Saturday, November 16, 2013

Weekly Overseas Health IT Links - 17th November, 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.

3 tips for proactively protecting PHI

November 8, 2013 | By Ashley Gold
In a recent podcast with Healthcare Informatics, Jared Rhoads, senior research specialist with the Computer Sciences Corporation (CSC) Global Institute for Emerging Healthcare Practices, spoke about emerging technologies to protect personal health information (PHI).
Rhoads talked, in particular, about how the environment is changing for medical identity theft and why hospitals and medical practices need to be more vigilant.

ONC Enhances Certified EHR Database

NOV 7, 2013 3:01pm ET
Following the government shutdown, the Office of the National Coordinator has updated its Certified Health IT Product List database of software that complies with one or more electronic health records meaningful use requirements.
ONC also has introduced new functions on the site. Links to test result summaries are available for newly-certified products, with summaries for previous certified products becoming available later this month.

EHR Interoperability Remains Elusive

John Commins, for HealthLeaders Media , November 8, 2013

A lack of standards, privacy concerns, and proprietary and competition issues are just a few of the hurdles hampering the interoperability of EHR data among participants in health information exchanges.

Healthcare providers have made solid progress over the last decade building in-house electronic health records systems to share patient data within their networks. However, interoperability with outside providers and payers remains a significant barrier, according to eHealth Initiative's 10th annual survey of health information exchanges.
Three-quarters of the nearly 200 eHI survey respondents said they've had to build numerous time-consuming and expensive interfaces between different systems to facilitate information sharing, including 68 organizations that said they had to build 10 or more interfaces with different systems. More than 140 respondents cited interoperability as a pressing concern.

An 'unintended consequence' of EHR adoption: Litigation discovery

November 5, 2013 | By Marla Durben Hirsch
Of the more than 300 comments have been submitted regarding proposed changes to the gathering of evidence during litigation, the American Health Information Management Association is the first to address the role electronic health records in discovery. 
The federal government has proposed revisions to the Federal Rules of Civil Procedure that would change the discovery of electronic information, make the discovery process less burdensome, improve litigation management and protect against sanctions in certain instances when evidence wasn't retained.  
In a recent comment letter, AHIMA CEO Lynne Thomas Gordon points out that the group's members play a "key role in e-discovery" but that the healthcare industry "is still primarily focused on the implementation of EHRs and their use in providing clinical care, rather than establishing new systems, processes and policies to respond to litigation and regulatory investigations." 

NHS England moves to regulate apps

6 November 2013   Lis Evenstad
NHS England is working with the US Food and Drug Administration on a bilateral framework for regulations on mobile health apps.
Last month, the FDA issued its final guidance on regulating health apps in the US, and NHS England is looking to follow in the same direction.
Speaking at EHI Live 2013, Inderjit Singh, head of enterprise architecture at NHS England, said it wants to define a set of standards for clinician facing apps.

Academy calls for standardised records

6 November 2013   Daloni Carlisle
Electronic patient records must be standardised to support both patient safety and patient access, the Academy of Medical Royal Colleges says today in a report on NHS IT.
The report calls for “radical changes” to healthcare IT to ensure that patients are treated safely and effectively, arguing that improved electronic records are crucial to delivering both.
Professor John Williams, Director of the Royal College of Physicians Health Informatics Unit, said: “The Francis Report and Berwick Review both identified that the NHS has lost its way, and must be reoriented to deliver patient-focused, compassionate, safe care.

NIST orders review of its encryption standards development processes

November 7, 2013 | By Susan D. Hall
After reports based on documents leaked by Edward Snowden raised questions about existing encryption standards, the National Institute of Standards and Technology (NIST) has launched a formal review of its processes.
NIST data encryption standards currently are used in electronic healthcare data security and exchange.
Both The New York Times and The Guardian published articles based on material from Snowden saying the National Security Agency (NSA) in the United States and the UK intel agency GCHQ have spent hundreds of millions of dollars to defeat Internet encryption.

