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, January 26, 2019

Weekly Overseas Health IT Links – 26th January, 2019.

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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Digital is a valuable tool for prevention – and so rightly it’s at the heart of the long term plan

Digital is at the heart of the NHS Long Term Plan. Quite right too, argues Tara Donnelly, newly appointed interim chief digital officer at NHS England – it can be the means of moving to prevention as a priority, something that will benefit health service and patients alike.
DHI Admin – 15 January, 2019
The 10-year blueprint for the NHS was, I think, worth the wait. Published last week, the Long Term Plan promises a major shift to prevention and supporting people stay healthy, unlocked by the power of digital. In fact, the word digital features 95 times in the 136-page document.
I’ve worked in the NHS for 30 years and am a realist. I completely get how hard it can be to imagine the bold commitments taking shape when days are so busy clinically and operationally. But it is only by thinking about the longer term and investing bravely that we can make the nearer term much better for staff and patients alike.
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Two countries united by natural language processing?

George Bernard Shaw famously quipped that the US and the UK were two countries separated by a common language. But in natural language processing, State-side hospitals are finding a means of better assesing the appropriateness of specific tests or procedures – and Dan Kazzaz argues the NHS could valuably follow suit.
DHI Admin – 17 January, 2019
Comparing the US healthcare system to that of the UK is often great sport. Points of comparison are frequently the cost of care, quality of care and waiting times. Less obvious is that the US and UK systems actually have a great deal in common, primarily how healthcare is funded.
The largest US healthcare insurer is Medicare, which is comparable to the NHS. Although Medicare is primarily for those over 65 years of age and does not cover all items covered by the NHS, both are highly dependent on the working population to support the retired population through taxes.
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Special Report: Shared Care Records

Last Spring, NHS England announced the latest initiative designed to radically advance shared care records. The five Local Health and Care Record Exemplars (LHCREs) are now starting to properly bed in. But how much progress has been made on shared records, what obstacles remain, and can the exemplars help other areas of the NHS progress? Maja Dragovic investigates.
The mission of the Local Health and Care Record Exemplars (LHCREs) cannot really be seen as new. Indeed, to look at the five regions that were selected – Greater Manchester, Wessex, One London, Yorkshire and the Humber, and Thames Valley and Surrey – is to see areas in which, no coincidence, some progress has already been made on constructing a shared record.
In Yorkshire and Humber, for example, the core software that underpins the orchestration of data across the region’s health and care organisations is based on software built for Worcestershire Health and Care NHS Trust as part of its global digital exemplar (GDE) programme.
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How machine learning can reduce tests, improve treatments for ICU patients

Written by Megan Knowles | January 16, 2019 | Print  |
Researchers from Princeton (N.J.) University are using machine learning to design a system that could reduce the frequency of tests and improve the timing of critical treatments for intensive care unit patients.
To create the system, the researchers used data from more than 6,060 patients admitted to the ICU between 2001 and 2012. The research team presented its results Jan. 6 at the Pacific Symposium on Biocomputing in Hawaii.
The analysis looked at four blood tests measuring lactate, creatinine, blood urea nitrogen and white blood cells. These indicators help diagnose two serious problems for ICU patients: kidney failure or sepsis.
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ONC: After EHR Adoption, Patient Data Access, Exchange Are Key

The 2018 ONC Report to Congress outlined current health IT limitations, such as poor patient data access and exchange.

January 10, 2019 - Although the US healthcare industry has nearly ubiquitously transitioned to EHRs and other electronic documentation, challenges remain for patient data access, according to the 2018 ONC Annual Report to Congress.
The report, presented to Congress at the end of last year, outlined some of the progress made since EHRs became a mainstay in healthcare.
Since 2015, EHR use and patient portal access has been near universal. In 2015, Certified EHR Technology (CEHRT) adoption reached 96 percent in non-federal acute care hospitals. For office-based physicians, that number reached 78 percent.
Patient portal access also grew between 2009 and present day. Per a July 2018 MGMA report, patient portal adoption rates reached over 90 percent.
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More than 772 million email addresses affected in 'Collection #1' data breach

By Johnny Lieu 17 January, 2019
It's time to change your password again.
More than 87GB of passwords and email addresses have been leaked and distributed in a folder dubbed "Collection #1" by hackers in a significant data breach.
As detailed by security researcher Troy Hunt, the trove of nearly 22 million unique passwords and more than 772 million email addresses was hosted on cloud storage service MEGA.
The link to the dump was posted on a hacking forum, but has been since taken down from the service.
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“Revolutionizing” Healthcare: How Non-Traditional Players are Shaking Up the Sector

January 15, 2019
by Rajiv Leventhal, Managing Editor
Traditional healthcare stakeholders will not be able to slow down new industry entrants such as Amazon, one leading consultant attests
In late November when Amazon announced that it was launching a machine learning service that will aim to mine data from electronic health records (EHRs), company officials, in a blog post, noted that the software, Amazon Comprehend Medical, is “a HIPAA-eligible machine learning service that allows developers to process unstructured medical text and identify information such as patient diagnosis, treatments, dosages, symptoms and signs, and more.”
Two of Amazon’s specialists—Matt Wood, Ph.D., a machine learning expert, and Taha Kass-Hout, M.D., a former FDA chief health informatics officer—noted that a core issue in healthcare and health IT today is that a large amount of critical data is stored as unstructured medical text, such as medical notes, prescriptions, audio interview transcripts, and pathology and radiology reports. “This means that being able to identify this information can be a manual and time-consuming process, which either requires data entry by high skilled medical experts, or teams of developers writing custom code and rules to try and extract the information automatically,” they outlined, adding that Comprehend Medical will instead aim to specifically allow developers “to identify the key common types of medical information automatically, with high accuracy, and without the need for large numbers of custom rules.”
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Bioethicists say consumer neurotechnologies need more oversight

