This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
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"
H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."
Saturday, June 28, 2014
Weekly Overseas Health IT Links - 28th June, 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.
Intermountain Healthcare has devoted an enormous amount of resources for ground-up development of decision support algorithms and protocols to fire against its patient population. That effort has paid off in decreased mortality and marked improvements in clinical outcomes for segments of that population.
But it’s not enough, not nearly enough, according to Stan Huff. M.D., the health system’s chief medical informatics officer. “We have about 200 clinical decision support programs running every day against patients, but without exaggerating, there are 5,000 algorithms that we could be doing, and should be doing,” Huff says. “The costs of analyzing problems, working with clinicians to develop solutions, and testing the solution via clinical trials and IT betas is absolutely enormous. And we, like everyone else, are targeting a small set of high-profile, high-cost disease states. For the rest of our patients, we’re not doing much.
“If someone gave us a lot of money, I can see how we could get from 200 protocols to 300, but we’ll never get to where we need to be under the current paradigm. Intermountain should be doing what Mayo Clinic or Regenstrief are doing right now, and vice versa. I’m not talking about ideas, I’m talking about executable programs.”
While wary clinicians remain a big hurdle, nine out of 10 hospitals plan to expand their use of front-end speech deployment, according to a new KLAS report.
The study, "Front-End Speech 2014: Functionality Doesn't Trump Physician Resistance," found that 50 percent of providers polled cited skeptical end-users as one of the biggest barriers to more successful uptake of speech recognition.
Nonetheless, the ROI from the technology was clear for these hospitals, according to KLAS. Facilities interviewed saw a higher impact in nearly every category measured in the report: reduced transcription costs, reduced documentation time and more complete patient-narratives.
Some 90 percent of healthcare organizations have reported at least one data breach in the past two years, with more than a third seeing more than five breaches. Responding to these breaches in the proper manner proves integral not only to reining in costs and avoiding litigation but also to maintaining the integrity of the organization.
Gerry Hinkley, partner at Pillsbury Winthrop Shaw Pittman's healthcare practice, says breach response is where many make major missteps, mistakes that can easily be avoided.
Hinkley, who spoke at the HIMSS Media and Healthcare IT News Privacy and Security Forum June 16 in San Diego, works with myriad organizations on proper breach response, many of which have faced legal action due to post-breach slip-ups on their part. One of the biggest takeaways? "Don't give in to individuals who want to sugar coat this," he said. "You do much better really saying what happened up front ... individuals respect that."
The global market for e-prescribing systems is expected to grow from $250.2 million in 2013 to $887.8 million by 2019, according to a report from Transparency Market Research.
Government incentive programs are among the factors driving the market, which is expected to have a compound annual growth rate of 23.5 percent over five years, according to an announcement. The report foresees an immense potential for the growth in implementation of electronic health record systems that include e-prescribing.
Draft guidance published Friday by the U.S. Food and Drug Administration seemingly paves the way for smoother medical device interoperability by lowering the burden on developers of medical device data systems (MDDS) to comply with agency requirements.
The guidance notes that "additional experience" with MDDS since down-classifying such tools from Class III devices, which are considered high-risk, to Class I (low-risk) in February 2011 prompted FDA's decision to "not enforce compliance with ... regulatory controls." Such tools, the guidance notes, are not intended to control or "alter the functions ... of any connected medical devices,"
by Anika Kempe, iHealthBeat Staff Writer Friday, June 20, 2014
WASHINGTON -- At the 2014 Government Health IT Conference & Exhibition in Washington, D.C., this week, lawmakers, federal officials, health care providers and patient advocates emphasized the potential of health IT to improve the health care system. However, the burden on health care providers and the need for better patient engagement need to be addressed, they said.
Lawmakers Support Health IT, but Push for Some Policy Changes
Rep. Tom Price (R-Ga.), a medical doctor and self-proclaimed "huge advocate for health IT, EHRs and EMRs," said he recognizes the value and potential of big data and health IT.
Rep. Michael Burgess (R-Texas) said that he took longer to embrace the benefits of health IT, noting that his "experience with health IT was not always a good one." However, he cited Hurricane Katrina -- which destroyed many paper medical records -- as a "firsthand example of why electronic health records are important." Burgess explained that many of those displaced by the hurricane came to his home state of Texas to receive care. Shortly thereafter, he visited New Orleans and saw firsthand the state of the city, and many water-sodden paper health records.
