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, September 02, 2018

Submission To The Senate Committee On Community Affairs References Committee. – Initial Draft For Comment.

Inquiry into the My Health Record system.

From Dr. David G More BSc MB BS PhD FANZCA FCICM FACHI.
Brief Background.
I am a retired Critical Care and Emergency Medicine Specialist who has been involved in the procurement and delivery of clinical computer systems as well as advising on these systems for over 25 years up until the present. Evidence of my expertise in Digital Health can be found at my blog (www.aushealthit.blogspot.com) which has over 5000 articles on the topic over the last 12 years.
Synopsis Of Submission.
After a review of the Inquiry Terms of Reference and review of what I have learned about the My Health Record System and predecessor systems (since initial planning in 2009 / 2010) over the last eight years I have concluded that there is only one possible course, (if cancelling the whole program is not possible – my preferred option) and that is to move the myHR to opt-in, to strengthen the security of the system, to delete all inactive accounts and to revert the system to a simple single patient record containing appropriate information to assist with emergency care. Deliberate choices can be made, if required, to retain / or not ancillary services such as immunisation registries and advanced care directives.
It simply makes no sense to store millions of PBS and MBS records in a duplicate secondary database or to imagine the myHR will ever replace the usual systems used by GPs and Specialists.
The investment that was to be made in the myHR can be more usefully be directed to the improvement of systems used by practitioners and the interoperability of those systems with each other and laboratory / imaging systems.
It is assumed that all this would be planned by an externally facilitated Strategic Planning Process to create a roadmap that could be followed by the ADHA to achieve more clinical benefit, patient safely and value for money.
Terms Of Reference – Specific Commentary
The My Health Record system, with particular reference to:
  1. the expected benefits of the My Health Record system;
  2. the decision to shift from opt-in to opt-out;
  3. privacy and security, including concerns regarding: 
    1. the vulnerability of the system to unauthorised access, 
    2. the arrangements for third party access by law enforcement, government agencies, researchers and commercial interests, and 
    3. arrangements to exclude third party access arrangements to include any other party, including health or life insurers;
  4. the Government’s administration of the My Health Record system roll-out, including: 
    1. the public information campaign, and 
    2. the prevalence of ‘informed consent’ amongst users;
  5. measures that are necessary to address community privacy concerns in the My Health Record system;
  6. how My Health Record compares to alternative systems of digitising health records internationally; and
  7. any other matters.
Each of these will be addressed in turn.
A. - The expected benefits of the My Health Record system.
To respond to the term of reference directly one needs to review the claims made by the ADHA for such benefits as reduced medication errors, improved patient safely, better care co-ordination and reduced repeat investigations etc. leading to reduced healthcare costs and an improved quality of care.
The problem is that after six years of operation none of these benefits have been convincingly demonstrated. The claim is that once everyone has a record, via opt-out implementation that the benefits will flow, but again there is no evidence backing this assertion I have seen – and I have looked diligently.
A clear pointer to the lack of evidence is that this year the ADHA has started to fund external organisations to try and demonstrate benefits etc. over the next few years confirming that to date any evidence base for benefit from the myHR is very flimsy to non-existent.
That any Government project has consumed in excess of $2.0Billion without rock-solid evidence of major financial or clinical benefit and proper detailed evaluation is both remarkable and alarming.
B. - The decision to shift from opt-in to opt-out.
The PCEHR was designed (2010-2012) from the outset (by Minister Nicola Roxon) to be specifically opt-in with a high level of personal / patient control of the information held within the system to avoid and manage any claims that the PCEHR was an stealth Australia Card or similar – there being considerable concern that such a link could cause the system to be abandoned.
With the change of Government the new Minister Dutton commissioned to Royle Review which found that there was a need to move from opt-in to opt-out as it otherwise would take many years for significant benefits to flow and that voluntary recruitment was not working well enough. There was no actual evidence backing the assertion suggesting the change.
A Privacy Impact Assessment (conducted by law firm Minter Ellison) of the transition to opt-out was given to Government in 2015 and raised many of the issues that have now emerged in the public dialogue in 2018.  As far as I can tell this report was simply ignored – and protection for adolescents, victims of various diseases and domestic violence were not implemented.
Essentially the work needed for a hoped for smooth transition from opt-in to opt-out was not properly recognised, scoped, planned for, funded and implemented, so while the switch may or may not have been a good idea (being based on hunch rather than evidence) the execution has so far been woeful.
C. - Privacy and security, including concerns regarding:
C1. - The vulnerability of the system to unauthorised access.
ALL internet-connected systems are vulnerable to hacking and intrusion and there is no evidence to suggest that the myHR is any different, containing as it does valuable personal data and being accessible via the internet from thousands of points. The believe otherwise is simply delusional.
C2. - The arrangements for third party access by law enforcement, government agencies, researchers and commercial interests.
My thoughts on Secondary Use of myHR data are found here where I made a full submission:
It is attached at the bottom of this submission.
C3.  - Arrangements to exclude third party access arrangements to include any other party, including health or life insurers.
I am opposed to any data access for insurers that might in any way harm the interests of any patient whose data in held in the myHR. Disclosure of this information should be at the total discretion of the data subject / patient.
D. - the Government’s administration of the My Health Record system roll-out, including
D1. –  the public information campaign.
The public information should have used a mix of traditional and social media and should have, at least in part, be run before the opt-out period began so the public were not as ‘startled’ as they were by a the zero notice about what was about to happen. It would be kind to describe the whole campaign as an ‘unmitigated fiasco which failed spectacularly to both alert and explain what was happening’.
D2. -  the prevalence of ‘informed consent’ amongst users.
Informal discussions with a range of clinician colleagues have suggested there has been very little cut-through in the community regarding the myHR and why people are suddenly being essentially to have one unless they are sufficiently digitally literate to opt out and are aware of potential issues that may arise if they do not.
E. – Measures that are necessary to address community privacy concerns in the My Health Record system.
Essentially what would be required if the plan to move to ‘opt out’ is continued with is acceptance of the recommendations of the 2015 Minter Ellison Privacy Impact Assessment and a much improved public communication / education program.
F. – How My Health Record compares to alternative systems of digitising health records internationally.
