Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, April 01, 2017

Weekly Overseas Health IT Links – 01st April, 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.

HL7 publishes Release 3 of FHIR Standard for Trial Use

Published March 23 2017, 7:15am EDT
Health Level 7 International has published Release 3 of its Fast Healthcare Interoperability Resources Standard for Trial Use (STU), moving it closer to a normative version of FHIR.
According to HL7, FHIR STU 3 is the “culmination of 18 months of extensive work to incorporate changes and enhancement requests received from implementation partners across the world” including the Argonaut Project, an industry-wide effort to accelerate the development and adoption of the emerging standards framework.
 “Release 3 represents a significant milestone for HL7 FHIR, demonstrating the continued evolution of the FHIR platform and a promise for interoperability, which it represents,” says HL7’s CEO Chuck Jaffe, MD. “It is a tribute to the hundreds of individuals worldwide who have contributed to the standard’s development and thousands to its implementation.”

Halamka: Meaningful Use, HIT certification program need reforms

Published March 24 2017, 7:33am EDT
The Meaningful Use program is stifling technical innovation and lacks a focus on outcomes-based care, while the certification program is “filled with outdated requirements” and is a significant drain on health IT developer resources.
That’s the contention of John Halamka, MD, outspoken chief information officer at Boston’s Beth Israel Deaconess Medical Center.
“Meaningful Use served a very useful purpose when (National Coordinator for Health IT) Dave Blumenthal did Stage 1—which is, it built a floor, and it ensured that doctors and hospitals had the basics of functionality that would be foundational for anything we’d do in the future,” says Halamka, who’s also been active on federal HIT committees.

Babylon Health app will be among first on NHS “digital tool” library

Ben Heather

17 March 2017
Five apps will help launch NHS’s new digital tool library, including the private video consultation on-demand service Babylon Health.
A presentation to the National Information Board last month reveals that five “demonstrator apps” will be launched in September this year.
Visitors to NHS.uk, the successor to the NHS Choices website that will host the digital tool library, will be able to “navigate to local demonstrators of care specific enabled apps”.

TPP sharing furore a reminder of the long shadow cast by care.data

Ben Heather

24 March 2017
Care.data, the now defunct NHS patient data sharing scheme, casts a long shadow.
Even when not acknowledged, the fears that the scheme fostered, that the NHS was using, perhaps even selling, our medical data without our say-so, persists.
That fear erupted again this month, as reports emerged that the Information Commissioner’s Officer has raised “data protection compliance concerns” about TPP’s SystmOne.
SystmOne is the second most popular GP electronic record, used by 2700 practices and holding the record of millions of patients.  It’s important that the information held is secure.

For one senior living community, EHRs help high-cost patients find the right care

Mar 24, 2017 8:57am
EHRs helped Juniper Communities connect seniors with chronic conditions to the right provider.
An innovative integrated care model that enabled seniors to transmit medical information to various providers and specialists could turn out to be a huge cost savings for Medicare.
Juniper Communities, which operates senior communities, cut hospitalization rates in half among its residents and reduced hospital readmission rates by 80% by improving care coordination through high-tech, high-touch initiatives. Using an upgraded EHR system, Juniper seamlessly transmitted up-to-date patient records to the appropriate care provider.  

Eric Topol: Technologies, genomics are pushing adoption of personalized medicine

Mar 24, 2017 12:15pm
Renowned digital health advocate Eric Topol said genomics is "probably the biggest [health-related] breakthrough in the last 50 years."
Digital apps, data, virtual doctor visits and genomics. Together, these innovations are giving the healthcare industry one last push into truly personalized care.  
That’s what Eric Topol, M.D., director of the Scripps Translational Science Institute, professor of genomics at the Scripps Research Institute and a longtime digital health advocate, told the audience at Arizona State University’s McKenna Lecture, according to ASU Now.
Topol told attendees that “genomics is probably the biggest [health-related] breakthrough in the last 50 years,” allowing physicians and researchers to design personalized treatments that target specific conditions. Genomics serves as the bedrock of ongoing research and initiatives directed at precision medicine. In a recent survey, 40% of clinicians and healthcare executives said genomics data will be useful in the next five years.

