Here are a few I came across last week.
Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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Google is quietly infiltrating medicine — but what rules will it play by?
By Michael L. Millenson
January 3, 2019
What’s received little attention from physicians or the public is the company’s quiet metamorphosis into a powerhouse focused on the actual practice of medicine.
If “data is the new oil,” as the internet meme has it, Google and its Big Tech brethren could become the new OPEC. Search is only the start for Google and its parent company, Alphabet. Their involvement in health care can continue through a doctor’s diagnosis and even into monitoring a patient’s chronic condition for, essentially, forever. (From here on, I’ll use the term Google to include the confusing intertwining of Google and Alphabet units.)
Suppose you’re worried that you might have diabetes. Googling “diabetes” brings up not just links but also a boxed summary of relevant information curated by the Mayo Clinic and other Google partners. Google recently deployed an app enabled with artificial intelligence for remote professionals to use that can all but confirm diabetes-related retinopathy, a leading cause of blindness. Diabetes is also a diagnosis your doctor might have predicted using more Google AI applied to the electronic health record.
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2019 predictions: UK digital health leaders on what lies ahead
As we welcome a new year, it is custom to look ahead to what the key themes will be in 2019 in the world of health technology.
Hanna Crouch, 2 January 2019
We asked a number of leading figures from the sector to give their thoughts on what they think will be big this year.
Will Smart, national CIO for Health and Care
“I predict England will have its first HIMSS7 Acute Hospitals, demonstrating that NHS secondary care organisations can deliver high quality technology and we’ll continue to make progress with Local Health and Care Record Exemplars.
“Informatics will have an increasingly important voice at board level rights across the NHS, as technology is recognised as a key tool to deliver real transformation across all parts of the system, delivering real benefits to patients.”
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Your data was probably stolen in cyberattack in 2018 – and you should care
Mike Snider, USA TODAY Published 6:00 a.m. ET Dec. 28, 2018 | Updated 3:59 p.m. ET Jan. 1, 2019
When it comes to data breaches, 2018 was neither the best of times nor the worst of times. It was more a sign of the times.
Billions of people were affected by data breaches and cyberattacks in 2018 – 765 million in the months of April, May and June alone – with losses surpassing tens of millions of dollars, according to global digital security firm Positive Technologies.
Cyberattacks increased 32 percent in the first three months of the year and 47 percent during the April-June period, compared to the same periods in 2017, according to the firm, which was founded in 2002.
There wasn't a breach "quite as significant" as the Equifax data breach from September 2017 in which an estimated 143 million Americans faced potential lifelong threat of identity theft, said Marta Tellado, president and CEO of Consumer Reports. "But the sheer volume of breaches of major companies was stunning," she said.
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January 4, 2019 / 4:38 AM / a day ago
Most U.S. patients not using online medical portals
(Reuters Health) - Most people in the U.S. with health insurance don’t use the patient portals that are increasingly provided by doctors for online communication, a new study suggests.
In a nationally representative survey, researchers found that nearly two-thirds of insured participants had not used an online medical portal in the past year.
Disparities among those who said they’d been offered portal use, and among those who chose to use it, suggest this technology can become a source of unequal access to healthcare, the study team writes in Health Affairs.
“Previous research has shown there are real benefits to portal use. Patients become more engaged in their own health and really stick to their treatments,” said senior author Denise Anthony of the University of Michigan in Ann Arbor.
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Pharmacy refill data helps providers detect medication non-adherence
Published January 04 2019, 7:24am EST
A combination of provider reports and pharmacy refill data offers the highest sensitivity for identifying and predicting medication non-adherence.
According to Johns Hopkins researchers, a study of 87 adolescents and young adults with chronic kidney disease, evaluated five adherence measures—provider reports, patient reports, caregiver reports, electronic medication monitoring and pharmacy refill data.
Specifically, the
study—published in the January issue of
Pediatric Nephrology—examined whether using additional measures, beyond provider assessment alone, improves the accurate identification of non-adherence.
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Microsoft, Google use artificial intelligence to fight hackers
By Dina Bass Bloomberg
Published January 04 2019, 4:32pm EST
Last year, Microsoft Corp.’s Azure security team detected suspicious activity in the cloud computing usage of a large retailer: One of the company’s administrators, who usually logs on from New York, was trying to gain entry from Romania. And no, the admin wasn’t on vacation. A hacker had broken in.
