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, November 04, 2017

Weekly Overseas Health IT Links – 4th 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.

Epic go-live at UMass Memorial a masterclass in getting staff behind an EHR switch, CIO says

Engagement across the health system, starting with the selection and eventual design of the system, helped $700 million project go off without a hitch.
October 27, 2017 11:43 AM
UMass Memorial Health Care CIO Tim Tarnowski says his system’s Oct. 1 Epic go-live could be a model for change management, calling it “the smoothest go-live that I’ve ever been a part of.” 
Tarnowski, who has been doing this type of work for 30 years, has led two other Epic implementations in the past as well as rollouts of EHRs from multiple other vendors, he said.
UMass Memorial, which serves central Massachusetts, operates four hospitals, with 1,600 physicians on the medical staff.

Somerset introduces web-based EPR viewer across all clinical services

Shireen Khalil

23 October 2017
A web viewer that allows all clinicians sight of patient records created in primary care is being rolled out across Somerset.
The Emis Web EPR Viewer enables all healthcare professionals to view GP medical records for the patients they are treating, subject to patient consent at the point of care.
Its rollout follows a successful pilot at Musgrove Park Hospital (part of Taunton and Somerset NHS Foundation Trust), Yeovil District Hospital, and at mental health units and community hospitals run by Somerset Partnership NHS Foundation Trust.

NIH’s Eric Dishman: EHR access is a ‘fundamental’ pillar of precision medicine research

Oct 27, 2017 11:27am
All of Us Director Eric Dishman said NIH plans to invest in helping participants get access to an "increasingly richer and deeper record."
Access to EHR data will be a critical part of the National Institute of Health’s precision medicine research efforts, but even the director of the agency’s large-scale research initiative is sympathetic to the skepticism of prospective participants.
Eric Dishman, director of the All of Us campaign that plans to collect information from 1 million people, said access to a “holistic, longitudinal health records is just a fundamental pillar of the program,” in a video addressing concerns participants might have about turning their medical information over to government researchers.

Machine Learning Applied To Predicting High-Risk Breast Lesions May Reduce Unnecessary Surgeries

Posted on October 20, 2017
MedicalResearch.com Interview with:
Manisha Bahl, MD, MPH
Director, Breast Imaging Fellowship Program,
Massachusetts General Hospital
Assistant Professor of Radiology,
Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Image-guided biopsies that we perform based on suspicious findings on mammography can yield one of three pathology results: cancer, high-risk, or benign. Most high-risk breast lesions are noncancerous, but surgical excision is typically recommended because some high-risk lesions can be upgraded to cancer at surgery. Currently, there are no imaging or other features that reliably allow us to distinguish between high-risk lesions that warrant surgery from those that can be safely followed, which has led to unnecessary surgery of high-risk lesions that are not associated with cancer.

Doctor, Please Put Down That Computer

By Steven Reinberg
HealthDay Reporter
THURSDAY, Oct. 26, 2017 (HealthDay News) -- Most patients aren't thrilled about their doctor using a computer during office visits, University of Texas researchers report.
As electronic medical records become more common, it's not unusual for doctors to enter data into a computer as they talk with their patients. But after viewing videos of patients and doctors, researchers saw that people in the study preferred the doctors who were logged off.
"Most patients found doctors who used computers were less compassionate, had poorer communication skills and were less professional than the doctors who didn't use computers," said lead author Dr. Ali Haider. He's an assistant professor in the department of palliative, rehabilitation and integrative medicine at the University of Texas MD Anderson Cancer Center in Houston.

U.K. report blames North Korea for WannaCry attack on NHS

Published October 27 2017, 5:01pm EDT
The U.K. government holds North Korea responsible for the global WannaCry ransomware attack that crippled parts of the state-run National Health Service, a charge contained in a damning report that highlights the health system’s weak defense against such attacks.
While the rogue Asian state has long been suspected as the culprit, this is the first time it’s been officially acknowledged by Britain.
“This attack, we believe quite strongly, came from a foreign state,” U.K. Security Minister Ben Wallace told BBC Radio. “North Korea was the state that we believe was involved in this worldwide attack on our systems. We can be as sure as possible.”

