Sunday, November 29, 2015

It Seems I Was Really Right About The Purpose Of The PCEHR. It Is Nothing To Do With Helping Provide Doctors The Tools They Need.

This tender appeared a few days ago:

Request for Expression of Interest for a Framework for secondary uses of My Health Record.

ATM ID                              Health/041/1516
Agency                              Department of Health
Category                           80101504 - Strategic planning consultation services
Close Date & Time       21-Dec-2015 2:00 pm (ACT Local time)
Publish Date                   26-Nov-2015
The basic description is here:
The Request for Expression of Interest will require respondents to articulate how they will deliver a framework for the secondary use of My Health Record system data (previously ‘Personally Controlled Electronic Health’). Respondents will be expected to include a detailed description of how they would conduct community consultations regarding a draft Framework, to the required standards within the stated timeframes.
The final Framework will enable the System Operator (currently the Secretary, Department of Health) to make informed decisions about the benefits, risks and costs of options presented for secondary uses of My Health Record system data. Respondents should note that the Department intends to assess expressions of interest and short list submissions to identify organisations who have the experience and expertise required. 
Here is a little bit more detail:
From the tender document:
2.1    The Commonwealth of Australia acting through the Department of Health (‘the Department’) is responsible for better health and wellbeing for all Australians. The Department aims to achieve its vision through strengthening evidence-based policy advice, improving program management, research, regulation and partnerships with other government agencies, consumers and stakeholders.
2.2    Secondary use of data from the My Health Record (previously called the ‘Personally Controlled Electronic Health Record,’ or PCEHR) system for research, policy, system use, quality improvement and evaluation activities can support the capacity, quality and safety of healthcare and the healthcare system and lead to innovative approaches to healthcare.
2.3    A framework for the secondary use of data will enable the System Operator (currently the Secretary, Department of Health) to make informed decisions about implementation of proposed arrangements for the secondary use of data including community consultation, risks, benefits and costs of options presented.
2.4    The final framework will ensure that personal data contained in the My Health Record system will remain secure and always be de-identified for secondary use purposes.
2.5    The final framework will also provide assurance that the My Health Record system data is available for the purposes provided for by the Personally Controlled Electronic Health Record Act 2012 (note that this Act will become the My Health Records Act 2012 in early December 2015, following Royal Assent).
----- End Extract.
Funny that just last week I said:
“If you are looking to provide clinical utility for most of the stated purposes of the PCEHR all that is needed is the Shared Summary. Of course you can create a huge pile of results and prescriptions but how often, if ever, is anyone going to actually wade through all the junk to find something relevant, rather than just ring the relevant provider etc?
The only reason a national system would want the results of billions of blood test results has to be for some - unannounced - data mining project or the like.”
See here:
Well it has now the plan been announced - and even worse where is the Tender on making the PCEHR more useful and where is the Tender on evaluation of the PCEHR?
It is clear the Government has no interest in supporting the quality and safety of care as a priority - rather than setting up a tool to assist them micro-managing and controlling clinical practice.
I am sure the RACGP and the AMA will now understand just why the Government is trying to compel use of their hopeless system by clinicians - to obtain the information with which they can control what goes on - and not for any clinical - but rather financial reasons. I seriously doubt they will fall for that!
Everyone should also remember that de-identification in this day and age is getting to the stage of a practical impossibility - so to trust any framework developed for government is pretty unwise.
For individuals - putting your information into this national system for the Government to exploit - without your consent - is just folly in my view. It may, at any time, come back to bite.
This lot simply can’t lie straight in bed and are not to be trusted. For five years they have claimed the PCEHR was a clinical care tool - and now we know that was a ‘whopper’!

AusHealthIT Poll Number 298 – Results – 29th November, 2015.

Here are the results of the poll.

Should Government eHealth Incentive Payments (ePIP) Be Contingent On GPs Uploading Patient Summaries To The PCEHR?

Yes 10% (8)

No 89% (71)

I Have No Idea 1% (1)

Total votes: 80

Again a pretty decisive poll. It would seem there is not much support of this sort of approach to achieving higher usage of the PCEHR!

Good to see such a great number of responses!

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


Saturday, November 28, 2015

Weekly Overseas Health IT Links -28th November, 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.

