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FHIR, the hottest topic at HIMSS16, sets stage for population health
CMS, ONC promise to not only accelerate adoption of the interoperability spec but also have some providers looking ahead at ways they can put it to use.
March 11, 2016 08:26 AM
The emerging protocol known as FHIR has been most closely associated with interoperability so far. The acronym, after all, stands for Fast Healthcare Interoperability Resources. But if the standard succeeds in its mission of enabling widespread data exchange, FHIR might soon have a higher calling to serve as a foundation for population health management.
"FHIR is a better-designed Lego," said Doug Dietzman, executive director of Great Lakes Health Connect, a self-sustaining health information exchange in Grand Rapids, Michigan. "I'm looking forward to having it in my toolbox."
Feds back FHIR, big-time
There is certainly no lack of public support for FHIR right about now. National coordinator Karen DeSalvo, MD, started the fire at HIMSS16 by launching a $625,000 triptych of developer challenges. One focuses on patient-facing apps, the second on software geared toward providers and for the third ONC is hoping the funding and recognition inspire someone to create what essentially would be an app store for housing these FHIR-based apps and making them available for download.
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Small providers increasingly likely to be hack targets
Published March 10 2016, 2:24pm EST
Too many small hospitals and small or mid-sized physician practices believe defending against cyber attacks is pointless and they’re just hoping to be saved by being obscure.
That’s a risky approach, because hackers are not just looking for big targets; rather, they’re setting their sights on easy targets.
Banking on obscurity “is something that’s not going to happen,” says Chase Cunningham, director of cyber threat research and innovation at Armor Defense, which sells a healthcare secure cloud platform.
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Using Data To Help Home Health Workers Manage Patients’ Conditions
BALTIMORE — There is little in Ruby’s life that is easy. Nearly blind and unable to walk more than a step or two, the 39-year-old struggles to raise three sons while dealing with a daunting array of health conditions, from diabetes that recently landed her in the hospital to pain from bulging spinal disks.
Without support, odds are she’ll end up back in a hospital. But Ruby, who asked that her last name not be used to protect her family’s privacy, is part of a growing effort to reduce those odds by arming home care aides and other non-medical workers with the power of data.
On a recent Monday, health coach Nhaomie Douyon visited Ruby in the small, rented two-story row house where she lives with her children. Douyon works for the Coordinating Center, a Maryland-based nonprofit that helps organize medical and social needs for clients like Ruby, who live in designated medically underserved areas.
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4 keys to data-driven hospital quality improvement
March 10th, 2016
by Warren Strauss
From required Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control and Prevention reporting to Agency for Healthcare Research and Quality (AHRQ) indicators, hospitals now track and report large volumes of data on a daily basis. But how can hospitals use these data to drive improvement initiatives, predict performance for value-based purchasing and improve patient outcomes? For many healthcare IT professionals, these are critical questions that play a big role in shaping the effectiveness (or ineffectiveness) of their hospital’s quality improvement program.
The data-driven healthcare movement is premised on the idea that better data will lead to better patient outcomes. By looking at patterns in adverse events, for example, hospitals can determine where they need to focus quality improvement efforts and track the results of those efforts over time. However, many hospitals find it difficult to cut through the clutter and find actionable, meaningful information among the data points.
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Frustrations linger around electronic health records and user-centered design
Experts say healthcare providers need to turn up the pressure on tech vendors to create more intuitive products.
March 10, 2016 10:29 AM
Electronic health record usability might not have been the hottest topic at HIMSS16 this past week – our polling shows big data and interoperability tied for that honor, with privacy/security just nudging population health for the second spot – but it was certainly top of mind for many.
The multi-day User Experience Forum, for instance, explored the human factor and design choices that can directly impact the use and efficacy of health information technology, examining UX from the perspective of physicians, nurses, patients, vendors and more. Sessions gave voice to end-user frustrations, looked to tear down the barriers to innovation and tracked the clinical and financial return that can be gained from improved software interfaces.
In a provocative prime-time speech, meanwhile, Acting CMS Administrator Andy Slavitt threw down the gauntlet: "I'm certainly not bashful about what we need to do better, and I'm not going to be bashful here, even in the face of some very good reasons for optimism, about ways we need to take our game up across the board.”
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Wellcome Trust issues new data sharing report
9 March 2016
The Wellcome Trust has returned to the debate about the use of health data with a report that finds hostility to sharing information with insurers and marketers and a need for companies and researchers to show 'public benefit' for this to be acceptable.
