Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Saturday, October 21, 2017

Weekly Overseas Health IT Links – 21st October, 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.
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Cerner tackles interoperability from two new angles

Its launch of portal-connected consumer health record and extension of free CommonWell exchange services are meant to show commitment to interoperability, "no matter what the definition," said President Zane Burke.
October 12, 2017 03:25 PM
At the 2017 Cerner Health Conference this week, attended by more than 16,000 customers from around the world, the company put interoperability and patient access front and center.
First, Cerner announced a new consumer-directed patient record, "at our cost," said Cerner President Zane Burke.
That means, he explained, that Cerner "will work in concert" with a given provider's patient portal so every patient "has the ability to take our information and create our own experience."
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HIMSS ‘call to action’ seeks consistency in a diverse health IT ecosystem

Oct 13, 2017 10:32am
One of the leading health IT trade groups has issued a directive to the Department of Health and Human Services and the broader health IT community to achieve widespread interoperability in healthcare.
The “call to action” issued by HIMSS earlier this week outlines six areas where policymakers and in-the-trenches IT professionals can advance data sharing through uniform standards and consistent exchange frameworks. The six calls to action are:
  • Demand integration between the interoperability approaches and trusted exchange frameworks for the public good.
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A Failed mHealth Program Offers Lessons Learned For Future Projects

An project to have FQHC patients use an mHealth app to manage their diabetes and hypertension at home collapsed after a few weeks. But researchers say they learned valuable lessons.

October 12, 2017 - A recent program to have patients at a federally qualified health center use an mHealth app to manage their hypertension or diabetes failed miserably, with most of the patients abandoning the app within a couple weeks.
But while highlighting the challenges faced by healthcare providers in getting patients to use digital health tools to manage their care at home, the project offers some good lessons for future programs.
As detailed in the Journal of Medical Internet Research, the four-month project first identified 22 FQHC patients with hypertension, diabetes or both chronic conditions, then assigned them an mHealth app for managing their conditions at home. The plan was to have those patients collect their data through the app, then communicate with FQHC providers to improve care management.
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Trump unleases Obamacare chaos as he halts insurer subsidy

Published October 13 2017, 10:12am EDT
President Donald Trump’s administration took its most drastic step yet to roll back the Affordable Care Act, cutting off a subsidy to insurers hours after issuing an executive order designed to draw people away from the health law’s markets.
The moves -- which critics call deliberate attempts to sabotage the law -- come just weeks before Americans will be able to start signing up for coverage for 2018. They follow other steps the Trump administration has taken, such as slashing advertising and outreach budgets to bolster enrollment in Obamacare plans, as well as planning outages of the website where people can sign up.
Shares of publicly traded hospital chains dropped in early U.S. trading, as did insurers such as Centene Corp. that are still present on Obamacare markets. The largest insurance companies in the country have mostly or entirely exited the exchanges, and are unlikely to see much impact.
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October 4, 2016

Do Physicians in Ambulatory Care Spend More Time with the EMR Than with Patients?

Jamaluddin Moloo, MD, MPH reviewing Sinsky C et al. Ann Intern Med 2016 Sep 6. Hingle S. Ann Intern Med 2016 Sep 6.
For every hour of direct time with patients, physicians spent nearly 2 hours interacting with the electronic medical record system.
Outpatient practices have weathered substantial changes during the past decade, and these changes have placed new demands on physicians' time. In this study, researchers directly observed 57 physicians in 16 primary care or specialty outpatient practices (family medicine, internal medicine, cardiology, and orthopedics); time spent on various activities during the clinical day was documented. In addition, 21 physicians also kept after-hours diaries. Fifteen practices mandated use of electronic medical record (EMR) systems. Trained observers recorded the time each physician spent on various activities.
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Royals give biggest grant ever to digital mental health scheme

Shireen Khalil

10 October 2017
When it comes to mental health, Prince Harry is quick to break down the “stigmas” associated with it – speaking openly about coping with his mother’s death earlier this year, the prince hoped to start a national conversation about mental health.
He, together with The Duke and Duchess of Cambridge have reconfirmed their commitment to the issue of mental health with the announcement of a £2m investment to establish a new start-up to support innovative mental health digital tools.
The money has come from their charitable trust, the Royal Foundation and is the largest single grant ever given by the foundation since it began operating in 2011.
The investment will be used to establish a new start-up for digital mental health innovations.
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17 NHS trusts to use OpenEHR for 100,000 Genomes Project

