Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, December 24, 2015

Seems Health Information Exchange Might Not Make The Scale Of Difference Hoped For.

This appeared a little while ago.

HIE not 'causally related' to cost improvements, care quality benefits

March 3, 2015 | By Dan Bowman
An examination of health information exchange research published this month in Health Affairs determines that despite an increase in the sharing of health data across organizations, benefits on costs and care quality are scarce.
For the study, the researchers--from the University of Alabama at Birmingham, Weill Cornell Medical College in New York and Indiana University--analyzed 27 articles that included 94 individual analyses. For each discrete analysis, the researchers then determined whether or not a beneficial relationship existed between the exchange of health data and the outcomes.
Overall, 54 analyses found beneficial effects of health information exchange. However, the researchers argued, of six studies that used designs with strong internal validity--those "capable of identifying causal relationships"--only two found beneficial results.
"Despite the abundance of observational studies finding a beneficial relationship between HIE and outcomes, there is currently no strong evidence to suggest that HIE is causally related to any widespread generalizable benefits," the authors said.
The authors submitted that most of the studies they examined focused on "first-generation" iterations of health information exchange systems, as well as on institutions where active HIE usage was low. Continued meaningful use of such systems, they added, could likely enable better evaluation adoption.
Lots more here:
Here is the published abstract:

Despite The Spread Of Health Information Exchange, There Is Little Evidence Of Its Impact On Cost, Use, And Quality Of Care

  1. Nir Menachemi3,*

Abstract

Health information exchange (HIE), which is the transfer of electronic information such as laboratory results, clinical summaries, and medication lists, is believed to boost efficiency, reduce health care costs, and improve outcomes for patients. Stimulated by federal financial incentives, about two-thirds of hospitals and almost half of physician practices are now engaged in some type of HIE with outside organizations. To determine how HIE has affected such health care measures as cost, service use, and quality, we identified twenty-seven scientific studies, extracted selected characteristics from each, and meta-analyzed these characteristics for trends. Overall, 57 percent of published analyses reported some benefit from HIE. However, articles employing study designs having strong internal validity, such as randomized controlled trials or quasi-experiments, were significantly less likely than others to associate HIE with benefits. Among six articles with strong internal validity, one study reported paradoxical negative effects, three studies found no effect, and two studies reported that HIE led to benefits. Furthermore, these two studies had narrower focuses than the others. Overall, little generalizable evidence currently exists regarding benefits attributable to HIE.
Here is the link:
Given that it would be hard to describe the PCEHR as much more than a pretty weak attempt at a Health Information Exchange - seems we really need to check that it is making a difference before spending too much more!

See also the first link from yesterday for confirmation of the view.

http://www.fiercehealthit.com/story/studies-hie-benefits-few-and-far-between/2015-12-18

Happy Christmas knowing that the PCEHR is probably a major ongoing waste of money!

David.

More Evidence That Health Information Exchange My Not Be All That Beneficial. Worth A Read.

This appeared a little while ago:

Health Information Exchanges Show Little Evidence of Benefits

MAR 27, 2015 7:42am ET
Though health information exchanges are supposed to improve the speed, quality, safety and cost of patient care, there is little evidence of these benefits in existing HIE studies.
That is the conclusion of a research paper, published in this month’s issue of the journal Health Affairs, in which researchers reviewed 27 studies looking for evidence that HIEs increased efficiency, reduced healthcare costs or improved outcomes.
While researchers found that 57 percent of published analyses reported some benefit from HIE, they also reported that articles employing study designs having strong internal validity—such as randomized controlled trials or quasi-experiments—were significantly less likely than others to associate HIE with benefits.
 “Among six articles with strong internal validity, one study reported paradoxical negative effects, three studies found no effect, and two studies reported that HIE led to benefits,” state the researchers. “Furthermore, these two studies had narrower focuses than the others.”
Two of the six studies found beneficial effects largely as a result of a reduction in diagnostic and imaging tests, associated costs or both, and these studies were based in a single clinic affiliated with an Indiana hospital or in one healthcare system in Israel. Overall, the paper found that “little generalizable evidence currently exists regarding benefits attributable to HIE.”
More here:
Here is the free abstract:

Despite The Spread Of Health Information Exchange, There Is Little Evidence Of Its Impact On Cost, Use, And Quality Of Care

