Monday, April 27, 2015

Weekly Australian Health IT Links – 27th April, 2015.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

A rather quiet week with some bad news about Health IT in Victoria, more news on some apparently dodgy dealings in Pharmacy Systems, and a little more discussion from NEHTA and Telstra.
We are still lacking any news on the PCEHR and NEHTA with the Budget for 2016 only a couple of weeks away. You have to feel sorry for the staff involved in these initiatives with all the uncertainty, or have they already been told what will happen? Leaks welcome!
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Doctors say patients are dying because of inadequate IT systems

Date April 22, 2015 - 12:15AM

Julia Medew Health Editor

Victorians are dying because of inadequate IT systems for hospital staff to communicate crucial information about their care to GPs, doctors say – with many still relying on faxes.
Despite more than $1 billion being spent on healthcare technology over the past decade, the Victorian branch of the Australian Medical Association says thousands of patients are being shunted around between doctors every day without a standardised system to efficiently transmit their personal information.
The chairman of AMA Victoria's section of general practice, Dr Michael Levick, said this "ad hoc" approach to communicating patients' diagnoses, test results and treatments was so dangerous, he knew of patients who had died as a result.
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Poor communication systems between doctors and hospitals put patients at risk, AMA says

Posted April 22, 2015
Doctors in Victoria say patients are dying due to inadequate technology and poor communication between hospitals and local GPs, and have called for $50 million to help fix the problem.
Privacy laws mean emails about patients medical history have to be encrypted, but only a few hospitals have the technology to do that.
The chairman of the Australian Medical Association Victoria's section of general practice, Dr Michael Levick, said vital patient information was instead being passed on via written notes or by fax.
He said that meant updates about major changes to patient treatment while they were in hospital were often delayed or even missed completely.
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Political will is holding back digital health: Experts

Far from being a technology problem, digital health initiatives are being held back by a lack of incentive and government backing, a panel of health experts has said.
Imagine you have the technology platform, the tools, and the know-how to help move forward an industry that is about to have its costs increase imminently, but despite the improvements your scheme would bring, no one can or wants to step forward and make it happen.
Welcome to the digitisation of health care in Australia.
Despite more than AU$1.1 billion being spent on the Personally Controlled E-Health Record (PCEHR) project by governments of different political persuasions, an electronic record is no closer to being fully integrated into the health system.
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Pharmacy lobby in conflict row over IT firm’s windfall

A struggling technology business backed by the Pharmacy Guild of Australia has reaped millions of dollars in government grants intended for pharmacists, fuelling concerns that the lobby group is beset by conflicts of interest as it heads into battle over the next round of funding for the industry.
Fred IT, which was 50 per cent-owned by the pharmacy guild when the federal government’s $15.6 billion Community Pharmacy Agreement was struck in 2010, was one of two private companies to share in a $9.7 million windfall after key funding for pharmacies was later redirected.
The handout was not approved under the original agreement and was made despite the guild previously agreeing that the funding in question — $75.5m to offset pharmacists’ costs of switching to processing prescriptions electronically — be made only to pharmacies.
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New health alliance to help community

By Ashleigh Tullis

April 22, 2015, 2:07 p.m.
Wollondilly Council has established a Health Alliance which aims to create a healthier community.
This follows a Health Needs Assessment which was completed last year and identified top health priorities.
The alliance is trialling new models of health care and ways to promote health so Wollondilly has better access to services.
Wollondilly Council community services manager Peter Wright said due to the small but dispersed population of Wollondilly, access to health services was difficult because they were primarily focused in the larger population centres of Campbelltown and Liverpool.
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CHF consensus statement ignores evidence for telehealth: experts

20th Apr 2015
TELEHEALTH and telemonitoring should be a vital part of national chronic heart failure (CHF) care models but the modalities continue to be ignored, researchers say.
Professor of acute care nursing at Flinders University, Robyn Clark, and NSW Cardiovascular Research Network Life Science Fellow, Associate Professor Sally Inglis, argue that CHF patients could achieve better outcomes with telemonitoring but note that a national consensus statement on management of the condition fails to recommend its integration into practice.
According to the consensus expert panel, convened by the Heart Foundation, a significant proportion of the estimated $1 billion per year expenditure on CHF management is associated with preventable CHF readmissions.
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Shared Health Summary, Event Summary and Common Conformance Profile April 2015 Update

Created on Thursday, 23 April 2015
NEHTA has released updated specifications for key clinical document types, Shared Health Summary and Event Summary.
This is the first-ever full update of core specification documents and addresses issues identified during the implementation of the previous versions.
Also included in this release are minor updates for the
  • Common Conformance Profile for Clinical Documents
and the publication of the
  • Conformance Test Specification for PCEHR Usability.
Updates for Shared Health Summary and Event Summary
The new releases of the Shared Health Summary and Event Summary end products provide updates aimed at:
  • Addressing issues identified during the implementation of SHS and ES specifications;
  • Clarifying existing requirements;
  • Improving interoperability, clinical safety and privacy through additional requirements;
  • Improving usability by incorporating selected recommendations from the Clinical Usability Programme (CUP);
  • Supporting additional use cases through relaxation of requirements;
  • Supporting additional use cases through additional fields;
  • Supporting version 3 of the Australian Medicines Terminology (AMT);
  • Aligning clinical modelling and CDA® mapping with other document types;
  • Resolving errors.
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Outcomes of the recent survey

