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, May 05, 2018

Weekly Overseas Health IT Links – 5th 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.

How to Accelerate the Adoption of Digital Health Technology

April 26, 2018

In 1997, health information technology and digitial health pioneer Warner Slack wrote his bold and prophetic book, Cybermedicine: How Computing Empowers Doctors and Patients for Better Care.  Slack argued that “the electronic digital computer, with its capacity to hold large amounts of data and to execute multiple complex instructions and accuracy would…find an important clinical role in both diagnosis and treatment.”
While the digitization of health information has solved many problems in American medicine — particularly, helping to reduce medical errors by enhancing clinical decision support — it has inevitably created many new ones. Clinician-oriented solutions such as electronic health records (EHRs) are contributing to physician burnout instead of facilitating patient care. Many anticipated that health information technology would reduce costs by limiting the duplication of tests and studies, but there is little evidence that it has accomplished this. And while patient-oriented digital solutions have proliferated in number, their clinical impact has been limited. Slack anticipated a world in which patient access to records would enhance “patient power” — yet many patient-oriented solutions have little relevance in the clinical exam room.
Yet there are rays of light, each of which shares a common denominator: a rigorous focus on the specific needs of the end user, be it patient or clinician. When creative health systems consider and engage the end user of the digital technology as the “customer” of that technology, adoption levels are high and so, too, is the impact. Two CareMore Health initiatives serve as examples: One provides patients with non-emergency transportation, and the other is a new secure platform for clinical team communication and collaboration.

Succeeding in sepsis: The transformation with mobile technology continues

25 April 2018
Improving outcomes for patients with sepsis is a major NHS priority. The condition, which annually costs the NHS an estimated £2.5 billion, claims at least 44,000 lives in the UK each year. Around 14,000 of these deaths are preventable.
Despite concerted efforts to accelerate the identification and treatment of patients with sepsis, County Durham & Darlington NHS Foundation Trust recognised it needed to do more to help its clinical teams drive quality improvement in this area of high NHS priority.
The subsequent deployment of mobile technology to help expedite diagnosis and escalate treatment pathways has transformed sepsis care across the integrated organisation. County Durham & Darlington is now among the best performing trusts in England in its identification and treatment of patients with sepsis.
This is their story.

Read the full case study


Plymouth plans to go live with OpenEHR in next six months

26 April 2018
The CIO at University Hospitals Plymouth NHS Trust has said the organisation is planning to go live with an open source electronic health record (EHR) “some time between June and October” this year.
Andy Blofield confirmed his trust was plans to initially go live with an open-standards based electronic prescribing module, on a single pilot ward.
He added that he doesn’t have “all the information” as the technology is still “very new”. The trust is thought to be the first to go live with OpenEPR, the open standards electronic health architecture which is supported by Slovenian company Marand.

HIT Think How EHRs can help in the battle against the opioid crisis

Published April 27 2018, 5:51pm EDT
There are distressing similarities between what the United States faced with HIV/AIDS in the 1980s and the current opioid epidemic. Most people have a personal story related to the harm that can be associated with opioids, and the numbers of opioid deaths and people suffering from substance use disorder has reached staggering proportions.
Many smart and influential people are working hard to address the issues from multiple fronts, lift the stigma and put improvements in place, such as the following:
  • The U.S. omnibus spending bill, passed in March, includes $4 billion to address the opioid crisis.
  • All the key federal agencies under Health and Human Services (CDC, NIH, FDA, SAMSHA) are mobilized.
  • Both the Senate and House are actively working on numerous bills that will direct actions related to preventing and treating opioid addiction.

Partnership Working – Advisory Series, April 2018

By Maja Dragovic – Digital Health
Digital’s ability to support greater partnership working in healthcare has been frequently touted. But, as Maja Dragovic reports, it’s also increasingly proving the means or motivator for initiatives which extend partnerships beyond health and into broader care.
As regions across the country bid for national investment in shared health and care records, the potential for digital to help forge collaborations within and beyond the NHS has once again been highlighted. Local Health and Care Record Exemplars (LHCREs) will initially be focused on developing shared care records, but the intention is that – in the longer term – they will open up possibilities for greater collaboration and integration across a local care landscape.
But LHCREs aren’t the only national initiative with digitally-supported partnership working as a stated aim. Venture into the local government sector, and you’ll uncover the Social Care Digital Innovation Programme. Developed in collaboration with NHS Digital, the programme sees the Local Government Association (LGA) award funds to councils developing digital technology projects to improve social care.

