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

Saturday, November 11, 2017

Weekly Overseas Health IT Links – 11th November, 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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Artificial intelligence helps detect ovarian cancer early and accurately

Published November 03 2017, 7:47am EDT
Ovarian cancer is difficult to diagnose, particularly in its early stages, when survival rates are much higher. Because there is no consistently reliable screening test to detect ovarian cancer, most women are diagnosed with the disease when it’s in an advanced stage.
However, researchers at Brigham and Women’s Hospital and Dana-Farber Cancer Institute have developed a non-invasive diagnostic test using artificial intelligence for the accurate detection of true cases of early-stage disease. Results of their study were published online this week in the journal eLife.
By combining next generation sequencing with artificial intelligence, researchers have created a novel blood test based on serum microRNAs—small, non-coding pieces of genetic material that help control where and when genes are activated—for the early diagnosis of ovarian cancer.
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Senators reintroduce EHR Regulatory Relief Act to dramatically change meaningful use

The proposed legislation would remove the all-or-nothing approach of meaningful use and extend flexibility for hardship exemptions and payment adjustments.
November 02, 2017 02:52 PM
A group of United States Senators on Thursday put forth legislation intended to reduce the burden that using EHRs and attesting to the meaningful use incentive program put on doctors.
“Our bill ensures that unnecessary regulatory burdens do not continue to negatively affect providers’ ability to leverage technology to improve patient care,” said Senator John Thune, R-South Dakota. “With such strong and continued support for this legislation, I’m hopeful it will lead to swift and meaningful action in the Senate.”
Along with Thune, Sens. Lamar Alexander, R-Tennessee, Mike Enzi, R-Wyoming, Pat Roberts, R-Kansas, Richard Burr, R-North Carolina, and Bill Cassidy, R-Louisiana, signed the original EHR Regulatory Relief Act in June 2016 and reintroduced it on Thursday.
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NHS England CIO says service needs ‘at least’ another £4.2 billion for IT

Jon Hoeksma

2 November 2017
NHS England’s CIO Will Smart has said the NHS needs at least another £4.2 billion of IT investment to finish the job of digitisation.
Speaking at the EHi Live trade show on Tuesday Smart said: “We got £4.2 billion a couple of years ago, we need at least that again if we are to finish the job.”
Some £4.2 billion was committed to NHS IT investment over five years by Secretary of State Jeremy Hunt in February 2016, but little of the money has yet found its way directly to NHS trusts or STPs.
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‘No process in place to fund’ Ireland’s Euro 850m electronic health record

Shireen Khalil

31 October 2017
A revolutionary change in Ireland’s healthcare system is on its way – a Euro 850m business case has been approved but the process to fund this continues to be a challenge.
Ireland remains the last country in the EU to still be using a paper-based system to deliver hospital care.
However, the adoption of an electronic health record across the country forms the cornerstone of Ireland’s eHealth strategy.
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Another view: of private doctor apps

Claire Read

31 October 2017
I saw Uber for the first time the other day. I know that’s probably quite sad, but there was only one driver who responded when the person I was with put out the call, so I don’t think it’s as popular in Cheshire as it has been in London.
Anyway, it reminded me of all the private doctor apps out there. Some of them arrange a video consultation, some email, some arrange home visits. They all seem to have a pool of doctors willing to work privately. I know some have been criticised for very fast consultations, though the counter to that is the IT asks the questions and the GPs just make a quick decision. This is how we do a lot of medication queries in my practice, so I get it.
A capital difference
I’m unclear whether doctors do this full time, or if they do it as extras and fit it in in between other stuff. They seem to mostly be London-based, perhaps because there isn’t much of a locum workforce outside of the capital.
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The top 10 technology trends to watch in 2018

