Saturday, August 27, 2016

Weekly Overseas Health IT Links – 27th August, 2016.

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.

Patients at risk of ransom from hackers with stolen medical records

Patrick Fazio
6:11 AM, Aug 16, 2016
KANSAS CITY, Mo. - Millions of stolen medical records are up for sale online and hackers are no longer just using that information for identity theft, they’re now blackmailing patients for money.
This is happening worldwide and reports about similar incidents have been made in China and the U.K. after a California hospital paid a ransom earlier this year.
A service provider for Blue Cross and Blue Shield of Kansas City was also recently hit with a data breach where more than 400,000 Missouri members may have had their member information potentially exposed. No health plans’ systems were accessed or affected in any way, according to the Department of Insurance, Financial Institutions and Professional Registration. 
41 Action News uncovered at least 159 million patient records had been breached in the past.  

3 ways precision medicine can improve population health

Aug 19, 2016 11:44am
A lot is riding on the White House’s precision medicine initiative, but if it achieves its potential, it could considerably improve population health, argues a JAMA blog post.
While the initiative has been hailed as a "turning point" and has the support of a majority of people, it may fail to move the needle on population health for a few key reasons, write Muin J. Khoury, M.D., Ph.D., of the Centers for Disease Control and Prevention, and Sandro Galea, M.D., of Boston University School of Public Health. Not only is pathogenesis considerably complex, particularly for non-communicable diseases, but identifying predictors of diseases to guide interventions is unlikely to be effective for most complex diseases. Furthermore, the success of the initiative requires high-risk patients to change their behavior in response to learning of health risks, but available data suggests patients can’t be relied on to do that.
No uniform legal approach to telehealth; concerns about reimbursement limit implementation
THURSDAY, Aug. 18, 2016 (HealthDay News) -- Telehealth technologies can allow delivery of high-quality care at a lower cost, especially in underserved areas, but there is currently no uniform legal approach to telehealth, hampering its provision, according to a Health Policy Brief published online Aug. 15 in Health Affairs.
Noting that 20 percent of Americans live in areas with shortages of physicians and health care specialists, Tony Yang, from George Mason University in Fairfax, Va., discusses the use of telehealth and the legal issues pertaining to its use.
Yang notes that telehealth can improve access to health care in populations that are underserved, such as rural areas. Areas of concern about telehealth include fears of breakdown in the health professional-patient relationship, problems with quality of health information, and organizational complications.

Prescription for ER overuse: Engage patients in EHR data and health information exchange

A pair of population health programs are already reducing non-emergent visits to emergency departments in Louisiana. At the heart of that success are patients tapping technologies and data to manage their health.
August 19, 2016 07:58 AM
Louisiana Health Care Quality Forum communications manager Jamie Martin credited a marketing campaign with driving patient awareness about what they can do with EHRs, health data and patient portals.
Louisiana is known as being woefully behind when it comes to healthcare. But in the realm of population health, it is making some serious progress. The state, in fact, launched both a direct-to-consumer patient engagement campaign and a health information exchange-enabled emergency department data registry.
Consequently, in one year the state has realized a 23 percent increase in health IT utilization among at-risk patients and a 10.2 percent decrease in non-emergent utilization of emergency departments among members of one of the state’s Medicaid MCOs.

Analyzing records to assess patient well-being

Published August 17 2016, 7:01am EDT
HealthPartners, an integrated provider and insurance healthcare organization serving Minnesota and Wisconsin, is creating a measure of patient well-being to encourage physician conversations with patients about their overall life satisfaction.
Measuring patients’ perceptions of the quality of their lives is an important barometer of future health, says Tom Kottke, MD, a cardiologist and senior clinical investigator at Health Partners. Even people whose health is good and are doing well financially can be unhappy or dissatisfied with aspects of their lives, and that can have medical consequences over time. “What we know is that being healthy and wealthy doesn’t necessarily contribute to well-being,” Kottke adds.
For two decades, HealthPartners has been analyzing clinical and claims data to improve how the organization conducts preventive care, manages chronic disease, and promotes healthy behaviors to improve medical outcomes.

iPatient Emis integration complete

Ben Heather
16 August 2016
iPatient has been approved as the first patient facing softward available under the GP Systems of Choice contracts.
Brian Fisher, co-director of health software company PAERs, said final approval to “pair” iPatient with the Emis Health’s primary GP system was granted by NHS Digital last week.
This means that iPatient, a patient record and communication software, is available to patients across any GP practices using the Emis Web system. Emis Health says it covers 54 of the GP market.

