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Editorial: The eHealth money pit
By Ottawa Citizen Editorial, Ottawa Citizen
Ontarians are likely to groan at the news, reported by the Toronto Star, that more than 700 employees at eHealth Ontario are getting a little extra in their paycheques this month, as they share $2.3 million in performance bonuses.
This is the agency tasked with creating a system of electronic health records in Ontario. In 2009, the province’s auditor general found that a lack of oversight and planning meant that Ontario was “near the back of the pack compared to most other provinces,” and found disturbing evidence of favouritism, sole-sourcing, inefficiencies and overspending. One consultant, paid $2,700 a day, famously billed for expenses right down to a few dollars for Choco Bites. But the real scandal is that despite all the money paid to develop electronic health records — more than $1 billion from 2002 to 2009 — the province still does not have an integrated, universal electronic health system.
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Study shows EHRs help docs boost care
Posted on Jan 03, 2014
By Bernie Monegain, Editor
A new study in the journal Health Services Research finds nearly three-quarters of physicians using electronic health records in 2011 said there were clinical benefits when patients' medical histories were kept in digital files. The study focused on doctors' perceptions of clinical benefits to patient care when EHRs were in place.
Jennifer King, chief of research and evaluation at the Office of the National Coordinator for Health Information Technology and lead author of the study, explained in the article that physicians with longer experience using EHRs were more likely to report clinical benefits.
Researchers looked at the responses from 3,180 physicians to the Physician Workflow Survey questionnaire about their experiences with EHRs.
"A majority of physicians said they were alerted to a potential medication error or critical lab value, and about one-third reported that EHRs helped them identify needed lab tests or facilitated direct communication with patients," said King.
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Fundamental connectivity lacking in many current digital health endeavors
January 3, 2014 | By Ashley Gold
One of the main problems digital health faces is the fundamental connection between user and device, Forbes contributor John Nosta argues in a recent post.
Nosta writes that it's easy for fitness enthusiasts and athletes to understand the connection, but says connectivity is imperative to realizing the true potential of digital medicine for all. The problems include:
1. The initial patient connection: Digital health devices are marketed toward in-shape runners and young healthy types, while they also claim to be all about disease management, Nosta says. Meanwhile, he says, the "60-year-old man with hypertension and diabetes ... is still wearing a Timex."
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Looking back to before data was big
Posted on Jan 02, 2014
By Mike Miliard, Managing Editor
It's hard to go too long these days without hearing someone hype the benefits of big data. It's to the point where the term is all but a cliché. Hard to believe that's it's still a fairly recent coinage.
"Maybe three years ago?" says Cynthia Burghard research director for accountable care IT strategies at IDC Health Insights, when asked when she first heard the now-ubiquitous term. "It's still relatively new, across all industries. Some industries have used pieces of the big data and analytics technology stack, but not in its entirety."
So much has changed in the past few years when it comes to data and analytics in healthcare – never mind the quantum leap from where we were a decade ago.
"We've come a long way," she says. "We now have technology that can do high-performance computing, that can bring data in from multiple sources – both structured and unstructured. Ten years ago, you were lucky if you could even find data that you could use.
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Cost-effectiveness of CDS unclear, researchers say
December 30, 2013 | By Julie Bird
Clinical decision support tools in electronic medical records may well reduce inpatient costs, but there's little evidence yet to support that, according to research recently published in BMC Medical Informatics and Decision Making.
After screening thousands of published articles, the study's authors found that only 12.8 percent of the 78 published studies they closely examined directly measured the financial impact of CDS intervention. Only one study included data on cost-effectiveness, they found. The primary area of research involved pharmacotherapy and the impact of computerized physician order entry.
"Significantly more research is required on the impact of clinical decision support on inpatient costs," the researchers concluded. "In particular, there is a remarkable gap in the availability of cost effectiveness studies required by policy makers and decision makers in healthcare systems."
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Dossier médical partagé : un coût excessif pour un succès mitigé
Le Monde.fr avec AFP | 04.01.2014 à 08h50 • Mis à jour le 04.01.2014 à 13h56
Selon des informations du Parisien publiées samedi 4 janvier, la mise en place du dossier médical personnel (DMP) a coûté 500 millions d'euros pour seulement 418 011 ouvertures sur les cinq millions prévus. « Selon un document interne du Conseil national de la qualité et de la coordination des soins, chargé d'arbitrer les financements destinés à l'amélioration de la médecine de ville, 500 millions d'euros ont été versés depuis 2004 », indique le quotidien qui a pu consulter le document.
Le Parisien souligne que c'est la première fois qu'un document officiel mentionne le chiffre exact du financement du DMP. Ces fonds proviennent en grande partie de l'assurance maladie, précise le journal.
