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.
It was in July 1948 that Alan Turing’s Intelligent Machinery report was delivered to the National Physical Laboratory. It started with the words: “’You cannot make a machine to think for you.’ This is a commonplace that is usually accepted without question. It will be the purpose of this paper to question it.”
In his speech, he talked up the importance of AI to the NHS. “All of the great advances in the human condition have been led by improvements in knowledge and collective intelligence,” Hancock stated.
The high-tech accessory is teaching kids to read facial expressions, a pilot trial suggests
Google Glass may have failed as a high-tech fashion trend, but it’s showing promise as a tool to help children with autism better navigate social situations.
“Healthcare providers increasingly use mobile devices to store, process, and transmit patient information,” wrote report authors. “When health information is stolen, inappropriately made public, or altered, healthcare organizations can face penalties and lose consumer trust, and patient care and safety may be compromised.”
The 260-page guide includes an example solution for improving the security of patient EHRs accessed through mobile devices developed in collaboration with the National Cybersecurity Center of Excellence (NCCoE).
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CMS issues final rule to provide patients with access to health data
Published August 03 2018, 6:37am EDT
The Centers for Medicare and Medicaid Services on Thursday finalized a rule designed to put patients in control of their own health data and to overhaul the Meaningful Use program.
In March, CMS announced at the HIMSS18 conference the launch of the MyHealthEData initiative—led by the White House Office of American Innovation—to ensure patients have access to their full healthcare records and can decide how their data is used.
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Walgreens digital effort gives customers easy way to access care
Published August 03 2018, 2:46pm EDT
One of the country’s largest pharmacy chains is planning a digital health platform for customers, linking them to established care providers.
Walgreens is rolling out the service, called Find Care Now, offering it as a marketplace that helps connect its mobile and online visitors to healthcare services, with the intent of improving patient access to local health services.
Company executives say the initiative will help connect customers to services at Walgreen stores as well as community providers. As of this week, Walgreens has cemented relationships with 17 provider organizations in a variety of markets.
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Survey: Two thirds of teens, young adults have used a health app
August 01, 2018
Just under two-thirds of U.S. teens and young adults have used a health-related mobile health app, according to
a new survey of more than 1,300 US teens and young adults aged 14 to 22 years.
The survey, sponsored by Hope Lab and Well Being Trust, was designed and analyzed in part by Susannah Fox, a former HHS chief technology officer who also conducted similar surveys in the past as a part of the Pew Research Center. Fox was joined by former director of the Kaiser Family Foundation’s Program for the Study of Media and Health Victoria Rideout. The research was conducted earlier this year by NORC at the University of Chicago (formerly the National Opinion Research Center).
A major focus of the report was to get a grounding of understanding on the relationship between depression and social media use in teens and young adults. It found that the relationship there is complicated: teens and young people who use social media extensively aren’t significantly more likely to have symptoms of depression, but those with depressive symptoms are more likely to report both negative and positive social media experiences.
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Direct Exchange Transactions Increased 26 Percent in Q2 2018
August 1, 2018
by Heather Landi
Use of Direct messages to transmit health information continues to grow steadily, according to DirectTrust, as there were 50.5 million Direct exchange transactions in the second quarter of 2018, an increase of 26 percent over the same period last year.
The cumulative total of Direct exchange transactions climbed to nearly 432 million at the end of the second quarter.
The number of health care organizations served by DirectTrust health information service providers (HISPs) and engaged in Direct exchange increased nearly 23 percent to more than 121,000 in the second quarter of this year, compared with the same time last year, according to the organization.
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Accidents Were Most Frequent Cause of Healthcare Data Breaches
In the second quarter of 2018, the most frequent cause of healthcare data breaches was accidental disclosures, according to incidents reported to the Beazley Breach Response Services team.
August 01, 2018 - In the second quarter of 2018, the most frequent cause of healthcare data breaches was accidental disclosures, according to incidents reported to the Beazley Breach Response Services team.
Accidental disclosures made up 38 percent of the data breaches in the healthcare sector, hacking/malware were 26 percent of breaches, followed by insiders at 14 percent, physical loss of a nonelectronic record at 7 percent, loss or theft of a portable device at 6 percent, social engineering at 4 percent, and unknown/other at 5 percent.