Tinder hooks 200,000 people up to online health - report

17 August 2016
More than 200,000 people have been through the Government’s flag ship attempt to improve digital health skills, a self-evaluation by the charity involved says.
The self-assessment, published last month, studied the Widening Digital Participation Programme that was run by NHS England and the Tinder Foundation from July 2013 to April 2016.
The report said the scheme trained 221,941 people in digital skills, and in its final year this training led to 21% making fewer visits or calls to their GP and 6% making fewer trips to A&E. The report claimed these behavioural changes could save the NHS £6 million a year in avoided GP and A&E visits.

Majority of healthcare leaders elevating cybersecurity as a priority, according to HIMSS

But many say lack of financial resources and personnel is hindering better security practices.
August 18, 2016 11:06 AM
As cybercriminals continue to assault the healthcare industry, most health executives are elevating data security as a business priority, according to the 2016 HIMSS Cybersecurity Survey, released Tuesday.
Eighty-five percent of the report's 150 surveyed IT security leaders are increasing cybersecurity awareness, motivated by potential phishing attacks (80 percent of acute care providers, 65 percent non-acute); viruses or malware (68 percent acute, 65 percent non-acute); and risk assessment results (64 percent acute, 77 percent non-acute).
But there are serious barriers inhibiting better cybersecurity practices. About 71 percent of non-acute care and 50 percent of acute care respondents pointed to a lack of financial resources, while about 60 percent of respondents pointed to a lack of cybersecurity personnel.

Does healthcare need a more modern way to define and measure EHR interoperability?

For the meaningful use and MACRA, the government uses an IEEE description of interoperability that pre-dates today's crop of EHRs. Whether that will carry the healthcare industry into the future, or not, is a matter of some debate. 
August 18, 2016 07:28 AM
KLAS executive vice president Taylor Davis said that measuring interoperability can get messy because the EHR market is currently immature. 
Industry experts and the federal government are divided on the best way to assess the state of the nation’s health IT interoperability.
The Office for the National Coordinator for Health IT, for instance, has proposed using CIO surveys to gauge the status of interoperability among and between healthcare organizations.
To that end, ONC posted a Request for Information (RFI) on how to best assess interoperability that closed last month — just not before drawing some sharp comments from across the industry.

Editor's Corner: Why are EHRs being left in the evolution dust?

Aug 17, 2016 10:53am
Would someone please explain why electronic health record development is still struggling?
Just look at some of this past week’s headlines.
First, the good news. After a rocky start, health information exchanges (HIEs) appear to be proving their worth. A new study in the Journal of the American Medical Informatics Association found that where clinicians in an emergency department asked for outside patient data from an HIE, they not only received the information faster than by fax or scan and were more likely to read it, but they also were able to capitalize on the information, reducing the length of the ED visit, the likelihood of imaging, the need for admission and even the cost of the treatment.  While less than 20 percent of the requests came via the HIE, had all outside information requests been fulfilled in that manner, researchers said the benefits would have increased five-fold. This really demonstrates that health IT and data exchange can improve patient health and reduce the costs of healthcare.

Survey shows most people support Precision Medicine Initiative

Aug 18, 2016 10:38am
It may seem like a daunting task to get 1 million people to share their health data for the Precision Medicine Initiative Cohort Program, but a new survey shows that most patients approve of the program.
Nearly 80 percent of the 2,600 participants surveyed by the National Institutes of Health said they support the program and 54 percent said they would “definitely” or “probably” take part in it. The survey also found that there were no “significant differences” in support when participants were broken into demographic groups such as gender, age, race or ethnicity.
The survey results are “extremely promising,” study author Kathy L. Hudson, Ph.D., deputy director for science, outreach and policy at NIH, said in an announcement. She said that “they show that after people learn about the PMI Cohort Program they’re supportive, and they recognize the value in taking part.”