Microsoft quickly alerted its customer, and the attack was foiled before the intruder got too far.
Chalk one up to a new generation of artificially intelligent software that adapts to hackers’ constantly evolving tactics. Microsoft, Alphabet Inc.’s Google, Amazon.com Inc. and various startups are moving away from solely using older “rules-based” technology designed to respond to specific kinds of intrusion and deploying machine-learning algorithms that crunch massive amounts of data on logins, behavior and previous attacks to ferret out and stop hackers.
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HIT Think How AI can fit into healthcare’s priorities in 2019
Published January 04 2019, 4:45pm EST
Two-thirds of attendees
polled at a recent innovation summit by The Economist agree that healthcare is the sector that will benefit the most from artificial intelligence. However, questions loom on exactly how it will help the industry, and perhaps more importantly, if there is the possibility of it accomplishing what it promises.
The latter concern was recently experienced by IBM when its Watson cognitive recognition system was used as part of the “
moon shot” project launched by the MD Anderson Cancer Center to diagnose and recommend treatment plans for certain forms of cancer. The project costs spiraled past $62 million while the system had yet to be used on an actual patient. The extremely bold and ambitious initiative failed to deliver.
At the same time, the IT group at the Cancer Center was experimenting with more humble and simple applications of AI. These included making hotel and restaurant recommendations for patients' families, determining which patients needed help paying bills and addressing staff IT problems. These smaller efforts paid off in time savings, patient satisfaction and financial performance. Perhaps there is a lesson here.
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3 Predictions for Virtual Care in 2019
Readers tell us what trends will have the greatest impact on telehealth in the year ahead.
What changes will 2019 bring to the realm of virtual care? We asked our readers to peer into the future and predict which trends will have the greatest impact on telehealth in the coming year.
Despite the fact that they work for a broad array of organizations, including health systems and companies that provide telehealth services, the input provided was surprisingly similar. Nearly all feedback fell under three distinctive banners that will spur growth: reimbursement, expansion beyond direct-to-consumer models, and technological advancements.
Regardless of the reason, everyone expects the next 12 months to bring accelerated growth.
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Devices That Will Invade Your Life in 2019 (and What’s Overhyped)
A.I. that responds to your voice. Next-generation wireless networks. If this year’s biggest consumer technology trends have a familiar ring, there’s a reason for that.
Credit Glenn Harvey
Imagine a future where you are never truly alone. Even when your spouse is on a business trip or your children are away at summer camp, you will always have someone (or something) to talk to. In the morning, you could ask the microwave to heat up a bowl of oatmeal. In your car, you could tell your stereo to put on some ’90s music. And when you walk into the office, you could ask your smartphone, “What’s on my calendar today?”
This is increasingly the world the tech industry is building with a bloating portfolio of devices that can react to voice commands — and that the companies will be pitching to you even more in 2019.
The future will be on display next week at CES, a consumer electronics trade show in Las Vegas that serves as a window into the year’s hottest tech trends. Artificially intelligent virtual assistants will take center stage as the most important tech topic, with companies big and small expected to showcase voice-controlled devices like robot vacuums, alarm clocks, refrigerators and car accessories. Most of these products will be powered by Amazon’s Alexa or Google’s Assistant, the two most popular artificially intelligent assistants, industry insiders said.
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KLAS ranks population health management vendors on partnering and guidance
Epic beats Cerner and Allscripts for customer satisfaction – but HealthEC, Health Catalyst, Arcadia and Enli take top spots.
January 03, 2019 11:10 AM
KLAS released its latest report on population health management vendors this time focusing on how well vendors did when it comes to partnering and guidance helping healthcare providers make the transition to value-based care.
WHY IT MATTERS
Hospitals will not achieve population health success with just technology, of course, and KLAS noted that getting to value-based reimbursement will also require partnering and guidance from your tech vendors.
“Some vendors have risen to the challenge, while others have faltered following acquisitions or efforts to scale,” researchers wrote in the new report, Population Health Management, Part 1 - Partnering and guidance: The X Factors to PHM success.
