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."

Sunday, November 28, 2021

Is Anyone Out There Clear Abut The Reasons Bendigo Health Is Moving Away From Use Of Secure Clinical Messaging While ADHA etc. Are Encouraging It?

I had this e-mail from a GP Tech Support Consultant a few days ago.

Begin Quote -----

I'd like to give you a heads up on a recent development by Bendigo Health regarding the secure delivery of discharge summaries to GP clinics in the region.

I understand that these were sent by Argus, 6 months or more ago and have since been sent by a variety of other methods. The default method is now snail mail with them moving to an email-based method. As far as I have been able to determine, they are emailing GP clinics with a link to the discharge summary held on a secure site. There is some method of ensuring that the information cannot be downloaded by unauthorised persons but Bendigo Health has been scant in detail.

I am assuming, that from a security perspective, the information is safe. However, Bendigo Health has been less than forthcoming in providing this level of detail. Despite repeated requests. The information I have received from them is somewhat limited.

My main concerns are around the workflow impacts on GP clinics in the region and the unnecessary additional work imposed on these businesses. From discussions with my GP clinic clients, the time taken to access the discharge summary in this way, download it, remove any blank or unnecessary pages, upload it into the clinical software and apply the necessary metadata could take say 2 minutes per document. This would be performed by a GP clinic staff member. This is 2 minutes more than what would be required if the message was sent via HL7 messaging. In this case, Argus.

Discharge summaries are bad enough at 50000+ per year. If this approach is taken with specialist letters and ED presentations then the total number of messages could be in excess of 200000 per year. That will translate into a lot of additional unnecessary work imposed on GP clinics which could be easily avoided.

I have based these possible message volumes on information published in the Bendigo Health annual report.

It seems clear to me that the people who think it is acceptable to impose unnecessary costs on a business have never had to run a business.

Without appearing alarmist, some of the communication I have had with Bendigo Health personnel imply that similar approaches are being adopted by other similar organisations across Victoria. If this is true then we have a huge problem developing.

I believe that the widespread adoption of the Bendigo Health proposed approach has the potential to put clinical messaging back 20 years in Victoria - at least as far as the state-funded health services are concerned. In my view, this is unconscionable conduct by those involved.

I am happy to share with you all of the information I have collated on this issue so far.

End Quote -----

I have had a look at a range of the associated materials and e-mails and it does indeed seem Bendigo Health wants to move to a system of e-mailing links to GPs for them to download and process into their systems the Discharge Summaries (and other clinical documents) from a central secure server.

On the face of it, compared with the access provided by the use of Argus (or other SMD solutions), this does rather seem like a step backwards.

Can anyone reading here let us all know just what is going on and is this some sort of policy change at Bendigo Health or Victoria more widely?

Anyone want to comment on how SMD is working for GPs more broadly and what, if anything, is needed,  to improve things?

Root causes of any problems seen always welcome!

David.

 

AusHealthIT Poll Number 607 – Results – 28th November, 2021.

Here are the results of the poll.

Is It Time To Give Up On The DOH/NETHA/ADHA Experiment Of Federal Government Involvement In Digital Health In Australia?

Yes - It Has Been Long Enough 53% (43)

No - They Need More Time To Get It Right 35% (28)

I Have No Idea 12% (10)

Total votes: 81

A small majority want to see the pain of the last decade stop while many more that usual are really confused. Quite a few wanted to be patient for a while longer - maybe worried about their jobs?

Any insights on the poll are welcome, as a comment, as usual!

A good number of votes with a clear outcome! 

A very large 10 of 81 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.

Saturday, November 27, 2021

Weekly Overseas Health IT Links – 27 November, 2021.

Here are a few I came across last week.

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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https://mhealthintelligence.com/news/remote-monitoring-via-text-linked-to-fewer-covid-19-deaths

Remote Monitoring Via Text Linked to Fewer COVID-19 Deaths

Penn Medicine leveraged a text-based remote monitoring program which resulted in three deaths as compared to 12 deaths among patients who received usual outpatient care protocols.

By Anuja Vaidya

November 19, 2021 - An automated texting program helped Philadelphia-based Penn Medicine lower the risk of death for COVID-19 patients who quarantined at home, according to a new study.

As the novel coronavirus surged in waves across the country last year, hospitals were overwhelmed with patients. As a result, many hospitals turned to remote patient monitoring to keep an eye on COVID-19 patients at home and free up inpatient beds for those who needed it the most.

The study, which was published in the Annals of Internal Medicine, examined data for patients who tested positive for COVID-19 between March 23 and Nov. 30, 2020.

Researchers compared outcomes of patients enrolled in COVID Watch — a Penn Medicine program designed to remotely monitor patients via twice-a-day, automated text message check-ins — with patients who received the usual outpatient care. Those in COVID Watch had the option to report worsening symptoms, which were managed 24/7 by a dedicated team of telemedicine clinicians.

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https://patientengagementhit.com/news/new-ama-policies-target-medical-disinformation-care-access

New AMA Policies Target Medical Disinformation, Care Access

AMA has adopted a policy to combat medical disinformation spread by healthcare professionals throughout the pandemic.

By Sarai Rodriguez

November 19, 2021 - Members of the American Medical Association (AMA) announced new policies to combat medical disinformation distributed by healthcare professionals in a Special Interim Meeting.

The members addressed the increasing number of healthcare professionals making false claims about COVID-19, which undermines public health initiatives and poses a risk to patients. The false claims include how the virus is transmitted, promoting untested treatments and cures, and encouraging patients to defy public health efforts such as masking and vaccinations.

Members agreed that the number of health professionals purposely spreading disinformation to individuals is small, but they damage the overall credibility of trusted healthcare professionals, including physicians. 