No country with a population of 25 million people has ever successfully established a secondary national electronic record system for all its citizens that has served to needs of both clinicians and patients. The problems associated with having individual clinicians, laboratories and so on feed data to a central hub and then have it made usefully accessible to both the patient and their doctor have not and I believe, will not be soluble, for reasons of currency, accuracy, reliability and useability. The size of the population served really matters which is why the more successful systems are found in Scandinavia and Scotland and why there are no detailed national systems in the UK, the US and so on.
KP Connect – the computer system operated by Kaiser Permanente to connect service their 9 million patients cost approximately $500,000 per doctor to install and up until 2010 cost $US6billion +.   
G. – Any Other Matters.
The topics I want to address under this heading are:
1. The possibility that a comprehensive digital health record for each of the population may not be a good idea and that it may be preferable only to have a small emergency care summary to support emergency care with more detailed records being help by the patient and / or their practitioner.
2. The poor depth of the advice provided to Governments of both political stripes in an area as complex as national Digital Health. Most advice has failed to recognise that Digital Health systems, to work acceptably, need to be focussed on the needs of either the patient OR the clinician. Their system needs are different and cannot be served successfully by the same system. See book citation below.
3. The need to clearly face the possibility that the My Health Record program will not deliver what is desired and to start again with a process to discover what might actually be beneficial> This needs to ignore the anxiety associated with the large ‘sunk cost’ of what has gone before.
4. The actuality that the My Health Record program, by providing such a large footprint on a small e-health industry has had a damaging impact on innovation and initiative in this area where most actors in this sector have been forced to serve a rather poor idea (the PCEHR and then the myHR) for financial survival. This has been a very damaging distortion.
5. Any Digital Health System must, of necessity, be supported strongly by the Clinical community to be a success. Polls of clinicians conducted recently show that GPs are, by and large, uninterested in the system and are not supportive of the myHR without profound and far reaching improvement. Attempting to ‘strong-arm’ the profession will simply not work!
What Is Needed If A (Wrong) Decision Is Taken To Persist With the myHR.
If, for some reason it is decided to persist with the myHR System (which I do not advise) the following is an expansion of the steps are required to possibly make the system barely acceptable.
1. Making the default security settings such that you (the information owner) have to consent to any sharing of information rather than having to specifically block sharing. 
2. Making the idea of “standing consent” be recognised for the nonsense it is in the sharing of personal health information, and require specific consent on all occasions.
3. Making the overall consent model of the myHR fully opt-in with the ability to restrict / delete the entire record – as well as the ability to download and preserve the record in a machine readable form.
4. Making available a suitable MBS item number to make it worthwhile for the GP to curate the record with the patient to ensure accuracy and currency of the data held in the system.
5. Allowing the capacity for the patient to print out a summary of their myHR to carry in their wallet to assist should they fall ill or be injured.
6. Full military grade encryption of the data-base to ensure breaches of the system lead to minimal data loss as well as two factor individualised authentication – with appropriate audit trail – to ensure it is very hard to get away with anonymous penetration of the system.
7. Specific measures to harden the security of the GP and Pharmacy endpoints to access the system with all other access removed except in secured emergency rooms. Uploads of information would still be permitted by Pathology, Radiology etc. but allied health, podiatrists and the like would be excluded. This means that just identified pharmacists and doctors can access the system – and no one else other than the patient – who also requires two factor ID.
8. Careful review of the situations regarding minors, estranged partners to ensure maximum user safety and privacy.
9. Make it illegal to discriminate against someone on the basis of whether or not they have a MHR
10. Law to make it illegal to discriminate against someone on the basis of whether or not they provide access to their MHR
11. Law to make applications to use data for research have ethics committee approval and explicit patient consent
12. Data cannot be used for commercial gain; it can only be used for public good with explicit consent from patients
13. Emergency access codes can only be used for direct care of the patient (not for 'public safety' reasons)
14. No government department to have access to MHR. Only police for investigation of an actual crime (not for prevention) with a court order
15. Make it illegal for any myHR data to be sold by anyone and no secondary use for commercial purposes.
16. Clarify how non-English speakers, those with intellectual disabilities (eg dementia), those without good computer proficiency can opt-out and/or change settings in the MHR.
17. All data access logged so the patient can see it (including police access).
18. All data access logged to an individual rather than an organisation.
19. Make default setting maximal restriction (rather than the minimal privacy setting it now has) - data cannot be shared by default – that it can only ever be shared via affirmative consent
20. Pause in the rollout whilst a public enquiry is held in to the privacy, data security implications of MHR.
Note: A number of these points were kindly suggested by Dr Thomas Rechnitzer of the Royal Melbourne Hospital.
Other than addressing the privacy and security issues discussed above there need to be major clinical utility and patient safety modification and review to optimise the clinical utility and data quality and so on as well as review of the various work-processes that surround the system.
This work requires formal expertise from a range of independent Health Informatics experts with a wide range of differing skill sets and would be best conducted independently by an international consulting firm.
Given the cost in practitioners time to curate the large number of health records (think 1-2 hours per week for 40,000 practitioners at $100 per hour = Close to $1B per annum) we also need a hard-nosed cost-benefit / value for money analysis. The myHR is going to have a considerable ongoing cost and we need to know there are not better ways to achieve as good if not better outcome.
Also needed is a proper Architectural Review to assess which of the  alternatives as there are a range of other non-centralised options such as linked regional health information exchanges with operating parameters similar to the above, direct on-line access to beefed up GP systems or various shapes of card based systems which may be cheaper and better.
----- End Submission.
Recommended Book:
The committee could very usefully review this book which makes a very large number of useful points and provides pretty recent background:
Title         The Digitalization of Healthcare: Electronic Records and the Disruption of Moral Orders
Publisher Oxford University Press, 2017
ISBN        0191804061, 9780191804069
-----
Useful Background Links:
Draft 1 - Aged Care Complaints (Minter Ellison PIA .doc)
----- End Submission
Appendix 1.
November 16, 2017

Final Submission - Secondary Use Of MyHR Data.

