Saturday, March 31, 2018
Weekly Overseas Health IT Links – 31st 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.
The use of technology to support self-care is considered to be a holy grail of any sustainable health service. So how can the NHS utilise and share such information to improve patient experience and empower them to manage their health better? Jennifer Trueland reports.
In the relatively short time since Mona Johnson started working as a GP she has noticed a significant shift in the way that patients and clinicians interact.
Rather than almost every contact being face-to-face and in person, there’s an ever-increasing menu of options including video appointments, text messaging, sending information via remote monitoring devices, and even the distinctly old-tech telephone.
19 March 2018
Since introducing System C’s CareFlow Vitals electronic observations software across the Trust’s two acute hospitals, East Sussex Healthcare Trust (ESHT) has seen marked improvements in patient safety – notably with reduced cardiac arrest rates and improving outcomes for patients. Other benefits include smarter, more pro-active working and earlier interventions. The software has also helped the Trust develop a culture of improvement, using real-time data to drive change.
The Trust’s implementation and use of CareFlow Vitals (formerly Vitalpac) by its Outreach Team is praised by the CQC as an area of excellence.
20 March 2018
Google has launched a new cloud application programming interface (API) that aims to address interoperability challenges in the healthcare industry.
Cloud Healthcare API is an open-source tool designed to enable healthcare providers to collect and manage various types of medical data via the cloud, including DICOM, HL7 and Fast Healthcare Interoperability Resources (FHIR) standards.
Google hopes the API will provide a jumping-off point for healthcare organisations to launch analytics and machine-learning projects in the cloud, using data aggregated from multiple clinical systems.
Healthcare providers will be able to run analytics on this data to identify patterns that could help improve patient outcomes.
By Fred Bazzoli
Published March 23 2018, 2:43pm EDT
Artificial intelligence is beginning to provide an early down payment on benefits to healthcare providers, but the industry is still early in understanding how to use advanced computing to improve care.
Still, the potential is great, because providers are accumulating significant patient data that can be used to deliver precise and effective care, said presenters this week at Solve: Healthcare, an event sponsored by Intel to discuss the role of AI in healthcare and medicine.
“We’re using less than 5 percent of (patient) data” as clinicians make decisions on providing care, says Rachel Callcut, MD, a trauma surgeon and director of data science and advanced analytics for UCSF Medical Center.
By Shawn Burke
Published March 23 2018, 5:09pm EDT
When Hancock Health was hobbled by ransomware, it wasn’t for the usual reasons. No one had clicked a suspicious link in a phishing email. It had its system fully backed up and recoverable.
The attack came from an outside vendor. Hackers stole credentials from one of Hancock Health’s hardware providers, then targeted the hospital’s backup site.
They delivered the ransomware via the connection between the backup site and the hospital’s main site server farm, compromising the backups, the connection and the hospital’s records.
Published March 22 2018, 7:26am EDT
The Centers for Medicare and Medicaid Services is leveraging HL7’s Fast Healthcare Interoperability Resources standard and OAuth 2.0 security profiles so that Medicare beneficiaries will be able to access and share their claims data in a universal digital format.
“CMS is going to be releasing Medicare claims data, and what’s different about Blue Button 2.0 is its going to be using the open API FHIR protocol as well as OAuth 2.0,” said National Coordinator for Health IT Don Rucker, MD, at Wednesday’s HIT Advisory Committee meeting. “It will be the first of a number of efforts there with the ultimate goal of getting everything on people’s smartphones.”
By Kate Monica
March 21, 2018 - The price tag for the VA Cerner implementation contract has spiked by 60 percent, judging by testimony given at a recent House Appropriations subcommittee hearing.
In her opening statement, House Military Construction and VA Appropriations Subcommittee Ranking Member and Representative Debbie Wasserman Schultz (D-FL) revealed the cost of VA’s EHR modernization project had increased $6 billion above what was initially expected to be a $10 billion contract.
“The FY 2019 budget requests $1.2 billion to continue the massive implementation, preparation, development, interface, management, rollout, and maintenance of a veteran’s electronic healthcare record system which is excruciatingly long overdue,” said Wasserman Schultz.
Published March 22 2018, 5:53pm EDT
Over the past year, healthcare-related hacks like WannaCry have made for some significant headlines. Yet, this recent surge of cybercrime—and its effects on consumer confidence—is unsurprising.