Chilmark: HIE models have reached their limits

Research firm said that the transition to value-based care is driving a need for diverse data flows and APIs to more effectively supply and consume data.   
March 22, 2017 11:26 AM
As the healthcare industry continues its focus on value-based care and payments, data interoperability is becoming more critical than ever, Chilmark Research concluded in its most recent report.
Chilmark analysts said messaging-based and document-centric models of health information exchange have reached their limits.
Instead, value-based care is driving the need to assess risk across a population and effectively manage that risk across a distributed clinical care delivery network. This requires far richer, diverse information flows across a greater diversity of market participants, Chilmark researchers note.

6 health IT billionaires make Forbes list

March 22, 2017 07:23 AM
These are billionaires you probably know
Forbes is out with its annual list of billionaires, and the roster resembles last year’s list, with the top 10 billionaires pretty much who you might expect, with Bill Gates of Microsoft leading the pack – again, with a net worth of $86 billion. He’s followed closely by multi-national conglomerate Bershire-Hathaway’s Warren Buffett, with a net worth of $75.6 billion.
Incidentally, the top 10 billionaires are all men.
It was a record year for the richest people on the planet, according to Forbes. The number of billionaires jumped 13 percent to 2,043, up from 1,810 last year.

Opportunities for providers as seniors adopt digital healthcare

By Natasha Egan on March 24, 2017 in Technology
A majority of Australian seniors are using digital devices to manage their health, signalling a critical role for consumer-focused technologies in aged care, new report finds.
The report draws on Accenture’s 2016 survey of 7,840 consumers in seven countries – including 241 Australians aged over 65 – and their views on health and healthcare technology.
With a majority of older people reporting they use technology to manage their health at least monthly, the analysis concluded there were many opportunities for aged care providers to offer digital services to Australia’s four million seniors.

DeepMind Health is in talks with NHS trusts across England

Laura Stevens

20 March 2017
Google’s artificial intelligence subsidiary is in talks with NHS trusts across the country to implement its technology, but says that the cheap introductory prices won’t last.
DeepMind Health deployed its acute kidney injury (AKI) alerting app, Streams, at the Royal Free London NHS Foundation Trust, and has signed up Imperial College Healthcare NHS Trust for a similar deal.
DeepMind also has research partnerships at Moorfields Eye Hospital NHS Foundation Trust and University College London Hospitals NHS Foundation Trust.
Mustafa Suleyman, DeepMind’s co-founder and head of applied AI, told Digital Health News that “there are not many trusts that we haven’t spoken to”.

ICO moves to calm controversy over TTP patient data sharing

Ben Heather

21 March 2017
The Information Commissioner’s Office (ICO) says thousands of GPs using TPP should not switch off “enhanced” information sharing, despite ongoing concerns about the security of patient information, due to the potential impact on patient care.
Controversy over security in TPP’s SystmOne, the electronic patient record systems used by about 2700 GP practices in England, reignited over the weekend, after it was picked up by the Telegraph.
The Telegraph reported that that the security of up to 26 million patients medical records could at risk because of a sharing function in SystmOne, which potentially allowed patient records to be viewed by “thousands of strangers”.

Telemedicine saves time, travel costs, even air quality, new study finds

March 22, 2017
While telehealth policies, technological advancements and utilization continue to grow, whether it actually reduces healthcare costs and improves outcomes is still a point of some contention. As the bulk of such analysis focuses on the bottom line of health plans and employers, researchers at University of California Davis instead are looking on how it impacts patients at a more basic level: driving costs.
Spanning across two decades – and undoubtedly many fluctuations in gas prices and internet connectivity capabilities – the study, which was published in the online journal Value in Health, examines 18 years of UC Davis’s own clinical records from 1996 to 2013, evaluating inpatient and outpatient interactive video visits for 19,246 patients. Typically, the patient would still visit their primary care doctor, but they would then together consult a UC Davis specialist via video consultation. The cost savings were measured based on patient travel to a telemedicine center near there home versus traveling to UC Davis Health in Sacramento for specialty care.
Collectively, telemedicine visits saved patients nearly nine years of travel time, five million miles and $3 million in costs. Of course, on a more granular, individual level, those numbers are a little more modest: over 20 years, one person could see a cost savings of four hours of driving time, 278 miles and $156 in direct travel costs.

