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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Trusts set to miss Axe the Fax deadline due to ‘concerning lack of progress’
A new report looking into the number of fax machines still in use across the NHS in England has shown “a concerning lack of progress” amongst trusts working to remove the them ahead of the April 2020 deadline.
Owen Hughes
30 September, 2019
The report reveals that the trusts with the most fax machines have collectively axed just 42% over the past twelve months, with less than six months to go until the ‘axe the fax’ deadline.
The new findings come from a Freedom of Information (FOI) request published by Silver Buck, the marketing and PR agency responsible for running the Axe the Fax campaign.
The FOI also found that trusts that had identified a solution for replacing their fax machines had, on average, removed 9.4% more fax machines than those that hadn’t.
This latest FOI request follows that published by the Royal College of Surgeons (RCS) July 2018, which revealed that the NHS was the world’s largest purchaser of fax machines with nearly 9,000 in use across the healthcare system.
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FBI issues alert warning of potential 'high-impact' ransomware attacks
By Maggie Miller - 10/03/19 03:23 PM EDT 27
The FBI on Wednesday warned U.S. businesses and organizations of the increasing threat posed by ransomware cyberattacks, following several high-profile attacks on government offices and other public entities.
The agency said the attacks, which involve encrypting a computer before demanding money in return for unlocking it, are “becoming more targeted, sophisticated, and costly.”
“Since early 2018, the incidence of broad, indiscriminate ransomware campaigns has sharply declined, but the losses from ransomware attacks have increased significantly,” the FBI wrote.
The agency has issued similar warnings of malicious actors trying to hack into websites seen as more "secure" and have warned of business email compromises, but this was the first in 2019 highlighting ransomware attacks.
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Trump Pushes Telehealth, mHealth Adoption in Medicare Executive Order
President Trump's Executive Order on Medicare includes directives to increase telehealth adoption in Medicare Advantage plans and improve the process for permitting and covering new mHealth tools and services.
October 04, 2019 - President Donald Trump is ordering Medicare to adopt more telehealth programs and pave the way for new technologies, including mHealth tools and services.
In a scheduled visit to a Florida retirement community on Thursday, the President signed an Executive Order that, among other things, aims to give the Centers for Medicare & Medicaid Services more leeway to use connected health services, particularly in Medicare Advantage programs.
Specifically, the order calls on the Secretary of Health and Human Services to, within a year, “propose a regulation to provide beneficiaries with improved access to providers and plans by adjusting network adequacy requirements for MA plans to account for … “the enhanced access to health outcomes made possible through telehealth services or other innovative technologies.”
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Health plans need to better use tech to simplify quality initiatives
October 04, 2019, 3:41 p.m. EDT
Value-based care depends on measuring and reporting outcomes, but doing so is causing burnout in physicians.
That additional challenge for physicians comes despite widespread efforts to reduce this burden, according to a new survey of 23 health plans conducted by Harrisburg, Penn.-based Geneia, an analytic solutions and services company.
Part of the problem lies in the fact that there are more than 500 provider quality measures—with little overlap between the measures that insurers need or the 1,700 measures used by government agencies, Geneia says.
“It is no surprise that 86 percent of physicians cite the ‘heightened demand for data reporting to support quality measures’ as a top driver of physician burnout, and view multiple and duplicative quality measures as one of the main barriers to accepting downside risk and moving into value-based care arrangements,” authors of the study say.
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Use of e-prescribing for controlled substances is low, but rising
October 03, 2019, 11:17 p.m. EDT
While the usage rate of electronic prescribing for controlled substances by clinicians is low, adoption of the technology is growing, according to the Office of the National Coordinator for Health IT.
A new ONC data brief, based on results from the 2017 National Electronic Health Records Survey, reveals that 32 percent of office-based physicians that prescribed controlled substances did so electronically.
“New data show that use of EPCS technology is on the rise, but varies across clinician characteristics,” write ONC’s Chief Clinical Officer Andrew Gettinger, MD, and Chief Medical Officer Thomas Mason, MD, in an October 3 blog post. “Understanding differences in clinicians’ use of EPCS technology is critical to identifying ways to address barriers to use such as costs and security requirements.”
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Allscripts Partners With Northwell Health To Build New Voice-Enabled, AI-Based EHR
October 4, 2019
Allscripts has struck a deal to collaboratively design, test and release an AI-based, voice-enabled EHR with New York state’s largest health system. The vendor will be collecting input from clinicians, IT experts and administrators with partner Northwell Health, which expects to deploy the newly-developed platform systemwide.
Northwell’s system includes a total of 23 hospitals and about 750 outpatient facilities with more than 13,600 affiliated physicians. It also incorporates a medical school, graduate nursing school, and physician assistant program.
During the development process, Northwell will continue to use the Allscripts Sunrise EHR platform, which is already in use at Northwell’s 19 hospitals, which it has had in place since 2009 for use in both inpatient and outpatient care.
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Getting Patients To Engage With Their Healthcare Data Is Still A Challenge
October 4, 2019
I haven’t always been familiar with my healthcare records. In fact, until a few years ago, I couldn’t have told you anything about their contents, and in fact, didn’t give it a second thought.
More recently, though, I’ve developed an intense interest in my healthcare data, as I struggle to keep up with the handful of chronic conditions I manage. These days, I can cite you chapter and verse as to how my key health metrics are trending, whether the current trend represents a change and how it correlates with my day-to-day health status. I’ve actually become something of a health data nerd.
