This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Saturday, May 14, 2022
Weekly Overseas Health IT Links – 14th May 2022.
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.
May 06, 2022
- EHR vendor Cerner’s revenue for Q1 of 2022 came
in at $1.43 billion, a three percent increase compared to Q1 of 2022.
“I am pleased
with Cerner’s solid results in the first quarter,” David Feinberg, MD, Cerner
president and CEO, said in a news release. “Our results reflect solid execution
across the business and strong contributions from Cerner EnvizaSM, which is
well-positioned to build on a terrific first year by accelerating the
discovery, development, and deployment of therapies.”
The EHR
vendor also reported a GAAP operating margin of 17.6 percent for Q1 of 2022, up
190 basis points from 15.7 percent in Q1 2021.
“During the
first quarter, we delivered revenue growth in line with our expectations and
expanded Adjusted Operating Margin by 130 basis points, resulting in strong
Adjusted Diluted EPS growth of 17 percent,” said Mark Erceg, Cerner executive
vice president and chief financial officer.
Draft standards and interoperability strategy is published
A draft
standards and interoperability strategy has been published with the aim of
driving interoperability across the NHS and social care.
Hanna Crouch
May 5, 2022
The Faculty
of Clinical Informatics (FCI) was commissioned by the NHS England and
Improvement Transformation Directorate to help them with consultation on the
proposed strategy which involved stakeholders from across health and care.
The overall
aim of the document is to improve levels of interoperability across the NHS and
social care through the development and adoption of standards. This includes an
overview of the challenges and opportunities, clarifies definitions of key
terms and outlines the main proposed solutions.
According to
the strategy there are a number of “foundations of success” which include
“understanding and overcoming current barriers to implementation” and
“introducing a mechanism to identify which vendors’ systems are conformant”.
Maven
Clinic's partnership with Blue Shield of California is part of the plan’s
Health Reimagined strategy, which was launched in 2020 with the goal of
improving access to care. (Mironov Konstantin/Getty Images)
Maven
Clinic, a virtual clinic for women’s and family health, inked a partnership
with Blue Shield of California to expand access to pregnancy and postpartum
support.
The
partnership, which began in January, opens up Maven’s virtual care platform for
fertility, pregnancy and parenting to more than half of the plan’s total
membership—to 2.4 million eligible members. More than 500 members enrolled in
one day after being notified of their eligibility, the company said in an
announcement. Since then, pregnant members’ most frequently booked virtual
appointments are with doulas and childbirth educators as well as mental health
providers, lactation consultants, OB-GYNs and physical therapists.
Members of the healthcare industry
are once again pressuring Congress to remove what they say is a major pain
point in their operations and in the delivery of patient care: the ban on
a nationwide unique patient identifier.
Almost 120 health IT groups, EHR
vendors, hospitals, physicians and health insurers sent letters on
Wednesday to House
and Senate
appropriators urging them to remove decades-old rider language in a 2023
appropriations bill that prevents the HHS from spending federal dollars to
create or adopt a UPI standard.
Signees, including payer lobby AHIP,
software companies Cerner and Epic, and health systems Banner Health and
Intermountain, called the ban “archaic” in the letters. However,
regulators have noted a UPI is unlikely to be a silver bullet against the
nation’s patient matching problem.
Dive Insight:
Identifying
patients and matching them correctly to their records is a perennial issue in
healthcare, and one that’s resulted in a
patchwork of strategies across the industry in absence of one
overarching federal standard. Like many other gaps in the U.S. medical system,
the absence of a cohesive patient matching infrastructure has been highlighted
by the coronavirus pandemic, as public health agencies struggled to collect
and track longitudinal data on metrics like testing and vaccinations.
UPIs,
which are numbers, codes or data used to differentiate one person from another,
are a popular solution, with proponents saying enacting one linked to patients’
record — regardless of their health insurer, provider or medical history —
would cut waste, duplicates and avoidable medical errors.
Docs Find New and Better Ways to Cut EHR Documentation Time
Leigh Page
May 05, 2022
Sixty percent
of physicians cite documenting information in the electronic health record
(EHR) and other paperwork as major
contributors to burnout. Physicians have been working with a variety of
ways to reduce their documentation burdens; could one of them be right for you?
Two methods
involve human scribes — working either on-site or off-site. Two other methods
involve digital solutions: The first is widely used speech-to-text software,
which requires the doctors to manually enter the text into the EHR; the second
uses artificial intelligence (AI) to not only turn speech into text but to also
automatically organize it and enter it into the EHR.
These AI solutions,
which are only a few years old, are widely considered to be a work in progress
— but many doctors who have used these products are impressed.
Other
People Do the Documenting: On-site Scribes
"It's
estimated that now 1-in-5 to 1-in-8 doctors use scribes," said Jeffrey A.