Across industries, the top two causes of data breaches in the second quarter were hacking/malware attacks (39%) and accidental disclosure (22%). Hack or malware was down 3 percentage points from the first quarter, despite an increase in the number of email compromises. This was due to a decrease in the number of reported
ransomware incidents in second quarter.
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Organizations lack cyber security experts to fight data threats
Published August 02 2018, 7:31am EDT
The vast majority of CIOs expect cyber security threats to increase during the next three years, new research from Gartner indicates.
However, many say their organizations do not have a cyber security expert in place to protect crucial data, according to a new report from the research firm.
The firm queried 3,160 CIOs in 98 countries as part of its 2018 CIO Agenda Survey, and found that 95 percent anticipate cyber threats will increase during the next three years. Only 65 percent of their organizations currently have a cyber security expert, however.
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HIT Think How to create a data governance program that works
Published August 02 2018, 6:06pm EDT
Data governance is a key enabler in improving the value and trust in information, helping achieve efficiencies and cost savings while playing a key role in patient engagement, care coordination and community health.
As data governance matures within the healthcare industry, organizations need to treat data as an asset. Data is a powerful tool for gaining actionable insights. But like any other asset, data needs to be governed to provide its true value to the organization.
The goals of data governance have long been clear outside of the healthcare industry. Organizations want to enable better decision making, reduce operational friction, protect the needs of data stakeholders, train management and staff to adopt common approaches to data issues, build standard, repeatable processes, reduce costs and increase effectiveness through coordination of efforts, and ensure transparency of processes.
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Fed up with hunting down other providers' test results, physician built a new platform
Offices using the technology from his company, LabFinder.com, report receiving 64 percent fewer phone tag calls, and say office staff feel less overwhelmed.
August 02, 2018 02:19 PM
Healthcare can be chaotic for caregivers, especially when it comes to the logistics of tracking down a patient's results on tests ordered by other providers. Clinicians can spend an excessive amount of time and energy on the telephone contacting other providers' offices or having staff waste valuable time and effort that can be focused on other patient care duties.
This chaos was getting to Robert Segal, MD, CEO of Medical Offices of Manhattan. So he took matters into his own hands and founded LabFinder.com, which offers a platform operated by patients, clinicians, and labs and imaging facilities that eliminates the hassle caregivers experience when trying to lay their hands on a patient’s test results from other providers.
Earlier this month, Quest Diagnostics subscribed to LabFinder’s network. And as is commonly the case with homegrown technologies, Segal’s own practice uses the platform, too. Segal’s colleague Denise Pate, MD, an internal medicine doctor at Medical Offices of Manhattan, uses LabFinder.com and has reaped rewards, she said.
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What hospitals need for successful AI: a digital base
Artificial intelligence depends on several different fundamental technologies, and a robust and modernized infrastructure – cloud, mobile and web – to build upon is a must-have first step.
August 01, 2018 04:09 PM
If ever a technology was the opposite of plug-and-play, artificial intelligence is it. Beyond the obvious table stakes – having sound information and a smart data strategy – getting AI right requires a broad array of closely interrelated technologies to work well together. And it demands that each organization be able to tailor its deployments to their own particular needs.
The data literacy part of the equation is hard enough to get right, for instance.
"Very few health systems that I have seen and talked to have figured out their data strategies,"
said Nevenka Dimitrova , chief technology officer for oncology informatics and genomics at Philips Healthcare, speaking at the HIMSS Precision Medicine Summit this spring.
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Jamie Dimon says health care initiative with Buffett and Bezos may start small like Amazon did with books before expanding
Published 3:22 PM ET Mon, 30 July 2018 Updated 7:24 AM ET Tue, 31 July 2018 CNBC.com
J.P. Morgan Chase's CEO
Jamie Dimon said Monday that his partnership with
Jeff Bezos and
Warren Buffett to improve health care for employees will likely start small, akin to Amazon's small-scale operation during its first few years.
"This is an absolute critical issue and all of us have a long-term view and we've been through the amount of money spent on fraud, administration, end-of-life, the misuse of drugs," and others, Dimon told CNBC's Wilfred Frost. "I'll remind people that Jeff Bezos, when he started Amazon, he might have had visions about the 'everything store,' but he started with books. And he spent 10 years getting books right."
"So we may spent a bunch of time getting one piece of it right, and testing various things to see what works," he added.