Rough translation:
An update on the French 'shared medical record'. In brief, 500 million euro spent (since 2004). 5 million records anticipated 418 011 records created as of 2 January 2014. Still going and costing money!
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Mount Sinai EMR program slashes sepsis deaths
December 29, 2013 | By Julie Bird
Mount Sinai Hospital in New York City is expanding a successful sepsis-reduction program hospital wide in January after a test program using alerts generated by electronic medical records cut sepsis rates by 40 percent, the Canadian Medical Association Journal reported.
The EMR intervention program triggered a red alert based on subtle changes in vital signs, including higher temperatures and pulse or breathing rates, that rarely prompted intervention in the past, according to the report.
"There was a much greater appreciation of the seriousness that is suggested by these abnormalities in vital signs, and a significant reduction in any apprehension that may have existed before to call on an advanced-level provider," Charles Powell, Mount Sinai chief of pulmonary and critical care medicine, told CMAJ.
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NHS England puts IT in five year plans
23 December 2013 Lyn Whitfield
NHS England has warned that it will work with commissioners to impose “increasingly stringent sanctions” on provider organisations that fail to use the NHS Number as their primary patient identifier.
Use of the NHS Number as a primary identifier has been a goal of successive NHS IT strategies, dating back at least 20 years.
In draft planning guidance for 2014-15, issued last week, the commissioning board notes that it was also a key aim of its first guidance for the NHS, ‘Everyone counts’.
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MU3 Expected to Have Increased Patient-Generated Data Requirements
ONC's Health IT Policy Committee has announced its intentions to include expanded requirements for hospitals and health systems to collect and use patient-generated data in meaningful use stage 3 objectives.
The Committee adopted recommendations on patient-generated health data from its Consumer Empowerment Workgroup, stating that patients' ability to electronically submit health information should be a part of meaningful use stage 3.
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13 Experts Reflect on 2013 Health IT Progress, Frustrations and Hopes for 2014
Thursday, January 2, 2014
2013 marked significant growth in the adoption and meaningful use of electronic health records, as well as some key changes that could affect the future of the program.
As of the end of October, CMS has disbursed nearly $17 billion in incentive payments to eligible hospitals and medical professionals participating in the meaningful use program. CMS reported at that time that more than 430,000 eligible hospitals and professionals had achieved meaningful use of EHRs, while 93% of eligible hospitals and 80% of eligible professionals had registered for the program.
Despite the progress, both lawmakers and health care stakeholders urged federal officials to make changes to the timeline of the meaningful use program, citing a limited number of Stage 2 certified EHR vendors and a host of competing federal health IT priorities. Federal officials listened, and in December CMS proposed delaying the start of Stage 3 of the meaningful use program, while the Office of the National Coordinator for Health IT proposed adjustments to its certification process.
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Big growth forecast for health IT market
Posted on Dec 30, 2013
By Bernie Monegain, Editor
The North American healthcare information technology market is forecast to grow at a compound annual growth rate of 7.4 percent to reach $31.3 billion by 2017 from $21.9 billion in 2012, according to Research and Markets’ North American Healthcare IT Market Report 2013-2017. The growth is driven by increasing demand for clinical information technology, and administrative solutions and services.
“Healthcare information technology has emerged as a promising development to transform the paper-based healthcare system into a digitized one,” report authors write in a news release. “HCIT also gives clinicians real-time access to patient data, and provides them with support to make the best possible decisions. It streamlines processes and reduces administrative overhead. The impact of IT on healthcare in the past decade has been modest, despite the huge potential.”
The report segments the market on the basis of applications, delivery modes, and components. Based on application, the North American healthcare information technology is segmented into provider (clinical information technology and non-clinical information technology) and payer, while the market by delivery mode is further categorized as on-premises, Web-based, and cloud-based. The healthcare information technology by component is made up of hardware, software and services.
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Continua achieves standards 'milestone'
Posted on Dec 27, 2013
By Bernie Monegain, Editor
The International Telecommunications Union’s Telecommunications Sector has approved Continua’s interoperability design guidelines for personal connected health as a new global standard. ITU called the move "a milestone for global e-health standardization."
ITU called the approval “an important milestone for global e-health standardization.”
“Devices such as wireless blood pressure cuffs, weight scales and a wide range of activity trackers can play a critical role in the prevention and improved management of chronic conditions such as diabetes, hypertension and heart disease," ITU officials said in a news release. “Establishing global interoperability standards will stimulate innovation and nourish the personal connected health ecosystem. For manufacturers, standards will decrease time-to-market, reduce development costs and increase efficiencies. In particular they will enable quicker, less expensive integration to electronic medical records or health information exchange platforms.”