“Physicians are among the most trusted source of information and advice for patients and the public at large, which is why it’s so dangerous when a physician or other health care professional spreads disinformation,” AMA Board Member Jesse M. Ehrenfeld, MD, MPH, said in the press release. 

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https://www.digitalhealth.net/2021/11/how-digitisation-can-help-transform-icu/

How digitisation can help transform ICU

The Covid-19 pandemic showed just how invaluable access to near-real time patient data can be and in response, Digital Health and Care Wales announced the establishment of a project that will bring a national critical care information system to Wales’ ICUs. Professor Tamas Szakmany is the project’s clinical lead and he explains why digitising ICU provides clinicians with a ‘single source of electronic truth’.

DHI News Team 18 November, 2021

In September 2020 the governmental Welsh health IT provider, Digital Health and Care Wales (formerly known as NHS Wales Informatics Services), announced a partnership with healthcare ICT and mobile workflow specialist, Ascom, to provide a customised version of its software solution Digistat to all 14 Adult Intensive Care Units in Wales. Before then, just three ICUs in Wales used electronic systems.

The objective was, and remains, to roll out a national critical care information system that will enable intensive care unit (ICU) staff to manage many more aspects of patient care electronically and support the standardisation of care pathways across Wales.

News regarding the development of this system wasn’t just welcome because it spelled an end to an antiquated paper-based system that was laborious, but also because it offers the chance to transform workflows, make clinicians’ lives easier and ultimately improve patient care. How? By enabling a digital ‘single source of truth’ for each patient and those caring for them.

Counting the cost of time lost 

To explain what I mean by this, it’s important to understand the challenges clinicians face at present. In a fast-paced environment such as an ICU, having a paper-based records system which dictates workflow is hugely inefficient and prone to error.

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https://www.fastcompany.com/90696636/best-health-tech-innovations

11-18-21

Health tech: The 15 next big things, from easier dialysis to AI ultrasounds

Microsoft and Adaptive Biotech’s COVID-19 immune-response database, a smartphone app that records blood pressure, fraud-fighting edible barcodes, and more.

By Fast Company Staff

As you might guess, health-technology innovations relating to the COVID-19 pandemic are well represented among the winners of Fast Company’s first Next Big Things in Tech awards. But the winners and honorable mentions span a gamut of issues related to medical challenges, including a new device that makes dialysis less of a burden, tools for keeping people out of the hospital, and even a way for people with paralysis to control computers through brain waves.

See a full list of Next Big Things in Tech winners across all categories here.

Winners

Biospectal
For measuring blood pressure through smartphones
Using the camera on a smartphone, Biospectal’s OptiBP app can record a user’s blood pressure through a fingertip in just 20 seconds. The WHO is currently validating the technology in a large-scale global study.

Brightseed
For mapping plants’ chemical diversity and using it for medicine
The Forager platform leverages large-scale data processing and machine learning to get a deeper understanding of the compounds within plants to identify potential medical applications. For example, the company used it to identify a compound that it’s testing as a treatment for fatty liver disease.

Caption Health
For adding intelligence to ultrasounds
Caption Health’s ultrasound uses AI to guide healthcare providers through the imaging process and offer preliminary interpretations of scans. This year, the company used the technology to monitor cardiac impacts from COVID-19.

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https://www.healthcareittoday.com/2021/11/19/2021-security-review-key-takeaways-practical-cybersecurity-insights/

2021 Security Review: Key Takeaways & Practical Cybersecurity Insights

November 19, 2021

John Lynn

In a recent virtual meetup Healthcare IT Today did with Proofpoint, we took a look back at the year that was 2021 when it comes to cybersecurity.  The speakers shared some of their key takeaways and learnings from this last year and offered some practical insights for healthcare CISOs and CIOs that are looking at how they can improve their cybersecurity efforts.

While we’re not able to share the entire event, we wanted to highlight a number of the insights and perspectives that stood out at the event.

Insight #1

Many healthcare organizations still need to do basic security hygiene.  While we like to talk about the latest and greatest in IT security, many organizations would benefit from stepping back and doing some of the basic security efforts they still haven’t done.  Ryan Witt, Managing Director, Industry Solutions Group and Resident Healthcare CISO at Proofpoint, shares a few of what those basic efforts might be.

Insight #2

While we often talk about security solutions, Drex Deford, Executive Healthcare Strategist at Crowdstrike, shared that one of the best things healthcare organizations can do to secure their environment is to cleanup their aging and often randomly pieced together infrastructure.

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https://ehrintelligence.com/news/apis-that-connect-to-certified-ehr-technology-on-the-rise

APIs That Connect to Certified EHR Technology on the Rise

The number of APIs that integrate with certified EHR technology is expected to continue to climb as more developers meet Cures Act requirements.

By Hannah Nelson

November 18, 2021 - ONC research has found an increase in the number of application programming interface (API) adoption that integrate with certified EHR technology, which should increase patient access to health information, according to a HealthITBuzz blog post written by ONC’s Christian Johnson and Vaishali Patel.

The ONC 21st Century Cures Act Final Rule, published in 2020, built upon previous federal initiatives to enhance patient access to personal health information through standards-based API adoption.

APIs make it easier patients to use smartphones, tablets, and desktop apps to access their personal health information from certified EHR systems.

ONC survey data has revealed a rapid uptick in healthcare providers enabling patient data access through APIs. In 2019, about 7 in 10 non-federal acute care hospitals enabled this capability, which is a two-fold increase compared to 2017.

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https://mhealthintelligence.com/news/follow-up-visit-volumes-similar-for-telehealth-in-person-care

Follow-Up Visit Volumes Similar for Telehealth, In-Person Care

Telehealth services and in-person care were accompanied by similar volumes of follow-up visits and subsequent hospitalizations.

