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."

Saturday, June 21, 2014

Weekly Overseas Health IT Links - 21st June, 2014.

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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How Japan can revamp EHR certification

Posted on Jun 13, 2014
By Diana Manos, Senior Editor
What can the U.S. healthcare industry learn from other nations? In the realm of EHR certification, arguably a whole lot, policymakers say. The question arose during health IT policy talks in May, and reemerged this week: Could a Kaizen study of certification -- an end-to-end analysis -- reveal what has been lacking in the EHR certification process? 
The Health IT Policy Committee sees enough potential that, in fact, this week it voted unanimously to approve a recommendation for ONC to hold a Kaizen review of the entire end-to-end certification process.
Kaizen, of Sino-Japanese origins, according to multiple reference sources, means "continuous improvement," and pertains to any type of change, whether it be brief or enduring. The word is also referenced when discussing corporate improvement methods, like that of lean manufacturing, for instance. 
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Security tips from the health IT pros

Posted on Jun 13, 2014
By Erin McCann, Associate Editor
As anyone who's ever worked for IT security can attest, the job is no walk in the park. New threats, compliance mandates, vulnerabilities and updates are constant. But with strong leadership, and a culture of compliance and responsibility to match, many healthcare organizations have shown it can be done right -- and well.
Beth Israel Deaconess Medical Center's Chief Information Officer John Halamka, MD, said for this kind of career, it's a matter of first understanding that, "a CIO has limited authority but infinite accountability." You have to ask, "How do you reduce risk to the point where government regulators and, more importantly, patients will say, 'What you have done is reasonable?'" he said.
This involves thinking about how to encrypt every device and how to protect the data center from both internal and external attacks.
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Google plans rival to Apple's HealthKit

June 13, 2014 | By Susan D. Hall
Google plans to launch a health platform called Google Fit that will aggregate data from fitness-tracking devices and health-related apps, Forbes reports, citing multiple sources familiar with Google's plans.
The article calls the platform a direct competitor to Apple's HealthKit and Samsung's Sami biometric platforms. Google plans to launch it at the Google I/O conference for developers later this month. One source told Forbes that data from fitness devices could interface with Google's cloud services. It also could tie in with Android Wear, a version of Google's Android mobile operating system for wearable devices and smart watches.
So far, Google's keeping its plans for the I/O conference close to the vest.
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Bioelectronics: headache? e-health might be the answer

By Andrew WardAuthor alerts
A new technology uses electronic pulses to treat ailments without exposing the body to surgical risks or toxic side effects
It is one of the hottest topics in Silicon Valley: the potential for digital technology to transform the way we manage our health. Apple and Samsung have each announced new e-health platforms in recent weeks that aim to integrate the growing range of apps and wearable devices that track everything from calorie-burn to fertility cycles.
Yet scientists say that gimmicky wristband monitors barely scratch the surface of what will eventually be possible. The big hope, they say, is to move beyond passive monitoring to direct therapeutic intervention. A hint of the future is provided by US company electroCore, which has developed a handheld device that treats migraine headaches with electronic pulses instead of drugs.
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Startup launches 'first wearable health record' for Google Glass

By Christina Farr
SAN FRANCISCO Thu Jun 12, 2014 6:05pm EDT
(Reuters) - Google Inc's futuristic eyeglasses are finding their way into hospitals and clinics throughout the United States.
To meet the growing demand for Google Glass from physicians, Drchrono, a Mountain View, Calif., based electronic medical record company has developed a new application for the device it claims is the first "wearable health record."
Doctors who register for the Drchrono app for Glass can use it to record a consultation or surgery with the patient's permission. Videos, photos and notes are stored in the patient's electronic medical record or in Box, a cloud-based storage and collaboration service and can be shared with the patient on request.
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3 suggestions for ONC in creating its health IT safety center

June 12, 2014 | By Marla Durben Hirsch
The letter was prompted by the draft report required by the Food and Drug Administration Safety and Innovation Act (FDASIA), which calls for the FDA, in consultation with ONC and the Federal Communications Commission (FCC), to produce a report on a proposed "risk based regulatory framework" regarding health IT. The report, released in April, recommends that ONC--not the FDA--be the primary agency to spearhead health IT safety efforts and that ONC create a public/private heath IT safety center to regulate electronic health records and other HIT programs. There would be no new FDA oversight.
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Telehealth gets big boost from AMA