APNA has been working with NEHTA to provide its members with information on the personally controlled electronic health (eHealth) record system. The recent survey has provided us with some valuable feedback on the current levels of knowledge and use of the eHealth record system.
Insights
There were a number of issues raised about the difficulty in using and the beliefs held regarding the eHealth record system.
As a result we have been working with NEHTA to address the concerns about the usability of the system. Some significant enhancements to the clinical software used by General Practice have been made through the NEHTA Clinical Usability Programme in consultation with peak clinical organisations. Many of the GP desktop software systems have been updated making the eHealth record system easier to use.
These enhancements include:
  • streamlining the process to register for an eHealth record
  • fewer clicks to upload clinical documents
  • easier to view a patient's record
  • preventative measures to enhance security and privacy.
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Electronic health tools for chronic kidney disease

21st Apr 2015
A/Prof Craig Nelson MBBS, FRACP, PhD
Director of Nephrology, Western Health, Victoria; 
Honorary Clinical Associate Professor, University of Melbourne
Dr Aspasia Pefanis MBBS, BMedSci
Advance Trainee in Nephrology,
Western Health, Victoria
THE IMPORTANCE OF CHRONIC KIDNEY DISEASE
CHRONIC kidney disease (CKD) is defined as reduced kidney function/glomerular filtration rate (GFR <60ml m="" min="" sup="">2
) and/or evidence of kidney damage (usually indicated by albuminuria or proteinuria) for a period of at least three months (Johnson et al, 2013). Decreased estimated GFR (eGFR) and increased urinary albumin excretion have been shown to predict end-stage renal disease (ESRD) and death across a wide range of settings (Levey et al, 2011).
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Bellin’s Pete Knox on Accountable Care and Innovation

While activity based funding or fee-for-service is a widely used model in healthcare systems around the globe it is increasingly coming under fire for cost and health-outcome reasons, leading some countries and systems to try different models.
Over the last five years the United States has been experimenting with funding outcomes-focused healthcare delivered by Accountable Care Organisations or ACOs.
“Here in the US, ACOs are being defined as a group of providers coming together to deliver care to a population of people, and in doing so, achieve better health outcomes at a lower cost, and with a better experience for the healthcare consumer,” says Pete Knox, executive vice president, chief learning and innovation officer at Bellin Health, in the central US state of Wisconsin.
Knox, who has served with Bellin in a variety of roles for the last 35 years, tells eHealthspace.org that ACOs began to emerge following the introduction of President Obama’s widely debated Affordable Care Act.
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Robot assistants to give surgeons a leg-up

Jennifer Foreshew

Australian researchers are exploring the use of robot assistants to help undertake knee ­arthro­scopies and other minimally invasive surgeries.
The use of robots was expected to slash patient waiting lists, simplify training for new surgeons and prolong their labour-intensive careers.
Queensland University of Technology and the Australian Centre for Robotic Vision are tackling key medical issues with affordable, simple robotic devices.
The project team is made up of orthopedic surgeon Ross Crawford, roboticist Jonathan Roberts and biologist Anjali Jaiprakash.
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The full story...

Kids Helpline: Increase in children needing urgent mental health advice

Bridget Brennan reported this story on Monday, April 20, 2015 12:56:00
ELEANOR HALL: Now to the 24-hour youth help service that's reporting a huge spike in the use of its emergency services.
Kids Helpline says its counsellors are now making more than twice as many emergency interventions as they were two years ago.
Bridget Brennan has our report.
BRIDGET BRENNAN: The National Mental Health Commission says 600,000 Australian children between the ages of 4 and 17 are affected by a mental health problem every year.
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Medical workers team with Readify in 'critical patient' care project

Frontline medical workers in Victoria have helped software company Readify develop “groundbreaking” technology that is transforming the treatment of critically ill patients across the state.
The medical workers who worked with Readify are employed with Adult Retrieval Victoria (ARV), a department of Ambulance Victoria responsible for coordinating doctors, paramedics, ambulances, planes, helicopters and equipment to transfer critically ill patients between hospitals.
ARV, whose 30 clinical coordinators and retrieval specialists handle approximately 4,200 cases a year working with almost 150 hospitals across the state, was in the process of transitioning from paper to online processes, but was using an interim system that did not allow for real-time digital case management.
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The AMT v20150430 April 2015 release is now available for download

Created on Friday, 24 April 2015
The AMT v20150430 April 2015 release is now available for download from the NEHTA website.
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Here’s why you should own Telstra Corporation Ltd shares

By Darryl Daté-Shappard - April 20, 2015 |
Telstra Corporation Ltd (ASX: TLS) is taking its next major step into healthcare by opening its new e-health product, MyCareManager. The telecommunications leader is leveraging its expertise in communications and mobile networking to provide customers a way to have medical consultation services via online video.
GP and healthcare specialists can discuss health issues with patients, as well as monitor and analyse their conditions via high-speed broadband and cloud data applications.
If you’ve ever had the experience of meeting with a medical professional, you would greatly appreciate the time saving and convenience this offers. Regularly, people might have to travel one or two hours to a medical centre. Then they would sit in a waiting room a long while for their appointment, all for a consultation that could last only a short 10-15 minutes possibly.
New e-Health division growing quickly
Telstra’s e-health division has grown with a number of recent acquisitions. In the first half of financial year 2015, Telstra made five acquisitions and investments in e-health companies in its drive to become the leading e-health service provider in Australia.
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Teardown of Apple Watch shows sensor could measure blood oxygen levels