Gold, MD, an internist who has studied the phenomenon. Utilization is already
very high in emergency medicine and has been surging in specialties such as
orthopedic surgery; it is also growing in primary care, Gold and others say.
Joint audit finds DOD, VA fell short on EHR interoperability
The Offices
of Inspector General for both agencies said the Federal Electronic Health
Record Modernization Program Office did not take an active role in managing the
initiative's success.
A
joint report released this week from the Offices of Inspector General
for the Departments of Defense and Veterans Affairs found that the agencies had
not taken all necessary actions to achieve interoperability of patient care
information when they deployed the Cerner electronic health record system and
launched the Joint Health Information Exchange.
"Achieving
interoperability between the DOD, VA, and external healthcare providers through
the deployment of a single EHR system is critical because healthcare providers
will have the ability to securely transfer and share health care information
for the nation’s 9.6 million DoD armed forces members, dependents and retirees,
and 9.21 million enrolled users," read the report.
"VA
appreciates the recommendations," said VA spokespeople in response to
requests for comment from Healthcare IT News. "We consider all
opportunities for improvement in VA’s approach to ensuring a complete
electronic health record that accomplishes a seamless transition from military
service to veteran status.
"We
will continue to work closely and effectively with the Federal Electronic
Health Record Modernization Office and our DOD colleagues on our joint
effort," the spokespeople continued.
Best Practices For Password Security, Cyber Hygiene
Healthcare
organizations should encourage cyber hygiene among employees and require proper
password security measures, such as multifactor authentication.
May 05, 2022
- The first Thursday of every May is known as World Password Day, a day in
which organizations and individuals are encouraged to brush up on their cyber
hygiene and password
security measures.
Weak
passwords may be an easy way for threat actors to gain credentials and worm
their way into a healthcare organization’s network. Cyber education and an
enterprise-wide culture
of cybersecurity can help organizations mitigate risk.
While this is
not an exhaustive list, the following tips and best practices are important
concepts for healthcare organizations to enforce across their workforces.
Implement
Multi-factor Authentication
Multi-factor
authentication (MFA), or two-factor authentication (2FA), requires a user to
verify their identity using two or more authentication factors when logging in.
For example, a user may have to verify their identity by entering a password on
their computer and then responding to a mobile push notification.
In
the world of mental health apps, privacy scandals have become almost routine.
Every few months, reporting or research uncovers unscrupulous-seeming data
sharing practices at apps like the Crisis Text Line, Talkspace, BetterHelp, and
others: people gave information to those apps in hopes of feeling better, then
it turns out their data was used in ways that help companies make money (and
don’t help them).
It
seems to me like a twisted game of whack-a-mole. Whenunderscrutiny,
the appsoften
change or adjust their policies — and then new apps or problems pop up. It
isn’t just me: Mozilla researchers said
this week that mental health apps have some of the worst privacy
protections of any app category.
Watching
the cycle over the past few years got me interested in how, exactly, that keeps
happening. The terms of service and privacy policies on the apps are supposed
to govern what companies are allowed to do with user data. But most people
barely read them before signing (hitting accept), and even if they do read
them, they’re often so complex that it’s hard to know their implications on a
quick glance.
“That
makes it completely unknown to the consumer about what it means to even say
yes,” says David Grande, an associate professor of medicine at the University
of Pennsylvania School of Medicine who studies digital health privacy.
For
healthcare organizations to support today’s rapid transformation, developing a
continuously learning healthcare system is needed to help glean lessons from
the past and carefully plan for the future.
In 2007, the
National Academy of Medicine (formerly the Institute of Medicine) defined
the learning health system as an environment in which “science, informatics,
incentives and culture are aligned for continuous improvement and innovation,
with best practices seamlessly embedded in the delivery process, [with]
patients and families active participants in all elements, and new knowledge
captured as an integral by-product of the delivery experience.”
Over the past
15 years, steady progress has been made toward achieving these goals. The
healthcare industry has never been so driven by data, so centered on patients
or so close to truly aligning incentives for the shared benefit of all
stakeholders.
But there’s
still plenty more work to do to make the learning health system a reality.
Patients must be better engaged so they can become active participants in this
endeavor.
Apple,
Google and Microsoft announced Thursday that they planned to expand support for
a common standard created by the FIDO Alliance and the World Wide Web
Consortium that does not require a password to sign in.
"This
will simplify sign-ins across devices, websites and applications no matter the
platform — without the need for a single password," wrote Sampath
Srinivas, PM director of Secure Authentication at Google and president of the
FIDO Alliance, in a blog.
WHY IT
MATTERS
The
FIDO Alliance – whose executive council comprises Srinivas along with
representatives from Microsoft, Amazon, Intel, Thales and NTT DoCoMo – has been
working toward a passwordless authentication protocol since 2012.
As
noted in a joint press release, password-only authentication can create
security issues that span industries – leading to account takeovers, data
breaches and disrupted services.
