Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, February 16, 2020

Talk About Strategic Overreach And Total Stupidity In A Planned Use Of The #myHealthRecord.

I came upon this alarming document the other day.

AMA Submission to the Therapeutic Goods Administration – Proposed amendments to the Poisons Standard – March 2020

medicines.scheduling@health.gov.au

The AMA thanks the Therapeutic Goods Administration (TGA) for the opportunity to comment on the Proposed amendments to the Poisons standard consultation. The following feedback applies to the scheduling proposals referred to the Advisory Committee on Medicines Scheduling (ACMS #29) and joint ACMS/ Advisory Committee on Chemicals Scheduling (ACCS) meetings (ACMS-ACCS #24), March 2020.
The AMA does not support the down-scheduling of medicines unless there is strong evidence it is safe to do so, and there is demonstrated patient benefit and safety in dispensing the medication by this method.

Regulation through the My Health Record

The AMA’s view is that if additional supply requirements or controls are required in order for pharmacists to safely dispense a medicine, then it is by definition unsafe and inappropriate to down-schedule that medicine.
The AMA understands that the scheduling changes for rizatriptan, melatonin, and adapalene, include an obligation for pharmacists to enter the details of the supply of these medicines into the patient’s My Health Record. My Health Record includes a Medicines view that lists PBS Medicines prescribed and dispensed but healthcare providers are not obligated to use it with every patient or for every encounter. An individual’s My Health Record may not include a record of every interaction the patient has had with the health system or an up-to-date status of their health. One in ten Australians do not have a My Health Record1.
The My Health Record was never designed to replicate the full clinical notes curated by the patient’s treating medical practitioner and is an inappropriate tool to be used by non-clinician pharmacists to inform clinical judgements about the appropriateness and risks of administering medicines to individual patients. The My Health Record is also consumer facing and patient controlled. Privacy, security and consent aspects of the My Health Record permit patients to set record access codes to limit access to selected healthcare providers, control access to specific documents, remove documents or delete their entire record. Consequently, the AMA opposes reliance on pharmacy uploads to the patient’s My Health Record to support down-scheduling medicines that without the My Health Record would otherwise be considered unsafe to supply over the counter. Decisions to down-schedule medicines should be decided on clinical merit.
Further, the Committee needs to consider how such an obligation would be enforced and monitored given the privacy and security nature of patient’s My Health Record.
Referring to down-scheduling generally, the AMA reiterates its concern that there is, in effect, no compliance or enforcement mechanisms except through a complaint being brought to the Pharmacy Board or the relevant State/Territory government agency. Without any monitoring or reporting mechanisms in place it is likely that non-compliance will only come to the attention of these bodies when a patient suffers an adverse event.
This is clearly a ‘brain fart’ on the part of the TGA (or whoever). The #myHealthRecord is totally inappropriate as a manager of this sort of information where completeness, timeliness and accuracy are important.
This is as stupid policy suggestion as I have ever seen and I have seen some beauts!
David.

AusHealthIT Poll Number 514 – Results – 16th February, 2020.

Here are the results of the poll.

Do You Believe The Government(s) Will Provide The Significant Funding Necessary To 'Replatform' The #myHealthRecord In The Next Year Or Two?

Yes 19% (19)

No 77% (79)

I Have No Idea 4% (4)

Total votes: 102

A clear majority vote. Most don’t think the Government will fund the #myHealthRecord redevelopment. This suggests most don't think it has a future.

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

A very reasonable turn out of votes.

It must have been a harder question as 4/102 readers were not sure how to respond.

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

David.

Saturday, February 15, 2020

Weekly Overseas Health IT Links – 15 February, 2020.

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 ACOs are Integrating Social Determinants of Health in Practice

A new report found that data, community partnership, and funding are challenging ACOs addressing the social determinants of health.
February 04, 2020 - Despite agreement that the social determinants of health (SDOH) can impact accountable care organization (ACO) success, many see challenges in integrating interventions into practice, according to a new study published in Health Affairs obtained ahead of print by journalists.
Specifically, ACOs face challenges in collecting data about patients experiencing key SDOH, creating meaningful community health partnerships, and making a financial case for SDOH interventions, the researchers said.
This comes even as ACOs are poised to tackle SDOH given their payment structure. The social determinants of health can impact between 40 and 90 percent of patient outcomes, and given that ACOs are paid based on those outcomes, it is natural that they are gearing up to integrate SDOH work into practice.
But the road getting there hasn’t exactly been well-paved, the researchers said.
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Insider Breach Remediation Costs Health, Pharma $10.81M Annually

Overall, new research shows healthcare and pharma entities spend $10.81 annually on insider breach remediation. Across all sectors, organizations spend $11.4 to combat insider threats.
February 06, 2020 - Health and pharma organizations that experience security incidents caused by careless or malicious insiders spend an average of $10.81 million each year to remediate the threat, according to a recent report from Proofpoint.
Overall, organizations across all sectors spend an average of $11.4 million each year to remediate the threat – up 31 percent from $8.76 million in 2018. And impacted organizations spent an average of 77 days to contain each insider event.
Just 13 percent of insider incidents were contained in less than 30 days.
The Cost of Insider Threats 2020 Global Report was commissioned with the Ponemon Institute and co-sponsored by IBM. Researchers surveyed about 1,000 IT and IT security leaders from across the globe, with each represented organization from the study experiencing at least one insider-related security event in the last year.
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NIST offers providers tips for protecting complex cyber supply chains