Factors contributing to medication errors made when using computerized order entry in pediatrics: a systematic review

Journal of the American Medical Informatics Association, ocx124, https://doi.org/10.1093/jamia/ocx124
Published: 26 October 2017


To identify and understand the factors that contribute to medication errors associated with the use of computerized provider order entry (CPOE) in pediatrics and provide recommendations on how CPOE systems could be improved.
Materials and Methods
We conducted a systematic literature review across 3 large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline. Three independent reviewers screened the titles, and 2 authors then independently reviewed all abstracts and full texts, with 1 author acting as a constant across all publications. Data were extracted onto a customized data extraction sheet, and a narrative synthesis of all eligible studies was undertaken.
A total of 47 articles were included in this review. We identified 5 factors that contributed to errors with the use of a CPOE system: (1) lack of drug dosing alerts, which failed to detect calculation errors; (2) generation of inappropriate dosing alerts, such as warnings based on incorrect drug indications; (3) inappropriate drug duplication alerts, as a result of the system failing to consider factors such as the route of administration; (4) dropdown menu selection errors; and (5) system design issues, such as a lack of suitable dosing options for a particular drug.
Discussion and Conclusions
This review highlights 5 key factors that contributed to the occurrence of CPOE-related medication errors in pediatrics. Dosing support is the most important. More advanced clinical decision support that can suggest doses based on the drug indication is needed.

EU Cloud in Health Advisory Council offers recommendations on health data

The European Cloud in Health Advisory Council has launched a Call to Action for policy-makers to “Enable data-driven healthcare & research for citizen benefit while protecting patient privacy” which includes specific recommendations for Member States as they implement GDPR into their national data protection laws.
TALLINN, ESTONIA - (HealthTech Wire / News) - The European Cloud in Health Advisory Council was founded in 2015 under the leadership of Microsoft and has been actively advocating for an environment which allows healthcare institutions- and patients- to reap the benefits of cloud-based solutions. Meeting twice per year and including input from 30 high level representatives from hospitals, university medical centres, industry solution providers, policy advocates and even patient groups, the Council has spent recent meetings focusing on an emerging set of issues related to requirements for handling patient data under the new General Data Protection Regulation (GDPR), enabling “research” uses of health data under the GDPR as well as issues related to  the growing interest in Artificial Intelligence (AI) in the healthcare sector.

Decision support: Making a difference can be easy

Digital alerts are among the most straight-forward healthcare IT tools to substantially improve patient care. This has been demonstrated once again. So why aren’t these tools ubiquitous?
By Philipp Grätzel von Grätz
Treatment of patients with chronic hepatitis C is one of the most amazing medical success stories of the last decade. Meticulously designed antiviral drugs have turned a devastating and often deadly disease into one that is fully curable in many cases now. Nobody would be surprised should this be awarded with a Nobel Prize sooner or later.
There is a problem though. Many patients remain unknown, without a diagnosis. Once they run into advanced liver failure or develop hepatocellular carcinoma, it is too late. Patients at risk include the baby boomer generation, born in the two decades after World War II. Their risk of being infected with hepatitis C is five times higher than that of other adults, mainly because the hepatitis C virus was only discovered in 1989.

Health, wellness apps pose risks to consumer privacy

Published October 26 2017, 7:31am EDT
While there are federal regulations governing how personal health data is shared, only a fraction of the increasingly popular consumer apps on the market are actually regulated, leaving enormous amounts of information largely unprotected.
As a result, Americans should be concerned about how these apps collect and share their personal health data. That’s the warning being made by Rice University medical media expert Kirsten Ostherr in a presentation at today’s “Data Privacy in the Digital Age” symposium hosted in Washington by the Department of Health and Human Services.
“There’s a lot of concern around issues of data privacy—especially the more that we have these huge breaches like Equifax and everything that’s come before—and little understanding of how that might spill over or play out in health data domains, such as consumer-facing apps and internal EHR systems,” says Ostherr, director of Rice University’s Medical Futures Lab.