"While
password managers and legacy forms of two-factor authentication offer
incremental improvements, there has been industry-wide collaboration to create
sign-in technology that is more convenient and more secure," said the
companies.
Real-time tracking is a must for chronic care management
Dr. Jay
Anders, chief medical officer at Medicomp Systems, describes how technology can
help track hallmark indicators, and better engage patients for quality care.
To
ensure success under value-based care models, providers need specific clinical
information readily available at the point of care to make decisions and take
measures to improve outcomes. Unfortunately, in most instances, they simply
don't have it.
No
one person can keep track of every relevant indicator for a disease. But with
the key hallmark indicators, providers can proactively engage the patient,
engage their family, engage their home care provider, and say, "These are
the things you should watch closely that could indicate a problem."
The
patients should be monitored, regularly, beyond documenting them during the
physician encounter, to avoid trips to the ER and acute episodes. So, real-time
tracking of key indicators can help turn the corner, and communication between
the provider, the patient and the payer team could make chronic care management
work.
Healthcare
IT News sat down with Dr. Jay Anders, chief medical officer at
Medicomp Systems, which develops tools to help make data more usable, to discuss
chronic care management today.
Allscripts Healthcare
Solutions, Inc. (Nasdaq:MDRX) today announced that it has completed the
sale of the net assets of the Allscripts Hospital and Large Physician Practices
business segment to Constellation Software Inc. (TSX:CSU), through its
wholly-owned subsidiary N. Harris Computer Corporation (“Harris”).
“This
transaction enables Allscripts to strengthen its focus on high growth end
markets of interest as well as provide additional value for our clients,
employees, and shareholders,” said Rick Poulton, President and CFO of
Allscripts.
About
Allscripts
Allscripts
(NASDAQ: MDRX) is a leader in healthcare information technology solutions that
advance clinical, financial and operational results. Our innovative solutions
connect people, places and data across an Open, Connected Community of Health™.
Connectivity empowers caregivers to make better decisions and deliver better
care for healthier populations. To learn more, visit www.allscripts.com, Twitter, YouTube and It
Takes A Community: The Allscripts Blog.
Self-contained
telehealth kiosks had a short-lived heyday about 10 years ago. Now they're
getting a second chance, as healthcare organizations look at new ways to
improve access and deliver care to remote populations.
KEY
TAKEAWAYS
·Self-contained telehealth kiosks enjoyed some
popularity roughly 10 years ago with the Healthspot, but a lack of clear ROI
and that company's eventual bankruptcy put an end to the trend.
·Telehealth kiosks then evolved into smaller
workstations and cubicles, and they've been placed in busy emergency
departments, community health clinics, libraries, pharmacies and retail
locations, offering on-demand access to a virtual health visit for popualtions
who can't or won't go to a doctor's office or hospital.
·Newer models like the H3 Cube aim to improve
access to care in rural and remote communities by giving residents access to a
self-contained healthcare visit and allowing healthcare providers to extend
their reach and help underserved populations like the homeless, veterans,
low-income and Native communities.
The
telehealth kiosk may be making a comeback.
Canada-based
UniDoc Health Group unveiled its H3 Cube Virtual Care Solutions Model (VCSM)
kiosk at the American Telemedicine Association conference this week in Boston,
alongside news on a handful of projects around the world and proposed new uses.
The
announcement raises the profile of a direct-to-consumer telehealth form factor
that had enjoyed a heyday roughly a decade ago before sinking into obscurity.
Now, with an emphasis on delivering care to populations in remote locations and
helping people access care outside the hospital or doctor’s office, healthcare
organizations are taking another look.
More
than four years ago, Tennessee nurse RaDonda Vaught typed two letters into a
hospital’s computerized medication cabinet, selected the wrong drug from the
search results, and gave a patient a fatal dose.
Vaught
was prosecuted this year in an extremely
rare criminal trial for a medical mistake, but the drug mix-up at the
center of her case is anything but rare. Computerized cabinets have become
nearly ubiquitous in modern health care, and the technological vulnerability
that made Vaught’s error possible persists in many U.S. hospitals.
Since
Vaught’s arrest in 2019, there have been at least seven other incidents of
hospital staffers searching medication cabinets with three or fewer letters and
then administering or nearly administering the wrong drug, according to a KHN
review of reports provided by the Institute for
Safe Medication Practices, or ISMP. Hospitals are not required to report
most drug mix-ups, so the seven incidents are undoubtedly a small sampling of a
much larger total.
Safety
advocates say errors like these could be prevented by requiring nurses to type
in at least five letters of a drug’s name when searching hospital cabinets. The
two biggest cabinet companies, Omnicell and BD, agreed to update their machines
in line with these recommendations, but the only safeguard that has taken
effect so far is turned off by default.
May 04, 2022
- The App Association’s Connected Health Initiative (CHI) provided
comments to the ONC on its Draft (v3) US Core Data for Interoperability
(USCDI) and its ongoing USCDI expansion process (draft USCDI).