Data Breaches: What and When to Disclose

NOV 20, 2015 2:37am ET
When a healthcare organization experiences a breach, there is so much to do, so many issues to consider. One is figuring out how much information to give the public and how quickly to give it.
Health insurer Anthem gave various estimates of the number of affected individuals following its massive hack as it tried to quickly get information out to the public and got some criticism for the changing numbers, but the company was still about 10-14 days away from being ready to start mailing notification letters when the hack was announced.
Other organizations have been criticized for not moving fast enough to go public. In many cases, local police or the FBI ask an organization to delay announcing a breach until their investigation is over, says Donna Wilson, chair of the privacy and data security practice at the law firm Manett, Phelps & Philips. “The intent is to capture bad guys and determine what they’ve done.” It can be a no-win scenario, she adds.

Medtronic enables pacemaker monitoring by smartphone

Posted on Nov 20, 2015
By Mike Miliard, Editor
The new MyCareLink Smart Monitor from Medtronic, just approved by the FDA, enables patients with implantable pacemakers to use their smartphones to transmit secure data from their pacemakers to their physicians.
The MyCareLink app is available for free on Android and Apple platforms and works in tandem with a physician-prescribed portable device reader.
When the monitor is connected to cellular or Wi-Fi service, patients can initiate transmission of pacemaker data, uploading it to Medtronic's secure CareLink remote monitoring network.

PwC: Technology a linchpin to primary care's future

November 20, 2015 | By Katie Dvorak
Technology will be one of the key drivers when it comes to "revving" up the role of primary care, according to a recent PwC report.
The report looks to the future of the healthcare economy, and the makeover primary care needs as the industry moves from a fee-for-service system to one based on value.
For the report, PwC interviewed 25 executives from healthcare, trade associations and academia; researchers also surveyed 1,500 clinicians and 1,000 consumers on the future of primary care.
November 18, 2015

Telemedicine Market Nearly Doubled Since 2011, Group Says

By Alex Ruoff
Nov. 17 — The number of companies offering telemedicine services has nearly doubled in the past four years, the head of research for the country's largest health IT industry group said Nov. 17.
The number of technology vendors offering telemedicine services grew from 45 to 85 between 2011 and 2015, Brendan FitzGerald, the director of research for HIMSS Analytics, said during an online presentation.
Growth in the telemedicine industry over the past four years could be even greater than HIMSS is reporting, FitzGerald said. He said telemedicine is difficult to define because it incorporates video conference tools for health-care providers, telephones and possibly fitness devices.

Apixio Launches Cognitive Computing Platform That Extracts and Analyzes Patient Data

November 19, 2015
by Heather Landi
Apixio Inc., a San Mateo, Calif.-based data science company, announced the launch of its Iris cognitive computing platform designed to bring advanced data insights into healthcare by extracting and analyzing patient data from electronic medical records (EMRs).
The Iris platform uses Apixio's proprietary data extraction tools and machine learning algorithms to create a self-learning system that’s designed, according to the company, to give healthcare providers better access to patient data to create a more accurate care profile, thus improving the quality and efficiency of healthcare. IBM’s Watson also applies a cognitive computing platform to healthcare.
The U.S. healthcare industry produces 1.2 billion clinical care documents and most of the information need for patient care is in unstructured documents, according to HIMSS Analytics.

Feds Want mHealth Developers Better Educated on HIPAA

NOV 19, 2015 7:37am ET
The HHS Office for Civil Rights, which enforces the HIPAA privacy, security and breach notification rules, wants mobile health developers—as well as developers of other health IT products—to become more familiar with HIPAA.
OCR has rolled out a new portal, hosted by crowdsourcing platform vendor IdeaScale, to help developers learn about the rules and submit questions or offer comments, with a subtle warning that the portal should be used.
“Building privacy and security protections into technology products enhances their value by providing some assurance to users that the information is safe and secure and will be used and disclosed only as approved or expected,” the agency explains. “Such protections are sometimes required by federal and state laws, including the HIPAA privacy, security and breach notification rules. Yet, many mHealth developers are not familiar with the HIPAA rules and how the rules would apply to their products.”

Cybersecurity: best practices for fighting insider threats

Posted on Nov 19, 2015
By Mike Miliard, Editor
Since the first Internet worm in 1988, Randy Trzeciak, technical director of the CERT Insider Threat Center at Carnegie Mellon University's Software Engineering Institute, has been on the front lines of cybersecurity.
With more than 25 years' experience in software engineering, information security and database design, he's hand an up-front seat for the evolution of security threats over the past few decades. Since 2001, Trzeciak and his colleagues at CERT have been researching the insider threats; to date it has collected and analyzed more than 1,100 incidents where insiders have intentionally or un-intentionally harmed an organization.
From that insight, he's identified patterns of technical and non-technical behaviors organizations could integrate into their insider threat anomaly detection capabilities. At the Healthcare IT News Privacy & Security Forum in Boston on Dec. 1, he'll discuss those – spotlighting the different types of threats posed by insiders and describing best practices for mitigating them.