UC Davis tracks 18 years of telemedicine and finds benefits beyond the bottom line

Rather than only looking at how the technology reduces costs and improves outcomes, researches focused on related time, transportation and environmental factors. 
March 23, 2017 10:58 AM
Telehealth use is growing but the question of whether the technology reduces costs and improves outcomes remains a point of contention.
Whereas the bulk of such analysis focuses on the bottom line of health plans and employers, researchers at University of California Davis instead are looking on how it impacts patients at a more basic level: transportation costs.
Spanning nearly two decades – and undoubtedly many fluctuations in gas prices and internet connectivity capabilities – the study, which was published in the online journal Value in Health, examines 18 years of UC Davis’s own clinical records from 1996 to 2013, evaluating inpatient and outpatient interactive video visits for 19,246 patients.

EHRs raise ethical questions for medical profession

Mar 23, 2017 11:48am
Electronic health records have benefits for patients and physicians, but they also raise ethical concerns.
EHRs should facilitate patient care and strong patient-physician relationships, the American College of Physicians (ACP) said in a new position paper (PDF) published in the Journal of General Internal Medicine.
“Electronic health records can aid in the delivery of high quality care to patients. However, health information technology also poses unintended ethical concerns that the medical profession must examine and address,” Nitin S. Damle, M.D., ACP president, said in an announcement.

HHS names secretary for health technology

The newly-appointed John Fleming said that the Office of the National Coordinator for Health IT may be reorganizing.
March 21, 2017 10:17 AM
HHS deputy assistant secretary for health technology John Fleming. Credit: Gage Skidmore via Flickr.
The U.S. Department of Health and Human Services announced that former Louisiana Rep. John Fleming is taking a new post as deputy assistant secretary for health technology.
Fleming said as secretary for health technology he will work on issues and regulations tied to technology and the practice of medicine. "It's clear there's a lot of work to do, and they're anxious to get somebody in place and start activating this," he told NOLA.com.

Beyond ACA repeal and replace: Health experts issue a blueprint to make American healthcare great again

Mar 22, 2017 12:36pm
A new report by the National Academy of Medicine provides a roadmap to make healthcare in America great again. Photo credit: Getty/Eugenia Chaikina
While Congress continues to hash out the details of a GOP bill to repeal and replace the Affordable Care Act, leading public health experts say the debate fails to address the actual challenges to American health and healthcare and will have a limited impact on the health of the population.
The National Academy of Medicine (NAM) has released a new discussion paper (PDF) that goes beyond the debates over insurance coverage and creates eight policy directions that are essential to advance American health, healthcare and scientific progress.
The publication is part of NAM’s Vital Directions for Health and Health Care Initiative, which called together more than 150 leading experts 18 months ago to examine ongoing healthcare problems, including high costs, disparities in health and the burden of chronic illness and disability.

Shulkin sets summer deadline for VistA decision, tempers expectations of switch to commercial EHR

Mar 22, 2017 10:46am
VA Secretary David Shulkin has set a summer deadline for a decision on the fate of VistA, but will the system switch to a commercial EHR?
Department of Veterans Affairs Secretary David Shulkin confirmed that he will make a decision about whether to ditch the VA’s existing EHR for a commercial product by this summer, but didn’t offer any hints as to whether the agency is leaning toward a commercial solution.
At an event hosted by Politico, Shulkin appeared willing to consider either option, adding that he isn’t pinned to a strict deadline to decide whether to stick with VistA, but that he’s “targeting the July time frame.” If the VA elects to pursue a commercial system at that time, senior leadership will begin the task of identifying a vendor.