The Unisys Security Index™, which gauges the attitudes of consumers on a wide range of security-related issues, found that security concerns regarding viruses/malware and hacking rose dramatically.
Given that an electronic medical health record (EHR) can be worth hundreds or even thousands of dollars on the black market, compared with just 25 cents for a typical credit card number, it is no surprise that healthcare has been increasingly targeted by hackers. From a member and patient perspective, robust security is not an option; it is an absolute necessity.
For most of her life, Tammy Dobbs, who has cerebral palsy, relied on her family in Missouri for care. But in 2008, she moved to Arkansas, where she signed up for a state program that provided for a caretaker to give her the help she needed.
There, under a Medicaid waiver program, assessors interviewed beneficiaries and decided how frequently the caretaker should visit. Dobbs’ needs were extensive. Her illness left her in a wheelchair and her hands stiffened. The most basic tasks of life — getting out of bed, going to the bathroom, bathing — required assistance, not to mention the trips to yard sales she treasured. The nurse assessing her situation allotted Dobbs 56 hours of home care visits per week, the maximum allowed under the program.
For years, she managed well. An aide arrived daily at 8AM, helped Dobbs out of bed, into the bathroom, and then made breakfast. She would return at lunch, then again in the evening for dinner and any household tasks that needed to be done, before helping Dobbs into bed. The final moments were especially important: wherever Dobbs was placed to sleep, she’d stay until the aide returned 11 hours later.
Published March 21 2018, 7:22am EDT
Electronic health records are poorly designed to support longitudinal, personalized healthcare and must be reconfigured around patients’ life and health goals, providing clinicians with relevant and actionable information that is responsive to patient needs.
So argues Zsolt Nagykaldi, associate professor and director of research in the Department of Family and Preventive Medicine at the University of Oklahoma Health Sciences Center, and an international team of primary care researchers.
Writing in the latest issue of the Annals of Family Medicine, Nagykaldi and his colleagues contend that most existing EHR systems were “designed in the prevailing disease- and payment-focused care paradigm that often loses sight of the goals, needs and values of patients and clinicians.”
By Kate Monica
March 21, 2018 - Health IT developers should consider creating new EHR functionality that supports goal-directed healthcare rather than problem-oriented healthcare, according to a new report by researchers at the University of Oklahoma Health Sciences Center Department of Family and Preventative Medicine.
In the study published in the Annals of Family Medicine, researchers made a case for innovating a new EHR design that highlights life and health goals as top priorities to help healthcare providers deliver truly comprehensive patient care that focuses on the full scope of health and wellness.
Current EHR functionality primarily supports a problem-oriented, fee-for-documentation-based health system. This EHR design is not conducive to supporting the goals, needs, and values of patients and clinicians, researchers argued.
By May 25, U.S. providers caring for EU patients will need to brush up on consent forms, data sharing and privacy monitoring because the General Data Protection Regulation is tougher than HIPAA.
March 21, 2018 09:31 AM
The European Union General Data Protection Regulation will go into effect on May 25, and healthcare organizations who treat patients from any of the 28 EU nations will need to familiarize themselves with the law to ensure compliance.
GDPR requires companies to gain affirmative consent for any data collected from people who reside in the EU. And organizations that violate the law could face fines up to four percent of their global annual revenue or 20 million euros -- whichever fine is higher.
While U.S. organizations must remain HIPAA-compliant, GDPR rules could be a game-changer for those who care for EU patients. Providers will need to consider data flows, cross-border data transfer, privacy and security monitoring, to ensure their policies are compliant with the law.
The organizations said they intend to establish digital pathology centers and to create best practices and protocols for the digital transformation of the field.
March 20, 2018 11:58 AM
Massachusetts General and Brigham and Women’s announced on Tuesday that they will roll out Philips IntelliSite digital pathology tools to both enable research and support clinical diagnosis and collaboration.
Mass General and Brigham and Women’s, both part of Partners HealthCare in Boston, expect the work will help inform the use of digital pathology across the country using best practices and protocols.
Pathology is a branch of medicine that deals with the laboratory examination of samples of body tissue for diagnostic or forensic purposes.
by Evan Sweeney
Mar 21, 2018 8:54am
Part of a plan unveiled by President Donald Trump on Monday to address opioid abuse includes transitioning states to a nationally interoperable Prescription Drug Monitoring Program (PDMP) designed to reduce the number of opioid prescriptions across the country.
