Saturday, March 14, 2015

Weekly Overseas Health IT Links - 14th March, 2015.

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.

Senators Blast ONC Interoperability Roadmap for Lack of Details

MAR 6, 2015 7:51am ET
While the Office of the National Coordinator for Health IT’s draft Interoperability Roadmap attempts to define a framework for interoperable electronic health records, five Republican Senators charge that the document is heavy on generalities and light on specifics.
“The ONC roadmap provides a framework for responsibility, governance, and accountability in regard to the future development and implementation of interoperable EHRs. But instead of offering specific objectives, deadlines, and action items, ONC’s roadmap falls short on the nitty gritty technology specifics that vendors and providers need when developing IT products,” write Senators Lamar Alexander (R-Tenn.), Richard Burr (R-N.C.), Mike Enzi (R-Wyo.), Pat Roberts (R-Kan.), and John Thune (R-S.D.) in a blog published by Health Affairs.

Informatics off the radar for most med students

Posted on Mar 06, 2015
By Bernie Monegain, Editor-at-Large
A new survey published in the Journal of the American Medical Informatics Association wanted to gauge medical students' attitudes regarding clinical informatics training and careers. Instead, researchers found a surprising lack of awareness about the field.
The study closely follows a report by the career company Burning Glass Technologies, a Boston-based labor market analytics firm, which showed that there are plenty of jobs available in the healthcare informatics field, but few qualified candidates to fill them.
JAMIA's online survey received 557 responses from medical students at four medical schools, the available opportunities for training in clinical informatics far surpassed the respondents' awareness of what was available – medical school electives, residency electives, or academic fellowships, for example.

HITECH: Doomed from the start?

March 6, 2015 | By Dan Bowman
Despite $28 billion spent to date, the HITECH Act has failed to boost efficiency, cut costs or improve care quality for patients, primarily due to a lack of interoperability, five Republican senators say.
The senators--John Thune (S.D.), Lamar Alexander (Tenn.), Pat Roberts (Kan.), Richard Burr (N.C.) and Mike Enzi (Wyo.)--also argue in a Health Affairs Blog post that the Office of the National Coordinator for Health IT's draft interoperability roadmap does not go far enough to address the issue. Instead of providing specific goals and deadlines, they say, the roadmap "speaks in generalities" and fails to address all of the concerns raised by the senators in an April 2013 report that calls for a reboot of the Meaningful Use program.

Sharing Patient Records Is Still A Digital Dilemma For Doctors

March 06, 2015 3:37 AM ET
Technology entrepreneur Jonathan Bush says he was recently watching a patient move from a hospital to a nursing home. The patient's information was in an electronic medical record, or EMR. And getting the patient's records from the hospital to the nursing home, Bush says, wasn't exactly drag and drop.
"The time of letting a thousand flowers bloom and having a set of standards that are quite variable should come to an end. We should be working off the same set of standards."
"These two guys then type — I kid you not — the printout from the brand new EMR into their EMR, so that their fax server can fax it to the bloody nursing home," Bush says.

EHRs to Play Central Role in Precision Medicine Initiative

MAR 5, 2015 7:22am ET
Testifying before a U.S. House subcommittee on March 3, National Institutes of Health Director Francis Collins, M.D., credited the advent of electronic health record systems with providing the big data necessary for President Obama’s new $215 million Precision Medicine Initiative.
Collins told a hearing on NIH’s fiscal year 2016 budget request, held by the House Subcommittee on Labor, Health and Human Services and Education, that information about the “interaction between genes and environment that results in disease” has been elusive to date.
Yet, with “electronic health records now becoming the norm,” the NIH director asserted “that’s why this is the right time to initiate a program of this sort” whose aim is “groundbreaking and historic.” Collins commented that without advances in EHRs, environmental sensors, and DNA analysis at an increasingly affordable cost “we couldn’t have probably done it 10 years ago, but now we can.” 

