This blog is totally independent and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Saturday, June 14, 2014
Weekly Overseas Health IT Links - 14th June, 2014.
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.
WEDI’s letter outlines steps it says HHS should take to minimize disruption to the healthcare industry that it says will come because of the delay. It says HHS should ensure Medicare and Medicaid readiness transparency, expedite and expanding industry testing, expand provider education, target outreach to non-covered entities, conduct or support limited pilots, and establish clear milestones and track readiness.
Healthcare payers want technology developers to create systems that measure value. This time, tech is lagging social changes.
As the purchaser representative on the federal Health IT Policy Committee, David Lansky, PhD., is the voice of employers, insurers, and other organizations responsible for healthcare compensation.
It's a role he's handled for five years, one that complements his full-time position as CEO and president of Pacific Business Group on Health, a nonprofit business coalition that helps its 60 purchaser members provide coverage to more than 3 million employees by improving the quality and affordability of healthcare.
When it comes to laboratory information systems, lab executives says it's been a few steps forward, a few steps back.
Advances in testing devices have expanded life-saving potential for molecular testing, mass spectrometry and flow cytometry, among others, and orders are flowing like a river for labs, especially those at academic medical centers and large health systems that cater to diverse patient populations and clinical staffs
That progress, however, is tempered by the struggles for information systems to analyze and distribute results from more complex tests.
It's a similar story with regard to interoperability and results distribution. More and more large health systems are taking an enterprise approach to information systems by adopting full suites of technology from large HIT vendors. While that helps large systems streamline their data and reach more users, experts say the move can a mixed blessing for labs, which have to forgo best-of-breed lab information systems for systems that sacrifice lab-specific functionality for broader compatibility throughout the enterprise. Lab technologists and lab IT staff tend to get lost in the shuffle.
While most people responding to a recent survey by media company Morning Consult said they expect hospitals to use electronic health records, only about half believe that those records would be "safe."
For the poll, Morning Consult surveyed 3,687 likely voters in March and May. Overall more than four-fifths (83 percent) of respondents said they expect hospitals to use EHRs.
However, only 53 percent of respondents thought that the information in the EHRs would be safe; 39 percent said they were "worried."
It seems everything that could go wrong with an EHR rollout did at the Ventura County Health Care Agency, a county-run healthcare system in Thousand Oaks. Calif. A grand jury investigation found the county neglected to plan, hire and adequately train for the transition.
Moreover, according to the report, dated May 29, 2014, VCHCA failed to procure laptops and servers in a timely way, significantly underestimating the total number of simultaneous users the EHR system had to accommodate, and it lacked a dedicated and experienced project manager to oversee, track and report all tasks.
VCHCA tapped Kansas City, Mo.- based Cerner for its EHR. The grand jury found that beginning with the Cerner contract in October 2011, the county lacked a project manager.
By 2024, the national health IT infrastructure and data standards will evolve to support robust information sharing and aggregation, creating a "continuous learning" environment for care, according to an ONC paper published today.
The Office of the National Coordinator for Health IT outlined a 10-year plan to develop an interoperable health IT ecosystem that can simultaneously improve population health, boost patient engagement and lower costs.
The agency shared a set of five "critical building blocks" for achieving its goals, while also revealing its expectations for three, six and 10 years down the road.
Two days after Apple announced a major health tracking partnership with the Mayo Clinic, another big name healthcare provider — Kaiser Permanente has announced that its flagship app, also called Kaiser Permanente, has now surpassed 1 million downloads.
“We’re seeing that members are using the app most often to securely email their doctors and manage appointments,” Madhu Nutakki, vice president of digital presence technologies, Kaiser Permanente said in a statement. “Giving members the ability to quickly and easily connect with their doctors and other care providers, no matter where they are, empowers them to become actively engaged in their health care.”
Kaiser Permanente members can use the app to email physicians, schedule or cancel appointments, get refills for a prescription, and access lab results. The app will also help users find nearby KP medical facilities.
When practices use a patient-centered medical home (PCMH) model that relies heavily on electronic health records (EHRs), they achieve a higher quality of care than non-PCMH models that use EHRs or those that use paper health records. However, the benefit is found in a combination of elements that goes beyond the EHR, according to research published in the June 3 issue of the Annals of Internal Medicine.
Lead author Lisa Kern, MD, an associate professor at Weill Cornell Medical College in New York City, told Medscape Medical News that although other recent studies have questioned the value of PCMHs, this study adds to the body of evidence that the model is promising and deserves further study.
