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Beyond Wachter: 1% for the 99%
Ewan Davis and Tony Shannon say there is a lot to like about the Wachter Review, but identify some worrying gaps between its approach and NHS policy. They call for an open platform and a challenge fund to secure digital transformation for all, and not just for the exemplars.
As the NHS looks forward to another/perpetual winter, it has the Wachter Review to read. This is the outcome of the review of NHS IT (actually acute IT) that health secretary Jeremy Hunt asked US ‘digital doctor’ Robert Wachter to undertake last November.
We broadly welcome Watcher’s recommendations, but they don’t go far enough. So far, their main impact has been to encourage Hunt and NHS England to announce a programme of investment focused on a few “exemplar” trusts, which Hunt has described as an ‘Ivy League’ for others to aspire to.
In combination, we don’t see any sign of the radically different approach that is required if digital technology is going to enable the radical transformation the NHS requires.
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Cherokee Health Takes Telemedicine to School
John Commins, October 12, 2016
For the past eight years, Sevier County in East Tennessee has partnered with a federally qualified health center to provide remote access to basic acute- and primary-care services for more than 14,000 students in the county's public school system.
The promise of telemedicine is delivering now in East Tennessee.
For the past eight years, the public schools of Sevier County, located just east of Knoxville, have relied on Cherokee Health Systems to provide more than 11,000 acute and primary care episodes and screenings for the system's 14,000 students.
In the 2015–16 school year alone, there were 1,631 visits across 23 schools in Sevier County, the largest rural school district in the Volunteer State,
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http://www.healthcareitnews.com/news/legal-records-lurking-ehrs-add-new-wrinkle-malpractice-lawsuits
Legal records lurking in EHRs add new wrinkle to malpractice lawsuits
Electronic health records platforms are leaving doctors exposed by making it hard to demonstrate what they did and why. Some providers are even settling malpractice suits and not because of guilt. Hospitals cannot ignore the issue anymore.
October 13, 2016 07:08 AM
Jodi Daniel, partner with Crowell & Moring and former policy director at ONC, recommended that providers include legal risks associated with EHRs in risk mitigation strategies.
Chad Brouillard deals with the unsavory topic of medical malpractice lawsuits and the increasing complexity EHRs add to them everyday.
The attorney at Foster & Eldridge in Cambridge, Massachusetts defends physicians in malpractice suits and witnesses first-hand the hassle and uncertainty of EHRs as evidence in court.
When paper records were prolific, the problems that arose around gathering evidence pertained mostly to illegible notes and abbreviations that, when written, looked like other abbreviations, he said.
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Both the EHR and docs’ judgment required for medication reconciliation
Oct 14, 2016 10:25am
For all the time and work involved in training doctors to use the electronic health record (EHR) to document care, the benefits are many. For one, the EHR has a pivotal role to play in medication reconciliation, which can be particularly helpful with elderly patients and those who may have a substance abuse problem.
The beauty of many EHRs today is physicians often have access to information about medications prescribed to their patients by other providers--and that allows doctors to reach out to patients and their families to determine the right course of treatment, writes Fred N. Pelzman, M.D., of Weill Cornell Internal Medicine Associates in MedPageToday.
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ONC pubs final 'direct review' rule for certified health IT
Oct 14, 2016 1:03pm
The Office of the National Coordinator for Health IT on Friday finalized a rule that clarifies its ability to directly review certified health information technology and hold developers accountable for non-conformity.
Direct reviews, the rule outlines, will focus on two specific areas, National Coordinator for Health IT Vindell Washington said on a press call: where there are risks to public health and safety, and where there are circumstances present that provide challenges for ONC authorized certification bodies (ACBs).
“These may be ones such as when issues arise involving multiple certified functionalities or products that have been certified by multiple ONC ACBs,” Washington said.
He added that, because certified health IT can fail to perform as it should when interacting with either uncertified capabilities within a product or other technologies, ONC’s actions under the direct review process will focus on the certified health IT and not on uncertified capabilities or other tools.
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Docs have 'grave concerns' about eHealth review
Worry patient privacy will be put at risk
By Shawn Jeffords, Political Bureau Chief
TORONTO - Ontario’s doctors say they have “grave concerns” about a key review of eHealth by a government privatization guru.
Ontario Medical Association president Dr. Virginia Walley wrote to Ed Clark on Thursday to express the group’s concern about his review of the health records bureaucracy. Clark, the former TD Bank CEO who recommended the partial sale of Hydro One, was appointed Friday by Health Minister Eric Hoskins to look at the agency.
