Saturday, August 17, 2013

Weekly Overseas Health IT Links - 18th August, 2013.

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.

Simple Steps to Reduce EHR Clicks

AUG 7, 2013 10:33pm ET
Mastering electronic health record technology is a difficult process and it demands an ongoing commitment from ambulatory practices and their EHR users. No matter how few ‘clicks’ it takes providers to prescribe a medication, review lab results, or document a visit in their EHR system, most think it is too many.
Many ambulatory practices become complacent and feel resigned to accept their EHR system after the ‘go-live’ phase. They fail to develop an ongoing process to refine and optimize the system to better suit their evolving patterns of use. This static approach often leads to frustration, complaints, and a feeling that users have to cater to the system’s needs.

Clinical informatics critical to reform

Posted on Aug 09, 2013
By John Andrews, Contributing writer
The growth and maturity of clinical informatics over the past decade has been a prime catalyst in positioning the healthcare industry for the changes posed by reform measures. By understanding the process of analytics, clinical informatics specialists say healthcare providers have the insight necessary to make the process adjustments in the future.
"Clinical informatics will serve as the foundation for all aspects of successful healthcare reform initiatives as they are instituted," said Greg Chittim, director of analytics and performance improvement for Burlington, Mass.-based Arcadia Solutions. "As the baby boomer generation continues to age and move away from commercial insurance to CMS and Medicare Advantage programs, clinical informatics will ensure that seniors are cared for and transitioned consistently across the landscape of their primary care physicians, hospitals, long-term care facilities, and hospice centers."

Telemedicine improves pediatric care in rural ERs

August 9, 2013 | By Dan Bowman
Care quality for pediatric patients in rural emergency rooms improved "significantly" when delivered via telemedicine consultations, according to a study published online this week in the journal Critical Care Medicine.
For the study, researchers from the University of California Davis Children's Hospital examined ER cases for 320 seriously ill or injured patients 17 years old and younger between 2003 and 2007. The patients all were treated at hospitals in Northern California outfitted with videoconferencing units. ER physicians used the tools to work with pediatric critical-care specialists at UC Davis Children's Hospital.

KLAS: Decision support surveillance tools 'significantly' impact clinical outcomes

August 9, 2013 | By Dan Bowman
Clinical decision support surveillance tools have a moderate to significant impact on clinical outcomes for a majority of providers recently surveyed by Orem, Utah-based research firm KLAS.
In a report published this week, KLAS polled more than 140 providers about their use of CDS surveillance tools from 10 vendors. The vendors were divided into three categories: pharmacy-focused surveillance; enterprise-wide surveillance and electronic medical record surveillance.

ONC Releases HIE, Interoperability Strategy

Written by Helen Gregg | August 08, 2013
The Office of the National Coordinator for Health Information Technology has released its strategy for increasing the use of health information exchanges and fostering interoperability.
The strategy announcement comes as a result of a Request for Information released by ONC in March. During a webinar, representatives from ONC outlined responses received from the request and the office's resulting strategies and goals for HIEs and improved interoperability.

Will Health Information Exchange Become Medicare Payment Criterion?

Government could tie Medicare reimbursement to information sharing by providers, suggests CMS/ONC report.
The use of interoperable electronic health record (EHR) systems to share information could eventually become part of reimbursement criteria in the Medicare and Medicaid programs, according to a new position paper from the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS).
The report, "Principles and Strategy for Accelerating Health Information Exchange (HIE)," states the government's principles in three categories: accelerating health information exchange, advancing standards and interoperability, and consumer/patient engagement. The strategies were informed by the stakeholder comments that ONC received in response to a request for information it issued earlier this year.
To accelerate the use of interoperable systems, the paper said, "HHS [Department of Health and Human Services] will implement policies that could encourage HIE incrementally and could evolve from incentive and reward structures to ultimately considering HIE a standard business practice for providers."