Jon Hoeksma

12 October 2017
A growing group of leading NHS trusts in and around London have begun making use of OpenEHR to capture and manage genomics data as part of the high-profile 100,000 Genomes Project.
One of the leading informatics managers working on the project in London, says that national genomics initiative has quietly resulted in the introduction of OpenEHR into 17 trusts ‘by stealth’.
A total of 17 NHS trusts, including Great Ormond Street Hospital, participating in the 100,000 genomes project, have started, or will soon start, using the open source EHR platform for taking part in collecting genomics data.
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MGMA 2017: Anders Gilberg offers 6 predictions for healthcare in 2018

Oct 12, 2017 5:50pm
ANAHEIM, California—It’s always risky business trying to predict the future. Especially so when trying to predict what Washington is going to do and what lies ahead for healthcare.
But Anders Gilberg, senior vice president for government affairs for the Medical Group Management Association, decided to go out on a limb this week at this year’s conference. Some of the questions about what lies ahead for physician practices will get answered soon, as the Centers for Medicare & Medicaid Services will come out with a final rule updating MACRA and a new physician fee schedule by Nov. 1.
 “We’ll have 3,000 pages of rules come out in about three weeks,” he said. But what he says is the most onerous issue on the horizon—whether CMS will require a full year of quality reporting under the Merit-based Incentive Payment System (MIPS) in 2018—he admits is a big question mark.
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Survey: Patients Increasingly Using Patient Portals to Access Health Records

October 11, 2017
by Heather Landi
Four out of five consumers take advantage of their healthcare provider’s patient portal, according to a 2016 survey on consumer access to health information released by the American Health Information Management Association (AHIMA).
The survey findings, based on survey responses from 167 consumers, demonstrate the opportunity for healthcare providers and health information management (HIM) professionals to better engage consumers in accessing and using their personal health information (PHI), according to AHIMA.
“Providing individuals with access to their health information is necessary in delivering high-quality care,” Kim Murphy-Abdouch, clinical associate professor of health information management at Texas State University, said in a statement. “With the age of technology, healthcare providers and health information management professionals must adapt to accommodate the increase in demand for PHIs, both electronic and paper.”
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Education, Information Sharing Key in Healthcare Cybersecurity

Leaders at HIMSS and CHIME recently discussed healthcare cybersecurity best practices, highlighting the need for cyber education and risk assessments.

October 10, 2017 - Creating a strong culture of healthcare cybersecurity, including employee education, risk assessments, and information sharing are all essential aspects for healthcare organizations currently, according to industry stakeholders.
Cook Children’s Health Care System Senior VP & CIO Theresa Meadows explained in a recent CHIME blog post that healthcare IT teams must understand potential threats to respond to them in the best way and mitigate damage.
Building a culture of healthcare cybersecurity is one key step, she wrote. This includes educating employees about the threats and underlining the need for proper cyber hygiene.
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Machine learning automatically identifies brain tumors

Published October 12 2017, 7:14am EDT
A team of researchers led by the University of Texas at Austin has developed a new, fully automatic method that combines biophysical models of tumor growth with machine learning algorithms to automatically identify brain tumors.
Researchers are using supercomputers at UT’s Texas Advanced Computing Center as part of the process to analyze magnetic resonance imaging data of patients with gliomas, the most common and aggressive type of primary brain tumor.
 “Our goal is to take an image and delineate it automatically and identify different types of abnormal tissue—edema, enhancing tumor (areas with very aggressive tumors), and necrotic tissue,” said George Biros, professor of mechanical engineering at and leader of the ICES Parallel Algorithms for Data Analysis and Simulation Group.
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ONC challenges industry to build secure FHIR servers