Community Health Plan of Washington's most vulnerable patients are doing a better job of sticking to their treatment plans -- thanks to big data, analytics, and hospital partner Health Integrated.
Ignoring doctors' orders often lands patients in the hospital, perhaps suffering from a new complaint or worsening medical problem that takes longer and costs more to treat.
Each year, about 125,000 people in the United States with treatable ailments die because they don't take their medication correctly, according to a New England Journal of Medicine report (registration required). More than half the 3.8 billion prescriptions written annually are taken incorrectly or not at all, the article said. Poor compliance is linked to between 33% and 69% of drug-related adverse effects that result in hospital admissions. And the Journal of General Internal Medicine reported (registration required) that poor compliance is associated with approximately one-fourth of nursing home admissions.
The Food and Drug Administration has proposed draft industry guidance to ensure that social media and Internet communications relating to medical products are clear, accurate, truthful, and do not mislead the public.
Concerned that patients and healthcare providers regularly get information about FDA-regulated medical products through social media and other Internet sources, the agency drafted two separate draft guidances with recommendations to help manufacturers accurately communicate online about prescription drugs and medical devices.
“We developed these new guidances, in part, to respond to requests for best practices from companies and other stakeholders,” states a blog posting by Thomas Abrams, director of the Office of Prescription Drug Promotion in the FDA’s Center for Drug Evaluation and Research. “We gave careful thought to our draft recommendations, and we understand technology will continue to evolve. So we worked across FDA Centers and Offices to develop best practices that can be applied to existing online Internet sites — and those that have yet to be developed.”
It's well established that vendor electronic health record and related contracts heavily favor the vendor to the detriment of the provider. Many of them limit the vendor's liability, require that the EHR software be taken "as-is," prohibit class-action lawsuits or require arbitration.
"They all limit their liabilities ... and [allow] the vendor much legal leeway," Carl Bergman, a consultant who serves as managing partner of EHRselector.com, a free service that enables providers to compare different ambulatory EHR products, tells FierceEMR.
They're also hard to find, making review and comparison virtually impossible.
Look, Ma, no hands! EHR company drchrono is incorporating Google Glass in its platform. The idea is to create the first wearable health record -- one that is always mobile. Drchrono offers its EHR free on the iPad, iPhone and cloud. Adding Google Glass to its platform would enable physicians to work hands-free, its officials say.
"The iPad was a new consumption device that changed the world, and now we are seeing that doctors want to use more and more hands-free technology,” drchrono CEO and Co-Founder Michael Nusimow said, in a news release. "Glass is one of the first of its kind to do this. A physician wants to practice medicine and not be burdened with all of the paperwork that goes on in the practice. We knew this would be an important app to integrate into our EHR platform, and we're excited to now offer this to doctors using drchrono."
Nusimow imagines a future where the doctor has an iPad, iPhone, laptop and Glass all connected through a mobile EHR platform so they can operate efficiently and spend more one-on-one time with patients instead of processing paperwork.
The review, undertaken by HSCIC board member Sir Nick Partridge, sets out a series of measures to guarantee greater openness and reassurance to the public, stricter controls over data use, and better clarity for data users.
Home-based telehealth programs help military service members receive better care at lower costs than service members who only receive in-person care, according to figures touted this week by U.S. Department of Veterans Affairs officials.
Between 2009 and 2012, annual healthcare costs for veterans treated via telehealth fell 4 percent one year after starting use of such programs.
Additional figures, presented this week at the HIMSS Government Health IT conference in the District of Columbia by Adam Darkins, chief consultant for telehealth services at the VA, showed that veterans who participated in telehealth programs also had lower hospital admission rates and emergency room visits, FCWreported.
A computer programmer and a kid in a Batman suit walk into a pancake house ...
“ Like all great health care breakthroughs, it happened at the International House of Pancakes.
- Dave Vockell, CEO, Lyfechannel
It sounds like a joke, but it really happened, and now the programmer — — has a to bring to market. It's an app to help seniors talk to their doctors about medical care.
"Like all great health care breakthroughs, it happened at the International House of Pancakes," he says, half-jokingly.
Venture capitalists are pouring more money than ever into digital health startups — more than $2 billion so far , according to the venture capital firm Rock Health. These investors are betting that entrepreneurs can help doctors, hospitals and insurers become leaner — which the Affordable Care Act strongly encourages.