February 07, 2020, 3:39 p.m. EST
The National Institute of Standards and Technology is offering strategies for healthcare organizations and other industries to better secure their cyber supply chains.
NIST computer experts have developed a set of risk management techniques into a guidebook, available here.
The guidebook gives ideas to address cybersecurity issues posed by modern information and communications technology products that are built using components and services supplied by third-party organizations.
Consequently, the nature of these devices and systems makes them difficult to secure effectively against malware, placing manufacturers, service providers and end users at risk, according to Jon Boyens, one of the report authors at NIST.
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HIT Think

2020: The year of the patient centricity

February 07, 2020, 3:50 p.m. EST
The concept of patient centricity has been around for some time, but traditional product-based approaches have persisted, especially within pharma companies.
However, life science organizations are increasingly understanding that they can’t deliver tomorrow’s innovation today if they are still using yesterday’s business models. Focusing on product doesn’t enable the responsiveness and agility needed to meet changing patient expectations.
Instead, we are witnessing a much deeper patient engagement that requires greater communications and collaboration both between the patient and healthcare providers and pharma companies as well as between different functions with life science organizations.
We’re already seeing an explosion in the mobile health market. In 2020, we’ll see more advances in the connected patient, where mobile and wearable devices and healthcare apps not only share data, but give patients direct access to their treatment regimes.
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Community hospitals weigh replacing their EHR systems

February 06, 2020, 10:31 p.m. EST
Community hospitals—smaller providers generally believed to be late to implement electronic health records systems—are now taking a closer look at whether they’re getting a return on their digital investment.
New research suggests that a majority of the nation’s smaller healthcare facilities with fewer than 150 beds are questioning whether current health information technologies are delivering business value.
Cloud-based solutions—which weren’t available a decade ago—are under increasing consideration, according to research based on first quarter results from the 2020 survey of consultancy Black Book.
The results of Black Book’s research are significant because it suggests that rural, specialty and critical access hospitals are taking a fresh look at the electronic systems they now have in place. Many hurried to implement systems to get incentives and achieve compliance with federal efforts during the past decade that encouraged providers to implement EHRs.
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AMA: Growing numbers of docs embracing digital health tech

February 06, 2020, 10:44 p.m. EST
Adoption of digital health tools by physicians in the last three years has grown significantly, according to an American Medical Association survey of more than 1,300 doctors.
AMA found that not only has there been an increase in the number of physicians that see a “definite advantage” in using digital health technology, but the rise in usage extends to all doctors surveyed regardless of gender, specialty or age.
The 2019 survey results, released Thursday, provide an update to a 2016 AMA study. What they show is that more than 87 percent of physicians see at least some advantage in digital health tools, and almost 30 percent of doctors have adopted the technology.
“Requirements for adopting digital health tools have remained unchanged,” according to the AMA. “Integration with EHR and being as good as traditional care are the two key requirements. The importance of digital health tools being covered by standard malpractice insurance has increased significantly as a requirement. Demonstration of safety and efficacy in peer-reviewed publications has also increased in importance.”
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AMA sees surge in health IT adoption, 'rise of the digital-native physician'

Its new report on emerging technologies sees appetite and aptitude growing for telehealth and virtual visits, remote patient monitoring, clinical decision support and more.
February 06, 2020 03:00 PM


Physicians' use and appreciation of information technology and digital health tools has seen a big uptick over the past five years, according to a new survey from the American Medical Association.
The AMA, which first began benchmarking how various health technologies are being integrated into  clinical practice in 2016, says its new research finds physicians – more than ever – see digital health as a key driver for quality outcomes, cost efficiency and patient access.
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Interoperability? Yes, for value’s sake!

When we talk about connected care and interoperability, we tend to do so within an outdated framework that prioritises ‘medicine’ over ‘health’. We shouldn’t get stuck there, writes Dr Charles Alessi, HIMSS International chief clinical officer.
February 07, 2020 04:15 AM
There is a misconception that the terms health and medicine are interchangeable, but they describe very different concepts and states.
Health has been subject to whole series of definitions and WHO defined health in the Alma Ata declaration in 1978 as follows: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”. It is called the Alma Ata declaration as this was the place WHO were then meeting – now Almaty in Kazakhstan.
But is this the best definition? I am a male who has less than perfect eyesight – although well corrected and also perhaps not the most abundant crop of hair. Does this mean I can never attain the “complete physical, mental and social well-being”?  
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Is Epic Poised To Own The Healthcare Voice Assistant Market? Not Quite.

February 7, 2020
Given its position atop the EHR industry, the things Epic does can have an outsized influence on the healthcare world. Will such be the case when Epic debuts its new voice assistant at HIMSS20? I’d argue that this time, perhaps, not so much.
According to a piece appearing in Healthcare IT News, Epic is debuting an assistant called “Hey, Epic!” At the upcoming HIMSS20 show. The assistant, which Epic describes as ambient voice technology, works in much the same way as the now-ubiquitous Alexa assistant bundled with a wide range of Amazon smart speakers.
In this case, the device and smart assistant are set up to get information for clinicians and help them take action. The clinicians will be able to say “Hey Epic” to summon the assistant, which is reportedly in use already by almost 20 organizations. Hey Epic can place orders, called members of a patient’s care team, and create reminders, as well as performing other emerging functions, according to Sean Bina, vice president of access and patient engagement.
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The Safe Bets You Used to Choose Aren’t The Safe Bets Anymore

