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What is Big Data?
MAR 6, 2014
Last September, two computer science students from the University of St. Andrews in the U.K. attempted to pin down a definition of Big Data, publishing “Undefined by Data: A Survey of Big Data Definitions” in the open-source journal arxiv.org. Their round-up included:
- Gartner Group: The “Four V’s” definition: volume, velocity, variety, veracity
- Oracle: The derivation of value from traditional relational database-driven business decision-making, augmented with new sources of unstructured data such as blogs, social media, sensor networks, and image data.
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How to measure the value of health IT
Posted on Mar 07, 2014
By Mike Miliard, Managing Editor
There's been a whole lot of capital invested in health information technology these past few years. And some people – especially those who are in charge of spending more of it – want to know whether it's money well spent.
It may seem obvious to some in this industry, but it's still a question that bears asking: Is the value of health IT self-evident at this point, five years after HITECH? Or is the jury still out?
"I think in the United States we've passed a tipping point," says John Hoyt, executive vice president of HIMSS Analytics. "People understand that IT can create value."
The catch? "It's not automatic."
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Report: Provider Satisfaction With HIE Solutions Has Dropped
Healthcare organizations are not as happy with their health information exchange solutions as they have been in the past, according to a report from KLAS Research.
Overall satisfaction has dropped 8 percent as compared with last year's report. Vendors' inability to keep up with customer demand, along with overall declining enthusiasm for HIEs and the struggles faced by public exchanges, have contributed to providers' disappointments with their HIE solutions.
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Health IT benefits outweigh the negative, report shows
By Erin McCann, Contributing Editor
A new study conducted by RAND Corporation for the Office of the National Coordinator for Health IT has found that the benefits of health IT outweigh any negative or neutral effects of their use.
The January study examined 236 health IT studies from 2010 to 2013. It found that 77 percent of them reported either positive or mixed-positive outcomes -- meaning there existed at least one negative association between health IT and the care metric, but the original authors concluded the benefits outweighed negative or neutral effects.
However, nearly 20 percent of the studies on health IT's efficiency outcomes yielded negative results, and only 45 percent saw overwhelmingly positive outcomes. Researchers described efficiency as including costs, utilization and timelines.
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GAO: EHR Program Lacks Strategy, Measures
MAR 6, 2014
While the Department of Health and Human Services has established some performance measures for its meaningful use EHR program that are tied to strategic goals, HHS has not established measures that would "help them to track progress toward program outcomes such as health care quality, efficiency, and patient safety," a new Government Accountability Office report finds.
"Although HHS expects that the use of EHRs can help achieve improved outcomes and support other efforts that are also intended to improve care, that result is not yet assured," concluded the GAO report. "The Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health Information Technology may lack critical information necessary to establish program priorities and subsequently make program adjustments based on progress toward outcomes."
In particular, government auditors argued that the lack of a comprehensive strategy "limits HHS's ability to ensure the department can reliably use the clinical quality measures (CQM) collected in certified EHRs for quality measurement activities."
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Too Many Docs Served by HIE Order Duplicate CT Scans
MAR 5, 2014
An 18-month study at HEALTHeLINK, the health information exchange serving western New York, finds more than 2,700 CT scans--10 percent of the total such scans of three parts of the body ordered during the period--were potentially unnecessary duplicate scans.
Further, 90 percent of the unnecessary scans were ordered by physicians who never or rarely used the HIE to query for previous scans for the patient. The study covered scans ordered for the same patient covering the head and neck, chest and abdomen.
More than 70 percent of the duplicate scans were ordered by physicians who did not query for past scans through HEALTHeLINK, and 95 percent of duplicates came from hospitals, including 44 percent from emergency departments. Only 1.1 percent of orders for duplicate scans came from physicians who are frequent users of the HIE, suggesting they are querying for earlier scans before ordering.
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Are EHRs at a 'tipping point'?
Posted on Mar 06, 2014
By Mike Miliard, Managing Editor
With more than 50 percent of practices and 80 percent of hospitals having adopted electronic health records and attested for meaningful use by now, it's time to talk about next steps.
The March edition of the Journal of AHIMA does just that, with a story that looks at the changes and challenges ahead for health information management professionals as EHRs become a fact of life.
“We have reached a tipping point in adoption of electronic health records,” said Health and Human Services Secretary Sebelius in May 2013. “More than half of eligible professionals and 80 percent of eligible hospitals have adopted these systems, which are critical to modernizing our health care system.”
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Open source plans revealed
3 March 2014 Rebecca Todd
NHS England is looking to create a series of community interest companies to act as custodians for open source products introduced to the NHS.