"The [PCMH] is a combination of the technology plus the people and how they reorganize the workflow in the practice to facilitate quality improvement," Dr. Kern said. Part of the value comes from trying to understand and systematically care for a population, rather than individual patients, she said.
by Helen R. Pfister, Susan R. Ingargiola and Marlee Ickowicz, Manatt Health Solutions Thursday, June 5, 2014
To date, the federal government's efforts have largely focused on encouraging hospitals and ambulatory care providers to adopt electronic health records so that they may share health information electronically with one another. With that task well underway, a new focus area is emerging: connecting emergency medical service providers with hospitals. To this end, HHS' Office of the Assistant Secretary for Preparedness and Response launched a new "collaborative community campaign" called "Health IT and EMS" to spark new ideas about how to involve EMS providers in electronic health information exchange.
Recognizing that the collection of electronic data can help improve care, most EMS providers use electronic EMS documentation systems, such as electronic patient care reporting -- or ePCR -- software, to record patient health information. These systems often feed into statewide EMS databases and into the National EMS Information System, known as NEMSIS. However, EMS providers' ePCR systems generally do not connect to the one place where the information can make a real-time impact: the hospital emergency department. Despite recent increases in EHR adoption by hospitals, few EMS providers are able to connect to these hospitals and electronically share patient health information.
Apple is rolling out an app to piece together healthcare information from many third-party apps, including from health systems, to give consumers and providers a new comprehensive medical view, setting the stage for new approaches to information exchange.
The new offering is called Apple HealthKit, although the app itself is simply called Health. It is impressive in its ability to present patients and doctors with a holistic view of medical data. The power of HealthKit, though, relies on changes in an Apple development tradition, where data for any app cannot be accessed by any other app or (for the most part) by the operating system. Although that data-sharing promises huge potential healthcare benefits, it also raises serious questions about security and privacy.
Apple's vision is that Health would collect a wide range of healthcare information – temperature, blood pressure, pulse, exercise speed/duration, photos/videos of a rash or the patient demonstrating motion limitations, glucose level, oxygen saturation, sleep apnea monitors, daily diet, etc. – via assorted Apple apps, from medical facilities, fitness apps from a bicycle manufacturer, sporting goods chain or perhaps a cereal company.
Obstructive sleep apnea patients using the SleepMapper mobile app and web-based platform achieved a 22 percent higher positive airway pressure (PAP) therapy adherence rate than non-users, according to a study by Philips Respironics.
Results of the study were presented at the SLEEP 2014 conference.
To test the effectiveness of SleepMapper, researchers randomly analyzed over 15,000 patients from the Philips Respironics EncoreAnywhere database and compared adherence and usage rates between those who were provided with SleepMapper upon initial PAP setup and those who were not. Patients who were provided with SleepMapper achieved a 78 percent adherence rate based upon the Centers for Medicare and Medicaid (CMS) guidelines, compared to the average 56 percent compliance rate among patients who were not provided with SleepMapper.
Healthcare's all about the patients, right? Earning their trust so they return for annual checkups, delivering high-quality care while respecting their medical privacy at the highest level. But far too often, there's a disconnect – the idea that the care ends when the patient exits the building or a diagnosis is made, the idea that clinical deals with clinical and information technology deals with IT. But, that's not often the case in this digital age. Lines are blurred, and what happens in one area can have serious implications for another – especially when it comes to patient privacy.
Healthcare organizations are charged with safekeeping some of the most personal and sensitive information on individuals who come to receive care. That bout of depression you had in your early 20s, the sexually transmitted infection you were treated for last year, blood tests of every ilk, cancer diagnoses, medical procedures, HIV statuses, psychiatric disorders, every medication you've ever been prescribed, administered vaccinations, Social Security numbers, dates of birth, demographics, where you live, insurance details, even payment information. Healthcare organizations are gold mines of data. Valuable data. And, traditionally, protecting said data hasn't been the industry's strong suit.
Since 2009 when the HIPAA breach notification requirements took effect, nearly 1,000 large data breaches – those involving 500 individuals or more – have been reported to the Department of Health and Human Services, affecting almost 32 million people.
Does your organization have a comprehensive data governance program? If not, you're not alone. But you're also not close to where you should be if you want to provide better care at lower cost, according to a new report.
More than two-thirds of healthcare organizations still lack a comprehensive information governance strategy, a new analysis from AHIMA finds, despite the obvious importance of having one in place to improve care delivery and population health – to say nothing of an organization's bottom line.
