This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
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."
NSW
Health has picked Epic to deliver its Single Digital Patient Record project,
which seeks to unify all EMR and pathology information systems across the
state.
Subject to the successful completion of
contractual negotiations, Epic's supply contract will replace nine existing EMR
platforms, six PAS, five pathology LIMS and several other clinical support
systems, which have been provided by Cerner, Orion Health, DXC, Citadel, and
Integrated Software Solutions.
The SDPR will provide comprehensive, real-time
electronic access to medical records across NSW Health, covering 15 Local
Health Districts (LHDs), two specialty health networks and all NSW Health
pathology laboratories.
According to eHealth NSW chief executive and
CIO Dr Zoran Bolevich, they engaged more than 350 expert stakeholders,
including clinicians, scientists and technical experts, to evaluate Epic's
supply proposal.
"Their
expertise, along with meaningful engagement with healthcare consumers, will
continue to guide us as we roll out SDPR across the state," he added.
Meanwhile, the NSW
government last year invested over $105 million in SDPR. The system will go live first at
Hunter New England LHD before its full rollout across the state.
Epic has won the bid to transform NSW
Health’s digital health ecosystem by usurping long-term incumbent Cerner.
The IT transformation is expected to take
six years and aims to achieve NSW Health’s goals including single patient
identifiers, patient information portals and embedding virtual care
as a part of routine care. In all, 350 expert stakeholders weighed in
on the tender and favoured Epic over Cerner.
Michelle O’Brien is a digital health thought
leader and former business executive for Medical Director and MediRecords. She
said the decision to move away from Cerner was unexpected given the extent that
Cerner is embedded in NSW Health.
“What is surprising though is the thought
that you would put two global competitors into NSW Health together and expect
them to be able to work together. I think that’s what shocked everyone in the
market,” Ms O’Brien said.
Ms O’Brien added that although the market
may be surprised, some users of NSW Health digital health systems were probably
not as shocked by the decision.
“The
systems in NSW hospitals are pretty old and a mishmash of technology. Cerner
has multiple instances [versions] operating across NSW hospitals. I think
Epic’s technology is seen as more innovative and more in line with the ability
to be flexible and scalable,” she said.
So,
who is Epic?
In
short, the market leader in the US. They possess nearly 33% of the hospital market, according to Beckers Hospital
Review. They have an office in Melbourne and 10 other cities around the globe
and call their main office Wisconsin, US their “intergalactic headquarters”.
A
future version the statewide digital health record to be rolled
out in New South Wales over the coming years could give patients access to
their clinical record, much like the national My Health Record system.
NSW Health this week announced its
partnership with US-based electronic medical record (EMR) vendor Epic to
deliver the state’s Single Digital Health Record (SDHR), ending a three-year
search for a provider.
Epic has spent the last two years delivering
the Australian Capital Territory’s Digital Health Record (DHR), having won a
$128.3 million contract in July 2020. The DHR went live across Canberra last
week.
New South Wales’ SDHR will replace nine
existing EMR platforms provided by Cerner and Orion Health, six patient
administration systems from Cerner and DXC and five pathology laboratory
information management system.
It will be used across all 15 Local Health
Districts, two Specialty Health Networks and NSW Health Pathology laboratories,
giving clinicians access to real-time NSW Health medical records regardless of
where a person is admitted.
The
digital platform will be unlike the My Health Record system at the national
level in that it is designed to be an operational record used by clinicians to
manage patients within the NSW public health system.
But
an eHealth NSW told InnovationAus.com that platform to be delivered by Epic
“offers some additional functionality, such as a patient portal, which will be
considered in the future to support patient interactions with the system”.
eHealth
NSW first raised the prospect of allowing patients to access their NSW medical
records when it initially went to market for the SDHR in mid-2019.
In
a statement, eHealth NSW chief executive and NSW Health chief information
officer, Dr Zoran Bolevich, said Epic was chosen after a “robust process”
involving more than 350 clinicians, scientist, technical experts and other
stakeholders.
The
key question I have about all this is whether there has been any form of
benefits analysis that shows that the benefits flowing to NSW from this change
going to be in excess of the $1 Billion being spent and that those benefits are
in excess of the benefits of the status quo which I am pretty sure have not
been fully amortised!
A
extra billion dollars is no chicken feed on top of what has already been spent –
which seems to be working to some significant degree – as I observed personally
in a recent stay at RNS a few years ago.
The
disruption and retraining of the 120,000 staff in NSW Health is no trivial
matter and has a real economic cost which I am sure is largely ignored – and remember
these people are still recovering from a pretty terrible 3 years with COVID! I really
wonder if the issues with the present systems are so severe and so urgent this
switch has to happen now or is this some empire building in the part of
eHealthNSW?
Simply
might the NSW Health System have say a 5 year breather as COVID settles before
being destabilised again? Can this huge move be really justified now?
What
to people think? Insider comments welcome!
I note, in passing, that Epic does provide good patient information access facilities which may go some way to explaining the switch. Of course you could fix that issue for way less than a billion dollars!
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AI Clinical Decision Support Tool Can Help Predict COVID-19 Prognosis
Researchers
from The Feinstein Institutes for Medical Research at Northwell Health have
developed an artificial intelligence tool to predict COVID-19 prognosis and
disease severity.
November 18,
2022 - Researchers from The Feinstein Institutes for Medical Research, the
research arm of Northwell Health, have developed
an artificial intelligence (AI)-based clinical decision support tool that can
predict COVID-19 patient prognosis and severity of the disease using blood work
and EHR data.
According to
the study
describing the tool, clinical prognostic models can assist in patient care
decisions, but their performance can dip or drift because of shifts in time and
location. The researchers state that these models necessitate regular
monitoring and updating to address this.
Further, the
authors note that prognostic models for COVID-19 do not account for these
changes in performance, despite rapid, significant changes across variants and
disease waves. The research team set out to develop a model that accounts for
quick changes in patient conditions and outcomes.