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Next-gen cloud computing: How healthcare can prepare for the future
Don’t leave it up to tech vendors to drive the next phase of integrated data that gets channeled between doctors, payers, providers and patients.
August 01, 2018 10:22 AM
There has been a notable shift in healthcare clouds from simple data storage to using the technology to lower costs, gain efficiencies and even move on to tasks such as personalizing patient care.
Black Book Research, in fact, found that 93 percent 93 percent of hospital CIOs are actively acquiring the staff to configure, manage and support a HIPAA-compliant cloud infrastructure.
This is happening as the service offerings of cloud technology vendors such as Amazon AWS, Google Cloud, IBM Cloud and Microsoft Azure, in particular, are constantly changing. What’s more, 91 percent of CIOs in the Black Book survey report cloud computing is allowing more agile, nimble products and services with the proliferation of healthcare data.
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DHS sets up hub to protect banks, critical infrastructure from foreign cyberattacks
Published: July 31, 2018 7:45 a.m. ET
Threats from Russia and elsewhere can not only harm industry but also cause damage to society, top official says
By DustinVolz
The Department of Homeland Security will announce on Tuesday the creation of a new center aimed at guarding the nation’s banks, energy companies and other industries from major cyberattacks that could cripple critical infrastructure, agency officials said.
The launch of the National Risk Management Center is expected to be unveiled by DHS Secretary Kirstjen Nielsen at a government-hosted cyber summit in New York City, at which Vice President Mike Pence and several other cabinet secretaries are expected to speak.
The center’s creation was motivated by a growing recognition in government that sophisticated cyberattacks, particularly those deployed by foreign adversaries, can not only harm a company or industry but can cause systemic failure across society, Chris Krebs, DHS’s top cyber official, said in an interview.
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Survey: Physicians Cite EHRs as Biggest Contributor to Burnout
July 31, 2018
by Heather Landi
A recent survey on physician burnout and stress found that, perhaps unsurprisingly, physicians cited electronic health records (EHRs) as the top factor contributing to stress, followed by dealing with payers and pre-authorization and then regulatory compliance.
Reaction Data, a market research firm focused on the healthcare and life sciences industries,
surveyed 254 physicians across the country in a wide variety of specialties about what factors contribute to physician burnout. Twenty-one percent of respondents cited EHRs, followed by payers/pre-authorization (19 percent), regulatory compliance (18 percent) and internal bureaucracy (17 percent). And, these factors all have a common theme: they are time consuming and prevent the physician from providing care for the patient.
Other burnout factors cited by respondents included work/life balance (11 percent) and malpractice risk (6 percent).
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When patient data isn’t shared, predictive analytics suffer
Published August 01 2018, 5:50pm EDT
Data silos that prevent the sharing of patients’ medical information between organizations may hamper analytics efforts and short-circuit patient care.
Physicians have a vast array of data in their electronic health record systems to help them understand past treatments of a patient. However, what they often don’t have is information from other providers that have treated the patient, and they don’t know if the patient is following the prescribed treatments of these providers.
Lacking a complete picture of the patient’s overall treatment and health status increases the risk that a physician may be unaware that a patient is headed toward a major adverse healthcare event.
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HIT Think Why providers need to brace for ransomware attacks this fall
Published August 01 2018, 5:55pm EDT
When it comes to cybercrime, online attacks often follow seasonal trends. So as the kids head back to school, it’s safe to assume that cybercriminals have learned and developed some new ransomware tricks that will be coming to a computer near you this fall.
Most healthcare organizations are probably not prepared to deal with this new wave of attacks. Among the endless flow of sensational cyberattack headlines including NotPetya and the Erie County Medical Center, it’s easy to become numb to the threat of ransomware—choosing to believe that your organization is either too small to be a likely target or that your existing cybersecurity measures provide adequate protection. Unfortunately, this optimism has led to the peril of many healthcare providers and, in turn, the patients they serve.
The biggest cybersecurity concern used to be hackers invading healthcare systems to steal sensitive patient data and then selling it to the highest bidder. But today, one of the easiest assaults on a computer system is ransomware—a debilitating attack through which an anonymous criminal encrypts your files and then forces you to pay them whatever amount they request in order to regain access to your system—and all the important files it may contain.