In the benchmarking survey of comprehensive IG practices in healthcare – billed as the first of its kind – a whopping 95 percent of more than 1,000 respondents said improving the quality and safety of patient care was the chief rationale for implementing IG strategies.
The creation of a blueprint for the use of open data in healthcare was the driving force behind a recent collaboration between researchers at New York University's GovLab and England's National Health Service.
In a report developed as part of the partnership, "The Open Data Era in Health and Social Care," researchers said that while there is currently "widespread recognition" of open data's possibilities, the overall healthcare industry remains in the adolescent stages of understanding the best ways to take advantage of such resources..
Patient portals and online electronic medical record access have been shown to improve medication adherence and patient engagement. Patients with chronic conditions have taken advantage of patient portals at a higher rate than their healthy counterparts — 30 percent to 24 percent, according to a new survey from Accenture.
Despite patients with chronic conditions showing an increased desire to access and manage their health information, many do not use patient portals. According to the survey, many simply don't know how — 55 percent of survey respondents said not knowing how to log on was the main reason they don't use patient portals.
Artificial Intelligence Is Now Telling Doctors How to Treat You
By Daniela Hernandez, Kaiser Health News
6:30 am |
Long Island dermatologist Kavita Mariwalla knows how to treat acne, burns, and rashes. But when a patient came in with a potentially disfiguring case of bullous pemphigoid–a rare skin condition that causes large, watery blisters–she was stumped. The medication doctors usually prescribe for the autoimmune disorder wasn’t available. So she logged in to Modernizing Medicine, a web-based repository of medical information and insights.
Within seconds, she had the name of another drug that had worked in comparable cases. “It gives you access to data, and data is king,” Mariwalla says of Modernizing Medicine. “It’s been very helpful, especially in clinically challenging situations.”
The system, one of a growing number of similar tools around the country, lets Mariwalla tap the collective knowledge gathered from roughly 3,700 providers and more than 14 million patient visits, as well as data on treatments other doctors have provided to patients with similar profiles. Using the same kind of artificial intelligence that underpins some of the web’s largest sites, it instantly mines this data and spits out recommendations. It’s a bit like Amazon.com recommending purchases based on its massive trove of data about what people have bought in the past.
The crowd in a hotel ballroom in Washington, D.C., was rocking on Monday, the 2,000 people shrieking with excitement over federal health-care databases. That could only happen at Health Datapalooza, the annual summit for data geeks, doctors, researchers and patients who want to use data to transform health care — or at least make a buck.
Both of those goals are proving to demand a lot more than just coming up with a nifty API and getting the venture capitalists to buy in.
Speakers at the Datapalooza gave plenty of examples of how people are trying to use data to make medical care safer, swifter and less expensive. But almost all of these projects are still works in progress.
By combining technology, best practices, and education, IT departments can safeguard even the most mobile healthcare departments.
Insecurities lurk beneath the surface of the fast-growing world of mobile healthcare, putting data at risk. But organizations can protect patient data by implementing a mix of technologies and best practices.
The practice of using mobile devices in healthcare is growing. More than half -- 51% -- of physicians use tablets for professional purposes and 74% use smartphones at work. The mobile monitoring and diagnostic medical devices market will reach $8.03 billion by 2019, compared with a mere $0.65 billion in 2013, according to Transparency Market Research. This year alone 90 million wearable health devices will ship, reported ABI Research.
N Engl J Med 2014; 370:2161-2163June 5, 2014DOI: 10.1056/NEJMp1401111
Interview with Dr. Sebastian Schneeweiss on opportunities for and obstacles to the use of big health care data. (11:18)
The routine operation of modern health care systems produces an abundance of electronically stored data on an ongoing basis. It's widely acknowledged that there is great potential for utilizing these data, within the system that generates them, to inform treatment choices in ways that improve patient care and health outcomes.1 Imagine entering your office in the morning and finding an e-mail message reading, “Thanks to your new vaccination screening program, as of yesterday your practice had given 120 more vaccinations than similar practices had.”
Rebecca Kush, Ph.D., and Michel Goldman, M.D., Ph.D.
N Engl J Med 2014; 370:2163-2165June 5, 2014DOI: 10.1056/NEJMp1401444
The diverse ways in which data are collected and reported in clinical studies make it hard to query across data sets, pool and share data, or integrate data for multi-trial analyses to gain new scientific insights. Use of standard data formats can solve these problems.
The reorganization at the Office of the National Coordinator for Health Information Technology doesn’t seem to portend major changes at ONC.