“COVID-19 was
one of the most dynamic diseases we’ve witnessed in modern history and
information about how to care for patients was constantly evolving,” said Theo
Zanos, PhD, senior author of the paper and associate professor at the Feinstein
Institutes’ Institute of Health System Science and Institute of Bioelectronic
Medicine, in the press release. “By harnessing data and developing a real-time
auto-updating clinical tool, we set out to create a tool that accounts for
these developments and helps clinicians make the decisions they need to deliver
better care.”
Beyond the hospital walls: how digital will revolutionise cancer care
Dr Majid
Kazmi, director of innovation for cancer and surgery and deputy medical
director, Guy’s and St Thomas’ NHS Foundation Trust, outlines how digital
promises to revolutionise cancer care.
DHI News Team
16 Nov 2022
The number of
people living longer with cancer is on the rise. In the UK, fifty percent of
people can now expect to live with cancer for ten years or more after a
diagnosis1.
This is
clearly a good thing but it does present a challenge for the NHS when combined
with a shrinking oncology workforce2 and escalating costs.
With these
resource challenges, managing patients through their cancer journey is becoming
more difficult.
And as people
live longer with cancer, keeping patients connected, better informed and giving
them the ability to make decisions about their care becomes increasingly
important.
Ransomware Gangs Shift Tactics, Making Crimes Harder to Track
Jack Gillum, Bloomberg News 18 Nov,
2022
(Bloomberg)
-- Ransomware gangs increasingly use their own or stolen computer code, moving
away from a leasing model that made their activities easier to monitor, new
research shows.
Numerous
prominent hacking groups in recent years have functioned by leasing their
malicious software and computing infrastructure to other bad actors, in what’s
known as ransomware-as-a-service. That model, which experts say turbocharged
the number of ransomware attacks, was offered by infamous groups such as Conti,
which shuttered Irish health systems, and REvil, deemed responsible for a 2021
intrusion at the IT management firm Kaseya Ltd.
But
now the number of smaller hacking groups has rapidly increased, with many of
them deploying their own code or stealing it from others, according to Allan
Liska, a threat intelligence analyst at Recorded Future Inc. The shift has
coincided with a reduction in activity by some higher-profile groups, according
to research Liska presented Friday after the CYBERWARCON security conference.
The
evolution is complicating efforts to track various new groups, such as Onyx,
which researchers believe reuses Conti’s code and has claimed to target several
victims.
The
U.S. government has warned of ongoing malicious activity by the notorious Hive ransomware gang, which
has extorted more than $100 million from its growing list of victims.
A
joint
advisory released by the FBI, the U.S. Cybersecurity and Infrastructure
Security Agency, and the Department of Health and Human Services on Thursday
revealed that the Hive ransomware gang has received upwards of $100 million in
ransom payments from more than 1,300 victims since the gang was first observed
in June 2021.
This
list of victims includes organizations from a wide range of industries and
critical infrastructure sectors such as government facilities, communications
and information technology, with a focus on healthcare and public health
entities.
Hive,
which operates a ransomware-as-a-service (RaaS) model, claimed the
Illinois-based Memorial Health System as its first healthcare victim in August
2021. This cyberattack forced the health system to divert care for emergency
patients and cancel urgent care surgeries and radiology exams. The ransomware
gang also released sensitive health information of about 216,000 patients.
From
providing virtual therapy sessions to patients in the front seats of their
cars, to sessions with patients who turn out to be in another state, the
new paradigm of telepsychiatry is presenting clinicians with a host of
situations with unwritten or constantly changing rules.
But
key practice tips are emerging for the optimization of virtual sessions, said
Sanjay Gupta, MD, chief medical officer of the BryLin Behavioral Health System
in Buffalo, N.Y., during a presentation on the subject at the 21st Annual
Psychopharmacology Update presented by Current Psychiatry and the American
Academy of Clinical Psychiatrists in Cincinnati, Ohio.
Gupta
noted that while "many pitfalls [may] occur," an overriding rule that
should be emphasized with telepsychiatry is that "[virtual visits] are
held to the same standard of care as an in-person visit." This
"rule" needs to be followed diligently, he said, as the key
difference in virtual visits is a reduced sense of the formality of a
psychotherapy session.
With
virtual sessions, the therapeutic experience "can feel kind of
trivialized," said Gupta, who is also a clinical professor in the
department of psychiatry, State University of New York at Buffalo. He noted
that it is crucial that "the sacredness of a private setting should not be
diluted."
Challenges
in finding that privacy for some, however, lead to the issue of the
"patients in cars" scenario, Gupta said. Still, he added, while
psychiatric sessions should never be conducted when a patient is driving, the
front seat of a parked car may, for some, be the most private setting
available.
The
21st
Century Cures Act codifies immediate access to health information
for patients. The Act paves the way for patients to become more pro-active
partners in their care. Access alone, however, is not sufficient. There is
little value for patients to access health information they cannot understand.
This is especially the case with radiology. A typical radiology report contains
a lot of medical jargon and data that can be misinterpreted easily by those
without medical training. One radiologist-led health technology company, SCANSLATED is addressing this
challenge by offering AI-powered report translation software to help patients
more easily understand their imaging results.
Patients
Proactive Participants in Their Care
Studies
have shown that patients who are more active in their care, experience better
health outcomes at lower costs compared to less active patients. An “activated”
patient is one that has the skills, ability, and willingness to manage their
own health and health care experience.
Until
recently, the healthcare system did not make it easy for patients to be active
in their own care. It was difficult for patients to get copies of their medical
records and when they did, the information was often out-of-date or incomplete.
Only the most determined patients are able to successfully navigate the maze of
healthcare policies and organizations to gather their records in one place.