By Victoria Bailey

November 18, 2021 - Telehealth visits for primary care services did not lead to any significant increases in in-person follow-up visits, hospitalizations, or prescription orders, according to a study by Kaiser Permanente researchers published in JAMA Network Open.

Direct-to-consumer telehealth platforms are on the rise, due to their ability to provide individuals with instant virtual care. However, these visits often take place with a new doctor and are not integrated with the patient’s regular physician and EHR. This can potentially lead to over-prescribing and increased follow-up visit volumes.

To understand if the results differ when the telehealth visits are between patients and their regular primary care physicians, researchers looked at all primary care visits at Kaiser Permanente Northern California between January 2016 and May 2018.

Out of the nearly 2.2 million primary care visits, 1.8 million were in-person and 307,888 were conducted via telehealth. Around 20,000 of the telehealth appointments were video visits, while the remaining were audio-only telephone visits.

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https://patientengagementhit.com/news/chime-reports-increased-patient-engagement-technology-use-in-2021

CHIME Reports Increased Patient Engagement Technology Use in 2021

The pandemic, regulatory programs, and the push for remote patient care have fueled a surge in patient engagement technology use this past year.

By Sara Heath

November 18, 2021 - The COVID-19 pandemic has heralded in a new era of patient engagement technology and utilization, with healthcare organizations reporting new levels of patient portal, mobile app, online health information gathering, and digital health insurance card use, CHIME described in its 2021 Digital Health Most Wired report.

These trends in patient engagement and experience of care come with additional reports about increased use of health data analytics, EHR reporting, cybersecurity measures, and price transparency tools, the organization wrote.

“A monumental shift is occurring across the industry as more and more organizations adopt digital health strategies that transform health and care,” CHIME President and CEO Russell P. Branzell, said in a statement emailed to journalists.

“The survey covers multiple categories to assess how effectively healthcare organizations are advancing on their digital health journeys,” Branzell continued. “This year, we see not only individual gains in categories but also cumulative gains from the past two years that reflect a digital revolution long in the making. Top performers are setting an example that is inspiring widespread change at an unprecedented pace.”

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https://www.healthdatamanagement.com/articles/why-remote-patient-care-is-likely-to-expand-quickly

Why remote patient care is likely to expand quickly

The benefits of remote patient monitoring were underscored by the pandemic, and opportunities are rising to use technology more broadly.

Nov 18 2021


Matthew Fisher

The pandemic and evolving patient preferences are bringing new attention to technologies that enable care delivery where and when patients want them.

So it’s no surprise that remote patient monitoring (RPM) is an area of telehealth receiving a fair amount of attention. The basic premise of RPM is to record and obtain physiologic data about individuals in their daily lives that is then fed to the care team, which in turn enables management of an identified condition. The premise builds upon goals of improving health while also beginning to meet patients where they are.

Adoption of RPM has not necessarily been as quick as expected, though data are starting to be generated as to the benefits that can be derived. Anecdotally, patients and clinicians are happy with the interactions and results that can be obtained.

Before diving into the past, present and future of RPM and healthcare, it is also helpful to consider whether calling the interaction remote patient monitoring is even accurate. The service is arguably a lot more comprehensive than just monitoring. While patients are certainly recording data and having that data transmitted for review, there are also direct interactions, whether by audio/visual visit or in person, along with recommendations for lifestyle changes. In many solutions, patients are also able to access and interact with the data collected, enabling the opportunity to self-identify trends or share with additional care teams.

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https://healthtechmagazine.net/article/2021/11/3-tips-integrate-ehr-clinical-communication-and-collaboration-tools

3 Tips to Integrate EHR with Clinical Communication and Collaboration Tools

From understanding your healthcare system’s needs to improving patient care, here are considerations for your clinical and IT teams.

by  Nathan Eddy

Healthcare systems looking to remedy the fatigue brought on by unwieldy electronic health records systems and mounting staff shortages can explore how the integration of clinical communication and collaboration tools modernize their workflows and ultimately enhance patient care.

At a foundational level, CC&C tools integrated into an EHR system improve convenience for a care team by enabling them to view messages from and respond back to multiple members, says Dr. Allen Hsiao, chief medical information officer for Yale New Haven Health and the Yale School of Medicine.

“The ability to drag and drop chart results you want other clinicians to see, or group messaging where all care team members are in the loop, are great time-saving tools,” Hsiao says. “The key is to build functionality that allows people to prioritize the messages. For example, you can see the doctor’s status is writing orders, so they don’t get interrupted when they are in certain parts of the chart.”

Mobile functionality, such as speech recognition technology and the ability to write orders, is also important, he adds, but he would like to see improved status markers.

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https://www.fiercehealthcare.com/digital-health/report-most-physicians-worry-telehealth-made-them-miss-signs-drug-abuse-during

Report: Most physicians worry telehealth made them miss signs of drug abuse during the pandemic

by Rebecca Torrence 

Nov 16, 2021 12:23pm

Telehealth offered numerous benefits to patients during the COVID-19 pandemic, providing access to care when in-person visits weren’t safe or feasible for many. But a new report shows providers worry that virtual visits allowed signs of drug abuse to slip by unnoticed.

In a report from Quest Diagnostics released Monday, 67% of the over 500 primary care physicians surveyed said they fear they missed signs of drug abuse in their patients during the pandemic.

And nearly all of them were prescribing those often-misused drugs—a whopping 97% reported prescribing opioids within 6 months of taking the survey.

