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."

Sunday, August 31, 2014

So What Happens Next Now The Consultation On The PCEHR Review Has Finished?

Regular readers will be aware that over approximately the last 2 months Deloitte has been assisting DoH in consulting stakeholders on the PCEHR as produced by the Royle Committee the report of which was released in May.
There is a link discussing all this here:
About a month ago we had the astonishingly botched release of an online survey for the public and others (vendors and clinicians) to respond to. You can read about all that here:
and here:
There was also an article I published a month ago pointing out that the options for the PCEHR Review were pretty limited. See here:
Finally we have had a leak of a NEHTA Report dated June 2014 which basically said most GPs who were surveyed and were PCEHR enabled were basically not at all impressed and were not using the system.
Internally we know that present Government E-Health leadership are in denial on the usability and utility of the PCEHR and really seem, for some evidence free reasons, to think that the thing should rumble on.
We also know that many stakeholders (RACGP, Software Providers, many academics etc.) are aware there are major problems with the whole program and have been providing feedback to that effect, as I have been. See here:
So what happens next? It seems to me there are three basic options.
Option 1. - Abandon the whole PCEHR program and move back to a progressive funded implementation of a revised National E-Health Strategy with a collaborative approach with the private sector - accepting National Programs need to develop from the ground up and not top down.
Option 2. - Decide to announce consultation on a National E-Health Strategy Refresh and defer consideration on the fate of the PCEHR until the Strategy is developed, agreed and funded.
Option 3. - The Ostrich Option - pretend all is well and just continue with what is presently happening and going no-where.
I would be OK with Options 1 or 2 but fear we will get Option 3!

AusHealthIT Poll Number 233 – Results – 31st August, 2014.

Here are the results of the poll.

Do You Believe The NEHTA Leadership Should Be Held Accountable For The Slow Progress In E-Health Over Almost The Last Decade?

For Sure 48% (79)

Possibly 34% (56)

Neutral 6% (10)

Probably Not 5% (8)

No Way 4% (7)

I Have No Idea 2% (3)

Total votes: 163

This is a clear cut outcome. The readers of this blog largely believe NEHTA has failed and needs major change.

Again, many, many thanks to the many that voted!


Saturday, August 30, 2014

Weekly Overseas Health IT Links - 30th August, 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.

New Technology Gives Surgeons Unprecedented Views of Patients’ Bodies

by George Putic
When could a video game possibly save your life?  A new imaging technology, now being used at Methodist Hospital in Houston, Texas,  has direct links to video games.  It can provide detailed views of patients’ bodies -- helping surgeons plan and execute complicated operations with much more confidence. 
Those who think that developing video games software has no other purpose than entertainment should think again.  
So says Dr. Brian Butler, a radiation oncologist at Houston Methodist hospital and the principal author of a new imaging technology called Plato’s CAVE. “Computer engineers and video gamers -- really propelled this type of technology into a possibility,” he said.

Is 4D printing next for healthcare?

Posted on Aug 22, 2014
By Mike Miliard, Managing Editor
The healthcare industry will be among the first to reap the benefits of emerging four-dimensional printing technology, according to a new report from Frost & Sullivan.
4D printing develops chameleonic materials whose properties shift according to external stimuli, such as temperature changes.
As MIT research scientist Skylar Tibbits described it in a TED talk, the technology "will allow us to print objects that then reshape themselves or self-assemble over time. Think: a printed cube that folds before your eyes, or a printed pipe able to sense the need to expand or contract."

6 success factors for HIE participation by a health system

August 22, 2014 | By Dan Bowman
The participation of health system leadership and timely and accurate communication are among the biggest factors contributing to the success of hospital participation in a health information exchange, according to research published this month in the Journal of Medical Internet Research – Medical Informatics.
Through a combination of interviews, data analysis and direct observation, the researchers--from the University of South Carolina and Claremont Graduate University in Claremont, California--pinpoint six factors for success in examining the implementation of Falls Church, Virginia-based Inova Health System into the ConnectVirginia EXCHANGE, the state's HIE.