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HHS Pain Management Task Force Recommends Improvements to PDMPs
January 2, 2019
by Heather Landi, Associate Editor
A pain task force within the U.S. Department of Health and Human Services (HHS) issued a draft report addressing best practices for pain management, including acute and chronic pain, and the recommendations include leveraging innovative solutions to pain management such as telemedicine as well improving prescription drug monitoring programs (PDMPs).
The Comprehensive Addiction and Recovery Act (CARA) of 2016 led to the creation of the Pain Management Best Practices Inter-Agency Task Force, a 29-member group whose mission is to determine whether gaps in or inconsistencies between best practices for acute and chronic pain management exist and to propose updates and recommendations to those best practices. The task force members have experience across the disciplines of pain management, patient advocacy, substance use disorders, mental health, and minority health.
The
draft report describes preliminary recommendations, which will be finalized and submitted to Congress later in 2019.
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Hospitals Spend 64% More on Advertising After a Data Breach
The costs are associated with efforts to repair the hospital’s image and minimize patient loss to competitors; researchers say it could be avoided with better data security.
January 02, 2019 - Hospitals spend 64 percent more annually on advertising after a breach over the following two years, according to a
recent report from the American Journal of Managed Care.
Researchers Sung J. Choi and M. Eric Johnson examined nonfederal acute care inpatient hospitals’ advertising expenditures after a breach, compared to institutions without a breach. The analysis was based on data from The Healthcare Cost Report Information System, market competition, and surveys of media vehicles from 2011 to 2014.
They found a hospital breach significantly increased the amount of spending around advertising for two years after the event, presumably due to efforts to repair the hospital’s image and minimize patient loss to competitors.
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Machine learning enables physical activity data to be re-identified
Published January 03 2019, 6:43am EST
By leveraging machine learning algorithms, it is possible to re-identify physical activity data collected from wearable devices from which protected health information has been removed.
That’s the contention of Anil Aswani, assistant professor in industrial engineering and operations research at the University of California at Berkeley.
“This type of data that’s collected by activity trackers is very useful for improving treatments and wellness programs but there’s also hidden privacy risks,” says Aswani.
In a cross-sectional study of national physical activity data from 14,451 individuals, Aswani and his colleagues applied linear support vector machine (SVM) and random forest methods from machine learning to re-identify the 20-minute-level physical activity data of about 80 percent of children and 95 percent of adults.
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HIT Think Three important goals for health IT in 2019
Published January 03 2019, 4:31pm EST
Healthcare is on the cusp of an exciting era. It’s been nearly one decade since the HITECH Act of 2009, which catapulted the electronic health record to national policy.
The more than $35 billion dollars that HITECH brought also included raft of unintended consequences, including physicians burned out by technology hassles, frameworks of abstract interoperability best practices and EHR checkboxes, and a general reluctance to challenge the status quo.
But newcomers have arrived. The post-EHR era has been heralded by disruptive, ventured-backed, technology-enabled provider groups bringing their own clinical experiences to the table, by the convergence of consumer technology and traditional health information technology (HIT), and by an interoperability environment rapidly shifting to networks rather than installations.
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As tech companies move into health care, here’s what to watch in 2019
Our bodies, our tech companies
From Amazon and Apple opening clinics to Uber launching a medical transit program, technology giants spent 2018 moving into the health care space. Many of these initiatives are still in very early stages, but they’ll continue to grow in 2019, and some of them may have an impact on Americans’ health care experiences as soon as this year.
The moves make sense from a financial standpoint: in any country, the health care market is one of the biggest industries there is, bringing in more than
$2.8 trillion annually in the US alone. As experts point out over and over, the American health care industry is also
extremely inefficient, which means there’s a lot of potential money to be made. Finally, the industry is enormous and has many sectors, giving the big companies plenty of space to maneuver without directly competing with each other... yet.
Here’s what we’ll be watching out for at the intersection of technology companies and health care in 2019.
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January 2nd, 2019
How Did Our Medical Notes Become So Useless?
Dot Phrase, by Grace Farris, MD
Among the many complaints about electronic medical records (EMRs), the death of the useful medical note ranks very high.
Notes are too long, too complex, and filled with unhelpful words. It’s often impossible to glean what the clinician thinks is going on, or what’s planned.
