say, business plan writing for example! Again, same target group and no competition. You have just tripled your marketing reach and efficiency.

You can probably think of other “good fits” with your business that could equally increase your marketing reach and efficiency in the very same way!

The point here is that through “team marketing” smaller players with more limited time and monetary budgets can achieve faster and greater success by combining their resources and efforts.

Now, where do you start when forming such alliances? First, you need to have the right people, of course. It helps a lot when they are compatible and share the same vision and values. They also need to commit to the same goals, and each of them needs to “pull their own weight”. Motivation and determination are paramount. No free-loading or piggybacking for anyone!

Of course, if you have assembled such a team, you can even take it one step further and go from a “strategic alliance” to a full-fledged company formation.

Imagine, under a single company umbrella you could even qualify for group healthcare insurance rates and enjoy many other cost-saving benefits (e.g. common business cards, brochure, website, and other marketing support materials, etc.).

In addition to the cost savings, just think how much more ground you could cover with a like-minded team compared to what you could achieve on your own with your own, limited resources (both, time and money)!

For example, instead of dividing your available hours between phone calls, networking events, direct mail preparation, trade show attendance, and social media participation, you could divvy those tasks up between different team members and run those activities simultaneously instead of consecutively.

Think of the afore-mentioned cost saving opportunities. Let’s say you had $5,000 to build and run your business. If you do it on your own, you pretty much have to spend the money on operational cost and marketing just to keep the business going.

Now imagine you had three like-minded “partners” who all had $5,000 working capital as well. All of the sudden the “company” has $20,000 working capital. Even if you would now have to spend $8,000 on operations and marketing, the company would still have $12,000 to invest.

Now, the “company” could take, say, $10,000 of its remaining “investment capital” and – instead of just brokering cash flows – actually acquire some paper as well!

Congratulations! You have just created a double-income stream. One from brokering and one from investing.

In other words, the share of the “company’s” working capital that is being “invested” is now actually producing a direct return, instead of just being “spent” on activities that are expected to generate a return in the future.

That is a huge difference when it comes to the bottom line.

If you put that scenario on a forward trajectory, any surplus money the “company” generates (i.e., income minus expenses and taxes) could now flow into the acquisition of more paper (invoices or notes or tax liens or whatever else best fits the team’s short- or long-term investment strategy and goals).

Of course, it is a quite a leap to go from the idea of being a one-person cash flow broker to a multi-person team or company that not only brokers cash flows but also shares the risks of investing in them.

However, just like being a rocket scientist or a brain surgeon is not for everyone, investing in cash flows may not be for you.

The good news though is that the market entry barriers for becoming a cash flow investor are much lower – unless you’re already on your way to becoming a rocket scientist or brain surgeon, that is, of course.

But if you’re intrigued about the opportunities and challenges of brokering and investing in cash flows, just play it out in a plan and run the numbers (or let me know if you need any help).

If you think this all sounds great on paper but that it is way too difficult to pull off in reality, you might be right.

However, perhaps not necessarily for the “technical” reasons you probably have in mind. The real hard part about the whole thing is finding the right people with the right attitude and the right commitment with whom to team up.

Using Healthcare Technology for Your Aging in Place Loved Ones

The preponderance of healthcare technology in the home is growing by leaps and bounds, and especially those items made for the parents of baby boomers. With the start of boomers turning 65 on the first of this year, there is a growing aging population that knows about this technology and welcomes it for their parents who are aging in place. The older generation, the parents, however, may not be as likely to choose it, as they may feel that web and cell-based information invades their privacy or limits their independence. Other barriers to choosing technology in the home may be that the expense is cost-prohibitive.

Some of the home-based health technologies available today include complete wireless systems that will monitor the movement of an individual, provide fall detection and a panic button, and report medical issues such as temperature and blood pressure. Other devices monitor just one or two of the above separately. In addition, pill-taking reminders, symptom and patient record systems, video phones and caregiving assistance tools can be found from numerous manufacturers.

A study regarding healthcare technologies by the National Alliance for Caregiving and UnitedHealthcare was recently released at the annual Consumer Electronics show in Las Vegas this year. It showed that in a study of 1,000 family caregivers, two thirds welcome new devices that can help them with their duties. These people had all used some form of technology to help them out and provide at least five hours of unpaid service per week. The ages of the respondents was split by 47% over 50 and 53% under 50.

Here are the top three devices that 70% or more of those surveyed said would be most helpful:
– Personal Health Record Tracking – A computerized, web or cell-based system that tracks the health condition of the care recipient, including medications, current readings such as temperature and blood pressure, and manages test results and patient history.
– Caregiving Coordination System – An automated record that lets family members coordinate physician appointments and work together to organize caregiving assignments for the recipient.
– Medication Support Systems – A device that notifies the care recipient when it is time to take prescriptions and supplements and dispenses them into a handy container. The system-supported device can also notify caregivers when a dose has not been taken.

