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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How technology can transform end-of-life care
Ian Bailey, a district nurse and clinical director at EMIS Health, explores how technology can help transform care for the increasing number of terminally ill patients being cared for at home.
DHI News Team – 12 November, 2019
Every year, expert end-of-life teams care for more than 200,000 people with terminal or life-limiting illnesses in 220 hospices across the UK.
It is the type of holistic care that accounts for a dying patient’s emotional well-being and not just their physical requirements – the kind of care we would all hope for when the time comes. An overwhelming 82% of such patients want to die at home, yet half of them will die in hospital.
So, it is heartening to see an increasing number of hospices providing care in people’s own homes. The right technology can help transform this care, and the good news is that it already exists.
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Technology is the answer to the healthcare productivity challenge
As healthcare spending rises in the UK, Jonathan Pearson, UK head of healthcare at PA Consulting, looks at why technology could help improve productivity in the NHS.
DHI Admin Team – 14 November, 2019
In 1970, UK public and private healthcare spending in the UK amounted to 4% of GDP. By 2016 it had risen to almost 10% and if the trend continues, by the end of the century we will be spending 40% of our GDP on healthcare. The UK is not alone, research by PA Consulting’s health economics unit suggests that France will spend 39%, Sweden 48%, Canada 56% and the US 90% of GDP to fund their health services.
This is clearly unsustainable and the only way to meet these growing demands will be to improve the productivity of the NHS.
New approaches
While this has proved very difficult in that past, the advantage we now have is that there are a range of technological tools available, from data analytics to robotics that can both drive significant increases in efficiency and improve the quality of care.
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Special Report: Interoperability
Interoperability is an issue which is high on the agenda for many NHS IT leaders and increasingly, standards such as FHIR and SNOMED-CT are being used by suppliers for the purpose of interoperability. Jennifer Trueland investigates whether FHIR and similar standards have finally become fully embedded in healthcare IT.
Few eyebrows if any will have been raised earlier this year when NHS IT leaders named interoperability as their top priority.
It’s the second year in a row that this thorny topic has taken the number one spot in the Digital Health Intelligence NHS IT Leadership survey, with 78% identifying it as their prime concern.
Although this is down slightly on 2018 (from 84%), the survey results suggest that of all the issues crossing IT chiefs’ desks, the (in)ability to share information remains a major challenge.
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Differences in Ambulatory EHR Use Patterns for Male vs. Female Physicians
Case Study · November 13, 2019
Kiran Gupta, MD, MPH, Sara G. Murray, MD, MAS, Urmimala Sarkar, MD, MPH, Michelle Mourad, MD & Julia Adler-Milstein, PhD
UCSF Health
Widespread adoption of electronic health records (EHRs) has transformed patient care. While prior studies have linked EHR use to physician burnout, understanding different approaches to EHR use facilitates a more nuanced understanding of this relationship. Prior work has revealed that physician gender is tied to burnout as well as to patient expectations and outcomes. Therefore, in this study, we sought to understand differences in EHR use patterns — across an array of measures related to time spent on documentation, approaches to EHR documentation, and use of EHR tools — by physician gender for all ambulatory physicians (n = 1,336) at a large academic medical center. Measures were derived from EHR access logs and were reported on a per-physician-per-6-week-period basis over 1 year. On a per work relative value unit (wRVU) basis, women physicians spent more time in the EHR after hours on clinic days as well as on non-clinic days, spent more time handling messages in the system’s In Basket, and spent more time performing clinical review. Women also had different documentation patterns, including longer notes, a greater use of the copy/paste function, more patient contacts returned within 24 hours, and fewer visits closed on the same day. Finally, women used more documentation efficiency tools. These results offer new insights into how physicians differ in approaching EHR-related work, which will serve to inform opportunities for improving EHR workflow and addressing burnout.
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11/14/2019 02:10 PM
Well-known Trojans Emotet and Trickbot are cybercriminals' favorite weapons in their campaigns.
Cybercriminals are increasingly targeting hospitals, doctors' offices, and other healthcare organizations, with attacks using Trojan malware climbing by 82% between the second and third quarters of this year.
Cyberattacks against healthcare organizations jumped 60% in the first nine months of the year, compared to all of 2018, according to a report published this week by anti-malware firm Malwarebytes.
While the healthcare industry is currently the seventh-most targeted industry by online malware, attackers seem to be aiming to infect more organizations, especially via Trojan malware focused on compromising and controlling computers. While Malwarebytes saw a growth rate of 45% in threats between Q3 and Q2 this year, Trojan attacks climbed by 82%, according to the firm's Cybercrime Tactics and Techniques: The 2019 State of Healthcare report.
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Risks and remedies for artificial intelligence in health care
W. Nicholson Price II Thursday, November 14, 2019
Editor's Note:
This report from The Brookings Institution’s Artificial Intelligence and Emerging Technology (AIET) Initiative is part of “AI Governance,” a series that identifies key governance and norm issues related to AI and proposes policy remedies to address the complex challenges associated with emerging technologies.
Introduction
Artificial intelligence (AI) is rapidly entering health care and serving major roles, from automating drudgery and routine tasks in medical practice to managing patients and medical resources. As developers create AI systems to take on these tasks, several risks and challenges emerge, including the risk of injuries to patients from AI system errors, the risk to patient privacy of data acquisition and AI inference, and more. Potential solutions are complex but involve investment in infrastructure for high-quality, representative data; collaborative oversight by both the Food and Drug Administration and other health-care actors; and changes to medical education that will prepare providers for shifting roles in an evolving system.
