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.
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Beyond passwords: How NIST cybersecurity framework gives risk management a boost
Inside access control of employees a must says health law attorney Barry Herrin.
By Mike Miliard
March 30, 2018 09:49 AM
Enterprise risk management is a tall order, as healthcare organization strive in earnest to mitigate their exposure to a wide array of threats and uncertainties. But what if there was a roadmap already written that could help guide the way?
There is, says healthcare attorney Barry Herrin, founder of Herrin Health Law. It's just too often seen as something to be filed away with health systems' cybersecurity plans.
The NIST Cybersecurity Framework will be familiar to many hospital IT and security personnel as they grapple with this frightening new era of weaponized malware, insider threats and nation-state hacking, of course.
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Without a single solution, hospitals are taking different paths to interoperability
SSM Health, a 20-hospital Catholic not-for-profit health system in the Midwest, has pursued multiple avenues to facilitate data exchange by joining health information exchanges (HIEs) in Missouri, Oklahoma and Wisconsin, tapping into Carequality’s Interoperability Framework, and using Direct Messaging. It was the first health system to go live with Surescripts’ national locator service and shares patient data with both the Department of Defense and the Veterans Administration’s virtual electronic health record program, known as VLER.
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Patient, Provider Training Key for Patient Portal Use in Oncology
Patient portal use in the oncology setting will require a better understanding of how patients want to receive sensitive test results, research says.
By Sara Heath
March 29, 2018 - Healthcare organizations and medical systems need to create better patient education and provider training when implementing patient portals in oncology units, according to a new study published in the Journal of Medical Internet Research.
Doing so will support patient-provider communication and relationships in a vulnerable medical specialty, the researchers said.
Healthcare professionals have touted the necessity for transparent and easy access to patient medical records via the patient portal. Patient portal access has created new pathways for patient-provider communication, patient health literacy, and patient data access.
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The government wants to free your health data. Will that unleash innovation?
By Casey Ross
March 29, 2018
n health care, breakthrough cures are no longer just hidden in the innumerable mysteries of biology and chemistry. Increasingly, they are locked away in a place even harder to access: electronic patient records.
These files could help establish which patients, with which backgrounds and disease characteristics, respond best to certain therapies — secrets that are often carefully guarded in service of patient privacy, and private profit.
But the federal Centers for Medicare and Medicaid Services is seeking to open the data floodgates. The agency wants to put patients in charge of their information instead of the hospitals and insurers that collect it and keep it locked within their own systems. And it wants to do so explicitly to help app and device makers gain access to high-quality data.
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Top HIT Infrastructure Uses for Healthcare Blockchain
While it still has a long way to go, healthcare blockchain has potential to enhance data storage, data availability, and interoperability.
March 27, 2018 - Healthcare blockchain is becoming more of a reality as vendors and entities alike are exploring blockchain options for different parts IT infrastructure.
Blockchain is being considered for data storage, interoperability, and security in the healthcare industry, but the technology is still young.
Only the earliest healthcare blockchain deployments are currently being used and payment transactions are the first use case for healthcare blockchain.
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Do Apple's recent hospital deals signal industry shakeup ahead?
Obama-era officials David Blumenthal and Aneesh Chopra say yes.
March 28, 2018 01:39 PM
In a recent opinion piece published by the Harvard Business Review, David Blumenthal, MD, who served as the National Coordinator for Health IT from 2009 to April 2011, writes that Apple's recent pacts with big-name healthcare systems might indeed be poised to disrupt the healthcare industry.
Blumenthal co-authored the piece with former U.S. Chief Technology Officer Aneesh Chopra, and both contend the pact has not gotten the attention it deserves.
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How EHR Use Enables Effective Responses to Public Health Crises
Petaluma Health Center relied on advanced EHR use to streamline care delivery following the wildfires in northern California.
By Kate Monica
March 27, 2018 - Last year, providers at hospitals and health systems across the country faced major care challenges when dealing with the aftermath of natural disasters including Hurricane Harvey, Hurricane Irma, and the northern California wildfires.
The latter charred more than 200,000 acres of land across 10 counties and was declared a public health emergency by HHS Acting Secretary Eric Hargan. Natural disasters of this magnitude can have a significant impact on patient access to care, health data access, and clinician workflows. Patients fleeing natural disasters often seek care at medical facilities they have not visited previously, which requires providers to find ways to access necessary patient health information for well-informed clinical decision-making.