HHS has released its latest data breach report to Congress, summarizing breaches of unsecured protected health information for 2011 and 2012.
Here are 10 key findings from HHS' report.
1. Between 2011 and 2012, HHS received 458 reports of data breaches affecting 500 or more individuals. In total, approximately 14.69 million individuals were affected by breaches during those two years.
2. The number of data breaches affecting more than 500 people in 2011 and 2012 accounts for 64.5 percent of all data breaches affecting more than 500 people since the required reporting began in September 2009.
Google Glass plays a growing role in healthcare as developers incorporate the device into medical and personal health software.
A week before Google is expected to release Google Fit at its I/O conference, several vendors unveiled Google Glass-related healthcare products. Shipments of the smart glasses could reach 6.6 million units in 2016, compared to the measly half-million units sold in 2012, according to IHS Research.
Apps are crucial to the success of Google Glass, and healthcare developers are rising to the challenge, enabling new and existing applications to work with Google's powerful eyewear. EHR developer drchrono this week began accepting beta test applicants for a Glass-enabled version of its cloud-based software. Wearable health records (WHRs) will become the preferred way for providers to interact with health data, CEO Michael Nusimow predicts in an interview. "We are definitely ahead of the curve, but since we started asking doctors to sign up for our beta program, the reaction has been overwhelmingly positive and excited about using Glass in their practices," he says.
It's not just the thought of having a data security breach that scares Kaiser Permanente's Jim Doggett. It's the far-reaching damage such an event could wreak that really keeps him up at night.
Doggett, the chief security officer and chief technology risk officer at the 38-hospital Kaiser Permanente, who kicked off the HIMSS Media/Healthcare IT News Privacy and Security Forum in San Diego this week, said that these days, if an organization reports a data breach, they're going to see serious repercussions.
"What scares me more is the impact of these," he said.
The Royal Free London NHS Foundation Trust has become the first Cerner Millennium trust in London to exit its National Programme for IT contract.
Will Smart, Royal Free’s director of IM&T, told EHI the trust successfully migrated its data from BT’s London data centre to Cerner’s data centre last weekend, after arranging with the Health and Social Care Information Centre to leave its contract early as a “proof of concept” for other trusts.
The HSCIC has covered the trust’s exit costs, in an apparent indication of how it may approach the wider funding of NPfIT contracts coming to an end.
Royal Free was one of the first London trusts to deploy Millennium. It went live with the system in 2008, and has gone on to use its MPages to give clinicians customisable views of its data, and to run Millennium on tablets.
A white paper released Tuesday by the House Energy and Commerce Committee seeks information on how to improve the digital healthcare landscape.
The 21st Century Cures initiative, launched last April by the committee, aims to "accelerate the discovery, development, and delivery cycle to get promising new treatments and cures to patients more quickly," according to the white paper.
Committee Chairman Fred Upton (R-Mich.), commenting on the paper, said that technology has great potential to help our healthcare system evolve. "As we work toward a path to cures, we must always be improving and evolving, embracing the technologies of today as we pursue the treatments for tomorrow," Upton (pictured) said.
Will collect information from 20,000 patients across four countries
Merck & Co is to launch a global registry of patients with type 2 diabetes in order to evaluate their experience of treatment in a real world setting.
Comprising 20,000 patients sites across the US, German, France and Japan, Merck said the registry will collect data from 900 sites, such as diabetes clinics and health centres, to help provide real-world evidence to advance care in type 2 diabetes.
It follows a similar project announced earlier this year by Lilly, which is teaming up with the research organisation T1D Exchange to build a registry for type 1 diabetes.
Merck's interest in diabetes currently includes the DPP-4 inhibitor Januvia (sitagliptin), one of the world's 20 best-selling drugs, and the company also intends to develop a biosimilar version of Sanofi's Lantus (insulin glargine) in partnership with Samsung Bioepis.
Taking a page from the Office of the National Coordinator for Health IT’s recently released 10-year interoperability roadmap, the American Health Information Management Association has endorsed the core values of a “learning health system” designed to share secure, high-quality data with the goal of improving patient health.
According to AHIMA, a national-level learning health system represents a “transformative vision of data, information, and knowledge sharing to empower all stakeholders to routinely engage in virtuous cycles of continuous learning and improvement” based on 10 core values: person-focused, privacy, inclusiveness, transparency, accessibility, adaptability, governance, cooperative and participatory leadership, scientific integrity, and value.