Published January 18 2019, 7:36am EST
While direct-to-consumer neurotechnologies are popular, these products are not fully supported by science and have little regulatory oversight.
That’s the contention of two bioethicists from Penn Medicine and the University of British Columbia, writing this week in the journal Science. The authors propose the creation of an independent working group to study the poorly regulated market for these products—such as mental health apps—which is predicted to reach $3 billion by 2020.
“A growing ecosystem of neurotechnology products is being sold direct to consumers (DTC) without necessitating the physician as intermediary,” state the authors. “Yet there are good reasons to conclude that regulatory oversight of DTC neurotechnologies is insufficient.”
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Gartner's top data and analytics predictions for 2019

Published January 18 2019, 4:00am EST
The use of analytics to improve operations is growing, and healthcare organizations are on the cusp of deriving increasing value from the data they have. Gartner, a major consulting firm, has issued a set of predictions for the implications that data and analytics will have across all industries. This post originally published on Andrew White's Gartner blog, which can be viewed here.

Predictions about data and analytics strategy

* By 2022, 90 percent of corporate strategies will explicitly mention information as a critical enterprise asset and analytics as an essential competency.

* By 2022, 30 percent of CDOs will partner with their CFO to value the organization’s information assets for improved information management and benefits.

* By 2022, more than half of major new business systems will incorporate continuous intelligence that uses real-time context data to improve decisions.

* By 2023, data literacy will become an explicit and necessary driver of business value, demonstrated by its formal inclusion in over 80 percent of data and analytics strategies and change management programs.

* By 2023, 60 percent of organizations with more than 20 data scientists will require a professional code of conduct incorporating ethical use of data and AI.
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HIT Think How an omni-channel approach can aid patient experience

Published January 18 2019, 4:01pm EST
Patient dissatisfaction often comes from wait times rather than from actual clinical care. In healthcare, the complete consumer experience is repeatedly overlooked as a critical component to building loyal, repeat visitors.
With smartphones in hand, we’ve gotten used to receiving instant information and a seamless customer experience. Text messages and alerts telling us that a package has just been delivered, or that our table is now available, provide timely information in a way that enables us to do more with the time we have.
And yet, in healthcare, we wait. In many ways, the healthcare industry is extremely advanced. In other areas, we are woefully behind. Customer experience is one of the areas where most healthcare providers’ processes, procedures and technology are archaic compared to other digital interactions. But it doesn’t have to be.
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Dutch govt to put EUR 90 mln into e-health for the elderly

Friday 18 January 2019 | 20:56 CET | News
The Dutch government will in the coming years put EUR 90 million into E-Health Home, a subsidy scheme aimed at stimulating e-health applications for older people with chronic diseases or disabilities. Providers of care and support for the elderly, together with the purchasers of this care, will be able to submit plans this spring to receive a subsidy. Over the next three years, EUR 30 million will be available each year. A total of around 280 initiatives will be funded from the scheme.  
The government believes the use of digital technology can help people live independently and with a good quality of life. This would also reduce pressure on health personnel.
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  • 01.16.19

IoT security is so bad, many companies can’t tell when they’re hacked

And only 14% believe that IoT security is an ethical responsibility.

Internet of Things devices–like smart lightbulbs or ovens or even toilets–are notoriously susceptible to being hacked. But the security problems go much deeper than preventing your average smart toaster from becoming a foot soldier in a botnet army.
A new report from the security company Gemalto surveyed 950 companies that both make and use IoT technology, and found that 48% of companies that use IoT devices in the workplace don’t have mechanisms in place to detect if any of their devices are hacked or not… even though nearly all respondents believe that security is an important way to win over customers and 65% believe security is a way to differentiate from the competition.
As the number of connected devices grows–the report states that the industry is on track to see 20 billion IoT devices by 2023–the security of these devices will only become more important. That growing significance is reflected in the percentage of budget companies spend on IoT security, which has increased from 13% in 2017 to 15% today. While budget is increasing, 15% still seems like a laughably small amount to be spending on security in a time when data breaches are in the news every month.
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AJMC: Which HIE approach is best?

Written by Julie Spitzer | January 16, 2019 | Print  | Email
Approaches to health information exchange that rely on shared EHRs or EHR vendor alliances may disadvantage smaller healthcare organizations using less popular IT systems, according to a study published in the American Journal of Managed Care.
Researchers analyzed Medicare patient transitions and physician EHR adoption to determine the proportion of transitions that could be covered by one of the three approaches to data exchange. The three approaches were data exchange between physicians who "are part of the same integrated system," physicians who "use the same EHR" or physicians who "use an EHR that participates in an EHR vendor alliance."
Three study findings:
  1. Thirty-three percent of transitions could be completed with one of the three proprietary data-sharing approaches listed above.
  2. Open data exchange methods, such as those offered by community HIEs, were still required for 45 percent of patients.
  3. Physicians who did not use a market-leading EHR, did not belong to a large integrated health system and shared patients with a broader network of physicians have the greatest need for an "open" HIE.
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How the government shutdown is putting national cybersecurity at risk