Submission  - Secondary Use Of My Health Record Data  - November 2017.

Background to Submission Author.

Dr. David G More MB, PhD, FACHI, the author of this submission, is a registered medical practitioner with an over 20 year background in Digital Health implementation and use.

Short Summary.

Overall I would just like to be sure that whatever Framework the Consultation comes up with we have strong public accountability as to who is doing what with whose data and that it is conducted under ethical supervision - assuming that we decide we agree to proceed with Secondary Use  - which I remain sceptical of - given the context of reduced public trust of institutions and other risks. If Secondary Use is to proceed I also offer what I believe is a sensible and pragmatic approach to implementation.

Background To Submission.

On behalf of the Commonwealth Department of Health HealthConsult has been tasked with assisting to develop a “Framework for the Secondary Use of My Health Record Data”
Conceptually this framework is to enable use of the data in this system (which is identified clinical and administrative data) of the purposes of extraction, analysis and reporting on any manner of data elements held in the record for health related purposes and for the ‘public good’.
Apparently specifically excluded is use of the data ‘exclusively’ for commercial or administrative purposed but ‘mixed’ use is apparently permitted.
An example of mixed use might be the use by a for-profit drug company of the data to assist in locating individuals for a clinical trial – as recently discussed on RN’s AM.
See here:
It seems to me that all those who have a myHR should at the least be offered an opportunity to opt-out and any Secondary Use while retaining their myHR if so desired.

Issues That Will Need To Be Addressed In The Final Framework.

Individual Consent
There is a general privacy principle that indicates the personal information should, in general, only be used, by anyone, for the purposes it was collected. As far as the myHR is concerned this would suggest the information held in the system is to be used for the purpose of delivering or supporting the individuals health care. Clearly using this same information for research, management etc. is unrelated to the direct care of the individual and so on is not what the data was given to the myHR for.
Data Quality
The data held in the myHR is largely held in rather old fashioned data-bases in forms where the is very little quality control and where it is held in forms that makes it very problematic to actually search or use the data. This has been openly acknowledged by the ADHA.
History Of Government Attempts To Misuse Health Data.
It was public opinion in the UK that resulted in the cancellation of the so called care.data program and in Australia data releases have been withdrawn after issue with the quality of anonymization were discovered. At the very least these issues should result in extreme care and caution with the use of the data or maybe have some actual experts oversee what Government does.
If There Is Any ‘Social License’ For Unannounced Use Of Personal Health Data Held In The myHR
It can be, not unreasonably, argued that unless individuals are fully informed and provided consent for data use that use of their data is a violation of the ‘social contract’ between the individual and the Government and that it is this sort of retrospective change of ‘the rules’ that is a contributor to the current lack of trust is government as starkly revealed in my recent poll.
----- Dated 12 November, 2017:

Do You Trust Government To Keep Safe And Not Abuse Private Information You Share With It?

Yes 4% (4)
No 95% (99)
I Am Not Sure One Way Or The Other 1% (1)
Total votes: 104
There Is Internal Government Awareness Of Complexity In, and Risks Of, Allowing Access To The Data
Discussions with the ADHA have not only confirmed major data quality and accessibility issues but also significant issues with safely providing any form of individual data access or downloading.

Proposal For Ethical Use Of Data Held In The myHR If It Is To Proceed.

Given that it is important that health data be properly used (where ethically possible) for the benefit of everyone I recommend the following approach to secondary use of the data held in the myHR system.
The approach also permits linkage to other relevant data sources.
1. All use of the data be as a result of a written publicly available proposal. This can be developed with the analytic entity. (A possibility for this entity may be a unit of the Australian Institute Of Health And Welfare)
2. The secondary use proposal is formally reviewed by an independent appropriately qualified and diverse expert ethics committee, and only proceeds if approved. The details of the Ethics Committee discussion should be publicly released. There should be a clear set of guidelines developed to explain what, and what not, constitutes ethical use.
3. All data analysis and reporting done in house – at a small group or sole purpose entity expert in handling data extraction, linkage and analysis. NO raw data leaves the analytic entity.
4. Researchers are encouraged to work with the entity experts to conduct analysis and reporting – but no data actually leaves the Government controlled repositories.
5. All summary reports resulting from the research  / analytics  is made publicly available on a dedicated web-site which also has the research proposal and ethic committee comments.
6. The supervising analytic entity should be within Government and publicly accountable.
This approach provides maximum transparency, considerable assurance of proper use of the information, reasonable data access and high security. There can also be total public confidence in what is done being done due to mandated transparency and disclosure. Additionally since no data is actually released, except in summary report form, the need to consent is obviated.
The disadvantages may be that outcomes may take a little time and may be more costly than simply handing the data over for use (and potential misuse).
I am happy to provide more details as may be useful to assess the proposal.
It should be noted that this submission is based on the assumption that the myHR Program proceeds as presently intended by the ADHA.
To be clear, overall I do not see Secondary Use of myHR data as either inevitable or positive, especially given the fact that most of the data is held and can be used elsewhere within Government, is more accessible there, and use of those sources avoids many of the privacy concerns associated with the myHR.
David More 16/11/2017.
----- End Appendix 1.
Comments Please....
David.


AusHealthIT Poll Number 438 – Results – 2nd Septembert, 2018.

Here are the results of the poll.

How Would You Rate Former Minister Hunt's Performance In The Digital Health Space?

Great 1% (1)

OK 1% (2)

Neutral 33% (53)

No Good 43% (69)

Just Dreadful 22% (36)

I Have No Idea 0% (0)

Total votes: 161

This is a totally clear cut with, ignoring the neutral, 105 negative votes and 3 positive votes.

