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Advanced analytics: All systems go
Posted on Jun 04, 2015
By Bernie Monegain, Editor-at-Large
This is Part III of our three-part June 2015 print cover story on healthcare analytics. Part I focuses on the first steps of launching an analytics program. Part II focuses on intermediate strategies, and Part III takes a look at the advanced stages of analytics use.
When it comes to providing the right care to the right patient in record time, the nation's policymakers, researchers, doctors and nurses seem on the verge of critical mass, or what author Malcolm Gladwell would call "the tipping point."
Today, healthcare organizations – big, medium and small – have the spotlight shining on the promise of data analytics, and recent government initiatives are providing synergy with ambitious and promising new efforts on the big data and personalized medicine front.
President Obama launched his push for precision medicine on Jan. 30. It's a project led by National Institutes of Health Director Francis Collins, MD. It's the same Francis Collins who directed the Human Genome Project, which was completed ahead of time and under budget, making precision medicine possible.
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Future direction of EHRs laid down by AMIA
June 3, 2015 | By Alok Saboo
By John DeGaspari
Specific recommendations were recently outlined by the American Medical Informatics Association (AMIA) on what it sees as the present status and future direction of electronic health records. The findings were presented at the iHealth Clinical Informatics Conference in Boston on May 29.
The report focused on five key areas that should be addressed within the next five years: simplify and speed documentation; refocus regulation; increase transparency and streamline regulation; foster innovation; and patient-centered healthcare.
Specific recommendations in the report include:
- Decrease the data entry burden for clinicians by encompassing information entered by other care team members
- Separate data entry by the patient, family members and the care team, which can be used to generate customized reports
- Regulations should clarify and simplify certification procedures; improve data exchange and interoperability; reduce the need for re-entering data; and prioritize patient outcomes
- Flexibility and transparency in how a vendor should satisfy certification criteria, to improve usability and safety and fostering innovation
- Integration of EHRs into the full context of care, including home health, specialist care, laboratory and long-term care
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ONC Survey Finds Disparities for Some Health IT
JUN 4, 2015 7:27am ET
A survey by the Office of the National Coordinator for Health Information Technology shows that consumers with lower incomes, less education and those in rural settings are less likely to use smartphone health apps, email their providers or look up test results online.
In addition, ONC found evidence of racial disparities in health IT use. For instance, individuals of Hispanic race/ethnicity had significantly lower rates of looking up test results online and emailing their provider compared to white non-Hispanics. “These differences may partially be related to language barriers; we found that individuals who took the survey in Spanish had lower rates of looking up test results online and emailing their provider,” states a new ONC data brief.
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FDA-cleared digital health devices to save healthcare $100B by 2018
FDA clearances for digital health devices are on track to triple by 2018, according to new research from Accenture, as digital health offerings drive more than $100 billion in savings over that same time period.
Thirty-three digital health devices were cleared by the FDA in 2014, according to Accenture, and they predict 100 will be cleared in 2018.
The research group estimates that FDA-cleared digital health devices — defined as “an internet-connected device or software created for detection or treatment of a medical indication” — saved the US healthcare system $6 billion last year in the form of improved medication adherence, behavior modifications and fewer emergency room visits. They predict that savings will grow to $10 billion in 2015, $18 billion in 2016, $30 billion in 2017 and $50 billion in 2018.
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IT could save $100B for US healthcare
Posted on Jun 05, 2015
By Mike Miliard, Editor
New research from Accenture projects that digital health tools will save the U.S. healthcare industry more than $100 billion over the next four years.
In 2014 alone, it calculates, technology such as Web-enabled devices, digital diagnostic tools and other FDA-approved IT help achieve some $6 billion in reduced costs – mostly thanks to things such as improved medication adherence, behavior modifications and fewer emergency room visits.
Accenture expects that number to approach $10 billion this year and $18 billion next year – increasing to $30 billion in 2017 and $50 billion in 2018 as these technologies take hold, proliferate and evolve.
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Cloud-based EHRs popularity grows among small practices
June 3, 2015 | By Alok Saboo
By John DeGaspari
Nearly seven out of 10 small and solo physician practices have affirmed their confidence in Web-based electronic health records, according to a recently published survey by Black Book Market Research.
The results are based on a four-month user poll among 5,700 small and solo physician practices across all medical and surgical specialties. According to 83 percent of the respondents, the single biggest trend in physician technology is cloud-based EHRs.