Axed patient feedback service cost £1.2m

Rebecca McBeth
16 November 2015
NHS England’s abandoned patient feedback service Care Connect cost on average £1,600 for every patient query resolved during the pilot phase.
A Freedom of Information request by Digital Health News reveals that the total cost of the scheme between 2013-15 was £1.25 million.
Pioneered by NHS England’s national director for patients and information Tim Kelsey, it allowed patients to go online, ring a telephone number, text or use social media to log concerns, ask a question or provide feedback on their experiences
Twenty-two trusts in London and the North of England piloted the service between July 2013 and February 2014. Care Connect case handlers completed 760 cases and dealt with another 220 “miscellaneous questions” via text, the FOI response reveals.

Doubt cast on value of computerised CBT

Thomas Meek
17 November 2015
Computer courses to treat depression are likely to be ineffective, according to research by the University of York.
A study published in the British Medical Journal says that participants offered computerised cognitive behaviour therapy experienced “no additional improvement in depression” when compared with patients who received their usual care from a GP after four months of treatment.
The two-year REEACT trial included 691 patients with depression selected from 83 general practices across England.
Patients were randomised to receive 'usual GP care for depression' or 'usual GP care plus' one of two computerised CBT programme recommended by the National Institute for Health and Care Excellence.

Irish hospital plans records access

Thomas Meek
18 November 2015
A hospital in Ireland plans to give patients access to their medical records by this time next year.
The private Galway Clinic is working with its electronic patient record provider, Meditech, to allow patients to see the data held on its Meditech 6.1 system, which is due to go live in November 2016.
Raphael Jaffrezic, chief information officer at Galway Clinic, said that giving patients access to this information, which is usually only accessible by clinicians, will help to “empower patients” to take control of their own care.
“We really want to give patients access to their record to engage them with their treatment,” Jaffrezic told Digital Health News.

End of NPfIT in London and the South

Rebecca McBeth
19 November 2015
The National Programme for IT has come to an end in London and the South with the exit of the final trust to deploy Cerner Millennium from the BT data centre.
All of the trusts that received Cerner’s electronic patient record system have switched to individual supplier contracts with the company or with new providers.
Seventeen trusts that received Millennium from BT as part of NPfIT had to exit the BT data centre and move to individual contracts before 31 October.
A contract extension had to be enacted for North Bristol NHS Trust after it failed to exit on time, but it went live with its Lorenzo EPR from CSC on 15 November.

Meaningful Use Stage 3 Not Set in Stone; Make Your Voice Heard

by Bethany Jones and Naomi Levinthal Thursday, November 19, 2015
Anantachai (Tony) Panjamapirom, senior consultant at The Advisory Board Company, and Ye Hoffman, senior analyst at The Advisory Board Company, contributed to this Perspective.
On Oct. 16, CMS published a long-awaited final rule that modifies the Electronic Health Record Incentive Program (aka meaningful use) requirements for 2015 through 2017 and establishes requirements for Stage 3, which starts in 2018. While CMS "finalizes" Stage 3 requirements within this final rule, the agency has signaled that these regulations are not set in stone. The public may submit feedback for the Stage 3 requirements until Dec. 15.
This public comment opportunity may be in response to the chorus of industry associations and lawmakers who recently have called for a delayed start to Stage 3. While CMS does not intend to propose stages beyond Stage 3, the program continues until at least 2024, as it is a component of the new Medicare payment methodology -- the Merit-based Incentive Payment System -- for eligible professionals. The meaningful use program appears to continue as-is for eligible hospitals. CMS encourages providers to comment on both Stage 3 requirements and the transition process to MIPS.

Seeking Interoperability in a Sea of Data

Scott Mace, for HealthLeaders Media , November 19, 2015

While it has been an elusive goal for years, the costs associated with not having standardization are mounting and "interoperability is becoming the main act" for healthcare leaders, says an HIT expert.