To reach the watch's inner components, iFixIt used a "destructive process" that would make it "impossible" for a person to repair the watch
The Apple Watch's sensor may hold more health monitoring functions than Apple has revealed, including measuring blood oxygen levels, a feature that's not enabled on the device and that Apple hasn't talked about.
That's one of the findings from iFixIt, which disassembled an Apple Watch Sport Edition on the day the wearables started shipping to customers.
U.S. government regulations may prevent Apple from allowing the watch to capture blood oxygen data, according to iFixIt, whose website lets people offer each other advice on how to fix a variety of things, including computer hardware. The site is also known for breaking apart Apple's new products as soon as they go on sale.
People eager to perform their own fixes on the Apple Watch may have to stick with swapping out the watch bands. That's the easiest repair to make on the device and only entails pressing a button to release the peg holding the bands in place.
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Sydney Adventist Hospital’s Big Data play

Sydney Adventist Hospital on Sydney’s upper North shore is embracing the Internet of Things and Big Data in a bid to improve operational efficiency and deliver better patient outcomes. However, as Barbara MacKenzie, SAH’s head of IS operations and infrastructure notes, at present Big Data and the internet of things is not about saving lives. Yet.
“The way that we use our network is as the synapses between different objects,” she observes. “The variety of systems and the information that is being captured across the network is absolutely mind-blowing.”
However, it has been a long journey towards the internet of things, where all devices are connected to the network using standard internet protocol. According to MacKenzie, this journey began around eight years ago, when medical device vendors started to build networking into their equipment. At that stage, SAH did not allo these devices to connect to the network, or into the corporate communications room.
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InterSystems Unveils Major New Release of Caché

Caché 2015 Achieves New Milestones in Scalability

SYDNEY, Aust., April 20, 2015 – InterSystems, a global provider of data management technologies, today announced the latest version of InterSystems Caché ®, its massively scalable data platform. InterSystems Caché 2015 doubles the scalability of prior releases, based on independent third-party testing.

“Caché continues to improve in scalability and performance, and we continue to spend a smaller percentage of revenue on IT than our competitors, despite growing annual revenues from $140 million to over $3.9 billion since choosing Caché for our specialised IT systems,” said Peter Joseph, CIO at Sonic Healthcare. “The new version offers massive processing power on standard hardware, further improving its impressive price performance.”

Sonic Healthcare Limited (ASX: SHL) is one of the world’s largest medical diagnostic companies. It is the largest pathology company in Australia and Germany, the third largest in the United States, and also operates laboratories in Switzerland, Belgium, Ireland and the United Kingdom.
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Darren Jones, Senior VP Australia, Orion Health

April 20, 2015
Please provide a brief overview of the company?
Orion Health has over 20 years’ experience in developing healthcare specific software solutions and today our products are sold in over 30 countries where they are used by thousands of clinicians to help improve healthcare outcomes for millions of people. In Australia, where we have operated since 2001, we have more than 100 customers ranging from hospitals to local health districts and state health departments, including ACT Health, Hunter New England Health, NSW Health, Tasmania Health, Healthscope and Epworth Hospital.
We focus on three specific market segments.
  • Intelligent Integration – Our software rapidly and reliably connects, integrates and shares information between disparate health software systems and organisations.
  • Smarter Hospitals – Our software connects all clinical information into a single viewer within a hospital, and includes a software platform to automate a hospital
  • Healthier Populations – Our software connects, consolidates and structures healthcare information to make it accessible and available across a geographic region
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The PCEHR – a GP's Experience

Dr Ewen McPhee, a rural doctor from Emerald in Queensland, presented at the Rural Medicine Australia 2014 conference on the personally controlled electronic health record (PCEHR).
In a 15-minute demonstration, Dr McPhee shows how he uses the PCEHR in his practice, explains what data cleansing is, how to register your patients and then he creates a shared health summary and uploads it to the PCEHR.
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Shedding New Light on the Search for the 'Invisible' Dark Matter

April 24th, 2015
We can map it, weigh it and simulate it, yet we still have no idea what it is. But dark matter is coming into the spotlight as never before.
Astronomers now know that for every grams worth of atoms in the universe, there are at least five times more of a new, invisible matter neither shining or blocking light.
We can also create model universes inside supercomputers that reproduce in stunning detail what we see around us in the night sky but only by assuming this invisible dark matter passes through us like a ghost.
Finally, in the past decade we have begun to almost routinely map out the invisible, finding it matching the simulation predictions.
Yet of the numerous candidates that particle physicists have thought up for dark matter we are still far from knowing which is right. A quest that is every bit as grand and in some ways even more difficult than the search for the God Particle, the Higgs Boson.
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Enjoy!
David.

Sunday, April 26, 2015

It Looks Like All Is Not Entirely Kosher With The Way The Pharmacy Guild Has Involved Itself In Pharmacy IT.