Improvements in Web-based EHRs--including implementations, updates, usability and customization--have reversed overall EHR satisfaction in small practices from barely 13 percent in 2012 to 83 percent overall, small practice EHR users said in the second quarter of 2015.
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Cornwall GPs follow Guru
3 June 2015 Rebecca McBeth
A patient record sharing scheme in Cornwall has gone county-wide with all GPs signed up to share their information using Microtest’s Guru.
A group of nine practices started using the clinical data-sharing tool in 2013 to give hospital and urgent care centre staff remote access to a read-only view of their GP records.
NHS Kernow CCG has now implemented Guru at all of the area’s 68 practices.
The CCG’s clinical lead for urgent care Dr Matthew Boulter said he and the group’s chair had been becoming increasingly frustrated that despite enormous effort and plans put in place by GPs to keep people out of hospital, patients would often be admitted over the weekend when practices are shut.
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Health Datapalooza: Government officials talk public health data, information blocking
June 4, 2015 | By Katie Dvorak
Government leaders spoke about the importance of empowering communities and patients through public health data as well as the need to ensure that health information is protected during Health Datapalooza this week.
In general, when it comes to data acceptance "patients are ahead of the game," said Tim Kelsey, national director for patients and information for the U.K.'s National Health Service. Patients are by and large ready, particularly once they have a medical condition, to share their data and work with other patients with similar conditions, he added.
"[Data] has to be part of how consumers and patients think about their care experience," added Patrick Conway, chief medical officer at the Centers for Medicare & Medicaid Services. "We're working to enable patients to have their data through things like APIs to make sure that information is accessible."
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CDS systems still lack imaging appropriateness criteria
June 4, 2015 | By Susan D. Hall
Clinical decision support (CDS) systems can help reduce the number of orders for unnecessary imaging, but practical challenges remain when it comes to putting the tools to work in clinical settings, according to a study by the RAND Corp. published in of the Journal of the American Medical Association.
Too often the CDS systems don't have or can't find appropriateness criteria for a particular test on which to make recommendations.
The Medicare Imaging Demonstration was sponsored by the Centers for Medicare & Medicaid Services. The RAND Corp. independently evaluated the demonstration, testing whether exposing physicians to appropriateness guidelines for advanced imaging would reduce or eliminate unnecessary tests. National medical specialty societies developed the appropriateness criteria that were loaded into the CDS tools for all participating clinicians.
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Cybersecurity on Lawmakers' Radar
Thursday, June 4, 2015
Bills before Congress and policy proposals from the White House take aim at cybersecurity, and although the efforts are not geared specifically toward health care, they touch on areas of interest to the industry.
Health Care Security Incidents on the Rise
A recent Ponemon Institute report found that nearly two-thirds of health care organizations say they have experienced an electronic information-based security incident within the last two years. Meanwhile, three major insurers so far this year have disclosed security incidents.
"[C]oming into the year, many security and privacy experts expected that this would be the year of the health care data breach, not unlike last year, where retail and financial services [were] under attack," ID Experts President and Co-Founder Rick Kam said in a podcast accompanying the report, adding, "And 2015, really, unfortunately, has become the year of the health care data breach."
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Patients Concerned about EHRs but Not Withholding Info
JUN 3, 2015 7:34am ET
Despite growing concerns about privacy and security, less than 1 in 10 patients withhold information from their providers. That is the finding of a recent national survey conducted by the Office of the National Coordinator for Health IT.
While more than 70 percent of respondents worry about security of their data, that doesn’t stop them from openly sharing information with providers. Consequently, ONC argues that the survey “suggests that increased adoption of EHRs is not associated with individuals’ privacy and security concerns.”
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Brookings finds HIE investment poised to yield benefits
Jeff Rowe
Jun 03, 2015
Few healthcare stakeholders dispute the potential benefits of health information exchange (HIE), but many providers have been slow to join them. A new report says that may be about to change.
Niam Yaraghi, a fellow at the Brookings Center for Technology Innovation, looked at both the federal government’s significant investment in HIE and some of the results. Over the past decade the ONC has awarded $548 million in grants to states to establish their own health information exchange platforms.
