Saturday, October 15, 2016

Weekly Overseas Health IT Links – 15th October, 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.

Charlotte hospitals analyze social determinants of health to cut ER visits

The North Carolina city tapped analytics tools to help hospitals better serve an influx of immigrants in the community by understanding the patients on both individual and system levels.
October 06, 2016 06:55 AM
Michael Dulin, MD, said that using a Big Data analysis model enabled officials to better engage patients and increase primary care usage.
When Charlotte, North Carolina, experienced an unexpected increase in the Hispanic immigrant community, among the consequences of this influx was an increase in preventable emergency room visits at local hospitals.
It’s a common situation: Immigrants lacking insurance often show up at emergency rooms for what amounts to primary care. So if the health of the Charlotte population was going to be effectively managed, something had to be done about this ER emergency.

Pediatric hospitals show wide gap in EHR safety performance

Published October 07 2016, 6:57am EDT
While pediatric hospitals using computerized physician order entry and clinical decision support in electronic health record systems are able to intercept a majority of potential medication errors, researchers have found that these healthcare organizations vary widely in their safety performance.
Children are particularly vulnerable to medication errors, which is why hospitals have been leveraging CPOE with associated clinical decision support in their EHRs to reduce medication errors and subsequent adverse drug events, according to the researchers.
“Use of CPOE for hospitalized children has demonstrated a reduction in some types of medication errors, but results have been variable,” they contend in a recent article published in the Journal of the American Medical Informatics Association.

Successfully managing a large scale IT project

By Carrie Armitage, director, Armitage Associates
So, you’ve been put in charge of a large information technology project, but I bet everyone is saying: “This isn’t an IT project, it’s a business change project”. I like to think these are two sides of the same coin. You can’t do one without the other. So a successful project that has technology at its heart needs to have:
  • IT that works. There is no getting away from this. It has to be fast, responsive, and always available. To accomplish all that is an “IT project” and you need to make sure you have a team with the right technical skills and understanding to deliver.
  • Users committed to changing the way they work, so as to get the best from the new computer system. You need people on your team who understand how the clinical service is delivered and can talk the same language as the users. You also need senior management and clinical management who are prepared to back you when the new system requires changes to current working practices.
As a chief information officer, you’ve got to be the translator between these two groups. You also need to take into account several key considerations at each stage of the project.

Precision medicine, Blue Button high priorities in Open Government plan

by Dan Bowman 
Oct 7, 2016 12:41pm
The Precision Medicine Initiative Cohort Program and a pilot of the display of Quality Ratings Systems star ratings for marketplace health plans that begins next month are among the seven new flagship initiatives outlined in the latest version of the Health and Human Services Department’s Open Government Plan.
In the plan (.pdf), unveiled Thursday, HHS says that the initiatives represent advances in financial reporting, digital strategies and open source code that help to drive modern technology adoption.
“We’re seeking new approaches to connect with underserved communities to share ways HHS can help them have the building blocks for healthy and productive lives,” HHS Acting Deputy Secretary Mary Wakefield, Ph.D., R.N., says in a blog post promoting the plan. “Many of these efforts come in the form of making data and information products available to the public.”

Can You Put a Dollar Amount on Your Company’s Cyber Risk?

October 05, 2016
Cyber breaches are one of the most likely and most expensive threats to corporations. Yet few companies can quantify just how great their cyber risk exposure truly is, preventing them from effectively protecting themselves.
Most managers rely on qualitative guidance from “heat maps” that describe their vulnerability as “low” or “high” based on vague estimates that lump together frequent small losses and rare large losses. But this approach doesn’t help managers understand if they have a $10 million problem or a $100 million one, let alone whether they should invest in malware defenses or email protection. As a result, companies continue to misjudge which cybersecurity capabilities they should prioritize and often obtain insufficient cybersecurity insurance protection.
No institution has the resources to completely eliminate cyber risks. That means helping businesses to make the right strategic choices regarding which threats to mitigate is all the more important. But right now, these decisions are made based on an incomplete understanding of the cost of the various vulnerabilities. Organizations often fail to take into account all of the possible repercussions, and have a weak grasp of how the investments in controls will decrease the probability of a threat. It’s often unclear whether they are stopping a threat or just decreasing its probability — and if so, by how much?