Their concerns extend beyond the pandemic into telemedicine use today. Only 50% of physicians said they were confident they could recognize signs of drug misuse during telehealth visits, a far cry from the 91% that said the same of in-person patient interactions.

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https://www.healthcareitnews.com/blog/broadband-achilles-heel-telehealth

Broadband is the Achilles' heel of telehealth

The fate of virtual care adoption is tied to the fate of broadband expansion.

By Craig Settles

November 18, 2021 05:16 PM

Six years ago I had a stroke and telehealth saved my life. Make no mistake, I am a believer!

However, as wonderful as telehealth is, it has a serious Achilles' heel. The fate of telehealth adoption is tied to the fate of broadband adoption.

Some folks believe telehealth applications take up very little space on patients' computers, so how can broadband be an Achilles' heel? Let me count the ways.

No broadband, no telehealth

"We recently provided testimony before the Missouri legislature about the ties between digital equity and telehealth, how not having internet connections at the requisite speeds means you can't have telehealth", says McClain Bryant Macklin, director of policy and strategic initiatives at the Health Forward Foundation.

"Broadband is now revered as the super-social determinant of health because it has a direct impact on all of the other social determinants of health."

But what if there's no broadband? More than 14 million urban homes and nearly 4 million rural homes have no broadband. People of color make up 75% of the unconnected population in urban counties.

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https://www.healthcareitnews.com/news/emea/new-report-finds-digitisation-making-great-progress-germany

New report finds that digitisation is making 'great progress' in Germany

Digital infrastructure, including e-Prescription and electronic patient record, being rolled-out successfully according to findings from German agency, gematik.

By Anna Engberg

November 18, 2021 04:39 AM

The German agency gematik - focused on the digitisation of the country's healthcare system - has published a new report, the 'Telematics Infrastructure Atlas', providing an update on the current status of the digital health architecture in Germany.

The publication highlights development potential and addresses the use of the electronic patient record (ePA) by healthcare providers and patients in Germany.

According to the report, dental practices (97 per cent), pharmacies (96 per cent) and doctors' offices (93 per cent) are the medical facilities in Germany which are most frequently connected to the telematics infrastructure (TI), followed by psychotherapy practices and hospitals with least 88 per cent.

Although trust in health data protection is high among insured Germans, many health care providers seemingly still have concerns about data security.

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https://www.healthcareittoday.com/2021/11/18/ltis-comprehensive-telehealth-platform-for-developing-countries/

LTI’s Comprehensive Telehealth Platform for Developing Countries

November 18, 2021

Andy Oram

Telehealth has been crucial during the COVID-19 pandemic to connect patients to their health care systems. It’s impressive that clinicians, regulators, and payers managed to quickly integrate telehealth—and the innovations seem to be catching on permanently. But in the U.S., at least, these accommodations of telehealth were disappointingly limited to reproducing the doctor/patient visit. A comprehensive telehealth strategy is called “connected health.” It focuses on building better behaviors through planning, monitoring, and support.

We are far from a connected healthcare system in most countries, but Let’s Talk Interactive (LTI) is building a solution and reaching out to Latin America. LTI has long offered a wide range of solutions in behavioral medicine monitoring, not just televisits. Elements of LTI’s system (Figure 1) include telehealth software, medical carts, kiosks, and other medical devices, provider networks, HIPAA-compliant web development, cybersecurity, and APIs for integration with other systems.

Understanding the Context

I got a sense of how difficult care in remote areas is from an email message by Juán Carlos Lenz, a board member of Wings of Hope, which provides medical aid by air and the Internet to these areas.

“When the people in El Charco, on the Pacific coast of Colombia, need access to specialist doctors or for special diagnoses, they have to go to the nearest high level hospital. This hospital is in Tumaco, about four to eight hours away by boat in the best cases. Sometimes, and for more complex issues, they have to go to Pasto, which is another nine hours by bus. The transportation is very expensive given it is by water, and the trip can be hard on pregnant women and other groups of people, such as the elderly. Travel is also expensive because the insurance covers only the tickets, but there is only one trip per day, so patients have to stay overnight in Tumaco or Pasto. Some of the indigenous people don’t speak Spanish and don’t even have appropriate clothing to withstand the cold from a high-altitude capital like Pasto. Imagine also even thinking of letting your 5 or 7 kids alone at home. Additionally, low schooling levels leave people with difficulties accessing the health system, and interpreting the results they might get, Sometimes the doctor’s advice can be out of touch with their reality.”

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https://healthitsecurity.com/news/cisa-iranian-government-sponsored-threat-actors-targeting-healthcare

CISA: Iranian Government-Sponsored Threat Actors Targeting Healthcare

The US and its allies are warning healthcare entities about Iranian government-sponsored threat actors targeting Microsoft Exchange and Fortinet vulnerabilities.

By Jill McKeon

November 17, 2021 - US cyber officials along with allies from Australia and the UK issued an advisory warning the healthcare and transportation sectors about an Iranian government-sponsored advanced persistent threat (APT) group that has been exploiting Microsoft Exchange ProxyShell and Fortinet vulnerabilities.

The FBI, along with the Cybersecurity and Infrastructure Security Agency (CISA), the Australian Cyber Security Centre (ACSC), and the United Kingdom’s National Cyber Security Centre (NCSC) have observed the APT group exploiting Fortinet vulnerabilities since at least March 2021 and Microsoft Exchange vulnerabilities since at least October 2021.

The threat actors are known to focus on exploiting known vulnerabilities and subsequently leverage the access for data exfiltration or encryption, ransomware, and extortion.

“In March 2021, the FBI and CISA observed these Iranian government-sponsored APT actors scanning devices on ports 4443, 8443, and 10443 for Fortinet FortiOS vulnerability CVE-2018-13379, and enumerating devices for FortiOS vulnerabilities CVE-2020-12812 and CVE-2019-5591,” the advisory stated.

