Quote Of The Year

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

Sunday, March 31, 2019

Grahame Grieve Has A Look At Where We Are With Secure Clinical Messaging.

This went up a day or so and it is reproduced with permission.

Clinical Messaging in Australia

Posted on March 28, 2019 by Grahame Grieve
The Australian Digital Health Agency is working hard on replacing faxing with secure messaging. Peter MacIsaac discusses one of the ancillary challenges this causes in Pulse IT today:
“The second barrier to successful cross-transfer of messages is that the messages sent by almost all health services do not comply with Australian messaging or vocabulary standards.
Likewise the major clinical system vendors are not capable of processing a standard HL7 message, if one were to be delivered to them. Senders and receivers have each interpreted the international HL7 messaging standard independently of the agreed Australian standard and associated implementation guidelines.”
I don’t think this quite expresses the problem – while there definitely are problems with non-conformance, there are also areas with the Australian standards are simply not detailed enough, and a lot of the problems are in this area. 
Peter also recalls that we discussed this: 
“A collaborative effort to achieve networking by messaging vendors some eight years ago was run in a process facilitated by IHE Australia, HL7 Australia and the MSIA”
Indeed we did, and we came up with a list of issues with implementations that went beyond non-compliance with the standards. I later wrote these up for MSIA, but the MSIA never published this document and pushed for conformance to it – another lost opportunity, from my point of view. Since the document was never released openly, here it is:
MSIA Clinical Messaging Profile Download (The document date is 2011)
Looking back at this – the document format rules around pdf, rtf, etc. are problematic – that’s the set of rules that we required then – and pretty much still do now – to get true clinically safe interoperability. But I don’t think many implementers in the industry can actually implement them – they depend on libraries that just don’t have that kind of control. To me, this underlines the fact that clinically safe interoperability is always going to be work in progress, since we need better standards compliance than the wider industry (so far as I know)
----- End Article.
It should be noted that this shows one aspect of the work that is needed and right now is not happening with any speed! There are a lot of other parts to also be addressed.
After all this time I wonder why this 2011 effort did not make more progress. Anyone with deep history knowledge of all this?
I look forward to some interesting comments on how far we have to go to make ‘axe the fax’ anywhere near reality – despite the ADHA propaganda.
David.

ps. Away from the article can I just comment on the 'Axe the Fax' nonsense. The fax machine will be phased out when the vast majority of actors in the health sector have access to reliable, trustworthy and secure clinical messaging. This means virtually all specialists, GPs, Hospitals Labs etc. and Allied Health. This is what determines when the axe falls and I would be surprised if it is done in under a decade. What is your call?

D.
 

AusHealthIT Poll Number 468 – Results – 31st March, 2019.

Here are the results of the poll.

Do Electronic Health Records Need A Fundamental Re-think In The Light Of The Range Of Problems That Have Now Become Apparent In Their Implementation And Use?

Yes 96% (138)

No 3% (5)

I Have No Idea 1% (1)

Total votes: 144

What an clear-cut poll again. Most seem to think the EHR needs much more work to make it more useful for clinicians and patients.

Any insights on the poll welcome as a comment, as usual.

A more than reasonable turnout of votes!

It must have been a fairly easy question as just 1/144 readers were not sure what the appropriate answer was.

Again, many, many thanks to all those that voted!

David.

Saturday, March 30, 2019

Weekly Overseas Health IT Links – 30th March, 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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The future is now when it comes to digital communication with patients

Text messaging transformed the way many of us communicate, and the next generation of such communication promoses to do the same again. Here Kenny Bloxham argues the NHS valuably could – and indeed should – harness these new tools, for the benefit of patients and staff alike.
DHI Admin – 19 March, 2019
Imagine if you could help patients book a hospital clinic appointment, navigate to a new hospital and check in – all via a single automated communication and with no need for a dedicated NHS app.
Today’s digital messaging technology –  Facebook Messenger and WhatsApp or promising entrants like Apple Business Chat and RCS (Rich Communication Service – the much touted successor to SMS) – can do exactly that. But while the efficiency and effectiveness of such tools are already proven in business, the NHS is yet to comprehensively support them.
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NHS Digital to appoint ‘Robin Hood of data’ as interim chief medical officer