  1. Nir Menachemi3,*

Abstract

Health information exchange (HIE), which is the transfer of electronic information such as laboratory results, clinical summaries, and medication lists, is believed to boost efficiency, reduce health care costs, and improve outcomes for patients. Stimulated by federal financial incentives, about two-thirds of hospitals and almost half of physician practices are now engaged in some type of HIE with outside organizations. To determine how HIE has affected such health care measures as cost, service use, and quality, we identified twenty-seven scientific studies, extracted selected characteristics from each, and meta-analyzed these characteristics for trends. Overall, 57 percent of published analyses reported some benefit from HIE. However, articles employing study designs having strong internal validity, such as randomized controlled trials or quasi-experiments, were significantly less likely than others to associate HIE with benefits. Among six articles with strong internal validity, one study reported paradoxical negative effects, three studies found no effect, and two studies reported that HIE led to benefits. Furthermore, these two studies had narrower focuses than the others. Overall, little generalizable evidence currently exists regarding benefits attributable to HIE.
Here is the link:
Looks like we will need to wait a little longer to be sure we have HIEs that are working or we need to carefully rethink what is likely to make a real positive difference.
David.

Wednesday, December 23, 2015

Weekly Overseas Health IT Links - 23rd December, 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.
-----

Studies on HIE benefits few and far between

December 18, 2015 | By Katie Dvorak
More reviews are needed on benefits and impacts of health information exchange (HIE), according to researchers who found that clinical outcomes and harms of info sharing are not fully studied.
The researchers, from Oregon Health & Science University, the Seattle-based University of Washington and the Veteran's Affairs Maine Healthcare System, examined 34 studies on outcomes of HIE.
However, the studies were very limited. They did not report on primary clinical outcomes, such as mortality and morbidity, nor did they identify potential issues caused by HIE, according to an article published in the Journal of Medical Internet Research: Medical Informatics.
-----

Kaiser Permanente Plans to Open a Medical School

WASHINGTON — Kaiser Permanente, the health system based in California that combines a nonprofit insurance plan with its own hospitals and clinics, announced Thursday that it would open its own medical school in the state in 2019.
The system’s leaders said their central goal was to teach Kaiser’s model of integrated care to a new generation of doctors who will be under pressure to improve health outcomes and control costs by working in teams and using technology.
“Health care is evolving at a very, very rapid pace in our country and we have a model of care that’s increasingly being looked to as an answer,” said Dr. Edward M. Ellison, executive medical director for the Southern California Permanente Medical Group, who is helping to oversee the medical school’s creation.
-----

AHRQ Sees Budget Cuts, but Agency Remains in Place

December 17, 2015
by Rajiv Leventhal
The House Appropriations Committee has cut funding for the Agency for Healthcare Research and Quality (AHRQ) in its final fiscal year 2016 omnibus bill, but the research agency will not be terminated after all.
In June, the House Appropriations Committee voted in favor of a bill that would eliminate the Department of Health & Human Services’ (HHS) AHRQ all together, a research agency that has long been disliked by some members of Congress who feel that the organization's work has not led to proven results. However, the White House had asked for funding of the AHRQ, which has areas devoted to health IT research, to remain static. Now, in its FY16 final omnibus bill, the House Appropriations Committee has provided AHRQ with $334 million in budget authority in FY16, down from $364 million in FY15, or a cut of about 8 percent.
-----

Five Security Tips for 2016 That Could Save Your Job

DEC 17, 2015 12:30am ET
Pretty much everyone expects the pace of cyberattacks seen over the past two years to continue in 2016, but there are some differences in next year’s security predictions. For one thing, we're hearing the term “prediction” used more in place of “prevention.”
The reason: Nearly everyone agrees now that cyber incidents are inevitable for … nearly everyone. That means that CIOs and CISOs need to have a response plan in place. Failure to do so will likely cost someone their job should a significant incident occur. That’s already happening to some degree in the healthcare industry.
But beyond the “when not if” shift in security attitudes, what else should organizations expect in 2016? We put that question to Amit Yoran, the president at RSA, the information security arm of EMC. He prefaced his predictions by reviewing the major trends of 2015.
-----

AHRQ: Despite uptick, HIE use still 'low'

December 15, 2015 | By Marla Durben Hirsch
The use of health information exchange (HIE) is increasing, but overall use remains "low," according to a new report from the Agency for Healthcare Research and Quality (AHRQ).
The 465-page report, released this week, reviews 136 studies of HIEs, and finds that more than three-fourths (76 percent) of U.S. hospitals were exchanging information in 2014, a 23 percent increase since 2013. However, only 38 percent of office-based physicians used an HIE in 2013, and use is very low (1 percent) by long-term care providers.
Studies reviewed were somewhat limited in their scope and content, and most were of low quality, according to AHRQ.
-----