The truth, though, is that at least in the circles in which I travel, my interest in such things is still pretty unusual, even among those with chronic conditions. My sense is that for those who work outside of healthcare, aside from perhaps a small group of wearables power users, getting that granular wouldn’t be worth the effort. In fact, I believe that starting from the assumption that consumers generally want to see their records is a mistake. Worth noting is that all patients should have access to their health record (It’s their right and people like me will access it), but we also shouldn’t just assume that by making the record available a wave of patients will start accessing the record.
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Cybersecurity: Ransomware attacks shut down clinics, hospitals
October 4, 2019
Andis Robeznieks
Senior News Writer
American Medical Association
What’s the news: October is National Cybersecurity Awareness Month and it arrives not a moment too soon. Ransomware attacks across all industries grew by 118% in the first quarter of the year, according to the August 2019 McAfee Labs Threat Report, and recent news reports reveal that health care-related computer systems are becoming an increasingly popular target for cyber criminals.
The threat is global in scope. Recent victims include the DCH Regional Health System, a three-hospital public safety-net provider based in Tuscaloosa, Alabama, and two large health systems in southwest Australia.
Why it matters for patients and physicians: Cybersecurity is not just a technical issue; it’s a patient safety issue. AMA research has revealed that 83% of physicians work in a practice that has experienced some kind of cyberattack. Unfortunately, practices are learning that cyberattacks not only threaten the privacy and security of patients’ health and financial information, but also patient access to care.
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Novartis, Microsoft collab to ‘transform medicine’ with AI
2nd October 2019
By Anna Smith
Novartis and Microsoft have announced a new collaboration in order to “transform medicine with artificial intelligence.”
Novartis announced the “important step in reimagining medicine” by founding the Novartis AI innovation lab, choosing Microsoft as its strategic AI and data-science partner.
The company says that the new lab aims to bolster Novartis AI capabilities from research through commercialisation and help accelerate the discovery and development of transformative medicines for patients worldwide.
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Data standards may be wonky, but they will transform health care
By and
October 3, 2019
A story with enormous implications for the health of all Americans is likely flying below their radar and that of their physicians. In a nutshell, it’s this: A proposed rule that sets data standards will make electronic health information more accessible to patients and doctors through smartphone-style apps and will transform health care.
Most Americans are familiar with this scenario: During the “conversation” parts of a medical appointment, the doctor faces a computer screen and types information into an electronic medical record system. Such systems store data on hundreds of millions of Americans.
Yet even with all of this data entry going on, it is a struggle for patients to get copies of their records, and an even bigger one to get them in useful, digital formats. Even more alarming, despite the vast amount of data collected by electronic medical record systems, little of it is used to help clinicians make decisions about their patients’ care. That’s unacceptable.
Each of us should reasonably expect that health systems invest as much into providing clinicians with insights to make the right diagnosis or choose the right treatment as they currently invest in determining the right ad to display on a webpage. Although that hasn’t been the case so far, there’s now an opportunity to take a quantum leap to meet that expectation.
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MEDITECH and Google Cloud Partner to Bring EHRs to the Cloud
Google Cloud is teaming up with MEDITECH to get EHRs on the public cloud platform and develop applications.
October 02, 2019 - MEDITECH is collaborating with Google Cloud to offer EHRs through the Google Cloud Platform, which will deliver greater access to patient data, facilitate interoperability, and enhance scalability.
“This is the future of healthcare,” said MEDITECH CEO Howard Messing.
“We’ve been retooling MEDITECH for the new healthcare paradigm, reshaping our company to meet the needs of today’s market and today’s customers,” continued Messing. “It began with Expanse, one of the first web-based solutions, released as one of the first full-scale platforms of the post-Meaningful Use era. Now, this collaboration with Google Cloud and our commitment to the public cloud further expands the productivity and agility of our customers.”
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EHR mortality prediction model boosts palliative care consults
October 02, 2019, 11:59 p.m. EDT
Powered by predictive analytics, an electronic health record mortality prediction model was able to increase palliative care consultations for hospitalized patients by 74 percent.
That’s the finding of a study, conducted by researchers at the University of Pennsylvania’s Perelman School of Medicine, published in the Journal of General Internal Medicine.
In addition, patients in the study at an urban academic medical center were seen by palliative care earlier in their hospital stay—an average of a day and a half sooner.
“Targeting hospital-based palliative care using an EHR mortality prediction model is a clinically promising approach to improve the quality of care among seriously ill medical patients,” concludes the study. “More evidence is needed to determine the generalizability of this approach and its impact on patient- and caregiver-reported outcomes.”
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The real cybersecurity risk sits between the chair and keyboard
Cybersecurity is at least as much about behaviour as it is about technology.
October 03, 2019 06:51 AM
A recent survey on healthcare cybersecurity that PwC performed in Germany chose an interesting approach. Usually this type of survey is directed at hospital CEOs or at healthcare IT professionals. But this time, PwC decided to ask the public. One thousand people were polled, and nearly one in three said that, in the case of a hospital visit, they would be deeply worried that IT systems might break down as a result of a cyberattack. Every second German said they were convinced that hospitals are unprepared for cyberattacks.
Two out of three want mandatory cybersecurity education for medical staff
These figures are high but not totally surprising. More remarkable was the “risk analysis” of the survey participants. When asked about the type of measures that might improve data security in hospitals, what came out first was neither penetration tests, nor surveillance, nor introducing a standardised security concept. All this was mentioned, for sure, but what appeared at the top of the list with a staggering 87% of participants mentioning it was better education of staff.
In fact, 67% of Germans said that hospitals should be forced by law to train their staff on cybersecurity and proper behaviour. Citizens, it seems, are acutely aware of where healthcare-related cybersecurity risks lie. Technology is an issue, but more important is the risk factor ‘between the chair and the keyboard’, in other words the professional user.
