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4 former national coordinators, a CIO and a CEO weigh in on how to fix meaningful use
A rock star lineup of health IT pros including Karen DeSalvo, John Halamka weigh in on where the program went astray and suggest the direction that government and industry should steer towards.
September 07, 2017 02:08 PM
Karen DeSalvo, MD, Vindell Washington, MD, and John Halamka, MD, are among the health IT pros sparring over how to fix meaningful use.
Meaningful use essentially digitized the healthcare system arguably faster than any other sector of the U.S. economy. But as with so many federal government programs, laws, rules and regulations, that is not even close to suggesting the endeavor was an indisputable success.
Could the total $37 billion paid out thus far, according to newest summary report CMS posted, have been spent more wisely? Did the program succeed or fail? Perhaps the most critical question right now is: looking to the future what should the federal government’s role be?
“We believe that now is the time to step back and recalibrate the role of the federal government on the basis of lessons learned,” John Halamka, MD, and Micky Tripathi wrote in an article in the New England Journal of Medicine.
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Don't fear the robot: Artificial intelligence could be a game-changer for physicians and their patients
Sep 8, 2017 11:50am
IBM Watson is one of the most recognizable artificial intelligence platforms and is being used by healthcare systems.
Automation might make some physicians nervous. But even as the debate rages over whether machines could or should "replace" doctors, artificial intelligence continues to gain ground in the healthcare industry.
AI could change the way medicine is practiced and ultimately free up doctors to spend more time with their patients, said Paul Balagot, chief experience officer at Precisioneffect, a California healthcare marketing and advertising agency that focuses on scientific advances in some of its campaigns.
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Don't let IBM's blunders in health care blind you to the huge benefits of technology in medicine
- IBM Watson is clearly struggling to revolutionize medicine with artificial intelligence.
- Computational tools can support doctors in the coming years, experts say.
- The key is to understand the needs of a health system, rather than throwing sexy tech at the problem.
Published 5:08 PM ET Thu, 7 Sept 2017 | Updated 7:55 PM ET Thu, 7 Sept 2017
IBM Watson might not deliver on its lofty goal to revolutionize medicine with artificial intelligence, as a recent investigation suggests.
But that doesn't mean new technology will be incapable of improving health care.
IBM put a heavy dose of investment and hype into the medical potential of its machine learning system Watson. It was supposed to help doctors make decisions on how to identify and treat diseases, most specifically cancer.
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Med management, AI to assist patients with compliance at home
Published September 06 2017, 4:16pm EDT
Medication management vendor MedMinder and Cyft, an artificial intelligence vendor that helps providers identify patients most likely to benefit from interventions, are joining forces to help improve chronic care treatment.
MedMinder offers services that manage complex drug regimens for patients, using an automated pill dispensing product and alerts that increase medication adherence rate to more than 90 percent.
For its part, Cyft will integrate in-home medication adherence data into nightly predictions to prioritize patients based on actionable risk, while also giving MedMinder clients care management notes, a call center and claims data to determine risks and associated urgency.
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Camden integrated care record used by 1,400 staff in 18 months
Shireen Khalil
4 September 2017
More than 1,400 health and care professionals in Camden have accessed information via a shared care record since the system went live last year.
The Care Integrated Digital Record (CIDR), run by Camden CCG, allows for patients’ information to be accessed by health and care organisations across the borough.
The record went live in January last year and is now accessible from 34 out 36 Camden GP practices as well as four trusts including University College London Hospitals NHS Foundation Trust.
Connected systems include EMIS, Cerner and SystmOne.
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http://www.fiercehealthcare.com/analytics/ibm-and-mit-launch-240m-ai-research-lab-a-focus-healthcare
IBM and MIT launch $240M AI research lab with a focus on healthcare applications
Sep 7, 2017 11:14am
IBM and the Massachusetts Institute of Technology have inked a 10-year, $240 million deal to develop a research lab devoted entirely to artificial intelligence, with a heavy emphasis on healthcare.
The collaboration’s core objectives will focus on advancing AI algorithms and expanding the capabilities of machine learning, according to Thursday’s announcement, which noted the lab will be “one of the largest long-term university-industry AI collaborations to date.” MIT professors and students will have access to IBM’s research lab which includes IBM Watson Health and IBM Security.