Clark’s been asked to find ways to appraise its potential to raise cash for the government as it tries to fund billions in infrastructure projects.
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Doctors worry about patient privacy as they speculate on government plans for eHealth
The province’s doctors are expressing ‘grave concerns’ about the government’s plans for the electronic health records agency.
Thu., Oct. 13, 2016
The province’s doctors are expressing “grave concerns” about the Liberal government’s plans for eHealth Ontario.
In the wake of Health Minister Eric Hoskins’ decision to ask Premier Kathleen Wynne’s privatization guru, Ed Clark, to appraise the monetary value of the electronic health records agency, the Ontario Medical Association is sounding the alarm over patient privacy.
“To be clear, Ontario’s physicians are very concerned about the sanctity of the information shared by their patients in the context of the physician-patient relationship,” wrote OMA president Dr. Virginia Walley in an open letter to Clark on Thursday.
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Why AMIA worries about assessing biomedical data repositories
Published October 12 2016, 3:31pm EDT
The American Medical Informatics Association would like to see the National Institutes of Health consider different metrics to assess data quality and completeness when measuring the value of biomedical digital data repositories.
“In the era of precision medicine, biomedical data repositories are the lifeblood of clinical research,” said AMIA President and CEO Doug Fridsma, MD. “As we begin to re-engineer the clinical research enterprise, it will be critical to objectively differentiate between quality and inferior repositories.”
NIH issued a request for information on metrics and repositories to which AMIA responded with a letter to Francis Collins, MD, NIH’s director, arguing against a “one-size fits all” set of value measures which are insufficient for the task of assessing the value of the wide array of current repositories and those in the future.
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Survey: Docs 'extremely unhappy' with EHRs from all of the major vendors
Oct 10, 2016 10:35am
Physicians are still “highly dissatisfied” with their electronic health records, but currently have few expectations that any of the systems will be much better in the near future, according to a new survey released by peer60.
The survey of 1,053 physicians, conducted in August, found that overall, 85 percent of ambulatory facilities have an EHR. Most of those who did not were small clinic organizations that did not believe that they needed one or couldn't afford one, although 34 percent of those were planning on adopting an EHR in the near future.
The market leaders for the acute care participants were Epic, Cerner and Allscripts; the field was more competitive in the ambulatory space, but Epic led with 18 percent, followed by Allscripts and eClinicalWorks.
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Joe's view: of consent models
Joe McDonald has been thinking about retirement. But first he wants to defeat psychosis, which means gathering lots of data, which means getting the consent model right, which means starting with the Great North Care Record…
I am 48 days away from retirement, and I think I’m about ready to go. When he died at the age of 67, my father was the longest lived of nine siblings.
“The McDonald men are built for speed rather than endurance, son, enjoy every day - it might be your last,” he told me. Consequently, when I heard that psychiatrists get to retire at 55 this played a part in my choice of career.
Unsurprisingly, at this late stage of that career, I have begun to reflect on my 30 years as a psychiatrist and whether I have the emotional stamina to carry on.
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NHS 24 IT system now four years late and 73% over budget
12 October 2016
The costs of introducing a new computer system to Scottish helpline NHS 24 have now risen to 73% more than was originally budgeted, according to the country’s official auditors.
Audit Scotland says that every month the Future Programme project is not operational, NHS 24 is incurring another £500,000 in additional costs.
The programme was launched in 2009, and awarded contracts to Capgemini and BT to modernise its telephone and IT systems two years later. The programme ran into a series of delays, which prompted the threat and then the withdrawal of legal action against Capgemini.
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KLAS: Interoperability progressing but still challenging between disparate EHRs
The research firm found that no vendor community excels at exchanging records with other vendors and while providers see value in participating in CommonWell and Carequality only a small subset are actively sharing data today.
October 12, 2016 10:52 AM
Most healthcare providers agree that a high level of interoperability across different EHRs is critical for improving patient care, but a new KLAS report showed there’s a lot more work ahead to achieve impactful record exchange.
“We learned that challenges related to effective sharing, especially with a different EMR vendor than your own, are experienced across all facility types and across all vendors,” KLAS VIce President of Provider Relations Bob Cash said in a statement. “No vendor community stood out as exceptional in consistently and effectively sharing with partners using a different EMR.”
The research did find some good news: “Vendors and providers seem committed to working through challenges identified in the study,” Cash added, noting that this year’s findings would serve as a baseline for tracking progress going forward.
