Quote Of The Year

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

Saturday, May 26, 2018

Weekly Overseas Health IT Links – 26th May, 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.
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EHR market revenues approach $30B in 2017, Kalorama reports

Published May 18 2018, 6:02pm EDT
The electronic health records market reached $29.7 billion in annual revenue 2017 and will rise to $39.7 billion by 2022, according to a new annual report from Kalorama Information, a research firm.
The EHR market includes computerized physician order entry systems and services such as installation, training, servicing and consulting. Picture archiving and communication systems and hardware are not included in Kalorama’s market projections.
“We believe adoption and upgrading activities will still be stimulating growth in 2017-2022,” says Mary Ann Crandall, author of the report.
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Critical-Care Group Updates TeleICU Standards

Jennifer Thew, RN, May 18, 2018

The American Association of Critical-Care Nurses' consensus statement reflects current evidence and best practices in TeleICU nursing.

Telehealth is a growing segment in the healthcare industry, thus providing nurses with new settings and opportunities in which to practice. The American Association of Critical-Care Nurses recognized the need for guidance in this area and issued the first authoritative document to define practice guidelines specifically for the emerging telenursing practice in critical care in 2013
Telehealth continues to evolve and so must nursing practice standards.
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Sutter Health back online after 24 hours of systemwide EHR outage

The activation of a fire suppression system of one of the health system’s data centers on Monday shut down its Epic EHR and other information systems.
May 16, 2018 01:21 PM
Sutter Health faced more than a day of downtime of its Epic EHR and an outage of internal communications this week after the activation of a fire suppression system in one of its data centers, officials said.
All systems currently are back online.
The outage began late Monday night and impacted all 24 hospitals in the California-based health system, according to an internal memo obtained by the Press Democrat. The outage affected certain information systems, the service desk and some of its phone systems.
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Johns Hopkins unveils new computational method for precision oncology

Hospitals could use the math-based technique to make it easier to tailor treatments for patients.
May 17, 2018 10:06 AM
One of the ongoing dilemmas faced by provider organizations with precision medicine is that for all the advances made in genomic research, sometimes it can still be hard to translate into routine clinical practice: Physicians don't always know how best to turn genetic-based data into appropriate treatments.
A key challenge for clinicians is that each primary form of cancer, such as breast or prostate, may have multiple subtypes, each of which responds differently to a given treatment.
Healthcare IT News is reporting this week from the HIMSS Precision Medicine Summit in Washington, D.C. Also this week, researchers at nearby Johns Hopkins announced what they say is a new computational strategy that can help translate complex precision medicine data into a more simplified format that keeps the focus on patient-to-patient variation in the molecular signatures of cancer cells.
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CMS Accepting New Promoting Interoperability Measure Proposals

CMS will accept proposals from stakeholders for new Promoting Interoperability measures until June 29.

May 16, 2018 - CMS recently announced it is accepting proposals for new measures stakeholders would like to see included in the Medicare Promoting Interoperability (PI) program.
The federal agency will accept proposals until June 29.
CMS is encouraging stakeholders to submit measure proposals as part of its annual call for measures for eligible hospitals and critical access hospitals (CAHs) participating in the newly-minted PI program — formerly known as meaningful use. Submitted measures will be considered for inclusion in 2019 rulemaking.
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VA finally pulls trigger and awards Cerner $10B EHR contract

Published May 17 2018, 6:24pm EDT
After nearly a year of negotiations with Cerner, the Department of Veterans Affairs on Thursday finally awarded the vendor a $10 billion electronic health record modernization contract to replace the VA’s decades-old legacy EHR system.
“I am pleased to announce we have signed a contract with Cerner today that will modernize the VA’s healthcare IT system and help provide seamless care to veterans as they transition from military service to veteran status, and when they choose to use community care,” said Robert Wilkie, the VA acting secretary. “This is one of the largest IT contracts in the federal government, with a ceiling of $10 billion over 10 years. And with a contract of that size, you can understand why former Secretary Shulkin and I took some extra time to do our due diligence and make sure the contract does what the President wanted.”
In June 2017, then-VA Secretary David Shulkin announced his decision to award a sole-source contract to Cerner in order to replace the legacy Veterans Health Information Systems and Technology Architecture with a single common EHR system with the Department of Defense based on Cerner’s Millennium platform. However, President Trump’s recent firing of Shulkin and the resignation of the VA’s acting chief information officer Scott Blackburn cast doubt on the agency’s EHR efforts.
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Why EHR data interoperability is such a mess in 3 charts