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https://www.healthcareitnews.com/news/californias-sutter-health-reaps-rewards-investments-innovation
California's Sutter Health reaps rewards from investments in innovation
Seven administrative and clinical executives from across the health system discuss efforts from an electronic ICU to an AI symptom checker to ‘smart hospital’ tech.
By Bill Siwicki
October 03, 2019 12:19 PM
Sutter Health, a health system based in Sacramento, California, has made innovation a part of its mission. It’s made investments in many different technologies, research projects and medical advancements to improve the patient experience and patient outcomes.
From patient safety technology to a virtual symptom checker and more, here is a closer look at Sutter Health’s efforts to innovate, based on Healthcare IT News interviews with executives from throughout the health system and an infographic from Sutter.
The integrated delivery network model
Integrated networks such as Sutter Health foster a more user-friendly healthcare system, promote patient-centered care and drive healthier outcomes by coordinating medical and support services between caregivers, leaders there said. This integration allows doctors and hospitals to share innovations and work together to ensure patients get the care they need when they need it so that they can benefit from faster recovery and reduced costs.
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AI Chest X-Ray Reads Approved by FDA
October 3, 2019
A couple weeks ago, we got the exciting news that the FDA had approved an artificial intelligence (AI) algorithm that does reads on images from a portable X-ray in order to screen for collapsed lung. The teams at GE Healthcare and UC San Francisco are behind this technology and research.
This is really exciting news because I believe it’s the first time the FDA has approved an AI algorithm for this type of radiology read. No doubt this is the first of many and shows the promise of what’s going to be possible when it comes to technology reading images.
Many large organizations may look at this and wonder why it’s such a big thing since they have a radiologist and radiology equipment available to do these reads and avoid adverse outcomes. While this is true at many large organizations, it’s not true for many resource limited care settings including late at night when the radiology staff might be sleeping.
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Physician Satisfaction with Electronic Health Records – the Data Might Surprise You – Part 1
October 3, 2019
What factors predict physician satisfaction with clinical systems? As healthcare organizations select an EHR, they contemplate the best vendor, the breadth of functionality, integration across other applications, initial investment and maintenance costs, resources required to support the systems, and many other factors. While these factors have some influence on the adoption of an Electronic Health Record (EHR), none of them even make the “top 4” predictors of physician satisfaction.
Two independent research efforts have led to a better understanding of the most important variables in predicting long term satisfaction with EHRs. The Breakaway Group (now Atos) conducted several research studies that identified the factors that predict clinical systems adoption and overall satisfaction with the technology after implementation. They were able to compare many factors that impact EHR adoption across organizations at various levels of use and satisfaction. The outcomes from that research are published in a book titled Beyond Implementation: A Prescription for the Adoption of Health Information Technology.
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7 Highlights from InterSystems Global Summit 2019
October 3, 2019
The InterSystems Global Summit provides developers and executives the knowledge they need to empower their businesses with data. The future of healthcare data will be led by companies and systems that are organized now. InterSystems Global Summit 2019, hosted in Boston this past month, was a great opportunity to better understand how to refine and perfect healthcare data, as well as meet with experts in creating a high-value healthcare system. For the uninitiated, Global Summit plays a valuable part in cultivating leadership in data science and the future of healthcare data.
If you didn’t make it to Global Summit this year, it is a valuable time to improve your healthcare data future, and you should consider attending in 2020. If you didn’t get to go to any of the developer sessions or meetups, make sure you attend one next year as Global Summit will be held in Seattle. You can watch the video about it HERE.
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Medical device surveillance with electronic health records
npj Digital Medicine volume 2, Article number: 94 (2019)
Abstract
Post-market medical device surveillance is a challenge facing manufacturers, regulatory agencies, and health care providers. Electronic health records are valuable sources of real-world evidence for assessing device safety and tracking device-related patient outcomes over time. However, distilling this evidence remains challenging, as information is fractured across clinical notes and structured records. Modern machine learning methods for machine reading promise to unlock increasingly complex information from text, but face barriers due to their reliance on large and expensive hand-labeled training sets. To address these challenges, we developed and validated state-of-the-art deep learning methods that identify patient outcomes from clinical notes without requiring hand-labeled training data. Using hip replacements—one of the most common implantable devices—as a test case, our methods accurately extracted implant details and reports of complications and pain from electronic health records with up to 96.3% precision, 98.5% recall, and 97.4% F1, improved classification performance by 12.8–53.9% over rule-based methods, and detected over six times as many complication events compared to using structured data alone. Using these additional events to assess complication-free survivorship of different implant systems, we found significant variation between implants, including for risk of revision surgery, which could not be detected using coded data alone. Patients with revision surgeries had more hip pain mentions in the post-hip replacement, pre-revision period compared to patients with no evidence of revision surgery (mean hip pain mentions 4.97 vs. 3.23; t = 5.14; p < 0.001). Some implant models were associated with higher or lower rates of hip pain mentions. Our methods complement existing surveillance mechanisms by requiring orders of magnitude less hand-labeled training data, offering a scalable solution for national medical device surveillance using electronic health records.
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Industry Voices—During natural disasters, HIEs on the front lines of addressing fragmentation in healthcare
Oct 1, 2019 8:05am
In the middle of California’s fire season, it’s hard not to think about the role healthcare organizations can and must play when it comes to providing and coordinating care for patients during a natural disaster. These events will become more frequent and intense as the impacts of climate change increase.
Natural disasters like the fires emerging here in California serve as a strong reminder of how complex and fragmented our healthcare system is not only in times of disaster but in everyday life, too—especially for those who are most vulnerable.