Published October 12 2017, 7:07am EDT
The Office of the National Coordinator for Health Information Technology has announced a challenge to industry to address the potential security vulnerabilities of HL7’s emerging Fast Healthcare Interoperability Resources standard.
Under the Secure API Server Showdown Challenge, ONC is inviting interested stakeholders to build secure FHIR servers using current industry technical standards and best practices as well as recently issued implementation guide requirements.
 “FHIR, the standard, in and of itself doesn’t have a security protocol built into it,” says Steve Posnack, director of ONC’s Office of Standards and Technology. As a result, he contends that FHIR “needs to be paired with appropriate security standards when it gets deployed in a production setting in real life.”
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HIT Think Why IT is crucial in supporting effective emergency management

Published October 12 2017, 4:45pm EDT
Healthcare facilities in the U.S. continue to fall short in disaster planning and preparedness. This lack of preparation creates the potential for serious ramifications, putting staff, patients, and the financial security of the hospital, at risk.
Below are five key components to an effective emergency management plan. The use of information technology in achieving these components is not always obvious, but it’s clear that IT has a role to play in improving facilities’ disaster preparation.
Clear communication
In the past, it’s often been a natural reaction for organizations to try to withhold information from the public. This is the wrong approach. Healthcare facilities can prove their worth to their communities by being open and honest. In today’s world, information will leak out one way or another, so it’s essential the public gets the correct information from the healthcare experts instead of the wrong information from someone else.
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Clinicians express dissatisfaction with devices in meeting their needs

Published October 12 2017, 4:15pm EDT
Many physicians, dentists and other clinicians say they are highly dissatisfied with the ability of medical devices to meet their needs and expectations.
The attributes of devices that providers most frequently are disappointed include patient outcomes, familiar procedures, efficacy, customer service, basic product features and flexible contract options.
The survey of 9,000 medical professionals was conducted for Vennli, a vendor of a customer choice analytics platform to assess marketing messaging, project pipelines and sales effectiveness. It conducted the survey in which provider respondents selected attributes that are most important to them when purchasing medical devices.
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Healthcare stakeholders weigh value of claims and clinical data

Published October 11 2017, 7:17am EDT
In healthcare, claims data is often described as a river that is a mile wide but only an inch deep, while clinical data—the analogy goes—is a mile deep and an inch wide. Yet, with the widespread adoption of electronic health record systems by providers, claims data often gets short shrift relative to EHRs.
However, understanding the distinctive benefits of claims and clinical data is critical if providers are to properly exploit their respective values.
Isaac Kohane, MD, chair of the Department of Biomedical Informatics at Harvard Medical School, knows better than anybody the value of different kinds of data and their respective limitations. As Kohane points out, EHR data is definitely more detailed than claims data. However, he believes there are circumstances when the latter is more useful than clinical data.
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3 ways EHRs can reduce unnecessary care

Oct 11, 2017 1:29pm
Automated alerts in EHRs have reduced unnecessary tests at Virginia Mason Medical Center.
Not everyone is down on the often-maligned EHR.
In fact, two directors at Virginia Mason Medical Center believe EHRs can be a platform for “innovation and creativity.”
EHRs can make a significant impact on reducing unnecessary care and medical errors, A. James Bender, M.D., medical director for clinical informatics at Virginia Mason and Robert Mecklenburg, M.D., medical director of the system’s Center for Health Care Solutions, wrote in Havard Business Review.
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mHealth Group Posts Action Plan for Using Consumer-Facing Data

A committee of healthcare officials and FDA executives at Duke University has issued an action plan for incorporating consumer-facing mHealth data and devices into clinical trials.

October 09, 2017 - A group of mHealth experts brought together by Duke University’s Duke-Margolis Center for Health Policy has drafted an action plan to integrate consumer-facing mHealth technology into clinical trials.
The 39-page plan, “Mobilizing mHealth Innovation for Real-World Evidence Generation,” examines the different types of data being generated by consumer-grade devices, such as wearables and apps, and offers five recommendations to make that data relevant to healthcare.
“There is not yet a clear path for how mHealth technologies can reliably and efficiently elicit, validate, and transmit relevant data, and such data are currently not being collected on a sustained and longitudinal basis,” the group says in its executive summary. “Consequently, this is a crucial time for mHealth, with growing attention to overcoming the challenges of interoperability, common data elements, and data definitions in order to allow disparate data streams to combine to create actionable insights for improving or maintaining an individual’s health and treating disease.”
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Novel Metrics Suggested for Assessing EHR Use
Metrics aim to provide insight into the clinician experience in light of impaired practice efficiency
TUESDAY, Oct. 10, 2017 (HealthDay News) -- Novel metrics have been developed to assess electronic health record (EHR) use and are described in an opinion article published online Oct. 9 in the Annals of Internal Medicine.
Noting that the EHR has impaired practice efficiency, largely because of poor design, Yumi T. DiAngi, M.D., from Stanford University School of Medicine in Palo Alto, California, and colleagues proposed a set of EHR-related metrics to provide insight into the clinician experience.
The researchers proposed six categories to measure EHR use.
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Health IT Security, FHIR Focus of ONC Secure API Server Challenge