Hospitals have a complex web of electronic health record vendors but once data sharing broadens it will open the door to innovation.
May 16, 2018 10:07 AM
The thorny matter of interoperability in healthcare, as it is or has historically been in other industries, is almost all-consuming among technology vendors and their clients. 
Indeed, a big part of the problem is exactly how many EHR companies are out there and, more specifically, the average number of platforms hospitals are running today.
It’s 16. That’s right: 16 distinct electronic health records platforms, according to statistics HIMSS Analytics pulled from its Logic database looking at 571,045 providers affiliated with 4,023 hospitals.
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Cyberattackers Exploiting Weaknesses in Healthcare Data Security

Cyberattackers are exploiting inherent weaknesses in healthcare data security, making the sector the most targeted industry in the first quarter of 2018, according to Rapid7’s quarterly threat report.

May 15, 2018 - Cyberattackers are exploiting inherent weaknesses in healthcare data security, making the sector the most targeted industry in the first quarter of 2018, according to Rapid7’s quarterly threat report released May 15.
The Rapid7 research found that the leading attack vectors in healthcare were remote access, such as  suspicious logins, access attempts from disabled accounts, and account leaks, as well as phishing and ransomware.
There are several factors that attract attackers to the healthcare sector, according to researchers.
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State health departments face government barriers to interoperability, report says

May 16, 2018 1:10pm
State health departments can harness data analytics to inform policy and improve outcomes for large populations—but there are a number of hurdles to fully taking advantage of the technology, according to a new report. 
Researchers at Leavitt Partners interviewed officials at state health departments in Utah, Oklahoma, Washington, Colorado and Idaho to gather a cross-section of states at different points in the journey to a robust and interoperable analytics program. 
Through those interviews, the authors were able to identify several pain points for health officials looking to expand their abilities to gather and use data. In particular, governance and legal challenges, such as the Health Insurance Portability and Accountability Act (HIPAA), pose a significant barrier to data sharing for these agencies. 
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New program aims to ensure identities in exchanging health data

Published May 16 2018, 7:21am EDT
The Electronic Healthcare Network Accreditation Commission, which accredits industry stakeholders for meeting best business practices that include privacy and security protections, now is focusing on a new accreditation program to ensure identity verification and authentication of stakeholders conducting health information exchange, as well as supporting blockchain and cloud hosting services.
Organizations collaborating with EHNAC to develop the new Trusted Exchange Accreditation Program include the Workgroup for Electronic Data Interchange, SAFE-BioPharma Association, eHealth Initiative and the EP3 Foundation which facilitates secure identity to support data sharing for research and clinical trials without revealing personal or sensitive information.
The goal of Trusted Exchange is to offer the industry third-party accreditation for a wide range of healthcare entities.
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$148 for a PDF? Patient Access to Medical Records Hit or Miss

Steven Porter, May 16, 2018

A watchdog agency cites egregious cases as the federal government promotes interoperability of health data.

The fees patients pay for copies of their own medical records vary drastically, sometimes running afoul of the restrictions written into federal law, according to a Government Accountability Office report released this week.
The watchdog agency's report provided a list of egregious cases, including one in which a patient was charged $148 for a digital copy of her medical record. Two others were charged more than $500 apiece for a single request, the report said, citing an unnamed patient advocacy organization.
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GAO: Patient access to medical records remains a challenge

Published May 15 2018, 7:20am EDT
Despite the widespread adoption of electronic health records by providers, patients continue to face challenges in accessing their healthcare information, according to a new audit by the Government Accountability Office.
Under HIPAA, consumers have the right to inspect, review and receive a copy of their medical records, while providers are authorized to charge a reasonable cost-based fee when patients request copies of their medical records or request that their records be forwarded to another provider or entity, such as an insurer or lawyer.
However, according to the GAO, the fees for third-party requests are generally higher than the fees charged to patients—which can vary significantly across states—while high fees can adversely affect patients’ access to their medical records.
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Precision medicine: 'We want to make sure people feel respected,' clinical ethicist says

As hospitals collect patient data they must characterize it well, apply new technologies – and practice what Cleveland Clinic’s Paul Ford calls "human medicine."
May 14, 2018 11:44 AM
While precision medicine continues picking up momentum it’s going to change many aspects of healthcare, notably shared decision making in the doctor-patient relationship, confidentiality and data privacy.
Managing those is going to require a human touch. If physicians and caregivers just focus on genetics and genomics without taking into account who the patients are as people to better understand their activity and behavior then they will be missing a big part of what drives an individual’s health.
“We want to make sure that precision medicine continues to be human medicine – person-centered – as in treating the whole person,” said Paul Ford, a clinical ethicist and Director of the Center for Bioethics at the Cleveland Clinic Foundation. “We want to make sure people feel respected. In some ways, making things personalized – tailors it, makes them feel less like a whole mass.”  
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Cerner has almost double EHR global market share of closest rival Epic, Kalorama says