Running out of HITECH Act funds, ONC needs to move from a grant-making organization doling out money for programs authorized under HITECH, to an organization one that focuses on HIT standards, certification programs and policies.
While there will be a flatter reporting structure and less offices and sub-offices, the new-look ONC will continue to have most of the same top leaders. But there are no significant budget or personnel impacts from the realignment, according to an anonymous official.
Jacob Reider, will remain the No. 2 leader behind National Coordinator Karen DeSalvo. Kelly Cronin, Joy Pritts, Lisa Lewis, Doug Fridsma, Judy Murphy, Jodi Daniel, Kimberly Lynch and Nora Super all will be in charge of a major office within ONC.
As expected, Apple announced a major health platform in its new iOS8 mobile operating system at its Worldwide Developers Conference in San Francisco.
The company's Health app and HealthKit API platform include partnerships with Nike and Mayo Clinic, which Apple says will facilitate integration of personal health information across applications and among healthcare providers of a consumer's choosing.
The transparency movement is growing across the world. From government to corporate data, and healthcare especially stands to benefit, even as traditions are broken and openness leaves some incumbents perhaps a little uncomfortable.
In the public sector, the latest open information proposal is in California, where voters are deciding whether to require local governments to meet state law for public access to meetings and records of government officials and to pay for it themselves.
Local governments have been doing this, albeit with state funding, and have complained about now having to cover the costs. Supporters of Proposition 42 counter that making transparency the default — posting inspection reports and city council meeting minutes online, rather than having citizens request them — poses only minor costs.
Rivaling her record-setting selfie at the Oscarsfeaturing a dozen or so stars, two thousand attendees at the fifth annual Health Dapalooza joined in a selfie taken by Bryan Sivak, chief technology officer for the U.S. Department of Health and Human Services.
The excitement? It was palpable.
And here at Health Datapalooza exactly how information gets analyzed is up for new ways to be disrupted, revamped and rethought.
The theme: endless possibilities. In fact, the ways that the gathering of the appropriate data and the analysis of it can improve health outcomes is astounding. But first the right data must to be collected.
Information sharing to support more integrated health and social care is back on the agenda. EHI will be running a series of case studies over the summer looking at the approaches that healthcare communities in England are taking. To start the series, Lis Evenstad and Lyn Whitfield look back at the long history of information sharing initiatives and ask what lessons can be learned from them.
3 June 2014
Encouraging the different organisations that make up the NHS to share information, and to create a ‘seamless’ journey for patients in the process, has been a long-standing goal of NHS IT policy.
Before the National Programme for IT was set up, the Information for Health strategy tried to create ‘lifelong’ electronic health records to achieve this; and ran some Electronic Patient Record Development and Implementation projects to show what could be done.
NPfIT itself aimed to create an integrated care record service, with a Summary Care Record to provide access to key patient information to any professional, anywhere.
The pilot launch of the FDA's open data initiative begins with 10 years' worth of adverse event data, available to the public at large.
Medicare isn't the only federal health agency looking to dump some of its data on the public. The FDA announced today the launch of its openFDA initiative, through which the agency is pulling back the veil on a trove of data on controlled substances.
The FDA today published the pilot version of the openFDA program with 10 years' worth of data on adverse drug events, providing unprecedented access to the agency's database. Previously, interested parties would have to request access by submitting cumbersome Freedom of Information Act requests or by using "difficult to use reports," the FDA said.
Healthcare organizations use integration engines to cope with the lack of standards and multiple disparate systems clinicians use.
By using multiple electronic health records (EHRs) and other applications, hospitals take a best-of-breed approach that allows them to use the most appropriate solution for different departments or requirements. Yet a lack of standards can force workarounds, data duplication, and interoperability problems for IT and end-users.
To address this, some healthcare providers standardize on one platform across their organization, even though it may not meet the specific needs of departments such as radiology or surgery. Others, looking to retain these separate EHRs or access to legacy systems, use integration tools to provide users with access to data housed in multiple applications.
Lena J. Weiner, for HealthLeaders Media , June 3, 2014
Spending on electronic health records systems by hospitals and health systems continues to rise, as enthusiasm for them wanes among senior healthcare executives, survey results show.
Dissatisfaction with electronic records systems is ratcheting up among senior healthcare executives, says the group purchasing organization, Premier, Inc. Survey results released Monday show that that 41% of C-Suite respondents say they are either dissatisfied or indifferent toward their EHR systems.
