Saturday, March 18, 2017

Weekly Overseas Health IT Links – 18th March, 2017.

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.

Ransomware, email scams causing cyber threats to soar

Published March 09 2017, 4:55pm EST
Cyber threats reached an all-time high in 2016, with ransomware and business email compromise scams gaining increased popularity among cyber criminals looking to extort enterprises, according to a new study by security technology company Trend Micro.
A 752 percent increase in new ransomware families resulted in $1 billion in losses for enterprises worldwide, the report said. Trend Micro and the Zero Day Initiative (ZDI), a program started by Trend Micro’s TippingPoint unit to reward security researchers for responsibly disclosing vulnerabilities, discovered 765 vulnerabilities in 2016.
Of these, 678 were brought to ZDI through its bug bounty program, then verified and disclosed to the affected vendors. Compared with vulnerabilities discovered by Trend Micro and ZDI in 2015, Apple saw a 145 percent increase in vulnerabilities, while Microsoft bugs decreased by 47 percent.

RAND: Direct-to-consumer telemedicine expands services, but doesn't reduce care costs

Researchers found patients were adding telehealth to traditional care, which increased costs up to $45 per patient.
March 09, 2017 11:25 AM
While direct-to-consumer telehealth services may be convenient, it may actually increase healthcare costs and use, according to a RAND Health study published this week.
Patients who use telehealth may actually use the service in addition to traditional medical appointments, the report found. In fact, merely 12 percent of patients used telehealth to replace provider visits. The other 88 percent tacked telehealth on as a new service.
RAND researchers studied the patterns of over 300,000 beneficiaries of the health plan CalPERS from 2011 to 2013. The plan included telemedicine use. While the service increased access to healthcare, researchers found new strategies are needed, if telehealth is to become a cost-saving device.

Shulkin confirms VA will transition to commercial EHR

Mar 10, 2017 9:18am
VA Secretary David Shulkin confirmed that the system is switching to a commercial EHR system.
Less than a month after he was confirmed as secretary of the Department of Veterans Affairs, David Shulkin, M.D., said the VA is officially switching to a commercial, off-the-shelf EHR system, replacing its frequently maligned VistA software.
Shulkin made the announcement during a hearing before the House Committee on Veterans’ Affairs discussing the VA’s Choice Program aimed at improving community health options for veterans.
“I’ve come to the conclusion that VA building its own software products and doing its own software development inside is not a good way to pursue this—we need to move towards commercially tested products,” Shulkin said. “If somebody could explain to me why veterans benefit from VA being a good software developer, then maybe I would change my mind. But right now, we should focus on the things veterans need us to focus on and work with companies that know how to do this better than we do.”

Disabling Data Analysis Paralysis

By Paul Nicolaus
March 9, 2017 | Trillions of bacteria call our bodies home. Some helpful, others not. One microbe in our gut helps break down food while another wreaks havoc and makes us sick. In recent years, the interest in this complex ecosystem of microbes living in and on us has only grown as researchers attempt to better understand its impact on human health and disease.
Look no further than Virginia Commonwealth University (VCU) and its Multi-Omic Microbiome Study-Pregnancy Initiative (MOMS-PI) for an example of this interest and related research. The study is one of several that make up the Integrative Human Microbiome Project (iHMP), established in 2014 as the second phase of the National Institute of Health (NIH) Common Fund’s Human Microbiome Project (HMP).
In collaboration with the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) at Seattle Children’s Hospital, the study follows the microbes of women throughout pregnancy and shortly after childbirth to examine the impact of the vaginal microbiome. A cohort of about 1,500 women provided samples from the mouth, skin, vagina, and rectum at every trimester throughout pregnancy, at labor and delivery, and at follow-up visits in addition to blood collected early in pregnancy and again at triage. Participants also completed surveys detailing health history, habits, and diet.

Most email attacks enabled by easily obtained credentials

Published March 10 2017, 4:22pm EST
A new report from two information security firms examines the prevalence of email attacks based on a review of 1,000 healthcare organizations that include physicians, third party administrators, software vendors, regional health plans, medical billing firms and hospitals.
On average, 68 percent of the reviewed entities and their business associates had employees compromised accounts with visibly available credentials on the Dark Web, where stolen information is marketed. Some 76 percent of stolen credentials included actionable password information, and 23 percent had fully visible text passwords, according to Evolve IP and ID Agent, which conducted the survey.
Evolve IP is a cloud hosting company supporting disaster recovery, virtual desktops and data centers, call centers and phone systems. ID Agent markets threat intelligence, identity monitoring and software protection products.

