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EHR safety goes to court
One patient's blood pressure plummeted dangerously after he was allegedly discharged with the wrong medications. In another instance, a physician couldn't place a pharmacy order for a newborn to receive vitamin K, which is given to babies to prevent serious bleeding.
On several other occasions, patients weren't accurately tracked, creating potential problems getting drugs to them.
Each of these alleged mishaps occurred at PinnacleHealth, a three-hospital system based in Harrisburg, Pa. PinnacleHealth blames each of the mishaps on its electronic health records vendor, Siemens; Cerner Corp. purchased Siemens' health IT business in February 2015.
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Clinical informaticist says the best is yet to come for FHIR
InterSystems' Russell Leftwich, MD, says 'there's still a lot of data yet to be incorporated' with the HL7 standard.
June 23, 2016 05:19 PM
"There's quite a bit more to be done" with HL7's FHIR, says Russell Leftwich, MD.
The FHIR interoperability spec brings healthcare forward, helping it catch up with the technology other industries have been using for the past decade or two. It's healthcare's version of what other industries or domains have used for some time now. And what healthcare is most excited about, is the "ease of interoperability."
This is according to Russell Leftwich, MD, adjunct professor of biomedical informatics at Vanderbilt University and senior clinical advisor for interoperability at Cambridge, Massachusetts-based InterSystems.
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Intermountain surgeons save patient's kidney with 3D printing during dicey operation
Doctors used a 3D rendering of Linda Green’s kidney to determine the best way to maneuver around arteries and remove a tumor.
June 24, 2016 10:43 AM
Intermountain physician Jay Bishoff, MD, said that the 3D printed model enabled doctors to identify a nub on a patient's kidney before starting surgery.
Doctors at Intermountain Medical Center printed and used a 3D kidney model to save a patient’s organ during a recent complicated tumor-removal.
The 3D model made it possible for the surgeons to study the patient’s kidney and figure how to best remove the tumor that was positioned near vital arteries and veins. With the 3D-model of the organ, they were better able to maneuver around those areas, remove the tumor and save the patient’s kidney.
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Data in patient records hold the best hope for improving research
Published June 24 2016, 6:26am EDT
The plethora of data available from electronic health records, claims systems, registries and from patients themselves is an unprecedented opportunity to modernize and augment clinical trials, while improving the current drug development process through the use of real-world evidence.
That’s the conclusion of a new report released Thursday by the Bipartisan Policy Center, which contends that real-world evidence can only be derived from real-world data gathered from sources outside of randomized controlled trials. The best data can come from sources such as EHRs, because it reflects the actual experiences of patients during routine care.
“Bringing safe and effective cures and treatments to patients in a timely and cost-effective manner will require new processes and new policies to support them,” according to Bill Frist, MD, former Senate majority leader, and Bart Gordon, former Congressman, who were co-chairs of BPC’s initiative, entitled, “FDA: Advancing Medical Innovation” initiative.
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Lack of interoperability could derail opioid Rx monitoring efforts, says advocacy group
Prescription drug monitoring programs have been demonstrated to reduce the number of opioid-related overdose deaths, but programs largely operate within state borders, meaning a patient can theoretically move from state to state to fill opioid prescriptions and databases wouldn't pick up on that activity. This, according to advocacy group Health IT Now, illustrates a need for nationwide standards to create an interoperable PDMP program.
In a letter to Senate Majority Leader Mitch McConnell, Senate Minority Leader Harry Reid, Speaker of the House Paul Ryan and House Minority Leader Nancy Pelosi, Health IT Now urged Congress to support efforts for interoperable standards for PDMP programs.
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E-prescribing Tackles the Opioid Epidemic
Scott Mace, June 21, 2016
Using two-factor authentication when e-prescribing for controlled substances saves physicians hours and helps stem prescription drug abuse.
As the U.S. Senate begins reconciling its bill to stem the opioid epidemic with the House, one health system in Massachusetts is already using e-prescribing technology, newly enabled to include controlled substances, to help reduce opioid abuse.
An executive at Massachusetts-based Cambridge Health Alliance says the system, in place for a year, has already saved its more than 700 physicians hundreds of hours and has made patients' lives immeasurably easier.