Today,
the widespread adoption of electronic health records (EHRs) and patient portals
has made it easier for patients to access their own health information. That
access is an important first step in turning passive patients into activated
ones. However, to truly activate and engage patients in their care will require
helping them understand
the information contained in their medical records.
Radiology
reports, for example, are particularly difficult for patients to understand.
The
healthcare conference celebrated its 5th year in Las Vegas, where almost
10,000 attendees discussed the biggest challenges in healthcare alongside
gambling, gin and tonics, and glowsticks.
KEY
TAKEAWAYS
·Roughly 10,000 people attended HLTH's fifth
annual conference this past week in Las Vegas.
·Attendees discussed a number of critical
healthcare issues, including provider burnout, workforce shortages,
interoperability, digital health, patient engagement, and AI.
·The combination of healthcare and typical
Vegas-style entertainment may have ruffled some feathers, but the event gave
attendees an opportunity to break down barriers and discuss a redefined
landscape that focuses on both health and care.
At times it
felt like a rock concert or a rally. There was food, drinks, a meditation tent,
beauty salon, games, mimosas in the registration line, popcorn and ice cream.
And the glitz and glamor of Las Vegas was just beyond the walls of the Venetian's
conference center.
Was this really
a healthcare conference?
Yes, it was.
And while HLTH 2022 put on quite a show, it was still all about healthcare. But
a new definition of "healthcare," which has been battered by the
pandemic and bruised by the politics. Now, it's about both health and care, and
all the connections that can—and should—be made to support that strategy.
Artificial
intelligence (AI)
is playing an increasingly relevant and important role in our lives. Be it
through your personal devices, streaming platforms or the production of
vaccines, our symbiotic relationship with AI is unquestionable. This rapid rise
in the use of AI raises challenging questions for patent law: are AI-created
technologies patentable and should AI be recognised as the inventor? We take a
look at the decisions leading up to the decision of the High Court to refuse Dr
Thaler’s application for special leave, where these questions were answered.
With innovation heavily embracing AI across all industry sectors, this decision
is key for all businesses to understand.
Litigation
History
The
patent application in question lists the inventor as the AI system “DABUS”, an
acronym for “device
for the autonomous bootstrapping of unified sentience”. The Deputy
Commissioner of Patents determined that the Patents Act and Regulations were
inconsistent with AI being recognised as an inventor (see Stephen
L. Thaler [2021] APO 5).
Dr
Thaler appealed to the Federal Court, where Justice Beach concluded that, on
the contrary, an AI system can be recognised as an inventor under the Patents
Act. This, Justice Beach said, would be to accord the word “inventor”
with its ordinary meaning, a meaning that must not only recognise the “evolving
nature of patentable inventions and their creators” in light of the
newly inserted objects clause under the Patents Act, but a meaning that must
reflect reality (i.e. if the AI system is not the inventor, who is: would it be
the programmer, the owner, the operator, the trainer, or perhaps the person who
provided input data?). Our detailed report on the first instance decision can be found here.
A
review of 12 healthcare websites that focus on substance abuse finds that 11 use tracking cookies, four use session
recordings, six use Meta Pixel, and all 12 sent data to advertising companies.
New healthcare privacy challenges as online data tracking, sharing methods
evolve
With security
concerns, including a potential breach and a class-action suit, around Meta
Pixel and other web tracking tools, health systems should be considering
"all the ways PHI may be used, disclosed and accessed," says a former
OCR investigator.
This
past June, a John Doe plaintiff who was a patient at Baltimore-based Medstar
Health System filed a class-action complaint against Meta Platforms in the U.S.
District Court for the Northern District of California.
Since
then, at least two other class-action suits have been filed against Meta
alleging illegal information harvesting. And several major U.S. health systems
have either been named as co-defendants (Dignity Health, UCSF) or faced
lawsuits themselves (Northwestern Memorial Hospital) for alleged misuse or
misconfiguration of the Pixel tool.
Meanwhile,
in August, Novant Health disclosed a data breach related to the Java tracking
script that may have affected 1.3 million individuals. And in October, Advocate
Aurora Health said as many as 3 million users of its MyChart patient portal and LiveWell
website and app may have had their data transmitted via Pixel technology.
EHNAC
to merge with and into DirectTrust; EHNAC Commission will remain intact
DirectTrust
and the Electronic Healthcare Network Accreditation Commission (EHNAC) today
announced an agreement to merge EHNAC with and into DirectTrust, effective
January 4, 2023. DirectTrust is a non-profit healthcare industry alliance
created to support secure, identity-verified electronic exchanges of protected
health information. EHNAC is a non-profit standards development organization and
accrediting body for organizations that electronically exchange healthcare
data.
With
EHNAC’s incorporation into DirectTrust, DirectTrust anticipates bringing to
fruition new accreditation programs, with a program focused on Credential
Service Providers related to consumer access and use of health data as an early
target.
EHNAC’s
senior leaders, Executive Director and CEO Lee Barrett and COO Debra Hopkinson
are long-standing pillars of the health IT trust and accreditation communities
and will continue to work for and consult with DirectTrust. EHNAC staff members
and assessors will also join DirectTrust.
The
EHNAC Commission will remain intact and be designated as Commissioners
overseeing accreditation-specific matters. The DirectTrust Board of Directors
will continue as is.
AMA Releases Blueprint to Optimize Digitally Enabled Care
A recent
blueprint from the American Medical Association described how digitally enabled
care can impact future healthcare and how organizations can collaborate to
enhance these services.
November 16,
2022 - With the goal of filling in gaps related to virtual healthcare, the
American Medical Association (AMA) and Manatt Health released a Blueprint for
Optimizing Digitally Enabled Care, which describes
six pillars that can help optimize digital health practices.
According to
the AMA, there is untapped potential associated with digitally enabled care.
The organization noted that investments, technology adoption, and patient needs
play a significant role in how digitally enabled care evolves and how it can be
used to improve access and care quality.