AHIP, Blues push Congress to lift ban on patient identifier

By Joseph Conn  | October 6, 2016
The leaders of nearly two dozen healthcare industry organizations want Congress to continue to push for lifting an 18-year-old ban that prevents HHS from developing a national patient identifier.
The Healthcare Information and Management Systems Society, payers such as America's Health Insurance Plans and the Blue Cross and Blue Shield Association, providers Intermountain Healthcare and the Nemours Children's Health System, prescription drug network Surescripts and the College of Healthcare Information Management Executives were among the 22 groups to sign a letter (PDF) sent to the chairs and ranking members of the House Appropriations Committee and its Labor, Health and Human Services, Education and Related Agencies Subcommittee.
The letter asks the committee to “develop a coordinated national strategy that will promote patient safety by accurately identifying patients to their health information.”

10 things Zimbabwean startups need to consider when developing Electronic Health Record (EHR) solutions

Posted 10 hours ago by Dr Marlon-Ralph
At the centre of good e-Health practice is the Electronic Health Record (EHR). We have witnessed a lot of discussion around Telemedicine and mHealth services but to fully unpack the benefits of eHealth we have to also mature electronic patient information systems.
The Ministry of Health is implementing the SAP Healthcare application for its central hospitals. As a result, Chitungwiza Central Hospital is on a sure path towards paperless operation.
However, EHR adoption and utilization is still low in the many GP practices, specialist rooms, clinics and hospitals in the private sector.

Caldicott 3: Easy to say, hard to do?

Dame Fiona Caldicott’s latest report wanted a ‘simple’ way for patients to have their data opt-out wishes recorded across the health and care system. As Jennifer Trueland discovers, finding a technical solution to do that may be anything but.
Launching her latest report into data security in the NHS, national data guardian Dame Fiona Caldicott kept coming back to one word: simple.
Speaking at The King’s Fund, she said she wanted a new “simple” model for consent and opt-outs, giving people a “simple choice”. But just how simple would it be to set this up, IT wise?
What Dame Fiona appears to envisage is a flagging system, evident across the health and care system, that can be changed at any time, and that makes it clear to patients what will happen to their data.
This would, presumably, mean that if a patient tells her GP that she does, or doesn’t, want her data shared for particular purposes, this choice would be apparent wherever else she turned up, be that in hospital or in the community service. Oh, and that any health professional could amend that choice across the whole record as the patient wishes.

5 ways to ensure the EHR doesn’t hurt the patient-doc relationship

by Aine Cryts 
Oct 5, 2016 11:56am
There’s no way around it. As a result of practices’ involvement in accountable care organizations and the implementation of the Affordable Care Act, capturing patient data in the electronic health record (EHR) is here to stay. Thus, physicians and patients have little choice but to make room for the computer in the exam room.
Still, there are ways doctors can accommodate the computer during the patient visit without disrupting their interactions with patients, according to Medical Economics
Reviewing the patient record before entering the exam room and explaining the value of the EHR are two ways doctors can prevent the computer from disrupting their face time with a patient, as previously reported by FiercePracticeManagement.

Low health literacy a potential hurdle to consumer HIT adoption

Oct 6, 2016 11:06am
Low health literacy may pose a barrier to adoption of health IT, as well as perceptions of ease of use and usefulness of such tools, new research out of the University of Texas at Austin finds.
For the study, researchers asked 4,974 adults about their experience and perceptions for four types of health IT tools: fitness and nutrition apps, activity trackers and patient portals. They also gauged participants' perceptions of privacy offered by the tools, as well as their trust in institutions such as government, media and healthcare.
Not surprisingly, users with lower health literacy were less likely to use these tools, according to the research published online in the Journal of Medical Internet Research. It echoes previous research indicating that the poor may need extra help with online health resources.