Large providers, including Kaiser Permanente and Bon Secours, push the boundaries of telemedicine

Oct 26, 2017 9:05am
Marc Zubrow, M.D., vice president of telemedicine for UMMS and medical director of its eCare program, says many of the organization's telemedicine services have been "provider-driven."
Remote reading of radiology images used to be called "teleradiology." Now the service is so common that most folks just call it radiology. Large hospitals and health systems have led the way not only in adopting telemedicine but also making it commonplace.
But their services and delivery formats are still evolving, several healthcare leaders tell FierceHealthcare, as access, satisfaction, cost and consumerism drive the latest wave of remote care programs.

How decision support can help derive value from wellness exams

Published October 26 2017, 5:11pm EDT
Wellness exams, typically an increasingly common annual event for most patients, can be automated to expedite the process and make the resulting findings more useful.
That’s the experience of a small New Mexico health system, which is moving to an automated system to get more value out of the health-preserving initiative.
In most wellness exams, a physician goes through a checklist that includes an eye exam, family history, vaccinations, smoking status, body mass index and any history of depression or diabetes, among other checkpoints. Often, the checklist is manual but increasingly it is done electronically, with the updated checklist moving information to the electronic health record, where it is more likely to be acted upon.

HIT Think Why text and email use face a host of regulatory constraints

Published October 26 2017, 4:55pm EDT
Communication by text or email is a part of daily life. Such forms of communication occur non-stop and through a variety of means, whether it be Gmail, WhatsApp, iMessage or any other number of services.
However, the question that arises just as frequently is whether texting or email are appropriate in healthcare. The simple answer is yes—texting and email fit very well into healthcare and are very much permissible.
However, staying at the level of the simple answer is not sufficient. It is necessary to dive deeper and determine just how text and email communication can be done. Answering the more nuanced question largely depends upon the purpose of the communication. The purpose can be broken into two primary categories—marketing or provision of information. As would be expected, marketing communications create more concern and require attention to a wider array of regulatory requirements.

Wearables can save your life (not that you'd know it)

Commentary: Wearables like the Apple Watch and Fitbit Alta HR aren't for me. But they may be for you -- if you want to live.
October 26, 2017 5:00 AM PDT
I nearly suffered a heart attack at the gym a few months ago. At least, I thought I did. I actually just pulled a muscle in my shoulder while warming up on the bench press.
I'm just 25 years young with no health problems that I know of, but I'm also a hypochondriac (and WebMD never helps). Not long ago, I thought I had neck cancer because my lymph nodes expanded following a bout with tonsillitis.
Neck cancer may not be real, but do you know what is? Heart attacks. And did you know shoulder pain is a symptom of a heart attack? Did you?!

DirectTrust Health Data Exchange Likely to Hit 170M Transactions

Third quarter 2017 metrics showed a 114-percent increase in health data exchange transactions over the same time last year.

October 24, 2017 - DirectTrust announced it expects to reach 170 million cumulative health data exchange transactions for 2017 following a period of continued steady growth in users, addresses, and transactions in the third quarter of the year.
The healthcare industry alliance also revealed two new healthcare organizations — Brokers Broker and Janie Appleseed — have joined the DirectTrust network since July 1. DirectTrust’s total membership is now 121 organizations.

HIT Think How big data can predict, detect and respond to cyber threats

Published October 25 2017, 4:44pm EDT
From Anthem’s cyberattack that exposed the information of nearly 80 million people in 2015 to the WannaCry ransomware attack that affected the National Health Service in the UK, cyberattacks show no sign of slowing down.
Many healthcare organizations still rely on a patchwork of legacy systems that do not adequately manage and protect against increasingly complex cyberattacks. When combined with traditional information security practices, lack of modern response plans and insufficient resources in dedicated cyber security teams, healthcare organizations are left particularly vulnerable to attacks.
The changing healthcare landscape (industry consolidation and network centralization) adds scaling challenges associated with increasing volumes of patient data and places additional pressure on hospital IT systems.

