Saturday, August 20, 2016

Weekly Overseas Health IT Links – 20th August, 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.

VA seeks information on EHR replacement for VistA

Published August 12 2016, 7:04am EDT
The Department of Veterans Affairs has issued a request for information seeking industry feedback on how the VA might transition from its legacy electronic health record system to a commercial EHR.
While it continues to modernize the decades-old Veterans Health Information Systems and Technology Architecture (VistA) system, the VA is having second thoughts about whether the legacy EHR is able to meet its needs going forward.
“Over the years and due to local customization, there are few standard data elements, a variety of complex algorithms and heterogeneous mix of legacy hardware and software supporting 130 unique VistA instances across the VA enterprise, making modernization and standardization efforts extremely complicated, expensive and time consuming,” states the VA’s request for information.

Automated detection tools reduce adverse drug events, curb alert fatigue

Aug 12, 2016 10:05am
Automated electronic detection tools can help providers to reduce medication errors and improve patient safety, according to a new study published in the Journal of the American Medical Informatics Association.
The researchers, from Cincinnati Children’s Hospital Medical Center and elsewhere, note that such programs have proven successful in the past, but wanted to see if they could use electronic health records to create an algorithm that would automatically detect overdoses and adverse drug events, as well as lessen the number of medication alerts.
Fatigue from too many alerts and alarms, FierceHealthIT has previously reported, is a pressing problem at hospitals today.

Brain-robot training triggers improvement in paralysis

  • 11 August 2016
In a surprise result, eight paraplegic people have regained some sensation and movement after a one-year training programme that was supposed to teach them to walk inside a robotic exoskeleton.
The regime included controlling the legs of a virtual avatar via a skull cap, and learning to manipulate the exoskeleton in the same way.
Researchers believe the treatment is reawakening the brain's control over surviving nerves in the spine.

Employer Health Plans May be 100% Telemedicine-enabled by 2020

Gregory A. Freeman, August 10, 2016

The great appeal of telemedicine is that it comes at a lower cost than other care access points, and payers have exhausted other cost efficiencies on the front end.

Having squeezed all they can out of health plan design, employers are now pinning their hopes on telemedicine as the way to bring down their health insurance costs.
Telemedicine is growing rapidly and within a few years will be a routine part of healthcare plans offered by employers, according to the president and CEO of the National Business Group on Health (NBGH), a non-profit association of 425 large employers.

Half a billion images migrated at Oxford acute trust

Laura Stevens
8 August 2016
One of the largest data migrations in the UK has been successfully undertaken at the Oxford University Hospitals NHS Foundation Trust, as part of a move to a new digital imaging system.
More than 100 terabytes of historical data was transferred by Insignia Medical Systems ahead of the trust’s go-live with the company’s InSight picture and archiving communications system. The PACS went live 10 July, four months after the start of the migration.
The move to Insignia’s PACS will also give the trust the opportunity to share images with neighbouring trusts, support home reporting and merge images from other departments.

Attorneys outline next steps for closing healthcare privacy gaps

Aug 11, 2016 9:32am
The United States must answer three important questions as it moves forward to protect patient data, according to attorneys with the healthcare group at law firm Crowell & Moring.
In a report published by Bloomberg BNA, Jodi Daniel, Elliot Golding and Jennifer Williams address the next steps necessary for following up a recent report from the Office of the National Coordinator for Health IT outlined gaps between HIPAA protections and mHealth technologies
Questions that must be asked, they say, include:
  • Why develop standards and requirements?
  • What should those standards be and who should develop them?
  • How should organizations be held accountable?

Data theft rises sharply, insiders to blame

A new study suggests many data breaches are caused by insider threats -- whether through malice or accident.
By Charlie Osborne for Zero Day | August 10, 2016 -- 08:03 GMT (18:03 AEST) | Topic: Security
A new survey exploring the main causes of corporate data breaches suggests that three out of four organizations in the US have been hit with the loss or theft of sensitive data in the last two years -- and insiders are usually the ones at fault.
According to the researchers involved in the study, rising data breach and information loss is often due in part to compromised employee accounts, which is further exacerbated by staff and third parties having access to more sensitive information than they need.
In addition, the "continued failure" by businesses to properly monitor access and activity around email and file systems is to blame.