Although the lab will broadly focus on AI’s impact across several industries, there’s a clear emphasis on how to integrate new algorithms into healthcare and cybersecurity. Anantha Chandrakasan, the dean of MIT’s School of Engineering, who helped broker the agreement, said cancer diagnosis is a particular target, including the use of AI in imaging and radiology to detect breast cancer.
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Experts agree on HITECH’s value but diverge on ONC's new role in enhancing interoperability
Sep 7, 2017 10:59am
The healthcare industry desperately wants interoperability, but what role should the government play?
Some of the nation’s foremost health IT experts see the value in the Health Information Technology for Economic and Clinical Health (HITECH) of 2009 that created federal incentives to entice thousands of hospitals and physician offices to adopt EHR systems in a matter of years.
Those same experts also concede that the industry is facing entirely new challenges when it comes to EHR usability and interoperability. And the federal government’s role in that next step varies depending on who you ask.
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HIT Think 4 ways to raise defenses against rising ransomware threats
Published September 07 2017, 3:42pm EDT
There's a new ransomware variant making the rounds, and it may prove more productive for attackers and more problematic for healthcare security teams. Rather than the “spray and pray” type attacks we saw in the past, the new twist is focusing on select, high-risk targets.
“Spray and pray” ransomware attacks are a volume game. It works like this—target a very large audience with a spear phishing scheme and hope to fool a relatively small percentage of people. Encrypt their files and ask for hundreds of bitcoins/dollars to unlock them.
In “Spray and Pray” attacks, the messages are generic and often designed to trigger an emotion-based response. Take for example, the recent spate of emails pretending to be from the IRS or FBI. They look official and convey a fear inducing message—“You are in big trouble and better respond fast.”
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Yale EHR Integrated with Connecticut Opioid Monitoring System
Alexandra Wilson Pecci, September 7, 2017
The system allows physicians logged into Yale’s EHR to quickly identify which patients are at high risk for adverse events and overdose.
In an effort to fight opioid abuse, Yale New Haven Health and Yale School of Medicine have integrated its EHR with the Connecticut Prescription Monitoring and Reporting System (CPRMS).
Although Connecticut has a database of opioid and other controlled prescription information, the stand-alone system is considered cumbersome and has created barriers to clinicians’ use, reports Yale. Physicians have had to access separate systems with different logins, requiring a break in their workflows.
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Health Catalyst’s analytics effort aims to improve treatment decisions
Published September 05 2017, 3:29pm EDT
Health Catalyst is hoping to revamp the approach for using data to improve care and make better cost-based decisions by incorporating more types of data and enabling a closed-loop analytics process that pushes findings back into electronic health records systems.
The Salt Lake City-based vendor on Tuesday announced what it’s calling a Data Operating System, which combines features of data warehousing, clinical data repositories and health information exchanges.
The concept will use open APIs to better support third party application development, says Dale Sanders, executive vice president of product development for the company.
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Experts say IBM Watson’s flaws are rooted in data collection and interoperability
Sep 6, 2017 2:04pm
IBM Watson promised to revolutionize cancer care. So far, experts say it's fallen well short.
Despite being backed by a significant budget and the marketing power of a major technology company, IBM Watson appears to be falling short of expectations when it comes to revolutionizing cancer care.
The shortcomings of IBM’s premier artificial intelligence system—made famous by its appearance on Jeopardy in 2011 and later c-oopted to provide support for oncologists—are linked to a number of factors, according to an in-depth investigation by Stat that included interviews with doctors and artificial intelligence experts from around the world.
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FDA finalizes guidance on medical device interoperability
Sep 6, 2017 10:01am
The FDA's new guidelines emphasize the use of existing consensus standards to ensure uniform data exchange.
The Food and Drug Administration has finalized new guidance for medical device manufacturers that focuses on transparency, risk management and the use of consensus standards to ensure safe and effective interoperability with connected devices.
The new recommendations (PDF), released on Tuesday, maintain the FDA’s steady stream of digital health guidance that has emerged as a priority under Commissioner Scott Gottlieb. Medical device interoperability is one of several policies the agency outlined in its Digital Health Innovation Plan released in July, and it comes on the heels of finalized guidelines on the use of real-world data to regulate innovative medical devices.
Highlighting the value of data generated by medical devices across the healthcare ecosystem, Bakul Patel, the FDA’s associate director for digital health at the Center for Devices and Radiological Health (CDRH), said safety is the agency’s foremost concern. Consistent data formatting and greater transparency from manufacturers regarding their products interface can limit the possibility of inadvertent medical errors.