Simple EHR changes can significantly impact lab utilization

March 1, 2015 | By Marla Durben Hirsch
Tweaking the menu in an electronic health record can have a direct impact on ordering patterns for laboratory testing, according to a new case study published in BMC Medical Informatics and Decision Making.
The researchers, from the University of Iowa Hospital Clinics and elsewhere, noted concerns with laboratory testing utilization, including overutilization, underutilization and incorrect test ordering.
They studied the effects of changes to the EHRs and computerized physician order entry (CPOE) to lab testing and ordering in a 711-bed academic medical center over a five-year period. Following the installation of the EHR, the academic medical center put interventions in place over time to promote better, more cost-effective utilization of lab testing, such as limits on selectable frequency of ordering lab tests, posting of lab test charges in the CPOE order entry, restricting the sending out of tests and expanding the checking for duplicative tests.

Docs who don't adopt EHRs face 'unique' challenges

March 3, 2015 | By Marla Durben Hirsch
Physicians who have not transitioned to electronic health records face a "unique" set of challenges that limits their ability to make the change, according to a study and article in the Annals of Internal Medicine.
The researchers, from Mathematica Policy Research in Cambridge, Massachusetts, found that while many physicians have adopted EHRs, some don't plan to and some who have are opted not to participate in the Meaningful Use program, which could impact the success of the program and the need to implement other, broader changes.
The researchers conducted a survey of 3,437 U.S. physicians engaged either in primary care or in specialties where they would likely care for a given patient over a period of time. The researchers found that by 2013, 63 percent of respondents had an EHR and another 20 percent were in the process of implementing one.

Improvements needed in dissemination of clinical effectiveness research

March 5, 2015 | By Susan D. Hall
While the Agency for Healthcare Research and Quality (AHRQ) has made some progress in disseminating comparative effectiveness research (CER) as mandated by the Affordable Care Act, it needs to do more, according to a report from the Government Accountability Office.
The report noted AHRQ has created tools to organize and disseminate research findings, but it has not established clear time frames for implementation or distributed information and tools to certain stakeholder groups specified in the law.
"While [the U.S. Department of Health and Human Services] has multiple, ongoing efforts to meets its requirements under [ACA] related to CER, it has not determined how it will fully address some of these requirements, particularly those related to dissemination and data capacity building," the report says.

Calif. Supreme Court To Mull Privacy, Access Rules for Rx Monitoring Database

by Joe Infantino, iHealthBeat Staff Writer Thursday, March 5, 2015
The California Supreme Court this year is poised to decide what further limitations -- if any -- should be placed on third-party investigators' access to the state's prescription drug monitoring database.
At issue in Lewis v. The Superior Court of California is whether the state medical board's access to records in the prescription drug monitoring program -- called the Controlled Substance Utilization Review and Evaluation System, or CURES -- violates patient privacy.

Background on CURES

CURES, maintained by the California Department of Justice, was established in 2009 to help physicians and law enforcement officers identify patterns of over-prescribing by doctors or prescription drug-shopping by patients. In addition, the database allows providers to make better-informed decisions by accessing a patient's prescription drug history.

How Does the FDA Regulate Mobile Medical Apps?

Lindsay Kobayashi - PLoS Blogs
Last month, the FDA released new guidance regarding the regulation of mobile medical apps, to replace its earlier version from 2011. Since that time, the amount of health and medical apps on the market has exploded, with the release of Apple's Health app with iOS 8 cementing mobile health as 'a thing'. Needless to say, it is about time for a regulatory update.
The FDA defines a 'mobile medical app' as a mobile app that is intended to either [1]:
  • Be used as an accessory to a regulated medical device; or
  • Transform a mobile platform into a regulated medical device.
What is a regulated medical device? The FDA guidance states that [1]:
When the intended use of a mobile app is for the diagnosis of disease or other conditions, or the cure, mitigation, treatment, or prevention of disease, or is intended to affect the structure or any function of the body of man, the mobile app is a device.

David Brailer: Current method of HIT regulation 'faulty,' unsustainable

March 4, 2015 | By Dan Bowman
While health IT has the ability to enable high-value care, its potential has yet to be reached on a broad scale due to a number of different factors, most notably inefficient government policies, according to several industry stakeholders who spoke at an event Wednesday in the District of Columbia hosted by Brookings.
For instance, former National Coordinator for Health IT David Brailer (pictured right), who now serves as managing partner and CEO at investment firm Health Evolution Partners, called the current architecture of health IT regulation, which focuses on regulating providers, a "very faulty model" that is not sustainable in the long term.
"Last year, health IT had a record investment from venture capital firms--$4.1 billion--and the numbers are growing tremendously," Brailer said. "Everyone thinks about the patient and how to organize IT around them and those that touch them ... but in Washington, we're still very much regulating the enterprises, so there's a tremendous mismatch."