Potential benefits
Although the field is quite young, AI has the potential to play at least four major roles in the health-care system:[1]
Pushing boundaries of human performance. The flashiest use of medical AI is to do things that human providers—even excellent ones—cannot yet do. For instance, Google Health has developed a program that can predict the onset of acute kidney injury up to two days before the injury occurs; compare that to current medical practice, where the injury often isn’t noticed until after it happens.[2] Such algorithms can improve care beyond the current boundaries of human performance.
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Yes, Google's using your healthcare data – and it's not alone
There's a multi-billion dollar industry built around collecting healthcare data and anonymizing it so it can be used for research; it's perfectly legal.
Senior Reporter, Computerworld | Nov 15, 2019 9:49 am PST
Google is working with one of the largest healthcare systems in the U.S. to collect patient data on millions of Americans in 21 states and across 2,600 hospitals or clinics in order to analyze it and come up with advice for better patient care and cost cutting measures.
The project was reportedly revealed by a whistleblower who said the program, dubbed "Project Nightingale," involved Ascension – the largest Catholic health system in the world – and up to 50 million private medical records from healthcare providers.
It wasn't Google's only public controversy this week. Shortly after its deal with Ascension became public, The Washington Post reported that the National Institutes of Health (NIH) stopped the tech giant from posting more than 100,000 human chest x-rays.
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November 15, 2019 / 1:25 AM / a day ago
Apple launches app to let users enroll in health studies
(Reuters) - Apple Inc on Thursday launched an app that will let users of its devices to enroll in three health studies, allowing them to share health-related data for medical research.
The studies are conducted in partnership with research institutes, including Harvard T.H. Chan School of Public Health and the NIH’s National Institute of Environmental Health Sciences.
People who download the research app would be able to enroll in studies including Apple Women’s Health Study, Apple Heart and Movement Study and Apple Hearing Study, the company said in a study.
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HIT Think
Why recent affiliations raise questions about use of data and HIPAA’s role
November 15, 2019, 3:43 p.m. EST
Privacy of health information is receiving a significant spotlight as a result of big technology companies moving into the healthcare industry.
While Amazon and Microsoft seem to slip past many headlines, Google is not in the same boat. Various arrangements between Google and systems including the Mayo Clinic, the University of Chicago and Ascension Health draw concern and fears of Google just taking multitudes of personal information about thousands or millions of individuals.
Is the use and obtaining of data inconsistent with regulatory requirements, or is there a permissible basis? Despite the most common statement being that Google is stepping around HIPAA, the most likely answer is that Google (and really many other technology based vendors) can receive the data as a business associate.
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Singapore’s national AI strategy to focus on chronic disease management and prevention
In the next three years, Selena+, a system which analyzes retinal photographs across the nation for diabetes screening will be deployed.
By Dean Koh
November 13, 2019 01:51 AM
Deputy Prime Minister and Minister for Finance, Heng Swee Keat, today announced at the SFF X SWITCH (SingaporeFinTech Festival and Singapore Week of Innovation and TeCHnology) Conference, a national Artificial Intelligence (AI) strategy to transform Singapore’s economy and improve the lives of citizens.
The key approach of the strategy is to adopt a human-centric approach, and focus on delivering tangible benefits to citizens and businesses through AI. Five national AI projects have been identified for a start:
- Transport and Logistics: Intelligent Freight Planning
- Smart Cities and Estates: Seamless and Efficient Municipal Services
- Healthcare: Chronic Disease Prediction and Management
- Education: Personalized Education Through Adaptive Learning and Assessment
- Safety and Security: Border Clearance Operations
Drilling specifically into healthcare, the emphasis of the national AI strategy will be on chronic disease management and prevention. Below are some key timelines and targets.
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Mayo Clinic study links EHR usability with clinician burnout
Researchers sought to assess and benchmark how physicians view electronic health record usability, as defined by a standardized metric, and use that to evaluate how poor UX correlates with feelings of job frustration and burnout.
By Mike Miliard
November 15, 2019 09:20 AM
Here's a sentence that does not mince words: "The usability of current EHR systems received a grade of F by physician users when evaluated using a standardized metric of technology usability. A strong dose-response relationship between EHR usability and the odds of burnout was observed."
WHY IT MATTERS
That's the conclusion of a new study published in Mayo Clinic Proceedings, which sought to assess and benchmark how physicians view electronic health record usability, as defined by a standardized metric, and use that to evaluate how poor usability correlates with feelings of burnout.
That's the conclusion of a new study published in Mayo Clinic Proceedings, which sought to assess and benchmark how physicians view electronic health record usability, as defined by a standardized metric, and use that to evaluate how poor usability correlates with feelings of burnout.
Researchers polled U.S. physicians across all specialties in 2017 and 2018, using the American Medical Association Physician Masterfile. Nearly 5,200 completed the surveys, with a random one-quarter of those respondents also asked to take a subsurvey evaluating their EHR thoughts on usability; 870 completed that second survey.
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Technology optimization: refining clinical decision support
Five CDS technology pros describe some comprehensive best practices for making the technology work optimally for provider organizations.