NHS England revealed in mid-2013 that it wanted to encourage an open source option for trusts looking to invest in electronic patient record systems, and that some of the £260m ‘Safer Hospitals Safer Wards: Technology Fund’ would go towards this.
Last week, NHS England head of business systems Richard Jefferson told EHI that ten to 12 trusts are “seriously engaged in looking at a moderate-to-large open source EPR-type solution."
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ONC publishes new review of health IT functionalities
March 5, 2014 | By Marla Durben Hirsch
More than three-fourths of studies on health IT have found that technology provides at least some positive impact on patient care, but the studies themselves need improvement, according to the Office of the National Coordinator for Health IT's new literature review, prepared by the RAND Corporation.
The 145-page report updates previous reviews on the effects of health IT on patient care. This is the first review to focus specifically on identifying and summarizing the evidence relating to the use of health IT outlined in the Meaningful Use regulations.
The review of literature, from January 2010 to August 2013, found that 77 percent of the studies meeting the eligibility criteria reported positive or mixed positive results; studies on safety and quality reported more positive results than those on electronic health record efficiencies. The researchers also found that the effect of health IT was influenced by the particulars of the IT system used, the implementation process and the context in which the IT was implemented.
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ONC publishes new review of health IT functionalities
March 5, 2014 | By Marla Durben Hirsch
More than three-fourths of studies on health IT have found that technology provides at least some positive impact on patient care, but the studies themselves need improvement, according to the Office of the National Coordinator for Health IT's new literature review, prepared by the RAND Corporation.
The 145-page report updates previous reviews on the effects of health IT on patient care. This is the first review to focus specifically on identifying and summarizing the evidence relating to the use of health IT outlined in the Meaningful Use regulations.
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Direct patient access to test results adds new responsibilities for all
Posted: March 1, 2014 - 12:01 am ET
Last month, the federal government took a major step toward enhancing the ability of millions of Americans to access their health data and improve patient engagement as we know it in the U.S.
HHS issued a final rule that gives patients direct access to their personal laboratory information without first requiring the approval of their healthcare provider or other designated party. Before this rule, about a dozen states—including California, Florida and New York—prohibited direct patient access to their lab test results without their doctor's prior receipt and approval.
This rule is significant for a number of reasons. Enabling patients to access their results directly from their lab provider will help reduce the risk that an abnormal result will not get acted upon. In a recent multi-institutional study, about 7.1% of abnormal results reportedly were not acted upon or communicated to patients.
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Obama budget tags $1.8B for health IT
Posted on Mar 05, 2014
By Diana Manos, Senior Editor
In his $3.9 trillion fiscal year 2015 budget proposal released Tuesday, President Obama asked for $1.8 billion to support health information technology incentive payments — the same amount he requested last year. Actual spending for this category came to $1.07 billion in 2013.
The budget also included $77.1 billion in discretionary funding to support HHS’s mission, $800 million below the 2014-enacted level.
According to the administration, the $77.1 billion in base discretionary resources for HHS is intended “to help make coverage affordable, drive down long-term health care costs, and improve care for millions of Americans, as well as to train new health care providers, address public health priorities, assist vulnerable populations, and support medical research.”
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Health IT benefits called into question
Posted on Mar 05, 2014
By Erin McCann, Associate Editor
Healthcare organizations nationwide have spent billions of dollars to implement health information technology, most with the expectation that it will improve quality and safety, and lower costs. According to a recent report, however, not all outcomes have been positive, particularly with regard to efficiency.
The January study, conducted by RAND Corporation for the Office of the National Coordinator for Health IT, examined 236 health IT studies from 2010 to 2013. It found that 77 percent of them reported either positive or mixed-positive outcomes -- meaning there existed at least one negative association between health IT and the care metric, but the original authors concluded the benefits outweighed negative or neutral effects.
However, nearly 20 percent of the studies on health IT's efficiency outcomes yielded negative results, and only 45 percent saw overwhelmingly positive outcomes. Researchers described efficiency as including costs, utilization and timelines.
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10 years of HIEs: Progress, but there's a long way to go
March 5, 2014 | By Susan D. Hall
Nearly 10 years after the creation of the Office of the National Coordinator (ONC), the U.S. healthcare system is making advances in harnessing the power of health information to improve care, but many important health policy decisions will need to be confronted in the years ahead, concludes a report from the California HealthCare Foundation.
The report, "Ten Years In: Charting the Progress of Health Information Exchange in the U.S.," traces the history of the HITECH Act, healthcare reform, electronic health record adoption and health information exchange efforts.
"Now, after HITECH's investments, the primary question many experts are struggling with is: What constitutes the right mix of government HIT programs versus market forces to continue development of an HIT infrastructure that can support higher quality, more cost-effective health care?" it states.