Why a learning health system is important for patient care

March 4, 2015 | By Susan D. Hall
A report published this past December by JASON--an independent group of scientists that advises the U.S. government on science and technology--states that the ultimate goal in healthcare is to achieve an "agile, national-scale 'Learning Health System' for identifying and sharing effective practices of care."
The organization's previous reports called for building a robust infrastructure, saying that Meaningful Use Stage 3 should embrace interoperability at its core as a basis for that learning system.
A range of stakeholders aiming to galvanize a national grassroots movement to create a learning health system, now known as the Learning Health Community, grew out of a May 2012 summit focused on reports from the Institute of Medicine and sponsored by the Joseph H. Kanter Family Foundation. 

McKesson EHR goes dark after HVAC burnout

Posted on Mar 03, 2015
By Erin McCann, Managing Editor
A Northern California hospital has acknowledged that its electronic health record system went dark for about a week, which resulted in clinicians unable to access patient medical records and even having to postpone serious medical treatments. 
Robert Chason, chief executive officer of Rideout Health in Marysville, Calif., admitted the health system's electronic health record went down in mid February after a HVAC unit burned out, according to a local news report
The two-hospital health system recently implemented the McKesson Paragon platform, but Chason emphasized that the EHR system was not at fault. Rather, HVAC units contained in an off-site data center were to blame after one burned out, and the other overheated soon after. Rideout Health officials did not respond to Healthcare IT News' inquiries for further details on the incident.

Swiss Doctors Develop Prostate Cancer Detection App

March 4, 2015
Doctors at the Aarau Cantonal Hospital in Switzerland have developed an app that promotes early detection of prostate cancer by analyzing a person’s risk based on their PSA level, age, family history and other relevant factors.
ProstateCheck also calculates the likelihood that the user will develop prostate cancer in the next four, eight or twelve years.

Half of physicians don't use prescription drug monitoring programs

Written by Emily Rappleye (Twitter | Google+)  | March 03, 2015
Nearly one in four physicians are unaware of state prescription drug monitoring programs, according to a survey published in Health Affairs.
Of the 72 percent of physicians who are aware of these databases, only 53 percent reported actually using a prescription drug monitoring program.
Through state-specific drug monitoring programs, which have been implemented in 49 states except Missouri, physicians access electronic databases to make clinical decisions regarding the prescription of controlled substances, particularly opioids. They are meant to reduce "doctor shopping," when patients visit multiple providers to double up on prescriptions of controlled substances.

The Next Marketing Frontier: Your Medical Records

Startup’s electronic-patient records alert doctors when vaccines are needed, with a nudge from Merck

Practice Fusion, which gives its software free to doctors like Allan Treadwell, has built a database of 100 million patient records. Photo: Laura Morton for The Wall Street Journal
By  Elizabeth Dwoskin
March 3, 2015 1:50 p.m. ET
When Allan Treadwell views patient charts on his computer, a yellow alert sometimes pops up—a handy feature that tells him when a patient is due for vaccines for hepatitis B, influenza or other ailments.
“It’s a nice safety net,” said Dr. Treadwell, an internist in San Francisco.
Dr. Treadwell isn’t the only one who is pleased with the alerts. So is Merck & Co., which pays for the notifications sent to Dr. Treadwell and 20,000 other health-care providers. Medical-record software startup Practice Fusion Inc., which sells the alerts and displays them through its software, said that during a four-month study period ending in August, it observed a 73% increase in vaccinations—amounting to 25,000 additional treatments—compared with a control group. The company didn’t disclose its fees for delivering sponsored alerts but said it doesn’t take a cut of sales that result.
Practice Fusion, which has raised $157.5 million from investors, is pioneering a new type of data-driven business. Health-care providers increasingly use software to keep patient records. Many of these programs alert doctors when the information stored there indicates that a patient needs a particular treatment. Practice Fusion has taken the opportunity to sell sponsorships for alerts to drug companies and others.