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Technology, prevention will move health care costs down
Electronic records and consumer education are improving health care and lowering costs
Story Highlights
- Experts point to progress in many areas but say much more is still needed
- Insurance that covers medications is one key to health care cost reduction
- YMCA's diabetes prevention efforts are showing promising results
WASHINGTON — In 2014, expect a flurry of changes to continue to bend the health cost curve down, accelerated by the Affordable Care Act, experts say.
Even die-hard believers in the connection between the economy and how people spend on medical expenses are saying this may be the year that proves them wrong, as providers and insurers rush to make changes to keep profit margins high in light of changes in how they're billed. They'll be led by improved technology that helps them see how to improve quality; preventive programs that have proven they can save millions in long-term costs; and an acknowledgement that consumers hold the purse strings.
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Telemedicine, Mobile Health Markets Expected to Explode
The convergence of telemedicine and PTT devices is also a driving force that relates to the overall trend toward clinical reimbursement.
Telemedicine push-to-talk (PTT) dedicated device and software markets, which were at $214 million in 2012, are anticipated to reach $4.4 billion by 2019, according to a report from WinterGreen Research.
The report also projected mobile health (mHealth) markets related to telemedicine, which currently stand at $1.4 billion, would reach $1.5 trillion by 2019 due to the leveraging of 8.5 billion smartphones and 5 billion connected tablet devices all over the world.
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Healthcare Data Breaches To Surge In 2014
12/26/2013 09:00 AM
The healthcare industry will see even bigger breaches of data and patient privacy in 2014, an Experian report says.
Healthcare will be a hotbed of consumer data breaches in 2014, according to an Experian report, "2014 Data Breach Industry Forecast."
"The healthcare industry, by far, will be the most susceptible to publicly disclosed and widely scrutinized data breaches in 2014," according to the report (registration required), which addressed healthcare risks as one of six major trends. "The sheer size of the industry makes it vulnerable when you consider that as Americans, we will spend more than $9,210 per capita on healthcare in 2013. Add to that the Healthcare Insurance Exchanges (HIEs), which are slated to add seven million people into the healthcare system, and it becomes clear that the industry, from local physicians to large hospital networks, provide an expanded attack surface for breaches." The "attack surface" of a system refers to the parts that pose the greatest opportunity for attack or error.
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HIMSS, NeHC merge with shared mission
Posted on Dec 26, 2013
By Diana Manos, Senior Editor
HIMSS has announced that the HIMSS Foundation and the National eHealth Collaborative have merged. NeHC has worked closely with the Office of the National Coordinator for Health IT as well as other public and private organizations to encourage effective use of health IT.
“Both organizations embrace a similar mission to engage with all stakeholders to drive positive change in healthcare with IT and provide a single, mission-driven voice and focus,” HIMSS explained in a prepared statement.
NeHC’s board of directors approved the merger in late November, and NeHC members and the HIMSS Foundation board of directors approved the merger in mid-December.
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Interoperability top of mind in 2013
Posted on Dec 26, 2013
By Anthony Brino, Editor, HIEWatch
From the start, 2013 brought more focus to the issue of interoperability than ever before, and there is no sign the interest will abate. After all, interoperability is critical to data exchange.
In the first week of January, Health Affairs ran a commentary by two Rand Corp analysts arguing that the predictions of cost and productivity benefits from EHRs haven’t materialized. Arthur Kellermann, MD, and Spencer Jones wrote that EHR disconnectedness was so common it “can be a problem even when two organizations acquire the same health IT system from the same vendor.”
By March, Allscripts, athenahealth, Cerner, CPSI, Greenway and McKesson launched the CommonWell Health Alliance, promising to develop “interoperability for the common good” and “create universal access to individual’s health information.” CommonWell represents about 42 percent of the acute EHR market and 23 percent of the ambulatory EHR marke, and in late December announced its first rollout of interoperability services in Chicago, Elkin and Henderson, North Carolina, and Columbia, South Carolina.
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Federal Legislation Seeks Standards for Telehealth
DEC 20, 2013 3:26pm ET
Legislation introduced in the U.S. House would create a federal definition for telehealth and set principles for states to use as guidance when developing policies that govern telehealth. Based on California law, the bill’s goal is to incentivize states to enact more favorable and uniform telehealth policies.
Reps. Doris Matsui (D-CA) and Bill Johnson (R-OH) sponsor H.R. 3750, “The Telehealth Modernization Act.” Both are members of the powerful Energy and Commerce Committee. The proposed federal definition for telehealth is: “The term ‘telehealth’ means, with respect to health care that a health care professional is authorized to deliver to an individual in person under state law, such health care delivered by such health care professional to such individual not in person, from any location to any other location, and by means of real-time video, secure chat or secure email, or integrated telephony.”
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Editor's letter: 10 years and 6 czars into HIT, where are we now?