Baby boomers realize the benefits of health technologies, especially when they are not in the same city or cannot get to the care recipient on a regular basis. The survey respondents said that the advantages of the systems include saving time, making caregiving easier logistically, making the recipient feel safer, feeling more effective as a caregiver and reducing caregiving stress. While some of the elderly parents may be resistant to the health technology, over time, baby boomers will be looking to these solutions for themselves, and realize the benefits over the barriers.

Ransomware Attacks Show That Healthcare Must Take Cybersecurity Seriously

While healthcare providers and healthcare industry vendors cannot afford to ignore HIPAA, a new threat has emerged and is poised to become much bigger: ransomware attacks on hospitals and healthcare providers that are not seeking to breach patient information but instead render it inaccessible until the organization pays a hefty ransom.

In just the past few weeks, the following major ransomware attacks on healthcare facilities have occurred:

In February 2016, hackers used a piece of ransomware called Locky to attack Hollywood Presbyterian Medical Center in Los Angeles, rendering the organization’s computers inoperable. After a week, the hospital gave in to the hackers’ demands and paid a $17,000.00 Bitcoin ransom for the key to unlock their computers.

In early March 2016, Methodist Hospital in Henderson, Kentucky, was also attacked using Locky ransomware. Instead of paying the ransom, the organization restored the data from backups. However, the hospital was forced to declare a “state of emergency” that lasted for approximately three days.

In late March, MedStar Health, which operates 10 hospitals and over 250 outpatient clinics in the Maryland/DC area, fell victim to a ransomware attack. The organization immediately shut down its network to prevent the attack from spreading and began to gradually restore data from backups. Although MedStar’s hospitals and clinics remained open, employees were unable to access email or electronic health records, and patients were unable to make appointments online; everything had to go back to paper.

Likely, this is only the beginning. A recent study by the Health Information Trust Alliance found that 52% of U.S. hospitals’ systems were infected by malicious software.

What is ransomware?

Ransomware is malware that renders a system inoperable (in essence, holding it hostage) until a ransom fee (usually demanded in Bitcoin) is paid to the hacker, who then provides a key to unlock the system. As opposed to many other forms of cyber attacks, which usually seek to access the data on a system (such as credit card information and Social Security numbers), ransomware simply locks the data down.

Hackers usually employ social engineering techniques – such as phishing emails and free software downloads – to get ransomware onto a system. Only one workstation needs to be infected for ransomware to work; once the ransomware has infected a single workstation, it traverses the targeted organization’s network, encrypting files on both mapped and unmapped network drives. Given enough time, it may even reach an organization’s backup files – making it impossible to restore the system using backups, as Methodist Hospital and MedStar did.

Once the files are encrypted, the ransomware displays a pop-up or a webpage explaining that the files have been locked and giving instructions on how to pay to unlock them (some MedStar employees reported having seen such a pop-up before the system was shut down). The ransom is nearly always demanded in the form of Bitcoin (abbreviated as BTC), an untraceable “cryptocurrency.” Once the ransom is paid, the hacker promises, a decryption key will be provided to unlock the files.

Unfortunately, because ransomware perpetrators are criminals – and thus, untrustworthy to begin with – paying the ransom is not guaranteed to work. An organization may pay hundreds, even thousands of dollars and receive no response, or receive a key that does not work, or that does not fully work. For these reasons, as well as to deter future attacks, the FBI recommends that ransomware victims not cave in and pay. However, some organizations may panic and be unable to exercise such restraint.

Because of this, ransomware attacks can be much more lucrative for hackers than actually stealing data. Once a set of data is stolen, the hacker must procure a buyer and negotiate a price, but in a ransomware attack, the hacker already has a “buyer”: the owner of the information, who is not in a position to negotiate on price.

Why is the healthcare industry being targeted in ransomware attacks?

There are several reasons why the healthcare industry has become a prime target for ransomware attacks. First is the sensitivity and importance of healthcare data. A company that sells, say, candy or pet supplies will take a financial hit if it cannot access its customer data for a few days or a week; orders may be left unfilled or delivered late. However, no customers will be harmed or die if a box of chocolates or a dog bed isn’t delivered on time. The same cannot be said for healthcare; physicians, nurses, and other medical professionals need immediate and continuous access to patient data to prevent injuries, even deaths.

U.S. News & World Report points to another culprit: the fact that healthcare, unlike many other industries, went digital practically overnight instead of gradually and over time. Additionally, many healthcare organizations see their IT departments as a cost to be minimized, and therefore do not allocate enough money or human resources to this function:

According to the statistics by Office of National Coordinator for Health Information Technology, while only 9.4 percent of hospitals used a basic electronic record system in 2008, 96.9 percent of them were using certified electronic record systems in 2014.