Wales sets out digital ambitions

Thomas Meek
15 December 2015
Welsh patients will access their medical record online and use smartphones to manage their health as part of a five-year digital health strategy published by the Welsh government.
‘Informed Health and Care: a digital health and social care strategy for Wales’ sets out the country’s ambitions to improve access to patient information across health and social care and to make better use of digital technology.
Many of its goals mirror that of ‘Personalised Health and Care 2020’, the framework that is being used to drive the uptake of digital technology for health and social care services in England.
-----

Ireland races to implement health IT

Rebecca McBeth
17 December 2015
Ireland has created an Individual Health Identifier for all patients, and implemented an e-referral system in half of all its hospitals, over the past six months
Digital Health News reported in June this year that Ireland had launched a 'Knowledge and Information Strategy', which focused on getting a new IT infrastructure, interoperable systems, data use, and patient services in place for its health services.
Ireland’s chief information officer for health Richard Corbridge said getting that plan approved and published gave the go-ahead to create eHealth Ireland, taking different IT functions from across the country and moving them into one national function for delivery of healthcare IT.
-----

Survey: More Primary Care Support Means Better Care Coordination

December 16, 2015 02:48 pm News Staff – Primary care physicians in the United States are not alone in their struggle to coordinate care for patients with chronic or mental illnesses, a recent international survey(www.commonwealthfund.org) of physicians indicates.
Technology, a lack of shared data with other health professionals and payment restrictions were common limiting factors cited in the study by the Commonwealth Fund, which was published recently(content.healthaffairs.org) in Health Affairs. The authors concluded that a stronger primary care infrastructure is the first step toward a solution.
The survey asked primary care physicians in 10 Western countries to evaluate their ability to care for patients who are considered the costliest, along with their overall experiences in dealing with the health care system.
-----

2016: Technology Driving the Triple Aim

by Jane Sarasohn-Kahn Thursday, December 17, 2015
While the health care market environment for 2016 has many uncertainties, there is one certainty that will drive adoption and deeper use of IT: the need to do more with less money. Whether value-based, bundled or slashed reimbursement, health care providers and consumers will be faced with rising costs and the need to do more with less.
Providers are savvier, more critical health IT buyers. With several years of living and working with electronic health records, health care providers know what they like, and don't like, about the first generation of adopted systems. Most physicians are dissatisfied with their EHRs, and many will shop for a second generation of new-and-improved systems at HIMSS 2016. Others will add complementary functionality through niche tools -- such as team collaboration and patient engagement platforms -- that help extend care beyond the providers' walls that enable more team-based care to more effectively function in the value-based payment environment.
-----

Omnibus funding bill requires HHS to convene cybersecurity taskforce

December 16, 2015 | By Dan Bowman
The U.S. Department of Health and Human Services would be on the hook for convening a cybersecurity task force and submitting a report to Congress next year on the ability of the agency, and the healthcare industry at large, to respond to cybersecurity threats, under an omnibus funding bill unveiled Wednesday morning.
That language is part of a larger cybersecurity bill included in the omnibus bill, which encourages businesses to share information on hackers with the government, according to a report from The Hill. The omnibus bill did not include any alterations to the Meaningful Use program, according to Politico, and kept funding for the Office of the National Coordinator for Health IT relatively flat.
-----

Why Secure Text Messaging Alone Isn't Enough

December 14, 2015
Recent studies show that HIPAA-compliant messaging app adoption remains low in healthcare, with some estimates pegging the number of HCOs utilizing non-compliant messaging solutions at 90%. It isn't for a lack of options, however—there are an estimated 100+ secure messaging apps available on the market, with more emerging daily.
So why do most of these options fail in a healthcare environment? And, as solution providers, what can we do to address the unserved 90% portion of the market?
In order to facilitate proper healthcare workflow, healthcare needs something much more comprehensive than a simple HIPAA compliant secure texting app. A large percentage of our current customers had previously evaluated and adopted other secure messaging products, but a mere year later they were already looking for something more robust and healthcare-focused.
-----