Rather confirms the opinion offered by Peter Van Onselen in the Australian

“Compromised ministers now adorn the ranks of cabinet and the outer ministry. How anyone could believe any longer a single word Health Minister Greg Hunt utters in combating Labor attacks is beyond me. Put to one side his policy gymnastics in e-health and so on. Hunt stood up in parliament and expressed confidence in his prime minister immediately after voting to oust him, and immediately before doing so again. And he was scheming with Peter Dutton to run on a ticket as his deputy.”

Here is the link:

https://www.theaustralian.com.au/news/inquirer/dutton-backers-wont-stop-at-toppling-turnbull/news-story/d105a21e1e2233a2db045e1577d3add8

What a pathetic, vengeful, malevolent, self-obsessed, self-indulgent and sad klutz! It is surely all about him and not at all about the public - like so many politicians at present it seems. He is a good example of the species of ideologically driven politicians who have brought us to where we are now, and who need to either wake up or get out.

If you have not already, don’t forget to come to grips with what we are really facing…..

https://www.youtube.com/watch?v=XlUQMH19BkQ (62,271 views so far!)

Any insights welcome as a comment, as usual.

A really, great turnout of votes!

It must have been a very easy question as 0/161 readers were not sure what the appropriate answer was.

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

David.

Saturday, September 01, 2018

Weekly Overseas Health IT Links – 1st September, 2018

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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For fax sake: Retro tech leaves NHS open to cyber-attacks, say researchers

Hackers could gain access to NHS networks by exploiting vulnerabilities in fax machines, security researchers have suggested.
20 August 2018
Staff at Check Point Software discovered exploits in widely-used fax machines that enable hackers to spread malware through a malicious image file.
Malware can be coded into the image file which, when decoded by the fax machine and uploaded to its memory, will spread through any network it is connected to.
The exploit discovered by Check Point only requires that a hacker know the fax number of the organisation it wishes to target, which can be easily found online.
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Joe’s View: On the value of patient-centric records

When you’re out at sea and your yacht’s engine fails, it isn’t too much of a problem. You’ve got sails, a radio and cold beer in the fridge.
23 August 2018
Our problem was that we were only 200 metres off the land and drifting towards it. In all recorded fights between land and ships, ships have yet to score. I got on the radio to summon help. We waited nervously.
Then Michael turned up. The day before, Michael and I had both picked up yachts in Corfu to do a ”delivery trip”; a way to get a cheap sailing holiday in the Greek islands at the start and end of the summer season.
In the winter, the yacht rental companies keep their boats in cheap but less-than-beautiful boatyards up in the north. Come springtime the boats need to be moved about 400 miles south, where they will be rented to holiday makers over the summer.
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How hospitals can navigate overlooked IoT risks

An Internet of Things expert from Travelers discusses equipment maintenance software, smart screens and IoT-linked cabinets.
August 23, 2018 02:09 PM
The global healthcare sector will spend nearly $270 billion on Internet of Things devices and services by 2023, according to P&S Market Research. But with the explosive growth of IoT in healthcare, there are plenty unintended consequences and risks – some that few people are talking about.
For example, equipment maintenance software can help prevent IoT-linked MRI machine outages – but also opens up these machines to increased vulnerability to hackers, said Patty Nichols, medical technology practice lead and an IoT expert at Travelers
"Any machine that is network connected has software that will periodically require updates," said Nichols. "This maintenance is a major part of the software application development life cycle. However, the always-on nature of IoT makes patches and service releases particularly challenging because there is no concept of scheduled downtime; updates need to be applied when devices are in use."
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Healthcare is ready to invest in blockchain as new business cases emerge

The technology is "getting closer to its breakout moment," says Deloitte, whose new survey finds healthcare organizations seeing "disruption" on the horizon and preparing to spend accordingly.
August 23, 2018 01:50 PM
Healthcare organizations' understanding and appreciation of blockchain has evolved over the past years and more and more health systems are realizing that they need to invest as preparation for its "imminent disruption," according to Deloitte.
For its 2018 Global Blockchain Survey, Deloitte polled more than 1,000 executives worldwide, from across all industries. Nearly three-quarters (74 percent) of all respondents said their organizations see a "compelling business case" for the use of blockchain, and are planning their tech investments accordingly.
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Why Russian trolls stoked US vaccine debates

Updated 1341 GMT (2141 HKT) August 24, 2018
Russia's meddling online went beyond the 2016 US presidential election and into public health, amplifying online debates about vaccines, according to a new study.
The recent research project was intended to study how social media and survey data can be used to better understand people's decision-making process around vaccines. It ended up unmasking some unexpected key players in the vaccination debate: Russian trolls.
The study, published in the American Journal of Public Health on Thursday, suggests that what appeared to be Twitter accounts run by automated bots and Russian trolls masqueraded as legitimate users engaging in online vaccine debates. The bots and trolls disseminated both pro- and anti-vaccine messages between 2014 and 2017.
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NIH brain research initiative taps computing power to gain insights

Published August 24 2018, 7:43am EDT
Biomedical research is being transformed by the “explosion in computing power” and a tsunami of big data, says Francis Collins, director of the National Institutes of Health.
Recent advances in computational power have the potential to drive medical breakthroughs and therapeutic discoveries, Collins told the Senate health committee during a hearing on Thursday.
In particular, he pointed to NIH’s Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, an effort to push the boundaries of neuroscience research and equip scientists with insights necessary for treating a wide variety of brain disorders such as Alzheimer’s disease, Parkinson’s, schizophrenia, autism and drug addiction.
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HIT Think Why digital transformation success will depend on data governance

Published August 24 2018, 5:47pm EDT
Want your digital transformation strategy to succeed? You need a rock-solid data governance framework.
The imperative is there—some 85 percent of enterprise decision makers believe they have only two years to integrate their digital initiatives before falling behind their competitors, and 27 percent view digital transformation as a matter of corporate survival, according to research by cloud services provider Advance 2000.
But regardless of the reason an organization undertakes a digital transformation—be it to glean operational insights, change the way it engages with customers or to set the stage for other emerging technologies such as machine learning and artificial intelligence—it needs reliable data as its foundation. And that requires robust data governance.
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23andMe will no longer let app developers read your DNA data