HIT Think How the Internet of Things will pose new data pressures for providers

Published August 17 2016, 2:59pm EDT
What will health care look like in 2025?
Picture this: moment by moment, an abundant network of apps, sensors and devices produces patient-generated health data (PGHD) are helping providers to better manage chronic diseases, adjust treatment plans and keep patients healthy.
Patients, no longer reliant on visiting a “brick and mortar” health facility, are monitored and treated virtually in their homes, while feedback from their PGHD inspires them to adopt healthier habits and become active partners in their care. Advanced, real-time analytics give providers continuous knowledge to improve patient outcomes, clinical protocols and population health.
It’s a picture we’re swiftly catapulting toward.
Accelerating the blazing speed of change is the Internet of Things (IoT), or in healthcare, the Internet of Healthcare Things (IoHT)—the vast world of Web-enabled devices and the people connected to them. From wearables and implantables to ingestible sensors, smartphone apps to home monitoring systems, the IoHT facilitates data gathering, analysis and sharing, creating an intricately connected health care cosmos, one that’s ready to revolutionize patient care.

Digital health technology not popular among seniors

Published August 16 2016, 3:05pm EDT
Seniors might be the sickest, most expensive and fastest growing segment of the U.S. healthcare population, but they are not embracing digital health technology.
That’s the finding of David Levine, MD, a researcher in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital in Boston, and his colleagues, who found that there is a low rate of Internet use for health purposes by Americans over age 65.
“There’s a lot of hype in industry, government and academia about the power of digital health tools,” says Levine. “People point to them as almost magical tools for seniors and older adults.”

Using big data to smooth patient flow

Aug 17, 2016 11:03am
For Wake Forest Baptist Health in North Carolina, big data analytics has helped smooth traffic flow at its hematology-oncology clinic, according to an article at HealthITAnalytics.
The hospital usually had a crush of patients between 10 a.m. and 2 p.m., but few people in its 43 treatment chairs during other hours.
“During those high-capacity hours, it’s almost like working in a fast food place when someone drops off a busload of customers,” Karen Craver, clinical practice administrator, said in the article. It's a situation that left patients waiting and staff members stressed, he said.

5 steps to cybersecurity for Internet of Things medical devices

Forrester Research offers insight into best practices to prevent criminals from wreaking havoc as IoT innovation outpaces medical device security.
August 17, 2016 07:06 AM 
The healthcare industry is plagued with data breaches and other cybersecurity nightmares. At the same time, connected medical devices – components of the so-called Internet of Things – are multiplying, opening more holes in security and creating terrible potential for patient casualties.
Without doubt, unsecured medical devices currently are putting hospitals and patients at risk, according to “Healthcare’s IoT Dilemma: Connected Medical Devices,” a new report from Forrester Research analyst Chris Sherman.
“You have less control over connected medical devices than any other aspect of your technology environment,” the report said. “Many times, vendors control patch and update cycles, and vulnerabilities persist that require segmentation from your network. Considering that many of these devices are in direct contact with patients, this is a major cause for concern.”

New FHIR-based genomics API promises to accelerate precision medicine

By helping spot gene-based drug interactions, Translational Software says the interface could spur more routine clinical use of genomic data.
August 17, 2016 09:31 AM 
Translational Software CEO Don Rule said the new API can be used to integrate testing into clinical workflows and overcome that barrier to the common use of pharmacogenomics. 
Translational Software, a Bellevue, Washington-based developer of clinical decision support tools, has unveiled an application programming interface to help providers, labs and technology vendors to speed development of precision medicine-focused apps.
The API, developed using HL7's open source Fast Healthcare Interoperability Resources specification, can query the company's platform, powered by First Databank, for data on drug-drug-gene interactions – alerting clinicians to potential adverse interactions.

Physicians speak out against EHR 'shackles' in JAMA commentary

Written by Max Green | August 16, 2016
Physician dissatisfaction with EHRs is not news at this point. Complaints about integrating the technology into practice and whether they add anything meaningful to the patient experience and care delivery process have been flying since the ONC first incentivized adoption. But after a few years into life with EHRs, physicians are able to pinpoint with more precision exactly what isn't working with the technology.
"At present, the spectacular effects of computers in science and in the secular world are not reflected in the EHR, which for physicians remains burdensome, all-consuming, and far from intuitive; this is not surprising, when the dominant EHRs are designed for billing and not primarily for ease of use by those who provide care," the authors of a commentary in the Journal of the American Medical Association wrote this week.