February 7, 2020
One of the most famous phrases in technology selection is “Nobody ever got fired for buying IBM.” If you’ve worked in technology, you’ve heard this phrase. If you’ve worked in healthcare technology, then you’ve probably heard the similar phrase, “Nobody ever got fired for buying Epic.”
Turns out that this phrase while often accurate is also not a great approach for many technology business decisions. Sometimes the incumbent, reliable technology is the best option and sometimes it’s not. However, choosing the reliable technology from the vendor everyone knows just because it’s reliable and won’t get you fired is a bad strategy that will hurt your organization or business long term. Even if the FUD (Fear, Uncertainty, and Doubt) this phrase creates for managers is real.
When talking with Josh Gluck, VP, Healthcare Technology Strategy at Pure Storage, he introduced me to a new phrase:
“The Safe Bets You Used to Choose Aren’t The Safe Bets Anymore”
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eHealth can't rule out theft of personal information in cyberattack

"We may never know for sure exactly what is in those files."
Updated: February 7, 2020
New evidence suggests a significant number of files were transferred to “suspicious” IP addresses in a recent cyberattack against the province’s electronic health system — meaning eHealth Saskatchewan is no longer certain personal information was not compromised.
An investigation by SaskTel found that the files were sent to “suspicious” IP addresses during a ransomware attack against eHealth Saskatchewan on Jan. 5.
Since the files were encrypted, CEO Jim Hornell said he can no longer rule out the possibility that personal information may have been compromised 
“We can’t unequivocally say whether they have it or not,” Hornell said.
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eHealth files stolen in ransomware attack

By Mickey Djuric
Updated February 7, 2020 6:44 pm
Saskatchewan’s eHealth agency has confirmed that some of their files were stolen in a ransomware attack that occurred in January.
The recent discovery came to light during the organization’s forensic analysis.
“There were some files that did leave our organization and went to some suspicious IP addresses in Europe,” said Jim Hornell, CEO of eHealth.
The files are locked by the attacker, making it difficult for eHealth to determine what’s on them.
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Cerner CEO Speaks Out in Favor of ONC Interoperability Rule

Cerner took an indirect stance against Epic by backing the ONC interoperability rule on Tuesday.

February 05, 2020 - The back-and-forth between EHR vendors, health organizations, and the federal government regarding the Office of the National Coordinator’s proposed rule on interoperability and information blocking took another turn on Tuesday when Cerner Chairman and CEO Brent Shafer addressed the matter on an earnings conference call.
“For several decades, Cerner has been a trusted steward of health information and a leader in the pursuit of data interoperability,” said Shafer. “We have been a vocal proponent of the 21st Century Cures Act, and we look forward to continuing our work with the ONC, clients, and other key stakeholders to ensure the secure flow of information across disparate systems and health care entities.”
Two weeks ago, Epic CEO Judy Faulkner urged hospital executives via email to take a stand against the Department of Health and Human Services’ (HHS) proposed regulations that are intended to make it easier to share medical information.
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Medtronic Patches Vulnerabilities in CareLink, Implanted Medical Devices

Medical device giant Medtronic recently issued a set of patches for previously disclosed vulnerabilities found in its CareLink programmers and certain implanted devices.

February 05, 2020 - Medtronic recently issued a set of patches for previously disclosed vulnerabilities found in certain implanted cardiac medical devices and its CareLink Encore 29901 programmers.
The first set of updates are for MedTronic’s proprietary Conexus telemetry system flaw first disclosed in March 2018. Found in thousands of the vendor’s cardio defibrillators, the vulnerability could allow a hacker to remotely control the implanted devices.
According to the initial alerts from the Department of Homeland Security and the Food and Drug Administration, the issue lies with a lack of authentication or authorization for the protocol. As a result, an attacker in close range could gain access to the defibrillator with its radio turned on, then inject, replay, modify, and or intercept data communications.
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February 05, 2020 04:23 PM

ECRI Institute creates hospital resource center for coronavirus

The ECRI Institute launched a resource center on its website to help providers prepare for potential threats associated with the Wuhan coronavirus.
The Coronavirus Outbreak Preparedness Center, which is free to the public, includes lists of supplemental devices and supplies as well as guidance on how clinicians can prepare for viral outbreaks.
Although only 11 U.S. patients have been diagnosed with the 2019 novel coronavirus, hospitals should still be preparing for a more widespread threat that could impact them, said Dr. Andrew Furman, executive director of clinical excellence at the ECRI Institute.
"They (hospitals) should be looking at this," he said. "The more you are ready for what could come in, there is no panic in the room, everyone feels comfortable in their role, the patient and family sense that same level of comfort because they know they are in good hands to get the care they need."
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Surveys examine patient, dermatopathologist views on understanding of reports

February 6, 2020
Alice Watson
Dermatopathology reports may need to be redesigned to increase patient comprehension due to the lack of understanding patients have of current reports, according to a research letter published in JAMA Dermatology.
An anonymous survey was offered to all patients at Brigham and Women’s Hospital dermatology clinic over 6 days in April 2019. The survey asked about demographics and attitudes about technology, with a request to interpret a deidentified pathology report. However, a separate survey suggested that most practitioners would not change the content of dermatopathology reports and that a “substantial proportion” of practitioners already receive phone calls from patients who read their reports and want to discuss the results.
Patient survey
“This study showed that sharing of health data, such as dermatopathology results, with patients may not be achieving the goal of transparency, as even a highly educated patient population struggled to correctly identify the diagnosis or its implications when asked to interpret a standard report,” Alice Watson, MD, MPH, of the department of dermatology at Brigham and Women’s Hospital at Harvard Medical School in Boston, told Healio.
Two hundred twenty-five patients completed the survey; 84% had higher education, and 70% used a patient portal on at least a monthly basis. Overall, participants rated themselves as confident in their technology and health literacy.
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Providence works with outside providers through platform to stem ED repeats