IBM launches blockchain tool on Linux Hyperledger Fabric

Big Blue also announced new developer and governance tools for blockchain.
March 20, 2017 01:00 PM
IBM unveiled a cloud-based Blockchain offering on Monday along with governance and developer tools.  
Calling it the first enterprise-ready blockchain service, the company said that the technology makes it possible for developers to build and host production of blockchain networks on the IBM Cloud in a secure environment.
IBM’s new Blockchain offering runs on the Linux Foundation's open source Hyperledger Fabric, which is being developed by members of the Hyperledger consortium alongside other open source blockchain technologies. Hyperledger, which just recently emerged from incubator stage, was developed to provide a framework for building enterprise-grade blockchain networks that can scale as new network members join.

Report: 60 Percent of Healthcare Data Breaches in February Came From Within the Organizations

March 20, 2017
by Heather Landi
In February, hacking incidents only accounted for 12 percent of total healthcare data breach incidents, yet insiders were responsible for almost 60 percent of the total breach incidents during the month, which points to a troubling trend, according to the latest Protenus “Breach Barometer” report.
The Protenus Breach Barometer is a monthly snapshot of reported or disclosed breaches impacting the healthcare industry, with data compiled and provided by DataBreaches.net. This month’s analysis showed 31 breach incidents either reported to the U.S. Department of Health and Human Service or first disclosed in media or other sources, which is the same number of incidents as reported in January.
While the number of incidents remained the same, February experienced a 47 percent drop in the number of affected patient records (206,151 vs. 388,207), according to Protenus. The largest single incident involved 100,000 patient records, and was the result of insider-error.

Insider threat health data breaches doubled in February, Protenus says

The good news? Hacking was down and only comprised 12 percent of reported incidents during the last month.
March 20, 2017 04:45 PM
The number of healthcare security breaches caused by insiders doubled from January to February, according to the latest Protenus Breach Barometer.
While both January and February had the same number of total breaches — 31 apiece, February saw a 47 percent drop in affected patient records. There were 206,151 in February as opposed to the 388,307 reported in January. Officials said the largest single breach involved 100,000 patient records, which stemmed from insider-error.
Protenus, working with Databreaches.net, calculated its totals from Health and Human Services data, media and other source reports. Details were available for 26 incidents. 

WEDI Calls for Health IT System Cybersecurity Improvements

In a recent white paper, WEDI addresses ways the healthcare industry can protect against cyberattacks on health IT infrastructure as the industry increases its reliance on digital health data.

March 20, 2017 - WEDI is calling for increased cybersecurity investments by healthcare organizations to protect health IT infrastructure from the growing interest of cybercriminals.
WEDI, a nonprofit organization focusing on using health IT for health data exchange working with the Department of Health and Human Services (HHS), recently drafted a white paper to inform healthcare insiders of the best ways to avoid security issues at the hands of hackers.  
 “As the use of health IT becomes more widespread, cybersecurity must be more directly integrated into the fabric of healthcare and ultimately become an organizational asset that is perceived as commonplace and mission-critical as hygiene and patient safety procedures have become to quality care,” the authors stated.

Why blockchain offers a fresh approach to interoperability

Published March 21 2017, 5:06pm EDT
It’s no exaggeration to say that our EHR systems’ lack of interoperability is the single strongest barrier to nationwide population health management. That’s exactly what ONC reported to Congress in December 2015. A year later in its December 2016 report ONC acknowledged a few efforts in the right direction, but could point to no definitive progress.
With the new bipartisan Cures Act, HHS aims to exercise more muscle with reluctant EHR vendors by requiring them to meet interoperability standards by the end of 2017. But President Trump’s new “one-in, two-out” rule that requires federal agencies to kill two regulations for every new one has essentially put interoperability progress through the Act on hold because so much rule-making is needed to implement it.
But healthcare isn’t “on hold,” and new technologies are being nurtured in the trenches to meet the challenge.

Digital Transformation Nascent Among Providers, Payers

Alexandra Wilson Pecci, March 21, 2017

Only 10% of payers and providers say they are actively executing digital transformation, but the number is expected to grow as the maturity curve accelerates.

"Digital transformation" is a term that's used loosely in healthcare. It doesn't mean what the same thing to everyone.
When Jeff Rivkin, research director at IDC Health Insights, talks with industry leaders about "digital transformation," he often hears about efforts associated with an organization's EHR/EMR system.
"Was that really a disruption?" he asks. "Or did you just automate the chart?"