NHS Digital is to freshen its clinical leadership with the appointment of a champion of shared records and interoperability.
21 March 2019
Digital Health News understands the national body is set to appoint Dr Amir Mehrkar as its new interim chief medical officer.
Dr Mehrkar is currently a clinical advisor for the agency, with a lead role on interoperability and promoting adoption of FHIR standards.
Notably, he is also the co-founder and co-chair of the INTEROPen standards group, a collaboration of suppliers and NHS bodies working on development and adoption of FHIR in the health service.
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Lack of clarity around data sharing risks ‘irreparable mistrust’, NHS Digital chief warns

Absolute clarity is needed around how the NHS will use patient data or we risk “deep and almost irreparable mistrust”, the NHS Digital chief has said.
15 March 2019
Sarah Wilkinson said the NHS needs to formalise its position on the secondary use of patient data in order to fully benefit from the insights already available within the national data set.
Speaking at a Kings Fund and IBM Watson event on artificial intelligence in healthcare on Tuesday, Wilkinson said we need to “directly address people’s concerns by laying out our ethical approach to dealing with data and providing absolutely clarity on how we intend to use health data”.
She warned that “political interest” could interfere while there is no clear guidance.
“Today the legislation that governs the use of health and care data in the system allows for multiple interpretations,” she told the audience in London.
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Techy toilet seat made to monitor heart patients

March 22nd, 2019
In the not-too-distant future, when congestive heart failure patients are being released from hospital, they may be given a special toilet seat to take home. That device would measure their vital signs every time they sit on it, sending alerts if more heart trouble were detected.
Developed by a team at the Rochester Institute of Technology, the seat is equipped with an electrocardiogram, ballistocardiogram, and a photoplethysmogram. These allow it measure the patient's heart rate, blood pressure, blood oxygenation levels, body weight and stroke volume, which is the amount of blood that the heart pumps out with each beat.
Special algorithms analyze all that data, and determine if the patient's condition is deteriorating – a diagnosis can be made even before the patient develops any noticeable symptoms. Once developed further, the seat would then transmit a notification to the user's physician.
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Researchers Create Fake Profiles On 24 Health Apps And Learn Most Are Sharing Your Data

Mar 22, 2019, 10:00am
Using apps to keep track of your medication or look up the symptoms of your latest mysterious illness might be convenient.
But a new study out this week highlights the hidden privacy risks of plugging sensitive health information into your smartphone.
Namely, that medical apps love to collect your data, but are only sometimes upfront about what they’re doing with it and with whom they’re sharing it.
Researchers in Canada, the U.S., and Australia teamed up for the study, published Wednesday in the BMJ. They tested 24 popular health-related apps used by patients and doctors in those three countries on an Android smartphone (the Google Pixel 1).
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Oregon DHS staff fall for phishing scheme, affecting data of 350,000

Published March 22 2019, 3:59pm EDT
The Oregon Department of Human Services is notifying 350,000 individuals after learning that nine employees fell victim to a phishing attack.
The attack occurred on January 8, the state department believes, and on January 28, a cybersecurity team confirmed the breach had occurred.
After stopping unauthorized access to email boxes, the department now is reviewing the breach and the information involved. Possibly compromised information includes first and last names, addresses, dates of birth, Social Security numbers, case numbers and information used to administer DHS programs.
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Hackers increasingly target medical devices for intrusion

Published March 22 2019, 3:23pm EDT
Hackers are now looking to monetize their efforts, moving beyond ransomware gambits to efforts that seek to manipulate medical devices.
Under these new approaches, some hackers no longer are just interested in getting quick money by encrypting healthcare provider data and demanding a ransom. Instead, they also want the organization’s data, and that includes selling the information in medical devices, such as a dispensing cabinet, says Vidya Murthy, vice president of operation at MedCrypt, a medical device security company.
Most dispensing cabinets and other devices do not have robust security features built in, and that’s why it is important for nurses to not enter a password to get in a cabinet, but to have a secure authenticated badge or thumb scan to access medications and other items, Murthy explains.
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HIT Think One man’s disruption is another man’s inexorable evolution

Published March 22 2019, 3:29pm EDT
No doubt, this has been a disrupted decade for American healthcare. It seems like 2010 came in like a lion and as of this point in 2019, it will leave the decade like a den of hungry lions (I’m allowed to mix and mangle metaphors because it’s a Friday).
It’s clear that the industry is under significant pressure to make progress toward the triple aim, particularly reducing the cost, improving the health of populations and improving the patient experience of care. That’s propelling the move toward value-based care.
And the role of technology—and technological change agents—in the industry is inexorable. The implementation of electronic health records systems and other digital capabilities have moved the delivery of healthcare into a new sphere, where data, analytics, artificial intelligence and other advanced technologies can be used to improve care. And it’s no surprise that large technology companies, such as Amazon, Google, Apple, Microsoft, CVS-Aetna and others, will seek to take a fresh look at how care is delivered.
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NIH-backed startup uses machine learning to catch opioid, drug theft