This appeared last week:

Pharmacy lobby in conflict row over IT firm’s windfall

A struggling technology business backed by the Pharmacy Guild of Australia has reaped millions of dollars in government grants intended for pharmacists, fuelling concerns that the lobby group is beset by conflicts of interest as it heads into battle over the next round of funding for the industry.
Fred IT, which was 50 per cent-owned by the pharmacy guild when the federal government’s $15.6 billion Community Pharmacy Agreement was struck in 2010, was one of two private companies to share in a $9.7 million windfall after key funding for pharmacies was later redirected.
The handout was not approved under the original agreement and was made despite the guild previously agreeing that the funding in question — $75.5m to offset pharmacists’ costs of switching to processing prescriptions electronically — be made only to pharmacies.
It also came as Fred IT, which had recently launched a new Prescription Exchange Service for the transfer of electronic prescriptions, known as e-scripts, which was billed as a breakthrough in the fight against prescription forgery, was struggling financially.
The revelation comes as the Community Pharmacy Agreement — a contract between the government and the guild that sets out how much pharmacies are paid to dispense drugs — has ­attracted scrutiny, after an audit report questioned its “value for money’’, potential conflicts of interest and a lack of transparency.
As The Australian reported on Monday, the group has amassed a $6.2m fighting fund ahead of what are widely tipped to be tough negotiations with the government, which wants savings under the next agreement. The current agreement ends on June 30.
Industry groups including the Consumer Health Forum and Professional Pharmacists Australia are concerned about the guild’s roles in the arrangement.
As well as negotiating the Community Pharmacy Agreement, the guild administers programs for the Health Department and receives funds to run professional programs.
Lots more here:
All this fills in rather more of the story with it becoming apparent that the development and implementation of e-prescribing has not gone as well, or been as transparent, as one might expect of an initiative receiving Government funds.
All this follows revelations a week or so ago regarding pharmacists selling patient prescription data. See here:
Additionally we have an Audit report from a month ago regarding how IT usage  payments for e-prescriptions did not seem to go to the pharmacists where it was intended to go - rather than to the Pharmacy Guild for a range of promotional activities and technical interoperability updates.
Here are the detail of what the Auditor General found about six weeks ago.
Overall it looks to me that there is a concerted campaign being run to have the Pharmacy Guild’s horns clipped a bit and to do something about the rather restrictive business practices Pharmacy has been forcing on the public for many years. The Harper review of competition  which was recently released has made it clear they at least think Community Pharmacy is a rather inefficient and provides overly costly service provides in the community. People can make up their own minds about how they view all this, but I certainly get the feeling there is at least some sense that the Pharmacy Guild has used its very considerable background political influence to seek outcomes that may have not totally been in the public interest.
I reckon we might well see some changes in the Budget and in the new (sixth) Community Pharmacy Agreement as a result of the Audit and subsequent publicity.  For more see the commentary in next Thursday’s Budget blog on all this.
David.

Update 9am 27 April, 2015.

According to Fairfax Ms Sussan Ley (Health Minister) has confirmed major changes to the PBS in the 2016 Budget.

See here:

http://www.smh.com.au/federal-politics/political-news/sussan-ley-confirms-pharmaceutical-benefits-scheme-crackdown-in-may-budget-20150426-1mtxx9.html

D.

AusHealthIT Poll Number 267 – Results – 26th April, 2015.

Here are the results of the poll.

Should Parents Who Refuse To Vaccinate Their Children Loose Family Benefits Payments?

Yes 69% (52)

Probably 16% (12)

Neutral 1% (1)

Probably Not 4% (3)

No Way 8% (6)

I Have No Idea 1% (1)

Total votes: 75

The vast majority (85%) seem to think this is a good policy idea!

Good to see such a good number of responses!

Again, many, many thanks to all those that voted!

David.

Saturday, April 25, 2015

Weekly Overseas Health IT Links - 25th April, 2015.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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Cerner adds FHIR power

Posted on Apr 17, 2015
By Bernie Monegain, Editor-at-Large
Health IT giant Cerner is working with Geisinger Health System and xG Health Solutions, Geisinger's commercial spinoff, to enable the use of emerging SMART on FHIR industry standards. The idea is to facilitate use of software applications across open platform EHRs, such as Cerner Millennium.
Geisinger and xG Health will be able to use these new draft standards to deploy their apps to run inside Cerner Millennium and other FHIR-compliant EHR systems.
FHIR – pronounced "fire" –  is an acronym for Fast Health Interoperability Resources.
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A dispatch from HIMSS

Posted on Apr 15, 2015
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
Unfortunately, I was unable to attend HIMSS this year because a special request from Andy Grove, the former CEO of Intel. He asked me to serve with Roni Zeiger (Smart Patients, Google Health) and John Mattison (CMIO of Kaiser) as co-presenters for the first annual Marc Shuman Anti-Medical School Lecture in San Francisco, sponsored by the Grove Foundation. When Andy calls, you listen.
My second-in-command at BIDMC, Manu Tandon, attended HIMSS on my behalf and sent the following analysis of the key themes he experienced.
"Interoperability is big at HIMSS in 2015. The challenge of patient identification and finding the location of patient records are important informatics problems to solve.
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Survey: 50 percent of docs use smartphones, but 56 percent use desktops