By Diana Manos, Senior Editor
23 December, 2013
It has been almost a decade since President George W. Bush launched the Office of the National Coordinator for Health IT and since that time hordes of pilots, projects, grants, initiatives, federal advisory committees and regulations have been launched or established.
In those ten years alone, adoption of health IT has gone from mostly uninterested or hesitant adopters to a thriving, nearly-unanimous vision for digitizing the U.S. healthcare system.
Both the Bush and Obama Administrations retained similar visions particular to health IT against the backdrop of partisan hostility over healthcare in general. And we are nearing the final year for Bush’s goal: to have electronic health records for every American by the end of 2014.
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5 not-so-merry tales of healthcare fraud dark side
By Rick Kam and Christine Arevalo, is director of healthcare identity management, ID Experts
It’s December, the time of holiday cheer, but for victims of healthcare fraud and medical identity theft, the season is not a happy one. The news is full of dishonest people making patients sicker and healthcare costlier.
A quick scan of the headlines pulls up some stories that you have to read to believe.
1. Wanted: Medicaid number to rent
Linda Radeker, a mental-health practitioner enrolled with North Carolina Medicaid, “rented out” her Medicaid provider number to co-conspirators, keeping up to 50 percent of the fraudulent reimbursements. On the false claims, her cohorts in crime mainly used the Medicaid numbers of children whose parents believed were participating in after-school programs — programs owned and operated by these fraudsters. Radekar has been ordered to pay more than $6 million in restitution to Medicaid, according to the IRS.
Linda Radeker, a mental-health practitioner enrolled with North Carolina Medicaid, “rented out” her Medicaid provider number to co-conspirators, keeping up to 50 percent of the fraudulent reimbursements. On the false claims, her cohorts in crime mainly used the Medicaid numbers of children whose parents believed were participating in after-school programs — programs owned and operated by these fraudsters. Radekar has been ordered to pay more than $6 million in restitution to Medicaid, according to the IRS.
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Health IT pay continues upward trajectory
December 23, 2013 | By Susan D. Hall
The scramble to meet Meaningful Use, ICD-10 and other federal mandates with a limited talent pool continues to push IT salaries up, according to a new compensation survey from the the Healthcare Information and Management Systems Society (HIMSS).
Some of the biggest paychecks and raises are at consulting firms ($141,818, up 6.64 percent) and software companies ($116,159, up 5.74 percent), according to 1,160 responses from HIMSS members.
Overall, the average health IT salary was $113,269. More than two-thirds of respondents said they had received a raise, with the average pay bump equaling 4.16 percent. That compares with an average raise of 2.3 percent for IT pros in the industry overall, according to to a Computerworld survey published last spring.
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Putting Security to the Test: Health Insurance Exchanges
Monday, December 23, 2013
When security researcher Jesper Jurcenoks visited the HealthCare.gov website, he found the tell-tale signs of attempted cyber assaults.
Like many sites, HealthCare.gov has a search box that suggests popular search terms as a user begins to key in his or her inquiry. Jurcenoks typed in the first character of a typical SQL injection attack and discovered that more than half of the suggested searches contained commands used in that type of attack. In SQL injection, assailants target the database behind a website, typing database commands in the boxes where users enter data. A successful exploit lets attackers steal or alter the data housed in the database.
"They have access to the key to the kingdom," Jurcenoks -- director of security research at Critical Watch, a Dallas-based information security technology provider -- said. "There are plenty of places where you can attack a website, but the attack that most people are going to try first is SQL injection," Jurcenoks said.
On subsequent visits to HealthCare.gov, Jurcenoks found that the site administrators had since prevented the search box from generating attack suggestions. He said that, to his knowledge, none of the attacks he encountered were successful.
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HL20: Fred Trotter—Balancing Skepticism, Crowdsourcing, and Big Ideas in Healthcare IT
Scott Mace, for HealthLeaders Media , December 20, 2013
Fred Trotter has written a book called Hacking Healthcare, but now he is going to try Hacking HIPAA. That's the name of Trotter's newest venture, a crowdfunded project aimed at circumventing standards bodies and sluggish healthcare giants in order to bring HIPAA into the 21st century.
At an impromptu lunchtime gathering in Silicon Valley's Computer History Museum, Fred Trotter is drawing lines and boxes on a whiteboard. From around the room, other programmers, healthcare IT experts, and a privacy expert or two toss in suggestions. Trotter excitedly adds to the drawing, challenging some suggestions as he goes, accepting others, and even raising a skeptical eyebrow at his own work.
It's all in a day's work—and play—for the author of Hacking Healthcare, who this May day was helping lay the groundwork for a crowdfunding project known as Hacking HIPAA, which tries to circumvent ponderous standards bodies, sluggish large healthcare giants, and secretive startups to bring HIPAA into the 21st century by clever coding and collaboration.
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Enjoy!
David.
