Sunday, December 17, 2017

AusHealthIT Poll Number 401 – Results – 17th December, 2017.

Here are the results of the poll.

Does The myHR Need A Major And Expensive Re-Development To Be Able To Deliver On The Expectations Of The ADHA For Utility, Adoption and Use?

Yes 21% (34)

No - Minor Mods Are All That Is Needed 2% (4)

No - It Is Just Not Fixable 77% (126)

I Have No Idea 0% (0)

Total votes: 164

Any insights welcome as a comment, as usual. An amazing result evaluating a program that has already taken seven years and cost towards two billion dollars. Most seem pretty pessimistic anything can be salvaged. I wonder why people feel this way?

A really great turnout of votes!

We note no respondents who are clueless!

Again, many, many thanks to all those that voted! Hard to believe there have been over 400 polls! I wonder why the ADHA believes it can ignore such results?

David.

Saturday, December 16, 2017

Weekly Overseas Health IT Links – 16th December, 2017.

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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2018 is primed for blockchain, big data and cloud computing advancements, all with a better security plan

Here's what you can expect in the year ahead.
December 07, 2017 03:13 PM
Health IT is in a very fluid state and evolving quickly. Hospital executives and technology professionals no doubt have their hands full keeping up with technological advances, security events and much more.
Following are six health IT predictions for 2018 from various experts in the field that can help C-suite executives and other health IT pros stay on top of the latest trends and developments moving into the new year.
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Google DeepMind’s Streams technology branded ‘phenomenal’

Hannah Crouch

4 December 2017
An NHS consultant nurse who is part of a team using an app which helps to detect early signs of kidney failure has branded it ‘phenomenal’.
Sarah Stanley, who leads the patients at risk and resuscitation team at the Royal Free Hospital in north London, is one of 30 using Google DeepMind’ Health’s Stream app.
The British machine learning company’s technology sends a range of test result data straight to staff’s mobile phones and alerts them to which patients could be in danger of developing acute kidney infection (AKI).
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Health systems' IT priorities for 2018: Cybersecurity technologies, patient-generated data

Dec 8, 2017 12:30am
Many major health systems plan to invest in improved cybersecurity technologies next year.
Cybersecurity improvements are top-of-mind for health IT executives in the coming year, but they're planning a more cautious approach when it comes to technologies like wearables and artificial intelligence, according to a new survey. 
The Pittsburgh-based Center for Connected Medicine, a partner of UPMC, and the Health Management Academy surveyed IT leaders at more than 20 major U.S. health systems and found that 92% plan to increase spending technology to improve cybersecurity next year. 
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VA to spend $10B on Cerner EHR to replace legacy system

Published December 08 2017, 7:04am EST
The Department of Veterans Affairs will spend $10 billion over 10 years to implement a new Cerner electronic health record to replace its decades-old legacy system.
By comparison, the Department of Defense in 2015 awarded a $4.3 billion contract to a Leidos-led team to modernize its EHR with Cerner’s Millennium—the same system that the VA is procuring. However, the VA’s healthcare system is about three times the size of DoD’s, has 2.5 times more facilities, 3.7 times more interfaces and triple the number of licensed users.
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Standardization Biggest Barrier to Healthcare Interoperability

With stakeholders on board to end information blocking, standardization remains the biggest obstacle to healthcare interoperability.

December 05, 2017 - As one of the earliest adopters of health data exchange in its region, the Hattiesburg Clinic in Mississippi understands the importance of enabling healthcare interoperability to improve clinical efficiency and reduce provider frustrations.
The Hattiesburg Clinic first made the decision to begin participating in information sharing in 2011.  Though hospital officials knew health data exchange still had a long way to go before it reached maturation, the clinic embraced the capability and helped to pave the way for other hospitals that were hesitant to engage in the burgeoning practice.
Hattiesburg Clinic Chief Medical Informatics Officer (CMIO) Bryan Batson recently spoke to EHRIntelligence.com about how health data exchange has changed since his clinic first began sharing data and the barriers keeping exchange from reaching its full potential.
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Kiosk enables patients to access radiology images and reports

Published December 08 2017, 4:02pm EST
Patient engagement remains a high priority for most healthcare organizations, and enabling patients to access their medical records has been established by many providers as a key way to do so.
Now, access to reports in electronic health records is no longer the only way to get patients involved—a recently developed kiosk gives them access to their medical imaging exams.
Carestream Health is deploying its MyVue Center Self-Service Kiosk in six countries in Europe and South America in recent weeks; plans to make it available in the U.S. are not yet certain, although the company says it plans to launch more broadly “in coming months.”
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Why we need to fix the broken technology pipeline for digital medicine now