Petaluma Health Center CMIO Danielle Oryn saw firsthand how natural disasters can prompt a sudden and pressing need to quickly access patient EHRs for efficient care delivery.
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Are You OK with Having a Robot Dentist?
A new survey indicates people would let a robotic dentist do some procedures on them but not others.
Economists and scientists say robots will be taking orders at drive-thru restaurants soon.
Robots may even be changing the oil in cars or rotating tires.
But will robots clean teeth, perform a root canal, or fill a cavity?
Americans say: “Not so fast.”
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Physician Group Eases EMR Burden on Clinicians
Christopher Cheney, March 29, 2018
A medical group's organizational efforts have improved its electronic medical record's user friendliness, helped by personalized settings, in-basket management, and improved training.
At Gould Medical Group, a multipronged effort to ease the use of its electronic medical record has contributed to physician satisfaction and low burnout rates.
The physician group contracts exclusively with Sacramento, California–based Sutter Health, which features 20 acute care hospitals.
"Internally within Sutter, which has eight medical groups, we consistently have the highest or second-highest physician satisfaction score, and we have the lowest physician burnout score," says Martin Pricco, MD, MBA, president of Gould Medical Group.
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Doctors underestimate how often they prescribe opioids
Published March 28 2018, 7:28am EDT
When it comes to writing prescriptions for opioids, nearly two-thirds of emergency department physicians underestimate how often they prescribe the highly addictive painkillers for patients. However, ED doctors who were made aware of their prescribing patterns using electronic health record data reduced prescription rates.
That’s the finding of a year-long prospective, multi‐center randomized trial conducted by researchers at the University of Colorado Anschutz Medical Campus and the University of Massachusetts Medical School.
Published earlier this month in the journal Academic Emergency Medicine, the study involved surveying 109 providers at four different hospital EDs in the University of Massachusetts healthcare system about their perceived opioid prescribing rates compared to their peers—and, then showing them the actual data on prescriptions extracted the EHR.
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EHR usability issues linked to patient harm events
Published March 28 2018, 7:41am EDT
Electronic health record usability issues are linked with potentially serious patient harm events, according to a new analysis conducted by MedStar Health.
The study, funded by the Agency for Healthcare Research and Quality, looks at some of the patient safety challenges of EHRs and potential ways to make improvements when it comes to their use.
Raj Ratwani, director of MedStar Health’s National Center for Human Factors in Healthcare, and his colleagues analyzed patient safety reports from 2013 to 2016 from 571 medical facilities in Pennsylvania and from a large, mid-Atlantic multihospital academic health system.
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Conservative estimates of EHR safety incidents belie bigger industry concerns
by Evan Sweeney
Mar 28, 2018 9:05am
Researchers and patient safety advocates have often warned about the association between EHR usability and patient harm, but hard numbers have been difficult to pin down.
However, new research shows just a small percentage of patient safety events can be traced back to specific aspects of EHR usability. The study, published this week in JAMA, reviewed 1.7 million events reported to the Pennsylvania Patient Safety Authority and from a large multihospital academic medical center between 2013 and 2016. The authors found just 0.11% of events explicitly mentioned an EHR vendor or product and just over 500 events (0.03%) includes language explicitly referencing EHR usability.
The most common categories were data entry and alerting, making up nearly half EHR-related events.
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Improving Clinician EHR Use Through Provider Communication
Researchers at AU Health used a provider communication tool to identify and address problems with clinician EHR use.
By Kate Monica
March 27, 2018 - Implementing an EHR-integrated provider communication tool may help health systems improve clinician EHR use, according to researchers at the Augusta University (AU) College of Allied Health Sciences.
Researchers implemented a social knowledge networking (SKN) system to allow clinicians to more easily report and discuss problems with EHR medication reconciliation (MedRec) tools.
As part of a two-year project funded by the Agency for Healthcare Research and Quality (AHRQ), Rangachari et al. aim to improve clinician engagement with EHR MedRec technology by encouraging medical staff to share best practices about EHR use across the health system.
