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, March 03, 2018

Weekly Overseas Health IT Links – 03rd March, 2018

Here are a few I came across last week.
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.

HHS takes aim at reducing the administrative burden of EHRs

Published February 23 2018, 7:20am EST
The Department of Health and Human Services is firmly committed to reducing the regulatory and administrative burdens on clinicians who use electronic health records, as required under the 21st Century Cures Act.
That’s the message the Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health IT delivered on Thursday during a listening session with stakeholders intended to get feedback on the challenges and opportunities for alleviating burdensome EHR requirements.
Kate Goodrich, MD, chief medical officer and director of the CMS Center for Clinical Standards and Quality, predicted that 2018 is going to be a “pretty significant year in terms of regulatory reform and administrative burden reduction.”

Special Report: PACS

As healthcare organisations move to their second or third PACS procurements, they are now demanding new systems fit for the future. This can range from having reporting functionality to new systems being capable of operating artificial intelligence. But can the new-generation PACS achieve all this? Jen Trueland reports.
The NHS is demanding more and more of its picture archiving and communications systems (PACS) and this trend is only likely to continue. As healthcare organisations move to their second or third PACS procurements, pioneers are insisting that new systems should be fit for the future – even if we don’t quite know what the future will hold yet.
This can mean anything from stipulating in tenders that PACS systems have reporting functionality to ensuring that they can operate not just at an enterprise level, but across an entire region, or even nationally.

VA partners with DeepMind to identify risks during hospital stays

The partnership will use AI to uncover risk predictors for the most common conditions experienced during hospital stays and work to improve care.
February 23, 2018 09:32 AM
The Department of Veterans Affairs has announced a research partnership with Alphabet subsidiary DeepMind that will tackle issues concerning patient deterioration during hospital care.
Using a dataset comprised of 700,000 historical, de-personalized health records, the machine learning platform will help the VA identify risk factors for deterioration while predicting its onset.
“Medicine is more than treating patients’ problems,” VA Secretary David J. Shulkin, MD, said in a statement. “Clinicians need to be able to identify risks to help prevent disease. This collaboration is an opportunity to advance the quality of care for our nation’s veterans by predicting deterioration and applying interventions early.”

Epic to demo new Sonnet EHR at HIMSS18

The electronic health record software vendor will also be showing the new One Virtual System Worldwide as we well as updates to its MyChart patient portal.
February 23, 2018 09:49 AM
Last year at HIMSS17 Epic Systems founder and CEO Judy Faulkner announced the company was developing two new EHRs for hospitals that don’t need the full version of Epic. 
This year at HIMSS18 attendees can get the first look at Epic Sonnet, which Faulkner described as Epic technology with some of the features removed, and at a lower cost.
She explained that smaller hospitals might not require the full version of the Epic EHR, yet they could add all the Epic features later.

Online Tool Aids Decision Making About Breast Cancer Treatment

Findings based on assessment of the interactive iCanDecide tool
WEDNESDAY, Feb. 21, 2018 (HealthDay News) -- The interactive iCanDecide breast cancer treatment decision tool can improve high-quality decision making about breast cancer surgical treatment, according to a study published online Jan. 24 in the Journal of Clinical Oncology.
Sarah T. Hawley, Ph.D., from the University of Michigan in Ann Arbor, and colleagues randomized 537 patients with newly diagnosed, early-stage breast cancer to the iCanDecide interactive and tailored website (intervention) or the iCanDecide static website (control).
The researchers found that patients in the intervention arm had higher odds of making a high-quality decision versus those in the control arm (odds ratio, 2.00; P = 0.0004). This difference was driven primarily by the rates of high knowledge in the groups. In the intervention arm, more patients had high decision preparation (P = 0.027), but there were no significant differences in the other decision appraisal outcomes. The effect of the intervention was similar for women at enrollment who were leaning strongly toward a treatment option versus with those who were not.

EHR Time Exceeds Patient Face Time in Family Practice Visits

Tara Haelle
February 23, 2018
Primary care physicians spend less time interacting face-to-face with their patients than they do working on electronic health records (EHR), according to a cross-sectional study published in the February issue of Family Medicine.
"The majority of family physicians worked through lunch, stayed late at clinic, or took their work home to complete the day's EHR work," write Richard A. Young, MD, from the JPS Family Medicine Residency Program in Fort Worth, Texas, and colleagues.
"Significant predictors of visit length included the number of reasons for the visit, new patients to the practice, the number of medications prescribed, whether the physician was Hispanic, whether a resident physician presented the patient to an attending physician, whether the patient had one or multiple physicians caring for him or her, and a few other factors," the authors explain.
"Our findings have important economic implications for family physicians."

