Saturday, January 25, 2014

Weekly Overseas Health IT Links - 26th January, 2014.

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.

Health IT experts brainstorm with ONC on clinical quality measures

Posted on Jan 17, 2014
By Anthony Brino, Editor, HIEWatch
Informaticists joined clinical quality experts in a brain storming session this week with new ONC chief Karen DeSalvo, exchanging ideas on developing the "next generation" of quality measures. 
Charged with developing new e-clinical quality measures that can work in tandem with accountable care measures, the HIT Policy Committee’s Quality Measures Workgroup offered recommendations to Karen DeSalvo at her first policy meeting.
The Workgroup’s co-chairs, National Quality Forum VP Helen Burstin, MD, and Veterans Health Administration informatics director Terry Cullen, MD, developed recommendations for measure domains, criteria and implementation, some of which seems to have drawn resistance from a few health IT companies.

CIOs gauge decade of health IT headway

Posted on Jan 17, 2014
By Bernie Monegain, Editor
The healthcare IT industry just marked  the 10-year anniversary of then President George W. Bush’s call to action – in his 2004 State of the Union address – to finally transform a paper-mired healthcare system into a digital-age industry that operates more like other sectors of the economy.
As we look back on 10 years, we spoke to some leaders on the frontline of health information technology, asking them to take measure of how far the industry has moved towards a truly high-tech, data-driven system of care.

Patients using telehealth services to hit 7 million by 2018

January 17, 2014 | By Dan Bowman
The number of patients worldwide using telehealth services will rise from less than 350,000 in 2013 to roughly seven million in 2018, according to a new report published by IHS Technology.
Additionally, the report estimates that revenue for telehealth services will balloon tenfold, from $440.6 million in 2013 to $4.5 billion in 2018. The report's authors point to the introduction of mobile health hubs and projected growth in wearable technology as catalysts for such growth.
"Amid rising expenses, an aging population and the increasing prevalence of chronic diseases, the healthcare industry must change the way it operates," Roeen Roashan, a medical devices and digital health analyst at IHS, said in an announcement. "Telehealth represents an attractive solution to these challenges, increasing the quality of care while reducing overall healthcare expenditures."

3 Trends Are Reshaping Healthcare IT

Skepticism of innovative health technology is nothing new. But trends such as social technology will redefine healthcare's future.
1/16/2014 00:10 AM
Kaveh Safavi
The history of healthcare is one of constant discovery, progress, and invention -- and often skepticism from both practitioners and patients.
Take this prediction from The Times of London in 1834: "That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble." The innovation in question: the newly invented stethoscope.
The same is true with the development of healthcare information technology (HIT) today. Its transformational power has yet to be fully recognized. While tools like electronic health records (EHR) are now accepted and mainstream, there are more wide-ranging, IT-driven opportunities still to be grasped. Above all, Internet access, mobile technologies, and social networks collectively offer a future where it is possible to deliver highly personalized care without necessarily having to do it in-person, or even with a doctor.

WEDI to Sebelius: You Need More ICD-10 Testing

JAN 15, 2014 3:40pm ET
The Workgroup for Electronic Data Interchange has sent a letter to Health and Human Services Secretary Kathleen Sebelius giving a variety of compelling reasons for the department to expand its ICD-10 testing before the Oct. 1, 2014, compliance date. Here is the letter, dated Jan. 13:
“In its advisory role under the Health Insurance Portability and Accountability Act of 1996, the Workgroup for Electronic Data Interchange periodically brings to your attention issues related to healthcare information exchange and related areas that it believes merit review and consideration by the Secretary of Health and Human Services. We take this opportunity to ask you to consider additional Medicare testing prior to ICD-10-CM and ICD-10-PCS (ICD-10) implementation.
“In the January 16, 2009 Federal Register (74 FR 3328), HHS published a final rule adopting the ICD-10-CM and ICD-10-PCS medical code sets as the HIPAA standards to replace the previously adopted ICD-9-CM medical code set for diagnosis and inpatient procedure coding. The compliance date established by the final rule was October 1, 2013. In the September 5, 2012 Federal Register the compliance date for this requirement was extended to October 1, 2014.