Why federal turmoil could affect healthcare IT

Published March 10 2017, 3:45pm EST
Less than two months into the new Trump administration and under Republican leadership, and the country is definitely in a tizzy.
Center stage now is the sharp debate that continues over the Republican plan to repeal and replace the Affordable Care Act. With the GOP in charge of Congress and the White House, the final form of the legislation, now called the American Health Care Act, is still in flux.
House leadership hopes to have a final form of the legislation up for a vote next month, but that looks to be optimistic—the debate is likely to continue for weeks. In addition to inevitable entrenched Democratic opposition, the proposed law introduced this week is running into opposition from conservative and moderate Republicans.

Physician-rating Sites Get Low Marks

Alexandra Wilson Pecci, March 10, 2017

Few websites allow users to search by clinical condition, gender of physician, hospital affiliation, languages spoken, or insurance accepted, researchers find.

Patients increasingly consider online reviews important when they're choosing healthcare providers, but research finds that the websites they're using aren't very good.
Since publicly reported quality data are not reported at the physician level, patients are left to search physician-rating websites for reviews instead, say researchers at Baystate Medical Center in Springfield, MA.

Special Report: Digital Patient – March 2017

Digital Patient Services
Achieving a shift to digital patient services is a golden thread of STP plans, Claire Read examines how the landscape is shifting and attitudes are changing to the diverse range of new tools and services that place patients in control of their health, but the key challenge remains reaching scale. 
If, for your sins, you read through every one of the carefully crafted 44 local sustainability and transformation plans (STPs), you will frequently come across the word “digital”. In fact you will realise – as you gulp down two paracetamol for the splitting headache you’ve suddenly developed – that you saw that word in 43 out of the 44 proposals.
In many instances, it’s used in reference to the local digital roadmap, an exercise in jointly planning the digital direction of health and care communities, which has become somewhat swept up by the STP juggernaut. But it’s also frequently used in more general overviews of each area’s plans.

Special Report: PACS

Collaborative Trust PACS procurements start to pick up

Over the past 12-months new PACS procurements have largely come from individual trusts. But ‘DevoManc’ and a growing focus on transformation and sustainability across regions are beginning to shape new priorities.
In the past year, most of the procurement activity for picture archiving and communications systems has come from individual trusts.  Vendors are, however, eagerly awaiting a collaborative of trusts in Greater Manchester to go out to tender later this year.
Much of the excitement is related to the opportunities presented by local devolution, which includes the transfer of the health and social care budget to Greater Manchester.

Online tool helps patients better understand EHR notes

Published March 09 2017, 6:34am EST
Sharing electronic health record notes with patients is a practice being embraced nationwide by providers as a way to improve physician-patient communication and foster greater transparency.
However, EHR notes written by physicians are full of medical terminology and technical language, making them difficult for patients to understand. Complicating matters is the fact that the average American has a reading level between the seventh and eighth grade, while more than a third of the U.S. population have basic or below basic health literacy.
According to Hong Yu, professor in the Department of Quantitative Health Sciences at the University of Massachusetts Medical School’s College of Information and Computer Science, studies have shown that patients are confused by their EHR notes. However, an online tool now is helping patients who are struggling to understand clinical notes.

HIE use leads to shorter lengths of hospital stay, lower chance of ED readmission

Study: New York hospitals that accessed outside patient records reduced average length of stay by more than 7 percent and rates of 30 day readmission by 4.5 percent.
March 08, 2017 12:36 PM
HealthlinkNY CEO Christina Galanis expects further clinical and operational ROI from the HIE as patient data sets get more robust and more physicians gain experience using the exchange.
Hospitals in New York are finding big quality and efficiency gains thanks to the ability to access patient EHR data via a regional health information exchange.
A new study just released by HealthlinkNY, which operates the HIE connecting providers and patients in more than a dozen counties across the Hudson Valley and Southern Tier of New York, finds that use of the exchange reduced the patient's length of stay both in the ED and inpatient stay.

NHS app library to be launched this month

Laura Stevens

8 March 2017
The long awaited NHS app library will be live by the end of March, but initially with only with a handful of apps on offer.
Speaking at the Digital Technology Show in London on Tuesday, Indra Joshi, clinical lead digital in urgent care at NHS England, said on Tuesday that the app library would be up and running this month.
In a Q&A session following her talk, Joshi also said “by end of year we’ll have a good app library up and running, which will tell you what the leading apps are in this space”.