OpenNotes Movement Gets $10M in Funding for Expansion

December 15, 2015
by Rajiv Leventhal
Continuing the progress of the OpenNotes movement, four institutions have jointly announced $10 million in new funding to spread access to clinical notes to 50 million patients nationwide.
The practice of sharing visit notes more readily began with the OpenNotes yearlong pilot in 2010. At the end of a year, those who read their notes reported feeling more in control of their care and having better recall, knowledge and understanding of their medical conditions. Ninety-nine percent of patients wanted the practice to continue, and all participating doctors chose to keep their notes open after the study ended. Over time, researchers have continued to find benefits in providers sharing notes with their patients.
-----

5 Trends that Will Drive Big Data in 2016

DEC 14, 2015 7:49am ET
Big data, the cloud, mobile technology and IT security continued to grab the lion’s share of technology headlines in 2015, and IT and data leaders can expect more of the same in 2016.
That is the prediction of MapR CEO and Co-founder John Schroeder, who spoke with Information Management about the five major developments he sees in big data in 2016. “We are in the midst of the biggest change in enterprise computing in decades,” he notes.
“How data is stored, analyzed and processed is transforming businesses. Businesses are being revolutionized and new ones are being formed based on converged data and analytics across industries, from insurance carriers basing premiums on actual behavior and specific risk profiles, to healthcare providers improving personalized treatment, to retailers dynamically adjusting inventory, to telecom carriers enhancing mobile service areas, to advertising technology companies driving continued growth.”
-----

Commentary: Home Monitoring Tech Heads Off Crises for CHF Patients

DEC 15, 2015 3:16pm ET
Changing the way we manage patients with chronic diseases is one of the major challenges to improving outcomes while controlling costs, and technology used in the home can have a dramatic impact on the results.
These patients already account for 70 percent of the total amount spent on healthcare in the U.S. Thanks to the growing effectiveness of medical treatments, the prevalence of chronic disease is increasing because patients are living longer. As their average age goes up, so does the cost of treating them.
This is especially true for patients who have chronic diseases that get worse “in secret” – diseases such as congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), where deterioration takes place out of sight of clinicians. With these “silent” diseases, early signs of problems are too often missed, along with the opportunity to intervene before a trip to the hospital is required.
-----

CIOs target population health, patient engagement in 2016

Posted on Dec 14, 2015
By Mike Miliard, Editor
Whether they work at small rural hospitals or sprawling, multi-state health systems, staffers at the 21 winning Healthcare IT News' 2015 Best Hospital IT Departments are very busy folks.
They were busy in 2015, and they'll be busy in 2016 as the demands of delivering better technology-enabled care -- all under the watchful eye of an increasingly demanding federal government, wanting bigger bang for its reimbursement bucks -- continue to evolve.
We polled the chief information officers of the winning IT departments and asked them about the projects they'll be pursuing in 2016 as well as their predictions for healthcare or health IT in the coming year.
-----

Telemedicine produces 'positive results,' but more research needed on primary care effectiveness

December 15, 2015 | By Katie Dvorak
Telemedicine is helpful for communication, counseling and monitoring and managing chronic disease, according to a draft technical brief from the Evidence-based Practice Center (EPC) created for the Agency for Healthcare Research and Quality (AHRQ).
The brief is based on information from 44 systematic reviews and interviews with key stakeholders in the industry. The EPC found that much of the research determined telehealth interventions produced "positive results." The majority examined using telemedicine for chronic disease management and psychotherapy as part of behavioral health.
-----

ONC's HIT standards committee names co-chairs

Written by Akanksha Jayanthi (Twitter | Google+)  | December 14, 2015
The Health IT Standards Committee, a Federal Advisory Committee that works with the ONC, has appointed Lisa Gallagher and Arien Malec as co-chairs.
-----

Rock Health: Venture funding in 2015 surpassed $4.3 billion

December 14, 2015
Venture funding in 2015 has reached $4.3 billion, right on track with 2014, according to Rock Health’s 2015 Year in Review report. There were 279 total deals this year and the average deal size was $15.6 million. Though the number of deals has decreased from last year, the average deal size is higher.
Rock Health only including funding deals that are above $2 million and the data is current as of December 8th.
The number of later stage deals also grew this year, which Rock Health says is an indicator that the industry is maturing. While seed and Series A deals still accounted for a majority of the deals, Series C deals represented 18 percent of deal volume and even later stage deals represented 25 percent of deal volume. Some 34 companies that raised a round in 2014 raised at least one more round in 2015.
-----

CommonWell Alliance Inches Toward Better Interoperability

Scott Mace, for HealthLeaders Media , December 15, 2015

The ideal interoperable electronic health record system will never be as simple to use as an ATM. Healthcare data is just not that simple.

