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By ROBERT M. WACHTER
March 21, 2015
LAST year, I saw an ad recruiting physicians to a Phoenix-area hospital. It promoted state-of-the-art operating rooms, dazzling radiology equipment and a lovely suburban location. But only one line was printed in bold: “No E.M.R.”
In today’s digital era, a modern hospital deemed the absence of an electronic medical record system to be a premier selling point.
That hospital is not alone. A 2013 RAND survey of physicians found mixed reactions to electronic health record systems, including widespread dissatisfaction. Many respondents cited poor usability, time-consuming data entry, needless alerts and poor work flows.
If the only negative effect of health care computerization were grumpy doctors, we could muddle through. But there’s more. A friend of mine, a physician in his late 60s, recently described a visit to his primary care doctor. “I had seen him a few years ago and I liked him,” he told me. “But this time was different.” A computer had entered the exam room. “He asks me a question, and as soon as I begin to answer, his head is down in his laptop. Tap-tap-tap-tap-tap. He looks up at me to ask another question. As soon as I speak, again it’s tap-tap-tap-tap.”
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- March 20, 2015, 1:03 PM ET
- By Irving Wladawsky-Berger
Guest Contributor
Continuing genomics research, combined with advancements in digital technology and data storage and analytics, hint at medicine’s next frontier. But maximizing the potential of a new health-analytics approach may require a rethink in the culture of patient care and new approaches to data ownership and security
On Feb. 24 I attended a workshop in MIT on the Future of Health Analytics. The event was sponsored by MIT Connection Science, a recently organized research initiative aimed at leveraging data science to quantify and analyze human behaviors, and to leverage the new insights thus obtained in key societal applications, including health care, transportation and finance. Connection Science, with which I’m affiliated as a Fellow, was founded by Media Lab professor Alex “Sandy” Pentland. He’s the author of several books, including the recently published Social Physics: How Good Ideas Spread.
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Posted on Mar 20, 2015
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
The March 2015 HIT Standards Committee was one of the most impactful meetings we have ever had. No, it was not the release of Meaningful Use Stage 3 or the certification rule. It was the creation of a framework that will guide all of our work for the next several years - everything we need for a re-charted standards harmonization convening body as well as a detailed interoperability roadmap, complementing the 10 year general plan developed by ONC. Thanks to Arien Malec for yeoman’s work in both areas.
We started the day with an overview of current security risk presented by Ron Ross, National Institute of Standards and Technology (NIST). Admittedly I missed that presentation. Although my flight from Dubai to Washington was early, Metro was shutdown due to an equipment failure at the Rosslyn station. I’m told it was a sobering overview of the increased threats we all are facing.
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March 20, 2015 | By Marla Durben Hirsch
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) have issued their proposed rules outlining the requirements for Stage 3 of the Meaningful Use incentive program. The proposed rules make several expected changes to Meaningful Use.
The CMS rule specifies the Meaningful Use criteria and maintains, for the most part, payment adjustments and hardship exceptions. Following a proposed "optional" year in 2017, starting in 2018 all providers would report on the same streamlined definition of Meaningful Use at the Stage 3 level, regardless of prior participation. It would also require reporting on a calendar-year basis starting in 2017.
The rule contains only eight objectives, which focus on advanced use of electronic health record (EHR) systems. The eight objectives are designed to align with national healthcare quality improvement efforts, promote interoperability and health information exchange and focus on the triple aim of reducing costs, improving access and improving quality. The objectives are meant to be flexible and pertain to health information exchange, consumer engagement and public health.
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Some 75 percent of US adults said it is “very important” that their important health information can be easily shared between physicians, hospitals, and other health care providers, according to a survey of 1,011 adults conducted by ORC International. The Society of Participatory Medicine published the study.
“What this survey points out is that when critical health information can’t be shared across medical practices and hospitals, patients are put at risk,” Daniel Z. Sands, cofounder of the Society of Participatory Medicine, said in a statement.
Additionally, 20 percent of respondents said that they, or a family member, had experienced a problem receiving medical care because their health records could not be shared between different healthcare providers.
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Black Book Market Research has released results of its annual hospital EHR user poll, identifying the top-ranked vendors according to the people who use them every day.
The rankings indicate user satisfaction by hospital bed size.