“The USCDI is
central to enhanced interoperability of healthcare data by specifying a common
set of data classes required for exchange and identifying a predictable,
transparent, and collaborative process,” CHI officials said in a letter to
Micky Tripathi, national coordinator for health IT.
The officials
noted that CHI supports the USCDI’s
proposed Version 3’s data classes, which build upon the data classes
referenced in the 2015 Edition Common Clinical Data Set (CCDS) definition and
includes clinical notes and provenance.
CHI also
supports USCDI expansion to include social
determinants of health (SDOH) with privacy risk management practices
that acknowledge the sensitivity of SDOH data.
“This
includes incorporating SDOH data that considers social and environmental
factors of patients’ lives outside of the health care system in the USCDI with
adequate safeguards, which requires ONC to coordinate with the HHS’ Office for
Civil Rights, standards development organizations, and other impacted
stakeholders, which we support and encourage,” the officials noted.
May 03, 2022
- Health Level Seven International (HL7) announced
that ONC's FHIR at Scale Taskforce (FAST) will transition into an HL7 FHIR
Accelerator.
ONC
originally founded the FAST project to define a common set of infrastructure
standards for scalable Fast Healthcare Interoperability Resources (FHIR)
solutions. As an Accelerator, FAST will continue its interoperability work with
participation from various stakeholders.
"As a
widely adopted standard supported by many of the most notable stakeholders in
the health IT community, FHIR is making rapid, real-world progress toward
addressing the biggest challenges of health data interoperability,"
Charles Jaffe, MD, PhD, HL7 International CEO, noted in a public statement.
"The
FAST Accelerator will bring us closer to defining a consistent and scalable
approach to deploying FHIR across high-value use cases and disseminating these
best practices to the industry," Jaffe added.
May 03, 2022
- The Office of Inspector General (OIG) called HHS’ security program “not
effective” in an audit of
Federal Information Security Modernization Act (FISMA) requirements for fiscal
year 2021. The determination was consistent with fiscal year 2020,
2019, and 2018 FISMA
audits.
FISMA
requires Inspectors General to perform annual evaluations of their agency’s
information security programs. HHS OIG engaged the services of Ernst &
Young LLP (EY) to conduct the audit. Auditors revied federal laws and
regulations and assessed information security program policies across multiple
operating divisions.
The auditors
deemed HHS’s information security program “not effective” based on HHS failing
to meet the “managed and measurable” maturity level for four function areas:
identify, protect, detect, and recover.
“However, HHS
continues to implement changes to strengthen the maturity of its
enterprise-wide cybersecurity program,” the report stated.
May 02, 2022 · Health Data · Regulatory
and Health Industry · · CE Quiz Avaiable
AI, ML, and NLP Snub Patients’ Right of Access
By Grace Cordovano, PhD, BCPA
The Patterns That Every AI/ML Platform Missed
Artificial
intelligence (AI) and machine learning (ML) are expected to transform
healthcare. Clinical decision support (CDS) tools are expected to streamline
physician workflows while intelligently personalizing patient care, decreasing
physician burden, and enhancing patient care with precision and accuracy.
However,
patients currently do not have access to their own intelligent summaries or
data outputs. While patients do not see documentation in their medical records
if their physicians are utilizing CDS outputs to guide their care, they should
be able to submit a medical record request to request a copy of the CDS outputs
being used at the point of care. Patients need to be granted access to CDS
outputs that are used to guide patient care and care coordination. This is a
matter of patient safety, transparency, and patients’ HIPAA
Right of Access if the output is being used to make decisions about an
individual.
It
is concerning that many patients are unaware of the range of digital health
AI/ML tools that their providers may be leveraging to guide their care. Most
patients have no idea these outputs exist and currently have no way to request,
inspect, access them, or correct the information depicted if errors exist.
For the
gastrointestinal condition known as ulcerative colitis, some physicians
recommend using a particular drug twice a day, others, three times. But which
protocol is the best way to help people with the condition to avoid surgery?
Instead of launching a clinical trial, Peter Higgins, a gastroenterologist at
the University of Michigan at Ann Arbor, examined the data.
Many health
systems in the United States export clinical data from electronic health
records (EHRs) into repositories known as health data warehouses for
institutional use by researchers, Higgins says. Working with the University of
Michigan’s health informaticians, he identified and compared people on the two
protocols. The scientists found that giving people the drug three times a day
seemed to result in fewer operations (J. A. Berinstein et al. Clin.
Gastroenterol. Hepatol. 19, 2112–2120; 2021).
Such
searches are complex because the underlying records are so variable, Higgins
says. “It’s a little bit of a needle in a haystack hunt,” he explains, because
the data are not standardized.