Invistics says its platform deploys machine learning algorithms to detect drug diversion that would otherwise go unnoticed or unreported.
March 22, 2019 09:01 AM
Healthcare inventory visibility and analytics specialist Invistics launched a machine learning-based platform for monitoring drug diversion.
WHY IT MATTERS
The Drug Enforcement Administration (DEA) compliant software platform provides hospitals with access to the analytics and for detecting and stopping drug diversion.
Backed by the National Institutes of Health, the software helps eliminate paper from controlled substance tracking programs.
“As many as ten percent of healthcare workers divert from their workplace, and most of these instances of theft go unreported,” Tom Knight, CEO of Invistics, said in a statement. “This is a serious issue for our healthcare systems, jeopardizing patient safety, and leading to large DEA fines for non-compliance.”
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HIMSS writes new definition of interoperability

The association is seeking feedback until March 23, 2019.
March 22, 2019 10:23 AM
HIMSS has crafted a new definition for interoperability and is seeking public feedback on it.
HIMSS, the owner of Healthcare IT News, described the new concept as one specifically fit for the larger healthcare ecosystem.
Mari Greenberger, senior director of informatics at HIMSS, explained that there are now four layers to the proposed interoperability definition: foundational, structural, semantic and organizational.
"This definition is an aspirational one," said Greenberger. "It's what HIMSS is trying to accomplish and work toward when it comes to achieving global interoperability. We added the additional level of ‘organizational’ to illustrate the critical need for a robust interoperability infrastructure as well as highlighting the non-technical considerations that play into successful interoperability.
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HIMSS Weighs in on HHS Interoperability Proposals: 8 Takeaways

By Mandy Roth  |   March 22, 2019

Costs could stifle innovation, new requirements could add to provider burden, and the President's budget blueprint might not provide the government resources needed to support the proposed rules.

As the May 3 deadline approaches for comments related to proposed rules from the U.S. Department of Health and Human Services (HHS) to support seamless and secure access, exchange, and use of electronic health information, the Healthcare Information Management Systems Society (HIMSS) conducted a press briefing on Thursday.
The session offered a glimpse into the direction of commentary from HIMSS, as well as concerns it is hearing from its constituents, including health systems.
The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS) are "trying to use all available policy levers to push interoperability data exchange forwards," says Jeff Coughlin, senior director of federal and state affairs for HIMSS. "The idea about placing patients at the center of the healthcare ecosystem is important as well."
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FDA Chief Calls For Stricter Scrutiny Of Electronic Health Records

By Kaiser Health News  |   March 22, 2019

Secretary Scott Gottlieb said Congress would need to enact legislation to define when an electronic health record would require government oversight.


KEY TAKEAWAYS

·         The 21st Century Cures Act of 2016 excludes the FDA from having oversight over electronic health records as a medical device.
·         Gottlieb said the best approach might be to say that an EHR that has a certain capability becomes a medical device.
·         He called EHRs a "unique tool," noting that the risks posed by their use aren't the same as for a traditional medical device implanted in a patient.
This article was first published on Thursday, March 21, 2019 at Kaiser Health News.
Food and Drug Administration Commissioner Scott Gottlieb on Wednesday called for tighter scrutiny of electronic health records systems, which have prompted thousands of reports of patient injuries and other safety problems over the past decade.
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Electronic prior authorization merits wider adoption, health IT, payer groups say

March 20, 2019

Dive Brief:

  • Electronic prior authorization led to faster turnaround times and higher dispense rates, according to new CoverMyMeds data. More than 60% of ePA requests received a determination in less than two hours compared to 0% of PA requests done over the phone or fax — and they led to an 80% higher dispense rate.
  • When electronic PA was combined with a real-time benefit check at the point of prescribing, medication adherence jumped by 20%, the healthcare software company found.
  • But provider adoption remains relatively low at less than half of the market, a point of contention between payers and providers. A Health Information Technology Advisory Committee hearing on prior authorization Wednesday similarly reiterated a call for wider adoption while streamlining the snags in the process that prevent physicians, clinics and health systems from getting on board.
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The impact of healthcare data breaches in February — 1 ASC affected