Published November 01 2017, 3:58pm EDT
In their new report, “The Top 10 Technology Trends to Watch: 2018 To 2020 - Ten Trends Will Help You Maximize the Value of Business Technology,” Forrester Research analysts Brian Hopkins, Bobby Cameron, Ted Schadler and Rusty Warner offer their picks on the technology and business trends that will most shape the IT landscape.
Trend No. 1: IoT Shifts Computing Toward the Edge
“The growth of IoT aspirations and technologies has led to a host of technology innovations in edge devices, such as gateway servers, microdata centers, cloudlets, fog fabric nodes, intelligent routers and device firmware,” the authors write. “Firms in the vanguard of this trend will engage customers more quickly and squeeze new efficiencies out of processes. Exploiting computing power on the edge will give them an actual edge. CIOs must understand the extension of compute to the edge to find opportunities for competitive advantage.”
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EHR fatigue has frustrated doctors looking to cut clinical hours

New AMA report finds the weight of technology and administrative burdens is creeping into time physicians need for patient care.
November 01, 2017 11:40 AM
The burden and bureaucracy of modern medicine, not to mention technological frustrations, inflict a toll on U.S. physicians and appear to be major factors influencing their intentions to reduce clinical work hours or leave the profession, according to new research by experts at the American Medical Association, Mayo Clinic and Stanford University.
The research calls for a comprehensive approach by national policymakers and healthcare providers to address the challenges.
Published in the new issue of Mayo Clinic Proceedings, the findings show roughly one in five physicians intend to reduce clinical work hours in the next year. And about one in 50 physicians intend to leave medicine for a different career entirely in the next two years.
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Advisory Series: Analytics

By Shreshtha Trivedi

Data analytics has become increasingly touted as a means of transforming healthcare, not least with the rapid advancement of artificial intelligence. But can potential concerns around privacy – not least amid the looming spectre of care.data – finally be overcome? Shreshtha Trivedi reports.
Few subjects have generated as much interest in the NHS in recent times as data analytics. The process of collecting, analysing and interpreting large datasets to understand previously unknown patterns and derive insight is increasingly being considered a game changer where healthcare is concerned.
It is notable that the recent life sciences industrial strategy encourages the government to create regional data innovation hubs – a recommendation which NHS England chief executive Simon Stevens has heartily endorsed.
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Commission calls for integrated data environment to combat opioid crisis

Published November 02 2017, 6:49am EDT
The federal government should create an integrated data environment that brings together publicly available data with agency-specific data to help address the nation’s opioid epidemic.
That’s among the 56 recommendations made by the President’s Commission on Combating Drug Addiction and the Opioid Crisis in its final report released Wednesday.
In addition, the commission recommends a federal effort to strengthen data collection activities enabling real-time surveillance of the opioid crisis at the national, state, local and tribal levels, as well as reinstituting the Drug Abuse Warning Network (DAWN), a public health surveillance system that monitored drug-related hospital emergency department visits and was discontinued in 2011.
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Geneticists are starting to unravel evolution's role in mental illness

Hints emerge that past environments could have influenced psychiatric disorders.
30 October 2017
Human genome databases are enabling researchers to take a deeper dive into the evolution of psychiatric disorders.
Psychiatric disorders can be debilitating and often involve a genetic component, yet, evolution hasn’t weeded them out. Now, recent work is beginning to reveal the role of natural selection — offering a peek at how the genetic underpinnings of mental illness has changed over time.
Many psychiatric disorders are polygenic: they can involve hundreds or thousands of genes and DNA mutations. It can be difficult to track how so many genetic regions evolved, and such studies require large genome data sets. But the advent of massive human genome databases is enabling researchers to look for possible connections between mental illnesses and the environmental and societal conditions that might have driven their emergence and development. Others are looking to Neanderthal genetic sequences to help inform the picture of these disorders, as well as cognitive abilities, in humans. Several of these teams presented their findings at the American Society of Human Genetics (ASHG) meeting in Orlando, Florida, in late October.
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HIT Think 5 tech tools that can improve care delivery by nurses