Published Mon, Jan 14 2019 • 3:14 PM EST | Updated Tue, Jan 15 2019 • 3:30 PM EST
Kate Fazzini                       
Key Points
  • The country’s cybersecurity stance has been weakened by the partial government shutdown, with both immediate and longer term negative consequences. 
  • This is especially true as a longstanding “brain drain” of cybersecurity talent has turned into an open bleed.
  • Many essential cybersecurity functions continue, but their jobs are made harder by the fact that other IT staff who would normally implement routine fixes are furloughed.
The partial government shutdown is quickly turning into a nightmare scenario for the country’s cybersecurity functions, and often in unexpected ways. Even after Congress ultimately reaches a deal to end the shutdown, these negative effects could last far into the future.
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Provider organizations look to tech to improve the patient experience

Published January 17 2019, 7:49am EST
Novant Health understands the value of getting patients involved in their own care, and it’s using technology to lure them in.
The four-state integrated network of physician clinics, outpatient centers and hospitals has been offering portals since 2011 and was one of the first in the country to have 100,000 patients using the technology to look at their medical records. And Novant is doing more than just providing access to health records. For example, it’s using its database of patient information to initiate personal contacts, such as its “birthday letters” to patients containing reminders about health services and tests that patients need.
It’s a key to the chain’s long-term strategy. “We’ve made it easier for patients to address their needs,” added Ryan Neaves, director of IT applications at Novant Health Lakeside Primary Care. “We can offer an e-visit for patients, and that has really made it a more cohesive experience for them.”
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AMIA: Clinical research and care need to be better aligned

Published January 17 2019, 7:43am EST
Despite widespread adoption of electronic health record systems by providers, data-driven healthcare remains “overwhelmingly” unrealized.
That’s the conclusion of a new American Medical Informatics Association paper, published on Wednesday in JAMIA Open, which calls for better integrating clinical research and clinical care to fully leverage America’s existing healthcare information technology infrastructure.
“Increasingly, all health stakeholders have the opportunity—and obligation—to leverage health information technology systems, and the valuable data they contain, for the development and delivery of new interventions,” state the paper’s authors.
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Healthcare providers increasingly lucrative for pros’ ransomware attacks

Published January 17 2019, 6:06pm EST
Ransomware attacks are continuing to proliferate, as hackers have become professionals and are operating as a business.
Hackers are no longer primarily acting alone, but in concert with each other and sharing the rewards, according to Jason Green, chief revenue officer at Trustifi, an email security vendor with products that include 256-bit military-grade email encryption, email tracking systems and automated electronic postmarking of emails. Hackers are now acting as a business and not just hacking for amusement.
“Phishing attacks have become an economy in its own right,” Green contends. “Providers have failed to know the value of data until patients become victims of identity theft, because providers failed to protect patients. It is cheap to encrypt data, but it is not done, even though providers don’t have to worry if they just encrypt.”
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NHS Chair Lord Prior talks challenges, opportunities of digital health tech

Part of the NHS's new 10-year plan is to make the organisation a testbed for new health tech, such as the portal-like HealthTechConnect.
January 14, 2019
Lord Prior of Brampton, who took over last year as chair of NHS England, has big plans for the organisation he now helps lead — many of which were laid out in the 10-year plan announced last week. Lord Prior was also on hand at the JP Morgan Healthcare Conference in San Francisco, stopping by the StartUp Health Festival, where MobiHealthNews caught up with him.
Broadly, the organisation is working to better integrate different kinds of care and to move its focus from treatment to prevention. Through its 100,000 Genomes Project, which met its eponymous milestone last month, he hopes to make the UK a world leader in personalised medicine. And finally, the NHS is increasingly focused on quickly and responsibly deploying digital health services.
“We’re setting up what we call HealthTech Connect, which is kind of a portal. Any digital product that any companies want to introduce in the UK can come through HealthTech Connect straight into the NHS,” Lord Prior said on stage at StartUp Health. “We want the NHS to be sort of a testbed for new technology. And obviously it’s got to be safe, it’s got to be approved and regulated, but we want the NHS to be the most accessible healthcare system in the world for new technology.”
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Pew: Here's what APIs need to succeed for healthcare

The private sector and government have accomplished a lot and the next phase is critical to the best use of APIs.
January 17, 2019 09:41 AM
Application programming interfaces are all the rage in healthcare and just about every other industry undergoing digital transformation. And with the release of Health Level 7’s Fast Health Interoperability Resources 4 earlier this month, the excitement around open APIs, FHIR and data interoperability just kicked into a higher gear.
“Increasing the use of APIs could represent a dramatic shift in how health data is accessed, extracted, and utilized to improve patient care. APIs can help get patients their data, support information exchange among healthcare facilities, and enable enhanced clinical decision support tool,” said Ben Moscovitch, project director of health information technology at Pew Charitable Trusts.
Indeed, the 21st Century Cures Act gives the Office of the National Coordinator for Health IT the opportunity to advance standards around open API, FHIR included, and to encourage vocabularies and code sets for clinical concepts, Moscovitch added, while the private sector has been making strides of its own.
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Here are 6 major issues facing healthcare in 2019, according to PwC

Connected care, upskilled workers, tax reform, a Southwest Airlines approach, private equity and the Affordable Care Act all will impact healthcare organizations in 2019, a new PwC report says.
January 17, 2019 12:09 PM
The U.S. healthcare industry is looking less like a special case, a large segment of the U.S. economy with its own unique quirks, and is beginning to behave like other industries, according to "Top health industry issues of 2019: The New Health Economy comes of age," the 13th annual healthcare report from consulting giant PwC.
So for PwC Health Research Institute's latest report, rather than focusing on issues only U.S. health organizations face, it for the first time is examining how healthcare is adapting to factors common to all industries: deals, business and tax strategy, risk and regulatory issues, workforce trends and digital transformation. The details may be specific to healthcare, but the business issues are shared with many other parts of the economy.
The new report identifies six overarching issues facing healthcare in 2019:
  • Digital therapeutics and connected care reshape the life sciences industry
  • Your company's new, upskilled health worker of the future is you
  • Tax reform has only just begun for healthcare companies
  • Creating the Southwest Airlines of healthcare
  • Private equity – healthcare's new growth accelerator
  • The Affordable Care Act in 2019 – still alive
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Singapore’s Minister for Health outlines key responses to COI report’s recommendations