CPSI was the top ranking vendor for hospitals under 100 beds.
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Posted on Mar 20, 2015
By Mike Miliard, Editor
- The Stage 3 proposed rule can be read here.
- New 2015 Edition IT certification criteria can be seen here.
CMS says the Stage 3 rules are meant to drive better-quality, more cost-effective and coordinated care by improving the way providers are paid and – crucially – bolstering better information sharing.
"The flow of information is fundamental to achieving a health system that delivers better care, smarter spending and healthier people," said HHS Secretary Sylvia M. Burwell in a press statement. "The steps we are taking today will help to create more transparency on cost and quality information, bring electronic health information to inform care and decision making, and support population health."
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Senate panel hears of woes in implementing electronic health records as lawmakers mull legislation to ease the administrative burden in health IT systems.
CIO | Mar 19, 2015 5:52 AM PT
For all of the enthusiasm around electronic health records (EHRs), the systems that providers have put in place are still limited in their effectiveness because, too often, they don't talk to one another and only add to the administrative burden that they are intended to help reduce.
Those were among the complaints aired Tuesday at a Senate hearing considering the state of EHRs, the first in a planned series of meetings as lawmakers consider legislation to update the 2009 HITECH Act, which provided a roadmap for implementing the systems and developing standards.
"The hope was that the program would improve care, coordination and reduce costs. The evidence suggests these goals haven't been reached," said Lamar Alexander (R-Tenn.), the chairman of the Senate health committee.
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Ramesh Shankar, Mumbai
Friday, March 20, 2015, 08:00 Hrs [IST]
The Union health ministry will soon establish the National eHealth Authority (NeHA) which will be the nodal authority that will be responsible for development of an Integrated Health Information System (including Telemedicine and mHealth) in India, while collaborating with all the stakeholders, viz., healthcare providers, consumers, healthcare technology industries, and policymakers.
The Authority will act as a promotional, regulatory and standards setting organization to guide and support India’s journey in e-Health and consequent realization of benefits of ICT intervention in health sector in an orderly way. It will be responsible for enforcing the laws & regulations relating to the privacy and security of the patients health information & records.
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March 19, 2015 | By Susan D. Hall
Hospitals need more flexibility in complying with Meaningful Use mandates and more certainty that the current ICD-10 deadline will stand, the American Hospital Association (AHA) said in a statement to the Senate Health, Education, Labor and Pensions Committee.
It also asked Congress to enact policies to hold vendors accountable for designing and marketing safe, interoperable products.
While the federal incentives were helpful in offsetting the costs of purchasing and installing electronic health records, the organization said those payments covered only 10 percent of members' implementation costs. It estimated that between 2010 and 2013, hospitals spent an average of $47 billion per year on IT operating and capital costs. Data are not yet available for 2014.
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March 19, 2015 | By Susan D. Hall
While drone technology is still in its infancy, the machines hold the potential to effectively deliver medical supplies to disaster areas and other remote locations, according to a paper at Air Medical Journal.
Drones are already doing so in other countries, but the Federal Aviation Administration (FAA) has so far prohibited using unmanned aerial vehicles (UAVs) in U.S. airspace. However, it's expected to issue new rules covering drones this year, according to the researchers.
The researchers, lead by Cornelius A. Thiels, a surgeon at Mayo Clinic's campus in Rochester, Minnesota, are referring to small, rotary-wing aircraft being tested by Google, Amazon and several startups.
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12 March 2015 Thomas Meek
A bill proposing to mandate the use of a common patient identifier across the health and social care system will be discussed in the House of Lords tomorrow.
The Health and Social Care (Safety and Quality) Bill, sponsored by Conservative MP Jeremy Lefroy and former Royal College of Surgeons president Lord Ribeiro, includes several proposed amendments to the Health and Social Care Act 2012 to improve the safety and quality of care offered by NHS and social care services.
Provisions include a duty for the health secretary to specify a “consistent identifier” that can track an individual across all health and social care services, including hospitals, GP surgeries and care homes.
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Written by Elizabeth Earl | March 18, 2015
Monitoring and diagnostic devices are projected to drive the global wearable medical devices market at a 21.3 percent annual growth rate through 2020.