Let the Left Hand Know What the Right Is Doing

A Vision for Care Coordination and Electronic Health Records

Despite the potential for electronic health records to help providers coordinate care, the current marketplace has failed to provide adequate solutions. Using a simple framework, we describe a vision of information technology capabilities that could substantially improve four care coordination activities: identifying collaborators, contacting collaborators, collaborating, and monitoring. Collaborators can include any individual clinician, caregiver, or provider organization involved in care for a given patient. This vision can be used to guide the development of care coordination tools and help policymakers track and promote their adoption.

ONC Sets the Stage for Higher Focus on HIE

AUG 7, 2013 2:42pm ET
After considering more than 200 comments to a March 2013 request for information on ways to accelerate health information exchange, the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services have identified a set of principles to guide new strategies.
The principles in three categories--Accelerating HIE, Advancing Standards and Interoperability and Consumer/Patient Engagement--work toward three core goals: To improve the patient experience, improve population health management and reduce the total cost of care, all facilitated by supporting new models of payment. The next step is to develop policies and programs so that information flows to where it needs to be and supports care coordination, said Farzad Mostashari, M.D., national HIT coordinator, during a Web presentation on August 7.

Meaningful Use progress 'uneven' for hospitals

August 5, 2013 | By Marla Durben Hirsch
The attestation outlook for hospitals is not quite as sunny as the government has indicated, with smaller, more rural hospitals struggling to meet Meaningful Use and at risk of incurring penalties, according to a new study in the August issue of Health Affairs.
The researchers, from Mathematica Policy Research and elsewhere, found that there was a "significant" increase in the percentage of hospitals receiving incentive payments for achieving Meaningful Use between 2011 and 2012--from 17.4 percent to 36.8 percent.
However, the majority of eligible hospitals still did not achieve Meaningful Use in the first two years of the program, according to the researchers. Moreover, hospitals are making "uneven" progress, typically associated with the "digital divide," with larger, teaching, for profit and Northeast hospitals the most successful.

GSK switches on to electronic medicine

By Clive Cookson, Science Editor
The prospect of using electronic implants to treat a huge range of diseases from arthritis and asthma to diabetes and high blood pressure has taken a big step closer to reality with the backing of one of the world’s largest pharmaceutical companies.
GlaxoSmithKline is betting on this new vision of medicine – curing patients through electronics instead of chemicals – by launching a $50m venture capital fund to “invest in companies that pioneer bioelectronic medicines and technologies”, while building its own research expertise in bioelectronics.
The ambition of Moncef Slaoui, GSK head of research and development, is “to have the first medicine that speaks the electrical language of our body ready for approval by the end of this decade”.

Next ONC chief could be in plain sight

Posted on Aug 07, 2013
By Bernie Monegain, Editor
The announcement Aug. 6 that Farzad Mostashari, MD, would be stepping down from his job as national coordinator for health information technology this fall  led much praise about his passion for the work, and his many achievements.
However, no one who spoke with Healthcare IT News was willing to offer names of potential candidates to fill what many say are extraordinarily big shoes.
Bill Spooner, vice president and chief information officer of Sharp Healthcare in San Diego, said he couldn't immediately suggest a successor, but did offer that, "I would like to see someone from community healthcare, where adoption and patient engagement are still challenging, lead ONC."

Big data's promise, constraints: Part 2

Posted on Aug 07, 2013
By John W. Loonsk, MD, CMO CGI Federal
In Part 1 of this series ( we provided a loose definition of big data, described some of the ways that big data tools can be used in health, and identified the high degree of alignment of big data capabilities with quality and efficiency analytics as well as observational health research.
Big data tools also show great promise in managing the copious amounts of health data emanating from patients via social networking and home monitoring, as well as many areas that have a genomic data component. We also pointed out the irony that while quality and efficiency uses can frequently fall under HIPAA “treatment, payment, and operations,” patient identifiable data for research by virtue of being “designed to develop or contribute to generalizable knowledge,” must address much more strenuous constraints.
Some big data analytics and observational research can also be done on HIPAA de-identified data. But the traditional issues with de-identified data will be particular obstacles for other big data outcomes. Big data tools and data sets, for example, will increasingly bring re-identification of HIPAA de-identified data to the fore. When larger and broader publicly available data sets are joined with newly de-identified data, existing de-identification approaches become even less durable and identities become easier to re-establish.

