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, February 20, 2016
Weekly Overseas Health IT Links - 20th February, 2016.
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.
Early in my IT career, I became an expert in discarding data. Now, with data collection easier than ever, I wonder if it’s time to reconsider those early lessons.
My first healthcare IT job was installing the SMS Command database applications that included report writing, medical records, infection control and utilization review. The database structure parsed into Active and Historical data files. Data elements that did not move from the online system to the Active file were purged, according to user defined parameters. Likewise, user-defined parameters determined Active and Historical file data retention, based on pre-defined purge schedule.
Right after leaving SMS to move out-of-state with a former spouse, I landed a leadership positon in an HBOC client site. Soon after I started my new position, the clinical systems upgraded from Clinpro to Clinstar, a totally new application on a new platform.
Cybersecurity attacks and data breaches soared during 2015, according to results of the sixth annual report from security firm Redspin on leaks of protected health information.
Since 2009, a total of 154,368,781 patient records have been breached, and nearly three-quarters of those records—more than 113 million—were breached in 2015, Redspin noted. Further, 98 percent of patient records breached last year were a result of hacking incidents.
From 2009 through 2013, the primary cause of breaches was the theft of unencrypted computing devices, but in large part, thieves valued the device more than the information they held, according to Redspin’s report. “Not so in 2015. Hackers knew exactly what they were after as they pilfered health information and/or other personal data for nefarious purposes, such as medical ID theft and fraud,” it stated.
Electronic reminders seem to be essential to keeping patients engaged in reading their physicians' notes, according to a study on the OpenNotes program.
The research, published in the Journal of the American Medical Informatics Association, examined 14,000 patients at Beth Israel Deaconess and at Geisinger Health System who have access to the notes their doctors keep in their files.
Doctors at Beth Israel Deaconess sent reminders for the two years of the study; Geisinger sent no reminders after the first year.
The rise of telemedicine represents one of the biggest shifts in healthcare delivery over the last decade—but the telemedicine changes we have seen so far are nothing compared to what we’re likely to see in 2016.
Telemedicine is on the verge of rapid, widespread growth and adoption as the forces that have fueled its rise so far—mainly the growth of value-based care and patient convenient access— continue to gain momentum. Additional drivers are poised to push telemedicine’s expansion beyond what we’ve seen to date. The global telemedicine market is expected to expand at a compound annual growth rate of 14.3% over the next five years, eventually reaching $36.2 billion, compared to $14.3 billion in 2014.
These new drivers reflect broader forces at work: advances in telemedicine technology, evolution in legislators’ and regulators’ views of telemedicine, and providers’ and insurers’ relentless efforts to provide cost-effective care with high-quality results. This is amplified by the growing demand for convenience, innovation and personalized care among healthcare consumers around the world.
In the government’s annual report of national security threats, released Tuesday, a new entry made the list: genome-editing.
It might seem surprising to place genome-editing in the company of cyberattacks by China, the nuclear ambitions of North Korea, and new cruise missiles being deployed by Russia. But in his report to Congress, director of national intelligence James Clapper said genome-editing research “probably increases the risk of the creation of potentially harmful biological agents or products,” whose “deliberate or unintentional misuse might lead to far-reaching economic and national security implications.”
The report did not elaborate, and the Senate panel to whom Clapper testified about the report did not ask him to.
Mac McMillan doesn’t hold back in discussing his concerns about security vulnerabilities in healthcare, and wireless infusion pumps are on his list as a risk factor for providers.
McMillan is co-founder and CEO of CynergisTek, an information security and privacy consulting firm and has long been at the head of industry security efforts. He is a member of CHIME’s AEHIS Advisory Board, Chair of the HIMSS Privacy and Security Policy Task Force and brings nearly 40 years of combined intelligence, security countermeasures and consulting experience from positions within the government and private sector.
Recently, Health Data Management editor Fred Bazzoli discussed rising industry concerns about the security vulnerability posed by wireless infusion pumps, and potential ways to deal with the risks.