By Bill Siwicki
November 15, 2019 12:49 PM
Physicians on the front lines of healthcare delivery welcome the assistance of clinical decision support technology – as long as it works well, gives proper suggestions and does not get in their way.
Perhaps more than other healthcare information technologies, clinical decision support systems really require CIOs, CMIOs and other health IT and clinical leaders to make sure the tech is highly optimized for ideal performance. Not to mention optimized to meet the specific needs of the organization.
Here, five experts in clinical decision support offer their best practices for healthcare provider organizations to optimize the technology so that physicians and other clinicians get the most out of this key health IT investment.
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HIEs Must Shift From Health Data Sharing To Curating And Analyzing Data
November 15, 2019
After years of evolving and struggling to find a solid business model, HIEs have finally found a reasonably secure place in the healthcare system. The thing is, the job they’ve learned to do – serving as an exchange point for any and all data coming their way – may already be outmoded, according to Claudia Williams, CEO of California-based HIE Manifest MedEx.
In an article for Stat News, Williams argues that the problems involved in exchanging data efficiently have largely been solved, in part by the emergence of new API standards. Now, she says, HIEs need to step up and take on an active role in making sense of this data. She contends that HIEs need to offer new capabilities, including the following:
- HIEs should identify patterns and problems from within data that might not be visible to clinicians and public health officials looking at just their own organization’s results. For example, she notes, Cincinnati’s Health Collaborative tells physicians how much radiation patients had already been exposed to, information which can help them weigh the potential risks involved with further imaging studies.
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Apple Heart Study shows a lot of promise for digital health, but cardiologists still have questions
Published Wed, Nov 13 20195:00 PM ESTUpdated Wed, Nov 13 20196:07 PM EST
Key Points
- More than 400,000 people signed up for the Apple Heart Study, which makes it one of the largest research efforts ever.
- About 0.5% of them received an irregular heart notification from their Apple Watch.
- Some of those people had a condition called atrial fibrillation. But not everyone in the medical community is convinced that consumer tools should be used on a general population, especially when it’s not always clear how to treat them.
Stanford Medicine published its long-awaited research on the Apple Heart Study, which represents one of the largest research efforts of its kind that relies on consumer devices to better understand human health.
The paper, published on Wednesday in the New England Journal of Medicine, looked at how the Apple Watch could be used to detect atrial fibrillation, a condition that is associated with an increased risk of stroke.
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November 14, 2019 / 9:34 AM / a day ago
Genome sequencing in newborns raises ethical issues
(Reuters Health) - Screening newborns for health risks using genomic sequencing can raise ethical and equity questions, the authors of a new paper warn.
Testing newborns for a handful of specific childhood conditions is already commonplace in the U.S. “Newborn screening is often done without parental permission and has been justified on the grounds that the direct benefits to the child greatly outweigh the harms,” said Dr. Lainie Friedman Ross of the MacLean Center for Clinical Medical Ethics at the University of Chicago in Illinois, who co-authored the case study in Pediatrics, November 12.
However, these tests are done to identify conditions that can be diagnosed and treated early.
Sequencing all or large parts of a baby’s genome at birth could reveal genetic variations that increase risk for conditions that occur in childhood or not until adulthood. The conditions could be benign or ultimately be untreatable later, Ross said.
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HITRUST develops suite of tools to help in gauging third-party risk
November 14, 2019, 3:39 p.m. EST
HITRUST is offering new tools and a methodology intended to help organizations automate and improve the effectiveness of managing third-party risk.
HITRUST says the new products and services are aimed at ensuring confidentiality, integrity and availability of data being received or transmitted. Today, providers that comply with HIPAA requirements can be uncertain about what constitutes reasonable and appropriate data protections.
Executives for HITRUST—which certifies healthcare providers, vendors, insurers, suppliers and other stakeholders to determine whether they are handling healthcare data in a safe way—say the platform is being enhanced to help providers qualify business associates and other third parties for doing business with them based on the risk they pose, explains Bryan Cline, its chief research officer.
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Smart toilets seen as future real-time health monitoring tech
November 13, 2019, 11:34 p.m. EST
Toilets are currently used for disposing of human waste. But researchers see tremendous value in the metabolic information contained in urine as a source of real-time monitoring of peoples’ health.
Scientists at the University of Wisconsin-Madison and the Morgridge Institute for Research are working on a proof of principle for an integrated "smart toilet" system that could yield important metabolic data.
Researchers published results of an observational study in the journal Nature Digital Medicine, in which they collected urine samples from two research subjects over a 10-day period and analyzed the samples using gas chromatography and mass spectrometry.
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Patients still facing big obstacles getting their own health data
Despite HIPAA's right of access rule, and CMS and ONC prioritizing consumer access in their forthcoming 21st Century Cures regs, a new scorecard shows that providers have work to do.
By Mike Miliard
November 14, 2019 09:41 AM
"Patients need their records, and it shouldn't be hard to get them," says Deven McGraw, chief regulatory officer at Ciitizen, a startup founded in 2017 that develops tools to help patients access, manage and share their medical records.
There's a reason Ciitizen has a market for its services. Because, unfortunately, "the majority of medical record providers are not compliant" with the HIPAA Privacy Rule's right of access provisions, according to the company.