By: Jonah Comstock | Apr 16, 2015
While most clinicians carry one or more mobile devices for a variety of use cases, it’s still the case that no single screen is as popular as the desktop computer for physicians, according to a new survey released by Microsoft. The online survey of 402 U.S. physicians was conducted by YouGov.
Fifty percent of physicians used smartphones, 49 percent used laptop computers, and 23 percent used tablets, according to the survey, but 56 percent still used a desktop computer. Additionally, 55 percent still use a fax machine and 27 percent still use pagers. Thirty-nine percent still use paper.
The desktop was still the primary choice for physicians for many information-sharing use cases: 46 percent used it to communicate with colleagues or specialists, 40 percent used it to schedule surgeries, 39 percent used it to communicate with pharmacists, and 35 percent used the desktop to contact patients.
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HIMSS15: Federal Health Officials 'Optimistic' About Future of Health IT

by Kate Ackerman, iHealthBeat Editor in Chief Friday, April 17, 2015
CHICAGO -- On the final day of the Healthcare Information and Management Systems Society's annual conference, National Coordinator for Health IT Karen DeSalvo and acting CMS Administrator Andy Slavitt took the stage to detail federal efforts to leverage health IT.
With recent changes to the meaningful use program, the health IT implications of a new law to repeal the sustainable growth rate formula and a new report on health information blocking, the record-breaking 43,129 attendees at HIMSS15 were eager to hear from the top health officials on the administration's health IT plans.
DeSalvo said, "I'm so optimistic about the bright future we have" in leveraging health IT to improve health.
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Switching EHRs Adds Functionality but Not Always Satisfaction

Joyce Frieden, News Editor, MedPage Today , April 17, 2015

Providers who switch from one electronic health record to another do so to add more functionality, but often it doesn't make them more satisfied, according to a recently published survey. From MedPage Today.

CHICAGO -- Providers who switch from one electronic health record (EHR) to another do so to add more functionality, but often it doesn't make them more satisfied, according to a recently published survey.
"I love my EHR, but I work with a lot of physicians who don't," Kenneth Adler, MD, MMM, a family physician in Tucson, Ariz., said here Thursday at the annual meeting of the Healthcare Information and Management Systems Society. "I bought them an EHR and they still blame me for it."
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Inherent Risks of Health IT, EHRs Putting Patients in Peril

APR 2, 2015 7:53am ET
As the adoption of health information technology continues to grow industry-wide, the potential for health IT-related harm to patients and even death will increase unless risk-reducing measures are put into place by healthcare organizations.
That’s the dire warning of a new alert from The Joint Commission that identifies specific types of sentinel and adverse events, describes their common underlying causes, and recommends steps to reduce risk and prevent future occurrences. According to the alert, health IT has inherent risks. Specifically, the document cites “incorrect or miscommunicated information entered into health IT systems” and “interfaces built into the technology” as contributing to adverse events, which “may occur through the use of electronic health records and related technologies.”
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Lack of Funds from Congress Leaves Health IT Safety Center in Limbo

APR 16, 2015 6:47am ET
The Office of the National Coordinator for Health Information Technology’s plan to establish a $5 million Health IT Safety Center remains up in the air due to Congress’ refusal to authorize funds for the center.
“It is not funded—that’s a reality,” Andrew Gettinger, M.D., acting director of ONC’s Office of Clinical Quality and Safety, told Health Data Management at HIMSS15 in Chicago. “We would like it to be funded. We have put it in our budget. We will continue to put it in our budget.”
The $5 million for the Health IT Safety Center was part of the Department of Health and Human Services’ $92 million budget request for ONC in fiscal year 2016. Had the agency secured the funding, Gettinger said that ONC would have “stood up” the Health IT Safety Center next year, “but Congress chose not to fund it.”
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Clinicians create own customized alerts with new CDS tool

April 14, 2015 | By Marla Durben Hirsch
A new approach to clinical decision support (CDS) will allow physicians and others to craft their own CDS rules based on their personal experiences with patients, according to an April 13 announcement from the Regenstrief Institute and Indiana University.
The approach, called Rule Authoring and Validation Environment, or RAVE, was developed by the Regenstrief Institute and tested at Eskenazi Health; it is being presented at the Healthcare Information and Management Systems Society's annual conference in Chicago this week.
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Usability, interoperability remain barriers to HITECH goals

April 16, 2015 | By Susan D. Hall
The HITECH Act has stimulated adoption of digital infrastructure in healthcare to improve care and reduce costs, but problems with usability, interoperability and the fee-for-service paradigm require further government action, according to research published in the Journal of the American Medical Informatics Association.
The authors conducted 47 interviews with government, health policy and HIT experts, as well as physicians, payers, patient advocates, and vendors from across the United States.
There was widespread acknowledgement that HITECH was directly responsible for catalyzing adoption of EHRs in hospitals and ambulatory settings. Physicians, however, expressed concerns about the usability of EHRs and computerized decision support systems, seeing them as immature technologies written on old code bases originally designed for hospital billing, according to the report.
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ONC touts 'significant' boost in health data exchange by hospitals

April 16, 2015 | By Katie Dvorak
From 2008 to 2014 the healthcare industry saw major growth in the adoption of electronic medical records and the ability to exchange information.
In a nationwide survey of non-federal acute care providers, the American Hospital Association found that last year, three out of four hospitals acquired a basic EHR system, according to a brief from the Office of the National Coordinator for Health IT on the survey.
That number is a huge jump from 2013, when only 27 percent of hospitals had EHRs, and an eight-fold increase since 2008, according to the survey.
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Hospitals Monitor ICU Patients Virtually, From Many Miles Away