These disasters shine a spotlight on the importance and value of being able to access patient records—including both clinical and claims data—in real time. And these disasters highlight the role health information exchanges (HIEs) can and must play in connecting all facets of care, from first responders to clinicians to patients and families in search of their loved ones.
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Top EU court rules websites must seek explicit consent for personal data
Laws are moving to rein in tech companies’ activities.
By Mark Scott
Updated 10/1/19, 5:26 PM CET
Europe’s highest court is not satisfied with a pre-ticked box.
On Tuesday, judges at the Court of Justice of the European Union (CJEU) ruled that websites must obtain explicit consent from users in order to collect their personal data.
In their decision, the judges ruled it is not enough to flash a pre-ticked box in front of people to have them consent for their digital information to be collected. Instead, websites must ask users to actively opt in to sharing their data.
The ruling from the Luxembourg-based court dealt a blow to search engines, social media platforms and other websites that rely heavily on such boxes to obtain consent with minimal input from people across the 28-country bloc.
The ruling, which will apply across the European Union, originated in Germany where a group of consumer organizations filed a lawsuit against Planet 49, a local website that hosted an online lottery.
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HIT Think
How to balance EHR productivity requirements with training
October 02, 2019, 3:41 p.m. EDT
When I became a physician over 25 years ago, I learned to chart on paper. I scribbled down medications on prescription pads, never knowing whether they were filled. I made phone calls asking for charts to be faxed and jotted reminders on sticky notes for nurses to call patients back with their lab results.
Nurses had to try to understand my handwriting, which I have been assured by many—from my third grade teacher to my colleagues today—is the world’s worst. It definitely wasn't good for efficiency or ideal for patient safety.
Electronic health records have changed all of that. I know that the prescriptions I write match the medications given to patients by the pharmacy. I have instant access to patient records when I need them. Lab results are sent automatically to patients, and nurses can easily read what I write in my orders without a collaborative translation session.
Most importantly, the digitization of medicine has improved care and outcomes for patients. Doctors and patients are automatically reminded about preventive care and can act on reminders right away, so rates of vaccinations, mammograms and colonoscopies have all gone up.
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Totality of data compromised shows the true impact of a breach
October 02, 2019, 3:50 p.m. EDT
Data breaches frequently occur in healthcare, and when these breaches become public, there’s always a tally on the number of affected patients.
In a new report published in the Annals of Internal Medicine, John Jiang of Michigan State University, and Ge Bai, from the Johns Hopkins Bloomberg School of Public Health, say follow the compromised data, not the patients. That’s because more than 70 percent of breached information is ripe for stealing to commit identity or financial fraud.
“The reporting requirements, academic research and public attention regarding consequences of protected health information breaches are primarily focused on the number of affected patients rather than the types of compromised PHI, limiting the potential to manage the risk for breach effectively,” the researchers contend.
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Groups release statement on ethical use of AI in radiology
October 01, 2019, 11:44 p.m. EDT
Artificial intelligence has tremendous potential for increasing the efficiency and accuracy of radiology. However, the technology also has “inherent pitfalls and biases” that must be addressed.
That’s the contention of the American College of Radiology, European Society of Radiology, Radiological Society of North America, Society for Imaging Informatics in Medicine, European Society of Medical Imaging Informatics, Canadian Association of Radiologists and American Association of Physicists in Medicine—all of which jointly published a statement on the ethical use of AI in radiology.
“Widespread use of AI-based intelligent and autonomous systems in radiology can increase the risk of systemic errors with high consequence and highlights complex ethical and societal issues,” according to the international multi-society statement. “The radiology community should start now to develop codes of ethics and practice for AI that promote any use that helps patients and the common good and should block use of radiology data and algorithms for financial gain without those two attributes.”
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The long view of pharma and digital health
At the HIMSS Connected Health Conference, Bob Coughlin, president and CEO of Mass Biotech Council, offers his expert view of how these two areas of healthcare will impact each other in the future.
By Bill Siwicki
October 02, 2019 01:43 PM
Digital health tools are shifting the paradigm for companies developing new therapeutics or medical devices, from early-stage innovation through the entire lifecycle of a product – with potential to make innovation more efficient, extend business lines and enhance provider and patient relationships.
Bob Coughlin, president and CEO of Mass Biotech Council, will be speaking on this subject and the long view of pharma and digital on October 16 at the HIMSS Connected Health Conference.
Integration of digital health into the life sciences
The first trend Coughlin identifies when it comes to the long view of pharma and digital is better tracking of patient outcomes to demonstrate the long-term value of therapies.
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URGENT/11: FDA issues alert for cyber vulnerability that threatens medical devices, networks
If exploited by a remote attacker, the set of vulnerabilities could pose safety and security risks for connected medical devices and hospital networks.
By Mike Miliard
October 02, 2019 12:42 PM
The U.S. Food and Drug Administration issued a safety communication on Tuesday – aimed at healthcare organizations, IT professionals, device manufacturers and patients – warning of the cybersecurity vulnerabilities known as URGENT/11.
WHY IT MATTERS
The risk, said FDA officials in the communication, is that URGENT/11, if exploited by a remote attacker, could pose safety and security risks for connected medical devices and hospital networks.
The risk, said FDA officials in the communication, is that URGENT/11, if exploited by a remote attacker, could pose safety and security risks for connected medical devices and hospital networks.
The URGENT/11 vulnerabilities center around a third-party software, IPnet, that computers use to communicate with each other over a network. They affect at least six different operating systems and could impact connected equipment such as routers, connected devices or other critical infrastructure.