Published November 02 2017, 2:26pm EDT
Of all caregivers, nurses tend to have the most interactions with patients. They're the ones that inpatients call if something is wrong, and they are also often the point of contact for the patient’s family.
So nurses have perhaps the greatest opportunity to create a safer environment for patients.
They also frequently interact with information technology as part of their jobs. For example, they may record patient measurements in an electronic health records system, get orders from computerized order entry systems and communicate via digital communications systems, to name a few.
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Informaticists seek a leader for data science research

Published November 02 2017, 2:53pm EDT
The American Medical Informatics Association is calling on the National Library of Medicine to lead data science research efforts in health and biomedicine across the National Institutes of Health.
NLM issued a request for information in September, seeking input from stakeholders on promising directions for new data science research to make science more open and reproducible, as well as developing new partnerships to boost data science.
In response to the information request, AMIA suggests that NLM focus research on the basic science of data standards, improve open science and reproducibility, and build on its leadership in informatics education and training.
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Telehealth Is More Disruptive Than We May Think

Jim Molpus, November 1, 2017
Clayton Christensen coined the phrase disruptive innovation two decades ago as a way of embracing the deconstruction that is necessary when a new technology displaces an old one.
Ever since then, it seems healthcare has been waiting for a series of disruptions to alter the course of the industry.
If there is a technology that could put healthcare in a blender for the next decade, it's the increasing scope of telehealth and its close relative, telemedicine.
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Diagnosing the aims and obstacles facing ehealth programs

A broad analysis of ehealth initiatives from around the world reveals a similar set of goals. The challenges, however, are numerous and varied.
The healthcare industry has a supply and demand problem. To cope, organisations are increasingly turning to digital initiatives to change the delivery of healthcare services.
“Chief Economist reports tell us in the next 30 years GDP in most regions will need to double just to stand still and provide the same levels of care that we do today for future generations,” Mike Jones, Research Director at Gartner, said during a presentation at the Gartner Symposium earlier this week.
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The next precision medicine breakthrough is about apps, not EHRs

Hospitals such as Beth Israel Deaconess and Providence St. Joseph Health are building their own apps to transform the future of personalized care.
October 31, 2017 12:09 PM
Whatever may become the killer app for precision medicine might not be apparent just yet, but one thing is clear: The future of more personalized patient care is not in an EHR.
I went into our HIMSS and Healthcare IT News Big Data and Analytics Forum in Boston last week with the understanding that precision medicine is going to require new and emerging technologies. But while the idea that EHR vendors will come to dominate hospital’s population health-enabling technology purchasing decisions is a possibility, I now think the same seems unlikely for precision medicine.
“Do I really believe that the next precision medicine breakthrough is coming within an EHR? No,” said John Halamka, MD, CIO of Beth Israel Deaconess Medical Center. “It will come from third-parties … twenty-six-year-olds working in their garage to link innovations to EHRs using FHIR APIs.”
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5G is coming in 2019: Here's what hospitals should know about it

The technology could improve connectivity of IoT devices in the healthcare sector, but policies and standards must evolve to allow the tech to reach its full potential.
October 31, 2017 11:25 AM
Last week, Qualcomm announced that it has created a working 5G chip and completed its first test of 5G connectivity on a mobile device. The news follows similar announcements from Ericsson and Orange, Sprint and T-Mobile, which point to the industry steadily pushing a transition from 4G to 5G.
And Nokia just recently said it’s bringing 4.5G Pro to mobile providers, with a plan for 4.9Gs in the near future. AT&T and Verizon have been testing 5G in a number of controlled sites, with plans to roll out more trials over the next 10 years.
While Qualcomm’s successful test wasn’t the first for wireless carriers, it focused highly on both power and constraints of a smartphone. The test reached gigabit speeds, but won’t hit 5G speeds until full 5G deployments are completed.
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Trump's opioid commission releases final report to combat drug addiction, abuse

