Saturday, July 16, 2016

Weekly Overseas Health IT Links – 16th July, 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.
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Declining number of public HIEs raises concerns about interoperability

Jul 8, 2016 10:56am
The number of public health information exchanges (HIEs) has dropped, raising concerns about the ability to achieve widespread clinical data exchange, according to a new study in Health Affairs.
The study, conducted by researchers at the University of Michigan, found an 11 percent drop in state and community HIEs from 2012 to 2014, from 119 to 106. It’s the first decline in HIEs in the history of such surveys, which began in 2007. It’s also the first measurement of the number of HIEs since federal funding aiding their development ended.
The HIEs that were still operational reported that only half of them were financially stable, and all of them were running into problems that affected their success, such as an unsustainable business model, lack of integration of the HIE into provider workflow and lack of funding. Key stakeholder participation was also low, which indicates that the HIEs may hold limited value.
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Data quality issues bog down use of analytics

Published July 06 2016, 3:16pm EDT
Key data performance management issues challenge the IT executives in organizations of all sizes, and resolving problems wastes time and delays the use of data, many in the industry believe.
Prime challenges for organizations range from stopping bad data to keeping data flows operating effectively, according to a new survey by Dimensional Research.
The vast majority (87 percent) of the 300 data management professionals surveyed report that they’ve added bad data into their data stores, while just 12 percent consider themselves good at the key aspects of data flow performance management.
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Researchers: Doc note accuracy higher on paper records vs. newly implemented EHRs

Jul 7, 2016 6:54am
Physician progress notes tend to be more accurate in paper records than in newly implemented electronic health records, but there is more information omitted in paper notes, according to a new study in the Journal of the American Medical Informatics Association.
The researchers reviewed the initial progress notes of patients admitted to Beaumont Hospital in Royal Oak, Michigan, between August 2011 and July 2013. They retrospectively reviewed 500 notes, some before implementation of the EHR in 2012 and some after implementation, and studied five specific diagnoses with invariable physical findings: permanent atrial fibrillation, aortic stenosis, intubation, lower limb amputation and cerebrovascular accident with hemiparesis. 
They found that overall accuracy of documentation was “poor”, with 54.4 percent accuracy of documentation of physical exam findings in paper records and 58.4 percent in EHRs. However, the rate of inaccurate documentation was “significantly” higher with EHRs (24.4 percent v. 4.4 percent). When it came to missing information, expected physical exam findings (such as the presence of a murmur) was more likely to be omitted in the paper notes (41.2 percent v. 17.6 percent).
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Doctors make more note-taking mistakes with EHRs than paper records, JAMIA study finds

New research published in the Journal of the American Medical Informatics Association research found that inaccuracies within electronic health records are significantly higher than those in paper records. 
July 08, 2016 07:58 AM
A study of medical reporting at a Michigan hospital found that doctors’ progress notes in the initial implementation of electronic health records contained more inaccuracies compared to paper charts.
The Journal of the American Medical Informatics Association report found that the rate of inaccurate documentation was significantly higher in the EHRs compared to the paper charts: 24.4 percent versus 4.4 percent. 
Researchers examined initial progress notes of patients admitted to Beaumont Hospital in Royal Oak, Michigan between August 2011 and July 2013. They reviewed 500 notes, some before implementation of the EHR in 2012 and some after implementation, and examined five specific diagnoses with invariable physical findings: permanent atrial fibrillation, aortic stenosis, intubation, lower limb amputation and cerebrovascular accident with hemiparesis. 
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HL7, NATE offer advice for working with patients who want EHR data downloaded to their health app of choice

Doctors are required by law to allow patients to view, download and transmit data and that new reality is giving rise to many hesitations. Here’s a look at pressing issues to understand before proceeding. 
July 07, 2016 07:18 AM
National Association for Trusted Exchange CEO Aaron Seib said that sharing data with patients is unsettling for many doctors accustomed to protecting it under HIPAA. 
Meaningful use and more recently the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rules call for doctors to enable patients to view, download and transmit their electronic health record data.  
And some patients are beginning to inquire about adding that information to various healthcare apps that range from blood pressure monitoring to fitness trackers to glucose reading software for diabetes, among others.
The thorny part: Doctors have had it drilled into their heads for years that under HIPAA they need to protect the data, but that was when records lived on paper.
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11 million patient record breaches make June worst month for information security in 2016