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Virginia’s new data-sharing platform could be a peace offering in payer-provider battle to control ED utilization
Jul 31, 2018 3:51pm
Virginia has launched a single, statewide platform to connect 129 hospital emergency departments across the state, allowing physicians to access patient records and tap into the state’s prescription monitoring program.
In doing so, the state may have discovered one way to smooth over what has become an increasingly combative relationship between emergency physicians and payers over ED utilization.
Unveiled by Gov. Ralph Northam on Tuesday, Virginia’s Emergency Department Care Coordination program is a collaboration that stretches across providers, payers and state agencies aimed at controlling ED utilization costs and directing patients to the appropriate care provider.
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Virginia platform links all ED patient data across the state
Published August 01 2018, 7:27am EDT
Virginia has launched a program to connect all the state’s emergency departments to ensure patient data can be shared in near real time.
The communication and collaboration platform—called Emergency Department Care Coordination (EDCC) Program—is the first of its kind in the country to link EDs statewide, according to Governor Ralph Northam’s office, which made the announcement on Tuesday. The initiative also integrates the state’s Prescription Monitoring Program and the Advance Healthcare Directive Registry.
“Virginia continues to be at the forefront of healthcare innovation, and the ED Care Coordination Program marks an important step forward in making sure Virginians in every part of the Commonwealth have access to the highest quality of care,” said Northam in a written statement. “With this secure technology, we can provide emergency medical personnel with access to a patient’s critical medical information in a timely way, which will increase effective and efficient care, avoid duplicative tests, reduce unnecessary costs and improve health outcomes.”
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10% of medical practices still don't offer patient portals, MGMA poll finds
Written by Jessica Kim Cohen |
July 30, 2018 | Print | Email
While most of today's medical practices offer a patient portal, practices are split on allowing patients to input their own patient-generated health data, according to a recent Medical Group Management Association
survey .
MGMA, an Englewood, Colo.-based association of medical practice leaders, polled 1,700-plus members about the use of patient portals at their respective organizations in late July. These portals typically provide patients with online access to health data, appointment scheduling, billing and prescription refill requests.
The majority of respondents — 90 percent — indicated their practice offered a portal, while the remaining 10 percent reported that they did not. Of the medical practices that offered a portal, 43 percent said the platform allows patients to input their own patient-generated health data for clinical review.
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Radiologists say cost data, leadership keys to reversing botched EMR transition
Imagine a scenario in which hospital leadership insisted on switching to a new electronic medical record (EMR) without first consulting the staff who use it?
Four radiologists were asked how they would handle a hypothetical EMR transition if it resulted in a loss of referrals, scheduling mix-ups and additional radiologists needed to complete basic tasks. Their
answers were published in a recent
Journal of the American College of Radiology article.
Not surprisingly, all four pointed to a disconnect between radiologists and hospital administrators as the source of the problem, but all focused on how they would arrive at a solution.
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Patient-Reported Data on Readmissions, Complications is Accurate
Patient-reported data on key quality measures, including hospital readmissions and complications, can provide important information for value-based care.
July 30, 2018 - Patient-reported data can be a valuable resource for healthcare providers looking to develop longitudinal records of past events, such as emergency room care, hospital readmissions, and complications from previous procedures, according to
a new article published in the Journal of Medical Internet Research (JMIR).
Researchers from Anthem, Kaiser Permanente, and HealthLoop Inc. found that patients accurately self-reported important markers of quality and outcomes, and that their recollections of key events were useful for filling in gaps in their records.
The study may help healthcare organizations collect more
meaningful and comprehensive data on readmissions, especially if services are conducted across multiple, unconnected healthcare systems.
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Half of US Adults Are Anxious About Healthcare Data Security
Around half of US adults (49%) are extremely or very concerned about their healthcare data security, according to a survey of more than 2,000 US adults by The Harris Poll on behalf of healthcare marketing firm Scout.
July 30, 2018 - Around half of US adults (49%) are extremely or very concerned about their healthcare data security, such as diagnoses, health history, and test results, according to a
survey of more than 2,000 US adults by The Harris Poll on behalf of healthcare marketing firm Scout.
The survey also found that US adults are most concerned about diagnosed medical conditions and diseases being mishandled or shared without their permission.
At the same time, more than two-thirds of US adults are extremely or very concerned about the security of their personal financial information, such as credit card details, bank account numbers, and financial passwords, the survey found.