Some of the key responses include enhancing governance and organisation structures, a cybersecurity model with multiple lines of defence and considerations for a tiered model of Internet access.
January 16, 2019 09:23 PM
Minister for Health Gan Kim Yong delivered a ministerial statement on the Committee of Inquiry (COI) report on the SingHealth cyberattack in the Singapore Parliament on January 15 2019. In the statement, he said that the Ministry of Health (MOH) has appointed a Cybersecurity Advisory Committee to conduct a horizontal review of the cybersecurity governance structures and processes across the public healthcare clusters and Integrated Health Information Systems (IHiS), the IT agency for the Ministry.
He also outlined four key responses to the COI report’s recommendations. The first is enhancing governance and organisational structures as there is a “need for clearer cybersecurity risk ownership and accountability between IHiS and the public healthcare clusters, underpinned by a strong relationship to avoid fragmenting the Ministry’s healthcare IT strategy.”
At MOH, the Chief Information Security Officer (CISO) is currently also the Director of Cyber Security Governance at IHiS but these roles will be separated. The MOH CISO will be supported by a dedicated office in MOH and report to the Permanent Secretary. The MOH CISO office will be the cybersecurity sector lead for the healthcare sector. It will coordinate efforts to protect Critical Information Infrastructure in the healthcare sector, and ensure that the sector fulfils its regulatory obligations under the Cybersecurity Act.  For its part, IHiS will have its own separate Director of Cyber Security Governance.
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Virtual video visits give patients more flexibility without diminishing care quality: 7 survey findings

Written by Anuja Vaidya (Twitter | Google+)  | January 15, 2019 | Print  | Email
A majority of patients and providers agree that virtual video visits do not offer lower care quality when compared to regular office visits, according to a study published in the American Journal of Managed Care.
Researchers from Boston-based Massachusetts General Hospital surveyed 254 patients after their first virtual visit via the MGH TeleHealth Program, which was launched in 2012 and began offering video visits in 2013. They also polled 61 clinicians who participated in the first full year of the program.
Seven key findings from the survey:
1. Sixty-two percent of patients reported virtual video visit quality was similar to that of office visits.
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Hospitals with value-based care contracts more likely to use emerging tech

Written by Julie Spitzer | January 15, 2019 | Print  | Email
Hospitals that have implemented value-based payment models are more likely to adopt technologies for population health, care coordination, data management and analytics, according to Deloitte's "Beyond the EHR" report.
For the report, researchers from professional services firm Deloitte analyzed data from 4,500 U.S. hospitals between 2012 and 2016. The analysis centered on two key questions:
1. "Were hospitals that receive a higher share of revenue from quality and value contracts more likely to adopt technology that supports new required capabilities?"
2. "Which technologies were hospitals with quality and value incentives more likely to adopt?"
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Industry Voices—EHRs causing undue physician burden? Give me a break

Jan 16, 2019 12:13pm
As we enter 2019, I have been reflecting on a great couple of days I spent in DC at the ONC annual meeting in November. A major part of the focus of the IT-focused meeting was on a relatively newer topic: “physician burden.” 
I get it.
The feds have been pounding at physicians for years with the Meaningful Use program, which has been great at gaining EHR adoption and needed digitization of a paper-based industry, but it seems the pendulum has finally hit a wall. There was precious little time to spend with patients in the past and now there’s even less.
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GAO: Patient matching hampered by demographic data

Published January 16 2019, 7:20am EST
While healthcare providers are increasingly sharing electronic health records, they continue to face challenges in matching patients to their EHRs, according to the Government Accountability Office.
Patients are matched to their medical records—either manually or automatically via software—through demographic information, such as name, date of birth or sex.
However, a GAO audit based on stakeholder interviews found that “inaccurate, incomplete or inconsistently formatted demographic information in patients’ records” is posing challenges to matching medical records. Particularly problematic is the matching of medical records for newborns and multiple-birth siblings such as twins, according to the report.
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GAO Highlights Need to Better Match Patient Records

Assessment spotlights Pew-backed strategies to boost electronic match rates and promote quality care

Article January 15, 2019
By: Ben Moscovitch Topics: Health Care Projects: Health Information Technology Read time: 3 min
A federal report released Jan. 15 underscores the need to improve how patients’ electronic health records are linked among the various doctors’ offices and hospitals where they receive care. Better matching of these records would enhance the quality of that care and help reduce costs.
The Government Accountability Office (GAO) report makes clear that problems with patient matching persist and examines strategies to address them. The 21st Century Cures Act, a wide-ranging health bill enacted in late 2016, required the agency’s review of current practices and ways the federal government could improve match rates.
In its health information technology work, The Pew Charitable Trusts has identified two key opportunities to improve matching: standardizing the way that demographic data, such as addresses, are used by electronic health record (EHR) systems; and examining how biometrics, such as fingerprint or iris scans, can help link patient records. The GAO report highlights both.
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National Institutes of Health asks Fitbit users to share data