An Altered Electronic Order Set Could Create Cost Savings, Better Care

November 5, 2013
Altering the design of an electronic order set in electronic medical record (EMR) could ultimately lead to better care and increased cost savings for patients, says a University of Missouri researcher.
Victoria Shaffer, an assistant professor of health sciences in the MU School of Health Professions, and a team of researchers looked at how physicians selected lab tests using three order set list designs on the same EMR. One was “opt-in,” where no lab tests were pre-selected; the second was opt-out, in which physicians had to de-select lab tests that were not clinically relevant; and third had only a few tests pre-selected based on recommendations by pediatric experts.
What they found was clinicians ordered three more tests when using the opt-out version than the opt-in or recommended versions. Additionally, they ordered more tests recommended by the pediatric experts when using the recommended design than when using the opt-in design.

Diagnostic Error Detection Comes Into Focus

Cheryl Clark, for HealthLeaders Media , November 7, 2013

A developing discipline aims to find ways to measure efficient accuracy and diagnostic prowess, just as we now scrutinize core measures and surgical outcomes.

Last month's shocker that a robustly healthy long-time friend had just been diagnosed with an awful cancer has devastated me. The discovery of his illness came so late that it allowed him just a few weeks to prepare for his death.
Distracted and irritable, I hid behind life's minutiae to deny what was actually happening. I told myself the poor prognosis was exaggerated. After the inevitable had been confirmed and I had had a good cry, it prompted the question we all ask ourselves when terrible stuff like this happens.
Why didn't his doctors catch this sooner?

Study Links Medical Errors to EHR Default Values

SEP 5, 2013 2:58pm ET
A new study analyzes errors related to “default values” which are standardized medication order sets in electronic health records and computerized physician order entry systems.
The Pennsylvania Patient Safety Authority, an independent state agency, conducted the study. “Default values are often used to add standardization and efficiency to hospital information systems,” says Erin Sparnon, an analyst with the authority and study author. “For example, a healthy patient using a pain medication after surgery would receive a certain medication, dose and delivery of the medication already preset by the health care facility within the EHR system for that type of surgery.”
These presets are the default value, but safety issues can arise if the defaults are not appropriately used. Sparnon studied 324 verified safety reports, noting that 314, or 97 percent, resulted in no harm. Six others were reported as unsafe conditions that caused no harm and four reports caused temporary harm involving some level of intervention.

Analytics works wonders in Colorado

Posted on Nov 06, 2013
By Anthony Brino, Editor, HIEWatch
Among state experiments in Medicaid policy, Colorado’s accountable care collaborative program is showing early successes in coordinating care and curtailing overutilization — and its analytics platform is supporting a good deal of the collaboration, despite a number of hurdles.
Now covering about half the state’s beneficiaries, Colorado’s Medicaid accountable care program saw a 15 percent reduction in hospital admissions and a 25 percent reduction in high-cost imaging in the 2013 fiscal year, contributing to $44 million in savings, the Department of Health Care Policy and Financing announced recently.
Most of that is going to providers as incentive bonuses and $6 million is returning to state coffers.

Software design can affect lab tests ordered

November 6, 2013 | By Susan D. Hall
Modifying the software list of lab tests for a particular condition can affect the number and relevance of those ordered, according to research from the University of Missouri.
Victoria Shaffer, an assistant professor of health sciences in the MU School of Health Professions, and her team focused on three configurations in the same electronic medical system: an opt-in version in which no lab tests were pre-selected, an opt-out version in which physicians had to de-select lab tests they believed were not clinically relevant, and one with a few tests pre-selected based on recommendations by pediatric experts.

Alarm fatigue tops health technology hazards list

November 6, 2013 | By Ashley Gold
The ECRI institute released its top 10 health technology hazards list yesterday, bringing to attention that with new innovation comes great responsibility--for training, implementation and day-to-day use.
"All of the items on the list represent problems that can be avoided or risks that can be minimized through careful management of technologies," the report states. "For this Top 10 list, we focus only on what we call generic hazards--problems that result from the risks inherent to the use of certain types or combinations of medical technologies."