Posted on Jun 12, 2014
By Eric Wicklund, Editor, mHealthNews
The nation's largest physicians' association has officially put its foot forward with telemedicine, after establishing guiding principles to ensure appropriate coverage and reimbursement for telemedicine services.
It's the latest in a continuing barrage of votes, letters, position papers and announcements from professional organizations, trade groups and other telemedicine advocates to push the needle ahead on this technology and give providers the support they need to use telemedicine, telehealth and mHealth tools.
During its annual meeting, the American Medical Association approved a list of guiding principles "for ensuring the appropriate coverage of and payment for telemedicine services."
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As access to student EHRs expands, so too does the role of school nurses

June 12, 2014 | By Katie Dvorak
School officials and health systems are banding together to make sure students with chronic conditions receive comprehensive care, reports Kaiser Health News. Such partnerships, according to the article, let school health professionals gain access to students' electronic health records and/or specialists and other health system resources.
In Delaware, for instance, a partnership that dates back to 2011 enables school nurses to access read-only records for more than 1,500 students with complex conditions and special needs.
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More access to tech for non-clinical staff improves care at medical campuses

June 12, 2014 | By Katie Dvorak
As technology's role in healthcare grows, so too does the opportunity for non-clinical or lower-level staff members to assist in myriad tasks, giving doctors and nurses more time to address complex cases.
A recent report by the Brookings Institute explores the role of medical campuses in innovation districts--geographic areas where "leading-edge institutions and companies cluster, connect with start-ups, [business] anchors and accelerators." 
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High Rates of Physician-Level Variability in EHR Use

Written by Akanksha Jayanthi (Twitter | Google+)  | June 11, 2014
Healthcare providers using the same electronic health records develop personalized patterns of EHR use for different features, according to a study in the Journal of the American Medical Informatics Association.
Researchers retrospectively analyzed EHR usage for 430,803 EHR encounters by 112 clinicians to determine how they accessed and added patient data, used clinical decision support, communicated and used panel management options.
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Putting Prevention-Intervention in Place

by Robin Schepper Thursday, June 12, 2014
The Affordable Care Act was created to improve health care delivery and access. Now that more than eight million Americans have enrolled in coverage under the ACA, what's next?
What we need to focus on is looking at ways to promote an optimized health care system that keeps consumers healthy rather than our current "sick-care" system. With the ACA and advancements in health technology, the consumer has more power to optimize their personal health status. Easier access to personal health records and health monitoring tools such as sensors to keep track of medications or chronic disease episodes helps consumers proactively monitor their health outside of the doctor's office. These innovations in health technology play a complementary role in one of the less highlighted, but most significant parts of the ACA legislation -- the focus on prevention.
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'My Cancer Genome' Goes Mobile

Greg Goth
JUN 10, 2014 9:29am ET
My Cancer Genome, an online cancer treatment tool developed by researchers at Vanderbilt-Ingram Cancer Center, Nashville, Tenn., has unveiled an updated free mobile app that provides more information about genetic alterations in various types of cancer and the therapies available to treat those alterations.
The new MCG mobile app is searchable and features regularly updated information from the My Cancer Genome website. The app has been redesigned to accommodate an iPad tablet layout and is available for iPhone and iPad at no cost in the iTunes online store.
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The Need for a New Type of HIE

Chilmark Research is advocating new thinking about health information exchanges and the value they can bring to healthcare organizations. “With few exceptions, existing EHR and HIE efforts have not delivered the breadth of clinical or financial benefits that healthcare organizations (HCOs) have envisioned,” the firm contends. In a recent report, Chilmark makes the argument for a new type of HIE and a new name: Clinician Network Management.