The wearables market is expanding rapidly through the proliferation of smart devices and apps, but monitoring and diagnostic devices are still the vast majority of sales — 78 percent in 2014, according to a market research survey by IndustryARC. These devices cater to three main sectors in the market: home health, remote patient monitoring and fitness. Home health constituted the largest portion of the market with 68 percent of the revenue, which will likely continue because of an aging population that wants to live at home, according to a news release.
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Har Puri Thursday, March 19, 2015
Ever since the move from paper-based to electronic health records, people and organizations have been working to advance health care interoperability -- the ability to exchange information between EHRs. The vision has been to interconnect EHRs and give providers the ability to look up a patient's treatment history nationwide or even punch a few buttons on the computer to send supporting documentation for a referral to another provider. The idea is that the receiving provider, likewise equipped with an EHR, would simply import the information and browse the patient's longitudinal medical record in support of the final diagnosis.
The HealthIT.gov dashboard shows that public policy initiatives, such as the CMS EHR incentive programs, have driven hospital-based EHR use into the 90 percentile range. In 2013, more than nine in ten (93%) hospitals possessed certified EHR technology. But, we have not made much progress to the utopia of unhindered information exchange, such as in the case of referrals mentioned above. Half of the hospitals cannot query patient health information from external sources, and more than half cannot get or send secure messages from their EHRs. In 2013, only 14% of physicians surveyed could electronically exchange information outside their organization.
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MAR 17, 2015 5:26pm ET
Premera Blue Cross in Mountlake Terrace, Wash., discovered on January 29, 2015 a cyberattack on its information systems. Following an investigation during which it learned the attack initially hit on May 5, 2014, the insurer now is notifying about 11 million affected individuals.
Those affected, including current and former members dating back to 2002, as well as individuals doing business with the company, are being offered two years of credit monitoring and identity theft protection services from Experian, according to a Premera statement.
The hacking affects Premera Blue Cross, Premera Blue Cross Blue Shield of Alaska, and its affiliate Vivacity and Connexion Insurance Solution brands.
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Posted on Mar 18, 2015
By Mike Miliard, Editor
The healthcare industry is becoming more enlightened about the benefits of the Blue Button Initiative, and adoption of personal health records continues to grow, according to a new report from the Workgroup for Electronic Data Interchange
WEDI conducted its first survey on Blue Button's use for exporting patient healthcare records in 2013; as a follow-up, it conducted another poll of stakeholders – including providers, payers, vendors and clearinghouses – in late 2014.
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March 18, 2015 | By Susan D. Hall
Lawmakers focused on the problems created by the lack of interoperability among electronic health record systems at a Tuesday hearing of the Senate Health, Education, Labor and Pensions Committee.
The meeting echoed concerns that five Republican senators made in a Health Affairs Blog post--that the HITECH Act has failed to boost efficiency, cut costs or improve care quality for patients, primarily due to a lack of interoperability.
"The interoperability barriers that exist between providers are driven by a lack of incentives. EHR vendors do not have a business case for seamless, affordable interoperability across vendor platforms, and provider organizations find it an expense that they often can't justify," Julia Adler-Milstein, a health policy expert who teaches at the University of Michigan, said in testimony at the hearing.
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March 17, 2015 by Gabriel Perna
The College of Health Information Management Executives (CHIME), the Ann Arbor, Mich.-based advocacy group, is putting up $1 million to challenge innovators to create a solution that accurately matches patients with their healthcare information.
CHIME plans to launch its National Patient ID Challenge by the summer. It is currently raising the money and has put a task force of healthcare IT leaders in place who will form challenge guidelines and winning criteria.
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Written by Elizabeth Earl | March 17, 2015
The ONC published hundreds of responses that were submitted by industry stakeholders about its Federal Health IT Strategic Plan.
The Federal Health IT Strategic Plan outlines an effort among more than 35 federal departments and agencies to improve the use of electronic health information to improve care, public health and research. The draft was open to public comment until Feb. 6, according to the ONC's website.
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Greg Slabodkin
MAR 17, 2015 7:56am ET
Awareness of the Blue Button Initiative—a public-private effort to provide patients with easy, secure online access to their health information—is slowly building, as is usage and adoption of personal health records among key industry stakeholders.