Researchers: EHR outcome, MU studies need to shift focus

January 13, 2014 | By Marla Durben Hirsch
Clinical decision support tools and computerized physician order entry--both Meaningful Use program requirements--are proven to have positive effects on quality outcomes, but reporting of contextual and implementation details have been "poor," making it impossible to determine why some electronic health record implementations were successful and some not, according to a new study funded by the Office of the National Coordinator for Health IT published in the Annals of Internal Medicine.
The researchers, from the RAND Corporation, reviewed 236 studies assessing EHRs and outcomes with an eye on the Meaningful Use requirements. Fifty-six percent of the studies focused on CDS and CPOE, and most reported a positive or mixed positive result.   
"Healthcare providers should be encouraged to adopt CDS and CPOE, and future studies of CDS and CPOE should concentrate on how to make them work better rather than testing the hypothesis of whether they work at all," the researchers said.

EHR research needs to be more meaningful

January 16, 2014 | By Marla Durben Hirsch
I usually take electronic health record research at face value. These are generally scientific endeavors, often conducted by esteemed institutions or academicians who are testing the effectiveness of such tools, assessing their impact on satisfaction and productivity, or determining their role in research.
So it's disconcerting to read not one, but two studies this week that question the quality of some of the EHR research being conducted.
First there's the RAND Corporation's study on Meaningful Use, funded by the Office of the National Coordinator for Health IT. If you read ONC's blog post about the study, Meaningful Use is fabulous. It "improves quality, safety and efficiency outcomes." The blog post provides all sorts of statistics to support its claim. It glosses over the fact, however, that most of the studies being cited pertain only to clinical decision support and computerized physician order entry; the other components of Meaningful Use "are not as well studied."

ONC chief's early years inform her work

Posted on Jan 16, 2014
By Anthony Brino, Editor, HIEWatch
Karen DeSalvo, MD, has stepped into the role of national coordinator for healthcare information technology at a time when American healthcare is in a state of unprecedented change.
Her resume shows that DeSalvo has the right mix of skills to advance the healthcare system while helping the IT industry create better tools for providers and patients alike.
A practicing internist, she recently led a purchasing committee select a new EHR system. DeSalvo served as the New Orleans public health commissioner until recently, after working at Charity Hospital and Tulane University’s medical school.
DeSalvo’s experience in New Orleans -- such as patients suffering end-stage diseases that could have been prevented or mitigated and the disaster of Hurricane Katrina -- combined with her upbringing, left her with concerns about inequality in access to healthcare and an insufficient medical communications infrastructure.

Patient-generated data: Which road to travel?

Source: Joseph Kvedar, MD, Center for Connected Health Date: Jan 15, 2014 e-mail to a friend
Patients who could most benefit from personal health tracking are not currently the ones doing so. But the convergence of BYOD, connected sensors and evolving EHRs presents a number of paths providers should consider travelling, keeping in mind Robert Frost's famous poem, argues Joseph Kvedar.
Two roads diverged in a wood, and I—I took the one less traveled by, And that has made all the difference.”  Robert Frost
I received two emails from organizational leadership in the past week that represent milestones to me. One was about our efforts to better manage populations in the context of risk-bearing (pay-for-value) contracts with our payers: “[Partners] is undergoing a planning process to determine what we can do over the next 3 years (2015 to 2017) to better prepare for increased risk in payer contracts….there is a segment of our Hypertension and Diabetes population (and CHF) that would benefit from telemonitoring.” The language here is not dramatic, but the recognition that patient-generated data can be a critical tool for population health management and improved efficiency of care delivery is something we have strived to demonstrate over the last 10 years or more. It feels good to hear it come from others.

Insider view

On the first anniversary of health secretary Jeremy Hunt’s groundbreaking speech on NHS IT, EHI editor Jon Hoeksma asks whether the ‘paperless’ NHS needs to start a new chapter.
16 January 2014
A year ago, health secretary Jeremy Hunt announced that he wanted to see a ‘paperless’ NHS by 2018.
Twelve months on, the idea remains an important clarion call to action, without a huge amount of clarity on what paperless means, why it should be achieved, or how it will be taken forward.
Literally paperless a pipe dream
Almost nobody working in NHS IT believes in the objective in a literal sense. There is not a chance the NHS will have ceased to use paper within four years.  Stationers and printers across the land can sleep a little easier.