Electronic health records are typically touted as providing two primary and vital services: readily accessible patient records and protection against contraindicated medications. But at Intermountain Healthcare, we're benefiting from a growing versatility in the application of electronic health records that has the potential to transform the healthcare landscape far more broadly.
Key to it is trust – in the data, in its utility, and in the people developing and advancing it. Achieving that trust requires an organizational culture from top-to-bottom that is data-driven.
Intermountain Healthcare pioneered electronic health records in the 1970s, so their application is not new to us. Still, technological advances in recent years have evolved significantly, and that evolution has made more versatile applications possible.
Today, the many benefits that we are receiving from electronic health records include the following: analyzing relationships between conditions; improving patient procedures; reducing rates of infection; reducing antibiotic use; tracking vital signs; and reducing supply chain costs.
A recent study funded by Agency for Healthcare Research and Quality suggests that patients with fully electronic health records experienced fewer adverse events such as hospital-acquired infections.
In order to be considered a fully electronic EHR, "physician notes, nursing assessments, problem lists, medication lists, discharge summaries and provider orders are electronically generated," according to researchers.
Using 2012 and 2013 Medicare Patient Safety Monitoring System data, AHRQ examined outcomes for cardiovascular, pneumonia and surgery patients – specifically with regard to occurrence rates of 21 adverse events in four clinical domains: hospital-acquired infections, adverse drug events, general events (falls or pressure ulcers, for instance) and post-procedural events.
Health plan members are more likely to engage in preventive care measures when able to access their health information online and receive alerts on gaps in care, according to a Kaiser Permanente study.
Consumers who use Kaiser's Online Personal Action Plan, which provides access to health data and sends emails if members need preventive care, are more likely to see closure of care gaps, especially in a few specific areas.
For example, portal users were 9 percent more likely to have mammograms, 6 percent more likely to receive a Pap smear and 12 percent more likely to schedule HbA1c testing for diabetes.
Cerner has launched its new Cerner Open Developer Experience -- known as "code_" -- in a bid to spur wider collaboration with third-party and client developers for SMART on FHIR applications.
SMART on FHIR tools run on top of electronic health records, giving physicians access to the apps from within their workflow, enabling them to more easily interact with health data.
Developers who visit code.cerner.com can begin coding immediately with the SMART on FHIR tools and browse current apps that are available or in development. Cerner officials say code_ is designed with open communications and robust API documentation in mind, meant to offer access to tools that enable innovative app development.
Although the healthcare industry has moved with "tremendous speed" in addressing security in the past couple of years, Internet of Things health devices are creating more potential for cyberattacks, cybersecurity expert Tyler Cohen Wood tellsHealthcareInfoSecurity.com.
"The more connected you become, and the more software you're utilizing, typically the more open you are to attack," says Wood, cybersecurity adviser at Inspired eLearning and a former Defense Department intelligence officer.
Everybody can see the case for getting community nurses and other staff mobile; but there have been significant barriers, from resistance to new ways of working, to contracting mobile networks, to a lack of integration between the core systems to which staff need access.
Daloni Carlisle reports on the progress that some healthcare communities are making, and the challenges that still need to be addressed, with a focus on work underway in Surrey [case study 1] and Locala [case study 2].
The road to mobilising the community nursing workforce has been strewn with obstacles; sometimes it must seem that as soon as one is overcome another crops up.
A few years ago, it was nurses who were the main barrier, as they fought the adoption of new technologies tooth and nail, arguing that they could not be replaced by a computer.
President John F. Kennedy galvanized the nation’s focus for a cause on Sept. 12, 1962, when he set a course for the moon, and having Americans land there, and safely return by the end of the decade.
In pointing the nation forward, he said these words: “We choose to go to the Moon in this decade and do the other things, not because they are easy, but because they are hard; because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one we intend to win.”
I strongly feel that healthcare needs a moon shot in achieving drastic improvements, with healthcare IT playing a lead or supporting role.
The Department of Health and Human Services has proposed new rules on patient record disclosures to ensure substance use disorder patients can participate in new integrated healthcare models without risk of having their records shared inappropriately.