Written by Rachel Popa | March 20, 2019 | Print  | Email
More than one data breach occurred each day in February, according to HIPAA Journal.
The key details to know:
1. Over 2.11 million records were compromised in February, which was a 330 percent increase from January.
2. Columbia Surgical Specialists of Spokane (Wash.) was the second largest data breach in February, with over 400,000 patients affected.
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Telehealth in primary care risks fragmentation of patient info

Published March 21 2019, 7:25am EDT
A new study suggests that the use of telemedicine in primary care could potentially lead to further fragmentation of care.
It’s possible that the use of the technology could lead to disconnected care, counteracting the benefits of improved patient access to care, contends Winston Liaw, MD, chairman of the Department of Health Systems and Population Health Sciences at the University of Houston’s College of Medicine.
 “Video visit platforms have their own electronic health records that may or may not communicate with the broader healthcare system,” says Liaw. “We have two systems operating in parallel that are completely distinct silos that have very little communication between them. We need to watch this closely.”
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HIT Think How telemedicine is evolving to support variety in care delivery

Published March 21 2019, 5:38pm EDT
Telemedicine is nothing new; former American Telemedicine Association CEO Jonathan Linkous estimates that it’s been around for about 40 years, ever since doctors started doing two-way telephone consultations.
What is new is how telemedicine has grown exponentially in the past five years. Simply put, more sophisticated and cheaper telecommunications, mobile device and remote monitoring technologies are empowering telemedicine to substantially bridge the gap, quite literally, between the physical locations of doctors and patients, anywhere in the world.
This progress is just the tip of the iceberg. In terms of efficiently and economically integrating multi-disciplinary treatment and establishing interoperability across the continuum of care, telemedicine is just beginning to realize its vast potential.
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Special Report: Remote monitoring and self-care

Telehealth was once touted as the key to providing better care closer to home, allowing for remote monitoring of patients and better support for self-care. Then the pot seemed to go somewhat off the boil. With technology having marched on significantly are we back to a situation in which it’s once more in the ascendant? Jennifer Trueland investigates.
Rachel Binks has a vision. As nurse consultant for digital and acute care with Airedale NHS Foundation Trust, she wants telehealth be part of a transformation that will radically change the way the health service engages with people.
Airedale has long been at the forefront of telehealth innovation and its services and approach have won much praise and many awards. It also has a reach well beyond its local area. More than 500 care homes across England have signed up to its digital support service, for instance, which allows 24/7 access to clinical advice and support for residents via a secure two-way video link.
It has also developed services for prisons and for people in the last year of life, as well as monitoring people with long term conditions at home, preventing hospital admissions and GP appointments.
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HIT Think Why organizations must make mobile security a priority in 2019

Published March 20 2019, 5:20pm EDT
It’s not a matter of if; it’s a matter of when. Ominous? Absolutely. But steeped in hard facts.
To be fair, as a security researcher, I deal with facts all the time. It’s from these facts that I can determine what can and should be done in a particular situation.
Here are the facts:
  • According to the GSM Association, a trade body that represents the interests of mobile network operators worldwide, there are more than five billion mobile devices in the world. Approximately 3.7 billion of them have internet accessibility.
  • Per the RSA Fraud & Risk Intelligence Service, more than 70 percent of online fraud is now mobile.
  • Verizon’s Mobile Security Index 2019 states 33 percent of companies admitted to having suffered a compromise involving a mobile device and the majority of those affected said that the impact was major. In addition, as mobile devices increasingly have access to sensitive business and customer data, 67 percent of organizations said they are less confident of their security than their other IT assets.
The reality is, while there may be a debate as to whether the proliferation of internet accessible mobile devices will continue to increase, the amount of data and information - both personal and professional - found on mobile devices is staggering. And therein lies the proverbial carrot for hackers.
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Time to tackle IT and culture barriers to social data integration, says Jacob Reider

The CEO of the Alliance for Better Health and former deputy national coordinator talks EHR and interoperability challenges, the need for ROI, physicians' changing roles and why "social determinants" might not be the right term.
March 20, 2019 02:05 PM
During a discussion at HIMSS19 this past month about the vast promise but big challenges of tackling patients' social determinants of health, a group of diverse professionals detailed the steps they're taking to ensure better health and living conditions for the populations they serve.
  • An employee of one medical group described visiting people's homes to observe variability, with clinicians prompted to gather certain information to create standardized assessments of different ways of life.
  • One expert pointed out that data feeds from homeless management information systems and criminal justice systems could be better put to use for population health management.
  • The need for states, with help from federal funding, to potentially act as conveners helping ensure access to housing groups, food banks and other essential social services was discussed.
  • The central importance of food security, birth plans, neonatal nutrition, transportation and many other social factors was a common theme. An attendee made the case that patients should be screened for loneliness the way they would be for any other medical condition.
  • One healthcare professional likened the process of screening for social factors to "deep learning" – not in the artificial intelligence meaning of the word, but the sense of gleaning insights from patients' day-to-day lives when they're not presenting at the clinic or the ED.
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FHIR, cloud, pop health and social determinants spark new security challenges