This past summer, Ciitizen launched its Patient Record Scorecard, which assesses providers nationwide and assigns them a score – one to five stars – on how well they complied with patients rights under that access rule.
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Is it 1970 or 2019? Nine in 10 in healthcare industry still using fax machines, survey finds
Nov 13, 2019 11:06am
When it comes to communication, it looks like the healthcare industry got stuck in a time warp.
A new survey finds that healthcare organizations are still heavily reliant on 1970s technology, with 89% using fax machines and 39% using pagers. And despite living in a mobile-reliant society, healthcare organizations rely heavily on landline phones to communicate, according to a new report by TigerConnect, a healthcare communication platform.
“Adoption of modern communication solutions has occurred in every other industry but healthcare,” said Brad Brooks, CEO and co-founder of TigerConnect, in a statement.
The report was based on an online survey conducted in July of almost 200 respondents who work in the healthcare industry, including physicians, nurses and ancillary providers, C-suite executives, information technology professionals, administrative staff and others.
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Dept. of Veterans Affairs believes games can help soldiers reconnect, reduce suicides. Here’s how.
November 11, 2019 at 11:02 p.m. GMT+11
After Microsoft CEO Satya Nadella crashed his car into a sand trap in the Xbox One video game Forza, he wondered aloud if it was time to give up. His competitor, Roger Brannon, thought differently.
“Never give up,” Brannon said.
“That’s a Marine,” Nadella replied.
Brannon, a veteran who served in the armed forces for over half his life, was playing against Nadella using Microsoft’s Adaptive Controller, a video game controller designed for individuals with limited mobility. Brannon, who suffers from the neuromuscular disease ALS, demonstrated the benefits of the device to Microsoft leadership at the VA Medical Center in Washington, D.C. in early October.
The controllers, which were released to the market last September, were distributed to 22 veteran rehabilitation centers across the country earlier this month as part of a collaborative effort between the U.S. Department of Veterans Affairs and Microsoft to enhance socializing, therapeutic and rehabilitative practices for veterans through gaming.
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CMS Expands Telehealth Coverage for Opioid Abuse Disorder Treatment
In the finalized 2020 Physician Fee Schedule, CMS is adding three CPT codes for telehealth services included in bundled episodes of care for opioid abuse treatment, including care delivered to the home.
November 12, 2019 - The Centers for Medicare & Medicaid Services is moving forward with new reimbursement codes for care providers who use telehealth to treat patients dealing with opioid abuse.
As part of the 2020 Physician Fee Schedule, CMS is adding three CPT codes that will allow providers to bill Medicare for telehealth services included in bundled episodes of care for opioid abuse treatment, including care delivered to the home. The codes were first proposed in July as a means of applying connected health technology to the ongoing opioid abuse epidemic.
“We are announcing proposals so that the government doesn't stand in the way of patient care, by giving clinicians the support they need to spend valuable time coordinating the care of these patients to ensure their diseases are well-managed and their quality of life is preserved,” CMS Administrator Seema Verma said in a July press release announcing the proposed codes.
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Pop health shift spurs increased use of remote patient monitoring
November 13, 2019, 3:12 p.m. EST
Population health management is driving provider investments in remote patient monitoring applications, according to a new study by Spyglass Consulting Group.
Some 88 percent of hospitals and health systems surveyed by the consultancy have invested or plan to invest in the technology to help care managers monitor and manage high-risk patients who have chronic conditions, or who are unstable and at risk for hospital readmissions or unexpected emergency department visits.
The move to monitoring applications is a downstream effect of the Affordable Care Act—since then, providers have been consolidating into larger delivery systems, says Gregg Malkary, managing director.
“They are formulating strategies and deploying foundational technologies and processes required to support population health management programs focused on chronic disease management,” Malkary notes. “Remote patient monitoring solutions have been identified as important early symptom management tools for handling large numbers of chronically ill patients.”
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New York estimates state HIE saves up to $195M annually in care spending
November 13, 2019, 3:34 p.m. EST
New York estimates that its statewide health information exchange reduces healthcare costs by $160 million to $195 million dollars annually.
Savings generated by the Statewide Health Information Network for New York (SHIN-NY) includes significant savings for both Medicaid and Medicare programs within the state.
Even if just current users of the HIE used its full capabilities, nearly $1 billion could be saved annually in costs associated with duplicate testing, avoidable hospitalizations and readmissions, and preventable emergency department visits, the state’s research notes.
Studies show that meaningful data exchange results in better healthcare and reductions of unnecessary healthcare spending, says Valerie Grey, executive director of the New York Health Collaborative, which works with the New York State Department of Health by integrating HIE across the state. “This statewide estimate for New York gives us a sense of the magnitude of the current impact and what tomorrow could bring as SHIN-NY continues to grow and evolve,” she adds.
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Google denies it’s misusing health data as HHS starts inquiry
November 13, 2019, 3:49 p.m. EST
Google’s top health and cloud executives said the company isn’t misusing health data from one of the biggest U.S. healthcare providers, pushing back against news reports that have triggered criticism from lawmakers and prompted a federal inquiry.
Google employees only have access to patient information to build a new internal search tool for the Ascension hospital network, said David Feinberg, head of Google Health. No patient data is being used for Google’s artificial intelligence research, he added.