  • 23andMe is preventing third-party developers from accessing customers' raw genetic information.
  • The company sent an email to its developer partners on Thursday.
  • More than 5 million people have purchased 23andMe's at-home DNA test.
Published 7:00 PM ET Thu, 23 Aug 2018 Updated 6 Hours Ago
23andMe, which provides DNA testing kits for consumers, is telling outside app developers that they'll no longer have access to the company's raw genomic data.
Developers of health apps, weight loss services and quantified self tests have been able to use 23andMe's anonymized data sets since 2012, when the company announced the opening of its application programming interface (API). The idea was to "allow authorized developers to build a broad range of new applications and tools for the 23andMe community," the company said at the time.
But on Thursday, 23andMe sent an email to developers, informing them that the API was being disabled in two weeks and that apps will only be able to use reports generated by the company and not the hard data.
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ED tech and process changes help hospital reduce readmissions by 25%

A case manager at Legacy Salmon Creek Medical Center devised a new program that also reaped an 81 percent reduction in avoidable emergency department visits by high utilizers.
August 23, 2018
08:47 AM
Cynthia Miceli, RN, a case manager at Legacy Salmon Creek Medical Center in Vancouver, Washington, designed a process – supported by a care collaboration network and emergency department-specific technology platform – that focused on identifying and supporting at-risk patients coming into the ED.
As a result, her team reduced the hospital's all-cause readmissions rate by nearly 25 percent, and saw an 81 percent reduction in avoidable emergency department visits by high-utilizers over about 24 months.
The IT, from vendor Collective Medical, is just a part of her story. Miceli used the the technical backbone to the program, which involved a process change to teach her team to think critically and holistically about the patient.
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Facebook, NYU Collaborating on the Use of AI to Improve MRIs

August 22, 2018
by Heather Landi, Associate Editor
Facebook and NYU School of Medicine’s Department of Radiology are collaborating on a research project to investigate the use of artificial intelligence (AI) to make magnetic resonance imaging (MRI) scans up to 10 times faster.
According to a blog post from Larry Zitnick from the Facebook Artificial Intelligence Research (FAIR) group and Daniel Sodickson, M.D., Ph.D, and Michael Recht, M.D., from NYU School of Medicine, if the project, called fastMRI, is successful, it will make MRI technology available to more people, expanding access to this key diagnostic tool. And, the project also represents one of Facebook’s major moves into healthcare.
MRI scanners provide doctors and patients with images that typically show a greater level of detail related to soft tissues — such as organs and blood vessels — than is captured by other forms of medical imaging. But they are relatively slow, taking anywhere from 15 minutes to over an hour, compared with less than a second or up to a minute, respectively, for X-ray and CT scans, Zitnick, Sodickson and Recht wrote in the blog post.
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Firms Lack Cyber Insurance Despite Healthcare Data Breach Costs

Given the proliferation and cost of healthcare data breaches and ransomware attacks, it is surprising that more than two-thirds of healthcare organizations have no cyber insurance.

August 22, 2018 - Given the proliferation and cost of healthcare data breaches and ransomware attacks, it is surprising that 70 percent of healthcare organizations have no cyber insurance, according to a survey of security executives by Ovum for analytics firm FICO.
This compares with only 24 percent of US firms across industries not having cyber insurance coverage, down significantly from 50 percent in 2017.
“It's is great to see that progress is being made but still surprising, that nearly a quarter of US firms surveyed have no cybersecurity insurance coverage,” said FICO vice president for cybersecurity solutions Doug Clare.  
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Google’s AI can outperform experts in diagnosing eye disease

Published August 23 2018, 7:47am EDT
Google’s DeepMind AI arm has created a new deep learning framework that diagnoses eye diseases and triages treatment options.
Research suggests that the approach can do just as well as—and, in some cases, better—than eye specialists, and could help patients receive treatment faster and thus avoid the loss of sight.
The AI approach uses studies from ocular coherence tomography (OCT), a three-dimensional volumetric medical imaging technology that measures the reflection of near infrared light. There’s a widespread availability of OCT images in ophthalmology.
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25-bed facility cites usability, savings for shift to cloud-based EHR

Published August 23 2018, 5:07pm EDT
Montgomery (W.Va.) General Hospital is shifting to a cloud-based electronic health records system after more than a quarter century using a server-based platform.
The 25-bed critical access facility in has been a user of Meditech’s electronic health records system for 27 years. Faced with the need of an upgrade of its servers and the current platform being out of favor with physicians, the facility became the first to adopt the vendor’s cloud-based Expanse EHR platform.
The hospital annually cares for more than 1,000 in-patients, 40,000 outpatients and 10,000 emergency patients.
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HIT Think Why EMPI is crucial for current patient identification needs

Published August 23 2018, 5:31pm EDT
The depth and breadth of patient identification errors that currently exist across the U.S. healthcare system demand that stakeholders develop more comprehensive approaches to accurately linking individuals to their health data.
Because the safety of the patient starts with consistently identifying and matching them to their records, there lies greater pressure on the industry to improve EHR interoperability and to strengthen Enterprise Master Patient Index (EMPI) systems. This is critically important as healthcare organizations become more dependent on initiatives such as ACOs, population health, precision medicine and health information exchanges (HIEs), all of which rely on accurate and easily accessible patient data.
Despite newly directed federal efforts to encourage information exchange and patient data empowerment, the industry still struggles to recognize the foundational role of patient identification in achieving the interoperability goals of the administration.
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August 22, 2018 / 3:13 AM / a day ago