ONC announced a Secure API Server Showdown Challenge, urging stakeholders to focus on health IT security in building FHIR servers.

October 10, 2017 - ONC is challenging healthcare stakeholders to build secure Fast Healthcare Interoperability Resources (FHIR) servers to improve health IT security and ensure that secure FHIR options are available in the future.
The Secure API Server Showdown Challenge will ideally “identify unknown security vulnerabilities in the way open source FHIR servers are implemented,” ONC Office of Standards and Technology Director Steven Posnack, MS, MHS, wrote in a blog post
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US Data Breach Exposed Medical Records, Including Blood Test Results, Of Over 100,000 Patients

Oct 12, 2017, 5:00am
The records, discovered by researchers at the Kromtech Security Center, had been stored on an unsecured Amazon S3 bucket. According to Kromtech, the files were publicly accessible and were not protected by a password. A cursory examination of the contents revealed a wide range of sensitive details about patients whose names, addresses, phone numbers, diagnoses, and test results were exposed.
The files have been linked to a healthcare services company, Patient Home Monitoring Corporation (PHM), a division of which provides US patients with in-home monitoring and disease management services. The data breach contained about 47.5 GB-worth of data composed of roughly 316,000 PDF files.
The breach was first discovered on September 29th, Kromtech security researcher Bob Diachenko told Gizmodo. On October 5th, PHM was alerted that sensitive medical records belonging to the company had been exposed. Following notification, the bucket was secured on the same day. PHM did not, however, respond to Kromtech's inquiries.
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HIT Think Why the EHR is essential for effective care management

Published October 11 2017, 5:58pm EDT
Only a very small percentage of patients are enrolled in CMS’ Chronic Care Management (CCM) program. Care management is a notoriously complex process, and getting paid for doing care management within the Medicare CCM program has been especially difficult.
Some physicians don’t believe in the value of these preventive services, many don’t know who is eligible for these services, and others deliver them but don’t know the right way to code for them and miss out on getting reimbursed appropriately.
Advisory Board is working with two health systems that have built stellar care management programs. Both organizations took a unique approach to engaging their clinical staff but did not initially account for the critical role that technology—specifically the EHR—has in scaling the care management program and making their people much more effective.
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EHRs In Primary Care Practices Not Suited for Cancer History

HealthLeaders Media Staff, October 11, 2017

The EHRs have limited capability to record information on patients' cancer history, and clinicians are not provided with actionable recommendations for follow-up care. 

Primary care medicine is currently not able to meet the healthcare needs of cancer survivors, despite a long effort by the medical establishment to move long-term survivorship care out of the specialist's realm, according to a new Rutgers study.
The study, published in JAMA Internal Medicine, examined 12 advanced primary care practices selected from a national registry of workforce innovators; not one had a comprehensive survivorship care program in place.
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Special Report: Infrastructure as a Service


Hosting a huge piece of computer equipment with the associated support costs, or buying computer power in the cloud on a pay as you go basis? In an era of constrained costs and security concerns, more organisations are starting to consider the latter. But might the traditional NHS model of capital expenditure stymy uptake of infrastructure as service within healthcare? Claire Read reports.
At Midlands and East Lancashire Commissioning Support Unit there lives a three terabyte database which, for John Uttley, epitomises the potential appeal of infrastructure as a service (Iaas) to the NHS.
Currently, the database sits on a physical server in the CSU’s offices. But Uttley, the organisation’s e-innovation director, has recently been exploring the costs of moving it into the cloud, via a large scale IaaS provider.
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Western New York HIE reaches 1 million patient consents