The
variations in data formats, combined with regulations to protect patient
privacy, make working with data warehouses challenging. Access to a repository
is usually restricted to people within an institution, and international data
protections can prove even more daunting. “The data are just truly not
interoperable across health systems,” says Melissa Haendel, a data scientist at
the University of Colorado Anschutz Medical Campus in Aurora.
May 02, 2022
- The Healthcare and Public Health Sector Coordinating Council (HSCC)
Cybersecurity Working Group (CWG) released a checklist
to help healthcare staff and executives preserve operational continuity while
recovering from a serious cyberattack. One week prior, HSCC released
guidance on medical device vulnerability communications.
Healthcare
organizations can use the Operational Continuity-Cyber Incident (OCCI)
checklist to maintain business continuity even amid an extended enterprise
outage, HSCC explained. The checklist, created by the Incident
Response/Business Continuity (IRBC) Task Group of the HSCC’s CWG, is meant to
serve as a living document that can be altered based on stakeholder feedback
and experience.
“As the IRBC
Task Group was being stood up, it was clear that geopolitical tensions from the
Ukraine-Russia conflict were introducing a higher threat level to the health
sector, calling for heightened awareness and immediate preparations against
potential disruptions to health care delivery,” the document began.
“Accordingly,
through the IRBC TG the HSCC created this tactical checklist with an
accelerated development cycle to anticipate the potential for an extended
outage in the event of direct cyber-attacks or collateral fallout and put it
into the hands of our stakeholders as quickly as possible.”
ACP, ATA, ORCHA announce new framework supporting health app safety
The Digital
Health Assessment Framework includes components to analyze tools' data and
privacy, clinical assurance and safety, usability and accessibility, and
technical security and stability.
The
American College of Physicians, the American Telemedicine Association and the
Organization for the Review of Care and Health Applications announced a new
framework this week aimed at helping healthcare professionals and patients make
informed decisions about digital health tools.
The
Digital Health Assessment Framework will help analyze technologies including
mobile apps and web-based tools used by professionals and consumers.
"ACP’s
collaboration on this project is an important step forward in identifying and
creating digital health tools that are valuable and safe for our members and
patients," said Dr. Ryan D. Mire, ACP president, in a statement.
WHY IT
MATTERS
As
noted on the
framework's website, more than 86 million people in the United States
currently use a health or fitness app. Yet the field of health apps
is often an unregulated one, say the organizations.
DirectTrust Celebrates 10 Years of Healthcare Interoperability Initiatives
Nonprofit
healthcare industry alliance DirectTrust acknowledged 14 individuals for their
contributions to healthcare interoperability on its tenth anniversary.
May 03, 2022
- To celebrate its tenth anniversary, nonprofit healthcare industry
alliance DirectTrust recognized a
special class of Interoperability Heroes.
“It’s been an
exciting decade for DirectTrust and the electronic health information
industry,” Scott Stuewe, DirectTrust president and CEO, said in a public
statement.
“We are
extremely pleased and proud of DirectTrust’s accomplishments during this time,”
he added. “We couldn’t have done it without the many agencies, companies,
organizations, and individuals, who, like us, are committed to advancing
interoperability and the foundation of Trust essential for its continuation.
Our heartfelt thanks to all for making this a very robust ten years.”
DirectTrust
acknowledged the following individuals as Interoperability Heroes who have been
instrumental in the organization’s formation and growth:
ATA, Others Release Digital Health App Assessment Framework
In
collaboration with its partners, the American Telemedicine Association has
released an open framework to help clinicians and patients select and adopt
high-quality digital health tools.
May 03, 2022
- A newly
developed framework aims to provide physicians and patients with a process
for assessing digital health technologies, including mobile applications and
web-based tools.
Released by
the American Telemedicine Association (ATA), American College of Physicians
(ACP), and the Organization for the Review of Care and Health Applications
(ORCHA), the Digital Health Assessment Framework is intended to be an open
framework, accessible to anyone.
The framework
aims to support the adoption of high-quality digital health technologies and
help clinicians and patients make informed decisions. It includes four
components: data and privacy; clinical assurance and safety; usability and
accessibility; and technical security and stability.
"Digital
health technologies can offer safe, effective, and engaging access to
personalized health and support, and provide more convenient care, improve
patient and provider satisfaction, and achieve better clinical outcomes,"
said Ann Mond Johnson, CEO of the ATA in a press release. "There are
literally hundreds of health apps and devices for patients and clinicians to
choose from, and our goal is to provide confidence that the health and wellness
tools reviewed in this framework meet quality, privacy, and clinical assurance
criteria in the US."
— There must be a better way to sort out which portal messages actually
need our urgent attention
by Fred Pelzman,
MD, Contributing Writer, MedPage Today May 2, 2022
Last Updated
May 3, 2022
Extending
the care of our patients beyond the confines of the office visit has never been
easier -- which has its good points and its bad ones.