Health IT vendors among fastest growing

Posted on Aug 22, 2014
By Erin McCann, Associate Editor
Health IT companies once again made it to the list of fastest growing companies this year, with three big name EHR vendors chief among them. 
Inc., which on Thursday released its hallmark annual list of private America's 5,000 fastest growing companies, found 377 -- or 8 percent -- to be healthcare related; despite the low percent, however, the sector accounted for the lion's share of revenue ahead of all industries at $21.8 billion. What's more, within the sectors, it's a tech dominated list, with health IT companies faring quite well. 
Among the fastest growing were three recognized EHR platform companies: CareCloud; drchrono and eClinicalWorks, which ranked 127th, 249th and 4064th respectively. Both CareCloud and drchrono are new to this year's list.

Study: Many patients don’t understand electronic lab results

Author Name Jennifer Bresnick   |   Date August 21, 2014   |  
More and more patients may be accessing their personal health information online through patient portals thanks to Stage 2 of meaningful use, but only slightly more than half of patients, on average, were able to decipher electronic lab test results on their own, says a study from the University of Michigan.  Patients who scored on the lower end of numerical and health literacy tests were twice as likely to express confusion when shown a hypothetical blood glucose test result, said study author Brian Zikmund-Fisher, associate professor of health behavior and health education at the U-M School of Public Health.

Apple steps up Health push as it begins talks with insurers

Summary: With Apple's new Health app set to launch this year, the company has been in discussions with insurance companies about where it could fit into their business.
By Liam Tung | August 22, 2014 -- 10:46 GMT (20:46 AEST)
Apple has been in talks with US health insurance firms, it has emerged - notably those that have already taken steps to integrate data from wearables into insurance policies.
Apple has been preparing the ground for the launch of its Health application, which will debut alongside iOS 8 later this year. Besides recent talks with US healthcare providers and developers of health-related apps, Apple has also been courting large US health insurance firms.
News of Apple's discussions with health insurers came via an interesting report from Bloomberg today on the emergence of company-funded wearables in the workplace. The report notes that Apple has talked with America’s biggest insurer, UnitedHealth, as well as fellow health insurer Humana.

Microsoft taps into mHealth

Posted on Aug 21, 2014
By Erin McCann, Associate Editor
With nearly 26 million Americans living with diabetes -- and racking up $245 billion in costs each year -- many stakeholders have been looking for innovative ways to help those individuals better keep tabs on their condition. With its new mobile health project, Microsoft is the latest company to offer a diabetes management platform.
Microsoft on Thursday announced it was inking a deal with wireless provider TracFone to extend mHealth technology to underserved and high-risk populations, specifically aimed at patients living with diabetes. 
The two companies have teamed up with Miami-based Health Choice Network to launch a pilot program aimed at examining how access to mobile technology affects patient disease-management and outcomes. 

Computer bug 'Heartbleed' likely source of Community Health Systems data breach

August 21, 2014 | By Katie Dvorak
Hackers likely used the computer bug Heartbleed to gain access to the data of about 4.5 million patients at Community Health Systems--and the FBI is warning other hospitals they could be at risk too, Reuters reports.
The hack at CHS is the first known large-scale cyberattack using the bug, which compromises the Web encryption program OpenSSL, opening hundreds of thousands of websites to data theft. 
During this morning's monthly cyber threat briefing, broadcast online, HITRUST CEO Dan Nutkis spoke about the need for greater dissemination of information when breaches like this happen.

90% of hospitals and clinics lose their patients' data

By Jose Pagliery  @Jose_Pagliery August 20, 2014: 11:06 AM ET

No industry has been hit harder by hacking and data breaches than health care.

Recent numbers show 90% of health care organizations have exposed their patients' data -- or had it stolen -- in 2012 and 2013, according to privacy researchers at the Ponemon Institute.
The medical industry faces more breaches than the military and banking sectors combined.
As of last week, the medical industry has been slammed with 204 incidents this year, nearly half of the major breaches so far. It has lost 2.1 million records. And that doesn't even count the 4.5 million names and Social Security numbers taken from Community Health Systems' computer network in a major hack that was revealed on Monday.