Published January 16 2019, 5:26pm EST
The National Institutes of Health and Fitbit are encouraging users of the activity technology to supply data to find linkages between health and personal activity data
NIH and Fitbit—a vendor of wearable technology –want Fitbit users to sync their Fitbit accounts to help researchers find insights into relationships between health indicators that include physical activity, heart rate, sleep patterns and health outcomes.
Data from Fitbit users will support one of the largest precision medicine studies by building diverse data sets for research. Fitbit is the first wearable to be used in the project, but others will be included.
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HIT Think Why healthcare has an unhealthy detection and protection problem

Published January 16 2019, 5:00pm EST
This past year has been an eventful one for the world of healthcare, and we have made some massive strides in improving the overall security posture. As a result, many of the year-end reports and statistics are showing that healthcare is the fastest improving vertical in terms of information security.
Unfortunately, this is an honor that was bestowed on healthcare because the industry was (and still is) by far the furthest behind in the security and privacy of networks.
The security elements that are most lacking in the healthcare industry are directly related to the detection of threats and protection of information and systems. Criminals worldwide have come to the realization that the American healthcare industry has loads of incredibly valuable information that is not as well protected as the less-valuable information that other industries store and protect. This is a problem that started with the forcing of EHR adoption over a decade ago and has only grown as healthcare has struggled to figure out how to secure their systems with less resources than most other verticals.
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Definitive Healthcare Acquires HIMSS Analytics' Data Services

By Jack O'Brien  |   January 16, 2019

The move will allow HIMSS Analytics' clients to access HIMSS' data as well as Definitive's proprietary data.

Framingham, Massachusetts-based Definitive Healthcare has bought HIMSS Analytics' vendor data services business, the health information services company announced Wednesday morning.
As part of the deal, Definitive has purchased HIMSS' subsidiaries including Logic, Predict, Analyze, and additional custom research products.
The acquisition is final and Definitive will now undergo the process of integrating HIMSS' "datasets and platform functionality," while also improving "coverage of IT purchasing intelligence."
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Definitive Health acquires HIMSS Analytics’ data business

Published January 16 2019, 5:11pm EST
Definitive Healthcare has purchased the vendor data services business line of HIMSS Analytics, which includes its product lines and customized research capabilities.
Definitive Healthcare is a vendor of data and intelligence on hospitals, physicians and other types of healthcare providers. The HIMSS Analytics purchase includes research products called Logic, Predict and Analyze, as well as customized research products.
Terms of the deal were not disclosed.
The companies started talking some time ago about ways to give providers the data they need via an online platform, says Jason Krantz, Founder and CEO at Definitive Healthcare. The goal of the combination is to enable providers to run their own data analytics to gain insight on initiatives such as mergers and acquisitions, helping them identify physicians they want to recruit, physician referral patterns, patient leakage, network growth strategies and new partnerships,
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Artificial intelligence, bias and clinical safety

  1. Robert Challen1,2,
  2. Joshua Denny3,
  3. Martin Pitt4,
  4. Luke Gompels2,
  5. Tom Edwards2,
  6. Krasimira Tsaneva-Atanasova1

Introduction

In medicine, artificial intelligence (AI) research is becoming increasingly focused on applying machine learning (ML) techniques to complex problems, and so allowing computers to make predictions from large amounts of patient data, by learning their own associations.1 Estimates of the impact of AI on the wider economy globally vary wildly, with a recent report suggesting a 14% effect on global gross domestic product by 2030, half of which coming from productivity improvements.2 These predictions create political appetite for the rapid development of the AI industry,3 and healthcare is a priority area where this technology has yet to be exploited.2 3 The digital health revolution described by Duggal et al 4 is already in full swing with the potential to ‘disrupt’ healthcare. Health AI research has demonstrated some impressive results,5–10 but its clinical value has not yet been realised, hindered partly by a lack of a clear understanding of how to quantify benefit or ensure patient safety, and increasing concerns about the ethical and medico-legal impact.11
This analysis is written with the dual aim of helping clinical safety professionals to critically appraise current medical AI research from a quality and safety perspective, and supporting research and development in AI by highlighting some of the clinical safety questions that must be considered if medical application of these exciting technologies is to be successful.
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IHiS and SingHealth fined S$1 million in total by PDPC for data breach arising from cyberattack

The financial penalties on the two organisations involved are the highest ever imposed by PDPC to-date.
January 15, 2019 02:10 AM
Following the release of the public report by the Committee of Inquiry (COI) for the SingHealth cyberattack which occurred in July 2018 and Integrated Health Information Systems (IHiS) taking disciplinary action on staff members involved in the incident and senior management team staff, the Personal Data Protection Commission (PDPC) has imposed financial penalties on both IHiS and SingHealth, according to an official statement.
The PDPC administers the Personal Data Protection Act 2012 (PDPA) in Singapore, which aims to safeguard individuals’ personal data against misuse and promote proper management of personal data in organisations. PDPC’s investigations into the data breach arising from a cyberattack on SingHealth’s patient database system, found that IHiS had failed to take adequate security measures to protect the personal data in its possession. PDPC has imposed a financial penalty of S$750,000 on IHiS.
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HIMSS19 looks at lessons learned in accelerating innovation in England

Chief Information Officer Adrian Byrne will provide an update on University Hospital Southampton NHS Foundation Trust's journey as a Global Digital Exemplar.
January 15, 2019 05:41 AM
With a new Debut Square exhibit, a Developer Innovation Lab or a Healthcare of the Future pavilion, HIMSS19 is fast approaching. This week, we caught up with Adrian Byrne, Chief Information Officer at the University Hospital Southampton NHS Foundation Trust, to find out how policy and technology advances are accelerating sharing of health IT innovation in England, and what is next for the flagship Global Digital Exemplar programme.
Q. How is the Global Digital Exemplar (GDE) programme driving digitisation of mental health, acute trusts and ambulance trusts in England?   
A. I am only directly involved in the acute programme. The GDE programme has accelerated the plans of a number (16 plus Fast Followers) of acute trusts. These were already comparatively quite advanced in terms of digital maturity, yet it was clear the NHS does/ did not have any true exemplars. The programme will show that full digitisation of organisations can work in the NHS, and will show that lessons learned can be replicated, or blueprinted.
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Montana Senator to VA CIO: “EHR Modernization Cannot Fail”