Expanding Horizons

Up to now, HIEs have focused on point-to-point data exchange rather than the information requirements of networks of clinicians working together to improve the efficiency and effectiveness of care, Chilmark argues. Success for an HCO, regardless of size, will depend on how well it supports and manages its clinician network (owned and affiliated) across the care continuum with standardized, evidence-based care pathways to better manage risk, reduce variability and provide higher patient-centric care.
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Hacker calls health security 'Wild West'

Posted on Jun 11, 2014
By Erin McCann, Associate Editor
Kevin Johnson is a professional hacker -- albeit a self-described ethical one. As head of the security consulting firm Secure Ideas, his job involves probing into organizations' networks and applications to identify vulnerabilities. And what he sees in healthcare terrifies him.
Johnson, who will moderate a panel ­– "Frontline Perspective: Combating Cyber Crime in Healthcare" – at the HIMSS Media and Healthcare IT News Privacy and Security Forum June 16-17 in San Diego, has conducted tests for health insurance companies, hospitals and medical app companies. For the majority of them, he said, "security sucks."
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A prescription for e-prescribing

Two rounds of tech fund money look set to invigorate e-prescribing; but can the market cope, and is the tech fund approach the best way to get e-prescribing into effective use across England? Lyn Whitfield investigates.
It has taken a long time for e-prescribing to reach the health service at scale. But in the past year it has been given a significant boost with health secretary Jeremy Hunt’s call for a ‘paperless’ NHS by 2018 and two rounds of tech fund money.
When the ‘Digital Challenge Fund’ was announced in May 2013, the Department of Health indicated that it would be used for e-prescribing and other patient safety technologies.
In mid-summer, NHS England extended the scope of what had become the ‘Safer Hospitals, Safer Wards: Technology Fund’ to include scheduling, bedside notes and observations, and integrated records.
When the list of projects to be supported by the fund was issued at the end of May, it included a surprisingly large number of big, electronic patient record programmes. But around 40 e-prescribing projects, worth more than £30.5m, were given the go-ahead.
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CommonWell interoperability available this summer

June 11, 2014 | By Dan Bowman
While CommonWell, according to a Forbes report, has yet to set a specific date, alliance officials are optimistic about their plans, which were confirmed via a post to the group's website on Tuesday. Cerner Director of Client Results Scott Stuewe, who serves as the head of CommonWell's program management committee, told Forbes that the alliance has been busy obtaining patient consent for participation; to date, more than 10,000 have done so.
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Big Data Used to Predict Sepsis in NICU Newborns

June 10, 2014
Kaiser Permanente’s neonatal intensive care unit (NICU) doctors have begun using big data techniques to determine if newborn babies are at risk for sepsis.
The Oakland-based integrated care provider’s Division of Research has provided the NICU docs with an online calculator for analysis. Doctors can enter the gestational age, the highest maternal antepartum temperature, rupture of membranes (ROM) in hours, and other information related to the pregnancy and it will come up with a probability per 1,000 babies of sepsis in a newborn. The calculator uses years of information on the vital signs of mothers and babies who develop sepsis.
“Prior to the online sepsis calculator, a maternal fever of 100.4 or higher meant a trip to the NICU regardless of how a baby looked, or other risk factors. That meant separating the mother and baby, starting an IV, and putting the infant on intravenous antibiotics," stated research scientist Michael Kuzniewicz, M.D., MPH, in an interview on Kaiser Permanente’s website. “Now we can be smarter on which babies we identify to evaluate and treat for infection.”
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6 reasons why the market for biosensor wearables is changing

June 10, 2014 6:30 am by Stephanie Baum | 0 Comments
A new report from Rock Health looking at the future of the biosensor wearables market shows a market in transition. The next generation of wearables is more targeted towards patient populations, particularly chronic conditions. In a Google hangout about the report, Malay Gandhi, a co-author of the report, talked about some of the qualities that are making these wearables more appealing to consumers and the b2b market and features that will give them staying power.
Athletic trackers aimed at the mass market have lost ground Nike’s exit from the wearables market shows there are far more fitness tracking devices than the market can support. There’s also a certain amount of consumer fatigue because the accuracy of fitness bands can vary. It’s difficult to keep most consumers interested in using them after six months. That prompted The New York Times article comparing these wristbands to “digital snake oil.” Another problem is the marketing. Companies have pursued an aspirational market. Rather than focusing on specific-use cases, they have taken a generic, mass market approach with the expectation that consumers will get it and see their inherent value. The successful companies will the ones that can diversify and show how their wearables applies to specific needs. Commoditization has forced companies to develop more sophisticated tools.
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HIMSS Releases EHR Readiness Assessment Toolkit