Patient-generated health data can be used to improve patients’ health – here’s how

February 22, 2018
The rise of innovative digital health technologies has increased the ease of capture, use, and sharing of Patient-Generated Health Data (PGHD). PGHD, gathered using digital health tools such as online questionnaires, personal health records, mobile apps, wearables, and connected medical devices, can help patients become more engaged in their care.

The interest of consumers in capturing their own health data has grown considerably, introducing new challenges and also tremendous opportunities for clinicians and researchers to gain insights from the data. This is why many health practitioners are actively looking for ways to capitalize on the pervasiveness of these devices and find opportunities to use the abundance of data that patients are generating.
Healthcare professionals often don’t have real-time access to data about a patient’s life outside of the clinical setting. This limits the potential for a holistic perspective of their patients’ health and care. The use and sharing of PGHD for clinical care and research are not yet in widespread practice, in part due to several barriers across the health ecosystem.

Synergy Between Nurses And Automation Could Be Key To Finding Sepsis Early

February 22, 201812:40 PM ET
Ian C. Bates for NPR
A quarter of a million Americans die every year from sepsis, which is the body's reaction to overwhelming infection. This cascade of organ failure can be nipped in the bud if health care workers know it's ramping up, but that's often not easy to do.
"Sepsis is a really frustrating disease," says Dr. David Carlbom, a critical care pulmonologist, and medical director of the sepsis program at the Harborview Medical Center in Seattle. "There's no blood test for sepsis," he says. "There's nothing you can look at under the microscope and say 'this is sepsis.' "
So a few years ago, Carlbom set out to devise a system that uses more subtle clues from a patient's day-to-day electronic health records to send up warning flags of impending sepsis.

Drug mistakes killing up to 24,000 patients a year

Chris Smyth, Health Editor
February 23 2018, 12:01am, 
The Times
A report has recommended ending handwritten prescriptions in a bid to avoid potentially fatal drugs errors
Handwritten NHS prescriptions must end, the health secretary will say today as a report concludes that errors involving dispensed medicines kill up to 22,300 patients a year.
NHS staff make 237 million drugs errors every year, more than a quarter of which injure patients and cost up to £1.6 billion, a study ordered by the government has found.
Jeremy Hunt intends to stop the “appalling levels of harm and death” that result from doctors prescribing the wrong dose, pharmacists handing out the wrong medicine and nurses mixing up patients. He has set a five-year target to halve harm from drug mistakes.

Clinical decision support takes to the cloud

At HIMSS18, longtime health informaticist Blackford Middleton will show how CDS can be deployed online and via SMART on FHIR apps and shared across EHRs nationwide.
February 22, 201801:58 PM
The era of value-based care demands the smart use of clinical decision support. With quality improvement now an imperative, CDS is crucial to help health systems move the needle on more effective care delivery.
Ideally, CDS tools will be readily accessible to a wide array of caregivers where and when they need them, irrespective of what electronic health record they're using. That's easier said than done but success stories are emerging. 
Take the AHRQ-funded CDS Consortium Project, for instance. 
"The CDS Consortium project demonstrated successfully that CDS from Partners Healthcare could be delivered to disparate EMRs across the country," said Blackford Middleton, chief informatics and innovation officer at Apervita. 
Other EHR platforms in the consortium work include Epic, NextGe

JAMA: EHRs fail to reduce administrative billing costs

While EHRs were implemented with the idea that they would reduce administrative costs, Harvard and Duke researchers found primary care services cost providers about $100,000 annually.
February 21, 2018 11:28 AM
No evidence was found that EHR systems reduced billing costs related to physician services the studies found.
One of the core reasons the federal government made its push for the adoption of electronic health records was that it would reduce administrative costs. But a new study published this week in the Journal of the American Medical Association found EHRs aren’t getting the job done.
Researchers from Harvard Business School and Duke University examined the use of a certified EHR at a large academic healthcare system, which found estimated costs for billing and insurance-related functions were substantial and varied by the type of clinical encounter.
February 21, 2018 / 11:59 AM / 2 days ago

Artificial intelligence poses risks of misuse by hackers, researchers say

FRANKFURT (Reuters) - Rapid advances in artificial intelligence are raising risks that malicious users will soon exploit the technology to mount automated hacking attacks, cause driverless car crashes or turn commercial drones into targeted weapons, a new report warns.
Sophia, a robot integrating the latest technologies and artificial intelligence developed by Hanson Robotics is pictured during a presentation at the "AI for Good" Global Summit at the International Telecommunication Union (ITU) in Geneva, Switzerland June 7, 2017. REUTERS/Denis Balibouse
The study, published on Wednesday by 25 technical and public policy researchers from Cambridge, Oxford and Yale universities along with privacy and military experts, sounded the alarm for the potential misuse of AI by rogue states, criminals and lone-wolf attackers.