Some hospital systems are using a sort of virtual command center to monitor their sickest patients from dozens or even hundreds of miles away. Virtual intensive care units, also called eICUs, are a way to bring the expertise of a major medical center to remote hospitals in rural areas.
In the intensive care unit at a small hospital in Lincolnton, Richard Gilbert thought he had two TVs in his room. The screens both look down at his hospital bed. 
"I was sitting here watching television and then all of a sudden the other one comes on, and I thought, well, how’d I turn that on?" he said with a laugh.
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Mon Apr 13, 2015 5:06pm EDT

IBM launches new health unit, teams up with Apple, J&J, Medtronic

SEATTLE | By Bill Rigby
 (Reuters) - International Business Machines Corp, deepening its partnership with Apple Inc to make use of health information gathered by millions of Apple devices, is creating a unit dedicated to providing data analytics to the healthcare sector.
Its new Watson Health unit plans to aggregate health information from a large number of devices and providers in the cloud and offer insights to health companies such as Johnson & Johnson and Medtronic, which can then integrate results into services they sell to healthcare companies.
IBM said it will create headquarters for the unit in Boston with 2,000 employees, including about 75 medical practitioners. IBM also said it bought two health technology firms, Explorys and Phytel, for an undisclosed amount, to add to its skills in health data analytics.
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A genomic CDS takes shape at Intermountain

Posted on Apr 15, 2015
By Gus Venditto, VP, Content
Breakthroughs in genetic research represent an exciting frontier for medicine. But in these early stages, the need for more clinical data is clear. And the obvious place to look for this data is in hospital EHRs.
To explore the potential from merging these disparate collections of data, Intermountain Healthcare and Intel set out to build a clinical decision support (CDS) application based on all of the information available to the hospital.
“Today, we can do alerts with clinical decision support in our EHR. And we collect family health records that show risk factors that show the history of their relatives. When did they die? What did they die from? And we can look at genomic data, to see if a specific genomic variant sets a risk factor by itself,” said Grant Wood, senior IT  strategist with Intermountain Healthcare’s Clinical Genetics Institute. “What if we brought all three together to form a combined data set? Could we define new risk algorithms and put them in a decision support application?”
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EHR plug-and-play capabilities emerging from SMART on FHIR apps

Posted on Apr 14, 2015
By Frank Irving, Editor, Medical Practice Insider
Have a great idea for a new way to interact with EHR data? An emerging platform enables you to build your own app or use another from an open community.
The name says it all when it comes to an open, standards-based app platform called SMART — Substitutable Medical Applications & Reusable Technologies.
The SMART project was started in 2010 with a four-year, $15 million grant from the Office of the National Coordinator for Health IT, in broad terms to build an app platform for healthcare.
"The idea is that we wanted to support apps that could be chosen by clinicians. The app could plug into their existing EHR system, and then if a better app came along, you could get rid of the old one and swap the new one in," explained Josh Mandel of Boston Children's Hospital, the architect for the collaborative SMART platform team.
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6 in 10 Health Data Breaches Due to 'Criminal Activity'

Cheryl Clark, for HealthLeaders Media , April 15, 2015

Researchers discover that in the majority of incidents, the security and privacy of patient health data is compromised by the theft of paper or electronic medical records rather than computer system hacking.

Theft, illegal hacking, and other breaches of protected health information have compromised 29 million medical records in 949 incidents between 2010 and 2013, spelling out a crying need for better data security, according to a report published in JAMATuesday.
"Most data breaches resulted from overt criminal activity," says the report, written by Vincent Liu, MD, of Kaiser Permanente Division of Research, Mark Musen, MD, of Stanford Center for Biomedical Informatics Research, and Timothy Chou of Stanford's Department of Computer Science.
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Unauthorized Breaches of Medical Records on the Rise

Researchers call for enhanced security as more patient information is stored online
By Dennis Thompson
HealthDay Reporter
TUESDAY, April 14, 2015 (HealthDay News) -- Breaches in data security exposed more than 29 million health records to potential criminal misuse between 2010 and 2013, a new study found.
Most of the breaches occurred due to simple theft of a computer, with some criminal grabbing a tablet or laptop that contained sensitive and unencrypted medical records, researchers at Kaiser Permanente in California and Stanford University found.
But electronic health records also are increasingly vulnerable to exposure through hacking, the researchers reported.
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e-Referral Service 'live on 15 June'

14 April 2015   Rebecca McBeth
The new NHS e-Referral Service will go-live on 15 June as part of plans to replace all paper-based referrals.
The Health and Social Care Information Centre has confirmed the new date after a planned November 2014 go-live for the electronic booking service was pushed back to spring 2015.
At the time, the HSICIC said the delay was down to the need for “significant test, assurance and defect resolution activity” to be completed.
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EMRs can be costly in malpractice suits