Digital health tools likely to decrease visits to the doctor

Researchers at Johns Hopkins analyze recent trends in digital health care, concluding that health-related apps and electronic health records will dramatically reduce in-person doc visits.
November 4, 2013 3:23 PM PST
In the not-too-distant future, it is quite likely that most interactions between patients and the health care system will happen online, according to researchers at the Johns Hopkins Bloomberg School of Public Health, who partnered with The Commonwealth Fund to review recent trends in digital health care as well as scientific literature.
Thanks to consumer-directed health apps, electronic health records (EHRs), telemedicine, and the like, researchers say that patients are going to dramatically change the way they interact with their doctors. They report their findings in the November issue of the journal Health Affairs.

Mobile Health Tech Could Reduce Doctor Visits

Scripps researchers laud potential, say more evidence needed to show whether apps to manage acute and chronic illnesses are safe and effective.
Because of mobile health apps and home monitoring, physicians will eventually see patients far less often for minor acute problems and followup visits than they do today, said three doctors from Scripps Health in a commentary in the Journal of the American Medical Association (JAMA). But before that can happen, they cautioned, "real-world clinical trial evidence" is needed to confirm the benefits of mobile health apps for patients, clinicians and payers.
The three cardiologists who wrote the commentary all work at the Scripps Translational Science Institute, which does clinical trials of mobile health applications and devices. They include Eric Topol, the institute's director and a longtime mobile health advocate; Steven R. Steinhubl, director of digital medicine for Scripps Health; and Evan D. Muse, a clinical scholar and cardiovascular fellow at the institute.

Health I.T. vs. Influenza

NOV 1, 2013
One of the influenza strains that afflicted New Yorkers in 2012 was so sneaky that it even fooled Pascal Imperato, M.D., the former head of the city's health department, a renowned expert on infectious diseases, and now dean of the school of public health at SUNY Downstate Medical Center in Brooklyn.
"I didn't think of taking an antiviral because it began in an insidious manner and I didn't think it was the flu," he says. "Then it caused severe chills. I've never in my life had chills like that-and I've had malaria." By the time his wife started showing symptoms, Imperato knew enough to get her a dose of Tamiflu, which banished the bug in two days.
If the subtle early symptoms had been more widely known and publicized, Imperato might have saved himself a week in bed and a month of feeling not quite himself. The prevailing techniques of flu surveillance-tracking test results and reports of "influenza-like illness"-are blunt instruments for providing that kind of information, but they're being supplemented increasingly by information gleaned from sophisticated lab testing, social media, electronic health records and simply asking people to report whether they have the flu. These new information streams, properly analyzed and integrated, can help providers see disease patterns even among people who don't go to the doctor or the hospital, can give early warning when a virus has undergone changes or presents in an unfamiliar way, and can produce a complete picture of the overall human toll and cost of a season of flu.

Once they start sharing notes with patients, docs don't want to stop

By Diana Manos, Senior Editor
The call to action came when Jan Walker saw her physician’s notes.
“My doctor had been telling me for years to lose weight, but when I saw that he called me mildly obese in his note, and how he’s really worried about my weight, it finally sank in,” Walker said, “and I decided to do something about it.”
A registered nurse and principal associate in medicine at Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, Walker is not the only one to change her life because of what doctors had written but not always told patients.
Yet the practice of sharing physician notes is mired in conjecture about elongated visit times, numerous questions outside normal encounters, curtailed productivity, and the concern that doing so will either offend or unnecessarily worry patients. Perceived factors that a new study has determined to be largely illegitimate.

IBM goes big with two data projects

Posted on Nov 05, 2013
By Bernie Monegain, Editor
IBM has launched two separate projects with two top health systems. One involves the use of big data to help clinicians provide predictive care at Emory University Hospital. The other is focused on reducing vendor fraud – again by employing big data analytics.
The company announced the details of its work Nov. 4 at IBM's Information On Demand conference.
Emory University Hospital is collaborating with IBM and Excel Medical to employ a novel use of big data to help ICU doctors and nurses provide predictive care for critically ill patients.  