Cerner EHR project for VA will take 7 to 8 years, Shulkin says

While the launch of the new EHR to replace the outdated VistA system will take just 18 months, but the whole system overhaul will take much longer.
October 24, 2017 03:10 PM
It will take 18 months for the U.S. Department of Veterans Affairs to launch the new Cerner electronic health record and another seven to eight years to transition the whole legacy EHR system once the contract with Cerner is finalized, VA Secretary David Shulkin, MD,  told the House Committee on Veterans’ Affairs on Tuesday.
But some on the committee weren’t convinced of the timeline.
"This isn’t a scientific analysis, but I have yet to see a VA budget for time or cost [not] exceeded," said Rep. Beto O’Rourke, D-Texas. "It usually goes beyond the budgeted time, beyond the budgeted costs."

Telepsychiatry app LARKR launches with multi-user sessions, counseling for minors

October 23, 2017
Mental health-focused video consultation platform LARKR has launched in the Apple App Store. The service employs state-certified therapists across the country, and supports multi-user, multi-location conferences to enable group therapy sessions.
“When I learned of the massive void leaving 60 percent of the 50 million Americans who suffer from mental illness without care, I felt compelled to create a practical and effective solution,” CEO and cofounder Shawn Kernes, who previously held positions in StubHub and eBay, said in a statement. “LARKR breaks through roadblocks to care by providing meaningful therapy for anyone who needs it, at the moment they need it, even if they live in a remote area with no local therapists.”
After downloading the app and answering a few questions, LARKR users can access 50-minute live therapy sessions on-demand for a flat fee of $85 per session. Along with pick-up sessions, users can schedule recurring sessions from the same therapist without minimum commitments, monthly subscription plans, or other more involved payment systems. The developers noted in the statement that LARKR is currently seeking an additional 10,000 qualified mental health specialists from all 50 states for employment in its budding service.

HIT Think Why policymakers hold the key to prodding interoperability

Published October 24 2017, 4:45pm EDT
It’s not exactly a sweater or tie that gets worn once and then relegated to the top of the closet, but it turns out that patient data may have something in common with unloved holiday gifts. Both, it appears, are shared and then seldom used.
At least that’s one takeaway from a recent Health Affairs study on interoperability and how far forward we’ve actually moved the ball. The authors used the most recent available data (2015) and the four interoperability standards established by the Office of the National Coordinator (ONC)—finding, sending, receiving, integrating—to conclude that progress on this measure is lagging, at best.

EHR Helped Hospital Track C. Diff

MedPage Today, October 24, 2017

Spatial, temporal analytics may aid infection control in hospitals.

This article first appeared October 23, 2017 on Medpage Today.
By Alexandria Bachert, MPH
Using electronic health record (EHR) data on time and location allowed researchers to identify a source of a Clostridium difficile at the University of California San Francisco Medical Center.
Exposure to C. difficile infection (CDI) in the computed tomography scanner in the emergency department (CT-ED) was associated with a 4% incidence of CDI (OR 2.5 versus unexposed individuals in the same space; 95% CI 1.2-5.2), reported Russ Cucina, MD, senior study author and chief health information officer at UCSF, and colleagues.

AI in EHRs Could Help Doctors With CDI Burden

Alexandra Wilson Pecci, October 24, 2017

Alleviating documentation headaches would help physicians, but price also has to be right, says analyst.

The use of artificial intelligence (AI) in healthcare might be one of the most promising areas for investment and research.
Among those hopping on the AI train is EHR company Epic, which counts 190 million current patients in its system and plans to use AI to help improve physician documentation.
According to Koustav Chatterjee, a healthcare IT industry analyst for Frost & Sullivan, it's a smart move.
"Epic has catered to a relevant market pain point and rightly aims to help physicians repurpose time for better patient care," he says.

ONC approves new way to transmit immunization records

Published October 23 2017, 7:42am EDT
The electronic health records meaningful use program includes requirements that a provider’s EHR or other clinical systems can successfully test transmission of immunization records and appropriate data to an immunization registry.
Now, the Office of the National Coordinator for Health Information Technology has approved an alternative testing method developed by HIMSS, known as the HIMSS Immunization Integration Program, or HIMSS-IIP.
The new methodology uses a testing tool developed by the National Institute of Standards and Technology. HIMSS collaborated on the program with ICSA Labs and Chickasaw Health Consulting under a contract with the Centers for Disease Control and Prevention.