Focusing on two emergency departments in Western New York, Yaraghi studied the impact of regional health information exchange on the number of laboratory tests and radiology exams conducted during ED visits in the last quarter of 2014. The key to HIE success, Yaraghi argued, is ensuring that queries are “done in a setting where there is a wealth of available medical data for each patient and . . . the database of (the) HIE platform is being queried in 100 percent of patient encounters.”
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As teens turn to Internet for health info, accuracy paramount
June 3, 2015 | By Susan D. Hall
Eighty-four percent of teens get some of their health information from the Internet, and one in four say they get "a lot" of their health information online, according to a new study from Northwestern University.
The study highlights the need to ensure the information is accurate, appropriate and easily accessible to teens "because it's used and acted upon," Ellen Wartella, director of Northwestern's Center on Media and Human Development and lead author of the report, told the Washington Post.
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Digital service for mental healthcare growing in US
June 3, 2015 | By Susan D. Hall
Big White Wall, a digital mental health service created in the United Kingdom that has been used extensively with military families and others, is expanding to the United States.
It's designed to empower people to seek assistance for their mental health challenges for the first time, and can be used as a stand-alone service, a wrap-around for those waiting for conventional care, to help with medication adherence and to prevent readmission for those leaving acute care. It complements and integrates with conventional care services, according to a Health Affairs Blog post.
Participants are offered personalized care pathways driven by machine learning algorithms, including data correlating depression and anxiety scores, along with assessments of the language they use.
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What Patients Gain By Reading Their Doctor’s Notes
During a recent physical, Jeff Gordon’s doctor told him he may be pre-diabetic. It was a quick mention, mixed in with a review of blood pressure numbers, other vital statistics like his heart rate, height and weight, and details about his prescription for cholesterol medication. Normally, Gordon, 70, a food broker who lives in Washington, D.C., would have paid it little attention.
But his physician, who recently joined MedStar Health, uses the system’s Web portal that allows him to share his office notes with patients. For Gordon, seeing the word “pre-diabetic” in writing made it difficult to ignore, and he took action.
He contacted MedStar about joining a pre-diabetes clinical study. In the course of taking the tests required to participate, the otherwise healthy septuagenarian found out his blood sugar wasn’t elevated enough to qualify.
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Why Doug Fridsma is High on FHIR Interoperability
JUN 2, 2015 7:29am ET
Doug Fridsma, M.D., president and CEO of the American Medical Informatics Association, has seen the future of health IT—a future in which data, not documents, are at the core of the exchange of health information.
“When you have standards that are essentially document specifications, they don’t do as well when you have to try to move to a more granular data-driven approach to managing information,” Fridsma, a former senior official in the Office of the National Coordinator for HIT, tells Health Data Management. “That’s why I think data-centric standards like HL7’s Fast Healthcare Interoperability Resources have caught the eye of folks.”
Fridsma said he is very positive about data-centric standards like HL7’s FHIR that leverage existing web-based technology “rather than ones that are much more about creating structured documents” such as the Consolidated-Clinical Document Architecture.
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A beginners guide to data analytics
Posted on Jun 02, 2015
By Erin McCann, Managing Editor
This is Part I of our three Part June 2015 print cover story on doing analytics. Part I focuses on the first steps of doing an analytics program. Part II will focus on intermediate, and Part III will focus on the advanced stages of an analytics program.
This first part may sting a bit: To those healthcare organizations in the beginning stages of rolling out a data analytics program, chances are you're going to do it completely and utterly wrong.
At least that's according to Eugene Kolker, chief data scientist at Seattle Children's Hospital, who has been working in data analysis for the past 25 years. When talking about doing the initial metrics part of it, "The majority of places, whether they're small or large, they're going to do it wrong," he tells Healthcare IT News. And when you're dealing with people's lives, that's hardly something to take lightly.
Kolker would much prefer that not to be the case, but from his experiences and what he’s seen transpire in the analytics arena across other industries, there's some unfortunate implications for the healthcare beginners.
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CDS can mean fewer tests, but has limits
Posted on Jun 02, 2015
By Mike Miliard, Editor
A new study from RAND Corporation shows that decision support technology can lead to a reduction in inappropriate advanced imaging studies. But practical challenges remain when it comes to putting the tools to work in clinical settings.
Overuse of imaging tests as MRI and CT is a big cause of rising healthcare costs. Starting in 2017, the Centers for Medicare & Medicaid Services will require the use of clinical decision support to inform the ordering of any advanced diagnostic imaging study paid for by Medicare.