The health IT sector should look to drug and device industries as examples to establish a successful ecosystem of innovation.
December 06, 2017 10:16 AM
When it comes to health information technology, innovative ideas and companies abound. Downstream improvements in outcomes or costs of care resulting from these innovations, however, have to date been underwhelming.
To illustrate this observation, there is no better example than the limited results yielded by the massive investment in electronic health records (EHRs). Another can be found in the $28.7 billion consumer wearable technology market. A recent randomized controlled clinical trial found that individuals using wearables lost less weight over 24 months than those making lifestyle changes alone.
This finding is disappointing, but unfortunately not unusual — despite generating such excitement and investments in these innovations, less-than-optimal or even negative outcomes make it clear that we have yet to fully ascertain HIT’s potential.
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After a 6-year wait, FDA’s clinical decision support guidelines get a mixed reaction

Dec 7, 2017 6:21pm
It’s been six years since the Food and Drug Administration said it would begin developing guidance for clinical decision support (CDS) software.
Now that the guidance is finally here, some industry experts are feeling slightly underwhelmed. For Bradley Merrill Thompson, a medical device attorney with Epstein Becker & Green in Washington, D.C., the FDA’s guidance “stopped at the edge” of the regulatory framework outlined in the 21st Century Cures Act, which carves out an oversight exemption for software that can be independently reviewed by physicians.
I’m afraid I was expecting much more,” Thompson wrote in an email to FierceHealthcare. “I was expecting a guidance that focuses on risk, rather than simply explaining the statutory language in slightly greater detail.
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FDA releases long-awaited clinical decision support guidance, clarifies oversight of mobile apps

Dec 7, 2017 12:00pm
The Food and Drug Administration released three new guidance documents on Thursday with implications for the digital health industry, including one highly anticipated guideline on how the agency plans to regulate clinical decision support tools.
The draft guidance covers decision support technology for both clinicians and patients and builds on several notable exemptions outlined in the 21st Century Cures Act. According to the guidance, analytics technology intended to support clinical diagnoses that provides room for a physician to independently review the basis of the software’s recommendations would not be regulated by the FDA. That includes software that provides current treatment guidelines based on patient information or tools that offer recommendations for a certain intervention, test or drug consistent with clinical guidelines.
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Hospital Impact—Why doctors should oversee, not conduct, clinical documentation

Dec 7, 2017 9:27am
I am old enough to remember a time when physicians could write an abbreviated note on a 3-x-5 note card that stated CHF (congestive heart failure) Rx (prescribe) Lasix 20 mg bid (a diuretic) and he or she would be paid in full. Submit documentation like that today, and payers will send it back as inadequate and not meeting criteria for any payment at all.
Over the past 40 years the complexity of documentation required for any payment—let alone optimal payment—has grown ever more complex. Physicians and advanced-practice practitioners (APPs) are required to spend increasing time at computer terminals doing work they were never properly trained for and that doesn't reflect the reason why they became clinicians in the first place.
Physicians spend up to 50% of their time doing non-productive work—both from a clinical and financial perspective, according to the American Medical Association. The American Nursing Association has reported even higher percentages (70%-75%) for nurses.
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Massachusetts credits database with 30% opioid prescription reduction

Published December 07 2017, 7:26am EST
A recent upgrade has injected new life into Massachusetts’ prescription monitoring efforts, resulting in better coordination of care because of the database and reduced orders for opioids.
Massachusetts has the oldest Prescription Drug Monitoring Program in the United States and—under an October 2016 state law—all prescribers must query the electronic database before writing any new opioid prescriptions.
The Massachusetts Prescription Awareness Tool (MassPAT) was showing its age around the time last year’s law required Bay State doctors to check the database, according to Marylou Sudders, State Secretary of Health and Human Services.
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Making Surgical Pathology and Radiology Reports More Patient-Friendly

To restate the obvious, surgical pathology reports have a new audience -- patients. Some of them are accessing their reports via patient portals (see, for example: Patients Often Lukewarm about Patient Portals; Problems with Training?; Could Apple Be Trying to Develop a "Patient Portal" for the iPhone?). Traditionally, pathologists have dictated these reports with the understanding that they were communicating primarily with the physicians who submitted the tissue for diagnosis. An important question these days is whether the language of these reports needs to be altered in any way now that patients are reading them. A recent article discussed a radiologist-developed "platform" that tweaks radiology reports so that they can be better understood by patients (see: New platform creates patient-friendly radiology reports).
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Docs: It's Time to Certify Specialists in Telemedicine

Debra Shute, December 7, 2017

Virtual medicine practice is more than technological competence. A doctor who proposed the idea of telemedicine certification advocates why this is so.