Welsh boards share info via portal

14 January 2014   Lis Evenstad
Two health boards in Wales are sharing patient information across hospitals using the Welsh Clinical Portal.
In a four-month pilot, eight clinicians at Abertawe Bro Morgannwg Health Board have used the portal to view information about patients referred from Hywel Dda Health Board.
Dr Stephen Dorman, consultant cardiologist at Morriston Cardiac Centre, said the project has improved the speed with which they are able to view a patient’s details.
“The Welsh Clinical Portal cross border pilot has enabled us as clinicians to access vital test results on our patients in a much more timely fashion,” he said.

ONC suite of guides aims to boost EHR safety

January 16, 2014 | By Susan D. Hall
The Office of the National Coordinator for Health IT announced this week that it has issued nine guides to help healthcare organizations assess the safety of electronic health records and to use them effectively. Known as the Safety Assurance Factors for EHR Resilience (SAFER) Guides, they offer a suite of tools that include checklists and recommended practices to boost EHR safety.
The nine guides are:
  • High Priority Practices
  • Organizational Responsibilities
  • Patient Identification
  • CPOE with Decision Support
  • Test Results Review and Follow-up
  • Clinician Communication
  • Contingency Planning
  • System Interfaces
  • System Configuration
The guides have been in the works since the U.S. Department of Health & Human Services released a final health IT safety plan last July, Jacob Reider, ONC Chief Medical Officer, said in a post yesterday to the Health IT Buzz blog.

ONC aims for SAFER use of EHRs

Posted on Jan 16, 2014
By Mike Miliard, Managing Editor
The Office of the National Coordinator for Health IT has released what it calls Safety Assurance Factors for EHR Resilience guides: nine toolkits to help providers make safer use of electronic health records and other technology.
The SAFER suite include checklists and recommended practices designed to help care providers and affiliated organizations optimize EHR safety. ONC officials say it's an important component of the Health IT Patient Safety Action and Surveillance Plan issued by the Department of Health and Human Services this past July.
"A basic premise of the Health IT Safety Plan is that all stakeholders have a shared responsibility to make sure that health IT is safely implemented and that it is used to improve patient safety and care," said Jacob Reider, MD, chief medical officer at ONC, in a press statement. "The SAFER Guides combine the latest applied knowledge of health IT safety with practical tools that will help providers – working closely with EHR developers, diagnostic service providers and others – effectively assess and optimize the safety and safe use of EHR technology within their organizations."

HIMSS Analytics: Expect rapid growth for portal, data mining, radiology barcoding apps

January 16, 2014 | By Susan D. Hall
Patient portals, clinical data warehousing/mining and radiology barcoding applications are poised for rapid growth among hospitals, according to the HIMSS Analytics report "Essentials of the U.S. Hospital IT Market, Winter 2013 Edition."
Though more than half the health systems, hospitals and clinics in a recent KLAS survey reported offering a portal, the HIMSS report says of the three application types, "first-time purchases of these advanced [electronic medical record] applications are expected to increase greatly among hospitals across the country."
It also predicts a high volume of replacement sales for several foundational applications that have already saturated the market, including laboratory barcoding, pharmacy management systems and information systems for radiology and laboratory departments.

Telemedicine a Win for Stressed-Out Doctors

Jacqueline Fellows, for HealthLeaders Media , January 16, 2014

A provider of urgent and primary care is shining a spotlight on telemedicine's reach. This is more than just a way to reach patients in rural areas and cut healthcare costs. Early data shows that patients and physicians are finding other reasons to like virtual provider visits.

As a young medical student, Ben Green, MD, was a family physician in training at a typical primary care office. Rushing around to fit in as many as 20-30 patients per day, he realized quickly that this wasn't what he envisioned medicine to be, and became disillusioned.
"Ten minutes was the average face-to-face time with a patient," says Lee who is now one of the medical directors at Carena, a Seattle-based virtual telemedicine provider of urgent and primary care. "I don't feel like that's the right thing for patients in a primary care setting. I have a lot of respect for providers who do that, but for me, it didn't fit with my comfort level."

EHR payments soar to near $20B

Posted on Jan 15, 2014
By Anthony Brino, Editor, HIEWatch
Electronic health record incentive payments to eligible docs and hospitals continue to climb into the new year. The "inexorable progress" of the federal EHR incentive program continues, with payments to providers moving ever closer to $20 billion.
As of the end of November, more than 436,000 hospitals and health professionals have registered for the Medicaid and Medicare EHR incentive program, and the federal government has made more than $17.7 billion in payments, the Centers for Medicare and Medicaid Services told the Health IT Policy Committee in an update.

