Saturday, November 15, 2014

Weekly Overseas Health IT Links - 15th November, 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.

Commentary: Will GOP Change Health IT Policy?

NOV 5, 2014 2:57pm ET
With Republicans in charge of both houses of Congress in January, some health information technology legislation that has languished might get resurrected in 2015, and efforts to challenge the statutory authority of federal agencies to regulate HIT also may be renewed.
The U.S. House in particular has seen several bills introduced in the past two years, generally led by a Republican member but some also co-sponsored by a Democrat. None of the bills could likely move on their own, but could get attached to legislation going through both chambers. Example: A new ICD-10 compliance date and delayed enforcement of the Medicare two-midnight payment policy were part of the “Doc-Fix” legislation enacted last spring to stave off a huge cut in Medicare reimbursement rates for physicians.
The proposed HIT legislation, which dies at the end of this year if not enacted, can be reintroduced in the new two-year congressional session that starts in January. Major legislation moving through Congress, such as an emergency appropriations bill or another Doc-Fix bill early in the year, could include HIT provisions. HIT bills introduced in the current congressional session that could be brought back next year include:

Rethinking resistance to ‘big IT’: a sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies

Authors: Greenhalgh T, Swinglehurst D, Stones R.
Journal: Health Services and Delivery Research Volume: 2 Issue: 39
Publication date: November 2014 - DOI: 10.3310/hsdr02390
Citation:  Greenhalgh T, Swinglehurst D, Stones R. Rethinking resistance to ‘big IT’: a sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies. Health Serv Deliv Res 2014;2(39)



Nationally mandated information and communication technology (ICT) systems are often locally resented and little used. This problem is sometimes framed in behaviourist terms, depicting the intended user of technology as a rational actor whose resistance stems from Luddism and/or ignorance, and viewing solutions in terms of training, incentives and sanctions. The implication is that if we get the ‘rewards’ and ‘punishments’ right, people will use technologies. Previous research in the social sciences, notably sociotechnical systems theory, actor–network theory and normalisation process theory, have considered the human, social and organisational context of technology use (and non-use). However, these have all had limitations in explaining the particular phenomenon of resistance to nationally mandated ICT systems.

CDC Ebola Safety Videos Available Online

NOV 6, 2014 11:00am ET
The Ebola virus disease training modules for healthcare workers developed in collaboration between experts at Johns Hopkins Medicine and the Centers for Disease Control and Prevention are now available online.
The interactive, web-based learning program, called Ebola Preparedness: PPE Guidelines, is available for free through the CDC’s website. The program trains healthcare providers in three critical areas: proper donning of personal protective equipment (PPE), the safe removal of gear, and active monitoring skills.

Allscripts posts $25.8M loss in Q3

Posted on Nov 07, 2014
By Mike Miliard, Managing Editor
Allscripts stock tumbled late Thursday as the company announced a $25.8 million net loss for the third quarter, but CEO Paul M. Black insisted the electronic health record developer "continued to show progress," citing new clients here and abroad.
Moreover, that net loss was much preferable to the $48.9 million loss posted for the same quarter in 2013.
Allscripts' bookings were $223 million in Q3, compared with $236 million in the third quarter of 2013 and $234 million in the second quarter of 2014.
Still, Allscripts made the case that it's continuing to rebound from its annus horribilis of 2012. For the first nine months of 2014, bookings totaled $680 million – an increase of approximately 8 percent over the first nine months of 2013.

New CIO to lead eHealth Strategy

November 7, 2014 by Gary Culliton
Richard Corbridge, who was named one of the top 20 Chief Information Officers (CIOs) in the UK and has been nominated for a number of awards for delivery of business intelligence systems in healthcare, is to be the first health service CIO for Ireland.
The appointment is timed to coincide with new moves to develop Community Healthcare Organisations and hospital Groups. The Government’s eHealth Strategy recommended the establishment of eHealth Ireland under the leadership of a CIO for the Health Service. Arising from this, the Office of the CIO, incorporating eHealth Ireland, is being established. The CIO will lead the transformation of health information technology (ICT) and also develop “eHealth ecosystems” —partnerships between health service providers, academia, industry and patients.