"Security researchers, manufacturers and the FDA are aware that the following operating systems are affected, but the vulnerability may not be included in all versions of these operating systems," the FDA said, listing the operating systems:
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The Bigger the Better: Getting Data for Health Care Analytics at Wolters Kluwer
October 2, 2019
News comes over the transom on a daily basis about Johns Hopkins or the Mayo Clinic or some other health care institution using modern analytics and machine learning. But a basic tenet of machine learning holds that you need lots and lots of data to derive valid and trustworthy insights. Health care institutions rarely have data at the scale enjoyed by Google, major social media sites, or even large retailers. And this is where Wolters Kluwer Health has a leg up on other institutions: after decades in the health care field, with numerous acquisitions and partnerships, they’ve accumulated a set of patient data that they boast is even bigger than the anonymized sets released by Medicare (as well as more diverse, because it is not limited by age or nationality).
To be fair, even with small amounts of data, some providers cite impressive results. This past August, as just one example, I reported on a small chain that found ways to save money by analyzing their own patient base–although I noticed that the chain was using the data to confirm what they already knew through conventional observation. The data available to a single chain has limited uses, and–as pointed out by John T. Langton, Director of Data Science at Wolters Kluwer–it isn’t generalizable to other institutions. Each institution has to start over, deriving what insights it can from its unique set of patients.
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California Provider to Close After Ransomware Attack Damages System
Wood Ranch Medical reported ransomware recently encrypted its systems and backups, which the provider was unable to recover; Campbell County continues its recovery and another ransomware incident complete this week’s breach roundup.
September 30, 2019 - California-based Wood Ranch Medical will permanently close its doors, after the provider was unable to recover its patient records that were encrypted by ransomware this summer.
In August, the servers containing the electronic health records of WRM were infected with ransomware. All patient data was encrypted, including the backup hard drives. The damage to the computer system was severe enough that data recovery was not an option.
As a result, officials said it would be impossible to rebuild its medical records. WRM will close its practice and cease operations on December 17, 2019.
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FDA and DEA Jointly Warn Illegal Online Opioid Networks
Posted 30 September 2019 | By Zachary Brennan
In a first for the US Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA), the agencies came together to warn four online networks operating 10 websites that illegally market unapproved and misbranded versions of opioids.
FDA notes that the illegal online pharmacies may put people at risk because there is no guarantee that the medicines are safe and because several of these websites sell opioids online without a prescription.
In the warning letters, dated 6 September, the agencies cited companies for selling unapproved versions of tramadol, marketed as “Top-Tram” or “Tramadol (Ultram) 100 mg” or “Tramadol 200mg Tablets,” and another opioid known as tapentadol, among others.
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FDA notes that the illegal online pharmacies may put people at risk because there is no guarantee that the medicines are safe and because several of these websites sell opioids online without a prescription.
In the warning letters, dated 6 September, the agencies cited companies for selling unapproved versions of tramadol, marketed as “Top-Tram” or “Tramadol (Ultram) 100 mg” or “Tramadol 200mg Tablets,” and another opioid known as tapentadol, among others.
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Patient record retention: Tips for compliance and protection
September 26, 2019
Sometimes, electronic health record (EHR) systems fail to live up to their full potential as tools to assist with patient care. The same can be said for their promise to ease patient record storage, retention and retrieval.
Although electronic records are easier than paper to store and search, they still present an array of technical, legal and regulatory issues. Consultants and attorneys say that working through these issues proactively can alleviate records-related headaches, especially during practice transitions, such as a change in ownership or EHR vendor.
When developing a records retention policy, one of the first hurdles practices may encounter is that retention laws vary from state to state. Many state medical societies have thorough online guidelines explaining state laws about medical record ownership and retention, such as this one from the Michigan State Medical Society.
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HIT Think
How HIPAA enforcement can help direct security best practices
October 01, 2019, 3:52 p.m. EDT
How is HIPAA enforced? That may be a simple enough question, but it also contains more nuance than may initially be expected.
The answer is important because determining how HIPAA is enforced can depend upon how the term enforcement is viewed and interpreted.
The first step is to define enforcement. The dictionary definition of enforcement includes the following statements: To give force to; to urge with energy; constrain or compel; to effect or gain by force; and to carry out effectively. Looking at the definition comprehensively, enforcement is a means of compelling compliance with a concept or requiring another to follow a particular thing (in this case law and regulations). Enforcement by its nature is arguably imposing a non-voluntary action or requirement onto a person through some outside force.
Given the broad definition and impact of enforcement as a concept, how does that apply to HIPAA? For HIPAA, enforcement looks at how a person (defining a person to be an actual individual, an organization or any other entity) is forced into acting consistently with the dictates of the HIPAA statute and implementing regulations. As with the definition, means of enforcement in practice can and are quite varied.
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https://www.healthdatamanagement.com/news/fda-releases-separate-guidance-on-cds-and-medical-software
FDA releases separate guidance on CDS and medical software
October 01, 2019, 12:52 a.m. EDT
The Food and Drug Administration has issued revised draft guidance on the categories of clinical decision support software subject to FDA oversight.
The agency has issued the guidance in response to requirements of the 21st Century Cures Act, and it’s also put forth final guidance on the kinds of software no longer considered medical devices under the law.
The draft clinical decision support (CDS) guidance, based on public comments received on the previous draft published in 2017, is meant to provide clarity on the scope of the FDA’s regulation of software intended for healthcare professionals and patients.
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Health system uses Epic EHR, communications tech to reduce sepsis mortality rate by 20%
Epic calculates vital signs and triggers alerts sent to caregivers by the communications platform. The sepsis program saves 40 lives a year at University of Utah Health.
By Bill Siwicki
October 01, 2019 01:02 PM
University of Utah Health is the Mountain West’s only academic health system, combining care, research and teaching. The health system frequently is ranked among U.S. News & World Report’s Best Hospitals.