Under the broader digital transformation happening, today’s tech trends promise more accessibility and health data exchange, which also demands new ways of thinking about how to protect sensitive information.
March 20, 2019 02:15 PM
With increasing buzz around population health and social determinants of health, those two forces are poised to change philosophies around care delivery and how a hospital or health system works to keep the surrounding community healthy. While that likely means good things for patients and outcomes, it also drives more sharing, more data and more risk of losing your privacy.
There is also a big push for increasing a patient’s autonomy around their personal health information and the access they have to it, especially via personal devices which are likely to be used in the future to communicate directly with providers, if they aren’t already.
There is also the continued push toward interoperability and the use of AI and machine learning. David Finn, EVP of Strategic Innovation for CynergisTek, said that while all these things carry huge potential to positively impact healthcare delivery, they also create new dimensions of risk when it comes to cybersecurity.
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1 in 5 patients have noticed an error in their EHRs, survey shows

Jackie Drees - Print  | Email
As the use of EHRs has increased within health systems, some patients have expressed concern about privacy and accuracy issues, according to the Kaiser Family Foundation's January 2019 Health Tracking Poll.
The number of poll respondents who said their health providers use EHRs has increased from 46 percent in 2009 to 88 percent in 2019.
Twenty-one percent of respondents said they have noticed an error in their individual medical records. The types of errors participants noticed centered on incorrect information in the following areas:
9 percent: Medical history
5 percent: Personal information
3 percent: Lab results
3 percent: Medication/prescription information
1 percent (or less): Billing errors/issues
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Health Data Not Covered by HIPAA Needs Values Framework

Manatt Health and the eHealth Initiative Foundation share the need for a values framework, as consumer devices and health apps amass troves of health data.

March 19, 2019 - With the rapid pace of technology development and the explosion of health data collected by health apps and consumer devices, healthcare sector stakeholders should develop a values framework to reduce the risk to health data not covered by HIPAA, according to a recent eHealth Initiative Foundation and Manatt Health report.
The brief, Risky Business? Sharing Data with Entities Not Covered by HIPAA, outlines the extent of health data is generated from consumer devices and apps that are left ungoverned by the HIPAA rule. As HIPAA was drafted long before the creation of consumer-driven apps and other advanced technologies, there’s a gray area in determining how that data should be handled by app developers.
“Privacy and security in healthcare are at a critical juncture, with rapidly changing technology and laws that are struggling to keep pace,” Jennifer Covich Bordenick, eHealth Initiative CEO said in a statement.
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AI colonoscopy system may detect clues physicians ‘not tuned in to recognize’

March 15, 2019
Using an artificial intelligence system for automatic polyp detection during colonoscopy helped increase adenoma detection, particularly smaller, diminutive polyps, according to study results published in Gut.
Tyler M. Berzin, MD, of Beth Israel Deaconess Medical Center, told Healio Gastroenterology and Liver Disease that the AI system (Shanghai Wision AI) can train on large image sets and its deep learning system determines a variety of visual features that help it identify when a polyp is on the screen.
 “What's interesting about a deep learning system like this is that it may be recognizing features/colors/patterns that are different than the visual cues an endoscopist uses,” he said. “In other words, the AI system may recognize polyp features or clues that physicians are not tuned in to recognize at all.”
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Nielsen warns US 'not prepared' for foreign cyberattacks

Jacqueline Thomsen 83
Homeland Security Secretary Kirstjen Nielsen on Monday called for the U.S. to take on a “whole of society” approach to combat cyber threats, saying the U.S. “is not prepared” to handle hackers backed by other countries.
“It’s not just U.S. troops and government agents on the frontlines anymore,” Nielsen said at a speech at George Washington University. “It’s U.S. companies. It’s our schools and gathering places. It’s ordinary Americans.”
The Department of Homeland Security (DHS) chief said that as hackers target the devices of all Americans, “your average private citizen or company is no match against a nation-state such as China, Iran, North Korea or Russia.”
“It is not a fair fight,” Nielsen continued. “And until now our government has done far too little to back them up.”
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Clinician-AI combination is best in diagnosing diabetic retinopathy