The trust has been involved in this area since its then-director, Dr Mark Walport, now the government’s chief scientific advisor, co-authored a data sharing review that strongly backed information sharing with researchers.
The review also floated the idea that the members of the public who used the NHS had a duty to allow their data to be shared, and that they should be assumed to have given ‘implied consent’ for this to happen.
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£55m to increase e-Referral uptake
10 March 2016
NHS England has set aside £55 million to reward GPs and hospitals to increase the uptake of electronic referrals to 100% by 2018.
Around half of all patients are currently referred for hospital appointments electronically using the new NHS e-Referral Service. NHS England wants to see this increase to 60% by this September, 80% by 2017 and 100% by 2018.
Planning guidance released by the national commissioning board in December 2012 set the target of paperless referrals by March 2015, but this date was later pushed back by three years.
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http://www.clinical-innovation.com/topics/ehr-emr/onc-unveils-million-hearts-ehr-optimization-guides
ONC unveils Million Hearts EHR Optimization guides
The Office of National Coordinator for Health IT has released the Million Hearts EHR Optimization Guides which will "help healthcare professionals use their EHR systems to identify at-risk patients and protect them from heart attacks, strokes and other cardiovascular events," according to a blog post written by the agency's chief medical officer, Thomas A. Mason, MD.
The EHR Optimization Guides offer step-by-step instructions on how providers can use their EHR products to find, use and improve data on the “ABCS”:
- Aspirin therapy when appropriate
- Blood pressure control
- Cholesterol management
- Smoking cessation
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Electronic records lag at hospitals U.S. doesn’t pay for tech upgrades
(Reuters Health) - Psychiatric, long-term care and rehabilitation hospitals that don’t qualify for U.S. subsidies to adopt electronic medical records aren’t upgrading to this technology as quickly as hospitals that receive cash incentives, a recent study suggests.
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 set aside incentive payments through the government health programs Medicare and Medicaid for eligible hospitals and providers that adopted electronic health records (EHRs).
Four years later, roughly 59 percent of hospitals eligible for subsidies had adopted at least basic EHR systems, the study found.
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Industry under the gun to quickly optimize EHR use
Published March 08 2016, 2:50pm EST
If anyone has a global perspective of the changes occurring within federal policy on healthcare IT, it’s probably Paul Tang, MD.
Tang, as vice president and CMIO for the Palo Alto Medical Foundation, has made it a mission to stay deeply involved with healthcare IT initiatives that federal agencies have created to get private input on healthcare IT.
In addition to Tang’s day job with the Palo Alto Medical Foundation, he carries a heavy load on various federal panels, including chair of the Advanced Health Models and Meaningful Use committee, vice chair of the Health IT Policy Committee, member of the Health IT Strategy and Innovation committee and chair of the Clinical, Technical, Organizational and Financial Barriers to Interoperability task force.
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Cyberattacks increase in sophistication, breaches go 'unchecked,' survey finds
March 9, 2016 | By Katie Dvorak
Cyberattacks throughout all industries are growing more sophisticated and the number of breaches at organizations "continues to go unchecked," according to a survey of cybersecurity managers and practitioners.
Seventy-five percent of the 461 respondents to the RSA Conference and ISACA survey said they expected to see an attack on their organization this year. About 6 percent of the respondents work in the healthcare industry, which is one of the most targeted and least prepared sectors when it comes to cybersecurity.
The Ponemon Institute recently released a report that found healthcare organizations could face about one cyberattack per month.
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Inappropriate use of 'notes' field in e-prescribing can cause patient harm
March 9, 2016 | By Susan D. Hall
Doctors' use of the free-text "notes" field in e-prescriptions to communicate additional prescription-related information to pharmacists can create confusion and even patient harm, according to research published in JAMA Internal Medicine.
The researchers evaluated 28,002 e-prescriptions transmitted over the Surescripts network in November 2013. The researchers found 14.9 percent included information in the notes field, with 66.1 percent of that data seen as inappropriate content for which an available standard, structured data-entry field should have been used.
The researchers deemed 19 percent of the field's content, including inappropriate content, a potential safety concern since it may conflict with information in the "directions" field.
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Writing the future
Over the past year, there has been an explosion of frameworks, declarations and charters supporting interoperability.
But are they promoting the right things? Is action happening fast enough? Do they have the levers to engage suppliers? And are trusts asking the right questions? Daloni Carlisle asks the experts.
Interoperability used to be the territory of the techie. Now it’s a buzzword bandied about by everyone who is anyone in health policy and clinical leadership; not least because the last 12 months have seen an unprecedented flurry of activity.