EHR-generated clinical quality information can be made more reliable

November 4, 2014 | By Marla Durben Hirsch
Providers can come together to standardize the data extracted from electronic health records in order to increase the reliability of quality measure reports, support quality improvement and align with national clinical reporting requirements, according to the results of a new case study published in eGEMs (Generating Evidence and Methods to Improve Patient Outcomes).
The lack of standardization in data capture and reporting within EHRs drives distrust in the EHR data. The case study, conducted by the researchers from the Louisiana Public Health Institute, focused on an initiative by the Crescent City Beacon Community in New Orleans, creating a five-step process implemented in 13 safety net clinics over nine months using diabetes and cardiovascular disease data.

CIOs: EHR usability for record retrieval 'poor'

November 3, 2014 | By Marla Durben Hirsch
Electronic health records are falling down on the job when it comes to finding the information that they hold, according to a new survey from Frost and Sullivan.
The study, "EHR Usability-CIOs Weigh in on What's Needed to Improve Information Retrieval," which was conducted in conjunction with the College of Health Information Management Executives (CHIME), surveyed about 60 CIOs, primarily from mid to large community hospitals. The respondents reported that while the EHR market was mature, the technology itself was immature, and was too slow and lacked precision when it came to information retrieval. These problems, as well as the difficulty in finding and reviewing the data, created "significant" productivity losses and increased potential risks to patient safety.

At Cerner, interoperability is personal

Posted on Nov 06, 2014
By Bernie Monegain, Editor
Cerner CEO Neal Patterson put EHR interoperability front and center during the Cerner Health Conference – a client gathering that drew as many as 11,000 participants to the Kansas City Convention Center this week.
Kansas City is headquarters for the healthcare IT giant.
On Tuesday Patterson delivered a keynote talk that made the quest for interoperability personal by invoking the travails of his wife Jeanne as she carried bags of healthcare documents from one location to another around the country during her battles with cancer.

Epic ups and downs at Cambridge

6 November 2014   Claire Read
A week and a half after its launch, Epic is “starting to deliver some real benefits” to Cambridge University Hospitals - although the trust’s eHospital programme director admitted that the implementation has not been without its teething problems.
Speaking at a well attended session at the Health CIO Network conference, held alongside EHI Live 2014 in Birmingham, Carrie Armitage said that there had been more than 2,000 support calls from staff on the first Monday after go live.
“An awful lot were ‘I can’t remember my password’ – very basic problems. But over the first week, the number of tickets has fallen off considerably, and over two thirds of outstanding issues have now been resolved.”
Other challenges had been around “the little, tricksy things that trip you up,” she reported.

Partners' Cara Babachicos: The people part of IT is really complicated

November 6, 2014 | By Dan Bowman
While health IT education is a passion for Cara Babachicos, the corporate director of information systems and CIO of community hospitals and non-acute entities at Boston-based Partners HealthCare, also has a bevy of day-to-day responsibilities to ensure that the 10 sites she oversees run smoothly. From a personnel standpoint, alone, the task is not an easy one.
"There are a lot of differences in all the sites and people that report to me," she said at the College of Healthcare Information Management Executives' annual fall forum in San Antonio last week. "Some CIOs who report to me might be more influential when it comes to their hospital's executive team, while others are reporting to their facility's chief financial officer and struggling to get a seat at the decision-making table."
In part II of FierceHealthIT's exclusive interview with Babachicos, she talks about the state of Partners' move from a homegrown electronic health record system to a vendor product, as well as ongoing security efforts.

Many May Have Undiagnosed Diabetes

Diabetes may be undiagnosed in many, but electronic record searches may identify these patients

November 4, 2014 / Author:  Don Rauf / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh
 (dailyRx News) Left untreated, diabetes can lead to a host of health problems, such as heart attack, stroke and kidney disease. The condition, however, may go undetected in many patients.
If a person’s blood sugar stays at a high level because of untreated diabetes, it can damage the heart, eyes, kidneys, nerves and other parts of the body over time. Medication and lifestyle changes like diet and exercise can keep the complications at bay.
But a new study found that many patients may not even know they have the condition. A simple electronic search of medical records, however, may easily pinpoint those who have the condition, the study authors noted.