Wearables unlikely to increase physical activity

by Dan Bowman 
Oct 6, 2016 12:44pm
Just weeks after researchers called into question the effectiveness of wearable activity trackers to help users lose weight, a new study claims that such tools are unlikely to help even increase activity.
For the study, published this week in The Lancet Diabetes & Endocrinology, researchers from the Duke-NUS Medical School in Singapore recruited 800 individuals, equipping roughly 600 with Fitbit Zip trackers; 201 were assigned to a control group and 203 to a Fitbit only group, while 197 were told to use the tracker and promised a weekly cash reward for activity for six months. The remaining 199 were told to use the tracker and were promised a weekly reward for six months for activity that would go to charity. Activity was measured at the end of the intervention at six months and again at 12 months.
The researchers found that while cash helped increase “moderate-to-vigorous physical activity” through the first six months, that increase did not last. They also determined that despite the increase in steps, the activity trackers failed to produce noticeable health improvements.

Telemedicine to attract 7M patient users by 2018 — 12 statistics on the thriving market

Written by Megan Wood | October 05, 2016 |
Telemedicine continues to gain traction in the healthcare industry, offering a convenient, integrated experience for patients.
Jackson Healthcare gathered surveys and data on a broad range of topics relating to U.S. physicians, including telemedicine practices, in its "Physician Trends 2016 Report."
Here are 12 key statistics about telemedicine:
1. The global telemedicine market is anticipated to grow at a compound annual growth rate of 14.3 percent between 2014 and 2020, based on a Nathaniel Lacktman, Esq. Healthcare Partner, Foley & Lardner report.
2. The market value is set to hit $36.2 billion by 2020, up from $14.3 billion in 2014, according to the report.
3. In 2015, 42 states proposed a total of more than 200 pieces of legislation addressing telemedicine, according to the State Health Telehealth Laws and Reimbursement Policies Report, April 2016.

IBM to invest $3 billion to groom Watson for the Internet of Things

As part of the project, Big Blue will spend $200 million on a global Watson IoT headquarters in Munich
October 04, 2016 10:06 AM
IBM executives say there is escalating demand from customers for IBM Watson to work on IoT.
If there were any doubts that IBM would put its cognitive computer Watson to work on the Internet of Things, it would be tough to argue now.
IBM announced October 3 that it would not only put Watson to work on IoT, but would also ante up $200 million of a $3 billion total investment – the most IBM has ever spent in Europe – to open a new global headquarters in Munich for Watson's IoT business. The goal is for Watson to develop new IoT capabilities around Blockchain and security.

Rethinking clinical documentation for the EHR era

'The voices of regulation, defensive medicine, billing and quality measure reporting have been so loud that the primary reason for documentation has been ignored.'
October 04, 2016 12:15 PM
"Eight years ago when I was seeing patients, I would dictate for 90 seconds after every patient in free text and communicate all care provided," said Shaun Grannis, MD. "Today, I fill-out a five-page template for a sore throat that no one wants to read, with details that providers often miss."
Shaun Grannis, MD, can relate to the recent study in the Annals of Internal Medicine showing that physicians spend 37 percent of their time on clinical documentation in their electronic health records.
"Eight years ago when I was seeing patients, I would dictate for 90 seconds after every patient in free text and communicate all care provided," said Grannis, interim director of the Center for Biomedical Informatics at the Indianapolis-based Regenstrief Institute.
"Today, I fill out a five-page template for a sore throat that no one wants to read, with details that providers often miss," he said.

Special Report: Business intelligence: population health management

There is growing interest in population health management, or aggregating data from multiple IT systems to change clinical service and financial outcomes. Lyn Whitfield asks why this is happening now, and hears the big driver is policy.
There is a shift underway in healthcare analytics. Certainly, there is still an important role for what might be called traditional business intelligence – surfacing, analysing, and reporting on the data held by specific systems, departments or organisations.
But interest is growing in what is called population health management – aggregating data from multiple systems hosted by different organisations, and using this to inform changes to clinical, service and financial outcomes.
Or, as Graham James, vice president of CACI, puts it: “We are seeing a move towards a wider range of data being collected and used to deliver health and social care in a different way.”

Special Report: Business intelligence: using PACS and RIS data

Imaging systems hold a wealth of data, and suppliers are increasingly working with trusts to make sure they can use it to improve efficiency and patient pathways. Kim Thomas reports.
Along with the picture archiving and communications systems used for storing images, radiology information systems are part of the standard toolkit of hospital radiology departments.
The RIS plays a critical role: handling referrals, making appointments, managing workflow and keeping a record of radiologists’ reports on imaging procedures.
As a result, it holds a rich repository of operational data that can show how efficiently the department is performing – how many films are unreported, for example, or which patients are regularly not attending appointments.