HIT Think How healthcare’s regulatory landscape will affect HIT in 2018

Published February 22 2018, 5:08pm EST
As the Trump administration moves into its second full year, there are many updates to U.S. healthcare policy to take into account. From attempts to repeal the Affordable Care Act to naming a new HHS secretary, change is buffeting the healthcare sector.
Many of these challenges will have either direct or indirect effects on how organizations use healthcare information technology in the coming years.
Here’s a rundown of the regulatory landscape for the upcoming year.
The Republican tax bill and ACA’s individual mandate
In December, the Republican tax bill passed and President Trump signed it into law. The tax bill didn’t repeal the individual mandate, which is the ACA’s provision that requires folks who don’t qualify for a hardship exemption to carry a minimum level of health coverage. Technically, it eliminated the penalty for not having health insurance in the year 2019 and onward.

4 policy priorities for HIMSS in the coming year

Feb 21, 2018 10:05am
With 2018 shaping up to be an interesting year for health policy, the Healthcare Information Management Systems Society (HIMSS) has outlined its priorities for the next several months. 
HIMSS is among the many industry groups awaiting the Office of the National Coordinator for Health IT's forthcoming information blocking rule, and Jeff Coughlin, HIMSS' senior director of federal affairs, said at a press roundtable that he expects the group's Trusted Exchange Framework and Common Agreement to "set the stage" for that rule. 
"It's a tough challenge" for ONC, HIMSS Vice President for Government Relations Tom Leary said at the briefing, because the definition of what exactly constitutes information blocking can vary so widely. 

EHRs fall short in reducing administrative costs

Published February 21 2018, 7:39am EST
Electronic health records were expected to reduce administrative costs for providers, but a study of a large academic healthcare system with a certified EHR system reveals that the estimated costs of billing and insurance-related activities were substantial and varied depending on the type of clinical encounter.
Researchers from Duke University and Harvard Business School estimated the billing and insurance-related costs for five types of patient encounters—primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, as well as inpatient surgical procedures.
According to the results of their study published February 20 in the Journal of the American Medical Association, the estimated costs of billing and insurance-related activities ranged from about $20 for a primary care visit to approximately $215 for an inpatient surgical procedure—representing 3 percent to 25 percent of professional revenue.
“For primary care visits, this translated to an estimated more than $99,000 of billing and insurance-related expenses annually for each primary care physician working in the system just to get paid,” states a separate editorial accompanying the JAMA study.

HT Think Three ways to build a foundation for advanced healthcare technologies

Published February 21 2018, 5:35pm EST
Cutting-edge technologies like deep machine learning, digital pathology, precision medicine and genomics are fueling some of the most exciting discussions in the healthcare industry.
However, in addition to these discussions, it’s also critical to talk about the digital foundation a healthcare organization has put in place and whether or not its IT staff is prepared to examine, adopt and support these advanced solutions.
To deliver sophisticated technologies like these requires the full focus and attention of a unique breed of IT specialists. And while these people may already be on an organization’s IT staff, if they’re bogged down with the daily operation of an infrastructure, the intellectual bandwidth needed to tackle the implementation and deployment of new clinical or research technologies simply won’t be available.

Survey: 72% of international EHR users cite APIs, clinical portals as ways to improve interoperability

Written by Jessica Kim Cohen | February 18, 2018 | Print  | Email
Seven percent of global EHR users describe their regional health IT system as having meaningful connectivity with other providers, according to a Feb. 12 report released by Black Book Research.
For the survey, the health IT research firm polled 7,459 physicians, health administrators, technology managers and clinical leaders in ambulatory and inpatient settings across 23 countries about their attitudes toward EHRs.
Ninety percent of international respondents from outside of the U.S. indicated confusion surrounding the definition of a highly interoperable EHR systems. When asked their preferred strategy for linking disparate health IT systems, 72 percent of respondents cited capabilities such as application programming interfaces, clinical portals and web services.