Published March 19 2019, 7:28am EDT
Assisted by a deep-learning algorithm, physicians were able to more accurately diagnose diabetic retinopathy—a potentially blinding eye disease—than either a clinician or algorithm alone.
That’s the finding of a new study from the Google AI research group, which will be published in the April edition of Ophthalmology, the journal of the American Academy of Ophthalmology.
In the study, 10 ophthalmologists—five general ophthalmologists, four retina specialists and one retina fellow—read images for diabetic retinopathy severity based on a severity scale in each of three conditions—unassisted, grades only and grades plus heatmap. In total, the study’s participants utilized 1,796 retinal fundus images from 1,612 diabetic patients.
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Attorney warns HHS is likely to get tougher on data security

Published March 19 2019, 5:36pm EDT
Much of the nation’s healthcare stakeholders aren’t doing enough to take cybersecurity measures necessary to mitigate cyber threats.
The lack of sufficient action is despite continuing assaults from hackers and mounting regulatory actions by the HHS Office for Civil Rights, which enforces the laws on data protection.
OCR regulators want to see more effort to secure data; they want to see adequate cyber technology, processes and additional appropriate controls by providers and insurers, says attorney Laura Hammargren, a partner in the Mayer Brown law firm in Washington.
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Why The Promise Of Electronic Health Records Has Gone Unfulfilled

March 18, 20193:15 PM ET
The reality of electronic medical records has yet to live up to the promise.
A decade ago, the U.S. government claimed that ditching paper medical charts for electronic records would make health care better, safer and cheaper.
Ten years and $36 billion later, the digital revolution has gone awry, an investigation by Kaiser Health News and Fortune magazine has found.
Veteran reporters Fred Schulte of KHN and Erika Fry of Fortune spent months digging into what has happened as a result. (You can read the cover story here.)
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Involve Docs in Using Health Data, Expert Tells Health Insurers

By MedPage Today  |   March 15, 2019

The reams of data on patient healthcare won't do any good if it's not given to clinicians to act on it.

KEY TAKEAWAYS

·         Big technology companies are investing in healthcare, but so far without much effect.
·         Much of the innovation is coming from small companies with tangible, practical solutions.
·         Investing in social determinants of health, such as housing and transporation, is another potentially big area.
This article was first published on Thursday, March 14 in MedPage Today.
By Joyce Frieden, News Editor, MedPage Today
WASHINGTON -- All the healthcare data being collected on patients won't do any good unless it's funneled to doctors and other clinicians who can act on it, Dan Mendelson, founder of consulting firm Avalere Health, told health insurance executives gathered here.
"We have the [patient] data; we can look at cohorts, do predictive analytics ... to predict where patients are likely to get in trouble and how to engage [them] in a cost-effective way," Mendelson said Wednesday at a health policy conference sponsored by America's Health Insurance Plans. "But it's not enough to have the information; you have to have a connection to physicians who are actually touching the patients ... That targeted intervention is really necessary to reap the benefits of the data. Data without intervention is a science experiment."
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A Big Step Toward Giving Patients Control Over Their Health Care Data

March 15, 2019
The seeds of a consumer-driven health care revolution, one that could turn the U.S. health care system on its head, were sown in early March. This potential disruption comes from an unlikely source: two proposed rules from the Department of Health and Human Services that could have consumers and America’s biggest tech firms joining forces.
The rules, from the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS) are both focused on allowing consumers free and easy access to their health data and letting them opt to share that data with big tech or whomever else they chose.
The ONC rule would require that health care providers and vendors of electronic health record (EHR) vendors make patients’ health data easily and cheaply available to them electronically. This implements provisions of the 2016 21st Century Cures Act that requires providers and vendors to adopt so-called open application program interfaces. APIs allow different programs to talk to each other. Open APIs will make it easy for consumers — acting through authorized third parties — to gain direct access to their EHRs and their personal clinical data. Think of APIs as tunnels into the clinical data warehouses that have been created by EHRs. Think of third parties as new and existing IT powerhouses — including the likes of Apple, Amazon, and Google — that have been authorized by patients to act as data stewards on their behalf.
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Silver Tsunami is coming to healthcare: Time to prepare