The Alphabet company’s contract is governed by U.S. health privacy law that permits it access to patient records solely for the task of organizing Ascension’s various health records systems and building a tool to make them easier to search, Feinberg said.
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Germany introduces Digital Supply Act to digitalise healthcare
Health minister Jens Spahn defended the new legislation against concerns about the use of patient data for medical research.
By Tammy Lovell
November 13, 2019 07:21 AM
German federal parliament, the Bundestag has passed legislation to digitalise the country’s healthcare.
The Digital Supply Law (DVG), which was proposed by minister of health Jens Spahn earlier this year, was passed by the parliament on 8 November.
Under the new legislation, doctors will be able to prescribe digital health apps to patients, which can be reimbursed by the country’s statutory health insurance. App providers will have to prove to the federal Institute for Drugs and Medical Devices (BfArM) that their apps can improve patient care.
Also, doctors will be able to receive money for providing online consultation to patients with statutory insurance. Doctors will be allowed to provide information about video and online consultations on their websites, whereas before they had only been able to discuss these in private conversations.
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Project Nightingale seems to square with HIPAA, but next steps matter
While Google apparently signed a business associate agreement with Ascension, and the scope of the data sharing appears to be in line with HIPAA allowances, there are still many questions about how the patient information is being put to use.
By Nathan Eddy
November 13, 2019 02:24 PM
The health data sharing collaboration between Google and Ascension has raised some big concerns nationwide – starting with some employees at Ascension – about what the initiative could mean for patient privacy.
The so-called "Project Nightingale," overall does appear to meet HIPAA compliance standards, based on Google's and Ascension's own statements and what has been reported so far by The Wall Street Journal and others.
But the news that Google – which makes its money off data-based advertising and has long been the subject of privacy concerns – would have access to protected health information has understandably raised some alarms across an industry where privacy and security are meant to be paramount. (The partnership has now led to a new federal inquiry.)
CNBC reported that, while Ascension and Google did sign a business associate agreement, as required by HIPAA, "some Ascension employees were concerned that some tools that Google is using to import and export data were not compliant with HIPAA privacy standards."
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Big Tech: Is Apple’s Healthcare Confidence Justifiable?
November 13, 2019
A few months ago, Apple CEO Tim Cook made an amazing claim.
During his September appearance on CNBC’s Mad Money, he suggested that while Apple’s hardly going to stop doing other things, healthcare may represent the brass ring. “If you zoom out into the future, and you look back, and you ask the question: ‘What was Apple’s greatest contribution to mankind?’ it will be about health,” he said.
This isn’t coming completely from left field. According to Cook, on a trailing basis Apple’s revenue from wearables is already 50% more than iPod revenues at their peak. That’s a pretty serious business by even the biggest tech company’s standards, and while it’s obviously facing massive competition in the wearables space, it has room to grow as well.
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Finger Pointing is Easy in Healthcare IT
November 13, 2019
I’ve regularly talked about how in healthcare there’s always a reason available not to do something. Basically, if there’s something you don’t want to do, you can come up with a reason not to do it. If all else fails, just call out the word HIPAA and everything grinds to a halt. It’s sad, but true and often takes a real leader to overcome these false excuses for why people don’t want to do something and dive into the real core of why they don’t want to adopt some new technology.
Turns out, there’s a related topic when it comes to the failure of any IT system and that’s finger pointing.
Finger pointing happens in every industry, but in healthcare technology it’s so easy to point fingers at someone else. This starts with how healthcare selects, purchases, and implements new technology. If you’re in healthcare, you’re all too familiar with the committee based decision making that happens in every healthcare organization of any reasonable size. There are no impulse buys in healthcare and everything that’s purchased is governed by at least one and often many committees.
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Published on: November 11, 2019
Money, Mandate Are Keys to FDA's Drive for Use of Real-World Evidence, Gottlieb Says
Mary Caffrey
Former FDA Commissioner Scott Gottlieb, MD, who has returned to the American Enterprise Institute, left FDA in April after 2 whirlwind years that saw a record pace of approvals and policy actions that covered everything from high drug prices to teen vaping. He spoke Friday in Philadelphia at Patient-Centered Oncology Care®, the annual meeting of oncology reimbursement stakeholders held by The American Journal of Managed Care®.
Use of real-world evidence in the drug approval process will accelerate rapidly, former FDA Commissioner Scott Gottlieb, MD, said Friday, because Congress has given the agency both the money and a mandate to make this happen.
Real-world evidence, which can include data from electronic health records (EHRs) or claims, allows regulators to “fill in the blanks,” which Gottlieb said can eliminate the need for strict randomization when evaluating treatments for rare conditions or other unmet medical needs.
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Real-world evidence, which can include data from electronic health records (EHRs) or claims, allows regulators to “fill in the blanks,” which Gottlieb said can eliminate the need for strict randomization when evaluating treatments for rare conditions or other unmet medical needs.
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We Teach A.I. Systems Everything, Including Our Biases
Researchers say computer systems are learning from lots and lots of digitized books and news articles that could bake old attitudes into new technology.
By Cade Metz
· Published Nov. 11, 2019Updated Nov. 12, 2019, 2:34 p.m. ET
SAN FRANCISCO — Last fall, Google unveiled a breakthrough artificial intelligence technology called BERT that changed the way scientists build systems that learn how people write and talk.