DeSalvo to step down from top position at ONC

Published August 11 2016, 3:35pm EDT
Karen DeSalvo, national coordinator for health information technology, will be leaving her technology office position, to be replaced by Vindell Washington, MD, currently serving as the principal deputy national coordinator at ONC.
Sylvia Burwell, secretary of the Department of Health and Human Services, made the announcement today, indicating that the transition of responsibilities would begin on Friday, August 12.
DeSalvo, who has filled the lead role for two and a half years, will continue to serve as acting assistant secretary for health. Named to that position in late 2014, industry observers long expected that she would gravitate toward the HHS post.

Karen DeSalvo through the years: A look back at her ONC tenure

DeSalvo made her way from New Orleans to Washington and while serving as National Coordinator, she realigned ONC and delivered visionary strategic plans for interoperability and health IT, before President Obama nominated her to a key HHS post.
August 12, 2016 11:24 AM
When Karen DeSalvo, MD, became the fifth National Coordinator for Health IT in January 2014, she took charge of ONC at a critical time for the industry, as four years of momentum spurred by meaningful use started to pay exciting dividends – but also sowed frustrations as many healthcare providers struggled with burdensome federal requirements.
She also had some big shoes to fill. Her two immediate predecessors,  David Blumenthal, MD, and Farzad Mostashari, MD, had helped conceive and implement Stage 1 and Stage 2, respectively, of the transformative EHR incentive programs – setting the stage for widespread uptake of basic IT systems, then dramatically raising expectations about how hospitals and practices should put them to work.
But DeSalvo was the right person for the job, at the right time. Her public health bona fides – honed in her hometown of New Orleans, first in the wake of Hurricane Katrina as Vice Dean Community Affairs and Health Policy at Tulane University and later as New Orleans Health Commissioner – made her the ideal national coordinator for a period that saw the building blocks of basic EHRs mature into interoperable networks focused on improved population health.

Geisinger, KeyHIE bolster clinician productivity an hour a day with patient alerts

In conjunction with the Keystone Health Information Exchange, Geisinger Health System sends clinicians push HL7 ORU messages in a population health management program to identify at-risk patients and reduce readmissions.
August 10, 2016 07:48 AM
Kim Chaundy, an IT director at Gesinger and director of operations at Keystone Health Information Exchange, said that sending real-time notifications prevented nurses from traveling to see patients who where not there. 
The Keystone Health Information Exchange, also known as KeyHIE, a collaborative HIE that includes Geisinger Health System, employs what it calls the Information Delivery Service “push” messaging technology designed to enable proactive care with real-time delivery of alerts, notifications and critical patient information to clinicians and care managers across the community.
The Information Delivery Service’s centralized aggregation technology brings all of a patient’s data into a single record. The system identifies chronically ill and at-risk patients and consolidates a community’s health data in one place to help care managers and accountable care organizations manage diverse population groups. And clinicians can customize their subscriptions to important alerts, notifications and patient information updates.

On paper, IT contingency plans a must for hospitals

Aug 10, 2016 10:40am
As part of its contingency plan for IT emergencies, Boston Children's Hospital has developed what it calls a "downtime cart," according to an article published in Bloomberg BNA.
The cart, the article notes, contains all the paper forms and instructions doctors and nurses need to do their jobs should computer systems fail, whether for a power outage or a cybersecurity incident. The number of employees who don’t know how to fulfill their functions without electronic systems was an eye-opener for MedStar Health, which took all systems down for about five days earlier this year due to a ransomware attack.
A ransomware attack at Hollywood Presbyterian Medical Center also left staffers working with paper and faxes for more than a week.

Health IT costs top $32K per doctor per year

Aug 10, 2016 11:21am
High tech means high costs for physician practices.
Keeping up in the digital age is proving to be a continuing expense for physician practices, with the cost of health information technology reaching more than $32,500 per doctor annually, according to a new analysis from the Medical Group Management Association.
That figure reflects a continued rise in costs, as physician-owned multi-specialty practices spent more than $32,500 in 2015 for each full-time doctor on health IT equipment, staff, maintenance and other related costs, the MGMA said in an announcement.