Nov 1, 2017 5:07pm
The commission recommended that the Trump administration and Congress administer block grant funding to states that can be used to implement evidence-based programs to fight opioid addiction.
A commission tasked by President Donald Trump to address the country’s opioid epidemic issued its final report on Wednesday, outlining more than 50 recommendations, including calling for clinicians who prescribe opioids to receive training on safe prescribing before they can renew their licenses with the Drug Enforcement Administration.
However, the 131-page report (PDF) doesn’t specify the amount of federal funding needed to implement the recommendations to combat the crisis, which Trump declared last week was a national public health emergency.
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Hospitals Utilize Artificial Intelligence to Treat Patients

Health care providers are getting into the artificial intelligence game, and the technology is being used in myriad ways.

By Arlene Weintraub, Contributor |Oct. 31, 2017, at 11:00 a.m.
Hospitals Utilize Artificial Intelligence to Treat Patients
The ability of computer systems to assume tasks for humans has improved efficiency in virtually every industry, including health care. (Daniel Hertzberg for USN&WR)
Just six months after El Camino Hospital in Silicon Valley implemented artificial intelligence technology, the rate at which patients suffered dangerous falls dropped 39 percent. The key, alongside additional fall prevention strategies, was a software program that predicts which individuals are most likely to fall by combing over electronic health records for risk factors and merging the data discovered there with real-time tracking of patients.
"Every time a patient pushes a call light or hits a bathroom or bed alarm, it's recorded," says Cheryl Reinking, chief nursing officer at El Camino. The software takes that information and compares the rate at which a patient is requesting assistance to data such as what surgeries he's had or which medications have been prescribed.
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What Are Basic, Essential Healthcare Cybersecurity Measures?

OCR’s September Cybersecurity Newsletter highlighted basic healthcare cybersecurity measures that entities should implement for comprehensive data security.

October 27, 2017 - With October being National Cybersecurity Awareness Month (NCAM), OCR highlighted top healthcare cybersecurity measures that all covered entities and business associates should keep in mind.
NCAM is an ideal time for organizations to review basic cybersecurity tips, to ensure that ePHI stays secure and that entities are able to make necessary adjustments as technology evolves.
“The security of electronic health information is more critical than ever, and it is the responsibility of all in the regulated community to ensure the confidentiality, integrity, and availability of electronic protected health information (e-PHI),” OCR wrote in its September 2017 Cybersecurity Newsletter.
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HIT Think How precision medicine will leverage data, analytics and AI

Published November 01 2017, 4:10pm EDT
Precision medicine is sometimes defined as the “application of genotypic and OMICS-biomarkers to determine the most appropriate, outcome-driven treatment of or therapy for individual patients.” The applications of precision medicine result in a customized approach to healthcare, where medical decisions, care pathways and services are tailored for each individual patient to achieve the most beneficial outcomes.
Precision medicine is rapidly evolving as the influences of genomic biomarkers are becoming better understood and next generation sequencing (NGS) is becoming more affordable.
While precision medicine (specifically, precision oncology) will continue to build upon and leverage new genomic datasets and knowledge, it helps to look at a comprehensive definition of precision medicine that addresses important questions on outcomes, access and affordability.
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ONC expects to meet all Cures Act requirements—except one

Published November 01 2017, 7:24am EDT
The 21st Century Cures Act, signed into law in December 2016, is meant to reduce the burdens of providers using electronic health records and to advance healthcare information technology interoperability. However, some members of the Senate are concerned that the legislation’s HIT provisions are not being implemented as intended by Congress.
“The goal of the health IT provisions in Cures was to make it easier for patients to access their health records and for doctors and hospitals to get the information they need to treat patients,” said Sen. Lamar Alexander (R-Tenn.), chairman of the Senate health committee, during a hearing Tuesday on the legislation. “The law set clear deadlines for the administration to meet.”
Jon White, MD, deputy national coordinator for health IT, noted in his testimony before the committee that ONC plays the primary role in implementing the HIT provisions in the Cures Act.
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The Adolescence of Telehealth

Philip Betbeze, November 1, 2017

Telehealth has moved from a novelty to a mainstream access point. But questions remain about the limits of its reach and effectiveness, and, most problematically, its reimbursement.