The CDS tools in this study, which match a patient's characteristics against treatment criteria and recommend options, translated into a higher percentage of tests for Medicare fee-for-service patients rated as appropriate, according RAND's findings, which were published today in the Journal of the American Medical Association. Still, there were some significant limitations.
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Health 3.0: with Thomas Meek
In the first of a new, monthly column looking at disruptive technologies and their uses Digital Health reporter Thomas Meek considers the potential of the iWatch – and why so many electronic patient record vendors are looking to link up with it, particularly in the US.
20 May 2015
A month on from the launch of the Apple Watch, and we’re still waiting to see if the device ranks alongside the like of the Apple’s iPhone and iPad as a revolutionary technology for both personal and business use - or remains a niche toy for the tech-obsessed fanatics.
Reaction from tech blogs tended to suggest that the device was another solid if underwhelming Apple product, with limited functionality and a lack of killer apps; although most were keen to write up its potential.
For Apple, much of the value of the product is based on its abilities in healthcare, with seemingly hundreds of personal health apps signed up to the service already.
However, if the Watch is to have the kind of impact that, say, Sir Bruce Keogh was predicting recently, it will need to link into enterprise electronic patient records using HealthKit, which serves as a platform to house and connect healthcare and fitness apps on the company’s devices.
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Consumers support EHRs, HIEs despite security, privacy concerns
June 2, 2015 | By Susan D. Hall
Consumers remain concerned about the privacy and security of their medical records--and whether the physician uses an electronic system makes little difference, according to a new data brief from the Office of the National Coordinator for Health IT.
While building public trust is vital to the spread of electronic health records and health information exchanges (HIEs), public support remains strong for these efforts, suggesting that consumers are aware of the benefits despite the risks, the paper concludes.
In a poll of more than 2,000 people conducted in 2013, seven in 10 expressed concern about the privacy of their medical records, and three out of four voiced concerns about security. However, less than one in 10 reported withholding information from their doctor because of those worries.
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Partners’ $1.2b patient data system seen as key to future
Aims for one file per person, fewer errors
“This is going to allow us to improve service for our patients,” said Dr. Gregg S. Meyer, chief clinical officer at Partners HealthCare.
After two years as an intensive care nurse at Brigham and Women’s Hospital, Aqua Bang will no longer need to carry a pen and binder to record the vital signs of her patients. Instead, that information will instantly flow from bedside monitors to each patient’s computerized health record, part of a massive information technology system launched over the weekend by Partners HealthCare.
The new system will eventually house millions of patient records across a network of 10 hospitals and 6,000 doctors. It comes with a $1.2 billion price tag, the single biggest investment Partners has ever made — nearly twice what it cost to build the massive Lunder Building at Massachusetts General Hospital in 2011.
While it’s a big shift for employees, the new system will initially change little about what patients experience at the hospital. Eventually, however, it will allow patients better online access to their medical information. And it has the potential to reduce medical errors. Instead of a separate record at every Partners facility, a patient will have one record throughout the Partners system, so information is more readily shared among doctors.
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NIH Research Weighs Benefits, Burdens of EHR Clinical Reminders
JUN 1, 2015 7:18am ET
David Chan, M.D., an assistant professor at Stanford School of Medicine, has received a National Institutes of Health Early Independence Award to study the impact of electronic health record clinical reminders on the quality of primary care. These reminders include a range of clinical messages for providers, from a simple prompt to write a prescription to more complex recommendations for follow-up testing and specialist referrals.
“On the one hand, electronic reminders can present helpful information to support better patient care,” says Chan, also a physician scientist at Veterans Affairs Palo Alto Health Care, in his research proposal. “On the other hand, given the limits of human cognitive processing and attention, there is the distinct possibility that reminders may overburden clinicians with too much information. There is currently little empirical evidence weighing the benefits and burdens of increasing the informational content of systems of electronic reminders.”
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Cloud-Based EHRs Rate High among Small Practices
JUN 1, 2015 7:23am ET
Cloud-based electronic health record systems are the highest ranked EHRs in terms of physician satisfaction among small and solo practices, according to Black Book Rankings.