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https://www.science.org/doi/10.1126/scirobotics.abi8017?mc_cid=bce3a02a2c&mc_eid=0c3635cc12

A decade retrospective of medical robotics research from 2010 to 2020

Pierre E. Dupont Bradley J. Nelson Michael Goldfarb Blake Hannaford et al.

Science Robotics • 10 Nov 2021 • Vol 6, Issue 60DOI: 10.1126/scirobotics.abi8017

Abstract

Robotics is a forward-looking discipline. Attention is focused on identifying the next grand challenges. In an applied field such as medical robotics, however, it is important to plan the future based on a clear understanding of what the research community has recently accomplished and where this work stands with respect to clinical needs and commercialization. This Review article identifies and analyzes the eight key research themes in medical robotics over the past decade. These thematic areas were identified using search criteria that identified the most highly cited papers of the decade. Our goal for this Review article is to provide an accessible way for readers to quickly appreciate some of the most exciting accomplishments in medical robotics over the past decade; for this reason, we have focused only on a small number of seminal papers in each thematic area. We hope that this article serves to foster an entrepreneurial spirit in researchers to reduce the widening gap between research and translation.

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https://www.theverge.com/2021/11/16/22785163/digital-health-physical-activity-inequity

Health apps and wearables help rich people the most, study finds

They don’t help improve physical activity for poorer people

Digital tools like motivational text messages that try to nudge people to do more physical activity aren’t effective for poor people, according to a new meta-analysis. In one of the most comprehensive efforts to tease apart the impact of behavioral change programs on people with different income levels, the study authors showed that apps and wearables only helped bump physical activity levels for people with high socioeconomic status.

The finding bolsters arguments that digital health interventions can end up widening health gaps between groups and that they’re designed for people with more money and more education.

The new analysis looked at 19 studies that tested whether things like text messages, web-based prompts, or wearable step trackers could nudge people to increase their levels of physical activity. Across all of the studies, the behavioral tools were not effective for people with low socioeconomic status, even when they worked well for wealthier people. That pattern held across every type of approach tested.

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https://www.healthit.gov/buzz-blog/interoperability/information-sharing-after-the-21st-century-cures-act

Information Sharing After the 21st Century Cures Act

Steven Posnack | November 16, 2021

When President Obama signed the bipartisan 21st Century Cures Act (Cures Act) into law in 2016, it marked a significant shift in health policy and health law. Not since the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has there been a more noteworthy change in how electronic health information (EHI) is approached under United States federal law. Importantly, the Cures Act’s information blocking provision should always be considered in the context of other laws that speak to how EHI is shared in health care.

The Cures Act’s information blocking provision requires new thinking, new practices, and adjustments to prior norms. It also potentially makes the “starting line” for evaluating whether a given practice might be considered information blocking different depending on the fact pattern and the actor(s) involved (health care providers, health IT developers of certified health IT, and health information networks or health information exchanges, as defined in the information blocking regulations). As a result, understanding how the information blocking provision may apply to particular practices must account for case-by-case details, including whether a regulatory exception has been met, what an actor’s intent was, and whether an interference in the access, exchange, or use of EHI has occurred.

When it comes to the information blocking provision and its intersection with other laws, we suggest keeping in mind how other laws align and interact with three main concepts set forth in the information blocking regulations: 1) “required by law,” 2) the definition of “interference,” and 3) information blocking “exceptions.”

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https://www.healthcareitnews.com/news/what-should-interoperability-look-eight-years-onc-asked-you-answered

What should interoperability look like in eight years? ONC asked, you answered

The Office of the National Coordinator for Health IT said it received more than 700 predictions from stakeholders about healthcare outcomes in 2030.

By Kat Jercich

November 17, 2021 12:16 PM

This past May, the U.S. Office of the National Coordinator for Health IT asked healthcare stakeholders: What should healthcare look like in 2030, and what should interoperability have enabled by then?

According to a blog post published this week by Deputy National Coordinator Steven Posnack, the agency received more than 700 submissions in response over the course of the next few months.  

As Posnack explained, the agency "analyzed each statement and looked for trends, groupings, combinations, and other affinities."  

The resulting theme statements ran the gamut from shifts in individual and care delivery experiences to changes at health systems.  

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https://www.healthcareittoday.com/2021/11/17/study-looks-at-impact-of-virtual-first-care-in-chronic-disease-management/

Study Looks at Impact Of Virtual-First Care in Chronic Disease Management

November 17, 2021

Anne Zieger

New research suggests that virtual-first care can improve the results of chronic care programs.

The data underlying the research comes from Omada Health, which offers virtual-first care programs for a number of chronic illnesses, including diabetes, hypertension, musculoskeletal conditions and behavioral health issues.

To look at the effectiveness of these programs, Omada pulled together more than 1 billion actionable data points from 100 million devices across all programs. It also collected 13 million care messages spanning these programs.

The Omada Insights Lab found that virtual-first care generated some significant successes. For example, it concluded that 94% of members engaged with a COVID health coach in the first week were more likely to achieve the health outcomes caregivers had in mind.

Also, when coaches offered proactive feedback, patients showed a 10% to 15% increase in meal tracking retention. This correlated with a 0.5% increase in weight loss for the first four months, compared to the control group that got reactive coaching.

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https://www.healthleadersmedia.com/innovation/digital-health-paradox-record-funding-2021-yet-path-broad-adoption-needs-unique-approach

Digital Health Paradox: Record Funding in 2021, Yet Path to Broad Adoption Needs Unique Approach

Analysis  |  By Pothik Chatterjee  |   November 16, 2021

Maryland-based payer-provider partnership looks to mentor healthcare startups to bridge the development divide.