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EHR Usability Contributes to Possible Patient Harm Events
Usability challenges mainly occur during order placement and medication administration
TUESDAY, March 27, 2018 (HealthDay News) -- Electronic health record (EHR) usability may contribute to possible patient harm events, according to a research letter published in the March 27 issue of the Journal of the American Medical Association.
Jessica L. Howe, from MedStar Health in Washington, D.C., and colleagues analyzed patient safety reports from 2013 to 2016 to identify those that explicitly mentioned a major EHR vendor or product. Two usability experts reviewed reports to assess whether the report contained explicit language to associate the harm report with an EHR usability issue.
The researchers found that 0.11 percent of 1.735 million reported safety events explicitly mentioned an EHR vendor or product and were reported as possible patient harm. Overall, 557 reports (0.03 percent) had language that explicitly indicated that EHR usability contributed to possible patient harm. Of the 557 reports, harm level analysis showed that the patient was reached and potentially required monitoring to preclude harm, potentially caused temporary harm, potentially caused permanent harm, and could have necessitated intervention to sustain life or could have resulted in death (84, 14, 1, and <1 16="" 37="" 9="" administration="" and="" challenges="" documentation="" during="" medication="" occurred="" of="" order="" p="" percent="" placement="" respectively="" results="" review="" usability="">
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Study: Hospital data breaches tied to thousands of additional patient deaths
A researcher at Nashville, Tenn.-based Vanderbilt University Owen Graduate School of Management claims more than 2,100 patient deaths each year can be attributed to hospital data breaches, according to The Wall Street Journal.
Sung Choi, PhD, analyzed data from HHS and CMS to compare patient-care metrics at hospitals that have experienced a data breach with those that have not. The study was presented March 22 at a cyberrisk quantification conference hosted by Drexel University's LeBow College of Business in Philadelphia.
One of the care metrics Dr. Choi reviewed was the proportion of heart attack patients who die within 30 days of being admitted to a hospital. She found the rate of patient deaths increased by 0.23 percent one year after a breach and by 0.36 percent two years after a breach. This equates to 2,160 additional patient deaths per year.
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HIT Think Why blockchain will pay dividends in clinical research
Published March 28 2018, 5:14pm EDT
Blockchain is the buzzword in healthcare IT. But what is it about blockchain that makes it so valuable for clinical research?
Currently, most electronic health records (EHRs) are scattered across several data silos, with healthcare providers only having access to data on their specific network. This means that patients don’t have access to their own records and medical history. In fact, essentially nobody has their complete longitudinal health data on hand.
That’s a problem in clinical research, because gathering patients’ full medical information is costly and time consuming, and centralizing medical records makes data vulnerable to security breaches. Additionally, it is the patient who is best positioned to access and aggregate his or her clinical and genetic data, because only they have a complete picture of where they have received care or which labs they used for medical testing.
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Majority of organizations now using biometric authentication
By Bob Violino
Published March 28 2018, 3:51pm EDT
Almost two-thirds of organizations now use biometric authentication technology, and an another 24 percent plan to use it within the next two years, according to a new study by Spiceworks, an online community for IT professionals.
For its research, Spiceworks surveyed 492 technology professionals in North America and Europe in February. Responses to the survey found that 62 percent use biometrics for authentication.
The findings show that although most IT professionals think biometric authentication is more secure than traditional forms of authentication—such as text-based passwords, personal identification numbers and personal security questions—only 10 percent consider biometrics to be secure enough to be used as the sole form of authentication.
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Without context or cushion, do online medical results make sense?
Mar 27, 2018 12:20pm
As she herded her two young sons into bed one evening late last December, Laura Devitt flipped through her phone to check on the routine blood tests that had been performed as part of her annual physical. She logged onto the patient portal link on her electronic medical record, scanned the results and felt her stomach clench with fear.
Devitt’s white blood cell count and several other tests were flagged as abnormal. Beyond the raw numbers, there was no explanation.
“I got really tense and concerned,” said Devitt, 39, a manager of data analysis who lives in New Orleans. She immediately began searching online and discovered that possible causes ranged from a trivial infection to cancer.
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5 ways Amazon could disrupt healthcare
What hospitals know about Amazon plans is just a taste of what the future will bring, consultants predict.