3 ways to make BYOD (fairly) easy

Posted on Nov 05, 2013
By Jeff Rowe, Contributing Writer
Sometimes, developing new policies comes down to putting a foundation under a process that’s already well under way, and perhaps in no sector of healthcare is this truer than in mobile health.  
After all, doctors and other caregivers are as curious about mobile communications technology as the next person, but unlike many other people when they get a new gadget they want to start using it both at home and at work.
According to Ed Ricks, vice president of information services at Beaufort Memorial Hospital, in Beaufort, S.C., that’s essentially how his organization’s bring your own device policy got launched.

5 HIO practices that put data integrity at risk

November 5, 2013 | By Julie Bird
Health information exchange organizations (HIOs) routinely put data security at risk through five risky practices, two health IT experts contend in an article published by the Journal of the American Health Information Management Association (AHIMA).
"Despite their potential, system issues, stakeholder demands, and resource limitations have forced many HIOs to resort to subpar data integrity practices that, while appearing harmless on the surface, could compromise the long-term success of the HIO--and potentially patient safety," write Grant Landsbach, data integrity/MPI manager for Denver-based Sisters of Charity of Leavenworth and Exempla Health System, and Beth Haenke Just, founder and CEO of Just Associates, a healthcare data integration consulting firm.

Hospital saw deaths, code blues and length of stays rise with telehealth use

November 5, 2013 | By Julie Bird
Patients in one hospital's intensive care units had slightly higher mortality rates and stayed slightly longer in the ICU after the hospital started using telemedicine monitoring tools, according to preliminary study results reported by MedPage Today.
None of the effects were statistically significant, study author Ajit Dhakal, M.D., of Northside Medical Center in Youngstown, Ohio, said in presenting the findings at the CHEST meeting in Chicago, according to the article. But, he said, the results were trending in the wrong direction.
The year-over-year mortality rate rose from 78 to 90 and the mean length of stay increased from 3 to 3.2 days. The rate of falls went from zero to 0.81, the study found, and the number of code blues rose from 39 to 54.

ECRI Announces Top 10 Healthcare Technology Hazards

Cheryl Clark, for HealthLeaders Media , November 5, 2013

ECRI Institute collects data on adverse events and near misses and releases an annual report on the top technology dangers in healthcare.

Occupational radiation hazards to healthcare workers in 'hybrid' operating rooms, failure to test EHR software or network devices before they're used, and surgical errors caused by insufficient training on robot devices are three new types of danger that made the ECRI Institute's top 10 technology hazards list for 2014.
"Every year that we've published this list it's continued to get more attention, and I believe it's helped healthcare organizations focus on important technology concerns," James P. Keller, ECRI's vice president of health technology evaluation and safety, said in an interview about the 7th annual report, which the institute released Monday.
"In my 29 years with ECRI, I don't believe hospitals have paid close enough attention to technology safety."

3 Tech Things That Irk Me

Scott Mace, for HealthLeaders Media , November 5, 2013

Destructive APIs, a lack of interoperability standards—and their glacial pace—and Twitter are a few of the tech irritants on Scott Mace's mind this week.

This week, I've worked up a mini-rant about some of the most maddening things about information technology, in a healthcare context, of course.
1. APIs work great, until they break
Epic recently announced an application program interface (API) for its EHR software. Details remain sketchy, but I can guarantee one thing: Somewhere down the road, for some good reason, Epic will change its API and break a whole bunch of things built on top of the first API.
Don't blame Epic. It's the nature of APIs to change, particularly if the business model of the company publishing them depends on not allowing too much openness with competitors or potential competitors.
That's why we hunger for standards from groups such as HL7 to set the APIs in concrete. But standards are usually the product of vendors jockeying to deny each other any kind of competitive advantage, so they always end up being some kind of least common denominator.