THE PROBLEM
In the U.S., sepsis is the most common cause of death among critically ill patients in noncoronary intensive care units – and the most expensive condition treated at U.S. hospitals, costing $24 billion annually. Consequently, identifying and responding to sepsis is a priority for virtually every organization.
Sepsis is a challenge for many hospitals, and it is the most expensive inpatient condition to treat in part because decompensation can happen quickly and it can be difficult to detect, said Dr. Devin Horton, a hospitalist and assistant professor in the division of internal medicine at the University of Utah Health.
“The primary problem we had was that we had the information that showed decompensation – that is, worsening vital signs – but sometimes those became stuck in the black hole of our HER, from Epic,” he said. “The information was not getting to a person who could act on it in real time.”
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Virtual Sitters Can Improve Patient Safety and Reduce Unbudgeted Hospital Costs
October 1, 2019
The following is a guest article by Wendy Deibert, EMBA, BSN, RN, VP Clinical Solutions at Caregility.
A common practice in hospitals today is the use of patient sitters, also called “specialling”, in which non-clinical staff is assigned on a one-to-one basis to provide in-room monitoring of patients at high risk for falls, self-harm, or other types of perilous events. Patient types often include those with neurological conditions or injuries, those who are agitated from substance abuse withdrawal, and those in mental distress who may be at risk of suicide. This layer of observation can bolster patient safety and prevent costly in-hospital injuries. The Agency for Healthcare Research and Quality estimates that 700,000 to 1 million hospitalized patients fall each year, with more than one-third resulting in serious injury.
Sitters are trained to respond to patient needs by following specific hospital protocols. A sitter might verbally respond to a disoriented patient, answering questions and providing reassurance. A fall-risk patient attempting to get out of bed would be redirected by a sitter, who may also alert nursing staff if necessary. The goal is twofold — keep patients safe and free up nursing staff to tend to more demanding and specialized clinical duties.
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Older Americans Wary of Telemedicine
By John Commins | October 01, 2019
In a new poll, most adults ages 50-80 expressed concerns about the quality of care that comes with remote provider visits.
KEY TAKEAWAYS
· More than 70% of the respondents voiced concerns that providers couldn't do a physical exam over a webcam or smartphone camera.
· Another 68% suggested that remote care wouldn't be as good as in-office visits.
· Among the 4% of respondents who had used telehealth within the past year, 58% said office visits offered better care quality, and 48% were concerned about privacy.
Older adults and seniors are not exactly embracing telemedicine, but that doesn't mean they're unwilling to try it, a new survey shows.
A survey of 2,250 adults aged 50 to 80 conducted by the National Poll on Healthy Aging found that only 4% of respondents had had a video-based telehealth visit with a provider via smartphone or computer in the past year.
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DOJ arrests 35 in $2.1B Medicare scam targeting seniors for fraudulent genetic testing
Sep 30, 2019 7:45am
The Department of Justice (DOJ) has taken down what it calls one of the largest healthcare fraud schemes, charging 35 people with unlawfully charging Medicare $2.1 billion.
According to the DOJ, the scheme represents the next big frontier in healthcare fraud: genetic cancer testing.
The DOJ charged nearly three dozen people in five federal districts associated with dozens of telemedicine companies and cancer genetic testing laboratories. According to the charges, these defendants fraudulently billed Medicare more than $2.1 billion for cancer genetic tests. Among those charged are 10 medical professionals, including nine doctors, the DOJ announced in a press release Friday.
The alleged scheme involves the payment of illegal kickbacks and bribes by cancer genetic testing laboratories in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for expensive cancer genetic tests that were medically unnecessary, federal officials said.
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FDA delivers regulatory guidance on AI software and clinical decision-making aids
by Conor Hale
Sep 26, 2019 1:01pm
A package of new guidance documents from the FDA describes what and how the agency plans to regulate as software designed to aid clinical decision-making—such as programs that provide documentation and diagnostic support or that call up medically relevant reference information and recommendations based on patient’s particular case.
The guidances also include updated, finalized policies for the regulation of smartphone-based medical apps, as well as manufacturers’ use of so-called “off-the-shelf” commercial software in medical devices.
The FDA defines software for clinical decision support, or CDS, as tech that can provide doctors, patients or caregivers “with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care.”
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Many organizations are careless with sensitive paper documents. It's increasing the risk of data breaches
Sep 30, 2019 12:01am
It doesn't take the stealth of a cyberattacker to cause a healthcare data breach. Typical workplace occurrences like leaving a sensitive document on a printer tray also can lead to data breaches.
And in healthcare organizations, it happens more than you think.
Seven in 10 managers at healthcare organizations have seen or picked up documents containing confidential or sensitive information left in the printer. Close to two-thirds (63%) say they are concerned their employees or contractors have printed and left behind a document that could lead to a data breach, according to a survey by the Ponemon Institute. The survey was compiled in a report by Shred-It, an information security service.
This seemingly innocent workplace mistake isn’t the only thing threatening information security. More than 3 in 4 (78%) managers admit they have accidentally sent an email containing sensitive information to the wrong person. What’s more, 84% have received an email containing sensitive information from someone within or outside of their organization they were not intended to receive.
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At Tech’s Leading Edge, Worry About a Concentration of Power
By Steve Lohr
· Sept. 26, 2019
Each big step of progress in computing — from mainframe to personal computer to internet to smartphone — has opened opportunities for more people to invent on the digital frontier.
But there is growing concern that trend is being reversed at tech’s new leading edge, artificial intelligence.
Computer scientists say A.I. research is becoming increasingly expensive, requiring complex calculations done by giant data centers, leaving fewer people with easy access to the computing firepower necessary to develop the technology behind futuristic products like self-driving cars or digital assistants that can see, talk and reason.