But BERT, which is now being deployed in services like Google’s internet search engine, has a problem: It could be picking up on biases in the way a child mimics the bad behavior of his parents.
BERT is one of a number of A.I. systems that learn from lots and lots of digitized information, as varied as old books, Wikipedia entries and news articles. Decades and even centuries of biases — along with a few new ones — are probably baked into all that material.
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EHR Use Training Key to High EHR Satisfaction Across Specialists
KLAS surveyed over 30,000 physicians from differing specialties and found that high-quality training is crucial to EHR satisfaction.
November 12, 2019 - High-quality EHR use training is crucial to EHR satisfaction, according to a recent KLAS survey of over 30,000 physicians.
The survey, which looked at the Net EHR Experience Score for physicians from 33 different specialties, found that physician satisfaction with their tools is highly variable.
For example, pathology physicians scored their EHRs an average of a 24.3, while other specialties reported much lower satisfaction, like neurosurgery physicians who scored EHRs a 2.2 on a minus 100-to-100-point scale.
The key factor, the respondents said, is the quality of initial training. The physicians that responded well and showed high satisfaction noted robust initial EHR training for their specialty.
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Time For A Health Information Agency
The US health care system is finally at a tipping point of much needed and overdue modernization. While it promises a brave new world of streamlined and improved health care, we are facing nothing short of a revolutionary transformation that is based on a tsunami of readily accessible health information and digital tools.
Currently, there is no federal agency, public-private collaboration, or private industry mechanism that is prepared to handle the ensuing activity in its entirety. We need to get a handle on how best to protect our private health care data while also making sure that information is allowed to flow as freely as necessary to improve our delivery system and population’s health. We need a dedicated team of experts who speak the language of both information technology and public policy. We need a new federal agency that has jurisdiction and dedicated staff to oversee health information and the technology that will simplify and operationalize the information.
This need is urgent because of the pending final rules of the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). In February, they announced their proposals to make the health care system “powered by technology.” Under the proposed rules, any payer doing business with Medicare, Medicaid, or as a qualified health plan in the federal Marketplaces will have to make health data available electronically by 2020. Individuals will be able to see and send their information anytime and anywhere via third-party apps on their computers and smartphones. The problem is that the rules oversee health plans and health care providers, but there are no rules for the software developers of the consumer-facing apps.
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VA collaborating to expand availability of telehealth for vets
November 12, 2019, 3:29 p.m. EST
A wide range of healthcare stakeholders and outside organizations have joined in a quest to make telehealth services for rural veterans a reality.
The program is called Accessing Telehealth through Local Area Stations (ATLAS) and is a collaboration between the VA, Veterans of Foreign Wars, American Legion and vendors including Philips Healthcare, Caregility, CareLink and Steelcase.
Philips and Steelcase have designed, built and donated small enclosure rooms called pods, which will be placed in VFW halls and Legion posts. This enables veterans to access telehealth at local VA centers rather than having to travel to the nearest VA facility that could be hours away.
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AI leverages ECG data to predict irregular heartbeat, death risk
November 11, 2019, 10:37 p.m. EST
Using electrocardiogram data, Geisinger researchers have trained deep neural networks to predict patients’ risk of developing a potentially dangerous irregular heartbeat or of dying within the next 12 months.
That’s the finding of two preliminary studies to be presented at the American Heart Association’s Scientific Sessions 2019 on November 16 to 18 in Philadelphia, which leveraged more than 2 million ECG results from three decades of Geisinger's archived medical records.
According to researchers, both studies are among the first to use artificial intelligence to predict future events—such as atrial fibrillation (AF)—from an ECG rather than to detect current health problems.
In one study, the neural network predicted that, within the top 1 percent of high-risk patients, one out of every three patents was diagnosed with AF within a year. In addition, the patients predicted to develop AF at 12 months had a 45 percent higher hazard rate in developing AF over 25-year follow-up than the other patients.
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Cancer registry joins with big pharma to create clinico-genomic dataset
November 11, 2019, 10:47 p.m. EST
The American Association for Cancer Research and nine biopharmaceutical companies have teamed to collect and share clinical and genomic data in order to advance precision oncology.
The five-year, $36 million research collaboration—part of the existing AACR Project Genomics Evidence Neoplasia Information Exchange (GENIE)—is aimed at linking clinical-grade cancer genomic data with clinical outcomes in a publicly accessible international cancer registry of real-world data.
Currently, AACR Project GENIE’s registry includes clinical-grade cancer genomic sequencing data from almost 71,000 patients. However, the goal of the new five-year collaborative research project is to obtain clinical and genomic data from 50,000 de-identified patients treated at 19 of the world’s leading cancer centers, creating a clinico-genomic dataset.
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Patient experience is evolving as providers embrace telehealth
While face-to-face visits are still preferred by many, 90% of healthcare organizations polled by HIMSS Media say they're using or piloting remote care services to boost care coordination, manage at-risk patients and broaden pop health efforts.
By Mike Miliard
November 12, 2019 12:15 PM
More and more patients are able to take advantage of remote consults and other virtual care options as health systems have begun pursuing telehealth programs in earnest, new HIMSS Media research shows.
WHY IT MATTERS
That's not necessarily to say that many patients – and, indeed, many providers – don't still prefer old-fashioned, in-person, one-on-one doctor-patient consults.