Health IT Standard FHIR Ready to Advance Interoperability

By Kyle Murphy, PhD on August 09, 2016

FHIR is a draft health IT standard and API, but that doesn't mean it's not ready for primetime.

Fast Healthcare Interoperability Resources (FHIR) remains a draft standard and application programming interface, but that status doesn't mean this health IT resource is not ready for the big time, according to the head of Health Level Seven (HL7) International.
"There's this tension between making FHIR, which is not a normative standard identified in regulation and predicated for use, and a recognition that FHIR is evolving very, very quickly — sometimes nightly — and getting better with each iteration," HL7 CEO Charles Jaffe, MD, PhD, told
August 8, 2016

Lessons learned from EHR-related medical malpractice cases

Richard L. Oken, M.D., FAAP
The physician’s pen has been replaced by the electronic health record (EHR) resulting in improved medical record documentation and legibility. The EHR also has been heralded as the best tool to help physicians achieve the triple aim of better care, better population health and lower health care costs per capita. However, malpractice insurers report that EHRs can be a source of medical liability.
A national medical liability insurer’s recent review of EHR-related malpractice claims revealed that 42% were derived from system errors and 64% were from user factors (see table).
Becoming aware of and preventing potential and real risks of EHR errors is the best policy.
The following factors can play a role in EHR liability.

'DarkOverLord' ransomware accounts for nearly 30 percent of health data breaches in July

Among the breaches revealed last month, the average time to report incidents was a surprising two years.
August 09, 2016 02:27 PM
Cybercriminals launching ransomware attacks – and one hacker in particular known as TheDarkOverLord – represented nearly 30 percent of the 39 data breaches in July. The average time an attack went unreported, meanwhile, was a whopping two years.
That’s according to the July Breach Barometer from and security specialist Protenus.  
Protenus CEO Robert Lord said that the amount and variety of attacks hackers perpetrate against healthcare organizations suggest that July’s findings may persist into the foreseeable future. 

OSU Center for Health Systems Innovation launches new Center for Predictive Medicine

Posted: Tuesday, August 9, 2016 12:01 am
Oklahoma State University’s Center for Health Systems Innovation announced the launch of its Center for Predictive Medicine on Tuesday.
The center will use the largest clinical database in the country to develop and implement information-technology tools designed to improve patient care.
The HIPAA-compliant health-care database, which documents the clinical information of 63 million patients, was donated to OSU in 2014 by Cerner Corp. founder Neal Patterson.
The data comes from more than 850 facilities across the United States and includes more than 75 million clinical event encounters collected over the last 16 years.

OpenNotes hits 10 million patient milestone

OpenNotes Executive Director Catherine DesRoches said the growing number of patients able to access their medical records online is advancing the shift toward transparency between doctors and patients.  
August 08, 2016 03:15 PM
Ten million U.S. healthcare consumers now can read their medical records securely online through efforts by the OpenNotes initiative.
OpenNotes advocates for a fully transparent record, including the notes physicians, nurses and other clinicians write after a visit. The Department of Veterans Affairs and 50 health systems in 35 states now share notes online using secure patient portals, and OpenNotes is actively working with healthcare organizations moving toward implementation in a majority of the remaining 15 states.
“The results of the OpenNotes study involving 105 primary care doctors and 20,000 of their patients were shared in the Annals of Internal Medicine in 2012 – just four years later, we’re seeing the culture shift toward transparency in the patient and provider relationship really take hold, and we’re beginning to understand the benefits that openness brings to everyone in the healthcare delivery system,” said Catherine DesRoches, DrPH, OpenNotes executive director and a caregiver at Beth Israel Deaconess Medical Center.