Study: Use of e-Prescribing Reduces Diabetes-Related Adverse Drug Events

March 8, 2017
by Heather Landi
According to research published in Medical Care, the use of electronic prescriptions with diabetes patients is associated with a lower risk of emergency department visits or hospitalizations for diabetes-related adverse drug events.
According to the study, although the adoption of e-prescriptions among physicians has increased substantially under the Medicare Improvements for Patients and Providers Act and Meaningful Use programs, little is known of its impact on patient outcomes. For the study, which was funded by the Agency for Healthcare Research and Quality (AHRQ), researchers examined the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events, including hypoglycemia.

Why it’s time for EHRs to make an impact on healthcare costs

Published March 09 2017, 4:36pm EST
Earlier this year, Monmouth University conducted a survey to determine which issues were most important as the country transitions to a new presidential administration. Among all the potential concerns Americans now face, the issue that rises to the top is healthcare costs.
How acute a concern is this? It’s significant enough that, when asked the open-ended question, “turning to issues closer to home, what is the biggest concern facing your family right now?” 25 percent of respondents made it their No. 1 issue.
“It’s also worth noting that issues that have been dominating the news, such as immigration and national security, rank very low on the list of items that keep Americans up at night,” said Director Patrick Murray of the politically independent Monmouth University Polling Institute.

IBM and Salesforce team up on artificial intelligence

IBM’s Watson met Salesforce’s Einstein in a deal the companies said could help healthcare organizations advance data-driven decision making. 
March 07, 2017 06:43 AM
IBM and Salesforce partnered to integrate IBM’s Watson AI capabilities directly into the Salesforce Intelligent Customer Success Platform. The overarching goal is to combine deep customer insights from Salesforce Einstein with Watson's structured and unstructured data across many sources and industries including weather, healthcare, financial services and retail, the vendors said.
Both companies already have in place healthcare platforms that stand to benefit from the initiative: IBM Watson for Oncology analyzes a patient’s medical information against a vast array of data and expertise to provide evidence-based treatment options while Salesforce’s Health Cloud patient management software incorporates Einstein.

The future of artificial intelligence in healthcare relies on crowdsourced data

Mar 9, 2017 3:17pm
Researchers say computerized decision support software needs more robust clinical data to accurately diagnose patients and gain trust from physicians.
Since the long-held potential for technology to assist in clinical decision-making has not come to fruition, researchers argue that the next generation of computerized support software requires more robust data to effectively identify disease patterns within specific patient populations.
Physicians are trained to rely on probabilities to diagnose patients, but humans are generally poor performers when it comes to probabilistic reasoning, according to a viewpoint published in the Journal of Medical Internet Research by two informatics researchers, including one with the IBM TJ Watson Research Center. So far, technology has failed to fill in those knowledge gaps, in part because clinical-decision support systems are still ineffective at consistently recognizing patterns.

Improving outcomes with a bundle of nudges

by Matt Kuhrt 
Mar 8, 2017 11:18am
Preventing common, chronic diseases can be as simple as a timely reminder, but payers need to figure out how to reimburse practices.
Technology allows healthcare providers to deliver reminders that help chronic care patients manage their conditions more successfully. Whether that means text messages that remind patients to take their medications or a more comprehensive program customized for diabetes management, healthcare providers see value in behavioral services delivered to patients between office visits.
As the healthcare industry shifts its focus toward value-based care models, such relatively low-cost methods for improving outcomes will become increasingly attractive, writes Mike Payne, head of commercial and policy at Virta Health, in a post for His company focuses on “nudges” delivered to patients via frequent contacts from health coaches. Despite research indicating the value of this approach in modifying patient behaviors, Payne reports the biggest barrier to broader adoption is its ill fit with traditional fee-for-service (FFS) payment approaches.

In Colorado Springs, UCHealth, Centura Health and EMS Leverage Mobile Technology to Coordinate Care

March 7, 2017
by Heather Landi
At Penrose-St. Francis Health Services, a part of Centura Health, the use of a mobile app to coordinate care teams has helped reduce “door to CT” times for stroke patients
Hospital physicians and nurses know all too well that time can make a difference when treating patients suffering from a heart attack or stroke. Unfortunately, gaps in communication between emergency responders and hospital staff is a persistent and common problem and can slow down the process of getting accurate, pertinent patient information from the field, such as the emergency medical technicians and paramedics on the scene, to the hospital staff.
To tackle these challenges, hospitals from two different health systems have partnered with each other and with a dozen local emergency medical services (EMS) agencies to use mobile technology to coordinate their care teams to accelerate time to treatment for critical care patients and to provide better care for stroke and heart attack patients.
Typically, when someone suffers a stroke in Colorado Springs, first responders from local fire departments and American Medical Response (AMR) provide initial care, and quickly notify the hospital. The hospital emergency department prepares to receive the patient and deliver the immediate care required when the patient arrives. And the stroke team mobilizes to treat and reverse the cause of the stroke as soon as possible.