New Tool Predicts Public Health Policy Impact

AUG 20, 2014 10:16am ET
HealthPartners Institute for Education and Research, Partnership for Prevention, and the Robert Wood Johnson Foundation have launched a web-based tool that predicts the health and economic impact of evidence-based public health interventions and policies at the county level.
The tool, called Community Health Advisor, enables public health officials, employers, community leaders, policymakers and others to more accurately determine which public health policies and programs will have the greatest impact on health, mortality and medical costs on a county, state or national level.
“This tool is the first to provide estimates of future health outcomes and medical costs from public health interventions for every county in the country,” said George Isham, M.D., senior adviser, HealthPartners, and member of the National Commission on Prevention Priorities. “It helps lawmakers, community leaders, employers and others make informed decisions about where to make public health investments.”

EHRs Behind Bars: Progress and Barriers

by Heather Drost, iHealthBeat Associate Editor Thursday, August 21, 2014
Although electronic health records are widely seen as a way to improve care coordination and boost patient outcomes, they are underutilized in the treatment of some of the individuals who stand to benefit the most: jail inmates.

Background on Inmate Health Care

The nation's more than 3,300 county, city and local jails process about 11 million admissions annually. Jail populations are highly mobile, with an average weekly turnover of 60%, and are largely uninsured with high rates of chronic diseases, mental illness and substance misuse.
Since the 1976 Supreme Court decision in Estelle v. Gamble, jails have been legally required to meet the medical needs of inmates in accordance with community standards of care. Jails that fail to meet those needs could be held in violation of the Eighth Amendment prohibition against cruel and unusual punishment.
However, jails historically have not been recognized as providers of health care and tend to be left out of major policy discussions, such as the 2009 passage of the HITECH Act, which created the meaningful use electronic health record incentive payment programs.

CA Powers Up $80M HIE to 'Create Value in the Data'

Christopher Cheney, for HealthLeaders Media , August 21, 2014

California's latest multimillion-dollar attempt to build a statewide health information exchange aims to shave healthcare costs and improve care, but its leaders face a long-term funding challenge.

This month's launch of an ambitious statewide health information exchange in California poses an $80 million challenge to the project's organizers: sustaining an HIE over the long haul.
Blue Shield of California and Anthem Blue Cross are picking up the $80 million tab for Cal INDEX during its first three years of operation. After the seed money has been depleted, subscription fees are expected to keep Cal INDEX finances in the black.

The 4 Biggest Obstacles ACOs Face

8/14/2014 @ 12:59PM

In a recent interview, business guru and best-selling author Clayton Christensen described American health care as “sick and getting sicker.”
He criticized the system’s administrative overhead, perverse payment models and lack of leadership for failing to incite meaningful reform.
Christensen thrives on examining complex topics. So, when I asked him what topic he’d like me to cover, he picked one that’s as complex as they come: Accountable Care Organizations (ACOs).
“A lot of the thinking behind the Affordable Care Act, how it can improve quality while lowering cost, relies heavily on ACOs,” Christensen said. “Most health care players would say that ACOs have helped. I’d argue they’re not yet fixing the problems.”

Meaningful use medication measures reduce ADEs by 35%

Author Name Jennifer Bresnick   |   Date August 18, 2014   |  
Hospitals that adopt all five of the core medication management measures inherent in meaningful use experience fewer adverse drug events (ADEs), says a new study funded by the Agency for Healthcare Research and Quality, reducing the number of patient safety errors by more than one third.  The use of computerized provider order entry (CPOE) technology, decision support systems that check for drug and allergy interactions, and health information exchange that encourages the sharing of medication lists and allergy information with other providers were key features associated with the significant improvement in the rate of ADEs, explain John White, MD and Judy Murphy, RN, Director of the Office of Clinical Quality and Safety and Chief Nursing Officer at the ONC.
“When the Health Information Technology for Economic and Digital Health (HITECH) Act was passed in 2009 as part of the American Recovery and Reinvestment Act, hopes were high that widespread use of electronic health records (EHRs) would reduce the rate of adverse drug events in hospitals,” Murphy and White write in a blog post for HealthIT Buzz.  “Advocates believed incentives that encouraged hospitals and physicians to adopt EHRs would not only encourage faster adoption, but help to improve patient health.”