As medicine sees advancements in technology and expansion of knowledge in care delivery, specialties and their commensurate board certifications continue to proliferate.
With telemedicine use and applications growing, a premier candidate for this process may be a specialty representing the "medical virtualist," proposed two physicians at New York-Presbyterian (NYP) in a recent JAMA Viewpoint.
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5 Steps to Take If Your Org Has a Data Breach

Philip Betbeze, December 7, 2017

Senior healthcare leaders must formulate an action plan for addressing a data breach at their organizations. Knowing how to deal with one could help limit the damage.

With the news out of Michigan this week that the data of 20,000 patients has been compromised because of a breach, it is wise for healthcare leaders to proactively prevent their organizations from becoming part of the misery.
But if you do experience a data breach, it is your responsibility to respond quickly and fully, executing your action plan. Here are the five steps your action plan should include:
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Cedars-Sinai pharmacy staff uses data to cut patient drug errors by 80%

Published December 06 2017, 7:24am EST
Errors in medication histories inadvertently put into electronic health records can have potentially disasterous consequences for patients admitted to the hospital. However, Cedars-Sinai Medical Center in Los Angeles is turning to pharmacists and pharmacy technicians—instead of clinicians—to accurately capture the information.
“There’s information already in the electronic health record for a lot of patients when they come into the hospital, but you don’t know how accurate that information is,” says Joshua Pevnick, MD, associate director of the Division of Informatics at Cedars-Sinai and an assistant professor of medicine.
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Future-proofing precision medicine: IT leaders, clinicians and patients must prepare for changes

Precision medicine is no longer just a buzzword, so teams must prime their infrastructure, retool workflows, develop data governance and educate clinicians now.
December 03, 2017 11:22 AM
How close are we to precision medicine being commonplace, widespread – perhaps even the standard of care? How near are we to an environment where genomic advances are routinely part of the equation when it comes to treating patients?
"The changes are happening so quickly," said India Hook-Barnard, associate director of precision medicine at University of California San Francisco. "I think the world is going to be a very different place in five years."
Suddenly we seem to be nearing a critical mass where precision medicine is no longer just a buzzword but is actually widely integrated into the way physicians deliver care.
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Google makes AI tool for precision medicine open source

The company also made DeepVariant, which can be used to improve the accuracy of genomic sequencing, available through Google Cloud.
December 05, 2017 01:44 PM
Google announced Monday an open source version of DeepVariant, the artificial intelligence tool that last year earned the highest accuracy rating at the precisionFDA’s Truth Challenge.
The open source tool comes as academic medical centers, hospitals, insurance companies and other healthcare organizations are gearing up for if not already embarking on artificial intelligence, cognitive computing and machine learning as well as precision medicine and the genomic sequencing that entails.
Likewise, Google rivals IBM and Microsoft are all moving into the healthcare AI space while much speculation surrounds Apple and Amazon making forays into the space.
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FCC’s Ajit Pai says net neutrality reform will help telehealth, but experts worry a tiered system complicates connectivity

Dec 6, 2017 11:54am
Ajit Pai says telehealth will feel the benefits of net neutrality reforms, but one industry expert says providers won't use technology they can't afford to support. (FCC)
With the Federal Communications Commission poised to roll back Obama-era net neutrality regulation, FCC Chairman Ajit Pai has argued that the government’s light touch approach to high-speed internet will be a net benefit for telemedicine.
But industry experts worry that the agency’s reforms will be problematic for healthcare providers, telemedicine vendors, and patients, all of whom require robust connectivity to meet the demands of video consultations that could come at a higher cost.
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Carequality Interoperability Framework Now Connects 50% of U.S. Providers

December 5, 2017
by Rajiv Leventhal
More than 50 percent of U.S. healthcare providers are connected through the Carequality interoperability framework, officials of The Sequoia Project said this week.
During The Sequoia Project’s annual meeting this week, one of its key initiatives, Carequality, reported significant growth since it became operational in July 2016. To date, more than 1,000 hospitals, 25,000 clinics, and 580,000 healthcare providers are connected through the Carequality interoperability framework.
Carequality is a national-level, consensus-built, common interoperability framework to enable exchange between and among health data sharing networks. It brings together electronic health record (EHR) vendors, record locator service (RLS) providers and other types of existing networks from the private sector and government, to determine technical and policy agreements to enable data to flow between and among networks and platforms.
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Real-time interaction with patient data to enable robust pharmacy-patient coherence