Written by Akanksha Jayanthi (Twitter | Google+)  | June 10, 2014
Ambulatory medical facilities preparing to implement an electronic health record can take advantage of HIMSS' EHR Readiness Assessment Toolkit.
The toolkit provides resources for facilities to analyze the benefits and challenges of implementing an EHR as well as tips on how to properly prepare for the transition.
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IBM Partners with Epic in Battle for Pentagon’s Multibillion-Dollar EHR Deal

By Frank Konkel June 10, 2014 2 Comments
IBM has teamed with electronic health records provider Epic to compete for the Defense Department’s Healthcare Management Systems Modernization contract expected to be bid out this summer, with an expected value of approximately $11 billion.  
IBM and Epic have been collaborating for months in preparation for the contract, and becoming the first systems integrator and EHR provider to formally announce a partnership highlights IBM’s aggressive efforts in the health care market. Big Blue has been bold in highlighting its important federal healthcare hires in recent months, and the company’s partnership with Epic, whose software is used by private sector health care leaders such as Johns Hopkins Medicine and Kaiser Permanente, solidifies it as a major contender for the upcoming DHMSM.
“Our collaboration with Epic for DHMSM was a natural extension of our global partnership,” Andy Maner, managing partner at IBM U.S. Federal, said in a statement. “Together, we understand that we must step forward and bring our best to improve health outcomes for those who proudly serve our nation. Improving quality of care and reductions to the overall costs for our military will be our primary goal. This is going to require bringing a physician’s mindset, proven past performance and a commitment to innovation.” 
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Healthcare, Embedded and Connected

Scott Mace, for HealthLeaders Media , June 10, 2014

The Internet of Things is enabling healthcare leaders to achieve objectives through better collection and reporting of data.

This article appears in the June 2014 issue of HealthLeaders magazine.
Technology is now in the process of not only tracking many everyday objects in healthcare, but also allowing those objects to sense and report things in a connected way to unprecedented degrees.
This technology is informing applications such as patient wayfinding, robotic transfer of supplies, interactive or informational displays throughout hospitals, and badges that employees or patients can carry or wear to optimize patient care and patient experience.
Wayfinding is essential in large medical facilities such as 395-bed Boston Children's Hospital, which built its own mobile phone application, MyWay, to help patients physically navigate their way through a campus consisting of 12 interconnected buildings with 150 total floors.
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Personal health information key to reducing care costs

By Diana Manos, Senior Editor
Emerging care and reimbursement models will only go so far in the effort to overhaul American healthcare. Personal health information will be the deciding factor, according to two industry experts.
“Providers and patients must continue to partner together to improve the health status and overall population health in the U.S. Health Information technologies are a tool to make that partnership a reality, and an empowered patient,” said Mary Griskewicz senior director of healthcare information systems at the Health Information Management and Systems Society (HIMSS).
According to a HIMSS resource on personal health information (PHI), every patient is unique, from both a personal risk perspective — whether that is a preventable disease progression or a critical care event. In addition, patients come from different socio-economic behavioral standpoints.
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How public health can harness Big Data

By Anthony Brino, Associate Editor
The hype over Big Data is starting to settle down as it becomes clear that advanced comparative effectiveness and large-scale monitoring are still a ways away. But they are on the horizon, and headway is being made.
For health organizations, especially public sector health agencies, there is first the often complicated task of linking disparate pieces of data across multiple sources.
As LexisNexis Risk Solutions senior director Kim Jayhan will outline at the Government Health IT Conference & Exhibition in Washington DC June 17-18, that is the first step on the path to meaningful analytics, blending together multiple databases to create a platform for probing immediate needs — then going from there.
For hospitals and health systems, examining a patient’s clinical and claims data in tandem can let analysts create profiles for internal quality research or to comply with Medicare, Medicaid and commercial insurance contracts, especially accountable care ventures.
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Health IT doc to head the AMA

Posted on Jun 10, 2014
By Erin McCann, Associate Editor
The American Medical Association on Monday named its new president-elect, who has been recognized for his involvement with health information technology. The to-be president has been critical of several aspects of the EHR Incentive Program.  
Steven J. Stack, MD, an emergency physician currently practicing in Lexington, Ky., will assume the role of AMA president starting June 2015 after serving a one-year term as president-elect. At 43, he is poised to be the youngest AMA president in the past century, according to officials. 
"It is a deep honor and privilege to be named president-elect of an organization that is committed to serving as a strong physician voice and a dedicated patient advocate on the pressing healthcare issues confronting our nation," said Stack, in a June 9 press release. "With vision and perseverance, I look forward to creating a brighter future for patients and the medical profession."
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IT and informatics play well together