March 27, 2018 09:43 AM
Just about everyone paying attention in healthcare is wondering exactly what Amazon has up its sleeve. After inking an alliance with JP Morgan Chase and Berkshire Hathaway in late January, then expanding into the Medicaid market to take on retail rival Walmart, the Seattle giant appears to be amassing a number of puzzle pieces.
Exactly how they will all fit together remains to be seen. Indeed, L.E.K. Consulting asserted that what healthcare has seen thus far from Amazon is just a hint of the lasting disruption that’s to come.
"Anyone who thinks of Amazon as just a very big digital retailer needs to think again," L.E.K Managing Director Rob Haslehurst wrote in a new report. "They have continually expanded their business model and today they are a leader in cloud computing, a provider of in-home services and a bricks-and-mortar food purveyor in addition to their e-commerce offerings. They have repeatedly shown that they have the capabilities, the patience, and the deep pockets to disrupt industry after industry. Healthcare is no exception."
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How Parkland Health used telemedicine to cut GI consultation wait times
Dallas-based Parkland Health & Hospital System implemented an e-consult program that significantly reduced unnecessary clinic appointments at its gastroenterology specialty clinic.
The clinic receives 400-plus referrals a month from Parkland's community-oriented primary care centers. The wait list for an appointment in 2016 was six months or longer. Many of the patients being seen in the clinic did not need an in-person appointment.
The GI clinic team joined forces with the health system's IT staff to develop an e-consult platform that was integrated into Parkland's existing EHR. The e-consult platform allows referring physicians to request either an electronic or face-to-face consultation.
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Reduce technology burden to restore joy for physicians
March 25, 2018
A recent Mayo Clinic study on physician satisfaction with their EHRs showed that only 36 percent of 6,375 physicians interviewed were satisfied with their use. Furthermore, a majority of respondents indicated their systems were causing a clinical burden, resulting in emotional exhaustion, depersonalization and a reduced sense of personal accomplishment.
“We’ve burnt out a generation of clinicians despite the greatest advances in technology in healthcare,” says Bridget Duffy, MD, chief medical officer for healthcare communications firm, Vocera, and co-founder of the Experience Innovation Network, a research collaborative that focuses on alleviating physician burnout.
Duffy does not, however, recommend ditching technology as the answer, but instead thoughtfully employing these tools in ways that can remove hassles from physicians’ work days. “Physicians can no longer be data entry clerks,” she says. Instead, healthcare systems and practices must find technologies “that enable and restore the sacred relationship between physician and patient.”
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Report: 5 malware trends to watch in 2018
Barkly, a cybersecurity company focused on endpoint protection, released its 2018 Malware Trends Forecast, which details malware evolution during the past year.
Here are five malware trends that have gained traction since 2017.
1. Attacks that are "fileless," leveraging exploits and scripts rather than installing malicious files. These fileless techniques attempt to bypass traditional security measures that focus on scanning files, such as antivirus solutions.
2. Attacks that are "clickless," meaning they do not rely on tricking users into selecting a malicious application. Instead, these attacks take advantage of vulnerabilities to deploy remote execution exploits to infect computers.
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AI rapidly produces higher quality medical imaging from less data
Published March 27 2018, 7:44am EDT
Researchers at Massachusetts General Hospital have developed a new medical imaging technique based on artificial intelligence designed to enable clinicians to acquire higher quality images without having to collect additional data.
The AI technique—called AUTOMAP (automated transform by manifold approximation)—produces high-quality images in less time with MRI or with lower radiation doses with X-ray, CT and PET. And, as a result of its very quick processing speed, the approach could help in making real-time clinical decisions about imaging protocols while the patient is in the scanner, according to MGH researchers.
A description of the technique, published last week in the journal Nature, shows dramatic differences between images reconstructed from the same data with conventional approaches compared to AUTOMAP.
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The U.S. healthcare system is tied up in costly red tape
Published March 27 2018, 3:43pm EDT
The American healthcare system has a unique problem with paperwork. The sheer number of participants—physicians, hospitals, clinics, insurance companies, patients—makes settling payments complicated, time-consuming and really expensive.
The share of U.S. healthcare spending devoted to administrative costs, including billing, is roughly three times what it is in other affluent countries. And it's a major reason the U.S. spends twice as much on healthcare.