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Providers seek to find ways to unlock ROI on records systems
Published July 31 2018, 7:32am EDT
“Cedars-Sinai Doctors Cling to Pen and Paper,” read a 2005
Washington Post headline. The
article described how the Los Angeles academic health center shelved its initial home-built electronic health record three months after launch because physicians refused to use the clunky system.
Some 13 years and a new Epic EHR later, the mutiny is difficult to conjure. Cedars-Sinai Medical Center is among the first 162 hospitals to achieve HIMSS Stage 7 on its EMRAM scale, the highest level of EHR progress, and nearly 100 percent of clinicians now document orders electronically.
Yet CIO and Senior Vice President Darren Dworkin remembers the not-so-long-ago days when Cedars-Sinai measured EHR success primarily by the percentage of clinicians documenting on paper. “When we first implemented our EMR, we were focused on achieving adoption,” he says. “A lot of our measurements were engagement metrics.”
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Algorithm, patient registry help safety net clinics control hypertension
Published July 31 2018, 6:59am EDT
UC San Francisco has partnered with the city’s Department of Public Health to provide a simplified intervention that improves blood pressure control.
Researchers adapted Kaiser Permanente evidence-based protocols to a racially and ethnically diverse population at 12 safety net clinics and developed an internal hypertension patient registry—in order to track blood pressure management—as well as a treatment algorithm that encouraged the use of fixed-dose medications, with two or more drugs in a single pill.
In addition to the algorithm, the program included regular check-up visits in which nurses and pharmacists were allowed to take standardized blood pressure measurements. All 12 of the safety net clinics shared the same eClinicalWorks electronic health record system.
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HIT Think 3 ways artificial intelligence can disrupt healthcare
Published July 31 2018, 5:40pm EDT
New data predicts the market for AI-driven healthcare technologies will exceed $6 billion in just three years. That’s a significant leap from its $600 million valuation just 4 years ago. The surge is being driven largely by growing demand and acceptance among consumers for electronic, data-driven and virtual-based care, and the desire for more convenient, accessible, and affordable care.
While it’s entertaining to speculate on the future of these applications to healthcare, there are several use cases underway today which promise to change the way we think about and deliver care at the individual and population levels. These three areas highlight where AI is already making an impact in the delivery, treatment, and reimbursement of care.
Bio-surveillance. Tracking disease prevalence, treatment methods, and patient response through widespread systematic data collection, analysis, and dissemination has the potential to help us fine tune treatment protocols based on clear evidence of what’s working and what’s not across various disease states and populations.
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How to Use Healthcare IT to Avoid Diagnostic and Medication Mix-Ups
Recommendations fall into three categories: communication, tracking, and acknowledgement of an information review and associated actions.
Healthcare IT has a key role to play in limiting
diagnostic errors and botched medication changes, an ECRI Institute
report says.
"Results can be—and often are—missed when the loop of receipt, acknowledgment, and action remains open. The resulting consequences stem from these now delayed, missed, and incorrect diagnoses. A closed loop provides timely and effective therapies and mitigates diagnostic error," the report says.
Healthcare IT can help ensure that
patient data requiring action is delivered to the right people at the right time in the right format, but the challenge can be daunting.
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ECRI lays down 3 steps to close patient safety loop for diagnostic testing
Institute says technology can help guard against medical errors if hospitals implement it well.
July 30, 2018 09:32 AM
WIth the goal of lowering risk and harm while working to improve patient safety, the workgroup focused on how to implement health IT to cut missed, delayed, and incorrect diagnoses on testing results and medication changes.
To that end, ECRI outlined three tactics: communication, tracking and acknowledgment of action taken.
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Biometrics entering a new era in healthcare
Hospitals, consultants and tech vendors explain what’s happening now and where biometrics are headed.
July 30, 2018 09:19 AM
Biometrics technologies such as fingerprint scanners, palm vein readers, facial recognition tech, iris scanners and others, have long held promise to tighten up identification of patients and employees.
This would help reliably verify that patients are who they say they are, guarantee caregivers are working with the proper medical and demographic information, and ensure only the proper employees have access to the right information.
But biometrics technologies have been slow to catch on in healthcare. Sure, many hospitals and clinics have implemented some basic tech, but biometrics is not yet fully in the mainstream of healthcare practices. And it will still take some time and effort on the part of healthcare CISOs and biometrics technology vendors to get the tech swimming in the mainstream.