Personal, technical support may be key to increasing portal use by African Americans, Latinos

Oct 4, 2016 11:18am
Many African Americans and Latinos may be avoiding patient portals because they view them as hard to use and don’t want to lose out on face-to-face, personal time with their providers, a new study finds.
Patient access and use of portals are linked to better satisfaction and outcomes. However, it has become apparent that non-Hispanic whites use patient portals more often, leading to a potential digital divide and increase in health disparities. The researchers, from Kaiser Permanente and the University of California, San Francisco, sought to understand the specific barriers to portal use among African American and Latino patients; their work was published in the Journal of Medical Internet Research.
A total of 10 focus groups were held that included 87 Kaiser Permanente African American or Latino members from the Mid-Atlantic, Georgia and southern California who were not registered for Kaiser’s portal. All of the participants were current internet users.

Strong Patient Demand for Telehealth Motivated by Convenience

By Jennifer Bresnick on October 03, 2016

Patients are just as likely to ask for telehealth as providers are to offer it, according to a new survey released at the ATA Fall Forum last week.

The convenience factor is a major driver for patients investigating the use of telehealth to consult with their providers, according to a survey by the American Telemedicine Association and WEGO Health. 
The poll of 429 patients, conducted at the ATA’s Fall Forum Event in New Orleans, found that 22 percent of participants had used a video conferencing tool to communicate with their healthcare provider.  While half of those users said that their provider had offered a telehealth option to them, the other 50 percent had actively requested a remote consult with their clinician.
Tue Oct 4, 2016 | 3:58pm EDT

J&J warns diabetic patients: Insulin pump vulnerable to hacking

Johnson & Johnson is telling patients that it has learned of a security vulnerability in one of its insulin pumps that a hacker could exploit to overdose diabetic patients with insulin, though it describes the risk as low.
Medical device experts said they believe it was the first time a manufacturer had issued such a warning to patients about a cyber vulnerability, a hot topic in the industry following revelations last month about possible bugs in pacemakers and defibrillators.
J&J executives told Reuters they knew of no examples of attempted hacking attacks on the device, the J&J Animas OneTouch Ping insulin pump. The company is nonetheless warning customers and providing advice on how to fix the problem.

HIT Think Why healthcare quality metrics miss the mark for consumers

Published October 05 2016, 3:58pm EDT
Healthcare is falling victim to a classic misunderstanding about quality. When the “experts” in any industry define quality, they often use technical gee-whiz measures that can miss what the customer wants.
The title of a statement by the Agency for Healthcare Research and Quality (AHRQ) asked, “What is Health Care Quality and Who Decides?”. The statement goes on to say, “the Agency fulfills this mission.” A number of federal and state agencies have taken admirable strides toward collecting and using quality metrics, but do these truly measure healthcare quality? How will the best healthcare providers and payers build healthcare systems to deliver quality metrics during the coming five years?
AHRQ defines quality healthcare “as doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results.” To put their definition in action, National Committee for Quality Assurance (NCQA) developed the widely used Health Plan Employer Data and Information Set (HEDIS). The Centers for Medicare and Medicaid Services (CMS) has another stet of metrics it uses for measuring physician quality, the Physician Quality Reporting System (PQRS).

FDA’s medical device arm ramps up HIT strategies

Published October 03 2016, 7:08am EDT
The Food and Drug Administration’s Center for Devices and Radiological Health has released its regulatory science priorities for fiscal year 2017, which starts on October 1, with a heavy emphasis on health information technology.
The document from FDA’s Center for Devices and Radiological Health (CDRH)—which is responsible for assuring the safety, effectiveness, performance and quality of medical devices and radiation-emitting products used to treat, prevent, and diagnose disease—lays out its top regulatory science priorities for FY17.
“Health IT is critical to those strategic priorities in order to develop, generate and integrate high-quality evidence for regulatory decision-making,” says Bakul Patel, associate director of digital health in the Center for Devices and Radiological Health at FDA.