"What we are hearing increasingly from healthcare leaders is dissatisfaction with their existing EHR systems, often citing cost and difficulty of use," said Michael J. Alkire, chief operating officer at Charlotte, NC-based Premier.
"Providers need a solution that integrates clinical, financial and operational data across their hospitals and health systems; the majority of EHR systems cannot do that."
Scott Mace, for HealthLeaders Media , June 3, 2014
IT leaders at healthcare providers are under siege. ROI, legacy systems, cloud software, and the EHR wars are a few of their current concerns.
I'm at the annual Health Datapalooza in Washington D.C., where executives from provider organizations are few in number and the vibe is all about payers, app and website developers, patients, physicians, and government regulators feasting on the latest batch of hospital cost data. The event appears to have doubled in size from last year. From this vantage, it's hard to view traditional healthcare providers as anything but under siege. Here are a few concerns bubbling up:
1. When hospitals install fancy hardware such as a da Vinci surgical system, it doesn't look good for the ROI on that system if it isn't getting used. CMS' 2012 batch of hospital payment data may bring to light evidence that surgical procedures that could be done well enough without such gear are deliberately being crowded out by procedures using the magical technology at hand, in order to justify someone's return on investment for purchasing the fancy hardware in the first place. If they are not already doing so, hospitals and payers must deploy oversight systems to make sure that high-tech intervention isn't conducted unnecessarily.
Even as healthcare providers across the country are struggling to make their new, expensive technology work, a new survey shows providers are more frustrated with their purchases than ever.
The survey of C-suite healthcare executives from Premier healthcare alliance reveals that, despite heavy investments and continuing frustrations with their electronic health records, providers are gearing up for increased spending in health IT, including EHRs. They are also eyeing purchases in advanced IT, telecommunications and modern clinical equipment, according to Premier’s spring 2014 Economic Outlook C-suite survey.
Premier’s Economic Outlook highlights emerging economic and industry trends impacting alliance members and the overall industry.
Whether it's an online commercial database or a home-grown system, data mining is informing--and transforming--how clinicians treat patients. But although such systems can process vast amounts of structured data, they still have trouble with more nuanced pieces of information, notes an article at Kaiser Health News.
Researchers and tech companies are working on systems that can access unstructured text from doctor's notes or an individual patients' full range of symptoms and treatments and incorporate this information into its recommendations.
Stage 1 Meaningful Use (MU) likely is impacting how hospitals sequence EHR adoption, according to a study published in the Journal of the American Medical Informatics Association . For example, it spurs providers to move clinical guidelines and medication computerized provider order entry ahead in sequence.
Researchers from the University of Michigan analyzed the order in which 2,797 general acute care non-federal hospitals adopted several EHR functions. They also qualitatively assessed whether Stage 1 MU functions were adopted early in the sequence.
The study found that patient demographic and ancillary results functions were consistently adopted first, while physician notes, clinical reminders and guidelines were the final functions adopted.
Electronic health records dramatically advance patient care. At Atrius Health, we fervently support the intent of meaningful use, a CMS program started in 2011 that provides financial incentives to organizations that use EHRs to improve patient care and penalties to those that don't. We have watched with anticipation as this program has helped move the majority of U.S. physicians to electronic patient records. However, as the program progresses, we encourage Congress and CMS to re-assess the program's sustainability. The current approach, with large-scale changes from one stage to another, is proving to be a significant challenge and may in fact hinder, rather than improve, the adoption of EHRs.
Atrius Health has extensive experience with electronic patient records -- our largest medical group, Harvard Vanguard Medical Associates, has used the Epic EHR system for more than 20 years and pioneered a home-grown EHR before that. Following suit, our other medical groups fully transitioned to Epic from 2006 to 2008.
This may be one industry that is not set up to easily absorb outside innovation
By J. Niels Rosenquist | June 01, 2014
IF IT’S Monday, your smartphone might remind you, you should probably be thinking about quitting smoking. Your odds of being diagnosed with the MERS virus are 1 in 150 based on other cases in your city. Oh, and don’t worry — your blood pressure has stayed steady with your latest prescription. No need to see the doctor.
These are only a handful of the insights that e-health, or the use of remote technology to provide medical care, could someday tell us and our doctors about how we live. The idea that a computer screen, a cellphone, or even a wearable wristband could revolutionize medicine isn’t exactly far-fetched. Already, tools exist to measure, communicate, and even analyze health conditions in ways that can dramatically help clinicians treat patients, even from thousands of miles away.