Posted on Jun 10, 2014
By Mike Miliard, Managing Editor
When CHRISTUS Health decided to spin out two separate IT and healthcare informatics departments, there were plenty of challenges to grapple with. But so far the decision has been well worth it, with both clinical and financial ROI.
A balanced, well-defined and cooperative relationship between the two sides – with each focused on the tasks it does best – is key, says Bill Morgan, senior regional director of information management at Corpus Christi, Texas-based CHRISTUS Spohn Health System, which comprises six hospitals and six family health centers along the Gulf Coast.
"As CHRISTUS Health made the decision to stand-up a formal informatics department and separate it out from information management as a pure IT function, we came to realize there were a lot of little things IT was doing," says Morgan. "There was a lot of regionalization of the informatics effort. And in order to get a full-on informatics capability, CHRISTUS decided to break it out separately."
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Mind the gap

This year’s NHS Confederation conference heard from lots of people with big ideas, all of which will be heavily dependent on technology. But will they arrive in time to address the NHS’ pressing problems? Lyn Whitfield reports.
10 June 2014
There was certainly a change of tone at this year’s NHS Confederation conference. For the past few years, the event has been focused on the repercussions of Andrew Lansley’s reorganisation of the NHS, and by the growing financial pressure on it.
In advance of this year’s conference in Liverpool, the King’s Fund think-tank warned that, even though the NHS has been keeping up with the ‘Nicholson Challenge’ to find £20 billion of efficiency savings by 2015, it has done so by holding down the acute tariff, management costs and wages.
As these sources of funding give-out, it predicted that a financial crisis will become “inevitable”. It also urged the government to find more money to bail out trusts and pump-prime the service changes that policy makers and managers argue are essential to create a “sustainable” service.
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Hunt's pet project - Skyping GPs

6 June 2014   Lyn Whitfield
Health secretary Jeremy Hunt has urged the NHS to “put its head above the parapet” and make more creative use of technology in a speech to the NHS Confederation.
At the end of a positive speech, in which he praised the NHS for delivering increased activity on “only a very small” increase in budget, and said he was convinced that a “sustainable” NHS, “true to its values” could be delivered, Hunt was challenged on innovation.
A delegate from Moorfields Eye Hospital, where the openeyes electronic patient record is being developed, said the health service needed “disruptive technology” and asked how Hunt would support this, even if some ideas failed.
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Don't be gun shy of IT - Stevens

4 June 2014   Lyn Whitfield
Simon Stevens has told the NHS not to be "gun shy" of technology after its experience with the National Programme for IT.
In a brief presentation to the launch of a new Clinical Leaders Network Informatics Forum ahead of its his first speech to the NHS Confederation annual conference, Stevens said that technology would be vital if the NHS was to meet the challenges on it over the next five years.
Stevens, who recently took up the job of chief executive of NHS England after a decade working for the US healthcare giant United Health, said no other industry had met these challenges without adopting IT to radically change its working practices.
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H&HN Daily

AMA's 12 Steps to Better Physician Satisfaction

06.09.14 by Marty Stempniak

Responding to growing dissatisfaction among physicians, AMA officials issued a call to action at their annual meeting. The group is developing a set of interventions to help doctors shift their time away from administrative duties and back toward the bedside.

CHICAGO — With all the pressures bearing down on their profession — from payment reform to the loss of independence and the introduction of difficult-to-master electronic tools — docs are a sometimes disillusioned and dissatisfied bunch. One recent study by The Doctors Company found that nine out of 10 physicians surveyed wouldn't recommend health care as a profession worth pursuing.
The American Medical Association commissioned a survey of 30 physician practices in six states last year, looking to get to the bottom of this dissatisfaction. The results were released in October and, now, the nation's largest physicians group is figuring out how it can turn these dissatisfiers in the other direction. AMA officials detailed the findings and discussed their call to action at the association's annual meeting, which kicked off on Friday here in the Windy City.
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Q&A: Karen DeSalvo on Meaningful Use, ONC Reorg

Scott Mace, for HealthLeaders Media , June 10, 2014

In an in-depth interview, National Coordinator for Health Information Karen DeSalvo, MD, discusses meaningful use, EHR usability, innovation, and the recently announced restructuring at the Office of National Coordinator. Part one of two.