ONC, CMS outline strategy to 'accelerate' interoperability

August 7, 2013 | By Marla Durben Hirsch
The Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT, in issuing a response to their Request for Information (RFI) on accelerating health information exchange (HIE) and interoperability Wednesday, released their principles and strategy, taking an "incremental yet comprehensive" approach and steps to "encourage" widespread "voluntary" use.
"This is complicated but we are making progress," National Coordinator for Health IT Farzad Mostashari said on a webinar announcing the strategy. "It took a decade for ATMs to be interoperable, and they only use seven data fields."

ONC Research: HIE Between Providers Jumps Up Significantly

August 6, 2013
New research from the Office of the National Coordinator for Health Information Technology (ONC) revealed that health information exchange (HIE) between hospitals and providers has jumped up 41 percent between 2008 and 2012.
The research was authored by Farzad Mostashari, M.D., National Coordinator for Health IT, who has just confirmed that he is stepping down from the position in the fall. Overall, Mostashari and his team of researchers from the ONC found that approximately 60 percent of hospitals actively exchanged electronic health information with providers and hospitals outside their organization in 2012.

Study: Compensation, Workload Prevent Docs from Using Electronic Communication

August 6, 2013
Electronic communications in clinical care will likely not be widely adopted by primary care physicians unless patient workloads are reduced or the doctors are paid for the time they spend using them, according to research from Weill Cornell Medical College, Cornell University's medical school based in New York.
The push for electronic communications has been widely endorsed as a means to improve quality of care by, for example, e-mailing test results to patients, or managing clinical conditions without requiring a time-consuming and costly office visit. And the study found that there is improved patient satisfaction through electronic communication with doctors.
Still, few physicians use it. By 2008, the latest year for which figures are available, less than 7 percent of physicians regularly communicated with their patients electronically, according to Weill Cornell investigators. 

EMRs Lower Odds of Heart Failure Readmission

Published: Aug 6, 2013 | Updated: Aug 7, 2013
By Cole Petrochko, Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Action Points

  • Heart failure patients whose EMR kept track of risks for 30-day readmission had a significant reduction in readmission rates.
  • Note that there was no difference in readmission rates before and after the intervention period among those admitted with acute MI or pneumonia.
When electronic medical record (EMR) data was used to assess of risks of 30-day readmission for hospitalized heart failure patients, there was a significant reduction in readmission rates, researchers found.
The EMR-based intervention allowed healthcare professionals to allocate intensive evidence-based interventions to those at greatest risk, which was associated with a significant readmission reduction versus the rate of readmission prior to the intervention (21.2% versus 26.2%, P<0.01), according to Ruben Amarasingham, MD, of the University of Texas Southwestern Medical Center in Dallas, and colleagues.

Health IT outsourcing demands rise

Posted on Aug 06, 2013
By Bernie Monegain, Editor
The global healthcare IT outsourcing market is forecast to grow at a compound annual growth rate of 7.6 percent, to reach $50.4 billion by 2018 from $35 billion in 2013, according to a new RnR Market Research report.
The health insurance industry, healthcare systems industry, and pharmaceutical industry are driving the outsourcing market. These industries are looking to the outsourcing model to enhance their focus on core business, reduce operational and maintenance costs, increase access to IT skilled and trained staff – further reducing hiring and training costs – share risk, and quickly implement new technologies, according to the report: Healthcare IT Outsourcing Market – By Application [Provider (EHR, RCM, LIMS) Payer (CRM, Claims Management, Fraud Detection, Billing) Life Science (ERP, CTMS, CDMS) Operational (SCM, BPM) & Infrastructure (IMS, Cloud Computing)] & Industry – Global Forecast To 2018.