During this past summer's Congressional hearings on healthcare IT interoperability, the CommonWell Health Alliance was held up as a shining example of the kind of industrywide cooperation that should be emulated, and perhaps even given legislative blessing.
It was also compared to the banking industry's interlocking network of ATM networks, which has made getting cash from any ATM so easy, the question practically asks itself: Why can't getting healthcare data be just as simple?
-----

Getting Smart About Patient ID

Scott Mace, for HealthLeaders Media , December 15, 2015

Payers and providers are widening their use of a combination of technologies to simplify patient identification at check-in, spurred in part by progress being made in the credit card industry.

This article appears in the December 2015 issue of HealthLeaders magazine.
Until recently, most patient ID technology centered on building and maintaining master patient indexes. Enterprise master patient index technology—not a foolproof method of positively identifying someone presenting for treatment—continues to perform foundational work in healthcare.
Now, payers and providers are widening their use of a combination of technologies to simplify patient identification at check-in, spurred in part by progress being made in the credit card industry to adopt smart card technologies, as well as advances in other biometric and cloud technologies.
-----

Release of De-Identified Health Data Poses Elevated Risk

DEC 14, 2015 7:42am ET
Healthcare organizations continue to face challenges in de-identifying health data for secondary uses other than direct patient care, such as data analysis, research, safety measurement, public health, payment, and provider certification. Consequently, organizations may be releasing data with serious risks for re-identification, according to a new survey. 
The survey of 271 professionals who handle protected health information, conducted by de-identification technology vendor Privacy Analytics in collaboration with the Electronic Health Information Laboratory, finds that while 62 percent of respondents indicated that their organizations currently release data for secondary purposes, more than two out of three of these organizations lack confidence in their ability to share data safely in order to protect individual privacy. Nonetheless, more than half (56 percent) are planning on increasing the volume of data they share in the next 12 months. 
-----

John Halamka: Security work to increase in 2016

December 14, 2015 | By Susan D. Hall
Security threats have increased despite healthcare organizations expanded efforts to educate workers on the risks; security is a process that's never finished, Boston-based Beth Israel Deaconess Medical Center CIO John Halamka writes at his blog
He cites attacks that have taken place this year, including:
  • A clinician downloaded an infected copy of Angry Birds to an Android phone and then logged into his/her email. After a barrage of spam, the Internet service provider blocked the email domain.
  • A phishing email mimicked a hospital's Oracle Financials site to steal usernames and passwords that were used to misdirect direct deposits at the real site.
-----

Protocols needed for mental health eVisits

December 14, 2015 | By Susan D. Hall
University of Pittsburgh Medical Center data from the first three years it offered care through a patient portal indicate a need for mental health care offerings, according to research published in the American Journal of Managed Care.
From the 3,601 eVisits conducted between April 2009 and mid-June 2012, 23.9 percent chose the "other" option when their reason for visiting the site wasn't among the offered diagnoses, such as sinusitis and urinary tract infections.
-----

FDA officials: Don't overlook the importance of health IT terminology

December 14, 2015 | By Dan Bowman
When it comes to data in healthcare, the correct use of terminology, while many times overlooked, is every bit as vital to industry success, according to U.S. Food and Drug Administration officials Robert Califf and Rachel Sherman.
In a recent post published to the FDAVoice blog, Califf, the FDA's deputy commissioner for medical products and tobacco, and Sherman, Califf's associate deputy commissioner, say that, all too often, terms such as "data," "information" and "evidence" are mistakenly seen as interchangeable.
-----

Telehealth 2.0? Remote Diagnosis Market Heating Up

by Rebecca Vesely, iHealthBeat Contributing Reporter Monday, December 14, 2015
Startup ventures are racing to capture the market in patient-led remote diagnosis -- often as an add-on to telehealth services -- though the future of the sector is unclear because of federal regulations, reimbursement challenges and uncertainty about provider adoption.
Remote diagnostic devices allow consumers to conduct an exam on their own and then send results -- usually via a smartphone -- to their clinician. Sometimes referred to as DIT, or "Do It Together," health care, the sector is coming to market with a suite of hardware and software products that can allow patients to conduct exams remotely for everything from skin cancer to heart problems to an ear infection.
-----

Enjoy!
David.