Consumer baby monitors may get vital signs wrong

 (Reuters Health) - Two popular monitors that promise to keep parents informed about their babies’ vital signs scored poorly in a test comparing them with actual hospital quality monitors, researchers say.
The commercially available monitors, which are not approved by the U.S. Food and Drug Administration, promise to sound an alarm via parents’ cell phones if the baby’s heart rate or blood oxygen levels move into danger zones, according to the study in JAMA.
Of the two monitors, the Owlet Smart Sock 2 performed better. But it still often sounded the alarm when there was nothing wrong and sometimes missed instances when blood oxygen levels were too low. The other monitor, the Baby Vida, performed even worse, completely missing unhealthy vital signs.
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UK's NHS struggling with security after WannaCry, losing 10K patient records last year

Months after all NHS trusts failed security assessments, a new assessment from a think tank found the majority of hospitals still are leaning on handwritten documentation, and often misplace patient records.
August 21, 2018 12:59 PM
Just months after all 200 U.K. National Health Service trusts failed government-issued assessments, a recently released report from think tank Parliament Street found the NHS lost nearly 10,000 patient records last year.
The report examined the number of records misplaced by NHS trusts during the last financial year, which found 68 NHS trusts lost or misplaced 9,132 patient records.
The team only worked with the 68 trusts to compile the data, made up of information on patient records reported missing and details of handwritten records. Data from the other 132 NHS trusts were not included in the report.
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Mobile apps could be the solution to better patient matching, RAND analysis says

Aug 22, 2018 12:01am
As little as 50% of patient records are correctly matched between providers. And when clinicians use information in the wrong record to make medical decisions, it can lead to dangerous situations in patient care.
There should be an app for that, according to a new analysis from the RAND Corporation.
An EHR app makes sense because smartphone adoption and functionality have increased dramatically in recent years, RAND says. This solution would also simplify the check-in process and provide patients with greater control over their records, the report explains.
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Blockchain in healthcare: 3 promising use cases in a sea of skepticism

Aug 22, 2018 1:15pm
WASHINGTON, D.C.—At the recent Blockchain Health Summit, healthcare CEOs from around the world gathered to learn exactly how blockchain technology could revolutionize the healthcare business.
While conference attendees scrounged for evidence indicating the technology could solve some of healthcare's most pressing problems, they were also forced to wade through a heady dose of hype.
“We all know this terrible thing blockchain; it’s a disease. Once we get it, we become obsessed with it,” warned Tori Adams, vice president of Consensys Civic.
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Individuals’ use of online medical records is on the rise

It’s taken years, but healthcare consumers are now becoming comfortable with the notion of accessing their medical records online. In fact, the use of portals and other mechanisms to access medical records is rising, according to the Office of the National Coordinator for Health Information Technology.
And the pressure will rise in coming years, with the 21st Century Cures Act including provisions intended to improve patients’ access to and use of their electronic health information. Using data from the National Cancer Institute’s 2017 Health Information Trends Survey, ONCHIT earlier this year analyzed consumer access and use of online medical records and the use of technology such as smartphones, tablets and electronic monitoring devices for health related needs.
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Survey finds many providers fall short on security preparedness

Published August 22 2018, 5:48pm EDT
A significant percentage of hospitals and group practices are struggling to comply with a range of standards for privacy and security.
Acute-care facilities and related group practices routinely deal with multiple types of data or data-related processes that are subject to privacy and security compliance requirements, and only 65 percent of providers report being compliant across a range of standards, according to results of a new survey.
The survey of 360 organizations was conducted by business performance improvement firm Aberdeen Group and supported by Liaison Technologies, which provides a data integration platform that helps companies handle data from various sources.
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HIT Think How to bridge the potential divide between IT and the clinical side

Published August 22 2018, 5:54pm EDT
I recently had the chance to speak with Rob Schreiner, MD, president of Wellstar Health System and a member of the KLAS Arch Collaborative. Wellstar Health System was the very first organization to take KLAS up on its offer to participate in the EHR benchmarking study.
The organization had been looking for a way to measure its ability to gauge users’ satisfaction with its electronic health records system. Now, data indicates that the organization is in the top echelon of performance.
KLAS is particularly impressed with how Wellstar Health System has approached the EHR implementation. They’ve recently added 11 hospitals and 250 medical offices, all of which began implementing their current EHR in 2013. Through all of that EHR work, Schreiner says has learned quite a bit.
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Before Using Birth Control Apps, Consider Your Privacy

Score one for the quantified self-surveillance movement. Last week, the US Food and Drug Agency approved the first-ever, over-the-counter digital contraceptive—a polished and almost preternaturally upbeat mobile app called Natural Cycles. Basal body temperature readings and monthly menstruation data feed into an algorithm that tells users whether or not they should be having unprotected sex. Like most forms of birth control, it’s not foolproof; the app has been dogged by reports of unwanted pregnancies that prompted two ongoing investigations by European authorities into its Swedish maker’s marketing claims.
But that hasn’t hurt Natural Cycles’ popularity.
The app, which is available without a prescription, boasts more than 900,000 users, or “Cyclers” worldwide, according to the company. And with its new FDA approval—clearing the way for similar fertility and period-tracking apps—the company is expanding operations with a new US office in New York. It also recently added a research team based in Geneva, made up mostly of scientists hired away from CERN. (Natural Cycles’ husband and wife co-founders Elina Berglund and Raoul Scherwitzl began work on the app while she was employed as a physicist at the Swiss particle-smashing facility and he was pursuing research at the University of Geneva.) The new team will search a growing collection of user information for insights, beyond contraception and planning a pregnancy, says Berglund. It’s not exactly the Higgs boson, but it could turn out to be more lucrative.
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Amazon’s latest health care hire is a master of bringing technology into the clinic

August 21, 2018
Dr. Maulik Majmudar has spent years toiling on a task Amazon must master to disrupt the nation’s health care industry: getting physicians to incorporate novel technologies into their practices.
This week, he announced he is taking a new job with the ecommerce giant following several years incubating new technologies at Massachusetts General Hospital.
In an interview with STAT Monday, Majmudar, the former associate director of the health care transformation lab at Mass. General, said the job at Amazon offers a chance to drive the uptake of technology solutions that could impact patients worldwide.
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AI reduces time needed to generate radiation therapy plans