HIT Think Why providers can’t let up on security training

Published August 08 2016, 3:39pm EDT
Peter Singer, director of the Brookings Institution’s Center for 21st Century Security and Intelligence and co-author of the book “Cybersecurity and Cyberwar: What Everyone Needs to Know,” was quoted in Fortune as saying “Stop looking for others to solve it for you, stop looking for silver bullet solutions and stop ignoring it.”
The “it” healthcare management professionals must address is cybersecurity; the art and science of proactively and reactively protecting your hospital’s data, especially patient health information (PHI).
There’s a saying in IT security circles about how organizations acknowledge the ever-present threat of unauthorized intrusions into their information infrastructures. Basically, it notes at least 95 percent of public and private sector entities admit to have been hacked, while the other 5 percent are liars. Singer suggests 97 percent of all such institutions have been attacked and the remaining 3 percent don’t know it.

Study: Continuous Patient Monitoring Could Save Healthcare $15B

Continuous contact-free patient monitoring can save the US healthcare system up to $15 billion annually, according to peer-reviewed paper published in Critical Care Medicine.  Conducted by researchers from Harvard School of Medicine, and a new Frost & Sullivan report, Finding Top-Line Opportunities in a Bottom-Line Healthcare Market, each hospital bed monitored with EarlySense enables hospitals to achieve a cost savings of approximately $19,940.
The cited cost savings are attributed to clinical outcome improvements published by hospitals implementing EarlySense. The technology has been proven to assist clinicians in earlier detection of patient deterioration, helping to reduce patient length of stay, minimizing ICU utilization, reducing falls and pressure ulcers, and avoiding cardiac and respiratory arrests.

OpenNotes' benefits extend to care partners

Aug 8, 2016 10:07am
The ability to view doctors’ notes electronically benefits not only the patients, but their care partners as well, according to research published in the Journal of the American Medical Informatics Association.
Geisinger Health System surveyed adults before and after 12 months of exposure to OpenNotes, a service to allow patients to see all clinician notes from their care visits. That transparency was found to improve the doctor-patient relationship in previous research.
Geisinger’s portal, MyGeisinger, allows patients to designate care partners who also can view medical records. The health system polled 323 patients and 389 care partners in a baseline survey and 184 patients and 252 care partners again at 12 months.

IBM Watson, in minutes, solves patient care problem that stumped doctors for months

Aug 9, 2016 10:07am
Doctors in Japan were perplexed for months over the case of a woman with leukemia who did not take to any of the treatments prescribed to her--then IBM’s Watson took over and solved the mystery in minutes.
The artificial intelligence system was able to conclude that the patient did not have the form of leukemia with which she initially was diagnosed, a form that required a different course of treatment, according to an article at the International Business Times.
The solution was discovered by the machine after it analyzed the patient’s medical information and cross-referenced it with millions of oncological records that doctors uploaded to its system from the University of Tokyo's Institute of Medical Science.

IBM Watson pinpoints rare form of leukemia after doctors misdiagnosed patient

The supercomputer identified a different type of cancer than the one doctors were currently treating for a patient in Japan.
August 08, 2016 10:58 AM
University of Tokyo doctors report that IBM Watson spotted a 60-year-old woman's rare form of leukemia – a diagnosis that had eluded her doctors for months.
Physicians had judged the woman’s leukemia to be another type, and were treating her accordingly, but having little effect.
Watson compared the patient's genetic changes with a database of 20 million cancer research papers, according to reports. The supercomputer’s diagnosis led to the right treatment for the patient.

Patient eReferrals produce few adverse outcomes

Published August 08 2016, 6:48am EDT
An electronic referral and consultation system at Zuckerberg San Francisco General has been shown to improve communication between referring and specialty providers, replacing an inefficient paper-based approach.
According to a study published in the August issue of The Joint Commission Journal on Quality and Patient Safety, the infrastructure of specialty referral systems in primary care is “deeply flawed” and paper referral syste “unreliable, wait times can be long, and information flow is limited.” As a result, its authors assert that there is the potential for “safety problems leading to missed and delayed diagnoses.”
However, a web-based referral and consultation system—called eReferral—has been integrated into Zuckerberg San Francisco General’s electronic health record system enabling referring providers to enter relevant clinical information via an online interface, ensuring that referrals do not fall through the cracks and are optimized.