December 4, 2017 | By Brian Eidex
Over 12.5 million people misused prescription opioids in 2015. Pharmacists have a great responsibility to track and manage the use of controlled substances and other drugs of interest not only for the betterment of the industry but for the good of humanity. Non-adherence also remains a huge burden of the healthcare system. Half of all patients with chronic diseases don’t take their medications as prescribed.
Unfortunately, solutions to these challenges have remained elusive due to the disjointedness of patient prescription data. For pharmacists, data coordination remains a major industry challenge, as does the incongruence among various states’ prescription drug monitoring programs. It remains to be seen if, when, and how a national database of drug use is implemented across the U.S. But it’s time for pharmacists to consider both the deep responsibility for and operational benefits of transmitting patient dispensing data to a contributory database.  After all, we can wait for the government to pass legislation based on their perspective, or each of us in the industry can take on the challenge to improve patient care and our positions within the healthcare system.
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HIT Think How 5 tools can help prevent nurse burnout

Published December 06 2017, 4:37pm EST
At a recent Advisory Board session on nurse manager overload and the contributing factors that lead to nurse burnout, it was acknowledged this problem is an issue that affects both staff and patients.
According to the Agency for Healthcare Research and Quality, burnout is emotional exhaustion that results in depersonalization and decreased personal accomplishment at work. A recent article states that 70 percent of nurses report burnout in their current positions; needless to say, that’s a high percentage that seems to keep growing. Factors include stress, time crunches and workflow challenges, to name a few. Ultimately, burnout can put a patient's safety at risk.
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US Healthcare Spending Hit $3.3T in 2016

John Commins, December 6, 2017

Hospital spending grew to $1.1 trillion in 2016, representing 32% of overall US healthcare spending, even as expenditure growth for hospital care slowed to 4.7% from 5.7% in 2015.

Healthcare spending in the United States grew by 4.3% to $3.3 trillion, or $10,348 per person, and represented nearly 18% of the national economy in 2016, federal actuaries report.
The new analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services shows national health spending growth slowed in 2016, when compared to spending increases of 5.1% and 5.8% in 2014 and 2015, respectively.
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Pilot sites to test concept of patients contributing to clinical notes

Published December 05 2017, 7:46am EST
Four healthcare organizations have agreed to serve as pilot sites for OurNotes, an initiative aimed at encouraging patients and providers to jointly create clinical notes and care plans within a shared electronic health record.
Beth Israel Deaconess Medical Center, Dartmouth-Hitchcock Medical Center, the University of Colorado and the University of Washington will be piloting OurNotes starting in the spring, with a focus on engaging patients who have chronic conditions.
Matthew Germak, MD, with the OurNotes team at Beth Israel Deaconess Medical Center, says that in addition to being one of the four pilot sites BIDMC—which has its own homegrown EHR—is helping to coordinate and standardize efforts with the other three sites, all of which are using Epic systems.
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Senate bill aimed at modernizing VA health system includes telehealth licensing provision

Dec 5, 2017 11:17am
A bill introduced by two senators on Monday designed to modernize the Department of Veterans Affairs includes a provision that would allow physicians to practice telehealth across state lines.
Introduced by Sens. John McCain, R-Ariz. and Jerry Moran, R-Kan., the Veterans Community Care and Access Act of 2017 (PDF) would consolidate community care authorities into a single program, implement data-driven access and quality standards, improve walk-in care and ensure safe prescribing practices, among a slew of other requirements.
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OCR: 5 ways to fight internal health data breaches

Dec 5, 2017 12:43pm
Healthcare organizations are a prime target for internal breaches caused by former employees, but there are several steps that groups can take to protect themselves from the threat. 
The Department of Health and Human Services Office for Civil Rights (OCR) issued a number of tactics (PDF) to prevent recently terminated staffers from accessing private healthcare data. 
"Data breaches caused by current and former workforce members are a recurring issue across many industries, including the healthcare industry," according to OCR. "Effective identity and access management policies and controls are essential to reduce the risks posed by these types of insider threats." 
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PMI national cohort to leverage common data model for EHR sharing

Published December 04 2017, 7:31am EST
Electronic health records are a critical piece of the massive dataset that the National Institutes of Health intends to gather from a national cohort of 1 million or more Americans, as part of the Precision Medicine Initiative’s All of Us research program.
In particular, longitudinal tracking of health outcomes through EHRs is vital to the effort. However, tapping into disparate EHRs from a wide range of healthcare provider organizations (HPOs) across the country is a significant challenge for NIH, according to Joni Rutter, director of scientific programs for the All of Us research program.
“To enable electronic health records to be shared with researchers has been a difficult task,” Rutter told the annual meeting of the Office of the National Coordinator for HIT on Friday in Washington.
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Are Your Patients Reluctant to Share PHI?