Digital health funding in 2021 has already shattered 2020's record with more than $20 billion invested in digital health startups, according to Rock Health’s recent industry report.  

While it is heartening to see increased investment in historically neglected areas such as mental health, female-funded startups and health equity, there remains a fundamental paradox in digital health. Out of these thousands of mobile apps and digital disrupters embraced by both Silicon Valley and consumers (who are now used to these technologies from other industries) getting to broad adoption and reimbursement in the healthcare industry remains challenging.  

There may be many reasons for this. Healthcare providers are interested in validated outcomes (how can this mobile app help make my patients healthier?) and identifying effective digital solutions they can “prescribe” to their patients from a myriad of potential solutions. Similarly, payers/insurers are interested in outcomes and cost reduction to justify reimbursement for new tech. Who will create solutions that emerge as industry standards and get adopted at scale by the healthcare industry? 

It is imperative that digital health entrepreneurs work closely with both providers and payers to figure out the complex challenges around implementation, requiring culture change and disruption of status quo with electronic medical records and current infrastructure investments, outcomes validation and sustainability of business models. Paradigm shifts in healthcare innovation require a multi-disciplinary and multi-stakeholder approach grounded in collaboration.

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https://www.healthdatamanagement.com/articles/onc-clarifies-expectations-for-data-sharing-with-patients

ONC clarifies expectations for data sharing with patients

In a series of answers to questions raised by the 21st Century Cures Act, the agency explains how much data organizations must share.

Nov 16 2021

Fred Bazzoli

Responses released Monday by a federal agency bring more clarity to long-standing questions surrounding the information blocking of the 21st Century Cures Act.

In a series of answers to frequently asked questions, the Office of the National Coordinator for Health Information Technology put a stake in the ground on what it expects provider organizations to be able to after October 2022, as well as providing guidance on interference, content and manner.

Current rules limit data that must be shared to the U.S. Core Data for Interoperability (USCDI), but ONC said in one of its responses that, after October 6, 2022, the definition of information blocking “will apply to the full scope of EHI” and means electronic protected health information as defined in federal statute. The rules will apply “regardless of whether the group of records are used or maintained by or for a covered entity.”

However, EHI shall not include psychotherapy notes or “information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative proceeding.”

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https://www.healthcareitnews.com/news/looking-back-year-interoperability-milestones-ehealth-exchange

Looking back on a year of interoperability milestones at eHealth Exchange

The health information network's executive director, Jay Nakashima, sees big progress with 21st century Cures Act compliance, TEFCA, data quality, FHIR adoption and information exchange among providers, public health agencies and labs.

By Mike Miliard

November 16, 2021 10:59 AM

After more than a decade of hard work, and not a little frustration at the slow pace of change, interoperability has been making some significant progress recently. And 2021 was a particularly notable year for U.S. efforts toward more widespread and seamless data flow, says Jay Nakashima, executive director of eHealth Exchange.

The nationwide exchange – it's literally in all 50 states – is a network of networks that links federal agencies and private-sector healthcare organizations for care delivery and public health. In recent times, of course, that's meant, among other imperatives, "sending millions of COVID-19 testing and diagnoses reports to the CDC, and other national and state agencies."

But the eHealth Exchange has been making progress on many other fronts toward the wider goals of free-flowing movement of health information across the healthcare ecosystem.

For instance, it's working in tandem with the U.S. Food and Drug Administration to leverage FHIR next year for FDA’s Center for Biologics Evaluation and Research initiative, which gathers patient data for clinical follow-up after adverse events.

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https://www.healthcareitnews.com/news/biggest-healthcare-data-breaches-2021

The biggest healthcare data breaches of 2021

More than 40 million patient records have been compromised this past year by incidents reported to the federal government in 2021.

By Kat Jercich

November 16, 2021 09:54 AM

Amidst warnings from the U.S. Federal Bureau of Investigation about hacking groups and news from the Department of Justice about ransomware-related arrests, an adage has begun to be repeated among cybersecurity professionals: It's not "if" an attack will happen, but "when."

And 2021 has been a particularly dire year for healthcare data breaches, with incidents taking down networks for weeks at a time and potentially leading to disruptions of care throughout the country.   

To add insult to injury, some hospitals even face legal action after restoring access to their network. Overall, 40,099,751 individuals' records have been affected by exposures reported to the federal government so far this year.

For anyone who needs a refresher on how things have gone, Healthcare IT News has compiled a list of the 10 largest data breaches reported to the U.S. Department of Health and Human Services' Office of Civil Rights this year so far:  

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https://www.healthcareittoday.com/2021/11/16/the-future-is-open-data-what-healthcare-can-learn-from-finance/

The Future is Open Data: What Healthcare Can Learn From Finance

November 16, 2021

The following is a guest article by Mike Simmons, CEO and Founder at andros.

Sharing information across platforms has become so ubiquitous that many of us hardly notice it happening—interconnected technologies touch almost every area of our lives. Industries ranging from tourism to e-commerce have adopted data-sharing practices; greater access to information has proven, unsurprisingly, to lead to better experiences.

And yet, information-sharing innovations that would allow for streamlining and convenience are lagging in one of the most vital sectors: healthcare. If healthcare is going to join those sectors that are more advanced in both technology and consumer experience, it would do well to take a page from fintech—or more specifically, the open data paradigm known as open banking.

The goal of open banking is to lower barriers to entry across different financial services by making consumer financial data accessible and open through purpose-built APIs. This allows customers to choose the ideal financial product for them, be it easily opening a new credit card or adopting a new financial planning app.