“When
equitably designed and thoughtfully integrated, digital health tools can
effectively augment and enhance care,” said AMA President Jack Resneck Jr., MD,
in a press release. “Yet often, digital health products exist in silos and risk
additional fragmentation, higher costs, and diminished care experiences.
Optimizing the full potential of digitally enabled care requires a
collaborative effort and the blueprint offered by the AMA outlines
opportunities for physicians and other stakeholders to move in partnership
toward improving the health of the nation.”
The AMA's
blueprint highlights six areas stakeholders should focus on when optimizing
digitally enabled care.
November 16,
2022 - Patient safety has gotten better in the past 10 years, with general
hospitals across the country getting better scores in a number of performance
measures, including some never events, according to The Leapfrog Group’s fall
2022 Hospital Safety Grades, which were obtained via email.
This
iteration of the Hospital Safety Grades marks the 10th year the organization
has issued its rankings, with an additional analysis showing positive change
over time.
“Never in
history have we seen across-the-board improvement in patient safety until this
last decade, coinciding with the history of the Hospital Safety Grade,” Leah
Binder, president and CEO of The Leapfrog Group, said in a statement emailed to
journalists. “We salute hospitals for this milestone and encourage them to
accelerate their hard work saving patient lives.”
The Leapfrog
Group clarified that it has not always tracked the same patient safety
performance measures; however, for the performance measures that have remained
consistent since the measures’ inception, the organization said there’s been
vast improvement over the decade.
FDA, MITRE Publish Updated Medical Device Security Incident Response
Playbook
The
updated playbook highlights additional key medical device security considerations
and contains a new resource appendix to help healthcare organizations navigate
incident preparedness and response.
November 16,
2022 - The US Food and Drug Administration (FDA) and MITRE released an updated
version of their “Medical Device Cybersecurity Regional Incident
Preparedness and Response Playbook.” The playbook provides healthcare
organizations with actionable strategies and resources for responding to cyber
incidents while ensuring medical device security.
Since the first
iteration of the playbook was released in 2018, cyberattacks have continued
to impact the healthcare sector at alarming rates. Medical device security
remains a top concern for healthcare organizations, and keeping those devices
in operation throughout a cyber incident is crucial.
“Because
these cyber incidents have often affected multiple medical devices and IT
systems, they have led to widespread disruptions from which it can take weeks
or months to fully recover,” the playbook stated.
“FDA believed
that it would be valuable to update the playbook to reflect these evolving
trends, and once again contracted MITRE to reach out to stakeholders to
identify gaps, challenges, and additional resources since the original
publication of the playbook.”
Imagine
calling a suicide prevention hotline in a crisis. Do you ask for their data
collection policy? Do you assume that your data are protected and kept secure?
Recent events may make you consider your answers more carefully.
Mental
health technologies such as bots and chat lines serve people who are
experiencing a crisis. They are some of the most vulnerable users of any
technology, and they should expect their data to be kept safe, protected and
confidential. Unfortunately, recent dramatic examples show that extremely
sensitive data has been misused. Our own research has found that, in gathering
data, the developers of mental health–based AI algorithms simply test if they
work. They generally don’t address the ethical, privacy and political concerns
about how they might be used. At a minimum, the same standards of health care
ethics should be applied to technologies used in providing mental health care.
Politicorecently
reported
that Crisis Text Line, a not-for-profit organization claiming to be a secure
and confidential resource to those in crisis, was sharing data it collected
from users with its for-profit spin-off company Loris AI, which develops
customer service software. An official from Crisis Text Line initially
defended the data-exchange as ethical and “fully compliant with the law.”
But within a few days the organization announced
it had ended its data-sharing relationship with Loris AI, even as it maintained
that the data had been “handled securely, anonymized and scrubbed of personally
identifiable information.”
EHR-based decision support system helps prevent VTE in hospitalized
patients
CHICAGO
— In hospitalized medically ill patients, an electronic health record-based
decision support system reduced major thromboembolic events compared with usual
care, researchers reported.
Use
of the system was also associated with higher rates of appropriate
thromboprophylaxis compared with usual care.
Alex
C. Spyropoulos, MD, professor at the Zucker School of Medicine
at Hofstra/Northwell and the Institute of Health System Science at the
Feinstein Institutes for Medical Research in Manhasset, New York, and
colleagues designed the cluster-randomized IMPROVE-DD trial to determine
whether an EHR-based clinical decision support system, which informed
clinicians of each patient’s IMPROVE-DD venous thromboembolism risk score,
would increase the use of appropriate thromboprophylaxis and reduce major
thromboembolic events compared with usual care in hospitalized medically ill
patients. The results were presented at the American Heart Association
Scientific Sessions.
Increasing thromboprophylaxis
“A
big proportion of venous thromboembolism in the community is due to
hospitalization for recent medical illness,” Spyropoulos told Healio. “By far,
more severe and fatal VTE events occur in nonsurgical medically ill patients.
There are approximately 8 million hospitalized medically ill patients in the
United States every year. Thromboprophylaxis for this heterogeneous, difficult
population is misused or underused, especially in the post-discharge period.
Data show only 4% of hospitalized medically ill patients receive any kind of
post-discharge prophylaxis. We know that about one in four hospitalized
medically ill patients are at high risk of thrombosis, not just in the hospital
but after discharge.”
Existing
systems to improve VTE prophylaxis in this population are either inefficient or
very expensive, he said.
Statistics on
nurse turnover is sobering, and information technology must answer the call to
stem the tide of the shrinking provider workforce, and augment and extend care
teams in place.
Current data
suggest that the U.S. healthcare industry may have 200,000 to 450,000 nursing
vacancies by 2025, but those estimates may be understated because of
disillusionment with the profession, noted panelists at HLTH in Las Vegas on
Sunday, November 13.