CEO Spotlight: Former ONC chief Farzad Mostashari on EHR shortcomings and pop health potential

Mostashari, now the chief executive at Aledade, discusses how technology must better address the needs of population health and ACOs, and wages a complaint against many EHR vendors.
October 03, 2016 02:54 PM
Farzad Mostashari, MD, has a unique vantage point over the health information technology industry. Previously he served as the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. Today he is founder and CEO of Aledade, a company that markets technology and services designed to help independent primary care practices come together to form accountable care organizations (ACOs) that can take on the total cost of care and share in value created.
Aledade operates ACOs across 11 states and handles nearly 100,000 patients in more than 110 physician practices. In June 2015, the company raised a Series B Funding Round of $30 million and now employs a staff of more than 80 experts in health policy, technology and practice transformation. This growth, the company said, is driven by the need of primary care physicians to begin the shift from volume-based care to value-based care with the aim of delivering better care at a lower cost.
Healthcare IT News spoke with Mostashari about about a variety of topics, from ACOs and technology trends to EHR shortcomings.

Physician Survey: EHRs Increase Practice Costs, Reduce Productivity

October 3, 2016
by Heather Landi
Three out of four physicians believe electronic health records (EHRs) increase practice costs, outweighing any efficiency savings, and seven out of 10 think EHRs reduce their productivity, according to a Deloitte’s recent 2016 Survey of U.S. Physicians.
The survey findings indicate that the majority of physicians hold negative perspectives on some aspects of EHRs, similar to a 2014 survey of physicians by Deloitte. However, the survey also found that physicians believe that EHRs are most useful for analytics and reporting capabilities compared to other attributes, such as supporting value-based care or improvements to clinical outcomes.
Researchers at the Deloitte Center for Health Solutions surveyed 600 primary care and specialty physicians on their attitudes and perceptions on a range of topics on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), value-based payment models, consolidation, and health information technology (HIT).

Yahoo hack spurs push for legislation

By Katie Bo Williams - 10/02/16 08:30 PM EDT
Supporters of legislation that would dictate how and when companies have to notify customers of a data breach are seizing on the hack of 500 million Yahoo accounts to push their effort forward.
“We haven’t hit that sweet spot quite yet, but we’re close. I’m hoping this revelation about Yahoo will provide the needed impetus to get across the finish line,” Sen. John Thune (R-S.D.) told reporters this week.
Thune, the Commerce Committee chairman, is in talks with a handful of senators, some of whom have competing proposals to address data breach rules.

Hackers in no rush to cash in on stolen data

Published October 03 2016, 6:57am EDT
As cyber attacks continue to target healthcare organizations, hackers are changing tactics, becoming more patient and sitting on stolen data until the perfunctory credit monitoring services offered to patients expires.
They can afford to do so, says Pam Hepp, a healthcare attorney at the Buchanan, Ingersoll & Rooney law firm in Pittsburgh. Sometimes, a hacker may dip into some of the acquired data to monetize it, but increasingly they’re holding most of it until monitoring activity ends.
Hackers can be patient because they know that physicians and staff members still need access to data and are still likely to fall victim to phishing scams, Hepp adds. Further, while security oversight of internal and vendor processes are improving, much of the processes still rest on a business associate agreement, which often hasn’t provided much protection.

How artificial intelligence, machine learning can lessen breach risks

Published October 04 2016, 3:41pm EDT
Healthcare organizations are struggling to find ways to manage the risks of massive data breaches, which have proven hard to detect, often taking months to discover.
In 1996 the Health Insurance Portability and Accountability Act (HIPAA) was enacted. The Accountability portion of the law requires that healthcare providers protect the privacy of patient health information and includes security measures that must be followed. Provider success has been mixed and has recently come under intense scrutiny due to the number and size of reportable breaches of health information.
There are several major contributors to this increase. The first is the passage of the American Recovery and Reinvestment Act of 2009. The ARRA included the formation of the Health Information Technology for Economic and Clinical Health Act (HITECH). It also made permanent the Office of the National Coordinator for Healthcare Information Technology (ONC) to set policy and standards and establish procedures to guide and measure the success of the implementation of electronic health records.

Jonathan Bush Talks Trump and an EHR Innovation

Scott Mace, October 4, 2016

Athenahealth CEO Jonathan Bush says the U.S. healthcare system "created Donald Trump" and reveals his company's efforts to turn Epocrates into "a universal remote for EHRs that you hate to use."