Trump’s plan, which aims to reduce the number of opioid prescriptions by one-third over the next three years, is part of a three-pronged effort to stem the opioid epidemic through increased awareness, tighter prescribing practices and a push to prosecute drug dealers with the death penalty.
A nationally interoperable PDMP network that shares prescribing data across state lines is popular among health IT and drug abuse experts that see it as one of several tools to improve data collection and integrate clinical decision support tools.
Rasu Shrestha, MD, chief innovation officer for Pittsburgh-based UPMC, will helm the U.S. Department of Veterans Affairs' open application programming interface pledge, the agency announced March 19.
VA Secretary David Shulkin, MD, unveiled the API pledge March 9 at the HIMSS Annual Conference & Exhibition in Las Vegas. An initial 11 providers signed on to the initiative during the conference.
Under the pledge, providers commit to collaborating with the VA to advance EHR interoperability through the Fast Healthcare Interoperability Resources standards framework.
While the integration of EHRs into America's health system aimed to advance the practice of good medicine and improve patient safety, the technology's rapid adoption occurred with little insight from providers, causing unforeseen shortcomings that have compromised productivity and the patient-physician relationship, according to a commentary article published March 7 in Anesthesiology News.
In the commentary, Peter Papadakos, MD, a professor in the department of anesthesiology at the University of Rochester (N.Y.) Medical Center, argued the implementation of EHRs was mainly carried out to aid in the transition from the fee-for-service model to value-based care, rather than to optimize productivity. Dr. Papadakos believes the key to resolving these issues is provider education.
"Medical providers at all levels need to gain exposure to digital training along with their traditional education in pharmacology, physiology and physical diagnosis," Dr. Papadakos wrote. "Human-to-technology interfacing should have a major role in training providers to recognize, evaluate and correct faults in computer records, guarding against errors and increasing patient safety, which could prevent legal misadventures."
March 20, 2018
Four advocacy organizations penned a letter March 14 to the ONC and HHS' Agency for Healthcare Research and Quality to request support for their joint National Health IT Safety Collaborative.
In their letter, the ECRI Institute, the Alliance for Quality Improvement and Patient Safety, the Bipartisan Policy Center, and The Pew Charitable Trusts highlighted their decision to establish a national health IT organization, the National Health IT Safety Collaborative, to improve the use and safety of health IT.
The four organizations requested in the letter ONC and AHRQ send agency representatives to participate in the collaborative.
Published March 21 2018, 5:20pm EDT
Hospital staff and executives often sit through meetings where important tasks are discussed, but when it comes time to delegate the work or follow-up afterward, things get lost in the shuffle, particularly in an emergency department.
However, during an EHR implementation, those leading the implementation cannot afford to get lost. They need to be focused, stay driven and keep up with the timeline for the go-live date.
But how do leaders keep a department full of busy clinicians on schedule and on task? By doing two things—finding champions, and facilitating clear, constant communication.
Published March 20 2018, 7:22am EDT
Interventional radiologists at Stanford University Medical Center are using visualization software from EchoPixel that turns 2D CT scans into 3D images so they can virtually view patents’ unique arterial anatomy to help them prepare for endovascular repair of splenic artery aneurysms.
According to Zlatko Devcic, MD, a fellow of interventional radiology at Stanford University School of Medicine, splenic artery aneurysms—a rare and life-threatening clinical disorder—have complex anatomy that require meticulous pre-procedure planning.
“Treating splenic artery aneurysms can be very difficult because of their intricate nature and anatomic variations from patient to patient,” says Devcic. “This new platform allows you to view a patient’s arterial anatomy in a three-dimensional image, as if it is right in front of you, which may help interventional radiologists more quickly and thoroughly plan for the equipment and tools they’ll need for a successful outcome.”
Published March 20 2018, 7:16am EDT
President Trump on Monday announced a wide-ranging policy initiative aimed at confronting the forces of supply and demand that are fueling the country’s opioid epidemic, including cutting nationwide opioid prescription fills by one-third within three years.
In an effort to reduce demand and over-prescription, the Stop Opioids Abuse and Reduce Drug Supply and Demand initiative calls for leveraging federal funding opportunities related to opioids to “ensure that states transition to a nationally interoperable Prescription Drug Monitoring Program (PDMP) network.”