Calif., N.Y. Efforts Highlight How HIE Activity Is Shifting Away From Fed Gov't

By William S. Bernstein and Susan R. Ingargiola, Manatt Health Solutions Thursday, November 6, 2014
A major source of funding for electronic health information exchange has historically been federal grants, such as those provided by the HITECH Act, which included, among other things, grants for the development of statewide HIE infrastructure. With this funding largely gone, the locus of electronic HIE activity has been shifting from the federal government to public -- and, increasingly, private -- health care stakeholders at the state and local level.
In the absence of federal funding, health care providers, health plans, consumer advocates and state policymakers are all testing new strategies to increase interoperability and to shore up the financial sustainability of their HIE efforts. Not surprisingly, their strategies are diverse and include regional HIE initiatives (e.g., the Santa Cruz HIE and various other regional HIEs operating throughout California) and private proprietary HIE initiatives operated by hospitals that use Epic Care or other health IT tools to connect with health care providers in the community, among others.
Two unique efforts are occurring in California and New York. Both serve as viable options for a large-scale exchange; they also provide a glimpse into how a nationwide health information network might evolve in the post-HITECH world (i.e., in a world without federal grants to fund electronic HIE).

Poor MU showing renews calls for change

Posted on Nov 05, 2014
By Mike Miliard, Managing Editor
A fresh batch of disheartening Stage 2 attestation numbers has prompted several industry groups to once again implore the Centers for Medicare & Medicaid Services to shorten the meaningful use reporting period in 2015.
Officials from the AMA, CHIME, HIMSS and MGMA said in a joint press release that the numbers are "disappointing, yet predictable," and reiterated their calls for CMS to offer more leniency to help address providers' widespread difficulty in meeting federal electronic health record requirements.
CMS numbers released Nov. 4 show that fewer than 17 percent of U.S. hospitals have demonstrated Stage 2 capabilities. Even worse, fewer than 38 percent of eligible hospitals and critical access hospitals have met either stage of meaningful use in 2014. The data suggest inherent difficulty in the program, and suggest that these travails will only continue in 2015, according to industry groups.

Trust issues over health privacy persist

Posted on Nov 05, 2014
By Erin McCann, Associate Editor
Healthcare industry, listen up: You've got a consumer distrust issue on your hands. The majority of American consumers continue to have serious doubts over the privacy and security of their medical records – so much so that a sizable number of them actually withheld information from care providers over those concerns. 
This according to a new Centers for Medicare & Medicaid Services survey, which took a pulse of consumer perceptions toward healthcare privacy and security. The numbers are telling.
After surveying more than 2,000 consumers, CMS officials found that about three-quarters of them were either very or somewhat concerned over the privacy and security of their medical records. What's more, 10 percent of respondents withheld information from their healthcare provider who used an electronic health record. (This compared to the 6 percent who withheld data from providers who used paper medical records.) The differences between the two were not statistically different, CMS pointed out. 

Geisinger's Glenn Steele: OpenNotes changing care at a fundamental level

November 5, 2014 | By Dan Bowman
Through initiatives like the OpenNotes project, Danville, Pennsylvania-based Geisinger Health System is aiming to change patient care at a fundamental level, CEO Glenn Steele said during a keynote speech at last week's College of Healthcare Information Management Executives annual fall forum in San Antonio, Texas.
Steele called the current healthcare environment "schizophrenic," saying that despite a push toward care accountability on the part of providers and payers, fee-for-service still reigns.
"We're moving away from a fragmented system," Steele said. "We're moving away from a doctor-centric and hospital-centric approach."
November 3, 2014, 1:49 PM

Google revamps Flu Trends after it overestimated illness

Google says it is revamping its online flu tracking system after it vastly overestimated the number of U.S. flu cases in recent seasons.
Google Flu Trends launched in the U.S. in 2008, aiming to document and predict the spread of the flu based on how many people were searching for flu-related terms online. "We do hope it can help alert health professionals to outbreaks early, and in areas without traditional monitoring, and give us all better odds against the flu," the company said in a blog post.
At first, Google said its results seemed to be remarkably accurate when compared with official data released by the Centers for Disease Control and Prevention.

Less than 17% of Hospitals Demonstrate MU Stage 2 Capabilities, CMS Says

John Commins, for HealthLeaders Media , November 5, 2014

Key stakeholders say the results of a federal report are "disappointing, yet predictable" and call once again for the Centers for Medicare & Medicaid Services to shorten the 2015 reporting period.

News Tuesday from the federal government that less than 17% of the nation's hospitals have reached Stage 2 capabilities under Meaningful Use requirements was met with consternation but not surprise from a coalition of provider associations.
The news came Tuesday during a briefing by the Department of Health and Human Services' HIT Policy Committee, which also reported that less than 38% of eligible hospitals and critical access hospitals have met either stage of Meaningful Use so far in 2014.