In our increasingly digitized world, this kind of convenience, a result of open data, is often expected. By taking a cue from finance, healthcare can move beyond the slowdown of the initial ACA-incentivized telehealth boom over ten years ago to embrace newer technologies, and the possibilities of open data.

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https://www.healthleadersmedia.com/technology/drone-deliveries-taking-healthcare

Drone Deliveries Taking Off in Healthcare

Analysis  |  By Eric Wicklund  |   November 15, 2021

Intermountain Healthcare and several other healthcare providers are using drones to deliver prescriptions, medical supplies, and telemedicine platforms.

Intermountain Healthcare will be using drones to deliver prescriptions and other medical supplies to homes in and around Salt Lake City.

The multi-state health system, based in Salt Lake City, has announced a partnership with Zipline, a San Francisco-based medical product delivery company. The deal will enable Intermountain to used drones to ship specialty pharmaceuticals and homecare products to homes within 50 miles of the health system’s distribution center.

“Making access to healthcare faster and more convenient will lead to better health outcomes for our patients,” Intermountain President and CEO Marc Harrison said in a press release.

“Patients can connect with providers from the home, and then receive the medications and supplies they need in a matter of minutes, directly to their doorsteps,” said Keller Rinaudo, co-founder and CEO of Zipline, which has facilitated more than 200,000 drone deliveries and is currently involved in programs in Ghana and Rwanda. “For example, a cancer patient could receive her medication without ever leaving her home. Or a single parent could get his child’s antibiotics without a trip to the pharmacy. Instant access to care is not just about convenience. It comes down to making healthcare more equitable, efficient, and reliable for people, regardless of where they live or their circumstances.”

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https://ehrintelligence.com/news/data-standards-key-for-ehr-documentation-of-gender-minority-patients

Data Standards Key for EHR Documentation of Gender Minority Patients

A health system implemented SOGI EHR documentation protocols, but a lack of data standards limits the usability of SOGI data across the care continuum.

By Hannah Nelson

November 15, 2021 - As healthcare organizations look to sexual orientation and gender identity (SOGI) EHR documentation to improve health equity for gender-minority patients, a lack of national data standards limits data usability across the care continuum, according to a study published in JAMIA.

Geisinger, an integrated health system located in rural Pennsylvania, modified its Epic EHR system to enable the collection and use of SOGI-related information.

In particular, the health system added four new data elements:

·         Gender identity, which refers to how individuals perceive themselves

·         Birth sex, which documents anatomic and/or physiologic characteristics

·         Affirmation history, which documents transition steps for transgender patients

·         Organ inventory, which documents organ history for transgender patients

The health system also configured the EHR to ensure inclusive documentation for existing data elements such as legal sex, pronouns, correct name, marital status, and emergency contacts.

Geisinger modified clinical decision support tools in the EHR to ensure the correct use of the updated data elements. For instance, wherever the EHR used a patient’s sex, Geisinger configured the system to map to legal sex, gender identity, or birth sex, based on the context.

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https://mhealthintelligence.com/news/patients-used-telehealth-as-a-substitute-for-post-discharge-visits

Patients Used Telehealth as a Substitute for Post-Discharge Visits

Post-discharge visit volumes remained steady, but more patients used telehealth while the number of in-person visits decreased, a study found.

By Victoria Bailey

November 15, 2021 - The number of outpatient visits after hospital discharges remained stable during the COVID-19 pandemic but telehealth use for these visits increased, suggesting that telehealth was a substitute for in-person care rather than an addition, a study published in JAMA Health Forum revealed.

There was a significant uptick in telehealth use at the start of the pandemic. Since then, patients and providers alike have expressed their satisfaction with virtual care.

As policymakers consider the future of telehealth, they must weigh the pros and cons of virtual care. Understanding if telehealth increases access to care and if it substitutes for or adds to in-person care are two key areas of consideration.

University of Pennsylvania researchers analyzed hospital discharges and subsequent outpatient visits from commercially insured patients to track telehealth use during the pandemic.

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https://www.healio.com/news/hepatology/20211113/artificial-intelligence-algorithms-lead-the-way-for-health-cares-bold-new-future

November 13, 2021

Artificial intelligence, algorithms lead the way for health care’s ‘bold’ new future’

Data used well via artificial intelligence and transparent algorithms offers health care a glimpse into democratization and equitable, efficient and efficacious care, according to an expert speaking at The Liver Meeting Digital Experience.

“Over the next six quarters, ... we are going to see technology advancements, we are going to see policy and regulatory change and cultural expectations that will ask us to deliver cures in novel settings using novel methods and processes that will require us as providers to rethink how health care works in this country and internationally,” John D. Halamka, MD, MS, president of the Mayo Clinic Platform, said during his President’s Choice Lecture.

Prerequisites to streamlined care

Halamka challenged meeting attendees to adjust their views of what a platform is and what it offers to both physicians and patients.

“Whether you’re a provider or just a care navigator for a family ... in 2020 and 2021, care is often challenging to coordinate. It’s not clear where you go next, what disease state you have, ... bringing the right patient to the right facility ... to get the right care ... is guesswork,” he said. “We want something different. By 2030, we want continuous care that’s easy to access and navigate based on evidence and [we want to] make this care equitable and highly available to all. And if we are going to achieve that, there are several prerequisites.”

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https://www.statnews.com/2021/11/15/its-time-for-individuals-not-doctors-or-companies-to-own-their-health-data/

It’s time for individuals — not doctors or companies — to own their health data

By Juhan Sonin, Annie Lakey Becker and Kim Nipp Nov. 15, 2021

Health data should be like a mountain stream, flowing in a single direction with a clear purpose: improving health and medical outcomes. Instead, it’s a complex puzzle that only data scientists and physicians can meaningfully put together and use.