Trauma related
to the COVID-19 pandemic resulted in 100,000 nurses leaving the workforce in
2021, and this year, annual turnover stands at 27 percent, said Bonnie Clipper,
moderator of the panel and managing director of Innovation Advantage, a
consultancy specializing in nursing issues. Younger nurses are becoming
disillusioned with caregiving workloads, and 57 percent of new nurses leave the
profession after two years.
Nurses
leaving in droves
“There’s an
exodus out of healthcare that no one talks about,” said Rebecca Love, chief
clinical officer of IntelyCare, which provides technology that matches nurses
wanting to work with providers seeking nurse services. “One in three bedside
nurses plan to exit (the profession soon). The irony is that there have never
been more nurses in the U.S. than there are today. What we have is a shortage
of nurses willing to work in the healthcare system today.”
Top 3 Digital Innovations that Transformed Healthcare
November 16, 2022
The
following is a guest article by Chad Anguilm, Vice President of Growth at Medical Advantage
Patient
engagement is the next frontier in healthcare and single-platform patient
portals created the digital foundation for this ongoing transformation. In
today’s technology-driven world, patients now expect a seamless healthcare
experience, which translates to a digital “one-stop shop” for managing their
personal health information.
Many
patients already use patient portals for tasks such as scheduling appointments
and requesting prescription refills. However, today patients are increasingly
utilizing existing technology to participate in their own health journey more
actively.
The
Progress of Digital Transformation
Digital
transformation occurs when positive changes in health information technology
improve interactions between providers and patients. Legacy EHRs, while
transformational for early adopters, were designed primarily for the safe
exchange of patient data between providers.
Today’s
EHRs
have transformed the healthcare landscape by providing patients unprecedented –
and long overdue – access to their personal health information. Legislation
regulating patient data also favors transparency, since providers, developers,
and health information networks now are prohibited from engaging in practices
that would prevent patients from receiving personal health data or inhibit an
exchange of data at the patient’s request.
November 15,
2022 - Healthcare consumerism is becoming more than just a buzzword, with
medical technology (MedTech) executives signaling that the trend is starting to
influence their company’s strategic planning, according to a new report
from Accenture and AdvaMed.
The concept
of healthcare consumerism, defined as the personal choice and
responsibility in paying for and managing one’s own health, isn’t exactly new.
With the rise
in high-deductible health plan (HDHP) enrollment, patients are increasingly
on the hook for their medical expenses. That, coupled with the expansion of
health technology options and focus on chronic disease prevention and
management, has transformed the patient into a consumer who has choice and
agency.
Patients are
now approaching their healthcare the way they might book a trip or shop on
Amazon, and healthcare needs to answer that call.
Online Appointment Scheduling Falls Short, Dissuades Care Access for 61%
Seventy
percent of patients said that despite using an online appointment scheduling
tool, they had to complete appointment booking over telephone, dissuading care
access for 61% of folks.
November 15,
2022 - More than half of patients are going without care access because
the online appointment scheduling systems they rely on are not fulfilling their
needs and expectations, according to surveying
from OnePoll on behalf of Notable.
Particularly,
patients reported that they are being rerouted to other methods of appointment
scheduling, like telephone call, when they try to utilize an organization’s
online self-scheduling tools.
Self-scheduling
has been central in medicine’s transformation toward healthcare consumerism.
Patients have been on the record saying they want access
to online self-scheduling options for years, with surveys showing that
patients like the convenience that online tools offer them.
But although
most healthcare organizations have followed that call and installed online
appointment scheduling tools on their websites and in their patient
portals, these systems aren’t always workable, the survey of 1,005 patients
showed.
Particularly,
61 percent of respondents said they did not access healthcare in the past year
because using an online self-scheduling system was too complicated.
November 15,
2022 - Numerous cloud attacks are successfully exploiting the healthcare
sector for financial gain, according to a newly released
2022 Cloud Security Report by cybersecurity vendor Netwrix.
Cloud
infrastructure has become an integral part of daily workloads for millions of
organizations worldwide, the press release stated.
"Healthcare
organizations plan to increase the share of their workload in the cloud from 38
percent to 54 percent by the end of 2023,” Dirk Schrader, vice president of
security research at Netwrix, said in a public statement.
Could Diet Be Another Vital Sign in the Electronic Health Record?
Neha Pathak, MD
November 11, 2022
Dr Kristi Artz
For
almost 20 years, Kristi Artz, MD, witnessed the staggering toll of diet-related
disease on the patients in her emergency room (ER).
Every
day, Artz's ER became ground zero for patients with the most severe chronic
disease complications. Some presented with strokes, others required limb
amputations from uncontrolled diabetes, all were people she hoped to save.
Ultimately, Artz tells Medscape Medical News, she just "felt like
I was putting a band-aid on the problem."
Artz
decided to change course and pursue further training in therapeutic lifestyle
interventions and culinary medicine to focus on health promotion and chronic
disease reduction and remission.
When
she had the opportunity to help start a lifestyle and culinary medicine program
in Michigan, Artz jumped at it. She recognized the critical need to help
patients assess and improve diet quality as a fundamental step to better
health.
Artz
is now medical director of such a program within a large integrated
health system in Michigan. She and her team were early adopters of a digital
platform, Diet ID, which enabled them to
standardize and track diet like other vital signs, directly into the electronic
health record (EHR).
The
pandemic not only sped up the adoption of technology in the senior living and
care field; it also opened the door to a variety of new technologies that one
expert said are here to stay.
Technologic
innovations have helped long-term care organizations tackle everything from
resident safety and mobility to filling gaps left by staff shortages.
Infection
control, as well as staff and resident screenings, introduced during the
COVID-19 pandemic remain important technology components across settings,
according to the 2022 edition of the LeadingAge Ziegler 200.