Posted on Apr 13, 2015
By Mike Miliard, Editor
The numbers drew audible gasps from the audience: $1.7 million here, $7.5 million there.
These were damages hospitals had to pay plaintiffs as a result of malpractice cases whose verdicts hinged directly on the documentation – or lack thereof – in electronic medical records.
At HIMSS15 on Monday, Keith Klein, MD, clinical professor of medicine at UCLA, presented four real-world cases where providers were penalized big bucks thanks to deficient use of their EMRs.
His talk, "Medical-Legal Cases That Went South, Costing Over $30 Million," was a stark reminder that while EMRs can improve care, they can also, when used improperly, leave health organizations vulnerable to huge penalties.
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Technology calls for strategic master design plan for clinical setting

April 14, 2015 | By Susan D. Hall
Technology can pose a challenge healthcare when accommodating new tools in the clinical space, where providers must prioritize patient safety and workflow, according to an article at Hospitals & Health Networks.
Health systems must create a strategic technology master plan that aligns with their vision and mission, Debbie Gregory, R.N., a senior clinical consultant with engineering firm Smith Seckman Reid Inc., says in the article.
She urges organizations to create a technology governance committee to guide the process, to review technology investments and service contracts, and evaluate effectiveness and look for potential duplication. Providers should develop a manageable clinical communication strategy that encompasses nurse call, mobile devices and alarm management and focus on consolidating and streamlining devices.
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IBM, Apple partner to anaylze medical data

April 14, 2015 | By Sean West
As part of its partnership with Apple, IBM is taking advantage of health information gathered by the tech giant's devices to create its new Watson Health unit, designed to provide data analytics, Reuters reported.
Watson Health will aggregate health information from devices and providers in the cloud and give insights to health companies such as Johnson & Johnson and Medtronic. IBM will open a unit headquarters in Boston with 2,000 employees, including 75 medical practitioners.
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Confidentiality Shortcomings With EHR Use for Parents, Teens

Modifications needed for EHRs and PHRs to meet confidentiality requirements of parents, teens
MONDAY, April 13, 2015 (HealthDay News) -- Electronic health records (EHRs) and personal health records (PHRs) require significant modifications in order to meet the confidentiality requirements of specific populations, including parents and adolescents, according to a perspective piece published online April 13 in Pediatrics.
Noting that confidential information shared by adolescent patients and parents is accessible in EHRs and PHRs, Fabienne C. Bourgeois, M.D., M.P.H., from the Boston Children's Hospital, and colleagues discuss ways to overcome these challenges in protecting confidentiality.
The researchers note that EHRs have not been designed to allow all types of information that require special consideration to be flagged as sensitive. Furthermore, PHRs should be designed with different access tools so that users can have different views of the data. These shortcomings have been ignored in the rapid adoption of PHRs. Many health care centers have chosen to discontinue access for parents of adolescents, suppress health information, or revoke all access to the PHR, thereby limiting the risk of disclosure but impeding access to health information. Some centers have a process whereby the adolescent consents to sharing information in the PHR with their parents and can discontinue information sharing at any point due to a confidential visit.
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HIMSS15: Patient Engagement Tug-of-War

by Kate Ackerman, iHealthBeat Editor in Chief Tuesday, April 14, 2015
CHICAGO -- Patient engagement seems to be the catchphrase of this year's Healthcare Information and Management Systems Society's annual conference. It was a major theme in Monday's keynote speech, dominated conversations in conference hallways and was a key part of pitches in the exhibit hall.
On the one hand, it's been a long time coming. Patient advocates for years have been pushing for the country's largest health IT conference to have a bigger patient focus. On the other hand, the timing is interesting, given that CMS on Friday proposed a rule to significantly scale back the meaningful use requirement for patients to electronically download, view and transmit their medical records. Under the proposal, released in response to provider pushback, only one of an eligible professional's patients must do so, down from 5% of patients.
The competing messages have created somewhat of a tug-of-war over what patient engagement really means. 
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Technology and the Patient Experience

Scott Mace, for HealthLeaders Media , April 14, 2015

In addition to cutting-edge tools and devices, some healthcare leaders are finding that even putting consumer feedback on a website can play a role.

This article appears in the April 2015 issue of HealthLeaders magazine.
All too often, technology manages to get in the way of superior patient experiences in healthcare. Despite the benefits technology brings to healthcare, it also can intrude on doctor-patient communications. Too much gathered information remains locked up, unavailable to the public. But at more and more healthcare organizations, attention is shifting to leveraging technology to make the healthcare experience better and more transparent.
Dignity Health, a San Francisco–based system that employs 56,000, has started using Google Glass, along with technology and services provided by startup Augmedix, in patient encounters. "It was with great delight that I got to bring something to bear that actually had a different experience for our physicians," says Davin Lundquist, MD, CMIO for physician integration at Dignity.
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eHealth Exchange Claims Title of Largest U.S. HIE Network

APR 12, 2015 10:37pm ET
The eHealth Exchange, an initiative of the non-profit Healtheway collaborative focused on advancing the implementation of interoperable nationwide health information exchange, has the distinction of being the largest HIE network in the United States.
Healtheway CEO Mariann Yeager told a HIMSS15 Health Information Exchange Symposium on Sunday that as the “largest data sharing network” the eHealth Exchange connects 30 percent of all U.S. hospitals, supports 10,000 medical groups, 8,200 pharmacies, 900 dialysis centers, four federal agencies, and more than 100 million patients around the country—about a third of America’s population.
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HIMSS Survey: Informatics Nurses Leaving Mark on Health IT