Despite a catchy name, telehealth isn't exactly cutting-edge technology. Really, very few of the components needed to make it work are in the vanguard of innovation for either healthcare or technology. 
But to think of telemedicine in healthcare as a technology story really misses the point. In fact, telehealth is more than that: It's critical and strategic.
Telehealth plays a key, if not starring, role in a continuing saga familiar to senior healthcare executives nationwide: the quest to meet the so-called triple aim of quality, access, and reduction of unit costs.
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Cleveland Clinic picks top 10 innovations for 2018: Scalp cooling, next-gen vaccines make the cut

From a better way to manage diabetes to preventing hair loss from chemotherapy, Cleveland Clinic offers a glimpse of 10 top medical innovations to expect in 2018.
October 27, 201712:18 PM
For the 15th year in a row, Cleveland Clinic this week revealed the top 10 innovations doctors at the prestigious healthcare system found worth watching over the next year.
As is traditional, the unveiling came Wednesday at the close of Cleveland Clinic’s 2017 Medical Innovation Summit. A panel of Cleveland Clinic physicians and scientists choose the up-and-coming technologies to highlight.
Among the innovations on the horizon are a patch for a flu vaccine, an implant to relieve sleep apnea and new ways to reduce that bad cholesterol. Here are the top 10 innovations for 2018:
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How HIPAA Information Sharing Regulations Impact the Opioid Crisis

OCR reminded organizations that HIPAA regulations allow for information sharing, which could have a large impact on the current opioid crisis.

October 30, 2017 - With the opioid crisis recently declared a nationwide public health emergency, OCR issued guidance on how HIPAA regulations allow providers to participate in information sharing in an effort to improve patient care.
There are often misunderstandings and misinterpretations of patient data protection laws, which can create obstacles to the care and treatment process, OCR explained.
“We know that support from family members and friends is key to helping people struggling with opioid addiction, but their loved ones can’t help if they aren’t informed of the problem,” OCR Director Roger Severino said in a statement.  “Our clarifying guidance will give medical professionals increased confidence in their ability to cooperate with friends and family members to help save lives.”
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IBM taps machine learning to predict cirrhosis mortality rates

Published October 31 2017, 3:23pm EDT
New research from IBM using electronic health record data and a new risk scoring process supported with machine learning technology is being used to generate a post-discharge mortality prediction model for patients with a cirrhosis-related admission.
Nine variables are the most effective predictors for 90-day mortality, which can save lives, researchers note in a study published in the Journal of Critical Care. The predictors include total bilirubin, creatinine, albumin, INR, WBC, length of stay, age, sodium and total cholesterol.
Researchers created a post-discharge mortality prediction model for patients with cirrhosis receiving care at Massachusetts General Hospital or Brigham and Women’s Hospital between 1992 and 2010, then identified 4,781 cirrhosis-related admissions at the hospitals—of which 778 resulted in death within 90 days of discharge.
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Healthcare goes digital but regulation hard to disrupt

Baker McKenzie

Global, USA October 28 2017
Healthcare technology is at a pivotal moment in its development. The healthcare industry is primed to take advantage of the innovative tools that technology can provide and governments are positive as to the potential healthcare cost savings that are expected to follow. Regulators around the world are increasingly starting to acknowledge that conventional approaches to regulation may act as an impediment to digital innovation in healthcare and are looking to modernise health regulation. But we are still a long way off an environment where regulation has caught up with technology.
Digitisation of healthcare
Across the world technology is changing the way that healthcare is provided. The adoption of digital health technologies is helping medical practitioners to perform complex procedures, administer medicines with fewer errors and monitor and care for patients in a more consistent and effective manner.[1] Researchers have also concluded that the digitisation of healthcare can improve drug development and supply-chain management.[2] Governments are also looking to fully digitise health services by implementing digital initiatives such as online health record systems and secure digital channels to improve the continuity and coordination of treatments.[3]
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Robotic surgery comes with a hefty price tag, but studies show it's often no more effective