First patient facing app to get GP system approval

Ben Heather
1 August 2016
The first patient facing app is expected to get approval to integrate with a GP primary system this week, after years of development.
PAERs’ is one of three patient facing subsidiary suppliers, along with iPlato and Wiggly Amp, that has been going through the long and sometimes arduous process of pairing with primary systems.
Brian Fisher, co-director of PAERs, said the company’s iPatient product was being piloted in five GP practices using the Emis Health primary system and he expects to get approval for full roll-out across every Emis GP site in the country imminently.
“It has taken an unbelievably long time but we think what we have to offer is going to change how we do health care,” he said.

Campaigners fear plans still live

Ben Heather
4 August 2016
Parts of the controversial programme could live on but with fewer options for patients to opt-out, MedConfidential has warned.
Last month the government “closed” the national data collection and sharing programme. The decision was made public on the same day the National Data Guardian, Dame Fiona Caldicott’s report on data security, consent and opt-outs was released.
But Phil Booth, co-founder of privacy campaign group medConfidential, said many recommendations in the report would see the programme continue in another guise; with the extraction of a new GP dataset set to go ahead.

Digital health 'not reaching' seniors

Aug 3, 2016 11:26am
Patients over the age of 65 are often the sickest and most expensive to treat--yet despite the advantages health IT holds for them, the number adopting digital health tools remains low, according to a research letter published in the Journal of the Medical Association.
The research is based on the National Health and Aging Trends Study, which asked 4,355 seniors about their use of technology yearly from 2011 to 2014.
Although 76 percent of the respondents used cellphones and 64 percent used computers in 2011, only 16 percent obtained health information online. In addition, far fewer used digital health tools to fill prescriptions (8 percent), contact clinicians (7 percent) and handle insurance claims (5 percent).

Provider Directory Data Accuracy in CA Law's Crosshairs

Scott Mace, August 9, 2016

Inaccurate provider directories are a hurdle to consumers seeking healthcare, but a California law is pushing providers and technology professionals to make improvements.

Consumer frustration with inadequate provider directories may finally be getting the attention it deserves.
At next month's innovation-focused Health 2.0 conference, the Robert Wood Johnson Foundation and ProPublica will announce the $50,000 first-prize winner of their Finding the Right Provider Challenge.
The winner will demonstrate a tool letting consumers experience searching for and finding the right provider, considering factors such as cost, hours and location, participation with insurance plans, and feedback from other consumers.

Hospital eases patient navigation with software

Published July 29 2016, 3:21pm EDT
Here is Health Data Management’s weekly roundup of health information technology contracts and implementations:
* Mission Hospital in Mission Viejo, Calif., will implement navigation software that enables patients to use their smartphone to find their way through the 509-bed facility, and find the best parking location based on where they are going. Mission Hospital is the pilot site, and over time the software from Connexient will be rolled out at its Laguna Beach campus. The software gives turn-by-turn indoor navigation with position accuracy of one to two meters, along with navigation cues and visual landmarks.
* Covenant Health serving eastern Tennessee has chosen electronic health records, financial management and population health management software from Cerner across its 10 hospitals and nearly 100 ambulatory sites. The vendor’s predictable total cost of ownership was a factor in the decision, according to Jim Vandersteeg, president and CEO at Covenant Health. Cerner will host the software at its data center.

Patients suffering from schizophrenia utilize mHealth program

by Judy Mottl 
Aug 1, 2016 12:44pm
A mobile phone intervention program can prove useful for patients with schizophrenia-spectrum disorders by engaging them during high-risk periods--though further study is needed to assess the tool's impact on reducing relapse outcomes.
A research study published at the Journal of Medical Internet Research Mental Health shows that the program, FOCUS, provides automated real-time and real-place illness management support and is built for patients dealing with psychotic disorders.
Looking also at a research report on FOCUS from 2014, the researchers said the findings show that "the FOCUS mobile phone program may be a useful method to reach a clinical population that is typically difficult to engage in clinic-based services during high-risk periods. The system-initiated mHealth functions led to proportionally more exposure to treatment content than on-demand tools."