The firm reports that the top 20 ranked vendors for 2015 were all cloud EHRs and all of them scored more than 90 percent in overall client satisfaction across 18 key performance indicators. Further, 83 percent of the more than 5,700 small and solo medical practices surveyed by Black Book indicated that the single biggest physician technology trend is cloud-based EHRs.
Thanks to improvements in web-based EHRs including implementations, updates, usability and customization, the survey reveals a reversal in overall EHR satisfaction in small practices from barely 13 percent meeting or exceeding expectations in 2012 to 81 percent in the second quarter of 2015.
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AMIA Tackles EHR Adoption Challenges
JUN 1, 2015 7:35am ET
To address the challenges of electronic health records adoption, the American Medical Informatics Association’s EHR-2020 Task Force has issued 10 recommendations for creating a person-centric, learning health system over the next five years.
Published and presented publicly on Friday at the AMIA iHealth 2015 Clinical Informatics Conference in Boston, the task force recommends changes that will “support patient engagement, improve provider workflow, support innovation, and set the stage for future improvements” designed to transform healthcare in this country.
In its report, the task force makes 10 recommendations in five areas: simplify and speed documentation, refocus regulation, increase transparency and streamline certification, foster innovation, and offer person-centered care delivery. Yet, despite these EHR challenges, the task force concludes that “these problems are soluble and the future for EHRs is bright.”
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Flawed technology, flawed humans
Posted on Jun 01, 2015
By Michelle Ronan Noteboom, Contributing writer
Recently I borrowed my father's car and noticed that the dashboard's oil indicator light was illuminated. When I mentioned this to my dad, he said, "Don't worry. It doesn't mean anything. It's always on."
Hmm. So I asked him, "If it's always on, how do you know when something is wrong? If there really is an oil leak don't you risk burning up the engine?"
Crickets from my dad.
I suppose an always-on oil lamp is the automobile version of alarm fatigue in healthcare, when a doctor clicks through yet another drug-drug interaction warning with barely a glance. Or when staff ignores an alarm at a nurse station because 90 percent of the unit's alerts are medically insignificant.
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EHR roadblocks holding docs back
Posted on Jun 01, 2015
By Sherree Geyer, Contributing writer
Anna Orlova, senior director, standards at AHIMA, compares the current interoperability of today's electronic health record systems to treadle sewing machines of the early 20th century.
"What we give physicians is a mechanical sewing machine," she says. "You just need to move your legs to create data. It shouldn't be that way."
Steven J. Stack, MD, president-elect of the American Medical Association, says difficulties exchanging and sharing data stem in large part from "an overabundance of measures with specifications that are unaligned," creating confusion for overburdened physician practices.
"A recent study found this uncoordinated approach resulted in too much variability in the large array of measures being promoted across the healthcare system," says Stack.
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FCC Versus Your Health
Monday, June 1, 2015
The Federal Communications Commission's recent decision to regulate the Internet with the same law that was created for "Ma Bell" before World War II has plenty of implications for the health innovation economy. The era of "permission-less innovation" may be coming to an end as the FCC will scrutinize telemedicine applications and other broadband-enabled health care services because they involve connectivity. If Congress can act quickly to rein in the FCC, a disaster can be averted.
Many recognize net neutrality as a code word for a longstanding lobbying effort by high-bandwidth users like Netflix and Google to get the government to force carriers to let them monopolize bandwidth without paying for it. However, it's about more than people trying to break the Internet by sending cat videos to their friends. Net neutrality, as regulated by the FCC in some 300 pages of rules, threatens one of the most promising areas of innovation in health care -- using mobile devices to maintain and improve people's health.
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Halamka: 'Probably Time to Retire the Meaningful Use Construct'
Tinker Ready, for HealthLeaders Media , June 1, 2015
John Halamka, MD, the Beth Israel Deaconess Medical Center CIO who is co-chair of the federal HIT Standards Committee, shares his views on interoperability, information blocking, and the lifespan of Meaningful Use.
John Halamka, MD, chief information officer of Beth Israel Deaconess Medical Center, has issues with the way both Congress and the federal government see the state of health information technology. Last week he wrote in his blog about "how Congress… [has] entered the Trough of Disillusionment for EHRs and interoperability."
Halamka spoke with HealthLeaders Media on May 29 about interoperability, Meaningful Use, and information blocking. The transcript has been edited for brevity and clarity.
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Enjoy!
David.
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