Health data breaches vs. security incidents: a primer

The uptick in ransomware is giving rise to a new question of whether hackers actually breach the data they encrypt or not and, in turn, how victimized organizations should respond.
March 20, 2017 08:48 AM
Under the HIPAA Notification Rule, all HIPAA-covered entities and business associates are required to provide notification after a breach of unsecured protected health information. The Federal Trade Commission has similar breach provisions that apply to vendors of personal health records and third-party service providers.
So what’s the difference between a breach and a security incident?
OCR describes a breach as “impermissible use or disclosure that compromises the security or privacy of protected health information.” But providers must presume that impermissible use or disclosure was a breach unless it can prove undeniably there’s a low probability PHI was compromised.

FHIR holds big promise for interoperability, but will need to coexist with other standards for the foreseeable future

Russell Leftwich, MD, senior clinical advisor of interoperability at InterSystems and member of the HL7 board of directors, says IT professionals need to have a strategy for integrating the spec with existing standards into a hybrid model.
March 17, 2017 07:36 AM
Once again this year, HL7's FHIR specification was a hot topic at HIMSS17, a burning issue discussed ardently across the show floor. (Our apologies, but heat- and flame-related puns seem to be required when writing about FHIR. Thankfully, we've gotten them out of the way early.)
But while many vendors were touting their embrace of the interoperability spec, and while the promise it holds for enabling faster and easier exchange of data is very real, the open API isn't going to supplant existing HL7 standards such as Version 2 and CDA any time soon. That means the industry will be taking a hybrid approach to interoperability standards for the foreseeable future.
We recently spoke with HL7 board member Russell Leftwich, MD, senior clinical advisor of interoperability at InterSystems and co-chair of both HL7's Learning Health Systems Workgroup and its Clinical Interoperability Council, for his perspective on FHIRs place in healthcare now and prospects for the future.

Providers embrace Apple's push into healthcare

Mar 20, 2017 11:57am
Apple is making a bigger push into the healthcare industry as providers look to improve access to patient health information.
More healthcare providers are turning to Apple products to help patients access medical records and improve engagement, a shift that is likely to grow given the company’s expanding interest in the healthcare industry. 
Health systems like Cedars-Sinai Health System in Los Angeles, Parkview Medical in Colorado and Ochsner Medical Center in New Orleans are integrating iPads and Apple Watches into their system, according to Fast Company. The devices give patients new insight into their care by allowing them to easily access and transport their medical records and provide doctors with streamlined alerts.

Exam tip: Ask patients to type their concerns into EHR before doctor visit

Mar 20, 2017 12:35pm
In a new study, patients typed their concerns directly into the EHR before meeting with their doctor. Patients and clinicians found the process improved communication.
Doctors sometimes encourage patients to write down their concerns prior to an office visit. But what if patients could type the reasons for their visit right into the electronic health record (EHR), giving their doctor a heads up before getting into the exam room? 
That was what 101 patients did in a small study conducted at Harborview Medical Center, a large primary care safety-net county clinic in Seattle. Patients typed directly into a laptop computer linked to the EHR, with comments such as “my ankle is not getting better” and “[concerned about] lumps on my lung.” Clinicians then looked over those agendas in the electronic progress notes before entering the exam room or at the start of the visit.

3 ways to improve the return on IT investments

Published March 20 2017, 3:31pm EDT
This past February, the President announced that the delivery of healthcare to America’s 300 million residents embraced more complexity than he previously realized. Only a few days before, at the annual HIMSS conference in Orlando, former Speaker of the House John Boehner cast doubt on the ability of the President and Congress to repeal the Affordable Care Act (ACA) because of the disruption such a repeal would bring to the healthcare delivery system.
The ACA evolved from tough negotiations among all healthcare stakeholders, including physicians, provider organizations, life science companies, payers and technology vendors. Such negotiations led to rules and incentives, both intelligent and imperfect. In turn, the stakeholders adjusted their business models to optimize their revenue while working under the provisions of the ACA.
Since its implementation, the ACA facilitated the healthcare coverage of more than 20 million Americans who previously had none. Although the ACA legislation greatly improved access to services, healthcare costs continue to rise at unsustainable rates. In addition, the HITECH Act, the ACA’s “sister” legislation that was enacted to speed the adoption of healthcare information technology, has not delivered the quality improvements and cost savings it was initially expected to bring about.