The revisions on the Confidentiality of Alcohol and Drug Abuse Patient Records would also facilitate health information exchange and to address legitimate privacy concerns of patients seeking treatment for substance use, HHS said.
“This proposal will help patients with substance use disorders fully participate and benefit from a healthcare delivery system that’s better, smarter and healthier, while protecting their privacy,” HHS Secretary Sylvia Burwell said in a statement.
Patients and physicians "need to get over it" when it comes to fears and frustrations surrounding sharing healthcare records, David B. Agus, a professor of medicine and engineering at the University of Southern California, writes in a recent commentary published in the New York Times.
The Improving Health Information Technology Act and six other bills cleared the Senate health committee with bipartisan support at a hearing on Tuesday.
Notably, the revised Improving HIT Act, for which draft legislation was unveiled late last month, removes verbiage calling for the creation of a Health IT Advisory Committee through a combination of the current Health IT Policy and Health IT Standards Committees. It also does not carry over language mandating electronic health record products to be capable of trusted exchange with "multiple other EHR products."
The Senate Health, Education, Labor and Pensions (HELP) Committee today unanimously passed the Improving Health Information Technology Act as well as six other biomedical innovation bills with bipartisan support.
The 51-page Improving Health IT Act legislation aims at making electronic health records (EHRs) more interoperable and has a number of goals including establishing an unbiased rating system for health IT products to help providers better choose those products and addresses information blocking by giving the Department of Health and Human Services (HHS) Office of the Inspector General the authority to investigate and establish deterrents to information blocking practices.
The section of the bill that establishes a star-rating system for EHRs based on security, usability and interoperability was a provision of the Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015 by Sen. Bill Cassidy (R-La.) and Sheldon Whitehouse (D-R.I.).
The United Kingdom government will spend £4.2 billion (A$8.6 billion) to bring its national health service (NHS) into the digital age through initiatives like electronic records and online appointments and prescriptions.
The government intends for the NHS to offer a paperless service that works better for both patients and physicians by removing outdated technology like fax machines in favour of digital health services.
The funding will include £1.8 billion to create a paper-free NHS, £1 billion on cyber security and privacy initiatives, £750 million to transform remote care, and £400 million to digitise the NHS through the likes of mobile apps and free wi-fi.
Handling more than 1 million patient visits each year, including more than 100,000 in its emergency department—rated as one of the busiest in the nation— Cleveland’s MetroHealth System prides itself on providing high-quality care, enabled by health information technology.
The integrated health system has been a pioneer in the implementation and use of healthcare IT. In fact, it was the first public health system in the country to install an Epic electronic health record; it went live with the system in 1999 and was fully deployed enterprise-wide in 2009 throughout all ambulatory clinics, inpatient areas, and the ED.
It is an EHR system for which MetroHealth has won multiple industry awards, attaining HIMSS Analytics Stage 7 Ambulatory Status in 2014 and Stage 7 Hospital Status that same year. Most recently, it was named a 2015 HIMSS Enterprise Davies Award recipient.
Doctors' assessments of seriously ill children through the use of telemedicine were similar to bedside evaluations, according to new research published online in Pediatrics.
The doctors used the Yale Observation Scale to assess 132 children with fever, and 145 children with respiratory symptoms were evaluated using the Respiratory Observation Checklist. These two conditions were chosen for the study because they can be difficult to assess, the authors said.
A group of pediatric emergency physicians, fellows or mid-level providers served as evaluators, switching out to both assess children at the bedside and remotely. In addition, 30 children were assessed by two observers simultaneously at the bedside, and two observers via telemedicine to further evaluate inter-observer reliability, according to an announcement.
During a public health emergency, timely access to data is crucial. To improve access to data on the Zika virus during the current epidemic, the World Health Organization Bulletin is implementing a new data-sharing and reporting protocol.
Under the new protocol, research manuscripts on the Zika epidemic — which WHO has declared an international public health emergency — will be posted online in WHO's "Zika Open" collection within 24 hours while undergoing peer review. During the review process, the papers will be available for free, allowing readers to scrutinize, distribute and reproduce the research in any medium.