That is the finding of a new survey conducted by the Workgroup for Electronic Data Interchange, which included 274 respondents. Providers, health plans, vendors and clearinghouses were re-surveyed in late 2014 to determine Blue Button adoption compared to a similar 2013 WEDI survey.
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Posted on Mar 13, 2015
By Chris Nerney, Contributing Writer
As the healthcare industry continues toward its goal of making all patient health records electronically accessible, a health system’s safety increasingly is determined by the quality of its EHR implementation.
Last November ECRI Institute, a non-profit organization that uses scientific methods to test medical products, rated “incorrect or missing data in electronic health records and other health IT systems” as the No. 2 hazard that will put patients at risk in 2015.
“Once inaccurate data gets into the electronic health record, it’s hard to get it out,” said Ronni Solomon, executive vice president and general counsel for ECRI Institute. “That’s a challenge, and the less detectable it is, the higher the risk. You don’t know it’s in there.”
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13 March 2015 Sam Sachdeva
Emis and TPP have signed a data sharing agreement to enable direct interoperability between their clinical systems, with pilot sites set to trial information sharing within three months.
The companies say the move is part of an effort to help deliver more integrated patient care across multiple settings and address a growing need for interoperability.
The companies’ primary care IT systems, Emis Web and SystmOne, hold GP records for the majority of the UK population, while their solutions are also starting to spread across other care settings including community services and some hospitals.
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Scott Mace, for HealthLeaders Media , March 17, 2015
Hospitals are ill-equipped to own and operate their own cell-signal-extending equipment inside their facilities. The right network service provider can get the job done and raise reliability to carrier-grade levels.
Wi-Fi has been an essential element of information technology infrastructure for nearly 20 years, but in the quest for ever-more-reliable IT, healthcare organizations are opting for in-building cellular networks which increase uptime and could possibly save lives.
It wasn't that many years ago that hospitals banned the use of mobile phones inside hospitals, initially out of fear that they would interfere with everything from delicate medical equipment to someone's pacemaker. Many of those fears were overblown, but over time, interference among devices seems to have been lessened by smarter embedded radios, coupled with a diminishing number of reports of interference.
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March 13, 2015 | By Leslie Small
Score one more for the power of social media: Patients' Facebook ratings of hospitals appear to correlate with a widely used metric of care quality, a new study found.
The study, published in the Journal of General Internal Medicine, compared how 4,800 U.S. hospitals rated on Facebook's five-star scale with their 30-day readmission rates, as reported by Medicaid's Hospital Compare website. After controlling for hospital size and type, researchers found that the average Facebook rating was higher for hospitals with lower than average readmission rates, while hospitals with the highest readmission rates received fewer stars from Facebook users.
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Written by Elizabeth Earl | March 13, 2015
Although most practices have adopted some form of EHR, a survey from the American Academy of Family Physicians discovered who makes up the corps of physicians who refuse to adopt EHRs.
These physicians tend to be older and work in independent solo or two-physician practices, according to the AAFP. The survey included 3,437 physicians during two time periods — from October 2011 to March 2012 and between May and July 2013 — and asked about EHR adoption plans.
Approximately 9 percent of surveyed physicians had no plans to adopt an EHR within either reporting period. The AAFP applied the label "persistent nonadopters" to this group and expressed concern that this group will further isolate themselves by refusal to adopt.
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Ken Terry, iHealthBeat Contributing Reporter Monday, March 16, 2015
The giant hack at Anthem, which impacted nearly 80 million consumers, has refocused the health care industry's attention on the vulnerability of protected health information (PHI). Because Anthem's data were not encrypted, some experts have called for all PHI to be encrypted, whether in transit or at rest. Two Congressional committees plan to take up the issue in reviews of health information security.
This legislative scrutiny raises the possibility that the HIPAA security rule could be revised to require encryption of all PHI, including patient data in electronic health records. Under the current rule, encryption is "addressable," meaning that it should be done wherever practicable. But 41% of health care providers don't encrypt their data, according to a recent Forrester Research report.
Does it make sense to encrypt everything, and would that protect clinical data more than current procedures do? Anthem's attackers stole employee credentials to gain access to health plan members' identity and health data; even if the information had been encrypted, that safeguard would have been useless, the company and outside observers have pointed out.
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Enjoy!
David.