The aging population is not only poised to swell but Baby Boomers are bringing tech chops and consumerism-era demands that health systems will be smart to embrace.
March 15, 2019 09:17 AM
The Silver Tsunami is already rolling in and projections from the U.S. Census Bureau point to 2030 as a milestone year in which older people will actually outnumber children for the first time in history.
Census Bureau data also estimates that one in every five Americans will be retirement age by that year. And beyond that, come 2035 some 78 million people will be over 65, while 76.7 million will be 18 or younger.
That means it’s imperative for healthcare organizations, from solo practitioners to big practices, hospitals, health systems and insurance companies to start preparing now for what will inevitably be a transformative demographic shift.
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HHS Comes Up Short in Web Application, Network Security, says OIG

Eight HHS operating divisions were tested for web application and network security and found wanting, according to a recently released OIG report.

March 13, 2019 - Eight HHS operating divisions were tested for web application and network security and found wanting, according to a recently released OIG report.
The HHS divisions came up short in configuration management, access control, data input controls, and software patching.
To identify the vulnerabilities, OIG contracted with Defense Point Security to conduct penetration testing during FY 2016 and FY 2017.
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Industry Voices—The latest tips to secure your organization against ransomware

Mar 18, 2019 5:18pm
Data security is now one of the top aspects of healthcare technology. It can make or break patient satisfaction and institutional reputation. Healthcare providers have a professional obligation not only to care for their patients’ health but also to protect their patients’ data.
Cybercrime is on the rise against the sector because healthcare providers are often seen as easy targets with valuable information and insufficient security to protect it.
While several endpoint security tools can reduce data risk through detection and response methods, the most effective measures should be taken on the front line where staff members handle devices and sensitive information. Implementing a few simple best practices can significantly reduce risk.
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Apple Watch can detect irregular heart rate, but more research needed—Stanford study

Mar 18, 2019 9:33am
For 8 of 10 Apple Watch wearers, the device could potentially spot a heart problem that might lead to stroke, according to a new study out of Stanford Medicine.
The Stanford Medicine Apple Heart Study, based on 400,000 participants, found that the Apple Watch detected irregular heart rhythms in about 2,000 participants and 84% of wearers who received irregular heartbeat notifications were in atrial fibrillation.
Stanford Medicine researchers presented the findings from the large-scale, Apple-funded study at the American College of Cardiology’s 68th Annual Scientific Session and Expo in New Orleans over the weekend and touted the results as showing the potential role for consumer wearable devices to provide an early warning for life-threatening health conditions.
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Hospital work environment impacts how nurses perceive EHRs

Published March 18 2019, 7:30am EDT
Data gathered from more than 12,000 nurses at 353 hospitals in four states reveal that those working in less favorable healthcare environments are dissatisfied with their electronic health record systems.
Penn Nursing’s Center for Health Outcomes & Policy Research (CHOPR) assessed nurse satisfaction with EHR systems and the concurrent effects of EHR adoption level and the hospital work environment on usability and quality outcomes.
What CHOPR found was that 25 percent of nurses reported dissatisfaction with their current EHRs while similarly high percentages reported usability issues. In addition, more than half of the nurses reported that EHRs interfered with patient care, while nearly one-third indicated that the systems did not help them to do their work efficiently.
The first-of-its-kind study, published in the journal Applied Clinical Informatics, was supported by the Agency for Healthcare Research and Quality and the National Institute of Nursing Research.
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eHealth Exchange selects InterSystems as it eyes expansion

Published March 18 2019, 7:33am EDT
The country’s largest nationwide health information network is pursuing expansion plans and is adopting a new technology platform to do it.
The eHealth Exchange will implement InterSystems’ HealthShare suite of connected health solutions to help develop initial enhancements to its network.
The Vienna, Va.-based network plans to accelerate network expansion and introduce new use cases, such as population-level exchange, push notifications, discrete data-level queries, prescription drug monitoring programs and more.
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HIT Think Why AI needs a reality check

Published March 18 2019, 5:16pm EDT
Visionary Elon Musk fears it. Astrophysicist Stephen Hawking worried about it. Microsoft’s Bill Gates embraces it. Science fiction writer Phillip K. Dick wrote about androids having the capacity to dream because of it. At HIMSS 2019, everyone talked about it.
So, what is artificial intelligence? According to Wikipedia, researchers Kaplan and Haenlein define AI as “a system’s ability to correctly interpret external data, to learn from such data and to use those learnings to achieve specific goals and tasks through flexible adaptation.”
Except for computer scientists immersed in AI research, most experts generally equate AI with machine learning and include natural language processing (NLP) as a tool used within AI research.
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Dozens Fired After Actor's Health Info Viewed, Reports Claim