Is the Electronic Health Record Defunct?

by Jerome Carter on April 28, 2014 ·
When building software, requirements are everything. And although good requirements do not necessarily lead to good software, poor requirements never do.   So how does this apply to electronic health records?   Electronic health records are defined primarily as repositories or archives of patient data. However, in the era of meaningful use, patient-centered medical homes, and accountable care organizations, patient data repositories are not sufficient to meet the complex care support needs of clinical professionals.   The requirements that gave birth to modern EHR systems are for building electronic patient data stores, not complex clinical care support systems–we are using the wrong requirements.
Two years ago, as I was progressing in my exploration of workflow management, it became clear that current EHR system designs are data-centric and not care or process-centric. I bemoaned this fact in the post From Data to Data + Processes: A Different Way of Thinking about EHR Software Design.   Here is an excerpt.
Do perceptions of what constitutes an electronic health record affect software design?  Until recently, I hadn’t given much thought to this question.   However, as I have spent more time considering implementation issues and their relationship to software architecture and design, I have come to see this as an important, even fundamental, question.

mHealth takes on diabetes

Posted on Aug 20, 2014
By Eric Wicklund, Editor, mHealthNews
Boston's Joslin Diabetes Center is using an mHealth platform to help diabetics and their caregivers control a potentially fatal side-effect of the disease.
Joslin and Glooko have launched the HypoMap, a mobile tool that enables diabetics and their caregivers to identify low blood-sugar readings, or hypoglycemia. If left untreated, the condition can plunge the diabetic into a coma and even lead to death. It’s especially dangerous for a percentage of the world's diabetics who can't recognize the symptoms associated with hypoglycemia – a condition known as hypoglycemia unawareness – and therefore don't recognize the danger signs.

Sharing electronic records with patients gains traction, raises new concerns

August 19, 2014 | By Marla Durben Hirsch
More hospitals and physicians are choosing to provide their patients with access to their electronic records, but the practice is also raising new controversies, according to a recent article on National Public Radio.
In the article, Leana Wen, director of patient-centered care research in the department of emergency medicine at George Washington University, points out that sharing notes with patients has been a positive experience, enabling her to correct errors caught by patients' review of the records and providing information that helps her diagnose conditions more quickly. The access also increases trust.

Physician groups call for EHR education in med school

Written by Helen Gregg (Twitter | Google+)  | August 18, 2014
The American Osteopathic Association has become the latest physician group to advocate for EHR training to be a part of medical students' education.
During its annual House of Delegates meeting in July, the AOA approved a resolution to work with the American Association of Colleges of Osteopathic Medicine and the American Osteopathic Association of Medical Informatics to increase opportunities for medical students to practice working with EHRs.

AHA releases cybersecurity resource for hospital boards

Written by Akanksha Jayanthi (Twitter | Google+)  | August 19, 2014
The American Hospital Association has issued a new guide reviewing the role of hospital and health system boards in cybersecurity risk management and response.

HIEs and interoperability: 6 statistics on quality, efficiency

Written by Akanksha Jayanthi (Twitter | Google+)  | August 19, 2014
The majority of physicians who electronically exchange data report health information exchanges are overall beneficial to their practice. However, physicians also often experience barriers to data sharing capability implementation.
Here are six statistics on the quality and efficiency of HIEs and interoperability, reported in the ONC's National Health Information Exchange and Interoperability Landscape report.
1. One-quarter of providers reported HIEs increase the practice's liability due to other providers lacking adequate privacy and/or security safeguards.