At the annual Health Datapalooza in Washington D.C., last week, I spoke with Karen B. DeSalvo, MD, MPH, MSc, National Coordinator for Health Information Technology, one-on-one for the first time.
DeSalvo, who was appointed to the ONC position in December, has a record of public service. She served as Health Commissioner for the City of New Orleans and as a senior health policy advisor to the mayor. After Hurricane Katrina in 2005, she led the creation of a neighborhood-based primary care and mental health services model for underserved individuals.
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SAP Offers Software to Employees for Personalized Cancer Treatment

Greg Goth
JUN 6, 2014 12:05pm ET
Enterprise software platform developer SAP intends to offer a personalized treatment option service, in collaboration with MolecularHealth and GATC Biotech, to qualified employees fighting cancer.
The service would be based on MolecularHealth’s TreatmentMAP software and generate an individual tumor analysis for each patient, providing a clinical interpretation of the clinical and genomic patient data to support their physician in making an individualized treatment decision. In Europe, sequencing data is planned to be provided by GATC Biotech; and in the U.S., MolecularHealth intends to run its own CLIA-certified sequencing lab.
This data would be processed with an ultra-fast genome alignment algorithm, which is part of the SAP Genomic Analyzer and used to assemble the full exome DNA sequence in three minutes--about 300 times faster than the alignment software previously used.
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Registries Key to Population Health Management

David Nash, M.D., founding dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, Penn., is one of the nation's foremost experts on the task facing the healthcare industry as it moves to population health management models. He shared some of his insights with Health Data Management recently.
HDM: How should healthcare organizations prioritize facing the issues around EHRs with the issues around the other technologies that will facilitate population health management?
Nash: We want people to continue to focus on Meaningful Use. It's important and I'm not advocating abandoning it. But we are looking around the bend and thinking about where the buck is going, and we are confident it is all about measuring the outcomes of care from a population perspective. You cannot get that from an electronic medical record--that we view as an electronic chart and a charting system. The word we're looking for here is a registry function.
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Cardiac patients taking PHRs to heart

Posted on Jun 09, 2014
By Mike Miliard, Managing Editor
An ongoing study that relays data from implantable cardiac devices directly into personal health records is showing very encouraging early returns.
It all started back in 2011 with another research project. The Office of the National Coordinator for Health IT awarded a Challenge Grant for a study examining consumer-mediated data exchange to Indiana Health Information Technology, then the Hoosier State's designated entity, and PHR developer NoMoreClipboard.
Working with Fort Wayne, Ind.-based Parkview Physicians Group as a pilot site, the project focused on 200 patients who'd undergone coronary revascularization (stent or bypass operations). Parkview helped each of them set up a NoMoreClipboard PHR account and gave them training on its use.
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ONC interoperability plan draws tempered industry reaction

June 9, 2014 | By Dan Bowman
Reaction to the Office of the National Coordinator for Health IT's 10-year interoperability plan, unveiled last Thursday, has been mixed, with organizations calling for stronger language and greater detail but also praising this first step.
Jeff Smith, director of federal relations for the College of Healthcare Information Management Executives, told FierceHealthIT in a phone interview that although the document is important, it lacks detail.
"The issues that are being raised in this document are not unlike issues that were raised two, three, five, 10 years ago," Smith said. "While seeing ONC spotlight interoperability and health information exchange is a very good thing, what we'll need to see next is how they want to turn that policy into reality."
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Health Care Harnesses Social Media

More and more doctors and nurses are using Facebook, Twitter and other platforms to interact with - and monitor - their patients.