Want to reduce security risks? Assess near misses

By Rick Kam, President and co-founder, ID Experts and Mahmood Sher-Jan, Vice president of product management at ID Experts
Life is full of “near misses”: the rear-end collision that didn’t happen, the chest pain that wasn’t a heart attack, the time your child stumbled but didn’t fall. Healthcare organizations also experience their own near misses; that is, they have hundreds, even thousands, of privacy or security incidents involving PHI/PII that never become data breaches.
But there are lessons to be learned from these near misses — they are a treasure trove of information that most CISOs or privacy officers may not be mining to identify their future security vulnerabilities.
In an article in CIO Insight, “Security strategies must be integrated,” the author notes that one of “security’s primary aims is to prevent negative incidents” since it is “almost impossible for organizations to avoid such events.” He says that without a proper analysis of negative incidents — these near misses — that an organization may “not spend money where it’s most needed to reduce the odds of a major data breach or other security incident.” In other words, to reduce data breach risks, an organization needs to look at the incidents that might have been data breaches.

Hospitals are finding ROI from RFID

Posted on Nov 04, 2014
By Anthony Vecchione, Contributing Writer
Just a few years ago, discussion of the use of radio-frequency identification in healthcare was usually limited to drug manufacturers and wholesalers, who use RFID as a way to track drug products through the supply chain or to combat counterfeit drugs.
Nowadays, RFID technology is being used by more and more hospitals to improve safety and efficiency.
At University of Michigan Hospitals and Health Centers in Ann Arbor, hospital pharmacists are using RFID to help them manage drug kits through the use of an automated pharmacy stocking system.
By utilizing cloud-based software and an RFID scanning station from Washington, DC-based Kit Check, pharmacy technicians inventory dozens of medications in seconds that are in pharmacy kits including crash carts and anesthesia trays. Previously technicians and pharmacists would inspect each kit vial individually, a process that can take up to ten times longer.

How ACOs are harnessing IT to transform care coordination

November 4, 2014 | By Susan D. Hall
The Office of the National Coordinator for Health Information Technology (ONC), in a new report, highlights success stories from accountable care organizations that are harnessing technology in the transition to value-based payments.
While adoption of electronic health records helps individual providers access patient information and evidence-based guidelines for care, population health management and registry tools help them see larger trends among groups of patients. At the same time, infrastructure that ties together collaborating organizations and communities are necessary to fully deliver coordinated care, write the authors of a post at Health IT Buzz.

EHRs can improve clinical note quality

Beth Walsh
Nov 03, 2014
Physicians' clinical notes improved in quality after EHR implementation, according to an article published in the Journal of the American Medical Informatics Association (JAMIA).
Researchers from the Uniformed Services University of the Health Sciences in Maryland conducted a five-year multicenter study of the quality of handwritten and electronic outpatient clinical visit notes for 100 patients with Type 2 diabetes. The notes were evaluated six months before EHR implementation, six months after implementation and five years after implementation, using an instrument called QNOTE.

The Impact of the ICD-10 Delays

Scott Mace, for HealthLeaders Media , November 4, 2014

Despite a Congress-mandated fourth delay of the implementation deadline, ICD-10 preparations continue, though the effect on organizations varies.

This article appears in the October 2014 issue of HealthLeaders magazine.
Although Congressional action has postponed the ICD-10 coding mandate until at least October 1, 2015, preparations to adopt it continue at a slower pace, even though physician opposition to the mandate remains steadfast.
"We were prepared to be ready October 1 of 2014," says Randy McCleese, vice president of information systems and CIO at St. Claire Regional Medical Center in Morehead, Kentucky, which has 110 staffed beds and 2013 revenue of about $126 million.

Why technology won't replace human interaction in healthcare

November 3, 2014 | By Katie Dvorak
Technology may take the place of human interaction in some aspects of healthcare, but that doesn't make in-person contact any less important, according to two industry professionals. 
Humans and computers are very good at different things, Sam Altman, president of Silicon Valley-based tech incubator Y Combinator, told the Wall Street Journal in an interview.
"A computer doctor will do a better job than a human on looking at a massive amount of data ... but on cases that require judgment or creativity or empathy, we are nowhere near any computer system that is any good at this," he said.

EHR Clinical Decision Support Produces Better Patient Care

Author Jennifer Bresnick | Date October 31, 2014

EHRs equipped with clinical decision support tools are associated with higher quality of care in a new study.