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CHIME and HL7 Announce Partnership
March 3, 2014 by Rajiv Leventhal
As part of a partnership to advance healthcare interoperability, the College of Healthcare Information Management Executives (CHIME) and Health Level Seven International (HL7) will work together to promote a standardized approach to interoperable data exchange, the organizations announced.
“CHIME is pleased and eager to collaborate with HL7 to combine our efforts in achieving greater interoperability and health information exchange,” CHIME president and CEO Russell P. Branzell, said in a statement. “This partnership emphasizes our commitment to drive the effective use of data sharing to improve the safety, quality and efficiency of patient care.”
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UCLA develops Google Glass app for reading diagnostic test strips
Researchers in the Ozcan Research group at UCLA’s Henry Samueli School of Engineering and Applied Science have developed a Google Glass app that allows users to interpret diagnostic test strips for a variety of diseases and health conditions, such as HIV, malaria, and prostate cancer.
The research was published in ACS Nano, a journal that publishes articles on nanoscience and nanotechnology research.
To use the app, which the team refers to as RDT reader, Google Glass wearers take pictures of rapid diagnostic tests (RDTs), which are small strips on which blood or other fluid samples are placed and which change color to indicate the presence of various conditions. Users can then upload the picture to a UCLA-designed server platform that is connected to the app. After uploading the picture, the app provides them with analyses of the samples. According to the researchers, Google Glass’s camera offers a more detailed report than simply analyzing the samples with the human eye.
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AMA says ICD-10 needs back-up plan if testing reveals billing problems
CMS is conducting testing in March for claims submitted using the new code set
Publish date: MAR 04, 2014
The American Medical Association (AMA) says it’s “deeply concerned” that a contingency plan has not been put in place if issues occur during ICD-10 testing this month.
“The slightest glitch in the ICD-10 rollout could potentially cause a billion dollar back-log of medical claims that jeopardizes physician practices and disrupts patients’ access to care,” Ardis Dee Hoven, MD, president of the AMA, said in a written statement. “The AMA is deeply concerned that Medicare does not have a back-up plan if last minute testing demonstrates anticipated problems with this massive coding transition. At the end of the day sticking hard and fast to the ICD-10 deadline without a back-up plan to address disruptions in medical claims processing will hurt doctors and their patients.”
The Centers for Medicare and Medicaid Services (CMS) is conducting front-end testing the first week in March for claims submitted using the ICD-10 code set.
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A bad week in the bunker for care.data
EHI editor Jon Hoeksma reflects on another difficult week for NHS England's flagship open data project, and its champion Tim Kelsey.
3 March 2014
Health leaders gathered in Manchester for the Healthcare Innovation Expo look set to have their future-gazing overshadowed by the disarray over care.data, after a truly disastrous week for the open data initiative.
A fortnight ago, NHS England was forced to announce a six-month delay to the project to link the Hospital Episode Statistics to other databases and make the information available to researchers and others, after a public outcry about the lack of consultation on the plans.
But the commissioning board had begun a fight back in defense of the programme, with a major communications campaign promised in an otherwise fraught session at the Commons’ health select committee, and tough new legislation unveiled by health secretary Jeremy Hunt.
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mHealth market scales to new heights
Posted on Mar 04, 2014
By Erin McCann, Associate Editor
Over the next six years, the global mHealth market will continue to make a mark in a serious way, with the industry poised to exceed $49.1 billion by 2020, according to a new market report.
According to research conducted by San Francisco-based market analysis and consulting firm Grand View Research, monitoring services are projected to remain the dominant and most rapidly growing market segment, with revenue topping $1.2 billion in 2012, and seeing a nearly 50 percent CAGR from 2014 to 2020.
Although healthcare expenditures are among the lowest rates on record -- a 3.7 percent spending increase in 2012, according to Centers for Medicare and Medicaid Services -- they are still on an upward trajectory, making medical services unaffordable for a percentage of the population, report officials point out. Resultantly, hospitals, providers and payers are looking to the financially favorable mHealth market.
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Another view: watching the iWatch
GP Neil Paul has been following speculation about Apple’s latest venture – and reckons it could have huge benefits for health (if the rumours are true).
4 March 2014
Tech sites and bloggers have whipped themselves into a frenzy over reports that Apple may have hired a number of health related techies (and I’m secretly hoping for a call myself).
The hires are certainly interesting if true. One is reportedly an expert in finding veins using infra red technology; others are experts in exercise and physiology.
And there’s a lot of informed and not so informed debate ‘below the line’ (all part of the fun) on what this might mean for Apple’s future and for health.