NY Health Information Exchange Improves ED Quality, Efficiency

A study of four emergency departments in the HealthlinkNY health information exchange showed access to patient EHRs markedly improves patient care.

March 07, 2017 - A recent study of hospital emergency departments found that health information exchange (HIE) use significantly improves operational efficiency and quality of patient care.
The study by Janakiraman et al. found physician HIE access to EHRs reduces the length of patient stay in emergency departments, the likelihood of ER readmission within 30 days, and the number of physicians needed to deliver patient care.

Why providers will increase the use of connected health devices

Published March 08 2017, 4:18pm EST
Just as digital technology has transformed every aspect of our lives, the introduction of digital health devices will provide an opportunity to solve one of the hardest problems in medical care delivery—patient-oriented and individualized, timely and convenient service and seamless communication.
These connected devices—running the gamut from smartphones to wearable technology to metabolic sensors to implantable devices—offer new capabilities that providers can use to expand care delivery in ways that new reimbursement plans are enabling.
The single biggest driver may surprise you: the Affordable Care Act (ACA)—or whatever rises to replace it in the months ahead—has forced changes in how medical payments are structured, and moved the industry further away from a fee-for-service model. Today, medical service payments are linked to measures of performance, and providers are rewarded for managing more patients outside of the walls of costly hospital stays and clinics.

The Unintended Consequences of Health Information Technology Revisited

E. Coiera (1), J. Ash (2), M. Berg (3)
(1) Australian Institute of Health Innovation, Macquarie University, Australia; (2) Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, USA; (3) Principal, Advisory, KPMG LLP (US)


Introduction: The introduction of health information technology into clinical settings is associated with unintended negative consequences, some with the potential to lead to error and patient harm. As adoption rates soar, the impact of these hazards will increase. Objective: Over the last decade, unintended consequences have received great attention in the medical informatics literature, and this paper seeks to identify the major themes that have emerged. Results: Rich typologies of the causes of unintended consequences have been developed, along with a number of explanatory frameworks based on socio-technical systems theory. We however still have only limited data on the frequency and impact of these events, as most studies rely on data sets from incident reporting or patient chart reviews, rather than undertaking detailed observational studies. Such data are increasingly needed as more organizations implement health information technologies. When outcome studies have been done in different organizations, they reveal different outcomes for identical systems. From a theoretical perspective, recent advances in the emerging discipline of implementation science have much to offer in explaining the origin, and variability, of unintended consequences. Conclusion: The dynamic nature of health care service organizations, and the rapid development and adoption of health information technologies means that unintended consequences are unlikely to disappear, and we therefore must commit to developing robust systems to detect and manage them.

Electronic consults improve access to specialty care in Los Angeles

by Matt Kuhrt 
Mar 6, 2017 4:00pm
According to a new study, the Los Angeles County Department of Health Services' eConsult system, implemented in 2012, has produced some remarkable results.
As patient access to primary care physicians has increased, the ability for specialists to keep up with referrals has not kept pace. E-consultations, in which primary care physicians submit referrals through their electronic health record system, have shown promise as a way to streamline the process, particularly among underserved populations.
Now, a Los Angeles program demonstrates potential for electronic consultations with specialists to deal with that gap in access to care.

Telehealth saves money, reduces ED visits

Mar 06, 2017 | Cara Livernois
Telehealth may be able to connect patients to physicians at the most urgent times—on the way to the emergency department (ED). A study published in the Journal of Telemedicine and Telecare explored the effectiveness of using telehealth in pre-hospital emergency medical services (EMS) and the associated costs.
The study included 5,570 patients, split into intervention and control groups, who were studied for differences over the course of one year. The intervention group included a telehealth consultation between a 9-1-1 patient and EMS physician. Non-urgent patients were then scheduled and transported to a primary care physician.  

mHealth Management Tools Sought by Younger Diabetic Patients

New research on diabetic treatment found that most younger patients with type 1 diabetes want mHealth tools that provide alerts and educational resources.

March 06, 2017 - A team of researchers in New Zealand found that a majority of young diabetics preferred receiving diabetes self-management support via texting, according to a study published in the Journal of Medical Internet Research.
Nearly two-thirds (64 percent) of diabetics with a mean age of 19 years reported a preference for SMS text messaging for managing their condition.
The research team from the National Institute of Health and the University of Auckland performed a cross-sectional survey of type one diabetic patients from ages 16 to 24 as a way to see mHealth’s role in diabetic treatment.