Just Do It: Making Information Governance Work

MAR 3, 2015 7:58am ET
Organizations of all types and sizes recognize they must improve their information governance capabilities—and they must do so soon. They are already dealing with too much information, but data collection rates continue to accelerate, further increasing the cost and complexity burden on IT while raising legal, compliance and security concerns throughout the organization.
Conceptually, the solution is simple. If we reduce the amount of information we store or slow its growth, we reduce both risk and costs. For many organizations, however, taking the first step toward developing an information lifecycle governance (ILG) program that addresses data growth is the most difficult one. Most people think that ILG programs are tedious and fraught with complexity. They worry about a significant commitment of effort and budget. But companies that rely on ILG resources and best practices developed by the Compliance, Governance and Oversight Counsel (CGOC) often find that getting started on the journey can actually be much simpler than most people think. CGOC is a forum of legal, IT, records and information management professionals.

3 lessons privacy and security teams can learn from each other

By Rick Kam, President and co-founder ID Experts
Remember the old Reese’s Peanut Butter Cups commercial, where the guy’s chocolate bar lands in the girl’s peanut butter, and they discovered “two great tastes that taste great together?” Privacy and security are no different.
In many organizations the two disciplines often operate as siloes. But recent trends toward holistic management of privacy and security risks have more organizations moving the functions under one umbrella in order to improve communication and collaboration — and to learn valuable lessons from each other’s best practices.
Lessons from data security
Over the years, the IT industry has developed a host of data protection best practices that privacy organizations could adapt to their own activities.

What is the optimal future role for ONC?

Posted on Mar 02, 2015
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
As Meaningful Use winds down and incentive dollars are fully spent, what is the optimal role for ONC going forward?
Some pundits have suggested that ONC step aside and return all aspects of HIT policy and technology to the private sector. Others have suggested top down command and control of HIT including centralized governance to ensure interoperability.
Harmony is when all parties feel equally good about the path forward. Compromise is when everyone leaves the table equally unhappy. Here’s my view about the future of ONC that includes points from both sides.

HIE not 'causally related' to cost improvements, care quality benefits

March 3, 2015 | By Dan Bowman
An examination of health information exchange research published this month in Health Affairs determines that despite an increase in the sharing of health data across organizations, benefits on costs and care quality are scarce.
For the study, the researchers--from the University of Alabama at Birmingham, Weill Cornell Medical College in New York and Indiana University--analyzed 27 articles that included 94 individual analyses. For each discrete analysis, the researchers then determined whether or not a beneficial relationship existed between the exchange of health data and the outcomes.
Overall, 54 analyses found beneficial effects of health information exchange. However, the researchers argued, of six studies that used designs with strong internal validity--those "capable of identifying causal relationships"--only two found beneficial results.

Would a 'roll back' of ONC's strategic plan be good for health IT?

February 26, 2015 | By Marla Durben Hirsch
The National Center for Policy Analysis (NCPA) certainly didn't pull any punches in its comments on the Office of the National Coordinator for Health IT's updated strategic plan.
Unlike some commenters on the plan, who for the most part deferred to ONC, NCPA, known to favor private free market forces rather than government regulation, came out strongly against it.
NCPA didn't actually have a problem with the goals of the plan. Rather, its issue is that the federal government shouldn't be leading the brigade.
The organization said that the federal government, as "chief financier, certifier and regulator" of health IT, had rather botched the job, and that the plan should "roll back" and let market forces take over.

5 Strategies for Avoiding a Data Breach

Scott Mace, for HealthLeaders Media , March 3, 2015

The massive Anthem data breach reported last month has been having a ripple effect throughout the healthcare industry. Security experts offer five steps to take now.

Worries about data security have been piling up in the minds of CIOs the past three weeks like record-setting snows falling on New England.
"Security is an incredibly hot topic," says Marc Probst, chief information officer at Intermountain Healthcare. "Anthem takes it to a whole new level of consciousness."
Probst, of course, is referring to revelations last month that Anthem suffered a breach of 80 million member and employee records. Since the revelations, healthcare and related organizations have been subjected to an unprecedented number of scams and schemes, as bad guys, armed with names, social security numbers, and income data have tried to defraud insurance companies of various benefits, including bogus workman's comp claims.