5 Ways Healthcare Can Defend Itself Against Orangeworm

Jack Murtha
APRIL 25, 2018
By now, you’ve heard of the enigmatic hacker group Orangeworm and how it has blasted healthcare over the past few years. Its Kwampirs malware might be simple and messy, but it has proved effective in stealing patients’ protected health information. So, what can healthcare organizations do to prevent—or respond to—an Orangeworm attack?
To answer this question and more, Healthcare Analytics News™ reached out to John Nye, senior director of cybersecurity research and communications for CynergisTek, a security and information management firm with deep roots in healthcare. Nye understands how malicious actors operate because, well, that’s his job. He’s been a penetration tester for years, meaning companies have retained him to break into the very networks they want to protect. So, when news of Orangeworm broke, he began analyzing the cyberattacks and what went wrong.
Right off the bat, he lists 2 notable things about the Orangeworm hacks: For one, it’s unlikely that a nation-state (like China, Russia, or North Korea) is behind this. Second, although the group has mostly targeted healthcare, it has also terrorized businesses, like information technology companies, that are linked to healthcare.

FDA requests $100M to tap EHRs for evaluating medical products

Published April 26 2018, 7:07am EDT
The Food and Drug Administration is asking for $100 million in its Fiscal Year 2019 budget request for a new initiative aimed at better utilizing electronic health record data to help streamline clinical development as well as inform the safe and effective use of medical products.
FDA Commissioner Scott Gottlieb, MD, told a Senate appropriations subcommittee on Tuesday that the funding for the initiative would create the capability to “conduct near-real-time evaluation down to the level of individual electronic health records for at least 10 million individuals from a broad range of healthcare settings.”
Currently, the FDA’s active post-market data monitoring systems—the National Evaluation System for health Technology (NEST) for medical devices and Sentinel system for drugs and biologics—depend largely on the secondary use of claims data.

How ‘-omics’ data can revamp treatment of diseases

Published April 26 2018, 5:16pm EDT
Healthcare professionals can draw lifesaving conclusions from omics data sets—molecular data from genomics, proteomics and metabolomics—to help inform their clinical decision-making and improve patient care.
What distinguishes omics data from previous molecular biology research is the ability to express all of a cell’s proteins, rather than a single protein, says Mark Depristo, head of deep learning for genetics and genomics at Google. “You collect a lot of data very quickly because you're not selecting for specific proteins you want to cite,” Depristo noted.
Depristo and Anthony Philippakis, MD, the chief data officer of the Broad Institute, a Harvard and MIT biomedical and genomic research center, will be among the experts discussing this topic at the HLTH session “Discovering Meaning From Massive Omics Data Sets” scheduled to begin at 3:20 p.m. on Tuesday, May 8, at the Aria in Las Vegas.

mHealth Apps With CDS Can Help Doctors Make Quicker, Better Decisions

An analysis of an mHealth app developed by the CDC finds that it - and other properly evaluated apps - can help physicians make better decisions on ordering diagnostic and lab tests. And they can do it quicker and with more confidence.

April 24, 2018 - mHealth apps for clinical decision support can help clinicians make better and quicker decisions about ordering diagnostic and lab tests, according to a recent study by researchers at the Baylor College of Medicine and the Centers of Disease Control and Prevention.
But those apps, researchers said, have to be evaluated and approved, so that doctors know which of the ever-growing number of mobile health apps are reliable. That’s particularly important when physicians report that they’re uncertain about what tests to order for one of every seven patients.
In their study, recently highlighted in the Journal of the American Medical Informatics Association, experts from Baylor and the CDC evaluated the effectiveness of one particular app, PTT Advisor, against typical decision support tools, including online and text resources. The app, developed by the CDC’s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC), offers guidelines for diagnostic and test ordering decisions for certain coagulation and bleeding disorders.