The high number of breaches span payers, providers and an NFL team and prove just how vulnerable the industry is, the new Healthcare Breach Barometer from Protenus and Databreaches.net said. 
July 07, 2016 09:55 AM
The number of healthcare security attacks continues to grow with breaches of over 11 million patient records in June, more than any other month this year, according to a report from security firm Protenus and DataBreaches.net
The June breaches totaled 11,061,649 patient records, representing 23 of 29 incidents for which exact numbers were available. Most of the breaches are attributable to a single hack that included a large insurer database (10.3 million records).
“The impact and rate of breaches illustrate how vulnerable the healthcare industry remains, as well as the need to proactively protect patient privacy and data with new technologies,” the report said. 
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Tough penalties and better data control - Caldicott

Ben Heather
6 July 2016
Dame Fiona Caldicott’s latest review of information governance and security in the NHS says trusts should make security control as high a priority as financial control, and recommends a tougher IG Toolkit for trusts.
The national data guardian’s long awaited report was released on Wednesday morning, after the 'purdah' restrictions that prevent civil servants from making politically controversial statements was lifted following the EU referendum.
“The leadership of every organisation should demonstrate clear ownership and responsibility for data security, just as it does for clinical and financial management and accountability,” the report says. "People’s confidential data should be treated with the same respect as their care."
This would include using a “redesigned” IG Toolkit and giving the Health and Social Care Information Centre the ability to report organisations with poor data controls to the Care Quality Commission.
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Care.data dumped after Caldicott review

Ben Heather
6 July 2016
The controversial care.data programme has been killed off following the release of Dame Fiona Caldicott's latest report on security and information governance in the NHS, which recommends sweeping changes to NHS data protection.
A statement from the Department of Health and minister for life sciences George Freeman, released on Wednesday afternoon, said: “NHS England has taken the decision to close the care.data programme” in light of the report.
While no specific alternative has been offered, the statement said the government remains “committed to realising the benefits of sharing information, as an essential part of improving outcomes for patients."
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US Government Issues Call for Blockchain Healthcare Research

Stan Higgins | Published on July 6, 2016 at 21:01 BST
News
The US Department of Health and Human Services (HHS) is soliciting research papers related to blockchain applications in healthcare and health research.
According to a notice published in the Federal Register, HHS is seeking white papers that explore how the technology can be leveraged for healthcare purposes. The submission date is 29th July, with the winners set to be announced late next month.
The only stipulations, the notice states, is that papers shouldn’t be longer than 10 pages and that no more than three papers should be submitted by any one researcher or group.
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Researchers look to biosensors as way to monitor opioid use

Published July 05 2016, 6:35am EDT
Faced with a national opioid epidemic, researchers have found that wearable biosensors hold great promise for detecting episodes of drug use in real time with the potential for keeping opioid users on track with substance abuse treatment programs by triggering interventions in the event of a relapse.
The sensors, developed by Waltham, Mass.-based Affectiva, detect and record physiological signs of opioid use. A University of Massachusetts Medical School team tested the use of these wristband sensors worn by patients in an emergency room who were receiving opioids for severe pain relief.
“Our goal was to see if mobile biosensors could indeed identify when someone used an opioid drug,” says Stephanie Carreiro, MD, a fellow in the Division of Medical Toxicology, Department of Emergency Medicine at the University of Massachusetts Medical School.
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EHRs combined with precision medicine can improve depression treatment