But Epic leads in the physician office sector, according to the new report, and GE is now among the top four electronic health record vendors.
May 15, 2018 09:32 AM
Cerner leads the worldwide EHR market with Epic taking the second spot, Allscripts in third and GE Healthcare at fourth. 
“In the competition for large healthcare systems, it's the top four EHR companies mainly participating with some exceptions,” Mary Anne Crandall, a senior analyst at Kalorama Information, wrote in the firm’s annual report on the state of EHRs.
For 2017, Cerner earned 17.3 percent market share, while Epic has 8.8 percent. 
Allscripts, thanks to mergers and acquisitions of Misys and Eclipsys, rose to 6.1 percent. 
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Large hospitals more likely to use Cerner, small hospitals opt for Epic: 4 report insights

Written by Julie Spitzer | May 14, 2018 |
With 17 percent of the global market share, Cerner is the most used EMR, according to Kalorama Information's annual EMR industry report.
For its report, EMR 2018: The Market for Electronic Medical Records, Kalorama analyzed the global EMR market and the trends affecting it through a statistical review of industry influences, demographics, life expectancy and company strategies.
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One Hospital's $1M Savings in CDI Transcription Costs

Alexandra Wilson Pecci, May 15, 2018

Phoenix Children's CMIO reveals the IT-clinical collaboration behind its ambulatory disease-specific clinical documentation templates.

For many years, the ambulatory clinics at Phoenix Children's Hospital lagged in their EHR use.
"The ambulatory was a little step behind," says Vinay Vaidya, MD, vice president and chief medical information officer at Phoenix Children's. "Everything was on paper or dictation."
Now, the clinics not only use a clinical documentation platform in all 30 divisions of its ambulatory clinics, but the organization is in the process of building disease-specific templates that are part of a larger quality improvement initiative for chronic diseases.
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Cybersecurity: Nightmare scenarios and guiding principles

From legacy infrastructure to potential medical device hacks, some of the industry’s leading voices opened up about how the industry can begin to combat the inevitable breach.
May 11, 2018 03:07 PM
Some clinicians share their passwords with nurses in order to complete charts with the idea of “a care efficiency: rather than a risk.
By now, the healthcare sector is fully aware of the looming target placed on its back by hackers. The issue is that legacy infrastructure, staffing shortages and insider threats can make it tough to tackle these issues.
The biggest threats lie within the legacy infrastructure of healthcare itself. This includes medical devices operating on outdated platforms, along with IoT devices. We have not have seen it happen frequently but, if those devices are hacked cybercriminals can actually put patient lives at risk.
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New cloud-based machine learning tools offer programmatic approach to security

After years of wariness from healthcare providers about off-premise data, new AI capabilities from Amazon, Google, IBM and Microsoft could make cloud storage easier and more trustworthy than ever.
May 14, 2018 08:40 AM
For years, many healthcare organizations tended to be skeptical and resistant (if not outright hostile) to the idea of storing their data, particularly protected health information, in the cloud. IT and security decision-makers had deep reservations about stashing such sensitive data anywhere but their own on-premises servers, safe under their own watchful eyes.
But not too long ago that changed, and seemed to change quickly. To the surprise of many, over the past few years, it appears that many healthcare providers have been getting markedly more comfortable putting their trust in the cloud.
"If you had asked me in 2011, I would have predicted that healthcare would still be one of the slower moving industries," said Jason McKay, chief technology officer of Logicworks, a managed hosting company that helps organizations in many sectors build and manage cloud infrastructure. "We were surprised at the uptake."
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Next-gen analytics: Here's what's coming in the future

Hospitals should expect orders of magnitude more data – but will also see emerging tools such as artificial intelligence and 5G connectivity helping to put both structured and unstructured information to work.
May 14, 2018 09:11 AM
The healthcare analytics market is booming and will be worth close to $54 billion worldwide by 2025, according to a March 2018 report from Grand View Research.
Given the need to achieve the Triple Aim, along with the rise of precision medicine and the move toward value-based care, data analytics have never been more important to healthcare provider organizations.
As the technology continues to grow and mature, here's the pressing question for healthcare and IT leaders: How will analytics tools evolve – and what should they expect to come next?
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Cerner EHR Ranked Highest for 3rd Year in Nursing EHR Satisfaction

Black Book research showed that nursing EHR satisfaction levels continue to rise, with the majority of nurses not wanting to return to paper records.