Study: 9 in 10 Clinicians to Use Mobile Devices at Bedside by 2022

April 24, 2018
by Heather Landi
A recent study indicates a rising adoption in clinical mobility, such as the use of mobile devices like handheld mobile computers, tablets, cordless barcode scanners and mobile printers, in hospitals and clinicians increasingly see mobile devices as improving the quality of patient care and helping to reduce medication administration errors.
Nine in 10 clinicians expect to use a mobile device at the bedside by 2022, according to Zebra Technologies’ 2022 Hospital Vision Study. Zebra Technologies, a mobile device solutions company, surveyed 1,500 nursing managers, IT decision-makers and patients and the survey compiles the feedback from respondents across the United States, Brazil, China, United Kingdom, Saudi Arabia, Kuwait, Qatar, and United Arab Emirates.

CMS floats proposal tying medical records sharing to Medicare participation

Apr 25, 2018 1:20pm
Buried underneath changes to the Meaningful Use program, a newly proposed hospital payment rule includes the possibility of more stringent federal requirements that would force providers to share data to participate in Medicare and Medicaid.
That approach, which involves revising Conditions of Participation (CoPs), would allow the Centers for Medicare & Medicaid Services to wield a far heftier regulatory stick and offer a clear-cut business case for interoperability. 
The 1,880-page rule (PDF) released by the Centers for Medicare & Medicaid Services (CMS) on Tuesday includes what the agency dubbed as an “overhaul” of the Meaningful Use program, now known as Promoting Interoperability. As part of that change, the agency shaved down number or measures hospitals are required to meet from 16 to six and revamped the program to a points-based scoring system.

HIT Think Meaningful Use changes are only part of CMS’ proposed rule

Published April 26 2018, 5:55pm EDT
This week, CMS released its Inpatient Proposed Rule for Fiscal Year 2019. Early reactions from stakeholders have been varied, with some healthcare stakeholders bemoaning "the death of Meaningful Use" while others praised the triumph of "Patients Over Paperwork" and the clear influence such efforts have played in this year's proposals.
In keeping with stated goals of the current administration, one aspect of the 1,882-page regulation is undeniably clear: CMS is intently focused on reducing administrative burden for providers. While CMS anticipates that its proposals to eliminate some reporting requirements will save hospitals many hours, providers shouldn't assume that the net effects of these proposals will automatically lead to more favorable financial impacts than in the past, especially because some of the proposed changes are to the pay-for-performance programs.

Patients prefer the doctor without the computer, MD Anderson researchers find

Apr 24, 2018 9:15am
Take the computer out of the exam room and patients perceive the doctor as more compassionate and professional, with better communication skills.
That’s the finding of a study by researchers at the University of Texas MD Anderson Cancer Center in Houston, published in JAMA Oncology.
The researchers conducted the randomized clinical trial to assess patients’ perception of doctors who use a computer in the examination room.

CMS overhauls meaningful use EHR program, removes redundancies

Administrator Seema Verma said changes to the program eliminate 25 measures and ultimately save hospitals over 2 million hours of work.
April 24, 2018 06:08 PM
Centers for Medicare and Medicaid Services Administrator Seema Verma on Tuesday announced changes to overhaul the meaningful use EHR incentive program, including equipping patients with access to their electronic health records on the day they leave the hospital.
Indeed, it starts with a new moniker: meaningful use is being renamed “Promoting Interoperability.”
The proposed rules and request for comment are a follow up to Verma’s March announcement during HIMSS18 in Las Vegas for better interoperability between providers and for patients.