Jul 6, 2016 9:11pm
Using genetic information in a patient’s electronic health record can help pinpoint which antidepressant drugs should be prescribed and in what amounts, according to a new article in Mayo Clinic Proceedings.
There are more than 20 Food and Drug Administration-approved treatments for depression. However, genetic variations among patients may contribute to the effectiveness of different treatments and to adverse events. For example, cytochrome P4502D6 (CYP2D6) and cytochrome P4502C19 (CYP2C19) are subject to genetic variation and metabolize differently with different selective serotonin reupdate inhibitors (SSRIs). However, many clinicians are not familiar or comfortable with pharmacogenetics, despite growing evidence of its clinical importance.
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Telehealth sweet spot? Remote monitoring of patients with cardiovascular or respiratory disease, AHRQ says

The U.S. Agency for Healthcare Research and Quality pinpointed instances where telemedicine consults are most effective, though to date information is lacking about cost and utilization. 
July 05, 2016 02:20 PM
The U.S. Agency for Healthcare Research and Quality combed through 58 systematic reviews amid a substantial volume of research on telemedicine to pinpoint when telehealth interventions work best.
The data suggests telehealth improves outcomes such as mortality, quality of life and reductions in hospital admissions when used for remote patient monitoring for certain chronic conditions as well as for psychotherapy as part of behavioral health.
Top chronic conditions for telehealth success: cardiovascular and respiratory disease, according to AHRQ.
AHRQ noted, however, that information on how telehealth affects cost and utilization is currently limited.
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ONC identifies two core metrics to monitor MACRA progress

Jeff Rowe
Jul 06, 2016
After reviewing the comments received following the release of the proposed Medicare Access and CHIP Reauthorization Act (MACRA), the Office of the National Coordinator for Health IT (ONC) has announced it will use two metrics to measure the interoperability of health information across the country.
In a July 1 post on ONC’s HealthIT Buzz blog, Seth Pazinski, director of ONC’s Office of Planning, Evaluation and Analysis, and Talisha Searcy, the office’s director of research and evaluation, wrote that “based on internal analysis, external feedback, and MACRA’s specific definitions of ‘widespread interoperability’ and the relevant population to be measured,” the two metrics that are most applicable to monitoring MACRA’s requirements are “the proportion of health care providers who are electronically engaging in the following core domains of interoperable exchange of health information: sending; receiving; finding (querying); and integrating information received from outside sources,” and; “the proportion of health care providers who report using the information they electronically receive from outside providers and sources for clinical decision-making.”
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Why simplified standards can boost widespread data exchange

Published July 06 2016, 3:25pm EDT
HITECH was specifically designed to facilitate better healthcare through EHR interoperability among providers. But, seven years and more than $30 billion in incentives later, meaningful interoperability is still lacking, according to the ONC’s report to Congress in December 2015.
Despite the near universal consensus that continuity of care is critical to better outcomes and reduced costs, effective information exchanges remain elusive. Of the five issues the ONC report cites, two stand out as principal obstacles.
  • Complex and changing standards. Albert Einstein once said, “If you can’t explain it simply, you don’t understand it well enough.” With that in mind, how easy is it to explain the difference between CDA, CCR, CCD, Green CDA, CCDA and C32 to the average health professional? It’s extremely difficult to understand how each one fits into the overall picture; worse, implementation of any standard demands specialized knowledge. Further, these standards are brittle, as each vendor may have their own interpretation of the specifications. The result is a time-consuming and difficult integration process, even though sending and receiving systems have been developed from the same specifications.
  • Security and privacy considerations. If no harm comes from unauthorized use of the data, the penalties for breach are still severe. Even after a vendor manages to work through a sea of standards and the related maze of specifications, exchanging information in compliance with state and federal regulation remains an issue. Security and privacy demands are very high and require even more specialized knowledge. Things such as VPNs, HISPs, DirectMessaging, SSL certificates, AES-256, encryption at rest and minimum necessary privilege present yet another barrier to the process. The penalties, damage to reputation and specialized skill sets needed for secure transactions discourage organizations from doing anything except meeting the bare interoperability requirements. It’s easy to see why some might find it simply not worth the effort or risk to break new ground.
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Predictive Analytics, Healthcare IoT Lead EHR Market Growth

By Jennifer Bresnick on July 05, 2016

Predictive analytics and the Internet of Things are at the top of the wish list for potential purchasers of new electronic health record offerings.