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Mobile health apps proliferate, but few make money as demand dips
Oct 12, 2016 1:31pm
While supply of mobile health apps is spiking, demand is plummeting and most publishers are struggling to make money, according to a new report from Research2Guidance.
The report, which annually examines the status and trends of the mHealth app market, notes that the one constant in the field is that a majority of these apps remain focused on helping people improve health conditions. More than 2,600 people from across the globe participated in the survey.
“There is no end in sight for the current hype surrounding mHealth apps, but only a fraction of mHealth publishers have found a way to monetize on it,” the report states. “The core business of mHealth app publishing is developing at only a moderate speed. The breakthrough is yet to come.”
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Moving CPOE design into the real world to prevent patient harm
Oct 13, 2016 9:27am
Computerized provider order entry (CPOE) systems can introduce unintended patient harms and it will take more than better design to eliminate them, according to Robert L. Wears, a professor in the Department of Emergency Medicine at the University of Florida.
Systems are designed based on “work-as-imagined”--an order is placed electronically and the appropriate department carries it out--yet “work-as-done” reflects what actually happens in the real world, Wears writes in an article posted recently to the Agency for Healthcare Research and Quality's Patient Safety Network.
He tells of an intern inexperienced on a CPOE system who ordered "CT Abdomen and Pelvis with contrast" from a long drop-down list when she wanted oral contrast, which she ordered separately, but not intravenous contrast. Unfortunately, this included both oral and intravenous contrast bundled with the scan, and the patient developed signs of contrast nephropathy.
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Why providers still must take unstructured data into account
Published October 13 2016, 3:56pm EDT
We have arrived at the digital transformation era in healthcare. We have full-throttle EMR use in multiple settings, database sizes that rival our on-premise storage assumptions, we are checking our boxes to meet meaningful use metrics and electronic workflows that decimate the paper-pushing of the past.
Yet through this transformation, discrete data abounds. Clinicians now trade the completion of paper forms and disjointed information-sharing for the clean “click-on-the-drop-down” form of creating documentation.
EMR purists will tell you:
- “The only way to survive in a value-based reimbursement environment is to leverage analytics and BPM tools in more aggressive ways.”
- “The best way to predict successful outcomes is to use evidence based-practices.”
- “The only way to manage population health is through the analysis and aggregation of discrete data.”
- “Evidence-based analysis needs to occur more often at the point of care, tailored to patient-specific variables.”
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Arm care teams with data to reduce readmission risks
Oct 12, 2016 2:00pm
Editor’s note: The following is an excerpt from the FierceHealthPayer eBook, The Expanding Role of Pharmacy to Cut Readmissions.
Assessing which patients are at risk for readmission is not an exact science. Instead, it’s closer to handicapping a race before it’s run: Poring over a patient’s past healthcare history, present circumstances and other esoteric details to determine a risk for readmission.
But pharmacists and other clinicians don’t accomplish this by reading tote sheets. They have to perform their own form of handicapping. And for that they need data analytics. “When you’re looking at a patient population with chronic conditions, you’re not going to get 100 percent accuracy. But when it comes to a root cause, there are certain specific factors that put a patient at higher risk of readmission,” says Asif “A.J.” Ally, a pharmacist by training and vice president of clinical affairs for Argus Health Systems, a Kansas City, Missouri-based company that provides pharmacy management services to health insurers.
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4 steps to safeguard patients’ health information
Oct 12, 2016 12:27pm
All healthcare organizations should have a plan for how they will protect patients’ electronic health information. But for medical practices, many of them without the resources available to large healthcare systems and hospitals, it’s an even bigger challenge.
With increasing numbers of healthcare data breaches and cyber attacks in the news, there are steps physician practices should take to safeguard patient data, according to Medical Economics. They include:
- Start with a security risk assessment. It’s required by Health Insurance Portability and Accountability Act (HIPAA) regulations and mandated by the Meaningful Use program. If you don’t know where your vulnerabilities are, how can you fix them? Hiring a security consultant can be expensive, but you may need that expertise. There are online risk assessment tools available from the Health Information Management and Systems Society and the Office of the National Coordinator for Health IT that can get you started.
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Kaiser CEO: Telehealth Outpaced In-Person Visits Last Year
52 percent of last year's patient transactions at Kaiser Permanente were conducted online, by virtual visits or through the health system's apps, CEO Bernard Tyson says.
Kaiser Permanente is seeing more patients online than in person, according to its CEO.
The California-based health network, one of the nation’s largest integrated health systems, saw some 110 million people last year, with some 59 million connecting through online portals, virtual visits or the health system’s apps, Bernard J. Tyson told attendees at the recent Salesforce.com Dreamforce conference in San Francisco.