Many
years ago, for the most part the only interactions we had with our patients
occurred when they came to see us in the office for their annual physical
examination. There were occasionally sick visits in between, and many
conditions that patients had required more regular follow-up and longitudinal
office visits every few months. But long ago I can recall as a resident
admitting patients from attendings in the community for evaluation and workups
for anemia or fatigue, the easiest way for follow-up to occur.
Many
Forms of Care
Ongoing
care today takes many forms, and we can expedite care and make so much more
happen with better systems. Video visits and interim care from other members of
the team can enhance the course of managing a condition, and e-consults and
chatting with colleagues can help move things along as well. Home monitoring
and testing at local labs near home can further enhance care and lead to
swifter diagnoses. And with the advent of the electronic health record, the
ease with which our patients are able the reach us, and we are able to reach
them, seems to have increased exponentially.
As
I've said in many ways, this is so very good, but it certainly comes with some
challenges, and there may be ways we can make it better. Looking through the
messages each of us gets through the patient portal each day, it amazes me how
many things our patients reach out to us to check on, to discuss, to get a
little medical advice, to update us on how they're doing, to download the last
months' worth of blood pressure or fingerstick glucose readings.
Children’s hospitals need to greatly improve website functionality
to meet young parents’ expectations. And that portends the challenge for all
facilities.
Recently, I had the pleasure of
giving a talk to the Children’s Hospital Association on trends in
healthcare and their implications for health IT. In preparing for this talk, I
delved into how children’s hospitals were preparing (or not) for their
just-arriving customers.
Consumers of pediatric services
for young families are “digital natives,” otherwise known as Generation Z. But
What I learned in my research leading up to this event was frankly shocking.
Houston, we have a problem
Members of Gen Z have
characteristics that will make them savvy digital health consumers. A key
characteristic of this generation is their demanding nature – loyalty to a
brand must be earned and continually won again and again. Secondly, they are
highly dependent on the views of others, such as influencers, but also those
who provide ratings of a given service or product.
A 2021
Press-Ganey report on the consumer in healthcare found that Gen Z is far more
dependent on using reviews by others than actual referrals from their doctors.
And if a doctor has less than a four-star review – well, he or she will not be
getting any Gen Z business.
Gen Z’ers have grown up with a
digital device nearly always close at hand. They are extremely comfortable
using digital tools to accomplish any number of tasks.
Claims
contending information blocking are being filed with the government, but action
against most alleged violators is on hold until rules implementing consequences
can be finalized.
The 21st
Century Cures Act puts the responsibility on the Office of the National
Coordinator of Health IT (ONC) to create a standardized process for the public
to report claims of possible information blocking by health IT developers, health
information networks and exchanges, and providers.
ONC created
an Information Blocking portal on which claims can be
reported. ONC performs a form of triage to see if the claim meets the
definition of information blocking, according to Michael Lipinski, Division
Director for ONC’s Regulatory and Policy Affairs Division with ONC’s Office of
Policy. ONC confirms receipt with the submitter and assigns the claim a
tracking number.
OIG’s
enforcement responsibility
But ONC is
not in charge of investigating most information blocking claims. That falls to
HHS’ Office of Inspector General (OIG), which has the authority to investigate
claims against all actors subject to the Cures Act.
As a result,
ONC shares with OIG – typically within two days – the claims it receives
through the portal. “Then, it’s up to OIG in how they process claims,” says
Lipinski.
AMIA and HL7 join forces to promote interoperability standards
The two-year
collaboration will focus efforts to extend comprehensive standards for
interoperability and specs such as FHIR across the the healthcare community.
The
American Medical Informatics Association and Health Level Seven International
on Tuesday announced a new partnership to drive efforts to broaden use of
comprehensive standards for healthcare interoperability and information
exchange.
WHY IT
MATTERS
The two-year collaboration will see AMIA's informatics professionals working
with HL7 to promote interoperability specifications such as FHIR, making
standards and implementation guides available to healthcare stakeholders.
AMIA
and HL7 have collaborated before over the past several years, such as with the
FHIR Application Competition held the last four years at the AMIA Annual
Symposium.
Winners
of the most recent app competition include:
·First Place: Ken Kawamoto – Disease Manager
·Second Place: Subha Airan-Javia – Bringing FHIR
to the Bedside: An EHR Connected Mobile Application to Bring Real-Time Clinical
Data Coupled with a User-First Team Collaboration Platform to the Point of Care
·Third Place: Ajay Dharod – Involving Patients
Using FHIR
A
hospital program
aimed at reducing EHR alert fatigue by cutting down the number of
“interruptive” alerts has made a meaningful impact on the number of alerts
clinicians received.
The
program was kicked off in 2020, by the Vanderbilt University Medical Center’s
Clinical Informatics Center in collaboration with VUMC’s health IT department.
The program was designed to optimize clinical decision support alerts generated
by eStar, VUMC’s IT system. With clinical decision support alerts being known
as best practice advisories or BPAs, the effort to rid the system of suboptimal
alerts was named BPA Clickbusters.