Marcia Frellick
March 13, 2019
Dozens of employees at Northwestern Memorial Hospital in Chicago, Illinois, were reportedly fired last week, accused of violating the HIPAA (Health Insurance Portability and Accountability Act of 1996) by accessing the electronic health record (EHR) of former "Empire" actor Jussie Smollett, according to several news reports.
NBC Chicago reported that "at least 50" employees were fired, citing anonymous sources.
Northwestern Medicine told Medscape Medical News that it could not comment on the reports of firings, citing privacy reasons.
Smollett reported to Chicago police in January that attackers assaulted him and yelled racial and homophobic slurs. He was taken to the hospital. Police and prosecutors now allege the report was a hoax meant to generate publicity, and Smollett now faces multiple felony charges.
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Ochsner and Pfizer Constructing 'Digital Superhighway' for Clinical Trials

By Mandy Roth  |   March 18, 2019

The alliance employs FHIR to quickly transmit data from the EHR with the hope of enhancing access to experimental therapies for patients and clinicians.

Construction of a "digital superhighway" for clinical trials is underway at New Orleans-based Ochsner Health System using HL7's Fast Healthcare Interoperability Resources (FHIR)—possibly the first time this technological solution has been successfully employed to transmit such data from Electronic Health Records (EHR) via FHIR to a study sponsor, in this case, Pfizer Inc.
The first phase of the experiment, transfer of mock data, has been completed, laying the groundwork for faster and more effective data capture and transfer between organizations. Ultimately, this alliance between Ochsner and Pfizer aims to enhance clinician and patient access to experimental therapies.
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March 15, 2019

Assessment of a Deep Learning Model Based on Electronic Health Record Data to Forecast Clinical Outcomes in Patients With Rheumatoid Arthritis

Author Affiliations Article Information
JAMA Netw Open. 2019;2(3):e190606. doi:10.1001/jamanetworkopen.2019.0606
Question  How accurately can artificial intelligence models prognosticate future patient outcomes for a complex disease, such as rheumatoid arthritis?
Findings  In this prognostic study of 820 patients with rheumatoid arthritis, a longitudinal deep learning model had strong performance in a test cohort of 116 patients, whereas baselines that used each patient’s most recent disease activity score had statistically random performance.
Meaning  The findings suggest that building accurate models to forecast complex disease outcomes using electronic health records is possible.
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Death by a Thousand Clicks: Where Electronic Health Records Went Wrong

The U.S. government claimed that turning American medical charts into electronic records would make health care better, safer, and cheaper. Ten years and $36 billion later, the system is an unholy mess: Inside a digital revolution gone wrong. A joint investigation by Fortune and Kaiser Health News.
4:30 AM EDT
The pain radiated from the top of Annette Monachelli’s head, and it got worse when she changed positions. It didn’t feel like her usual migraine. The 47-year-old Vermont attorney turned innkeeper visited her local doctor at the Stowe Family Practice twice about the problem in late November 2012, but got little relief.
Two months later, Monachelli was dead of a brain aneurysm, a condition that, despite the symptoms and the appointments, had never been tested for or diagnosed until she turned up in the emergency room days before her death.
Monachelli’s husband sued Stowe, the federally qualified health center the physician worked for. Owen Foster, a newly hired assistant U.S. attorney with the District of Vermont, was assigned to defend the government. Though it looked to be a standard medical malpractice case, Foster was on the cusp of discovering something much bigger—what his boss, U.S. Attorney Christina Nolan, calls the “frontier of health care fraud”—and prosecuting a first-of-its-kind case that landed the largest-ever financial recovery in Vermont’s history.
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Weekly News Recap

  • Rutland Regional Medical Center (VT) experiences its second email-related breach
  • Australian imaging software vendor Mach7 fires its CEO and eliminates the CTO role as part of a restructuring and cost-cutting program that it hopes will propel its US growth
  • An investment analyst thinks Apple will expand the Watch’s medical sensors and then sell the data of wearers to their doctors for $10 per patient per month
  • Hill-Rom announces that it will acquire mobile clinical communications vendor Voalte for up to $195 million
  • An investigative report finds that medical device manufacturers have been able to hide widespread patient safety issues by using the FDA’s alternate summary reporting program
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Enjoy!
David.