Ever get a note from an urgent care clinic on a patient who went there with a viral syndrome? Or a discharge summary? The note contains pages of indecipherable gobbledygook, ICD10 codes, irrelevant review of systems, stock phrases — the medical words are there, but where is the content? Give a click on this note for a particularly egregious example (all identifying information removed). Then come on back here. I’ll wait.*
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Oak Street Health decision support system reduces readmissions by 26%
Its homegrown Canopy system is an example of the type of platform that value-based models of the future will need to deliver evidence-based care in a complex care ecosystem.
January 02, 2019 01:43 PM
With each patient rehospitalization, thousands of dollars are spent on additional care and the risk of patients getting sicker or suffering preventable setbacks grows.
THE PROBLEM
There is high-quality, peer-reviewed evidence for what works for these high-risk patients, but not many physician practices are able to get it right. This isn't because it's impossible, but because it requires precision teamwork and a choreographed response to deliver what patients need.
An analysis of reports from MEDLINE, EMBASE, Web of Science and the Cochrane Library showed that patients require many interventions, not just one, during their transitions from hospital to home in order to have the best chance of avoiding readmission.
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The push for interoperability gains new urgency in 2019
Published January 02 2019, 7:14am EST
Now that most providers have implemented an electronic health or medical record system to comply with federal Meaningful Use requirements, the government has turned its attention in healthcare technology to interoperability. In fact, last April, the Centers for Medicare and Medicaid Services renamed the program—it’s now Promoting Interoperability.
It makes sense to shift the attention to data exchange, experts say. “There’s no need to measure things people are already doing universally,” says David Harlow, a lawyer and consultant who specializes in healthcare business and regulatory issues.
But it’s not so universal to actually use the data within EHR and EMR systems—along with other sources such as patient portals, connected devices, sensors and apps—to deliver meaningful and actionable data to improve outcomes across the care continuum and at the point of care for populations of patients. Although there are hurdles to overcome, the industry—driven by new regulations, incentives and the shift to value-based care—is definitely moving in that direction.
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HHS Releases Best Practice Healthcare Cybersecurity Guidelines
The goal is to outline practical security methods to cost effectively reduce cyber risk within health organizations, from local clinics to major health systems.
December 31, 2018 - The Department of Health and Human Services
issued cybersecurity guidelines for the healthcare sector on Friday, focused on voluntary cybersecurity practices to reduce security risks and bolster cybersecurity programs across the industry.
The four-volume publication dubbed Health Industry Cybersecurity Practices: Managing Threats and Protecting Patients was drafted in partnership with more than 150 cybersecurity healthcare and cybersecurity leaders.
“Cybersecurity is everyone’s responsibility,” Janet Vogel, HHS Acting Chief Information Security Officer, said in a statement. “It’s the responsibility of every organization working in healthcare and public health. In all of our efforts, we must recognize and leverage the value of partnerships among government and industry stakeholders to tackle the shared problems collaboratively.”
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HL7 Releases FHIR Version 4.0 for Healthcare Interoperability
HL7 FHIR R4 contains the first normative content for the interoperability standard, creating a firm foundation for the healthcare IT industry.
January 02, 2019 - HL7 International
has published the long-anticipated FHIR Release 4 (R4), allowing healthcare organizations to make new leaps forward in health data interoperability.
“R4 is the culmination of 18 months of extensive work to finalize the base parts of the specification, and incorporate changes and enhancement requests received from implementation partners across the world,” HL7
said in a blog post announcing the release.
“FHIR Release 4 marks a significant milestone with the introduction of a normative base. This new maturity will help support our very active and growing community.”
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HL7 releases FHIR 4
Fast Healthcare Interoperability Resources is now normative, and the new edition brings thousands of other updates.
January 02, 2019 11:47 AM
WHY IT MATTERS
Many in the healthcare industry have been eagerly awaiting the fourth iteration of FHIR 4 because future changes will now be backward compatible.
"Applications that implement the normative parts of R4 no longer risk being non-conformant to the standard," said FHIR Product Director Grahame Grieve on the
FHIR blog.
Grieve also noted that in addition of the base platform several key piece of FHIR are also now normative, including the RESTful API, the XML and JSON formats, the terminology layer, the conformance framework as well as Patient and Observation resources.
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HL7 publishes normative version of FHIR standard
Published January 02 2019, 3:24pm EST
Health Level 7 International has published Release 4 of its Fast Healthcare Interoperability Resources, marking a major milestone for the emerging standard, which is based on modern internet conventions.