Electronic health record vendors looking to attract customers to the next generation of upgrades and installs will likely be relying on predictive analytics and the healthcare Internet of Things, according to a series of new market reports. 
The compound annual growth rate (CAGR) in the EHR marketplace will continue to rise at approximately 5.5 percent, says Research and Markets, as vendors begin to roll out a new set of integrated big data analytics offerings. 
Predictive analytics are in particularly high demand among the provider community, the report added, as healthcare organizations square up to the challenge of value-based reimbursements, population health management, and rising regulatory demands.
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Google Glass not a flop in the emergency room, doctor says

Tuesday, 5 Jul 2016 | 1:51 PM ET
The medical community is breathing new life into Google Glass.
The once-anticipated hot tech trend that consists of a pair of eyeglasses with a computer, microphone and camera built into the frame failed to catch on with the broader mainstream market when it debuted to select consumers in 2013. But now, the old technology is taking on a new function — serving as a tool for doctors in emergency situations.
"Consumers weren't ready for Google Glass," said emergency physician Dr. Peter Chai. "But the medical community has given it a second life."
Chai, who's also a toxicologist and assistant professor at the University of Massachusetts Medical School, says doctors are using Glass as a way to bring specialists to patients in a more efficient manner.
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Healthcare organizations lag in sharing cyber attack info

Published July 01 2016, 6:49am EDT
Through a presidential executive order and legislation enacted by Congress in 2015, the federal government set in motion procedures for healthcare organizations, companies in other industries and local governments to collect and share cyber threat information among themselves and with the government.
The federal initiatives included incentives to enable organizations to receive threat information not just from other organizations but from government agencies such as the Departments of Homeland Security and Health and Human Services.
However, threat data sharing in healthcare has gotten off to a slow start even as cyber attacks have accelerated. Many stakeholders are not aware of the initiative; others have needed time to develop arrangements for sharing with each other and to develop analytics capability to analyze threats and turn them into actionable alerts, says Lisa Gallagher, managing director of the healthcare cybersecurity and privacy practice at consultancy PricewaterhouseCoopers.
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How healthcare security strategies might not prevent patient harm

Jul 5, 2016 7:06am
The healthcare industry focuses its security strategy almost exclusively on protecting patient health records, yet rarely addresses potential patient harms from a cyberthreat perspective, Independent Security Evaluators’ executive partner Ted Harrington says in an interview with CSO.
Attackers targeting patient records are likely to go after different systems in different ways that those intending to do patient harm, he says, so for organizations to focus their resources only on protection of records increase the likelihood that patient harm will occur.
Vulnerabilities in medical devices such as pacemakers and even vital sign monitors could prove deadly in the hands of determined hackers, and protections aimed at patient data wouldn’t really help, Harrington says.
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Report: More research needed on emerging telemedicine models

Jul 5, 2016 10:38am
While evidence supports the use of telemedicine for a scenario like remote monitoring of patients with chronic conditions, there is little research to support its use in other areas, such as maternal health, according to a technical brief from the Agency for Healthcare Research and Quality (AHRQ).
The Pacific Northwest Evidence-based Practice Center in Portland, Oregon, analyzed 58 systematic reviews assessing the vast amount of research and conducted interviews with key stakeholders in the industry to create an “evidence map” for telemedicine for AHRQ. A draft of the report was released in December.
The work grew from a push by Sens. Bill Nelson (D-Fla.) and John Thune (R-S.D.) for evidence backing expanded access to telemedicine.
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CMS unleashes bigger trove of claims data to help hospitals improve care quality

New rules under MACRA mean that qualified providers can share or sell analyses of Medicare and private claims data, which the Centers for Medicare and Medicaid Services could be a boon to better care delivery.
July 05, 2016 10:48 AM
CMS Chief data Officer Niall Brennan said the new data will enable caregivers to make smarter clinical decisions.
The Centers for Medicare and Medicaid Services is making more claims data and analyses available to help care providers, employers and others boost the quality of care across the country.
The goal is to help organizations and individuals make better informed decisions about care delivery and quality improvement.
The new rules required by the Medicare Access and CHIP Reauthorization Act, or MACRA, allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups that can use the data to support improved care.
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Mobile videoconferencing from ambulance speeds up stroke care