February 06, 2020, 3:10 p.m. EST
Providence Healthcare System is collaborating with providers outside its organizational walls and enlisting technology to successfully curb unnecessary utilization of its emergency departments.
Physicians and staff in the system’s emergency departments were seeing unusually high rates of patients who were frequently coming to the EDs for care—for example, some patients were visiting EDs at least six times in six months, and some were registering as many as 20 visits in a year.
Providence is an expansive delivery system with 50 hospitals and 829 clinics across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Knowing that many of the patients had needs that extended beyond the ED, the organization knew it needed to go beyond its delivery system. Consequently, Providence began collaborating with outside providers that included primary care, behavioral health and specialty providers. To facilitate this, it also adopted a care collaboration platform from Collective Medical. The platform gave staff and clinicians insights into patient needs that include existing conditions, safety concerns, comorbid behaviors and substance use disorders.
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Wilkie: VA will soon have the world’s first 5G-enabled hospital

February 05, 2020, 10:55 p.m. EST
The Department of Veterans Affairs’ Palo Alto Health Care System is on the verge of becoming the world’s first 5G-enabled hospital.
“President Trump last year challenged America to be the first 5G wireless service, and VA met that challenge,” said VA Secretary Robert Wilkie on Wednesday during a speech at the National Press Club in Washington. “As I speak, our hospital in Palo Alto is about to become the first 5G-enabled health facility in the world.”
According to Wilkie, 5G technology—the fifth generation of cellular mobile communications—will be operational this week at the VA Palo Alto Health Care System.
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Data and technology to play key role in Europe’s Beating Cancer Plan, says EU chief

European Commission president Ursula von der Leyen launched a consultation to shape the upcoming strategy on World Cancer Day.
February 06, 2020 03:41 AM
Estimates from the International Agency for Research on Cancer indicate that, globally, there were 17 million new cases of cancer in 2018. Within the next two decades, that number is projected to grow to 27.5 million.
In the EU, although 3.5 million people are diagnosed every year, the last scheme for the prevention and detection of cancer ‘dates back 30 years’, according to European Commission president Ursula von der Leyen.
Vowing to take action, on World Cancer Day (4 February), von der Leyen announced the launch of a public consultation to help shape Europe’s Beating Cancer Plan, a new strategy expected to be released before the end of the year.
“For me, and for so many of you, this is personal. We all have our personal stories of struggle, pain and resilience,” the EU chief said this week at a conference in Brussels.
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How hospitals need to shift their thinking about trust

The modern cyber threat landscape means health systems can't take any chances on their networks. At HIMSS20, one expert will describe the ethos of "never trust, always verify."
February 06, 2020 11:54 AM
It's a scary world out there. The explosion of internet-connected devices have been matched only by the volume and sophistication of attacks they are susceptible to. For a hospital IT manager, the stakes here are exceptionally high.
Protected Health Information still remains one of the most highly-sought after targets for digital theft, and hospitals are the main repository of that information. Compliance requirements like HIPAA or HITECH, meant to combat these kind of attacks, have become stricter and pose another set of constraints and challenges on IT administrators.
"Traditional security approaches follow a model where it was enough to keep everything secured inside behind a defined perimeter," says Amanda Rogerson, senior product marketing manager at Duo Security, now part of Cisco.
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Healthcare Employers are Competing for Data Science Talent

February 6, 2020
The healthcare industry has spent the better part of the last decade building new and revamping old information systems. We’ve created new ways to collect, store and share data and have been hyper focused on what comes next for that data. But as the industry has done so, one thing that has been become clear is the need for more talent capable of working with that data.
The need for data science professionals is growing alongside the rate at which technology invades healthcare. A 2019 analysis of health data scientist job postings published in the Journal of the American Medical Informatics Association highlighted the ferociousness with which healthcare providers, IT vendors and insurance companies are competing for data science talent.
The skills most sought after include knowledge of common programming languages and machine learning development. These organizations are looking make better use of the data they have by structuring and analyzing it to create stories from data that is diverse in content and fragmented throughout systems.
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The long road to fairer algorithms

Build models that identify and mitigate the causes of discrimination.
An algorithm deployed across the United States is now known to underestimate the health needs of black patients1. The algorithm uses health-care costs as a proxy for health needs. But black patients’ health-care costs have historically been lower because systemic racism has impeded their access to treatment — not because they are healthier.
This example illustrates how machine learning and artificial intelligence can maintain and amplify inequity. Most algorithms exploit crude correlations in data. Yet these correlations are often by-products of more salient social relationships (in the health-care example, treatment that is inaccessible is, by definition, cheaper), or chance occurrences that will not replicate.
To identify and mitigate discriminatory relationships in data, we need models that capture or account for the causal pathways that give rise to them. Here we outline what is required to build models that would allow us to explore ethical issues underlying seemingly objective analyses. Only by unearthing the true causes of discrimination can we build algorithms that correct for these.
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Industry Voices—How telehealth can slow the spread of the coronavirus outbreak, other infectious diseases