According to HL7, the most significant advancement with FHIR Release 4 (R4) is that the base platform of the standard has passed a normative ballot and will be submitted to the American National Standards Institute.
“Some of the resources are normative, meaning that backward compatibility is assured for those,” says Chuck Jaffe, MD, HL7’s CEO, who contends that applications that implement the normative parts of R4 no longer risk being non-conformant to the standard.
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I want my Digital Twin, not an Electronic Health Record
Jan 31, 2018
Digitizing paper health records is a far cry from the benefits we get from our digital prototype.
The world of Industrial Internet of Things (IIoT) is awash with stories of how digital twins will create value via predictive maintenance. Consider the zillion discussions we have everyday on how early detection of failures of a robot in a production line can save millions from preventing downtime (“ZDT” or Zero-downtime), if only it were connected and monitored from the cloud.
As 2018 dawned, I found myself longing for my own digital twin.
Why can’t I have a digital twin, if a robot gets its own?
EHR: Maintenance Logs in the Cloud
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EHR Use Helps to Reduce Hospital Readmissions, Length of Stays
Research suggests hospitals engaging in EHR use to fulfill federal regulations achieve improvements in patient health outcomes.
December 27, 2018 - The ongoing debate over whether EHR use improves or impedes patient care has persisted for nearly ten years.
While the technology is unpopular among many of its users, a
recent study by Wani
et al. offers evidence to suggest the technology may be yielding small but notable improvements in patient health outcomes.
As part of the Journal of Operations Management study, researchers analyzed patient EHR data from California’s Office of Statewide Health Planning and Development (OSHPD). The health records detailed patient stays spanning 2010-2013.
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3 common high-security cyber risks for healthcare facilities
User authentication deficiencies are among the most common high-security risks healthcare organizations face with regard to cybersecurity, according to a
CyberIntelligence Insight Bulletin from Clearwater Compliance.
The company analyzed critical risks facing hospitals and health systems in its database and summarized them. Clearwater gathered the data from HIPAA risk analyses performed using its IRM|Analysis software that provides an automated process for assessing and remediating cybersecurity risks.
The three most common risks found during a HIPAA risk analysis using the IRM|Analysis software were:
• User authentication deficiencies
• Endpoint leakage
• Excessive user permissions
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User Authentication Most Common Cyber Risk for Hospitals, Health Systems
Excessive user permissions and endpoint leaks round out the top three security vulnerabilities found in health systems and hospitals by Clearwater CyberIntelligence Institute.
December 27, 2018 - User authentication deficiencies, endpoint leakage, and excessive user permissions are the three most common cyber risks facing health systems and hospitals, according to new data from Clearwater CyberIntelligence Institute.
The report reflected similar findings in a recent Crowe analysis that found access management will be one of the biggest health IT risk concerns across the healthcare sector in 2019.
Clearwater researchers analyzed data from by IRM Analysis, a database of millions of risk records accumulated over the last six years from NIST-based risk analyses of Clearwater customers. The data focused exclusively on risk profiles of hospitals, Integrated Delivery Networks, and business associates.
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HHS issues voluntary healthcare cybersecurity practices
Published December 31 2018, 7:13am EST
The Department of Health and Human Services has released voluntary cybersecurity practices to the healthcare industry in an effort to move organizations “towards consistency” in mitigating cyber threats.
According to HHS, the four-volume publication provides guidance on “cost-effective methods that a range of healthcare organizations at every size and resource level can use to reduce cybersecurity risks” and is meant to raise awareness of cyber threats as well as provide vetted practices.
“Cybersecurity is everyone’s responsibility—it is the responsibility of every organization working in healthcare and public health,” says HHS Acting Chief Information Security Officer Janet Vogel. “In all of our efforts, we must recognize and leverage the value of partnerships among government and industry stakeholders to tackle the shared problems collaboratively.”
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HIT Think 10 targets for sharpening HIT’s aim for the 2020s
Published December 31 2018, 4:04pm EST
So you’re doubtlessly wondering why the following column appears now, apparently so dismissive of 2019, which is the newest year we’re all worrying about.