Providers who use electronic health records equipped with clinical decision support (CDS) technologies are able to produce better blood pressure control and more comprehensive cancer screenings for patients than providers who had disabled or didn’t use CDS features, says a study in the American Journal of Managed Care.  The study suggests that the basic level of clinical analytics encouraged by the EHR Incentive Programs may be having a measurable impact on quality and outcomes.
“Although the meaningful use requirements have already been established, the evidence is inconsistent regarding improvement in healthcare processes or patient outcomes as a result of the implementation of general and individual EHR components,” writes the team of researchers from Brigham and Women’s Hospital, Harvard Medical School, and the Harvard School of Public Health.
“Prior studies have shown that EHR-based CDS is associated with improved prescribing safety, preventive care measures, and diabetes testing and control. CDS has also been associated with some improvements in quality indicators, but results have been variable.  Despite having EHRs, many physicians report being unable to complete basic panel management activities, which affects their ability to deliver high-quality care for patients with chronic conditions.”

Doctors Using EHRs Spend More Time on Administrative Work, Study Finds

October 31, 2014
Doctors who use electronic health records (EHRs) are more likely to spend time on administrative work than those who do not.
That was one of the key findings of a study from researchers at the City University of New York and Harvard Medical School. The study was published this week in the peer-reviewed International Journal of Health Services.
The researchers, Steffie Woolhandler, M.D. and David Himmelstein, M.D., looked at the 2008 Health Tracking Physician Survey, which used a sample of 4,720 physicians who practiced at least 20 hours per week. The average doctor spends 8.7 hours per week, or 16.6 percent of their working time, on administration. Doctors with an EHR spend 17.2 percent of their time on administrative tasks while it’s 18 percent for those who use both electronic and paper. Those who only use paper records spend 15.5 percent of their time on administration.

Conference Highlights Progress on Different Fronts in Connected Health Technology

by Andy Oram Monday, November 3, 2014
Technology is not the focus of the Connected Health Symposium, but technical advances play a major role there because of the potential for digital technology to help health care meet its broad goals of listening to patients and coordinating care among these patients, their family members and the professional team.
In some ways, the technology is far more advanced than the health care providers who could benefit from it, and it is up to those health care institutions to evolve organizationally and culturally. But on the other hand, much technology looks good only on the surface and quickly comes to shame when connected to real-life workflows and patient needs.

Devices: Bold Without Being Big

For people used to traditional blood pressure cuffs, infusion pumps and other conveyers of individual health, the modern landscape for devices will surprise you.
For instance, the Muse and BioBeats Pulse headbands provide biofeedback about brain activity. These have been used by many people to reduce stress and learn how to focus better on what they want to achieve.

Hospital Records Are Adapting to Flag Ebola

A New Application Matches Patient’s Travel and Family History With Medical Symptoms

Dr. Garry Choy, who helped design Mass General’s QPID system. Dominick Reuter
By Melinda Beck
Nov. 2, 2014 8:20 p.m. ET
A month ago, Massachusetts General Hospital in Boston had no way to flag in its electronic medical records if an incoming patient had been to West Africa and had symptoms suggesting Ebola.
Now it does. Five days after the first U.S. case was confirmed in Texas, the hospital deployed a new Ebola application made by QPID Health Inc. that automatically matches a patient’s travel and family history with medical symptoms. If Ebola is suspected, the application flashes a blinking “Q” to alert hospital personnel.
Medical experts say concern over Ebola cases entering the U.S. has become a “teachable moment” for electronic medical records systems, or EMRs.
EMR vendors have scrambled to add new screening questions and alerts to their systems in the wake of the missteps with the Ebola patient at Texas Health Presbyterian Dallas Hospital. That patient, Thomas Eric Duncan, who had recently come to the U.S. from Liberia, was initially misdiagnosed as having “sinusitis” and sent home, only to return three days later, gravely ill.

What Technology Can Do for Health

Sue Desmond-Hellmann and Sam Altman on Tackling the Big Problems

Sue Desmond-Hellmann Gary Fong/Dow Jones
Nov. 2, 2014 4:35 p.m. ET
Sue Desmond-Hellmann runs the $40 billion Bill and Melinda Gates Foundation, which is probably best known for investing in the development of drugs and vaccines to fight widespread diseases such as AIDS and malaria. Sam Altman is the president of Y Combinator, one of the best-known technology incubators in Silicon Valley.
Together, they sat down with Dennis Berman, The Wall Street Journal’s business editor, to discuss how technology is being used to solve the world’s problems. Here are edited excerpts.


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