Feb 5, 2020 11:55am
The impending U.S. provider shortage has been generating headlines for years, but an overlooked specialty shortfall is a threat even scarier than the coronavirus turning into a pandemic.
Infectious disease (ID) specialists, who play a critical role in curtailing the spread of outbreaks, seem to be a dwindling breed. Between 2009 and 2017, the number of academic programs that filled their adult-infectious-disease training positions dropped by 41%, according to a report by Emory University.
A New York Times article maintains that infectious disease is one of only two medical subspecialties that routinely do not fill all of their training spots in the National Resident Matching Program.
We are living in an age of antibiotic-resistant microbes, or “superbugs,” which means the possibility of widespread drug resistance has broad implications. Antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths annually, according to the U.S. Centers for Disease Control and Prevention.
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Study Sees Success in Using mHealth to Help People With Eating Disorders

Researchers at New York's Mount Sinai health system say an mHealth app helped people living with a variety of eating disorders manage their health, reduce adverse clinical outcomes and move toward remission for at least a year.

February 04, 2020 - People living with eating disorders can use an mHealth platform to curb their impulses and improve long-term care management, according to research done at the Icahn School of Medicine at Mount Sinai.
As reported this week in The American Journal of Psychiatry, cognitive behavioral therapy (CBT) delivered through an mHealth app with telehealth capabilities showed success in helping people with a variety of eating disorders for at least a year. The results show promise for the estimated 6.5 million Americans living with issues that range from binge eating disorder to bulimia nervosa.
“We know the platform is acceptable to patients, feasible to deliver, and when combined with CBT-GSH (guided self-help) with a trained clinician, improves symptoms,” Thomas D. Hildebrandt, PsyD, Chief of the Center of Excellence in Eating and Weight Disorders at The Mount Sinai Hospital and lead author of the study, said in a press release. “The purpose of this study was to evaluate the robustness of the intervention when delivered by non-specialist health coaches in a community health care system via telemedicine. We were encouraged by the results that showed that this intervention is effective and can be scaled outside of specialty clinical programs.”
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Dr Don Rucker on interoperability, FHIR and global collaboration

As a first year medical student in 1978, a young Donald Rucker was exposed to early health technology at his American university and knew there had to be a better way to communicate critical information.
February 05, 2020 06:33 AM
 “It struck me as how monumentally inefficient and labour intensive this environment was. It was random; innately, you could see safety issues just because it was very one-off labour intensive,” Dr Rucker told HIMSS Insights.
“I thought that automation was going to be a driving force in healthcare to make it less expensive, more efficient, more reproducible, far more safer and also, frankly, responsive to the consumer.”
But it would take many more years than he expected for healthcare to be transformed.
“I thought the EHR problem would probably be solved on Silicon Valley time in 1991 or so. So I was off by [more than] two and a half decades.”
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What’s Behind Microsoft’s New Public Health AI Play?

February 5, 2020
In a play for public health street cred, Microsoft has announced the creation of a new program designed to help public health researchers and organizations to leverage AI. The software giant plans to spend $40 million over five years in locations around the world for this effort, which is part of Microsoft’s $165 million AI for Good program. The new initiative is dubbed AI for Health.
There are a few ways to look at this announcement, and I’ll start with the most generous view. In taking this step, Microsoft is reaching out to help populations that are unlikely to see the benefits of the health AI explosion anytime soon. This is certainly commendable, and quite a public-spirited use of Microsoft resources, something one would hope to see more often from other Big Tech players.
Another, somewhat less flattering take on this announcement reads as follows. Perhaps Microsoft is hoping to demonstrate that AI isn’t some sort of sinister force that will eventually make unsympathetic, even horrifying medical decisions that harm human beings. “Look at all the people in Third World countries that we’ve helped with AI!” I can imagine PR execs telling the press. (Of course, some health insurance companies are already making heartless decisions about people’s care, but the public doesn’t always remember this.)
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Humana Opens The Door To Massive Influx Of Patient-Generated Data

February 5, 2020
Here’s a deal that could have a greater impact than it might appear upon first glance. Humana has cut a deal with a vendor allowing members to share data from a very wide range of devices and apps with its wellness division.
Working with personal health data platform Validic, Humana will allow members to connect hundreds of patient-facing connected technologies, including wearables, health apps, and in-home medical devices. The new effort is being run by the health plan’s Go365 wellness and rewards program.
Humana eventually expects to expand the devices and data points Go365 connects with to address a wider range of wellness challenges such as nutrition, smoking cessation and mental health concerns.
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Teenager, Parent, and Clinician Perspectives on the Electronic Health Record

Jennifer L. Carlson, Rachel Goldstein, Tyler Buhr and Nancy Buhr
Management of adolescent confidentiality and sensitive services has always posed challenges to medical clinicians. State and federal laws, as well as institutional policies, may dictate what information can or cannot be shared by a clinician with a parent or guardian of an adolescent. Clinicians concerned about diagnosis disclosure via insurance notifications may limit their testing or prescription, refer sensitive services to more specialized reproductive health clinics, or appeal to noninsurance funders to cover sensitive testing and confidential prescriptions. All factors may be burdensome to patients, families, and/or clinicians.
With the advent of electronic health records (EHRs), clinicians face additional challenges for preserving adolescent confidentiality.1 Clinicians are frequently in the difficult situation of balancing their patient’s need for confidentiality with creating an accurate and complete medical record that enhances coordination of care with families and other clinicians.2 Current EHR systems are often extremely limited in their ability to ensure confidentiality of items such as medications or problem lists across the many interfaces in which these items could be disclosed (such as after-visit summaries, shared or open notes, problem and medication lists within the portal system).3 Whereas some institutions have a practice of using confidential note types or confidential encounters for sensitive information, this practice relies on clinicians to consistently document the appropriate information in the appropriate location. Institutions have also used custom-built functionality for excluding specific laboratory values or medications from being shared within the portal, but this is a labor-intensive undertaking.
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How deep learning-based natural language processing is changing radiology