Alexandra Wilson Pecci, December 5, 2017

Patient and provider education is a crucial factor in facilitating PHI sharing.

When patients consent to share their personal health information electronically with providers they can help enable collaboration among multiple healthcare providers and avoid redundant testing; however, patients might worry about the privacy and protection of their information, how it will be used, and with whom it will be shared.
That's why education—among both patients and providers—is key to facilitating PHI sharing, according to a new study in the Journal of Medical Internet Research.
"If healthcare providers give patients a better understanding of how they're being protected, then patients will be more secure and more willing to share that personal health information," says Joana Gaia, PhD, one of the study authors and clinical assistant professor of the Management Science and Systems Department at the University at Buffalo School of Management.
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Anesthesiologists find EHRs free up face-time for patients

The software also helps such specialists operate more smoothly and meet government reporting requirements under MACRA and MIPS.
December 04, 2017 02:18 PM
Technology has been steadily transforming the practice of medicine, but the field of anesthesiology has not quite kept pace. Documentation is still largely a pen-and-paper enterprise, and that’s costing practices time and efficiency, affecting the bottom line.
As more and more practices are ditching pen and paper and moving to electronic health records, however, vendors such as athenahealth, MedEvolve Practice Management, Mercury Medical and Recordation are offering software platforms or cloud-based services for anesthesiologists. 
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UPMC, Sharp case study shows how hospitals are already pushing AI to the limit

But what are limits today will soon become opportunities, as health systems sit on mounds of data ripe for integration into AI and machine learning tools.
December 02, 2017 08:49 AM
Early adopting providers such as Sharp Healthcare and UPMC have been keen on seeing how far they can push the complex but extraordinarily helpful technology today, knowing that AI will play a much bigger role in their organizations tomorrow.
“Currently, very little artificial intelligence is being utilized across the healthcare sector overall,” said Brett MacLaren, vice president of enterprise analytics at Sharp HealthCare. “At Sharp, we are using predictive algorithms to predict a patient’s propensity to pay their bill, and are leveraging that insight to prioritize who to contact and negotiate with to increase their likelihood of payment.”
In addition, Sharp HealthCare recently completed a proof of concept to develop an algorithm to predict patient decline in the acute care setting by analyzing its electronic health record data to see when rapid response teams are called in to intervene on its sickest patients.
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A New Algorithm Identifies Candidates for Palliative Care by Predicting When Patients Will Die

End-of-life care can be stressful for patients and their loved ones, but a new algorithm could help provide better care to people during their final months.
A paper published in arXiv by researchers from Stanford describes a deep neural network that can look at a patient’s records and estimate the chance of mortality in the next three to 12 months. The team found that this serves as a good way to identify patients who could benefit from palliative care. Importantly, the algorithm also creates reports to explain its predictions to doctors.
Palliative care is a growing trend in the U.S. It can make the end of someone’s life much less painful, and it can usually be done at home. Even as such care becomes more widespread, though, the researchers note that although 80 percent of Americans say they would like to die at home, only 20 percent end up getting to do so.
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Hacking back is a terrible idea, but companies are still keen to try it

It's tempting to take revenge on hackers, but the downsides far outweigh any benefits.
By Steve Ranger | December 1, 2017 -- 13:32 GMT (00:32 AEDT) | Topic: Security
Tired of being attacked by cybercriminals, some organisations are keen to take the fight back to the hackers -- but the risks of 'hacking back' are likely to be much greater than any potential gains.
Hacking back against an assailant -- perhaps tracking down the systems they are using and either deleting the information they stole or disabling the computers -- is currently illegal. But a new survey from Fidelis Cybersecurity has discovered that companies think they have the capability to respond more aggressively to hacking attacks, should they so wish.
Over half of respondents said that companies should be able to hack back, and that their organisation had the technical ability to identify an intruder, infiltrate their systems, and destroy any data that had been stolen after a cyberattack.
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PMI national cohort to leverage common data model for EHR sharing

Published December 04 2017, 7:31am EST
Electronic health records are a critical piece of the massive dataset that the National Institutes of Health intends to gather from a national cohort of 1 million or more Americans, as part of the Precision Medicine Initiative’s All of Us research program.
In particular, longitudinal tracking of health outcomes through EHRs is vital to the effort. However, tapping into disparate EHRs from a wide range of healthcare provider organizations (HPOs) across the country is a significant challenge for NIH, according to Joni Rutter, director of scientific programs for the All of Us research program.
“To enable electronic health records to be shared with researchers has been a difficult task,” Rutter told the annual meeting of the Office of the National Coordinator for HIT on Friday in Washington.
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Enjoy!
David.