January 14, 2019
by Rajiv Leventhal, Managing Editor
Senate VA (Department of Veterans Affairs) Committee Ranking Member Jon Tester has urged new VA CIO James Gfrerer to avoid past failures as he helps to move forward the department’s EHR (electronic health record) modernization project.
Gfrerer, an ex-marine and former executive director at Ernst & Young, was recently confirmed by the Senate to serve as assistant secretary of information and technology and CIO (chief information officer) at the Department of Veterans Affairs.
One of Gfrerer’s top tasks will be helping to update hospitals’ infrastructures as the VA continues to work on replacing the department’s 40-year-old legacy EHR system, called VistA, by adopting the same platform as the U.S. Department of Defense (DoD), a Cerner EHR system. That contract was finally signed last May and the implementation project is scheduled to span over 10 years.
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ONC releases 'snapshot' of new interoperability standards: 4 notes

Written by Jessica Kim Cohen | January 14, 2019 | Print  | Email
The ONC has released the 2019 reference edition of its interoperability standards advisory, according to an agency blog post published Jan. 14.
Four notes:
1. The interoperability standards advisory conveys the ONC's latest thinking around standards development to the rest of the healthcare industry. It is updated throughout the year.
2. The 2019 reference edition is a "snapshot" view of the current interoperability standards advisory, which was updated after the 2018 comment period closed in October.
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NHS England digital chief moves to digital GP company

By Ben Heather11 January 2019
  • Juliet Bauer to join Livi as an executive
  • Ms Bauer was NHS England’s first chief digital officer
  • Livi holds NHS contracts to provide video GP consultations
NHS England chief digital officer Juliet Bauer is leaving to work for one of the new digital GP companies working on NHS contracts, focusing on NHS partnerships.
According to an internal memo obtained by HSJ, Ms Bauer will leave “with immediate effect” and move to the digital company Livi in April, where she will be an executive with responsibility across Europe and NHS partnerships. Livi, also known as Kry in its native Sweden, holds several contracts in the NHS to provide video GP consultations. 
Ms Bauer was NHS England’s first chief digital officer and had responsibility for digital projects focused on patients, including the NHS app, NHS 111 online, the NHS app library, and widening digital patient participation.
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VC funding for digital health reaches $9.5B in 2018

Published January 15 2019, 7:15am EST
Last year was a record-breaking year for venture capital funding for healthcare IT companies, reaching $9.5 billion for the first time, according to research firm Mercom Capital Group.
Overall, 2018 saw 698 deals with U.S. digital health companies, raising close to $7 billion; the remaining $2.5 billion was raised by companies from other countries. All told, there was a 32 percent increase from the previous record set in 2017 of $7.2 billion in 778 deals.
In particular, the highest funded tech categories last year included data analytics ($2.1 billion), mHealth apps ($1.3 billion), telemedicine ($1.1 billion), mobile wireless technology ($847 million), clinical decision support ($714 million) and wearable sensors technology ($703 million).
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IT execs see rising need to achieve interoperability

Published January 15 2019, 7:22am EST
Interoperability efforts for electronic health systems in the U.S. are mired in mediocrity.
That’s the assessment of Donald Rucker, MD, the country’s National Coordinator for Health Information Technology. In testimony before the House Energy and Commerce Subcommittee on Health, Rucker graded the nation’s interoperability at, well, less than average.
In fact, Rucker told representatives that health data exchange graded out at C-minus overall. He said health information exchange is “highly patchy” on a national level, with “A students and F students” in different regions—that, in his estimation, “averages out to a C-minus” overall.
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Walgreens Boots Alliance and Microsoft form digital health link

Published January 15 2019, 12:08pm EST
Walgreens Boots Alliance and Microsoft have entered a seven-year agreement to form a strategic partnership to build digital healthcare solutions.
The companies say they are joining forces to develop new healthcare delivery models, technology and retail innovations. The intent is to combine Microsoft’s Azure cloud and AI platform—as well as its ability to make healthcare investments and retail solutions—with Walgreeens’ customer reach, retail pharmacy locations, outpatient services and industry expertise.
As part of the strategic partnership, the companies have committed to a multiyear research and development investment to build healthcare solutions, improve health outcomes and lower the cost of care. This investment will include funding, subject matter experts, technology and tools.
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Microsoft, Walgreens team up to develop new healthcare delivery models

by Tina Reed 
Jan 16, 2019 10:19am
There's a new team in the race to bring innovation into the consumer healthcare space.
Walgreens Boots Alliance Inc. (WBA) and Microsoft Corp. announced on Tuesday that they will team up to develop new healthcare delivery models, including technology and retail innovations to disrupt the healthcare delivery space.
The partnership will combine Microsoft Azure—which is Microsoft's cloud and AI platform—with Walgreens' outpatient healthcare and retail footprint, officials said. Both companies have committed to a multiyear research and development investment to build new healthcare solutions aimed at improving outcomes and lowering the cost of care.
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HIT Think Why 2018 offered key HIPAA insights for providers