Michael Walter | February 03, 2020 | Medical Imaging
Natural language processing (NLP) can provide significant value in radiology, extracting key data from the electronic health record and prioritizing radiologist worklists. According to a new analysis published in the Journal of the American College of Radiology, deep learning (DL) technology is now being used to make NLP even more effective—and it’s a growing trend that shows no signs of slowing down.  
“DL NLP is increasingly encountered in the literature,” wrote lead author Vera Sorin, MD, Chai Sheba Medical Center in Israel, and colleagues. “It is expected to play a larger role in research and clinical practice in coming years.”
Sorin et al. analyzed 10 academic studies on DL NLP and radiology, searching for key trends that could help radiologists and other imaging professionals gain a better understanding of this new technology. All studies were published from January 2017 to September 2019.
The team noted that researchers are exploring the effectiveness of DL NLP in a number of ways. For instance, some studies focused on how it can be used to flag and classify radiology reports.
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Cerner, MedStar Start Learning Health Network for Clinical Research

MedStar Health and future members of Cerner Learning Health Network aim to improve patient care and enhance clinical research through teamwork and a pool of de-identified data.

February 04, 2020 - MedStar Health, the largest healthcare provider in Maryland and Washington DC, announced it is the first health system to join Cerner Learning Health Network, a collaborative platform that connects care providers to drive clinical research.
The Cerner Learning Health Network will provide participating health systems and clinical research organizations with de-identified data and resources to develop better, more efficient medical research.
“We are proud to be one of the first health systems in this innovative approach to clinical research,” said Neil J. Weissman, MD, president of MedStar Health Research Institute and chief scientific officer for MedStar Health. “Using a network of academic health systems, linked with streamlined electronic data, will transform the efficiency and effectiveness of clinical trials.”
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HIT Think

How to improve patient outcomes with accurate identity matching

February 04, 2020, 3:37 p.m. EST
The U.S. House of Representatives recently voted to lift a decades-old ban on developing a national patient identifier, a unique identification number that could be used across healthcare systems nationwide.
It’s a fairly simple concept, but very complex in practice, with deep implications for both privacy and well-being. It is critical to patient safety, public health and program integrity that we all get it right.
While a national system is still a long way off, there are things we should be doing to improve our patient matching and unique identifier capabilities. We must work toward standardizing processes to accurately tie dissimilar sets of data together while maintaining the highest level of privacy safeguards. This will potentially provide a more complete picture of each patient’s health and an improved understanding of public health, while reducing the burden of the cost and time on the healthcare industry to create a patient matching system.
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Researchers: Feds must pay for $3B EHR at Indian Health Service

February 03, 2020, 11:52 p.m. EST
The federal government has “an obligation” to fund a major healthcare IT modernization program at the Indian Health Service, and the bill will be high.
It could cost $3 billion to replace the agency’s legacy electronic health record system, according to an assessment of researchers from the Regenstrief Institute and Indiana University School of Medicine, writing in a Health Affairs blog.
IHS, an agency of the Department of Health and Human Services, currently uses the Resource and Patient Management System (RPMS), which was developed in close partnership with the Department of Veterans Affairs to manage its clinical, financial and administrative information.
However, according to researchers, “years of inattention and underfunding have left the RPMS unusable by current technological standards, making it difficult to provide continuous, consistent care.”
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Hackers use phishing attacks to take advantage of coronavirus crisis

February 03, 2020, 11:44 p.m. EST
The spread of the Wuhan coronavirus and the threat to public health is being exploited by cybercriminals who are using the global crisis to launch malicious phishing campaigns.
On Monday, the Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response warned that phishing attacks have been made via emails with attached Word documents—as well as PDF and MP4 file attachments—offering guidance on how to prevent infection.
In addition, ASPR’s Division of Critical Infrastructure Protection reported that hackers have sent spam emails to users in Japan alerting them about a supposed new strain of coronavirus.
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Medical device deployments demand a robust security strategy

With the number of connected devices steadily increasing, health systems and hospitals need a comprehensive plan to guard against cyber threats. At HIMSS20, one infosec pro will describe some best practices.
February 04, 2020 10:35 AM
Medical devices are a weak link in the security chain, uniquely susceptible to cyberattack. And the stakes – patient lives – couldn't be higher.
Historically, medical devices were standalone, and only interacted with the patient. But today devices are storing and transmitting data, and contain configurable embedded computer systems and are connected to the network, potentially accessible by anyone on the network and subject to cyberattack.
Complicating the picture, many are legacy devices with no control options, and current medical device inventory lacks basic IT information. So how can a health system build a robust medical device security program?
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Changes To EHR Presets Can Lower Number Of Opioid Pills Prescribed

February 4, 2020
Part of a growing body of evidence putting EHRs at the center of opioid use reduction efforts, a new study has concluded that small changes to EHR presets can lower the number of opioid pills physicians prescribe. This is particularly interesting when thinking back to the Practice Fusion opioid kickbacks we wrote about last week.
After concluding their analysis, researchers at UC San Francisco found that when EHR presets suggesting the prescription of a standard number of opioid pills were lowered, physicians prescribed fewer pills. The study was published this month in JAMA Internal Medicine.
Previous research has already examined the extent to which leveraging existing EHR data could predict post-hospital use.  For example, a 2018 study published in the Journal of General Internal Medicine described a model predicting the likelihood of future chronic opioid use based on hospital data.
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Cerner Notches Nearly $5.7B in Full Year Revenues

By Jack O'Brien  |   February 04, 2020

The Kansas City-based health information technology company's backlog totaled $13.71 billion.