The
VUMC team went through two three-month rounds of clickbusting in 2020. When the
team performed comprehensive reviews of 20% of the rule-based alerts in use, it
led to 71,227 fewer interruptive alerts being sent per week. This netted out to
a 15% reduction in interruptive alerts overall.
May 02, 2022
- EHR Vendor Epic Systems had the greatest market share growth in 2021,
significantly outperforming its competition once again, according
to a KLAS market share report based on acute care EHR purchasing
activity.
A substantial
portion of Epic’s market share growth comes from 4 net-new customer
organizations which comprise a total of 28 hospitals. In total, Epic Systems
scored 74 hospitals and over 80,000 beds. The vendor’s four losses were due to
merger and acquisition activity.
Epic also
remained the top choice for large healthcare organizations, gaining over 32
hospitals in 2021.\
Seventy-eight
of the multispecialty acute care hospitals that chose a new EHR vendor were
part of small organizations, making this market extremely competitive in 2021.
Continuing the trend, Epic won nearly half of the acute care hospital wins in
this space.
Emergency Room Follow-Ups Similar After Telehealth, In-Person Visits
In most
cases, emergency department follow-up rates were similar among patients who
received care through telehealth and those who sought care in person, a new
study shows.
May 02, 2022
- Researchers from Johns Hopkins Bloomberg School of Public Health found that patients
who participated in an initial visit through telehealth were not more likely to
need emergency department follow-up visits than those who received care in
person, except for cases related to respiratory infection, bronchitis, and
pharyngitis.
In the study,
which was published in JAMA Network Open, researchers collaborated with Blue
Health Intelligence and the Digital Medicine Society to draw information from
40 million privately insured patients. The patients were younger than 65, and
the data collected was from July to December 2020. Researchers found that 17
percent of non-emergency visits occurred through telehealth in this
period.
For 18 out of
21 conditions reviewed in the study, unplanned hospitalizations and follow-up
emergency department visit rates were similar for in-person and telehealth
visits within 14 days of the initial visit.
Among the
remaining three conditions, respiratory infection, bronchitis, and pharyngitis,
telehealth patients had higher rates of emergency department follow-up visits.
For example, in cases involving a bronchitis diagnosis, telehealth patients
were 1.18 times more likely to visit the emergency department and 1.23 times
more likely to see the doctor again.
May 02, 2022
- As telehealth claims a more prominent place in care delivery,
researchers noted that various
efforts could continue service enhancement while reducing costs, avoiding
fraud and abuse, and increasing patient utilization.
Before the
start of the COVID-19 pandemic, Medicare had strict telehealth restrictions,
which limited the availability of services to those living in urban
environments.
However, many
restrictions were lifted during the pandemic, increasing access to telehealth,
resulting in a rise in claims by 12 percent in April 2020.
Although
telehealth has been very resourceful, increased utilization levels have likely
resulted in increased costs.
Researchers
noted that an expansion of telehealth would require a payment model such as
Accountable Care Organizations rather than a fee-for-service payment.
May 02, 2022
- The Healthcare and Public Health Sector Coordinating Council (HSCC)
Cybersecurity Working Group (CWG) released a checklist
to help healthcare staff and executives preserve operational continuity while
recovering from a serious cyberattack. One week prior, HSCC released
guidance on medical device vulnerability communications.
Healthcare
organizations can use the Operational Continuity-Cyber Incident (OCCI)
checklist to maintain business continuity even amid an extended enterprise
outage, HSCC explained. The checklist, created by the Incident
Response/Business Continuity (IRBC) Task Group of the HSCC’s CWG, is meant to
serve as a living document that can be altered based on stakeholder feedback
and experience.
“As the IRBC
Task Group was being stood up, it was clear that geopolitical tensions from the
Ukraine-Russia conflict were introducing a higher threat level to the health
sector, calling for heightened awareness and immediate preparations against
potential disruptions to health care delivery,” the document began.
“Accordingly,
through the IRBC TG the HSCC created this tactical checklist with an
accelerated development cycle to anticipate the potential for an extended
outage in the event of direct cyber-attacks or collateral fallout and put it
into the hands of our stakeholders as quickly as possible.”
Telehealth can play a vital role in reducing carbon emissions
Researchers
from The Ohio State University Wexner Medical Center found that telehealth
appointments saved 2.2 million gallons of gas for patients since the start of
the pandemic.
Telehealth's
potential to bridge the services gap for people without ready transportation
access has been well-documented.
Less
explored, however, is virtual care's possible role in reducing carbon
emissions, specifically by allowing patients to connect with providers without
relying on a car.
The
Ohio State University Wexner Medical Center built
a dashboard to estimate the environmental impact of the medical facility's
telehealth offerings. By examining the reduced travel enabled by virtual care,
the center's IT and sustainability team calculated gasoline usage and carbon
emissions.