This article appears in the November 2015 issue of HealthLeaders magazine.
Interoperability of electronic health records and other healthcare IT systems remains elusive. Healthcare organizations clamor for it and the federal government voices support, but until very recently providers and vendors have lacked incentive to do more than create isolated networks. Yet many providers around the country are creating their own workarounds to achieve at least partial interoperability. These efforts take a lot of work, but technology leaders undertake them in pursuit of cost savings and patient safety.
The Institute for Electrical and Electronics Engineering defines interoperability as "the ability of two or more systems or components to exchange information and to use the information that has been exchanged," and that is the commonly agreed-on aspiration of all stakeholders in healthcare.

Telehealth Saves Money, Improves Patient Engagement and Outcomes

NOV 18, 2015 7:23am ET
First Health of the Carolinas, a four-hospital delivery system serving the mid-section of North Carolina, was an early adopter of home-based telehealth patient monitoring services in 2005.
The organization got multiple federal and private grants over the years, expanding to other care settings beyond the home. But other settings used different remote monitoring systems and the time came to standardize the technology so programs would not conflict with each other, says Patty Upham, director of the FirstHealth Care Transitions unit.
First Health in October 2014 adopted a remote monitoring platform from Health Recovery Solutions, starting with a 25-unit pilot program. Today, 160 units are being used as needed to monitor chronically ill patients, and then rotated to other homes, and more than 800 patients have been served. When setting up the system, the organization experienced minor video and firewall issues but they were quickly worked through, Upham says. “We’ve been doing this since 2005 so we’re pretty experienced.”

'Post-EHR era'? Not so fast

Posted on Nov 18, 2015
By Mike Miliard, Editor
Many have commented these past couple years (including your humble correspondent) about the "post-EHR era." In the half-decade since Stage 1 meaningful use, the story goes, health providers all now have their electronic health records installed, humming and finely-tuned and are now turning their attention to newer and more advanced species of IT - to better prepare them for the realities of care coordination and analytics-driven population health management.
But a recent study in Health Affairs suggests the truth is a bit more complicated than that.
In "Electronic Health Record Adoption In US Hospitals: Progress Continues, But Challenges Persist," researchers show how EHRs may not be quite as widespread and commonplace as some might think.

Special report: electronic document management

Docs for docs
As it moves towards paperless working by the end of the decade, the NHS will need both electronic patient record and electronic document management systems. But what, exactly, is the role of EDM? And why has uptake been relatively slow? Paul Curran reports.
Back in January 2013, health secretary Jeremy Hunt called for the NHS to become ‘paperless’ by 2018.
That aim has since been refined, so the health service is now charged with having paperless working in core services by this date and fully digital and interoperable records by 2020.
Some of this will be achieved by implementing electronic patient records; NHS England’s bid to the Treasury for a further round of technology funding indicates that some £2 billion will be needed to complete their roll-out over the next five years.

Five Telemedicine Trends Transforming Health Care in 2016

Article By:
Nathaniel M. Lacktman
Telemedicine is a key component in the health care industry shift to value-based care as a way to generate additional revenue, cut costs and enhance patient satisfaction. One of the biggest changes to health care in the last decade, telemedicine is experiencing rapid growth and deployment across a variety of applications.
The quick market adoption of telemedicine is fueled by powerful economic, social, and political forces — most notably, the growing consumer demand for more affordable and accessible care. These forces are pushing health care providers to grow and adapt their business models to the new health care marketplace.
Simultaneously changing is the misconception that telemedicine creates a financial strain or relies on grant funding. Smart health system leadership are creating sustainable telemedicine arrangements that generate revenue, not just cost savings, while improving patient care and satisfaction. Research conducted by the American Telemedicine Association reveals that telemedicine saves money for patients, providers, and payers compared to traditional health care practices, particularly by helping reduce the frequency and duration of hospital visits.

Federal privacy law lags far behind personal-health technologies

November 17
Jacqueline Stokes spotted the home paternity test at her local drugstore in Florida and knew she had to try it. She had no doubts for her own family, but as a cybersecurity consultant with an interest in genetics, she couldn’t resist the latest advance.
At home, she carefully followed the instructions, swabbing inside the mouths of her husband and her daughter, placing the samples in the pouch provided and mailing them to a lab.
Days later, Stokes went online to get the results. Part of the lab’s Web site address caught her attention, and her professional instincts kicked in. By tweaking the URL slightly, a sprawling directory appeared that gave her access to the test results of some 6,000 other people.
The site was taken down after Stokes complained on Twitter. But when she contacted the Department of Health and Human Services about the seemingly obvious violation of patient privacy, she got a surprising response: Officials couldn’t do anything about the breach.