Published January 15 2019, 4:34pm EST
With the holidays quickly receding, there was some time for reflection. I spent some time considering different issues about HIPAA. Here are some of my various musings about HIPAA.
  • Why is it assumed that HIPAA and the goals of value-based care cannot co-exist with HIPAA as currently in place? The permissible uses and disclosures under treatment, payment and healthcare operations are quite extensive. In fact, in beginning to work on comments for submission to Office for Civil Rights (OCR) in response to the request for information, population health style concepts are already included in the definition of health care operations. Further, sharing of information among healthcare providers and payers is clearly permissible. If other parties are brought into the fold, then those parties will likely fit into one of those categories or be a business associate. In all instance, HIPAA allows utilization of the data.
  • Control and use of data are essential components of most contracts. Almost every analytics, consulting or similar vendor wants to retain and keep using patient data even once a contract ends. While most such vendors are aware enough to request continued use of only de-identified data, that is not always the case. When a vendor wants to keep identifiable patient data, it suggests that the vendor does not accurately understand HIPAA. However, retention of de-identifiable data is strongly argued for since it can enable development of new tools or refinement of existing ones. To the vendors, there is an arguable tradeoff that the fees charged will be less if data can be kept or some other argument. These arguments counter the often default position of covered entities that de-identification and subsequent use can only occur with explicit permission. As with all things, neither side is right or wrong, but it is an unavoidable debate.
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Health-care data in the cloud? Early adopter took a giant leap, and it paid off

The decision to go with the cloud may seem like a no-brainer now, but for Think Research there were pros and cons to consider back in 2010
Updated January 14, 2019
A doctor examines an X-ray on a digital tablet. This is how medical charts could look in the digital age. Founded in 2006, Think Research consolidates and provides data to doctors and other health-care providers and administrators.
The series: We look at decision makers among Canada’s mid-sized companies who took successful action in a competitive global digital economy.
Living up to the company’s name, Think Research’s Sachin Aggarwal thought ahead to what the future of health-care data could look like. But the outcome took a leap of faith.
“We took health-care data and put it into the cloud back in 2010, when that was completely unheard of,” says Mr. Aggarwal, who became the Toronto-based company’s chief executive officer in September of that year.
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January 11, 2019

Personal Health Records More Promising in the Smartphone Era?

Author Affiliations Article Information
JAMA. Published online January 11, 2019. doi:10.1001/jama.2018.20434
As health care delivery organizations shift from implementation of electronic health records to optimization of these systems, the persistent problem of patient data interoperability is becoming increasingly relevant. Interest in accessing medical information from hospital records and databases and providing convenient patient-controlled portable records is increasing. Technology companies are seeking to develop innovative solutions to meet these demands.
Interoperable personal health records are not a novel concept; unsuccessful attempts to collect digital patient records have been pursued by several major technology companies. As 1 of the first 12 health care organizations to integrate one company’s next-generation approach (Apple Health Records) into a patient portal, UC (University of California) San Diego Health is assessing whether this new functionality can overcome prior challenges and catalyze systemic change toward meaningful patient-controlled interoperability.1
Personal health records, which are distinct from patient portals tethered to health system electronic health records, are repositories of clinical data managed and maintained by patients.2 These records can contain many of the same types of data as hospital medical records including medical history, diagnostic test results, and clinician documentation. Paper repositories have transitioned to digital platforms that are accessible by personal computers or mobile devices over the internet.
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An overview of Thailand’s healthcare sector

The healthcare sector is poised to be one of the key economic drivers in Thailand in the coming years, with government-led incentives and an increasing private-sector interest moving in tandem.
January 13, 2019 10:05 PM
One of the fast-growing sectors that have been identified in Thailand is healthcare and it is expected to be a key driver of the country’s economy. Deloitte estimates that the health care spending in Thailand would have reached $18.7bn last year, growing by 8% between 2014 and 2018. The consultancy added that total spending was $12.8bn in 2013. The medical equipment market is growing quickly as well, having risen in value from BT25.92bn ($780.2m) in 2010 to BT38bn ($1.1bn) in 2015. Nearly 80% of this medical equipment is imported.
The government’s share of sector spending is the second highest in the region, at 77%, yet private sector spending is on the rise. In 2008, the Thai government spent BT8.2bn ($246.8m) on health care while the private sector spent BT2.6bn ($78.3m). By 2015, the government was spending BT12.5bn ($376.3m) for health care, while the private sector spent BT4bn ($120.4m). Private hospitals have benefited from government efforts to provide universal health care. Local hospitals report having experienced sharp increases in patient numbers, and this has led patients with the financial means to seek treatment at privately run establishments.
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AI and the physician: A blessing or a curse?

HIMSS Chief Clinical Officer Charles Alessi looks at the role of AI in the digital transformation of health and care.
January 14, 2019 04:39 AM
The interface between AI and the physician is a complex one. Some view AI as part of the digital transformation of health and care and leverage it as a clinical extender, while others think that all it will bring is a damaging change to the existing role of the physician.
Like most innovations, AI can be deployed in a variety of ways and can be viewed as a positive development or the converse. Our attitude to change in healthcare to innovation does however skew our stance in many instances.
We tend to view changes to the existing business model as potentially deleterious unless proved otherwise, and, although there are merits to us being cautious, mainly because we need to make sure we satisfy safety and consistency of outcome, perhaps we sometimes overshoot the balance between assurance and innovation and end up not innovating at all.
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E-Health cards to be issued from February

Monday, January 14, 2019 - 12:05
Minister of Health, Nutrition and Indigenous Medicine, Dr. Rajitha Senaratne, said that issuing an eHealth card in Sri Lanka would commence in February.

As the preliminary stage it is planned to issue e-Health cards at Kalutara General Hospital, Bandaragama Regional Hospital.