Docs who email are still a rare breed

Posted on Aug 06, 2013
By Mike Miliard, Managing Editor
Despite the fact that patients are clamoring for it and health organizations see its benefits, electronic communication from primary care physicians won't become commonplace until doctors' workloads are reduced – or they get paid extra for emails and phone calls.
That's according to a new study from Weill Cornell Medical College, which examined six different medical practices that routinely use electronic communication for clinical purposes. The report appears in the August issue of Health Affairs.
"Leaders of medical groups that use electronic communication find it to be efficient and effective – they say it improves patient satisfaction and saves time for patients," said Tara F. Bishop, MD, assistant professor in the Department of Public Health and Medicine at Weill Cornell Medical College, in a statement. "But many physicians say that while it may help patients, it is a challenge for them.

EMR-using patients more loyal to docs

Posted on Aug 06, 2013
By Diana Manos, Senior Editor
Patients who have used electronic medical records are significantly more satisfied with their doctors overall, according to a new study.
According to a study released Monday by Aeffect and 88 Brand Partners, patients also express higher satisfaction across multiple specific dimensions of care, such as ease of access to information and clarity and thoroughness of communication.
Patients who use EMRs also believe they receive better quality of care (82 percent), the study found. EMR users believe they engage in clearer and more responsive communications with their physicians, and can gain access to information easier than non-EMR users.
An estimated 24 percent of Americans surveyed are currently using EMRs to check their test results, order prescription refills and make appointments. Yet another 52 percent say they are interested in using EMRs but currently are not accessing these systems for a variety of reasons, the study found.

Patient platform to save £1 billion

5 August 2013   Lis Evenstad
The integrated customer service platform being developed by NHS England is expected to save the NHS more than £1 billion by encouraging patients to get involved in online self-care.
A report presented to the Informatics Services Commissioning Group’s July board meeting, says that the platform, dubbed “the daughter of NHS Choices”, will contribute £1 billion towards the £2.9 billion NHS England estimates it can save through promoting ‘digital first’ in healthcare.
“The programme will deliver the most cost-effective health and care service (£0.11 per interaction) by catalysing Digital First (reducing face-to-face and paper-based interactions), stimulating the health technology market and increasing the percentage of the population who are informed, involved and engaged with their health,” says the paper.

3 reasons docs aren't communicating electronically with patients

August 6, 2013 | By Dan Bowman
Although the use of electronic communications by some physician practices has led to improved efficiency and patient satisfaction, widespread adoption of such technology remains elusive, according to research published this week in Health Affairs.
For the study, researchers from Weill Cornell Medical College in New York spoke with leaders at 21 medical groups--as well as staff for six of those groups--all of which use electronic tools to communicate with patients "extensively." By and large, patient satisfaction and workflow improved for the facilities, with several respondents touting the efficiency of sending emails to patients.

Mostashari to step down; health IT leaders hail ONC chief's efforts

Posted: August 6, 2013 - 1:30 pm ET
Dr. Farzad Mostashari will step down this fall as head of the Office of the National Coordinator for Health Information Technology at HHS, where he's had a big hand in guiding federal health IT policy for the past four years, including the challenging rollout of meaningful use rules for electronic health-record systems.
The announcement came in an e-mail to staff from HHS Secretary Kathleen Sebelius.
“During this time of great accomplishment, Farzad has been an important advisor to me and many of us across the department,” Sebelius said. “His expertise, enthusiasm and commitment to innovation and health IT will surely be missed. In the short term, he will continue to serve in this role while a search is underway for a replacement. Please join me in wishing Farzad all the best in his future endeavors.”