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Feds take another step toward approving wireless body sensors
Published June 21 2016, 6:29am EDT
U.S. healthcare facilities are getting closer to making Medical Body Area Networks a reality. A new website has been launched so hospitals can formally register their deployments of MBANs, which support wireless patient monitoring to transmit patient health data over a short range at low power levels.
The networks are envisioned as a platform to support multiple wireless body-worn sensors used for measuring and recording physiological parameters, as well as other patient information, and for performing diagnostic and therapeutic functions.
The U.S. is the first country to allocate spectrum for MBANs. In May 2012, the Federal Communications Commission allocated 40 megahertz of spectrum in the 2360 to 2400 MHz band for these low-power networks, with the 2360 to 2390 MHz band to be used indoors only.
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VA officials discuss commercial EHR replacement, IT costs with lawmakers
Jun 23, 2016 12:19pm
Officials with the Department of Veterans Affairs, testifying in front of a Senate committee Wednesday, indicated that the agency likely will turn to the private sector to replace its aging homegrown electronic health record system.
At the hearing of the Senate’s Committee on Veterans’ Affairs, VA CIO LaVerne Council said she cringes when she thinks about how old the current system is because, at the end of the day, it constitutes working with something to which few people can relate.
“I have a lot of respect for the VistA product, but [it] is a 40-year-old product,” said Council, who called 40 to 50 years “ancient” in the world of IT.
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Real-time sharing of records 'virtual safety net' for patients at Calif. hospitals
Jun 23, 2016 11:19am
Six East Bay-area hospitals in California plan to share patient records in real-time to create a “virtual safety net” for patients, reports Hospitals & Health Networks.
Participating hospitals are the Alta Bates Summit Medical Center in Oakland and Berkeley, Highland Hospital in Oakland, Sutter Delta Medical Center in Antioch, Eden Medical Center in Castro Valley and San Leandro Hospital.
“We’re trying to use technology and available information to make it so no matter what door a patient walks through in Alameda County, we’re all on the same page,“ Jim Hickman, CEO of Better Health East Bay, Sutter Health’s philanthropic foundation partner in the East Bay, says in the article.
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IBM Watson aligns with 16 health systems and imaging firms to apply cognitive computing to battle cancer, diabetes, heart disease
The supercomputer will be used to mine insights from ‘previously invisible’ unstructured imaging data and combine it with other information to make personalized care decisions that also impact broader patient populations.
June 22, 2016 03:15 PM
IBM Watson Health has formed a medical imaging collaborative with more than 15 leading healthcare organizations. The goal: To take on some of the most deadly diseases.
The collaborative, which includes health systems, academic medical centers, ambulatory radiology providers and imaging technology companies, aims to help doctors address breast, lung, and other cancers; diabetes; eye health; brain disease; and heart disease and related conditions, such as stroke.
Watson will mine insights from what IBM calls previously invisible unstructured imaging data and combine it with a broad variety of data from other sources, such as data from electronic health records, radiology and pathology reports, lab results, doctors' progress notes, medical journals, clinical care guidelines and published outcomes studies.
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Study: EMRs Cited As Top Trigger for Physician Burnout
74% of US primary care physicians (PCPs) and ER doctors do not feel their healthcare facility or practice is taking effective steps to address and prevent physician burnout, according to a new microsurvey by InCrowd, a provider of real-time market intelligence to life sciences and healthcare firms.
The data represents a mid-year checkpoint on physician perceptions as Affordable Care Act (ACA) measures change the nature of doctoring, and as at least 30 major teaching hospitals undertake initiatives aimed at reducing burnout ahead of its potential impact on patient safety and quality outcomes.
Top Causes for Physician Burnout
Burnout was defined as decreased enthusiasm for work, depersonalization, emotional exhaustion, and a low sense of personal accomplishment.
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IBM Watson forms medical imaging collaborative
Published June 23 2016, 6:35am EDT
IBM is forming a medical imaging collaborative that will leverage cognitive computing to extract insights from unstructured imaging data.
The collaborative, announced on Wednesday, will use the Watson Health platform as a basis, and already includes 16 health systems, academic medical centers, ambulatory radiology providers and imaging technology vendors.