Docs equate EHRs to 'shackles,' say they hurt morale

Aug 16, 2016 1:14pm
Physicians are dependent on electronic health records for diagnosing, monitoring and treating patients, but the systems are rife with shortcomings, particularly in the increasingly complex world of medicine, according to a new viewpoint article in the Journal of the American Medical Association (JAMA).
The article, written by doctors from the Stanford University School of Medicine and VA Palo Alto Health Care System in Menlo Park, California, note that while EHRs have benefits, such as clinical decision support, they have not kept up with technology used to track, synthesize and visualize information in other areas of modern life. For instance, they say, while EHRs and algorithms using EHR data can identify patients at risk for certain conditions, most systems don’t integrate that information in a way that supports tailored treatment decisions based on the individual patient. EHRs also don’t include social and behavioral factors needed for a patient’s treatment response and health outcomes, the authors write, such as unique stressors at home.

JAMA: EHRs aren't keeping up with evolution of other technologies

Stanford clinicians shine a light on how today's products are missing out on big opportunities.
August 19, 2016 10:53 AM
Use of electronic health records has come a long way in the past decade. But so has the ubiquity and maturity of many technologies. A new report in the Journal of the American Medical Association, in fact, argued that EHRs need to play catch-up to make the most of other data management advances.
As tech-savvy strategies for diagnosis, monitoring and treatment have become commonplace, EHRs aren't always able to capitalize on the ways they can help improve care, wrote the authors, Donna M. Zulman, MD, Nigam H. Shah and Abraham Verghese, MD, all of the Stanford University School of Medicine.
"The EHR has many virtues: It supports arduous and time-intensive tasks such as order entry and medical history review, and most systems routinely alert clinicians if they prescribe medication combinations that might cause harm," they noted. "But the evolution of EHRs has not kept pace with technology widely used to track, synthesize, and visualize information in many other domains of modern life. 

FBI Agent to CHIME Attendees: The Cybersecurity Environment Is Becoming More Dangerous

August 15, 2016
by Mark Hagland
FBI Agent Timothy J. Wallach shared with CHIME/AEHIS LEAD Forum attendees some of the latest disturbing trends
The level of cybersecurity threat is growing exponentially in healthcare right now, but there are some very clear strategies that the leaders of patient care organizations can and should do in order to fight back. That was the core of the message that Timothy J. Wallach, a supervisory special agent in the Cyber Task Force in the Seattle Field Office of the Federal Bureau of Investigation (FBI) told attendees Monday morning at the CHIME/AEHIS LEAD Forum Event, being held at the Seattle Marriott Waterfront in Seattle, and sponsored by the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) and by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under the Vendome Group, LLC umbrella).
Supervisory Special Agent Wallach began his presentation on Monday morning by discussing the main groups that pose threats to healthcare IT security and to IT security across industries. There are six main groups and sources of threats: hacktivists; cyber-criminals; insiders; espionage; terrorism; and warfare, he noted. Hacktivists are low-level threats primarily motivated to deface websites and initiate DDOS (distributed denial of service) attacks against entities they are politically opposed to. Insiders are individuals within organizations who either purposefully or inadvertently expose their organizations to breaches and cybercriminality. Terrorists are beginning to consider how they might use technology to attack potential targets. And warfare involves actual nations waging war on each other. The two biggest threats by far, he said, are cybercriminals and those involved in cyber-espionage—including hostile foreign governments.