Study: How should physicians assess EHR readability?

Written by Jessica Kim Cohen | March 06, 2017 |
A study in the Journal of Medical Internet Research questioned whether standard readability formulas can appropriately measure patient comprehension of EHR notes.
The researchers — led by Jiaping Zheng at University of Massachusetts in Amherst — assessed the readability of 140 general health information articles from Wikipedia and 242 EHR notes by using standard readability formulas and asking laypeople to report their perception of difficulty.

How the GOP plan could affect healthcare IT

Published March 07 2017, 3:19pm EST
Attempting to reform healthcare has always been a bit like the arcade game Whac-A-Mole. The last several decades are fraught with examples of efforts to contain costs that only resulted in other expenses popping up somewhere else.
With that in mind, it’s difficult to assess the eventual future of yesterday’s Republican proposal that aims to repeal the Affordable Care Act and replace it. As the nation’s Chief Executive has noted about a week ago, “Nobody knew healthcare could be so complicated.” Well, it is—it’s a multi-trillion dollar industry, with a wide range of provider types, labor and supply costs, and other expenses intrinsic to managing patients, institutions and financial transactions.

CIO Investments Target EHR/EMR Improvements

Alexandra Wilson Pecci, March 7, 2017

Survey data indicates that with penetration of electronic medical record systems at high levels, healthcare investments will focus on system optimization.

Chief information officers, plan to invest heavily over the next three years to improve how electronic medical record systems are used, according to a survey of College of Healthcare Information Management Executives members by KPMG.
Although the Office of the National Coordinator of Health IT puts EHR/EMR implementation rates at more than 95% of hospitals, most EHR systems aren't optimized for users, says a KPMG report about the poll and its findings. Instead, the systems "implemented as one-time, factory boilerplate-style system installations," the report says.

Patient expectations for health data sharing exceed reality, study says

The survey also found that a majority of patients use a digital device and believe it would be helpful for that data to be part of their medical history.
March 03, 2017 07:22 AM
Transcend Insights CMO Thomas Van Gilder, said that patients see information sharing as essential and it’s time that providers give them the tools they need to stay connected. 
Patient expectations about the power of digital health records are well ahead of the ability of healthcare providers to keep up, according to a new survey.
The report, by Transcend Insights, Humana’s population health management company, found that a vast majority of patients (97 percent) believe it is important for any health institution, regardless of type or location, to have access to their full medical history in order to deliver high-quality care.
When asked to rate factors that are most important to receiving personalized care, they listed having access to their own medical records (92 percent) and the ability for care providers to easily share and receive important information about their medical history — wherever they needed treatment (93 percent).

Penn Medicine's Brian Wells: A strategy for AI adoption

by Matt Kuhrt 
Mar 6, 2017 11:23am
As the major AI manufacturers woo consumers, developers in a corporate setting face challenges in deploying the technology.
Artificial intelligence (AI) technology is hitting its stride for consumers, but developers have some work to do before it becomes viable for corporate use, according to Brian Wells, associate vice president of health technology and academic computing at Penn Medicine.
The bleeding edge of healthcare technology has already begun to engage with elements of AI via assists from cognitive computing platforms. The potential for medical robots that could free up time, energy and attention for practitioners has attracted attention to the technology, not to mention funding.

Machine Learning and Knowledge Discovery

Machine learning finds common patterns in data, machine discovery seeks knowledge from those common patterns

By  Irving Wladawsky-Berger
Mar 3, 2017 11:52 am ET
After decades of promise and hype, artificial intelligence is finally achieving an inflection point of market success. It’s now seemingly everywhere In the past few years, the necessary ingredients have come together to propel AI forward beyond the research labs into the marketplace: huge amounts of data; powerful, inexpensive computer technologies; and the advanced algorithms needed to analyze and extract insights from those oceans of data. This is evidenced by the number of companies embracing AI as a key part of their strategies, the innovative, smart products and services they’re increasingly bringing to market, and the volume of articles being written on the subject.

3 tech breakthroughs that will change medicine

Mar 6, 2017 10:00am
Brain implants could soon restore freedom of movement for spinal cord patients.
From brain implants to a map of human cells, the Massachusetts Institute of Technology is out with its annual list of 10 breakthrough technologies. And although it’s peppered with cool stuff like face-detecting tech that can authorize payments and 360-degree selfies, three healthcare breakthroughs made this year’s list.

Brain implants

Scientists are making remarkable progress at using brain implants to restore the freedom of movement that spinal cord injuries take away, according to the report.


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