A year is a long time in interoperability
A year ago, in March 2015, a new GPSoC framework specified that principal system suppliers must provide interface mechanisms to allow suppliers of subsidiary services to integrate with them.
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Analyst: add 'social determinants' to Big Data to improve health risk predictions
Jeff Rowe
Mar 09, 2016
There’s been no shortage of buzz around the potential of “Big Data” to transform the way many sectors, including healthcare, conduct their business. Despite that potential, however, healthcare organizations still “largely depend on the analysis of traditional data sources to understand and predict patient and population health risk.”
That’s according to one risk analyst, who says the time has come for healthcare providers and policymakers to begin to take advantage of newly available types of data in order to better predict the health of both individual patients and entire populations.
Writing for Executive Insight, Kathy Mosbaugh, vice president of clinical solutions for LexisNexis Risk Solutions, argues that traditional data sources, including billing, laboratory, pharmacy, medical claims and patient health risk assessments, “are no longer enough to provide accurate risk and outcome predictions.”
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HIT Think Getting a glimpse of virtual and augmented reality in healthcare
Published March 09 2016, 3:20pm EST
Virtual reality (VR) and augmented reality (AR) will be the next big computing platforms after PCs and smartphones.
Today, most people think of these technologies as an interface for games and entertainment, but virtual reality will soon be woven into all aspects of society, business, commerce and education—including healthcare.
The VR/AR market is predicted to reach $80 billion in sales by 2025, according to a new VR market report by Goldman Sachs Global Investment Research. Market penetration will be heavy in the healthcare sector, where VR applications are forecast to top $5.1 billion in sales by 2025, with 3.4 million active users. Goldman Sachs estimates that 8 million physicians and EMTs worldwide could use VR/AR technology, including 1.5 million medical professionals in the U.S. alone.
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Patient portal use varies among seniors
When it comes to accessing and using patient portals, not all seniors do so equally.
Researchers conducted a study of patient portal usage by seniors between 65 and 79 years old who were members in the Kaiser Permanente Northern California health plan. Results were published in the Journal of Medical Internet Research.
They found adults between 70 and 79 were significantly less likely to be registered to use the patient portal than adults between 65 and 69 years old.
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ONC taps Accenture to create patient-generated health data framework
March 08, 2016
At the HIMSS16 annual conference in Las Vegas last week, Accenture Federal Services announced a two-year consulting contract with the ONC to help the federal government create a framework for collecting and using patient generated health data in both research and clinical care. Accenture executives told MobiHealthNews that this framework is an important first step toward creating standards that would make patient generated health data more interoperable.
MobiHealthNews has interviewed informaticists before who have pointed out that, for the most part, all healthcare data is patient-generated in the end, but the term has come to refer to health data that is often collected from or by the patient while outside of clinical care settings.
Mary Edwards, who leads Accenture's work with federal civilian health agencies, explained to MobiHealthNews during an interview at HIMSS16, that this type of data increasingly is collected by consumer devices, like Fitbits, and is rarely a part of a clinical or claims record.
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Providers must boost vigilance to limit EHR risks
Published March 08 2016, 6:12am EST
When it comes to electronic health records, a lack of planning could lead to patient death, which is why hospitals must implement policies and procedures to reduce EHR risks.
While the health IT movement is gaining traction across the nation, it still has a long way to go and issues still exist within electronic health records, says Trish Lugtu, associate director of research at MMIC Insurance.
Speaking at an educational session at HIMSS16 last week, Lugtu said that in the past, people were not paying attention to health IT and it “scared her.” As an example, she shared research on two patients who died as a result of errors within their records, including a patient who died following an anaphylactic reaction to known allergies because notifications were turned off in the patient record, and a patient who died following a failure to diagnose and treat a small bowel obstruction when an X-ray was not routed correctly.
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Quality reporting costs doctors more than $15.4 billion a year, Health Affairs says
Nearly 75 percent say they waste time and money with measures that aren't clinically relevant.
March 08, 2016 11:17 AM
Medical practices spend an average of 785 hours per physician and $15.4 billion annually reporting quality measures to Medicare, Medicaid and private payers, according to a new report in Health Affairs.
The study, led by researchers from Weill Cornell Medical College, looked at the quality reporting efforts of primary care, cardiology, orthopedic and multi-specialty practices, polling 1000 of them (250 of each type), drawn at random from the membership rolls of the Medical Group Management Association.
Their findings suggest that, while "much is to be gained from quality measurement, the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report," researchers said.