Ultrasound machines used for more than looking at babies

Christy Millweard, KVUE 6:11 PM. CDT March 16, 2017
For a short time only, Williamson County EMS has ultrasound machines on a few of their ambulances.
The paramedics are participating in a study that looks at the use of ultrasound machines on patients before they get to the hospital.
"You can see the black circle in the middle of the screen, that is an artery in Dan’s arm,” said John Hamilton, the Senior Medical Officer for Williamson County EMS, as he shows KVUE how the machine works.

IT Security Workers Expect IoT Cybersecurity Attack Increase

A recent survey found that 96 percent of IT security professionals plan to see an increase in cybersecurity attacks on Internet of Things this year.

March 17, 2017 - As more industries, including healthcare, continue to implement connected devices in critical infrastructure segments, there will likely be an increase in Industrial Internet of Things (IIoT) cybersecurity attacks, according to a recent Tripwire survey.
The majority of surveyed IT security professionals – 96 percent – reported that they expect to see an increase in IIoT security attacks in 2017. However, 51 percent admitted that they “do not feel prepared for security attacks that abuse, exploit, or maliciously leverage insecure IIoT devices.”
“Industry professionals know that the Industrial Internet of Things security is a problem today. More than half of the respondents said they don’t feel prepared to detect and stop cyber attacks against IIoT,” Tripwire Chief Technology Officer David Meltzer said in a statement. “There are only two ways this scenario plays out: Either we change our level of preparation or we experience the realization of these risks. The reality is that cyber attacks in the industrial space can have significant consequences in terms of safety and the availability of critical operations.”



Anonymous said...

Interesting times at the UK NHS, we have Tim Kelsey's old deputy resetting the culture of NHS and the departure of chief executive Andy Williams, there seems to be funding being withheld from the exlemplar projects. My April 1 predictions is Tim will pop up in the U.K. In the near future to test if his 2 year exile is over and he will be offered the CEO role. It is always a good thing in the UK government to resign at the right time and take one for the team.

Anonymous said...

Some great articles this week, I have a question around the need for FHIR to coexist with other standards (and I would suggested beyond just HL7), and the rapid emergence of precision medicine, something FHIR seems a natural fit to support. My question is targeted at the SMD work, how focused is this work on meeting then it so distant future and are they looking at coexistence needs?

Sorry if this is published somewhere, trawling through all the non-existent material made available by our new transparent ADHA I can find little information

Grahame Grieve said...

FHIR does need to co-exist with many standards, including those outside HL7, and that's something the community as a whole spends a lot of time on. It doesn't feature explicitly in the standard itself since there's no much we can so proscriptively or normatively about that. That doesn't mean we aren't interested.

In my view, the SMD work is just completing earlier work that never made it to completion in the market. It's a short term thing that doesn't really relate to the longer term technical agenda other that we would be able to rely on secure doctor to doctor communications as part our overall planning.

There's some noise (here on this blog and elsewhere) about the very limited goals of the current SMD work, but I think that this is good - one step at a time, instead of permutating your risks by doing too much at once.

Anonymous said...

5.0 pm There's no way "Tim will pop up in the U.K. In the near future to test if his 2 year exile is over and he will be offered the CEO role."

Why? Because no-one would pay him $522,000 per annum except ADHA. The Prime Minister would be disgusted if he knew what scam was being played out around the MyHR disaster.

Anonymous said...

I would not hold your breath waiting for the PM to be aware of or doing anything about your claims, digital health is not a big enough issue, which is probably more a reflection of how big the issues both Labour and the current government have created really are. Also to some commentators, pointing fingers at inderviduals is not helpful, this is politics and everyone is someone's puppet and there is no shortage of puppets willing to do things that may not reflect their true self or their true position on things.