The danger, they say, is that pioneering artificial intelligence research will be a field of haves and have-nots. And the haves will be mainly a few big tech companies like Google, Microsoft, Amazon and Facebook, which each spend billions a year building out their data centers.
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Another Voice: Health information exchanges connecting providers nationwide
By Dan Porreca
While most of your health care is local, there may be times when you or a loved one needs care away from home. A recent survey by the Strategic Health Information Exchange Collaborative illustrates the growth of health information exchanges nationally and the value that is being delivered both to the health care community and to patients, including when that information is shared across state lines.
According to the survey, 92% of the U.S. population is served by collaborative-member HIEs, which includes HEALTHeLINK, Western New York’s HIE, and together they are delivering more than 1 billion clinical alerts nationally.
These real-time notifications of hospital admissions, discharges or transfers are delivered to doctors, hospitals and other health care organizations, triggering follow-up care and care coordination that reduce hospital readmission and improve patient outcomes.
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Algorithm using EMR data may better predict mortality in polytrauma patients
September 28, 2019
Ryan W. Fairchild
DENVER — At the Orthopaedic Trauma Association Annual Meeting, a presenter said an algorithm that uses electronic medical record data may offer clinicians a clearer description of mortality risk in polytrauma and assist them in decision-making during early hospitalization.
“The polytrauma early mortality model ... stratifies patients into just two groups: high and low risk,” Ryan W. Fairchild, MD, said during his presentation. “High-risk patients have a one in three risk of mortality in the first 2 days. In low-risk patients, they have a 99% plus chance of survival in the first 48 hours.”
At a level 1 trauma center, Fairchild and colleagues developed the polytrauma early mortality model, a machine-learning algorithm that predicts 48-hour mortality during the first 72 hours after hospitalization using EMR data. Every 12 hours, the model updates and evolves with a patient’s physiologic response to trauma and ongoing resuscitation. From 2009 to 2014, the model was trained on 4,567 hospitalized polytrauma patient encounters. From 2015 to 2016, the model was tested on 484 encounters.
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NIST guidance aims to help PACS users enhance data security
September 30, 2019, 3:40 p.m. EDT
The National Institutes of Standards and Technology has issued draft cybersecurity guidance for securing Picture Archiving and Communication Systems.
The guidance has been released for public comment, with the comment period ending November 18; after that, NIST will develop final guidance.
“PACS fits within a highly complex healthcare delivery organization (HDO) environment that involves interfacing with a range of interconnected systems,” NIST notes. “This complexity may introduce or expose opportunities that allow for malicious actors to compromise the confidentiality, integrity and availability of the PACS ecosystem.”
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HIT Think
Why Social Determinants of Health raise the question, 'Now What?'
September 30, 2019, 3:50 p.m. EDT
From Hippocrates to Doogie Howser, physicians both real and fictional have understood that improving the health of their patients requires an inquiry deeper than the sciences of physical medicine. Great physicians look beyond the physical variables to a person's social context—the state of their housing, food, transportation, family life and other matters that contribute to at least half of a person’s health.
Unfortunately, the impact of such a broader inquiry doesn’t get very far. The valley between social and medical funding in our country has meant that doctors have historically done little more for a patient with overbearing social issues than to hand them a list of community nonprofits and wish them good luck.
Today, that’s changing. Social determinants of health (SDOH) are at last being given the recognition they deserve, thanks largely to their central role in achieving value-based care. One example of the increased recognition is the creation of ICD-10 “Z codes,” enabling providers to document and communicate SDOH issues within the electronic health record. Initiatives such as the Social Interventions Research & Evaluation Network (SIREN) Gravity Project are focused on identifying and expanding medical codes across multiple standards systems to improve providers’ capacity to document and communicate SDOH screening, diagnoses, and related interventions.
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Report: U.S. infrastructure for sharing health and social data needed
September 30, 2019, 12:10 a.m. EDT
The United States needs a strategic national vision, defined technology standards and significant resources to support the integration of healthcare and social care data in order to improve health outcomes and reduce disparities.
That’s among the findings of a new report from the National Academies of Sciences, Engineering and Medicine on how to integrate patients’ social needs into healthcare delivery.
“Interoperability and data sharing between healthcare and social care are hampered by the lack of infrastructure, data standards and modern technology architecture shared between and among organizations,” states the report.
To address the problem, the authors call for the development of a digital infrastructure that is interoperable between healthcare and social care organizations, as well as the resources to finance the integration of healthcare and social care.
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Healthcare orgs reaching analytics maturity in 3 key areas
Most organizations surveyed for a new report said their primary method to determine ROI is financial returns and improvements, followed by clinical outcome improvement and staff efficiency.
By Nathan Eddy
September 30, 2019 11:34 AM
Analytics solutions have been very effective toward improving clinical, financial and operational performance at healthcare organizations, according to a HIMSS Analytics and Dimensional Insight study of 109 senior healthcare executives.
WHY IT MATTERS
The survey found nearly 85 percent of organizations that are leveraging analytics are doing so in multiple areas, with two-thirds leveraging analytics in all three areas spotlighted by the survey – financial, operational and clinical.
The survey found nearly 85 percent of organizations that are leveraging analytics are doing so in multiple areas, with two-thirds leveraging analytics in all three areas spotlighted by the survey – financial, operational and clinical.
Organizations have the highest overall success rate (78 percent) with clinical metrics, with a particular focus on using analytics to reduce readmission rates, infection control and reduction, and patient outcome improvements.
Analytics is seen as an extremely important component to organizations' future strategy, with operational efficiency and cost management ranking as the top reasons for implementing analytics across all three areas.