Precision medicine: Analytics, data science and EHRs in the new age

The promise of genomics and personalized care are closer than many realize. But clinical systems and EHRs are not ready yet. While policymakers and innovators play catch-up, here’s a look at what you need to know. 
August 15, 2016 07:05 AM 
Considering how fast technology advances in the healthcare industry, it seems natural that a once-innovative concept could become obsolete in the span of, say, a dozen years. Knowledge, comprehension and capabilities continue moving forward, and if the instruments of support don't keep pace, it can cause a rift to appear. If nothing is done, it can exacerbate into a seismic event.
Some contend that this situation exists with the rapid advancement of precision medicine continually outstripping the static state of electronic health records. Medical research is forging ahead with genomic discoveries, while EHRs remain essentially the same as when the Office of the National Coordinator for Health Information Technology launched the interoperability initiative in 2004.
Over that time, healthcare provider IT teams have worked tirelessly at implementing systems with EHR capability and towards industry-wide interoperability. If the relationship between science and infrastructure has hit an inexorable bottleneck, what are the reasons for it?

EHR use, practices hinder patient safety improvement research

Aug 15, 2016 3:27pm
While electronic health records hold a lot of data that could improve patient safety, barriers remain that hinder patient safety improvement research, according to a study published recently in Elsevier.
The researchers, from the Michael E. DeBakey VA Medical Center in Houston and elsewhere, investigated the ability to research EHRs for patient safety using a case study of the delay/missed follow-up of abnormal test results at three private healthcare systems that use commercial EHR-based test result communication systems.

Machine learning leads researchers to more accurate cancer diagnoses

Aug 16, 2016 10:24am
The amount of data in pathology images has previously been too vast for researchers to process easily, but that's changing thanks to advanced machine learning.
A group of researchers from Stanford University were able to more accurately predict lung cancer prognoses by grabbing images from the Cancer Genome Atlas from patients with the disease, and then through those train a computer software program to pinpoint characteristics in the images previously unable to be seen by the human eye, according to an announcement. Their research was published in Nature Communications.
Once the researchers could home in on those specific characteristics, they were able to figure out the cancer subtype, as well as how long a patient would live with that diagnosis.

HIT Think Why data and analytics aren’t enough to change healthcare

Published August 16 2016, 2:37pm EDT
Healthcare operations are undergoing change as dramatic as the discovery of penicillin to treat bacterial infection or hand washing to reduce patient mortality. The opportunity to use data to improve efficiency and drive innovation is within reach for most hospitals.
Every other major industry from shipping (UPS, Fedex) to retail (Amazon, Walmart) and airlines (United, American) has been revolutionized by their data operations. Data helps these industries know how many trucks to deploy, how much inventory to order and how to plan for unpredictable weather or traffic.
Now that hospitals have updated to their first and even second generation electronic health records, the data exists for a similar revolution in healthcare administration. All that remains is the will to change.

4 EHR Best Practices for Improving Clinical Workflows

By Sara Heath on August 15, 2016

Although EHRs are a point of debate, it is important for users to understand how to leverage them to improve clinical workflows.

EHR systems and their ability to improve clinical workflows is a heated point of debate between different healthcare professionals. Some believe EHRs are critical for improving clinical workflows while others say they are a hindrance.
Despite this debate, it is critical to understand how EHR use can work to improve a healthcare practice. After all, most of the industry is using these tools, with adoption up to nearly 100 percent. While providers either love or hate EHRs, it is clear that these technologies are not going anywhere.

Solving a State's Interop Challenge, Differently

Scott Mace, August 16, 2016

How the South Carolina Medical Association and the Medical Association of Georgia plan to leverage the health information exchange built by the state of Kansas.

State health information exchanges continue to fall short of their potential to make exchanging medical records more like a utility and less like a computer science problem.
Despite recent HIE discord in neighboring Missouri, Kansas's HIE has not only thrived, it is exporting the technology to other states, notably Georgia and most recently South Carolina.
Most interestingly, the move, both in Kansas and in Georgia and South Carolina, is spearheaded by medical associations.

Quest application automates a popular test for cognitive health

Published August 12 2016, 7:20am EDT
Quest Diagnostics has developed a digitized version of the Memory Orientation Assessment Test, called MOST, to assess patients with cognitive dysfunction, such as Alzheimer’s disease or dementia.
The product is CogniSense, which integrates assessment results into a patient’s electronic health record, where disease progression can be tracked over time, says Edward Ginns, MD, a practicing neurologist and medical director of neurology at Quest.
The initial target audience is primary care providers, because they are most likely to intervene early in the course of a disease, when early intervention has a better likelihood of achieving a better outcome.