HIT Think How healthcare organizations can become information-driven

Published April 25 2018, 5:35pm EDT
Over the last several years, data analytics has become a driving force for organizations wanting to make informed decisions about their operations and their patients.
With further advancements in open source analytic tools, faster storage and database performance and the advent of sensors and IoT, IDC predicts that the big data analytics market is on track to become a $200 billion industry by the end of this decade.
Many organizations now understand the value of extracting relevant information from their enterprise data and using it for better decision-making, superior customer service and more efficient management. But to realize their highest potential in this space, organizations will have to evolve from being "data-driven” to being “information-driven.” While these two categories might sound similar, they’re actually quite different.

APIs: A Path to Putting Patients at the Center

April 24, 2018, 8:42 am / Don Rucker M.D. / National Coordinator for Health Information Technology
I remember when visiting a city required paper maps and often actual guidebooks. Today, I tap on a map app on my phone, enter my destination, and review options for getting from point A to point B. In recent years, these applications have expanded to integrate ride-sharing, bike-sharing, and public transit information. Map apps provide two key real-time data points to help me compare the different options: the time it will take to get to my destination and the cost.
Behind those data points are elegant algorithms that analyze traffic patterns and conditions, as well as the real-time data exchange between multiple apps through modern, Representational State Transfer (RESTful) application programming interfaces (APIs). What makes our smartphones so powerful is the multitude of apps and software programs that use open and accessible APIs for delivering new products to consumers and businesses, creating new market entrants and opportunities. There is nothing analogous to this app ecosystem in healthcare.

EHR Capabilities Impact Patient Satisfaction Levels, Report Finds

April 23, 2018
by Rajiv Leventhal
Electronic health record (EHR) technology and the ways that providers use it to communicate with their colleagues and with patients is affecting how satisfied consumers are with their hospital organizations, according to a new Black Book market research.
The insight is revealed within the eighth annual Black Book industry surveys of inpatient EHR users including hospital staff, managers, networked physicians and patient panels. The data revealed that 89 percent of healthcare consumers under 40 years old, who were polled in this year's survey on hospital provider technologies, disclosed they are unsatisfied with the technology capabilities of the healthcare organizations with which they seek services. And 84 percent asserted they are seeking the most technologically advanced and electronically communicative medical organizations available for their healthcare alternatives.
“Involvement with healthcare consumers through technologies is proving to be a significant element of patient satisfaction," said Doug Brown, managing partner of Black Book Research. "Healthcare consumers more frequently interact through electronic media in 2018, and while they value contact with their providers, they don't have the patience for lacks in hospital interoperability, incorrect billing and access to scheduling and results."

36% of administrators continue to struggle with EHR interoperability

April 23, 2018 | Cara Livernois
As a result of the implementation of varying electronic health record (EHR) systems, 36 percent of medical record administrators struggle with the exchange of patient health records with providers with differing EHR platforms. Findings were published April 20 in a report by Black Book Market Research.
The report included responses from 3,040 hospital EHR users.
Key findings included:
  • 36 percent of medical record administrators struggled with the exchange of patient health records to other healthcare providers with differing EHR platforms, a slight improvement from 41 percent in 2016.
  • 24 percent of administrators were unable to use meaningful patient data they received electronically from outside sources not within a siloed EHR system.

Medical Device Security Should Be Focus for Healthcare Providers

While ransomware attacks on hospitals have caught the headlines, medical device security and supply chain risk should be of greater concern to healthcare providers, according to a recent report by Trend Micro and HITRUST.

April 23, 2018 - While ransomware attacks on hospitals have caught the headlines, medical device security and supply chain risk should be of greater concern to healthcare providers, according to a recent report by Trend Micro and HITRUST entitled Securing Connected Hospitals.
Researchers at Trend Micro analyzed internet-connected medical devices and systems using the Shodan search engine and found many that were viewable publicly.
Hospitals and clinics leave devices and systems exposed online because they incorrectly configure infrastructure, internet connection is a requirement for the device or system to function, and/or remote access enables remote troubleshooting or remote operations.