This explosive growth rate is alarming and indicates that health care entities could not have the organizational readiness for adopting information technologies over such short period of time. Many of the small- or medium-sized health care organizations do not view IT as an integral part of medical care but rather consider it as a mandate that was forced on them by larger hospitals or the federal government. Precisely due to this reason, health care organizations do not prioritize IT and security technologies in their investments and thus do not allocate required resources to ensure the security of their IT systems which makes them especially vulnerable to privacy breaches.

What can the healthcare industry do about ransomware?

First, the healthcare industry needs a major shift in mindset: Providers must stop seeing information systems and information security as overhead costs to be minimized, realize that IT is a critical part of 21st century healthcare, and allocate the appropriate monetary and human resources to running and securing their information systems.

The good news is, since ransomware almost always enters a system through simple social engineering techniques such as phishing emails, it is fully possible to prevent ransomware attacks by taking such measures as:

Instituting a comprehensive organizational cyber security policy
Implementing continuous employee training on security awareness
Regular penetration tests to identify vulnerabilities

Going Green: 5 Ways Hospitals Can Help the Environment

In 2009, St. Joseph, Mo.-based Heartland Health began a journey to go “green.” It was then the health system’s COO Curt Kretzinger approached David Jones, vice president of support services, with the challenge to become an environmentally friendly facility.

The hospital began its green initiative, which it cleverly titled “Jones ‘n to be Green’ after its unofficial Green leader, by forming a green committee and opened it to all levels of employees with an interest in reducing the system’s carbon footprint. The group began its efforts by defining what ‘going green’ meant for Heartland Health: 65 percent of efforts would be around lowering energy use, 25 percent around transportation and 10 percent around reusing and recycling. “The biggest thing you can do to protect the environment and lower costs is reducing energy use, says Mr. Jones. “It has the most bang for your buck.”

After setting energy as a priority, the green team used the Premier healthcare alliance’s “Executive Scorecard on the Environment” to score its environmental friendliness and identify areas of opportunity. Changes were incorporated into the health system’s facility plan and implemented. While the hospital made numerous changes to reduce its carbon footprint, here are a few of the most notable.

1. Replace inefficient lighting. Heartland began its quest to improve its energy efficiency by replacing fluorescent and other inefficient lighting with energy efficient bulbs. The facility plan was also altered to require the replacement of bulbs every two years. “As bulbs age, their light output diminishes; thus they need more energy to operate,” says Mr. Jones. The change also created an unintended benefit, “People thought we’d painted and replaced the carpet.” Additionally, maintenance workers readjusted how indirect lighting was aimed so that less lighting was needed.

2. Upgrade HVAC system, other equipment and materials. Another major change Heartland made was to upgrade its HVAC system, adding monitoring tools and automated controls, as well as its boiler controls. Additionally, the facility plan called for thicker insulation of windows and walls. As a result of these and the lighting changes, the system was able to bring its energy costs per square foot down from $2.92 in 2007 to $2.39 today, despite a 30 percent increase in energy rates. Reducing energy use also reduced the number of generators required to keep the system running during the 8-10 power outages the hospital experiences each year.

3. Ensure vendor contracts require recycling of waste. Mr. Jones worked to find a paper shredding vendor that would agree to recycle the paper waste after it was shredded. Hospital employees were then encouraged to put all paper waste in the shredding bins, not just those with sensitive material, since it would mean the waste would be recycled. The hospital also found a cardboard baler willing to recycle the hospital’s cardboard waste, which averaged 1,500 pounds per day from 2009-2010. The changes saved more than 15,300 trees, 342,400 gallons of oil and 2,703 cubic yards of landfill space, according to Heartland’s estimates.

4. Replace vehicles with energy efficient models. Heartland has one security vehicle that patrol its campus, which used to fuel up 2-3 times per week. After purchasing hybrid vehicles, trips to the gas station dropped to once every week and a half, creating significant savings on gas costs. The hospital also has an electric charging station available.

5. Grease from cafeteria fryers recycled into fuel. One of the more unique changes Heartland made was contracting with a vendor that would remove fryer grease out of dietary services. The new vendor charges less to remove the grease than the previous vendor, because it is paid a nominal fee for the grease by another group that converts it into fuel.

In the future, Heartland will focus on improving its waste management and is currently in the processes of using a centralized waste management service for all of its facilities, says Mr. Jones. He calls Heartland’s journey to become a green facility a rewarding one, and he hopes more hospitals will start making similar changes to lessen their impact on the environment.