Every EHR's weakest link

When asked to rate the security of typical electronic health records, SANS Institute senior analyst John Pescatore answered: 9.
At first blush that might even seem positive, but in the world of IT and information security where the phrase “five 9’s” — in this case meaning 99.999 percent secure — indicates the highest level of protection, a simple 9 leaves plenty to be desired.
And with stolen health information commanding ever-higher prices on the black market, criminals growing more and more sophisticated, and the complex nature of EHRs themselves, it’s time to better understand the problem.

Snooping staff still top security issue

Posted on Aug 19, 2014
By Erin McCann, Associate Editor
When it comes to data breaches, hacking and loss or theft of unencrypted devices are far from healthcare security professionals' only concerns. Employee snooping and insider misuse also prove to be among the biggest privacy threats in the healthcare sector today.  
Just last week, a former Tufts Health Plan employee was convicted of disclosing patient information in a fraudulent tax refund scheme after stealing the personal data of more than 8,700 members. The former employee, Emeline Lubin, started working at Tufts Health Plan in Watertown, Mass., back in 2010. For that time, Lubin sent lists of member data to a Florida man in efforts to file false income tax returns. Lubin could face up to five years in prison and a $250,000 fine. 

On the buses

In the latest of EHI’s series on information sharing initiatives, Rebecca Todd reports on the Oxfordshire Care Summary.
12 August 2014
The Oxfordshire Care Summary is an unusual information sharing initiative because it was created by a hospital IT team and is hosted in an acute environment.
Similar initiatives in other parts of the country have been created by shared IT services with a focus on primary care, because their aim has been to share GP information with other parts of the system, or to create entirely new records to work across health and social care.
The OCS, by contrast, is hosted on Oxford University Hospitals’ ‘case notes’, a clinical intranet that GPs have been able to use for 20 years to access pathology results and some other data.

Another view of savings

GP Neil Paul says some clear thinking is needed about where IT can be used to meet patient demand and save the NHS money, and where it will make things worse; but a couple of real cases show the difference pretty clearly.
19 August 2014
I keep thinking about the concept of ‘failure demand’. Invented by John Seddon, it’s a concept that says that service industries often fail their customers by making them follow pointless processes, instead of just dealing with what they want or need. 
Often this occurs during some attempt to outsource or restructure for efficiency reasons. The problems it leads to include: a tendency to produce much more activity than was expected, thereby failing to save on costs; and making customers unhappy, thereby losing good will and reputation.

Records access may reduce GP pressures

19 August 2014   Lyn Whitfield
Giving patients access to their GP records can reduce demand for traditional appointments and telephone calls to practices, a research study has suggested.
The government has set a target of giving all patients who want it access to their GP record – or the elements included in the Summary Care Record - by 2015.
But in a forward to the study by Caroline Fitton, published in the London Journal of Primary Care, Brian Fisher, a GP in Lewisham, says “many practitioners worry that their workload will increase as a result”.
He says GPs worry that patients “will not understand what they read”, leading to more demand for appointments.

Why 'prevention security' isn't enough in healthcare

August 19, 2014 | By Katie Dvorak
Data security is one of the healthcare industry's biggest obstacles, and the key to addressing that is understanding and identifying areas of risk, says Blair Smith, Ph.D., dean of Informatics-Management-Technology at American Sentinel University.
Smith, in an interview with HealthITSecurity.com, says some of the places where risk is highest in health IT include the practice of "bring your own devices" and cloud security. Mobile devices pose serious concerns for security personnel, he says, as more hackers and outside threats bring exposure and risks to organizations.
Just this week one of the biggest cyberattacks on a healthcare organization was announced. Community Health Systems is facing a breach in which the data of 4.5 million patients was compromised.

CFO Exchange: Smartphones Poised to Disrupt Healthcare, Says Topol

Scott Mace, for HealthLeaders Media , August 19, 2014

The democratization of medicine is as close as the phone in your pocket, says Eric Topol, MD. Healthcare leaders had better be ready for empowered consumers, cost-cutting mobile apps, and genetic sequencing, which promises to be a differentiator.