Published August 21 2018, 7:30am EDT
Researchers from the University of Toronto have developed an artificial intelligence tool that needs less time to create treatment plans for cancer patients.
While it can often take days to produce radiation therapy plans tailored for each patient, engineers at UT have cut the time down to just hours to generate such individualized treatment plans.
Aaron Babier, an engineering researcher, and his team at UT’s Department of Mechanical and Industrial Engineering, developed the automated software that leverages AI to mine historical radiation therapy data, which is then applied to an optimization engine to come up with radiation therapy plans.
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UK health chiefs block controversial app for patient safety concerns

While a recent review showed Babylon’s GP at Hand smartphone app improved care access, the plans to expand its roll-out were prohibited by officials.
August 21, 2018 04:22 PM
The roll-out of a controversial smartphone app in Birmingham – the UK’s second largest city - is still being blocked this week, despite the publication of a report that shows that the software “advances equality of access to GP services.”
The GP at Hand app claims to reduce pressure on primary care and hospitals, yet is being blocked from expanding in the city following concerns about patient safety.
The app being blocked comes during the same week that the NHS is struggling with WannaCry, after losing some 10,000 records last year and just weeks after the NHS kicked off a startup challenge for financial innovation.
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KLAS: Business Intelligence Use Varies, Epic Systems Leads Adoption

Providers are using a wide range of healthcare business intelligence vendors for an equally wide range of uses, resulting in BI use and outcomes variation, KLAS reports.

August 20, 2018 - Health IT giant Epic Systems has the deepest adoption of healthcare business intelligence solutions, but healthcare organizations are also increasingly seeking the advanced data analytics tools offered by Jvion, HBI Solutions, and other newcomers, a new KLAS report showed.
In its “Healthcare Business Intelligence 2018: Who's Advancing Data Analytics & Infrastructure?” report, KLAS interviewed three innovative clients of major and emerging healthcare business intelligence vendors to identify and validate which advanced analytics functionalities healthcare organizations are using and what outcomes they have realized using the tools.
KLAS researchers found that it is a mixed bag with healthcare business intelligence tool adoption and use.
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6 common habits that put you at risk for identity theft

Data breaches and hacks are often unavoidable, but security experts say there are some everyday habits that put consumers even more at risk.
by Emily Long / Aug.21.2018 / 12:36 AM ET
According to a report by Javelin Strategies, U.S. residents lost $16.8 billion to fraudsters in 2017, and the number of victims increased 8 percent over the previous year.
U.S. residents lost $16.8 billion to fraudsters in 2017.
Unfortunately, identity thieves are getting smarter, which means that consumers have to be even more vigilant when it comes to protecting their personal information and their financial well-being. Thieves are launching more complex schemes, but consumers also don’t think twice about many common practices that put their data — and their money — at risk.
It’s easy to be cavalier with your passwords and personal information — and to believe identity theft won’t happen to you. Here are six common habits to break right now.
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Which IT trend is most promising? 29% of provider execs say telemedicine

Written by Jessica Kim Cohen | August 20, 2018 
Twenty-nine percent of executives from healthcare providers agree telemedicine is the most promising emerging technology trend in the healthcare industry, according to a Reaction Data report.
Reaction Data surveyed 97 C-suite executives and directors from various provider organizations, including hospitals, long-term care facilities and specialty clinics, about their view of the future of healthcare.
Here's how the 97 executives responded when asked, "Which technologies will have the biggest impact?":
1. Telemedicine: 29 percent
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Lessons from an Angry Patient

  • Emmet Hirsch, M.D.
She bore a scowl and a combative attitude from the moment I walked into the room. In response to my hopeful “How can I help you?” she unleashed a tirade that seemed to pick up where some prior conversation had left off. Though she was new to my practice, she seemed to have already concluded that she would get no satisfaction from me.
And I experienced an uneasy feeling: she was probably right.
I took a history. The patient had had a terrible outcome to her pregnancy nearly a decade earlier. Her premature baby, delivered by emergency cesarean section, had died, and she herself had nearly died from sepsis. Since that time, she reported, she’d had an abnormal vaginal discharge. A different doctor had validated her suspicion that there was a persistent bacterial infection, the same one that had caused her septic pregnancy. That other doctor had treated her with antibiotics, but the discharge had remained. Her boyfriend complained about it. She believed it was responsible for her failure to conceive a second time. For years, she had gone to practitioner after practitioner. All were either unable or unwilling to help her.
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The Latest Thing You Need to Worry About Cybercriminals Hacking? Your Voice.

The shift to voice biometrics and speech-controlled systems is raising the risk of voice cloning and subliminal attacks.
Larry Johnson
Guest Writer : Chief Strategy Officer at CyberSponse
August 16, 2018
It may sound like science fiction, but a new threat is emerging in the world of hackers that is taking aim at the human voice.
"Voice hacking" can take many forms, but in most cases it is an effort by an attacker to copy an individual's unique "voiceprint" in order to steal his or her identity or to use hidden audio commands to target a speech-controlled system.
If this seems farfetched, it's not. We've already seen cybersecurity researchers demonstrate some of these methods in proof-of-concept attacks, and the risk gained further priority this August at the Black Hat conference, where ethical hackers demonstrated new methods of voice "spoofing" and attacking a widely used personal digital assistant through voice commands.
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CDC analysis finds imaging reports important in physician data exchange

August 17, 2018 | Matt O'Connor | Imaging Informatics
A new analysis from the Centers for Disease Control and Prevention (CDC) found imaging reports among the top three pieces of patient data physicians electronically received and integrated in 2015.
Using data from the 2015 National Electronic Health Records Survey, the CDC examined the types of patient health information (PHI) that are electronically sent, received, integrated and searched for by office-based physicians with an electronic health record (EHR) system in the United States.
Here are the results:
Physician-sent personal health information
The most common type of data were referrals (67.9 percent), lab results (67.2 percent) and medication lists (65.1 percent).
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, 2018

Why patients and doctors are still dissatisfied by electronic health records

Physicians were less satisfied by the system overall, citing the time it took to enter data, changes to workflow and decreased productivity.