Most organizations surveyed said their primary method to determine ROI is financial returns and improvements, followed by clinical outcome improvement and staff efficiency.
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Ageing population trend provides massive opportunities for Japan, UK health tech collaboration, report finds
New research funded by the government of Japan looks at the potential of collaboration for Japan and the UK to help reduce pressures on healthcare through the use of digital technology.
September 30, 2019 11:02 AM
Japan's healthcare system shares a couple of similarities with the UK's. Both countries provide universal healthcare, and both are now grappling with the challenges posed by ageing populations. According to a report published today, that trend is also creating new opportunities for collaboration.
WHY IT MATTERS
In 2018, citizens aged 65 and over accounted for 28% of Japan’s population, according to figures from the government. This number is estimated to rise to 38% by 2050.
The UK is facing a similar issue, with around 21% of the population projected to be aged 65 and over by 2027, compared to around 18% in 2017.
In the report, Professor Sudhesh Kumar, dean of the Medical School at the University of Warwick in England, argues that digital technologies could alleviate some of the pressures that healthcare systems around the world face in providing services tailored to the new demand.
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Australia’s My Health Record gets upgrade with enhanced clinical workflow capabilities
With this upgrade, Pathology and Diagnostic Imaging Overviews are automatically available from Clinical Information System (CIS) applications that implemented the My Health Record Document List.
By Dean Koh
September 30, 2019 12:55 AM
The Australian Digital Health Agency (ADHA) today announced the upgrade of My Health Record (MHR), an online, electronic summary of one’s key health information, with enhanced clinical workflow capabilities, which will enable healthcare providers to more easily identify and group together relevant tests and results and provide the best possible healthcare. This includes the keeping track of tests, knowing when they were carried out and monitoring patients’ results over time.
According to ADHA, more than 31 million clinical documents and more than 1.3 billion Medicare documents have already been uploaded to MHR. The upgrade means that Pathology and Diagnostic Imaging Overviews are automatically available from Clinical Information System (CIS) applications that implemented the My Health Record Document List.
Prior to this upgrade, CIS vendors had to do development work to implement the Pathology and DI Views. Now CIS applications that have implemented the MHR Document List will be able to provide the Pathology and DI Overviews without additional development work from the CIS vendors.
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NHS trusts risk failing to reach axe the fax target, Freedom of Information requests reveal
Last year, the Royal College of Surgeons found that NHS hospital trusts in England owned more than 8,200 fax machines, prompting the health secretary to order a complete phase-out by the end of March 2020.
September 30, 2019 07:18 AM
NHS trusts risk falling short of meeting the deadline set by health and social care secretary Matt Hancock to “axe the fax” by April 2020, according to the new findings from Freedom of Information requests published today.
WHAT HAPPENED
A 2018 report from the Royal College of Surgeons made headlines after revealing that NHS hospital trusts in England owned over 8,200 fax machines, prompting widespread criticism of the health service’s reliance on outdated technology.
Hancock later banned the NHS from purchasing fax machines, ordering a complete phase-out by April 2020. “I am instructing the NHS to stop buying fax machines and I’m setting a deadline for getting rid of them altogether. Email is much more secure and miles more effective than fax machines,” he said at the time.
But now, FOI requests submitted by London-based PR and marketing agency Silver Buck indicate that the trusts with the largest number of fax machines have removed only 42% of them during the past year. The request was issued to organisations that had over 200 or more fax machines, based on the data collected by the RCS, and three did not reply.
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Cybercriminals Are Selling Admin Access To Patient Portals
September 30, 2019
Another day, another scheme to profit from the high prices commanded by healthcare data. This time, the industry is confronting a new wave of cybercrime in which intruders are selling access to patient portals.
According to a new report by IntSights, a global threat intelligence firm, an emerging group of cybercriminals is auctioning off master keys offering administrative access to portals. When a potential attacker gets master key access, it can be devastating for that provider, as it allows them not only to steal but also to alter or corrupt data.
This latest scourge is part of a larger environment in which for a number of reasons, healthcare data stands out as a target.
One key reason they are so attractive is that healthcare records are rich with information. Healthcare records include personally identifiable information such as Social Security Numbers, addresses and phone numbers. These details can be leveraged to take over accounts and create synthetic IDs, the report points out.
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Whose Data is it Anyway? Collaboration in Digital Health
The demand for healthcare innovation is driving collaboration between formerly disparate healthcare companies and bringing in new players, such as technology companies and start-ups, into an already complex space. As companies build partnerships and pool resources – particularly healthcare data – data ownership presents numerous challenges that need to be addressed throughout the lifecycle of the collaboration. This episode of the Of Digital Interest podcast explores
- Key concerns for companies executing data-driven collaborations
- Consumer expectations surrounding data use, data privacy and their impact digital health collaborations
- The role of HIPAA and federal and state regulators in regulating data use
- Common questions about secondary use and identifiable and deidentified data
- Commercialization strategies and “green flags” for identifying the right collaboration partner
Click here to listen the audio
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Weekly News Recap
- FDA releases draft guidance explaining how it will determine if a clinical decision support software product should be regulated as a medical device.
- Emids is acquired by a private equity firm.
- Prescription discount service GoodRx adds virtual visits.
- Amazon launches a virtual medical clinic for its Seattle-area employees.
- China’s Ping An Good Doctor reaches 300 million registered users of its online healthcare platform.
- CHIME, AMIA, and other groups ask Congress to address specific information blocking issues and to extend the timeline for enforcement.
- University of Kentucky HealthCare diverts patients over several days after a registration system update causes a system crash.
- Campbell County Health (WY) diverts patients following a ransomware attack.
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Enjoy!
David.
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