Infection
control technology is here to stay
The
publication, which includes trends in the adoption of various aging-related
technologies across 1,570 market-rate communities, showed that 49% of
communities — compared with 51% last year — continue to use infection control
technologies.
Team-based Clinical Documentation Cuts Physician Time Spent on EHR Notes
Researchers
found that decreased time spent on EHR notes is primarily a function of manual
text reduction and team-based clinical documentation practices.
November 14,
2022 - Team-based clinical documentation led to decreased physician time
on EHR notes, according to an article
published in JAMIA.
Researchers
used 2021 EHR metadata for 130,079 ambulatory physician Epic users to identify
groups of physicians who decreased note length or documentation time.
The study
found that decreasing note length and decreasing physician time in notes are distinct
goals supported by different strategies of note composition. Of the 37,857
physicians that the researchers identified as having reduced note length or
note time, only 6,793 (17.9 percent) achieved decreases in both measures.
“Our
exploration of mechanisms further supports this interpretation, as we show that
decreases in these two measures are functions of distinct mechanisms of note
composition and team-based contribution,” the authors wrote. “These distinct
underlying forces suggest that most physicians may be pursuing one of these
goals at the expense of the other.”
Introducing Amazon Clinic, a virtual health service that delivers
convenient, affordable care for common conditions
Written by
Dr. Nworah Ayogu, Chief Medical Officer and General Manager, Amazon Clinic
November 15,
2022
At
Amazon, we want to make it dramatically easier for people to get and stay
healthy. We’ve begun that journey with Amazon Pharmacy—where customers can get
their medication delivered to their door conveniently—in just two days for
Prime Members. We’ve also entered into an agreement to acquire One Medical, a
human-centered and technology-powered provider of primary care. One Medical
members benefit from a dedicated relationship with their provider, a friendly
and convenient in-office experience, and ongoing engagement via a dedicated
app.
Amazon
Pharmacy and One
Medical (once the deal closes) are two key ways we’re working to make care
more convenient and accessible. But we also know that sometimes you just need a
quick interaction with a clinician for a common health concern that can be
easily addressed virtually. We’ve thought hard about how to improve this part
of the experience as well. That’s why today we’re also introducing Amazon
Clinic, a message-based virtual care service that connects customers with
affordable virtual care options when and how they need it—at home, after
dinner, at the grocery store, or on the go—for more than 20 common health
conditions, such as allergies, acne, and hair loss.
We
believe that improving both the occasional and ongoing engagement experience is
necessary to making care dramatically better. We also believe that customers
should have the agency to choose what works best for them. Amazon Clinic is
just one of the ways we’re working to empower people to take control of their
health by providing access to convenient, affordable care in partnership with
trusted providers. Our new health care store lets customers choose from a
network of leading telehealth providers based on their preferences. Every
telehealth provider on Amazon Clinic has gone through rigorous clinical quality
and customer experience evaluations by Amazon’s clinical leadership team.
Provider burnout rates have leveled off, says KLAS report
The rates are
holding steady at 34% since 2021, but the percentage of clinicians citing a
chaotic work environment has stayed at 28% over the last five years.
November 15,
2022 02:58 PM
Combining
research on provider burnout, electronic health record experiences and other
data, KLAS researchers address what organizations can do to address staff
shortages and patient care.
WHY IT
MATTERS
Most
of the measured contributors to burnout have become less prevalent than they
were at the start of the COVID-19 pandemic, according to a new Provider Burnout
and the EHR Experience report from the KLAS Arch Collaborative.
Beyond
the news that overall provider burnout rates did not increase with this year's
survey, KLAS researchers found the following factors have improved:
High levels of trust in
organizational leadership around the EHR correlated with a lower
percentage of providers reporting burnout.
Reducing the after-hours workload
can decrease burnout significantly.
Organizations that implement
burnout-prevention programs are seeing results.
However,
staffing shortages – a newly-measured factor studied by KLAS researchers – are
more frequently reported by all types of clinicians, with 40% of those surveyed
citing this contributing factor as a stressor.
The
stressor with the most significant drop was too much time spent on bureaucratic
tasks – from 48% to 42%.
Ever
since data went online, health care organizations and others have been
struggling to provide useful data for advanced analytics while guarding
Protected Health Information (PHI). Data masking, data aggregation, synthetic
data, and differential
privacy are among the solutions, but each presents difficulties and
limitations.
Each
solution, for instance, requires expert intervention to determine how much data
transformation is required to achieve de-identification. If you’re trying to
protect data for a large population, such as people with high blood pressure,
you can be fairly loose about anonymization, whereas if you’re tracking a rare
condition, you have to suppress much more data to prevent individuals from
being re-identified. Experts apply statistical tests to determine the right
amount of protection.
Each
solution also limits the questions researchers can ask. You might prepare a
data set for researchers to track high blood pressure, or even to correlate
high blood pressure with congestive heart failure—but if they think up some
other correlation you haven’t anticipated, they may need a separate dataset
with new privacy transformations to precisely study it.
I
recently talked to David Singletary, co-founder of Subsalt, about their innovative approach to
providing anonymized synthetic data on demand in response to a data consumer’s
specific needs. Subsalt uses advanced generative AI models in an automated
manner to offer multiple views into the same data, depending on the task at
hand.
Team-based Clinical Documentation Cuts Physician Time Spent on EHR Notes
Researchers
found that decreased time spent on EHR notes is primarily a function of manual
text reduction and team-based clinical documentation practices.
November 14,
2022 - Team-based clinical documentation led to decreased physician time
on EHR notes, according to an article
published in JAMIA.
Researchers
used 2021 EHR metadata for 130,079 ambulatory physician Epic users to identify
groups of physicians who decreased note length or documentation time.
The study
found that decreasing note length and decreasing physician time in notes are
distinct goals supported by different strategies of note composition. Of the
37,857 physicians that the researchers identified as having reduced note length
or note time, only 6,793 (17.9 percent) achieved decreases in both measures.