Members of the collaborative see a wide array of possibilities for study, including breast, lung and other cancers; diabetes; eye health, brain disease; and heart disease and related conditions, such as stroke.
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The Holistic Patient Health Record: Image-Enabling the EHR
Morris Panner
Jun 15, 2016
Here's a fact that may come as a surprise: According to an IBM Global Technology Outlook report, medical images are projected to require 30% of the world's storage and could soon represent 10% of all of U.S. healthcare costs--about 1.5% of US GDP. That's a lot of storage, and one whopper of a price tag.
Provider demand for streamlined, intuitive medical imaging services is heating up. According to a recent study, 67% of providers cite image sharing as a critical priority; 88% of providers identify receiving medical images from other sites as the most important problem to solve through image sharing. Though providers access images differently, the greatest demand for medical imaging is via the electronic health record. With an image-enabled EHR, providers have access to critical patient data that can not only save lives, but also improve care coordination and provide a platform for innovation.
Just five years ago, this was nearly impossible. Fast-forward to today, and the solutions are in reach for every provider, large and small. The big question on everyone's minds is, how? How does image management fit into their EHR? This is where things get cloudy--in a good way.
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Research lags on use of CDS tools by nurses
Jun 22, 2016 11:09am
The use of clinical decision support (CDS) tools for bedside nurses shows promise as a means to improve care, but research lags far behind that of physician use of CDS for decision-making, according to research published in the Journal of the American Medical Informatics Association.
Nurses often are seen as collectors of data rather than decision-makers, yet at the bedside, they do make decisions when assessing conditions such as patient deterioration, the authors note.
Based on a literature review of 28 studies, the authors also note a “clear need to increase the sophistication and rigor of the study designs.” One common problem was a lack of specific metrics to gauge the effects of CDS.
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HIT Think Why providers must improve electronic communication with consumers
Published June 21 2016, 3:44pm EDT
One of the chief tenets of reform initiatives involves the notion of patient-centric care. The idea is that patients need to be fully engaged in their care, participating in making decisions and active in the follow-through of treatment.
It sounds as basic, and as inherently correct, as mom and apple pie. And it is flat out hard to accomplish. From the perspective of consumers-patients, we are just beginning to get comfortable with this notion; as consumers of healthcare we often have dwelled as passive recipients, not active participants. And we tend to not engage with the healthcare system until something goes horribly wrong with our health.
From the provider side, this is a difficult transition. Much of the industry has been provider-centric, or organization-centric, or process-centric, or reimbursement-centric. With so many participants in providing healthcare, each dependent on the system for reimbursement, it’s difficult to suddenly change the world and put the patient at the center.
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HIT Think How HIT executives can meet rising ROI demand
Published June 23 2016, 3:22pm EDT
In the past, IT was simply considered a functional department within most healthcare facilities. Today, thanks to widespread product innovation and federal drivers like the Health Information Technology for Economic and Clinical Health Act (HITECH), IT is viewed as a key component in the overall strategy of a healthcare delivery organization (HDO). With this in mind, it’s not surprising that a recent study by cloud services provider Peak 10 shows that 67 percent of 157 healthcare leaders surveyed anticipate health IT budgets to increase in the next two years.
As more money is dedicated to technology, much more is expected from these investments as well. It’s not enough for technology solutions to merely digitize information or enable processes; they must play a central role in optimizing productivity, efficiency, revenue and patient outcomes.
As a result, healthcare CIOs need to spend their IT budgets wisely to ensure these types of measurable returns in a short time. Certainly, satisfying meaningful use and other compliance-based criteria will drive a great deal of IT spending, but CIOs must look beyond simply ticking these checkboxes and aim to address larger strategic goals through IT.
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CIOs tell ONC: It's time to let the EHR market innovate to drive interoperability
Several experts contend that the Office of the National Coordinator for Health IT is attacking the wrong problems and the last thing anyone needs is more prescriptive regulation about EHR functionality, usability and quality measurement.
June 21, 2016 07:39 AM
The time has come for the Office of the National Coordinator for Health Information Technology and other federal regulators to back off trying to “fix” interoperability with regulations, and let the market solve the problem, according to several industry leaders.