By Alan Neuhauser June 5, 2014 | 6:00 a.m. EDT + More
Anniversaries meant trouble.
On a recent August afternoon, Ruthi Moore, director of nursing for the Navy-Marine Corps Relief Society, got an alert in her inbox: One of her patients had just had a message posted to Facebook, and the implications weren’t good.
“One of his friends wrote, you know, ‘I know this is the anniversary of so-and-so’s date, and I’m thinking about you,’” she tells U.S. News. “I went out to see him a week later, for that reason.”
What she learned: “His best friend died in his arms in August. He had three other buddies he worked with closely die the following month. We were just getting to know each other then, he didn’t want to elaborate.
“August is a very hard month for him – and I found out about it through social media.”
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Nuances of Health IT Regulation Remain Up in the Air

by Rebecca Vesely, iHealthBeat Contributing Reporter Monday, June 9, 2014
A draft framework for the regulation of health IT, including mobile health applications, is receiving tentative applause, but industry insiders say the toughest decisions on regulation have yet to be finalized and perhaps never will.

Overview of FDASIA Report

Known as the FDASIA report, the draft document is the culmination of several years of discussion and study of the best way forward to ensure patient safety while supporting product innovation.
The 2012 Food and Drug Administration Safety Act called on FDA, the Office of the National Coordinator on Health IT and the Federal Communications Commission to produce the FDASIA report. A workgroup of 30 industry stakeholders appointed by then-HHS Secretary Kathleen Sebelius issued recommendations for the report in fall 2013.
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  • June 6, 2014, 3:37 PM ET

Hospital Giant Uses Data to Vet Treatment Options

University of Pittsburgh Medical Center has found a way to improve health outcomes at lower cost thanks to a new data analytics program in which the hospital-and-insurance behemoth invested $105 million last year.
UPMC says a pilot program that directed patients to a centralized care facility helped save $15 million in medical costs over the course of a year. These clinics, known as patient centered medical homes, centralize all of a patient’s various care and medical services under the auspices of a single physician, and are assigned to patients once they’ve been released from the hospital.
Dr. Pamela Peele, who runs the analytics program at UPMC, said the hospital hadn’t previously been able to determine whether the program was successful enough to be maintained or expanded — or whether it should be dismantled. She said UPMC decided the program was so successful that it should be expanded. “If data doesn’t change how the organization does business, you’ve wasted a lot of money,” she said during an interview at The Wall Street Journal’s offices this week.
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E-health experts weigh in on Sask. auditor’s report

Amber Rockliffe
SASKATOON – Saskatchewan’s acting auditor Judy Ferguson released the first volume of her 2014 report this week. The report describes the implementation of the government’s electronic health records system as fragmented and inefficient.
Health care consultants, doctors, and data experts gathered in Saskatoon over the weekend to discuss electronic health implementation at the Federation of Medical Regulatory Authorities of Canada annual general meeting.
“Our role is to work with doctors to adopt this new and evolving technology,” said the federation’s chair Dr. Rocco Gerace.
Ferguson said different health regions are at different stages of implementing the electronic records system, something e-health experts say is a big pitfall.
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Enjoy!
David.

Friday, June 20, 2014

This Is A Really Important Issue Which Clearly Involves Electronic Health Records And Evidence Based Health Care.

This appeared a little while ago.

Cardiac Practice Guidelines Have High Turnover

Published: May 27, 2014 | Updated: May 28, 2014
By Salynn Boyles, Contributing Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Action Points