HIT Think How healthcare IT executives can better control ‘shadow IT’

Published October 20 2017, 3:50pm EDT
Think Shadow IT isn't a big deal? Consider the following.
According to data from Microsoft, more than 80 percent of employees admit to using unapproved SaaS apps for corporate purposes.
Research from Cisco suggests that 15 to 25 times the number of known cloud services are purchased by employees without IT involvement.

Regenstrief to evaluate how health information exchange impacts EDs

Published October 23 2017, 7:33am EDT
Under a two-year grant from the Agency for Healthcare Research and Quality, the Regenstrief Institute is conducting the first study of health information exchange utilization in emergency departments at multiple institutions to determine whether it improves patient outcomes over time.
“Almost 70 percent of hospital admissions for Medicare beneficiaries originate in the ED, of which many may be avoidable if comprehensive information was available to clinicians,” states the AHRQ website regarding the grant.
Despite the fact that HIE is more frequently used in EDs than in any other healthcare setting, little research has been conducted to evaluate the impact of long-term use on emergency care, according to Brian Dixon, Regenstrief’s principal investigator on the study and an assistant professor of epidemiology at Indiana University’s Richard M. Fairbanks School of Public Health.

Go figure: The key to big data is actually small data

Healthcare organizations should break down data into smaller sets that can be used to build into larger programs, experts say.
October 23, 2017 03:05 PM
Abbas Mooraj, Optum Vice President (right), and Dexter Braff, The Braff Group (left), speaking at the HIMSS Big Data and Analytics Forum on Monday.
BOSTON – To successfully leverage healthcare analytics, it might be time to break big data down into smaller increments to better transform the information into knowledge.
“Small data will tell us more than all of the big data we have now,” said Optum Vice President Abbas Mooraj, speaking at the HIMSS Big Data and Analytics Forum Monday.

Halamka: Decision support, care management key to accelerating precision medicine

The Beth Israel Deaconess Medical Center CIO says tailored treatment plans could be here soon with more widespread FHIR exchanges enabling easier access to cloud-based CDS insights.
October 23, 2017 11:06 AM
Beth Israel Deaconess Medical Center CIO John Halamka, MD, has written and presented often over the past few years about his wife Kathy's cancer treatment and the ways precision medicine techniques have helped guide her care plan.
In a recent HIMSS Learning Center webinar, he shared some lessons learned from a recent chapter in that journey and offered some optimistic words about the timeline for improving the delivery and reimbursement of personalized treatments.
In Halamka's telling, effective precision medicine entails and requires much more than just the genomic science most commonly associated with the term. It depends on patient and family engagement, social determinant factors, easily interoperable clinical decision support tools and more.

Special Report: Vendor Neutral Archive (VNA)

With the case for easy data sharing within healthcare being made frequently and at high levels, vendor neutral archives (VNAs) should arguably be enjoying their moment in the sun. But, as Jennifer Trueland reports, there is still a sense that healthcare trusts could go further in their use of such systems.
When Matthew Swindells addressed the 2017 Health and Care Innovation Expo in Manchester last month, he had a very clear message for IT vendors and for those working in the NHS.
Software providers should not be protective about data they considered “theirs”, he warned, and NHS bodies should be tenacious – “really grippy” was his phrase – about only choosing vendors who helped to drive openness and data sharing into the system.

How AI can help you stay ahead of cybersecurity threats

Artificial intelligence and machine learning can be force multipliers for under-staffed security teams needing to respond faster and more effectively to cyber threats.

Contributing Writer, CSO | Oct 19, 2017 3:31 AM PT
Since the 2013 Target breach, it’s been clear that companies need to respond better to security alerts even as volumes have gone up. With this year’s fast-spreading ransomware attacks and ever-tightening compliance requirements, response must be much faster. Adding staff is tough with the cybersecurity hiring crunch, so companies are turning to machine learning and artificial intelligence (AI) to automate tasks and better detect bad behavior.

What are artificial intelligence and machine learning?

In a cybersecurity context, AI is software that perceives its environment well enough to identify events and take action against a predefined purpose. AI is particularly good at recognizing patterns and anomalies within them, which makes it an excellent tool to detect threats.


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