The e-Health card is to be given to the public within a period of six months. The Health Ministry said,that the issuing of the e-health card allows the patient to receive treatment in any part of the country with complete patient reports of patients.

The e-Healthcare Card was introduced to Sri Lanka at the 71st anniversary of the World Health Organization on April 7, 2018. It was held at the Nelum Pokuna Theater in Colombo under the auspices of the President. The minister further stated that the people will be able to provide services sooner with the introduction of new technology.
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Want to give blood? There’s an app for that.

By Erin Blakemore
January 14 at 12:38 PM
It happens every two seconds: a person needs donated blood or platelets to survive a surgery, cancer treatment, a traumatic injury.
But blood stocks aren’t always high enough, especially during the winter when the holidays and nasty weather make some donations drop off. And each year, only 3 percent of the population actually gives blood, according to the American Red Cross, the organization responsible for 40 percent of the nation’s blood supply.
If you’ve been meaning to donate blood but haven’t, give the Red Cross Blood Donor App a try. Available for iPhone and Android, the app makes the process more convenient.
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Three healthcare IT trends to watch in 2019

January 11, 2019
By Morris Panner

We’re starting to see significant initiatives in Healthcare IT take shape that are fundamentally changing both the way healthcare consumers interact with providers and how providers administer care across their networks.

Consolidation of regional health systems and major mergers such as the CVS-AETNA deal continue to push forward demands for improved and streamlined Health IT systems supported by modern cloud technology. Just a few years ago, the cloud was still treated with suspicion in healthcare, and it now has moved to be a key way that health systems solve complex workflow challenges and extend medical imaging access. We’re also starting to see the spoils of tech titans such as Google, Amazon, and Apple making further inroads in Health IT, especially in the academic and research fields.
As our world becomes more global and more millennials become the decision-makers in the workplace, healthcare may be placed with a new set of demands to increase data access, availability, and promise secure recovery. Here are three trends to watch in 2019:

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6 barriers to healthcare interoperability, according to ONC

Written by Jessica Kim Cohen | January 11, 2019 | Print  | Email
There are six overarching barriers limiting the electronic exchange of health information between hospitals today, according to a report prepared by the ONC.
The ONC filed the 22-page report to Congress as a year-end summary on nationwide trends in health information exchange in 2018, including the adoption of EHRs and other technologies that support electronic access to patient information.
"HHS is committed to the use of health IT to support the free flow of health information for patients, healthcare providers and payers as well as to promote competition in healthcare markets," the report reads.
Six challenges inhibiting electronic data exchange in healthcare, as described by the ONC:
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Health IT Roundup—Report to Congress from ONC finds too many interoperability hurdles

Jan 14, 2019 3:29pm

ONC: Too many barriers to interoperability

Patients still often lack access to their own records, and providers often struggle to find patient data at the point of care when multiple healthcare providers maintain different pieces of data, according to a report to Congress from the Office of the National Coordinator.
Released last week, the report updated Congress on the status of interoperability efforts in health IT. Among the report's findings, payers often lack access to clinical data on groups of covered individuals to assess the value of services provided to their customers. Hurdles included technical barriers, financial barriers and trust barriers. (Report)
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AI combined with EHR and other data improves influenza forecasting

Published January 14 2019, 7:18am EST
With influenza cases elevated nationally and widespread throughout the country, researchers led by Boston Children’s Hospital contend that machine learning can produce highly accurate local flu surveillance.
In fact, they say that combining two forecasting methods with artificial intelligence produces the most accurate estimates of flu activity available to date—a week ahead of traditional healthcare-based reports, at the state level across the United States.
While the Centers for Disease Control and Prevention monitors influenza-like illnesses (ILI) in the U.S. by gathering information from physicians’ reports about patients with ILI seeking medical attention, the availability of the data has a lag time of as much as two weeks.
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HIStalk Announcements and Requests

A convincing 88 percent of poll respondents who self-identify as longstanding HIMSS members say their feelings about the organization are less-positive now than five years ago.
Gerald says that at least HIMSS now acknowledges that the annual conference is a “trade show” (or a “boat show,” as Jonathan Bush always said, although at least boat show attendees are spending their own money instead of someone else’s) instead of claiming that its primary purpose is education. He says he hasn’t attended a provider’s educational session there in the past five conferences, which is about the same as my own record.
A reader asked via a poll question what’s wrong with HIMSS. My answer as a longstanding member, off the top of my head:
  1. They run their operation like a dues-funded vendor, maximizing revenue at every opportunity.
  2. In fact, they really are a vendor, having acquired for-profit companies, conferences, and publications while somehow remaining a non-profit.
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January 13 2019, 12:01am, The Sunday Times

Doctor, doctor, I’m being diagnosed by robot and I’ve a bad feeling about it

Adam Kay
The Sunday Times Magazine’s new columnist thinks apps such as Babylon are dangerous for patients and the NHS
I am a great believer in technological advances. Almost every aspect of my home (which I found on an app, naturally) is controlled by my phone, from my lights to the heating and the locks. I don’t always get it right — ask the Google Glass lying forgotten in a drawer — but you can’t win ’em all with new gadgetry.
In medicine you have to win ’em all — you’d never expose a patient to a drug or a procedure that hasn’t been rigorously tested. These stringent in-depth studies and strict regulatory checks exist because when things go wrong, they can be life-altering. Life-ending, even.
It’s puzzling, then, to see the space-shuttle trajectory of the healthcare app Babylon. For the uninitiated, Babylon aims to cut through pesky waiting times and those hours spent on hold when you call your GP by hooking up patients with an artificially “intelligent” Symptom Checker for the price of a Netflix subscription.
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Enjoy!

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