“Our
exploration of mechanisms further supports this interpretation, as we show that
decreases in these two measures are functions of distinct mechanisms of note
composition and team-based contribution,” the authors wrote. “These distinct
underlying forces suggest that most physicians may be pursuing one of these
goals at the expense of the other.”
ONC Outlines Health IT Certification Tips for 2015 Edition Cures Update
While ONC
Health IT Certification Program participation is voluntary, not complying with
the 2015 Edition Cures Update can negatively affect end users’ ability to meet
other HHS requirements.
November 14,
2022 - The 2015 Edition Cures Update made
several changes to the ONC Health IT Certification Program, including new
functionalities and requirements establishing the Conditions and Maintenance of
Certification.
Most
certified health IT developers must update their certified Health IT Modules by
December 31, 2022.
Certified
health IT developers with API
technology certified to the § 170.315(g)(8) Application Access- data
category request criterion must update their product(s) to the § 170.315(g)(10)
Standardized API for patient and population services criterion.
“If certified
health IT developers face challenges with successfully testing to §
170.315(g)(10), they should communicate with their ONC Authorized Certification
Body (ONC-ACB) as soon as possible and work with them to successfully test with
an ONC Authorized Testing Lab (ONC-ATL) by the deadline,” Laura M. Urioste of
ONC wrote in the blog post.
WHO Releases Guide to Enhance Delivery of Telehealth Services
The agency
issued a consolidated guide containing recommendations and processes to assist
policymakers and providers in delivering telehealth services.
November 14,
2022 - A recent guide issued by the World Health Organization (WHO) provided
a set of recommendations and strategies for future telehealth implementation,
ultimately aiming to advance telehealth use.
Amid the
elimination of in-person care restrictions added during the COVID-19 pandemic,
healthcare stakeholders believe telehealth will remain an integral part of the
new normal.
Although
these services have generally been efficient and accessible, the WHO noted that
there is room for improvement and that future optimization is necessary to
maintain telehealth use. This led the organization to create a consolidated
guide designed to support the process of telehealth implementation among WHO
Member States.
"For
telemedicine to have the most impact when and where it is needed, the enabling
environment is critical. Investments in national policies, governance, and
standards are important to have in place," said Professor Alain Labrique,
director of the Department of Digital Health and Innovation at WHO, in a press
release. "This Guide is not a stand-alone solution, but rather a complementary
tool that works in tandem with user-centered solutions that are accessible by
all, towards delivering high-quality remote care that is accountable and
suitable to the context in which patients live."
CISA: 3 Steps to Improve Cybersecurity Vulnerability Management
Automation
and increased prioritization are crucial to improving efficiency within
cybersecurity vulnerability management, CISA’s executive assistant director for
cybersecurity wrote.
November 14,
2022 - New cybersecurity vulnerabilities are a constant challenge for
organizations of all sizes, Eric Goldstein, executive assistant director for
cybersecurity at the Cybersecurity and Infrastructure Security Agency (CISA)
wrote in a recent blog
post.
The
information may be useful for the healthcare sector, an industry that is known
to face
challenges with device security and managing ever-changing cyber
threats. In addition, the sector is an appealing target to threat actors,
who often go after unpatched
vulnerabilities to exploit victims.
“Organizations
with mature vulnerability management programs seek more efficient ways to
triage and prioritize efforts. Smaller organizations struggle with
understanding where to start and how to allocate limited resources,” Goldstein
wrote.
“Fortunately,
there is a path toward more efficient, automated, prioritized vulnerability
management.”
Good afternoon! In today's
edition, we asked a group of experts to tell us about the actions that
executives can take to improve data quality in short order. Questions or
comments? Send us a note at braintrust@protocol.com
Ram Venkatesh
CTO at
Cloudera
The
key to improving data quality is implementing robust dependency tracking for
data sets with quality as a first-class metadata annotation. The lack of
quality in a data set can have severe and extensive consequences across any
enterprise, from broken reports to incorrect predictions and everything in
between. It can also be a significant source of waste and even missed
service-level agreements. There are two essential pieces that together enable a
quick and efficient resolution of any data quality issues: lineage and
annotations.
Increasingly,
data sets are no longer hidden behind poorly designed or unnecessarily
complicated reports but are a part of a “network” of use cases within
companies. For example, a pricing model might depend on a customer data set, an
order history data set, and a catalog data set. The catalog data set might
depend on a vendor feed underneath. If a data quality problem is identified in
the catalog data set, users need the ability to trace both provenance — the
origin of the data — and the impact on the downstream consumers who are
affected. Additionally, by annotating data sets with quality measures using
metadata — the data about the data — quality itself can be conveyed along a
data dependency graph as a metric. Jobs, models, and reports can do pre-checks
for data quality, triggering automated actions when issues are detected.
The
Biden administration is pushing to resolve big gaps in the quality and accuracy
of data on health equity as it installs new requirements for payers and
providers.
The
Centers for Medicare & Medicaid Services (CMS) released a blog post late
Thursday outlining steps to address data issues such as aligning standards for
collection and gradually implementing equity scores.
“Data
can tell a story, but if the data is incomplete or unaligned, the story is also
incomplete,” wrote LaShawn McIver, M.D., director of CMS’ Office of Minority
Health. “To work to advance health equity, we must improve our data, especially
our health equity data.”
The
Department of Health and Human Services (HHS) has made closing equity gaps a
key pillar of the Biden administration, including pursuing new equity
requirements in health plans and value-based care payment models.
Check
out the on-demand sessions from the Low-Code/No-Code Summit to learn how to
successfully innovate and achieve efficiency by upskilling and scaling citizen
developers. Watch now.