Cerner Corp.'s Q4 2019 and full year revenues both increased 6% year-over-year, according to the company's latest earnings report released Tuesday afternoon.
For Q4, Cerner reported revenues of $1.4 billion, which were in line with company expectations, and full year revenues of nearly $5.7 billion.
The Kansas City-based health information technology company reported full year bookings of almost $6 billion, which were represented a year-over-year decline due to Cerner "being more selective in the types of contracts it pursues."
Additionally, Cerner reported an operating cash flow of $ 437.6 million and a free cash flow of $292.1 million, which both marked improvements compared to Q3 2019. 
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Industry Voices—Next-generation HIEs: Providing measurable value in a network of networks

Feb 3, 2020 11:12am
To survive and thrive in the ever-evolving health information exchange (HIE) marketplace across the nation, HIE organizations need to be entrepreneurial and have a collaborative working spirit by partnering with others.
HIEs also need to have the ability to adapt to opportunities and change, while working to deliver real, measurable value to their stakeholders. 
The proposed Trusted Exchange Framework and Common Agreement (TEFCA) certainly presents opportunities and change, and also accelerates this HIE evolution by establishing a core set of data that needs to be available for exchange, laying out a common set of privacy and security requirements, as well as ensuring that healthcare stakeholders need just a single on-ramp to participate in the exchange on a local, regional and national level.
While TEFCA establishes this baseline exchange framework with core data sets and common sharing methods, such as the HL7 Fast Healthcare Interoperability Resources (FHIR) standard, entrepreneurial HIEs can work to deliver value to their stakeholders by supporting specific use cases, enhancing value-based care initiatives and managing data on a population-level—something that many HIEs indicated was an important future priority in a 2019 Survey on HIE Technology Priorities.
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Meditech rebound continues as the EHR vendor expands partnerships with tech giants

Feb 3, 2020 12:43pm
Meditech continues to climb back from a three-year backslide, reporting its third straight year of revenue growth.
The Massachusetts-based electronic health record (EHR) vendor reported $493.8 million in revenue in 2019, a 1.2% increase from the previous year’s $488.2 million, according to year-end financials reported to the Securities and Exchange Commission (SEC).
The company suffered a three-year slip during which it saw revenue drop more than $117 million. The company’s sales dropped gradually since 2013 when it posted nearly $580 million in revenue. In 2014, Meditech posted $517 million in revenue and that dropped to $475 million in 2015, followed by year-end revenue of $462 million in 2016.
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World Health Organization CIO on healthcare data, privacy, trust, and ethics (CxOTalk interview)

The CIO of WHO talks about the risks and opportunities of big data when it comes to health care. Large technology companies are important partners in building trust and advancing efforts around digital health. But determining how to partner is not always simple or easy.
By Michael Krigsman for Beyond IT Failure | January 30, 2020 -- 19:24 GMT (06:24 AEDT) | Topic: Digital Transformation
I recently spoke with the chief information officer of the World Health Organization, Bernardo Mariano, about digital transformation and healthcare on episode 364 of the CxOTalk series of discussions with the world's top innovators.
The subject of data ownership and related ethical considerations was one of the most interesting aspects of our conversation.
We all know that technology companies -- Facebook, Google, Amazon, and most other online companies -- gather, aggregate, share, and monetize their users' personal data. The scale of data aggregation, together with the impact of that scale on peoples' lives, raise questions in areas such as data privacy, ownership of data, and legal protections for consumers.
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Data Transparency and Curation Vital to Success of Healthcare AI

By Scott Mace  |   January 31, 2020

More transparency, better human curation, and standards to control privacy were some of the solutions presented at the Precision Medicine World Conference to address healthcare systems' hesitancy to implement AI.


KEY TAKEAWAYS

·         The false start of Watson AI technology points to the need for human curation, said one healthcare executive presenter.
·         A recurring theme during the conference was the need for a third party to provide trusted certification that machine learning and AI algorithms are free from bias.
·         Amid advances in precision medicine, healthcare is facing the twin challenges of having to curate and tailor the use of patient data to drive genomics-powered breakthroughs.
That was the takeaway from the AI & data sciences track of last week’s Precision Medicine World Conference in Santa Clara, California.
"There aren't a lot of physicians saying, 'Bring me more AI,' " said John Mattison, MD, emeritus CMIO and assistant medical director of Kaiser Permanente. "Every physician is saying bring me a safer and more efficient way to deliver care."
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Medical professionals battle virus misinformation online