That's not necessarily to say that many patients – and, indeed, many providers – don't still prefer old-fashioned, in-person, one-on-one doctor-patient consults.
But as the new realities of staffing challenges and value-based care become apparent – and regulatory and reimbursement policies evolve to accommodate it – more and more healthcare organizations are embracing telehealth.
Nine in 10 of them, in fact, are offering or piloting telehealth programs, according to the new 2019 HIMSS report, "Telehealth: Disrupting the Care Delivery Paradigm."
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Are We Entering An Era of Radical Interoperability? Deloitte Says Yes
November 12, 2019
If you’ve been watching stop-and-start efforts toward health data interoperability over the last several years, many of which have netted little progress, you might be surprised to hear a top-drawer consulting firm argue that we’re moving ahead into an era of radical interoperability in the healthcare and life science industries.
But that is just the claim being made by Deloitte, whose recent research concludes that these industries’ interoperability efforts are “picking up speed and moving from aspiration to reality.” This conclusion comes from the Deloitte Center for Health Solutions, which surveyed 100 technology executives at health systems, health plans, biopharma companies and medtech companies and interviewed another 21 experts.
This shift is happening, in part, because tech capabilities needed to foster interoperability are finding their way into the healthcare industry, Deloitte reported. For example, 53% of execs said they were building their own APIs, 73% have a dedicated, centralized interoperability team in place, 60% host more than half of their applications in the cloud, 57% have established an architecture strategy for interoperability across business functions and almost 80% have had data architects to define their strategies.
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3 Global Health IT Takeaways You Need to Know – Reflections from ONC 3rd Interoperability Forum
Aisha Hasan | November 12, 2019
The Office of the National Coordinator for Health IT (ONC) engages in several global health IT projects from a United States government perspective. ONC works with global counterparts to share experiences, and ensure alignment between global interoperability efforts and the United States’ approaches to interoperability. This includes working through worldwide partnerships, bi-lateral and multi-lateral engagements, global networks, and memoranda of understanding. Through these engagements, we focus on advancing common health data standards for global interoperability, enhancing individuals’ access to their data, progressing healthcare providers’ experiences, and improving factors associated with transparency and competition.
This past summer, ONC hosted the 3rd Interoperability Forum in Washington DC, where we heard from several global health IT leaders who are working on similar health IT issues in their own countries. This post highlights the insights and resources these leaders provided during the Forum, and is not inclusive of ONC’s complete global health IT efforts.
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Does the Patient Engagement Technology Market Meet Consumer Needs?
KLAS outlined key patient engagement technology vendors that appear to be meeting consumer needs.
By Sara Heath
November 11, 2019 - The patient engagement technology field has long been a crowded one, with a vast array of solutions promising to meet patient needs and ease the healthcare experience. Until now, it’s been hard for industry experts to identify leading technologies, but as more providers focus on the patient experience, top-performers are emerging, according to a new KLAS report.
“Patient engagement is one of the most complex and overwhelming areas of healthcare IT that KLAS measures, involving dozens of relevant HIT capabilities and a slew of vendors claiming to offer them,” KLAS wrote in its report.
As healthcare consumerism began to take hold, one-off patient engagement solutions emerged, promising to fill in gaps in the healthcare experience patients so desperately wanted filled. Because of the broad tech solutions available to providers, it’s been challenging for industry leaders to identify top choices, KLAS has previously reported.
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How to Engage Physicians in Innovative Health Care Efforts
November 11, 2019
There is no shortage of digital health offerings in the market promising to enhance patient care and achieve aspects of the quadruple aim of enhancing the patient experience, improving population health, reducing costs, and improving the work life of health care providers. They include apps, devices, augmented intelligence, and data analytics. However, it is unclear how many of these options solve the right problems based on actual user needs.
Because the digital health ecosystem is growing and evolving so rapidly, it has become difficult for physicians, patients, and health system administrators to navigate potential solutions that can address multifaceted problems, as well as meet requirements for privacy, security, clinical efficacy, usability, and interoperability. To help address this problem, the American Medical Association created its Physician Innovation Network (PIN), which connects physicians, residents, and medical students to health technology companies and entrepreneurs. Through research and talking with physicians active on the platform, the AMA has gathered some best practices for engaging physicians, residents, and medical students in health care innovation. Below are some thoughts based on our interactions with physicians and innovators involved in PIN.
Engage early and often. It is critical for digital health companies to involve physicians (and patients) early in the development of their products to help articulate how they should function, touch a patient’s life, and integrate into clinical practice.
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Machine learning identifies patients in need of end-of-life planning
November 11, 2019, 12:28 a.m. EST
Penn Medicine researchers have developed a machine learning algorithm that identifies oncology patients at risk of short-term mortality who need end-of-life conversations with clinicians.
In a study of 26,525 patients receiving outpatient oncology care, the algorithm accurately predicted patients with cancer who were at risk of six-month mortality using electronic health records, including whether a patient had high blood pressure as well as laboratory and electrocardiogram data.
The study found that 51 percent of the patients the algorithm identified as “high priority” for end-of-life conversations died within six months vs. fewer than 4 percent in the “lower priority” group.
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Wide variance in safety indicator drug monitoring by GP practices in England and Wales revealed in new data
Disparity found in analysis of practice data from CCGs using First Databank’s prescribing decision tool.