Tiger team to focus on privacy issues arising from authorized access to patient records

January 15, 2014 | By Dan Bowman
The Privacy and Security Tiger Team--which makes recommendations to the Health IT Policy Committee--laid out its 2014 agenda and named a new co-chair at its first meeting of the new year on Monday. The team's agenda will focus on, among other issues, the privacy of patients who grant other individuals access to their electronic health data, Healthcare Info Security reported.
In particular, the team will discuss such issues as they relate to the records of adult patients in Q1 of 2014. That focus won't shift to issues as they relate to minors until Q3 due to complexities involved in such situations, including parental consent.
Potential second-quarter discussions will center on the data practices of business associates, in particular, data intermediaries, according to Healthcare Info Security. Business associates, of course, now are liable for the protection of private patient information under the Health Insurance Portability and Accountability Act.

'Next chapter' of ONC's work to focus on population health management, DeSalvo says

January 15, 2014 | By Dan Bowman
National Coordinator for Health IT Karen DeSalvo has wasted no time sharing her thoughts on the direction of ONC's work under her tenure. At Tuesday's Health IT Policy Committee meeting, DeSalvo, one day after taking office, said she believes ONC's next phase will focus on harnessing health IT for, among other things, population health.
"That is the major next chapter that we must undertake as part of the President's major domestic policy initiative," DeSalvo said. "[T]o see the promise of health information technology in the clinical interface for the health systems and the population and community at large to come to fruition."
The new ONC head added that she would like to see "real improvements" in health over time that could help with things like preparedness in the face of disasters. DeSalvo, of course, served as health commissioner for the City of New Orleans, where she helped to establish health IT infrastructure in the wake of Hurricane Katrina. She also previously served as president of the Louisiana Health Care Quality Forum, taking the lead on efforts to secure health information exchange and regional extension center grant funding.

Health IT banks record VC cash in 2013

Posted on Jan 14, 2014
By Erin McCann, Associate Editor
Health IT is where the money's at -- at least in 2013, which saw venture capital funding nearly double from the previous year, according to a new industry report released Monday.  
The Mercom Capital Group report highlighted VC and merger and acquisition activity for the healthcare IT market over the past year, and the numbers did not disappoint. 
Venture capital funding in the healthcare IT sector almost doubled, reaching $2.2 billion in 2013 across 571 deals, compared to $1.2 billion across 163 deals in 2012. The biggest recipient of VC dollars was the mobile health sector, which raised some $564 million. 

Resolutions on EHR usability, ROI: A welcome relief, or just lip service?

January 9, 2014 | By Marla Durben Hirsch
I read with great interest this week's proposals to improve electronic health records in the new year. First we have Jacob Reider, Acting National Coordinator for Health IT, who published a blog post on Jan. 6 acknowledging that EHR usability continues to be an unresolved issue that remains a priority for ONC. He also notes that the agency is working to understand the issues and determine what the government's role should be regarding EHR usability.
Then we have the Institute of Medicine on the same day issuing a proposed standard model for hospitals and others to evaluate the financial benefits and costs of purchasing an EHR and its potential return on investment (ROI). The proposed model helps provide inter-organizational comparisons, identify "best-in-class" implementation approaches and prioritize process redesign endeavors.
These are welcome developments. It's about time that there's an emphasis on EHR usability and a real tool to help providers determine their ROI when purchasing an EHR. Plus, these initiatives are coming from the government and the Institute of Medicine, no less, so they're backed with notable credibility.

The Hospital Room PC, Reimagined

Scott Mace, for HealthLeaders Media , January 14, 2014

A new PC being tested in hospital rooms isn't like any PC you know. Sure, it delivers streaming video and gaming, but it can also provide patient monitoring and reporting.

Virtual desktops may be on a trajectory to erase the traditional work PC in hospitals, but at the International CES show last week, Intermountain proved that PCs have a new, somewhat surprising starring role in healthcare.
Last September, I wrote about how Memorial Healthcare in Owosso, Michigan had decided to replace traditional PCs with so-called "zero client" hardware that provided maximum mobility for clinicians and minimum maintenance headaches for IT staff. That trend continues, although some readers noted that antiquated software licensing policies at Microsoft and the PC-based EHR companies are slowing the move to zero-client PCs.