PDMPs are electronic databases that help states track controlled substance prescriptions by flagging suspicious patient prescribing activities. Last year, the President’s Commission on Combating Drug Addiction and the Opioid Crisis called for more data sharing among state-run PDMPs, charging that these databases are being significantly underutilized in the vast majority of states.
Published March 21 2018, 7:29am EDT
The new Trump administration program to fight the opioid crisis is suggesting a constructive data-based approach to monitoring problematic prescriptions through its proposal for a national prescription drug monitoring network, says the head of Health IT Now, an industry coalition.
“Instead of tinkering around the edges with tweaks to our existing Prescription Drug Monitoring Program, the White House’s opioid plan looks to be taking a bolder stance: embracing our proposal for a new nationwide interoperable prescription safety alert system,” says Joel White, executive director at Health IT Now, representing patient, provider, employer and insurance organizations seeking incentives to use health information technologies to improve care and outcomes.
The nationwide initiative complements the role of PDMPs “while addressing troubling blind spots in the current system to deliver real-time information to clinicians at the point of care,” White says.
The MyHealthEData Initiative, announced by CMS' Seema Verma at HIMSS18, is too light on detail to make much of a difference, said the former VP – who offered his own way forward.
By Mike Miliard
March 19, 2018 04:44 PM
A new commentary from former Vice President Joe Biden says interoperability roadblocks have been standing for far too long – and that the Trump administration's current plans to fix the problem are insufficient.
Writing for Fortune, Biden alluded to HIMSS18, where Centers for Medicare and Medicaid Services Administrator Seema Verma unveiled the MyHealthEData Initiative, which aims to make patients a lynchpin of data exchange improvements, and where White House Advisor Jared Kushner said President Donald Trump is "is determined to make interoperability a reality for all Americans."
Cybersecurity experts offer valuable advice on dealing with third parties because while a third party may be responsible for a breach, it's the healthcare organization that is accountable.
By Bill Siwicki
March 19, 2018 02:23 PM
Healthcare continues to come under attack from cybercriminals looking for easy pickings. And one of the weak links in the healthcare chain is connections to third-party vendors that hackers can exploit to break into hospital networks.
So what can healthcare information security teams do to protect against penetration through third parties? Cybersecurity experts point out the specific vulnerabilities and offer a variety of suggestions for actions to be taken.
Although the third-party challenges to a healthcare provider around cybersecurity tend to be vast, there are several prevalent, top-of-mind and significant challenges currently within the industry, said David Stanton, a managing director and a cybersecurity expert at Protiviti, a global consulting firm.
Published March 20 2018, 5:48pm EDT
Information technology staff for hospitals and other healthcare providers must regularly give their cybersecurity practices thorough reviews to keep them abreast of the latest security challenges.
In its annual study on privacy and security of healthcare data, Ponemon Institute reported that almost 90 percent of healthcare organizations have been breached. Potentially more alarming is that the average cost of each data breach for a healthcare provider is $2.2 million.
In 2018, most industry observers predict that cyberattacks will become increasingly sophisticated, more pervasive and costlier. Underscoring this point is a recent Deloitte survey of 370 medical device professionals, which found that more than a third had experienced a cybersecurity incident in the last 12 months, and that the regularity of such incidents is expected to increase.
Published March 19 2018, 7:31am EDT
A prediction model leveraging electronic health record data could be used to help providers identify hospitalized patients who are at highest risk of progressing to chronic opioid use after they’re discharged from the hospital.
Researchers at the University of Colorado Anschutz Medical Campus, who developed the model using patient data from the Denver Health Medical Center, say the model could be integrated into the EHR and activated in the form of an alert when a physician orders opioid medication, informing the doctor of their patient’s risk for developing chronic opioid use.
“The goal was to identify who these patients were to let providers know at the time of care that these patients are at higher risk, so they think twice before they prescribe an opioid or think about other ways to manage their pain in the hospital setting,” says Susan Calcaterra, MD, a fellow in addiction medicine at the CU School of Medicine and lead author of a study published last month in the Journal of General Internal Medicine.
As healthcare organizations start to dip their toes in the waters of distributed ledger technology, the COO of Hashed Health offers advice about doing it right.
By Mike Miliard
March 19, 2018 10:12 AM
Blockchain is no longer the far-out and inscrutable mystery it once was. More and more healthcare professionals are starting to understand how it works – and how it can work for them.