National Coordinator for Health IT Vindell Washington: 9 things to know about the new ONC chief

The sixth ONC leader is a longtime proponent of health IT and information exchange.
August 15, 2016 11:16 AM
This past Friday, Karen DeSalvo, MD, officially stepped down as National Coordinator, passing the baton to her second-in-command, Vindell Washington, MD. The former principal deputy national coordinator has been with ONC since January 2016.
As National Coordinator, Washington will continue working toward the goal of leveraging health IT to reform care delivery and empower clinicians with research and innovation, Health and Human Services Secretary Sylvia Burwell said in a statement.
As Washington settles into this new job, here are nine things to know about him.
1. As principal deputy national coordinator, Washington worked on delivery system reform, the opioid crisis and President Obama's Precision Medicine Initiative.

How to tackle privacy, security challenges of a national HIE

Aug 15, 2016 6:56am
Creating a national health information exchange will require building a workable framework for privacy and security, then training those who work with the data in a way similar to that of a multinational corporation that deals with sensitive information, Valita Fredland, the new privacy officer of the Indiana Health Information Exchange, says in an interview.
One of the biggest challenges for organizations using big data to build profiles and predictive models is ensuring they understand the regulations and restrictions on each of the data elements, she tells
The patchwork of state and federal laws, as well as restrictions on sharing different types of data, such as teens’ information, mental health and substance abuse data, can seem to prohibit efficient data-exchange, she notes.

Clinical Workflow Progress Vital to Boost Health IT Quality

By Sara Heath on August 12, 2016

78 percent of healthcare quality experts say improved clinical workflow is vital for improving health IT technology quality.

For 78 percent of healthcare quality experts, improved clinical workflow and efficiency are the keys to boosting health information technology quality.
In a recent survey conducted by the American Society for Quality (ASQ), healthcare quality professionals noted the steps toward ensuring better health IT quality. In addition to designing more efficient clinical workflows, 71 percent of the 170 survey respondents stated that healthcare organization leaders need to better foster IT initiatives.

Top 3 Challenges Limiting Patient Access to Health Data

By Sara Heath on August 11, 2016

Patients may struggle to access health data because of underutilized patient portals, ambiguous security protocols, and lack of health IT interoperability.

Patient access to health data is an important component of patient engagement because it empowers patients with knowledge about their conditions and incorporates the patient as a partner in care.
Access to health data isn’t only good for improving care. It also drives patient satisfaction. According to a data set from the Office of the National Coordinator for Health IT, eighty percent of patients with access to health data found it  useful to review their information.

HIT Think How ONC’s experience can apply to reform efforts

Published August 15 2016, 2:38pm EDT
It was an interesting assignment—reviewing the roles that the six national coordinators have played in leading ONC.
The current transition from Karen DeSalvo, MD, to Vindell Washington, MD, seems like an apt time to take stock of the role that this important office has played in getting electronic health records widely deployed in healthcare organizations.
The role has only been in existence for a dozen years, and even that seems hard to believe—hasn’t it always been there? It’s equally hard to remember how ecstatic the healthcare IT industry was when President George Bush briefly mentioned electronic health records in his State of the Union address in 2004, which was the forerunner of the call to create ONC.

Let’s Get Serious About Data Interoperability

Jack Cox MD, August 15, 2016
The U.S. Department of Health and Human Services has set a target of attaining data interoperability by 2024, and we need to get serious about it. There are many benefits for having our nation’s electronic health information systems seamlessly share data, including improved quality of care, greater health care efficiencies and more convenience for patients as they navigate among various health care networks. Yet, this goal of having systems truly “speak the same language” may be difficult to achieve, especially given where we are today.
Significant gaps still exist for health care before our data can truly be shared.  Why has progress been so frustratingly slow? Let’s go back several years when health systems first began purchasing and implementing their electronic health record (EHR) systems. In those early days of EHR, replacing paper records and adoption of new electronic systems among clinical staff was our big concern–not interoperability across health systems. Most of the EHRs we purchased were not designed as open systems that could pull in information across multiple providers. These systems were created to coordinate care within a distinct ecosystem, and at the time, that in itself, seemed a good thing.


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