“It’s time to return the agenda to the private sector and let clinicians drive vendors to produce the products and services they want,” said John Halamka, MD, chief information officer of Beth Israel Deaconess Medical Center and co-chair of ONC’s Health IT Standards Committee.
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Interoperability boosters agree on FHIR
A way of connecting computers in healthcare passed another milestone toward widespread use this week as two healthcare interoperability advocates reached an accord over the Fast Healthcare Interoperability Resources standard.
The two groups are Health Level Seven International, which for 29 years has been developing standards for health information exchange, including the fast-spreading FHIR (pronounced “fire”) and Integrating the Healthcare Enterprise, which has helped promote and test interoperability of HIT systems since 1998.
Several major health IT developers, including Athenahealth, Cerner, Epic, McKesson and Meditech, have been working since 2014 with FHIR-based technology as a tool to build interfaces with other developers' products to move data in and out of their systems.
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In iOS 10, you’ll be able to request medical records on an iPhone: Here’s how it works
If you’ve ever tried to get medical records from your doctor’s office, you likely know how frustrating it can be. Even if you do get access, it may be in some strange barely-readable format you can’t make sense of.
With iOS 10, you will be able to request those records directly from your iPhone, so long as your doctor has at least made a small step towards digitizing your paperwork.
As it stands, medical records you get from a doctor are usually in a pile of papers or perhaps on a CD. If your doctor is digitizing your records, you may be able to access them online, but it may look jargon-y and unfamiliar because the standard for digitally keeping those records isn’t meant to be patient-friendly.
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EHRs and health IT infrastructure not ready for precision medicine
'Our technology to produce data from genetic medicine is far more advanced than our ability to use it in a clinical environment.'
June 16, 2016 08:24 PM
"We currently store genetic data in a very robust, complicated, standard format that was developed nearby here, in Silicon Valley," said Nephi Walton, MD, in San Francisco on Wednesday. "The problem is, it was developed in 1993 and it's called a PDF."
The promise of genomics and personalized medicine is immense. But right now health information technology is seriously unprepared to capitalize on the medical advancements that could be just around the corner.
"We're really not in near as good a position as we should be to take advantage of the data that's here right now," said Nephi Walton, biomedical informaticist and genetics fellow at Washington University School of Medicine, speaking Wednesday at the HIMSS Big Data and Healthcare Analytics Forum in San Francisco.
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Physicians struggle to get timely data, and patient care suffers
Published June 17 2016, 6:22am EDT
Despite widespread use of electronic health records, a recent survey has found gaps in how information flows between clinicians and also between physicians and their patients.
The survey, conducted by Nielsen Strategic Health Perspectives and sponsored by the Council of Accountable Physician Practices, reveals that health IT is coming up short in supporting the easy flow of information within healthcare, although some of the underlying reasons are not directly related to shortcomings of the technology.
The survey, which involved 30,000 consumers and 626 physicians, found significant gaps between what patients need and expect, and what clinicians are providing them with, including a lack of access and use of robust health information technology.
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Hunt "relentless" on delivering paperless NHS
16 June 2016
Health secretary Jeremy Hunt has said he will be “relentless’ in seeing through his commitment to a ‘paperless’ NHS by 2020, because technology underpins his ambitions for the NHS.
At the NHS Confederation’s annual conference in Manchester, Hunt said the paperless commitment, first made to a think-tank in 2013, was one of his “bolder promises’, but one he remained committed to because it was so important.
Indeed, he argued that new technology was one of three things that the NHS needed to concentrate on as it sought to tackle deficits while aiming to become “the highest quality healthcare system in the world.”
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AMA posts new telehealth ethical guidance
The American Medical Association’s latest guidelines clarify doctors responsibilities when tapping into telemedicine technologies and services.
June 15, 2016 12:10 PM
The American Medical Association adopted new ethical guidance to clarify physicians’ responsibilities when interactions occur through telemedicine, compared to traditional patient interactions at a medical office or hospital.
The new guidelines permit physicians utilizing telehealth and telemedicine technology to exercise discretion in conducting a diagnostic evaluation and prescribing therapy within certain safeguards.