In
today’s connected world, digital products have to entice, excite and entertain
to keep our attention. There’s an app for everything: Ordering a ride-share,
purchasing groceries and even for monitoring your home. We can’t deny that this
technology inspires us to continue to innovate. It removes friction from our
day-to-day lives and makes connecting more efficient and convenient. However,
the dark side is that some of these apps are created to keep us addicted.
Over
the past few years, we’ve seen a saturation of apps focused on wellness and
mental health because there’s a need for the accessibility they bring. However,
many of these tools are created with haste and without considering the
potential consequences on users’ lives. The underlying goal is to get the
consumer to stay on the app as much as possible by conditioning users to rely
on the app to make them feel better — obsessing over likes, follower counts,
and refreshing news feeds.
What
if the tech industry shifted the paradigm by keeping authenticity at the
forefront through more intentional creation, versus providing users a “quick
fix?” The good news is there are steps both the technology industry and
consumers can take to safeguard against falling victim to creating and using
these addictive apps.
New AMA blueprint seeks to tap the full potential of digital health
Six core
concepts, developed with input from industry experts and stakeholders, offer
chances for healthcare organizations to evolve in digitally enabled care.
The
American Medical Association's had offered a blueprint as a call to action to
address the divide between the unprecedented levels of digital health funding,
partnerships, mergers and acquisitions – and their underwhelming impact, thus
far, on healthcare quality improvement
Re-center care around the
patient-physician relationship.
Improve and adopt payment models
that incentivize high-value care.
Create technologies and policies
that reduce fragmentation.
Scale evidence-based models quickly.
More
than $100 billion of venture funding has been invested in digital health
companies since 2010, but that investment has not addressed healthcare's
greatest needs, according to the AMA report.
Direct-to-consumer
telehealth aims to give consumers a quick and easy path to healthcare services,
but critics say it bypasses a critical element in healthcare delivery: The
health system.
KEY
TAKEAWAYS
·Direct-to-consumer telehealth is designed to
enable consumers to connect virtually with a care provider for quick and easy
treatment, particularly for health issues that might not require a trip to the
doctor's office or hospital.
·Supporters say the platform meets the demands of
the consumer and reduces unecessary traffic in waiting rooms.
·Critics, meanwhile, say the platform can be used
to cut corners and bypass the health system, endangering healthcare quality.
As the HLTH conference convenes this
week amid the glitz and glamor of Las Vegas, the healthcare industry is facing
a conundrum. Direct-to-consumer (DTC) care is blurring the line between
provider and vendor and forcing everyone to rethink the concept of healthcare
delivery.
And while DTC telehealth
might help boost access to care for consumers who can't easily make a doctor's
appointment or go to a clinic or hospital, it does have its
drawbacks. Some see the platform as way of bypassing the traditional
healthcare provider and selling a product—namely, healthcare—directly to the
consumer. This, in turn, leads to questions around where the traditional
provider fits into the new ecosystem.
As the
technology improves and payers begin to support virtual care, hospitals and
health systems are debating whether to outsource some services to DTC
telehealth providers or launch their own platforms in-house.
The Global
Medical Doctor Validation Association (GMDVA) is looking for technology
donations to support care providers working in some of the world's most
underserved locations.
KEY TAKEAWAYS
·Digital health technology can help to improve
healthcare delivery in developing countries, where care providers often
struggle with a lack of resources and training.
·The Global Medical Doctor Validation Assocation
(GMDVA) is a Belgium-based international organization athat offers resources,
education, technology, and connections for providers in developing nations.
·The GMDVA has launched a new program aimed at
supplying providers in developing countries with digital health technology and
training to help them improve care delivery.
While digital
health technology and programs have the potential to improve healthcare in the
US, their value to healthcare providers in developing countries is even greater.
That's where
the Global Medical Doctor
Validation Association (GMDVA) comes in. Based in Belgium, the organization
provides technology, education, resources, a network, and connections for
placement opportunities for providers around the world.
Telehealth is a valuable option in cardiovascular care, though challenges
remain
New American
Heart Association statement finds telehealth is effective for CVD care,
however, issues like access to technology hinder widespread adoption
Statement
Highlights:
Telehealth is an effective option
for educating, diagnosing, monitoring and following people with health
issues including cardiovascular disease.
Telehealth may reduce health care
costs, improve access to care in rural and under-resourced communities,
and increase quality of care and patient satisfaction.
Advances in technology have
enabled telehealth’s growth and improved accessibility to routine care.
While the COVID-19 pandemic
improved telehealth’s infrastructure and increased its use, the pandemic
also exposed limitations to its use for some people, such as limited
resources to afford the technology, lack of internet bandwidth and
language differences that may prevent people from using digital platforms
to their fullest extent.
Research into telehealth
implementation barriers and addressing those will help ensure equitable,
high-quality care for people with cardiovascular disease.
DALLAS,
Nov. 14, 2022 — Telehealth is a proven and valuable option for people with
cardiovascular disease, however, there are limitations to its use in rural and
under-resourced communities, according to a new scientific statement from the
American Heart Association, published today in the Association’s flagship
peer-reviewed journal Circulation. An American Heart Association
scientific statement is an expert analysis of current research and may inform
future treatment guidelines.
An NHS project to incorporate
tens of millions of personal digital medical records into one of the biggest
health data platforms in the world is to be launched without seeking new
patient consent.
Health
officials confirmed this weekend the proposed £360m new data platform for England will incorporate
the NHS shared care records that track patients across the health and care
system.
The American
software firm Palantir, which is chaired by the billionaire Donald Trump
supporter Peter Thiel, is considered the favourite to win the contract. The
firm has hired two senior officials from the NHS and has been advised by Global
Counsel, the consultancy firm set up by the former Labour cabinet minister Lord
Mandelson.
Ministers
have disclosed in parliamentary answers that the patient information project
does not require a public consultation before the five-year contract is
tendered or additional patient consent. They say the project, called a
federated data platform, will help improve care and provide new insights into the
nation’s health.