By Tammy Lovell
November 11, 2019 02:16 AM
Drug and medical device knowledge company First Databank (FDB) is urging GP practices to standardise their approaches to routine testing and monitoring of drugs, after its data revealed variance in compliance across key safety indicators for drug prescriptions.
The firm’s OptimiseRx tool, which is used by two thirds of Clinical Commissioning Groups (CCGs) in England and Wales, prompts prescribers to monitor patients if evidence of routine drug monitoring recommended by Royal College of General Practitioners (RCGP) safety indicators is not found in the patient record.
According to an FDB press release, the figures from analysis of OptimiseRx usage in 2018/2019 “suggest the need for prescribers to increase essential routine testing of clinical markers for patient harm from medications, and for more robust recording of test results into the primary care clinical system.”
WHY IT MATTERS
For the mood stabiliser lithium, monitoring prompts through OptimiseRx arose for an average 3% of prescriptions against the relevant RCGP indicator where no evidence of test results were found in the previous six months.
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Providers, payers and pharma must work together to thwart cyber criminals
Sharing of threat information across stakeholders helps create situational awareness – not just for individual organizations but for the healthcare industry as a whole, says one expert.
By Bill Siwicki
November 11, 2019 01:45 PM
When it comes to building cybersecurity defenses against bad actors in healthcare, generally speaking each provider organization, payer or pharmaceutical company relies on its own self-developed strategies and self-selected technologies.
But what if there was a more concerted effort by all of these players to work together to thwart hackers and other cyber criminals? That would be a better way of going about cybersecurity, argues Greg Conti, senior security strategist at IronNet Cybersecurity.
Beefing up your own security is not enough
“At first glance, it may seem that hardening only your own organization and standing alone makes sense as a cost-efficient security and business strategy,” Conti said. “For sure, hardening your own systems and people is necessary, but it is not sufficient. First, I believe that a tenacious state actor can successfully breach even the best-resourced companies given sufficient time, resources and motivation.”
Second, the healthcare industry is a complex and interconnected ecosystem; an ecosystem that all member organizations depend upon to thrive, he said.
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Ascension, Google working on 'secret' patient data project, says WSJ
With the initiative, reportedly called Project Nightingale, the health system and tech giant have been collecting and analyzing detailed medical records, including names and birth dates, according to the Wall Street Journal.
By Mike Miliard
November 11, 2019 04:50 PM
The Wall Street Journal reported on Monday that Google has been working since 2018 on a "secret" project involving patient data with Ascension, the St. Louis-based nationwide health system.
WHY IT MATTERS
The initiative, which WSJ said had drawn some questions, both "technological and ethical," from some Ascension employees about how the information was being analyzed and shared, had reportedly been codenamed Project Nightingale.
The initiative, which WSJ said had drawn some questions, both "technological and ethical," from some Ascension employees about how the information was being analyzed and shared, had reportedly been codenamed Project Nightingale.
Google is apparently using the data to help inform its design of new AI and machine learning software for Ascension. WSJ reports that employees at different Alphabet divisions, including Google Brain, have access to the patient information.
Until recently neither patients nor physicians knew that "at least 150 Google employees already have access to much of the data on tens of millions of patients" across 21 states, according to the article's author Rob Copeland, including "lab results, doctor diagnoses and hospitalization records, among other categories ... including patient names and dates of birth."
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Google’s ‘Project Nightingale’ Gathers Personal Health Data on Millions of Americans
Search giant is amassing health records from Ascension facilities in 21 states; patients not yet informed
By Rob Copeland
Updated Nov. 11, 2019 4:27 pm ET
Google is engaged with one of the country’s largest health-care systems to collect and crunch the detailed personal health information of millions of Americans across 21 states.
The initiative, code-named “Project Nightingale,” appears to be the biggest in a series of efforts by Silicon Valley giants to gain access to personal health data and establish a toehold in the massive health-care industry. Amazon.com Inc., Apple Inc. and Microsoft Corp. are also aggressively pushing into health care, though they haven’t yet struck deals of this scope.
Google began Project Nightingale in secret last year with St. Louis-based Ascension, the second-largest health system in the U.S., with the data sharing accelerating since summer, according to internal documents.
The data involved in the initiative encompasses lab results, doctor diagnoses and hospitalization records, among other categories, and amounts to a complete health history, including patient names and dates of birth.
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Weekly News Recap
- A study finds that only 10% of discharged hospital patients look at their medical information online afterward.
- CompuGroup Medical is rumored to be a bidder for Agfa’s health IT business.
- The VA makes patient records available on Apple Health Records.
- A federal court orders behavioral EHR vendor ZenCharts to pay rehab EHR vendor Kipu Systems $19.5 million for stealing its trade secrets.
- University of Rochester Medical Center will pay $3 million to settle OCR charges involving loss of two unencrypted mobile devices.
- Google announces that it will acquire Fitbit for $2.1 billion in cash.
- CMS delays implementation of a requirement that hospitals publicly share their negotiated contract prices.
- Allscripts announces Q3 results that beat Wall Street expectations on adjusted earnings, but fell short on revenue.
- Wake Forest Baptist Medical Center will bring registration and billing back in-house two years into a seven-year agreement with NThrive, which will eliminate 839 jobs in central North Carolina as a result.
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Enjoy!
David.
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