I’ve posted some comments myself (under a pseudonym) asking whether the company is going for a sports/fitness device or health monitoring/early warning/chronic disease management system.
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Risk prediction, personalized medicine still in their infancy
March 4, 2014 | By Susan D. Hall
While risk prediction and personalized therapies are advancing in some areas, there's much work to be done to make such efforts effective, according to an article in BMC Medicine.
Daniel F. Hayes of the University of Michigan Comprehensive Cancer Center advocates for better industry oversight for tumor biomarker tests and the need to know whether a particular biomarker is significant clinically--whether to give or withhold a particular treatment. Few tests have demonstrated both analytical and clinical utility, he says.
Next-generation sequencing--comparing a tumor to a patient's normal DNA--is the next step, though that's still in its infancy.
Electronic medical records will provide the capability to review millions of patients' outcomes and apply lessons from them, he says.
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Despite coming tech transformation, healthcare CEOs say they're not ready
March 4, 2014 | By Susan D. Hall
While most healthcare CEOs believe technological advances will transform their business in the next five years, few organizations are prepared for the changes, according to a new survey from PricewaterhouseCoopers.
Eighty-six percent of healthcare CEOs identified technological advances such as the digital economy, mobile devices and big data as key trends transforming their business, with demographic shifts coming in a close second.
Fifty-seven percent of healthcare CEOs--more than in other industry sectors--are worried that the speed at which technology is progressing will make their efforts obsolete and slow growth.
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7 Most Common Mobile Devices Provided to Clinicians
To improve clinicians' workflow and facilitate adoption of mobile health IT, the majority (95 percent) of healthcare organizations supply clinicians with some sort of mobile device, according to HIMSS Third Annual Mobile Technology Survey.
The most commonly issued devices include:
- Laptops: 87 percent
- Computers/workstations on wheels: 81 percent
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Accenture: Global EHR Market to Reach $22.3 Billion by End of 2015
MAR 3, 2014
During the HIMSS14 conference, Accenture released its forecast for the global EHR market which is projected to reach $22.3 billion by the end of 2015, with the North American market accounting for $10.1 billion or 47 percent. In particular, the U.S. market is predicted to reach $9.3 billion with a 7.1 percent annual growth rate and is expected to remain the largest EHR market globally.
Consolidation and EHR meaningful use in the U.S. are the big growth drivers, according to the consulting firm. Except for the U.S., the EHR market in Brazil valued at $400 million represents the next greatest relative growth opportunity as that country's Unified Health System initiative is expected to drive 9.7 percent annual growth over the next few years.
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HIMSS Survey: Hospitals Putting Patient Data at Risk
MAR 3, 2014
According to survey results published last week during HIMSS14, inconsistent data backup and archiving practices at hospitals are “putting data and organizations at risk and unnecessarily straining IT storage budgets.”
The study, conducted by HIMSS Analytics and sponsored by Boston-based storage services company Iron Mountain, was based on a survey of 150 senior-level technology professionals at hospitals across the nation. The survey assessed how hospitals protect data from potential loss or disaster, as well as archive it to meet long-term compliance requirements.
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HIMSS: Software Bugs, Shifting Alliances Unsettling for Healthcare CIOs
Scott Mace, for HealthLeaders Media , March 4, 2014
Some revelations made at the HIMSS 2014 conference illustrate how difficult this period of transition is for healthcare executives charged with bringing compliant, interconnected electronic health records systems online at their organizations.
Another HIMSS conference is done, leaving CIOs plenty to ponder.
On the last day of the event, CMS announced it would grant more hardship exemptions to those who cannot meet their end-of-2014 attestation dates for Meaningful Use Stage 2. The announcement was a clear victory for CHIME, the College of Healthcare Information Management Executives, whose leaders had lobbied hard along with the American College of Physicians for some leeway during a difficult year. More on that in a future column.
Earlier at HIMSS, the CommonWell Alliance demonstrated its patient ID service operating across different vendors' electronic health record software on the show floor, and arranged for some of its pilot sites to meet with the media. But this was a lower-key event than I would have imagined a year ago. Still, the announcement of a major commitment to the work of the alliance by Tenet Healthcare was evidence of some solid momentum.
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Health IT Literature Review Report and Interactive
Data Visualization on the Health IT Dashboard!
ONC recently updated its Health IT Dashboard with the results of a comprehensive literature of the impacts of health IT titled: Health Information Technology: An Updated Systematic Review with a Focus on Meaningful Use Functionalities. The literature review updates previous systematic reviews with the new peer review literature published during the 2010 to 2013 time frame.