Some health clinics employ more clerks than care providers—not just to generate invoices but to send along the patient information insurers need to approve treatments, to dispute insurer decisions denying payment, to fix mistakes, to handle patients' questions, and on and on. For every $1 billion in revenue, the healthcare system employs the equivalent of 770 full-time people to settle the bills. That's almost eight times more than other industries. And doctors have to spend inordinate time dealing with red tape.
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HIT Think How to keep health data safer in the cloud
Published March 27 2018, 4:23pm EDT
The illusion of control is tempting, even intoxicating. It’s also a common characteristic that almost all humans manifest to one degree or another as we work to satisfy competence motives, the need for security, survival instincts.
Because proximity often feels like control, it might also get in the way of secure healthcare IT.
“Files stored in reliable cloud services are some of the most secure files you can have, provided you have good passwords,” says software engineer John Miller, PhD. “Google, Microsoft and Amazon all provide reliable cloud services for consumer file storage.”
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Overridden Alerts Linked to Increase in Adverse Drug Events
Alexandra Wilson Pecci, March 27, 2018
Overriding alerts that are clinically relevant can potentially lead to harm.
Two things are likely familiar to any physician working in an electronic medical record: Seeing clinical decision support (CDS) alerts and overriding those alerts.
Such alerts remind clinicians about everything from a patient's drug allergies, to possible drug interactions, to dosing guidelines, to lab testing guidance. Clinicians can either follow the alerts' recommendations or override or ignore them.
"They're frequently overridden, and often these are done appropriately," says Adrian Wong, PharmD, MPH, BCPS, BCCCP, an outcomes research and pharmacy informatics fellow in the division of general internal medicine and primary care at Brigham and Women's Hospital.
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New York's opioid fight: PDMP now interoperable with 25 states, DC
Providers can now view a complete picture of a patient’s prescribing history to help combat doctor shopping.
March 23, 2018 04:43 PM
New York state’s prescription drug monitoring program is now fully interoperable with 25 states and Washington, D.C, giving in-state providers access to the controlled substance history of about 150 million patients.
The PDMP program now allows in-state providers to select participating states within the platform for a fuller profile of the prescribing histories of their patients. Officials said it will help providers better detect and prevent doctor shopping.
New York became the first state to mandate e-prescribing for the majority of prescriptions in 2016, and officials said since enacted, the state has reduced doctor shopping incidents by more than 98 percent.
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FHIR and Open APIs are here to stay - but are they ready for prime time?
While developers can catch on to standards like FHIR quickly there’s more work to be done than simply adding them to EHRs and other clinical apps.
By Mike Miliard
March 26, 2018 10:06 AM
What is an application programming interface? One of the more evocative definitions in recent memory comes, of all places, from the U.S. Department of Veterans Affairs:
"Think of an API as a server in a restaurant," according to the VA. "Imagine you are sitting at a table with a menu of choices to order from, and the kitchen is the part of the system that will prepare the order. What’s missing is the critical link to communicate your order to the kitchen and deliver your food back to your table. That’s where the server, or API, comes in."
Like an overworked waitress during dinner time rush, APIs have been doing a lot of heavy lifting recently as this industry tries to solve its longstanding interoperability challenges – with a lot of hungry parties expecting tip-top service.
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Mayo Clinic uses analytics to filter out meaningless data for ICU physicians
by Evan Sweeney
Mar 26, 2018 10:38am
Using data analytics layered on top of the EHR, the Mayo Clinic has turned the firehose of patient data into more of a trickle.
The renowned hospital system headquartered in Rochester, Minnesota, has used that approach to filter tens of thousands of data points down to 60 pieces of critical information that are displayed for ICU physicians in a visually appealing format. Using “ambient-intelligence” applications licensed by system’s venture capital arm, the approach gives physicians an extra hour each day that can be utilized for bedside care, three Mayo Clinic physicians wrote in Harvard Business Review.
“In fast-paced critical care units, where even small errors can have big consequences, this digital team member can overload physicians with information,” the authors wrote. “The sheer volume of data in EHRs creates a staggering challenge in complex environments such as intensive care units (ICUs) and emergency medicine departments.”
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AAFP Urges Improvements to Fledgling Patient Data Initiative
March 22, 2018 04:11 pm News Staff – The AAFP is working to propel a new CMS initiative meant to give patients better access to -- and control of -- their health care data into action that improves patient care and reduces physicians' administrative burden.