Email Fraud Continues To Inundate Inboxes

·         by Jess Nelson , Yesterday
Business organizations were more heavily impacted by email fraud in 2017 than in 2016, according to a recent Proofpoint study that details the growth of email phishing attacks year-over-year. 
The enterprise security company analyzed 160 billion emails delivered to 2,400 global companies at the end of 2017 in its Email Fraud Threat Report, concluding that 88.8% of organizations were targeted by at least one email phishing attack over the past year.
This is a significant increase from results detailed in Proofpoint’s 2016 report, which cited that 75% of organizations had been impacted by email fraud.
More identities were spoofed in 2017, as well according to Proofpoint, with almost half of organizations having more than five spoofed email identities. The majority of spoofed identities -- instances when fraudsters leverage spoofed emails to impersonate individuals within an organization to trick their victims -- held job titles related to finance and/or accounting. Similar results were found in a study released by KnowBe4 that suggests people usually click on phishing attacks that concern money, whether the money is being promised or threatened.

Privacy advocates fear Common Rule could shortchange patient rights

Published February 19 2018, 7:34am EST
A primary purpose of the Common Rule governing how medical research is done is protection of humans participating in such research, and the rule is applicable whenever federal funds support research involving human subjects, according to Rebecca Herold, CEO at The Privacy Professor, a consultancy, and President at SIMBUS360.com, a cloud services corporation.
But Herold worries that privacy and security considerations often are secondary when human research is being conducted. “There has been great concern since the initial final rule was published about the lack of clarity and specifics within the final rule, and also the ways in which the wording could allow for use of patient data in research without the associated individuals’ true consent or even knowledge,” she contends.
A new interim final rule issued recently would supersede provisions of the initial final rule, but the privacy and security concerns remain valid.

Apple’s Move to Share Health Care Records Is a Game-Changer

Aneesh Chopra and Shafiq Rab
·         science 02.19.18 09:00 am
Imagine if Apple further opens up Apple Health so it no longer serves as the destination, but a conduit that can help guide patients through decisions to better manage their health.
In late January, Apple previewed an iOS feature that would allow consumers to access their electronic health records on their phones. Skeptics said the move was a decade too late given a similar (and failed) effort from Google. Optimists argued that Apple was capable of translating health data into something meaningful for consumers.
But the announcement portends great things for consumers and the app developers seeking to serve them, from our perspectives as the former US chief technology officer under President Obama, and as an early adopter of the Apple service as Rush University Medical Center’s chief information officer. That’s because Apple has committed to an open API for health care records—specifically, the Argonaut Project specification of the HL7 Fast Health Interoperability Resources—so your doctor or hospital can participate with little extra effort.

Medicare to Reimburse for Telestroke Regardless of Location

Alexandra Wilson Pecci, February 20, 2018

The FAST Act changes Medicare rules to expand telestroke reimbursement to urban and suburban hospitals.

Incorporated within the bipartisan budget deal signed into law earlier this month is the FAST (Furthering Access to Stroke Telemedicine) Act, which expands telemedicine for stroke by requiring Medicare to reimburse for telestroke services regardless of where a patient receives treatment.
Telemedicine adoption has been inconsistent throughout the United States for several reasons, including how providers would get reimbursed for such services, limitations about which services can be reimbursed for telehealth, and restrictions on where patients can receive the telehealth treatments.
For example, Medicare covers certain services performed at certain locations, while state regulations vary for Medicaid payments, with some states only covering certain services performed by certain types of specialists.

Apple Health app effort to engage consumers by sharing EHR info

Published February 19 2018, 7:27am EST
Apple’s recently announced efforts to enhance the healthcare capabilities of its iPhone Health app represent a jump-start for efforts to advance the coordination of patient care through record sharing.
The push has direct implications for Apple’s designs to play a more significant role in enabling consumers to monitor and improve their health, while trying to advance providers’ IT efforts to share data with other organizations, as well as with consumers themselves.
The initiative’s success will hinge on the ability of an emerging standard to pull together patients’ medical information from a variety of records systems and present a unified view of that information to consumers.