Published October 10 2017, 6:36am EDT
HEALTHeLINK, the clinical information exchange connecting hospitals, physicians, and payers in Western New York, has secured more than 1 million uniquely consented patients.
According to Dan Porreca, executive director of HEALTHeLINK, this achievement represents a significant community milestone for the eight counties the HIE serves, as it continues to improve quality of care, patient safety, while reducing healthcare costs by eliminating redundant tests.
“It is the doctors, practices and hospitals that capture the patient consents, so they can get access to the information,” says Porreca, noting that New York is an opt-in state for patients wanting to share their data with HIEs. But, he contends it is patients that “hold the key” to enabling their treating providers to have a “more complete picture of their medical record.”
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More than half of providers plan to expand telehealth offerings, survey shows

Oct 10, 2017 10:30am
Healthcare providers still lack clarity around the future of telehealth reimbursement, but that’s not stopping them from growing their programs.
Nearly 60% of providers plan to expand the telehealth service lines or push the technology into other specialties, according to a survey conducted by the College of Healthcare Information Management Executives (CHIME) and KLAS Research. A quarter of the 104 providers in the survey plan to increase patient access and 10% say they will focus on follow-up care.
Ten percent of respondents also said they had no future plans for telehealth.
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Survey: Healthcare execs name data analytics, population health among top challenges for 2018

Written by Jessica Kim Cohen | October 09, 2017 
The HealthCare Executive Group released its list of the top 10 challenges the healthcare industry will face in 2018 during the group's annual forum in Nashville, Tenn., Oct. 3.
The HealthCare Executive Group compiled and ranked the list after analyzing survey responses from leaders of health systems, health plans and related associations.
Here are the top 10 challenges the HealthCare Executive Group identified for 2018.
1. Clinical and data analytics
2. Population health services organizations
3. Value-based payments
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Consumers Optimistic that EMRs will Improve Patient Care

October 9, 2017
by Rajiv Leventhal
About three-fourths of consumers in a recent survey believe that electronic medical records (EMRs) will improve the quality of healthcare in general.
The research from The Physicians Foundation, an organization seeking to empower physicians to lead in the delivery of quality and cost-efficient healthcare, included responses from more than 1,700 consumers. Eighty-five percent of respondents said they believe EMRs either help patient care a great deal (42 percent) or help somewhat (43 percent). Six percent of consumer respondents said that EMRs hurt patient care somewhat, with 2 percent reporting that they hurt patient care a great deal.
Further, 74 percent of consumers said they think EMRs will improve the quality of healthcare in general—up from 67 percent in the 2016 survey. Regarding access, 82 percent of respondents said they think all doctors should provide patients with EMR access, while 79 percent said they feel that all doctors should have EMR access themselves. But, 77 percent of those surveyed said that their doctor actually provides them with EMR access, compared to 66 percent in the previous year’s survey.
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EHR Interoperability to Transform Healthcare in Decade Ahead

Centralized, cloud-based systems will achieve EHR interoperability making care delivery more efficient in the near future.

October 09, 2017 - A new report from the Deloitte Center for Health Solutions examined ways EHR centralization, integration, and interoperabilty will likely transform the healthcare industry in the next 10 years.
Researchers conducted a crowdsourcing simulation with 33 healthcare experts worldwide — including physician and nurse leaders, public policy leaders, and IT experts — to develop specific use cases for the design of digital hospitals in ten years.
“Many of these use case concepts and technologies already are in play,” wrote authors. “Hospital executives should be planning how to integrate technology into newly built facilities and retrofit it into older ones. A well-crafted strategy can lay the foundation for future investments in care delivery, talent, data management, and cyber security.”
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How robots and artificial intelligence could slow the aging process

Published October 10 2017, 3:43pm EDT
The University of California San Diego has teamed with IBM on a multi-year program to enhance quality of life for senior citizens, supported with artificial intelligence. The program includes a study of the health implications of the human microbiome, which are microoganisms in the body to protect against germs and break down food more easily, among other benefits, as well as microoganisms that can be injurious to human health.
The five-year project will, for the first time, study the impact that a combination of daily habits, the environment, genetics and the microbiome have on the health and cognition of older adults. Subtle changes of aging will be modeled and the initiative includes deployment of personalized interventions via robots that help support wellness. The goal is to help senior citizens live independently longer and with a higher quality of life.
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How the EMR Is Increasing Innovation and Creativity in Health Care