That accounted for 52 percent of the health system’s total visits that year, he said.
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Most organizations lack confidence in data security measures
Published October 11 2016, 3:18pm EDT
Issues around data security have taken center stage at most organizations, but a new study finds that most organizations fail to update their security plans and lack confidence in the ability of their security measures to protect them from attack.
The fourth annual IT security study by the Ponemon Institute shows that “data breach preparedness certainly is on companies’ radar, and having a response plan in place is par for the course. The number of organizations with a plan increased from 61 percent in 2013 to 86 percent in 2016. However, despite this strong majority of companies that now have a response plan in place, 38 percent of organizations surveyed have no set time period for reviewing and updating it, and 29 percent have not reviewed or updated their plan since it was put in place.”
The study set out to discover how prepared senior-level executives feel their companies are to respond to a data breach. The report, which was sponsored by Experian Data Breach Resolution, revealed that “while more companies have data breach incident response plans in place, they still lack confidence and are failing to take crucial steps as part of the preparedness process, preventing them from being truly ready for a real life data breach incident.”
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IBM Offering U.S. Employees Watson Technology to Identify Cancer Treatments
IBM uses software in several oncology treatment centers globally but says it’s the first time it will be available to U.S. employees
By Rachel Emma Silverman
Oct. 11, 2016 8:00 a.m. ET
Navigating the labyrinth of cancer treatments can be so disorienting for patients that International Business Machines Corp. is enlisting its powerful supercomputer Watson to help.
The computing giant today says it will offer its Watson artificial intelligence software to its U.S. employees to help them identify appropriate treatments and options for clinical trials. The benefit will be available beginning early next year to employees and their families who are covered under several of the company’s insurance plans.
The cancer-fighting service uses a mixture of artificial intelligence and human doctors. IBM is working with Best Doctors Inc., a service which helps patients review treatment options. With patients’ permission, medical professionals from Best Doctors will collect health records about the workers’ conditions and feed the relevant data into Watson, which will process the data alongside thousands of medical journal papers and other relevant scientific data. The supercomputer will then generate a report that patients and their oncologists can review.
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Wearable device market to more than double over 5 years
Published October 10 2016, 3:58pm EDT
Global wearable device shipments will increase from nearly 202 million in 2016 to more than 501 million by 2021, according to ABI Research.
While about 17 percent of these shipments will be attributed to enterprise end users in 2016, a 35 percent compound annual growth rate (CAGR) in enterprise wearables will put the segment on track to more than double its shipments by 2021.
“Wearables in the workforce are becoming more prominent, as they give workers immediate, direct access to important information, such as profiling health care records on a smart glass display,” said Stephanie Lawrence, research analyst at ABI. “This hands-free approach saves time, allowing staff to become more efficient and, ultimately, saving companies money.”
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6 steps to proactively manage patient-matching problems
Oct 11, 2016 10:34am
Healthcare organizations must proactively address the challenges of patient matching, but new analysis of a survey published earlier this year reveals gaps in their processes for ensuring accurate patient identification.
In the survey, conducted by the American Health Information Management Association (AHIMA), 45 percent of respondents said they did not know their duplicate medical record rate. What's more, while 72 percent said they work on mitigating duplicate records on a weekly basis, the researchers noted that there is a general lack of resources available to adequately correct duplicates.
Only 47 percent of respondents said they have a quality assurance step in their registration process. Meanwhile, just 4 percent said they use biometrics during registration, technology that could help prevent identity theft and fraud.
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6 steps to proactively manage patient-matching problems
Oct 11, 2016 10:34am
Healthcare organizations must proactively address the challenges of patient matching, but new analysis of a survey published earlier this year reveals gaps in their processes for ensuring accurate patient identification.
In the survey, conducted by the American Health Information Management Association (AHIMA), 45 percent of respondents said they did not know their duplicate medical record rate. What's more, while 72 percent said they work on mitigating duplicate records on a weekly basis, the researchers noted that there is a general lack of resources available to adequately correct duplicates.
Only 47 percent of respondents said they have a quality assurance step in their registration process. Meanwhile, just 4 percent said they use biometrics during registration, technology that could help prevent identity theft and fraud.
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Joseph Kvedar: Benefits of health data sharing outweigh security risks
Oct 10, 2016 10:56am
The risk vs. reward of sharing personal health data is a trade-off that Partners HealthCare’s Joseph Kvedar says he’s willing to make to ensure better care at lower costs.