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HIEs Matter
We have watched with sadness as Hurricane Harvey has flooded first southeast Texas and now Louisiana. We have seen the spirit of the American people at its best. Volunteers from around the country have brought their own boats to rescue residents while thousands have donated money and supplies. As of Thursday morning, there had been over 25,000 water rescues.
Hospitals are meant to operate and care for patients 24/7 through a disaster. But they too were impacted by the rising waters. I took a break mid-day yesterday to watch the news. I watched in that 15-minutes the evacuation of patients from Baptist Hospital in Beaumont, Texas after the city lost its water supply. Without clean water, the hospital had to close and transfer 190 patients.
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The HITECH Era and the Path Forward
More than a decade ago, the National Academy of Medicine outlined the serious consequences of a paper-based health system: redundant tests; increased costs; uncoordinated and fragmented care; medical decisions made with incomplete data, leading to adverse events; and potential clinical innovations left undiscovered, hidden in patient files.1,2 To help address these concerns, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009. The law spurred rapid progress toward digitizing the health care delivery system, which has experienced a dramatic transformation as a result of concerted efforts by both public and private sectors. We believe we’re at an inflection point in terms of the capability to share research results, clinical guidelines, and patient data seamlessly and securely. The federal government’s actions to date have set the stage for an expanding role for health information technology (IT) in improved care delivery.
Through Executive Order 13335, President George W. Bush launched the Office of the National Coordinator for Health Information Technology (ONC) in 2004 to shepherd the health care sector into the digital age. The HITECH Act statutorily authorized the ONC and called for establishing the Health IT Certification Program to set health IT standards and implementation specifications. It also provided substantial resources to offset the cost of adopting and using electronic health records (EHRs) for eligible hospitals and providers, support population health management with data, and develop a national infrastructure for health information exchange.
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The HITECH Era in Retrospect
At a high level, the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 accomplished something miraculous: the vast majority of U.S. hospitals and physicians are now active users of electronic health record (EHR) systems. No other sector of the U.S. economy of similar size (one sixth of the gross domestic product) and complexity (more than 5000 hospitals and more than 500,000 physicians) has undergone such rapid computerization.
Along the way, however, we lost the hearts and minds of clinicians. We overwhelmed them with confusing layers of regulations. We tried to drive cultural change with legislation. We expected interoperability without first building the enabling tools. In a sense, we gave clinicians suboptimal cars, didn’t build roads, and then blamed them for not driving.
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Industry group issues its clinical decision support guidelines
Published September 05 2017, 7:07am EDT
The CDS Coalition, a group of software developers and medical device manufacturers, has released final guidelines on the design of medium-risk clinical decision support that it hopes will serve to self-regulate the industry as the Food and Drug Administration looks to publish its own guidance on high-risk CDS early next year.
“The coalition wanted to do its part to assure the safety of unregulated CDS by developing guidelines that would ensure that medium-risk CDS either leaves the decision-making in the hands of qualified users or is properly validated,” says Bradley Merrill Thompson, general counsel for the group. “We also wanted to leave low-risk CDS untouched to avoid burdening innovation in that area.”
Under the 21st Century Cures Act signed into law late last year, certain CDS software is now outside the scope of FDA regulation. While the regulatory agency will need to interpret the exact line drawn by the statute, the CDS Coalition wants to give FDA confidence that, for unregulated software, the “industry will do an adequate job of self-regulation,” Thompson contends.
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NQF issues new quality measurement reports for telehealth and interoperability
Sep 5, 2017 1:50pm
Thanks to funding from HHS, NQF published two new frameworks to measure the impact of interoperability and telehealth.
The National Quality Forum released new frameworks to measure the value of telehealth and the impact of data interoperability, two issues that have been getting more attention from federal policymakers.
The organization’s deep dive into interoperability—conducted on behalf of the Department of Health and Human Services—comes as the Office of the National Coordinator for Health IT is developing its trusted exchange framework required under the 21st Century Cures Act. NQF identified four broad categories of interoperability: the quality and volume of health data exchange, health data usability, patient care applications, and the impact on patient safety, costs savings and care coordination. More specially, NQF’s Interoperability Committee identified 53 potential measures to be used now and in the future.