October 10, 2017
Americans are both undertreated and overtreated in a health care system that wastes up to $1 trillion a year and delivers profoundly uneven quality: Current estimates indicate that preventable medical errors are the third leading cause of death in the United States. Fifty-eight percent of patients referred to Virginia Mason, our medical center in Seattle, for back surgery would be more appropriately treated without an operation. Tens of millions of Americans, most with health care insurance, have never had appropriate screening for colon cancer. Electronic medical records can help correct these systemic defects.
Every day, online retailers use computer-based transactions to guide us through stepwise sequences to buy a pair of jeans, apply for a credit card, or book a flight. As we follow these electronic pathways, we can’t really go wrong: If we omit critical inputs or make an inappropriate choice, the program does not allow us to proceed until we get it just right. In the language of systems engineering, the transaction is “mistake-proofed.” And in the rare circumstance of a unique or very complex transaction, we can pick up the phone to work through the issue with a content expert. This same mistake-proofing process and technology embedded in the electronic medical record (EMR) can move us a great distance toward safer, higher quality, and more affordable health care.
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Social determinants of health and the $1.7 trillion opportunity to slash spending

The potential to harness this data to both make people healthier and help hospitals and payers save money is enormous.
October 09, 2017 09:53 AM
Social determinants of health are not just about soft skills and the promise of helping patients by better understanding their individual circumstances any more. Rather, there’s a legitimate business case to be made — and it’s a powerful one. 
Exactly how big is the opportunity when you start to look at overall spending? And what does the data coming out of successful social determinants initiatives reveal?
I got a sense of certain bits and pieces that tease at answers to those questions at the HIMSS and Healthcare IT News Pop Health Forum in Chicago last week.
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EHR satisfaction survey 2017: After years of frustrations, user wish-list turns positive

CIOs, clinical staff still want better interoperability and ease of use, but the focus is shifting to improving EHRs, not just fixing them.
October 09, 2017 01:12 PM
In our third annual Healthcare IT News EHR Satisfaction Survey we asked hospital leaders, IT professionals and clinicians to rate their inpatient electronic health records systems.
Their answers are illustrative of the hopes and frustrations of the folks on the front lines, for whom EHRs have become an intrinsic and indispensable part of their work.
Questions included: How satisfied are you with the features of your EHR? What do you like best about the software? What would you change? How do you rate user interface and experience? How is its interoperability with other systems, and with medical devices? Security? Modularity? Vendor support services?
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New evidence proves the value of patient-reported outcomes over time

by Matt Kuhrt 
Oct 9, 2017 11:59am
Partners Healthcare in Boston has seen benefits for physician and patient satisfaction after implementing patient-reported outcomes.
The transition to value-based care delivery has resulted in a huge variety of quality measures. The promising results seen from patient-reported outcomes (PROs) suggest their benefits may outweigh the barriers to their implementation.
Physicians at Partners HealthCare have seen evidence that properly implemented PROs can benefit patients and doctors alike, according to an op-ed article in the New England Journal of Medicine. More than 1,500 physicians use PROs, which the system introduced in 2012. Despite initial challenges smoothing out technological kinks and accommodating PROs in physician workflows, physician sentiment has shifted over time.
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Is There A Robot 'Friend' In Your Future?

Where grown-ups keep growing Opinions expressed by Forbes Contributors are their own.
By Steve Outing, Next Avenue Contributor 
Human relationships will never go out of style. But as robotics technology and artificial intelligence (AI) advance, and robots gain greater "social" abilities, we humans will form relationships with our robot helpers. We may even come to feel as though they are our friends.
Is that really something we want? It's hard to imagine that having a robot as a friend is a future many of us would desire. But human nature may pave the way for these relationships. And it may be inevitable.
A big reason is practical: People are living longer and there's an expanding demographic bulge of people over 65, many of whom will need some form of care as they age. Elder-care experts foresee a shortage of human caregivers to meet ever-growing demand. Robots of some form will be necessary to fill the gaps. (Should you have the misfortune of being bedridden, a robotic bear might lift you to give your human aide's back a break, for example.)
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Enjoy!
David.

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