May 11, 2018 - There has been a definite shift in nursing EHR satisfaction levels over the past few years, showing the perceived value in EHRs in delivering higher quality care, according to recent Black Book research.
Cerner EHR received top rankings from a nursing functionality and usability perspective for the third consecutive year, with a mean satisfaction ranking of 93 percent, the poll found. MEDITECH and Allscripts both had mean satisfaction rankings of 88 percent, while McKesson had an 85 percent mean product satisfaction ranking.
Approximately 15,000 registered nurses from 40 states were interviewed for three separate surveys, discussing how they implemented hospital EHRs over the past four years.
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HIT Think How telehealth can improve medication management and patient safety

Published May 11 2018, 5:47pm EDT
Medication errors account for at least one death each day and injuries to an estimated 1.3 million people annually. But while implementing new workflows can put a dent in this problem, making a significant impact requires a huge dedication of resources.
What’s not typically part of the discussion? How telehealth can improve medication safety.
While telehealth’s power to enhance acute-care programs is undisputed, its ability to improve the less-prominent (but equally important) medication reconciliation and safety processes is largely untested, and potentially eyebrow raising.
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'Stigmatizing' language in EHRs may negatively affect patient care for years

Written by Jessica Kim Cohen | May 12, 2018 | Print  |
Including nonessential, "stigmatizing" notes in a patient's health record may lead them to receive inadequate care in the future, according to a study out of Baltimore-based Johns Hopkins University School of Medicine and published in the Journal of General Internal Medicine.
For the study, the researchers developed a series of chart notes, half of which employed "neutral language," and half of which employed "stigmatizing" language. The researchers enrolled 413 medical students and internal and emergency medicine residents to review these notes and suggest next steps, in an effort to assess whether stigmatizing language affected providers' attitudes toward patients.
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FDA Turns to AI and Digital Health, So Why Are There Still Fax Machines?

MAY 10, 2018
Recently, FDA Commissioner Dr. Scott Gottlieb, spoke discussed how he sees digital health playing out and where the agency stands in a speech titled "Transforming FDA's Approach to Digital Health." Some things he said are worth exploring in more depth.
Gottlieb started out by saying that the digital health space has really matured and is the time for regulation.
"Digital health tools have vast potential improve our ability to accurately diagnose and treat disease and to enhance the delivery of health care for the individual, making medical care truly patient centric -- empowering the individual," Gottlieb said.
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DOD report blasts MHS Genesis rollout, citing inaccurate patient information and safety concerns

May 14, 2018 3:42pm
A scathing report from the Department of Defense says its MHS Genesis EHR is “neither operationally effective nor operationally suitable,” highlighting concerns that the system’s failures jeopardize patient safety.
The April 30 report (PDF), released by the DOD last week, describes a system rife with critical problems impacting patient care and clinical usability. Robert Behler, the DOD’s director of operational test and evaluation, reviewed the Cerner implementations at three facilities in Washington state and found that 156 incident reports were of “critical deficiencies” that included potential patient safety concerns.
The report was released shortly after Politico reported that the system was riddled with errors that could lead to patient deaths.
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U.S. doctors’ clinical notes 4 times as long as those in other countries

May 10, 2018 1:40pm
Regulations that require doctors to document patient care may be responsible for the fact that U.S. physicians’ clinical notes are, on average, four times as long as those in other countries.
Those regulations may be causing U.S. physicians, who commonly complain about the time they spend on electronic health records (EHR), to overdocument when compared to their overseas counterparts, according to an opinion piece in the Annals of Internal Medicine.
"Documentation in other countries tends to be far briefer, containing only essential clinical information," the authors said. "It does not contain much of the compliance and reimbursement documentation that commonly bloats the American clinical note."
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DoD rollout of Cerner EHR deemed not operationally effective or suitable

Published May 14 2018, 7:22am EDT
While the Department of Defense contends that its initial deployment last year of MHS GENESIS—a new Cerner electronic health record system—at four military sites in the Pacific Northwest was a success, the EHR is “neither operationally effective nor operationally suitable,” according to a new report from DoD’s director of operational test and evaluation.
DOT&E’s initial test and evaluation report, dated April 30 and released by DoD on Friday, is based on an assessment of three of four military sites in Washington State that were part of the rollout.
“MHS GENESIS is not operationally effective because it does not demonstrate enough workable functionality to manage and document patient care,” wrote Robert Behler, director of operational test and evaluation, in a letter to senior Pentagon officials accompanying his report. “Users successfully performed only 56 percent of the 197 tasks used as measures of performance. MHS GENESIS is not operationally suitable because of poor system usability, insufficient training and inadequate help desk support. Survivability is undetermined because cybersecurity testing is ongoing.”
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FHIR information exchange capability now coming of age