EHR interoperability, connectivity a big challenge around globe new study finds

Black Book also predicted a coming shift away from silo electronic health records systems to regional care coordination and information exchange in other countries.
February 19, 2018 04:41 PM
Ninety percent of healthcare professionals participating in a new survey confessed to being confused about what makes a highly interoperable EHR. Black Book Research, in fact, surveyed 11,838 doctors, healthcare administrators, technology managers and clinical leaders around the world.
What’s more, 72 percent stated that their preferred strategy for EHRs is to link disparate systems through messaging, APIs, web services and clinical portals -- but only seven percent of all international EHR survey respondents described their regional HIT system as having meaningful connectivity with other providers.
That’s at least part of the reason why Black Book in its new “State of the Global EHR Industry, 2018” report predicted a pending shift from silo EHR systems toward regions of healthcare delivery organizations in Europe, the Middle East and South Asia. Respondents to the survey anticipate a move to enterprise-wide electronic health records systems with data exchange and care coordination capabilities similar to the global offerings of current U.S.-based vendors by 2023.

Google AI now can predict cardiovascular problems from retinal scans

This is a big step forward, Google officials said, because the tech is not imitating an existing diagnostic but rather using machine learning to uncover a new way to predict health problems.
February 19, 2018 12:18 PM
Google AI has made a breakthrough: successfully predicting cardiovascular problems such as heart attacks and strokes simply from images of the retina, with no blood draws or other tests necessary.
This is a big step forward scientifically, Google AI officials said, because it is not imitating an existing diagnostic but rather using machine learning to uncover a surprising new way to predict these problems. What's more, the new system shows what parts of the eye image lead to successful predictions, giving researchers new leads into what causes cardiovascular disease.
The results of the Google AI research have been published in an article entitled "Prediction of Cardiovascular Risk Factors from Retinal Fundus Photographs via Deep Learning" in Nature Biomedical Engineering.

House balks at $10 billion price tag for VA-Cerner EHR project

VA Committee Chair Phil Roe was also concerned that the amount doesn’t cover maintenance or the cost to update the infrastructure necessary to accommodate the new platform.
February 16, 2018 01:04 PM
As the time draws near for the U.S. Department of Veterans Affairs to sign its EHR contract with Cerner, Congressional members are growing increasingly concerned over not only the $10 billion price tag, but that the agency will need to keep the legacy system in place, perhaps indefinitely.
“While the EHR modernization effort is necessary, it is very expensive,” House VA Committee Chairman Phil Roe, MD, R-Tennessee, said during the Thursday hearing on the VA’s 2019 budget requests.
“The contract with Cerner alone has a price tag of about $10 billion and that doesn’t even include the costs of updating infrastructure to accommodate the new EHR, implementation support or sustaining VistA up until the day it can be turned off,” he continued.

Doctors Don't Need to Redocument Students' EHR Entries: CMS

Kerry Dooley Young
February 15, 2018
Federal officials will let medical students' entries into electronic health records stand for parts of Medicare claims, eliminating a need for teaching physicians to redocument much of their work.
The Centers for Medicare & Medicaid Services (CMS) on February 2 made changes to rules for billing for evaluation and management services. Teaching physicians still must personally perform or reperform physical exams and handle decision-making steps for an evaluation and management service, but they now can simply verify the students' documentation of them in the medical record.
CMS earlier required that teaching physicians both verify and redocument notes on the physical exam and medical decisions.

Hospital Data Breaches Most Common, Affect the Most Patients

A recent study found that hospitals account for one-third of all reported incidents to OCR and that hospital data breaches impact more individuals.

February 16, 2018 - Hospital data breaches accounted for approximately 30 percent of large data security incidents reported to OCR from 2009 to 2016, according to a study published in the American Journal of Managed Care (AJMC).
The largest number of individuals were impacted in hospital data breaches as well, found the research team led by Meghan Hufstader Gabriel, PhD, University of Central Florida.
There were 215 breaches that affected 500 or more individuals in the research time period, with 185 occurring at nonfederal acute care hospitals. Thirty hospitals had multiple breaches during that time, which included 24 hospitals having two breaches and five hospitals reporting three breaches. One hospital had four breaches, the study found.
15 Feb 2018 News

Two Billion Files Leaked in US Data Breaches in 2017

Tara Seals US/North America News Reporter, Infosecurity Magazine
Nearly 2 billion files containing the personal data of US citizens were leaked last year—and that number could be significantly underreported.
In 2017, a total of 551 breaches affected organizations, with over 1.9 billion files leaked, according to research from Citrix ShareFile.
Using data collected from the Privacy Rights Clearinghouse and the 2017 Cost of Data Breach Study by the Ponemon Institute, in partnership with IBM Security, the analysis found that malicious hacking was the most common type of breach in 2017, 819 million files exposed. Unintended disclosure (such as cloud storage misconfigurations) and physical loss were found to be the second and third most common data leakage causes.

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