“Telehealth and telemedicine are another stage in the ongoing evolution of new models for the delivery of care and patient-physician interactions,” AMA Board Member Jack Resneck, MD, said in a statement. “The new AMA ethical guidance notes that while new technologies and new models of care will continue to emerge, physicians’ fundamental ethical responsibilities do not change.”
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Researchers: Patient safety a concern for EHR use by UK docs
Jun 10, 2016 8:16am
Some clinicians view electronic health records as more negative than positive when it comes to patient safety, according to a new study in BMC Medial Informatics and Decision Making.
The researchers, from the University of York and elsewhere, wanted to determine how the implementation of an EHR system affects patient safety in England's National Health Service (NHS). Most patient safety information was coming from the U.S., whose health system is different economically, organizationally and structurally. They interviewed 19 NHS clinicians in a maternity unit at an NHS teaching hospital in the north of England during the first year of its implementation of an EHR in 2014.
They found that significantly more challenges with the system were reported than benefits, with clinicians reporting perceived and actual increased risks to patient safety. For instance, there were concerns that the clinicians would make inputting errors due to lack of typing skills. The interviewees also expressed concern that the data being added was less detailed and accurate, since it took longer to type.
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ONC guide focuses on adopting EHRs to aid patient safety
Published June 14 2016, 4:31pm EDT
Most of the nation’s healthcare organizations have rushed to implement electronic health records in the last few years, and recent research suggests that the complex technology can be challenging to install and use safely.
In response to growing concerns about the impact of healthcare information technology on patient safety, the Office of the National Coordinator for Health Information Technology has released a guide to help providers safely adopt, implement and use it.
Despite the widespread adoption of HIT by hospitals and physician practices, studies have shown that electronic health records have mixed results in detecting and preventing errors that can lead to adverse events and even death. In fact, poorly implemented, designed and used EHRs “can actually lead to errors associated with health IT,” contends Andrew Gettinger, MD, ONC’s chief medical information officer and executive director of the Office of Clinical Quality and Safety.
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Screen flashes and pop-up reminders: 'Alert fatigue' spreads through medicine
Electronic health records increasingly include automated alert systems.
June 15, 2016 09:32 AM
“When providers are bombarded with warnings, they will predictably miss important things,” says David Bates, senior vice president at Brigham and Women’s Hospital in Boston.
Some people receive constant reminders on their personal smartphones: birthdays, anniversaries, doctor’s appointments, social engagements. At work, their computers prompt them to meet deadlines, attend meetings and have lunch with the boss. Prodding here and pinging there, these pop-up interruptions can turn into noise to be ignored instead of helpful nudges.
Something similar is happening to doctors, nurses and pharmacists. And when they’re hit with too much information, the result can be a health hazard. The electronic patient records that the federal government has been pushing — in an effort to coordinate health care and reduce mistakes — come with a host of bells and whistles that may be doing the opposite in some cases.
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Why Healthcare Application Security is Critical Area
A recent survey, along with an OCR statement, reiterate the importance of organizations understanding healthcare application security measures.
As more covered entities and business associates continue to implement mobile options, healthcare application security is an increasingly critical aspect to overall data security.
If a recent survey is any indication, organizations should take particular care when it comes to cloud-based applications, as over one-quarter of such apps were found to be risky.
CloudLock’s Q2 2016 Cloud Cybersecurity Report found that 27 percent of third-party apps are classified as high risk.
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http://www.healthdatamanagement.com/opinion/how-to-improve-the-usability-of-clinical-records-systems
HIT Think How to improve the usability of clinical records systems
Published June 14 2016, 3:13pm EDT
“It is incredibly disruptive for physicians and nurses to make use of a new electronic health record. The current generation of electronic health records are not very usable. They are not well designed to increase our efficiency and to make our work easier—but rather, they slow us down.”
—Steven J. Stack, MD, president of the American Medical Association, in a May 2016 article in The Boston Globe.
—Steven J. Stack, MD, president of the American Medical Association, in a May 2016 article in The Boston Globe.
Technology holds the key to improved patient outcomes, reduced costs and the success of the shift to a value-based payment environment. Unfortunately, the journey has become painful for many clinicians as they grapple with new electronic health records systems.