Jeff Lagasse, Associate Editor
Electronic health records are intended to streamline and improve access to information -- and have been shown to improve quality of care -- but a new study shows they can also leave both doctors and patients unsatisfied, even after full implementation.
Takeaways for health professionals: During EHR implementations, or even once the system is in full swing, keep in mind how patients will be affected -- and perhaps even do training on patient interactions with EHRs to mitigate some of the negative effects. Also, since the brunt of documentation impact falls to physicians and impacts productivity, adjustments should be made to productivity targets that take that into consideration.
The study, by researchers at Lehigh University and the Lehigh Valley Health Network, surveyed physicians, mid-level providers and non-clinical staff at OB-GYN practices where EHRs were installed and analyzed survey answers given by patients.
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Verma calls on insurers to use APIs. Some answer more enthusiastically than others

Aug 17, 2018 8:32am
At the Blue Button Developer Conference on Monday, Centers for Medicare & Medicaid Services Administrator Seema Verma called on insurers to follow the agency’s lead and jump on board the open standards train.
“We are leading by example and calling on all insurers to release data in an API format," Verma said. "You'll see through our regulatory process that we're very serious about that."
It’s the second time Verma has called on insurers to adopt an API format. In April, shortly after unveiling Blue Button 2.0, CMS said it is considering a mandate that would require payers to use data platforms that “meet or exceed the capabilities of CMS’s Blue Button 2.0.”
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FDA approves device to treat obsessive-compulsive disorder

Published August 20 2018, 7:22am EDT
The Food and Drug Administration has cleared a device that uses magnetic fields to stimulate nerve cells in the brain for the treatment of a common mental illness.
The procedure, called transcranial magnetic stimulation, was approved by the FDA as a treatment for major depression in 2008. The regulatory agency subsequently expanded the use to include TMS for treating pain associated with certain migraine headaches in 2013.
Now, the FDA has decided to permit the marketing of the Deep Transcranial Magnetic Stimulation System from Israeli vendor Brainsway for obsessive-compulsive disorder (OCD), based on the agency’s review of data from a randomized, multi-center study of 100 patients.
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Faster CPU can accelerate ability to use AI on medical images

Published August 20 2018, 4:49pm EDT
Tests suggest that computer processors can accelerate the speed with which artificial intelligence can be applied to image studies.
That’s good news for the future of using deep learning to derive insights and find anomalies on medical images. The use of AI in imaging was being constrained by limitations in the memory constraints of graphics processing units (GPUs).
Recent testing by Philips and Intel demonstrated the value of high-power central processing units in applying deep learning to imaging studies. The companies used Intel-brand scalable processors and a Philips AI toolkit on two deep learning inference models. One involved X-rays of bones for bone-age prediction modeling, while the other was on CT scans of lungs for lung segmentation.
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HIT Think How a New Mexico facility is using IT to battle addiction

Published August 20 2018, 5:36pm EDT
McKinley County, New Mexico, is home to many Native Americans of Navajo decent living on a reservation. It borders on Gallup, N.M., which gained renown as "Drunk Town, USA" 30 years ago.
For many years, Gallup ranked No. 1 nationally in the number of alcohol-related deaths, highlighting the need for behavioral healthcare. The National Institute of Health reported that Native American youth have the highest rates of alcoholism of any racial group in the country. Addiction’s partner is the abject poverty of McKinley County, one of the poorest counties in the U.S., with a large population of Navajo, Zuni and Hopi Indians.
In addition to addiction, another behavioral health related disease afflicting the territory is diabetes. In 2016, diabetes was the sixth leading cause of death for New Mexicans and the seventh leading cause in the U.S.
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Sepsis: 3 Innovations You Need to Know

By Mandy Roth  |   August 20, 2018

Best practices and innovations in sepsis can drop mortality rates and lead to earlier detection.

KEY TAKEAWAYS

Remote monitoring helped Nemours Children's Hospital drop its sepsis rate to zero.
Emory's AI device in development predicts sepsis 4—12 hours prior to clinical recognition.
New test may detect sepsis earlier by measuring body's immune response rather than detecting pathogens.
Sepsis is deadly, it's expensive, and there are abundant initiatives under way that could lead to earlier detection, lowering costs, and saving lives.
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Tech firms say A.I. can transform health care as we know it. Doctors think they should slow down

  • Some doctors worry that those in the tech world think AI can not only help clinicians, but even do a better job.
  • They fear the fast-paced nature of the still nascent AI industry could come at the risk of patient safety.
  • One U.K. health industry body believes regulators should keep pace with the rapid advances in technology.
Published 1:33 AM ET Fri, 17 Aug 2018 Updated 10:53 AM ET Fri, 17 Aug 2018
A medical doctor examines a patient with a stethoscope at a CCI Health and Wellness Services health center in Gaithersburg, Maryland.
As an industry reliant on patient records and beset by outdated technology, health care is widely thought to be a prime target for an artificial intelligence revolution.
Many believe the technology will provide a host of benefits to clinical practitioners, speeding up the overall experience and diagnosing illnesses early on to identify potential treatment.
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https://www.thetimes.co.uk/edition/news/fraud-fears-as-hospitals-lose-thousands-of-patient-records-hnth020pk

Fraud fears as hospitals lose thousands of patient records

Kat Lay Health Correspondent
August 20 2018, 12:01am, The Times
NHS hospitals lost nearly 10,000 patient records last year, according to figures released under freedom of information laws.
The mislaid records, both paper and electronic, prompted concerns over the implications for patient safety and data security. Experts warned that sales of such records on the dark web and cases of identity fraud were on the rise, making better protection of patients’ data “urgent”.
Campaigners said that not having a full record available during a consultation could make it harder for doctors to make an accurate diagnosis or prescribe the correct medication, even though some records were eventually located. Only 68 hospitals released data on missing or lost patient records for the report by the Parliament Street think tank, meaning the scale of the problem is likely to be much bigger.
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Enjoy!
David.