My wife has spent her entire career in health-care management and when she talks about it, my brain tends to go numb. When I speak about Big Data and analytics, my wife tells her colleagues that she thinks I am in the CIA. I think she means NSA.
When it comes to data and health care, what I’ve never understood is why I must repeat my medical history every time I see a medical professional. Don’t they keep this stuff on file? So, it surprises me when I am told by many very smart people that health care and life sciences are the next frontier for Big Data. While financial service firms have been collecting, organizing, analyzing, and acting on data for decades now, health-care firms are trying to leap from the Stone Age to the Information Age in real time.
To understand the Big Data opportunity, as well as the challenges, confronting the health-care system, I sought out two executives who have spent long careers in the financial services industry before coming to health care. I also spoke with a senior clinician and professor at Harvard Medical School, to elicit the perspective of a practicing physician.
Search engine giant Google wants back into the healthcare market with its Google Fit mobile platform to collect and analyze data from wearable health apps. But, will it work?
Naveen Rao, a patient and consumer engagement industry analyst at Chilmark Research in Cambridge, Mass., gives an idea of the market forces that will impact Google as it enters the wearable health apps market. For starters, Apple and Samsung sell smartphones and can market their own apps to their customers.
Apple’s recent announcement of its Healthkit initiative got a lot of buzz, Rao notes in comments sent to Health Data Management, “but I’m more interested in how this will interplay with Samsung’s SAMI platform. The ‘vehicles’ for these platforms to go to market are phones and wearables, so while Google may be the best positioned of the three to build a consumer friendly data management platform, it remains to be seen how they can productize it.”
Eighty percent of respondents to the inaugural 2014 HIMSS Analytics Cloud Survey say they currently use cloud-based IT services. Still qualms about performance and privacy persist.
Lower maintenance costs, faster deployment and the ability to step in when staffing resources are scarce are the cloud's top three selling points, according to the poll, which finds that of the organizations currently making use of the cloud, nearly all of them plan to expand their use.
Half of the cloud adopters are hosting clinical applications in the cloud, primarily using software-as-a-service tools, according to HIMSS Analytics. Typical cloud services include health information exchange, the hosting human resources applications and backup and disaster recovery.
Athenahealth and Epocrates, an athenahealth service, released a mobile trends report that shows nurse practitioners, physician assistants and pharmacists emerging as the most engaged users of mobile technology today.
More than 1,200 healthcare professionals from across the Epocrates member base, including physicians, nurse practitioners, physician assistants and, for the first time, retail and hospital pharmacists, shared opinions on mobile device usage and its impact on the medical profession and clinical workflow.
The push towards electronic health record (EHR) implementation has slowed mobile adoption among clinicians, according to a new report from athenahealth, a Watertown, Mass.-based provider of a cloud-based EHR system, and Epocrates, an athenahealth service.
The third annual Epocrates Mobile Trends Report included more than 1,200 healthcare professionals from across the Epocrates member base, including physicians, nurse practitioners, physician assistants, and for the first time—retail and hospital pharmacists—shared opinions on mobile device usage and its impact on the medical profession and clinical workflow.
In the first of EHI’s series on information sharing across healthcare communities, Lis Evenstad visits Bristol to see its Connecting Care programme in action. The project has just received tech fund support as an integrated digital care record ‘exemplar’, but it has been working since 2011 to join up 13 organisations – and has another four in its sights.
16 June 2014
Getting an NHS trust to share data with a local authority is a challenge. Getting 13 health and social care organisations to share data, with the appropriate governance arrangements in place might, to some, seem almost impossible.
But don’t you dare mention that word to Andy Kinnear, the director of business intelligence and informatics at NHS South West Commissioning Support Unit, because he has done exactly that.
The Connecting Care programme in Bristol, which went live in December last year, shares real-time patient data between GPs, community providers, local authorities and three acute trusts.
Further plans will bring in the local ambulance trust, a mental health trust, an academic health science network and another council, bringing the total number of organisations involved to 17.
People in the UK are unaware of telehealth and telecare
More than 90% of people in the UK do not know what telehealth and telecare technologies,defined as 'health and safety devices' is, research from the government’s Technology Strategy Board has found.
The researchers, who surveyed more than 2000 people in the UK, also found that more than 70% of people are not aware of health and care apps available on smartphones and tablets.