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HHS Fails To Fix Cybersecurity Vulnerabilities, Putting PHI At Risk
HHS has failed to remedy cybersecurity vulnerabilities in its systems that could put PHI at risk, warned the GAO in a report released July 25.
July 27, 2018 - HHS has failed to remedy cybersecurity vulnerabilities in its systems that could put PHI at risk, warned the GAO in a
report released July 25.
The GAO cited problems at CMS that threaten to compromise Medicare beneficiary data and the privacy of users’ data on state-based marketplaces.
In addition, HHS had not fully addressed key security elements in its guidance for protecting the security and privacy of electronic health information, GAO noted.
These failures to act are not just an issue with HHS. Across federal agencies, GAO has since 2010 made more than 3,000 recommendations to agencies to address cybersecurity shortcomings. As of July 2018, about 1,000 still needed to be implemented.
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In California, a new app aims to keep patients up-to-date on physician misconduct
Written by Jessica Kim Cohen |
July 27, 2018 | Print | Email
A new smartphone app
will alert patients in California about changes to their physicians' licensing status — whether that means a change of address or an incident of misconduct.
The app, developed by the Medical Board of California and released July 26, aims to help inform patients who are making decisions about their healthcare providers.
Patients who download the app can track up to 16 physicians in the state. The app pulls data from the California Department of Consumer Affairs' license search interface and notifies users when there's an update to one of their physicians' licenses.
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Worried about 'defensive medicine' in telehealth? Go on the offensive
Jul 27, 2018 12:35am
WASHINGTON—Despite substantial industry excitement around telehealth as a way to coordinate care and improve outcomes, there is still some lingering concern that virtual care could lead to defensive medicine.
Defensive medicine has its roots in medical malpractice, with physicians ordering unnecessary tests to limit their liability. For telehealth, concerns revolve more around the limitations of virtual care: If a doctor is limited to calling or even video-calling a patient, they may lack many of the diagnostic tools they need to determine whether a test is necessary. To play it safe, they'll call for the test.
But a panel of experts at an event hosted by the Connected Health Initiative at the Microsoft Innovation & Policy Center on Tuesday said those costs can be mitigated through improved remote diagnostics and better planning on providers' part. Moreover, given sufficient coordination, telehealth applications can end up cutting costs and providing hospitals with a new, profitable service line.
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New technique uses light to train artificial neural networks
Published July 30 2018, 7:35am EDT
Optical chips can be trained to support networks that enable artificial intelligence, with significant implications for machine learning in imaging.
A new study, published in Optica, contends that artificial neural networks can be recorded directly on an optical chip, potentially avoiding the need to use conventional computers for machine learning.
Artificial neural networks are one of the most important algorithms in artificial intelligence and machine learning. They must be trained to perform a given task, which is done by fine-tuning the algorithm and testing it until the desired function is achieved.
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Health IT improving patient safety, care quality
Published July 30 2018, 7:16am EDT
Providers are seeing benefits from increased utilization of health information technology, according to data from the American Hospital Association.
Primarily, the most significant benefits include improvements in patient safety and quality of healthcare, as well as support for new models of care.
That’s the finding of two briefs recently released by the AHA based on results from the 2016 AHA Annual Survey Information Technology Supplement for community hospitals, collected from November 2016 to April 2017.
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HIT Think 4 crucial steps to ensure successful change management
Published July 30 2018, 6:05pm EDT
Being at the intersection of healthcare and IT makes for compelling and meaningful work, but often, it’s also complex and challenging. One thing is for certain—both industries demand constant change.
Whether it be the rapid advancements of technology, new challenges in security, pressures to improve clinical outcomes and patient safety or the seemingly never-ending regulatory mandates, all leaders in healthcare and IT are faced with the challenge of motivating teams through various levels of change. This can be especially daunting when those teams are comprised of highly skilled and tenured professionals who may be unreceptive to change.
I’ve had to lead teams through various change initiatives, ranging from the adoption of new required processes and methodologies to managing teams through acquisitions (both as the acquirer and as the acquired). The scope of impact has widely varied, from small teams to cross-organizational global teams, but the basic principles of leadership remain the same.
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Enjoy!
David.
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