ONC's Mostashari Announces Departure

John Commins, for HealthLeaders Media , August 7, 2013

No clear reason or firm date was given for Farzad Mostashari's plan to exit the Office of the National Coordinator. His unexpected move comes at a critical time as HHS grapples with complex issues over the implementation of Meaningful Use Stage 2.
The physician leading the federal government's sweeping and aggressive efforts to implement healthcare information technology has announced that he will leave the job this fall.
After four years at the Office of the National Coordinator for Health Information Technology  and leading the office since 2011, Farzad Mostashari, MD, ScM, made the unexpected announcement Tuesday in a letter to colleagues.
"It is difficult for me to announce that I am leaving. I don't know what I will be doing after I leave public service, but be assured that I will be by your side as we continue to battle for healthcare transformation, cheering you on," Mostashari wrote.
He declined to say why he was leaving and did not say what he planned to do after leaving the office. Officials at HHS declined to comment on the reasons for his departure.

Disconnected Health Data 'Beyond Absurd,' Says Innovator and Patient

Scott Mace, for HealthLeaders Media , August 6, 2013

Health data from medical devices and electronic health records remains frustratingly siloed beyond the reach of individuals and analytical tools. Anna McCollister-Slipp, co-founder of a real-time analytics platform, is working to change that.
Patients want it. Innovators want it. Providers want it. What is it? Data, liberated from electronic health records, and medical devices. Not to mention millions of records and documents still trapped in paper form.
Getting this data into a form where it can be browsed, analyzed, and applied to a thousand new theories about disease and treatment is no small feat. Doing it while the healthcare system as we know it is being reinvented is even more challenging.

Hospital HIE Use Up 41%, ONC Says

John Commins, for HealthLeaders Media , August 6, 2013

Six in 10 hospitals routinely swapped electronic health information with healthcare providers and health systems beyond their walls in 2012, says a study from the Office of the National Coordinator for Health Information Technology.
Health information exchanges between hospitals and other providers jumped 41% from 2008 to 2012, according to federal government research published this week in Health Affairs.
The study, led by National Coordinator for Health Information Technology, Farzad Mostashari, MD, examined national surveys and found that six in 10 hospitals routinely swapped electronic health information with providers and hospitals beyond their walls in 2012.
"EHR adoption and HIE participation were associated with significantly greater hospital exchange activity, but exchanges with providers outside the organization and exchanges of clinical care summaries and medication lists remained limited," the study said.  

Electronic messaging key to state's control of disease outbreak

August 5, 2013 | By Ashley Gold
Electronic messaging and media attention allowed the Iowa Department of Public Health (IDPH) to increase testing of Cyclospora, a parasite disease, the Centers for Disease Control and Prevention announced last week. In late June, the IDPH reported two cases of cyclosporiasis in its weekly electronic newsletter, and by July 3, an additional four cases had been reported to IDPH, indicating that an outbreak could be occurring.

5 ways to classify health technologies

August 5, 2013 | By Ashley Gold
Telehealth services and simple technology like thermometers get lumped into the "digital health" category, even though their premises are different, and often times, a lot more simple than perceived. It's important to clarify which health technology falls into which categories, and to surmise what direction they're headed in, a recent article in Forbes points out.

FDA Guidance Highlights Medical Device Security Concerns

by John Moore, iHealthBeat Contributing Reporter Monday, August 5, 2013
Concern over the security of networked medical devices appears to be spreading, with FDA now weighing in on the matter.
FDA in June issued a safety bulletin, titled, "Cybersecurity for Medical Devices and Hospital Networks," targeting medical device makers, hospitals and health care IT personnel. Also that month, FDA published draft guidance for device manufacturers on managing cybersecurity in medical devices. Interested parties will have until mid-September to submit comments on the guidance, which may lead to formal regulations.
FDA's move follows a 2012 Department of Homeland Security warning on medical device security. The report, titled, "Attack Surface: Healthcare and Public Health Sector," pointed to the communications security of medical devices as a "major concern," citing the potential for medical information theft and malicious intrusion.
Academics and IT security vendors also have highlighted the vulnerabilities of network-attached medical devices.


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