The literature review results include findings that the majority of new studies indicate that health IT enabled significant gains in health care quality, but efficiency and safety were still the subjects of relatively little research. In addition, this report has a complementary interactive data visualization that allows users to see the value of health IT across these outcomes. The report and data visualization are just one of many examples of what ONC has been doing to show the value of health IT and make data come alive.
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From Rockwell to reality: The evolving role of the physician
Posted on Mar 03, 2014
By William K. Kapp III, MD, Contributing Writer
In Norman Rockwell’s, Doctor and Boy Looking at Thermometer, a white-haired man in a tailored gray suit sits on the edge of bed and is engaged attentively with his patient. That physician made house calls and had the time to teach a young patient how to take a temperature. But, that was then.
The reality is that Rockwell’s physician actually spent more time providing care than documenting it. He wasn’t required to view patient data on a screen, document care on a keyboard in the hallway, or point-and-click his way through a checklist of symptoms. In today’s digital era, getting physicians refocused on patients means finding ways to integrate technology directly into current clinical workflows.
If it doesn’t work like physicians, it doesn’t work for physicians
Physicians speak a unique language. We observe and assimilate a lot of seemingly unrelated data points about our patients to come up with a diagnosis. What works for us is intuitive technology. We need an electronic system that captures the unique conversational interaction between doctor and patient—not drop down menus that miss the nuances of the patient’s unique story. Put simply, our ability to capture the complete patient story while remaining focused on the human life at hand is what the art of medicine is all about.
Physicians speak a unique language. We observe and assimilate a lot of seemingly unrelated data points about our patients to come up with a diagnosis. What works for us is intuitive technology. We need an electronic system that captures the unique conversational interaction between doctor and patient—not drop down menus that miss the nuances of the patient’s unique story. Put simply, our ability to capture the complete patient story while remaining focused on the human life at hand is what the art of medicine is all about.
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The case for health IT internships
Posted on Mar 03, 2014
By Stephen Burrows, Sacred Heart University’s College of Health Professions
The recent federal mandates for healthcare information technology have increased demand on the field, boosting the need for educated and knowledgeable staff for health IT projects. But with the emergence and recent popularity of graduate education in healthcare informatics, we are seeing an influx of students entering these programs who do not have clinical or information technology backgrounds.
These individuals have a great desire to work in informatics and recognize the enormous impact the field can have on healthcare, but they lack the hands-on experience that many employers seek. Some of these students have even reported challenges getting hired after obtaining their master’s degree, for lack of ‘experience.’
Given this, how do we prepare these individuals and give them the tools and experience they need to succeed?
Recently, the graduate program for which I am the director began the process of engaging partners in the health IT sector to act as internship sites for our students. This process will be multi-part, but in the end will provide excellent experience for graduating students.
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Patient portal use doesn't effect face-to-face visits
March 3, 2014 | By Ashley Gold
Use of patient portals and electronic visits had no significant impact on the frequency of face-to-face primary care visits for adults in a trial, researchers from the Mayo Clinic have found.
In a study published in the March issue of Telemedicine and e-Health, researchers looked at 2,357 primary-care patients who used electronic messaging on a patient portal. The study's authors took into account face-to-face appointment frequencies before and after the first message in a matched-pairs analysis.
Primary-care patients who sent a minimum of one message did not have a significant amount of face-to-face visit before and after doing so. More analysis showed that there was no significant change in visit frequency among patients with higher message utilization, or for patients who had been using the message feature for longer.
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Why the Global mHealth Market Will Hit $49B by 2020
The global mHealth market is projected to reach $49 billion by 2020, according to a new report from Grand View Research.
Two of the major drivers of the expansion will be increasing consumer desire to manage their health more cheaply at home, as well as the proliferation of 3G and 4G networks capable of handling the demands of telemedicine and other mHealth services.
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Recent FTC Ruling Could Cloud Data Security Enforcement
Monday, March 3, 2014
The arcane world of data security regulations just got a little more ambiguous.
In January, the Federal Trade Commission affirmed its authority to bring action against businesses that fail to adequately protect consumer data. The decision has particular implications for health care, as the case involved LabMD, a medical testing laboratory and a covered entity under HIPAA.
FTC last August filed a complaint against LabMD alleging the company exposed the personal information of about 10,000 people in two incidents. LabMD responded with its own missive: a motion to dismiss the complaint on the grounds that the FTC enforcement action clashed with HIPAA's information security regulations.
On Jan. 16, FTC commissioners rejected LabMD's arguments. As a result, health care providers and their business associates now need to consider FTC in addition to HHS' Office for Civil Rights as a data security enforcement organization.
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Enjoy!
David.
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