One reason harkens back to my early journalistic years at a community newspaper, where we were forbidden to use the phrase “ ‘Tis the season” in a headline more than once a year. Hence, we copy editors would race to deploy it as quickly as possible, usually the day after Thanksgiving. One year, I managed to sneak in “ ‘Tis the season: It’s Santa’s time to reign, dear,” thus managing to use both the coveted phrase and a nasty pun at one fell swoop.
Thus, this is a thinly veiled attempt to get the jump on what is likely to be a slew of columns, articles and prognostications on what the next decade will look like for HIT.
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How 'cranky comments' can help spot CDS alert errors
Partners HealthCare researchers show how they mine override comments to detect areas where clinical decision support systems could be improved.
December 31, 2018 01:47 PM
It's an all too common occurrence for clinical decision support alerts to misfire or otherwise malfunction. And that's a common frustration for clinicians. New research in the
Journal of the American Medical Informatics Association shows how data scientists at Partners HealthCare are making use of provider feedback to spotlight and fix CDS errors.
WHY IT MATTERS
Rule-based alerts in the electronic health record could help notify physicians of risks such as adverse drug interactions or nudge them to add relevant information to the EHR.
But such alerts can also malfunction, break, or might be triggered for the wrong reasons or patient populations. That could cause alert fatigue or pose safety risks.
The variety and types of these misfires can vary widely - as can clinicians' responses to inaccurate CDS alerts.
"In prior work, we developed a taxonomy of CDS alert malfunctions based on 68 cases of alert malfunctions collected from healthcare institutions in the United States," wrote Partners HealthCare researchers in JAMIA.
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What docs want from EHR vendors in 2019
A little listening and responsiveness could go a long way to help cure alert fatigue and physician burnout in the year ahead.
December 31, 2018 09:52 AM
Software solutions that purport to be innovative are flooding the healthcare world, but often become more of a problem than the ones they set out to solve.
A recent
CNBC report detailed how entrepreneurs, engineers and developers need to pair with physicians to gain better insight into the type of problems they aim to solve.
For example, it points to Epic sending engineers to open heart surgeries as an illustration of the standard medical software developers should aspire toward.
Many vendors don’t have that degree of connection to the practitioner, however – and the result is alert fatigue, hours spent on data entry, and a general malaise towards software solutions that are supposed to help, but really just mean more work and another clunky interface.
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6 Ways Telehealth Made Progress in 2018
Readers weigh in about the most significant advances in virtual care.
2018 may have marked a turning point in the way telehealth services are utilized and perceived. With significant progress in consumer acceptance, reimbursement, and legislation, many health systems report that telehealth has moved from a "nice to have" service to an essential component of the way healthcare is delivered.
We asked our readers to share the top trends they witnessed over the past year. Representatives from health systems and the companies that provide telehealth resources and services responded enthusiastically. This posting is a continuation of an article posted on December 28:
How Did 2018 Change the World of Telehealth?
Did your health system gain traction in virtual care over the past year? What trends may impact the way you move forward? Here are six ways our readers think the practice of telehealth made progress in 2018:
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Suicide prediction technology is revolutionary. It badly needs oversight.
Should we trust Facebook to dispatch police to the homes of distraught users?
Mason Marks, a visiting fellow at Yale Law School’s Information Society Project, specializes in health and technology law.
December 20
Last year, more than 1 million Americans attempted suicide, and 47,000 succeeded. While some people display warning signs, many others do not, which makes suicide difficult to predict and leaves family members shocked — and anguished that they couldn’t do something.
Medical providers and tech companies, including the Department of Veterans Affairs and Facebook, are increasingly applying artificial intelligence to the problem of suicide prediction. Machine learning software, which excels at pattern recognition, can mine health records and online posts for words and behaviors linked to suicide and alert physicians or others to impending attempts. The potential upside of this effort is huge, because even small increases in predictive accuracy could save thousands of lives each year.
This research, however, is progressing along two tracks, one academic-medical and one skewed heavily toward the commercial. Through a pilot program called REACH VET, for example, VA uses artificial intelligence to analyze medical records and identify vets at high risk for self-harm. The system weighs such factors as patients’ prior suicide attempts, past medical diagnoses and current medications (red flags include recent chronic-pain diagnoses and prescriptions for opioids or Ambien). Early results are encouraging, but progress both within and beyond VA is necessarily slowed by the need to be sure this line of research complies with health laws and ethical standards, and the need to demonstrate efficacy at each step.
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Enjoy!
David.