Published May 14 2018, 7:31am EDT
2018 is shaping up as a pivotal year for Health Level 7 International’s Fast Healthcare Interoperability Resources application programming interface. Significant momentum continues to build as a growing number of use cases indicate FHIR has reached a tipping point as a mature standard for the electronic exchange of health information.
In March, Apple launched an enhancement to its Health app—which leverages FHIR—enabling patients at 39 participating U.S. healthcare organizations to view their medical records on their iPhones after updating to the iOS 11.3 mobile operating system.
The enhanced Health Records section within the Health app allows patients to see medical data— encrypted and protected with their iPhone passcodes—gathered from various institutions and presented in a single, aggregated view. Patients also receive electronic notifications when their records are updated by providers.
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HIT Think Why it's important to give nurses the data they need

Published May 14 2018, 5:49pm EDT
Florence Nightingale, widely recognized as the founder of the nursing profession, could also be considered the first informatics nurse. The definition of nursing informatics is drawn from the IMIA Special Interest Group on Nursing Informatics, which uses this description: "The science and practice [that] integrates nursing, its information and knowledge, with information and communication technologies to promote the health of people, families, and communities worldwide."
A study completed by Nightingale, done on note cards, used a huge set of data collected between 1854-1855 that changed our knowledge of—and had an enormous impact on—hospital sanitation. Her insights were based on detailed analyses of the cause of death of the British soldiers stationed in Crimea.
She used data to identify trends that allowed her to look at the root cause of the deaths, and from that insight, suggested changes in care. Her reforms in Crimea, including the introduction of mandatory hand-washing, cut the death rate in military hospitals from 42 percent to 2 percent. We still leverage that knowledge and advice on patient care, which remains relevant for hand hygiene protocols in hospitals globally.
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Electronic medical records are a burden or the future, depending on who you ask

BY JON O'CONNELL, STAFF WRITER / Published: May 13, 2018
Dr. Kevin Olsen spends up to 12 hours most weekends hunched over a laptop doing something he hates.
The Scranton cardiologist updates his patients’ electronic medical or health records, often called EMRs or EHRs.
They’re made to reduce redundancy and errors and give doctors a complete picture of care for each patient by showing them how other doctors are treating them.
On the flip side, independent doctors like Olsen, who have small staffs and who have practiced medicine using paper records for decades, are duly burdened by them.
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Foreign experts find error slowing down e-health system in Latvia

BC, Tallinn, 14.05.2018.
International experts have found the main error in one of the e-health system's modules that was slowing down the entire system, Health Minister Anda Caksa (Greens/Farmers) told Latvian Television this morning, cites LETA.
Caksa did not specify how much repairing the system would cost, she only said that the Health Ministry's budget section for the e-health system would not be exceeded, and that the experts were paid on an hourly basis.
According to Caksa, it became clear in two or three months after the launch of the e-health system that something was slowing it down each day around noon. International experts were hired to find out what was wrong, and last week they found the main error in one of the e-health system's modules that was slowing the system down. The experts said that repairing the system would take two months.
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Foreign experts find 'bug' in national "e-health" system

Today, 11:29 | Health Authors: eng.lsm.lv (Latvian Public Broadcasting)
International experts probing the country's "e-health" system have found a bug that had caused it to slow down. It should be fixed within two months, said Latvia's Health Minister Anda Čakša, reported LTV May 14.
"We found, after it had been working for two to three months, that there are slow-downs...especially during midday when there's a peak in the number of active users. 
"Understanding there's an error somewhere in the core [of the code], we invited international experts who have identified the main problem," she said.
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Vietnam to issue electronic health insurance cards

It is expected to help boost supervision and avoid fraudulent activities in medical examinations and treatment under the health insurance policy.

Devdiscourse News Desk 13 May 2018, 03:27 AM Vietnam
Vietnam’s insurance sector will issue electronic health insurance cards in 2018 to facilitate the management of information regarding medical examinations and treatment.
According to the Vietnam Social Security (VSS), people with e-cards visit health facilities for examinations and treatment or visit relevant agencies to solve their social insurance interests, their information can be clearly displayed by using card reader chips.
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Enjoy!
David.

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