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Apple Mac computers hit with first ransomware attack, researchers find
The malicious code, which spread through a file-sharing program, waits three days before connecting with hackers' servers.
March 08, 2016 10:00 AM
Cyberattackers targeted Apple users over the weekend with the first known ransomware written specifically for Apple software, according to security firm Palo Alto Networks.
Ransomware is a fast-growing threat that encrypts data on infected machines and demands that users pay a ransom in digital currencies, such as Bitcoin, to receive an electronic key so they can retrieve their data.
The most high-profile ransomware attack happened just last month when attackers struck Hollywood Presbyterian Medical Center and held its data hostage, effectively reverting the hospital back to a pre-digital state in which employees used paper records and fax machines.
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E-consults improve communication between clinicians, specialists
March 8, 2016 | By Katie Dvorak
When it comes to improving access to specialty care, especially for underserved populations, e-consultations are a viable solution, according to a recent study published in the Annals of Family Medicine.
As the number of ambulatory care visits that lead to a referral to another clinician grows, so does the need for communication between clinicians and specialists. However, only 34 percent of specialists routinely get information from referring primary care clinicians, according to the study's authors.
The researchers conducted the study at Community Health Center Inc. (CHCI) in Connecticut, a patient-centered medical home that provides medical, behavioral and dental care to medically underserved patients. E-consultations were submitted by the clinician via the electronic health record system and messages were received by specialists as an incoming message in the EHR.
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Health wearables market to hit $17.8B by 2021
March 6, 2016 | By Judy Mottl
The healthcare wearable device market is projected to hit $17.8 billion in revenue by 2021 as the industry undergoes what a new report describes as a big transformation.
Digital health will be a driver in more efficient, affordable and wide ranging healthcare and wearables are pushing healthcare into the digital age, according to a new Tractica market forecast. The top device leaders will be fitness trackers and smartwatches.
The 2015 wearables market saw a 139.4 percent growth rate, from 35.5 million shipments in 2014 to 85 million last year; that figure is expected to hit 560 million by 2021. The No. 1 device revenue generator is the Apple Watch, which, despite lower than projected unit sales, hit $5.5 billion in revenue for 2015.
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Feedback loops on patient health data key to engagement
March 8, 2016 | By Susan D. Hall
Feedback loops connecting patients and their doctors are key to engaging and helping consumers, according to an article at NEJM Catalyst.
What patients really want is better health, not more health services, writes author Kevin Volpp, M.D., director of the Center for Health Incentives and Behavioral Economics at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania.
Wearables and other consumer devices hold the potential to improve self-management, but feedback loops help sustain consumer interest in using them, Volpp says.
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Verily looks to create 'Google of human systems biology'
March 8, 2016 | By Katie Dvorak
Verily, Google's life sciences arm, is looking to create a library that uses machine-learning technology to help medical professionals search for medical information, according to a Fast Company report.
Andy Conrad, head of Verily, said in the article that the new venture will be the "Google of human systems biology."
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HIE market to hit $980M value: 5 things to know
March 07, 2016
High demand is expected to spur growth in the global health information exchange market, according to a Research and Markets report.
Here are five things to know about the market.
1. The global HIE market is projected to reach a value of $980 million by 2019.
2. The market's growth factors include incentives from the federal government, increased investment, an aging population and demand for reduced healthcare costs.
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http://www.clinical-innovation.com/topics/mobile-telehealth/longer-term-research-required-telehealth
Longer term research required for telehealth
In contrast to claims that telehealth can solve numerous healthcare problems, including access to care, a paper published in the Journal of Medical Internet Research says research on the practice is overly positive because it is often based on short-term projects.
Written by members of the Transatlantic Telehealth Research Network, the paper calls for future research to study the impact and effective use of telehealth.
"Future research is needed to identify additional factors that promote telehealth acceptance, such as human-technology interaction, organization of the healthcare system and social factors," the authors, led by Birthe Dinesen, MS, PhD, of Denmark’s Aalborg University, wrote.
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Tech Tactics for the Long-Term
Scott Mace, March 7, 2016
With growing emphasis on postacute care, leaders are looking for solutions that enhance information exchange and patient safety.
Technology is driving a new wave of care coordination into long-term postacute care and home settings to enable improved outcomes at lower cost.
In July 2015, the Centers for Medicare & Medicaid Services published a proposed rule that incorporates encouragement for LTPAC facilities to adopt electronic health records, even though the meaningful use incentive payment program provided zero dollars for purchasing EHRs.
Many LTPACs are still using paper records at this point.