HIT Think Why consumers are casting a wary eye at Terms of Use

Published April 24 2018, 5:12pm EDT
Many websites, mobile applications, software solutions and similar solutions are offered for “free.” The services are free from the perspective that there is no cost to acquire or use the service.
However, as the famous saying used commonly by the author Robert Heinlein goes, “There ain’t no such thing as a free lunch.” While a user may believe there is no cost, the provider of the service will seek to obtain a benefit in some manner.
In the context of a mobile app or software, how does that happen? The data entered into the services is where the value lies. From this perspective, understanding the Terms of Service, Terms of Use or other similar document is important. And after the recent debacle at Facebook regarding user information and privacy concerns, consumers of healthcare services are among those paying more attention to these stipulations.

CMS issues proposed rule to revamp Meaningful Use

Published April 24 2018, 5:05pm EDT
The Center for Medicare and Medicaid Services Tuesday proposed broad changes in the way it handles providers’ efforts to implement electronic health records systems, as well as the ways in which those systems support changes in patient care.
CMS released its proposed rule to implement its MyHealthEData initiative to strengthen interoperability and change the rules of the Medicare and Medicaid Electronic Health Record Programs, commonly called the Meaningful Use program.
CMS officials say they intend to rename the Meaningful Use program “Promoting Interoperability” to emphasize that measures in the policies will “require the exchange of health information between providers and patients.”

Changing the game: Machine learning in healthcare

When EHRs can learn – gather and remember – what works best for each user, they can attain maximum efficiency.
April 20, 2018 02:16 PM
As we live in the new world of quality, value-based care, we must be able to draw more insights and conclusions from ever-increasing amounts of information. We have the data, now we must put it to work. When we combine all of this data with machine learning, we are equipped to make smarter decisions. We have the power to transform healthcare – from the way we use electronic health records to the way we predict and deliver care.

A game changer for EHRs

Most EHRs are built on technology that is 20 or 30 years old. Generally, EHRs have kept up with rapid changes in healthcare by making incremental improvements over time. But it is challenging to retrofit EHRs to take full advantage of new innovations.
EHRs must do more than store data. They should be smart enough to deliver the right information at the right time, at the point of care. When an EHR is powered by machine learning, it can pre-populate information based on usage patterns and deliver preference reminders, constantly surveilling trends by user and organization to create opportunities for more effective care.

Comcast partners with Independence Health to create digital health company

Companies say the cross-sector partnership will create open source platform that it hopes other tech companies will use to innovate.
April 20, 2018 11:22 AM
Independence Health Group, one of the biggest Blue Cross insurers in the country, is working with Comcast on a consumer-focused healthcare platform designed to improve the efficiency and experience of care delivery.
The plan is that the patient-centered technology and communications platform will provide patients with access to data about their healthcare journey, according to officials. Comcast and Independent Health plan to make the platform available nationwide on a range of devices and distribution channels.
"Rapid technological advances in recent years have changed the expectations consumers have about accessing and using goods and services,” Independence CEO Daniel Hilferty said in a statement. “Healthcare is no exception.”

AI: A data scientist explains how deep and shallow learning can work together to create cost savings

Nationwide Children’s Hospital Chief Research Information Officer Simon Lin says applying artificial intelligence to patient data enables efficiencies and better outcomes for its Medicaid patients.
April 23, 2018 08:54 AM
For all the hype and excited pronouncements about the impacts it can have driving healthcare efficiencies, artificial intelligence is still not deployed as widely (or wisely) as it could be.
But many health systems are working in earnest to roll out AI-driven analytics projects – even if their particular payoff isn't quite yet in sight – with the understanding that the technology is evolving at a dizzying pace, and big improvements could be just around the corner.
That's the case at Partners for Kids, an accountable care organization affiliated with Nationwide Children's Hospital in Columbus, Ohio. As one of the largest pediatric ACOs in the country, PFK has a big opportunity to enable big savings by bettering the health of its Medicaid patients.