Computer Simulation Models Measles Outbreaks

MAR 2, 2015 7:58am ET
To bring facts and clarity to the public debate about immunization in light of the recent measles outbreak, the University of Pittsburgh Graduate School of Public Health has created  a computer simulation that explores the impact of measles outbreaks in cities across the U.S. Users can see how an outbreak would play out if their city had high or low vaccination rates.
The simulation – which is easily accessible from mobile devices – is an adaptation of the Framework for Reconstructing Epidemiological Dynamics (FRED), a free resource created at Pitt.
“FRED users can see on a map of any major metropolitan area in the U.S. how one case of measles can turn into a major outbreak or be quickly quashed, all depending on the vaccination rates of a community,” said Donald S. Burke, M.D., Pitt Public Health dean and UPMC-Jonas Salk Chair of Global Health. “Our hope is that people will use this to have informed discussions about the value of vaccination and its role in preventing epidemics.”

Ending EHR absurdities

Posted on Mar 02, 2015
By Michelle Ronan Noteboom, Contributing writer
For all their promise, electronic health records sometimes suffer from design flaws that can lead to processes that are just plain nonsensical.
I’m a self-proclaimed health IT enthusiast. I applaud providers who ditch paper and embrace tablets. I always pick the portal over the telephone to schedule my appointments. I get a little giddy when I’m able to walk out of my doctor’s office, head to the pharmacy, and find my meds ready for pick-up, thanks to the miracle of e-prescribing.
But as much as I love health IT, I realize that our not-so-perfect systems have the potential to create some absurd workflows. Case in point: I recently I made a trip to the emergency room as patient. Despite my physical discomfort (all is well now), I did my typical perusal of all things health IT-related there, and paid particular attention to how the staff was using the EHR.

Are EHR vendors holding patient data hostage?

March 1, 2015 | By Marla Durben Hirsch
To spur data exchange, the government should consider letting market forces work to spur electronic health record vendors to lower their prices, according to a blog post from Niam Yaraghi, a fellow at the Brookings Institution's Center for Technology Innovation.
In his blog post, Yaraghi says that the HITECH Act, which created the Meaningful Use Incentive program, is one of the few healthcare laws that still has bipartisan support. However, the government created a "hole" that it now has to dig itself out of because it did not anticipate that the vendors would limit interoperability and charge high prices to provide it. Since the EHR market is now "saturated," the only way vendors can currently make money is by charging for data sharing.

5 things to know about the healthcare cloud computing market

Written by Akanksha Jayanthi (Twitter | Google+)  | February 27, 2015
The healthcare cloud computing market is projected to be valued at $12.6 billion dollars by 2020, according to Persistence Market Research.
Here are five more things to know about the healthcare cloud computing market.
1. In 2014, the market was valued at $4.2 billion. It is expected to grow at a compound annual growth rate of 20.1 percent over the next five years.
2. Reasons for the cloud computing market's growth include increased government spending on healthcare IT, improving features of cloud computing, growing demand for improved healthcare facilities and an increasing popularity of wireless and cloud technologies.

Diabetes: Ripe for the Convergence of Services, Big Data and Technology

by Laurel Fuqua and Robby Booth Monday, March 2, 2015
Innovation and new care delivery paradigms are now emerging as a result of the truly staggering costs of health care in the U.S. New organizational structures, such as accountable care organizations and clinically integrated health networks, are focusing on creating care delivery models that will proactively monitor and manage patients for improvements in both clinical and financial outcomes. 
Many of these efforts are focused on the management of chronic diseases, and one particular chronic disease should stand at the forefront of any organization's attempts at reining in costs and improving quality of care: diabetes. 
According to the most recent data from the American Diabetes Association and CDC, more than 29 million Americans have diabetes. But even more importantly, another 86 million -- or one in three -- have pre-diabetes. Without effective intervention, it is estimated that 15% to 30% of those individuals will develop diabetes within five years.


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