The Trouble with EHRs

Scott Mace, for HealthLeaders Media , January 14, 2014

Although electronic health records are known to reduce healthcare costs, concerns about accuracy and usability—and the risk of EHR-caused medical errors—are growing.

This article appears in the December issue of HealthLeaders magazine.
The move away from paper medical records to EHRs has many benefits, but the flip side is that providers need to carefully manage the usability, accuracy, and audit trails of EHRs across the entire care team.
Providers say the day of the doctor carefully controlling and supervising every aspect of a medical record is giving way to an age where the entire medical team and even patients will scrutinize and update a record's accuracy, all while legal and regulatory requirements for maintaining those records are met. At the same time, the complexity of EHR software itself increases the risk of EHR-caused medical errors.
While EHRs have been around for years, the requirements of meaningful use stage 2 for patients to be able to view, download, and transmit their medical records to providers across the care continuum as well as health information exchanges mean it is time for providers to pay special attention to proper record maintenance.

Standard Framework Offered to Assess HIT Return on Investment

JAN 10, 2014 3:37pm ET
A team of researchers from across the industry have developed a framework for assessing the return on investment of health information systems.
The Institute of Medicine has published the framework as a discussion paper, available here. “Although it may seem obvious that both the demands for higher reliability and higher-value health care require robust electronic health records, information exchange and deep analytic capabilities, it remains difficult to measure the return on investment in information systems,” the authors note. “The lack of a standard model for ascribing the costs of implementing or the benefits of using EHRs and related technology makes comparisons across different institutional experiences, different implementation approaches, and different technologies difficult. Moreover, the absence of a format for a standard business case for information investment may add to the hesitation for investment in information systems and thwart progress in creating the reliable digital foundation needed for a continuously learning health system.”

ONC seeks more input on tech to support patient involvement

January 13, 2014 | By Susan D. Hall
The Office of the National Coordinator for Health IT has been working to change focus from technology to support physicians to technology that centers on patients. Publishing an issue brief summing up the work done so far and what remains, the office is also asking for public input.
"A little over a year ago, we embarked on an effort to look to a long term future, where health IT and communications technology could support people in managing their own health and partnering in their health care. We engaged visionaries and subject matter experts to help us develop a policy framework for putting the person more at the center of their own health and health care, enabled by health IT," writes Jodi G. Daniel, Director of the Office of Policy and Planning, in a post at Health IT Buzz.
It points to efforts such as Blue Button Plus, Patient Centered Outcomes Research (PCOR) and expansion of the Investing in Innovation ("i2") Program that have focused on using technology to improve care and give patients more access to their own information.

A Review of the Federal Health IT Activity in Q4 2013

by Helen R. Pfister, Susan R. Ingargiola and Erica L. Cali, Manatt Health Solutions Monday, January 13, 2014
The federal government continued to implement the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act, during the fourth quarter of 2013. Below is a summary of key developments and milestones achieved between October 1, 2013, and December 31, 2013.


The fourth quarter of 2013 saw a number of important developments:
  • HHS Announces New National Coordinator. On Dec. 19, 2013, HHS Secretary Kathleen Sebelius announced that Karen DeSalvo will be the next national coordinator for health IT. DeSalvo last served as the New Orleans Health Commissioner and a senior health policy adviser to Mayor Mitch Landrieu (D). She takes over the national coordinator post on Jan. 13.
  • CMS Proposes To Extend the Meaningful Use Timeline. On Dec. 6, 2013, CMS proposed a new timeline for the implementation of meaningful use under the Medicare and Medicaid Electronic Health Record Incentive Programs. Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. On the same day, ONC proposed to allow for certification criteria to be updated more frequently under the ONC Health IT Certification Program. 

Charities launch campaign on sharing medical data

By Clive Cookson
Britain’s largest medical charities are launching a campaign on Monday to encourage National Health Service patients to share their records for research and other purposes beyond their own clinical care.
The charities want to convince people that the benefits of medical data sharing – with safeguards to protect confidentiality – “far outweigh inflated privacy concerns”.
Their campaign coincides with an expansion of patient data-sharing across NHS England.


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