APR 12, 2015 10:48pm ET
Informatics nurses are having a positive impact on the health information technology environments in which they work. That’s the finding of a new survey of 576 respondents released at the HIMSS15 conference in Chicago.
The 2015 HIMSS Impact of the Informatics Nurse Survey, which follows up on research conducted in 2009, addresses several areas such as the impact that informatics nurses bring to the clinical systems process at their healthcare organizations, as well as their impact on quality of care and their role with respect to emerging technologies.
According to the survey’s respondents, informatics nurses bring greatest value to the implementation phase (85 percent) and optimization phase (83 percent) of the clinical systems process. While implementation was also the top item identified in the 2009 study, this year’s respondents were much more likely to indicate that informatics nurses would bring value to the optimization process. In addition, those surveyed also reported that informatics nurses have a high degree of impact on workflow, patient safety and user acceptance.
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ONC releases updated health IT privacy and security guide

April 13, 2015 | By Katie Dvorak
The Office of the National Coordinator for Health IT this morning issued a new version of its privacy and security guide to help healthcare providers better understand how to integrate the requirements into their practices.
The Guide to Privacy and Security of Electronic Health Information has new information on Medicare and Medicaid electronic health record incentive programs and on HIPAA Privacy, Security and Breach Notification Rules.
The guide is the first step toward fulfilling the commitment made by the ONC in its Interoperability Roadmap to foster better understanding in the industry of how security regulations in place help support interoperability, Lucia Savage (pictured right), ONC's chief privacy officer, writes at the agency's Health IT Buzz Blog.
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A new way to make EHR notes

Posted on Apr 12, 2015
By Mike Miliard, Editor
Greg Shorr, MD, has some issues with electronic health record user experience.
Generally, he's not a fan of how little they've evolved in recent years: Most systems "pretty much look the way they looked at the turn of the century, in 2000," he says.
More specifically, he has a problem with an original sin of EHR design: the fact that "we have elements in EHRs carried over from days of paper."
That skeuomorphism – tabs, notes – sells short the potential for digitized patient records, says Shorr, chief medical information officer at Apex Data Solutions.
Shorr has more than four decades of EHR development experience; he was on the founding team of the Indian Health Services' customizable health information system, Resource and Patient Management System (RPMA) and is veteran informaticist.
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Even as EHR proficiency rises, enthusiasm dips

Posted on Apr 13, 2015
By Tom Sullivan, Executive Editor, HIMSS Media
Doctors have become better at using electronic health records software in the last two years but, fewer physicians believe EHRs actually improve care. 
Whereas 62 percent of doctors in 2012 believed their EHR helped improve patient care, only 46 percent answered the same way in 2015, according to research that Accenture published on Monday.
More specifically, 72 percent of respondents indicated that their EHR reduced medical errors and 58 percent said they improved outcomes in 2012 – while those numbers dipped to 64 and 46 percent, respectively.
The takeaway? 
“This is a legitimate recognition that improving patient care is about more than just technology,” said Kaveh Safavi, MD, lead of Accenture’s global health business. “The kind of technologies that are going to be useful are bigger than electronic health records.”
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Survey: Docs Better at Using EHRs, But See Little Benefit

APR 13, 2015 2:41pm ET
While most physicians have become adept at using electronic health records in their practices, they are not sold on the ability of EHRs to aid their treatment decisions, reduce medical errors or improve outcomes.
Those are among the findings of a survey from consultancy Accenture of about 600 doctors in the United States. Though Accenture’s 2015 survey found health IT use among physicians has averaged double-digit growth compared to a similar 2012 survey, fewer physicians believe that EHRs have improved treatment decisions (46 percent in 2015 vs. 62 percent in 2012), reduced medical errors (64 vs. 72 percent) and improved outcomes (46 vs. 58 percent).
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CDC to Launch Ebola Mobile Training App for Clinicians

The Centers for Disease Control and Prevention (CDC) will soon launch an Ebola mobile app that provides intuitive coaching to clinicians on CDC’s guidelines for proper use of personal protective equipment (PPE) to prevent transmission of Ebola. 
Powered by 22otters’ innovative, speech-enabled and animated, step-by-step mobile coaching technology, will allow healthcare workers to access easy-to-follow directions for putting on (donning) and removing (doffing) PPE and a powered air purifying respirator (PAPR) to ensure that they are following the latest CDC guidelines to prevent transmission of Ebola (for an example of the app’s coaching visit http://www.22otters.com/video/ppevid.mp4). Following the initial Ebola app release, 22otters will release a variant of the app allowing training progress tracking and content modules customized for providers. 
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EHR Data 'Blocking' Hobbles HIT, Says ONC

John Commins, for HealthLeaders Media , April 13, 2015

Technology vendors, hospitals, and health systems restrict data access under the guise of security and confidentiality, but it can be challenging to identify and differentiate information-blocking from more benign impediments, says an ONC report.

The federal government's $28 billion investment in health information technology interoperability is undermined by vendors and providers who don't want to share data with perceived competitors, a new study says.
In a report requested by Congress, the Office of the National Coordinator for Health Information Technology said that "information blocking" is a significant problem that is likely to get worse as expectations and the capabilities for HIT mature and improve.
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Enjoy!
David.