Batea: a Wikipedia hack for medical students

Posted on Nov 17, 2015
By Tom Sullivan, Editor-in-Chief, Healthcare IT News
Medical students use Wikipedia in great numbers, but what if it were a more trusted source of information? 
That's the idea behind Batea, a piece of software that essentially collects data from clinical reference URLs medical students visit, then aggregates that information to share with WikiProject Medicine, such that relevant medical editors can glean insights about how best to enhance Wikipedia's medical content.
Batea takes its name from the Spanish name for gold pan, according to Fred Trotter, a data journalist at DocGraph.

Tie Financial Incentives to Data Exchange, Fed Advisers Say

NOV 16, 2015 7:47am ET
A Health IT Policy Committee task force has made four recommendations targeting financial and business barriers that are holding back the interoperability of healthcare information.
Paul Tang, M.D., chair of the interoperability task force, acknowledged that none of the recommendations are “likely to change the facts on the ground overnight.” But he argued that alignment of incentives for providers and vendors could foster business practices that result in routine interoperable data exchange.
According to Tang, a key inhibitor to health information exchange has been economic incentives—which he asserts at best have not encouraged, and at worst have even discouraged, sharing of clinical information among providers. Part of the problem is traditional fee-for-service payments models do not create incentives to make HIE processes and technologies a higher priority.

EHR Adoption for Small Hospitals Continues to Lag

NOV 16, 2015 7:54am ET
Electronic health record adoption rates are on the rise among U.S. hospitals, with 75 percent of hospitals now having adopted at least a basic EHR system—up from 59 percent in 2013. However, small and rural hospitals continue to lag behind their larger, urban counterparts.
Those are among the findings of researchers who published the results of their analysis of 2014 American Hospital Association Annual Survey–IT Supplement data in the November issue of Health Affairs, concluding that nationwide hospital EHR adoption is “in reach” but requires attention to small and rural hospitals, which have “persistently lagged in their adoption rates.”
Researchers point out that since 2008 there has been more than a 10-percentage-point gap between small and large hospitals in adoption of at least a basic EHR system. As of last year, small hospitals had an EHR adoption rate of 68 percent, compared with 85 percent for large hospitals, while 66 percent of rural hospitals last year adopted at least a basic EHR system, versus 78 percent of urban hospitals.

Study finds at-home telemedicine treatment for PTSD viable

November 16, 2015 | By Susan D. Hall
Telemedicine sessions at home can be a viable way to treat post-traumatic stress disorder in active-duty military personnel, according to a preliminary study published at Telemedicine and e-Health.
The study involved 10 previously deployed soldiers who agreed to complete eight sessions of behavioral activation therapy, a well-established treatment for depression, by telemedicine. All had experienced trauma during deployments to Iraq or Afghanistan.
During a pre-treatment session, a member of the research staff came to each soldier's home to familiarize him or her with the equipment and check the network connection--they used their own Internet service.
Two participants dropped out of the study, saying sessions took too much time away from their Army duties. One dropout, however, could be related to technical difficulties that soldier experienced, according to the paper.

AEGIS introduces Touchstone Project to help providers adopt interoperability standards

Written by Max Green | November 13, 2015
Organizations adopting Health Level Seven's Fast Healthcare Interoperability Resources standards for exchanging EHRs have a new tool to help them with a smooth implementation — AEGIS' Touchstone Project.
Touchstone is a cloud-based testing platform designed to help guide providers through the implementation of FHIR to attain a high degree of interoperability and conformance. After one month of FHIR testing, Touchstone has performed more than 185 unique testing executions.

California Researchers Eye Robots To Help People Age at Home

by Lisa Zamosky, iHealthBeat Contributing Reporter Monday, November 16, 2015
SAN DIEGO -- University of California-San Diego researchers are working to develop robots that can listen, speak and react to human needs.
Earlier this month, the university launched its Contextual Robotics Institute, a multi-disciplinary effort to develop robotic technology with artificial intelligence that can be used to help the country's growing elderly population "age in place."  
Rajesh Gupta -- professor and chair of the computer science and engineering department at UC-San Diego -- said the new institute's work is unique in that it draws heavily on cognitive sciences with the goal of developing robots that can read emotions and respond to people more like humans.