Aparna
Dial, senior director of Sustainability and Strategic Services at OSU, sat down
with Healthcare
IT News to discuss the team's findings, along with how the
healthcare industry can be environmentally sustainable in the long term.
Q.
What were some of your findings regarding telehealth and environmental impact
during the COVID-19 pandemic?
A. These
last couple of years have been unusual, to say the least, with a global
pandemic that was unlike anything we have experienced before. That said, there
were some positive aspects that have resulted in sustainability gains, such as
the more widely adopted practices of telehealth and telework.
The
American Telemedicine Association kicked off ATA2022 this week with an
examination of the challenges faced by care providers, and a plea that
telehealth could be the avenue by which providers reconnect with their patients
and understand the patient experience.
Telehealth,
as everyone likes to say these days, is here to stay. But the really exciting
thing is what it can do to bring humanity back to healthcare.
That was the
big take-away from the first day of the American Telemedicine
Association’s first in-person conference in three years, taking place this
week in Boston. With a theme focused on “What now?”, the several hundred
attendees milling about the convention center were told that empathy and
connection are the keys to continuing virtual care in a post-pandemic world.
“It’s really
about how we care for people,” said Adrienne Boissy,
the former chief experience officer of the Cleveland Clinic who became chief
medical officer of digital health company Qualtrics in 2021, in an opening
keynote that focused on the idea of agility.
ATA CEO Ann
Mond Johnson kicked off the three-day event Sunday morning with a call for
attendees to recognize that the pandemic may have brought telehealth to the
forefront and proven its value, but it also exposed long-standing challenges,
ranging from policy and regulation to licensing and addressing social
determinants of health.
An
investigation into mental health and prayer apps has revealed a disturbing lack
of concern surrounding user security and privacy.
On
Monday, Mozilla released the findings of a new study into these types of apps,
which often deal with sensitive topics including depression, mental health
awareness, anxiety, domestic violence, PTSD, and more, alongside
religion-themed services.
According
to Mozilla's latest *Privacy Not Included guide, despite the deeply personal
information these apps manage, they "routinely share data, allow weak
passwords, target vulnerable users with personalized ads, and feature vague and
poorly written privacy policies."
In
a study of 32 applications geared toward mental health and religion, the
organization found that 25 of them did not meet Mozilla's Minimum Security
Standards.
These
standards act as a benchmark for the *Privacy Not Included reports.
The mismanagement or unauthorized sharing and sale of user data, vague data
management policies, a lack of encryption, weak password policies, no clear
vulnerability management system, and other lax security policies can all
downgrade a vendor product in the eyes of Mozilla.
Oxford
Open Digital Health is an Open Access journal that publishes
methodologically rigorous evaluations, evidence reviews, study protocols and
other policy-relevant research on Digital Health Interventions (DHIs) with a
particular focus on Low and Middle-Income Countries (LMICs). The journal aims
to provide a high-impact outlet for research that adds to the evidence-base of
DHIs used to strengthen health systems, and accelerate progress towards
universal health coverage.
The journal encourages the submission of high-quality evaluations of DHIs
involving a range of research approaches such as randomized controlled studies
and implementation science research. In each case, to further replicability of
the digital health interventions being deployed, we encourage a clear
description of the design and technical features of the interventions, and
where possible, direct inclusion of or reference to evidence on acceptability,
gender, equity, ethical, legal and sociocultural implications. We actively seek
to identify and purposefully target gaps in the literature, such as the current
dearth of rigorous costing and economic evaluations of digital health
interventions. We support interdisciplinary research spanning the disciplines
of engineering, computer science, public health and medicine, across all health
areas. Negative or null results are also encouraged to be submitted.
How technology can play a key support role for clinicians
Providers ramp up the use of a wide range of IT, whether it’s
esoteric artificial intelligence or support systems that ensure that deep personal
needs are met.
Technology can be a burden to
clinicians, but some healthcare organizations are focusing the potential of
information and tools to support them in their day-to-day tasks.
Whether it involves the use of
advanced computing and artificial intelligence, or applications that enable
easier sharing of expressions of gratitude for care, technology can play a role
in improving clinicians’ experience, said presenters Wednesday in Episode 4 of the HDM KLASroom.
AI’s potential
Artificial intelligence
exemplifies both the challenge and promise of technology that is increasing its
footprint in healthcare. The eventual promise is for AI to play more of a role
in predictive models that can help clinicians make better decisions, said Jennifer
Hickenlooper, insights director for KLAS Research.
AI is top of mind with more
players in the healthcare industry, but there’s growing interest in using it to
help answer vexing problems, said John
Halamka, MD, president of the Mayo Clinic Platform. “No one is waking up in
the morning saying, ‘I need an AI algorithm.’ They are saying I have a pain
point and I need a solution.” Because of this, healthcare organizations are
more interested in end-to-end solutions incorporating AI rather than individual
solutions, he said.
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