Cash-strapped country makes financial strides with health IT

Posted on Nov 04, 2013
By Erin McCann, Associate Editor
Greece is no stranger to fiscal turmoil. It has one of the highest unemployment rates in the Western world and has racked up more than €321 billion of public debt, which translates to about 169 percent of the country's GDP. But some say the country's two-and-a-half-year-old e-prescribing system, one of the most advanced in Europe, is one thing on the right track, helping reduce pharmaceutical expenditures by 50 percent.  
At the EU-US eHealth conference in Boston last month, Christina Papanikolaou, general secretary of public health in Greece, shared her country's e-prescribing story, and how the system -- which now has a whopping 97 percent of doctors using it -- has helped curb pharmaceutical expenditures by up to €2.5 billion, or $3.4 billion, since 2009. 
Papanikolaou spoke to international world health leaders on how the financial crisis, both local and international, served as a catalyst for innovative idea development to shrink the country's climbing deficit. "I believe that effective use of innovative technologies in the health sector is a big challenge and at the same time an opportunity towards structural reforms for an efficient and sustainable healthcare system," she said.

Technology combines array of monitoring into single information stream

November 4, 2013 | By Julie Bird
Doctors at Emory University Hospital in Atlanta are using health IT to combine complex streams of data collected by multiple machines used in critical care into a single report they hope will provide a comprehensive picture of a patient's condition, the Associated Press reported.
It's part of healthcare's emerging efforts to make big data actionable, including through the use of predictive medicine.
"If you were to ask me, 'What's been going on with this patient for the last minute? The last five minutes? The last 30 minutes?' I couldn't tell you. There's so much data going by," Tim Buchman, M.D., director of the Emory Center for Critical Care, told the AP.

Physician Buy-In Key to Reducing Health Care Costs

Robert Wood Johnson Foundation report finds some points of agreement among physician panel
FRIDAY, Nov. 1 (HealthDay News) -- Physician buy-in is essential for creation of any new payment system aimed at reducing health care costs, according to an article published Oct. 21 in Medical Economics.
Researchers at the Robert Wood Johnson Foundation interviewed a panel of 18 physicians regarding solutions to help halt the rise of health care expenses.

Superbug app spreads with 100K downloads in first month

The free iOS app Epocrates Bugs + Drugs uses aggregated electronic health record data and geotagging to help users see superbug prevalence as well as sensitivity to drugs.
October 31, 2013 2:38 PM PDT
An app that tracks the presence of superbugs and their sensitivities to drugs by ZIP code is making the rounds among doctors in the US. The app, which has been downloaded more than 100,000 times since it was released in early October, shot to the top of the Apple App Store's free medical app list in its first week alone and now boasts an average user rating of 4+ stars.
Epocrates Bugs + Drugs, a free app for iOS devices, uses aggregated electronic health record (EHR) data and geotagging to help users see both superbug prevalence and sensitivity to drugs by location. The developers, Athenahealth and Epocrates, add more than 6,000 lab isolate data points (from urine, blood, and skin samples) every day to keep the results fresh.

Deaths at VA hosptial blamed on poor EHR use

By Anthony Brino, Associate Editor
Three recent deaths at the Memphis VA Medical Center emergency department could probably have been prevented with better communication, documentation and layout design, according to an investigation by the Veterans Administration Inspector General.
After receiving an anonymous complaint describing potential inadequate care incidents at the Memphis VA Medical Center’s 22 bed ED, the VA OIG reviewed committee minutes, relevant documents, and the electronic health records of the patients, and largely substantiated the claims, finding physicians missing nurse notes and EHR alerts, and a poor ED design leaving some patients only partly monitored.
One patient came to the ER complaining of back and neck pain and confirmed an aspirin allergy with a nurse upon arrival, but the physician reviewing the patient three hours later hand-wrote on paper an order for the aspirin-containing anti-inflammatory drug ketorolac, missing an alert that would have noted a contraindication and bypassing the medical center’s policy of digital documentation.

Still a Long Way To Go in Overcoming Health Data Exchange Barriers

by Kate Ackerman, iHealthBeat Editor in Chief Monday, November 4, 2013
WASHINTGON -- At the eHealth Initiative's Health Data Exchange & Interoperability Summit last week, eHI CEO Jennifer Covich Bordenick said she's been getting a lot of questions over the last few weeks about the health insurance exchanges and how an important technology launch could have so many problems.
But the technology issues plaguing the health insurance exchanges are not surprising to those in the health IT world, Covich Bordenick noted. "The connections and complexity of exchanging data [are] not easy," she said.
She likened it to trying to connect Lego blocks and Lincoln logs.


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