Published: Monday 4 July 2016
A study of a mobile videoconferencing system - where paramedics accompanying patients in ambulances confer with doctors through computer tablets - shows it can produce stroke assessments on a par with those done at the hospital bedside. Such a system could help stroke patients receive treatments more promptly and thus reduce the risk of disability and death.
The findings of the clinical trial, by researchers from the University of Virginia (UVA) Health System in Charlottesville, are published in the journal Neurology.
Andrew M. Southerland, assistant professor of neurology and head of the study team, says:
"Acute stroke is a very time-dependent illness. Specifically, in acute ischemic stroke, if you can remove the vascular obstruction and re-vascularize the injured part of the brain in a timely way, you can potentially prevent disability and death."
In the United States, stroke is a leading cause of serious long-term disability and is responsible for 130,000 deaths a year - that is one out of every 20 deaths.
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Jun 30, 2016 @ 08:00 AM

Telemedicine Companies See Mental Health As Next Frontier

Telemedicine companies that have been landing a flurry of new contracts with employers and insurers to provide less expensive and more convenient medical consultations with physicians are now adding mental health services for their customers.
MDLive, Teladoc and American Well are among the telehealth firms getting into the business of offering access to psychiatrists, psychologists and therapists via smartphone, tablet and computer as the nation grapples with a rising rate of suicides, opioid addiction and other mental health issues.
The companies see a huge growth opportunity, with more Americans suffering mental health conditions than common medical conditions like diabetes and heart disease. Meanwhile, less than 50% of Americans who are prescribed medications to treat mental health conditions take them as directed, if at all, according to industry reports and Walgreens Boots Alliance .
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Electronic health records can increase malpractice risks

NORTH BAY BUSINESS JOURNAL STAFF REPORT
July 4, 2016, 5:45AM
Widespread use of the electronic health record (EHR) in medical practices may be contributing to more errors and malpractice liability, according to a recent report by The Doctors Company, a Napa-based medical malpractice insurance company.
The Doctor’s Company closed almost 100 claims between January 2007 and June 2014 in which EHRs were a contributing factor. The top allegation among the 97 claims was for diagnosis-related errors, followed by medication-related errors, with the wrong medication, the wrong dose, or improper medication management given to the patient.
“It takes 4-5 years from the time a claim is filed until it is resolved one way or another. The study, tracking EHR errors, saw very few claims at the beginning, the speculation being that these kinds of malpractice risks are increasing,” said Denise Moore, public relations director at the Company, which is the nation’s largest doctor-owned medical malpractice insurer, with 78,000 members and $4.3 billion in assets.
From 2007-2010, two claims were closed in which the EHR was a contributing factor. In 2013 that number had increased to 28, and 26 claims were closed in the first two quarters of 2014.
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An EHR Tailored for Pediatricians Closes Some Gaps

Scott Mace, July 5, 2016

Modifying electronic health record software can help catch early signs of childhood obesity, problems with oral health, vision, and hearing, and the risk of developing autism, expert says.

Electronic health record software has not met some pressing needs of pediatricians.
After years of federally funded studies of the problem, and few meaningful actions as part of meaningful use, it's time for a change.
One healthcare organization has identified pediatricians' biggest EHR pain points and is working to improve the situation.
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HIT Safety Concerns Mount Among Providers

HealthLeaders Media News, July 5, 2016

Healthcare providers are not well prepared for the "unintended consequences" of the shift to greater use of health information technology, researchers say.

Providers are not equipped to recognize, analyze, and learn from patient safety problems linked to the use of health information technology, according to speakers at a health services research conference in Boston last week.
Providers are familiar with patient safety issues from the Institute of Medicine's landmark 1999 report on medical error, said Hardeep Singh a professor Baylor College of Medicine in Houston. But health information technologies (HIT) are completely changing the way doctors practice, he said.
Providers were not prepared for the "unintended consequences" of the shift to greater use of HIT, he said.
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Enjoy!
David.

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