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In Texas, Hurricane Harvey response efforts provide a ‘defining moment’ for telehealth
Sep 5, 2017 11:59am
Vendors and providers around the country are providing free medical care via telehealth in the aftermath of Hurricane Harvey.
As Texas recovers from the unprecedented devastation caused by Hurricane Harvey, Houston residents affected by the storm will have access to medical providers throughout the country in ways that haven’t been fully utilized during previous large-scale disasters.
Relief efforts are getting a boost from technology vendors and hospitals across the country that are offering free telehealth services to those affected by a storm that dropped 19 trillion gallons of rain across Southeast Texas. Although telehealth has certainly gained a stronger foothold throughout the medical community over the last several years, it’s still not fully ingrained in the public consciousness.
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Toward More Proactive Approaches to Safety in the Electronic Health Record Era
Article
DOI: 10.1016/j.jcjq.2017.06.005
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http://www.healthcareitnews.com/news/nqf-says-interoperability-goes-far-beyond-ehr-ehr-data-exchange
NQF says interoperability goes far beyond EHR-to-EHR data exchange
The National Quality Forum has released new guiding principles for a truly interoperable healthcare system.
September 05, 2017 02:05 PM
The National Quality Forum published a framework for measuring the progress of interoperable health information exchange.
Within the 83-page document, NQF defined interoperability as “the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user.” NQF said that definition is consistent with one the Office of the National Coordinator for Health IT uses in its nationwide interoperability roadmap.
To accomplish that, the agency outlined five guiding principles for defining key criteria of interoperability.
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With few hospitals using SAFER Guides, experts call for regulators to improve focus on EHR patient safety
Sep 5, 2017 10:55am
Concerns about EHR patient safety have grown, but few hospitals are using federally sponsored guidelines.
More than three years after the Office of the National Coordinator for Health IT released EHR safety guidelines, few healthcare organizations have used the resource to address IT-specific patient safety concerns. Regulators might be the one to move the needle.
ONC released the SAFER Guides (Safety Assurance Factors for EHR Resilience) in January 2014, and they have undergone several updates in the past several years. But competing IT priorities, the absence of safety-related measurements for EHRs and a lack of incentives to use the guides have limited widespread adoption, two experts involved with the creation of the SAFER Guides wrote in an article for The Joint Commission Journal on Quality and Patient Safety.
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HIT Think How to optimize a patient portal for Meaningful Use Stage 3
Published September 05 2017, 3:29pm EDT
Most healthcare organizations offer patient portals that enable patients to schedule appointments, easily access their medical information, pay bills, request prescription refills and even message their physicians. They are also becoming increasingly important to providers in preparing to meet the latest Meaningful Use requirements.
Patient portal requirements for Meaningful Use Stage 1 were fairly minimal, but Stage 2 presented a tougher task. Organizations now needed patients to actually use their portals, and immediately it became clear that some patients were hesitant.
This wasn’t a technology issue, but an education issue, both within and beyond hospitals’ walls. Caregivers weren’t brought up to speed and therefore could not effectively educate patients on the benefits of being engaged. Patients were expected to enroll on their own, and then did not. These issues still remain and hamper adoption.
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Heart Pathway app aids doctors in addressing necessity of cardiac treatment
- By Richard Craver Winston-Salem Journal
- Sep 3, 2017
There are few situations in life more terrifying than experiencing a potential cardiac issue.
More than 8 million Americans face that scenario every year.
The emergency department protocol for decades has been to conduct several tests, whether blood, heart or stress, to determine if the individual is having a heart attack. At the least, an overnight stay for observation was recommended, if not required.
Yet, several studies have shown that in 90 percent of such cases, the patient was determined not to have been experiencing an acute coronary syndrome. Patients often are discharged with a hospital bill in the thousands of dollars.
Impathiq Inc., a Winston-Salem-based health-care technology company, is marketing what it believes is a viable alternative that could save diagnosis time in the emergency department, resources for hospitals and money for patients.
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Federal Law Would Fight Opioid Epidemic with E-prescribing
Alexandra Wilson Pecci, September 5, 2017
The Every Prescription Conveyed Securely Act would require electronic prescriptions for controlled substances under Medicare.
Sean Kelly, MD, sees the devastating effects of the opioid epidemic firsthand almost every day. "We see a lot of overdoses, I would say more this year than last year. Pretty much every shift has one or two," he says.