House committee to examine cybersecurity risks of legacy technology in healthcare

Apr 23, 2018 11:05am
An influential House committee is taking a deeper dive into the cybersecurity risks associated with legacy technology throughout the healthcare industry and asking for stakeholders to help policymakers establish possible solutions moving forward.
Calling healthcare cybersecurity a “complex, nuanced challenge with many different contributing factors,” lawmakers zeroed in on legacy devices as the “root cause” of many security incidents, according to a request for information (PDF) issued by the Energy and Commerce Committee last week.
The request acknowledged the simplest recommendation is to replace legacy technology with updated equipment. But the healthcare industry finds itself in a predicament with no easy solutions. Medical technology is more specialized with fewer replacement options for legacy devices. The cost of replacement is much higher than that of consumer technology, and for hospitals with thin operating margins, updating equipment often means sacrificing another portion of its budget.

Wearables Can Enhance Practice, But Questions Remain

Marcia Frellick
April 22, 2018
NEW ORLEANS — Wearable technology — such as fitness trackers, sensors, and monitors — can build patient engagement, save time on office visits, and add real-time data points, according to physicians speaking here at the American College of Physicians Internal Medicine Meeting 2018.
And starting this year, the Centers for Medicare and Medicaid will reimburse physicians for time spent analyzing data the devices collect, as part of improvements to the Merit-Based Incentive Payment System.
"This is an area where there is a lot of focus from health systems so that they can actually bill for care coordination," said Priya Radhakrishnan, MD, from the HonorHealth Medical Group in Scottsdale, Arizona. "The caveat is that 20% has to be borne by the patient" under the Medicare rules of reimbursement.

Pew: 5 ways EHRs contribute to patient harm — and 2 ways to fix it

Written by Jessica Kim Cohen | April 20, 2018 |
The Pew Charitable Trusts outlined how EHR usability issues may contribute to patient harm and provided two suggestions on how to solve these safety issues in an April 17 infographic.
Here are five ways the Pew Charitable Trusts said EHR usability issues may harm patients.
1. Alert fatigue
2. Customization that hasn't undergone rigorous testing

Hacker group targets healthcare organizations through supply chain

Published April 23 2018, 1:27pm EDT
Data security vendor Symantec is warning of a new and significantly dangerous hacker ring targeting large healthcare organizations in the United States, Europe and Asia.
“Symantec has identified a previously unknown group called Orangeworm that has been observed installing a custom backdoor called Trojan.Kwempirs,” the vendor notes.
Orangeworm is looking for targets to engage in corporate espionage in healthcare and other industries. Targets are chosen carefully and deliberately with extensive planning before an attack is made, Symantec experts contend.

Why providers need IT to achieve a ‘whole person' approach

Published April 23 2018, 5:17pm EDT
Chronic diseases are responsible for seven out of 10 deaths in the United States each year, according to the U.S. Centers for Disease Control and Prevention. Many think a key to reducing chronic disease deaths is personalizing the information sent to each patient, to increase their chances of better managing their health.
Glen Tullman, chairman and CEO of Livongo, will speak at a panel called “Tech-Enabled Services Supporting Chronic Populations” at the upcoming HLTH conference on May 7. Tullman, a former CEO of EHR software company Allscripts, recently spoke with Health Data Management on the role analytics can play in managing chronic conditions. An edited version of the interview follows.
HDM: Livongo Health’s stated mission is to help people with chronic conditions using a “whole person” approach. Tell us about that.
Tullman: Livongo has traditionally been known as a company that helps people with diabetes. But if you look at our vision statement, we talk about empowering people with chronic conditions to live better and healthier lives. And the reason our statement doesn't mention diabetes is because we have always understood that you can't treat people in silos. We've always realized that we had to treat the whole person because that's who we are as people. We're not a disease. We're not a diabetic. We're not a heart patient. We have to look at the whole person. We have to have that kind of approach.

Telemedicine is getting trendy, but doctors may not be keeping up

April 22
For years, doctors have been told to look at the patient — not the computer — when providing medical care. What we haven’t been told is what to do when there’s only a computer.
Telemedicine is perhaps the most rapidly evolving area in health care. About 15 million Americans receive some form of remote medical care every year. Investment in on-demand health-care services is estimated at $1 billion annually, according to Accenture Consulting. Kaiser Permanente, the nation’s largest integrated delivery system, provides more visits virtually than it does in person.
All of which raises an important but overlooked question: Do doctors know how to use telemedicine?

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