CMS Administrator Seema Verma, M.P.H., publicly unveiled the MyHealthEData Initiative(www.cms.gov) on March 6 during a speech(www.cms.gov) at the Healthcare Information and Management Systems Society annual conference in Las Vegas.
She told her audience the United States will never achieve the long-sought goal of value-based care "until we put the patient of the center of our health care system."
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EHR Clinical Documentation Differs Between Nurses, Physicians
Nurses and physicians note different concepts for the same patients in EHR clinical documentation.
By Kate Monica
March 22, 2018 - Physicians and nurses note very different concepts in EHR clinical documentation during patient visits, according to a recent study by researchers at the in the International Journal of Medical Informatics.
Boyd et al. conducted the study to gain insight into the differences and similarities in patient care delivery between physicians and nurses by comparing notes between both kinds of healthcare providers in EHR clinical documentation.
Researchers analyzed 58 distinct physician discharge summaries and corresponding nurse plans using Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs). Researchers also extracted physician terms from free-text physician summaries using a natural language processing (NLP) program.
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Amazon Is already reshaping the healthcare industry
Published March 26 2018, 3:01pm EDT
Without having done much yet, Amazon.com is already transforming U.S. healthcare—and not necessarily for the better.
The mere threat of the online giant getting into the health business prompted the country's two largest pharmacy benefit managers—CVS Health and Express Scripts Holding—to join forces with two of its largest insurers, Aetna and Cigna. These deals will put more healthcare under the control of fewer companies. The merging companies say this will lower costs for consumers and the country, but the reality will likely be less rosy and more complicated.
That these companies can even make such deals is due partly to the Federal Trade Commission and the Department of Justice, which blocked the mergers of Anthem with Cigna and Aetna with Humana. Those mega-insurers would have been too busy digesting to make big vertical deals and too large to be acquired by other insurers.
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Platform enables state programs to share opioid prescription information
Published March 26 2018, 7:15am EDT
President Trump last week called for a nationally interoperable network of state-run Prescription Drug Monitoring Programs as part of a new initiative to combat the opioid epidemic.
However, the standards and infrastructure for data sharing nationwide between state PDMPs already exists, according to Jim Huizenga, MD, chief clinical officer for vendor Appriss Health, which offers solutions for early identification, prevention and management of substance use disorder.
“What’s not known by many people is that we’re already there—at significant scale,” says Huizenga, an emergency physician with an interest and some training in the area of addiction medicine.
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Cerner envisions EHR as platform for FHIR apps
Published March 26 2018, 7:32am EDT
Cerner sees its EHR system emerging as a technology platform for a plethora of apps that leverage HL7’s emerging Fast Healthcare Interoperability Resources standard, enabling physicians to access these pluggable apps directly within their workflow to more easily visualize, interact and transmit health data.
“We’re really looking at this as Cerner is a platform versus a product solution,” says Zane Burke, president of Cerner. “We’ll know we’re there when you see a lot of apps on our platform.”
To realize this vision, Burke notes that the vendor is encouraging third-party developers to build Substitutable Medical Applications and Reusable Technologies (SMART) on FHIR apps on top of Cerner’s Millennium EHR and HealtheIntent population health platforms. So far, he notes that they have 20 validated apps.
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HIT Think A reality check on AI in healthcare
Published March 26 2018, 4:23pm EDT
There is a lot of talk in healthcare about using artificial intelligence to improve patient care and boost operational efficiencies. But is the technology being overhyped? Or are AI applications making a real difference? James Golden, senior managing director for PwC’s Healthcare Advisory group, is an AI expert. He discussed those topics, AI adoptions rates and more with Health Data Management at the recent HIMSS conference. An edited version of the interview follows.
HDM: People are buzzing about artificial intelligence and machine learning. But it seems the terms still need to be defined. How do you define AI and machine learning when talking about healthcare?
Golden: It’s important to have the terms defined correctly. AI is a branch of computer science that basically is about making computers do things more like human beings. So that’s a very simple explanation. Machine learning, which is a sub-branch of AI, is really about statistical learning, where we don’t exclusively derive a program. We actually expose algorithms to data and it’s self-learning.
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Enjoy!
David.
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