"They're beginning to understand the technical questions around it, which is fundamentally about shared infrastructure," said Corey Todaro, chief operating officer at Nashville, Tennessee-based blockchain company Hashed Health.
At its core, blockchain is about networks: "Enterprises jointly share and operate transactional infrastructure, and they do so for a value proposition," Todaro explained at HIMSS18.
Cabell Huntington Hospital also diminished the average sepsis-related hospital length of stay with machine learning-generated clinician alerts.
By Bill Siwicki
March 16, 2018 03:57 PM
Last year, Cabell Huntington Hospital faced sepsis head-on and came out on top. Implementing machine learning technology specifically designed to fight sepsis in part through clinician alerts, the organization saw the sepsis-related in-hospital mortality rate was 33.5 percent lower during the post-implementation period and the average sepsis-related hospital length of stay was 17.1 percent lower during the same period. Analyses included 2,298 adult patients in the emergency department and intensive care unit.
Through an ongoing review of internal data, it appears that InSight clinical alerts, from machine learning vendor Dascena, and clinical documentation/coding of sepsis are showing an increased correlation, said Hoyt J. Burdick, MD, chief medical officer at Cabell Huntington Hospital.
“Of course, this phenomenon is not just dependent on the machine logic alerting, but is also subject to clinician education, documentation, coding and billing variables,” he explained. “But since we only recently began to adjust some of the machine logic parameters, it seems more likely that the clinicians are more confident in making diagnoses and decisions based upon the improved alerts.”
by Evan Sweeney
Mar 16, 2018 8:30am
As more startups enter the healthcare space, health IT companies that aren't aware of the industry's unique fraud and abuse laws could draw the ire of investigators and face steep penalties, according to two federal prosecutors.
With an influx of new companies testing the waters of healthcare, navigating fraud regulations can mean the difference between a successful business model and a prison sentence, the officials with the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) told audience members during a session at the HIMSS annual conference in Las Vegas.
What passes for an innocuous gimmick in one industry—a gym that offers a $25 credit for members who refer a friend, for instance—could lead to civil or criminal charges for companies and executives that work with providers.
March 16, 2018 | Anicka Slachta
Applying natural language learning and deep neural networks to mortality risk models could help predict cardiovascular outcomes with more accuracy than modern support vector machines, researchers said at the 67th annual American College of Cardiology conference in Orlando.
In an effort to represent heart patients more wholly and predict postoperative outcomes after major cardiovascular procedures, Yijan Shao, PhD, and colleagues designed a risk model that used electronic health record (EHR) data to estimate frailty—a factor crucial to the care of elderly patients but one that’s frequently unaccounted for.
Death after major cardiovascular procedures is common among older patients, Shao said, but frailty isn’t taken into consideration in clinical prediction models.
Elon Musk has been one of the few Silicon Valley luminaries to place intense attention on the potential dangers of AI, raising a billion dollars with Y Combinator’s Sam Altman to found OpenAI . Musk has continued the drumbeat on AI’s dangers, telling a crowd at SXSW this week that “A.I. is far more dangerous than nukes” and asking “So why do we have no regulatory oversight? This is insane.”
Well, the wheels of Washington are turning, and DCers are starting to investigate the opportunities and challenges that AI poses to the nation. Today, the Center for a New American Security (CNAS), one of America’s top defense and foreign policy think tanks, announced the creation of a Task Force on Artificial Intelligence and National Security, as part of the organization’s Artificial Intelligence and Global Security Initiative.
The task force will be co-led by Andrew Moore, the current dean of Carnegie Mellon University’s School of Computer Science, and Robert O. Work, who was deputy defense secretary from 2014-2017 and formerly CEO of CNAS.
By Simon Harris
Published March 19 2018, 4:57pm EDT
It’s clear that artificial intelligence is continuing to stake territory in radiology, and professionals are looking to incorporate the technology in helping them deliver care.
For the first time at this month’s European Congress of Radiology, there was a dedicated section of the Expo for AI—the Artificial Intelligence Future Lab. There were also a handful of medical imaging AI companies dotted around the main exhibition halls, and most of the major vendors found an angle to add AI to their booths.
From walking the exhibition floor, it’s clear that AI continues to make inroads into medical imaging and the pace of technology commercialization is accelerating.
Posted by Dr David G More MB PhD at Saturday, March 31, 2018