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ONC releases two new health IT safety reports
Jun 13, 2016 12:27pm
The Office of the National Coordinator for Health IT has published two new guidances to help providers address health IT and patient safety, according to a new post at its Health IT Buzz blog from Andrew Gettinger, M.D., chief medical information officer and director of its Office of Clinical Quality and Safety.
The first report examines the most recent evidence on health IT and patient safety. It identifies gaps in research, encourages the development or refinement of existing tools or interventions that could enhance the safety and safe use of health IT, highlights information about the types and frequency of safety events, and addresses the issues of usability and interoperability that can improve safety. For instance, it discusses patient identification problems and how clinical decision support can both enhance patient safety and adversely impact it due to alert fatigue.
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How to build an effective ransomware defense
Published June 13 2016, 3:25pm EDT
Ransomware continues to plague healthcare organizations, despite the best efforts of IT security professionals. Recent incidents in Wichita, Kan., and DeKalb, Ind., are only some of the latest and they surely won’t be the last.
Ransomware has proven popular with cyber-criminals because while only a small percentage of attacks are successful, the effort required to launch them is minimal and the reward can be great. The FBI estimates that crooks extorted $209 million in ransoms in the first three months of 2016 alone.
In the past, it was mostly individuals who paid the ransoms. More recently, however, large healthcare organizations—such as Hollywood Presbyterian Hospital in California—have paid off their attackers to restore access to their healthcare data.
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Patient wishes are tough to see in electronic health records
End-of-life preferences aren't being carried out.
June 11, 2016 — 10:17pm
When her chest pains morphed into cardiac arrest in the Regions Hospital emergency room two years ago, doctors saved Beth Bedell’s life.
She has mixed feelings about that.
Bedell, 67, of St. Paul, is happy to be alive. But she’s troubled that caregivers did not follow her health care directive for no resuscitation, a document drafted after she was diagnosed with a brain tumor.
Frustration built this spring when Bedell made a subsequent trip to the emergency room. Concerned what would happen if her condition took a turn for the worse, she asked staff to look up her end-of-life care wishes in the hospital’s electronic health record system.
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Is It Fair To Call Digital Health Apps Today's "Snake Oil"?
American Medical Association CEO James Madara is concerned about the rapid proliferation of new health apps and devices.
Back in the middle of the 19th century, the American Medical Association declared war on the so-called "snake oil elixirs" that were all the rage. Today, it has identified a new target: digital health apps.
In a speech delivered at the AMA's recent annual meeting, CEO James Madara described the digital health industry as peddling apps and devices that "impede care, confuse patients, and waste our time." Without naming names, he referenced ineffective electronic medical records, direct-to-consumer digital health products, and apps of "mixed quality."
"This is the digital snake oil of the early 21st century," he declared.
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Jun 13, 2016 @ 09:00 AM
AMA Warns Of Digital Health 'Quackery'
The American Medical Association is warning of digital health technology that threatens quality and patient safety from new apps and telemedicine to electronic health records that don’t allow physicians to communicate effectively.
The AMA’s chief executive officer, speaking to the group’s policy-making House of Delegates, warned of the need to better vet technology used by physicians as well as an “explosion of direct-to-consumer digital health products.”
“From ineffective electronic health records, to an explosion of direct-to-consumer digital health products, to apps of mixed quality, this is the digital snake oil of the early 21st century,” Dr. James Madara, AMA’s executive vice president and CEO told AMA members this past weekend.
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AMA CEO calls digital products modern-day ‘snake oil’
Published June 13 2016, 3:04pm EDT
When it comes to electronic health record technology, the American Medical Association has been an outspoken critic about what it perceives as the shortcomings of EHRs, voicing the widespread dissatisfaction of the doctors who use the systems.
However, the nation’s largest physician group is now taking aim at new and emerging health IT technologies—such as mobile healthcare apps—that it believes are leading to practice disruption.
In a June 11 address to AMA’s House of Delegates at its annual meeting in Chicago, CEO James Madara, MD, blasted the current technological landscape, calling it a “digital dystopia” that has generated tools that lack the medical evidence necessary to demonstrate the efficacy of the technology.
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Enjoy!
David.