Kvedar, who serves as vice president of connected health at Partners, argues in a recent post to his cHealth Blog that while many people remain fearful of the consequences of increased data sharing in healthcare--as evidenced by phone calls he received while discussing connected health on a radio program--the advantages boast even greater potential for consumers.
“What we unfortunately don’t talk about is what consumers have to gain by sharing their data,” Kvedar says. “For instance, the same information that can be used to create highly personalized programs to help people stay healthier and happier can also be a key factor in improving efficiencies and reducing healthcare costs. ... Yes there is always some risk sharing personal data--whether online banking or communicating with your healthcare provider. But there are also rewards.”
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EHR data can identify patients at risk of heart failure
Oct 10, 2016 9:19am
Algorithms based on electronic health record data can help flag hospitalized patients at risk of heart failure, with the most complicated algorithms yielding the most accurate results, according to a recent study in JAMA Cardiology.
Real-time, accurate identification of patients with heart failure can catch the problem earlier and results in better outcomes. However, heart failure is a condition not easily identified. The researchers, from the New York University School of Medicine and elsewhere, hypothesized that data analysis using algorithms may help.
The authors developed five algorithms of increasing complexity to determine how well they would work to identify acute and chronic heart failure. They conducted a retrospective study of 47,119 hospitalizations at New York University Langone Medical Center using EHR data for adult patients admitted from Jan. 1, 2013 through Feb. 28, 2015. The potential structured data elements used for heart failure classification were demographics, lab results, vital signs, problem list diagnoses and medications used in the treatment of heart failure.
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Auditory masking could cause clinicians to miss alarms
Oct 10, 2016 11:34am
"Auditory masking" could cause hospital staff to miss important patient alarms, and threaten patient safety.
The phenomenon happens when two similar sounds occur at the same time. Because of acoustics, one sound is hidden behind the other. And it can cause doctors and nurses to miss patient alarms such as those linked to IVs or heart rate monitors, writes Andrew Boyd, M.D., assistant professor of biomedical and health information sciences at the University of Illinois, Chicago, writes in an article for NetworkWorld.
When alarms go unanswered, providers often take the blame, Boyd writes, which is why auditory masking can be dangerous not only to patients but also to caregivers.
“It’s difficult to demonstrate or even record all of the devices sounding at the same time,” he writes. “In these situations, it’s easy to attribute the missed alert to alarm fatigue,” or a sensory overload clinicians may face if they’re constantly surrounded by noisy machinery.
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How Does Patient Health Literacy Affect Digital Health Use?
New research shows that patients with lower health literacy are less likely to use different forms of digital health tools than those with high health literacy.
Patients with high health literacy are more likely to use digital health tools than those with lower health literacy, finds a new study published in the Journal of Medical Internet Research.
The study of nearly 5,000 adult patients first tested patient health literacy using the Newest Vital Sign measure for health literacy. Patients then answered questions regarding their relationship with digital health, including whether or not they had used fitness and nutrition apps, activity trackers, or patient portals.
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Physicians' opinions of EHR vendors: 13 findings
The latest report from healthcare technology market research firm peer60 finds physicians remain highly dissatisfied with their EHRs, some providers still seeking to switch vendors and Epic gaining traction in the ambulatory EHR market, making other vendors more vulnerable for replacement.
The report gathers responses from 1,053 physicians, in both acute care and ambulatory settings, who offered their perspectives on the current EHR market.
Here are 13 key findings from the report.
1. Fifty percent of surveyed acute care physicians use Epic's EHR. Cerner holds the second highest share, with 21 percent of physicians reporting using its EHR. Nine percent of respondents said they use Allscripts' EHR.
The report notes that physician respondents disproportionately represented large integrated delivery networks and larger hospitals, which may account for absence of vendors like MEDITECH that cater to smaller acute care facilities.
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The 5 things keeping IT leaders up at night
Published October 10 2016, 4:03pm EDT
It should come as a surprise to no one that IT professionals at the top of their field are facing increased anxiety within the workplace. While it used to be an ancillary part of the business, IT is now taking on a central strategic role that touches every facet of the business, including HR, marketing and customer relations.
With data breaches making daily news headlines and the near-constant pressure to remain abreast of the latest best practices, IT has evolved well beyond a typical 9-to-5 job as businesses are expected to make themselves available to customers 24/7.
Vess L. Johnson has seen this IT role shift firsthand. Three decades ago he began his career as an electrical engineer, working his way up until he served as CEO for multiple startups in the semiconductor space.
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Enjoy!
David.
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