  • One in five cardiology class I clinical practice guidelines published since the late 1990s have been downgraded, reversed, or omitted.
  • Point out that after accounting for guideline-level factors, the probability of being downgraded, reversed, or omitted was three times greater for recommendations based on opinion or on one trial or observational data versus recommendations based on multiple trials.
One in five cardiology class I clinical practice guidelines published since the late 1990s have been downgraded, reversed, or omitted, with recommendations not supported by strong clinical trial evidence the most likely to get the axe, an analysis of more than 600 guidelines found.
Among recommendations with available information on level of evidence, 90.5% (95% CI 83.2%-95.3%) supported by multiple randomized studies were retained versus 81% (95%CI 74.8%-86.3%) supported by one randomized trial or observational data, and 73.7% (95% CI, 65.8%-80.5%) supported by opinion (P=0.001), wrote Mark D. Neuman, MD, of the University of Pennsylvania in Philadelphia, and colleagues, in the May 28 issue of the Journal of the American Medical Association.
After accounting for guideline-level factors, the probability of being downgraded, reversed, or omitted was three times greater for recommendations based on opinion (odds ratio 3.14, 95% CI 1.69-5.85, P<0 .001="" 1.45-8.41="" 3.49="" 95="" ci="" data="" em="" observational="" on="" one="" or="" trial="">P
=0.005) versus recommendations based on multiple trials, the group reported.
The findings revealed that shifts in cardiology guidelines over time are largely predictable, with recommendations based on just one clinical trial or on retrospective studies much more likely to be changed than those made on the basis of multiple clinical trials, Neuman told MedPage Today.
He said there were clear implications for policymakers charged with identifying quality and performance measures for cardiology practices.
"I would say the safest bet in terms of ensuring that these measures will endure would be to build them around areas of medicine where there are multiple clinical trials to show something works," he said.
Study Details
The analysis included clinical practice recommendations jointly produced by the American College or Cardiology (ACC) and the American Heart Association (AHA). All were current as of Sept. 1, 2013 and all had at least one prior version.
The sample included 11 guidelines addressing:
  • Atrial fibrillation
  • Perioperative cardiovascular evaluation
  • Cardiac pacemakers and antiarrhythmia devices
  • Secondary prevention of coronary artery disease
  • Coronary artery bypass graft surgery
  • Cardiovascular disease prevention in women
  • Heart failure
  • Percutaneous coronary intervention
  • Chronic stable angina
  • Unstable angina and non-ST-segment elevation myocardial infarction
  • Valvular heart disease
For each guideline, the researchers considered the version immediately preceding the current one to be the index. They identified 619 class I recommendations in the 11 index guidelines published between 1998 and 2007. The median number of years between the index guideline and the next full revision was 6, the number of listed writing committee members for index guidelines ranged from 11 to 33 (median 14), and the percentage of members retained between versions ranged from 0% to 75% (median 30.8%).
The durability of class I ACC/AHA guideline recommendations for procedures and treatment varied significantly across individual guidelines and levels of evidence, with the most omissions by topic seen for preoperative cardiovascular evaluation (nine of 13 guidelines omitted, 69.2%) and congestive heart failure (25 of 66 guidelines omitted, 37.9%).
Downgrades or reversals were most common among level B recommendations (single randomized trial or nonrandomized studies), occurring in 12.8% (95% CI 8.5%-18.3%, 25 of 195), while omissions were most common among level C (consensus opinion, standard of care, or case studies) evidence, occurring in 16.9% (95% CI 11.2%-23.9%, 25 of 148).
When the researchers assessed changes over time in the level of evidence for downgraded or reversed recommendations whose initial level of evidence was B or C, they found that the level of evidence increased for eight (20.5%) and decreased or stayed the same for 311 (79.5%).
"While our results highlight the overall durability of cardiovascular disease guideline recommendations, they also emphasize that particular subsets of recommendations may be more fragile than others as a basis for changes in practice and policy," the researchers wrote. "For example, one of eight recommendations that was based on a single trial or observational data was either downgraded or reversed in the subsequent guideline version, versus one of 26 recommendations based on two or more randomized trials."
Lots more here:
The implication of this study is that not only is clinical knowledge advancing rapidly but that this good news is meaning that quality evidence based practice is getting harder and harder as the evidence base is not all that stable.
If an Electronic Health Record has guideline based decision support it is vital to ensure that these guidelines are the most current available as if this is not done there are risks of liability etc.
A secondary implication of this is that clinicians must ensure they are using the most current versions of their EHR software and that their EHR provider is actively keeping up with new releases of the guideline they have integrated. This is a very good reason to pay annual maintenance fees etc.
I have to say the other issue that strikes me is just how hard it is for even super-specialists to stay on top of their field. It was really much easier even a decade or two ago!
And to top it up even more have a browse at this post from the KevinMD blog.

http://www.kevinmd.com/blog/2014/05/problem-evidencebased-health.html

As Dr Lowinger says:

"Yet lately the inadequacies with evidence have become more and more glaring to me. Lately it seems to me that we need to start paying better attention to what  evidence can’t do — as much as to what it can do. And I wonder if it isn’t time for a better approach in developing and transmitting health information via any channel.

Evidence, for one thing, doesn’t last. It is a fluid beast — forever slithering under our grasp. Recommendations change over time and there seems to be a growing fuzziness around the edges."

Tricky what?
David.