Kelly is an attending ED physician at Beth Israel Deaconess Medical Center in Boston. He is also chief medical officer of Imprivata and an assistant clinical professor of emergency medicine at Harvard Medical School.
But it's not only overdosed patients who come into the ED comatose or coding.
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Interoperability 2016-2017 Final Report
Date of Publication:
SEP 2017
Associated Project:
Abstract
Interoperability is an important process that can enable providers to connect and share information with other providers and specialists to guide better decision making, improve quality of care, and increase involvement of patients in their own healthcare processes. The sharing and appropriate use of information, specifically electronic information, are important aspects of healthcare. NQF developed a common framework and measure concepts to serve as a foundation to address the current gaps in the measurement of interoperability and its impact. This measurement framework seeks to identify gaps where new measures need to be developed and identify suitable existing measures. To do so, the project synthesized available evidence from the environmental scan, key informant interviews, and input from an expert, multistakeholder audience, including NQF membership and public stakeholders and combined all of these elements into a framework applicable to various stakeholders.
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Apple, IBM, Google hold keys to make EHR data more actionable, Kalorama says
Today’s technologies are not going to cut it in a big data future, the analyst firm said, but major IT vendors are ramping up their focus on healthcare.
September 01, 2017 12:07 PM
“With the data mining skills of Apple, IBM and Google, there is increased hope that their entrance into the healthcare market will help realize the industry goal of turning EMR data into actionable Big Data insights,” said Bruce Carlson, publisher of Kalorama Information.
Big data: There’s an abundance of excitement yet so few practical applications deployed in healthcare today.
The current fistful of overarching industry trends — precision medicine, population health, next-generation EHRs and value-based care among those — is creating enormous opportunities for traditional and new health IT vendors to serve hospitals customers in new ways.
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New leader ready to prepare HIMSS for the approaching silver tsunami
Hal Wolf believes an aging population will require a new approach from healthcare IT leaders.
September 01, 2017 03:13 PM
Hal Wolf is firmly behind HIMSS involvement in public policy and is already involved in work to educate the FDA on certification of digital devices and is focused on emerging technologies like blockchain.
When Hal Wolf looks at the future of HIMSS, he sees “tremendous opportunities” but he is also keenly focused on the “silver tsunami” that is coming.
“We must recognize that healthcare systems are going to be financially strapped,” he said in his first interview with Healthcare IT News. “We have a lot of people living longer and there are going to be fewer people producing GDP.”
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- Author: Megan Molteni
- 09.01.17
- 07:00 am
Harvey Evacuees Leave Their Belongings—and Health Records—Behind
A patient is taken to the St. Josephs hospital after evacuating when Hurricane Harvey caused heavy flooding in Houston on August 28, 2017.
MARK RALSTON/AFP/Getty Images
Digitizing the world's medical records was supposed to make doctors' lives easier and patients' lives longer. But unlike banking and shopping, medicine has had a rough time transitioning to the new digital order. Because health care providers use different systems for their electronic health care records, it’s still difficult for a patient’s data to follow them through the medical ecosystem.
Most of the time, siloed medical information is more of a nuisance than anything else. But when Hurricane Harvey hit the Houston area last week, evacuations and rescue efforts forced patients to seek treatment anywhere they could. And most of the time, their health records didn’t go with them. That information void can be almost as catastrophic as the catastrophe itself.
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‘Biological teleporter’ to fight pandemics
Tom Whipple, Science Editor
September 4 2017, 12:01am, The Times
A so-called “biological teleporter” can be used to transmit DNA, viruses and vaccines by email, in a technology that scientists hope will provide a potent weapon against pandemics.
Craig Venter, a US scientist who pioneered human genome sequencing, has built a prototype machine that works like a 3D printer for biological material, speeding up the process of synthesising and transporting DNA. If the machine could be developed and mass produced then it would allow physicians in the field to send the genetic code for biological specimens, such as new viruses, direct to laboratories, which could then make the organism. If a vaccine were produced then it in turn could be sent immediately to any hospital with the machine.
“We can digitally send DNA and proteins: we can email them if you have one of these converters,” Dr Venter said. “Vaccines could be made immediately and if every major institution in the world had one of these machines we could distribute the vaccine in a fraction of a second.”
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Enjoy!
David.