February 1, 2020
Dr. Rose Marie Leslie, a family physician at the University of Minnesota, is fighting misleading and false information around a virus outbreak with the very tool used to spread much of it: social media.
Leslie turned to TikTok, a platform popular with teens, to share her videos offering facts about the respiratory virus originating in China, which has so far sickened nearly 10,000 people. As of Friday, the videos had raked in more than 3 million views.
“The thing about TikTok as a platform is any video can go viral whether or not somebody is giving out factual information, and usually people don’t post where they get their information,” she said. “My goal is to be able to give the facts in every single one of my videos.”
From fringe groups pushing false — and dangerous — claims about how to prevent the virus to videos said to show people fleeing the outbreak or experiencing horrendous side effects, misinformation online is fueling fears and sowing confusion.
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FDA clears AI algorithms for detecting AFib, heart murmurs

February 02, 2020, 10:13 p.m. EST
The Food and Drug Administration has given clearance to algorithms for the detection of atrial fibrillation and heart murmurs, when used in combination with a digital stethoscope.
Developed by digital health vendor Eko, the company contends that their artificial intelligence-powered stethoscope is the first to screen for these serious cardiovascular conditions and will enable providers to make more accurate patient diagnoses during routine physical exams.
According to Connor Landgraf, Eko’s co-founder and CEO, the company’s AI software puts the “ears of a cardiologist” in a clinician’s stethoscope by accurately analyzing electrocardiogram and heart phonocardiogram (heart sound) data.
 “We interpret those (cardiac data) to identify whether a patient has a murmur in a heart sound or whether they have an arrhythmia in the ECG,” says Landgraf. “What our technology does is allow the clinician to do a very quick screening test in the office that is highly accurate.”
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Report: Healthcare must harness patient data beyond that in EHRs

February 02, 2020, 10:05 p.m. EST
If clinicians are to gain a more holistic view of their patients and improve the quality of care, they must leverage data beyond merely tapping information in electronic health records.
That’s the assessment of a new report from the U.S. Chamber of Commerce, which contends that the real promise of EHRs can be found in combining medical records with genetic information as well as non-clinical data.
In particular, the report—Data for Good: Promoting Safety, Health and Inclusion—makes the case that physicians are increasingly turning to social determinants of health (SDOH), a relatively new term in healthcare.
 “Using SDOH data to improve the quality of healthcare is a newer application,” states the joint report from the U.S. Chamber of Commerce’s Technology Engagement Center and the Policy and Economic Research Council. “It has been discussed and researched for decades—especially by multilaterals in the context of emerging markets—but has not made its way into mainstream until recently. Discussions are now heating up about how to acquire and apply the data.”
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Why interoperability is cool (again)

The ability to gain access to the data through reusable APIs significantly improves developer productivity, enabling CIOs to achieve more with the same resources.
February 03, 2020 01:13 PM
Healthcare data integration was in the news recently with the Office of the National Coordinator highlighting API-led connectivity across Health IT applications as part of its proposed five-year Federal Health IT Strategic Plan.
ONC has been waging a battle with the healthcare and technology sectors to open up data access to patients. While emphasizing greater accessibility of data to patients, ONC chief Don Rucker also noted that the healthcare system’s transformation is “hindered by entrenched interests looking to prohibit access to that information.”
Aside from concerns around data blocking and data access for patients, the ONC’s endorsement of API-led integrations is significant. APIs are the connective tissue that can actually unlock the data and enable access to patients, researchers, and others looking to create engaging digital health experiences.
APIs are pieces of code that expose data from underlying information systems in industry-standard formats (such as FHIR, along with the widely adopted HL7 v2). APIs enable uniform, scalable, and repeatable integrations that accelerate development cycles through standardization and reuse.
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Epic is a Standout in Best in KLAS Software and Services Rankings

By Mandy Roth  |   February 03, 2020

Annual report recognizes software and service organizations that excel in helping healthcare professionals deliver better patient care.

The annual Best in KLAS 2020 Software & Services report is out, and Epic rose to the top of the rankings in multiple categories, earning the title as the top overall software suite for the tenth consecutive year. Also noted for outstanding performance were the top overall IT services firm, Pivot Point Consulting, a Vaco Company, and Accenture, which was named the top overall healthcare management consulting firm. 
The report was released today by KLAS Research, the Salt Lake City-based research and insights firm, recognizing the software and service organizations that excelled in helping healthcare professionals deliver better patient care in the United States. Also released today is the global version of the report, Best in KLAS 2020 Global (Non-US).
“Providers and payers demand better performance, usability, and interoperability from their vendor partners every year,” says Adam Gale, president of KLAS in a news release. “Best in KLAS winners set the standard of excellence in their market segment."
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Weekly News Recap

  • Allscripts will pay $145 million to settle federal allegations that EHR vendor Practice Fusion, which it acquired two years ago, accepted $1 million in opioid prescribing kickbacks and falsified its ONC EHR certification.
  • Imprivata acquires mobile device access management technology vendor GroundControl Solutions.
  • HHS Secretary Alex Azar and CMS Administrator Seema Vema vow that profit-protecting “bad actors” won’t waylay HHS’s propose interoperability rules.
  • The private equity owner of wearables-powered employee wellness vendor VirginPulse reportedly is preparing to sell the company for up to $2 billion.
  • imaging and radiology workflow systems vendor Intelerad sells a majority stake in the company to an investment fund manager.
  • A Health Affairs blog post describes the funding and operational challenges of the Indian Health Service in maintaining and eventually replacing its obsolete, VistA-based RPMS enterprise and EHR system as the VA moves to Cerner.
  • Epic makes a rare public statement in explaining that its opposition to HHS’s proposed interoperability rules involve the potential of app vendors to misuse patient data and for patient family information to be inadvertently shared without the permission of those individuals.
  • Evive acquires WiserTogether.
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Enjoy!
David.