The survey was done by the Delivering Assisted Living Lifestyles at Scale, or DALLAS programme, which was set up by the government in 2011 to enable more independent living for people through the use of digital technology.
People use social media, Wikipedia and other such sites to share information about current events and their day-to-day lives. Now, Beth Israel Deaconess Medical Center CIO John Halamka envisions a world where similar sites are used to share medical information.
Halamka, a FierceHealthIT Editorial Advisory Board member who also serves as co-chairman of the federal Health IT Standards Committee, said that sites similar to social media platforms could allow doctors to "tweet" on patients' conditions and make Wikipedia-esque entries on their care, according to an article in The Boston Herald.
The websites would be HIPAA-compliant and would have security protections, Halamka said at a meeting being held by JASON, an independent group made up of scientists who advise the government on science and tech matters.
The Department of Defense is one step closer to making its final pitch to industry for a modernized electronic health record system. The third draft of the DoD Healthcare Management System Modernization (DHMSM) solicitation was released June 12, and "promises to substantially reflect our final requirement," according to a covering letter from program manager Capt. John Windom.
Is this abundance of data a treasure trove for improving patient care and growing knowledge about effective treatments? Is that data trove a Pandora's black box that can be mined by obscure third parties to benefit for-profit companies without rewarding those whose data are said to be the new currency of the economy? That is, patients themselves?
In this emerging world of data analytics in health care, there's Big Data and there's My Data ("small data"). Who most benefits from the use of My Data may not actually be the consumer.
Scott Mace, for HealthLeaders Media , June 17, 2014
In Part Two of an in-depth interview, National Coordinator for Health Information Karen DeSalvo, MD, discusses EHR certification, modular functionality, meaningful use audits, and glitchy software.
At the annual Health Datapalooza in Washington D.C., recently, I spoke with Karen B. DeSalvo, MD, MPH, MSc, National Coordinator for Health Information Technology, one-on-one for the first time. This is the conclusion of that conversation. Read Part One.
The case studies include a chapter comparing America’s two most broadly deployed EHRs: The VA’s VistA and Epic. The tale RAND tells is not one of different EHR technologies, as both VistA and Epic both employ the MUMPS programming language and file-based database. Rather, it is about how different origins, business models and practices have dramatically influenced the respective systems. As the report itself says, the contrast offers “useful insights into the development, diffusion, and potential future of EHRs.”
Imagine if almost everyone walking into your hospital – patients, doctors, visitors, salespeople – was carrying an active homing beacon, which broadcast, unencrypted, their presence and repeatedly updated exact location to anyone who chose to listen.
That's where things stand today, courtesy of the mobile MAC address signal (it stands for media access control), a unique ID coming from every smartphone, tablet and wearable device.
But not for long, given upcoming changes to how Apple products will handle MAC address broadcasts – a move almost certain to be copied by Google's Android.
Apple's iOS 8 change, focusing initially on how MAC addressing interacts with Wi-Fi scans, will shift to using "randomly, locally administered" MAC addresses. The result, according to Apple: "The MAC address used for Wi-Fi scans may not always be the device's real – universal – address." (That description is on page 18 of an Apple PDF, available here.)
Hospital IT executives increasingly turn to the cloud to lower maintenance costs while trying to meet their growing technology needs, according to a new survey published today by HIMSS Analytics.
Of the 150 respondents to the survey--a majority of whom were hospital CIOs--close to 83 percent indicated that they use cloud technology; half of those providers said they use the cloud to host clinical applications. The exchange of patient data and disaster recovery efforts also were among top reasons for both current and future use by providers.
June 13, 2014 | Eric Wicklund - Editor, mHealthNews
Researchers at the University of Missouri are working on a home-based monitoring solution for seniors that automatically synchs with the hospital, a key step in the effort to allow more people to "age in place" while reducing avoidable hospitalizations.
The "closed-loop healthcare" system is more than a decade in planning, and was displayed during this week's SmartAmerica Challenge Expo in Washington D.C. Its goal is to allow seniors to live in their own homes while being monitored by healthcare providers and other caregivers, and to allow the instant transfer of biometric data from home to hospital.
Researchers say this set-up would enable healthcare providers to react more quickly in the event of an accident at home, as well as enabling them to spot medical concerns before they become acute. They point to a Robert Wood Johnson Foundation study that estimates the U.S. spends $31 billion each year on preventable hospitalizations among adults, many of which could be avoided "through better integration and coordination."