Oct 30, 2017 12:09pm
Robot-assisted kidney removal surgeries cost about $2,700 more per patient than laparoscopic surgeries with the same outcomes.
Over the past decade, hospitals have invested significant dollars in robotic surgical equipment, often to keep pace with their regional competitors.
But the costs associated with robotic systems don’t always pay off, according to two new studies published in JAMA last week that show robot-assisted surgeries cost more but are just as effective as certain laparoscopic surgeries. The results led one surgeon to question how hospitals should track the value of robotics, particularly as the industry transitions to value-based reimbursement models.
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Small physician practices embrace telemedicine

Oct 25, 2017 3:36pm
Telemedicine allows smaller practices to expand their offerings.
Sure, the biggest telemedicine programs are run out of large hospitals and health systems. But increasingly, standalone primary care providers and specialists are finding value in seeing patients remotely—both to keep revenues that might otherwise go to outside telemedicine providers and as a cost-effective way to attract patients from a wider region.
Smaller practices are looking to expand their offerings as well. Kenneth M. Klebanow, M.D. & Associates, a pediatric practice with 16 providers in Columbia, Maryland, started offering telemedicine services to the practice’s students enrolled in Howard County schools as part of a local government initiative in 2015.
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Massive botnet quietly harvesting 2 million vulnerable IoT devices, report says

Researchers say this virus is significantly more powerful than the Mirai botnet of 2016, which shut down Netflix, Twitter, Spotify and other major websites in October 2016.
October 26, 2017 10:40 AM
Research teams from Chinese security firm Qihoo 360 Netlab and Israeli security firm Check Point are alerting the public of a powerful IoT attack malware dubbed Reaper or IoTroop that is spreading through flaws in IoT software and hardware.
So far, the botnet has infected 2 million vulnerable IoT devices across more than 1 million organizations.
Researchers are warning that Reaper is much more powerful than the Mirai botnet that hit globally last year. The cyberattack hit the East Coast of the U.S., bringing down Twitter, Spotify, Netflix and other major websites in October 2016.
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CMS announces new ‘Meaningful Measures’ initiative

Published October 30 2017, 4:48pm EDT
The Centers for Medicare and Medicaid Services on Monday announced a new initiative intended to streamline quality measures, reduce regulatory burden and promote innovation in the healthcare industry as it transitions from fee-for-service to value-based payment.
The effort, called the Meaningful Measures initiative, is being described as a “new approach to quality measurement.” CMS Administrator Seema Verma made the announcement during a plenary session at the Health Care Payment Learning and Action Network (LAN) Fall Summit in Arlington, Va.
“We need to move from fee-for-service to a system that pays for value and quality—but how we define value and quality today is a problem,” Verma said. “We all know it: Clinicians and hospitals have to report an array of measures to different payers. There are many steps involved in submitting them, taking time away from patients. Moreover, it’s not clear whether all of these measures are actually improving patient care.”
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October 26, 2017

The Evolution of Patient Diagnosis

From Art to Digital Data-Driven Science

JAMA. Published online October 26, 2017. doi:10.1001/jama.2017.15028
Physicians are still taught to diagnose patients according to the 19th-century Oslerian blueprint. A physician takes a history, performs an examination, and matches each patient to the traditional taxonomy of medical conditions. Symptoms, signs, family history, and laboratory reports are interpreted in light of clinical experience and scholarly interpretation of the medical literature. However, diagnosis is evolving from art to data-driven science, whereby large populations contextualize each individual’s medical condition. Advances in artificial intelligence now bring insight from population-level data to individual care; a recent study sponsored by and including researchers from Google used data sets with more than 11 000 retinal fundus images to develop a deep learning algorithm that outperformed clinicians for detecting diabetic retinopathy.1
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Enjoy!
David.

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