You're carrying the key to healthcare's salvation in your pocket.
That was the message from Eric Topol, MD, keynote speaker at last week's HealthLeaders CFO Exchange. In a one-hour tour-de-force session, he made his case for the many virtues of smartphones as constant healthcare companions, patient empowerment, and disruption to the way healthcare has been practiced as far back as ancient Egypt when doctors were also priests.

Survey: Healthcare lagging in information governance

August 18, 2014 | By Susan D. Hall
Healthcare organizations must improve their information governance (IG) practices, which are an "undeniable imperative," according to an American Health Information Management Association (AHIMA) white paper.
In the survey of 1,000 healthcare professionals, conducted in in partnership with records-management consultants Cohasset Associates, 35 percent of respondents did not know whether their organization had any information governance efforts underway or did not recognize a need for them.

Community Health Systems hack compromises info for 4.5 million patients

August 18, 2014 | By Katie Dvorak
Personal information for about 4.5 million patients of Franklin, Tennessee-based Community Health Systems--which operates 206 hopsitals in 29 states--was compromised in April and June when hackers gained access to its computer network.
The data included patient names, addresses, birth dates and Social Security numbers, according to a Wall Street Journal article. The data did not include medical or credit card information.
CHS, in an Aug. 18 filing with the U.S. Securities and Exchange Commission, said they believe the attack was the work of a group originating in China. The hackers were able to bypass the health system's security measures to copy and transfer data outside of the company.

New health apps, games reward patients who take their meds

By Christina Farr and Malathi Nayak
SAN FRANCISCO Thu Aug 14, 2014 7:59pm EDT
 (Reuters) - A group of ex-gaming industry executives say they can use their design chops to solve a major health challenge: Sick patients neglecting to take their medication and costing employers and insurance providers billions of dollars.
Jason Oberfest began thinking about applying game design tricks to complex medical problems in 2011, while at mobile game company ngmoco.
Oberfest built the app to engage users in their health, but he maintained some of the most viral aspects of mobile games, such as gifts, and a feature to see how friends are faring in their treatment. The app also includes a drug database and sends refill alerts to patients.

ONC highlights EHR adoption by community health centers

Author Name Kyle Murphy, PhD   |   Date August 15, 2014   |  
The Office of the National Coordinator for Health Information Technology (ONC) is looking to the progress made by community health centers whose adoption of EHR technology is nearing 90 percent as any indicator of significant improvements to delivering high-quality care to patients.
In a post on Health IT Buzz, Kerry Souza, ScD, MPH, and Michael Wittie, MPH, highlight data released by the Health Resources and Services Administration (HRSA). According to the recently publishing 2013 data, more than 1,200 national program grantees are providing care to 21.7 million patients.
A total of 87.8 percent of these federally funded health centers are using EHR systems and an even 54 percent are operating patient-centered medical homes (PCMHs). Although the percentage of PCMHs remains unchanged since 2012, the corresponding number for EHR adoption has increased by nearly ten percentage points in one year, up from 79.3 percent in 2012.

Link All-Payer Claims Databases With Other Data To Boost Transparency

by Virginia Long and David Mould Monday, August 18, 2014
All-payer claims databases -- which already are in place in several states and are about to be implemented in many more -- are intended to make provider and hospital costs more transparent. APCDs include claims data for medical, mental health, pharmacy and dental procedures across providers. Access to these data enables analysis that can help make important comparisons, such as price for services or performance of physicians or hospitals across a state. Thus, APCDs can provide powerful and illuminating information, from tracking state health care spending to guiding patient/consumer choices.

Hospitals must help patients access digital records — or else

By Ben Sutherly The Columbus Dispatch  •  Sunday August 17, 2014 6:39 AM
The digitization of health-care records has long been heralded as the cure for familiar headaches that afflict patients and their families.
No more hassles in getting medical records from your elderly father’s hospital stay transferred to the nursing home where he’ll recuperate. No more waiting to find out the result of that Pap smear; just go online and avoid playing phone tag with your doctor’s office.
But a new study in the journal Health Affairs found that some of the digital health capabilities that consumers are most likely to notice or find useful are among the biggest digital challenges for hospitals.