With the 2016 presidential election 34 days away and early voting underway, I decided it was time to check in with Bush.
That's Jonathan Bush, co-founder, chief executive officer and president of athenahealth, who also happens to be a cousin of former president George W. Bush. We spoke one-on-one last week at the Health 2.0 conference about the election, then moved on to MACRA and other pressing topics. The transcript below has been lightly edited.
HealthLeaders: Isn't it ironic that rising healthcare costs, the very thing that's making the economy leading up to this election so agonizing, is the one thing that they haven't talked about so far in the debates?
Bush: I think it's ironic beyond words. I believe that our healthcare system created Donald Trump.

Klara raises $3 million to advance its 'WhatsApp for medicine'

Startup founders said they will use the funding to build out a nervous system for healthcare that connects providers, patients, pharmacies, labs and specialists. 
September 30, 2016 10:41 AM
Klara, a New York-based healthcare messaging company launched in 2014, has raised $3 million in its most recent round of funding.
Company executives describe its cloud-based HIPAA-compliant messaging platform as a professional “WhatsApp” for medicine.
With the new funding, Klara will pursue its vision to build “the central nervous system of healthcare,” which will connect all medical providers, patients and other medical professionals such as pharmacies, labs and specialists together on one platform.

Are EHRs getting better? Readers rank vendors higher than last year in new survey

Epic beat Cerner, MEDITECH, McKesson, Allscripts and others again in Healthcare IT News EHR Satisfaction Survey 2016. The big surprise? Most, but not all, of the vendors fared better this time than in 2015.
October 03, 2016 06:33 AM
In the year since we unveiled the results of Healthcare IT News' inaugural EHR Satisfaction Survey, the nature and perception of electronic health records has changed. So too has much of what the providers who use EHRs and the vendors who make them think is important.
But many of the complaints about the systems remain the same. For instance, just like in the first survey, one of the most common pieces of anecdotal feedback was a variation of the following sentiment: "Too many clicks!"
Once again, we sought those of our readers who manage EHRs every day to tell us how they really feel. We reached out to CIOs, CTOs, VPs of IT, CMIOs, CNIOs, CSOs and more – in addition to directors of radiology, lab services, cardiology, oncology, pathology and other clinical chiefs.
We sent the survey to professionals at hospitals, health systems, academic medical centers, ambulatory care facilities, group practices, long-term care facilities, the Department of Defense, the VA and others provider sites.

Survey: One in three people tracks health, fitness with an app or device

September 29, 2016
About a third of internet-connected people worldwide currently track their health and fitness via an online or mobile app or a wearable according to a new survey by Gfk, who conducted an online survey of more than 20,000 consumers aged 15 or older across 16 countries.
"These findings demonstrate the attraction that health and fitness monitoring has within much wider groups than just the obvious young sports players," ​Jan Wassmann, global lead for wearables research at GfK, said in a statement. "Manufacturers and retailers can use these insights, combined with our point-of-sales data on purchases of wearable devices, to understand who are their real-life users and why, and tailor their products to deepen that appeal."
The survey asked only two questions, outside of collecting demographic information: do you track your health with an app or device and, if so, why? They found that, worldwide, 33 percent said they currently track or monitor, 18 percent said they don't, but have in the past, and 45 percent said they had never self-tracked using an app or device (4 percent weren't sure).


October 3, 2016

Does Initiating or Changing a Hospital EMR Lead to Adverse Outcomes?

Jeffrey Hedley, MD and Daniel D. Dressler, MD, MSc, SFHM, FACP Reviewing Wears RL., BMJ 2016 Jul 28; 354:i3941
This observational study about electronic medical records says no, but it's fraught with design flaws.
Implementing an electronic medical record (EMR) system or changing from one EMR to another represents a major shift in hospital process and might be associated with adverse short-term outcomes (J Am Med Inform Assoc 2014; 21:1053). Investigators used 2010–2012 Medicare data to compare 17 hospital systems that transitioned to new EMRs in a single day (single “go-live” date) with 399 control hospitals in the same regions; 90 days before and after EMR transition dates (or control index dates) were evaluated. Hospitals that transitioned to new EMRs using staggered rollouts (over more than a single day) were excluded.


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