Why a health IT safety center is vital in the age of ransomware

Aug 1, 2016 10:51am
The rise in ransomware underscores the need for a national health IT safety center to help healthcare organizations learn to better protect themselves, say patient-safety advocates Dean Sittig and Hardeep Singh in a Health Affairs Blog post.
The Office of the National Coordinator for Health IT created a five-year plan for such a center and made a $5 million request in the 2017 budget for it. And the American Medical Association voted at its annual meeting to support that plan.
Such a center could dispatch teams in health IT, cybersecurity, clinical informatics and patient safety to sites to determine how ransomware attacks took place and create best practices for mitigating future attacks, Sittig and Singh say. It also could help develop and disseminate information on strategies to reduce risk proactively, and work with institutional and government leaders to ensure these strategies are used to their fullest impact.

Glaxo, Alphabet Form Venture to Make Bioelectronic Medicines

August 1, 2016 — 4:37 PM AEST Updated on August 1, 2016 — 7:01 PM AEST
  • Companies to invest 540 million pounds over seven years
  • Bioelectronics could be used to treat arthritis, diabetes
GlaxoSmithKline Plc, the U.K.’s biggest drugmaker, is forming a joint venture with Google parent Alphabet Inc.’s life-sciences business to explore using electrical signals to treat diseases.
Glaxo will hold a 55 percent stake in the venture, called Galvani Bioelectronics, and Alphabet’s Verily Life Sciences LLC will hold 45 percent, according to a statement on Monday. The companies will invest up to 540 million pounds ($715 million) over seven years if the research and development efforts meet certain goals.
Glaxo is seeking new sources of revenue growth as its blockbuster respiratory treatment Advair faces the threat of competition from generics in the U.S. Bioelectronic medicine is a new field that aims to tackle chronic diseases using miniature, implanted devices that modify electrical signals that pass along nerves in the body. Glaxo’s researchers are betting conditions like arthritis, diabetes and asthma could be treated using these devices, and the first such medicine may be ready within a decade.

Do no harm: an oath for health IT developers

The risks for enterprises when security in health IT lags behind

CSO | Aug 1, 2016 6:30 AM PT
As health professionals, nurses, doctors, and even pharmacists are held to a high standard of making sure everything they do is above board. They can lose license for failing to comply with ethical guidelines. Even though software engineers in health IT have a far greater reaching impact on patients, no equivalent code of conduct exists for developers.
The National Institute of Health (NIH) recently granted the Mayo Clinic $142-million to create a biobank as part of the Precision Medicine Initiative Cohort Program. Aiming to enroll at least a million volunteers willing to share their health data in order to advance precision medicine, the program serves as a reminder of the security risks is health IT yet security in the health care sector continues to lag behind.
Collecting health data is moving fast, which begs the question should health IT programmers working on similar projects be held to the same ethical standards as doctors and other medical professionals? 
In order to prioritize security in health IT, programmers  should be required to take the Hippocratic oath just as health professionals do, especially as more biobanks are created.

Artificial Intelligence’s Long-Term Impact on Jobs: Some Lessons From History

By Irving Wladawsky-Berger
Jul 29, 2016 10:14 am ET
Artificial intelligence has been making extraordinary progress in the past few years. It’s ironic that after years of frustration with AI’s missed promises, many now worry that its mighty power is now upon us while we still don’t know how to properly deploy it. Some fear that at some future time, a sentientsuperintelligent general AI might pose an existential threat to humanity.But while being dismissive of such dire concerns, many experts worry that the real threat is that AI advances could lead to widespread economic dislocation.
What impact will AI have on jobs? Could our smart machines lead to mass unemployment? What will life be like in such an AI future?  “After 200 years, the machinery question is back. It needs to be answered,” notes The Economist in a special report on AI in the June 25 issue. What can we learn from history that will help us better respond to AI’s technological advances?
People have long worried about the impact of technology on society, be it railroads, electricity, and cars in the Industrial Age, or the internetmobile devices and smart connected products now permeating just about all aspect of our lives. The Economist reminds us that these worries have been with us ever since the advent of industrialization two centuries ago. Eminent English economist David Ricardo first raised the machinery question in 1821, that is, the “opinion entertained by the labouring class, that the employment of machinery is frequently detrimental to their interests”.


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