When most people think of personal health data, they think about their medical records. These reside — usually unconnected — in the offices of primary care physicians and specialists, in imaging companies, hospitals, and elsewhere. These records contain information such as vital signs, prescriptions and allergies, illnesses and injuries, physicians’ notes, and more.

But health data represent so much more than that, since most “health” happens outside of medical care settings. It includes your personal circumstances, the choices you make, and the things you do. This includes information from apps that log your workouts. It’s information from your past, like trauma or adverse childhood events. It’s information about where you live, what you eat and drink, your education, salary, emotional and social history, and other things, all combining to provide the whole picture of your health.

With health data scattered across each facility and provider you’ve ever visited and across each app and wearable you’ve ever used, it’s impossible to see the full picture. But that is something that should be available to everyone.

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https://www.healthcareitnews.com/news/telephone-video-visits-critical-enabling-safety-net-care-access

Telephone, video visits 'critical' for enabling safety-net care access

But a recent study published in the Journal of the American Board of Family Medicine found that clinicians are still concerned about hurdles to telehealth implementation.

By Kat Jercich

November 15, 2021 01:28 PM

A study published this month in the Journal of the American Board of Family Medicine found that safety net providers in New York state reported positive experiences using telephone and video during the COVID-19 pandemic.  

At the same time, researchers noted, "When it comes to equity in access, telemedicine presents a double-edged sword."  

"On the one hand, telemedicine visits can make care more convenient and accessible by removing physical barriers such as distance or transportation costs. On the other hand, some telemedicine modalities, such as videoconferencing, entail using digital tools and technologies that may not be equally accessible to all patients," they continued.   

"COVID-19 has further exposed dramatic inequities in technology access and utilization, compounding socioeconomic and racial disparities in health equity," they added.  

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https://www.healthcareitnews.com/news/nation-state-threat-actors-are-motivated-intelligence-cash

Nation-state threat actors are motivated by intelligence, cash

H-ISAC Chief Security Officer Errol Weiss warns that individuals working on COVID-19 vaccines and treatments are of "high interest" to adversaries. He'll discuss more at the upcoming HIMSS Healthcare Cybersecurity Forum.

By Kat Jercich

November 15, 2021 10:16 AM

As cyberattacks continue to hamper the operations of critical infrastructure, including hospitals, it may be tempting to think of the hackers as if they're the main characters in the 1995 film of the same name: Kids who want to stir up trouble, and maybe make some cash doing it.  

But "this is not a teenager in a hoodie doing these kinds of attacks. These are elaborate, sophisticated, organized criminal gangs," as Errol Weiss, chief security officer at H-ISAC, warned at HIMSS21 this past summer.  

And some of these gangs have the muscle of nation-states behind them – making them even more potentially threatening to healthcare organizations of all sizes.  

Weiss, who will be appearing this December at the virtual HIMSS Healthcare Cybersecurity Forum, spoke with Healthcare IT News this past week just as news broke that the U.S. Department of Justice had charged two men for their alleged involvement in deploying Russia-linked REvil ransomware.

He discussed the motivations for nation-state threat actors, what can be done to tamp down on ransomware and why it's so important for everyone to protect themselves and their data.  

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https://www.nyu.edu/about/news-publications/news/2021/november/telemedicine-during-covid-19.html

Telemedicine During COVID-19: Video vs. Phone Visits and the Digital Divide

Nov 15, 2021

Health and Medicine Engineering, Science and Technology

New York City

Telemedicine visits accounted for more than 60 percent of patient care at New York community health centers during the peak of the COVID-19 pandemic in spring 2020, finds a new study by researchers at NYU School of Global Public Health.

While video visits have their advantages, telephone visits accounted for a larger proportion of telemedicine care and are critical for providing access and addressing the “digital divide,” according to the study published in the Journal of the American Board of Family Medicine.

“Our study suggests that both video and phone visits will continue to shape how health care is delivered in a post-pandemic world,” said Ji Eun Chang, assistant professor of public health policy and management at NYU School of Global Public Health and the lead author of the study.

The COVID-19 pandemic has catalyzed profound transformations across the healthcare delivery system, including an abrupt shift toward telemedicine. While a significant amount of research has centered on the rapid adoption of telemedicine in the early weeks of the COVID-19 pandemic, less is known about the feasibility, use, and benefits of phone vs. video visits in the months following the widespread transition to remote care, particularly for “safety net” providers who care for vulnerable populations.

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https://www.thetimes.co.uk/article/testing-firm-can-profit-from-sale-of-covid-swabs-w6vkb2f2f

Testing firm can profit from sale of Covid swabs

Company saves customer DNA for future use

Shanti Das and George Greenwood

Sunday November 14 2021, 12.01am GMT, The Sunday Times

A large Covid-19 testing provider is being investigated by the UK’s data privacy watchdog over its plans to sell swabs containing customers’ DNA for medical research.

Cignpost Diagnostics, a government-approved supplier trading as ExpressTest, said it intended to analyse the samples to “learn more about human health”, to develop drugs and products or to sell information to third parties, company documents show.

Analysis of sensitive medical data can typically be carried out only with explicit informed consent. But customers booking tests through expresstest.co.uk were not clearly told their data would be used for purposes beyond Covid-19 testing. Instead they were asked to tick a box agreeing to a 4,876-word privacy policy, which links to another document outlining its “research programme”.

It is not clear how many samples have been stored by Cignpost or whether they have been sold or used for any research so far, but the policy says that data belonging to all those providing a swab is retained indefinitely. There is no minimum age set out in the research document, suggesting children are included.

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Enjoy!

David.