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HealthNet records system enables quality care for the poor
Published March 07 2016, 7:43am EST
A decade ago, HealthNet Community Health Centers was looking at an aging practice management system that no longer was delivering what the Indianapolis-based organization needed.
The journey to replace that system led to an electronic medical record implementation in 2009, and a HIMSS Davies award in 2015 for using EHR to both improve outcomes and reduce costs.
“We knew many of the payers and other organizations we worked with increasingly wanted us to be on an EMR, and we knew we really should be looking at a unified practice management and EMR system,” says Lauren Borgmann, HealthNet's clinical information systems/EMR program manager. “That sparked the conversation about what else we could get out of the technology—the goals.”
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The need for a culture of security compliance
Published March 04 2016, 1:17pm EST
As the threat of cyber attacks hangs over the healthcare industry, providers increasingly understand that lost laptops or other data memory devices are no longer the greatest breach threat.
The most worrisome threat now is social engineering by hackers to trick employees into giving access to an organization’s information network, said Chris Bowen, founder and chief security officer at cloud-hosting and security services firm ClearDATA, during an interview at HIMSS16. “We’ve seen an uptick in investments of social engineering simulations. If an employee clicks on a link they should not, it takes them to a training page.”
ClearDATA sells software to monitor compliance with encryption, access control, back-up, patching, login system log retention and security screening policies, among others. While employees are the biggest threat to an organization’s network, they also can be the best defense, said Scott Whyte, a senior vice president at ClearDATA and former IT leader at Phoenix Children’s Hospital and Dignity Health.
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CIO says VA should rethink VistA, consider other off-the-shelf EHRs
In reaction to GAO recommendations, the department’s undersecretary for health also said the agency is challenging all of the assumptions that have made VistA an underperforming part of the department.
March 07, 2016 11:24 AM
U.S. Department of Veterans' Affairs CIO LaVerne Council said last week that the VA needs to reconsider whether its proprietary Veterans Information Systems and Technology Architecture is the best electronic health record for its more than 1,200 healthcare sites.
Council explained during testimony to U.S. House appropriators that changes in the VA's healthcare delivery plan, such as emphasis on mobility, security and women's health, as well as connections with private sector providers, are forcing the reconsideration of VistA.
Specifically, Council said it was time to "take a step back" from the planned modernization of the VistA health record and announced VA plans to review whether it should continue upgrading VistA or turn to a commercial off-the-shelf product, much the way the Department of Defense elected to forego its in-house Armed Forces Health Longitudinal Technology Application, aka AHLTA, and is replacing it with a Cerner EHR.
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Elderly black, Latino patients less likely to use health organization's online portal
March 7, 2016 | By Katie Dvorak
Patients who are over the age of 69 and black or Latino are less likely to use a health organization's online patient portal, and organizations that serve elderly populations should be aware of such disparities, according to a recent study.
Researchers at Kaiser Permanente locations in California and Oregon found that adults older than 69 were "significantly" less likely to have access to a patient portal, according to the study published in the Journal of Medical Internet Research (JMIR). Older patients who did have portal access were less likely to use the tool to send messages, view lab results and refill prescriptions.
The study also found that black and Latino consumers were less likely to use a portal. Only about 26 percent of black members between the ages of 75 and 79 used a portal once, compared to about 56 percent of non-Hispanic white patients.
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Adoption of Health Apps, Wearable Devices Grows
An Accenture report found that the vast majority of consumers and doctors believe wearables help patients engage in their health.
The number of U.S. consumers using wearables and mobile apps for managing their health has doubled from 16 percent in 2014 to 33 percent today.
The findings are part of a seven-country Accenture survey of roughly 8,000 consumers, including 2,225 in the United States.
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National Quality Forum: 3 considerations for health IT & patient safety
March 04, 2016
The National Quality Forum has released a new report outlining guidance on safe use of health IT.
The report was created by a NQF panel of 22 health IT and patient safety experts. The committee highlighted these three high-level concepts for health IT users to consider when creating health IT patient safety measures:
• Safe health IT. Ensure health IT is accessible to all members of a care team, and ensure data are secure, accurate and complete.
• Using health IT safely. Ensure health IT features and functionality are effective and implemented as intended. Also put in place processes for safe use of health IT.
• Improving patient safety. Use health IT to reduce patient harm and improve patient care.
• Using health IT safely. Ensure health IT features and functionality are effective and implemented as intended. Also put in place processes for safe use of health IT.
• Improving patient safety. Use health IT to reduce patient harm and improve patient care.
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Enjoy!
David.
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